Periodontal health: A national cross-sectional study of knowledge, attitudes and practices for the public oral health strategy in China

AIM

To assess the status of periodontal health knowledge, attitudes and practices (KAP) among Chinese adults.

MATERIALS AND METHODS

A cross-sectional study was conducted in a nationally representative sample of adults (N = 50,991) aged 20 years or older from ten provinces, autonomous regions, and municipalities. Percentages of Chinese adults with correct periodontal knowledge, positive periodontal attitudes, and practices were estimated. Multiple logistic regression analyses were used to examine the related factors.

RESULTS

Less than 20% of Chinese adults were knowledgeable about periodontal disease. Very few (2.6%) of Chinese adults use dental floss ≥once a day and undergo scaling ≥once a year and visit a dentist (6.4%) in the case of gingival bleeding. Periodontal health KAP was associated with gender, age, body mass index, marital status, place of residence, education level, income, smoking status, and history of periodontal disease.

CONCLUSIONS

Periodontal health KAP are generally poor among the Chinese adult population. Community-based health strategies to improve periodontal health KAP need to be implemented. Increasing knowledge of periodontal disease, the cultivation of correct practices in response to gingival bleeding, and the development of good habits concerning the use of dental floss and regular scaling should be public oral health priorities.

Magnetic Resonance Imaging (MRI) and Three-Dimensional Transvaginal Ultrasonography Scanning for Preoperative Assessment of High Risk in Women with Endometrial Cancer

Background

To evaluate the diagnostic performance of MRI and 3D-TVS for assessment of deep myometrial invasion (MI), cervical involvement (CI), and Lymph node metastases (LNM) in endometrial cancer staging before surgery.

Material/Methods

From January 2016 to December 2017, we reviewed data from 314 women with endometrial cancer who underwent preoperative MRI and 3D-TVS before surgery. The diagnostic sensitivity, specificity, PPV, NPV, and accuracy in detecting MI, CI, and LNM were estimated based on ultimate pathology results.

Results

The sensitivity, specificity, PPV, NPV, and accuracy of MRI in the diagnosis of MI were 89.19%, 88.97%, 67.35%, 97.99%, and 89.01%, respectively, and the indexes of 3D-TVS for MI were 86.36%, 91.07%, 79.17%, 94.44%, and 89.74%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of MRI for CI were 75% and 92.35%, 40.9%, 98.13%, and 91.2%, respectively. The indicators of 3D-TVS were 77.78%, 94.29%, 63.63%, 97.06%, and 92.4%, respectively. There were no significant differences in sensitivity, specificity, NPV, and accuracy between MRI and 3D-TVS in the diagnosis of MI and CI. For MI and CI, the sensitivity of combined MRI and 3D-TVS was higher than any other single method (P<0.05). For LNM, the sensitivity, specificity, PPV, NPV, and accuracy of MRI were 58.33%, 96.26%, 63.63%, 95.37%, and 92.43%, respectively.

Conclusions

3D-TVS is equivalent to MRI in predicting MI and CI. Combined MRI and 3D-TVS can improve the assessment sensitivity, and they are useful in optimizing individualized surgical procedures. The sensitivity of MRI for LNM prediction needs to be improved.

Physiochemical properties and paclitaxel release behaviors of dual-stimuli responsive copolymer-magnetite superparamagnetic nanocomposites

Magnetically driven drug delivery systems of superparamagnetic iron oxide nanoparticles have a considerable potential as candidates to overcome the present obstacles of drug delivery in anti-tumor therapy owing to its remote controllability by external magnetic fields and other unique properties. In this work, a biodegradable anionic copolymer with side carboxylic groups named methoxy-poly (ethylene glycol)-block-poly(α-carboxyl-ε-caprolactone) was synthesized to complex iron oxide magnetic nanoparticles and load paclitaxel (PTX) to form dual-stimuli responsive copolymer-magnetite superparamagnetic nanocomposites with an elastic core and carboxylic groups on the surface in a very easy way. The physiochemical properties of these nanocomposites were measured. High PTX loading content and high saturation magnetization were obtained. Being proved to be stable at a wide pH range and low cytotoxic in vitro, these nanocomposites presented faster PTX release in vitro at pH 6.5 than at pH 7.4 and obviously reduced burst release.

Predicting forced vital capacity (FVC) using support vector regression (SVR)

OBJECTIVE

Spirometry, as the gold standard approach in the diagnosis of chronic obstructive pulmonary disease (COPD), has strict end of test (EOT) criteria (e.g. complete exhalation), which cannot be met by patients with compromised health states. Thus, significant parameters measured by spirometry, such as forced vital capacity (FVC), have limited accuracies. To address this issue, the present study aimed to develop models based on support vector regression (SVR) to predict values of FVC under the condition that the EOT criteria were not fully met.

APPROACH

The prediction models for the quantification of FVC were developed based on SVR. A total of 354 subjects underwent conventional spirometry (CS), and the resulting data of forced expiratory volumes in 1 s (FEV1), peak expiratory flow (PEF), age and gender were used as input features, while the resulting values of the FVC were used as the target feature in the prediction models. Next, three prediction models (mixed model, normal model and abnormal model) were established according to the criterion in the diagnosis of COPD that a postbronchodilator shows an FEV1/FVC ratio lower than 0.70. Then, 35 subjects were recruited to be tested using both CS and a low-degree-of-EOT criteria spirometry (LDCS), which did not fully meet the EOT criteria of CS. In LDCS, subjects were allowed to terminate the procedure at their own will at any time after the technicians had assumed that both acceptable values of FEV1 and PEF had been obtained. Quantified values of FVC derived from both CS and LDCS were compared to validate the performances of the developed prediction models.

MAIN RESULTS

The FVC prediction performances of the normal model and abnormal model were better than that of the mixed model. The root mean squared error are lower than 0.35 l and the accuracies are higher up to 95%. One-tailed t test results demonstrate that the absolute differences in the measured and predicted values are not significantly different from 0.15 l for both the abnormal model and the normal model.

SIGNIFICANCE

Our study shows the possibility of predicting FVC with acceptable precision in cases where the EOT criteria of spirometry were not fully met, which can be beneficial for patients who cannot or did not achieve full exhalation in spirometry.

PACT cessation overcomes ovarian cancer cell chemoresistance to cisplatin by enhancing p53-mediated apoptotic pathway

Ovarian cancer ranks as a lethal gynecological malignancy, and development of resistance to chemotherapy agents constitutes a major clinical challenge in ovarian carcinoma management. P53-associated cellular protein-testes derived (PACT) is recently proven to be expressed aberrantly in several cancers, and exerts a critical roles in cell proliferation, apoptosis and migration. Up to now, its function in chemoresistance of ovarian cancer remains poorly defined. In the present study, elevated expression of PACT was detected in cisplatin-resistant A2780/CP cells relative to cisplatin-sensitive A2780 cells. Moreover, exposure to cisplatin also increased PACT expression in A2780 cells. Functional assay confirmed that knockdown of PACT further aggravated the inhibitory effects of cisplatin on A2780 cell viability and enhanced cell apoptosis and caspase-3 activity in cisplatin-treated A2780 cells, indicating that PACT cessation elevates cell sensitivity to cisplatin in A2780 cells. Whilst, deletion of PACT affords little effects on cisplatin resistance in p53-defective SKOV3 cells. Mechanistic analysis corroborated that depression of PACT notably enhanced cisplatin-induced p53 expression, concomitant with the increases in p53-downstream Bax, p21 expression and decrease in Bcl-2 expression. Intriguingly, blocking the p53 pathway notably reversed PACT inhibition-increased cell sensitivity to cisplatin in A2780 cells by elevating cell viability and depressing cell apoptosis. Additionally, abrogation of p53 signaling also blunts PACT suppression-overcomed chemotherapy resistance to cisplatin in A2780/CP cells. Together, these findings confirm that targeting PACT may antagonize ovarian cancer cell resistance to cisplatin, supporting a promising therapeutic strategy to overcome the chemotherapy resistance in the treatment of ovarian cancer.

[Related factors on secondary drug resistance in HIV infected persons receiving antiretroviral therapy in Shandong province: a case-control study]

Objective: To explore the causes of secondary drug resistance among HIV infected persons who were receiving antiretroviral therapy in Shandong province, and provide evidence for the improvement of antiretroviral therapy strategy. Methods: A case-control study was designed with 1∶2 matching on case and control groups. Household and face-to-face interview were conducted in October, 2015. All the study subjects were screened from both the drug resistant database of antiretroviral therapy of Shandong provincial laboratory and national comprehensive HIV/AIDS database in Shandong. The sample size was estimated as 330 cases including 110 drug resistant and 220 non-drug resistant cases. Subjects were people living with HIV/AIDS (PLWHA) aged 15 or older and received antiretroviral therapy for more than 6 months with records of virus load (VL). Subjects who presented VL above 1 000 copies/ml would receive drug resistance testing. Subjects who were confirmed resistant to with secondary drug, were selected as case group, the rest subjects with non-secondary drug resistance would form the control group. EpiData 3.1 software and SPSS 22.0 software were used to establish a database. Related influencing factors were analyzed with non- conditional stepwise logistic regression model. Results: A total of 288 cases were enrolled, including 103 in the case and 185 cases in the control groups, with average age as (37.62±1.06) years and (37.90±0.74) years old, respectively. Most of them were male, married/cohabitant, with education level of junior/senior high school or below and under Han nationality. Results from the multivariate logistic regression model showed that ORs (95%CI) of receiving antiretroviral therapy for 1-3 years, or more than 3 years were equal to 8.80 (3.69-21.00), 3.00 (1.20-7.53), compared with receiving antiretroviral therapy less than one year, respectively. OR (95%CI) of Among the PLWHA that with missing rate above 25.0% on medication, the OR appeared as 15.41(4.59-51.71), compared with not missing medication. OR (95%CI) among those who took the medicine themselves was 0.22 (0.07-0.74). Conclusions: Factors as duration of treatment, missing rate on medication and taking medicine by oneself were of influence on secondary drug resistance. Other factors as duration on antiretroviral therapy longer than 1 year, missing rate above 25.0% on medication, were related to the risk on secondary drug resistance. However, if the medicine was taken by oneself, it served as a protective factor for secondary drug resistance. It is necessary to strengthen the intervention and health education programs related to antiretroviral therapy.

Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia

The aim of this study was to explore the predictive value of procalcitonin (PCT) in Gram-negative bloodstream infections (BSIs) in hematological patients with febrile neutropenia. A total of 1466 samples (396 blood culture (BC)-positive, 1052 BC-negative, and 18 contaminated specimens) were included, comprising 268 Gram-negative, 88 Gram-positive, 19 fungal, and 21 polymicrobial BSIs. Median PCT value (0.72 ng/mL; IQR: 0.23-3.87) was significantly higher in Gram-negative than Gram-positive (0.34 ng/mL; IQR: 0.14-2.23; p < .01), or fungal (0.27 ng/mL; IQR: 0.13-0.40; p < .01) BSIs. In mono-microbial BSIs, the best PCT cutoff distinguishing Gram-negative BSIs from all other fever causes was 0.56 ng/ml, with a specificity of 76.8%. PCT levels were significantly higher in BSIs from multidrug-resistant (MDR) Gram-negative strains than from non-MDR (p < .01). This study confirms that elevated PCT may predict Gram-negative BSIs in hematological patients with febrile neutropenia, and demonstrates higher PCT levels in MDR Gram-negative BSIs in these patients.

TLR4 May Be Involved in the Regulation of Colonic Mucosal Microbiota by Vitamin A

Objectives: To investigate the specific role of Toll-like receptor 4 (TLR4) in the regulation of the intestinal mucosa-associated microbiota by vitamin A (VA).

Methods: Both TLR4^-/- (knockout, KO) and wild-type (WT) female mice were randomly fed a VA normal (VAN) or VA deficient (VAD) diet for 4 weeks to establish the following four mouse model groups: TLR4^-/- mice fed a VAN diet (KO VAN), TLR4^-/- mice fed a VAD diet (KO VAD), WT mice fed a VAN diet (WT VAN), and WT mice fed a VAD diet (WT VAD). Then, the mice from each experimental group were mated with male mice with the same genetic background. The pups in the KO VAD and WT VAD groups were subsequently fed the VAD diet after weaning, while the pups in the KO VAN and WT VAN groups were fed the VAN diet continuously after weaning. The serum retinol levels of 7-week-old offspring were determined using high-performance liquid chromatography, and colons were collected from mice in each group and analyzed via 16S rRNA gene sequencing using an Illumina MiSeq platform to characterize the overall microbiota of the samples.

Results: The abundance and evenness of the colon mucosa-associated microbiota were unaffected by dietary VA and TLR4 KO. VAD decreased the abundance of Anaerotruncus (Firmicutes), Oscillibacter (Firmicutes), Lachnospiraceae _NK4A136 _group (Firmicutes) and Mucispirillum (Deferribacteres) and increased the abundance of Parasutterella (Proteobacteria). TLR4 KO decreased the abundance of Bacteroides (Bacteroidetes) and Alloprevotella (Bacteroidetes). However, the abundance of Allobaculum (Firmicutes), Ruminiclostridium_9 (Firmicutes), Alistipes (Bacteroidetes), and Rikenellaceae_RC9 (Bacteroidetes) impacted the interaction between VA and TLR4.

Conclusion: TLR4 may play a pivotal role in regulation of the intestinal mucosa-associated microbiota by VA to maintain the intestinal microecology.

Complex Role for E-Prostanoid 4 Receptors in Hypertension

Background Prostaglandin E2 ( PGE 2) is a major prostanoid with multiple actions that potentially affect blood pressure ( BP ). PGE 2 acts through 4 distinct E-prostanoid ( EP ) receptor isoforms: EP 1 to EP 4. The EP 4 receptor ( EP 4R) promotes PGE 2-dependent vasodilation, but its role in the pathogenesis of hypertension is not clear. Methods and Results To address this issue, we studied mice after temporal- and cell-specific deletion of EP 4R. First, using a mouse line with loss of EP 4 expression induced universally after birth, we confirm that EP 4R mediates a major portion of the acute vasodilatory effects of infused PGE 2. In addition, EP 4 contributes to control of resting BP , which was increased by 5±1 mm Hg in animals with generalized deficiency of this receptor. We also show that EP 4 is critical for limiting elevations in BP caused by high salt feeding and long-term infusion of angiotensin II . To more precisely identify the mechanism for these actions, we generated mice in which EP 4R loss is induced after birth and is limited to smooth muscle. In these mice, acute PGE 2-dependent vasodilation was attenuated, indicating that this response is mediated by EP 4R in vascular smooth muscle cells. However, absence of EP 4R only in this vascular compartment had a paradoxical effect of lowering resting BP , whereas the protective effect of EP 4R on limiting angiotensin II-dependent hypertension was unaffected. Conclusions Taken together, our findings support a complex role for EP 4R in regulation of BP and in hypertension, which appears to involve actions of the EP 4R in tissues beyond vascular smooth muscle cells.

Targeting IL-17 attenuates hypoxia-induced pulmonary hypertension through downregulation of β-catenin

BACKGROUND

The role of interleukin 17 (IL-17) in hypoxic pulmonary hypertension (HPH) remains unclear. This study is designed to explore whether IL-17 is a potential target for HPH treatment.

METHODS

Clinic samples from the lung tissue and serum were obtained from qualified patients. Western blotting, immunohistochemistry and/or ELISA were used to measure the expression of relevant proteins. HPH models were established in C57BL/6 wild-type (WT) and IL-17 ^-/- mice and were treated with exogenous recombinant mouse IL-17 (rmIL-17) or an IL-17 neutralising antibody. Assays for cell proliferation, angiogenesis and adhesion were employed to analyse the behaviours of human pulmonary arterial endothelial cells (HPAECs). A non-contact Transwell coculture model was used to evaluate intercellular interactions.

RESULTS

Expression of IL-17 was increased in lung tissue of both patients with bronchiectasis/COPD-associated PH and HPH mouse model. Compared with WT mice, IL-17 ^-/- mice had attenuated HPH, whereas administration of rmIL-17 aggravated HPH. In vitro, recombinant human IL-17 (rhIL-17) promoted proliferation, angiogenesis and adhesion in HPAECs through upregulation of Wnt3a/β-catenin/CyclinD1 pathway, and siRNA-mediated knockdown of β-catenin almost completely reversed this IL-17-mediated phenomena. IL-17 promoted the proliferation but not the migration of human pulmonary arterial smooth muscle cells (HPASMCs) cocultured with HPAECs under both normoxia and hypoxia, but IL-17 had no direct effect on proliferation and migration of HPASMCs. Blockade of IL-17 with a neutralising antibody attenuated HPH in WT mice.

CONCLUSIONS

IL-17 contributes to the pathogenesis of HPH through upregulation of β-catenin expression. Targeting IL-17 might provide potential benefits for alternative therapeutic strategies for HPH.

Efficacy and safety of mTOR inhibitors (rapamycin and its analogues) for tuberous sclerosis complex: a meta-analysis

Background

The treatment of tuberous sclerosis complex (TSC) using mammalian target of rapamycin (mTOR) inhibitors is clinically promising. The aim of the present study was to evaluate the efficacy and safety of mTOR inhibitors for improving the clinical symptoms of TSC.

Methods

We performed a systematic search of major electronic databases (PubMed, EMBASE, Cochrane Library and WanFang, CNKI, and VIP databases) to identify randomized controlled trials (RCTs) and quasi-randomized studies from the date of database inception to November 2017; the Chinese Food and Drug Administration and clinicaltrials.gov were also searched for unpublished studies. The endpoints of the study were the tumor response rate and seizure frequency response rate (the proportion of patients achieving a ≥ 50% reduction relative to the baseline). Two researchers screened articles, assessed the risk of bias and extracted data independently. The included RCTs were analyzed using RevMan 5.3, which was provided by the Cochrane Collaboration.

Results

Compared with the placebo, mTOR inhibitors significantly reduced tumor volume in both angiomyolipoma (AML) (RR = 24.69, 95% CI = 3.51,173.41, P = 0.001) and subependymal giant cell astrocytoma (SEGA) (RR = 27.85, 95% CI = 1.74,444.82, P = 0.02). Compared with the placebo, mTOR inhibitors significantly reduced seizure frequency (RR = 2.12, 95% CI = 1.41,3.19, P = 0.0003). Regarding safety, compared with patients who did not receive mTOR inhibitors, those who did had a higher risk of suffering stomatitis (RR = 3.20, 95% CI = 1.49,6.86, P = 0.003). In contrast, patients who did and did not receive mTOR inhibitors experienced similar adverse events, such as upper respiratory tract infections (RR = 1.08, 95% CI = 0.81,1.45, P = 0.59) and nasopharyngitis (RR = 0.86, 95% CI = 0.60,1.21, P = 0.38).

Conclusion

In view of the efficacy and safety associated with tumor and seizure frequency in the TSC patients, mTOR inhibitors is a good therapeutic choice. Unlike the risks of upper respiratory tract infections and nasopharyngitis, mTOR inhibitors seem to increase the risk of stomatitis, mostly grade 1 and 2.

Managing creativity and compliance in the pursuit of patient safety

Background

Are creativity and compliance mutually exclusive? In clinical settings, this question is increasingly relevant. Hospitals and clinics seek the creative input of their employees to help solve persistent patient safety issues, such as the prevention of bloodstream infections, while simultaneously striving for greater adherence to evidence-based guidelines and protocols. Extant research provides few answers about how creativity works in such contexts.

Methods

Cross-sectional survey data were collected from employees in 24 different U.S.-based outpatient hemodialysis clinics. Linear mixed-effects models were utilized to test study hypotheses. Professional status, clinic climate variables, and interaction terms were modeled as fixed effects, with a random effect for clinic included in all models.

Results

Our results show that high status employees contributed more creative patient safety improvement ideas compared to low status employees. However, when high status employees were part of clinics with a stronger safety climate of compliance, they contributed fewer creative ideas compared to their counterparts working in clinics with a reduced compliance orientation. We also predicted low status employees working in less punitive clinics would contribute more creative ideas, but this hypothesis was not fully supported.

Conclusions

This study suggests that in hospitals and clinics that rely on strict protocols and formal hierarchies to meet their goals, the factors that promote creativity may be distinctively context-dependent. Implications for theory, practice, as well as future directions for research examining creativity in healthcare and safety critical contexts are discussed.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3935-2) contains supplementary material, which is available to authorized users.

Clinical trial update on bispecific antibodies, antibody-drug conjugates, and antibody-containing regimens for acute lymphoblastic leukemia

The relapse rate remains high after chemotherapy for adult patients with acute lymphoblastic leukemia (ALL). With better molecular diagnosis and classification as well as better assessment for minimal residual disease, major progress in the treatment for refractory and/or relapsed ALL is being made. In addition to the tyrosine kinase inhibitors (TKIs) for Philadelphia chromosome-positive ALL, immunotherapeutic agents, blinatumomab, inotuzumab ozogamicin (INO), and chimeric antigen receptor (CAR) T cells, are changing the treatment paradigm for ALL. Blinatumomab and INO are being incorporated into induction chemotherapy regimens and combined with TKIs for ALL therapy. A novel low-intensity regimen, miniHCVD-INO-blinatumomab, appears to be less toxic and more effective than conventional intensive chemotherapy regimens. This review summarized new therapeutic researches of ALL and updated latest progress in clinical trials on bispecific antibodies, antibody-drug conjugates, and new regimens incorporating these novel antibodies.

Early increased neutrophil-to-lymphocyte ratio is associated with poor 3-month outcomes in spontaneous intracerebral hemorrhage

The aim of this study was to evaluate the association of dynamic neutrophil-to-lymphocyte ratio (NLR) with 3-month functional outcomes in patients with sICH. We retrospectively identified 213 consecutive patients with sICH hospitalized in The First Affiliated Hospital of Zhengzhou University from January 2017 to May 2018. Patients were divided into functional independence (FI) or unfavorable prognosis (UP) groups based on 3-month outcomes. Admission leukocyte counts within 24 hours of symptom onset were obtained, and the recorded fraction, of which the numerator is neutrophil and the denominator is lymphocyte, as NLR0. Determined NLR1, NLR3, NLR7, and NLR14 were recorded on day 1 (n = 77), day 3 (n = 126), day 7 (n = 123), and day 14 (n = 105), respectively. The relationships between dynamic NLR or leukocyte counts and clinical features were evaluated using Spearman’s or Kendall’s correlation analysis. Logistic regression analyses were used to identify the risk factors for unfavorable 3-month prognosis. The patients’ dynamic NLR was positively associated with the National Institutes of Health Stroke Scale, ICH score, and hematoma volume at admission, while inversely correlated to the onset GCS score and FI at 3-month follow-up. Furthermore, higher NLR or lower absolute lymphocyte count obtained at admission was independently risk factor for UP at 3 months (adjusted odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.003, 1.12; OR: 0.41, 95% CI: 0.18, 0.94, respectively). In conclusion, higher NLR and lower lymphocyte counts at early stages were predictive of 3-month unfavorable outcomes in sICH patients.

[Effect of transcutaneous oximetry on prognosis of patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation]

Objective: To investigate the prognostic value of transcutaneous oximetry in patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation(ECMO). Methods: Forty-nine patients diagnosed as severe acute respiratory failure receiving Venous-Venous(V-V)ECMO were enrolled from January 2013 to December 2015 in intensive care unit(ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University.The 10-min oxygen challenge test was performed using transcutaneous oximetry 6 h after the initiation of ECMO, and the 10-min oxygen challenge test value(OCT(10)) and oxygen challenge index(OCI) were calculated.The following data were collected: patients' baseline characteristics, results of arterial blood gas analysis, ventilator settings, APACHEⅡ, SOFA and Murray lung injury score. Patients were stratified into the survival group and the death group based on their mortality status at 60 d after initiation of ECMO.Patients' characteristics and clinical data were analyzed with SPSS 22.0 software. Receiver operating characteristics (ROC) analysis for predicting 60 d mortality was carried out to find area under curve (AUC) and threshold levels of OCT(10) and OCI. Analysis of survival probability was carried out by Kaplan-Meier method and log-rank test. Multivariable logistic regression was used to identify factors associated with outcomes. Results: There were 25 patients in the survival group and 24 patients in the death group. The characteristics(i.e., age, sex, primary disease) and clinical data(i.e., results of arterial blood gas, ventilator settings) of the 2 groups were similar (P>0.05). The survival group had a significant higher OCT(10) and OCI [(77±11) mmHg(1 mmHg=0.133 kPa), 0.77±0.17] than the death group [(57±12) mmHg, 0.55±0.13, all P<0.05]. The AUC value of OCT(10) and OCI for predicting 60 d mortality were 0.87±0.07(95%CI: 0.69-0.96, P<0.05) and 0.83±0.18(95%CI: 0.64-0.94, P<0.05) respectively, and the cutoff points for OCT(10) and OCI were 72.00 mmHg and 0.80. Kaplan-Meier survival analysis showed that a OCT(10)≥72 mmHg (81.3% vs 15.4%, χ(2)=7.04, P<0.01) and a OCI≥0.8(77.8% vs 21.7%, χ(2)=13.15, P<0.01) were related to better outcome. Multivariate logistic regression analysis showed that OCT(10)(OR=0.88, 95%CI: 0.80-0.96, P<0.01) and OCI (OR=0.01, 95%CI: 0.001-0.086, P<0.01) were both risk factors associated with 60 d mortality. Conclusion: The OCT(10) and OCI are predictive of mortality for patients with severe acute respiratory failure receiving ECMO support.

Fast esophageal layer segmentation in OCT images of guinea pigs based on sparse Bayesian classification and graph search

Endoscopic optical coherence tomography (OCT) devices are capable of generating high-resolution images of esophageal structures at high speed. To make the obtained data easy to interpret and reveal the clinical significance, an automatic segmentation algorithm is needed. This work proposes a fast algorithm combining sparse Bayesian learning and graph search (termed as SBGS) to automatically identify six layer boundaries on esophageal OCT images. The SBGS first extracts features, including multi-scale gradients, averages and Gabor wavelet coefficients, to train the sparse Bayesian classifier, which is used to generate probability maps indicating boundary positions. Given these probability maps, the graph search method is employed to create the final continuous smooth boundaries. The segmentation performance of the proposed SBGS algorithm was verified by esophageal OCT images from healthy guinea pigs and the eosinophilic esophagitis (EoE) models. Experiments confirmed that the SBGS method is able to implement robust esophageal segmentation for all the tested cases. In addition, benefiting from the sparse model of SBGS, the segmentation efficiency is significantly improved compared to other widely used techniques.

Effect of Qiangxin Huoli decoction on rats with adriamycin-induced chronic heart failure

OBJECTIVE

To investigate the effect of Qiangxin Huoli decoction on rats with chronic heart failure (CHF) induced by adriamycin (ADR), and to investigate the underlying mechanism of this effect.

METHODS

Ninety-six healthy Wistar rats were divided into six groups: control, CHF model, CHF treated by Shenfu injection, and three CHF groups treated with Qiangxin Huoli decoction at high, medium, and low doses, respectively. Qiangxin Huoli decoction was administered orally to protect the stomach in the three Qiangxin Huoli decoction groups, while the control group and the CHF model group were administered the same volume of 0.9% physiological saline, and the Shenfu group wereadministered the same volume of Shenfu injection. Ten days later, the CHF model was then induced in all groups except the control group by intraperitoneal injection of ADR at gradient dose intervals. The bodyweights were recorded on days 10, 20, 30, and 40. Hemodynamic indices were recorded, including left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), maximum increase in left ventricular pressure (+dp/dtmax), maximum decrease in left ventricular pressure (-dp/dtmax), heart rate (HR), and electrocardiogram using an eight-channel physiological recorder with LabChart software monitoring. The plasma brain natriuretic peptide (BNP) concentration was determined by enzyme-linked immunosorbent adsorption. The expressions of B-cell lymphoma-2 (Bcl-2) and Bcl-2-associated X protein (Bax) were detected by immunohistochemical methods.

RESULTS

The CHF model group were in poor condition, and the mean bodyweight was significantly decreased compared with the control group. Furthermore, compared with the control group, the CHF groups had significantly decreased LVSP, +dp/dtmax, and -dp/dtmax, and significantly increased LVEDP. The CHF groups also showed significant increases in HR, S-T segment elevation, and plasma BNP levels compared with the control group. Compared with the CHF model group, the treatment groups had significantly increased Bax expression (P < 0.05) and significantly decreased Bcl-2 expression (P < 0.01), indicating less apoptosis. The high dose Qiangxin Huoli decoction group and the Shenfu group showed the most significant improvements.

CONCLUSION

In the rat model of CHF, Qiangxin Huoli decoction significantly reduces the abnormal hemodynamics, improves cardiac function, reduces plasma BNP concentration, regulates the expression of apoptosis proteins, inhibits the apoptosis of myocardial cells, and plays a protective role.

Noninvasive Activation Imaging of Ventricular Arrhythmias by Spatial Gradient Sparse in Frequency Domain-Application to Mapping Reentrant Ventricular Tachycardia

The aim of this paper is to develop and evaluate a novel imaging method [spatial gradient sparse in frequency domain (SSF)] for the reconstruction of activation sequences of ventricular arrhythmia from noninvasive body surface potential map (BSPM) measurements. We formulated and solved the electrocardiographic inverse problem in the frequency domain, and the activation time was encoded in the phase information of the imaging solution. A cellular automaton heart model was used to generate focal ventricular tachycardia (VT). Different levels of Gaussian white noise were added to simulate noise-contaminated BSPM. The performance of SSF was compared with that of weighted minimum norm inverse solution. We also evaluated the method in a swine model with simultaneous intracardiac and body surface recordings. Four reentrant VTs were observed in pigs with myocardial infarction generated by left anterior descending artery occlusion. The imaged activation sequences of reentrant VTs were compared with those obtained from intracardiac electrograms. In focal VT simulation, SSF has increased the correlation coefficient (CC) by 5% and decreased localization errors (LEs) by 2.7 mm on average under different noise levels. In the animal validation with reentrant VT, SSF has achieved an average CC of 88% and an average LE of 6.3 mm in localizing the earliest and latest activation site in the reentry circuit. Our promising results suggest that the SSF provides noninvasive imaging capability of detecting and mapping macro-reentrant circuits in 3-D ventricular space. The SSF may become a useful imaging tool of identifying and localizing the potential targets for ablation of focal and reentrant VT.

G-CSF-primed haplo-identical HSCT with intensive immunosuppressive and myelosuppressive treatments does not increase the risk of pre-engraftment bloodstream infection: a multicenter case-control study

A multicenter retrospective study in 131 patients (44 females/87 males) with hematological disorders who underwent G-CSF-primed/haplo-identical (Haplo-ID) (n = 76) or HLA-identical (HLA-ID) HSCT (n = 55) from February 2013 to February 2016 was conducted to compare the incidence and risk factors for pre-engraftment bloodstream infection (PE-BSI). In the Haplo-ID group, 71/76 patients with high-risk (n = 28) or relapsed/refractory hematological malignancies (n = 43) received FA5-BUCY conditioning (NCT02328950). All received trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. Blood cultures and catheter tip cultures were obtained to confirm the BSI. PE-BSI was detected in 24/131 HSCT patients (18/76 in Haplo-ID and 6/55 in HLA-ID) after 28 febrile neutropenic episodes. Among 28 isolates for the 24 patients, 21 (75%) were G^neg bacteria, 6 (21.4%) G^pos and 1 (3.6%) fungi. Bacteria sources were central venous line infection (7/29.2%), gastroenteritis (6/25%), lower respiratory tract infection (LRTI; 5/20.8%), perianal skin infection (4/16.7%), and unknown (2/8.3%). The duration of neutropenia (P = 0.046) and previous G^neg bacteremia (P = 0.037) were important risk factors by univariate analysis, while the type of HSCT was not. A trend of TMP-SMX-resistant BSI in both groups may be due to routine antibacterial prophylaxis strategies. Our data show that G-CSF-primed Haplo-ID HSCT did not increase the risk of PE-BSI, even with intensive immunosuppressive treatments.

Investigating the use of synthetic humic-like acid as a soil washing treatment for metal contaminated soil

Humic acid can effectively bind several metals and is regarded as a promising soil washing agent. Previous studies indicate that carboxylic groups dominate metal binding to humic acid. In this study, a synthetic humic-like acid (SHLA) with high COOH content (5.03 mmol/g) was used as a washing agent to remove metals (Cu, Zn, Ni, Pb, As) from two contaminated agricultural soils (Soil 1 (pH: 6.17 ± 0.11; organic carbon: 5.91 ± 0.40%; Cu: 302.86 ± 3.97 mg/kg; Zn: 700.45 ± 14.30 mg/kg; Pb 323.56 ± 4.84 mg/kg; Ni: 140.16 ± 1.59 mg/kg) and Soil 2 (pH: 9.83 ± 0.01; organic carbon: 2.52% ± 0.25%; Cu: 242.81 ± 10.66 mg/kg; Zn: 841.00 ± 22.31 mg/kg, Pb 451.21 ± 1,92 mg/kg, As: 242.23 ± 5.24 mg/kg)). The effects of solution pH (4 to 11), liquid/solid ratio (L/S ratio, 5:1 (mL:g) to 80:1 (mL:g)), SHLA concentration (100 mg/L to 2000 mg/L), and contact time (0 to 1440 min) on % metal removal were investigated and optimum conditions identified: pH of 9, L/S ratio of 1:80, SHLA concentration of 1500 mg/L at 25 °C for 4 h. Under optimum conditions, a single washing removed 45.2% of Cu, 34.6% of Zn. 42.2% of Ni and 15.6% of Pb from Soil 1, and 30.6% of Cu, 28.1% of Zn. 14.6% of As and 18.1% of Pb from Soil 2. A modified BCR extraction of the two soils before and after washing indicated that the SHLA mainly removed metals in the exchangeable and acid soluble fraction and reducible fraction, which could effectively reduce bioavailability and environmental risk of metals. On a molar basis, SHLA was a more effective washing agent than commercial humic acid, Na₂EDTA, citric acid and tartaric acid. Overall, SHLA shows great potential for use as a soil washing agent.