[The role of neutrophil density in neutrophils-mediated inflammatory response induced by monosodium urate crystals]

Objective: To study the role of neutrophil density and molecular mechanism in neutrophils-mediated inflammatory response induced by monosodium urate (MSU) crystals. Methods: Polymorphonuclear neutrophils (PMNs) isolated from healthy human peripheral blood were treated with MSU crystals at different density (5×10(6)/ml, 20×10(6)/ml, 100×10(6)/ml) in vitro. The mean fluorescence intensity (MFI) of PMNs and production of reactive oxygen species (ROS) were detected by flow cytometry. The distribution of MSU crystals was observed by polarized light microscopy. The neutrophil extracellular traps (NETs) formation was detected by immune fluorescence. The cytokines in cell supernatant were measured by beads assay including interleukin 1β (IL-1β) , tumor necrosis factor α (TNFα) , interleukin 8 (IL-8) , interferon inducible protein 10 (IP-10) , macrophage inflammatory protein 1 (MIP-1) , monokine induced by interferon-γ (MIG) , macrophage inflammatory protein 1α (MIP-1α) , macrophage inflammatory protein 1β (MIP-1β) . Results: (1) After MSU crystal intervention, the side scatters (SSC) of neutrophils with medium-cell density (20×10(6)/ml) and high-cell density (100×10(6)/ml) were 128±13 and 93±9 respectively, both significantly lower than 170±19 in low-cell density (5×10(6)/ml) group.(2) Similarly, compared with low-cell density group, the MFI (lucifer yellow) of PMNs with high-cell density was 1.8±0.2, also significantly decreased (P<0.05). When co-treated with oxygenated adenosine triphosphate (oxATP), MFI of PMNs were all enhanced consistently. (3) In MSU crystals stimulated PMNs, after adding 2',7'-dichlorodihydrofluorescein diacetate, the MFI values were 0.85±0.32, 2.49±0.78, 4.54±1.02 in low cell density groups, medium cell density groups, and high cell density groups respectively, indicating that the generation of ROS was positively correlated with the increase of PMN density (P<0.05). After the intervention of oxATP, the ROS production was significantly reduced. (4) MSU crystal induced NETs formation, especially at high cell density. NETs formation promotes MSU crystal aggregation, which could be partially overcome by oxATP pretreatment. (5) The expression of cytokines were all significantly decreased in the supernatant of PMNs at high cell density exposed to MSU crystals compared with PMNs at medium cell density (P<0.05) . Conclusion: The PMN-mediated inflammation induced by MSU crystals is cell density dependent, and ATP may play a role in partially overcoming the process.

Genome-wide identification and characterization of the BES1 gene family in apple (Malus domestica)

As the most important transcription factor in the brassinosteroid (BR) signal transduction pathway, BES1 not only affects growth and development of plants but also regulates stress resistance of crops. The physicochemical properties, gene structure, cis-acting elements and gene chip expression of apple BES1 transcription factors were analysed using bioinformatics, and expression of this gene family was analysed with qRT-PCR. There were 22 members of the apple BES1 transcription factors, distributed on eight chromosomes, divided into seven subtribes (I-VII), and the same subtribe contained the same basic motifs. Gene structure analysis showed that the number and position of exons differed, and there was no upstream and downstream structure. Analysis of cis-acting elements indicated that BES1 transcription factors contain response elements for hormones and abiotic stress, as well as organ-specific elements. Gene chip expression profile analysis revealed that expression patterns of BES1 transcription factors differed in different apple hybrids and different organs. In addition, expression of apple BES1 genes was higher in flowers, young fruits, mature fruits and leaves. qRT-PCR demonstrated that expression of MdBES1 genes was highest 12 h after BR induction. At the same time, there were differences in expression in response to PEG, NaCl and MeJA. This paper provides a theoretical basis for analysis of the biological function and stress resistance mechanism of BES1 transcription factors in apple.

Willingness of women with early estrogen receptor-positive breast cancer to take adjuvant CDK4/6 inhibitors

Background

The steady decline in breast cancer (bca) mortality has come at the cost of increasingly toxic and expensive adjuvant therapies. Trials evaluating the addition of 2 or 3 years of cyclin-dependent kinase 4/6 (cdk4/6) inhibitors to adjuvant endocrine therapy (et) are ongoing, but the willingness of patients to take such additional therapy is unknown.

Methods

We surveyed 100 consecutive postmenopausal women with nonmetastatic estrogen receptor-positive bca who had initiated adjuvant et within the preceding 2 years. Participants were asked about perceived recurrence risk, bca worry, and overall health. They were then asked about their willingness to accept 2 years of treatment with an additional oral drug that would reduce recurrence by 40% for a range of baseline recurrence risks in 2 hypothetical scenarios.

Results

Mean age of the 99 evaluable participants was 61.7 years. In the scenario with no drug toxicity, 85% of respondents were likely to accept the new drug for a reduction in recurrence to 30% from 50%, but only 49% would take the drug if risk was reduced to 3% from 5%. In a scenario with drug-induced fatigue, the corresponding drug acceptance rates were 55% and 39% respectively. For the second scenario, bca worry was correlated with increased willingness to take the drug, even for only a 2% absolute reduction in recurrence risk.

Conclusions

The willingness of patients with estrogen receptor-positive bca to take an adjuvant cdk4/6 inhibitor will greatly depend on the expected benefit and toxicities described to them as well as on worry about bca recurrence.

[Risk considerations of periodontal tissues reconstructions in the strategies of orthodontic treatment]

With the increase of adult patients seeking for orthodontic treatment, the influence of periodontal tissue on orthodontic treatment has gradually become the focus. For patients with periodontitis, it is essential to controlling the severity of periodontitis prior to orthodontic treatment. Periodontal disease can cause additional bone loss and make the orthodontic treatment complicated. Reducing the risk of orthodontic treatment in this situation is our major concern. In addition to periodontitis, orthodontic treatment may also cause gingival recession. On the other hand, the alveolar bone defects such as bone fenestration and bone dehiscence are common in some patients without periodontitis. For these patients, we should take more care of the interrelationship between bone defects and orthodontic treatment. This article briefly demonstrates the risk considerations of periodontal supporting tissue in orthodontic therapy focusing on the influence of periodontitis, gingival recession and alveolar bone fenestration and dehiscence.

Relationships of growth, stable carbon isotope composition and anatomical properties of leaf and xylem in seven mulberry cultivars: a hint towards drought tolerance

The fast growth of mulberry depends on high water consumption, but considerable variations in drought tolerance exist across different cultivars. Physiological and anatomical mechanisms are important to plant survival under drought. However, few research efforts have been made to reveal the relationships of these two aspects in relation to drought tolerance. In this study, growth rates, leaf functional physiology and anatomical characteristics of leaf and xylem of 1-year-old saplings of seven mulberry cultivars at a common garden were compared. Their relationships were also explored. Growth, leaf physiology and anatomy were significantly different among the tested cultivars. Foliar stable carbon isotope composition (δ¹³ C) was negatively correlated with growth rates, and closely related to several leaf and xylem anatomical traits. Particularly, leaf thickness, predicted hydraulic conductivity and vessel element length jointly contributed 77% of the variability in δ¹³ C. Cultivar Wupu had small stomata, intermediate leaf thickness, the smallest hydraulically weighted vessel diameter and highest vessel number, and higher δ¹³ C; Yunguo1 had high abaxial stomatal density, low specific leaf area, moderate hydraulic conductivity and δ¹³ C; these are beneficial features to reduce leaf water loss and drought-induced xylem embolism in arid areas. Cultivar Liaolu11 had contrasting physiological and anatomical traits compared with the previous two cultivars, suggesting that it might be sensitive to drought. Our findings indicate that growth and δ¹³ C are closely associated with both leaf and xylem anatomical characteristics in mulberry, which provides fundamental information to assist evaluation of drought tolerance in mulberry cultivars and in other woody trees.

Dynamic changes of interferon gamma release assay results with latent tuberculosis infection treatment

OBJECTIVES

Using QuantiFERON-TB Gold In-Tube (QFT-GIT) for monitoring tuberculosis (TB) and latent TB infection treatment effect is controversial. The present study aimed to evaluate the dynamic changes of interferon gamma (IFN-γ) levels along with latent TB infection treatment via a randomized controlled study.

METHODS

A total of 910 participants treated with 8 weeks of once-weekly rifapentine plus isoniazid (group A), 890 treated with 6 weeks of twice-weekly rifapentine plus isoniazid (group B) and 818 untreated controls (group C) were followed for 2 years to track active TB development. QFT-GIT tests were repeated three times for all groups: before treatment (T0), at completion of treatment (T1) and 3 months after completion of treatment (T2).

RESULTS

Similar rates of persistent QFT-GIT reversion were observed in groups A (19.0%, 173/910), B (18.5%, 165/890) and C (20.7%, 169/818) (p 0.512). The dynamic changes of IFN-γ levels were not statistically significant among the three groups. In treated participants, individuals with higher baseline IFN-γ levels showed increased TB occurrence (1.0%, 9/896) compared to those with lower baseline levels (0.2%, 2/904) (p 0.037). A similar but statistically insignificant trend was also observed in untreated controls (1.8% (7/400) vs. 0.5% (2/418), p 0.100). When TB cases were matched with non-TB cases on baseline IFN-γ levels, no significant differences were found with respect to the dynamic changes in IFN-γ levels with time, regardless of whether they received treatment.

CONCLUSIONS

QFT-GIT reversion or decreased IFN-γ levels should not be used for monitoring host response to latent TB infection treatment.

Clinical and genetic analysis of idiopathic normophosphatemic tumoral calcinosis in 19 patients

PURPOSE

Tumoral calcinosis is a rare clinicopathological entity characterized by ectopic soft-tissue calcification, typically periarticular. Normophosphatemic tumoral calcinosis is seldom reported in East Asian populations, and the preoperative diagnosis is often elusive. This study was performed to characterize the clinical profile of normophosphatemic tumoral calcinosis and investigate the presence of the SAMD9 gene mutation.

METHODS

The clinical features, pathological examination findings, and outcomes of 19 subjects were retrospectively reviewed. All patients were analyzed for SAMD9 gene mutation using paraffin-embedded tumoral calcinosis specimens.

RESULTS

Nineteen subjects were analyzed (7 males, 12 females). Their mean age at surgery, mean age at symptom onset, and median disease duration was 51.9 ± 17.3 (range 7-75) years, 49.1 ± 17.2 (range 7-74) years, and 1.3 (interquartile range 0.5-3.0) years, respectively. Lesions were located in the hand in 8 (42.1%) subjects; wrist in 5 (26.3%); shoulder in 2 (10.5%); and hip, knee, buttock, and scrotum in 1 (5.3%) subject each. The lesions in 17 (89.5%) subjects were located around the joints [small joints (hand and wrist) in 13 (68.4%) and large joints (shoulder, hip, and knee) in 4 (21.1%)]. Lesions occurred in the upper limbs in 15 (78.9%) subjects and in the lower limbs in 2 (10.5%). Multiple-lesion involvement (distal right index finger and middle finger) occurred in one (5.3%) subject. Symptoms included pain in 15 (78.9%) subjects, impaired mobility in 5 (26.3%), swelling in 5 (26.3%), numbness in 2 (10.5%), and an asymptomatic mass in 2 (10.5%). The serum inorganic phosphorus concentration was normal in all 19 subjects (mean 1.17 ± 0.15 mmol/L). The serum calcium concentration was normal in 18 subjects and low in 1. The serum alkaline phosphatase concentration was normal in all 19 subjects. Pathological examination indicated multiple nodules of calcified materials that manifested an amorphous or granular blue-purple crystal and were surrounded by proliferation of mononuclear or multinuclear macrophages, osteoclastic-like giant cells, fibroblasts, and chronic inflammatory cells. Notably, different phases of pathological manifestations were observed in the same microscopic field. During follow-up (0.5-65.0 months), no recurrence of tumoral calcinosis was observed in 18 (94.7%) subjects, but 1 subject developed in situ recurrence of an asymptomatic subcutaneous mass after 6 months postoperatively. Genetic analysis in all 19 subjects revealed no SAMD9 gene mutations.

CONCLUSIONS

Most subjects were females and developed calcinosis in adulthood. Small joints (hand and wrist) and the upper limbs were frequently involved. The presence of different phases of pathological features in the same subject suggests that about half of the study participants had been misdiagnosed with another condition (such as gout, osteoarthritis, etc.). Complete surgical excision led to cure without recurrence during follow-up in majority of the study participants.

P191 The effectiveness of mindfulness-based interventions on perceived stress, depression and anxiety in patients with coronary heart disease: A systematic review and meta-analysis

Background

An increasing number of people are living with coronary heart disease (CHD) globally. Psychological conditions such as stress, depression, and anxiety are prevalent for people with CHD, which impose a great challenge for secondary prevention of CHD. Mindfulness-based interventions (MBIs), which incorporate mindfulness skills and cognitive or behavioural therapy, are suggested as a promising approach to help patients with CHD to improve their psychological health. However, the effectiveness of MBIs for patients with CHD has not been systematically reviewed.

Purpose

To synthesise the evidence regarding the effects of MBIs on reducing perceived stress, depression, and anxiety in patients with CHD.

Methods

  Search was conducted in seven English electronic databases and two Chinese electronic databases from inception to January 2019. Randomized controlled trials (RCTs) that evaluated the effects of MBIs on stress, depression, and anxiety in adults with CHD were included. Two reviewers independently screened records for eligibility, extracted data, and assessed risks of bias using the Cochrane tool. Meta-analysis was conducted by combining the standard mean difference (SMD) with 95% confidence interval (CI) of post-intervention outcome measures using Review Manager Version 5.3. We used a fixed-effects model if no significant heterogeneity (I² &lt; 50%), while in case of significant heterogeneity (50% &lt; I² &lt; 75%), we used a random-effects model.

Results

Six RCTs involving 473 participants were included. Five of all studies compared MBIs with inactive controls (i.e., usual care and waitlist control). The remaining study utilized a self-help group that received a booklet containing identical mindfulness information as an active control. There were high concerns about the risk of bias across studies, mainly in performance bias and detection bias. The meta-analysis of two studies showed MBIs may reduce perceived stress at post-intervention (SMD -0.82; 95% CI -1.28 to -0.36; P &lt; 0.001; I² 0%) compared with inactive controls. Compared with active control, the single study did not observe a significant reduction of perceived stress in intervention group. The meta-analysis of five studies revealed that MBIs appear effective in reducing depression (SMD -1.08; 95% CI -1.28 to -0.87; P &lt; 0.001; I² 22%) and anxiety (SMD -1.16; 95% CI -1.57 to -0.75; P &lt; 0.001; I² 71%) immediately after intervention, compared with inactive or active controls.

Conclusions

The results of this review provide evidence for the effects of MBIs on reduction in perceived stress, depression and anxiety at post-intervention in patients with CHD. However, these findings need to be interpreted with caution given the small sample size and methodological limitations within included studies. Rigorous-designed research is urgently needed to further confirm the effectiveness of MBIs on improving psychological health and explore its sustainable effects in patients with CHD.

Description of demographic and clinical characteristics of extrapulmonary tuberculosis in Shandong, China

BACKGROUND

According to the clinical manifestation, tuberculosis (TB) is divided into pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). The incidence rate of EPTB has increased in many countries. The demographic and clinical characteristics of EPTB in China remain still unclear.

MATERIALS AND METHODS

We retrospectively analyzed the medical records of 5,624 hospitalized patients with positive M. tuberculosis culture between January 2008 and June 2013 in Shandong province. We investigated the epidemiological, demographic, and clinical characteristics of patients with EPTB.

RESULTS

Among 5,624 hospitalized TB patients with positive M. tuberculosis culture, 4,277 (76.05 %) had PTB, 618 (10.99 %) had EPTB, and 729 (12.96 %) had both PTB and EPTB. The proportion of EPTB increased significantly from 6.97 % in 2008 to 19.98 % in 2012 (p <0.001).  The most frequent sites or foci of EPTB were pleura (63.27 %), followed by bone/joint (13.75 %), and lymph nodes (8.9 %). The mean duration of treatment for pleural TB was eight months and for EPTB in the other foci was more than 15 months.

CONCLUSION

The proportion of EPTB in Shandong province has significantly increased. Clinicians need to be aware of the trend and remain vigilant against EPTB. EPTB requires prolonged treatment, and clinical supervision should be strengthened to prevent drug resistance. HIPPOKRATIA 2020, 24(1): 27-32.

Operation of RF-driven negative hydrogen ion source in China Spallation Neutron Source

The China Spallation Neutron Source started delivering neutron beams to users in March 2018. To upgrade the beam power to 500 kW and improve the performance of the ion source, an RF-driven negative hydrogen (H^-) ion source is under development. The source has a silicon nitride ceramic plasma chamber surrounded by a 4.5-turn antenna. The plasma is ignited by a pulsed DC spark gap and then driven by a 2 MHz solid-state amplifier with a repetition rate of 25 Hz. The commissioning of the source started in January 2019. When uncesiated, it produced about 20 mA beam at an RF power of 32 kW and pulse width of 450 μs. This paper describes the configuration of the ion source, several peculiar technologies used in it, and the first negative hydrogen (H^-) ion beam extraction.

Excessive daytime sleepiness with snoring or witnessed apnea is associated with handgrip strength: a population-based study

BACKGROUND

Sarcopenia is emerging as an important public health problem, and evidences have determined that poor sleep is associated with muscle strength, but the potential effects of excessive daytime sleepiness (EDS), snoring and witnessed apnea on handgrip strength have not been evaluated.

AIM

We aimed to examine the association between EDS, snoring, witnessed apnea and muscle strength in an adult population.

DESIGN

Cross-sectional study.

METHODS

This cross-sectional study comprised 19 434 adults. Handgrip strength was measured using a handheld digital dynamometer. EDS was assessed by Epworth Sleepiness Scale, snoring and witnessed apnea during sleep were reported through simple yes/no questions. Analysis of covariance was carried out to determine the association between EDS with snoring or witnessed apnea and muscle strength.

RESULTS

The means (95% confidence interval) for average handgrip strength/body weight (kg/kg) across symptoms categories were 0.396 (0.333-0.472), 0.393 (0.330-0.467), 0.396 (0.333-0.471) and 0.386 (0.325-0.460) (P < 0.0001), respectively. Similar results were observed with maximal handgrip strength/body weight (kg/kg).

CONCLUSIONS

Self-reported EDS accompanied with snoring or apnea is associated with lowest handgrip strength, independently of confounding factors. Whether improvement of EDS, snoring and apnea, can ameliorate age-associated decline in muscle strength warrants further studies.

[Effectiveness of continuous positive airway pressure ventilation in improving genioglossus electromyography in patients with moderate to severe obstructive sleep apnea]

Objective: To compare the changes of genioglossus electromyography (GGEMG) with and without continuous positive airway pressure (CPAP) ventilation in moderate to severe obstructive sleep apnea (OSA) patients. Methods: Each of subjects, including male snorers and non-snorers, underwent polysomnography (PSG) with synchronous GGEMG recording with intra-oral bipolar silver ball electrodes at the Sleep Center of Beijing Tsinghua Changgung Hospital from August 2016 to Sepember 2017. Manual CPAP pressure titration and with GGEMG were performed in patients diagnosed moderate to severe OSA. T-test was used to compare the changes of GGEMG in OSA group (n=12, AHI (65.90+23.67) events/h) and control group (n=6, AHI(2.30+1.93) events/h) before and after CPAP treatment. Results: Variables of GGEMG (including tonic, peak and phasic GGEMG) were higher in OSA group than in control group during both wakefulness and non rapid eye movement(NREM) sleep. However, with CPAP treatment, the GGEMG variables were significantly decreased in OSA group during NREM sleep(tonic GGEMG: 1.23%±0.73% vs. 2.54%±1.12%, t=4.024, P=0.002; peak GGEMG: 12.37%±13.19% vs. 26.98%±15.52%, t=2.795, P=0.017; phasic GGEMG: 3.81%±2.47% vs. 8.82%±3.84%, t=5.113, P<0.001). Conclusions: CPAP treatment can eliminate respiratory events and maintain airway patency. It is helpful to normalize the excessive GGEMG response in OSA patients during sleep, which has therapeutic significance to alleviate and prevent genioglossal neuromuscular lesions.

The role of the GABAA receptor Alpha 1 subunit in the ventral hippocampus in stress resilience

Pre-pubertal stress increases post-traumatic stress disorder (PTSD) susceptibility. We have previously demonstrated that enriched environment (EE) intervention immediately after pre-pubertal stress protects from the effects of trauma in adulthood. Here, we examined whether exposure to EE would also be beneficial if applied after exposure to trauma in adulthood. We have recently shown that exposure to juvenile stress and under-water trauma (UWT) is associated with increased expression of GABA_A receptor subunit α1 in the ventral hippocampus. However, differentiating between affected and unaffected individuals, this increased expression was confined to stress-exposed, behaviorally unaffected individuals, suggesting upregulation of α1 expression as a potential mechanism of resilience. We now examined whether EE-induced resilience renders increased expression of α1 in the ventral hippocampus redundant when facing a trauma later in life. Adult rats were exposed to UWT, with pre-exposure to juvenile stress, and tested in the open field and elevated plus maze paradigms four weeks later. EE exposure during juvenility prevented pre-pubertal stress-induced vulnerability, but not if performed following UWT in adulthood. Furthermore, juvenile EE exposure prevented the trauma-associated increase in α1 expression levels. Our findings emphasize the importance of early interventions in order to reduce the likelihood of developing psychopathologies in adulthood.

[Polysomnographic comparation between dexmedetomidine-induced sleep and natural sleep]

Objective: To compare the parameters of polysomnography (PSG) in sleep structure and respiratory events between dexmedetomidine-induced sleep and natural sleep. Methods: From April 2016 to September 2018, a total of 44 patients with obstructive sleep apnea (OSA) and 3 patients with simple snoring completed PSG monitor both in natural sleep and dexmedetomidine-induced sleep in Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tsinghua Changgung Hospital. The PSG parameters were statistically analysed with SPSS 22.0 software. Results: The average dose of dexmedetomidine was (104.60±27.93) μg, and there was no significant difference between the induced-sleep efficiency and the natural sleep efficiency (82.14%±16.66% vs. 86.50%±9.18%, t=-1.559, P>0.05). There was no rapid eye movement(REM) stages in all 47 subjects and only 1 case of them had non-rapid eye movement(NREM) stage 3 in induced sleep. The percentage of NREM1 in total sleep time was statistically different between the two groups (42.10%±26.71% vs. 17.47%±11.68%, t=5.997, P<0.001),but there was no significant difference in the percentage of NREM2 in total sleep time between the two groups (56.96%±26.0% vs. 62.95%±9.03%, t=-1.521, P=0.135). About respiratory events, there were significant differences in apnea hypopnea index ((46.29±20.23)/h vs. (39.67±25.41)/h), obstructive apnea index (25.20[10.50,45.40]/h vs. 16.20[3.30,35.20]/h) between induced-sleep and natural sleep (t=2.297, Z=-3.008, all P<0.05), these difference were more significant in mild-to-moderate OSA. There were no statistically significant differences in central apnea index (0.00[0.00,2.80]/h vs. 0.40[0.10,1.20]/h), mixed apnea index (0.00[0.00,6.20]/h vs. 0.00[0.00,3.40]/h, hypopnea index (4.20[0.00,3.30]/h vs. 12.00[5.20,17.40]/h), Z=-0.110,-0.508,-1.544, all P>0.05). There were statistical differences in the lowest oxygen saturation (84.77%±7. 59% vs. 80.21%±11.62%, t=2.558, P=0.014). Conclusions: There is no significant difference in sleep efficiency and NREM2 between dexmedetomidine induced sleep and natural sleep.NREM3 sleep is rare induced, but REM sleep is none of all. And dexmedetomidine induced sleep may aggravate obstructive sleep apnea, but not central apnea.

[The effect of genioglossus activity to velopharyngeal surgery in patient with obstructive sleep apnea hypopnea syndrome]

Objective: To investigate the effect of genioglossus (GG) activation at sleep onset on the outcome of velopharyngeal surgery in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods: Thirty-five patients between April 2014 and February 2015 in Beijing Tongren Hospital with OSAHS underwent overnight polysomnography with synchronous genioglossus electromyography (GGEMG) using intraoral electrodes. The upper airway (UA) anatomy was evaluated by three-dimensional computer tomography (3D-CT) in OSAHS patients. Then, all of the patients received velopharyngeal surgery, including revised uvulopalatopharyngoplasty (UPPP) with uvula preservation or UPPP combined transpalatal advancement pharyngoplasty. All patients were followed-up using polysomnography 3-6 months after surgery. T-test or Wilcoxon test were used to compare the variables between groups, and Spearman correlation analysis was used to test the correlation between parameters. Results: Thirty-five patients received velopharyngeal surgery. Twenty-two patients (62.86%) were responders, and 13 patients (37.14%) were non-responders. Responders had a higher mean GGEMG during sleep onset (15.31±3.74 vs. 9.92±2.93, t=4.504, P=0.001). The decreased AHI was significantly positively related to the sleep onset mean GGEMG (r=0.541, P=0.004) and the change in GGEMG (r=0.422, P=0.028). The decreased AHI was significantly negatively related to the minimal cross sectional airway area (mCSA,ρ=0.629,P=0.000) and the minimal lateral airway dimension (mLAT, ρ=0.484, P=0.009) at velopharynx. Conclusions: The outcome of velopharyngeal surgery was affected by the mean GGEMG during sleep onset. We speculated that the patient with higher GGEMG at sleep onset and narrower velopharynx were more suitable candidates for velopharyngeal surgery.

[Analysis of polysomnography results between pre- and post-operation in pediatric obstructive sleep apnea hypopnea syndrome patients]

Objective: To determine the objective effects of adenotonsillectomy on pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) through analyzing the polysomnography (PSG) results between pre and post-operation. Methods: A total of 56 pediatric OSAHS patients were included who underwent adenoidectomy or/and tonsillectomy and completed PSG follow-up from January 1, 2017 to March 31, 2018. All the pediatric patients who underwent adenoidectomy or/and tonsillectomy during the research period were arranged to take a preoperative PSG study. Patients who were diagnosed OSAHS would be encouraged to complete a follow-up PSG study ranged from1 to 3 months after surgery. The parameters of respiration and sleep architecture of PSG were compared and analyzed. The paired student t test was used to compare preoperative and postoperative mean values. The unpaired student t test was used to compare quantitative variables among different groups. The rank sum test was used if the data were abnormal distribution. Results: Totally 238 patients completed preoperative PSG study, 62 patients were diagnosed as pediatric OSAHS, 56 eligible patients finished post-operative PSG. Hypopnea was the majority in all type of respiratory events in 56.45% (35/62) subjects, while central apnea as the majority in 29.03% (18/62) subjects who can also get significant CAI decrease after surgery. However, obstructive apnea as the majority only exist in 14.52% (9/62) subjects. The short-term cure rate of pediatric OSAHS was 85.71% (48/56). The postoperative AHI, MAI, CAI, HI, ODI, LoSpO(2), percentage of stage I sleep and arousal index were significantly decreased, however, the OAI was no statistical decrease. The percentage of stage Ⅱ and rapid eye movement (REM) sleep were significantly increased, while no significant change in percentage of slow wave sleep and sleep efficiency(t=2.32, P=0.017). Conclusions: Pediatric OSAHS manifest different characteristics of respiratory events from that of adults. Adenotonsillectomy can significant decrease respiratory events and improve sleep architecture, however, there are still some patients who can't be completely relieved with adenotonsillectomy.

Rigidity controls human desmoplastic matrix anisotropy to enable pancreatic cancer cell spread via extracellular signal-regulated kinase 2

It is predicted that pancreatic ductal adenocarcinoma (PDAC) will become the second most lethal cancer in the US by 2030. PDAC includes a fibrous-like stroma, desmoplasia, encompassing most of the tumor mass, which is produced by cancer-associated fibroblasts (CAFs) and includes their cell-derived extracellular matrices (CDMs). Since elimination of desmoplasia has proven detrimental to patients, CDM reprogramming, as opposed to stromal ablation, is therapeutically desirable. Hence, efforts are being made to harness desmoplasia's anti-tumor functions. We conducted biomechanical manipulations, using variations of pathological and physiological substrates in vitro, to culture patient-harvested CAFs and generate CDMs that restrict PDAC growth and spread. We posited that extrinsic modulation of the environment, via substrate rigidity, influences CAF's cell-intrinsic forces affecting CDM production. Substrates used were polyacrylamide gels of physiological (~1.5 kPa) or pathological (~7 kPa) stiffnesses. Results showed that physiological substrates influenced CAFs to generate CDMs similar to normal/control fibroblasts. We found CDMs to be softer than the corresponding underlying substrates, and CDM fiber anisotropy (i.e., alignment) to be biphasic and informed via substrate-imparted morphological CAF aspect ratios. The biphasic nature of CDM fiber anisotropy was mathematically modeled and proposed a correlation between CAF aspect ratios and CDM alignment; regulated by extrinsic and intrinsic forces to conserve minimal free energy. Biomechanical manipulation of CDMs, generated on physiologically soft substrates, leads to reduction in nuclear translocation of pERK1/2 in KRAS mutated pancreatic cells. ERK2 was found essential for CDM-regulated tumor cell spread. In vitro findings correlated with in vivo observations; nuclear pERK1/2 is significantly high in human PDAC samples. The study suggests that altering underlying substrates enable CAFs to remodel CDMs and restrict pancreatic cancer cell spread in an ERK2 dependent manner.

Self-compassion may reduce anxiety and depression in nursing students: a pathway through perceived stress

OBJECTIVES

Nursing students report high levels of anxiety and depression, which requires urgent attention. A growing amount of evidence indicates that self-compassion may indirectly (through perceived stress) and directly influence anxiety and depression, yet the research to date has not fully examined the reasons for this association. The present study examines the effects of self-compassion on anxiety and depression through perceived stress and may thus provide an innovative starting point for developing effective interventions for affected nursing students.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Using structural equation modelling (SEM), we estimated the strength of the pathways between self-compassion, perceived stress and anxiety and depression among 1453 nursing students in Ningbo, China. The measurements included demographics, the Self-Compassion Scale-Short Form, the Chinese version of the Perceived Stress Questionnaire and the Goldberg Anxiety and Depression Scale.

RESULTS

Nursing students had an average score of 4.50 ± 2.44 on the Goldberg Anxiety Scale (GAS) and 3.58 ± 2.34 on the Goldberg Depression Scale (GDS), indicating high levels of anxiety and depression. The GAS and GDS scores were significantly different by the academic year, part-time employment and career prospects. The average scores for self-compassion and perceived stress were 38.99 ± 4.55 and 0.40 ± 0.14, respectively. The SEM results suggested that self-compassion was negatively associated with anxiety and depression (-0.44, P < 0.001). Perceived stress was positively associated with anxiety and depression (0.64, P < 0.001). Self-compassion was negatively associated with perceived stress (-0.65, P < 0.001). Self-compassion had no significant correlation with anxiety and depression in the effect of perceived stress (-0.14, P = 0.127). Thus, self-compassion indirectly influences anxiety and depression through perceived stress.

CONCLUSIONS

Self-compassion might reduce nursing students' anxiety and depression through perceived stress. Interventionists can consider using self-compassion training to alleviate perceived stress, anxiety and depression in nursing students.