Regulation of proliferation and cell cycle by protein regulator of cytokinesis 1 in oral squamous cell carcinoma

Protein regulator of cytokinesis 1 (PRC1), a microtubule-associated protein, has emerged as a critical regulator of proliferation and apoptosis, acting predominantly in numerous tumors. However, its function in oral squamous cell carcinoma (OSCC) is still unknown. To establish the roles of PRC1 in OSCC, 95 oral clinical samples (54 OSCC, 24 oral leukoplakia [OLK], and 17 normal oral mucosa) and seven oral cell lines (6 OSCC and 1 normal oral cell lines) were analyzed using a series of molecular and genomic assays both in vivo and in vitro were conducted in this study. Herein, we provide evidence demonstrating that expression of PRC1 closely correlates with the degree of epithelial dysplasia in OLK (n = 24) (p < 0.001), and the poor differentiation, large tumor volume, lymph node metastasis, and high-clinical stage in OSCC (n = 54) (p < 0.05), illustrating that PRC1 has a promotive influence on tumor progression in OSCC. Simultaneously, we observed that PRC1 knockdown in OSCC cell lines caused G2/M phase arrest (p < 0.05), inhibited cell proliferation in vitro (p < 0.05) and tumor growth in vivo (p < 0.001). Furthermore, the effects of PRC1 on the regulation of proliferation and cell cycle transition in OSCC samples were mediated by p53. The p53/PRC1/EGFR signaling pathway was found to be implicated in the tumor progression of OSCC. Based on our data, we demonstrate that PRC1 is a key factor in regulating proliferation and the cell cycle, pointing to the potential benefits of PRC1-targeted therapies for OSCC.

Effects of Talaromyces marneffei infection on mortality of HIV/AIDS patients in southern China: a retrospective cohort study

OBJECTIVE

Talaromyces marneffei is an opportunistic infection with high morbidity among human immunodeficiency virus (HIV)/AIDS patients in Southeast Asia and southern China. Its effects on mortality in HIV/AIDS patients has not been clearly elucidated.

METHODS

We conducted a retrospective cohort study of hospitalized HIV-infected individuals at the Fourth People's Hospital of Nanning, Guangxi, China during 2012-2015. Kaplan-Meier analyses were used to calculate the cumulative mortality. Cox proportional hazard models and 1:1 propensity score matching (PSM) were used to evaluate the effects of T. marneffei infection on mortality of HIV/AIDS patients.

RESULTS

In total, 6791 HIV/AIDS patients were included, 1093 of them (16.1%) with documented T. marneffei co-infection. The mortality of T. marneffei-infected patients (25.0 per 100 person-months, 95% CI 21.5-26.7) was the highest among all AIDS-associated complications and was significantly higher than that of T. marneffei-uninfected HIV/AIDS patients (13.8 per 100 person-months, 95% CI 12.5-15.1; adjusted hazard ratio (AHR) 1.80, 95% CI 1.48-2.16). The results using PSM were similar (AHR 4.52 95% CI 2.43-8.42). The mortality of T. marneffei-infected patients was also significantly higher than that of patients without any complications. When stratified by demographic characteristics, T. marneffei infection has higher mortality risk in all stratifications. Co-infection with T. marneffei carries a higher mortality risk in patients at any CD4⁺ T-cell count.

CONCLUSIONS

Talaromyces marneffei infection is commonly found in hospitalized HIV/AIDS patients in southern China and was associated with a higher mortality rate than most HIV-associated complications. These results highlight the need for improved diagnosis, treatment and prevention of infection by this neglected fungal pathogen in southern China.

[Clinicopathologic features and prognosis of inflammatory pseudotumor-like follicular dendritic cell sarcomas in liver and spleen: an analysis of seven cases]

Objective: To investigate the clinicopathological features and prognostic parameters of the inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) of liver and spleen. Methods: Ninteen cases of inflammatory pseudotumor (IPT) and 5 cases of IPT-like FDCS of the liver and spleen were collected at the First Affiliated Hospital, Army Medical University from 2006 to 2016. HE sections, immunohistochemical staining, and Epstein-Barr virus encoded nuclear RNA (EBER) in situ hybridization were reviewed along with a summary of the literature. Results: Among the previously diagnosed 19 cases of IPT of the liver and spleen, 2 cases were misdiagnosed (the ratio of 2/19). Among 7 new cases including 3 males and 4 females, 3 cases involved the liver and 4 cases involved the spleen. The age range was 37-64 years (mean 53 years). The maximum tumor diameter ranged from 3.0 to 11.0 cm (mean 6.5 cm). Surgical resections were performed in all patients with follow-up time ranging from 3 to 84 months.All patients were disease-free.7 new cases were all positive for EBER, and showed the expression of at least one of the FDC markers, including CD21, CD23, and CD35. The rest of 17 cases of IPT were all negative for EBER and essentially negative for FDC markers, but were all positive for SMA. Conclusions: IPT-like FDCS of the liver and spleen is a rare low-grade malignant tumor morphologically mimicking inflammatory pseudotumor, and is easy to be misdiagnosis due to under-recognition. EBER in situ hybridization and FDC markers are indispensable for confirming the diagnosis.

Inactivation of Listeria monocytogenes on and within Apples Destined for Caramel Apple Production by Using Sequential Forced Air Ozone Gas Followed by a Continuous Advanced Oxidative Process Treatment

This study evaluated the efficacy of using sequential forced air ozone followed by an advanced oxidative process (AOP) treatment to inactivate Listeria monocytogenes on and within Empire apples. The forced air ozone treatment consisted of a reactor that introduced ozone (6 g/h) into an airstream that flowed through an apple bed (ca. 30 cm in depth). Before treatment, the apples were conditioned at 4°C to ensure that condensate had formed before the apples were transferred to the reactor. The condensate ensured sufficient relative humidity to enhance the antimicrobial action of ozone. Air was passed through the apple bed at 9.3 m/s, and the ozone was introduced after 10 min. The ozone concentration measured after exiting the apple bed reached a steady state of 23 ppm. A 20-min ozone treatment supported a 2.12- to 3.07-log CFU reduction of L. monocytogenes, with no significant effect of apple position within the bed. The AOP-based method was a continuous process whereby hydrogen peroxide was introduced as a vapor into a reactor illuminated by UV-C and ozone-emitting lamps that collectively generated hydroxyl radicals. Operating the AOP reactor with UV-C light (54-mJ cm² dose), 6% (v/v) hydrogen peroxide, 2 g/h ozone, and a chamber temperature of 48°C resulted in a 3-log CFU reduction of L. monocytogenes on the surface of the apples and internally within the scar tissue. Applying a caramel coating, from a molten solution (at 80°C), resulted in a 0.5-log CFU reduction of L. monocytogenes on the apple surface. In apples treated with the sequential process, L. monocytogenes could only be recovered sporadically by enrichment and did not undergo outgrowth when the caramel apples were stored at 22°C for 19 days. However, growth of L. monocytogenes within the core, but not the surface, was observed from caramel apples prepared from nontreated control fruit.

Sol-Gel Derived Antibacterial Ag-Containing ZnO Films on Biomedical Titanium

ZnO and Ag-containing ZnO (ZnO/Ag) films with the Ag/Zn molar ratio of 3.3 and 9.1%, respectively were sol-gel coated on biomedical titanium for antibacterial and bioactive surface modification. X-ray diffraction analysis indicates that ZnO peaks increase with the calcination temperature of the samples. Scanning electron microscopy and energy dispersive of X-ray analyses reveal Ag-rich white particles (300~750 nm) on ZnO/Ag samples that were calcined at 400 °C. X-ray photoelectron spectroscopy analysis of ZnO/Ag samples shows that Zn and O exist as ZnO and Ag presents in metallic state. The coating samples exhibit similar UV light-induced hydrophilic conversion behavior. Potentiodynamic polarization test in a Ca-free Hank's balanced solution demonstrates better corrosion resistance of the coating samples compared with the polished sample. In the in vitro bioactivity test using the simulated body fluid, a layer of apatite is gradually deposited on the surface of sample ZnO/9Ag after 12 days of soaking. The MTT assay test shows that ZnO and ZnO/Ag films have weak compatibility with the L929 cells. The antibacterial test against E. Coli by the disk diffusion assay reveals that antibacterial activity of the coating samples increases with silver content of the films.

EZH2 Impairs Human Dental Pulp Cell Mineralization via the Wnt/β-Catenin Pathway

The enhancer of zeste homolog 2 (EZH2) is a catalytic subunit of PRC2 (polycomb repressor complex 2). It mediates gene silencing via methyltransferase activity and is involved in the determination of cell lineage. However, the function of EZH2 and the underlying mechanisms by which it affects the differentiation of human dental pulp cell (hDPC) have remained underexplored. In this research, we found that EZH2 expression decreased during the mineralization of hDPCs, with attenuated H3K27me3 (trimethylation on lysine 27 in histone H3). Overexpression of EZH2 impaired the odontogenic differentiation of hDPCs, while EZH2 without methyltransferase activity mutation (mutation of suppressed variegation of 3 to 9, enhancer of zeste and trithorax domain, EZH2ΔSET) did not display this phenotype. In addition, siRNA knockdown studies showed that EZH2 negatively modulated hDPC differentiation in vitro and inhibited mineralized nodule formation in transplanted β-tricalcium phosphate / hDPC composites. To further investigate the underlying mechanisms, we explored the Wnt/β-catenin signaling pathway in view of the fact that previous research had documented the essential role that it plays during hDPC mineralization, as well as its links to EZH2 in other cells. We demonstrated for the first time that EZH2 depletion activated the Wnt/β-catenin signaling pathway and enhanced the accumulation of β-catenin in hDPCs. Chromatin immunoprecipitation analysis suggested that these effects are attributable to the level of the EZH2-regulated H3K27me3 on the β-catenin promoter. We conclude that EZH2 plays a negative role during the odontogenic differentiation of hDPCs. Suppression of EZH2 could promote hDPC mineralization by epigenetically regulating the expression of β-catenin and activating the Wnt canonical signaling pathway.

Paradoxical roles of TGF-β signaling in suppressing and promoting squamous cell carcinoma

Transforming growth factor β (TGF-β) signaling either promotes or inhibits tumor formation and/or progression of many cancer types including squamous cell carcinoma (SCC). Canonical TGF-β signaling is mediated by a number of downstream proteins including Smad family proteins. Alterations in either TGF-β or Smad signaling can impact cancer. For instance, defects in TGF-β type I and type II receptors (TGF-βRI and TGF-βRII) and in Smad2/3/4 could promote tumor development. Conversely, increased TGF-β1 and activated TGF-βRI and Smad3 have all been shown to have tumor-promoting effects in experimental systems of human and mouse SCCs. Among TGF-β/Smad signaling, only TGF-βRII or Smad4 deletion in mouse epithelium causes spontaneous SCC in the mouse model, highlighting the critical roles of TGF-βRII and Smad4 in tumor suppression. Herein, we review the dual roles of the TGF-β/Smad signaling pathway and related mechanisms in SCC, highlighting the potential benefits and challenges of TGF-β/Smad-targeted therapies.

[A prospective pilot study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas]

Objective: To carry out a prospective cohort study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas (HCC) and to observe the safety and postoperative complications. Methods: A total of 79 patients with centrally located HCC who underwent hepatectomy were divided into two groups: experimental group (combined with targeted intra-operative radiotherapy, 32 cases) and control group (single surgical operation, 47 cases). Patients in the experimental group received intra-operative electron radiotherapy after tumor resection, while patients in the control group received to intra-operative electron radiotherapy.The haemorrhagia amount and operation time during the operation, intra-operative liver function and the recovery of liver and gastrointestinal tract of patients in these two groups were compared. Results: No postoperative 30-day mortality was observed in all of the patients. The average total operation time of patients in the experimental group was (319±76) min, significantly longer than (233±76) min of the control group (P<0.001). The average aspartate transaminase (AST) level of patients in the experimental group at postoperative day 1 was 562.5 U/L, significantly higher than 347.0 U/L of control group (P=0.031). However, the average prothrombin activity levels of patients in the experimental group at postoperative day 3 and day 7 were (68.3±17.9)% and (73.4±10.2)%, respectively, significantly lower than (78.9±15.9)% and (80.0±10.6)% of control group (both P<0.05). There were no significant differences of tumor volume, differentiation degree, satellite lesion, dorsal membrane invasion, microvascular invasion between these two groups (all P>0.05). There were no significant differences of hospital stay, ventilation time, the incidence of hepatic insufficiency, ascites, pleural effusion, infection, biliary fistula between these two groups (all P>0.05). There were no significant differences of alanine aminotransferase (ALT), albumin, total bilirubin between these two groups at postoperative day 1, 3, 5 and 7 (all of P>0.05). Conclusion: The resection of centrally located HCC combined with intra-operative radiotherapy may increase the total operation time, delay the early postoperative recovery of liver function, but it is still safe and feasible. Trial registration: National Cancer Centre /Cancer Hospital, Chinese Academy of Medical Sciences, ChiCTR-TRC-12002802.

[Cost-effectiveness of multiple screening modalities on breast cancer in Chinese women from Shanghai]

Objective: To determine the most cost-effective modality for breast cancer screening in women living in Shanghai. Methods: A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district, Shanghai, during 2008 to 2012. Parameters of the model were derived from literatures. General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years. Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality. Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness. Results: The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one. The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved, which were within the threshold of 2-3 times of local per capita Gross Domestic Product. Results from sensitivity analysis showed that, due to higher incidence rate of breast cancer in Shanghai, the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China. Conclusion: Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai, and thus be widely promoted in this population elsewhere.

Bioactive compounds in Diospyros mafiensis roots inhibit growth, sporulation and aflatoxin production by Aspergillus flavus and Aspergillus parasiticus

Diospyros mafiensis F. White is a medicinal shrub or small tree (6 m tall) widely distributed in the Zanzibar-Inhambane regional mosaic and traditionally used to treat leprosy, diarrhoea, and skin fungal infections in Tanzania and Mozambique. Our objective was to determine the anti-aflatoxigenic properties of compounds from D. mafiensis root bark against vegetative growth, sporulation and aflatoxin production by Aspergillus flavus and Aspergillus parasiticus. Bioassay-guided extraction, fractionation, and isolation of bioactive compounds using A. parasiticus B62 were employed. The bioactive compounds were elucidated using 1H and 13CNMR and LC-MS. Growth inhibition was determined by measuring the colony diameter of A. flavus AF3357 and A. parasiticus SU-1 ATCC56775. Inhibitory effects on sporulation were estimated using a haemocytometer. Total aflatoxin was quantified by direct competitive enzyme-linked immunosorbent assay (ELISA). Bioactive compounds diosquinone (DQ) and 3-hydroxydiosquinone (3HDQ) were identified. DQ weakly inhibited A. flavus and A. parasiticus vegetative growth (MIC50 > 100 µg/ml) and 3HDQ strongly inhibited A. flavus (MIC50 = 14.9 µg/ml) and A. parasiticus (MIC50 = 39.1 µg/ml). DQ strongly reduced total aflatoxin production by A. flavus from 157 to 36 ng/plate, and by A. parasiticus from 1,145 ng/plate to 45 ng/plate at 100 µg/ml. 3HDQ reduced total aflatoxin production by A. parasiticus from 1,145 to 32 ng/plate; stimulated production by A. flavus from 157 to 872 ng/plate at 12.5 µg/ml but reduced to 45 ng/plate at 100 µg/ml. In summary, DQ and 3HDQ could be used as natural antifungal compounds to prevent mould growth and aflatoxin accumulation in food and feed.

[Neutrophil to lymphocyte ratio in peripheral blood: a novel independent prognostic factor in patients with head and neck squamous cell carcinoma]

Objective: To investigate whether neutrophil to lymphocyte ratio (NLR) in peripheral blood can be an independent prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Clinical data of 97 HNSCC patients who received surgical treatment in our department between January 2008 and January 2012 were analyzed retrospectively. The 97 patients were divided into low NLR group (NLR≤5, n=69) and high NLR group (NLR>5, n=28) according to the NLR in preoperative peripheral blood. The relationships of NLR and clinicopathological features were analyzed. Kaplan-Meier method was used for univariate survival analysis and Cox proportional hazard model for multivariate survival analysis. Results: The clinical stages were significantly different between high NLR group and low NLR group (P<0.05), however, the age, gender, location, lymph node metastasis, smoking and alcohol of the two groups showed no significant differences (P> 0.05 of all). Univariate survival analysis showed that smoking, lymph node metastasis, clinical stage and NLR value were risk factors for 3-year overall survival (OS) rate and relapse-free survival (RFS) rate of HNSCC patients (P<0.05). The OS rate of high NLR and low NLR groups was 42.9% and 91.3%, and the RFS rate was 44.2% and 80.1%, respectively, with a statistically significant difference (P<0.05 for both). Cox multivariate survival analysis showed that clinical stage and NLR were independent factors for prognostic evaluation of HNSCC patients (P<0.05 for both). Conclusions: NLR level is significantly associated with clinical stage of HNSCC. High NLR is an independent prognostic rick factor and plays an important role in prognostic evaluation of HNSCC patients.

Hypoxia associated biomarkers in lung cancer - an update

The high incidence rates of lung cancer have resulted in multiple progressions in cancer research leading to the development of novel therapeutic strategies. The three main branches of cancer research where improvements are being made are surgery, chemotherapy, and radiotherapy. These research developments have significantly improved the survival rates of cancer patients as most of these therapeutic options target specific molecules involved in cancer progression and metastasis. Experimental research has successfully identified potentially important molecules responsible for cancer progression. Further, the above molecular markers of disease are clinically approved biomolecules of significant prognostic value. The above molecular biomolecules also helped in rapid identification of subgroups of patients who need immediate emergency treatment. Hypoxia is one of such conditions where the human system is deprived of an adequate oxygen supply and requires immediate treatment. Hypoxia markers have been proved to be beneficial in the timely management of cancer. The present review is focused on the latest updates in the area of hypoxia related to markers in the prognosis of lung cancer.

Methamphetamine causes neurotoxicity by promoting polarization of macrophages and inflammatory response

Macrophages, especially their activation state, are closely related to the progression of neurotoxicity. Classically activated macrophages (M1) are proinflammatory effectors, while alternatively activated macrophages (M2) exhibit anti-inflammatory properties. As a powerful addictive psychostimulant drug, coupled with its neurotoxicity, methamphetamine (Meth) abuse may lead to long-lasting abnormalities in the neuronal system. The present study investigated the effect of Meth at subtoxic concentration on macrophage activation state and its underlying toxicity to neuronal cells. PC12 and Murine RAW264.7 cells were coincubated with Meth to test its toxicity. 3-(4,5-Dimethylthiazol)-2,5-diphenyltetrazolium-bromide, enzyme-linked immunosorbent assay, real-time polymerase chain reaction, and Western blot assays were performed to evaluate the toxicity, cytokine secretion, gene, and protein expression. Results showed that cytotoxicity was enhanced on PC12 cells after coculturing with RAW264.7 stimulated with Meth. RAW264.7 macrophages tended to switch to the M1 phenotype, releasing more nitric oxide and proinflammatory cytokines, including tumor necrosis factor α (TNFα), interleukin (IL)-12, and IL-1β, while decreasing the release of anti-inflammatory cytokine IL-10 after treatment with Meth. Meth upregulated the gene expression of IL-6, IL-1β, and TNFα and downregulated the expression of Arg-1, IL-10, and KLF4. Meth could also upregulate the protein expression of IL-1β and TNF α and downregulate the expression of Arg-1 and KLF4. However, the abovementioned effects induced by Meth were abolished by the addition of dopamine receptor D3 antagonist. In conclusion, our study demonstrated that Meth promoted macrophage polarization from M0 to M1 and enhanced inflammatory response, which provided the scientific rationale for the neurotoxicity caused by the chronic use of Meth.

Self-planarized quantum-disks-in-nanowires ultraviolet-B emitters utilizing pendeo-epitaxy

The growth of self-assembled, vertically oriented and uniform nanowires (NWs) has remained a challenge for efficient light-emitting devices. Here, we demonstrate dislocation-free AlGaN NWs with spontaneous coalescence, which are grown by plasma-assisted molecular beam epitaxy on an n-type doped silicon (100) substrate. A high density of NWs (filling factor >95%) was achieved under optimized growth conditions, enabling device fabrication without planarization using ultraviolet (UV)-absorbing polymer materials. UV-B (280-320 nm) light-emitting diodes (LEDs), which emit at ∼303 nm with a narrow full width at half maximum (FWHM) (∼20 nm) of the emission spectrum, are demonstrated using a large active region ("active region/NW length-ratio" ∼50%) embedded with 15 stacks of Al_xGa_1-xN/Al_yGa_1-yN quantum-disks (Qdisks). To improve the carrier injection, a graded layer is introduced at the AlGaN/GaN interfaces on both p- and n-type regions. This work demonstrates a viable approach to easily fabricate ultra-thin, efficient UV optoelectronic devices on low-cost and scalable silicon substrates.

Monolayer-graphene-based perfect absorption structures in the near infrared

Subwavelength perfect optical absorption structures based on monolayer-graphene are analyzed and demonstrated experimentally. The perfect absorption mechanism is a result of critical coupling relating to a guided mode resonance of a low index two-dimensional periodic structure. Peak absorption over 99% at wavelength of 1526.5 nm with full-width at half maximum (FWHM) about 18 nm is demonstrated from a fabricated structure with period of 1230 nm, and the measured results agree well with the simulation results. In addition, the influence of geometrical parameters of the structure and the angular response for oblique incidence are analyzed in detail in the simulation. The demonstrated absorption structure in the presented work has great potential in the design of advanced photo-detectors and modulators.

Two 'Candidatus Liberibacter asiaticus' Strains Recently Found in California Harbor Different Prophages

'Candidatus Liberibacter asiaticus' (CLas), an α-proteobacterium, is associated with citrus Huanglongbing (HLB; yellow shoot disease). In California, two cases of CLas have been detected in Los Angeles County, one in Hacienda Heights in 2012 and the other in San Gabriel in 2015. Although all infected trees were destroyed in compliance with a state mandate, citrus industry stakeholder concerns about HLB in California are high. Little is known about the biology of CLas, particularly the California strains, hindering effective HLB management efforts. In this study, next-generation sequencing technology (Illumina MiSeq) was employed to characterize the California CLas strains. Data sets containing >4 billion (Giga) bp of sequence were generated from each CLas sample. Two prophages (P-HHCA1-2 and P-SGCA5-1) were identified by the MiSeq read mapping technique referenced to two known Florida CLas prophage sequences, SC1 and SC2. P-HHCA1-2 was an SC2-like or Type 2 prophage of 38,989 bp in size. P-SGCA5-1 was an SC1-like or Type 1 prophage of 37,487 bp in size. Phylogenetic analysis revealed that P-HHCA1-2 was part of an Asiatic lineage within the Type 2 prophage group. Similarly, P-SGCA5-1 was part of an Asiatic lineage within Type 1 prophage group. The Asiatic relatedness of both P-HHCA1-2 and P-SGCA5-1 was further presented by single nucleotide polymorphism analysis at terL (encoding prophage terminase) that has been established for CLas strain differentiation. The presence of different prophages suggests that the two California CLas strains could have been introduced from different sources. An alternative explanation is that there was a mixed CLas population containing the two types of prophages, and limited sampling in a geographic region may not accurately depict the true CLas diversity. More accurate pathway analysis may be achieved by including more strains collected from the regions.

[Analysis of clinicopathological features and prognosis of 98 cases of small hepatocellular carcinoma]

Objective: To analyze the clinicopathological features and prognosis of patients with small hepatocellular carcinoma. Methods: The clinicopathological and follow-up data of 98 patients with small hepatocellular carcinoma who underwent R0 resection from January 2009 to December 2013 were analyzed retrospectively. Results: All of the patients were followed up. Their postoperative 1-year, 3-year and 5-year overall survival rates were 99.0%, 91.7%, and 76.3%, respectively. Their postoperative median overall survival (OS) period was 52 months. The postoperative progression-free survival rates were 86.7%, 66.2% and 55.0%, respectively, and the median progression-free survival (PFS) period was 43.5 months. The univariate analysis showed that satellite nodules, liver capsule invasion and postoperative recurrence time were associated with OS (P<0.05), and long-term heavy drinking, satellite nodules and liver capsule invasion with PFS (P<0.05). The multivariate analysis indicated that long-term heavy drinking was an independent factor influencing the progression-free survival period of patients with small hepatocellular carcinoma (P=0.003) and postoperative recurrence time and liver capsule invasion were independent factors affecting their overall survival period (P<0.05). Conclusions: The treatment of small hepatocellular carcinoma still concentrates on the active treatment of surgery. It is beneficial to patients to minimize the resection scope of normal liver under the premise of R0 removal of tumor. Postoperative recurrence time of ≤2 years suggests poor prognosis of small hepatocellular carcinoma. Long-term heavy drinking can accelerate the recurrence of small hepatocellular carcinoma.

[Affected side location and clinical value of horizontal semicircular canal benign paroxysmal positional vertigo]

Objective:To explore the clinical value of rolling test（HRT）, bow and lean test（BLT） and subjective vertigo sensation(SVS) for affected side localization of patients with horizontal semicircular canal benign paroxysmal positional vertigo（HSC-BPPV）.Method:One hundred and thirty-eight patients（94 HSC-Can and 44 HSC-Cup）with HSC-BPPV were enrolled. Patients were tested with HRT and then were asked about SVS, followed by BLT. According to the results of HRT, SVS and BLT, HSC-Can and HSC-Cup were repositioned by Barbecue method and modified Kim method respectively. The detection rate of the affected side of HRT, BLT, SVS and the curative effect were analyzed. Result:In 94 HSC-Can patients and 44 HSC-Cup patients,BN and / or LN were induced by BLT to be 81.91% and 84.09% respectively. HRT induced bilateral asymmetric nystagmus 90.43%, 88.64%, SVS told vertigo symptoms worse side 60.64%,63.64%. There was no significant difference in the detection rate of HRT and BLT(P>0.05)，but have significant difference with SVS(P<0.05). Excluding four patients in whom the comparison among HRT,BLT,SVS were inconclusive，we compared the curative effect of first treatment in 92 HSC-Can patients and 42 HSC-Cup patients. The curative effect of HRT positive only were 66.67% and 60.00% respectively , BLT positive only were 71.43% and 66.67% respectively , HRT and BLT both positive with ipsilateral affected side were 70.37% and 65.50% respectively , HRT and BLT both positive with contralateral affected side were 37.50% and 30.00% respectively. The curative effect of HRT positive only and BLT positive only had no significant difference with that of HRT and BLT both positive with ipsilateral affected side , but they both had significant difference with that of HRT and BLT both positive with contralateral affected side . Conclusion:HRT is the most effective method for detecting affected side of HSC-BPPV, but BLT and SVS also have auxiliary diagnostic value as HSC-BPPV localization method.

[Effects of perioperative transfusion of blood components on the long-term prognosis of hepatocellular carcinoma]

Objective: To investigate the effects of perioperative transfusion of blood components on the long-term prognosis of hepatocellular carcinoma (HCC) patients. Methods: A total of 339 patients with primary HCC who underwent curative hepatectomy between January 2003 and December 2010 at the Cancer Hospital, Chinese Academy of Medical Sciences were enrolled. The clinical data of the patients were retrospectively analyzed. These patients were divided into non-transfusion, fresh frozen plasma (FFP) transfusion only and concentrated red cells (CRC) transfusion groups. Disease-free survival and overall survival were estimated using the Kaplan-Meier method, and Cox regression was performed to identify clinicopathological factors related with survival. Results: Among the 339 patients, the 1-, 3- and 5-year disease-free survival rates were 63.1%, 35.4% and 22.4%, respectively, and the median disease-free survival was 22 months. While the 1-, 3- and 5-year overall survival rates were 90.5%, 69.5% and 56.4%, respectively, and the median overall survival was 72 months. The median disease-free survivals of the non-transfusion (n=181), FFP transfusion only (n=48) and CRC transfusion (n=110) groups were 28, 22 and 12 months, respectively, while the median overall survivals of the three groups were 99, 63 and 40 months respectively. Significant differences in the disease-free and overall survivals were observed among the three groups (both P<0.01). Multivariate Cox regression analyses showed that FFP transfusion only (HR=1.658, P=0.026), CRC transfusion (HR=1.470, P=0.030), serum alpha-fetoprotein>400 μg/L (HR=1.686, P=0.002), albumin<35 g/L (HR=1.782, P=0.047), tumor capsule (HR=0.597, P=0.012), tumor necrosis (HR=1.820, P=0.001) and the TNM stage Ⅲ or above (HR=2.537, P=0.000) were independent predictors of overall survival after hepatectomy. Conclusion: Both perioperative FFP only transfusion and CRC transfusion may have detrimental effect on the long-term prognosis of HCC.

GDF11 does not improve the palmitate induced insulin resistance in C2C12

OBJECTIVE

GDF11 (Growth Differentiation factor 11) has been reported to rejuvenate skeletal muscle, heart and brain in aged mice, and the aged skeletal muscle is closely related to insulin resistance. We wondered whether GDF11 has an effect on skeletal muscle insulin resistance.

MATERIALS AND METHODS

High fat diet induced obese mice with insulin resistance were established in vivo. Palmitate-induced insulin resistance in C2C12 myotubes was established in vitro. The mRNA expression of GDF11, GLUT4, IRS-1 (insulin receptor substrate-1) and PGC-1α (peroxisome proliferator-activated receptor-gamma coactivator 1) were tested by reverse transcriptase-polymerase chain reaction (RT-PCR). The protein level of GDF11 and PGC-1α were detected by Western blot. The glucose uptake was measured by 2NBDG uptake assay.

RESULTS

In high fat diet induced obese mice, both serum level of GDF11 and the expression of GDF11 in skeletal muscle decreased. Similarly, the expression of GDF11 also reduced in palmitate-treated C2C12 myotubes. In vitro, the glucose uptake and the expression of GLUT4, IRS-1 and PGC-1α significantly decreased after palmitate intervention, but GDF11 treatment did not reverse the reduction of glucose uptake and the expression of GLUT4, IRS-1 and PGC-1α in C2C12 myotubes.

CONCLUSIONS

We firstly confirmed that the expression of GDF11 decreased both in the skeletal muscle of obese mice and palmitate-treated myotubes, but supplementation GDF11 does not ameliorate the palmitate-induced insulin resistance in C2C12 myotubes.

The management of open tibial fractures in children

Aims

Following the introduction of national standards in 2009, most major paediatric trauma is now triaged to specialist units offering combined orthopaedic and plastic surgical expertise. We investigated the management of open tibia fractures at a paediatric trauma centre, primarily reporting the risk of infection and rate of union.

Patients and Methods

A retrospective review was performed on 61 children who between 2007 and 2015 presented with an open tibia fracture. Their mean age was nine years (2 to 16) and the median follow-up was ten months (interquartile range 5 to 18). Management involved IV antibiotics, early debridement and combined treatment of the skeletal and soft-tissue injuries in line with standards proposed by the British Orthopaedic Association.

Results

There were 36 diaphyseal fractures and 25 distal tibial fractures. Of the distal fractures, eight involved the physis. Motor vehicle collisions accounted for two thirds of the injuries and 38 patients (62%) arrived outside of normal working hours. The initial method of stabilisation comprised: casting in nine cases (15%); elastic nailing in 19 (31%); Kirschner (K)-wiring in 13 (21%); intramedullary nailing in one (2%); open reduction and plate fixation in four (7%); and external fixation in 15 (25%). Wound management comprised: primary wound closure in 24 (39%), delayed primary closure in 11 (18%), split skin graft (SSG) in eight (13%), local flap with SSG in 17 (28%) and a free flap in one. A total of 43 fractures (70%) were Gustilo-Anderson grade III. There were four superficial (6.6%) and three (4.9%) deep infections. Two deep infections occurred following open reduction and plate fixation and the third after K-wire fixation of a distal fracture. No patient who underwent primary wound closure developed an infection. All the fractures united, although nine patients required revision of a mono-lateral to circular frame for delayed union (two) or for altered alignment or length (seven). The mean time to union was two weeks longer in diaphyseal fractures than in distal fractures (13 weeks versus 10.8 weeks, p = 0.016). Children aged > 12 years had a significantly longer time to union than those aged < 12 years (16.3 weeks versus 11.4 weeks, p = 0.045). The length of stay in hospital for patients with a Gustilo-Anderson grade IIIB fracture was twice as long as for less severe injuries.

Conclusion

Fractures in children heal better than those in adults. Based on our experience of deep infection we discourage the use of internal fixation with a plate for open tibial fractures in children. We advocate aggressive initial wound debridement in theatre with early definitive combined orthopaedic and plastic surgery in order to obtain skeletal stabilisation and soft-tissue cover. Cite this article: Bone Joint J 2017;99-B:544–53.

Cut-points for associations between vitamin D status and multiple musculoskeletal outcomes in middle-aged women

This was the first study examining optimal vitamin D status for musculoskeletal health in middle-aged women. A 25-hydroxyvitamin D level of at least 29 to 33 nmol/L appears required for optimal musculoskeletal health, but the current cut-off of 50 nmol/L may be warranted.

INTRODUCTION

This study aimed to determine whether cut-points exist for associations between serum 25-hydroxyvitamin D (25OHD) and musculoskeletal health outcomes in middle-aged women, below which greater 25OHD levels are associated with musculoskeletal health benefits and above which no such associations exist.

METHODS

This is a cross-sectional study of 344 women aged 36-57 years. Cut-points for associations of serum 25OHD with lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD), lower limb muscle strength (LMS), timed up and go test (TUG), functional reach test (FRT), lateral reach test (LRT), and step test (ST) were explored using locally weighted regression smoothing and nonlinear least-squares estimation, and associations above and below the identified cut-points were estimated using segmented regression.

RESULTS

The prevalence of low 25OHD was 28 % (<50 nmol/L). Significant cut-points (nmol/L) were identified for FN BMD 31 (95 % confidence interval (CI): 18, 43), LS BMD 31 (17, 45), TUG 30 (24, 36), ST 33 (24, 31), FRT 31 (18, 43), and LMS 29 (8, 49) but not LRT (42 (-8, 93). Below these cut-points, there were beneficial associations between higher 25OHD level and each outcome, while above the cut-points, there were no beneficial associations.

CONCLUSIONS

In middle-aged women, there are thresholds for associations between serum 25OHD concentrations and bone density and most balance measures, suggesting that 25OHD levels of at least 29 to 33 nmol/L are required for optimal musculoskeletal health in this population. The current cut-off of 50 nmol/L may be higher than needed for some outcomes but appears warranted overall.

A review of heavy weight market pigs: status of knowledge and future needs assessment

Marketing weight is an important economic variable that impacts the productivity and profitability of finishing pig production. Marketing weight has been increasing worldwide over the past decades driven by the dilution of fixed production cost over more weight per pig and the improvement of genetic selection of lean-type pigs. This review was aimed to summarize current knowledge and assess the future research needs on producing finishing pigs with marketing weight greater than 130 kg. Based on a thorough literature review, increasing marketing weight affected overall pig growth; in particular, cumulative average daily gain (ADG) decreased by 4.0 g, average daily feed intake (ADFI) increased by 78.1 g, and gain-to-feed ratio (G:F) decreased by 0.011 for every 10 kg increase of marketing weight. Increasing marketing weight by 10 kg increased carcass yield by 0.41% units, backfat by 1.8 mm, longissimus muscle (LM) area by 1.9 cm², carcass length by 2.2 cm, and belly yield by 0.32% units, but decreased percentage of fat-free-lean by 0.78 units and decreased loin, shoulder, and ham yields by 0.13, 0.16, and 0.17% units, respectively. Studies that investigated the effects of marketing weight on pork quality observed decreased pH by 0.02 and 0.01 at 45 min and 24 h postmortem, respectively, and increased a* value by 0.28 per 10 kg marketing weight increase. Heavier market pigs had increased concentrations of saturated fatty acids and intramuscular fat. However, studies reported conflicting results for L* and b* values, drip loss, Warner-Bratzler shear force, and sensory properties of pigs in response to increasing marketing weight. A limited amount of research has been conducted to estimate nutrient requirements for pigs greater than 140 kg. Increased weight and size of heavy pigs can create challenges to farm and packer facilities and equipment. Discussions and recommendations are provided concerning the adjustments for floor and feeder space, barn design, ventilation, disease control, transportation, and carcass processing needed for increasing marketing weight. In conclusion, increasing marketing weight creates both opportunities and challenges to current finishing pig production, and future research is needed to provide nutritional and management guidelines and improve feed efficiency and meat quality of heavy weight market pigs.

Advanced parental age and autism risk in children: a systematic review and meta-analysis

OBJECTIVE

Advanced parental age has raised additional concern as a risk factor of autism. We conducted a meta-analysis of observational studies investigating the association between advanced parental age and risk of autism.

METHOD

PubMed, EMBASE, and Web of Science were searched for reports published up to November 11, 2015. Risk estimates from individual studies were pooled using random-effects models.

RESULTS

Twenty-seven studies were included in the meta-analysis. Compared with the reference points, the lowest parental age category was associated with a reduced risk of autism in the offspring, with adjusted odds ratios (ORs) 0.89 (95% confidence intervals [CIs] 0.75-1.06) and 0.81 (95% CI 0.73-0.89) for mother and father, respectively, and the highest parental age category was associated with an increased risk of autism in the offspring, with adjusted ORs 1.41 (95% CI 1.29-1.55) and 1.55 (95% CI 1.39-1.73) for mother and father respectively. Dose-response meta-analysis indicated that an increase of 10 years in maternal and paternal age was associated with an 18% and 21% higher risk of autism.

CONCLUSION

Advanced parental age was associated with an increased risk of autism in the offspring. More mechanistic studies are needed to further explain this positive association.