Gene replacement therapy in Bietti crystalline corneoretinal dystrophy: an open-label, single-arm, exploratory trial

Bietti crystalline corneoretinal dystrophy is an inherited retinal disease caused by mutations in CYP4V2, which results in blindness in the working-age population, and there is currently no available treatment. Here, we report the results of the first-in-human clinical trial (NCT04722107) of gene therapy for Bietti crystalline corneoretinal dystrophy, including 12 participants who were followed up for 180-365 days. This open-label, single-arm exploratory trial aimed to assess the safety and efficacy of a recombinant adeno-associated-virus-serotype-2/8 vector encoding the human CYP4V2 protein (rAAV2/8-hCYP4V2). Participants received a single unilateral subretinal injection of 7.5 × 1010 vector genomes of rAAV2/8-hCYP4V2. Overall, 73 treatment-emergent adverse events were reported, with the majority (98.6%) being of mild or moderate intensity and considered to be procedure- or corticosteroid-related; no treatment-related serious adverse events or local/systemic immune toxicities were observed. Compared with that measured at baseline, 77.8% of the treated eyes showed improvement in best-corrected visual acuity (BCVA) on day 180, with a mean ± standard deviation increase of 9.0 ± 10.8 letters in the 9 eyes analyzed (p = 0.021). By day 365, 80% of the treated eyes showed an increase in BCVA, with a mean increase of 11.0 ± 10.6 letters in the 5 eyes assessed (p = 0.125). Importantly, the patients' improvement observed using multifocal electroretinogram, microperimetry, and Visual Function Questionnaire-25 further supported the beneficial effects of the treatment. We conclude that the favorable safety profile and visual improvements identified in this trial encourage the continued development of rAAV2/8-hCYP4V2 (named ZVS101e).

Multiparametric MRI-based radiomics nomogram for predicting malignant transformation of sinonasal inverted papilloma

AIM

To investigate the feasibility of a radiomics nomogram model for predicting malignant transformation in sinonasal inverted papilloma (IP) based on radiomic signature and clinical risk factors.

MATERIALS AND METHODS

This single institutional retrospective review included a total of 143 patients with IP and 75 patients with IP with malignant transformation to squamous cell carcinoma (IP-SCC). All patients underwent surgical pathology and had preoperative magnetic resonance imaging (MRI) and computed tomography (CT) sinus studies between June 2014 and February 2022. Radiomics features were extracted from contrast-enhanced T1-weighted images (CE-T1WI), T2-weighted images (T2WI), and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator (LASSO) were performed to select the features extracted from the sequences mentioned above. Independent clinical risk factors were identified by multivariate logistic regression analysis. Radiomics nomogram was constructed by incorporating independent clinical risk factors and radiomics signature. Based on discrimination and calibration, the diagnostic performance of the nomogram was evaluated.

RESULTS

Twelve radiomics features were selected to develop the radiomics model with an area under the curve (AUC) of 0.987 and 0.989, respectively. Epistaxis (p=0.011), T2 equal signal (p=0.003), extranasal invasion (p<0.001), and loss of convoluted cerebriform pattern (p=0.002) were identified as independent clinical predictors. The radiomics nomogram model showed excellent calibration and discrimination (AUC: 0.993, 95% confidence interval [CI]: 0.985-1.00 and 0.990, 95% CI: 0.974-1.00) in the training and validation sets, respectively.

CONCLUSION

The nomogram that the combined radiomics signature and clinical risk factors showed a satisfactory ability to predict IP-SCC.

[CT features of abnormally whole-course wide eustachian tubes with microtia and atresia]

Objective: To study the clinical and CT features of the abnormal whole-course wide of eustachian tube (AWWET) with microtia and atresia(MA). Methods: The clinical and CT data of 19 patients (20 ears) from January 2017 to December 2021 with AWWET with MA were retrospectively analyzed, including 15 males and 4 females. The age ranged from 5 to 16 years, with an average of 9.5 years. 50 patients with common MA without wide eustachian tube(ET) as a case control group, including 32 males and 18 females.The age ranged from 5 to 16 years, with an average of 9.2 years. 20 patients (40 ears) who had normal ear CT for tinnitus, otalgia as a normal control group, including 12 males and 8 females. The age ranged from 5 to 16 years, with an average of 12.5 years. We measured the dimension and length of the bony portion of the ET, the total length, the angle between the bony portion and the cartilage portion, and the horizontal angle of ET on CT imagings, and compared with 40 normal ears by SPSS 27.0 software. Results: According to the relationship between AWWET and tympanum, patients were divided into the communicated group and the blocked group. A male predominance, left ear predominance, with high incidence of hemifacial microsomia exhibited in both groups. AWWET was presented as a widened lumen on CT. In 11 ears (4 ears in the communicated group, 7 ears in the blocked group), ETs bifurcated, the upper bony tube extended to the sphenoid body, the lower part continued down to cartilaginous ET and opened onto the nasopharynx, with"mastoid-like"pneumatization of the sphenoid body in 6 ears. The middle ear deformity in case group was more serious than MA control group, especially the blocked group. The incidence of otitis media in the communicated group was lower than that in the MA control group, and 4 cases in the blocked group had effusion in the ET. Compaired with normal ear, the bony ET elongated significantly in the AWWET groups, and the whole course of ET was significantly shortened, specially in the blocked group. The angle between the bony ET and the cartilaginous ET was decreased and the horizontal angle of the ET increased in the AWWET groups, the difference was considered to indicate statistical significance(P<0.05). Conclusions: AWWET with MA is rare, a male predominance, left ear predominance, and with high incidence of hemifacial microsomia. The middle ear deformity is more serious than common MA, especially in the blocked group. The incidence of otitis media in the communicated group is significantly lower than that in the common MA, and the blocked group may be accompanied by ET inflammation.

Exploring the Diagnostic Potential of EPB41L3 Methylation in Cervical Cancer and Precancerous Lesions: A Systematic Review and Meta-Analysis

OBJECTIVE

This meta-analysis aimed to comprehensively evaluate the diagnostic use of erythrocyte membrane protein band 4.1like3 (EPB41L3) methylation detection in cervical cancer (CC) and its precancerous lesions.

METHODS

CNKI, Wanfang, Cochrane Library, PubMed, and Ovid databases were searched using a combination of subject headings and free words. Pertinent data were retrieved after screening for inclusion and exclusion criteria, and the quality of the included studies was evaluated using QUADAS-2 criteria. The appropriate software was used for heterogeneity analysis and combined effect size calculation. Additionally, sensitivity analysis was used to evaluate the robustness of the combined results, and meta-regression and subgroup analysis were conducted to investigate the origins of heterogeneity.

RESULTS

This meta-analysis included six studies, including 525 healthy individuals, 182 cervical intraepithelial neoplasia 1 (CIN1) samples, 182 CIN2 samples, 281 CIN3 samples, and 226 CC samples. EPB41L3 methylation detection for CIN2 and above lesions demonstrated combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and the area under the curve of the comprehensive receiver operating characteristic curve of 0.67, 0.76, 3.19, 0.41, 7.60, and 0.80, respectively; CIN3 and above lesions demonstrated these evaluations at 0.73, 0.84, 4.35, 0.33, 23.94, and 0.90, respectively. Meta-regression analysis revealed that the population, time, sample type, detection method, literature quality, and sample size were not significant sources of heterogeneity affecting the combined diagnostic efficacy of CIN2 and above lesions (p > 0.05). Subgroup analysis revealed higher combined diagnostic values of CIN2 and above lesions in retrospective studies, tissue samples, and Chinese populations, with DORs of 41.03, 14.59, and 13.70, respectively.

CONCLUSION

EPB41L3 methylation demonstrated a relatively low diagnostic performance in CC and precancerous lesions. However, it merits further investigation as a potential biomarker. Integrating it with multiple gene detection, human papillomavirus testing, and ThinPrep liquid-based cytology test examination is recommended to explore improved diagnostic strategies for CC and its precancerous lesions.

Development of an Immediate-Release Prototype Tablet Formulation of Hydroxychloroquine Sulfate with an Interwoven Taste-Masking System

Hydroxychloroquine sulfate (HCQS) was granted US-FDA approval in 1955 for the prevention and treatment of malaria. Since then, its uses have expanded to treat systemic lupus erythematosus and rheumatoid arthritis.  For each indication, HCQS is a crucial option for the treatment of pediatric, juvenile, adult, and elderly populations. Existing currently on the market are only 200-mg strength tablets exclusively for adult administration. To facilitate weight-based administration for pediatric and juvenile patients, an HCQS suspension is made by compounding a 200-mg HCQS tablet and suspending the crushed granules into water and Ora-Plus®. The Ora-Plus® suspension does not alter the extreme bitterness of HCQS such that it facilitates oral administration. Additional research has been executed to affirm that a slightly buffered, ion-pairing system, reduces the bitterness of HCQS. The buffered, ion-pairing system can be interwoven into an immediate-release tablet formulation likely without compromising tablet performance. With the taste-masking system embedded, the tablet could be more easily be compounded and suspended in water to generate a palatable oral suspension. Such a novel HCQS 200-mg tablet would be tailored for adult usages wherein the interwoven task-masking system could be utilized to facilitate weight-based administration for pediatric and juvenile patients. The dual quality target product profile of the tablet and the tablet compounded for suspension in water would make the tablet formulation applicable to a wide patient population ranging from pediatric to elder adults to facilitate in improving compliance and overall health outcomes.

[The study of relationship between occupational stress and sleep quality of video display terminals]

Objective: To investigate the sleep quality of video operators in Shenzhen, and explore the relationship between sleep quality and occupational stress and different work and life habits. Methods: In December 2020, a cluster sampling method was used to investigate 791 video operators in Shenzhen from June to December 2020 who were engaged in printing, design, IT and other industries. The Pittsburgh Sleep Quality Index Scale was used to investigate the sleep quality of video operators, and the Job Content Questionnaire was used to investigate the occupational stress of video operators, The Pay Return Imbalance Questionnaire was used to investigate the pay return imbalance of video operators. The measurement data conforming to the normal distribution shall be expressed by mean±standard deviation, and t-test, analysis of variance and linear correlation analysis shall be adopted according to the type of independent variable. Those that do not conform to the normal distribution are described by the median M (Q(1), Q(3)), and two sample Wilcoxon test is used according to the binary data of independent variable type. Kruskal Wallis test was used for multi classification data, and Spearman rank correlation was used for single factor analysis for ordinal classification data. The counting data were analyzed by chi square test or Fisher exact probability method. Logistic regression was used for multivariate analysis. Results: the pittsburgh sleep quality index was 4.76±2.86. 499 of them had high sleep quality. 292 people had low sleep quality, accounting for 36.91% (292/791). Compared with the low sleep quality group, the high sleep quality group had lower work requirement scores (13.48±1.77), higher autonomy scores (24.08±3.33), higher social support scores (23.95±3.08), lower pay scores (16.11±2.63), higher return scores (31.11±3.65), and lower internal input scores (14.98±2.55). There were statistically significant differences between the two scales in each dimension index group (P<0.05). Multi factor unconditional logistic regression analysis showed that high education level (OR=1.57, 95%CI=1.26~1.98, P<0.05), occupational stress (OR=1.69, 95%CI=1.21~2.36, P<0.05), and high pay and low return (OR=1.41, 95%CI=1.01~1.96, P<0.05) were the main influencing factors of sleep quality. Conclusion: The occurrence of occupational stress in video operators is a risk factor for low sleep quality, which should be paid enough attention.

Explainable Artificial Intelligence Methods in Combating Pandemics: A Systematic Review

Despite the myriad peer-reviewed papers demonstrating novel Artificial Intelligence (AI)-based solutions to COVID-19 challenges during the pandemic, few have made a significant clinical impact, especially in diagnosis and disease precision staging. One major cause for such low impact is the lack of model transparency, significantly limiting the AI adoption in real clinical practice. To solve this problem, AI models need to be explained to users. Thus, we have conducted a comprehensive study of Explainable Artificial Intelligence (XAI) using PRISMA technology. Our findings suggest that XAI can improve model performance, instill trust in the users, and assist users in decision-making. In this systematic review, we introduce common XAI techniques and their utility with specific examples of their application. We discuss the evaluation of XAI results because it is an important step for maximizing the value of AI-based clinical decision support systems. Additionally, we present the traditional, modern, and advanced XAI models to demonstrate the evolution of novel techniques. Finally, we provide a best practice guideline that developers can refer to during the model experimentation. We also offer potential solutions with specific examples for common challenges in AI model experimentation. This comprehensive review, hopefully, can promote AI adoption in biomedicine and healthcare.

Proposing Causal Sequence of Death by Neural Machine Translation in Public Health Informatics

Each year there are nearly 57 million deaths worldwide, with over 2.7 million in the United States. Timely, accurate and complete death reporting is critical for public health, especially during the COVID-19 pandemic, as institutions and government agencies rely on death reports to formulate responses to communicable diseases. Unfortunately, determining the causes of death is challenging even for experienced physicians. The novel coronavirus and its variants may further complicate the task, as physicians and experts are still investigating COVID-related complications. To assist physicians in accurately reporting causes of death, an advanced Artificial Intelligence (AI) approach is presented to determine a chronically ordered sequence of conditions that lead to death (named as the causal sequence of death), based on decedent’s last hospital discharge record. The key design is to learn the causal relationship among clinical codes and to identify death-related conditions. There exist three challenges: different clinical coding systems, medical domain knowledge constraint, and data interoperability. First, we apply neural machine translation models with various attention mechanisms to generate sequences of causes of death. We use the BLEU (BiLingual Evaluation Understudy) score with three accuracy metrics to evaluate the quality of generated sequences. Second, we incorporate expert-verified medical domain knowledge as constraints when generating the causal sequences of death. Lastly, we develop a Fast Healthcare Interoperability Resources (FHIR) interface that demonstrates the usability of this work in clinical practice. Our results match the state-of-art reporting and can assist physicians and experts in public health crisis such as the COVID-19 pandemic.

Differentiation of malignant from benign orbital tumours using dual-energy CT

AIM

To investigate the diagnostic accuracy of dual-energy computed tomography (DECT)-derived iodine concentration (IC), effective atomic number (Z_eff), and spectral attenuation information for differentiating malignant and benign orbital tumours.

MATERIALS AND METHODS

Data from 41 patients with orbital tumours from November 2019 to March 2021 were analysed retrospectively. Each patient underwent contrast-enhanced DECT using a 128-section dual-source computed tomography (DSCT) system. Dual-energy information, including IC, normalised iodine concentration (NIC), Z_eff, virtual monoenergetic images (VMIs) reconstructed from 40 to 120 keV and slope (k) value were determined. Quantitative measurement of DECT parameters was undertaken by two independent radiologists blinded to clinical data. Differences in parameters were assessed using independent sample t-test. Diagnosis performance was calculated by the receiver operating characteristic (ROC) curve analysis. Radiation doses of conventional CT and DECT were compared by paired t-tests.

RESULTS

Forty-one patients with histopathologically confirmed tumours were enrolled, including 10 malignant cases and 21 benign cases. Malignant orbital tumours exhibited significantly greater IC, NIC, Z_eff, CT attenuation of VMIs at 40-105 keV, and k values compared to benign orbital tumours (p<0.05). In ROC analyses, 40 keV VMI demonstrated the highest diagnostic performance of single parameters (area under the ROC curve [AUC], 0.940), and combined parameters achieved the best performance (AUC, 0.971; sensitivity, 90%; specificity, 93.55%). Radiation doses were significantly reduced in DECT than conventional CT (p<0.001).

CONCLUSIONS

Quantitative DECT analysis can be a useful technique, which yields excellent diagnostic accuracy, in the differentiation of malignant and benign orbital tumours with low radiation dose.

CT and MRI features of extraocular muscle granular cell tumour: preliminary experience in eight cases

AIM

To characterise the computed tomography (CT) and magnetic resonance imaging (MRI) features, in particular the functional MRI characteristics, of extraocular muscle granular cell tumours (GCTs).

MATERIALS AND METHODS

The CT (n=6) and MRI (n=8) features of eight extraocular muscle GCTs cofirmed at histopathology were analysed retrospectively. The imaging findings were evaluated with emphasis on the location, size, margin, shape, extent, bony change, internal architecture, enhancement pattern, and extent of lesions. Based on diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI, the apparent diffusion coefficient (ADC) value of six lesions and time-intensity curve (TIC) of one lesion were reviewed.

RESULTS

Immunohistochemistry revealed strong positivity for S-100 protein and a low Ki-67 index (2-5%) in all cases. Most of the lesions (7/8) were confined to the muscle belly with an ovoid shape. All of the tumours were isodense to cerebral grey matter and showed homogeneously mild enhancement on CT images. All lesions were hypointense to cerebral grey matter on T2-weighted imaging (T2WI) and showed homogeneously marked enhancement on contrast-enhanced T1-weighted imaging (T1WI). All lesions showed a hypo- or isointense signal on DWI images with a high b-value. The mean ADC of six lesions was (0.72 ± 0.14) × 10^-3 mm²/s. The TIC of the case examined using DCE-MRI showed a plateau pattern (type II).

CONCLUSION

A well-defined oval mass confined to the muscle belly with a hypointense signal on T2WI, homogeneously marked enhancement on contrast-enhanced T1WI, hypo- or isointense signal on DWI, and low ADC value is highly suggestive of a GCT.

[Clinical and imaging features of middle ear hairy polyps]

Objective: To collect the clinical cases of middle ear hairy polyp, and to summarize the imaging features. Methods: We retrospectively analyzed the clinical data of four cases middle ear hairy polyp confirmed by surgical and pathologic between January 2007 and January 2020 at the Affiliated Eye & ENT Hospital of Fudan University. There were three females, one male, with two left ears and two right ears, aged from 1 to 59 years. The CT and MRI imaging of the patients, and the corresponding clinical manifestations were analyzed. Results: Hairy polyps originated from tympanum in one case, originated from Eustachian tube in two cases, exhibiting recurrent otorrhea without evident inducement. The other case, hairy polyps originated from the Eustachian tube pharyngeal orifice and protruded into the nasopharyngeal cavity, with pharynx discomfort and aural fullness, endoscope showed offwhite polypoid mass with a little hair. All the four cases presented polypoid soft tissue masses on CT and MRI imaging, containing soft tissue wall and a large amount of adipose tissue, with soft tissue in the center of the mass which liked the core, and enhanced. MRI showed stratified arrangement of fat and soft tissue in the wall of the mass. Four cases all had surgical treatment, postoperative pathology examination presented that hair follicles, mature sebaceous glands and other skin appendages were found under squamous epithelium. A large amount of adipose tissue, part of muscle tissue, cartilage tissue, and some fibro-collagenous tissue were proliferated in the mass, accompanied by collagen degeneration. Conclusion: The middle ear hairy polyps has imaging characteristics, the polypoid soft tissue mass usually looks smooth and contains a large amount of adipose tissue, with a soft tissue in the center, and can be suggestively diagnosed by CT and MRI.

[Bax inhibitor-1 inhibits calcification of vascular smooth muscle cells in vitro]

OBJECTIVE

To investigate the effect of Bax inhibitor-1(BI-1)on calcification of vascular smooth muscle cells(VSMCs).

METHODS

VSMCs were isolated from the thoracic aorta of SD rats.VSMCs or BI-1-overexpressing VSMCs(transfected with a BI-1-overexpressing plasmid) were cultured in normal medium or calcified medium containing β-glycerophosphate and calcium chloride, and the cell calcification was examined with Alizarin red staining.Enzyme-linked immunosorbent assay was used to determine the intracellular calcium content and alkaline phosphatase activity.The expression levels of Runt-related transcription factor 2 (RUNX2), bone morphogenetic protein 2 (BMP-2) and caspase-3 were detected with Western blotting.

RESULTS

After 14 days of culture in the calcified medium, the VSMCs showed significantly reduced expression of BI-1 protein(P=0.001).BI-1 overexpression in the VSMCs caused a significant reduction of calcium level and alkaline phosphatase activities(P=0.0006) and lowered the expression levels of RUNX2 and BMP-2 (P=0.0001) in the cells.The VSMCs with induced calcification exhibited a significantly increased apoptosis rate, but BI-1 overexpression obviously inhibited VSMC apoptosis in the calcified medium (P=0.0003).

CONCLUSION

BI-1 may attenuate vascular calcification by inhibiting calcium deposition, osteogenic differentiation and apoptosis.

P–371 Clinical value assessment between endometrial receptivity array and immune profiling in patients with implantation failure

Study question

To evaluate whether the pregnancy outcomes could be improved in implantation failure patients by endometrial receptivity array, endometrial immune profiling, or a combination of both.

Summary answer

There was no statistical difference between different endometrial receptivity evaluation and treatment in improving the clinical pregnancy rate.

What is known already

Both endometrial receptivity array and endometrial immune profiling were promised to improve the endometrial receptivity and subsequent clinical pregnancy. However, less is known about the efficiency between each other and whether the combination could further enhance their clinical value.

Study design, size, duration

Between November 2019 and September 2020, 143 women with a history of at least two or more consecutive implantation failure in IVF/ICSI treatment in Chengdu Xinan Gynecology Hospital were included. They were divided into three groups: ‘ERA + Immune Profiling’ (n = 70), ‘Immune Profiling’ (n = 41), and ‘ERA’ (n = 32).

Participants/materials, setting, methods

Inclusion criteria were age ≤ 38, with normal uterus and uterine cavity. All patients were suggested to evaluate endometrial receptivity by ERA test (Igenomix, Valencia, Spain) and endometrial immune profiling based on immunohistochemistry simultaneously, who would be free to choose each or both evaluation approaches. Personal Embryo Transfer and/or personal medical care were adopted according to evaluation results. Clinical pregnancy was confirmed by gestational sacs observed under ultrasonography.

Main results and the role of chance

The overall prevalence of displaced window of implantation (WOI) is 84.3%, and nearly 74.8% (83/111) patients were diagnosed as endometrial immune dysregulation. Clinical Pregnancy rate and embryonic implantation rate decreased in the ‘Immune Test’ groups, but without a statistical difference (P = 0.311, and 0.158, respectively). Multivariable logistic regression analysis showed that different endometrial receptivity evaluation and treatment was not associated the clinical pregnancy rate, suggesting the performance of different endometrial receptivity evaluation and treatment is similar in improving the clinical pregnancy rate. Neither the immune profiling (CD56, P = 0.591; FOXP3, P = 0.195; CD68, P = 0.820; CD163, P = 0.926; CD1a, P = 0.561; CD57, P = 0.221; CD8, P = 0.427; CD138 CE, P = 0.372) nor histologic endometrial dating defined by Noyes criteria (P = 0.374) were associated with ERA phases.

Limitations, reasons for caution

Although the selection of evaluation approaches was based on patients’ willingness, the variances of baseline characteristics and immune profiling existed in different groups. The immunological treatment efficacy based on immune profiling was not evaluated before embryo transfer.

Wider implications of the findings: To our knowledge, this is the first study comparing the pregnancy outcomes after two typical endometrial receptivity evaluation approaches. The findings highlight the unsubstitutability for each assessment, indicating that both asynchronous and pathological WOI contribute to implantation failure.

Trial registration number

X2019004

Embedding Fe3C and Fe3N on a Nitrogen-Doped Carbon Nanotube as a Catalytic and Anchoring Center for a High-Areal-Capacity Li-S Battery

The biggest obstacles of putting lithium-sulfur batteries into practice are the sluggish redox kinetics of polysulfides and serious "shuttle effect" under high sulfur mass loading and lean-electrolyte conditions. Herein, Fe₃C/Fe₃N@nitrogen-doped carbon nanotubes (NCNTs) as multifunctional sulfur hosts are designed to realize high-areal-capacity Li-S batteries. The Fe₃N and Fe₃C particles attached to NCNT can promote the conversion of polysulfides. Besides, NCNT can not only enhance the chemisorption of polysulfides but also increase the special surface area and electrical conductivity by constructing a three-dimensional skeleton network. Integrating the merits of high electrical conductivity, high catalytic activity, and strong chemical binding interaction with lithium polysulfides (LiPSs) to achieve in situ anchoring conversion, the Fe₃C/Fe₃N@NCNT multifunctional hosts realize high sulfur mass loading and accelerate redox kinetics. The novel Fe₃C/Fe₃N@NCNT/S composite cathode exhibits steady cycle ability and a high areal capacity of 9.10 mAh cm^-2 with a sulfur loading of 13.12 mg cm^-2 at 2.20 mA cm^-2 after 50 cycles.

Sinonasal synovial sarcoma: evaluation of the role of radiological and clinicopathological features in diagnosis

AIM

To explore the value of radiological and clinicopathological features in the diagnosis of sinonasal synovial sarcomas (SS).

MATERIALS AND METHODS

Six patients with sinonasal SS were studied retrospectively using computed tomography (CT; n=6) and magnetic resonance imaging (MRI; n=4). The radiological and clinicopathological findings in this series were reviewed.

RESULTS

Three lesions were located, in both the nasal cavity, and the paranasal sinuses; one was located in the nasal cavity and nasopharynx, and the remaining two were located restrictively within the nasal cavity. An aggressive nature (invasion of adjacent structure) was found in four cases. At CT, lesions were found with isodensity with calcification mainly in the peripheral areas. Bony changes were visible in all cases. Five cases showed marked heterogeneous enhancement, and three cases contained necrotic or cystic areas. At MRI, haemorrhage was observed in three cases. All cases demonstrated the "triple sign", and two high-grade SS showed a "cobblestone-like" appearance on T2-weighted imaging (WI). All time-signal intensity curves (TICs) were of the washout type. The mean apparent diffusion coefficient (ADC) values of the two high-grade cases were lower than those of the low-grade or intermediate-grade cases. Histopathologically, all but one was of the monophasic type. During the 8-40 month period of follow-up, recurrence occurred in four cases.

CONCLUSIONS

A sinonasal tumour exhibiting characteristic calcification and bony change, together with haemorrhage, "triple sign" or "cobblestone-like" appearance, should engender a diagnosis of SS.

Platinum Atomic Clusters Embedded in Defects of Anatase/Graphene for Efficient Electro- and Photocatalytic Hydrogen Evolution

Electro- and photocatalytic hydrogen evolution reaction (e-HER and p-HER) are two promising strategies to produce green hydrogen fuel from water. High intrinsic activity, sufficient active sites, fast charge-transfer capacity, and good optoelectronic properties must be taken into consideration simultaneously in pursuit of an ideal bifunctional catalyst. Here, platinum atomic clusters embedded in defects of TiO₂ nanocrystals/graphene nanosheets (Pt-T/G) are reported as a bifunctional catalyst for electro- and photocatalytic hydrogen evolution reaction (e-HER and p-HER). High activity is delivered due to the charge transfer from the other part of the catalyst to the active center (Pt₂-O₄-Ti_x), decreasing the activation energy of the rate-limiting step, which is revealed by synchrotron X-ray absorption spectroscopy, photoelectrochemical measurements, and simulated calculations. In regard to e-HER, it outperforms the commercial 20 wt % Pt/C catalyst by a factor of 17.5 on Pt mass basis, allowing for a 93% reduction in Pt loadings. In regard to p-HER, it achieves photocatalytic efficiency (686.8 μmol h^-1) without any attenuation in 9 h.

Selective Adsorption and Electrocatalysis of Polysulfides through Hexatomic Nickel Clusters Embedded in N-Doped Graphene toward High-Performance Li-S Batteries

The shuttle effect hinders the practical application of lithium-sulfur (Li-S) batteries due to the poor affinity between a substrate and Li polysulfides (LiPSs) and the sluggish transition of soluble LiPSs to insoluble Li₂S or elemental S. Here, we report that Ni hexatomic clusters embedded in a nitrogen-doped three-dimensional (3D) graphene framework (Ni-N/G) possess stronger interaction with soluble polysulfides than that with insoluble polysulfides. The synthetic electrocatalyst deployed in the sulfur cathode plays a multifunctional role: (i) selectively adsorbing the polysulfides dissolved in the electrolyte, (ii) expediting the sluggish liquid-solid phase transformations at the active sites as electrocatalysts, and (iii) accelerating the kinetics of the electrochemical reaction of multielectron sulfur, thereby inhibiting the dissolution of LiPSs. The constructed S@Ni-N/G cathode delivers an areal capacity of 9.43 mAh cm^-2 at 0.1 C at S loading of 6.8 mg cm^-2, and it exhibits a gravimetric capacity of 1104 mAh g^-1 with a capacity fading rate of 0.045% per cycle over 50 cycles at 0.2 C at S loading of 2.0 mg cm^-2. This work opens a rational approach to achieve the selective adsorption and expediting of polysulfide transition for the performance enhancement of Li-S batteries.

[Effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults - A meta-analysis of randomized controlled trials with trial sequential analysis]

OBJECTIVES

To compare the effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults, and to investigate the influence of protein intake upon the outcome effects of hypocaloric feeding.

DESIGN

A meta-analysis of randomized controlled trials (RCTs) and trial sequential analysis (TSA) were carried out.

SETTING

Intensive Care Unit (ICU).

PATIENTS

Or participants Critically ill adults.

INTERVENTIONS

Hypocaloric enteral feeding versus standard enteral feeding.

MAIN VARIABLES OF INTEREST

The primary outcomes were all-cause short-term mortality and the incidence of nosocomial infection.

RESULTS

Eleven RCTs met the inclusion criteria; of these trials, two were judged as having low risk of bias. Compared with standard enteral feeding, hypocaloric enteral feeding had no benefits in terms of reducing short-term mortality, the incidence of nosocomial infection, or long-term mortality, though it had a positive impact upon the incidence of gastrointestinal intolerance. The TSA further confirmed these results. In turn, hypocaloric enteral feeding had no effects upon the incidence of bloodstream infection, pneumonia, hypoglycemia or the duration of mechanical ventilation, ICU stay, or in-hospital stay. The above results remained unchanged in the sub-analysis of trials with a low risk of bias, trials administering a similar dose of protein, or trials administering different doses of protein.

CONCLUSIONS

Compared with standard enteral feeding, hypocaloric enteral feeding was not associated with better clinical outcomes in critically ill adults, except for a lower risk of gastrointestinal intolerance. The difference in protein intake between groups might have no influence on the outcome effects of hypocaloric enteral feeding. High quality randomized controlled trials are needed to confirm this, however.

Early Prediction of Sepsis in EMR Records Using Traditional ML Techniques and Deep Learning LSTM Networks

Sepsis is a life-threatening condition caused by infection and subsequent overreaction by the immune system. Physicians effectively treat sepsis with early administration of antibiotics. However, excessive use of antibiotics on false positive cases cultivates antibiotic resistant bacterial strains and can waste resources while false negative cases result in unacceptable mortality rates. Accurate early prediction ensures correct, early antibiotic treatment; unfortunately, prediction remains daunting due to error-ridden electronic medical records (EMRs) and the inherent complexity of sepsis. We aimed to predict sepsis using only the first 24 and 36 hours of lab results and vital signs for a patient. We used the Medical Information Mart for Intensive Care III (MIMIC3) dataset to test machine learning (ML) techniques including traditional methods (i.e., random forest (RF) and logistic regression (LR)) as well as deep learning techniques (i.e., long short-term memory (LSTM) neural networks). We successfully created a data pipeline to process and clean data, identified important predictive features using RF and LR techniques, and trained LSTM networks. We found that our best performing traditional classifier, RF, had an Area Under the Curve (AUC-ROC) score of 0.696, and our LSTM networks did not outperform RF.

Sulfur-/Nitrogen-Rich Albumen Derived "Self-Doping" Graphene for Sodium-Ion Storage

The development of sodium-ion batteries (SIBs) is hindered by the rapid reduction in reversible capacity of carbon-based anode materials. Outside-in doping of carbon-based anodes has been extensively explored. Nickel and NiS₂ particles embedded in nitrogen and sulfur codoped porous graphene can significantly improve the electrochemical performance. Herein a built-in heteroatom "self-doping" of albumen-derived graphene for sodium storage is reported. The built-in sulfur and nitrogen in albumen act as the doping source during the carbonization of proteins. The sulfur-rich proteins in albumen can also guide the doping and nucleation of nickel sulfide nanoparticles. Additionally, the porous architecture of the carbonized proteins is achieved through removable KCl/NaCl salts (medium) under high-temperature melting conditions. During the carbonization process, nitrogen can also reduce the carbonization temperature of thermally stable carbon materials. In this work, the NS-graphene delivered a specific capacity of 108.3 mAh g^-1 after 800 cycles under a constant current density of 500 mA g^-1 . In contrast, the Ni/NiS₂ /NS-graphene maintained a specific capacity of 134.4 mAh g^-1 ; thus the presence of Ni/NiS₂ particles improved the electrochemical performance of the whole composite.

[Interference research of umbilical cord mesenchymal stem cells on the pulmonary fibrosis in silicosis rats]

Objective: To explore the effect of the umbilical cord mesenchymal stem cells(UC-MSCs) on the pulmonary fibrosis in silicosis rats. Methods: SPF male Sprague Dawley rats were randomly divided into control group, silica model group and UC-MSCs treatment group with 12 rats each group. SiO(2) intra-tracheal injection(0.5 ml of 50 mg/ml/rat) were applied to silica model group and UC-MSCs treatment groups. After that UC-MSCs treatment group received 1 ml UC-MSCs suspension (3×10(6) cells/ml) by tail vein injection on the 29th, 36th, 43th and 50th day after exposure to the first silica suspension. On the 60th and 75th day after exposure to silica suspension, all animals were examed for pulmonary CT. Then the rats were euthanized on 75th day after the first exposure to silica.Lung's histopathological examination of the rats from all the groups were carried out. The content of hydroxyproline in lungs, TGF-β1 and IL-6 in serum were examined. Results: The lung's histopathological examination showed no obvious inflammatory cell and no fibrosis in the lung tissue of the control group, there were a lot of inflammatory cell aggregation and collagen fiber deposition in silica model group, while in the UC-MSCs intervention group and treatment group, there were less inflammatory cells and collagen fiber. The rats from silica model groups had higher HYP, TGF-β1 and IL-6 than the rats from UC-MSCs treatment group and control group. Lung fields of rats in the control group were clear and no obvious high-density shadow. Different-sized granular high-density shadows or reticular fibrous shadows were found diffusely distributed in the lungs of the rats in silica model group. Lung field of rats in UC-MSCs intervention group and treatment group were less high density shadows, and more clear. Conclusion: UC-MSCs can alleviate the pulmonary fibrosis in silica model rats through regulating the secretion of some fibrosis related cytokines.

Improving Classification of Breast Cancer by Utilizing the Image Pyramids of Whole-Slide Imaging and Multi-Scale Convolutional Neural Networks

Whole-slide imaging (WSI) is the digitization of conventional glass slides. Automatic computer-aided diagnosis (CAD) based on WSI enables digital pathology and the integration of pathology with other data like genomic biomarkers. Numerous computational algorithms have been developed for WSI, with most of them taking the image patches cropped from the highest resolution as the input. However, these models exploit only the local information within each patch and lost the connections between the neighboring patches, which may contain important context information. In this paper, we propose a novel multi-scale convolutional network (ConvNet) to utilize the built-in image pyramids of WSI. For the concentric image patches cropped at the same location of different resolution levels, we hypothesize the extra input images from lower magnifications will provide context information to enhance the prediction of patch images. We build corresponding ConvNets for feature representation and then combine the extracted features by 1) late fusion: concatenation or averaging the feature vectors before performing classification, 2) early fusion: merge the ConvNet feature maps. We have applied the multi-scale networks to a benchmark breast cancer WSI dataset. Extensive experiments have demonstrated that our multiscale networks utilizing the WSI image pyramids can achieve higher accuracy for the classification of breast cancer. The late fusion method by taking the average of feature vectors reaches the highest accuracy (81.50%), which is promising for the application of multi-scale analysis of WSI.

[A questionnaire survey for gout management in physicians in Beijing]

Objective: To provide helpful continued medical education (CME) for physicians and improve gout treatment, we conducted a questionnaire survey to investigate physicians' knowledge in nine districts of Beijing. Methods: A questionnaire survey including ten gout-related questions was conducted among 298 physicians in Beijing. Demographic data and previous gout CME experience were collected. Chi-square test or Student's t test, univariate analysis and logistic regression analysis were used to evaluate the relevant factors of physicians' knowledge level. Results: A total of 250 valid copies were collected including 127 from community service centers (CSC), 123 from tertiary hospitals. The correct answer rate of gout etiology, pathogenesis and attack symptoms were over 70% in both groups. 45.5% (56/123) CSC doctors and 57.4% (66/115) tertiary doctors answered right drugs to control acute gout attack (P=0.067). Only 42.3% (52/123) in CSC and 53.4% (63/118) in hospitals chose allopurinol as a urate-lowering drug (ULT), while 46.3% (57/123) and 32.2% (38/118) doctors considered colchicine as a ULT drug (P=0.084) respectively. Near half doctors considered that gout patients should take long-term ULT [40.5% (51/126) vs. 57.6%(68/118)respectively, P=0.007]. Univariate analysis showed that CME training could improve gout-related knowledge in CRC doctors. Conclusion: Most CSC doctors generally understand basic knowledge of gout, while confusion of treatment is still significant. CME especially including standard gout treatment should be performed by doctors in tertiary hospitals.

[Clinical features of adult patients with chronic active Epstein-Barr virus infection]

Objective: To investigate the clinical features of adult-onset chronic active Epstein-Barr virus infection (CAEBV). Methods: A total of 21 adult patients with CAEBV who were admitted to the department of General Internal Medicine at Peking Union Medical College Hospital from January 2006 to January 2016 were retrospectively analyzed. Demographic data, disease duration, clinical manifestations, laboratory findings, treatments and prognosis were reviewed. Results: Eighteen females and 3 males were enrolled with a mean age of 39 years. The most common clinical manifestations included fever in 20 patients, splenomegaly in 20 patients, lymphadenopathy in 18 patients, and hepatomegaly in 10 patients, followed by laryngopharyngeal disorders in 6 patients, pleural effusion and peritoneal effusion each in 5 patients, rash in 4 patients, interstitial lung disease in 3 patients, gastrointestinal hemorrhage in 2 patients, and peripheral neuropathy and pulmonary hypertension each in 1 patient. Six patients were complicated with hemophagocytic lymphohis-tioncytosis(HLH) that developed 5-17 (mean: 9) months following CAEBV onset, all of whom experienced hyperpyrexia, pancytopenia, lymphadenopathy, splenomegaly, and liver dysfunction, 3 with hepatomegaly. Nineteen of the 21 patients had received steroid therapy including 10 combined with immunosuppressive agents, 11 with antiviral therapy, and 8 with intravenous immunoglobulin. Thirteen patients died, including 10 of multiple organ failure, (including 6 of HLH) 2 of severe pulmonary infection, and 1 of lymphoma. Six patients remained on follow-up, yet 2 were missing. Conclusions: CAEBV is expected with severe condition and poor prognosis, which is likely to be complicated with HLH. Clinical physicians should pay attention to adult patients with fever, hepatosplenomegaly and lymphadenopathy, which suggests possible CAEBV.

Hyperbaric oxygen treatment for Parkinson's disease with severe depression and anxiety: A case report

RATIONALE

Patients with Parkinson's disease (PD) frequently suffer from psychiatric disorders, and treating these symptom whereas managing the motor symptoms associated with PD can be a therapeutic challenge.

PATIENT CONCERNS

We report a case of PD patient with severe depression and anxiety that refused to be treated with dopaminagonists or SSRIs, the most common treatments for PD patients suffering from psychiatric symptoms.

DIAGNOSES

Parkinson's disease with severe depression and anxiety.

INTERVENTIONS

This man was treated with hyperbaric oxygen treatment for 30 days.

OUTCOMES

Clinical assessment scores for depression and anxiety, including Unified Parkinson's Disease Rating ScaleI (UPDRS I), UPDRS II, Hanmilton Depression Rating Scale, and Hamiliton Anxiety Rating Scale, were improved following the hyperbaric oxygen treatment.

LESSONS

Hyperbaric oxygen treatment may be a potential therapeutic method for PD patient suffering from depression and anxiety. Further research is needed to validate this finding and explore a potential mechanism.

Interpretable Predictions of Clinical Outcomes with An Attention-based Recurrent Neural Network

The increasing accumulation of healthcare data provides researchers with ample opportunities to build machine learning approaches for clinical decision support and to improve the quality of health care. Several studies have developed conventional machine learning approaches that rely heavily on manual feature engineering and result in task-specific models for health care. In contrast, healthcare researchers have begun to use deep learning, which has emerged as a revolutionary machine learning technique that obviates manual feature engineering but still achieves impressive results in research fields such as image classification. However, few of them have addressed the lack of the interpretability of deep learning models although interpretability is essential for the successful adoption of machine learning approaches by healthcare communities. In addition, the unique characteristics of healthcare data such as high dimensionality and temporal dependencies pose challenges for building models on healthcare data. To address these challenges, we develop a gated recurrent unit-based recurrent neural network with hierarchical attention for mortality prediction, and then, using the diagnostic codes from the Medical Information Mart for Intensive Care, we evaluate the model. We find that the prediction accuracy of the model outperforms baseline models and demonstrate the interpretability of the model in visualizations.

A Novel Temporal Similarity Measure for Patients Based on Irregularly Measured Data in Electronic Health Records

Patient similarity measurement is an important tool for cohort identification in clinical decision support applications. A reliable similarity metric can be used for deriving diagnostic or prognostic information about a target patient using other patients with similar trajectories of health-care events. However, the measure of similar care trajectories is challenged by the irregularity of measurements, inherent in health care. To address this challenge, we propose a novel temporal similarity measure for patients based on irregularly measured laboratory test data from the Multiparameter Intelligent Monitoring in Intensive Care database and the pediatric Intensive Care Unit (ICU) database of Children's Healthcare of Atlanta. This similarity measure, which is modified from the Smith Waterman algorithm, identifies patients that share sequentially similar laboratory results separated by time intervals of similar length. We demonstrate the predictive power of our method; that is, patients with higher similarity in their previous histories will most likely have higher similarity in their later histories. In addition, compared with other non-temporal measures, our method is stronger at predicting mortality in ICU patients diagnosed with acute kidney injury and sepsis.

Categories and Subject Descriptors

H.3.3 [Information Storage and Retrieval]: Retrieval models and rankings - similarity measures; J.3 [Applied Computing]: Life and medical sciences - health and medical information systems.

General Term

Algorithm.

InterVisAR: An Interactive Visualization for Association Rule Search

Association rule mining has been utilized extensively in many areas because it has the ability to discover relationships among variables in large databases. However, one main drawback of association rule mining is that it attempts to generate a large number of rules and does not guarantee that the rules are meaningful in the real world. Many visualization techniques have been proposed for association rules. These techniques were designed to provide a global overview of all rules so as to identify the most meaningful rules. However, using these visualization techniques to search for specific rules becomes challenging especially when the volume of rules is extremely large. In this study, we have developed an interactive association rule visualization technique, called InterVisAR, specifically designed for effective rule search. We conducted a user study with 24 participants, and the results demonstrated that InterVisAR provides an efficient and accurate visualization solution. We also verified that InterVisAR satisfies a non-factorial property that should be guaranteed in performing rule search. All participants also expressed high preference towards InterVisAR as it provides a more comfortable and pleasing visualization in association rule search.

Effect of low-expression gene filtering on detection of differentially expressed genes in RNA-seq data

We compare methods for filtering RNA-seq lowexpression genes and investigate the effect of filtering on detection of differentially expressed genes (DEGs). Although RNA-seq technology has improved the dynamic range of gene expression quantification, low-expression genes may be indistinguishable from sampling noise. The presence of noisy, low-expression genes can decrease the sensitivity of detecting DEGs. Thus, identification and filtering of these low-expression genes may improve DEG detection sensitivity. Using the SEQC benchmark dataset, we investigate the effect of different filtering methods on DEG detection sensitivity. Moreover, we investigate the effect of RNA-seq pipelines on optimal filtering thresholds. Results indicate that the filtering threshold that maximizes the total number of DEGs closely corresponds to the threshold that maximizes DEG detection sensitivity. Transcriptome reference annotation, expression quantification method, and DEG detection method are statistically significant RNA-seq pipeline factors that affect the optimal filtering threshold.

[The spontaneous herniation of temporomandibular joint into external auditory canal: diagnosis of otoscopy, CT and MRI]

OBJECTIVE

To summarize the otoscopy, CT and MRI features of spontaneous herniation of the temporomandibular joint(TMJ) into the external auditory canal(EAC) through the persistence Huschke's foramen(PHF).

METHODS

The otoscopy, CT and MRI images of three cases with the herniation of the TMJ into the EAC through the PHF were analyzed retrospectively.

RESULTS

Otoscopy revealed the masses located in the antero-inferior aspect of the bony EAC, and the mass displayed an alternative of forward and backward motion during opening and closing of the mouth.CT of the temporal bone showed a bony defect and a consecutive soft mass in the antero-inferior wall of the bony EAC. The margin of the bony defects were well-defined in all cases, the bone adjacent to PHF was pressed and partially wrapped around the soft mass as 'holding ball' in two cases, partly peripheral pseudo bony shell of the soft mass were showed in two cases. The soft mass in EAC appeared equal attenuated with the soft tissue of TMJ, and on enhanced CT scans showed no enhancement of the soft mass. On MRI scans, the imaging displayed a bony defect in the antero-inferior wall of the EAC with a soft mass which was formed by the capsule of the TMJ, and the mass showed iso-signal to the capsule of the TMJ on all sequences, and there was no enhancement after contrast administration.

CONCLUSION

The otoscopy, CT and MRI features of the spontaneous herniation of the TMJ into the EAC through the PHF is special, and the above examinations are valuable for diagnosis of the disease.

Transcriptional profiling of interleukin-2-primed human adipose derived mesenchymal stem cells revealed dramatic changes in stem cells response imposed by replicative senescence

Inflammation is a double-edged sword with both detrimental and beneficial consequences. Understanding of the mechanisms of crosstalk between the inflammatory milieu and human adult mesenchymal stem cells is an important basis for clinical efforts. Here, we investigate changes in the transcriptional response of human adipose-derived stem cells to physiologically relevant levels of IL-2 (IL-2 priming) upon replicative senescence. Our data suggest that replicative senescence might dramatically impede human mesenchymal stem cell (MSC) function via global transcriptional deregulation in response to IL-2. We uncovered a novel senescence-associated transcriptional signature in human adipose-derived MSCs hADSCs after exposure to pro-inflammatory environment: significant enhancement of the expression of the genes encoding potent growth factors and cytokines with anti-inflammatory and migration-promoting properties, as well as genes encoding angiogenic and anti-apoptotic promoting factors, all of which could participate in the establishment of a unique microenvironment. We observed transcriptional up-regulation of critical components of the nitric oxide synthase pathway (iNOS) in hADSCs upon replicative senescence suggesting, that senescent stem cells can acquire metastasis-promoting properties via stem cell-mediated immunosuppression. Our study highlights the importance of age as a factor when designing cell-based or pharmacological therapies for older patients and predicts measurable biomarkers characteristic of an environment that is conducive to cancer cells invasiveness and metastasis.

Protective effect of ischaemic preconditioning in total knee arthroplasty

OBJECTIVE

To investigate the genomic response induced by ischaemic preconditioning (IPC) in muscle biopsies taken from the operative leg of total knee arthroplasty patients.

MATERIALS AND METHODS

The gene expression profile GSE21164 was extracted from Gene Expression Omnibus (GEO) database. Patients undergoing primary knee arthroplasty were randomized to control and treatment (IPC) groups. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Limma package of R language was used to identify the differentially expressed genes (DEGs) between control and treatment group. To find out specific genes, DEGs at T0 were compared with DEGs at T1. Scansite was used to find out the binding domain for specific DEGs. Functional enrichment analysis was done by DAVID.

RESULTS

Of the genes queried on the Affymetrix Human Genome U133 Plus 2.0 microarray, we identified 263 (T0) and 266 (T1) DEGs compared to the control group. Down-regulation of DEGs related with regulation neuron apoptosis was observed at T1. The most significant function of DEGs at T0 was related with neurological system process. The most specific DEG was FAM125B at T0 and T1 time points. Its common binding domain was SH3.

CONCLUSIONS

The protective effect of IPC was associated with altered expression of genes involved in neurological system process and regulation of neuron apoptosis. The dynamic expression of FAM125B can be a supervised marker during the surgery. IPC may be of potential benefit in this and other musculoskeletal conditions.

[Investigation of ophthalmic resources in Xinjiang Uyghur Autonomous Region in China]

OBJECTIVES

To explore ophthalmic resources and existing problems in Xinjiang Uyghur Autonomous Region, and to provide reasonable developing configuration for the future.

METHODS

It was a population-based cross-section study. By using questionnaire to collect data from all eye units (national and private) which were registered in Xinjiang area. Investigation included: (1) ophthalmic medical unit of name, structure type, departments constitute; (2) the ophthalmic medical work; (3) the number of ophthalmology health technicians and distribution; (4) ophthalmic devices usage; (5) carry out the problems and difficulties encountered in ophthalmic work. Descriptive statistic method was used to analyze the structure of ophthalmic material, the availability of resource, the medical institution of different regions and types.

RESULTS

One hundred and thirty questionnaire were filled out and 110 questionnaire were recovery. There were 107 eye units, 1709 beds for ophthalmic, 1672 employees, including 525 doctors, the ratio of doctors and nurses was 1.0:1.3. And the ophthalmic resources mainly distributed in northern Tianshan, very few in the eastern area in Xinjiang; ophthalmic units were denser in general hospitals which were above the county level. There were 43 580 ophthalmic surgeries in all, the main eye operation carried out was cataract surgery, including 20 303 (counted 46.59%) cataract operation.

CONCLUSIONS

The ophthalmic units distribution is unbalanced, which is short of ophthalmologists. It provides base for government to arrange ophthalmic resources reasonably, to enhance the research motivation and to cultivate more professors, and to increase the number of ophthalmic specialists in the general hospitals, and eventually to maximize the benefit of ophthalmic service in Xinjiang.

Late onset of subfoveal choroidal neovascularisation following cerebral radiotherapy

A report of choroidal neovascularisation (CNV) associated with radiation retinopathy. A 43-year-old Caucasian man presented with a 4-week history of sudden loss of central vision in the left eye, 8.5 years following radical radiotherapy for left tempero-parietal anaplastic astrocytoma. His visual acuity was 6/6 in the right eye and 6/60 in the left eye. Ophthalmoscopy of the left eye showed central macular pigmented area surrounded by subretinal fluid, haemorrhage and exudates. Fundus fluorescein angiography revealed left subfoveal CNV with surrounding macular oedema and peripheral retinal ischaemia. Radiation retinopathy associated CNV is a late ocular complication of cerebral radiotherapy. It should be investigated as a possible aetiology of severe visual loss in long-term survivors of cerebral tumours who have previously received radiotherapy.

Resistance of Spiroplasma citri Lines to the Virus SVTS2 Is Associated with Integration of Viral DNA Sequences into Host Chromosomal and Extrachromosomal DNA

Spiroplasmavirus SVTS2, isolated from Spiroplasma melliferum TS2, produces plaques when inoculated onto lawns of Spiroplasma citri M200H, a derivative of the type strain Maroc R8A2. S. citri strains MR2 and MR3, originally selected as colonies growing within plaques on a lawn of M200H inoculated with SVTS2, were resistant to SVTS2. Genomic DNA fingerprints and electrophoretic protein profiles of M200H, MR2, and MR3 were similar, but three proteins present in M200H were missing or significantly reduced in both resistant lines. None of these three polypeptides reacted with antiserum against S. citri membrane proteins, indicating that they probably are not surface-located virus receptors. Electroporation with SVTS2 DNA produced 1.5 x 10(sup5) transfectants per (mu)g of DNA in M200H but none in MR2 or MR3, suggesting that resistance may result from inhibition of viral replication. The digestion patterns of the extrachromosomal double-stranded (ds) DNA of these lines were similar. Three TaqI fragments of MR2 extrachromosomal DNA that were not present in M200H extrachromosomal DNA hybridized strongly to an SVTS2 probe, and two of these fragments plus an additional one hybridized with the MR3 extrachromosomal DNA, indicating that a fragment of SVTS2 DNA was present in the extrachromosomal ds DNA of MR2 and MR3 but not of M200H. When the restricted genomes of all three lines were probed with SVTS2 DNA, strong hybridization to two EcoRI fragments of chromosomal MR2 and MR3 DNA but not M200H DNA indicated that SVTS2 DNA had integrated into the genomes of MR2 and MR3 but not of M200H. When MR3 extrachromosomal ds DNA containing a 2.1-kb SVTS2 DNA fragment was transfected into M200H, the transformed spiroplasmas were resistant to SVTS2. These results suggest that SVTS2 DNA fragments, possibly integrated into the chromosomal or extrachromosomal DNA of a previously susceptible spiroplasma, may function as viral incompatibility elements, providing resistance to superinfection by SVTS2.

Triterpenoid prosapogenols and prosapogenins from the husks of Xanthoceras sorbifolia

Two new prosapogenins, 16-O-acetyl-21-O-(4-angeloyl)-alpha-l-rhamnopyranosyl barringtogenol C (1), 28-O-beta-d-glucopyranosyl 16-deoxybarringtogenol C (2), were isolated from the acid hydrolyzate of the crude saponin obtained from the husks of Xanthoceras sorbifolia Bunge, along with six known triterpenoids. These structures were established on the basis of chemical and detailed spectral evidences. Compounds 1 and 2 showed cytotoxic activity against human cell lines (A375-S2, HeLa).

Norisoprenoids from Ulva lactuca

Five norisoprenoids were isolated from the green marine alga Ulva lactuca. Two new compounds were assigned to (3R,5R,6R,7E)3,5,6-trihydroxy-7-megastigmen-9-one (1) and (3S,5R,6S,7E)3,5,6-trihydroxy-7-megastigmen-9-one (2). The structures and absolute configurations of the five compounds were determined by analyses of NMR, MS and circular dichroism (CD).

A new perylenequinone from the fruit bodies of Bulgaria inquinans

A new perylenequinone, 4,9-dihydroxy-1,2,11,12-tetrahydroperylene-3,10-quinone (1), together with three known compounds, have been isolated from the ethanolic extract of the fruit bodies of Bulgaria inquinans, and their structures elucidated on the basis of the spectral data and comparison with the literature.

A new triterpene glycoside from Asterias rollentoni

A new triterpene glycoside, rollentoside A, has been isolated from Asterias rollentoni Bell and identified as 3beta-O-{3-O-methyl-beta-D-xylopyranosyl-(1-->3)-O-beta-D-glucopyranosyl-(1-->4)-O-beta-D-quinopyranosyl-(1-->2)-O-beta-D-xylopyranosyl}-16-beta-acetoxy-23S-acetoxy-holost-7-ene (1), together with a new natural product, rollentoside B (2). The structures of compounds1 and 2 were elucidated by extensive 1D and 2D NMR investigation (1H-1H COSY, TOCSY, HSQC, HMBC, NOESY).

A novel sulphur glycoside from the seeds of Descurainia sophia (L.)

A new sulphur glycoside, named descurainoside (1), and the known compound sinapic acid (2) have been isolated from the seeds of Descurainia sophia (L.) Webb ex Prantl. The structure of 1 has been identified as (1R,6S,8R,9S,10S)-9,10-dihydroxy-4-[(4-hydroxy-3,5-dimethoxyphenyl)methylene]-8-(hydroxymethyl)-2,7-dioxa-5-thiabicyclo[4.4.0]decan-3-one by means of physico-chemical properties and spectroscopic methods (1D and 2D NMR, HRMS, ESI-MS).

Generation and flanking sequence analysis of a rice T-DNA tagged population

Insertional mutagenesis provides a rapid way to clone a mutated gene. Transfer DNA (T-DNA) of Agrobacterium tumefaciens has been proven to be a successful tool for gene discovery in Arabidopsis and rice ( Oryza sativa L. ssp. japonica). Here, we report the generation of 5,200 independent T-DNA tagged rice lines. The T-DNA insertion pattern in the rice genome was investigated, and an initial database was constructed based on T-DNA flanking sequences amplified from randomly selected T-DNA tagged rice lines using Thermal Asymmetric Interlaced PCR (TAIL-PCR). Of 361 T-DNA flanking sequences, 92 showed long T-DNA integration (T-DNA together with non-T-DNA). Another 55 sequences showed complex integration of T-DNA into the rice genome. Besides direct integration, filler sequences and microhomology (one to several nucleotides of homology) were observed between the T-DNA right border and other portions of the vector pCAMBIA1301 in transgenic rice. Preferential insertion of T-DNA into protein-coding regions of the rice genome was detected. Insertion sites mapped onto rice chromosomes were scattered in the genome. Some phenotypic mutants were observed in the T1 generation of the T-DNA tagged plants. Our mutant population will be useful for studying T-DNA integration patterns and for analyzing gene function in rice.

Beta-turn formation by a six-residue linear peptide in solution

A model peptide AAGDYY-NH2 (B1), which is found to adopt a beta-turn conformation in the TEM-1 beta-lactamase inhibitor protein (BLIP) in the TEM-1/BLIP co-crystal, was synthesized to elucidate the mechanism of its beta-turn formation and stability. Its structural preferences in solution were comprehensively characterized using CD, FT-IR and 1H NMR spectroscopy, respectively. The set of observed diagnostic NOEs, the restrained molecular dynamics simulation, CD and FT-IR spectroscopy confirmed the formation of a beta-turn in solution by the model peptide. The dihedral angles [(phi3, phi3) (phi4, phi4)] of [(-52 degrees, -32 degrees ) (-38 degrees, -44 degrees )] of Gly-Asp fragment in the model peptide are consistent with those of a type III beta-turn. In a conclusion, the conformational preference of the linear hexapeptide B1 in solution was determined, and it would provide a simple template to study the mechanism of beta-turn formation and stability.

Computerized 3D-reconstructions of the ligaments of the lateral aspect of ankle and subtalar joints

3D-reconstruction images of the structures of lateral aspect of the ankle and subtalar joints were produced using plastination to make equidistant serial sections of 1.2 mm in thickness. A SGI workstation was employed to reconstruct the structures of the ligaments of the lateral aspect of ankle and subtalar joints in three dimensions. Reconstructed structures were displayed singly, in groups or as a whole, and these were rotated continuously at different velocities in 3D space. Different diameters and angles of the reconstructed structures could be measured easily. Improved results could be achieved with the use of a special sectional anatomical technique, i.e. contours + marching cubes algorithm.

A four-day study to evaluate the anti-plaque efficacy of an experimental triclosan-containing dentifrice

Four-day, non-brushing studies have been used successfully to demonstrate the anti-plaque efficacy of triclosan-containing dentifrices. The treatment effects observed are variable, likely due to differences in formulation, study design and measurement techniques. This randomized, double-blind crossover study was conducted to evaluate the anti-plaque efficacy of an experimental, multiple-benefit, triclosan-containing dentifrice versus two currently marketed sodium fluoride dentifrices in a four-day, lingual-brushing model on subjects in Beijing. People's Republic of China. Subjects brushed the lingual surfaces for 30 seconds, and before expectorating, swished the saliva/dentifrice slurry over the buccal surfaces for an additional 30 seconds. This procedure was repeated. Subjects performed their assigned brushing regimen twice daily for four days under supervision. On Day 5, plaque was measured using the Turesky Modification of the Quigley-Hein Plaque Index. There were highly significant treatment effects in favor of the experimental triclosan-containing dentifrice for whole mouth, buccal and lingual sites when compared to either of the sodium fluoride dentifrices (p < 0.0001).