MRI assessment of the bone adjacent to giant cell tumours and its association with local recurrence after intralesional curettage

AIM

To assess the tumour border surrounding giant cell tumour of the bone (GCTB) using magnetic resonance imaging (MRI) and investigate its association with local recurrence.

MATERIALS AND METHODS

Sixty-nine GCTBs in proximal tibiae and distal femurs were studied. The pathological basis of the paintbrush border sign was explored. Expression of Ki-67, matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), receptor activator of nuclear factor-κ B (RANK), and RANK ligand (RANKL) in GCTBs were investigated using immunohistochemistry. Patients treated with intralesional curettage were analysed retrospectively to investigate the prognostic role of the paintbrush border sign. The differences between rates were tested using the chi-square test or Fisher's exact test, as appropriate.

RESULTS

The paintbrush border sign correlated well with infiltrative margins. The expression of MMP-9 was associated with the paintbrush border sign, and positively correlated with RANKL and VEGF expression. GCTBs with the paintbrush border sign had a higher rate of local recurrence (76.19 versus 20.59%, p<0.05). The paintbrush border sign was more common in proximal tibiae, and positively correlated with cystic change. The paintbrush border signs were detected at T1-weighted imaging, but the sign was only evident in four cases on T2-weighted imaging.

CONCLUSION

Pathologically, the paintbrush border sign correlates well with invasion of the bone around GCTB. MMP-9 might play a key role in the formation of penetrating irregular margins. The paintbrush border sign is revealed as a risk factor for local recurrence of GCTB. Sagittal T1-weighted imaging is crucial to diagnose the paintbrush border sign.

A genome-wide association study of growth and fatness traits in two pig populations with different genetic backgrounds

Improvement in growth and fatness traits are the main objectives in pig all breeding programs. Tenth rib backfat thickness (10RIBBFT) and days to 100 kg (D100), which are good predictors of carcass lean content and growth rate, respectively, are economically important traits and also main breeding target traits in pigs. To investigate the genetic mechanisms of 10RIBBFT and D100 of pigs, we sampled 1,137 and 888 pigs from 2 Yorkshire populations of American and British origin, respectively, and conducted genome-wide association study (GWAS) through combined analysis and meta-analysis, to identify SNPs associated with 10RIBBFT and D100. A total of 11 and 7 significant SNPs were identified by combined analysis for 10RIBBFT and D100, respectively. And in meta-analysis, 8 and 7 significant SNPs were identified for 10RIBBFT and D100, respectively. Among them, 6 and 5 common significant SNPs in two analysis results were, respectively, identified associated with 10RIBBFT and D100, and correspondingly explained 2.09% and 0.52% of the additive genetic variance of 10RIBBFT and D100. Further bioinformatics analysis revealed 10 genes harboring or close to these common significant SNPs, 5 for 10RIBBFT and 5 for D100. In particular, Gene Ontology analysis highlighted 6 genes, PCK1, ANGPTL3, EEF1A2, TNFAIP8L3, PITX2, and PLA2G12, as promising candidate genes relevant with backfat thickness and growth. PCK1, ANGPTL3, EEF1A2, and TNFAIP8L3 could influence backfat thickness through phospholipid transport, regulation of lipid metabolic process through the glycerophospholipid biosynthesis and metabolism pathway, the metabolism of lipids and lipoproteins pathway. PITX2 has a crucial role in skeletal muscle tissue development and animal organ morphogenesis, and PLA2G12A plays a role in the lipid catabolic and phospholipid catabolic processes, which both are involved in the body weight pathway. All these candidate genes could directly or indirectly influence fat production and growth in Yorkshire pigs. Our findings provide novel insights into the genetic basis of growth and fatness traits in pigs. The candidate genes for D100 and 10RIBBFT are worthy of further investigation.

Arabidopsis FIM4 and FIM5 regulates the growth of root hairs in an auxin-insensitive way

Tip-growing cells provide a useful model system for studying the underlying mechanisms of plant cell growth. The apical growth of root hairs is dependent on the microfilament skeleton, and auxin is an important regulator of root hair development. We functionally characterized actin bundling proteins AtFIM4 and AtFIM5, which were preferentially expressed in tip-growing cells such as pollen tubes and root hairs. The morphology and length of root hairs in atfim4/atfim5 double mutant line had obvious defects. In addition, we found the growth of root hairs of atfim4/atfim5 double mutant was insensitive to exogenous IAA (indole-3-acetic acid) treatment. So we consider that AtFIM4 and AtFIM5 act together to regulate the growth of root hair in an auxin-insensitive way.

[Therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults]

Objective: To explore the therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults. Methods: The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was performed on 21 adults with ischemic moyamoya disease since January 2013 in the second hospital of Shandong university.All of the patients were followed up for 3 months to 3 years.Digital subtraction angiogram (DSA) reexamination was performed and the cerebral MR perfusion imaging (PWI) was used to observe the perfusion of cerebral ischemic area before and after operation quantificationally, and the KPS scores before and after the surgery were analysed by the statistics.The clinical symptoms of the 21 patients gradually improved after the operation, there was statistical significance by paired t test of the KPS scores (P<0.001). Results: 19 patients were reexamined by DSA and PWI.The DSA results revealed there was apparent neovascularization in 65 burr-holes of total 72 holes , mainly came from the middle meningeal artery and superficial artery, and there was neovascularization in 33 burr-holes of total 35 holes whose arachnoid was completed, there was no statistical significance by χ(2) test (P>0.05). The revascularization of the ischemic cerebral tissue was obtained through the PWI.The postoperative complications included 1 case of subdural hematoma, 3 cases of postoperative temporary neurological deficits. Conclusion: The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was effective, the MR perfusion imaging could assessment the effect exactly, there was no significant difference of neovascularization whether or not opening the arachnoid.

Effects of Ginkgo biloba leaves (Ginkgo biloba) and Ginkgo biloba extract on nutrient and energy utilization of broilers

An experiment using 112 21-day-old male Arbor Acres broilers that were randomly allocated to 7 treatments with 8 replicates in a completely randomized design was conducted to assess the effects of Ginkgo biloba leaves (Ginkgo biloba, GL) and Ginkgo biloba extract (EGB) on utilization of nutrients of broiler chickens. The dietary treatments were corn-soybean meal based diets: 1) T1, control diet; 2) T2, T1 + 20 g/kg GL; 3) T3, T1 + 40 g/kg GL; 4) T4, T1 + 60 g/kg GL; 5) T5, T1 + 0.4 g/kg EGB; 6) T6, T1 + 0.8 g/kg EGB; and 7) T7, T1 + 1.2 g/kg EGB. Endogenous losses were obtained from another 16 broilers. Excreta samples were collected to analyze the dry matter (DM), organic matter (OM), ether extract (EE), crude protein (CP), gross energy (GE), and amino acids (AA), and GE was analyzed for computation of AME and TME. As compared with those of the control treatment, the apparent digestibility (AD) and true digestibility (TD) of EE, CP, Thr, Val, Ile, Leu, Phe, Lys, His, and Arg were quadratically (P < 0.05) increased; moreover, the AD and TD of Met was linearly (P < 0.05) increased as the concentration of the EGB in the diet increased. Increasing GL from 0 to 60 g/kg of diet linearly (P < 0.05) increased the AD and TD of EE, Thr, Val, Leu, His, and Met and tended (0.05 < P < 0.1) to increase the TME, TMEn, and Arg. Supplementation of EGB increased (P < 0.05) AD and TD of EE, Thr, Val, Ile, Leu, Phe, His, and Arg and tended (0.05 < P < 0.1) to increase Lys as compared with those in the GL-supplemented groups. Dietary supplementation of GL and EGB improved the utilization of nutrients of broiler chickens in a dose-dependent manner, and the optimum supplementation levels of GL or EGB in the diet of broilers was 60 or 0.8 g/kg of diet, respectively.

[Technical specification for clinical application of critical ultrasonography]

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.

Cerebrospinal fluid rhinorrhoea following transsphenoidal surgery for pituitary adenoma: experience in a Chinese centre

The aim of this study was to elucidate the risk factors for cerebrospinal fluid (CSF) rhinorrhoea following transsphenoidal surgery and discuss its prevention and treatments. We retrospectively reviewed 474 consecutive cases of pituitary adenoma treated with 485 transsphenoidal surgical procedures from January 2008 to December 2011 in our department. We analysed the incidence of intra- and post-operative CSF leakage and outcomes of various repair strategies. Intra-operative CSF leakage was encountered in 85 cases (17.9%), and post-operative CSF rhinorrhoea in 13 cases (2.7%). Seven of the 13 patients with post-operative CSF rhinorrhoea did not experience intra-operative CSF leakage; three of these patients had adrenocorticotropic hormone-secreting adenomas. Of the remaining 6 patients with both intra- and post-operative CSF leakage, 2 were treated for giant invasive prolactinomas, and 2 had previously undergone transsphenoidal surgery. In eight patients, the leak was resolved by lumbar puncture, lumbar external drainage, resting in a semi-reclining position, or other conservative treatment. Two CSF leaks were repaired with gelatine foam and fibrin glue using a transsphenoidal approach, and two with autologous fat graft and sellar floor reconstruction using a transnasal endoscopic approach. After undergoing two transnasal endoscopic repairs, one patient with post-operative CSF rhinorrhoea was successfully treated by further lumbar subarachnoid drainage. In conclusion, procedures using gelatine foam, fibrin glue and autologous fat graft are common and effective techniques for the management of CSF rhinorrhoea after transsphenoidal surgery. When a CSF leak is detected during transsphenoidal surgery, thorough sellar reconstruction and long-term follow-up are necessary.

Toward Scalable Boson Sampling with Photon Loss

Boson sampling is a well-defined task that is strongly believed to be intractable for classical computers, but can be efficiently solved by a specific quantum simulator. However, an outstanding problem for large-scale experimental boson sampling is the scalability. Here we report an experiment on boson sampling with photon loss, and demonstrate that boson sampling with a few photons lost can increase the sampling rate. Our experiment uses a quantum-dot-micropillar single-photon source demultiplexed into up to seven input ports of a 16×16 mode ultralow-loss photonic circuit, and we detect three-, four- and fivefold coincidence counts. We implement and validate lossy boson sampling with one and two photons lost, and obtain sampling rates of 187, 13.6, and 0.78 kHz for five-, six-, and seven-photon boson sampling with two photons lost, which is 9.4, 13.9, and 18.0 times faster than the standard boson sampling, respectively. Our experiment shows an approach to significantly enhance the sampling rate of multiphoton boson sampling.

Measurement of the neutron lifetime using a magneto-gravitational trap and in situ detection

The precise value of the mean neutron lifetime, τ_n, plays an important role in nuclear and particle physics and cosmology. It is used to predict the ratio of protons to helium atoms in the primordial universe and to search for physics beyond the Standard Model of particle physics. We eliminated loss mechanisms present in previous trap experiments by levitating polarized ultracold neutrons above the surface of an asymmetric storage trap using a repulsive magnetic field gradient so that the stored neutrons do not interact with material trap walls. As a result of this approach and the use of an in situ neutron detector, the lifetime reported here [877.7 ± 0.7 (stat) +0.4/-0.2 (sys) seconds] does not require corrections larger than the quoted uncertainties.

Calcium signaling involved in bovine herpesvirus 1 replication in MDBK cells

Calcium is one of the most prominent second messengers in eukaryotic cells. The involvement of calcium signaling in bovine herpesvirus 1 (BoHV-1) replication was not yet reported. In this study, we revealed that the L-type Ca2+ calcium channel blocker, Verapamil and store-operated calcium channel blocker, 2-aminoethyl diphenylborinate (2-APB) inhibited BoHV-1 replication in MDBK cells at the post-entry stages, and the Na+/Ca²+ exchanger inhibitor, N-arachidonoyl glycine exchanger (NAGly) interfered with the viral entry process. NAGly also effected the phosphorylation of PLCγ-1 at Ser1248, which corroborated our previous findings, that PLCγ-1 is important for BoHV-1 entry. Collectively, these results suggest that diverse calcium channels are employed by BoHV-1 for efficient replication.

Measurement of the neutron lifetime using a magneto-gravitational trap and in situ detection

The precise value of the mean neutron lifetime, τ_n, plays an important role in nuclear and particle physics and cosmology. It is used to predict the ratio of protons to helium atoms in the primordial universe and to search for physics beyond the Standard Model of particle physics. We eliminated loss mechanisms present in previous trap experiments by levitating polarized ultracold neutrons above the surface of an asymmetric storage trap using a repulsive magnetic field gradient so that the stored neutrons do not interact with material trap walls. As a result of this approach and the use of an in situ neutron detector, the lifetime reported here [877.7 ± 0.7 (stat) +0.4/-0.2 (sys) seconds] does not require corrections larger than the quoted uncertainties.

Classify epithelium-stroma in histopathological images based on deep transferable network

Recently, the deep learning methods have received more attention in histopathological image analysis. However, the traditional deep learning methods assume that training data and test data have the same distributions, which causes certain limitations in real-world histopathological applications. However, it is costly to recollect a large amount of labeled histology data to train a new neural network for each specified image acquisition procedure even for similar tasks. In this paper, an unsupervised domain adaptation is introduced into a typical deep convolutional neural network (CNN) model to mitigate the repeating of the labels. The unsupervised domain adaptation is implemented by adding two regularisation terms, namely the feature-based adaptation and entropy minimisation, to the object function of a widely used CNN model called the AlexNet. Three independent public epithelium-stroma datasets were used to verify the proposed method. The experimental results have demonstrated that in the epithelium-stroma classification, the proposed method can achieve better performance than the commonly used deep learning methods and some existing deep domain adaptation methods. Therefore, the proposed method can be considered as a better option for the real-world applications of histopathological image analysis because there is no requirement for recollection of large-scale labeled data for every specified domain.

Slow Collateral Flow Is Associated with Thrombus Extension in Patients with Acute Large-Artery Occlusion

BACKGROUND AND PURPOSE

It is still poorly understood about the dynamic changes of the thrombus after intravenous thrombolysis and how the remaining thrombus affects clinical outcome in human stroke. Collateral flow was assumed to help to deliver endo/exogenous tissue-type plasminogen activator to the clot. We aimed to analyze the impact of collateral flow on the dynamic changes of the thrombus in patients with acute large-artery occlusion who received intravenous thrombolysis.

MATERIALS AND METHODS

We reviewed consecutive patients with acute ischemic stroke with M1 segment or distal internal carotid artery occlusion who underwent multimodal MR imaging or CT perfusion before and 24 hours after intravenous thrombolysis without recanalization. Patients were divided into 3 groups (thrombus extension, shortening, and no change) according to thrombus-length change between baseline and 24 hours. Collateral flow was measured with arrival time delay and the collateral scoring system. Poor outcome was defined as a 3-month modified Rankin Scale score of ≥3.

RESULTS

Among 51 patients, 18 (35.3%) had thrombus extension, 14 (27%) had thrombus shortening, and 19 (37.3%) had thrombus without change. Arrival time delay was independently associated with thrombus extension (OR = 1.499; 95% CI, 1.053-2.135; P = .025). Similarly, the collateral score on the peak artery phase was independently associated with thrombus extension (OR = 0.456; 95% CI, 0.211-0.984; P = .045), whereas baseline National Institutes of Health Stroke Scale score (OR = 0.768; 95% CI, 0.614-0.961; P = .021) and baseline thrombus length (OR = 1.193; 95% CI, 1.021-1.394; P = .026) were associated with thrombus shortening. All patients with thrombus extension had poor outcomes.

CONCLUSIONS

Slow collateral flow was related to thrombus extension in patients with large-artery occlusion without recanalization after intravenous thrombolysis.

Short communication: Improving the accuracy of genomic prediction of body conformation traits in Chinese Holsteins using markers derived from high-density marker panels

This study investigated the efficiency of genomic prediction with adding the markers identified by genome-wide association study (GWAS) using a data set of imputed high-density (HD) markers from 54K markers in Chinese Holsteins. Among 3,056 Chinese Holsteins with imputed HD data, 2,401 individuals born before October 1, 2009, were used for GWAS and a reference population for genomic prediction, and the 220 younger cows were used as a validation population. In total, 1,403, 1,536, and 1,383 significant single nucleotide polymorphisms (SNP; false discovery rate at 0.05) associated with conformation final score, mammary system, and feet and legs were identified, respectively. About 2 to 3% genetic variance of 3 traits was explained by these significant SNP. Only a very small proportion of significant SNP identified by GWAS was included in the 54K marker panel. Three new marker sets (54K+) were herein produced by adding significant SNP obtained by linear mixed model for each trait into the 54K marker panel. Genomic breeding values were predicted using a Bayesian variable selection (BVS) model. The accuracies of genomic breeding value by BVS based on the 54K+ data were 2.0 to 5.2% higher than those based on the 54K data. The imputed HD markers yielded 1.4% higher accuracy on average (BVS) than the 54K data. Both the 54K+ and HD data generated lower bias of genomic prediction, and the 54K+ data yielded the lowest bias in all situations. Our results show that the imputed HD data were not very useful for improving the accuracy of genomic prediction and that adding the significant markers derived from the imputed HD marker panel could improve the accuracy of genomic prediction and decrease the bias of genomic prediction.

Genome-wide association study for reproductive traits in a Large White pig population

Using the PorcineSNP80 BeadChip, we performed a genome‐wide association study for seven reproductive traits, including total number born, number born alive, litter birth weight, average birth weight, gestation length, age at first service and age at first farrowing, in a population of 1207 Large White pigs. In total, we detected 12 genome‐wide significant and 41 suggestive significant SNPs associated with six reproductive traits. The proportion of phenotypic variance explained by all significant SNPs for each trait ranged from 4.46% (number born alive) to 11.49% (gestation length). Among them, 29 significant SNPs were located within known QTL regions for swine reproductive traits, such as corpus luteum number, stillborn number and litter size, of which one QTL region associated with litter size contained the ALGA0098819 SNP for total number born. Subsequently, we found that 376 functional genes contained or were near these significant SNPs. Of these, 14 genes—BHLHA15, OCM2, IL1B2, GCK, SMAD2, HABP2, PAQR5, GRB10, PRELID2, DMKN, GPI, GPIHBP1, ADCY2 and ACVR2B—were considered important candidates for swine reproductive traits based on their critical roles in embryonic development, energy metabolism and growth development. Our findings contribute to the understanding of the genetic mechanisms for reproductive traits and could have a positive effect on pig breeding programs.

Genomic prediction for growth and reproduction traits in pig using an admixed reference population

This study investigated the efficiency of genomic prediction using an admixed reference population comprising 3 Yorkshire populations with different genetic backgrounds. In total, 2,084 and 1,388 individuals with growth and reproduction records, respectively, were genotyped with a PorcineSNP80 marker panel. The corrected phenotypic values derived from conventional EBV of each population were taken as response variables. Three approaches, that is, a linear genomic BLUP (GBLUP) model, a Bayesian mixture model (BayesR), and single-step GBLUP (ssGBLUP), were implemented to predict genomic breeding values. Our results indicated that the accuracy of genomic prediction was increased by enlarging the reference population by admixing different populations. However, the improvement was lower than expected, because the relationships among individuals of different populations were not strong enough. Among the 3 approaches, for reproduction and growth traits, ssGBLUP produced 30 to approximately 38% and 23 to 31%, respectively, higher accuracy than GBLUP. And the ssGBLUP produced 28 to approximately 38% and 18 to approximately 31% higher accuracy than BayesR. In addition, ssGBLUP also yielded lower bias. In most situations, BayesR performed comparably to GBLUP for most traits. Our results indicated ssGBLUP using an admixed reference population is also meaningful for national joint genetic evaluation of Chinese pig breeding.

Expression analyses of candidate genes related to meat quality traits in squabs from two breeds of meat-type pigeon

In this study, meat quality traits were compared between squabs from two pigeon breeds: one Chinese indigenous breed, the Shiqi (SQ) meat-type pigeon, and an imported breed, the white king (WK) meat-type pigeon. Breed differences were detected in the content of intramuscular fat (IMF) in the breast muscle. SQ squabs had significantly higher IMF content than the WK birds. The shear force value (an objective measure of meat tenderness) of SQ birds was also relatively lower than that of the WK squabs. Further analysis of fatty acids profile revealed that SQ squabs exhibited significant advantage in the synthesis of polyunsaturated fatty acids, while WK squabs were significantly higher in the sum of monounsaturated fatty acids. Breast muscle in the SQ squabs was also significantly higher in the ratio of polyunsaturated fatty acids to saturated fatty acids, as well as the sum of omega 6 fatty acids. Variability of expression levels of functional genes in relation to fat accumulation and meat tenderness was analysed by qRT-PCR. Gene expression analyses showed that the hepatic expression of LPL (lipoprotein lipase), FABP4 (fatty acid-binding protein 4), and CAPN2 (calpain-2) were significantly higher in the SQ squabs. In the breast muscle tissue, the FABP3 (fatty acid-binding protein 3) and CAPN2mRNA abundance was significantly higher in SQ squabs. Our results suggested that these differentially expressed genes might be candidate genes used in the programmes of targeted selection for squabs with higher IMF content, tender meat, and more favourable fatty acids composition.

[Experts consensus on the management of the right heart function in critically ill patients]

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

[Differential evaluation of diagnostic criteria for pediatric obstructive sleep apnea hypopnea syndrome]

Objective:To evaluate the difference of accessing pediatric sleep symptoms and living qualities between 3 diagnostic criteria: American Thoracic Society (ATS), International Classification of Sleep Disorder (ICSD-3), domestic Urumqi criterion (Draft); To investigate the relationship of PSG parameters and quality of life scale OSA-18. Method:Children with snoring who received PSG in Capital Medical University Beijing Tongren Hospital were recruited from Jan 2016 to Apr 2017. Subjects were diagnosed and grouped to SS, ICSD, ATS&ICSD (ATS&ICSD1, ATS&ICSD2) according to 3 criteria: ATS (AHI>5 or OAI>1), ICSD-3 (OAHI≥1) and Urumqi (AHI>5 or OAI>1, with LSaO₂<92%). Subjects' height, weight as well as quality of life scale OSA-18 were recorded. Result:Five hundred and fifteen children were finally included (Male: 350 cases, Female: 165 cases). There were 315, 70 and 130 children in group SS, ICSD, ATS&ICSD respectively. Weights and BMI of ICSD and ATS&ICSD were significantly higher than those of SS (P<0.05), and dysplasia scale of ATS&ICSD was higher than SS (P<0.05); after adjusting height, weight and BMI, sub-scores of sleep disorder were statistically different between 3 groups (P<0.05). Numbers and indexes of respiratory events other than central apneas and hypopneas in group SS, ICSD and ATS&ICSD were increased sequentially and statistically different (P<0.05); numbers and indexes of respiratory events other than mixed apneas in ATS&ICSD2 were significantly higher than that of ATS&ICSD1 (P<0.05). Conclusion:OAHI≥1/h combined with LSaO₂<92% should be used as pediatric OSAHS diagnostic criterion.

Observation of SOA tracers at a mountainous site in Hong Kong: Chemical characteristics, origins and implication on particle growth

Secondary organic aerosol (SOA) is an important constituent of airborne fine particles. PM_2.5 (particles with aerodynamic diameters≤2.5μm) samples were collected at a mountainous site in Hong Kong in autumn of 2010, and analyzed for SOA tracers. Results indicated that the concentrations of isoprene SOA tracers (54.7±22.7ng/m³) and aromatics SOA tracers (2.1±1.6ng/m³) were on relatively high levels in Hong Kong. Secondary organic carbon (SOC) derived from isoprene, monoterpenes, sesquiterpenes and aromatics was estimated with the SOA tracer based approach, which constituted 0.35±0.15μg/m³ (40.6±5.7%), 0.20±0.03μg/m³ (30.4±5.5%), 0.05±0.02μg/m³ (5.6±1.7%) and 0.26±0.20μg/m³ (21.3±8.2%) of the total estimated SOC. Biogenic SOC (0.60±0.18μg/m³) dominated over anthropogenic SOC (0.26±0.20μg/m³) at this site. In addition to the total estimated SOC (17.8±4.6% of organic carbon (OC) in PM_2.5), primary organic carbon (POC) emitted from biomass burning also accounted for a considerable proportion of OC (11.6±3.2%). Insight into the OC origins found that regional transport significantly (p<0.05) elevated SOC from 0.37±0.17 to 1.04±0.39μg/m³. Besides, SOC load could also increase significantly if there was influence from local ship emission. Biomass burning related POC in regional air masses (0.81±0.24μg/m³) was also higher (p<0.05) than that in samples affected by local air (0.29±0.35μg/m³). Evidences indicated that SOA formation was closely related to new particle formation and the growth of nucleation mode particles, while biomass burning was responsible for some particle burst events in Hong Kong. This is the first SOA study in afforested areas of Hong Kong.