Effectiveness of a Short-Term Mixed Exercise Program for Treating Sarcopenia in Hospitalized Patients Aged 80 Years and Older: A Prospective Clinical Trial

OBJECTIVES

To assess the effectiveness of short-term exercise for treating sarcopenia in hospitalized older patients aged 80 years and over.

DESIGN

Prospective clinical trial.

SETTING

A post-acute care unit.

PARTICIPANTS

Sarcopenic patients aged 80 years or over.

INTERVENTIONS

The participants were allocated to the intervention group (to receive a mixed exercise program with 10 sessions over two weeks) or the control group (usual care) based on the sequence of admission.

OUTCOMES

The primary outcome was the improvement in activities of daily living (ADL) estimated by the change in Barthel Index (BI) score from the baseline to the end of the 2-week intervention. The secondary outcomes were the changes in gait speed, handgrip strength, the time "UP and GO" test (TUG) score, and the Short Physical Performance Battery (SPPB) score.

RESULTS

We included 121 participants (intervention group: n = 62; control group: n = 59). All participants in the intervention group finished all 10 exercise sessions. After the 2-week intervention, patients in the mixed exercise group achieved a significant improvement in ADL compared with their counterparts in the control group (the adjusted mean difference of the change in BI score was 7.8 points, 95% confidence interval (CI) 4.0 to 11.8 points). The mixed exercise program significantly but slightly improved gait speed (adjusted group difference in mean change: 0.06 m/s, 95% CI 0.02 to 0.11 m/s). However, the mixed exercise program did not significantly improve the handgrip strength, SPPB score, or TUG score compared with usual care.

CONCLUSION

Very old inpatients with sarcopenia can benefit from a mixed exercise program (even as short as two weeks) by improving their ADL and gait speed. However, the long-term effects of exercise on important clinical outcomes need to be further evaluated.

Effects of laying breeder hens dietary β-carotene, curcumin, allicin, and sodium butyrate supplementation on the growth performance, immunity, and jejunum morphology of their offspring chicks

This study evaluated the growth performance, immunity, and jejunum morphology of chicks hatched from laying breeder hens given dietary additive supplementation, as well as chicks receiving direct antibiotic supplementation in early life. Hy-line breeder hens were allotted to 2 groups with 3 replicates. A control group (CON) was fed a basal diet, and the treatment group (CCAB) received β-carotene, curcumin, allicin, and sodium butyrate in addition to basal diet for 5 wk. Breeder-hen eggs were collected and hatched. The chicks hatched from the CON group were assigned to 2 treatments: a chick control group (cCON) and a chick treatment group (Cipro) given ciprofloxacin lactate into drinking water; the cCON group, Cipro group, and the chicks hatched from the CCAB group (cCCAB) were fed the same diet for 4 wk. The results demonstrated that there were significant differences between the CON and CCAB groups in the serum levels of IgA, IgG, IgM (triple P < 0.01), lysozyme (P < 0.05), and β-defensin (P < 0.05). The body weights of the cCCAB group's chicks increased at 1, 7, and 28 D of age (P < 0.05, P < 0.05, P < 0.01, respectively), and those of the Cipro group's chicks increased at 7 and 21 D of age (P < 0.01, P < 0.05). The tibial lengths of the cCCAB group's chicks increased at 1, 7, 14, 21, and 28 D of age (P < 0.01, P < 0.05, triple P < 0.01), and the lengths in the Cipro group increased at 7 and 14 D of age (P < 0.01, P < 0.01). Intestinal development, including intestinal length, jejunum morphology, and IgA positive cells, helps to explain these results. The breeder eggs from the CCAB group had higher IgG (P < 0.05) and IgM (P < 0.05) levels in the egg whites and higher IgA, IgG, and IgM levels (triple P < 0.01) in the egg yolks. In conclusion, β-carotene, curcumin, allicin, and sodium butyrate supplementation of laying breeder hen diets produced more advantages in growth performance and intestinal development in offspring than in chicks directly supplemented with antibiotics.

Screening for Sarcopenia with a Self-Reported Cartoon Questionnaire: Combining SARC-F with Finger-Ring Test

OBJECTIVES

No pictorial questionnaire is available for screening sarcopenia. We aimed to develop a self-reported cartoon questionnaire based on the SARC-F and the Finger-Ring test and to compare its diagnostic accuracy with the SARC-F and the SARC-F combined with calf circumference (SARC-CalF).

DESIGN

A diagnostic accuracy study.

SETTING

Urban communities in Chengdu, China.

PARTICIPANTS

Older adults aged ≥ 60 years.

METHODS

We established a multidiscipline team to design this pictorial questionnaire, entitled Self-Reported Cartoon SARC-CalF (cSARC-CalF). We used the Asian Working Group for Sarcopenia (AWGS) criteria as the "gold standard" of sarcopenia. We performed sensitivity/ specificity analyses of the three tools (cSARC-CalF, SARC-CalF, and SARC-F) and applied the receiver operating characteristics (ROC) curves and the area under the ROC curves (AUC) to compare the diagnostic accuracy of the three tools.

RESULTS

We included 1,009 participants. Using the Youden Index method, the cutoff of the cSARC-CalF for identifying sarcopenia was set as ≥11 points. Both the cSARC-CalF and the SARC-CalF showed better sensitivity but similar specificity than the SARC-F for identifying sarcopenia (sensitivity: 33.3%, 41.4%, and 23.0%; specificity: 90.1%, 85.9%, and 88.1%). The AUCs of the cSARC-CalF, SARC-CalF, and SARC-F were 0.74 (95% CI, 0.71 - 0.77), 0.79 (95% CI, 0.76 - 0.81), and 0.67 (95% CI, 0.64 - 0.70), respectively. The difference in AUCs between cSARC-CalF and SARC-F and the difference in AUCs between SARC-CalF and SARC-F was statistically significant (p=0.012 and p<0.001, respectively). However, the difference in AUCs between cSARC-CalF and SARC-CalF was not significant (p=0.109).

CONCLUSION

The cSARC-CalF showed a better overall diagnostic accuracy than the SARC-F and a similar overall diagnostic accuracy as the SARC-CalF in Chinese community-dwelling older adults. It may serve as a new tool for screening sarcopenia; however, it needs to be validated in other populations.

Hepatitis B virus infection status is not associated with poor prognosis in classical Hodgkin lymphoma patients

Few studies focused on the relationship between hepatitis B virus (HBV) infection and classical Hodgkin lymphoma (cHL). This study was to evaluate the impact of HBV infection on the treatment outcome and survival of cHL patients. Clinical data of 352 cHL patients treated with ABVD regimen (doxorubicin, bleomycin, vincristine and dacarbazine) between January 2002 and January 2018 were retrospectively collected. According to HBV infection status, the patients were divided into three groups: with HBV infection [hepatitis B surface antigen (HBsAg)-positive], with past HBV infection [HBsAg-negative but anti-hepatitis B core antigen (anti-HBc)-positive], and without HBV infection (HBsAg-negative and anti-HBc-negative). The incidence of HBV infection and past HBV infection in cHL patients were 7.4% (26/352) and 16.5% (58/352), respectively. The median age of patients without HBV infection was lower than those in other two groups (p<0.001). The complete remission rates after first-line therapy were different among 3 groups (65.4% for the group with HBV infection, 87.9% for the group with past HBV infection, and 76.1% for the group without HBV infection, respectively, p=0.049). After a median follow-up of 34.6 months, the 3-year progression-free survival rates for the three groups were 69%, 74% and 80%, respectively (p=0.566) and the 3-year overall survival rates were 72%, 91% and 87%, respectively (p=0.096). No HBV reactivation was observed during chemotherapy among 3 groups, but 1 patient in the group with HBV infection experienced delayed HBV reactivation when prophylactic entecavir was discontinued 12 months after the last cycle of chemotherapy. HBV infection status did not affect the clinical outcome and prognosis of cHL patients, especially in the era of prophylactic antiviral therapy.

Creation and annihilation of topological meron pairs in in-plane magnetized films

Merons which are topologically equivalent to one-half of skyrmions can exist only in pairs or groups in two-dimensional (2D) ferromagnetic (FM) systems. The recent discovery of meron lattice in chiral magnet Co₈Zn₉Mn₃ raises the immediate challenging question that whether a single meron pair, which is the most fundamental topological structure in any 2D meron systems, can be created and stabilized in a continuous FM film? Utilizing winding number conservation, we develop a new method to create and stabilize a single pair of merons in a continuous Py film by local vortex imprinting from a Co disk. By observing the created meron pair directly within a magnetic field, we determine its topological structure unambiguously and explore the topological effect in its creation and annihilation processes. Our work opens a pathway towards developing and controlling topological structures in general magnetic systems without the restriction of perpendicular anisotropy and Dzyaloshinskii–Moriya interaction.

A meron is one half of a skyrmion but whether a single meron pair can be created and stabilized remains a challenging question. Here, Gao et al. develop a method to create and stabilize individual pairs of merons in a continuous Py film by local vortex imprinting from Co disks.

A mutational signature associated with alcohol consumption and prognostically significantly mutated driver genes in esophageal squamous cell carcinoma

Background

Esophageal squamous cell carcinoma (ESCC) is often diagnosed at an advanced and incurable stage. Information on driver genes and prognosticators in ESCC remains incomplete. The objective was to elucidate significantly mutated genes (SMGs), mutational signatures, and prognosticators in ESCC.

Patients and methods

Three MutSig algorithms (i.e. MutSigCV, MutSigCL and MutSigFN) and '20/20+' ratio-metric were employed to identify SMGs. Nonnegative matrix factorization was used to decipher mutational signatures. Kaplan-Meier survival analysis, multivariate Cox and logistic regression models were applied to analyze association between mutational features and clinical parameters.

Results

We identified 26 SMGs, including 8 novel (NAV3, TENM3, PTCH1, TGFBR2, RIPK4, PBRM1, USP8 and BAP1) and 18 that have been previously reported. Three mutational signatures were identified to be prevalent in ESCC including clocklike C>T at CpG, APOBEC overactive C>T at TpCp[A/T], and a signature featured by T>C substitution. The T>C mutational signature was significantly correlated with alcohol consumption (OR: 3.59; 95% CI: 2.30-5.67; P < 0.001). This alcohol consumption signature was also observed in liver cancer and head and neck squamous cell carcinoma, and its mutational activity was substantially higher in samples with mutations in TP53. Survival analysis revealed that TENM3 mutations (HR: 5.54; CI: 2.68-11.45; P < 0.001) and TP53 hotspot mutation p.R213* (HR: 3.37; CI: 1.73-8.06; P < 0.001) were significantly associated with shortened survival outcome. The association remained statistically significant after controlling for age, gender, TNM stage and tumor grade.

Conclusions

We have uncovered several new SMGs in ESCC and defined an alcohol consumption related mutational signature. TENM3 mutations and the TP53 hotspot mutation p.R213* are independent prognosticators for poor survival in ESCC.

Elevated aerobic glycolysis in renal tubular epithelial cells influences the proliferation and differentiation of podocytes and promotes renal interstitial fibrosis

OBJECTIVE

The aim of this study was to elaborate the influence of changing energy metabolism pattern of renal tubular epithelial cells in the process of renal interstitial fibrosis on podocytes. Meanwhile, we also investigated the relationship between energy metabolism pattern and the development of renal interstitial fibrosis.

MATERIALS AND METHODS

We established a model of renal interstitial fibrosis by unilateral ureteral obstruction (UUO). The protein and messenger RNA (mRNA) expression of fibrosis signs, such as α-smooth muscle actin (α-SMA) and fibronectin (FN) were detected. We also measured the protein and mRNA expression of key glycolytic enzymes, including pyruvate kinase muscle isozyme 2 (PKM2) and human glandular kallikrein 2 (HK2). The proliferation and differentiation of podocytes during fibrosis were observed by monitoring the expression of nephrin and myocardin. In vitro experiments, primary podocytes were extracted, cultured, and stimulated with lactate. Then the alterations during the process were observed. Finally, PKM2 expression was inhibited by intravenous infusion of the plasmid. The link between the expression of marker protein as well as differentiation protein in podocytes and renal interstitial fibrosis was analyzed.

RESULTS

During the process of renal interstitial fibrosis, phenotypic changes and enhanced expression of fibrosis and proliferation markers were found in fibroblasts. Meanwhile, in renal tubular epithelial cells, increased expression of key enzymes of glycolysis, the level of glycolysis as well as lactate metabolites cooperatively led to hypoxic and acidic environment, eventually inhibiting the proliferation and differentiation of podocytes and aggravating fibrosis. When the level of glycolysis in renal tubular epithelial cells was reduced, the number and function of podocytes were partially restored, and renal interstitial fibrosis was alleviated.

CONCLUSIONS

During renal interstitial fibrosis, glycolysis of renal tubular epithelial cell was increased, leading to the recodification of energy metabolism. This process affected the number and function of podocytes and aggravated renal interstitial fibrosis.

[High level of hemoglobin during the first trimester of pregnancy associated with the risk of gestational diabetes mellitus]

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM (OR=2.799, 95%CI: 1.186-6.604; P<0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

Preliminary evaluation of GLP-1R PET in the diagnosis and risk stratification of pheochromocytomas

Noninvasive imaging methods for the diagnosis and risk stratification of pheochromocytomas (PHEOs) remain a great clinical challenge. The glucagon-like peptide-1 receptor (GLP-1R) has been validated to be overexpressed in PHEOs and therefore may be a reliable target for PHEOs. In this study, we firstly synthesized a novel radiotracer 68Ga-NOTA-MAL-Cys39-exendin-4 that specifically targets GLP-1R and evaluated the performance of GLP-1R PET for the diagnosis and risk stratification of PHEOs. Cys39-exendin-4 was conjugated to NOTA-MAL and then radiolabeled with 68Ga. The reaction was completed within 20 min with a yield of 91.6 ± 2.8%. In vitro cell uptake studies validated its high specificity. PET images showed promising tumor visualization with high uptake (1.88 ± 0.10 %ID/g for PC-12 poorly differentiated tumors and 1.09 ± 0.003 %ID/g for PC-12 highly differentiated tumors at 30min after injection). There was a significant difference in the uptake of 68Ga-NOTA-MAL-Cys39-exendin-4 between PC-12 poorly and highly differentiated tumors (p < 0.001), but no significant difference could be observed by 18F-FDG PET. Biodistribution results confirmed the findings of GLP-1R PET and demonstrated that 131I-MIBG couldn't be used for the risk stratification of PHEOs. Immunohistochemistry (IHC) staining revealed differences in GLP-1R expression between PC-12 poorly and highly differentiated tumor tissues. These results demonstrated that 68Ga-NOTA-MAL-Cys39-exendin-4 can specifically target GLP-1R with favorable pharmacokinetic properties. GLP-1R PET can be used for PHEOs detection and has potential for the risk stratification of PHEOs.

[Changes of surgical interventions on necrotizing pancreatitis]

Objective: To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data. Methods: One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ(2) test was used for the statistical test. Results: Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175 /1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018,which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant,4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period,debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346),and 6.03%(23/365) and 6.91%(27/346), respectively. Conclusions: Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don't decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.

[Changes of surgical interventions on necrotizing pancreatitis]

Objective: To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data. Methods: One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ(2) test was used for the statistical test. Results: Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175 /1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018,which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant,4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period,debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346),and 6.03%(23/365) and 6.91%(27/346), respectively. Conclusions: Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don't decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.

P1216Evaluation of alphavbeta3 integrin-targeted positron emission tomography and photoacoustic tracer for imaging of carotid plaque in apoE–/– mice

Background

Cardiovascular disease is the leading cause of death in the world. The majority of cardiovascular events result from the rupture of vulnerable atherosclerotic plaques, which are characterized by high and active macrophage content. The integrin αVβ3 is expressed by activated macrophages and endothelial cells in atherosclerotic lesions and thus is a marker of high-risk plaques. Therefore, 89Zr-RGD-melanin nanoparticle (MNP) positron emission tomography (PET)/photoacoustic imaging (PAI) imaging of αVβ3 expression in plaques might provide a novel noninvasive biomarker of plaque vulnerability.

Purpose

In this study, the intrinsic photoacoustic signals and the native strong chelating properties with metal ions of MNP, positron-emitting metal ions 89Zr and αVβ3 integrins targeting ability of cyclic c (RGDfC) peptide was employed to construct an efficient nanoplatform. And we evaluated the feasibility of 89Zr-RGD-MNP PET/PAI of αVβ3 expression in vivo and in vitro.

Methods

We conjugated αVβ3 integrins, cyclic c (RGDfC) peptide, to MNP and chelated the long-lived positron-emitting nuclide 89Zr. The bio-stability and targeting action was detected in macrophages. And the PET/PAI imaging was performed in apoE−/− mice with partial carotid ligation leading to atherosclerosis. In PET imaging, tracer uptake was measured in the stenotic areas of the carotid arteries, as well as on the contralateral side at different time points in vivo. In PAI, photoacoustic signal was measured in the atherosclerosis of the carotid arteries in vivo. Melanin staining and immunohistochemistry of αVβ3 expression were detected in atherosclerosis of the carotid arteries.

Results

89Zr-RGD-MNP showed excellent bio-stability and targeting action. PET imaging showed specific tracer accumulation at plaques in the left carotid artery, confirmed by competitive receptor blocking studies and the contrast in the right carotid artery. In the biodistribution studies, the left carotid (5.29%±0.78%) showed higher uptake than the right carotid (2.11%±1.55%). PAI showed the PA signal in the surgery group (452±85 a.u.) were stronger than the control (156±45 a.u.) and blocking group (254±66 a.u). The result was consistent with PET imaging and the presence of nanoparticles, as indicated by pathological examinations. These results presented good in vivo multimodality imaging (PET/PAI) properties.

Conclusions

We have developed 89Zr-labeled atherosclerotic plaques imaging agents based on the natural melanin nanoparticle. 89Zr-RGD-MNP demonstrates specific tracer accumulation in mice atherosclerotic carotid plaques. In this model, its uptake was associated with αVβ3 expression. 89Zr-RGD-MNP is a potential tracer for noninvasive imaging in atherosclerosis.

Acknowledgement/Funding

National Natural Science Foundation of China 81770452, 81470401

Field-induced magnetic transitions and strong anisotropy in α-CoV2O6 single crystal

The Ising-like antiferromagnet α-CoV₂O₆ has received considerable interests because of stabilized 1/3 magnetization plateau around 5 K under magnetic field applied along magnetic easy c-axis. In this work, this magnetization plateau was studied by varying temperature or rotating magnetic field. As temperature decreased, this stabilized plateau collapsed, and additional magnetic transitions were observed. As a result, a rich magnetic phase diagram was constructed and extended to temperature lower than previously reported. When magnetic field moved from the c to b (or a) axis, the magnetization plateau developed with field directions and vanished finally when the field was restricted in the ab plane. An impressive observation is that this 1/3-plateau can be stabilized and remain robust even when magnetic field deviated from the c axis, accompanied by the evolutions of the magnetic moments and the critical transition fields. We suppose that the origins of these temperature and angular dependences of the 1/3 magnetization plateau are related to strong spin-orbital coupling. Indeed, electron spin resonance (ESR) measurement gives large Landé factor of 8.9, evidencing that there exists strong spin-orbital coupling.

Two linked TBXT (brachyury) gene polymorphisms are associated with the tailless phenotype in fat-rumped sheep

T‐box transcription factor T (TBXT), encoding the brachyury protein, is an embryonic nuclear transcription factor involved in mesoderm formation and differentiation. Previous studies indicate that TBXT mutations are responsible for the tailless or short‐tailed phenotype of many vertebrates. To verify whether the tailless phenotype in fat‐rumped sheep is associated with TBXT mutations, exon 2 of the TBXT gene for 301 individuals belonging to 13 Chinese and Iranian sheep breeds was directly sequenced. Meanwhile, 380 samples were used to detect the genotypes of the candidate variations by mapping to their reads databases in the Sequence Read Archive repository of GenBank. The results showed that one missense mutation, c.334G>T (GGG>TGG) with a completely linked synonymous variant c.333G>C (CCG>CCC) was found to be associated with the ‘tailless’ characteristic in typical fat‐rumped sheep breeds. The c.334G>T transversion led to the conversion of glycine to tryptophan at the 112th amino acid in the T‐box domain of the brachyury protein. In addition, crossbreeding experiments for long‐tailed and tailless sheep showed that CT/CT allele of nucleotides (nt) 333 and 334, a recessive mutation, would cause sheep tails to be shorter, suggesting that these two linked variants at nucleotides 333 and 334 in TBXT are probably causative mutations responsible for the tailless phenotype in sheep.

The mechanism of miR-23a in regulating myocardial cell apoptosis through targeting FoxO3

OBJECTIVE

Myocardial cell apoptosis represents important pathologic basis of ischemia-reperfusion injury (I/R). MiR-23a is related to myocardial hypertrophy and cardiac remodeling by regulating myocardial cell growth and apoptosis. This study intended to observe the regulating effect of miR-23a in myocardial cell and related target, and investigate its clinical significance to I/R injury.

MATERIALS AND METHODS

The rats were divided into sham group and myocardial I/R group. Myocardial cell cycle and miR-23a expression were tested. H2O2 was applied to treat H9c2 rat myocardial cell to simulate oxidative stress during I/R. The cells were divided into blank group, NC group, miR-23a mimic group, H2O2 group, and miR-23a + H2O2 group. ROS content and cell apoptosis were detected by flow cytometry. MiR-23a, FoxO3a, and BIM gene expression were determined by qRT-PCR. FoxO3a and BIM protein levels were measured by Western blot.

RESULTS

Compared with sham group, myocardial apoptosis increased, while miR-23a expression was significantly downregulated in I/R group. H2O2 treatment markedly increased ROS levels in H9c2 cells and elevated apoptosis. The overexpression of mMiR-23a effectively reduced cell apoptosis induced by H2O2 treatment. H2O2 treatment significantly decreased miR-23a expression, while markedly elevated the levels of FoxO3a and BIM. The overexpression of miR-23a apparently impeded the induction of FoxO3a and BIM by H2O2.

CONCLUSIONS

The downregulation of miR-23a plays a negative role in oxidative stress and cell apoptosis induced by I/R. The overexpression of miR-23a is of significance to alleviate cell apoptosis through inhibiting FoxO3a and downstream target BIM expression.

[Diagnostic value of HBP, PCT combined with APACHE Ⅱ score respectively in ventilator-associated pneumonia]

Objective: To evaluate the diagnostic value of the heparin-binding protein (HBP), procalcitonin (PCT) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in ventilator-associated pneμmonia (VAP). Methods: A total of 160 patients who required tracheotomy or intubation and assisted breathing with invasive mechanical ventilator from the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 was included in this prospective study,and divided into VAP group and no-VAP group based on if VAP happened or not; the VAP group was further divided into deterioration group and improvement group based on the curative effect after anti-infective treatment for 1 week. A total of 40 community acquired pneumonia (CAP) patients and 30 healthy volunteers were also included as control groups. The levels of HBP and PCT in blood of the subjects were tested with enzyme-linked immuno sorbent assay (ELISA) and chemiluminescence immunoassay (ECLIA) respectively, APACHE Ⅱ score was utilized to assess the severity of illness. The difference of HBP, PCT levels and APACHE Ⅱ score among the groups were analyzed. Receiver operating characteristic(ROC) curve was utilized to analyze the diagnostic value of HBP, PCT, APACHE Ⅱ score in VAP. Results: A total of 230 subjects participated in this study, including 68 VAP patients, 92 non-VAP patients, 40 CAP patients and 30 healthy volunteers. Before administration of mechanical ventilation, there were no statistically significant differences in HBP, PCT and APACHE Ⅱ score between VAP group and non-VAP group (all P>0.05). The levels of HBP,PCT and APACHE Ⅱ score were (41.4±21.3) μg/L,(0.355±0.254) μg/L,(13.4±2.5) respectively when the VAP was diagnosed,which were higher than those within the first 12 h of mechanical ventilation (7.3±2.7) μg/L, (0.080±0.038) μg/L, (8.4±2.0), all P<0.001). The HBP, PCT and APACHE Ⅱ score had no significant difference between within the first 12 h of mechanical ventilation and after mechanical ventilation in non-VAP group (all P>0.05). The levels of HBP was positively correlated with PCT and APACHE Ⅱ score (r=0.82, 0.68, all P<0.001). In deterioration group,the HBP,PCT and APACHE Ⅱ score after 1 week of anti-infective treatment were higher than those when the VAP was diagnosed (all P<0.001). No matter it is when the VAP was diagnosed or after anti-infective treatment for 1 week,the levels of HBP, PCT and APACHE Ⅱ score in deterioration group were higher than those in the improvement group (all P<0.001). The area under curve (AUC) of HBP+APACHE Ⅱ score, PCT+APACHE Ⅱ score for VAP diagnosis was 0.98, 0.95 respectively. The sensitivity of HBP+APACHE Ⅱ score in the diagnosis of VAP was lower than PCT+APACHE Ⅱ score (94.1% vs 95.6%),and the specificity was higher (92.4% vs 82.6%). Conclusion: The diagnostic value of HBP+APACHE Ⅱ score for early VAP is superior to PCT+APACHE Ⅱ score.

Nectar yeasts enhance the interaction between Clematis akebioides and its bumblebee pollinator

It has been hypothesised that intense metabolism of nectar-inhabiting yeasts (NIY) may change nectar chemistry, including volatile profile, which may affect pollinator foraging behaviours and consequently plant fitness. However, empirical evidence for the plant-microbe-pollinator interactions remains little known. To test this hypothesis, we use a bumblebee-pollinated vine Clematis akebioides endemic to southwest China as an experimental model plant. To quantify the incidence and density of Metschnikowia reukaufii, a cosmopolitan NIY in floral nectar, a combination of yeast cultivation and microscopic cell-counting method was used. To examine the effects of NIY on plant-pollinator interactions, we used real flowers filled with artificial nectar with or without yeast cells. Then the volatile metabolites produced in the yeast-inoculated nectar were analysed with coupled gas chromatography and mass spectrometry (GC-MS). On average 79.3% of the C. akebioides flowers harboured M. reukaufii, and cell density of NIY was high to 7.4 × 10⁴ cells mm^-3 . In the field population, the presence of NIY in flowers of C. akebioides increased bumblebee (Bombus friseanus) pollinator visitation rate and consequently seed set per flower. A variety of fatty acid derivatives produced by M. reukaufii may be responsible for the above beneficial interactions. The volatiles produced by the metabolism of M. reukaufii may serve as an honest signal to attract bumblebee pollinators and indirectly promote the female reproductive fitness of C. akebioides, forming a potentially tripartite plant-microbe-pollinator mutualism.

Decreased A20 expression on circulating CD56bright NK cells contributes to a worse disease status in patients with ankylosing spondylitis

A20, a pivotal anti-inflammatory protein, preserves immune homeostasis and regulates prolonged inflammation. A previous study has shown that A20 expression levels are down-regulated in peripheral blood mononuclear cells (PBMCs) from patients with ankylosing spondylitis (AS). However, the precise role of A20 in reducing autoimmune disorders needs to be further elucidated. In this study, A20 expression was found to be preferentially reduced on circulating CD56^bright natural killer (NK) cells in patients with AS, and its level was negatively correlated with that of proinflammatory cytokines. Further investigation demonstrated that A20 reduces interferon (IFN)-γ and tumour necrosis factor (TNF)-α production in CD56^bright NK cells after stimulation with monokines or phorbol myristate acetate (PMA)/ionomycin(P/I). Furthermore, CD56^bright NK cells isolated from AS patients promote TNF-α secretion by autologous monocytes, and increasing the A20 expression level partially attenuates this process. More importantly, decreased A20 expression on circulating CD56^bright NK cells is associated with worse disease status in patients with AS. Our findings reveal that A20 participates in the pathogenesis of AS by negatively regulating CD56^bright NK cells and that its reduced expression contributes to a worsened disease status in patients with AS.

Beclin1 enhances cisplatin-induced apoptosis via Bcl-2-modulated autophagy in laryngeal carcinoma cells Hep-2

To investigate the role of Beclin1 in cisplatin-induced apoptosis in laryngeal carcinoma cells Hep-2 and to explore the potential mechanism. We up-regulated Beclin1 expression in Hep-2 cells. The survival rate and apoptotic rate were evaluated by MTT and flow cytometry (FCM). The Beclin1 overexpression group and the control group were treated with cisplatin for 24 hours. The proliferation and cell apoptosis of laryngeal cancer cell lines were evaluated. The mitochondrial membrane potentials were detected by DiOC6(3). Activities of Caspase-8/9/3 and convention of microtubule-associated protein one light chain 3 (LC3) were detected by western blot. The effect of Bcl-2 overexpression on increased cisplatin-sensitivity and autophagy induced by Beclin1 was investigated using Bcl-2 cDNA transfection. Expression of Beclin1 in Hep-2 cells was meaningfully enhanced by transfection, and the proliferation and the apoptosis were not considerably affected. By cisplatin treatment, the Beclin1 overexpression group showed lower survival rate and higher apoptotic rate than the control group (p<0.05). Decrease of mitochondrial membrane potential and increase of activities of Caspase-8, Caspase-9 and Caspase-3 were detected. Beclin1 overexpression increase the convention of LC3, especially after the cisplatin treatment. Overexpression of Bcl-2 decreased the cisplatin-induced apoptosis and inhibited Beclin1-induced autophagy. In conclusion, Beclin1 enhances cisplatin-induced apoptosis in laryngeal carcinoma cells Hep-2 via Bcl-2 modulated autophagy.

A Novel SCN9A Mutation (F826Y) in Primary Erythromelalgia Alters the Excitability of Nav1.7

BACKGROUND

Primary erythromelalgia (PE) is a dominant inherited disorder characterized by recurrent pain, redness, and warmth of the extremities that is caused by gain-of-function mutations in Nav1.7 encoding gene SCN9A. Most of the PE-causing mutations of Nav1.7 have been shown to be able to render Nav1.7-expressing cells hyperexcitable, however in most PE cases the symptoms are refractory to treatment with sodium channel blockers and the mechanism underlying the intractability has not been clearly clarified.

OBJECTIVE

To identify the mutation of SCN9A in a Chinese Han family with typical symptoms of PE and study the electrophysiological effect of the identified mutation.

METHODS

A Chinese Han family with typical symptoms of PE was collected and the proband's response to treatment was recorded. All the exons and flanking intronic sequences of SCN9A were amplified with PCR and sequenced. Several online programs were used to predict the damaging effect of variants. The functional effect of variants was studied by voltage-clamp analysis in CHO-K1 cells.

RESULTS

The PE symptoms of the proband are refractory to all kinds of reported medications. Sequence analysis of SCN9A showed that a novel c.2477T>A (p. F826Y) mutation co-segregated with the disease phenotype. Several online programs predicted that the F826Y mutation has a deleterious effect on the gene product. Voltage-clamp analysis showed that while compared with the wild-type channel, activation of the F826Y mutant channel was shifted by 7.7 mV in a hyperpolarizing direction, whereas steadystate inactivation was shifted by 4.3 mV in a depolarizing direction.

CONCLUSION

A novel disease-causing SCN9A Mutation (F826Y) was identified in a Chinese family with typical PE symptoms refractory to treatment. F826Y of Nav1.7 could render DRG neurons hyperexcitable, contributing to the pathogenesis of PE.

Mechanisms of Toxicity and Cardiotoxicity of Alcohol Extract from Root, Stem and Leaf of Chloranthus Serratus

Abstract

Objective To compare the differences of cardiotoxicity of alcohol extract from root, stem and leaf of Chloranthus serratus in the rats, and discuss preliminarily its mechanism of toxicity. Methods Rats were randomly divided into four groups: blank, root alcohol, stem alcohol and leaf alcohol, with 8 in each group. After 14 days of continuous intragastric administration, the body mass change curves were drawn. The cardiac coefficient was calculated. The contents of creatine kinase （CK）, creatine kinase isoenzyme （CK-MB）, lactate dehydrogenase （LDH） and α-hydroxybutyrate dehydrogenase （α-HBDH） as well as the content changes of oxidative stress indexes - total superoxide dismutase （T-SOD） and malondialdehyde （MDA） in the serum of rats were detected. The cardiac pathomorphology changes in the rats were observed. The expression of intercellular adhesion molecule （ICAM-1） and heme oxygenase （HO-1） in myocardial tissue was detected. Results Body mass growth rate： stem alcohol group was the smallest, followed by leaf alcohol group. The difference of cardiac coefficient of every group had no statistical significance （P>0.05）. The myocardial tissues of stem alcohol group suffered the most serious damage, followed by the leaf alcohol group. The contents of CK, CK-MB, LDH and α-HBDH in stem alcohol group increased （P<0.05）. The increase of MDA content and decrease of T-SOD content in stem alcohol group had statistical significance compared with the blank group and root alcohol group, while the leaf alcohol group only had statistical significance in the decrease of T-SOD content compared with the blank group （P<0.05）. The positive expression of ICAM-1 enhanced and the expression of HO-1 protein decreased in every group after the intervention of different extracts. The change trend was stem alcohol > leaf alcohol > root alcohol group. Conclusion The alcohol extract from the stem has the highest cardiotoxicity, followed by the leaf extract, and its mechanism of toxicity may be related to oxidative stress.

[Altered regional brain activity of functional connectivity in patients with obstructive sleep apnea]

Objective: To investigate the changes of default mode network in subjects with obstructive sleep apnea (OSA) using functional connectivity (FC). Methods: Clinical data were collected from thirty-three subjects with OSA who went to the Zhongda Hospital, Southeast University, and twenty-nine normal controls were recruited from community from Jan 2016 to Jan 2018. The OSA group was divided into two subgroups according to apnea-hypopnea index (AHI) and the lowest oxygen saturation at night: 15 patients in the mild group and 18 in the moderate to severe group. Both of the two group subjects underwent functional magnetic resonance imaging scans, and their default network was extracted based on independent component analysis to compare the differences in FC. Results: Body Mass Index (BMI), AHI, oxygen desaturation index (ODI), mini-mental state examination (MMSE) and Epworth Sleepiness Scale (ESS) in the OSA group were significantly higher than those in the control group [(27.1±4.3) vs (22.2±2.7) kg/m(2), (29.5±22.1) vs (2.4±1.6) events/h, 19.5 (4.6, 39.1) vs 0.6 (0.2, 1.6) events/h, (27.5±1.5) vs (29.4±0.8) score, (8.6±3.3) vs (3.5±1.6) score] (all P<0.001). The OSA group showed an increase in left limbic lobe, left cingulate, left parietal lobe, left inferior parietal lobule; a decrease in bilateral temporal lobe, bilateral limbic lobe and parahippocampa gyrus, left frontal lobe in FC value, compared with the normal control group (all P<0.001). The moderated-severe group showed a significant increase in the left occipital lobe, bilateral cuneus, right parietal lobe; a decrease in the bilateral parietal lobe, inferior parietal lobule in FC value compared with the mild group (all P<0.01). Conclusions: The FC of default mode network in OSA group is disrupted, with parts of brain regions suffering injury,while parts of brain regions experiencing compensatory reaction. Additionally, the compensatory period translates to the decompensation period with disease progression in OSA group.

[Efficacy of bronchoalveolar lavage and its influence factors in the treatment of Mycoplasma pneumoniae pneumonia with atelectasis]

Objective: To investigate the efficacy of bronchoalveolar lavage (BAL) and its influence factors in the treatment of Mycoplasma pneumoniae pneumonia (MPP) with atelectasis. Methods: A retrospective case control study was performed on hospitalized MPP patients with atelectasis and received BAL in the Department of Pulmonology, Children's Hospital Zhejiang University School of Medicine from January 1, 2015 to July 31, 2017. Fever relieved in 48 hours and chest imaging improved in one week after BAL were considered effective. Clinical data, including age, sex, blood routine tests, lactate dehydrogenase (LDH), cytokines, complications, fever duration before BAL, course of disease before BAL, sputum plug, atelectasis area and its CT values of atelectasis site were collected. Student's t test, Mann-Whitney U test, or chi square test were used. Results: (1) A total of 163 patients were enrolled, including 69 boys and 94 girls, with the ratio of 1∶1.36. Their ages ranged from 6 months to 12.6 years. (2) On the day of bronchoscope, 113 patients still had fever. They were divided into effective group (n=66) and ineffective group (n=47) according to whether fever was relieved in 48 hours after BAL. The effective group were found to have less sputum plug compared with the ineffective group (33% (22/66) vs. 57% (27/47), χ(2)=6.499, P=0.011). The other factors such as sex, age, fever duration before BAL, course of disease before BAL, C reactive protein (CRP), LDH, IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, atelectasis area and CT value showed no significant difference between the two groups (all P>0.05). (3)A total of 122 cases had chest imaging after BAL. According to chest imaging improvement, they were divided into effective group (n=81) and ineffective group (n=41). The effective group showed lower CT value ((58±9) vs. (63±8) HU, t=-2.436, P=0.017), IL-6 and IL-10 (M(Q(1), Q(3))) (21.0 (1.9, 48.4) vs. 36.4(21.8, 93.6), 4.9 (3.7, 9.6) vs. 7.7 (4.4, 12.0) ng/L, Z=-2.387,-2.009, P=0.017, 0.045). Sex, age, fever duration before BAL, course of disease before BAL, CRP, LDH, IL-2, IL-4, TNF, IFN-γ, atelectasis area showed no significant differences between the two groups (all P>0.05). (4) Patients were divided into sputum plug group (57 cases) and non sputum plug group (106 cases) according to bronchoscopic findings. The sputum plug group showed higher LDH, CRP, IL-6, IFN-γ, incidence of pleural effusion and extrapulmonary complications (585(433, 833) vs. 369 (312, 588) U/L, 42 (19, 103) vs. 25 (12, 45) mg/L, 38.8 (22.1, 71.3) vs. 20.7 (9.2, 48.3) ng/L, 33.1 (13.5, 89.3) vs. 12.7 (6.5, 33.6) ng/L, 73.7% (42/57) vs. 52.8% (56/106), 40.4% (23/57) vs. 17.0% (18/106)), with statistically significant differences (Z=-4.865,-3.435,-3.098,-3.704, χ(2)= 0.010, 0.001, all P<0.01) . Additionally, fewer patients showed fever relief within 48 hours after BAL in the cases with sputum plug cases compared those without sputum plug (44.9% (22/49) vs. 68.8% (44/64), χ(2)= 0.011, P=0.009). Fewer patients showed chest imaging improvement within one week after BAL in the cases with sputum plug compared with those without sputum plug, but did not show significant difference (56.5% (26/46) vs. 72.4% (55/76), χ(2)=0.073, P=0.056). Conclusions: BAL has some therapeutic effect on fever or atelectasis in MPP children complicated with atelectasis. Chest imaging improvement or fever relief may be hampered by sputum plug, increased IL-6 or IL-10.

[Impact of hypoxia-reoxygenation environment on autophagy level of osteoblasts]

Objective: To investigate the impact of hypoxia-reoxygenation environment on the level of autophagy in osteoblasts. Methods: Osteoblasts were purified from the skulls of newborn SD rats within 24-48 hours by tissue block adherence culture and differential centrifugation. The osteoblasts were identified by alizarin red staining and alkaline phosphatase staining. The third generation osteoblasts were cultured in normal state and randomly divided into four groups: group A was cultured under normal condition for 36 hours; group B was cultured under normal condition for 18 hours, then under hypoxia for 18 hours; group C was cultured under hypoxia for 36 hours; group D was cultured under hypoxia for 18 hours, and then under normal condition for 18 hours. The ability to form calcium nodules of osteoblasts in the four groups was observed after culture. The proliferation activity of osteoblasts was detected by CCK-8 assay. The expressions of autophagy specified gene Beclin 1, microtubule-associated protein light chain 3(LC3) and collagen Ⅰ(COL-Ⅰ), bone morphogenetic protein 2 (BMP-2) genes were detected by real time polymerase chain reaction (RT-PCR), and the protein expressions of Beclin 1, LC3-Ⅰ,LC3-Ⅱ and P62 were detected by immunoblotting. Results: Alizarin red staining showed that osteoblasts in group A had the strongest calcification ability, and calcification ability of osteoblasts in group B,C and D lowered gradually, and it was lowest in group D. The proliferative activity under the CCK-8 detection in group A, B, C and D was 98%±8%, 90%±8%,82%±9%,76%±8%, respectively (F=35.764, P=0.000). The mRNA expression of Beclin 1, LC3-Ⅱthe 4 groups increased gradurally (group D> group C> group B> group A)(F=38.327, 16.583, both P<0.05); and the mRNA expression of COL-Ⅰ, BMP-2 decreased gradually in the 4 groups (group A> group B> group C> group D) (F=20.387, 12.426, both P<0.05). The protein expression of Beclin 1,LC3-Ⅱ/LC3-Ⅰ increased gradually in the groups (group D>group C>group B>group A) (F=26.843, 28.576, bothP<0.05), and the expression of P62 protein decreased gradually (F=18.946, P=0.011). Conclusions: Hypoxia-reoxygenation environment can reduce the proliferation activity of osteoblasts and up-regulate the expression of autophagy-related genes in osteoblasts. Anoxic reoxygenation environment promotes the increasing of autophagy levels in osteoblasts.

In-vitro analysis of a novel 'add-on' silicone cuff to improve sealing properties of tracheal tubes

Leakage of colonised oropharyngeal secretions across the tracheal tube cuff may cause iatrogenic pulmonary infection. We studied a novel 'add-on' cuff, which can be inserted over an existing tracheal tube and advanced into the subglottic region. The physical properties of the novel silicone cuff (BronchoGuard, Ciel Medical, USA) were evaluated in comparison with the Hi-Lo^® tracheal tube. In a bench study, we identified saline inflation volumes required to transmit pressures between 15 and 30 cmH₂ O against artificial tracheas of 18, 20 and 22 mm internal diameter. We computed cuff compliance, and minimal inflation volume to achieve air sealing during mechanical ventilation. Finally, we compared the leakage flow rate of artificial saliva across the novel cuff. On average, the mean (SD) inflation volumes necessary to transmit tracheal pressures of 15, 20, 25 and 30 cmH₂ O were 4.1 (2.2), 4.4 (2.3), 4.6 (2.4) and 4.8 (2.4) ml for the novel cuff and 7.7 (2.5), 8.0 (2.6), 8.4 (2.6) and 8.7 (2.7) ml for the Hi-Lo tube, respectively (p < 0.001). The minimal inflation volumes to achieve air sealing were 3.8 (0.9) and 10.5 (2.1) ml (p < 0.001), which resulted in transmitted tracheal pressures of 8.3 (9.8) and 27.6 (34.8) cmH₂ O (p < 0.001). Compliance was 0.026 (0.004) and 0.616 (0.324) ml.cmH₂ 0^-1 , respectively (p < 0.001). Although massive leak was found when the novel cuff transmitted pressures ≤ 20 cmH₂ O against the trachea, leakage was avoided with pressures ≥ 25 cmH₂ O, owing to optimal contact between the cuff and the tracheal wall. In contrast, the standard cuff consistently leaked irrespective of the pressure. We conclude that the novel cuff has advantageous properties that warrant clinical corroboration.

[Brain alteration in neonates with congenital heart disease using apparent diffusion coefficient histograms]

Objective: To evaluate the value of apparent diffusion coefficient (ADC) histogram in neonatal brain alteration with congenital heart disease (CHD). Methods: MRIs of 60 neonates with CHD confirmed by echocardiography were retrospectively analyzed in Children's Hospital of Nanjing Medical University from January 2012 to December 2016.Twenty-two MRIs of neonates with mild pneumonia or scalp hematoma who were suspicious of brain disease but normal MRI findings were enrolled as normal control.MRIcron and ImgJ softwares were used to acquire ADC histogram.The correlation between the gestational age and ADC histogram values were calculated respectively.Then t-test was used to analyze the differences of the histogram values and the diagnostic efficacy of different parameters was analyzed using the receiver operating characteristic curve. Results: The ADC values were significantly correlated with the gestational age (P<0.05). The 70th-90th ADC, skewness, kurtosis and variance were statistically significant (P<0.05). The area under the curve of the 90th ADC value was the largest at 0.698. Conclusions: The ADC histogram can quantify and objectively provide more diffusion information of brain tissue. It is a rapid and feasible quantitative method to identify brain changes in neonates with CHD.