[Clinical research of minimally invasive spine surgery with Vesselplasty]

Objective: To evaluate the efficacy and safety of Vesselplasty in the treatment of osteoporotic vertebral fractures and vertebral metastases. Methods: From June 2010 to December 2016, data of 81 patients with spinal diseases treated with Vesselplasty in Department of Spinal Surgery, Beijing Friendship hospital, Capital Medical University were retrospectively analyzed. There are 49 cases of vertebral fractures with age (70.2±8.2) years. Among them, 16 cases have posterior vertebral wall breakage, but no symptoms of nerve injury. Clinical result were evaluated with Visual Analogue Scale(VAS) , the kyphotic angle(Cobb's angle) and Oswestry disability index(ODI) was measured preoperatively, postoperatively and follow-up. At the same time, the operation time and cement leakage were recorded. There were 32 patients with vertebral metastases, with age of (69.6±11.1) years old. The posterior wall of the vertebral body was damaged in 22 cases. The VAS scores were recorded and compared preoperatively and postoperatively. The operation time was recorded also. Results: All patients were completed the operation safely and with no complications. Compared with preoperative VAS, postoperative VAS was significantly decreased in all subjects(P<0.05). The average operation time of each vertebral body was 16.2±4.6 min, and the postoperative VAS score significantly decreased (P<0.05), Cobb 's angle from preoperative (13.9±6.0) ° to( 5.2±4.0) ° (P<0.05) in 49 cases of vertebral fracture(58 vertebrae). The clinical results were still satisfied in follow-up . In 32 cases of vertebral metastases(38 vertebrae), the average operation time was (17.6±5.4) min. The postoperative VAS score was obviously decreased also(P<0.05). A small amount of bone cement leakage occurred in 4 cases of 4 vertebrae. The rate of bone cement leakage was 4.2%, but there were no clinical symptoms in these cases. Conclusion: Vesselplasty is a safe and effective treatment of osteoporotic vertebral fractures and vertebral metastases. It can lead to satisfactory clinical effect, partial recovery of vertebral height. Besides, the bone filling mesh can reduce the risk of bone cement leakage, which can provide a new choice for minimally invasive treatment of vertebral fracture and metastases.

[Practice of parenting and related factors on children aged 0-5 in the urban areas of China]

Objective: To characterize the relations between the practice of parenting and associated factors on children (0-5 years old) in urban areas of China, in order to provide evidence for promoting the early development of children and to provide positive guidance and service programs on parenting. Methods: A total of 4 515 parents from 15 cities (14 provinces) were surveyed with a self-administered questionnaire. Parenting and Family Adjustment Scales (PAFAS) was used, including parameters as: consistency and coercive parenting, positive encouragement, parent-child relationship and parental emotion adjustment, family relationship and parental teamwork aspects, etc. Both single factor analysis and multiple linear regression were used to examine the associations between parenting practice, individual, parental and family factors. Results: The mean score of PAFAS was 21.00 (15.00-28.00), associated with factors as children's age, only-child family, premature delivery, father's education level, confidence on parenting, problems regarding the parental mood, annual family income, family structure and behavior on seeking professional help, etc. Results showed that there were big differences on the practice of parenting in China and influenced by variety of factors. Conclusions: The general situation of parenting was well, in the urban areas of China. The practice of parenting was associated with a series of individual, parental and family factors. Programs on improving the parenting skills and promoting the early development of children, should be highlighted.

[Clinical effect and safety of pegylated interferon-α-2b injection (Y shape, 40 kD) in treatment of HBeAg-positive chronic hepatitis B patients]

Objective: To investigate the clinical effect and safety of long-acting pegylated interferon-α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 μg/week) in the treatment of HBeAg-positive chronic hepatitis B (CHB) patients, with standard-dose Peg-IFN-α-2a as positive control. Methods: This study was a multicenter, randomized, open-label, and positive-controlled phase III clinical trial. Eligible HBeAg-positive CHB patients were screened out and randomized to Peg-IFN-α-2b (Y shape, 40 kD) trial group and Peg-IFN-α-2a control group at a ratio of 2:1. The course of treatment was 48 weeks and the patients were followed up for 24 weeks after drug withdrawal. Plasma samples were collected at screening, baseline, and 12, 24, 36, 48, 60, and 72 weeks for centralized detection. COBAS® Ampliprep/COBAS® TaqMan® HBV Test was used to measure HBV DNA level by quantitative real-time PCR. Electrochemiluminescence immunoassay with Elecsys kit was used to measure HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe). Adverse events were recorded in detail. The primary outcome measure was HBeAg seroconversion rate after the 24-week follow-up, and non-inferiority was also tested. The difference in HBeAg seroconversion rate after treatment between the trial group and the control group and two-sided confidence interval (CI) were calculated, and non-inferiority was demonstrated if the lower limit of 95% CI was > -10%. The t-test, chi-square test, or rank sum test was used according to the types and features of data. Results: A total of 855 HBeAg-positive CHB patients were enrolled and 820 of them received treatment (538 in the trial group and 282 in the control group). The data of the full analysis set showed that HBeAg seroconversion rate at week 72 was 27.32% in the trial group and 22.70% in the control group with a rate difference of 4.63% (95% CI -1.54% to 10.80%, P = 0.1493). The data of the per-protocol set showed that HBeAg seroconversion rate at week 72 was 30.75% in the trial group and 27.14% in the control group with a rate difference of 3.61% (95% CI -3.87% to 11.09%, P = 0.3436). 95% CI met the non-inferiority criteria, and the trial group was non-inferior to the control group. The two groups had similar incidence rates of adverse events, serious adverse events, and common adverse events. Conclusion: In Peg-IFN-α regimen for HBeAg-positive CHB patients, the new drug Peg-IFN-α-2b (Y shape, 40 kD) has comparable effect and safety to the control drug Peg-IFN-α-2a.

[Improvement and effect analysis of a new neuroendoscopic trans-nasal-sphenoidal pituitary tumor resection approach]

Objective: To modify the individual neuroendoscopic surgical approach of pituitary tumors with specific imaging features, and to analyze the clinical outcomes. Methods: The clinical data of 116 patients with pituitary tumors who underwent surgical treatment at the pituitary tumor diagnosis and treatment center of Ruijin Hospital from April 2014 to December 2017 were collected, then the resection effects and complication rates of pituitary tumors from three different kinds of transsphenoidal approaches (e.g. classical single nostril approach, bilateral approach, "one-and-a-half" approach) were compared. Results: Pituitary tumor resection with "one-and-a-half" trans-nasal-sphenoidal approach achieved the same surgical effects with the bilateral approach, which was difficult to resect with the single-nostril classical approach. And it had significant advantages in the average length of postoperative hospitalization ( "one-and-a-half" : 6.9 days, bilateral: 12.5 days, P<0.01), the average postoperation VAS of olfactory retention ( "one-and-a-half" : 8.6, bilateral: 7.0, P<0.01) and preventing posterior nasal septum perforation (the occurrence rate of "one-and-a-half" : 0%, bilateral: 27%). Conclusion: The "one and a half" approach increases the ability to control and completely resect the lesion beyond the medial edge of the internal carotid artery on the same side of the nostril involving endoscope. It is a good supplement and improvement to the bilateral approach.

[Liver transplantation for polycystic liver disease: 11 cases report and literature review]

Objective: To explore the indications and safety of orthopedic liver transplantation for polycystic liver disease (PLD). Methods: Data of 11 patients with PLD who underwent orthotopic liver transplantation between 2004 and 2013 was retrospectively analyzed. Demographic, clinical and follow-up data were collected for statistical analysis. The survival rate was calculated by Kaplan-Meier method. Results: Over a period of 10 years, the patients received modified piggyback orthopedic liver transplantation (n=9) or combined liver-kidney transplantation (n=2) for PLD. The recipients' median age was 56 years. Seven patients were classified as Gigot type Ⅱ PLD, and four were classified as Gigot type Ⅲ PLD. Eight patients had severe decreased mobility (Eastern Cooperative Oncology Group, ECOG≥3). Only three cases were Child-Pguh Class C patients and the model for end-stage liver disease (MELD) score was>20. The mean hospitalization duration was (45.4±15.3) days, and the mean length of stay in intensive care unit was (4.1±1.9) days. The perioperative mortality was 18.2% and morbidity of complications was 63.6%. The median follow-up period was 111 months. Two patients died of severe complications after combined liver-kidney transplantation. One patient died of ischemia cholangitis during follow-up. The actuarial 1-, 5-and 10-year survival rate during the follow-up period was 82.2%, 81.8%, and 65.5%, respectively. Conclusions: Liver transplantation is the only curative and safe procedure for PLD, and it provides a good long-term prognosis and high quality of life for PLD patients. Liver transplantation could be a primary option in treating progressive or advanced PLD.

No high Tibetan Plateau until the Neogene

The Late Paleogene surface height and paleoenvironment for the core area of the Qinghai-Tibetan Plateau (QTP) remain critically unresolved. Here, we report the discovery of the youngest well-preserved fossil palm leaves from Tibet. They were recovered from the Late Paleogene (Chattian), ca. 25.5 ± 0.5 million years, paleolake sediments within the Lunpola Basin (32.033°N, 89.767°E), central QTP at a present elevation of 4655 m. The anatomy of palms renders them intrinsically susceptible to freezing, imposing upper bounds on their latitudinal and altitudinal distribution. Combined with model-determined paleoterrestrial lapse rates, this shows that a high plateau cannot have existed in the core of Tibet in the Paleogene. Instead, a deep paleovalley, whose floor was <2.3 km above mean sea level bounded by (>4 km) high mountain systems, formed a topographically highly varied landscape. This finding challenges prevailing views on tectonic processes, monsoon dynamics, and the evolution of Asian biodiversity.

[Research advances in chronicity of hepatitis E virus infection]

Hepatitis E virus (HEV) infection usually causes acute hepatitis and has a self-limiting progression. The patients often recover within 6 months with good prognosis. Recent studies have found that HEV infection may become chronic in special situations, which manifests as persistent liver function abnormalities for at least 6 months after acute HEV infection and the presence of viral nucleic acid in serum, feces, and/or liver tissue. Chronicity of HEV infection mainly occurs in immunocompromised patients, and it is rare but very dangerous in clinical practice. An understanding of the pathogenesis, clinical manifestations, treatment methods, and preventive measures of chronicity of HEV infection helps clinical physicians develop an effective management regimen and improve patient prognosis. This article introduces related issues, in order to raise the awareness of this disease among clinical physicians.

Significant Efficacy of Apatinib in a Patient With Hepatocellular Carcinoma Lung Metastases After Liver Transplantation: A Case Report

Antiangiogenesis therapy plays an important role in the treatment of advanced hepatocellular carcinoma (HCC). However, treatment options for HCC recurrence after liver transplantation are currently limited. Apatinib is a small tyrosine kinase inhibitor molecule targeting vascular endothelial growth factor receptor-2. Here, we report for the first time one case of a patient with advanced HCC who received apatinib after occurring lung metastasis 7 months after liver transplantation. He took 500 mg of apatinib daily for one month, which was decreased to 250 mg daily because of side effects. The patient was confirmed to have a partial response, according to the Response Evaluation Criteria in Solid Tumors, for 10 months, and the progression-free survival time was greater than 21 months. Our data and experience have indicated that apatinib may be a good choice for HCC recurrence after liver transplantation.

Sex disparities in clinical characteristics and prognosis of immunoglobulin G4–related disease: a prospective study of 403 patients

Objectives

To study the impact of sex on the clinical presentation of IgG4-related disease (IgG4-RD).

Methods

We prospectively enrolled 403 newly diagnosed IgG4-RD patients. We compared the demographic features, clinical manifestations, organ involvement, laboratory tests and treatment outcomes between female and male patients. The organs involved were divided into superficial organs (salivary glands, lacrimal glands, orbit, sinus and skin) and internal organs (all the other organs). The patients treated with glucocorticoids with or without additional immunosuppressants were included in the assessment of treatment outcomes, and potential confounding factors were corrected by propensity score matching or multivariate Cox regression analysis.

Results

Female patients showed younger age at both symptom onset and diagnosis, and a longer interval between symptom onset and diagnosis. Allergy history, Mikulicz’s disease and thyroiditis were more common in female patients, while autoimmune pancreatitis, sclerosing cholangitis and retroperitoneal fibrosis were more common in male patients. In accordance, female patients more frequently presented with superficial organ involvement, while male patients more frequently had internal organ involvement, and the discrepancy was more prominent in the patients with older age. Male sex was associated with higher peripheral eosinophils, CRP and IgG4 levels at baseline. In response to glucocorticoid-based therapies, male sex was associated with a higher IgG4-RD responder index during follow-up as well as a greater risk of relapse (hazard ratio 3.14, P = 0.003).

Conclusion

Our study revealed the sex disparities in clinical characteristics of IgG4-RD, and indicated that male sex was independently associated with worse prognosis in response to glucocorticoid-based therapies.

[Survey of prevalence of iron deficiency and iron deficiency anemia in pregnant women in urban areas of China]

Objective: To investigate the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women in urban areas of China. Methods: The study was a national cross-sectional survey conducted from September 19th, 2016 to November 20th, 2016. According to the classification of the National Bureau of Statistics, all survey sites were set up in 6 regions of the country.Pregnant women were continuously selected using multistage stratified sampling. A total of 12 403 pregnant women were collected and examined for serum ferritin and hemoglobin levels. Results: The median serum ferritin level during pregnancy was 20.60 μg/L (11.78-36.98 μg/L) , the hemoglobin level was (118±12) g/L. With the progress of pregnancy, the levels of serum ferritin and hemoglobin decreased gradually. The median serum ferritin levels in the first, second trimester and third trimester were 54.30 μg/L (34.48-94.01 μg/L) , 28.60 μg/L (16.40-50.52 μg/L) , and 16.70 μg/L (10.20-27.00 μg/L) respectively (P<0.01) . The mean hemoglobin levels were (127±10) g/L, (119±11) g/L and (117±11) g/L respectively (P<0.01) . The prevalence of ID in urban pregnant women was 48.16% (5 973/12 403) , and IDA prevalence was 13.87% (1 720/12 403) . The prevalence of IDA in the first, second trimester and third trimester were 1.96% (20/1 019) , 8.40% (293/3 487) and 17.82% (1 407/7 897) ,respectively (P<0.01) . The prevalence of standardized ID and IDA were significantly different in various regions of China (P<0.01) . The standardized prevalence of ID were relatively higher in East China and Northeast China, 57.37% and 53.41% respectively, while it was the lowest in Southwest China, 30.51%. The standardized prevalence of IDA in South Central, Northwest, and East China were relatively high, 21.30%, 16.97% and 17.53% respectively, and the standardized prevalence of IDA in Southwest China was the lowest, 5.44%, the differents in various regions were significant (all P<0.01) . Conclusion: The current phenomenon of ID and IDA in pregnant women is still very common, and nutrition and health care during pregnancy should be strengthened.

EGFL7 silencing inactivates the Notch signaling pathway; enhancing cell apoptosis and suppressing cell proliferation in human cutaneous melanoma

Melanoma is the main cause of death in patients with skin cancer. While the pathogenesis of cutaneous melanoma is poorly understood, increasing evidence shows that epidermal growth factor (EGF) may be involved. Herein, we tested the hypothesis that down-regulation of EGFL7 inhibits development and progression of human cutaneous melanoma (CM). Initially, we performed immunohistochemical analysis of EGFL7 in 130 specimens and the findings indicated that EGFL7 was highly expressed in CM. The expressions of EGFL7 and Notch signaling pathway-related genes in CM were then measured by reverse transcription quantitative polymerase chain reaction (RT-qPCR) and Western blot assay. In order to assess biological functions of EGFL7 in CM we up-regulated or down-regulated endogenous EGFL7 using EGFL7-OE or shRNA against EGFL7 in the A375 CM cell line. To better understand the pivotal role of Notch signaling pathway in CM, we blocked this pathway in A375 cells by inhibitor treatment. Finally, tumor xenograft in nude mice was performed to test the in vivo tumorigenesis of the transfected A375 cells. While EGFL7 activated the Notch signaling pathway in CM, gain- and loss-of-function studies established that decreased EGFL7 inhibited cell proliferation and promoted apoptosis in A375 cells. Moreover, down-regulated EGFL7 suppressed in vivo tumorigenesis. Most importantly, we determined that down-regulating EGFL7 inhibited CM development by suppressing the Notch signaling pathway. The combined findings define potential roles of decreased EGFL7 as inhibitors of CM development by suppressing the Notch signaling pathway, and EGFL7 may therefore be a novel therapeutic target in cutaneous melanoma patients.

Micro-RNAS Regulate Metabolic Syndrome-induced Senescence in Porcine Adipose Tissue-derived Mesenchymal Stem Cells through the P16/MAPK Pathway

Mesenchymal stem cells (MSCs) constitute an important repair system, but may be impaired by exposure to cardiovascular risk factors. Consequently, adipose tissue-derived MSCs from pigs with the metabolic syndrome (MetS) show decreased vitality. A growing number of microRNAs (miRNAs) are recognized as key modulators of senescence, but their role in regulating senescence in MSC in MetS is unclear. We tested the hypothesis that MetS upregulates in MSC expression of miRNAs that can serve as post-transcriptional regulators of senescence-associated (SA) genes. MSCs were collected from swine abdominal adipose tissue after 16 weeks of Lean or Obese diet ( n = 6 each). Next-generation miRNA sequencing (miRNA-seq) was performed to identify miRNAs up-or down-regulated in MetS-MSCs compared with Lean-MSCs. Functional pathways of SA genes targeted by miRNAs were analyzed using gene ontology. MSC senescence was evaluated by p16 and p21 immunoreactivity, H2AX protein expression, and SA-β-Galactosidase activity. In addition, gene expression of p16, p21, MAPK3 (ERK1) and MAPK14, and MSC migration were studied after inhibition of SA-miR-27b. Senescence biomarkers were significantly elevated in MetS-MSCs. We found seven upregulated miRNAs, including miR-27b, and three downregulated miRNAs in MetS-MSCs, which regulate 35 SA genes, particularly MAPK signaling. Inhibition of miR-27b in cultured MSCs downregulated p16 and MARP3 genes, and increased MSC migration. MetS modulates MSC expression of SA-miRNAs that may regulate their senescence, and the p16 pathway seems to play an important role in MetS-induced MSC senescence.

Immunosuppressive effect of the gut microbiome altered by high-dose tacrolimus in mice

The alterations induced in gut microbiota by tacrolimus may affect immune function and organ transplantation. Mice were treated with high-dose tacrolimus for 14 days. The fecal microbiota were analyzed by pyrosequencing the 16S rRNA genes, and the effect on metabolism was predicted using the sequence data. The subgroups of T cells in the serum, gut-associated lymphoid tissue, and draining lymph nodes were determined by flow cytometry. Tacrolimus treatment significantly altered the relative abundance of Allobaculum, Bacteroides, and Lactobacillus and CD4⁺ CD25^hi FoxP3⁺ regulatory T cells in the colonic mucosa and the circulation. These were significantly increased after either tacrolimus treatment or treatment by fecal microbiota transfer from tacrolimus-treated donors. Further, treatment with low-dose tacrolimus plus fecal microbiota transfer from high-dose tacrolimus-altered mice increased skin allograft survival rate in a skin transplantation model. Thus, high-dose tacrolimus alters the compositions and taxa of the gut microbiota. Administration of these conditioned gut microbiota plus low-dose tacrolimus resulted in regulation of colonic and systemic immune responses and an increased allograft survival rate. This study demonstrated a new strategy for controlling allograft rejection by combining an immunosuppressive agent with gut microbiome transplantation.

[Application of RapidHIT™ 200 System in Forensic Medicine]

OBJECTIVES

To validate the analysis capability of RapidHIT™ 200 system for four kinds of routine forensic samples and the recyclable capability of template, template DNA and PCR products in the process of twice duplicate detection.

METHODS

The buccal swabs underwent the test twice by RapidHIT™ 200 system, and the template DNA and PCR products that arose in the system were also tested for two times. After four kinds of routine forensic samples were detected by RapidHIT™ 200 system, the follow-up tests of the template, template DNA and PCR products that arose in the system were performed.

RESULTS

The STR loci could be detected in the buccal swabs by the system for the first time. However, part of the STR loci lost during the second test. And the peak value obtained in the second test was significantly reduced than the one in the first time. The average STR loci detection rates of the template DNA and PCR products were both less than 50% in the second test, which were significantly reduced than that in the first test. In addition, the analysis capability of the system for the tissues and buccal swabs was better than that for the blood and cigarette butts. Compared with the first test, the STR loci detection rate of the tested items, template DNA and PCR products decreased with the numbers of tests.

CONCLUSIONS

RapidHIT™ 200 system is more effective in retesting buccal swabs than other samples, whereas the items, DNA template, PCR products obtained in the first and second time cannot be directly used for the further application and study of forensic medicine.

Nomogram to predict lymph node metastasis in patients with early oesophageal squamous cell carcinoma

Background

Lymph node status is crucial in determining the prognosis for early oesophageal squamous cell carcinoma (SCC). This study aimed to develop and validate a nomogram for the prediction of lymph node metastasis in patients with early SCC.

Methods

A prediction model was developed in a derivation cohort of patients with clinicopathologically confirmed early SCC. Patients who underwent oesophagectomy for pT1 SCC between January 2010 and December 2013 were identified from an institutional database. Risk factors for lymph node metastasis were assessed using a binary logistic regression modelling technique. A nomogram for the prediction of lymph node metastasis was constructed using the results of multivariable analyses. For internal validation, bootstraps with 1000 resamples were performed. The predictive performance of the nomogram was measured by Harrell's concordance index (C-index). An independent cohort from the same hospital was used to validate the nomogram. This cohort included consecutive patients with early SCC who underwent oesophagectomy from January 2014 to December 2015.

Results

The derivation cohort included 281 patients. Four variables associated with lymph node metastasis were included in the model: depth of tumour invasion (odds ratio (OR) 4·37, 95 per cent c.i. 1·59 to 12·03; P = 0·004), grade of differentiation (OR 4·47, 1·02 to 19·70; P = 0·048), tumour size (OR 2·52, 1·11 to 5·75; P = 0·028) and lymphovascular invasion (OR 6·58, 2·54 to 17·05; P &lt; 0·001). The C-index was 0·790 (95 per cent c.i. 0·717 to 0·864) in the derivation cohort and 0·789 (0·709 to 0·869) for the validation cohort (198 patients).

Conclusion

A validated nomogram for patients with early oesophageal SCC can predict the risk of lymph node metastasis.

[Effects of metformin on papillary thyroid carcinoma in nude rats model]

Objective:To establish an subcutaneous xenotransplanted tumor model of papillary thyroid carcinoma (PTC) and investigate the role of metformin in apoptosis of PTC.Method:Model rats were randomly divided into four groups: control group, Met group and Met+DM group. The tumor volumes were recorded each week. Flow cytometry was used to detect the apoptosis rate of tumor. Immunohistochemistry was used to detect CyclinD1 and the cellular proliferative activity index PCNA and Ki-67.Result:Compared to the control group,there were a significant decrease in tumor volume and antitumor effect in Met and Met+DM groups. The apoptosis rate increased in Met and Met+DM groups. While compared with the control group, the expressions of PCNA,CyclinD1 and Ki-67 significantly decreased in Met and Met+DM groups. There was no difference between Met and Met+DM group.Conclusion:The effect of Metformin on inhibiting tumor growth were related with the imbalance of cell proliferation and apoptosis.

Fundamental supply of skin blood flow in the Chinese Han population: Measurements by a full-field laser perfusion imager

BACKGROUND

Skin blood flow is believed to link with many diseases, and shows a significant heterogeneity. There are several papers on basal cutaneous microcirculation perfusion in different races, while the data in Chinese is vacant.

OBJECTIVE

The aim was to establish the database of absolute fundamental supply of skin blood flow in the Chinese Han population.

METHODS

With a full-field laser perfusion imager (FLPI), the skin blood flow can be quantified. Cutaneous perfusion values were determined in 17 selected skin areas in 406 healthy participants aged between 20 and 80 years (mean 35.05 ± 11.33). Essential parameters such as weight, height were also measured and values of BMI were calculated. The perfusion values were reported in Arbitrary Perfusion Units (APU).

RESULTS

The highest cutaneous perfusion value fell on eyelid (931.20 ± 242.59 in male and 967.83 ± 225.49 in female), and pretibial had the lowest value (89.09 ± 30.28 in male and 85.08 ± 33.59 in female). The values were higher in men than women on the bank of fingertips, nose, forehead, cheek, neck and earlobe (P < .05). Perfusion values on stretch and flexion side of forearm had negative correlation with age (P = .01 and P = 4.88 × 10^-3 , respectively) in male. Abdomen was negatively correlated with BMI in both gender (P = .02, respectively).

CONCLUSIONS

Skin blood flow values vary with skin regions. There is a tendency to measure higher perfusion values in men than in women. And the values are irrelevant with age or BMI.

Interpretation of liver stiffness measurement-based approach for the monitoring of hepatitis B patients with antiviral therapy: A 2-year prospective study

Liver biopsy is not routinely performed in treated chronic hepatitis B. Liver stiffness measurement has been validated for noninvasive liver fibrosis assessment in pretreatment chronic hepatitis B but has not been assessed for fibrosis monitoring during antiviral therapy. Liver stiffness was systemically monitored by Fibroscan^® every 6 months in a cohort of patients with hepatitis B receiving antiviral therapy and compared with liver biopsies at baseline and week 104. A total of 534 hepatitis B e antigen-positive treatment-naive patients receiving telbivudine-based therapy with qualified liver stiffness measurement at baseline and week 104 were analyzed, 164 of which had adequate paired liver biopsies. Liver stiffness decreased rapidly (-2.2 kPa/24 weeks) in parallel with alanine aminotransferase (ALT) from 8.6 (2.6-49.5) kPa at baseline to 6.1 (2.2-37.4) kPa at week 24. Interestingly, liver stiffness decreased slowly (-0.3 kPa/24 weeks) but continually from week 24 to week 104 (6.1 vs 5.3 kPa, P < .001) while ALT levels remained stable within the normal range. More importantly, liver stiffness declined significantly irrespective of baseline ALT levels and liver necroinflammation grades. From baseline to week 104, the proportion of patients with no or mild fibrosis (Ishak, 0-2) increased from 74.4% (122/164) to 93.9% (154/164). Multivariate analysis revealed that percentage decline of 52-week liver stiffness from baseline was independently associated with 104-week liver fibrosis regression (odds ratio, 3.742; P = .016). Early decline of 52-week liver stiffness from baseline may reflect the remission of both liver inflammation and fibrosis and was predictive of 104-week fibrosis regression in treated patients with chronic hepatitis B.

Risks of diabetic foot syndrome and amputation associated with sodium glucose co-transporter 2 inhibitors: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

The U.S. Food and Drug Administration recently issued a safety communication requiring new warnings of increased leg and foot amputation risk be added to canagliflozin drug labelling. However, the risk associated with other sodium-glucose co-transporter 2 inhibitors (SGLT2i) remains uncertain.

AIM

This meta-analysis aimed to evaluate the potential risks of diabetic foot syndrome (DFS) and amputation associated with SGLT2i.

METHODS

Relevant databases were searched from inception to June 14, 2017 to identify randomized controlled trials (RCTs) that evaluated risks of DFS and amputation associated with SGLT2i use. A random effects model was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) using STATA 14.

RESULTS

Fourteen RCTs involving 26,167 patients were eligible for this meta-analysis. SGLT2i were not significantly associated with increased risk of DFS compared with placebo (OR 1.05, 95% CI: 0.58-1.89). No significant association was observed in the subgroup and sensitivity analysis on DFS risk either. Although SGLT2i, as a class, were not significantly associated with amputation risk (OR 1.40, 95% CI: 0.81-2.41), subgroup analysis showed an increased incidence of amputation in participants using canagliflozin (OR 1.89, 95% CI: 1.37-2.60), compared with oral anti-diabetic drugs and placebo, but not in those using empagliflozin (OR 1.02, 95% CI: 0.71-1.48).

CONCLUSION

Current evidence from RCTs suggests that canagliflozin may be positively associated with an increased risk of amputation. Due to limited data, large-scale studies are required to further clarify the association between amputation and individual SGLT2i drugs.

Shear-banding in entangled xanthan solutions: tunable transition from sharp to broad shear-band interfaces

We report on the smooth transition between gradient-banded velocity profiles with a sharp interface and curved velocity profiles, both resulting from strong shear-thinning dispersions of concentrated xanthan (a highly charged poly-saccharide). Pronounced shear-banded flow, where two extended shear-bands are separated by a relatively sharp interface, is observed in a limited range of shear rates, at very low ionic strength and at a high concentration, using heterodyne light scattering to measure spatially resolved velocity profiles. The width of the interface between the coexisting shear-bands broadens to span a sizable fraction of the gap of the shear cell, either by changing the shear rate, by lowering the concentration, or by increasing the ionic strength. The broadening results in a smooth transition to highly curved velocity profiles and is connected to a disappearing flow birefringence. Thus, these experiments show that the classic shear-banding instability can give rise to highly curved velocity profiles, due to the existence of broad interfaces between the bands, with an extent of the order or larger than the cell gap width. This observation may aid to resolve the ongoing dispute concerning shear-banding of highly entangled polymeric systems, suggesting that the curved velocity profiles that have been observed in the past are in fact shear-banded states with an unusually broad interface.

[Analysis of 2 204 stillbirths in 11 hospitals of Guangdong province]

Objective: To analyze the incidence and causes of stillbirth in 11 hospitals of Guangdong province, and to explore the appropriate interventions. Methods: Clinical data of stillbirth in 11 hospitals of Guangdong province were collected from January 2014 to December 2016. The gestational weeks, causes, maternal conditions and other factors were analyzed. Results: (1) From 2014 to 2016, 103 472 newborns were delivered in the 11 hospitals, and the number of stillbirth was 2 204, with the incidence of 2.13%. Among them, 0.71%(738/103 472) was therapeutic induction, 1.42%(1 066/103 472) was natural stillbirth. At different gestational age (<28 weeks, 28-<37 weeks and ≥37 weeks), the incidence of stillbirth was 55.63% (1 226/2 204), 28.45% (627/2 204) and 15.92% (351/2 204), respectively, with statistically significant difference (P<0.01). (2) For stillbirth<28 weeks, the first reason was therapeutic induction, accounting for 53.34% (654/1 226). For stillbirth during 28-37 weeks, pre-eclampsia was the major cause, accounting for 40.67% (255/627). And for full-term stillbirth, the causes were umbilical cord factors (19.37%, 68/351), abnormal labor (17.09%, 60/351). (3) In all the stillbirth cases, the incidence of fetal growth restriction (FGR) <28 weeks was significantly higher than that during 28-37 weeks [23.49% (288/1 226) vs 18.02% (113/627) , P<0.01]. (4) The stillbirth rate during labor was significantly higher in women ≥35 years old than in younger women [63.88% (191/299) vs 36.12% (108/299) ; χ(2)=9.346, P=0.000]. For the causes of stillbirth during labor, the incidence of severe maternal obstetrical complications [61.11% (33/54) vs 38.89% (21/54) ; χ(2)=3.323, P=0.002], abnormal labor [65.82% (52/79) vs 34.18% (27/79) ; χ(2)=4.067, P=0.001] and abnormal fetal position [66.63% (26/39) vs 33.37% (13/39) ; χ(2)=3.002, P=0.013] were higher in women ≥35 years old than in younger women. (5) Cesarean section during labor accounted for 33.77% (101/299) of stillbirth, including 76 cases of emergency cesarean section or converted to cesarean section during labor. Conclusions: (1) The incidence of stillbirth in the 11 hospitals is high, and the causes are different at different gestational ages, therefore, different interventions are needed to reduce the incidence in different gestational weeks. Supervision of therapeutic induction should be strengthened <28 gestational weeks; standard management of pregnancy might decrease the occurrence of natural death ≥28 weeks. (2) Attention should be paid to fetal body weight during pregnancy, especially FGR. (3) The stillbirth rate is high in elderly pregnant women, so it is important to strengthen the management of the elderly pregnant women.

[Efficacy and safety of pegylated interferon α-2b injection (Y shape, 40 kD) in treatment of patients with genotype 1/6 chronic hepatitis C]

Objective: To investigate the efficacy and safety of the new investigational drug pegylated interferon α-2b (Peg-IFN-α-2b) (Y shape, 40 kD) injection (180 µg/week) combined with ribavirin in the treatment of patients with genotype 1/6 chronic hepatitis C (CHC), with standard-dose Peg-IFN-α-2a combined with ribavirin as a positive control. Methods: A multicenter, randomized, open-label, and positive-controlled phase III clinical trial was performed. Eligible patients with genotype 1/6 CHC were screened out and randomly divided into Peg-IFN-α-2b(Y shape, 40kD) group and Peg-IFN-α-2a group at a ratio of 2:1. The patients in both groups were given oral ribavirin for 48 weeks in addition and then followed up for 24 weeks after drug withdrawal. Abbott Real Time HCV Genotype II was used to determine HCV genotype, and Cobas TaqMan quantitative real-time PCR was used to measure HCV RNA level at 0, 4, 12, 24, 48, and 72 weeks. Adverse events were recorded in detail. The primary efficacy endpoint was sustained virological response (SVR), and a non-inferiority test was also performed. Results: A total of 561 patients with genotype 1/6 CHC were enrolled, among whom 529 received treatment; 90.9% of these patients had genotype 1 CHC. The data of the full analysis set showed that SVR rate was 69.80% (95% CI 65.00%-74.60%) in the trial group and 74.16% (95% CI 67.73%-80.59%) in the control group (P = 0.297 0). The data of the per protocol set (PPS) showed that SVR rate was 80.63% (95% CI 76.04%-85.23%) in the trial group and 81.33% (95% CI 75.10%-87.57%) in the control group (P = 0.849 8), and the 95% CI of rate difference conformed to the non-inferiority standard. The analysis of the PPS population showed that of all subjects, 47.9% achieved rapid virologic response, with a positive predictive value of 93.8%. The incidence rate of adverse events was 96.30% in the trial group and 94.94% in the control group, and the incidence rate of serious adverse events was 5.13% in the trail group and 5.06% in the control group. Conclusion: In the regimen of Peg-IFN-α combined with ribavirin for the treatment of genotype 1/6 CHC, the new investigational drug Peg-IFN-α-2b(Y shape, 40 kD) has comparable clinical effect and safety to the control drug Peg-IFN-α-2a.

Biochemical characteristics of newborns with carnitine transporter defect identified by newborn screening in California

Carnitine transporter defect (CTD; also known as systemic primary carnitine deficiency; MIM 212140) is due to mutations in the SLC22A5 gene and leads to extremely low carnitine levels in blood and tissues. Affected individuals may develop early onset cardiomyopathy, weakness, or encephalopathy, which may be serious or even fatal. The disorder can be suggested by newborn screening. However, markedly low newborn carnitine levels can also be caused by conditions unrelated to CTD, such as the low carnitine levels often associated with normal pregnancies and some metabolic disorders occurring in the mother. In order to clarify the biochemical characteristics most useful for identification of CTD in newborns, we examined California Department of Public Health newborn screening data for CTD from 2005 to 12 and performed detailed chart reviews at six metabolic centers in California. The reviews covered 14 cases of newborn CTD, 14 cases of maternal disorders (CTD, 6 cases; glutaric aciduria, type 1, 5; medium-chain acyl CoA dehydrogenase deficiency, 2; and cobalamin C deficiency, 1), and 154 false-positive cases identified by newborn screening. Our results show that newborns with CTD identified by NBS exhibit different biochemical characteristics, compared to individuals ascertained clinically. Newborns with CTD may have NBS dried blood spot free carnitine near the lower cutoff and confirmatory plasma total and free carnitine levels near the normal lower limit, particularly if obtained within two weeks after birth. These findings raise the concern that true cases of CTD may exist that could have been missed by newborn screening. CTD should be considered as a possible diagnosis in cases with suggestive clinical features, even if CTD was thought to be excluded in the newborn period. Maternal plasma total carnitine and newborn urine total carnitine values are the most important predictors of true CTD in newborns. However, biochemical testing alone does not yield a discriminant rule to distinguish true CTD from low carnitine in newborns due to other causes. Because of this biochemical variability and overlap, molecular genetic testing is imperative to confirm CTD in newborns. Additionally, functional testing of fibroblast carnitine uptake remains necessary for cases in which other confirmatory testing is inconclusive. Even with utilization of all available diagnostic testing methods, confirmation of CTD ascertained by NBS remains lengthy and challenging. Incorporation of molecular analysis as a second tier step in NBS for CTD may be beneficial and should be investigated.

Efficacy and safety of three adefovir-based combination therapies in HBeAg-positive chronic hepatitis B patients with suboptimal response to adefovir monotherapy

Although high potent nucleos(t)ide analogues are strongly recommended as first-line therapy for chronic hepatitis B (CHB) in China, some patients are still being treated with adefovir disoproxil (ADV), especially those low-income patients whose health insurance could not reimburse the drug cost. Therefore, the management of patients who have failed ADV therapy or who sustained renal damage during ADV therapy remains an important clinical problem in China. This retrospective study aimed to compare the efficacy and safety of lamivudine (LAM), telbivudine (LdT) or entecavir (ETV) add-on strategies to optimize the treatment of patients with prior suboptimal response to ADV monotherapy. A total of 277 eligible patients were included in this study, and the baseline characteristics were similar among the LAM + ADV (n = 116), LdT + ADV (n = 72) and ETV + ADV (n = 89) groups. At week 96, both the proportion of undetectable HBV DNA (81.03% for LAM + ADV, 84.72% for LdT + ADV and 88.76% for ETV + ADV; P = .317) and ALT elevation (5.17% for LAM + ADV, 4.17% for LdT + ADV and 4.49% for ETV + ADV; P = 1.000) were similar among the three groups; also, a significant decline in liver stiffness was observed in each group from baseline to week 96. At week 96, the rate of HBeAg seroconversion was significantly higher in LdT + ADV than in LAM + ADV (26.39% vs 13.79%, P = .031) and ETV + ADV (26.39% vs 10.11%, P = .007). During the 96 weeks, no obvious renal injury was reported in any of the three groups, but an improvement in eGFR was found in LdT + ADV compared with LAM + ADV and ETV + ADV. In summary, all three combination strategies provide good control of virus replication, but the LdT + ADV combination therapy may yield better HBeAg seroconversion and eGFR improvement.

Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies

In this meta-analysis, evidence of an association between type 2 diabetes mellitus (T2DM) and low-energy fractures has been evaluated including 12 observational studies. The results suggested that T2DM patients had an enhanced risk of low-energy fractures.

INTRODUCTION

Type 1 diabetes mellitus (T1DM) patients have been shown to be at enhanced risk of fracture injury, but less is known about low-energy fractures among patients with T2DM.

METHODS

We performed a meta-analysis of 12 observational studies identified in Medline and EMBASE that included 938,742 participants, including 30,827 low-energy fracture cases. The incidence rate ratios (IRRs) of low-energy fractures were determined using a random-effects model.

RESULTS

The IRRs of low-energy fracture for men and women were 1.37 (95% confidence interval [CI], 0.94-2.00; p = 0.096) and 1.22 (95% CI, 1.09-1.35; p = 0.000), respectively, and the overall IRR was 1.23 (95% CI, 1.12-1.35; p = 0.000). The IRRs for hip and vertebral fractures were 1.08 (95% CI, 1.02-1.15; p = 0.007) and 1.21 (95% CI, 0.98-1.48; p = 0.073), respectively. The IRRs of low-energy fracture in case-control, prospective, retrospective, and cross-sectional studies were 1.18 (95% CI, 0.81-1.72; p = 0.380), 1.17 (95% CI, 1.05-1.32, p = 0.006), 1.15 (95% CI, 1.02-1.29; p = 0.020), and 1.60 (95% CI, 1.21-2.12; p = 0.001), respectively. The IRRs of low-energy fracture for less than 5 years, 5 to 10 years, and more than 10 years were 1.30 (95%, CI 1.13-1.50; p = 0.000), 1.05 (95% CI, 1.03-1.08; p = 0.000), and 1.19 (95% CI, 1.00-1.41; p = 0.049), respectively.

CONCLUSIONS

Patients with T2DM had a greater risk of low-energy fracture especially of the hip, compared with that in non-diabetic subjects. However, since according to our funnel plot a publication bias may be present and due to study heterogeneity as well as the limited number of publications, the finding needs to be interpreted with caution.

Safety and efficacy of telbivudine for chronic hepatitis B during the entire pregnancy: Long-term follow-up

The management of hepatitis B virus (HBV) infection in pregnancy is a unique issue. Telbivudine (LdT) is recommended to block HBV mother-to-child transmission (MTCT) in the third trimester. However, the safety of LdT treatment during the entire pregnancy for the long-term growth of infants is unclear. The aim of this study was to evaluate the efficacy and long-term safety of LdT for the entire pregnancy period. This retrospective cohort study included 40 pregnant women and 43 children from 2011 to 2017. The antiviral effects and maternal abnormalities were evaluated. In addition, adverse events regarding infants at delivery and HBV vaccination outcomes were recorded. The status of physical development in the children during follow-up was also evaluated. Among pregnant women, the rates of HBV DNA flare were 5.00% during pregnancy and 7.50% postpartum, and the HBeAg seroconversion rates were 7.50% during pregnancy and 7.50% postpartum. No severe maternal abnormalities were observed. Regarding the infants, no one was positive for HBsAg, and only one infant was negative for anti-HBs in children over 7 months of age. Furthermore, no birth defects or severe adverse events were observed at delivery, and 97.67% normal height and 93.02% normal weight in children were observed on follow-up until 5 years of age. In conclusion, LdT use for the entire pregnancy is both effective for treating pregnant women and blocking HBV MTCT. Moreover, LdT is safe for women and infants. Most importantly, the long-term follow-up indicated that LdT is safe and does not affect the growth of children.

Entecavir maleate versus entecavir in Chinese chronic hepatitis B predominantly genotype B or C: Results at week 144

Reports on the efficacy and safety of long-term entecavir treatment in chronic hepatitis B (CHB) predominantly genotype B or C are insufficient. This study presents the efficacy and safety of entecavir maleate in Chinese CHB patients. Patients were randomly assigned to receive 48-week treatment with either 0.5 mg/day entecavir (group A) or 0.5 mg/day entecavir maleate (group B), and then all patients received treatment with 0.5 mg/day entecavir maleate from week 49. Two hundred and seventy-five patients with CHB (HBeAg-positive: 218) were analysed, predominantly (98.5%) with genotype B or C. Baseline characteristics were balanced. For the HBeAg-positive CHB patients, the mean HBV DNA level decreased similarly (A: by 6.36 log₁₀ IU/mL vs B: by 6.31 log₁₀ IU/mL) between groups at week 144. The percentages of patients who achieved undetectable HBV DNA were similar (A: 70.59% vs B: 66.67%) between groups. Similar HBeAg loss rates (A: 43.53% vs B: 40.23%; P>.05) and HBeAg seroconversion rates (A: 21.52% vs B: 21.18%) were achieved. For the HBeAg-negative CHB patients, similar reductions in HBV DNA levels from baseline (A: by 6.13 log₁₀ IU/mL vs B: by 5.65 log₁₀ IU/mL) and percentages of patients who achieved undetectable HBV DNA (A: 100% vs B: 100%) were achieved. The overall incidence of adverse events was comparable between groups. In conclusions, 48-week administration of entecavir maleate and entecavir showed similar efficacy and safety in Chinese patients with CHB. Long-term entecavir maleate treatment was effective and safe in CHB patients.