[Progress and implementing of novel surgical concepts and techniques in patients with resectable gastric cancer liver metastasis]

In recent years, advances in surgical techniques and evolving concepts have significantly improved treatment strategies and prognosis for patients with gastric cancer liver metastases. In particular, patients diagnosed with initially resectable gastric cancer liver metastases shows marked improvement in survival. Despite variations in the definition of initially resectable gastric cancer liver metastases among different consensus and guidelines, surgical resection and hepatic physiotherapy are increasingly crucial components of comprehensive treatment. Meanwhile, the advancement of the multidisciplinary team model for diagnosis and treatment, along with the evolution of minimally invasive surgical concepts, offers patients increasingly personalized and less intrusive therapeutic alternatives. According to the Chinese Consensus Classification System for Gastric Cancer Liver Metastasis, the optimal clinical pathway for patients initially diagnosed with resectable gastric cancer liver metastasis involves precise categorization, guided selection of surgical approaches and physiotherapy using the multidisciplinary team model, and consideration of molecular classification. However, the refinement and confirmation of these clinical strategies is still required through high-quality clinical trials.

[Comparison of the efficacy of different surgical strategies in the treatment of patients with initially resectable gastric cancer liver metastases]

Objective: To examine the impact of varied surgical treatment strategies on the prognosis of patients with initial resectable gastric cancer liver metastases (IR-GCLM). Methods: This is a retrospective cohort study. Employing a retrospective cohort design, the study selected clinicopathological data from the national multi-center retrospective cohort study database, focusing on 282 patients with IR-GCLM who underwent surgical intervention between January 2010 and December 2019. There were 231 males and 51 males, aging (M(IQR)) 61 (14) years (range: 27 to 80 years). These patients were stratified into radical and palliative treatment groups based on treatment decisions. Survival curves were generated using the Kaplan-Meier method and distinctions in survival rates were assessed using the Log-rank test. The Cox risk regression model evaluated HR for various factors, controlling for confounders through multivariate analysis to comprehensively evaluate the influence of surgery on the prognosis of IR-GCLM patients. A restricted cubic spline Cox proportional hazard model assessed and delineated intricate associations between measured variables and prognosis. At the same time, the X-tile served as an auxiliary tool to identify critical thresholds in the survival analysis for IR-GCLM patients. Subgroup analysis was then conducted to identify potential beneficiary populations in different surgical treatments. Results: (1) The radical group comprised 118 patients, all undergoing R0 resection or local physical therapy of primary and metastatic lesions. The palliative group comprised 164 patients, with 52 cases undergoing palliative resections for gastric primary tumors and liver metastases, 56 cases undergoing radical resections for gastric primary tumors only, 45 cases undergoing palliative resections for gastric primary tumors, and 11 cases receiving palliative treatments for liver metastases. A statistically significant distinction was observed between the groups regarding the site and the number of liver metastases (both P<0.05). (2) The median overall survival (OS) of the 282 patients was 22.7 months (95%CI: 17.8 to 27.6 months), with 1-year and 3-year OS rates were 65.4% and 35.6%, respectively. The 1-year OS rates for patients in the radical surgical group and palliative surgical group were 68.3% and 63.1%, while the corresponding 3-year OS rates were 42.2% and 29.9%, respectively. A comparison of OS between the two groups showed no statistically significant difference (P=0.254). Further analysis indicated that patients undergoing palliative gastric cancer resection alone had a significantly worse prognosis compared to other surgical options (HR=1.98, 95%CI: 1.21 to 3.24, P=0.006). (3) The size of the primary gastric tumor significantly influenced the patients' prognosis (HR=2.01, 95%CI: 1.45 to 2.79, P<0.01), with HR showing a progressively increasing trend as tumor size increased. (4) Subgroup analysis indicates that radical treatment may be more effective compared to palliative treatment in the following specific cases: well/moderately differentiated tumors (HR=2.84, 95%CI 1.49 to 5.41, P=0.001), and patients with liver metastases located in the left lobe of the liver (HR=2.06, 95%CI 1.19 to 3.57, P=0.010). Conclusions: In patients with IR-GCLM, radical surgery did not produce a significant improvement in the overall prognosis compared to palliative surgery. However, within specific patient subgroups (well/moderately differentiated tumors, and patients with liver metastases located in the left lobe of the liver), radical treatment can significantly improve prognosis compared to palliative approaches.

[Establishment of a prognostic nomogram and discussion on optimal treatment for cervical adenocarcinoma:a retrospective study based on SEER database and Chinese single-center data]

Objective: To establish and validate a predicting nomogram for cervical adenocarcinoma based on surveillance, epidemiology and end results (SEER) database and Chinese single-center data, and to explore the optimal treatment for cervical adenocarcinoma. Methods: This study selected 2 478 cervical adenocarcinoma patients from the SEER database as the training cohort, and 195 cervical adenocarcinoma patients from Cancer Hospital of Dalian University of Technology, Liaouing Cancer Hospital and Institute as an external validation cohort. Clinicopathological information and follow-up data of the two cohorts were collected. The radiotherapy group was defined as receiving comprehensive treatment based on concurrent chemoradiotherapy after initial diagnosis, while the surgery group was defined as receiving comprehensive treatment based on radical surgery. Log-rank test and cox regression were used to evaluate factors affecting the prognosis of cervical adenocarcinoma patients. A nomogram was drawn to predict the 3-year and 5-year overall survival rates of cervical adenocarcinoma patients, and then internal validation of the training cohort from SEER database and external validation of the hospital cohort were conducted. Results: (1) In the SEER database training cohort, there were 385 patients (15.54%, 385/2 478) in the radiotherapy group and 2 093 patients (84.46%, 2 093/2 478) in the surgery group. Overall survival time of the radiotherapy group was (55.8±51.3) months, while that of the surgery roup was (94.4±61.7) months, the difference between the two groups was statistically significant (χ2=256.44, P<0.001). Log-rank test showed that age, marital status, maximum of tumor diameters, pathological grade, International Federation of Gynecology and Obstetrics (FIGO) stage, and treatments were all significant factors affecting the overall survival time of cervical adenocarcinoma patients (all P<0.001). Multivariate Cox regression analysis showed that elder (>50 years old), single status, huge tumors (>4 cm), high pathological grades (G2, G3), and advanced FIGO stages (≥Ⅱa2 stage) were independent risk factors for the overall survival time of cervical adenocarcinoma patients (all P<0.05); compared with radiotherapy, surgery was a protective factor for the prognosis of cervical adenocarcinoma patients (HR=0.619, 95%CI: 0.494-0.777; P<0.001). Further analysis of locally advanced stage and Ⅲc stage of patients showed that surgery was a protective factor for the prognosis of cervical adenocarcinoma patients with a maximum tumor diameter >4 to <6 cm (HR=0.414, 95%CI: 0.182-0.942; P=0.036) in locally advanced stage and Ⅲc T1 to T2 stage (HR=0.473, 95%CI: 0.307-0.728; P=0.001). (2) The external validation cohort consisted of 39 patients (20.00%, 39/195) in the radiotherapy group and 156 patients (80.00%, 156/195) in the surgery group. The overall survival time of patients in the radiotherapy group was (51.7±34.3) months, while that of the surgery group was (63.1±26.6) months (χ2=28.41, P<0.001). Further analysis was conducted on locally advanced stage and Ⅲc stage patients, and multivariate Cox regression analysis was performed after propensity score matching, which showed that surgery was a protective factor for the prognosis of cervical adenocarcinoma patients with a maximum tumor diameter >4 to <6 cm in locally advanced stage (HR=0.141, 95%CI: 0.023-0.843; P=0.032) and Ⅲc T1 to T2 stage (HR=0.184, 95%CI: 0.036-0.947; P=0.043). (3) Establishment and internal and external validation of nomogram: based on the six factors screened out by the multivariate Cox regression model, the nomogram was developed to predict the prognosis of cervical adenocarcinoma patients. The consistency index of the internal and external validation were 0.801 and 0.766, respectively, and the calibration curves matched well with the ideal fitting line. Conclusions: The key to the treatment of cervical adenocarcinoma is to prioritize radical surgery for patients with conditions for radical tumor resection. Compared with concurrent chemoradiotherapy, patients with locally advanced stages (Ⅰb3, Ⅱa2), and Ⅲc (T1, T2) stages cervical adenocarcinoma could benefit from comprehensive treatment based on radical surgery. The nomogram of this study has been validated internally and externally, and show good survival prediction efficacy for cervical adenocarcinoma patients.

Osiris17 is essential for stable integrin localization and function during insect wing epithelia remodeling

The dynamic adhesion between cells and their extracellular matrix is essential for the development and function of organs. During insect wing development, two epithelial sheets contact each other at their basal sites through the interaction of βPS integrins with the extracellular matrix. We report that Osiris17 contributes to the maintenance of βPS integrins localization and function in developing wing of Drosophila and locust. In flies with reduced Osiris17 expression the epithelia sheets fail to maintain the integrity of basal cytoplasmic junctional bridges and basal adhesion. In contrast to the continuous basal integrin localization in control wings, this localization is disrupted during late stages of wing development in Osiris17 depleted flies. In addition, the subcellular localization revealed that Osiris17 co-localizes with the endosomal markers Rab5 and Rab11. This observation suggests an involvement of Osiris17 in endosomal recycling of integrins. Indeed, Osiris17 depletion reduced the numbers of Rab5 and Rab11 positive endosomes. Moreover, overexpression of Osiris17 increased co-localization of Rab5 and βPS integrins and partially rescued the detachment phenotype in flies with reduced βPS integrins. Taken together, our data suggest that Osiris17 is an endosome related protein that contributes to epithelial remodeling and morphogenesis by assisting basal integrins localization in insects.

[Prevalence and risk factors of sarcopenia after radical gastrectomy for gastric cancer]

Objective: To investigate the prevalence and risk factors of sarcopenia in patients following radical gastrectomy with the aim of guiding clinical decisions. Methods: This was a retrospective observational study of data of patients who had undergone radical gastrectomy between June 2021 and June 2022 at the Department of General Surgery, First Medical Center of Chinese PLA General Hospital. Participants were reviewed 9-12 months after surgery. Inclusion criteria were as follows: (1) radical gastrectomy with a postoperative pathological diagnosis of primary gastric cancer; (2) no invasion of neighboring organs, peritoneal dissemination, or distant metastasis confirmed intra- or postoperatively; (3) availability of complete clinical data, including abdominal enhanced computed tomography and pertinent blood laboratory tests 9-12 after surgery. Exclusion criteria were as follows: (1) age <18 years; (2) presence of gastric stump cancer or previous gastrectomy; (3) history of or current other primary tumors within the past 5 years; (4) preoperative diagnosis of sarcopenia (skeletal muscle index [SMI) ≤52.4 cm²/m² for men, SMI ≤38.5 cm²/m² for women). The primary focus of the study was to investigate development of postoperative sarcopenia in the study cohort. Univariate and multivariate logistic regression were used to identify the factors associated with development of sarcopenia after radical gastrectomy. Results: The study cohort comprised 373 patients of average age of 57.1±12.3 years, comprising 292 (78.3%) men and 81 (21.7%) women. Postoperative sarcopenia was detected in 81 (21.7%) patients in the entire cohort. The SMI for the entire group was (41.79±7.70) cm2/m2: (46.40±5.03) cm2/m2 for men and (33.52±3.63) cm2/m2 for women. According to multivariate logistic regression analysis, age ≥60 years (OR=2.170, 95%CI: 1.175-4.007, P=0.013), high literacy (OR=2.512, 95%CI: 1.238-5.093, P=0.011), poor exercise habits (OR=3.263, 95%CI: 1.648-6.458, P=0.001), development of hypoproteinemia (OR=2.312, 95%CI: 1.088-4.913, P=0.029), development of hypertension (OR=2.169, 95%CI: 1.180-3.984, P=0.013), and total gastrectomy (OR=2.444, 95%CI:1.214-4.013,P=0.012) were independent risk factors for postoperative sarcopenia in post-gastrectomy patients who had had gastric cancer (P<0.05). Conclusion: Development of sarcopenia following radical gastrectomy demands attention. Older age, higher education, poor exercise habits, hypoproteinemia, hypertension, and total gastrectomy are risk factors for its development post-radical gastrectomy.

[Interpretation of the limit values of iodide in the "Standards for Drinking Water Quality（GB5749-2022）" in China]

The Drinking Water Sanitation Standard (GB 5749-2022) has been officially promulgated and implemented, with the iodide listed as a new reference indicator for water quality. This study interprets the distribution of iodine in environmental media, the impact of water iodine on health, the significance of establishing iodide standard limits, and the use of iodide standard limits, in order to provide a scientific basis for the application of iodide standard limits in this revised standard.

[Analysis of clinicopathological characteristics, therapeutic strategy and prognosis of 501 patients with gastric neuroendocrine neoplasms attending a single center]

Objective: To explore the clinicopathological features, treatment strategy and to analysis of prognosis-related risk factors of gastric neuroendocrine neoplasms(G-NEN). Methods: In this study, a retrospective observational study method was used to collect the clinicopathological data of patients diagnosed with G-NEN by pathological examination in the First Medical Center of PLA General Hospital from January 2000 to December 2021. The basic information of the patients, tumor pathological characteristics, and treatment methods were entered, and the treatment information and survival data after discharge were followed up and recorded. The Kaplan-Meier method was used to construct survival curves, and the log-rank test to analyze the differences in survival between groups. Cox Regression model analysis of risk factors affecting the prognosis of G-NEN patients. Results: Among the 501 cases confirmed as G-NEN, 355 were male and 146 were female, and their median age was 59 years. The cohort comprised 130 patients (25.9%) of neuroendocrine tumor (NET) G1, 54 (10.8%) of NET G2, 225 (42.9%) of neuroendocrine carcinoma (NEC), and 102 cases (20.4%) of mixed neuroendocrine-non-neuroendocrine(MiNEN). Patients NET G1 and NET G2 were mainly treated by endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). The main treatment for patients with NEC/MiNEN was the same as that for gastric malignancies, namely radical gastrectomy+lymph node dissection supplemented with postoperative chemotherapy. There were significant differences in sex, age, maximum tumor diameter, tumor morphology, tumor numbers, tumor location, depth of invasion, lymph node metastasis, distant metastasis, TNM staging and expression of immunohistological markers Syn and CgA among NET, NEC, and MiNEN patients (all P<0.05). Further for NET subgroup analysis, there were significant differences between NET G1 and NET G2 in the maximum tumor diameter, tumor shape and depth of invasion(all P<0.05). 490 patients (490/501, 97.8%) were followed up with a median of 31.2 months. 163 patients had a death during follow-up (NET G1 2, NET G2 1, NEC 114, MiNEN 46). For NET G1, NET G2, NEC and MiNEN patients,the 1-year overall survival rates were 100%, 100%, 80.1% and 86.2%, respectively; the 3-year survival rates were 98.9%, 100%, 43.5% and 55.1%, respectively. The differences were statistically significant (P<0.001). Univariate analysis showed that gender, age, smoking history, alcohol history, tumor pathological grade, tumor morphology, tumor location, tumor size, lymph node metastasis, distant metastasis, and TNM stage were associated with the prognosis of G-NEN patients (all P<0.05). Multivariate analysis showed that age ≥60 years, pathological grade of NEC and MiNEN, distant metastasis, and TNM stage III-IV were independent factors influencing the survival of G-NEN patients (all P<0.05). 63 cases were stage IV at initial diagnosis. 32 of these were treated with surgery and 31 with palliative chemotherapy. Stage IV subgroup analysis showed that the 1-year survival rates were 68.1% and 46.2% in the surgical treatment and palliative chemotherapy groups, respectively, and the 3-year survival rates were 20.9% and 10.3%, respectively; the differences were statistically significant (P=0.016). Conclusions: G-NEN is a heterogeneous group of tumors. Different pathological grades of G-NEN have different clinicopathological features and prognosis. Factors such as age ≥ 60 years old, pathological grade of NEC/MiNEN, distant metastasis, stage III, IV mostly indicate poor prognosis of patients. Therefore, we should improve the ability of early diagnosis and treatment, and pay more attention to patients with advanced age and NEC/MiNEN. Although this study concluded that surgery improves the prognosis of advanced patients more than palliative chemotherapy, the value of surgical treatment for patients with stage IV G-NEN remains controversial.

Chitinase 6 is required for procuticle thickening and organ shape in Drosophila wing

The polysaccharide chitin is a major scaffolding molecule in the insect cuticle. In order to be functional, both chitin amounts and chitin organization have been shown to be important parameters. Despite great advances in the past decade, the molecular mechanisms of chitin synthesis and organization are not fully understood. Here, we have characterized the function of the Chitinase 6 (Cht6) in the formation of the wing, which is a simple flat cuticle organ, in the fruit fly Drosophila melanogaster. Reduction of Cht6 function by RNA interference during wing development does not affect chitin organization, but entails a thinner cuticle suggesting reduced chitin amounts. This phenotype is opposed to the one reported recently to be caused by reduction of Cht10 expression. Probably as a consequence, cuticle permeability to xenobiotics is enhanced in Cht6-less wings. We also observed massive deformation of these wings. In addition, the shape of the abdomen is markedly changed upon abdominal suppression of Cht6. Finally, we found that suppression of Cht6 transcript levels influences the expression of genes coding for enzymes of the chitin biosynthesis pathway. This finding indicates that wing epidermal cells respond to activity changes of Cht6 probably trying to adjust chitin amounts. Together, in a working model, we propose that Cht6-introduced modifications of chitin are needed for chitin synthesis to proceed correctly. Cuticle thickness, according to our hypothesis, is in turn required for correct organ or body part shape. The molecular mechanisms of this processes shall be characterized in the future.

Survival of itinerant excitations and quantum spin state transitions in YbMgGaO4 with chemical disorder

A recent focus of quantum spin liquid (QSL) studies is how disorder/randomness in a QSL candidate affects its true magnetic ground state. The ultimate question is whether the QSL survives disorder or the disorder leads to a “spin-liquid-like” state, such as the proposed random-singlet (RS) state. Since disorder is a standard feature of most QSL candidates, this question represents a major challenge for QSL candidates. YbMgGaO₄, a triangular lattice antiferromagnet with effective spin-1/2 Yb³⁺ions, is an ideal system to address this question, since it shows no long-range magnetic ordering with Mg/Ga site disorder. Despite the intensive study, it remains unresolved as to whether YbMgGaO₄ is a QSL or in the RS state. Here, through ultralow-temperature thermal conductivity and magnetic torque measurements, plus specific heat and DC magnetization data, we observed a residual κ₀/T term and series of quantum spin state transitions in the zero temperature limit for YbMgGaO₄. These observations strongly suggest that a QSL state with itinerant excitations and quantum spin fluctuations survives disorder in YbMgGaO₄.

It remains an open question as to whether the quantum spin liquid state survives material disorder, or is replaced by some spin-liquid like state. Here, Rao et al succeed in resolving a resolving a κ₀/T residual in the thermal conductivity of YbMgGaO₄ strongly suggesting the survival of the quantum spin liquid state.

[Advances and controversies of statins application in prevention and treatment of hepatocellular carcinoma]

Statins, as lipid-regulating drugs, have been widely used in the treatment for hyperlipidemia and the primary and secondary prevention of cardio-cerebrovascular diseases. Hepatocellular carcinoma (HCC) is a serious burden of liver disease in China with poor prognosis, thus effective adjuvant drug used for HCC treatment has attracted much attention. Statins can suppress tumor growth, decrease the risk of tumorigenesis and postoperative recurrence of HCC, extend the survival time and improve the therapeutic effect of other treatment, therefore might increase the benefit obtained by the HCC patients. Statins also can impact the expression of MAPK/ERK signaling pathway, promote the apoptosis of malignant cells and ameliorate the HCC risk of hepatitis B virus infected patients. Statins not only prevents the HCC, but also has part therapeutic effect on the different stage of HCC. Although it can't replace the operation, radiofrequency ablation, molecular targeted treatment and immunotherapy currently, statins may be a potential adjuvant drug to provide clinical benefit for HCC patients. The advancement of statins application in the prevention and treatment of HCC has attracted more attention recently, however, discussion and controversy also existed about whether it can eventually become an adjuvant therapy for HCC. The purpose of this paper is to summarize and comment on the new development and disputes of statins application in the prevention and treatment of HCC in recent years, to provide help for the future clinical practice.

[Analysis of clinicopathologic characteristics of gastric cancer patients undergoing gastrectomy based on a single-center gastric cancer database with above 10 000 cases]

Objective: The storage of medical data has been digitized in China, but a unified and structured model has not yet been established. The standardized collection, analysis and sorting of tumor clinical data is the foundation of improving the standard of tumor diagnosis and treatment. Therefore, establishing a database platform of gastric cancer (GC) is an urgent need to integrate data resources and improve the level of diagnosis and treatment. The population economics indexes of GC patients in the last 20 years are analyzed in a single-center GC database. The medical records were structured by natural language processing technology. Authors aim to investigate the clinical pathological characteristics, staging and survival of the GC patients with gastrectomy. Method: A retrospective cohort study was carried out. Clinicopatological data of patients receiving surgical treatment from 2000 to 2019 were retrospectively collected. According to the gastric cancer TNM staging guidelines from the Union for International Cancer Control and the American Joint Committee on Cancer (UICC/AJCC) 8th edition, the structured gastric cancer clinicopathological data were re-evaluated and interpreted. The Kaplan-Meier method and the log-rank test were used to compare survival rate among different groups of patients with complete follow-up data of 2010-2016. Results: Clinicopathological data of 13 492 GC patients were enrolled. The ratio of men to women in the whole group was 3.25:1.00, including 10 320 men with average onset age of 59.68 years, which was basically stable in recent 20 years, and 3172 women with average onset age of 55.93 years, which presented a trend of average increasement of 0.17 year per year. The average hospitalization duration for GC patients showed a decreasing trend year by year, which was 13.87 days in 2019. Average hospitalization cost for GC patients was increasing year by year, with a peak of 83 600 CNY in 2017 and 75 400 CNY in 2019. By natural language identification and exclusion criteria screening, a total of 7218 GC patients obtained structured clinicopathological information. Analysis on clinicopathological characteristics of 3626 GC patients in the last 5 years showed that the average diameter of tumor was (4.44±2.61) cm; the average number of harvested lymph node was 24.30±13.29; the proportion of surgical methods were as following: open surgery in 1398 cases (38.55%), laparoscopic surgery in 1856 cases (51.19%) and robotic surgery in 372 cases (10.26%). The postoperative pathological stage was as following: IA in 658 cases (18.15%), IB in 318 cases (8.77%), IIA in 559 cases (15.42%), IIB in 543 (14.98%), III A in 632 (17.43%), III B in 612 cases (16.88%), III C in 276 cases (7.61%), and IV in 28 cases (0.77%). Complete follow-up data of 3431 patients from 2010 to 2016 were presented. The 1-, 3- and 5-year survival rates were 82%, 69% and 60%, respectively for the whole group. The 1-, 3- and 5-year survival rates for patients undergoing laparoscopic surgery were 83%, 70% and 64%, respectively, and for those undergoing open surgery were 81%, 67% and 56%, respectively, and the difference between the two groups was not statistically significant (P=0.109). The 5-year survival rate of GC patients with different AJCC stages was as following: 88% in IA, 77% in IB, 70% in II A, 62% in II B, 44% in III A, 32% in III B, 22% in III C, and 17% in IV. Conclusion: This study provides basic data for the establishment of comprehensive diagnosis and treatment model of multicenter, shedding light on the improvement of comprehensive treatment of GC in China.

Chitinase 10 controls chitin amounts and organization in the wing cuticle of Drosophila

Wings are essential for insect fitness. A number of proteins and enzymes have been identified to be involved in wing terminal differentiation, which is characterized by the formation of the wing cuticle. Here, we addressed the question whether chitinase 10 (Cht10) may play an important role in chitin organization in the wings of the fruit fly Drosophila melanogaster. Initially, we first found that Cht10 expression coincides with the expression of the chitin synthase coding gene kkv. This suggests that the respective proteins may cooperate during wing differentiation. In tissue-specific RNA interference experiments, we demonstrate that suppression of Cht10 causes an excess in chitin amounts in the wing cuticle. Chitin organization is severely disrupted in these wings. Based on these data, we hypothesize that Cht10 restricts chitin amounts produced by Kkv in order to ensure normal chitin organization and wing cuticle formation. In addition, we found by scanning electron microscopy that Cht10 suppression also affects the cuticle surface. In turn, cuticle inward permeability is enhanced in Cht10-less wings. Moreover, flies with reduced Cht10 function are unable to fly. In conclusion, Cht10 is essential for wing terminal differentiation and function.

[The therapeutic effect of carnosine combined with dexamethasone in the lung injury of seawater-drowning]

Objective: To explore the therapeutic effect of carnosine and dexamethasone in lung injury caused by seawater drowning. Methods: The in vitro experiments with A549 cells were divided into 5 groups: blank control group (C), seawater injury group (S), seawater injury+dexamethasone treatment group (S+D), seawater injury+carnosine treatment group (S+C), seawater injury dexamethasone and carnosine combined therapy(S+D+C) group. The optimal therapeutic dose of drugs for the treatment of seawater drowning lung injury was tested in vitro. Based on the optimal dose, the levels of TNF-α and IL-6 in each group at different time points were detected at the cell level by ELISA. The level of apoptosis was detected by flow cytometry. The in vivo experiments with SD rats were randomly divided into 5 groups (n=8 each): blank control group (RC),seawater drowning injury group (RS),seawater drowning injury+dexamethasone treatment group (RSD),seawater drowning injury+carnosine treatment group (RSC),seawater drowning injury+dexamethasone+carnosine combined treatment group (RSDC). The animal model with seawater inhalation acute lung injury was made by intratracheal infusion (4 ml/kg). The pathological changes of the lungs were observed. The expression of superoxide dismutase (SOD) in each group was detected by Western blot. Results: The results of in vitro experiments showed significant increase of apoptosis after seawater injury. The normal cell rate in group C was 98.3% while the apoptosis rate was 1.7%. The normal cell in group S was 18.8%, and the apoptosis rate was 81% (P<0.01). TNF-α and IL-6 levels in group S increased to 180.25 ng/L and 61.56 ng/L, respectively, which were statistically significant compared with group C (P<0.01). After drug protection, apoptosis was reduced in S+D group, S+C group and S+D+C group, with apoptosis rates of 65.4%, 70.9% and 42.6%, respectively. The contents of TNF-α and IL-6 also decreased in the S+D+C group (P<0.01). The results of in vivo experiments showed obvious lung injury and disordered lung tissue structures in the RS group at 4 h after modeling. There was hemorrhage in the pulmonary interstitium and a large number of inflammatory cells. Results of western blot showed that the expression of SOD increased in the RS group. Compared with RS group, the treatment alleviated acute lung injury and decreased the expression level of SOD in RSD, RSC and RSDC groups (P<0.01). Conclusion: Dexamethasone and carnosine reduced the influence of seawater inhalation on the lung in the rat model. The positive effect of combination of these two drugs on lung injury caused by seawater inhalation was stronger than a single drug.

[Comparison of long-term efficacy between watch and wait strategy and total mesorectal excision in locally advanced rectal cancer patients with clinical complete response after neoadjuvant therapy]

Objective: To compare long-term efficacy between watch and wait (W&W) strategy and total mesorectal excision (TME) in patients who were diagnosed with locally advanced rectal cancer (LARC) and attained clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT). Methods: A retrospective cohort study was carried out. A total of 238 patients with stage II-III LARC exhibiting cCR after nCRT in Sun Yat-sen University Cancer Center from September 16, 2010 to January 9, 2018 were enrolled. Patients who were diagnosed with other malignant tumor within 5 years, did not receive regular follow-up in our center for more than 1 year and had no complete examination items after nCRT were excluded. Of 238 patients, 151 were male and 87 were female with a median age of 57 (27-83) years old. According to TNM stage, 61 cases were cII, 177 cases were cIII. Concurrent chemoradiotherapy (CCRT) was performed in 20 patients. CCRT plus induction/consolidated chemotherapy was performed in 218 patients. Intensity-modulated radiotherapy (IMRT) was applied to radiotherapy. The median radiation dose was 50 Gy/25 Fr for both the primary tumor and clinical target volumes, and the total dose was 45.0 to 50.6 Gy for 227 patients. In 27 patients, single-agent fluorouracil or capecitabine was used as concurrent chemotherapy. But in the other 211 patients, a combined regimen of oxaliplatin and fluorouracil or capecitabine was used. After nCRT, 59 and 179 patients received W&W (W&W group) and TME 6-12 weeks later (TME group), respectively. After the ending of treatment, patient was interviewed one time every 3 months and after 3 years, one time every six months. Overall survival (OS) rate, distant-metastasis-free survival (DMFS) rate, and local-recurrence-free survival (LRFS) rate were compared between two groups. The salvage treatment and sphincter preservation rate were analyzed. The survival curve was drawn with Kaplan-Meier method and evaluated by log-rank method. Results: In the cases treated with TME, the median interval from nCRT to surgery was 59 days. The postoperative pCR rate was 63.1%(113/179). The median follow-up time of the whole cohort was 41.8 (12.0-99.0) months. The 3-year and 5-year OS rates were 98.4% and 96.5%; the 3-year and 5-year LRFS rates were 96.5% and 96.5%; the 3- and 5-year DMFS rates were 91.0% and 87.9%, respectively. The 3-year OS rates in the W&W group and the TME group were 100% and 97.9%; the 5-year OS rates in W&W group and the TME group were 90.6% and 97.9% (P=0.339); The 3-year local recurrence rate (LRR) in the W&W group was 12.9% (7 cases recurred within 2 years), which was significanthy higher then that in the TME group (0.6%, P=0.003). Salvage surgery was successful in 5/6 cases. After salvage surgery, LRFS rate was not significantly different between the two groups (P=0.137). The 3-year DMFS rate in the W&W group and the TME group were 88.4% and 81.1%, whose difference was not significant (P=0.593). Recurrence with simultaneous metastasis was seen in 3/7 cases of the W&W group. The sphincter was preserved in 89.8% (53/59) of patients in the W&W group, which was significantly higher than 73.7% (132/179) in the TME group (P<0.001). When distance of tumor from the anal verge was ≤ 5 cm, the sphincter preservation rate (SPR) in the W&W group was 88.0% (44/50), which was significantly higher than the 54.4% (56/103) in the TME group (P<0.001). Conclusions: W&W is safe and feasible for patients with LARC and cCR after nCRT. The results should be verified by further clinical trials.

[Utility of the type 3 portable monitor for the diagnosis of patients with obstructive sleep apnea]

Objective: To evaluate the utility of a portable monitor at home for diagnosis of obstructive sleep apnea (OSA) in Chinese adults. Methods: Eighty nine patients suspected of OSA underwent overnight, unattended home sleep apnea testing (HSAT) with a portable monitor (Nox-T3, Nox Medical Inc. Iceland)followed by an in-laboratory polysomnogram (PSG) with simultaneous portable monitor (PM) recording within one week. PSG and PM recorder were scored according to recommended guidelines by independent technicians. The correlation between PSG apnea hypopnea index (AHI) and PM respiratory disturbance index (RDI) were evaluated. Results: Sleep testing showed RDI was (30.0±20.9) events/h on HSAT, and (33.4±22.4) events/h on in-laboratory PM recording. Apnea-hypopnea index (AHI) on PSG was (35.1±23.7) events/h. There was significantly statistical difference among the three group (P<0.001). Both RDI on HSAT and RDI on in-laboratory PM correlated significantly with AHI on PSG (r=0.877, P<0.001 and r=0.962, P<0.001, respectively). Bland-Altman analysis of AHI on PSG versus RDI on HSAT showed a mean difference of 4.4 events/h; limits of agreement was -17.6 to 26.5 events/h. Closer agreements were present when comparing the simultaneous recordings, with AHI on PSG versus RDI on in-laboratory PM showing a mean difference of 1.4 events/h, and limits of agreement was -11.3 to 14.2 events/h. Based on a threshold of AHI≥5 events/h, RDI on HSAT had 98.8% sensitivity, 40.0% specificity. Using an AHI ≥ 15 events/h, RDI on HSAT had 91.5% sensitivity, 76.5% specificity. Conclusion: Type 3 PM has a good diagnostic value for adult OSA patients and there is close agreement between the Type 3 portable monitor and PSG.

[Effect of Anluohuaxianwan on the expression of matrix metalloproteinases and their inhibitors in rat liver with fibrosis]

Objective: To investigate the effect of anluohuaxianwan (ALHXW) using rat model of carbon tetrachloride (CCl(4)) induced liver fibrosis on the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). Methods: Thirty-six male Wistar rats were randomly assigned into control, model and treatment groups. Rats in the model and treatment groups were injected intraperitoneally with 40% CCl(4) (2 ml/kg), and the control group were given isotonic saline twice a week for six weeks. Meanwhile, the treatment group were gavaged with ALHXW solution daily (concentration 0.15 g/ml, 9.9 ml/kg) for 6 weeks, while the control and model groups were given isotonic saline once a day for 6 weeks. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at the end of third and sixth week. At the end of six weeks, liver tissues were harvested for histopathological evaluation and the detection of mRNA and protein expression levels of MMP-2/13 and TIMP-1/2. According to different data, LSD method, parametric (one-way ANOVA) and non-parametric tests (Kruskal-Wallis H-test and Mann-Whitney U test) were used for statistical analysis. Results: Compared with the model group, ALHXW markedly alleviated liver injury in the treatment group, and thereby improved the general state of rats, liver and spleen morphological characteristics, and ALT and AST levels. Histopathological examination demonstrated that the extent of liver fibrosis was improved (2.75 ± 0.75 vs. 3.55 ± 0.69, P = 0.015) in the treatment group as compared with the model group. The mRNA and protein expression levels of MMP-13 in the treatment group were significantly higher than that of the model group (mRNA: 10.50 ± 7.64 vs. 4.40 ± 2.97, P = 0.029. Protein: 1.15 ± 0.09 vs. 0.78 ± 0.21, P = 0.016), whereas the mRNA and protein expression levels of MMP-2, TIMP-1/2 in the treatment group were significantly lower than that of the model group (mRNA: 4.55 ± 3.29 vs. 7.83 ± 4.19, P = 0.048; 1.66 ± 0.73 vs. 3.69 ± 2.78, P = 0.023; 2.25 ± 1.16 vs. 3.41 ± 1.51, P = 0.049; respectively. Protein: 0.44 ± 0.11 vs. 0.65 ± 0.05, P = 0.03; 0.69 ± 0.06 vs. 1.07 ± 0.21, P = 0.016; 0.46 ± 0.09 vs. 0.81 ± 0.13, P = 0.003; respectively). Conclusion: ALHXW exerts anti-liver fibrosis effects mainly by improving liver function, inhibiting the activation of hepatic stellate cells, enhancing the expression of MMP-13, and inhibiting the expression of MMP-2 and TIMP-1/2.

[Application of direct antiviral drugs in special patients with HCV infection]

Patients with HCV infection can develop decompensated cirrhosis, hepatocellular carcinoma (HCC), even liver failure. As a result, efficient antiviral treatment is very essential to prevent HCV-related disease progression. Newly developed direct-acting antiviral agents (DAAs) have shown safety profile, favorable tolerability, and relatively short duration, which provide an opportunity to expand the number of patients who can be treated for HCV infection. There is a need for further clinical observation and summaries for DAAs in a real world. In the era of DAAs, special patients with HCV infection still get lots of attention from doctors. This review aims at the application of DAAs in patients with HCV infection, combined with chronic kidney diseases, hepatocellular carcinoma, HBV/HCV co-infection, HIV/HCV co-infection, post liver transplantation, pregnancy, children, lymphoma and retreatment.

[Incidence of depressive disorders and related independent risk factors in patients with chronic hepatitis C]

Objective: To investigate the incidence and related independent risk factors of depression in treatment-naïve Han ethnic Chinese patients with chronic hepatitis C. Methods: Nine hundred and ninety-seven Han Chinese patients with confirmed chronic HCV infection were enrolled. Beck's depression inventory scale was used to assess depression score. Patients were divided into two groups according to the score: score≥17, depression group (16.85%, 168/997); score <17, no depression group (83.15%, 829/997). Multivariate logistic regression was used to analyze independent risk factors related with the onset of depression in patients with chronic hepatitis C. Results: There was a statistically significant difference between the two groups in terms of gender distribution, marital status, education level, income level and smoking status (P < 0.05). Independent risk factors were female [odds ratio (OR) = 3.85; 95% CI: 2.28-6.50, P = 0.001], decompensated cirrhosis [OR = 2.31; 95% CI: 1.20-4.48, P = 0.013], unmarried [OR = 2.01; 95% CI: 1.12-3.60, P = 0.019], separated [OR = 17.39; 95% CI: 1.64-184.47, P = 0.018], divorced [OR = 3.82; 95% CI: 1.36-10.74, P = 0.011], without higher education [OR = 2.04; 95% CI: 1.22-3.42, P = 0.007], low income [OR = 3.94; 95% CI: 1.38-11.28, P = 0.011], middle income [OR = 2.96; 95% CI: 1.02-8.62, P = 0.047], uninterrupted smoking [OR = 3.67; 95% CI: 2.13-6.31, P = 0.001], and previously smoked [OR = 3.33, 95% CI: 1.66-6.68, P = 0.001]. Conclusion: The incidence of depression in patients with chronic hepatitis C is relatively high. The independent risk factors related with depression include female, unmarried, separated, and divorced, without higher education, low and middle-income level, smoking and disease progression to decompensated cirrhosis, but no significant correlation between hepatitis C virus genotypes and viral load.

[Application of pegylated recombinant human granulocyte colony-stimulating factor to prevent chemotherapy-induced neutropenia in patients with lymphoma: a prospective, multicenter, open-label clinical trial]

目的

评价聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）预防淋巴瘤患者化疗后发生中性粒细胞减少症的有效性和安全性。

方法

本研究为多中心、开放、单臂、Ⅳ期临床试验。纳入410例淋巴瘤患者接受多周期化疗并预防性使用PEG-rhG-CSF。主要观察患者各化疗周期Ⅲ/Ⅳ度中性粒细胞减少症和发热性中性粒细胞减少（FN）的发生率，同时观察患者整个化疗期间抗生素的使用率。

结果

①410例患者中，违背入选标准8例（1.95%），失访35例（8.54%），发生不良事件19例（4.63%），出现符合终止研究标准者12例（2.93%），疾病进展或复发15例（3.66%），故最终321例（78.29%）进入符合方案集。②在第1~4个治疗周期，初级预防给予PEG-rhG-CSF后，Ⅳ度中性粒细胞减少症的发生率分别为19.14%（49/256）、12.50%（32/256）、12.18%（24/197）、13.61%（20/147），FN的发生率分别为3.52%（9/256）、0.39%（1/256）、2.54%（5/197）、2.04%（3/147）；次级预防给药后，Ⅳ度中性粒细胞减少症的发生率从61.54%（40/65）降至16.92%（11/65）、18.46%（12/65）、20.75%（11/53），FN的发生率从16.92%（11/65）降至1.54%（1/65）、4.62%（3/65）、3.77%（2/53）。③整个化疗期间接受抗生素治疗的受试者比例为34.39%（141/410）。④与PEG-rhG-CSF相关的不良事件发生率为4.63%（19/410），最常见的不良反应为骨痛[3.90%（16/410）]、乏力（0.49%）和发热（0.24%）。

结论

在淋巴瘤患者化疗过程中，预防性使用PEG-rhG-CSF能够有效降低化疗过程中Ⅲ/Ⅳ度中性粒细胞减少症和FN的发生率，确保淋巴瘤患者接受标准剂量化疗，提高治愈率。

[Hepatitis C-related hepatocellular carcinoma and the treatment with direct-acting antiviral agents]

With the wide use of direct-acting antiviral agents (DAAs), more and more patients with chronic hepatitis C achieve sustained virological response; however, no consensus has been reached on the application of DAAs in the treatment of hepatitis C virus-related hepatocellular carcinoma (HCC). This article summarizes and evaluates related issues in this field, including whether antiviral therapy with DAAs in patients with hepatitis C can increase the incidence or recurrence rate of HCC, as well as whether DAAs can be used for hepatitis C in HCC patients after antitumor treatment and the efficacy of DAAs in such patients.

[Impact factor of postoperative prognosis of esophageal cancer patients with stage pT2N0~1M0]

Objective: To investigate the postoperative prognosis and the related factors of patients with stage pT2N0-1M0 of thoracic esophageal carcinoma(EC). Methods: From 2008 to 2011, clinical data of 275 cases with stage pT2N0-1M0 of thoracic EC treated by esophagectomy were enrolled. These cases includ 180 male and 95 female. Among them, 32 cases were upper thoracic EC, 186 cases were middle thoracic EC and 57 cases were lower thoracic EC. Alternatively, 205 cases were stage pN0, 70 cases were stage pN1. 155 cases received esophagectomy alone and 120 cases received esophagectomy and postoperative adjuvant therapy. Results: The end of follow-up time was on September 30th, 2014. The 1-, 3-, 5-year overall survival (OS) rates were 91.6%, 70.2% and 63.7%, respectively. The 1- 3-, 5-year progression-free survival (PFS) rates were 83.9%, 64.0% and 60.0%, respectively. The result of univariate analysis showed that the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with OS (all of P<0.05). Moreover, the gender, the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with PFS (all of P<0.05). Cox multivariate analysis showed that the location of primary tumor and pN stage were the independent factors of OS (both P<0.05). The gender, pN stage and postoperative adjuvant therapy were the independent factors of PFS (all of P<0.05). Conclusion: Among the patients with pT2N0~1M0 stage of thoracic EC, patients with upper thoracic EC or pN1 stage have poorer postoperative prognosis compared with others, and postoperative adjuvant treatment is recommended for these patients.

[Glucocorticoids and liver diseases]

Glucocorticoids is a type of steroid hormone secreted from zona fasciculata of adrenal cortex.As an immune and inflammatory inhibitor, glucocorticoids has been used to treat many kinds of diseases.T cell response plays a crucial role in the pathogenesis of liver diseases. However, the role of glucocorticoids in the mechanism and treatment of liver disease in current clinical practice is controversial. This paper summarizes the progress of glucocorticoid use for the treatment of liver diseases in recent years. References will be provided for how to grasp the indications,application timing and proper dosage of glucocorticoids in liver diseases.

Exposure Duration Is a Determinant of the Effect of Sinusoidal Electromagnetic Fields on Peak Bone Mass of Young Rats

We proposed a three-step strategy to obtain the optimal therapeutic parameters, which is composed of large-scale screening at cellular level, verification in animal experiments, and confirmation by a clinical trial. The objective of the current study was to test the feasibility of our strategy. Newborn rat calvarial osteoblasts were treated by 50 Hz 1.8 mT sinusoidal electromagnetic fields (SEMFs) with 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 h/days, respectively. The osteogenic differentiation and maturation of the osteoblast were assayed and compared to obtain the optimal duration. One-month-old growing rats were then treated by the same SEMFs with 0.5, 1.5, and 2.5 h/days, respectively, and the peak bone mass was analyzed after 2 months. It was found that the optimal exposure duration to promote the osteogenic differentiation and maturation of osteoblasts was 1.5 h/days, judging by the increasing degrees of ALP activity, calcified nodules formed, the gene and protein expression levels of Runx-2, BMP-2, and Col-I, as well as the expression levels of signaling proteins of the BMP-2/Smad1/5/8 pathway. The highest increase of peak bone mass after 2 months was also obtained by 1.5 h/days, judging by the results of X-ray dual-energy absorptiometry, mechanical property analysis, micro-CT scanning, and serum bone turnover marker examinations. The above results indicated that exposure duration is a determinant for the therapeutic effect of EMFs, and the optimal therapeutic effects only can be obtained by the optimal exposure duration.

[Hemoptysis in adults with bronchiectasis: correlation with disease severity and exacerbation risk]

Objective: To investigate the association between hemoptysis and disease severity and risks of acute exacerbations in patients with bronchiectasis. Methods: Between September 2012 and January 2014, we recruited 148 patients (56 males, 92 females, mean age: 44.6 years) with clinically stable bronchiectasis, who were classified into hemoptysis group (36 males, 70 females, mean age: 45.6 years) and non-hemoptysis group (20 males, 22 females, mean age: 41.8 years). We inquired the past history, and evaluated chest imaging characteristics, lung function, cough sensitivity assessed using capsaicin cough challenge tests, and airway inflammation. We also performed a 1-year follow-up to evaluate whether patients with hemoptysis would have greater risk of having acute exacerbations. Results: In the hemoptysis group, median 24-hour sputum volume was 20.0 ml, median Bronchiectasis Severity Index (BSI) was 7.0, median bronchiectatic lobes was 4.0, median chest CT score was 7.0, the geometric mean for eliciting 5 coughs following capsaicin cough sensitivity (C5) was 77 μmol/L, 67 cases (63%) had cystic bronchiectasis and 52 cases (49%) had pulmonary cavity shown on chest CT, and 35 cases (33%) had Pseudomonas aeruginosa colonization. In the non-hemoptysis group, median 24-hour sputum volume was 5.0 ml, median BSI was 4.0, median bronchiectatic lobes was 3.0, median chest CT score was 5.0, 15 cases (36%) had cystic bronchiectasis and 10 cases (24%) had pulmonary cavity, the geometric mean for C5 was 212 μmol/L, and 4 cases (10%) had Pseudomonas aeruginosa colonization. All the above parameters differed significantly between the hemoptysis and the non-hemoptysis group (P<0.05). In the hemoptysis group, 29 patients with pulmonary cavity (27%) had reported the use of intravenous antibiotics, and 44 cases (42%) had at least one hospitalization within the previous 2 years. In the non-hemoptysis group, 8 cases (19.0%) had reported the use of intravenous antibiotics, and 8 cases (19.0%) reported hospitalization within 2 years. A prior history of hemoptysis was associated with a greater risk of experiencing bronchiectasis exacerbations during follow-up, after adjusting for age, sex, smoking status and BSI (62 cases in the hemoptysis group, 18 cases in the non-hemoptysis group, χ(2)=16.06, P=0.03). In a multivariate model, cystic bronchiectasis was the sole risk factor for hemoptysis; 67 cases which accounted for 63% of patients in the hemoptysis group and 15 cases which accounted for 36% of patients in the non-hemoptysis group, odds ratio: 2.84, 95% confidence interval: 1.00-8.14, P=0.05 . Conclusions: In this study, 72% of bronchiectasis patients had experienced hemoptysis, which was associated with the severity of bronchiectasis. Patients with a prior history of hemoptysis had a greater risk of acute exacerbations during follow-up than those without.

[Surveillance on drinking-water-born endemic fluorosis in China, 2013]

OBJECTIVE

To investigate the prevalence of fluorosis and related control measures on drinking water type of endemic fluorosis in China.

METHODS

According to the national program- "Surveillance Scheme of Drinking-Water-Borne Endemic Fluorosis" , 136 counties were selected in 29 provinces, autonomous regions and municipalities. Three epidemic villages were randomly selected as fixed monitoring sites in each county. Dental fluorosis of all the children aged 8-12 living in the villages under the monitoring program, was identified under the ariteria from "Diagnosis of dental fluorosis" (WS/T 208-2011). Operating conditions and contents of fluoride in all the'water-improved projects' were investigated. Contents of fluoride in drinking water were tested in villages without the 'water-improved projects'. "Standard Test Method for Drinking Water" (GB/T 5750.5-2006) was used to detect the water fluoride.

RESULTS

The overall prevalence of dental fluorosis among children aged 8-12 in all the villages under monitor program, was 28.58% (7 950/27 817), with the dental fluorosis index (DFI) as 0.58. Among them, the prevalence was 22.28% (3 917/17 583) and DFI was 0.44 in the'water-improved projects' villages that under normal operation and with qualified fluoride contents. The prevalence appeared as 38.74% (1 926/4 971) with DFI as 0.84 in those villages with 'water-improved projects' but mal-operated or with excessive fluoride. The prevalence was 40.03% (2 107/5 263), and DFI was 0.81 in those villages without 'water-improved projects'. The prevalence rates of dental fluorosis in children from the three types of endemic areas were significantly different. For 'water-improved projects', the normal opration rate was 93.77% (286/305) and the qualification rate of fluoride content was 76.77% (228/297).

CONCLUSIONS

Dental fluorosis in children living in the drinking-water-born endemic fluorosis areas was on the edge of epidemics in China. Effective improvement on the quality of drinking water can significantly reduce the severity of dental fluorosis in children. The rate of proper operation on 'water-improved projects' was near to 95% in the endemic area. However, rate that met the criteria on qualified fluoride contents of these projects was still below 80%.

Effect of electroacupuncture on the cervicospinal P2X7 receptor/fractalkine/CX3CR1 signaling pathway in a rat neck-incision pain model

Increasing evidence supports that acupuncture intervention is an effective approach for intraoperative and postoperative pain. Neuron-microglia crosstalk, mediated by the purinergic P2X7 receptor (R)/fractalkine/CX3CR1 cascade in the spinal cord dorsal horn, plays a pivotal role in pain processing. However, its involvement in the analgesic effect of electroacupuncture (EA) remains unclear. In this study, a rat neck-incision pain model was established by making a longitudinal incision along the midline of the neck and subsequent repeated mechanical stimulation. EA stimulation was applied to bilateral LI18, LI4-PC6, or ST36-GB34. The thermal pain threshold, cervicospinal ATP concentration, expression levels of purinergic P2XR and P2YR subunits mRNAs, and fractalkine, CX3CR1 and p38 MAPK proteins, were detected separately. The neck incision induced strong thermal hyperalgesia and upregulation of spinal ATP within 48 h. No significant change was found in thermal hyperalgesia after a single session of EA intervention. However, a single session of EA dramatically enhanced the neck incision-induced upregulation of ATP and upregulated the expression of P2X7R, which was reversed by two sessions of EA. Two sessions of EA at bilateral LI18 or LI4-PC6 attenuated hyperalgesia significantly, accompanied with downregulation of P2X7R/fractalkine/ CX3CR1 signaling after three sessions of EA. EA stimulation of LI18 or LI4-PC6 alleviates thermal hyperalgesia in neck-incision pain rats, which may be associated with its effects in regulating the neck incision-induced increase of ATP and P2X7R and subsequently suppressing fractalkine/CX3CR1 signaling in the cervical spinal cord.

Cloning and characterization of ChiMYB in Chrysanthemum indicum with an emphasis on salinity stress tolerance

v-myb avianmyeloblastosis viral oncogene homolog (MYB) transcription factors are key regulators of stress responsive gene expression in plants. In this study, the MYB gene, ChiMYB (GenBank accession No. KT948997), was isolated from Chrysanthemum indicum, and was functionally characterized with an emphasis on salinity stress tolerance. The full ChiMYB cDNA sequence (948 bp) encoded a typical R2R3 MYB transcription factor that contained 315 amino acid residues and two MYB domains. The temporal expression pattern of ChiMYB was noted in C. indicum, and the highest level was detected in the roots, followed by leaves and stems. ChiMYB expression was induced by NaCl treatments, and transient expression of the fusion of ChiMYB and green fluorescent protein (GFP) indicated that the protein was targeted to the nuclei of onion epidermal cells. Arabidopsis plants overexpressing ChiMYB displayed improved tolerance to drought and salt stress. When under salt stress conditions, transgenic Arabidopsis plants had higher survival rates than non-transgenic wild-type plants. Chlorophyll content, intercellular CO₂ concentration, photosynthetic rate, and stomatal conductance were higher in the transgenic Arabidopsis plants than in non-transgenic control plants. Further investigation revealed that ChiMYB was able to regulate the expression of RD29A, RAB18, COR15, ABI1, and ABA genes, which are involved in salt stress signaling pathways. Our findings demonstrated that ChiMYB is essential for plant responses to salt stress, and it may have great potential for the improvement of salt tolerance in crops.

Biological characterization of liver fatty acid binding gene from miniature pig liver cDNA library

Liver fatty acid binding proteins (L-FABP) are a family of small, highly conserved, cytoplasmic proteins that bind to long-chain fatty acids and other hydrophobic ligands. In this study, a full-length enriched cDNA library was successfully constructed from Wuzhishan miniature pig, and then the L-FABP gene was cloned from this cDNA library and an expression vector (pEGFP-N3-L-FABP) was constructed in vitro. This vector was transfected into hepatocytes to test its function. The results of western blotting analysis demonstrated that the L-FABP gene from our full-length enriched cDNA library regulated downstream genes, including the peroxisome proliferator-activated receptor family in hepatocytes. This study provides a theoretical basis and experimental evidence for the application of L-FABP for the treatment of liver injury.

Responses of microbial respiration to nitrogen addition in two alpine soils in the Qinghai-Tibetan Plateau

An incubation experiment was conducted to examine the effects of nitrogen (N) application on microbial respiration in alpine meadow and alpine shrub soils from eastern of Qinghai-Tibetan Plateau. Four different levels of nitrogen fertilization were selected in this study: control (CK, 0 mg N g(-1)), low (LN, 0.04 mg N g(-1)), medium (MN, 0.16 mg N g(-1)), high (HN, 0.4 mg N g(-1)). The results showed that microbial respiration was higher in alpine shrub than in alpine meadow soil, regardless of the rate of N application. Total microbial respiration overthe course of incubation period decreased in both soils with HN and MN treatments relative to control, but no significant differences were observed in soils with LN treatments. There was significantly positive correlation between total microbial respiration and dissolved organic carbon concentration in both soils. The results indicated that DOC may be a useful indicator of microbial respiration rate in alpine soils and the increasing N inputs could drive a negative feedback to global warming effects of carbon dioxide emitted to the atmosphere in alpine soils.

The impact of oral health status on the oral health-related quality of life (OHRQoL) of 12-year-olds from children's and parents' perspectives

OBJECTIVES

To assess the effect of dental caries, periodontal status and dental fluorosis on the oral health-related quality life (OHRQoL) of 12-year-olds and to assess the agreement between parents and children on the children's OHRQoL relative to the children's oral health status.

METHODS

A two-stage sampling method was used to select a sample of 12-year-olds from Binzhou, China. Their oral health status was recorded using the DMFT, CPI and Dean's Index. The Child Perception Questionnaire 11-14 (CPQ(11-14)) and the Parental Perception Questionnaire (PPQ) were administered to the children and their parents, respectively, to assess the children's oral health-related quality of life.

RESULTS

The data used in the analysis were collected from 1,120 children. The prevalence of tooth decay was 31.6% and that of dental fluorosis was 29.7%; 4.1% of the children had healthy gums and 52.4% had dental calculus. There was a moderate to good correlation between the CPQ and PPQ (ICC = 0.51-0.68). Having dental fluorosis and brushing teeth less than twice a day negatively influenced the emotional well-being domain of the CPQ, but was not related to this domain of the PPQ. Having calculus, dental fluorosis, brushing teeth less than twice a day and having dental visits negatively influenced the social well-being domain of the CPQ, but only tooth brushing was related to this domain of the PPQ.

CONCLUSIONS

Children's self-reported CPQ(11-14) scores were more strongly associated with their oral health status and OHRQoL than their parents' PPQ scores were, especially in the social and emotional well-being domains. Having caries, dental fluorosis or dental calculus negatively affected children's oral health-related quality of life.

Three-dimensional digital visible heart model and myocardial pathological characteristics of fetal single ventricle connected with aortic coarctation

This study aimed to provide data for imaging diagnosis and clinical surgical plans by reconstructing a three-dimensional (3-D) digital visible heart model of single ventricle (SV) connection with aortic coarctation (CoA) and characterizing the myocardial and vascular wall pathological characteristics. Fifteen miscarried fetus cadavers with SV and CoA were selected. Fourteen cardiac specimens were systematically reviewed for segmental anatomy and conventional histological examinations. One fetus cadaver was used to obtain the structural dataset of the fetal body and to reconstruct a 3-D digital visible heart model. Specimen pathological dissection indicated hypertrophic myocardium SV, significant aortic wall thickening, and localized coarctation area elevation. Ten cases of SV with left ventricular morphology displayed a large muscle ridge and solitus normally aligned great arteries. Five cases of SV with right ventricular morphology had coarse, parallel trabeculations and received a common atrioventricular valve. The reconstructed 3-D heart and the main internal structures were realistic, which were beneficial for clinical and image teaching of fetal heart development. The change of characteristics of the myocardium and great vascular wall was obvious and may be the critical cause leading to progressive dysfunction in the postnatal heart.

Comparing bacterial membrane interactions and antimicrobial activity of porcine lactoferricin-derived peptides

Antibiotic treatment for microbial infections is under scrutiny due to increasing resistance to conventional antibiotics, warranting discovery of new classes of antibiotic agents. Antimicrobial peptides are part of the innate defense system found in nearly all organisms and possess bactericidal mechanisms that make it more difficult for bacteria to develop resistance. Porcine lactoferricin (LFP-20) is an antimicrobial peptide located in the N terminus of lactoferrin (LF). To develop novel cell-selective antimicrobial peptides with improved antimicrobial specificity compared with LFP-20, analogs LF2A LF-2, LF-4, and LF-6 were substituted with Ala, Ser, or Trp residues at different positions in the molecule. Analogs displayed a 2- to 16-fold higher antimicrobial activity than LFP-20, but were hemolytic at 64 μg/mL. Additionally, LFP-20, LF2A, LF-2, and LF-4 exhibited lower cytotoxicity against human peripheral blood mononuclear cells than LF-6 at concentrations of 25 to 100 μg/mL. To better understand the antibacterial mechanisms of LFP-20 and its analogs we examined their effect on the cytoplasmic membrane of Escherichia coli. The LFP-20 was not effective in depolarizing cytoplasmic membranes, whereas the other 3 analogs gradually dissipated the membrane potential of E. coli. Membrane potential increased with minimal inhibitory concentrations changes, demonstrating a correlation between bactericidal activity and membrane depolarization. Analogs were more efficient than LFP-20 in displacing lipopolysaccharide-bound dansyl-polymyxin B, which also rapidly increased 1-N-phenyl-naphthylamine uptake and release of cytoplasmic β-galactosidase by increasing the permeability of the outer and inner membranes of E. coli. The 3 analogs caused an increased potential for calcein leakage from negatively charged lipid vesicles at high concentrations. Collectively, these results suggest that the first targets of LF-2, LF-4, and LF-6 in E. coli are cytoplasmic membranes. The 3 analogs exhibited lethal effects based on their abilities to disrupt membranes and permit transit of large intracellular components, such as calcein.

Melting, expansion behavior and electric transport of In-filling in MgO nanotubes

By using a one-step approach, In-filled MgO nanotubes with diameters of 200-300 nm and lengths of several micrometers are synthesized. A Gatan heating experiment in a transmission electron microscope (TEM) shows that In-filling begins to melt far below the melting point 156.6 degrees C of In and abnormally shrinks upon increasing temperature above 270 degrees C. Massive In-filled MgO nanotubes were pressed into a disk and its resistance starts dramatically decrease upon increasing temperature above -150 degrees C, suggesting a temperature switch with a protective point -150 degrees C. The expansion and I-V characteristics were discussed.

Microstructure and photoluminescence studies of Sb-doped SnO2 zigzag nanobelts

SnO2 zigzag nanobelts were successfully Sb-doped by a simple vapor deposition method. Field emission scanning electron microscope (FESEM), high resolution transmission electron microscope (HRTEM), and X-ray diffraction (XRD) were used to characterize these Sb-doped nanobelts. The Sb doping in SnO2 nanobelts was confirmed by Energy Dispersive X-ray spectrum (EDS) and X-ray photoelectron spectroscopy (XPS). It is found that there is no apparent lattice distance difference between the pure SnO2 and the 0.705 at% Sb doped SnO2 nanobelts. A slight blue-shift in the photoluminescence (PL) spectra was shown with the increase of Sb doping concentration and a reasonable explanation was given.

Synthesis and microstructural analysis of Si3N4 nanorods

Alpha-Si3N4 nanorods with 20-80 nm width were synthesized by carbothermal reduction of SiO with amorphous activated carbon (AAC) as a reductant. Microstructural characterization of the synthesized nanorods was carried out by high resolution transmission electron microscopy (HRTEM) and energy dispersive X-ray analysis. Many Si3N4 nanorods were found to be twisted. Each twisted nanorod contained several straight Si3N4 parts. The straight parts had the rod axes orientated along the (1010) direction, which is the closest packing direction of alpha-Si3N4. There were two kinds of joints between the two adjacent straight Si3N4 parts. Formation mechanism of the Si3N4 nanorods is discussed.

Upper limb salvage with microvascular bone transfer for major long-bone segmental tumor resections

A series of 14 young, active patients who underwent vascularized bone graft reconstructions of large (9-15 cm) segmental skeletal defects of the upper extremity resulting from resection of a variety of bony tumors is presented. Eight defects involved the proximal humerus and required shoulder joint reconstruction, two were mid humeral and four involved the distal radius. Surgical techniques for both distal radius reconstruction with vascularized iliac crest and vascularized fibular head and glenohumeral reconstruction using the vascularized fibula are described. Several cases are discussed in detail, including achievement of bony union, postoperative range of motion and pain, and each patient's ability to resume activities. The literature is reviewed, and other reconstructive options for large bony defects of the upper extremity after tumor resection are discussed: nonvascularized bone grafts, allograft transfer, and custom prosthetic devices. The authors think that vascularized bone grafting offers the most favorable method of upper extremity salvage with preservation of joint function, especially at the shoulder.

Hydroxyurea induces a senescence-like change of K562 human erythroleukemia cell

Hydroxyurea, a differentiation-inducing agent of human erythroleukemia K562 cells, is commonly used to treat some types of leukemia. However, the mechanism for its therapeutic effect is not clearly understood yet. In this study, we have observed an interesting effect of hydroxyurea on tumor cells: an induction of senescence-like changes. Human erythroleukemia K562 cells, when treated with hydroxyurea for 7 days or more, underwent a change into phenotypically senescent cells together with a reduction of hemoglobin generation, a differentiation marker. The hydroxyurea-treated cells showed positive senescence associated-beta-galactosidase staining, a senescence index, and the accumulation of cdk (cyclin dependent kinase) inhibitors, such as p16INK4a, p21Waf1, and p27Kip1, implicated in cellular senescence. Nonetheless, these changes were not accompanied by DNA fragmentation. Taken together, we summarize that the long-term treatment of cancer cells with hydroxyurea can induce cellular senescence different from differentiation or programmed cell death.

Radiation retards muscle differentiation but does not affect osteoblastic differentiation induced by bone morphogenetic protein-2 in C2C12 myoblasts

PURPOSE

Effects of radiation on the differentiation of C2C12 myoblasts were studied using cell cultures in which the cells differentiated into either muscle cells or osteoblasts.

MATERIALS AND METHODS

A mouse skeletal myoblast cell line, C2C12, was cultured and irradiated at confluence. Muscle differentiation was estimated by counting the number of myosin heavy chain (MHC)-positive multinucleated myotubes. Osteoblast differentiation was analysed by measuring alkaline phosphatase (ALP) activity and osteocalcin production in C2C12 cells treated with recombinant human bone morphogenetic protein-2 (rhBMP-2).

RESULTS

Myotube formation in C2C12 cells was inhibited by 2 and 4 Gy irradiation, but recovered to non-irradiated control levels following further culture. In irradiated cultures, the number of MHC-positive mononucleated cells increased significantly. Irradiation did not, however, alter the induction of osteoblastic phenotypes induced by rhBMP-2 in C2C12. Irradiation also did not affect the expression of MyoD mRNA and myogenin mRNA in myogenic differentiation and induction of osteocalcin mRNA in osteoblastic differentiation.

CONCLUSIONS

During differentiation of C2C12 cells, myotube formation was delayed after irradiation, while induction of osteoblasts with BMP-2 was unaffected.

Suppressive effect of genistein on rat bone osteoclasts: involvement of protein kinase inhibition and protein tyrosine phosphatase activation

The suppressive effect of genistein on osteoclast-like multinucleated cells from rat femoral tissues was investigated. The bone cells isolated from rat femoral tissues were cultured for 48 h in an alpha-minimal essential medium (5% fetal bovine serum) containing either vehicle or genistein (10(-7)-10(-5) M). Osteoclasts were estimated by staining for tartrate-resistant acid phosphatase, a marker enzyme of osteoclasts. The presence of genistein caused a significant decrease in the number of osteoclasts. Such a decrease was also seen in the presence of calcium choride (10(-5) M). Magnesium chloride (10(-5)-10(-3) M), a blocker of Ca2+ channels, had no effect on the number of osteoclasts. The effect of genistein (10(-5) M) or calcium (10(-3) M) in decreasing osteoclasts was significantly prevented by the presence of magnesium (10-3 M). Vanadate (10(-6)-10(-4) M), an inhibitor of protein tyrosine phosphatase activity, did not have an effect on the number of osteoclasts. The genistein's effect was not altered by vanadate. When isolated osteoclasts were cultured for 24 h in the presence of genistein (10(-7)-10(-5) M), protein kinase activity in the 5500 g supernatant of homogenate of the cells was significantly decreased, while protein tyrosine phosphatase activity was significantly elevated. Such an effect was also seen by the addition of genistein (10(-7)-10(-5) in the enzyme reaction mixture in vitro. The present study suggests that the suppressive effect of genistein on rat bone osteoclasts is partly involved in the inhibition of protein kinase and the activation of protein tyrosine phosphatase in osteoclasts.

Synergistic effect of genistein and zinc on bone components in the femoral-metaphyseal tissues of female rats

The effect of genistein and zinc on bone components in rats was investigated. Femoral-metaphyseal tissues obtained from female rats (4 weeks old) were cultured for 24 h in a medium containing either vehicle or genistein (10(-7)-10(-5) M) in the absence or presence of zinc sulfate (10(-6)-10(-4) M) in vitro. The presence of genistein (10(-6) and 10(-5) M) or zinc (10(-6) and 10(-5) M) caused a significant increase in alkaline phosphatase activity, deoxyribonucleic acid (DNA), and calcium content in the metaphyseal tissues. These increases were significantly enhanced by the combination of each compound. The synergistic effect on bone components was seen in the combination with genistein (10(-6) and 10(-5) M) plus zinc (10(-5) M). Such an effect was completely blocked by the presence of cycloheximide (10(-6) M), an inhibitor of protein synthesis. Moreover, the oral administration of genistein (100 and 300 micrograms/kg body weight) or zinc sulfate (1 and 5 mg Zn/kg) to rats for 3 days caused a significant elevation of alkaline phosphatase activity, DNA, and calcium content in the femoral-metaphyseal tissues. These increases were significantly enhanced by the combination of each compound. The synergistic effect was seen in the case of genistein (100 and 300 micrograms/kg) plus zinc (5 mg/kg). These results demonstrate that the anabolic effect of genistein on bone components is synergistically enhanced by zinc in vitro and in vivo. This study further supports the view that the combination of nutritional factors has a potent anabolic effect on bone metabolism.

The microstructural analysis of SiC nanorods by high-resolution electron microscopy

Beta-SiC nanorods have been synthesized by the reaction of SiO and carbon nano-capsules. For the synthesis of SiC nanorods, it was examined that the reaction temperature and the ratio of SiO to carbon nanocapsules are important and the most appropriate temperature and ratio are around 1380 degreesC and 5:2, respectively. The synthesized SiC nanorods were characterized by high-resolution electron microscopy. Most of the SiC nanorods are straight and have the diameter of 30-150 nm while the SiC tips of the SiC nanorods have the size 100-400 nm. The SiC nanorods have many stacking faults normal to the [111] direction. Each SiC nanorod has one kind of preferential axis direction, which is either parallel or normal to the [111] direction. Based on the microstructural analysis of the SiC nanorods, a possible growth mechanism of the SiC nanorods is proposed.

Prolonged intake of fermented soybean (natto) diets containing vitamin K2 (menaquinone-7) prevents bone loss in ovariectomized rats

The effect of the prolonged intake of dietary vitamin K2 (menaquinone-7, MK-7) on bone loss in ovariectomized (OVX) rats was investigated. OVX rats were freely given experimental diets containing the fermented soybean (natto; including 9.4 micrograms MK-7/100 g diet) without or with supplemental MK-7 (containing 14.1 or 18.8 micrograms of MK-7 as total per 100 g diet) for 150 days. Feeding produced a significant elevation of MK-7 concentration in the serum of OVX rats. In this case, the femoral MK-4 content was significantly increased, but MK-7 was not detected in the femoral tissues, indicating degradation of MK-7. Serum gamma-carboxylated osteocalcin concentration was significantly decreased by OVX. This decrease was significantly prevented by the feeding of the natto diets with supplemental MK-7 (18.8 micrograms/100 g diets). OVX caused a significant decrease in femoral dry weight, femoral calcium content, and mineral density. These decreases were significantly prevented by feeding with diets containing natto with MK-7 (total, 18.8 micrograms/100 g diets). This study demonstrates that the prolonged intake of natto dietary including MK-7 has a preventive effect on bone loss induced by OVX. Dietary MK-7 may be useful in the prevention of osteoporosis.