Comparative efficacy and acceptability of different exercise patterns for reducing cardiovascular events in pre-diabetes: protocol for a systematic review and network meta-analysis of randomised controlled trials

INTRODUCTION

Exercise has been used to reverse dysglycaemic states in patients with pre-diabetes. Systematic reviews show that exercise is an effective way to reduce the incidence of diabetes, but there is conflicting evidence for reducing the occurrence of cardiovascular events. Therefore, we present a systematic review and network meta-analysis protocol designed to compare the effectiveness of different forms of exercise in reducing cardiovascular events and their tolerability in different populations.

METHODS AND ANALYSIS

We will include all randomised controlled trials and compare one exercise intervention to another. We will compare the following exercise patterns: standard endurance training, strength training, high-intensity interval training, mind-body exercise, and mixed strength and aerobic training. The primary outcomes are the occurrence of major cardiovascular events and the rate of patient attrition during the intervention. We will search major English and Chinese databases as well as trial registry websites for published and unpublished studies. All reference selection and data extraction will be conducted by at least two independent reviewers. We will conduct a random effects model to combine effect sizes and use the surface under the cumulative ranking curve and the mean ranks to rank the effectiveness of interventions. All data will be fitted at WinBUGS in a Bayesian framework and correlation graphs will be plotted using StataSE 14. We will also use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to evaluate the quality of evidence for the study results.

ETHICS AND DISSEMINATION

This study does not involve a population-based intervention, and therefore, does not require ethical approval. We will publish the findings of this systematic review in a peer-reviewed scientific journal, and the dataset will be made available free of charge. The completed review will be disseminated electronically in print and on social media, where appropriate.

PROSPERO REGISTRATION NUMBER

CRD42023422737.

Analysis of Amplitude Modulation of EEG Based on Holo-Hilbert Spectrum Analysis During General Anesthesia

OBJECTIVE

The study aims to investigate the relationship between amplitude modulation (AM) of EEG and anesthesia depth during general anesthesia.

METHODS

In this study, Holo-Hilbert spectrum analysis (HHSA) was used to decompose the multichannel EEG signals of 15 patients to obtain the spatial distribution of AM in the brain. Subsequently, HHSA was applied to the prefrontal EEG (Fp1) obtained during general anesthesia surgery in 15 and 34 patients, and the α-θ and α-δ regions of feature (ROFs) were defined in Holo-Hilbert spectrum (HHS) and three features were derived to quantify AM in ROFs.

RESULTS

During anesthetized phase, an anteriorization of the spatial distribution of AMs of α-carrier in brain was observed, as well as AMs of α-θ and α-δ in the EEG of Fp1. The total power ([Formula: see text]), mean carrier frequency ([Formula: see text]) and mean amplitude frequency ([Formula: see text]) of AMs changed during different anesthesia states.

CONCLUSION

HHSA can effectively analyze the cross-frequency coupling of EEG during anesthesia and the AM features may be applied to anesthesia monitoring.

SIGNIFICANCE

The study provides a new perspective for the characterization of brain states during general anesthesia, which is of great significance for exploring new features of anesthesia monitoring.

Ultrasonic treatment treated sea bass myofibrillar proteins in low-salt solution: Emphasizing the changes on conformation structure, oxidation sites, and emulsifying properties

The physiochemical properties, structure characteristics, oxidation, and emulsifying properties of myofibrillar proteins (MPs) in low salt solution after treated by the ultrasound were investigated. The solubility, mean diameters, sulfhydryl content, and carbonyl contents of MPs after ultrasonic treatment increased, while the turbidity decreased. The surface hydrophobicity of MPs with 200 W-600 W treatment increased, but decreased at 800 W treatment. The circular dichroism analysis revealed that α-helix content increased, while β-sheet and random coil content decreased after ultrasonic treatment. Fluorescence spectroscopy indicated the fluorescence intensities of MPs were increased after ultrasonic treatment. SDS-PAGE results showed more protein polymers due to myosin heavy chain (MHC) aggregation via disulfide bonds. Based on LC-MS/MS result, the myosin heavy chain was susceptible to oxidation, with monooxidation being the main oxidative modification. Finally, the emulsions stabilized by ultrasonically treated MPs, especially those treated at 800 W, exhibited decreased particle size, improved uniformity, and enhanced stability.

Visualization and analysis of knowledge domains for recent developments in coal mechanical properties studies

To better understand the research progress and trends in the mechanical properties of coal, and to promote theoretical research on the prevention and control of dynamic disasters, we employed the bibliometric method to analyze the research progress in this field. A total of 3450 documents from the Web of Science (WOS) core database were reviewed and analyzed. Our analysis focused on the annual distribution of literature, the distribution by country/region, organization, and author, as well as the distribution of significant source journals. We also identified research hotspots and frontiers. The results indicate a significant increase in the number of research papers on the mechanical properties of coal. China, America, Australia, India, Spain, Poland, England, Japan, South Korea, and Turkey were found to be the most active countries in this research area. The research results from China, America, and Australia were found to be the most influential, and C&BM, FUEL, INT J ROCK MECH MIN, INT J COAL GEOL, RM&RE, C&CR, and JCP were identified as the primary sources of research publications on the mechanical properties of coal. The basic theory and research system of coal mechanical properties investigation have been established, and there are numerous future research directions and areas to explore. Some current hotspots include the development of coal mechanical property models, permeability models related to mechanical properties, establishment and prediction of coal strength-temperature relationships, investigation of the proportioning scheme of granite and coal bottom ash in concrete mixes, and research on the improvement effect of fly ash on concrete manufacturing properties.

Pulmonary rehabilitation protocols in urgent lung transplantation patients

BACKGROUND

Prolonged invasive respiratory support and extracorporeal membrane oxygenation (ECMO) in patients requiring urgent lung transplantation (ULTx) present significant challenges to clinical practice due to severe underlying diseases and complex conditions. The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.

METHODS

A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation (IMV) and ECMO between January 2018 and January 2023. Data were retrieved from electronic medical records at our lung transplant center.

RESULTS

Fourteen patients (mean age 57.43±10.97 years; 12 males, 2 females) underwent ULTx with bridging ECMO and IMV. The mean body mass index was 23.94±3.33 kg/m², and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21.50±3.96. The Nutritional Risk Screening 2002 (NRS 2002) scores were ≥3. ULTx was performed after an 8.5-day waiting period (interquartile interval [IQR] 5.0-26.5 d). Following the surgeries, the average lengths of ECMO and IMV were 1.0 (IQR 1.0-2.0) d and 5.0 (IQR 3.0-7.3) d, respectively. The total length of hospital stay was 60.1±30.8 d, with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d. Two patients died within 30 d after ULTx, with a 30-day survival rate of 85.71%.

CONCLUSION

Patients receiving ULTx showed an acceptable short-term survival rate, validating the practicality and safety of the treatment protocols implemented in our center.

A Hierarchical Multi-Dimensional Cognitive Training Program for Preventive Cognitive Decline in Acute Ischemic Stroke Patients: Study Protocol for a Randomized Controlled Trial

Background

One of the most popular ways to address cognitive decline is cognitive training. The fact that cognitive deterioration is permanent is one of the main issues. This issue might be resolved by preventive cognitive training when it is acute. As a result, this study aims to design and assess how well stroke patients respond to hierarchical, multi-dimensional preventative cognitive training.

Objective

To describe the study design of this center implementation trial.

Methods

Participants in the study will be recruited from a hospital in China and randomly assigned to the intervention group or the usual care group. Interventions will include four-week hierarchical multi-dimensional preventive cognitive training through a WeChat program. for Primary outcome measures will be the Montreal Cognitive Assessment, Mini-Mental State Examination, and Post-Stroke Cognitive Impairment (PSCI) Incidence. The secondary outcome measure will include the Hamilton Depression Scale, Hamilton Anxiety Scale, Modified Barthel Index, and National Institutes of Health Neurological Deficit Score. Outcomes will be measured at baseline, 12 weeks, and 24 weeks from the baseline.

Results

We expect that the hierarchical multi-dimensional preventive cognitive training program will be easy to implement, and the cognitive function, cognitive psychology, ability of daily living will vary in each setting.

Conclusions

The results will provide evidence highlighting differences in a new strategy of cognitive training through the WeChat program, which allows the home-based practice, puts forward an advanced idea of preventive cognitive training in the acute stage, and has the highest effectiveness of reducing cognitive impairment, and Alzheimer's disease.

Values and preferences of health care professionals, policy-makers, patients and family members regarding recommendations of adapted physical restraint guidelines in critical care: A survey research

BACKGROUND

The values and preferences of stakeholders are crucial in the development of guidelines.

AIM

The aim of this study was to investigate stakeholders' values and preferences regarding draft recommendations for adapted physical restraint guidelines in China.

STUDY DESIGN

This survey research was carried out at four university-affiliated comprehensive hospitals based in the eastern, central, western, and north eastern zones of China from January 5-30, 2022. A 48-item self-report questionnaire was distributed, and values and preferences were assessed on a 10-point Likert scale. One-way ANOVA was used to compare values and preference scores among stakeholders. As effect-size measures, partial η2 and Cohen's f values are reported for ANOVA results.

RESULTS

A total of 1155 stakeholders were enrolled in the study. The mean value and preference scores were higher than seven for 46 draft recommendations. There was either no significant difference in the values and preferences of the stakeholders for the draft recommendations or there was a significant difference (p values ranged from <0.001 ∼ .048), but the effect size was small or very small (partial η2 value ranged from 0.011 ∼ .044; Cohen's f value ranged from 0.101 ∼ .214). The mean scores of patients for items related to cyber therapy and early tracheotomy were 6.84 and 6.60, respectively, which were lower than those of family members, policy-makers, and health care professionals and were statistically significant (p < 0.001). The partial η2 and Cohen's f values of the effect size were 0.083/0.062 and 0.302/0.256, respectively, which indicated that the differences were moderate.

CONCLUSION

These recommendations were in line with the values and preferences of stakeholders. Patients were more supportive of implementing cyber therapy or hypnosis for pain management but did not support early tracheotomy to reduce the duration of mechanical ventilation. Guideline panels could use value and preference information to revise and endorse recommendations of adapted physical restraint guidelines in critical care.

RELEVANCE TO CLINICAL PRACTICE

Practitioners should implement recommendations based on the values and preferences of stakeholders.

The impact of medication belief on adherence to infliximab in patients with Crohn's disease

Objective: Crohn's disease (CD) is an incurable chronic disease that requires long-term treatment. As an anti-tumor necrosis factor (TNF) agent, Infliximab (IFX) is widely used in the treatment of Crohn's disease, while the adherence is not high. The purpose of this study was to investigate the adherence to IFX among CD patients in China and evaluate the association between medication belief and IFX adherence. Methods: Demographic data, clinical information and patients' medication beliefs were collected using an online questionnaire and reviewing electronic medical records (EMRs). The Beliefs about Medicines Questionnaire (BMQ)-specific was used to assess medication beliefs which contains the BMQ-specific concern score and the BMQ-specific necessity score. An evaluation of adherence factors was conducted using univariate and multidimensional logistic regression analyses. Results: In all, 166 CD patients responded the online questionnaire among which 77 (46.39%) patients had high adherence. The BMQ-specific concern score in patients in low adherence was 30.00 and in high adherence patients was 27.50, and patients with lower BMQ-specific concern score had higher adherence (p = 0.013). The multiple regression analysis showed that the BMQ-specific concern score (OR = 0.940, 95% CI: 0.888-0.996) significantly affected the IFX adherence in CD patients. Otherwise, gender, marital status, time spent on the way (including the waiting time in infusion center) and accommodation to the center were also the influencing factors of adherence. Conclusion: The IFX adherence to CD in China was not high. Medicine concerns may be predictive factor of adherence. Education, the duration of IFX therapy and experience of adverse effects were not significantly associated with IFX adherence. By enhancing knowledge and relieving medicine concerns, we may increase patients' adherence to IFX.

Frailty-originated early rehabilitation reduces postoperative delirium in brain tumor patients: Results from a prospective randomized study

Objective

To investigate the impact of frailty-originated, evidence-based early activity training on postoperative delirium in patients who have undergone brain tumor resection.

Methods

A randomized controlled trial was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine, from July 2019 to June 2020. Data on the patients' general information, incidence and duration of delirium, duration of hospital stay, and activities of daily living were collected. From the first day after surgery, the patients were randomly assigned to either the traditional care group or the frailty-originated rehabilitation towards intracranial tumors using distinct evidence (FORTITUDE) group. Non-parametric, chi-square, and log-rank tests were used to compare the onset time and duration of postoperative delirium and activities of daily living performed by the participants between the two groups.

Results

In total, 291 patients, 150 and 141 in the control group and FORTITUDE group, respectively, participated in the study. Patients in the FORTITUDE group had a lower incidence of postoperative delirium (15.6% vs. 28.7%, P ​= ​0.007), delayed onset of delirium (Z ​= ​-2.108, P ​= ​0.035), shorter duration of postoperative delirium (χ² ​= ​26.67, P ​< ​0.001), shorter hospital stay (Z ​= ​-2.037, P ​= ​0.042), and higher scores in the activities of daily living one week (Z ​= ​-2.304, P ​= ​0.021) and one month (Z ​= ​-2.724, P ​= ​0.006) after surgery than in the control group.

Conclusions

The FORTITUDE program was safe and effective in reducing the incidence and duration of postoperative delirium and improving the quality of life of patients who underwent brain tumor resection.

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

BACKGROUND

Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of adherence to APP is essential to increase the adherence of therapy and improve patient outcomes. The objective of this study was to explore the barriers and facilitators of adherence to awake prone ventilation using a qualitative approach and the Capability, Opportunity, Motivation-Behavior (COM-B) model.

METHODS

Semi-structured, in-depth interviews were conducted with patients involved in awake prone ventilation. Data were analyzed using an adapted inductive thematical approach and mapped onto the COM-B model to identify barriers and facilitators to adherence of APP.

RESULTS

Nineteen patients were interviewed (aged 55-92 years). Fifteen themes were identified and mapped directly on to the six COM-B constructs, with "physical challenges" related to physical capability being the primary barrier. These COM-B sub-items reflected five other barriers, including low self-efficacy(M), treatment environment(O), availability of time(O), misconceptions about the treatment(C), and insufficient knowledge(C). Key facilitators in adhering to APP were ability to identify and overcome obstacles(C), availability and affordability of treatment(O), family influences(O), beliefs and trust in treatment(M), fear about the disease(M), and perceived benefits(M). In addition, three factors played the role of both facilitator and barrier, such as media influences(O), healthcare influences(O), and behavioral habits(M).

CONCLUSION

The COM-B model was proved to be a useful framework for identifying the barriers and facilitators of adherence to awake prone ventilation. The findings suggest that adherence behavior is a dynamic and balanced process and interventions aimed at improving adherence to APP should address the barriers related to capability, opportunity, and motivation. Healthcare providers should focus on providing proper guidance and training, creating a comfortable environment, and offering social support to improve patients' capability and opportunity. Additionally, promoting patients' positive beliefs and attitudes towards the treatment and addressing misconceptions and fears can further enhance patients' motivation to adhere to the treatment plan.

Effects of Simulated In Vitro Digestion on the Structural Characteristics, Inhibitory Activity on α-Glucosidase, and Fermentation Behaviours of a Polysaccharide from Anemarrhena asphodeloides Bunge

The purpose of this study is to investigate the effects of the simulated saliva-gastrointestinal digestion of AABP-2B on its structural features, inhibitory α-glucosidase activity, and human gut microbiota. The salivary-gastrointestinal digestion results show that there is no significant change in the molecular weight of AABP-2B, and no free monosaccharides are released. This indicates that, under a simulated digestive condition, AABP-2B is not degraded and can be further utilized by gut microbiota. AABP-2B still possessed good inhibitory activity on α-glucosidase after salivary-gastrointestinal digestion, which may be attributed to the largely unchanged structural characteristics of AABP-2B after simulated digestion. Furthermore, in vitro fecal fermentation with AABP-2B after salivary-gastrointestinal digestion showed that AABP-2B modulated the gut microbiota structure and increased the relative proportions of Prevotella, Faecalibacterium, and Megasphaera. AABP-2B can also modify the intestinal flora composition by inhibiting pathogen growth. Moreover, the AABP-2B group resulted in a significant increase in short-chain fatty acid (SCFAs) content during fermentation. These findings demonstrate that AABP-2B can be used as a prebiotic or functional food to promote gut health.

The controlling nutritional status score and risk factors associated with malnutrition in patients with acute ischemic stroke

Objectives

Malnutrition is an independent risk factor for poor outcomes in patients who suffered an acute ischemic stroke (AIS). The controlling nutritional status (CONUT) score can provide information for nutritional management in AIS patients. However, the risk factors associated with the CONUT score have not been established to date. Therefore, in this study, we aimed to investigate the CONUT score of patients with AIS and explore the potential risk factors associated with it.

Methods

We conducted a retrospective review of the data from consecutive AIS patients who were recruited in the CIRCLE study. Within 2 days of admission, we gathered the CONUT score, the Nutritional Risk Screening 2002, the Modified Rankin Scale, the National Institutes of Health Neurological Deficit Score (NIHSS), and demographic data from medical records. We used chi-squared tests to examine admission, and a logistic regression analysis was performed to explore the risk factors associated with CONUT in patients with AIS.

Results

A total of 231 patients with AIS participated in the study, with a mean age of 62.32 ± 13.0 years and a mean NIHSS of 6.77 ± 3.8. Of these patients, 41(17.7%) had hyperlipidemia. In terms of nutritional assessment, 137(59.3%) patients with AIS had high CONUT scores, 86(37.2%) patients with AIS had low or high BMI, and 117(50.6%) patients with AIS had NRS-2002 scores below 3. The chi-squared tests showed that age, NIHSS, body mass index (BMI), and hyperlipidemia were associated with the CONUT score (P &lt; 0.05). The logistic regression analysis showed that low NIHSS scores (OR = 0.055 95% CI: 0.003–0.893), younger age (OR = 0.159 95% CI: 0.054–0.469), and hyperlipidemia (OR = 0.303 95% CI: 0.141–0.648) were independently associated with lower CONUT scores (P &lt; 0.05), whereas BMI was not found to be independently associated with the CONUT.

Conclusions

More than half of the patients with AIS were at risk of malnutrition, with age and neurological deficits being identified as risk factors for nutritional control. Hyperlipidemia was found to be a protective factor of the CONUT, while NRS-2002 and BMI did not affect the nutritional control in patients with AIS.

Structural characteristics and antioxidant and hypoglycemic activities of a heteropolysaccharide from Anemarrhena asphodeloides Bunge

In this study, an acid polysaccharide (AABP-1B) was extracted from the rhizome of Anemarrhena asphodeloides Bunge and purified using 60 % alcohol precipitation and DEAE-52 cellulose. The molecular weight of AABP-1B was 105 kDa, and it consisted of mannose (Man), rhamnose (Rha), galacturonic acid (GalA), glucose (Glc), galactose (Gal), and arabinose (Ara) in a ratio of 6.3:1.3:1.1:0.2:0.4:0.7. Methylation and NMR analyses revealed that the backbone of AABP-1 consists of 4)-β-D-Manp-(1 and 4)-2-O-acetyl-β-D-Manp-(1. In addition, the biological activity assays showed that AABP-1B not only displays potential antioxidant activity but also exhibits the α-glucosidase and α-amylase inhibitory effect. Moreover, AABP-1B enhanced glucose consumption and glycogen synthesis in insulin-resistant (IR) HepG2 cells. These results suggest that AABP-1B has potential hypoglycemic activity.

Limb heaviness as a sensorimotor disorder alters rehabilitation adherence after a stroke

Introduction

To the best of our knowledge, it is still unknown how perceived limb heaviness affects rehabilitation adherence. As rehabilitation adherence is very important for the functional recovery of patients with stroke, it is important to explore the relationship between perceived limb heaviness and rehabilitation adherence.

Methods

We retrospectively reviewed the data of patients with consecutive stroke recruited in the CIRCLE study. The influence of age, gender, time from onset to enrollment, educational background, hypertension, diabetes, Modified Rankin Scale (MRS), and National Institutes of Health Stroke Scale (NIHSS) on rehabilitation adherence was analyzed. Multiple linear regression analysis was used to examine the association between perceived limb heaviness and rehabilitation adherence changes.

Results

A total of 108 participants completed the study. About 40 (37.0%) participants felt limb heaviness. The mean scores on the Medical Research Council (MRC) scale for the upper affected limb strength were 3.05 ± 1.7, and the mean score on the exercise adherence questionnaire (EAQ) was 34.27 ± 8.9. Univariate analysis showed that rehabilitation adherence levels differed in upper limb muscle strength and whether they perceived limb heaviness. After adjustment for independent predictors, we found that perceived limb heaviness was associated with rehabilitation adherence (B = −9.681 ± 1.494, p < 0.05) and R² was 0.332 and 0.074 if the muscle strength of the upper limb and perceived limb heaviness were included in the model and the model was without perceived limb heaviness, respectively.

Conclusion

By identifying patients with stroke with limb heaviness, it led to lower levels of motor functional rehabilitation adherence. We must pay more attention to limb heaviness and provide effective interventions to improve rehabilitation adherence and promote patient recovery.

Structural characterization and in vitro hypoglycaemic activity of glucomannan from Anemarrhena asphodeloides Bunge

A new polysaccharide (AABP-2B) was obtained from Anemarrhena asphodeloides Bunge after purification by gradient alcohol precipitation and DEAE-52 cellulose column chromatography. AABP-2B was confirmed to be a homogeneous polysaccharide with a molecular weight of 5800 Da and was composed of mannose and glucose at a molar ratio of 7.2 : 2.8. Structural analysis demonstrated that the backbone of AABP-2B was mainly composed of 4)-β-D-Manp-(1, 4,6)-β-D-Glcp-(1 and 3,6)-β-D-Manp-(1. The hypoglycaemic effect of AABP-2B was evaluated by its inhibition of α-glucosidase activities and insulin resistance in a HepG2 cell model. The results showed that AABP-2B displayed α-glucosidase inhibitory activities and could significantly improve glucose consumption by activating the IRS-1/PI3K/Akt signalling pathway in insulin-resistant HepG2 cells. Hence, AABP-2B may have potential as a functional food or medicine for diabetes therapy.

Stroke-associated pneumonia: A bibliometric analysis of worldwide trends from 2003 to 2020

Stroke-associated pneumonia (SAP) is a spectrum of pulmonary infections in patients within 7 days of stroke. Which is one of the most common complications after stroke and is significantly associated with a poor prognosis of stroke. To the best of our knowledge, a bibliometric method was not previously used to analyze the topic of SAP; we aim to describe the situation and evolution of SAP from 2003 to 2020, and to discuss the research hotspots and frontiers.A total of 151 articles were retrieved from the Scopus database. Bibliometric analysis was used to explore the dynamic trends of articles and the top subject areas, journals, institutes, citations, and co-keywords. VOS viewer software (version 1.6.15) was used to graphically map the hot topics of SAP based on the co-keywords.A total of 151 articles were identified. Articles have increased over the recent years and faster in the last 2 years (55 articles, 36.4%), the majority of subject areas are medicine (124 articles, 82.1%) and neuroscience (38 articles, 25.2%). The "Journal Of Stroke And Cerebrovascular Diseases" with 15 articles has been scored as the first rank followed by "Plos One." Regarding the geographical distribution of articles, China is the most productive country with 50 articles (33.1%), others are more prominent in Europe, and most institutes are universities. Citations have increased over time, the main country of the top five highly cited published articles are Germany and before 2008. The co-keywords are mainly divided into four aspects: risk factors, predictive scores, preventions, and outcomes.This study could provide practical sources for researchers to find the top subject areas, journals, institutes, citations, and co-keywords. Moreover, the study could pave the way for researchers to be engaged in studies potentially lead to more articles in this field.

Observation of the curative effect of intraocular lens in patients with cataract and establishment of the intraocular lens database

BACKGROUND

Intraocular lenses are widely used in the treatment of cataract patients, but currently clinical, procedural and product information is incomplete in many hospitals and there is an urgent need for a database to improve surgical safety, and outcomes.

METHODS

Data on the brand and specifications of the intraocular lens, and the postoperative outcome of cataract patients after intraocular lens implantation from January 2017 to June 2018 were collected to create an intraocular lens database as an online public platform.

RESULTS

A total of 96 cataract patients were divided into groups A and B based on preoperative corrected visual acuity. At 3 months after surgery the visual acuity of patients in group A recovered from 1.51±0.19 to 0.76±0.18, and the in group B it recovered from 1.02±0.27 to 0.49±0.13. Overall, the postoperative visual acuity of all patients improved significantly (P<0.001). We also used the NEI-VFQ-25 visual function questionnaire to evaluate the visual function of the patients before and after surgery. At 3 months after surgery, the mean score of patients in group A increased from 21.89±14.21 to 59.97±18.29 and in group B it increased from 38.26±17.57 to 70.28±12.37. Overall, the patients' postoperative scores increased significantly (P<0.001).

CONCLUSIONS

Cataract phacoemulsification and intraocular lens implantation can effectively and safely restore and improve the visual function of cataract patients. Information sharing through establishment of an intraocular lens information database will assist in further advances and consistency in the treatment of cataract patients.

Knockdown of p66ShcA activates Nrf2 pathway to protect cardiomyocytes from oxidative stress and inflammation induced by H2O2

OBJECTIVE

Oxidative stress and inflammation are the most common causes of myocardial ischemia and hypoxia. This article focuses on the effect of p66ShcA on H2O2-induced cardiomyocytes.

MATERIALS AND METHODS

The p66ShcA knockdown model of H9c2 cells was constructed by plasmid transfection. After treatment of different groups with H2O2, oxidative stress-related factors and inflammatory factors were detected.

RESULTS

The expressions of SOD1, SOD2, GPX1, and GPX3 in H2O2 cells were significantly decreased, IL-1β and IL-6 expression were significantly increased, while p66ShcA siRNA negative group could promote the expression of SOD1, SOD2, GPX1, and GPX3, inhibit the expression of IL-1β and IL-6 significantly, and activates the Keap1/Nrf2 pathways.

CONCLUSIONS

Knockdown of p66ShcA can activate Keap1/Nrf2 pathway, which inhibits H2O2-induced oxidative stress and inflammation in H9c2 cells.

[Comparative study on visual fatigue caused by watching liquid crystal display and projection display]

Objective: To explore the effect of different types of visual display terminals (VDT) on visual fatigue. Methods: A total of 68 subjects were enrolled and divided into flat screen group, metal screen group and glass bead screen group. The subjects watched a video in the same environment for 60 minutes. Before and after watching, they were asked to fill in a visual fatigue rating scale and underwent visual function examinations. The blink rate of subjects was recorded during the experiment. Results: After watching the video, for the metal screen, glass bead screen, and flat screen group respectively: (1)The median (interquartile range, IQR) of visual fatigue rating increased significantly (before: 1.0 (1.2), 1.3 (1.6), 0.5 (0.9); after: 2.1 (1.9), 2.1 (1.7), 1.2 (1.0); Z=-4.72, -4.83, -3.75; all P<0.05). (2) The median (IQR) of blink frequency increased significantly (before: 11.5 (10.6), 15.3 (11.9), 7.0 (13.0) times/minute; after: 15.0 (13.0), 17.0 (16.0), 15.0 (12.0) times/minute; Z=-2.64, -2.74, -4.12; all P<0.05). (3) The mean (±standard deviation) of critical flicker fusion frequency (CFF) decreased significantly [before: (35.76±2.98), (35.84±2.79), (35.44±2.21) Hz; after: (35.09±2.78), (34.94±2.67), (34.57±2.33) Hz; t=-2.64, -2.38, -4.12; all P<0.05). (4)The median (IQR) of near point of convergence (NPC) became significantly larger [before: 3.9 (2.6), 4.0 (2.5), 4.3 (2.7) cm; after 5.4 (3.8), 4.8 (2.7), 6.1 (3.9) cm; Z=-3.39, -2.27, -3.36; all P<0.05]. (5)The median of negative relative accommodation (NRA) reduced significantly [before: 2.00 (0.50), 2.00 (0.56), 2.00 (0.25) cm; after 1.75 (0.50), 1.75 (0.25), 1.75 (0.50) cm; Z=-1.98, -2.09, -2.53; all P<0.05]. Meanwhile, no significant changes were found for the positive relative accommodation (PRA), accommodative amplitude, accommodative response, negative relative vergence in all groups after watching the video. The comparisons between the three groups showed that, after watching the video, the participants in the two kinds of projection screen group (the metal and glass bead screen group) had more subjective visual fatigue than those in the flat screen group respectively (Z=-2.09, -2.21; all P<0.05), while there was no significant difference in subjective visual fatigue between the two projection screen groups (P>0.05). In addition, positive fusional vergence recovery point and break point decreased after watching the video in the metal screen and glass bead screen group, respectively (t=4.15, 2.07; all P<0.05). However, no such change was found in the flat screen group. Conclusions: Short-term and long-distance VDT operations have significant effects on visual fatigue, which may be due to the decreased positive convergence ability. VDT operations over projection screens may result in more visual fatigue than LED flat panel display, while the effect of different projection screen types have insignificant influences on visual fatigue. (Chin J Ophthalmol, 2019, 55:595-600).

A thermal protective urethral heater applied to modulate the prostate cryoablation area

BACKGROUND

Urethral warmer and cryoheater are invented and applied in cryoablation to overcome urethral cryoinjury, but these devices cannot be fixed and precisely control the released heat which excessively reduces the effective ablation area. Current warmers enlarge the operation difficulty and decrease the precision in temperature control.

OBJECTIVE

A reformed catheter termed urethral heater aims to protect the urethra and simultaneously control the released heat so as to meet the aid of doctors' convenient operation in effective therapy, device fixation and precise heat controllability.

MATERIALS AND METHODS

In this paper, the temperature controller combined with temperature monitor was used to control the heating behavior of the urethral heater with the initial active temperature. The controllability and thermal protection of the urethral heater was simulated and tested, which compared with that of urethral warmer.

RESULTS

During the trials in vitro, the lowest temperature at the urethra surface is -3.7 degree C when one cryoprobe was introduced in the cryoablation for 15 min and -15.3 degree C with two cryoprobes. Above all, the effective cryoablation area increased with the decline of initial active temperatures.

CONCLUSION

The urethral heater is able to prevent the urethra from irreversible damage and modulate the ablation area. The delay of heat is a new way to decline the recurrence rate and facilitate the desire of aconuresis during the cryoablation.

Reversal of multidrug resistance of gastric cancer cells by down-regulation of ZNRD1 with ZNRD1 siRNA

The over-expression of a new zinc ribbon (ZNRD1) gene has been shown previously to promote a multidrug-resistant phenotype in gastric cancer cells through the up-regulation of permeability-glycoprotein (P-gp). In the present study, siRNA eukaryotic expression vectors of ZNRD1 are constructed and transfected into SGC7901/VCR cells to examine whether or not down-regulation of ZNRD1 increases cell sensitivity towards chemotherapeutic drugs. After transfection, ZNRD1 expression decreased dramatically in ZNRD1 siRNA transfectants compared with that in parental cells and empty vector control cells. Down-regulation of ZNRD1 significantly enhanced the sensitivity of SGC7901/VCR cells to vincristine, adriamycin and etoposide, but not to 5-fluorouracil and cisplatin. Cell capacity to efflux adriamycin decreased markedly in ZNRD1 siRNA transfectants, and correlation between ZNRD1 down-regulation and increased multidrug resistance 1 (MDR1) gene transcriptional activity was observed. These results suggest that the ZNRD1 siRNA constructs down-regulate the expression of ZNRD1 effectively and reverse the resistant phenotype of gastric cancer cells. Furthermore, ZNRD1 might influence transcription of the MDR1 gene and thus play an important role in multidrug resistance in gastric carcinoma.

Mitochondrial SIRT3 and its target glutamate dehydrogenase are altered in follicular cells of women with reduced ovarian reserve or advanced maternal age

STUDY QUESTION

Is the activity of sirtuin 3 (SIRT3) altered in granulosa and cumulus cells from young women with reduced ovarian reserve or women of advanced maternal age?

SUMMARY ANSWER

SIRT3 mRNA and active protein in granulosa and cumulus cells were decreased in women with reduced ovarian reserve and advanced maternal age.

WHAT IS KNOWN ALREADY

Young women with reduced ovarian reserve or women of advanced maternal age have reduced oocyte viability, possibly due to altered granulosa and cumulus cell metabolism. The mitochondrial SIRT3 protein may be implicated in these processes as it is able to sense the metabolic state of the cell and alter mitochondrial protein function post-translationally.

STUDY DESIGN, SIZE, DURATION

This is a prospective cohort study, in which women (n = 72) undergoing routine IVF/ICSI were recruited and allocated to one of three cohorts based on age and ovarian reserve (as assessed by serum anti-Mullerian hormone level). Women were classified as young (≤35 years) or of advanced maternal age (≥40 years).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Granulosa and cumulus cells were collected. SIRT3 mRNA and protein levels and protein activity was analysed in granulosa and cumulus cells via quantitative PCR, immunohistochemistry and western blotting, and deacetylation activity, respectively. Activity of the glutamate dehydrogenase (GDH) enzyme, a known target of SIRT3, was assessed, and acetylated proteins in mitochondria isolated from granulosa and cumulus cells were separated by immunoprecipitation and acetylation of GDH assessed by western blotting. Data for women with good prognosis (young women with normal ovarian reserve) were compared with those from young women with reduced ovarian reserve and those of advanced maternal age.

MAIN RESULTS AND THE ROLE OF CHANCE

SIRT3 mRNA and active protein were present in granulosa and cumulus cells and co-localized to the mitochondria. SIRT3 mRNA in granulosa cells was decreased in young women with reduced ovarian reserve and advanced maternal age versus young women with normal ovarian reserve (P < 0.05). SIRT3 mRNA in cumulus cells was decreased in women of advanced maternal age versus young women with normal ovarian reserve only (P < 0.05). Granulosa cell GDH activity was decreased in young women with reduced ovarian reserve and in women of advanced maternal age (P < 0.05), whereas cumulus cell GDH activity was reduced in the advanced maternal age group only (P < 0.05). The acetylation profile of GDH in mitochondria revealed increased acetylation of GDH in granulosa and cumulus cells from women of advanced maternal age (P < 0.05) while young women with reduced ovarian reserve had increased GDH acetylation in granulosa cells only (P < 0.05).

LIMITATIONS, REASONS FOR CAUTION

Although patients were allocated to groups based on maternal age and ovarian reserve and matched for BMI, other maternal factors may also alter the 'molecular health' of ovarian cells.

WIDER IMPLICATIONS OF THE FINDINGS

Our data suggest that SIRT3 post-translational modification of mitochondrial enzymes in human granulosa and cumulus cells may regulate GDH activity, thus altering the metabolic milieu surrounding the developing oocyte. Owing to the association between the decline in oocyte quality and pregnancy rates in women of advanced maternal age and the possible association with reduced ovarian reserve, knowledge of perturbed SIRT3 function in granulosa and cumulus cells may lead to novel therapies to improve mitochondrial metabolism in the oocyte and follicular cells in women undergoing IVF treatment.

STUDY FUNDING/COMPETING INTEREST(S)

No conflicts of interest to declare. Research was funded by an NHMRC project grant.

Clonal Status and Clinicopathological Features of Langerhans Cell Histiocytosis

Some studies have demonstrated that Langerhans cell histiocytosis (LCH) is a neoplastic hyperplasia of Langerhans cells, however some researchers consider that clonality should be assessed in more patients with LCH, both at disease presentation and during the disease course. Monoclonality is a major characteristic of most tumours, whereas normal tissue and reactive hyperplasia are polyclonal. To elucidate the nature of Langerhans cells further, the present study investigated the clinicopathological features and clonality of three cases of LCH in female patients using laser microdissection and a clonality assay, based on X-chromosomal inactivation mosaicism in somatic tissues and polymorphism of the androgen receptor gene. The results indicated that LCH was composed of Langerhans cells with a characteristic morphological appearance, eosinophils, giant cells, neutrophils and foamy cells. Immunohistochemically, the Langerhans cells were positive for CD1a, S-100 protein and vimentin. The clonality assay demonstrated that the Langerhans cells formed a monoclonal population, showing that LCH is neoplastic. We conclude that LCH is characterized by clonal proliferation, although additional studies with larger sample sizes are required to prove this conclusively.

Overexpression of PrPC and its antiapoptosis function in gastric cancer

Cellular prion protein (PrP(C)), a glycosylphosphatidylinositol-anchored membrane protein, was found in our lab to be widely expressed in gastric cancer cell lines. In order to evaluate its biological significance in human gastric cancer, we investigated its expression in a large series of gastric tissue samples (n = 124) by immuno histochemical staining with the monoclonal antibody 3F4. Compared with normal tissues, gastric adenocarcinoma showed increased PrP(C) expression, correlated with the histopathological differentiation (according to the WHO and Lauren classifications) and tumor progression (as documented by pTNM staging). To better understand the underlying mechanism, we introduced the PrP(C) and two pairs of RNAi into the poorly differentiated gastric cancer cell line AGS and found that PrP(C) suppressed ROS and slowed down apoptosis in transfected cells. Further study proved that the apoptosis-related protein Bcl-2 was upregulated whereas p53 and Bax were downregulated in the PrP(C)-transfected cells. A reverse effect was observed in PrP(C) siRNA-transfected cells. These results strongly suggested that PrP(C) might play a role as an effective antiapoptotic protein through Bcl-2-dependent apoptotic pathways in gastric cancer cells. Further study into the mechanism of these relationships might enrich the knowledge of PrP, better our understanding of the nature of gastric carcinoma, and further develop possible strategies to block or reverse the development of gastric carcinoma.

Islet cell autoimmunity in youth onset diabetes mellitus in Northern India

We characterised a consecutive cohort of 132 youth onset diabetic individuals (age at onset<30 years, mean duration of disease 5.5+/-6.0 years) from North India, by serological determination of the determination of the islet cell autoantibodies, GAD(65) and IA2, and clinically for coexisting autoimmune thyroid disease, malnutrition and pancreatic calcification. Five types of diabetes were delineated: Type 1 (37%), ketosis resistant (32%), Type 2 (13%), fibrocalculous pancreatopathy (11%) and autoimmune polyglandular syndrome (7%). C-peptide response to glucagon was assessed in a representative subset of 50 patients with Type 1, ketosis resistant, and autoimmune polyglandular syndrome. A total of 22.4% of Type 1 and 30% of autoimmune polyglandular syndrome subjects showed both GAD(65) plus IA-2 autoantibody positivity, significantly more than the 4.7% positivity shown by the ketosis resistant type. However, GAD(65) antibody positivity alone was seen in 38% of ketosis resistant subjects which was significantly more than the 14.2 and 10% positivity seen in Type 1 and autoimmune polyglandular groups, respectively. The fibrocalculous pancreatopathy group showed GAD(65) plus IA-2 autoantibody positivity in 14.2% and GAD(65) autoantibody alone positivity in 7.1%. 26 and 60%, respectively, of the Type 1 and autoimmune polyglandular syndrome groups had thyroid microsomal autoantibody positivity. Type 1 showed significantly less C-peptide response to glucagon when compared to the ketosis resistant and autoimmune polyglandular syndrome groups. The controls and Type 2 diabetic individuals tested negative for islet cell autoimmunity markers. These findings demonstrate a role of islet cell autoimmunity in the pathogenesis of four out of the five clinical types of youth onset diabetes seen in North India.

[The effect of calponin and caldesmon in regulation of the gastrointestinal motility during pathophysiological adaptation]

OBJECTIVE

To investigate the expression of calponin (CaP) and caldesmon (CaD) in the gastrointestinal tract and their effect in regulating gastrointestinal motility during physiological and pathological adaptation.

METHODS

Models of chronic gastrointestinal motility hyperfunction in mice were induced by intragastric administration of senna extraction and models of chronic gastrointestinal motility hypofunction in rats were established with carbon tetrachloride induced cirrhosis, CaP and CaD were detected in the gastrointestinal tract of different model groups using SDS-PAGE and Western blot. The color development of Western blots was scanned using densitometric scanning. The relative contents of gastrointestinal CaP and CaD were compared with control animals with different state of gastrointestinal motility.

RESULTS

Animal models of abnormal gastrointestinal motility were established in mice and rats. Densitometric quantification of CaP and CaD blots by CP1 and C98 mAbs showed that normal animal colon contained higher amounts of h1-CaP and CaD. In normal mice and rats, the content of CaP and CaD was successively in this order :colon > stomach > small intestine. The content was reduced in mice of chronic gastrointestinal motility hyperfunction, but the expression of CaP and CaD was promoted in rats with cirrhosis and declined to normal level after treatment with L-NAME.

CONCLUSION

There is close relation between expression of CaP and CaD and state of gastrointestinal motility. CaP and CaD may inhibit gastrointestinal motility. These suggest that CaP and CaD may play a role in the regulation of gastrointestinal motility during physiological and pathological adaptation.

Phosphorylation of protein phosphatase inhibitor-1 by Cdk5

Protein phosphatase inhibitor-1 is a prototypical mediator of cross-talk between protein kinases and protein phosphatases. Activation of cAMP-dependent protein kinase results in phosphorylation of inhibitor-1 at Thr-35, converting it into a potent inhibitor of protein phosphatase-1. Here we report that inhibitor-1 is phosphorylated in vitro at Ser-67 by the proline-directed kinases, Cdk1, Cdk5, and mitogen-activated protein kinase. By using phosphorylation state-specific antibodies and selective protein kinase inhibitors, Cdk5 was found to be the only kinase that phosphorylates inhibitor-1 at Ser-67 in intact striatal brain tissue. In vitro and in vivo studies indicated that phospho-Ser-67 inhibitor-1 was dephosphorylated by protein phosphatases-2A and -2B. The state of phosphorylation of inhibitor-1 at Ser-67 was dynamically regulated in striatal tissue by glutamate-dependent regulation of N-methyl-d-aspartic acid-type channels. Phosphorylation of Ser-67 did not convert inhibitor-1 into an inhibitor of protein phosphatase-1. However, inhibitor-1 phosphorylated at Ser-67 was a less efficient substrate for cAMP-dependent protein kinase. These results demonstrate regulation of a Cdk5-dependent phosphorylation site in inhibitor-1 and suggest a role for this site in modulating the amplitude of signal transduction events that involve cAMP-dependent protein kinase activation.

Only multiple autoantibodies to islet cells (ICA), insulin, GAD65, IA-2 and IA-2beta predict immune-mediated (Type 1) diabetes in relatives

We report here our prospective study of 15,224 non-diabetic, first-degree relatives of probands with immune-mediated (type 1) diabetes (IMD), of which 135 were found to eventually develop diabetes. We determined islet cell, insulin, GAD65, insulinoma-associated antigen-2 and 2beta autoantibodies (ICA, IAA, GAD65A, IA-2A and IA-2betaA), on the first available serum samples. The latter three autoantibodies were however assayed on subsets of the relatives with and without ICA, IAA and/or GAD65A, plus most of the relatives who developed diabetes. Of the relatives who progressed to diabetes, 94% had at least one of these autoantibodies on the first screening, while ICA proved to be the most sensitive single marker (sensitivity 74%). Risk of diabetes was however negligible when ICA was found in the absence of the others (5-year risk=5.3%), but increased dramatically whenever two or more autoantibodies were present (5-year risk=28.2% and 66.2%, respectively). The most predictive combination of markers was ICA plus IA-2A and/or IA-2beta A. Loss of first phase insulin release to IVGTT also occurred only in those ICA-positive relatives who had one or more of the other autoantibodies. The data suggests that significant beta-cell damage is seen only when the underlying autoimmunity has spread to multiple antigenic islet cell determinants. Combinations of the autoantibodies occurred most often in relatives with the highest risk HLA-DR/DQ phenotypes. These data document that only relatives positive for at least two or more of these five autoantibodies are at significant risk of diabetes themselves. Intervention trials for the prevention of type 1 diabetes could be designed based on testing for these autoantibodies alone, without the need for HLA typing and IVGTT testing.

The influence of diabetes on free flap transfer: II. The effect of ischemia on flap survival

Insulin-dependent diabetes mellitus causes microangiopathic changes in many tissues, including skin and muscle. It is not known if such changes are detrimental to free flap transfer, particularly after extended ischemia. To address this issue, we used an experimental design by using a syngeneic rat strain (Lewis) for free groin flap and muscle flap transplantations from streptozotocin-induced diabetic rats (2 month's duration of symptoms) to normal rats. Flaps from age-matched normal donors were transplanted to normal recipients for control comparisons. Groin flaps were stored ischemically for 12 or 18 hours at room temperature, or for 48 hours in the cold (4 degrees C) before transplantation. Flap survival and vascular patency were assessed at 7 days. Cutaneous maximus muscle flaps were transplanted to the groins of recipients after 6 hours of room temperature ischemia. Vascular patency, muscle viability, flap weight change (edema), and dehydrogenase activity were assessed after 2 days of reperfusion. Seventy percent, 67%, and 73% of diabetic groin flaps survived after 12, 18, or 48 (cold) hours of ischemia, respectively, in comparison with 90%, 73%, and 87% of normal flaps undergoing the same respective ischemia periods. The differences were not significant, even when the data were pooled (p greater than 0.1). Muscle flaps also showed no significant differences for the parameters studied. These results support the use of microvascular reconstructive surgery in diabetic patients, suggesting that moderate ischemic challenges do not compromise free flap transfer or extremity replantation.

Microvascular salvage procedures with adjuvant antithrombotic therapy for restitution of patency in a rat model

Thrombosis following microvascular anastomosis requires further surgical intervention, involving anastomotic resection and reanastomosis or interpositional vein grafting. This study was undertaken to investigate different methods of salvaging thrombosed vessels, using a rat-vein model of error-induced thrombosis. Vessels were reconstructed 4 hr after the onset of thrombosis, using one of three methods: Group 1--removal of the erroneously placed stitch; Group 2--anastomotic resection and re-anastomosis; and Group 3--resection and replacement with a vein graft. Adjuvant antithrombotic therapy was simultaneously evaluated, assessing the influence of systemic Iloprost or heparin. Patency rates at one day postoperatively were 0 percent, 12.5 percent and 37.5 percent for Groups 1, 2, and 3, respectively. Following Iloprost infusion, these rates increased to 25 percent, 25 percent, and 56.3 percent, respectively and, following heparin administration, to 50 percent, 68.8 percent, and 81.8 percent, respectively. Significant increases were found for vein grafting (Group 3), and for the heparin-treated subgroups using all three methods. Effective levels of both Iloprost and heparin were confirmed by increases noted in rat-tail bleeding times. Significant rates of recanalization by three days following one-day occlusion were found in Groups 1 and 2. These results support the application of vein-graft replacement for thrombosed veins, concurrently with systemic heparinization. This study further confirms the high rate of recanalization seen in thrombosed rat femoral veins.

[Effects of semen Ziziphis Spinosae oil and Ziziphis Spinosae extract on the decrease of serum lipoprotein and inhibiton of platelet aggregation]

Our experiments have shown that oral administration of Semen Ziziphis Spinosae oil(SZSO) or Ziziphis Spinosae extract (ZSE) given to quails for 53 days can significantly reduce their TC, LDL and TG and markedly subdue the fatty degeneration in their livers. Also, SZSO pressed into the stomach of rats for five days can conspicuously inhibit their platelet aggregation, while ZSE cannot.

Rat femoral vein-to-vein grafts as a microvascular practice model: factors that influence patency

The rat femoral vein has become a standard model for microvascular anastomosis practice as well as for research investigations into various manipulative influences upon venous patency. Although vein grafts to the rat artery are the focus of many experimental studies, few reports have investigated vein-to-vein grafts. This study examines the short-term patency (1-3 days) of vein grafts interpositioned to the rat femoral vein. Several factors are studied for their ability to alter the patency rate. The results indicate that patency is difficult to achieve following the creation of a second serial anastomosis (construction of a vein-to-vein graft). Systemic heparin consistently improves patency rates, and trends toward increased patency are seen for reduction in longitudinal tension of the repaired vessel. It is also implied that a deeper understanding of venous hemodynamics and thrombotic events may lead to improved methodologies in the clinical applications of microvenous repairs. These results indicate that rat vein-to-vein grafts may provide a challenging microvascular training model, while introducing the novice microsurgeon to some of the complicating factors encountered with microvascular grafting.

Common denominators in the etiology and pathology of visceral lesions of cystic fibrosis and Keshan disease

The common denominator of a unique disseminated multi-focal miliary myocardial hyaline necrosis and fibrosis in Keshan disease (KSD) and cystic fibrosis (CF) and a commonality of the affected age groups of fetuses and preschool children led to the review of existing KSD autopsy material to search for pancreatic and hepatic lesions considered pathognomonic for CF. Pancreatic lesions considered pathognomonic for CF were found in 595, or 35% of 1700 documented cases of KSD. The pancreatic lesions were limited to tissues of fetuses and preschool children. Adults dying of KSD had diagnostic lesions limited to the cardiovascular system, liver, and skeletal muscle. Varying degrees of focal biliary cirrhosis were identified in 850, or 50% of the KSD autopsies, and 85, or 5% developed severe lobular cirrhosis. The common denominator in CF and KSD appears to be a primary or induced secondary selenium deficiency in age-susceptible humans, prenatally at or around 22 wk of fetal life, during early postnatal life, or during the rapid-growth preschool years. The basic difference between the natural history of CF and KSD is that the selenium deficiency is totally environmental in KSD and appears to be the result of a maternal malabsorptive syndrome or an abnormality of selenium transfer in CF.

Laser-assisted microsurgical anastomoses in traumatized blood vessels

Technological advances have made CO2 laser-assisted microvascular anastomoses (LAMA) feasible. This study seeks to compare results of LAMA versus CSMA (conventional suture microsurgical anastomosis) in traumatized vessels. Using a rat model, femoral arteries and veins were either crushed and transected or divided by avulsion and then repaired by either LAMA or CSMA. LAMA resulted in higher patency rates than CSMA at early postoperative observation periods. With time, the patency rates improved in both groups and, by the end of the study, the patency rates were equivalent. These findings indicate that the laser technique may be a better option when working with traumatized vessels because of the critical nature of early patency rates. The improved results may be due to a reduction of suture material at the anastomotic site when using the laser technique. Some physiologic aspects of vessel thrombosis, recanalization, and the role of collateral circulation are discussed.

The laser-assisted end-to-side microvascular anastomosis

A simple method of performing the laser-assisted end-to-side microvascular anastomosis was devised. This technique was tested on 150 Sprague-Dawley rats in two separate series of experiments. In the first, end-to-side anastomoses were performed on the iliac artery under the normal tension due to the elastic recoil of severed vessels. Four stay sutures were placed 90 degrees apart, and the intervals were "spot welded" with a low-wattage CO2 microsurgical laser unit. The patency rate (96 percent) was equivalent to that found in a control group utilizing the conventional all-suture method (92 percent), but there was a significantly higher aneurysm rate (44 versus 11 percent). In a second model, an arterial bypass with very low anastomotic tension was performed around an obstruction created in the carotid artery. This model resulted in turbulent flow but low anastomotic tension. Here the laser-anastomosis patency rate was 98 percent, versus 42 percent for the conventional all-suture method. The placement of fewer sutures in association with turbulent flow in this model may account for the improved patency rate. The avoidance of excessive tension at the anastomotic site reduced the incidence of aneurysms to a negligible level.

Bursting strength in CO2 laser-assisted microvascular anastomoses

Iliac artery end-to-end anastomoses were performed in 42 Sprague-Dawley rats, divided into seven groups, to determine the welding effects of CO2 laser radiation in microvascular anastomoses. Conventional suture techniques were performed on right iliac arteries, and left iliac arteries were anastomosed with a laser-assisted technique. Bursting strength and diameters of the anastomotic sites were measured at different intervals (from one day to five weeks) post surgery. The anastomotic patency rate was 100 percent in both groups, and the aneurysm rate was only 2 percent in the laser group. Bursting strength was low at one and three days post surgery in both groups; then, it increased gradually until both groups could withstand higher than physiologic pressures. Results of high patency rates, low aneurysm formation, and the ability to withstand pressures higher than physiologic, suggest that the laser-assisted anastomotic technique can play an important role in microvascular surgery.