[The predictive value of dynamic changes of neutrophil/lymphocyte ratio (NLR) combined with the model of end-stage liver disease (MELD) score in patients with acute-on-chronic hepatitis B liver failure]

Objective: To determine the predictive value of dynamic changes of neutrophil/lymphocyte ratio (NLR) combined with the model of end-stage liver disease (MELD) score in patients with acute-on-chronic hepatitis B liver failure. Methods: Patients with acute-on-chronic hepatitis B liver failure who were hospitalized in the Department of Hepatology of Qilu Hospital of Shandong University from January 2010 to July 2023 were retrospectively enrolled. According to the clinical outcomes of patients within 30 days of admission, they were divided into the survival group and the death group. The dynamic changes in NLR and initial values on day 3, 5, 8, and 12 in two groups were analyzed for the diagnostic value of 30-day prognosis in patients with acute-on-chronic hepatitis B liver failure. Logistic regression analysis and machine learning XGBoost algorithm were used to evaluate the risk factors influencing the prognosis of patients at 30 days. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of NLR and initial value change combined with MELD score on day 12 of admission in patients with chronic acute hepatitis B liver failure. Results: A total of 243 patients were enrolled in the study, including 145 patients in the survival group [115 males, 30 females, aged 25-74 (47±11)] and 98 patients in the death group [80 males, 18 females, aged 22-80 (49±13) ]. The median initial NLR of survival group and death group were 3.5 (2.1, 5.3) and 4.9 (2.9, 8.3), respectively, and the difference was statistically significant (P=0.003). The variation of NLR from the initial value on day 3, 5, 8, and 12 in the survival group [1.6 (0, 4.3), 1.9 (-0.2, 4.1), 2.0 (-0.1, 4.3) and 2.9 (0.3, 7.0), respectively] were lower than that in the death group [3.2 (0.9, 7.5), 5.1 (1.8, 7.6), 5.8 (2.0, 10.6) and 9.6 (3.5, 16.4), respectively] (all P<0.001). Logistic regression multivariate analysis showed that the changes in NLR on the 12th day and initial value (OR=1.07,95%CI:1.01-1.14, P=0.014), the changes in NLR on the 3rd day and initial value (OR=2.71, 95%CI: 1.32-5.55, P=0.007), the initial value of NLR (OR=1.18,95%CI:1.01-1.37,P=0.035) and fibrinogen (OR=0.21,95%CI:0.05-0.96,P=0.044) were related factors for death within 30 days. Machine learning XGBoost algorithm showed that the weight of the change between the NLR on the 12th day and the initial value was the highest. The area under the ROC curve of the combined MELD score was 0.812 (95%CI: 0.728-0.895), the specificity was 67.78%, and the sensitivity was 82.35%. Conclusion: Dynamic change of NLR combined with MELD score has high predictive value for the short-term prognosis of patients with acute-on-chronic hepatitis B liver failure.

[Evaluation effect of COMPERA 2.0 risk assessment model on prognosis of Chinese patients with pulmonary arterial hypertension]

Objectives: To clarify the evaluation effect of COMPERA 2.0 risk assessment model on prognosis of pulmonary arterial hypertension (PAH) in China. Methods: Patients with newly diagnosed PAH admitted in Fuwai hospital between April 2019 and March 2022 were enrolled retrospectively and divided in low, intermediate-low, intermediate-high and high strata by scores of COMPERA 2.0 risk assessment model. All the patients were followed up by clinic or telephone. The primary endpoint was defined as a composite of all-cause mortality, exacerbated heart failure and aggravated symptoms. Kaplan-Meier analysis and log-rank trend test were used to determine the risk of endpoints among the 4 groups. Multivariate Cox proportional hazards regression were used to analyze the association between COMPERA 2.0 scores and prognosis in patients with PAH. Results: A total of 951 patients with PAH were enrolled in this study. The age [M (Q₁, Q₃)] of the patients was 35 (28, 47) years, of which 706 cases (74.2%) were females. A total of 328 cases (34.5%) were assigned in low strata, 264 cases (27.8%) in intermediate-low strata, 193 cases (20.3%) in intermediate-high strata, and 166 cases (17.5%) in high strata. During the duration [M (Q₁, Q₃)] of follow-up after discharge of 1.8 (1.0, 2.8) years, the primary endpoint was occurred in 12.8% (42/328), 21.2% (56/264), 28.5% (55/193) and 42.8% (71/166) of low, intermediate-low, intermediate-high and high strata, respectively. The rates of primary endpoint were significantly increased with strata rising (P<0.001). Multivariate Cox proportional hazards regression showed that COMPERA 2.0 risk scores were associated with the primary endpoints in PAH patients (HR=1.801, 95%CI: 1.254-2.588, P=0.001) after adjusting confounders. Conclusion: COMPERA 2.0 risk assessment model is a simple and effective tool for evaluating the prognosis of newly diagnosed PAH patients in China.

[Prevalence and risk factors of chronic kidney disease in diabetic population aged over 40 years in Henan province]

Objective: To investigate the prevalence and risk factors of chronic kidney disease (CKD) in diabetic patients aged over 40 years in Henan province. Methods: A cross-sectional study was conducted. Diabetic patients aged over 40 years were recruited from four cities including Xuchang, Zhumadian, Luoyang and Zhengzhou in Henan Province between June 2015 and July 2019. Multivariate logistic regression analysis was employed to analyze the risk factors for CKD. Results: A total of 3 067 diabetic patients were included in this study, including 1 238 males and 1 829 females. The mean age of all participants was (60.9±9.7) years and 85.8% (2 633/3 067) of them were living in rural areas. There were 1 155 participants who had CKD, and the overall prevalence of CKD was 37.7% (95%CI: 35.9%-39.4%). Compared with those without CKD, participants with CKD had older age [(61.4±10.3) vs (60.6±9.3) years], higher proportion of male patients (43.2% vs 38.7%), urban residents (19.4% vs 11.0%) and habitual drinkers (15.8% vs 12.7%), higher body mass index [(25.8±3.7) vs (25.4±3.6) kg/m²), higher proportion of having hypertension (57.0% vs 37.2%), hyperuricemia (10.7% vs 7.1%) and dyslipidemia (46.5% vs 42.7%) (all P<0.05). The prevalence of estimated glomerular filtration rate (eGFR) less than 60 ml·min^-1·(1.73 m²)^-1 and albuminuria was 4.9% (149/3 067) and 35.6% (1 092/3 067), respectively. Compared with rural participants [35.4% (95%CI: 34.4%-36.4%)], urban participants [51.6% (95%CI: 50.0%-53.2%)] had higher prevalence of CKD (P<0.001). Multivariate logistic regression analysis showed that habitual drinker (OR=1.27, 95%CI: 1.00-1.61, P=0.046), moderate physical activities (OR=1.23, 95%CI: 1.01-1.51, P=0.039), having hypertension (OR=2.27, 95%CI: 1.95-2.64, P<0.001), dyslipidemia (OR=1.21, 95%CI: 1.04-1.40, P=0.012) and hyperuricemia (OR=1.56, 95%CI: 1.21-2.02, P=0.001) were independent risk factors for CKD. Conclusions: The prevalence of CKD is high in diabetic patients who aged over 40 years in Henan province. The associated factors for developing CKD include habitual drinking, heavier physical activities and having chronic diseases. Targeted prevention and intervention for associated factors would be beneficial for controlling CKD in middle and old aged diabetic patients.

[Intraseasonal variation of the association between cold temperature and mortality risk in Shandong Province]

Objective: To explore the intraseasonal variation in mortality risk from cold temperature exposure in Shandong Province. Methods: Mortality data in Shandong province from 2013 to 2018 were collected from the cause of death surveillance system of Shandong Center for Disease Control and Prevention. The basic information mainly included the date of death, age, gender, education level, cause of death, home address, etc. The daily meteorological data from China Meteorological Data Network mainly included the grid coordinate data of 0.01°×0.01° latitude and longitude, such as daily average temperature (℃) and daily average relative humidity (%). The cold season was from November to February. The first two months were the early cold season and the last two months were the late cold season. The extreme cold temperature was defined as the 10^th percentile of the temperature range of cold season. Time-stratified case crossover design with distributed lag non-linear model analyzed the association between temperature and mortality and the association between extreme low temperature and mortality in different lag days in the cold season, and compared the intraseasonal differences between early (November-December) and late (January-February) cold season. Results: The temperature ranged from -17.3 ℃ to 18.6 ℃ in Shandong Province during the cold season from 2013 to 2018, and the P₁₀ (extreme low temperature) was -13.7 ℃. The average daily temperature in the early cold season was (3.63±4.66) ℃. The temperature in the late cold season was (-0.09±3.70) ℃. The average daily relative humidity was (63.89±14.75) % in the early cold season and (62.27±14.19) % in the late cold season. This study included 1 473 300 deaths in the cold season in Shandong Province between 2013 and 2018. There were 824 601 (55.97%) males and 349 824 (23.75%) cases aged<65 years. There were 803 691 (54.55%) deaths due to circulatory diseases and 140 415 (9.53%) deaths due to respiratory diseases. The results of DLNM showed that the cumulative OR of extreme low temperature in the four months of cold season was 1.74 (95%CI: 1.63, 1.86) with the optimal temperature of 18.6 ℃ as the reference. The cumulative OR values of early and late cold season were 1.50 (95%CI: 1.32, 1.71) and 2.56 (95%CI: 2.12, 3.09), respectively (P<0.001). The lag effect lasted for 12 d. Conclusion: There is an intraseasonal variation of the association between cold temperature and mortality risk in Shandong Province. The mortality risk related to cold temperature in the late cold season is higher than that in the early cold season.

[Early interventions of oral habits]

Oral habits, such as mouth breathing, sucking, and lip and tongue habits, are important factors that lead to malocclusion. The abnormal pressure will disrupt the muscle balance of the oral and maxillofacial complex and interfere with the normal development of the maxillofacial complex. Therefore, early diagnosis and successful treatment of oral habits are pivotal to the early treatment of malocclusion. This paper discusses the malocclusion caused by children's oral habits and the corresponding intervention methods.

[Malignant solitary fibrous tumors: a clinicopathological and molecular genetic analysis]

Objective: To explore the clinicopathological features, immunophenotype and molecular genetic characteristics of malignant solitary fibrous tumor (MSFT). Methods: Seven cases of MSFT were collected from the First Affiliated Hospital of Zhengzhou University from July 2018 to December 2020. Immunohistochemistry, RNA-based NGS and DNA-based NGS were performed. Results Among the 7 patients, there were 5 males and 2 females with a median age of 53 years (37-69 years). Two tumors located at skull base, and one in the tentorium of cerebellum, parietal occipital region, occipital area, chest and buttock respectively. The maximum diameter of the tumor was 2.5-20.0 cm. Microscopically, typical hemangiopericomatoid structures were noted; the tumor was cellular, fusiform or oval, very pleomorphic, with necrosis and high mitotic figures (>4/10 HPF). In some cases, classical solitary fibrous tumor morphology and dedifferentiated region were observed. Immunohistochemically, the tumor was positive for CD34 (6/7), STAT6 (7/7), bcl-2 (7/7), but negative for S-100 (7/7); CKpan or EMA was positive to varying degrees; mutated p53 was noted (3/7); Ki-67 positive index was more than 10%. NAB2-STAT6 gene fusion was typically detected in all the 7 cases. In 4 cases, ZNF415-FGFR1, COPG1-MET, IPO11-LRRC70_ncRNA-PLAG1 and Clorf198-CD274 (PD-L1) gene fusions were also detected. NOTCH1 mutation was found in 7 cases and TP53 mutation in 4 cases. TERT promoter mutations were not detected in all the cases. Conclusions: MSFT is rare and needs to be differentiated from many other spindle cell tumors. Especially when tumors express epithelial markers, they are easily misdiagnosed as sarcomatoid carcinoma and synovial sarcoma, etc. Immunohistochemistry and molecular detection of NAB2-STAT6 gene fusion have important diagnostic values. NOTCH1 and TP53 mutations may be associated with the progression of MSFT. Some patients have FGFR1 gene fusion and MET gene fusion, which may be potential therapeutic targets.

Histopathology-Based Diagnosis of Oral Squamous Cell Carcinoma Using Deep Learning

Oral squamous cell carcinoma (OSCC) is prevalent around the world and is associated with poor prognosis. OSCC is typically diagnosed from tissue biopsy sections by pathologists who rely on their empirical experience. Deep learning models may improve the accuracy and speed of image classification, thus reducing human error and workload. Here we developed a custom-made deep learning model to assist pathologists in detecting OSCC from histopathology images. We collected and analyzed a total of 2,025 images, among which 1,925 images were included in the training set and 100 images were included in the testing set. Our model was able to automatically evaluate these images and arrive at a diagnosis with a sensitivity of 0.98, specificity of 0.92, positive predictive value of 0.924, negative predictive value of 0.978, and F1 score of 0.951. Using a subset of 100 images, we examined whether our model could improve the diagnostic performance of junior and senior pathologists. We found that junior pathologists were able to delineate OSCC in these images 6.26 min faster when assisted by the model than when working alone. When the clinicians were assisted by the model, their average F1 score improved from 0.9221 to 0.9566 in the case of junior pathologists and from 0.9361 to 0.9463 in the case of senior pathologists. Our findings indicate that deep learning can improve the accuracy and speed of OSCC diagnosis from histopathology images.

[Safety and efficacy of left atrial appendage closure combined with patent foramen ovale closure for atrial fibrillation patients with patent foramen ovale]

Objective: To analyze the safety and efficacy of combined left atrial appendage (LAA) and patent foramen ovale (PFO) closure in adult atrial fibrillation (AF) patients complicating with PFO. Methods: This study is a retrospective and cross-sectional study. Seven patients with AF complicated with PFO diagnosed by transesophageal echocardiography (TEE) in Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences from June 2017 to October 2020 were selected. Basic data such as age, gender and medical history were collected. The atrial septal defect or PFO occluder and LAA occluder were selected according to the size of PFO, the ostia width and depth of LAA. Four patients underwent left atrial appendage closure(LAAC) and PFO closure at the same time. PFO closure was performed during a one-stop procedure of cryoablation combined with LAAC in 2 patients. One patient underwent PFO closure at 10 weeks after one-stop procedure because of recurrent transient ischemic attack (TIA). All patients continued to take oral anticoagulants. TEE was repeated 8-12 weeks after intervention. In case of device related thrombus(DRT), TEE shall be rechecked 6 months after adjusting anticoagulant and antiplatelet drug treatment. Patients were follow-up at 1, 3, 6, 12, 24 months by telephone call, and the occurrence of cardio-cerebrovascular events was recorded. Results: Among the 7 patients with AF, 2 were male, aged (68.0±9.4) years, and 3 had a history of recurrent cerebral infarction and TIA. Average PFO diameter was (3.5±0.8)mm. Three patients were implanted with Watchman LAA occluder (30, 30, 33 mm) and atrial septal defect occluder (8, 9, 16 mm). 2 patients were implanted with LAmbre LAA occluder (34/38, 18/32 mm) and PFO occluder (PF1825, PF2525). 2 patients were implanted with LACbes LAA occluder (24, 28 mm) and PFO occluder (PF2525, PF1825) respectively. The patients were followed up for 12 (11, 24) months after operation. TEE reexamination showed that the position of LAA occluder and atrial septal defect occluder or PFO occluder was normal in all patients. DRT was detected in 1 patient, and anticoagulant therapy was adjusted in this patient. 6 months later, TEE showed that DRT disappeared. No cardiovascular and cerebrovascular events occurred in all patients with AF during follow-up. Conclusions: In AF patients complicated with PFO, LAAC combined with PFO closure may have good safety and effectiveness.

Single nucleotide polymorphisms rs102313, rs118231 and rs201832 of CTEP TaqIB gene correlated with lipid metabolism abnormalities and cerebral infarction in patients with atherosclerosis

OBJECTIVE

The purpose of this study was to investigate the correlations of cholesterol ester transfer protein (CTEP) TaqIB gene polymorphism with lipid metabolism abnormalities and cerebral infarction (CI) in patients with atherosclerosis (AS).

PATIENTS AND METHODS

A case-control study was conducted on 100 AS patients complicated with (CI) as AS+CI group, and 200 AS patients with matched age, gender and race as controls (AS group). Single nucleotide polymorphisms (SNPs) rs102313, rs118231 and rs201832 in the promoter region of CTEP TaqIB gene were classified by conformational differential gel electrophoresis. Then, Chi-square test was carried out to determine whether the distribution frequency of CTEP TaqIB genotypes conforms to the law of genetic equilibrium. In the meantime, the correlations of gene polymorphisms and allelotypes in the promoter region of CTEP TaqIB with CI and lipid metabolism abnormalities in AS patients were analyzed.

RESULTS

Hardy-Weinberg genetic equilibrium analysis showed that the three polymorphisms of CTEP TaqIB gene were in accordance with the genetic equilibrium distribution (p>0.05). Moreover, the results of gene association analysis revealed that the polymorphisms rs102313 and rs118231 and allelotypes in the promoter region of CTEP TaqIB gene were correlated with CI in AS patients (p<0.05). Specifically, AS patients with GG genotype and allele G at rs102313 and those with TT genotype and allele T at rs118231 had a higher risk of CI (p<0.05). Besides, the polymorphism rs102313 in the promoter region of CTEP TaqIB gene was markedly related to lipid metabolism abnormalities in AS patients (p<0.05).

CONCLUSIONS

The polymorphisms rs102313 and rs118231 in the promoter region of CTEP TaqIB gene are associated with CI in AS patients, and the polymorphism rs102313 is remarkably correlated with lipid metabolism abnormalities in AS patients.

Toward Clinically Applicable 3-Dimensional Tooth Segmentation via Deep Learning

Digital dentistry plays a pivotal role in dental health care. A critical step in many digital dental systems is to accurately delineate individual teeth and the gingiva in the 3-dimension intraoral scanned mesh data. However, previous state-of-the-art methods are either time-consuming or error prone, hence hindering their clinical applicability. This article presents an accurate, efficient, and fully automated deep learning model trained on a data set of 4,000 intraoral scanned data annotated by experienced human experts. On a holdout data set of 200 scans, our model achieves a per-face accuracy, average-area accuracy, and area under the receiver operating characteristic curve of 96.94%, 98.26%, and 0.9991, respectively, significantly outperforming the state-of-the-art baselines. In addition, our model takes only about 24 s to generate segmentation outputs, as opposed to >5 min by the baseline and 15 min by human experts. A clinical performance test of 500 patients with malocclusion and/or abnormal teeth shows that 96.9% of the segmentations are satisfactory for clinical applications, 2.9% automatically trigger alarms for human improvement, and only 0.2% of them need rework. Our research demonstrates the potential for deep learning to improve the efficacy and efficiency of dental treatment and digital dentistry.

[Early outcome of valve sparing aortic root replacement with partial upper sternotomy]

Objective: To examine the early outcome of valve sparing aortic root replacement with reimplantation technique (David procedure) with partial upper sternotomy. Methods: From April 2016 to April 2020, 31 patients underwent valve sparing aortic root replacement under partial upper sternotomy at Vascular Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. There were 28 males and 3 females, aging (44±13) years (range: 11 to 65 years). Preoperative aortic regurgitation was found greater than moderate in 15 patients, moderate in 6 patients and less than moderate in 10 patients. The diameter of aortic annulus was (26±3) mm (range: 21 to 34 mm), the diameter of aortic sinus was (51±6) mm (range: 41 to 68 mm), the diameter of ascending aorta was (43±8) mm (range: 26 to 62 mm). The preoperative ejection fraction was (65±4) % (range: 59% to 72%) and left ventricular end-diastolic diameter was (55±6) mm (range: 42 to 68 mm). All cases were treated with David Ⅰ procedure, including simple David procedure in 26 patients, David+ascending aorta and partial aortic arch replacement in 3 patients, David+thoracic endovascular aortic repair in 1 patient, David+stent elephant trunk implantation in 1 patient. Results: The operation time, cardiopulmonary bypass time and aortic cross-clamping time were (330±58) minutes (range: 214 to 481 minutes), (138±23) minutes (range: 106 to 192 minutes) and (108±17) minutes (range: 82 to 154 minutes), respectively. There were no death and serious complications (stroke, myocardial infarction, renal insufficiency, severe infection, etc.). The postoperative drainage volume within 24 hours was (314±145) ml (range: 130 to 830 ml). The intubation time was (14±3) hours (range: 8 to 21 hours), and the ICU time was (M(Q_R)) 2.1(1.5) days (range: 1.0 to 5.0 days). Eight patients had no blood transfusion, the proportion of red blood cell use was 9.7% (3/31), plasma use was 22.6% (7/31), and platelet use was 71.0% (22/31). The postoperative left ventricular ejection fraction was (62±4)% (range: 54% to 69%), and left ventricular end-diastolic diameter was (48±4) mm (range: 39 to 56 mm). After operation, aortic regurgitation was significantly improved, with no more than moderate regurgitation, small to moderate regurgitation in 3 patients, minor regurgitation in 3 patients, micro regurgitation in 12 patients and no regurgitation in 13 patients. The follow-up period was 3.5(6.1) months (range: 2.0 to 39.0 months). Echocardiographic follow-up data were obtained in 26 cases, including moderate regurgitation in 1 patient, small to moderate regurgitation in 9 patients, minor regurgitation in 5 patients, micro regurgitation in 6 patients and no regurgitation in 5 patients. There were no major adverse cardiovascular events and aortic events during the follow-up period. No patient was reoperated for aortic regurgitation. Conclusion: Valve sparing aortic root replacement under partial upper sternotomy is safe and feasible, and the early result is satisfactory.

Onset of inverse magnetic energy transfer in collisionless turbulent plasmas

Inverse magnetic energy transfer from small to large scales is a key physical process for the origin of large-scale strong magnetic fields in the universe. However, so far, from the magnetohydrodynamic perspective, the onset of inverse transfer is still not fully understood, especially the underlying dynamics. Here, we use both two-dimensional and three-dimensional particle-in-cell simulations to show the self-consistent dynamics of inverse transfer in collisionless decaying turbulent plasmas. Using the space filtering technique in theory and numerical analyses, we identify magnetic reconnection as the onset and fundamental drive for inverse transfer, where, specifically, the subscale electromotive force driven by magnetic reconnection do work on the large-scale magnetic field, resulting in energy transfer from small to large scales. The mechanism is also verified by the strong correlations in locations and characteristic scales between inverse transfer and magnetic reconnection.

Automated Radiographic Evaluation of Adenoid Hypertrophy Based on VGG-Lite

Adenoid hypertrophy is a pathological hyperplasia of the adenoids, which may cause snoring and apnea, as well as impede breathing during sleep. The lateral cephalogram is commonly used by dentists to screen for adenoid hypertrophy, but it is tedious and time-consuming to measure the ratio of adenoid width to nasopharyngeal width for adenoid assessment. The purpose of this study was to develop a screening tool to automatically evaluate adenoid hypertrophy from lateral cephalograms using deep learning. We proposed the deep learning model VGG-Lite, using the largest data set (1,023 X-ray images) yet described to support the automatic detection of adenoid hypertrophy. We demonstrated that our model was able to automatically evaluate adenoid hypertrophy with a sensitivity of 0.898, a specificity of 0.882, positive predictive value of 0.880, negative predictive value of 0.900, and F1 score of 0.889. The comparison of model-only and expert-only detection performance showed that the fully automatic method (0.07 min) was about 522 times faster than the human expert (36.6 min). Comparison of human experts with or without deep learning assistance showed that model-assisted human experts spent an average of 23.3 min to evaluate adenoid hypertrophy using 100 radiographs, compared to an average of 36.6 min using an entirely manual procedure. We therefore concluded that deep learning could improve the accuracy, speed, and efficiency of evaluating adenoid hypertrophy from lateral cephalograms.

Circ-DONSON promotes malignant progression of glioma through modulating FOXO3

OBJECTIVE

The aim of this study was to investigate the expression level of circ-DONSON in glioma and to explore its effect on glioma metastasis and the underlying mechanism.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was performed to examine circ-DONSON expression in 40 paired glioma tumor tissues and adjacent tissues. Meanwhile, the relation between circ-DONSON level and clinical parameters of glioma and the prognosis of patients was analyzed. The expression of circ-DONSON in glioma cell lines was analyzed by qRT-PCR as well. In addition, circs-DONSON silencing model was constructed in glioma cell lines. Cell counting kit-8 (CCK-8), cell scratch, and transwell migration assays were performed to investigate the effect of circ-DONSON on biological functions of glioma cells. Finally, the interplay between FOXO3 and circ-DONSON was explored.

RESULTS

QRT-PCR results revealed that the expression level of circ-DONSON in glioma tumor tissues was remarkably higher than that of adjacent tissues, and the difference was statistically significant (p<0.05). Compared with patients with low expression of circ-DONSON, significantly higher prevalence of lymph node or distant metastasis and worse prognosis were observed in patients with high expression of circ-DONSON (p<0.05). The proliferation and migration abilities of glioma cells in circ-DONSON silenced group were remarkably suppressed when compared with NC group (p<0.05). Additionally, FOXO3 expression was remarkably down-regulated in glioma cell lines and tissues. FOXO3 expression was negatively correlated with circ-DONSON expression. In addition, cell reverse experiment demonstrated that circ-DONSON and FOXO3 can regulate each other, thereby together affecting the malignant progression of glioma.

CONCLUSIONS

Circ-DONSON was remarkably associated with lymph node or distant metastasis, as well as poor prognosis of patients with glioma. Furthermore, it promoted the metastasis of glioma cells via regulating FOXO3.

[Effects of smoking on the wound healing of stage 4 pressure ulcers in rats]

Objective: To explore the effect of smoking on the wound healing of stage 4 pressure ulcers in rats. Methods: Fifty male Sprague-Dawley rats aged 6-8 weeks were divided into simple pressure ulcer group and smoking+ pressure ulcer group according to the random number table, with 25 rats in each group. After the rats in the smoking+ pressure ulcer group received passive smoking intervention for 12 weeks, an iron plate was placed in the back muscle of each rat in 2 groups, and a magnet was placed outside the skin at the corresponding position of the iron plate for 2 h at each time, with 5 times a day and continuously for 6 days to reproduce stage 4 pressure ulcer model. Immediately after establishing the model, 3 rats in each group were sacrificed and wound tissue was collected, and hematoxylin-eosin staining was applied to observe the pathological changes of the wounds. On 1, 3, 7, and 14 day (s) after establishing the model, 3 rats in each group were collected to measure the pressure ulcer wound area by the paper jam method. After measurement of the wound area, the rats were sacrificed and the wound tissue was collected, and the protein expression levels of matrix metalloproteinases 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) in wound tissue were detected by immunohistochemical method, and the ratio of MMP-9/TIMP-1 was calculated.The wound healing time of the remaining 10 rats in each group was recorded. Data were statistically analyzed with analysis of variance for factorial design, two independent sample t test, and Bonferroni correction. Results: (1) Immediately after establishing the model, muscle fiber necrosis and dissolution with large areas were seen on the wound, the myofibrils arranged loosely, and more lymphocytes and monocytes infiltration were seen around the wound of rats in simple pressure ulcer group. A large number of necrotic myofibers were dissolved and gradually disappeared, the myofibrils arranged loosely, and the number of diffuse lymphocytes and monocyte infiltration in wound of rats in smoking+ pressure ulcer group were significantly higher than those in simple pressure ulcer group. (2) The wound areas of rats in smoking+ pressure ulcer group were significantly larger than those in simple pressure ulcer group on 1, 3, 7, and 14 day (s) after establishing the model (t=3.019, 2.549, 2.181, 3.674, P<0.05 or P<0.01). (3) On 1 to 14 days after establishing the model, the protein expression levels of MMP-9 and TIMP-1 in the wound tissue and the ratio of MMP-9/TIMP-1 of rats in the two groups increased first and then decreased. On 1, 3, 7, and 14 day (s) after establishing the model, the protein expression levels of MMP-9 in the wound tissue and the ratio of MMP-9/TIMP-1 of rats in smoking+ pressure ulcer group were significantly higher than those in simple pressure ulcer group (t=4.783, 4.508, 6.325, 7.204, 3.078, 2.989, 4.081, 4.696, P<0.05 or P<0.01), and the protein expression levels of TIMP-1 in wound tissue of rats in the two groups were similar. (4) The wound healing time of rats in smoking+ pressure ulcer group was (48.9±2.6) d, which was significantly longer than (35.2±2.3) d of simple pressure ulcer group (t=12.477, P<0.05). Conclusions: Smoking can up-regulate the expression of MMP-9 in pressure ulcer wound and result in an imbalance of MMP-9/TIMP-1, thereby affecting the wound healing of stage 4 pressure ulcers in rats.

Inhibition of miR-221 influences bladder cancer cell proliferation and apoptosis

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, "Inhibition of miR-221 influences bladder cancer cell proliferation and apoptosis, by H. Liu, J.-K. Chang, J.-Q. Hou, Z.-H. Zhao, L.-D. Zhang, published in Eur Rev Med Pharmacol Sci 2017; 21 (14): 3193-3199-PMID: 28770966" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/13140.

[Changes of urinary monocyte chemotactic protein 1 and epidermal growth factor and their correlations with clinicopathology in idiopathic membranous nephropathy patients]

Objective: To explore the changes and clinical value of urinary monocyte chemotactic protein 1 (MCP-1), epidermal growth factor (EGF) and their ratio in patients with idiopathic membranous nephropathy (IMN). Methods: A total of 67 IMN patients were enrolled according to kidney biopsy in the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018. The patients included 28 males and 39 females, with an average age of (47.6±14.2) years. Eighteen age-and sex-matched healthy controls were also enrolled. Clinical and pathological data, blood and urine samples of all subjects were collected. Urinary MCP-1 and EGF level were detected by enzyme-linked immunosorbent assay (ELISA). And then the levels of urinary MCP-1, EGF and the ratio of EGF/MCP-1 and their correlations with clinicopathology were analyzed. Results: There was no statistical difference of the urine EGF levels between the two groups [8.3(6.0,12.6) vs 8.4(6.5,10.2) ng/mg Cr, P=0.575]. The urine MCP-1 levels of IMN patients were 0.37 (0.21, 0.69) ng/mg Cr, which was statistical significantly higher than those of the control group [0.09 (0.02, 0.19) ng/mg Cr] (P<0.001), while the EGF/MCP-1 ratio was lower than that of the control group [22.2(15.1,36.6) vs 87.6(71.2,132.7), P<0.001]. Urine MCP-1 was negatively correlated with eGFR (r=-0.303, P=0.012), but positively correlated with the urinary ratio of albumin to creatinin (r=0.368, P=0.002). EGF was positively correlated with eGFR (r=0.722, P<0.001), but negatively correlated with the severity of interstitial fibrosis and renal tubular atrophy (IFTA) (r=-0.312, P=0.011). EGF/MCP-1 ratio was positively correlated with eGFR (r=0.693, P<0.001), but negatively correlated with the severity of the urinary ratio of albumin to creatinin and IFTA (r=-0.261, P=0.028 and r=-0.684, P<0.001, respectively). Further multivariate logistic regression analysis showed that EGF/MCP-1 was a protective factor for moderate-to-severe IFTA (OR=0.891, 95%CI: 0.844-0.949, P=0.008). Conclusion: Patients with IMN have elevated urine MCP-1 level and decreased EGF/MCP-1 ratio, which correlate with clinical indicators. In particular, EGF/MCP-1 ratio is independently related to moderate-severe IFTA, and may be a potential clinical biomarker for diagnosis of IMN.

[Clear aligner therapy: risks and clinical strategies]

Clear aligner, as a transparent and removable appliance, offers an alternative to conventional fixed appliance to patients with high demands for esthetics and comfort. Meanwhile, the rapid development of materials and techniques has made clear aligner more widely used in orthodontics. However, there are still several concerns and risks in clinical practice of clear aligners, which may result in unfavorable outcomes. Herein, we have discussed the clinical risks of clear aligner therapy, and provided some targeted strategies, in order to promote the clinical application of clear aligners.

[Expression of HLA-DP in patients with neuromyelitis optica spectrum disorders]

Objective: To investigate the effect of HLA-DP gene expression on the susceptibility and disease status of neuromyelitis optica spectrum disorders (NMOSD). Methods: A total of 86 NMOSD patients (52 in acute phase and 34 in remission phase), 52 multiple sclerosis (MS) patients (20 in acute phase and 32 in remission phase) diagnosed in Department of Neurology, the Third Affiliated Hospital of Sun Yat-sen University and 29 healthy controls were enrolled prospectively. Genotyping of HLA-DP was performed. The expression levels of HLA-DP molecules in peripheral blood B cells and monocytes were measured by flow cytometry. The transcription levels of HLA-DPB1 mRNA in peripheral blood mononuclear cells (PBMC) were measured by real time-PCR. The results were compared among different groups Results: There was no statistically significant difference of the distributions of HLA-DPB1*0501/HLA-DPB1*0501, HLA-DPB1*0501/X and X/X genotypes and the frequencies of allele of HLA-DPB1*0501 among NMOSD, MS patients and healthy controls (P=0.96 and 0.71, respectively). The expression levels of HLA-DP on the surface of B cells in NMOSD patients, especially in remission phase patients, were significantly higher than those in healthy controls(212±328 and 374±394 vs 55±57, P=0.049 and 0.002, respectively). The expression levels of HLA-DP on the surface of monocytes in NMOSD patients in acute phase were significantly higher than those in healthy controls(158±175 vs 65±90, P=0.025). The transcription levels of PMBC HLA-DPB1 mRNA in acute phase and remission phase of NMOSD patients were significantly higher than those in healthy controls (3.0±1.4 and 2.9±1.3 vs 1.5±1.4, P=0.000 and 0.003, respectively). The expression levels of HLA-DP molecules on the surface of peripheral blood B cells and monocytes and the transcription levels of PMBC HLA-DPB1 mRNA in MS patients at the acute and remission stages were not significantly different from those in healthy controls. The expression levels of HLA-DP molecules on the surface of B cells in patients with HLA-DPB1*0501/HLA-DPB1*0501, HLA-DPB1*0501/X and X/X genotypes were statistically different (P=0.017). Conclusion: HLA-DP gene transcription and molecular expression levels in antigen presenting cells may affect the susceptibility and disease status of NMOSD patients, while HLA-DPB1*0501 allele may affect the transcription and molecular expression levels of HLA-DP gene in antigen presenting cells.

[Study on the relationship between EPHX1 gene polymorphism and antioxidant capacity in patients with chronic obstructive pulmonary disease]

Objective: To explore the difference of mRNA, protein expression levels and the indexes of peripheral blood antioxidant capacity in peripheral blood lymphocytes of different EPHX1 genotypes in chronic obstructive pulmonary disease(COPD). Methods: A case-control study was conducted to collect peripheral blood samples of 220 stable chronic COPD patients with smoking history and 230 healthy smokers (control group) from October 2016 to February 2018 in the First Affiliated Hospital of Kunming Medical University, and the genetic testing was carried out according to the operation instructions of BigDye Terminator v1.1 DNA Sequencing Kit. Based on their EPHX1 exon 3 and exon 4 polymorphism status, the EPHX1 was classified into 4 groups, i. e., normal activity, slow activity, extremely slow activity and fast activity. Then COPD patients were allocated to either a slow activity group (slow and very slow activity) or a fast activity group (normal and fast activity) according to EPHX1 genotype and gene activity. The expression of EPHX1 mRNA and protein in peripheral blood lymphocytes were detected by qRT-PCR and Western blot, and indexes of serum antioxidant capacity was detected by corresponding kits. Results: (1)The 2(-ΔΔCt) of the control group was 1.000, and the 2(-ΔΔCt) of the COPD group was 1.052±0.023. There was no significant difference in the level of EPHX1 mRNA expression between the two groups (t=1.992 P=0.865). The level of EPHX1 mRNA expression in the slow activity group was not different significantly compared to that in the fast-active group (1.053±0.023 vs 1.048±0.021, t=1.133, P=0.260). (2)The level of EPHX1 protein expression by Western blot analysis showed that the EHPX1/GAPDH gray ratio was not different significantly between the COPD group and the control group (0.613±0.089 vs 0.602±0.075, t=0.805, P=0.422). The level of EPHX1 protein expression in the slow activity group was not significantly different compared to that in the fast activity group (0.606±0.088 vs 0.622±0.092, t=-0.786 P=0.434). (3)There were significant differences in indexes of antioxidant capacity between the control group and the COPD group (P<0.05). There were significant differences in indexes of antioxidant capacity between the slow activity group and the fast activity group of COPD patients (P<0.05). Conclusions: The different antioxidant capacity of COPD patients with different EPHX1 genotypes may be related to the polymorphism of EPHX1 gene affecting the activity of microsomal epoxidase, but not to the level of EPHX1 mRNA and protein expression.

Effect of RhoC silencing on multiple myeloma xenografts and angiogenesis in nude mice

In this study, we investigated the expression of RhoC in the multiple myeloma (MM) cell line RPMI- 8226, as well as the effects of silencing RhoC on the growth of tumor xenografts and tumor-induced angiogenesis in nude mice with MM. For this purpose, we transduced RPMI-8226 cells with lentiviral particles overexpressing short hairpin RNAs (shRNA) targeting RhoC. Tumor xenografts were generated by subcutaneously injecting nude mice with RPMI-8226 cells overexpressing control shRNA [negative control (NC) group] or the RhoC shRNA [the experimental (S) group], respectively. RhoC protein and mRNA levels in the tumor xenografts were measured. Nude mice were also subcutaneously inoculated with Matrigel mixed with vascular endothelial growth factor, and CD31 and KI67 levels in the tumor xenografts were measured by immunohistochemistry. Similarly, we assessed tumor xenograft growth and angiogenesis in Matrigel implants in the mice of both groups. We found that RhoC levels, microvessel density, and CD31 labeling index were more reduced in the S group than in the NC group. However, there was no significant difference in the size of tumor xenografts between the 2 groups. The number of new vessels and the neovascular length in the Matrigel implants were significantly lower in the S group than in the NC group. Therefore, we concluded that RhoC expression in myeloma xenografts has important effects on the induction of angiogenesis.

[Clinical analysis of MRS and DWI in predicting delayed brain edema after spontaneous intracerebral hemorrhage]

Objective: Prediction of delayed brain edema after spontaneous intracerebral hemorrhage by magnetic resonance spectroscopy combined with diffusion weighted imaging, and to explore the causes and treatment of delayed brain edema after intracerebral hemorrhage. Methods: The patients with spontaneous cerebral hemorrhage diagnosed by CT from January 2015 to June 2018 in our hospital were analyzed. Magnetic resonance spectroscopy and diffusion weighted imaging examinations were performed on the third day after hemorrhage. It was diagnosed as delayed brain edema that the edema range enlarged more than 1 cm in CT scan on the 14th day Compare with the 7th Day. The patients were divided into the delayed brain edema group and the control group(n=27 for each). The NAA/Cr value and rADC value of the edema area in the two groups were analyzed by T test. Results: The NAA/Cr value (1.67±0.38) in the edema area of patients with delayed brain edema was significantly decreased Compare with the control group(1.92±0.42), and the rADC value (2.59±0.42) reduced significantly Compare with the control group (2.93±0.51), the differences were statistically significant (P<0.05). Conclusion: MRS and DWI were susceptive in showing delayed brain edema lesions at hyper-early phase. Combination of MRS and DWI can provide a basis for clinical individual treatment programs selection and prognostic evaluation.

[Correlation between DCE-MRI quantitative perfusion histogram parameters, apparent diffusion coefficient and Ki-67 in different pathological types of lung cancer]

Objective: To explore the efficacy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) histogram molecular imaging index, apparent diffusion coefficient (ADC) in different types of lung cancer and explore their correlation with Ki-67. Methods: A total of 33 cases of lung cancer patients confirmed by pathology in Shaoxing People's Hospital from March 2017 to March 2018 were collected, 28 males and 5 females aged 50-85 years old, including 15 cases of squamous cell carcinoma, 12 cases of adenocarcinoma, and 6 cases of small cell carcinoma. All patients performed DCE-MRI and DWI imaging within one week before surgery or puncture. ADC values, DCE-MRI quantitative perfusion parameters by histogram metrics analysis (mean value, skewness, kurtosis, uniformity, entropy, energy, quantile) of K(trans), K(ep), V(e), and V(p) were then collected. Ki-67 expression in lung cancer tissue was detected by immunohistochemical method. One-way analysis of variance and least significant difference were used to compare the differences among the parameters of the three groups which were normal distribution and equal variances, while Kruskal-Walls test and Mann-Whitney U test were used to compare the parameters that did not conform to normal distribution or variance. Pearson correlation analysis was used to compare the correlations between quantitative perfusion histogram parameters, ADC values and immunohistochemical scores of Ki-67. Results: The Ki-67 count in small cell lung cancer(458±82, P=0.011) and squamous cell carcinoma(355±277, P=0.034)were significantly higher than that in adenocarcinoma (168±164). The correlation analysis showed that there was a significant negative correlation between ADC values and Ki-67 (P=0.018, r=-0.416). And V(e) (Q5, Q10) was negatively related to Ki-67 (P=0.017, r=-0.420; P=0.040, r=-0.366). In squamous cell carcinoma patients, V(e) (homogeneity) was significantly negatively correlated with the expression of Ki-67 (P=0.033, r=-0.570). K(trans)(homogeneity) and V(e) (homogeneity, Q5, Q10, Q25) were significantly positively correlated with ADC values (P value from 0.001 to 0.035, r value from 0.545 to 0.765). Conclusion: DCE-MRI quantitative perfusion histogram parameters, ADC value can evaluate the lung cancer cell proliferation activity in different pathological types.

[A review of the effectiveness and long-term stability of the functional appliance]

The orthopedic treatment of the orthodontics is a typical and crucial technique and method that uses functional appliances to fully work out the potentials of the jaws and muscles, and accordingly to correct the functional or mild skeletal malocclusions in pre-pubertal children and adolescents. A successful orthopedic treatment involves its short-time effectiveness and its long-term stability. For many years, however, the effectiveness of the functional appliance is controversial and the long-term stability of the functional appliance has always been overlooked. Thus, with an aim of presenting guidelines on orthopedic treatment, the effectiveness and the long-term stability of the functional appliance are discussed in this article.

Measurement of the Dynamical Structure Factor of a 1D Interacting Fermi Gas

We present measurements of the dynamical structure factor S(q,ω) of an interacting one-dimensional Fermi gas for small excitation energies. We use the two lowest hyperfine levels of the ^{6}Li atom to form a pseudospin-1/2 system whose s-wave interactions are tunable via a Feshbach resonance. The atoms are confined to one dimension by a two-dimensional optical lattice. Bragg spectroscopy is used to measure a response of the gas to density ("charge") mode excitations at a momentum q and frequency ω, as a function of the interaction strength. The spectrum is obtained by varying ω, while the angle between two laser beams determines q, which is fixed to be less than the Fermi momentum k_{F}. The measurements agree well with Tomonaga-Luttinger theory.

[Comparison of spontaneous correction in thoracic curves after anterior versus posterior selective fusion in Lenke type 5C adolescent idiopathic scoliosis]

Objective: To analyze the long-term results and the influence factors of spontaneous correction of unfused thoracic curves in anterior and posterior selective fusions in Lenke type 5C adolescent idiopathic scoliosis (AIS). Methods: From January 2005 to December 2011, 89 Lenke type 5C AIS patients with a minimum of 5-year follow-up who underwent thoracolumbar/lumbar (TL/L) selective fusion in Spine Surgery of Nanjing Drum Tower Hospital were reviewed.Forty-six patients underwent anterior fusion (anterior group), while 46 underwent posterior fusion (posterior group). The following radiological parameters were measured and analyzed at pre-operation, post-operation, and latest follow-up: curve magnitude of primary thoracolumbar/lumbar and secondary thoracic curve, trunk shift, thoracic apical vertebral translation, upper instrumented vertebra tilt, thoracic kyphosis, proximal junctional angle, sagittal vertical axis. Independent sample t test was used to compare the above parameters between the two groups. Results: Compared with those in posterior group, anterior group were found with less fusion levels (5.4±0.6 vs 5.9±0.8, t=3.318, P=0.001) and longer operation time[(276±28)min vs (186±36)min, t=13.101, P<0.001]. Immediately after surgery, the spinal deformity was significantly corrected in the two groups. The mean spontaneous correction rates of the minor curve were 50%±21% and 56%±20% in anterior and posterior groups, respectively (t=1.489, P=0.140). After a mean follow-up of (6.8±1.7) years in anterior group and (6.3±1.3) years in posterior group, the spontaneous correction rate of minor curve was maintained at 46%±22% and 49%±19%, respectively (t=0.703, P=0.484), with no significant correction loss. Other radiographic parameters were also stably maintained. According to the correlation analysis, the spontaneous correction rate was significantly correlated with upper instrumented vertebra (UIV) tilt in both groups (anterior: r=-0.526, posterior: r=-0.399, both P<0.05). Conclusions: Both anterior and posterior selective fusion can achieve satisfactory spontaneous correction of unfused thoracic curves in Lenke type 5C AIS, with no significant difference between the two surgical approaches. UIV tilt is a key influence factor of spontaneous correction of thoracic curves.

[Effects of ubiquitin-specific proteases 2-69 on proliferation of breast cancer cells]

Objective: To investigate the expression and significance of ubiquitin-specific proteases 2-69(USP2-69) in invasive ductal carcinoma of breast. Methods: Twenty-four cases of human breast tissue with invasive ductal carcinoma diagnosed at Huanshan Hospital, Fudan University from 2013 to 2015 were collected, and the expression of USP2-69 mRNA and protein was detected by molecular hybridization, Western blot and immunohistochemistry. USP2-69 was over-expressed in cultured human breast cancer cell line MCF-7 by USP2-69 plasmid transfection. The cellular proliferative activity was investigated in vitro. Results: The USP2-69 mRNA and protein were highly expressed in breast invasive ductal carcinoma, compared to adjacent normal tissues (P<0.01). Ki-67 protein expression was also increased in cases with high USP2-69 protein level. Western blot showed significantly higher USP2-69 protein level in cancer tissue compared to the adjacent normal tissue. In the cultured tumor cells, there was increased S phase fraction, cellular proliferation rate, flat positive clones, cyclin D1 expression and decreased p27 expression in USP2-69-transfected MCF-7 cells. Conclusions: USP2-69 is over-expressed in breast invasive ductal carcinoma, and is closely related to proliferation promoting effects. The data provide an important experimental basis for further study on the molecular mechanism of breast cancer cell proliferation.

Asthma symptoms among Chinese children: the role of ventilation and PM10 exposure at school and home

SETTING

Respiratory symptoms in relation to environment in Taiyuan, China.

OBJECTIVE

To study associations between school/home exposure and prevalence of respiratory symptoms and self-reported respiratory infections (RIs) among students.

DESIGN

A total of 2134 pupils from 10 schools answered a questionnaire; air pollution at school was measured.

RESULTS

The prevalence of current wheeze, daytime attacks of breathlessness, nocturnal cough, nocturnal respiratory symptoms and RI was respectively 4.4%, 18.7%, 11.6%, 3.6% and 32.3%. Environmental tobacco smoke (ETS) at home was associated with daytime attacks of breathlessness (OR 1.41), nocturnal cough (OR 1.41) and RI (OR 1.26). Redecoration or indoor painting at home was associated with wheeze (OR 2.02), daytime attacks of breathlessness (OR 1.57) and nocturnal symptoms (OR 1.83). Dampness or mould at home was associated with daytime attacks of breathlessness (OR 1.68), nocturnal cough (OR 1.68) and RI (OR 1.69). Particulate matter of diameter  10 microns (PM10) in the classroom was associated with nocturnal cough (OR 1.20/10 μg/m3). PM10 outside school was associated with daytime attacks of breathlessness (OR 1.07/10 μg/m3) and nocturnal cough (OR 1.13/10 μg/m3). Indoor carbon dioxide, a marker of poor ventilation (OR 1.52/1000 parts per million), and relative humidity (RH) (OR 1.33/10%) were associated with nocturnal cough.

CONCLUSION

Dampness, redecoration and ETS at home, as well as poor ventilation flow, and high RH and PM10 concentration at school may influence respiratory health.

[Research on the natural history of non-alcoholic fatty liver disease should be taken seriously]

Nonalcoholic fatty liver disease (NAFLD) is a multi-system disease, and metabolic syndrome, type 2 diabetes, and NAFLD interact as both cause and effect. Deaths caused by cardiovascular diseases and malignant tumors are the adverse outcome of patients with NAFLD and nonalcoholic steatohepatitis (NASH), and increased deaths caused by liver disease is mainly seen in NASH patients. There is a causal relationship between NASH and hepatocellular carcinoma, and almost 50% of patients with NASH-associated hepatocellular carcinoma do not have liver cirrhosis. At present, cohort studies on the natural history of NAFLD in China should be enhanced in order to provide a basis for the development of health strategies and prevention and treatment measures. This editorial elaborates on the association of NAFLD with diabetes, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma from the perspective of clinical epidemiology, in order to emphasize the importance of the natural history of NAFLD.

[Invisible orthodontics: clear aligners and customized lingual appliances]

In recent years, invisible orthodontics has been one of the concerns of both orthodontists and patients. As two types of invisible orthodontics, clear aligners fit for cases that have high demand for living quality, need distalization of molars or intrusion of incisors, suffer from severe periodontitis, or that have non-abundant time for visits. While customized lingual appliances fit for cases that have high demand for aesthetics, have deep overbite or complex malocclusion, need maxillary expansion or retraction of incisors, or that have low compliance and good economic conditions. Based on aspects of clinical application, this article presents the characteristics of these two types of invisible orthodontics, in order to provide reference for individualized options according to different situations.

[Clinical application of three-dimensional O-arm navigation system in treating patients with dystrophic scoliosis secondary to neurofibromatosis type Ⅰ]

Objective: To investigate the clinical outcomes and the accuracy of O-arm-navigation system assisted pedicle screw insertion in dystrophic scoliosis secondary to neurofibromatosis type Ⅰ(NF-1). Methods: A retrospective study was conducted in 41 patients with dystrophic NF-1-associated thoracic scoliosis who were surgically treated at Department of Orthopaedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between June 2012 and October 2014 with more than 18 months follow-up. The patients were then divided into two groups: 18 patients were under the assistance of O-arm-navigation-based pedicle screw insertion (O-arm group) and the remaining 23 patients' pedicle screws insertion were conducted by free-hand (free-hand group). The X-ray and CT were analyzed to investigate the correction rate and safety of pedicle insertion. t-test was used to analyze measurement data and χ(2) test was used to analyze accuracy of screw insertion between the two groups. Results: The mean coronal Cobb angle was 63.2°±8.7° in the O-arm group and 66.9°±7.4° in the free-hand group (P>0.05), which was then corrected into 23.1°±6.8° and 30.2°±7.6°(t=2.231, P=0.031) after surgery respectively.Operation time was (265.0±70.3)minutes and estimated blood loss was (1 024±465)ml in the O-arm group. Operation time and estimated blood loss was (243.0±49.6)minutes and (1 228±521)ml respectively in the free-hand group, which had no significant difference between the two groups. However, the implant density was higher in the O-arm group than that in the free-hand group ((64.1±10.8)% vs.(44.3±15.3)%)(t=4.652, P=0.000). The O-arm group comprised 122 screws, of which 72.9% were excellent, 22.1% were good and 4.9% were bad. The free-hand group comprised 136 screws and 48.5% of them were excellent, 33.8% were good and 17.6% were bad.Accuracy of pedicle screw insertion was higher in the O-arm group than that in the free-hand group(χ(2)=10.140, P<0.05). By June 2016, the average follow-up period was (20.9±3.4)months(ranging from18 to 26 months), including (20.3±3.1)months in the O-arm group and (21.4±5.5)months in the free-hand group. At last follow-up point, coronal correction loss was significantly higher in the free-hand group than that in the O-arm group (6.3°±2.6° vs. 4.4°±1.6°)(t=2.719, P=0.009). Conclusions: Compared with free-hand technique, O-arm-navigation technique could enhance accuracy of pedicle insertion and implant density of dystrophic region in dystrophic NF-1-associated scoliosis patients, which result in a better correction rate and less correction loss. Besides, the advantage of O-arm-navigation do not increase operative time and estimate blood loss.

Inhibition of miR-221 influences bladder cancer cell proliferation and apoptosis

OBJECTIVE

Janus kinase (JAK) - signal transducer and activator of transcription (STAT) signaling pathway participate in cell proliferation and apoptosis. Suppressors of cytokine signaling 3 (SOCS3) are negative regulators of JAK-STAT3. SOCS3 was found significantly declined, while microRNA-221 (miR-221) obviously up-regulated in bladder cancer tissue. Bioinformatics analysis revealed the complementary binding site between miR-221 and 3'-UTR of SOCS3. This study investigated the role of miR-221 in regulating SOCS3/JAK-STAT3 signaling pathway and bladder cancer cell proliferation and apoptosis.

PATIENTS AND METHODS

Bladder cancer tumor tissue and para-carcinoma tissue were collected from patients to test miR-221 and SOCS3 expressions. Dual luciferase assay was used to test the targeting regulatory effect of miR-221 on SOCS3. MiR-221, SOCS3, p-JAK1, p-JAK2, and survivin expressions were compared in T24 and HBEC cells. T24 cells were divided into miR-NC, miR-221 inhibitor, pSicoR-blank, pSicoR-SOCS3, and miR-221 inhibitor + pSicoR-SOCS3 groups. Flow cytometry was applied to detect cell apoptosis. EdU staining was adopted to evaluate cell proliferation.

RESULTS

MiR-221 significantly increased, while SOCS3 obviously reduced in bladder cancer tissue compared with para-carcinoma tissue. MiR-221 targeted inhibited SOCS3 expression. MiR-221, phosphorylated JAK1 (p-JAK1), phosphorylated JAK2 (p-JAK2), phosphorylated STAT3 (p-STAT3), and survivin levels markedly up-regulated, whereas SOCS3 expression apparently declined in T24 cells compared with that in HBEC cells. MiR-221 inhibitor and/or pSicoR-SOCS3 elevated SOCS3 expression, decreased p-JAK1, p-JAK2, p-STAT3, and survivin levels, enhanced cell apoptosis, and attenuated cell proliferation.

CONCLUSIONS

MiR-221 elevated, while SOCS3 reduced in bladder cancer tissue. Inhibition of miR-221 suppressed T24 cell proliferation and induced apoptosis by up-regulating SOCS3 expression, lowering JAK-STAT3 signaling pathway activity, and attenuating survivin expression.

[Application on the quantitative perfusion parameters of dynamic contrast-enhanced MRI in the pathological subtype of uterine leiomyoma]

Objective: To analyze the value of the quantitative perfusion parameters of dynamic contrast-enhanced MRI(DCE-MRI) in the pathological subtype of uterine leiomyoma. Methods: A total of 35 cases of uterine leiomyoma confirmed by surgery and pathology were retrospectively analyzed in Shaoxing People's Hospital from October 2015 to May 2016.All cases underwent DCE-MRI. Quantitative perfusion parameters were prospectively measured and analyzed, including transfer constant (K(trans)) , efflux rate constant (K(ep)), extravascular extracellular space volume ratio (V(e)), blood plasma volume ratio (V(p)), permeability surface area product (PS) and plasma flow (F(p)) , using signal-input two-compartment tracer kinetic models (Extended Tofts model and Exchange model) in 35 leiomyoma cases.After the operation, the 35 cases were divided into three groups according to the pathological classfication , the ordinary, the cellular and the degeneration type.To analyze the differences among the three groups about the quantitative perfusion parameters of uterine leiomyoma. Compared with the gold standard of pathological findings, the ROC curves were drawn to evaluate the diagnostic efficacy of different quantitative perfusion parameters. Results: In the ordinary, cellular and degeneration type of uterine leiomyoma, K(trans) value were respectively(0.684±0.341), (1.897±0.458), (0.554±0.514)/min; K(ep) were respectively(1.004±0.685), (2.362±1.001), (1.274±1.093)/min; V(e) were respectively 0.789%±0.186%, 0.806%±0.203%, 0.537%±0.314%; V(p) were respectively 0.145%±0.196%, 0.502%±0.338%, 0.062%±0.106% and F(p) were respectively(0.792±0.461), (2.426±0.509), (0.628±0.551)ml/min.Among three groups, the value of K(trans), K(ep), V(e), V(p) and F(p) had statistical difference(all P<0.05), the value of PS didn't have statistical difference. The value of K(trans), K(ep), V(p) and F(p) in cellular type were higher than the ordinary type(all P<0.01); the value of K(trans), V(p) and F(p) in cellular type were higher than the degeneration type(all P<0.01); the value of V(e) in ordinary type was higher than the degeneration type(P<0.05). The area under ROC curve was 0.981 for K(trans), 0.904 for K(ep), 0.622 for V(e), 0.840 for V(p) and 0.994 for F(p). Conclusion: The quantitative perfusion parameters of DCE-MRI , especially the value of K(trans), K(ep), V(p) and F(p) have a great diagnostic efficacy in the pathological classfication of uterine leiomyoma which will become a predictive factor of pathological classfication in uterine leiomyoma.

The blood genome-wide DNA methylation analysis reveals novel epigenetic changes in human heart failure

OBJECTIVE

Epigenetic mechanisms, such as microRNA, histone modification, and DNA methylation, are critical for dysregulated gene expression in heart failure (HF). However, the relationship between DNA methylation and dysregulated gene expression of blood leukocytes during HF remains unclear.

PATIENTS AND METHODS

In this study, DNA methylation status and gene expression in blood leukocytes from ischemic end-stage cardiomyopathy patients were compared to normal controls by using reduced representation bisulfite sequencing (RRBS), and the results were validated by quantitative MassARRAY analysis and RT-qPCR.

RESULTS

Three differentially methylated genes between two groups were identified. Furthermore, the differential expression of each corresponding gene was found to be correlated with differential DNA methylation. Diverse blood leukocyte DNA methylations existed in HF patients, which were correlated with differential expression of corresponding genes.

CONCLUSIONS

Therefore, detecting DNA methylation in blood leukocytes could be an attractive approach for HF study.

[The clinical application of retractorless surgery in patients with hypertensive basal ganglia hemorrhage]

Objective: To discuss the clinical feasibility and practical application of retractorless surgical for patients with hypertensive basal ganglia hemorrhage. Methods: A total of 84 patients underwentretractorless surgery in The First People's Hospital of Huzhou from Jun 2014 to Jun 2016 were retrospectively reviewed.There were 53 male and 31 female of the 84 patients. Their mean age were 58.7 years with range: 29-74 years.Glasgow coma scale score(GCS) at admissionwereas follow: GCS 4-5 points 10 cases(including 3 cases companied dilated pupils), GCS 6-8 points 25 cases, GCS 9-12 points 32 cases, and GCS 13-14 points 17 cases.The average volume of hematoma was 50.2 (30-100) mL.Complications related tosurgery and postoperative activities of daily living (ADL) scorewere analyzed. Results: 0f the 84 cases, there were 76 (90.5%) patientswhose intracranial hematoma were removed more than 90%. Postoperative bleeding was occurred in 6 cases (7.1%), all without secondary surgery. Cerebral infarctionwas occurred in 2 cases (2.4%), subcutaneous effusion associated with infectionwas occurred in 7 cases (8.3%). Postoperative follow-up of 58 cases, 85.3% recovered well. Conclusions: With the proficiency in microneurosurgery methods, retractorless surgery couldreduce the related postoperative complications, such as postoperative cerebral infarction.

[Correlative factors on prevalence rate of dislipidemia among 1 337 coal miners in Shanxi province]

Objective: To understand the prevalence rate and correlative factors of dislipidemia among Shanxi coal miners and to provide evidence for the development of programs on dislipidemia prevention. Methods: We investigated 1 337 mine workers from a Coal Group in April 2016 and collected data related to their blood biochemistry. We then classified the types in accordance with the diagnostic criteria of " Guidelines for prevention and treatment of dyslipidemia in Chinese adults (2007)" , using χ(2) test and unconditional logistic regression model for analysis. Results: The overall prevalence rate of Dislipidemia was 59.1% (790/1 337), with males as 60.4% (708/1 173) and females as 50.0%(82/164) while males appeared higher (χ(2)=6.386, P<0.05). Among the 20-34, 35-49, 50 and above year-old groups, the rates were 68.8%, 58.7%, 49.5%, respectively. Results from the χ(2) test showed that gender, age and body mass index were the influencing factors on dislipidemia (χ(2)=7.117, P<0.01; χ(2)=37.135, P<0.01; χ(2)=7.009, P<0.05), while logistic regression analysis showed that sex, age, body mass index level, systolic blood pressure were significantly associated with dislipidemia (P<0.05). Male miners appeared 1.501 times (OR=1.501, 95%CI: 1.895-2.516) higher than female miners in suffering from the risk of dyslipidemia. In different age groups, risks of dyslipidemia in the 35-49, 20-34 year-old groups were 1.672 (OR=1.672, 95%CI: 1.501-2.392) and 2.369 times (OR= 2.369, 95% CI: 1.275-3.469) higher than the 50 year-old. Group that with high BMI, the risk of dyslipidemia was 1.443 times (OR=1.443, 95%CI: 1.139-1.828) higher than the normal BMI group. Group with abnormal systolic pressure was 1.829 times (OR=1.829, 95%CI: 1.152-2.906) higher than normal systolic pressure group. However, diastolic blood pressure, blood sugar, uric acid, and electrocardiogram findings did not seem to show statistically significant meanings on dislipidemia. Conclusion: Among the coal mine workers, those who were males, aged from 20 to 34, having high blood pressure (systolic blood pressure abnormalities) or with high BMI (≥24.0 kg/m(2)) need to be taken special attention on care and prevention of dislipidemia.

[Effect of inserted angle on the stability of loaded microscrews]

Objective: To evaluate the effect of different insertion angles on the osseointegration of loaded microscrews in beagle jaws. Methods: Forty-eight microscrews were inserted at four different angles (30°, 50°, 70° and 90°) into the interradicular zones between the mandibular first molar and third premolar in twelve beagles and the microscrews had been loaded with a force of 2 N immediately for 8 weeks. After microscrew-bone specimens fixed, the maximum output value (F_max) of pull-out test was recorded and the histomorphological changes of hard tissue were observed. The bone-implant contact (BIC%) was quantitatively analyzed and the osseointegration of microscrew-bone interface was comprehensively evaluated. Results: Both F_max and BIC% values of microscrews were influenced by the insertion angles. The maximum value of F_max was (385±23) N in the group with 50° angle, and the minimum value was (198±16) N in the group with 30° angle(P <0.05). The maximum value of BIC% was (59.1±6.0)% in the group with 70° angle, and the minimum value was (30.2±3.2)% in the group with 30° angle (P <0.05). Histomorphology observation revealed that in peri-screws region, the various degree of bone remodeling was found in different angle samples. Conclusions: The insertion angles (50°and 70°) were favorable to the stability of the microscrew.

[Mutation screening of 433 families with Duchenne/Becker muscular dystrophy]

OBJECTIVE

Mutation analysis of unrelated families with Duchenne/Becker muscular dystrophy (DMD/BMD) was performed to investigate the characteristic of DMD gene mutation, especially the distribution pattern of point mutation of DMD gene in Chinese population.

METHODS

A total of 433 unrelated DMD/BMD families were collected at the Center of Prenatal Diagnosis of the First Affiliated Hospital of Zhengzhou University from March 2010 to December 2014. The deletions or duplications in 79 exons of DMD gene were screened using multiplex ligation-dependent probe amplification (MLPA). Any single-exon deletion detected by MLPA was further validated by PCR amplification. In the 117 unrelated Chinese families in which large-scale deletions and duplications had been excluded by MLPA, the point mutation in 79 exons of DMD gene were tested in the propositus using next-generation sequencing (NGS), and further verified the point mutation using Sanger sequencing.

RESULTS

In the 433 unrelated DMD/BMD families, 316 families with DMD deletions/duplications were identified by MLPA. Out of 57 single-exon deletions detected by MLPA, 3 were found as point mutations by PCR and Sanger sequencing, including 2 nonsense mutation (c.1729G>T [p.Glu577X], c. 3346A>T [p.Lys1116X]) and 1 frame-shift mutation (c.8605_8606delGT [p.Val2869ThrfsX25]). Direct sequencing with Ion PGM and Sanger sequencing in 117 families with negative results in MLPA detected 92 different point mutations in 96 families, including 46 novel mutations, 42 previously reported ones, and 4 possible polymorphisms (rs189143447, rs202008454, rs200213555, rs187617705). The 46 novel mutations consisted of 16 nonsense mutations (c.100A>T [p.Lys34X], c. 1201C>T [p.Gln401X], c. 1707C>A [p.Cys569X], c. 1831G>T [p.Glu611X], c. 1912C>T [p.Gln638X], c. 2213C>G [p.Ser738X], c. 3673_3673delA [p.Ile1225X], c. 3774C>A [p.Cys1258X], c. 4858G>T [p.Glu1620X], c. 5764A>T [p.Lys1922X], c. 6035T>G [p.Leu2012X], c. 6408G>A [p.Trp2136X], c. 7717C>T [p.Gln2573X], c. 7864G>T [p.Glu2622X], c. 8184_8185insT [p.Lys2729X], c. 8215C>T [p.Gln2739X]), 5 missense mutations (c.139G>A [p.Gly47Arg], c. 238G>C [p.Ala80Pro], c. 335G>T [p.Trp112Leu], c. 804A>C [p.Leu268Phe], c. 1149G>T [p.Glu383Asp]), 6 splice-site mutations (c.2293-3C>A, c. 2380+ 1G>T, c. 3277-1G>C, c.4519-7A>G, c. 5740-15G>T, c. 7661-1G>C), 16 small deletions (c.688_688delA [p.Met230CysfsX14], c.1760_1791del32 [p.Thr587IlefsX37], c. 2271_2271delA [p.Asp774ThrfsX22], c. 2281_2285delGAAAA [p.Glu761SerfsX10], c. 2527_2527delG [p.Glu843SerfsX3], c. 3405_3405delC [p.Asn1135LysfsX18], c. 4450_4450delC [p.His1484ThrfsX14], c. 4770_4770delA [p.Thr1590ThrfsX5], c. 4937_4937delA [p.Glu1646GlyfsX11], c. 5253_5256delATTA [p.Lys1751LysfsX2], c. 5654_5654delA [p.Gln1885ArgfsX6], c. 7441_7441delG [p.Glu2481AsnfsX13], c. 7860_7860delC [p.Ile2620IlefsX18], c. 8668-8668delG /c.8668+ 1-8668+ 1delG, c. 9009_9009delC [p.Thr3003ThrfsX18], c. 9021_9021delT [p.Ile3007IlefsX14]), and 3 small insertions (c.305_306insG [p.Gly102GlyfsX4], c. 3116_3117insA [p.His1039GlufsX11], c. 9197_9198insATCTC [p.Ser3066SerfsX25]). And 87.4% (83/95) of the pathologic point mutations disrupted the translational reading frame (46 nonsense mutations, 24 frame-shift mutations, and 13 splice-site mutations).

CONCLUSIONS

Inexpensive and efficient genetic/prenatal diagnosis of DMD/BMD may be plausible by MLPA analysis, NGS, and Sanger sequencing. Most of the mutations identified in this study led to a predictable premature stop codon or splicing defects, resulting in defective function of dystrophin.

Changes of expression of estrogen and progestrone receptors, human epithelial growth factor receptor 2 and Ki-67 after neoadjuvant chemotherapy in the treatment of breast cancer

Recent studies suggest that the development and prognosis of breast cancer is in close correlation to molecular subtype of breast cancer. Neoadjuvant chemotherapy has been extensively applied in the treatment of local breast cancer in advanced stage. In order to verify the correlation between expression changes of estrogen receptor, progestrone receptor, human epithelial growth factor receptor 2 and Ki-67 after neoadjuvant chemotherapy and neoadjuvant chemotherapy, we studied 120 patients with stage IIAIIIC breast cancer who underwent neoadjuvant chemotherapy in Binzhou Medical University Hospital, Shandong, China from February 2011 to February 2015. Clinical characteristics were retrospectively analyzed. The expression of estrogen receptor, progesterone receptor, human epithelial growth factor receptor 2 and Ki-67 of patients were detected using the immunohistochemical method before and after neoadjuvant chemotherapy. The results suggest that the overall remission rate of neoadjuvant chemotherapy was 76.7% (92/120) of which 16.7% (20/120) of cases had complete remission, 60% (72/120) had partial remission and 23.3% (28/120) were stable. There were no cases of progressive disease. The property of estrogen receptor and the expression of Ki-67 of primary tumor were correlated to the remission rate of neoadjuvant chemotherapy (P less than 0.05). The expression of Ki-67 had a significant decline after neoadjuvant chemotherapy, and the difference had statistical significance (P less than 0.05). The difference in expression of estrogen receptor, progesterone receptor and human epithelial growth factor receptor 2 before and after neoadjuvant chemotherapy had statistical significance (P > 0.05). Hence, it can be concluded that breast cancer patients with negative estrogen receptor expression and high Ki-67 expression before neoadjuvant chemotherapy can achieve better curative effects. Neoadjuvant chemotherapy cannot change the expression states of estrogen receptor, progesterone receptor and human epithelial growth factor receptor 2, but it can lower the expression level of Ki-67. Ki-67 can also be used for predicting the curative effect of neoadjuvant chemotherapy.

Changes in methylation of genomic DNA from chicken immune organs in response to H5N1 influenza virus infection

DNA methylation is an important epigenetic modification in eukaryotes, which plays a significant role in regulating gene expression. When the host is invaded by the influenza virus, gene expression is regulated via changes in DNA methylation levels or patterns, leading to the activation or suppression of relevant signaling pathways or networks, triggering a series of immune responses against viral invasion. Here, we investigated the changes in genomic DNA methylation in the immune organs of chicken infected with H5N1 influenza virus. Genome-wide DNA methylation levels in the spleen, thymus, and bursa of Fabricius of specific pathogen-free (SPF) chicken infected with the Guangdong (G-H5N1) and Anhui (A-H5N1) H5N1 strains, and water (control) were analyzed by fluorescence-labeled methylation-sensitive amplified polymorphism (F-MSAP). The results indicated that total DNA methylation levels did not differ between spleen genomic DNA in chicken treated with different viral strains and the control (P > 0.05). However, the total DNA methylation levels were significantly upregulated in the thymus (P < 0.01) and bursa (P < 0.05) of chicken in the A-H5N1 group compared to those in the G-H5N1 and control groups. These results provide a basis for the screening of avian influenza-resistance genes or methylation markers, analyzing the epigenetic regulation mechanisms of avian influenza, and performing selective breeding for disease resistance.

Tonsillectomy and inflammatory bowel disease: a meta-analysis

AIM

The pathogenesis of inflammatory bowel diseases remains unclear. Genetic and environmental factors are involved. Studies of the association between tonsillectomy and inflammatory bowel disease have yielded conflicting results.

METHOD

PubMed and EMBASE were searched to identify studies evaluating the association between tonsillectomy and inflammatory bowel disease [Crohn's disease (CD) and ulcerative colitis (UC)]. Odds ratios with 95% CI were calculated using a random- or fixed-effects model. The χ(2) test and I(2) test were used to assess homogeneity. Egger's test was used to evaluate publication bias.

RESULTS

Thirteen observational case-control studies including 4122 patients (3035 UC/1087 CD) and 5103 controls were analysed. The summary odds ratio estimated for UC following a tonsillectomy was 0.932, 95% CI 0.819-1.062. The odds ratio for CD following a tonsillectomy was 1.194, 95% CI 0.992-1.437. Publication bias was not detected (Egger's test coefficient -3.50 to 1.55; P = 0.39).

CONCLUSION

No obvious association between tonsillectomy and inflammatory bowel disease was identified in our meta-analysis.

[ZNF143 is involved in CTCF-mediated chromatin interactions by cooperation with cohesin and other partners]

ZNF143 is a ubiquitously expressed transcription factor conserved in vertebrates and might regulate the expression of numerous genes. But its function in mediating chromatin interactions remains elusive. By integrated analysis of public datasets, we provided evidence that a majority of ZNF143 binding sites (BSs) were involved in CTCF-mediated chromatin interaction networks (CTCF-CINs) by overlapping with cohesin-BSs and CTCF-BSs. We further showed that only a very few CTCF-CINs were associated with ZNF143 alone, whereas those associated with ZNF143 and cohesin simultaneously were highly overlapped with constitutive, conserved CTCF-BSs and enriched at boundaries of chromatin topologically associating domains. These observations implicate that as an important partner of CTCF, ZNF143 helps it establish the conserved chromatin structure by cooperating with cohesin.

[Clinical features of Takayasu arteritis patients with pulmonary hypertension due to pulmonary artery involvement]

OBJECTIVE

To summarize the clinical features of Takayasu arteritis (TA) patients with pulmonary hypertension due to pulmonary artery involvement.

METHODS

Ninety-four TA patients with pulmonary artery involvement treated in Fuwai Hospital from Jun 1988 to Jun 2014 were retrospectively summarized. Patients were divided into two groups according to whether aorta and its main branches affected (APTA, n=48) or not (PTA, n=46). Clinical features and angiographic data were further analyzed.

RESULTS

Of all the patients, male to female rate was 1∶3.3, age ranged from 8 to 60 years with median age of 33.5 years when symptom onset. Main symptoms included dyspnea on exertion. Heart murmur and mid-systolic murmur in pulmonic area were commonly found by physical examination. All patients had pulmonary hypertension by echocardiographic examination. Angiographic data showed that multi-lobular and multi-segmental pulmonary branches were predominantly affected, followed by sub-segmental and peripheral branches. Both sides of pulmonary artery involvement were more common than one side involvement, while the right pulmonary arteries were more often affected than the left. Most of the clinical symptoms and signs between APTA group and PTA group were comparable. However, erythrocyte sedimentation rate and N-terminal pro-natriuretic peptide were significant higher in APTA group than that in PTA group when admission [14.0(5.0, 28.0) vs 8.5(3.0, 19.3) mm/1 h and (1 936±1 769) vs (1 627±1 153) ng/L, both P<0.05].

CONCLUSIONS

Dyspnea on exertion may be the main manifestation of TA with pulmonary artery involvement. All patients present with pulmonary hypertension and moderate to severe heart failure when symptom onset.

BLCA-4 and UBC combined detection for early diagnosis of bladder cancer

The objective of the present study was to report the clinical significance of bladder cancer specific nuclear matrix protein 4 (BLCA-4) and urinary bladder cancer (UBC) on early diagnosis of bladder cancers. Enzyme-linked immunosorbent assay (ELISA) was used to detect BLCA-4 and UBC of 56 bladder cancer patients and 26 patients with urinary tract benign diseases, serving as controls. Urine exfoliated cell test was performed, and then the significance of BLCA-4 and UBC on the diagnosis of bladder cancers was analyzed. The sensitivity of BLCA-4 and UBC of the bladder cancer patients was significantly higher than that of the urine exfoliated cell test (P less than 0.05). The difference of BLCA-4 and UBC was not significant (P >0.05). The difference of BLCA-4 and UBC in the tumors with different gradings and stagings was not significant (P >0.05). Combined detection of BLCA-4 and UBC could improve the diagnosis sensitivity and specificity of bladder cancers with the advantages of high maneuverability, repeatability and objective results.

[Clinical characteristics and outcomes of patients with acute aortic dissection: impact of hypertension]

OBJECTIVE

To observe the clinical characteristics and outcomes of patients with acute aortic dissection (AAD) and explore the impact of hypertension.

METHODS

The present study enrolled 1 087 consecutive patients with AAD who were confirmed by computed tomographic scanning in Fuwai Hospital from January 2008 to December 2010. The major endpoints were in-hospital death and long-term mortality during follow up.

RESULTS

A total of 595 (54.7%) patients were Stanford type A and 492 (45.3%) patients were Stanford type B. The median length of follow-up was 24.2 months (interquartile range 10.9, 40.8 months). The prevalence of hypertension was 67.4%(733 cases), and was significantly higher in type B patients than in type A patients (71.3%(351/492) vs. 64.2%(382/595), P=0.01). Regardless of Stanford classification, patients complicating with hypertension were older, had higher comorbidities (coronary heart diseases or diabetes), and less likely to receive surgical treatment compared with those without hypertension (all P<0.05). In Stanford type A AAD group, patients with hypertension had higher levels of admission blood pressure, serum creatinine and inflammatory markers (including WBC count, D-dimer and CRP) than those without hypertension (all P<0.05). In-hospital death (9.9% (38/382)vs. 5.6%(12/213), P=0.07) and long-term mortality (9.0% (31/344) vs. 8.9% (18/201), P=0.98) were similar in hypertensive and normotensive AAD type A patients. In type B AAD group, the in-hospital death rate was significantly higher in patients with hypertension than those without hypertension (5.4%(19/351) vs. 0.7%(1/141), P=0.02), while the long-term mortality was similar (6.9%(23/332) vs. 7.9%(11/140), P=0.71) between patients with and without hypertension. Multiple logistic regression analysis showed that hypertension did not predict the increased risk of in-hospital death of type A or type B AAD patients. The main protective factor of in-hospital mortality was operation in patients with type A AAD. The independent predictors of in-hospital death were age and surgical treatment in patients with type B AAD.

CONCLUSIONS

Hypertension is a common co-morbidity in patients with AAD. AAD patients with hypertension are usually elder, have higher comorbidities of cardiovascular diseases, and less likely to receive surgical treatment compared with those without hypertension, but hypertension is not associated with increased risk of in-hospital and long-term mortality in both AAD type A and type B patients.