Effect and mechanism of recombinant human fibroblast growth factor 18 on osteoporosis in OVX mice

OBJECTIVES

This study aimed to investigate the effect and the mechanism of recombinant human fibroblast growth factor 18 (rhFGF18) on postmenopausal osteoporosis.

METHODS

The effect of rhFGF18 on the proliferation and apoptosis of osteoblasts and the mechanism underlying such an effect was evaluated using an oxidative stress model of the MC3T3-E1 cell line. Furthermore, ovariectomy was performed on ICR mice to imitate estrogen-deficiency postmenopausal osteoporosis. Bone metabolism and bone morphological parameters in the ovariectomized (OVX) mice were evaluated.

RESULTS

The results obtained from the cell model showed that FGF18 promoted MC3T3-E1 cell proliferation by activating the extracellular signal-regulated kinase (ERK) and p38 instead of c-Jun N-terminal kinase (JNK). FGF18 also prevented cells from damage inflicted by oxidative stress via inhibition of apoptosis. After FGF18 administration, the expression level of anti-apoptotic protein Bcl-2 in the mice was upregulated, whereas those of the pro-apoptotic proteins Bax and caspase-3 were downregulated. Administering FGF18 also improved bone metabolism and bone morphological parameters in OVX mice.

CONCLUSIONS

FGF18 could effectively prevent bone loss in OVX mice by enhancing osteoblastogenesis and protecting osteoblasts from oxidative stress-induced apoptosis.

[Changes of uterine morphology and endometrial T2 signal intensity in the fibrotic repair secondary to endometrial injury]

Objective: To investigate the value of uterine morphological parameters and endometrial T2 signal intensity (T2-SI) in evaluating the degree of the fibrotic repair secondary to endometrial injury. Methods: From Sep. 2018 to Feb. 2023, this study prospectively enrolled 29 patients with fibrotic repair secondary to severe endometrial injury (severe group), 17 patients with fibrotic repair secondary to mild to moderate endometrial injury (mild to moderate group), and 40 healthy women of reproductive age (control group) in Nanjing Drum Tower Hospital. The length of uterine cavity (LUC), length of cervix and isthmus (LCI), width of upper uterine cavity (WUUC) and width of lower uterine cavity (WLUC) were measured using magnetic resonance imaging. T2-SI of endometrium and subcutaneous fat of buttocks were measured, and endometrial normalized T2-SI (nT2-SI; T2-SI of endometrium/T2-SI of subcutaneous fat of buttocks) was calculated. Statistical analyses of data were performed using one-way analysis of variance, Mann-Whitney U test, intraclass correlation coefficient, Spearman rho test, area under the receiver operating characteristic curve (AUC). Results: LUC, WUUC, WLUC and endometrial nT2-SI of severe group [(19.7±3.5) mm, (26.9±6.4) mm, (7.9±1.4) mm, 0.73±0.11, respectively] were significantly lower than those of the control group (all P<0.01), while LCI and WUUC/LUC [(51.3±7.3) mm and 1.38±0.34] were significantly higher than those of the control group (all P<0.001). LUC and WLUC of severe group were significantly lower than those of mild to moderate group [(32.4±5.1) mm and (8.8±1.2) mm; all P<0.05], while LCI and WUUC/LUC were significantly higher than those of mild to moderate group [(41.8±8.6) mm and 0.94±0.16; all P<0.001]. LUC and endometrial nT2-SI of mild to moderate group were significantly lower than those of the control group [ (32.4±5.1) vs (35.3±3.5) mm, 0.68±0.13 vs 0.80±0.12; all P<0.01]. LUC, WUUC, WLUC and endometrial nT2-SI were significantly negatively correlated to the degree of the fibrotic repair secondary to endometrial injury (Spearman rho:-0.794, -0.441, -0.471 and -0.316, respectively; all P<0.05), while LCI and WUUC/LUC were significantly positively correlated to the degree of the fibrotic repair secondary to endometrial injury (Spearman rho: 0.481 and 0.674, respectively; all P<0.05). LUC and WUUC/LUC showed high value in distinguishing severe group from the control group or mild to moderate group (all AUC>0.9, all P<0.001). Conclusion: As noninvasive and quantitative biomarkers, uterine morphological parameters and endometrial nT2-SI could evaluate the degree of the fibrotic repair secondary to endometrial injury.

[Determination of 4-methyl-2-pentanol in workplace air by solvent desorption-gas chromatography]

Objective: To establish a method for the determination of 4-methyl-2-pentanol in the air of workplace by gas chromatography. Methods: In January 2022, 4-methyl-2-pentanol in the air of workplace was collected by activated carbontube, eluted with dichloromethane-methanol (95∶5, V/V), separated by capillary column and determined by gas chromatogram. Results: The limit of detection for 4-methyl-2-pentanol was 0.04 μg/ml. The linear range of 4-methyl-2-pentanol was 0.16-1616.60 μg/ml, with the regression equation of y=1.94x-5.48, and the coefficient correlation was 0.99958, and the minimum detection concentration was 0.03 mg/m(3) (collected sample volume was 1.50 L). The within-run precisions were 1.08%-1.75% and the between-run precisions were 1.41%-2.52%. The desorption rates were 95.15%-99.91%. The samples could be stored at least 3 days at room temperature and 7 days at 4 ℃ without significant loss. Conclusion: The method has the advantages of good precision, high sensitivity and simple operation. It is suitable for the determination of 4-methyl-2-pentanol in the air of workplace.

[Application value of serum protein indicators in constructing the early prediction model for the prognosis of patients with pulmonary tuberculosis]

Objective: To analyze the clinical significance of laboratory examination indicators as the key prognostic factors and to construct an early prediction model for prognosis assessment of pulmonary tuberculosis patients. Methods: The basic information, biochemical indexes and blood routine items of 163 tuberculosis patients (144 males and 19 females, aged 41-70 years, with an average age of 56 years) and 118 healthy persons who underwent physical examination (101 males and 17 females, aged 46-64 years, with an average age of 54 years) in Suzhou Fifth People's Hospital from January 2012 to December 2020 were retrospectively collected. According to the presence of Mycobacterium tuberculosis after six months of treatment, the enrolled patients were divided into a cured group (96 cases) and a treatment failure group (67 cases). To analyze the baseline levels of laboratory examination indicators between these two groups, we screened the key predictors and the binary logistic regression method in SPSS statistics software was used to construct the prediction model. Results: The baseline levels of total protein, albumin, prealbumin, glutamic-pyruvic transaminase, erythrocyte, hemoglobin and lymphocyte were significantly higher in the cured group than in the treatment failure group. After 6 months of treatment, the indexes of total protein, albumin and prealbumin increased significantly in the cured group, but remained at the low levels in the treatment failure group. Receiver operating characteristic (ROC) curve analysis showed that total protein, albumin and prealbumin as independent predictors for forecasting the prognosis of pulmonary tuberculosis patients had the highest prediction accuracy. Logistic regression analysis showed that the combination of these three key predictors could construct the best early prediction model for assessing the prognosis of pulmonary tuberculosis patients, with a prediction accuracy of 0.924 (0.886-0.961), sensitivity of 75.0%, specificity of 94%, showing an ideal prediction accuracy. Conclusions: The routine test indexes of total protein, albumin and prealbumin show good application value in the construction of early prediction model for prognosis evaluation of pulmonary tuberculosis treatment. The combined prediction model consisting of total protein, albumin and prealbumin is expected to provide a theoretical basis and reference model for precision treatment and prognosis assessment of tuberculosis patients.

[Clinical follow-up analysis of multidisciplinary treatment of children with spinal muscular atrophy]

Objective: To analyze the follow-up and clinical effect of multidisciplinary treatment on the children with spinal muscular atrophy (SMA). Methods: The clinical data including nutritional status, respiratory function, bone health and motor function of 45 children with SMA who received multidisciplinary management 1-year follow-up in the Children's Hospital, Zhejiang University School of Medicine from July 2019 to October 2021 were retrospectively collected. Comparisons before and after management were performed using paired-samples t-test or Wilcoxon rank-sum test, etc. Results: The age of 45 patients (25 boys and 20 girls) was 50.4 (33.6, 84.0) months at the enrollment, with 6 cases of type 1, 22 cases of type 2, and 17 cases of type 3 respectively. After the multidisciplinary management, the cases of SMA patients with malnutrition decreased from 22 to 12 (P=0.030), the level of vitamin D were significantly increased ((45±17) vs. (48±14) nmol/L, t=-4.13, P<0.001). There was no significant difference in the forced vital capacity %pred, the forced expiratory volume at 1 second %pred, and the peak expiratory flow %pred ((76±19)% and (76±21)%, (81±18)% and (79±18)%, (81±21)% and (78±17)%; t=-0.24, 1.36, 1.21; all P>0.05). The Cobbs angle of scoliosis also improved significantly (8.0°(0°, 13.0°) vs. 10.0°(0°, 18.5°), Z=-3.01, P=0.003). The Hammersmith functional motor scale expanded scores of children with SMA type 2 and type 3 both showed significant elevation (11.0 (8.0, 18.0) vs. 11.0 (5.0, 18.5) scores, 44.0 (36.5, 53.0) vs. 44.0 (34.0, 51.5) scores, Z=2.44, 3.11, P=0.015, 0.002). Conclusion: Multidisciplinary management is beneficial for delaying the progression of the multi-system impairments of SMA patients, such as malnutrition, restrictive ventilation dysfunction and scoliosis.

[Clinical follow-up analysis of nusinersen in the disease-modifying treatment of pediatric spinal muscular atrophy]

Objective: To explore the clinical efficacy of disease-modifying drug nusinersen on children with spinal muscular atrophy. Methods: The baseline and longitudinal clinical data of 15 children who were treated with nusinersen in the Children's Hospital, Zhejiang University School of Medicine from October 2019 to October 2021 were retrospectively collected. The general data (gender, age, genotype, and clinical classification, etc.), motor function, nutritional status, scoliosis and respiratory function were analyzed. Wilcoxon rank-sum test was used for comparing multi-system conditions before and after treatment. Results: The age of 15 cases (7 males, 8 females) was 6.8 (2.8, 8.3) years, with 2 cases of type 1, 6 cases of type 2, and 7 cases of type 3 respectively, and the course of disease was 55.0 (21.0, 69.0) months. After 9.0 (9.0, 24.0) months of treatment, the motor function scale evaluations of the Hammersmith neurological examination section 2 (13.0 (7.0, 23.0) vs. 18.0 (10.0, 25.0) scores, Z=-2.67, P=0.018) of 15 children, the Hammersmith functional motor scale expanded (38.0 (18.5, 45.5) vs. 42.0 (23.0, 51.0) scores, Z=-2.38, P=0.018), and the revised upper limb module (27.0 (19.5, 32.0) vs. 33.0 (22.5, 35.5) scores, Z=-2.52, P=0.012) of children with type 2 and 3 had significantly improved. Thirteen patients achieved clinically significant motor function improvement, and 2 of them had kept stable scale scores. Subjective reports also indicated that the muscle strength and daily exercise ability of these children improved after treatment, and no serious adverse reactions were reported. Supplemented by the multi-disciplinary team management, the levels of some indicators such as Cobbs angle of scoliosis and forced vital capacity all had significantly improved (all P<0.05). Conclusions: Nusinersen can improve the motor function of patients with 5q spinal muscular atrophy, which is also proved safe to be used in children. The drug treatment supplemented by the multi-disciplinary team management is helpful to improve the multi-system function of the children with spinal muscular atrophy.

[Safety and efficacy evaluation of laparoscopic and open hepatectomy for hepatolithiasis: a propensity score matched analysis]

Objective: To compare the safety and efficacy of laparoscopic and open hepatectomy for hepatolithiasis. Methods: Between January 2014 and May 2020, the clinicopathological data of 254 patients with hepatolithiasis who underwent laparoscopic or open hepatectomy at the First Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College were collected retrospectively. There were 74 males and 180 females with age of (56±8) years (range: 38 to 77 years). Of the 254 patients, 162 underwent laparoscopic surgery (laparoscopic group) and 92 underwent open surgery (open group). Propensity score matching(PSM) was performed to match baseline characteristics of the two groups,and then the perioperative results and follow-up efficacy were compared between the two groups. The t-test, Mann-Whitney U test, χ² test or Fisher's exact probability method was used to compare the perioperative data and follow-up results of the two groups after matching, respectively. Results: Each group had 63 patients after PSM with well-balanced baseline characteristics. There was no statistic difference in the type of hepatectomy,combined common bile duct exploration rate,T tube drainage placement rate,operation time,intraoperative transfusion rate,intraoperative accidental injury rate,initial and final stone clearance rate,and stone recurrence rate between the two groups. However,compared with the open hepatectomy group, the laparoscopic group had significantly lower intraoperative blood loss (M(IQR))(300(175)ml vs. 350(145)ml, Z=3.227,P=0.001),shorter postoperative hospital stay((10.6±4.1)days vs. (14.0±4.0)days,t=4.634,P<0.01),shorter time to postoperative oral intake ((1.8±1.1)days vs. (2.9±1.6)days, t=4.556, P<0.01), and lower postoperative complication rate (25.4%(16/63) vs. 49.2%(31/63), χ²=7.635, P=0.006). Conclusion: Laparoscopic hepatectomy is safe and effective for hepatolithiasis with the advantages of less intraoperative blood loss,lower postoperative complications and faster postoperative recovery.

[Smoking cessation in chronic obstructive pulmonary disease patients aged 40 years or older in China, 2014-2015]

Objective: To understand the smoking cessation behaviors in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China and provide evidence for COPD control and prevention. Methods: COPD patients with post-bronchodilator FEV(1)/FVC<70% were selected from COPD surveillance (2014-2015) of China, in which 5 791 current or former smokers defined by questionnaire survey were included in the study. The smoking cessation rate/ratio and the successful smoking cessation rate in COPD patients, the successful smoking cessation rate in COPD patients who ever smoked daily and the rate of attempting to quit smoking in current smokers with COPD were estimated using data adjusted by complicated sampling method. Results: The smoking cessation rate was 25.0% and the successful smoking cessation rate was 19.1% in COPD patients aged 40 years or older who ever smoked. The smoking cessation ratio was 23.1% and the successful smoking cessation ratio was 17.6% in COPD patients who ever smoked daily. The rate and ratio were higher in urban area than rural area (P<0.05) and increased with age (P<0.05). Patients who were aware of smoking being a risk factor for COPD had higher rate and ratio than patients who were not aware (P<0.05). Patients with more severe airflow limitation and patients smoking less had higher rate and ratio (P<0.05). Conclusions: The smoking cessation rate and ratio were low in COPD patients in China. More health education for COPD patients about smoking cessation needs to be strengthened. It is suggested for healthcare workers to actively advise smoking cessation and suggest smoking cessation ways for patients who smoke in their routine clinical service to increase the successful smoking cessation rate/ratio in COPD patients.

[Analysis on awareness of chronic obstructive pulmonary disease (COPD) status and related knowledge in patients with COPD in China, 2014-2015]

Objective: To understand the awareness of chronic obstructive pulmonary disease (COPD) status and awareness of COPD-related knowledge and its influencing factors in COPD patients aged ≥40 years in China in 2014-2015. Methods: The study subjects were selected through multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces (autonomous regions, municipalities) in China. The number of the subjects was 75 107. The relevant variables about COPD diagnosis and COPD-related knowledge awareness were collected by electronic questionnaire in face to face interviews. A total of 9 134 participates with post-bronchodilator FEV(1)/FVC<70% were diagnosed with COPD. Based on the complex sampling design, the awareness rate of COPD status and related knowledge were estimated, and the influencing factors were analyzed. Results: A total of 9 132 COPD patients were included in the analysis. Among COPD patients aged ≥40 years in China, 0.9% were aware of their COPD status (95%CI: 0.6%-1.1%), and 5.7% were aware of COPD related knowledge (95%CI: 4.8%-6.6%), and 3.4% were aware of pulmonary function test (95%CI: 2.8%-4.0%). The COPD status awareness rate was 3.9% in the patients with history of chronic respiratory disease (95%CI: 2.9%-4.8%), 2.4% in the patients with respiratory symptoms (95%CI: 1.7%-3.1%), and 7.1% in the patients with COPD related knowledge awareness (95%CI: 4.5%-9.8%) respectively. The results of multivariate logistic regression analysis showed that chronic respiratory disease history, respiratory symptoms, occupational dust and/or harmful gas exposure and COPD related knowledge awareness had influences on the awareness rate of COPD status. Educational level and chronic respiratory disease history had influences on the awareness rate of COPD related knowledge. And ethnic groups, educational level and history of chronic respiratory diseases had influences on the awareness rate of pulmonary function test. Conclusions: The awareness rates of COPD status, COPD-related knowledge and pulmonary function test in COPD patients in China were low. The comprehensive intervention of COPD should be carried out to improve the level of diagnosis and the awareness COPD status of COPD patients.

[Analysis on respiratory rehabilitation in patients with chronic obstructive pulmonary disease aged 40 years or older in China, 2014-2015]

Objective: To understand the situation of respiratory rehabilitation and oxygen inhalation therapy in chronic obstructive pulmonary disease (COPD) patients aged 40 years or older in China, and provide basic information for the development of pulmonary rehabilitation. Methods: The data were from 2014-2015 COPD surveillance in China. Chinese residents aged 40 years or older were recruited through a complex multi-stage stratified cluster sampling from 125 COPD surveillance points in 31 provinces (autonomous regions, municipalities). Standardized face to face electronic questionnaires were used to collect information about respiratory rehabilitation and oxygen inhalation therapy of the patients. Spirometry was performed on all participants, and patients with post- bronchodilator FEV(1)/FVC<70% were diagnosed with COPD. The number of defined COPD patients was 9 134. Based on the complex sampling design, the respiratory rehabilitation treatment rate and oxygen inhalation therapy rate of COPD patients aged 40 years old or older in China were estimated, and the influencing factors were analyzed. Results: A total of 9 118 COPD patients aged 40 years or older were included in the analysis. The rate of respiratory rehabilitation was 0.8% (95CI: 0.6%-1.0%), and the rate of oxygen inhalation therapy was 2.5% (95%CI: 2.0%-2.9%). Among patients with severe symptoms or high risk of acute exacerbation (combined COPD assessment groups B, C, D), the rate of respiratory rehabilitation was 1.4% (95%CI: 0.9%-1.9%), and the rate of oxygen inhalation therapy was 5.4% (95%CI: 4.4%-6.4%). Multivariate logistic regression analysis showed that urban or rural residences, geographic area, awareness of COPD, history of acute exacerbation and severity of airflow restriction had influences on the respiratory rehabilitation rate in the COPD patients. Gender, geographic area, awareness of COPD, history of acute exacerbation, mMRC scores and severity of airflow restriction had influences on the patients' oxygen inhalation therapy rate. Conclusions: The rate of respiratory rehabilitation and oxygen inhalation therapy in COPD patients aged 40 years or older was relatively low in China. It is necessary to explore an effective model of pulmonary rehabilitation and COPD management, so that more COPD patients may have access to scientific pulmonary rehabilitation treatment.

[Analysis on passive smoking exposure in adults aged 40 years and older in China, 2014]

Objective: To describe and analyze the passive smoking exposure level in adults aged ≥40 years in China. Methods: A total of 75 107 adults from 125 sites of COPD surveillance points in China were surveyed by electronic questionnaire during face to face interviews. After comprehensive weighting of the samples, the passive smoking exposure level was analyzed. Results: The passive smoking exposure rate of the adults aged ≥40 years was 44.9% (95%CI: 42.3%-47.5%). The exposure rate was highest in those aged from 40 to 49 years (51.0%, 95%CI: 47.9%-54.1%) in term of age groups, in those with senior high school education level and above (48.6%, 95%CI: 44.9%-52.2%) in term of education level, and in office workers (57.7%, 95%CI: 51.8%-63.7%) in term of occupation. The adults reporting passive smoking exposure every days in a week accounted for 27.7% (95%CI: 25.5%-29.8%), and those reporting household passive smoking exposure accounted for 28.3% (95%CI: 26.2%-30.5%). Logistic regression analysis showed that the passive smoking exposure level was different in different age groups and occupation groups. Conclusion: The passive smoking exposure level is still high in adults in China. Age and occupation are the influencing factors of passive smoking exposure level.

[Survey of smoking prevalence in adults aged 40 years and older in China, 2014]

Objective: Smoking is the most important risk factor for COPD. Understanding the smoking rate, current smoking rate, average age to start smoking and average daily consumption of cigarettes among people aged ≥40 years in China can provide scientific evidence for the effective control and prevention of COPD. Methods: Data were from COPD surveillance in China (2014 to 2015) which covered 31 provinces, autonomous regions and municipalities. A total of 75 107 adults aged ≥40 years selected through multi-stage stratified cluster sampling from 125 surveillance sites (county/district) were surveyed by electronic questionnaire during face to face interviews. The smoking rate and other smoking index were estimated by using weighting complex sampling design. Results: The smoking rate and current smoking rate were 40.0% (95%CI: 38.5%-42.0%) and 31.0% (95%CI: 29.7%-32.0%), respectively, among the Chinese aged ≥40 years in 2014. The smoking rate and current smoking rate in males (74.1% and 57.6%) were much higher than those in females (5.4% and 4.0%). And the two rates were significantly higher in rural area (41.2% and 32.4%) than in urban area (38.8% and 29.5%). The mean age of smokers to start smoking was 20.1 (95%CI: 19.7-20.5) years. The younger the smokers were, the earlier their average age to start smoking was (The ages to start smoking for smokers aged 40-, 50-, 60-, ≥70 years were 18.3, 19.2, 20.9 and 23.1 years, respectively). Average daily cigarette consumption of current daily smokers was 18.9 (95%CI: 18.1-19.7) cigarettes, and the daily cigarette consumption was higher in males (19.3 cigarettes) than in females (12.5 cigarettes). Conclusion: The smoking rate in males aged ≥40 years is high in China. Compared with urban area, the smoking rate in rural area is higher, posing a big challenge for COPD control and prevention.

[Survey and analyses of rate of spirometry examination in adults aged 40 years and older in China, 2014]

Objective: To understand the performance of spirometry examination in adults aged ≥40 years and provide evidence for the improvement of comprehensive prevention and control of COPD and the evaluation on the effects of current prevention and control measures. Methods: The study subjects were those included in national COPD surveillance in China during 2014-2015. The surveillance used a multi-stage, stratified cluster sampling strategy and a total of 125 surveillance points in 31 provinces were covered. A total of 75 107 adults aged ≥40 years received a questionnaire survey in face to face interviews to collect the information about their acceptance of spirometry examination in previous years. The estimated rate (95%CI) of spirometry examination was calculated based on complex sampling weight design. Results: A total of 74 591 subjects were included in the analyses. The estimated rate of spirometry examination was 4.5% (95%CI: 3.7%-5.2%), and it was significantly higher in men than in women (P<0.001), in urban population than in rural population (P<0.001). The rate of spirometry examination increased with the increase of education level (P<0.001). The rate of spirometry examination was highest in retirees (10.8%, 95%CI: 8.2%-13.3%), and lowest in those working in the industry of agriculture, forestry, animal husbandry, fishery and water conservancy (2.4%, 95%CI: 2.0%-2.9%). The rate of spirometry examination was high in those with previous chronic respiratory diseases and respiratory symptoms, i.e. 13.4% (95%CI: 10.5%-16.4%) and 15.0% (95%CI: 10.5%-19.4%) respectively. The rate of spirometry examination in former smokers was 7.4% (95%CI: 6.0%-8.8%), slightly higher than those in current smokers and never smokers, 4.7% (95%CI: 3.9%-5.5%) and 3.9% (95%CI: 3.0%-4.7%), respectively. In different population groups, the rate of spirometry examination was lowest in rural population who had received no formal education (1.8%, 95%CI: 1.2%-2.3%) and highest in urban population with respiratory symptoms (20.2%, 95%CI: 12.6%-27.8%). Conclusion: The rate of spirometry examination is extremely low in adults aged ≥40 years in China, therefore effective measures should be taken to increase the rate of spirometry examination in adults in China.

[A summary of item and method of national chronic obstructive pulmonary disease surveillance in China]

COPD refers to a group of chronic respiratory diseases which seriously influence the people's health and life quality. The national COPD surveillance in China has been implemented since 2014 with the goal of monitoring the prevalence and trend of COPD and related risk factors in China. The paper summarizes the item and method of national COPD surveillance in China.

[Survey and analyses of population at high risk of chronic obstructive pulmonary disease in China, 2014]

Objective: To understand the distribution and characteristics of people aged ≥40 years who are at high risk of COPD in China and provide evidence for COPD prevention and control. Methods: The survey was conducted among the subjects selected through multi-stage stratified cluster sampling from 31 provinces (autonomous regions and municipalities) in China for 2014-2015 national chronic obstructive pulmonary disease surveillance. A total of 75 107 people aged ≥40 years in 125 surveillance points were surveyed in face to face interviews. Subjects who met at least one of the following conditions, including chronic respiratory symptoms, exposure to risk factors, medical history of respiratory diseases, and family history, were defined as population at high risk. The weighted proportion of the population at high risk of COPD and 95%CI were estimated by using complex sampling design. Results: Among eligible 74 296 subjects, the proportion of population at high risk of COPD was 89.5% (95%CI: 87.8%-91.2%). The proportion significantly increased with age (P<0.001). The proportion of the population at high risk was significantly higher in men than in women (P<0.001), and in rural area than in urban area (P<0.001). The highest proportion of population at high risk was observed in men in rural area in western China. The proportion of population at high risk of COPD who met at least two conditions was 32.0% (95%CI:29.7%-34.2%), the proportion of those who met at least three conditions was 7.4% (95%CI: 6.6%- 8.3%), and the proportion of those who met all the conditions was 1.5% (95%CI: 1.2%-1.8%). Among population at high risk of COPD, those who only had exposure to one risk factor accounted for 61.7% (95%CI: 59.8%-63.7%). Conclusion: About 90% of people aged ≥40 years in China are at high risk for COPD. It is necessary to conduct population-based screening for COPD and take comprehensive measures to reduce prevalence of risk factors.

[Prevalence of biomass fuel exposure in women aged 40 years and older in China, 2014]

Objective: To understand the prevalence of biomass fuel exposure in women aged ≥40 years in China during 2014-2015, and provide evidence for the prevention and control of bio-fuel exposure. Methods: All participants were selected from a national representative cross-sectional survey during 2014-2015 in the mainland of China. A multi-stage stratified cluster sampling strategy was used. A total of 37 795 women aged ≥40 years received a face-to-face questionnaire survey at 125 surveillance points in 31 provinces. The level of biomass fuel exposure was analyzed after complex sample weighting to represent the overall Chinese women aged ≥40 years. Results: A total of 37 777 women were included in the analysis. With complex weighting, the rate of biomass fuel exposure in Chinese women aged ≥40 years was 35.8% (95%CI: 29.6%-42.1%), the exposure rate was higher in rural women than in urban women (P<0.001). The biomass fuel exposure rate was highest in northeastern and lowest in northern areas of China (χ(2)=17.03, P=0.009). The estimated biomass fuel exposure rate decreased with the increase of educational level (P<0.001). Conclusion: The prevalence of biomass fuel exposure is high in women aged ≥40 years in China, especially in those in rural areas. The exposure level differs with age and area. Appropriate measures should be taken to reduce the level of biomass fuel exposure in Chinese women.

[Analysis on occupational exposure to dust and harmful gas and corresponding protection in adults aged 40 years and older in China, 2014]

Objective: To understand the current status of dust and/or harmful gas exposure in adults aged ≥40 years and corresponding protection in China, and provide evidence for strengthening the occupational protection against dust and harmful gas exposure. Methods: The data were obtained from 2014-2015 COPD surveillance in China. A total of 75 107 adults aged ≥40 years selected through multi-stage stratified cluster sampling from 125 surveillance points in 31 provinces (autonomous regions and municipalities) were surveyed in face to face interviews. Occupational exposure was defined as occupational exposure to dust and/or harmful gas for more than 1 year. The weighted percentages of exposure were estimated by using complex sampling design. Results: Among eligible 71 061 participants, the exposure rate of dust and/or harmful gas was 46.3%. The exposure rate in rural area (51.7%) was significantly higher than that in urban area (40.3%), and the exposure rate in the western area was higher than those in the eastern and central areas (P<0.001). Among the groups with different education level, the exposure rate in those with education level of primary school and below was highest (49.7%, P<0.001). The exposure protection rate was 26.7%, and the exposure protection rate was highest in the eastern area (29.9%), followed by that in the central area (27.0%) and that in the western area (22.9%) The exposure protection rate in urban area was significantly higher than that in rural area, and the exposure protection rate was lowest in those with education level of primary school and below. The regular exposure protection was taken by only 50.7% of the adults surveyed. Conclusion: The exposure rate of dust and/or harmful gas is high in China, while the exposure protection rate is very low. Health education, occupational protection and supervision should be strengthened among those with low education level, and those living in rural area and in the western area.

[Awareness of knowledge about chronic obstructive pulmonary disease and related factors in residents aged 40 years and older in China, 2014]

Objective: To understand the awareness of knowledge about COPD and related factors in residents aged ≥40 years in China. Methods: Through multi-stage stratified cluster sampling, residents aged ≥40 years were selected from 125 sites of COPD surveillance (2014-2015) in 31 provinces of China for a face to face questionnaire survey. The demographic characteristics and awareness rate of knowledge about COPD among 75 082 subjects were described as frequency and percentage. The awareness rate of knowledge about COPD and its 95% confidence interval (CI) among the residents aged ≥40 years were estimated with complicated sampling weights. Meanwhile, the knowledge awareness related factors were screened in complicated sampling data. Results: The awareness rate of COPD was 9.2%. The awareness rate of pulmonary function test was 3.6% and the awareness rate of COPD-related knowledge was 5.8%. All of the awareness rates were associated with gender, age, education level and occupation. Besides, the awareness rate of pulmonary function test and COPD-related knowledge were related with living area. Compared with females, the ORs of the three awareness rates among males were 0.88, 0.81 and 0.78. Compared with the residents aged ≥70 years, the ORs of the three awareness rates among those aged 60-69 years were 1.28, 1.08 and 1.51. Compared with the residents with education level of primary school or below, the ORs of the three awareness rates among those with college degree or above were 2.28, 3.43 and 3.14. The OR of the awareness rate of pulmonary function test among the residents in the eastern area was 1.77 compared with those in the central area. The ORs of the awareness rate of COPD-related knowledge among the residents in the eastern and western areas were 1.95 and 2.16 compared with those in the central area(all above P<0.05). Among COPD symptoms, the awareness rate of dyspnea was highest (67.9%), and among the risk factors for COPD, the awareness rate of smoking was highest (81.3%). The source of awareness of COPD for most residents was television program (38.2%). Conclusion: The awareness rate of knowledge about COPD was low in residents aged ≥40 years in China in 2014. It is necessary to strengthen the health education about COPD to improve the prevention and control of the disease.

[Preliminary experience of transoral robotic surgery in laryngeal and hypopharyngeal tumors with da Vinci surgical system]

Objective:The purpose of this study was to summarize preliminary clinical experience of transoral robotic surgery (TORS) in laryngeal and hypopharyngeal tumors with da Vinci surgical system.Method:Twelve patients were reviewed who were diagnosed with laryngeal (n=7) and hypopharyngeal tumors (n=5) and treated with TORS in Beijing Anzhen Hospital from July 1, 2016 to January 31, 2018.Result:Ten cases were male and two cases were female. The median age was 58 years old (ranging from 30 to 81 years). The robotic surgeries were performed successfully on all of the 12 patients. The average surgical time was 31.7 min. The average blood loss was 12.3 ml. The average recovery time for oral intake was 4.6 day. All surgical resection margins were free of carcinoma. Eight cases received neck dissection and 7 cases received adjuvant radiotherapy. There were no perioperative complications. There was no local recurrence, metastasis or death except 1 regional recurrence with a follow-up of 3 to 20 months.Conclusion:TORS is a feasible, safe, minimally invasive, and effective surgical procedure in selected laryngeal and hypopharyngeal tumors.

[Efficacy of endoscopic approach to reconstruct the medial orbital fracture with perpendicular plate of ethmoid]

Objective:To study the efficacy of endoscopic sinus approach in the repair of medial orbital fracture with perpendicular plate of ethmoid.Method:Retrospective chart was reviewed in 10 cases receiving endoscopic approach to reconstruct the medial orbital fracture with perpendicular plate of ethmoid.We observed the improvement of the symptom such as diplopia, eye movement,and enophthalmos of the preoperative and postoperative.Result:After postoperative follow-up of 4 months to 23 months, all the patients had no graft loss or displacement, infection and other complications, and except for 1 patient with mild diplopia, other patients recovered completely, including eye movement disorder, diplopia,and enophthalmos.Conclusion:Endoscopic approach is a safe and effective treatment in the repair of medial orbital fracture with perpendicular plate of ethmoid.

[Exploration of feasibility and safety of transoral robotic surgery in pharyngolaryngeal tumors]

Objective: To investigate the indication, feasibility, and safety of da Vinci robotic surgical system in pharyngolaryngeal tumor resection. Methods: Thirty patients were diagnosed with pharyngolaryngeal tumors and treated with a transoral robotic surgery (TORS) in Beijing Anzhen Hospital from June 1, 2016 through November 30, 2017. Inclusion criteria included lesions of the oropharynx (n=13), parapharyngeal space (n=7), larynx (n=6) and hypopharynx (n=4). Twenty cases were males and ten cases were females. The median age was 56 years old (ranging from 30 to 81 years). Results: The robotic surgeries were performed successfully on 30 patients. One patient (3.3%) underwent TORS combined with a neck incision. The mean operative time was 40.7 min. The mean blood loss was 15.8 ml. The mean recovery time for oral intake was 5.3 days. The mean hospital stay was 9 days. None of the patients underwent tracheotomy or mandible split. Postoperative pathological examination showed that 18 cases (60.0%) were malignant and 1 case (5.6%) had positive surgical margin. Sixteen cases received neck dissection. No serious complications occurred during or after the operation. There was no local recurrence, metastasis or death except for regional recurrences in 2 cases (11.1%) with a follow-up of 1 to 18 months(median 13 months). Conclusion: Transoral robotic surgery is a feasible, safe and effective surgical procedure with clear operation field, rapid surgical access, minimally invasive surgery, lesser hemorrhage, good cosmetic effect and fast recovery.

[Transformation of endogenous reactive oxygen species participates into bacterial antibiotic resistance]

A growing body of diversified antibiotic resistances raises a significant challenge to anti-infection clinical therapeutics. The emergence of superbugs carrying MCR-1/2 or NDM-1 determinants underlines the importance and urgency in elucidation of molecular mechanisms shared by antibiotic resistances. It is aware that different classes of bactericidal antibiotics consistently stimulate the production of deleterious reactive oxygen species (ROS), which are accompanied with metabolic disturbance. The different destinations of ROS determine its consequence on bacterial fate. Here, we review antibiotic-induced production, progression and transformation of ROS, as well as its role in the development of antibiotic resistance. Additionally, we anticipate that mesosome-like structures-aided exclusion of hydrogen peroxide might represent a previously-unknown mechanism for antibiotic resistance. This mini-review is aiming to present an update overview on antibiotic resistance and provide clues to the development of novel antibiotics.

[Disease burden of thyroid cancer in the Chinese population, in 1990 and 2013]

OBJECTIVE

To analyze the disease burden of thyroid cancer in the Chinese population, in 1990 and 2013.

METHODS

Data on China from the Global Burden of Disease 2013 (GBD2013) was used to analyze the related parameters as mortality, prevalence,years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) of thyroid cancer in China in 1990 and 2013 among all the Chinese population.

RESULTS

There were 33 939 thyroid cancer patients identified in 2013 (7 146 men and 26 793 women), with an increase of 21 898 patients than the number in 1990. The incidence rate of thyroid cancer increased by 181.86%. The incidence rates of thyroid cancer showed an increase in females but a decrease in males. In 2013, 4 974 people (2 292 men and 2 682 women) died of thyroid cancer, with an increase of 1 810 patients, compared with the figures in 1990. The mortality rate of thyroid cancer in 2013 decreased by 14.29%, compared with the figures in 1990. The mortality rate of thyroid cancer decreased in females while the incidence rate in males showed an increase. The incidence rates increased with age in females, reaching a peak at the 50-54 years old group. The mortality rate of thyroid cancer increased with age. The DALY, YLL and YLD due to thyroid cancer appeared as 13.35, 11.42 and 1.93 ten thousand person years, respectively, in 2013. Between 1990 to 2013, the age-standardized rates on DALY, YLL and YLD decreased from 10.33/100 000 to 8.84/100 000, from 9.60/100 000 to 7.61/100 000 and increased from 0.72/100 000 to 1.23/100 000, respectively. In 2013 the top three incidence rates were recorded in Qinghai, Xinjiang and Fujian provinces while the lowest was in Tibet. Compared with those in 1990, the incidence rates increased in all the provinces except for Tianjin. The top three high mortality rates were recorded in Qinghai, Hong Kong and Fujian and the lowest was also in Tibet. The mortality rates increased in five provinces.

CONCLUSIONS

Compared with those in 1990, the incidence of thyroid cancer increased, but the mortality decreased in 2013. Although significant decrease of DALY due to thyroid cancer was seen in 2013, the YLD burden was still increasing.

Mapping the Interaction Anatomy of BmP02 on Kv1.3 Channel

The potassium channel Kv 1.3 plays a vital part in the activation of T lymphocytes and is an attractive pharmacological target for autoimmune diseases. BmP02, a 28-residue peptide isolated from Chinese scorpion (Buthus martensi Karsch) venom, is a potent and selective Kv1.3 channel blocker. However, the mechanism through which BmP02 recognizes and inhibits the Kv1.3 channel is still unclear. In the present study, a complex molecular model of Kv1.3-BmP02 was developed by docking analysis and molecular dynamics simulations. From these simulations, it appears the large β-turn (residues 10–16) of BmP02 might be the binding interface with Kv 1.3. These results were confirmed by scanning alanine mutagenesis of BmP02, which identified His9, Lys11 and Lys13, which lie within BmP02’s β-turn, as key residues for interacting with Kv1.3. Based on these results and molecular modeling, two negatively charged residues of Kv1.3, D421 and D422, located in turret region, were predicted to act as the binding site for BmP02. Mutation of these residues reduced sensitivity of Kv 1.3 to BmP02 inhibition, suggesting that electrostatic interactions play a crucial role in Kv1.3-BmP02 interaction. This study revealed the molecular basis of Kv 1.3 recognition by BmP02 venom, and provides a novel interaction model for Kv channel-specific blocker complex, which may help guide future drug-design for Kv1.3-related channelopathies.

[Disease burden of leukemia in the Chinese population, in 1990 and 2013]

OBJECTIVE

To analyze the disease burden of leukemia in the Chinese population, in 1990 and 2013.

METHODS

Data related to province-specific disease burden in China was used to analyze and compare related parameters as incidence, mortality, the disability-adjusted life years (DALY), years of life lost due to premature mortality (YLL) and years lived with disability (YLD) on leukemia in China in 1990 and 2013. Standardized mortality rates of leukemia in each province in 2013 and the changes since 1990, were described.

RESULTS

In 2013, the standardized incidence and mortality rates of leukemia in China were 6.70/100 000 and 4.05/100 000, with reduction of 8.84% and 36.22% when compared with those in 1990, respectively. The standardized DALY rate and YLL rate appeared as 174.58/100 000 and 170.42/100 000 in 2013, with 44.68% and 45.32% reduction, respectively, when compared with the figures in 1990. The standardized YLD rate of leukemia in 2013 was 4.16/100 000, with an 6.94% increase, comparing with that in 1990. Age-specific data showed that the proportion of people who died from leukemia among those who died from all the cancers was more than 10% in people under 35 years old. DALY rate of leukemia was highest among children aged 5 years old and under, which appeared as 317.61/100 000. Compared with those in 1990, the standardized mortality of leukemia appeared decreasing in all the provinces in 2013. The top three provinces with the highest standardized mortality of leukemia in 2013 were Xinjiang (4.72/100 000), Ningxia (4.56/100 000) and Fujian (4.50/100 000).

CONCLUSIONS

Although the standardized incidence rate, mortality rate, DALY rate and YLL rate due to leukemia decreased, YLD rate due to leukemia increased. Proportions of children and adolescents who died from leukemia remained high. Although the standardized mortalities of leukemia decreased in all the provinces, the differences among them still remained.

Spreading endothelial cell dysfunction in response to necrotic trophoblasts. Soluble factors released from endothelial cells that have phagocytosed necrotic shed trophoblasts reduce the proliferation of additional endothelial cells

The pathogenesis of preeclampsia is not clear but the disease is characterised by systemic endothelial cell dysfunction that is considered to be triggered by a placental factor. Necrotic trophoblastic debris that is deported in the maternal blood is one possible placental trigger for preeclampsia. Syncytial knots were first associated with preeclampsia over 100 years ago. However, syncytial knots are very large and most are trapped in the pulmonary capillaries making it difficult to envisage how they could lead to widespread systemic endothelial cell dysfunction. This study was undertaken to examine whether conditioned medium from endothelial cells that have phagocytosed necrotic trophoblastic debris could adversely affect the proliferation or survival of fresh endothelial cells. Trophoblastic cellular debris, harvested from placental explants was added to endothelial cell monolayers directly or after induction of necrosis by freeze-thawing. Conditioned medium from the endothelial cell cultures was exposed to fresh endothelial cells and their proliferation measured by Alamar Blue, and CyQUANTNF cell proliferation assays. Endothelial cell death was examined by a fluorogenic caspase-3 activity assay and LDH release. Conditioned medium from endothelial cells that had phagocytosed necrotic but not apoptotic trophoblastic debris significantly inhibited the proliferation of fresh endothelial cells but did not induce their death. The conditioned medium also reduced cell-surface endoglin expression by fresh endothelial cells. These results confirm that phagocytosis of necrotic trophoblastic debris by endothelial cells results in the secretion of soluble factors that might explain how necrotic trophoblastic debris trapped in the pulmonary capillaries could induce systemic endothelial cell dysfunction.

Comparative analysis of cardiac troponin I and creatine kinase-MB as markers of acute myocardial infarction

BACKGROUND

The World Health Organization (WHO) criteria for the diagnosis of acute myocardial infarction (AMI) includes presentation of chest pain over 20 min, evolutionary changes on the electrocardiogram (ECG), and abnormal levels of cardiac enzymes.

HYPOTHESIS

A multicenter study was conducted to evaluate the efficacy of cardiac troponin I (cTnI) in detecting and ruling out AMI.

METHODS

The normal range for cTnI in 149 apparently healthy subjects without known history of cardiac or other diseases was 0 to 0.5 ng/ml. Cutoffs of 2.5 ng/ml for c TnI and 5.0 ng/ml for creatine kinase-MB (CK-MB) were used.

RESULTS

The diagnostic sensitivity of blood collected from 291 consecutive patients with suspicion of AMI was 95.0 and 96.4%, respectively, for samples obtained at 4-48 h after AMI onset. CK-MB was more sensitive during the early 4-8 h interval (84 vs. 74%); both had 100% sensitivity from 12-36 h. CTnI remained at 100% for 72 h, while CK-MB declined to 57%. The clinical specificity was 97.4 vs. 85.8%, respectively, on non-AMI patients with cardiac and noncardiac diseases, and those with renal disease.

CONCLUSION

cTnI is an excellent marker for detecting and ruling out AMI, because it has better specificity and a wider diagnostic window than the accepted standard, CK-MB.

Resonant Raman scattering of the smallest single-walled carbon nanotubes

We report optical properties of the smallest single-walled carbon nanotubes (SWNTs) with a diameter of only 3 A. These ultrasmall SWNTs are fabricated in the elliptical nanochannels of an AlPO-11 (AEL) single crystal. Polarized and resonant Raman scattering unambiguously revealed that these 0.3 nm SWNTs are of (2,2) armchair symmetry. Interestingly, the (2,2) armchair tube has two metastable ground states corresponding to two slightly different lattice constants in the axial direction: one state is metallic and the other is semiconducting.

Electricity production from beer brewery wastewater using single chamber microbial fuel cell

The performance of electricity production from beer brewery wastewater in a single chamber membrane-free microbial fuel cell (MFC) was investigated. Experimental results showed that the MFCs could generate electricity from full-strength wastewater (2,239 mg-COD/L, 50 mM PBS added) with the maximum power density of 483 mW/m2 (12 W/m3) at 30 degrees C and 435 mW/m2 (11 W/m3) at 20 degrees C, respectively. Temperature was found to have bigger impact on cathode potential than anode potential. Results suggested that it is feasible to generate electricity with the treatment of beer brewery wastewater.

Blockage of intermediate-conductance-Ca(2+) -activated K(+) channels inhibits progression of human endometrial cancer

Potassium (K(+)) channels have been implicated in proliferation of some tumor cells. However, whether K(+) channels are important to the pathogenesis of endometrial cancer (EC) remains unknown. In the present study, we report that intermediate-conductance Ca(2+)-activated K(+) (IKCa1) channels play a critical role in the development of EC. The expression of IKCa1 at both mRNA and protein levels in EC tissues was greatly increased than that in atypical hyperplasia and normal tissues. Treatment of EC cells with clotrimazole and TRAM-34, two agents known to inhibit IKCa1 channels, suppressed the proliferation of EC cells and blocked EC cell cycle at G(0)/G(1) phase. Similarly, downregulation of IKCa1 by siRNA against IKCa1 inhibited EC cell proliferation and arrested its cell cycle at G(0)/G(1) phase. A clotrimazole-sensitive K(+) current was induced in EC cells in response to the increased Ca(2+). The current density induced by Ca(2+) was greatly reduced by clotrimazole, TRAM-34, charybdotoxin or downregulation of IKCa1 by the siRNA against IKCa1. Furthermore, TRAM-34 and clotrimazole slowed the formation in nude mice of tumor generated by injection of EC cells. Our results suggest that increased activity of IKCa1 channel is necessary for the development of EC.

Layer spacings in coherently strained epitaxial metal films

Laterally resolved measurements of the quantum size effect (QSE) in electron reflectivity are made with low energy electron microscopy on coherently strained Ag films on a W(110) surface. The evolution of the total film thickness with increasing number of atomic layers is determined accurately by dynamical theory analysis of the QSE features. Combined with a model of layer spacings obtained from first-principles calculations, this provides for a novel approach to determine the buried interface layer spacing, which is inaccessible to other methods.

Electro-catalytic oxidation of phenol on several metal-oxide electrodes in aqueous solution

Elecrtochemical degradation of phenol was evaluated at five typical anodes for mineralization to carbon dioxide or for being a pre-treatment method in toxic aromatic compounds. Three kinds of RuO(2)-base electrodes were prepared by thermal deposition, which were coated by the oxides of Ru or by Ru, Sn and Sb or by Ru, Sn, Sb and Gd on Ti metal surface, respectively. Another electrode Ti/ PbO(2) was prepared by electro-deposition method with PbO(2) coated on Ti. A Pt electrode was chosen for comparison. Characteristics of the typical five electrodes were investigated by cyclic voltammetry, SEM and its degradation ability for phenol. Performance for phenol degradation of the three RuO(2) electrodes lie in: Ti/Sb-Sn-RuO(2)-Gd> Ti/Sb-Sn-RuO(2)> Ti/RuO(2) and the electrode with beta-PbO(2) coating was superior to RuO(2)-based electrodes and Pt electrode. Aromatic ring opening take place at all researched electrodes and it is supposed that electrolysis run stop at different intermediates, such as benzoquinone, maleic acid, etc. Under the present experimental conditions, whole mineralization to CO(2) takes place only in the beta-PbO(2) anode. A pathway of electrochemical degradation of phenol was suggested based on the experimental analysis.

Serum antioxidant status of civil aircrew

Objective. To study the serum antioxidant status in civil aircrew members who had more than 4000 h of cumulative flight hours, therefore exposed to a higher dose of cosmic radiation comparing to the dose received by ground residents. Method. Differences in the serum levels of total antioxidant capacity (TAOC), superoxide dismutase (SOD) and malondialdehyde (MDA) were investigated in 230 crew members, 37 local ground residents in Xinjiang, and 37 ground residents in Tianjin. Result. Significantly higher levels of all the three serum indexes were found in civil aircrew members. Serum levels of TAOC and SOD were higher in Xinjiang than in Tianjin ground residents, although no difference was found for MDA. Positive correlations were observed among the three serum indexes in this study. Conclusion. The elevated serum level of MDA in civil aircrew members deserves a proper attention by health care policy makers.

A randomized placebo-controlled trial to assess the efficacy of antiinflammatory therapy with methylprednisolone in unstable angina (MUNA trial)

AIMS

The purpose of this study was to assess the efficacy of antiinflammatory therapy with methylprednisolone during the acute phase of unstable angina.

METHODS

This is a randomized 'prospective' double-blind, placebo-controlled trial. Patients with the diagnosis of unstable angina were randomized to a 48-h course of methylprednisolone (n=81) or placebo (n=85). Patient care and therapy were otherwise decided by their attending cardiologist. The primary end-point was a composite of in-hospital recurrence of angina, silent ischaemia on Holter recording, emergency coronary revascularization, readmission with unstable angina, and myocardial infarction or death during the 30-day follow-up.

RESULTS

The two groups were well balanced and had similar clinical characteristics at baseline. Forty-eight hours after randomization, mean C-reactive protein levels decreased by 2.6 mg. l(-1)in the methylprednisolone group, but increased by 1.6 mg. l(-1)in the placebo group (P=0.03). The primary end-point occurred in 44% of the methylprednisolone patients and in 33% of the placebo patients (P=0.12). Coronary revascularization rates were equal between the two groups (38% and 40%). When adjustment was made for the difference in revascularization times, a trend towards better event-free survival was seen in the control group (67% vs 57%;P=0.09).

CONCLUSION

A 48 h course of antiinflammatory therapy with methylprednisolone given at the doses of this study did not improve the short-term outcome of patients with unstable angina.

Cutaneous blood vessels in scent pigs

The purpose of this study was to systematically provide anatomic data for flap research in plastic surgery on the cutaneous blood vessels. Seven scent pigs used in this study were killed anesthetically, and their carotid vessels were intubated and injected with a black liquid rubber. Twenty-four hours later, the integument of the scent pig was removed, and the perforating points of the cutaneous vessels were recorded. The different-sized pieces of integument became transparent. Part of this transparent skin tissue was cut into cross-sectional strips. There were three types of the cutaneous vascular source, the same as in humans. Six division levels of vessels in the skin were identified, which formed five vascular plexuses and two systems (the perforating vessel system and the cutaneous vessel system). There were two sets of vein systems: the concomitant vein and the oscillating vein; the latter can be divided into regular and irregular types. The structures of the perforating vessel system and the cutaneous vessel system were the morphological basis for choosing flaps. Two anatomic points have been emphasized: the preserved vascular plexus in thin flaps (not the subcutaneous vascular network reported previously) and the dependency of vascular structure on its location. Otherwise, this study has also provided two new kinds of flaps used in experimental study: the arterial loop flap and the intermuscular septal perforator flap. Although there were differences as well as similarities in skin vasculature between humans and the scent pig, the scent pig is still suitable for flap research.

Polymorphisms in the genes for coagulation factors II, V, and VII in patients with ischemic heart disease

BACKGROUND

Cardiovascular disease remains the leading cause of mortality in the United States, accounting for approximately 33% of all deaths in this country. Of these deaths, most are due to acute myocardial infarctions (AMIs), which are associated with thrombotic coronary artery obstruction and/or occlusion. These events could potentially be due to alterations in genes coding for coagulation factors. Several polymorphisms have been described in the factor II, V, and VII genes, which may predispose one to increased risk for ischemic heart disease (IHD).

OBJECTIVE

To determine if mutations in 3 coagulation factor genes could predispose an individual to increased risk for arterial thrombosis as a mechanism for developing unstable angina (UA) or AMI.

METHODS

We examined 125 hospitalized patients (mean age, 53 +/- 6 years, 79 men and 46 women), including 32 with AMI, 68 with UA, and 25 noncardiac controls, for a genetic predisposition for increased risk of IHD. EDTA-anticoagulated whole blood was collected at the time of hospital admission. DNA was extracted, and the polymorphisms were detected by polymerase chain reaction amplification of these genes with subsequent restriction enzyme digestion and gel electrophoresis.

RESULTS

Our results showed that 3 (9.4%), 3 (4.4%), and 1 (4%) individuals were heterozygous for prothrombin G20210A and 3 (9.4%), 5 (7.4%), and 1 (4%) individuals were heterozygous for factor V Leiden in the AMI, UA, and control groups, respectively. The following genotype frequencies for the factor VII R353Q polymorphism were identified: 25 (78.1%), 56 (82.4%), and 18 (72%) with RR and 7 (21.9%), 12 (17. 6%), and 7 (28%) with RQ in the AMI, UA, and control groups, respectively. No QQ homozygotes were identified. For the HVR4 size polymorphism, the following genotypes were identified: 3 (9.4%), 4 (5.9%), and 5 (20%) individuals with H7H7; 11 (34.4%), 33 (48.5%), and 12 (48%) with H6H7; and 18 (56.2%), 31 (45.6%), and 8 (32%) with H6H6 genotypes in the AMI, UA, and control groups, respectively. There were no H7H5 and H6H5 genotypes found in this study.

CONCLUSIONS

Although the frequency differences of these polymorphisms in patients with AMI and UA were not statistically significant from those in controls, several trends are consistent with what has been reported in the literature. Although any of these or other undefined genetic abnormalities may result in IHD, it is possible that phenotypic predisposition to IHD initially presents as UA. A larger population study addressing the significance of these polymorphisms in the sequence of events that lead to IHD, including cases of UA, is warranted.

Optical properties of an ionic-type phononic crystal

An ionic-type phononic crystal composed of two ferroelectric media with opposite spontaneous polarization aligned periodically in a superlattice structure was studied theoretically and experimentally. The coupling between vibrations of the superlattice and the electromagnetic waves results in various long-wavelength optical properties, such as microwave absorption, dielectric abnormality, and polariton excitation, that exist originally in ionic crystals. The results show that this artificial crystal structure can be used to simulate the microscopic physical processes in real crystals.

[Effect of human inhibin alpha-fragment 1-32-Tyr(P33) on apoptosis of cultured rat corpus luteal cells]

Recently, increasing evidence suggests that alpha inhibin or related proteins may be a functional regulator in the ovary, which is independent of hetero-dimer inhibin. In our previous study, it was demonstrated that human inhibin alpha-N-terminal fragment Tyr-1-32 (P(33)) significantly inhibited progesterone production by rat corpus luteal cells in vitro, and stimulated luteal functional regression and apoptosis in vivo. In the present work, the action of P(33) on apoptosis was further studied in vitro in cultured rat CL cells. Gel electrophoretic analysis for detection of oligonucleosomal DNA fragmentation, AO-EB or PI assays and flow cytometry were used to observe the action of P(33) on the occurrence of spontaneous apoptosis by collagenase-DNase dispersed CL cells, obtained from PMSG-hCG induced pseudopregnant rats. The results showed that P(33) (1 microg/ml) stimulated spontaneous apoptosis of CL cells. The inhibitor of tyrosine protein kinase, genistein (50 microg/ml),inhibited P(33) enhanced spontaneous apoptosis. RNA and protein synthesis inhibitors cycloheximide (Cyx,50 microg/ml) and actinomycin D(Act D,50 microg/ml) did not protect the cells from apoptosis stimulated by P(33). The results suggest that P(33) stimulates spontaneous apoptosis in cultured rat CL cells with the involvement of tyrosine specific protein kinase system. This work provides further evidence for the hypothesis that alpha inhibin or related protein might be a functional regulator in the ovary.

Simultaneous rapid measurement of whole blood myoglobin, creatine kinase MB, and cardiac troponin I by the triage cardiac panel for detection of myocardial infarction

This multicenter study evaluated the Biosite Triage(R) Cardiac Panel as a quantitative, multimarker, whole blood system for the detection of acute myocardial infarction (MI). Optimum cutoffs for the discrimination of acute MI (n = 192 patients, 59 with MI) as determined by ROC curve analyses were as follows: 0.4 microgram/L for cardiac troponin I (cTnI); 4.3 microgram/L for the creatine kinase MB isoenzyme (CK-MB); and 107 microgram/L for myoglobin. The Triage Panel showed the following concordances for detection or rule-out of MI compared with established devices: cTnI >89%; CK-MB >81%; myoglobin >69%. No significant differences were present between methods for the same marker. Diagnostic efficiencies demonstrated comparable sensitivities and specificities for the diagnosis of MI in patients presenting with symptoms compared with the Dade, Beckman, and Behring CK-MB, cTnI, and myoglobin assays; the ratio of sensitivity to specificity for each marker was as follows: cTnI, 98%:100%; CK-MB, 95%:91%; myoglobin, 81%:92%. The areas under the ROC curves for the Biosite myoglobin, CK-MB, and cTnI were 0.818, 0.905, and 0.970, respectively; the areas were significantly different, P <0.05. In patients with skeletal muscle injury and renal disease, the Triage cTnI showed 94% and 100% specificity, respectively. The Triage panel offers clinicians a whole blood, point-of-care analysis of multiple cardiac markers that provides excellent clinical sensitivity and specificity for the detection of acute MI.

The pharmacokinetics of intravenous estradiol--a preliminary study

Estradiol USP was extemporaneously compounded for intravenous administration. Eight postmenopausal women were randomized to receive one of four estradiol dosages. Serum estradiol concentrations were determined at frequent intervals after single bolus dosing. The concentration-time profile was stripped and fit, and pharmacokinetic values were generated. Approximate dosage proportionality was seen with area under the curve, the terminal half-life was 27.45+/-5.65 minutes, and volume of distribution was very low (0.082+/-0.015 L/kg). Estradiol was well tolerated by all study participants.

Biochemical differences between cTnT and cTnI and their significance for diagnosis of acute coronary syndromes

Although assays for cardiac troponin T (cTnT) and cardiac troponin I (cTnI) exhibit similar clinical performance in patients with acute coronary syndromes for diagnosis and risk stratification, there are differences in the release and clearance of these proteins from damaged myocytes. There are also differences in the percentages of patients with chronic renal failure and skeletal muscle myopathies that have abnormal results. A review of the biochemistry of these proteins may provide insights as to the nature of these differences. Cardiac troponin T has a higher overall tissue concentration and free cytoplasmic concentrations than cTnI, and appears in blood of patients with acute myocardial infarction as a mixture of complexed (cTnT-I-C) and free cTnT. Cardiac troponin I is more hydrophobic and appears in blood predominately in the binary complex (I-C) form, with smaller amounts of the ternary (T-I-C) complex. Degradation of the complex will lead to faster clearance of the protein. There are also differences in standardization and availability of commercial troponin kits. Cardiac troponin T assays are available from only one manufacturer and are standardized to a single material, whereas cTnI is available from multiple vendors. While there is some degree of correlation between assays, there are significant proportional biases between results which can be problematical when different tests are made on the same patient.

Comparison of cardiac troponin I, creatine kinase-MB, and myoglobin for detection of acute ischemic myocardial injury in a swine model

To study the comparative value of the levels of cardiac troponin I (cTnI), creatine kinase-MB isoenzyme (CK-MB), and myoglobin in the detection of acute ischemic myocardial injury, we serially measured plasma concentrations of these cardiac proteins in 12 pigs with myocardial ischemia subtending severe coronary artery stenoses and in 5 pigs with a sham operation performed, but without coronary artery stenosis. In the stenosis group, flow in the left anterior descending (LAD) artery was reduced by 36% and maintained for 24 hours (n = 3), 7 days (n = 6), or 4 weeks (n = 3). Flow in the coronary artery was measured by a flowmeter, and regional left ventricular dysfunction was monitored by echocardiography. Myocardial infarction was identified with triphenyltetrazolium chloride staining. All pigs with stenosis of the LAD had significant ultrastructural abnormalities consisting of loss of myofibrils and an increase in mitochondria and glycogen deposition. Cardiac proteins were released in all pigs with stenosis of the LAD artery during the development of myocardial ischemia; the levels of cTnI, CK-MB, and myoglobin increased significantly relative to the baseline. The sensitivity and specificity for cTnI were higher than for CK-MB or myoglobin. Results of this study show that cTnI is the better marker for the detection of acute ischemic myocardial injury. Increased levels of cTnI can be found in reversible and irreversible myocardial ischemic injury in this model.

Prognostic role of troponin T versus troponin I in unstable angina pectoris for cardiac events with meta-analysis comparing published studies

Controversy exists as to the clinical roles and relative specificities of cardiac troponin T or I in patients with unstable angina pectoris (UAP). We measured troponin T and I levels on admission in 123 patients with UAP. Of the 107 patients with normal creatine kinase during the first 24 hours, troponin T and I were elevated in 14 and 13 patients, respectively. At 30 days, 5 of 14 patients (36%) with elevated troponin T and 3 of 93 patients (3.2%) with normal troponin T had acute myocardial infarction (odds ratio [OR], 16.7; 95% confidence interval [CI] 3.4 to 81.5; p <0.001). Of 13 patients with elevated troponin I, 5 patients (39%) and 3 of 94 patients (3.2%) with normal troponin I had acute myocardial infarction (odds ratio, 21.7; 95% CI 4.3 to 110; p <0.001). No deaths occurred within 30 days. Both markers demonstrated equivalent sensitivity (63%) and specificities (troponin T: 91%; troponin I: 92%) for myocardial infarction. Meta-analysis of 12 published troponin T and 9 troponin I studies in patients with UAP produced risk ratios of 4.2 (95% CI 2.7 to 6.4, p <0.001) for troponin I compared with 2.7 (95% CI 2.1 to 3.4, p <0.001) for troponin T. Comparison of the sensitivities and specificities of both markers using summary receiver operating characteristic curves showed no significant difference in their abilities to predict acute myocardial infarction and cardiac death. Troponin T and I show similar prognostic significance for acute myocardial infarction or death in the same patients with UAP. The 2 markers are equally sensitive and specific, as confirmed by meta-analysis, and this supports a role in risk stratification.

Characterization of cardiac troponin subunit release into serum after acute myocardial infarction and comparison of assays for troponin T and I. American Association for Clinical Chemistry Subcommittee on cTnI Standardization

We examined the release of cardiac troponin T (cTnT) and I (cTnI) into the blood of patients after acute myocardial infarction (AMI). Three postAMI serum samples were applied in separate analytical runs onto a calibrated gel filtration column (Sephacryl S-200), and the proteins were separated by molecular weight. Using commercial cTnT and cTnI assays measured on collected fractions, we found that troponin was released into blood as a ternary complex of cTnT-I-C, a binary complex of cTnI-C, and free cTnT, with no free cTnI within the limits of the analytical methodologies. The serum samples were also examined after incubation with EDTA and heparin. EDTA broke up troponin complexes into individual subunits, whereas heparin had no effect on the assays tested. We added free cTnC subunits to 24 AMI serum samples and found no marked increase in the total cTnI concentrations, using an immunoassay that gave higher values for the cTnI-C complex than free cTnI. To characterize the cross-reactivity of cTnT and cTnI assays, purified troponin standards in nine different forms were prepared, added to serum and plasma pools, and tested in nine quantitative commercial and pre-market assays for cTnI and one approved assay for cTnT. All nine cTnI assays recognized each of the troponin I forms (complexed and free). In five of these assays, the relative responses for cTnI were nearly equimolar. For the remainder, the response was substantially greater for complexed cTnI than for free cTnI. Moreover, there was a substantial difference in the absolute concentration of results between cTnI assays. The commercial cTnT assay recognized binary and ternary complexes of troponin on a near equimolar basis. We conclude that all assays are useful for detection of cardiac injury. However, there are differences in absolute cTnI results due to a lack of mass standardization and heterogeneity in the cross-reactivities of antibodies to various troponin I forms.