[Feasibility and efficacy of percutaneous pulmonary vein stenting for the treatment of patients with severe pulmonary vein stenosis due to fibrosing mediastinitis]

Objective: To evaluate the feasibility and safety percutaneous pulmonary vein intervention in patients with severe pulmonary vein stenosis (PVS) caused by fibrosing mediastinitis(FM). Methods: This retrospective analysis included 5 FM patients (2 male, 3 female, 54-77 years old) confirmed by clinical presentation and chest computed tomography (CT) scan from January to June 2018 who were from Gansu Provincial Hospital and Shanghai Chest Hospital. CT pulmonary angiography (CTPA) further revealed severe PVS caused by fibrotic tissue compression in mediastinum. After selective pulmonary vein angiography, gradually balloon angioplasty was used to expand the pulmonary vein and then stents were implanted in the pre-dilated stenotic pulmonary veins. Evaluation of therapeutic effect was made at 6 months after the procedure. Results: All of 11 serious compression PVS were treated with stent implantation (diameter: 7-10 mm, length: 17-27 mm). After stenting, degree of pulmonary vein stenosis decreased from (83±16)% to (12±4)% (P<0.01). The minimal diameter of the stenotic pulmonary vein was significantly increased from (0.8±0.5)mm to (7.5±0.8)mm (P<0.01). Trans-stenotic gradient decreased from (27.0±15.1)mmHg (1 mmHg=0.133 kPa) to (2.50±0.58)mmHg (P<0.05). Mean pulmonary pressure measured by cardiac catheter decreased from (45.0±9.0)mmHg to (38.7±8.4)mmHg (P<0.05). One patient experienced cardiac arrest due to vagal nerve reflex during big sizing balloon stent dilation and recovered after cardiopulmonary resuscitation. There were no other serious procedure related complications. During the follow-up, severe stenosis at end of proximal stent was evidenced in 1 patient due to fibrotic compression, and another patient developed in-stent thrombosis due to discontinuation of prescribed anticoagulant. Conclusion: Percutaneous intervention for severe pulmonary vein stenosis caused by FM is feasible and safe, and can improve hemodynamic caused by the compression of mediastinal vascular structures in these carefully selected patients.

Constraints on Spin-Independent Nucleus Scattering with sub-GeV Weakly Interacting Massive Particle Dark Matter from the CDEX-1B Experiment at the China Jinping Underground Laboratory

We report results on the searches of weakly interacting massive particles (WIMPs) with sub-GeV masses (m_{χ}) via WIMP-nucleus spin-independent scattering with Migdal effect incorporated. Analysis on time-integrated (TI) and annual modulation (AM) effects on CDEX-1B data are performed, with 737.1 kg day exposure and 160 eVee threshold for TI analysis, and 1107.5 kg day exposure and 250 eVee threshold for AM analysis. The sensitive windows in m_{χ} are expanded by an order of magnitude to lower DM masses with Migdal effect incorporated. New limits on σ_{χN}^{SI} at 90% confidence level are derived as 2×10^{-32}∼7×10^{-35}  cm^{2} for TI analysis at m_{χ}∼50-180  MeV/c^{2}, and 3×10^{-32}∼9×10^{-38}  cm^{2} for AM analysis at m_{χ}∼75  MeV/c^{2}-3.0  GeV/c^{2}.

[Clinicopathological features of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract: a report of five cases]

Objective: To investigate the clinicopathological features of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. Methods: Five cases of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract from the Affiliated Hospital of Qingdao University from 2016 to 2019 were retrospectively reviewed. The clinical and pathological parameters were analyzed by combining clinical data and reviewing the available literature of 35 cases (34 cases abroad and 1 case in China). Results: There were 4 males and 1 female with a median age of 47 years (18-66 years). All patients had abdominal pain and constitutional symptoms including diarrhea, emaciation, intermittent mucous stool or oral and epiglottic ulcers. Endoscopic manifestations included multiple punctate congestion, erosion and ulcer at the terminal ileum and colorectum. Two cases had congestion and erosion of antrum and angle of stomach, and the lesions did not fuse and form tumors. Histologically, the lamina propria was expanded by a dense, medium to small lymphocyte infiltration, which was monomorphic, with slightly irregular nuclei without prominent nucleolus or lymphoepithelial lesions. There were admixed small amount of plasma cells and eosinophils. In 4 cases, immunohistochemistry showed the lesional cells were positive for CD3, CD8, TIA1, and negative for CD4, CD56, granzyme B and Ki-67 index was ≤10%. In situ hybridization showed that EBER was negative and clonal TCR gene rearrangement was detected. One consultation case was CD3(+), CD5(-) and Ki-67 index of 10%, although other indicators were not done. All five patients were treated with symptomatic support. In follow-up observation for 2 to 25 months, all patients were alive with the disease. Conclusions: Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract is a newly classified monoclonal T-cell proliferative disease, with low incidence, clinical inertia and long-term survival. It has unique clinicopathological features but pathologically it is easily misdiagnosed as inflammatory bowel disease or T-cell lymphoma. Correct diagnosis is of great important clinical significance.

[Clinical characteristics and next generation sequencing of three cases of Listeria monocytogenes meningitis with complications]

Objective: To summarize the clinical characteristics of Listeria monocytogenes meningitis (LMM) with complications, and analyze the outcomes of next generation sequencing. Methods: Clinical characteristics, laboratory findings, imaging features, antibiotics treatment, and next generation sequencing of cerebrospinal fluid were analyzed in 3 LMM patients who were hospitalized in the Department of Infectious Diseases of Beijing Children's Hospital Affiliated to Capital Medical University from July 2015 to November 2017. Results: The three patients were 1-year-old girl, 2-year-old girl, and 9-year-old boy, with normal immune function. They had eaten refrigerated food, milk or dairy products before onset. Symptoms included fever, headache, abdominal pain, diarrhea, vomiting, and convulsions, etc. The complications of two cases (case 2 and 3) were appendicitis and Meckel's diverticulitis. The other one (case 1) was with sepsis and pneumonia. Leukocyte counts in cerebrospinal fluid were elevated in all the three cases, and cranial magnetic resonance imaging showed meningeal or periventricular involvement. All the children were diagnosed with LMM by positive CSF culture. CSF for next generation sequencing was sent after carbapenem antibiotics using, yet all the results were positive. The positive results were returned 2, 9, and 9 days earlier than culture results, respectively. The gene coverage was 5.00%, 7.00%, 0.04%, and the reads was 2 561, 1 011 and 8, respectively. All the three children had recurrent fever despite using cephalosporin. Levels of leukocytes in the blood and CSF further elevated. After using carbapenem antibiotics, patients improved eventually and were discharged from hospital. Conclusions: LMM can occur in children with normal immune function and is usually associated with digestive system symptoms. Listeria monocytogenes can be detected quickly and accurately by the next generation sequencing technology, without being limited to sampling time and antibiotics application.

[Comparison of flow conditions of adhesives and retention force of restorations among four cement-retained methods of implant-supported fixed prostheses]

Objective: To compare the effect on the flow conditions of adhesives and the retention force of restorations among different cement-retained methods of implant-supported fixed prostheses. Methods: Four common cement-retained methods were selected, including the occlusal hole for screw access (OH), the lingual hole for adhesives overflow (LH), the resin replica for titanium abutment (RR), and the traditional cement-retained method (the control group). The adhesive used in this study was resin-modified glass ionomer cement. The two-dimensional analysis models of computational fluid dynamics (CFD) were established. The flow conditions of adhesives in the adhesion process was analyzed by the CFD analysis. The internal filling ratio and the amount of neck overflow of adhesives below the edge of the prosthesis were calculated. Ten zirconia prostheses in each group were processed and cemented. The retention force was examined by mechanical tensile experiments in vitro. Results: The CFD analysis showed the internal filling ratio of adhesives from high to low was the LH group, the OH group, the RR group and the control group. The amount of neck overflow of adhesives below the edge of the prosthesis from less to more was the RR group, the OH group, the LH group and the control group. The retention force was (240.7±33.9) N in the control group, (278.2±59.1) N in the OH group, (292.9±47.9) N in the LH group, and (262.8±59.4) N in the RR group. There was a statistically significant difference in the retention force between the LH group and the control group (P=0.029). There was no significant difference among the other groups (P>0.05). Conclusions: The modified cement-retained methods can effectively reduce the amount of neck overflow of adhesives, and improve the filling condition of adhesive in the adhesive clearance to ensure the retention force of the prostheses. Clinically, the appropriate modified cement-retained method should be selected according to the three-dimensional position of the implant and the position of prosthetic margin.

["Watch and wait" strategy after neoadjuvant therapy for rectal cancer: status survey of perceptions, attitudes and treatment selection in Chinese surgeons]

Objective: To understand the perceptions, attitudes and treatment selection of Chinese surgeons on the "watch and wait" strategy for rectal cancer patients after achieving a clinical complete response (cCR) following neoadjuvant chemoradiotherapy (nCRT). Methods: A cross-sectional survey was used in this study. Selection of subjects: (1) Domestic public grade III A (provincial and prefecture-level) oncology hospitals or general hospitals possessing the radiotherapy department and the diagnosis and treatment qualifications for colorectal cancer. (2) Surgeons of deputy chief physician or above. Using the "Questionnaire Star" online survey platform to create a questionnaire about cognition, attitude and treatment choice of the "watch and wait" strategy after cCR following nCRT for rectal cancer. The questionnaire contained 32 questions, such as the basic information of doctor, the current status of rectal cancer surgery, the management of pathological complete remission (ypCR) after nCRT for rectal cancer, the selection of examination items for diagnosis of cCR, the selection of suitable people undergoing "watch and wait" approach, the nCRT mode for promotion of cCR, the choice of evaluation time point, the willingness to perform "watch and wait" approach and the treatment choice, and the risk and monitoring of "watch and wait" approach. A total of 116 questionnaires were sent to the respondents via WeChat between January 31 and February 19, 2019. Statistical analysis was performed using Fisher's exact test for categorical variables. Results: Forty-eight hospitals including 116 surgeons meeting criteria were enrolled, of whom 77 surgeons filled the questionnaire with a response rate of 66.4%. "Watch and wait" strategy was carried out in 76.6% (59/77) of surgeons. Seventy surgeons (90.9%) were aware of the ypCR rate of rectal cancer after preoperative nCRT and 49 surgeons (63.6%) knew the 3-year disease-free survival of patients with ypCR in their own hospitals. Fifty-five surgeons (71.4%) believed that patients with ypCR undergoing radical surgery met the treatment criteria and were not over-treated. Three most necessary examinations in diagnosing cCR were colonoscopy (96.1%, 74/77), digital rectal examination (DRE) (90.9%,70/77) and DWI-MRI (83.1%, 64/77). Responders preferred to consider a "watch and wait" strategy for patients with baseline characteristics as mrN0 (77.9%, 60/77), mrT2 (68.8%, 53/77) and well-differentiated adenocarcinoma (68.8%, 53/77). Sixty-six surgeons (85.7%) believed that long-term chemoradiotherapy (LCRT) with combination or without combination of induction and/or consolidation of the CapeOX regimen (capecitabine + oxaliplatin) should be the first choice as a neoadjuvant therapy to achieve cCR. Forty-one surgeons (53.2%) believed that a reasonable interval of judging cCR after nCRT should be ≥ 8 weeks. Forty-four surgeons (57.1%) routinely, or in most cases, informed patient the possibility of cCR and proposed to "watch and wait" strategy in the initial diagnosis of patients with non-metastatic rectal cancer. Thirteen surgeons (16.9%) would take the "watch and wait" strategy as the first choice after the patient having cCR. Fifty-two surgeons (67.5%) would be affected by the surgical method, that was to say, "watch and wait" approach would only be recommended to those patients who would achieve cCR and could not preserve the anus or underwent difficult anus-preservation surgery. Sixteen surgeons (20.8%) demonstrated that "watch and wait" strategy would not be recommended to patients with cCR regardless of whether the surgical procedure involved anal sphincter. Eleven surgeons (14.3%) believed that the main risk of "watch and wait" approach came from distant metastasis rather than local recurrence or regrowth. Twenty-nine of surgeons (37.7%) did not understand the difference between "local recurrence" and "local regrowth" during the period of "watch and wait". Twenty-six surgeons (33.8%) thought that the monitoring interval for the first 3 years of "watch and wait" strategy was 3 months, and the follow-up monitoring interval could be 6 months to 5 years. Surgeons from cancer specialist hospitals had higher approval rate, notification rate, and referral rate of "watch and wait" strategy than those from general hospitals. Thirty-one surgeons (42.5%) considered that the difficulty and concern of carrying out "watch and wait" approach in the future was the disease progress leading to medical disputes. Twenty-six surgeons (35.6%) demonstrated that their concern was lack of uniform evaluation standard for cCR. Conclusions: Chinese surgeons seem to have inadequate knowledge of non-operative management for rectal cancer patients achieving cCR after nCRT and show relatively conservative attitudes toward the strategy. Chinese consensus needs to be formed to guide the non-operative management in selected patients. Chinese Watch & Wait Database (CWWD) is also needed to establish and provide more evidence for the use of alternative procedure after a cCR following nCRT.

[The clinical effects of methylprednisolone combined with vestibular rehabilitation and methylprednisolone in the treatment of vestibular neuritis]

Objective:To explore the clinical effect of vestibular rehabilitation on vestibular neuritis. Method:Fifty patients with vestibular neuritis (VN) were randomly divided into study group (n=26) and control group (n=24). The patient in study group received methylprednisolone treatment and peripheral vestibular rehabilitation therapy, while that in the control group received methylprednisolone only. Spontaneous nystagmus (SN), caloric test (CP), directional preponderance (DP),vestibular muscle evoked potential (VEMP) were comparative for study group and control group at admission, 1 month after treatment, and 3 months after treatment. Result:①There was no significant difference in the balance between the two groups. ②After 1 month treatment, the directional preponderance of DP decreased (P<0.01) in the study group（21.09±16.90）% compared with the control group（41.11±24.03）%, VEMP extraction rate increased (P<0.05) in the study group compared with the control group, dynamic balance score of the study group (70.77±16.15) increased (P<0.05) compared with the control group (53.83±26.76). ③After 3 months, canal paresis CP of the study group (33.26±20.01)% decreased (P<0.05) compared with the control group (50.07±25.42)%, DP of the study group (8.63±5.65)% decreased (P<0.01) compared with the control group (17.98±8.84)%, and the comprehensive dynamic balance score of the study group (81.58±3.67) increased (P<0.01) compared with the control group (62.50±29.24). Conclusion:Peripheral vestibular rehabilitation can accelerate vestibular compensation and is an effective treatment for vestibular neurons.

Synergistically dual-functional nano eye-drops for simultaneous anti-inflammatory and anti-oxidative treatment of dry eye disease

We have developed a rapid and straightforward topical treatment method for dry eye disease (DED) using poly(catechin) capped-gold nanoparticles (Au@Poly-CH NPs) carrying amfenac [AF; a nonsteroidal anti-inflammatory drug (NSAID)] through effective attenuation of ocular surface tissue damage in dry eyes. A dual-targeted strategy based on ocular therapeutics was adopted to simultaneously block the cyclooxygenase enzymes-induced inflammation and reactive oxygen species (ROS)-induced oxidative stress, the primary two causes of DED. The self-assembled core-shell Au@Poly-CH NPs synthesized via a simple reaction between tetrachloroaurate(iii) and catechin possess a poly(catechin) shell (∼20 nm) on the surface of each Au NP (∼60 nm). The anti-oxidant and anti-inflammatory properties of AF/Au@Poly-CH NPs were evaluated by DCFH-DA and prostaglandin E2/VEGF assays, respectively. Our results demonstrate that Au@Poly-CH NPs not only act as an anti-oxidant to suppress ROS-mediated processes, but also serve as a drug carrier of AF for a synergistic effect on anti-inflammation. In vivo biocompatibility studies show good tolerability of AF/Au@Poly-CH NPs for potential use in the treatment of ocular surface pathologies. The dual-targeted therapeutic effects of AF/Au@Poly-CH NPs lead to rapid recovery from DED in a rabbit model. Au@Poly-CH NPs loaded with NSAIDs is a promising multifunctional nanocomposite for treating various inflammation- and oxidative stress-related diseases.

Subatomic-scale resolution with SPM: Co adatom on p(2 × 1)Cu(110):O

We study the limits of SPM subatomic resolution in imaging orbital magnetic features on a model system of a Co atom on a p(2 × 1)Cu(110):O surface. We show that scanning tunneling spectroscopies allow the determination of the occupation of the Co d shells and the value of the Hubbard U in the DFT + U modeling, and that standard near-contact AFM can in principle image the asymmetry due to partial filling of the d shells at close distances in the small-amplitude regime. Due to the partially ionic character of Co, a faint asymmetry is predicted to also arise in the electrostatic force. We anticipate these features to be even stronger for a transition metal adsorbate featuring larger departures from sphericality in charge/spin densities.

[Analysis of clinical features of secondary benign paroxysmal positional vertigo]

Objective:To analyze the clinical features of secondary benign paroxysmal positional vertigo (BPPV) and provide evidence for its precise diagnosis and treatment. Method:There were 942 patients with vertigo related to BPPV, including 204 patients with primary BPPV, 592 patients with vestibular migraine (VM), 83 patients with Meniere's disease (MD), 48 patients with vestibular neuronitis (VN), and 15 patients with sudden sensorineural hearing loss (SSNHL) accompanied by vertigo.There were 127 patients with BPPV secondary to vertigo in MD, VN, VM, and SSNHL. All patients received otolith repositioning treatment by hand or instrument based on detailed medical history. Secondary BPPV patients are treated according to the principle of diagnosis and treatment of primary BPPV. The incidence of secondary BPPV in each related disease was counted, and the difference between primary and secondary BPPV in gender, age, affected semicircular canal, number of reductions, and vertigo control rate was compared. Result:①The incidence of MD, VN, sudden vertigo, and VM secondary BPPV were 36.1% (30/83), 35.4%(17/48), 33.3% (5/15), and 12.7% (75/592). ②In patients with BPPV secondary to MD, the proportion of multi-semicircular canals involved was higher than that of primary BPPV, the difference was statistically significant (P<0.05), and there was no significant difference in the distribution of semicircular canals involved among the remaining diseases. ③The vertigo control rate of BPPV secondary to MD and VM was lower than that of primary BPPV, and the difference was statistically significant (P<0.05). ④The repositioning time of BPPV secondary to VM (2.88±2.32) and MD (2.53±1.14) was higher than that of primary BPPV (2.37±1.77). The difference was statistically significant (P<0.05). There was no significant difference in the repositioning time between other secondary BPPV and primary BPPV. Conclusion:Common causes of secondary BPPV include MD, VN, SSNHL, and VM. Same as primary BPPV, the secondary BPPV was more common in women and the posterior semicircular canal was most affected. BPPV secondary to MD is more susceptible to multi-semicircular canals involvement than primary BPPV. Detailed medical history combined with targeted examination is conducive to the accurate diagnosis of BPPV. Secondary BPPV can also be treated by manipulation or instrument, however, the effect is worse than primary BPPV. Secondary BPPV should be treated according to the treatment principle of primary disease besides otolith repositioning.

[Particulate matter pollution and allergic rhinitis]

Summary Outdoor air pollution has become a major environmental health problem throughout the world. In particular, exposure to particulate matter(PM) has been associated with the development and exacerbation of allergic rhinitis（AR）. Although the adverse health effects of PM have been demonstrated for many years, the underlying mechanisms have not been fully identified. In this review, we refer to recently published literature to describe the composition of PM, the epidemiological evidence of PM-induced AR, and the possible immune mechanisms of PM-induced AR.

Methylation-Based Age Estimation Model Construction and Its Effectiveness Evaluation

OBJECTIVES

To screen the DNA methylation loci associated with the age of Han males in northern China and to construct an age estimation model.

METHODS

Twenty-one candidate methylation loci were screened. The DNA methylation levels of 476 blood samples from Chinese Han males were detected for 21 amplicons using EpiTYPER technology platform, and data on 153 DNA methylation loci were obtained.

RESULTS

After correlation analysis, 8 age-related DNA methylation loci were finally screened. CpG1, CpG2, CpG4, CpG7, CpG8 were located on TRIM59, RASSF5, Clorf132, CSNK1D, ELOVL2,CpG5, CpG6 on PDE4C, and CpG3 on chr17:21452808. Based on the 8 loci, 352 samples were used for model construction. A multivariate linear regression age estimation model was constructed （R²=0.93）, with mean absolute deviation （MAD） of 2.69 years old. When 109 samples were used for model validation, the MAD was 3.80 years old. The test was repeated 3 times in 15 new samples, with MADs of 4.08, 4.68 and 3.93 years old, respectively.

CONCLUSIONS

The age estimation model on Han males in northern China constructed in this study can be used to estimate the age of victims and suspects and to narrow the scope of investigation, and therefore has practical application value.

Improving the performance of optical antenna for optical phased arrays through high-contrast grating structure on SOI substrate

A novel optical antenna for optical phased arrays is proposed and simulated. A high-contrast grating structure is used to achieve extremely efficient emission. The emission efficiency is as high as 93.94% at 1.55 μm, which exceeds 50% in a range of wavelength from 1.48 μm to 1.62 μm. The antenna can achieve a perfect grating lobe suppression with background suppression of 28.4 dB when the phase difference between adjacent waveguides is 0. A 16-wire optical phased array can easily achieve a scan range of ± 22.8° × 20.2° with a beam width of 2.4° × 2.5°, by employing the optical antenna proposed.

[Clinicopathologic features of primary renal neuroendocrine carcinoma]

Objective: To investigate the clinicopathologic characteristics, diagnostic features and prognosis of primary renal neuroendocrine carcinoma (NEC). Methods: The clinicopathologic data of eight cases of renal NEC was collected from January 2008 to December 2017 from Affiliated Hospital of Qingdao University. Immunohistochemical staining was performed, and follow-up information was analyzed, and the relevant literature reviewed. Results: The patients' mean age at diagnosis was 45 years (range, 27-66 years); five were women, and three were men. The tumors located on the left side in five patients, and on the right side in three. Five cases were detected incidentally, and three patients presented with loin pain. Microscopically, these cases included five well-differentiated NECs (three carcinoids, two atypical carcinoids), two small cell NECs, and one large cell NEC according to the World Health Organization classification of 2016. The tumors infiltrated the renal capsule in six cases. Necrosis was found in five cases. Vascular invasion with tumor emboli was seen in three cases. Lymph node metastasis was identified in one case. Immunohistochemically, the expression rates of neuroendocrine markers CD56, chromogranin A (CgA) and synaptophysin (Syn) were 6/8, 4/8, and 8/8 respectively. Some of the NECs were positive for epithelial markers CKpan (6/8, with three cases showing focal positivity) and CAM5.2 (4/8) of variable degrees. The Ki-67 proliferation index was≤3% in the carcinoids; ≥50% in the small cell carcinoma and large cell carcinoma; and 5% and 8% for the two cases of atypical carcinoid, respectively. All cases were negative for EMA, CK7, CA9, CD10, CD117, PAX2, PAX8, WT1, p63, S-100 and TTF1. Three patients (two with small cell carcinoma and one with large cell carcinoma) died of extensive metastases at 3 months, 4 months and 9 months after operation, while five patients were well, without recurrence or distant metastasis for follow-up period of one to nine years. Conclusions: Primary renal NEC is rare. Carcinoid is the most common histological type. The pathomorphological features and neuroendocrine markers (CD56, CgA, Syn), epithelial markers (CKpan, CAM5.2) and nephrogenic markers (PAX2, PAX8) are important for the diagnosis. Renal carcinoid tumors are indolent and prone to early metastasis, but are associated with prolonged survival. The small cell renal cell carcinoma and large cell carcinoma are highly malignant renal tumors with poor prognosis and short survival.

A 3D electropolymerized thin film based on a thiophene-functionalized Ru(ii) complex: electrochemical and photoelectrochemical insights

A 3D electropolymerized Ru(ii) complex film exhibited a rapid redox reaction and an oxygen reduction enhanced photocurrent which increased by 1.5 fold to 2.3 μA cm⁻².

[Changes of intestinal mucosal barrier in mice with chronic ulcerative colitis]

Objective: To study the damage and mechanism of intestinal mucosal barrier function in mice with ulcerative colitis induced by Dextran sulphate sodium (DSS). Methods: Mice models of chronic ulcerative colitis induced by DSS were established. The mice were completely randomized into normal control group and DSS group, 25 mice in each group. The body weight and colon length of the mice were monitored. The pathological examination of colon tissue was confirmed the success of the model and assessed the integrity of the colonic mucosal barrier; Evan's Blue's intestinal permeability analysis assessed the function of colon mucosal barrier; immunofluorescence staining and Western blot were used to evaluate the expression of intestinal mucosal barrier integrity-related proteins. Results: Compared with the normal control group, the DSS group had lower body weight [(25.6±0.7)g vs (23.5±0.7)g, t=2.14, P<0.05], and the colon length was shorter [(7.3±0.4)cm vs (5.6±0.2)cm, t=3.975, P<0.001]; colonic pathological results showed that the intestinal mucosa became thinner and part of the intestinal mucosa was defective; Evan's Blue instilled into the intestinal lumen was more abundant into the intestinal mucosa, and the optical density at 620 nm (OD(620))/colon tissue weight (g) was higher [(0.11±0.01) vs (0.15±0.01), t=4.174, P<0.05]; immunofluorescence and Western blot results showed lower expression of ZO-1, Claudin-1, and F-actin in colonic mucosa. Conclusion: The structure and function of intestinal mucosal barrier in DSS-induced chronic ulcerative colitis mice is impaired.

Different distributions of interstitial cells of Cajal and platelet-derived growth factor receptor-α positive cells in colonic smooth muscle cell/interstitial cell of Cajal/platelet-derived growth factor receptor-α positive cell syncytium in mice

AIM

To investigate the distribution and function of interstitial cells of Cajal (ICCs) and platelet-derived growth factor receptor-α positive (PDGFRα⁺) cells in the proximal and distal colon.

METHODS

The comparison of colonic transit in the proximal and distal ends was performed by colonic migrating motor complexes (CMMCs). The tension of the colonic smooth muscle was examined by smooth muscle spontaneous contractile experiments with both ends of the smooth muscle strip tied with a silk thread. Intracellular recordings were used to assess electrical field stimulation (EFS)-induced inhibitory junction potentials (IJP) on the colonic smooth muscle. Western blot analysis was used to examine the expression levels of ICCs and PDGFRα in the colonic smooth muscle.

RESULTS

Treatment with NG-nitro-L-arginine methyl ester hydrochloride (L-NAME) significantly increased the CMMC frequency and spontaneous contractions, especially in the proximal colon, while treatment with MRS2500 increased only distal CMMC activity and smooth muscle contractions. Both CMMCs and spontaneous contractions were markedly inhibited by NPPB, especially in the proximal colon. Accordingly, CyPPA sharply inhibited the distal contraction of both CMMCs and spontaneous contractions. Additionally, the amplitude of stimulation-induced nitric oxide (NO)/ICC-dependent slow IJPs (sIJPs) by intracellular recordings from the smooth muscles in the proximal colon was larger than that in the distal colon, while the amplitude of electric field stimulation-induced purinergic/PDGFRα-dependent fast IJPs (fIJPs) in the distal colon was larger than that in the proximal colon. Consistently, protein expression levels of c-Kit and anoctamin-1 (ANO1) in the proximal colon were much higher, while protein expression levels of PDGFRα and small conductance calcium-activated potassium channel 3 (SK3) in the distal colon were much higher.

CONCLUSION

The ICCs are mainly distributed in the proximal colon and there are more PDGFRα⁺ cells are in the distal colon, which generates a pressure gradient between the two ends of the colon to propel the feces to the anus.

[Clinical experience and next-generation sequencing analysis of encephalitis caused by pseudorabies virus]

Objective: To detect potential pathogens including pseudorabies virus in patients with encephalitis of unknown etiology in China and describe novel encephalitic entities. Methods: Patients with clinically suspected infectious encephalitis were enrolled in a multicenter study to identify the pathogens in PUMCH Encephalitis Program.Next-generation sequencing(NGS) of cerebrospinal fluid (CSF) was used in patients with encephalitis of unknown etiology enrolled from 2016 to 2017.The patients diagnosed as PRV encephalitis were studied to describe this novel entity. Results: The four patients(3 male, 1 male, 38-54 years old) had occupational exposure to raw park when working in the production or marketing of pork and at least one got injured during pork-cutting.Two of them were confirmed with NGS of CSF, and anti-PRV antibodies were positive in 3 patients whose serum was available for serological analysis.They all presented with an acute onset of fever, convulsion, loss of consciousness and respiratory failure within 1 to 4 days and rapidly deteriorated even on extensive treatment.All the patients needed ICU admission and 3 needed mechanical ventilation.Two patients also had bilateral retinitis.Neuroimaging revealed symmetric gray matter lesions including limbic system, basal ganglia and midbrain without obvious hemorrhage.Lumbar puncture revealed elevated intracranial pressure and lymphocytic pleocytosis [(6-64)×10(6)/L] of CSF.The patients failed to response to the treatment of acyclovir combined with intravenous immunoglobulin and steroids.Modified Rankin Score was 3, 5, 5 and 6 (died) for the 4 patients respectively on last follow-up. Conclusions: PRV could be a cause of severe encephalitis.The patients with suspected pseudorabies encephalitis (PRE) need to be tested for PRV DNA timely.Severe encephalitis with bilateral involvement of limbic system, basal ganglion, thalamus and midbrain in patient with occupational exposure indicate this emerging infectious encephalitis.

[HER2 status in gastric adenocarcinoma of Chinese: a multicenter study of 40 842 patients]

Objective: To investigation HER2 status in gastric adenocarcinoma of Chinese and contributing factors to the HER2 expression. Methods: HER2 status of 40 842 gastric adenocarcinomas and clinical data were retrospectively collected from 23 hospitals dated from 2013 to 2016. The association between HER2 positivity and clinicopathologic features was analyzed. Results: Of the 40 842 patients the median age was 62 years, the male female ratio was 2.6∶1.0. The rate of HER2 positivity was 8.8% (3 577/40 842). HER2 expression was related to the tissue type, tumor location, Lauren classification and tumor differentiation (P values: 0.009, 0.001, <0.01 and <0.01, respectively). Different HER2 expression status was observed between primary and recurrent tumors in 7.6% (48/635) cases. The rates of HER2 positivity ranged from 2% to 10% among different institutions. The rates of HER2 FISH amplification were dramatically different among the 23 hospitals (0-100%) with an average rate of 10% (810/8 156) in patients with HER2 IHC 2+ . Conclusions: HER2 expression is associated with clinicopathologic characteristics. HER2 re-assessment of tumor tissue and use of in situ hybridization techniques increase HER2 positivity. The current retrospective study should reflect the HER2 status in gastric adenocarcinoma of Chinese patients.

[Clinical and pathological features and mutational types of WT1 mutation-associated nephropathy]

Objective: To explore the clinical and pathological features and mutational types and their relations with WT1 mutation-associated nephropathy (WT1MAN). Methods: The clinical and pathological data and the results of WT1 mutation analysis of the cases from Nanfang Hospital of Southern Medical University, Sun Yat-sen Memorial Hospital and The First Affiliated Hospital of Sun Yat-sen University whom we recruited recently and reported during the last ten years were analyzed. Results: Totally, 20 cases (6 males and 14 females), included 5 newly diagnosed cases, were recruited. (1) Ten children were diagnosed with Denys-Drash syndrome (DDS): The median onset age of proteinuria was 1 year and 7 months. Diffuse mesangial sclerosis (DMS) were revealed in 3 cases, minimal lesions (MCD) in 4 cases, and focal segmental glomerulosclerosis (FSGS) in 1 case; renal pathology was not available in the other 2 cases. Glomerular basement membrane (GBM) thickening was observed in 2 cases. Calcineurin inhibitors (CNIs) were administered in 5 cases, complete remission of proteinuria was observed in 3 cases, partial remission in the other 2 cases. Genetic analysis revealed that six cases had WT1 missense mutation, 3 had nonsense mutation, and 1 had frameshift mutation. (2) Two cases were diagnosed with Frasier syndrome (FS): proteinuria was observed at 1 year and 1 month of age and 1 year and 9 months of age, respectively. FSGS with GBM layering were observed in both cases. They progressed to ESRD at 1 year and 6 months of age and 6 years and 6 months of age, respectively. CNI was tried in 1 case with partial proteinuria remission. Both patients were detected to have WT1 splice mutation. (3) Isolated nephropathy (IN) was observed in 8 cases: three had splice mutation, 5 had missense mutation. Of the 3 patients with splice mutation, one was found to have nephropathy and renal failure at the age of 5 months. The other two cases (1 was FSGS and another MCD), both had GBM layering. CNIs were tried on both of them, one got partial remission with normal renal function at the age of fourteen years, the other one had no response and entered ESRD at the age of 6 years and 9 months. Of the 5 cases with missense mutation, 3 had DMS, 2 of them entered ESRD within 6 months of age, another case had DMS entered ESRD at 9 years of age. One case with FSGS, was treated with CNIs and got complete remission. Conclusions: Slow progression (7/10) nephropathy was observed in DDS patients. Missense mutation (11/20) was the most common type of WT1 variants, followed by splice mutation (5/20) in this group of patients. Early onset nephropathy (4/5), rapid progression (4/5) and GBM layering (4/4) wereobserved in patients with splice mutation. CNI was effective in reducing or even eliminating proteinuria in WT1 MAN patients (8/9).

[Occupational activity disorders of extremely severe mass burn patients in recovery period after injury: a cross-sectional survey]

Objective: To observe the distribution of occupational activity disorders of extremely severe mass burn patients in recovery period after injury. Methods: From December 2014 to December 2015, 65 extremely severe burn patients conforming to the inclusion criteria involved in August 2 Kunshan factory aluminum dust explosion accident were admitted to Kunshan Rehabilitation Hospital. They received comprehensive rehabilitation treatment after burns, including wearing pressure clothes, ultrasound treatment, semiconductor laser and red light irradiation, motor function training, and so on. Over 2 years after injury, a cross-sectional survey was conducted on the patients' occupational activity disorders. Modified Barthel index (MBI) was used to assess the degree of activities of daily living (ADL) disorder of patients and to grade the independent level of completing each item of MBI, and then the independent level of patients completing self-care MBI items (bathing, dressing, grooming, eating, going to the toilet, urine control, and stool control) was compared with that of mobility items (going up and down stairs, bed and chair transfer, and walking). The Canadian Occupational Performance Measure (COPM) was used to assess the distribution of occupational activity disorders of patients. The distribution of the five most serious occupational activity disorders was counted, then the frequency and probability of which with frequency greater than or equal to 16 times were calculated. Data were processed with Pearson Chi-square test. Results: Over 2 years after injury, the MBI score of patients was (76±22) points, and the ADL of 83.08% (54/65) patients reached completely self-care or light ADL disorder level. The MBI items arranged according to the completing independent level of patients from high to low were urine control/stool control, walking, bed and chair transfer, going up and down stairs, going to the toilet, eating, grooming, dressing, and bathing. The independent level of patients completing self-care MBI items was lower than that of mobility items (χ(2)=62.298, P<0.001). Over 2 years after injury, the five most serious occupational activity disorders in COPM dimension were mainly concentrated in the self-care dimension, accounting for 55.38% (180/325), followed by 22.46% (73/325) of production activities and 22.15% (72/325) of recreational activities, and the centrally distributed item was the personal self-care item under self-care dimension, accounting for 42.46% (138/325). Over 2 years after injury, the five most serious occupational activity disorders with frequency greater than or equal to 16 times were dressing and undressing, bathing, perineal cleaning, wearing pressure clothes, caring for children, visiting relatives and friends, 31, 25, 16, 17, 18, and 22 times respectively, with a probability of 47.69%, 38.46%, 24.62%, 26.15%, 27.69%, and 33.85% respectively. Conclusions: Over 2 years after injury, most of the patients with extremely severe burns caused by the aluminum dust explosion were completely or basically self-care in their daily life. The disorder of self-care ADL was more serious than that of mobility, and the disorder of individual self-care activity was still the most serious occupational activity disorder of patients in this stage. Clinical trial registration: Chinese clinical trial registry, ChiCTR-OOC-16009188.