[Endometriosis-related recurrent unilateral hemorrhagic pleural effusion: a case report]

Hemorrhagic pleural effusion (PE) is common in clinical practice. According to the guidelines, the etiological diagnosis of PE should focus on the identification of common diseases. In most cases, the etiology of PE can be determined by clinical history, physical examination, laboratory and imaging examinations, and pleural biopsy or video-assisted thoracic surgery (VAST). We reported a rare case of a 32-year-old woman with recurrent unilateral hemorrhagic pleural effusion (highly correlated with menstrual cycle) and chest pain that was diagnosed as thoracic endometriosis syndrome (TES) by pathological biopsy and immunohistochemistry. Later she underwent surgery combined with hormone therapy. During the follow-up, the right PE decreased, and she had no chest pain. Therefore, women of reproductive age with regular unilateral bloody pleural effusions should be alert to TES.

Efficacy of the 'Five-Needle' method for pancreatojejunostomy in laparoscopic pancreaticoduodenectomy: an observational study

Objective

The five-needle pancreato-intestinal anastomosis method is used in laparoscopic pancreaticoduodenectomy (LPD). The aim of this study was to explore the clinical efficacy and adverse reactions of this new surgical method and to provide a scientific reference for promoting this new surgical method in the future.

Methods

A single-centre observational study was conducted to evaluate the safety and practicality of the five-needle method for pancreatojejunostomy in LPD surgeries. The clinical data of 78 patients who were diagnosed with periampullary malignancies and underwent LPD were collected from the 1st of August 2020 to the 31st of June 2023 at Lanzhou University First Hospital. Forty-three patients were treated with the 'Five-Needle' method (test groups), and 35 patients were treated with the 'Duct-to-Mucosa' method (control group) for pancreatojejunostomy. These two methods are the most commonly used and highly preferred pancreatointestinal anastomosis methods worldwide. The primary outcome was pancreatic fistula, and the incidence of which was compared between the two groups.

Results

The incidence of pancreatic fistula in the five-needle method group and the duct-to-mucosa method group was not significantly different (25.6% vs. 28.6%, p=0.767). Additionally, there were no significant differences between the two groups in terms of intraoperative blood loss (Z=-1.330, p=0.183), postoperative haemorrhage rates (p=0.998), length of postoperative hospital stay (Z=-0.714, p=0.475), bile leakage rate (p=0.745), or perioperative mortality rate (p=0.999). However, the operative time in the 'Five-Needle' method group was significantly shorter than that in the 'Duct-to-Mucosa' method group (270 ± 170 mins vs. 300 ± 210 mins, Z=-2.336, p=0.019). Further analysis revealed that in patients with pancreatic ducts smaller than 3 mm, the incidence of pancreatic fistula was lower for the 'Five-Needle' method than for the 'Duct-to-Mucosa' method (12.5% vs. 53.8%, p=0.007).

Conclusion

The five-needle method is safe and efficient for pancreatojejunostomy in LPD, and is particularly suitable for anastomosis in nondilated pancreatic ducts. It is a promising, valuable, and recommendable surgical method worthy of wider adoption.

Artificial kagome lattices of Shockley surface states patterned by halogen hydrogen-bonded organic frameworks

Artificial electronic kagome lattices may emerge from electronic potential landscapes using customized structures with exotic supersymmetries, benefiting from the confinement of Shockley surface-state electrons on coinage metals, which offers a flexible approach to realizing intriguing quantum phases of matter that are highly desired but scarce in available kagome materials. Here, we devise a general strategy to construct varieties of electronic kagome lattices by utilizing the on-surface synthesis of halogen hydrogen-bonded organic frameworks (XHOFs). As a proof of concept, we demonstrate three XHOFs on Ag(111) and Au(111) surfaces, which correspondingly deliver regular, breathing, and chiral breathing diatomic-kagome lattices with patterned potential landscapes, showing evident topological edge states at the interfaces. The combination of scanning tunnelling microscopy and noncontact atomic force microscopy, complemented by density functional theory and tight-binding calculations, directly substantiates our method as a reliable and effective way to achieve electronic kagome lattices for engineering quantum states.

Draft genome of Brasenia schreberi, a worldwide distributed and endangered aquatic plant

OBJECTIVES

Brasenia is a monotypic genus in the family of Cabombaceae. The only species, B. schreberi, is a macrophyte distributed worldwide. Because it requires good water quality, it is endangered in China and other countries due to the deterioration of aquatic habitats. The young leaves and stems of B. schreberi are covered by thick mucilage, which has high medical value. As an allelopathic aquatic plant, it can also be used in the management of aquatic weeds. Here, we present its assembled and annotated genome to help shed light on medial and allelopathic substrates and facilitate their conservation.

DATA DESCRIPTION

Genomic DNA and RNA extracted from B. schreberi leaf tissues were used for whole genome and RNA sequencing using a Nanopore and/or MGI sequencer. The assembly was 1,055,148,839 bp in length, with 92 contigs and an N50 of 22,379,495 bp. The repetitive elements in the assembly were 555,442,205 bp. A completeness assessment of the assembly with BUSCO and compleasm indicated 88.4 and 90.9% completeness in the Eudicots database and 95.4 and 96.6% completeness in the Embryphyta database. Gene annotation revealed 67,747 genes that coded for 73,344 proteins.

Characterization of Firmiana danxiaensis plastomes and comparative analysis of Firmiana: insight into its phylogeny and evolution

BACKGROUND

Firmiana danxiaensis is a critically endangered and ecologically important tree currently only found in four locations in Danxia or Karst habitats in northern Guangdong Province, China. The specialized habitat preference makes it an ideal model species for study of adaptive evolution. Meanwhile, the phylogenetic relationships of F. danxiaensis in four locations under two landforms are unclear. Therefore, we sequenced its complete chloroplast (cp.) genomes and conducted comprehensive interspecific and intrageneric plastome studies.

RESULTS

The F. danxiaensis plastomes in four locations showed a typical quadripartite and circular structure that ranged from 160,832 to 161,206 bp in size, with 112 unique genes encoded. Comparative genomics showed that the plastomes of F. danxiaensis were relatively conserved with high similarity of genome organization, gene number, GC content and SSRs. While the genomes revealed higher biased codon preferences in Karst habitat than those in Danxia habitats. Eighteen and 11 divergent hotpots were identified at interspecific and intrageneric levels for species identification and further phylogenetic studies. Seven genes (clpP, accD, ccsA, ndhH, rpl20, rpoC2, and rps4) were under positive selection and may be related to adaptation. Phylogenetic analysis revealed that F. danxiaensis is sister to F. major and F. simplex. However, the interspecific relationships are not consistent with the habitat types.

CONCLUSIONS

The characteristics and interspecific relationship of F. danxiaensis plastomes provide new insights into further integration of geographical factors, environmental factors, and genetic variations on the genomic study of F. danxiaensis. Together, our study will contribute to the study of species identification, population genetics, and conservation biology of F. danxiaensis.

Chromosome-level genome assembly and demographic history of Euryodendron excelsum in monotypic genus endemic to China

Euryodendron excelsum is in a monotypic genus Euryodendron, endemic to China. It has intermediate morphisms in the Pentaphylacaceae or Theaceae families, which make it distinct. Due to anthropogenic disturbance, E. excelsum is currently found in very restricted and fragmented areas with extremely small populations. Although much research and effort has been applied towards its conservation, its long-term survival mechanisms and evolutionary history remain elusive, especially from a genomic aspect. Therefore, using a combination of long/short whole genome sequencing, RNA sequencing reads, and Hi-C data, we assembled and annotated a high-quality genome for E. excelsum. The genome assembly of E. excelsum comprised 1,059,895,887 bp with 99.66% anchored into 23 pseudo-chromosomes and a 99.0% BUSCO completeness. Comparative genomic analysis revealed the expansion of terpenoid and flavonoid secondary metabolite genes, and displayed a tandem and/or proximal duplication framework of these genes. E. excelsum also displayed genes associated with growth, development, and defence adaptation from whole genome duplication. Demographic analysis indicated that its fluctuations in population size and its recent population decline were related to cold climate changes. The E. excelsum genome assembly provides a highly valuable resource for evolutionary and ecological research in the future, aiding its conservation, management, and restoration.

[Comparison of the anorectal function before and after neoadjuvant radiotherapy in mid-low rectal cancer: a retrospective observational study from single center]

Objective: The aim of this study was to evaluate the impact of neoadjuvant radiotherapy on anorectal function of patients with mid-low rectal cancer by means of high-resolution anorectal manometry. Methods: A retrospective observational study was conducted. Information on patients with mid-low rectal cancer was collected from the prospective registry database of Rectal Cancer at Peking Union Medical College Hospital (PUMCH) from June 2020 to April 2023. Anorectal functions were detected using three-dimensional high-resolution manometry system. Logistic regression analysis was performed to identify the factors associated with the changed anorectal manometry. Results: A total of 45 patients with mid-low rectal cancer were included in the study. Thirty-two (71.1%) patients were male, 13 (28.9%) patients were female. The mean age was 60±11 years, and the mean BMI was 23.4±3.7 kg/m2. The mean distance between the lower edge of the tumor and the anal verge was 5.4±1.5 cm. The median size of the tumor was 3.4 (2.9-4.5) cm, and the median circumferential extent of the tumor was 66.0 (45.5-75.0) %. 41 (81.1%) patients were MRI T3-4 and 40 (88.9%) patients were MRI N positive. The resting pressure has a decreasing trend after neoadjuvant radiotherapy (55.3±32.0 mmHg vs. 48.0±28.5 mmHg, t=1.930, P=0.060). There was no significant change in maximum squeezing and the length of the high-pressure zone after neoadjuvant radiotherapy. All volumes describing rectal sensitivity (first sensation, desire to defecate, and maximum tolerance) were lower after neoadjuvant radiotherapy. And maximum tolerance was significantly lower (66.0 [49.0,88.0] ml vs. 52.0 [39.0,73.5] ml, Z=-2.481,P=0.013). Univariate analysis demonstrated that the downstage of N-stage was associated with the decrease in maximum tolerance (OR=6.533, 95%CI:1.254-34.051, P=0.026). Conclusion: Neoadjuvant radiotherapy damages anorectal function by decreasing the resting pressure and rectal sensory threshold of patients. The N-stage downstaging was associated with a decrease in maximum tolerance.

Draft genome of Castanopsis chinensis, a dominant species safeguarding biodiversity in subtropical broadleaved evergreen forests

OBJECTIVES

Castanopsis is the third largest genus in the Fagaceae family and is essentially tropical or subtropical in origin. The species in this genus are mainly canopy-dominant trees, and the key components of evergreen broadleaved forests play a crucial role in the maintenance of local biodiversity. Castanopsis chinensis, distributed from South China to Vietnam, is a representative species. It currently suffers from a high disturbance of human activity and climate change. Here, we present its assembled genome to facilitate its preliminary conservation and breeding on the genome level.

DATA DESCRIPTION

The C. chinensis genome was assembled and annotated by Nanopore and MGI whole-genome sequencing and RNA-seq reads using leaf tissues. The assembly was 888,699,661 bp in length, consisting of 133 contigs and a contig N50 of 23,395,510 bp. A completeness assessment of the assembly with Benchmarking Universal Single-Copy Orthologs (BUSCO) indicated a score of 98.3%. Repetitive elements comprised 471,006,885 bp, accounting for 55.9% of the assembled sequences. A total of 51,406 genes that coded for 54,310 proteins were predicted. Multiple databases were used to functionally annotate the protein sequences.

Genome assembly of Erythrophleum Fordii, a special "ironwood" tree in China

OBJECTIVES

Erythrophleum is a genus in the Fabaceae family. The genus contains only about 10 species, and it is best known for its hardwood and medical properties worldwide. Erythrophleum fordii Oliv. is the only species of this genus distributed in China. It has superior wood and can be used in folk medicine, which leads to its overexploitation in the wild. For its effective conservation and elucidation of the distinctive genetic traits of wood formation and medical components, we present its first genome assembly.

DATA DESCRIPTION

This work generated ~ 160.8 Gb raw Nanopore whole genome sequencing (WGS) long reads, ~ 126.0 Gb raw MGI WGS short reads and ~ 29.0 Gb raw RNA-seq reads using E. fordii leaf tissues. The de novo assembly contained 864,825,911 bp in the E. fordii genome, with 59 contigs and a contig N50 of 30,830,834 bp. Benchmarking Universal Single-Copy Orthologs (BUSCO) revealed 98.7% completeness of the assembly. The assembly contained 471,006,885 bp (54.4%) repetitive sequences and 28,761 genes that coded for 33,803 proteins. The protein sequences were functionally annotated against multiple databases, facilitating comparative genomic analysis.

[Application value of CT examination of lymph node short diameter in evaluating cardia-left gastric lymph node metastasis in thoracic esophageal squamous cell carcinoma]

Objective: To investigate the application value of computed tomography (CT) examination of lymph node short diameter in evaluating cardia-left gastric lymph node metastasis in thoracic esophageal squamous cell carcinoma (ESCC). Methods: A total of 477 patients with primary thoracic ESCC who underwent surgical treatment in the Affiliated Cancer Hospital of Zhengzhou University from January 2013 to December 2017 were collected. All of them underwent McKeown esophagectomy plus complete two-field or three-field lymph node dissection. Picture archiving and communication system were used to measure the largest cardia-left gastric lymph node short diameter in preoperative CT images. The postoperative pathological diagnosis results of cardia-left gastric lymph node were used as the gold standard. Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of CT lymph node short diameter in detecting the metastasis of cardia-left gastric lymph node in thoracic ESCC, and determine the optimal cut-off value. Results: The median short diameter of the largest cardia-left gastric lymph node was 4.1 mm in 477 patients, and the largest cardia-left gastric lymph node short diameter was less than 3 mm in 155 cases (32.5%). Sixty-eight patients had cardia-left gastric lymph node metastases, of which 38 had paracardial node metastases and 41 had left gastric node metastases. The lymph node ratios of paracardial node and left gastric node were 4.0% (60/1 511) and 3.3% (62/1 887), respectively. ROC curve analysis showed that the area under the curve of CT lymph node short diameter for evaluating cardia-left gastric lymph node metastasis was 0.941 (95% CI: 0.904-0.977; P<0.05). The optimal cut-off value of CT examination of the cardia-left gastric lymph node short diameter was 6 mm, and the corresponding sensitivity, specificity and accuracy were 85.3%, 91.7%, and 90.8%, respectively. Conclusion: CT examination of lymph node short diameter can be a good evaluation of cardia-left gastric lymph node metastasis in thoracic ESCC, and the optimal cut-off value is 6 mm.

Genome Assembly of Cordia subcordata, a Coastal Protection Species in Tropical Coral Islands

Cordia subcordata trees or shrubs, belonging to the Boraginaceae family, have strong resistance and have adapted to their habitat on a tropical coral island in China, but the lack of genome information regarding its genetic background is unclear. In this study, the genome was assembled using both short/long whole genome sequencing reads and Hi-C reads. The assembled genome was 475.3 Mb, with 468.7 Mb (99.22%) of the sequences assembled into 16 chromosomes. Repeat sequences accounted for 54.41% of the assembled genome. A total of 26,615 genes were predicted, and 25,730 genes were functionally annotated using different annotation databases. Based on its genome and the other 17 species, phylogenetic analysis using 336 single-copy genes obtained from ortholog analysis showed that C. subcordata was a sister to Coffea eugenioides, and the divergence time was estimated to be 77 MYA between the two species. Gene family evolution analysis indicated that the significantly expanded gene families were functionally related to chemical defenses against diseases. These results can provide a reference to a deeper understanding of the genetic background of C. subcordata and can be helpful in exploring its adaptation mechanism on tropical coral islands in the future.

Identifying topological corner states in two-dimensional metal-organic frameworks

Due to the diversity of molecular building blocks, the two-dimensional (2D) metal-organic frameworks (MOFs) are ideal platforms to realize exotic lattice models in condensed matter theory. In this work, we demonstrate the universal existence of topological corner states in 2D MOFs with a star lattice configuration, and confirm the intriguing higher-order nontrivial topology in the energy window between two Kagome-bands, or between Dirac-band and four-band. Furthermore, combining first-principles calculations and scanning tunneling microscopy measurements, the unique topological corner state is directly identified in monolayer Ni3(HITP)2 (HITP = 2,3,6,7,10,11-hexaiminotriphenylene) grown on the Au(111) substrate. Our results not only illustrate the first organic topological state in the experiments, but also offer an exciting opportunity to study higher-order topology in 2D MOFs with the large insulating band gap.

[The comparison between endoscopic and surgical treatment of delayed iatrogenic bile duct injury by propensity score matching]

Objective: To compare the safety and clinical efficacy of endoscopic and surgical treatment of patients with delayed iatrogenic bile duct injury (DBDI) with severity (SG) grade 1 to 2. Methods: The clinical data of 129 patients with SG grade 1 to 2 DBDI who received endoscopic or surgical treatment in the First Hospital of Lanzhou University from November 2007 to November 2021 were retrospectively collected. There were 46 males and 83 females,aged (M(IQR)) 54(22)years(range: 21 to 82 years). The baseline data of the two groups were matched 1∶1 by propensity score matching(caliper value was 0.2). Independent sample t test,rank sum test,χ2 test or Fisher exact probability test were used to analyze the data of the two matched groups. Results: There were 48 patients in each of the endoscopic treatment and surgical groups after matching,and there was no difference in general information between the two groups(both P>0.05). The bile duct injury-repair interval and intraoperative anesthesia complications were not statistically significant between the two groups after matching(all P>0.05). Compared with the surgical group, patients in the endoscopic treatment group had significantly shorter operative time(50 (30) minutes vs. 185 (100) minutes, Z=7.675,P<0.01) and postoperative hospital stay(5 (5) days vs. 12 (7) days, Z=5.848, P<0.01).For safety,there was no statistical difference in the incidence of immediate postoperative complications between the two groups with Clavien-Dindo classification of surgical complications<Ⅲ;the incidence of serious postoperative complications (Clavien-Dindo classification of surgical complications≥Ⅲ) was significantly higher in the surgical group than in the endoscopic treatment group(P=0.012). The incidence of long-term postoperative complications was not statistically different between the two groups(28.1% vs. 20.7%,P=0.562). In terms of efficacy,the postoperative liver function indexes of patients in both groups improved significantly compared with the preoperative period and returned to normal or near normal levels; the postoperative infection indexes of both groups showed an increasing trend,but were within the normal range. Of the 96 patients in both groups,61 obtained follow-up,and the follow-up time was (89.4±48.0)months(range: 3 to 165 months),and there was no statistical difference between the two groups(P=0.079). The probability of excellent long-term follow-up (78.1% vs. 86.2%) was not statistically different between the two groups(P=0.412).In patients with Strasberg-Bismuth type E1,the probability of excellent long-term follow-up was higher in the endoscopic treatment group compared with the surgical group(13/14 vs. 2/5,P=0.037). Conclusions: For DBDI patients with SG grade 1 to 2 and bile duct continuity,endoscopy can be used as the first deterministic treatment. The advantages of endoscopic therapy compared to surgery are the lower incidence of postoperative serious complications,and the shorter duration of surgery and postoperative hospital stay.

[Comparison between laparoscopic-assisted natural orifice specimen extraction surgery and conventional laparoscopic surgery for left colorectal cancer: 5-year follow-up results of a randomized controlled study]

Objective: To evaluate the long-term efficacy of laparoscopic-assisted natural orifice specimen extraction surgery (NOSES) colectomy using Cai tube for treating left-sided colorectal cancer. Methods: This was a randomized controlled trial. Inclusion criteria were as follows: preoperative pathological diagnosis of left-sided colorectal adenocarcinoma (rectal, sigmoid colon, descending colon, or left transverse colon cancer with the caudad margin ≥8 cm from the anal margin); preoperative abdominal and pelvic computed tomography (or magnetic resonance imaging) showing maximum tumor diameter <4.5 cm; and BMI <30 kg/m2. Patients with synchronous multiple primary cancers or recurrent cancers, a history of neoadjuvant chemoradiotherapy, preoperative evidence of significant local infiltration, distant metastasis, or complications such as intestinal obstruction and intestinal perforation, or who were not otherwise considered suitable for laparoscopic surgery were excluded. A random number table was used to randomize sequential patients to NOSES surgery using Cai tube (non-assisted incision anal sleeve: patent number ZL201410168748.2) (NOSES group) or traditional laparoscopic-assisted surgery (CLS group). Relevant clinical data of the two groups of patients were analyzed, the main outcomes being disease-free survival, overall survival, overall recurrence rate, and local recurrence rate 5 years after surgery. Results: Patients in both study groups completed the surgery successfully with no requirement for additional surgery. After mean 70 (7-83) months postoperative follow-up, the 5-year overall postoperative survival in the NOSES and CLS groups was 90.0% and 83.3%, respectively (P=0.455); disease free survival was 90.0% and 83.3%, respectively (P=0.455); overall recurrence rate 6.6% and 10.0%, respectively (P=0.625); and local recurrence rate both were 3.3% (P=0.990), respectively. None of these differences was statistically significant. Conclusions: NOSES and CLS have similar long-term efficacy, and NOSES deserves to be used in clinical practice.

[Specimen extraction through natural orifices with Cai tubes in gastrointestinal surgery: a single-institute series of 234 cases]

Objective: To investigate the feasibility of Cai tube-assisted natural orifice specimen extraction surgery (NOSES) in gastrointestinal surgery. Methods: This was a descriptive case-series study. Inclusion criteria: (1) colorectal or gastric cancer diagnosed by preoperative pathological examination or redundant sigmoid or transverse colon detected by barium enema; (2) indications for laparoscopic surgery; (3) body mass index <30 kg/m² (transanal surgery) and 35 kg/m² (transvaginal surgery); (4) no vaginal stenosis or adhesions in female patients undergoing transvaginal specimen extraction; and (5) patients with redundant colon aged 18-70 years and a history of intractable constipation for more than 10 years. Exclusion criteria: (1) colorectal cancer with intestinal perforation or obstruction, or gastric cancer with gastric perforation, gastric hemorrhage, or pyloric obstruction; (2) simultaneous resection of lung, bone, or liver metastases ; (3) history of major abdominal surgery or intestinal adhesions; and (4) incomplete clinical data. From January 2014 to October 2022, 209 patients with gastrointestinal tumors and 25 with redundant colons who met the above criteria were treated by NOSES utilizing a Cai tube (China invention patent number:ZL201410168748.2) in the Department of Gastrointestinal Surgery, Zhongshan Hospital, Xiamen University. The procedures included eversion and pull-out NOSES radical resection in 14 patients with middle and low rectal cancer, NOSES radical left hemicolectomy in 171 patients with left-sided colorectal cancer, NOSES radical right hemicolectomy in 12 patients with right-sided colon cancer, NOSES systematic mesogastric resection in 12 patients with gastric cancer, and NOSES subtotal colectomy in 25 patients with redundant colons. All specimens were collected by using an in-house-made anal cannula (Cai tube) with no auxiliary incisions. The primary outcomes included 1-year recurrence-free survival (RFS) and postoperative complications. Results: Among 234 patients, 116 were male and 118 were female. The mean age was (56.6±10.9) years. NOSES was successfully completed in all patients without conversion to open surgery or procedure-related death. The negative rate of circumferential resection margin was 98.8% (169/171) with both two positive cases having left-sided colorectal cancer. Postoperative complications occurred in 37 patients (15.8%), including 11 cases (4.7%) of anastomotic leakage, 3 cases(1.3%) of anastomotic bleeding, 2 cases (0.9%) of intraperitoneal bleeding, 4 cases (1.7%) of abdominal infection, and 8 cases (3.4%) of pulmonary infection. Reoperations were required in 7 patients (3.0%), all of whom consented to creation of an ileostomy after anastomotic leakage. The total readmission rate within 30 days after surgery was 0.9% (2/234). After a follow-up of (18.3±3.6) months, the 1-year RFS was 94.7%. Five of 209 patients (2.4%) with gastrointestinal tumors had local recurrence, all of which was anastomotic recurrence. Sixteen patients (7.7%) developed distant metastases, including liver metastases(n=8), lung metastases(n=6), and bone metastases (n=2). Conclusion: NOSES assisted by Cai tube is feasible and safe in radical resection of gastrointestinal tumors and subtotal colectomy for redundant colon.

Draft genome and transcriptome of Nepenthes mirabilis, a carnivorous plant in China

OBJECTIVES

Nepenthes belongs to the monotypic family Nepenthaceae, one of the largest carnivorous plant families. Nepenthes species show impressive adaptive radiation and suffer from being overexploited in nature. Nepenthes mirabilis is the most widely distributed species and the only Nepenthes species that is naturally distributed within China. Herein, we reported the genome and transcriptome assemblies of N. mirabilis. The assemblies will be useful resources for comparative genomics, to understand the adaptation and conservation of carnivorous species.

DATA DESCRIPTION

This work produced ~ 139.5 Gb N. mirabilis whole genome sequencing reads using leaf tissues, and ~ 21.7 Gb and ~ 27.9 Gb of raw RNA-seq reads for its leaves and flowers, respectively. Transcriptome assembly obtained 339,802 transcripts, in which 79,758 open reading frames (ORFs) were identified. Function analysis indicated that these ORFs were mainly associated with proteolysis and DNA integration. The assembled genome was 691,409,685 bp with 159,555 contigs/scaffolds and an N50 of 10,307 bp. The BUSCO assessment of the assembled genome and transcriptome indicated 91.1% and 93.7% completeness, respectively. A total of 42,961 genes were predicted in the genome identified, coding for 45,461 proteins. The predicted genes were annotated using multiple databases, facilitating future functional analyses of them. This is the first genome report on the Nepenthaceae family.

Genome assembly of Musa beccarii shows extensive chromosomal rearrangements and genome expansion during evolution of Musaceae genomes

BACKGROUND

Musa beccarii (Musaceae) is a banana species native to Borneo, sometimes grown as an ornamental plant. The basic chromosome number of Musa species is x = 7, 10, or 11; however, M. beccarii has a basic chromosome number of x = 9 (2n = 2x = 18), which is the same basic chromosome number of species in the sister genera Ensete and Musella. Musa beccarii is in the section Callimusa, which is sister to the section Musa. We generated a high-quality chromosome-scale genome assembly of M. beccarii to better understand the evolution and diversity of genomes within the family Musaceae.

FINDINGS

The M. beccarii genome was assembled by long-read and Hi-C sequencing, and genes were annotated using both long Iso-seq and short RNA-seq reads. The size of M. beccarii was the largest among all known Musaceae assemblies (∼570 Mbp) due to the expansion of transposable elements and increased 45S ribosomal DNA sites. By synteny analysis, we detected extensive genome-wide chromosome fusions and fissions between M. beccarii and the other Musa and Ensete species, far beyond those expected from differences in chromosome number. Within Musaceae, M. beccarii showed a reduced number of terpenoid synthase genes, which are related to chemical defense, and enrichment in lipid metabolism genes linked to the physical defense of the cell wall. Furthermore, type III polyketide synthase was the most abundant biosynthetic gene cluster (BGC) in M. beccarii. BGCs were not conserved in Musaceae genomes.

CONCLUSIONS

The genome assembly of M. beccarii is the first chromosome-scale genome assembly in the Callimusa section in Musa, which provides an important genetic resource that aids our understanding of the evolution of Musaceae genomes and enhances our knowledge of the pangenome.

[Analysis of the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 for intrahepatic parenchymal substantial lesions ≤3.0 cm]

Objective: To investigate the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 in high-risk hepatocellular carcinoma (HCC) patients with intrahepatic parenchymal substantial lesions ≤3.0 cm. Methods: A retrospective analysis was conducted in hospitals between September 2014 to April 2020. 131 pathologically confirmed non-HCC cases with lesions ≤3.0 cm in diameter were randomly matched with 131 cases with lesions ≤3.0 cm in diameter and divided into benign (56 cases), other hepatic malignant tumor (OM, 75 cases), and HCC group (131 cases) in a 1:1 ratio. MRI features of the lesions were analyzed and classified according to LI-RADS v2018 criteria (tie-break rule was applied to lesions with both HCC and LR-M features). Taking the pathological results as the gold standard, the sensitivity and specificity of the LI-RADS v2018 classification criteria and the more stringent LR-5 criteria (with three main signs of HCC at the same time) were calculated for HCC, OM or benign lesions diagnosis. Mann -Whitney U test was used to compare the classification results. Results: The number of cases classified as LR-M, LR-1, LR-2, LR-3, LR-4, and LR-5 in HCC group after applying the tie-break rule were 14, 0, 0, 12, 28, and 77, respectively. There were 40, 0, 0, 4, 17, 14 and 8, 5, 1, 26, 13, 3 cases in benign and OM group, respectively. There were 41 (41/77), 4 (4/14) and 1 (1/3) lesion case in the HCC, OM and benign group, respectively, that met the more stringent LR-5 criteria. The sensitivity of LR-4 combined with LR-5 (LR-4/5) criteria, LR-5 criteria and more stringent LR-5 criteria for HCC diagnosis were 80.2% (105/131), 58.8% (77/131) and 31.3% (41/131), respectively, and the specificity were 64.1% (84/131), 87.0% (114/131) and 96.2% (126/131), respectively. The sensitivity and specificity of LR-M were 53.3% (40/75) and 88.2% (165/187), respectively. The sensitivity and specificity using LR-1 combined with LR-2 (LR-1/2) criteria for the diagnosis of benign liver lesions were 10.7% (6/56) and 100% (206/206), respectively. Conclusions: LR-1/2, LR-5, and LR-M criteria have high diagnostic specificity for intrahepatic lesions with a diameter of ≤3.0 cm. Lesions classified as LR-3 are more likely to be benign. The specificity of LR-4/5 criteria is low, while the more stringent LR-5 criteria has a high specificity for HCC diagnosis.

The complete chloroplast genome sequence of Durio oxleyanus (Malvaceae) and its phylogenetic position

Durio oxleyanus (Griff) of Malvaceae is considered a natural heritage by the countries that produce it, including Peninsular Malaysia, Sumatra, and Borneo. Even though the species is regarded as a commercially valuable fruit, cultivation of this species is uncommon. The dwindling population of this species in the wild has put its survival in jeopardy. Conservation efforts are required for this species, which are limited. In this study, the complete chloroplast (cp) genome of D. oxleyanus was assembled and characterized as a genomic resource for conservation programs. The complete cp genome size was 164,831 bp in length, with a pair of inverted repeats of 23,782 bp each, separating the 96,446-bp large and the 20,823-bp small single copies. A total of 135 genes were predicted, which consisted of 90 protein-coding, 37 tRNA, and eight rRNA genes. The overall GC content was 35.8%. The phylogenetic analysis based on the maximum-likelihood and Bayesian inference methods revealed that D. oxleyanus is closely related to D. zibethinus. The genomic data obtained will be useful for future studies of Malvaceae’s phylogenetics and evolution.

The complete chloroplast genome of Prunus campanulata ‘Fugui’ (Rosaceae)

Prunus campanulata ‘Fugui’ is newly bred cultivar. Here, we report its complete chloroplast genome. The length of the P. campanulata ‘Fugui’ chloroplast genome is 157,948 bp, with a large single-copy region of 85,948 bp, a small single-copy region of 19,128 bp and a pair of inverted repeat regions of 26,436 bp each. The genome contains 90 protein-coding genes, 65 transfer RNA genes and 9 ribosomal RNA genes. In addition, the genome contains 67 simple sequence repeats. Phylogenetic analysis revealed that P. campanulata ‘Fugui’ is genetically related to previously reported P. campanulata.

[Comparison between laparoscopic-assisted natural orifice specimen extraction surgery and conventional laparoscopic surgery for left colorectal cancer: a randomized controlled study with 3-year follow-up results]

Objective: To evaluate the mid-term efficacy of laparoscopic-assisted natural orifice specimen extraction surgery (NOSES) colectomy using the Cai tube in the treatment of left colorectal cancer. Methods: A prospective randomized control trial (China Clinical Trials Registration Number: ChiCTR-OOR-15007060) was performed. Sixty patients with left colorectal cancer at Department of Gastrointestinal Surgery of Zhongshan Hospital from September 2015 to August 2017 were prospectively enrolled. Case inclusion criteria: (1) left colorectal adenocarcinoma (rectal cancer with distance ≥ 8 cm from tumor low margin to anal edge, sigmoid colon cancer, descending colon cancer and left transverse colon cancer) confirmed by preoperative pathology; (2) satisfactory conditions of conventional laparoscopic surgery; (3) maximum diameter of the tumor < 4.5 cm confirmed by preoperative abdominal and pelvic CT or MRI; (4) BMI < 30 kg/m². Case exclusion criteria: (1) benign lesions, mucinous adenocarcinoma, signet-ring cell carcinoma and other special pathological types of tumors confirmed by preoperative pathological examination; (2) multiple or recurrent cancers; (3) with a history of neoadjuvant chemoradiotherapy; (4) obvious regional infiltration or distant metastasis indicated by preoperative imaging examination; (5) intestinal obstruction, intestinal perforation, etc. Participants were randomly assigned to NOSES group (using the Cai tube) and conventional laparoscopy (CL) group by random number table method. Clinical data between two groups were compared and analyzed, including perioperative conditions, tumor exfoliation cell detection and bacterial culture results of intraperitoneal lavage fluid, postoperative complications (Clavien-Dindo grading), postoperative pain [visual simulation scoring (VAS) assessment], anal function (Kirwan anal function grading assessment), and postoperative 3-year disease-free survival (DFS), overall survival (OS), overall recurrence rate, and local recurrence rate. Results: A total of 60 patients were enrolled, with 30 in the NOSES group and 30 in the CL group. All the patients in the NOSES group successfully completed operation with Cai tube. Baseline data between the two groups were not significantly different (all P>0.05). There were no statistically significant differences between two groups in conversion rate to open surgery, number of lymph node harivested, proximal and distal resection margin of tumor, negative rate of circumferential margin, operation time, blood loss, inflammatory indexes, postoperative anal function, postoperative hospital stay, hospitalization cost, morbidity of postoperative complications (Clavien-Dindo grade II or above) (all P>0.05). Compared to the CL group, the NOSES group had lower maximum postoperative VAS score (2.5±0.3 vs. 5.1±0.4, t=3.187, P<0.01), and fewer use of additional postoperative analgesia [6.7% (2/30) vs. 33.3% (10/30),χ²=6.670, P=0.02]. The postoperative time to gas passage was shorter in the NOSES group [(2.2±1.4) days vs. (3.1±1.2) days,P=0.026]. No tumor cells and bacterial contamination were found in abdominal lavage fluid before and after operation in either group. The anal function at postoperative 3-month of all the patients in the NOSES group was Kirwan grade I to II, while in the CL group, anal function of 2 cases (6.7%) was Kirwan grade III, and of 28 cases was also Kirwan grade I to II, whose difference was not statistically significant (P>0.05). In the NOSES group and the CL group, 3-year DFS was 96.7% and 83.3% (P=0.090), OS was 100% and 90% (P=0.096), overall recurrence rate was 3.3% and 10.0% (P=0.166), and local recurrence rate was 3.3% and 3.3% (P=0.999), respectively, whose differences were not statistically significant (all P>0.05). Conclusions: In the treatment of left colorectal cancer, compared with conventional laparoscopic colectomy, NOSES colectomy using Cai tube exhibits less scar, less postoperative pain, shorter recovery of gastrointestinal function, and similar mid-term outcomes. Given proper surgical indications, the surgical procedure is safe and feasible.

Choledocholithiasis characteristics with periampullary diverticulum and endoscopic retrograde cholangiopancreatography procedures: Comparison between two centers from Lanzhou and Kyoto

BACKGROUND

Most of study regarding periampullary diverticulum (PAD) impact on endoscopic retrograde cholangiopancreatography (ERCP) therapy for choledocholithiasis based on data from one endoscopy center and lacked to compare the clinical characteristic of choledocholithiasis with PAD from different geographical patients.

AIM

To compare the choledocholithiasis clinical characteristics between two regional endoscopy centers and analyze impacts of clinical characteristics on ERCP methods for choledocholithiasis patients with PAD.

METHODS

Patients seen in two endoscopy centers (The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China, and Kyoto Second Red Cross Hospital, Kyoto, Japan) underwent ERCP treatment for the first time between January 2012 and December 2017. The characteristics of choledocholithiasis with PAD were compared between the two centers, and their ERCP procedures and therapeutic outcomes were analyzed.

RESULTS

A total of 829 out of 3608 patients in the Lanzhou center and 241 out of 1198 in the Kyoto center had choledocholithiasis with PAD. Lots of clinical characteristics were significantly different between the two centers. The common bile duct (CBD) diameter was wider, choledocholithiasis size was lager and multiple CBD stones were more in the Lanzhou center patients than those in the Kyoto center patients (14.8 ± 5.2 mm vs 11.6 ± 4.2 mm, 12.2 ± 6.5 mm vs 8.2 ± 5.3 mm, 45.3% vs 20.3%, P < 0.001 for all). In addition, concomitant diseases, such as acute cholangitis, gallbladder stones, obstructive jaundice, cholecystectomy, and acute pancreatitis, were significantly different between the two centers (P = 0.03 to < 0.001). In the Lanzhou center, CBD diameter and choledocholithiasis size were lower, and multiple CBD stones and acute cholangitis were less in non-PAD patients than those in PAD patients (13.4 ± 5.1 mm vs 14.8 ± 5.2 mm, 10.3 ± 5.4 mm vs 12.2 ± 6.5, 39% vs 45.3%, 13.9% vs 18.5%, P = 0.002 to < 0.001). But all these characteristics were not significantly different in the Kyoto center. The proportions of endoscopic sphincterotomy (EST), endoscopic balloon dilatation (EPBD), and EST+EPBD were 50.5%, 1.7%, and 42.5% in the Lanzhou center and 90.0%, 0.0%, and 0.4% in the Kyoto center, respectively. However, the overall post-ERCP complication rate was not significantly different between the two centers (8.9% in the Lanzhou and 5.8% in the Kyoto. P = 0.12). In the Lanzhou center, the difficulty rate in removing CBD stones in PAD was higher than in non-PAD group (35.3% vs 26.0%, P < 0.001). But the rate was no significant difference between the two groups in Kyoto center. The residual rates of choledocholithiasis were not significantly different between the two groups in both centers. Post-ERCP complications occurred in 8.9% of the PAD patients and 8.1% of the non-PAD patients in the Lanzhou Center, and it occurred in 5.8% in PAD patients and 10.0% in non-PAD patients in the Kyoto center, all P > 0.05.

CONCLUSION

Many clinical characteristics of choledocholithiasis patients with PAD were significantly different between the Lanzhou and Kyoto centers. The patients had larger and multiple stones, wider CBD diameter, and more possibility of acute cholangitis and obstructive jaundice in the Lanzhou center than those in the Kyoto center. The ERCP procedures to manage native duodenal papilla were different depending on the different clinical characteristics while the overall post-ERCP complications were not significantly different between the two centers. The stone residual rate and post-ERCP complications were not significantly different between choledocholithiasis patients with PAD and without PAD in each center.

The genome of the Paleogene relic tree Bretschneidera sinensis: insights into trade-offs in gene family evolution, demographic history, and adaptive SNPs

Among relic species, genomic information may provide the key to inferring their long-term survival. Therefore, in this study, we investigated the genome of the Paleogene relic tree species, Bretschneidera sinensis, which is a rare endemic species within southeastern Asia. Specifically, we assembled a high-quality genome for B. sinensis using PacBio high-fidelity and high-throughput chromosome conformation capture reads and annotated it with long and short RNA sequencing reads. Using the genome, we then detected a trade-off between active and passive disease defences among the gene families. Gene families involved in salicylic acid and MAPK signalling pathways expanded as active defence mechanisms against disease, but families involved in terpene synthase activity as passive defences contracted. When inferring the long evolutionary history of B. sinensis, we detected population declines corresponding to historical climate change around the Eocene–Oligocene transition and to climatic fluctuations in the Quaternary. Additionally, based on this genome, we identified 388 single nucleotide polymorphisms (SNPs) that were likely under selection, and showed diverse functions in growth and stress responses. Among them, we further found 41 climate-associated SNPs. The genome of B. sinensis and the SNP dataset will be important resources for understanding extinction/diversification processes using comparative genomics in different lineages.

The complete chloroplast genome of Ormosia purpureiflora (Fabaceae)

Ormosia purpureiflora is endemic to China. It is named after its purple flowers. It is a small tree only up to 3 m. It has leathery leaves, racemose inflorescences. The seeds are elliptic and red in coat. It is only confined to Luofushan Provincial Nature Reserve in Huizhou of Guangdong Province. Herein, we first reported on its complete chloroplast genome sequence as genomic resource for conservation purposes. The chloroplast genome of O. purpureiflora was 173,364 bp in length, with a large single-copy region of 73,465 bp, a small single-copy region of 18,751 bp, and a pair of inverted repeat regions that were 40,574 bp each. A total of 90 protein-coding genes, 38 transfer RNA genes, and eight ribosomal RNA genes were predicted, while 106 simple sequence repeats were recorded throughout the genome. Phylogenetic analysis revealed that O. purpureiflora was sister to O. emarginata.

[Effect of platelet reactivity on clinical events in patients using bivalirudin in selective percutaneous coronary intervention]

Objective: To investigate the effect of platelet reactivity and other clinical factors on the postoperative 1-year adverse clinical events in patients who underwent selective percutaneous coronary intervention (PCI) anticoagulated with bivalirudin. Methods: This is a multicenter, retrospective and observational study, enrolling 632 patients at high risk of bleeding adjudicated by operators who underwent selective PCI anticoagulated with bivalirudin and had preoperative thrombelastography (TEG) test results in Fuwai Hospital, Northern Theater General Hospital and Xinxiang Central Hospital between January 2017 and August 2018. Platelet reactivity was tested by TEG and adenosine-induced maximal amplitude (MAADP) was recorded. According to MAADP patients were divided into three groups: low on-treatment platelet reactivity (LTPR) group (MAADP<31 mm, n=229), normal on-treatment platelet reactivity (NTPR) group (31 mm≤MAADP≤47 mm, n=207) and high on-treatment platelet reactivity (HTPR) group (MAADP>47 mm, n=196). The endpoints consisted of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding events. The definition of MACCE was the composite of all-cause mortality, myocardial infarction, intrastent thrombosis, stroke and revascularization. Bleeding events were defined by bleeding academic research consortium (BARC) type 2, 3 and 5 bleeding. Using multivariate Cox regression to analyze the factors of MACCE and bleeding events in patients underwent selective PCI anticoagulated with bivalirudin. Results: A total of 632 patients were finally enrolled in the study with age of (68.3±10.0) years and there were 423 (66.9%) males. All of 632 patients finished one-year follow-up, and 48 (7.6%) patients occurred MACCE and 11 (1.7%) patients occurred bleeding events. There was not statistically significant difference in the incidence of MACCE (8.3% (19/229) vs. 6.3% (13/207) vs.8.2% (16/196), P=0.68) and bleeding events (1.8% (4/229) vs. 2.9% (6/207) vs. 0.5% (1/196), P=0.17) in LTPR, NTPR and HTPR group. Multivariate Cox regression showed that HTPR was not the independent factor of MACCE (HR=1.25, 95%CI 0.67-2.30, P=0.49), and the history of peripheral vessel disease was the independent risk factor of MACCE (HR=2.47, 95%CI 1.19-5.11, P=0.02). LTPR was not the independent factor of bleeding events (HR=1.35, 95%CI 0.39-4.66, P=0.64), and the independent factors of bleeding events were history of peripheral vessel disease (HR=3.95, 95%CI 1.03-15.22, P=0.05) and hemoglobin (HR=0.96, 95%CI 0.93-0.99, P=0.01). Conclusions: In patients undergoing selective PCI anticoagulated with bivalirudin, there is no significant association between platelet reactivity and postoperative 1-year MACCE or bleeding events. History of peripheral vessel disease is an independent risk factor of MACCE, and history of peripheral vessel disease and decreased hemoglobin are independent risk factors of bleeding events.

[The enlightenment of foreign MD-MPH double degree program to the cultivation of high-level applied public health talents in China]

Objective: To understand the current status of foreign dual-degree programs of Medical Doctor (MD) and Master of Public Health (MPH) and provide evidence-based decision-making reference for promoting the education of high-level applied public health talents in China. Methods: The list of involved institutions and information of foreign MD-MPH dual-degree programs was collected through literature retrieval, online information searching, and additional survey of key figures. We extracted the details of each project regarding professional fields, core competence, length of schooling, teaching and learning arrangement, internship eligibility, and graduation assessment. Python 3.8.0 was used for data cleaning, and the occurrence frequency of related items in each dimension was calculated. Results: A total of 99 MD-MPH programs from 104 foreign institutions were included, among which 97.1% of them were implemented in universities from the United States. The School of Public Health provided 42.4% (42/99) of the programs. Epidemiology was the major discipline set up among most programs, accounting for 12.0% (29/241) of all the specialties involved. Epidemiological research methods, health policy management and practice, and public health practice were the top 3 core competencies to be mastered. Of the 99 programs, 87 gave information on the length of the program, of which 74.7% (65/87) were five years, 6.9% (6/87) were four years, and 18.4% (16/87) included both 4-year and 5-year programs. Conclusions: The international MD-MPH programs were sophisticated and mainly organized by the School of Public Health alone or in conjunction with the School of Medicine. Epidemiology is the core course and competence objective, with a length of 4-5 years. Through learning experience from international MD-MPH programs and the Chinese unique medical development background, China should optimize its medical education system to develop a suitable talent training strategy for MD-MPH dual-degree programs in the new era.

The complete mitochondrial genome of Ormosia boluoensis

Ormosia is a particular genus in the Fabaceae family with its striking seeds. The genus Ormosia boluoensis is a newly reported and critically endangered species, and field investigations have indicated that there are only hundreds of it. For the effective conservation, we report its complete mitochondrial genome. The length of the O. boluoensis mitochondrial genome is 248,619 bp, including 28 protein-coding genes, 14 transfer RNA genes, 3 ribosomal RNA genes, and 45 simple sequence repeats. Phylogenetic analysis revealed that O. boluoensis was a sister to the clade including Sophora flavescens, Ammopiptanthus nanus, and Ammopiptanthus mongolicus.

The complete chloroplast genome of Rhododendron kawakamii (Ericaceae)

Rhododendron kawakamii is endemic in Taiwan island and is a unique and epiphytic species. Here, we report its complete chloroplast genome. The length of the R. kawakamii chloroplast genome is 230,777 bp, with a large single-copy region of 146,155 bp, a small single-copy region of 72,082 bp, and a pair of inverted repeat regions (IRA) of 6,270 bp each. The genome contains 77 protein-coding genes, 29 transfer RNA genes, and four ribosomal RNA genes. In addition, the genome contains 81 simple sequence repeats. Phylogenetic analysis revealed that R. kawakamii is genetically related to R. datiandingense.

Chromosomal-level assembly of the Leptodermis oblonga (Rubiaceae) genome and its phylogenetic implications

Rubiaceae is the fourth largest and a taxonomically complex family of angiosperms. Many species in this family harbor low reproductive isolation and frequently exhibit inconsistent phenotypic characteristics. Therefore, taxonomic classification and their phylogenetic relationships in the Rubiaceae family is challenging, especially in the genus Leptodermis. Considering the low taxonomic confusion and wide distribution, Leptodermis oblonga is selected as a representative Leptodermis for genome sequencing. The assemblies resulted in 497 Mbp nuclear and 155,100 bp chloroplast genomes, respectively. Using the nuclear genome as a reference, SNPs were called from 37 Leptodermis species or varieties. The phylogenetic tree based on SNPs exhibited high resolution for species delimitation of the complex and well-resolved phylogenetic relationships in the genus. Moreover, 28,987 genes were predicted in the nuclear genome and used for comparative genomics study. As the first chromosomal-level genome of the subfamily Rubioideae in Rubiaceae, it will provide fruitfully evolutionary understanding in the family.

[The effect of visualized saphenous nerve block through minimally invasive far medial-subvastus approach on the analgesia after total knee arthroplasty]

Objective: To report a method of visualized saphenous nerve block (VSNB) through minimally invasive far medial-subvastus approach distal to the adductor canal in total knee arthroplasty (TKA), and investigate the effect of VSNB in this way on postoperative pain relief. Methods: A total of 100 patients with knee osteoarthritis were prospectively included from June 2018 to October 2019, 29 males and 71 females, aged 50-87(70±8) years. All patients undergoing TKA through minimally invasive far medial-subvastus approach were randomized to visualized saphenous nerve block combined with periarticular infiltration analgesia group (Group VSNB+PIA) or only periarticular infiltration analgesia group (Group PIA),50 cases in each group. The visual analogue scale (VAS) was used to evaluate the pain degree of patients. Furthermore, the scores of VAS in resting and active state at 4, 8, 12, 24, 48, 72 hours after operation and the proportion of patients receiving parecoxib within 72 hours after operation were compared between the two groups. Results: There was statistically significant difference between the two groups in terms of VAS scores in resting state after surgery(F=15.295,P<0.05).The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at resting state were 1.3±0.8, 1.4±0.7, 1.7±0.8, 3.1±0.8 respectively, which were all significantly lower than those of Group PIA (1.6±0.9, 1.8±0.8, 2.3±0.9, 3.6±0.8) (P<0.05). The overall difference in terms of VAS scores at active state after surgery was statistically significant between the two groups(F=18.532, P<0.05). The postoperative VAS scores of Group VSNB+PIA at 4, 8, 12, 24 hours at active state were 2.0±0.8, 2.2±0.7, 2.7±0.6, 3.7±0.7 respectively, which were all significantly lower than those of Group PIA (2.3±0.8, 2.7±0.7, 3.3±0.8, 4.4±0.7)(P<0.05). Fourteen percent of patients (7/50) in VSNB+PIA group accepted parecoxib within 72 hours after surgery, which was significantly lower than that in PIA group (34%, 17/50) (P<0.05). Conclusions: It is easy to expose the saphenous nerve beyond the adductor canal through minimally invasive far medial-subvastus approach. The Combination therapy of VSNB+PIA is more effective than the simple per-articular infiltration analgesia in providing pain relief after total knee arthroplasty.

Draft genome of Puya raimondii (Bromeliaceae), the Queen of the Andes

Puya raimondii, the Queen of the Andes, is an endangered high Andean species in the Bromeliaceae family. Here, we report its first genome to promote its conservation and evolutionary study. Comparative genomics showed P. raimondii diverged from Ananas comosus about 14.8 million years ago, and the long terminal repeats were likely to contribute to the genus diversification in last 3.5 million years. The gene families related to plant reproductive development and stress responses significantly expanded in the genome. At the same time, gene families involved in disease defense, photosynthesis and carbohydrate metabolism significantly contracted, which may be an evolutionary strategy to adapt to the harsh conditions in high Andes. The demographic history analysis revealed the P. raimondii population size sharply declined in the Pleistocene and then increased in the Holocene. We also designed and tested 46 pairs of universal primers for amplifying orthologous single-copy nuclear genes in Puya species.

The complete chloroplast genome of Rhododendron datiandingense (Ericaceae)

Rhododendron datiandingense is newly reported and endemic to China. The genome of R. datiandingense is 207,311 bp in length, including a large single-copy region of 190,689 bp and a small single-copy region of 2582 bp, a pair of inverted repeat regions (IRA) of 7020 bp each. The genome encodes 110 genes, comprising 77 protein-coding genes, four ribosomal RNA genes, and 29 transfer RNA genes. Repeat analysis revealed 62 simple sequence repeats (SSRs) in the genome. Phylogenetic analysis revealed that R. datiandingense is clearly separated from the other Rhododendron species and shown in the basal position.

[Characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease patients of different age groups]

Objective: To explore the characteristics of esophageal motility and clinical presentation in gastroesophageal reflux disease (GERD) patients of different age groups. Methods: This was a case-control study. Confirmed GERD patients in the Department of Gastroenterology of Peking Union Medical College Hospital from January 2015 to September 2018 were enrolled and divided into two groups: elderly group (≥60 years old) and young and middle-aged group (<60 years old). Characteristics of gender, disease course, clinical symptoms, esophageal motility, gastroscopic manifestations and esophageal hiatus function of patients in the two groups were analyzed. Results: A total of 250 patients met the inclusion criteria, with 61 patients in elderly group and 189 in young and middle-aged group. There were no significant differences in gender ((male/female: 24/37 vs 78/111, P>0.05) and disease course((4.9±4.2) years vs(4.5±3.8)years, P>0.05) between the two groups. However, there were significant differences in typical symptoms (acid regurgitation and heartburn) and atypical symptoms (chest pain, cough, foreign body sensation in pharynx, etc.) (typical/atypical symptoms: 35/26 vs 146/43, P<0.01) between the two groups. Compared with young and middle-aged group, upper esophageal sphincter (UES) resting pressure was lower ((65±28) mmHg (1 mmHg=0.133 kPa)vs (74±28) mmHg, P<0.05), but the percentage of ineffective esophageal motility (IEM) (78.7%(48/61) vs 65.1%(123/189),P<0.05) and DeMeester score (16.3(6.0,36.3) vs 6.4(2.5,18.0), P<0.05) were higher in elderly group. There were no significant differences in lower esophageal sphincter (LES) resting pressure and distal contractile integral (DCI) between the two groups. Higher proportion of grade C and D reflux esophagitis,and grade C and D reflux esophagitis complicated with esophageal hiatus dysfunction was observed in elderly group compared with young and middle-aged group (2.04%(8/49) vs 0.65%(1/155); 14.29%(7/49) vs 0(0/155); both P<0.01). Pearson correlation analysis showed that there was a negative correlation between UES resting pressure and age(r=-0.145, P<0.05), while there was a positive correlation between the LES length and age (r=0.129, P<0.05). Conclusion: Compared with young and middle-aged GERD patients, the atypical symptoms, lower LES resting pressure, increased incidence of ineffective esophageal motility and acid exposure were more prominent in the elderly. Considering that anti-reflux function was weakened, long-term acid suppressants may be needed in elderly patients.

[Epidemiological characteristics and outcome analysis of inhalation injury patients combined with burn area less than 30% total body surface area in a single center from 2008 to 2016]

Objective: To explore the epidemiological characteristics and treatment outcomes of inhalation injury patients combined with burn area less than 30% total body surface area (TBSA) admitted to the First Affiliated Hospital of Naval Medical University. Methods: Retrospective observational study with performed on medical records of 266 inhalation injury patients combined with burn area less than 30% TBSA who were admitted to the First Affiliated Hospital of Naval Medical University from January 2008 to September 2016 and met the inclusion criteria. The gender, age, injured site, injurious factors of inhalation injury, degree of inhalation injury, combined total burn area, way of tracheotomy, time of tracheotomy, whether conducted mechanical ventilation or not, whether in intensive care unit (ICU) or not, microbial culture results of bronchoalveolar lavage, total hospitalization days, ICU days, mechanical ventilation days, and whether respiratory infections occurred or not. Single factor and multivariate linear regression analysis was used to screen out the risk factors impacting the total hospitalization days, ICU days, and mechanical ventilation days of patients. Single factor and multivariate logistic regression analysis was used to screen out the risk factors impacting respiratory infections of patients. Results: The 266 patients included 190 males and 76 females, with the majority age of above and equal to 21 and below 65 years (217 patients). Confined space was the major injured site. Hot air was the major factor of inhalation injury. Mild and moderate inhalation injuries were commonly seen in patients. The combined total burn area was 9.00 (3.25, 18.00) %TBSA. In 111 patients who were conducted with tracheotomy, the most were conducted before admitted to the First Affiliated Hospital of Naval Medical University. The total hospitalization days of patients were 27 (10, 55) days. The ICU days of 160 patients were 15.5 (6.0, 40.0) days. The mechanical ventilation days of 109 patients were 6.0 (1.3, 11.5) days. A total of 119 patients were diagnosed with respiratory infections, with 548 strains including 35 types of pathogens were isolated, mainly of Gram-negative bacteria. Single factor linear regression analysis showed age, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the total hospitalization days of patients (95% confidence interval (CI)=-0.397－0.001, -0.395－-0.053, 0.015－0.028, 0.009－0.263, 0.008－0.319, -0.419－-0.176, 0.242－0.471, 0.340－0.555, P<0.1). Multivariate linear regression analysis showed smoke inhalation, mechanical ventilation, and respiratory infections were the independent risk factors impacting the total hospitalization days of patients (95% CI=-0.384－0.082, 0.022－0.271, 0.261－0.506, P<0.05 or P<0.01). Single factor linear regression analysis showed injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the ICU days of patients (95% CI=0.053－0.502, 0.006－0.010, -0.018－0.457, -0.022－0.428, -0.575－-0.241, -0.687－-0.018, 0.132－0.486, 0.369－0.678, P<0.1). Multivariate linear regression analysis showed that no tracheotomy and respiratory infections were the independent risk factors impacting the ICU days of patients (95% CI=-0.414－-0.084, 0.278－0.601, P<0.01). Single factor linear regression analysis showed injured site, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, and whether respiratory infections occurred or not were the risk factors impacting mechanical ventilation days of patients (95% CI=-0.565－-0.034, 0.145－0.946, 0.051－1.188, 0.001－0.009, 0.127－0.847, 0.436－1.162, -1.243－-0.229, 0.005－0.605, P<0.1). Multivariate linear regression analysis showed open space inhalation, smoke inhalation, severe inhalation injury, no tracheotomy, prophylactic tracheotomy, and respiratory infections were the independent risk factors impacting mechanical ventilation days of patients (95% CI=-0.588－-0.127, 0.138－0.560, 0.143－0.848, -0.909－-0.330, -1.008－-0.015, 0.007－0.519, P<0.05 or P<0.01). Single factor logistic regression analysis showed age, injured site, degree of inhalation injury, combined total burn area, way of tracheotomy, and whether conducted mechanical ventilation or not were the risk factors impacting respiratory infections of patients (95% CI=0.840－1.362, 0.641－1.044, 1.122－1.526, 1.028－1.661, 1.344－2.405, 1.460－2.612, 0.744－1.320, 0.241－0.424, 2.331－4.090, P<0.1). Multivariate logistic regression analysis showed prophylactic tracheotomy, no tracheotomy, and mechanical ventilation were the independent risk factors impacting respiratory infections of patient (95% CI=0.430－0.641, 0.290－0.511, 2.152－8.624, P<0.05 or P<0.01). Conclusions: The inhalation injury patients combined with burn area less than 30% TBSA are mainly young and middle-aged males. Confined space, smoke inhalation, mechanical ventilation, respiratory infection, and way of tracheotomy are influencing factors of the outcomes in hospital of inhalation injury patients combined with burn area less than 30% TBSA. Additionally, prophylactic tracheotomy shows its potential role in avoiding respiratory infection for patients with moderate or severe degree of inhalation injury.

Higher-Order Band Topology in Twisted Moiré Superlattice

The two-dimensional (2D) twisted bilayer materials with van der Waals coupling have ignited great research interests, paving a new way to explore the emergent quantum phenomena by twist degree of freedom. Generally, with the decreasing of twist angle, the enhanced interlayer coupling will gradually flatten the low-energy bands and isolate them by two high-energy gaps at zero and full filling, respectively. Although the correlation and topological physics in the low-energy flat bands have been intensively studied, little information is available for these two emerging gaps. In this Letter, we predict a 2D second-order topological insulator (SOTI) for twisted bilayer graphene and twisted bilayer boron nitride in both zero and full filling gaps. Employing a tight-binding Hamiltonian based on first-principles calculations, three unique fingerprints of 2D SOTI are identified, that is, nonzero bulk topological index, gapped topological edge state, and in-gap topological corner state. Most remarkably, the 2D SOTI exists in a wide range of commensurate twist angles, which is robust to microscopic structure disorder and twist center, greatly facilitating the possible experimental measurement. Our results not only extend the higher-order band topology to massless and massive twisted moiré superlattice, but also demonstrate the importance of high-energy bands for fully understanding the nontrivial electronics.

The complete chloroplast genome sequence of Begonia coptidifolia

Begonia (Begoniaceae) is a large, pantropically distributed genus, comprising more than 1900 species. Due to poorly available genome resources, the phylogeny of this species-rich genus is still challenged. B. coptidifolia is a newly discovered species of restricted distribution in Southern China, and its genetic relationship with the other Begonia species has not been reported. Therefore, in this study, we report for the first time its chloroplast genome for future phylogenetic analysis. The circular chloroplast genome of B. coptidifolia is 169,412 bp in length, with a GC content of 35.57%. Its large single-copy region is 75,937 bp, a small single-copy region is 18,362 bp, and two inverted repeat regions are 37,556 bp and 37,557 bp, respectively. The genome encodes 82 protein-coding genes, 8 ribosomal RNA genes, and 40 transfer RNA genes. Phylogenetic analysis indicated that B. coptidifolia is genetically closest to B. pulchrifolia.

The complete chloroplast genome of Aganope dinghuensis (Fabaceae)

Aganope is a genus in the family Fabaceae, with only 11 species. They are distributed throughout Asia and Africa. Aganope dinghuensis, a newly reported species, is native to China with a restricted distribution. We, therefore, report its complete chloroplast genome for better future conservation. The chloroplast genome of A. dinghuensis is 143,690 bp, with a GC content of 35.32%. In the genome, a pair of inverted repeat regions of 13,015 bp each, a large single-copy region of 98,824 bp, and a small single-copy region of 18,836 bp were identified. Genome annotation identified 115 genes, comprising 74 protein-coding genes, 8 ribosomal RNA genes, and 33 transfer RNA genes. Repeat analysis indicates that the chloroplast genome of A. dinghuensis contains 126 simple sequence repeats (SSR), of which the majority are A/T mononucleotides. Phylogenetic analysis revealed that A. dinghuensis is a sister to the clade that includes Indigofera tinctoria, Desmodium uncinatum, Sarcodum scandens, Wisteria brachybotrys, and Callerya nitida.

The complete mitochondrial genome sequence of Aquilaria sinensis

Aquilaria sinensis, endemic to China, is an economically important evergreen tree species and a source of agarwood. Due to the high market demand for agarwood, this species is heavily overexploited in the wild and is now listed as an endangered species. Although its nuclear and chloroplast genomes have been previously reported, little is known about its mitochondrial genome. Using the paired-end short reads generated by the Illumina sequencing platform, we assembled and herein report the mitochondrial genome of A. sinensis for future phylogenetic, evolutionary, and preservative studies. The length of the A. sinensis mitochondrial genome was found to be 341,829 bp and the GC content was 45.01%. A total of 32 protein-coding genes, 19 tRNA genes, and three rRNA genes were annotated. The phylogenetic tree indicated that A. sinensis is most closely genetically related to Vigna radiata.

The complete chloroplast genome sequence of Ormosia formosana

Ormosia formosana is an important hardwood species and its seeds are popular as decorative jewelry. Currently, this species is threatened in the natural forests due to habitat destruction. Here, we first report the chloroplast genome of O. formosana for future studies in ecology, phylogeny, and conservation. The chloroplast genome of O. formosana is 173,587 bp in length with a GC content of 35.80%. It includes a large single-copy region of 73,550 bp, a small single-copy region of 18,683 bp, and two inverted repeat regions of 40,696 bp and 40,658 bp, respectively. The genome was totally annotated with 135 genes, including 90 protein-coding genes, eight ribosomal RNA genes, and 37 transfer RNA genes. Phylogenetic analysis indicated that O. formosana is most genetically similar to O. boluoensis.

Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation

BACKGROUND

Different types of periampullary diverticulum (PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation, but the clinical significance of the two current PAD classifications for cannulation is limited.

AIM

To verify the clinical value of our newly proposed PAD classification.

METHODS

A new PAD classification (Li-Tanaka classification) was proposed at our center. All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.

RESULTS

A total of 3564 patients with native papillae were enrolled, including 967 (27.13%) PAD patients and 2597 (72.87%) non-PAD patients. In the Li-Tanaka classification, type I PAD patients exhibited the highest difficult cannulation rate (23.1%, P = 0.01), and type II and IV patients had the highest cannulation success rates (99.4% in type II and 99.3% in type IV, P < 0.001). In a multivariable-adjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio (OR) = 1.87, 95% confidence interval (CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group, the difficulty of cannulation in the type I PAD group according to the Li-Tanaka classification was greater (OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower (OR = 0.27, 95%CI: 0.11-0.66, P < 0.001), while it was higher in the type II PAD group (OR = 4.44, 95%CI: 1.61-12.29, P < 0.01).

CONCLUSION

Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.

The complete chloroplast genome sequence of Ormosia boluoensis

Ormosia boluoensis is a critically Endangered species that is exclusively distributed in Xiangtoushan National Nature Reserve in Guangdong province, China. At present, the population of the species is made up of less than 100 adult individuals. Here, we are the first to report the complete chloroplast genome sequence of O. boluoensis. The chloroplast genome of O. boluoensis is 175,760 bp long and includes a large single-copy region that is 74,613 bp, a small, 18,719 bp single copy region and a pair of inverted repeat regions that are 40,771 bp and 41,657 bp in length, respectively. The overall GC content of the O. boluoensis chloroplast genome is 35.58% and contains a total of 134 genes, including 89 protein-coding genes, 8 ribosomal RNA genes, and 37 transfer RNA genes. Phylogenetic analysis revealed that O. boluoensis is genetically similar to O. xylocarpa and O. emarginata genera.

[Feasibility and safety of new "blind" axillary vein puncture technique in pacemaker implantation]

Objective: To explore the feasibility and safety of a newly developed simple and rapid axillary vein puncture technique based on the surface landmarks for pacemaker implantation. Methods: From January to November 2018, we enrolled 110 patients who underwent pacemaker implantation in Beijing Anzhen Hospital. Basic clinical characteristics, such as gender, age, major diagnosis, type of pacemaker, and His-purkinje system pacing, were collected. The success rate of this axillary vein puncture technique, complications, and technical parameters of present puncture method were analyzed. Results: There were 58 (52.7%) male patients in this cohort and the average aged was (70.26±10.45) years old. This "blind" axillary vein puncture method was successful in 105 out of 110 patients (95.5%). The relevant puncture-related parameters included: the distance between points "a and b" was (3.89±0.40) cm, the first angle α was (25.84±5.54)° and the second angle β was (66.18±10.26)°. There were no puncture-related complications, such as hematoma, pneumothorax and hemothorax. Conclusion: The new "blind" axillary vein puncture approach is a simple, effective and safe technique for pacemaker implantation, which is easy to learn and practice and suitable for promotion.

Hourglass Fermion in Two-Dimensional Material

The hourglass fermion, as an exotic quasiparticle protected by nonsymmorphic symmetry, has excited great research interest recently. However, its bulk counterpart in two-dimensional (2D) solid-state materials has seldom been studied. In this Letter, we propose a 2D rectangular lattice made of p_{x} and p_{y} orbitals with glide mirror symmetry but without inversion symmetry to realize the hourglass fermion. The glide mirror symmetry guarantees a Dirac nodal line, while the Rashba spin-orbital coupling splits it into two Weyl nodal lines and generates two pairs of hourglass fermion located at the glide mirror plane. Furthermore, based on first principles calculations, we predict a surface-supported 2D material Bi/Cl-SiC(111) to realize our proposal, making a huge-bandwidth hourglass cone. Moreover, the hourglass fermion exhibits a spin-momentum locking spin texture and also sustains a giant spin Hall conductivity. Our results demonstrate a general routine for designing an hourglass fermion in 2D materials, which will be easily extended to other surfaces with different adatoms and lattice symmetries.

Two-Dimensional Quadrupole Topological Insulator in γ-Graphyne

Two-dimensional quadrupole topological insulator (2D QTI), as a new class of second-order topological phases, has been experimentally confirmed in various artificial systems recently. However, its realization in electronic materials has seldom been reported. In this work, we predict that the experimentally synthesized γ-graphyne is a large-gap (∼0.2 eV) 2D QTI. Three characterized features for 2D QTI are simultaneously observed in γ-graphyne: quantized finite bulk quadrupole moment, gapped topological edge states, and in-gap topological corner states. Intriguingly, we found that gapped topological edge states exist on armchair edge with C≡C (but not C-C) termination, and in-gap topological corner states exist at corner with 120° (but not 60°) termination, which can be explained by different edge-hopping textures and corner chiral charges. Moreover, the robustness of in-gap topological corner states is further identified by varying edge-disorder and system-size calculations. Our results demonstrate a realistic electronic material for large-gap 2D QTI, which is expected to draw immediate experimental attention.

Endangered but genetically stable-Erythrophleum fordii within Feng Shui woodlands in suburbanized villages

Feng Shui woodlands are naturally or artificially formed green areas in southern China. They are precious for maintaining ecosystem balance in modern semiurban environments. However, they are generally small and geographically isolated from each other, and the status of genetic diversity of the plant species within them has been almost neglected. Therefore, we studied the genetic diversity of the endangered Erythrophleum fordii in eight Feng Shui woodlands (a total of 1,061 individuals) in Guangzhou, a large city in southern China, using microsatellites. For comparison, one population with 33 individuals sampled in a nature reserve was also studied. Although our results indicate that significant demographic declines occurred historically in E. fordii, such declines have not resulted in consistent reductions in genetic variation over generations in Feng Shui populations in the recent past, and the levels of genetic variation in these populations were higher than or comparable to the genetic variation of the population in the nature reserve. In addition, our parentage and paternity analyses indicated widespread and potential long‐distance pollen flow within one Feng Shui woodland, indicating the presence of an unbroken pollination network, which would at least partially alleviate the genetic erosion due to habitat fragmentation and the unequal gene contributions of E. fordii parents to their progenies when favorable recruitment habitats are absent under most of the parent trees. Overall, our results suggest that E. fordii in Feng Shui woodlands may not be driven to extinction in the near future. Nevertheless, uncontrolled fast urban development with a lack of awareness of Feng Shui woodlands will cause the local extinction of E. fordii, which has already happened in some Feng Shui woodlands.