Performance evaluation and metagenomic analysis of sequencing batch reactor under transient 2,4,6-trichlorophenol shock

The transient chlorophenol shock under some emergency conditions might directly affect the pollutant removal of bioreactor. Therefore, the recovery of bioreactor performance after transient chlorophenol shock is a noteworthy issue. In the present research, the performance, antioxidant response, microbial succession and functional genes of sequencing batch reactor (SBR) were evaluated under transient 2,4,6-trichlorophenol (2,4,6-TCP) shock. The chemical oxygen demand (COD) and ammonia nitrogen (NH4+-N) removal efficiencies decreased sharply in the first 4 days after 60 mg/L 2,4,6-TCP shock for 24 h and gradually recovered to normal in the subsequent 8 days. The nitrogen removal rates and their corresponding enzymatic activities rapidly decreased after transient 2,4,6-TCP shock and then gradually increased to normal. The increase of antioxidant enzymatic activity, Cu-Zn SOD genes and Fe-Mn SOD genes contributed to the recovery of SBR performance. The abundance of genes encoding ammonia monooxygenase and hydroxylamine dehydrogenase decreased after transient 2,4,6-TCP shock, including amoA, amoC and nxrA. Thauera, Dechloromonas and Candidatus_Competibacter played key roles in the restorative process, which provided stable abundances of narG, norB , norC and nosZ. The results will deeply understand into the effect of transient 2,4,6-TCP shock on bioreactor performance and provide theoretical basis to build promising recoveries strategy of bioreactor performance.

Effect of light intensity on nitrogen transformation, enzymatic activity, antioxidant system and transcriptional response of Chlorella pyrenoidosa during treating mariculture wastewater

The nitrogen transformation, enzymatic activity, antioxidant ability and transcriptional response of Chlorella pyrenoidosa (C. pyrenoidosa) treating mariculture wastewater were compared under different light intensities. The microalgal growth, chlorophyll synthesis and nitrogen removal ability of C. pyrenoidosa increased with the light intensity from 3000 to 7000 Lux, whereas they slightly decreased under 9000 and 11,000 Lux. The nitrogen metabolism enzymatic activities displayed obvious differences under different light intensities and affected the nitrogen transformation process. The reactive oxygen species (ROS) production increased with the increase of operational time, whereas it had distinct differences under different light intensities. The changes of antioxidant enzymatic activities were positively correlated with the ROS production. The transcriptional response of C. pyrenoidosa was in accordance with the variation of the photosynthesis, nitrogen assimilation and antioxidant system under different light intensities. This study provides theoretical basis and technical support to select suitable light intensity for algae treating mariculture wastewater.

Mechanochemically Reprogrammed Interface Orchestrates Neutrophil Bactericidal Activity and Apoptosis for Preventing Implant-Associated Infection

The onset of implant-associated infection (IAI) triggers a cascade of immune responses, which are initially dominated by neutrophils. Bacterial aggregate formation and hypoxic microenvironment, which occur shortly after implantation, may be two major risk factors that impair neutrophil function and lead to IAI. Here, the implant surface with phytic acid-Zn2+ coordinated TiO2 nanopillar arrays (PA-Zn@TiNPs) and oxygen self-supporting CaO2 nanoparticles, named as CPZTs, is mechanochemically reprogrammed. The engineered CPZTs interface integrates multiple properties to inhibit the formation of nascent biofilm, encompassing antibacterial adhesion, mechanobactericidal effect, and chemobiocidal effect. Meanwhile, continuous oxygenation fuels the neutrophils with reactive oxygen species (ROS) for efficient bacterial elimination on the implant surface and inside the neutrophils. Furthermore, this surface modulation strategy accelerates neutrophil apoptosis and promotes M2 macrophage-mediated osteogenesis both in vitro and in a rat model of IAI. In conclusion, targeting neutrophils for immunomodulation is a practical and effective strategy to prevent IAI and promote bone-implant integration.

Single-Cell Microgel Encapsulation Improves the Therapeutic Efficacy of Mesenchymal Stem Cells in Treating Intervertebral Disc Degeneration via Inhibiting Pyroptosis

While mesenchymal stem cell (MSC) shows great potentials in treating intervertebral disc degeneration, most MSC die soon after intradiscal transplantation, resulting in inferior therapeutic efficacy. Currently, bulk hydrogels are the common solution to improve MSC survival in tissues, although hydrogel encapsulation impairs MSC migration and disrupts extracellular microenvironment. Cell hydrogel encapsulation has been proposed to overcome the limitation of traditional bulk hydrogels, yet this technique has not been used in treating disc degeneration. Using a layer-by-layer self-assembly technique, we fabricated alginate and gelatin microgel to encapsulate individual MSC for treating disc degeneration. The small size of microgel allowed intradiscal injection of coated MSC. We demonstrated that pyroptosis was involved in MSC death under oxidative stress stimulation, and microgel coating suppressed pyroptosis activation by maintaining mitochondria homeostasis. Microgel coating protected MSC in the harsh disc microenvironment, while retaining vital cellular functions such as migration, proliferation, and differentiation. In a rat model of disc degeneration, coated MSC exhibits prolonged retention in the disc and better efficacy of attenuating disc degeneration, as compared with bare MSC treatment alone. Further, microgel-coated MSC exhibited improved therapeutic effects in treating disc degeneration via suppressing the activation of pyroptosis in the disc. For the first time, microgel-encapsulated MSC was used to treat disc degeneration and obtain encouraging outcomes. The developed biocompatible single-cell hydrogel is an effective strategy to protect MSC and maintain cellular functions and may be an efficacious approach to improving the efficacy of MSC therapy in treating disc degeneration. The objective of this study is to improve the efficacy of cell therapy for treating disc degeneration using single-cell hydrogel encapsulation and further to understand related cytoprotective mechanisms.

Metagenomic insights into the nitrogen metabolism, antioxidant pathway, and antibiotic resistance genes of activated sludge from a sequencing batch reactor under tetracycline stress

Tetracycline is prevalent in wastewater treatment plants and poses a potential threat to biological nitrogen removal under long-term exposure. In the present study, the influence of different tetracycline concentrations on the nitrogen removal, bioactivity response, and the spread of antibiotic resistance genes (ARGs) was assessed in sequencing batch reactor (SBR). The nitrogen removal efficiency, nitrification rate, and denitrification rate and their corresponding enzymatic activities gradually decreased with an increase in tetracycline concentration from 0.5 to 15 mg/L. The remarkable toxicity induced by tetracycline led to a significant increase in the peroxidation and the response of antioxidant system, as evidenced by strengthened antioxidant enzymatic activity and abundant genes (SOD12, katG, PXDN, gpx, and apx). Tetracycline addition significantly inhibited the ammonia-oxidizing bacterium Nitrosomonas and functional genes (amoA, amoB, and amoC). The presence of tetracycline decreased the abundance of citrate synthase and genes (CS, IDH3, and acnA) and interfered with carbon source metabolism, leading to impaired bioactivity and treatment performance. In addition, the presence of tetracycline induces diversity and differences in ARGs. The results provide reliable basic data for a deeper understanding of the effects of tetracycline on the nitrogen removal performance of bioreactors and provide a theoretical basis to build a promising strategy for relieving antibiotic-caused process fluctuations.

Hyperbranched polyphthalocyanine micelles with dual PTT/PDT functions for bacteria eradication under an NIR window

A Zinc phthalocyanine-based (ZnPc-PA) polymeric micelle around 70 nm and with dual-modal PTT/PDT functions for non-antibiotic bacteria eradication was developed. It showed an excellent bacterial killing efficiency of 95.2% and 96.7% in vitro against Methicillin-resistant Staphylococcus aureus (MRSA) and its biofilm, respectively. Furthermore, the in vivo experiments proved its great potential for implant-associated infection (IAI).

Performance evaluation, enzymatic activity change and metagenomic analysis of sequencing batch reactor under divalent zinc stress

Divalent zinc (Zn2+) are widely detected in domestic and industrial wastewater, and it is essential to evaluate the effect of Zn2+ on wastewater biological treatment process due to its bio-toxicity. In this study, the nitrogen removal rates and their corresponding enzymatic activities of sequencing batch reactor decreased with the increase of Zn2+ concentration. The Zn2+ accumulation in activated sludge caused significant antioxidant response, and the reactive oxygen species (ROS) production and antioxidant enzymatic activities were positively correlated with Zn2+ concentration. The presence of Zn2+ inhibited the metabolic pathways related to energy production and electron transport. The abundance decreases of nitrification and denitrification functional genes led to the deterioration of nitrogen removal performance under Zn2+ stress. The correlation analysis between functional gene modules and microbial genera revealed that Zoogloea had obvious Zn2+ resistance. This study can provide the insights into the influencing mechanism of Zn2+ on the biological nitrogen removal process.

Comparative evaluation of four Chlorella species treating mariculture wastewater under different photoperiods: Nitrogen removal performance, enzyme activity, and antioxidant response

The nitrogen removal performance, nitrogen metabolism enzyme activities, and antioxidant response of four Chlorella species (Chlorella sp., Chlorella vulgaris, Chlorella sorokiniana, and Chlorella protothecoides) were compared under different light: dark (L:D) photoperiods during treating mariculture wastewater. The increase of light duration in the range of 8L:16D to 16L:8D was beneficial to the chlorophyll synthesis of selected four Chlorella species. Chlorella vulgaris was the most effective to treat mariculture wastewater than Chlorella sp., Chlorella sorokiniana, and Chlorella protothecoides. and its microalgae density, photosynthetic activity, and nitrogen metabolism enzyme activity were higher than those of the other three Chlorella species. An obvious oxidative stress in microalgal cells was under 20L:4D photoperiod, which led to a decrease in photosynthetic activity and nitrogen metabolizing enzyme activity. Among the four Chlorella species, Chlorella protothecoides had the highest degree of light-induced stress and ROS accumulation. This study can provide suitable microalgae and optimal photoperiod for treating mariculture wastewater.

External validation of AF-BLEED for predicting major bleeding and for tailoring NOAC dose in AF patients: A post hoc analysis in the ENGAGE AF-TIMI 48

OBJECTIVE

AF-BLEED, a simple bleeding risk classifier, was found to predict major bleeding (MB) in patients with atrial fibrillation (AF) and identify AF patients at high risk of MB who might potentially benefit from a lower direct oral anticoagulant dose. This post hoc study aimed to externally validate these findings in the ENGAGE AF-TIMI 48 (Effective aNticoaGulation with factor Xa next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction study 48) trial.

METHODS

The ENGAGE AF-TIMI 48 trial randomized AF patients to higher-dose edoxaban regimen (HDER 60/30 mg) versus lower-dose edoxaban regimen (LDER 30/15 mg), with prespecified dose reduction criteria. AF-BLEED was calculated in the modified intention-to-treat cohort (n = 21,026 patients) used for primary outcome analysis. Annualized event rates and hazard ratios (HRs) were obtained for the primary composite outcome (PCO) and its single components (MB, ischemic stroke/systemic embolism and death) to compare LDER 30 mg with HDER 60 mg in both AF-BLEED classes.

RESULTS

AF-BLEED classified 2882 patients (13.7 %) as high-risk, characterized by a two- to three-fold higher MB risk than AF-BLEED classified low-risk patients. AF-BLEED classified high-risk patients randomized to LDER 30 mg demonstrated a 3.3 % reduction in MB at the cost of a 0.5 % increase in ischemic stroke/systemic embolism. LDER 30 mg resulted in a 3.1 % reduction of PCO compared to HDER 60 mg (HR of 0.81; 95%CI 0.65-1.01). Additional to existing dose reduction criteria, another 6 % of patients could potentially benefit of this dose adjustment strategy.

CONCLUSION

AF-BLEED could identify AF patients to be at high risk of major bleeding. Our findings support the hypothesis that LDER 30 mg might provide a reasonable option in AF patients with legitimate bleeding concerns.

A Redox Homeostasis Modulatory Hydrogel with GLRX3+ Extracellular Vesicles Attenuates Disc Degeneration by Suppressing Nucleus Pulposus Cell Senescence

Characterized by nucleus pulposus (NP) cell senescence and extracellular matrix (ECM) degradation, disc degeneration is a common pathology for various degenerative spinal disorders. To date, effective treatments for disc degeneration are absent. Here, we found that Glutaredoxin3 (GLRX3) is an important redox-regulating molecule associated with NP cell senescence and disc degeneration. Using a hypoxic preconditioning method, we developed GLRX3⁺ mesenchymal stem cell-derived extracellular vehicles (EVs-GLRX3), which enhanced the cellular antioxidant defense, thus preventing reactive oxygen species (ROS) accumulation and senescence cascade expansion in vitro. Further, a disc tissue-like biopolymer-based supramolecular hydrogel, which was injectable, degradable, and ROS-responsive, was proposed to deliver EVs-GLRX3 for treating disc degeneration. Using a rat model of disc degeneration, we demonstrated that the EVs-GLRX3-loaded hydrogel attenuated mitochondrial damage, alleviated the NP senescence state, and restored ECM deposition by modulating the redox homeostasis. Our findings suggested that modulation of redox homeostasis in the disc can rejuvenate NP cell senescence and thus attenuate disc degeneration.

Impact of aerobic/anoxic alternation number on performance, microbial community and functional genes of sequencing batch biofilm reactor treating mariculture wastewater

The performance, microbial community and functional genes of a sequencing batch biofilm reactor (SBBR) were investigated in treating mariculture wastewater under different aerobic/anoxic alternation number. The removal efficiency of chemical oxygen demand (COD) and NH₄⁺-N kept at 95.66 ± 1.83 % and 90.28 ± 2.42 % under aerobic/anoxic alternation number between 1 and 4. The total nitrogen (TN) removal efficiency gradually decreased from 94.45 ± 1.12 % to 83.06 ± 1.25 % with the increase of aerobic/anoxic alternative number from 1 to 4. The nitrification rates and their corresponding enzymatic activities increased slightly with the increase of aerobic/anoxic alternation number, whereas the denitrifying process had the contrary results. The variation of aerobic/anoxic alternation number obviously affected the microbial diversity and abundance. The microbial network structure and keystone taxa were different under different aerobic/anoxic alternation number. The functional genes abundance for the denitrification pathway decreased with the increase of aerobic/anoxic alternation number.

Platymonas helgolandica-driven nitrogen removal from mariculture wastewater under different photoperiods: Performance evaluation, enzyme activity and transcriptional response

The nitrogen removal performance and biological mechanism of Platymonas helgolandica var. Tsingtaoensis (P. helgolandica) were investigated in treating mariculture wastewater under different light: dark (L:D) photoperiods. The growth of P. helgolandica was positively correlated with the photoperiods from 6L:18D to 15L:9D, and the highest photosynthetic activity appeared under 6L:18D photoperiod on day 3. P. helgolandica exhibited the highest removal efficiencies of total nitrogen and COD at 89 % and 93 % under 15L:9D photoperiod, respectively. NH₄⁺-N assimilation was proportional to the photoperiods from 6L:18D to 15L:9D and longer illumination promoted NO₂^--N removal. However, the highest NO₃^--N reduction rate was achieved under 12L:12D photoperiod. The different nitrogen-transformed enzymatic activities were affected by photoperiod. Transcriptome revealed that unigenes were enriched in nitrogen metabolism and photosynthesis pathways, of which the functional gene expression was up-regulated significantly. This study provides insights into the optimization of photoperiod for mariculture wastewater treatment by P. helgolandica.

A Janus Au-Polymersome Heterostructure with Near-Field Enhancement Effect for Implant-Associated Infection Phototherapy

Polymer-inorganic hybrid Janus nanoparticles (PI-JNPs) have attracted extensive attention due to their special structures and functions. However, achieving the synergistic enhancement of photochemical activity between polymer and inorganic moieties in PI-JNPs remains challenging. Herein, the construction of a novel Janus Au-porphyrin polymersome (J-AuPPS) heterostructure by a facile one-step photocatalytic synthesis is reported. The near-field enhancement (NFE) effect between porphyrin polymersome (PPS) and Au nanoparticles in J-AuPPS is achieved to enhance its near-infrared (NIR) light absorption and electric/thermal field intensity at their interface, which improves the energy transfer and energetic charge-carrier generation. Therefore, J-AuPPS shows a higher NIR-activated photothermal conversion efficiency (48.4%) and generates more singlet oxygen compared with non-Janus core-particle Au-PPS nanostructure (28.4%). As a result, J-AuPPS exhibits excellent dual-mode (photothermal/photodynamic) antibacterial and anti-biofilm performance, thereby significantly enhancing the in vivo therapeutic effect in an implant-associated-infection rat model. This work is believed to motivate the rational design of advanced hybrid JNPs with desirable NFE effect and further extend their biological applications.

Arbutin-modified microspheres prevent osteoarthritis progression by mobilizing local anti-inflammatory and antioxidant responses

Osteoarthritis (OA) is a common degenerative joint disease worldwide and currently there is no effective strategy to stop its progression. It is known that oxidative stress and inflammation can promote the development of OA, and therapeutic strategies against these conditions may alleviate OA. Arbutin (ARB), a major ingredient of the Chinese medicinal herb cowberry leaf, exerts good antioxidant and anti-inflammatory activities yet has not been studied in OA. Here we developed ARB-loaded gelatine methacryloyl-Liposome (GM-Lipo@ARB) microspheres which showed long-term release of ARB and excellent cartilage-targeting effects. The ARB-loaded microspheres effectively reduced the inflammatory response in interleukin (IL)-1β-treated arthritic chondrocytes. Moreover, the synthesized GM-Lipo@ARB microspheres regulated cartilage extracellular matrix (ECM) homeostasis through anti-inflammation effect via inhibiting NF-κB signaling and anti-oxidative stress effect via activating Nrf2 pathway. Intra-articular use of GM-Lipo@ARB can effectively reduce inflammation and oxidative stress in the articular cartilage and thus, attenuating OA progression in a mouse model. The study proposed a novel ARB-laden functional microsphere, GM-Lipo@ARB, and demonstrated that this compound may be used as an alternative therapeutics for treating OA.

Metagenomic analysis and nitrogen removal performance evaluation of activated sludge from a sequencing batch reactor under different salinities

The effect of salinity on the nitrogen removal performance and microbial community of activated sludge was investigated in a sequencing batch reactor. The NH₄⁺-N removal efficiency was over 95% at 0-4% salinity, indicating that the nitrification performance of activated sludge was slightly affected by lower salinity. The obvious nitrite accumulation was observed with the increment of the salinity to 5%, followed by a notable decline in the nitrogen removal performance at 6% salinity. The salinity inhibited the microbial activity, and the specific rate of nitrification and denitrification was decreased by the increasing salinity obviously. Additionally, the lower activity of superoxide dismutase and peroxidase and higher reactive oxygen species content in activated sludge might account for the deteriorative nitrogen removal performance at 6% salinity. Metagenomics analysis revealed that the genes encoding the ABC-type quaternary amine transporter in the ABC transporter pathway were abundant in the activated sludge at 2% and 4% salinity, and the higher salinity of 6% led to the loss of the genes encoding the p-type Na⁺ transporter in the ABC transporter pathway. These results indicated that the salinity could weaken the ABC transporter pathway for the balance of osmotic pressure in activated sludge. The microbial activity and nitrogen removal performance of activated sludge were decreased due to the unbalanced osmotic pressure at higher salinity.

Biomimetic Self-Assembling Metal-Organic Architectures with Non-Iridescent Structural Coloration for Synergetic Antibacterial and Osteogenic Activity of Implants

Materials in nature feature versatile and programmable interactions to render macroscopic architectures with multiscale structural arrangements. By rationally combining metal-carboxylate and metal-organophosphate coordination interactions, Au₂₅(MHA)₁₈ (MHA, 6-mercaptohexanoic acid) nanocluster self-assembled structural color coating films and phytic acid (PA)-metal coordination complexes are sequentially constructed on the surface of titanium implants. The Lewis acid-base coordination principle applies for these metal-organic coordination networks. The isotropic arrangement of nanoclusters with a short-range order is investigated via grazing incidence wide-angle X-ray scattering. The integration of robust M-O (M = Ti, Zr, Hf) and labile Cu-O coordination bonds with high connectivity of Au₂₅(MHA)₁₈ nanoclusters enables these artificial photonic structures to achieve a combination of mechanical stability and bacteriostatic activity. Moreover, the colorless and transparent PA-metal complex layer allows the viewing of the structural color and surface wettability switching to hydrophilic and makes feasible the interfacial biomineralization of hydroxyapatite. Collectively, these modular metal-organic coordination-driven assemblies are predictive and rational material design strategies with tunable hierarchy and diversity. The complete metal-organic architectures will not only help improve the physicochemical properties of the bone-implant interface with synergistic antibacterial and osseointegration activities but also can boost surface engineering of medical metal implants.

A Combined Cyanine/Carbomer Gel Enhanced Photodynamic Antimicrobial Activity and Wound Healing

As a non-invasive and non-specific therapeutic approach, photodynamic therapy (PDT) has been used to treat antibiotic-resistant bacteria with encouraging efficacy. Inspired by light, the photosensitizers can produce excessive reactive oxygen species (ROS) and, thus, effectively destroy or kill bacteria. Cyanine (Cy), a traditional photosensitizer for PDT, has the advantages of low cytotoxicity and high ROS yield. Yet, the water solubility and photostability for Cy are poor, which substantially limit its antibacterial efficiency and clinical translation. Herein, we combined Cy with carbomer gel (CBMG) to form a photodynamic Cy-CBMG hydrogel. In this system, Cy was evenly dispersed in CBMG, and CBMG significantly improved the water solubility and photostability of Cy via electrostatic interactions. The developed Cy-CBMG gel had less photodegradation under laser irradiation and thus can effectively elevate ROS accumulation in bacteria. The Cy-CBMG compound presented remarkable ROS-induced killing efficacy against methicillin-resistant Staphylococcus aureus (93.0%) and extended-spectrum β-lactamase-producing Escherichia coli (88.7%) in vitro. Moreover, as a potential wound dressing material, the Cy-CBMG hydrogel exhibited excellent biocompatibility and effective antimicrobial ability to promote wound healing in vivo. Overall, this work proposed a practical strategy to synthesize a photosensitizer–excipient compound to enhance the photophysical property and antibacterial efficacy for PDT.

Determinants of label non-adherence to non-vitamin K oral anticoagulants in patients with newly diagnosed atrial fibrillation

Aims

To evaluate the extent and determinants of off-label non-vitamin K oral anticoagulant (NOAC) dosing in newly diagnosed Dutch AF patients.

Methods and results

In the DUTCH-AF registry, patients with newly diagnosed AF (<6 months) are prospectively enrolled. Label adherence to NOAC dosing was assessed using the European Medicines Agency labelling. Factors associated with off-label dosing were explored by multivariable logistic regression analyses. From July 2018 to November 2020, 4500 patients were registered. The mean age was 69.6 ± 10.5 years, and 41.5% were female. Of the 3252 patients in which NOAC label adherence could be assessed, underdosing and overdosing were observed in 4.2% and 2.4%, respectively. In 2916 (89.7%) patients with a full-dose NOAC recommendation, 4.6% were underdosed, with a similar distribution between NOACs. Independent determinants (with 95% confidence interval) were higher age [odds ratio (OR): 1.01 per year, 1.01–1.02], lower renal function (OR: 0.96 per ml/min/1.73 m2, 0.92–0.98), lower weight (OR: 0.98 per kg, 0.97–1.00), active malignancy (OR: 2.46, 1.19–5.09), anaemia (OR: 1.73, 1.08–2.76), and concomitant use of antiplatelets (OR: 4.93, 2.57–9.46). In the 336 (10.3%) patients with a reduced dose NOAC recommendation, 22.9% were overdosed, most often with rivaroxaban. Independent determinants were lower age (OR: 0.92 per year, 0.88–0.96) and lower renal function (OR: 0.98 per ml/min/1.73 m2, 0.96–1.00).

Conclusion

In newly diagnosed Dutch AF patients, off-label dosing of NOACs was seen in only 6.6% of patients, most often underdosing. In this study, determinants of off-label dosing were age, renal function, weight, anaemia, active malignancy, and concomitant use of antiplatelets.

Implication of microglia in ketamine-induced long-term cognitive impairment in murine pups

BACKGROUND

Ketamine, a non-competitive N-methyl-D-aspartate receptor (NMDAR) antagonist, is widely applicable to anesthesia, analgesia, and sedation. However, the function and mechanisms of ketamine in the long-term learning and memory function of neonatal mice are unclear.

OBJECTIVE

The present study aims to investigate whether long-term learning and memory function will be affected by multiple ketamine exposures in the early development period.

METHODS

The mRNA and protein levels were measured by RT-qPCR and western blot, respectively. The Morris Water Maze test was performed to assess spatial learning and memory.

RESULTS

We identified that neonatal exposure to ketamine downsized the positive neurons for microtubule-associated protein doublecortin (DCX) and Ki67 in hippocampal dentate gyrus at the juvenile and late adolescence stages. Double-labeling tests demonstrated that the counts of Iba1⁺ cells and Ki67⁺ cells were pronouncedly diminished with exposure to ketamine. Further, qPCR assays to screen the key factors predisposing the populations and maturation of microglia exhibited remarkable decline of CX3CR1 mRNA levels in ketamine group versus the control group. The close relation of microglia to synaptic plasticity was depicted by the significantly downregulated synaptic plasticity-related proteins NR2B and PSD-95 subsequent to multiple exposures to ketamine. Finally, we found that both the protein and mRNA levels of BDNF were markedly decreased in ketamine group versus the control group.

CONCLUSION

We found that multiple exposures to ketamine in neonatal mice lead to spatial learning and memory dysfunction. The alterations of microglial development and function are the possible mechanisms of long-term learning and memory impairment.

Antithrombotic therapy and bleeding complications in patients with atrial fibrillation and active cancer

Background

Little is known about the extent to which an active cancer diagnosis increases bleeding and thromboembolic risks in atrial fibrillation (AF) patients. Data on major bleeding rates per antithrombotic management strategy are lacking in AF patients with active cancer.

Purpose

To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with active cancer and to examine whether cancer type impacts major bleeding and thromboembolic risks.

Methods

We used Danish population-based health care databases to conduct this cohort study. We included all incident AF (including atrial flutter) patients aged ≥50 years between January 1st 1995 and December 31st 2016, out of whom we identified AF patients who subsequently developed cancer. We used International Classification of Diseases 10th Revision codes to identify data on cancer type and outcomes (i.e. major bleeding, arterial and venous thromboembolism). We used Anatomical Therapeutic Chemical codes to provide information on antithrombotic treatment (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or a combination of antithrombotic drugs) which was evaluated as a time-dependent variable. The follow-up started from the incident cancer diagnosis until the occurrence of an outcome, death or the end of the two year follow-up. Incidence rates per 100 patient-years and adjusted hazard ratios were computed.

Results

22,996 AF patients with a subsequent incident cancer diagnosis were included in the study. These patients had higher major bleeding and thromboembolic risk compared to those without cancer, with adjusted HRs of 2.11 (1.99–2.23) and 1.36 (1.27–1.44), respectively (Figure 1). Highest bleeding risk was observed for intracranial and respiratory cancer, while haematological and respiratory cancer were associated with highest thromboembolic risk. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with active cancer compared to those without, across all exposure categories (Figure 2).

Conclusions

Patients with AF and active cancer are at increased risk of major bleeding and thromboembolisms than those without cancer. Treatment with dual or triple antithrombotic therapy in AF patients with active cancer showed very high bleeding rates.

Funding Acknowledgement

Type of funding sources: None.

Atrial fibrillation in patients with a history of cancer and risk of bleeding complications associated with antithrombotic therapy

Background

Up to one in four patients with atrial fibrillation (AF) has a cancer diagnosis. It is largely unknown to which extent a prior cancer diagnosis affects major bleeding and thromboembolic risk in AF patients. Moreover, data on major bleeding rates per antithrombotic treatment type are lacking in these patients.

Purpose

To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with prior cancer and to examine whether cancer type and the time-interval between AF and cancer influence major bleeding and thromboembolic risks.

Methods

This nationwide population-based cohort study included incident Danish AF patients aged ≥50 years between 01–01–1995 and 31–12–2016. Data on prior cancer, major bleeding and thromboembolisms (i.e. arterial and venous) were obtained from Danish health registries via International Classification of Diseases 10th Revision codes. We stratified according to prior cancer and by time between the AF and cancer diagnosis (i.e. <1 year, 1–3 years, >3 years), and cancer type. Data on antithrombotic exposure (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or combination of antithrombotic drugs) were evaluated as a time-dependent variable. We computed incidence rates per 100 patient-years and adjusted hazard ratios in a Cox regression model.

Results

We identified 39,178 AF patients with a prior cancer diagnosis. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with a history of cancer compared to those without, across all exposure categories (Figure 1). The increased bleeding risk was similar across different time intervals between cancer and AF diagnosis. The increased thromboembolic risk steeply declined with increasing time intervals between AF and cancer diagnosis (Figure 2). Prior gastrointestinal, intracranial, haematological, respiratory and urogenital cancers were associated with an increased bleeding risk. The two latter cancer types were also associated with increased thromboembolic risks.

Conclusion

We showed that patients with atrial fibrillation and a prior history of cancer experience higher rates of bleeding than those without cancer. Both respiratory and urogenital cancers had the highest rates of bleeding and thromboembolisms.

Funding Acknowledgement

Type of funding sources: None.

Improved robot-assisted laparoscopic telesurgery: feasibility of network converged communication

The converged transmission-assisted network communication architecture used in this study could meet the requirements of telesurgery, and effectively guarantee the security and immediacy of communication. With the security, flexibility, and universality of the network converged transmission, the clinical practical application of telesurgery and telemedicine would step up to a higher level.

Cancellous bone allograft is comparable to fibular strut allograft for augmentation in three- or four-part proximal humeral fractures

BACKGROUND

Bone grafts have been used for augmentation and improving stability of reduced fractures in proximal humeral fractures. The aim of this study was to analyze the clinical and radiological outcomes after the use of cancellous bone allografts (CAs) for augmentation in 3- or 4-part proximal humeral fractures, and compare with fibular strut allografts (FAs).

METHODS

Between November 2016 and February 2018, 55 patients, followed for at least 1 year, with 3- or 4-part proximal humeral fractures fixed with locking plates were included and grouped according to the type of allograft bone used for augmentation. In this retrospective analysis, we assessed and compared the clinical and radiological outcomes of the 2 groups, using the visual analog scale score, the Constant-Murley score (CMS), the disability of the arm, shoulder, and hand (DASH) score, the range of movement, neck-shaft angle (NSA), humeral head height (HHH), and the changes of NSA and HHH, as well as recording any complications. The repeatedly measured clinical and radiological outcomes were analyzed by linear mixed models. The differences in outcomes between groups at the final follow-up were compared using Student's t test.

RESULTS

There were 28 patients in the CA group and 27 patients in the FA group with an average follow-up of 14.5 months. The mean age of all patients was 64 (36-86). Nonsignificant group effects were observed on CMS (β = -8.792, P = .216), DASH (β = 1.329, P = .094), NSA (β = 1.432, P = .752), and HHH (β = 1.660, P = .628). At the final follow-up, the patients in the CA group showed no significant differences in visual analog scale (1.8 vs. 2.2, P = .276), CMS (81.5 vs. 75.4, P = .072), and DASH (11.0 vs. 13.5, P = .235) scores compared with the FA group. There were no significant differences in the change of NSA (6 vs. 4, P = .387) or HHH (1 vs. 2, P = .261).

CONCLUSIONS

Patients with 3- or 4-part proximal humeral fractures treated with locking plates combined with CAs have good clinical and radiographic outcomes, similar to those treated with FAs.

Ablation Index-guided 50W ablation for left atrial posterior wall isolation compared with lower powers: feasibility and lesion level analysis

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Groupe de Rythmologie de la Société Française de Rythmologie

Background 

Posterior Wall Isolation (PWI) is increasingly performed for Atrial Fibrillation (AF). The use of Ablation Index (AI)-guided 50W ablation for PWI has not been described, nor the interplay between ablation parameters at this power when compared to lower powers. 

Methods 

40 consecutive AF patients (26 males, 65.5 ± 10.0 years. 95% non-paroxysmal AF) underwent PWI following pulmonary vein isolation. A roof line and floor line were created with point-by-point ablation, targeting a contact force (CF) of 10-30g, AI 550-600 on the roof and 400-450 on the floor, and inter-tag distance of <6mm. 35-40W powers were used for the first 20 patients, and 50W used for the next 20. Generator impedance was monitored in real time for each lesion. Ablation inside the box was delivered in case of failure of first pass isolation (FPI). All VisiTags (n = 959) were analyzed retrospectively. 

Results 

PWI was successful in 19(95%) of the 35-40W group and in all 20 patients in the 50W group, with FPI seen in 8(40%) and 10(50%) respectively, p = 0.53. The mean CF and number of RF applications on the roof. floor and inside the box were similar between the two groups. Ablation time per lesion (10.4 [8.8-12.5]sec) and total ablation time per patient (3.84[3.34-4.66] min) were shorter in the 50W group as compared to 35-40W (13.0 [11.6-16.2] sec and 5.86 [4.23-7.73] min respectively), p < 0.005. The mean AI and Impedance Drop were larger in the 50W group (Table). There was no steam pop observed in any of the 959 radiofrequency applications. 

Conclusion 

Ablation Index guided 50W ablation has a very high success rate for posterior wall isolation with shorter ablation times and higher impedance drop compared to conventional powers. Steam pops may be avoidable by targeting CF < 30g, and by monitoring impedance in real-time. 50W Group(N = 458) 35-40W Group(N = 501) p-value Number of lesions (s, IQR)Roof lineFloor lineAdditional ablation inside box 21.5 [19.5-26.3]7.0 [5.8-9.0]13.0 [10.8-14.3]6.0 [6.0-6.8] 24.0 [20.8-29.5]8.0 [6.0-10.0]12.5 [10.8-14.0]5.5 [2.8-9.0] 0.330.180.850.59 Ablation Time per lesion (s, IQR)Roof lineFloor lineAdditional ablation inside box 10.4 [8.8-12.5]13.0 [10.9-16.0]9.9 [8.7-11.4]8.1 [6.9-9.0] 13.0 [11.6-16.2]14.5 [12.4-19.0]12.7 [11.4-15.9]11.8 [10.6-14.0] <0.005<0.005<0.005<0.005 Total RF Time (min, IQR)Roof lineFloor lineAdditional ablation inside box 3.84 [3.34-4.66]1.54 [1.15-1.90]2.06 [1.68-2.54]0.79 [0.65-1.07] 5.86 [4.23-7.73]1.98 [1.62-2.59]2.78 [2.28-3.25]1.07 [0.59-1.42] < 0.0050.0190.0090.50 Impedance Drop (ohms, IQR)Roof lineFloor lineAdditional ablation inside box 7.4 [5.2-10.3]8.7 [6.1-11.3]6.9 [5.0-10.1]7.1 [5.4-9.8] 6.9 [4.8-9.7]7.5 [5.1-10.0]6.0 [4.2-8.3]8.3 [5.8-10.9] 0.0070.04< 0.0050.17 Contact Force (g, IQR)Roof lineFloor lineAdditional ablation inside box 21.1 [14.5-30.3]23.9 [17.8-32.7]19.2 [13.2-25.3]25.5 [18.5-36.9] 21.2 [14.9-28.1]24.3 [17.2-30.3]19.0 [14.1-25.0]23.1 [16.9-31.7] 0.560.450.870.21 Ablation Index (IQR)Roof lineFloor lineAdditional ablation inside box 471 [441-519]560 [509-571]453 [436-475]461 [430-488] 461 [434-493]502 [466-541]446 [426-464]455 [434-478] < 0.005< 0.005< 0.0050.59 Lesion level analysis for Posterior Wall Isolation

Comparison of nitrite accumulation performance and microbial community structure in endogenous partial denitrification process with acetate and glucose served as carbon source

Although the combination of endogenous partial denitrification (EPD) and Anammox (EPD-AMX) were developed for deep-level nitrogen removal, the effects of different carbon source were not clear. In this study, the EPD performance was investigated comparatively with acetate (EPD_A) and glucose (EPD_G). Results revealed that through regulating chemical oxygen demand to phosphate ratio, Candidatus_Competibacter was highly enriched in EPD_A (54.2%) and EPD_G (51.3%), resulting high intracellular carbon storage efficiencies (90.2% and 85.3%, respectively). More stable nitrite accumulation was observed in EPD_G than EPD_A. But, higher specific nitrite generated rate (r_NO2, 8.25 > 7.04 mgN·gVSS^-1·h^-1) and nitrate-to-nitrite transformation rate (NTR, 87.9% > 85.2%) were achieved in EPD_A than those in EPD_G. The functional bacterium was also shifted to Defluviicoccus in both EPD_A (30.6%) and EPD_G (25.8%). Moreover, with whether acetate or glucose, the EPD-AMX processes could achieve the same level of total nitrogen removal efficiencies (88.7% and 91.3%, respectively) via anammox mainly (87.8% and 89.4%, respectively).

Development of novel denitrifying nitrite accumulation and phosphorus removal (DNAPR) process for offering an alternative pretreatment to achieve mainstream Anammox

For achieving mainstream anaerobic ammonium oxidation (Anammox), there is a need to achieve organic carbon and phosphorus removal meanwhile supplying nitrite (NO₂^--N). Based on this demand, a novel anaerobic/anoxic/aerobic operated denitrifying nitrite accumulation and phosphorus removal (DNAPR) process was proposed for treating synthetic municipal and nitrate (NO₃^--N) wastewaters simultaneously (volume ratio of 5:1). By adjusting influent composition, discharging anaerobic-end supernatant, shortening anoxic duration, and adding a short aerobic stage, DNAPR process achieved promising and stable nitrate-to-nitrite transformation (78.35%) and phosphorus removal (98.34%) performance. Moreover, effluent with chemical oxygen demand of 16.63 mg/L, nitrite of 54.16 mg/L, orthophosphate of 0.37 mg/L, and nitrite to ammonia ratio of 1.3 were finally obtained after 141-day operation. Microbiological analysis showed that Thauera (34.9%) and unclassified_f_Rhodobacteraceae (6.79%) were both responsible for DNAPR. Therefore, DNAPR, serving as promising alternative pretreatment, might possess significance for achieving mainstream Anammox.

[Research Progress and Prospect of Facial Reconstruction in Forensic Science]

Abstract

Facial reconstruction is a way to recover facial morphology by restoring soft tissues based on unidentified skulls using the knowledge of anatomy, anthropology, aesthetics, and computer science. It is applied in forensic science, oral plastic surgery and archeology, and especially plays an important role in the identification of the origin of the unknown corpses in forensic science. Facial reconstruction is the supplementary means of identification when other approaches （such as DNA comparison, imaging matching, dental records comparison, etc.） cannot identify individual identity. Facial soft tissue thickness （FSTT） is the basis of facial reconstruction and with the development of imaging and computer science, the techniques for measuring FSTT are improving rapidly and many related researches have appeared. This paper summarizes the application of facial reconstruction in forensic science, the accuracy of different methods and the research progress of this field to provide reference to this field.

A Gold Nanocluster Constructed Mixed-Metal Metal-Organic Network Film for Combating Implant-Associated Infections

The development of modular strategies for programming self-assembled supramolecular architectures with distinct structural and functional features is of immense scientific interest. We reported on the intrinsic antibacterial capability of anionic amphiphilic gold nanoclusters (GNCs) capped by para-mercaptobenzoic acid, which was closely related to the protonation level of terminal carboxylate groups. By using of the metal-ligand coordination-driven and solvent evaporation-induced self-assembly, we constructed GNCs-based mixed-metal metal-organic network (MM-MON) films on titanium disks as antibacterial nanocoatings. Taking the reasonable utilization of tetravalent metal ions M⁴⁺ (Ti, Zr, Hf; hard Lewis acid) and bactericidal divalent metal ions M²⁺ (Cu, Zn; borderline acid) co-incorporated metal-carboxylate coordination bonds, the MM-MON films exhibited superior stability due to the robust M⁴⁺-O bonds and M²⁺ releasing behavior resulting from the labile M²⁺-O coordinating. Together, the MM-MON films integrated the bacteria-responsive character of GNCs, exceptional chemical stability, and greatly enhanced antibacterial activity, ultimately killing adherent bacteria and initiating a self-defensive function. In a rat model for subcutaneous implant-associated infection, the MM-MON nanocoating showed an approximately 2 and 1 log lower multidrug-resistant Staphylococcus aureus implant and tissue colonization, respectively. The generalizable modular strategy of the GNC-metal networks is amenable to facilitate the functionalization of metal surfaces for combating implant-associated infections.

Role and Mechanism of Rhizopus Nigrum Polysaccharide EPS1-1 as Pharmaceutical for Therapy of Hepatocellular Carcinoma

Objective: This work is to study the effect of Rhizopus nigrum polysaccharide EPS1-1 on hepatocellular carcinoma (HCC) in vitro and in vivo. Methods: HepG2 and Huh-7 cells and nude mice models of liver cancers were used in this study. The cells and nude mice were treated with EPS1-1 at different concentrations. The CCK8 assays were used to measure the proliferation activities of cells, apoptosis was determined with flow cytometry, cell migration was measured by wound-healing assays, cell invasion was evaluated by Transwell assay, and the survival periods of different groups of tumor-bearing mice were compared. Real-time PCR and Western blot were used to measure the expression levels of mRNAs and proteins of the genes related to proliferation, apoptosis, migration, and invasion. Results: In vitro experiments revealed that when treated with EPS1-1, HepG2 and Huh-7 cell proliferation activities decreased, while there was an increase for the apoptosis rate, and the migration and invasion capabilities were significantly reduced. In vivo experiments showed that EPS1-1 could significantly reduce the tumor growth and lung metastasis of HCC, and prolong the survival periods of tumor-bearing nude mice. Furthermore, EPS1-1 has no apparent damage to the heart, liver, and kidney. Further studies showed that EPS1-1 could affect the expression of proliferation-related genes CCND1 and c-Myc, apoptosis-related genes BAX and Bcl-2, and migration and invasion related genes Vimentin and Slug, thereby affecting the biological process of HCC. Conclusion: EPS1-1 can inhibit the malignant process of HCC in vitro and in vivo, which indicates that EPS1-1 has the potential value of clinical application as chemotherapy or adjuvant in the treatment of liver cancer.

Research Progress of Age Estimation Based on the Demirjian's Method

Abstract

In recent years, individual age estimation has gained increasing attention in forensic practice. Common age estimation methods mainly use developments of teeth and bones. Compared with bones, teeth are stronger and are highly resistant to external factors, therefore plays an important role in age estimation. Demirjian's method is one of the most commonly used methods to evaluate dental age and has been widely used in many countries. In this paper, the accuracy of its application in different populations is reviewed. It is found that compared with the chronological ages, most of the estimated ages are overestimated. By combining research results of many scholars and by analyzing, it can be assumed that this situation may be related with race, region, sex, etc.

Construction of Age Estimation Model of 18-Year-Olds in the Northern Chinese Population Based on the Development of Mandibular Second and Third Molars

Abstract

Objective To establish a linear relationship between age and the development process of the mandibular second, third molars in a northern Chinese population and test its accuracy in inferring whether the subject is over 18 years old. Methods The orthopantograms （OPGs） of 960 northern Chinese people aged between 10.00 to 25.99 years were selected. The gender, birth date, and date of the orthopantograms of each sample were recorded. The development stages of left mandibular second and third molars were divided with Demirjian method. The experimental group （760 individuals） constructed a Logistic regression equation to infer whether the subject is over 18 years old. The validation group （200 individuals） tested the accuracy of the equation. Results When only using third molar, the formula obtained for inferring whether the subject's age is over 18 years is： logit P₁=-18.276+0.494 x₁+2.953 x₃. When combining the second and the third molars, the formula is： logit P₂=-21.045+3.177 x₁+0.619 x₂+2.088 x₃. （x₁ stands for gender, male is marked as 1 and female is marked as 2; x₂ and x₃ stand for the development stage of second molar and third molar, respectively）. The accuracy rates of this equation in estimating whether ages of subjects from the validation group were over 18 years old for males and females were 88.0%-92.0% and 85.0%-88.0%, respectively. Conclusion The age estimation formulas based on the development of mandibular second and third molars have important value in judging whether the individual is over 18 years old. Meanwhile, the accuracy of age estimation can be improved by combining the development of second and third molars together.

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

BACKGROUND

The aim of the study was to probe the morphological features of the proximal segment (V1) of vertebral artery (VA) in a sample of Chinese cadavers.

MATERIALS AND METHODS

The origin, course and outer diameter at origin of the pre-vertebral part of the VAs were evaluated in 119 adult cadavers.

RESULTS

It was found that 94.12% of the VAs originated from the subclavian arteries, bilaterally. The variant origins were present in 5.88% of the cadavers and all originated directly from the arch of the aorta. All the variations were observed on the left side of male cadavers. The average outer diameters at origin of the normal and variation groups were 4.35 ± 1.00 mm and 4.82 ± ± 1.42 mm, respectively, p = 0.035. In the normal group, but not in the variation group, the average diameter in the males was significantly larger than that in the females (4.50 ± 0.99 mm, 3.92 ± 0.92 mm, respectively, p = 0.000). In addition, only 5 cadavers in the normal group had hypoplastic VAs (4.20%, 4 males, 3 right-sided). Vertebral artery dominance (VAD) was present in 91 (69 males) out of 112 cadavers and more common on the left (n = 48). In addition, 3 cadavers satisfied conditions for coexistence of VAD and vertebral artery hypoplasia. All 7 cadavers in the variation group exhibited VAD, which was more common on the right side (n = 5).

CONCLUSIONS

The morphologic variations and frequencies described above have implications for the early prevention, abnormal anatomy detection, accurate diagnosis, safe surgery and endovascular treatment of cardiovascular and neurological disease.

[Research Progress of Age Estimation Based on Age-related Changes of Dentin-pulp Complex]

Age estimation is a hot and difficult issue in forensic practice. Teeth are the most solid organs in human body and can be kept in vitro for a long time. With age, the secondary dentin gradually generates and the volume of pulp cavity constantly decreases. Therefore, forensic dentists proposed that age-related changes of dentin-pulp complex could be used to estimate age, which has been widely applied in forensic practice over the years. Due to the development of imaging technology, a variety of methods have been advocated by forensic dentists to detect the age-related changes of dentin-pulp complex for age estimation. However, different methods have their own advantages and limitations, forensic scientists should combine the use of different methods for improving the accuracy of age estimation according to the actual situation. This paper reviews current research of age estimation based on dentin-pulp complex, so as to provide reference for related research.

An autonomous tumor-targeted nanoprodrug for reactive oxygen species-activatable dual-cytochrome c/doxorubicin antitumor therapy

The precise tumor cell-specific delivery of therapeutic proteins and the elimination of side effects associated with routine chemotherapeutic agents are two current critical considerations for tumor therapy. In this study, we report a reactive oxygen species (ROS)-activated yolk-shell nanoplatform for the tumor-specific co-delivery of cytochrome c (Cyt c) prodrug and doxorubicin, in which the bioactivity of Cyt c could be restored by the intracellular ROS-trigger and readily initiate the sequential doxorubicin release. The DOX-loaded lactobionic acid-modified yolk-shell mesoporous silica nanoparticles were first encapsulated with 4-nitrophenyl 4-(4,4,5,5-tetramethyl-1,3,2-dioxaborolan-2-yl)benzyl carbonate (NBC)-modified Cyt c via boronic ester linkages, and functionalized again with lactobionic acid to further shield Cyt c and confer the selective tumor targeting against liver cancer cells. The key feature in this design is that by taking advantage of the boronic ester linkage, the cytotoxicity of Cyt c capped on the nanoparticle could be temporarily deactivated during blood transportation and rapidly restored upon exposure to the ROS-rich microenvironment within liver cancer cells, thereby simultaneously achieving the protein therapy and stimuli-responsive doxorubicin release. This study presents a novel strategy for the development of tumor-sensitive co-delivery nanoplatforms.

Cardiac magnetic resonance imaging-indeterminate/negative cardiac sarcoidosis revealed by 18F-fluorodeoxyglucose-positron emission tomography: two case reports and a review of the literature

Background

Sarcoidosis is an inflammatory disorder of immune dysregulation characterized by non-caseating granulomas that can affect any organ. Cardiac sarcoidosis is an under-recognized entity that has a heterogeneous presentation and may occur independently or with any severity of systemic disease. Diagnosing cardiac sarcoidosis remains problematic with endomyocardial biopsies associated with a high risk of complications. Several diagnostic algorithms are currently available that rely on histopathology or clinical and radiological measures. The dominant mode of diagnostic imaging to date for cardiac sarcoidosis has been cardiac magnetic resonance imaging with gadolinium enhancement.

Case presentations

We report the cases of two adult patients: case 1, a 50-year-old white man who presented with severe congestive cardiac failure; and case 2, a 37-year-old white woman who presented with complete heart block. Both patients had a background of untreated pulmonary sarcoidosis. Cardiac magnetic resonance imaging did not show evidence of sarcoidosis in either patient and both proceeded to ¹⁸F-fluorodeoxyglucose-positron emission tomography scans that were highly suggestive of cardiac sarcoidosis. Both patients were systemically immunosuppressed with orally administered prednisone and methotrexate and had subsequent improvement by clinical and nuclear medicine imaging measures.

Conclusions

Current consensus guidelines recommend all patients with sarcoidosis undergo screening for occult cardiac disease, with thorough history and examination, electrocardiogram, and transthoracic echocardiogram. If any abnormalities are detected, advanced cardiac imaging should follow. While cardiac magnetic resonance imaging identifies the majority of cardiac sarcoidosis, early disease may not be detected. These cases demonstrate ¹⁸F-fluorodeoxyglucose-positron emission tomography is warranted following an indeterminate or normal cardiac magnetic resonance imaging if clinical suspicion remains high. Unidentified and untreated cardiac sarcoidosis risks significant morbidity and mortality, but early detection can facilitate disease-modifying immunosuppression and cardiac-specific interventions.

Dengue fever with compartment syndrome of the right arm

A 44-year-old woman was admitted to our hospital with dengue fever. She developed a haematoma in the right arm at the site of a previous arterial line insertion. Due to coexisting thrombocytopenia, the bleeding was severe enough to cause compartment syndrome. An emergency fasciotomy was performed and her limb salvaged. The case illustrates one important potential complication of this common infectious disease.

Heightened clinical suspicion of pulmonary embolism and disregard of the D-dimer assay: a contemporary trend in an era of increased access to computed tomography pulmonary angiogram?

BACKGROUND

Prospective studies have shown that utilising qualitative D-dimers in those with a low Wells pre-test probability (PTP) of pulmonary embolism (PE) have significantly reduced the number of computed tomography pulmonary angiograms (CTPA) being performed. These studies have been based on a PE prevalence of approximately 6% in the low PTP group.

AIM

This study compares the diagnostic approach to PE in the study institution to well-established guidelines. The study also re-examines the cost-benefit analyses of qualitative d-dimers and CTPA in the low PTP group.

METHODS

A retrospective study of 169 consecutive CTPA requested in the emergency department of a major teaching hospital during a 12-month period.

RESULTS

The prevalence of PE was 0% (0/65), 11.7% (9/77) and 0% (0/2) in the low, moderate and high Wells PTP groups respectively, and 6.3% (9/144) overall. PTP was documented in 10 (6.9%) cases, and the qualitative Clearview Simplify D-dimer was only ordered in 33.8% (22/65) of low PTP subjects. The false positive D-dimer rate was 90.2% (37/41). Cost-benefit analysis and assay performance defines a narrow range of low PTP PE prevalence between 1% and 5% for the utilisation of the qualitative D-dimer assay.

CONCLUSIONS

The overall prevalence of PE in subjects undergoing CTPA was significantly lower compared with data in the literature. The authors recommend warranted clinical suspicion of PE should be confirmed by a senior physician prior to placing a patient in the PE work-up pathway. In such patients, the qualitative D-dimer assay should be utilised if PTP is low, and the exclusionary efficiency of the D-dimer will be improved in the setting of higher PE prevalence in this subgroup. Hospitals should audit local PE prevalence, as cost-benefit analyses raises questions about the effectiveness of D-dimers when PE prevalence is very low in the low PTP subgroup.

Role of p300 in regulating neuronal nitric oxide synthase gene expression through nuclear factor-κB-mediated way in neuronal cells

Nuclear factor (NF)-κB acetylation has been shown to participate in a number of neurological processes by regulating the expression of certain genes. We have previously demonstrated the neuronal nitric oxide synthase (nNOS) expression and nitric oxide (NO) production may be regulated by NF-κB acetylation via an NF-κB responsive element within the nNOS promoter in neuronal cells. p300 is a ubiquitous transcription coactivator with intrinsic histone acetyltransferase (HAT) activity, which is important in the nervous system. In the present study, we aimed at probing if p300 participated in regulating the nNOS expression through the NF-κB-mediated way. As a result, we found p300 enhanced the nNOS protein and mRNA levels in human neuroblastoma SK-N-SH cells by enhancing the binding of NF-κB to the nNOS promoter and NF-κB-mediated nNOS transcription. Meanwhile, p300 was shown to directly acetylate NF-κB p65 and p50 subunits, interact with NF-κB and bind to the NF-κB responsive element region within the nNOS promoter. Taken together, our results indicate p300 acts as both an HAT and a coactivator in regulating NF-κB-mediated nNOS expression, which provide some correlations between p300 and nNOS in neuronal cell, and suggest that some p300-related neurological disorders may be partially based on its effect on the nNOS expression.

Early Diagnosis of Acute Myocardial Infarction by Bedside Multimarker Test at an Emergency Department in Hong Kong

Introduction

Cardiac biomarker measurement can aid diagnosis of acute myocardial infarction. The present study evaluates the efficacy and efficiency of point-of-care multimarkers measurement of myoglobin, creatine kinase (CK-MB) and troponin in identifying patients with acute myocardial infarction.

Method

We prospectively enrolled consecutive patients (N=105) in the emergency department who were being evaluated for possible acute myocardial infarction. Point-of-care testing (POCT) of myoglobin, CK-MB and troponin I (TnI) was performed in all patients. Central laboratory measurement of troponin I was also performed simultaneously. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and receiver operating characteristic (ROC) curve were evaluated.

Result

The specificity and positive likelihood ratio of TnI (POCT) and TnI (laboratory) were 98%, 13.0 and 98%, 21.8 respectively. The areas under curve of the ROC curve of TnI (POCT) and TnI (laboratory) were 0.692 and 0.725 respectively.

Conclusion

A high positive likelihood ratio for acute myocardial infarction through point-of-care testing can help timely diagnosis and just-in-time appropriate management for patients presenting with chest pain.