[Understanding and reflection on the prevention and control of pre-myopia in children]

The International Myopia Institute introduced the concept of "pre-myopia" in 2019, defining it as children with refractive error ≤+0.75 D and >-0.50 D. By considering baseline refractive error, age, and other quantifiable risk factors, there is a significant likelihood that individuals falling into this category may develop myopia in the future. Therefore, it is deemed worthwhile to implement preventative intervention measures.This article delves into the epidemiology of premyopia in children and adolescents, the criteria for determining pre-myopia, the characteristics of refractive changes, and the existing evidence gaps in pre-myopia control technology. Furthermore, it explores the role and advantages of implementing pre-myopia control to enhance efforts in preventing and managing myopia. The paper highlights the essential value and future trajectory of pre-myopia control in the comprehensive management of myopia. The ultimate goal is to foster collaboration with professionals, aiming to discuss innovative strategies for effectively preventing and managing the onset and progression of myopia.

Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study

Background

Point-of-care ultrasound (POCUS) can guide umbilical vein catheter placement in real time and monitor catheter tip position, allowing avoidance of severe complications due to catheter malposition. This study aims to explore the effectiveness of POCUS in guiding venous catheter insertion and monitoring complications.

Methods

Sixty-eight neonates with ultrasound-guided venous catheter insertion at the Neonatal Department of Dongguan Children's Hospital between December 2020 and February 2022 were included. POCUS was applied to monitor catheter tip location daily until catheter removal. A displacement range exceeding the intersection of the inferior vena cava and right atrium by ±0.5 cm was considered misalignment.

Results

Sixty-four neonates had a displaced catheter tip (94.1%, 64/68), with a median displacement distance of 0.4 cm (minimum -0.2 cm, maximum 1.2 cm). Ten neonates had a misalignment (14.7%, 10/68) caused by displacement. Displacement usually occurs within 2-4 days after placement, with displacement rates of 94.1% (64/68), 90.6% (58/64), and 98.3% (59/60) on days 2, 3, and 4, respectively, and could still occur on day 9 post-placement. In addition, misalignment mainly occurs on the second day after placement. During the monitoring process, 58 neonates had catheter tip displacement ≥2 times, resulting in 252 displacement and 22 misalignment incidents. Among them, the catheter tip migrated outward from the inferior vena cava seven times, all of which were removed in time. Ultrasound was used for positioning 486 times, and x-ray was indirectly avoided 486 times.

Conclusion

The catheter tip is prone to displacement and misalignment after umbilical vein catheterization, which most commonly occurs on days 2-4. POCUS is recommended for daily monitoring of the tip location during umbilical vein catheterization until catheter removal.

[Epidemiology of high myopia among children and adolescents in China]

Myopia, especially high myopia, seriously affects the children and adolescents' quality of learning and life relating to a series of eye diseases. More and more studies show that the prevalence of high myopia in children and adolescents in China continues to rise, and gradually increases with age, showing a trend of younger age development. In this review, the existing literature was systematically reviewed to explore the differences in the prevalence of high myopia among people at different times, ages, and regions and understand the epidemiological status of high myopia in children and adolescents, so as to provide theoretical basis for further prevention and control of high myopia.

[Clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for severe MAS in neonates with meconium-stained amniotic fluid]

OBJECTIVES

To study the clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for the development of severe MAS in neonates with meconium-stained amniotic fluid (MSAF).

METHODS

A total of 295 neonates who were hospitalized due to Ⅲ° MSAF from January 2018 to December 2019 were enrolled as subjects. The neonates were classified to a non-MAS group (n=199), a mild/moderate MAS group (n=77), and a severe MAS group (n=19). A retrospective analysis was performed for general clinical data, blood gas parameters, infection indicators, and perinatal clinical data of the mother. The respiratory support regimens after birth were compared among the three groups. The receiver operating characteristic (ROC) curve and multivariate logistic regression analysis were used to investigate predicting factors for the development of severe MAS in neonates with MSAF.

RESULTS

Among the 295 neonates with MSAF, 32.5% (96/295) experienced MAS, among whom 20% (19/96) had severe MAS. Compared with the mild/moderate MAS group and the non-MAS group, the severe MAS group had a significantly lower 5-minute Apgar score (P<0.05) and a significantly higher blood lactate level in the umbilical artery (P<0.05). Compared with the non-MAS group, the severe MAS group had a significantly higher level of interleukin-6 (IL-6) in peripheral blood at 1 hour after birth (P<0.017). In the severe MAS group, 79% (15/19) of the neonates were born inactive, among whom 13 underwent meconium suctioning, and 100% of the neonates started to receive mechanical ventilation within 24 hours. Peripheral blood IL-6 >39.02 pg/mL and white blood cell count (WBC) >30.345×109/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (P<0.05).

CONCLUSIONS

Meconium suctioning cannot completely prevent the onset of severe MAS in neonates with MSAF. The neonates with severe MAS may develop severe respiratory distress and require mechanical ventilation early after birth. Close monitoring of blood lactate in the umbilical artery and peripheral blood IL-6 and WBC at 1 hour after birth may help with early prediction of the development and severity of MAS.

[Two-year follow-up study in type 2 diabetic patients with mild visual impairment]

Objective: To determine the 2-year visual prognosis in Chinese type 2 diabetic patients with mild visual impairment and identify the predictors factors. Method: This was a 2-year population-based cohort study. The study population consisted of 650 type 2 diabetic patients with bilateral mild visual impairment in 2014 who were followed up in 2016. The demographic information, systemic and ophthalmological examination results for each participant was collected. Mild visual impairment was defined as best-corrected visual acuity (BCVA)<20/25 to ≥20/63, moderate and severe visual impairment was defined as BCVA<20/63 to ≥20/400, blindness was defined as BCVA<20/400 following the International Council of Ophthalmology (ICO) 2002 definition. The two-year visual prognosis was divided into three groups: visual impairment regression, progression, and stable. Using chi-square test or independent t-test, the predictor factors of visual prognosis and the leading causes of visual impairment were studied. Results: 605 patients completed the follow-up in 2016. Among them, 477 were still bilateral mild visual impairment, accounting for 78.8% (477/605). The level of unilateral or bilateral visual impairment regressed in 8.1% (49/605), while progressed in 13.1% (79/605). Young age (t=2.7, P<0.05), short duration of diabetes (t=2.5, P<0.05), low blood glycemic hemoglobin (t=2.5, P<0.05) and total cholesterol (t=2.8, P<0.05) were associated with regression of visual impairment. Low levels of education (t=5.2, P<0.05), high blood glycemic hemoglobin (t=2.4, P<0.05) and total cholesterol (t=2.4, P<0.05)were associated with progression of visual impairment. Cataracts and diabetic retinopathy were the first and second cause of mild, moderate severe visual impairment or blindness. Conclusions: The percentage of 2-year visual acuity decline is relatively high in type 2 diabetic patients with mild visual impairment. We should strengthen blood glucose and cholesterol control to reduce the progress of visual impairment.(Chin J Ophthalmol, 2021, 57: 766-771).

Clinical features and prognosis of severe meconium aspiration syndrome with acute respiratory distress syndrome

OBJECTIVES

To study the clinical features and prognosis of neonates with severe meconium aspiration syndrome (MAS) and acute respiratory distress syndrome (ARDS).

METHODS

A retrospective analysis was performed on the medical data of 60 neonates with severe MAS who were admitted from January 2017 to December 2019. According to the presence or absence of ARDS, they were divided into two groups: ARDS (n=45) and non-ARDS (n=15). Clinical features and prognosis were compared between the two groups.

RESULTS

Among the 60 neonates with severe MAS, 45 (75%) developed ARDS. Arterial blood gas analysis showed that the ARDS group had a significantly higher median oxygenation index within 1 hour after birth than the non-ARDS group (4.7 vs 2.1, P<0.05), while there was no significant difference between the two groups in white blood cell count, C-reactive protein (CRP), and interleukin-6 (IL-6) on admission and the peak values of procalcitonin, CRP, and IL-6 during hospitalization (P>0.05). The ARDS group had a significantly higher incidence rate of shock than the non-ARDS group (84% vs 47%, P<0.05). There was no significant difference between the two groups in the incidence rates of persistent pulmonary hypertension, pneumothorax, pulmonary hemorrhage, hypoxic-ischemic encephalopathy, intracranial hemorrhage, and disseminated intravascular coagulation (P>0.05). The ARDS group required a longer median duration of mechanical ventilation than the non-ARDS group (53 hours vs 3 hours, P<0.05). In the ARDS group, 43 neonates (96%) were cured and 2 neonates (4%) died. In the non-ARDS group, all 15 neonates (100%) were cured.

CONCLUSIONS

Neonates with severe MAS and ARDS tend to develop respiratory distress earlier, require a longer duration of mechanical ventilation, and have a higher incidence rate of shock. During the management of children with severe MAS, it is recommended to closely monitor oxygenation index, give timely diagnosis and treatment of ARDS, evaluate tissue perfusion, and actively prevent and treat shock. Citation.

Identification of miRNAs, mRNAs, lncRNAs, and circRNAs associated with hepatocellular carcinoma recurrence after interferon treatment

To study the molecular mechanism of interferon-alpha (IFN-α) in the treatment of hepatocellular carcinoma (HCC) and the molecular markers that can predict the therapeutic effect, differentially expressed (DE)-miRNAs, -mRNAs, -lncRNAs, and -circRNAs were screened between 12 samples collected from 4 patients who had not received treatment (control), 4 patients who had received recombinant human interferon a-2b treatment (case1), and 4 patients who had relapsed after receiving recombinant human interferon a-2b treatment (case2). Enrichment analyses were performed to determine the principal functions of the DE-RNAs. We also constructed protein-protein interactions (PPI) and competing endogenous RNA (ceRNA) networks. In addition, a series-cluster analysis was performed to analyze changes in gene expression across different groups of HCC. Furthermore, the expression of the genes were verified in the Cancer Genome Atlas (TCGA) database. A total of 36 union DE-miRNAs, 175 union DE-mRNAs, 65 union DE-lncRNAs, and 52 union DE-circRNAs were obtained between the control vs case1, and case2 vs case1 groups. DE-mRNAs were mainly involved in the mitochondrial inner membrane. DE-circRNAs were mainly enriched in the Golgi apparatus. ceRNA network contained 68 DE-mRNAs, 26 DE-miRNAs, 45 DE-lncRNAs, and 23 DE-circRNAs. A total of 24 DE-miRNAs, 175 DE-mRNAs, 65 DE-lncRNAs, and 52 DE-circRNAs were classified into eight profiles, respectively. A total of 26 genes showed a significant correlation with prognosis of HCC (p < 0.05). Some genes may be used to predict the efficacy of IFN-α in the treatment of HCC. The results may lay a foundation for investigating the different sensitivities of IFN-α in the treatment of HCC.

CircRNA ZNF609 promotes angiogenesis in nasopharyngeal carcinoma by regulating miR-145/STMN1 axis

Nasopharyngeal carcinoma (NPC) is the most common type of human malignant tumor in the head and neck, and tumor angiogenesis is essential for its development. Here, we showed that the circRNA ZNF609/microRNA (miR)-145/Stathmin 1 (STMN1) axis regulated angiogenesis in NPC.Circ-ZNF609, miR-145, and STMN1 expression in NPC cells and NPC samples were examined using qRT-PCR. The protein levels of STMN1, VEGFR1, and VEGFR2 were evaluated using western blotting. VEGF level was determined by ELISA. The proliferation of NPC cells and HUVECs was examined using a CCK-8 assay. Transwell assays and wound-healing assays were applied to assess the migration of NPC cells and HUVECs, respectively. Angiogenesis of HUVECs was evaluated by an angiogenesis assay. In addition, a dual-luciferase reporter assay and RNA pull-down assays were employed to verify the binding relationship between circ-ZNF609 and miR-145 as well as between miR-145 and STMN1. Here, we showed that circ-ZNF609 and STMN1 expression was increased, while miR-145 expression was decreased in NPC cells and NPC samples. Circ-ZNF609 may negatively regulate miR-145 expression by acting as a ceRNA. Silencing circ-ZNF609 suppressed cell proliferation, migration, and angiogenesis in NPC, while knockdown of miR-145 reversed these effects. In addition, we found that STMN1 was the downstream target of miR-145. MiR-145 overexpression suppressed cell proliferation, migration, and angiogenesis in NPC, which was abolished by STMN1 overexpression. Our data suggested that circ-ZNF609 promotes cell proliferation, migration, and angiogenesis in NPC by upregulating the expression of STMN1 by sponging miR-145 in NPC.

[The safety of atropine for myopia prevention and control]

Atropine is a classical drug with a wide use in clinical practice. In ophthalmology, atropine can be used for cycloplegia before optometry, and the treatment of amblyopia, iridocyclitis, malignant glaucoma, etc. In recent years, the "old drugs with new application " research and application of atropine for myopia prevention and control has become a hotspot and the efficacy of atropine has been preliminarily recognized. However, before the widely used in clinical, the safety of atropine draws attention. Researches concerning side effects of atropine were searched. The most common problem is photophobia due to dilated pupils, followed by poor near visual acuity, allergy and inflammation, local irritation. Other side effects include withdraw rebound, dry eyes, elevation of intraocular pressure, system reactions, photic damage and toxicity. Among them, some side effects are theoretical yet, and the long-term effects of some side reactions are not clear. Further research and exploration is needed to serve clinical evidence. At present, investigational usage for myopia prevention and control in clinical trials of atropine can be beneficial. Safety observation and efficacy evaluation are equally important in the course of application. (Chin J Ophthalmol, 2021, 57: 299-304).

[Forcasting the prevalence of myopia among students aged 6-18 years in China from 2021 to 2030]

Objective: To predict the prevalence of myopia among Chinese students aged 6-18 years under different intervention scenarios from 2021 to 2030. Methods: The multi-state Markov model was developed based on the transition process of study stages and myopia statuses. The development of myopia was simplified into two statuses: non-myopia and myopia. Students aged 6-18 years were also divided according to their study stages including senior kindergarten, primary school (from Grade 1 to 6), junior school (from Grade 1 to 3) and high school (from Grade 1 to 3). The parameters were extracted from the National Myopia Investigation in 2018 and published articles of cohort studies. The transition probability was applied to simulate the intervention scenarios, and sensitivity analysis was carried out. Results: The cumulative incidence of myopia among Chinese school-aged children and adolescents would increase consistently. It would be 91.3% (min to max: 83.7% to 96.7%) upon graduation from high school. Without any intervention, the myopia prevalence would increase to 61.8% (min to max: 55.4% to 69.5%) by 2030 among Chinese school-aged children and adolescents. And the myopia prevalence among students in primary schools, junior schools and high schools would be 45.6% (min to max: 40.2% to 54.3%), 81.3% (min to max: 72.6% to 91.0%) and 90.5% (min to max: 82.4% to 96.7%), respectively, all higher than the national target. If the interventions could achieve 70% of the desired effect, the myopia prevalence would be lower than the national target at each stage. Conclusions: Without effective interventions, the prevalence of myopia among students aged 6-18 years may keep increasing in the next ten years. If the interventions achieve the desired effect, the national target for myopia prevention and control could be reached. It is urgent to identify more effective interventions and call on the whole society to participate in the myopia prevention action to achieve the national goal by 2030. (Chin J Ophthalmol, 2021, 57: 261-267).

Postoperative secondary aggravation of obstructive sleep apnea-hypopnea syndrome and hypoxemia with bilateral carotid body tumor: A case report

BACKGROUND

Carotid body tumor (CBT) is a chemoreceptor tumor located in the carotid body, accounting for approximately 0.22% of head and neck tumors. Surgery is the main treatment method for the disease.

CASE SUMMARY

We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome (OSAHS) and hypoxia after surgical resection of bilateral CBTs. This patient was admitted, and relevant laboratory and imaging examinations, and polysomnography (PSG) were performed. After the definitive diagnosis, continuous positive airway pressure (CPAP) treatment was given, which achieved good efficacy.

CONCLUSION

This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs, and diagnosis by PSG and CPAP treatment are helpful for this patient.

[Epidemiological characteristics of pneumoconiosis in Gansu Province from 2010 to 2018]

Objective: The epidemiological characteristics of occupational pneumoconiosis in Gansu Province from 2010 to 2018 were analyzed to provide a theoretical basis for the development of prevention and control strategies for pneumoconiosis in Gansu Province. Methods: In March 2019, the data of newly diagnosed occupational pneumoconiosis in 2010-2018 and the data of occupational pneumoconiosis as of December 31, 2018 in Gansu Province were collected by the Occupational Disease and Occupational Health Information Monitoring System. The stage, type of disease, time, enterprise information of newly diagnosed pneumoconiosis and the region, type of disease, enterprise information of existed pneumoconiosis were analyzed. Results: From 2010 to 2018, a total of 1269 new cases of occupational pneumoconiosis were reported in Gansu Province, including 818 cases (64.46%) of stage I pneumoconiosis, 284 cases (22.38%) of stage II pneumoconiosis, 167 cases (13.16%) of stage III pneumoconiosis. Silicosis, coal worker's pneumoconiosis and cement pneumoconiosis ranks the top 3, accounting for 55.71% (707/1269) , 37.67% (478/1269) and 3.78% (48/1269) of the total number, respectively. The new cases of stage III pneumoconiosis were mainly distributed in private economy (58.09%, 79/136) and small-sized (59.88%, 97/162) enterprises. As of December 31, 2018, Gansu Province had reported a total of 12211 cases of occupational pneumoconiosis, of which 58.16% (7102/12211) were coal worker's pneumoconiosis and 28.15% (3438/12211) were silicosis. Mainly distributed in Baiyin city (21.63%, 2641/12211) , Lanzhou city (17.79%, 2172/12211) and Wuwei city (13.73%, 1676/12211) . The existed cases of pneumoconiosis are mainly distributed in state-owned economy (76.95%, 9396/12211) and large-sized (54.23%, 6622/12211) enterprises. Conclusion: Silicosis and coal worker's pneumoconiosis are the main type of pneumoconiosis in Gansu Province. And the number of silicosis reported is on the rise, which should be taken seriously. Pneumoconiosis in Gansu Province is mainly distributed in state-owned economy and large-sized enterprises. However, pneumoconiosis patients in private economy and small-sized enterprise is generally serious, so it should be the focus of supervision.

[Detection of right-to-left shunt with transthoracic contrast echocardiography in patients with pulmonary hypertension]

Objective: To explore the value of right heart contrast echocardiography in etiological diagnosis and severity assessment of pulmonary hypertension (PH). Methods: A retrospective analysis was conducted on 74 patients who underwent transthoracic contrast echocardiography in China-Japan Friendship Hospital from May 2015 to July 2018, all of whom were diagnosed as PH by right heart catheterization. Patients were divided into three groups according to contrast echocardiography: the intra-cardiac shunt group (<4 cardiac cycles with microbubbles in the left heart); Intrapulmonary shunt group (>4 cardiac cycles with microbubbles in the left heart); non-shunt group. The etiology, partial arterial oxygen pressure (PO(2)), N-terminal pro-brain natriuretic peptide (NT-proBNP), mean pulmonary artery pressure (mPAP), right atrial pressure (RAP), pulmonary vascular resistance (PVR) and cardiac output (CO) were analyzed. Central nervous system complications were also compared among the three groups. Results: Among the 74 patients, right-to-left shunt was found in 28 cases (37.8%) by contrast echocardiography, including 11 cases (14.9%) of intra-cardiac shunt and 17 cases (23.0%) of intrapulmonary shunt. In the 11 cases of intra-cardiac shunt, 7 were diagnosed with congenital heart disease and 4 were patent foramen. Two with hereditary hemorrhagic telangiectasia (HHT) and 1 with pulmonary arteriovenous malformation (PAVM) were included in the 16 cases of intrapulmonary shunt. There was no statistical difference in PO(2), mPAP, PVR, NT-proBNP, RAP, CO and functional class among the three groups (all P>0.05). A total of 5 cases (6.8%) were found with nervous system comorbidities, 4 cases (5.4%) with cerebral infarction and 1 cases epilepsy, and 2 cases of cerebral infarction were diagnosed as paradoxical embolism. Nervous system complications were more common in patients with intra-cardiac shunt than in other groups. Conclusion: While right-to-left shunt detected by contrast echocardiography has no relationship with disease severity, it has complementary value in the etiological diagnosis of PH, and intra-cardiac shunt may increase the risk of nervous system complications.

Use of Neonatal Lung Ultrasound for the Early Detection of Pneumothorax

OBJECTIVE

Pneumothorax (PTX) can be diagnosed using lung ultrasonography (LUS) in adult patients, but there are only a few reports of LUS in PTX diagnosis in neonates. The aim of the study was to assess the diagnostic accuracy for PTX.

STUDY DESIGN

This was a retrospective review study performed in our neonatal intensive care unit (level III) between June 2015 and June 2018. All eligible patients underwent an LUS scan before undergoing a chest X-ray (CXR), which was considered the reference standard. When a diagnosis of PTX was inconsistent between LUS and CXR, a chest computed tomography (CT) scan or chest drain was considered the gold standard.

RESULTS

Among 86 infants included in the study, 30 (34.9%) were diagnosed with PTX. In these 30 infants, 35 PTXs were detected by bedside LUS (five bilateral PTXs). Moreover, 11 infants with 14 PTXs were diagnosed only by LUS and were missed by CXR. Out of these 11 infants, 7 underwent a CT scan, whereas the remaining 4 underwent thoracentesis that confirmed PTX diagnosis.

CONCLUSION

In neonates with PTX, LUS was more sensitive and specific for the early detection of PTX compared with CXR.

[Effect of different antibiotic use strategies on infection in neonates with premature rupture of membranes and high-risk factors for neonatal infection]

OBJECTIVE

To study the effect of different antibiotic use strategies on infection in neonates with premature rupture of membranes and the high-risk factors for neonatal infection.

METHODS

A retrospective analysis was performed for the clinical data of 223 neonates with premature rupture of membranes. According to the antibiotic use strategies, they were classified into two groups: study group (n=95) and control group (n=128). The neonates in the study group were given antibiotics based on risk assessment and infection screening, and those in the control group were given antibiotics based on risk assessment alone after admission. General status and prognosis were compared between the two groups. According to the presence or absence of infection, the neonates were classified into two groups: infection group (n=32) and non-infection group (n=191). The clinical data were compared between the two groups. A logistic regression model was used to investigate the high-risk factors for infection in neonates with premature rupture of membranes.

RESULTS

Compared with the control group, the study group had a significantly longer time of premature rupture of membranes, a significantly higher rate of cesarean section, and a significantly lower antibiotic use rate at admission and a significantly lower total antibiotic use rate (P<0.05). The study group also had a significantly higher incidence rate of infection and a significantly lower incidence rate of sepsis (P<0.05). There were no significant differences in the incidence rates of other complications between the two groups (P>0.05). Compared with the non-infection group, the infection group had a significantly lower gestational age, a significantly longer time of premature rupture of membranes, a significantly higher rate of cesarean section, and significantly higher levels of C-reactive protein (CRP) and procalcitonin on admission and during reexamination (P<0.05), with fever as the most common symptom. The logistic regression analysis showed that preterm birth and cesarean section were high-risk factors for infection in neonates with premature rupture of membranes (P<0.05).

CONCLUSIONS

Strict adherence to the indications for antibiotic use in neonates with premature rupture of membranes does not increase the incidence rate of complications. Neonates with premature rupture of membranes, especially preterm infants and infants delivered by cesarean section, should be closely observed for the change in disease conditions, and infection indices including CRP should be reexamined in case of fever and antibiotics should be used to prevent serious infection.

[Effect of different antibiotic use strategies on infection in neonates with premature rupture of membranes and high-risk factors for neonatal infection]

OBJECTIVE

To study the effect of different antibiotic use strategies on infection in neonates with premature rupture of membranes and the high-risk factors for neonatal infection.

METHODS

A retrospective analysis was performed for the clinical data of 223 neonates with premature rupture of membranes. According to the antibiotic use strategies, they were classified into two groups: study group (n=95) and control group (n=128). The neonates in the study group were given antibiotics based on risk assessment and infection screening, and those in the control group were given antibiotics based on risk assessment alone after admission. General status and prognosis were compared between the two groups. According to the presence or absence of infection, the neonates were classified into two groups: infection group (n=32) and non-infection group (n=191). The clinical data were compared between the two groups. A logistic regression model was used to investigate the high-risk factors for infection in neonates with premature rupture of membranes.

RESULTS

Compared with the control group, the study group had a significantly longer time of premature rupture of membranes, a significantly higher rate of cesarean section, and a significantly lower antibiotic use rate at admission and a significantly lower total antibiotic use rate (P<0.05). The study group also had a significantly higher incidence rate of infection and a significantly lower incidence rate of sepsis (P<0.05). There were no significant differences in the incidence rates of other complications between the two groups (P>0.05). Compared with the non-infection group, the infection group had a significantly lower gestational age, a significantly longer time of premature rupture of membranes, a significantly higher rate of cesarean section, and significantly higher levels of C-reactive protein (CRP) and procalcitonin on admission and during reexamination (P<0.05), with fever as the most common symptom. The logistic regression analysis showed that preterm birth and cesarean section were high-risk factors for infection in neonates with premature rupture of membranes (P<0.05).

CONCLUSIONS

Strict adherence to the indications for antibiotic use in neonates with premature rupture of membranes does not increase the incidence rate of complications. Neonates with premature rupture of membranes, especially preterm infants and infants delivered by cesarean section, should be closely observed for the change in disease conditions, and infection indices including CRP should be reexamined in case of fever and antibiotics should be used to prevent serious infection.

[Epidemiological study of occupational diseases in Gansu province, China in 2010-2017]

Objective: To analyze the epidemiological characteristics of occupational diseases in Gansu Province, China in 2010-2017, and to provide a scientific basis for the prevention and control of occupational diseases. Methods: The cluster sampling method was adopted to make statistical analysis of 1339 cases of occupational disease reported by "occupational disease and occupational health information monitoring system" in Gansu province from 2010 to 2017, to investigate the diseases, regions and industries of occupational diseases in June 2018. Results: A total of 1339 cases of occupational diseases (39 types, 8 classes) were diagnosed and reposed in 2010-2017. The three most frequent diseases were pneumoconiosis (87.53%, 1172/1339), occupational poisonings (5.83%, 78/1339), and occupational ear, nose, and throat (ENT) diseases (3.14%, 42/1339). The cases of silicosis accounted for 54.61% (640/1172) of all cases of pneumoconiosis, the second was coalworker pneumoconiosis, which accounted for 38.57% (452/1172). In the cases of occupational poisonings, 32.05% (25/78) suffered from carbon monoxide poisoning. Patients with occupational diseases were reported in 14 districts of Gansu, mostly in Lanzhou (27.52%, 347/1261), Jinchang (16.57%, 209/1261), and Baiyin (14.20%, 179/1261). The reported cases are mainly concentrated in mining (71.56%, 468/654) and manufacturing (21.87%, 143/654), the types of state-owned economy (55.63%, 692/1244) and private economy (33.68%, 419/1244), large (43.41%, 540/1244) and small enterprises (35.21%, 438/1244) in 2010-2017 in Gansu. Conclusion: The pneumoconiosis caused by silicious and coal dust and the occupational poisonings caused by carbon monoxide seem to be the main occupational hazards in Gansu province. Occupational diseases occur in all districts of Guangzhou and in various industries. The state-owned economy and private sector, large and small enterprises should be the focuses of occupational health supervision.

[Strengthening the understanding of the pathological evolution of myopia]

The concern of high myopia in adolescents is increasingly prominent, because of the high prevalence and early onset of myopia in younger children. High myopia increases the risk of various fundus complications, resulting in serious damage to the vision of the working population. The mechanisms underlying the fundus pathology in high myopia remain unknown, although some studies have indicated the initial thinning of the choroid during the myopia progression might count a lot. The thinning of the choroid would influence the blood supply of the retina and sclera and accelerate the progression of myopia to high myopia, inducing the pathologic changes of the fundus. Since the treatment for pathological myopia is limited and cannot reverse the already existed visual impairment, preventive measures are necessary, including the attempts to delay the onset of myopia, to retard progression from mild myopia to high myopia and to retard the pathological changes of high myopia. Future researches should strengthen the understanding of the characteristics of pathologic changes of myopia, establish a predictive index system and a health management system to monitor early pathological changes, and promote early detection and intervention, so as to prevent fundus complications related to high myopia in multiple ways and avoid blindness and visual impairment caused by pathological fundus changes of myopia. (Chin J Ophthalmol, 2019, 55:721-725).

[Effect of monoacylglycerol lipase with proliferation of MHCC97H human liver cancer cells in vivo]

Objective: To investigate the effects of different expression of monoacylglycerol lipase (MAGL) in tumor-associated macrophages (TAMs) with the proliferation of MHCC97H human liver cancer cells in vivo and its mechanism. Methods: Human peripheral blood-derived monocyte was induced to differentiate into M2-type TAMs and was identified by flow cytometry. The co-culture model of TAMs and MHCC97H human liver cancer cells was established, and the expression of MAGL in TAMs cells was detected by qRT-PCR. The expression of MAGL in TAMs cells was detected by plasmid transfection. ELISA and qRT-PCR was used to detect the mRNA expression levels and secretion levels of inflammatory factors in TAMs cells. The subcutaneous tumor model of MHCC97H mice was constructed to observe the effect of different expression of MAGL in TAMs cells with the proliferation of MHCC97H human liver cancer cells in vivo. F-test was used for the measurement of homogeneity of variance between two independent samples. A t-test was used for homogeneity of variance, and the corrected t-test was used for non-homogeneity of variance. Results: Human peripheral blood-derived monocytes were successfully induced to differentiate into M2-type TAMs. An in vitro co-culture model was established. qRT-PCR showed that MHCC97H human liver cancer cells significantly down-regulated the expressional level of MAGL in TAMs cells. The constructed subcutaneous tumor model of mice demonstrated that up-regulation up-regulation of MAGL expression in M2-type TAMs inhibited the proliferation of MHCC97H human liver cancer cells in vivo. Furthermore, the mechanistic study illustrated that the high expression of MAGL promoted the transcription and secretion of inflammatory factors such as interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha in M2-type TAMs cells. Conclusion: The overexpression of MAGL inhibits the proliferation of MHCC97H hepatocellular carcinoma cells in vivo, and its mechanism may be associated to the release of inflammatory factors that from TAMs cells.

Long non-coding RNA PICART1 suppresses proliferation and promotes apoptosis in lung cancer cells by inhibiting JAK2/STAT3 signaling

Lung cancer remains the most common cause of tumor-related death worldwide. Recent studies have revealed that long non-coding RNAs (lncRNAs) are involved in the development of various cancers, including lung cancer. This study aimed to investigate the effect and the molecular basis of lncRNA PICART1 on lung cancer. We first assessed the PICART1 expression in lung cancer in vitro and vivo by qRT-PCR. Then the expression of PICART1 in SPC-A-1 and NCI-H1975 cell lines was inhibited and overexpressed by transient transfections. Thereafter, cell viability, cell cycle, migration and apoptosis were respectively measured by MTT, Transwell and flow cytometry assay. Furthermore, qRT-PCR and western blot analysis were mainly performed to assess the expression levels of apoptosis- and migration-related proteins and JAK2/STAT3 pathway proteins. Tumor formation was measured by xenograft tumor model assay in vivo. PICART1 expression was down-regulated in human lung cancer tissues and cell lines. Knockdown of PICART1 increased cell viability of lung cancer cell lines. However, PICART1 overexpression inhibited cell cycle progression and promoted apoptosis in SPC-A-1 and NCI-H1975 cell lines. PICART1 overexpression also inhibited migration, as evidenced by up-regulation of E-cadherin, and down-regulation of Twist1, MMP2 and MMP9. Furthermore, we found PICART1 inhibition may regulate cell apoptosis and migration through activating JAK2/STAT3 pathway. In vivo experiments revealed that PICART1 knockdown significantly promoted tumor formation. This study demonstrates that PICART1 overexpression represents an anti-growth and anti-metastasis role in lung cancer cells. Additionally, PICART1 acts as a tumor suppressor may be via regulation of JAK2/STAT3 pathway.

[Construction and identification of lentiviral vector mediated GATA-3 gene RNA interference in mouse]

Objective:The aim of this study was to construct and identify a lentiviral vector for RNA interference of mouse GATA-3.Method:The coding region of the GATA-3 gene sequences were analyzed for a single-stranded oligo design and synthesis.PCR was performed for splicing reaction of synthetic oligo,which was synthesized into the lentiviral vector and transformed into the competent cell DH5α.An expression vector shRNA-GATA-3 was constructed after sequencing and identifying the gene sequence of the recombinant clones.Accoding to the target gene sequence ,four pairs are as following: siRNA-685 group(LV3-GATA-3-Mus-685),siRNA-1152 group (LV3-GATA-3-Mus-1152),siRNA-1615 group(LV3-GATA-3-Mus-1615) and control group ,which were designed and syntheized and builded into the lentiviral carrier.The shRNA vectors were cotransfected with expression vectors into the 293T cell line,and the optimal interference sequence was screened by QPCR. The 293T cells were cotranfected with the constructed lentiviral interference vectors and packing plasmids,the viruses were packed,the virus stock was collected and concentrated by ultracentrifugation,and the titer of the viruses was determined. Result:Gene sequence proved that the recombinant clone gene sequence was correct,and the lentiviral vector was successfully constructed. The relative expression of GATA-3 mRNA in siRNA-1615 group(0.004) was significantly reduced after RNA interference comparing with that in the control group(0.022),siRNA-1152 group(0.009) and siRNA-685 group(0.009). The screened LV3-GATA-3-Mus-1615 ,as the most effective interference sequence,was constructed into the lentiviral vector.The titer of the concentrated virus of LV3-GATA-3-Mus-1615 was 5×108 TU/ml in the viral supernate of 293T cells collected at 48 hours after co-transfection. Conclusion:Alentiviral RNAi expression vector targeting the GATA-3 gene (LV3-GATA-3-Mus-1615) was successfully constrcted and identified.

Evolution of differential efficiency in blue InGaN laser diodes before and after a lasing threshold

The optical power emitting from the cavity facet of blue InGaN-based laser diodes (LDs) is measured to investigate the efficiency droop. The efficiency droop behavior of blue InGaN-based LDs near the threshold is confirmed in our experiments. From measurements of optical power at different wavelengths, it is analyzed that the droop behavior of LDs can be ascribed to the efficiency reduction of longer wavelengths. The efficiency of longer wavelengths is subject to the carrier occupation process in quantum levels. In addition, it is found that the droop behavior may be largely affected by the relatively large threshold current of InGaN-based LDs and the screening effect of polarization, and it can be suppressed by stimulated emission.

[A cross-sectional study of moderate or severe visual impairment and blindness in residents with type 2 diabetes living in Xinjing Town, Shanghai]

Objective: To investigate the prevalence, underlying causes and risk factors of moderate or severe visual impairment and blindness in a population with type 2 diabetes in Xinjing Town, Shanghai, China. Methods: A cross-sectional survey among local Han adult residents, who were previously diagnosed as type 2 diabetes, was conducted between October 2014 and January 2015. The survey was preceded by a pilot study; operational methods were refined and quality assurance evaluation was carried out. The best corrected visual acuity was recorded and classified following the modified World Health Organization grading system. Assigned ophthalmic doctors assured the leading causes of every blind or visually impaired eye. Binary logistic regression analysis was used to determine the related factors of blindness and moderate or severe visual impairment. Results: A total of 2 216 type 2 diabetic residents were enrolled, and 166 eyes (3.7%, 166/4 432) were blind. Cataract was the leading cause of blindness (39.8%); macular degeneration (18.0%) and eyeball atrophy (11.4%) were the second and third leading causes of blindness, respectively. Moderate or severe visual impairment was found in 376 eyes (8.5%, 376/4 432), and the most frequent cause was cataract (65.7%), followed by diabetic retinopathy (9.8%) and macular degeneration (9.4% ). Older age, female gender, earlier onset diabetes and a lower spherical equivalent in the better eye were associated with best corrected visual acuity<20/63 in the better eye. Conclusion: The prevalences of moderate or severe visual impairment and blindness in our population with type 2 diabetes were high. (Chin J Ophthalmol, 2016, 52: 825-830).

[The study of establishment of the " Chinese provincial Blindness prevention technical guidance group performance evaluation system"]

Objective: To establish an assessment system, including indexes and scoring methods, that can be used for performance evaluation of the provincial blindness prevention technical guidance group properly and effectively . Methods: The indexes and scoring methods were set based on the core content of The " National Plan of Prevention and Treatment of Blindness (2012-2015)" , the specific requirement and target of the World Health Organization (WHO) "For the General Eye Health: Global plan of Action (2014-2019)" , and the current situation of the China's provinces and autonomous regions. These indexes should be of effectiveness, feasibility, comparability, guidance and advancing. Formed by a literature review of candidate indicators, the framework of the system is built by qualitative assessment. With the Delphi method, the system was further revised and improved. Empirical pilot study was then used to prove the feasibility, followed by the final qualitative analysis that establish the " Chinese provincial Blindness prevention technical guidance group performance evaluation system" . Results: Through the literature review and qualitative assessment, a six dimensional system framework was built, including 6 first-level indicators, 16 second-level indicators, and 29 third-level indicators through Delphi method evaluation. With the variation coefficient method, the coeffiences of the first-level index weight were calculated as: Organization and management 0.15, Development and implementation of blindness prevention plans 0.15, Implementation of blindness prevention projects 0.14, Training 0.17, Health education 0.18, and Cooperation and exchanges 0.21. The specific scoring method for this system is confirmed as: data and files check, field interview, and record interview, sampling investigation. Empirical pilot study was conducted in the Jilin, Guizhou and Gansu provinces, and the self-assessment results from local experts were consistent with the scores from the systems. Conclusion: This system established is appropriate at current time, and it can effectively evaluate the performance of the Chinese provincial Blindness prevention technical guidance group. (Chin J Ophthalmol, 2016, 52:814-824).

[Misdiagnosis analysis: Schwannoma of the facial nerve trunk in parotid gland]

A 64 years old woman with chief complain of a lump without pain in her left face for 9 days. She was admitted to head and neck department for tumor of parotoid gland. There was not significan facial paralysis in left face.A no pain lump of 3.5 cm×4.0 cm with clear boundary was palpable in the left parotoid gland and no motion. Blood and urine routine test, X-ray of chest, electrocardiogram(ECG) were done.Ultrasonography showed that there was a cystic lump of 2.8 cm×3.4 cm with clear boundary in her left parotoid gland.CT of parotoid gland showed that there was a lump of 2.8 cm×2.3 cm with clear boundary and uneven density in left parotoid gland.While, contrast meium enhancement CT scaning shown that the density is slight uneven enhancement.The lesion of the main facial nerve trunk was visualized and dissected intraoperatively and was diagnosed as Schwannoma of facial nerve by pathology postoperatively.

[Clinical characteristics and surgical management in patients with third and fourth branchial anomalies]

Objective:To analysize the clinical characteristics as well as the effect and methods of the surgical treatment in patiets with the third and fourth branchial anomalies.Method:The clinical data of 25 patients diagnosed as third and fourth branchial cleft fistula by pathological method were analyzed retrospectively.Two of 25 patients had undergone fistulectomy simply.Based on the embryologicc and anatomic features of branchial anomalies,23 of 25 patients had received different types of selective neck dissection.All of lesions were confirmed as branchial cleft fistula by pathology.All patients were received the examinations of Esophagus myelography,MRI and CT preoperatively.Result:The features of the third and the fourth bianchial fistula were as following:most patients suffered from recurrent neck abscess and had undergone incision and drainage. Esophagus myelography and CT were important auxiliary examination for branchial anomalies.No recurrent and complications were found in all patients by using treatment of selective neck dissection (23/25 cases) and fistulectomy simply(2/25 cases) within 12 to 36 months following-up,postoperatively.Conclusion:Branchial anomalies is characterized by recurrent acute abscess,acute thyroiditis or fistula secretion inferior to neck.Complete removal of branchial lesions and inflammatory granuloma using selective neck dissection is a safty and effective treatment for recurrent branchial anomalies.

Emission efficiency enhanced by reducing the concentration of residual carbon impurities in InGaN/GaN multiple quantum well light emitting diodes

A series of samples with varying growth pressure are grown and their optical and structural properties are investigated. It is found that the residual carbon concentration decreases when the reactor pressure increases from 80 to 450 Torr during the InGaN/GaN multiple quantum well growth. It results in an enhanced peak intensity of electroluminescence because carbon impurities can induce deep energy levels and act as non-radiative recombination centers in InGaN layers.

Differential resistance of GaN-based laser diodes with and without polarization effect

In this paper, we used numerical calculation and simulation to investigate the differential resistance of GaN-based laser diodes (LDs) with and without polarization effect. We confirmed the existence of a kink at the vicinity of threshold current in the differential resistance curve of GaN-based LDs and found that the kink polarity can be reversed dependent on the polarization effect. The serial parasitic diodes should be included in the theoretical analysis of the equivalent circuit of the LD devices. We determined that the superposition effects of the n-side, active, and p-side regions of the LDs caused the kink and its polarity. We also found that the differential resistance before and after the threshold was dominated by the p-side region and its gradual reduction is related to an electron overflow into p-side. Finally, we studied the effects of cavity facet reflectivity on the kink.

Suppression of electron leakage by inserting a thin undoped InGaN layer prior to electron blocking layer in InGaN-based blue-violet laser diodes

InGaN-based blue-violet laser diodes (LDs) suffer from electron leakage into the p-type regions, which could be only partially alleviated by employing the electron blocking layer (EBL). Here, a thin undoped InGaN interlayer prior to EBL is proposed to create an additional forbidden energy range above the natural conduction band edge, which further suppresses the electron leakage and thus improve the characteristics of LDs. Numerical device simulations reveal that when the proper composition and thickness of InGaN interlayer are chosen, the electron leakage could be efficiently eliminated without inducing any severe accumulation of electrons at the interlayer, resulting in a maximum output power of the device.

Peritoneal metastasis of third ventricular atypical teratoid/rhabdoid tumor after VP shunt implantation for unexplained hydrocephalus

BACKGROUND

Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system (CNS) is a highly malignant neoplasm seen frequently in infancy and early childhood. This report presents a 9-year-old girl of primary third ventricular AT/RT with peritoneal metastasis after ventriculoperitoneal (VP) shunt catheter implantation for hydrocephalus before the identification of the CNS tumor.

METHODS

The data of clinical course, laboratory and imaging studies were obtained and carefully reviewed. Serial imaging studies including enhanced CT and MRI were performed at the first admission, during which the patient was diagnosed with a non-malignant communicating hydrocephalus. Secondary radiological studies were carried out 5 months after VP shunt, during which the patient demonstrated worsening clinical signs of intracranial hypertension. An imaging study identified a tumor in the third ventricle.

RESULTS

The patient was treated by a surgical resection, showing the specimen was pathologically consistent with AT/RT 5 months after VP shunt. Systematic chemotherapy and radiotherapy were prescribed for the patient. After 6 months, PET/CT revealed peritoneal metastasis but negative findings in the CNS. The parents of the patient refused further intervention, and she died one month later.

CONCLUSION

VP shunt in a patient with AT/RT may cause distant seeding of the tumor in unrelated areas of the body, even after intensive multimodality treatment. Further studies on shunt related metastases are needed.

Covariation of copy number located at 16q22.1: new evidence in mammary ductal carcinoma

Copy number variation (CNV) is crucial for gene regulation in humans. A number of studies have revealed that CNV contributes to the initiation and progression of cancer. In this study, we analysed four breast cancer cell lines and six fresh frozen tissues from patients to evaluate the CNV present in the genome using microarray-based comparative genomic hybridization (aCGH). Six genes located at 16q22.1 were analysed by real-time PCR. The real-time PCR analysis revealed that the loss of CDH1/E2F4 may be associated with worse clinical and pathological findings. Interestingly, covariation of CDH1, CDH3, CTCF and E2F4 was found to be associated with triple negative breast cancer and HER-2 receptor status. In conclusion, our study supports the idea that CNV at 16q22.1 in breast cancer is a frequent event; furthermore, it reveals the covariation of CDH1, CDH3, CTCF and E2F4. The role of the covariation is more complex than a simple additive effect of these four separate genes, which may provide a novel target for breast cancer.

A silver staining procedure for nucleic acids in polyacrylamide gels without fixation and pretreatment

Silver staining of nucleic acid has been widely used in molecular marker analysis such as simple sequence repeat (SSR), single-strand conformation polymorphism (SSCP), and amplified fragment-length polymorphism (AFLP). Many alternatives to silver staining methods have been described, but these methods are not efficient or cost-effective. Here we report a silver staining method that requires less than 10min for one gel and can save chemicals as well. It has a detection limit of approximately 5.6pg of DNA/mm(2) in nondenaturing polyacrylamide gels and 12.8pg/mm(2) in denaturing polyacrylamide gels.

Increasing tuberculosis case detection through intensive referral and tracing in Hunan, China

OBJECTIVE

To explore a feasible approach to increase case finding of tuberculosis (TB) through intensive referral and tracing of TB suspects and patients.

METHODS

A quasi-experimental study was conducted in three Chinese cities. A strategic referral and tracing system was developed for the local situation in Hunan, China. Data from a 1-year monitoring of referral, tracing and diagnosis of TB suspects/cases were used to assess outcomes.

RESULTS

Among 126 public general hospitals and clinics in 38 project counties, the 124 (98.4%) health facilities that participated referred an average of 10 TB suspects and cases to the TB dispensary every month. A total of 6364 suspects and 5759 cases were referred. Compared to the previous year, the number of TB suspects increased by 102.1%, from 25 719 to 51 967; the referral of TB suspects increased five-fold; 10 596 new smear-positive pulmonary tuberculosis (PTB) cases were identified; and the notification of new smear-positive PTB increased by 112.9%, from 27.1/100 000 before the project year to 57.7/100 000, a significantly higher percentage than that of non-project areas, which had a notification rate of 38.8/100 000.

CONCLUSION

Intensive referral and tracing of TB suspects/patients is a feasible and effective method of increasing case finding. Strengthening administrative interventions and incentives is essential to achieve project objectives.

[Plasma resistin level in obstructive sleep apnea hypopnea syndrome]

OBJECTIVE

To explore the changes and clinical implications of plasma resistin level in obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODS

Plasma resistin level was measured by radioimmunoassay in 30 obese OSAHS patients (obese OSAHS group), 7 in the low apnea hypopnea index (AHI) subgroup, 9 in the medium AHI subgroup, and 14 in the high AHI subgroup, 30 obese subjects (obese group), and 28 normal healthy adults (control group). Stepwise multiple linear regression analysis was conducted to determine the correlation of plasma resistin level with body mass index (BMI), body fat percentage, waist to hip ratio (WHR), fasting blood glucose (FBG), blood lipid, AHI, and lowest arterial oxygen saturation (LSaO(2)).

RESULTS

The plasma resistin levels of the obese OSAHS group and obese group were (8.48 +/- 1.44) and (7.60 +/- 1.53) microg/L respectively, both significantly higher than that of the control group [(5.78 +/- 1.62) microg/L, both P < 0.05], and that of the obese OSAHS group was significantly higher than that of the obese group (P < 0.05). The plasma resistin level of the high AHI obese OSAHS subgroup was (9.60 +/- 0.51) microg/L, significantly higher than those of the medium and low AHI obese OSAHS subgroups [(7.96 +/- 1.06) and (6.90 +/- 1.32) microg/L respectively, both P < 0.01]. Correlation analysis demonstrated that the fasting plasma resistin level was positively correlated with BMI, neck circumference, waist circumference, WHR, FBG, total cholesterol, triglyceride, and AHI (r = 0.52, 0.66, 0.74, 0.52, 0.59, 0.48, 0.46, and 0.80, all P < 0.05); and negatively correlated with high-density lipoprotein cholesterol and LSaO(2) (r = -0.52, r = -0.60, both P < 0.01). A stepwise multiple linear regression analysis showed that AHI was the most significant contributing factor for the increased plasma resistin level in the obese OSAHS group (R(2) = 0.618).

CONCLUSIONS

Plasma resistin level in obese OSAHS patients are increased, and are positively correlated with AHI. It may be used as an important biological index to evaluate the severity of OSAHS.

[Anatomic study on the nervous distribution of the human recurrent laryngeal nerve]

OBJECTIVE

In order to supply the anatomic data for the selective reinnervation operation of the recurrent laryngeal nerve, the nervous distribution of the recurrent laryngeal nerve was investigated.

METHOD

50 total fresh human larynx were systematically dissected by the method of microdissection.

RESULT

In most cases, the recurrent laryngeal nerve diverges at the level of 1.0-2.5 cm under the cricothyroid articulation for forming the extralaryngeal division. There are three types of extralaryngeal division. Except the cricothyroid muscle, all the laryngeal intrinsic muscles are innervated by the anterior branch of the recurrent laryngeal nerve. In 88% of the cases, the posterior cricoarytenoid muscle is innervated by two nervous pedicle, the others are innervated by a single nervous pedicle.

CONCLUSION

At the level of the posteroinferior part of the thyroid cartilage, by opening a small window, we can easily find the abducent branch of the recurrent laryngeal nerve, following this branch, we can see the adducent branch and the thyroarytenoid branch. The anatomic specifity of the nervous distribution can supply us the data for the operation of selective nervous reinnervation to overcome the possibility of syncinesis of the laryngeal muscle.

On-line identification of phytochemical constituents in botanical extracts by combined high-performance liquid chromatographic-diode array detection-mass spectrometric techniques

It is necessary to determine all of the phytochemical constituents of botanical extracts in order to ensure the reliability and repeatability of pharmacological and clinical research, to understand their bioactivities and possible side effects of active compounds and to enhance product quality control. HPLC chromatographic fingerprints can be applied for this kind of documentation. Combined HPLC-diode array detection-MS techniques can provide on-line UV and MS information for each peak in a chromatogram. In most cases, direct identification of the peaks is possible, based on comparison with published data or with standard compounds. This review will primarily focus on electrospray and thermospray ionization MS and their applications for the qualitative analyses of phenolic compounds, saponins, alkaloids and other classes of natural products in botanical extracts. Twenty-one of the most commonly used herbal examples, their phytochemical analyses and characteristics of their mass spectra are described.

Liquid chromatography-electrospray ionization mass spectrometry study of the flavonoids of the roots of Astragalus mongholicus and A. membranaceus

High-performance liquid chromatography-electrospray ionization mass spectrometry has been applied to analyze the flavonoids of Huangqi, the roots of Astragalus mongholicus and A. membranaceus. Eight flavonoids were identified as calycosin-7-O-beta-D-glucoside, calycosin-7-O-beta-D-glucoside-6"-O-malonate (2), ononin, (6aR,11aR)-3-hydroxy-9,10-dimethoxypterocarpan-3-O-bet a-D-glucoside, calycosin, (3R)-7,2'-dihydroxy-3',4'-dimethoxyisoflavan-7-O-beta-D-glucoside, formononetin-7-O-beta-D-glucoside-6"-O-malonate and formononetin by direct comparison with the isolated standards from Huangqi. The existence of (6aR,11aR)-3-hydroxy-9,10-dimethoxypterocarpan, (3R)-7,2'-dihydroxy-3',4'-dimethoxyisoflavan, astrapterocarpanglucoside-6'-O-malonate and astraisoflavanglucoside-6'-O-malonate was detected. This is the first report of flavonoid glycoside malonates in these two Astragalus species, and malonate 2 is a structurally completely identified new compound.

LC-ESI-MS study of the flavonoid glycoside malonates of red clover (Trifolium pratense)

High-performance liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) was applied to the analysis of the flavonoids and their glycoside malonates of the flowers and leaves of red clover (Trifolium pratense). Through LC-MS comparative studies on the plant extracts and their malonate-free extracts, approximately 20 flavonoid glycoside malonates were detected in the flower extract. Eight were identified as genistin 6' '-O-malonate (39), formononetin 7-O-beta-D-glucoside 6' '-O-malonate (40), biochanin A 7-O-beta-D-glucoside 6' '-O-malonate (41), trifoside 6' '-O-malonate (42), irilone 4'-O-beta-D-glucoside 6' '-O-malonate (43), pratensein 7-O-beta-D-glucoside 6' '-O-malonate (44), isoquercitrin 6' '-O-malonate (45), and 3-methylquercetin 7-O-beta-D-glucoside 6' '-O-malonate (46). About 15 other flavonoids and clovamides were proved to be present in this extract. The study also found that the flowers contained flavones as the major flavonoids, whereas the leaves had isoflavones as the major flavonoids. This is the first detection of the six malonates (39 and 42-46) in the extracts of red clover, and among them, 42, 43, and 46 are new compounds.

LC-ESI-MS study of the flavonoid glycoside malonates of red clover (Trifolium pratense)

High-performance liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) was applied to the analysis of the flavonoids and their glycoside malonates of the flowers and leaves of red clover (Trifolium pratense). Through LC-MS comparative studies on the plant extracts and their malonate-free extracts, approximately 20 flavonoid glycoside malonates were detected in the flower extract. Eight were identified as genistin 6' '-O-malonate (39), formononetin 7-O-beta-D-glucoside 6' '-O-malonate (40), biochanin A 7-O-beta-D-glucoside 6' '-O-malonate (41), trifoside 6' '-O-malonate (42), irilone 4'-O-beta-D-glucoside 6' '-O-malonate (43), pratensein 7-O-beta-D-glucoside 6' '-O-malonate (44), isoquercitrin 6' '-O-malonate (45), and 3-methylquercetin 7-O-beta-D-glucoside 6' '-O-malonate (46). About 15 other flavonoids and clovamides were proved to be present in this extract. The study also found that the flowers contained flavones as the major flavonoids, whereas the leaves had isoflavones as the major flavonoids. This is the first detection of the six malonates (39 and 42-46) in the extracts of red clover, and among them, 42, 43, and 46 are new compounds.

Constraints on the phase gamma and new physics from B --> kpi decays

Recent results from CLEO on B-->Kpi indicate that the phase gamma may be substantially different from that obtained from other fit to the KM matrix elements in the standard model. We show that gamma extracted using B-->Kpi,pipi is sensitive to new physics occurring at loop level. It provides a powerful method to probe new physics in electroweak penguin interactions. Using effects due to anomalous gauge couplings as an example, we show that within the allowed ranges for these couplings information about gamma obtained from B-->Kpi,pipi can be very different from the standard model prediction.

Electrospray high performance liquid chromatography-mass spectrometry in phytochemical analysis of kava (Piper methysticum) extract

HPLC coupled with electrospray (ES) MS was used to study a chloroform extract from kava roots ( PIPER METHYSTICUM). A total of thirteen kavalactones and flavokavains were identified. Seven major kavalactones, methysticin, dihydromethysticin, kavain, 7,8-dihydrokavain, 5,6-dehydrokavain, 5,6-dehydromethysticin and yangonin, were easily recognized in the extract by their [M + H] (+) or [M + Na] (+) ions, UV spectra, and retention times, compared with those of standard compounds. Six minor constituents were isolated as our own reference compounds. These constituents were identified by their [M + H] (+) or [M + Na] (+) ions, UV spectra and NMR data as 11 -hydroxy-12-methoxydihydrokavain, 7,8-dihydro-5-hydroxy-kavain, 11,12-dimethoxydihydrokavain, and flavokavains A, B and C. HPLC-ES-MS appears to be a suitable technique for identification of kavalactones and kavachalcones in the kava extract. The method also provides direct guidance for identification of other trace constituents from kava extracts.