Pseudorapidity Dependence of Particle Production and Elliptic Flow in Asymmetric Nuclear Collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200 GeV

Asymmetric nuclear collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200  GeV provide an excellent laboratory for understanding particle production, as well as exploring interactions among these particles after their initial creation in the collision. We present measurements of charged hadron production dN_{ch}/dη in all such collision systems over a broad pseudorapidity range and as a function of collision multiplicity. A simple wounded quark model is remarkably successful at describing the full data set. We also measure the elliptic flow v_{2} over a similarly broad pseudorapidity range. These measurements provide key constraints on models of particle emission and their translation into flow.

Formation of n- and p-type regions in individual Si/SiO2 core/shell nanowires by ion beam doping

A method for cross-sectional doping of individual Si/SiO₂ core/shell nanowires (NWs) is presented. P and B atoms are laterally implanted at different depths in the Si core. The healing of the implantation-related damage together with the electrical activation of the dopants takes place via solid phase epitaxy driven by millisecond-range flash lamp annealing. Electrical measurements through a bevel formed along the NW enabled us to demonstrate the concurrent formation of n- and p-type regions in individual Si/SiO₂ core/shell NWs. These results might pave the way for ion beam doping of nanostructured semiconductors produced by using either top-down or bottom-up approaches.

Delineation of disease phenotypes associated with esophageal adenocarcinoma by MALDI-IMS-MS analysis of serum N-linked glycans

N-Linked glycans, extracted from patient sera and healthy control individuals, are analyzed by Matrix-assisted laser desorption ionization (MALDI) in combination with ion mobility spectrometry (IMS), mass spectrometry (MS) and pattern recognition methods. MALDI-IMS-MS data were collected in duplicate for 58 serum samples obtained from individuals diagnosed with Barrett's esophagus (BE, 14 patients), high-grade dysplasia (HGD, 7 patients), esophageal adenocarcinoma (EAC, 20 patients) and disease-free control (NC, 17 individuals). A combined mobility distribution of 9 N-linked glycans is established for 90 MALDI-IMS-MS spectra (training set) and analyzed using a genetic algorithm for feature selection and classification. Two models for phenotype delineation are subsequently developed and as a result, the four phenotypes (BE, HGD, EAC and NC) are unequivocally differentiated. Next, the two models are tested against 26 blind measurements. Interestingly, these models allowed for the correct phenotype prediction of as many as 20 blinds. Although applied to a limited number of blind samples, this methodology appears promising as a means of discovering molecules from serum that may have capabilities as markers of disease.

Developing a hospital-based combat injury registry at the Chinese Peacekeeping Level 2 Military Hospital in GAO, Mali

BACKGROUND

Having served more than 4000 personnel including the peacekeeping troops, UN police and civilian staff, the Chinese Peacekeeping Level 2 Military Hospital has accumulated 1235 inpatient medical records in 4 years. Assessment of the records stored in the CHN L2 identified that the data collected by different teams were incoherent and highlighted the need for implementation of a hospital-based combat injury registry and the establishment of a combat injury surveillance system.

METHODS

A one-page, 21-item registry form was designed to collect general information about the injuries, including such data as demographics, injury event, severity, diagnosis and treatment, and outcome. All relevant personnel was required to undergo a 2-day training in order to master the use of the registry form. The new registry form was used to collect the data on all of the cases recorded in the CHN L2 between 26 April 2014 and 31 March 2017.

RESULTS

Analysis of the collected data identified improvised explosive device as the most common (44.95%) mechanism of combat injury in Sector East of MINUSMA. Anefis, the centre of the UN logistic transit, was identified as the location where most of the combat injuries (42.20%) occurred. Based on these results, certain suggestions that addressed this threat were given to the Operation department in Sector East of MINUSMA.

CONCLUSION

A hospital-based combat injury registry was successfully developed and implemented in the Chinese Peacekeeping Level 2 Hospital. It can provide data to support the policy changes to minimise the impact of combat injuries on peacekeeping troops. The designed registry form provides more accurate estimates of the magnitude of the morbidity due to different causes in the battlefield and lays a foundation for an injury surveillance system.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

Association between 5,10-methylenetetrahydrofolate, gene polymorphism and congenital heart disease

This article is to investigate the association between C677T polymorphism of 5, 10-methylenetetrahydrofolate (MTHFR) gene and congenital heart defects (CHD). Two hundred thirty-five nuclear families (father, mother and child) with CHD were enrolled in the study (experimental group), and two hundred thirty-five healthy nuclear families were selected as a control group. Under the case-control study, the C677T polymorphism of MTHFR gene was detected with polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing. The distribution of genotype frequency in the CHD group and control group were analyzed. SPSS 13.0 software was used to analyze the data. The distribution of genotype frequency at C677T polymorphism site was significantly different between the CHD group (including ventricular septal defect, atrial septal defect, tetralogy of fallot, double outlet right ventricle, patent ductus arteriosus) (child and mother) and healthy control group (child and mother). There were no differences between CHD group-fathers and healthy control group-fathers. Analyses of the MTHFR genotypes of CHD nuclear family data with transmitted disequilibrium test (TDT) and haplotype-based haplotype relative risk statistical method both revealed significant indications that the parents transmitted more T allele of MTHFR to their CHD children. TT genotype of MTHFR gene is associated with CHD, and a mother or a child with T allele has a much higher risk of CHD.

[Diagnosis value of late gadolinium enhancement derived from magnetic resonance imaging in patients with acute myocardial infarction]

Objective: To explore the diagnosis value of late gadolinium enhancement(LGE) detected by magnetic resonance imaging(MRI) in acute myocardial infarction(AMI) patients. Methods: The clinical and MRI data of 52 AMI patients hospitalized from January 2016 to July 2017 in our hospital were retrospectively analyzed. All patients received medication and revascularization therapies after admission and cardiac magnetic resonance examination was performed within 1 week after admission. According to whether there was LGE, AMI patients were divided into LGE(+) group(33 cases) and LGE(-) group(19 cases). According to the existence of microvascular obstruction(MVO) and/or intramyocardial hemorrhage(IMH),LGE(+) patients were divided into MVO/IMH(+) group(18 cases) and MVO/IMH(-) group(15 cases). Results: (1)There were no statistical significance between the LGE(+)group and LGE(-)group in the age, gender,smoking history, hypertension, diabetes mellitus, dyslipidemia, ventricular arrhythmia, culprit vessel, left ventricular end-diastolic volume(LVEDV), and left ventricular end-systolic volume(LVESV) (all P>0.05). The left ventricular ejection fraction was significantly lower in LGE(+) group than in LGE(-) group( (38.7±17.6) % vs. (51.2±7.9)%, P=0.001). (2)The infarct size was positively correlated with LVEDV and LVESV(r=0.436,P=0.011;r=0.479,P=0.005,respectively), and negatively correlated with left ventricular ejection fraction (r=-0.641, P<0.001) in LGE(+) group. (3) The infarct size, LVEDV, and LVESV were significantly higher in MVO/IMH(+) group thanin MVO/IMH(-) group ((26.5±7.3)%vs. (16.2±8.3)%, P=0.001; (145.7±40.9)ml vs. (112.2±23.8)ml,P=0.009; (90.0±30.8)ml vs. (61.4±19.0)ml,P=0.004, respectively), and the left ventricular ejection fraction was significantly lower in MVO/IMH(+) group than in MVO/IMH(-) group ((29.8±15.0)% vs. (49.3±14.5)%, P=0.001). Conclusions: LGE detected bycardiac magnetic resonance can provide useful information on the myocardial necrosis extent of AMI patients. Presence of MVO/IMH in LGE(+) patients is linked with larger infarct size and worse cardiac dysfunction in AMI patients.

The GBA p.Trp378Gly mutation is a probable French-Canadian founder mutation causing Gaucher disease and synucleinopathies

Biallelic GBA mutations cause Gaucher disease (GD), and heterozygous carriers are at risk for synucleinopathies. No founder GBA mutations in French-Canadians are known. GBA was fully sequenced using targeted next generation and Sanger sequencing in French-Canadian Parkinson disease (PD) patients (n = 436), rapid eye movement (REM)-sleep behavior disorder (RBD) patients (n = 189) and controls (n = 891). Haplotype, identity-by-descent (IBD) and principal component analyses (PCA) were performed using single nucleotide polymorphism-chip data. Data on GD patients from Toronto and Montreal were collected from patients' files. A GBA p.Trp378Gly mutation was identified in two RBD and four PD patients (1% of all patients combined), and not in controls. The two RBD patients had converted to DLB within 3 years of their diagnosis. Haplotype, IBD and PCA analysis demonstrated that this mutation is from a single founder. Out of 167 GD patients screened, 15 (9.0%) carried the p.Trp378Gly mutation, all in trans with p.Asn370Ser. Three (20%) of the GD patients with the p.Trp378Gly mutation had developed Parkinsonism, and 11 patients had family history of PD. The p.Trp378Gly mutation is the first French-Canadian founder GBA mutation to be described, which leads to synucleinopathies and to GD type 1 when in compound heterozygosity with p.Asn370Ser.

Selection of Differential Isolates of Magnaporthe oryzae for Postulation of Blast Resistance Genes

A set of differential isolates of Magnaporthe oryzae is needed for the postulation of blast resistance genes in numerous rice varieties and breeding materials. In this study, the pathotypes of 1,377 M. oryzae isolates from different regions of China were determined by inoculating detached rice leaves of 24 monogenic lines. Among them, 25 isolates were selected as differential isolates based on the following characteristics: they had distinct responses on the monogenic lines, contained the minimum number of avirulence genes, were stable in pathogenicity and conidiation during consecutive culture, were consistent colony growth rate, and, together, could differentiate combinations of the 24 major blast resistance genes. Seedlings of rice cultivars were inoculated with this differential set of isolates to postulate whether they contain 1 or more than 1 of the 24 blast resistance genes. The results were consistent with those from polymerase chain reaction analysis of target resistance genes. Establishment of a standard set of differential isolates will facilitate breeding for blast resistance and improved management of rice blast disease.

Evolution and characterisation of the AhRAF4 NB-ARC gene family induced by Aspergillus flavus inoculation and abiotic stresses in peanut

Aflatoxin contamination in peanut is a serious food safety issue to human health around the world. Finding disease resistance genes is a key strategy for genetic improvement in breeding to deal with this issue. We identified an Aspergillus flavus-induced NBS-LRR gene, AhRAF4, using a microarray-based approach. By comparison of 23 sequences from three species using phytogenetics, protein secondary structure and three-dimensional structural analyses, AhRAF4 was revealed to be derived from Arachis duranensis by recombination, and has newly evolved into a family of several members, characterised by duplications and point mutations. However, the members of the family descended from A. ipaensis were lost following tetraploidisation. AhRAF4 was slightly up-regulated by low temperature, drought, salicylic acid and ethylene, but down-regulated by methyl jasmonate. The distinct responses upon As. flavus inoculation and the differential reactions between resistant and susceptible varieties indicate that AhRAF4 might play a role in defence responses. Temporal and spatial expression and the phenotype of transformed protoplasts suggest that AhRAF4 may also be associated with pericarp development. Because tetraploid cultivated peanuts are vulnerable to many pathogens, an exploration of R-genes may provide an effective method for genetic improvement of peanut cultivars.

Heterogeneous oxidation of indoor surfaces by gas-phase hydroxyl radicals

We investigate heterogeneous oxidation kinetics of monolayer-thick, surface-sorbed organics, namely di-n-octyl phthalate (DnOP) and palmitic acid (PA), with gas-phase OH. The pseudo-first order rate constants for organic loss at OH concentrations of 1.6 × 108  molecules/cm3 are: (2.3 ± 0.1) × 10-4 to (4.8 ± 0.8) × 10-4  s-1 , and (1.3 ± 0.5) × 10-4  s-1 for DnOP and PA, respectively. Films developed in indoor office environments over a few weeks are also oxidized using the same OH concentration. Heterogeneous decay rate constants of mass signals from these films, attributed to phthalates (MW = 390.6) and to PA, are similar to those for the single-component films, ie, (1.9 ± 0.4) × 10-4 to (3.4 ± 0.5) × 10-4  s-1 , and (1.1 ± 0.4) × 10-4  s-1 , respectively. These results suggest that the lifetimes for OH heterogeneous oxidation of monolayer-thick indoor organic films will be on the timescale of weeks to months. To support this argument, we present the first analysis of the mass transfer processes that occur when short-lived gas-phase molecules, such as OH, are taken up by reactive indoor surfaces. Due to rapid chemical production, the diffusion limitation to mass transfer is less important for short-lived molecules than for molecules with little chemical production, such as ozone.

[The quantitative evaluation of early radiation-induced changes in the salivary glands using MRI]

Objective: To quantitatively evaluate the early radiation injury of salivary glands in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). Methods: Twenty patients with NPC between 2014 and 2015 from the Second Affiliated Hospital of Soochow University were retrospectively analyzed.All patients underwent an MRI scan before and after IMRT.The volumes, T(1)WI, T(2)WI signal intensity(SIs) and apparent diffusion coefficient (ADCs) of the parotid and submandibular glands were measured.The relative signal intensity (RSIs) of each salivary gland was calculated with cerebrospinal fluid as control.The quantitative parameters of salivary glands were compared before and after radiotherapy. Results: The volumes (cm(3)) and T(1)WI RSIs of the parotid and submandibular glands (14.88±6.00, 5.21±1.76, 2.98±1.05, 1.88±0.42, respectively) were significantly lower than those before radiotherapy (22.26±8.26, 7.76±2.45, 3.58±1.02, 2.27±0.50, respectively) (t=9.921, 4.013, 10.126, 4.202, respectively, P=0.000 for all). The T(2)WI RSIs and ADCs (×10(-3) mm(2)/s) of the parotid and submandibular glands (0.50 ± 0.08, 0.41±0.04, 1.31±0.19, 1.50±0.13, respectively) were significantly higher than those before radiotherapy (0.45±0.07, 0.33±0.05, 1.02±0.21, 1.23±0.13, respectively) (t=-4.846, -9.276, -9.957, -10.679, respectively, P=0.000 for all). The volumes of parotid and submandibular glands were correlated with ADCs (r=-0.512, P=0.000; r=-0.358, P=0.001; respectively). The volumes and ADCs of submandibular glands were correlated with T(1)WI RSIs and T(2)WI RSIs(P<0.05). Conclusion: MRI can quantitatively evaluate the early changes of salivary glands after radiotherapy of nasopharyngeal carcinoma as a noninvasive method, and has high clinical application potential.

Changing distribution and abundance of the malaria vector Anopheles merus in Mpumalanga Province, South Africa

Background: The malaria vector Anopheles merus occurs in the Mpumalanga Province of South Africa. As its contribution to malaria transmission in South Africa has yet to be ascertained, an intensification of surveillance is necessary to provide baseline information on this species. The aim of this study was therefore to map An. merus breeding sites in the Ehlanzeni District of Mpumalanga Province and to assess qualitative trends in the distribution and relative abundance of this species over a 9-year period. Methods: The study was carried out during the period 2005-2014 in the four high-risk municipalities of Ehlanzeni District. Fifty-two breeding sites were chosen from all water bodies that produced anopheline mosquitoes. The study data were extracted from historical entomological records that are captured monthly. Results: Of the 15 058 Anopheles mosquitoes collected, 64% were An. merus. The abundance and distribution of An. merus increased throughout the four municipalities in Ehlanzeni District during the study period. Conclusion: The expanded distribution and increased abundance of An. merus in the Ehlanzeni District may contribute significantly to locally acquired malaria in Mpumalanga Province, likely necessitating the incorporation of additional vector control methods specifically directed against populations of this species.

Case management of malaria in Swaziland, 2011-2015: on track for elimination?

Objective: To assess adherence to malaria diagnosis and treatment guidelines (2010 and 2014) in all health care facilities in Swaziland between 2011 and 2015. Methods: This was a cross-sectional descriptive study involving all health care facilities that diagnosed and managed malaria cases in Swaziland. Patients' age, sex, diagnosis method and type of treatment were analysed. Results: Of 1981 records for severe and uncomplicated malaria analysed, 56% of cases were uncomplicated and 14% had severe malaria. The type of malaria was not recorded for 30% of cases. Approximately 71% of cases were confirmed by rapid diagnostic tests (RDT) alone, 3% by microscopy alone and 26% by both RDT and microscopy. Of the uncomplicated cases, 93% were treated with artemether-lumefantrine (AL) alone, 5% with quinine alone and 2% with AL and quinine. Amongst the severe cases, 11% were treated with AL alone, 44% with quinine alone and 45% with AL and quinine. For severe malaria, clinics and health centres prescribed AL alone more often than hospitals (respectively 13%, 12% and 4%, P = 0.03). Conclusion: RDTs and/or microscopy results are used at all facilities to inform treatment. Poor recording of malaria type causes difficulties in assessing the prescription of antimalarial drugs.

[Research Progress of the Effects of Monocular Visual Impairment on Binocular Vision]

Binocular vision refers to a progress of analysing and integrating the binocular visual signals into a whole and three-dimensional sensory perception by higher nerve centre. In this process, the interac- tion between the two eyes results in the changes of output signal, which is called binocular interaction. Through a series of subjective and objective experiments, it can be concluded that binocular interaction can be divided into three types： facilitation, summation and suppression, and the forms of binocular interaction in different visual states are different. In general, the visual signal is processed by binocular interaction, so that there are some differences between binocular vision and monocular vision. The extent of the difference can be affected by the damage of monocular vision and then affects the binocular vision. Thus, it is necessary for forensic scientists to further study the effects of the monocular visual impairment on visual function. Based on relevant data, this paper reviews the mechanism of the monocular visual impairment in binocular vision, the research methods and the application prospect in forensic science.

Puerarin Stimulates Osteogenic Differentiation and Bone Formation Through the ERK1/2 and p38-MAPK Signaling Pathways

BACKGROUND

Osteoporosis is a world-wide health problem, which leads to decreased bone strength and increased susceptibility to fractures. Puerarin, a phytoestrogen extracted from Pueraria lobata (Willd.) Ohwi, has been identified as a promising intervention for preventing bone loss and promoting bone regeneration. However, the underlying mechanisms for its anabolic action are still not clear. In the present study, we aimed to investigate the effect of puerarin on the osteogenic differentiation of bone marrow stromal cells (BMSCs) and the possible molecular mechanism mediating its action.

METHODS

Bone marrow stromal cells (BMSCs) and intragastric administration on ovariectomized(OVX) rats were used to study the anti-osteoporotic function of puerarin. The involvement of mitogen-activated protein kinase (MAPK) signaling pathways was determined.

RESULTS

Our results demonstrated that at optimal concentration, puerarin could promote osteogenic differentiation of BMSCs in vitro. This induction was mediated by MAPK signaling pathway. Further detailed study revealed that ERK1/2-Runx2 signaling pathway had more prominent effect than p38 signaling pathway in puerarin-induced differentiation of BMSCs toward the osteogenic phenotype. We also found that puerarin protected against reduction in bone mineral density and improved femur trabecular bone structure in ovariectomized rats.

CONCLUSION

Our findings revealed the functional mechanism of puerarin in promoting osteogenic differentiation which involved ERK1/2 and p38-MAPK pathway and provided experimental evidence for the potential application of puerarin for estrogen replacement therapy of osteoporosis.

The effect and mechanism of metallothionein MT1M on hepatocellular carcinoma cell

OBJECTIVE

Liver cancer is one of the most common digestive system malignant solid tumors. Its incidence and mortality rates keep high, causing serious mental and economic burden. So far, the exact mechanism of liver cancer onset has not been fully elucidated. Metallothionein (MT) widely exists in various types of organisms with highly conserved structure. It contains the short peptide of cysteine and sulfur protein with high affinity to heavy metals, including cadmium, zinc, and copper. MT1M is an important member of MT family that has been verified to participate in regulating hepatocellular carcinoma, thyroid cancer, cervical cancer, and other tumors. However, MT1M expression and mechanism in hepatoma cells have not been fully elucidated.

MATERIALS AND METHODS

Hepatoma cell line HepG2 was divided into control and MT1M group. MT1M plasmid was constructed and transfected to MT1M group. Real-time PCR was used to test MT1M expression. MTT assay was applied to detect HepG2 proliferation. Flow cytometry was performed to determine HepG2 apoptosis. Caspase-3 activity was measured. Western blot was used to detect Bcl-2 and Bax protein levels.

RESULTS

MT1M expression significantly increased after MT1M plasmid transfection compared with control (p < 0.05). MT1M group showed inhibited HepG2 proliferation, declined HepG2 apoptosis, enhanced Caspase-3 activity, reduced Bcl-2 protein level, and upregulated Bax protein compared with control (p < 0.05).

CONCLUSIONS

MT1M can suppress HepG2 proliferation and induce HepG2 apoptosis through downregulating Bcl-2, upregulating Bax, and enhancing Caspase-3 activity.

The Shape Effect on Polymer Nanoparticle Transport in a Blood Vessel

Nanoparticle therapeutic delivery is influenced by many factors including physical, chemical, and biophysical properties along with local vascular conditions. In recent years, nanoparticles of various shapes have been fabricated and have shown significant impact on transport efficiency. Identification of which nanoparticle shape helps to improve the therapeutic delivery process allows for enhanced therapeutic effects, yet is hard to be quantified in vivo due to the complex nature of the in vivo environment. In this work, we turn to biological models as a guide for informing improved nanoparticle therapeutic delivery, and quantify the contribution of various factors on delivery efficiency. Here we show that with a mimetic blood vessel, improved therapeutic delivery is achieved using long filamentous rod nanoparticles under low pressure conditions. When considering medium pressure conditions, a combination of nanoparticle shapes presents improved therapeutic delivery over the treatment time-course starting with long filamentous rod nanoparticles, followed by short rod nanoparticles. Conditions of high pressure required a combination of short rod nanoparticles, followed by spherical nanoparticles to achieve enhanced therapeutic delivery. Overall, improvement of therapeutic delivery via nanoparticle carriers is likely to require a combination of nanoparticle shapes administered at different times over the treatment time-course, given patient specific conditions.

Microfluidic platform analysis of therapeutic carrier delivery to cancerous sites for optimization of drug delivery efficiency over time-course treatment plans.

Clinical, pathological, and demographic factors associated with development of recurrences after surgical resection in elderly patients with neuroendocrine tumors

Background

Incidence of locoregional neuroendocrine tumors (NETs) is rising. However, after curative resection, the patterns and risk factors associated with recurrence remain unknown. Consensus guidelines recommend surveillance every 6-12 months for up to 10 years after surgery for resected, well-differentiated NETs irrespective of patient demographics, site, grade or stage of tumor with few exceptions.

Patients and methods

From the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified localized and regional stage NET patients who underwent surgical resection between January 2002 and December 2011. Development of recurrence was identified by capturing at least two claims indicative of metastatic disease until 31 December 2013.

Results

Of the 2366 identified patients (median age 73 years), 369 (16%) developed metastatic disease within 5 years and only an additional 1% developed metastases between years 5 and 10 with the majority dying due to unrelated causes. The 5-year risk of developing metastases (hazard ratio, HR) varied significantly (log-rank P < 0.001) by grade: 9.9% versus 25.9% (2.2) versus 48.1% (4.4) for grades 1, 2, and  ≥ 3, respectively; stage: 10.3% versus 31.1% (2.8) for localized versus regional; primary tumor size: 7.6% versus 15% (1.3) versus 26.6% (1.5) for <1, 1-2, and > 2 cm, respectively; and site: ranging from 11.3% for colon to 23.9% for pancreas.

Conclusions

Contrary to current guidelines, our study suggests that surveillance recommendations should be tailored according to patient and tumor characteristics. Surveillance past 5 years may be avoided in elderly patients with competing morbidities or low risk of recurrence. Pancreatic, lung, higher grade, and regional NETs have a higher risk of recurrence and may be considered for future adjuvant trials.

Efficient construction of bioactive trans-5A5B6C spirolactones via bicyclo[4.3.0] α-hydroxy ketones

The intricate 5_A5_B6_C-ring fusion topologies of tricyclic spiranoid β-hydroxybutyrolactones with environmentally benign characteristics and moderate biological activities were synthesized through lactonization of the key intermediate trans-α-hydroxyindenones with malonates by an efficient and convenient short synthetic procedure.

[Value of two left atrium and pulmonary vein stereoscopic imaging reconstruction methods on guiding radiofrequency ablation for atrial fibrillation]

Objective: To compare the value of two 3D imaging reconstruction methods for left atria and pulmonary vein on guiding the catheter ablation for atrial fibrillation (AF). Methods: From January 2014 to January 2017, a total of 100 drug refractory paroxysmal AF patients were divided into left atria direct angiography group (n=50), and indirect angiography group (n=50). 3D CARTO system was applied for mapping and guiding the ablation procedure. Patients assigned to direct angiography group were treated as follows: intraoperative puncture of atrial septum, inject contrast agent directly into the left atrium, conduct left atrial and pulmonary venous rotation angiography, reconstruct three-dimensional image, integrate the image into real-time X-ray system to facilitate circumferential pulmonary vein isolation. Patients assigned into the indirect angiography group were treated as follows: inject contrast agent through the right ventricle, conduct delayed rotation angiography of the left atria and pulmonary vein to guide circumferential pulmonary vein fixation and ablation. The left atrial and pulmonary venous image acquisition, the operation and X-ray exposure time, the success rate and the incidence of complication of the two groups were compared. The patients were followed up for 3-6 months. Results: General clinical characteristics of the two groups were similar(all P>0.05). Ablation was successful in all 100 patients. The operation time[(112.0±21.4)min vs. (134.0±24.3)min]and X-ray exposure time((10.7±4.7)min vs. (15.8±5.2)min)were significantly lower in direct angiography group than in indirect angiography group (both P<0.01). There was no significant difference between the two groups in the immediate (86%(43/50) vs. 82%(41/50), P=0.59) and short-term (76%(38/50) vs. 72%(36/50), P=0.65) success rate and complication rate (1 aneurysm in the direct angiography group, 1 pericardial tamponade in the indirect angiography group). In-hospital mortality was zero percent. Conclusion: It is safe and effective method to guide the radiofrequency catheter ablation of paroxysmal atrial fibrillation by reconstruction 3D image of left atrium and pulmonary vein. Compared with indirect angiography group, direct angiography group can improve the imaging quality of left atrium and pulmonary vein, decrease the X-ray exposure time of the ablation procedure.

De novo hepatocellular carcinoma post-multivisceral transplantation in a child

De novo hepatocellular carcinoma (HCC) post-transplantation in patients without viral hepatitis is extremely rare, with only three reported adult cases in the English literature. Here, we present a case of de novo HCC that developed in a 7-year-old female, who at 8 months of age received a liver, small bowel, spleen, and pancreas transplantation 6.5 years ago for gastroschisis and total parenteral nutrition (TPN)-related cirrhosis. The post-transplant course was complicated by Epstein-Barr virus (EBV) infection, post-transplant lymphoproliferative disease, and subsequent development of multifocal EBV-associated post-transplant smooth muscle tumors (EBV-PTSMT) in the small bowel 1 year and 10 months after transplantation, respectively. This was managed by reducing immunosuppression with rituximab and EBV-specific cytotoxic T-cell therapy. She was noted to have a new lesion in her transplanted liver graft 6.5 years post-transplantation that was diagnosed as HCC. The HCC was resected, and the patient remained clinically stable for 7 months. At that time, recurrence of the HCC was discovered on MRI. She passed away 6 months after. To the best of our knowledge, this is the first reported occurrence of de novo HCC post-transplantation in the pediatric population that is unrelated to viral hepatitis in either recipient or donor.

Observations and impacts of bleach washing on indoor chlorine chemistry

Ambient levels of chlorinated gases and aerosol components were measured by online chemical ionization and aerosol mass spectrometers after an indoor floor were repeatedly washed with a commercial bleach solution. Gaseous chlorine (Cl₂ , 10's of ppbv) and hypochlorous acid (HOCl, 100's of ppbv) arise after floor washing, along with nitryl chloride (ClNO₂ ), dichlorine monoxide (Cl₂ O), and chloramines (NHCl₂ , NCl₃ ). Much higher mixing ratios would prevail in a room with lower and more commonly encountered air exchange rates than that observed in the study (12.7 h^-1 ). Coincident with the formation of gas-phase species, particulate chlorine levels also rise. Cl₂ , ClNO₂ , NHCl₂ , and NCl₃ exist in the headspace of the bleach solution, whereas HOCl was only observed after floor washing. HOCl decays away 1.4 times faster than the air exchange rate, indicative of uptake onto room surfaces, and consistent with the well-known chlorinating ability of HOCl. Photochemical box modeling captures the temporal profiles of Cl₂ and HOCl very well and indicates that the OH, Cl, and ClO gas-phase radical concentrations in the indoor environment could be greatly enhanced (>10⁶ and 10⁵  cm^-3 for OH and Cl, respectively) in such washing conditions, dependent on the amount of indoor illumination.

Cartilage-specific deletion of Alk5 gene results in a progressive osteoarthritis-like phenotype in mice

OBJECTIVE

Previous studies have shown that Transforming growth factor-β (TGF-β)/TGFβRII-Smad3 signaling is involved in articular cartilage homeostasis. However, the role of TGF-β/ALK5 signaling in articular cartilage homeostasis has not been fully defined. In this study, a combination of in vitro and in vivo approaches was used to elucidate the role of ALK5 signaling in articular cartilage homeostasis and the development of osteoarthritis (OA).

DESIGN

Mice with inducible cartilage-specific deletion of Alk5 were generated to assess the role of ALK5 in OA development. Alterations in cartilage structure were evaluated histologically. The expressions of genes associated with articular cartilage homeostasis and TGF-β signaling were analyzed by qRT-PCR, western blotting and immunohistochemistry. The chondrocyte apoptosis was detected by TUNEL staining and immunohistochemistry. In addition, the molecular mechanism underlying the effects of TGF-β/ALK5 signaling on articular cartilage homeostasis was explored by analyzing the TGF-β/ALK5 signaling-induced expression of proteoglycan 4 (PRG4) using specific inhibitors.

RESULTS

Postnatal cartilage-specific deletion of Alk5 induced an OA-like phenotype with degradation of articular cartilage, synovial hyperplasia, osteophyte formation, subchondral sclerosis, as well as enhanced chondrocyte apoptosis, overproduction of catabolic factors, and decreased expressions of anabolic factors in chondrocytes. In addition, the expressions of PRG4 mRNA and protein were decreased in Alk5 conditional knockout mice. Furthermore, our results showed, for the first time, that TGF-β/ALK5 signaling regulated PRG4 expression partially through the protein kinase A (PKA)-CREB signaling pathway.

CONCLUSIONS

TGF-β/ALK5 signaling maintains articular cartilage homeostasis, in part, by upregulating PRG4 expression through the PKA-CREB signaling pathway in articular chondrocytes.

Spin Resonance Clock Transition of the Endohedral Fullerene ^{15}N@C_{60}

The endohedral fullerene ^{15}N@C_{60} has narrow electron paramagnetic resonance lines which have been proposed as the basis for a condensed-matter portable atomic clock. We measure the low-frequency spectrum of this molecule, identifying and characterizing a clock transition at which the frequency becomes insensitive to magnetic field. We infer a linewidth at the clock field of 100 kHz. Using experimental data, we are able to place a bound on the clock's projected frequency stability. We discuss ways to improve the frequency stability to be competitive with existing miniature clocks.

[Comparison of Measurement Methods of Exophthalmos and Its Forensic Significance]

OBJECTIVES

To compare the differences between Hertel exophthalmometry and CT on exophthalmos measurement, and explore its practical application value in forensic medicine.

METHODS

Fifty-six normal individuals without eye injuries or diseases were selected as the control group. The absolute values of exophthalmos were measured in the standardized CT image workstation. The difference of binocular exophthalmos was compared in normal group. Forty-seven cases with unilateral orbital fracture were divided into injured eye group and normal eye group according to the presence of binocular orbital fractures. The differences of the absolute values of eophthalmos from the same eye and the relative values of eophthalmos between two eyes for same person measured by Hertel exophthalmometry and CT were analyzed.

RESULTS

There was no statistical difference of exophthalmos between the normal eyes measured by CT method. In the normal eye group, the absolute value of exophthalmos measured by CT method was （16.66±5.41） mm, which was （16.16±4.45） mm when measured by the Hertel exophthalmometry method. There was no statistical difference between two groups （P>0.05）. In the injured eye group, there was statistical difference between the absolute values of exophthalmos measured by two measurement methods （ P<0.05）. There was no statistical difference of the relative values of exophthalmos between the injured eyes and the normal eyes by two measurement methods （P>0.05）.

CONCLUSIONS

CT method has a good consistency with Hertel exophthalmometry, which can be applied into the practice of medicolegal expertise.

[Intratympanic dexamethasone vesus post-auricular subperiosteal injection of methylprednisolone treatment for sudden hearing loss]

Objective:To compare the efficacy and side effect between intratympanic dexamethasone and subperiosteal injection of methylprednisolone treatment for sudden hearing loss.Method:One hundred and eight unilateral sudden hearing loss patients were enrolled in this study, randomly divided into A group, which was accepted intratympanic dexamethasone (10 mg/ml) , and B group, which was accepted post-auricular subperiosteal injection of methylprednisolone (40 mg/ml) by every 3 days intotal 5 times. After 3 months follow-up, analysis of the differences of pure tone threshold, tinnitus handicap inventory (THI), dizziness handicap inventory (DHI), blood glucose between pretreatment and postreatment was made. Side effect such as perforation of tympanic membrane, infection of post-auricular skin was also observed.Result:①Both in A and B group, there was no statistical changes in total efficiency and pure tone threshold decrease (P> 0.05), whereas the pure tone threshold statistical change was observed in the low frequency sudden deafness between A and B group (P< 0.05). ②Both in A and B group, there was no statistical changes in THI (P> 0.05), whereas the THI statistical decrease was observed in the high frequency sudden deafness between A and B group (P< 0.05). ③There was no statistical change in THI both in A and B group (P> 0.05). ④Both in A and B group, there was no statistical changes in fasting plasma glucose between pretreatment and postreatment (P> 0.05). ⑤There was no patient who had gotten tympanitis or postauricular infection, although in A group, there were 2 patients had gotten perforation of tympanic membrane, but they all healed after the follow-up.Conclusion:Both topical injection of glucocorticoid can improve pure tone threshold and reduce the score of THI and DHI for sudden hearing loss patients. Intratympanic dexamethasone can reduce more score of THI for high frequency sudden deafness patients whereas subperiosteal injection of methylprednisolone can improve pure tone threshold more for low frequency sudden deafness patients. None of the two administrations elevate blood glucose, but intratympanic dexamethasone have the risk of perforation of tympanic membrane.

Tailoring the optical properties of atomically-thin WS2via ion irradiation

Two-dimensional transition metal dichalcogenides (TMDCs) exhibit excellent optoelectronic properties. However, the large band gaps in many semiconducting TMDCs make optical absorption in the near-infrared (NIR) wavelength regime impossible, which prevents applications of these materials in optical communications. In this work, we demonstrate that Ar⁺ ion irradiation is a powerful post-synthesis technique to tailor the optical properties of the semiconducting tungsten disulfide (WS₂) by creating S-vacancies and thus controlling material stoichiometry. First-principles calculations reveal that the S-vacancies give rise to deep states in the band gap, which determine the NIR optical absorption of the WS₂ monolayer. As the density of the S-vacancies increases, the enhanced NIR linear and saturable absorption of WS₂ is observed, which is explained by the results of first-principles calculations. We further demonstrate that by using the irradiated WS₂ as a saturable absorber in a waveguide system, the passively Q-switched laser operations can be optimized, thus opening new avenues for tailoring the optical response of TMDCs by defect-engineering through ion irradiation.

Maternal pre-gravid cardiometabolic health and infant birthweight: A prospective pre-conception cohort study

BACKGROUND AND AIMS

Both low birthweight and high birthweight have been associated with the development of cardiometabolic disease in adulthood, possibly reflecting the effect of intrauterine fetal programming. As developmental programming can begin before conception, pre-gravid factors that predict birthweight may be relevant in this context. However, little is known about such factors. Thus, we established a pre-conception cohort to identify maternal pre-gravid cardiometabolic determinants of infant birthweight.

METHODS AND RESULTS

In this prospective observational cohort study, 1484 newly-married women in Liuyang, China, underwent baseline (pre-gravid) evaluation and then were followed across a subsequent pregnancy. Pre-gravid cardiometabolic characterization consisted of clinical (anthropometry, blood pressure) and biochemical evaluation (total/LDL/HDL cholesterol, triglycerides, glucose) at median 20 weeks before a singleton pregnancy. Mean birthweight was 3294 ± 444 g, with 173 neonates large-for-gestational-age (LGA) and 110 small-for-gestational-age (SGA). On multiple linear regression analysis, positive determinants of birthweight were maternal age, pre-gravid body mass index (BMI), weight gain in pregnancy, length of gestation, and male infant (all p ≤ 0.0003). On logistic regression analysis, independent predictors of an LGA delivery were maternal age (OR = 1.10 per year, 95%CI 1.03-1.18), pre-gravid BMI (OR = 1.21 per kg/m², 1.07-1.37), and gestational weight gain (OR = 1.10 per kg, 1.06-1.14). The only independent predictor of SGA was gestational weight gain (OR = 0.93 per kg, 0.89-0.97).

CONCLUSION

Maternal weight before and during pregnancy is the predominant cardiometabolic determinant of infant birthweight, rather than pre-gravid blood pressure, glucose or lipid profile.

Population dynamics of hepatitis C virus subtypes in injecting drug users on methadone maintenance treatment in China associated with economic and health reform

The extensive genetic heterogeneity of hepatitis C virus (HCV) requires in-depth understanding of the population dynamics of different viral subtypes for more effective control of epidemic outbreaks. We analysed HCV sequences data from 125 participants in Wuhan, China. These participants were newly infected by subtype 1b (n=13), 3a (n=15), 3b (n=50) and 6a (n=39) while on methadone maintenance treatment (MMT). Bayesian phylogenies and demographic histories were inferred for these subtypes. Participants infected with HCV-1b and 3a were clustered in well-supported monophyletic clades, indicating local subepidemics. Subtypes 3b and 6a strains were intermixed with other Chinese isolates, as well as isolates from other Asian countries, reflecting ongoing across geographic boundary transmissions. Subtypes 1b and 3a declined continuously during the past ten years, consistent with the health and economic reform in China, while subtype 3b showed ongoing exponential growth and 6a was characterized by several epidemic waves, possibly related to the recently growing number of travellers between China and other Asian countries. In conclusion, results of this study suggest that HCV subtype 3b and 6a subepidemics in China are currently not under control, and new epidemic waves may emerge given the rapid increase in international travelling following substantial economic growth.

Body mass index and mortality in lung cancer patients: a systematic review and meta-analysis

Studies examining the relation of body mass index (BMI) and mortality in patients with lung cancer have shown diverse results. We conducted a meta-analysis to investigate the association using all available studies from January 1982 to October 2016. PubMed and EMBASE were searched to identify relevant studies. We calculated the summary hazard ratio (HR) and 95% confidence interval (CI) using random effects model. The dose-response relationship was assessed by random effects meta-regression model. Fifty-five articles from 51 studies involving 3 152 552 subjects (males, 54.8%) were included. The pooled results suggested that on average a high BMI decreased risk of death from lung cancer or all-cause. Each 5 kg/m² increase in BMI had a 12% lower risk of lung cancer-specific mortality (HR=0.88, 95% CI: 0.75-1.02, P=0.09) and a 14% lower risk of all-cause mortality (HR=0.86, 95% CI: 0.77-0.96, P<0.01). When stratifying by ethnicity, each 5 kg/m² increase in BMI was associated with 22% and 28% reduction, respectively, in the risk of lung cancer-specific mortality (P<0.01) and all-cause mortality (P<0.01) in Asians, but no association was found in Westerners (P=0.51 and P=0.53, respectively). In conclusion, lung cancer patients with a higher BMI have a longer survival than those with a lower BMI. Considering the significant heterogeneity between included studies, future studies are needed to confirm these findings.