[Postauricular hairline plus temporal approach gasless full-endoscopic parotidectomy for tumors in deep lobe of parotid gland: a 16-case report]

To investigate the safety and feasibility of gasless total endoscopic resection of deep lobe parotid gland tumors via a postauricular hairline plus temporal approach. The approach was designed as: a 4 to 5 cm main incision was designed at the postauricular hairline, and a 0.5 cm auxiliary incision was designed in the temporal hairline. The operating cavity was established with the assistance of a special retractor. "Anterograde" dissection of the facial nerve was performed throughout the procedure, along with partial or total gland removal of the tumor. All 16 operations were successfully completed without conversion to open surgery. During the operation, the trunk and branches of the facial nerve were completely preserved, the tumor was completely removed, and the incision healed. Six patients had mild facial paralysis after operation, and recovered completely after 3 to 6 months. There was no salivary fistula, Frey syndrome, infection, or other complications. The postoperative incision was concealed and the aesthetic effect was good. The postauricular hairline plus temporal approach gasless total endoscopic parotidectomy is safe and feasible. This technique can achieve the complete dissection of the total trunk to the branches of the facial nerve, and has good access to the tumors located in any part of the parotid gland region. On the basis of radical resection of the tumor, it achieves minimally invasive and aesthetic improvement.

[Effects of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia on the early recovery in elderly patients undergoing laparoscopic radical resection of rectal cancer]

Objective: To observe the efficacy and safety of S(+)-ketamine combined with sufentanil for patient-controlled intravenous analgesia (PCIA) in elderly patients undergoing laparoscopic radical resection of rectal cancer and explore its impact on patients' early recovery. Methods: One hundred and ten patients undergoing laparoscopic radical resection of rectal cancer in Affiliated Cancer Hospital of Zhengzhou University from December 2020 to March 2021, were divided into two groups (n=55) using a random number table: group S received PCIA, with continuous infusion of S(+)-ketamine combined with sufentanil, while group C received PCIA, with continuous infusion of sufentanil. PCIA was initiated at the end of the surgery, and the formulations were as follows: group S, S(+)-ketamine (1.44 mg/kg), sufentanil (1.05 μg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline; group C: sufentanil (1.50 μg/kg), ketorolac tromethamine (2.0 mg/kg) and tropisetron (5 mg), in 100 ml of normal saline. Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of remedial analgesia, the effective compressions number of PCI during 48 h after the operation. Time to first ambulation, time to first anal exhaust, time to resume oral feeding were recorded. The occurrence of adverse effects was compared between the two groups. Results: A total of 10 patients were excluded during the study, including 4 cases of conversion to laparotomy, 3 cases of dropping out of the study, and 3 cases with operation time more than 4 hours. Finally, 50 cases in group S and 50 cases in group C completed the study. There were no significant differences in VAS scores and Ramsay sedation sores at all time points between two groups (all P>0.05). Likewise, there were also no significant differences in the number of remedial analgesia and effective compressions of PCIA during 48 h after the operation between the two groups (both P>0.05). The total dosage of sufentanil consumption in group S [(64±9) μg] was lower than that in group C [(95±12) μg] within 48 h of PCIA, with a statistically significant difference (P<0.001). Time to first ambulation in group S was (1.1±0.2) d, which was shorter than that in group C [(1.6±0.5) d], and the difference was statistically significant (P<0.001). Likewise, time to first anal exhaust in group S [(1.3±0.4) d] was shorter than that in group C [(1.8±0.6) d], with a statistically significant difference (P<0.001). Additionally, time to resume oral feeding in group S was (2.5±0.6) d, which was shorter than that in group C [(3.1±0.7) d], and there was a statistically significant difference (P<0.001). The incidence of nausea, vomiting and pruritus in group S were 4.0%, 2.0% and 0, which were lower than that in group C (16.0%, 10% and 8.0%, respectively), with statistically significant differences (all P<0.05). No case with psychiatric symptoms was found in both groups. Conclusion: When used for postoperative intravenous analgesia in elderly patients undergoing laparoscopic radical resection of rectal cancer, S(+)-ketamine combined with sufentanil can provide satisfactory analgesic effects, decrease total consumption of sufentanil and the incidence of adverse effects, and thus facilitate patients' early recovery.

P–570 Embryos originating from oocytes with smooth endoplasmic reticulum clusters have a lower euploidy rate via PGT-A testing using next-generation sequencing

Study question

Does the presence of smooth endoplasmic reticulum clusters (sERCs) in oocytes affect the human embryo ploidy?

Summary answer

The euploidy rate of embryos originating from sERCs + oocytes is lower

What is known already

While an expert panel strongly recommended that sERCs+ oocytes should not be inseminated, some normal healthy babies derived from sERCs+ oocytes have been reported. In previous studies have shown that declined fertilization rate and lower proportions of good quality embryos are found in oocytes showing sERCs. The updating findings of the molecular status of sERC+ oocytes elucidated the sERCs+ oocytes may have impaired chromosomal segregation ability. However, no study reveals the relation between sERCs and embryo ploidy.

Study design, size, duration

A retrospective study enrolled 129 preimplantation genetic testing (PGT) cycles from January 2017 to March 2020 at Chang Gung Memorial Hospital, Lonkou.

Participants/materials, setting, methods

ICSI fertilization rate, Day5 usable blastocyst rate (D5UBR), total usable blastocyst rate (TUBR), euploidy rate, mosaic rate, and aneuploidy rate are investigated between embryo originating from sERCs+ and sERCs- oocytes.

Main results and the role of chance

Although higher TBUR in blastocyst derived from sERCs+ oocytes than sERCs- group (73.7% vs. 62.5%) but accompanied lower euploidy rate (7% vs. 29%) and higher aneuploid rate (79% vs. 54%).

Limitations, reasons for caution

Limited sample size, need a large-scale study to confirm the conclusion. The live-birth rate per embryo transfer cycle was not included for analysis. As we did not perform polar body analysis, we cannot state for sure that embryonic aneuploidy was related to the oocyte.

Wider implications of the findings: This study demonstrates that embryos originating from sERCs+ oocytes have a lower euploidy rate.

Trial registration number

CMRPG3H0751

MicroRNA-802 promotes the progression of osteosarcoma through targeting p27 and activating PI3K/AKT pathway

PURPOSE

Increasing evidences suggest dysfunctions of microRNAs (miRNAs) are playing important part in tumors. Therefore, the role of miR-802 in osteosarcoma (OS) was exploited. The object was to evaluate the effect of miR-802 and verify its influence on p27 Kip1 (p27) in OS.

METHODS

RT-qPCR experiment was used to detect miR-802 and p27 expression in OS tissues and cells. We explored the function of miR-802 through Transwell assays. The phosphoinositide 3-kinase (PI3K)/AKT serine/threonine kinase pathway and epithelial-mesenchymal transition (EMT) was detected by Western blot assays. Luciferase assay was used to testify the target of miR-802.

RESULTS

MiR-802 expression was elevated in OS, which was related to poor clinical outcome in OS patients. MiR-802 overexpression promoted OS migration, invasion and EMT. Further, p27 is a direct target of miR-802. P27 elevation counteracted the promotion effect of OS on EMT, migration and invasion induced by miR-802. In addition, miR-802 overexpression inactivated PI3K/AKT pathway via targeting p27 in OS.

CONCLUSION

MiR-802 promoted the progress of EMT, migration and invasion in OS via targeting p27. This newly identified miR-802/p27/PI3K/AKT axis may represent potential targets for OS.

[Effects of positive end-expiratory pressure setting of mechanical ventilation guided by esophageal pressure in the treatment of patients with traumatic craniocerebral injury combined with acute respiratory distress syndrome]

Objective: To investigate the effects of positive end-expiratory pressure (PEEP) setting of mechanical ventilation guided by esophageal pressure in the treatment of patients with traumatic craniocerebral injury combined with acute respiratory distress syndrome (ARDS). Methods: The retrospective cohort study was conducted. From June 2016 to June 2018, 55 patients with traumatic craniocerebral injury combined with ARDS who met the inclusion criteria were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University. According to PEEP setting method, 28 patients were allocated to esophageal pressure group (17 males and 11 females, aged (40±13) years) and 27 patients were allocated to PEEP-fractional concentration of inspired oxygen (FiO₂) table group (18 males and 9 females, aged (38±10) years). Patients in the 2 groups were treated with mechanical ventilation guided by lung protective ventilation strategy, and the optimal PEEP at 0 (immediately), 24, 48, and 72 h after treatment was determined according to esophageal pressure and PEEP-FiO₂ table, respectively. The mechanical ventilation parameters in the 2 groups were adjusted according to the optimal PEEP. The transpulmonary end-expiratory pressure, pulmonary compliance, oxygen index, central venous pressure, mean arterial pressure, and intracranial pressure at 24, 48, and 72 h after treatment were recorded. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, independent sample t test, and Bonferroni correction. Results: The optimal PEEP of patients in esophageal pressure group at 0, 24, 48, and 72 h after treatment was (12.4±3.9), (11.2±3.5), (13.4±2.6), and (13.2±3.6) cmH₂O (1 cmH₂O=0.098 kPa), respectively, which was significantly higher than (8.2±2.5), (7.4±2.2), (8.3±2.3), and (8.5±2.5) cmH₂O in PEEP-FiO₂ table group, respectively (t=4.702, 4.743, 7.849, 5.623, P<0.01). The transpulmonary end-expiratory pressure and pulmonary compliance at 24, 48, and 72 h after treatment and oxygen index at 48 and 72 h after treatment of patients in esophageal pressure group were significantly higher than those in PEEP-FiO₂ table group (t=17.852, 20.586, 19.532, 4.752, 5.256, 7.446, 2.342, 4.178, P<0.05 or P<0.01). The central venous pressure of patients in esophageal pressure group at 24, 48, and 72 h after treatment was significantly higher than that in PEEP-FiO₂ table group (t=12.632, 5.247, 8.994, P<0.01), and there was no statistically significant difference in mean arterial pressure of patients between the 2 groups at 24, 48, and 72 h after treatment (P>0.05). The intracranial pressure of patients in esophageal pressure group was higher than that in PEEP-FiO₂ table group at 24, 48, and 72 h after treatment, but there was no statistically significant difference between the 2 groups (P>0.05). Conclusions: For patients with traumatic craniocerebral injury combined with ARDS, the optimal PEEP can be set under the guidance of esophageal pressure method, and the mechanical ventilation parameters adjusted according to the optimal PEEP can improve lung compliance and accelerate recovery of lung function more effectively, with no adverse effect in mean arterial pressure and intracranial pressure.

[The safety and efficacy of Firesorb bioresorbable scaffold in first-in-man study for coronary artery disease: the four-year outcomes]

Objective: To evaluate the 4-year clinical outcomes of patients following Firesorb bioresorbable scaffold (BRS) implantation. Methods: The study reported the 4-year follow-up results of the FUTURE I study. FUTURE I was a prospective, single-center, open-label, first-in-man study which evaluated the feasibility, preliminary safety, and efficacy of Firesorb stent in the treatment of coronary artery stenosis. A total of 45 patients with single de novo lesions in native coronary arteries ,who hospitalized in Fuwai Hospital from January to March 2016 were enrolled. After successfully stent implantation these patients were randomized in a 2∶1 ratio into cohort 1 (n=30) or cohort 2 (n=15). The patients in cohort 1 underwent angiographic, IVUS or OCT examination at 6 months and 2 years; and cohort 2 underwent angiographic, IVUS or OCT at 1 and 3 years. All patients underwent clinical follow-up at 1, 6 months and 1 year and annually thereafter up to 5 years. The primary endpoint was target lesion failure (TLF, including cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization). Secondary endpoints included patient-oriented composite endpoint (PoCE, defined as composite of all death, all miocardial infarction, or any revascularization). Results: A total of 45 patients were enrolled and implanted with Firesorb BRS, including 35 males (77.8%), and the age was (54.4±9.3) years. At 4 years, 10 patients in cohort 1 were reexamined by coronary angiography and OCT examination. Among them, 2 patients' stents were completely degraded and absorbed. Compared with the OCT images of the other 8 patients in cohort 2 at 3 years, the degree of stent degradation was increased, and no stent adherence was found. The 4-year clinical follow-up rate was 100%. In 4-year clinical following up, 2 patients suffered PoCE (4.4%): 1 patient underwent non-target vessel revascularization the day after index procedure and target vessel revascularization (Non-target lesion revascularization) at 2-year imaging follow-up; the other patient underwent target lesion revascularization during imaging follow-up at 4 years but not due to ischemic driven. There was no scaffold thrombosis or TLF events through 4 years. Conclusions: Four years after the implantation, complete degradation and absorption of the Firsorb stent are evidenced in some patients. Firesorb stent is feasible and effective in the treatment of patients with non-complex coronary lesions.

Effect of feeding frequency on the growth performance, carcass traits, and apparent nutrient digestibility in geese

This study was conducted to determine the effect of feeding frequency on growth performance, carcass traits, and apparent nutrient digestibility in geese from 28 to 70 D of age. In experiment 1, a total of 240 geese were distributed in a completely randomized design into 4 treatments and 6 replicates of 10 birds each. The treatments were free access to the feeder (ad libitum) and access to the feeder 3, 4, and 5 times daily. Geese fed 3 times daily had a lower (P < 0.05) BW, ADG, and ADFI and a higher (P = 0.064) feed conversion ratio (FCR) from 28 to 41 D of age compared with the other groups. Geese fed 4 times daily had a higher (P < 0.05) ADG and ADFI and a lower (P < 0.05) FCR from 42 to 55 D of age compared with ad libitum fed geese. Geese fed 3 times daily had a higher (P < 0.05) ADG from 56 to 69 D of age than geese fed ad libitum and 4 times daily. No differences (P > 0.05) in BW, ADFI, ADG, and FCR were observed between ad libitum and feeding frequency groups from 28 to 69 D of age. Carcass traits and gastrointestinal development were not affected (P > 0.05) by feeding frequency. In experiment 2, the apparent nutrient digestibility in geese from 71 to 77 D of age fed using different feeding frequencies was determined using the total fecal collection method. Feeding frequency did not affect (P > 0.05) the apparent digestibility of DM, CP, crude ash, calcium, phosphorous, or ether extract in geese. Our study demonstrates for the first time that compensatory growth can be gained by enhancing feed intake when a lower feeding frequency is imposed on geese. Both ad libitum feeding and fixed feeding frequency for 3 to 5 times daily are suitable for geese from 28 to 70 D of age to achieve optimum production.

Could artificial intelligence make human doctors obsolete? A survey based on public attitudes

Background

With the outbreak of pandemics such as SARS, MERS and COVID-19 etc., making full use of artificial intelligence (AI) become the focus of social discussion. Some experts think AI can reduce infection probability of medical staffs and improve medical efficiency, while opponents believe AI will increase unemployment and medical ethical crises. We try to answer the question: From public perspective, could AI replace human doctors?

Methods

According to occupational status and biological gender, we select four groups as respondents: on-job and retired men, on-job and retired women. We investigate their attitudes towards AI application in medical field. After collecting 400 anonymous questionnaires, we use sample statistics, ANOVA and cluster method (CFSFDP) to find out cognitive similarities and differences between different groups.

Results

Reliability (Cronbach's alpha coefficient) and validity (KMO test) of questionnaires are 0.740 and 0.875 respectively. To the four groups, there are significant (p &lt; 0.01) differences in answers of 7 questions but non-significant differences in the remaining 3 questions. By CFSFDP, questionnaires are automatically grouped into two clusters. Largest group in two clusters are on-job women and on-job men, respectively. Although 82.5% of respondents pay attention to news about AI, the overall average score for “public attitude to AI application in medical field” is 2.828 (full-score is 5.000), below neutral-score (3.000).

Conclusions

To AI application in medical field, cognitive differences among different groups are in existence, especially between on-job men and women. But in general, the public held a negative attitude towards the AI application in medical field, and trust human doctors more.

Key messages

According to the survey, it seems that AI is lesser probability to replace human doctors in recent years. It is also necessary to consider the public attitudes when promoting medical AI.

[Mode of median nerve irritation under different wrist forcing postures observed by ultrasonography and foot pressure measurement system]

Objective: To analyze the influence of simulation mouse use motion under different wrist forcing postures on median nerve, tendons and ligaments in the carpal tunnel. Methods: From June to November in 2017, a total of 49 healthy volunteers [aged from 18 to 27 years, 24 males (48 cases of hands) and 25 females (50 cases of hands)] were selected in the Institute of Digitized Medicine and First Affiliated Hospital of Wenzhou Medical University.Three hand postures of the volunteers were simultaneously and continuously measured by using LOGIQ E9 ultrasonic diagnostic apparatus and Zebris foot pressure distribution measurement system.Seventeen parameters of nerves, tendons and ligaments in carpal tunnel were observed under natural (0 N), and two forced (25 and 50 N) states.Double factor variance analysis was performed with generalized estimating equation (GEE). Results: With increasing pressure (0, 25 and 50 N) of hand postures, the distance between median nerve and transverse carpal ligament were all less than 0.2 cm.The differences in both the distance between median nerve and flexor pollicis longus under the hand pressure changes or under the hand posture changes and the top angle of a triangle composed of median nerve, flexor pollicis longus and flexor digitorum superficialis group under the hand pressure changes or under the hand posture changes were all significant under the GEE analysis (all P<0.01). There were no significant changes in all other structural parameters in the carpal tunnel with the increasing of hand pressure (all P>0.05). Conclusions: The influence of the transverse carpal ligament to the median nerve belongs to the mechanism of pressure-induced irritation damage.The influence of flexor pollicis longus to median nerve belongs to the mechanism of tension-induced irritation damage.The influence of flexor digitorum superficialis to median nerve belongs to the mechanism of mixed shear irritation damage.

Oxygen Electromigration and Energy Band Reconstruction Induced by Electrolyte Field Effect at Oxide Interfaces

Electrolyte gating is a powerful means for tuning the carrier density and exploring the resultant modulation of novel properties on solid surfaces. However, the mechanism, especially its effect on the oxygen migration and electrostatic charging at the oxide heterostructures, is still unclear. Here we explore the electrolyte gating on oxygen-deficient interfaces between SrTiO_{3} (STO) crystals and LaAlO_{3} (LAO) overlayer through the measurements of electrical transport, x-ray absorption spectroscopy, and photoluminescence spectra. We found that oxygen vacancies (O_{vac}) were filled selectively and irreversibly after gating due to oxygen electromigration at the amorphous LAO/STO interface, resulting in a reconstruction of its interfacial band structure. Because of the filling of O_{vac}, the amorphous interface also showed an enhanced electron mobility and quantum oscillation of the conductance. Further, the filling effect could be controlled by the degree of the crystallinity of the LAO overlayer by varying the growth temperatures. Our results reveal the different effects induced by electrolyte gating, providing further clues to understand the mechanism of electrolyte gating on buried interfaces and also opening a new avenue for constructing high-mobility oxide interfaces.

Clinical significance of fibrotic, haemostatic and endotoxic changes in patients with liver cirrhosis

BACKGROUND AND STUDY AIMS

To investigate the relationship among fibrotic, haemostatic and endotoxic changes in patients with different degrees of liver cirrhosis.

PATIENTS AND METHODS

Liver fibrotic markers, including hyaluronic acid (HA), Ccollagen IV (Col-IV), laminin (LN), and N-terminal pro-peptide of collagen type III (PIIINP), were determined by radioimmunoassay. A series of haemostatic tests, including prothrombin time (PT), international normalized ratio, activated partial thromboplastin time, antithrombin-III, thrombin time, fibrinogen, fibrin(ogen) degradation product and D-dimer were determined using an automatic coagulation analyszer. Plasma levels of endotoxin were detected quantitatively using an endotoxin detection kit. Correlation analysis of the data was performed.

RESULTS

Based on Child-Pugh classification, statistically significant differences in fibrotic markers and haemostatic parameters were found in 249 patients with liver cirrhosis, while no significant differences in endotoxin levels were observed. Based on ascites classification, statistically significant differences in fibrotic markers (such as HA, Col-IV and PIIINP, except for LN) and haemostatic parameters were found. As for endotoxin levels, there were significant differences between the ascites, spontaneous bacterial peritonitis (SBP) and no-ascites groups, while no significant differences were observed between the ascites and SBP groups. Correlation analysis demonstrated some correlation among fibrotic markers, haemostatic parameters and endotoxin.

CONCLUSIONS

A close relationship exists between the severity of cirrhosis and fibrotic changes, as well as haemostatic changes. Endotoxin may be an important contributing factor to the development of ascites in cirrhosis. Some correlation may exist between fibrosis, haemostatic and endotoxin.

Ambipolar ferromagnetism by electrostatic doping of a manganite

Complex-oxide materials exhibit physical properties that involve the interplay of charge and spin degrees of freedom. However, an ambipolar oxide that is able to exhibit both electron-doped and hole-doped ferromagnetism in the same material has proved elusive. Here we report ambipolar ferromagnetism in LaMnO₃, with electron-hole asymmetry of the ferromagnetic order. Starting from an undoped atomically thin LaMnO₃ film, we electrostatically dope the material with electrons or holes according to the polarity of a voltage applied across an ionic liquid gate. Magnetotransport characterization reveals that an increase of either electron-doping or hole-doping induced ferromagnetic order in this antiferromagnetic compound, and leads to an insulator-to-metal transition with colossal magnetoresistance showing electron-hole asymmetry. These findings are supported by density functional theory calculations, showing that strengthening of the inter-plane ferromagnetic exchange interaction is the origin of the ambipolar ferromagnetism. The result raises the prospect of exploiting ambipolar magnetic functionality in strongly correlated electron systems.

[Prevalance of peri-anesthesia allergy and its related risk factor: a retrospective survey from 2012-2017]

OBJECTIVE

To investigate the incidence of peri-anesthesia allergy in a tertiary teaching hospital.

METHODS

This was a retrospective cohort study. Patients who received anesthesia in operation rooms at Peking University First Hospital from January 2012 to April 2017 were enrolled. Researchers reviewed all the patients' electronic records and screened suspect allergy cases. Allergy was diagnosed according to the definition in Consensus on Management of Perioperative Allergy (China) and Scandinavian Clinical Practice Guidelines on the Diagnosis, Management and Follow-up of Anaphylaxis during Anesthesia. After obtaining the electronic records, two researchers began to screen and supplement missing data according medical records independently, then they checked out each other's data. The final data were reviewed by another two researchers. We collected the patients' basic characteristics, surgery type, anesthesia type, peri-anesthesia use of drugs, prognosis and other data. Univariate logistic regression was employed to screen potential factors of allergy. Factors with statistical significance (P<0.05) in univariate Logistic regression were entered into multivariate Logistic regression to identify independent risk factors of allergy.

RESULTS

In the study, 106 074 patients entered final statistic analysis. The incidence of peri-anesthesia allergy was about 1.5/1 000 (156/106 074). The incidence of Grades I, II and III allergy was 64.1% (100/156), 30.1% (47/156), and 5.8% (9/156) respectively. Multivariate logistic regression showed 5 independent risk factors of allergy including history of allergy (OR=6.836, 95%CI: 4.461-10.474, P<0.001), intraoperative use of sufentanil (OR=1.993, 95%CI: 1.228-3.232, P=0.005), intraoperative use of cis-atracuronium (OR=2.495, 95%CI: 1.599-3.893, P<0.001), intraoperative infusion of antibiotics (OR=2.005, 95%CI: 1.375-2.924, P<0.001) and frozen fresh plasma (OR=3.055, 95%CI: 1.842-5.068, P<0.001).

CONCLUSION

The incidence of peri-anesthesia allergy is high and further attempt is needed to establish standard operation process of diagnosis and treatment of allergy.

Acute Myocardial Injury and Complete Atrioventricular Block Induced by Transient Coronary Artery Spasm

A 65-year-old man with no previous history of heart disease presented with cardiogenic shock. Acute right ventricular failure following extensive inferior wall myocardial infarction and complete atrioventricular block were noted and emergent angiography revealed insignificant coronary arterial stenosis. In view of the finding and absence of myocardial vasculitis, coronary artery spasm was implicated as the cause of myocardial infarction and complete atrioventricular block. After the reversal of the shock and successful angioplasty, the patient continued to take lercanidipine and had been angina-free during follow-up of 5 months. (Hong Kong j.emerg.med. 2013;20:396-399)

Acute Myocardial Injury and Complete Atrioventricular Block Induced by Transient Coronary Artery Spasm

A 65-year-old man with no previous history of heart disease presented with cardiogenic shock. Acute right ventricular failure following extensive inferior wall myocardial infarction and complete atrioventricular block were noted and emergent angiography revealed insignificant coronary arterial stenosis. In view of the finding and absence of myocardial vasculitis, coronary artery spasm was implicated as the cause of myocardial infarction and complete atrioventricular block. After the reversal of the shock and successful angioplasty, the patient continued to take lercanidipine and had been angina-free during follow-up of 5 months. (Hong Kong j.emerg.med. 2013;20:396-399)

Dynamic Internet-Mediated Team-Based Case Management of High-Frequency Emergency Department Users

Introduction

We assessed whether a strategy using dynamic, internet-mediated, team-based case management could reduce the number of subsequent emergency department (ED) visits by frequent ED users.

Methods

Patients who attended the ED three or more times within 72 hours in June 2010 were identified. These cases were divided into the pain management or chronic disease group according to their chief complaint. Patients were assessed by expert panels, and initial care plans were developed and posted on an internal website. Thereafter, each emergency physician could follow or adjust the care plans dynamically via the internal website according to the patient's condition and use the website to communicate results. Care plans were revised by the team according to the patient's clinical situation as it changed. Patient ED visits over the subsequent six months were monitored.

Results

Fourteen cases were enrolled in the study, seven in each group. The mean number of visits per patient per month in the pain management and chronic disease groups decreased from 14.9 to 5.79 (p=0.031) and 6.1 to 2.9 (p<0.001) visits per month after the intervention, respectively. The overall mean number of visits per patient per month decreased from 10.5 to 4.36 (p=0.004), a decrease of 6.14 visits (58.27%).

Conclusions

Dynamic internet-mediated team-based case management may help to reduce subsequent visits in patients who frequently visit the ED. (Hong Kong j.emerg.med. 2014;21:161-166)

[Long term safety and efficacy of a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent for the treatment of coronary de novo lesions]

Objective: To compare the long term safety and efficacy of the novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent(Firehawk stent) and permanent polymer coating everolimus eluting stent(Xience V stent) for the treatment of coronary de novo lesions. Methods: This prospective, multi-center, non-inferiority, randomized control trial(TARGETⅠ trial) was performed between August 2010 and April 2011, a total of 460 patients with primary, de novo, single vessel and single coronary lesion from 16 medical centers were enrolled. The diameter stenosis of target lesion was ≥70%, and lesion length was≤24 mm. The patients were randomly assigned to treatment with Firehawk stent (Firehawk stent group) or Xience V stent (Xience V stent group) groups by a web-based allocation system and was stratified by center. The late lumen loss after 9 months, target lesion failure (TLF) which was a composite of cardiac death, target vessel myocardial infarction, or ischemia driven target lesion revascularization, patient-oriented composite endpoint (PoCE) which was a composite of all cause death, all cause myocardial infarction, or any revascularization, and stent thrombosis after 5 years were compared between the two groups. Results: (1) There were 2 patients without stent implantation dropped out of this trial. There were 227 patients in Firehawk stent group, and 231 patients in Xience V stent group. The baseline characteristics were similar between the two groups(all P>0.05). (2) The 9 months late lumen loss in Firehawk stent group was non-inferior to that in Xience V stent group ((0.13±0.24)mm vs. (0.13±0.18)mm, P=0.94). (3) A total of 442 (96.5%) patients completed 5 years clinical follow-up. There were no significant differences on 5-year TLF rate (6.0%(13/217) vs. 6.7% (15/225), P=0.77) and PoCE rate (12.0%(26/217) vs. 17.8% (40/225), P=0.09) between the Firehawk stent group and Xience V stent group. (4) Kaplan-Meier analysis showed that TLF rates between 1-5 years were similar in Firehawk stent group and Xience V stent group (5.7% and 6.6% respectively, HR=0.88, 95%CI 0.42-1.84, P=0.72). Land-Mark analysis showed that TLF rates bewteen 1-5 years were similar in Firehawk stent group and Xience V stent group (3.6% and 4.4% respectively, HR=0.83, 95%CI 0.34-2.00, P=0.67). Kaplan-Meier analysis showed that PoCE rates between 1-5 years were also similar in Firehawk stent group and Xience V stent group (11.4% and 17.3% respectively, HR=0.64, 95%CI 0.39-1.04, P=0.07). Land-Mark analysis showed that PoCE rates after 5 years were similar in Firehawk stent group and Xience V stent group (8.4% and 10.0% respectively, HR=0.66, 95%CI 0.40-1.10, P=0.11). (5) No stent thrombosis was documented in Firehawk stent group during the 5 years follow-up period, and there was 1 case of stent thrombosis in Xience V stent group after 3 years of stent implantation. Conclusion: TARGETⅠ trial results of 5 years follow up indicate the novel Firehawk stent have a durable safety and efficacy profile which is comparable to the Xience V stent in treating patients with single de novo coronary lesion. Clinical Trial Registration North American Clinical Trial Registration Center, NCT01196819.

Electron Accumulation and Emergent Magnetism in LaMnO_{3}/SrTiO_{3} Heterostructures

Emergent phenomena at polar-nonpolar oxide interfaces have been studied intensely in pursuit of next-generation oxide electronics and spintronics. Here we report the disentanglement of critical thicknesses for electron reconstruction and the emergence of ferromagnetism in polar-mismatched LaMnO_{3}/SrTiO_{3} (001) heterostructures. Using a combination of element-specific x-ray absorption spectroscopy and dichroism, and first-principles calculations, interfacial electron accumulation, and ferromagnetism have been observed within the polar, antiferromagnetic insulator LaMnO_{3}. Our results show that the critical thickness for the onset of electron accumulation is as thin as 2 unit cells (UC), significantly thinner than the observed critical thickness for ferromagnetism of 5 UC. The absence of ferromagnetism below 5 UC is likely induced by electron overaccumulation. In turn, by controlling the doping of the LaMnO_{3}, we are able to neutralize the excessive electrons from the polar mismatch in ultrathin LaMnO_{3} films and thus enable ferromagnetism in films as thin as 3 UC, extending the limits of our ability to synthesize and tailor emergent phenomena at interfaces and demonstrating manipulation of the electronic and magnetic structures of materials at the shortest length scales.

BBI608-503-103HCC: A phase Ib/II clinical study of napabucasin (BBI608) in combination with sorafenib or amcasertib (BBI503) in combination with sorafenib (Sor) in adult patients with hepatocellular carcinoma (HCC)

4077

Background: Napabucasin, a first-in-class cancer stemness inhibitor in clinical development, suppresses cancer stemness by targeting STAT3-driven gene transcription. Amcasertib targets multiple serine threonine stemness kinases and inhibits Nanog and other cancer stemness pathways. Preclinically, potent and broad-spectrum anti-cancer activity was observed in vitro and in vivo, alone and in combination with sorafenib. Methods: A phase Ib/II open-label, multi-center study in adult patients with advanced HCC who have not received prior systemic chemotherapy was performed to determine the safety, tolerability, and recommended Phase II dose (RP2D) ,according to the criteria for DLT and for dose-escalation of Napabucasin (Arm 1), administered at 160 mg BID (dose level I) and at 240 mg BID (dose level II) in combination with sorafenib and of Amcasertib (Arm 2), administered at 100 mg QD (dose level I) and at 200 mg QD (dose level II) in combination with sorafenib. Results: 20 pts were enrolled, 10 in Arm 1 and 10 in Arm 2. 12 patients were evaluable for DLT determination; 2 pts d/c prior to starting protocol treatment; 11 pts received evaluation by RECIST, 6 pts in Arm 1 and 5 pts in Arm 2. The safety profile was consistent with that of each agent as monotherapy and most common AEs were attributed to (Sor) and included rash, PPE, grade 1/2 diarrhea, nausea, abdominal cramps, and vomiting. No signs of drug-drug interactions were observed in pharmacokinetics. Among all patients who received RECIST evaluation, Disease Control Rate (DCR=CR+PR+SD) for Arm 1 was 100% (6/6pts) and 100% (5/5pts) for Arm 2. DCR in ITT Arm 1 population was 67% and 50% in Arm 2. Median OS is not yet reached. Conclusions: In this phase Ib study, RP2D were determined for napabucasin and amcasertib to be safely combined with sorafenib at full dose, showing encouraging anti-tumor activity in patients with HCC who have not received prior systemic chemotherapy. A randomized phase II is schedule to start. Clinical trial information: NCD02279719. [Table: see text]

BBI608-201GBM: A phase Ib/II clinical study of napabucasin (BBI608) in combination with temozolomide (TMZ) for adult patients with recurrent glioblastoma (GBM)

e13525

Background: Napabucasin, a first-in-class cancer stemness inhibitor in clinical development, suppresses cancer stemness by targeting STAT3-driven gene transcription. Pre-clinically, potent and broad-spectrum anti-cancer activity was observed in vitro and in vivo, alone and in combination with other agents. PK studies demonstrated napabucasin penetration in the murine orthotopic GBM model. Methods: A phase Ib/II open-label, multi-center study in pts with GBM at first recurrence who have not received bevacizumab, was performed to determine safety and preliminary activity of napabucasin administered orally at 480mg BID po in combination with TMZ 150mg/m²/day po; days 1 through 5 of each 28 day cycle, until disease progression or unacceptable toxicity. A 6-patient safety cohort was planned to evaluate the occurrence of DLT during the first 28 days of combination treatment with napabucasin and TMZ. 4 additional patients have been enrolled under the RP2D expansion phase. Results: 11 pts have been enrolled to date; no DLT was observed in the safety cohort and the RP2D of the combination is 480 mg BID for napabucasin. The safety profile was consistent with that of each agent as monotherapy and most common AEs included grade 1/2 diarrhea, nausea, abdominal cramps, and vomiting. Two patients requested to withdraw treatment due to concurrent conditions and AE s. 9 patients were evaluable by RANO; Disease Control Rate was observed in 5 patients (55.5%) of which 4 achieved PR (44.4%) and 1 achieved SD (11.1%). The Overall response rate was 44.4% in the evaluable patients. Conclusions: This phase Ib/II study demonstrated that napabucasin at 480 mg BID can be safely combined with temozolomide at full dose and showed encouraging anti-tumor activity in patients with recurrent Glioblastoma. Clinical trial information: NCT02315534. [Table: see text]

NGF promotes mitochondrial function by activating PGC-1α in TM4 Sertoli cells

Nerve growth factor (NGF), which is required for the survival and differentiation of the nervous system, has been proved to play important roles in male reproductive physiology. Several studies have focused on the roles of NGF in the testes. However, no study has reported on the mechanism of paracrine and autocrine actions of NGF in Sertoli cells. This study showed that NGF stimulated mitochondrial activity and biogenesis in TM4 Sertoli cells. Moreover, our results demonstrated that peroxisome proliferator-activated receptor-gamma coactivator-1α is a possible downstream key target of the NGF signalling pathway. In a 3-nitropropionic acid cell model, NGF treatment attenuated mitochondrial activity defect and depolarisation. This NGF-triggered signalling may help in discovering new therapeutic targets for certain male infertility disorders.

The growth mechanism of calcareous deposits under various hydrostatic pressures during the cathodic protection of carbon steel in seawater

Ca²⁺ was substituted by Mg²⁺ in CaCO₃ crystallization under high pressure resulting in a crystal transformation from aragonite to dolomite.

Cost-Effective Management of bEnign Positional Vertigo Using Canalith Repositioning

OBJECTIVE: The misdiagnosis and inappropriate treatment of benign positional vertigo have resulted in significant costs to the medical system. In the current medical-economic climate, there is an increased emphasis on cost control. Recent studies have shown that the canalith repositioning procedure (CRP) is effective; the next step is to show the impact of CRP in cost-effective management of benign positional vertigo.

METHODS: Forty-six of 100 patients who underwent CRP for benign positional vertigo responded to a survey regarding the financial impact of their disease. They were asked to subjectively estimate the sum of all disease-related expenses. Objective substantiation of this number was estimated by tabulating physician data, laboratory data, and failed treatment costs.

RESULTS: The subjective figure totaled $2684.74 per individual. Summation of the tangible objective figures yielded $2009.63 per patient, corroborating the subjective figure.

CONCLUSIONS: Because CRP is a relatively simple procedure that can obviate many wasted expenses in most patients, we believe that it is very cost-effective and should be incorporated into routine practice.

Effects of Nitrogen Application Rate on the Yields, Nutritive Value and Silage Fermentation Quality of Whole-crop Wheat

Whole-crop wheat (Triticum aestivum L.) as forage has been extensively used in the world. In this study, the effects of N application rates on the yields, nutritive value and silage quality were investigated. The N application rates were 0, 75, 150, 225, and 300 kg/ha. The research results indicated that the dry matter yield of whole-crop wheat increased significantly with increasing N rate up to 150 kg/ha, and then leveled off. The crude protein content and in vitro dry matter digestibility of whole-crop wheat increased significantly with increasing N up to 225 kg/ha, while they no longer increased at N 300 kg/ha. On the contrary, the content of various fibers tended to decrease with the increase of N application. The content of lactic acid, acetic acid and propionic acid in silages increased with the increase of N rate (p<0.05). The ammonia-N content of silages with higher N application rates (≥225 kg/ha) was significantly higher than that with lower N application rates (≤150 kg/ha). Whole-crop wheat applied with high levels of N accumulated more nitrate-N. In conclusion, taking account of yields, nutritive value, silage quality and safety, the optimum N application to whole-crop wheat should be about 150 kg/ha at the present experiment conditions.

Molecular characterization and expression pattern of dmrt1 in the immature Chinese sturgeon Acipenser sinensis

In this study, the cDNA of dmrt1 gene from the Chinese sturgeon Acipenser sinensis was isolated and its expression pattern was characterized in different tissues of immature A. sinensis. By real-time quantitative PCR (qrtPCR) analysis, the A. sinensis dmrt1 mRNA was detected mainly in gonad and with a higher level in the testis than the ovary, especially in 3 and 4 year-old samples. This indicated that the dmrt1 expression exhibited gradual testis specificity with development. The subcellular localization analysis indicated that the Dmrt1 protein exists only in germ cells and not in somatic cells. These results suggest that A. sinensis dmrt1 might be a highly specific sex differentiation gene for testis development and spermatogenesis.

Hypervalinemia and hyperleucine-isoleucinemia caused by mutations in the branched-chain-amino-acid aminotransferase gene

Valine, leucine, and isoleucine are essential branched chain amino acids (BCAAs). When BCAA metabolism is genetically impaired in human, serum levels of BCAA and/or their metabolites rise considerably, causing severe neurological dysfunction. The first step in BCAA catabolism is catalyzed by branched chain aminotransferase (BCAT). Hypervalinemia and hyperleucine-isoleucinemia caused by BCAT gene mutation in human have not been reported previously. A 25-year-old man presented with headache complaints and mild memory impairment for about six years. Brain MRI showed symmetric white matter abnormal signals. Metabolic studies revealed remarkably elevated plasma valine and leucine concentrations. Maple syrup urine disease (MSUD) diagnosis was not supported since all genes for the branched-chain α-keto acid dehydrogenase complex (BCKD) gene were normal. Interestingly, two heterogeneous BCAT2 gene mutations were found in the patient, including c.509G > A (p.Arg170Gln) and c.790G > A (p.Glu264Lys). In addition, c.509G > A (p.Arg170Gln) and c.790G > A (p.Glu264Lys) were found in his father and mother, respectively, suggesting an autosomal recessive disorder. BCAT2 functional studies demonstrated that the two BCAT2 gene mutations resulted in decreased BCAT2 enzyme activity. After treatment with vitamin B6, the levels of BCAA, especially valine were remarkably decreased and brain MRI lesions were improved. These findings suggest a new type of branched chain amino acid metabolism disorder. This rare case provides great insight into the further understanding of BCAA metabolism and its defect in human. BCAT2 gene mutations can cause hypervalinemia and hyperleucine-isoleucinemia, which are associated with brain white matter lesions.

Computed tomography versus magnetic resonance imaging for diagnosing cervical lymph node metastasis of head and neck cancer: a systematic review and meta-analysis

Computed tomography (CT) and magnetic resonance imaging (MRI) are common imaging methods to detect cervical lymph node metastasis of head and neck cancer. We aimed to assess the diagnostic efficacy of CT and MRI in detecting cervical lymph node metastasis, and to establish unified diagnostic criteria via systematic review and meta-analysis. A systematic literature search in five databases until January 2014 was carried out. All retrieved studies were reviewed and eligible studies were qualitatively summarized. Besides pooling the sensitivity (SEN) and specificity (SPE) data of CT and MRI, summary receiver operating characteristic curves were generated. A total of 63 studies including 3,029 participants were involved. The pooled results of meta-analysis showed that CT had a higher SEN (0.77 [95% confidence interval {CI} 0.73–0.87]) than MRI (0.72 [95% CI 0.70–0.74]) when node was considered as unit of analysis (P<0.05); MRI had a higher SPE (0.81 [95% CI 0.80–0.82]) than CT (0.72 [95% CI 0.69–0.74]) when neck level was considered as unit of analysis (P<0.05) and MRI had a higher area under concentration-time curve than CT when the patient was considered as unit of analysis (P<0.05). With regards to diagnostic criteria, for MRI, the results showed that the minimal axial diameter of 10 mm could be considered as the best size criterion, compared to 12 mm for CT. Overall, MRI conferred significantly higher SPE while CT demonstrated higher SEN. The diagnostic criteria for MRI and CT on size of metastatic lymph nodes were suggested as 10 and 12 mm, respectively.

Nanoscale lithography of LaAlO₃/SrTiO₃ wires using silicon stencil masks

We have developed a process to fabricate low-stress, fully crystalline silicon nanostencils, based on ion irradiation and the electrochemical anodization of p-type silicon. These nanostencils can be patterned with arbitrary feature shapes with openings hundreds of micrometers wide connected to long channels of less than 100 nm in width. These nanostencils have been used to deposit (2.5 μm- to 150 nm-wide) lines of LaAlO3 (LAO) on a SrTiO3 (STO) substrate, forming a confined electron layer at the interface arising from oxygen vacancies on the STO surface. Electrical characterization of the transport properties of the resulting LAO/STO nanowires exhibited a large electric field effect through back-gating using the STO as the dielectric, demonstrating electron confinement. Stencil lithography incorporating multiple feature sizes in a single mask shows great potential for future development of oxide electronics.

Double-loop locking cross-stitch suture and suspension fixation for medial collateral ligament origin reconstruction

The purpose of this study was to summarize the clinical application and results of the double-loop locking cross-stitch suture and suspension fixation method for medial collateral ligament origin reconstruction. Thirty-six patients (21 males, 15 females) with an average age of 40 years (range = 17-58 years), who underwent treatment for acute fracture of the medial collateral ligament at our hospital from February 2008 to May 2009, were included in this study. All patients presented unilateral injuries (17 right-sided, 19 left-sided) and underwent repair with the double-loop locking cross-stitch suture and suspension fixation method. All incisions in this group of patients healed by first intention. Thirty-two patients were followed up for 6-20 months (average = 12 months). There were no reports of wound infection, ligament re-fracture or other complications in the follow-up period. Based on the Lysholm knee-scoring scale, the patients received a 100% excellent and good rating (20 patients - excellent score, 12 patients - good score) postoperatively. The advantages of the double-loop locking cross-stitch suture and suspension fixation method are a smaller incision, reliable fixation, and early restoration of knee joint stability. It is, therefore, an effective and low-risk method for the reconstruction of medial collateral ligament origin.

Effect of brain-derived neurotrophic factor haploinsufficiency on stress-induced remodeling of hippocampal neurons

Chronic restraint stress (CRS) induces the remodeling (i.e., retraction and simplification) of the apical dendrites of hippocampal CA3 pyramidal neurons in rats, suggesting that intrahippocampal connectivity can be affected by a prolonged stressful challenge. Since the structural maintenance of neuronal dendritic arborizations and synaptic connectivity requires neurotrophic support, we investigated the potential role of brain derived neurotrophic factor (BDNF), a neurotrophin enriched in the hippocampus and released from neurons in an activity-dependent manner, as a mediator of the stress-induced dendritic remodeling. The analysis of Golgi-impregnated hippocampal sections revealed that wild type (WT) C57BL/6 male mice showed a similar CA3 apical dendritic remodeling in response to three weeks of CRS to that previously described for rats. Haploinsufficient BDNF mice (BDNF(±) ) did not show such remodeling, but, even without CRS, they presented shorter and simplified CA3 apical dendritic arbors, like those observed in stressed WT mice. Furthermore, unstressed BDNF(±) mice showed a significant decrease in total hippocampal volume. The dendritic arborization of CA1 pyramidal neurons was not affected by CRS or genotype. However, only in WT mice, CRS induced changes in the density of dendritic spine shape subtypes in both CA1 and CA3 apical dendrites. These results suggest a complex role of BDNF in maintaining the dendritic and spine morphology of hippocampal neurons and the associated volume of the hippocampal formation. The inability of CRS to modify the dendritic structure of CA3 pyramidal neurons in BDNF(±) mice suggests an indirect, perhaps permissive, role of BDNF in mediating hippocampal dendritic remodeling.

Efficacy of short-term chincup therapy for mandibular growth retardation in Class III malocclusion

OBJECTIVE

To assess the efficacy of chincup therapy for mandibular growth retardation in early orthopedic treatment of Class III malocclusion.

MATERIALS AND METHODS

An electronic search for articles reporting randomized clinical trials, controlled clinical trials, and cohort studies testing the efficacy of chincup appliance for Class III malocclusion published up to the present was done through four databases: Cochrane Central Register of Controlled Trials (CENTRAL; to March 2010), MEDLINE (1950-March 2010), EMBASE (1980-March 2010), and CBM (1978-March 2010). Study quality assessment and data extraction were done by two reviewers independently. Meta-analysis was done with the assistance of Revman 5.01.

RESULTS

The search resulted in 50 articles. After selection following the established criteria, four cohort studies qualified for the final review analysis. The results showed that chincup therapy decreased SNB angle and increased ANB angle; the total pooled weighted mean difference values (95% confidence interval) were −1.18 (−1.69, −0.67; P < .00001) and 1.90 (0.60, 3.21; P = .004), respectively. Two studies showed a increase in Gonial angle (P < .05) but no significant change in the mandibular length (Cd-Gn; P = .059 and .39, respectively). One study indicated that chincup therapy exerted no effect on mandibular growth retardation, and mandibular growth continued after the treatment in a downward direction.

CONCLUSION

There are insufficient data in these studies to make clear recommendations regarding the efficacy of chincup therapy in the retardation of mandibular growth.

Prevalence of erosive esophagitis and Barrett's esophagus in the adult Chinese population

BACKGROUND AND STUDY AIM

The aim of this study was to determine the prevalence, characteristics, and risk factors of erosive esophagitis and Barrett's esophagus in an adult Chinese population without gastroesophageal reflux symptoms.

PATIENTS AND METHODS

Between March 2006 and February 2007, consecutive individuals aged between 18 and 75 years, who underwent routine upper endoscopy as part of their regular medical examination were recruited. Demographic and medical information were collected. Erosive esophagitis was defined endoscopically as visible breaks of the distal esophageal mucosa. Barrett's esophagus was diagnosed endoscopically and confirmed histologically. "Silent GERD" was defined when erosive esophagitis and/or Barrett's esophagus were present in an individual without reflux symptoms.

RESULTS

Among the 2580 individuals included, erosive esophagitis and Barrett's esophagus were found in 4.3 % (n = 110) and 1.0 % (n = 27), respectively. In individuals with erosive esophagitis and Barrett's esophagus, 33.6 % and 40.7 %, respectively, were asymptomatic. Thus, the prevalence of erosive esophagitis and Barrett's esophagus in individuals without GERS was 1.6 % and 0.5 %, respectively, giving an overall prevalence of silent GERD of 2.0 % (46 / 2270). Multivariate analysis identified that male sex (odds ratio [OR] = 2.87, 95 % confidence interval [CI] 1.24 - 6.66; P = 0.014), hiatus hernia (OR = 9.68, 95 %CI 5.00 - 17.95; P < 0.001), and alcohol consumption (OR = 3.17, 95 %CI 1.44 - 6.97; P = 0.004) were positively associated with erosive esophagitis, whereas Helicobacter Pylori infection (OR = 0.37, 95 %CI 0.14 - 0.98; P = 0.046) was negatively associated with erosive esophagitis. Alcohol consumption (OR = 5.32, 95 %CI 1.55 - 13.33; P = 0.008) was positively associated with Barrett's esophagus in asymptomatic individuals.

CONCLUSION

In this cohort of the adult Chinese population without reflux symptoms, the prevalence of erosive esophagitis and Barrett's esophagus is 1.6 % and 0.5 %, respectively, with an overall prevalence of silent GERD of 2.0 %. Male sex, hiatus hernia, and alcohol consumption are positively associated with erosive esophagitis, whereas a negative association exists for H. pylori infection. Alcohol consumption is positively associated with Barrett's esophagus.

First Report of Choke Disease Caused by Epichloë typhina on Orchardgrass (Dactylis glomerata) in China

Orchardgrass or cocksfoot (Dactylis glomerata L.) has been widely cultivated as a forage crop in many provinces of China (1). It is also a native perennial forage grass, which grows at the edge of forests, shrubs, and mountainous grasslands in Xinjiang and Sichuan (2). In September of 2007, signs of choke disease on orchardgrass were observed in a native grassland under birch woodland near Altai City, Xinjiang, China. Stromata, which formed on culms of diseased grass, enclosing the inflorescence and leaf sheath, were 4.5 to 5.5 mm long, smooth or wrinkled, white and later becoming yellowish or yellow, tuberculate, dry, and covered with perithecia. Inflorescences surrounded by fungal stromata were choked and failed to mature, thus restricting seed production. Pure cultures were obtained by directly scraping stromata from the surface and incubating it on antibiotic potato dextrose agar (PDA). The colonies were cottony, white on the upper surface, and white to yellow on the reverse. The growth rate was 13 to 21 mm per week at 25°C on PDA. Conidia were hyaline, lunate to reniform, and measured 4.1 ± 0.5 × 2.2 ± 0.5 μm. They accumulated in small globose heads at the tips of conidiogenous cells and were produced singly on conidiophores of 13 to 33 μm long and 2.7 to 4.1 μm wide at the base. Internal transcribed spacer (ITS) sequence by BLAST search had 99% similarity with an Epichloë typhina isolate of orchardgrass in Spain (GenBank Accession No. AM262420.1). Cultural characteristics, microscopic examination, and phylogenetic analysis showed that this choke disease on D. glomerata was caused by the fungus E. typhina (Pers.) Tul. & C. Tul. as described by White (4). To our knowledge, this is the first report of E. typhina causing choke disease on orchardgrass in China. The pathogen has been identified in France, England, Germany, Sweden, Switzerland, and the United States (3,4) with the same symptoms as those reported here. In 1997, choke disease was found in 70% of the fields in the Willamette Valley of Oregon, with disease incidences ranging from 0.05 to 28%. It was predicted to increase and spread under the prevailing climatic conditions (3). This new disease report is to provide observational and diagnostic information to help with recognition and prevention of disease spread in orchardgrass cultivation regions of China. References: (1) X. R. Chao et al. Shandong Agric. Sci. 1:7, 2005. (2) S. X. Jia, ed. China Forage Plant Flora. China Agriculture Press, Beijing, 1987. (3) W. F. Pfender and S. C. Alderman. Plant Dis. 83:754, 1999. (4) J. W. White. Mycologia 85:444, 1993.

Identification and characterization of a MBP isoform specific to hypothalamus in orange-spotted grouper (Epinephelus coioides)

Myelin basic protein (MBP), as a major component of the myelin sheath, has been revealed to play an important role in forming and maintaining myelin structure in vertebrate nervous system. In teleost, hypothalamus is an instinctive brain center and plays significant roles in many physiological functions, such as energy metabolism, growth, reproduction, and stress response. In comparison with other MBP identified in vertebrates, a smallest MBP is cloned and identified from the orange-spotted grouper hypothalamic cDNA plasmid library in this study. RT-PCR analysis and Western blot detection indicate that the EcMBP is specific to hypothalamus, and expresses mainly in the tuberal hypothalamus in adult grouper. Immunofluorescence localization suggests that EcMBP should be expressed by oligodendrocytes, and the expressing cells should be concentrated in hypothalamus and the area surrounding hypothalamus, such as NPOpc, VC, DP, NLTm, and NDLI. The studies on EcMBP expression pattern and developmental behaviour in the brains of grouper embryos and larvae reveal that the EcMBP-expressing cells are only limited in a defined set of cells on the border of hypothalamus, and suggest that the EcMBP-expressing cells might be a subpopulation of oligodendrocyte progenitor cells. This study not only identifies a smallest MBP isoform specific to hypothalamus that can be used as a molecular marker of oligodendrocytes in fish, but also provides new insights for MBP evolution and cellular distribution.

Uptake and distribution of N, P and heavy metals in three dominant salt marsh macrophytes from Yangtze River estuary, China

We examined the variation in aboveground biomass accumulation and tissue concentrations of nitrogen (N), phosphorus (P), copper (Cu), zinc (Zn) and lead (Pb) in Phragmites australis (common reed), Spartina alterniflora (salt cordgrass), and Scirpus mariqueter throughout the growing season (April-October 2005), in order to determine the differences in net element accumulation and distribution between the three salt marsh macrophytes in the Yangtze River estuary, China. The aboveground biomass was significantly greater in the plots of S. alterniflora than in the plots of P. australis and S. mariqueter throughout the growing season (P<0.05). In August, the peak aboveground biomass was 1246+/-89 gDW/m(2), 2759+/-250 gDW/m(2) and 548+/-54 gDW/m(2) for P. australis, S. alterniflora and S. mariqueter, respectively. The concentrations of nutrients and heavy metals in plant tissues showed similar seasonal patterns. There was a steady decline in element concentrations of the aboveground tissues from April to October. Relative element concentrations in aboveground tissues were at a peak during the spring sampling intervals with minimum levels during the fall. But the concentrations of total nitrogen and total phosphorus in the belowground tissues were relatively constant throughout growing season. Generally, trace metal concentrations in the aboveground tissues of S. mariqueter was the highest throughout the growing season, and the metal concentrations of S. alterniflora tissues (aboveground and belowground) were greater than those of P. australis. Furthermore, the aboveground pools of nutrients and metals were consistently greater for S. alterniflora than for P. australis and S. mariqueter, which suggested that the rapid replacement of native P. australis and S. mariqueter with invasive S. alterniflora would significantly improve the magnitude of nutrient cycling and bioavailability of trace metals in the salt marsh and maybe transport more toxic metals into the water column and the detrital food web in the estuary.

Comparative SAGE analysis of the response to hypoxia in human pulmonary and aortic endothelial cells

We utilized serial analysis of gene expression (SAGE) to analyze the temporal response of human pulmonary artery endothelial cells (HPAECs) to short-term chronic hypoxia at the level of transcription. Primary cultures of HPAECs were exposed to 1% O2hypoxia for 8 and 24 h and compared with identical same-passage cells cultured under standard (5% CO2-95% air) conditions. Hierarchical clustering of significant hypoxia-responsive genes identified temporal changes in the expressions of a number of well-described gene families including those encoding proteins involved in thrombosis, stress response, apoptosis, angiogenesis, and cell proliferation. These experiments build on previously published data describing the transcriptomic response of human aortic endothelial cells (HAECs) obtained from the same donor and cultured under identical conditions, and we have thus taken advantage of the immortality of SAGE data to make direct comparisons between these two data sets. This approach revealed comprehensive information relating to the similarities and differences at the level of mRNA expression between HAECs and HPAECs. For example, we found differences in the cell type-specific response to hypoxia among genes encoding cytoskeletal factors, including paxillin, and proteins involved in metabolic energy production, the response to oxidative stress, and vasoreactivity (e.g., endothelin-1). These efforts contribute to the expanding collection of publicly available SAGE data and provide a foundation on which to base further efforts to understand the characteristics of the vascular response to hypoxia in the pulmonary circulation relative to systemic vasculature.

Mapping QTL associated with resistance to Fusarium head blight in the Nanda2419 x Wangshuibai population. II: type I resistance

Fusarium head blight (FHB) is a serious disease in wheat and barley affecting both yield and quality. To identify genes for resistance to infection, the RIL population derived from 'Nanda2419' x 'Wangshuibai' and the parents were evaluated for percentage of infected spikes (PIS) in four different environments. Using a 2,960 cM marker framework map constructed for this population, ten chromosome regions were detected for their association with type I resistance through interval mapping with Mapmaker/QTL, among which QTLs mapped in the intervals of Xwmc349--Xgwm149 on chromosome 4B, of Xwmc96--Xgwm304 on chromosome 5A and of Xgwm408--Xbarc140 on chromosome 5B were revealed in at least three environments and have Wangshuibai as the source of resistance alleles. Qfhi.nau-4B and Qfhi.nau-5A had larger effects and explained up to 17.5 and 27.0% of the phenotypic variance, respectively. To detect epistasis QTLs, two-locus interactions were examined by whole genome scan. Interactions of five locus pairs were found to have significant effects on type I resistance with the LOD score ranging 3.8-6.5 and four of them conferred resistance in parental phase. The one with the most significant effect was Xcfd42--Xgwm469 (6D)/Xwmc390-2--Xbd04 (2A) pair. No QTL x E interaction was detected for PIS. It was found that flowering time did not have significant effects on PIS in this population. Our studies indicated that Wangshuibai is useful for breeding for both type I and type II scab resistance and the markers associated with the QTLs could be used in marker-assisted selection and isolation of scab-resistance QTLs.

Mapping QTL associated with resistance to Fusarium head blight in the Nanda2419 x Wangshuibai population. II: type I resistance

Fusarium head blight (FHB) is a serious disease in wheat and barley affecting both yield and quality. To identify genes for resistance to infection, the RIL population derived from 'Nanda2419' x 'Wangshuibai' and the parents were evaluated for percentage of infected spikes (PIS) in four different environments. Using a 2,960 cM marker framework map constructed for this population, ten chromosome regions were detected for their association with type I resistance through interval mapping with Mapmaker/QTL, among which QTLs mapped in the intervals of Xwmc349--Xgwm149 on chromosome 4B, of Xwmc96--Xgwm304 on chromosome 5A and of Xgwm408--Xbarc140 on chromosome 5B were revealed in at least three environments and have Wangshuibai as the source of resistance alleles. Qfhi.nau-4B and Qfhi.nau-5A had larger effects and explained up to 17.5 and 27.0% of the phenotypic variance, respectively. To detect epistasis QTLs, two-locus interactions were examined by whole genome scan. Interactions of five locus pairs were found to have significant effects on type I resistance with the LOD score ranging 3.8-6.5 and four of them conferred resistance in parental phase. The one with the most significant effect was Xcfd42--Xgwm469 (6D)/Xwmc390-2--Xbd04 (2A) pair. No QTL x E interaction was detected for PIS. It was found that flowering time did not have significant effects on PIS in this population. Our studies indicated that Wangshuibai is useful for breeding for both type I and type II scab resistance and the markers associated with the QTLs could be used in marker-assisted selection and isolation of scab-resistance QTLs.

Pharmacological induction of Hsp70 protects apoptosis-prone cells from doxorubicin: comparison with caspase-inhibitor- and cycle-arrest-mediated cytoprotection

Selective modulation of cell death is important for rational chemotherapy. By depleting Hsp90-client oncoproteins, geldanamycin (GA) and 17-allylamino-17-demethoxy-GA (17-AAG) (heat-shock protein-90-active drugs) render certain oncoprotein-addictive cancer cells sensitive to chemotherapy. Here we investigated effects of GA and 17-AAG in apoptosis-prone cells such as HL60 and U937. In these cells, doxorubicin (DOX) caused rapid apoptosis, whereas GA-induced heat-shock protein-70 (Hsp70) (a potent inhibitor of apoptosis) and G1 arrest without significant apoptosis. GA blocked caspase activation and apoptosis and delayed cell death caused by DOX. Inhibitors of translation and transcription and siRNA Hsp70 abrogated cytoprotective effects of GA. Also GA failed to protect HL60 cells from cytotoxicity of actinomycin D and flavopiridol (FL), inhibitors of transcription. We next compared cytoprotection by GA-induced Hsp70, caspase inhibitors (Z-VAD-fmk) and cell-cycle arrest. Whereas cell-cycle arrest protected HL60 cells from paclitaxel (PTX) but not from FL and DOX, Z-VAD-fmk prevented FL-induced apoptosis but was less effective against DOX and PTX. Thus, by inducing Hsp70, GA protected apoptosis-prone cells in unique and cell-type selective manner. Since GA does not protect apoptosis-reluctant cancer cells, we envision a therapeutic strategy to decrease side effects of chemotherapy without affecting its therapeutic efficacy.