[Analysis of gene mutations and clinic features in 108 patients with myeloproliferative neoplasm]

Objective: To analyze the genetic mutations and clinical features of the subtypes of classical BCR-ABL-negative myeloproliferative neoplasm (MPN) . Methods: Mutations of 108 newly diagnosed BCR-ABL-negative MPN patients [including 55 patients with essential thrombocytopenia (ET) , 24 with polycythemia vera (PV) , and 29 with primary myelofibrosis (PMF) ] were identified using next-generation sequencing with 127-gene panel, and the relationship between gene mutations and clinical features were analyzed. Results: Total 211 mutations in 32 genes were detected in 100 MPN patients (92.59% ) , per capita carried (1.96±1.32) mutations. 85.19% (92/108) patients carried the driver gene (JAK2, CALR, MPL) mutations, 69.56% (64/92) of these patients carried at least 1 additional gene mutation. In descending order of mutation frequency, the highest frequency was for activation signaling pathway genes (42.2% , 89/211) , methylation genes (17.6% , 36/211) , and chromatin-modified genes (16.1% , 34/211) . There was a significant difference in the number of mutations in the activation signaling pathway genes, epigenetic regulatory genes, spliceosomes, and RNA metabolism genes among the three MPN subgroups. The average number of additional mutations in PMF patients was higher than that in ET and PV patients (1.69±1.39, 0.67±0.70, 0.87±1.22, χ(2)=13.445, P=0.001) . MPN-SAF-TSS (MPN 10 score) (P=0.006) and myelofibrosis level (P=0.015) in patients with ≥ 3 mutant genes were higher and the HGB level (P=0.002) was lower than in those with<3 mutations. Twenty-six patients (24.1% ) carried high-risk mutation (HMR) , and patients with HMR had lower PLT (P=0.017) , HGB levels (P<0.001) , and higher myelofibrosis level (P=0.010) and MPN10 score (P<0.001) . The frequency of ASXL1 mutations was higher in PMF than in PV patients (34.5% vs. 4.2% , P=0.005) . PMF patients with ASXL1 had lower levels of PLT and HGB (P=0.029 and 0.019) . Conclusion: 69.56% of MPN patients carry at least one additional mutation, and 24.1% patients had HMR. Each subgroup had different mutation patterns. PMF patients had a higher average number of additional gene mutations, especially a higher frequency of ASXL1 mutation; PLT and HGB levels were lower in ASXL1 mutation PMF patients.

[A case of acute osteofascial compartment syndrome caused by rodenticide poisoning]

Acute osteofascial compartment syndrome is a series of symptoms and signs caused by acute ischemia of muscles and nerves in osteofascial compartment. If it is not treated in time, it can lead to tissue necrosis. It is rare that it is caused by rodenticide poisoning. Such patients are often difficult to diagnose and treat early and have poor prognosis. In May 2018, a patient with acute osteofascial compartment syndrome caused by anticoagulant rodenticide poisoning was admitted to the Twelfth Hospital of Guangzhou City. After systematic treatment, he finally recovered and discharged. The early manifestations of this patient were mainly coagulation dysfunction, and finally acute osteofascial compartment syndrome. 5 days later, the diagnosis was made, and the operation of incision decompression and vacuum sealing drainage (VSD) was performed.

[Application effects of self-made simple vacuum sealing drainage device in postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle]

Objective: To investigate the application effects of self-made simple vacuum sealing drainage (VSD) device in the postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle. Methods: From January 2017 to January 2019, 36 patients with foot and ankle skin defects and bone exposure admitted to People's Hospital of Xinjiang Uygur Autonomous Region met the inclusion criteria, and a retrospective cohort study was conducted. According to the bandaging method of the operative area, simple negative pressure group and antibacterial dressing group were both allocated with 18 patients, with 12 males and 6 females in the former group, 14 males and 4 females in the latter group, aged (41.6±2.8) and (42.3±2.6) years, respectively. Patients in the two groups all received sural neurocutaneous flap transplantation. Patients in antibacterial dressing group received nano silver antibacterial dressing change in the operative area, and the dressing was changed once every 3 days. In simple negative pressure group, the operative area was sealed with a simple VSD device made of gauze, silicone sputum suction tube with holes cut out, and biological permeable membrane, etc., which was connected with the wall central negative pressure suction system for continuous VSD treatment of -40.0 to -16.6 kPa. The negative pressure material was changed once every 5 days. The number of dressing change, the pain score evaluated by Numeric Rating Scale during each dressing change, the cost of dressing change, and the degree of flap swelling evaluated on the 3rd and 5th day after surgery were recorded, and the flap survival was observed. Data were statistically analyzed with independent sample t test, Wilcoxon rank sum test, and chi-square test. Results: The number of dressing change of patients in simple negative pressure group was (3.4±0.5) times, which was significantly less than (7.0±0.8) times in antibacterial dressing group (t=15.338, P<0.01). The pain score during dressing change of patients in simple negative pressure group was (4.3±0.8) points, which was significantly lower than (6.8±0.7) points in antibacterial dressing group (t=10.168, P<0.01). The cost of dressing change of patients was similar between the two groups. On the 3rd and 5th day after surgery, the degrees of flap swelling of patients in simple negative pressure group were significantly superior to those in antibacterial dressing group (Z=4.448, 2.395, P<0.05 or P<0.01). The flap survival of patients in simple negative pressure group was significantly superior to that in antibacterial dressing group (χ(2)=4.500, P<0.05). Conclusions: Compared with the traditional dressing bandage, the self-made simple VSD device used after sural neurocutaneous flap transplantation can reduce the frequency of dressing change, relieve the pain of dressing change and the swelling of flap, and promote the flap survival, which is worth popularizing and applying in clinic.

Progress on Copy Number Variation and Its Application in Forensic Medicine

Abstract

Recently, researches on copy number variation （CNV） have extended to every field, such as etiological exploration and precise treatment of complex diseases, as well as genetic breeding and evolution. The unique genetic characteristics of CNV have made people gradually believe that it could be used as a biological genetic marker to solve related problems. With the development of detection technology, application of CNV in forensic medicine will increase gradually. In this paper, the concept and development of CNV, as well as its application in forensic medicine are summarized, to provide new ideas for the practical application of CNV in the future.

[A pair of baby twins with severe burns simultaneously]

December 22, 2018, a pair of female baby twins aged 2 years with severe burns at the same time were transferred from the primary hospital to the People's Hospital of Xinjiang Uygur Autonomous Region on day 17 post burn. Physical examination on admission showed that both of them had severe burns on head, face, left upper limb, foot, etc. The blood preparations were difficult for them due to their rare blood types, with the elder sister of type B blood combined with Rh D mutant and the younger sister of type B combined with Rh negative blood. The total area of burn of the younger sister was 15% total body surface area (TBSA), with full-thickness burns with tendon and bone exposure in left ear and most of the ear auricle fallen off. The younger sister was treated with anti-infection, anti-shock by fluid infusion, and nutritional support. Split-thickness skin graft on left thigh was harvested to repair wound on left upper limb, and thin medium-thickness skin graft was harvested from right thigh in different operations to repair wounds on head and face, and thin medium-thickness skin graft from right thigh with area of 3 cm×1 cm was reserved. The total area of burn of the elder sister was 22% TBSA, combined with inhalation injury and severe lung infection after tracheotomy, and the condition was critical. After admission to the hospital, anti-infection, anti-shock by fluid infusion, nutritional support, atomization, and eliminating phlegm treatment were performed. After the general condition was basically stable and blood preparation was sufficient, thin medium-thickness skin grafts were harvested from left thigh to repair wounds on head, face, and left upper limb, and the reserved thin medium-thickness skin graft from right thigh of the younger sister was transferred to the posterior ear wound of the elder sister. The skin grafts survived after operation with expansion showing no difference from autogenous skin. The elder sister and the younger sister were discharged from the hospital on the 24 and 21 day of hospitalization respectively. During follow-up of 6 months, the effect of the operation was good.

[Relationship of body mass index, waist circumference and waist-to-hip ratio with diabetes mellitus in community residents aged 15 years old and above in Pudong new district, Shanghai]

Objective: To analyze the relationship of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) with diabetes mellitus in community residents aged ≥15 years in Pudong new district of Shanghai, and provide evidence for the prevention and treatment of diabetes mellitus. Methods: Using multi-stage stratified cluster sampling method, a total of 7 194 community residents aged ≥15 years were surveyed by using questionnaire, physical examination and laboratory tests in 2016. The relationship of BMI, waist circumference and waist-hip ratio with diabetes mellitus was analyzed by χ(2) test, single factor linear correlation and logistic regression analyses. Results: In 2016, the crude prevalence rate of diabetes mellitus in Pudong was 27.37%, which was 12.75% after standardization. The prevalence rate of diabetes mellitus was slightly higher in men than in women and was increased with age. The levels of FPG, 2 h plasma glucose and HbA1c were positively correlated with BMI, WC and WHR. After adjusting the confounding factors, multiple logistic regression analysis showed that obesity (OR=1.351, P<0.01), excessive waist circumference (OR=1.255, P<0.01) and high WHR (OR=1.291, P<0.01) were risk factors for diabetes mellitus. Conclusions: The increase of obesity, WC and WHR will increase the risk for diabetes mellitus. It is important to maintain healthy weight, especially the control of WC and WHR, reduce the accumulation of abdominal fat to reduce the risk for diabetes mellitus.

miR-17-5p knockdown inhibits proliferation, autophagy and promotes apoptosis in thyroid cancer via targeting PTEN

Thyroid cancer is one common endocrine malignancy with various pathological types. MicroRNAs (miRNAs) play essential roles in development, prognosis and treatment of thyroid cancer. However, the role of miR-17-5p in thyroid cancer progression and its mechanism remain poorly understood. The expressions of miR-17-5p and phosphatase and tensin homolog (PTEN) were measured in thyroid cancer tissues and cells by quantitative real-time polymerase chain reaction or western blot. Cell proliferation and apoptosis were detected by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide assay and flow cytometry, respectively. The protein levels of biomarkers in autophagy or protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) pathway were analyzed by western blot. The interaction between miR-17-5p and PTEN was probed by luciferase activity assay. We found that miR-17-5p expression was elevated and PTEN level was reduced in thyroid cancer tissues and cells compared with their corresponding controls. Knockdown of miR-17-5p or overexpression of PTEN suppressed cell proliferation and autophagy but promoted apoptosis in thyroid cancer cells. PTEN was indicated as a target of miR-17-5p and its interference reversed abrogation of miR-17-5p-mediated inhibition of proliferation and autophagy and increase of apoptosis. Moreover, downregulation of miR-17-5p impeded the activation of AKT/mTOR pathway in thyroid cancer cells, which was attenuated by silencing PTEN. Our data supported that knockdown of miR-17-5p upregulated PTEN expression, therefore leading to suppression of the malignancy of thyroid cancer and inactivation of AKT/mTOR pathway, providing a novel avenue for treatment of thyroid cancer.

[Adverse effects of double-hit combining ISS-Ⅲ stage and 1q gain or del (17p) on prognosis of patients with newly diagnosed multiple myeloma]

Objective: To evaluate the prognostic significance of combining ISS-Ⅲ and high risk cytogenetic abnormalities [HRCAs, including 1q gain/amplification and del (17p) ] in patients with newly-diagnosed multiple myeloma (NDMM) . Methods: The clinical characteristics and relevant variables were retrospectively analyzed in a total of 270 NDMM patients diagnosed between November 2009 and May 2018. ISS-Ⅲ stage and HRCAs [detected by FISH, including 1q gain/amplification and del (17p) ] were defined as risk factors (hit) . Based to the number of hit per case, these patients were divided into four groups carrying 0 to 3 risk factors, respectively. Progress-free survival (PFS) and overall survival (OS) were then analyzed using the Kaplan-Meier estimator. Results: Patients who carried single hit (n=120, 44.4%) had shorter median PFS (23.0 vs 28.9 months; P>0.05) and OS (42.3 vs 53.7 months; P>0.05) than those with no risk factors (n=66, 24.4%) . Of note, the outcome of patients who had two or more risk factors (double/triple, n=84, 31.1%) was much worse than those with either no or one risk factor, indicated by significantly reduced median PFS (14.5 months; HR=1.584, 95%CI 1.082-2.319; P=0.003 for double/triple vs single hit) and OS (18.4 months, HR=2.299, 95%CI 1.485-3.560; P<0.001 for double/triple vs single hit) . Strikingly, patients who had three risk factor (triple hit, n=5, 1.9%) displayed the poorest survival with extraordinarily shorter PFS (0.9-15.1 months) and OS (0.9-18.9 months) compared to those carrying two risk factors (double hit) . Analogous results were obtained when different combinations of ISS stages and HRCAs were analyzed. Conclusion: These results suggest a potential but rather important role of combining multiple (e.g. double or triple) adverse factors determined via the routine ISS staging and FISH detection of cytogenetic abnormalities in risk stratification and prognostic prediction, which might be helpful to identify high risk patients more precisely at diagnosis. It also raised a possibility that a small group of ISS-Ⅲ patients carrying both 1q gain/amplification and del (17p) might represent an "extremely-high risk" subset of MM.

[Evaluation on the effect of exclusive breastfeeding among women with primipara, using the Information-motivation-behavioral skills model intervention model]

Objective: To explore the effects of intervention programs during primipara, using the Information-motivation-behavioral skills model (IMB) intervention model on initial exclusive breastfeeding. Method: 206 women of primiparas who were registered to the top three hospitals were selected in Shandong province, 2018. These women were hospitalized in the obstetrics/gynaecology wards during the later periods. IMB model was used to support the intervention programs at the following stages: antenatal period, 1 day postpartum, 3-4 days postpartum and 42 days postpartum. Questionnaire regarding self-efficacy energy meter, knowledge and behavior related to breastfeeding, were used before and after the intervention programs. Results: Through intervention programs, statistically significant differences in breastfeeding self-efficacy scores between the four stages (F=150.680, P=0.000) were recorded. Significant differences were also noticed in scores on knowledge of breastfeeding (F=176.556, P=0.000). Conclusion: The application of IMB intervention model in women at childbearing age seemed to be helpful in improving the effect of primary breastfeeding in women at childbearing age.

P4740Clinical predictors of graft occlusion after coronary artery bypass grafting: a case-control study

Objective

Coronary artery bypass grafting (CABG) is still one of the most common surgical procedures aimed at improving blood circulation in atherosclerotic coronary arteries.Graft occlusion influences outcome CABG. The risk factors of long-term graft occlusion remain uncertain.The aim of the present study was to investigate the clinical predictors of graft occlusion after CABG.

Methods

All patients with prior CABG in our center who underwent coronary computed tomography angiography (CTA) and/or percutaneous coronary angiography for follow-up between Aug 2013 and Dec 2017 were included in the present study. We excluded patients who underwent multiple CABG surgeries or percutaneous coronary intervention after index CABG. With regard to one patient with two or more different angiography results, we selected the angiography result which showed graft occlusion for the first time or the last angiography result. The baseline clinical data at index CABG was analyzed for their independent impact on graft occlusion in a case-control study using multivariate logistic regression.

Results

1178 (27.5%) of 4289 patients experienced at least one graft occlusion. The mean age was 63.23±9.02 years, 1004 (23.4%) patients were female. From all the occlusion cases, artery occlusion occurred in 337 (28.6%) patients and saphenous vein graft occlusion occurred in 875 (74.3%) patients.Complete baseline data was available for evaluation from 1178 of them (case group). We matched these patients through gender, age and time interval between the index CABG and angiography/CTA to another 1178 patients who did not have graft occlusion (control group). After multivariate logistic regression, chronic renal dysfunction (OR=1.008; 95% CI, 1.001–1.021; P=0.038) hyperuricemia (OR=1.89; 95% CI, 1.101–3.876; P=0.040) and hyperlipemia (with low density lipoprotein increased) (OR=1.377; 95% CI, 1.021–1.926; P=0.042) significantly increased the risk of long-term graft occlusion.

Conclusions

Chronic renal dysfunction hyperurcemia and hyperlipemia were independent risk factors of long-term graft occlusion.

Acknowledgement/Funding

National Key Research and Development Program of China (2017YFC0908800)

[Prognostic analysis of 182 newly diagnosed multiple myeloma patients with high risk cytogenetic abnormalities]

Objectives: To evaluate the clinical characteristics and prognosis of high risk cytogenetic abnormalities (HRCA) and various combinations of cytogenetic abnormality in patients with newly-diagnosed multiple myeloma (NDMM) . Methods: This retrospective study collected 182 NDMM patients in the First Affiliated Hospital of Jilin University between Nov. 2009 and May 2018. HRCA included 1q+, del (17p) , t (4;14) , and t (14;16) detected by FISH, and non-HRCA included del (13q) , t (11;14) detected by FISH. The clinical characteristics among three groups, including cases who carrying a single HRCA, 1 HRCA in combination with non-HRCA and cases carrying two or more HRCAs (double/triple-hit) were observed. Kaplan-Meier curve was used to analyze both progression-free survival (PFS) and overall survival (OS) for the three groups. Results: The survivals of patients with 1 HRCA in combination with non-HRCA were similar to those with two or more HRCAs (double/triple-hit) , the median PFS (mPFS) was 19.1 m vs 12.1 m (P=0.248) and median OS (mOS) was 29.6 m vs 29.3 m (P=0.774) . Furthermore, the prognosis of these two groups were both inferior to patients with a single HRCA, respectively. (mPFS: 32.2 m, P=0.040, P=0.001; mOS: 42.3 m, P=0.021, P=0.041) . Strikingly, both the mPFS and the mOS of patients with 1 HRCA in combination with non-HRCA (regardless of high risk or not) were significantly shorter than that of cases with a single HRCA (mPFS: 15.1 m vs 32.2 m, HR=2.126, 95%CI 1.176-3.843, P=0.005; mOS: 29.3 m vs 42.3 m, HR=1.442, 95%CI 0.705-2.950, P=0.011) . Conclusion: It is of prognostic significance value for detecting double/triple-hit based on FISH cytogenetics in NDMM.

[Effects of down-regulation of IGF2 gene on the biological characteristics of HCT116 colon cancer stem cells]

Objective: To investigate the effect of down-regulation of insulin-like growth factor 2 (IGF2) gene on the biological characteristics of HCT116 colon cancer stem cells (CSCs). Methods: Flow cytometry sorting technology was used to isolate CSCs from colon cancer cell line HCT116 by a monoclonal antibody against CD133; serum free floating culture assay was used for the enrichment of CSCs. The proportion of CD133(+) cells was analyzed by flow cytometry; CSCs were identified by sphere culturing, immunofluorescence analysis and soft agar clone formation. RT-qPCR method was used to examine transcriptional level of IGF2 gene in CSCs. Western blotting was used to examine IGF2 protein expression in CSCs. siRNA was used to establish IGF2 transient knock down model in CSCs. Cell proliferation array, cell cycle and apoptosis analysis, cell invasion array and colony forming assay were used to further examine the role of IGF2 on the biological characteristics of colon CSCs. Results: CSCs were successfully isolated from HCT116 cell lines, which were cultured to form cell spheres in serum-free stem cell culture medium. We found that the morphology of sphere-forming-like cells after several passages maintained the same characteristics as that of the first passage. The results of immunofluorescence showed that CSC markers including CD133 and ALDH continued positively expressing on the cell surface of CSCs, and flow cytometry analysis showed that more than 90% of the spheroid cells remained CD133 positive. The clone formation rate of non-CSCs group and CSCs group were (28.10±2.66)% and (43.73±2.30)% respectively, with significant difference (P<0.01). The RT-qPCR results showed that the transcriptional level IGF2 gene in non-CSCs group and CSCs group were (1.06±0.24) and (2.17±0.51) respectively, with significant difference (P<0.05). The western blot results showed that the protein expression of IGF2 in CSCs group and non-CSCs group were (1.10±0.55) and (2.14±0.23) respectively, with significant difference (P<0.05). Knockdown of IGF2 significantly decreased the percentage of CD133(+) cells in CSCs and cell proliferation (P<0.01). Knockdown of IGF2 increased the percentage of G(2)/M phase (23.46% of siNC group vs 60.14% of siIGF2 group) and cell apoptosis (2.80% of siNC group vs 40.70% of siIGF2 group), while decreased the percentage of G(0)/G(1) phase (40.77% of siNC group vs 17.73% of siIGF2 group). The invasion results showed that the number of cells penetrating into the basement surface in siNC group and siIGF2 group was (109.00±16.37) and (54.00±8.19) respectively, with significant difference (P<0.01). The rate of sphere-forming of colon CSCs in siNC group and siIGF2 group were (51.70±7.42)% and (21.27±2.35)% respectively, with significant difference (P<0.01). The clone formation rate of siNC group and siIGF2 group were (37.20±3.87)% and (18.23±2.25)% respectively, with significant difference (P<0.01). Conclusion: IGF2 gene plays an important role in maintaining the biological characteristics of colon cancer stem cells and promoting self-renewal and stemness of colon CSCs.

[Superficial siderosis of the central nervous system caused by myxopapillary ependymoma of conus medullaris and cauda equine: a case report and literature review]

Superficial siderosis of the central nervous system (SSCNS) is a rare disorder caused by hemosiderin deposits in the subpial layers of the brain and spinal cord due to prolonged or recurrent low-grade bleeding into the cerebrospinal fluid (CSF). Central nervous system tumor could be one of the sources of bleeding. Some problems exist at present regarding the diagnosis and treatment of SSCNS in China. On account of fewer cases, the insufficient awareness of the condition, and the lack of long-term follow-up data, enough attention has not been paid to etiological diagnosis. The speculative high rate of missed diagnoses of SSCNS indicates a great disparity in the treatment from the world's advanced level. Related data of clinical and basic research need to accumulate as soon as possible to promote the clinical diagnosis and treatment of the disease. The progressive neurological deficits are involved in the typical clinical manifestations of SSCNS with a triad of bilateral symmetrical sensorineural hearing loss, cerebellar ataxia and signs of corticospinal tract dysfunction. Nevertheless, there are few patients with the triad signs at the same time, which lead to a delayed diagnosis or misdiagnosis. Detection of this disease was commonly post-mortem until the advent of MRI with signal and location characteristics, which made diagnosis easier. Siderosis appears as a hypointense rim covering the surface of the cerebellum, the brain stem, the spinal cord, similar to a black pencil line, thin on SE-T2-weighted images, thick and conspicuous on GE-T2-weighted images or on susceptibility-weighted imaging (SWI). The only effective way of treating the disorder is to identify the source of bleeding and remove it. MR examination is useful for seeking a source of bleeding too. Therefore, once superficial siderosis is considered, lesions of the central nervous system must be searched using MRI of the brain and spine. We report here a 37-year-old male diagnosed of SSCNS with the classical clinical symptoms of cerebellar ataxia, sensorineural hearing loss and myelopathy. T2-weighed MRI showed characteristic marginal hypo-intensity around the central nervous system. Etiological explorations revealed a large conus medullaris / cauda equina ependymoma filling the lumbosacral spinal canal, a myxopapillary ependymoma (MPE) confirmed by surgical resection and histopathological examination. The related literature was reviewed to ascertain the mechanism of SSCNS secondary to MPE, and to discuss the pathogenesis, clinical features, diagnosis and treatment of SSCNS. This paper aims to improve the awareness of SSCNS and diagnostic level, and to lay stress on the etiological explorations that is beneficial to the development of exact treatment plan.

[Preliminary clinical outcomes of patients with acute myocardial infarction complicated with cardiogenic shock treated with PIE-2R model]

Objective: To investigate the clinical experience of application of PIE-2R model to treat patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS). Methods: A total of 129 patients with AMI complicated with CS treated with PIE-2R model, featuring in respiratory management, pacemaker, mechanical circulatory support (MCS) and timely myocardial revascularization, admitted in Beijing Anzhen Hospital, Capital Medical University between January 2013 and December 2018, were consecutively enrolled. Patient's baseline characteristics, implementation of each component of PIE-2R model, and in-hospital mortality were analyzed. Results: Participants' average age was 60 years, and male patients accounted for 78%. In all enrolled patients, 61% were implanted with temporary pacemaker due to severe bradyarrhythmia, 73% were treated with mechanical ventilation because of acute respiratory failure or pulmonary edema, and all patients were treated with percutaneous coronary intervention (PCI) supported by MCS (85% of cases with intra-aortic balloon pump and 15% of cases with veno-arterial extracorporeal membrane oxygenation or Impella), with an average first medical contact to MCS time of 87 minutes, and 79% were treated with second-generation drug-eluting stent. Eventually, after emergency treatment using PIE-2R model, 69 patients survived and in-hospital mortality was 46.5%. Conclusion: The application of PIE-2R model in patients with acute myocardial infarction complicated with cardiogenic shock is feasible, with a lower in-hospital mortality.

Effects of different starch sources on glucose and fat metabolism in broiler chickens

1. The aim of the present study was to investigate the effects of different starch sources (corn, wheat, and rice) on the blood glucose level, glycogen content of liver and muscle, expression of GSK-3β and FAS mRNA, abdominal fat weight and abdominal fat deposition in broiler chickens. 2. A total of 360, one-day-old AA (Arbor Acres) broiler chickens were randomly assigned to three treatment groups, each with six replicates, consisting of 20 chickens per replicate, and fed either a corn-, wheat- or rice-based diet for 21 days. The chickens were then subdivided into groups A and B, and the chickens in these two subgroups were processed or sampled for 28 days, respectively. 3. The results indicated that post-prandial time significantly affected the glucose concentration, glycogen content in the liver and breast muscle and expression of GSK-3β and FAS mRNAs (P < 0.05). The expression of the GSK-3β gene in the chicken liver of the corn-based diet group was higher (P < 0.05) than that in the wheat-based diet group, and the expression of the FAS gene in the corn-based diet group was lower (P < 0.05) than that in the wheat-based and rice-based diet groups. Abdominal fat weight and deposition in the corn-based diet group were lower than those of the wheat-based and rice-based diet groups, but these differences were not significant (P > 0.05). 4. The results suggested that the efficiency of glucose absorption in animals might have an effect on the fat deposition efficiency in the liver and that diets with different starch sources might affect fat deposition in chickens.

Evaluating the Efficiency of REPLI-g® Single Cell Kit for Trace DNA Amplification

Abstract

Objective To evaluate the efficiency of REPLI-g® Single Cell Kit for sample DNA amplification, and explore its application value in forensic trace DNA amplification. Methods Three DNA extraction kits were selected to extract DNA from peripheral blood of 10 unrelated individuals. The DNA yield and purity of the three DNA extraction kits were compared. According to the results of comparison, one DNA sample was selected to concentrate and dilute, then used as the initial sample of whole genome amplification （WGA）. REPLI-g® Single Cell Kit was used to amplify the initial sample at the whole genome level. The amplification yield and amplification times were calculated, and the distribution of DNA fragments was detected by agarose gel electrophoresis. Goldeneye® DNA ID System 20A Kit was used to perform the STR typing of the initial sample and DNA samples amplified at the whole genome level to evaluate the performance of REPLI-g® Single Cell Kit in trace DNA amplication in terms of purity and yield as well as the success rate of STR typing. Results After comparison, one DNA sample was selected from QIAsymphony® DNA Investigator® Kit extracts to concentrate and dilute as the initial sample of WGA. After amplifying the whole genome of a series of initial samples by REPLI-g® Single Cell Kit, the lowest average of amplification yield reached 8.77×103 ng, while the average of the corresponding amplification times reached 1.40×106. DNA fragments were large and concentrated. The STR typing success rate of WGA samples became lower with the decrease of initial samples used, but when the amount of samples was lower than 0.5 ng, the STR typing success rate of samples after DNA WGA was higher than that of samples without DNA WGA. Conclusion REPLI-g® Single Cell Kit can increase the yield of template DNA. Especially for trace DNA, the STR typing success rate can be improved to a certain extent.

[Value of intravoxel incoherent motion diffusion weighted imaging in evaluating the microstructure changes in white matter hyperintensities]

Objective: To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM DWI) in evaluating microstructure changes in elderly white matter hyperintensities (WMH) patients and to analyze the correlation between IVIM parameters and severity grading and cognitive scores. Methods: Sixty-two WMH patients in Zhejiang Hospital were collected from December 2014 to March 2018 and underwent conventional magnetic resonance (MR) plain scan and diffusion weighted imaging with different b values. The age was 60-92(74±10) years with 37 males, 25 females. The severity of WMH was assessed by T(2) fluid attenuated inversion recovery (FLAIR) sequence and Fazekas score,which were divided into two subgroups. Slow diffusion coefficient (D), fast diffusion coefficient (D(*)) and perfusion fraction (f) from IVIM parameters of double exponential model were compared between regions of WMH (deep WMH (DWMH) and periventricular WMH (PWMH)) and surrounding normal white matter (NWM).The Shapiro-Wilk test was used for normality tests, Kruskal-Wallis tests and Dwass-Steel-Critchlow-Fligner (DSCF) procedure were used for the comparison among these parameters. Furthermore, Wilcoxon two-sample test was used for the comparisons between different severity. Pearson correlation analysis was performed to determine whether these D, D(*), f values were correlated with the mini mental state examination (MMSE) scores. Results: D(D)WMH (0.83(0.72,0.99)×10(-3) mm(2)/s), D(PWMH)((1.13±0.25)×10(-3) mm(2)/s) were significantly higher than D(NWM) ((0.71±0.05)×10(-3) mm(2)/s)(P<0.01). f (DWMH) ((8.94%(7.46%,11.67%)), f (PWMH)(8.34%(6.73%,9.96%)) were significantly higher than f (NWM)(6.71%±1.72%)(P<0.01).D in DWMH were significantly lower than that in PWMH(P<0.01), there's no statistically difference between other groups. D in severe WMH (both DWMH and PWMH) were significantly higher than that in mild WMH (P=0.000 1, P=0.04). Only f in PWMH were positively associated with the MMSE scores (r=0.326 5,P<0.05). Conclusions: IVIM DWI can noninvasively assess the variation of microstructure diffusion and perfusion in WMH in one sequence,which may objectively reflect the severity of these lesions. This method has important clinical significance for better assessment and management of this disease.

[Diagnosis and treatment of pancreatic tuberculosis: experiences of 10 cases]

Objectives: To study the clinical characteristics of pancreatic tuberculosis, and therefore to improve the diagnosis and treatment of this disease. Methods: The clinical data of 10 patients with pancreatic tuberculosis form 1990 to 2017 were reviewed, including clinical characteristics, laboratory tests and imaging features. Results: The ten patients aged 28 to 71 (median 56) years. All of them presented varying degrees of abdominal pain and weight loss (3 to 8 kg). Hypo-echoic pancreatic masses were shown by abdominal ultra-sound in 7 cases, and cystic-solid masses with thick wall was shown by abdominal CT scan in 4 cases, but dilatation of the pancreatic duct was found in none of the 10 cases. Hemoglobin levels lower than 12 g/L were found in 6 cases, and ESR more than 20 mm/1 h was present in 7 cases. Four cases received PPD test, but only one was positive. CA19-9 was found to be higher than normal (27 IU/ml) in 3 cases (39.2 IU/ml, 125.7 IU/ml, 88.9 IU/ml respectively). Three cases received T-spot.TB tests, and all the results were positive. Seven cases received laparotomy, and the other 3 received endoscopic ultrasound-guided biopsy. Caseous necrosis and Langerhans cells were found in all the 10 cases. Nine patients were treated by 6 to 12 months' anti-tuberculosis therapies, and at 1-5 years' follow-up, 8 were cured and 1 improved. Conclusions: The manifestations of pancreatic tuberculosis were easy to be confused with other diseases, and therefore a comprehensive understanding of history and careful examinations were important for a correct diagnosis. Once the diagnosis was made, prompt standard anti-tuberculosis therapy could lead to a favorable outcome.

Sex Recognition of Skulls in Chinese Uygur

Abstract

Objective Logistic regression method was used to establish a multiple regression sex discriminant function to discriminate the complete skull model and the incomplete skull model without frontal bone, occipital bone and mandible of Uygur adults in Turpan, Xinjiang. Methods A total of 117 （60 male and 57 female） three-dimensional skull models were collected by CT. Sixteen cranial measurement indexes were measured and calculated by computer software. The multivariate regression sex discriminant function was established with Logistic regression method and retrospectively tested. Results Among the 16 measurement indexes, except for nose width （x₇） and maximum frontal breadth （x₁₃）, the remaining 14 indexes had statistical significance of differences between male and female （P<0.05）. For the discriminant function of complete skull established by eyebrow arch convexity （x₄）, mastoid width （x₆）, maximum cranial length （x₁₂）, cranial base length （x₁₅）, cranial circumference （x₁₆）, the male and female discrimination accuracy was 90.0% and 94.7%, respectively. For the sex discriminant function of incomplete skull without frontal bone established by mandibular angle width （x₁₀）, mandibular height （x₁₁） and cranial circumference （x₁₆）, the discrimination accuracy of male and female was 85.0% and 84.2%, respectively. For the sex discriminant function of incomplete skull without occipital bone established by the index of eyebrow arch convexity （x₄）, the discrimination accuracy of male and female was 80.0% and 73.7%, respectively. For the sex discriminant function of incomplete skull without mandible established by frontal chord （x₅） and occipital protrusion angle （x₉）, the discrimination accuracy of male and female was 85.0% and 78.9%, respectively. Conclusion The computer software and system developed in our study can achieve sex discrimination of complete skulls and incomplete skulls without frontal bone, occipital bone or mandible.

[Establishment and evaluation of a triple-color human papillomavirus pseudovirion neutralization assay]

Objective: To establish a triple-color pseudovirion-based neutralization assay (PBNA) and evaluate its capability of detecting immunogenicity of the sera generated by the immunization of HPV 9-valent vaccine. Methods: HPV pseudovirus (PsVs) 6/11/16/18/31/33/45/52/58 with the encapsidated fluorescence expressing red fluorescent plasmid N31-MCHREEY, green fluorescent N31-EGFP or blue fluorescent N31-mTagBFP were generated. The concentration of HPV PsVs and the infection titers of HPV PsVs were detected by double-antibody sandwich ELISA and TCID(50), respectively. The single- and triple color HPV 16/33/45 PsVs were used to detect the neutralization titers of mice sera immunized with HPV 9-valent vaccine and confirmed the accuracy and specificity of the triple-color PBNAs. Then, the single- and triple color HPV 6/11/18/31/33/45/52/58 PsVs were employed to detect the neutralization titers of cynomolgus macaques sera immunized with HPV 9-valent vaccine and determined whether the triple-color PBNAs could be applied to evaluate the immunogenicity of the sera generated by the immunization of HPV9-valent vaccine. Results: The concentration of HPV16 PsVs encapsulating green, red or blue fluorescent plasmid was 5.0 to 6.0 μg/ml and HPV6/11/18/31/33/45/52/59 triple-color HPV PsVs was about 1.0 to 3.0 μg/ml. 9 types HPV PsVs containing EGFP, Mcherry or mTagBFP reporter plasmid were obtained and the concentration can meet the need of neutralization detection. 9 types single-color fluorescent HPV PsVs had similar infectivity against 293FT cells with the infection titer values between 1×10(4) and 1×10(5). The results of PBNAs showed that there was no significant difference in the anti-HPV neutralization titers of mice sera induced by HPV 9-valent vaccine between single-color and triple-color HPV16/33/45 PsVs (P>0.05). Similarly, there was also no significant difference in the anti-HPV neutralization titers of cynomolgus macaques sera induced by HPV 9-valent vaccine between single-color and triple-color HPV6/11/18/31/33/45/52/58 PsVs (P>0.05). Conclusion: We successfully established the triple-color PBNAs and verified the accuracy and specificity of triple-color PBNAs consistent with single-color PBNAs. The triple-color PBNAs can be applied to evaluate the immunogenicity of HPV 9-valent vaccine's immune serum.

[Role of enolase 1 in hepatocellular carcinoma and possible mechanism]

Objective: To investigate the role of enolase 1 (ENO1) in hepatocellular carcinoma (HCC) and possible mechanism. Methods: Real-time PCR and Western blot were used to measure the expression of ENO1 in HCC tissue, adjacent tissue, hepatoma cells, and normal hepatocytes. The siRNA interference technique was used for ENO1 knockout in HepG2 cells, and then CCK-8, colony formation assay, and transwell assay were used to measure the proliferation, migration, and invasion abilities of HepG2 cells. Real-time PCR and Western blot were used to measure the expression of proteins and genes involved in the activation of the Notch signaling pathway. The two-independent-samples t test and a one-way analysis of variance were used for comparison. Results: HCC tissue and HepG2 cells had significantly higher expression of ENO1 than adjacent tissue and normal hepatocytes (P < 0.05). There were significant reductions in the proliferation, migration, and invasion abilities of HepG2 cells after siRNA interference (P < 0.05). There were also significant reductions in the expression of N1ICD, snail, slug, HEY1, HES1, and HES5 (P < 0.05). Conclusion: ENO1 may promote the development of HCC, possibly by participating in the regulation of the Notch signaling pathway.

Research Progress on Discrimination of Monozygotic Twins

Individual identification plays an import role in the practice of forensic medicine, and often provides crucial evidence for the analysis and detection of criminal cases. However, for individual identification in complex situations, such as monozygotic （MZ） twins assumed to be genetically identical, it is impossible to distinguish one from the other by using traditional forensic DNA typing system. Therefore, how to discriminate the MZ twins has become and will continue to be one of the difficult problems in forensic field. This paper summarized the genetic and epigenetic changes recently identified in MZ pairs, which might provide a new insight to forensic discrimination of MZ twins.

[Caloric test and hearing characteristics in patients with vestibular migraine and Meniere's disease]

Objective:This study was designed to distinguish vestibular migraine(VM) from Meniere's disease(MD) by comparing age, sex, family history, audiological and vestibular test results in patients with VM or MD. Method:Forty-six patients with suspected VM, 60 patients with confirmed VM, and 60 patients with confirmed MD were studied. All patients were asked for detailed medical history, and then underwent bithermal caloric test and audiological test. The hearing function and vestibular function were analyzed. Result:①General conditions: the sex ratio with suspected VM, confirmed VM and confirmed MD was 1∶4.75, 1∶5.67 and 1∶1. Family history in these three groups was 80.43%（37/46）,66.67%（40/60）,6.67%（4/60）, respectively. ②In the three groups, the abnormal rates of caloric test were 50.00% (23/46), 31.67% (19/60) and 78.33%(47/60), respectively.③The rate of pure tone audiometry abnormality in the three groups was 60.87% (28/46), 63.33% (38/60) and 100.00% (60/60), respectively. Of 46 suspected VM patients, 18 (39.13%) had high frequency hearing loss, 7 (15.22%) had full frequency hearing loss, and 3 (6.52%) had low frequency hearing loss. Among 60 confirmed VM patients, 18 (30.00%) had high frequency hearing loss, 15 (25.00%) had full frequency hearing loss, 4 (6.67%) had low frequency hearing loss, and 1 case (1.67%) with low frequency and high frequency hearing loss. Among 60 confirmed MD patients, 56 (93.33%) had full frequency hearing loss, and 4 (6.67%) had low frequency hearing loss. ④The difference of audiological test between patients with confirmed VM and patients with suspected VM was not statistically significant（P>0.05）. The difference of bithermal caloric test between patients with confirmed VM and patients with suspected VM was not statistically significant（P>0.05）.Compared with MD patients, the incidence of hearing loss and the incidence of abnormal bithermal caloric test in VM patients is lower（P<0.05）. Conclusion:The abnormality rate of caloric test and the incidence of hearing loss in MD patients were higher than VM. The confirmed and suspected VM patients can be accompanied by hearing loss mainly with high hearing frequency decline. There was no difference in clinical characteristics between confirmed and suspected VM patients.

[A retrospective study of the BiRd regimen in the treatment of relapsed/ refractory multiple myeloma]

Objective: To evaluate efficacy of the BiRd regimen, a combination of clarithromycin, lenalidomide, and dexamethasone, in the treatment of patients with relapsed/refractory multiple myeloma (RRMM) . Methods: Patients with RRMM treated with BiRd between September 11, 2013 and August 1, 2016 at six centers were included to evaluate overall survival rate (ORR) , clinical benefit rate (CBR) , progression-free survival (PFS) , overall survival (OS) , as well as adverse events. Results: Of 30 patients with RRMM, 27 patients were evaluable, and ORR and CBR were 51.9% (14/27) and 66.7% (18/27) respectively, including 1 sCR (3.7%) , 3 CR (11.1%) , 3 VGPR (11.1%) , and 7 PR (25.6%) . In 13 patients with prior Rd, ORR and CBR were 38.5% (5/13) and 61.5% (8/13) respectively, of which 5 patients with ≥MR carried high-risk cytogenetic[ (e.g.17p- or t (4;14) ] together with at least one of other adverse-prognostic cytogenetic (e.g.13q- and/or 1q21+) . In 24 patients with prior bortezomib-based therapy, ORR and CBR were 45.8 and 62.5%, respectively. With a median follow-up time of 14.9 (range 1.0-33.8) months, the median PFS and OS were 12.0 (95%CI 11.6-12.4) and 27.6 (95%CI 15.1-40.1) months, respectively. The BiRd regimen was well tolerated. Conclusion: The BiRd regimen is an effective and safety protocol for RRMM, including those carrying high-risk cytogenetic markers.