Intelligently Quantifying the Entire Irregular Dental Structure

Quantitative analysis of irregular anatomical structures is crucial in oral medicine, but clinicians often typically measure only several representative indicators within the structure as references. Deep learning semantic segmentation offers the potential for entire quantitative analysis. However, challenges persist, including segmentation difficulties due to unclear boundaries and acquiring measurement landmarks for clinical needs in entire quantitative analysis. Taking the palatal alveolar bone as an example, we proposed an artificial intelligence measurement tool for the entire quantitative analysis of irregular dental structures. To expand the applicability, we have included lightweight networks with fewer parameters and lower computational demands. Our approach finally used the lightweight model LU-Net, addressing segmentation challenges caused by unclear boundaries through a compensation module. Additional enamel segmentation was conducted to establish a measurement coordinate system. Ultimately, we presented the entire quantitative information within the structure in a manner that meets clinical needs. The tool achieved excellent segmentation results, manifested by high Dice coefficients (0.934 and 0.949), intersection over union (0.888 and 0.907), and area under the curve (0.943 and 0.949) for palatal alveolar bone and enamel in the test set. In subsequent measurements, the tool visualizes the quantitative information within the target structure by scatter plots. When comparing the measurements against representative indicators, the tool's measurement results show no statistically significant difference from the ground truth, with small mean absolute error, root mean squared error, and errors interval. Bland-Altman plots and intraclass correlation coefficients indicate the satisfactory agreement compared with manual measurements. We proposed a novel intelligent approach to address the entire quantitative analysis of irregular image structures in the clinical setting. This contributes to enabling clinicians to swiftly and comprehensively grasp structural features, facilitating the design of more personalized treatment plans for different patients, enhancing clinical efficiency and treatment success rates in turn.

Diagnosis of Malignant Pulmonary Nodules Using a Combination of Tumor-associated Autoantibodies and Computed Tomography

BACKGROUND

Diagnosis of malignant pulmonary nodules can greatly reduce the occurrence of lung cancer death, and computed tomography (CT) is commonly used in diagnosis. In addition, tumor-associated autoantibodies (TAAbs) show high specificity and stability. We aim to establish a computable risk model of pulmonary nodules by combining CT with TAAb detection.

METHODS

The concentrations of 7 TAAbs (p53, PGP9.5, SOX2, GAGE7, GBU4-5, CAGE, MAGEA1, and CAGE) were assayed using the enzyme-linked immunosorbent assay in 136 patients with pulmonary nodules (84 with newly diagnosed lung adenocarcinoma, 21 with squamous cell carcinoma, and 31 with benign nodules) and 42 control subjects without pulmonary nodules. We then drew receiver operating characteristic curves and conducted logistic regression to analyze the diagnostic efficiency of our method in the detection of lung cancer.

RESULTS

The positivity rate of the 7 TAAbs was 49.5%, and the specificity was 83.6%. Our regression results indicated 65% overall accuracy, 44.76% sensitivity, and 76.71% specificity. Notably, when combined with CT imaging and the demographic characteristics, diagnostic accuracy increased to 73.4%, sensitivity to 61.5%, and specificity to 87.1%. The positive predictive value and negative predictive value were 93% and 41%, respectively.

CONCLUSION

Our study provides a method that combines 7 serum TAAbs with imaging and demographic characteristics to diagnose malignant pulmonary nodules more accurately than existing methods.

[Clinical research of multisystem inflammatory syndrome in children]

Objective: To analyze the clinical characteristics of children with multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 in China, and to improve the understanding of MIS-C among pediatricians. Methods: Case series study.Collect the clinical characteristics, auxiliary examinations, treatment decisions, and prognosis of 64 patients with MIS-C from 9 hospitals in China from December 2022 to June 2023. Results: Among the 64 MIS-C patients, 36 were boys and 28 were girls, with an onset age being 2.8 (0.3, 14.0) years. All patients suffered from fever, elevated inflammatory indicators, and multiple system involvement. Forty-three patients (67%) were involved in more than 3 systems simultaneously, including skin mucosa 60 cases (94%), blood system 52 cases (89%), circulatory system 54 cases (84%), digestive system 48 cases (75%), and nervous system 24 cases (37%). Common mucocutaneous lesions included rash 54 cases (84%) and conjunctival congestion and (or) lip flushing 45 cases (70%). Hematological abnormalities consisted of coagulation dysfunction 48 cases (75%), thrombocytopenia 9 cases (14%), and lymphopenia 8 cases (13%). Cardiovascular lesions mainly affected cardiac function, of which 11 patients (17%) were accompanied by hypotension or shock, and 7 patients (12%) had coronary artery dilatation.Thirty-six patients (56%) had gastrointestinal symptoms, 23 patients (36%) had neurological symptoms. Forty-five patients (70%) received the initial treatment of intravenous immunoglobulin in combination with glucocorticoids, 5 patients (8%) received the methylprednisolone pulse therapy and 2 patients (3%) treated with biological agents, 7 patients with coronary artery dilation all returned to normal within 6 months. Conclusions: MIS-C patients are mainly characterized by fever, high inflammatory response, and multiple organ damage. The preferred initial treatment is intravenous immunoglobulin combined with glucocorticoids. All patients have a good prognosis.

[Bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis]

Objective: To analyze the bronchoscopic manifestations and interventional treatment of pulmonary mucormycosis. Methods: Clinical data of patients with pulmonary mucormycosis undergoing bronchoscopy and interventional therapy in 4 tertiary general hospitals in China from May 2006 to May 2022 were retrospectively analyzed and the literature on the subject were reviewed. Results: The data of 10 patients with pathologically diagnosed pulmonary mucormycosis undergoing bronchoscopy and interventional therapy were collected, including 8 males and 2 females. The patients' age ranged from 21 to 72 (44±15) years. The underlying diseases included 6 cases of diabetes ketoacidosis, 3 cases of leukemia, 1 case after operation of lung cancer. Bronchoscopy showed that white viscous necrotic matters grew along the airway and blocked the airway in 9 cases, accompanied by airway bleeding in 3 cases, bloody secretion blocked the airway in 1 case, and bronchopulmonary cavity fistula in 2 cases. The biopsy histopathology of white necrotic matters showed that many mucor filaments were tangled together which were named mucormycelium. Among the 10 patients, 9 were treated with systemic drugs, including intravenous application of amphotericin B deoxycholate in 5 cases, intravenous application of amphotericin B liposome in 4 cases, oral posaconazole in 6 cases and intravenous injection in 1 case. Local drug therapy included aerosol inhalation of amphotericin B deoxycholate in 8 cases and local perfusion under bronchoscope in 5 cases. Bronchoscopic interventional therapy was used to remove mucormycelium in the bronchus, including cryotherapy in 8 cases, biopsy forceps in 7 cases, snare treatment in 2 cases and foreign body forceps in 2 cases. All 10 patients were clinical cured and with no death. Conclusions: Pulmonary mucormycosis is more common in immunocompromised hosts. Bronchoscopy often showed mucormycelium blocking the airway. Systemic and local drug therapy combined with bronchoscopic interventional therapy can achieve good clinical efficacy.

[Identification of potential regulatory genes for embryonic stem cell self-renewal and pluripotency by random forest]

OBJECTIVE

To identify novel genes associated with self-renewal and pluripotency of mouse embryonic stem cells(mESCs)by integrating multiomics data based on machine learning methods.

METHODS

We integrated multiomics information of mESCs involving transcriptome, histone modifications, chromatin accessibility, transcription factor binding and architectural protein binding, and compared the signal differences between known stem cell self-renewal and pluripotency genes and other genes.By integrating these multiomics data, we established prediction models based on several machine learning classifiers including random forests and performed 5-fold cross validations.The model was trained using the training dataset containing two thirds of the input samples, and the remaining one third of the input samples were used as the test dataset to assess the performance of the model in independent tests.Finally, the results predicted by the model were validated through gene function annotation and cell function experiments including cell viability assay, colony formation assay and cell cycle analysis.

RESULTS

Compared with the random genes, the genes known to be associated with self-renewal and pluripotency of mESCs in the multiomics data showed significantly different features.Random forest outperformed the other machine learning algorithms tested on these multiomics data, with an area under the curve (AUC) of 0.883±0.018 for cross validation and an AUC of 0.880±0.028 for independent test.Based on this model, we identified 893 potential regulatory genes associated wwith self-renewal and pluripotency of mESCs, which were similar to the known genes in functional annotation.Known-down of the predicted novel regulator gene Cct6a resulted in significant decreases in the cell viability of mESCs (P < 0.0001) and the number of cell clones (P < 0.01), significantly increased the number of cells in G1 phase (P < 0.01) and decreasedthe number of S phase cells (P < 0.05).Knockdown of Cct6a also led to failure of positive alkaline phosphatase staining of the mESCs.

CONCLUSION

Machine learning model based on multiomics data can be used to predict potential self-renewal and pluripotency regulators with high performance.By using this model, we predicted potential self-renewal and pluripotency regulatory genes including Cct6a and applied experimental validation.This model provides new insights into the regulatory mechanism of mESCs and contribute to stem cell research.

Efficacy of sonothrombolysis using acoustically activated perflutren nanodroplets versus perflutren microbubbles

Background

The use of intermittent high mechanical index (HMI) ultrasound impulses in combination with intravenously administered microbubbles (MB) has been shown to dissolve arterial and microvascular thrombi. The recent development of liquid droplets with nanoscale diameter from commercially available microbubbles may optimize thrombus permeation and subsequent thrombus dissolution.

Methods

Thrombi were formed from fresh porcine arterial whole blood mixed with thrombin, and placed in a vascular system mimicking branching epicardial coronary circulation (Figure 1A) at 37 Celsius and flow rate. A diagnostic ultrasound system with a tissue mimicking phantom was placed on top of the thrombus to simulate transthoracic echocardiography. Thrombus treatment consisted of a 10-minute infusion of either diluted nanodroplets (ND) or MB (same concentration) with intermittent HMI fundamental multipulse (3 usec pulse duration; FUS) or single pulse harmonic (HUS) impulses. All treatments were randomized and compared with HMI impulses alone. Efficacy was evaluated by percentage thrombus dissolution (%TD). Transmission electron microscopy (TEM) of residual thrombi after treatment was performed to examine for droplet permeation and resultant formed microbubble size.

Results

A relatively monodisperse nanodroplets size distribution was formed from microbubble cooled compression (mean diameter was 147±54 nm). A total of 60 porcine arterial thrombi were tested, 20 in each MB and ND treated group (20 control). Overall, there was a significant difference in %TD between ND treated thrombi (combining HUS and FUS HMI treated groups) versus MB treated thrombi and control (p&lt;0.0001 and p=0.02, respectively; ANOVA, Figure 1B). The highest %TD was seen in the FUS HMI treated ND group (mean 51±17%; Figure 1B). TEM of the DND treated group demonstrated significant expansion (diameters of 6 microns; Figure 1 C) of acoustically activated droplets embedded within the thrombi.

Conclusion

ND in combination with intermittent HMI ultrasound resulted in significantly greater thrombolysis compared to MB. In-vivo studies on nanodroplet mediated sonothrombolysis for vascular and microvascular thrombi should be performed with this modification of a commercially available microbubble.

Figure 1

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Theodore F. Hubbard Foundation

MicroRNA-24 attenuates vascular remodeling in diabetic rats through PI3K/Akt signaling pathway

BACKGROUND AND AIMS

The vascular remodeling plays a crucial role in pathogenesis of diabetic cardiovascular complications. In this study, we intended to explore the effects and potential mechanisms of microRNA-24 (miR-24) on vascular remodeling under diabetic conditions.

METHODS AND RESULTS

MiR-24 recombinant adenovirus (Ad-miR-24-GFP) was used to induce miR-24 overexpression either in carotid arteries or high glucose (HG)-induced vascular smooth muscle cells (VSMCs). Cell proliferation was analyzed using CCK-8 method. Cell migration was examined using wound-healing and transwell assay. mRNA and protein expressions of critical factors were, respectively, measured by real-time PCR and western blot as follows: qRT-PCR for the levels of miR-24, PIK3R1; western blot for the protein levels of PI3K (p85α), Akt, p-Akt, mTOR, p-mTOR, 4E-BP1, p-4E-BP1, p70s6k, p-p70s6k, MMP 2, MMP 9, collagen Ⅰ, as well as collagen Ⅲ. Carotid arteries in diabetic rats suffered balloon injury were harvested and examined by HE, immunohistochemical and Masson trichrome staining. The expression of miR-24 was decreased in HG-stimulated VSMCs and balloon-injured carotid arteries of diabetic rats, accompanied by increased mRNA expression of PIK3R1. The up-regulation of miR-24 suppressed VSMCs proliferation, migration, collagen deposition not only induced by HG in vitro, but also in balloon-injured diabetic rats, which were related to inactivation of PI3K/Akt signaling pathway.

CONCLUSION

The up-regulation of miR-24 significantly attenuated vascular remodeling both in balloon-injured diabetic rats and HG-stimulated VSMCs via suppression of proliferation, migration and collagen deposition by acting on PIK3R1 gene that modulated the PI3K/Akt/mTOR axes.

Causes of ozone pollution in summer in Wuhan, Central China

In August 2016, continuous measurements of volatile organic compounds (VOCs) and trace gases were conducted at an urban site in Wuhan. Four high-ozone (O₃) days and twenty-seven non-high-O₃ days were identified according to the China's National Standard Level II (∼100 ppbv). The occurrence of high-O₃ days was accompanied by tropical cyclones. Much higher concentrations of VOCs and carbon monoxide (CO) were observed on the high-O₃ days (p < 0.01). Model simulations revealed that vehicle exhausts were the dominant sources of VOCs, contributing 45.4 ± 5.2% and 37.3 ± 2.9% during high-O₃ and non-high-O₃ days, respectively. Both vehicle exhausts and stationary combustion made significantly larger contributions to O₃ production on high-O₃ days (p < 0.01). Analysis using a chemical transport model found that local photochemical formation accounted for 74.7 ± 5.8% of the daytime O₃, around twice the regional transport (32.2 ± 5.4%), while the nighttime O₃ was mainly attributable to regional transport (59.1 ± 9.9%). The local O₃ formation was generally limited by VOCs in urban Wuhan. To effectively control O₃ pollution, the reduction ratio of VOCs to NO_x concentrations should not be lower than 0.73, and the most efficient O₃ abatement could be achieved by reducing VOCs from vehicle exhausts. This study contributes to the worldwide database of O₃-VOC-NO_x sensitivity research. Its findings will be helpful in formulating and implementing emission control strategies for dealing with O₃ pollution in Wuhan.

Efficacy of minimally invasive tonsil surgery for treatment of obstructive sleep apnea-hypopnea syndrome in children

This study aimed to investigate the efficacy of minimally invasive tonsil surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Tonsil ablation or turbinate reduction was performed on 49 pediatric patients with OSAHS by minimally invasive tonsil surgery. In order to evaluate the efficacy of surgery, a comparison was conducted between pre-operation and post-operation data in terms of the symptoms, signs and polysomnography test. Total effectiveness rate of the surgery was 83.7%. Subgroup analysis was also performed based on the severity of their conditions: mild, moderate, and severe groups had an effectiveness rate of 90.0, 88.9, and 66.7%, respectively (Hc=6.665, P<0.05). Postoperatively, the apnea-hypopnea index, the minimum oxygen saturation (SaO2), and corresponding symptoms improved compared to pre-operation conditions (P<0.05). Minimally invasive tonsil surgery was a safe and effective method for treating OSAHS in children.

Identification of genes involved in rice seed priming in the early imbibition stage

Phase II of seed imbibition is a critical process during seed priming. To identify genes involved in rice seed priming, the altered proteins between the dry and imbibed (24 h) seeds were compared using a two-dimensional gel electrophoresis system in this study. Ten significantly changed proteins (fold change ≥ twofold; P < 0.01) were successfully identified, which could be categorised as carbohydrate and protein biosynthesis and metabolism-related, signalling-related, storage and stress-related proteins. A meta-analysis indicated that the highest expression of the identified genes was at the milk and dough stages and in the endosperm tissue. Quantitative real-time PCR analysis showed that there was significant variation in gene expression (except FAD-dependent oxidoreductase) in embryos during seed priming (0-48 h). The expression of genes associated with stress appeared at the early imbibition stage, while those associated with carbohydrate metabolism, protein synthesis and signalling increased at the late imbibition stage. Three identified proteins (glucose-1-phosphate adenylyltransferase large subunit, aminotransferase and prolamin precursor) had similar transcript and protein expression patterns in embryos. Based on phenotype and gene expression, the optimal stop time for seed priming is 24 h, when these three genes have relatively low expression, followed by significant induction during imbibition in embryos. These three genes are ideal candidate biomarkers for rice seed priming.

Expression of long non-coding RNA (lncRNA) H19 in immunodeficient mice induced with human colon cancer cells

OBJECTIVE

To study the expression of long non-coding RNA (lncRNA) H19 in immunodeficient mice induced with human colon cancer cells. Long non-coding RNAs (lncRNA) have a vital and regulatory role, in almost all cancers including colon cancer. In the present study, the prominent regulatory role of IncH19 RNA in immunodeficient mice induced with human colon cancer cells was identified. Interestingly, the lncH19 RNA was up-regulated in human colon cancer cells induced immunodeficient mice colon cancer samples.

PATIENTS AND METHODS

The expression profile of the lnc H19 RNA in the colon cancer tissues were identified by RT-PCR and the further the data was confirmed and validated by Northern blot analysis.

RESULTS

Based on the data, it was identified that lnc H19 RNA was increased significantly in immunodeficient mice induced with human colon cancer cells, when compared with controls. The data was further confirmed and validated by Northern blot analysis.

CONCLUSIONS

The obtained data future potential application in colon cancer diagnosis. At the same time, lncH19 RNA may serve as a new target for anti-tumor therapy in colon cancer. Also, the obtained data is the important clue to find out the key roles of lncH19 RNA-miRNA functional network in colon cancer.

Diagnostic performance of anti-citrullinated protein/peptide antibodies in juvenile idiopathic arthritis

The prevalence rates of anti-citrullinated protein/peptide antibodies (ACPAs) were investigated in a cohort of juvenile idiopathic arthritis (JIA) patients, and their diagnostic performances were compared. ACPAs, including anti-cyclic citrullinated peptide IgG (anti-CCP), anti-CCP IgG/IgA (anti-CCP3.1), citrullinated recombinant rat filaggrin antibodies (CPA), anti-mutated citrullinated vimentin (anti-MCV), and antibodies to citrullinated human IgG-derived peptides (RA/CP), were measured in the sera from 81 JIA patients. Serum samples from 55 children with other joint diseases or viral infections and 49 healthy donors were tested as controls. Of the 81 JIA patients, 7 (8.6%), 8 (9.9%), 17 (21.0%), 23 (28.4%), and 18 (22.2%) were found to be positive for anti-CCP, anti-CCP3.1, CPA, anti-MCV, and RA/CP, respectively, with specificities of 98.1, 95.1, 93.3, 84.6, and 86.5%. Analysis by subtype revealed that 7/7 (100%) of RF-positive polyarticular JIA patients tested positive at high serum levels for anti-MCV or RA/CP, and 5/7 (71.4%) were positive for anti-CCP, anti- CCP3.1, or CPA (P < 0.001, compared with controls). Eighteen of 81 JIA patients demonstrated joint erosions on radiographs and erosive arthritis occurred more often in ACPAs positive patients (P < 0.01). Our findings indicate that although ACPAs are not satisfactory screening biomarkers for JIA due to low sensitivity, ACPA measurement can aid in diagnosing RF-positive polyarticular JIA and identifying JIA patients with severe bone involvement. The diagnostic performance of each ACPA in JIA is different, and the careful selection of assays is necessary.

Effects of MK-801 concentration on cell proliferation in rats with focal cerebral ischemia-reperfusion

We explored the relationship between MK-801 concentration and neural stem cell proliferation in rats with focal cerebral ischemia-reperfusion (FCIR). A total of 60 male Sprague Dawley rats were randomized into control (six rats), sham-operation (six rats), operation (12 rats), and MK-801 groups. The MK-801 group comprised 36 rats that were subjected to different doses of MK-801 (0.2, 0.4, 0.6, 0.8, 1.0, and 1.2 mg/kg). Suture occlusion was used to establish an ischemia reperfusion model of middle cerebral artery occlusion (MCAO); 30 min before establishing the FCIR model, the MK-801 group rats were intraperitoneally injected with different doses of MK-801, while the sham-operation and control groups were injected with normal saline. Seven days after model establishment, bromodeoxyuridine-positive cerebral cortex cells adjacent to the focus of infarction were labeled for immunohistochemistry. MK-801 at a concentration of 0.4 mg/kg prevented endogenous neural stem cell proliferation, and this inhibitory effect was strengthened with increasing MK-801 concentration, especially at concentrations greater than 0.8 mg/kg. MK-801 inhibits endogenous neural stem cell proliferation in rats with FCIR, and the inhibitory effect is strengthened with increasing MK-801 concentration.

Parallel enzyme-linked immunosorbent assay screening for human immunodeficiency virus among blood donors in five Chinese blood centres: a retrospective analysis

AIMS

To evaluate the strategy of parallel screening with different enzyme-linked immunosorbent assays (ELISA) among Chinese blood donors.

BACKGROUND

Parallel screening with ELISA has been the main strategy to detect human immunodeficiency virus (HIV) in blood donations in China for more than a decade. The performance of the strategy should be analysed.

METHODS

A total of 821,927 donations collected from five Chinese blood centres in 2008-2010 were tested using two third-generation ELISAs by different manufacturers licenced and confirmed by the Western blot (WB) in this study. The confirmatory positive predictive values (PPV), false positive rates (FPR), false negative rates (FNR) and potential risks for transfusion resulting from single or sequential ELISA screening were evaluated.

RESULTS

A total of 5318 (0·647%) of donations screened HIV reactive and were discarded. WB confirmatory results on 1668 available samples suggested that PPVs for dual ELISA, one round ELISA reactive and grey zone samples were 75·1, 0·7 and 0·5%, respectively. Eight out of 1124 one round ELISA reactive and 1 out of 195 grey zone samples were WB confirmed positive. All but one ELISA assay displayed comparable PPVs but variable FPRs and FNRs that differed by blood centre.

CONCLUSIONS

In the absence of nucleic acid testing (NAT), parallel ELISA screening prevented a substantial number of HIV infected donations from entering the Chinese blood supply. However, the loss of false positive donors should be re-evaluated especially given the frequently reported blood supply shortage in China.

Occult macrophage activation syndrome in systemic-onset juvenile idiopathic arthritic syndrome--a case report

Macrophage activation syndrome (MAS) is a severe and life-threatening complication of rheumatic disorders in children. We described a 9-year-old girl in whom MAS developed as a complication of systemic juvenile idiopathic arthritis (S-JIA) at onset with obvious hemophagocytosis presented in the marrow. She suffered from high fever and generalized rash subsequently joints swelling for two weeks before admission. Physical examination revealed mild cervical lymphadenopathy and hepatosplenomegaly. Laboratory findings were: abnormal liver enzymes, increased triglyceride and ferritin levels, anemia .Hyperplasia of hemophagocytic macrophages was remarkable in her bone marrow. Methylprednisolone and cyclosporin therapy resulted in clinical and laboratory improvement. It is unusual that hemophagocytosis presented in the marrow at onset of So-JIA without obvious abnormal coagulation profile, thrombocytopenia and leucopenia. It seemed that MAS may be occult at onset of SJIA. It may be integral to the pathogenesis of SJIA. The proper cyclosporine serum lever at the onset of MAS is as high as 200-300 ng/ml.

Primary immunodeficiency in south China: clinical features and a genetic subanalysis of 138 children

OBJECTIVES

We analyzed the clinical features of 138 patients with primary immunodeficiency (PID) and performed genetic testing on a subset of patients in order to complete gaps in research on PID in South China and thus improve pediatricians' ability to recognize and diagnose PID.

METHODS

We performed a retrospective analysis based on the medical records of PID patients hospitalized in our institution between May 1999 and June 2012. Gene sequencing was performed in 59 cases.

RESULTS

Children with PID usually present with fever and repeated infections that generally affect the respiratory and digestive tracts. Growth retardation is observed in some cases. Of the 138 patients, 113 were boys, median age at onset was 5 months (range, 0-119 months), and age at diagnosis was 10 months (2-159 months). A family history of repeated infection or death of family members in infancy because of recurrent infections was recorded in 20 cases (14.49%). Antibody defects were detected in 48 cases (34.78%), combined immunodeficiency disease in 45 cases (32.61%), and other well-defined immunodeficiency syndromes in 45 cases (32.61%). Of the 59 patients from the genetic subanalysis, 24 (15.94%) had a genetic mutation (x-linked agammaglobulinemia, 8 cases; severe combined immunodeficiency, 8 cases; hyperimmunoglobulin M syndrome, 3 cases; hyperimmunoglobulin E syndrome, 3 cases; chronic granulomatous disease, 2 cases). We detected 4 novel mutations. No relevant mutations were found in the remaining 35 cases.After treatment with intravenous immunoglobulin and anti-infectious agents, 16 patients died in hospital, and 5 cases died after discontinuing treatment (mortality, 15.22%).

CONCLUSIONS

In recent years, the number of patients with PID has risen gradually in South China. Genetic testing can confirm diagnosis. Since PID seriously affects children's quality of life, it is important to diagnose, treat, and intervene early.We hope our clinical and genetic analyses of children with PID can provide diagnostic guidance for clinicians.

PIV pictures of stream field predict haemolysis index of centrifugal pump with streamlined impeller

Previously it has been found by pump haemolysis testing that the flow rate has a remarkable effect on index of haemolysis (IH), while pressure head does not affect IH. Recent investigation with particle image velocimetry (PIV) technology has demonstrated that IH is directly related to the flow pattern of stream field in impeller vane channels. PIV is a visible approach showing the real flow status in the pump. The different positions of a tracer particle in two PIV pictures taken at 20 micros intervals decide the velocity value and direction. The velocity vectors of many particles draw the flow pattern of the stream field. The same pictures are taken at 2, 4 and 6 l min(-1) flow rates while the pressure head is kept unchanged at 100 mmHg; then the pictures are taken at 4 l min(-1) flow with different pressure heads of 80, 100 and 120 mmHg. Results reveal that the flow rate of 4 l min(-1) (IH = 0.030) has the best stream field, and neither turbulence nor separation can be seen. In other flow rates (IH: 0.048 - 0.082), there is obviously second flow. Meanwhile, no significant difference can be seen among the PIV pictures of different pressure heads pumped, which agrees with the results of haemolysis testing showing that pressure has no effect on pump haemolysis. It may be concluded that the haemolysis property of a centrifugal pump can be assessed approximately by PIV pictures, which are much easier to take than haemolysis tests.

World-smallest LVAD with 27 g weight, 21 mm OD and 5 l min-1 flow with 50 mmHg pressure increase

To investigate the feasibility of a long-term left ventricular assist device (LVAD) placed in the aortic valve annulus, an implantable aortic valve pump (21 mm outer diameter, weighing 27 g) was developed. The device consists of a central rotor and a stator. The rotor assembly incorporates driven magnets and an impeller. The stator assembly has a motor coil with an iron core and outflow guide vanes. The device is to be implanted identically to an aortic valve replacement, occupying no additional anatomic space. The pump delivers the blood directly from left ventricle to the aortic root, like a natural ventricle, therefore causing less physiologic disturbance to the natural circulation. Neither connecting conduits nor 'bypass' circuits are necessary. The pump is designed to cycle between a peak flow and zero net flow to approximate systole and diastole. Bench testing indicates that the pump can produce a blood flow of 5 l min(-1) with 50 mmHg pressure increase at 17,500 rpm. At zero net flow rate, the pump can maintain a diastole aortic pressure against 80 mmHg at the same rotating speed.

An improved design of axially driven permanent maglev centrifugal pump with streamlined impeller

BACKGROUND

In 1839, Earnshaw proved theoretically that it is impossible to achieve a stable equilibrium with a pure permanent maglev. Furthermore, in 1939, Braunbeck deduced that it is only possible to stabilize a super conductive or an electric maglev. In 2000, however, the present authors discovered that stable levitation is achievable by a combination of permanent magnetic and nonmagnetic forces, and its stability can be maintained even with mere passive magnetic forces by use of the gyro-effect.

DESIGN CONCEPTS

An improved design of permanent maglev impeller pump has been developed. Passive magnetic (PM) bearings support the rotor radially; on its right side, an impeller is fixed and on its left side a motor magnets-assemble is mounted. Unlike a previous prototype design, in which the rotor magnets were driven by a motor via magnetic coupling, a motor coil is installed opposite to the motor magnets disc, producing a rotating magnetic field. At standstill or if the rotating speed is lower than 4000 rpm, the rotor has one axial point contact with the motor coil. The contact point is located at the centre of the rotor. As the rotating speed increases gradually to higher than 4000 rpm, the rotor will be drawn off from the contact point by the hydrodynamic force of the fluid. Then the rotor becomes fully suspended.

KEY POINTS OF STABILIZATION

For radial and peripheral stabilization, a gyro-effect is important, which is realized by designing the motor magnets disc to have large diameter, short length and high rotating speed; for axial stability, an axial rehabilitating force is necessary, which is produced by PM bearings.

RESULTS

The rotor demonstrated a full levitation by rotation over 4000 rpm. As a left ventricular assist device, the rotation of the pump has a speed range from 5000 to 8000 rpm. The relation between pressure head and flow rate indicates that there is neither mechanical friction nor hydrodynamic turbulence inside the pump; the former is due to the frictionless maglev and the latter is a result of the streamlined design of the impeller.

Novel totally implantable trans-ventricular and cross-valvular cannular pump with rolling bearings and purge system for recovery therapy

In the early 1990s, Yamazaki et al. developed a partly intra-ventricular pump, which was inserted into the left ventricle via the apex and then into the aorta through the aortic valve. The pump delivered blood flow directly from the left ventricle to the aorta, like a natural heart, and needed no inflow and outflow connecting tubes; it could be weaned off after the left ventricle had been recovered. The shortcomings were that the driving DC motor remained outside of the ventricle, causing an anatomic space problem, and the sealing and bearing were not appropriate for a durable device. Recently, a totally implantable trans-ventricular pump has been developed in the authors' laboratory. The device has a motor and a pump entirely contained within one cannula. The motor has a motor coil with iron core and a rotor with four-pole magnet; the pump has an impeller and an outflow guide vane. The motor part is 60 mm in length and 13 mm in diameter; the pump part is 55 mm in length and 11 mm in diameter. The total length of the device is therefore 115 mm. The total weight of the device is 53 g. The motor uses rolling bearing with eight needles on each side of the rotor magnets. A special purge system is devised for the infusion of saline mixed with heparin through bearing to the pump inlet (30 - 50 cc per hour). Thus neither mechanical wear nor thrombus formation along the bearing will occur. In haemodynamic testing, the pump can produce a flow of 4 l min-1 with 60 mmHg pressure increase, at a pump rotating speed of 12,500 rpm. At zero flow rate, corresponding to the diastolic period of the heart, the pump can maintain aortic blood pressure over 80 mmHg at the same rotating speed. This novel pump can be quickly inserted in an emergency and easily removed after recovery of natural heart. It will be useful for patients with acute left ventricular failure.

Computational fluid dynamics verified the advantages of streamlined impeller design in improving flow patterns and anti-haemolysis properties of centrifugal pump

Computational fluid dynamics (CFD) technology was applied to predict the flow patterns in the authors' streamlined blood pump and an American bio-pump with straight vanes and shroud, respectively. Meanwhile, haemolysis comparative tests of the two pumps were performed to verify the theoretical analysis. The results revealed that the flow patterns in the streamlined impeller are coincident with its logarithmic vanes and parabolic shroud, and there is neither separate flow nor impact in the authors' pump. In the bio-pump, the main flow has the form of logarithmic spiral in vertical section and parabola in cross section, thus there are both stagnation and swirl between the main flow and the straight vanes and shroud. Haemolysis comparative tests demonstrated that the authors' pump has an index of haemolysis of 0.030, less than that of the bio-pump (0.065).

New concepts and new design of permanent maglev rotary artificial heart blood pumps

According to tradition, permanent maglev cannot achieve stable equilibrium. The authors have developed, to the contrary, two stable permanent maglev impeller blood pumps. The first pump is an axially driven uni-ventricular assist pump, in which the rotor with impeller is radially supported by two passive magnetic bearings, but has one point contact with the stator axially at standstill. As the pump raises its rotating speed, the increasing hydrodynamic force of fluid acting on the impeller will make the rotor taking off from contacting point and disaffiliate from the stator. Then the rotor becomes fully suspended. The second pump is a radially driven bi-ventricular assist pump, i.e., an impeller total artificial heart. Its rotor with two impellers on both ends is supported by two passive magnetic bearings, which counteract the attractive force between rotor magnets and stator coil iron core. The rotor is affiliated to the stator radially at standstill and becomes levitated during rotation. Therefore, the rotor keeps concentric with stator during rotation but eccentric at standstill, as is confirmed by rotor position detection with Honeywell sensors. It concludes that the permanent maglev needs action of a non-magnetic force to achieve stability but a rotating magnetic levitator with high speed and large inertia can maintain its stability merely with passive magnetic bearings.

Study on stable equilibrium of levitated impeller in rotary pump with passive magnetic bearings

It is widely acknowledged that the permanent maglev cannot achieve stable equilibrium; the authors have developed, however, a stable permanent maglev centrifugal blood pump. Permanent maglev needs no position detection and feedback control of the rotor, nevertheless the eccentric distance (ED) and vibration amplitude (VA) of the levitator have been measured to demonstrate the levitation and to investigate the factors affecting levitation. Permanent maglev centrifugal impeller pump has a rotor and a stator. The rotor is driven by stator coil and levitated by two passive magnetic bearings. The rotor position is measured by four Hall sensors, which are distributed evenly and peripherally on the end of the stator against the magnetic ring of the bearing on the rotor. The voltage differences of the sensors due to different distances between the sensors and the magnetic ring are converted into ED. The results verify that the rotor can be disaffiliated from the stator if the rotating speed and the flow rate of the pump are large enough, that is, the maximal ED will reduce to about half of the gap between the rotor and the stator. In addition, the gap between rotor and stator and the viscosity of the fluid to be pumped also affect levitation. The former has an optimal value of approximately 2% of the radius of the rotor. For the latter, levitation stability is better with higher viscosity, meaning smaller ED and VA. The pressure to be pumped has no effect on levitation.

World-first implantable aortic valvo-pump (IAVP) with sufficient haemodynamic capacity

For better anatomic and physiologic fitting, a novel implantable aortic valvo-pump (IAVP) has been developed. A valvo-pump is a micro axial flow impeller pump, which has the same dimensions and function, as well as the same location, of a valve. Therefore, IAVP needs no inlet and outlet tubes, no additional anatomic occupation, and has less physiologic disturbance to natural circulation compared with the traditional bypass left ventricular assist device (LVAD). The device has a stator and a rotor. The stator consists of a motor coil with an iron core and an outflow guide vane; the rotor includes driven magnets and impeller. There is neither bearing nor strut in both the pump and the motor. In order to reduce the attractive force between the rotor and the stator, so as to enhance the durability of the performance, the rotor magnets were minimized without reducing the driving torque and efficiency of the motor. The impeller vane was designed according to a three-dimensional and analytical method, for preventing stasis and turbulence. The largest outer diameter is 24.7 mm and the length at this point is 12.4 mm. The total weight is 40 g (including the rotor of 11 g). The consumed power is 7 W (14 V x 0.5 A) at 15 000 rpm. This rotating speed stays unchanged during haemodynamic testing together with a pulsatile centrifugal pump, which imitates a failing ventricle. The maximal flow cross IAVP reaches over 10 l min(-1) and the pressure head at 0 l min(-1) can be as large as 80 mmHg. At flow rate of 4 - 8 l min(-1), IAVP enlarges the flow c. 1 l min(-1) and meanwhile increases the pressure about 10 mmHg. The pressure pulsatility generated by the pulsatile centrifugal pump remains 40 mmHg after passing IAVP. By first animal experimental trial the device was sewed in aortic position of an 80 kg pig without harm to adjacent tissue and organs. IAVP promises to be a viable alternative to natural donor heart for heart transplantation in the future.

A novel permanent maglev rotary LVAD with passive magnetic bearings

It has been widely acknowledged that permanent maglev cannot achieve stability; however, the authors have discovered that stable permanent maglev is possible under the effect of a combination of passive magnetic and nonmagnetic forces. In addition, a rotary left ventricular assist device (LVAD) with passive magnetic bearings has been developed. It is a radially driven impeller pump, having a rotor and a stator. The rotor consists of driven magnets and impeller; the motor coil and pump housing form the stator. Two passive magnetic bearings counteract the attractive force between motor coil iron core and rotor magnets; the rotor thereafter can be disaffiliated from the stator and become levitated under the action of passive magnetic and haemodynamic forces. Because of the pressure difference between the outlet and the inlet of the pump, there is a small flow passing through the gap of rotor and stator, and then entering the lower pressure area along the central hole of the rotor. This small flow comes to a full washout of all blood contacting surfaces in the motor. Moreover, a decreased Bernoulli force in the larger gap with faster flow produces a centring force that leads to stable levitation of the rotor. Resultantly, neither mechanical wear nor thrombosis will occur in the pump. The rotor position detection reveals that the precondition of levitation is a high rotating speed (over 3250 rpm) and a high flow rate (over 1 l min(-1)). Haemodynamic tests with porcine blood indicate that the device as a LVAD requires a rotating speed between 3500 and 4000 rpm for producing a blood flow of 4 - 6 l min(-1) against 100 mmHg mean pressure head. The egg-sized device has a weight of 200 g and an O.D. of 40 mm at its largest point.

Refined glufosinate selection in Agrobacterium-mediated transformation of soybean [Glycine max (L.) Merrill]

Modern genetic analysis and manipulation of soybean ( Glycine max) depend heavily on an efficient and dependable transformation process, especially in public genotypes from which expressed sequence tag (EST), bacterial artificial chromosome and microarray data have been derived. Williams 82 is the subject of EST and functional genomics analyses. However, it has not previously been transformed successfully using either somatic embryogenesis-based or cotyledonary-node transformation methods, the two predominant soybean transformation systems. An advance has recently been made in using antioxidants to enhance Agrobacterium infection of soybean. Nonetheless, an undesirable effect of using these antioxidants is the compromised recovery of transgenic soybean when combined with the use of the herbicide glufosinate as a selective agent. Therefore, we optimized both Agrobacterium infection and glufosinate selection in the presence of L-cysteine for Williams 82. We have recovered transgenic lines of this genotype with an enhanced transformation efficiency using this herbicide selection system.

A novel permanent maglev impeller TAH: most requirements on blood pumps have been satisfied

Based on the development of an impeller total artificial heart (TAH) (1987) and a permanent maglev (magnetic levitation) impeller pump (2002), as well as a patented magnetic bearing and magnetic spring (1996), a novel permanent maglev impeller TAH has been developed. The device consists of a rotor and a stator. The rotor is driven radially. Two impellers with different dimensions are fixed at both the ends of the rotor. The levitation of the rotor is achieved by using two permanent magnetic bearings, which have double function: radial bearing and axial spring. As the rotor rotates at a periodic changing speed, two pumps deliver the pulsatile flow synchronously. The volume balance between the two pumps is realized due to self-modulation property of the impeller pumps, without need for detection and control. Because the hemo-dynamic force acting on the left impeller is larger than that on the right impeller, and this force during systole is larger than that during diastole, the rotor reciprocates axially once a cycle. This is beneficial to prevent the thrombosis in the pump. Furthermore, a small flow via the gap between stator and rotor from left pump into right pump comes to a full washout in the motor and the pumps. Therefore, it seems neither mechanical wear nor thrombosis could occur. The previously developed prototype impeller TAH had demonstrated that it could operate in animal experiments indefinitely, if the bearing would not fail to work. Expectantly, this novel permanent magnetic levitation impeller TAH with simplicity, implantability, pulsatility, compatibility and durability has satisfied the most requirements on blood pumps and will have more extensive applications in experiments and clinics.

A novel impeller TAH using magnetic bearings for load reduction

A novel impeller TAH (total artificial heart), i.e. bi-ventricular assist impeller pumps, has been developed. The device consists of a rotor with motor magnets and two impellers, a stator with motor coil and iron core, and two pump housings. In both sides of the rotor magnets, as well as the stator coil core, a pair of magnetic bearings was devised to partly counteract the attractive forces between the rotor magnets and the stator coil core. This means the magnetic bearings are used for load reduction. On hydrodynamic testing, the two pumps both produced a flow rate as high as 6 l min(-1) and the left pump had a pressure head of 150 mm Hg, and that of the right pump was 50 mm Hg. The highest efficiency of the device, including the motor, the two pumps and the controller, reached 14.7%. The device, weighing 250 g, had a length of 80 mm and a diameter of 40 mm at its largest point. Currently in the world, this is a unique TAH, which is electrically powered and driven by a single motor and has only one moving part, can produce either pulsatile or non-pulsatile flow, both pumps eject flow synchronistically by pulsatile mode, and the volume equilibrium of the two pumps can be achieved automatically without the need for control.

Experimental method to reveal the effect of rotor magnet size and air gap on artificial heart driving motor torque and efficiency

To investigate experimentally the effect of rotor magnet design on artificial heart driving motor performance, seven rotors with different magnet lengths or thicknesses, as well as different peripheral angles, were manufactured and tested in the same motor stator with different rotating speeds. The input power (voltage and current) and output torque were measured and the motor efficiency was computed. The results demonstrated that the reduction of rotor magnet size and the enlargement of the air gap between the rotor magnets and the stator coil core have no significant effect on motor efficiency, but will reduce the torque value on which the motor achieves the highest efficiency; it could be remedied however by increasing the rotating speed, because the torque at the high efficiency point will increase along with the rotating speed. These results may provide a basis for developing small rotor magnets, large air gap and high efficiency motors for driving an artificial heart pump.

Axial Reciprocation of Rotating Impeller: A Novel Approach to Preventing Thrombosis in Centrifugal Pump

For long-term application, rotary pumps have to solve the problems of bearing wear and thrombosis along the bearing. Some investigators choose the magnetic bearing for zero friction and to provide no contact between the rotor and stator; the former avoids the mechanical wear and the latter eliminates the possibility of thrombus formation. The authors have tried and have found, however, that it is difficult to apply a magnetic bearing to the rotary pump without disturbing its simplicity, reliability, and implantability, and have therefore developed a much simpler approach to achieve the same results. Instead of using a sliding bearing, a rolling bearing has been devised, and its friction is about 1/15 that of the sliding bearing. Furthermore, a wearproof material of ultra high molecular weight polythene has been adopted to make the rollers, and its antiwear property is eight times better than metal. The service life of the bearing has thus been prolonged. To prevent thrombus formation along the bearing, the impeller reciprocates axially as the impeller changes its rotating speed periodically to produce a pulsatile flow. The reciprocation is the result of the effects of a magnetic force between the motor rotor and stator and a hydraulic force between the blood flow and the impeller. Similar to a piston pump, the oscillating impeller can make the blood flow in and out of the bearing, resulting in washout with fresh blood once a cycle. This obviously helps to prevent thrombosis along the bearing and in the pump. Endurance tests with saline of this novel pump demonstrated device durability, promising long-term assisted circulation.

[Changes of glutamate and GABA in cerebrospinal fluid of patients with pneumonia complicated with central nervous system damage]

Glutamate(Glu), gamma-aminobutyric acid(GABA), and malondialdehyde(MDA) in cerebrospinal fluid (CSF) were measured in 18 children with pneumonia complicated with central nervous system(CNS) damage, 14 children with pneumonia without CNS damage, and 7 children with hypocalcemic tetany. The concentration of Glu and MDA and the ratio of Glu/GABA in CSF of pneumonia without CNS damage were significantly higher than the others. The ratio of Glu/GABA in CSF of the children with pneumonia with consciousness obstacle after convulsion was higher than that without consciousness obstacle after convulsion. These results suggest that Glu and free radicals may play a critical role in the CNS damage caused by pneumonia, however GABA may reduce the CNS damage caused by pneumonia.

Recent progress in developing durable and permanent impeller pump

Since 1980s, the author's impeller pump has successively achieved the device implantability, blood compatibility and flow pulsatility. In order to realize a performance durability, the author has concentrated in past years on solving the bearing problems of the impeller pump. Recent progress has been obtained in developing durable and permanent impeller blood pumps. At first, a durable impeller pump with rolling bearing and purge system has been developed, in which the wear-less rollers made of super-high-molecular weight polythene make the pump to work for years without mechanical wear; and the purge system enables the bearing to work in saline and heparin, and no thrombus therefore could be formed. Secondly, a durable centrifugal pump with rolling bearing and axially reciprocating impeller has been developed, the axial reciprocation of rotating impeller makes the fresh blood in and out of the bearing and to wash the rollers once a circle; in such way, no thrombus could be formed and no fluid infusion is necessary, which may bring inconvenience and discomfort to the receptors. Finally, a permanent maglev impeller pump has been developed, its rotor is suspended and floating in the blood under the action of permanent magnetic force and nonmagnetic forces, without need for position measurement and feed-back control. In conclusion, an implantable, pulsatile, and blood compatible impeller pump with durability may have more extensive applications than ever before and could replace the donor heart for transplantation in the future.

Streamlined design of impeller and its effect on pump haemolysis

To investigate the effect of impeller design on pump haemolysis, five impellers with different numbers of vanes or different vane angles were manufactured and tested in one pump for haemolysis comparison. The impellers had the same dimension and logarithmic spiral vane form that coincided with the stream surfaces in the pump, according to an analytical and three-dimensional design method developed by the authors. Consequently, an impeller with six vanes and a 30 degrees vane angle had the lowest haemolysis index. The result agrees with the theoretical analyses of other investigators searching for the optimal vane number and vane angle to achieve the highest efficiency of the pump.