[Clinical effect of fractional carbon dioxide laser in the treatment of contracture scars]

Objective: To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars. Methods: A retrospective before-after self-control study was conducted. From December 2016 to April 2021, 16 patients (7 males and 9 females, aged 3-49 years) with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued. The treatment times of each patient were recorded. Before the first treatment and 6 months after the last treatment, the ranges of motion of the affected joint were measured in each patient, and the difference was calculated, meanwhile, the Vancouver Scar Scale (VSS) was used to evaluate the scar of each patient. In the treatment of 1 joint scar in each of 6 patients (totally 6 times of treatments), the ranges of motion of the affected joint before the current treatment, immediately after the treatment, and at the first follow-up after the treatment were documented, and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated. Adverse effects after the treatment in the treatment area were documented. At the last follow-up, a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period. Data were statistically analyzed with Wilcoxon rank sum test. Results: Eighteen joint scars in 16 patients received 2 (1, 3) times of fractional carbon dioxide laser treatment. The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5 (39.0, 128.8)°, notably higher than 38.4 (22.9, 116.3)° before the first treatment (Z=-3.724, P<0.01), showing a remarkable improvement by 17.4 (8.0, 24.1)°. The vascular distribution, softness, and thickness scores, and total score in VSS scoring of scars of 16 patients 6 months after the last treatment were significantly lower than those before the first treatment (Z=-2.989, -3.762, -2.814, -3.739, P<0.01), with the most obvious improvement in softness. In 6 times of treatments, the range of motion of the affected joint immediately after treatment and at the first follow-up of (2.5±0.6) months after treatment were 156.2 (148.0, 164.2)° and 160.2 (156.7, 166.4)°, both notably higher than 151.4 (145.7, 155.3)° before treatment (Z=-2.201, -2.201, P<0.05), showing a remarkable improvement by 9.1 (4.4, 13.0)° and 13.1 (8.0, 15.7)°, respectively. No adverse effects such as blisters, infection, or hypertrophic scar formation were observed in the treatment area of 16 patients after treatment. Most patients adopted physical therapy, compression, silicone gel or sheets, and braces during the treatment interval and follow-up period. Conclusions: The fractional carbon dioxide laser can soften the scar and increase the range of motion of the affected joint, which is suitable for the clinical treatment of mild contracture scars.

[Clinical application and mechanism of botulinum toxin type A in scar treatment]

Pathological scars cause both local physical discomforts and mental disorders for patients. With the development of research, botulinum toxin type A (BTX-A) has been gradually used in the clinical treatment of scars. This article summarizes three potential mechanisms of BTX-A, including early tension reduction, inhibition of connective tissue hyperplasia, and alleviation of skin inflammation, as well as the clinical application of BTX-A in treating different types of scars. However, at present there is no uniform standard for the time, method, and proportioning of BTX-A injection for scar treatment, and there is also a lack of long-term follow-up results. Further researches are needed in future to clarify the mechanism of BTX-A in inhibiting scars, establish a uniform protocol of BTX-A injection, and provide a more effective treatment plan for scars.

[Epidemiological investigation and analysis of etiological characteristics of infection on 3 067 hospitalized pediatric patients with burns]

Objective: To investigate the epidemiological characteristics and etiological distribution of infection on 3 067 hospitalized pediatric patients with burns, and explore the prevention and treatment strategy of pediatric burns. Methods: A cross-sectional survey was conducted. An analysis was performed on the data of 3 067 hospitalized pediatric patients with burns who met the inclusion criteria and were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from January 2012 to December 2020, including gender, age, causative factors, locations and severities of burns, seasons of accidents, and the type, source of tissue or body fluid, and drug resistance of pathogenic bacteria. API bacterial identification batten and automatic microbial identification system were applied for pathogen identification. Drug sensitivities of top 3 consistent ratio pathogen identifed were tested with minimum inhibitory concentration and disk diffusion method. WHONET 5.6 software was applied to analyze the data. Results: There were 3 067 hospitalized pediatric patients with burns, including 1 768 boys and 1 299 girls. The majority of pediatric burn patients were >1 and ≤4 years, accounting for 72.9% (2 236/3 067), and the minority of pediatric burn patients were >8 and ≤12 years, accounting for 4.9% (150/3 067). Moderate burns and severe burns of pediatric burn patients accounted for the majority parts, and the proportions of the two were close. The top cause of pediatric burns was scald, accounting for 81.6% (2504/3 067). Extremities were the most common burn sites in that of entire 3 254. The most pediatric burns occurred in winter, accounting for 29.4% (903/3 067). A total of 1 018 strains of pathogenic bacteria were collected from pediatric burn patients, all of which were non-repeated isolates. The pathogens with top five consistent ratio were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, and Escherichia coli, among which Staphylococcus aureus ranked the first every year. The pathogens were mainly isolated from the wound exudate, accounting for 81.34% (828/1 018). Staphylococcus aureus from 2012 to 2020 showed no resistance to vancomycin, linezolid or teicoplanin while Staphylococcus aureus isolated in 2019 was 100% resistant to macrolides, penicillin, aminoglycosides, and quinolones. Pseudomonas aeruginosa was not resistant to polymyxin B. Acinetobacter baumannii showed a high rate of drug resistance to most antibiotics. Conclusions: Among the pediatric burn patients admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from 2012 to 2020, the majority are male children aged >1 and ≤4 years with moderate burns. Scalds are the leading cause; and extremities are the common burn sites; and the most pediatric burns occurre in winter. Staphylococcus aureus from wound exudate is the primary pathogen of burn wound infections in pediatric patients.

In Situ Optical Characterization of Twinning in Liquid Crystalline Blue Phases

Crystal twinning is an intergrowth of two or more single crystals of the same species with specific crystallographic relations in their orientations. Here, we perform microscopic optical characterization of (211) twins in the three-dimensional liquid crystalline phase known as the blue phase (BP), with I4₁32 space group symmetry. We describe the effect of twinning on the optical diffraction pattern-Kossel pattern-of blue phases and analyze the patterns to deduce structural information such as the twin elements and the previously unnoticed deviations from the perfect cubic structure at zero electric field. Further, we obtain in situ observations as a field is applied along the [110] direction of the twinning crystals and find that the twin boundary shows a pinning effect that defines the orientation of the twinned pair through the cubic-to-orthogonal structure transformation. Our findings not only provide important insights for the application of BPs as electro-optic crystals but also present a step in understanding the hierarchical structures that are crystallographic.

A novel five-gene signature predicts overall survival of patients with hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common public health challenges, worldwide. Because of molecular complexity and tumor heterogeneity, there are no effective predictive models for prognosis of HCC. This underlines the unmet need for accurate prognostic models for HCC. Analysis of GSE14520 data from gene omnibus (GEO) database identified multiple differentially expressed mRNAs (DEMs) between HCC and normal tissues. After randomly stratifying the patients into the training and testing groups, we performed univariate, lasso, and multivariable Cox regression analyses to delineate the prognostic gene signature in training set. We then used Kaplan-Meier plot, time-dependent receiver operating characteristic (ROC), multivariable Cox regression analysis of clinical information, nomogram, and decision curve analysis (DCA) to evaluate the predictive and overall survival value of a novel five-gene signature (CNIH4, SOX4, SPP1, SORBS2, and CCL19) within and across sets, separately and combined. We also validated the prognostic value of the five-gene signature using The Cancer Genome Atlas-Liver Hepatocellular Carcinoma (TCGA-LIHC), GSE54236 and International Cancer Genome Consortium (ICGC) sets. Multivariable Cox regression analysis revealed that the five-gene signature and tumor node metastasis (TNM) stage were independent prognostic factors for overall survival of HCC patients in GSE14520 and TCGA-LIHC. Combining TNM stage clinical pathological parameters and nomogram greatly improved the prognosis prediction of HCC. Further gene set enrichment analysis (GSEA) revealed enrichment of KEGG pathways related to cell cycle in the high-risk group and histidine metabolism in the low-risk group. Finally, all these five mRNAs are overexpressed between 12 pairs of HCC and adjacent normal tissues by quantitative real-time PCR validation. In brief, a five-gene prognostic signature and a nomogram were identified and constructed, respectively, and further validated for their HCC prognostic value. The five-gene risk score together with TNM stage models could aid in rationalizing customized therapies in HCC patients.

Effect of Different Amounts of TiF3 on the Reversible Hydrogen Storage Properties of 2LiBH4-Li3AlH6 Composite

Hydrogen is a potential green alternative to conventional energy carriers such as oil and coal. Compared with the storage of hydrogen in gaseous or liquid phases, the chemical storage of hydrogen in solid complex hydrides is safer and more effective. In this study, the complex hydride composite 2LiBH4-Li₃AlH₆ with different amounts of TiF₃ was prepared by simple ball-milling and its hydrogen storage properties were investigated. Temperature programmed desorption and differential scanning calorimetry were used to characterize the de/rehydrogenation performance, and X-ray diffraction and scanning electron microscopy (SEM) were used to explore the phase structure and surface topography of the materials. The dehydrogenation temperature decreased by 48°C in 2LiBH4-Li₃AlH₆ with 15 wt% TiF₃ composites compared to the composite without additives while the reaction kinetics was accelerated by 20%. In addition, the influence of hydrogen back pressure on the 2LiBH4-Li₃AlH₆ with 5 wt% TiF₃ composite was also investigated. The results show that hydrogen back pressure between 2.5 and 3.5 bar can improve the reversible performance of the composite to some extent. With a back pressure of 3.5 bar, the second dehydrogenation capacity increased to 4.6 wt% from the 3.3 wt% in the 2LiBH₄-Li₃AlH₆ composite without hydrogen back pressure. However, the dehydrogenation kinetics was hindered. About 150 h, which is 100 times the time required without back pressure, was needed to release 8.7 wt% of hydrogen at 3.5 bar hydrogen back pressure. The SEM results show that aluminum was aggregated after the second cycle of dehydrogenation at the hydrogen back pressure of 3 bar, resulting in the partial reversibility of the 5 wt% TiF₃-added 2LiBH4-Li3AlH₆ composite.

Oxidative Desymmetrization of Isoindolines Realized by tert-Butyl Nitrite (TBN) Initiated Radical sp3 C–H Activation Relay (CHAR)

An oxidative desymmetrization of isoindolines was realized by TBN initiated radical sp3 C–H activation relay (CHAR), providing a series of ω-hydroxylactams in high yields. This reaction exhibits broad substrate scope and functional group tolerance, and even N-alkyl iso­indolines can be well tolerated. The mechanistic study shows that the C–H bond oxidation, dioxygen trapping and intramolecular 1,5-H shift might be the key steps to achieve the oxidative desymmetrization.

microRNA-29b mediates Th17/Treg imbalance in chronic obstructive pulmonary disease by targeting IL-22

Chronic obstructive pulmonary disease (COPD) represents a chronic inflammatory disorder of the airways induced mainly by cigarette smoking. In the current study, cigarette smoke extract (CSE) was used to develop an in vitro COPD model using human bronchial epithelium (HBE) cells to expound the possible role of microRNA-29b (miR-29b) in COPD. Firstly, miR-29b and interleukin (IL)-22 expression was assessed in serum of 20 healthy non-smokers, 20 healthy smokers and 20 COPD patients as well as CSE-treated HBE cells. Then, miR-29b and IL-22 expression was altered to evaluate their functions in Th17/Treg ratio. miR-29b inhibited Th17/Treg ratio and levels of IL-22; whereas overexpression of IL-22 reversed these trends. Moreover, rescue experiments found that IL-22 neutralized the repressive effects of miR-29b on Th17/Treg ratio and inflammatory response. Finally, we found that miR-29b blocked the JAK/STAT3 pathway in CSE-treated HBE cells. These data highlighted that miR-29bs modulated Th17/Treg imbalance in CSE-induced experimental COPD through inhibition of IL-22-dependent JAK/STAT3 pathway.

[Analysis of clinical characteristics of 481 HBV-related liver cirrhotic patients with low viral load]

Objective: To analyze the clinical characteristics of HBV-related liver cirrhotic patients with low viral load. Methods: A retrospective analysis on 481 inpatients with HBV-related cirrhosis with low viral load [HBV DNA≤2 000 IU/ml (10(4) copies/ml)] general condition, virological indicators, liver function-related indicators, complications, and incidence of complications were analyzed. The t-test was used to compare the average measurement data, and the χ (2) test was used to compare the count data. Results: 481 cases were mainly male (male/female: 324/157), aged 20-83 (53.31 ± 11.67) years old. Han nationality accounted for 71.518%. 386 cases were HBsAg positive. 391 cases were HBeAg positive, and 140 cases were HBV DNA positive. The average value of bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase, platelets, and prothrombin were 50.59 ± 91.25 (μmol/L), 33.68 ± 7.5 (g/L), and 60.66 ± 106.95(U/L), 63.37 ± 86.19(U/L), 106.65 ± 83.22(×10(9)/L), 68.82% ± 25.33%, respectively. CTP class A/B/C had 220/150/111 cases. The average values of CTP, MELD, APRI and FIB-4 were 7.61 ± 2.58, 10.98 ± 5.79, 2.34 ± 3.56, 6.91 ± 8.04, respectively. The overall incidence of complications in HBV-related cirrhotic patients with low viral load, HBV DNA negative, HBV DNA positive, HBsAg negative, and HBsAg positive were 80.0%, 82.7%, 73.6%, 85.3%, and 78.8%, respectively. Among them, 283 cases (58.84%), 197 cases (55.77%), 86 cases (61.43%), 52 cases (54.74%) and 231 cases (59.84%) were of hypersplenism, and 267 cases (55.51%), 197 cases (55.77%), 70 cases (50.00%), 56 cases (58.95%), and 211 cases (54.66%) were of esophagogastric varices. There were 59 cases (12.27%), 48 cases (14.08%), 11 cases (7.86%), 12 cases (12.63%), and 47 cases (12.18%) of rupture of esophageal and gastric varices, respectively. 202 cases (42.00%), 147 cases (43.11%), 55 cases (39.29%), 42 cases (44.21%), and 160 cases (41.45%) were of ascites, respectively. 17 cases (3.53%), 12 cases (3.52%), 5 cases (3.5%), 2 cases (2.11%), 15 (3.89%) cases were of hepatic encephalopathy, respectively. There were 6 cases (1.25%), 3 cases (0.88%), 3 cases (2.14%), 0 cases (0%), 6 cases (1.55%) of liver cancer. 29 cases (6.03%), 21 cases (6.16%), 8 cases (5.71%), 9 cases (9.47%) and 20 cases (5.18%) were of portal vein thrombosis. Compared with the overall incidence of complications, 341 HBV DNA-negative patients and 95 HBsAg-negative patients still had higher incidence of complications. The patients were grouped by age, and in < 40 years old, 40-50 years old, and > 50 years old, the overall complications were 80.8% in 42 cases, 76.8% in 116 cases and 81.7% in 227 cases, and the difference was not statistically significant. Conclusion: HBV infection patients with low viral load, and those whose HBsAg has disappeared, are still at risk of developing liver cirrhosis and even serious complications, and whether such population need antiviral therapy and benefit from it deserves further research.

[Artificial intelligence aided measurement of cervical squamous epithelial thickness and its correlation with cervical precancerous lesions]

Objective: To study the thickness of cervical squamous epithelia and its correlation with cervical precancerous lesions. Methods: We selected 495 HE slides of 209 cervical biopsies from January 2020 to June 2020 in the Department of Pathology, the First and Seventh Medical Center of the PLA General Hospital, including 173 slides with low grade squamous intraepithelial lesion (LSIL) and 214 slides with high grade squamous intraepithelial lesion (HSIL). Artificial intelligence labeling software was used to assist in measuring the epithelial thickness of normal cervical squamous epithelium, LSIL and HSIL of each slide. The thickest, thinnest, and middle widths of epithelial thickness were measured, respectively. Average epithelial thickness was defined as the sum of the above three widths divided by 3. The correlation statistical analysis was performed by combining the data of age and pathological diagnosis. Results: The average thickness of normal cervical squamous mucosa was (245.83±91.40) μm, which was (222.42±81.22) μm and was (195.95±66.59) μm in LSIL and HISL epithelial respectively (F=27.09, P<0.01). The average cell layers of normal cervical squamous epithelium was (15.5±4.2) layers, which of LSIL was (14.8±4.8) layers, and that of HSIL was (15.8±4.8) layers. The differences among normal, LSIL and HSIL were not statistically significant (P>0.05). Further statistical analysis was stratified by age (≤30 years, 31-40 years, 41-50 years, 51-60 years, and >60 years), the results of Pearson correlation analysis showed that the thickness of normal cervical squamous epithelial gradually thinned with age (correlation coefficient r=-0.141 9, P<0.05), while LSIL and HSIL epithelial thickness had significant correlation with age (P>0.05). In the subgroup of ≤50 years old, the epithelial thickness of normal squamous epithelium was the thickest, followed by LSIL, and HSIL epithelial thickness was the thinnest. The differences were statistically significant (P<0.05). While in the subgroup of >50 years, the differences were not statistically significant (P>0.05). Conclusions: The cervical squamous epithelium gradually becomes thinner with the degree of precancerous lesions increasing among patients of ≤50 years old. However, after age of 50 years, with the onset of menopause, the normal mucosal epithelium is becoming atrophy, so that mucosal thickness is no longer correlated with the extent of the lesion. In addition, it is suggested that the cervical vinegar white test performance during colposcopy is related to the protein changes in the mucosal epithelial cells, but not directly related to the thickness of the epithelial layer.

Machine Learning-Based Prediction of Small Intracranial Aneurysm Rupture Status Using CTA-Derived Hemodynamics: A Multicenter Study

BACKGROUND AND PURPOSE

Small intracranial aneurysms are being increasingly detected while the rupture risk is not well-understood. We aimed to develop rupture-risk models of small aneurysms by combining clinical, morphologic, and hemodynamic information based on machine learning techniques and to test the models in external validation datasets.

MATERIALS AND METHODS

From January 2010 to December 2016, five hundred four consecutive patients with only small aneurysms (<5 mm) detected by CTA and invasive cerebral angiography (or surgery) were retrospectively enrolled and randomly split into training (81%) and internal validation (19%) sets to derive and validate the proposed machine learning models (support vector machine, random forest, logistic regression, and multilayer perceptron). Hemodynamic parameters were obtained using computational fluid dynamics simulation. External validation was performed in other hospitals to test the models.

RESULTS

The support vector machine performed the best with areas under the curve of 0.88 (95% CI, 0.85-0.92) and 0.91 (95% CI, 0.74-0.98) in the training and internal validation datasets, respectively. Feature ranks suggested hemodynamic parameters, including stable flow pattern, concentrated inflow streams, and a small (<50%) flow-impingement zone, and the oscillatory shear index coefficient of variation, were the best predictors of aneurysm rupture. The support vector machine showed an area under the curve of 0.82 (95% CI, 0.69-0.94) in the external validation dataset, and no significant difference was found for the areas under the curve between internal and external validation datasets (P = .21).

CONCLUSIONS

This study revealed that machine learning had a good performance in predicting the rupture status of small aneurysms in both internal and external datasets. Aneurysm hemodynamic parameters were regarded as the most important predictors.

[Feasibility and safety of right ventricular endomyocardial biopsy via the right internal jugular vein approach]

Objective: To evaluate the feasibility and safety of right ventricular endomyocardial biopsy (EMB) via the right internal jugular vein approach. Methods: It was a retrospective and descriptive study. A total of 272 patients, who underwent right ventricular EMB from December 2014 to June 2020 in Fuwai Hospital and Peking Union Medical College Hospital were enrolled. The preliminary diagnosis included suspected myocarditis, myocardiopathy, unexplained heart failure etc after exclusion of coronary heart disease. Clinical characteristics including age, sex, height, weight, NYHA functional class, NT-proBNP, chest radiography, echocardiography, and hemodynamics parameters were collected at baseline. EMB was performed via right internal jugular vein approach under the biplane fluoroscopic guidance. Success rate was calculated in this study. Complications related to operation were recorded according the following definitions. Major complications included death, urgent cardiac surgery, advanced cardiac life support, pericardiocentesis in cardiac tamponade, permanent complete atrioventricular block requiring permanent pacing etc. Minor complications included pericardial effusion without pericardiocentesis, temporary (lasting less than 24 hours) or permanent right bundle-branch block, temporary Mobitz type Ⅱ atrioventricular block (AV block) with AV conduction 2∶1 requiring medical treatment with atropine, or additive temporary pacing, non-sustained ventricular tachycardia with long runs of more than 10 ventricular complexes, and an episode of atrial fibrillation lasting less than 12 hours or cardioversion of atrial fibrillation. Other complications included tricuspid anterior chorda rupture and new onset tricuspid regurgitation after EMB. Results: In this study, right ventricular EMB were performed successfully in 270 patients, the total success rate was 99.3% (270/272), and EMB were failed in 2 (0.7%) patients. Age of the enrolled patients was (42.7±16.9) years, and there were 164 (60.3%) males. Major complication including cardiac tamponade requiring pericardiocentesis occurred in 2 (0.7%) patients. Minor complications such as small amount pericardial effusion occurred in 18 (6.6%) patients, tricuspid anterior chorda rupture occurred in 1 (0.4%) patient. No patient died, or requiring permanent pacing, or requiring emergency cardiac surgery. The complication rate was 9.3% (13/140), 7.8% (7/90), and 2.4% (1/42) in operators with 1, 2, and 3 years' experience. Conclusions: EMB via the right jugular vein approach under fluoroscopic guidance is a simple, safe and feasible procedure. The complication rates decrease significantly with increasing operator experience.

Elevated Creatinine Clearance in Lupus Nephritis patients with Normal Creatinine

Objectives: The present study aimed to observe the differences in creatinine clearance (Ccr) in systemic lupus erythematosus (SLE) patients with normal serum creatinine at different levels of urinary protein. Method: The present cross-sectional study included 177 SLE patients with normal serum creatinine from Qilu Hospital of Shandong University between January 2010 and April 2020. The following data were collected: blood urea nitrogen (BUN), serum creatinine (Cr), serum total protein, serum albumin, immunoglobulin (Ig) G, IgA, IgM, complement 3, complement 4, anti-ds-DNA antibody, routine urine test, urine protein/creatinine ratio (UPCR) (g/g), and the SLE disease activity index. The estimated Ccr was calculated according to the Cockcroft formula. Results: 123 patients were with positive urinary protein (Lupus Nephritis, LN group) and 54 patients were with negative urinary protein (Non-LN group). Compared with the Non-LN group, the LN group had higher BUN (5.76±3.22 vs. 4.78±1.58, P=0.007) and Cr (62.36±19.53 vs. 54.83±11.09, P=0.001). There was a strong correlation between the UPCR and the semi-quantitative determination of urine protein in LN patients (r=0.9583, P=0.0417). The serum creatinine levels were significantly higher in patients with urine protein 3+ (72.97±25.16) or massive proteinuria (62.32±19.66) than the other groups. Patients with urinary protein ± exhibited a significantly elevated Ccr when compared to patients with urinary protein 3+ (130.6±44.15 vs. 110.5±33.50, P=0.02), and patients with UPCR<0.15 g/g had higher Ccr than other groups and showed significantly increased Ccr compared with patients with UPCR≥0.15 g/g (132.44±21.02 vs. 115.14±35.89, P=0.007). Conclusions: Early renal function impairment may be present in LN patients. The kidneys of LN patients with urinary protein ± or UPCR<0.15 g/g are in a state of hyperfunction.

[A comparison of clinical characteristics between patients with and without"recurrence"RNA positive with COVID-19]

Objective: To analysis the clinical characteristics of"recurrence"RNA positive patients with Coronavirus disease 2019 （COVID-19） and compared with those without"recurrence". Methods: 98 patients with COVID-19 in Wuhan Jinyintan Hospital and designated treatment hospitals in Quanzhou were included in this study from February 2020 to April 2020. There were 55 males and 43 females， aged from15 to 83 years， with a median age of 57.5 years， in which 20 cases were complicated with basic diseases. 15 of these patients had been diagnosed and hospitalized had been found as"recurrence"2019-nCoV RNA positive after discharge while the other 83 cases were all negative. The clinical classification of all patients was common type. Clinical data of the COVID-19 RNA"recurrence"patients were collected， and general situations， symptoms， laboratory examinations and CT images were also observed and analyzed. The patients were divided into 2019-nCoV"recurrent"group and 2019-nCoV"non-recurrent"group. There are 10 males and 5 females in 2019-nCoV"recurrent"group while 45 males and 38 females in"non-recurrent"group （χ²=0.800，P=0.371）. The age of 2019-nCoV"recurrent"group （57±21） was higher than that of"non-recurrent"group（53±17）. 8 of 15 the COVID-19"recurrent"group patients and 12 of 83"non-recurrent"patients have basic diseases. IgG and IgM of 2019-nCoV， IL-6， procalcitonin， ESR， CRP， BNP and other serum biochemical index levels were measured and compared between groups. Results: （1） The proportion of patients with common type of COVID-19 was 15.3% during 2-week medical observation after discharge. （2） All of the 2019-nCoV"recurrent"patients were hospitalized due to COVID-19 RNA positive， when they were quarantined after discharged from hospital. All the patients with mild symptoms which were clarified as common type， including 5 cases of fever， 6 cases of cough， 5 cases of expectoration， and 2 cases of slight shortness of breath. The time of symptoms appeared on （5.73±2.82） days after discharge. （3） The serum procalcitonin of all 2019-nCoV"recurrent"group patients were normal（all<0.05 ng/ml）. The BNP of"recurrent"group （151±171） ng/L， was higher than that of"non-recurrent"group （63±78） ng/L （t = 3.207， P = 0.000）. There was no significant difference in laboratory tests like leukocyte ［（6.17±2.4） and （6.04±2.41）×10⁹/L］， lymphocyte［（1.59±0.52） and （1.32±0.64）×10⁹/L］， CRP ［（12.54±28.20） and （21.74±25.63）mg/L］， ESR ［（31.07±28.72） and （34.10±22.16）mm/1 h］， AST ［（24.73±9.15） and （30.24±23.20）U/L］， ALT ［（22.60±12.82） and （36.47±34.12）U/L）， LDH ［（268±208） and （270±164）U/L］， D-dimer ［（0.60±0.50） and （0.84±0.98）μg/L］， ferritin ［（294±195） and （395±319）μg/L］， IL-6 ［（9.17±6.42） and （14.28±17.74）ng/L］ and BUN （5.77±2.66） and （4.74±2.81）U/L］ between"recurrent"and"non-recurrent"groups （all P>0.05）. （4） In"recurrent"group， ground glass， exudative or solid lesions could be found in most of the chest CT performed on re-admission. Meanwhile， fibrosis lesion was relatively rare. （5） There were no secondary transmissions were found to be caused by the 2019-nCoV"recurrent"group patients. Conclusions: Most of the 2019-nCoV patients had underlying diseases and active lesions were still found in CT images， so the possibility of virus replication may still exist. All"recurrent"patients had mild illness which may suggest that they were in recovery stage, and no evidence of transmission is found.

Exogenous melatonin reduces the inhibitory effect of osmotic stress on antioxidant properties and cell ultrastructure at germination stage of soybean

Understanding the relationship between exogenous melatonin and water deficit stress is crucial for alleviating the effects of water deficit stress at germination stage of soybean (Glycine max (L.) Merrill) in agriculture. This study investigated the effects of exogenous melatonin on soybean antioxidant properties and cell ultrastructure under water deficit stress induced by polyethylene glycol (PEG) 6000. The drought-sensitive soybean variety Suinong 26 was used as the material to study the effects of different concentrations of melatonin (0, 300, 500 μmol·L-1) soaking soybean seeds under drought stress (PEG-6000: 3% and 6%). The results showed that the germination rate (GR), germination potential (GP), germination index (GI) and radicle shape of soybean were affected negatively to different degrees under PEG stress. Moreover, stress induced by different PEG concentrations overproduced the content of reactive oxygen species (H2O2, O2·-) in cells, leading to increased lipid membrane peroxidation as electrolyte leakage (EL) and malondialdehyde (MDA) content, which resulted in impaired cell integrity. However, after seeds soaking with melatonin, the lipid peroxidation of the cell membrane was reduced, and the activities of antioxidant enzymes such as superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX) further increased to minimize the excessive generation of ROS. Similar results were obtained for soluble protein and proline, that may help in regulating the osmotic pressure and maintain cellular integrity. With the interaction of these enzymes, compared with 300 μmol·L-1 melatonin, 500 μmol·L-1 melatonin could more effective to remove the ROS and reduce cell peroxidation. Overall, 500 μmol·L-1 melatonin performed better than 300 μmol·L-1. In conclusion, the seed soaking with melatonin promoted the germination of soybean seeds under water stress.

Transcriptomic and metabolomic profiling of melatonin treated soybean (Glycine max L.) under drought stress during grain filling period through regulation of secondary metabolite biosynthesis pathways

There is a growing need to enhance the productivity of soybean (Glycine max L.) under severe drought conditions in order to improve global food security status. Melatonin, a ubiquitous hormone, could alleviate drought stress in various plants. Earlier, we demonstrated that exogenous melatonin treatment could enhance the tolerance of drought-treated soybean. However, the underlying mechanisms by which this hormone exerts drought resistance is still unclear. The present study used transcriptomic and metabolomic techniques to determine some critical genes and pathways regulating melatonin response to drought conditions. Results showed that exogenous melatonin treatment could increase relative water content and decrease electrolyte leakage in the leaves and increase seed yield under drought stress. Transcriptomic analysis showed that there were 852 core differentially expressed genes (DEGs) that were regulated by drought stress and melatonin in soybean leaves. The most enriched drought-responsive genes are mainly involved in the 'biosynthesis of secondary metabolites'. Metabolomic profiling under drought stress showed higher accumulation levels of secondary metabolites related to drought tolerance after exogenous melatonin treatment. Also, we highlighted the vital role of the pathways including phenylpropanoid, flavonoid, isoflavonoid, and steroid biosynthesis pathways for improvement of drought tolerance in soybean by exogenous melatonin treatment. In all, findings from this study give detailed molecular basis for the application of melatonin as a drought-resistant agent in soybean cultivation.

Neuroprotective Effects of Chronic Resveratrol Treatment and Exercise Training in the 3xTg-AD Mouse Model of Alzheimer's Disease

To date, there is no cure or effective treatment for Alzheimer’s disease (AD), a chronic neurodegenerative condition that affects memory, language, and behavior. AD is characterized by neuroinflammation, accumulation of brain amyloid-beta (Aβ) oligomers and neurofibrillary tangles, increased neuronal apoptosis, and loss of synaptic function. Promoting regular exercise and a diet containing polyphenols are effective non-pharmacological approaches that prevent the progression of neurodegenerative diseases. In this study, we measured various conformational toxic species of Aβ and markers of inflammation, apoptosis, endolysosomal degradation, and neuroprotection after 5 months of exercise training (ET), resveratrol (Resv) treatment, or combination treatment in the 3xTg-AD mouse model of AD. Our main results indicate that Resv decreased neuroinflammation and accumulation of Aβ oligomers, increased levels of neurotrophins, synaptic markers, silent information regulator, and decreased markers of apoptosis, autophagy, endolysosomal degradation and ubiquitination in the brains of 3xTg-AD mice. ET improved some markers related to neuroprotection, but when combined with Resv treatment, the benefits achieved were as effective as Resv treatment alone. Our results show that the neuroprotective effects of Resv, ET or Resv and ET are associated with reduced toxicity of Aβ oligomers, suppression of neuronal autophagy, decreased apoptosis, and upregulation of key growth-related proteins.

Synergistic plasmon resonance coupling and light capture in ordered nanoarrays as ultrasensitive and reproducible SERS substrates

An effective SERS substrate for on-field detection needs to satisfy high sensitivity to analyte and signal reproducibility even in the special case of tilting or bending of substrates. Herein, we transferred monolayer AuNPs into a nanocavity to construct a Au particle-in-hemispherical honeycomb nanoarray (PIHHN) as an ultrasensitive and spatially reproducible SERS substrate. The capacity of detection for R6G in an optimal PIHHN substrate is as low as a concentration of 10^-15 M, and the RSD of signal deviation is no more than 5.6%. FDTD simulations explain that placing AuNPs into a metallic nanocavity can capture and focus the light field to improve the interaction between the light and the substrate and provide the collective effect of multiple plasmon coupling, which can induce a stronger electromagnetic field. In addition, the system can generate more hot spots between AuNPs and between AuNPs and the metallic nanocavity. In particular, when the substrate is tilted or bent at an angle from 0° to 60°, the SERS performance remains stable due to the rotational symmetry of the PIHHN structure, which demonstrates the capability of on-field detection. Furthermore, the PIHHN substrate is employed as a highly sensitive multiplex sensor in on-field analysis for contaminated soil, achieving the detection of analytes down to 0.5 ppb.

[A case of using profunda artery perforator flap as an intraoperative salvage for failed deep inferior epigastric artery perforator flap harvesting in autologous breast reconstruction]

On April 11, 2019, a 36-year-old female patient was admitted to Hunan Cancer Hospital. Five years after the modified radical mastectomy for right breast cancer, she planned to undergo scar releasing and reconstruction of right chest wall and free deep inferior epigastric artery perforator (DIEP) flap transfer, right breast reconstruction, and left breast mastopexy. The defect of right chest wall after scar resection was 18 cm×10 cm. During the operation, the vascular pedicle of DIEP flap was accidentally injured, then the profunda artery perforator flap in left inner thigh was designed for salvage. The size of the flap was 20 cm×11 cm, the thickness was 4.5 cm, the length of perforator vessel pedicle was 7.6 cm, and the weight of the flap was 360 g. The right breast defect was repaired with the transferred flap and the deep cavity was filled. The vascular pedicle of profunda artery was anastomosed with the proximal end of the right internal mammary artery. The blood supply of the flap was good during surgery. The left breast mastopexy was completed at the same time, and the donor site of thigh and abdomen was closed directly. The flap survived well and the donor site healed well after surgery. During the follow-up of 7 months post surgery, the appearance and function of thigh donor site were good, no obvious complications were found, and the reconstructed breast was smaller than the contralateral side. This case suggests that the profunda artery perforator flap could be a valuable option as an alternative for DIEP harvesting failure for autologous breast reconstruction.

Correlation analysis between vitamin D receptor gene polymorphism (BsmI) and hallux valgus

Hallux valgus is a common foot deformity disease caused by various extrinsic and intrinsic factors, and systemic conditions, but the etiopathogenesis and pathogenesis of this deformity are still unknown. Hallux valgus affects 10-20% of Chinese adults. Although considered highly heritable, the candidate gene is unclear. We conducted the first candidate gene study of hallux valgus to identify the biological mechanism. Between June 2015 and July 2018, the records and radiographs of 80 patients diagnosed with hallux valgus and 80 controls who were treated were analyzed. In order to compare the differences in severity associated with this deformity, the charts of 80 patients were divided into 3 groups from the angle of hallux valgus. Clinical and basic studies were also statistically compared by PCR and data analysis. Patients and controls had significant differences in age and gender, however, there were no significant differences in age and gender among the light, moderate and severe groups. Post-operative groups resulted in significant improvements in all of the measured radiographic parameters compared with pre-operative groups. BsmI seemed to show a specific variation, and may serve as a useful bio-marker for the disease (OR = 5.88, 95% CI 1.54-22.35, P <0.001). In this paper, the article which proved the VDR polymorphisms (BsmI) playing an important role in hallux valgus were studied to understand and manage the hallux valgus more scientifically.

Improved Constraints on Sterile Neutrino Mixing from Disappearance Searches in the MINOS, MINOS+, Daya Bay, and Bugey-3 Experiments

Searches for electron antineutrino, muon neutrino, and muon antineutrino disappearance driven by sterile neutrino mixing have been carried out by the Daya Bay and MINOS+ collaborations. This Letter presents the combined results of these searches, along with exclusion results from the Bugey-3 reactor experiment, framed in a minimally extended four-neutrino scenario. Significantly improved constraints on the θ_{μe} mixing angle are derived that constitute the most constraining limits to date over five orders of magnitude in the mass-squared splitting Δm_{41}^{2}, excluding the 90% C.L. sterile-neutrino parameter space allowed by the LSND and MiniBooNE observations at 90% CL_{s} for Δm_{41}^{2}<13  eV^{2}. Furthermore, the LSND and MiniBooNE 99% C.L. allowed regions are excluded at 99% CL_{s} for Δm_{41}^{2}<1.6 eV^{2}.

High-yield strain of fusidic acid obtained by atmospheric and room temperature plasma mutagenesis and the transcriptional changes involved in improving its production in fungus Fusidium coccineum

AIMS

To obtain the high-yield strain of fusidic acid, which is produced from fungus Fusidium coccineum and is the only fusidane-type antibiotic that has been used clinically, and confirm the changes in the transcription levels involved in increasing its production.

METHODS AND RESULTS

By using the atmospheric and room temperature plasma mutagenesis technology, a high-yield mutant strain of fusidic acid-producing fungus F. coccineum was obtained. Using the genomic analysis of the original strain based on biosynthetic pathways of ergosterol and helvolic acid, we demonstrate that the pathway involved in the biosynthesis of 2,3-oxidosqualene from acetyl coenzyme A was shared by fusidic acid and ergosterol, and fusidic acid was finally synthesized by the catalysis of multiple cytochrome P450s and short-chain dehydrogenase/reductase from 2,3-oxidosqualene. Then, through the transcriptomic analysis of the original and mutagenized strain, it revealed that the proposed pathway from sucrose to fusidic acid was the most significantly up-regulated in the transcription levels of the mutant strain.

CONCLUSIONS

The changes in the transcription levels of fusidic acid during its biosynthesis might result in high-yield of fusidic acid in the mutant strain. This is the first report on the whole biosynthetic pathway of fusidic acid in F. coccineum.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study obtain the genetic basis for the biosynthesis of fusidic acid which could be beneficial for the molecular modifications of F. coccineum to further increase its yield by fermentation in future, and established the foundation to reveal the mechanism of the high-yield of the mutant strain.