Dual second harmonic generation and up-conversion photoluminescence emission in highly-optimized LiNbO3 nanocrystals doped and co-doped with Er3+ and Yb3

Preparation from the aqueous alkoxide route of doped and co-doped lithium niobate nanocrystals with Er3+ and Yb3+ ions, and detailed investigations of their optical properties are presented in this comprehensive work. Simultaneous emission under femtosecond laser excitation of second harmonic generation (SHG) and up-conversion photoluminescence (UC-PL) is studied from colloidal suspensions according to the lanthanide ion contents. Special attention has been paid to produce phase pure nanocrystals of constant size (∼20 nm) thus allowing a straightforward comparison and optimization of the Er content for increasing the green UC-PL signals under 800 nm excitation. An optimal molar concentration at about 4 molar% in erbium ions is demonstrated, that is well above the concentration usually achieved in bulk crystals. Similarly, for co-doped LiNbO3 nanocrystals, different lanthanide concentrations and Yb/Er content ratios are tested allowing optimization of the green and red up-conversion excited at 980 nm, and analysis of the underlying mechanisms from excitation spectra. All together, these findings provide valuable insights into the wet-chemical synthesis and potential of doped and co-doped LiNbO3 nanocrystals for advanced applications, combining both SHG and UC-PL emissions from the particle core.

Novel model predicts diastolic cardiac dysfunction in type 2 diabetes

OBJECTIVE

Diabetes mellitus complicated with heart failure has high mortality and morbidity, but no reliable diagnoses and treatments are available. This study aimed to develop and verify a new model nomogram based on clinical parameters to predict diastolic cardiac dysfunction in patients with Type 2 diabetes mellitus (T2DM).

METHODS

3030 patients with T2DM underwent Doppler echocardiography at the First Affiliated Hospital of Shenzhen University between January 2014 and December 2021. The patients were divided into the training dataset (n = 1701) and the verification dataset (n = 1329). In this study, a predictive diastolic cardiac dysfunction nomogram is developed using multivariable logical regression analysis, which contains the candidates selected in a minor absolute shrinkage and selection operator regression model. Discrimination in the prediction model was assessed using the area under the receiver operating characteristic curve (AUC-ROC). The calibration curve was applied to evaluate the calibration of the alignment nomogram, and the clinical decision curve was used to determine the clinical practicability of the alignment map. The verification dataset was used to evaluate the prediction model's performance.

RESULTS

A multivariable model that included age, body mass index (BMI), triglyceride (TG), creatine phosphokinase isoenzyme (CK-MB), serum sodium (Na), and urinary albumin/creatinine ratio (UACR) was presented as the nomogram. We obtained the model for estimating diastolic cardiac dysfunction in patients with T2DM. The AUC-ROC of the training dataset in our model was 0.8307, with 95% CI of 0.8109-0.8505. Similar to the results obtained with the training dataset, the AUC-ROC of the verification dataset in our model was 0.8083, with 95% CI of 0.7843-0.8324, thus demonstrating robust. The function of the predictive model was as follows: Diastolic Dysfunction = -4.41303 + 0.14100*Age(year)+0.10491*BMI (kg/m2) +0.12902*TG (mmol/L) +0.03970*CK-MB (ng/mL) -0.03988*Na(mmol/L) +0.65395 * (UACR > 30 mg/g) + 1.10837 * (UACR > 300 mg/g). The calibration plot diagram of predicted probabilities against observed DCM rates indicated excellent concordance. Decision curve analysis demonstrated that the novel nomogram was clinically useful.

CONCLUSION

Diastolic cardiac dysfunction in patients with T2DM can be predicted by clinical parameters. Our prediction model may represent an effective tool for large-scale epidemiological study of diastolic cardiac dysfunction in T2DM patients and provide a reliable method for early screening of T2DM patients with cardiac complications.KEY MESSAGESThis study used clinical parameters to predict diastolic cardiac dysfunction in patients with T2DM. This study established a nomogram for predicting diastolic cardiac dysfunction by multivariate logical regression analysis. Our predictive model can be used as an effective tool for large-scale epidemiological study of diastolic cardiac dysfunction in patients with T2DM and provides a reliable method for early screening of cardiac complications in patients with T2DM.

Effectiveness and Electrophysiological Mechanisms of Focal Vibration on Upper Limb Motor Dysfunction in Patients with Subacute Stroke: A Randomized Controlled Trial

Upper limb motor dysfunction is a common complication after stroke, which has a negative impact on the daily life of patients. Focal vibration (FV) has been used to improve upper limb motor function in acute and chronic stroke patients, but its application in subacute stroke patients has not been extensively explored. Therefore, the purpose of this study was to explore the therapeutic effect of FV on upper limb motor function in subacute stroke patients and its underlying electrophysiological mechanism. Twenty-nine patients were enrolled and randomized into two groups: control group and vibration group. The control group were treated with conventional therapy including passive and active physical activity training, standing and sitting balance exercises, muscle strength training, hand extension and grasping exercises. The vibration group were given conventional rehabilitation and vibration therapy. A deep muscle stimulator (DMS) with a frequency of 60 Hz and an amplitude of 6 mm was used to provide vibration stimulation, which was sequentially applied along the biceps muscle to the flexor radialis of the affected limb for 10 minutes, once a day, and 6 times a week. Both groups received treatments for 4 consecutive weeks. In the vibration group, the motor evoked potential (MEP) latency and the somatosensory evoked potential (SEP) latency were significantly shortened (P<0.05) immediately after vibration and 30 minutes after vibration; the SEP amplitude and MEP amplitude were significantly increased (P<0.05) immediately after vibration and 30 minutes after vibration. The MEP latency (P=0.001) and SEP N20 latency (P=0.001) were shortened, and the MEP amplitude (P=0.011) and SEP N20 amplitude (P=0.017) were significantly increased after 4 weeks in the vibration group. After 4 consecutive weeks, the vibration group showed significant improvements in Modified Ashworth Scale (MAS) (P=0.037), Brunnstrom stage for upper extremity (BS-UE) (P=0.020), Fugl-Meyer assessment for upper extremity (FMA-UE) (P=0.029), Modified Barthel Index (MBI) (P=0.024), and SEP N20 (P=0.046) compared to the control group. The Brunnstrom stage for hand (BS-H) (P=0.451) did not show significant differences between the two groups. This study showed that FV was effective in improving upper limb motor function in subacute stroke patients. The underlying mechanism of FV may be that it enhances the efficacy of sensory pathways and induces plastic changes in the sensorimotor cortex.

[Vogt-Koyanagi-Harada syndrome in the setting of vemurafenib therapy for metastatic melanoma: a case report]

A 53-year-old female patient complained of 1 week of bilateral visual blurring. She was previously diagnosed with metastatic melanoma of the inguinal lymph nodes and treated with the oral targeted drug vemurafenib. She exhibited aqueous flare in the left eye, and her fundus examination revealed optic disc swelling in the left eye and bilateral serious detachment of the retinal neuroepithelial layer. Fluorescein angiography showed multiple pinpoint hyperfluorescence leakage spots in the prometaphase and appeared as multilobular dye pooling in the late phase. We diagnosed her as Vogt-Koyanagi-Harada syndrome and gave glucocorticoid treatment for eyes. Oral vemurafenib was also taken intermittently under the guidance of an oncologist. After treatment, her bilateral vision improved, the anterior segment inflammation disappeared, and the retinal neuroepithelial layer reattached, with presence of the "sunset glow" fundus.

Plasma cell neoplasm with initial presentation as an ovarian mass: a rare case report

Introduction/Objective

Plasmacytoma is a discrete, solitary mass of neoplastic plasma cells. Extramedullary plasmacytoma (EMP) is a rare entity arising in tissues other than bone and it constitutes about 1% of all plasma cell neoplasms. Most cases of reported EMPs are in the upper aerodigestive tract (~80%). We present a very rare case with the initial presentation as an ovarian mass with metastasis into the peritoneal and pleural cavity.

Methods/Case Report

This is a 66-year-old female who presented with generalized abdominal pain, unexpected weight loss, and occasional fever and night sweats. Computed tomography (CT) scan of abdomen and pelvis showed an extensive metastatic disease including bilateral cardiophrenic angle lymphadenopathy, peritoneal spread encasing the bowel loops, bladder, and uterus as well as moderate right pleural effusion. The positron emission tomography (PET)-CT showed an ill-defined soft tissue density in the pelvis with hypermetabolism. The pelvic ultrasound showed a 2.6 x 2.2 x 1.1 cm hypoechoic mass in the left adnexa. The patient's serum cancer antigen (CA-125) was elevated at 123 U/mL and the post-thoracentesis chest x-ray was unremarkable with no acute osseous abnormalities. Other clinical data were not available.

Results (if a Case Study enter NA)

Cytopathologic evaluation of the pleural fluid showed abundant atypical cells with eccentrically located nuclei, scant to moderate cytoplasm with a paranuclear hof, frequent binucleation and mitoses. The cells ranged in size from small to large. Further immunohistochemical (IHC) analysis on the cell block showed that the tumor cells diffusely positive for CD138 and lambda light chain and negative for MOC31, BerEP4, calretinin, D2-40, WT1, HHV8, ALK1, and EBER in situ hybridization (ISH). The biopsy of the left adnexal mass showed a diffuse proliferation of tumor cells with frequent mitotic figures. The IHC analysis on the biopsy specimen showed tumor cells positive for CD79a and CD56 (weak) and negative for CD20 and PAX5. Kappa/lambda ISH analysis confirmed lambda light chain restriction of the tumor cells. These morphological and immunophenotypic features were consistent with plasma cell neoplasm.

Conclusion

The ovary is an unusual location to be involved by plasma cell neoplasm. We use this case to remind the pathologists and clinicians that ovarian plasmacytoma can be the initial presentation of the plasma cell neoplasm, although rare, and to aid the patients to receive an appropriate treatment. A thorough workup is needed to make an accurate diagnosis of this entity.

Clinical effect of open reduction and internal fixation with a steel plate through the triceps approach in the treatment of fractures of the middle and lower 1/3 of the humerus

OBJECTIVE

The stability of fractures of the middle and lower 1/3 of the displaced humeral shaft is poor, and surgery is currently the main treatment. The posterolateral approach to the upper arm has many advantages but it is not widely used in clinical applications. The aim of the study was to investigate the clinical effect of open reduction and internal fixation with a steel plate through the triceps approach in the treatment of fractures of the middle and lower 1/3 of the humerus.

PATIENTS AND METHODS

A retrospective analysis was performed on 26 patients with fractures of the middle and lower 1/3 of the humerus who were admitted to our hospital from January 2018 to December 2021. According to the AO ASIF classification, 12 patients had type A, 8 patients had type B, and 6 patients had type C fractures. The posterior transtriceps approach was used for open reduction and internal fixation with a steel plate to evaluate its clinical efficacy.

RESULTS

All patients were followed completely, and the follow-up time was 6.0-18.0 months. Fracture nonunion occurred in 1 patient after the operation, and the other 25 patients healed well; 2 patients showed symptoms of radial nerve injury and numbness in the tiger's mouth area, which improved after 2 weeks. The average healing time of the fracture was 12.3 weeks. There were no infections or complications such as plate fractures. Elbow joint function according to Mayo scoring standards was as follows: 19 cases were excellent, 3 cases were good, 2 cases were fair, and 2 cases were poor. The excellent and good rate was 84.6%.

CONCLUSIONS

Open reduction through the triceps approach and internal fixation with a steel plate for the treatment of the middle and lower 1/3 of the humerus can directly expose and protect the radial nerve and its branches and reduce radial nerve damage, and plate fixation on the tension side is biomechanical and worthy of clinical application.

Inhibiting Hh Signaling in Gli1+ Osteogenic Progenitors Alleviates TMJOA

The increased prevalence of temporomandibular joint osteoarthritis (TMJOA) in children and adolescents has drawn considerable attention as it may interfere with mandibular condyle growth, resulting in dento-maxillofacial deformities. However, treatments for osteoarthritis have been ineffective at restoring the damaged bone and cartilage structures due to poor understanding of the underlying degenerative mechanism. In this study, we demonstrate that Gli1+ cells residing in the subchondral bone contribute to bone formation and homeostasis in the mandibular condyle, identifying them as osteogenic progenitors in vivo. Furthermore, we show that, in a TMJOA mouse model, derivatives of Gli1+ cells undergo excessive expansion along with increased but uneven distribution of osteogenic differentiation in the subchondral bone, which leads to abnormal subchondral bone remodeling via Hedgehog (Hh) signaling activation and to the development of TMJOA. The selective pharmacological inhibition and specific genetic inhibition of Hh signaling in Gli1+ osteogenic progenitors result in improved subchondral bone microstructure, attenuated local immune inflammatory response in the subchondral bone, and reduced degeneration of the articular cartilage, providing in vivo functional evidence that targeting Hh signaling in Gli1+ osteogenic progenitors can modulate bone homeostasis in osteoarthritis and provide a potential approach for treating TMJOA.

Effects of Paired Associative Stimulation on Metabolites in Ischemia Stroke Rats Model as Studied by Nuclear Magnetic Resonance Spectrum

Paired associated stimulation (PAS) has been confirmed to play a role in motor recovery after stroke, but the underlying mechanism has not been fully elucidated. In this study, we employed a comprehensive battery of measurements, including behavioral test, electrophysiology and 1H-NMR approaches, to investigate the therapeutic effects of PAS in rat model of cerebral ischemia and its underlying mechanism. Rats were randomly divided into a transient middle cerebral artery occlusion group (tMCAO group), a tMCAO + PAS group (PAS group), and a sham group. PAS was applied over 7 consecutive days in PAS group. The behavioral function of rats was evaluated by modified Garcia Scores and Rota-rod test. Electrophysiological changes were measured by motor evoked potentials (MEP). Metabolic changes of ischemic penumbra were detected by 1H-NMR. After PAS intervention, the performances on Rota-rod test and Garcia test improved and the amplitude of MEP increased significantly. The gamma-aminobutyric acid (GABA) in penumbra cortex was decreased significantly, whereas the glutamate showed the opposite changes. The results suggested that post-stroke recovery promoted by PAS may be related to the metabolites alteration in ischemic penumbra and also regulate the excitability of motor cortex.

Effects of oxidation on humic-acid-enhanced gypsum scaling in different nanofiltration phases: Performance, mechanisms and prediction by differential log-transformed absorbance spectroscopy

The aim of this study was to evaluate the effects of oxidation on humic-acid-enhanced gypsum scaling in different nanofiltration phases, including the short-term membrane flux behaviors and the long-term ones. On the basic of correlation analysis between the changing physicochemical properties of feed solution and membrane fouling, the inner mechanisms were revealed from aspects of bulk crystallization (interaction between humic acid and inorganic ions) and surface crystallization (compositions and morphologies of surface crystallization). Furthermore, the reliability of applicating differential log-transformed absorbance spectroscopy for predicting membrane fouling was also systematically evaluated. There was an upward trend in short-term membrane fouling with increasing dosage of NaClO, while long-term membrane fouling decreased after an initial increase. During short-term filtration, the enhanced combination between inorganic ions and the humic acid with stronger density of carboxyl groups, which was generated more easily under stronger oxidation conditions, favored the earlier appearance of flux decline. During long-term filtration, the size of bulk crystallization depended on the total content of carboxyl groups in feed solution. Both of them increased firstly and then decreased with increasing oxidation. The terminal fouling layer resistance also shared a similar tendency with them, because the deposition of bulk crystallization on membranes and the formation of dense scaling layer were the direct reasons for the long-term membrane fouling. Furthermore, the differential log-transformed absorbance spectroscopy was proven to be an efficient approach to predict short-term membrane fouling, especially in the wavelength range of 260 to 280 nm. This research could not only provide guidance on alleviating oxidation-enhanced membrane fouling in nanofiltration but also propose an efficient way to predict the membrane fouling which was influenced by the interaction between organic matters and inorganic ions.

Human spinal GABA neurons alleviate spasticity and improve locomotion in rats with spinal cord injury

Spinal cord injury (SCI) often results in spasticity. There is currently no effective therapy for spasticity. Here, we describe a method to efficiently differentiate human pluripotent stem cells from spinal GABA neurons. After transplantation into the injured rat spinal cord, the DREADD (designer receptors exclusively activated by designer drug)-expressing spinal progenitors differentiate into GABA neurons, mitigating spasticity-like response of the rat hindlimbs and locomotion deficits in 3 months. Administering clozapine-N-oxide, which activates the grafted GABA neurons, further alleviates spasticity-like response, suggesting an integration of grafted GABA neurons into the local neural circuit. These results highlight the therapeutic potential of the spinal GABA neurons for SCI.

Between-trial heterogeneity in ARDS research

Purpose

Most randomized controlled trials (RCTs) in patients with acute respiratory distress syndrome (ARDS) revealed indeterminate or conflicting study results. We aimed to systematically evaluate between-trial heterogeneity in reporting standards and trial outcome.

Methods

A systematic review of RCTs published between 2000 and 2019 was performed including adult ARDS patients receiving lung-protective ventilation. A random-effects meta-regression model was applied to quantify heterogeneity (non-random variability) and to evaluate trial and patient characteristics as sources of heterogeneity.

Results

In total, 67 RCTs were included. The 28-day control-group mortality rate ranged from 10 to 67% with large non-random heterogeneity (I² = 88%, p < 0.0001). Reported baseline patient characteristics explained some of the outcome heterogeneity, but only six trials (9%) reported all four independently predictive variables (mean age, mean lung injury score, mean plateau pressure and mean arterial pH). The 28-day control group mortality adjusted for patient characteristics (i.e. the residual heterogeneity) ranged from 18 to 45%. Trials with significant benefit in the primary outcome reported a higher control group mortality than trials with an indeterminate outcome or harm (mean 28-day control group mortality: 44% vs. 28%; p = 0.001).

Conclusion

Among ARDS RCTs in the lung-protective ventilation era, there was large variability in the description of baseline characteristics and significant unexplainable heterogeneity in 28-day control group mortality. These findings signify problems with the generalizability of ARDS research and underline the urgent need for standardized reporting of trial and baseline characteristics.

Supplementary Information

The online version of this article (10.1007/s00134-021-06370-w) contains supplementary material, which is available to authorized users.

Impacts of Glycemic Control on Intracranial Plaque in Patients with Type 2 Diabetes Mellitus: A Vessel Wall MRI Study

BACKGROUND AND PURPOSE

The relationship between glycemic control in patients with type 2 diabetes mellitus and intracranial atherosclerotic plaque features has remained understudied. This study aimed to investigate the association of type 2 diabetes mellitus and glycemic control with the characteristics of intracranial plaques using vessel wall MR imaging.

MATERIALS AND METHODS

In total, 311 patients (217 [69.8%] men; mean age, 63.24 ± 11.44 years) with intracranial atherosclerotic plaques detected on vessel wall MR imaging were enrolled and divided into 3 groups according to type 2 diabetes mellitus and glycemic control statuses: the non-type 2 diabetes mellitus group, the type 2 diabetes mellitus with good glycemic control group, and the type 2 diabetes mellitus with poor glycemic control group. The imaging features of intracranial plaque were analyzed and compared among the groups. The clinical risk factors for atherosclerosis were also analyzed using logistic regression analysis.

RESULTS

The plaque length and thickness were significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus group. The prevalence of strongly enhanced plaques was significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus and type 2 diabetes mellitus with good glycemic control groups (92.9%, 63.4%, and 72.7%, respectively; P < .001). Multivariate logistic regression analysis showed a significant association of poor glycemic control with the plaque length (OR = 1.966; 95% CI, 1.170-3.303; P = .011), plaque thickness (OR = 1.981; 95% CI, 1.174-3.340; P = .010), and strongly enhanced plaque (OR = 5.448; 95% CI, 2.385-12.444; P < .001).

CONCLUSIONS

Poor glycemic control, compared with the history of diabetes, might have a greater impact on the burden and vulnerability of intracranial atherosclerotic plaques.

Defining heart disease risk for death in COVID-19 infection

BACKGROUND

Cardiovascular disease (CVD) was in common in coronavirus disease 2019 (COVID-19) patients and associated with unfavorable outcomes. We aimed to compare the clinical observations and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with or without CVD.

METHODS

Patients with laboratory-confirmed SARS-CoV-2 infection were clinically evaluated at Wuhan Seventh People's Hospital, Wuhan, China, from 23 January to 14 March 2020. Demographic data, laboratory findings, comorbidities, treatments and outcomes were collected and analyzed in COVID-19 patients with and without CVD.

RESULTS

Among 596 patients with COVID-19, 215 (36.1%) of them with CVD. Compared with patients without CVD, these patients were significantly older (66 vs. 52 years) and had higher proportion of men (52.5% vs. 43.8%). Complications in the course of disease were more common in patients with CVD, included acute respiratory distress syndrome (22.8% vs. 8.1%), malignant arrhythmias (3.7% vs. 1.0%) including ventricular tachycardia/ventricular fibrillation, acute coagulopathy(7.9% vs. 1.8%) and acute kidney injury (11.6% vs. 3.4%). The rate of glucocorticoid therapy (36.7% vs. 25.5%), Vitamin C (23.3% vs. 11.8%), mechanical ventilation (21.9% vs. 7.6%), intensive care unit admission (12.6% vs. 3.7%) and mortality (16.7% vs. 4.7%) were higher in patients with CVD (both P < 0.05). The multivariable Cox regression models showed that older age (≥65 years old) (HR 3.165, 95% CI 1.722-5.817) and patients with CVD (HR 2.166, 95% CI 1.189-3.948) were independent risk factors for death.

CONCLUSIONS

CVD are independent risk factors for COVID-19 patients. COVID-19 patients with CVD were more severe and had higher mortality rate, early intervention and vigilance should be taken.

Role of miR-21 in rats with proliferative diabetic retinopathy via TGF-β signaling pathway

OBJECTIVE

To explore the effects of miR-21 on the rats with proliferative diabetic retinopathy by regulating the transforming growth factor-beta (TGF-β) signaling pathway.

MATERIALS AND METHODS

A total of 36 Sprague-Dawley rats were randomly divided into the normal group (n=12), model group (n=12), and inhibitor group (TGF-β signaling inhibitor) (n=12). No treatment was performed in the normal group, the diabetic retinopathy model was established in the model group, and the model was established in the inhibitor group after the intraperitoneal injection of the inhibitor. Then, the materials were sampled for detection. In each group, the retinal morphology was observed via hematoxylin-eosin (HE) staining, the expressions of TGF-β1 and Smad3 were detected via immunohistochemistry, the relative protein expression levels of phosphorylated Smad3 (p-Smad3) and TGF-β were determined via Western blotting, the expression of miR-21 was detected via quantitative Polymerase Chain Reaction (qPCR), and the hemodynamic indicators of the ocular tissues were detected using the color Doppler ultrasonography.

RESULTS

The HE staining results revealed that the rats in the model group had evident retinal damage, which could be effectively improved using the inhibitor. According to the immunohistochemistry detection results, the positive expression level of TGF-β1 was substantially raised in both model group and inhibitor group compared with that in the normal group (p<0.05), and it was notably lower in the inhibitor group than that in the model group (p<0.05). Moreover, the three groups did not differ in the positive expression level of Smad3 (p>0.05). The Western blotting results showed that the model and inhibitor groups had remarkably higher relative protein expression levels of p-Smad3 and TGF-β1 than the normal group (p<0.05), and they were markedly lowered in the inhibitor group compared with those in the model group (p<0.05). According to the qPCR results, the expression level of miR-21 was notably elevated in both model group and inhibitor group compared with that in the normal group (p<0.05), and there was no difference in the expression level of miR-21 between the former two groups (p>0.05). Finally, based on the color Doppler ultrasonography findings, the levels of the hemodynamic indicators substantially declined in both model group and inhibitor group compared with those in the normal group (p<0.05), and they were notably higher in the inhibitor group than those in the model group.

CONCLUSIONS

We found that miR-21 regulates the TGF-β signaling pathway to affect the hemodynamics in the rats with proliferative diabetic retinopathy.

Immobilizing Microcystis aeruginosa and powdered activated carbon for the anaerobic digestate effluent treatment

The environment pollution caused by livestock anaerobic digestate effluent (ADE) is becoming increasingly severe recently. In this study, immobilized technology, embedding Microcystis aeruginosa (MA) and powdered activated carbon (PAC) with sodium alginate (SA), was employed to investigate the removal performance of nitrogen (N), phosphorus (P) and dissolved organic matter (DOM) in the treatment of ADE solution. Initially, orthogonal experiment was carried out to achieve the optimal conditions of the beads fabrication with the concentration of imbedding agents (PAC-SA) of 5% (w/w) and the ratio of microalgae and imbedding agents was 1:1 (v/v). The results indicated that the total nitrogen (TN), total phosphorus (TP) and total organic carbon (TOC) can be efficiently removed under the optimal operation conditions, with average removals of 91.88 ± 2.91% in TN, 98.24 ± 0.12 in TP and 78.31 ± 1.57% in TOC, respectively. Moreover, the fluorescence excitation-mission matrix (EEM) results illustrated that IMA-PAC beads joined system can efficiently diminish the concentrations of protein-like compounds and humic substances. Therefore, the organic contaminants and nutrients (i.e. N and P) can be efficiently removed in IMA-PAC beads joined system, which would contribute to developing new strategies for the treatment of ADE solution and nutrient recycle.

LncRNA HOXA11-AS promotes migration and invasion through modulating miR-148a/WNT1/β-catenin pathway in gastric cancer

Increasing researches have focused on the biological functions of long noncoding RNAs (lncRNAs) in human cancers. HOXA11-AS, a widely known lncRNA, has been confirmed to be involved in the progression of several cancers, including gastric cancer (GC). Whereas, the detailed mechanism of this lncRNA in GC remains to be further illuminated. The abundances of HOXA11-AS, miR-148a and WNT1 in GC tissues and cell lines were examined by qRT-PCR. Clinicopathological and Kaplan-Meier survival analyses were determined to explore the relationship between HOXA11-AS expression and outcomes of patients. Transwell assay was performed for the evaluation of cell migration and invasion. Bioinformatics, dual-luciferase reporter and RNA immunoprecipitation assays were employed to analyze the correlation between HOXA11-AS and miR-148a or miR-148a and WNT1. The protein levels of WNT1 and β-catenin were assessed by western blot assay. Results showed that HOXA11-AS and WNT1 expression levels were upregulated, while miR-148a level was downregulated in GC tissues and cell lines relative to matched controls. Elevated expression of HOXA11-AS was associated with increased tumor size, lymph node metastasis, advanced TNM stage, as well as reduced survival of GC patients. HOXA11-AS induced migration and invasion of GC cells through serving as a molecular sponge for miR-148a. Furthermore, miR-148a inactivated WNT1/β-catenin signaling pathway via directly targeting WNT1. HOXA11-AS increased WNT1/β-catenin pathway activity, which was abolished by miR-148a overexpression in GC cells. In conclusion, overexpression of HOXA11-AS contributed to migration and invasion of GC cells via activation of WNT1/β-catenin signaling pathway through repressing miR-148a, providing a prospective therapeutic target for GC.

Early diagnostic role of PSA combined miR-155 detection in prostate cancer

OBJECTIVE

As a kind of malignant tumor in the male genitourinary system, prostate cancer exhibits significantly increased occurrence. Prostate-specific antigen (PSA) expression can be seen in the prostate cancer, prostatitis, and other diseases, therefore, lack of diagnostic specificity. The miR-155 expression is abnormally increased in the tumors. Therefore, this study aims to explore the clinical significance of PSA combined miR-155 detection in the early diagnosis of prostate cancer.

PATIENTS AND METHODS

A total of 86 patients diagnosed with prostate cancer were enrolled in this study. PSA and miR-155 gene expression in tumor tissue were detected by using Real-time PCR. The serum levels of PSA were measured by using enzyme-linked immunosorbent assay (ELISA). The correlation of PSA and miR-155 expression with age, body mass index (BMI), tumor volume, tumor-node-metastasis (TNM) stage, lymph node metastasis (LNM), and other clinicopathological features were analyzed, respectively.

RESULTS

Serum PSA expression and PSA gene in tumor tissue were significantly higher compared to that in adjacent tissues (p<0.05). PSA gene and protein increased significantly with the clinical stage of TNM and decreased following the increase of grade (p<0.05). The miR-155 level was significantly elevated in the tumor tissue compared with para-carcinoma tissue (p<0.05). PSA and miR-155 expressions were positively correlated with TNM stage, tumor volume, and LNM, and negatively correlated with grade (p<0.05).

CONCLUSIONS

PSA and miR-155 were closely related to the clinicopathological features of prostate cancer. Combined detection is helpful for the early diagnosis of prostate cancer.

[Clinical features and treatment outcome of inflammatory myofibroblastic tumor of the paranasal sinus]

Objective: To investigate the clinicopathological features and the clinical characteristics of inflammatory myofibroblastic tumor(IMT) of paranasal sinus. Method: Five cases of IMT of paranasal sinus treated from 2011 to 2018 were analyzed retrospectively. Of the 5 patients, CT and MRI were performed before operation. All tumors originated from paranasal sinus, and orbital, pterygopalatine fossa and palate was involved with variable degrees. All patients had been given operation and recovered well. Two cases received additional glucocorticoid therapy(prednisone) postoperatively. Result: After a follow-up of 3-80 months, one case recurred 2 years postoperatively and received surgery again. No recurrence was found after operation in the other four patients. The finial diagnosis depended on pathological findings. Postoperative pathological examination showed that the tumor cells were mainly composed of spindle fibroblasts and chronic inflammatory cells. Immunohistochemical staining showed positive expression of SMA protein. Conclusion: IMT of paranasal sinus is a rare clinical entity without specific clinical manifestations and the extent of the lesion can be assessed by imaging examinations. Pathological examination is required for final diagnosis. Radical resection should be taken for limited lesions. Besides surgery, corticosteroid administration and irradiation therapy is recommended in some circumstances. The overall prognosis is good.

Two linked TBXT (brachyury) gene polymorphisms are associated with the tailless phenotype in fat-rumped sheep

T‐box transcription factor T (TBXT), encoding the brachyury protein, is an embryonic nuclear transcription factor involved in mesoderm formation and differentiation. Previous studies indicate that TBXT mutations are responsible for the tailless or short‐tailed phenotype of many vertebrates. To verify whether the tailless phenotype in fat‐rumped sheep is associated with TBXT mutations, exon 2 of the TBXT gene for 301 individuals belonging to 13 Chinese and Iranian sheep breeds was directly sequenced. Meanwhile, 380 samples were used to detect the genotypes of the candidate variations by mapping to their reads databases in the Sequence Read Archive repository of GenBank. The results showed that one missense mutation, c.334G>T (GGG>TGG) with a completely linked synonymous variant c.333G>C (CCG>CCC) was found to be associated with the ‘tailless’ characteristic in typical fat‐rumped sheep breeds. The c.334G>T transversion led to the conversion of glycine to tryptophan at the 112th amino acid in the T‐box domain of the brachyury protein. In addition, crossbreeding experiments for long‐tailed and tailless sheep showed that CT/CT allele of nucleotides (nt) 333 and 334, a recessive mutation, would cause sheep tails to be shorter, suggesting that these two linked variants at nucleotides 333 and 334 in TBXT are probably causative mutations responsible for the tailless phenotype in sheep.

[Association of joint effect of overweight/obesity and elevated blood pressure with left ventricular hypertrophy in children]

Objective: To examine the association of joint effect of overweight (including obesity) and elevated blood pressure (BP) with left ventricular hypertrophy (LVH) in children. Methods: A convenient cluster sampling method was used to conduct a cross-sectional survey from November 2017 to January 2018 in a primary school in Huantai County, Zibo City, Shandong Province. A total of 1 319 children aged 6-11 years old who had complete data on anthropometric indices and variables collected using a questionnaire were included in the study. LVH was defined as left ventricular mass index (LVMI) ≥90 th percentile for sex and age of this population. Based on weight status (yes vs. no) and elevated BP status (yes vs. no), all participants were divided into four subgroups (normal weight and normal BP, normal weight and elevated BP, overweight and normal BP, overweight and elevated BP). LVMI levels or prevalence of LVH across four subgroups were compared. The multivariate logistic regression model was used to examine the association of joint effect between overweight and elevated BP with LVH in children. Results: The age of children was (8.4±1.6) years, and boys accounted for 53.3% (n=703). There were significant differences in LVMI levels and prevalence of LVH across four subgroups (P<0.05); Children with both overweight and elevated BP (n=184) had the highest LVMI levels and prevalence of LVH [LVMI: (30.69±0.32) g/m(2.7); the prevalence of LVH: 24.46%]. After the adjustment for potential covariates, compared to children with both normal weight and normal BP (n=657), the risk of LVH in children with elevated BP alone (n=136) was not increased [OR (95%CI) was 0.89 (0.30-2.62)]. Children with overweight alone (n=342) [OR (95%CI) was 5.69(3.39-9.55)] and those with both overweight and elevated BP [OR (95%CI) was 9.45 (5.47-16.33)] were at higher risk of LVH. Conclusion: The joint effect between overweight and elevated BP could be highly correlated with LVH in children.

The E3 ubiquitin ligase Cbl-b inhibits tumor growth in multidrug-resistant gastric and breast cancer cells

Most receptor tyrosine kinases (RTKs) contribute to tumor growth, and their ubiquitination and degradation is related to the inhibition of tumor growth. Our previous study showed that the ubiquitin ligase Cbl-b was expressed at low levels in multidrug-resistant (MDR) gastric cancer cells compared with their parental cells. However, whether enhancement of Cbl-b expression in MDR cancer cells could prevent tumor proliferation via ubiquitination and degradation of RTK remains unclear. In the present study, Cbl-b overexpression reduced cell proliferation in MDR gastric and breast cancer cells, and effectively inhibited tumor growth in vivo. Additionally, Cbl-b overexpression reduced the total protein level of insulin-like growth factor 1 (IGF-1R), an important member of the RTK family. Moreover, Cbl-b overexpression promoted interaction of Cbl-b with IGF-1R, and induced ubiquitination and degradation of IGF-1R and inactivation of the IGF-1R pathway. These results suggest that the ubiquitin ligase Cbl-b inhibited tumor growth via ubiquitination and degradation of IGF-1R in MDR gastric and breast cancer cells.

Risk factors and a predictive nomogram for non-sentinel lymph node metastases in Chinese breast cancer patients with one or two sentinel lymph node macrometastases and mastectomy

Background

Two ongoing prospective randomized trials are evaluating whether omitting axillary lymph node dissection (alnd) in patients with breast cancer (bca) and sentinel lymph node (sln) macrometastases undergoing mastectomy is safe. Determining predictive risk factors for non-sln metastases and developing a model to predict the probability of those patients having non-sln metastases is also important.

Methods

This retrospective study enrolled 396 patients with bca and 1-2 slns with macrometastases who underwent alnd and mastectomy between January 2012 and December 2016. Factors influencing the non-sln metastases were determined, and a predictive nomogram was formulated. Performance of the nomogram was evaluated by its area under the curve (auc).

Results

We developed a predictive nomogram with an auc of 0.81 (cross-validation 95% confidence interval: 0.75 to 0.86) that included 4 factors (tumour size, histologic grade, and number of negative slns and axillary lymph nodes on imaging).

Conclusions

Our predictive nomogram assesses the risk of non-sln metastases in patients with bca and 1-2 sln macrometastases undergoing mastectomy.

[Correlations between gastric Helicobacter pylori infection and colorectal polyps or cancer]

Objective: To investigate the correlations between gastric Helicobacter pylori (Hp) infection and colorectal polyps or cancer. Methods: Among patients who finished colonoscopy exams in Peking Union Medical College Hospital (PUMCH) between May 2012 and May 2017, 3 483 patients were diagnosed with colorectal polyps, 135 patients with newly diagnosed colorectal cancer. A total of 1 925 healthy subjects were enrolled as normal controls. Gastric rapid urease tests (RUT) were done in all patients. General clinical data, RUT results, sizes and numbers of polyps, cancer location were analyzed. Results: The proportion of Hp infection in patients with colorectal polyps was 31.5%, higher than that in healthy controls. The odds ratio (OR) of Hp infection in polyp group was 1.17 (95%CI 1.04-1.32) after age and gender were adjusted. The Hp infection rate in patients with polyps over or equal to 1 cm was significantly higher than that in patients with polyps smaller than 1 cm. Patients with more than 1 polyps presented a higher rate of Hp infection than patients with only 1 polyp. Hp infection rate in patients with colorectal cancer was 36.3%, with the adjusted OR 1.56 (95%CI 1.06-2.30). The location of colorectal cancer was not correlated with Hp infection. Conclusions: Gastric Hp infection is more common in patients with colorectal polyps than in healthy controls. Polyps ≥1 cm, multiple polyps and colorectal cancer are correlated with higher rates of Hp infection. Cancer location is irrelevant to Hp infection.

[Clinical application of pedicel frontal flap in reconstruction of the nasal defects]

Objective:The aim of this study is to explorethe application of improving the design of the myocutaneous flap and the transfer mode in nasal facial defect. Method:Six cases with nasal defects were treated by using lateral or median vascular frontal flap which is nourished by supratrochlear and supraorbital arteries. Three patients with basal cell carcinoma of external nose and three patients with cranial base tumor were hospitalized and underwent surgeries. Result:There were 6 cases in this cohort, with the largest defect being 6.5 cm×3.0 cm and the smallest one being 3.0 cm×2.5 cm in size. Except one patient was missing, the rest of the patients flaps survived, and wounds were healed by first intention. Among 6 patients, 3 patients were treated with lateral forehead flap, 2 patients were treated with median forehead flap, and 1 patient was treated with oblique forehead flap. The follow-up being conducted for 6 months to 12 months, the flaps were normal color and sensation, satisfactory appearance and functional recovery of forehead region. Conclusion:Forearm myocutaneous vessels running more constant, superficial, rich blood supply, easy to dissect and can provide a larger area flap, suitable for different causes of nasal facial defect repair. Large area of flap can be provided. These may be favorable choice for repair of the nasal defects. The tunnel through which the flap was transferred to the defect should be wide enough to avoid flap necrosis because of pedicel flap constriction.

Signals in Stem Cell Differentiation on Fluorapatite-Modified Scaffolds

Previously, we reported that the fluorapatite (FA)-modified polycaprolactone (PCL) nanofiber could be an odontogenic/osteogenic inductive tissue-engineering scaffold by inducing stem cell differentiation and mineralization. The present study aimed to explore which of the signal pathways affected this differentiation and mineralization process. The Human Signal Transduction PathwayFinder RT² Profiler PCR Array was used to analyze the involvement of potential signal transduction pathways during human dental pulp stem cell (DPSCs) osteogenic differentiation induced by FA-modified PCL nanofiber scaffolds. Based on the results, perturbation studies of the signaling pathways hedgehog, insulin, and Wnt were performed. Moreover, the autophagy process was studied, as indicated by the expression of the microtubule-associated protein 1 light chain 3A/B-II (LC3-II) and the cell osteogenic phenotypic changes. In a comparison of the cells grown on PCL + FA scaffolds and those on PCL-only scaffolds, the transcript expression of BMP2, BMP4, FOXA2, PTCH1, WNT1, and WNT2 (PCR array-labeled signal proteins of the hedgehog pathway); CEBPB, FASN, and HK2 (PCR array-labeled signal proteins of the insulin pathway); and CCND1, JUN, MYC, TCF7, and WISP1 (PCR array-labeled signal proteins of the Wnt pathway) doubled at day 14 when obvious cell osteogenic differentiation occurred. Phenotypically, in all the perturbation groups at day 14, ALP activity, OPN, and autophagy marker LC3-II expression were coincidently decreased. Consistently, no positive alizarin red staining or von Kossa staining was observed in the specimens from these perturbation groups at day 28. The results showed that when obvious cell differentiation occurred at day 14 on PCL + FA control groups, the inhibition of the hedgehog, insulin, and Wnt pathways significantly decreased DPSC osteogenic differentiation and mineralization. The osteogenic differentiation of DPSCs grown on FA-modified PCL scaffolds appeared to be positively modulated by the hedgehog, insulin, and Wnt signal pathways, which were coordinated with and/or mediated by the cell autophagy process.

In vitro single-unit recordings reveal increased peripheral nerve conduction velocity by focused pulsed ultrasound

Ultrasound that is widely used in medical diagnosis has drawn growing interests as a noninvasive means of neuromodulation. Focused pulsed ultrasound (FPUS) effectively modulates neural encoding and transmission in the peripheral nervous system (PNS) with unclear mechanism of action, which is further confounded by contradictory experimental outcomes from recordings of compound action potentials (CAP). To address that, we developed a novel in vitro set up to achieve simultaneous single-unit recordings from individual mouse sciatic nerve axon and systematically studied the neuromodulation effects of FPUS on individual axon. Unlike previous CAP recordings, our single-unit recordings afford superior spatial and temporal resolution to reveal the subtle but consistent effects of ultrasonic neuromodulation. Our results indicate that, 1) FPUS did not evoke action potentials directly in mouse sciatic nerve at all the tested intensities (spatial peak temporal average intensity, I_SPTA of 0.91 to 28.2 W/cm²); 2) FPUS increases the nerve conduction velocity (CV) in both fast-conducting A- and slow-conducting C- type axons with effects more pronounced at increased stimulus duration and intensity; and 3) effects of increased CV is reversible and cannot be attributed to the change of local temperature. Our results support existing theories of non-thermal mechanisms underlying ultrasonic neuromodulation with low-intensity FPUS, including NICE, flexoelectricity, and solition models. This work also provides a solid experimental basis to further advance our mechanistic understandings of ultrasonic neuromodulation in the PNS.

Gene-Activated Matrices for Cartilage Defect Reparation

A cartilage defect has a very limited ability to repair itself spontaneously due to the shortage of blood. Many attempts have been made to restore the integrity of cartilage in clinical and experimental studies. Recently, tissue engineering has emerged as a new protocol for lost tissue regeneration. Meanwhile, the defect-repairing environment can be improved by gene therapy methods. Gene-activated matrices (GAM) fabricated with biomaterials and plasmids fill the cartilage defects to restore the integrity of joint surface, facilitating repair cell adhesion and proliferation as well as the synthesis of extracelluar matrix. And they also serve as a local gene delivery system, inducing therapeutic agent expression at the repair site. In the present study, we fabricated two- and three-dimensional matrices from chitosan and gelatin, then added a plasmid DNA encoding transforming growth factors-β1 (TGF-β1) for cartilage defect regeneration. First, we demonstrated primary chondrocytes could maintain their biological characteristics and secrete therapeutic proteins when they were cultured onto GAM in vitro. Subsequently we inserted three-dimensional GAM into cartilage defects of rabbit knee joints. With the results of the new cartilage tissue formation, we came to the conclusion that GAM was helpful for new tissue production and this therapeutic protocol provided a cheap, simple, and effective method for cartilage defect reparation.

Exosomes promote cetuximab resistance via the PTEN/Akt pathway in colon cancer cells

Cetuximab is widely used in patients with metastatic colon cancer expressing wildtype KRAS. However, acquired drug resistance limits its clinical efficacy. Exosomes are nanosized vesicles secreted by various cell types. Tumor cell-derived exosomes participate in many biological processes, including tumor invasion, metastasis, and drug resistance. In this study, exosomes derived from cetuximab-resistant RKO colon cancer cells induced cetuximab resistance in cetuximab-sensitive Caco-2 cells. Meanwhile, exosomes from RKO and Caco-2 cells showed different levels of phosphatase and tensin homolog (PTEN) and phosphor-Akt. Furthermore, reduced PTEN and increased phosphorylated Akt levels were found in Caco-2 cells after exposure to RKO cell-derived exosomes. Moreover, an Akt inhibitor prevented RKO cell-derived exosome-induced drug resistance in Caco-2 cells. These findings provide novel evidence that exosomes derived from cetuximab-resistant cells could induce cetuximab resistance in cetuximab-sensitive cells, by downregulating PTEN and increasing phosphorylated Akt levels.

Characteristics and adsorption study of the activated carbon derived from municipal sewage sludge

Sewage sludge-based activated carbon is proved to be an efficient and low-cost adsorbent in treatment of various industrial wastewaters. The produced carbon had a well-developed pore structure and relatively low Brunauer-Emmett-Teller (BET) surface area. Adsorptive capacity of typical pollutants, i.e. copper Cu(II) and methylene blue (MB) on the carbon was studied. Adsorptions were affected by the initial solution pH, contact time and adsorbent dose. Results showed that adsorption of Cu(II) and MB on the produced carbon could reach equilibrium after 240 min. The average removal rate for Cu(II) on the carbon was high, up to 97% in weak acidic conditions (pH = 4-6) and around 98% for MB in a very wide pH range (pH = 2-12). The adsorption kinetics were well fitted by the pseudo-second order model, and both Langmuir and Freundlich isotherm models could well describe the adsorption process at room temperature. The theoretical maximum adsorption capacities of Cu(II) and MB on sewage sludge-based activated carbon were 114.94 mg/g and 125 mg/g, respectively. Compared with commercial carbon, the sewage sludge-based carbon was more suitable for heavy metal ions' removal than dyes'.

In vitro multichannel single-unit recordings of action potentials from mouse sciatic nerve

Electrode arrays interfacing with peripheral nerves are essential for neuromodulation devices targeting peripheral organs to relieve symptoms. To modulate (i.e., single-unit recording and stimulating) individual peripheral nerve axons remains a technical challenge. Here, we report an in vitro setup to allow simultaneous single-unit recordings from multiple mouse sciatic nerve axons. The sciatic nerve (~30 mm) was harvested and transferred to a tissue chamber, the ~5mm distal end pulled into an adjacent recording chamber filled with paraffin oil. A custom-built multi-wire electrode array was used to interface with split fine nerve filaments. Single-unit action potentials were evoked by electrical stimulation and recorded from 186 axons, of which 49.5% were classed A-type with conduction velocities (CV) greater than 1 m/s and 50.5% were C-type (CV < 1 m/s). The single-unit recordings had no apparent bias towards A- or C-type axons, were robust and repeatable for over 60 minutes, and thus an ideal opportunity to assess different neuromodulation strategies targeting peripheral nerves. For instance, ultrasonic modulation of action potential transmission was assessed using the setup, indicating increased nerve conduction velocity following ultrasound stimulus. This setup can also be used to objectively assess the design of next-generation electrode arrays interfacing with peripheral nerves.

[The 455th case: swollen leg, jaundice and mental disturbance]

A 17-year-old young man with a history of swollen leg and intermittent jaundice was presented to Peking Union Medical College Hospital with acute fever and mental disturbance. He developed deep venous thrombosis, acute myocardial infarction and plantar skin necrosis during the past four years, and was presented with an acute episode of fever, thrombocytopenia, acute kidney injury, acute myocardial infarction, mental disturbance, and obstructive jaundice. Laboratory tests showed schistocytes on peripheral blood smear.High titer of antiphospholipid antibodies was detected.Strikingly, the activity of a disintegrin and metalloprotease with a thrombospondin type 1 motif, member 13 (ADAMTS13)was significantly decreased without the production of inhibitors. Images indicated stenosis of the common bile duct, common hepatic duct, and cystic duct, which caused dilation of bile ducts and the gall bladder. Corticosteroids and anticoagulation therapy were effective at first, but the disease relapsedonce the corticosteroids tapered down. Plasma exchange was administrated for 17 times, which was effective temporarily during this episode. Methylprednisolone pulse therapy, intravenous immunoglobulin, rituximab, anticoagulation therapy, and bile drainage, were all tried but still could not control the disease. The patient's family agreed to withdraw treatment after he developed septic shock.

The assessment of the long-term effects of elective CRT-D of coronary heart disease after PCI

OBJECTIVE

The present study was planned to evaluate the long-term effects of elective cardiac resynchronization therapy devices (CRT-D) of coronary heart disease after percutaneous coronary intervention (PCI).

PATIENTS AND METHODS

We continuously selected 124 patients with chronic stable heart failure to undergo PCI, and were randomly divided into two groups viz. control group with 72 cases and observation group with 52 cases. The control group was given intensive drugs, while the observation group was treated with a combination of intensive drugs with CRT-D. Followed-up for three years and contrasted their effects.

RESULTS

The survival rate of the observation group was significantly higher than that of the control group, and its major adverse cardiac events (MACE) rate was observed to be lower than that of the control group. During the follow-up of the control group, LVEDd, pro-BNP and NYHA increased but LVEF decreased. On the other hand, in the observation group, LVEDd, LVEF, NYHA showed no significant changes, but pro-BNP revealed a significant increase. The physical health, mental health, social health and total score of the observation group were significantly higher than that of the control group.

CONCLUSIONS

Patients with chronic stable heart failure who have CRT-D implant testified after PCI could have significant improvement in long-term survival rate, better quality of life, improved cardiac function and reduction in the occurrence of MACE too.