Adalimumab Dose Reduction and Withdrawal in Stable Non-Infectious Pediatric Uveitis: An Open-Label, Prospective, Pilot Study

PURPOSES

This study investigated the feasibility of adalimumab (ADA) dose reduction and withdrawal strategy in children with stable pediatric non-infectious uveitis (PNIU).

METHODS

This open-label prospective pilot trial recruited 18 stable PNIU patients (33 eyes) between two and eighteen years old who were treated with standard doses of ADA (20/40 mg every 2 weeks) plus oral methotrexate. The interval of ADA injection was extended to 4 weeks and followed up for 24 weeks. If the uveitis remained stable, ADA was discontinued and followed up for another 24 weeks. ADA was considered successfully stopped if no relapse occurred during this period. The relapse-free survival rate, best corrected visual acuity (BVCA), anterior chamber cell (ACC), vitritis, macular thickness (MT), and serum ADA levels were evaluated. Approval Number: 2021KYPJ201. ClinicalTrials.gov identifier: NCT05155592.

RESULTS

The relapse-free survival rate was 22.2% (4/18) at 48 weeks. 33.3% (6/18) of patients relapsed when ADA was given every 4 weeks, while 44.5% of patients (8/18) relapsed after ADA was stopped. The four patients successfully withdrawn from ADA were all diagnosed with BD. No statistically significant differences (p > 0.05) were observed in BCVA and MT between baseline and final follow-up. The proportion of ACC and vitritis exhibited an upward trend (p < 0.05) during follow-up. Serum ADA gradually decreased to zero during follow-up in both non-recurrence and recurrence groups.

CONCLUSIONS

In PNIU children who reached remission for 6 months, ADA dose reduction and withdrawal were associated with a high risk of inflammation recurrence. Timely adjustment of ADA to the last effective dosage frequency can regain control of the inflammation. Detection of ADA serum levels in patients with recurrence may help find the appropriate interval of ADA use.

Chemical Constituents of a Marine-derived Fungus Fusarium oxysporum F0888 and their Antibacterial Activity

Five new compounds, including four hydroxyphenylacetic acid derivatives, stachylines H-K (1-4), a derivative of hydroxyphenylethanol (5), as well as seven known compounds were obtained from a marine-derived fungus Fusarium oxysporum F0888 isolated from sediments in the South China Sea. The structures and absolute configurations of new compounds were determined by spectroscopic (IR, NMR, and HR-ESI-MS) analyses, comparison of optical rotations, and the modified Mosher's MTPA ester method. Antimicrobial and anti-inflammatory activities of compounds 1-12 were tested. Unfortunately, all of isolated compounds were inactivity.

[Pathological features of early gastric cancer and its background mucosa after eradication of Helicobacter pylori and their implications for biopsy diagnosis]

Objective: To investigate the clinicopathological changes of early gastric cancer, especially its background mucosa, after the eradication of Helicobacter pylori (H. pylori), and to investigate the causes of underdiagnosis in preoperative biopsy pathology. Methods: Ninety cases of early gastric cancer after H. pylori eradication and 120 cases of endoscopic submucosal dissection (ESD) specimens without H. pylori eradication and their corresponding biopsy specimens were collected from Beijing Friendship Hospital Affiliated to Capital Medical University during 2016-2021. The clinicopathological data of the patients were analyzed, and the histopathological characteristics and immunophenotypic results compared. Results: Compared with the early gastric cancer without H. pylori eradication history, the histopathological type of early gastric cancer after H. pylori eradication was differentiated adenocarcinoma, with staggered distribution of cancerous and non-cancerous epithelium in the tumor area. The morphologic characteristics of gastric mucosa in the background of early gastric cancer after H. pylori eradication, were distinctive, including widening of the opening of enterosylated glandular ducts, serrated change of luminal margin, eosinophilic and microvesicular cytoplasm of enterosylated epithelium. Low-grade atypia existed in gastric cancer epithelial cells after sterilization, which might lead to underdiagnosis or missed diagnosis in biopsy pathology. Conclusions: Early gastric cancer and its background mucosa after H. pylori eradication have unique morphological characteristics, which can be used as a clue for pathological diagnosis, improve the accuracy of biopsy pathology and reduce the underdiagnosis.

[Study on the development of public health and safety literacy assessment scale for university freshmen]

Objective: To develop a measurement scale for the public health and safety literacy of university freshmen. Methods: Item pooling was conducted through literature review and in-depth interview with public health experts, and a nominal group was organized to develop the initial items to form the questionnaire. A total of 250 freshmen were randomly selected to complete the questionnaire, and the assessment of psychometric properties were performed to carry out item reduction by using classical test theory and item response theory. Exploratory factor analysis method (EFA) was employed to calculate the item-factor loadings. The data collected from another 318 freshmen were analyzed using confirmatory factor analysis method (CFA). Results: The scale contained 3 dimensions and 9 items with all content validity index ≥0.8. The difficulty coefficient of 9 items was 1.18-2.43. The discriminative validity analysis showed that the difficulty index was 0.41-0.78, and the discrimination index was 0.38-0.64. Each of the remaining items had a statistically significant difference in the score value between the top 27% and lowest 27% of respondents (t>3, P<0.05). The item's Cronbach's α was 0.72-0.77, corrected item-total correlation was 0.33-0.60 and the overall α of the scale was 0.77. EFA indicated all item-factor loading were higher than 0.680, and the accumulated variance contribution of the 3 factors was 62.484%. Results of CFA showed that the overall fitness index of the model reached the fitness standard except for the χ² value. There was no statistical significance in the total score of the scale and the scores of each item among groups with different demographic characteristics (P>0.05). Conclusions: The newly developed public health safety literacy scale had a good reliability,validity,stability and item constancy.It can be used in measurement of the public health and safety literacy of university freshmen.

[Adrenocortical oncocytic tumors: a clinicopathological analysis of 44 cases]

Objective: To study the clinicopathological features of adrenocortical oncocytic tumors (ACOT) and to compare the diagnostic values of Lin-Weiss-Bisceglia (LWB) score and Helsinki score. Methods: Forty-four cases of ACOT diagnosed at Beijing Friendship Hospital, China from March 2008 to July 2019 were histologically analyzed to evaluate their malignant potential (benign versus malignant) according to two scoring criteria. Immunohistochemical studies (EnVision method) were also used. Results: There were 23 males and 21 females with an average age of 46 years. Histologically, the tumor cells were arranged in trabecular, chrysanthemum-shaped, glandular and microcapsule structures, while clear cells were rare or absent. Most of the tumor cells were moderately atypical, and intranuclear inclusion bodies were conspicuous. Immunohistochemical staining showed that tumor cells were positive for Melan A, inhibin, Syn and calretinin. The average proliferation index was 3% in benign ACOT, about 5% in ACOT of malignant potential, and>20% in malignant ACOT. According to the LWB score, 61.4% (27/44) of the tumors were on the left side and had multiple lesions. The percentage of benign ACOT was 59.1% (26/44), malignant potential 6.8% (3/44), malignant 34.1% (15/44), respectively. Among the 15 malignant ACOT, the mitotic figures>5/50 HPF were found in 13 cases, necrosis in 11 cases and capsule invasion in 10 cases. According to the Helsinki score, 65.9% (29/44) of the tumors were benign, and 34.1% (15/44) were malignant. There was no significant difference between the two scoring standards (P>0.05). During the follow-up of 9 to 144 months, 31 patients survived without disease and 13 patients relapsed or had metastasis. Conclusions: ACOT more likely be benign than malignant. The left side is more common. Malignant tumors are prone to recurrence and metastasis. The morphological parameters (high mitotic index, necrosis, and capsular invasion) in the LWB scoring standards combined with immunohistochemical parameters (Ki-67) in the Helsinki score are helpful for the diagnosis of malignant ACOT and are important predictors of poor prognosis.

[Correlation analysis between serum ferritin level and liver damage in acute stage of dengue fever]

Objective: To investigate the correlation between serum ferritin (SF) level and liver damage in the acute stage of dengue fever. Methods: A retrospective study was conducted to analyze 171 cases diagnosed with dengue fever as dengue fever group and 130 healthy patients as control group in Hangzhou 3A grade hospital from July to December 2017. Clinical data, SF and liver function related indicators were collected from both groups: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) to analyze the correlation between liver damage and SF in patients with dengue fever. Results: ALT, AST, and SF levels were significantly higher in the dengue fever group than those in the healthy control group (Z = 11.553, 15.054 and 15.163, P < 0.001). SF levels were higher in the dengue fever combined with liver damage group than those without the liver damage group (z = 6.930, P < 0.001). However, there was no statistically significant differences in age, gender, peak body temperature, and history of liver disease (P > 0.05). In addition, Spearman's correlation analysis showed that SF was positively correlated with ALT, AST, and TBIL (r = 0.464, 0.531 and 0.315, P < 0.001). Among dengue patients with different SF levels, there were significant difference in ALT, AST levels and incidence of liver damage (H = 14.240 and 17.584, χ(2) = 49.547, P < 0.001). Patients with higher SF levels had higher ALT, AST levels and incidence of liver damage. Binary logistic regression analysis showed that hyperferritinemia (SF≥500 ng/ml) was the risk factor for dengue fever combined with liver damage (OR = 8.120, P < 0.001). Furthermore, ROC curve analysis showed that the AUC for SF to judge dengue fever combined liver damage was 0.846 (95% CI: 0.785-0.908), and the sensitivity and specificity when the SF cut-off value was 1 506 ng/ml were 74.8% and 83.3%. Conclusion: There is a certain correlation between the SF level and the degree of liver damage in acute stage of dengue fever patients, and hyperferritinemia is a risk factor for dengue fever combined with liver damage.

Highly efficient polarization-entangled photon-pair generation in lithium niobate waveguides based on bound states in continuum

Integrated optics provides a platform for the experimental implementation of highly complex and compact circuits for practical applications as well as for advances in the fundamental science of quantum optics. The lithium niobate (LN) waveguide is an important candidate for the construction of integrated optical circuits. Based on the bound state in the continuum (BIC) in a LN waveguide, we propose an efficient way to produce polarization-entangled photon pairs. The implementation of this method is simple and does not require the polarization process needed for periodically poled LN. The generation rate of the entangled photon pairs increases linearly with the length of the waveguide. For visible light, the generation efficiency can be improved by more than five orders of magnitude with waveguides having the length of only a few millimeters, compared with the corresponding case without BICs. The phenomena can appear in a very wide spectrum range from the visible to THz regions. This study is of great significance for the development of active integrated quantum chips in various wavelength ranges.

[Anti-PD-1 therapy in advanced malignant liver tumor-induced type-1 diabetes mellitus: a case report]

Immune checkpoint inhibitor (ICI) has been emerged as a major breakthrough in tumor immunotherapy, but its unique mechanism of action has also led to a number of immune-related adverse events (irAE). Type 1 diabetes mellitus (T1DM) is one of the rarest irAEs. This paper reports a case of advanced malignant liver tumor-induced T1DM who received second-line anti-PD-1 therapy and showed initial symptoms of hyperosmolar coma and hyperglycemia. In addition, the relevant literature at home and abroad was collected and reviewed, and the clinical characteristics of T1DM induced by anti-PD-1 therapy were summarized with a view to achieve early detection, diagnosis and treatment.

Strong terahertz magneto-optical phenomena based on quasi-bound states in the continuum and Fano resonances

We propose new ways to produce strong terahertz (THz) magneto-optical phenomena from monolayer graphene based on bound states in the continuum (BICs) and Fano resonances. The BICs and Fano resonances of radiation modes in the monolayer graphene are realized by designing the photonic crystal slab-graphene-slab structure. Based on them, the magnetic circular dichroism near 100% has been achieved. Importantly, such magneto-optical phenomena can be modulated in intensity and frequency using only electrostatic doping at a fixed magnetic field. Comparing two ways to produce magneto-optical phenomena, it is found that the way based on BICs exhibits some advantages such as good electrical tenability due to narrower resonance width, higher conversion efficiency and more stability with the change of incident angle. These phenomena can appear in a broad THz range by designing the nanostructures, which are very beneficial to polarization conversion and optoelectronic devices.

[Relationship of TLR2 and TLR4 expressions on the surface of peripheral blood mononuclear cells to small intestinal bacteria overgrowth in patients with hepatocellular carcinoma]

Objective: To investigate TLR2 and TLR4 expressional situation on the surface of peripheral blood mononuclear cells (PBMC) in patients with hepatocellular carcinoma (HCC) and their relationship with small intestinal bacterial overgrowth (SIBO). Methods: Flow cytometry was used to detect TLR2 and TLR4 expressional situation on the surface of PBMC in 78 cases with HCC, 56 cases with cirrhosis and 33 healthy controls. Furthermore, lactose hydrogen breath test (LHBT) was used to detect small intestinal bacterial overgrowth. Results: Of the 78 cases with HCC, 56 cases (71.8%) were SIBO-positive, 23 cases (41.1%) were SIBO- positive in 56 cases with cirrhosis, and 1 (3.0%) was SIBO-positive in 33 healthy controls. The incidence of SIBO in HCC patients was higher than cirrhosis patients (χ(2) = 12.72, P < 0.05) and healthy controls (χ(2) = 41.18, P < 0.05). The expression levels of TLR2 and TLR4 in HCC patients (100.55 ± 24.22, 42.76 ± 15.96) were significantly higher than cirrhosis (67.42 ± 18.36, 24.38 ± 8.68)and healthy control group (33.06 ± 11.72, 12.52 ± 4.46) (P < 0.05). Furthermore, the expression levels of TLR2 and TLR4 in SIBO-positive patients (108.75 ± 20.40, 48.1 ± 14.98) were higher than SIBO-negative patients (79.67 ± 20.60, 28.62 ± 7.36) (P < 0.05). Conclusion: The expression of TLR2 and TLR4 and the incidence of SIBO in HCC patients are significantly higher than cirrhosis and healthy control group. Moreover, the high expressions of TLR2 and TLR4 in SIBO-positive HCC patients may promote the development of HCC.

[A clinicopathological analysis of 21 cases of hepatolenticular degeneration]

Objective: To improve the diagnostic quality of hepatolenticular degeneration by summarizing the clinicopathological features. Methods: A retrospective analysis of 21 cases that were diagnosed as hepatolenticular degeneration with liver biopsy in our hospital from January 2013 to August 2018 was reviewed, and then their clinicopathologic features were analyzed. The pathomorphological differences between liver biopsy and liver biopsy after transplantation, and the relationship between histopathological patterns and biopsy types and clinical indicators were analyzed by Fisher's exact test. Results: Of the 21 patients with hepatolenticular degeneration, 10 patients had liver biopsy, and 11 patients underwent liver biopsy after liver transplantation. Among them, four cases were presented as simple fatty liver pattern (19.0%, 4/21), eight cases as steatohepatitis pattern (38.1%, 8/21), four cases as inflammatory necrosis without cirrhosis pattern (19.0%, 4/21), and five cases as inflammatory necrosis with cirrhosis pattern (23.9%, 5/21). Twelve cases had copper deposition in the liver (57.1%, 12/21), and the pattern of copper distribution in the liver was uneven. Conclusion: A clinicalpathological features of hepatolenticular degeneration mainly manifests in four patterns, but lack characteristic changes. Hence, comprehensive judgment should rely on clinical history, laboratory examination, genetic test results and liver histopathological changes.

[Advances in the research of effects of glutamine on immune function of burn patients]

Glutamine is the most abundant amino acid found in plasma and cells. It is the preferred fuel for enterocytes in the small intestine, macrophages, and lymphocytes. After serious burn, increased requirement of glutamine by the gastrointestinal tract, kidney and lymphocytes, and relatively insufficient self synthesis likely contribute to the rapid decline of glutamine in circulation and cells. Glutamine supplementation can not only protect intestinal mucosa, maintain normal intestinal barrier function, reduce bacterial translocation, and enhance the intestinal immune function, but also increase the number of lymphocytes, enhance the phagocytic function of macrophage, promote the synthesis of immunoglobulin, and reduce the body's inflammatory response, so as to enhance the immune function. Therefore, glutamine supplementation can improve and enhance the immune function, reduce complications and promote the prognosis of severely burned patients.

First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study

BACKGROUND

Icotinib has been previously shown to be non-inferior to gefitinib in non-selected advanced non-small-cell lung cancer patients when given as second- or further-line treatment. In this open-label, randomized, phase 3 CONVINCE trial, we assessed the efficacy and safety of first-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance in lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutation.

PATIENTS AND METHODS

Eligible participants were adults with stage IIIB/IV lung adenocarcinoma and exon 19/21 EGFR mutations. Participants were randomly allocated (1 : 1) to receive oral icotinib or 3-week cycle of cisplatin plus pemetrexed for up to four cycles; non-progressive patients after four cycles were maintained with pemetrexed until disease progression or intolerable toxicity. The primary end point was progression-free survival (PFS) assessed by independent response evaluation committee. Other end points included overall survival (OS) and safety.

RESULTS

Between January 2013 and August 2014, 296 patients were randomized, and 285 patients were treated (148 to icotinib, 137 to chemotherapy). Independent response evaluation committee-assessed PFS was significantly longer in the icotinib group (11.2 versus 7.9 months; hazard ratio, 0.61, 95% confidence interval 0.43-0.87; P = 0.006). No significant difference for OS was observed between treatments in the overall population or in EGFR-mutated subgroups (exon 19 Del/21 L858R). The most common grade 3 or 4 adverse events (AEs) in the icotinib group were rash (14.8%) and diarrhea (7.4%), compared with nausea (45.9%), vomiting (29.2%), and neutropenia (10.9%) in the chemotherapy group. AEs (79.1% versus 94.2%; P < 0.001) and treatment-related AEs (54.1% versus 90.5%; P < 0.001) were significantly fewer in the icotinib group than in the chemotherapy group.

CONCLUSIONS

First-line icotinib significantly improves PFS of advanced lung adenocarcinoma patients with EGFR mutation with a tolerable and manageable safety profile. Icotinib should be considered as a first-line treatment for this patient population.

[Efficiency of FibroScan and FibroTouch in liver stiffness measurement and fat quantification: a comparative analysis]

Objective: To investigate the efficiency of FibroScan(FS)and FibroTouch(FT)in liver stiffness measurement(LSM)and fat quantification through a comparative analysis. Methods: The outpatients or hospitalized patients who underwent LSM and fat quantification using FS and FT were enrolled. The differences in success rate and detecting parameters between FS and FT were analyzed, as well as the correlation between FS and FT values. The t-test was used for comparison of normally distributed continuous data between groups, and a one-way analysis of variance or the Kruskal-Wallis test was used for comparison between multiple groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results: A total of 1621 patients were enrolled. The success rates of FT and FS were 100% and 94.96%, respectively, and the success rate of FS was influenced by sex, age, body mass index, and biochemical markers of liver function. FT has a significantly shorter duration of single detection and a significantly lower number of times of single detection than FS(duration of single detection: 190.21±38.78 s vs 220.89±68.36 s, P < 0.01; number of single detection times: 10.31±1.32 vs 11.81±3.76, P < 0.01), as well as a significantly lower ratio of interquartile range to median of fat quantification in the same patient(5.39%±4.81% vs 17.18%±14.07%, P < 0.01). The LSM and fat quantification of FS were significantly correlated with those of FT(r = 0.645 and 0.620, both Based on the duration and number of times of single detection, success rate, and stability of fat quantification, FT seems to have a better detection efficiency than FS. The detection values of FT and FS can be calculated with regression equations < 0.01). The equations of linear regression were LSM(FT)= 4.435+0.477×LSM(FS); CAP(FT)= 134.71+0.456×CAP(FS). Conclusion: Based on the duration and number of times of single detection, success rate, and stability of fat quantification, FT seems to have a better detection efficiency than FS. The detection values of FT and FS can be calculated with regression equations.

[A serum lipidomic study of patients with non-alcoholic fatty liver disease]

Objective: To investigate the serum lipidomic profile in patients with nonalcoholic fatty liver disease (NAFLD), and to analyze the lipid metabolism characteristics of NAFLD. Methods: The subjects were divided into control group (23 patients) and pathologically confirmed NAFLD group (42 patients), and ultra-high-performance liquid chromatography-tandem mass spectrometry was used to measure serum lipidomic metabolites. The partial least squares-discriminant analysis (PLS-DA) model was established to analyze the differences in lipid metabolism with reference to the univariate analysis. The t-test and Mann-Whitney U test were used for data analysis. Results: A total of 239 lipids were identified and qualitative and quantitative analyses were performed. The PLS-DA model (R2 = 0.753, Q2 = 0.456) and the univariate analysis showed that 77 lipids were metabolized differentially between the NAFLD group and the control group (VIP > 1, P < 0.05), including free fatty acid, phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, lysophosphatidylcholine, lysophosphatidylinositol (LPI), choline plasmalogen (PlsCho), ethanolamine plasmalogen (PlsEtn), ceramide (Cer), sphingomyelin, and triglyceride (TG). Compared with the control group, the NAFLD group had significant increases in monounsaturated fatty acids (increased by 39%, t = -3.954, P < 0.05) and TGs (increased by 36%, Z = -2.662, P < 0.05), mainly TGs with low numbers of carbon atoms and unsaturated bonds, while there were reductions in TGs with high numbers of carbon atoms and unsaturated bonds. In addition, compared with the control group, the NAFLD group had significant increases in the levels of LPI (increased by 223%, t = -3.858, P < 0.05) and Cer (increased by 21%, t = -2.481, P < 0.05) and significant reductions in PlsCho (reduced by 18%, t = 3.184, P < 0.05) and PlsEtn (reduced by 20%, t = 2.363, P < 0.05). Conclusion: There is a significant difference in lipid metabolism profile between NAFLD patients and healthy people, and a serum lipidomic analysis of NAFLD helps to further clarify the characteristics of lipid metabolism in patients with NAFLD.

[A clinical study of the association between hepatic controlled attenuation parameter and metabolic syndrome]

Objective: To investigate the association between hepatic controlled attenuation parameter (CAP) and metabolic syndrome (MetS) and the correlation of CAP and its changes with the incidence of MetS. Methods: A total of 2461 subjects who underwent physical examination from July 2013 to September 2015 were enrolled. Spearman correlation analysis was used to investigate the correlation of CAP with the number of MetS components and each MetS component, and the chi-square test was used to investigate the prevalence rates of MetS and each component under different CAP levels. Logistic regression analysis was used to analyze the odds ratio (95% confidence interval (CI)) of MetS under different CAP levels. A total of 230 subjects without baseline MetS were selected; in a prospective cohort study, these subjects were divided into groups according to the baseline CAP, change in CAP, and percent change in CAP, and the chi-square test was performed to compare the incidence of MetS. The Cox regression analysis was used to analyze the values of baseline CAP, change in CAP, and percent change in CAP in predicting MetS. Results: CAP was positively correlated with the number of MetS components (r = 0.309, P < 0.01) and significantly correlated with all components. There were significant differences in the prevalence rates of MetS and its components under different CAP levels (< 238 dB/m, 238-258 dB/m, 259-291 dB/m, and ≥292 dB/m) (P < 0.05). After the adjustment for sex and age, with < 238 dB/m as a reference, the odds ratios (95% CI) of MetS in patients with CAP levels of 238-258 dB/m, 259-291 dB/m, and ≥292 dB/m were 1.784 (1.369-2.325), 2.936 (2.292-3.760), and 4.363 (3.435-5.543), respectively (all P < 0.05). Follow-up data showed that 28 patients (12.2%) developed MetS. After the adjustment for related factors, the hazard ratios (95% CI) of MetS in patients with baseline CAP > 238 dB/m, change in CAP > 30 dB/m, and percent change in CAP > 25.0% were 3.337 (1.163-9.569), 7.732 (2.453-24.366), and 11.656 (3.329-40.813), respectively (all P < 0.05). Conclusion: CAP is closely associated with MetS and its components. CAP and its change can be used to predict the risk of MetS.

Effect of zinc-bearing zeolite clinoptilolite on growth performance, zinc accumulation, and gene expression of zinc transporters in broilers

This study investigated Zn-bearing zeolite clinoptilolite (Zn-ZCP) as a Zn supplement on performance, organ or tissue development, Zn accumulation in tissues, and gene expression of Zn transporters in the duodenum of broilers. A total of 300 1-d-old Arbor Acres chickens were randomly allocated to 5 dietary treatments with 6 replicate cages of 10 birds per treatment for a 21-d feeding period. The treatments comprised a basal corn–soybean meal diet without supplemental Zn (the control) or similar diets supplemented with 80 mg/kg Zn from ZnSO4 or 20, 40, or 80 mg/kg Zn from Zn- ZCP, respectively. Supplementation of Zn-ZCP had a positive effect on G:F (linear, P < 0.05) and had tendency difference on ADG (linear, P < 0.1) of broilers during 1 to 21 d. Incremental Zn-ZCP inclusion in the diet increased the fresh weight of the pancreas (linear, P < 0.05) and tibia (linear, P < 0.05) in broilers on d 14. The same trend to the fresh weight of the tibia (linear, P < 0.05) and pancreas (linear, P < 0.05) was observed on d 21. Increasing Zn-ZCP level showed a linear response on Zn concentration in the liver (linear, P < 0.001), pancreas (linear, P < 0.05), and tibia (linear, P < 0.05) on d 14. The same trend of Zn concentrations in pancreas (linear, P < 0.05) and tibia (linear, P < 0.001) was observed on d 21. The mRNA levels of Zn transporter 2 (ZnT-2) and Zn transporter 5 (ZnT-5) in the duodenum of chicks fed the diet with 80 mg/kg Zn from Zn-ZCP did not differ from those of chicks fed the control diet, but both were lower (P < 0.05) than those of chicks fed ZnSO4 diet. Metallothionein (MT) mRNA levels of broilers fed the diet supplemented with 80 mg/kg Zn from Zn-ZCP or ZnSO4 was higher (P < 0.05) than that in the control group. Dietary treatments did not affect the mRNA expression of Zn transporter 1 (ZnT-1) or metal response element-binding transcription factor-1 (MTF-1). In conclusion, as a Zn supplement, Zn-ZCP was comparable to ZnSO4 for enhancing Zn accumulation and growth performance of broilers during 1 to 21 d. Broilers fed the diet with 80 mg/kg Zn from Zn-ZCP had different expressions of ZnT-2 and ZnT-5 in the duodenum compared with those fed the ZnSO4 diet.

Effects of high thoracic epidural anesthesia on ischemic cardiomyopathy cardiac function and autonomic neural function

We aimed at observing the effects of high thoracic epidural anesthesia (HTEA) on cardiac structure and function, heart rate variability (HRV), and QT interval variation (QTV) in ischemic cardiomyopathy (ICM) patients with chronic heart failure. We divided 30 ICM patients into HTEA (N = 16) and control (N = 14) groups.The control group was treated with medication, and the HTEA group was treated with HTEA and medication for 4 weeks. We measured the changes in the left-ventricular end-diastolic diameter (LVEDd) and left-ventricular ejection fraction (LVEF) before and after treatment by using echocardiography and examined changes in HRV and QTV using ambulatory electrocardiogram. HTEA significantly narrowed the LVEDd, improved LVEF, significantly increased the HRV, and significantly reduced the QTV in the ICM group compared to the control group. HTEA significantly narrowed the ventricular chamber diameter size of ICM patients, enhanced myocardial contractility, increased myocardial electrical stability, and improved the cardiac structure and function.

Intensive insulin therapy in severe acute pancreatitis: a meta-analysis and systematic review

OBJECTIVE

To assess the effect of intensive insulin therapy on outcomes of patients with severe acute pancreatitis.

METHODS

Relevant literatures cited in these electronic databases: Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNK1) database, and Excerpta Medical database (Embase) were systematically searched for randomized controlled trials (RCTs) in which intensive insulin therapy was used in severe acute pancreatitis. Length of hospitalization, acute physiology and chronic health evaluation II (APACHE II) score, incidence of complications, and adverse effects were recorded for statistical analysis. The methodological quality of the eligible studies was assessed by Jadad scale. The results were analysed by Revman 4.3 software.

RESULTS

Three studies, which included a total of 118 cases, were finally reviewed. The methodological quality of the trials varied substantially In patients with severe acute pancreatitis, intensive insulin therapy was associated with shorter length of hospitalization (weighted mean difference (WMD) = -12.13, 95% confidence interval (CI) [-15.48, 8.78], p > 0.00001) and lower APACHE II score after 72 hours treatment (WMD = -3.80, 95% CI [-4.88,2. 72], p > 0.00001). One study reported insulin-related adverse event.

CONCLUSION

In patients with severe acute pancreatitis, intensive insulin therapy could relieve the patient's condition earlier and shorten the length of hospitalization without serious adverse effect.

Compact optical microfiber phase modulator

A compact optical microfiber phase modulator with MHz bandwidth is presented. A micrometer-diameter microfiber is wound on a millimeter-diameter piezoelectric ceramic rod with two electrodes. When a voltage is applied to the piezoelectric ceramic, the rod is strained, leading to a phase change along the microfiber; because of the small size, the optical microfiber phase modulator can have as high as a few MHz bandwidth response.

Theoretical and experimental demonstrations of a microfiber-based flexural disc accelerometer

The proof-of-concept demonstration of a microfiber-based flexural disc accelerometer is presented. The reduced microfiber size and bending radii give rise to high device compactness and responsivity. A flexural disc accelerometer manufactured from a 10 mm long microfiber showed a performance of ~2.2 rad/g, with the responsivity expected to increase proportionally with the microfiber length.

Top-down heating for low substrate temperature synthesis of carbon nanotubes

A top-down heating method to allow for low-temperature large area synthesis of carbon nanotubes using plasma-enhanced chemical vapour deposition is introduced in this paper. The approach utilizes top-down electromagnetic heating rather than conventional heating from a substrate heater under the electrode. A temperature gradient is created between the Ni catalyst surface and the substrate using a metal thermal control barrier layer, on which carbon nanotubes are grown as a function of the bias voltage, hydrocarbon concentrations and growth conditions. The heat during growth is provided by the plasma or energy coupling to the catalyst via top-down heating, which based on the coupled power density and the cooling of the substrate, in addition to the thermal 'barrier layer' properties will dictate the temperature of the growth surface. This unique approach of top-down heating with suitable cooling schemes, coupled with thermal barriers allows for the low substrate temperature synthesis of carbon nanotubes, scalable to large areas.

Ultraviolet upconversion fluorescence in rare-earth-ion-doped Y2O3 induced by infrared diode laser excitation

Room-temperature ultraviolet emission of Tm(3+) ions at 298 ((1)I(6)-->(3)H(6)), 364 ((1)D(2)-->(3)H(6)), and 391 nm ((1)I(6)-->(3)H(5)) was obtained in Y(2)O(3):Yb(3+)-Tm(3+) by continuous-wave diode laser excitation of 980 nm. Power dependence analysis demonstrates that five- and six-photon upconversion processes populate the (1)D(2) and (1)I(6) states, respectively. We believe that the (1)D(2) population originates from the cross relaxation (1)G(4)+(3)F(4)-->(3)H(4)+(1)D(2) of the Tm(3+) ions, while subsequent energy transfer from Yb(3+) to Tm(3+) excites the (1)D(2) state to the upper (1)I(6) state. High multiphoton-induced ultraviolet emission is also expected for other trivalent rare-earth ions similar to Tm(3+).

Polyurea-Functionalized Multiwalled Carbon Nanotubes: Synthesis, Morphology, and Raman Spectroscopy

An in situ polycondensation approach was applied to functionalize multiwalled carbon nanotubes (MWNTs), resulting in various linear or hyperbranched polycondensed polymers [e.g., polyureas, polyurethanes, and poly(urea-urethane)-bonded carbon nanotubes]. The quantity of the grafted polymer can be easily controlled by the feed ratio of monomers. As a typical example, the polyurea-functionalized MWNTs were measured and characterized in detail. The oxidized MWNTs (MWNT-COOH) were converted into acyl chloride-functionalized MWNTs (MWNT-COCl) by reaction with neat thionyl chloride (SOCl2). MWNT-COCl was reacted with excess 1,6-diaminohexane, affording amino-functionalized MWNTs (MWNT-NH2). In the presence of MWNT-NH2, the polyurea was covalently coated onto the surfaces of the nanotube by in situ polycondensation of diisocyanate [e.g., 4,4'-methylenebis(phenylisocyanate)] and 1,6-diaminohexane, followed by the removal of free polymer via repeated filtering and solvent washing. The coated polyurea content can be controlled to some extent by adjusting the feed ratio of the isocyanato and amino groups. The structure and morphology of the resulting nanocomposites were characterized by FTIR, NMR, Raman, confocal Raman, TEM, EDS, and SEM measurements. The polyurea-coated MWNTs showed interesting self-assembled flat- or flowerlike morphologies in the solid state. The signals corresponding to that of the D and G bands of the carbon nanotubes were strongly attenuated after polyurea was chemically tethered to the MWNT surfaces. Comparative experiments showed that the grafted polymer species and structures have a strong effect on the Raman signals of polymer-functionalized MWNTs.

[Environmental investigation in areas where Anopheles anthropophagus distributed in Hubei Province]

OBJECTIVE

To investigate the natural and socio-economical environment in the areas where Anopheles anthropophagus distributed in Hubei Province.

METHODS

5% of the villages in distribution area of An. anthropophagus were randomly selected for the investigation which included vegetation, soil, water, temperature, farming, resting places of the mosquito.

RESULTS

The vegetation of An. anthropophagus area consisted of forest, bush, sod and crops. The area was densely covered with river, ditches and ponds, the water pH being 6.1-7.7. The soil texture was either yellow, yellow brown, grey or black, contained 2.72% organic material. There were one or two seasons of rice plantation in the area and the amount of insecticide used was 0.828 kg/mu in the rice field. The annual average temperature was 16.9 degrees C and the humidity was 76.9%. The breed period of An. anthropophagus was from June to September. There are two peaks of mosquito population in area with two seasons of rice plantation, and one peak in one rice season. The composition of An. anthropophagus resting in households, cowsheds and pigpens was 80.9%, 12.2% and 6.0%, respectively.

CONCLUSION

The distribution of An. anthropophagus was in point, flaky or belt form in low hill, hillock, shallow hilly plain. These areas were full of vegetation and source of water, the principal crop was single cropping of rice, and soil texture is yellow or yellow brown. The major resting place of the mosquito was human dwellings.

A new 3-D display method for 12-lead ECG

A new three-dimensional (3-D) 12-lead electrocardiogram (ECG) display method is presented which employs a 3-D rectangular coordinate system to display the 12-lead cardiac electric signals in two 3-D graphs. The 3-D graph consists of a temporal axis representing the time domain of the cardiac signals, a spatial axis representing the lead positions, and an amplitude axis representing the voltages of the cardiac signals. The six horizontal plane leads and the other six frontal plane leads were displayed in two 3-D graphs, respectively. The voltages of the cardiac signals were represented in rainbow-like colors. Cubic interpolation was employed to insert interconnecting points between neighboring leads on each plane and to smooth the surface of the 3-D ECG graphs. The 3-D ECG graphs of a normal subject, a patient with myocardial infarction, and a patient with left bundle branch block were presented in this paper. This new display method could not only be used as a complementary display method to the 12-lead ECG, but also provide physicians with an overall integral view about the spatial distribution of the cardiac signals.

Functional analysis of promoter activity of murine beta-1,6-N-acetylglucosaminyltransferase

In the mouse, beta-1,6-N-acetylglucosaminyltransferase (IGnT) forms branches in poly-N-acetyllactosamines, which are good scaffolds for oncodevelopmental cell-surface antigens and recognition markers. There are two isoforms of IGnT, IGnT A and B, which are produced by alternative splicing of the IGnT gene; the unique portion is encoded by exon 1 and common portion is encoded by exons 2 and 3. Thus, the expression of each isoform is controlled by a different promoter. Here, we identified the regulatory regions of the mouse IGnT A and B genes. The promoter regions for IGnT A and B did not contain putative TATA or CAAT boxes, but each contained GT boxes. The upstream regulatory region of each gene was examined by transient luciferase reporter gene transfection experiments and gel mobility shift assay. Promoter activity for each gene was detected in F9 embryonal carcinoma cells, which express IGnT A and B, but not in N2a cells, which do not express the gene. Deletion analysis demonstrated that the regions 308 bp upstream from the transcriptional initiation site of IGnT A and 430 bp upstream from the transcriptional initiation site of IGnT B showed minimal promoter activity. Mutation of the single GT box in IGnT A and two GT boxes in IGnT B caused marked reduction of the promoter activity. These findings provided strong evidence that the GT boxes play crucial roles in transcriptional regulation of the genes.

Glypican-2 binds to midkine: the role of glypican-2 in neuronal cell adhesion and neurite outgrowth

Cell-surface heparan sulfate proteoglycans participate in molecular events that regulate cell adhesion, migration, and proliferation. The present study was performed to elucidate whether glypican-2 plays a role in interactions of neurons with midkine (MK), a heparin-binding neuroregulatory factor. MK bound to heparan sulfate chains of glypican-2 in a manner similar to syndecan-3. Microbeads coated with MK or poly-L-lysine induced clustering of glypican-2 as well as syndecan-3. Substratum-bound MK or poly-L-lysine induced cell adhesion of N2a neuroblastoma cells, while only MK promoted neurite outgrowth of these cells. Ligation of cell-surface glypican-2 with MK or an antibody against epitope-tagged glypican-2 induced cell adhesion and promoted neurite outgrowth. These results verified that cell-surface glypican-2 bound to MK and suggested that MK-glypican-2 interactions participate in neuronal cell migration and neurite outgrowth. In addition, we observed different localization of epitope-tagged glypican-2 and syndecan-3 on the surface of N2a cells; the result suggested that they may play different roles in MK-mediated neural function.

[Study on the essential oil components in Thymus quinquecostatus Celak]

AIM

To analyse the essential oil components of Thymus quinquecostatus Celak.

METHODS

Gas chromatography/mass spectrometry were used.

RESULTS

A total of 78 components were separated. 34 of them were identified, which accounted for 95.93% of the total peak area. The main constituents are o-cymene, carvacrol, caryophyllene, 2-isopropyl-1-methoxy-4-methylbenzene and gamma-terpene.

CONCLUSION

Thymus quinquecostatus Celak has perfume and medical development value.

A novel variant form of murine beta-1, 6-N-acetylglucosaminyltransferase forming branches in poly-N-acetyllactosamines

A novel form of murine beta-1,6-N:-acetylglucosaminyltransferase that forms branches in poly-N:-acetyllactosamines (designated as IGnT B) was cloned based on sequence homology to the known IGnT (designated as IGnT A). When expressed as proteins, IGnT B showed higher specific activity than IGnT A. The C-terminal 1/4 of IGnT B was identical to that of IGnT A, while the rest of the predicted sequences showed 63% identity. Genomic analysis indicated that IGnT A and IGnT B were derived by alternative splicing; the unique portion was encoded by exon 1, and the common portion was encoded by exons 2 and 3. IGnT B showed an expression profile closely related to that of IGnT A and was strongly expressed in the liver, kidney and intestine, and moderately in the mammary gland, submaxially gland, embryonic stem cells, and embryonal carcinoma cells. The specificity of IGnT B examined using various substrates was indistinguishable from that of IGnT A, which is classified as the central acting IGnT (cIGnT). Thus, IGnT B acted on Galbeta1-4GlcNAcbeta1-3Galbeta1-4Glc, but not on GlcNAcbeta1-3Galbeta1-4Glc. It formed branches in both of the internal galactosyl residues of Galbeta1-4Glc-NAcbeta1-3Galbeta1-4GlcNAcbeta1-++ +3Galbeta1-4Glc, and prolonged incubation resulted in production of the di-branched oligosaccharide. Although addition of sialic acid to the terminal galactosyl residue did not abolish the acceptor activity, alpha2-6 sialylation was a preferred one as compared to alpha2-3 sialylation.

Application of hemodilution in microsurgical free flap transplantation

The intra-operative hemodilution and blood auto-transfusion is a blood-saving technique that can be performed when major blood loss is expected. The effects of this technique were studied in 30 microsurgical free flap transplantation patients. Between 400-600 ml blood was collected from the patients before surgery. The patients received dextran, a balanced salt solution, and glucose with the ratio of 3:1 to the collected blood volume, bleeding, and urine before the blood auto-transfusion. There were no significant changes in RBC, HCT, MCV, blood pressure, or heart rate. Of the 30 free flaps, 28 were successful with a 93.3% survival rate. The safety of intra-operative hemodilution and autologous blood transfusion in microsurgery as well as the effect of hemodilution on transplanted flap survival are discussed in this study.

Effect of different recumbent positions on spectral indices of autonomic modulation of the heart during the acute phase of myocardial infarction

OBJECTIVE

To examine which recumbent position can lead to the highest vagal modulation in patients during the acute phase of myocardial infarction.

DESIGN

Descriptive study.

SETTING

Intensive care unit in a medical center.

PATIENTS

A total of 52 patients admitted to the intensive care unit because of acute myocardial infarction (AMI), 41 patients with coronary artery disease (CAD), and 28 patients with patent coronary arteriogram.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Heart rate variability analysis was performed in patients with AMI, patients with CAD, and patent coronary controls in supine, left lateral decubitus, and right lateral decubitus positions in random order. In the right lateral decubitus position, the vagal modulation was the highest and the sympathetic modulation was the lowest among three recumbent positions in three groups of patients. When the position was changed from supine to right lateral decubitus, the increase in vagal modulation was greater in patients who had more severely depressed vagal modulation in the supine position and the rate of increase was the greatest in patients with AMI, followed by patients with CAD and patent coronary controls. Detailed analysis showed that the vagal enhancing and sympathetic suppression effect of the right lateral decubitus position applied to patients with Q wave myocardial infarctions.

CONCLUSIONS

The right lateral decubitus position can lead to the highest vagal modulation and the lowest sympathetic modulation among three recumbent positions in patients with Q wave myocardial infarction. The right lateral decubitus position can be used as an effective vagal enhancer in patients with Q wave myocardial infarction but without severe bradycardia or atrioventricular block.

The impact of overall treatment time on outcomes in radiation therapy for non-small cell lung cancer

PURPOSE

A retrospective study was carried out to evaluate the impact of overall treatment time (OTT) on the results of radiation therapy for non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

From Jan. 1990 to Dec. 1996, 256 patients with stages I-IIIb NSCLC entered this analysis. All patients received definitive radiotherapy. Biologically effective dose (BED) was used to standardize the irradiation effects. The correlation between OTT and local progression-free survival was analyzed by linear-regression and Cox proportional hazard models. The prognostic variables for survival and distant metastasis were also briefly studied.

RESULTS

OTT had been shortened in 64 patients because of an accelerated hyperfractioned irradiation, while OTT was prolonged i n 114 patients due to interruptions of irradiation courses. The main ca uses of interruption were machine breakdown or delayed preparations of c errobend block for boost fields (55%), holidays (11%) and treatment toxi city and side effects (34%). Patients tre ated with prolonged OTT (> 45 days) had significant poorer local progression-free survival than whom with OTT of </=45 days, 1, 3 and 5 year actuarial local progression-free survivals being 49, 17 and 15% for the former, and 74, 35 and 25% for the latter, respectively (P<0.001). BED-T that contained the factor of OTT correlated directly to local controls, which implied that BED-T represented radiobiological effects accurately, in other words, OTT had played a role in determining the radiobiological effects. Linear-regression on 103 cases treated with BED of 80-85 Gy(10) showed that 3 year local progression-free survival decreased by 9% per week with prolongation of OTT, or vice versa it increased by 9% per week with shortening OTT in an OTT range of 30-76 days. Cox multivariate analyses confirmed that OTT was an independent prognostic factor for local controls.

CONCLUSION

OTT may have played an important role in determining local controls in radiotherapy for NSCLC. One should always keep in mind to make the OTT as short as possible, provided the patients can tolerate it, and to reduce irradiation interruptions for whatever reasons to a minimum.

Biphasic changes in autonomic nervous activity during pregnancy

To understand the sequential response of the autonomic nervous system to pregnancy, we studied heart rate variability in 23 first trimester, 23 second trimester and 21 third trimester pregnant women. Twenty non-pregnant women were recruited as controls. Time and frequency domain measures of heart rate variability in three recumbent positions were compared. We found that normalized high-frequency power in the supine position increased significantly in the first trimester (42.2 (95% confidence interval (CI) 5.4) nu (normalized unit); P < 0.05) compared with non-pregnant controls (33.0 (6.0) nu), and then decreased progressively in the second (27.3 (6.7) nu) and third (21.8 (6.0) nu; P < 0.05) trimesters. The low-/high-frequency power ratio in the supine position decreased significantly in the first trimester (0.8 (0.3); P < 0.05) compared with that of non-pregnant controls (1.1 (0.3)) and increased progressively in the second (1.5 (0.4)) and third (2.1 (0.8); P < 0.05) trimesters. When the position was changed from the supine to the right lateral decubitus, the percentage change in normalized high-frequency power correlated significantly and negatively with normalized high-frequency power in the supine position in non-pregnant controls (r = -0.56, P = 0.01) and in pregnant women in the first (r = -0.44, P = 0.034), second (r = -0.68, P < 0.001) and third (r = -0.68, P < 0.001) trimesters. These results indicate that autonomic nervous activity shifted towards a lower sympathetic and higher vagal modulation in the first trimester, and changed towards a higher sympathetic and lower vagal modulation in the third trimester as gestational age increased. The balance between the haemodynamic changes of pregnancy and aortocaval compression caused by the enlarging gravid uterus may be responsible for the biphasic changes in autonomic nervous activity during pregnancy.

Return of autonomic nervous activity after delivery: role of aortocaval compression

We have compared measures of heart rate variability (HRV) in 15 women in late pregnancy before and 3 months after delivery and in 20 non-pregnant controls, to study the effect of aortocaval compression on autonomic nervous activity. Normalized high-frequency power was used as an index of vagal activity and the low-/high-frequency power ratio as index of sympathovagal balance. We found that the decrease in vagal activity and increase in sympathovagal balance before delivery returned to normal 3 months after delivery. Percentage changes in vagal activity and sympathovagal balance 3 months after delivery in the left lateral decubitus position were least among three recumbent positions. The relief of aortocaval compression as a result of delivery of the fetus may be the main cause of return of autonomic nervous activity 3 months after delivery. Postpartum hormonal changes may also contribute to return of autonomic nervous activity after delivery.

Comparison of supine and upright positions on autonomic nervous activity in late pregnancy: the role of aortocaval compression

In order to understand the effect of aortocaval compression on autonomic nervous activity, we compared the effects of supine and upright postures on measures of heart rate variability in late pregnancy. Thirty-two women in late pregnancy and 23 nonpregnant age-matched women were studied. Both time and frequency domain heart rate variability measures were compared between the supine and upright positions, and between pregnant women and controls. The pregnant women had smaller mean RR interval, standard deviation of RR intervals and normalised high-frequency power, and a larger low- to high-frequency power ratio than nonpregnant women in the supine position. When the position was changed from upright to supine in nonpregnant women, the percentage change in the mean RR interval and normalised high-frequency power were increased, whereas the percentage change in the coefficient of variation of RR interval and low- to high-frequency power ratio were decreased. In contrast, the percentage change in normalised high-frequency power was decreased and the percentage change in low- to high-frequency power ratio was increased in pregnant women when the position was changed from upright to supine. These results indicate that the vagal enhancing effect seen in normal subjects when changing position from upright to supine was reversed in women in late pregnancy. Aortocaval compression in the supine position in pregnant women might be responsible for this reversal in the autonomic response to lying down.

Sequential changes in heart rate variability after coronary artery bypass grafting

Heart rate variability (HRV) decreased soon after coronary artery bypass grafting and returned to the preoperative level within 2 months; however, HRV did not exceed the preoperative level, even 6 months after coronary artery bypass grafting. Although myocardial ischemia can be improved by coronary artery bypass grafting, HRV did not benefit from coronary artery bypass grafting within 6 months.

Energy dissipation as a key factor for electroporation of protoplasts

Energy dissipation (epsilon) during electroporation was theoretically determined to be epsilon = 0.5CV02 for the various combinations of capacitance (C) and initial voltage (V0). Experiments on asparagus protoplasts established that electroporation efficiency (EE) and survival rate were directly proportional to energy dissipation during electroporation. A positive linear relationship exists between energy dissipation per unit volume and EE, whereas energy dissipation per unit volume and survival rate of protoplasts are related in a negative linear manner. At the same energy level, longer time constants were more effective at increasing EE. This suggests that energy dissipation approximating rectangular waveforms is more important than that dissipated as sharply decaying exponential waveforms. With energy as the key parameter, the optimization of electrical parameters for efficient electroporation is greatly simplified, is not machine-dependent, and generally applies to all species.

Clinical experience with orbicularis oculi myocutaneous flaps in the temporal area

There are many methods to repair facial skin defects in clinical practice. The desired outcome for the surgeon and the patient is the restoration of facial appearance and function. The temporal region is one of the ideal donor sites for the repair of a facial skin defect, because this area is relatively inconspicuous and the skin quality is similar to that of the face. In the past, the temporal region was always used as the donor site of the local flap for repairing the facial skin defect. Because the blood supply of the skin comes from the subjacent tissue mainly rather than from the contiguous tissue, the pedicles of the local flaps are short, limiting the use of this area as a donor site. From 1993 to 1996, the anatomy of the orbicularis oculi myocutaneous flap in five cadavers was studied; what was learned allowed for the use of this flap to repair skin defects of the face in 13 patients. In this paper, the clinical experiences using the orbicularis oculi myocutaneous flaps to repair skin defects of the face and the surgical anatomy of this myocutaneous flap are discussed.

Comparison of three recumbent positions on vagal and sympathetic modulation using spectral heart rate variability in patients with coronary artery disease

Patients with coronary artery disease (CAD) have depressed vagal modulation. Because the mortality risk from acute myocardial infarction is lower in patients with higher vagal modulation, methods that can increase vagal modulation are desirable for patients with CAD. The right lateral decubitus position has been found, in young healthy subjects, to lead to the highest vagal modulation among 3 recumbent positions using spectral heart rate variability (HRV) analysis. This study investigated which recumbent position can give rise to the highest vagal modulation in patients with severe CAD. Twenty-seven patients scheduled for coronary artery bypass graft surgery and 17 patients with angiographically normal coronary arteries were studied. Spectral HRV analysis was performed in random order on these patients in 3 recumbent positions: namely, the supine, left lateral decubitus, and right lateral decubitus positions. Normalized high-frequency power was the highest, whereas normalized low-frequency power and low/high-frequency power ratio in the right lateral decubitus position were the lowest, among the 3 recumbent positions in both groups of patients. The lower the normalized high-frequency power in the supine or left lateral decubitus position, the higher the increase in the normalized high-frequency power when the position was changed from supine or left lateral decubitus to right lateral decubitus in patients with severe CAD. Right lateral decubitus position can lead to the highest vagal modulation and the lowest sympathetic modulation among the 3 recumbent positions in patients with severe CAD. Therefore, the right lateral decubitus position can be used as an effective physiologic vagal enhancer in patients with severe CAD.

The effect of position on autonomic nervous activity in late pregnancy

We investigated the effect of three different recumbent positions on autonomic nervous activity in late pregnancy. Thirty pregnant and 24 nonpregnant aged-matched women were studied, and measures of heart rate variability in both time and frequency domains were compared using supine, right and left lateral decubitus positions. In the nonpregnant women, the normalised high-frequency power was greatest in the right lateral decubitus position. In the pregnant women, the normalised high-frequency power was lowest and the low/high-frequency power ratio was greatest in the supine position. Both the percentage decrease of normalised high-frequency power and the percentage increase of low/high-frequency power ratio in the supine and right lateral positions were greater than those in the left lateral position. For women in late pregnancy, the left lateral decubitus position may be beneficial because cardiac vagal activity is least suppressed and cardiac sympathetic activity is least enhanced. Aortocaval compression might be the mechanism underlying the change in cardiac autonomic nervous activity when supine and right lateral decubitus positions are assumed in late pregnancy.

The effect of the lateral decubitus position on vagal tone

The average person spends about one-third of their time in a recumbent position. However, little is known about the effect of recumbent posture on autonomic nervous activity. Manoeuvres which can increase vagal tone have been sought both in the normal subject and in patients with heart disease. We have studied the autonomic effect of various recumbent positions, namely the supine, left lateral decubitus and right lateral decubitus positions, in healthy subjects by using spectral heart rate variability analysis. Both time- and frequency-domain measures were calculated and compared between the three recumbent positions. The normalised high-frequency power was used as the index of cardiac vagal activity, the normalised low-frequency power as the index of cardiac sympathetic activity and the low-frequency power/high-frequency power ratio as the index of sympathovagal balance. The normalised high-frequency power is highest in the right lateral decubitus position, followed in decreasing order by left lateral decubitus and supine positions. The low-frequency power/high-frequency power ratio has the reversed trend as compared with that of the normalised high-frequency power. These results suggest that cardiac vagal activity is greatest when the right lateral decubitus position is adopted.

Congenital mitral stenosis: challenge of percutaneous transvenous mitral commissurotomy

A 26-year-old woman with congenital mitral stenosis and embolic stroke was referred to our hospital. The echocardiogram showed a hypoplastic posterior mitral valve leaflet with short, unbalanced chordal attachments to the posteromedial papillary muscle. The mitral valve area was 0.9 cm2 by the pressure half-time method. There was no left atrial thrombus and spontaneous echo contrast. Percutaneous transvenous mitral commissurotomy was performed since the suggestion of surgical management was refused by her family members. A rupture at the chordae tendinae of the hypoplastic posterior papillary muscle developed during the procedure and needed mitral replacement. We advise that percutaneous transvenous mitral commissurotomy be avoided in adult patients with congenital mitral stenosis having an asymmetric and hypoplastic mitral valve.