Case report of recurrent epistaxis caused by a live leech in the nasal cavity

RATIONALE

Epistaxis is one of the common emergencies in otolaryngology. There are many causes of epistaxis, but reports of epistaxis due to nasal foreign bodies like leeches are rare.

PATIENT CONCERNS

A 55-year-old male presented with "repeated epistaxis for over 20 days." Nasal endoscopy revealed a live leech in the olfactory area of the left nostril.

DIAGNOSES

The patient was diagnosed with epistaxis caused by a live leech in the nasal cavity.

INTERVENTIONS

Under nasal endoscopy, the leech was grasped with a vascular clamp and removed from the nasal cavity. The leech measured 8 cm in length. Hemostasis was achieved using a gelatin sponge at the wound site, and the nasal cavity was packed with Vaseline gauze.

OUTCOMES

The live leech was removed via nasal endoscopy. Two days later, the Vaseline gauze packing was removed, and the patient experienced no further nasal bleeding.

CONCLUSION

Live leeches in the nasal cavity can cause epistaxis. Nasal endoscopic removal of the live leech is an effective treatment.

LESSON

There are many causes of epistaxis, which are nonspecific and prone to missed or incorrect diagnosis. In patients with a history of fieldwork or direct contact with leeches who present with recurrent nasal bleeding, the possibility of epistaxis caused by a live leech should be considered, and timely and effective treatment should be provided.

Rhabdomyolysis caused by Botrychium ternatum intoxication: Case report and literature review

RATIONALE

Botrychium ternatum ((Thunb.) Sw.), a traditional Chinese medicine, is known for its therapeutic properties in clearing heat, detoxifying, cough suppression, and phlegm elimination. It has been extensively used in clinics for the treatment of many inflammation-related diseases. Currently, there are no documented cases of rhabdomyolysis resulting from Botrychium ternatum intoxication.

PATIENT CONCERNS

A 57-year-old male presented with a complaint of low back discomfort accompanied by tea-colored urine lasting for 4 days. The patient also exhibited markedly increased creatine phosphate kinase and myoglobin levels. Prior to the onset of symptoms, the patient consumed 50 g of Botrychium ternatum to alleviate pharyngodynia.

DIAGNOSES

The patient was diagnosed with rhabdomyolysis due to Botrychium ternatum intoxication.

INTERVENTIONS

The patient underwent a substantial volume of fluid resuscitation, diuresis, and alkalization of urine, as well as correction of the acid-base balance and electrolyte disruption.

OUTCOMES

Following a 10-day treatment plan involving massive fluid resuscitation, diuresis, and alkalization of urine, the patient showed notable improvement in his lower back pain and reported the absence of any discomfort. Following reexamination, the levels of creatine phosphate kinase and myoglobin were restored to within the normal ranges. Additionally, no abnormalities were detected in liver or renal function. As a result, the patient was considered eligible for discharge and was monitored.

CONCLUSIONS

Botrychium ternatum intoxication was associated with the development of rhabdomyolysis. To manage this condition, it is recommended that patients provide massive fluid resuscitation, diuresis, alkalization of urine, and other appropriate therapeutic interventions.

LESSON

Currently, there are no known cases of rhabdomyolysis resulting from Botrychium ternatum intoxication. However, it is important to consider the potential occurrence of rhabdomyolysis resulting from Botrychium ternatum intoxication when there is a correlation between the administration of Botrychium ternatum and the presence of muscular discomfort in the waist or throughout the body, along with tea-colored urine. Considering the levels of creatine phosphate kinase and myoglobin, the diagnosis or exclusion of rhabdomyolysis caused by Botrychium ternatum intoxication should be made, and suitable treatment should be administered accordingly.

Analysis and identification of oxidative stress-ferroptosis related biomarkers in ischemic stroke

Studies have shown that a series of molecular events caused by oxidative stress is associated with ferroptosis and oxidation after ischemic stroke (IS). Differential analysis was performed to identify differentially expressed mRNA (DEmRNAs) between IS and control groups. Critical module genes were identified using weighted gene co-expression network analysis (WGCNA). DEmRNAs, critical module genes, oxidative stress-related genes (ORGs), and ferroptosis-related genes (FRGs) were crossed to screen for intersection mRNAs. Candidate mRNAs were screened based on the protein-protein interaction (PPI) network and the MCODE plug-in. Biomarkers were identified based on two types of machine learning algorithms, and the intersection was obtained. Functional items and related pathways of the biomarkers were identified using gene set enrichment analysis (GSEA). Finally, single-sample GSEA (ssGSEA) and Wilcoxon tests were used to identify differential immune cells. An miRNA-mRNA-TF network was created. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to verify the expression levels of biomarkers in the IS and control groups. There were 8287 DE mRNAs between the IS and control groups. The genes in the turquoise module were selected as critical module genes for IS. Thirty intersecting mRNAs were screened for overlaps. Seventeen candidate mRNAs were also identified. Four biomarkers (CDKN1A, GPX4, PRDX1, and PRDX6) were identified using two types of machine-learning algorithms. GSEA results indicated that the biomarkers were associated with steroid biosynthesis. Nine types of immune cells (activated B cells and neutrophils) were markedly different between the IS and control groups. We identified 3747 miRNA-mRNA-TF regulatory pairs in the miRNA-mRNA-TF regulatory network, including hsa-miR-4469-CDKN1A-BACH2 and hsa-miR-188-3p-GPX4-ATF2. CDKN1A, PRDX1, and PRDX6 were upregulated in IS samples compared with control samples. This study suggests that four biomarkers (CDKN1A, GPX4, PRDX1, and PRDX6) are significantly associated with IS. This study provides a new reference for the diagnosis and treatment of IS.

A literature review and meta-analysis of the optimal factors study of repetitive transcranial magnetic stimulation in post-infarction aphasia

BACKGROUND

The existing literature indicates that repetitive transcranial magnetic stimulation (rTMS) can potentially enhance the prognosis of poststroke aphasia (PSA). Nevertheless, these investigations did not identify the most effective parameters or settings for achieving optimal treatment outcomes. This study involved a meta-analysis aimed to identify the optimal variables for rTMS in treating post-infarction aphasia to guide the use of rTMS in rehabilitating PSA.

METHODS

PubMed, Embase, and Cochrane Library databases were searched from inception to May 2023, and articles were reviewed manually using subject words and free words and supplemented with references from the included literature to obtain additional relevant literature. The search terms included "poststroke aphasia" and "repetitive transcranial magnetic stimulation (rTMS)" repetitive transcranial magnetic stimulation. Additionally, a review of the reference lists of previously published systematic reviews identified through the Cochrane Database of Systematic Reviews (search terms: poststroke aphasia, rTMS; restrictions: none) and PubMed (search terms: poststroke aphasia, rTMSs; restrictions: systematic review or meta-analysis) was performed. Information from studies involving different doses of rTMS in PSA was independently screened and extracted by 2 researchers.

RESULTS

This meta-analysis included 387 participants with PSA across 18 randomized controlled trials. The results showed that the total pulse had a trend toward a significant correlation with the treatment effect (P = 0.088), while all other variables did not correlate significantly. When rTMS was not grouped by stimulus parameter and location, our nonlinear results showed that when the total pulses were 40,000 (standardized mean difference (SMD):1.86, 95% credible interval (CrI) 0.50 to 3.33), the pulse/session was 1000 (SMD:1.05, 95% CrI 0.55-1.57), and an RMT of 80% (SMD:1.08, 95% CrI 0.60-1.57) had the best treatment effect. When rTMS was grouped by stimulus parameters and location, our nonlinear results showed that when the total low-frequency (LF)-rTMS-right inferior frontal gyrus (RIFG) pulse was 40,000 (SMD:1.76, 95% CrI:0.36-3.29), the pulse/session was 1000 (SMD:1.06, 95% CrI:0.54-1.59). Optimal results were obtained with an RMT of 80% (SMD:1.14, 95% CrI 0.54 - 1.76).

CONCLUSIONS

The optimal treatment effects of rTMS for PSA may be obtained with a total pulse of 40,000, a pulse/session of 1000, and an RMT of 80%. Further rigorous randomized controlled studies are required to substantiate the validity of these results.

[The works of Zhang Wenzhong as the Shang Yao Feng Yu in the early Tang Dynasty]

Zhang Wenzhong, a famous Chinese medical doctor in the early Tang Dynasty, was granted a particular position as Shang Yao Feng Yu, for the Empress Wu Ze Tian dealing with medication. He was good at dealing with stroke in particular. He also had unique viewpoints towards medical prescriptions and skills. He wrote medical books and developed his own medical theories. All these were recorded in both the Book of Tang and the New Book of Tang. However, most of his works had been lost due to time and the frequent wars in the middle and late Tang Dynasty. Six medical prescriptions signed by Zhang Wenzhong were discovered in documents unearthed from the Dun Huang Sutra Cave. They were believed to be important archives of Zhang Wenzhong's writing and medical thoughts. In addition, some pieces of work found in the documents unearthed from Tu Yu Gou were suspected of being written by Zhang Wenzhong. This can be compared with his works cited in the handed-down documents, such as The Collection of Secret Prescriptions (Wai Tai Mi Yao Fang). This paper takes a textual research approach to examine the medical works of Zhang Wenzhong, comparing the handed-down documents with the unearthed documents to examine his medical achievements.

[Endovascular thrombectomy in patients with intracranial large artery occlusion and atrial fibrillation]

Objective: To investigate the safety and efficacy of mechanical thrombectomy in patients with atrial fibrillation complicated with acute intracranial arterial occlusion. Methods: Fifty-eight patients with atrial fibrillation complicated with acute intracranial arterial occlusion in the intervention group of East (Endovascular Therapy for Acute ischemic Stroke Trial) were analyzed. According to the TOAST (Trial of Org 10 172 in Acute Stroke Treatment) classification, patients were divided into ICAS (Intracranial Atherosclerotic Stenosis) group and cardiogenic embolism group. Clinical characteristics, treatment methods and clinical prognosis were compared between ICAS group and cardiogenic embolism group. Results: A total of 58 patients with atrial fibrillation complicated with acute intracranial arterial occlusion were included in this study, including 46 patients in the cardiogenic embolism group (79%) and 12 patients in the ICAS group (21%). The pre-hospital transport time in ICAS group was longer than that in cardiogenic embolism group (P<0.05).Patency rate in patients with atrial fibrillation complicated with acute intracranial arterial occlusion was 98.3% (57/58), The rate of patients with the 90-day function independent (mRS 0-2) was 51.7% (30/58). There were no statistically significant differences in functional independence, mortality rate, ICH and sICH at 90 days between the cardiogenic embolism group and the ICAS group. Conclusions: Mechanical thrombectomy is an effective method to treat patients with atrial fibrillation complicated with acute intracranial arterial occlusion.

[Efficacy analysis of LVIS and Enterprise stent assisted coil in the treatment of vertebral artery dissection aneurysm]

Objective: To observe and evaluate the therapeutic efficacy of LVIS stent and Enterprise stent assisted coil in embolization of vertebral artery dissection aneurysm (VDA). Methods: Clinical data of 96 patients with VDAs treated by LVIS stent and Enterprise stent assisted coil were analyzed retrospectively between January, 2013 and June, 2017.Of all, the LVIS stent assisted coil was performed in 28 patients (LVIS-stent group) and Enterprise in 68 patients (Enterprise-stent group). The clinical and imaging follow-up were performed. The instant embolization rate, complications, and recurrence rate were analyzed and compared between the two groups. Results: Instant angiographic results:in the LVIS stent group, complete occlusion was achieved in 17 VDAs (60.7%), near-complete occlusion in 10VDAs (35.7%), and partial occlusion in 1 VDA (3.6%). In the Enterprise stent group, complete occlusion was achieved in 27 VDAs (39.7%), near-complete occlusion in 34VDAs(50.0%), partial occlusion in 7VDAs (10.3%). Procedure-related complications occurred in 3 patients (10.7%) in LVIS stent group and 3 patients (4.4%) in Enterprise stent group. DSA follow-up was performed during 6 to 12 months after surgery, and 10 patients with vertebral artery dissection aneurysm recurred, 2 in the LVIS group and 8 in the Enterprise stent group. The latest modified Rankin Scale score was 0 in 55 patients,1 in 13, 2 in 1, 3 in 1, and 6 in 1. Among them, all follow-up patients in the LVIS stent group had good prognosis, while in the Enterprise stent group, 50 patients (94.4%) had a good prognosis. Conclusions: The stent-assisted coils have a higher degree of embolization in the vertebral artery dissection aneurysms, a higher rate of near-total embolization, a lower incidence of neurological complications, and a good prognosis. The complete andnear-complete occlusion rates and the incidence of neurological complicationsin the LVIS group was higher than that in the Enterprise groupand the recurrence ratesin the LVIS group was lower than that in the Enterprise group,both with no statistically significant difference.

[Efficacy analysis of the endovascular treatment for 175 unruptured vertebrobasilar dissecting aneurysms]

Objective: To analyze the clinical characteristics, clinical effect and follow-up outcome of the different endovascular treatment techniques in the treatment of unruptured vertebrobasilar dissecting aneurysms (VBDAs). Methods: The clinical data of 160 consecutive patients (175VBDAs) from January 2012 to December 2016 in Beijing Tiantan hospital were retrospectively analyzed.All of the 175 aneurysms were treated with endovascular embolization, including 115 stent-assisted coils, 27 simple stents, 21 blood flow diverting devices, and 12 parent arteries occlusion.The imaging and clinical follow-up were performed after the operation. Results: Headache including cervical-occipital pain(43.1%)was the most common clinical manifestation.The incidence of perioperative complications was 3.75%, no intraoperative bleeding and no deaths.The imaging findings of 113 aneurysms were followed up for (9.9±7.3) months.Of the 71 stent-assisted coils, 62 recovered well and 9 relapsed; of the 19 aneurysms treated with simple stent, 4 recovered well, 11 improved, 2 stable and 2 relapsed; of the 15 aneurysms treated by the blood flow diverting devices, 4 recovered and 11 improved; all of the 8 aneurysms with parent arteries occlusion recovered well.A total of 144 patients were follow-up (17.3±16.6) months by the Modified Rankin Scale(mRS) score: 140 patients were 0-2 score and 4 patients were 3-6 score. Conclusions: The clinical manifestations of the unruptured VBDAs are complex, and the headache is the most common clinical symptom.Endovascular treatment for the treatment of unruptured VBDAs is safe and feasible.The principle of individualization should be followed during embolization.

Relationship between embryo development in vitro and 56-day nonreturn rates of cows inseminated with frozen-thawed semen from dairy bulls

Frozen-thawed bull semen with > 50% post-thaw motility from 40 batches (21 bulls, 2 consecutive ejaculates per batch) was used for fertilization (IVF) and embryo development in vitro to assess the relationship between field and laboratory fertility using a retrospective approach. Each frozen batch was tested in 3 or 4 replicates with 30 oocytes per replicate. Field fertility, quantified as the 56-d nonreturn rate and based on 89 to 441 artificial inseminations per frozen batch, ranged between 46.2 and 74.8%. The cleavage and blastocyst rates after IVF varied from 29.0 to 81.9% and from 1.8 to 32.0%, respectively, with significant differences among frozen batches. Rates of cleavage and blastocyst formation were significantly related to the nonreturn rate (r = 0.59, P < 0.001; r = 0.35, P < 0.05, respectively). The interaction between cleavage and blastocyst rate was 0.69 (P < 0.001). Significant variations (P < 0.05) among frozen semen batches within 15 bulls with >/= 2 different semen batches were found for the nonreturn rate (13.3%) of 2 bulls, for cleavage rates (26.7%) in 4 bulls and for blastocyst rates (20.0%) in 3 bulls. Significant differences (P < 0.05) among replicates within the 40 frozen semen batches were only found in 3 batches (7.5%) for the cleavage rate and in 7 batches (17.5%) for blastocyst rate. Overall, bull and frozen semen batch were the greatest sources of variation in the cleavage rate (30.6 and 29.4%, respectively), while testing date was the greatest source of variation in the blastocyst development rate (21.7%). The results indicated that in vitro fertilization and, to a lesser extent, culture to the blastocyst stage could be useful in estimating the potential fertilizing ability of frozen-thawed semen from dairy bulls.

Catalyst-free synthesis of well-aligned ZnO nanowires on In0.2Ga0.8N, GaN, and Al0.25Ga0.75N substrates

Well-aligned ZnO nanowires have been synthesized vertically on In0.2Ga0.8N, GaN, and Al0.25Ga0.75N substrates, using a catalyst-free carbon thermal-reduction vapor phase deposition method for the first time. The as-synthesized nanowires are single crystalline wurtzite structure, and have a growth direction of [0001]. Each nanowire has a smooth surface, and uniform diameter along the growth direction. The average diameter and length of these nanowires are 120-150 nm, and 3-10 )m, respectively. We suggest that the growth mechanism follow a self-catalyzing growth model. Excitonic emission peaked around 385 nm dominates the room-temperature photoluminescence spectra of these nanowires. The room-temperature photoluminescence and Raman scattering spectra show that these nanowires have good optical quality with very less structural defects.

Synthesis and optical properties of ZnTe single-crystalline nanowires

Single-crystalline ZnTe nanowires with the zincblende structure have been synthesized on silicon (Si) substrates via a vapor phase transport method. The ZnTe (99.99%) powders were used as the source, and 10 nm-thick thermal evaporated gold (Au) film was used as the catalyst. The as-prepared ZnTe nanowires have diameters of 30-80 nm and lengths of more than 10 microm. The products were analyzed by X-ray diffraction, field emission scanning electron microscopy, and high-resolution transmission electron microscopy. Optical properties of these nanowires were investigated by room-temperature Raman scattering spectrum and temperature-dependent photoluminescence measurements. The results show that the as-prepared ZnTe nanowires are of high crystal quality.

A preliminary study of chromium distribution in chromium-rich brewer's yeast cell by NAA

The purpose of this study was to assess the chromium (Cr) distribution in chromium-rich brewer's yeast cell. The chromium concentrations in the cell wall and protoplast fractions of the chromium-rich yeast were determined by neutron activation analysis (NAA). Moreover, the combined state of chromium and amino acid content in the Cr-rich brewer's yeasts was analyzed and measured. The experimental results indicate that the introduction of water-soluble chromium(III) salt as a component of the culture medium for yeasts results in a substantial amount of chromium absorbed through the cell wall by the yeast, among which 80.9% are accumulated in the protoplast. It implies that, under optimal conditions, yeasts are capable of accumulating large amounts of chromium and incorporating chromium into organic compounds.

Glycine betaine improves survival of fresh bovine spermatozoa

Fresh spermatozoa from bulls established as 'good freezers' and 'poor freezers' (consistently > or = 50% or < 20% motile spermatozoa after cryopreservation, respectively) were incubated for 96 h in Tes/Tris-egg yolk or TALP-egg yolk media at 37 degrees, 20 degrees , 5 degrees or 0 degrees C. The TALP extender contained 0, 100 or 200 mM glycine betaine (GB) to test the hypothesis that GB would efficiently maintain spermatozoa function during long-term incubation. The percentage of motile spermatozoa declined over time in a temperature- and medium-dependent fashion. No spermatozoa were motile by 24 h incubation at 37 degrees C or by 72 h incubation at 0 degrees C, and there were no significant differences in the percentage of motile spermatozoa from either category of bull when spermatozoa were incubated in any media for less than 24 h. Spermatozoa from poor freezers were significantly more motile than spermatozoa from good freezers after 96 h at 20 degrees or 5 degrees C in TALP alone; however, GB at both 100 and 200 mM increased the percentage of motile spermatozoa in poor and good freezers and eliminated these differences. Overall, the presence of GB at either 100 or 200 mM significantly improved the percentage of motile spermatozoa at 20 degrees, 5 degrees and 0 degrees C, but not at 37 degrees C.

[Photoluminescence from Er-doped silicon-rich silicon oxide film and Er-doped silicon-rich silicon nitride film and its annealing behavior]

Room temperature photoluminescence (PL) with a peak at 1.54 microns was observed from silicon oxide, silicon-rich silicon oxide, silicon nitride and silicon-rich silicon nitride films, all doped with Er and grown by the magnetron sputtering technique. To determine the optimum annealing temperature for the 1.54 microns PL, these films were annealed in the range of 600-1,100 degrees C with an interval of 100 degrees C. Among these four types of films annealed at an identical temperature, the intensity of 1.54 microns PL peak of the Er-doped silicon-rich silicon oxide film was always the strongest one, which arrived at a maximum in 800 degrees C annealing. A 1.38 microns PL band was also observed in each of these four types of films, and which in the silicon-rich silicon oxide or silicon-rich silicon nitride films was found to be correlated with the 1.54 microns PL band in intensity.

Presence of the acute phase protein, bikunin, in the endometrium of gilts during estrous cycle and early pregnancy

Noninvasive, epitheliochorial placental attachment in the pig is regulated through endometrial production of protease inhibitors. The objective of the present study was to determine if the light-chain serine protease inhibitor of the inter-alpha-trypsin inhibitor family, bikunin, is produced by the porcine endometrium during the estrous cycle and early pregnancy. Western blot analysis revealed the presence of bikunin in uterine flushings of gilts collected during the luteal phase of the estrous cycle and early pregnancy (Days 12-18). However, bikunin unbound to the inter-alpha-trypsin heavy chains was detected only in endometrial explant culture medium obtained from estrus and pregnant (Days 12, 15, and 18) gilts. Endometrial bikunin gene expression was lowest on Day 10 of the estrous cycle and pregnancy, followed by a 30- to 77-fold increase on Day 15 of the estrous cycle and pregnancy. Bikunin gene expression decreased on Day 18 of the estrous cycle, whereas endometrial bikunin gene expression continued to increase in pregnant gilts. Bikunin mRNA was localized to the uterine glands between Days 15 and 18 of the estrous cycle and pregnancy. In addition to its role as a protease inhibitor, bikunin functions in stabilization of the extracellular matrix, which suggests that bikunin could be involved with facilitating placental attachment to the uterine epithelial surface in the pig.

Relationship between heparin binding to spermatozoa and the fertility of dairy bulls

The presence of heparin in in vitro media has been implicated in improved fertility parameters of bull spermatozoa. In a previous study, Zhang et al. (25) obtained an estimate of bull nonreturn rates based on spermatozoal concentration, motility and zona pellucida binding (24). The objective of this study was to test for a relationship between fertility parameters previously estimated for the same batch of cryopreserved semen (25) and amount of heparin bound to spermatozoa. 3H-heparin binding to spermatozoa was assessed by radioimmunoassay, and statistical correlations were drawn to previously measured sperm characteristics. Preliminary experiments established optimal binding conditions of 25 degrees C, and 60 min incubation with 3H-heparin at a concentration of 50,000 cpm. 3H-heparin bound to an average of 2.2 x 10(6) receptors/cell with a Kd of 2.0 x 10(-7) M. The total 3H-heparin bound to spermatozoa from different bulls was significantly different (P<0.003). However, the total 3H-heparin bound to spermatozoa was not correlated with any measured sperm parameter, including zona pellucida binding, embryo cleavage and blastocyst formation, and 56-day nonreturn rates (P>0.19). Thus, the total amount of heparin bound to the surface of spermatozoa may not be relevant to fertilizing ability.

Prediction of bull fertility by combined in vitro assessments of frozen-thawed semen from young dairy bulls entering an AI-programme

In the present study, we assessed the degree to which various bull sperm traits, including the ability to bind to homologous zona pellucidae (ZP) and to fertilize in vitro, were related to field fertility after AI as 56d-non-return rates (56d-NRR based upon 8620 AIs) with frozen-thawed semen from 12 Swedish Red and White young (11-13 months) bulls (3 freezing batches/bull, 1-2 consecutive ejaculates/batch), entering a national breeding program and housed at two AI-bull stations. Significant (p < 0.01) correlations among in vitro tests were found for swim-up separated spermatozoa (concentration and concentration of motile spermatozoa) with the ZP-binding assay (ZBA, r = 0.72 and r = 0.73, respectively) and blastocyst rates (r = 0.79 and r = 0.79, respectively). A strong correlation was found between cleavage and blastocyst rates (r = 0.81, p < 0.01). Whereas bull station influenced (p < 0.05-0.001) all these variables, bull only affected (p < 0.05) ZBA and cleavage. There was no significant difference in 56d-NRRs (p > 0.05, range 62-67.2%) among bulls, once the absolute NRRs had been corrected for season, area and parity. Neither bull, batch nor station had a significant effect on field fertility (p < 0.05). None of the single sperm traits/tests in vitro correlated significantly with in vivo fertility. A correlation with bull fertility was, however, found when measures of sperm traits were combined and predicted NRRs, calculated by regression analyses, were tested against observed 56d-NRRs. The predictive bull fertility, based on the tested three frozen batches, varied from 61.8 to 67.5% (p < 0.05) and was highly correlated with the observed fertility NRRs (r = 0.92, p < 0.001). Although the results suggest that the combined analyses of swim-up separated sperm traits, ZBA and IVF can be used to predict bull fertility, it might not be possible to determine the life-time fertility of a breeding sire owing to the limited number of observations made.

Mutations in the gene encoding gap junction protein beta-3 associated with autosomal dominant hearing impairment

Hearing impairment is the most commonly occurring condition that affects the ability of humans to communicate. More than 50% of the cases of profound early-onset deafness are caused by genetic factors. Over 40 loci for non-syndromic deafness have been genetically mapped, and mutations in several genes have been shown to cause hearing loss. Mutations in the gene encoding connexin 26 (GJB2) cause both autosomal recessive and dominant forms of hearing impairment. To study the possible involvement of other members of the connexin family in hereditary hearing impairment, we cloned the gene (GJB3) encoding human gap junction protein beta-3 using homologous EST searching and nested PCR. GJB3 was mapped to human chromosome 1p33-p35. Mutation analysis revealed that a missense mutation and a nonsense mutation of GJB3 were associated with high-frequency hearing loss in two families. Moreover, expression of Gjb3 was identified in rat inner ear tissue by RT-PCR. These findings suggest that mutations in GJB3 may be responsible for bilateral high-frequency hearing impairment.

Sperm characteristics and zona pellucida binding in relation to field fertility of frozen-thawed semen from dairy AI bulls

The present study examined the relationship between bull sperm characteristics immediately post-thaw and some characteristics registered after swim-up, including the ability of spermatozoa to bind to homologous zona pellucidae (ZP) in vitro, and fertility after artificial insemination (AI) of 9426 females. Frozen-thawed semen from 22 AI bulls of the Swedish Red and White Breed, represented by 43 different frozen batches (1-4 batches/bull, 2 consecutive ejaculates/batch), was examined with the aim of determining concentration, motility patterns, morphology and membrane integrity. In addition, the frozen-thawed spermatozoa were subjected to a swim-up procedure and those separated in this way were tested with two assays of sperm-binding to the ZP of homologous oocytes in vitro (ZBA), using either a relative ZBA index against a control bull of proven high fertility or absolute binding (Absolute ZBA). The correlations of the various sperm traits and 56-day non-return rates (NRR) after field AI were retrospectively examined as single traits and as combinations of traits (combined measures), including regression analysis of significant traits. Among the sperm characteristics, positively significant (p < 0.01) correlations with NRR were found for linear motility post-thawing (r = 0.45-0.59) and the concentration of motile spermatozoa after swim-up (r = 0.43-0.63). Results obtained with the absolute ZBA approach were significantly (p < 0.05) correlated with NRR (r = 0.50), whereas the correlation between NRR and the ZBA index was not significant. The use of combined measures of sperm traits, including the ability to bind to ZP, showed a stronger predictive correlation with NRR (r = 0.68-0.75), compared with single traits. The results suggest that the combined analysis of sperm linear-motility patterns, swim-up separated sperm motility and absolute ZBA can provide a valuable assessment of the fertilizing capacity of AI bull semen.

Expression of endothelin-1 and constitutional nitric oxide synthase messenger RNA in saphenous vein endothelial cells exposed to arterial flow shear stress

BACKGROUND

It has long been speculated that increased blood flow shear stress might be one of the major factors affecting the patency of grafted saphenous vein in coronary artery bypass operations. The underlying cellular and molecular mechanisms for so-called "shear stress damage" have not yet been well elucidated.

METHODS

Endothelial cells harvested from human saphenous vein were cultured in vitro and then exposed to a high arterial level flow shear stress in the parallel flow chamber. The expression levels of endothelin-1 and constitutional nitric oxide synthase by the endothelial cells were evaluated semiquantitatively at the gene transcription (messenger RNA) level using reverse transcription polymerase chain reaction.

RESULTS

After 7 hours of exposure to arterial level shear stress, the expression of constitutional nitric oxide synthase messenger RNA by saphenous vein endothelial cells was significantly reduced, whereas the expression of endothelin-1 messenger RNA was substantially increased. These changes were more predominant at 24 hours.

CONCLUSIONS

Arterial level flow shear stress could cause important changes in the gene transcription level in saphenous vein endothelial cells within a short period of time. The functional alterations of saphenous vein endothelial cells, as manifested by the increased expression of endothelin-1 and decreased expression of nitric oxide synthase messenger RNA, might play a crucial role in the vein graft remodeling process.

Effects of sperm treatments on the in vitro development of bovine oocytes in semidefined and defined media

Bovine in vitro matured oocytes were inseminated with frozen-thawed spermatozoa prepared by A) swim-up through Fert-TALP supplemented with hyaluronic acid (HYA, 1 mg/ml), heparin (5.0 microg/ml) and bovine serum albumin (BSA, 6 mg/ml) or B) washing by centrifugation in modified Brackett-Oliphant medium (mBO) supplemented with 10 mM caffeine-sodium benzoate. For Method A, in vitro fertilization (IVF) was performed in Fert-TALP supplemented with 6 mg/ml BSA, 5.0 microg/ml heparin, 20 microM D-penicillamine, 10 microM hypotaurine and 1 microM epinephrine. For Method B it was performed in mBO medium supplemented with 10 mg globulin-free BSA/ml and 10 microg heparin/ml. Presumptive zygotes were cultured in 1 of 3 culture media: 1) BSAITS - TCM 199 supplemented with 10 mg/ml BSA and ITS (5 microg/ml insulin, 5 microg/ml transferrin, and 5 ng/ml sodium selenite); 2) BECM - bovine embryo culture medium; and 3) BECM supplemented with ITS. Altogether, a significantly higher proportion of oocytes developed to the blastocyst stage after insemination with spermatozoa prepared by Method A than by Method B (17.9 vs 7.1%, respectively; P < 0.001). For Method A, the cleavage rate and the proportion of zygotes with >2 cells 48 h after insemination did not differ significantly between any of the 3 culture media assayed, but blastocyst formation was significantly stimulated in BSAITS and BECMITS compared with that in BECM (20.7 and 22.1% vs 10.7%, respectively; P < 0.05). For Method B, the cleavage rate and the proportion of zygotes with >2 cells were significantly lower in BSAITS than in BECM and BECMITS (56.4 and 28.7% vs 71.6 and 42.1%; and 70.2 and 51.1%, respectively; P < 0.05). However, no significant differences were recorded in blastocyst development rates between any of the culture media assayed (6.4 to 7.4%; P > 0.05).

Relationship between sperm-zona pellucida binding assays and the 56-day nonreturn rate of cattle inseminated with frozen-thawed bull semen

Assays based on sperm-zona pellucida binding have been developed as diagnostic tests to predict the fertilizing potential of mammalian spermatozoa. Recently, we reported on the development of a sperm-zona pellucida binding assay (SZBA) for bull spermatozoa. The aim of the present study was to develop a hemi-zona assay (HZA) for bull spermatozoa and to investigate the relationship between SZBA and HZA outcomes and in vivo fertility. Frozenthawed semen samples from 8 fertile Swedish Red and White bulls (one ejaculate per bull) designated as the test semen samples and a single ejaculate from a fertile Holstein-Friesian bull designated as the control semen sample were used in this study. In the SZBA, 2 groups of 20 oocytes per semen test sample and in the HZA a minimum of 6 matching pairs of hemizonae were used for comparison of sperm binding with control semen. Sperm binding to matching hemi-zonae of individual semen samples was equal, and clearly demonstrated the feasibility of the HZA for cattle. A significant correlation was found between the SZBA and the HZA indices obtained from the different semen test samples (r = 0.42, P < 0.001; n = 67). There was no significant relation between the SZBA indices and the 56-d nonreturn rate of the test samples. However, the HZA indices of the semen test samples and the 56-d nonreturn rate were significantly correlated (r = 0.46, P < 0.0001; n = 67). It is concluded that HZA can be regarded as a potential assay for predicting the fertilizing ability of bovine semen samples. However, further studies using more semen samples are necessary to confirm this view.

Influence of batches of bovine oocytes on the outcome of an intact zona pellucida binding assay and in vitro fertilization

A series of experiments was performed in vitro to determine the variation between batches of abattoir-derived bovine oocytes to bind and to be fertilized by frozen-thawed spermatozoa provided by a single ejaculate from a bull with high field fertility after artificial insemination. Fourteen batches of oocytes, collected over a 90-day period, were divided randomly into two equal groups at each sampling period. One group of oocytes was subjected to in-vitro maturation and subsequently in-vitro fertilization (IVF) while the other group was used as intact oocytes in a zona binding assay (ZBA). Fertilized oocytes were evaluated for penetration and pronuclear formation and, in the ZBA, the number of spermatozoa bound to each oocyte was registered. Neither the results of the ZBA nor the IVF results varied significantly (p = 0.45) between batches. Furthermore, when a sperm concentration of 0.5 x 10(6)/ml was used, the number of spermatozoa bound to the zona pellucida correlated significantly with the frequency of oocytes penetrated after IVF (r = 0.76). The results suggest that variation between the batches of oocytes has no detrimental significance for the application of intact zona pellucida binding or IVF for assaying frozen-thawed bull semen, provided that a large number of oocytes/batch (> 15) are assayed.

[Mitral valve replacement with preservation of papillary muscles and chordae tendineae: a report of 53 cases]

Mitral valve replacement with preservation of papillary muscles and chordae tendineae (MVRP) was carried out in 53 cases in this group, among whom 17 underwent combined mitral and aortic valve replacement (AVR), 36 underwent simple mitral valve replacement (MVR) and tricuspid valve plasty was performed in 28 cases simultaneously. All the patients were given echocardiography one and six months after operation respectively which showed: (1) The left ventrical function of this group was obviously superior to that of the conventional mitral valve replacement (MVRC) group in the same period (SVI, EF, FS, P < 0.05) (2) The open shut velocity of the prosthetic disc was quicker (3) The contradictory movement of the ventrical septum disappeared. The follow-up for 2 to 36 months showed that all the patients were alive and healthy. It is suggested that MVRP can facilitate better recovery of the left ventrical function than MVRC and long-term results are excellent.

[Treatment of MSOF after heart valve replacement: an analysis of 53 cases]

We treated 53 patients with multiple system organ failure (MSOF) following heart valve replacement. MVR was performed in 20 cases, AVR in 6 and DVR in 27. Before operation, NYHA functional class II was in 5, III in 17, and IV in 31. MSOF of all 53 patients occurred within 2-7 days after operation, and failing organs involved heart, lungs, kidneys, brain, gastrointestinal and blood coagulation system. The patients with the maximum organ failure had 6 failing organs, 36 of the 53 patients were living and 17 (32.1%) died. The mortality correlated positively with the number of failing organs. The results of MSOF which occurred sequentially were better compared with those occurred simultaneously. The death rate in patients with class IV was higher than that in those class II, III. The type of operation (MVR, AVR, DVR) did not effect the result of MSOF. The causes and management of MSOF after heart valve replacement were discussed.

[Surgical treatment of combined valvular disease in 680 patients]

Between 1982 and May 1993, we operated on 680 patients with combined valvular disease. Previous operations were including closed mitral commissurotomy in 87, and bioprosthetic valve replacement in mitral position in 15. The types of combined valve disease included mitral valve disease combined with functional tricuspid regurgitation (FTR) (245), with organic tricuspid disease (OTD) (10); mitral and aortic disease (258), combined with FTR (128), and with OTD (39). The early mortality was 4.7% in total 2.4% and 6.1% respectively in MVR or DVR plus tricuspid procedures. The main cause of early death was low cardiac output syndrome. The late mortality was 2.6% pt-yr, congestive heart failure and coagulant-related hemorrhage were the predominant causes of late death. We considered that FTR is the outcome of right ventricle decompensation, while tricuspid valve must be actively inspected intraoperatively, and must be corrected completely. OTD can be successfully repaired in most patients. Myocardial protection should be emphasized, and continuous perfusion of cold blood cardioplegia and controlled reperfusion of warm blood contained mannitol have marked effect.

[Pathological classification and clinical implications on rheumatic heart disease with giant heart]

Between Jan. 1982 and July, 1993, 102 patients with rheumatic giant heart disease (cardio-thoracic ratio > or = 0.8) underwent valve replacement. Heart functional class III was in 54 patients, and class IV in 48. Early mortality was 8.8%, late mortality 3.6%. We classified the patients into five types, based on the valvular lesions, dilated degree of each atrial and ventricular chamber: Type I, giant left atrium (LA); Type II, obvious enlargement of LA and left ventricle (LV); Type III; obvious enlargement of LA, right atrium and ventricule (RA and RV); Type IV; all chambers obviously dilated; Type V, giant LA and RA. Clinical results showed that this kind of classification can reflect kinds of diseased valves, pathophysiological changes and clinical characteristics, and postoperative early and late outcomes, also can offer useful suggestions to operative method selection, and has great clinical significance for perioperative management.

[Valvuloplasty of rheumatic tricuspid valve disease]

This paper reports 49 cases with rheumatic tricuspid lesions underwent tricuspid valvuloplasty. Tricuspid stenosis was in 26, and combined with incompetence in 23. Posterior-septal, anterior-septal, and anterior-posterior commissural fusions were 9, 7, and 5 cases respectively. Tricuspid repair was used in all cases, fused chordae, papillary muscles and valvular commissures were each divided, then De Vaga's or Kay's annuloplasty was performed to correct the residual regurgitation. The associated procedures included DVR in 33, MVR in 15, and AVR in 1. Hospital death was 3 cases. All early survivors were followed up (2 months to 7 yrs, mean 4.2 yrs). There was no late death, heart functional class I was in 34, class II in 10 and class III in 2. Echocardiography performed 6 months postoperatively, showed no tricuspid regurgitation was in 38, moderate regurgitation in 8, and the right atrial volume decreased in various degrees. The principles and the methods of tricuspid valve repair in patients with rheumatic tricuspid lesions were discussed.