[Research Progress and Prospect of Facial Reconstruction in Forensic Science]

Abstract

Facial reconstruction is a way to recover facial morphology by restoring soft tissues based on unidentified skulls using the knowledge of anatomy, anthropology, aesthetics, and computer science. It is applied in forensic science, oral plastic surgery and archeology, and especially plays an important role in the identification of the origin of the unknown corpses in forensic science. Facial reconstruction is the supplementary means of identification when other approaches （such as DNA comparison, imaging matching, dental records comparison, etc.） cannot identify individual identity. Facial soft tissue thickness （FSTT） is the basis of facial reconstruction and with the development of imaging and computer science, the techniques for measuring FSTT are improving rapidly and many related researches have appeared. This paper summarizes the application of facial reconstruction in forensic science, the accuracy of different methods and the research progress of this field to provide reference to this field.

[Assessment of the clinical effect regarding three-dimensional printing individualized titanium mesh for bone augmentation in the esthetic area]

Objective: To evaluate the clinical effect of three-dimensional (3D) printing individualized titanium mesh for ridge augmentation in the esthetic zone. Methods: Forty-three patients were treated with personalized titanium mesh bone augmentation from Department of Oral Implantology, Stomatological Hospital of Chongqing Medical University from January, 2018 to June, 2020. According to the preoperative cone-beam CT (CBCT) data, the 43 patients [male: 21, female: 22, aged (30.1±5.8) years] were divided into three groups according to the Seibert classification as horizontal, vertical and horizontal-vertical classes (sample size: 14, 15, 14). Then, comprehensively the bone mass and esthetic requirements were taken into account to design and accordingly fabricate the 3D printing individualized titanium mesh. During the surgical process, autologous bone and xenogeneic bone substitutes were mixed at a 1∶1 ratio, combined with injectable platelet-rich fibrin (i-PRF) and individualized titanium mesh for ridge augmentation. All patients were recalled at 1, 3, and 6 months post-operation to observe the mesh exposure; the clinical effect of ridge augmentation was evaluated 6 months post-operation. After the implant placement and final restoration, the pink esthetic score (PES)/white esthetic score (WES) were evaluated. Results: Only one patient experienced early mesh exposure, and no obvious infection was observed. The bone gain regarding three types of bone defects was significantly higher immediately post-operation compared to pre-operation (horizontal, vertical and horizontal-vertical bone defect measured as (3.27±0.13), (17.41±0.46), (3.76±0.24), (14.37±0.89) mm pre-operation, respectively; and (5.25±0.15), (26.10±0.55), (6.35±0.29), (22.52±0.90) mm immediately post-operation, P<0.01). There was no obvious bone resorption 6 months post-operation [outcomes for horizontal, vertical and horizontal-vertical bone defect measured as (5.14±0.14), (25.67±0.52), (6.13±0.26), (22.35±0.89) mm, P>0.05]. The PES/WES scores of all patients were interpreted as "excellent". Conclusions: The 3D printing individualized titanium mesh is effective in repairing bone defects in the esthetic zone, and produces credible esthetic outcomes after implantation and final restoration.

Coping During Pregnancy Following Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

INTRODUCTION

This study investigated how coping strategies moderated the impact of disaster-related objective hardship on subjective distress in pregnant women.

METHODS

The objective hardship (exposure severity), subjective distress (Peritraumatic Distress Inventory, Peritraumatic Dissociative Experiences Questionnaire and Impact of Event Scale-Revised) and coping styles (Brief COPE) of pregnant women (N = 226) exposed to the 2011 Queensland, Australia flood were assessed. Moderation analyses were used to assess how coping strategies moderated the relationship between objective hardship and subjective distress levels.

RESULTS

We found that the more severe the objective flood exposure, the greater the women's subjective distress. The moderation analyses were significant for the Brief COPE's three coping styles (i.e., problem-focused coping, emotion-focused coping, and dysfunctional coping). For women experiencing high levels of objective hardship, problem-focused (∆R² = 1.7%) and dysfunctional coping (∆R² = 1.5%) elevated subjective distress levels. For women experiencing low or moderate levels of objective hardship, emotion-focused coping reduced levels of subjective distress (∆R² = 1.3%). A three-way interaction between objective hardship, emotion-focused coping, and dysfunctional coping approached significance (∆R² = 1.0%), indicating a protective role of emotion-focused coping under high levels of objective hardship, for women who frequently use maladaptive coping strategies.

LIMITATIONS

Sample was generally high SES and no measure of social support was available.

CONCLUSION

Results suggest that both problem-focused and dysfunctional coping strategies were maladaptive for women with relatively high exposure levels. Overall, emotion-focused coping strategies were more likely than problem-focused or dysfunctional strategies to reduce pregnant women's subjective distress following the flood.

[Effects of air pollution exposure on olfaction of rats in Beijing]

Objective: To evaluate the effects of exposure of fine particle matter (PM_2.5) and ozone (O₃) in Beijing as the main pollutants on olfaction of SD rats. Methods: In October 16, 2018, twenty 8-week-old SD rats were randomly divided into two groups, 10 rats in the exposure group and 10 rats in the control group. They were fed in air pollutant exposure system and clean experimental environment respectively, and the concentrations of PM_2.5 and O₃ in each system were measured. The degree of olfaction damage of SD rats at different feeding time was assessed by using the buried food test (BFT). The difference of BFT time between the two groups was analyzed by performing the repeated measures analysis of variance. Results: The results showed that the concentrations of PM_2.5 and O₃ in the exposure group were (22.65±11.47) μg/m³ and (12.36±5.87) μg/m³, respectively, while those in the control group were both 0 μg/m³. The repeated measures analysis of variance showed that the time of BFT in the exposure group was longer than that in the control group (F=6.49, P=0.031). With the increase of feeding time, the time of BFT was prolonged (F=61.69, P<0.001). Conclusion: Exposure to PM_2.5 and O₃ in the atmosphere might lead to olfaction damage in rats.

[Clinical consideration and management of coronavirus disease 2019]

Coronavirus disease 2019 (COVID-19) outbreak in Wuhan city, Hubei province in December 2019 and the epidemic so rapidly happened within the whole country and abroad, raising serious problems and urgent concerns, such as: how to control most effectively human-to-human transmission? When does infection rate rise to its peak? What will eventually be the number of infected patients? How to make early diagnosis? What effective antiviral drugs are available? How to use the existing drugs to achieve the best effect? Can available drugs effectively improve the survival rate of critical patients? In view of the above questions, this article now puts forwards the corresponding suggestions and considerations from the perspective of clinical infectious diseases physician.

[Management strategy for the resumption of regular diagnosis and treatment in gastrointestinal surgery department during the outbreak of coronavirus disease 2019 (COVID-19)]

Acute abdomen, abdominal trauma, gastrointestinal bleeding and gastrointestinal tumors are the main conditions that are routinely treated in gastrointestinal surgery department with high incidence and critical condition. These conditions need emergency or selective operations. During the outbreak of the coronavirus disease 2019 (COVID-19), it's a great challenge for us to meet the patients' requirement under the situation. As the COVID-19 was brought under control in China, the Department of General Surgery in Nanfang Hospital resumed regular medical services gradually. Based on our clinical practice, the four major measures of strengthening pre-hospital screening, perioperative prevention and control, medical staff protection, and ward management were adopted. These main measures include the strict implementation of the appointment system and triage system before admission; the conduction of epidemiological and preliminary screening of viral nucleic acids; the chest CT examination during the perioperative period to re-screen COVID-19; the reduction of the risk of droplets and aerosol transmission; the minimally invasive surgery combined with enhanced recovery program in order to reduce patient's susceptibility and shorten the length of postoperative hospital stay; the reinforcement of specific infection control training for medical staff; the strict implementation of hierarchical protection; the establishment of gastrointestinal surgery prevention and control system; the rehearsal of emergency exercise; the installation of quarantine wards; the screening and management of family care-givers; the strict disinfection of environment and materials. Our preliminary practice shows that following the work guidelines issued by the Guangdong Province COVID-19 Prevention and Control Office and adopting precise management strategies in combination with the specific clinical features of gastrointestinal surgery, it is possible to safely resume regular care for the patients and comply to epidemic control at the same time.

[Efficacy of mini nutritional assessment short-form in predicting the risk of acute exacerbation in old chronic obstructive pulmonary disease patients]

Objective: To evaluate the diagnostic efficacy of Mini Nutritional Assessment Short-form (MNA-SF) in predicting acute exacerbation of old chronic obstructive pulmonary disease (COPD) patients. Methods: The clinical data and Nutritional assessment of 202 outpatients who were given treatment in the Second Affiliated Hospital of Soochow University from January 2017 to May 2019 were analyzed. According to the frequency of acute exacerbation in the last year, patients were divided into high-risk group and low-risk group. The dependent variable was the risk of the acute exacerbation of COPD while the predicting model was established by using multivariate Logistic regression. Finally, the accuracy, sensitivity and specificity of the model was evaluated by the receiver operating characteristic (ROC) curve. Results: Among the 202 COPD patients, 131 patients (64.9%) were brought into the high-risk group and 71 patients (35.1%) were brought into the low-risk group. MNA-SF scores in high-risk group were significant lower than those in low-risk group [(9.4±2.1) vs (11.6±1.9), P<0.001]. The logistic regression analysis showed that MNA-SF score [OR=0.556(95%CI: 0.445-0.695), P<0.05] was an independent factor of acute exacerbation. The obtained model was Logit(P)=4.413-0.586×MNA-SF scores. The accuracy of model for the risk of the acute exacerbation of COPD was 77.4%, with a sensitivity of 79.7%, a specificity of 72.1%. Conclusion: MNA-SF is qualified for predicting the acute exacerbation of COPD patients in stable stage.

[The clinical decision-making value of prostate specific antigen and its derived indicators in prostate imaging reporting and data system version 2 3 lesions]

Objective: To explore the decision-making value of clinical data in prostate imaging reporting and data system version 2 (PI-RADS V2) 3 lesions, and to compare the diagnostic value of related data for prostate cancer (PCa) and clinically PCa(csPCa). Methods: From March 2016 to October 2018,a subset of 121 men with 121 PI-RADS 3 index lesions were retrospectively analyzed. There were 31 PCa lesions and 14 csPCa lesions, aged from 46 to 91 years with a mean age of (71±9) years. The clinical data of the age, prostate specific antigen (PSA), free PSA (fPSA), f/tPSA, PSA density (PSAD) and prostate volume (PV) were compared between PCa group and non-PCa group, csPCa group and non-csPCa group using univariate analysis, respectively.The receiver operating characteristic (ROC) curve was used to evaluate the efficiency of statistically data in detecting PCa and csPCa in men with PI-RADS 3 index lesions. Results: The differences of PSA, f/tPSA and PSAD were all statistically significant (Z=-2.004, -2.527, -2.623, all P<0.05) between PCa group and non-PCa group, and they were all also statistically significant(Z=-2.415, -2.158, -2.870, all P<0.05) between csPCa group and non-csPCa group. Both PSAD had the best diagnostic efficiency, the ROC curve of detecting PCa and csPCa was 0.658 and 0.736, respectively. If used PSAD>0.20 μg·L(-1)·ml(-1) as the biopsy threshold, the sensitivity, specificity, positive predictive value and negative predictive value of csPCa were 78.6%, 58.9%, 20.0%, 95.4%, and 54.5% (66/121) of the enrolled men can avoid biopsy, resulting only 3 cases of csPCa missed. Conclusion: PSA, f/tPSA, PSAD, especially PSAD can improve the detection efficiency of PCa,especially csPCa in PI-RADS 3 lesions, assisting clinical decision-making.

[Management and clinical thinking of Coronavirus Disease 2019]

In December 2019, the 2019 novel coronavirus pneumonia (NCP, officially named Coronavirus Disease 2019(COVID-19) by the World Health Organization) broke out in Wuhan, Hubei, and it quickly spread to the whole country and abroad. The situation was at stake. The sudden and serious COVID-19 epidemic has brought us a lot of urgent problems. How to effectively control the spread of COVID-19? When does the population infection rate rise to its peak? What will eventually be the number of infected patients? How to make early diagnosis? What effective antiviral drugs are available? How to effectively treat with existing drugs? Can it successfully improve the survival rate of critically patients? In response to the above questions, we put forward corresponding suggestions and reflections from the perspective of the infectious clinician.

Diagnostic performance of CT for differentiating peritoneal tuberculosis from peritoneal carcinomatosis: a systematic review and meta-analysis

AIM

To undertake a systematic review and meta-analysis of the diagnostic performance of CT for differentiating peritoneal tuberculosis (PTB) from peritoneal carcinomatosis (PC).

MATERIAL AND METHODS

PubMed, Embase, the Web of Science, and the Cochrane Library were searched for papers published before 23 July 2019. The methodological quality of the studies was analysed. Overlapping descriptors used in different studies to denote the same image finding were subsumed under a single CT feature. Sensitivity, specificity, and positive and negative likelihood ratios were pooled. A summary receiver operating characteristic curve (sROC) was constructed and the area under the curve (AUC) of the included studies was calculated when possible.

RESULTS

Six studies were included and 17 CT features were analysed. The pooled sensitivity and specificity of smooth peritoneal thickening were 59% (95% CI: 52-66%) and 84% (95% CI: 79-88%), respectively. The AUC of smooth peritoneal thickening was 0.83. Omentum line/rim, lymph node necrosis or calcification, and mesenteric macro nodules had a pooled specificity ranging from 95% to 100% and a pooled sensitivity ranging from 12% to 67%. The other 12 signs had a pooled sensitivity ranging from 21% to 79% and a pooled specificity ranging from 19% to 81%. Omentum involvement (cake-like pattern) showed a threshold-effect, so only the AUC (=0.70) was calculated.

CONCLUSIONS

Smooth peritoneal thickening shows fairly good diagnostic accuracy, while omentum rim/line, lymph nodes necrosis or calcification, mesenteric macro nodules have good specificity but limited sensitivity. The informative features summarised in this study may aid clinical practice and future studies.

Modeling Normal and Dysbiotic Subgingival Microbiomes: Effect of Nutrients

Screening for microbiome modulators requires availability of a high-throughput in vitro model that replicates subgingival dysbiosis and normobiosis, with a tool to measure microbial dysbiosis. Here, we tested various formulations to grow health- and periodontitis-associated subgingival microbiomes in parallel, and we describe a new subgingival dysbiosis index. Subgingival plaque samples pooled from 5 healthy subjects and, separately, 5 subjects with periodontitis were used to inoculate a Calgary Biofilm Device containing saliva-conditioned, hydroxyapatite-coated pegs. Microbiomes were grown for 7 d on either nutrient-rich media-including a modification of SHI medium, brain-heart infusion (BHI) supplemented with hemin and vitamin K, and a blend of SHI and BHI, each at 3 sucrose concentrations (0%, 0.05% and 0.1%)-or nutrient-limited media (saliva with 5%, 10%, or 20% inactivated human serum). The microbiomes were assessed for biomass, viability, and 16S rRNA profiles. In addition to richness and diversity, a dysbiosis index was calculated as the ratio of the sum of relative abundances of disease-associated species to that of health-associated species. The supplemented BHI and blend of SHI and BHI resulted in the highest biomass, whereas saliva-serum maximized viability. Distinct groups of bacteria were enriched in the different media. Regardless of medium type, the periodontitis-derived microbiomes showed higher species richness and alpha diversity and clustered with their inoculum separate from the health-derived microbiomes. Microbiomes grown in saliva-serum showed the highest species richness and the highest similarity to the clinical inocula in both health and disease. However, inclusion of serum reduced alpha diversity and increased dysbiosis in healthy microbiomes in a dose-dependent manner, mainly due to overenrichment of Porphyromonas species. The modification of SHI stood second in terms of species richness and diversity but resulted in low biomass and viability and significantly worsened dysbiosis in the periodontitis-derived microbiomes. Overall, saliva with 5% human serum was optimal for replicating subgingival microbiomes from health and disease.

Research Progress of Age Estimation Based on the Demirjian's Method

Abstract

In recent years, individual age estimation has gained increasing attention in forensic practice. Common age estimation methods mainly use developments of teeth and bones. Compared with bones, teeth are stronger and are highly resistant to external factors, therefore plays an important role in age estimation. Demirjian's method is one of the most commonly used methods to evaluate dental age and has been widely used in many countries. In this paper, the accuracy of its application in different populations is reviewed. It is found that compared with the chronological ages, most of the estimated ages are overestimated. By combining research results of many scholars and by analyzing, it can be assumed that this situation may be related with race, region, sex, etc.

[Hearing assessment and follow-up study of aeonatal deafness gene screening homozygous mutation infants]

Objective:To analyze the hearing assessment characteristics and follow-up of some deafness gene screening homozygous infants in Zhuhai. Method:The clinical data of 28 newborns with homozygous mutations transferred to Zhuhai Maternal and Child Health Hospital from Feb. 1, 2015 to Oct. 25, 2018 in hospitals of Zhuhai City were retrospectively analyzed. All the children were screened for hearing. The hearing characteristics and long-term follow-up results of homozygous mutations at different gene sites were analyzed by auditory diagnosis and behavioral follow-up from 1 to 3 years. Result:Fourteen cases of GJB2 c.109G>A with a homozygous mutation, 11 cases passed the hearing screening, the audiological diagnosis was normal, and the behavior test and follow-up were normal from 1 to 3 years. Hearing screening was not passed in 3 newborns, mild to moderate abnormalities of single or bilateral ears were diagnosed by audiology, 1 000 Hz without positive, and middle ear lesions were diagnosed. Eight cases of GJB2 c.235del C homozygous mutation were followed up by behavioral audiometry and follow-up from 1 to 3 years after cure. Among them, 5 cases were diagnosed as severe hearing impairment of bilateral ears and 3 cases as mild and moderate hearing impairment. One case of GJB3 547G>A homozygous mutation was followed up for 1-3 years, and all of them failed to pass the follow-up of behavioral audiometry and follow-up. Four cases of SLC26A4 IVS7-2A>G, 1 case of SLC26A4 1229C>T homozygous mutation, all of them failed to pass the neonatal hearing screening. All the patients were diagnosed as severe hearing impairment of binaural hearing, and the follow-up of 1-3 years' follow-up did not pass the follow-up tests. Conclusion:GJB2 C.235del C, SLC26A4 IVS7-2A>G locus homozygous mutation infant hearing impairment was mainly severe hearing impairment in bilateral ears, and there was no change in 1-3 years follow-up. GJB2 C.109G A homozygous mutant infants had normal hearing, and it was suggested that they should be followed up closely. It is very important to give correct and reasonable genetic counseling to parents with GJB2 C.109G A homozygous mutation without unnecessary panic.

Correlation between Frailty and Adverse Outcomes Among Older Community-Dwelling Chinese Adults: The China Health and Retirement Longitudinal Study

OBJECTIVES

Frailty is a state of decreased resilience when a person is exposed to an apparently innocuous stressor that is associated with numerous adverse outcomes. The aim is to examine frailty prevalence in China by demographic and investigate the correlation between frailty and outcome.

DESIGN

Cohort study.

SETTING

Community-dwelling adults from 28 Chinese provinces.

METHODS

The participants were 2,273 adults aged ≥65 years from the China Health and Retirement Longitudinal Study. Frailty was scored on the FRAIL scale. We estimated frailty prevalence in the overall sample. The association of frailty with adverse outcomes was evaluated by multinomial logistic regression analysis.

RESULTS

We found that 17.0% of adults aged ≥65 years were frail. Frail individuals had a higher prevalence of comorbidities, falls, and need for medical care than non-frail individuals. The multinomial logistic regression analysis demonstrated that frail status (OR = 2.061, 95% CI: 1.422-2.985) and pre-frail status (OR = 1.540, 95% CI: 1.135-2.089) were associated with falls in the previous two years. Serious falls in the previous two years were related to pre-frailty (OR = 1.815, 95% CI: 1.153-2.859) and frailty (OR = 2.797, 95% CI: 1.655-4.727). In addition, frail individuals were found to be at higher risk for outpatient visits over the previous month (OR = 2.091, 95% CI: 1.502-2.911) and readmission over the previous year (OR = 2.033, 95% CI: 1.480-2.792) in the analysis.

CONCLUSIONS

Pre-frailty and frailty were positively associated with major adverse outcomes, including falls and serious falls; they were also associated with more frequent outpatient visits and readmissions in the past.

Multifunctional phototheranostic nanomedicine for cancer imaging and treatment

Cancer, as one of the most life-threatening diseases, shows a high fatality rate around the world. When improving the therapeutic efficacy of conventional cancer treatments, researchers also conduct extensive studies into alternative therapeutic approaches, which are safe, valid, and economical. Phototherapies, including photodynamic therapy (PDT) and photothermal therapy (PTT), are tumor-ablative and function-reserving oncologic interventions, showing strong potential in clinical cancer treatment. During phototherapies, the non-toxic phototherapeutic agents can be activated upon light irradiation to induce cell death without causing much damage to normal tissues. Besides, with the rapid development of nanotechnology in the past decades, phototheranostic nanomedicine also has attracted tremendous interests aiming to continuously refine their performance. Herein, we reviewed the recent progress of phototheranostic nanomedicine for improved cancer therapy. After a brief introduction of the therapeutic principles and related phototherapeutic agents for PDT and PTT, the existing works on developing of phototheranostic nanomedicine by mainly focusing on their categories and applications, particularly on phototherapy-synergized cancer immunotherapy, are comprehensively reviewed. More importantly, a brief conclusion and future challenges of phototheranostic nanomedicine from our point of view are delivered in the last part of this article.

Curcumin micelles suppress gastric tumor cell growth by upregulating ROS generation, disrupting redox equilibrium and affecting mitochondrial bioenergetics

A proposed novel mechanism of anticancer activity of curcumin micelles through redox equilibrium in gastric cancer.

98 Effects of maternal age on oxygen consumption of oocytes and invitro-produced equine embryos

Mitochondrial replication is arrested during early cleavage stages, leaving the embryo dependent on maternally derived mitochondria for oxidative phosphorylation. Numbers of mitochondrial DNA (mtDNA) are used as indicators of functional mitochondria; however, direct comparisons for mtDNA and oxygen consumption rate (OCR) have not been performed for horses. The objectives of this study were to compare equine oocyte mtDNA copy numbers with a measure of mitochondrial function (OCR) and to determine whether maternal age of the oocyte donor impacts OCR of early-stage embryos. We hypothesised that (1) OCR in oocytes is not directly associated with mitochondrial numbers and (2) aerobic metabolism (OCR) is lower in early embryos from old than from young mares. Mares ages 6-13 years (Young, n=7) and=20 years (Old, n=8) were used as oocyte donors. Oocytes were collected from dominant follicles (=35mm) during oestrus and at 16±2h after induction of follicular maturation. Recovered oocytes were incubated in tissue culture medium 199 with 10% fetal calf serum, 25mgmL−1 of gentamicin, and 0.2mM pyruvate for 26±2h. Metaphase II oocytes (Young, n=14; Old, n=15) were fertilized by intracytoplasmic sperm injection (ICSI) using frozen-thawed sperm from one stallion. Presumptive zygotes were cultured in global medium (LifeGlobal Group). Other oocytes and early embryos were used for OCR. A microchamber containing an electrochemical sensor was used to measure OCR from individual oocytes (Young, n=9; Old, n=14) and early embryos (Young, n=8; Old, n=10). After analyses, oocytes were snap frozen, and mtDNA was later quantified by qPCR. Metabolic assays of embryos that cleaved were performed at Day 2 after ICSI. After the assay, embryos were placed back to culture until blastocyst formation at Day 7 or 8. Two-tailed Student's t-tests were used for OCR and mtDNA comparisons, and Fisher's exact tests were used to compare development rates. We found that OCR was higher (P=0.007) for oocytes from Young (mean±s.e.m.: 1.8±0.2) than from Old (1.3±0.1 fmol s−1). However, mtDNA numbers were not different (P=0.3) for Young (5.6±0.4×105) and Old (6.2±0.4×105). Cleavage rates were similar (P=0.6) between Young (11 out of 14, 79%) and Old (13 of 15, 87%). Day 2 embryos from Young had higher basal OCR compared with Old (3.8±0.1 and 3.2±0.2 fmol s−1, respectively; P=0.05). Blastocyst rates per cleaved oocytes were similar for Young (5 of 11, 45%) and Old (4 of 13, 31%; P=0.7). Lower OCR was observed in oocytes and early embryos from Old, which indicates that mitochondrial metabolic function is reduced for mitochondria originating in the oocytes of Old compared with Young. Use of mtDNA was not indicative of mitochondrial metabolic function. Although sample numbers were limited, cleavage and blastocyst development were not significantly different between Young and Old. Further developmental competence was not determined, although the compromised metabolic capacity of oocytes and embryos from old mares could ultimately contribute to lower fertility outcomes.

Sarcopenia in Community-Dwelling Oldest Old Is Associated with Disability and Poor Physical Function

OBJECTIVES

Sarcopenia is an age-related geriatric syndrome and is associated with numerous adverse outcomes. Although there is preponderance of studies on sarcopenia in community setting, few studies focused on the oldest old. We investigated the prevalence of sarcopenia in Chinese community-dwelling oldest old and examined the socio-demographic and lifestyle factors of sarcopenia. We also investigated the association between sarcopenia and disability in activities of daily living (ADL) and physical function among the oldest old.

DESIGN

Cross-sectional study.

SETTING

Urban community in Beijing, China.

PARTICIPANTS

664 community-dwelling older adults aged 80 years or older.

METHODS

The presence of sarcopenia and the relationship between sarcopenia and physical function and disability were examined in 582 adults aged 80 years and older. we used the backward stepwise logistic regression model to explore socio-demographic and lifestyle correlates of sarcopenia. Sarcopenia was assessed by an algorithm recommended by the Asian Working Group for Sarcopenia (AWGS).

RESULTS

The overall prevalence of sarcopenia was 26.6% (female 21.7%; male 33.3%). Age (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.06 - 1.22), body mass index (OR = 0.80, 95% CI: 0.73 - 0.89), and Mini-nutritional assessment (MNA) scores (OR = 0.78, 95% CI: 0.64 - 0.96) were independently associated with sarcopenia. The Odds of disability in ADL was approximately two times greater in oldest old with sarcopenia than those without. Sarcopenia was associated with poor lower extremity strength. Oldest old with sarcopenia have higher odds to reported difficulty in stooping, kneeing, or crouching, carrying weights over 5 kilograms, and walking 400 meters.

CONCLUSION AND IMPLICATIONS

We found over a quartile of the community-dwelling oldest old in China had sarcopenia. Older age, lower BMI, and worse nutritional status were significantly associated with the presence of sarcopenia. Sarcopenia was independently associated with disability and poor physical function.

[The clinical observation of serum specific biomarkers in patients with chronic graft-versus-host disease]

目的

研究异基因造血干细胞移植后患者血清生物标志物表达水平对慢性移植物抗宿主病（cGVHD）早期诊断的价值。

方法

采用液相悬浮芯片法检测接受异基因造血干细胞移植后发生和未发生cGVHD患者5种血清蛋白标志物（IL-1b、IL-16、CXCL9、CCL19、CCL17）表达水平。

结果

相较于未发生cGVHD的对照组，cGVHD患者血清中CXCL9、CCL17表达水平显著升高（P<0.05），其中CCL17与cGVHD的疾病严重程度相关（P<0.001）；CXCL9在皮肤损害的cGVHD患者血清中显著升高（P<0.01），CCL17在肝脏为靶器官的cGVHD患者中表达水平显著升高（P<0.01）。

结论

CXCL9联合CCL17可作为cGVHD的血清生物标志物，对辅助cGVHD诊断和评估严重程度有一定参考价值。

Association of Dysplastic Coronoid Process with Long-Face Morphology

Vertical malocclusion is a developmental condition, resulting from complex interactions among multiple etiological factors during the growth period. As a tricky dentofacial deformity clinically, long-face (LF) morphology is characterized by excessive vertical facial growth with severe disarrangement of jaws and teeth. Since the improvement of LF patients on facial profile and occlusion is often difficult and lacks long-term stability, it becomes important to unravel the etiology of LF pattern formation for early prevention and treatment. In the current studies, we identified a transgenic mouse model that exhibited a dysplastic coronoid process and LF morphology. Although the mutant mice exhibited jaw structures and occlusion comparable to controls at birth, they all acquired typical LF morphology with anterior open bite during postnatal growth, resembling clinical features of the selected skeletal class III patients. Since the coronoid process provides an insertion site for the temporalis attachment, we examined the initial development and differentiation of the temporalis and found identical results in both control and mutant mice before E17.5 when the temporal muscle makes attachment to the coronoid process. However, thereafter, we observed altered orientation and reduced size of the cross-sectional area of the temporalis in mutant mice, which persisted to the weaning stage. Biomechanical analysis and simulation modeling further support the idea that altered morphology of the coronoid process may impair the efficiency of the vertical temporalis contraction and appears to correlate with LF formation. Consistently, we present evidence that a dysplastic mandibular coronoid process was also seen in some human patients with skeletal III LF morphology. Taken together, the results presented in this study establish an association of the craniofacial bony structures with vertical patterning, which will have implications in earlier prediction for clinical precaution and intervention.

[A follow-up study of abnormal mutation in neonatal deafness gene screening]

Objective: To screen, diagnose and follow up the abnormal mutation in the gene screening of neonatal deafness. Methods: A total of 24161 newborns born in Zhuhai Maternal and Child Health Hospital from February 1, 2015 to January 31, 2008 were screened for hearing and deafness genes, and audiological screening, diagnosis and 1-3 years follow-up were carried out for the newborns with positive gene screening. Results: There were 991 cases of deafness gene mutation (533 males and 458 females), and the rate of abnormal mutation was 4.10%(991/24 161). Among them, 921 cases were single heterozygous mutation, 130 cases were failed in primary hearing screening, 11 cases were failed in secondary hearing screening, 8 cases were abnormal in audiological diagnosis finally. In these 8 cases, 3 were diagnosed as otitis media and passed audiological follow-up after cure, 2 cases of single ear sensorineural injury caused by high-risk factors, passed after close audiological follow-up, and the other 3 cases were closely audiological follow-up while none of them were successfully sequenced. All of them were moderate to severe sensorineural deafness, 1 case was heterozygous mutation at 3 loci of GJB2(c.235delC,c.408C>A,c.134G>A), 1 case was heterozygous mutation at 2 loci of GJB2(c.235delC, c.109G>A), and 1 case was single heterozygous mutation of GJB2(c.235delC). The remaining 913 cases who passed the primary screening, secondary screening or hearing diagnosis were followed up for 1 to 3 years. Three cases of multiple heterozygous mutation were found in gene screening(2 cases were SLC26A4 2168A>G, IVS7-2A>G, 1 case was GJB2 c.176_191del 16bp, c.299_300del AT), all of them passed both primary and secondary hearing screening. In these 3 cases, the final audiological diagnosis was moderate sensorineural deafness in both ears, with no improvement in the follow-up of 1-3 years. There were 9 monogenic homozygous mutations, 7 failed in primary hearing screening, 3 failed in secondary hearing screening and also failed in audiological diagnosis and 1-3 years' audiological follow-up, all of whom were GJB2 c.235 del C homozygous mutations, and one of whom had a definite family history of deafness. The remaining 6 cases of homozygous mutation diagnosed by primary screening, secondary screening or hearing diagnosis were GJB2 c109G>A homozygous mutation, and passed the 1-3 years' hearing follow-up. 58 children with mtDNA mutations, including 2 with 12S rRNA 1494C>T homozygous mutation, 47 with 1555A>G homozygous mutation, and 9 with 1555A>G heterozygous mutation, all passed the primary or secondary hearing screening, and were instructed to ban ototoxic drugs for the whole life, and passed the 1-3 years' hearing follow-up. Conclusions: The audiological follow-up of children with monogenic heterozygous mutations in deafness gene screening is generally normal. In case of abnormality, the influencing factors such as otitis media should be excluded at first. In case of unexplained moderate to severe sensorineural deafness, the whole-gene sequencing should be performed to find possible pathogenic factors. The children with homozygous mutation or compound heterozygous mutation in gene screening, most of whom show different degrees of hearing loss, should be followed up for a long time, and provide parents with scientific and reasonable genetic counseling according to the mutation genes and loci,. The hearing of drug-induced deafness gene carriers is normal after birth. Parents should be advised to strengthen prevention and follow-up is generally enough.

[Clinicopathological characteristics and therapeutic effects of adult rhabdomyosarcoma patients]

Objective: This study aimed to investigate the clinicopathological characteristics and prognosis of adult rhabdomyosarcoma (RMS) patients. Methods: The clinical data of 34 adult RMS patients were retrospectively analyzed. Based on their intervention and treatment, patients were divided into operation group (n=7), chemotherapy group (n=8) and operation plus chemotherapy group (n=19). The clinical characteristics and treatment outcomes of the three groups were compared. Results: A statically significant difference was found in IRSG surgical-pathological stage among the three groups (P=0.026), while no significant difference existed in gender, age of disease onset, primary site, tumor size, pathological subtypes and IRSG risk group in the three groups (all P>0.05). In the operation group, three CR, one PR, one SD and two PD were achieved and one CR, one PR, one SD and five PD were obtained in the chemotherapy group. While in the chemotherapy plus operation group, four CR, twelve PR, one SD and two PD were achieved. A significant difference was found in response (P=0.043) and median overall survival (OS) (P=0.036) among the three groups, which were 44.7, 26.9 and 53.6 months, respectively. Conclusions: Pleomorphic RMS was the main histological subtype for adult RMS patients, and the prognosis for adult RMS was usually poorer than that for pediatric RMS patients. Single therapeutic approach could not achieve satisfactory outcomes, while multimodal treatment consisted of surgery, chemotherapy and radiotherapy are helpful to improve the prognosis of adult patients with RMS.

Curcumin derivative WZ35 inhibits tumor cell growth via ROS-YAP-JNK signaling pathway in breast cancer

Background

Breast cancer is the most prevalent cancer among women worldwide. WZ35, an analog of curcumin, has been demonstrated to remarkably improve the pharmacokinetic profiles in vivo compared with curcumin. WZ35 exhibits promising antitumor activity in gastric cancer, HCC, colon cancer. However, antitumor effects of WZ35 in breast cancer and its underlying molecular mechanisms remain unclear.

Methods

CCK8, Flow cytometry and transwell assays were used to measure cell proliferation, cell cycle arrest, apoptosis, cell migration and invasion. We constructed xenograft mouse model and lung metastasis model to assess the antitumor activities of WZ35 in vivo. To explore the underlying molecular mechanisms of WZ35, we performed a series of overexpression and knockdown experiments. The cellular oxygen consumption rates (OCRs) was measured to assess mitochondrial dysfunction.

Results

We found that treatment of breast cancer cells with WZ35 exerts stronger anti-tumor activities than curcumin both in vitro and in vivo. Mechanistically, our research showed that WZ35 induced reactive oxygen species (ROS) generation and subsequent YAP mediated JNK activation in breast cancer cells. Abrogation of ROS production markedly attenuated WZ35 induced anti-tumor activities as well as YAP and JNK activation. In addition, ROS mediated YAP and JNK activation induced mitochondrial dysfunction in breast cancer cells.

Conclusion

Our study showed that novel anti-cancer mechanisms of WZ35 in breast cancer cells and ROS-YAP-JNK pathway might be a potential therapeutic target for the treatment of breast cancer patients.

[The treatment effect of opening,debridement and double-row fixation using suture anchor for severe patellar tendinopathy]

Objective: To evaluate clinical treatment efficacy of double-row fixation with bridging suture anchors for chronic, severe patellar tendinopathy. Methods: A retrospective study of 18 patients suffered from severe patellar tendinopathy and underwent surgical treatment during January 2009 and June 2014 at Department of Orthopedic, Beijing Chao Yang Hospital, Capital Medical University was conducted. All patients had received conservative therapy for more than 6 months(range: 6-30 months) but the effect was unsatisfactory. There were 10 males (12 knees) and 8 females (12 knees)with age of 47.2 years(range: 32-63 years). Seven cases on the left and 17 cases on the right. The surgical treatment included a midline incision at patellar tendon, complete debridement, and double-row fixation with bridging suture anchors. Visual analogue scale(VAS), Lysholm score were collected preoperatively and postoperatively, and compared by paired-t test. The postoperative complications was recorded. Results: All patients were followed up for 35.7 months (range:24-64 months) without any dropout.VAS decreased from 7.5±1.6 preoperative to 1.4±1.0 (t=4.45, P=0.00) postoperative, Lysholm score increased from 48.3±5.2 to 89.6±5.4 (t=-4.88,P=0.00).The Lysholm score was excellent in 3 cases and good in 15 cases.No patellar tendon rupture or suture fixation failure was recorded during the follow-up period. Conclusions: The effect of double-row fixation with bridging suture anchors is satisfactory with few postoperative complications.It can not only improve clinical symptoms of patients, but also restore knee joint function.

[Vascular injury and anatomy during laparoscopy - assisted distal gastrectomy with D2 lymphadenectomy for gastric cancer]

Objective: To evaluate the incidence of intraoperative vascular injury (IVI) and associated anatomical features during laparoscopy - assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Methods: A descriptive cohort study was performed. Clinical data and operational videos of 278 consecutive gastric cancer patients who underwent LADG with D2 lymphadenectomy for gastric cancer at Department of General Surgery of Nanfang Hospital between January 2010 and December 2017 were retrospectively analyzed. IVI and vascular anatomy during lymphadenectomy were observed and recorded in the following four scenes: scene I: No. 4sb and No.4d of lower left (tail of pancreas) area; scene II: No.6 of lower right (subpyloric) area; scene III: No.5 and No.12a of upper right (suprapyloric) area; scene IV: No. 7, No. 8a, No. 9, No. 11p of central area posterior to the gastric body. IVI was defined as the injury of main perigastric vessel requiring additional procedure for hemostasis such as electrocauterization, gauze compression, clipping or suture. Results: Among 278 patients, 125 (45.0%) had IVI. Two cases of IVI required conversion to open operation and the injuried vascular was left gastric artery (LGA) and right gastric artery (RGA), respectively. Higher incidence of IVI was found in scene II (92/278, 33.1%) and scene IV(39/278, 14.0%). More common IVI was observed in right gastroepiploic vein (RGeV, 57/278, 20.5%) and left gastric vein (LGV, 33/278, 11.9%). The right gastroepiploic vessels were observed in all 278 patients, including 3 (1.1%) cases with 2 RGeVs, and 2 cases with 2 right gastroepiploic arteries (RGeA). RGA was observed clearly in 265 (95.3%) patients, whose ramification pattern was as follows: from proper hepatic artery (PHA, 223/265, 84.2%), from gastroduodenal artery (GDA, 16/265, 6.0%), from left hepatic artery (LHA, 12/265,4.5%), from the crossing of PHA and GDA (8/265, 3.0%), and 6 (2.3%) patients with 2 RGAs simultaneously from PHA and GDA, respectively. The most common injury of RGA (4/12) occurred in LHA. Excluding 2 cases of conversion to open surgery due to intraoperative hemorrhage, among 276 patients, LGV was observed in 270 patients (97.1%), whose drainage pattern was as follows: into the portal vein (PV, 148/270, 54.8%), into the spleen vein (SV, 56/270, 20.7%), into the junction of these two veins (52/270, 19.3%), into left portal vein (LPV, 8/270, 3.0%), meanwhile 6 patients had 2 LGVs simultaneously, including LGVs of 5 cases into PV and SV, and of 1 case into PV-SV junction and SV. The most common IVI was found in those patients with two LGVs (4/6). Conclusions: IVI during LADG with D2 lymphadenectomy is common. The highest risk of IVI is found in scene II and scene IV. Attentions should be paid to anatomic variation of vessels, especially the RGeV, LGV and RGA.

[Evaluation of the application of moving epidemic method on making influenza epidemic thresholds in the 7 climate zones in China]

Objective: We planned to evaluate the effectiveness of moving epidemic method (MEM) in calculating influenza epidemic threshold of 7 climatic zones in China mainland. Methods: The positive rate of influenza virus was obtained from the National Influenza Surveillance Network System from 2010/2011 to 2017/2018. We divided the 31 provinces into 7 climatic zones according to previous literatures and applied MEM to calculate the influenza epidemic threshold of 2018/2019 influenza season for these climatic zones. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to evaluate the effectiveness of MEM. Results: Pre-epidemic threshold (the positive rate of influenza virus) varied from 9.66% (temperate zone) to 16.36% (subtropical zone) for 2018/2019 influenza season. The gap between pre-epidemic and post-epidemic thresholds was less than 5% except for plateau zone. The sensitivity was 86.16% (95CI:66.81%-98.23%), the specificity was 94.92% (95CI: 91.13%-98.41%), the positive predictive value was 89.87% (95%CI: 84.39%-94.38%), the negative predictive value was 92.96% (95%CI: 84.46%-99.17%). Conclusion: Overall, moving epidemic Method performs well in calculating influenza epidemic threshold in China, much better than the previous study.

A clinical pathway to minimize computed tomography for suspected nephrolithiasis in children

INTRODUCTION

Ultrasound (US) imaging is preferred in the initial evaluation for children with suspected nephrolithiasis; however, computed tomography (CT) continues to be used in this setting with resultant unnecessary ionizing radiation exposure. The study institution implemented a standardized clinical pathway to reduce rates of CT utilization for children with nephrolithiasis.

OBJECTIVE

The aim of this study was to evaluate the impact of this pathway on initial imaging strategies for children with suspected nephrolithiasis.

STUDY DESIGN

A standardized pathway was designed and implemented using a systematic quality improvement process. A suspected cohort was created using 'reason for study' search terms consistent with a nephrolithiasis diagnosis. A confirmed cohort of children with a final diagnosis of nephrolithiasis was derived from this suspected cohort. The primary outcome was CT use as the initial imaging study in children with suspected or confirmed nephrolithiasis presenting to the emergency department (ED) between October 2013 and February 2018. Comparisons were made before and after pathway implementation (October 2015). Secondary outcomes included rates of CT scan within 30 days, while balancing measures included rates of admission, ED length of stay, and return visits.

RESULTS

A total of 534 children with suspected (220 prepathway; 314 postpathway) and 90 children with confirmed (37 prepathway; 53 postpathway) nephrolithiasis were included. For the suspected cohort, CT scans performed as the initial imaging evaluation (9.2% vs 2.5%, P = 0.001) and at any time during the index visit (15.7% vs 5.7%, P = 0.001) decreased after pathway implementation. Within the confirmed cohort, a non-significant decrease in initial CT rates was observed after implementation. No differences were observed in admission rates or ED length of stay after implementation. A trend toward lower return visits to the ED was seen after pathway implementation (5.5% vs 2.2%, P = 0.058).

DISCUSSION

Within a tertiary care pediatric ED associated with a strong institutional experience with clinical pathways, initial CT rates were decreased after pathway implementation for children with suspected nephrolithiasis. While retrospective assessment of suspected disease is limited, this is one of the first studies to address imaging patterns for nephrolithiasis beyond the final discharge diagnosis, thus capturing a broader cohort of children. Children with suspected nephrolithiasis can be safely managed with an US-first approach, and postvisit CT scans are rarely necessary for management.

CONCLUSIONS

A standardized clinical pathway for suspected nephrolithiasis can reduce rates of initial and overall CT utilization without adversely impacting downstream care.

Mechanisms Underlying Therapeutic Effects Of Traditional Chinese Medicine On Gastric Cancer

Gastric cancer (GC) is one of the most common malignant tumors in the world. It is the fourth most common cancer and has the second highest mortality rate globally. Metastasis is an important feature of gastric cancer and is the most common cause of death. Exploring the mechanism underlying the metastasis of gastric cancer and searching for new drug targets has become the focus of several studies. Traditional Chinese medicine may show promise for treatment of gastric cancer. In this review, we report the recent progress in research on the anti-metastasis activity of Chinese medicine, to facilitate clinical development of treatments for gastric cancer.

Smad7 Regulates Dental Epithelial Proliferation during Tooth Development

Tooth morphogenesis involves dynamic changes in shape and size as it proceeds through the bud, cap, and bell stages. This process requires exact regulation of cell proliferation and differentiation. Smad7, a general antagonist against transforming growth factor-β (TGF-β) signaling, is necessary for maintaining homeostasis and proper functionality in many organs. While TGF-β signaling is widely involved in tooth morphogenesis, the precise role of Smad7 in tooth development remains unknown. In this study, we showed that Smad7 is expressed in the developing mouse molars with a high level in the dental epithelium but a moderate to weak level in the dental mesenchyme. Smad7 deficiency led to a profound decrease in tooth size primarily due to a severely compromised cell proliferation capability in the dental epithelium. Consistent with the tooth shrinkage phenotype, RNA sequencing (RNA-seq) analysis revealed that Smad7 ablation downregulated genes referred to epithelial cell proliferation and cell cycle G1/S phase transition, whereas the upregulated genes were involved in responding to TGF-β signaling and cell cycle arrest. Among these genes, the expression of Cdkn1a (encoding p21), a negative cell proliferation regulator, was remarkably elevated in parallel with the diminution of Ccnd1 encoding the crucial cell cycle regulator cyclin D1 in the dental epithelium. Meanwhile, the expression level of p-Smad2/3 was ectopically elevated in the developing tooth germ of Smad7 null mice, indicating the hyperactivation of the canonical TGF-β signaling. These effects were reversed by addition of TGF-β signaling inhibitor in cell cultures of Smad7^-/- molar tooth germs, with rescued expression of cyclin D1 and cell proliferation rate. In sum, our studies demonstrate that Smad7 functions primarily as a positive regulator of cell proliferation via inhibition of the canonical TGF-β signaling during dental epithelium development and highlight a crucial role for Smad7 in regulating tooth size.

Momentum Dependence of the Nematic Order Parameter in Iron-Based Superconductors

The momentum dependence of the nematic order parameter is an important ingredient in the microscopic description of iron-based high-temperature superconductors. While recent reports on FeSe indicate that the nematic order parameter changes sign between electron and hole bands, detailed knowledge is still missing for other compounds. Combining angle-resolved photoemission spectroscopy with uniaxial strain tuning, we measure the nematic band splitting in both FeSe and BaFe_{2}As_{2} without interference from either twinning or magnetic order. We find that the nematic order parameter exhibits the same momentum dependence in both compounds with a sign change between the Brillouin center and the corner. This suggests that the same microscopic mechanism drives the nematic order in spite of the very different phase diagrams.

Quantum Criticality of the Ising-like Screw Chain Antiferromagnet SrCo_{2}V_{2}O_{8} in a Transverse Magnetic Field

The quantum criticality of an Ising-like screw chain antiferromagnet SrCo_{2}V_{2}O_{8}, with a transverse magnetic field applied along the crystalline a axis, is investigated by ultralow temperature NMR measurements. The Néel temperature is rapidly and continuously suppressed by the field, giving rise to a quantum critical point (QCP) at H_{C_{1}}≈7.03  T. Surprisingly, a second QCP at H_{C_{2}}≈7.7  T featured with gapless excitations is resolved from both the double-peak structure of the field-dependent spin-lattice relaxation rate 1/^{51}T_{1} at low temperatures and the weakly temperature-dependent 1/^{51}T_{1} at this field. Our data, combined with numerical calculations, suggest that the induced effective staggered transverse field significantly lowers the critical fields, and leads to an exposed QCP at H_{C_{2}}, which belongs to the one-dimensional transverse-field Ising universality.

[The animal models using live pigs in the application and development of endoscopic submucosal dissection training]

Endoscopic submucosal dissection (ESD) is the gold standard technique for performing en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. It has not started in China until early 2006, when it was introduced at Endoscopy Center of Zhongshan Hospital. However, ESD is technically more difficult and can result in more complications, limiting its development in China. At present, reports about ESD training system in China are still not available. Therefore, our center continuously explored and gradually established structured training courses relied on the live pig model. Between 2009 and 2013, we held 23 hands-on ESD training workshops with 550 endoscopists. Questionnaires were distributed via e-mail, and there were 460 participants performing ESD in a step-up approach on the live pigs. More than one half of trainees could perform ESD with en bloc resection in the imaginary "lesion" of colon and stomach, and there were higher rates of hemorrhage and perforation occurring in colorectal ESD as compared to gastric ESD. After graduating from our hands-on workshop, up to over 90% of participants started ESD practice in their home hospitals. It was mostly provided by high-grade hospitals (IIIA) which played a major role as tertiary referral centers, covering almost all provinces and major cities in China. The training on live pig model revealed to be safe and effective as a prior step to its application in humans. It may enable novice endoscopists to acquire ESD skills and start performing ESD as soon as possible. The role of adequate training is of course to influence the spread of this technique and promote ESD development around China.