[Application and research advances of delayed sural neurotrophic vascular flap for diabetic foot ulcers]

Diabetic foot ulcer is one of the serious complications of diabetes. Diabetic wounds are of great difficulty to repair, causing a high amputation rate and a great burden to patients and their family members and society. Researches showed that the delayed sural neurotrophic vascular flap has a great effect in repairing diabetic foot ulcers. This article mainly reviewed the clinical status and research advances of the delayed sural neurotrophic vascular flap in repairing diabetic foot ulcers, intending to provide a reference for its application and research.

[Clinical repair strategy for ischial tuberosity pressure ulcers based on the sinus tract condition and range of skin and soft tissue defects]

Objective: To investigate the clinical repair strategy for ischial tuberosity pressure ulcers based on the sinus tract condition and range of skin and soft tissue defects. Methods: The study was a retrospective observational study. From July 2017 to March 2023, 21 patients with stage Ⅲ or Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to the First Affiliated Hospital of Nanchang University, including 13 males and 8 females, aged 14-84 years. There were 31 ischial tuberosity pressure ulcers, with an area of 1.5 cm×1.0 cm-8.0 cm×6.0 cm. After en bloc resection and debridement, the range of skin and soft tissue defect was 6.0 cm×3.0 cm-15.0 cm×8.0 cm. According to the depth and size of sinus tract and range of skin and soft tissue defects on the wound after debridement, the wounds were repaired according to the following three conditions. (1) When there was no sinus tract or the sinus tract was superficial, with a skin and soft tissue defect range of 6.0 cm×3.0 cm-8.5 cm×6.5 cm, the wound was repaired by direct suture, Z-plasty, transfer of buttock local flap, or V-Y advancement of the posterior femoral cutaneous nerve nutrient vessel flap. (2) When the sinus tract was deep and small, with a skin and soft tissue defect range of 8.5 cm×4.5 cm-11.0 cm×6.5 cm, the wound was repaired by the transfer and filling of gracilis muscle flap followed by direct suture, or Z-plasty, or combined with transfer of inferior gluteal artery perforator flap. (3) When the sinus tract was deep and large, with a skin and soft tissue defect range of 7.5 cm×5.5 cm-15.0 cm×8.0 cm, the wound was repaired by the transfer and filling of gracilis muscle flap and gluteus maximus muscle flap transfer, followed by direct suture, Z-plasty, or combined with transfer of buttock local flap; and transfer and filling of biceps femoris long head muscle flap combined with rotary transfer of the posterior femoral cutaneous nerve nutrient vessel flap; and filling of the inferior gluteal artery perforator adipofascial flap transfer combined with V-Y advancement of the posterior femoral cutaneous nerve nutrient vessel flap. A total of 7 buttock local flaps with incision area of 8.0 cm×6.0 cm-19.0 cm×16.0 cm, 21 gracilis muscle flaps with incision area of 18.0 cm×3.0 cm-24.0 cm×5.0 cm, 9 inferior gluteal artery perforator flaps or inferior gluteal artery perforator adipofascial flaps with incision area of 8.5 cm×6.0 cm-13.0 cm×7.5 cm, 10 gluteal maximus muscle flaps with incision area of 8.0 cm×5.0 cm-13.0 cm×7.0 cm, 2 biceps femoris long head muscle flaps with incision area of 17.0 cm×3.0 cm and 20.0 cm×5.0 cm, and 5 posterior femoral cutaneous nerve nutrient vessel flaps with incision area of 12.0 cm×6.5 cm-21.0 cm×10.0 cm were used. The donor area wounds were directly sutured. The survival of muscle flap, adipofascial flap, and flap, and wound healing in the donor area were observed after operation. The recovery of pressure ulcer and recurrence of patients were followed up. Results: After surgery, all the buttock local flaps, gracilis muscle flaps, gluteus maximus muscle flaps, inferior gluteal artery perforator adipofascial flaps, and biceps femoris long head muscle flaps survived well. In one case, the distal part of one posterior femoral cutaneous nerve nutrient vessel flap was partially necrotic, and the wound was healed after dressing changes. In another patient, bruises developed in the distal end of inferior gluteal artery perforator flap. It was somewhat relieved after removal of some sutures, but a small part of the necrosis was still present, and the wound was healed after bedside debridement and suture. The other posterior femoral cutaneous nerve nutrient vessel flaps and inferior gluteal artery perforator flaps survived well. In one patient, the wound at the donor site caused incision dehiscence due to postoperative bleeding in the donor area. The wound was healed after debridement+Z-plasty+dressing change. The wounds in the rest donor areas of patients were healed well. After 3 to 15 months of follow-up, all the pressure ulcers of patients were repaired well without recurrence. Conclusions: After debridement of ischial tuberosity pressure ulcer, if there is no sinus tract formation or sinus surface is superficial, direct suture, Z-plasty, buttock local flap, or V-Y advancement repair of posterior femoral cutaneous nerve nutrient vessel flap can be selected according to the range of skin and soft tissue defects. If the sinus tract of the wound is deep, the proper tissue flap can be selected to fill the sinus tract according to the size of sinus tract and range of the skin and soft tissue defects, and then the wound can be closed with individualized flap to obtain good repair effect.

[One case of acute poisoning with stramonium]

This paper reported 1 case of poisoning caused by stramonium. Cases of Datura poisoning have been reported nationwide, Its effect on the central nervous system of patients is characterized by first excitation and then inhibition, clinical manifestations include decreased gland secretion, dilated pupils, and tachycardia, etc. Its poisoning mechanism is anticholinergic effect, the effect on Peripheral nervous system is to inhibit Parasympathetic nervous system. Hemoperfusion combined with neostigmine anticholinergic therapy at the early stage of poisoning can effectively improve the clinical symptoms of patients in a short time.

[Application and exploration of small dose omalizumab in patients with recurrent eosinophilic sinusitis after extended sinus surgery]

Objective: To explore the short-term efficacy of small dose omalizumab in refractory sinusitis with eosinophilia after extended sinus surgery. Methods: A total of 24 patients who met the diagnostic criteria for eosinophilic chronic rhinosinusitis and remained poorly controlled after multiple surgical treatments were included in this study. These patients were admitted to Hunan People's Hospital between January 2020 and June 2022, and comprised 13 males and 11 females with an average age of (46.43±13.74) years. The patients were randomly divided into experimental group (12 cases) and control group (12 cases), both of which underwent extended sinus opening surgery. The experimental group received a small dose of omalizumab (150 mg/month) for 4 months, while no omalizumab was applied in the control group. All patients were followed up monthly, subjective and objective symptom scores were collected and compared between groups, which included visual analogue scale (VAS) score, sino-nasal outcome test (SNOT)-22 score, Lund-Mackay score, and Lund-Kennedy score. Statistical analysis was performed using SPSS 24.0 software. Results: The baseline was set at 1 month after surgery. There was no significant difference in baseline clinical characteristics between the two groups. After 4 months of treatment with omalizumab, the experimental group showed significant improvements in VAS scores for nasal obstruction, rhinorrhea, hyposmia, SNOT-22 score, and Lund-Kennedy score (3.11±1.05 vs 6.44±1.13, 2.00±0.87 vs 6.55±1.33, 2.22±0.67 vs 7.00±1.22, 4.44±0.88 vs 15.22±1.20, 1.67±1.00 vs 7.44±0.88, respectively, all P<0.001). Compared to the control group at 4 months after baseline, the experimental group had significantly lower scores for nasal obstruction, rhinorrhea, hyposmia, SNOT-22, and Lund-Kennedy (3.11±1.05 vs 7.11±1.17, 2.00±0.87 vs 7.67±1.41, 2.22±0.67 vs 7.56±0.88, 4.44±0.88 vs 15.33±2.34, 1.67±1.00 vs 9.00±1.41, respectively, all P<0.001). During a 2-month follow-up period after drug withdrawal, the VAS, SNOT-22, and Lund-Kennedy scores of the experimental group were slightly higher than those before drug withdrawal but showed no significant difference (3.44±1.33 vs 3.11±1.05, 2.22±1.09 vs 2.00±0.86, 2.55±0.88 vs 2.22±0.66, 4.77±0.97 vs 4.44±0.88, 2.11±1.05 vs 1.67±1.00, respectively, all P>0.05). Conclusion: For patients of refractory sinusitis with eosinophilia, a combination of extended sinus surgery and postoperative small dosage of omalizumab can effectively control mucous inflammation, promote mucosal epithelization, and play an important role in the critical early stage of disease recovery.

Optical spectrum analyzers and typical applications in astronomy and remote sensing

Scientists are increasingly relying on astronomical and remote sensing technologies to gain deeper insights into the Earth and the universe. In these fields, the optical spectrum analyzer (OSA) or spectrometer plays a pivotal role. This Review offers a comprehensive overview of the fundamental principles, key parameters, and applications of various branches of traditional OSAs, including prisms, gratings, interferometers, tunable filters, and reconstructive spectrometers. We specifically focus on their latest major applications in astronomy and remote sensing. Additionally, we present a mathematical model of the generalized reconstructive spectrometer and provide a summary of its principles pertaining to spectral mapping, reconstruction, and imaging. Despite its limited aperture and étendue, the reconstructive spectrometer holds great potential for future use in astronomy and remote sensing due to its compact size and exceptional ultrahigh spectral resolution.

[Clinical characteristics of anomalous aortic origin of a coronary artery in children]

Objective: To analyze the clinical characteristics, diagnosis and treatment of anomalous aortic origin of a coronary artery (AAOCA) in children. Methods: There were 17 children diagnosed with AAOCA from January 2013 to January 2022 in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine.Their clinical manifestations, laboratory and imaging data, treatment and prognosis were retrospectively analyzed. Results: These 17 children included 14 males and 3 females, with the age of (8.7±3.5) years. There were 4 anomalous left coronary artery (ALCA) and 13 anomalous right coronary artery (ARCA). Seven children presented with chest pain or chest pain after exercise, three patients presented with cardiac syncope, one complained chest tightness and weakness, and the other six patients had no specific symptoms. Cardiac syncope and chest tightness occurred in patients with ALCA. Fourteen children had the dangerous anatomical basis of myocardial ischemia caused by coronary artery compression or stenosis on imaging. Seven children had coronary artery repair, of whom two were ALCA and five were ARCA. One patient had received heart transplantation because of heart failure. The incidence of adverse cardiovascular events and poor prognosis in ALCA group was higher than that in ARCA group (4/4 vs. 0/13, P<0.05). They were followed up in the outpatient department regularly for 6 (6, 12) months; except for the one who lost visit, the rest of the patients had a good prognosis. Conclusions: Cardiogenic syncope or cardiac insufficiency usually occurs in ALCA, and adverse cardiovascular events and poor prognosis are more common in ALCA than in ARCA. Early surgical treatment should be considered for children with ALCA and ARCA accompanied by myocardial ischemia.

[Potential application of improved hard tissue section technique in the clinical pathological diagnosis of bone and bone marrow]

Objective: To discuss the application value of hard tissue section in the clinicopathology diagnosis. Methods: From March 2021 to December 2021, bone slices of 19 patients (1 patient with osteochondroma, 2 patients with chondrosarcoma, 4 patients with osteosarcoma, 2 patients with fibrous dysplasia, 2 patients with bone metastasis from thyroid papillary carcinoma, 2 patients with osteomyelitis, 4 patients with giant cell tumor of bone, 2 patients with Ewing sarcoma) and 16 hemopathy patients were collected from the Department of Pathology, Shanghai Sixth People's Hospital. Of the osteopathy patients, there were 14 male and 5 female with a median age of 31 (10-66) years. Meanwhile, there were 7 male and 9 female with a median age of 28 (16-65) years among these hemopathy patients. Thirty-five cases were treated with modified hard tissue slicing technique and paraffin embedding technique, respectively. The advantages and disadvantages of the two methods for clinical diagnosis of bone disease were compared by Hematoxylin-Eosin staining (H&E staining), immunohistochemical staining (IHC), fluorescence in situ hybridization (FISH) and Sanger sequencing. Results: The improved resin-embedded method showed better histological morphology and cell structure. Besides, the expression of Ki67, SATB2, CD34, SMA, CD68,MPO,CD4 and CD33 in immunohistochemical staining in bone tissues which were embedded in resin were more clear in the accurate positive localization than those using paraffin-embedded. MDM2 of FISH exhibited a higher fluorescence intensity and more accurate location. Meanwhile, both methods treated with Sanger sequencing met the requirements of DNA purity and mutation detection. Conclusion: The improved hard tissue section method is simple and short time-consuming, which is suitable for optimizing the clinical bone and bone marrow pathological diagnosis process.

[Investigation of newly diagnosed pneumoconiosis from artificial quartz stone manufacturers]

Artificial quartz dust exposure may cause associated pneumoconiosis. From November 2019 to July 2020, a total of 27 cases of silicosis associated with artificial quartz stone manufacturers were diagnosed and treated in the Occupational disease Department of Suzhou Fifth People's Hospital. The average age of onset was (46.8±6.6) years, and the average working age of dust exposure was (5.7±1.7) years.The main feature of high KV chest radiography is P/S shadow with strip shadow. CT imaging findings showed diffuse small nodules and ground glass shadows with band shadows. The lesions were mainly distributed in the upper lung, accompanied by pleural thickening, lymphadenopathy and calcification. The pulmonary function impairment was mainly mild restrictive ventilation disorder, and the bronchial mucosa longitudinal plica was the main manifestation under tracheoscopy. The age of silicosis of workers in artificial quartz stone production enterprises is younger, the working age of dust exposure is short, the lung function and bronchial mucosa have a certain degree of damage, and effective preventive measures should be taken in time.

[Application of three-dimensional visualized model of impacted tooth for surgical extraction in undergraduate oral experimental teaching]

Objective: To evaluate the effect of the application of a self-developed three-dimensional visualized model of impacted tooth for surgical extraction in undergraduate oral experimental teaching. Methods: Forty-one undergraduates majoring stomatology of Tongji University from 2018 [19 males and 22 females, aged (22.4±0.8) years] were enrolled and randomly divided into the conventional group and the experimental group. Students of the conventional group (21 students including 8 males and 13 females) received a teaching protocol for the surgical extraction of impacted tooth including theoretical lectures, watching operation videos, and operating on head-simulator teaching systems. Students of the experimental group (20 students including 11 males and 9 females) received an additional training of resistance assessment and surgical extraction using the three-dimensional visualized model of impacted tooth before operating on the head simulators. After class, a questionnaire survey was carried out among students, and the operation results on the head simulators were evaluated by the teacher. Results: The results of the questionnaire showed that the students in the experimental group were rated higher than those in the traditional group in terms of being able to imagine the relationship between impacted teeth and adjacent structures (U=114.00, P=0.006), avoiding damage to adjacent teeth (U=87.00, P<0.001) and inferior alveolar nerve during tooth extraction (U=111.50, P=0.006), and being more confident in clinical operations in the future (U=120.00, P=0.013). According to the evaluation results of tooth extraction on the head simulators, there was no significant difference in the operation time between the two groups (U=138.50, P=0.056). In the experimental group, 5% (1/20) caused adjacent tooth loosening and 15% (3/20) caused the excessive bone defect, which was less than those in the traditional group [38% (8/21) and 48% (10/21), respectively] (P=0.021; P=0.043). There was no significant difference in the incidence of grinding out the deep bone of impacted teeth between the two groups (P=0.232). Conclusions: The application of three-dimensional visualized model of impacted tooth for surgical extraction in undergraduate oral experimental teaching had achieved good results and was worth popularizing.

[Emphasizing the mutual effects of metabolic-associated fatty liver disease with infectious disease]

Metabolic-associated fatty liver disease is a hepatic manifestation of systemic metabolic disorders, with a high prevalence. Moreover, it often coexists and evidently interacts with liver injury caused by a variety of viral infections in association with specific bacterial or fungal infectious diseases, and thus unitedly affect the intra-and extrahepatic diseases clinical outcome. The mutual effects, natural process, and extrahepatic manifestations of the two diseases combined coexistence are now elaborated here.

[Efficacy and safety of segmental radiofrequency ablation for isolation of the superior vena cava in patients with atrial fibrillation]

Objective: To analyze the three-dimensional distribution of functional sinus node, right phrenic nerve and superior vena cava(SVC)-right atrial muscle sleeves by three-dimensional electrophysiological technique in patients with atrial fibrillation (AF), and to investigate the efficacy and safety of segmental radiofrequency catheter ablation (RFCA) for isolation of superior vena cava in these patients. Methods: In this retrospective study, we enrolled 136 AF patients who underwent first RFCA in the First Affiliated Hospital of Zhengzhou University from July 2018 to June 2019 and all patients underwent SVC isolation under sinus rhythm. Baseline clinical data of patients were collected. The functional sinus node was defined by activation mapping, pacing was guided by three-dimensional mapping (Carto) system, localization of the right phrenic nerve was defined by pacing map, the superior vena cava-right atrial muscle sleeves was determined according to the change of potential during SVC isolation, segmental RFCA was performed for SVC isolation, the three-dimensional distribution of functional sinus node, right phrenic nerve and superior vena cava(SVC)-right atrial muscle sleeves was determined by three-dimensional electrophysiological technique. Immediate SVC isolation was achieved in all patients. Patients were evaluated immediately after RFCA and patients were followed at 3, 6, 9, and 12 months after RFCA. Holter monitoring was performed every 3 months, the chest radiograph and the SVC ultrasonic examination were performed every 6 months after RFCA. Postoperative complications were assessed. Results: The mean age of the 136 patients with AF was (51.6±14.2) years, 86 (63.2%) were male, 98 cases (72.1%) were paroxysmal AF and 38 cases (27.9%) were persistent AF. Right atrium activation mapping revealed that 17 (12.5%) functional sinus node were located in the SVC, 78 (57.4%) were located at the SVC-right atrium junctions, 41 (30.1%) were located below the junction level. From the head to foot view, 83 (61.0%) functional sinus node were located at the anterior lateral segment of the SVC-right atrium three-dimensional reconstruction model, 34 (25.0%) located at the posterior lateral segment, 15 (11.0%) located at the anterior wall, 4 (2.9%) located at posterior wall or anterior septum. A total of 294 SVC muscle sleeves were detected among all patients, 94 (32.0%) SVC muscle sleeves were located at the anterior septum of the SVC-right atrium three-dimensional reconstruction model, 76 (25.9%) were located at the posterior septum, 21(7.1%) were located at the posterior free wall, 11 (3.7%) were located at the posterior lateral, 27 (9.2%) were located at anterior lateral wall and 65 (22.1%) were located at the anterior free wall. Right phrenic nerve positioned relatively fix, 133 (97.8%) were located at the lateral segment of the SVC-right atrium three-dimensional reconstruction model, 3 (2.2%) were located at the anterior free wall. Sinus rhythm and SVC isolation were successfully restored immediately after RFCA, no significant SVC stenosis, right phrenic nerve palsy and functional sinus node injury occurred immediately post procedure. All patients were followed up for (11.2±3.6) months and none had postoperative complication. Conclusions: Three-dimensional electrophysiological can determine the spatial location of functional sinus node, right phrenic nerve and SVC-right atrial sleeves. On this basis, segmental RFCA is a safe and effective method to achieve complete isolation of SVC.

TEMPO-oxidized nanocellulose films derived from coconut residues: Physicochemical, mechanical and electrical properties

The present work focuses on the development of cellulose nanofibrils (CNF) film that derived from sustainable biomass resources, which potentially to work as bio-based conductive membranes that assembled into supercapacitors. The chemically purified cellulose was isolated from different parts of coconut (coconut shell and its husk) and further subjected to 2,2,6,6-tetramethylpiperidine-1-oxyl radical (TEMPO)-mediated oxidation for CNF preparation. Physicochemical properties of prepared CNFs were studied in terms of chemical characteristics & crystallinity, surface functionalities, surface morphology, and thermal properties. Both coconut shell-derived CNF and coconut husk-derived CNF fulfilled with nanocellulose's characteristics with fibres width ranged of 70-120 nm and 150-330 nm, respectively. CNF films were further prepared by solvent casting method to measure the modulus elasticity, piezoelectric and dielectric properties of the films. Mechanical study indicated that coconut shell-derived CNF film showed a higher value of elastic modulus than the coconut husk-derived CNF film, which was 8.39 GPa and 5.36 GPa, respectively. The effectiveness of electrical aspects for CNF films are well correlated with the crystallinity and thermal properties, associated with it's composition of different coconut's part.

[Advances in diagnostic methods of maxillary transverse deficiency]

Maxillary transverse deficiency is one of the critical manifestations of malocclusion. It is of vital importance to diagnose maxillary transverse deficiency at the early stage because maxillary development in the transverse dimension stops early. Currently, there are several approaches to diagnose maxillary transverse deficiency, including clinical examination, dental cast measurement, poster-anterior cephalogram, and cone-beam CT. This narrative review will review these diagnostic and predictive approaches of maxillary transverse deficiency.

[Early mortality and risk analysis in adult patients with maintenance hemodialysis]

Objective: To retrospectively analyze the early mortality and related risk factors in adult patients with maintenance hemodialysis (MHD). Methods: Adult MHD patients from 2008 to 2018 were enrolled and divided into training data group and validation data group. In training data group, multivariate logistic regression was used to analyze the risk factors of early death within 120 days after hemodialysis and establish a prediction model. The receiver operating characteristic (ROC) curve was applied to evaluate the prediction ability of the model. Results: A total of 4 885 patients were included. The cumulative mortality within 120 days was 20.97/100 person years, and that within 365 days was 12.25/100 person years. A total of 3 603 patients in the training data group were analyzed. The following risk factors were correlated with early mortality (all P<0.05), including age at start of dialysis over 60 years old (OR=1.792), non-chronic glomerulonephritis (OR=2.214), cardio-cerebrovascular disease (OR=2.695), plasma albumin less than 35 g/L (OR=1.358), platelet count less than 120×10⁹/L (OR=2.194), serum creatinine less than 600 μmol/L (OR=1.652), blood urea nitrogen over 30 mmol/L (OR=1.887), blood phosphorus less than 1.13 mmol/L (OR=1.783), pulse pressure over 55 mmHg(1 mmHg=0.133 kPa) (OR=1.656), low density lipoprotein less than 1.5 mmol/L (OR=1.873), and blood calcium over 2.5 mmol/L (OR=1.876). Risk prediction model was established. The other 1 282 cases in the validation data group were verified. The area under ROC curve was 0.810, with sensitivity 85.7%, and specificity 62.5%. Conclusion: The mortality rate of adult MHD patients within 120 days after dialysis is high. The established prediction model can effectively predict the risk of early death.

[Efficacy and safety of implantable cardioverter-defibrillator implantation in pediatric tachycardia cases]

Objective: To analyze the indication, efficacy and complications of implantable cardioverter-defibrillator (ICD) implantation in children with severe tachycardia. Methods: The retrospective study collected the clinical data of 6 patients who accepted ICD implantation in Shanghai Children's Medical Center from January 2009 to January 2020. The etiologies of tachycardia, procedure of the ICD implantation and the operation associated complications were analyzed. Results: The 6 patients aged from 6 years and 5 months to 16 years and 2 months, and their weight were from 15.4 kg to 49.8 kg. Three patients were diagnosed with long QT syndrome, and the remaining three with catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy and lethal cardiac channelopathy, respectively. All the patients suffered from drug-resistant ventricular tachycardia or ventricular vibration before the operation. After the ICD implantation, 3 patients had electric storm, which was alleviated after analgesics-sedatives treatment with chlorpromazine, dexmedetomidine or midazolam combined with fentanyl, as well as reset of the ICD parameters and support from psychological consultation. The other 3 patients did not undergo any complications as the above comprehensive strategies were given after the operation prophylactically. All patients continued anti-arrhythmic medicine after the operation and all survived at the end of the follow-up period lasted from 1 month to 7 years. Two patients had ventricular tachycardia (VT) and ventricular vibration, which were successfully recognized and defibrillated by ICD. Conclusions: ICD implantation is safe and effective in children and adolescent patients. The electric storm may happen after operation, which could be prevented by the comprehensive strategies including appropriate ICD parameter-setting, analgesics-sedatives treatment and psychological support.

[Electrophysiological characteristics and therapeutic efficacy of radiofrequency ablation of focal atrial tachycardia originating from the right atrial appendage during pregnancy]

Objective: To analyze the electrophysiological characteristics and the therapeutic efficacy of irrigated-tip catheter radiofrequency ablation(RFA) without radiation for pregnant women with focal atrial tachycardia(AT) originating from the right atrial appendage (RAA). Methods: Data from 55 women with focal AT, who underwent radiofrequency ablation (RFA) in the First Affiliated Hospital of Zhengzhou University from October 2016 to March 2019, were screened. 2 non-pregnant women with right atrial appendage tachycardia (RAAT) and 4 pregnant women with non-RAAT were excluded. The remaining 49 cases were divided into RAAT during pregnancy group (n=6, including 4 cases of tachycardia-induced cardiomyopathy) and non-pregnant and non-RAAT group (control, n=43). Under the guidance of three-dimensional mapping system, the earliest activation site was identified, RFA with the irrigated catheter without x-ray fluoroscopy was performed in RAAT patients during pregnancy, all patients in control group underwent non-zero-ray ablation. Patients were followed up at 3, 6, 12 months post procedure, and yearly follow up thereafter in outpatient clinic. Electrocardiogram or Holter monitoring was performed during follow up. AT recurrence and surgical complications were recorded during follow up. At 6 months after RFA, echocardiography examination and laboratory examination including N-terminal B-type brain natriuretic peptide measurement were performed in the pregnant patients, delivery results were also recorded in the pregnant patients. The electrophysiological characteristics of RAAT during pregnancy were analyzed, the therapeutic efficacy of RFA was compared between the two groups. Results: This study is a retrospective study. Age ((30.7±6.2)years vs. (57.2±11.7)years), left ventricular ejection fraction ((46.0±12.8)% vs. (60.1±5.9)%), proportions of organic heart disease (0% vs. 58%) were significantly lower in the RAAT patients during pregnancy group than in control group (P<0.05), while proportions of patients with persistent tachycardia (100% vs. 7%), symptoms of chest distress and palpitation (6/6 vs. 49%) and left ventricular ejection farction≤50% (4/6 vs. 9%) were significantly higher in RAAT group than in control group (P<0.05), heart rate was similar between the two groups ((163.7±11.1)beats/minutes vs. (153.7±15.2)beats/minutes, P>0.05). The characteristic P-wave morphology was observed in RAAT patients during pregnancy, i.e, P wave was mostly upright (5/6) in inferior-leads (Ⅱ, Ⅲ, aVF) and in lead I and aVL, deep and wide negative P wave was found in V₁ lead (5/6), and gradually became positive from V₂-V₆. The mean tachycardia cycle length was (361.7±38.5) ms. Three-dimensional mapping showed that the origin points of the 6 RAAT pregnant patients were all scattered in the local region, the local region was ablated accordingly, 2 patients (2/6) received extensive ablation of local areas. Immediate successful rate was similar between the two groups (6/6 vs. 93%). During follow up ((15.3±4.0) months), no complications were observed after RFA, postoperative recurrence rate was similar (1/6 vs. 12%). Uncomplicated delivery was reported in all 6 pregnant RAAT post ablation. Normal cardiac structure and function was observed in the 4 pregnant patients with tachycardia-induced cardiomyopathy post ablation. Compared to pre-ablation phase, reduced left atrial dimension ((30.3±1.3) mm vs. (36.8±6.7) mm, P>0.05), increased left ventricular ejection fraction ((64.0±2.9)% vs. (39.8±10.7)%), reduced left ventricular end-diastolic dimension ((44.8±4.0) mm vs. (60.0±2.9) mm) and reduced N-terminal B-type natriuretic peptide value ((136.2±47.5) ng/L vs. (3 408.4±901.3) ng/L) were observed at 6 months post ablation (P<0.05). Conclusion: The electrophysiological characteristics are suggestive for focal AT originating from RAA during pregnancy. Under the guidance of 3-dimension activation mapping, no fluoroscopic RFA with irrigated-tip catheter is a safe and effective strategy for the treatment of focal RAAT during pregnancy.

[Efficacy and safety of early initiation of sacubitril-valsartan therapy in patients with acute decompensated heart failure]

Objective: To assess the efficacy and safety of the initiation of sacubitril-valsartan （ARNI） therapy, as compared with ACEI therapy, after hemodynamic stabilization among patients hospitalized for acute decompensated heart failure （ADHF）. Methods: A total of 199 hospitalized patients for ADHF in our department from January 2017 to June 2019 were included in this retrospective analysis. According to the medication early after hemodynamic stabilization, patients were divided into ARNI group (n=92) and ACEI group (n=107). Among the included patients, 61 patients with newly diagnosed heart failure at the time of admission were also divided into ARNI group (n=30) and ACEI group (n=31) according to the applied medication. Clinical baseline data and follow-up results of enrolled patients were collected through the electronic medical records at admission, outpatient and telephone follow-up. The primary effectiveness observation index was left ventricular ejection fraction (LVEF) and left ventricular end diastolic dimension (LVEDD) measured by echocardiography; the secondary observation index was death from any causes and hospitalization for heart failure. Safety outcomes were the incidences of symptomatic hypotension, worsening renal function, hyperkalemia, and angioedema. Results: The clinical baseline characteristics were similar between ARNI group and ACEI group（all P>0.05）. The duration of follow up was (15.2±6.5) months in all patients enrolled, (12.3±5.0) months in ARNI group, and (18.2±6.5) months in ACEI group. At the end of follow-up, prevalence of an absolute LVEF increase of more than 5% was 48.9% (45/92) in ANRI group and 25.2% (27/107) in ACEI group (P=0.001). Percent of LVEF increase to more than 50% was 17.4% (16/92) in ANRI group and 3.7% (4/107) in ACEI group (P=0.001). Percent of patients with more than 10 mm LVEDD reduction was 14.1% (13/92) in ANRI group and 3.7% (4/107) in ACEI group (P=0.009). All-cause mortality rate was 5.7% (5/88) in ARNI group and 15.3% (13/85) in ACEI group (P=0.038). Rate of re-hospitalization due to heart failure was 50% (46/92) in ARNI group and 71% (76/107) in ACEI group（P=0.002）.The rates of symptomatic hypotension, worsening renal function, hyperkalemia, and angioedema were similar between ARNI group and ACEI group (all P>0.05). In patients with first diagnosed heart failure，percent of LVEF increase to more than 50% was 30% (9/30) in ANRI group and 6.5% (2/31) in ACEI group (P=0.017). Percent of more than 10 mm LVEDD reduction was 26.7%(8/30) in ANRI group and 3.2%(1/31) in ACEI group (P=0.012). Percent of an absolute LVEF increase of more than 5% was 53.3% (16/30) in ANRI group and 51.6% (16/31) in ACEI group (P=0.893). Re-hospitalization due to heart failure was 23.3% (7/30） in ARNI group and 73.3% (11/31) in ACEI group（P<0.01）. Rate of all-cause death tended to be lower in patients receiving ARNI (3.4% (1/29)) as compared to patients receiving ACEI (13.0% (3/23), P=0.197）. Conclusions: Among patients with heart failure with reduced ejection fraction hospitalized for ADHF, the initiation of ARNI therapy after hemodynamic stabilization is associated with a more significant improvement of cardiac remodeling and pump function than ACEI therapy and satisfactory safety. In ADHF patients with first diagnosed heart failure, initiation of ARNI therapy after hemodynamic stabilization can more effectively improve cardiac remodeling and pump function than treatment with ACEI.

[Analysis of outpatient utilization of pneumoconiosis patients in Jiangsu province]

Objective: To understand the situation and characteristics of out-patient utilization of urban and rural pneumoconiosis patients in Jiangsu province, and to provide a reference for the formulation of relevant policies. Methods: Using a questionnaire on patients with pneumoconiosis and their influencing factors, 120 patients with pneumoconiosis were randomly selected in Nanjing, Wuxi, Suzhou, Yancheng Vocational Defense Institute or CDC. The rate of outpatients with pneumoconiosis in urban and rural areas and the choice of out-patient hospitals were analyzed. Results: Of the 75 patients with severe pneumoconi-related symptoms such as chest tightness and dyspnea in the first two weeks of the survey, 36 (48.0%) lived in cities and 39 (52.0%) lived in rural areas. Patients with pneumoconiosis who live in urban and rural areas have different aggravating conditions within two weeks. Two weeks of aggravated symptoms in outpatient consultations accounted for36 (48.0%) . Of the 36 patients who used outpatient treatment, rural residents mainly chose 8 people from a hospital and a township health hospital, accounting for 34.8%, while 10 people from urban residents chose a nursing home or nursing home, accounting for 40.0%. The main reason why urban and rural pneumoconiosis patients did not go to the doctor is "conscious symptoms are lighter" and "feel that the doctor is useless." Conclusion: The rate of outpatients with pneumoconiosis in Jiangsu province within two weeks is lower than that of ordinary elderly residents. There may be differences in treatment behavior patterns of urban and rural pneumoconiosis patients.Economic factors have a certain influence on the outpatient treatment behavior of pneumoconiosis patients. The recognition of outpatient service is the main factor affecting the outpatient treatment of pneumoconiosis patients. It is very important to popularize the knowledge of pneumoconiosis and do a good job in propaganda of occupational diseases and health education for pneumoconiosis patients. Focusing on the outpatient treatment of pneumoconiosis patients and making targeted medical policies is very important to standardize and improve the rehabilitation of pneumoconiosis patients.

[Analysis of annual hospitalization rate of pneumoconiosis patients and related influencing factors of social security]

Objective: To study the main factors that influencing Pneumoconiosis patients' healthcare seeking behaviors. Methods: Conducting a descriptive analysis to analyze the relationship between the annual hospitalization rate and social security status (medical insurance, location of medical insurance, proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis, whether they receive social assistance and a minimum allowance) , social relationship status of patients (whether there is pneumoconiosis in the family or relatives, whether there is a pneumoconiosis in a friend or a colleague, and whether or not he/she has received financial assistance) , life quality of patients (subjective feelings) and living standard of patients (dietary level) based on data acquired from 120 pneumoconiosis patients. Results: The results of single factor analysis reveal that the location of medical insurance, the proportion of insurance for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis are statistically significant in pneumoconiosis patients' hospital utilization ratio (P<0.05) . The place where medical insurance is located is the current place of residence, the reimbursement ratio of medical insurance for pneumoconiosis is listed as 50%-70%, the work unit has medical insurance, those who have not applied for compensation for pneumoconiosis have a higher utilization rate of hospitalization services. The annual hospitalization rate was 73.3%, 80.0%, 60.6%, 63.0%, respectively. Conclusion: The location of patient medical insurance, the proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, and whether to apply for compensation after pneumoconiosis are the influencing factors of the patients' annual hospitalization rate.

Characterization of three regulatory genes involved in enduracidin biosynthesis and improvement of enduracidin production in Streptomyces fungicidicus

AIMS

To increase enduracidin production in Streptomyces fungicidicus ATCC 31731 by overexpressing positive regulators in enduracidin biosynthesis.

METHODS AND RESULTS

Genes orf22 and orf42 were knocked out by in-frame deletion based on CRISPR/Cas9 strategy, while the orf41 gene was inactivated by replacing it with the apramycin resistance gene cassette aac(3)IV using a fast screening blue/white system. The integrative plasmid pSET152ermE was used for the overexpression of orf22, orf41 and orf42 individually. The constructed plasmids were transformed into wild-type strain Streptomyces fungicidicus ATCC 31731. Three gene inactivation mutants Δorf22, Δorf41 and Δorf42 and three recombinant strains overexpressing orf22, orf41 and orf42 were all fermented and the enduracidin production of each strain was detected and compared by HPLC analysis. Two resulting engineered strains were generated through overexpression of gene orf22 and orf42 in Streptomyces fungicidicus, respectively, and in these strains the enduracidins titres were increased by approximately 4·0-fold and 2·3-fold higher than that of the wild-type strain.

CONCLUSIONS

The functions of three regulatory genes orf22, orf41 and orf42 in the enduracidin gene cluster in Streptomyces fungicidicus ATCC 31731 were examined. The orf22 gene, encoding a SARP family protein, was proposed to act in a positive manner. The proteins encoded by genes orf41 and orf42 were proposed to compose a two-component regulation system, in which the response protein Orf41 was characterized as a repressor, and the kinase Orf42 was shown to be an activator. The production of enduracidins was improved considerably by overexpression of the two positive regulatory genes orf22 and orf42 respectively.

SIGNIFICANCE AND IMPACT OF THE STUDY

The production of enduracidins was successfully improved by manipulating the regulatory genes involving in enduracidin biosynthesis, providing an efficient approach to improve enduracidin production further for fermentation industry and synthetic biological research.

Prevention of Postdental Procedure Bacteremia: A Network Meta-analysis

Postdental procedure bacteremia is common and troublesome. The comparative efficacy of multiple prophylactic interventions is unclear. We compared the efficacy of interventions for the prevention of postdental procedure bacteremia. We conducted a review of ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov from inception to December 4, 2018. Randomized controlled trials that evaluated prophylactic interventions for the prevention of postdental procedure bacteremia were eligible. The primary outcome was the incidence of postdental procedure bacteremia. A total of 24 trials were included with 2,147 participants. Our network meta-analysis demonstrated that intravenous administration of 1,000/200 mg of amoxicillin/clavulanate provided the least incidence of postdental procedure bacteremia among all the prophylactic interventions (odds ratio = 0.03, 95% CI = 0.00 to 0.63) as compared with the placebo/controls. Oral 3 g of amoxicillin had the least incidence of postdental procedure bacteremia among all oral or topical forms of prophylactic interventions (odds ratio = 0.10, 95% CI = 0.02 to 0.44) as compared with the placebo/controls. No serious adverse events, such as anaphylactic shock, mortality, and the development of antibiotic-resistant bacteria, were reported. None of the included subjects were of high risk of infectious endocarditis. Our network meta-analysis demonstrates that intravenous amoxicillin/clavulanate and oral amoxicillin might be the best prophylactic interventions in preventing postdental procedure bacteremia among all the oral/topical forms of interventions for the overall populations.

Spin-charge-lattice coupling in YBaCuFeO5: Optical properties and first-principles calculations

We combined spectroscopic ellipsometry, Raman scattering spectroscopy, and first-principles calculations to explore the optical properties of YBaCuFeO5 single crystals. Measuring the optical absorption spectrum of YBaCuFeO5 at room temperature revealed a direct optical band gap at approximately 1.41 eV and five bands near 1.69, 2.47, 3.16, 4.26, and 5.54 eV. Based on first-principles calculations, the observed optical excitations were appropriately assigned. Analysis of the temperature dependence of the band gap indicated anomalies in antiferromagnetic phase transition at 455 and 175 K. Additionally, a hardening in the frequency of the Eg phonon mode was observed at 175 K. The value of the spin-phonon coupling constant was 15.7 mRy/Å2. These results suggest a complex nature of spin-charge-lattice interactions in YBaCuFeO5.

[Clinical analysis of transcatheter closure of ventricular septal defect with right coronary cusp bulge]

Objective: To access the feasibility, effectiveness and safety of transcatheter closure of ventricular septal defect (VSD) with right coronary cusp bulge. Methods: The study population consisted of 40 children (22 boys and 18 girls) undergoing transcatheter intervention for VSD with right coronary cusp bulge in Shanghai Children's Medical Center from August 2013 to June 2017. All patients were examined using transthoracic echocardiography and cardiovascular angiography before occlusion and received transcatheter closure of VSD by placing an occlude. During the operation, angiography and transthoracic echocardiography were used to detect residual shunts, new-onset or aggravation of aortic regurgitation, and surface electrocardiogram was used to assess the impact of occlusion on the conduction system. The children were followed up to evaluate the degree of aortic regurgitation and the presence of heart block by transthoracic echocardiography and electrocardiogram in outpatient department. Comparative analysis between two groups was used by t test. Results: The average age of the patients was (5.1±3.2) years, weight(20.6±10.7) kg. The diameter of defect shunt was (3.3±0.9) cm. The VSD of all 40 patients were successfully occluded immediately, and three patients (8%) with filament residual shunt were observed during the operation. No major surgical complication such as death, pericardial tamponade, embolism of important organs, infective endocarditis occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunt in three patients disappeared, and no new-onset or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular block, and one patient suffered from an incomplete right bundle branch block. There were significant differences between pre- and post-occlusion regarding the left ventricular end diastolic diameter ((3.8±0.5) vs. (3.7±0.5) cm, t=2.092, P=0.043), the left ventricular end systolic diameter ( (2.4±0.3) vs. (2.2±0.4) cm, t=2.068, P=0.045), and the QRS interval ((75.4±10.4) vs. (79.8±11.4) ms, t=-2.277, P=0.028). No significant differences were found between pre- and post-operation regarding the left ventricular ejection fraction (67.8%±4.7% vs. 68.1%±4.6%, t=-0.447, P=0.657) and the PR interval ((125.6±14.7) vs. (122.6±14.2) ms, t=1.540, P=0.132). Conclusions: Interventional closure of VSD with right coronary cusp bulge has small impact on aortic valve activity in children. With appropriate indications and methods, transcatheter interventional occlusion should be considered because it is effective for children diagnosed with VSD combined with right coronary cusp bulge.

[The efficacy of cognitive behavioral therapy in insomnic patients with or without comorbidities: a pilot study]

Objectives: To evaluate the effectiveness of cognitive behavior therapy for insomnia (CBT-i) in chronic insomnia patients in terms of the improvements of psychological and sleep diary parameters. Methods: Patients who met the diagnostic criteria of chronic insomnia, were divided into primary group or comorbid group. Both groups received standard CBT-i interventions. Psychological scales and sleep diaries were used to evaluate participants' severity of insomnia and psychological conditions related to insomnia at four time points: before intervention (baseline), immediate after intervention, 4 weeks and 16 weeks after intervention. Results: Both groups achieved significant improvements after intervention on psychological measurements and sleep diary parameters. Such improvements were maintained at 4-week and 16-week follow-ups. The sleep diary data indicated that by the end of the intervention, there were significant differences on sleep onset latency (51.72 min to 10.53 min in primary group, P<0.01; 59.26 min to 15.67min in comorbid group, P<0.01) and sleep efficiency (71% to 95% in primary group, P<0.01; 68% to 90% in comorbid group, P<0.01). There were differences on sleep onset latency (10.00 min vs. 13.93 min, P<0.05), total sleep time (355.71 min vs. 327.85 min, P<0.05) and sleep efficiency (95% vs. 91%, P<0.01) in primary group and comorbid group respectively. No differences were found on wake after sleep onset in the two groups. Conclusions: Chronic insomnia patients with or without comorbidities both have improvements after CBT-i. Sleep diary parameters rather than psychological measurements are different in two groups. Thus, CBT-i is an effective non-pharmaceutical therapy inpatients with chronic insomnia.

Hydrological and biogeochemical controls governing the speciation and accumulation of selenium in a wetland influenced by mine drainage

Controls governing the speciation and accumulation of Se in a 3.7-ha marsh influenced by mine drainage were assessed through examination of water balance, water quality, sediment, and plant tissue components. Over the 8-mo study period (April through November, 2009), mean monthly flows ranged from 1600 to 2300 m³  d^-1 (hydraulic retention time of 1-3 d). Total Se concentrations in the marsh outflow were lower than the inflow by 0.4 to 6.2 μg L^-1 (mean difference = 3.3 μg L^-1 ), illustrating Se removal. The Se accumulation pathways are illustrated by elevated concentrations of Se in sediments (3-35 mg kg^-1 dry wt) as well as in below-ground (2-41 mg kg^-1 dry wt; mean = 10 mg kg^-1 dry wt) and above-ground (0.8-6.3 mg kg^-1 dry wt; mean = 2 mg kg^-1 dry wt) emergent plant tissues. Redox stratification in the shallow water column had a marked effect on Se speciation and behavior, illustrating bottom water removal of dissolved selenate in suboxic horizons and increased mobility of dissolved organo-Se. Mass balance data yielded inflow and outflow loading rates for Se of 27 and 23 g d^-1 , respectively (net accumulation rate of 4 g d^-1 or 0.11 mg m²  d^-1 ). The rate of accumulation as calculated from the mass balance agrees with independently measured rates of Se accumulation in sediments for the site (3.6-8.1 g d^-1 or 0.10-0.22 mg m^-2  d^-1 ). Environ Toxicol Chem 2018;37:1824-1838. © 2018 SETAC.

Reliability and validity of the Brief Pain Inventory in individuals with chronic obstructive pulmonary disease

BACKGROUND

Pain is prevalent in chronic obstructive pulmonary disease (COPD) and the Brief Pain Inventory (BPI) appears to be a feasible questionnaire to assess this symptom. However, the reliability and validity of the BPI have not been determined in individuals with COPD. This study aimed to determine the internal consistency, test-retest reliability and validity (construct, convergent, divergent and discriminant) of the BPI in individuals with COPD.

METHODS

In order to examine the test-retest reliability, individuals with COPD were recruited from pulmonary rehabilitation programmes to complete the BPI twice 1 week apart. In order to investigate validity, de-identified data was retrieved from two previous studies, including forced expiratory volume in 1-s, age, sex and data from four questionnaires: the BPI, short-form McGill Pain Questionnaire (SF-MPQ), 36-Item Short Form Survey (SF-36) and Community Health Activities Model Program for Seniors (CHAMPS) questionnaire.

RESULTS

In total, 123 participants were included in the analyses (eligible data were retrieved from 86 participants and additional 37 participants were recruited). The BPI demonstrated excellent internal consistency and test-retest reliability. It also showed convergent validity with the SF-MPQ and divergent validity with the SF-36. The factor analysis yielded two factors of the BPI, which demonstrated that the two domains of the BPI measure the intended constructs. The BPI can also discriminate pain levels among COPD patients with varied levels of quality of life (SF-36) and physical activity (CHAMPS).

CONCLUSION

The BPI is a reliable and valid pain questionnaire that can be used to evaluate pain in COPD.

SIGNIFICANCE

This study formally established the reliability and validity of the BPI in individuals with COPD, which have not been determined in this patient group. The results of this study provide strong evidence that assessment results from this pain questionnaire are reliable and valid.

Obesity-associated cardiac pathogenesis in broiler breeder hens: Pathological adaption of cardiac hypertrophy

Broiler hens consuming feed to appetite (ad libitum; AL) show increased mortality. Feed restriction (R) typically improves reproductive performance and livability of hens. Rapidly growing broilers can exhibit increased mortality due to cardiac insufficiency but it is unknown whether the increased mortality of non-R broiler hens is also due to cardiac compromise. To assess cardiac growth and physiology in fully mature birds, 45-week-old hens were either continued on R rations or assigned to AL feeding for 7 or 21 days. AL hens exhibited increased bodyweight, adiposity, absolute and relative heart weight, ventricular hypertrophy, and cardiac protein/DNA ratio by d 21 (P < 0.05). Increased heart weights due to hypertrophic growth was attributed to enhanced IGF-1-Akt-FoxO1 signaling and its downstream target, translation initiation factor 4E-BP1 in conjunction with down-regulation of ubiquitin ligase atrogin-1/MAFbx (P < 0.05). Reduced activation of cardiac AMPK and downstream activation of ACC-1 in parallel with increased cardiac nitric oxide levels, calcineurin activity, and MAPK activation in AL hens (P < 0.05) suggested that metabolic derangement develops along the cardiovascular remodeling. These indictors of cardiac maladaptive hypertrophic growth were further supported by uregulation of heart failure markers, BNP and MHC-β (P < 0.05). Hens allowed AL feeding for 70 d exhibited a higher incidence of mortality (40% vs. 10%) in association with ascites, pericardial effusion, and ventricle dilation. A higher incidence of irregular ECG patterns and rhythmicity consistent with persistently elevated systolic blood pressure and ventricle fibrosis were observed in AL hens (P < 0.05). These observations support the conclusion that AL feeding in broiler hens results in maladaptive cardiac hypertrophy that progresses to overt pathogenesis in contractility and thereby increases mortality. Feed restriction provides clear physiological benefit to heart function of adult broiler hens.

Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States

Background

In 2012, the United States Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA) screening, despite evidence that Black men are at a higher risk of prostate cancer-specific mortality (PCSM). We evaluated whether Black men of potentially screening-eligible age (55-69 years) are at a disproportionally high risk of poor outcomes.

Patients and methods

The SEER database was used to study 390 259 men diagnosed with prostate cancer in the United States between 2004 and 2011. Multivariable logistic regression modeled the association between Black race and stage of presentation, while Fine-Gray competing risks regression modeled the association between Black race and PCSM, both as a function of screening eligibility (age 55-69 years versus not).

Results

Black men were more likely to present with metastatic disease (adjusted odds ratio [AOR] 1.65; 1.58-1.72; P < 0.001) and were at a higher risk of PCSM (adjusted hazard ratio [AHR] 1.36; 1.27-1.46; P < 0.001) compared to non-Black men. There were significant interactions between race and PSA-screening eligibility such that Black patients experienced more disproportionate rates of metastatic disease (AOR 1.76; 1.65-1.87 versus 1.55; 1.47-1.65; Pinteraction < 0.001) and PCSM (AHR 1.53; 1.37-1.70 versus 1.25; 1.14-1.37; Pinteraction = 0.01) in the potentially PSA-screening eligible group than in the group not eligible for screening.

Conclusions

Racial disparities in prostate cancer outcome among Black men are significantly worse in PSA-screening eligible populations. These results raise the possibility that Black men could be disproportionately impacted by recommendations to end PSA screening in the United States and suggest that Black race should be included in the updated USPSTF PSA screening guidelines.

Fluid Restriction for Treatment of “Fluid Creep” after Acute Burn Resuscitation

Objective

Fluid creep in patients recovering from acute burns still exists, despite the use of a more treatment conservative approach. Most of our severe burn patients develop fluid overload and body weight increase after acute fluid resuscitation. How to quickly return patients to their pre-injury body weight is an important issue.

Methods

Right after acute fluid resuscitation, we applied a “total fluid requirement” volume (usually 1/2 to 2/3 of initial 24 hour volume) and strictly monitored patients' hourly urine (between 0.5-1 ml/kg/hr). Patients' responses (body weight, enteric feeding amount, pulmonary condition, etc.) were also closely monitored and frequent adjustments of fluid volume administration were performed simultaneously.

Results

Most patients regained their pre-injury body weight within 2-3 weeks. Enteric feeding also improved markedly. No patients had severe oedema-related complications.

Conclusions

Stricter fluid administration after acute burn fluid resuscitation is advised for allowing patients to reduce body weight to their pre-injury weight or at least close to it. We use pre-injury body weight, enteric feeding and urine output as our guides. (Hong Kong j.emerg.med. 2014;21:222-229)

Clinical analysis of submucosal Medpor implantation for empty nose syndrome

BACKGROUND

Empty nose syndrome (ENS) describes symptomatology and radiographic findings after surgeries on turbinates.The treatment of ENS is still debatable.

PURPOSE

To analyse clinical outcomes of submucosal Medpor® implantation for ENS.

METHODS

A total of 18 patients underwent submucosal Medpor® implantation from 2006 to 2011. We applied SNOT-22 (SinoNasalOutcome Test) for statistical survey of the patients' symptoms before and after surgery.

RESULTS

Two patients were lost to follow up after the surgery. Most of the patients developed ENS-related symptoms gradually within 2 years to 16 years after the previous nasal surgery or treatment. The sites of submucosal implantation are mainly septum and nasal floor, unilaterally or bilaterally. There is a significant improvement of SNOT-22 pre-operatively to one year post-operatively.

CONCLUSIONS

The symptomatolgy remains the most important point when dealing with patients with ENS. Submucosal implantation of Medpor® is a feasible surgical treatment to ENS. A positive cotton test is suggested for the surgical indication and planning.

Skin collagen can be accurately quantified through noninvasive optical method: Validation on a swine study

BACKGROUND/PURPOSE

Diffuse reflectance spectroscopy (DRS) is a noninvasive optical technology characterized by relatively low system cost and high efficiency. In our previous study, we quantified the relative concentration of collagen for the individual keloid patient. However, no actual value of collagen concentration can prove the reliability of collagen detection by our DRS system.

METHODS

Skin-mimicking phantoms were prepared using different collagen and coffee concentrations, and their chromophore concentrations were quantified using the DRS system to analyze the influence of collagen and other chromophores. Moreover, we used the animal study to compare the DRS system with the collagen evaluation of biopsy section by second-harmonic generation (SHG) microscopy at four different skin parts.

RESULTS

In the phantom study, the result showed that coffee chromophore did not severely interfere with collagen concentration recovery. In the animal study, a positive correlation (r=.902) between the DRS system and collagen evaluation with SHG microscopy was found.

CONCLUSIONS

We have demonstrated that the DRS system can quantify the actual values of collagen concentration and excluded the interference of other chromophores in skin-mimicking phantoms. Furthermore, a high positive correlation was found in the animal study with SHG microscopy. We consider that the DRS is a potential technique and can evaluate skin condition objectively.

Dramatic band gap reduction incurred by dopant coordination rearrangement in Co-doped nanocrystals of CeO2

A dramatic band gap narrowing of 1.61 eV has been observed in Co-doped nanocrystals of CeO₂ (ceria), as a result of thermal annealing, without changing the ceria crystal structure and the Co concentration. As demonstrated by x-ray absorption fine structures, thermal annealing incurs an oxygen coordination rearrangement around Co atoms from an octahedral coordination to a square-planar coordination. First principle calculation using density functional theory reveals two stable oxygen coordination types surrounding Co, consistent with the experimental observation. The band gap values calculated for the two stable coordination types differ dramatically, reproducing the experimentally observed band gap narrowing. These prominent effects due to local structure rearrangement around dopant atoms can lead to unprecedented methods for band gap engineering in doped nanocrystal oxides.

Utilization of biopsy-based genomic classifier to predict distant metastasis after definitive radiation and short-course ADT for intermediate and high-risk prostate cancer

BACKGROUND

We examined the ability of a biopsy-based 22-marker genomic classifier (GC) to predict for distant metastases after radiation and a median of 6 months of androgen deprivation therapy (ADT).

METHODS

We studied 100 patients with intermediate-risk (55%) and high-risk (45%) prostate cancer who received definitive radiation plus a median of 6 months of ADT (range 3-39 months) from 2001-2013 at a single center and had available biopsy tissue. Six to ten 4 micron sections of the needle biopsy core with the highest Gleason score and percentage of tumor involvement were macrodissected for RNA extraction. GC scores (range, 0.04-0.92) were determined. The primary end point of the study was time to distant metastasis. Median follow-up was 5.1 years. There were 18 metastases during the study period.

RESULTS

On univariable analysis (UVA), each 0.1 unit increase in GC score was significantly associated with time to distant metastasis (hazard ratio: 1.40 (1.10-1.84), P=0.006) and remained significant after adjusting for clinical variables on multivariable analysis (MVA) (adjusted hazard ratio: 1.36 (1.04-1.83), P=0.024). The c-index for 5-year distant metastasis was 0.45 (95% confidence interval: 0.27-0.64) for Cancer of the Prostate Risk Assessment score, 0.63 (0.40-0.78) for National Comprehensive Cancer Network (NCCN) risk groups, and 0.76 (0.57-0.89) for the GC score. Using pre-specified GC risk categories, the cumulative incidence of metastasis for GC>0.6 reached 20% at 5 years after radiation (P=0.02).

CONCLUSIONS

We believe this is the first demonstration of the ability of the biopsy-based GC score to predict for distant metastases after definitive radiation and ADT for intermediate- and high-risk prostate cancer. Patients with the highest GC risk (GC>0.6) had high rates of metastasis despite multi-modal therapy suggesting that they could potentially be candidates for treatment intensification and/or enrollment in clinical trials of novel therapy.

[The first confirmed imported case of yellow fever in China]

OBJECTIVE

To describe the epidemiological characteristics of the first confirmed imported case of yellow fever in China.

METHODS

This case was reported through the Infectious Disease Surveillance Program. Information on epidemiology and clinical manifestation of the case was collected through case interview and related medical records. Blood and saliva samples of the case were collected and tested by real-time PCR.

RESULTS

The patient was male, 32 years old, and suffered a sudden onset of fever without other symptoms, on March 8(th), 2016. The patient arrived in Beijing at midnight on March 10(th). Condition of the patient got progressively worsened, with both liver and renal failures, hepatic encephalopathy, multiple organ failures and DIC, finally died on March 16(th). Serum of the case was positive for yellow fever virus by real time PCR. The patient was bit by mosquitoes six days before the onset of fever in Luanda, Angola.

CONCLUSION

This report summarized related information on the first confirmed but imported case of yellow fever in China that was helpful to the management of other imported yellow fever cases in the future.

[Advances in immunotherapy of pancreatic ductal adenocarcinoma]

The morbidity of pancreatic ductal adenocarcinoma (PDAC) has been increasing over years, while the treatment efficacy and prognosis of PDAC remain far from satisfying. The newly-ermerged tumor immunotherapy has not only made lots of breakthroughs in various malignancies, but also brought an opportunity to the treatment of pancreatic cancer.PDAC immunotherapies, mainly including vaccine therapy, adoptive T cell thanfer therapy, checkpoint blockade therapy, have achieved a certain effect, however, the clinical outcomes have not been satisfactory. Therefore, the combination of immunotherapies based on different theoretical views is important and is likely to be the trend in the future. Carcinoma associated fibroblast (CAF) is the most common cell in pancreatic cancer stromal component. It will be helpful to develop more potential therapeutic targets by further exploring CAF and the mechanism of fibrosis mediated immunosuppression.

First complete genome sequence of canine bocavirus 2 in mainland China

We obtained the first full-length genome sequence of canine bocavirus 2 (CBoV2) from the faeces of a healthy dog in Guangzhou city, Guangdong province, mainland China. The genome of GZHD15 consisted of 5059 nucleotides. Sequence analysis suggested that GZHD15 was close to a previously circulated Hong Kong isolate.

Expression pattern of heat shock protein 90 in patients with oral squamous cell carcinoma in northern Taiwan

Heat shock protein 90 (HSP90), which is expressed in cancer cells, profoundly affects progression, invasion, and metastasis. However, to our knowledge, in East Asia, the correlation between the expression of HSP90 and clinicopathological variables has seldom been discussed. We therefore investigated this and its prognostic value in 36 patients newly diagnosed with oral squamous cell carcinoma (SCC) in northern Taiwan. Samples of tumour and normal samples from the patients were compared immunohistochemically. HSP90 was expressed mainly in the samples of tumour, and was significantly higher in these than in the normal epithelium (p<0.001). Metastases to the lymph nodes in the 36 patients also correlated with expression of HSP90. Correlation between expression of HSP90 and the size of the tumour or pathological staging was not significant, but strong expression correlated with poor survival. In general, expression was low among our samples (30/36). It was significantly higher in the tumour samples than in normal samples, and correlated with metastases to lymph nodes in the neck.

[Seasonality of clustering of fever and diarrhea in Beijing, 2009-2015]

Objective: To understand the seasonal distribution of the clustering of fever and diarrhea. Methods: Concentration degree and circular distribution methods were used to analyze the seasonal distribution of the clustering of fever and diarrhea in Beijing from 2009 to 2015. The information were collected from the Infectious Disease Surveillance Information System of Beijing. Results: The M values of the clustering of fever and diarrhea were 0.57 and 0.47. Circular distribution results showed that the clustering of fever and diarrhea angle dispersion index R values were 0.57 and 0.46 respectively, the sample average angle of Rayleigh' s test Z values were 414.14, 148.09 respectively (all P<0.01). The clustering of fever and diarrhea had seasonality. The incidence peak of fever was on October 13, and the epidemic period was during August 13-December 14. The incidence peak of diarrhea was on July 31, and the epidemic period was during May 20-October 11. Conclusion: The clustering of fever had obvious seasonality in Beijing, which mainly occurred in autumn and winter. The cluster of diarrhea had certain seasonality, which mainly occurred in summer and autumn.

Tumour cell-derived WNT5B modulates in vitro lymphangiogenesis via induction of partial endothelial-mesenchymal transition of lymphatic endothelial cells

Metastasis of the cervical lymph nodes frequently leads to poor survival of patients with oral squamous cell carcinoma (OSCC). The underlying mechanisms of lymph node metastasis are unclear. Wingless-type MMTV integration site family, member 5B (WNT5B), one component of the WNT signal pathway, was markedly up-regulated in OSCC sublines with high potential of lymphatic metastasis compared to that in OSCC cells with low nodal metastasis. Increased WNT5B mRNA was demonstrated in human OSCC tissues in comparison with adjacent non-tumorous tissues. Interestingly, the high level of WNT5B protein in serum was associated with lymph node metastasis in OSCC patients. Knockdown of WNT5B expression in OSCC sublines did not affect tumour growth but impaired lymph node metastasis and tumour lymphangiogenesis of orthotopic transplantation. Conditioned medium from WNT5B knockdown cells reduced the tube formation of lymphatic endothelial cells (LECs). In contrast, recombinant WNT5B enhanced the tube formation, permeability and migration of LECs. In LECs stained with phalloidin, the morphology of those treated with recombinant WNT5B changed from flat to spindle-like. Recombinant WNT5B also increased α-smooth muscle actin and inhibited the expression of vascular endothelial-cadherin but retained characteristics of endothelial cells. The results suggest that WNT5B functions in the partial endothelial-mesenchymal transition (EndoMT). Furthermore, WNT5B-induced tube formation was impaired in the LECs following the knockdown of EndoMT-related transcription factor, SNAIL or SLUG. The WNT5B-induced expression of Snail or Slug was abolished by IWR-1-endo and Rac1 inhibitors, which are involved in the WNT/β-catenin and planar cell polarity pathways, respectively. Collectively, the data suggest that WNT5B induces tube formation by regulating the expression of Snail and Slug proteins through activation of canonical and non-canonical WNT signalling pathways.

Effect of flap design on periodontal healing after impacted third molar extraction: a systematic review and meta-analysis

The extraction of an impacted third molar violates the surrounding soft and bony tissues. The surgeon's access to the tooth, for which there are various surgical approaches, has an important impact on the periodontium of the adjacent second molar. The aim of this review was to analyze the relationships between the different flap techniques and postoperative periodontal outcomes for the mandibular second molars (LM2) adjacent to the impacted mandibular third molars (LM3). An electronic search of MEDLINE and other databases was conducted to identify randomized controlled trials fulfilling the eligibility criteria. To assess the impact of flap design on the periodontal condition, the weighted mean difference of the probing depth reduction (WDPDR) and the weighted mean difference of the clinical attachment level gain (WDCAG) at the distal surface of LM2 were used as the primary outcomes. The results showed that, overall, the different flap techniques had no significant impact on the probing depth reduction (WDPDR -0.14mm, 95% confidence interval -0.44 to 0.17), or on the clinical attachment level gain (WDCAG 0.05mm, 95% confidence interval -0.84 to 0.94). However, a subgroup analysis revealed that the Szmyd and paramarginal flap designs may be the most effective in reducing the probing depth in impacted LM3 extraction, and the envelope flap may be the least effective.

[Report and analysis of 2 cases of nerve paralysis with aspiration pneumonia after infection of herpes zoster virus]

Two cases of patients were hospitalized for sore throat with Dysphagia.Check:Wall of the pharynx,tongue and epiglottis scattered the ulcer.The patients were loss of pharynx reflex.Oropharynx and piriform fossa has a lot of saliva retention.Posterior pharyngeal wall was drooping like waterfull.CT scan showed may be the aspiration pneumonia in right lower lung.The admission diagnosiswere pharyngeal herpes zoster virus infection,pharyngeal side muscle paralysis,and inhalation pneumonia.The patients' clinical data were retrospectively analyzed,and the report is as follows.