[Surgical treatment of fecal incontinence]

This article describes the surgical treatment of fecal incontinence. There are many surgical methods for fecal incontinence, and each treatment has its own advantages and disadvantages and indications. The appropriate surgical procedure should be selected according to the patient's history, anatomical structure and severity of incontinence. Injectable bulking agents is suitable for passive fecal incontinence. Sphincteroplasty is suitable for patients with sphincter injury caused by vaginal delivery or surgical trauma. Sacral nerve stimulation and posterior tibial nerve stimulation are relatively conservative methods. Gracilomyoplasty, artificial anal sphincter or magnetic anal sphincter can be used in the treatment of refractory fecal incontinence, but with many complications. Colostomy is the ideal choice for patients who have failed to respond to conservative treatment and cannot undergo these procedures.

[Applications of anterior segment optical coherence tomography in corneal refractive surgery]

Anterior segment optical coherence tomography (AS-OCT) has the characteristics of non-contact, noninvasive, high sensitivity, and repeatability, and offers high-resolution in vivo imaging of the structures of the anterior eye segment. It can be used in the diagnosis and assistance of conditions related to the anterior eye segment. This review provides an update on the research and clinical applications of AS-OCT in corneal refractive surgery, including preoperative keratoconus screening, intraoperative real-time visualization of corneal structures, postoperative corneal evaluation, and management of postoperative complications. We also explore the potential application of AS-OCT in combination with corneal biomechanical detection for corneal refractive surgery.

[Preliminary report on the use of total lumpectomyconical remnant gastric - esophagus side overlap anastomosis in radical resection of Siewert type II proximal gastric cancer]

Objective: There is no standard method for esophageal remnant gastric reconstruction for proximal gastrectomy. Reflux esophagitis caused by esophagogastrostomy remains a difficult surgical problem. To report the preliminary surgical results of novel esophagus-conical remnant gastric side overlap anastomosis (CGEO) , with particular emphasis on postoperative esophageal reflux. Methods: In June 2022, we developed a novel CGEO for laparoscopic proximal gastrectomy on two patients with Siewert type II esophagogastric junction adenocarcinoma. Surgical procedures for CGEO: (1) Laparoscopic proximal gastrectomy and preparation of conically shaped gastric remnant; (2) Determining anastomotic site of residual stomach and esophagus; (3) Side-to-side anastomosis of right esophageal wall to anterior of conical gastric remnant; (4) Valvuloplasty of esophageal stump. Results: Case 1 was a 71-year-old man with an operation time of 305 minutes and was successfully discharged from the hospital on the 9th day after surgery, and the postoperative pathology was T3N0M0. Case 2 was an 82-year-old man with an operation time of 325 minutes. He was discharged on the 10th day after surgery. In both cases, only mild esophageal mucosal changes were seen in gastroscopy, there were no obvious symptoms of esophageal reflux. There was also no significant weight change at half a year after operation. Conclusion: CGEO is moderately safe in radical surgery for proximal gastric cancer, and may have a preventive effect on the occurrence of postoperative esophageal reflux, but long-term results need to be confirmed by further studies with follow-up.

[Corneal ectasia following small-incision lenticule extraction: a case report]

A 22-year-old male presented with complaints of blurred vision in his right eye over the past 2 years following small incision lenticule extraction (SMILE) surgery conducted 4 years ago. Following a thorough ocular examination and evaluation, he was diagnosed with corneal ectasia in the right eye after the SMILE procedure. Subsequently, the patient underwent corneal cross-linking (CXL) treatment in the right eye to prevent the progression of the condition. After 3 months of treatment, the corneal ectasia remained stable. This article outlines the process of diagnosis and treatment, reviews the corneal conditions prior to the SMILE surgery, and analyzes the possible reasons behind the occurrence of postoperative corneal ectasia.

[Enhance the management of cardiac arrest and improve the prognosis of the patients]

Cardiac arrest is one of the major public health problems with sudden onset, high mortality and high disability rate. The prevalence of cardiovascular disease continues to rise and the burden of cardiac arrest is increasing in China. It is of great significance to explore more effective prevention and treatment measures to improve the prognosis of patients with cardiac arrest. This article discusses the relevant progress on the treatment ability of emergency and critical cardiovascular diseases, medicines and technologies for cardiac arrest care, and registry studies of cardiac arrest, to further promote the effective improvement of key capacities at various stages of the prevention and treatment of cardiac arrest in China.

Amplification of a terahertz wave via stimulated Raman scattering

Extremely strong terahertz (THz) waves are desperately demanded for investigating nonlinear physics, spectroscopy, and imaging in the THz range. However, traditional crystal-/semiconductor-based THz sources have limitations of reaching extremely high amplitude due to the damage threshold of devices. Here, by introducing Raman amplification to the THz range, we propose a novel, to the best of our knowledge, scheme to amplify THz waves in plasma. A long-pulse CO₂ pump laser transfers its energy to a multicycle, 10-THz seed in a two-step plasma. By one-dimensional simulations, a 0.87-GV/m, 1.2-ps-duration THz seed is amplified to 10 GV/m in a 5.7-mm-long plasma with an amplification efficiency approaching 1%. The method provides a new technology to manipulate the intensity of THz waves.

[Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF)]

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

Isolation, identification, and evaluation of the biocontrol potential of a Bacillus velezensis strain against tobacco root rot caused by Fusarium oxysporum

AIMS

Tobacco (Nicotiana tabacum) is an economically important crop. Root rot caused by Fusarium oxysporum has become a damaging disease in N. tabacum crops grown in Henan province of China. Therefore, the objectives of this study were to screen bacterial isolates against F. oxysporum from rhizosphere soils of tobacco growing areas and to evaluate their antifungal activities, biocontrol effects, and effects on plant growth.

METHODS AND RESULTS

Nineteen strains with antifungal inhibition effects of >60% against F. oxysporum were obtained using the method of flat confrontation; the strain Ba-0321 was the strongest, with an antifungal effect of 75%. Moreover, this strain had broad spectrum antimicrobial activity to eight additional tobacco pathogens. The strain was identified as Bacillus velezensis by morphology and the 16S rDNA sequence. The B. velezensis strain Ba-0321 had strong UV resistance as well as tolerance to high temperatures and low nutrition. The bacteria inhibited spore germination and mycelial growth of F. oxysporum under in vitro co-culture conditions. In vivo assays demonstrated that the Ba-0321 strain significantly reduced the pathogenicity of F. oxysporum, resulting in a control effect on tobacco root rot of 81.00%. Simultaneously, the bacteria significantly promoted root development and the growth of tobacco plants.

CONCLUSION

Our results confirmed that the B. velezensis strain Ba-0321 has a strong antifungal effect and stress resistance that enable it to be used as a biological control agent for tobacco root rot caused by F. oxysporum.

SIGNIFICANCE AND IMPACT OF THE STUDY

Tobacco root rot caused by F. oxysporum has become a damaging disease in China. The B. velezensis strain Ba-0321 has promising application value for controlling tobacco root rot diseases, and it could provide a new biocontrol agent against root rot caused by F. oxysporum in other plant species.

[New progress of excimer laser corneal refractive surgery for presbyopia]

Presbyopia refers to the decline in the accommodation of eye that occurs with age, symptoms begin to appear after the age of 40 and the clarity of vision at near is insufficient to satisfy an individual's requirements. The correction of presbyopia include restoring natural accommodation and improving symptom. The former is still difficult to achieve at present, while the latter mainly involves wearing convex lens, and with more and more patients wanting to get rid of frame glasses, refractive surgery is gradually promoted and applied. Corneal refractive surgery, especially laser-assisted in situ keratomileusis, is one of the most common methods for surgical correction of presbyopia. We reviewed the recent literature to introduce the mechanism of corneal refractive surgery treating presbyopia and the efficacy of different surgical algorithms.

[Paying extremely high attention to customized option and visual quality evaluation of refractive surgery]

As one of the methods to correct ametropia, refractive surgery has been accepted by more and more patients for its good safety, effectiveness and long-term stability. The two major types of refractive surgery are corneal refractive surgery, which is mainly performed with excimer laser and/or femtosecond laser, and phakic intraocular lens implantation. Each type has its own advantages and disadvantages. Surgeons should choose the best method according to their own technical conditions and the individual situation of each patient. In the preoperative and postoperative evaluation, we should not only pay attention to uncorrected vision and refraction, but also carry out a comprehensive visual quality assessment from both subjective and objective aspects. The ultimate goal of refractive surgery is to maximize patient satisfaction.

[Correlation between the increase in corneal higher-order aberrations and the control of children's myopic anisometropia after wearing orthokeratology lenses]

Objective: To explore the interocular differences in both the increase of corneal higher-order aberrations (HOAs) and axial length elongation, and the correlation between them after orthokeratology lens (OK lens) wear in children with myopic anisometropia. Methods: It was a prospective cohort study. From 2018 to 2019, 31 children with myopic anisometropia who were fitted with OK lenses initially in the Department of Ophthalmology of Peking University Third Hospital were enrolled, including 15 males (30 eyes) and 16 females (32 eyes). The age was (10.7±1.4) years. Before (baseline) and 12 months after wearing OK lenses, corneal aberrations, corneal relative refractive power (corneal RRP, the difference between peripheral corneal refraction and central corneal refraction) and axial length were measured using the Sirius combining a corneal topographer and a tomographer and an IOL-Master intraocular lens biometer in two eyes. Interocular differences in corneal aberrations, corneal RRP and axial length were analyzed by the paired t test and Wilcoxon rank sum test. The Pearson and Spearman correlation analyses were used to explore the correlation between the increase in corneal HOAs, corneal RRP and axial length elongation. Results: At 12 months after wearing OK lenses, 6 children were lost for follow-up, and the data of the remaining 25 children (50 eyes) were evaluated. With 3.0- and 6.0-mm measuring zones of the total cornea and the anterior surface, the increases in total corneal HOAs, coma, spherical aberration of higher myopic eyes were significantly more than fellow lower myopic eyes (all P<0.05). The corneal RRP with 2.0-mm and 2.5-mm radius in the upper cornea and 2.5-mm radius in the inferior cornea of higher myopic eyes were more than fellow lower myopic eyes (t=-2.06, -2.07, -2.42; P=0.05, 0.049, 0.023), but there was no significant interocular difference in corneal RRP in the horizontal meridian direction of the cornea (both the nasal and temporal sides of the cornea) (both P>0.05). The axial length elongation in higher myopic eyes was 0.14 (0.08, 0.20) mm, which was significantly less than that in the contralateral eyes [0.18 (0.14, 0.35) mm] (Z =-3.21, P= 0.001). The interocular difference in axial length decreased from 0.40 (0.34, 0.54) mm at baseline to 0.33 (0.24, 0.54) mm (Z =-3.21, P = 0.001). The increases in HOAs, coma and spherical aberration of the anterior corneal surface with 3.0-mm measuring zone and the increase in coma of the anterior corneal surface with 6.0-mm measuring zone were all negatively correlated with axial length elongation (r=-0.493, -0.606, -0.500, -0.307; P<0.05). But the corneal RRP had no significant correlation with axial length elongation (r=-0.092, -0.104, -0.230, -0.061; P>0.05). Conclusion: After 12 months of OK lens wear, interocular difference in axial length reduced significantly in children with myopic anisometropia, which was related to the larger increase in corneal HOAs of higher myopic eyes than fellow lower myopic eyes, especially coma.

[Effect of hormones on keratoconus and its mechanism]

Keratoconus is an ectatic corneal disorder and characterized by central and/or inferior temporal corneal thinning in a cone shape. Studies have shown that its pathogenesis is related to changes in tissue proteins, enzymes, immune functions and specific genes, but the exact pathogenesis has not been clearly clarified yet. Hormones such as sex hormones have been found to be associated with keratoconus. This review aims to summarize and analyze the research progress of the effect of hormones on keratoconus and its mechanism, so as to explore the role of hormones in the early diagnosis of keratoconus and find new targets in the treatment of keratoconus, providing reference for clinical work.

Absolute stimulated Brillouin side scattering in an inhomogeneous flowing plasma

Theory of absolute stimulated Brillouin side scattering in an inhomogeneous flowing plasma is presented and verified numerically. The linearized coupling equations are transformed into a Schrödinger equation in k space and solved as an eigenvalue problem. Analytic threshold, growth rate, and scattering geometry are obtained for the pump laser with arbitrary incidence angle. Numerical solutions of the coupling equations show good agreements between the theoretical and numerical absolute thresholds when ion-acoustic wave damping is not too large, and thus an old but famous threshold in [Phys. Fluids 17, 1211 (1974)PFLDAS0031-917110.1063/1.1694867] is corrected. It also indicates that the theoretical analysis is not accurate for strong dampings, since it will overestimate the absolute threshold. Possibility of finding such instability in the current experiments is also discussed.

Investigation on gas permeability of compacted GMZ bentonite with consideration of variations in liquid saturation, dry density and confining pressure

During the long term operation of a disposal repository, gas will be inevitably generated. Determination of gas permeability of compacted bentonite is of great importance for the safety assessment of the engineered barrier system. In the present work, the steady-state and residual pressure methods were employed to determine the gas permeability of GaoMiaoZi (GMZ) bentonite with consideration of variations in liquid saturation, dry density and confining pressure. Results show that, gas migration in saturated GMZ bentonite was mainly controlled by diffusion with an effective gas permeability of 1E-23 m² - 1E-25 m². While in unsaturated GMZ bentonite, significant gas flow rates could be observed, which increased stably with the increase of gas injection pressure. Klinkenberg effect was significant when gas flow through GMZ bentonite. The Klinkenberg corrected gas permeability decreased by 3.5-5.5 orders of magnitude as the liquid saturation increased from 10% to 70%. A decreasing magnitude of 1-2 orders in Klinkenberg corrected gas permeability was presented with the dry density increased from 1.5 Mg/m³ and 1.7 Mg/m³. The Klinkenberg corrected gas permeability decreased by 0-1 orders of magnitude as the confining pressure increased from 3 MPa to 7 MPa. By using the accessible porosity, gas measured intrinsic permeability could be determined with values ranged between 1E-15 m² to 4E-15 m², which was higher than the water measured one by 5 orders of magnitude. Additionally, a generalized power law was successfully adopted in this study to describe the evolution of gas relative permeability with the liquid saturation. Overall, the effective gas permeability, Klinkenberg corrected gas permeability, intrinsic and relative permeability determined in this study provided a comprehensive perspective to assess the buffering property of GMZ bentonite in multi-physical field coupling environment. The parameters obtained can be adopted in further simulation works for long-term safety analysis of the disposal repository from the viewpoint of gas migration.

[Clinical study on topography-guided laser ablation combined with accelerated corneal collagen cross-linking for early keratoconus]

Objective: To study the safety and efficacy of topography-guided customized excimer laser subepithelial ablation combined with accelerated collagen cross-linking technique in treatment of early keratoconus. Methods: Ninteen patients(20 eyes) (13 males 14 eyes, and 6 females 6 eyes), aged 12 to 44 years (24.7±8.0) were diagnosed as keratoconus by three-dimensional corneal topography and tomography, clinical history and examinations, and classified as KC1~KC3. Based on the classical excimer laser subepithelial keratomileusis (LASEK) method, topography guided laser ablation was performed with an excimer laser system (WaveLight EX500). After laser ablation, the corneal stromal bed was immersed with 0.1% riboflavin for 10 minutes, and then was irradiated by ultraviolet light (Avedro KXL) at 30 mW/cm(2) for 4 minutes. All the patients were followed up for more than 12 months. The uncorrected visual acuity (UCVA), diopter, best corrected visual acuity (BSCVA), corneal topography, central corneal endothelial cell density (ECD), hexagonal cell percentage (HEX), coefficient of variation (CV) and other indicators were observed. For normal distribution variables, Dunnett-t test was used before and after operation, and Wilcoxon test was used for variables with abnormal distribution. And the complications were recorded. Results: There was no loss of BSCVA at 12 months postoperatively, 20% of the eyes had no change of BSCVA, and 15% of the eyes gained 1 line of BSCVA, 15% of the eyes gained 2 lines of BSCVA, 50% of the eyes gained 3 lines and more of BSCVA. There was no significant difference in UCVA, BSCVA, manifest refractive spherical equivalent (MRSE) and the cylinder at 3 months postoperatively (P>0.05). The BSCVA were significantly improved at 6 and 12 months postoperatively compared with those before operation (t=3.095, 3.079, <0.05). Although there was no significant difference in UCVA and MRSE, the cylinder was significantly reduced at 6 and 12 months postoperatively (t=-2.890, -2.435, P<0.05). Apex curvature (Kapex) and mean pupil power (MPP) within 4.5mm of central cornea decreased significantly (Z=-2.903, P<0.01; Z=-2.667, P<0.01). Even though the thinnest corneal thickness decreased from pre-operational (461.9±31.1) μm to post-operational (416.6±27.0) μm (Z=-3.059, P<0.01), the cornea became regular with keratometric asymmetry index of anterior corneal surface decreased (Z=-2.667, P<0.01). The corneal optical quality parameters were improved. There was no significant difference in ECD, HEX and CV at 12 months postoperatively (P>0.05). Twelve months after operation, grade 0, 0.5, 1 and 2 haze were seen on 20%, 55%, 20% and 5% corneas respectively. Conclusions: The topography guided excimer laser ablation combined with accelerated corneal collagen cross linking is safe and effective in treatment of early stage keratoconus. It can significantly improve corneal regularity while preventing keratoconus progression, so as to improve the best corrected visual acuity postoperatively. (Chin J Ophthalmol, 2019, 55: 904-910).

[Expression and clinical significance of long non-coding RNA CCAT1 in gastric cancer]

Objective: To investigate the expression and clinical significance of long non-coding RNA colon cancer associated transcript-1 (CCAT1) in gastric cancer (GC), and to further explore the effect of CCAT1 on cell proliferation of GC. Methods: The mRNA expressions of CCAT1 in GC tissues and matched adjacent normal tissues from 62 patients who received resection for gastric carcinoma between January 2013 and May 2015 in Nanjing Medical University Affiliated Wuxi Second Hospital and expressions in GC cell lines were assessed by quantitative real-time PCR (qRT-PCR). The clinical significance of CCAT1 expression was then analyzed. The expressions of CCAT1 in MGC-803 and SGC-7901 cells were inhibited by small interfering RNA (siRNA) transfection. The effect of CCAT1 on cell proliferation was studied by cell counting kit (CCK)-8 assay. Results: The expressions of CCAT1 mRNA in GC tissues were significantly higher than in the normal tissues (3.39±2.37 vs 1.28±0.74, P<0.05). Compared with immortalized human gastric epithelial cell line (GES-1), the expressions of CCAT1 mRNA were significantly higher in GC cell lines MGC-803 and SGC-7901 (3.07±0.69, 2.23±0.32 vs 1.01±0.12, both P<0.05). Besides, the expression of CCAT1 varied significantly among patients with different TNM stage, depth of invasion, and lymph node metastasis (χ(2) =5.199, 5.395, 9.239, all P<0.05). The results of CCK-8 assay showed that down-regulation of CCAT1 in MGC-803 and SGC-7901 cells significantly inhibited the cell proliferation (both P<0.05). Conclusions: CCAT1 is up-regulated in GC and may be significantly correlated with the progression of GC. Decreased expression of CCAT1 can suppress the proliferation of GC cells. CCAT1 might be used as a novel target for GC early diagnosis and treatment.

[Analysis on the role of Sirius combined topography and tomography system in screening for suspect keratoconus]

Objective: To evaluate the role of Sirius combined topography and tomography system in screening for suspect keratoconus among the corneal refractive surgery candidates. Methods: Retrospective case series study. Eight hundred and sixteen consecutive ametropic patients (1 632 eyes) who underwent routine examinations before corneal refractive surgery at Peking University Third Hospital from January 2016 to September 2016 were reviewed. All the cases were analyzed with Sirius combined topography and tomography system. Fifty-nine eyes of 37 patients, aged (28.9±7.4) years, classified as suspect keratoconus by the system were enrolled in the suspect group, including 25 females (40 eyes) and 12 males (19 eyes). A random eye of the first 59 patients, aged (27.1±6.4)years, whose both eyes were classified as normal by Sirius system were enrolled in the control group, including 38 females and 21 males. The corneal anterior surface, posterior surface and minimum thickness data of the suspect group were analyzed and then compared with the control group. The classified results were further verified by Pentacam system. Independent-samples t test and Mann-Whitney U test were applied to analyze the normal distribution and non-normal distribution data respectively. Results: The medians of anterior surface and posterior surface symmetry index and Baiocchi Calossi Versaci index of anterior surface and posterior surface of the suspect group were 0.84, 0.22, 0.58 and 0.51 D, and that of the control group were 0.05, 0.04, 0.09 and 0.06 D, and the differences were of statistical significance (Z=-18.764, -8.351, -12.248, -10.709, P<0.01). Mean corneal minimum thickness data of the suspect group were (504.4±30.0)μm, and that of the control group were (541.2±32.1)μm, the differences were of statistical significance (t=-6.408, P<0.01). In the suspect group, the eyes related with suspect or abnormal corneal anterior indices accounted for 47.5% (28/59), the eyes related with suspect or abnormal corneal posterior indices accounted for 55.9% (33/59), and the eyes related with suspect or abnormal corneal minimum thickness accounted for 40.7% (24/59). In the suspect group, 45 eyes (76.3%) were classified as suspect or abnormal according to the overall variance index "D" by Belin-Ambrósio Display (BAD) of the Pentacam system, and the other 14 eyes exhibited at least one abnormal index related with keratoconus. Conclusions: Sirius 3D combined topography and tomography and its integral automatic classification system is capable to screen out the suspect keratoconus simply and effectively. These indices maybe arranged in descending order in terms of the sensitivity as corneal posterior surface, followed by corneal anterior surface and then corneal thinnest point thickness. (Chin J Ophthalmol, 2018, 54: 33-38).

[Expression and significance of miR-210 in the epididymis in rats with varicocele and following varicocelectomy]

Objective: To investigate the expression of microRNA 210 (miR-210) in the epididymis of rats with varicocele and changes in miR-210 expression following high spermatic vein ligation, so as to explore the significance of the surgery in treating varicocele. Methods: A total of 21 male Sprague-Dawley (SD) rats aged 7 weeks were randomly divided into control group (n=7), experimental group (n=7), and surgical group (n=7). Varicocele model was established in both the experimental and surgical groups, while only vein isolation was performed in the control group. After 8 weeks, spermatic vein diameter were measured in the control and experimental rats, and collected the left epididymis (fixed in formaldehyde and frozen in refrigerator at -80 ℃). In the surgical group, left high spermatic vein ligation was performed, and the left epididymis was collected after 4 weeks as in the control and the experimental groups. The fixed epididymis tissues were treated with HE staining for observation of tissue injuries. The miR-210 expression in the epididymis was detected with reverse transcription-polymerase chain reaction (RT-PCR). At last every group had 5 rats. Results: The pathological examination showed that the number and distribution of mature sperms in epididymal duct in the experimental group were lower and less even compared to the control group, while the two indicators in the surgical group were better than those in the experimental group. The diameter of the left spermatic vein in the experimental group and pre-treatment surgical group were significantly enlarged than in the control group (P<0.01). The expression of miR-210 in the left epididymis in the experimental group was significantly higher compared with the control group(1.32±0.06 vs 0.98±0.14, P<0.01), while the expression of miR-210 in the left epididymis in the surgical group was significantly decreased compared with the experimental group (0.96±0.16 vs 1.32±0.06, P<0.01); the difference between the control group and the surgical group was not statistically significant (P>0.05). Conclusion: The expression of miR-210 in the epididymis may be increased by varicocele and reduced after high ligation of the affected spermatic vein.

[A large-scale, multicenter, retrospective study on efficacy of bivalirudin use during peri-percutaneous coronary intervention period for Chinese patients with coronary heart disease]

OBJECTIVE

To observe the efficacy and safety of bivalirudin use in Chinese patients with coronary heart disease (CHD) during the peri-percutaneous coronary intervention(PCI) period.

METHODS

A total of 3 271 patients who underwent PCI and received periprocedural bivalirudin treatment between July 2013 and October 2015 from 88 centers of China were involved in this study. The primary outcome was 30-day net adverse clinical events (NACE a composite of major adverse cardiac or cerebral events (MACE, all-cause death, reinfarction, urgent target vessel revascularization, or stroke) or bleeding), the secondary outcome was stent thrombosis at 30 days.

RESULTS

The mean age of enrolled patients was (65.12±12.44) years old, 27.4%(889/3 244) of them were female. Percent of stable coronary disease (SCD), non-ST segment elevation acute coronary syndrome (NSTE-ACS) and ST elevation myocardial infarction (STEMI) was 5.0%(162/3 248), 44.6%(1 450/3 248) and 50.4%(1 636/3 248) respectively. Radial access was performed in 89.5% (2 879/3 271) patients, and 9.7% (316/3 271) and 34.1% (1 115/3 271) patients also received ticagrelor and tirofiban medication. 69.3% (2 266/3 271) patients received post-procedural bivalirudin infusion, in which 46.3% (1 050/2 266) was treated at PCI-does, with a median duration of 2.5(1.0, 4.0) h. During the 30-day follow-up, NACE occurred in 3.45% (103/2 988) patients, the incidence of MACE, death was 2.17% (65/2 994) and 1.03% (31/3 017), respectively and bleeding events were recorded in 1.37% (41/2 996) patients. Four cases (0.13%) of stent thrombosis (3 acute stent thrombosis) were recorded.

CONCLUSION

Peri-PCI Bivalirudin use is safe and related with low bleeding risk in Chinese CHD patients.

Neural oscillatory correlates of duration maintenance in working memory

Working memory (WM) is a core element of temporal information processing, but little is known about the internal representation and neuronal underpinnings of the duration maintenance in WM. The neural oscillations during maintenance of duration in WM were examined using electroencephalogram (EEG) recordings. The EEG results showed that theta amplitude was not modulated by the length of duration retained in WM, while alpha amplitude decreased in a 4-s duration condition compared with 1-s, 2-s, and 3-s duration conditions. The amplitude of alpha power positively correlated with accuracy for the 3-s duration condition. The results suggest that alpha activity is involved in duration maintenance in WM. Our study provides electrophysiological evidence that different internal representations are retained in WM for durations below and above about 3s.

Correlation and interventional embolization therapy of posterior intercostal arteries-induced hemoptysis

The incidence of posterior intercostal arteries-induced hemoptysis, its correlation with primary diseases, and the value of interventional embolization therapy were investigated. Clinical data, multislice spiral computed tomography (MSCT), digital subtraction angiography (DSA), and other imaging data of 143 cases of hemoptysis were retrospectively analyzed. After the offending vessels were subjected to interventional embolization therapy, patients were followed-up for observations of clinical efficacies and complications. Thirty-one patients (21.7%) showed 65 branches of posterior intercostal arteries as the non-bronchial systemic arteries involved in hemoptysis; pleural thickening was evident in 25 (80.6%) cases. Posterior intercostal arteries-induced hemoptysis was observed in 16 of the 27 (59.3%) patients with pulmonary tuberculosis, and in 9 of the 10 (90.0%) patients with pulmonary tuberculosis and pulmonary damage. Posterior intercostal arteries-induced hemoptysis was correlated to pleural thickening (P<0.05), which differed significantly among different underlying diseases (P<0.05). Twenty-eight cases of 58 branches of posterior intercostal arteries were found to be involved in hemoptysis by preoperative chest CT angiogram (CTA); the intraoperative matching rates were 90.3% (28/31) and 89.2% (58/65), respectively. Thirty-one patients received transcatheter arterial embolization (TAE), of which 29 (93.5%) showed immediate hemostasis; 1 case had surgical treatment for ineffectuality, and 2 cases showed recurrence without serious complications. The posterior intercostal arteries were commonly involved in hemoptysis, and were closely associated with pleural thickening and pulmonary tuberculosis, especially when accompanied by pulmonary damage. Complete TAE could improve the treatment effect of hemoptysis and preoperative chest CTA was helpful for interventional embolization therapy.

Temporal induction of immunoregulatory processes coincides with age-dependent resistance to viral-induced type 1 diabetes

The dilute plasma cytokine milieu associated with type 1 diabetes (T1D), while difficult to measure directly, is sufficient to drive transcription in a bioassay that uses healthy leukocytes as reporters. Previously, we reported disease-associated, partially IL-1 dependent, transcriptional signatures in both T1D patients and the BioBreeding (BB) rat model. Here, we examine temporal signatures in congenic BBDR.lyp/lyp rats that develop spontaneous T1D, and BBDR rats where T1D progresses only after immunological perturbation in young animals. After weaning, the BBDR temporal signature showed early coincident induction of transcription related to innate inflammation as well as IL-10- and TGF-β-mediated regulation. BBDR plasma cytokine levels mirrored the signatures showing early inflammation, followed by induction of a regulated state that correlated with failure of virus to induce T1D in older rats. In contrast, the BBDR.lyp/lyp temporal signature exhibited asynchronous dynamics, with delayed induction of inflammatory transcription and later, weaker induction of regulatory transcription, consistent with their deficiency in regulatory T cells. Through longitudinal analyses of plasma-induced signatures in BB rats and a human T1D progressor, we have identified changes in immunoregulatory processes that attenuate a preexisting innate inflammatory state in BBDR rats, suggesting a mechanism underlying the decline in T1D susceptibility with age.

Hybrid phase-change plasmonic crystals for active tuning of lattice resonances

Tunable lattice resonances are demonstrated in a hybrid plasmonic crystal incorporating the phase-change material Ge2Sb2Te5 (GST) as a 20-nm-thick layer sandwiched between a gold nanodisk array and a quartz substrate. Non-volatile tuning of lattice resonances over a range Δλ of about 500 nm (1.89 µm to 2.27 µm) is achieved experimentally via intermediate phase states of the GST layer. This work demonstrates the efficacy and ease of resonance tuning via GST in the near infrared, suggesting the possibility to design broadband non-volatile tunable devices for optical modulation, switching, sensing and nonlinear optical devices.

Neural activity in relation to temporal distance: differences in past and future temporal discounting

This study investigated the differences between past and future temporal discounting in terms of neural activity in relation to temporal distance. Results show that brain regions are engaged differently in past and future temporal discounting. This is likely because past temporal discounting requires memory reconstruction, whereas future temporal discounting requires the processing of uncertainty about the future. In past temporal discounting, neural activity differed only when preferences were made between rewards received one hour prior and rewards received further in the past. The peak amplitudes of P2 and P3 varied as the temporal distance increased from 2 weeks to 50 years. In future temporal discounting, neural activity differed only when preferences were evaluated between two delayed rewards. The delay conditions (6 months:5 years) and (6 months:50 years) had a significant influence on P2 and N2. Findings indicate the existence of different decision-making systems operating in past and future temporal discounting.

Clopidogrel 150 vs. 75 mg day(-1) in patients undergoing percutaneous coronary intervention: a meta-analysis

BACKGROUND

Whether an increase in the daily oral maintenance dose of clopidogrel may improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated.

OBJECTIVES

This meta-analysis aimed to estimate the relative effect of a 150- vs. 75-mg daily maintenance dosage of clopidogrel on clinical and laboratory end-points in patients undergoing PCI.

METHODS

We searched electronic and printed sources (up to 14 December 2010) for both randomized control trials and observational studies satisfying the predefined inclusion criteria.

RESULTS

We retrieved 12 reports of studies including a total of 23,814 patients. Clopidogrel, 150 mg day(-1), was associated with significant reductions in major adverse cardiac and/or cerebrovascular events (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.48-0.94), myocardial infarction (OR, 0.72; 95% CI, 0.60-0.86), target vessel revascularization (OR, 0.27; 95% CI, 0.12-0.62) and stent thrombosis (OR, 0.64; 95% CI, 0.53-0.77) and decreased adenosine diphosphate-induced maximal platelet aggregation. However, as compared with 75 mg day(-1), the 150-mg daily maintenance dosage significantly increased the risk of minor bleeding (OR, 1.21; 95% CI, 1.08-1.36).

CONCLUSION

As compared with the currently recommended 75-mg day(-1) maintenance dosage of clopidogrel, the 150-mg day(-1) dosage can reduce major adverse cardiac and/or cerebrovascular events but may increase the risk of minor bleeding.

Effects of artificial liver support system on patients with acute or chronic liver failure

AIMS

Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Artificial liver support system (ALSS) is useful to bridge patients with liver failure to liver transplantation or to regenerate their own livers. The aims of this prospective study were to investigate the effects of ALSS on clinical manifestations, liver function, and 30-day survival to probe the factors related to mortality in patients with AoCLF.

METHODS

In this study, 338 enrolled patients with AoCLF who received ALSS treatment for 1 to 8 sessions, were compared with 312 patients treated with conventional medications.

RESULTS

Clinical manifestations and liver functions were significantly improved, namely, decreased levels of serum transaminases, total bilirubin, and bile acid, as well as increased levels of serum albumin following ALSS treatment. The 30-day survival rates of the patients who received ALSS versus controls were 47.9% versus 34.6%, respectively (P = .01). The MELD score and the stage of hepatic encephalopathy were highly associated with mortality (P < .001), but the sessions of ALSS showed a positive relation to the 30-day survival (P < .05).

CONCLUSIONS

ALSS appears to be efficacious and safe for the treatment of patients with AoCLF. Both model for end-stage liver disease (MELD) score and hepatic encephalopathy are useful to predict the mortality of patients.

Anti-carcinogenic and anti-metastatic properties of indole-3-carbinol in prostate cancer

Indole-3-carbinol (I3C), a compound present as glucobracissin in cruciferous vegetables has anticancer activities which is in line with some of the epidemiological evidence that suggests a beneficial effect of consumption of cruciferous vegetables on cancer incidence and progression. The precise target of indole-3-carbinol has not been determined. We examined the effect of I3C on prostate cancer in a well-defined R3327 model using Copenhagen rats and the transplantable cell line, MAT-LyLu. This cell line derived from a tumor in Copenhagen rats is androgen independent and metastasizes to the lung and lymph nodes. Tumors were induced in Copenhagen rats by injecting MAT-LyLu subcutaneously and the animals treated with I3C that was administered either intraperitoneally or intravenously, in order to achieve maximal systemic exposure. This was a departure from the traditional chemopreventive route of indole-3-carbinol where the compound was incorporated in the diet. Our results indicate that I3C inhibited the incidence, growth and metastases of MAT-LyLu cells and both i.p. and i.v. injections of I3C were equally effective. Statistical analysis (Kaplan-Meier curves) clearly indicates a tumor-free and overall survival benefit as a result of treatment with I3C. These studies show for the first time that I3C in an injectible form has anti-prostate cancer activity.

Peptide mimotopes of oncoproteins as therapeutic agents in breast cancer

Generation of an immune response to oncoproteins can lead to a cancer specific protective immunity. Several such oncoproteins are being examined as tumor targets with mixed results. We are evaluating the clinical utility of synthetic peptides that would mimic the antigen immunologically and elicit a tumor specific immune response. HER-2/neu, an oncoprotein whose expression in breast cancer is associated with poor prognosis, lower disease free-survival and a propensity for metastases was chosen as a model. Antibodies, Ab2, Ab4 and Ab5 directed towards the extracellular domain of HER-2/neu were reacted to peptides from two synthetic phage display peptide libraries, LX-8 (12-mer peptide library containing disulfide bridge) and X-15 (linear 15-mer). The isolated peptides were sequenced and characterized for ability to produce high titer antibodies and cross-reactivity. The peptides isolated did not show any sequence homology to protein databases but did show a hierarchy of immunogenic epitopes. Antibodies generated against peptides selected against the same antibody Ab2 or Ab4 showed affinity variation. Phages selected against Ab2 were also able to compete with binding of Ab2 to HER-2/neu. These results validate our hypothesis that synthetic peptides that mimic the antigenic epitope of oncoprotein can be generated and their clinical utility rests on devising a screening mechanism to identify peptides that can elicit an immune response directed to the oncoprotein and if possible its antigenic variants.

Induction of heat shock protein gp96 by immune cytokines

Cytokines play a major role in regulating both humoral and cell-mediated immune responses. Recent advances in our understanding of cell-mediated immune responses have focused on the antigen presentation machinery and the proteins in the endoplasmic reticulum (ER). These proteins help the formation and stabilization of the major histocompatibility complex (MHC)-peptide interaction. A 96-kDa, ER-resident glycoprotein (gp96) is being evaluated as a therapeutic agent in cancer because of its ability to associate with a vast number of cellular peptides irrespective of size or sequence. Because the antigen presentation complex is assembled in the ER and a number of ER-resident proteins are modulated by cytokines, it is important to examine the regulation of gp96 in response to immune cytokines interferon gamma (IFN-gamma), and interleukin 2 (IL-2). Defects in signaling pathway in either of the cytokines can result in suboptimal immune response. We examined the effect of the cytokines IFN-gamma and IL-2 on the induction of gp96 in different cancer cell lines and examined the induction of DNA-binding proteins that recognize gamma interferon-activating sequence (GAS), present in the promoter region of gp96. The induction of GAS binding protein correlated with the induction of STAT 1 protein, a transcriptional regulator and mediator of IFN-gamma-mediated gene expression. The use of cytokines in inducing gp96 levels may have significance in maintaining high levels of gp96 for a sustained immune response.

Multiple molecular targets of indole-3-carbinol, a chemopreventive anti-estrogen in breast cancer

The mechanism of action of the anti-estrogen indole-3-carbinol (I3C), present in cruciferous vegetables, is being examined in our laboratory with a view to promote the use of this naturally occurring chemopreventive as an alternative to synthetic anti-estrogens in human breast cancer. Our previous results clearly demonstrated that despite its low affinity for the estrogen receptor (ER), I3C abrogated estradiol-mediated cellular and biochemical effects in estradiol-responsive cells and tissues. In an earlier report, we identified ER phosphorylation as one of the targets of I3C, and in this communication we describe the consequence of inhibition of ER phosphorylation. Estradiol-induced DNA-binding proteins that bound to several DNA-responsive elements were inhibited by I3C and this effect was not at the level of DNA-protein physical interaction as inclusion of I3C in vitro in the reaction mix did not affect the binding. We analyzed the spectrum of genes induced by estradiol and modulated and/or intercepted by I3C. Our results conclude that although estradiol-mediated functions are affected by I3C, its biochemical targets are multiple and some of these may be modulated by the oligomeric products of I3C.

Compounds from Kadsura ananosma

The 18-(13-->12 beta)-abeo-lanostene triterpenoid acid, ananosic acid A (1), and the dibenzocyclooctadiene lignan, ananosin A (2), were isolated from the stem bark of Kadsura ananosma. Their structures were elucidated by extensive spectral studies and the structure of 1 was confirmed by single crystal X-ray diffraction analysis.

[New progress of serial analysis of gene expression]

As an efficient tool that has been developed recently, serial analysis of gene expression (SAGE) allows the qualitative and quantitative analysis of a large number of transcripts. It can define the transcripts at relatively low levels and characterize the genomic expression near completion. In addition, it provides insights into the timely and orderly expression of genes by comparing the profiles constructed for a pair of cells that are kept at different conditions, thus identifying a set of novel genes. In this review, the newest progress of SAGE's application and research is mentioned in details with its original method and principle outlined.

[Studies on chemical constituents of Schisandra propinqua (Wall.) Hook. f. et Thoms]

OBJECTIVE

To isolate and characterize compounds from the stems of Schisandra propinqua.

METHOD

Extracting with solvent, isolating by column chromatography and identifying by the spectroscopic methods.

RESULT

Six dibenzocyclooctadiene lignans were isolated and identified as tigloylgomisin P(1), angeloylgomisin O(2), angeloylisogomisin O(3), kadsulignan L(4), (+/-) 5,8-epoxyl-6, 7-dimethyl-2',3',2",3"-dimethylenedioxy-4', 1"-dimethyl-1,2:3,4-dibenzo-1, 3-cyclooctadiene(5) and wuweizisu C(6).

CONCLUSION

Compounds 4 and 5 were the first two dibenzocyclooctadiene lignans with an 6,9-epoxy bridge cycle discovered in the genus Schisandra. The others were originally isolated from S. propinqua.

The TGF beta receptor activation process: an inhibitor- to substrate-binding switch

The type I TGF beta receptor (T beta R-I) is activated by phosphorylation of the GS region, a conserved juxtamembrane segment located just N-terminal to the kinase domain. We have studied the molecular mechanism of receptor activation using a homogeneously tetraphosphorylated form of T beta R-I, prepared using protein semisynthesis. Phosphorylation of the GS region dramatically enhances the specificity of T beta R-I for the critical C-terminal serines of Smad2. In addition, tetraphosphorylated T beta R-I is bound specifically by Smad2 in a phosphorylation-dependent manner and is no longer recognized by the inhibitory protein FKBP12. Thus, phosphorylation activates T beta R-I by switching the GS region from a binding site for an inhibitor into a binding surface for substrate. Our observations suggest that phosphoserine/phosphothreonine-dependent localization is a key feature of the T beta R-I/Smad activation process.

[Studies on chemical constituents of Stellera chamejasma L]

OBJECTIVE

Isolate and identify the bioactive compounds from the root of Stellera chamejasma.

METHOD

The compounds were extracted with solvents, isolated by column chromatography and identified by spectroscopic methods.

RESULT

Seven compounds were isolated and identified as umbelliferone(1); daphnoretin (2); 2,6-dimethoxyl p-benzoquinone(3); (-)-eudesmin(4); (+)-matairesinol(5); lirioresinol B(6) and daucosterol(7).

CONCLUSION

Compounds 3, 4 and 5 were isolated from the plant for the first time.

Triterpenoid acids from Schisandra propinqua with cytotoxic effect on rat luteal cells and human decidual cells in vitro

Three triterpenoid acids, nigranoic acid (1), manwuweizic acid (2), schisandronic acid (3), and other four compounds were isolated from the stems of Schisandra propinqua. Compounds 1 and 2 showed significant cytotoxic effect against human decidual cells and rat luteal cells in vitro.

A cDNA from human bone marrow encoding a protein exhibiting homology to the ATP1gamma1/PLM/MAT8 family of transmembrane proteins

A cDNA clone, IWU-1, was cloned from human bone marrow. Its putative open reading frame encoded a protein of 115 amino acids with a calculated molecular mass of 12.9 kDa. The deduced amino acid sequence exhibited high homology (>68%) to members of the ATP1gamma1/PLM/MAT8 family of single transmembrane proteins, primarily in the region containing the putative transmembrane domain. The sequence at the amino-terminal side exhibited high homology (>61%) to the cytoplasmic region of the angiotensin II type 1 receptors.

Effects of pathway and neuronal aging on the specificity of motor axon regeneration

Youth is a strong predictor of functional recovery after peripheral nerve repair, while adulthood is commonly associated with poor outcome. Identification of the factors responsible for this difference could form the basis for strategies to improve regeneration in adults. Preferential reinnervation of motor pathways by motor axons (PMR) occurs strongly in young rats, but is often absent in older animals, and thus parallels the overall trend for superior results in young individuals. These experiments evaluate the individual contributions of peripheral nerve age and motoneuron age to the decline in regeneration specificity (PMR) which accompanies the aging process. The femoral nerves of young and old Lewis rats were removed as inverted "Y" grafts from the femoral trunk proximally to the terminal muscle and cutaneous branches distally. These grafts were transferred from (1) old to young, (2) young to old, (3) old to old, and (4) young to young bilaterally in 10 individuals per group. After 8 weeks of regeneration, reinnervation of cutaneous and muscle branches was assessed by dual labeling with HRP and Fluoro-Gold. Motor neuron regeneration was random in old to old (mean muscle branch (M) = 159, mean cutaneous branch (C) = 168), but PMR was seen when young pathways were used in old animals (M = 163, C = 116). PMR was vigorous when either type of graft was used in young animals (young graft, M = 218, C = 134; old graft, M = 204, C = 127). In this model, motoneuron age appears to be the primary determinant of specificity. However, the pathway also makes significant contributions, as shown by the ability of young pathways to generate specificity in old animals. Manipulation of graft Schwann cell behavior might therefore be an appropriate strategy to improve outcome in older individuals.

Expression of mPer1 and mPer2, two mammalian clock genes, in murine bone marrow

Although circadian variations in hematopoiesis have been well documented, the molecular mechanism of the circadian rhythms remains elusive. To determine if a clock system exists in bone marrow to mediate the circadian rhythms, we analyzed the expression of mPer1 and mPer2, both mouse homologues of the Drosophila period gene and known regulators of the clock system, in murine bone marrow by relative quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). We demonstrated that both genes were expressed in bone marrow. Furthermore, the expression patterns of mPer1 and mPer2 in total bone marrow cells exhibited two peaks over a 24-h period. In contrast, the expression patterns of these two genes in the Gr-1-positive cells isolated from bone marrow mainly contributed to one of the two peaks. These results indicate that a clock system exists in bone marrow and suggest that the circadian rhythms in bone marrow are lineage- and/or differentiation stage-dependent.

Engagement of bone morphogenetic protein type IB receptor and Smad1 signaling by anti-Müllerian hormone and its type II receptor

Anti-Müllerian hormone induces the regression of fetal Müllerian ducts and inhibits the transcription of gonadal steroidogenic enzymes. It belongs to the transforming growth factor-beta family whose members signal through a pair of serine/threonine kinase receptors and Smad effectors. Only the anti-Müllerian hormone type II receptor has been identified. Our goal was to determine whether anti-Müllerian hormone could share a type I receptor with another family member. Co-immunoprecipitation of known type I receptors with anti-Müllerian hormone type II receptor clearly showed that the bone morphogenetic protein type IB receptor was the only cloned type I receptor interacting in a ligand-dependent manner with this type II receptor. Anti-Müllerian hormone also activates the bone morphogenetic protein-specific Smad1 pathway and the XVent2 reporter gene, an anti-Müllerian hormone type II receptor-dependent effect abrogated by a dominant negative version of bone morphogenetic protein type IB receptor. Reverse amplification experiments showed that bone morphogenetic protein type IB receptor is co-expressed with anti-Müllerian hormone type II receptor in most anti-Müllerian hormone target tissues. Our data support a model in which a ligand, anti-Müllerian hormone, gains access to a shared type I receptor and Smad1 system through a highly restricted type II receptor.