Towards a better psychological satisfaction: developing a mixed multi-criteria evaluation system to urban 'Not in my back yard' facilities siting

'Not in My Back Yard (NIMBY)' facilities are psychologically sensitive to urban and regional development. Multi-criteria evaluation (MCE) method has been widely used for the decision-making of optimum siting of urban NIMBY facilities which aim to improve residents' psychological satisfaction. However, the evaluation of qualitative criteria in siting analysis remains under researched, such as the insufficient focus on urban and regional spatial development, social public opinion, and psychological factors. Thus, the effective improvement of MCE method through an interdisciplinary view can optimise the decision process and advance the factor assessment system of siting, which helps to supplement qualitative criteria evaluation. The specific improvement steps are as follows. The first step is to introduce the mixed MCE method to improve the qualitative criteria evaluation method by pre-processing qualitative criteria with min-max standardisation and normalization. This process transfers all negative factors to positive ones and transforms the F function to linear functions. The second step is to optimise the existing two-phase siting decision-making including the feasibility evaluation phase and the MCE phase. The third step is to propose a modular criteria system composed of urban and regional spatial planning, social psychological factors and the corresponding improvement strategy of this system from three perspectives of composition, measure, and weight. We argue that the improved method could be broadly applied to optimum siting decision of urban NIMBY facilities and enhance the psychological satisfaction of residents.

Housing debt and depressive symptoms: evidence from the China family panel studies

BACKGROUND

There is limited evidence on the association between housing debt and depressive symptoms in China. This study aimed to examine the impact of housing debt on depressive symptoms and explore the heterogeneous impacts arising from two sources of housing debt and two types of housing demands.

METHODS

Using data from the 2016 and 2018 China Family Panel Studies (CFPS), this study included 25,232 Chinese individuals. Depressive symptoms were assessed using the eight-item Center for Epidemiological Studies Depression Scale (CES-D8). Housing debt was measured by dummy variables, indicating whether an individual had housing debt, and continuous variables, which were the logarithm of the total amount of housing debt. The two-way fixed effects model was used to examine the relationship.

RESULTS

Housing debt had a significant positive impact on depressive symptoms in China. Individuals with housing debt had a 0.176-point higher depressive symptom score than those without housing debt. A 10% increase in the total amount of housing debt led to a 0.16-point increase in depressive symptoms. Non-bank housing loans significantly increased the level of depressive symptoms with a larger coefficient (coef = 0.289), while the impact of bank housing loans was small and not statistically significant. In terms of the types of housing demands, a positive impact was observed only among individuals who had only one property meeting their housing consumption demands.

CONCLUSIONS

This study found a significant positive impact of housing debt on depressive symptoms, primarily driven by non-bank housing loans. Furthermore, housing debt increased the depressive symptoms among individuals with consumption demands, while those with investment demands did not show a significant impact. Government interventions should prioritize easing formal financial constraints and providing support for individuals with housing consumption demands.

[Research progress of bariatric and metabolic surgery in the prevention of gastroesophageal reflux disease]

Gastroesophageal reflux disease (GERD) is a common digestive tract disease. Obesity is an independent risk factor for GERD. Laparoscopic sleeve gastrectomy (laparoscopic sleeve gastrectomy, LSG) is becoming more popular in bariatric metabolic surgery and is simple to perform with fewer complications, but its efficacy in treating postoperative anti-reflux in obese patients remains controversial. LSG has been reported to disrupt anti-reflux barrier function, such as altered cardiac notch, disruption of diaphragmatic continuity, and increased hiatal hernia after surgery. The cardiac notch is one of the important anti-reflux barriers at the gastroesophageal junction, and its accentuation has been shown to be effective in alleviating the symptoms of GERD, and LSG combined with angle of cardiac notch accentuation is expected to be an effective measure to prevent GERD after obesity surgery. Therefore, this article mainly reviews the research on the prevention of GERD by bariatric surgery, aiming to explore the effective treatment of GERD in obese patients after surgery, so as to improve the symptoms and quality of life of patients with GERD, and provide reference for the surgical treatment of GERD.

Exploring the Prognosis-Related Genetic Variation in Gastric Cancer Based on mGWAS

The use of metabolome genome-wide association studies (mGWAS) has been shown to be effective in identifying functional genes in complex diseases. While mGWAS has been applied to biomedical and pharmaceutical studies, its potential in predicting gastric cancer prognosis has yet to be explored. This study aims to address this gap and provide insights into the genetic basis of GC survival, as well as identify vital regulatory pathways in GC cell progression. Genome-wide association analysis of plasma metabolites related to gastric cancer prognosis was performed based on the Generalized Linear Model (GLM). We used a log-rank test, LASSO regression, multivariate Cox regression, GO enrichment analysis, and the Cytoscape software to visualize the complex regulatory network of genes and metabolites and explored in-depth genetic variation in gastric cancer prognosis based on mGWAS. We found 32 genetic variation loci significantly associated with GC survival-related metabolites, corresponding to seven genes, VENTX, PCDH 7, JAKMIP1, MIR202HG, MIR378D1, LINC02472, and LINC02310. Furthermore, this study identified 722 Single nucleotide polymorphism (SNP) sites, suggesting an association with GC prognosis-related metabolites, corresponding to 206 genes. These 206 possible functional genes for gastric cancer prognosis were mainly involved in cellular signaling molecules related to cellular components, which are mainly involved in the growth and development of the body and neurological regulatory functions related to the body. The expression of 23 of these genes was shown to be associated with survival outcome in gastric cancer patients in The Cancer Genome Atlas (TCGA) database. Based on the genome-wide association analysis of prognosis-related metabolites in gastric cancer, we suggest that gastric cancer survival-related genes may influence the proliferation and infiltration of gastric cancer cells, which provides a new idea to resolve the complex regulatory network of gastric cancer prognosis.

Prognostic Implication of Plasma Metabolites in Gastric Cancer

Gastric cancer (GC) typically carries a poor prognosis as it is often diagnosed at a late stage. Altered metabolism has been found to impact cancer outcomes and affect patients' quality of life, and the role of metabolites in gastric cancer prognosis has not been sufficiently understood. We aimed to establish a prognostic prediction model for GC patients based on a metabolism-associated signature and identify the unique role of metabolites in the prognosis of GC. Thus, we conducted untargeted metabolomics to detect the plasma metabolites of 218 patients with gastric adenocarcinoma and explored the metabolites related to the survival of patients with gastric cancer. Firstly, we divided patients into two groups based on the cutoff value of the abundance of each of the 60 metabolites and compared the differences using Kaplan-Meier (K-M) survival analysis. As a result, 23 metabolites associated with gastric cancer survival were identified. To establish a risk score model, we performed LASSO regression and Cox regression analysis on the 60 metabolites and identified 8 metabolites as an independent prognostic factor. Furthermore, a nomogram incorporating clinical parameters and the metabolic signature was constructed to help individualize outcome predictions. The results of the ROC curve and nomogram plot showed good predictive performance of metabolic risk features. Finally, we performed pathway analysis on the 24 metabolites identified in the two parts, and the results indicated that purine metabolism and arachidonic acid metabolism play important roles in gastric cancer prognosis. Our study highlights the important role of metabolites in the progression of gastric cancer and newly identified metabolites could be potential biomarkers or therapeutic targets for gastric cancer patients.

[Meta-analysis comparing long-term outcomes of intersphincteric resection versus abdominoperineal resection for low rectal cancer]

Objective: To compare the long-term outcomes of intersphincteric (trans-internal and external) sphincter resection (ISR) and abdominoperineal proctocolectomy (APR) for low-grade rectal cancer. Methods: We used a meta-analytic approach to compare these procedures . Published reports comparing ISR and APR for low rectal cancer in Pubmed, Medline, EMBASE and Cochrane, China Knowledge Network (CNKI), China Biomedical Literature Database, and Vipers databases between January 2005 and January 2023 were searched and those meeting the eligibility criteria were selected for extraction of data for analysis. Inclusion criteria were as follows: (1) all reports comparing ISR and APR for low rectal cancer before January 2023; and (2) prospective randomized controlled studies or well-designed cohort studies. Exclusion criteria were as follows: (1) full text not available; (2) duplicate publications, missing primary outcome indicators, and unknown data; and (3) invalid statistical analysis. Results: Sixteen studies with 2498 patients were included in this study. Compared with the APR group, patients in the ISR group were relatively younger (weighted mean difference [WMD]=-1.82, 95%CI=-2.94 to -0.70, P=0.01), had tumors farther from the anal verge (WMD=0.43, 95%CI=0.18 to 0.67, P<0.01), and lower pathological T-stage (T3-4 stage: OR=0.54, 95%CI=0.36 to 0.81, P<0.01). In contrast, there were no statistically significant differences between the two groups in gender (P=0.78), body mass index (P=0.77), or pathological N stage (P=0.09). Compared with the APR group, patients in the ISR group had a lower rate of postoperative complications (OR=0.77, 95%CI=0.60 to 0.99, P=0.04), shorter hospital stay (WMD=-4.30, 95%CI=-7.07 to -1.53, P<0.01), higher 5-year overall survival (HR=0.54, 95%CI=0.33 to 0.88, P=0.01), and higher 5-year disease-free survival (HR=0.65, 95%CI=0.47 to 0.90, P<0.01). Five-year locoregional failure (HR=0.66, 95%CI=0.40 to 1.10, P=0.11) and time to surgery (WMD=-9.71, 95%CI=-41.89 to 22.47, P=0.55) did not differ significantly between the two groups. Conclusion: ISR is a safe and effective alternative to APR for early-stage low-grade rectal cancer.

[Treatment of obstructive colorectal cancer]

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.

Examining the Human Activity-Intensity Change at Different Stages of the COVID-19 Pandemic across Chinese Working, Residential and Entertainment Areas

The COVID-19 pandemic has already resulted in more than 6 million deaths worldwide as of December 2022. The COVID-19 has also been greatly affecting the activity of the human population in China and the world. It remains unclear how the human activity-intensity changes have been affected by the COVID-19 spread in China at its different stages along with the lockdown and relaxation policies. We used four days of Location-based services data from Tencent across China to capture the real-time changes in human activity intensity in three stages of COVID-19-namely, during the lockdown, at the first stage of work resuming and at the stage of total work resuming-and observed the changes in different land use categories. We applied the mean decrease Gini (MDG) approach in random forest to examine how these changes are influenced by land attributes, relying on the CART algorithm in Python. This approach was also compared with Geographically Weighted Regression (GWR). Our analysis revealed that the human activity intensity decreased by 22-35%, 9-16% and 6-15%, respectively, in relation to the normal conditions before the spread of COVID-19 during the three periods. The human activity intensity associated with commercial sites, sports facilities/gyms and tourism experienced the relatively largest contraction during the lockdown. During the relaxations of restrictions, government institutions showed a 13.89% rise in intensity at the first stage of work resuming, which was the highest rate among all the working sectors. Furthermore, the GDP and road junction density were more influenced by the change in human activity intensity for all land use categories. The bus stop density was importantly associated with mixed-use land recovery during the relaxing stages, while the coefficient of density of population in entertainment land were relatively higher at these two stages. This study aims to provide additional support to investigate the human activity changes due to the spread of COVID-19 at different stages across different sectors.

[Effect of intestinal obstruction stent combined with neoadjuvant chemotherapy on the pathological characteristics of surgical specimens in patients with complete obstructive colorectal cancer]

Objective: To compare the effects of three treatment options: emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery, on the pathological characteris- tics of surgically-resected specimens from patients with completely obstructive colorectal cancer. Methods: This was a retrospective cohort study analyzing clinicopathological data of patients with complete obstructive colorectal cancer who were admitted to the General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, between May 2012 and August 2020. The inclusion criteria were diagnosed with complete colorectal obstruction, pathologically confirmed as adenocarcinoma, resectable on imaging assessment, and without distant metastasis, combined with the patients' clinical manifestations and imaging examination findings. Patients with multiple colorectal cancers, refusal to undergo surgery, and concurrent peritonitis or intestinal perforation before stenting of the intestinal obstruction were excluded. Eighty-nine patients with completely obstructive colorectal cancer were enrolled in the study and were divided into emergency surgery group (n=30), stent-surgery group (n=34), and stent-neoadjuvant chemotherapy- surgery group (n=25) according to the treatment strategy. Differences in the pathological features (namely perineural infiltration, lymphovascular infiltration, tumor deposits, specimen intravascular necrosis, inflammatory infiltration, abscesses, mucus lake formation, foreign body giant cells, calcification, and tumor cell ratio) and biomolecular markers (namely cluster of differentiation (CD)34, Ki67, Bcl-2, matrix metalloproteinase-9, and hypoxia-inducible factor alpha) were recorded. Pathological evaluation was based on the presence or absence of qualitative evaluation of pathological features, such as peripheral nerve infiltration, vascular infiltration, and cancer nodules within the specimens. The evaluation criteria for the pathological features of the specimens were as follows: Semi-quantitative graded evaluation based on the proportion of tissue necrosis, inflammatory infiltrates, abscesses, mucus lake formation, foreign body giant cells, calcification, and tumor cells in the field of view within the specimen were classified as: grade 0: not seen within the specimen; grade 1: 0-25%; grade 2: 25%-50%; grade 3: 50%-75%; and grade 4: 75%-100%. The intensity of cellular immunity was classified as none (0 points), weak (1 point), moderate (2 points), and strong (3 points). The two evaluation scores were then multiplied to obtain a total score of 0-12. The immunohistochemical results were also evaluated comprehensively, and the results were defined as: negative (grade 0): 0 points; weakly positive (grade 1): 1-3 points; moderately positive (grade 2): 4-6 points; strongly positive (grade 3): 7-9 points; and very strong positive (grade 4): 10-12 points. Normally-distributed values were expressed as mean±standard deviation, and one-way analysis of variance was used to analyze the differences between the groups. Non-normally-distributed values were expressed as median (interquartile range: Q1, Q3). A nonparametric test (Kruskal-Wallis H test) was used for comparisons between groups. Results: The differences were not statistically significant when comparing the baseline data for age, gender, tumor site, American Society of Anesthesiologists score, tumor T-stage, N-stage, and degree of differentiation among the three groups (all P>0.05). The differences were not statistically significant when comparing the pathological characteristics of the resected tumor specimens, such as foreign body giant cells, inflammatory infiltration, and mucus lake formation among the three groups (all P>0.05). The rates of vascular infiltration were 56.6% (17/30), 41.2% (15/34), and 20.0% (5/25) in the emergency surgery, stent-surgery, and stent- neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences between the groups (χ²=7.142, P=0.028). Additionally, the rate of vascular infiltration was significantly lower in the stent-neoadjuvant chemotherapy-surgery group than that in the emergency surgery group (P=0.038). Peripheral nerve infiltration rates were 55.3% (16/30), 41.2% (14/34), and 16.0% (4/25), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (χ²=7.735, P=0.021). The infiltration peripheral nerve rates in the stent-neoadjuvant chemotherapy-surgery group were significantly lower than those in the emergency surgery group (P=0.032). The necrosis grade was 2 (1, 2), 2 (1, 3), and 2 (2, 3) in the emergency surgery, stent- surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=10.090, P=0.006). Post hoc comparison revealed that the necrosis grade was higher in the stent-surgery and stent-neoadjuvant chemotherapy-surgery groups compared with the emergency surgery group (both P<0.05). The abscess grade was 2 (1, 2), 3 (1, 3), and 2 (2, 3) in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=6.584, P=0.037). Post hoc comparison revealed that the abscess grade in the emergency surgery group was significantly lower than that in the stent-surgery group (P=0.037). The fibrosis grade was 2 (1, 3), 3 (2, 3), and 3 (2, 3), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=11.078, P=0.004). Post hoc analysis revealed that the fibrosis degree was higher in both the stent-surgery group and the stent- neoadjuvant chemotherapy-surgery group compared with the emergency surgery group (both, P<0.05). The tumor cell ratio grades were 4 (3, 4), 4 (3, 4), and 3 (2, 4), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=8.594, P=0.014). Post hoc analysis showed that the tumor cell ratio in the stent-neoadjuvant chemotherapy-surgery group was significantly lower than that in the emergency surgery group (P=0.012). The CD34 grades were 2 (2, 3), 3 (2, 4), and 3 (2, 3) in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, and the difference was statistically significant (H=9.786, P=0.007). Post hoc analysis showed that the CD34 grades in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups were 2 (2, 3), 3 (2, 4), and 3 (2,3), respectively. Post hoc analysis revealed that the CD34 concentration was higher in the stent-surgery group than that in the emergency surgery group (P=0.005). Conclusion: Stenting may increase the risk of distant metastases in obstructive colorectal cancer. The stent-neoadjuvant chemotherapy-surgery treatment model promotes tumor cell necrosis and fibrosis and reduces the proportion of tumor cells, vascular infiltration, and peripheral nerve infiltration, which may help decrease local tumor infiltration and distant metastasis in completely obstructive colorectal cancer after stent placement.

[Comparison study for the proportion of underdiagnosed zonulopathy in angle closure glaucoma]

Objective: To analyze the proportion and clinical characteristics of underdiagnosed zonulopathy in angle closure glaucoma (ACG) patients and to explore the related risk factors. Methods: Case-control study. Continuous cases of ACG patients who underwent phacoemulsification combined with intraocular lens implantation and goniosynechialysis surgery [ACG group, including acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG)] from November 1, 2020 to October 31, 2021 and age-related cataract patients who underwent phacoemulsification combined with intraocular lens implantation surgery in the same period (control group) were included. The diagnosis of zonulopathy was determined according to the intraoperative signs such as wrinkles of the anterior capsule during continuous circular capsulorhexis. The proportion of zonulopathy, preoperative diagnosis rate of zonulopathy, demographic characteristics, anterior chamber depth (ACD), axis length, difference of ACD in both eyes (ACD of the contralateral eye minus ACD of the operated eye) were compared between the two groups. The related risk factors were explored. The paired t-test (comparison between two groups of normally distributed data), non-parametric test (comparison between two groups of non-normally distributed data), Chi-square test (categorical variables), univariate and multivariate logistic regression analysis were used. Results: There were 104 ACG patients (104 eyes), including 63 AACG patients (63 eyes) and 41 CACG patients (41 eyes), and 117 controls (117 eyes). There was no significant difference in age (P=0.29) and gender (P=0.07) between the two groups. The ACG group had shallower anterior chamber (P<0.001), shorter axial length (P<0.001) and more ACD difference in both eyes (P<0.001). In the ACG group, the proportion of zonulopathy was 46.2% (48/104), which was significantly higher than that (6.0%, 7/117) in the control group (P<0.001). In the control group, only zonular laxity was found, while in the ACG group, besides the predominant zonular laxity (68.8%, 33/48), there was zonular dehiscence (31.3%, 15/48). The eyes with AACG (57.1%, 36/63) had a higher proportion of zonulopathy than those with CACG (29.3%, 12/41) (P=0.006). In the ACG group, only 14 cases (29.8%) were diagnosed preoperatively according to slit lamp examination and/or ultrasound biomicroscopy. The proportion of underdiagnosed zonulopathy was 70.8% in the ACG group (34/48). A smaller ACD was found to be related to the zonulopathy in the ACG group. All AACG cases with an ACD ≤2.0 mm and CACG cases with an ACD ≤1.9 mm had zonulopathy. Multivariate logistic regression showed that the ACD difference in both eyes (P=0.025) and the diagnosis of ACG (AACG vs. cataract, P<0.001; CACG vs. cataract, P=0.023) were independent risk factors associated with zonulopathy. Conclusions: The proportion of underdiagnosed zonulopathy among ACG patients is high. Better preoperative diagnostic methods for zonulopathy are needed. Zonulopathy is common in ACG patients, especially in AACG patients, suggesting that zonulopathy may be related to the pathogenesis of ACG. The shallower the ACD, the riskier the zonulopathy. ACD differences between two eyes and ACG types (including AACG and CACG) were related risk factors of zonulopathy.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 11, 2022).

Recommendations for stereotactic body radiation therapy for spine and non-spine bone metastases. A GETUG (French society of urological radiation oncolgists) consensus using a national two-round modified Delphi survey

Background and purpose

The relevance of metastasis-directed stereotactic body radiation therapy (SBRT) remains to be demonstrated through phase III trials. Multiple SBRT procedures have been published potentially resulting in a disparity of practices. Therefore, the french society of urological radiation oncolgists (GETUG) recognized the need for joint expert consensus guidelines for metastasis-directed SBRT in order to standardize practice in trials carried out by the group.

Materials and methods

After a comprehensive literature review, 97 recommendation statements were created regarding planning and delivery of spine bone (SBM) and non-spine bone metastases (NSBM) SBRT. These statements were then submitted to a national online two-round modified Delphi survey among main GETUG investigators. Consensus was achieved if a statement received ≥ 75 % agreements, a trend to consensus being defined as 65-74 % agreements. Any statement without consensus at round one was re-submitted in round two.

Results

Twenty-one out of 29 (72.4%) surveyed experts responded to both rounds. Seventy-five statements achieved consensus at round one leaving 22 statements needing a revote of which 16 achieved consensus and 5 a trend to consensus. The final rate of consensus was 91/97 (93.8%). Statements with no consensus concerned patient selection (3/19), dose and fractionation (1/11), prescription and dose objectives (1/9) and organs at risk delineation (1/15). The voting resulted in the writing of step-by-step consensus guidelines.

Conclusion

Consensus guidelines for SBM and NSBM SBRT were agreed upon using a validated modified Delphi approach. These guidelines will be used as per-protocole recommendations in ongoing and further GETUG clinical trials.

[Short-term efficacy of laparoscopic sleeve gastrectomy plus uncut jejunojejunostomy (SG-uncut JJB) for treatment of obesity: a prospective study]

Objective: To analyze the short-term efficacy of sleeve gastrectomy plus uncut jejunojejunostomy (SG+uncut JJB) for patients with obesity. Methods: This prospective study was conducted in the General Surgery Department of Beijing Chaoyang Hospital from January to December 2020 (NCT04534504). The inclusion criteria were patients with a body mass index (BMI) of >32.5 kg/m², type 2 diabetes mellitus (T2DM) or at least two comorbidities with a BMI of 27.5-32.5 kg/m², a waist circumference of >90 cm (male) or >85 cm (female), and those aged between 16 and 65 years. The exclusion criteria included patients who were pregnant, diagnosed with severe neurological or mental illnesses, long-term users of antidepressants and immunosuppressants, and diagnosed with severe gastroesophageal reflux disease or underwent revision surgery. Patients with incomplete follow-up data or insufficient follow-up time were also excluded. Patients were divided into SG-uncut JJB group and SG group according to doctor's recommendation and patients' wills. The primary endpoint was the percentage of excess weight loss (%EWL), and the secondary endpoints were the percentage of total weight loss (%TWL) and the T2DM remission rate. All patients were regularly followed up until the end of December 2020. Results: After excluding seven patients who did not meet the inclusion criteria, 47 eligible patients were finally identified, with 21 in the SG+uncut JJB group and 26 in the SG group. The operation time (140 [110-180] minutes vs. 90 [70-180] minutes, Z=-3.642, P=0.001) and total cost ([54,000 ± 6000] yuan vs. [49,000 ± 7000] yuan, t=2.590, P=0.013) were slightly higher in the SG+uncut JJB group than in the SG group (all P<0.05). However, no significant differences were observed in terms of postoperative hospital stay, operative blood loss, and postoperative complications between the two groups (all P>0.05). The incidence of nausea and vomiting was significantly lower in the SG+uncut JJB group than in the SG group (9.5% [2/21] vs. 46.2% [12/26], χ²=7.453, P=0.006}. The %EWL and %TWL in the SG+uncut JJB group tended to increase gradually with time. The same trend was also observed in the SG group during the first 6 months of follow-up. The 12-month %EWL and %TWL in the SG group were slightly lower compared with the 6-month %EWL and %TWL (P=0.001). The 12-month %EWL values in the SG+uncut JJB and SG groups were (72.4%±12.3%) and (63.6%±25.7%), respectively. However, no significant differences were observed between the two groups in terms of %EWL. Moreover, the 1-month ([11.1%±2.4%] vs. [8.2%±4.4%], P=0.011) and 12-month %TWL ([29.7%±6.9%] vs. [20.3%±7.2%], P=0.001) were significantly higher in the SG+uncut JJB group than in the SG group. No significant differences were observed in terms of T2DM and hypertension remission (all P>0.05). Conclusion: SG+uncut JJB might achieve a promising weight-loss effect similar to SG with a relatively lower incidence of postoperative nausea and vomiting, and it might be an effective and safe approach for obesity management.

Hypericin blocks the function of HSV-1 alkaline nuclease and suppresses viral replication

ETHNOPHARMACOLOGICAL RELEVANCE

Hypericum perforatum L. has a long history in many countries of being used as a herbal medicine. It is also widely used in Chinese herbal medicine for the treatment of infections. Hypericin, a main component extracted from Hypericum perforatum L., has attracted the attention of many researchers for its remarkable antiviral, antitumor and antidepressant effects.

AIM OF THE STUDY

To find plant molecules that inhibit the alkaline nuclease (AN) of herpes simplex virus type 1 (HSV-1) and suppress viral replication.

MATERIALS AND METHODS

Bioinformatics methods were used to determine which compounds from a variety of natural compounds in our laboratory interact with AN. By this means we predicted that hypericin may interact with AN and suppress HSV-1 replication. Experiments were then carried out to verify whether hypericin inhibits the bioactivity of AN. The Pichia pastoris expression system was used to obtain recombinant AN. The exonuclease and endonuclease activity of AN treated with hypericin were tested by electrophoresis. Immunohistochemical staining of the HSV-1 nucleocapsids was used to find out whether hypericin inhibits the intracellular function of AN. Real-time PCR and western blotting analysis were performed to test viral gene expression and viral protein synthesis. The extent of viral replication inhibited by hypericin was determined by a plaque assay and a time of addition assay.

RESULTS

Recombinant AN was obtained by Pichia pastoris expression system. The exonuclease and endonuclease activity of recombinant AN were inhibited by hypericin in the electrophoresis assay. Hypericin showed no inhibitory effect on BeyoZonase™ Super Nuclease or DNase I. T5 Exonuclease activity was inhibited partially by10 μM hypericin, and was completely suppressed by 50 μM hypericin. Hind Ⅲ was inhibited by hypericin at concentrations greater than 100 μM, but EcoR I, BamH I, and Sal I were not inhibited by hypericin. HSV-1 nucleocapsids gathered in the nucleus when the viruses were treated with hypericin. Plaque formation was significantly reduced by hypericin (EC₅₀ against HSV-1 F is 2.59 ± 0.08 μM and EC₅₀ against HSV-1 SM44 is 2.94 ± 0.10 μM). UL12, ICP27, ICP8, gD, and UL53 gene expression (P < 0.01, 4.0 μM hypericin treated group vs control group) and ICP4 (P < 0.05, 6.0 μM hypericin treated group vs control group), ICP8 and gD (P < 0.05, 2.0 μM hypericin treated group vs control group) protein synthesis were inhibited by hypericin. In the time of addition assay, HSV-1 was suppressed by hypericin in the early stages of viral replication. Hypericin exhibits potent virucidal activity against HSV-1 and inhibits the adsorption and penetration of HSV-1.

CONCLUSION

Hypericin inhibits the bioactivity of AN and suppresses HSV-1 replication. The data revealed a novel mechanism of the antiherpetic effect of hypericin.

Outcomes of additional substrate modification in de novo atrial fibrillation ablation

Background

Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Data regarding additional substrate modification has been conflicting, both in paroxysmal and persistent atrial fibrillation.

Purpose

To assess the effect of additional linear substrate modification during de novo AF ablation on AF recurrence.

Methods

We reviewed 1575 AF ablations in 1254 patients from January 2013 to June 2021 at a single academic medical center. There were 1096 de novo ablations. We defined substrate modification as linear ablations including cavotricuspid isthmus (CTI), superior vena cava isolation, intercaval line, mitral isthmus, and left atrial roof and floor lines. We evaluated clinical and procedural characteristics to identify risk factors for AF recurrence and complications. Patients were followed for a minimum of 6 months.

Results

The 1096 de novo ablations included 65.5% males with mean age 61.1 years, mean BMI 31.3, 81.8% paroxysmal AF and 18.2% persistent AF. There were four AF ablation subgroups: PVI alone (41.6%), PVI and CTI ablation (37.1%), PVI with CTI and additional substrate modification (15.6%), and PVI with substrate modification without CTI ablation (5.7%). Overall, AF recurred in 36.9% cases. AF recurrence with PVI only ablation was 41% compared to 32.7% in patients with PVI and CTI ablation (p=0.02). When looking at patients with paroxysmal and persistent AF, results were similar, with decreased AF recurrence with the addition of CTI ablation in both paroxysmal (37.3% v. 29.2%, p=0.03) and persistent AF (58.1% v. 40.0%, p=0.02). Additional substrate modification did not result in significant difference in outcome in either paroxysmal or persistent AF (Figure 1).

Conclusions

In de novo AF ablations, addition of CTI ablation to de novo PVI ablation is associated with lower AF recurrence in both paroxysmal and persistent AF. Additional linear substrate modification did not impact outcomes.

Funding Acknowledgement

Type of funding sources: None.

Safety of same day discharge after atrial fibrillation ablation

Background

Atrial fibrillation (AF) ablation is an outpatient procedure with traditionally an overnight hospital observation (OHO). Recently, there has been a trend towards same day discharge (SDD).

Purpose

Compare AF ablation procedure safety outcomes with SDD vs. OHO.

Methods

We reviewed consecutive AF procedures performed from January 2013 to June 2021 at a single academic center. Patients underwent OHO until June 2020, after which patients had SDD whenever feasible. Adverse events were assessed at three months, which included pericardial effusion, pericarditis, post-procedure hypotension, embolic events, and vascular complications. We also assessed emergency department (ED) visits and procedure-related hospital admissions.

Results

There were 1254 patients who underwent 1575 AF ablations. 1440 patients underwent OHO and 135 had SDD. Mean age was 62.2 years, BMI 33 kg/m2, 65% were male, and 27.6% had persistent AF, without significant differences in baseline characteristics between OHO and SDD. We found that SDD was not associated with increased complications (OHO 0.20% v. SDD 0.49%; p&gt;0.05), ED visits, or hospital admissions (2% v. 5%; p&gt;0.05) (Figure 1, 2). There were no gender or age-related disparities in all outcomes (p&gt;0.05).

Conclusion

SDD protocol after AF ablation is feasible and not associated with higher incidence of complications, ED visits, and procedure-related hospitalizations.

Funding Acknowledgement

Type of funding sources: None.

Does body mass index affect atrial fibrillation ablation outcomes

Background

There are conflicting reports in the literature regarding whether body-mass index (BMI) influences the success and procedural complication rates of atrial fibrillation (AF) ablation.

Purpose

To determine if differences in BMI affect AF ablation outcomes

Methods

At a single academic center, AF ablation procedures were reviewed from 2013 to 2021. Primary outcomes were AF recurrence (after a 90 day blanking period), procedure-related complications, emergency department visits or hospital admission (ED/HOSP). Patients had a minimum of 6 months follow-up

Results

We analyzed 1569 AF ablation consecutive procedures (1093 de novo, 476 repeat ablation) using either radiofrequency or cryoablation. The study population was 65% male with a mean age 62 years, with 28% persistent AF. BMI was separated into three cohorts: &lt;25 kg/m2 (N=218), 25–30 kg/m2 (N=547), and &gt;30 kg/m2 (N=804). There were no significant differences in the type of AF, left atrial diameter, or left ventricular ejection fraction in the BMI subgroups. There was a direct relationship between the prevalence of co-morbid conditions and increasing BMI: hypertension (49.1%, 59.9%, 60.2%; p 0.04), diabetes (6.4%, 13.5%, 21.3%; p 0.01), and obstructive sleep apnea (5.5%, 10.8%, 26.7%; p&lt;0.01). There were no significant differences in AF recurrence, procedural complications or ED/HOSP among the BMI cohorts (p&gt;0.05) (Figure 1). No gender related disparities were noted in outcomes (p&gt;0.05).

Conclusion

Higher BMI was not associated with AF recurrence, complications, or ED/HOSP after AF ablation despite a higher prevalence of comorbid medical conditions

Funding Acknowledgement

Type of funding sources: None.

[Gene analysis and clinical features of MYH9-related disease]

Objective: To identify gene variants and investigate clinical features of nonmuscle myosin heavy chain 9-related disease (MYH9-RD). Methods: In this retrospective study, the data of patients with MYH9-RD admitted to Shenzhen Children's Hospital from July 2017 to September 2020 were extracted. The gene variants, clinical features and laboratory tests results were summarized. Results: Among the 6 children, 4 were males and 2 were females, aged 4.0 (0.5-7.6) years. Main clinical manifestations included thrombocytopenia (6 cases), epistaxis (3 cases), petechias (2 cases), traumatic hematoma (1 case), and abnormal liver enzymes (1 case). One patient had no family history, and the other 5 cases were pedigrees. Two pedigrees (2 cases) had long-term microscopic hematuria, one pedigree (2 cases) had history of early cataract, and three pedigrees (5 cases) had chronic mild elevation of liver enzymes. Four MYH9 gene variants were found in 12 patients, including c.2104C>T(p.R702C) in exon 17, c.4270G>A(p.D1424N) in exon 31, c.5521G>A (p.E1841K) in exon 39, and c.5797C>T (p.R1933X) in exon 41. According to the family pedigrees analysis, except for the case of variant in exon 17 which was spontaneous mutation with no family history, the other variants were from their father or mother. The complete blood count results showed a decreased platelet number in these patients, and the counting results of the automated hematology analyzer were significantly lower than that of manual counting method ((33.4±17.2) × 10⁹ vs. (60.4±21.0) × 10⁹/L,t=-5.83, P<0.05). The examination of the peripheral blood smear revealed the presence of thrombocytopenia with giant platelets and granulocyte inclusion bodies. The MYH9 gene variant (R702C) located at the N-terminus head domain of non-muscle myosin heavy chain ⅡA (NMMHC-ⅡA), which has ATPase activity, led to severe reduction of platelet number (<20×10⁹/L) and obscure granulocyte inclusion bodies. However, higher platelet numbers (40×10⁹-80×10⁹/L) and obvious granulocyte inclusion bodies were observed in patients with tail-position mutations at C-terminus. Conclusions: The clinical phenotypes of MYH9-RD were variable. The mutations in certain regions of MYH9 gene were related to platelet count and granulocyte inclusion bodies. MYH9-RD should be considered in individuals with unknown etiology and persistent thrombocytopenia which is non-responsive to conventional treatment, regardless of family history. Complete blood count and blood smear morphology examinations are the first steps to screen and diagnose the disease. The laboratory should pay attention to the morphological review rules and standardized reports.

Multiplasmid DNA in agarose gel electrophoresis: Suitable dye and temperature is essential for prominent profiles

Nucleic acids dye Goldview is widely used in agarose gel electrophoresis (AGE). However, in this study, a sample of multiplasmid DNA (multi-pDNA) stained with Goldview analyzed by AGE showed its instability at low temperature. Three types of DNA samples were analyzed, including linear DNA (ladder), single-plasmid DNA (single-pDNA), and multi-pDNA, electrophoretic conditions were optimized by adjusting the dye, the buffer, and the temperature (1-50°C). The results showed that the light intensity of Gelred is 2.2-times higher than that of Goldview in staining multi-pDNA. Compared with the single-pDNA and the linear DNA, the multi-pDNA stained with Goldview was greatly affected by temperature. This short communication indicated that Gelred is a highly applicable dye for analyzing multiplasmid samples. The degree and the way of binding of Goldview to multi-pDNA are greatly affected by temperature.

[Correlation of inflammatory cells and corneal nerve damage in fungal keratitis on in vivo confocal microscopy]

Objective: To investigate the relationship between inflammatory cell infiltration and nerve damage in patients with fungal keratitis at different degrees of severity. Methods: Retrospective study. A total of 44 consecutive patients (44 eyes) with fungal keratitis in Beijing Tongren Hospital Affiliated to Capital Medical University from January 2017 to December 2019 were selected as the patient group, including 30 males and 14 females, with an age of (58.3±11.5) years old. Twenty healthy people (20 eyes) were included as control group. Slit-lamp microscopy was performed to observe the corneal ulcer. According to the diameter of corneal ulcer, patients were divided into mild, moderate and severe groups. With in vivo confocal microscopic ,the images were obtained from the epithelial layer to the endothelial layer in the central cornea and superior, inferior, nasal and temporal peripheral cornea. Parameters of the maximum density of fungal hyphae, the maximum depth of hyphal infiltration, the density, area and length of dendritic cells (DCs), the nerve density, and the number and curvature of nerve trunks were collected. The Kruskal-Wallis test, Wilcoxon test, and Spearman correlation analysis were used for analyses. Results: On confocal microscopy, many uniform, highly reflective, segment-like structures in parallel or staggered rows were detected in the cornea, with a certain degree of physiological curvature and branching. Quantitative analysis of hyphal density found that the median rating of hyphal density was 2.6 (2.0, 3.0), mainly with medium to large amounts of hyphae. Most hyphae were 100-150 μm in depth (18 cases, 40.9%), and the maximum depth of hyphae in 95.5% (42 cases) of patients was within 300 μm. The hyphal invasion depth in the mild group was 89.4 (50.5, 106.8) μm, in the moderate group was 133 (122, 203) μm, and in the severe group was 135 (74, 151) μm. As the severity of the disease increased, the depth of hyphal invasion increased (F=4.248, P=0.001). Compared with the control group, the DC density [166 (81.3, 212.5) vs. 24.0 (20.8, 32.3) cells/μm²], area [441.3 (291.9, 529.5) vs. 63.7 (47.7, 70.3) μm²] and length [68.3 (39.4, 91.0) vs. 9.2 (7.0, 11.3) μm] increased in patients (W=493.5, 500.0, 500.0; P<0.01). The nerve density [5 398.3 (3 202.7, 6 828.3) vs. 19 171.8 (17 558.8, 21 550.4) μm/mm²; t=-14.448, P<0.01] and the length [692.7 (402.0, 925.1) vs.2 138.4 (1 940.4, 2 597.2) μm; t=-11.930, P<0.01] and number [2.9 (2.0,3.0) vs. 6.0 (5.5,7.0); t=-8.282, P<0.01] of nerve trunks in patients decreased. There were strong negative correlations between the nerve density, the number of nerve trunks, and the DC density (r=-0.555, -0.466; P<0.01). Conclusions: The depth of fungal hypha invasion in patients with fungal keratitis is mainly concentrated in the epithelial layer and superficial stroma layer. The density of mature dendritic cells in the lesion area was negatively correlated with the density and number of subbasal nerves. The density of subbasal nerves decreased as the increase of the severity of the lesion. (Chin J Ophthalmol, 2021, 57: 580-588).

Study on the evaluation model of serialized civil aircraft commonality index based on fuzzy set theory

Commonality, a typical commercial feature of serialized civil aircraft study and development, refers to a series of methods of reusing and sharing assets, which were developed based on broad similarity. The common design of serialized civil aircraft is capable of maximally saving R&D, production, operation, and disposal. To maximize the total benefits of manufacturers and operators, the common design of serialized civil aircrafts primarily exploits the commercial experience of serialized products in other fields (e.g., automobiles and mobile phones), whereas a scientific index system and quantitative evaluation model has not been formed. Accordingly, this study proposes a new civil aircraft commonality index evaluation model in accordance with fuzzy set theory and methods. The model follows two branches, i.e., attribute commonality and structural commonality, to develop a multi-level civil aircraft commonality index system. The proposed model can split the commonality into six commonality sub-intervals and build the corresponding standard fuzzy set with the characteristic attribute parameters of the civil aircraft as the elements. Next, based on considerable civil aircraft sample data, a fuzzy test is designed to yield the membership function of the fuzzy set. Thus, a model of evaluating civil aircraft commonality is constructed, taking the characteristic parameters of the civil aircraft to be evaluated as input, and selecting the degree of commonality of each level as output. Lastly, this study employs the evaluation model to evaluate the commonality of Boeing 757-200 with other civil aircrafts. Furthermore, the evaluated results well explain the actual situation, which verifies the effectiveness and practicability of the proposed model.

Zebrafish Minichromosome Maintenance Protein 5 Gene Regulates the Development and Migration of Facial Motor Neurons via Fibroblast Growth Factor Signaling

Minichromosome maintenance protein 5 (MCM5), a member of the microchromosomal maintenance protein family, plays an important role in the initiation and extension of DNA replication. However, its role in neural development in zebrafish remains unclear. Here, we used morpholino (MO) and CRISPR/Cas9 to knock down mcm5 and investigated the developmental features of facial motor neurons (FMNs) in the hindbrain of zebrafish. We found that knockdown of mcm5 using mcm5 MO resulted in a small head, small eyes, and a blurred midbrain-hindbrain boundary, while MO injection of mcm5 led to decrease in FMNs and their migration disorder. However, the mutant of mcm5 only resulted in the migration defect of FMNs rather than quantity change. We further investigated the underlying mechanism of mcm5 in the development of hindbrain using in situ hybridization (ISH) and fgfr1a mRNA co-injected with mcm5 MO. Results from ISH showed that the fibroblast growth factor (FGF) signaling pathway was changed when the MCM5 function was lost, with the decrease in fgfr1a and the increase in fgf8, while that of pea3 had opposite trend. FMN development defects were rescued by fgfr1a mRNA co-injected with mcm5 MO. Our results demonstrated that FGF signaling pathway is required for FMN development in zebrafish. Specifically, mcm5 regulates FMN development during zebrafish growing.

[Clinical observation and analysis on the effect of orthokeratology in myopic anisometropic children]

Objective: To evaluate the clinical effects of orthokeratology lens on children with myopic anisometropia. Methods: Retrospective case series study. The data of 226 myopic anisometropia children, (10.83±1.56)years old, including 95 males and 131 females, fitted with orthokeratology(OK) lens in Beijing Tongren Hospital from June 2017 to June 2019 were collected. According to the lens wearing condition and baseline anisometropia, they were divided into four groups: group A1 with an average age of (10.68±1.66) years (bilateral OK lens wearing with low anisometropia, 1.0 D≤SE difference<2.5 D, 50 males and 61 females), group A2 with an average age of (11.24±1.38) years (bilateral OK lens wearing with moderate and high anisometropia, SE difference≥2.5 D, 10 males and 23 females), group B1 with an average age of (10.79±1.51) years (unilateral OK lens wearing with low anisometropia, 1.0 D≤SE difference<2.5 D, 17 males and 21 females) and group B2 with an average age of (10.97±1.60) years (unilateral OK lens wearing with moderate and high anisometropia, SE difference≥2.5 D, 18 males and 26 females). After wearing OK lens for one year, the changes of axial length(AL) and AL difference were observed and statistically analyzed. Results: (1) AL changes: after wearing OK-lens for one year, AL of each eye increased. In group A1, the AL of the more myopic eyes and the less myopic eyes increased by (0.20±0.21) mm and (0.24±0.22) mm respectively, and the difference was statistically significant (t=-3.208, P=0.002); in group A2, the AL growth of the more myopic eyes and the less myopic eyes were (0.04±0.11) mm and (0.17±0.14) mm, and the difference was statistically significant (t=-5.545, P<0.001). In group B1, the AL elongation of the more myopic eyes and the less myopic eyes were (0.14±0.21) mm and (0.39±0.23) mm, and in group B2, the AL growth of the more myopic eyes and the less myopic eyes were (0.11±0.14) mm and (0.54±0.24) mm, with statistically significant differences(t=-6.533, -11.643; all P<0.001). There was a linear correlation between AL elongation and age of the more myopic eyes and the less myopic eyes in group A1(corrected R²=0.208, 0.237) and group A2 (corrected R²=0.169, 0.360). There was no linear correlation of the more myopic eyes and the less myopic eyes between AL change and age or baseline myopia in group B1 (F=0.514, 1.205;P=0.602, 0.312) and group B2 (F=0.841, 0.056; P=0.439, 0.946). (2)Change of AL difference: after wearing OK lens for one year, the changes of AL difference in groupA1, A2, B1 and B2 were (-0.04±0.14) mm,(-0.13±0.13) mm,(-0.26±0.24) mm and (-0.43±0.25) mm, and the decrease of AL difference in moderate and high anisometropia groups were greater than that in low anisometropia groups (t =-3.211, -3.180; P=0.002, 0.002).There was a linear correlation between the reduction of AL difference and baseline anisometropia in group A1, A2 and B2 (corrected R²=0.099, 0.149, 0.230), and there was no linear relationship between the decrease of AL difference and the baseline anisometropia in group B1 (F=0.014, P=0.908). Conclusions: Orthokeratology could effectively control the progression of myopia and to treat anisometropia. The effect of myopia control was better in the older binocular OK lens wearers, and for the patients with greater baseline anisometropia, the treatment effect of anisometropia was better.

[Concurrent radiation therapy and dual HER2 blockade in breast cancer: Assessment of toxicity]

PURPOSE

The tolerance of the concurrent use of radiotherapy, pertuzumab and trastuzumab is unknown. The purpose of this study was to evaluate the toxicity of this association in patients treated for HER2 positive metastatic and/or locally recurrent unrespectable breast cancer.

MATERIAL AND METHODS

A retrospective study was performed in our institution for all consecutive patients treated with concurrent irradiation, pertuzumab and trastuzumab. The radiotherapy was performed while pertuzumab and trastuzumab were administrated as a maintenance treatment at the dose of 420mg (total dose) and 6mg/kg respectively every 3 weeks without chemotherapy. Toxicity was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Left ventricular ejection fraction (LVEF) was measured at baseline and then every 3-4 months.

RESULTS

We studied 77 patients. treated in between 2013 and 2019 with median follow-up of 38 months (range 0-264 months). Median age was 53 years (33-86). There were 50 patients (64.9%) with metastatic and 27 patients (35.1%) with recurrent disease. All patients received docetaxel followed by P-T as first line treatment and they received 34 cycles (10-85) of pertuzumab and trastuzumab. All patients experienced partial or complete response according to RECIST criteria. Irradiation volumes were whole breast (41 patients, 53.2%) and chest wall (29 patients, 37.7%) at a dose of 50Gy with a median duration of 39 days. Radiotherapy of lymph nodes was performed in 53 patients (68.8%) as following: supraclavicular-infraclavicular and axillary lymph nodes in 52 patients (67.5%), and internal mammary nodes in 31 patients (40.3%). For 20 patients. (26.0%) radiotherapy was palliative: bone irradiation (12 patients, 15.6%), whole-brain radiotherapy (2 patients, 2.6%), cerebral metastasis irradiation (6 patients). As early toxicity we observed: radio dermatitis as following: 36 patients (46.8%) presented grade I, 17 patients (22.1%) presented grade II, and 3 patients (3.9%) presented grade III. One patient (1.3%) presented grade II esophagitis. One patient (1.3%) presented asymptomatic decrease of LVEF during treatment and 6 patients (7.7%) presented a decrease of LVEF. There was no radiation-induced pneumonitis. As late toxicity, we observed 1 (1.3%) case of grade I and 1 (1.3%) with grade II telangiectasia. There was 1 case (1.3%) of grade III cardiac toxicity, 8 months after the concurrent treatment.

CONCLUSION

The concurrent use of radiotherapy, pertuzumab and trastuzumab is feasible with good tolerance. Larger prospective data with longer follow-up is needed to confirm these results.

The therapeutic potential of attenuated diphtheria toxin delivered by an adenovirus vector with survivin promoter on human lung cancer cells

Adenoviral vectors are superior to plasmid vectors in their gene transport efficiency. The A subunit of the diphtheria toxin (DTA) gene is a popular suicide gene in cancer gene therapy. However, DTA is seldom used in adenoviral therapy due to its great toxicity. The toxicity of DTA is so great that even a single molecule of DTA is enough to kill one cell. To avoid this highly toxic effect on normal cells, DTA should be controlled by tumor-specific promoters. The survivin promoter is a widely used tumor-specific promoter. But genes driven by the survivin promoter show a low level of basal gene expression in non-cancer cells. DTA driven by the survivin promoter in adenoviral vectors may be highly toxic not only to cancer cells but also to normal cells. Therefore, DTA should be attenuated when it is used in adenoviral vectors driven by the survivin promoter. In this study, we compared the three kinds of recombinant adenoviruses that carry DTA or its attenuated forms (DTA176 and DTA197) in the treatment of human lung cancer. The results showed that in comparison with both DTA and DTA176, DTA197 is more suitable for adenoviral cancer therapy controlled by the survivin promoter. In addition, Adsur-DTA197 (DTA197 delivered by an adenoviral vector with the survivin promoter) sensitized human lung cancer cells to cisplatin both in vitro and in vivo. These results indicated that Adsur-DTA197 may be a potential chemosensitizer in cancer therapy.

[Prevalence and risk factors of common blinding ocular diseases among people aged 30 years and above in rural area of Handan]

Objective: To explore the prevalence and risk factors of common blinding ocular diseases in the population aged 30 years and above in rural areas of Handan City from 2006 to 2012. Methods: A cohort study with 6 830 subjects from rural areas of Handan City, Hebei Province was designed and conducted. The follow-up duration was 6 years, and the prevalence and incidence of common blinding diseases were evaluated. Logistic regression was used to explore the influencing factors of common blinding ocular diseases. Results: In 2006, 6 830 people participated in the baseline survey. There were 3 163 (46.31%) males and 3 667 (53.69%) females. The average age was (52.3±12.2) years (range, 30 to 97 years). There were 3 435 subjects who had common chronic systematic diseases, with a prevalence of 50.29%. In addition, 1 250 people suffered from common blinding ocular diseases, and the prevalence was 18.30%. There were 4 118 subjects without common blinding ocular diseases at baseline who participated in the six-year follow-up, during the 6-year follow-up, 247 participants developed common blinding ocular diseases. 9% (171/1 899) of patients with chronic systematic diseases developed common blinding ocular diseases, while only 3.42% (76/2 219) of normal subjects developed common blinding ocular diseases, with a statistically significant difference (χ(2)=56.504, P<0.001). The incidence of common blinding ocular diseases was age-dependent. Multivariate regression analysis showed that age (OR=1.045, 95%CI: 1.028-1.062, P<0.001), intraoccular pressure (IOP) (OR=1.064, 95% CI: 1.014-1.116, P=0.011) and baseline chronic diseases (OR=1.749, 95% CI: 1.288-2.375, P<0.001) were risk factors for common blinding ocular diseases. Moreover, the contribution of age, IOP and chronic systematic diseases to the model was 0.436, 0.084 and 0.511, respectively. Conclusions: The prevalence of common blinding ocular diseases among people over 30 years old in Handan is relatively high. From 2006 to 2012, about 1.5% patients of chronic systematic diseases developed common blinding ocular diseases each year. Moreover, chronic systematic diseases increase the risk of blinding ocular diseases sharply, and the effect is stronger than age and intraocular pressure.

A Lexical Representational Mechanism Underlying Verbal Satiation: An Empirical Study With Rarely Used Chinese Characters

High repetitions of a character induce a feeling of uncertainty of the character. This phenomenon is named as Verbal Satiation. However, the locus and nature of the verbal satiation remain controversial. To investigate whether verbal satiation occurs at the lexical representational locus, we used rarely used Chinese characters as stimuli to exclude confounding factor of meaning access. Participants were asked to judge whether or not a single Chinese character such as “” is a composition of a rarely used Chinese character such as “.” The experiment consists of 4 sets with 11 blocks in each set. Every 20 trials consist of a block, and the same rarely used characters were repeated in half of these trials. To observe the satiation effect that is offset by practice effect with more statistical power, we did ANOVA analysis for each set. The statistical results revealed that subjects responded differently at different time periods. In the first set, participants responded faster in later trials; After that, reversely, participants responded slower in later trials; Then they responded slower for the repeated characters in middle trials; Finally, participants responded slower for the repeated characters without regard to the trial position. These results show a competition process between satiation effect and practice effect and reveal that the verbal satiation can occur at a lexical representational locus.

Detection and characterization of a theta-replicating plasmid pLP60 from Lactobacillus plantarum PC518 by inverse PCR

Plasmid DNA of Lactobacillus plantarum PC518 was isolated by an improved method which contained a washing step for removing lysozyme. Three plasmid DNA libraries were constructed. A pair of outward primers was designed at both ends of the novel plasmid fragment obtained from plasmid DNA libraries, and the remainder of the circle plasmid was amplified by inverse PCR (iPCR). The whole sequence of plasmid was analyzed by the basic local alignment search tool, Tandem Repeats Finder, DNAMAN V6.0, DNASTAR and MEGA X software. The copy number was measured using quantitative real-time PCR. Plasmid extract showed 7 bands on agarose gel, indicating that L. plantarum PC518 contains multiple plasmids. The complete sequence of plasmid pLP60 was obtained by plasmid DNA libraries and iPCR. pLP60 is 6006 bp in length with a G + C content of 41.19 %, which encodes 8 open reading frames (ORFs). The ori site like theta-type could be located upstream of repB, which contains a short tandem repeats (sTR) and a long tandem repeats (lTR). RepB of pLP60 only had low similarity with Rep protein of known theta-type plasmids, but phylogenetic tree analysis showed that plasmids whose Rep proteins are similar to pLP60 have lTR at ori, and the conservativeness of lTR is consistent with similarity of Rep proteins, suggesting that RepB of pLP60 is a theta-replicating protein. So pLP60 was classified as class A of theta replication. The copy number of pLP60 was measured as 5 copies per cell by qPCR.

[Changes of eye care use among rural adults under the reform of New Rural Cooperative Medical Scheme: the Handan Eye Study]

Objective: To assess the utilization of eye care services in the rural area of Handan, China under the New Rural Cooperative Medical Scheme, and to analyze the factors associated with the uptake of these services. Methods: In a cohort population-based study, subjects who joined both the baseline (2006-2007) and follow-up (2012-2013) were included. Information of demographic characteristics, participation in the New Rural Cooperative Medical Insurance and use of eye care services, comprehensive ophthalmic examinations, blood pressure and fasting was collected. The protocol got approved by the ethics committee of Beijing Tongren Hospital, and each subject signed the informed consent. Results: Of 5 193 eligible participants, 549 [10.6%; 95% confidence interval (CI), 9.8%-11.4%] had used eye care services, and the prevalence had no significant difference from baseline surveys (P=0.20). The municipal hospitals undertook 50.1% of eye care services. "No need" (4 422, 95.2%) was the most common reason cited for not using an eye care service; 2 875 (65.0%) of these participants had at least one type of eye diseases, 3 505 (79.3%) had at least one type of ocular complaints. In the multiple binary logistics regression model, participants who were elder [adjusted odds ratio (OR), 1.319; 95%CI, 1.177-1.478], were female (adjusted OR, 1.466; 95%CI, 1.085-1.981), had a diabetes history (adjusted OR, 1.930; 95%CI, 1.381-2.696), had a low income (adjusted OR, 0.826; 95%CI, 0.688-0.922), had ocular complaints (adjusted OR, 3.556; 95%CI, 2.484-5.091), had refractive errors (adjusted OR, 1.256; 95%CI, 1.007-1.567), had visual impairment (adjusted OR, 4.398; 95%CI, 2.667-7.253) or had cataract (adjusted OR, 1.278; 95%CI, 1.013-1.612) were more likely to take an eye care service. Conclusions: Under the New Rural Cooperative Medical Scheme, the prevalence of New Rural Cooperative Medical Insurance was increased significantly, but the rate of eye care use in the rural area was still low. Further efforts towards higher quality medical service in county hospitals and village clinics as well as better education about eye disease among the rural population may raise the eye care use in rural areas. (Chin J Ophthalmol, 2018, 54:570-579).

Aplnra/b Sequentially Regulate Organ Left-Right Patterning via Distinct Mechanisms

The G protein-coupled receptor APJ/Aplnr has been widely reported to be involved in heart and vascular development and disease, but whether it contributes to organ left-right patterning is largely unknown. Here, we show that in zebrafish, aplnra/b coordinates organ LR patterning in an apela/apln ligand-dependent manner using distinct mechanisms at different stages. During gastrulation and early somitogenesis, aplnra/b loss of function results in heart and liver LR asymmetry defects, accompanied by disturbed KV/cilia morphogenesis and disrupted left-sided Nodal/spaw expression in the LPM. In this process, only aplnra loss of function results in KV/cilia morphogenesis defect. In addition, only apela works as the early endogenous ligand to regulate KV morphogenesis, which then contributes to left-sided Nodal/spaw expression and subsequent organ LR patterning. The aplnra-apela cascade regulates KV morphogenesis by enhancing the expression of foxj1a, but not fgf8 or dnh9, during KV development. At the late somite stage, both aplnra and aplnrb contribute to the expression of lft1 in the trunk midline but do not regulate KV formation, and this role is possibly mediated by both endogenous ligands, apela and apln. In conclusion, our study is the first to identify a role for aplnra/b and their endogenous ligands apela/apln in LR patterning, and it clarifies the distinct roles of aplnra-apela and aplnra/b-apela/apln in orchestrating organ LR patterning.

[Spontaneous focal lamina cribrosa defect in glaucoma and its relationship with nonprogressive glaucomatous neuropathy]

Objective: To investigate the relationship between the spontaneous focal lamina cribrosa (LC) defect and the progression of visual field defect (VFD) in primary open-angle glaucoma (POAG). Methods: Case-control study. The patients who were diagnosed as POAG with at least 5 visual field results had been collected from June 2018 to January 2019 at Beijing Tongren Hospital Affiliated to Capital Medical University. Serial imaging by swept source optical coherence tomography B-Scan of the optic discs were acquired at the end of the follow-up and LC defects status were reviewed. Intraocular pressure, mean defects of visual field, central corneal thickness and axis length were recorded in the follow-up duration. Eyes were classified as having either progressive or nonprogressive VFD, and associating factors were evaluated by χ(2) or Fisher's test, mixed-effect model analysis and multivariate Logistical regression analysis. Results: A total of 32 subjects (64 eyes) were enrolled in the study with mean age of (47±14) years, the group consisted of 17 males and 15 females. Fourty-five eyes showed nonprogressive VFD. LC defects were more common in eyes without (28/45) rather than with progressive VFD (5/19) (χ(2)=6.896, P=0.009). Eyes with nonprogressive VFD showed longer axis length[(26.82±1.34) mm vs. (25.79±1.44) mm; t=6.589, P=0.013] and wider LC defects diameter[211 (165-326) μm vs. 114 (106-156) μm; Z=4.797, P=0.042]. Multivariate Logistic regression analysis revealed that the presence of LC defect was significantly associated with nonprogressive VFD (odds ratio=0.217, P=0.012). There were 7 subjects with asymmetry VFD and the incedence of LC defects without progression (7/7) is higher than fellow eye with progression (1/7, P=0.002). There was only one patient with progressive VFD showed one LC defect with an smaller diameter (169 μm) than that in the contralateral eyes with stable VFD (269 μm). Conclusions: LC defects are more common in eyes with nonprogressive VFD. Spontaneous LC defects are associated with nonprogressive glaucomatous defects and could be a protective factor for POAG. (Chin J Ophthalmol, 2019, 55:338-346).

Receptor interacting protein kinase 3 promotes cisplatin-induced necroptosis in apoptosis-resistant HepG2/DDP cells

Hepatocellular carcinoma is the most common primary malignancy of the liver. The chemotherapeutic drug cisplatin is widely used for advanced liver cancer. However, the development of cisplatin resistance in cancer cells, which is related to the decreased cellular susceptibility to apoptosis, results in a major limitation of cisplatin-based chemotherapy. Recently, triggering necroptosis has been proposed to be a novel therapeutic strategy to eradicate apoptosis-resistant cancer cells. In this study, we provided evidence that cisplatin could induce cell death in HepG2 cells, but not in the apoptosis-resistant HepG2/DDP cells. Ectopic expression of RIP3 promoted cisplatin-induced HepG2/DDP cells death, HMGB1 and LDH release. Moreover, we demonstrated that this type of cell death was necroptosis and depended on RIP1-RIP3-MLKL signaling pathway because inhibition of MLKL activity by necrosulfonamide (NSA) or knockdown of RIP1 significantly attenuated cisplatin-induced cell death in HepG2/DDP-RIP3 cells. Finally, we found that ectopic expression of RIP3 sensitized HepG2/DDP cancer cells to cisplatin treatment in vivo. The findings offer new insights into the molecular mechanisms underlying cisplatin-induced necroptosis in liver cancer cells and suggest that combination of cisplatin with other drugs which can restore RIP3 expression in cancer cells maybe a better choice for therapy of apoptosis-resistant cancer.

Functional, histological and molecular characteristics of human exstrophy detrusor

INTRODUCTION

Bladder exstrophy is a congenital anomaly involving foetal exposure and protrusion of the open bladder through an incomplete lower abdominal wall. Techniques to surgically correct exstrophy after birth have greatly improved, but it still presents a major challenge to achieve continence and a good quality of life for patients and their families as the pathophysiology of bladder dysfunction is unknown.

OBJECTIVES

A multimodal approach was used to characterise the histological and biomechanical properties of exstrophy detrusor. These were correlated with myocyte responses to agonists and an evaluation of developmental signalling pathways to evaluate the cause of bladder dysfunction in exstrophy.

STUDY DESIGN

Detrusor muscle specimens were obtained during corrective surgery from four exstrophy groups: neonatal (1-3 days, n = 8), younger children (7 months-5 years, n = 13) and older children (8-14 years, n = 11) undergoing secondary procedures and cloacal exstrophy (16 days-9 years, n = 9); control specimens were obtained from children (3 months-9 years, n = 14) undergoing surgery for other pathologies but with normal bladder function. Five lines of experiments were undertaken: measurement of connective tissue to detrusor muscle ratio, contractile responses to electrical and agonist stimulation; in vitro biomechanical stiffness, intracellular Ca²⁺ responses to contractile agonists and immunohistochemistry for proteins (MMP-7, cyclinD1, β-catenin and c-myc) involved in fibrosis generation. Exstrophy data were compared with those from the control group.

RESULTS

Exstrophy tissue demonstrated reduced smooth muscle compared with connective tissue, reduced contractile responses and greater mechanical stiffness. However, intracellular Ca²⁺ responses to agonists were maintained. These changes were greatest in neonatal and cloacal exstrophy samples and least in those from older paediatric bladders. Immunolabelled MMP-7, β-catenin and c-myc were reduced in exstrophy samples.

DISCUSSION

These results highlight the reality that newborns with exstrophy have significantly reduced compliance and bladder underactivity, which may persist or return to normal values with surgery and age. The primary cause of underactivity is increased connective tissue in relation to detrusor muscle; however, detrusor myocyte function remains normal. Finally, the increase of the smooth muscle content in the paediatric bladder group indicates a remodelling response of the bladder to surgical correction and time. Excess gestational fibrosis is associated with changed expression of key proteins in the Wnt-signalling pathway, a potential aetiological factor and therapeutic target.

CONCLUSION

Results point to connective tissue deposition as the primary pathological process that determines bladder function with normal myocyte function. Future research that reduces connective tissue deposition may lead to improvement in outcomes for these children.

Adenovirus-Mediated CRM197 Sensitizes Human Glioma Cells to Gemcitabine by the Mitochondrial Pathway

PURPOSE

The cross-reacting material 197 (CRM197) is a mutation of the diphtheria toxin. The protein of CRM197 was used successfully for the therapy of various tumors in the recent studies. In this study, the recombinant adenoviruses containing the CRM197gene(AdCRM197) were used to enhance the cellar toxicity of gemcitabine in human glioma U87, U251, and H4 cells.

PROCEDURES

MTT assay and flow cytometric analysis were performed to test the apoptosis of the U87, U251 and H4 cells with the combined treatment of AdCRM197 plus gemcitabine. Western blotting analyses were carried out to detect the cell apoptosis of the mitochondrial pathway. And the xenograft nude mice were used to observe the enhanced antitumor effect of AdCRM197 in vivo.

RESULTS

AdCRM197 sensitizes human glioma cells to gemcitabine in vitro by the mitochondrial pathway. Tumor volume was inhibited and survival time was prolonged in the U251 or U87 xenografted nude mice with gemcitabine plus AdCRM197. The enhanced antitumor effect of AdCRM197 was also detected by the immunohistochemical analyses and TUNEL staining.

CONCLUSION

The authors found that AdCRM197 sensitized the human glioma to gemcitabine not only in vitro but also in vivo. They provide the first evidence that adenovirus-mediated CRM197 may be a potential chemosensitizing agent for the treatment of cancer. The diphtheria toxin is of great toxicity that even one molecule of diphtheria toxin is enough to kill one cell. However, because of the high toxicity, the diphtheria toxin would kill the packing cells when it is being packaged into the recombinant viruses. Therefore, the diphtheria toxin is hard to be used in the gene therapy for virus vectors. The cross-reacting material 197 (CRM197) is a mutation of the diphtheria toxin. Unlike DTA, CRM197 exhibit a weak toxicity. The week toxicity of CRM197 is a good feature for the virus packaging. In the present study, we used a recombinant adenovirus which carried a CRM197 gene (AdCRM197) to enhance the cellar toxicity of gemcitabine in human glioma cells.

[Therapeutic efficacy of ultraviolet combined with riboflavin for the rabbit bacterial keratitis]

Objective: To study the effects of ultraviolet light combined with riboflavin treatment (corneal collagen-crosslinking, CXL) on infectious control and stromal reconstruction of bacterial keratitis. Methods: Experimental Study. A Staphylococcus aureus rabbit keratitis model was established by injecting Staphylococcus aureus broth into the shallow stromal layer of the right eye cornea of New Zealand white rabbits. Forty-four rabbits that successfully established the model were randomly divided into four groups: corneal collagen cross-linking (CXL) group, antibiotic group, CXL+ antibiotic group and untreated group, with 11 rabbits in each group. Before the treatment and at 3, 7, 14 and 28 days after treatment, slit lamp corneal examination, AS-OCT and in vivo confocal microscopy (IVCM) were performed. Clinical efficacy of different treatments were evaluated at different time points. Parameters including conjunctival hyperemia, corneal ulcer, infiltration, edema, and neovascular. Histopathological examinations of corneal lesions were performed in order to detect the infiltration, inflammatory cells and repair in corneal tissue. Normal data were compared with paired t-test and non-normal data were compared with paired rank sum test before and after treatment. Kruskal-Wallis rank sum test was used to compare 4 groups of data and the generalized estimation equation is used to compare the repeated measurement data at each time point and the comparison between the groups of the treatment groups. Results: After treatment, different time points and specimens for pathological observation, we obtained the following results:Conjunctival hyperemia: in CXL and CXL+ antibiotic groups after treatment for 3 days from treatment before 3 (2, -4) and 3 (2, -3),The reduction was 2 (1, -3) and 2 (1, -2), the difference was statistically significant (Z=-3.91, -5.50; P<0.008); 14 days, the antibiotic group changed from 3 (3, -4) to 2 (1, -2) after treatment, the difference was statistically significant (Z=-5.11, P<0.008); the untreated group had no statistical significance before and after treatment. After 14 days of treatment, the area of corneal ulcer (0.08±0.11) cm(2), (0.07±0.05) cm(2) in CXL group and CXL+ antibiotic group was significantly lower than that before treatment (0.40±0.18) cm(2), (0.49±0.24) cm(2). The difference was statistically significant. Significance (Z=-3.29, -3.64; P<0.008); after 14 days of treatment, after 14 days of treatment, neovascularization in the CXL and CXL+ antibiotic groups began to resolve, 1 (1, -2) and 1 (0, -2) at 7 days of treatment. decreased to 1 (1, -1) and 0 (0, -1), the difference was statistically significant (Z=4.57, 3.80; P<0.012 5); The degree of corneal edema was significantly reduced in the CXL group and the CXL+ antibiotic group at 14 days after treatment, which was reduced from (650±154) μm and (785±255) μm before the treatment to (432±95) μm and (455±109) μm, the difference was statistically significant (t=4.50, 4.92; P=0.00); The density of corneal stromal cells was also reduced from (446±257)/mm(2), (321±145)/mm(2) to (107±66)/mm(2), (114±94)/mm(2), the difference was statistically significant (t=4.15, 4.76; P<0.05). Histopathological observation under light microscope showed that most of the corneal ulcers healed in the CXL group and the CXL+ antibiotic group at 7 days of treatment. The epithelial cells were clearly visible and misaligned, and a small amount of neutrophils in the stromal layer. The upper epithelial layer was treated for 14 days. The cells are arranged neatly, the structure is clear, and the inflammatory cells are significantly reduced. Conclusion: Ultraviolet light combined with riboflavin corneal collagen cross-linking has a certain therapeutic effect on rabbit bacterial keratitis infection control and ulcer repair, and can be used as an auxiliary treatment for antibiotics. (Chin J Ophthalmol, 2018, 54:902-910).

[Genetic typing and susceptibility testing of strains from Staphylococcus aureus keratitis or conjunctivitis patients]

Objective: To study the relationship between genetic typing and the antibiotic susceptibility of staphylococcus aureus (SA) isolated from keratitis or conjunctivitis patients. Methods: Experimental study. Thirty-four (34) strains of Staphylococcus aureus were isolated from 34 cases of keratitis or conjunctivitis. The genomic DNA was extracted and amplified with PCR. With the method of multi locus sequences typing (MLST), gene fragments from 7 house-keeping genes were amplified and the products were sequenced. The results were submitted to the MLST website (www.pubmlst.org). In comparison with the allele of the corresponding gene, the allele spectrums of the strain were obtained with 7 housekeeping genes. At last, the MLST genotypes of the isolated strains were determined. With the START software, the evolutionary tree was established with UPGMA method. With the microdilution method, the MIC(90) of 13 antimicrobial agents was determined. The MIC(90) value of antimicrobial agents among different genotypes of Staphylococcus aureus was comparatively analyzed. Results: Ten (10) genotypes were obtained from 34 strains of Staphylococcus aureus. The dominant types were ST239, ST2592 and ST188. The clustering of genotyping was relatively concentrated, mainly in group Ⅰ (25 strains of SA, 83.3% of the total), and followed by group Ⅱ (5 strains of SA, 16.7%). The conjunctival isolates were distributed in the subgroup A of group Ⅰ. The cornea isolates were concentrated in subgroup B and group Ⅱ. With the exact probability method, the R×C chi square tests were used as statistic analysis method. The difference between the bacterial genotyping of two sources was statistically significant (P=0.011). Twenty-four strains of SA in group Ⅰ was sensitive to Vancomycin, Rifampicin and Amikacin (sensitivity ratio was 24/24, 20/24 and 20/24, respectively), and was generally resistant to other antibiotics. The values of MIC(90) of ciprofloxacin, ofloxacin, gatifloxacin and moxifloxacin to Staphylococcus aureus in subgroup A (0.16±0.07, 0.51±0.42, 0.31±0.14, 0.22±0.33) were significantly lower than the values in subgroup B(0.74±0.11, 0.84±0.45, 0.67±0.03, 0.68±0.26). The difference was statistically significant (P=0.004, 0.026, 0.034, 0.001). There was no significant difference between the MIC(90) values of the other 9 kinds of antibiotics in the subgroup A and in the subgroup B of Staphylococcus aureus (P value 0.047-0.561). Conclusion: The genotype of Staphylococcus aureus of corneal isolations and conjunctival isolations were different. The conjunctival isolates were distributed in the subgroup A of group Ⅰ and the corneal isolates were concentrated in subgroup B and group Ⅱ. There is a significant correlation between the MLST genotypes and antibiotic sensitivity. (Chin J Ophthalmol, 2018, 54:767-774).

The rare case of an extraperitoneal ureteral herniation into the inguinal canal of a 12-year-old boy

Ureteric herniation into the inguinal canal is a rare condition in adults and even more so in the paediatric population. These hernia types can be categorised as paraperitoneal or extraperitoneal. The former are the only varieties encountered in the paediatric literature, where patients are generally infants, while the latter phenomenon is seen in 20% of ureteric herniations in adults. We present a case of an extraperitoneal ureteric herniation into the inguinal canal in a 12-year-old boy with previous surgery for cloacal exstrophy, analyse the existing literature on the condition and make the speculation that the extraperitoneal variety is an adult variant seen in this child because of weakness in the surrounding structures as a result of previous surgery.

[Histopathology manifestation and imaging characteristics of in vivo confocal microscopy for diagnosis of ocular surface squamous neoplasia]

Objective: To study the histopathology manifestation and imaging characteristics of in vivo confocal microscopy (IVCM) for diagnosis of ocular surface squamous neoplasia (OSSN) and analyze the reliability of IVCM in differential diagnosis from OSSN cases. Methods: A prospective study. Twenty-three patients (23 eyes) with OSSN were collected from September 2015 to November 2017 in Beijing Tongren Eye center. They were underwent the examinations sequentially as follows: visual examination; slit-lamp microscope examination and ocular surface photography; color fundus image; anterior segment optical coherence tomography examination; IVCM examination and histopathology examination after surgery. With histopathology diagnosis, all subjects were divided into two groups: conjunctival intraepithelial neoplasm (CIN) and squamous cell carcinoma (SCC). Compared with histopathological findings, the IVCM results (cell morphology, cytoplasm and nucleus) of OSSN were analyzed. The difference analysis between the count data of two groups was carried out by the chi square test or Fisher's exact test. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate SCC from OSSN. Results: There were 12 males and 11 females among the 23 patients aged (62±15) years. With the histopathological diagnosis, there were 15 cases (15 eyes) in the CIN group and 8 cases (8 eyes) in the SCC group. Eye redness, pain, foreign body sensation and tears were the symptoms of OSSN. There was no significant difference in clinical symptoms between the CIN and SCC groups. The size of tumors and the incidence of trophoblastic vessels in the SCC group were greater than those in the CIN group [8.5(6.5-15.5) mm vs. 5.8(4.0-8.5)mm, Z=4.702,P=0.029; 7/8 vs. 5/15, χ²=6.135, P=0.013). In histopathology, multilayered epithelia with cellular polymorphism, varied cytoplasm staining, and slightly thicker nuclei were observed in the CIN group. The corneal epithelial cells of SCC patients were markedly heterogeneous, and the intercellular bridge structure can be detected. Proliferative cells appeared with spindle shaped cells, nuclear mitotic figures and syncytial cells in the SCC group. The IVCM examination in the CIN group and SCC group showed that the cytoplasm was high and the ratio of nuclear plasma increased. There was no significant difference between the two groups in the size of epithelial cells, cytoplasm reflectivity, and nuclear cytoplasm ratio (P=0.053, 0.108, 0.067). The proportions of nuclear mitotic figures, spindle or chimeric cells, nests of whirlpool cells and the abnormal cells of the superficial stroma layer (8/8, 8/8, 8/8 and 8/8) in the SCC group was higher than those (2/15, 1/15, 4/15 and 0/15) in the CIN group, and the difference was statistically significant (P=0.001, 0.001, 0.003; P<0.001). Among these IVCM parameters, the abnormal cells of the superficial stroma layer had the highest diagnostic ability with the AUC value of 1.000, and the following AUC values were 0.933 for mitotic or double nuclei, 0.901 for spindle or chimeric cells, and 0.867 for the nests of whirlpool cells. Conclusions: The IVCM characteristics of OSSN are the dysplastic cells, hyper-reflective cytoplasm and increased nuclear plasma ratio in the corneal epithelium. Dysplastic cells appearing in the superficial stroma layer, nuclear mitotic figures and nests of vortex cells are the main IVCM parameters to support the malignant change of OSSN lesions. (Chin J Ophthalmol, 2018, 54: 652-660).

[Retinal image quality in northern rural Chinese adult population]

Objective: To assess the retinal image quality of the normal northern rural Chinese adult population. Methods: A normal population-based, cross-sectional study. From Oct, 2012 to Jan 2013, a clustered, random sampling procedure was used to select normal population who visual acuity≤ 0(LogMAR) and 30-69 years old from 2 villages. All eligible subjects were invited to undergo a comprehensive eye examination, and the retinal image quality related index were examined with pupil 4 mm using objective optical quality analysis systemⅡ(OQAS Ⅱ, Visiometrics, Spain), including MTFcutoff, VA20, VA9, PSF50, PSF10, OSI, SR. And describe the retinal image quality of different age group, including 30-39y, 40-49y, 50-59y, 60-69y. Results: Among 1 108 participants (61.9%) that completed examinations in our center, 681 participants (1 362 eyes) were recruited. There were 146, 586, 440 and 190 eyes in each group. The spherical equivalent refraction of each group was (-0.35±0.84), (-0.19±0.50), (-0.03±0.54) and (0.20±0.71) D. The best corrected vision acuity of each group was -0.02±0.04, -0.01±0.03, -0.01±0.02 and -0.00±0.01. The MTFcutoff of each group was (37.06±9.31), (36.69±8.93), (36.52±9.05) and (32.61±10.08) c/deg. Retinal imaging parameters were significantly different(MTFcutoff: MD=4.45, SR:MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, A9:MD=0.09, OSI:MD=-0.41, P<0.001)between aged 30-39 group and aged 60-69 group. Objective scattering index (OSI) were significantly different(MD=-0.13, P=0.004)between aged 30-39 group and aged 50-59 group. Retinal imaging parameters were significantly different(MTFcutoff:MD=4.45, SR:MD=0.03, PSF50:MD=-0.45, PSF10:MD=-2.87, VA20:MD=0.13, VA9: MD=0.09, OSI: MD=-0.41, P<0.001)between aged 40-49 group and aged 60-69 group. Retinal imageing parameters were significantly different(MTFcutoff: MD=4.45, SR: MD=0.03, PSF50: MD=-0.45, PSF10: MD=-2.87, VA20:MD=0.13, VA9:MD=0.09, OSI:MD=-0.41,P<0.001)between aged 50-59 group and aged 60-69 group. Conclusion: Retinal image quality was gradually worse over time in the northern rural Chinese adult population. (Chin J Ophthalmol, 2018, 54:593-598).

p53 Plays a Key Role in the Apoptosis of Human Ovarian Cancer Cells Induced by Adenovirus-Mediated CRM197

Cross-reacting material 197 (CRM197) is a mutant form of the diphtheria toxin. Recent studies have found that CRM197 exerts an experimental antitumor effect on several types of tumors. This study applied a novel treatment of adenovirus-mediated CRM197 (AdCRM197) to human ovarian cancer cells. Interestingly, it was found that A2780 cells were sensitive to AdCRM197, but SKOV3 cells were resistant to it. Since SKOV3 cells are p53 deletion cells, while A2780 cells are p53 wild-type cells, it was postulated that p53 might play a key role in AdCRM197-induced apoptosis. This presumption was demonstrated by means of knockdown of p53 of the A2780 cells through lentivirus-mediated RNA interference. This knockdown resulted in the A2780 cells becoming resistant to AdCRM197. To verify this presumption further, the wild-type p53 gene in the SKOV3 cells was replaced with adenovirus-mediated p53 (Adp53). As expected, AdCRM197 plus Adp53 resulted in apoptosis of the SKOV3 cells. The combined treatment of AdCRM197 plus Adp53 also showed a good antitumor effect in the in vivo experiment on nude mice with xenograft tumors. Taking these results together, it is concluded that AdCRM197 induces apoptosis of human ovarian cancer cells via the p53 pathway. Moreover, it was found that Adp53 can reverse the resistance of p53-deletion human ovarian cancer cells to AdCRM197. The combination of AdCRM197 and Adp53 may be a potentially effective method for overcoming the resistance of p53-deficient human ovarian cancer to AdCRM197.

[Application of decision curve on evaluation of MRI predictive model for early assessing pathological complete response to neoadjuvant therapy in breast cancer]

Objective: To construct a dynamic enhanced MR based predictive model for early assessing pathological complete response (pCR) to neoadjuvant therapy in breast cancer, and to evaluate the clinical benefit of the model by using decision curve. Methods: From December 2005 to December 2007, 170 patients with breast cancer treated with neoadjuvant therapy were identified and their MR images before neoadjuvant therapy and at the end of the first cycle of neoadjuvant therapy were collected. Logistic regression model was used to detect independent factors for predicting pCR and construct the predictive model accordingly, then receiver operating characteristic (ROC) curve and decision curve were used to evaluate the predictive model. Results: ΔArea(max) and Δslope(max) were independent predictive factors for pCR, OR=0.942 (95%CI: 0.918-0.967) and 0.961 (95%CI: 0.940-0.987), respectively. The area under ROC curve (AUC) for the constructed model was 0.886 (95%CI: 0.820-0.951). Decision curve showed that in the range of the threshold probability above 0.4, the predictive model presented increased net benefit as the threshold probability increased. Conclusions: The constructed predictive model for pCR is of potential clinical value, with an AUC>0.85. Meanwhile, decision curve analysis indicates the constructed predictive model has net benefit from 3 to 8 percent in the likely range of probability threshold from 80% to 90%.

High Expression of Nuclear Factor of Activated T Cells in Chinese Primary Non-Small Cell Lung Cancer Tissues

Purpose

Nuclear factor of activated T cells (NFAT) has been reported to be involved in the development of various types of cancer including adenocarcinoma of the breast. This research was the first to investigate NFAT protein expression in primary non-small cell lung cancer (NSCLC) tissues from Chinese patients.

Methods

NFAT protein expression was determined in 130 surgically resected primary NSCLC and matched normal tissues by immunohistochemical analysis. The association between NFAT expression and clinical categorical variables was further analyzed with the SPSS software.

Results

We found that NFAT expression was much higher in 85 tumor tissues (65.4%) and lower in 45 tumor tissues (34.6%) compared with the matched normal tissues. Further statistical analysis by the chi-square test showed that high expression of NFAT proteins was significantly associated with tumor differentiation (p=0.045), invasion (p=0.031), histology (p<0.0001), tumor size (p=0.038) and cigarette smoking history (p=0.024). However, there was no correlation between the expression of NFAT proteins and pTNM classification, and no difference in 5-year survival rate between patients with high or low expression of NFAT proteins. Multivariate logistic regression analysis for the correlation between NFAT protein expression levels and various characteristics showed a significant association with histology (p=0.008, OR=0.273).

Conclusion

Our results revealed that high NFAT expression was present in Chinese NSCLCs and that NFAT expression might be involved in the process of human lung cancer development.