[A preliminary study on the application of two-point traction with guidewire method in percutaneous transhepatic sinus tract dilation]

Objective: To explore the feasibility and effectiveness of the two-point traction with guidewire method to improve the safety of percutaneous transhepatic sinus tract dilation. Methods: The clinical data of 18 patients underwent the two-point traction guided by percutaneous transhepatic sinus dilation between January 2013 and July 2017 in Shengjing Hospital of China Medical University were analyzed retrospectively. The operation time, volume of intraoperative blood loss and postoperative complications were recorded. Results: All of the 18 patients were treated successfully. The mean size of the percutaneous transhepatic sinus tract was (18.6±2.3) Fr. The operation time was 15-45 min, with an average of 30 minutes, and the average intraoperative blood loss was about 11.7 ml. The incidence of postoperative complications was 22.2% (4/18), including cholangitis in 3 patients, pancreatitis in 1 case. All the complications were relieved after symptomatic treatment, no severe complications (biliary tract perforation or severe haemorrhage) occurred. A total of (3.3 ± 2.6) times cholangioscopic explorations for stone extraction were performed, with a overall clearance rate of 64.7% (11/17). Conclusions: From the results of limited patient data in this group, the two-point traction with guidewire can provide the exact guidance for percutaneous transhepatic sinus tract dilation, which is effective and easily conducted, but still need further clinical study to confirm.

[Metabolic Characteristics of Lethal Bradycardia Induced by Myocardial Ischemia]

OBJECTIVES

To explore the metabolic characteristics of lethal bradycardia induced by myocardial ischemia in rat's serum.

METHODS

A rat myocardial ischemia-bradycardia-sudden cardiac death （MI-B-SCD） model was established, which was compared with the sham-operation group. The metabolic profile of postmortem serum was analyzed by gas chromatography-mass spectrometry （GC-MS）, coupled with the analysis of serum metabolic characteristics using metabolomics strategies.

RESULTS

The serum metabolic profiles were significantly different between the MI-B-SCD rats and the control rats. Compared to the control rats, the MI-B-SCD rats had significantly higher levels of lysine, ornithine, purine, serine, alanine, urea and lactic acid; and significantly lower levels of succinate, hexadecanoic acid, 2-ketoadipic acid, glyceraldehyde, hexendioic acid and octanedioic acid in the serum. There were some correlations among different metabolites.

CONCLUSIONS

There is obvious metabolic alterations in the serum of MI-B-SCD rat. Both lysine and purine have a high value in diagnosing MI-B-SCD. The results are expected to provide references for forensic and clinical applications of prevention and control of sudden cardiac death.

Experimental study of delivery of humidified-warm carbon dioxide during open abdominal surgery

Background

The aim of this study was to monitor the effect of humidified‐warm carbon dioxide (HWCO₂) delivered into the open abdomen of mice, simulating laparotomy.

Methods

Mice were anaesthetized, ventilated and subjected to an abdominal incision followed by wound retraction. In the experimental group, a diffuser device was used to deliver HWCO₂; the control group was exposed to passive air flow. In each group of mice, surgical damage was produced on one side of the peritoneal wall. Vital signs and core temperature were monitored throughout the 1‐h procedure. The peritoneum was closed and mice were allowed to recover for 24 h or 10 days. Tumour cells were delivered into half of the mice in each cohort. Tissue was then examined using scanning electron microscopy and immunohistochemistry.

Results

Passive air flow generated ultrastructural damage including mesothelial cell bulging/retraction and loss of microvilli, as assessed at 24 h. Evidence of surgical damage was still measurable on day 10. HWCO₂ maintained normothermia, whereas open surgery alone led to hypothermia. The degree of tissue damage was significantly reduced by HWCO₂ compared with that in controls. Peritoneal expression of hypoxia inducible factor 1α and vascular endothelial growth factor A was lowered by HWCO₂. These effects were also evident at the surgical damage sites, where protection from tissue trauma extended to 10 days. HWCO₂ did not reduce tumorigenesis in surgically damaged sites compared with passive air flow.

Conclusion

HWCO₂ diffusion into the abdomen in the context of open surgery afforded tissue protection and accelerated tissue repair in mice, while preserving normothermia.

The global regulator CodY responds to oxidative stress by the regulation of glutathione biosynthesis in Streptococcus thermophilus

CodY_st is a global transcriptional regulator that modulates the metabolic network in Streptococcus thermophilus ST2017. In this study, experimental data showed that the cell survival of the codY_st defective mutant obviously declined at the presence of 10 mM H₂O₂, suggesting CodY_st was involved in response to the oxidative stress. To investigate this phenomenon, transcriptome analysis and real time-quantitative PCR were performed and the results indicated that the transcriptional level of a bifunctional glutathione synthetase gene (gshF) was downregulated by about 3-fold in the codY_st defective mutant, along with a decrease by 20% of the glutathione yield compared with the wild-type in minimal chemical defined medium, whereas half of the viable cells remained after H₂O₂ challenge. In vitro gel shift assays showed that the purified CodY_st could bind to the promoter region of gshF, with a conserved CodY_st box, confirming the regulation of CodY_st on the gshF gene. To our knowledge, this is first report of CodY_st in response to oxidative stress mediated by the regulation of gshF in S. thermophilus.

Thermal Decomposition Mechanism for Ethanethiol

The thermal decomposition of ethanethiol was studied using a 1 mm × 2 cm pulsed silicon carbide microtubular reactor, CH₃CH₂SH + Δ → Products. Unlike previous studies these experiments were able to identify the initial ethanethiol decomposition products. Ethanethiol was entrained in either an Ar or a He carrier gas, passed through a heated (300-1700 K) SiC microtubular reactor (roughly ≤100 μs residence time) and exited into a vacuum chamber. Within one reactor diameter the gas cools to less than 50 K rotationally, and all reactions cease. The resultant molecular beam was probed by photoionization mass spectroscopy and IR spectroscopy. Ethanethiol was found to undergo unimolecular decomposition by three pathways: CH₃CH₂SH → (1) CH₃CH₂ + SH, (2) CH₃ + H₂C═S, and (3) H₂C═CH₂ + H₂S. The experimental findings are in good agreement with electronic structure calculations.

In the face of pain: The choice of visual cues in pain conditioning matters

BACKGROUND

Visual cue conditioning is a valuable experimental paradigm to investigate placebo and nocebo effects in pain. However, little attention has been paid to the cues themselves and potential variability of effects (their quantity and quality) stemming from the choice of stimuli. Yet, this seemingly methodological question has important implications for the interpretation of experimental findings in terms of their significance for clinical practice.

METHODS

We investigated the effect of heat pain conditioning using different types of visual cues (abstract images, faces and pseudo-words) in a group of 22 healthy volunteers. We analysed conditioning effects calculated as the difference in pain ratings to heat stimuli of identical temperature preceded by conditioned high or low pain cues with (1) subliminal and supraliminal presentation; and (2) immediately after conditioning and following extinction. Awareness manipulation and test following indirect, observational extinction allowed us to assess the strength and robustness of the conditioning effects induced with different cue types.

RESULTS

We observed no differences in conditioning effect magnitudes between images, faces and words when all stimuli were presented supraliminally. With subliminal presentation, only face stimuli elicited a significant effect; equally only face cue-induced effect withstood extinction.

CONCLUSIONS

Our findings indicate that face-related associations to pain might be stronger than those elicited with other visual cues, as face cues seem to induce stronger subliminal effects and withstand mild extinction.

SIGNIFICANCE

We compared different types of neutral cues commonly used in conditioning paradigms and found that faces elicited a stronger, more robust nonconscious effect than abstract images or pseudo-words.

[Efficacy and safety of Sorafenib as monotherapy to FLT3-ITD positive acute myeloid leukemia]

Objective: To explore the efficacy and safety of Sorafenib as monotherapy to FLT3 positive acute myeloid leukemia (AML). Methods: From April 2014 to December 2015, fourteen AML patients with FLT3 positive, 7 males and 7 females with a median age of 42 (range: 14-81) years old, were enrolled in this study. Of the 14 cases, 4 were de novo cases, 9 refractory cases and 1 relapsed case, including 78.6% patients with severe complications and 57.1% patients with KPS score less than 60 [the median KPS score was 45 (20-70) ]. The administration of Sorafenib was 400 mg twice daily and Sorafenib was continued if tolerated. The treatment response was evaluated by MICM and the data were analyzed by paired samples t test before and after Sorafenib treatment. Results: The peripheral blood WBC count [4.2 (0.9-11.8) ×109/L vs 39.6 (2.3-209.5) ×109/L, P<0.001 ], the percentage of peripheral blast cell [0.07 (0-0.54) vs 0.53 (0-0.94), P<0.001] and the percentage of bone marrow blast cell [0.266 (0.020-0.880) vs 0.604 (0.180-0.900), P=0.003] were significantly decreased after Sorafenib monotherapy compared with before. The overall response rate was 57.1% (8/14), including 5 cases (35.7%) with complete remission (CR). Of 4 de novo cases, 2 achieved CR, 1 with PR, 1 with NR; 3 of 10 refractory and relapsed patients achieved CR and 2 cases achieved PR, 5 cases NR. The median duration of achieving molecular remission (FLT3-ITD negative) after Sorafenib was 46(33-72) days, and the median progression free survival (PFS) was 53 (28-175) days. Conclusion: Sorafenib shows activity in FLT3-ITD mutation positive AML patients. Sorafenib monotherapy could be used as a treatment option for elderly patients or patients with severe complications, and refractory and relapsed patients with not suitable for intensive chemotherapy.

Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014

With the aim of gathering temporal trends on bacterial epidemiology and resistance from multiple laboratories in China, the CHINET surveillance system was organized in 2005. Antimicrobial susceptibility testing was carried out according to a unified protocol using the Kirby-Bauer method or automated systems. Results were analyzed according to Clinical and Laboratory Standards Institute (CLSI) 2014 definitions. Between 2005 and 2014, the number of bacterial isolates ranged between 22,774 and 84,572 annually. Rates of extended-spectrum β-lactamase production among Escherichia coli isolates were stable, between 51.7 and 55.8%. Resistance of E. coli and Klebsiella pneumoniae to amikacin, ciprofloxacin, piperacillin/tazobactam and cefoperazone/sulbactam decreased with time. Carbapenem resistance among K. pneumoniae isolates increased from 2.4 to 13.4%. Resistance of Pseudomonas aeruginosa strains against all of antimicrobial agents tested including imipenem and meropenem decreased with time. On the contrary, resistance of Acinetobacter baumannii strains to carbapenems increased from 31 to 66.7%. A marked decrease of methicillin resistance from 69% in 2005 to 44.6% in 2014 was observed for Staphylococcus aureus. Carbapenem resistance rates in K. pneumoniae and A. baumannii in China are high. Our results indicate the importance of bacterial surveillance studies.

[The expression of p27Kip1 and β-catenin in multiple endocrine neoplasia type 1-related parathyroid tumors]

Objective: To explore tissue expression of cyclin-dependent kinase inhibitor p27^Kip1 and β-catenin in multiple endocrine neoplasia type1 (MEN1)-related parathyroid tumors (MHPT). Methods: Immunohistochemistry was performed to analyze the expression of p27^Kip1 and β-catenin in parathyroid glands from 31 subjects with MHPT collected at Peking Union Medical College Hospital from 2002 to 2013. Five normal parathyroid glands were used as control. Results: In MHPT subjects, nuclear expression of p27^Kip1 was absent in 4 (12.9%), weak in 10 (32.3%) and moderated staining in 17 parathyroid specimens (54.8%), respectively. While, in normal subjects, the nuclear expression of p27^Kip1 was observed in all subjects and was stronger than that from MHPT subjects (P=0.001). As to the expression of β-catenin, normal parathyroid showed a distinct to moderate membrane staining, a moderate to weak cytoplasmic staining and negative nuclear staining. Similarly, MHPT exhibited a marked to moderate membrane (P=0.087), a moderated to weak cytoplasmic (P=0.357), and negative nuclear β-catenin staining. Conclusions: The expression of p27^Kip1 is reduced or absent in MHPT tissue, and no nuclear expression of β-catenin is observed in the tumors, which suggesting p27^Kip1, but not β-catenin nuclear accumulation, play a role in the development of the tumors.

[Relationship between sleep architecture and blood pressure dynamic change in patients with sleep apnea syndrome]

OBJECTIVE

To investigate sleep architecture and blood pressure dynamic change in patients with Sleep apnea syndrome by electrocardiogram-based cardiopulmonary coupling analysis system.

METHODS

Seventy-nine sleep disorder participants (PSQI≥8) were enrolled. Electrocardiogram-based cardiopulmonary coupling analysis device and ambulatory blood pressure monitoring were synchronously used to evaluate sleep architecture and blood pressure circadian rhythm. The patients were divided into SAS group (47 participants) and non-SAS group (32 participants) according to the Apnea Hypopnea Index (AHI) that calculated by CPC device. The data of sleep architecture and blood pressure variability were compared between two groups.

RESULTS

Compared with non-SAS group, SAS group have less proportion of deep sleep, more proportion of light sleep, higher mean blood pressure in 24 hours and daytime, lower nocturnal blood pressure dipping, faster mean heart rate in night time (P<0.05). AHI has moderate inverse correlation with deep sleep time, wake/dream time (-0.6≤r<-0.3), moderate positive correlation with light sleep time (0.3<r≤0.6), high inverse correlation with nocturnal blood pressure dipping (r=-0.785, P=0.000), moderate positive correlation with mean diastolic blood pressure (r=0.425, P=0.019).

CONCLUSION

Our study shows that less proportion of deep sleep, more proportion of light sleep, 24 hours mean blood pressure and nocturnal blood pressure increase in the patients with Sleep Apnea Syndrome. The severity of Sleep Apnea Syndrome has a positive correlation with the severity of abnormal sleep architecture and the degree of blood pressure elevation.

Enhanced default mode network connectivity with ventral striatum in subthreshold depression individuals

Subthreshold depression (StD) is a highly prevalent condition associated with increased service utilization and social morbidity. Nevertheless, due to limitations in current diagnostic systems that set the boundary for major depressive disorder (MDD), very few brain imaging studies on the neurobiology of StD have been carried out, and its underlying neurobiological mechanism remains unclear. In recent years, accumulating evidence suggests that the disruption of the default mode network (DMN), a network involved in self-referential processing, affective cognition, and emotion regulation, is involved in major depressive disorder. Using independent component analysis, we investigated resting-state default mode network (DMN) functional connectivity (FC) changes in two cohorts of StD patients with different age ranges (young and middle-aged, n = 57) as well as matched controls (n = 79). We found significant FC increase between the DMN and ventral striatum (key region in the reward network), in both cohorts of StD patients in comparison with controls. In addition, we also found the FC between the DMN and ventral striatum was positively and significantly associated with scores on the Center for Epidemiologic Studies Depression Scale (CES-D), a measurement of depressive symptomatology. We speculate that this enhanced FC between the DMN and the ventral striatum may reflect a self-compensation to ameliorate the lowered reward function.

Pharmacological characterization of the first in class clinical candidate PF-05190457: a selective ghrelin receptor competitive antagonist with inverse agonism that increases vagal afferent firing and glucose-dependent insulin secretion ex vivo

BACKGROUND AND PURPOSE

Ghrelin increases growth hormone secretion, gastric acid secretion, gastric motility and hunger but decreases glucose-dependent insulin secretion and insulin sensitivity in humans. Antagonizing the ghrelin receptor has potential as a therapeutic approach in the treatment of obesity and type 2 diabetes. Therefore, the aim was to pharmacologically characterize the novel small-molecule antagonist PF-05190457 and assess translational pharmacology ex vivo.

EXPERIMENTAL APPROACH

Radioligand binding in filter and scintillation proximity assay formats were used to evaluate affinity, and europium-labelled GTP to assess functional activity. Rat vagal afferent firing and calcium imaging in dispersed islets were used as native tissues underlying food intake and insulin secretion respectively.

KEY RESULTS

PF-05190457 was a potent and selective inverse agonist on constitutively active ghrelin receptors and acted as a competitive antagonist of ghrelin action, with a human Kd of 3 nM requiring 4 h to achieve equilibrium. Potency of PF-05190457 was similar across different species. PF-05190457 increased intracellular calcium within dispersed islets and increased vagal afferent firing in a concentration-dependent manner with similar potency but was threefold less potent as compared with the in vitro Ki in recombinant overexpressing cells. The effect of PF-05190457 on rodent islets was comparable with glibenclamide, but glucose-dependent and additive with the insulin secretagogue glucagon-like peptide-1.

CONCLUSIONS AND IMPLICATIONS

Together, these data provide the pharmacological in vitro and ex vivo characterization of the first ghrelin receptor inverse agonist, which has advanced into clinical trials to evaluate the therapeutic potential of blocking ghrelin receptors in obesity and type 2 diabetes.

A food-grade fimbrial adhesin FaeG expression system inLactococcus lactisandLactobacillus casei

Enterotoxigenic Escherichia coli (ETEC) infection is the major cause of diarrhea in neonatal piglets. The fimbriae as colonizing factor in the pathogenesis of ETEC constitute a primary target for vaccination against ETEC. Lactic acid bacteria (LAB) are attractive tools to deliver antigens at the mucosal level. With the safety of genetically modified LAB in mind, a food-grade secretion vector (pALRc or pALRb) was constructed with DNA entirely from LAB, including the replicon, promoter, signal peptide, and selection marker alanine racemase gene (alr). To evaluate the feasibility of the system, the nuclease gene (nuc) from Staphylococcus aureus was used as a reporter to be expressed in both Lactococcus lactis and Lactobacillus casei. Subsequently, the extracellular secretion of the fimbrial adhesin FaeG of ETEC was confirmed by Western blot analysis. These results showed that this food-grade expression system has potential as the delivery vehicle for the safe use of genetically modified LAB for the development of vaccines against ETEC infection.

Prevalence, characteristics and natural history of cold intolerance after the reverse digital artery flap

This retrospective study was designed to investigate the prevalence, characteristics and natural history of cold intolerance after the use of the reverse digital artery flap. A total of 123 patients were treated between 2010 and 2013. After excluding patients who were lost to follow-up, 87 patients were studied. The mean follow-up time was 34 months (range 14-61). Cold intolerance occurred in 60% (52) of patients after the reverse digital artery flap procedure. The condition improved in only 15% (8) of the patients. Significant differences were observed in the age and the specific digit involved between the groups with and without cold intolerance. There was a lower incidence in younger patients, and the ring finger group showed a lower incidence than in other fingers. Furthermore, the Cold Intolerance Symptom Severity score was positively correlated with the temperature at which cold intolerance was triggered.

LEVEL OF EVIDENCE

IV.

Comparative study of functional and aesthetically outcomes of reverse digital artery and reverse dorsal homodigital island flaps for fingertip repair

This retrospective study was designed to compare functional and cosmetic outcomes of the reverse digital artery island flap and reverse dorsal homodigital island flap in fingertip repair. A total of 23 patients were followed for 24 to 30 months. The reverse digital artery island flap was used in 12 patients, and reverse dorsal homodigital island flap in another 11 patients. Flap sensibility was assessed using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Patient satisfaction, active motion of the finger joints, complications and cold intolerance were evaluated. The static 2-point discrimination and Michigan Hand Outcomes Questionnaire (appearance) of the fingers treated with a reverse digital artery flap were significantly better than those with a reverse dorsal homodigital flap. The static 2-point discrimination of the skin-grafted donor sides after dorsal homodigital flap were poorer than that in the contralateral finger. No significant differences were found between the two flaps for pressure or touch sensibility, active ranges of digital motion, complications and cold intolerance.

LEVEL OF EVIDENCE

III.