[Progress in surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava]

Hepatocellular carcinoma(HCC) is one of the most common malignancies of the digestive system,which is prone to be associated with microvascular or macrovascular invasion. Among them,HCC with inferior vena cava tumor thrombus(IVCTT) or right atrium tumor thrombus(RATT) is rare and has a poor prognosis. However,surgical treatment of HCC with IVCTT and (or) RATT is rarely reported and summarized. The review described the classification of HCC tumor thrombus with IVCTT and (or) RATT, summarized the progress of surgical approaches and surgical operations,and introduced a case of thrombectomy after pushing from the outer surface of the atrium,rendering the RATT to the inferior vena cava under non-cardiopulmonary bypass. The review also proposed the prospective treatments for HCC with IVCTT or RATT,providing clinical guidance to hepatobiliary surgeons.

[A cross-sectional survey on the allocation of nursing human resources in burn centers in China]

Objective: To investigate the allocation of nursing human resources in burn centers in China. Methods: A cross-sectional survey was conducted. Using a self-designed questionnaire, a survey was carried out from January to March 2022 to investigate the January to December 2021 status of 39 burn centers in China that met the inclusion criteria based on six strategic regions and other regions, including the hospital grade and the region, the number of nurses and opening beds in the burn centers and burn intensive care units (BICUs), the age, working seniority in burn specialty, educational background, professional title, personnel employment, and turnover of nurses and training of newly recruited nurses in the burn centers. Results: This survey covered 30 provinces, municipalities, and autonomous regions in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan region of China). A total of 39 questionnaires were collected, all of which were valid. The 39 burn centers were located in 38 tertiary A hospitals and 1 tertiary B hospital, with 26 burn centers in strategic areas. The nurse/bed ratio of burn centers in the Greater Bay Area of Guangdong, Hong Kong, and Macao was the highest, while the nurse/bed ratio of burn centers in border ethnic minority area was the lowest. Except for the Chengdu-Chongqing Economic Circle, BICUs had been set up in burn centers in other regions. Among the 39 burn centers, the percentage of nurses aged 25 to 34 years was 51.21% (738/1 441), the percentage of nurses worked in burn specialty for less than 5 years was 31.16% (449/1 441), the percentage of nurses with bachelor's degree was 69.74% (1 005/1 441), and the percentage of nurses with nursing professional title was 44.14% (636/1 441), which were the highest. There were significant differences in the employment of nurses, the percentage of permanent nurses in burn centers in the collaborative development zone of Beijing-Tianjin-Hebei was 82.48% (113/137), while the percentage of permanent nurses in burn centers in important military strategic area was only 9.42% (34/361); the turnover rate of nurses was 9.03% (143/1 584), among which the turnover rate of nurses was 18.14% (80/441) in burn centers in important military strategic area. The training for newly recruited nurses in 39 burn centers was mainly based on the guidance of senior nurses and the pre-job education+specialist training. Conclusions: The burn nursing human resources in strategic areas in China are seriously insufficient and unevenly distributed, with unstable nurse team and lack of standardized specialist training. In particular, the nursing human resources in BICUs need to be equipped and supplemented urgently.

Measurement of the ^{18}O(α, γ)^{22}Ne Reaction Rate at JUNA and Its Impact on Probing the Origin of SiC Grains

The ^{18}O(α,γ)^{22}Ne reaction is critical for AGB star nucleosynthesis due to its connection to the abundances of several key isotopes, such as ^{21}Ne and ^{22}Ne. However, the ambiguous resonance energy and spin-parity of the dominant 470 keV resonance leads to substantial uncertainty in the ^{18}O(α,γ)^{22}Ne reaction rate for the temperature of interest. We have measured the resonance energies and strengths of the low-energy resonances in ^{18}O(α,γ)^{22}Ne at the Jinping Underground Nuclear Astrophysics experimental facility (JUNA) with improved precision. The key 470 keV resonance energy has been measured to be E_{α}=474.0±1.1  keV, with such high precision achieved for the first time. The spin-parity of this resonance state is determined to be 1^{-}, removing discrepancies in the resonance strengths in earlier studies. The results significantly improve the precision of the ^{18}O(α,γ)^{22}Ne reaction rates by up to about 10 times compared with the previous data at typical AGB temperatures of 0.1-0.3 GK. We demonstrate that such improvement leads to precise ^{21}Ne abundance predictions, with an impact on probing the origin of meteoritic stardust SiC grains from AGB stars.

Supramolecular hydrogel for programmable delivery of therapeutics to cancer multidrug resistance

Multidrug resistance (MDR) has been considered as a major adversary in oncologic chemotherapy. To simultaneously overcome drug resistance and inhibit tumor growth, it is essential to develop a drug delivery system that can carry and release multiple therapeutic agents with spatiotemporal control. In this study, we developed a hydrogel containing an enzyme-cleavable peptide motif, with a network structure formed by 4-armed polyethylene glycol (PEG) crosslinked by complementary nucleic acid sequences. Hydrogen bond formation between nucleobase pairing allows the hydrogel to be injectable, and the peptide motif grants deliberate control over hydrogel degradation and the responsive drug release. Moreover, MDR-targeted siRNAs are complexed with stearyl-octaarginine (STR-R8), while doxorubicin (Dox) is intercalated with DNA and nanoclay structures in this hydrogel to enhance therapeutic efficacy and overcome MDR. The results show a successful configuration of a hydrogel network with in situ gelation property, injectability, and degradability in the presence of tumor-associated enzyme, MMP-2. The synergistic effect by combining MDR-targeted siRNAs and Dox manifests with the enhanced anti-cancer effect on drug resistant breast cancer cells in both in vitro and in vivo tumor models. We suggest that with the tailor-designed hydrogel system, multidrug resistance in tumor cells can be significantly inhibited by the co-delivery of multiple therapeutics with spatial-temporal control release.

Deep Underground Laboratory Measurement of ^{13}C(α,n)^{16}O in the Gamow Windows of the s and i Processes

The ^{13}C(α,n)^{16}O reaction is the main neutron source for the slow-neutron-capture process in asymptotic giant branch stars and for the intermediate process. Direct measurements at astrophysical energies in above-ground laboratories are hindered by the extremely small cross sections and vast cosmic-ray-induced background. We performed the first consistent direct measurement in the range of E_{c.m.}=0.24 to 1.9 MeV using the accelerators at the China Jinping Underground Laboratory and Sichuan University. Our measurement covers almost the entire intermediate process Gamow window in which the large uncertainty of the previous experiments has been reduced from 60% down to 15%, eliminates the large systematic uncertainty in the extrapolation arising from the inconsistency of existing datasets, and provides a more reliable reaction rate for the studies of the slow-neutron-capture and intermediate processes along with the first direct determination of the alpha strength for the near-threshold state.

[Introduction and implications of WHO position paper: vaccines against influenza, May 2022]

On May 13, 2022, World Health Organization(WHO) Position Paper on Influenza Vaccine (2022 edition) was published. This position paper updates information on influenza epidemiology, high risk population, the impact of immunization on disease, influenza vaccines and effectiveness and safety, and propose WHO's position and recommendation that all countries should consider implementing seasonal influenza vaccine immunization programmes to prepare for an influenza pandemic. In addition, it proposes that the influenza surveillance platform can be integrated with the surveillance of other respiratory viruses, such as SARS-CoV-2 and Respiratory Syncytial Virus. This position paper has some implications for the prevention and control of influenza and other respiratory infectious diseases in China: (1) Optimize influenza vaccine policies to facilitate the implementation of immunization services; (2) Influenza prevention and control should from the perspective of Population Medicine focus on the individual and community to integrate with "Promotion, Prevention, Diagnosis, Control, Treatment, Rehabilitation"; (3) Incorporate prevention and control of other respiratory infectious diseases such as influenza, COVID-19, respiratory syncytial virus and adenovirus, and intelligently monitor by integrating multi-channel data to achieve the goal of co-prevention and control of multiple diseases.

[Comparison of clinical characteristics between sporadic gastrinoma and multiple endocrine neoplasia type 1-related gastrinoma]

Objective: To compare clinical characteristics of sporadic gastrinoma and multiple endocrine neoplasia type 1 (MEN1)-related gastrinoma. Methods: A retrospective cohort study was conducted. Patients with clinical manifestations of Zollinger-Ellison syndrome, pathological diagnosis as neuroendocrine neoplasm (NEN) and complete clinical and follow-up data were enrolled. Patients with only high gastric acid secretion but without evidence of NEN, or with other concurrent non-NEN tumors were excluded. According to the above criteria, the clinicopathological data of 52 cases of gastrinoma diagnosed from April 2003 to December 2020 in the First Affiliated Hospital, Sun Yat-sen University, were collected. Patients who met the diagnostic criteria of gastrinoma and met one of the following conditions were diagnosed as MEN1-related gastrinoma: (1) the presence of pathogenic mutations in the MEN1 gene confirmed by genetic testing; (2) NENs involving two or more endocrine glands, namely, pituitary, parathyroid, thymic, pancreatic, and adrenal NENs; (3) NEN and at least one first-degree relatives diagnosed as MEN1. The remaining gastrinomas were defined as sporadic gastrinoma. Student's t test and chi-square test were used for statistical analysis. Clinicopathological characteristics, endoscopic findings, imaging characteristics, treatment, and prognosis of sporadic and MEN1-related gastrinoma were compared. Results: Among 52 patients with gastrinoma, 33 were sporadic gastrinoma and 19 were MEN1-related gastrinoma. The common symptoms of both sporadic and MEN1-related gastrinomas were diarrhea (24/33, 72.7%; 17/19, 89.5%) and abdominal pain (19/33, 57.6%; 9/19, 47.4%). Compared with sporadic gastrinoma, MEN1-related gastrinoma needed longer time for diagnosis [(7.4±4.9) years vs. (3.9±5.2) years, t=-2.355, P=0.022), were more likely multiple tumors [47.4% (9/19) vs. 15.2% (5/33), χ(2)=6.361, P=0.012], had smaller diameter [(1.7±1.0) cm vs. (3.1±1.8) cm, t=2.942, P=0.005), presented the lower tumor grade [G1: 83.3% (15/18) vs. 39.4% (13/33); G2: 11.1% (2/18) vs. 54.5% (18/33); G3: 5.6% (1/18) vs. 6.1% (2/33), Z=-2.766, P=0.006], were less likely to have serum gastrin which was 10 times higher than normal [11.8% (2/17) vs. 56.0% (14/33), χ(2)=8.396, P=0.004], had higher probability of complication with type 2 gastric neuroendocrine tumors (g-NET) [31.6% (6/19) vs. 3.0%(1/33), χ(2)=6.163, P=0.013], and had lower rate of liver metastasis [21.1% (4/19) vs. 51.5% (17/33), χ(2)=4.648, P=0.031). There was no obvious difference between sporadic gastrinomas and MEN1-related gastrinomas in endoscopic findings. Both types presented enlarged and swollen gastric mucosa under the stimulation of high gastric acid, and multiple ulcers in the stomach and duodenum could be seen. Gastrinoma with type 2 g-NET presented multiple polypoid raised lesions in the fundus and body of the stomach. (68)Ga-SSR-PET/CT scan had a 100% detection rate for both types while (18)F-FDG-PET/CT scan had a higher detection rate for sporadic gastrinoma compared with MEN1-related gastrinoma [57.9% (11/19) vs. 20.0% (3/15), χ(2)=4.970, P=0.026]. Among the patients with sporadic gastrinoma, 19 received surgical treatment, 1 underwent endoscopic submucosal dissection, 8 underwent transcatheter arterial embolization (TAE), and 5 underwent surgery combined with TAE. Among patients with MEN1-related gastrinoma, 13 received surgical treatment, and the other 6 received conservative treatment. The median follow-up of all the patients was 21.5 (1-129) months, and the 5-year survival rate was 88.4%. The 5-year survival rate of patients with sporadic and MEN1-related gastrinomas was 89.5% and 80.0% respectively (P=0.949). The 5-year survival rate of patients with and without liver metastasis was 76.2% vs. 100%, respectively (P=0.061). Conclusions: Compared with sporadic gastrinoma, MEN1-related gastrinoma has longer diagnosis delay, smaller tumor diameter, lower tumor grading, lower risk of liver metastasis, and is more likely to complicate with type 2 g-NET, while there is no difference in survival between the two tumor types.

[Establishment and validation of a nomogram to predict overall survival of patients with gastric neuroendocrine neoplasms]

Objective: To establish a novel nomogram to predict overall survival of patients with gastric neuroendocrine neoplasms (g-NEN). Methods: A case control study was conducted. Clinicopathological and follow-up data of patients with g-NEN who were treated in two academic medical centers in Southern China between July 2008 and June 2018 were retrospectively collected, including 174 patients from Sun Yat-sen University Cancer Center and 102 patients from the First Affiliated Hospital of Sun Yat-sen University. Univariate survival analysis using Kaplan-Meier method and multivariate analysis using Cox regression were performed to identify prognostic factors. A nomogram was subsequently established based on prognostic factors. Harrell's concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used to verify the performance of the model according to differentiation, calibration and clinical utility. Results: A total of 276 patients were enrolled in the study, of whom 189 patients were male and 87 were female. The age at diagnosis was below 60 years old in 150 patients and 60 years or older in 126 patients. There were patients diagnosed with gastric neuroendocrine carcinoma (g-NEC) and 101 patients with gastric neuroendocrine tumor (g-NET). The number of patients with primary tumor locating at upper, middle and lower parts of stomach was 131, 98 and 47, respectively. As for TNM stage, 72 patients were categorized as stage I, 26 patients stage II, 93 patients stage III, and 85 patients stage IV. Univariate analysis indicated that age, pathological type, primary site, Ki-67 index, T stage, N stage, and M stage were associated with overall survival of g-NEN patients (all P<0.05). Multivariate regression analysis testified that high Ki-67 index, advanced T stage and advanced M stage were independent prognostic factors (all P<0.05). The C-index of the nomogram was 0.806 (95%CI: 0.769-0.863). The calibration curve of the nomogram showed that the predicted survival rate was consistent with the actual survival rate in g-NEN patients. The ROC curves and DCA showed that the nomogram had better differentiation and clinical utility than the American Joint Committee on Cancer (AJCC) 8th TNM staging system (the area under the ROC curve was 0.862 vs. 0.792). Conclusion: The first nomogram to predict overall survival of patients with g-NEN is established and verified in this study, which provides individual prediction of 3-year overall survival rate and is applicable to both g-NET and g-NEC patients.

Direct Measurement of the Astrophysical ^{19}F(p,αγ)^{16}O Reaction in the Deepest Operational Underground Laboratory

Fluorine is one of the most interesting elements in nuclear astrophysics, where the ^{19}F(p,α)^{16}O reaction is of crucial importance for Galactic ^{19}F abundances and CNO cycle loss in first generation Population III stars. As a day-one campaign at the Jinping Underground Nuclear Astrophysics experimental facility, we report direct measurements of the essential ^{19}F(p,αγ)^{16}O reaction channel. The γ-ray yields were measured over E_{c.m.}=72.4-344  keV, covering the Gamow window; our energy of 72.4 keV is unprecedentedly low, reported here for the first time. The experiment was performed under the extremely low cosmic-ray-induced background environment of the China JinPing Underground Laboratory, one of the deepest underground laboratories in the world. The present low-energy S factors deviate significantly from previous theoretical predictions, and the uncertainties are significantly reduced. The thermonuclear ^{19}F(p,αγ)^{16}O reaction rate has been determined directly at the relevant astrophysical energies.

[Historical changes of a missionary hospital - Shanghai General Hospital (1864-1953)]

The Christian missionaries preached through medicine by combining religious preaching with secularisation and social adaptiveness of medicine in the 19th century. They attempted to avoid the negative influence of culture differences between the West and China. Desjacques Marin, one of the missionaries in China, was entrusted by Benoit Edan, a French consul in Shanghai to establish a hospital in 1864, named the "General Hospital". This hospital was moved to the north bank of Suzhou Creek in 1877 and renamed as the Gongji Hospital. The hospital was designated by the Japanese Army in 1940 as a hospital for sick foreign prisoners in the war. It was taken over as an enemy property by the government of the Republic of China in 1945 and became a public hospital opened formally to Chinese patients. It was renamed as "Shanghai First People's Hospital" in 1953. Review of the historical changes of the missionary hospital is of significance for the study on Chinese medical history and medical communication between China and the West.

[Rare thalassemia caused by novel nucleotide variants in the globin gene: four case reports and literature review]

目的

分析4例少见地中海贫血（地贫）患者的DNA序列、临床表型，提高对地贫的认识。

方法

对2014年5月至2019年12月4例少见地贫患者的临床及DNA序列特征进行回顾性分析并复习相关文献。

结果

地贫基因常规检测显示，例1～3均未检测到常见的3种α株蛋白1/2（HBA1/A2）基因缺失及其3种点突变和16种β株蛋白（HBB）基因点突变，例4检测到αα^--SEA缺失。HBA1/A2和HBB基因全序列Sanger测序示：例1～4分别存在HBB:c.347C>A、HBB:c.1A>G、HBB:c.393T>G及HBA2:c.301-1G>A（IVS-II-142 G>A）突变。同时，例2的祖父、父亲和姑姑均为HBB:c.1A>G杂合突变。

结论

本研究发现了新的珠蛋白基因突变，HBB:c.347C>A、HBB:c.1A>G和HBB:c.393T>G以及HBA2:c.301-1 G>A（IVS-II-142 G>A）突变在中国地贫患者中为首次报道，HBB:c.393T>G突变为全球首次报道，丰富了地贫基因突变数据库。

Neural tissue engineering: the influence of scaffold surface topography and extracellular matrix microenvironment

Strategies using surface topography, contact guidance and biomechanical cues in the design of scaffolds as an ECM support for neural tissue engineering.

Phytoremediation of heavy metals under an oil crop rotation and treatment of biochar from contaminated biomass for safe use

The disposal of contaminated plants limits the use of phytoremediation. Therefore, the disposal of contaminated sunflower was investigated after determining the phytoremediation of heavy metals under an oil crop rotation of sunflower (Helianthus annuus L)-sesame (Sesamum indicum L.). In the field experiment, the extraction efficiency of sunflower-sesame rotation was 0.07% for lead (Pb); 1.37% for zinc (Zn); 1.10% for copper (Cu); and 6.12% for cadmium (Cd). Contaminated sunflower stems were pyrolyzed at different temperature. The biochar produced at 300 °C was extracted in a two-step process (acid-extraction from biochar and metals precipitation in alkaline condition). At pH = 1, 65.67% of the Cd and much potassium (K) were extracted. After acid-extraction, adjust the pH of filtrate to 10, metals were precipitated and then separated from the K-enriched solution. Therefore, pyrolysis can process contaminated residues, and the biochar extracts can be reutilized as fertilizer to off-site crop production. Thus, an oil crop-rotation system, in addition to creating economic benefits, can be used by local farmers in contaminated soils.

[Diagnosis and treatment of cervical migratory foreign bodies caused by sharp esophageal foreign bodies]

Objective:Imaging findings and treatment of sharp foreign bodies penetrating the esophagus to migrate in the neck were collected. Method:All of 9 cases were determined by CT imaging. The foreign bodies were removed in 8 cases through the lateral cervical approach. The last case was taken out by bronchoscope. Eight cases successfully removed the foreign bodies. No definite foreign body was found in 1 case. Result:There were no postoperative complications in 8 patients that successful removed of foreign bodies. All patients begin to eat normally after operation and were discharged from hospital in 7 days. Tracheoesophageal fistula occurred that happened to the patient that no foreign body was found in operation. So gastric tube was retained for 7 days. Conclusion:CT imaging should be performed to determine whether there is the possibility of foreign body penetrating out of the esophagus, for the patients who had explicit history but the foreignbodies could not be found by barium meal examination. If necessary, three-dimensional CT reconstruction of the neck should be performed to locate the foreign body. Surgical exploration should be done as soon as possible to avoid aimless migration of foreign bodies, and it is difficult to find it during operation.

Bioinspired Self-assembling Peptide Hydrogel with Proteoglycan-assisted Growth Factor Delivery for Therapeutic Angiogenesis

Critical challenges still exist in surgical theaters and emergency rooms to stop bleeding effectively and facilitate wound healing efficiently. In circumstances of tissue ischemia, it is essential to induce proper angiogenesis to provide adequate vascular supply to the injury site. Methods: In view of these clinical unmet needs, we propose an applicable approach by designing functionalized self-assembling peptide (SAP) hydrogel with two sequences of RADA16-GGQQLK (QLK) and RADA16-GGLRKKLGKA (LRK) in this study. The SAP hydrogel conjugated with QLK functional motif could be crosslinked by endogenous transglutaminase, one of the intrinsic factors secreted during the coagulation process, the mechanical property of the hydrogel can then be enhanced without the need of external support. On the other hand, the LRK sequence exhibited a good binding affinity with the proteoglycan heparan sulfate and could act as a cofactor by sustaining the release of embedded growth factors. Results: The results showed that this SAP solution underwent self-assembling process in a physiological environment, formed hydrogel in situ, and possessed good shear thinning property with injectability. After pH adjustment, the SAP developed densely-compacted fiber entanglement that closely mimicked the three-dimensional fibrous framework of natural extracellular matrix. Such scaffold could not only support the survival of encapsulating cells but also promote the capillary-like tubular structure formation by dual angiogenic growth factors. The ex ovo chicken chorioallantoic membrane assay demonstrated that the growth factor-loaded hydrogel promoted the sprout of surrounding vessels in a spoke-wheel pattern compared to growth factor-free counterparts. Conclusion: The designer bioinspired SAP hydrogel may be an attractive and promising therapeutic modality for minimally-invasive surgery, ischemic tissue disorders and chronic wound healing.

[Effect of functional exercises on patients with rheumatoid arthritis: a meta-analysis]

OBJECTIVE

To evaluate the effect of functional exercises on disease activity, joint function and quality of life of patients with rheumatoid arthritis (RA).

METHODS

Randomized controlled trials were searched in Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), VIP database and Wanfang database with keywords being "rheumatoid arthritis/RA", "function exercise (training)/joint exercise (training)/physical exercise (training)/resistance movement (exercise)/isotonic and isometric/stretching exercise/muscle exercise", and "trials/clinical trials". Then literature selection, extraction and literature quality evaluation were carried out by two of the authors independently following the including and excluding standards. Then the outcome indicators were analyzed with Review Manager 5.3 software.

RESULTS

In the study, 2 173 articles were achieved by searching in databases, including 1 522 English papers and 651 Chinese papers. Then 913 duplicated papers were identified and removed using EndNote software. After reading the titles and abstracts, 1 194 papers were excluded that did not satisfy the including standards. Finally, the full texts of these papers were read and papers with insufficient data were excluded, resulting in 13 included papers for systematic review, including 8 English and 5 Chinese papers. A total of 812 cases were studied in these papers, including 426 in the experimental groups and 386 in the conventional groups. For the outcome index in these articles, disease activity score 28 (DAS28) was used in 5 of them, health assessment questionnaire (HAQ) was used in 8 articles, visual analogue scale (VAS) for pain was used in 6 articles, and morning stiffness duration was used in 3 articles. The meta-analysis showed that functional exercises could delay the development of the disease activity of RA patients (mean difference=-0.76; 95%CI: -1.13, -0.38; P<0.001), improve the joint function (mean difference=-0.36; 95%CI: -0.47, -0.24; P<0.001), alleviate the pain of joints (mean difference=-1.75; 95%CI: -1.98, -1.53; P<0.001), and reduce the duration of morning stiffness (mean difference=-17.65; 95%CI: -22.09, -13.21; P<0.001).

CONCLUSION

This study showed the positive effects of functional exercises on alleviating the pain of joints, reducing the morning stiffness duration, and delaying the disease exacerbation of RA patients. It has a positive effect on improving the joint function and improving the quality of life in patients with RA.

[Clinical significance of targeting drug-based molecular biomarkers expression in ovarian clear cell carcinoma]

Objective: To assess the expression level of targeting drug-based molecular biomarkers in ovarian clear cell carcinoma (OCCC) tissues and its clinical significance. Methods: A total of 63 OCCC patients included 40 primary OCCC and 23 recurrent OCCC for secondary cytoreductive surgery (SCS), who had received primary surgeries at Fudan University Shanghai Cancer Center between January, 2008 and December, 2015 were enrolled, and immunohistochemistry SP method was used to test human epidermal growth factor receptor (EGFR), human epidermal growth factor receptor-2 (HER2), aurora kinase A (AURKA), breast cancer susceptibility gene 1 (BRCA1), BRCA2 and programmed death-ligand 1 (PD-L1)protein expression in paraffin-embedded tissues. Results: The positive rates of EGFR, HER2, AURKA,BRCA1, BRCA2 and PD-L1 in primary and recurrent tumor tissues were respectively 20% (8/40) vs 30% (7/23) , 22% (9/40) vs 35% (8/23) , 38% (15/40) vs 35% (8/23) , 42% (17/40) vs 39% (9/23) , 20% (8/40) vs 22% (5/23) , 25% (10/40) vs 17% (4/23) , and there were no significant differences between primary and recurrent OCCC (all P>0.05). χ(2)-test or Fisher exact analysis revealed that HER2 expression in recurrent tumor tissues had a relationship with chemoresistance (P<0.05), while the expression of other biomarkers showed no significant relationship with chemoresistance (all P>0.05). Further, Kaplan-Meier survival analysis showed that patients with HER2 and AURKA-positive expression had a significantly shorter progression-free survival time in primary OCCC (4 months vs 10 months, log-rank test, P<0.05 for HER2; and 4 months vs 10 months, P<0.05 for AURKA); and a shorter overall survival time after SCS in recurrent OCCC (10 months vs 44 months, P<0.05 for HER2; and 13 months vs 43 months, P<0.05 for AURKA). However, multivariate Cox proportional hazards regression analysis indicated that none of these 6 biomarkers was independent risk factor of progression-free survival time of primary OCCC or overall survival time after SCS for recurrent OCCC (P>0.05). Conclusion: HER2 and AURKA could serve as prognostic factors in ovarian clear cell carcinoma.

[Effects of nasal polyps and allergy rhinitis on quantitative evaluation of subjective and objective assessment of chronic rhinosinusitis]

Objective:To investigate the effect of nasal polyps and allergy rhinitis on disease assessment of chronic rhinosinusitis, and to analyze the correlation between subjective and objective scores. Method:A total of 253 patients with chronic rhinosinusitis were enrolled from June 2016 to June 2017, and the clinical data such as sex, age, comorbidity, diagnosis and treatment were summarized. All patients were grouped as with or without nasal polyps, with or without eosinophilia, with or without allergic rhinitis group, and assessed by the visual analogue scale(VAS), Lund-Mackay CT score and Lund-Kennedy score respectively. The difference of the three grades in each group were analyzed by statistic analysis. The correlation between the three grades was analyzed. Result:Two hundred and fifty-three cases of chronic rhinosinusitis were included in the analysis. There were 143 males and 110 females with an average age of 44.44±15.44 years old, mostly in the 41-65 age group, and the difference was statistically significant (P<0.01). The scores of VAS, Lund-Mackay CT and Lund-Kennedy in the nasal polyp group were significantly higher than those in the non-nasal polyp group (P<0.05). The nasal endoscopy score of patients with allergic rhinitis was higher than that of non-allergic rhinitis group (P<0.01). There was no significant difference between VAS score, CT and endoscopic score in EOS group (P>0.05). There was a positive correlation between VAS score and nasal endoscopy score or CT score (P<0.01) in patients of non-allergic rhinitis or eosinophilia group, but there was no correlation (P>0.05) in patients with allergic rhinitis or eosinophilia group. There was no correlation when two or three factors exist at the same time beteen the nasal polyp, allergic rhinitis and EOS group (P>0.05), whereas show up positive correlation on non-merged group (P<0.01). Conclusion:Chronic rhinosinusitis complicated with nasal polyps or allergic rhinitis can significantly increase the subjective and objective symptoms of patients. There are differences between subjective symptoms and objective tests in the patients with nasal polyps, allergic rhinitis and EOS factors. Therefore, clinical attention should be paid to the impact of allergic factors on patients, using a variety of subjective and objective evaluation atrategies to evaluate the condition of patients with chronic rhinosinusitis comprehensively, to provide a basis for personalized diagnosis and treatment.

Effects of an injectable functionalized self-assembling nanopeptide hydrogel on angiogenesis and neurogenesis for regeneration of the central nervous system

Brain injury is a devastating medical condition and represents a major health problem. Tissue and organ reconstruction have been regarded as promising therapeutic strategies. Here, we propose a regenerative methodology focusing on the provision of functionalized nanopeptide scaffolds to facilitate angiogenesis and neurogenesis at the brain injury site. The peptide RADA16-SVVYGLR undergoes self-assembly to construct an interconnected network with intertwining nanofibers, and can be controlled to display various physicochemical properties by the adjustment of microenvironmental factors such as pH and ion concentration. Such scaffolds can support endothelial cells to form tube-like structures and neural stem cells to survive and proliferate. In an in vivo zebrafish brain injury model, sprouting angiogenesis and developmental neurogenesis were achieved, and functional recovery of the severed optic tectum was enhanced in RADA16-SVVYGLR hydrogel-implanted zebrafish. This nanopeptide hydrogel was non-toxic to zebrafish embryos during early developmental stages. This angiogenic self-assembling peptide hydrogel had programmable physical properties, good biocompatibility, and regenerative ability for functional recovery in the injured brain. We suggest that functionalized self-assembling peptides encapsulated with neural stem cells or used alone could be an attractive and effective therapeutic modality for brain injury and diseases (e.g., trauma, stroke, tumor, degenerative neurological disorders, etc.).

The extent of edema and tumor synchronous invasion into the subventricular zone and corpus callosum classify outcomes and radiotherapy strategies of glioblastomas

BACKGROUND AND PURPOSE

Irradiating glioblastoma preoperative edema (PE) remains controversial. We investigated the associations between tumors' PE extent with invasion into synchronous subventricular zone and corpus callosum (sSVZCC) and treatment outcomes to provide the clinical evidence for radiotherapy decision-making.

MATERIAL AND METHODS

Extensive PE (EPE) was defined as PE extending ≥2 cm from the tumor edge and extensive progressive disease (EPD) as tumors spreading ≥2 cm from the preoperative tumor edge along PE. The survival and progression patterns were analyzed according to EPE and sSVZCC invasion.

RESULTS

In total, 136 patients were followed for a median of 74.9 (range, 47.6-102.1) months. The median overall survival and progression-free survival were 19.7 versus 28.6 months (p = 0.005) and 11.0 versus 17.4 months (p = 0.011) in patients with EPE+ versus EPE-, and were 18.7 versus 25.4 months (p = 0.021) and 10.7 versus 14.6 months (p = 0.020) in those with sSVZCC+ versus sSVZCC-. The EPD rates for tumors with EPE-/sSVZCC-, EPE-/sSVZCC+, EPE+/sSVZCC-, and EPE+/sSVZCC+ were 2.8%, 7.1%, 37.0%, and 71.9%, respectively. In EPE+/sSVZCC+, tumor migration was associated with the PE extending along the corpus callosum (77.8%) and subventricular zone (50.0%).

CONCLUSIONS

Our results support the need for developing individualized irradiation strategies for glioblastomas according to EPE and sSVZCC.

Tailored design of multifunctional and programmable pH-responsive self-assembling polypeptides as drug delivery nanocarrier for cancer therapy

Breast cancer has become the second leading cause of cancer-related mortality in female wherein more than 90% of breast cancer-related death results from cancer metastasis to distant organs at advanced stage. The purpose of this study is to develop biodegradable nanoparticles composed of natural polypeptides and calcium phosphate (CaP) with sequential pH-responsivity to tumor microenvironments for active targeted drug delivery. Two different amphiphilic copolymers, poly(ethylene glycol)₃₄₀₀-aconityl linkage-poly(l-glutamic acid)₁₅-poly(l-histidine)₁₀-poly(l-leucine)₁₀ and LyP1-poly(ethylene glycol)₁₁₀₀-poly(l-glutamic acid)₁₅-poly(l-histidine)₁₀-poly(l-leucine)₁₀, were exploited to self-assemble into micelles in aqueous phase. The bio-stable nanoparticles provide three distinct functional domains: the anionic PGlu shell for CaP mineralization, the protonation of PHis segment for facilitating anticancer drug release at target site, and the hydrophobic core of PLeu for encapsulation of anticancer drugs. Furthermore, the hydrated PEG outer corona is used for prolonging circulation time, while the active targeting ligand, LyP-1, is served to bind to breast cancer cells and lymphatic endothelial cells in tumor for inhibiting metastasis. Mineralized DOX-loaded nanoparticles (M-DOX NPs) efficiently prevent the drug leakage at physiological pH value and facilitate the encapsulated drug release at acidic condition when compared to DOX-loaded nanoparticles (DOX NPs). M-DOX NPs with LyP-1 targeting ligand effectively accumulated in MDA-MB-231 breast cancer cells. The inhibition effect on cell proliferation also enhances with time, illustrating the prominent anti-tumor efficacy. Moreover, the in vitro metastatic inhibition model shows the profound inhibition effect of inhibitory nanoparticles. In brief, this self-assembling peptide-based drug delivery nanocarrier with multifunctionality and programmable pH-sensitivity is of great promise and potential for anti-cancer therapy.

STATEMENT OF SIGNIFICANCE

This tailored-design polypeptide-based nanoparticles with self-assembling and programmable stimulus-responsive properties enable to 1) have stable pH in physiological value with a low level of drug loss and effectively release the encapsulated drug with pH variations according to the tumor microenvironment, 2) enhance targeting ability to hard-to-treat breast cancer cells and activate endothelial cells (tumor region), 3) significantly inhibit the growth and prevent from malignant metastasis of cancer cells in consonance with promising anti-tumor efficacy, and 4) make tumors stick to localized position so that these confined solid tumors can be more accessible by different treatment modalities. This work contributes to designing a programmable pH-responsive drug delivery system based on the tailor-designed polypeptides.

[Value of single-source dual-energy CT (ssDECT) in differentiating lipid-poor adrenal adenomas from metastatic lesions]

Objective: To evaluate the value of single-source dual-energy CT (ssDECT) in differentiating lipid-poor adenomas from metastases in adrenal glands. Methods: From August 2011 to Oct 2014, 63 patients with 73 adrenal nodules (53 metastases proven by 5-6 months follow-up, and 20 histopathologically proven adenomas, CT value > 10 HU) underwent ssDECT scanning. The CT values of conventional polychromatic CT and virtual monochromatic images (40-140 keV) , fat-water density images and effective atomic number (eff-Z) were reconstructed on an ADW4.5 workstation and ROC curves were then constructed to evaluate the effectiveness of each parameter. The slope of spectral curve was measured and divided into 3 types: increment curve (K>0.1), straight curve (-0.1≤K≤0.1) and decrement curve (K< -0.1) according to the slope (the value of K) of spectral curve, and the curve patterns in the two groups were compared statistically. Results: There was no statistical difference between the mean CT values of metastases (35.12±5.29)HU and lipid-poor adenomas (32.48±6.94)HU by conventional polychromatic CT (P>0.05). The range of single-energy CT values of metastases [from (53.00±15.12) HU to (33.38±5.67) HU] was significantly higher than that of lipid-poor adenomas [from (26.90±26.94) HU to (28.77±10.66) HU] at energy levels ranging from 40 to 80 keV (P<0.05). There was no significant difference between the single-energy CT value of metastases and lipid-poor adenomas at energy levels ranging from 90 to 140 keV (P>0.05). The median fat-water concentration of metastases was -164.61 μg/cm^3, significantly lower than that of lipid-poor adenomas (114.32 μg/cm^3,P<0.05). The eff-Z of metastases (7.76±0.15) was also significantly higher than that of lipid-poor adenomas (7.50±0.25, P<0.05). When the threshold of fat-water concentration was -143.89 μg/cm^3, the sensitivity, specificity and accuracy rate of metastasis diagnosis was 70.0%, 66.0%, and 76.7%, respectively. When the threshold of eff-Z was 7.63, the sensitivity, specificity and accuracy rate of metastasis diagnosis was 83.0%, 65.0%, and 80.4%, respectively. The lower the energy, the higher the diagnostic accuracy at energy levels ranging from 40 to 80 keV, and that of 40 keV was the highest. The spectral curves of metastases included 2 (3.8%) ascending curves, 9 (17.0%) straight curves and 42 (79.2%) descending curves, while in the 20 lipid-poor adenomas, there were 9 (45.0%) ascending curves, 4 (20.0%) straight curves and 7 (35.0%) descending curves, showing significant differences between the two groups (P<0.05). Conclusions: Single-source dual-energy CT provides an effective multi-parameter approach for differentiating lipid-poor adrenal adenomas from metastases.

[Microsurgical management of petroclival meningiomas combined trans-subtemporal and suboccipital retrosigmoid keyhole approach]

OBJECTIVE

With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques, it is necessary to re-examine the therapeutic strategy for the treatment of petroclival meningiomas. To sum up the operative experience and methods in microsurgical resection of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach. To explore the minimally invasive operation approach of petroclival meningiomas, to raise the removal degree and to improve the postoperative result using this approach.

METHODS

The clinical data of the consecutive 21 patients with the petroclival meningiomas were reviewed retrospectively. The method, degree of tumor resection,techniques of the combining keyhole approach, Karnofsky performance score (KPS) before and after operation were also analyzed. The neuronavigation guided operation was performed in 9 cases, and 12 cases were operated in the neuroelectrophysiological monitoring.

RESULTS

Total excision of the tumor resection (Simpson, I-II levels) was conducted in 18 cases (85.7%, 18/21), and 3 patients underwent close resection (Simpson III level, 14.3%, 3/21). Postoperative three-dimensional CT showed good lock bone flap restoration; Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases (23.8%) , including transient trochlear nerve (3 cases), abducent nerve (1 case), and the motor branch of trigeminal nerve paralysis (1 case). Abducent nerve paralysis (1 case) appeared, with hearing impairment. After the 3-month follow-up, 11 cases had the same KPS aspreoperation, 7 cases improved, and 3 cases not improved. The KPS score was 77.14±23.12 on average, and there was no statistically significant difference compared with that before operation (P>0.05). The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases (KPS 70 or higher), and general recovery in 2 cases (KPS<70). The postoperative follow-up for 3-29 months showed no tumor recurrence or progress.

CONCLUSION

The combining trans-subtemporal and suboccipital retrosigmoid keyhole approach is simple, safe, and minimally invasive, and an ideal operation approach of petroclival meningioma. To master the operation skills and the intraoperative matters needing attention in the operation, is favorable to improve the resection rate and curative effect.

[Microsurgical management of petroclival meningiomas combined trans-subtemporal and suboccipital retrosigmoid keyhole approach]

OBJECTIVE

With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques, it is necessary to re-examine the therapeutic strategy for the treatment of petroclival meningiomas. To sum up the operative experience and methods in microsurgical resection of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach. To explore the minimally invasive operation approach of petroclival meningiomas, to raise the removal degree and to improve the postoperative result using this approach.

METHODS

The clinical data of the consecutive 21 patients with the petroclival meningiomas were reviewed retrospectively. The method, degree of tumor resection,techniques of the combining keyhole approach, Karnofsky performance score (KPS) before and after operation were also analyzed. The neuronavigation guided operation was performed in 9 cases, and 12 cases were operated in the neuroelectrophysiological monitoring.

RESULTS

Total excision of the tumor resection (Simpson, I-II levels) was conducted in 18 cases (85.7%, 18/21), and 3 patients underwent close resection (Simpson III level, 14.3%, 3/21). Postoperative three-dimensional CT showed good lock bone flap restoration; Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases (23.8%) , including transient trochlear nerve (3 cases), abducent nerve (1 case), and the motor branch of trigeminal nerve paralysis (1 case). Abducent nerve paralysis (1 case) appeared, with hearing impairment. After the 3-month follow-up, 11 cases had the same KPS aspreoperation, 7 cases improved, and 3 cases not improved. The KPS score was 77.14±23.12 on average, and there was no statistically significant difference compared with that before operation (P>0.05). The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases (KPS 70 or higher), and general recovery in 2 cases (KPS<70). The postoperative follow-up for 3-29 months showed no tumor recurrence or progress.

CONCLUSION

The combining trans-subtemporal and suboccipital retrosigmoid keyhole approach is simple, safe, and minimally invasive, and an ideal operation approach of petroclival meningioma. To master the operation skills and the intraoperative matters needing attention in the operation, is favorable to improve the resection rate and curative effect.

Decline in intrahepatic cccDNA and increase in immune cell reactivity after 12 weeks of antiviral treatment were associated with HBeAg loss

Viral load reduction facilitates recovery of antiviral T-cell responses. Dynamic alterations in intrahepatic viraemia clearance and immune cell reactivity during the early phase of nucleoside analogue (NA) therapy and the impact of these changes on HBeAg seroconversion are unknown. Fifteen HBeAg-positive chronic hepatitis B (CHB) patients were treated with adefovir dipivoxil. T-cell reactivity to HBV core and surface antigens were tested using ELISPOT assay from baseline to week 48 post-treatment (at 4-week intervals). Before and at week 12 of treatment, paired liver biopsies were analysed for intrahepatic HBV-DNA and cccDNA via real-time fluorescent PCR. In situ detection of CD4(+) , CD8(+) T cells and NK cells was analysed by immunohistochemistry. With viral load reduction, HBV-specific IFN-γ-producing CD4(+) T cells in patients with HBeAg loss were greatly enhanced and reached the highest level at week 12, with further increase observed between week 36 and week 48. After 12 weeks of treatment, total intrahepatic HBV-DNA and cccDNA had significantly decreased; however, there was no difference in the viral loads or extent of reduction between patients with and without HBeAg loss. Paralleling reduction in viral load, intrahepatic CD8(+) T lymphocytes increased in patients with HBeAg loss compared with baseline values. Only one patient without HBeAg loss exhibited similar results. Increased immune cells were observed in certain patients along with reduced hepatic viral loads during the second phase of HBV-DNA decline, which could promote the recovery of antiviral immunity and facilitate HBeAg loss.

Degradation and dissolution of hemicelluloses during bamboo hydrothermal pretreatment

To elucidate the hemicelluloses degradation and dissolution during hydrothermal pretreatment, hemicelluloses separated from both hydrolysate and pretreated substrate were investigated. Along with the pretreatment proceeding, some hemicelluloses fractions dissolved and diffused into the bulk liquor; MW (molecular weight) of these hemicelluloses fractions increased first and then decreased as well as amount of the fractions. Based on the definition of MW of the soluble hemicellulose, it has been concluded that some insoluble hemicellulose fractions appeared in the hydrolysate. In contrast, the hemicellulose degradation occurred continually and had been observed by the gradual decrease of MW of the hemicellulose isolated from pretreated substrate. Lingering dissolution at the later stage might attribute to the facts that some soluble fractions were still entrapped in the substrate. 5-15% hemicellulose fractions remained in the pretreated substrate at the later stage were composed of soluble species.

Experimental results of a dual-beam ion source for 200 keV ion implanter

A dual beam ion source for 200 keV ion implanter aimed to produce 200 keV H2 (+) and He(+) beams simultaneously has been developed. Not suitable to use the analyzing magnet, the purity of beam extracted from the source becomes important to the performance of implanter. The performance of ion source was measured. The results of experiments show that the materials of inlet tube of ion source, the time of arc ionization in ion source, and the amount of gas flow have significant influence on the purity of beam. The measures by using copper as inlet tube material, long time of arc ionization, and increasing the inlet of gas flow could effectively reduce the impurity of beam. And the method using the gas mass flow controller to adjust the proportion of H2 (+) and He(+) is feasible.

Lignin removal and benzene-alcohol extraction effects on lignin measurements of the hydrothermal pretreated bamboo substrate

Lignin content of hydrothermal pretreated bamboo chips was determined by the two methods: TAPPI standard method (222om-06) and TAPPI standard method without benzene-alcohol extraction (BAE). The results showed that including BAE resulted in lower Klason lignin (KL) and acid soluble lignin (ASL) measurements in the prehydrolyzed substrate, that is to say, BAE removed parts of KL and ASL. Therefore, the TAPPI standard method should be modified by omitting the BAE for lignin measurements of pretreated substrate. The following lignin removal analysis suggested that lignin was removed from the bamboo substrate during pretreatment by a combination of degradation reaction and deconstruction; thereafter the pseudo lignin generated in the hydrothermal pretreatment and condensation reaction between the lignin fragments accounted for the later KL increase.

Hydrothermal pretreatment of bamboo and cellulose degradation

A systematic hydrothermal pretreatment of bamboo chips had been conducted with an aim to trace the cellulose degradation. The results showed that cellulose chain cleavage basically occurred when the temperature exceeded 150°C. A slightly higher DP (degree of polymerization) than starting material had been observed at low temperature pretreatment. Treatment at higher temperature (≥ 170°C) caused severe cleavage of cellulose and therefore gave rise to low DP with more soluble species. DP of cellulose declined drastically without additional hemicelluloses dissolution when hemicelluloses removal reached to the limit level. Cellulose degradation under hydrothermal pretreatment generally followed the zero reaction kinetics with the activity energy of 121.0 kJ/mol. Besides, the increase of cellulose crystalline index and the conversion of Iα-Iβ had also observed at the hydrothermal pretreatment.

Inhibition of the sodium glucose co-transporter-2: its beneficial action and potential combination therapy for type 2 diabetes mellitus

Sodium glucose co-transporter-2 (SGLT2) inhibitors are an emerging class of glucose-lowering drugs in the management of type 2 diabetes mellitus (T2DM). In this context, SGLT2 is a low-affinity, high-capacity transporter that is expressed predominantly in the proximal renal tubules. The rationale for using SGLT2 inhibition as a drug for T2DM is derived from early evidence obtained from individuals with familial renal glycosuria, due to a SGLT2 mutation, which exhibits decreased renal tubular reabsorption of glucose in the absence of hyperglycaemia or any other signs of dysfunction. Thus, reduction of glucose reabsorption by SGLT2 inhibition represents a novel T2DM treatment approach. In light of the emerging role of SGLT2 inhibition in controlling glucose homeostasis, the current review provides a critical appraisal of the rationale, overviews of structural differences between SGLT2 inhibitors and summarizes recent preclinical and clinical studies. The physiological actions of SGLT2 inhibition in relation to insulin sensitivity, islet morphology, inflammation, body weight and blood pressure are reviewed. Finally, the safety and tolerability of SGLT2 inhibitors are also discussed in relation to their potential to provide insulin independence and enhance β-cell function, as well as their potential for synergistic/additive effects if used in combination with other antidiabetic drugs.

Surface characterizations of bamboo substrates treated by hot water extraction

Environment Scanning Electron Microscopy (ESEM) and X-ray photoelectron spectroscopy (XPS) were used to characterize the surface morphology and chemical changes on both the interior and exterior surface of bamboo (Dendrocalamopsis oldhami) substrates treated by hot water extraction. ESEM results showed the visible changes between exterior and interior surface of the treated substrates, in where spherical droplets did not extensively appear on both the surfaces at start of the pretreatment; nevertheless the droplets formation on the exterior surface occurred more rapidly than that of the interior surface. Results from XPS examination that the increase of C1 (C-C, C-H) concentration and decrease of O/C ratio and O1 (C=O) concentration of the samples on the both surfaces further demonstrated that both surfaces consisted of increasing amount of lignin as the extraction continued, especially for exterior surface. The O/C ratios finally reached to a level-off value with exterior surface 0.34 and interior surface 0.37.

Spark erosion: a high production rate method for producing Bi(0.5)Sb(1.5)Te3 nanoparticles with enhanced thermoelectric performance

We report a new 'spark erosion' technique for producing high-quality thermoelectric nanoparticles at a remarkably high rate and with enhanced thermoelectric properties. The technique was utilized to synthesize p-type Bi(0.5)Sb(1.5)Te(3) nanoparticles with a production rate as high as 135 g h(-1), using a relatively small laboratory apparatus and low energy consumption. The compacted nanocomposite samples made from these nanoparticles exhibit a well-defined, 20-50 nm size nanograin microstructure, and show an enhanced figure of merit, ZT, of 1.36 at 360 K. Such a technique is essential for providing inexpensive, oxidation-free nanoparticles which are required for the fabrication of high performance thermoelectric devices for power generation from waste heat, and for refrigeration.

Plasma amyloid-β oligomers level is a biomarker for Alzheimer's disease diagnosis

Amyloid beta (Aβ), especially Aβ oligomers, is important in Alzheimer's disease (AD) pathogenesis. We studied plasma Aβ(40), Aβ(42), and Aβ oligomers levels in 44 AD patients and 22 non-demented controls. Cognitive functions were assessed by Chinese version of mini-mental state examination (MMSE), Abbreviated Metal Test (AMT), Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-cog). Plasma Aβ monomers and oligomers levels were measured by ELISA. We found that the median plasma Aβ(40) and Aβ(42) levels were similar between AD and controls, and without significant correlation with cognition. Plasma Aβ oligomers level was higher in AD than controls (642.54 ng/ml [range 103.33-2676.93] versus 444.18 ng/ml [range 150.19-1311.18], p=0.047), and negatively correlated with cognition. In multivariate logistic regression analysis, the highest tertile of Aβ oligomers levels showed an increased risk of AD than the combined group of middle and lowest tertiles (OR=8.85, p=0.013), after adjustment of gender, age and APOE4 genotype. Increased plasma Aβ oligomers level was associated with decreased MMSE and AMT scores (p=0.037, p=0.043, respectively) and increased ADAS-cog score (p=0.036), suggesting negative correlation with cognitive function. We concluded that plasma Aβ oligomers level is an useful biomarker for AD diagnosis.

Thousandfold change in resistivity in magnetoresistive la-ca-mn-o films

A negative isotropic magnetoresistance effect more than three orders of magnitude larger than the typical giant magnetoresistance of some superlattice films has been observed in thin oxide films of perovskite-like La(0.67)Ca(0.33)MnOx. Epitaxial films that are grown on LaAIO(3) substrates by laser ablation and suitably heat treated exhibit magnetoresistance values as high as 127,000 percent near 77 kelvin and approximately 1300 percent near room temperature. Such a phenomenon could be useful for various magnetic and electric device applications if the observed effects of material processing are optimized. Possible mechanisms for the observed effect are discussed.

Electrochemical Modification of Vertically Aligned Carbon Nanotube Arrays

Electrochemical oxidation and reduction were utilized to modify vertically aligned carbon nanotube (CNT) arrays grown on a porous network of conductive carbon microfibers. Ultrafast and complete CNT opening and purification were achieved through electrochemical oxidation. Highly dispersed platinum nanoparticles were then uniformly and densely deposited as electrocatalysts onto the surface of these CNTs through electrochemical reduction. Using supercritical drying techniques, we demonstrate that the unidirectionally aligned and laterally spaced geometry of the CNT arrays can be fully retained after being subjected to each step of electrochemical modification. The open-tipped CNTs can also be electrochemically detached in full lengths from the supporting substrates and harvested if needed.

Health and reproductive profiles of malaria antigen-producing transgenic goats derived by somatic cell nuclear transfer

Nuclear transfer (NT) using transfected primary cells is an efficient approach for the generation of transgenic goats. However, reprogramming abnormalities associated with this process might result in compromised animals. We examined the health, reproductive performance, and milk production of four transgenic does derived from somatic cell NT. Goats were derived from two fetal cell lines, each transfected with a transgene expressing a different version of the MSP-1(42) malaria antigen, either glycosylated or non-glycosylated. Two female kids were produced per cell line. Health and growth of these NT animals were monitored and compared with four age-matched control does. There were no differences in birth and weaning weights between NT and control animals. The NT does were bred and produced a total of nine kids. The control does delivered five kids. The NT does expressing the glycosylated antigen lactated only briefly, probably as a result of over-expression of the MSP-1(42) protein. However, NT does expressing the non-glycosylated antigen had normal milk yields and produced the recombinant protein. These data demonstrated that the production of healthy transgenic founder goats by somatic cell NT is readily achievable and that these animals can be used successfully for the production of a candidate Malaria vaccine.

Expression of TRAIL, DR4, and DR5 in kidney and serum from patients receiving renal transplantation

Renal transplantation is the best treatment of some end-stage renal diseases. Unfortunately, not every transplant is successful due to the rejection or dysfunction of the transplanted kidney. Many cytokines participate in rejection by inducing inflammation or apoptosis. In this study, the expressions of TRAIL, DR4, and DR5 in rejected renal tissue and of serum soluble TRAIL (sTRAIL) in patients with kidney rejection were investigated by immunohistochemical staining and sandwich enzyme-linked immunosorbent assay, respectively. The results showed that the expression of TRAIL, DR4 and DR5, and serum sTRAIL levels were markedly upregulated among renal transplant patients. Since both membrane and soluble forms of TRAIL can induce apoptosis of DR4/DR5-expressing cells via recruiting FADD and caspase 8, elevated TRAIL and its receptors may participate in renal graft rejection.

Hip arthroplasty in patients with cirrhosis of the liver

We retrospectively reviewed 45 hip arthroplasties which were performed over a period of 20 years in 38 patients with cirrhosis of the liver. There was a high perioperative 30-day complication rate (26.7%). Advanced cirrhosis was associated with a higher risk of complications (p = 0.004) as also was increased age, a high level of creatinine, a low level of albumin, a low platelet count, ascites, encephalopathy and an increased operative blood loss. The survival of the prosthesis at five years was 77.8% and infection was a major cause of failure. In view of the high rate of early complications and the limited longevity of the prosthesis, surgeons who perform hip arthroplasty on such patients should counsel them appropriately preoperatively.

Acute paraplegia due to thoracic extramedullary hematopoiesis in chronic myeloproliferative disorder--an unusual presentation

Spinal cord compression due to extramedullary hematopoiesis is a well-known complication in a number of hematological diseases. Most of the patients present with progressive paraparesis due to the slow expansion of the extramedullary hematopoietic tissue. The authors report a case of chronic myeloproliferative disorder with spinal extramedullary hematopoiesis presenting with acute paraplegia. Chronic myeloproliferative disorder is an uncommon cause of spinal cord compression, especially when associated with acute paraplegia. The authors discuss the pathomechanism of this unusual presentation.

Surgical treatment of adjacent instability after lumbar spine fusion

STUDY DESIGN

This study is a retrospective review of 39 patients with previous instrumented lumbar fusion who underwent secondary spine surgery for lumbar adjacent instability. To the authors' knowledge, this is the largest study of surgical treatment of lumbar adjacent instability in the literature to date.

OBJECT

This study evaluated the feasibility of adjacent instability treated with medial facetectomy, fusion with autologous bone grafting, and pedicle screw instrumentation.

SUMMARY OF BACKGROUND DATA

The surgical treatment of adjacent instability has seldom been discussed. Revision spine fusions are challenged by high pseudarthrosis rates.

METHODS

Thirty-nine patients with previous lumbar fusion underwent second lumbar spine surgery for adjacent instability. All were treated with autogenous posterolateral arthrodesis and transpedicle screw fixation in addition to decompressive laminectomy. Medical records, radiographs, and pain scores were obtained.

RESULTS

The clinical results were excellent or good in 76.9% of patients, and the radiographic fusion was successful in 37 (94.9%) of patients. Flat back was noted in 8 (20.5%) of patients. In 5 patients (12.8%), neighboring segment breakdown again developed, and 2 of those patients underwent a third lumbar fusion. Dural tear during operation occurred in 2 patients. One patient experienced cauda equina syndrome but recovered bladder function 1 month later.

CONCLUSION

Autogenous posterolateral arthrodesis combined with pedicle screw fixation led to successful radiologic and clinical outcome in patients with lumbar adjacent instability. Adequate decompression of the adjacent stenosis requires medial facetectomy, thus preventing aggressive nerve root manipulation and reducing the incidence of dural tear.