[Chest hemorrhage after left total pulmonary resection for secondary rifampin-resistant tuberculosis:a case report]

The patient had received five courses of anti-tuberculosis treatment for recurrent tuberculosis. The drug sensitivity test results of the first three courses showed drug-sensitive pulmonary tuberculosis, and the fourth diagnosis was rifampin-resistant tuberculosis (RR-TB), complicated by chronic obstructive pulmonary disease, type Ⅱ respiratory failure, pulmonary heart disease, and heart failure (grade Ⅲ). The patient stopped taking the anti-tuberculosis drugs on his own in the eighth month of receiving the resistant treatment. After admission, the symptoms improved temporarily after receiving oxygen therapy, anti-infection, and anti-tuberculosis treatment. Because of hemoptysis, the patient underwent arterial embolization by catheterization, but a large amount of hemoptysis occurred shortly thereafter. Emergency left total lung resection and gauze packing for hemostasis were performed. After surgery, the patient's vital signs were maintained with mechanical ventilation and vasopressors. Forty-eight hours after surgery, the gauze was removed, and the patient underwent tracheotomy, enteral nutrition, and anti-tuberculosis treatment. After discharge, the patient underwent rehabilitative exercise and anti-resistant tuberculosis therapy. The patient's condition remained stable for more than six months of follow-up.

[Evaluation of uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculous empyema]

Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ² test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ²=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ²=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ²=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.

Local anesthesia with sedation and general anesthesia for the treatment of chronic subdural hematoma: a systematic review and meta-analysis

OBJECTIVE

Drilling and drainage is the main treatment for chronic subdural hematoma (cSDH). However, anesthesia methods also have an important effect on patients' postoperative outcomes. The clinical effect of drainage of cSDH under local anesthesia with sedation (LAS) and general anesthesia (GA) was systematically evaluated.

MATERIALS AND METHODS

A literature study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies that compare LAS and GA for cSDH. The following treatment outcomes were compared between LAS and GA: total duration of surgery, postoperative complications, mortality, recurrence rate, and hospital length of stay (LOS).

RESULTS

Four papers (n = 391, LAS: 196, GA: 195) met the inclusion criteria. Although there was no statistically significant difference between the two groups in mortality (OR: 0.47, 95% CI: 0.06-3.84, p = 0.48; p = 0.2, I2 = 39%), recurrence rate (OR: 0.82, 95% CI: 0.33-2.04, p = 0.66; p = 0.69, I2 = 0%), LOS (ratio of means: 0.86, 95% CI: 0.71-1.05, p = 0.14; p = 0.02, I2 = 75%). The total duration of surgery (MD: -26.71 min, 95% CI: -37.29 to -16.13, p < 0.00001; p = 0.65, I2 = 0%) was significantly shorter and the number of postoperative complications was significantly lower in the LAS group compared with the GA group (OR: 0.25, 95% CI: 0.13-0.50, p < 0.0001; p= 0.62, I2 = 0%).

CONCLUSIONS

A systematic review and meta-analysis of the existing literature showed that LAS reduces the total duration of surgery and postoperative complications compared to GA. No significant difference in mortality, recurrence rate, and LOS was observed between the two groups.

[Investigation of occupational noise exposure and hearing loss among automobile manufacturing workers]

Objective: To investigation the situation of occupational noise exposure and hearing loss among workers in automobile manufacturing enterprise during 2017-2019 in Wuhan. Methods: Workers in automobile manufacturing who underwent physical examination in Wuhan Hospital for the Prevention and Treatment of Occupational Diseases from 2017 to 2019 were included as subjects in the cross-sectional survey. Questionnaire survey, noise detection and pure tone threshold test were used. Excluding individuals with working time less than 3 years and information deficiency, 3 948 individuals were finally included in the study. Results: Among 3 948 workers, 128 workers had hearing loss and the rate of hearing loss was 3.24%, among which 101 workers had high-frequency hearing loss and 27 workers were diagnosed as occupational noise deafness. The prevalence of hearing loss among workers previously exposed to noise was significantly higher than that without prior exposure (12.10%, 0.96%, P<0.05) . The prevalence of hearing loss among workers with occupational noise exposure <80 dB (A) , 80~<85 dB (A) and ≥85 dB (A) was 1.83%, 2.69% and 5.09%, respectively. The prevalence of high frequency hearing loss was 1.60%, 2.05% and 3.71%, respectively. The prevalence of occupational noise deafness was 0.23%, 0.64% and 1.38%, respectively. The prevalence of hearing loss and high frequency hearing loss among workers exposed to different occupational noise was statistically significant (P<0.05) , while the prevalence of occupational noise deafness was not statistically significant (P>0.05) . There were statistically significant differences in the prevalence of hearing loss (2.88%, 4.45%) and occupational noise deafness (0.46%, 1.41%) between those who used protective equipment and those who did not (P<0.05) . Compared with workers exposed to occupational noise <80 dB (A) , workers exposed to occupational noise ≥85 dB (A) had A 3.16-fold increased risk of hearing loss (OR=3.16, 95%CI: 1.44~6.95, P<0.05) . Compared to workers using hearing protective equipment, the risk of hearing loss (OR=1.96, 95%CI: 1.25~3.06, P<0.05) and occupational noise deafness (OR=3.46, 95%CI: 1.51-7.96, P<0.05) significantly increased among those without using hearing protective equipment. Conclusion: The risk of hearing loss in automobile manufacturing workers is significantly associated with occupational noise exposure and the use of hearing protective equipment. Good hearing protection may reduce the risk of occupational noise-induced hearing loss and occupational noise deafness.

[Study on the association between occupational noise exposure and cardiovascular diseases]

Occupational noise is one of the most common occupational hazards in the workplace. Long-term exposure to occupational noise could not only lead to the damage of the hearing system, but also may cause a certain impact on the cardiovascular system. Studies have shown that occupational noise exposure was positively associated with cardiovascular diseases, including hypertension, coronary heart disease and myocardial infarction. However, the results of studies on occupational noise exposure and stroke are still controversial. This paper reviews the relationship between occupational noise exposure and hypertension, coronary heart disease, stroke, myocardial infarction by summarizing the epidemiological data of domestic and foreign population in recent years. Our study could provide evidence for the design and implementation of well-designed epidemiological and mechanism studies, and the recognition of the role of occupational noise exposure in the occurrence and development of cardiovascular diseases, so as to better protect workers' health.

Down-regulation of miR-155 promotes apoptosis of nasopharyngeal carcinoma CNE-1 cells by targeting PI3K/AKT-FOXO3a signaling

OBJECTIVE

Nasopharyngeal carcinoma is one of the common malignant tumors of the ear, nose, and throat in China. Cell apoptosis is expected to be closely related to prognosis. In recent years, with the development of non-coding RNA function research, it is proposed that miRNA plays an important role in the pathogenesis of nasopharyngeal carcinoma. This study aimed to investigate the role of miR-155 in the apoptosis of nasopharyngeal carcinoma cells.

PATIENTS AND METHODS

Cell transfection was performed to knockdown or overexpress the level of miR-155 or knockdown of the level of FOXO3a. The expression of the related protein was detected by immunoblotting. The Real Time quantitative-PCR was used to detect miR-155 expression. Cell proliferation was assessed by MTT assay. The changes of cell apoptosis were observed by flow cytometry using AV-PI staining and TUNEL staining.

RESULTS

The miR-155 inhibitor and mimics were successfully capable of knocking down or overexpressing miR-155 levels. After knocking down miR-155 level, cell proliferation was significantly attenuated, and apoptosis was significantly increased compared with the sham group (p < 0.05). After overexpression of miR-155, opposite results were observed. In addition, in the cells with the knockdown of miR-155 level, further knockdown of FOXO3a level significantly reduced the inhibitory effect of miR-155 on cell apoptosis compared with the control group (p < 0.05).

CONCLUSIONS

In nasopharyngeal carcinoma CNE-1 cell line, miR-155 can inhibit the proliferation and promote apoptosis of nasopharyngeal carcinoma cells by targeting PI3K/AKT-FOXO3a signaling. MiR-155 may be a novel target for the treatment of nasopharyngeal carcinoma.

[CD20-positive T cell lymphoma: clinicopathological features of five cases]

Objective: To investigate the clinicopathological characteristics of the T cell lymphomas with CD20 expression, and to better understand this rare entity. Methods: Two-hundred cases of T-cell lymphoma diagnosed in the Department of Pathology of the Affiliated Hospital of Qingdao University from November 2016 to February 2020 were examined, and 5 cases of CD20-positive T-cell lymphomas were identified and included. Combined with clinical data and review of the literature, the clinicopathological characteristics of the disease were analyzed. Results: The five patients were all male, and had an average age of 56 years (range, 47 to 64 years). There were 2 cases of monomorphic epitheliotropic intestinal T-cell lymphoma, 2 cases of mycosis fungoides (1 case was plaque stage and the other was tumor stage) and 1 case of indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. Immunohistochemistry showed that all 5 cases expressed multiple T cell markers (CD3/CD4/CD5/CD7/CD8) and only one of B cell markers (CD20). Three of the 5 cases were negative for CD20 at the first diagnosis, while CD20 was diffusely positive on the second biopsy from the recurrence or progression of the disease, without expression of CD79a or PAX5. Epstein-Barr encoding region (EBER) in situ hybridization was negative in all 5 cases. T-cell receptor gene analysis showed monoclonal rearrangement of β or/and δ chains;Ig rearrangements were all polyclonal. None of the five patients were treated with rituximab, and 4 patients survived with disease and 1 patient survived without disease at the end of follow-up. Among them, the patient with mycosis fungoides at the cancerous stage has progressed rapidly and had poor quality of life. Conclusions: CD20-positive T-cell lymphoma is extremely rare. Its prognosis is closely related to the type of T-cell lymphoma, clinical stage and initial therapeutic effect. However, the expression of CD20 indicates the recurrence or progression of the disease, and the prognosis is relatively poor. When CD3 expression is absent in T-cell lymphoma, it is easy to be misdiagnosed as B-cell lymphoma. The combination of multiple immunohistochemical antibodies and molecular detection can improve the accuracy of diagnosis.

Analysis of Scores of SCL-90 of Patients with Traumatic Subdural Effusion

Abstract

Objective To investigate the factors affecting changes of Symptom Check List-90 （SCL-90） of patients with traumatic subdural effusion. Methods One hundred and forty-two cases of patients with traumatic subdural effusion from the Center of Forensic Identification, Wannan Medical College collected from 2007-2018 were tested with SCL-90. The differences between SCL-90 results and the national norm and the influences of gender, age, education level, the number of effusion sites and location on SCL-90 results were analyzed. Results The differences between the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis factors and total mean scores in SCL-90 of traumatic subdural effusion and that of the national norm had statistical significance （P<0.05）. The differences in depression and hostility factor scores between males and females had statistical significance （P<0.05）. The differences in compulsion, anxiety and terror factor scores and total mean scores among different age groups had statistical significance （P<0.05）. The differences in hostility, paranoia and psychosis factors among patients with different degrees of education had statistical significance （P<0.05）. The differences in depression, anxiety, hostility and terror factor scores and total mean scores among single-site group, double-site group and multi-site group had statistical significance （P<0.05）. The differences in somatization, depression and anxiety factor scores and total mean scores between the right cerebral hemisphere group and the left cerebral hemisphere group and bilateral hemisphere group had statistical significance （P<0.05）. Conclusion Traumatic subdural effusion can cause certain psychological changes, which are related to the primary trauma of arachnoid tear as well as the number and location of effusion sites. Attention should be paid to the influence of the above factors during the assessment of psychological symptoms.

[Hypoxia-inducible factor-1α is involved in arsenite-induced epithelial-mesenchymal transition and malignant transformation of human liver epithelial cells via regulating Snail]

Objective: To investigate the role of hypoxia-inducible factor-1α (HIF-1α) in arsenite-induced epithelial-mesenchymal transition (EMT) and malignant transformation of human liver epithelial cells (L-02 cells). Methods: After the L-02 cells were chronic treated with 2.0 μmol/L NaAsO(2) for 0 (reference), 10, 20, or 30 passages, con siRNA or HIF-1α siRNA was transfected into arsenite-transformed L-02 (T-L-02) cells by lipofectamine(TM)2000 and were set as T-L-02+con siRNA group and T-L-02+HIF-1α siRNA group as well as L-02 group and T-L-02 group, EMT index and levels of HIF-1α were detected by western blots. The reporter assays were performed to determine if HIF-1α directly regulate Snail transcriptional activity, and soft agar colony formation and Transwell assay were used to detect the malignancy, invasion, and migration ability of cells. Results: When L-02 cells were treated for 10 generations with 2 μmol/L NaAsO(2), relative expressions of E-cadherin were gradually increased compared to control cells, while the levels of N-cadherin, Snail, and HIF-1α were gradually increased in the L-02 cells compared to control cells, showing the longer the treatment time was, the more obvious the change was (P<0.05) . Down regulating the level of HIF-1α by siNRA caused E-cadherin levels to rise compared to T-L-02 group, while the levels of N-cadherin and Snail fall back compared to T-L-02 group (P<0.05) . Double luciferase reporter gene assays showed that HIF-1α directly targeted Snail to regulate its expression. Soft agar colony formation and Transwell assays showed that the numbers of formed colonies, invasion cells, and metastasis cells of cells in T-L-02 group were all lower than those in L-02 group (P<0.05) . Conclusion: HIF-1α is involved in arsenite-induced EMT and malignant transformation of human liver epithelial cells via regulating Snail.

[Diagnosis value with Xpert Mtb/RIF assay for cervical tuberculous lymphadenitis]

Objective:To evaluate the accuracy of Xpert MTB/RIF assay in the diagnosis of cervical tuberculous lymphadenitis.Method:A total of 160 patients with cervical lymph node tuberculosis confirmed by pathology in Wuhan Pulmonary Hospital between January 2015 and June 2016 were enrolled. Cervical lymph node biopsy tissue specimens from these patients were collected and tested with acid-fast bacilli smear, TB-DNA assays, culture, and Xpert Mtb/RIF, respectively. The results were analyzed using SPSS 17.0 statistical software.Result:Using pathological diagnosis as the standard, the sensitivity of acid-fast bacilli smear was 8.12%(13/160), the sensitivity of TB-DNA assay was 69.38%(111/160), the sensitivity of culture was 31.88%(51/160), and the sensitivity of Xpert Mtb/RIF was 74.38%(119/160). The detection rate of multidrug-resistant lymphoid tuberculosis using a combination of Xpert Mtb/RIF, line probe assay (LPA), and culture methods was 9.38%(15/160).Conclusion:Xpert Mtb/RIF can rapidly detect cervical lymph node tuberculosis and assess rifampicin resistance. TB-DNA assay exhibited similar sensitivity as compared to Xpert Mtb/RIF and can detect both isoniazid and rifampicin resistant genes through LPA.These two methods are more effective than the traditional culture and smear methods.

[Influence of coke oven emissions on workers' blood pressure and electrocardiographic findings]

Objective: To investigate the influence of coke oven emissions on workers' blood pressure and electrocardiographic findings, and to provide a basis for the prevention and treatment of cardiovascular diseases. Methods: The concentration of coke oven emissions at the bottom, side, and top of coke ovens was determined in a coking plant. A total of 406 coke oven workers were enrolled as exposure group and 201 office staff members were enrolled as control group. Blood pressure and electrocardiographic findings were compared between the two groups, and the multivariate logistic regression analysis was performed to analyze the influencing factors for hypertension and abnormal electrocardiographic findings. Results: The concentration of coke oven emissions was the highest at the top of coke ovens, followed by the side and bottom of coke ovens, and there was a significant difference between the exposure group and the control group (P<0.01). The exposure group had significantly higher detection rates of hypertension, abnormal electrocardiographic findings, and abnormal chest X-ray findings than the control group (P<0.05). The logistic regression analysis showed that high concentration of coke oven emission and age were risk factors for hypertension and abnormal electrocardiographic findings (P<0.05). The workers exposed to high-concentration coke oven emissions were more likely to experience hypertension and abnormal electrocardiographic findings than those exposed to low-concentration coke oven emissions (OR=1.7 and 1.9). Conclusion: Besides lung injury, coke oven emissions also have adverse effects on the cardiovascular system. Therefore, more effective measures are needed to protect the health of coke oven workers.

PI3K, AKT, and P-AKT levels in thin endometrium

The aim of this study was to explore the expression of PI3K, AKT, and P-AKT, and to investigate the role of PI3K/AKT signaling pathway in thin endometrium. We included 40 women treated in affiliated Shenzhen Nanshan People's Hospital of Guangdong Medical University for endometrial conditions between August 2013 and January 2015, 20 with a normal endometrium, and 20 with thin endometrium. The expression of PI3K, AKT, and P-AKT was evaluated by the immunohistochemical S-P method. The expression of PI3K, AKT, and P-AKT proteins was significantly lower in the thin endometrium group than in the normal endometrium group (P < 0.05). The expression of PI3K and AKT was positively correlated with the expression of P-AKT. The expression of PI3K, AKT, and P-AKT proteins in the thin endometrium decreases during the proliferative phase, and this process could be associated with PI3K/AKT signaling.

Clinical analysis of 95 cases with ovarian pregnancy

BACKGROUND

Ovarian pregnancy (OP) is a rare ectopic pregnancy, in which it is very difficult to achieve preoperative diagnosis. Ovarian blood supply in OP increases which will lead to intra-abdominal bleeding, hazarding women's lives. Surgical exploration should be conducted once cases of OP are suspected.

OBJECTIVE

To investigate clinical characteristics, diagnosis, and therapy of OP.

MATERIALS AND METHODS

A retrospective study was conducted in 95 patients with OP admitted to the present hospital from January 2005 to June 2014.

RESULTS

OP accounted for 1.79% of ectopic pregnancy over the same period, of which 68.4% had a history of artificial abortion, 6.3% was treated with intrauterine contraceptive device (IUD), 87.4% had abdominal pain, 84.2% had a history of menopause, and 51.6% had vaginal bleeding. All patients had no preoperative diagnosis and underwent laparoscopic wedge resection of ovary or lesionectomy and were all were cured.

CONCLUSION

Since the cause of OP is still unknown and it has no typical clinical manifestations, the present authors adopt blood P-hCG combined with B-ultrasound to improve the preoperative diagnosis. They prefer laparoscopic wedge resection of ovary or lesionectomy, which induce higher rate of intrauterine pregnancy and lower rates of ectopic pregnancy and infertility in re-pregnancy after surgery.

Abundance and diversity of methanogens: potential role in high arsenic groundwater in Hetao Plain of Inner Mongolia, China

To investigate the community diversity and abundance of methanogens and their potential role in high arsenic groundwater, 17 groundwater samples from Hetao Plain of Inner Mongolia were investigated with an integrated method including 16S rRNA gene clone library, quantitative polymerase chain reaction and geochemistry analyses. Total arsenic (AsTot) concentrations were 82.7-1088.7 μg/L and arsenite (AsIII) mostly dominated in these samples with percentages of 0.04-0.79. CH₄ concentrations ranged from 0.01 to 292 μg/L and distinctly elevated only when AsTot were relatively high and SO₄(2-) were distinctly low. Principal component analysis indicated that these samples were divided into three groups according to the variations of AsTot, CH₄ and SO₄(2-). AsTot concentrations were distinctly high in the group with high CH₄ and low SO₄(2-) comparing to the other two groups (one with high CH₄ and high SO₄(2-), the other with low CH₄ and SO₄(2-)). The mcrA gene (methyl coenzyme-M reductase gene) based phylogenetic analysis of methanogens population showed that methanogenic archaea was diverse but mainly composed of Methanomicrobiales, Methanosarcinales, Methanobacteria and unidentified groups, with Methanomicrobiales being distinctly dominant (50.6%). The mcrA gene abundance in high arsenic groundwater ranged from 3.01 × 10(3) to 3.80 × 10(6)copies/L and accounted for 0-30.2% of total archaeal 16S rRNA genes. The abundance of mcrA genes was positively correlated with the concentrations of AsTot (R=0.59), AsIII (R=0.57) and FeII (R=0.79), while it was negatively correlated with oxidation-reduction potential (R=-0.66) and SO₄(2-) concentration (R=-0.64). These results implied that methanogenic archaea might accelerate As release in groundwater aquifers in Hetao Plain.

Neuroprotective effects of LBP on brain ischemic reperfusion neurodegeneration

AIM

The present study was conducted to investigate whether LBP had a protective effect on cerebral ischemic reperfusion injury and to determine the possible mechanisms.

MATERIALS AND METHODS

Male Kunming (KM) mice were used to make the model cerebral artery occlusion/reperfusion (MCAO/R). The behavioral test was used to measure neurological deficit scores for evaluation of ischemic reperfusion damage of brain. The change of electroencephalograph (EEG) was monitored by Model SMUP-E Bio-electric Signals Processing System. The infarction area of brain was assessed in brain slices with 2% solution of 2,3,5-triphenyl tetrazolium chloride (TTC). Spectrophotometric assay was used to determine the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and lactate dehydrogenase (LDH), contents of malondialdehyde (MDA) and adenosine triphosphate (ATP) of the brain.

RESULTS

The results showed that LBP at doses of 20 and 40 mg/kg markedly decreased the neurological deficit scores and the infarction area in MCAO/R mice. At the same time, LBP significantly decreased MDA content, and increased SOD, GSH-Px, CAT, LDH activities in ischemic reperfusion brain.

CONCLUSIONS

These suggest that LBP might act as a potential neuroprotective agent against the cerebral reperfusion-induced injury in the brain through reducing lipid peroxides, scavenging free radicals, and improving the energy metabolism.

Keratin-9 gene mutation in epidermolytic palmoplantar keratoderma combined with knuckle pads in a large Chinese family

Epidermolytic plamoplantar keratoderma (EPPK) is an autosomal dominant inherited disease. It caused by mutations in the highly conserved coil 1A domain of the keratin 9 gene, KRT9. We studied a four-generation family with EPPK combined with knuckle pads from Jiangsu province, China. In this study, a heterozygous nucleotide T-->C transition at position 500 in exon 1 of KRT9 was detected, which resulted in a leucine to serine (L167S) change. We describe this mutation in a Chinese pedigree with EPPK with knuckle pads for the first time, demonstrating the prevalence of this mutation in diverse population.

Efficacy assessment of phenobarbital in epilepsy: a large community-based intervention trial in rural China

BACKGROUND

Many people with epilepsy need not experience further seizures if the diagnosis and treatment are correct. Most epilepsy patients have convulsions, which are usually fairly easy to diagnose. This study tested a model for treatment of people with convulsive forms of epilepsy at primary health-care level in rural areas of China.

METHODS

Patients with convulsive epilepsy were identified at primary care level and provided with phenobarbital monotherapy. Local physicians, who were provided with special training, carried out screening, treatment, and follow-up. A local neurologist confirmed the diagnoses. Efficacy was assessed from the percentage reduction in seizure frequency from baseline and the retention of patients on treatment.

FINDINGS

The study enrolled 2455 patients. In 68% of patients who completed 12 months' treatment, seizure frequency was decreased by at least 50%, and a third of patients were seizure free. 72% of patients who completed 24 months' treatment had reduction of seizure frequency of at least 50% and a quarter of patients remained seizure free. Probability of retention was 0.84 at 1 year, and 0.76 at 2 years. Medication was well tolerated and reported adverse events were mild; only 32 patients (1%) discontinued medication because of side-effects.

INTERPRETATION

This pragmatic study confirmed that this simple protocol was suitable for the treatment of convulsive forms of epilepsy in rural areas of China. Physicians with basic training could treat epilepsy patients with phenobarbital, with beneficial effects for most patients with convulsive seizures. Few cognitive or behavioural adverse events were noted, but formal psychometric testing was not done.

The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study

The authors carried out a door-to-door survey to determine the prevalence of epilepsy among 55,000 people in China. The lifetime prevalence was 7.0/1000, and 41% of all persons had never received appropriate treatment. The prevalence of active epilepsy was 4.6/1000, and 63% of people with active epilepsy had not received antiepileptic treatment in the week before the survey. Figures for the prevalence and the treatment gap were significantly higher than previous estimates.

Longitudinal study of blood pressure and stroke in over 37,000 People in China

As part of a longitudinal study performed in urban China, 37,655 subjects were evaluated for stroke risk factors, including having their blood pressure measured in a standard fashion. The cohort was followed for 3.5 years during which time 427 subjects experienced incident strokes--221 ischemic, 203 hemorrhagic, and 3 undefined. Both systolic and diastolic blood pressure were significantly related to risk of stroke and stroke type. Associations were stronger for systolic than diastolic blood pressure. These results emphasize the importance of systolic blood pressure, as opposed to diastolic, as a risk factor for stroke. In this study, the risk of stroke is increased by about 25% with each 10 mm Hg increase in systolic blood pressure.

[Cloning and expression of TPS1 gene in Escherichia coli]

A S. cerevisiae TPS1 gene for trehalose-6-phosphate synthase was cloned by PCR amplification. The 1.5 kb DNA fragment was ligated to pUC19 and transformed into otsA deficient and deleted of E. coli strains FF4169 and FF4050 separately. otsA gene is encoding trehalose-6-phasphate synthase in E. coli. Restriction endonucleases digestion analysis of transformants' plasmid DNA showed that there was a cloned 1.5 kb fragment carried on the vector. The growth curve experiment result showed that the both transformants could grow well as wild type. Trehalose was synthesized and accumulated in these transformants during high osmotic stress by HPLC combined with ELSD (Evaporate light scatter detector) determination. From the result above, we could conclude that the TPS1 gene of S. cerevisiae was able to restore otsA gene function in E. coli for both osmotolerance and trehalose accumulation during salt stress.

[Isolation and characterization of PAOX2 mutant in Pichia pastoris]

Spontaneous Mut+ mutants of P. pastoris AOX1-defective expression strain have been isolated, they were identified as phenotypically utilized methanol to grow as wild type. The results obtained from measuring growth curve when cultivated in medium in which methanol as a sole carbon source and detecting HSA protein on SDS-PAGE confirmed that the mutants have increased ability to utilize methanol and express foreign HSA gene product. The promoter region of AOX2 gene from the mutants has been cloned by PCR amplification, and the DNA fragment is 1022bp in size. Sequencing analysis showed that there are two point mutations at positions of -529 and -255 from the translation initiation codon respectively. The mutations improved AOX-1 defective function and facilitate the foreign gene for higher expression.

[Cloning and expression of trehalose synthase genes in Escherchia coli]

Escherichia coli trehalose synthase otsBA genes have been cloned by using transposon Mu in vivo. The cloning frequency was 1.45 x 10(-3)/Kanr transductant. Genetic complements, endonuclase digestion and partial nucleotide sequencing analysis of these clones indicated that otsBA gene was on plasmid Mud5005. Subcloning 2.87 kb DNA fragment onto expression plasmids with higher or lower copy number and transforming into E. coli recipient strain FF4050, which have otsBA genes deleted respectively, the transformed strains obtained ability of growth on medium containing 0.5 mol/L NaCl and increased trehalose synthesis under high osmotic pressure. Production and accumulation of trehalose may play an important role in crop breeding. These studies will lay an important foundation for constructing an expression vector with the otsBA genes and transformation to tobacco mediated by Agrobacterium, and obtaining ability for drought resistance and high osmotic pressure tolerance.

Relative contribution of LFA-1 and Mac-1 to neutrophil adhesion and migration

To differentiate the unique and overlapping functions of LFA-1 and Mac-1, LFA-1-deficient mice were developed by targeted homologous recombination in embryonic stem cells, and neutrophil function was compared in vitro and in vivo with Mac-1-deficient, CD18-deficient, and wild-type mice. LFA-1-deficient mice exhibit leukocytosis but do not develop spontaneous infections, in contrast to CD18-deficient mice. After zymosan-activated serum stimulation, LFA-1-deficient neutrophils demonstrated activation, evidenced by up-regulation of surface Mac-1, but did not show increased adhesion to purified ICAM-1 or endothelial cells, similar to CD18-deficient neutrophils. Adhesion of Mac-1-deficient neutrophils significantly increased with stimulation, although adhesion was lower than for wild-type neutrophils. Evaluation of the strength of adhesion through LFA-1, Mac-1, and CD18 indicated a marked reduction in firm attachment, with increasing shear stress in LFA-1-deficient neutrophils, similar to CD18-deficient neutrophils, and only a modest reduction in Mac-1-deficient neutrophils. Leukocyte influx in a subcutaneous air pouch in response to TNF-alpha was reduced by 67% and 59% in LFA-1- and CD18-deficient mice but increased by 198% in Mac-1-deficient mice. Genetic deficiencies demonstrate that both LFA-1 and Mac-1 contribute to adhesion of neutrophils to endothelial cells and ICAM-1, but adhesion through LFA-1 overshadows the contribution from Mac-1. Neutrophil extravasation in response to TNF-alpha in LFA-1-deficient mice dramatically decreased, whereas neutrophil extravasation in Mac-1-deficient mice markedly increased.

Investigation of dopamine system genes in obsessive-compulsive disorder

Evidence from anatomical, pharmacological, and animal studies on the involvement of the dopamine system in obsessive-compulsive disorder (OCD) is mounting. This, along with evidence for a genetic diathesis provided by family and twin studies, prompted us to conduct genetic association studies of dopamine system genes in OCD. We genotyped OCD patients (n > 100) and matched controls for four loci: (1) a 40-base-pair repeat in the dopamine transporter gene; (2) the TaqIA polymorphism and the serine/cysteine variation in the D2 dopamine receptor gene; (3) an MscI polymorphism in the D3 dopamine receptor gene; and (4) a 48-base-pair repeat in the D4 dopamine receptor gene. Significant differences in allele frequencies were found between patients and controls for the D4 receptor gene, although replication is required with family-based controls before any conclusions can be entertained. This study represents the first comprehensive assessment of the roles of dopamine system genes in OCD.

No association between c-fos gene polymorphisms and sporadic Alzheimer's disease

Although ApoE epsilon 4 is a major risk factor for sporadic Alzheimer's disease (AD), 20-30% of sporadic AD patients do not have this allele. This indicates that other risk factors are involved in the pathogenesis of sporadic AD. Studies of the genetic association between AD and polymorphisms in the c-fos gene, a candidate gene for AD, were conducted. The polymorphisms of DsaI in exon 2 and Sau3 AI in intron 2 were examined in 89 patients diagnosed as sporadic cases of probable AD clinically and radiologically according to the NINCDS-ADRDA criteria. This was also undertaken in 96 controls. There was no significant difference between the groups in allele frequencies or genotype counts. Although c-fos gene as a locus conferring susceptibility to sporadic AD cannot be ruled out, these data could not support the hypothesis that a c-fos allele should be another risk factor for sporadic AD.

Screening for mutations at codon 717 of the amyloid precursor protein gene in Alzheimer's disease

Three kinds of missense mutation at codon 717 of amyloid precursor protein (APP) gene (Val --> Ile; Val --> Gly; Val --> Phe) were screened in 114 patients with familial and sporadic Alzheimer's disease (AD), using a rapid testing method for each Val --> Gly and Val --> Phe mutation and Goate's method for Val --> Ile mutation based on the polymerase chain reaction. Mutations were not found in the subjects, confirming earlier suggestions that these three mutations at codon 717 of APP gene account for only a small proportion of cases of not only familial AD but also sporadic AD.

The social course of epilepsy: chronic illness as social experience in interior China

Findings are reported from a collaborative research project on the experience of epilepsy and treatment among patients and family members in Shanxi and Ningxia Provinces in China. Family, marriage, financial and moral consequences of the social experience of epilepsy support the conceptualization of chronic illness as possessing a social course. Beyond traditional concern with stigma, application of concepts of delegitimation, sociosomatic processes, coping as resistance, contestation in the evaluation of efficacy and compliance, and the cultural ontology of suffering illustrate other ways that social theory is useful in research on chronic illness and disability.

No allelic association between Parkinson's disease and dopamine D2, D3, and D4 receptor gene polymorphisms

Parkinson's disease is thought to be caused by a combination of unknown environmental, genetic, and degenerative factors. Evidence from necropsy brain samples and pharmacokinetics suggests involvement of dopamine receptors in the pathogenesis or pathophysiology of Parkinson's disease. Genetic association studies between Parkinson's disease and dopamine D2, D3 and D4 receptor gene polymorphisms were conducted. The polymorphism was examined in 71 patients with Parkinson's disease and 90 controls. There were no significant differences between two groups in allele frequencies at the D2, D3, and D4 dopamine receptor loci. Our findings do not support the hypothesis that susceptibility to Parkinson's disease is associated with the dopamine receptor polymorphisms examined.

HLA-DR types in Japanese schizophrenics: analysis by group-specific PCR amplification

An association of HLA-DR8 and DR1 with DSM-III schizophrenia has been reported in Japan (Miyanaga et al. (1984) Biol. Psychiatr. 19, 121-129). To further investigate this preliminary finding, we compared HLA-DR types in 44 unrelated Japanese schizophrenics (DSM-III-R) with those in 51 unrelated, healthy Japanese volunteers. Group-specific PCR amplification was used in the determination of HLA-DR in the patients. No significant difference was observed in the frequency of any DR types between patients and controls, after statistical correction for multiple testing. However, the frequency of DR1 in our patients (23%) and controls (10%) was almost the same as those in the previous report (22% vs. 10%), which means that there is a suggestive trend which could become significant if numbers were larger. It is argued that an exact determination of HLA-DR by DNA typing is important in current HLA studies of schizophrenia.

Murine VCAM-1. Molecular cloning, mapping, and analysis of a truncated form

Vascular cell adhesion molecule-1 (VCAM-1) is a member of the Ig superfamily that shows increased expression in a number of pathologic conditions. The role of VCAM-1 in human disease remains undefined and murine models are being extensively studied to help define the importance of VCAM-1 in inflammatory disorders. We have cloned and characterized the murine Vcam1 gene including 3 kb of 5'-flanking sequences and mapped the gene to chromosome 3 near Amy1. cDNA clones isolated from a stimulated hepatic library were found to encode a truncated form of VCAM-1 (T-VCAM-1) which contains Ig domains 1 through 3 and has a unique alternative carboxyl terminus. This form arises by alternative splicing. High level expression of T-VCAM-1 in transfected L cells was sufficient to support adhesion of lymphocytes, and this adhesion was blocked by Abs to VCAM-1. Treatment of transfected COS cells with phospholipase C led to reduced levels of T-VCAM-1 on the cell surface consistent with glycosylphosphatidylinositol linkage. Northern blot analysis showed that mRNA for T-VCAM-1 is inducible in multiple tissues after stimulation with endotoxin. Both forms of VCAM-1 were expressed in cultured endothelial, fibroblast, and aortic smooth muscle cells, whereas neither form was observed in monocyte- and lymphocyte-derived lines. Differential regulation of both forms of VCAM-1 was observed in the three different cell types that are present in the vessel wall. Thus, expression of VCAM-1 is restricted and controlled at the level of transcription and by alternative splicing.

No evidence of linkage or allelic association of schizophrenia with DNA markers at pericentric region of chromosome 9

Based on our previous study suggesting the pericentric region of chromosome 9 as of potential importance in schizophrenia, we have carried out a linkage study between the schizophrenia phenotype and the dinucleotide repeat polymorphisms D9S55, D9S15, and D9S202 in three pedigrees multiply affected with schizophrenia. In addition, we have conducted allelic association studies using 60 patients with schizophrenia and 60 controls with polymorphisms at D9S55 and D9S15 markers. No evidence for linkage or association was found. The results indicate that susceptibility genes for schizophrenia are less likely to be located at the pericentric region of chromosome 9, assuming genetic homogeneity of the pedigrees.

Murine VCAM-1. Molecular cloning, mapping, and analysis of a truncated form

Vascular cell adhesion molecule-1 (VCAM-1) is a member of the Ig superfamily that shows increased expression in a number of pathologic conditions. The role of VCAM-1 in human disease remains undefined and murine models are being extensively studied to help define the importance of VCAM-1 in inflammatory disorders. We have cloned and characterized the murine Vcam1 gene including 3 kb of 5'-flanking sequences and mapped the gene to chromosome 3 near Amy1. cDNA clones isolated from a stimulated hepatic library were found to encode a truncated form of VCAM-1 (T-VCAM-1) which contains Ig domains 1 through 3 and has a unique alternative carboxyl terminus. This form arises by alternative splicing. High level expression of T-VCAM-1 in transfected L cells was sufficient to support adhesion of lymphocytes, and this adhesion was blocked by Abs to VCAM-1. Treatment of transfected COS cells with phospholipase C led to reduced levels of T-VCAM-1 on the cell surface consistent with glycosylphosphatidylinositol linkage. Northern blot analysis showed that mRNA for T-VCAM-1 is inducible in multiple tissues after stimulation with endotoxin. Both forms of VCAM-1 were expressed in cultured endothelial, fibroblast, and aortic smooth muscle cells, whereas neither form was observed in monocyte- and lymphocyte-derived lines. Differential regulation of both forms of VCAM-1 was observed in the three different cell types that are present in the vessel wall. Thus, expression of VCAM-1 is restricted and controlled at the level of transcription and by alternative splicing.

Further evidence of no linkage between schizophrenia and the dopamine D3 receptor gene locus

The dopamine hypothesis of schizophrenia proposed that dopaminergic pathways are involved in the etiology of the disease. In particular, interest among psychiatrists has focused on the D2 receptor because of its affinity to antipsychotic drugs. Recently a new dopamine receptor gene has been cloned, and named the dopamine D3 receptor. The D3 receptor is a potential site for antipsychotic drug action and may be involved in the pathophysiology of schizophrenia. We have carried out a linkage study between the susceptibility gene for schizophrenia and polymorphism of the dopamine D3 receptor gene in two Japanese pedigrees. The LOD scores were negative for all genetic models and for all affective status at a recombination fraction theta = 0. Linkage of DRD3 has been excluded for the model 1 (dominant model) and the model 3 (recessive model). The LOD score was -3.43 at theta = 0 for model 1 (dominant model) and broad definition of affected status. These results were consistent with previous studies.

Mismatch PCR RFLP detection of DRD2 Ser311Cys polymorphism and schizophrenia

We tested 100 schizophrenics and 100 controls to find association at the Serine311 Cysteine polymorphism of dopamine D2 receptor in Japanese population. There were no significant differences between the two groups. One homozygote for Cys311 was confirmed in the controls by mismatch-polymerase chain reaction and restriction fragment length of polymorphism (PCR-RFLP) analysis. None with Cys was detected among 61 individuals of nine multiply affected families with schizophrenia. Our data thus provide strong evidence against an etiological association between schizophrenia and the Ser311Cys variant. The polymerase chain reaction amplification of specific alleles (PASA) analysis was compared with the mismatch PCR-RFLP typing, revealing that the latter is more reliable than the former.

Association of apolipoprotein E4 with sporadic Alzheimer's disease is more pronounced in early onset type

Apolipoprotein E genotypes in 88 unrelated Japanese patients with NINCDS-ADRDA sporadic Alzheimer's disease (AD) were examined and compared with those of 93 healthy controls. Frequency of epsilon 4 allele was increased in patients with AD (31%) compared with controls (10%), as was reported previously. Individuals homozygous or heterozygous for the allele epsilon 4 had a 5.9-fold increased risk of AD. This tendency was more pronounced in early onset sporadic (= non-familial) type than late onset type. The relative risk was also greater for early onset type (RR = 11.7; 95% CI, 4.9-28.3) than late onset type (RR = 4.3; 95% CI, 2.1-8.8). Moreover, patients with homozygote for the allele epsilon 4 had a 14.7-fold increased risk of early onset sporadic AD (P < 0.005, chi 2 = 9.0, df = 1, 95% CI, 2.5-85.1). Our findings indicated that association of apolipoprotein epsilon 4 with sporadic Alzheimer's disease is more pronounced in early onset type than in late onset type.

Neurotrophin-3 gene polymorphism associated with schizophrenia

The recent possible neurodevelopmental etiology of schizophrenia makes the neurotrophin-3 (NT-3) gene an interesting candidate locus. We studied the allelic distributions of dinucleotide repeat polymorphism at the NT-3 gene locus in 70 patients with schizophrenia and in 70 controls. A highly significant difference between the two groups was observed at the allele A3. Even Bonferroni's correction was used, the difference was still significant. Individuals with homozygous or heterozygous for the allele A3 had a 2.4-fold increased risk of schizophrenia. Determination of NT-3 genotype may help to identify those at greater risk of schizophrenia. Furthermore, this finding supports evidence implicating neurodevelopmental deficit in the pathogenesis of this disorder.

Linkage studies between affective disorder and dopamine D2, D3, and D4 receptor gene loci in four Japanese pedigrees

Dopamine antagonists are effective in the treatment of episodes of acute mania. Conversely, drugs which increase dopamine activity can induce a switch to mania. Therefore, disturbances in dopamine transmission and dopamine receptors might be implicated in the pathophysiology of bipolar affective disorder. We have carried out linkage studies between the susceptibility gene for effective disorder and polymorphisms of dopamine DRD2, DRD3, and DRD4 receptor genes in four Japanese pedigrees. Linkages of both DRD2 and DRD3 have been excluded, at least for dominant and intermediate models. The result for DRD2 was consistent with previous studies. For DRD3 this is the first exclusion of affective disorder from this locus in the 3q13.3 where DRD3 has been localized. On the other hand, our data could not exclude linkage of DRD4.

Sex differences on the Chinese standardization sample of the WAIS-R

The Wechsler Adult Intelligence Scale-Revised (WAIS-R) has been adapted with minor revisions for use in China and standardized on a sample of 179 adults. Sex differences on the subtests are similar to those in the United States, with women obtaining higher means on the Digit Symbol subtest and men obtaining higher means on the Information and Arithmetic subtests. Men obtained higher verbal, performance, and full-scale IQs in China. The factor structure of the Chinese WAIS-R also is similar to those obtained on the Wechsler tests in the United States and Scotland.

A study of the association between schizophrenia and the dopamine D3 receptor gene

A study of the genetic association between schizophrenia and a BalI polymorphism in exon 1 of the dopamine D3 (DRD3) gene, a candidate gene for schizophrenia, was conducted. The polymorphism was examined in 91 patients whose symptoms satisfied DSM-III-R for schizophrenia and 90 controls. There were no significant differences between the groups in allele frequencies or genotype counts. Contrary to a previous report, the patients were no more likely to be homozygous than controls. Moreover, no association with the presence of illness could be demonstrated when the patients were grouped according to sex, age of onset, history of admission to psychiatric institutions or positive family history.

Characterization of the murine Icam-1 gene

Intercellular adhesion molecule-1 (ICAM-1, CD54) is a cell adhesion molecule that interacts with the leukocyte beta 2 integrins, LFA-1 and Mac-1. Murine inflammatory models are being utilized increasingly to define the role that ICAM-1 induction plays in the initiation of inflammation. We have isolated murine genomic clones that contain the Icam-1 gene including over 2 kb of 5' flanking sequence. The gene for murine Icam-1 spans over 13 kb and is composed of seven exons and six introns. Each of the extracellular immunoglobulin-like domains of ICAM-1 is encoded by a single exon that ends with the first base of the next codon. Examination of ICAM-1 expression in vivo shows that mRNA levels of ICAM-1 are low in all organs except for the lung but increase markedly in multiple organs at 3 h after administration of endotoxin. The 5' flanking region of the murine gene contains a putative TATA box and potential SP-1, AP-1, and AP-3 sites in positions nearly identical to those in the human gene.

Factor analysis of the mainland Chinese version of the Wechsler Adult Intelligence Scale (WAIS-RC) in a brain-damaged sample

We factor analyzed the Chinese revision of the Wechsler Adult Intelligence Scale (WAIS-RC) in a sample of 59 individuals with medically diagnosed brain damage. The Chinese subjects consisted of 42 males and 17 females with means for Verbal. Performance, and Full Scale IQ of 83.88 (SD = 22.11), 75.49 (SD = 20.63), and 78.42 (SD = 21.97), respectively. Clear support was found for a general intelligence factor (g) and the Full Scale IQ. Similarly, the two-factor solution provided support for Wechsler's (1981) Verbal and Performance IQ designations. The three-factor solution revealed the familiar Verbal-Comprehension and Perceptual-Organization factors. However, the Freedom From Distractibility factor was less clearly defined. Comparisons of Chinese and American factor structures for neurologically impaired persons demonstrated high coefficients of congruence, ranging from .93 to .98. Overall, the findings demonstrated substantial congruence cross culturally for Chinese and American brain-damaged samples and suggest that the WAIS-RC measures essentially the same constructs as the WAIS-R.

The virulence plasmids of Salmonella serovars typhimurium, choleraesuis, dublin, and enteritidis, and the cryptic plasmids of Salmonella serovars copenhagen and sendai belong to the same incompatibility group, but not those of Salmonella serovars durban, gallinarum, give, infantis and pullorum

We examined the compatibility of the Salmonella virulence plasmids of serovars choleraesuis, dublin, enteritidis, gallinarum and pullorum and the cryptic Salmonella plasmids of serovars copenhagen, durban, give, infantis and sendai, with the 90 kilobase pair (kb) virulence plasmid of S. typhimurium. The 90 kb virulence plasmid of S. typhimurium in the form of pWR33, a cointegrate of F'::Tn10lac+ts and the 90 kb virulence plasmid, was transferred by bacterial conjugation into the Salmonella strains (except for S. sendai). The compatibility of their plasmids with the 90 kb virulence plasmid of S. typhimurium was then tested. Separately, a 90 kb virulence plasmid tagged with Tn5 was transformed into the S. sendai strain. The 90 kb virulence plasmid of S. typhimurium was found to be incompatible with the plasmids of serovars choleraesuis, copenhagen, dublin, enteritidis, and sendai, but compatible with the plasmids of serovars durban, gallinarum, give, infantis, and pullorum.