Arthroscopy versus arthrocentesis and versus conservative treatments for temporomandibular joint disorders: a systematic review with meta-analysis and trial sequential analysis

The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.

[Prognostic significance of textbook outcome in advanced gastric patients who underwent neoadjuvant chemotherapy followed by surgical resection]

Objective: To investigate the risk factors and prognostic value of the textbook outcome (TO) in patients with advanced gastric cancer (AGC) who underwent neoadjuvant chemotherapy followed by surgical resection. Methods: This is a retrospective cohort study. A total of 253 patients with AGC who underwent neoadjuvant chemotherapy combined with gastrectomy and D2 lymphadenectomy in the Department of Gastric Surgery, Fujian Medical University Union Hospital from January 2010 to December 2019 were retrospectively included. There were 195 males and 58 females, aged (60.3±10.0) years (range: 27 to 75 years). The patients were then divided into the TO group (n=168) and the non-TO group (n=85). Multivariate Logistic regression was used to analyze the independent predictors of TO. Univariate and multivariate Cox analysis were used to analyze independent prognosis factors for overall survival (OS) and disease-free survival (DFS). Propensity score matching was performed to balance the TO and non-TO groups, and the Kaplan-Meier method was used to calculate survival rates and draw survival curves. Results: Among the 253 patients, 168 patients (66.4%) achieved TO. The Eastern Cooperative Oncology Group score (OR=0.488, 95%CI: 0.278 to 0.856, P=0.012) and ypN stage (OR=0.626, 95%CI:0.488 to 0.805, P<0.01) were independently predictive of TO. Multivariate analysis revealed that TO was an independent risk factor for both OS (HR=0.662, 95%CI: 0.457 to 0.959,P=0.029) and DFS (HR=0.687, 95%CI: 0.483 to 0.976, P=0.036). After matching, the 5-year OS rate (42.2% vs. 27.8%) and the 5-year DFS rate (37.5% vs. 27.8%) were significantly higher in the TO group than in the non-TO group (both P<0.05). Furthermore, patients in the non-TO group benefited significantly from postoperative chemotherapy (both P<0.05), but those in the TO group did not (both P>0.05). Conclusion: TO is an independent prognosis factor in patients undergoing neoadjuvant chemotherapy and surgery for AGC and is associated with postoperative chemotherapy benefits.

[Minimally invasive treatments and open joint surgery for disorders of the temporomandibular joint]

The initial treatment of symptomatic disorders of the temporomandibular joint typically consists of a conservative approach, in which medication (painkillers and muscle relaxants), orofacial physiotherapy and splints are most important. In most cases, minimally invasive treatment options, such as arthrocentesis, arthroscopy or joint injections, are only considered when conservative methods provide insufficient symptom reduction. There is, however, an ongoing debate about the optimal treatment strategy due to an increasing body of evidence concerning the superior effectiveness in symptom reduction of minimally invasive treatment options with regard to conservative treatments. If these minimally invasive treatment options are also ineffective, open joint surgery may be considered as a last option for a select group of patients.

[A successfully treated case of respiratory failure caused by eating Nassariidaes]

Food poisoning caused by Nassariidaes has occurred frequently in coastal areas of China, especially in summer and autumn. Nassariidaes poisoning can be manifested as lip and tongue paralysis, dizziness, headache, nausea and vomiting, arrhythmia and even respiratory failure. We admitted a case of respiratory failure caused by eating Nassariidaes. After timely respiratory support, hemoperfusion and other active treatment, the patient was recovered and was discharged. This paper summarized clinical characteristics and treatment of Nassariidaes poisoning, in order to provide reference for clinical diagnosis and treatment of similar cases.

[Predictive value of serum lactate dehydrogenase on prognosis of patients with paraquat poisoning]

Objective: To investigate the predictive value of serum lactate dehydrogenase (LDH) in the prognosis of patients with paraquat (PQ) poisoning, and to provide evidence for early prognosis assessment. Methods: In February 2022, 50 patients with PQ poisoning who completed serum LDH detection admitted to the Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University from January 2012 to December 2021 were selected as the observation group, and 50 healthy physical examination personnel were randomly selected as the control group. Patients with PQ poisoning were divided into survival group and death group according to the prognosis, and the differences of blood routine routine, liver and kidney function and other indicators in the first admission between the two groups were compared. Multivariate logisitic regression model was established, ROC curve was drawn, and the influencing factors of prognosis of patients with PQ poisoning were analyzed. Results: Compared with the control group, the white blood cell count (WBC), total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), LDH, glucose (GLU) and creatinine (Cr) in observation group were significantly increased, while albumin (ALB) and total cholesterol (TC) were significantly decreased (P<0.05). Univariate analysis showed that WBC, elevated LDH (>247 U/L), TBil, ALT, AST and Cr were significantly different between PQ poisoning survival group and death group (P<0.05). Multivariate logisitic regression analysis showed that elevated serum LDH was an independent risk factor for the prognosis of PQ poisoning patients (OR=9.95, 95%CI: 1.34-73.82, P=0.025). The area under the ROC curve of LDH was 0.811 (95%CI: 0.692-0.930). When the cut-off value was 340 U/L, the sensitivity was 0.889 and the specificity was 0.719. Log-rank test showed that there was a statistically significant difference in survival rate between the normal LDH group and the elevated LDH group (P=0.001) . Conclusion: Serum LDH has a good predictive value in evaluating the prognosis of patients with PQ poisoning. Elevated LDH is a risk factor for poor prognosis of patients with PQ poisoning.

[Study on HBV-related acute-on-chronic liver failure risk factors and novel predictive survival model]

Objective: To identify the predisposing factors, clinical characteristics, and risk factors of disease progression to establish a novel predictive survival model and evaluate its application value for hepatitis B virus-related acute-on-chronic liver failure. Methods: 153 cases of HBV-ACLF were selected according to the guidelines for the diagnosis and treatment of liver failure (2018 edition) of the Chinese Medical Association Hepatology Branch. Predisposing factors, the basic liver disease stage, therapeutic drugs, clinical characteristics, and factors affecting survival status were analyzed. Cox proportional hazards regression analysis was used to screen prognostic factors and establish a novel predictive survival model. The receiver operating characteristic curve (ROC) was used to evaluate predictive value with the Model for End-Stage Liver Disease (MELD) and the Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure score (CLIF-C ACLF). Results: 80.39% (123/153) based on hepatitis B cirrhosis had developed ACLF. HBV-ACLF's main inducing factors were the discontinuation of nucleos(t)ide analogues (NAs) and the application of hepatotoxic drugs, including Chinese patent medicine/Chinese herbal medicine, non-steroidal anti-inflammatory drugs, anti-tuberculosis drugs, central nervous system drugs, anti-tumor drugs, etc. 34.64% of cases had an unknown inducement. The most common clinical symptoms at onset were progressive jaundice, poor appetite, and fatigue. The short-term mortality rate was significantly higher in patients complicated with hepatic encephalopathy, upper gastrointestinal hemorrhage, hepatorenal syndrome, and infection (P < 0.05). Lactate dehydrogenase, albumin, the international normalized ratio, the neutrophil-to-lymphocyte ratio, hepatic encephalopathy, and upper gastrointestinal bleeding were the independent predictors for the survival status of patients. The LAINeu model was established. The area under the curve for evaluating the survival of HBV-ACLF was 0.886, which was significantly higher than the MELD and CLIF-C ACLF scores (P < 0.05), and the prognosis was worse when the LAINeu score ≥ -3.75. Conclusion: Discontinuation of NAs and the application of hepatotoxic drugs are common predisposing factors for HBV-ACLF. Hepatic decompensation-related complications and infection accelerate the disease's progression. The LAINeu model can predict patient survival conditions more accurately.

Elevated histone demethylase KDM5C increases recurrent miscarriage risk by preventing trophoblast proliferation and invasion

KDM5C is a histone H3K4-specific demethylase, which has been shown to play a key role in biological disease and development. However, the role of KDM5C in trophoblasts at early pregnancy is currently unknown. Here, we showed that KDM5C was upregulated in placental trophoblasts from recurrent miscarriage (RM) patients compared with healthy controls (HCs). Trophoblast proliferation and invasion was inhibited by KDM5C overexpression and was promoted by KDM5C knockdown. Transcriptome sequencing revealed that elevated KDM5C exerted anti-proliferation and anti-invasion effects by repressing the expression of essential regulatory genes. The combination analysis of RNA-seq, ChIP-seq and CUT&Tag assay showed that KDM5C overexpression leads to the reduction of H3K4me3 on the promoters and the corresponding downregulation of expression of several regulatory genes in trophoblasts. Among these genes, TGFβ2 and RAGE are essential for the proliferation and invasion of trophoblasts. Importantly, overexpression of KDM5C by a systemically delivered KDM5C adenovirus vector (Ad-KDM5C) promoted embryo resorption rate in mouse. Our results support that KDM5C is an important regulator of the trophoblast function during early pregnancy, and suggesting that KDM5C activity could be responsible for epigenetic alterations seen RM disease.

Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up

Arthrocentesis for arthralgia of the temporomandibular joint (TMJ) is often only indicated when conservative, non-surgical interventions have failed. However, performing arthrocentesis as initial therapy may facilitate earlier and better recuperation of the joint. The aim of this study was to assess the efficacy of this therapy with a long-term follow-up. Eighty-four patients were randomly allocated to receive either arthrocentesis as initial treatment (n = 41) or non-surgical intervention (n = 43). Pain (100-mm visual analogue scale, VAS) and mandibular function impairment questionnaire scores (MFIQ, 0-100) were recorded at 3, 12, and 26 weeks, and ≥ 5 years (median 6.2, interquartile range 5.6-7.4 years). Univariable analyses were performed and linear mixed-effect models were constructed. Patients in the arthrocentesis group experienced significantly lower TMJ arthralgia compared to those treated non-surgically (pain during movement: -10.23 mm (95% confidence interval -17.86; -2.60); pain at rest: - 8.39 mm (95% confidence interval -13.70; -3.08)), while mandibular function remained similar in the two groups (MFIQ -2.41 (95% confidence interval -8.61; 3.78)). Of the final sample, 10 patients (10/39, 26%) in the non-surgical intervention group and two patients (2/34, 6%) in the arthrocentesis group received additional treatment during follow-up. Thus, initial treatment with arthrocentesis reduced TMJ arthralgia more efficaciously than non-surgical intervention in the long term, while maintaining similar mandibular function.

[Phacoemulsification combined with goniosynechialysis under a gonioscope in the treatment of angle-closure glaucoma: the effect of reopening the synechial anterior chamber angle]

A total of 170 consecutive patients (181 eyes) who were diagnosed with primary angle-closure glaucoma (PACG) and underwent phacoemulsification and intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) with an instrument under a gonioscope in the Eye Hospital, Wenzhou Medical University from January 1, 2017 to December 31, 2019 were observed. Anterior chamber angle synechiae of 0 (0, 2) clock hour were released after PEI, while after combined goniosynechialysis, synechiae of 6 (3, 8) clock hours were further released. No matter in chronic PACG and acute PACG with cornea edema, the extent of anterior chamber angle synechiae was different before surgery and after PEI, and so was it in post-PEI and PEI-GSL prospectively (all P<0.01). Phacoemulsification alone can reopen the synechial anterior chamber angle in both chronic PACG and acute PACG in part, but not sufficiently. Combined goniosynechialysis under a gonioscope with an instrument is essential and effective.

[Predictive value of the product of plasma colchicine concentration and poisoning time for the prognosis of colchicine poisoning patients]

Objective: To investigate the predictive value of the product of first plasmacolchicine concentration and poisoning time for the prognosis of colchicine poisoning patients, and to provide a basis for early prognosis assessment. Methods: October 2021, patients with colchicine poisoning admitted in the First Affiliated Hospitol of Wenzhou Medical University from January 2017 to September 2021 were collected, including general information such as patient gender, age, oral colchicine dose, poisoning time, the first laboratory test index andplasma colchicine concentration after admission. The patients were divided into survival group and death group according to their prognosis. The differences in clinical indicators such as admission plasma colchicine concentration, blood routine, blood biochemistry, coagulation function, and blood gas analysis were compared between the two groups, and their predictive value for the prognosis of patients were analyzed. Results: A total of 23 patients with colchicine poisoning, aged 20-85 years, were included in this study, of which 15 cases (65.22%) survived and 8 cases (34.78%) died. The first plasma colchicine concentration at admision were 0.42-53.61 ng/ml. The plasma colchicine concentration and the concentration-time product were 10.08-2147.04 h·ng/ml.Compared with the survival group, the plasma colchicine concentration and the concentration-time product in the death group were significantly increased, and the differences were statistically significant (P<0.05). Univariate logistic regression analysis showed that first plasma concentration and poisoning time>132.48 h·ng/ml, high C-reactive protein, high D-dimer, high absolute value of BE were the risk factors for the prognosis of patients with colchicine poisoning (OR=12.000, 95%CI: 1.1181-128.836; OR=1.053, 95%CI: 1.009-1.098; OR=1.219, 95%CI: 1.039-1.429; OR=1.360, 95%CI: 1.1.044-1.773; P<0.05). High prothrombin time activity was protective factor affecting the prognosis of colchicine poisoning patients (OR=0.941, 95%CI: 0.892~0.993; P<0.05). ROC curve analysis showed that the areas under the curves of first plasma concentration and poisoning time, C-reactive protein, absolute value of BE, D-dimer for predicting the prognosis of patients with colchicine poisoning were 0.918, 0.888, 0.867, 0.837, respectively, and the areas under the curves of prothrombin time activityfor predicting the prognosis of patients with colchicine poisoning was 0.788 (P<0.05) . Conclusion: The product of the first plasma colchicine concentration at admission and poisoning time is closely related to the prognosis of patients with colchicine poisoning, it can be used as a predictor for early evaluation of the prognosis of poisoned patients.

[Predictive values of serum 8-hydroxydeoxyguanosine on disease progression and prognosis of patients with sepsis]

Objective: To investigate the values of serum 8-hydroxydeoxyguanosine (8-OHdG) in predicting disease progression and prognosis of patients with sepsis. Methods: The prospective observational research methods were used. A total of 124 patients with sepsis who met the inclusion criteria were admitted to the Department of Emergency of the First Affiliated Hospital of Wenzhou Medical University from April 2015 to July 2016, including 79 males and 45 females, aged (62±15) years. The sepsis-related organ failure assessment (SOFA) scores of all patients on admission and on the second day of admission and their difference (ΔSOFA) were calculated. The patients were divided into non-progression group with ΔSOFA score <2 (n=101) and progression group with ΔSOFA score ≥2 (n=23), and according to the survival during hospitalization, the patients were divided into survival group (n=85) and death group (n=39). Data of patients between non-progression group and progression group, survival group and death group were compared, including the gender, age, days in emergency intensive care unit (ICU), smoking, hypertension, diabetes mellitus, serum white blood cell count, serum C-reactive protein, and serum procalcitonin on admission, and serum 8-OHdG within 24 h of admission. The multivariate logistic regression analysis was used to screen the independent risk factors of disease progression and death during hospitalization in 124 patients with sepsis, the receiver's operating characteristic (ROC) curves were drawn according to the independent risk factors, and the area under the curve (AUC), the best threshold, and the sensitivity and specificity under the best threshold were calculated. The patients were divided into high 8-OHdG group (n=35) and low 8-OHdG group (n=89) according to the best threshold in ROC curve of death during hospitalization. The data including the gender, age, SOFA score on admission, SOFA score on the second day of admission, and ΔSOFA score of patients in the two groups were compared. The survival rates of patients within 90 d of admission in the two groups were compared by the Kaplan-Meier method. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, chi-square test, and Log-rank test. Results: The gender, age, days in emergency ICU, smoking, complicated with hypertension, complicated with diabetes mellitus, serum white blood cell count, serum C-reactive protein, and serum procalcitonin on admission of patients in non-progression group and progression group were similar (P>0.05). The serum 8-OHdG within 24 h of admission of patients in progression group was significantly higher than that in non-progression group (Z=-2.31, P<0.05). Multivariate logistic regression analysis showed that the serum 8-OHdG within 24 h of admission was the independent risk factor for disease progression of 124 patients with sepsis (odds ratio=1.06, with 95% confidence interval of 1.01-1.11, P<0.05). The AUC under the ROC curve of serum 8-OHdG within 24 h of admission to predict disease progression of 124 patients with sepsis was 0.65 (with 95% confidence interval of 0.52-0.79, P<0.05), the optimal threshold was 32.88 ng/mL, and the sensitivity and specificity under the optimal threshold was 52.2% and 79.2%, respectively. The gender, age, days in emergency ICU, smoking, complicated with hypertension, complicated with diabetes mellitus, and serum white blood cell count, serum C-reactive protein, and serum procalcitonin on admission of patients in survival group and death group were similar (P>0.05). The serum 8-OHdG within 24 h of admission of patients in death group was significantly higher than that in survival group (Z=-2.37, P<0.05). Multivariate logistic regression analysis showed that the serum 8-OHdG within 24 h of admission was the independent risk factor for death of 124 patients with sepsis (odd ratio=1.04, with 95% confidence interval of 1.00-1.09, P<0.05). The AUC under the ROC curve of serum 8-OHdG within 24 h of admission to predict death of patients during hospitalization was 0.63 (with 95% confidence interval of 0.52-0.75, P<0.05), the optimal threshold was 32.43 ng/mL, the sensitivity and specificity under the optimal threshold was 51.3% and 84.7%, respectively. The gender and age of patients in high 8-OHdG group and low 8-OHdG group were similar (P>0.05). The SOFA score on admission, SOFA score on the second day of admission, and ΔSOFA score of patients in high 8-OHdG group were significantly higher than those in low 8-OHdG group (with Z values of -2.49, -3.01, and -2.64, respectively, P<0.05 or P<0.01). The survival rate within 90 d of admission of patients in low 8-OHdG group was significantly higher than that in high 8-OHdG group (χ2=14.57, P<0.01). Conclusions: Serum 8-OHdG level is an independent risk factor for disease progression and death in sepsis patients with limited ability for predicting disease progression and prognosis of sepsis of patients. The patients with higher serum 8-OHdG level have higher death risk within 90 d of admission.

[Study on plasma Golgi protein 73 and related models in the diagnosis of nonalcoholic fatty liver disease]

Objective: To investigate the relationship between plasma Golgi protein 73 (GP73) levels and the occurrence and development of non-alcoholic fatty liver disease (NAFLD), and to establish a diagnostic model based on this combination with lipid metabolism indicators to clarify its diagnostic efficacy and clinical application value for NAFLD. Methods: 225 cases with NAFLD [diagnosed by ultrasound, transient elastography (FibroScan502) and liver biopsy (some patients)] and 108 healthy controls were selected from the Department of Hepatology and Physical Examination Center of Integrated Traditional Chinese and Western Medicine, The Third Hospital of Hebei Medical University. Clinical data, routine peripheral blood and serum biochemical test results were collected. The plasma GP73 level was detected by enzyme-linked immunosorbent assay. SPSS 21.0 statistical software was used for statistical analysis. Binary logistic regression model was used to calculate the NAFLD diagnostic model. Receiver operating characteristic curve was used to evaluate the NAFLD constructed model diagnostic efficacy. Results: NAFLD incidence was significantly reduced in younger age group, mostly in young and middle-aged male. However, the NAFLD incidence was increased with increasing age in female. The analysis of age ratio composition showed that the average age for NAFLD onset was 20 ~ 50 years old, and the incidence rate was as high as 47% in among 30 ~ 39 years old, but the incidence rate was significantly decreased in over 60 years old (4.00%). GP73 was an independent risk factor for the occurrence and development of NAFLD. The diagnostic models of GBT, GB and GT were established by GP73 (G) combined with body mass index (BMI, B) and serum triglyceride (TG, T), and the results showed that the areas under the curves of GBT, GB and GT models were 0.969, 0.937 and 0.909, respectively. The sensitivity and the specificity were 84.90%, 77.80% and 84.00%, and 95.40%, 95.40% and 82.40%, respectively, P < 0.05. The GBT model had efficacy of best diagnostic performance. Conclusion: NAFLD is more common in young and middle-aged male, but with advanced age, the incidence of female patients gradually increases. Plasma GP73 levels are related to the occurrence and development of NAFLD. The GBT model can be used as a new model for non-invasive diagnosis and one of the indicators for clinical evaluation of diagnostic efficacy of NAFLD.

Single-Cell Characterization of Malignant Phenotypes and Developmental Trajectories of Adrenal Neuroblastoma

Neuroblastoma (NB), which is a subtype of neural-crest-derived malignancy, is the most common extracranial solid tumor occurring in childhood. Despite extensive research, the underlying developmental origin of NB remains unclear. Using single-cell RNA sequencing, we generate transcriptomes of adrenal NB from 160,910 cells of 16 patients and transcriptomes of putative developmental cells of origin of NB from 12,103 cells of early human embryos and fetal adrenal glands at relatively late development stages. We find that most adrenal NB tumor cells transcriptionally mirror noradrenergic chromaffin cells. Malignant states also recapitulate the proliferation/differentiation status of chromaffin cells in the process of normal development. Our findings provide insight into developmental trajectories and cellular states underlying human initiation and progression of NB.

Deflection of a reflected intense circularly polarized light beam induced by asymmetric radiation pressure

A deflection effect of an intense laser beam with spin angular momentum is revealed theoretically by an analytical modeling using radiation pressure and momentum balance of laser plasma interaction in the relativistic regime as a deviation from the law of reflection. The reflected beam deflects out of the plane of incidence with a deflection angle up to several milliradians, when a nonlinear polarized laser, with the intensity I_{0}∼10^{19}W/cm^{2} and duration around tens of femtoseconds, is obliquely incident and reflected by an overdense plasma target. This effect originates from the asymmetric radiation pressure caused by spin angular momentum of the laser photons. The dependence of the deflection angle of a Gaussian-type laser on the parameters of laser pulse and plasma foil is theoretically derived, which is also confirmed by three-dimensional particle-in-cell simulations of circularly polarized laser beams with the different intensity and pulse duration.

Improving Electrochromic Cycle Life of Prussian Blue by Acid Addition to the Electrolyte

In this study, we examined the cyclic stability of Prussian blue (PB) films in electrolytes with acid. The cyclic stabilities of the PB films were investigated in K⁺ based electrolytes with different values of solution pH. The acidified KCl solution can significantly improve the durability of the film. Among the three pH values tested, the KCl solutions (pH = 2.15 and pH = 3.03) showed better performance. Furthermore, we investigated the cyclic stabilities of the PB films in LiClO₄/PC electrolyte containing different acids. We found that the cyclic stability of PB film was significantly improved when a small amount of acetic acid was dissolved in LiClO₄/PC electrolyte. The PB film exhibited stable optical modulation after up to 20,000 cycles in LiClO₄/PC electrolyte containing acetic acid—a much higher result than those of some literatures. This suggests that the addition of acetic acid to LiClO₄/PC electrolyte can promote the development of PB-based devices with improved stability.

[Effect of α7nAChR mediated cholinergic anti-inflammatory pathway on inhibition of atrial fibrillation by low-level vagus nerve stimulation]

Objective: To investigate the effect of α7nAChR mediated cholinergic anti-inflammatory pathway on inhibition of atrial fibrillation by low-level vagus nerve stimulation(LL-VNS). Methods: Eighteen beagles were randomized into control group (n=6), LL-VNS group (n=6) and methyllycaconitine (MLA) + LL-VNS group (n=6). All the beagles were subjected to rapid atrial pacing at 800 beats/min for 6 hours.And the effective refractory period (ERP) of atriums and pulmonary veins and induced atrial fibrillation (AF) were measured hourly during non-pacing.After cessation of pacing for 3 hours, the beagles in control group were injected with saline into four ganglionated plexis (GPs), the beagles in LL-VNS group were given LL-VNS and saline injected into four GPs, and the beagles in MLA+ LL-VNS group were injected with MLA into four GPs combined with LL-VNS.And the levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and acetylcholine (ACh) in the plasma at baseline condition, 3 h and 6 h were measured.At the end of this experiment, atrial tissues were collected to examine the levels of TNF-α, IL-6, ACh, NF-κBp65 and STAT3 proteins. Results: During the right atrium pacing for the first 3 hours, the ERPs were gradually decreased while AF inducibility were gradually increased in all groups. At the end of this experiment, compared with the control group and MLA+ LL-VNS group, the ERPs in LL-VNS group were increased, and the induced times and duration of AF were significantly decreased. The levels of TNF-α and IL-6 in plasma were all significantly decreased in LL-VNS group and MLA+ LL-VNS group when compared with the control group(pg/ml) [IL-6: (101±6) vs (119±7), P<0.05; (102±5) vs (119±7), P<0.05; TNF-α: (17.8±1.7) vs (22.1±2.0), P<0.05; (17.9±2.2) vs (22.1±2.0), P<0.05]. And the levels of ACh were higher than in the control group(μg/ml)[(151±13) vs (123±10), P<0.05; (145±5) vs (123±10), P<0.05]. After cessation of pacing for 6 hours, compared with the control groupand MLA+ LL-VNS group, the tissue levels of TNF-α and IL-6 were significantly decreased in LL-VNS group (P<0.05). The concentrations of NF-κBp65 proteins in atrial tissues were lower in the LL-VNS group (P<0.05), and the levels of STAT3 proteins in those tissues were higher in the LL-VNS group than in thein the two other groups (P<0.05). Conclusion: LL-VNS could inhibit the atrial electrical remodeling and atrial fibrillation induction; cholinergic anti-inflammatory pathway mediated by α7nAChR may be the important mechanism in vagal nerve regulated AF.

[Relationship between FGF23/FGFR4 expression in atrial tissue and atrial fibrosis in patients with atrial fibrillation]

Objective: To observe the expression of fibroblast growth factor 23 (FGF23) and FGFR4 in patients with atrial fibrillation (AF) and its relationship with atrial fibrosis. Methods: Fifty-one patients with rheumatic heart disease undergoing cardiac surgery at the Second Affiliated Hospital of Nanchang University from October 2016 to April 2017 were divided into two groups according to whether they were complicated with atrial fibrillation: 39 patients with persistent AF(AF group), and 12 patients with sinus rhythm (SR group). The right atrial appendage was cut out during cardiac surgery. The expression of FGF23 and FGFR4 mRNA was detected by quantitative real-time PCR. The expression of FGFR4 protein was detected by Western blot. Atrial structure was evaluated by echocardiography. Masson staining was used to evaluate the degree of atrial fibrosis. The expression of FGF23 and FGFR4 was compared between the two groups.Additionally, the relationship between FGF23 and FGFR4 expression and atrial fibrosis was evaluated. Results: AF group had significantly higher right and left atrial diameter than SR group((40.1±1.6 )mm vs (34.1±1.5)mm, (52.4±2.9)mm vs (41.3±2.4)mm, all P<0.05) . There were no statistically significant differences in age, gender, ejection fraction between the two groups. The expression of FGF23 and FGFR4 mRNA in AF group were significantly higher than those in SR group (1.93±0.32 vs 0.93±0.14, 1.89±0.17 vs 0.91±0.11, both P<0.05). Compared with the SR group, the protein expression of FGFR4 in the AF group was significantly higher(1.76±0.21 vs 0.84±0.12). In AF group, there was no correlation between FGF23 mRNA and atrial diameter (r=0.274 (left atrial), r=0.238 (right atrium), both P>0.05). Meanwhile, FGFR4 mRNA and protein expression had no correlation with atrial diameter either. There was positive correlation between FGF23 mRNA and atrial collagen volume fraction in AF group (r=0.42, P<0.05). The expression of FGFR4 mRNA and protein were positively correlated with the atrial collagen volume fraction (r=0.573, r=0.478, all P<0.05). Conclusion: The expression of FGF23 and FGFR4 in atrial fibrillation patients is increased, which is positively correlated with atrial fibrosis, suggesting that FGF23/FGFR4 pathway may play an important role in atrial fibrillation by promoting atrial fibrosis.

Comparison of Clinical Prediction Rules for Termination of Resuscitation of Out-of-Hospital Cardiac Arrests on Arrival to Emergency Department

Objective

To compare the discriminative capacities of various termination of resuscitation (TOR) rules in the prediction of futile resuscitation in the emergency department (ED).

Design

Prospective cohort study.

Setting

2 public hospitals in a cluster in Hong Kong.

Methods

The data were obtained from a Cardiac Arrest Registry of the EDs of two hospitals, including consecutive adult patients suffering from non-traumatic out-of-hospital cardiac arrest from 1st August 2010 to 30th June 2012. Those with return of spontaneous circulation before ED arrival and cases without resuscitation in the EDs were excluded. The modified basic life support (BLS), modified advanced life support (ALS) and neurologic TOR rules were applied to the cohort. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated. The outcome measures were survival to hospital admission (STA) and survival to discharge (STD).

Results

Totally 1125 cases were included. The mean age was 72.4. Return of spontaneous circulation and STA occurred in 302 patients and 9 had STD. Regarding the outcome of STD, the modified ALS and neurologic TOR rules had outperformed the modified BLS rule. The specificity and PPV were 100% for both rules in predicting death when the rules suggested TOR. Regarding the outcome of STA, the neurologic TOR rule had the highest specificity [84.4%; 95% confident interval (CI): 79.7-88.2%] and PPV (84.5%; 95% CI: 79.8-88.3%).

Conclusions

The modified ALS and neurologic TOR rules have similar discriminative capacities to predict STD. The neurologic TOR rule has the highest ability to predict STA in the ED. (Hong Kong j.emerg.med. 2013;20:343-351)

Outcome and Prognostic Factors of Patients in Out-Of-Hospital Cardiac Arrests Presenting with Non-Shockable Rhythm in Hong Kong

Objective

To obtain the recent local epidemiological data and evaluate factors associated with outcomes of adult patients in non-traumatic non-shockable out-of-hospital-cardiac-arrest (OHCA) in Hong Kong.

Methods

It was a cross-sectional study lasting for nine months (from July 2009 to March 2010) in two emergency departments (ED) which served a population of 1.1 million. All non-traumatic OHCA patients aged equal or greater than 18 years presented with non-shockable cardiac rhythms to ED without postmortem changes were included. The pre-hospital factors, managements and outcomes were recorded in a standardised data entry form at the time of patient consultation. Logistic regression was used to evaluate the relationship between survival to admission (STA) and various prognostic factors.

Results

A total of 348 patients fulfilled the inclusion criteria. The mean age was 75.9 years old. Overall, there were 61 patients (17.5%) with restoration of spontaneous circulation and 58 patients (16.7%) had STA. The survival to hospital discharge (STD) rate was 0.86% (3 patients). Factors independently associated with better prognosis in terms of STA were initial pulseless electrical activity arrest (PEA) rhythm in ED (OR=4.72, 95% CI 2.30-9.69), witnessed arrest (OR=8.00, 95% CI 3.38-18.96) and non-cardiac cause of arrest (OR=2.17, 95% CI 1.00-4.67).

Conclusion

STA for adults presenting with non-traumatic non-shockable OHCA in our centre is 16.7%. Witnessed non-shockable OHCA patients presenting with initial PEA arrest rhythm and with a presumed non-cardiac in etiology are significantly associated with higher STA rate.

How Useful are Vital Signs in Identifying Patient with Ruptured Ectopic Pregnancy? A Retrospective Correlation Study

Objectives

To determine whether initial vital signs correlate with the amount of haemoperitoneum in patient with ruptured ectopic pregnancy presenting to accident and emergency department.

Method

A retrospective study in a regional public hospital in Hong Kong. We retrospectively collected data of all patients with the diagnosis of rupture ectopic pregnancy (ICD-9-CM 633) from the period of January 2006 to December 2007. Demographics of the patients, gestational ages, triage vital signs (pulse rate and blood pressure), emergency department ultrasound record and operation record were reviewed. Mean arterial pressure and shock index were calculated accordingly. Different vital signs were used to correlate with the amount of haemoperitoneum by using Pearson correlation analysis.

Results

Ninety-three patients with ruptured ectopic pregnancy were recruited. Mean age of patients was 30 years (range 17-47, ±6 SD). Mean week of gestation was 6.7 week (range 3-12, ±2 SD). Forty-two patients (47%) had intraperitoneal free fluid shown in emergency department ultrasound scan. Pearson correlation coefficients between vital signs and amount of haemoperitoneum were: systolic blood pressure (-0.44, p<0.001), diastolic blood pressure (-0.24, p=0.01), mean arterial pressure (-0.37, p<0.001), pulse (0.18, p=0.05) and shock index (0.45, p<0.001).

Conclusion

None of the vital signs showed good correlation with the amount of haemoperitoneum. Doctors should consider fluid resuscitation and urgent referral to gynaecologist for immediate operation even though the vital signs are normal, as patient may already have significant intraperitoneal bleeding.

Predictors of Outcome in Out-Of-Hospital Cardiac Arrest Survived to Hospital Admission

Objective

To identify the independent predictors of survival to hospital discharge in the group of patients admitted to hospital with out-of-hospital cardiac arrest.

Design

Prospective cohort study.

Setting

Two public hospitals in a cluster in Hong Kong.

Methods

Data were reported to local Cardiac Arrest Registry using Utstein style template from 1st August 2010 to 31st October 2012. The post cardiac arrest care and outcome, premorbid mobility, activities of daily living (ADL) and medical illnesses were traced from medical records. Independent predictors were calculated using logistic regression model.

Results

A total of 323 patients were recruited in this study. Patients' age (Odds raio [OR]=0.966; 95% confidence interval [CI]=0.937-0.996), total down time (OR=0.897; 95% CI=0.858-0.938), pre-hospital defibrillation (OR=5.649; 95% CI=1.673-19.07), post-cardiac arrest intensive care (OR=3.674; 95% CI=1.001-13.951) were independent predictors of survival to hospital discharge.

Conclusions

Younger age, shorter down time, prehospital defibrillation for shockable rhythm, post-cardiac arrest intensive care are independent predictors of survival to discharge for patients admitted to hospital after out-of-hospital cardiac arrest. Premorbid health conditions, ADL and mobility are not predictors to patient's survival. (Hong Kong j.emerg.med. 2014;21:131-139)

Ball Bearing (BB) Gun Injuries

War game has become quite a popular recreational game in Hong Kong nowadays. Ball bearing (BB) and pellet gun-related injuries should not be overlooked. This article presented a case of BB gun-related soft tissue injury on the face with retained pellet. We also reviewed the types, power levels, and the injuries of non-power guns. The management of BB and pellet gun-related injuries and the preventive measures concerning legislation, education program, product safety awareness and protective gears usage would be emphasized.

Outcome Predictors of Patients in Out-Of-Hospital Cardiac Arrests with Pre-Hospital Defibrillation in Hong Kong

Objective

To report the epidemiology, outcomes and the predictors of survival in patients with out-of-hospital cardiac arrest (OHCA) with pre-hospital shockable cardiac rhythms in Hong Kong.

Methods

It was a prospective study based on data from the cardiac arrest registry of emergency departments (ED) in two regional hospitals in Hong Kong from 1st August 2010 to 31st January 2012. All non-traumatic patients aged 18 years or above presented with OHCA with shockable pre-hospital cardiac rhythm and received pre-hospital defibrillation were included. The characteristics of patients, pre-hospital data, management and outcomes were recorded in a standardised form compatible with Utstein template at the time of patient consultation. Binominal logistic regression was applied to evaluate the relationship between survival to admission (STA) and patients' variables.

Results

A total of 135 patients fulfilled the inclusion criteria. The mean age was 67.0 years old. The STA rate was 34.8% and the survival to discharge (STD) rate was 6.7%. Factors independently associated with better prognosis in terms of STA were presence of bystander cardiopulmonary resuscitation (CPR) (OR 5.76, 95% CI=1.08-30.5), restoration of spontaneous circulation (ROSC) before arrival to ED (OR 43.94, 95% CI= 4.19-460.43) and short time from calling emergency medical services (EMS) to first defibrillation (OR 0.82, 95% CI=0.70-0.96).

Conclusion

STA rate for adults presenting with shockable OHCA in our study was 34.8%. Patients with shockable OHCA with bystander CPR, short call-to-shock time and achieved ROSC before arrival to ED are significantly associated with higher STA rate.

Shorter Symptoms Onset to Emergency Department Presentation Time Predicts Failure of Needle Aspiration in Primary Spontaneous Pneumothorax

Objective

To evaluate factors in predicting the failure of needle aspiration in primary spontaneous pneumothorax, in particular the interval between symptom onset and emergency department presentation.

Methods

This is a retrospective cohort study carried out from January 2010 to October 2012 in two public hospitals in Hong Kong. All consecutive adult patients aged 18 or more who attended the emergency departments in the study period with the diagnosis of primary spontaneous pneumothorax, where needle aspiration was performed as the primary treatment were recruited. Age, smoking status, previous pneumothorax, symptom interval, size of pneumothorax and aspirated gas volume were included in the analysis. The outcome was successful or failed needle aspiration. Logistic regression was used to identify independent predictors of failed needle aspiration.

Results

A total of 196 patients were included. Overall, 105 patients (53.6%) were treated successfully with no recurrence upon discharge. Among those failure patient, 30 patients (15.3%) failed as evidence by the chest X-ray taken immediately after the procedure while 61 patients (31.1%) failed upon subsequent chest X-ray. Multivariate logistic regression showed factors independently associated with failure of needle aspiration included size of pneumothorax (apex to cupola distance) (odds ratio [OR]=1.022, 95% confidence interval [CI]=1.009-1.039, p=0.001) and symptoms onset to emergency department presentation time (OR=0.987, 95% CI=0.976-0.999, p=0.028).

Conclusions

Large pneumothorax and shorter symptoms onset to emergency department presentation time were associated with higher failure rate of needle aspiration for primary spontaneous pneumothorax. (Hong Kong j.emerg. med. 2014;21:16-22)

Cadherin- and Rigidity-Dependent Growth of Lung Cancer Cells in a Partially Confined Microenvironment

During tumor development, cancer cells constantly confront different types of extracellular barriers. However, fundamental questions like whether tumor cells will continue to grow against confinement or away from it and what key factors govern this process remain poorly understood. To address these issues, here we examined the growth dynamics of human lung epithelial carcinoma A549 cells partially confined in micrometer-sized cylindrical pores with precisely controlled wall stiffness. It was found that, after reaching confluency, the cell monolayer enclosed by a compliant wall was able to keep growing and pushing the boundary, eventually leading to a markedly enlarged pore. In contrast, a much reduced in-plane growth and elevated strain level among cells were observed when the confining wall becomes stiff. Furthermore, under such circumstance, cells switched their growth from within the monolayer to along the out-of-plane direction, resulting in cell stacking. We showed that these observations can be well explained by a simple model taking into account the deformability of the wall and the threshold stress for inhibiting cell growth. Interestingly, cadherins were found to play an important role in the proliferation and stress buildup within the cell monolayer by aggregating at cell-cell junctions. The stiff confinement led to an elevated expression level of cadherins. Furthermore, inhibition of N-cadherin resulted in a significantly suppressed cell growth under the same confining conditions.

Stable Superwetting Surface Prepared with Tilted Silicon Nanowires

ABSTRACT

Large-scale uniform nanostructured surface with superwettability is crucial in both fundamental research and engineering applications. A facile and controllable approach was employed to fabricate a superwetting tilted silicon nanowires (TSNWs) surface through metal-assisted chemical etching and modification with low-surface-energy material. The contact angle (CA) measurements of the nanostructured surface show a large range from the superhydrophilicity (the CA approximate to 0°) to superhydrophobicity (the CA up to 160°). The surface becomes antiadhesion to water upon nanostructuring with a measured sliding angle (α) close to 0°. Moreover, the fluorinated TSNWs surface exhibits excellent stability and durability because strong chemical bonding has been formed on the surface.

[Effectiveness research of medicated γ intrauterine device and medicated genefix intrauterine device inserted immediately after abortion]

OBJECTIVE

To compare the effectiveness of medicated γ intrauterine device (IUD) and medicated genefix IUD inserted immediately after abortion.

METHODS

A multicenter clinical trail was performed for the study from Mar. 2012 to Jan. 2013. Totally 840 women who volunteered to participate were randomly allocated to γ-group (medicated γ IUD) or genefix-group (medicated genefix IUD) immediately after abortion. While 464 abortion women who had not used IUD or steroids contraceptive methods were chosen as control group. The effectiveness of the IUD were followed up for 1 year. All women were required to record the number of vaginal bleeding days and blood volume of vaginal bleeding within 3 months after abortion.

RESULTS

At the 12(th) month, the expulsion was the most common reason for termination. The expulsion rates of genefix-group and γ-group were 2.48/100 women years and 3.12/100 women years, respectively (P>0.05). For the expulsion reasons, IUD moving down could account for more than seventy percent. The removal rate for IUD usage of two IUD groups were almost equal (3.91/100 women years verus 4.35/100 women years), the differences were not statistically significant (P>0.05). At the 90(th) day after abortion, comparing with control group, the bleeding and (or) spotting days of genefix-group and γ-group extended by 3.9 and 2.6 days respectively, the differences had statistical significance between the three groups (P<0.05). Among the bleeding and (or) spotting days, spotting days prolonged significantly. At the 12(t)h month, spotting days of genefix-group and γ-group were (9.2±5.9) days and (8.5±4.6) days respectively, more than (5.2±4.0) days of control group. The differences had statistical significance between IUD with control group (P<0.05), and had not between the two kinds of IUD (P>0.05).

CONCLUSION

The insertion of medicated genefix IUD and medicated γ IUD immediately after abortion is safe, feasible, has slight side effects and could be effective contraception.

PCDD/Fs in air and soil around an e-waste dismantling area with open burning of insulated wires in south China

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in ambient air and farmland soil sampled in 2006 around an e-waste dismantling area with open burning of insulated wires in Longtang in south China were investigated. The total toxic equivalent concentrations of PCDD/Fs were 3.2-31.7 pg/m(3) in air and 5.8 12.4 ng/kg in farmland soil at an e-waste site and 0.063-0.091 pg/m(3) in air at a background site. PCDD/Fs in the air at the e-waste site were characterized with dominant 1,2,3,4,6,7,8-HpCDF and OCDF and higher concentrations of furans than dioxins, suggesting open burning of insulated wires was likely to be the main source of PCDD/Fs. Compared with the results in this study, the level of PCDD/F tended to lessen with the average TEQ concentration decreasing by 41 % and the pattern changed to be dominated by OCDD in the air of Longtang in 2010 when insulated wires were openly burned in only a small scale. Our results indicate that the lower chlorinated congeners with higher vapor pressures have enhanced atmospheric transport tendencies.

Poor relevance of a lymphocyte proliferation assay in lamotrigine-induced Stevens-Johnson syndrome or toxic epidermal necrolysis

BACKGROUND

Prior use of 'lymphocyte transformation test' (LTT) in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) provided conflicting results, possibly dependent on sampling dates (acute vs. late).

OBJECTIVE

Evaluation of LTT in patients with SJS or TEN who reacted to lamotrigine (LTG). In a small subgroup we explored the possible role of regulatory T cells (T-reg).

METHODS

Acute phase samples (9) and post-recovery samples (14) from cases of SJS or TEN to LTG were provided by the RegiSCAR-study group. Controls were persons never exposed to LTG (12), patients exposed without reaction (6), and patients who developed a mild eruption to LTG (6). LTT was performed by measuring (3) H-thymidine incorporation after 3 days of incubation with phytohemmaglutinin, LTG (10 μg/mL) or medium. Stimulation index ≥ 2 was considered positive. In 16 cases LTT was redone after depletion of T-reg by fluorescence activated cell sorting.

RESULTS

Positive LTT was observed in 3/6 cases of mild eruptions, 1/9 SJS/TEN-cases tested during the acute phase and 3/14 SJS/TEN-cases tested after recovery. We noted a very mild and nonsignificant trend for an increased response after depletion of T-reg in late samples from SJS or TEN patients.

CONCLUSIONS AND CLINICAL RELEVANCE

With the largest number of LTT performed in patients with SJS or TEN to a single drug, we confirmed that reactive cells are rarely detected in these reactions. Poor reactivity did not seem related to T-reg. Other in vitro assays than those testing proliferation should be evaluated, before raising the hypothesis that specific cells disappeared by undergoing apoptosis during the reaction.

Self-assembled silicon oxide nanojunctions

Novel silicon oxide nanojunction structures with various shapes, such as X type, Y type, T type, ringlike and treelike, are fabricated in a self-assembled manner by the hydrothermal method without any metallic catalyst. In the silicon oxide nanojunctions, both the silicon oxide nanowire part and the junction part consist of the same chemical composition, forming homogeneous homojunctions and being made suitable for application in nanoscale optoelectronics devices. The formation of silicon oxide nanojunctions may be influenced by the surrounding environment in the reaction kettle, growth space among the silicon oxide nanowires and the weight of SiO droplets at the growth tip.

Mitochondrial modulation is involved in the hepatoprotection of Limonium sinense extract against liver damage in mice

AIM OF THE STUDY

Limonium sinense (Girard) Ktze is a Chinese folk medicine used to treat fever, hemorrhage, hepatitis, and other disorders. The present research focused on the protective effects of L. sinense extracts (LSE) against liver damage.

MATERIALS AND METHODS

In this study the extract from the root of Limonium sinense was used. Aminotransferase activity detection, electron microscopy, mitochondrial function evaluation, RT-PCR and western blot were used to evaluate the hepatoprotection of LSE in LPS/d-GalN-intoxicated mice.

RESULTS

Pretreatment with 100, 200 or 400mg/kg LSE significantly blocked the increase in both serum aspartate aminotransferase (sAST) and serum alanine aminotransferase (sALT) levels induced by treatment with LPS plus d-GalN (LPS/d-GalN). Ultrastructural observation by electron microscopy showed reduced hepatocyte nuclear condensation and less lipid deposition. The decrease in both the mitochondrial membrane potential (14.6%) and sensitivity to mitochondrial swelling induced by Ca(2+) (45.9%) observed in the liver of LPS/d-GalN-treated mice were prevented by pretreatment with LSE. In addition, different doses of LSE increased both the transcription and the translation of voltage-dependent anion channels (VDAC), which was down-regulated by LPS/d-GalN treatment.

CONCLUSIONS

In summary, LSE protects livers against LPS/d-GalN-induced damage, possibly by mitochondrial mechanisms related to increased expression of VDAC.

Co-culture of cord blood CD34(+) cells with human BM mesenchymal stromal cells enhances short-term engraftment of cord blood cells in NOD/SCID mice

BACKGROUND

The major challenge for cord blood transplantation (CBT) is higher rates of delayed and failed engraftment. In an attempt to broaden the application of CBT to more candidates, ex vivo expansion of hematopoietic stem/progenitor cells in CB is a major area of investigation. The purpose of this study was to employ human BM mesenchymal stromal cells (hBM-MSC) as the feeding-layer to expand CB cells ex vivo.

METHODS

In this study, hBM-MSC were isolated and characterized by morphologic, mmunophenotypic and RT-PCR analysis. The hBM-MSC at passage 3 were employed as the feeding-layer to expand CB CD34(+) cells in vivo in the presence of thrombopoietin, flt3/flk2 ligand, stem cell factor and G-CSF. The repopulating capacity of the ex vivo-expanded CB cells was also evaluated in a NOD/SCID mice transplant experiment.

RESULTS

After 1 or 2 weeks of in vitro expansion, hBM-MSC supported more increasing folds of CB in total nucleated cells, CD34(+) cells and colony-forming units (CFU) compared with CB without hBM-MSC. Furthermore, although NOD/SCID mice transplanted with CB cells expanded only in the presence of cytokines showed a higher percentage of human cell engraftment in BM than those with unexpanded CB CD34(+) cells, expanded CB cells co-cultured with hBM-MSC were revealed to enhance short-term engraftment further in recipient mice.

DISCUSSION

Our study suggests that hBM-MSC enhance in vitro expansion of CB CD34(+) cells and short-term engraftment of expanded CB cells in NOD/SCID mice, which may be valuable in a clinical setting.

Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy

OBJECTIVE

To determine whether measurement of cardiac troponin T (cTnT) concentration in newly diagnosed peripartum cardiomyopathy (PPCM) can be used to predict persistent left ventricular dysfunction after a 6-month follow-up.

PATIENTS AND METHODS

This was a prospective, multiple-centre clinical trial that studied 106 patients with newly diagnosed PPCM surviving over 6 months. cTnT concentration was measured within 2 weeks of the onset of PPCM.

RESULTS

Serum cTnT concentration was negatively correlated with left ventricular ejection fraction (LVEF) at follow-up (LVEF, r = -0.518, p = 0.0001). Analysis by receiver operator characteristic curve yielded an area under the curve of 0.764 (95% CI 0.669 to 0.860, p = 0.0001, vs null hypothesis value 0.5) for cTnT, and a cTnT concentration cut off of >0.04 ng/ml, predicting persistent left ventricular dysfunction with a sensitivity of 54.9% and a specificity of 90.9%. Among 106 recruited patients, there were 33 patients with cTnT concentrations >0.04 ng/ml and 73 patients with cTnT concentrations < or =0.04 ng/ml. After a 6-month follow-up, there was significantly smaller LVEF (35.42% (13.04% vs 50.16% (10.48%, p = 0.0001) and more persistent left ventricular dysfunction (84.8% vs 31.5%, OR = 12.17 (95% CI 4.17 to 35.57), p = 0.001) in patients with cTnT >0.04 ng/ml than in patients with cTnT < or =0.04 ng/ml.

CONCLUSION

Serum cTnT concentration measured within 2 weeks of the onset of PPCM was correlated negatively with LVEF at follow-up. This marker offers a simple, quick, inexpensive, non-invasive method for predicting a persistent LVEF of < or =50%. A cTnT concentration of >0.04 ng/ml predicted persistent left ventricular dysfunction with a sensitivity of 54.9% and a specificity of 90.9%.

A novel HLA allele, DRB1*1609, identified in the Chinese Han population*

A novel human leucocyte antigen-DRB1*16 (HLA-DRB1*16) allele (DRB1*1609) has been identified by sequencing-based typing (SBT) in Chinese Han population. This new allele has identical nucleotide sequence to DRB1*160101 in exon 2, except for a single-nucleotide substitution from A to T at position 127. This change leads to an amino acid change from tyrosine to phenylalanin at residue 47 (Y47F). SBT was performed for cloned DRB1*16-specific polymerase chain reaction fragment. The serological phenotype of DRB1*1609 is equivalent to DR16 antigen.

Inter-relationships between DNA damage, ascorbic acid and glycaemic control in Type 2 diabetes mellitus

AIMS

The onset of complications in Type 2 diabetes mellitus (DM) patients cannot be predicted in individuals. Evidence suggests a link between complications and hyperglycaemia, oxidative stress and antioxidants, but causality is unclear. This study investigated baseline (entry) fasting plasma ascorbic acid, lymphocytic DNA damage and glycaemic control in Type 2 DM as part of a long-term study, the aim of which is to explore a biomarker profiling approach to identify and improve outcome in high-risk subjects.

METHODS

A cross-sectional study, in which DNA damage, glycated haemoglobin (HbA(1c)), fasting plasma glucose (FPG) and ascorbic acid (AA) were measured on fasting blood samples collected from 427 Type 2 DM subjects.

RESULTS

DNA damage was significantly (P < 0.0001) and directly correlated to both FPG (r = 0.540) and HbA(1c) (r = 0.282), and was significantly (P < 0.0001), independently and inversely correlated to plasma AA (r = -0.449). In those subjects with both poor glycaemic control and low AA (< 48 microm, the overall mean value for the study group), DNA damage was significantly (P < 0.005) higher compared with those subjects with a similar degree of hyperglycaemia but with AA above the mean.

CONCLUSIONS

The novel finding of a significant inverse relationship between plasma AA and DNA damage in Type 2 DM indicates that poorly controlled diabetic subjects might benefit from increased dietary vitamin C. The data also have important implications for biomarker profiling to identify those subjects who might benefit most from intensive therapy. Longer-term follow-up is underway.

Self-assembled silicon nanotubes under supercritically hydrothermal conditions

Self-assembled silicon nanotubes with one-dimensional structure have been synthesized from silicon monoxide powder under supercritically hydrothermal conditions with a temperature of 470 degrees C and a pressure of 6.8 MPa. The silicon nanotubes were identified by transmission electron microscopy and high-resolution transmission electron microscopy. The results show that the silicon nanotubes (SiNT) have closed caps. The structures of the silicon nanotubes are hollow inner pore, crystalline silicon wall layers with a 0.31 nm interplanar spacing and 2-3 nm amorphous silica outer layers. Pure crystalline silicon nanotubes survive after etching the silicon nanotubes with 5% HF acid for enough time to imply that the self-assembled silicon nanotubes are stable. A possible theoretical reason for the growth of SiNTs from SiO under supercritically hydrothermal conditions was also proposed.

Mutational analysis of the three conserved valine residues of insulin and a proposal of "isosteric residue"

To further understand the role of the three conserved Val residues in insulin, B12Val, B18Val, and A3Val, five insulin mutants-[A3Ser]insulin, [B12Thr]insulin, (desB30)[B12Ser]insulin, [B18Thr] insulin, and [B18Leu]insulin--were obtained by means of site-directed mutagenesis and their receptor-binding activities as well as in vivo biological potencies were measured. The two B18 mutants, [B18Thr]insulin and [B18Leu]insulin, both retained relatively high receptor-binding activities (70% and 30% of native porcine insulin, respectively) as well as relatively high in vivo biological potencies. The receptor-binding activities of [B12Thr]insulin and (desB30)[B12Ser]insulin were 5.1% and 0.2%, respectively. However the in vivo biological potency of [B12Thr]insulin was still about 50% of native insulin, whereas that of (desB30)[B12Ser]insulin decreased drastically. The [A3Ser]insulin retained 1.4% of the receptor-binding activity and low in vivo biological potency. These results, together with previous reports showed that when the three conserved Val residues were replaced by residues containing a beta-branched side-chain, such as Thr or Ile, the insulin mutants retained higher biological activities than those mutants replaced by other residues. Here we propose that Val, Thr, and Ile are "isosteric residues' because they all contain a beta-branched side-chain. This proposal may have perhaps general significance in protein design and protein engineering.

B9-serine residue is crucial for insulin actions in glucose metabolism

AIM

To explore the importance of B9 and B10 amino acid residues in the insulin molecule.

METHODS

The [B9Glu, B10Asp] insulin (E,D-insulin) receptor binding activity, glucose upta ke activity, and lipogenesis activity were measured in isolated adipocytes. The translocation of glucose transporter 4 (Glut4) and the phosphorylation of insulin receptor (IR) stimulated by E, D-insulin were determined by Western blotting.

RESULTS

Compared with native insulin, the receptor binding activity of E,D-insulin was 31 %; the stimulating activity of E,D-insulin in glucose transport and lipogenesis were 45 % and 40 % respectively; the stimulations of Glut4 translocation and insulin receptor autophosphorylation of E,D-insulin were about 58 % and 46 % respectively.

CONCLUSION

B9-serine residue is crucial for insulin actions in glucose metabolism.

[Preparation and evaluation of wide-bore stainless-steel packed capillary liquid chromatographic columns]

A zero-dead volume column end and a conical shaped slurry reservoir for wide-bore stainless-steel packed capillary liquid chromatographic columns were designed and evaluated. A detailed procedure for the preparation of reversed-phase stainless-steel packed capillary columns with 0.5 mm-1.0 mm i.d. is described. The influences of the column length and the packing material on the column performance have been studied. Columns were evaluated by the reduced plate height vs reduced velocity curve and the peak asymmetric factor. Experimental results showed that the column efficiency and the reproducibility were better than 75% of theoretical value and 6% RSD, respectively. Separations of antiepileptic drugs and chlorinated benzenes are demonstrated.

Human insulin from a precursor overexpressed in the methylotrophic yeast Pichia pastoris and a simple procedure for purifying the expression product

The methylotrophic yeast Pichia pastoris, which proved successful in producing many heterologous proteins, was used to express an insulin precursor. A transformant with a high copy number of the gene integrated into the chromosome was obtained by the dot-blotting method. In high-density fermentation using a simple culture medium composed mainly of salt and methanol, the expression level reached 1.5 g/L. A simple two-step method was established to purify the expression product from the culture medium with an overall recovery of about 80%. After tryptic transpeptidation, human insulin with full receptor binding capacity and biological activity was obtained. In the presence of zinc, the recombinant human insulin could be crystallized in the rhombohedral form.

Four new monomeric insulins obtained by alanine scanning the dimer-forming surface of the insulin molecule

The residues A21Asn, B12Val, B16Tyr, B24Phe, B25Phe, B26Tyr and B27Thr, buried in the dimer of insulin, were identified by means of alanine-scanning mutagenesis. The receptor binding activity, in vivo biological potency and self-association properties of the seven single alanine human insulin mutants were determined. Four of the seven single alanine mutants, [B12Ala]human insulin, [B16Ala]human insulin, [B24Ala]human insulin and [B26Ala]human insulin, are monomeric insulin, which indicates that B12Val, B16Tyr, B24Phe and B26Tyr are crucial for the formation of insulin dimer. The monomeric [B16Ala]human insulin and [B26Ala]human insulin retain 27 and 54% receptor binding activity, respectively, and nearly the same in vivo biological potency compared with native insulin, so they could be developed as the fast-acting insulin.

Polarized optical coherence imaging in turbid media by use of a Zeeman laser

A method that uses a Zeeman laser in conjunction with a Glan-Thompson analyzer to image an object in a turbid medium is proposed. A heterodyne signal is generated only when the scattering photons are partially polarized, and the spatial coherence is not seriously degraded after the signal propagates in the turbid medium. A system combining polarization discrimination with optical coherence detection to image the object in a scattering medium is successfully demonstrated. The medium is a solution of polystyrene microspheres measuring 1.072 mum in diameter suspended in distilled water contained in a 10-mm-thick quartz cuvette. The advantages of this optical system, including better selectivity of the weak partially polarized scattering photons and better imaging ability in higher-scattering media, are discussed.

Fetal Doppler hemodynamic changes in spontaneous versus prostaglandin E1-induced active labor

BACKGROUND

To assess fetal hemodynamic changes before and during active labor, either spontaneous or prostaglandin E1 (PGE1)-induced labor.

MATERIALS AND METHODS

This is a prospective longitudinal study and a cohort of 49 healthy women at 37-41+ weeks gestation without signs of fetal distress was investigated until in labor. One group of 23 healthy women had spontaneous active labor, the second group of 26 women was in active labor induced by an intra-cervical administration of PGE1 for elective induction. Blood flow waveform indices (S/D ratio, RI, PI) were assessed by pulsed Doppler ultrasonography from the umbilical artery (UA) and fetal middle cerebral artery (MCA) before and in labor. Both groups were compared for the waveform indices and perinatal outcome including duration of labor, meconium stain, baby sex, birthweight, UA blood gas measurements at delivery, Apgar's scores, prolonged nursery stay (> or =5 days), and NICU admission.

RESULTS

Demographic data of the two groups were comparable. During spontaneous active labor, the S/D ratio and RI became significantly decreased in the UA (p<0.05) and the three wave-form indices were decreased more in the MCA (p<0.01, 0.005, 0.05, respectively) compared with those measured before labor. During PGE1-induced active labor, all the waveform indices were not significantly decreased in either the UA or the MCA. The occurrence of abnormal UA blood gas values was significantly more in the PGE1-induced group than in the spontaneous labor group (23.1% v.s. 4.3%; p<0.05). No other adverse perinatal outcomes were observed in either group.

CONCLUSIONS

Decreasing impedance in both the UA and MCA during spontaneous labor is a physiological fetal adaptation to labor to prevent fetal cerebral hypoxia by maintaining adequate brain blood flow during normal parturition. This fetal adaptation phenomenon was not observed in the group of PGE1-induced labor with the result of a high incidence of abnormal UA blood gas values.