Dexamethasone relieves the inflammatory response caused by inguinal hernia meshes through miR-155

BACKGROUND

Inguinal hernia is a relatively common condition. Most patients with inguinal hernia require surgery. At present, mesh repair is one of the most effective methods to treat inguinal hernia, but insertion of the mesh can cause inflammation. Dexamethasone (DEX) can treat inflammation, but the mechanism by which DEX alleviates inflammation caused by inguinal hernia mesh placement remains unclear.

METHOD

We randomly divided rats into groups: negative control (NC), inguinal hernia (IH), polypropylene mesh (PM), DEX treatment, and miR-155 treatment groups. RT-qPCR was performed to determine the expression of miR-155. ELISA was implemented to determine the secretion of IL-1β, IL-6, and IL-18. Western blotting was used to detect caspase-1, JAK1, p-JAK1, STAT3, and p-STAT3 expression. A dual-luciferase reporter gene array identified a connection between miR-155 and JAK1.

RESULTS

The results revealed that the expression of miR-155, IL-1β, IL-6, and IL-18 was upregulated in the PM group. After DEX treatment, the secretion of miR-155, caspase-1, IL-1β, IL-6, and IL-18 decreased. Dual luciferase results confirmed that miR-155 induced the targeted downregulation of JAK1, while a miR-155 mimic reversed the therapeutic effect of DEX, and the expression levels of p-JAK1 and p-STAT3 increased.

CONCLUSION

DEX regulates the JAK1/STAT3 signaling pathway through miR-155 to relieve inflammation caused by inguinal hernia meshes.

[Zellweger syndrome caused by PEX6 gene variation in 2 cases and literature review]

Objective: To summarize the clinical features and genetic characteristics of Zellweger spectrum disorder caused by PEX6 gene variation. Methods: This was a case series research. Clinical date and genetic results of 2 neonatal cases of Zellweger syndrome caused by PEX6 gene variation in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology and Affiliated Hospital of Guangdong Medical University from July 2021 to July 2022 were retrospectively collected and analyzed. Literature up to August 2023 was searched from electronic databases of China National Knowledge Infrastructure (CNKI), Wanfang Data and PubMed with the combined keywords of "Zellweger syndrome" "Zellweger spectrum disorder", and "PEX6 gene" both in Chinese and English. The main clinical features and genetic characteristics of Zellweger spectrum disorder caused by PEX6 gene variation were summarized. Results: The 2 male neonates both developed clinical manifestations as dyspnea, hypotonia, feeding difficulties, enlarged fontanelle, and high palatine arch after birth. Biochemical parameters indicated elevated bile acids, and the cranial ultrasound showed the enlarged bilateral ventricles and subependymal cyst in both 2 neonates. Zellweger syndrome was confirmed by whole exome sequencing, and the results revealed PEX6 gene variation in the 2 neonates, including compound heterozygous variants c.315G>A and c.2095-3T>G, and homozygous variant c.506_507del. Case 1 was hospitalized for 5 days, and case 2 for 32 days; they both died shortly after being discharged (the specific time is unknown). Literature review found 26 patients, including 2 neonates in this study, with Zellweger spectrum disorder caused by PEX6 gene defect reported in 1 Chinese article and 11 English articles. Clinical features included hearing loss (19 cases), developmental delay (19 cases), vision impairment (19 cases), elevated very long chain fatty acids (17 cases), brain malformations (15 cases), hypotonia (12 cases), hepatic insufficiency (12 cases), distinctive facies (10 cases), and dental impairment (9 cases). Compound heterozygous variations dominated the variation types (15 cases), and the frameshift variations (16 cases) were the main pathogenic variations. Conclusions: Zellweger spectrum disorder should be considered when neonates show hypotonia, feeding difficulty, distinctive facial appearance, brain malformations and failure of hearing screening, or when older children show retinitis pigmentosa, sensorineural hearing loss, amelogenesis imperfecta and developmental delays. Detection of genetic variation in the PEX gene is crucial for definitive diagnosis.

Potential low toxic alternative for Na-Cl cotransporter inhibition: A diuretic effect and mechanism study of Pyrrosia petiolosa

BACKGROUND

Hydrochlorothiazide, a diuretic commonly used for the treatment of hypertension, is often associated with serious metabolic side effects. Pyrrosia petiolosa (Christ) Ching is a traditional Chinese medicine that possesses diuretic properties, without any obvious side effects.

AIM

To evaluate the diuretic effect of P. petiolosa (Christ) Ching and to elucidate its underlying mechanism of action.

METHODS

Extracts obtained from different polar components of P. petiolosa (Christ) Ching were analyzed for toxicity in a Kunming mouse model. The diuretic effects of the extracts were compared to that of hydrochlorothiazide in rats. In addition, compound isolation procedures, cell assays of Na-Cl cotransporter inhibition and rat diuretic test of monomeric compounds were conducted to identify the active ingredients in the extract. Subsequently, homology modeling and molecular docking were performed to explain the reason behind the diuretic activity observed. Finally, LC-MS analysis was used to elucidate the underlying mechanism of action of P. petiolosa (Christ) Ching.

RESULTS

No toxicity was observed in mice administered P. petiolosa (Christ) Ching extracts. The ethyl acetate fraction showed the most significant diuretic effect. Similar results were obtained during the analysis for Na+ content in rat urine. Further separation of P. petiolosa (Christ) Ching components led to the isolation of methyl chlorogenate, 2',3'-dihydroxy propyl pentadecanoate, and β-carotene. Results from cell assays showed that the Na-Cl cotransporter inhibitory activity of methyl chlorogenate was greater than that of hydrochlorothiazide. This result was again confirmed by the diuresis tests of monomeric compounds in rats. The molecular simulations explain the stronger interactions between the methyl chlorogenate and Na-Cl cotransporter. Of the compounds determined using LC-MS analysis, 185 were identified to be mostly organic acids.

CONCLUSIONS

P. petiolosa possesses significant diuretic activities without any obvious toxicity, with least two possible mechanisms of action. Further study on this herb is warranted.

Intelligent surgical workflow recognition for endoscopic submucosal dissection with real-time animal study

Recent advancements in artificial intelligence have witnessed human-level performance; however, AI-enabled cognitive assistance for therapeutic procedures has not been fully explored nor pre-clinically validated. Here we propose AI-Endo, an intelligent surgical workflow recognition suit, for endoscopic submucosal dissection (ESD). Our AI-Endo is trained on high-quality ESD cases from an expert endoscopist, covering a decade time expansion and consisting of 201,026 labeled frames. The learned model demonstrates outstanding performance on validation data, including cases from relatively junior endoscopists with various skill levels, procedures conducted with different endoscopy systems and therapeutic skills, and cohorts from international multi-centers. Furthermore, we integrate our AI-Endo with the Olympus endoscopic system and validate the AI-enabled cognitive assistance system with animal studies in live ESD training sessions. Dedicated data analysis from surgical phase recognition results is summarized in an automatically generated report for skill assessment.

A New Treatment Planning Method for Efficient Proton ARC Therapy with Direct Minimization of Number of Energy Jumps

PURPOSE/OBJECTIVE(S)

The optimization of energy layer distributions is crucial for efficient proton ARC therapy: on one hand, a sufficient number of energy layers is needed to ensure the plan quality; on the other hand, an excess number of energy jumps can substantially slow down the treatment delivery. This work will develop a new treatment plan optimization method with direct minimization of number of energy jumps (NEJ), which will be shown to outperform state-of-the-art methods in both plan quality and delivery efficiency.

MATERIALS/METHODS

The proposed method jointly optimizes the plan quality and minimizes the NEJ. To minimize NEJ, (1) the proton spots x is summed per energy layer to form the energy vector y; (2) y is binarized via sigmoid transform into y1; (3) y1 is multiplied with a predefined energy order vector via dot product into y2; (4) y2 is filtered through the finite-differencing kernel into y3 in order to identify NEJ; (5) only the NEJ of y3 is penalized, while x is optimized for plan quality. The solution algorithm to this new method is based on iterative convex relaxation.

RESULTS

The new method is validated in comparison with state-of-the-art methods called energy sequencing (ES) method and energy matrix (EM) method. In terms of delivery efficiency, the new method had fewer NEJ, less energy switching time, and generally less total delivery time. In terms of plan quality, the new method had smaller optimization objective values, lower normal tissue dose, and generally better target coverage. A head-and-neck case is provided in the table with the following dosimetric parameters: planning objective value F; conformity index CI; homogeneity index HI; mean dose of larynx DOAR; mean body dose Dbody; the unit of dose is Gy.

CONCLUSION

We have developed a new treatment plan optimization method with direct minimization of NEJ, and demonstrated that this new method outperformed state-of-the-art methods (ES and EM) in both plan quality and delivery efficiency.

[Establishment of a digital remote platform for respiratory support and intelligent early warning in intensive care units]

During the disease progression or treatment of critically ill patients with lung injury, the changes in respiratory mechanics are continuous and dynamic. Establishing a digital platform for respiratory support in the ICU, which enables the continuous recording, dynamic analysis, and real-time alerting of numerical and waveform data from mechanical ventilation, can help intensivists improve their understanding of "dynamic respiratory mechanics", improve respiratory therapy and patient outcomes, as well as reduce workload and increase work efficiency. The construction of a dedicated database for mechanical ventilation, based on ventilator waveforms provides essential data support for projects such as respiratory mechanics data algorithm models. This will facilitate the establishment of an auxiliary decision-making system, enable the realization of intelligent mechanical ventilation, and create a new era of dynamic respiratory mechanics.

[Applications and challenges of large language models in critical care medicine]

The rapid development of big data methods and technologies has provided more and more new ideas and methods for clinical diagnosis and treatment. The emergence of large language models (LLM) has made it possible for human-computer interactive dialogues and applications in complex medical scenarios. Critical care medicine is a process of continuous dynamic targeted treatment. The huge data generated in this process needs to be integrated and optimized through models for clinical application, interaction in teaching simulation, and assistance in scientific research. Using the LLM represented by generative pre-trained transformer ChatGPT can initially realize the application in the diagnosis of severe diseases, the prediction of death risk and the management of medical records. At the same time, the time and space limitations, illusions and ethical and moral issues of ChatGPT emerged as the times require. In the future, it is undeniable that it may play a huge role in the diagnosis and treatment of critical care medicine, but the current application should be combined with more clinical knowledge reserves of critical care medicine to carefully judge its conclusions.

PEg TRAnsfer Workflow recognition challenge report: Do multimodal data improve recognition?

BACKGROUND AND OBJECTIVE

In order to be context-aware, computer-assisted surgical systems require accurate, real-time automatic surgical workflow recognition. In the past several years, surgical video has been the most commonly-used modality for surgical workflow recognition. But with the democratization of robot-assisted surgery, new modalities, such as kinematics, are now accessible. Some previous methods use these new modalities as input for their models, but their added value has rarely been studied. This paper presents the design and results of the "PEg TRAnsfer Workflow recognition" (PETRAW) challenge with the objective of developing surgical workflow recognition methods based on one or more modalities and studying their added value.

METHODS

The PETRAW challenge included a data set of 150 peg transfer sequences performed on a virtual simulator. This data set included videos, kinematic data, semantic segmentation data, and annotations, which described the workflow at three levels of granularity: phase, step, and activity. Five tasks were proposed to the participants: three were related to the recognition at all granularities simultaneously using a single modality, and two addressed the recognition using multiple modalities. The mean application-dependent balanced accuracy (AD-Accuracy) was used as an evaluation metric to take into account class balance and is more clinically relevant than a frame-by-frame score.

RESULTS

Seven teams participated in at least one task with four participating in every task. The best results were obtained by combining video and kinematic data (AD-Accuracy of between 93% and 90% for the four teams that participated in all tasks).

CONCLUSION

The improvement of surgical workflow recognition methods using multiple modalities compared with unimodal methods was significant for all teams. However, the longer execution time required for video/kinematic-based methods(compared to only kinematic-based methods) must be considered. Indeed, one must ask if it is wise to increase computing time by 2000 to 20,000% only to increase accuracy by 3%. The PETRAW data set is publicly available at www.synapse.org/PETRAW to encourage further research in surgical workflow recognition.

Comparative validation of machine learning algorithms for surgical workflow and skill analysis with the HeiChole benchmark

PURPOSE

Surgical workflow and skill analysis are key technologies for the next generation of cognitive surgical assistance systems. These systems could increase the safety of the operation through context-sensitive warnings and semi-autonomous robotic assistance or improve training of surgeons via data-driven feedback. In surgical workflow analysis up to 91% average precision has been reported for phase recognition on an open data single-center video dataset. In this work we investigated the generalizability of phase recognition algorithms in a multicenter setting including more difficult recognition tasks such as surgical action and surgical skill.

METHODS

To achieve this goal, a dataset with 33 laparoscopic cholecystectomy videos from three surgical centers with a total operation time of 22 h was created. Labels included framewise annotation of seven surgical phases with 250 phase transitions, 5514 occurences of four surgical actions, 6980 occurences of 21 surgical instruments from seven instrument categories and 495 skill classifications in five skill dimensions. The dataset was used in the 2019 international Endoscopic Vision challenge, sub-challenge for surgical workflow and skill analysis. Here, 12 research teams trained and submitted their machine learning algorithms for recognition of phase, action, instrument and/or skill assessment.

RESULTS

F1-scores were achieved for phase recognition between 23.9% and 67.7% (n = 9 teams), for instrument presence detection between 38.5% and 63.8% (n = 8 teams), but for action recognition only between 21.8% and 23.3% (n = 5 teams). The average absolute error for skill assessment was 0.78 (n = 1 team).

CONCLUSION

Surgical workflow and skill analysis are promising technologies to support the surgical team, but there is still room for improvement, as shown by our comparison of machine learning algorithms. This novel HeiChole benchmark can be used for comparable evaluation and validation of future work. In future studies, it is of utmost importance to create more open, high-quality datasets in order to allow the development of artificial intelligence and cognitive robotics in surgery.

Trans-SVNet: hybrid embedding aggregation Transformer for surgical workflow analysis

PURPOSE

Real-time surgical workflow analysis has been a key component for computer-assisted intervention system to improve cognitive assistance. Most existing methods solely rely on conventional temporal models and encode features with a successive spatial-temporal arrangement. Supportive benefits of intermediate features are partially lost from both visual and temporal aspects. In this paper, we rethink feature encoding to attend and preserve the critical information for accurate workflow recognition and anticipation.

METHODS

We introduce Transformer in surgical workflow analysis, to reconsider complementary effects of spatial and temporal representations. We propose a hybrid embedding aggregation Transformer, named Trans-SVNet, to effectively interact with the designed spatial and temporal embeddings, by employing spatial embedding to query temporal embedding sequence. We jointly optimized by loss objectives from both analysis tasks to leverage their high correlation.

RESULTS

We extensively evaluate our method on three large surgical video datasets. Our method consistently outperforms the state-of-the-arts across three datasets on workflow recognition task. Jointly learning with anticipation, recognition results can gain a large improvement. Our approach also shows its effectiveness on anticipation with promising performance achieved. Our model achieves a real-time inference speed of 0.0134 second per frame.

CONCLUSION

Experimental results demonstrate the efficacy of our hybrid embeddings integration by rediscovering the crucial cues from complementary spatial-temporal embeddings. The better performance by multi-task learning indicates that anticipation task brings the additional knowledge to recognition task. Promising effectiveness and efficiency of our method also show its promising potential to be used in operating room.

Stereo Dense Scene Reconstruction and Accurate Localization for Learning-Based Navigation of Laparoscope in Minimally Invasive Surgery

OBJECTIVE

The computation of anatomical information and laparoscope position is a fundamental block of surgical navigation in Minimally Invasive Surgery (MIS). Recovering a dense 3D structure of surgical scene using visual cues remains a challenge, and the online laparoscopic tracking primarily relies on external sensors, which increases system complexity.

METHODS

Here, we propose a learning-driven framework, in which an image-guided laparoscopic localization with 3D reconstructions of complex anatomical structures is obtained. To reconstruct the 3D structure of the whole surgical environment, we first fine-tune a learning-based stereoscopic depth perception method, which is robust to the texture-less and variant soft tissues, for depth estimation. Then, we develop a dense visual reconstruction algorithm to represent the scene by surfels, estimate the laparoscope poses and fuse the depth maps into a unified reference coordinate for tissue reconstruction. To estimate poses of new laparoscope views, we achieve a coarse-to-fine localization method, which incorporates our reconstructed 3D model.

RESULTS

We evaluate the reconstruction method and the localization module on three datasets, namely, the stereo correspondence and reconstruction of endoscopic data (SCARED), the ex-vivo phantom and tissue data collected with Universal Robot (UR) and Karl Storz Laparoscope, and the in-vivo DaVinci robotic surgery dataset, where the reconstructed 3D structures have rich details of surface texture with an accuracy error under 1.71 mm and the localization module can accurately track the laparoscope with only images as input.

CONCLUSIONS

Experimental results demonstrate the superior performance of the proposed method in 3D anatomy reconstruction and laparoscopic localization.

SIGNIFICANCE

The proposed framework can be potentially extended to the current surgical navigation system.

Imaging-Based Deep Graph Neural Networks for Survival Analysis in Early Stage Lung Cancer Using CT: A Multicenter Study

Background

Lung cancer is the leading cause of cancer-related mortality, and accurate prediction of patient survival can aid treatment planning and potentially improve outcomes. In this study, we proposed an automated system capable of lung segmentation and survival prediction using graph convolution neural network (GCN) with CT data in non-small cell lung cancer (NSCLC) patients.

Methods

In this retrospective study, we segmented 10 parts of the lung CT images and built individual lung graphs as inputs to train a GCN model to predict 5-year overall survival. A Cox proportional-hazard model, a set of machine learning (ML) models, a convolutional neural network based on tumor (Tumor-CNN), and the current TNM staging system were used as comparison.

Findings

A total of 1,705 patients (main cohort) and 125 patients (external validation cohort) with lung cancer (stages I and II) were included. The GCN model was significantly predictive of 5-year overall survival with an AUC of 0.732 (p < 0.0001). The model stratified patients into low- and high-risk groups, which were associated with overall survival (HR = 5.41; 95% CI:, 2.32–10.14; p < 0.0001). On external validation dataset, our GCN model achieved the AUC score of 0.678 (95% CI: 0.564–0.792; p < 0.0001).

Interpretation

The proposed GCN model outperformed all ML, Tumor-CNN, and TNM staging models. This study demonstrated the value of utilizing medical imaging graph structure data, resulting in a robust and effective model for the prediction of survival in early-stage lung cancer.

[Research advances on the clinical characteristics and diagnosis and treatment of autoimmune disease-related ulcers]

Studies have shown that autoimmune disease (AID)-related ulcers are disease complications that lead to serious poor prognosis such as infection and disability. It is difficult to make a clear diagnosis and there are contradictions between the applications of immunosuppressive therapy and anti-infectious therapy. Improper diagnosis and immunosuppressive therapy can easily delay the timing of anti-infectious therapy and surgery for patients, which bring adverse effects on the prognosis of patients. This paper reviews the concept, clinical characteristics and treatment suggestions of each subtype of AID-related ulcers, in order to provide more ideas for AID-related ulcers' clinical diagnosis and treatment.

A systematic review and meta-analysis of disease burden of healthcare-associated infections in China: an economic burden perspective from general hospitals

BACKGROUND

Healthcare-associated infections (HAIs) are a global public health issue. However, the economic burden attributable to HAIs at a national level is unknown in China. The aim of this systematic review was to estimate the direct economic burden caused by HAIs in China.

METHODS

Medline, EMBASE and Chinese Journals Online databases were searched, including studies published from 2009 to 2019. The pooled estimates with 95% Confidential Interval were calculated with Quantile Estimation. The random effect model of the DerSimonian-Laird method was used. The statistical significance was set as P<0.05.

RESULTS

2,756 publications were identified; 6 studies were included in a meta-analysis to calculate the pooled estimates of direct economic burden, while 5 were included in the pooled estimates of the additional economic burden. The pooled median estimates of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient of patients with HAIs were ¥34,415.62, ¥20,065.21 and 34.01 days, respectively (P <0.0001). The pooled median estimates of the differences of the total medical expenditure, the medicine expenditure and hospitalisation days per inpatient between patients with HAIs and patients without HAIs were ¥24,881.37, ¥9,438.46 and 13.89 days, respectively (P < 0.01).

CONCLUSIONS

The cost of care for patients with HAIs was significantly higher than that for those without HAIs. This excess economic burden is likely to impact on patients and their families as well as health service providers and the health care system as a whole. Effective surveillance systems and cost-effective interventions are needed to control HAIs.

MIcro-surgical anastomose workflow recognition challenge report

BACKGROUND AND OBJECTIVE

Automatic surgical workflow recognition is an essential step in developing context-aware computer-assisted surgical systems. Video recordings of surgeries are becoming widely accessible, as the operational field view is captured during laparoscopic surgeries. Head and ceiling mounted cameras are also increasingly being used to record videos in open surgeries. This makes videos a common choice in surgical workflow recognition. Additional modalities, such as kinematic data captured during robot-assisted surgeries, could also improve workflow recognition. This paper presents the design and results of the MIcro-Surgical Anastomose Workflow recognition on training sessions (MISAW) challenge whose objective was to develop workflow recognition models based on kinematic data and/or videos.

METHODS

The MISAW challenge provided a data set of 27 sequences of micro-surgical anastomosis on artificial blood vessels. This data set was composed of videos, kinematics, and workflow annotations. The latter described the sequences at three different granularity levels: phase, step, and activity. Four tasks were proposed to the participants: three of them were related to the recognition of surgical workflow at three different granularity levels, while the last one addressed the recognition of all granularity levels in the same model. We used the average application-dependent balanced accuracy (AD-Accuracy) as the evaluation metric. This takes unbalanced classes into account and it is more clinically relevant than a frame-by-frame score.

RESULTS

Six teams participated in at least one task. All models employed deep learning models, such as convolutional neural networks (CNN), recurrent neural networks (RNN), or a combination of both. The best models achieved accuracy above 95%, 80%, 60%, and 75% respectively for recognition of phases, steps, activities, and multi-granularity. The RNN-based models outperformed the CNN-based ones as well as the dedicated modality models compared to the multi-granularity except for activity recognition.

CONCLUSION

For high levels of granularity, the best models had a recognition rate that may be sufficient for applications such as prediction of remaining surgical time. However, for activities, the recognition rate was still low for applications that can be employed clinically. The MISAW data set is publicly available at http://www.synapse.org/MISAW to encourage further research in surgical workflow recognition.

Phenotypic and genetic correlations of pork myoglobin content with meat colour and other traits in an eight breed-crossed heterogeneous population

Meat colour is one of the most important meat quality traits affecting consumption desire. Genetic improvement for meat colour traits is not so easy because pigs can be phenotyped only after slaughter. Besides the parameters from the optical instrument, other indexes that reflect the material basis of meat colour should be measured accurately and used in the genomic analysis. Myoglobin (Mb) is the main chemical component determining meat colour. However, to what extent the Mb content contributes to meat colour, and whether it can be used as a trait for pig breeding to improve meat colour, and the correlations of Mb content with complex porcine traits are largely unknown. To address these questions, we measured the muscle Mb content in 624 pigs from the 7th generation of a specially designed eight breed-crossed pig heterogeneous population, evaluated its phenotypic and genetic correlations with longissimus thoracis colour score at 24 h after slaughter. More than that, we also systematically phenotyped more than 100 traits on these animals to evaluate the potential correlations between muscle Mb content and economically important traits. Our results showed that the average muscle Mb content in the 624 pigs was 1.00 mg/g, ranging from 0.51 to 2.17 mg/g. We found that higher Mb content usually correlated with favourable meat colour, higher marbling score, less moisture content, and less drip loss. Genetic correlation analysis between muscle Mb content and 101 traits measured in this study shows that Mb content is also significantly correlated with 31 traits, including marbling, shear force, firmness, and juiciness. To our knowledge, this is one of the largest studies about the correlations of muscle Mb content with as many as 100 various traits in a large-scale genetically diversified population. Our results showed that the Mb content could be a selection parameter for the genetic improvement of meat colour. The selection for higher Mb content will also benefit marbling, shear force, firmness, and overall liking but might not affect the growth, carcass, and fat deposition traits.

Temporal Memory Relation Network for Workflow Recognition From Surgical Video

Automatic surgical workflow recognition is a key component for developing context-aware computer-assisted systems in the operating theatre. Previous works either jointly modeled the spatial features with short fixed-range temporal information, or separately learned visual and long temporal cues. In this paper, we propose a novel end-to-end temporal memory relation network (TMRNet) for relating long-range and multi-scale temporal patterns to augment the present features. We establish a long-range memory bank to serve as a memory cell storing the rich supportive information. Through our designed temporal variation layer, the supportive cues are further enhanced by multi-scale temporal-only convolutions. To effectively incorporate the two types of cues without disturbing the joint learning of spatio-temporal features, we introduce a non-local bank operator to attentively relate the past to the present. In this regard, our TMRNet enables the current feature to view the long-range temporal dependency, as well as tolerate complex temporal extents. We have extensively validated our approach on two benchmark surgical video datasets, M2CAI challenge dataset and Cholec80 dataset. Experimental results demonstrate the outstanding performance of our method, consistently exceeding the state-of-the-art methods by a large margin (e.g., 67.0% v.s. 78.9% Jaccard on Cholec80 dataset).

[Technology specification of bedside hypertonic saline-contrast electrical impedance tomography of lung perfusion and clinical application]

Bedside hypertonic saline-contrast electrical impedance tomography (EIT) method for lung perfusion evaluation has several advantages of bedside, simple, noninvasive and radiation-free. For a long time, EIT perfusion image of hypertonic saline was mostly limited to animal experiments, and related clinical research is in the ascendant. This technical specification for clinical application is reached based on our previous researches, review of literatures in this field. The purpose of this technical specification is to facilitate the unified and standardized use of hypertonic saline-contrast EIT technology for regional lung perfusion, to evaluate the safety and quality control of the technology, and to unify the results.

[Diagnostic and prognostic value of peripheral lymphocyte subtyping for invasive candidiasis infection in critically ill patients with non-neutropenic sepsis]

Objective: To assess the diagnostic and prognostic value of lymphocyte subtyping for invasive candidiasis infection (ICI) in critically ill patients with non-neutropenic sepsis. Methods: A prospective observational cohort study was performed at Peking Union Medical College Hospital (PUMCH), 377 patients with non-neutropenic sepsis admitted to Department of Critical Care Medicine from January 2017 to November 2019 were enrolled. There were 9.0% (34/377) patients diagnosed as ICI. Vital signs, supportive care therapy and microbiological specimens were collected. Peripheral blood lymphocyte subtypes, serum globulin, complements, inflammatory factors such as interleukin(IL)-6, IL-8, IL-10 and tumor necrosis factor were detected within 24 hours after sepsis was diagnosed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value and prognostic significance of immunological indicators for ICI. Multiple logistic regression was used to analyze the independent risk factors for ICI. Kaplan-Meier analysis was used to analyze survival. Results: The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 17.0 (13.0, 21.0) in all 377 patients. The sequential organ failure score (SOFA) was 11.0 (8.0, 13.0), and the 28-day mortality rate was 27.6% (104/377). Peripheral blood CD8⁺absolute T lymphocyte count≤177 cells/μl, CD28⁺CD8⁺T-cell count≤81 cells/μl and 1, 3-β-D-glucan (BDG) ≥88.20 ng/L were closely correlated with the diagnosis of ICI (AUC=0.793,95%CI 0.749-0.833,P<0.000 1;AUC=0.892,95%CI 0.856-0.921, P<0.000 1;AUC=0.761, 95%CI 0.715-0.803,P<0.000 1, respectively), with sensitivity of diagnosis 94.12%, 100.00%, and 88.24%; the specificity of diagnosis 81.34%, 62.39%, 63.56% respectively. Multivariate logistic regression analysis identified CD8⁺T-cell count≤139 cells/μl (OR=7.463, 95%CI 1.300-42.831, P=0.024) and CD28⁺CD8⁺T-cell counts≤52 cells/μl (OR=57.494, 95%CI 3.986-829.359, P=0.003) as independent risk factors for higher mortality. Kaplan-Meier survival analysis suggested that CD8⁺T-cell count ≤139 cells/μl (P=0.0159) and CD28⁺CD8⁺T-cell count≤52 cells/μl (P=0.000 1) were associated with higher mortality within 28 days (68.8%, 91.7%). Conclusions: Low CD28⁺CD8⁺T cell count in peripheral blood is closely related to the development and clinical outcome of ICI in sepsis patients, which could be used as an effective indicator for the diagnosis and prognosis prediction of ICI.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is associated with IRF7, BANK1 and TBX21 polymorphisms in two populations

BACKGROUND AND PURPOSE

Autoantibodies targeting the GluN1(NR1) subunit of the anti-N-methyl-D-aspartate receptor (NMDAR) cause encephalitis. Although it has been shown that anti-NMDAR encephalitis is associated with human leukocyte antigen (HLA) loci, susceptibility genes for the disease outside the HLA loci remain unidentified. In this study, we aimed to explore the association of anti-NMDAR encephalitis with non-HLA genes.

METHODS

Two Chinese anti-NMDAR encephalitis cohorts from Han populations were recruited for this study. The North Chinese case-control set consisted of 98 patients and 460 controls, while the South Chinese case-control set included 78 patients and 541 controls. All participants were genotyped for 28 single nucleotide polymorphisms that are associated with autoimmune disorders or infectious diseases.

RESULTS

In two independent case-control sets, we identified significant associations of anti-NMDAR encephalitis with IRF7 rs1131665 (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.99-5.63; P < 0.000001, P^adjusted  = 0.00004), BANK1 rs4522865 (OR 1.44, 95% CI 1.15-1.82; P = 0.0017, P^adjusted  = 0.0149), and TBX21 rs17244587 (OR 2.03, 95% CI 1.35-3.05; P = 0.00051, P^adjusted  = 0.0066). Furthermore, analysis of the three polymorphisms with clinical features of the disease revealed that the IRF7 rs1131665 was associated with tumor status.

CONCLUSION

The present study has for the first time identified non-HLA susceptibility genes for anti-NMDAR encephalitis. The association of IRF7, BANK1 and TBX21 with anti-NMDAR encephalitis suggests that B-cell activation, Th1 responses, virus infection and the type I interferon signaling pathway are involved in the pathogenesis of the disease.

Effect of miR-26a on diabetic rats with myocardial injury by targeting PTEN

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "Effect of miR-26a on diabetic rats with myocardial injury by targeting PTEN, by S.-S. Cai, X.-W. Tao, Y. Long, K. Xia, Y. Zhang, published in Eur Rev Med Pharmacol Sci 2019; 23 (3 Suppl): 304-311-DOI: 10.26355/eurrev_201908_18661-PMID: 31389595" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/18661.

Effect of miR-26a on diabetic rats with myocardial injury by targeting PTEN

OBJECTIVE

To investigate the effect of micro ribonucleic acid (miR)-26a on diabetes-induced myocardial injury in rats by targeting the gene of phosphate and tension homology detected on chromosome ten (PTEN).

MATERIALS AND METHODS

Male Wistar rats aged 8-9 weeks old were divided into the control group (n=10), GK group (n=10), and miR-26a agomir group (n=10) according to the body weight. MiRanda and TargetScan target gene prediction software were used to predict and analyze the target gene of miR-26a-5p. The expressions of miR-26a and PTEN in the myocardial tissues of the diabetic rats were detected by quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR). Hematoxylin-eosin (HE) staining was adopted to observe the pathological changes in the myocardial tissues. In addition, the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was conducted to detect myocardial apoptosis, while the expression of PTEN protein was detected via immunohistochemistry, and the protein expressions of PTEN, b-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and cysteinyl aspartate specific proteinase-3 (Caspase-3) were tested by Western blotting.

RESULTS

TargetScan database analysis results showed that miR-26a-5p and PTEN 3'UTR had 6 pairs of complementary bases with the same sequence. Compared with those in the control group, the messenger RNA (mRNA) expression of PTEN in the GK group was notably increased (p<0.05), while that of miR-26a was substantially reduced (p<0.05). In comparison with those in the GK group, the mRNA expression of PTEN was significantly decreased, but that of miR-26a was significantly raised in miR-26a agomir group (p<0.05). Through observation under an optical microscope, it was manifested that in the control group, the myocardial fibers were intact with clear texture but no fracture, and the solid necrosis did not appear in myocardial cells. In the GK group, the myocardial fibers were disorderedly arranged and incomplete with an unclear edge and burrs. The myocardial fibers in the miR-26a agomir group were more regular, with less breakage and solid necrosis. According to TUNEL staining results, the TUNEL-stained brown granules in rats in the GK group were remarkably increased, relative to the control group (p<0.05). Compared with the GK group, miR-26a agomir group had markedly decreased the TUNEL-stained brown particles (p<0.05). It was found in immunohistochemical results that PTEN protein was in lighter color after staining in the control group, with a clear myocardial cell stripe structure. Compared with that in control group, PTEN protein in the GK group was in deeper color after staining, and in comparison with that in the GK group, the color of PTEN protein in miR-26a agomir group became significantly lighter. Moreover, the Western blotting results demonstrated that, compared with those in the control group, the Caspase-3 and Bax protein expressions in the GK group were significantly raised, while Bcl-2 protein expression was notably reduced (p<0.05). Besides, in comparison with the GK group, miR-26a agomir group evidently elevated Caspase-3 and Bax protein expressions and a notably increased Bcl-2 protein expression (p<0.05).

CONCLUSIONS

We showed that miR-26a can protect against myocardial injury in diabetic rats by regulating PTEN.

Activated inducible co-stimulator-positive programmed cell death 1-positive follicular helper T cells indicate disease activity and severity in ulcerative colitis patients

Inducible co-stimulator-positive (ICOS) and programmed cell death 1-positive (PD-1) are important markers for follicular helper T cells (Tfh); however, their roles and clinical values in ulcerative colitis (UC) remain unknown. In this study, we recruited 68 UC patients and 34 healthy controls. Circulating ICOS⁺ , PD-1⁺ and ICOS⁺ PD-1⁺ Tfh subsets were analyzed by flow cytometry. Twelve active UC patients achieving remission after treatment with 5-aminosalicylic acid were followed-up and Tfh subset changes were analyzed. Serum immunoglobulin (Ig)G, C-reactive protein (CRP), interleukin (IL)-4 and IL-21 levels and B cell subsets were analyzed and Mayo scores were calculated. Correlation analyses were performed between Tfh subsets and the clinical indicators. Receiver operating characteristic (ROC) curves were generated to evaluate the efficiency of Tfh subsets for disease monitoring. We found that levels of ICOS⁺ , PD-1⁺ and ICOS⁺ PD-1⁺ Tfh cells were significantly increased in active UC and significantly decreased when achieving clinical remission. Activated ICOS⁺ PD-1⁺ Tfh cells were positively correlated with serum CRP and Mayo scores. Furthermore, ICOS⁺ PD-1⁺ Tfh cells were significantly correlated with circulating new memory B cells and plasmablasts, as well as serum IgG, IL-4 and IL-21. ROC analyses showed that when ICOS⁺ PD-1⁺ Tfh cells were used in combination with PD-1⁺ Tfh cells, the diagnostic efficacy in distinguishing active UC from stable remission patients was higher than that of any one used alone, with area under curve (AUC) value 0·931. Our findings suggest that increased ICOS⁺ PD-1⁺ Tfh cells are associated with the activation of B cells in the pathogenesis of UC, and may be a potential biomarker for UC disease monitoring.

[Clinical value of early bedside ultrasound measurement of quadriceps femoris in diagnosis of ICU-acquired weakness]

Objective: To explore the correlation between quadriceps thickness (thickness of rectus femoris and vastus intermedius), cross-sectional area (cross-sectional area of the rectus femoris) and the strength score of the Medical Research Council (MRC) in critically ill patients, and to explore the changes in the length of hospital stay in the intensive care unit (ICU), and to determine the diagnostic value of muscle changes in the ICU-acquired weakness (ICU-AW). Methods: Patients admitted to the Department of Critical Care Medicine from March to October in 2019 who were expected to stay for more than five days were enrolled in this study. The cross-sectional area of the rectus femoris, the thickness of the rectus femoris, the thickness of the vastus intermedius on the first day of the ICU (D(1)), day 3 (D(3)), and day 5 (D(5)), day 7 (D(7)), out of ICU (D(ICU)), and the MRC muscle strength scores on the day of out of ICU prospectively were collected in all the patients, and the correlation and the regularity of quadriceps changes were analyzed. MRC>48 points on the day of dismiss of ICU were used as the standard for the diagnosis of ICU-AW, and the relationship between muscle changes of the quadriceps and ICU-AW was analyzed. The t test or the Mann-Whitney U test was used for data analysis. Results: A total of 45 patients were included, including 25 males and 20 females, aged (58±10) years. The rectus femoris cross-sectional area, rectus femoris thickness, and vastus intermedius thickness decreased with the length of ICU hospital stay. The cross-sectional area, thickness of the rectus femoris muscle, and the vastus intermedius thickness were positively correlated with the MRC score (r=0.452, 0.411, 0.402, all P<0.05), and the changes were all negatively correlated with the MRC score (r=-0.682, -0.740, -0.734, all P<0.05). On the 3rd day after ICU admission, the best cutoff value of rectus muscle cross-sectional area atrophy rate for discrimination of ICU-AW was 6.0%, with a sensitivity of 66.7% and a specificity of 77.8%; on the 5th day, the best cutoff value of rectus femoris thickness atrophy rate was 14.5%, with a sensitivity of 77.8% and a specificity of 66.7%; on the 7th day, the best cutoff value of vastus intermedius thickness atrophy rate was 19.9%, with a sensitivity of 70.6% and a specificity of 87.5%. Conclusion: Bedside ultrasound measurement of the quadriceps femoris cross-sectional area and thickness has certain diagnostic value for ICU-AW, and can identify patients with ICU-AW early.

[Relationship between social support, resilience, self-esteem and post-traumatic stress disorder in intensive care unit nurses]

Objective: To investigate the correlation between social support, resilience, self-esteem and post-traumatic stress disorder (PTSD) in intensive care unit (ICU) nurses. Methods: A total of 717 ICU nurses from 24 provinces conducted these questionnaires (Chinese version of Impact of Event Scale-Revised(IES-R), Social Support Rate Score(SSRS), Cannor-Davidson Resilience(CD-RISC) and Self-Esteem Scale(SES)). There were 101 males and 616 females, with an average age of (30±5) years. With the aim to investigate PTSD impact factors, the ICU nurses were divided into the PTSD positive group (IES-R>35) and PTSD negative group (IES-R<35). The correlation between IES-R and other scales were analyzed with linear regression analysis. Results: In this investigation, 414 nurses were screened with PTSD and 303 nurses without. IES-R score was negatively correlated with SSRS, CD-RISC and SES (r=-0.275, -0.202, -0.709, all P<0.05). Multivariate regression analysis showed that ICU clinical experience was an independent risk factor for PTSD, and SES Score, SSRS Score and physical health status were protective factors. SES partially mediated the association of SSRS with IES-R, and the mediating effect were 51.5%. The area under characteristic curve (ROC) showed that SSRS score, CD-RISC score, SES score and PTSD risk score Logit (P) for prediction of PTSD was 0.629, 0.604, 0.831 and 0.848, respectively. Conclusions: Social support, physical health and self-esteem are protective factors of PTSD, while ICU clinical experience is a risk factor. SES partially mediated the association of SSRS with IES-R.

Ulinastatin inhibits high glucose-induced cardiomyocyte apoptosis through activating Akt signaling

OBJECTIVE

Cardiomyocyte apoptosis is closely associated with the development of diabetic cardiomyopathy. Ulinastatin, a urinary trypsin inhibitor, exerts a protective effect on cardiac function. However, the molecular mechanism remains not fully clear. This study aims to explore the effect of ulinastatin on high glucose (HG)-induced cardiomyocyte apoptosis and the potential molecular mechanism.

MATERIALS AND METHODS

Neonatal rats cardiomyocytes were cultured and then treated with HG or/and ulinastatin. Cell viability was examined using a MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay. Cell apoptosis was detected by flow cytometry. Mitochondrial membrane potential (MMP) was stained using a JC-1 probe and evaluated by fluorescence microscopy. Protein expressions of B-cell lymphoma 2 (Bcl-2) , BCL2-Associated X (Bax), cleaved caspase 3, p-Akt and Akt were determined by Western blot.

RESULTS

Ulinastatin increased the HG-induced reduction in cell viability and MMP expression. Ulinastatin also inhibited HG-induced apoptosis. Ulinastatin decreased the Bax/Bcl-2 ratio and cleaved caspase 3 expression in cardiomyocyte treated with HG. Further, ulinastatin increased the phosphorylation level of Akt in cardiomyocyte treated with HG. These effects of ulinastatin were abrogated by LY294002, an Akt inhibitor.

CONCLUSIONS

Ulinastatin inhibited HG-induced cardiomyocyte apoptosis through activating Akt signaling.

[An assessment of the sublingual immunotherapy with Dermatophagoides farinae on asthma control level and pulmonary function of allergic asthma and rhinitis in adult patient]

Objective:To evaluate the efficacy, asthma control level and pulmonary function of sublingual immunotherapy on allergic asthma and rhinitis in adult patient. Method:This retrospective analysis of 182 cases of adult patient from 18-60 years with allergic asthma and rhinitis, according to the patients' wishes they were divided into drug group（66 patients） and SLIT group（116 patients）. Drug group patients were treated with low to moderate doses of inhaled corticosteroids+long-acting β2 receptor agonists and mometasone furoate nasal spray+desloratadine tablets as symptomatic treatment. SLIT group was treated by SLIT with Dermatophagoides farina drops on this basis. Before treatment and 1 year, 2 year and 3 years after treatment, the ACT, PEF%, DASS, NASS, TNSS and TMS were evaluated. Result:The ACT, PEF%, DASS, NASS, TNSS and TMS had continuously improved significantly 1 year, 2 year and 3 years after treatment in both groups comparing with baseline（P<0.05）. Compared with 1 year after treatment, SLIT group had lower ACT, PEF%, DASS, NASS, TNSS and TMS in 2 years after treatment（all P<0.05）, whereas drug group had lower TMS and DASS（all P<0.05）. In 3 years of treatment, only SLIT group resulted in significant continuous improvement in DASS and TMS（all P<0.05）. After 1 year, 2 and 3 years of treatment, SLIT group resulted in significantly better ACT, PEF%, DASS, NASS and TMS than drug group（all P<0.05）. After 2 and 3 years of treatment, TNSS of SLIT group were significantly lower than in drug group（P<0.05）. Conclusion:Sublingual immunotherapy for 3 yearswith Dermatophagoides farinae dropsin adult patient with allergic asthma and rhinitis was more effective than drug therapy alone, and asthma control and lung function improved significantly.

Effects of different diets on the intestinal microbiota and immunity of common carp (Cyprinus carpio)

AIMS

An 8-week trial was performed to evaluate the differences in the intestinal microbiota and immune function of common carp (Cyprinus carpio)-fed different diets.

METHODS AND RESULTS

The fish (initial weight 492·6 ± 30 g, n = 270) were randomly divided into three groups with three replicates and were fed earthworms (group A), earthworms + duckweed (group M) or duckweed (group P) respectively. The diversity and dominant microbiota of the intestinal bacteria were detected by denaturing gradient gel electrophoresis, and the abundance of dominant bacteria was quantified by qPCR. Additionally, the activities of some nonspecific immune enzymes and antioxidant enzymes were determined. The results showed that higher diversity and abundance of intestinal microbiota were observed in group M and group P (P < 0·05). Based on the intestinal microbiota, Cetobacterium was only detected in the intestines of common carp in group A, and Bacillus was identified in groups M and P. Additionally, a higher abundance of Bacteroidetes and Firmicutes was also found in the intestine in group P than in group A (P < 0·05). Interestingly, the higher activities of immune enzymes were detected in intestine of common carp in group M, such as acid phosphatase, phosphatase (AKP), lysozyme, total antioxidant capacity, superoxide dismutase, catalase, glutathione peroxidase. In addition, the lower level of metabolites were also detected, such as nitric oxide and malondialdehyde.

CONCLUSIONS

Our results indicate that the intestinal microbiota and intestinal immunity of common carp were affected by diet. Meanwhile, the results show that a mixed diet can promote and improve the immune function of the omnivorous carp intestine, which suggests that paddy fields might be more suitable for the intestinal health and animal welfare of omnivorous fishes because they contain plant and animal diets.

SIGNIFICANCE AND IMPACT OF THE STUDY

As an ecological aquaculture strategy, the rice-fish mode has attracted attention among farmers, researchers and even consumers, especially for the cultivation of common carp in paddy fields. In paddy fields, fish can eat plant- and animal-based diets. However, it is not clear whether common carp feeding on a mixed diet in paddy fields have better intestinal health. This experiment is one of only a few studies performed from the perspective of intestinal micro-organisms and immunity to successfully study the effects of different natural diets on adult common carp. This study also provides a theoretical basis for healthy breeding of common carp in paddy fields.

[Effectiveness of P-Gemox chemotherapy combined with radiotherapy in newly diagnosed,stage ⅠE to ⅡE, extranodal nasal type natural killer/T-cell lymphoma]

Objective: To investigate the efficacy and safety of pegaspargase, gemcitabine, and oxaliplatin(P-Gemox) chemotherapy combined with radiotherapy in the treatment of newly diagnosed, stage IE to IIE of Extranodal nasal type natural killer/T-cell lymphoma(ENKTL) patients.Method: P-Gemox chemotherapy combined with radiotherapy was used to analyze its clinical value and the factors affecting the prognosis in the treatment of 43 newly diagnosed ENKTL patients. In addition, toxicity related to chemotherapy was assessed. Result: The complete remission rate was 86.05% in 43 patients,the partial remission rate was 6.98%, and the total effective rate was 93.02%.Chi-square analysis showed tumor diameter, clinical stage and ECOG points were significant independent factors impacting on complete remission rate(P =0.025, 0.042, 0.037).The 1-year and 3-year overall survival rate and progression-free survival rate of 43 patients were 95.35% and 83.7%, 93.02% and 79.07%, respectively. Coxproportional analysis showed that tumor diameter and Ann Arbor stage were signifcant factors affecting overall survival(P =0.016,0.025).Adverse reactions caused by the P-Gemox chemotherapy regimen are mild and more common in grades I to II. Conclusion: The P-Gemox regimen combined with radiotherapy may be a promising option in the treatment of newly-diagnosed ENKTL due to its high efficacy yet low toxicity, and clinical stage has an important effect on CR and OS.

[Effects of overexpression of Notch intracellular domain on proliferation and osteogenic differentiation of human periodontal ligament stem cells]

Objective: To investigate the effect of overexpression of Notch intracellular domain (NICD) on proliferation and osteogenic differentiation of human periodontal ligament stem cells (hPDLSC). Methods: The third generation hPDLSC with stable overexpressing of NICD were assigned as experimental group, normal hPDLSC were as negative control group and hPDLSC transfected with empty vector were as blank control group. The effect of overexpressing NICD on proliferation ability of hPDLSC was detected by using cell counting kit-8 (CCK-8). Alizarin Red staining and real-time quantitative PCR (qPCR) were used to detect the effects of NICD on cementum attachment proteins (CAP), osteocalcin (OCN), Runt-related transcription factor 2 (RUNX2) and Notch signal pathway receptor Notch1. The effect of overexpressing NICD on hPDLSC osteogenic protein RUNX2 and flag marker protein (used to label NICD) were detected by using Western blotting. Results: CCK-8 results showed that there were no significant differences in A values amongst the three groups for 1-2 days (P>0.05). The number of cells in the experimental group was significantly increase than that of the two control groups from the third to seventh days (A values were 0.203±0.016, 0.364±0.014, 0.449±0.020, 0.549±0.020 and 0.570±0.020, respectively) (P<0.05). Alizarin red staining showed that compared with the blank control group and negative control group, the mineralized nodules in the experimental group had smaller formation range and lighter color, and the differences were statistically significant (P<0.05). The expressions of CAP gene (0.751±0.058, 0.887±0.025), osteocalcin gene (0.592±0.051, 0.670±0.045) and RUNX2 gene (0.319±0.038, 0.684±0.055) at 14 and 21 days in the experimental group were significantly lower than those in the negative control group respectively (P<0.05). However, the expression levels of Notch1 gene at 14 and 21 days (2.507±0.047, 4.041±0.219) were significantly higher than those of negative and blank control groups (P<0.05). The results of Western blotting showed that the expressions of flag marker protein (0.167±0.007, 0.204±0.010) at 14 and 21 days in the experimental group were significantly higher than those in the negative and blank control groups (P<0.05). However, the expressions of RUNX2 protein (0.075±0.006, 0.074±0.013) at 14 and 21 days were significantly lower than that in the negative control group (0.092±0.003, 0.118±0.008) and blank control group (0.174±0.006, 0.212±0.008) (P<0.05). Conclusions: Overexpression of NICD can promote the proliferation capacity of hPDLSC and inhibit its osteogenic differentiation.

Research on the expression of MRNA-518b in the pathogenesis of placenta accreta

OBJECTIVE

To investigate the expression of micro ribonucleic acid miR-518b and its regulatory role in the pathogenesis of placenta accreta.

PATIENTS AND METHODS

A total of 50 parturient women in the Obstetric Department were collected and divided into observation group (placenta accreta, n=23) and control group (normal placenta, n=27). After the placental tissues were removed via surgery, the expressions of osteopontin (OPN) and vascular endothelial growth factor (VEGF) were detected using the immunohistochemical method. The relative expression levels of OPN and VEGF proteins were detected via Western blotting, and the relative expression levels of OPN messenger RNA (mRNA), VEGF mRNA and miR-518b were detected via quantitative polymerase chain reaction (qPCR). Moreover, the correlations of miR-518b with OPN mRNA and VEGF mRNA were studied via Pearson correlation analysis.

RESULTS

Compared with those in control group, the expressions of OPN and VEGF proteins in observation group were significantly increased, while the levels of OPN mRNA, VEGF mRNA and miR-518b in observation group were also significantly elevated (p<0.05). There were positive correlations between miR-518b and levels of OPN, VEGF mRNA.

CONCLUSIONS

The high expression of miR-518b may lead to the development of placenta accreta through upregulating the transcription and protein expression of downstream VEGF and OPN, providing insights for the future therapy against the pathogenesis of placenta accreta.

[Using peripheral perfusion index and venous-to-arterial CO(2) difference/arterial-central venous O(2) difference ratio to assess lactate clearance in septic patients after resuscitation]

Objective: The relationship of venous-to-arterial CO(2) difference(Pv-aCO(2))/arterial-central venous O(2) difference (Ca-vO(2)) ratio, peripheral perfusion index(PI) and lactate clearance(LC) were investigated during resuscitation in septic patients. And, the meaning of the combination PI and Pv-aCO(2)/Ca-vO(2) ratio to interpret incoherence of lactate clear was explored. Methods: The patients with sepsis were prospectively observed, who admitted to critically care medicine department of Peking Union Medical College Hospital. The hemodynamic parameters, simultaneous arterial and central venous blood gas analysis and PI were obtained at the enrollment (T0) and 8 hours (T8) during resuscitation. The lactate clearance was defined as 8h-LC≥10% and non-lactate clearance was defined as 8h-LC ≤ 10%. Additionally, the patients were divided as three sub-groups according to the PI value at T8: the normalized PI group with PI≥1.4,the mild impaired PI with 1.4<PI<0.6 and severe impaired PI with PI≤0.6. Results: A total of 84 patients were enrolled in this study. There was no significant difference in Pv-aCO(2)/Ca-vO(2) ratio in the three groups. However, the PI≤0.6 group had a significantly higher Pv-aCO(2) than other groups. Moreover, the patients with non-lactate clearance (13/32) had a higher Pv-aCO(2)/Ca-vO(2) ratio than the patients with lactate clearance in PI≥1.4 group (1.9±0.7 vs. 1.3±1.0, P=0.01). Multivariate analysis showed both Pv-aCO(2)/Ca-vO(2) ratio [Exp(B) 2.235, 95% CI 1.232-4.055, P=0.008] and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) [Exp (B) 1.087, 95%CI 1.022-1.156, P=0.008] were independent risk factor of non-lactate clearance. 8h-PI was significantly negative correlated with the 8 h Pv-aCO(2) gap (r=-0.311, P=0.004), but not significantly with Pv-aCO(2)/Ca-vO(2) ratio (r=-0.094, P=0.385). Conclusions: Both high Pv-aCO(2)/Ca-vO(2) ratio and low PI were related to non-lactate clearance after resuscitation in sepsis. Combined PI and Pv-aCO(2)/Ca-vO(2) ratio could interpret incoherence of latacte clearance after resuscitation.

MLCK-mediated intestinal permeability promotes immune activation and visceral hypersensitivity in PI-IBS mice

BACKGROUND

Alterations in intestinal permeability regulated by tight junctions (TJs) are associated with immune activation and visceral hypersensitivity in irritable bowel syndrome (IBS). Myosin light chain kinase (MLCK) is an important mediator of epithelial TJ. The aim of this study is to investigate the role of MLCK in the pathogenesis of IBS using a post infectious IBS (PI-IBS) mouse model.

METHODS

Trichinella spiralis-infected PI-IBS mouse model was used. Urine lactulose/mannitol ratio was measured to assess intestinal epithelial permeability. Western blotting was used to evaluate intestinal TJ protein (zonula occludens-1) and MLCK-associated protein expressions. Immune profile was assessed by measuring Th (T helper) 1/Th2 cytokine expression. Visceral sensitivity was determined by abdominal withdrawal reflex in response to colorectal distension.

RESULTS

Eight weeks after inoculation with T. spiralis, PI-IBS mice developed decreased pain and volume thresholds during colorectal distention, increased urine lactulose/mannitol ratio, elevated colonic Th1/Th2 cytokine ratio, and decreased zonula occludens-1 expression compared to the control mice. MLCK expression was dramatically elevated in the colonic mucosa of PI-IBS mice compared to the control mice, alongside increased pMLC/MLC and decreased MLCP expression. Administration of MLCK inhibitor and TJ blocker both reversed the increased intestinal permeability, visceral hypersensitivity, and Th1-dominant immune profile in PI-IBS mice.

CONCLUSION

MLCK is a pivotal step in inducing increased intestinal permeability promoting low-grade intestinal immune activation and visceral hypersensitivity in PI-IBS mice. MLCK inhibitor may provide a potential therapeutic option in the treatment of IBS.

[Characteristics of non-marital and non-commercial heterosexual transmission of HIV infection in Miao-Dong Autonomous prefecture of Qiandongnan]

Objective: The goal of this research was to understand the demographic distribution and related factors of non-marital and non-commercial heterosexual transmission (non-commercial transmission) for HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). Methods: Data related to HIV/AIDS infected by non-marital heterosexual transmission and whose present address was in Qian Dongnan, were collected from Information System on the HIV/AIDS Prevention and Control. Information included demographic characteristics, the members of non-marital sex partners, transmission path, detection source, CD4(+)T lymphocyte level, et al. cases belong to homosexual history, injective drug use or non-classified non-marital heterosexuality transmission were excluded, totally collect HIV/AIDS 919 cases. Multivariate logistic regressions were used to analyze potential factors associated with non-marital and non-commercial heterosexual transmission. In addition, in March and June 2017, using a convenience sampling, we conducted one-to-one interviews among 10 HIV/AIDS who were infected by non-marital heterosexuality and had non-marital and non-commercial heterosexual experience in Kaili Center for Disease Control and Prevention. The content of the interview included basic information, sexual orientation, the main place of making friends and sexual behavior, attitude to commercial heterosexuality and non-martial and non-commercial heterosexuality and so on. Results: Out of the 919 cases, 645 (70.2%) were male, the proportion of non-commercial transmission was 55.06% (506). The proportion of female HIV/AIDS with non-commercial transmission was 84.7% (232), which was higher than male (42.5%(274)) (χ(2)=138.35, P<0.001). The proportion of Han HIV/AIDS with non-commercial transmission was 61.5% (275), which was higher than other religion (52.2%(412)) (χ(2)=6.32, P=0.012). The proportion of HIV/AIDS with non-commercial transmission who had 0-5 non-marital sexual partners was 58.8% (498), which was higher than who had>5 non-marital sexual partners (11.1%(8)) (χ(2)=61.10, P<0.001). The proportion of HIV/AIDS with non-commercial transmission who lived mobile was 72.9% (94), which was higher than who lived fixedly (52.2%(412)) (χ(2)=19.34, P<0.001). Qualitative interviews results revealed that the age of the respondents were 22-69. Respondents whose ages are in 22-34 were more likely to use mobile phone (4/10) and respondents whose ages are in 35-69 were less likely to look partners through party and the context of working. Conclusion: The proportion of cases being infected by non-marital and non-commercial heterosexual transmission in Qian dongnan was higher than general national levels. The characteristics of sex, marriage status, migration, vocation, the members of non-marital sex partners were significant differed between commercial heterosexual transmission and non-marital and non-commercial heterosexual transmission.

Use of D-dimer in oral anticoagulation therapy

Individualized anticoagulation management and improvement of the safety and effectiveness of oral anticoagulant have always been the focus of clinicians' attention. D-dimer, a sensitive marker of thrombosis and coagulation activation, is not only traditionally used in the diagnosis of venous thromboembolism, acute aortic dissection, and disseminated intravascular coagulation but can also be used as a helpful marker in the management of oral anticoagulant, including evaluating the anticoagulation quality, predicting clinical outcomes, and determining the optimal duration and intensity of anticoagulation.

Prevalence and natural course of occult hepatitis B virus infection in residents of 2 communities of Wuwei City, Gansu Province, China

Occult hepatitis B infection (OBI) is characterized by serum hepatitis B surface antigen (HBsAg) negative and hepatitis B virus (HBV) DNA positive (HBsAg-/HBV DNA+). Occult hepatitis B infection in community-based populations has been scarcely investigated, and OBI outcomes remain unclear, especially in Wuwei, a region located in Northwest China. This region is one of the areas in China that has the highest prevalence of chronic HBV infection. A prospective study was performed in the general population of 2 towns of Wuwei from June 2011 to May 2014. A questionnaire was used to collect demographic and medical data, and serum samples were collected from the participants and stored until analysis. DNA was detected using quantitative PCR (qPCR) or nested PCR, the HBV DNA from HBV DNA-positive or possible positive (below the detection limit) subjects was extracted and amplified by nested PCR, and the PCR products were sequenced. Sequence analysis was performed using the Mega 6.0 program and CLC sequence viewer software. Hepatitis B virus DNA was detected in 90 of 3,080 HBsAg-negative subjects, and the prevalence of OBI in the study population was 2.92% (90/3,080, 95% CI: 2.33%-3.51%). Hepatitis B virus genomes in 51 of 80 objects (63.75%) contained mutations in the "a" determinant of HBsAg. After 2 years follow-up, 42 of 90 HBV DNA of OBI subjects remained positive, and the natural clearance rate of OBI subjects was 53.3%. Occult hepatitis B infection prevalence in this cohort was much lower than chronic HBV infection in the same region. HBV DNA was cleared in most OBI subjects during the 2 year period. Our data suggest that some OBI may represent a late stage of resolving the HBV infection process.

[Experts consensus on the management of the right heart function in critically ill patients]

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

D-dimer to guide the intensity of anticoagulation in Chinese patients after mechanical heart valve replacement: a randomized controlled trial

Essentials Low anticoagulation intensity reduces bleeding but increases thrombosis during warfarin therapy. Elevated D-dimer level is associated with increased thrombosis events. D-dimer can be used to find potential thrombosis in those receiving low intensity therapy. D-dimer-guided therapy may be the optimal strategy for those with mechanical heart valve replacement.

SUMMARY

Background Controversies remain regarding the optimal anticoagulation intensity for Chinese patients after mechanical heart valve replacement despite guidelines having recommended a standard anticoagulation intensity. Objectives To investigate whether D-dimer could be used to determine the optimal anticoagulation intensity in Chinese patients after mechanical heart valve replacement. Patients/Methods This was a prospective, randomized controlled clinical study. A total of 748 patients following mechanical heart valve replacement in Wuhan Asia Heart Hospital were randomized to three groups at a ratio of 1 : 1 : 1. Patients in two control groups received warfarin therapy based on constant standard intensity (international normalized ratio [INR], 2.5-3.5; n = 250) and low intensity (INR, 1.8-2.6; n = 248), respectively. In the experimental group (n = 250), warfarin therapy was initiated at low intensity, then those with elevated D-dimer levels were adjusted to standard intensity. All patients were followed-up for 24 months until the occurrence of endpoints, including bleeding events, thrombotic events and all-cause mortality. Results A total of 718 patients were included in the analysis. Fifty-three events occurred during follow-up. There was less hemorrhage (3/240 vs. 16/241; hazard ratio [HR], 0.18; 95% confidence interval [CI], 0.07-0.45) and all-cause mortality (4/240 vs. 12/241; HR, 0.33; 95% CI, 0.12-0.87) observed in the D-dimer-guided group than in the standard-intensity group. A lower incidence of thrombotic events was also observed in the D-dimer-guided group when compared with the low-intensity group (5/240 vs. 14/237; HR, 0.35; 95% CI, 0.14-0.85). Overall, the total events were less in the D-dimer-guided group (9/240) when compared with the other two control groups (24/241, 20/237; HR, 0.37, 0.44; 95% CI, 0.19-0.72, 0.21-0.90 Conclusions The D-dimer-guided adjustment of anticoagulation intensity could reduce adverse events in Chinese patients after mechanical heart valve replacement.

TRIAL REGISTRY

NCT01996657; ClinicalTrials.gov.