[Application of percutaneous dilatation tracheotomy in patients with difficult airway]

Objective:To explore the application of percutaneous dilatation tracheotomy for patients with difficult airway. Method:Retrospectively analyzed the clinical data of percutaneous dilatation tracheotomy in difficult airway patients, summarized the difficulties, technical points and advantages. Result:Collecting the clinical data of 28 patients with difficult airway, 20 cases were head and neck tumor recurrence after surgery, radiation and chemotherapy, 3 cases were cervical hematoma, 2 cases were laryngeal neoplasm with heart failure, 2 cases were mandatory spondylitis, and 1 case was airway stenosis. The difficult points for tracheotomy were unable to lie down, neck stiffness, displacement of the trachea, coagulation disorder, unclear neck structure, etc. All patients accepted percutaneous dilatation tracheotomy, including cone and forceps dilatation tracheotomy, with none complication. Conclusion:Percutaneous dilatation tracheotomy was a safe, rapid and minimally invasive surgical method for patients with difficult airway requiring tracheotomy, and could be used as the preferred solution.

Numerical and experimental studies of water disinfection in UV reactors

Performance of UV reactors for water disinfection is investigated in this paper. Both experimental and numerical studies are performed on base reactor LP24. Enterobacteria phage MS2 is chosen as the challenge microorganism in the experiments. Experiments are conducted to evaluate the effect of different parameters, i.e. flow rate and UV transmission, on the reactor performance. Simulation is carried out based on the commercial software ANSYS FLUENT with user defined functions (UDFs) implemented. The UDF is programmed to calculate UV dose absorbed by different microorganisms along their flow trajectories. The effect with boundary layer mesh and without boundary layer mesh for LP24 is studied. The results show that the inclusion of boundary layer mesh does not have much effect on the reactor performance in terms of reduction equivalent dose (RED). The numerical results agree well with the experimental measurements, hence validating the numerical model. With this achieved, the numerical model is applied to study other scaled reactors: LP12, LP40, LP60 and LP80. Comparisons show that LP40 has the highest RED and log inactivation among all the reactors while LP80 has the lowest RED and log inactivation.

[Clinical study of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis]

Objective: To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN). Methods: The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery,Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3±12.4)years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3±14.2)years; 23 cases in combined approach group, including 13 males and 10 females,aging of(54.3±19.7)years;8 cases in digestive tract approach group, including 5 males and 3 females, aging of(50.2±12.5)years. Results: The time from onset to operation in retro-peritoneal, omental sac, combined and digestive tract approach groups were (44.3±22.8), (47.3±24.3), (52.6±21.2), (51.2±30.1)days, respectively; the operation time was (52.3±26.4), (64.3±29.2), (82.8±24.7), (78.2±38.1) minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml, respectively; and the first time to eat after operation was (2.5±1.6),(3.8±1.8),(3.7±2.0),(8.4±3.9) days, respectively. The incidence of complications (Clavien-Dindo grade Ⅲ and above)was 10.6%(13/123),10.2% (6/59),17.4%(4/23),1/8 and the mortality was 4.9%(6/123),3.4%(2/59),4.3%(1/23)and 0,respectively.The overall mortality of all patients was 4.2%(9/213).The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before,and no patients was converted to open surgery. Conclusion: Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.

[Feasibility and safety of new "blind" axillary vein puncture technique in pacemaker implantation]

Objective: To explore the feasibility and safety of a newly developed simple and rapid axillary vein puncture technique based on the surface landmarks for pacemaker implantation. Methods: From January to November 2018, we enrolled 110 patients who underwent pacemaker implantation in Beijing Anzhen Hospital. Basic clinical characteristics, such as gender, age, major diagnosis, type of pacemaker, and His-purkinje system pacing, were collected. The success rate of this axillary vein puncture technique, complications, and technical parameters of present puncture method were analyzed. Results: There were 58 (52.7%) male patients in this cohort and the average aged was (70.26±10.45) years old. This "blind" axillary vein puncture method was successful in 105 out of 110 patients (95.5%). The relevant puncture-related parameters included: the distance between points "a and b" was (3.89±0.40) cm, the first angle α was (25.84±5.54)° and the second angle β was (66.18±10.26)°. There were no puncture-related complications, such as hematoma, pneumothorax and hemothorax. Conclusion: The new "blind" axillary vein puncture approach is a simple, effective and safe technique for pacemaker implantation, which is easy to learn and practice and suitable for promotion.

Investigation and comparison of the anti-tumor activities of lactoferrin, α-lactalbumin, and β-lactoglobulin in A549, HT29, HepG2, and MDA231-LM2 tumor models

To investigate the anti-tumor activities of lactoferrin, α-lactalbumin, and β-lactoglobulin, 4 types of human tumor cells (lung tumor cell A549, intestinal epithelial tumor cell HT29, hepatocellular cell HepG2, and breast cancer cell MDA231-LM2) were exposed to 3 proteins, respectively. The effects on cell proliferation, migration, and apoptosis were detected in vitro, and nude mice bearing tumors were administered the 3 proteins in vivo. Results showed that the 3 proteins (20 g/L) inhibited viability and migration, as well as induced apoptosis, in 4 tumor cells to different degrees (compared with the control). In vivo, tumor weights in the HT29 group (0.84 ± 0.22 g vs. control 2.05 ± 0.49 g) and MDA231-LM2 group (1.11 ± 0.25 g vs. control 2.49 ± 0.57 g) were significantly reduced by lactoferrin; tumor weights in the A549 group (1.07 ± 0.19 g vs. control 3.11 ± 0.73 g) and HepG2 group (2.32 ± 0.46 g vs. control 3.50 ± 0.74 g) were significantly reduced by α-lactalbumin. Moreover, the roles of lactoferrin, α-lactalbumin, and β-lactoglobulin in regulating apoptotic proteins were validated. In summary, lactoferrin, α-lactalbumin, and β-lactoglobulin were proven to inhibit growth and development of A549, HT29, HepG2, and MDA231-LM2 tumors to different degrees via induction of cell apoptosis.

Determination of sulbactam in raw bovine milk by isotope dilution-ultra-high-performance liquid chromatography-tandem mass spectrometry

We developed a sensitive and selective isotope dilution ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for the determination of sulbactam residue in raw bovine milk. Sulbactam and internal standard, sulbactam-d₅, were extracted from raw bovine milk via liquid-liquid extraction and enriched with strong anion exchange solid-phase extraction cartridges and finally analyzed by using UPLC-MS/MS with multiple reaction monitoring mode. The method was validated according to European regulations. The calibration curve showed good linearity, with a correlation coefficient of 0.9998. Decision limit and detection capability of sulbactam were determined by matrix calibration curve and were 0.0445 and 0.0517 μg/L, respectively. The recoveries of sulbactam in fortified raw bovine milk ranged from 72.1 to 91.5%, with the intra- and interday relative standard deviations ranging from 3.0 to 18.9%. Furthermore, the developed method was applied to analyzing real raw bovine milk samples collected from dairy farms in Beijing, China. Sulbactam was not determined in all samples. The proposed method could ultimately serve as a methodological foundation for the determination of sulbactam in different types of raw milk and dairy products.

Recognizing basal cell carcinoma on smartphone-captured digital histopathology images with a deep neural network

BACKGROUND

Pioneering effort has been made to facilitate the recognition of pathology in malignancies based on whole-slide images (WSIs) through deep learning approaches. It remains unclear whether we can accurately detect and locate basal cell carcinoma (BCC) using smartphone-captured images.

OBJECTIVES

To develop deep neural network frameworks for accurate BCC recognition and segmentation based on smartphone-captured microscopic ocular images (MOIs).

METHODS

We collected a total of 8046 MOIs, 6610 of which had binary classification labels and the other 1436 had pixelwise annotations. Meanwhile, 128 WSIs were collected for comparison. Two deep learning frameworks were created. The 'cascade' framework had a classification model for identifying hard cases (images with low prediction confidence) and a segmentation model for further in-depth analysis of the hard cases. The 'segmentation' framework directly segmented and classified all images. Sensitivity, specificity and area under the curve (AUC) were used to evaluate the overall performance of BCC recognition.

RESULTS

The MOI- and WSI-based models achieved comparable AUCs around 0·95. The 'cascade' framework achieved 0·93 sensitivity and 0·91 specificity. The 'segmentation' framework was more accurate but required more computational resources, achieving 0·97 sensitivity, 0·94 specificity and 0·987 AUC. The runtime of the 'segmentation' framework was 15·3 ± 3·9 s per image, whereas the 'cascade' framework took 4·1 ± 1·4 s. Additionally, the 'segmentation' framework achieved 0·863 mean intersection over union.

CONCLUSIONS

Based on the accessible MOIs via smartphone photography, we developed two deep learning frameworks for recognizing BCC pathology with high sensitivity and specificity. This work opens a new avenue for automatic BCC diagnosis in different clinical scenarios. What's already known about this topic? The diagnosis of basal cell carcinoma (BCC) is labour intensive due to the large number of images to be examined, especially when consecutive slide reading is needed in Mohs surgery. Deep learning approaches have demonstrated promising results on pathological image-related diagnostic tasks. Previous studies have focused on whole-slide images (WSIs) and leveraged classification on image patches for detecting and localizing breast cancer metastases. What does this study add? Instead of WSIs, microscopic ocular images (MOIs) photographed from microscope eyepieces using smartphone cameras were used to develop neural network models for recognizing BCC automatically. The MOI- and WSI-based models achieved comparable areas under the curve around 0·95. Two deep learning frameworks for recognizing BCC pathology were developed with high sensitivity and specificity. Recognizing BCC through a smartphone could be considered a future clinical choice.

[Clinical study of microvascular decompression in patients with coexistent hemifacial spasm and ipsilateral trigeminal neuralgia]

Objective: To investigate the surgical nuances and efficacy of microvascular decompression in patients with coexistent hemifacial spasm and ipsilateral trigeminal neuralgia. Methods: Seventeen patients suffered from coexistent hemifacial spasm and ipsilateral trigeminal neuralgia were treated in Department of Neurosurgery, Henan Provincial People's Hospital from January 2008 to September 2017. The medical recorders, intra-operative findings and postoperative follow-up results of these patients were reviewed, and the surgical strategies and therapeutic effects of these patients were summarized. Results: The offending vessels of the patients coexistent hemifacial spasm and ipsilateral trigeminal neuralgia were complex. The tortuous vertebral artery shifted to the suffered side in nine patients (52.9%), among which seven cases had vertebral artery as the offending vessel or indirect offending vessel compressing facial nerve and/or trigeminal nerve. The effective rate was 100%,the cure rate was 94.1%, and the immediate relief rate was 82.4%. All the patients were followed up for more than one year without recurrence. Conclusion: Patients with coexistent hemifacial spasm and ipsilateral trigeminal neuralgia with tortuous vertebral artery shifted to the affected side were more common. Good surgical nuances and strategies in microvascular decompression are the guarantee of successful surgery.

[Prospective study of relationship between metabolic diseases and stroke in Jinchang Cohort]

Objective: To understand the incidence of stroke in the population of Jinchang Cohort and the relationship between metabolic diseases and stroke, and provide scientific evidence for the prevention and treatment of stroke in the population. Methods: The epidemiological investigation data and physical examination data of the 33 042 follow-up participants in Jinchang Cohort were collected for a prospective cohort study. Restricted cubic splines functions was used to analyze the dose-response relationship between metabolic indexes and the risk of stroke incidence. Results: 1) The incidence rate of stroke in Jinchang Cohort was 1.59%, and the standardized incidence rate was 3.99%. 2) Hypertension (male HR=2.20, female HR=4.45) and dyslipidemia (male HR=1.49, female HR=1.79) were the risk factors of stroke incidence in the population and diabetes had influence on the incidence of stroke only in the males (HR=1.79), while obesity had influence only in the females (HR=1.64). The more kinds of metabolic diseases, the higher risk of stroke incidence was. 3) Systolic blood pressure had a non-linear dose-response correlation with the risk of stroke incidence, while diastolic blood pressure had a positive linear correlation with the risk of stroke incidence. Conclusions: The incidence of stroke in Jinchang Cohort population was high compared with both domestic level and oversea level. The patients with metabolic diseases were the population at high-risk for stroke, and more attention should be paid to them in the prevention and treatment of stroke. Diastolic blood pressure might be more closely related to stroke.

Pathway crosstalk analysis in prostate cancer based on protein-protein network data

Prostate cancer (PCa) is one of the major leading cause in men and no effective biomarkers or therapy have been approved for it to date. This study aimed to explore the molecular mechanisms and identify the potential molecular biomarkers of PCa. The microarray profile GSE38241 including 18 prostate cancer metastasis and 21 normal prostate samples was retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified by Limma. DEGs functions were investigated by Gene Ontology (GO) and pathway enrichment analysis. Moreover, protein-protein interaction (PPI) network of DEGs was constructed, followed by functional analysis of modules. Additionally, pathway crosstalk network was constructed by integrating PPI network and Kyoto encyclopedia of genes and genomes (KEGG) pathways. Totally, 334 up - and 703 down-regulated DEGs were identified. The functions of up-regulated DEGs were significantly enriched in GO terms of cell cycle phase and cell cycle process. While down-regulated DEGs mainly participated in actin filament-based process. Among these pathways in the pathway crosstalk network, T cell receptor signaling pathway, chemokine signaling pathways, endometrial cancer and glioma were found to play critical roles during PC progression. Cell division cycle 45 (CDC45), baculoviral IAP repeat containing 5 (BIRC5) and cell division cycle associated 5 (CDCA5) may be useful markers for predicting tumor metastasis and therapeutic targets for the treatment of PCa patients. Moreover, the pathway crosstalk network provides the groundwork that targeting multiple pathways might be more effective than targeting one pathway alone.

[Adrenal androgen measurement for assessing the selectivity of adrenal venous sampling in primary aldosteronism]

Objective: To investigate the usefulness of adrenal androgens for assessing the selectivity of adrenal venous sampling (AVS). Methods: Between January 2010 and December 2016, 37 consecutive patients [with an average age of (47±14) years, 16 males and 21 females] with primary aldosteronism (PA) who underwent AVS were enrolled. AVS procedures were performed with the bilateral simultaneous technique without cosyntropin stimulation. Cortisol, androstenedione, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS) concentrations were measured in adrenal venous (AV) and peripheral venous (PV) samples, respectively. Results: The selectivity index (SI) based on androstenedione and DHEA was higher than that of cortisol (SI-left: 13.9, 13.1 vs 6.05, P=0.006, 0.035; SI-right: 30.4, 18.5 vs 11.6, P=0.028, 0.051). However, the SI based on DHEAS was lower than that of cortisol (SI-left: 1.3 vs 6.0, P=0.002; SI-right: 1.5 vs 11.6, P=0.038). Plasma androstenedione and DHEA concentrations were positively correlated with cortisol and aldosterone in AV samples (all P<0.001). Compared to cortisol, the variation ratio of AV androstenedione and DHEA was lower from t(-15) to t(0) (0.23, 0.43 vs 0.52, both P<0.05). Using the receiver operating characteristic curve, a SI ≥ 3.0 for androstenedione or DHEA provided optimal sensitivity(97.7%, 91.9%) and specificity (93.8%, 93.8%) in AVS. Conclusion: Given the greater AV/PV ratios and reduced variability compared to cortisol, the adrenal androgens androstenedione and DHEA are useful for assessing the selectivity of AVS without cosyntropin stimulation and may be superior analytes in conditions with marked variability of cortisol levels or with adrenocortical tumors co-secreting cortisol and aldosterone.

[Risk factors of gout in Jinchang cohort: a Cox regression analysis]

Objective: To explore the incidence and risk factors of gout in Jinchang cohort and provide scientific evidence for the prevention and control of gout. Methods: People without gout detected by baseline survey in Jinchang cohort were selected as study subjects. All the subjects were followed up through questionnaire interview, physical examination as well as laboratory test from January 24, 2013 to November 24, 2015. Cox regression model was used to analyze the risk factors for gout in Jinchang cohort. In addition, log-linear model was used to analyze the interaction between risk factors. Results: A total of 33 153 subjects were followed up, and there were 277 newly diagnosed gout cases in the cohort. The overall incidence of gout was 0.8%. The incidence of gout in males was higher than that in the females, but the incidence of gout in males and females was similar after the age of 60 years. Cox regression analysis showed that age >40 years (at age 40 to 59 years: HR=2.982, 95%CI: 1.503-5.981; at age 60 to 91 years: HR=2.588, 95%CI: 1.107-6.049), alcohol abuse (HR=2.234, 95% CI: 1.128-4.427), obesity (HR=2.204, 95% CI: 1.216-3.997), diabetes (HR=2.725, 95% CI: 1.500-4.950) and high uric acid (HR=5.963, 95%CI: 3.577-9.943) were risk factors for gout, while weekly beans intake ≥0.25 kg (HR=0.528, 95%CI: 0.345-0.808) and regular physical exercise (HR=0.499, 95% CI: 0.286-0.869) were protective factors for gout. The analysis with log-linear model showed that there were two order effects between the risk factors. Conclusions: Age, beans intake, alcohol abuse, physical exercises, obesity, diabetes and high uric acid were important factors influencing the incidence of gout. It is important to have healthy lifestyle and dietary habits, receive regular health examination to prevent and control the incidence of gout in this cohort.

[A large scale cohort study on AIDS in communities in Dali, Yunnan province, 2014-2015]

Objective: To understand HIV incidence in community residents and epidemiological characteristics of newly detected HIV infection cases in Dali, Yunnan province. Methods: A cohort study was conducted among 146 720 community residents who were tested to be HIV negative during 2010-2011, they were followed-up from June 1, 2014 to May 31, 2015. Results: A total of 136 356 community residents received follow up (92.9%). The follow-up time was 0.23-5.40 years (medium: 3.43 years), cumulatively 459 675 person years, and 78 people were found to be HIV positive. The incidence rate of HIV infection was 0.170/1 000 person years. The incidence rate was 0.037/1 000 person years in age group 15-29 years, 0.288/1 000 person years in age group 30-44 years, 0.210/1 000 person years in age group 45-59 years, 0.204/1 000 person years in age ≥60 years; 0.213/1 000 person years in males, 0.130/1 000 person years in females; 0.248/1 000 person years in Han ethnic group, 0.149/1 000 person years in Minorities; 0.194/1 000 in people with education level ≤ junior middle school, 0.046/1 000 person years in people with education level > junior middle school; 0.070/1 000 person years in the unmarried, 0.194/1 000 person years in the married and 0.425/1 000 person years in the divorced/widowed. Cox proportional hazards regression analysis showed that being male (HR=1.731), aged 30-44 years (HR=13.158), aged 45-59 years (HR=10.329), aged ≥60 years (HR=8.291), unmarried (HR=3.162) and divorced/widowed (HR=2.689) were the risk factors for HIV infection, while the education level > junior middle school (HR=0.132) was the protective factor for HIV infection. Conclusions: By medium 3.43 years follow up, the cohort study showed that incidence rate HIV infection was 0.170/1 000 person years in the community residents in Dali. Male, middle aged and old people, people with low education level, the unmarried and the divorced/widowed had relatively higher risk to be infected with HIV, Close attention should be paid to the prevention and control of AIDS in these populations.

[The value of platelet count in predicting the efficacy of rituximab treatment in adult patients with chronic primary immune thrombocytopenia]

目的

探讨血小板计数水平在成人慢性原发免疫性血小板减少症（ITP）患者利妥昔单抗疗效预测中的价值。

方法

回顾性分析2011年1月1日至2014年12月31日期间接受利妥昔单抗治疗（100 mg每周1次，连用4次）慢性ITP患者的临床资料，计算利妥昔单抗治疗后不同随访时间截点血小板计数预测疗效的敏感性、特异性和阳性预测值、阴性预测值，并通过ROC曲线下面积得出最佳截断点。

结果

103例患者纳入研究，男46例，女57例，中位年龄30（18~67）岁。首剂利妥昔单抗后第1、5、7天，成功组（治疗后PLT≥50×10⁹/L且未接受其他药物治疗）与无效组（治疗后PLT<50×10⁹/L）中位血小板计数差异均无统计学意义（P>0.05）；利妥昔单抗治疗后第14天，成功组中位血小板计数高于无效组[41（8~384）×10⁹/L对23（0~106）×10⁹/L，P=0.003]；在随后的各随访截点，成功组中位血小板计数进一步回升并维持于正常水平，无效组中位血小板计数均低于正常水平。以ROC曲线获得的预测治疗反应的优化界限值血小板计数50×10⁹/L为基础，首剂妥昔单抗治疗后第14、30、60天血小板计数能够组成一个预后评估体系。

结论

利妥昔单抗治疗后第14、30、60天血小板计数能够组成一个疗效预测评估体系，有助于随访和制定治疗计划。

[Analysis of 9 cases of nodular type of pulmonary cryptococcosis with coexisting lung cancer confirmed by pathological examinations]

Objective: To describe the characteristics of the nodular type of pulmonary cryptococcosis (PC) with coexisting lung cancer. Methods: A total of 9 cases of PC with coexisting lung cancer, admitted to Fuzhou Pulmonary Hospital of Fujian from 1st January 2009 to 31th December 2016, and confirmed by pathological examinations, were studied and the related literature were reviewed. Results: The patients consisted of 1 male and 8 females, with a mean age of (53±10) years (range, 38 to 68 years). Four patients (44.4%) had underlying diseases, 3 with diabetes mellitus and 1 with gastric cancer surgery. The main clinical manifestations of most cases were cough and phlegm. The lesions of PC on chest CT were mostly solitary or multiple nodules with a diameter < 1 cm, and the lesions of carcinoma were shown as solitary nodules with a variety of signs suggestive of malignancy. All the patients were confirmed to have concomitant PC and lung adenocarcinoma by pathological examinations. Lung cancer stage was early (Tis and Ⅰ-Ⅱ) in 88.9 % (8 cases) of the cases. All the patients received surgery and postoperative medical therapy. The prognosis was relatively good in most of them except 1 case with death due to lung cancer metastasis and 1 case with lung cancer recurrence. Conclusions: Coexistence of PC and lung cancer is rare and the clinical symptoms are not specific. When PC coexists with carcinoma and manifests as pulmonary nodule, it mimics malignant lesions and is extremely easy to be misdiagnosed. Therefore PC must be considered in the differential diagnosis of pulmonary nodules.

[Short-term effects of household indoor- and outdoor-originating fine particulate matters on heart rate and heart rate variability in chronic obstructive pulmonary diseases patients, Beijing]

Objective: To assess the associations of indoor fine particulate matter (PM(2.5)) from outdoor and indoor sources with heart rate (HR) and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease (COPD) of Beijing. Methods: A total of 40 male patients in a stable stage of COPD were recruited from a hospital in a panel study in Beijing with 5 consecutive days of measurement for each subject. General information and disease history of the participants from questionnaires were obtained prior to the study. HR and HRV were repeatedly examined using dynamic electrocardiograph. HRV included standard deviation of all NN intervals (SDNN), root mean square of successive differences between adjacent NN intervals (rMSSD), total power (TP) power in the low-frequency band (LF) and the high-frequency band (HF). Iron was used as tracer element to separate indoor-originated PM(2.5) and outdoor-originated PM(2.5). Mixed-effect models were applied to assess the associations of outdoor-originated PM(2.5) or indoor-originated PM(2.5) and health effects. Results: The P(50) (P(25), P(75)) values of daily indoor PM(2.5), indoor-originated PM(2.5) and outdoor-originated PM(2.5) were 50.9 (26.8, 122.7), 16.0 (1.9, 43.7) and 27.3 (13.5, 61.8) μg/m(3), respectively. The mean±SD of concentrations of real-time indoor PM(2.5), indoor-originated PM(2.5) and outdoor-originated PM(2).5 were (61.5±58.8), (25.3±39.1) and (36.2±42.7) μg/m(3), respectively. Compared with outdoor-originated PM(2.5), indoor-originated PM(2.5) had significant associations with HRV and HR. Each 10 μg/m(3) increase at 4 h indoor-originated PM(2.5) and outdoor-originated PM(2.5) moving average was associated with 3.4% (95%CI: -4.7%, -2.1%) and 0.6% (95%CI: -2.0%, -0.8%) reduction in TP (P<0.001). Each 10 μg/m(3) increase at 12 h indoor-originated PM(2.5) moving average was associated with 7.6% (95%CI: -10.1%, -5.1%), 4.7% (95%CI: -6.7%, -2.7%), 3.3% (95%CI: -4.2%,-2.4%) and 3.0% (95%CI: -4.5%, -1.5%) reduction in HF, LF, SDNN and rMSSD, respectively. Each 10 μg/m(3) increase at 12 h outdoor-originated PM(2.5) moving average was associated with 0.7% (95%CI: -2.7%, -1.4%), 0.2% (95%CI: -1.9%, 1.4%), 0.7% (95%CI: -1.4%, -0.1%) and 0.2% (95%CI: -1.3%, 0.9%) reduction in HF, LF, SDNN and rMSSD, respectively (P<0.001). Each 10 μg/m(3) increase at 8 h indoor-originated PM(2.5) and outdoor-originated PM(2.5) moving average was associated with 0.7% (95%CI: 0.4%, 1.0%) and 0.4% (95%CI: 0.2%, 0.6%) increase in HR. Conclusion: Exposure to indoor-originated PM(2.5) was more strongly associations with HRV indices and HR compared with outdoor-originated PM(2.5) in male COPD patients.

[Retrospectively analysis of the difference of bleeding frequency and hemophilic arthropathy between hemophilia A and hemophilia B patients]

目的

分析血友病A（HA）和血友病B（HB）的出血频率和X线分级情况、X线分级进展的危险因素及差异。

方法

回顾性分析2007年1月至2010年12月中国医学科学院血液病医院收治的211例血友病患者的临床资料，随访部分患者出血关节的X线Arnold-Hilgartner诊断分级结果。

结果

211例患者均为男性，其中HA 150例，HB 61例。HA组总体中位年均总出血次数、中位年均关节出血次数分别为20.5（0~48）、13.5（0~38）次，HB组总体中位年均总出血次数、中位年均关节出血次数分别为13（1~40）、8（0~33）次，中间型HA患者中位年均总出血次数和中位年均关节出血次数高于中间型HB患者[26（1~48）次对12（1~36）次，P<0.001；18（0~36）次对7.5（0~26）次，P=0.001]，而重型HA和HB患者中位年均总出血次数和中位年均关节出血次数比较差异无统计学意义[33（1~41）次对26（1~40）次，P=0.702；22（0~36）次对18（0~33）次，P=0.429]。108例HA、54例HB患者入院时行出血关节普通X线检查，HA患者血友病严重程度与关节X线Arnold-Hilgartner诊断分级呈正相关（r=0.063，P=0.004）；HB患者严重程度分级与关节X线Arnold-Hilgartner诊断分级无相关性（r=0.045，P=0.082）；36例HA和19例HB患者5年后复查病变关节X线片，总体HA与HB患者X线进展程度比较差异无统计学意义（z=1.941，P=0.052），但中间型HA患者进展程度高于中间型HB患者（z=0.076，P=0.002），重型HA和重型HB患者比较差异无统计学意义（z=3.139，P=0.945）。多因素分析显示关节出血次数[P<0.001，OR=1.166（95%CI 1.097~1.239）]和外伤[P=0.018，OR=2.842（95%CI 1.196~6.755）]是血友病患者关节X线Arnold-Hilgartner诊断分级进展的独立危险因素。

结论

HB患者出血频率低于HA患者，中间型患者差异尤其明显。中间型HB患者关节X线分级进展较中间型HA患者慢。关节出血次数和外伤是血友病患者关节X线Arnold-Hilgartner诊断分级进展的独立危险因素。

Molecular mechanism of action of valproate acid alone or in combination with chlorpromazine in the epigenetic regulation of schizophrenia

This study aimed to assess the molecular mechanism of the histone deacetylase inhibitor (HDACI) valproate acid (VPA) alone or in combination with the antipsychotic drug chlorpromazine in the epigenetic regulation of schizophrenia. A total of 60 perinatal CD-SD rats were divided in a control group (16 animals) and a schizophrenia model group (44 animals). For the schizophrenia model group the rats received phencyclidine (PCP) 10 mg/kg/day by intradermal injection on days 7, 9, and 11 after birth. The model was confirmed by the Morris water test in 40 rats. The control and model rats were divided into 7 groups. The Real Time PCR assay was used to detect the mRNA expression changes of GABA system gene [GABBR1 (GABA B receptor 1)], GAD1 (glutamic acid decarboxylase1), GAD2 (glutamic acid decarboxylase2), Lipase metabolic key enzyme LPL (lipoprotein lipase) gene, glutamate neurotransmitter gene GRIA2 (AMPA subtype glutamate receptors 2), inward rectifier potassium channel members KCNJ4 (potassium voltage-gated channel subfamily J member 4) and neuropeptide signal gene TAC1 (tachykinin precursor 1,TAC1) in four brain regions: the prefrontal cortex (PC), the amygdala (AM), the caudate-putamen (CPU) and the hippocampus (HIP). The platform arrival time of PMV and PMVC groups was significantly reduced compared to the PM group, the reduction being more significant in the PMV group. In the four brain regions of the epigenetic animal model of schizophrenia, the expression of GABBR1, GAD1, and GAD2 genes increased significantly. Following administration of HDACI VPA, the mRNA expression of this gene in the four brain regions decreased or approached normal levels. GABBR1 GAD1 and GAD2 are likely to be the target genes affected by the HDACI VPA.

Parametric Study and Optimization of Flow Characteristics of Wire-Nonparallel Plate-Type Electrostatic Air Accelerators

Wire and nonparallel plate electrode-type electrostatic air accelerators have attracted significant interest. The physical process involved in using accelerators is complicated. Moreover, mechanisms are unclear, especially for accelerators with double- and multiwire electrodes. In this study, the two-dimensional (2D) model of a wire-nonparallel plate-type accelerator validated by experiments is established with a finite element method. Onset voltage, average current, and outlet average velocity are analyzed with respect to different parameters. Onset voltage is derived by the proposed quadratic regression extrapolation method. Moreover, current is affected by interference and discharge effects, while velocity is also influenced by the suction effect. For the single-wire electrode, high wind speed can be obtained by either increasing channel slope or placing the wire near the entry section. For the double-wire electrode, velocity can be further increased when one of the wires is placed near the inlet and the distance between the two wires is widened. Comparatively, the velocity of the three-wire electrode is higher with larger gaps between wires and stronger discharge effect. The highest velocity is obtained by the four-wire electrode. Comparisons indicate that higher velocity can be obtained with weaker interference effect, stronger suction effect, and intensified discharge effect. Optimum parameter combinations are considered by the Taguchi method. Consequently, velocity can be enhanced by more than 39% after optimization compared with the reference design.

[Clinical analysis of brain abscess after endoscopic repairment of cerebrospinal fluid rhinorrhea]

Objective: To explore the clinical characteristics of the complication of brain abscesses after cerebrospinal fluid rhinorrhea repairment. Methods: A retrospective analysis was conducted on 149 patients undergone endoscopic repairment of cerebrospinal fluid rhinorrhea from October 2007 to October 2017 in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin HuanHu Hospital. The clinical characteristics and treating methods of 3 brain abscess cases were analyzed. Results: Of the 149 patients accepted the endoscopic repairment of cerebrospinal fluid rhinorrhea, 3 cases were complicated with postoperative brain abscesses, which showed as frontal lobe abscess by strengthened head MRI. The incidence of abscess was 2.0%. Abscess formation time was within 10 d after surgery. One case was treated with antibiotic and reducing intracranial pressure, while other 2 cases were treated with puncture drainage. After following-up of 1 to 24 months, these 3 cases had no recurrence of cerebrospinal fluid rhinorrhea or abscess. Conclusions: The complication of brain abscess formation after endoscopic repairment of cerebrospinal fluid rhinorrhea is more common in frontal lobe, which may take place within 7-10 d postoperatively. Conservative treatment is the first choice. Under the condition of obvious symptoms and pus cavity fusion, puncture drainage can be performed.

[Effects of high-efficiency particulate air purifiers on indoor fine particulate matter and its constituents in a district of Beijing during winter]

OBJECTIVE

To analyze the effect of domestic high-efficiency particulate air (HEPA) purifiers on the concentrations of indoor fine particulate matter (PM_2.5) and its elementary constituents in 20 residences in a district of Beijing during winter.

METHODS

From November 2015 to January 2016, 20 residences in a district of Beijing were selected, where indoor and outdoor PM_2.5 data were collected simultaneously in three time periods according to the operating of air purifiers (Group 0 h: 24 hours before operating; Group 24 h: 24 hours after operating; Group 48 h: 24 to 48 hours after operating). The content of 21 elements in PM_2.5 samples were determined by inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectrometry (ICP-OES). Indoor/outdoor particle concentration ratio (I/O ratios) and ΔI/O ratios were used to describe the pollution levels and the variation range of PM_2.5 and its 21 elementary constituents. One-way analysis of variance (ANOVA) for repeated measurement data was applied to compare the I/O ratios of PM_2.5 and its elementary constituents among the different groups, and Bonferroni method was used for comparison in pairs. Wilcoxon signed rank test for paired-samples was used to compare ΔI/O ratios of 21 elementary constituents with that of PM_2.5.

RESULTS

The median I/O ratios of PM_2.5 in the three groups were 1.27 (P25-P75: 0.50-2.68), 0.45 (P25-P75: 0.27-1.03) and 0.36 (P25-P75: 0.28-2.48), respectively. Compared with Group 0 h, the I/O ratios of PM_2.5 in Group 24 h (P=0.042) and Group 48 h (P=0.006) decreased significantly. However, there was no significant difference between Group 24 h and Group 48 h. Significant differences were found comparing ΔI/O ratios of aluminium, ferrum and titanium to that of PM_2.5, in both Group 24 h and Group 48 h (P<0.05). No significant change was found in the I/O ratios of these three elements among the three groups before and after air purifier operating (P>0.05). Distances from residences to traffic arteries could affect I/O ratios of some elements from traffic-related source (P<0.05).

CONCLUSION

Domestic HEPA air purifiers could effectively reduce indoor PM_2.5 concentration, and the pollution level of PM_2.5 tend to be stable after the purifier operating for a time. The purifiers had different effects on different elements, among which most showed statistical significances.

[Association between fatty liver and type 2 diabetes in the baseline population of Jinchang Cohort]

Objective: To explore the association between fatty liver and type 2 diabetes mellitus (T2DM) in the baseline-population of Jinchang cohort study. Methods: Data from all the participants involved in the baseline-population of Jinchang cohort study was used, to compare the risks of T2DM in fatty liver and non fatty liver groups and to explore the interaction between family history or fatty liver of diabetes and the prevalence of T2DM. Results: Among all the 46 861 participants, 10 574 were diagnosed as having fatty liver (22.56%), with the standardized rate as 20.66%. Another 3 818 participants were diagnosed as having T2DM (8.15%) with standardized rate as 6.90%. The prevalence of T2DM increased in parallel with the increase of age (trend χ(2)=2 833.671, trend P<0.001). The prevalence of T2DM in the fatty liver group was significantly higher than that in the non-fatty liver group, both in men or women and in the overall population. Compared with the group of non-fatty liver, the risks of T2DM in fatty liver group were seen 1.78 times higher in males, 2.33 times in women and 2.10 times in the overall population, after adjustment for factors as age, levels of education, smoking, drinking, physical exercise, BMI, family history of diabetes and some metabolic indicators (pressure, TC, TG, uric acid, ALT, AST, gamma-glutamyl transferase). Date from the interaction model showed that fatty liver and family history of diabetes present a positive additive interaction on T2DM (RERI=1.18, 95%CI: 0.59-1.78; AP=0.24, 95%CI: 0.14-0.34; S=1.43, 95%CI: 1.21-1.69). Conclusions: Fatty liver could significantly increase the risk of T2DM and a positive additive interaction was also observed between fatty liver and family history of diabetes on T2DM. It was important to strengthen the prevention program on T2DM, in order to effectively control the development of fatty liver.

[The outcomes of operation for 237 patients with Ebstein anomaly]

Objective: To evaluate the early and long-term outcomes cardiac surgery of patients with Ebstein anomaly. Methods: The clinic data of 237 patients with Ebstein anomaly received surgical procedures from March 2004 to December 2017 at Department of Cardiac Surgery, First Hospital of Tsinghua University was analyzed retrospectively. There were 105 male and 132 female patients with age of (19.4±16.7) years (ranging from 3 months to 64 years). The surgical procedures include anatomical repair in 188 patients, one and a half ventricle repair in 37 patients, tricuspid valve repair in 4 patients, tricuspid valve replacement in 10 patients, and Fontan procedure in 3 patients (total cavopulmonary connection in 2 patients; Glenn procedure in 1 patient). Results: The early mortality was 2.1% (n=5). One case of atrioventricular (0.4%) newly occurred. There were 228 patients available to follow-up. The range of follow-up duration was 3 to 168 months. Late survival was 99.1% (2 cases of late death) at 10 years. Three patients received reoperation (1.3%), including tricuspid valve repair of 1 patient and one and a half ventricle repair of 2 patients). Indication of tricuspid valve regurgitation improved from 3.6±0.3 to 1.5±0.4. Survival rate at 5 and 10 years was 98.6% and 98.2%, respectively. Conclusions: The principle of the techniques is to reconstruct the tricuspid valve and right ventricle anatomically. For most cases, the anatomical repair was demonstrated with low mortality, less complications and excellent durability at long-term follow-up. If the tricuspid valve is severely hypoplastic, one and a half ventricle repair and valve replacement may be alternatie.

[Application of anoptomagnetic probe Gd-DO3A-EA-FITC in imaging and analyzing the brain interstitial space]

OBJECTIVE

To investigate the application of the optical magnetic bimodal molecular probe Gd-DO3A-ethylthiouret-fluorescein isothiocyanate (Gd -DO3A-EA-FITC) in brain tissue imaging and brain interstitial space (ISS).

METHODS

In the study, 24 male SD rats were randomly divided into 3 groups, including magnetic probe group (n=6), optical probe group (n=6) and optical magnetic bimodal probe group (n=12), then the optical magnetic bimodal probe group was divided equally into magnetic probe subgroup (n=6) and optical probe subgroup (n=6). Referencing the brain stereotaxic atlas, the coronal globus pallidus as center level, the probes including gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA), fluorescein isothiocyanate (FITC) and Gd-DO3A-EA-FITC of 2 μL (10 mmol/L) were injected into the caudate nucleus respectively, magnetic resonance imaging (MRI) was performed in the magnetic probe group and magnetic probe subgroup to image the dynamic diffusion and distribution of the probes in the brain ISS, a self-developed brain ISS image processing system was used to measure the diffusion coefficient, clearance, volume fraction and half-time in these two groups. Laser scanning confocal microscope (LSCM) was performed in vitro in the optical probe group and optical probe subgroup for fluorescence imaging at the time points 2 hours after the injection of the probe, and the distribution in the oblique sagittal slice was compared with the result of the first two groups.

RESULTS

For the magnetic probe group and magnetic probe subgroup, there were the same imaging results between the probes of Gd-DTPA and Gd-DO3A-EA-FITC. The diffusion parameters of Gd-DTPA and Gd-DO3A-EA-FITC were as follows: the average diffusion coefficients [(3.31±0.11)×10^-4 mm²/s vs. (3.37±0.15)×10^-4 mm²/s, t=0.942, P=0.360], the clearance [(3.04±0.37) mmol/L vs. (2.90±0.51) mmol/L, t=0.640, P=0.531], the volume fractions (17.18%±0.14% vs. 17.31%±0.15%, t=1.961, P=0.068), the half-time [(86.58±3.31) min vs. (84.61±2.38) min, t=1.412, P=0.177], the diffusion areas [(23.25±0.68) mm² vs. (22.71±1.00) mm², t=1.100, P=0.297]. The statistical analysis of each brain was made by t test, and the diffusion parameters were not statistically significant. Moreover, for the optical probe group and optical probe subgroup, the diffusion area of Gd-DO3A-EA-FITC [(22.61±1.16) mm²] was slightly larger than that of FITC [(22.10±1.29) mm²], the statistical analysis of each brain was made by t test, and the diffusion parameters were not statistically significant (t=0.713, P=0.492).

CONCLUSION

Gd-DO3A-EA-FITC shows the same imaging results as the traditional GD-DTPA, and it can be used in measuring brain ISS.