[Impact of direct bilirubin on the long-term outcome of patients with acute coronary syndrome post percutaneous coronary intervention]

Objective: To investigate the impact of direct bilirubin on long-term prognosis of acute coronary syndrome (ACS) patients post percutaneous coronary intervention(PCI). Methods: As a prospective and observational cohort study, a total of 6 431 consecutive ACS patients underwent PCI from January to December 2013 in Fuwai hospital were included. Patients were divided into 3 groups according to tertiles values of direct bilirubin as follows: low direct bilirubin group(<2.2 μmol/L, n=2 219), moderate direct bilirubin group(2.2-3.0 μmol/L, n=2 016), and high direct bilirubin group(>3 μmol/L, n=2 196). The clinical characteristics were compared among the 3 groups, and the impact of direct bilirubin on clinical adverse events (main adverse cardiovascular and cerebrovascular events included cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis) were analyzed at 2 years after PCI. Results: (1) Percent of male patients was 66.5%(1 475/2 219), 78.0%(1 572/2 016), and 86.2%(1 892/2 196), body mass index was(25.7±3.1), (26.0±3.3),and (26.0±3.2) kg/m(2), the ratio of the history of old myocardial infarction was 11.9%(264/2 219), 13.0%(263/2 016),and 14.9%(328/2 196), the ratio of the current smoker was 56.3%(1 249/2 219), 59.1%(1 192/2 016),and 60.0%(1 317/2 196) in low, moderate and high direct bilirubin groups respectively, and the differences were statistically significant (P<0.01 or 0.05). (2) Two years after PCI, the all-cause mortality was 0.8%(17/2 219), 1.8%(36/2 016), and 1.5%(33/2 196) (P=0.011),the cardiogenic mortality was 0.5%(12/2 219), 1.3%(26/2 016), and 0.6%(13/2 196) (P=0.010),the ratio of myocardial infarction was 2.2%(49/2 219), 2.4%(49/2 016), and 1.4%(31/2 196)(P=0.044),the ratio of revascularization was 8.8%(195/2 219), 8.3%(168/2 016),and 8.9%(196/2 196)(P=0.783),the ratio of stroke was 1.4%(30/2 219),1.1%(22/2 016), and 1.9%(42/2 196)(P=0.076),the ratio of stent thrombosis was 0.9%(19/2 219), 1.2%(24/2 016),and 0.7%(15/2 196)(P=0.210) in low, moderate and high direct bilirubin groups, respectively. (3) Multivariable Cox regression analysis showed that, patients in moderate direct bilirubin group faced increased the risk of all-cause mortality compared with patients in the low direct bilirubin group (HR=2.23, 95%CI 1.23-4.05, P= 0.009), and the risk of all-cause mortality was similar between high direct bilirubin group and low direct bilirubin group (HR=1.84, 95%CI 0.99-3.38, P= 0.051). There were no statistically significant difference in the risks of main adverse cardiovascular and cerebrovascular events,cardiogenic death, myocardial infarction, revascularization, stroke, and stent thrombosis in moderate and high direct bilirubin groups compared with low direct bilirubin group (all P>0.05). Conclusion: Moderate direct bilirubin level is associated with increased risk of all-cause death at 2 years after PCI compared with low level of direct bilirubin group.

[Predictive value of GRACE discharge score for long-term out-of-hospital death in acute coronary syndrome after percutaneous coronary intervention]

Objective: To evaluate the prognostic value of Global Registry of Acute Coronary Events(GRACE) discharge score for long-term out-of-hospital death in acute coronary syndrome (ACS) after drug-eluting stents (DES) and with Dual-antiplatelet Therapy (DAPT). Methods: Our study was a prospective, observational, single center (Fuwai Hospital of China) study.A total of 6 431consecutive ACS patients underwent percutaneous coronary intervention(PCI)between January 2013 and December 2013 were involved.The primary endpoint was all-cause death and second endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) as a composite of all-cause death, myocardial infarction, revascularization, stent thrombosis or stroke. Results: Finally, 5 867 ACS patients who were received DES with DAPT and had no in-hospital event included in this study, and 59 (1.01%) death and 608 (10.36%) MACCE were reported during 2-year follow-up after discharge.GRACE score was significantly higher among death patients than those survivalpatients (94± 28 vs 78± 24, P<0.001). According to risk stratification of GRACE discharge score, as compared to the low-risk group, death risk in high-risk group was 6.73 times (HR=6.73, 95%CI 3.53-12.84; P<0.001) higher, but could not distinguish between the moderate and low risk group (HR=1.61, 95%CI 0.88-2.95; P=0.124). The GRACE score showed predictive value in ACS patients after DESand with DAPT (area under the receiver operating characteristic curve (AUROC)=0.661; 95%CI 0.586-0.736, P<0.001). In subgroup analysis, GRACE score also showed predictive value both in unstable angina pectoris (UAP)(AUROC=0.660, 95%CI 0.576-0.744; P<0.001) and acute myocardial infarction(AMI)subgroup (AUROC=0.748, 95%CI 0.631-0.864; P=0.001). Conclusion: GRACE discharge score shows prognostic value for long-term out-of-hospital death in ACS patients undergoing PCI with DES and DAPT, and demonstrates good risk stratification of high and low-risk of death.

[Outcome of patients with coronary artery disease and left ventricular ejection fraction less than 50% undergoing percutaneous coronary intervention]

Objective: To investigate the in-hospital and long-term outcomes of patients with left ventricular ejection fraction (LVEF) <50% undergoing percutaneous coronary intervention (PCI) . Methods: From January to December 2013, 10 445 consecutive patients who underwent PCI in Fuwai Hospital and the LVEF value was available were prospectively included. The patients were divided into LVEF≥50% group (9 896 cases) and LVEF<50% group (549 cases) . The in-hospital and 2-year clinical outcomes were compared between the 2 groups. The association between LVEF<50% and clinical outcomes was assessed using multivariable Cox regression analysis. Results: (1) Compared with LVEF ≥50% group, LVEF< 50% group had higher rates of in-hospital all-cause death (1.1% (6/549) vs. 0.2% (17/9 896) , P<0.01) , cardiac death (1.1% (6/549) vs. 0.1% (12/9 896) , P<0.01) , in-stent thrombosis (0.7% (4/549) vs. 0.2% (18/9 896) , P<0.01) , myocardial infarction (2.4% (13/549) vs. 1.2% (121/9 896) , P<0.05) ,and major adverse cardiovascular and cerebrovascular events (MACCE) which including death, myocardial infarction, revascularization, in-stent thrombosis, and stroke (3.6% (20/549) vs. 1.4% (137/9 896) , P<0.01) . (2) A total of 10 388 (99.5%) patients completed 2-year follow-up. Compared with LVEF ≥50% group, LVEF<50% group had higher rates of 2-year all-cause death (4.7% (26/549) vs. 1.0% (101/9 896) , P<0.01) , cardiac death (4.0% (22/549) vs. 0.5% (50/9 896) , P<0.01) , in-stent thrombosis (3.1% (17/549) vs. 0.7% (71/9 896) , P<0.001) , myocardial infarction (4.2% (23/549) vs. 1.9% (186/9 896) , P<0.01) ,and MACCE (17.9% (98/549) vs. 11.8% (1 172/9 896) , P<0.01) . There were no significant differences on the rates of 2-year target-vessel revascularization, bleeding and stroke between the two groups. (3) The multivariable Cox regression analysis demonstrated that LVEF< 50% was the independent risk factor of 2-year all-cause death (HR=2.47, 95%CI 1.49-4.08, P<0.01) , cardiac death (HR=3.25, 95%CI 1.79-5.90, P<0.01) , in-stent thrombosis (HR=4.19, 95%CI 2.39-7.34, P<0.01) , myocardial infarction (HR=2.00, 95%CI 1.26-3.16, P<0.01) , and MACCE (HR=1.40, 95%CI 1.13-1.74, P<0.01) . (4) After propensity score matching, all in-hospital outcomes were similar between the two groups, including all-cause death, cardiac death, in-stent thrombosis, myocardial infarction, revascularization, bleeding, stroke, and MACCE (all P>0.05) . After propensity score matching,the multivariable Cox regression analysis demonstrated that LVEF<50% was still an independent risk factor of 2-year all-cause death (HR=3.08, 95%CI 1.37-6.89, P<0.01) , cardiac death (HR= 4.12, 95%CI 1.53-11.07, P<0.01) ,and in-stent thrombosis (HR=3.82, 95%CI 1.27-11.5, P<0.05) . Conclusion: LVEF< 50% is an independent risk factor of 2-year all-cause death, cardiac death, and in-stent thrombosis in patients undergoing PCI, but it does not increase the risk of target-vessel revascularization, bleeding or stroke.

[Efficacy comparison of 3 strategies for real-world stable coronary artery disease patients with three-vessel disease]

Objective: To compare the effectiveness of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical therapy (MT) alone for real-world stable coronary artery disease (SCAD) patients with three-vessel disease (TVD) in mainland China. Methods: A total of 8 943 consecutive cases with TVD hospitalized in our center from April 2004 to February 2011 were screened for this study. In this cohort, 3 435 cases diagnosed as SCAD were analyzed. PCI, CABG, MT alone were performed in 1 313 (38.2%), 1 259 (36.7%) and 863 (25.1%) patients, respectively. Propensity score matching (PSM) analysis using nearest neighbor matching with a 1∶1 ratio was applied, and 758 pairs of CABG and PCI groups, 552 pairs of PCI and MT groups, 639 pairs of CABG and MT groups were selected, respectively. 1- and 2-year clinical outcomes were evaluated among PCI, CABG and MT group. Kaplan-Meier curves and multivariable Cox regression method were used for survival analysis. Results: Significant differences were found at baseline between PCI, CABG and MT group, including age, gender, body mass index, family history of coronary artery disease, hyperlipidemia, diabetes mellitus, previous myocardial infarction, stroke, previous revascularization, peripheral vascular disease, SNYTAX score, left ventricular ejection fraction, hemoglobin, serum creatinine, high-sensitivity C-reactive protein, triglyceride and medication (all P<0.05) . All-cause death rates of 1- and 2-year follow-up of PCI, CABG and MT group were 0.6% (8/1 313), 1.1% (14/1 259), 3.4% (29/863) (P<0.001) and 1.1%(14/1 313), 1.5%(19/1 259), 7.3%(63/863) (P<0.001), respectively. Multivariate Cox regression analysis showed that 1-year MACCE rate (HR=0.51, 95%CI 0.33-0.77, P=0.001) was significantly reduced, due to the significant decrease of myocardial infarction (MI) rate (HR=0.09, 95%CI 0.01-0.76, P=0.027) and repeat revascularization rate (HR=0.21, 95%CI 0.10-0.41, P<0.001) in CABG group compared to PCI group, while all-cause death (HR=1.21, 95%CI 0.48-3.00, P=0.69) and stroke rate (HR=2.31, 95%CI 0.82-6.47, P=0.112) were similar between 2 groups. 2-year outcome showed CABG was associated with higher stroke rate (HR=2.20, 95%CI 1.06-4.55, P=0.034) and lower MI (HR=0.19, 95%CI 0.06-0.59, P=0.004) and repeat revascularization rate (HR=0.22, 95%CI 0.13-0.37, P<0.001), and lower MACCE rate (HR=0.49, 95%CI 0.36-0.68, P<0.001). Compared to MT group, 2-year all-cause death (HR=0.22, 95%CI 0.12-0.42, P<0.001) and MACCE rate (HR=0.63, 95%CI 0.47-0.83, P=0.001) were lower in PCI group, while 2-year all-cause death (HR=0.21, 95%CI 0.13-0.37, P<0.001), MACCE (HR=0.31, 95%CI 0.23-0.42, P<0.001), MI (HR=0.19, 95%CI 0.06-0.60, P=0.004) and repeat revascularization rate (HR=0.24, 95%CI 0.13-0.41, P<0.001) were lower in CABG group. Results of multivariate Cox regression analysis after PSM were consistent with above results. Conclusion: For SCAD patients with TVD, CABG shows better effectiveness by reducing MI and revascularization risk as compared to PCI, even though stroke risk is somehow higher in CABG patients. Patients received MT alone are associated with worse outcomes than those undergoing revascularization strategies.

[Clinical characteristics and prognosis in the patients of stroke after percutaneous coronary intervention]

Objective: To investigate the clinical characteristics and prognosis in patients with stroke after percutaneous coronary intervention (PCI). Methods: From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI including acute coronary syndrome and stable angina pectoris were enrolled.A two years' follow up was conducted among these patients to investigate the clinical characteristics and prognosis of patients with stroke and of those without. A comparison was done between the two groups. Results: One hundred and forty-five patients had stroke (1.4%) during the follow-up period after PCI, including 124 cases with ischemic stroke (1.2%), out of whom 4 (3.2%) patients died; 21 cases with hemorrhagic stroke, out of whom 9 patients (42.9%) died.There was more female, and more patients with risks factors, hypertension, previous myocardial infarction, previous stroke, etc. in the patients with stroke.During the 2-year follow-up, patients with stroke experienced higher incidence of all-cause mortality (9% vs 1.1%, P<0.000 1). There were no significant differences in the incidences of cardiac death, myocardial infarction, revascularization, stent thrombosis and major adverse cardiovascular event rates between the two groups.COX regression analysis showed that stroke after PCI was associated with the increased mortality (HR=8.387, 95%CI: 4.725-14.855, P<0.000 1). Meanwhile, after propensity score matched analyses (129 pairs), the trend was not changed, and stroke was still an independent risk factor of all-cause mortality (HR=6.737, 95%CI: 1.52-29.85, P=0.012). Conclusions: The patients underwent PCI, who had stroke later, had more clinical risk factors, and more serious degree of atherosclerosis.The incidence of stroke is an independent risk factor for all-cause mortality in patients with coronary heart disease after PCI.

[Impact of platelet distribution width on the extent and long-term outcome of patients with stable coronary artery disease post percutaneous coronary intervention]

Objective: To evaluate the relationship between platelet distribution width(PDW) and the extent of coronary artery disease and 2-year outcome in patients received percutaneous coronary artery intervention(PCI) because of stable coronary artery disease(SCAD). Methods: We consecutively enrolled 4 293 patients who received PCI because of SCAD in Fuwai Hospital from Jan 2013 to Dec 2013, patients were followed up for 2 years. Patients were divided into three groups according to tertiles values of PDW as follows: PDW≤11.4%(1 402 patients), 11.4%<PDW≤12.9%(1 441 patients) and PDW>12.9% (1 450 patients). Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the occurrence of death, myocardial infarction, target vessel revascularization, intra stent thrombosis and stroke during follow-up. Multivariable logistic regression was used to evaluate the relationship between PDW and the extent of CAD. Multivariable Cox regression was used to evaluate the relationship between PDW and prognosis of SCAD patients. Results: PDW was associated with diabetes mellitus, body mass index, red cell distribution width, mean platelet volume (MPV), platelet counts and glycosylated haemoglobin (P<0.05), but not associated with age, sex, estimated glomerular filtration rate (P>0.05). PDW was not correlated with the extent of CAD(P=0.990), SYNTAX score(P=0.721), no-reflow phenomenon after PCI(P=0.978). Multivariable logistic regression also showed no relationship between PDW and extent of CAD (OR=0.994, 95%CI 0.961-1.029, P=0.73). PDW was found to be an independent risk factor of 2-year cardiac death (HR=1.242, 95%CI 1.031-1.497, P=0.022), but was not an independent risk factor of all-cause death and MACCE. Conclusions: PDW is not related with the extent of coronary artery disease. PDW is an independent risk factor of 2-year cardiac death, but is not an independent risk factor of all-cause death and MACCE in this patient cohort.

Correspondence between the electronic structure and phase separation in a K-doped FeSe system

Phase separated potassium intercalated FeSe thin films have been synthesized by pulsed laser deposition. The coexistence of FeSe phase and 245 phase was investigated both by x-ray photoemission spectroscopy (XPS) and x-ray diffraction. The volume ratio of these two phases is sensitive to temperatures and amount of extra potassium dosing. The XPS and ultraviolet photoelectron spectroscopy results indicated that these two phases shows the different hybridization strength between adjacent Fe layer and Se layer. We infer that the layered electronic structure is the necessary condition of superconductivity in potassium-doped FeSe system, and the phase separation is driven by competition between quasi-2D and 3D bonding mode within FeSe layer. Similar competition may also be able to interpret the phase seperation in K _x Fe_2-y Se₂ bulk single crystal.

[Efficacy and safety of Xiaoaiping combined with chemotherapy in the treatment of advanced esophageal cancer]

Objective: To evaluate the efficacy and safety of Xiaoaiping combined with chemotherapy in the treatment of advanced esophageal cancer. Methods: This is a multi-center, randomized, open label and parallel controlled study. A total of 124 advanced esophageal cancer patients with Karnofsky Performance Status (KPS) score ≥60 and expected survival time≥3 months were enrolled. We adopted design and divided the patients into study and control group. The patients in study group received Xiaoaiping combined with S-1 and cisplatin. The control group received S-1 and cisplatin. Each group included 62 patients and 21 days as a treatment cycle. The efficacy and adverse events in patients of the two groups were observed and compared. Results: 57 patients in the study group and 55 in the control group were included in efficacy assessment. The response rate was 54.4% and 34.5% in the study group and control group, respectively(P<0.05). Disease control rates were 86.0% and 69.1%, respectively(P<0.05). The median progression-free survival (PFS) was 7.97 in the study group and 6.43 months in the control group(P<0.05). The median overall survival(OS) was 12.93 in the study group and 10.93 months in the control group(P<0.05). The most common adverse events in the two groups were nausea and vomiting, thrombocytopenia, anemia, neutropenia, liver damage, pigmentation, oral mucositis, renal impairment and diarrhea. The incidences of nausea, vomiting, thrombocytopenia, leukopenia, neutropenia and diarrhea in the study group were significantly higher than those in the control group(P<0.05). Conclusion: Xiaoaiping combined with S-1 and cisplatin significantly increased response rate, and prolongedpatients' survival in patients with advanced esophageal cancer.

Low vaspin levels are related to endothelial dysfunction in patients with ankylosing spondylitis

Vaspin is a novel adipocytokine associated with glucose tolerance and chronic inflammation. Some studies reveal that vaspin may be involved in cardiovascular diseases. Our objective was to investigate the relationship between serum vaspin levels and endothelial function in patients with ankylosing spondylitis. One hundred and twenty patients with newly diagnosed ankylosing spondylitis and 100 healthy subjects were studied. Serum vaspin levels were measured with enzyme-linked immunosorbent assay. High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia (flow-mediated dilation, FMD) and after sublingual glyceryltrinitrate. Serum vaspin level in patients was 1.92±1.03 ng/mL, which was significantly lower than that in healthy subjects (2.88±0.81 ng/mL). By dividing the distribution of serum vaspin levels into quartiles, FMD levels increased gradually with the increase of serum vaspin levels in patients (P<0.01). Univariate analysis showed a correlation between vaspin and FMD (r=0.73, P=0.003), low-density lipoprotein cholesterol (r=-0.45, P=0.033), high-density lipoprotein cholesterol (r=0.63, P=0.025), fasting blood glucose (r=-0.79, P=0.006), triglycerides (TG) (r=-0.68, P=0.036), systolic blood pressure (r=-0.35, P=0.021), C-reactive protein (r=-0.67, P=0.011), homeostatic model assessment of insulin resistance (HOMA-IR) (r=-0.77, P=0.023) and erythrocyte sedimentation rate (r=-0.88, P=0.039) in patients. Multivariate analysis indicated that serum vaspin levels were independently associated with FMD, HOMA-IR and TG in patients. Our study found that serum vaspin levels were decreased in patients with ankylosing spondylitis and were associated with FMD levels. Vaspin may serve as an independent marker for detecting early stage atherosclerosis in patients with ankylosing spondylitis.

[Expression of elafin in peripheral blood in inflammatory bowel disease patients and its clinical significance]

OBJECTIVE

To quantify the expression of elafin mRNA in peripheral blood in patients with inflammatory bowel disease (IBD) and to explore its value in assessment of the activity and severity of IBD.

METHODS

From July 1 2015 to August 15 2015, 23 patients with IBD admitted to Peking University First Hospital were selected, including 15 cases with ulcerative colitis (UC) and 8 cases with Crohn's disease (CD). Among those, 5 cases were in remission (UC 3, CD 2), 6 cases were mild active (UC 3, CD 3), 3 cases were moderate active (UC 1, CD 2), and 9 cases were severe active (UC 8, CD 1). A total of 21 healthy individuals were selected as the control group. Peripheral blood samples of IBD patients and healthy controls were collected. The expression of elafin mRNA in peripheral blood leukocytes was detected by fluorescence quantitative real-time PCR. Mann-Whitney test was performed for comparison between the two groups. The correlation between the expression of elafin mRNA in peripheral blood and IBD activity score was analyzed by Pearson correlation analysis after transformation of variables.

RESULTS

The median expression of elafin mRNA in peripheral blood leukocytes in IBD group and control group was 0.005 8 (0.000 2, 0.043 5) and 0.015 3 (0.002 1, 0.175 8), respectively, with no significant difference (P>0.05). However, in the active IBD patients it was lower than that in the controls (0.004 6 (0.000 2, 0.034 8) vs 0.015 3 (0.002 1, 0.175 8), P<0.05) and also lower than that in the remission patients(0.004 6 (0.000 2, 0.034 8) vs 0.023 1 (0.012 6, 0.043 5), P<0.05); in the active UC patients it was lower than that in the controls(0.003 7 (0.000 2, 0.027 0) vs 0.015 3 (0.002 1, 0.175 8), P<0.05). The expression of elafin mRNA in peripheral blood was negatively correlated with modified Mayo score in UC patients (r=-0.513, P<0.05) and with the Crohn's Disease Activity Index (CDAI) of Best score in CD patients (r=-0.889, P<0.05).

CONCLUSION

The expression of elafin mRNA in peripheral blood in active IBD patients is decreased, which may be correlated with the activity of IBD, and negatively correlated with corresponding disease activity score, suggesting that it may play a protective role in IBD and may be helpful in predicting disease activity.

Nonlinear Transition from Mitigation to Suppression of the Edge Localized Mode with Resonant Magnetic Perturbations in the EAST Tokamak

Evidence of a nonlinear transition from mitigation to suppression of the edge localized mode (ELM) by using resonant magnetic perturbations (RMPs) in the EAST tokamak is presented. This is the first demonstration of ELM suppression with RMPs in slowly rotating plasmas with dominant radio-frequency wave heating. Changes of edge magnetic topology after the transition are indicated by a gradual phase shift in the plasma response field from a linear magneto hydro dynamics modeling result to a vacuum one and a sudden increase of three-dimensional particle flux to the divertor. The transition threshold depends on the spectrum of RMPs and plasma rotation as well as perturbation amplitude. This means that edge topological changes resulting from nonlinear plasma response plays a key role in the suppression of ELM with RMPs.

[Clinical value of a domestic portable monitoring system for the diagnosis of obstructive sleep apnea syndrome]

Objective:The aim of this study is to evaluate the clinical value of a portable monitoring system(YH600B) in OSAHS by comparing the consistency of overnight sleeping data recorded by polysomnography and YH600B. Method:One hundred and nineteen snoring patients underwent one-night polysomnography(PSG)and YH600B simultaneously.The measured data by the two methods were compared to analysis their correlation,including AHI and LSaO₂.The Bland Altman plots was used to assess the consistency between PSG and STD.Sensitivity and specificity comparisons were plotted graphically using receiver operating characteristic(ROC) curve analysis.Result:All cases were well tolerated the procedure.①AHI and LSaO₂ measured by the two techniques have strong correlation(r=0.981, r=0.882,P<0.05,respectively).②Bland Altman analyses showed strong agreement between AHI values from the YH600B and PSG recordings.③the ROC-curve showed that AHI cut off value was 7.25,area under the curve was 0.992 3,sensitivity was 98.1%,and specificity was 92.2%.Conclusion:These data suggest that YH600B have highly consistency with PSG,and YH600B is accurate in the application of the diagnosis of OSAHS.

[Clinical analysis of cutaneous manifestations and related factors in patients with ulcerative colitis]

OBJECTIVE

To investigate the cutaneous manifestations in patients with ulcerative colitis (UC) and related factors.

METHODS

Patients admitted to Department of Gastroenterology Peking University First Hospital from January 1994 to December 2014 and diagnosed as UC were retrospectively enrolled in this study. Skin disorders were confirmed by the dermatologists. Clinical data were collected and compared between patients with and without cutaneous manifestations.

RESULTS

Among the total 373 UC patients, there were 34 cases (9.1%) with cutaneous manifestations, including 11 pyoderma gangrenosum, 8 erythema nodosum, 6 eczema, 3 psoriasis, 2 pemphigus, 1 granulomatous cheilitis, 1 ichthyosis, 1 acne rosacea, and 1 impetigo. The skin manifestations may occur after the diagnosis, simultaneously or even before the diagnosis of UC, which were 24, 7 and 3 patients respectively. The mean age in patients with skin lesions was (47.2±12.1) years, male to female ratio 0.79∶1. More patients with skin manifestations had severe activity of UC compared with non-skin group [50.0%(17/34) vs 25.1%(85/339), P=0.01]. In addition, the proportion of extensive colitis in skin lesion group was significantly higher than that in non-skin group [76.5%(26/34) vs 54.6%(185/339), P=0.04].

CONCLUSIONS

The cutaneous manifestations associated with UC are polymorphic, erythema nodosums and pyoderma gangrenosums are the most common skin lesions seen in UC patients. Skin lesions occur concurrently, pre or post the diagnosis of UC. Skin lesions in UC patients suggest more severe disease activity. Clinicians need to pay more attention to this group.

Rab3A, Rab27A, and Rab35 regulate different events during mouse oocyte meiotic maturation and activation

Rab family members play important roles in membrane trafficking, cell growth, and differentiation. Almost all components of the cell endomembrane system, the nucleus, and the plasma membrane are closely related to RAB proteins. In this study, we investigated the distribution and functions of three members of the Rab family, Rab3A, Rab27A, and Rab35, in mouse oocyte meiotic maturation and activation. The three Rab family members showed different localization patterns in oocytes. Microinjection of siRNA, antibody injection, or inhibitor treatment showed that (1) Rab3A regulates peripheral spindle and cortical granule (CG) migration, polarity establishment, and asymmetric division; (2) Rab27A regulates CG exocytosis following MII-stage oocyte activation; and (3) Rab35 plays an important role in spindle organization and morphology maintenance, and thus meiotic nuclear maturation. These results show that Rab proteins play important roles in mouse oocyte meiotic maturation and activation and that different members exert different distinct functions.

Molecular cloning, polymorphisms, and expression analysis of the RERG gene in indigenous Chinese goats

The current study aimed to investigate the coding sequence, polymorphisms, and expression of the RERG gene in indigenous Chinese goats. cDNA of RERG, obtained through reverse transcription PCR was analyzed using bioinformatic techniques. Polymorphisms in the exon regions of the RERG gene were identified and their associations with growth traits in three varieties of indigenous Chinese goats were investigated. Expression of the RERG gene in three goat breeds of the same age was detected using real-time quantitative PCR. The results revealed that the cDNA of RERG, which contained a complete open reading frame of 20-620 bp, was 629 bp in length. The associated accession numbers in GenBank are JN672576, JQ917222, and JN580309 for the QianBei Ma goat, the GuiZhou white goat, and the GuiZhou black goat, respectively. Four consistent SNP sites were found in the exon regions of the RERG gene for the three goat breeds. mRNA expression of the RERG gene differed between different tissues in adult goats of same age. The highest expression was observed in lung and spleen tissues, while the lowest expression was recorded in thymus gland tissue. In addition, the expression of the RERG gene in the muscle of Guizhou white goat, GuiZhou black goat, and QianBei Ma goat decreased sequentially. Our results lay the foundations for further investigation into the role of the RERG gene in goat growth traits.

Analysis of skin color change and related gene expression after crossing of Dongxiang black chicken and ISA layer

This study evaluated the effects of the autosomal domi-nant Fm gene in conjunction with the sex-linked Id gene on skin color and related gene expression. Ten Dongxiang black cocks were selected to build ten families by mating 60 individuals of ISA B-line layers. The skin color of the F1 generation was observed at different time points. At 126 days, 36 chickens were slaughtered, and gene expression of TYRP1, TYRP2, MC1R, and EDNRB in breast skin was assessed by quantitative RT-PCR. The ratio of Dongxiang black chickens with white skin chicks in the F1 generation to that of non-white was 3:7 (HoFF: HeFf). At 126 days, all F1 generation cocks showed white skin (115/115), while the percentages of hens with black skin were 100% (HoFF, 27/27) and 53.75% (HeFf, 43/80). The change in skin color peaked between 42 and 84 days. The offspring of HoFF displayed significantly higher expres-sion of MC1R, compared with those of HeFf (P < 0.05). The "L" value of hen's skin was significantly lower, and TYRP1 and TYRP2 expres-sion was significantly higher (P < 0.05) than in cocks with the same Fm/fm genotype. These findings indicate the presence of homozygous and heterozygous Fm in Dongxiang black chickens, with the offspring of homozygous birds showing a higher percentage of black skin percentage. The expression of the four genes studied was correlated with skin color, with TYRP1 and TYRP2 representing the most suitable molecular markers.

Overexpression of a Populus trichocarpa H+-pyrophosphatase gene PtVP1.1 confers salt tolerance on transgenic poplar

The Arabidopsis vacuolar H(+)-pyrophosphatase (AVP1) has been well studied and subsequently employed to improve salt and/or drought resistance in herbaceous plants. However, the exact function of H(+)-pyrophosphatase in woody plants still remains unknown. In this work, we cloned a homolog of type I H(+)-pyrophosphatase gene, designated as PtVP1.1, from Populus trichocarpa, and investigated its function in both Arabidopsis and poplar. The deduced translation product PtVP1.1 shares 89.74% identity with AVP1. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and quantitative real-time PCR analyses revealed a ubiquitous expression pattern of PtVP1.1 in various tissues, including roots, stems, leaves and shoot tips. Heterologous expression of PtVP1.1 rescued the retarded-root-growth phenotype of avp1, an Arabidopsis knock out mutant of AVP1, on low carbohydrate medium. Overexpression of PtVP1.1 in poplar (P. davidiana × P. bolleana) led to more vigorous growth of transgenic plants in the presence of 150 mM NaCl. Microsomal membrane vesicles derived from PtVP1.1 transgenic plants exhibited higher H(+)-pyrophosphatase hydrolytic activity than those from wild type (WT). Further studies indicated that the improved salt tolerance was associated with a decreased Na(+) and increased K(+) accumulation in the leaves of transgenic plants. Na(+) efflux and H(+) influx in the roots of transgenic plants were also significantly higher than those in the WT plants. All these results suggest that PtVP1.1 is a functional counterpart of AVP1 and can be genetically engineered for salt tolerance improvement in trees.

Arabidopsis EF-Tu receptor enhances bacterial disease resistance in transgenic wheat

Perception of pathogen (or microbe)-associated molecular patterns (PAMPs/MAMPs) by pattern recognition receptors (PRRs) is a key component of plant innate immunity. The Arabidopsis PRR EF-Tu receptor (EFR) recognizes the bacterial PAMP elongation factor Tu (EF-Tu) and its derived peptide elf18. Previous work revealed that transgenic expression of AtEFR in Solanaceae confers elf18 responsiveness and broad-spectrum bacterial disease resistance. In this study, we developed a set of bioassays to study the activation of PAMP-triggered immunity (PTI) in wheat. We generated transgenic wheat (Triticum aestivum) plants expressing AtEFR driven by the constitutive rice actin promoter and tested their response to elf18. We show that transgenic expression of AtEFR in wheat confers recognition of elf18, as measured by the induction of immune marker genes and callose deposition. When challenged with the cereal bacterial pathogen Pseudomonas syringae pv. oryzae, transgenic EFR wheat lines had reduced lesion size and bacterial multiplication. These results demonstrate that AtEFR can be transferred successfully from dicot to monocot species, further revealing that immune signalling pathways are conserved across these distant phyla. As novel PRRs are identified, their transfer between plant families represents a useful strategy for enhancing resistance to pathogens in crops.

High-resolution melting curve analysis of the ADSL and LPL genes and their correlation with meat quality and blood parameters in chickens

Adenylosuccinate lyase (ADSL) and lipoprotein lipase (LPL) are key enzymes in the metabolism of inosine monophosphate (IMP) and fat mass, which are important factors in meat quality evaluation. In this study, we selected 50 hens from the ISA B-line layers and Guangxi Yellow chickens, slaughtered the chickens at 120 days old, and analyzed polymorphisms in the ADSL and LPL genes using the high-resolution melting curve method. Blood lipid parameters, intramuscular fat (IMF), and IMP content were higher (P < 0.05) in Guangxi Yellow chickens than in ISA B-line layers, while LPL activity was lower (P < 0.05). In exon 2 of the ADSL gene, a C3484T mutation was identified. In both breeds, the CC genotype showed the highest IMP, and IMP was the lowest in the TT genotype. In the 5ꞌ regulatory region of the LPL gene, a C293T mutation was identified. In both breeds, the CC genotype showed the lowest LPL and IMF, while IMF was the highest in the TT genotype. The percentages of individuals with the TT type in the ADSL gene, which was associated with the lowest IMP, were 16.0 and 52.0% in Guangxi chickens and ISA layers, respectively. The percentages of individuals with the CC type of the LPL gene, which was associated with the lowest LPL and IMF, were 28.0 and 44.0%, respectively. The ADSL and LPL gene mutations are correlated with differences in meat quality in different chicken breeds, and high-resolution melting curve is an effective prediction technology for these mutations.

[Developmental expression of Arabidopsis methyltransferase genes MET1, DRM2 and CMT3]

Cytosine methylation is an epigenetic mark found in the genome of fungi, plants, and animals. DNA methylation is catalyzed by DNA methyltransferases. The function of DNA methyltransferases was shown to be highly conversed, but biological role of these enzymes has not been clearly defined. We generated transgenic plants expressing METHYLTRANSFERASES::GUS reporter genes for three major DNA methyltransferases (MET1, DRM2 and CMT3) to gain insight into the potential physiological relevance of the distinct members of the DNA methyltransferase family in Arabidopsis thaliana, and to investigate the expression patterns in detail. We found that METHYLTRANSFERASE::GUS genes display unique tissue, cell-type, and temporal patterns of expression throughout normal development, particularly in the flower. Our findings are supported by semi-quantitative reverse-transcription PCR, as well as by analyses of microarray databases. These data suggest that DNA methyltransferase may contribute to morphogenesis at every developmental stage and in every plant organ.

Clinicopathological and prognostic analysis of follicular thyroid carcinoma in a single institute over a 15-year period

BACKGROUND

This study was to evaluate the clinicopathological and prognostic features of follicular thyroid carcinoma (FTC) in our institute over a 15-year period.

METHODS

The clinical features, management and outcome of 134 consecutive patients were analyzed according to the time of diagnosis: Group I (1997-2001), Group II (2002-2006), and Group III (2007-2011).

RESULTS

As time advanced, the ratio of FTC to papillary thyroid carcinoma decreased from 8.7% in group I to 4.3% in group III (p = 0.000). The percentage of patients undergoing total thyroidectomy seemed to be more commonly used in the later periods - from 10.5% in group I to 21.8% in group II and 18.9% in group III. The median diameter of tumors in group I was 4.2 cm and it showed a sharp decrease to 2.8 cm in group II and 2.9 cm in group III respectively. There was a trend towards a higher stage in patients from Group I vs. patients from Groups II and III (stage IV, 15.8% vs. 2.2% and 4.3%, p = 0.072). The outcome was improved in terms of disease-free survival (DFS). The 3-year DFS rate improved from 77.8% in group I to 93.7% in group II and 100% in group III (p = 0.008).

CONCLUSIONS

The clinical features, management and outcome of FTC patients changed over 15-year period. Patients diagnosed after 2001 had a better prognosis. This improvement was probably related to earlier diagnosis with smaller tumor size and presentation at earlier tumor stage.

Postoperative adverse outcomes after non-hepatic surgery in patients with liver cirrhosis

BACKGROUND

Postoperative adverse outcomes in patients with liver cirrhosis are not completely understood. This study evaluated the association between liver cirrhosis and adverse outcomes after non-hepatic surgery.

METHODS

Reimbursement claims were used to identify patients with preoperative liver cirrhosis who underwent non-hepatic surgery from 2004 to 2007. Control patients without cirrhosis were matched by age, sex, type of surgery and anaesthesia. The adjusted odds ratios (ORs) and 95 per cent confidence intervals (c.i.) of postoperative adverse events associated with liver cirrhosis were analysed by multivariable logistic regression.

RESULTS

Thirty-day mortality rates among 24 282 patients with cirrhosis and 97 128 control patients were 1·2 per cent (299 deaths) and 0·7 per cent (635 deaths) respectively. Liver cirrhosis was associated with postoperative 30-day mortality (OR 1·88, 95 per cent c.i. 1·63 to 2·16), acute renal failure (OR 1·52, 1·34 to 1·74), septicaemia (OR 1·42, 1·33 to 1·51) and intensive care unit admission (OR 1·39, 1·33 to 1·45). Postoperative mortality increased in patients who had liver cirrhosis with viral hepatitis (OR 2·87, 1·55 to 5·30), alcohol dependence syndrome (OR 3·74, 2·64 to 5·31), jaundice (OR 5·47, 3·77 to 7·93), ascites (OR 5·85, 4·62 to 7·41), gastrointestinal haemorrhage (OR 3·01, 2·33 to 3·90) and hepatic coma (OR 5·11, 3·79 to 6·87).

CONCLUSION

Patients with liver cirrhosis had increased mortality and complications after non-hepatic surgery, particularly those with cirrhosis-related clinical indicators.