Relationship of platelet microparticle CD62P and activated GP IIb/IIIa with hypercoagulable state after atrial fibrillation radiofrequency catheter ablation

OBJECTIVE

The morbidity of atrial fibrillation (AF) is 1%-2% in clinic. Radiofrequency catheter ablation (RFCA) is a type of radical interventional therapy for AF, whereas it may lead to a hypercoagulable state. This study evaluated platelet particle CD62P and platelet activation biomarker GP IIb/IIIa expressions in AF patients treated by RFCA, and aimed to analyze their relationships with the hypercoagulable state after RFCA.

PATIENTS AND METHODS

A total of 60 AF patients received RFCA in our hospital were enrolled. The patients were divided into group A as hypercoagulable state group and group B as non-hypercoagulable group. Healthy volunteers were selected as normal control. Serum D-Dimer, parathyroid activity index 1 (PAI-1), and tissue plasminogen activator (t-PA) content were tested by using enzyme-linked immunosorbent assay (ELISA), while peripheral CD62P and GP IIb/IIIa expressions were detected by using flow cytometry before, after, and seven days after RFCA.

RESULTS

D-Dimer and PAI-1 levels increased, while t-PA reduced in group A compared with that in group B and control (p<0.05). D-Dimer and t-PA contents gradually elevated, whereas t-PA level gradually declined in group A before, after, and seven days after RFCA (p<0.05). Serum CD62P and GP IIb/IIIa expressions in group A were significantly higher compared to that in group B and control (p<0.05). CD62P and GP IIb/IIIa levels were significantly higher seven days after RFCA compared with immediate after RFCA in group A (p<0.05). CD62P showed a positive correlation with GP IIb/IIIa in hypercoagulable state patients after RFCA (p<0.05).

CONCLUSIONS

AF patient may appear in hypercoagulable state after RFCA. CD62P and GP IIb/IIIa significantly increased and exhibited a positive correlation.

[Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite]

Objective: To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage. Methods: Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3)years (range: 18-69 yars). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI),the distance of odontoid tip above Chamberlain line,clivus-canal angle (CCA) and the length of syrinx were collected.The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test. Results: The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3,P=0.00).Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from 118.0 degrees preoperative to 143.7 degrees postoperative(t=6.2,P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients. Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks. Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed. Conclusions: The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.

[Relationship between smoking and the severity of OSA]

Objective:To explore the relationship between smoking and the severity of OSA. Method:There were 719 patients included in the study, who were accompanied by snoring, daytime sleepiness and other symptoms. Laboratory-based polysomnographic variables （including AHI, oxygen desaturation index and microarousal index, etc.）, and anthropometric measurements （including weight, neck circumference, waist circumference, hip circumference etc.） were collected for all participants. The severity of OSA was determined by AHI. No OSA was defined as AHI<5, mild OSA as AHI of 5 to 15，moderate OSA as AHI of >15 to 30, and severe OSA as AHI of >30. Smoking severity was determined by the smoking index （SI）. Light smoke was defined as SI<200, moderate smoke was as SI 200 to 400, and severe smoke as SI>400. Result:There were 138 cases of non-OSA and 581 cases of OSA. There were 381 non-smokers, 279 smokers and 59 quit smokers. The smoking rate of OSA group was significantly higher than that of non-OSA group （41.5% vs. 27.5%,P<0.01）. After excluding 59 quit smokers, the remaining 660 subjects were divided into four groups according to the severity of smoking, then each group was further divided into four groups according to OSA severity. Unadjusted analysis showed that OSA severity positively correlated with smoking severity （r=0.203,P<0.01）. The positive correlation remained significant after further adjustment for age, BMI and waist-hip ratio. In addition, logistic regression analysis showed that compared to non-smokers, the odd ratios for OSA in moderate smokers were 1.72 （95%CI 1.08-2.75） and in severe smokers were 2.68 （95%CI 1.61-4.46）, after adjustment for age, BMI and waist-hip ratio. Conclusion:The severity of smoking significantly correlated with the severity of OSA. There was increased risk of OSA in patients with severe smoke. The correlation was independent of some confounders such as age and obesity.

LncRNA KCNQ1OT1 controls cell proliferation, differentiation and apoptosis by sponging miR-326 to regulate c-Myc expression in acute myeloid leukemia

Long noncoding RNAs (lncRNAs) have been reported to play essential roles in development and treatment of acute myeloid leukemia (AML). However, the role of lncRNA potassium voltage-gated channel subfamily Q member 1 overlapping transcript 1 (KCNQ1OT1) in AML progression and its mechanism remain largely unknown. The expressions of KCNQ1OT1, microRNA-326 (miR-326) and c-Myc were measured by quantitative real-time polymerase chain reaction and western blot, respectively. Phorbol myristate acetate (PMA) was used for cell differentiation. Cell proliferation, apoptosis and differentiation were measured by MTT assay, flow cytometry and qRT-PCR, respectively. The interaction between miR-326 and KCNQ1OT1 or c-Myc was explored by luciferase activity, RNA immunoprecipitation or RNA pull-down assay. We found that the expression of KCNQ1OT1 was enhanced in AML samples compared with control. KCNQ1OT1 knockdown inhibited cell proliferation but promoted apoptosis and cell differentiation. KCNQ1OT1 was a decoy of miR-326 and c-Myc was a target of miR-326. KCNQ1OT1 regulated AML cell proliferation, apoptosis and differentiation by sponging miR-326. Moreover, overexpression of miR-326 suppressed proliferation but promoted apoptosis and PMA-induced differentiation by targeting c-Myc in AML cells. Besides, c-Myc protein level was suppressed by KCNQ1OT1 interference and rescued by miR-326 abrogation. Our data showed that KCNQ1OT1 regulates proliferation, differentiation and apoptosis in AML cells by acting as a competing endogenous RNA (ceRNA) for miR-326 to regulate c-Myc, providing a novel avenue for AML treatment.

[The association between serum bilirubin levels and hearing loss in the patients with bilateral sudden deafness]

Objective:The aim of this study was to investigate the association between serum bilirubin levels and the severity of bilateral sudden sensorineural hearing loss （BSSHL）. Method:A total of 113 patients with bilateral axillary sputum were enrolled, and the relationship between serum bilirubin levels and initial hearing levels was explored using a univariate and multivariate linear regression model. Result:Compared with the group with moderate and below hearing loss （≤70 dB HL）, patients with severe profound HL（>70 dB HL） were more likely to have lower levels of total and indirect bilirubin level, magnesium and relative hearing gain, higher levels of final hearing, white blood counts, neutrophil, platelet and alkaline phosphatase. After adjusting for possible confounders, only serum indirect bilirubin levels were significantly negatively correlated with initial hearing loss in patients with bilateral axillary sputum. 1 μmol/L increase of IBIL was associated with 1.1 dB （95%CI: -2.2, 0.0） reduction in initial hearing loss. Conclusion:Within the normal or mildly elevated range, higher levels of IBIL are independently and significantly associated with less severe hearing loss in BSSHL. It suggested a beneficial effect of bilirubin on auditory system.

Alprostadil attenuates LPS-induced cardiomyocyte injury by inhibiting the Wnt5a/JNK/NF-κB pathway

Background

Clinical research has demonstrated that alprostadil has an anti-inflammatory effect; however, to date, its molecular mechanisms remain unclear. This study aimed to examine the anti-inflammatory activity and related mechanisms of alprostadil in lipopolysaccharide (LPS)-treated H9c2 cells.

Methods

Cell morphology was observed under an inverted light microscope, while cell viability was assessed with the 3‑(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay. Enzyme-linked immunosorbent assays (ELISA) were conducted to study biochemical indicators of cellular damage, such as released lactate dehydrase (LDH) and troponin, and inflammatory cytokine levels including interleukin-1β (IL-1β), IL-6, IL-17, and tumor necrosis factor-α (TNF-α). The mRNA expression levels of Wnt5a, c‑jun N‑terminal kinase (JNK), and nuclear factor kappa B (NF-κB) were further investigated by real-time quantitative polymerase chain reaction (RT-PCR). The effects of alprostadil on the Wnt5a/JNK/NF-κB pathway in H9c2 cells was examined by Western blotting.

Results

Alprostadil increased the cell viability of LPS-stimulated H9c2 cells, reduced LDH and troponin production, and attenuated IL-1β, IL-6, IL-17, and TNF-α secretion. Moreover, alprostadil reduced the mRNA expression of Wnt5a, JNK, and NF-κB and decreased the expression of Wnt5a, NF-κB, and the ratio of p‑JNK/JNK in H9c2 cells treated with LPS. The siWnt5a or JNK inhibitor SP600125 significantly augmented the inhibitory effects of alprostadil on the Wnt5a/JNK/NF-κB pathway.

Conclusion

Our results show that alprostadil has anti-inflammatory effects and could attenuate LPS-induced injury in H9c2 cardiomyocytes via the Wnt5a/JNK/NF-κB pathway.

Development of a novel customized cutting and rotating template for Bernese periacetabular osteotomy

Background

Bernese periacetabular osteotomy (PAO) has been shown to be applicable as a hip-preserving technique for the treatment of developmental dysplasia of the hip (DDH). The approach could be designed preoperatively using various types of reverse-engineering software and finite element analysis, but how to implement it in the actual PAO remains a challenge. This study examines and evaluates a solution to achieve higher accuracy when performing a PAO.

Methods

A patient-specific cutting and rotating template was predesigned through computer-aided design (CAD) with three-dimensional (3D) modeling programs. The templates were then reproduced with rapid prototyping (RP) technology and used in the actual PAO. Finally, the clinical and radiographic effects were assessed and compared between the newly developed PAO and conventional PAO groups.

Results

The customized cutting template fit well with the bone surface and served as a guide for surgeons as they slid the osteotome to the precise location that had been determined prior to surgery. A very similar acetabular fragment was reproduced, and no major complications occurred when performing the osteotomy along the edge of the cutting template. The acetabular fragment was then corrected to the predetermined position through one-off manipulation with the customized rotating template. The final position of the acetabular fragment in the new developed PAO group was highly consistent with the planned position, and the postoperative morphological parameters were consistent with the preoperative planned data compared to the conventional PAO group. The duration of the operation and the number of irradiation decreased significantly. The Harris hip score (HHS) and visual analogue scale (VAS) score improved significantly with the use of the new developed PAO.

Conclusions

We demonstrate that our system, which was based on CAD-RP technology, is feasible and could realize the predicted results accurately during the actual PAO.

Abstract GS3-05: Prospective optimization of estrogen receptor degradation yields ER ligands with variable capacities for ER transcriptional suppression

ER+ breast cancers can depend on ER signaling throughout disease progression, including after acquired resistance to existing endocrine agents, providing a rationale for further optimization and development of ER-targeting agents. Fulvestrant is unique amongst currently approved ER ligand therapeutics due to classification as a full ER antagonist, which is thought to be achieved through degradation of ER protein. However, the full clinical potential of fulvestrant is believed to be limited by poor bioavailability, spurring attempts to generate ligands capable of driving ER degradation but with improved drug-like properties.

Here, we evaluate three ER ligand clinical candidates that recently emerged from prospective optimization of ER degradation – GDC-0810, AZD9496 and GDC-0927 - and show that they display distinct mechanistic features. GDC-0810 and AZD9496 are more limited in their ER degradation capacity relative to GDC-0927 and fulvestrant, display evidence of weak transcriptional activation of ER in breast cancer cells (i.e. partial agonist activity), and do not achieve the same degree of in vitro anti-proliferative activity as GDC-0927 and fulvestrant. In the HCI-013 (ER.Y537S) and HCI-011 (ER.WT) ER+ patient-derived xenograft models, GDC-0927 drives greater transcriptional suppression of ER, and greater anti-tumor activity relative to GDC-0810.

We found that despite their full antagonist phenotype, GDC-0927 and fulvestrant promote association of ER with DNA, including at canonical ERE motifs, prior to ER degradation. Interestingly however, integration of ER ChIP-Seq and ATAC-Seq data revealed that ER complexed with fulvestrant or GDC-0927 fails to increase chromatin accessibility at DNA binding sites, in contrast to partial agonists which result in increased chromatin accessibility at ER binding sites. Thus, although ER contacts DNA when engaged with fulvestrant and GDC-0927, it is functionally inert. To further explore mechanistic features that might account for the differential activity of full antagonists and partial agonists that occurs prior to ER degradation, we used cell-based florescence recovery after photobleaching (FRAP) to measure the kinetics of ER diffusion within the nucleus. We demonstrate that while ER is generally highly mobile, including after engagement with GDC-0810 and AZD9496, GDC-0927 and fulvestrant immobilize intra-nuclear ER. A site saturating mutagenesis screen revealed a series of novel ER mutations that prevent ER immobilization by fulvestrant and GDC-0927. This class of “always mobile” ER variants promotes an antagonist-to-agonist transcriptional switch for fulvestrant and GDC-0927, and simultaneously prevents ER degradation by these molecules, implying that ER immobilization is a key functional determinant of robust transcriptional suppression.

We thus propose that ER degradation is not a driver of full ER antagonism, but rather a downstream consequence of ER immobilization, occurring after a suppressive phenotype has been established at chromatin. We additionally argue that evaluating the transcriptional output of candidate ER therapeutics, both pre-clinically and clinically, will be critical for the identification of ER ligands with best-in-class potential.

Citation Format: Metcalfe C, Zhou W, Guan J, Daemen A, Hafner M, Blake RA, Ingalla E, Young A, Oeh J, De Bruyn T, Ubhayakar S, Chen I, Giltnane JM, Li J, Wang X, Sampath D, Hager JH, Friedman LS. Prospective optimization of estrogen receptor degradation yields ER ligands with variable capacities for ER transcriptional suppression [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS3-05.

[Characteristic and function of peripheral blood mononuclear cells-induced macrophages in patients with myelodysplastic syndrome]

目的

观察骨髓增生异常综合征（MDS）患者单个核细胞诱导的巨噬细胞的功能，分析其与MDS疾病发展的关系。

方法

以2014年9月至2015年12月天津医科大学总医院血液科24例MDS患者为病例组，以15名健康志愿者为正常对照组。收集外周血标本并分离单个核细胞，体外以GM-CSF诱导分化形成巨噬细胞。在光学显微镜下观察巨噬细胞的形态；使用流式细胞术检测巨噬细胞的数量及其表面受体CD206、SIRPα的表达水平；分别采用流式细胞术和免疫荧光显微镜检测巨噬细胞的吞噬功能。

结果

①MDS来源的巨噬细胞形态较正常对照差（形态不规则、细胞体积小、异形明显、无足突、数量减少），MDS外周血单个核细胞转化为巨噬细胞的转化率为（5.17±3.47）%，显著低于正常对照组的（66.18±13.43）%（t=3.529，P=0.001）；②MDS来源的巨噬细胞表面识别受体CD206的表达水平[（9.73±2.59）%]显著低于正常对照组[（51.15±10.82）%]（t=4.551，P<0.001），SIRPα的表达水平[（0.51±0.09）%]显著低于正常对照组[（0.77±0.06）%]（t=2.102，P=0.043）；③MDS来源的巨噬细胞吞噬免疫微球的吞噬指数、吞噬百分率分别为0.45±0.08、（23.69±3.22）%，显著低于正常对照组的0.92±0.07、（42.75±2.13）%（P值均<0.05），MDS来源的巨噬细胞吞噬单个核细胞的吞噬指数（0.24±0.04）显著低于正常对照组（0.48±0.96，t=3.464，P=0.001）。

结论

MDS患者外周血单个核细胞诱导形成巨噬细胞能力下降，吞噬识别受体减少，吞噬能力减弱。

Identification of Differentially Expressed Genes under the Regulation of Transcription Factors in Osteosarcoma

The present study was to investigate and identify the differentially expressed genes (DEGs) in the transcriptional regulatory network of osteosarcoma (OS). The gene expression dataset from Gene Expression Omnibus (GEO) datasets was downloaded. DEGs were identified and their functional annotation was also conducted. In addition, differentially expressed transcription factors (TFs) and the regulatory genes were identified. The electronic validation was used to verify the expression of selected genes. The integrated analysis led to 932 DEGs. The results of functional annotation indicated that these DEGs significantly enriched in the p53 signaling pathway, Jak-STAT signaling pathway and Wnt signaling pathway. ZNF354C, NFIC, NFATC2, SP2, FOXO3, EGR1, ZEB1, RREB1, EGR2 and SRF were covered by most TFs. The expression levels of NFIC and EGR2 in electronic validation were compatible with our bio-informatics result. In conclusion, the deregulation of these genes may provide valuable information in understanding the underlying molecular mechanism in the OS.

[Classification of sudden deafness prognosis based on deep learning method]

Objective:This study aimed to develop predictive models for sudden sensorineural hearing loss through deep belief network (DBN) and explore whether the model performances differ when adopting different outcome criteria. Method: 228 potential predictors involving the clinical characteristics, audio logical data, and serological parameters out of 1 220 hospitalized SSHL patients who were admitted from June 2008 to December 2015 were analyzed retrospectively. The hearing data of sudden deafness were classified into two or four categories based on Chinese criteria and Siegel criteria, which were used to develop the DBN models. The area under the receiver operating characteristic curve (ROC-AUC) and accuracy were used to compare the predictive performance of different models. Result: The DBN model developed for predicting the dichotomized outcomes had better performance than that of the fourcategory outcomes. When the iteration number reached 500 times, DBN model constructed for prediction of dichotomized outcomes based on Siegel's criteria had demonstrated the best performance with an accuracy of 76.25% and an AUC of 0.81. According to indices from first layer weights, DBN gave a rank of top 10 sensitive features for hearing outcome prediction focusing on indicators regarding coagulation, demographics and pre-treatment hearing levels independent of the outcome assessment criteria. Conclusion: DBN provides a robust outcome prediction ability in SSHL datasets with rich and complex variables, especially when utilized to predict dichotomized outcomes based on the Siegel criteria. In addition, this advanced deep learning technique can automatically extract valuable predictors, which is consistent with those that had been verified in previous studies by traditional statistical methods. This study provides further evidence for extending the use of DBN algorithm to the field of developing prediction or classification models for other otological diseases in the future..

[Technical specification for clinical application of critical ultrasonography]

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.

Efficacy of 3D VIBE Dixon fat quantification for differentiating clear-cell from non-clear-cell renal cell carcinoma

AIM

To assess the efficacy of three-dimensional (3D) volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) with Dixon quantification for differentiating clear-cell from non-clear-cell types of renal cell carcinoma (RCC).

MATERIALS AND METHODS

The 3D VIBE Dixon renal MRI examinations of 44 patients with 45 histologically confirmed RCCs was analysed. The fat fractions and signal intensity indexes (SI_index) of the solid portions of clear-cell and non-clear-cell RCCs were measured and compared using Student's t-test and receiver operating characteristic (ROC) curves. The agreement of measurements among observers was evaluated by the intraclass correlation coefficient (ICC), and Bland-Altman plots.

RESULTS

The mean values of fat fraction (13.16±7.16%) and SI_index (22.64±15.7%) in clear-cell RCCs were significantly higher than that in non-clear-cell RCCs (7.7±2% and 7.9±4.8%; p<0.001, respectively). With the area under the ROC curve (AUC) of the fat fraction at 0.811, 75% (95% CI: 55.1-89.43%) sensitivity and 76.5% (95% CI: 50.1-93.2%) specificity for diagnosing clear-cell RCC were obtained at a cut-off fat fraction value of 8.9%. With a cut-off value of 8.89%, the diagnostic sensitivity and specificity were 85.7% (95% CI: 67.3-96%) and 70.6% (95% CI: 44-89.7%), respectively. The AUC of the SI_index was 0.870 (0.766-0.973). ICC and Bland-Altman plots show excellent agreement of the tumour fat fraction and SI_index measurement between the two observers.

CONCLUSION

Intracellular lipid content analysis using the 3D Dixon technique can help to differentiate clear-cell from non-clear-cell RCCs.

The role for cyclic Glycine-Proline, a biological regulator of insulin-like growth factor-1 in pregnancy-related obesity and weight changes

Cyclic Glycine-Proline (cGP) regulates the homeostasis of insulin-like growth factor (IGF)-1 function and cGP/IGF-1 ratio determines IGF-1 bioactivity in vitro and in vivo. Plasma IGF-1 represents largely inactive IGF-1 and weakly associated with human obesity and hypertension. We evaluated the regulatory role for cGP in pregnancy-related obesity and hypertension, and in obesity status between pregnancy and postpartum. Women were recruited in their first pregnancy. A cross-sectional study compared plasma concentration of cGP, IGF-1 and IGF binding protein (IGFBP)-3 in women with obesity and/or hypertension to normal controls 6-year postpartum using UPLC-MS and ELISA. A longitudinal study compared the changes of these peptides from 15-week gestation to 6-year post-partum in the women who remained normal weight, remained obese or changed to obese or to normal respectively. Study 1 is a cross-sectional study. The obese group had lower IGF-1(p = 0.001), higher cGP/IGF-1 ratio (p = 0.0055) and the hypertensive group had lower IGFBP-3 (p = 0.046) and cGP (p = 0.043) than the controls. Study 2 is a longitudinal study. Women with weight loss had increased cGP/IGF-1 ratio (p = 0.0026) and decreased IGFBP-3 (p = 0.0001) compared with women whose weight remained normal. Women with weight gain had lower IGFBP-3 (p less than 0.0001) only. Women who remained obese had increased cGP/IGF-1 ratio (p = 0.006) only. Increase in cGP/IGF-1 ratio is associated with obesity, but not hypertension. Changes of IGFBP-3 and/or cGP/IGF-1 ratio are associated with weight changes. The data suggest the role for cGP in obesity through autocrine regulation of IGF-1.

Co-implantation of bone marrow mesenchymal stem cells and chondrocytes increase the viability of chondrocytes in rat osteo-chondral defects

Replacement of chondrocytes by adult stem cells was believed to improve the performance of autologous chondrocytes transplantation, since less chondrocytes were needed. Previous studies have demonstrated that the increased cartilage production in pellet co-cultures of chondrocytes and bone marrow mesenchymal stem cells (BMSCs) is due to the trophic effects of the MSC by stimulating chondrocyte proliferation and matrix production. However, the destination of MSCs or chondrocytes after implanted in osteo-chondral defects is not clear. The aim of the present study is to investigate the viability of MSCs and chondrocytes after co-implantation into a rat osteo-chondral defect model. MSCs were isolated from bone marrow and chondrocytes were extracted from knee joints of neonatal rats. Results of sulfated glycosaminoglycans (GAG) and collagen quantification demonstrated that co-culture pellets of BMSCs and chondrocytes have more GAG deposition than that of BMSCs or chondrocytes alone. Tracking cells with fluorescence protein demonstrated that MSCs disappeared following co-culture. In a rat knee injury model, co-implantation of BMSCs and chondrocytes contained more viable chondrocytes than chondrocytes implanted alone. To conclude, BMSCs were replaced by chondrocytes in pellet co-culture and BMSCs increased the viability of chondrocytes following co-implantation in a osteo-chondral defects model. Co-implantation of BMSCs and chondrocytes may be a promising approach to repairing osteo-chondral defects in the clinical setting.

Predicting the hearing outcome in sudden sensorineural hearing loss via machine learning models

OBJECTIVE

Sudden sensorineural hearing loss (SSHL) is a multifactorial disorder with high heterogeneity, thus the outcomes vary widely. This study aimed to develop predictive models based on four machine learning methods for SSHL, identifying the best performer for clinical application.

DESIGN

Single-centre retrospective study.

SETTING

Chinese People's liberation army (PLA) hospital, Beijing, China.

PARTICIPANTS

A total of 1220 in-patient SSHL patients were enrolled between June 2008 and December 2015.

MAIN OUTCOME MEASURES

An advanced deep learning technique, deep belief network (DBN), together with the conventional logistic regression (LR), support vector machine (SVM) and multilayer perceptron (MLP) were developed to predict the dichotomised hearing outcome of SSHL by inputting six feature collections derived from 149 potential predictors. Accuracy, precision, recall, F-score and the area under the receiver operator characteristic curves (ROC-AUC) were exploited to compare the prediction performance of different models.

RESULTS

Overall the best predictive ability was provided by the DBN model when tested in the raw data set with 149 variables, achieving an accuracy of 77.58% and AUC of 0.84. Nevertheless, DBN yielded inferior performance after feature pruning. In contrast, the LR, SVM and MLP models demonstrated opposite trend as the greatest individual prediction powers were obtained when included merely three variables, with the ROC-AUC ranging from 0.79 to 0.81, and then decreased with the increasing size of input features combinations.

CONCLUSIONS

With the input of enough features, DBN can be a robust prediction tool for SSHL. But LR is more practical for early prediction in routine clinical application using three readily available variables, that is time elapse between symptom onset and study entry, initial hearing level and audiogram.

[Application of three-dimensional printing technology for closed reduction and percutaneous cannulated screws fixation of displaced intraarticular calcaneus fractures]

Objective

To evaluate the effectiveness of three-dimensional (3-D) printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation.

Methods

A retrospective analysis was performed of the 19 patients (19 feet) with intraarticular calcaneal fracture who had been treated between March 2015 and May 2016. There were 13 males and 6 females with an average age of 38.2 years (range, 24-73 years). There were 3 open fractures and 16 closed fractures. By Sanders classification, 12 cases were type Ⅱ, 7 cases were type Ⅲ. By Essex-Lopresti classification, 13 cases were tongue type, 6 cases were joint-depression type. The time from injury to surgery was 1-10 days (mean, 4.7 days). A thin slice CT scan was taken of bilateral calcaneus in patients. By using the mirror imaging technique, the contralateral mirror image and the affected side calcaneus model were printed according to 1∶1 ratio. The displacement of fracture block was observed and contrasted, and the poking reduction was simulated. Calcaneal fracture was treated by percutaneous minimally invasive poking reduction and cannulate screw fixation. The Böhler angle and Gissane angle at immediate after operation and last follow-up was measured on X-ray films, and compared with preoperative measurement. The functional recovery was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) scores.

Results

The operation time was 25-70 minutes (mean, 45 minutes). The intraoperative blood loss was 10-40 mL (mean, 14.5 mL). All the incisions healed by first intention and had no relevant postoperative complications such as skin necrosis, nail tract infection, and osteomyelitis. All the patients were followed up 12-25 months (mean, 14.6 months). All patients obtained fracture healing, and the fracture healing time was 8-14 weeks (mean, 10.3 weeks). No screw withdrawal or breakage occurred during follow-up; only 1 patient with Sanders type Ⅱ fracture, whose calcaneus height was partially lost at 6 weeks after operation, the other patients had no reduction loss and fracture displacement, and no traumatic arthritis occurred. The Böhler angle and Gissane angle at immediate after operation and last follow-up were significantly improved when compared with preoperative ones ( P<0.05), but there was no significant difference between at immediate after operation and last follow-up ( P>0.05). The AOFAS score was 76-100 (mean, 88.2), and the results were excellent in 10 feet, good in 7, and fair in 2, the excellent and good rate was 89.5%.

Conclusion

3-D printing assisting minimally invasive for intraarticular calcaneal fractures with percutaneous poking reduction and cannulate screw fixation can reduce the surgical trauma, improve the quality of reduction and fixation, and make the operation more safe, accurate, and individualized.