[Clinical characteristics and CT findings of Pneumocystis Jirovecii pneumonia in 46 cases with hematological diseases]

Objective: To summarize the original CT features of Pneumocystis Jirovecii pneumonia in patients with hematological diseases. Methods: A retrospective analysis was carried out in 46 patients with proven pneumocystis pneumonia (PJP) in the Hospital of Hematology, Chinese Academy of Medical Sciences between January 2014 and December 2021. All patients had multiple chests CT and related laboratory examinations, imaging typing were conducted based on the initial CT presentation, and the distinct imaging types were analyzed against the clinical data. Results: In the analysis, there were 46 patients with proven pathogenesis, 33 males, and 13 females, with a median age of 37.5 (2-65) years. The diagnosis was validated by bronchoalveolar lavage fluid (BALF) hexamine silver staining in 11 patients and clinically diagnosed in 35 cases. Of the 35 clinically diagnosed patients, 16 were diagnosed by alveolar lavage fluid macrogenomic sequencing (BALF-mNGS) and 19 by peripheral blood macrogenomic sequencing (PB-mNGS) . The initial chest CT presentation was categorized into 4 types, including ground glass (GGO) type in 25 cases (56.5%) , nodular type in 10 cases (21.7%) , fibrosis type in 4 cases (8.7%) , and mixed type in 5 cases (13.0%) . There was no substantial discrepancy in CT types among confirmed patients, BALF-mNGS diagnosed patients and PB-mNGS diagnosed patients (χ(2)=11.039, P=0.087) . The CT manifestations of confirmed patients and PB-mNGS diagnosed patients were primarily GGO type (67.6%, 73.7%) , while that of BALF-mNGS diagnosed patients were nodular type (37.5%) . Of the 46 patients, 63.0% (29/46) had lymphocytopenia in the peripheral blood, 25.6% (10/39) with positive serum G test, and 77.1% (27/35) with elevated serum lactate dehydrogenase (LDH) . There were no great discrepancies in the rates of lymphopenia in peripheral blood, positive G-test, and increased LDH among different CT types (all P>0.05) . Conclusion: The initial chest CT findings of PJP in patients with hematological diseases were relatively prevalent with multiple GGO in both lungs. Nodular and fibrosis types were also the initial imaging findings for PJP.

[Management of the internal carotid artery during lateral skull base surgery: a series of 41 cases]

Objective: To introduce our experience on dealing with the internal carotid artery (ICA) during the resection of lateral skull base tumors, and to explore the reference values for using radiological findings to make a rational surgical plan. Methods: A retrospective study of patients who underwent resection of lateral skull base tumors involving ICA at Peking Union Medical College Hospital from May 2015 to May 2021 was conducted. The demographic information, preoperative examinations, diagnosis, surgical details and follow-ups were collected. A total of 41 patients were enrolled [24 (58.5%] females, 17 (41.5%) males], with an average age of 47.9 years. According to the preoperative imaging findings, the relationships between the tumors and ICA were divided into four types: adjacency, compression, invasion and ICA aneurysm. Results: The ICA was preserved in 32 (78.0%, 32/41) cases and was reconstructed in nine (22.0%, 9/41) cases. All the 27 (65.9%, 27/41) tumors adjacent to ICA were successfully separated from the artery. Among the 11 tumors compressing the ICA, six were resected with the involved ICA segment and vascular reconstruction was conducted. One (2.4%, 1/41) tumor invading ICA and two (4.9%, 2/41) ICA aneurysms required revascularization. The mean follow-up time was (26.1±2.9) months. There was no recurrence, except one case of adenoid cystic carcinoma which had brain metastases one year after surgery. Conclusions: According to the preoperative imaging, lateral skull base tumors adjacent to ICA can be detached from the vascular surface. Separation should be attempted first for tumors compressing ICA, and revascularization should be followed if separation failed. Vascular reconstruction is usually needed in the removal of tumors invading ICA and ICA aneurysms. Preoperative radiology can provide good references for planning a surgery for lateral skull base tumors.

[Clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower extremity]

Objective: To observe the clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower limbs. Methods: A retrospective observational study was conducted. From December 2017 to December 2020, 8 patients with large skin and soft tissue defect caused by degloving injury in lower extremity were admitted to Ningbo No.6 Hospital, including 5 males and 3 females, aged from 39 to 75 years, with wound area of 25 cm×12 cm-61 cm×34 cm. The free latissimus dorsi myocutaneous flap with latissimus dorsi muscle in the width of 12-15 cm and flap area of 20 cm×8 cm-32 cm×8 cm was used to repair the skin and soft tissue defect of bone/tendon exposure site or functional area. The other defect was repaired with bilayer artificial dermis, and the flap donor site was sutured directly. After the artificial dermis was completely vascularized, the split-thickness skin graft from thigh was excised and extended at a ratio of 1∶2 to 1∶4 and then transplanted to repair the residual wound, and the donor site of skin graft was treated by dressing change. The survival of latissimus dorsi myocutaneous flap, artificial dermis, and split-thickness skin graft after operation was observed, the interval time between artificial dermis transplantation and split-thickness skin graft transplantation was recorded, and the healing of donor site was observed. The appearance and function of operative area were followed up. At the last outpatient follow-up, the sensory recovery of flap was evaluated by British Medical Research Council evaluation criteria, the flap function was evaluated by the comprehensive evaluation standard of flap in Operative Hand Surgery, the scar of lower limb skin graft area and thigh skin donor area was evaluated by Vancouver scar scale, and the patient's satisfaction with the curative effects was asked. Results: The latissimus dorsi myocutaneous flap survived in 6 patients, while the distal tip of latissimus dorsi myocutaneous flap was partially necrotic in 2 patient and was repaired by skin grafting after resection at split-thickness skin grafting. The artificial dermis survived in all 8 patients after transplantation. The split-thickness skin graft survived in 7 patients, while partial necrosis of the split-thickness skin graft occurred in one patient and was repaired by skin grafting again. The interval time between artificial dermis transplantation and split-thickness skin graft transplantation was 15-26 (20±5) d. The donor site of latissimus dorsi myocutaneous flap healed with linear scar after operation, and the thigh skin graft donor site healed with scar after operation. The patients were followed up for 6-18 (12.5±2.3) months. The color and elasticity of the flap were similar to those of the surrounding skin tissue, and the lower limb joint activity returned to normal. There was no increase in linear scar at the back donor site or obvious hypertrophic scar at the thigh donor site. At the last outpatient follow-up, the sensation of the flap recovered to grade S2 or S3; 3 cases were excellent, 4 cases were good, and 1 case was fair in flap function; the Vancouver scar scale score of lower limb skin graft area was 4-7 (5.2±0.9), and the Vancouver scar scale score of thigh skin donor area was 1-5 (3.4±0.8). The patients were fairly satisfied with the curative effects. Conclusions: In repairing the large skin and soft tissue defect from degloving injury in lower extremity, to cover the exposed bone/tendon or functional area with latissimus dorsi myocutaneous flap and the residual wound with artificial dermis and extended split-thickness skin graft is accompanied by harvest of small autologous flap and skin graft, good recovery effect of functional area after surgery, and good quality of healing in skin grafted area.

Prurigo pigmentosa following a ketogenic diet: a case report

A 19-year-old female of South Asian descent presented with a three-day history of pruritic, clustered papules and vesicles on her abdomen, associated with significant pruritus and intermittent pain. She commenced a ketogenic diet four days prior to the emergence of the rash. Histopathological and clinical findings were in keeping with prurigo pigmentosa, an uncommon dermatosis characterised by pruritic, erythematous papules and vesicles presenting reticulated on the back, chest and neck. Prurigo pigmentosa may be distinguished from many other skin lesions by its reticular pattern. Its pathogenesis is unknown, but it has been hypothesised to be induced by a state of ketosis. Clinicians should therefore be aware of its association with the increasingly popular ketogenic diet. This dermatosis responds well to tetracyclines and has an excellent prognosis. In the patient with ketosis-induced prurigo pigmentosa, administration of insulin or an increase in carbohydrates can also resolve symptoms.

[Study of incidence and economic burden of herpes zoster based on community investigation among the aged in Laiwu district, Jinan city, Shandong Province of China]

Objective: To understand the incidence and economic burden of herpes zoster among the aged in Laiwu district, Jinan city. Methods: Retrospective cohort study was conducted in 5 communities in Laiwu District, Jinan City from July to September, 2019. A total of 8 300 residents born before July 1, 1959 and aged ≥60 years old were included in the investigation. At the same time, an economic burden survey was carried out among 220 cases who developed herpes zoster after July 1, 2017. A questionnaire was used to collect information on incidence and economic burden of HZ, and comparisons were carried out about the incidence and economic burden of herpes zoster among older people with different characteristics. Results: The age of 8 300 subjects was (71.46±6.71) years old. Male and female accounted for 44.10% and 55.90%, respectively. The cumulative incidence of disease after the age of 60 was 73.61‰ among population aged ≥60 years old. The cumulative incidence was 28.03‰, 71.26‰, 86.09‰, 93.48‰ and 88.10‰ among population aged 60-64, 65-69, 70-74, 75-79 and ≥80 years old,respectively. The average annual incidence of HZ was 9.49‰ and annual incidence was 7.59‰, 7.23‰, 8.43‰, 10.24‰ and 13.98‰ in 2014-2018, respectively. HZ cost was (2 626±667) RMB per patient with a median cost of 715 RMB (interquartile range 303-2 358) on 220 cases who developed disease after July 1, 2017. The cost of outpatient cases was (1 329±1 835) RMB per patient with a median cost of 560 RMB (interquartile range 300-1 320), and the cost of inpatient cases was (14 303±16 571) RMB per patient with a median cost of 8 190 RMB (interquartile range 4 368-15 160). Conclusion: The incidence of HZ is high among population aged≥60 years old, which could cause heavy economic burden for them.

[Clinical analysis of 3 cases of mucormycosis in children with acute lymphoblastic leukemia and literature review]

Objective: To investigate the clinical features, diagnosis,treatment and prognosis of children with acute lymphoblastic leukemia complicated with mucormycosis, and to improve the understanding of the disease. Methods: The clinical data of 3 children with acute lymphoblastic leukemia (ALL) complicated with mucormycosis treated at the First Affiliated Hospital of Zhengzhou University between October 2020 and January 2021 were analyzed retrospectively. Literature search and review covered the China national knowledge infrastructure, Wanfang database and Pubmed using the keywords of "acute lymphoblastic leukemia" and "mucormycosis" up to June 2021. Results: Case 1, a 12-year-old boy, was diagnosed with ALL, developed fever and chest pain during induction therapy. The Metagenomic next-generation sequencing (mNGS) testing of alveolar perfusion fluid suggested infection with Rhizopus oryzae. Amphotericin B combined with posaconazole was applied and amphotericin B was removed after improvement. Bone destruction was indicated by CT. Amphotericin B was applied again. Case 2, a 4-year-old boy, with a history of pallor and tetter, was diagnosed with ALL. He developed cough and fever during induction therapy. mNGS of blood suggested infection with Rhizomucor pusillus. Amphotericin B combined with voriconazole was applied, but the situation was not significantly improved. The disseminated infection occurred. Amphotericin B combined with posaconazole was applied and vacuum sealing drainage was performed. Case 3, a 2-year-old girl, was diagnosed with ALL, developed fever and cough during induction therapy. Rhizomucor pusillus was indicated by mNGS. Amphotericin B combined with posaconazole was used, and posaconazole was stopped after improvement. Follow-up until June 2021, the condition of the 3 children improved. There was no recurrent Mucor infection, and the primary hematopathy was in complete remission. According to the literature, 7 reports were found in Chinese journals, while 17 reports were found in English literature, 25 cases have been reported. Among a total of 28 children, 11 cases rhino-orbito-cerebral mucormycosis, four pulmonary mucormycosis, 2 cutaneous mucormycosis, 2 gastrointestinal mucormycosis and 9 disseminated mucormycosis. There were 17 cases developed infection during induction chemotherapy, 8 cases during maintenance therapy, 3 cases after hematopoietic stem cell transplantation. Voriconazole was used in 15 cases; 19 cases were treated with combined surgery, 7 cases were treated with drugs only, 2 cases were untreated; 21 cases showed improvement after treatment. Death occurred in seven cases. Conclusions: ALL complicated with mucormycosis often occurs in the stage of induction therapy. The clinical features lacked specificity, mNGS can help find the pathogen and provide evidence for diagnosis. Surgical treatment also could be combined when necessary, which is helpful to improve the prognosis.

[Epidemiological characteristics of herpes zoster in Xicheng district of Beijing in 2019: based on the health information system of medical institutions]

Objective: Using data of health information system (HIS) of medical institutions to study epidemiological characteristics of herpes zoster in Xicheng district of Beijing. Methods: To collect data of outpatient herpes zoster cases of all 42 medical institutions in 2019 based on HIS. After distinguishing the reduplicated cases, we organized these data for descriptive epidemiological analysis. Results: A total of 3 982 primary outpatient cases were investigated, the estimated incidence was 3.38‰ (3 982/1 178 999). The incidence was 2.90‰ (1 655/570 320) for males and 3.82‰ (2 327/608 679) for females and with increasing trends with age. Herpes zoster occurred from January to December. These cases mainly visited tertiary hospitals, with central departments as dermatology and traditional Chinese medicine involved. For the first identified cases, the average age was (60.48±15.43) years old. The ages of disseminated herpes zoster patients was (74.00±8.98) years old, while the age of herpes zoster in the outer ear was (54.32±15.73) years old. The top three diseases were herpes zoster, post-herpetic neuralgia, and Herpes zoster with other neurological complications, with proportions as 82.65% (3 291/3 982), 10.37% (413/3 982), and 4.37% (174/3 982), respectively. Conclusions: Most herpes zoster cases were more than 50 years old in Xicheng district of Beijing, with females have seen more than males. Complications commonly occurred among individuals more than 50 years old and with the most widely seen complication as post-herpetic neuralgia.

[Risk factors and prognosis of bronchopulmonary dysplasia associated pulmonary hypertension in preterm infants]

Objective: To analyze clinical features, prognosis and risk factors of bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH). Methods: Clinical data of 338 infants with BPD were collected from the neonatal intensive care unit (NICU) in Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University between January 2016 and December 2018. These infants were divided into PH group and non-PH group. The clinical features and prognosis were compared between these two groups by Chi-square test or nonparametric test. Risk factors for BPD-PH were analyzed with binary logistic regression model. Results: Among the 338 BPD infants, 314 had no PH (92.9%) and 24 had PH (7.1%), with an average gestational age of (27.1±1.8) weeks, and 206 were males and 132 females.PH infants had younger gestational age ((26.4±2.1) vs. (27.2±1.7) weeks, t=2.201, P=0.028) and lower birth weight ((798±255) vs. (1 003±240) g, t=4.030, P<0.01), compared to non-PH infants. Besides, duration of mechanical ventilation and non-invasive positive pressure ventilation were higher in PH group than that in non-PH group (14.3 (2.1, 43.7) vs. 0.5 (0, 4.7) d, Z=-4.553, P<0.01; 30.0 (22.5, 64.2) vs. 15.0 (7.0, 26.0) d, Z=-4.838, P<0.01). The proportions of maternal hypertension, small for gestational age (SGA), late onset sepsis, ventilator associated pneumonia, hemodynamically significant patent ductus arteriosus (hsPDA), patent ductus arteriosus (PDA) requiring ligation, severe BPD and severe extrauterine growth retardation (EUGR) were higher in PH group than those in non-PH group ((20.8% (5/24) vs. 6.4% (20/314), 33.3% (8/24) vs. 7.6% (24/314), 54.2% (13/24) vs. 7.3% (23/314), 25.0% (6/24) vs. 6.1% (19/314), 75.0% (18/24) vs. 39.2% (123/314), 45.8% (11/24) vs. 1.9% (6/314), 66.7% (16/24) vs. 7.3% (23/314), 75.0% (18/24) vs. 45.5% (143/314), all P<0.05). Multivariate logistic regression analysis showed that maternal hypertension (OR=12.950, 95%CI: 1.740-96.385), severe bronchopulmonary dysplasia (OR=10.160, 95%CI: 2.725-37.884), SGA (OR=4.992, 95%CI: 1.432-16.920), PDA requiring ligation (OR=19.802, 95%CI: 3.297-118.921), severe EUGR (OR=20.316, 95%CI: 2.221-185.853) were independent risk factors of BPD associated PH. In the 24 infants with PH, all 7 mild PH infants and 8 moderate PH infants survived, while 4 out of 9 severe PH infants died. Among the survivors, the longest duration of oxygen therapy was up to the corrected gestational age of 1 year and 2 months. Conclusions: PH is a severe complication of BPD, and associated with higher mortality and poor prognosis. Echocardiography screening and regular post-discharge follow up are recommended for BPD infants with risk factors of PH.

Equation Derivation of the Probability Distribution of IBS Score among Full Sibling Pairs

Objective To derive the general equation of the probability distribution of identity by state （IBS） score among biological full sibling pairs by calculating STR allele frequency. Methods Based on the Mendelian genetics law and the hypothesis that parents of biological full siblings （FS） were unrelated individuals, the IBS score and corresponding probability of different genotype combinations in the offspring when unrelated individuals of different genotype combinations give birth to two offsprings were derived. Results Given f_i （i=1, 2, …, m） as the frequency of the ith allele of a STR locus, the probability of sharing 2 alleles （p2FS）, 1 allele （p1FS） or 0 allele （p0FS） with biological full sibling pairs on the locus can be respectively expressed as follows： (see the text). The sum of p2FS, p1FS and p0FS must be 1. As for the multiple genotyping system that contained n STR loci, IBS scores between biological full sibling pairs conform to binomial distribution： IBS~B（2n, π1）. The population rate π1, can be given by the formula： (see the text). Conclusion The alternative hypothesis in biological full sibling testing is that two appraised individuals are biological full siblings. The probability of the corresponding alternative hypothesis of any STR locus combination or IBS score can be directly calculated by the equations presented in this study, and the calculation results are the basis for explanations of the evidence.

Ancestry Inference Using the ForenSeqTM DNA Signature Prep Kit

Objective To evaluate the effect of 56 ancestry informative single nucleotide polymorphism （aiSNP） genetic markers in the ForenSeq^TM DNA Signature Prep Kit on ancestry inference. Methods A total of 85 samples from five populations including Hebei Han population, Inner Mongolia autonomous region Mongolian population, Tibet autonomous region Tibetan population, Xinjiang Uygur autonomous region Uygur population and Nigerian population were collected. The library was constructed with the ForenSeq^TM DNA Signature Prep Kit and sequencing was performed based on the MiSeq FGx Forensic Genomics System. Using universal analysis software （UAS） of ForenSeq^TM, principal component analysis （PCA）, Structure and likelihood ratio method was used on the genotyping data of 56 aiSNP markers, respectively, and the genetic relationships between populations and inference of the origin of ancestors were analyzed. Results Among the five populations tested, the four ethnic populations in China （Hebei Han population, Inner Mongolia autonomous region Mongolian population, Tibet autonomous region Tibetan population and Xinjiang Uygur autonomous region Uygur population） could be significantly distinguished from Nigerian population. Xinjiang Uygur autonomous region Uygur individuals were shown as having mixed origins of ancestors and could be distinguished from the other three Chinese populations. However, the other three populations in China （Hebei Han population, Inner Mongolia autonomous region Mongolian population and Tibet autonomous region Tibetan population） could not be effectively distinguished by the system. Conclusion The 56 aiSNP markers in the ForenSeq^TM DNA Signature Prep Kit can make accurate ancestry inference from the intercontinental level, but it is not yet able to distinguish between Chinese subpopulations.

[Comparative analysis of sleep monitoring between young and middle-aged and elderly OSA patients]

Objective:The aim of this study is to compare the night sleep hypoxia degree and sleep structure of young and middle-aged and elderly patients with OSA, so that PSG has more important application value.Method:A total of 438 patients diagnosed with OSA from February 2017 to January 2019 were selected,including 119 patients in the youth group with an average age of (28.5±5.1）years,and 319 patients in the middle and elderly group with an average age of (45.8±2.7)years.The results recorded by PSG in the two groups were retrospectively analyzed. Result:①The AHI, ODI, OAI, MAI and ASaO₂of OSA patients in the junior group were significantly higher than those in the middle-aged and elderly group, while CAI was not statistically significant between the two groups (P=0.419).②The NREM stage Ⅰ (61.1±4.3)% in the junior group was significantly higher than that in the junior group (53.3±3.4)%.NREM stage Ⅱ (33.2±2.3)% and NREM stage Ⅲ+Ⅳ (4.3±1.3)% in the junior group were higher than those in the middle-aged group (29.2±3.9)% and stage Ⅲ+Ⅳ (2.6±0.9)%, while the percentage of REM stage and microarousal index were not statistically significant between the two groups.③Young OSA patients were associated with hypertension and 47.0% middle-aged and elderly patients were associated with hypertension.There was no statistical difference between the two groups in whether hypertension was associated with hypertension or not.Conclusion:The NREM phase is particularly susceptible to age, and age affects slow wave sleep. The sleep structure of middle-aged and older people demonstrates their sleep characteristics: reduced total sleep time,slow wave sleep,low sleep efficiency,and delayed sleep. The young people's nighttime hypoxia is more serious. AHI,ODI,OAI,MAI,ASaO₂ and other indicators are significantly higher than the middle-aged and elderly people, but the sleep structure 2 groups are similar, indicating that young people have strong sleep physiological compensation and Adjustment ability.

[Canalplasty: surgical technique and analysis of the results]

Objective:To determine the applications and results of canalplasty for closed middle ear surgery.Method:Charts of 74 ears who underwent a canalplasty and closed middle ear surgery because of chronic otitis media or middle ear cholesterol granuloma between 2012 and 2016 were reviewed for general condition, disease, surgery methods,surgical outcome,complications,results of pure tone audiometry pre-and post-operatively.Result:Sixteen(21.6%) ears have some problems of their anterior ligament of malleus.Post-operative there are 69 ears totally epithelization, of which the rate is 93.2%,and the average epithelization time is 5.3 weeks. The myringoplasties are successful on 72 ears(97.3%).There are 5 ears(6.8%) occurring complications relating to canalplasty.One year after surgery the air-bone gap has decreased by 8 dB, which has been improved significantly than pre-operative(P<0.05).Conclusion:This study shows that technique for canalplasty is safe and effective,which can exposure the whole tympanic membrane and is easy for tympanoplasty. The epithelization rate of our technique is high.And it's good for myringoplasty and hearing outcomes.

Full Sibling Testing Based on NGS-SNP Genotyping Method and IBS Strategy

Abstract

Objective To evaluate the effectiveness of single nucleotide polymorphism （SNP） genoty-ping in combination with identity by state （IBS） strategy in full sibling testing. Methods Thirty-five blood samples were collected from a four-generation family. Ninety autosomal SNPs were genotyped using Precision ID Identity Panel. The distribution of IBS scores for full siblings and other relationships were calculated and compared. The relationships were determined using Fisher discriminant function and threshold method, respectively. Results Based on family members and previous research, 44, 30, 111, 71 and 1 000 pairs of full siblings （FS）, grandparent-grandchild （GG）, uncle/aunt-nephew/niece （UN）, first cousins （FC） and unrelated individuals （UI） were obtained, respectively. The average IBS scores were 148, 130, 132, 124 and 120, respectively. Except for the GG and UN pairs, the distribution differences among the other relationships had statistical significance （P<0.05）. The false rates of Fisher discriminant function to determine relationships were 1.3%, 22.3%, 17.0% and 38.7% for FS, GG, UN and FC, respectively. Based on the simulation data, the thresholds t₁=128 and t₂=141 were recommended to determine full sibling relationships （the false rate ≤0.05%）. Conclusion The 90 SNP genetic markers included in the Precision ID Identity Panel meet the testing requirements for full sibling relationships. The threshold method based on IBS has a relatively lower false rate and is more flexible.

[Study on the correlation between meteorological factors and allergic rhinitis in outpatients in Yangzhou]

Objective:To investigate the characteristics of allergic rhinitis in Yangzhou area and its correlation with meteorological factors. Method:The characteristics of 17 491 cases of AR were analyzed in Yangzhou from 2015 to 2017. Meteorological environmental parameters, including mean temperature, air pressure, wind speed, humidity and AQI index, were monitored at the same period. The relationship between the onset characteristics of AR patients and meteorological factors was also analyzed. Result:The number of patients with allergic rhinitis in 2015, 2016 and 2017 were 6 167, 5 620 and 5 704. The total difference of the number of patients in 3 years was not statistically significant (P＞0.05). Each year the number of patients reached the peak in October, April, the lowest in February, and less than the other seasons in the summer (P<0.05). The number of visits per year reached peak in October, the lowest in February, and significantly less in summer than in other seasons (P<0.05). The number of children under the age of 12 is relatively small, and the number of patients aged 20 to 40 is the largest. In different age groups, the number of male patients was higher than that of women. There was a positive correlation between the average temperature and AQI index of the average allergic rhinitis patients(r=0.635, P=0.027; r=0.587, P=0.045), and the average temperature and average humidity of the patients with average allergic rhinitis were negatively correlated with regional average humidity and average wind speed(r=-0.193, P=0.045; r=-0.862, P=0.000). Conclusion:The incidence of allergic rhinitis in Yangzhou area has obvious age regularity and seasonality, and there may be some correlation between meteorological factors(especially AQI index) and the incidence of allergic rhinitis in patients.

TTTCA repeat expansion causes familial cortical myoclonic tremor with epilepsy

BACKGROUND AND PURPOSE

The aim was to investigate whether abnormal TTTTA and TTTCA repeat expansions in introns of SAMD12, TNRC6A and RAPGEF2 are involved in the pathogenesis of familial cortical myoclonic tremor with epilepsy (FCMTE).

METHODS

Five families diagnosed with FCMTE were included in the current genetic analysis. Whole-exome sequencing was performed in selected patients of each family. TTTTA and TTTCA expansions were examined by repeat-primed polymerase chain reaction. The clinical features of FCMTE were elicited as defined by the common genetic mechanism of 14 patients.

RESULTS

Abnormal TTTCA expansion was identified and co-segregated in all five FCMTE families, four inserted in SAMD12 and one in RAPGEF2. The insertion of expanded TTTCA was not found in 116 control alleles. TTTTA expansion in SAMD12 was detected in 90.9% (10/11) of patients or mutation carriers; TTTTA expansion in RAPGEF2 was not found. The onset age of myoclonic tremor was 27.4 ± 5.9 (19-37) and epilepsy usually presented around age 34. Focal and generalized seizures were witnessed with various origins recorded by electroencephalogram. Cognitive deficits were not common within the first 3 years after epilepsy onset. Emotional instability was reported by most patients. No patients showed any cerebellar deficits. Valproate added with clonazepam is effective in controlling seizures but cannot guarantee a complete remission of tremor. Repeat length showed intergenerational instability and was inversely correlated with age at onset of myoclonic tremor and epilepsy.

CONCLUSIONS

TTTCA expansion insertion is associated with FCMTE in Chinese families. The homogenous genetic mechanism allowed for a higher precision of FCMTE description.

Long-Term Ultrasound Follow-Up of Incidentally Detected Thyroglossal Duct Cysts in Adults

BACKGROUND AND PURPOSE

There has been no previous study that used ultrasonography for longitudinal changes of thyroglossal duct cysts, to our knowledge. We assessed the prevalence and interval changes in incidentally detected thyroglossal duct cysts in adults.

MATERIALS AND METHODS

From January 2010 to December 2016, we identified 796 ultrasonography radiologic reports from 513 subjects that contained the words "thyroglossal" or "TGDC" among 54,369 participants. Of 513 subjects, 172 (M/F = 103:69, mean age, 53 ± 11 years) who underwent ≥2 sonography studies were enrolled. Two reviewers determined ultrasonography features, including maximal diameter, location, internal echogenicity, wall thickness, and the presence of posterior enhancement, internal septa, and solid components.

RESULTS

The mean follow-up time of total 172 lesions was 2.01 ± 1.13 years. Thyroglossal duct cysts ranged from 2 to 32 mm (mean, 8.77 ± 3.83 mm) on the initial ultrasonography examination. On follow-up ultrasonography studies, 14 lesions (8.2%) increased by >2 mm, while most thyroglossal duct cysts (133 lesions, 77.3%) remained stable in size. During the follow-up period, 31 lesions (18.0%) showed interval changes in ultrasonography features. There was no significant relationship between the presence of ultrasonography feature changes and size changes (P = .12).

CONCLUSIONS

On ultrasonography, 0.9% of adults had incidental thyroglossal duct cysts. Most did not increase in size with time despite changes in various ultrasonography features. Therefore, we recommend performing an observation at long intervals of 2-3 years for asymptomatic thyroglossal duct cysts, and we suggest that fine-needle aspiration can be suspended unless suspicious findings of malignancy are detected.

[An analysis of the characteristics of perioperative cardiac troponin elevation in orthopaedic surgical patients]

Objective: Perioperative myocardial infarction remains a severe complication in non-cardiac surgery and is one of the major causes of death. Cardiac troponin (cTn) I elevation is associated with short-term and long-term mortality. The aim of the study was to assess the proportion rate of cTnI elevation and its clinical characteristics among patients admitted for orthopaedic surgery with or without cardiovascular events. Methods: This is a retrospective study including 27 744 patients aged 50 years or older who admitted for orthopaedic surgery from 2009-2015 in Beijing Jishuitan Hospital. Results: Two hundred and sixty-five patients [age (71.7±9.9) years] had cTnI level> 0.04 μg/L with 66% (175 patients) of them being female. Among them, 59 patients were isolated troponin rise (ITR) (n=59), 13 were preoperative acute myocardial infarction (AMI), and 193 were postoperative AMI. The proportion of postoperative AMI was 0.69%. Those patients were more likely to have a history of coronary artery disease or hypertension. Non-ST-segment elevation myocardial infarction (NSTEMI) was more common (93.3%) than ST-segment elevation myocardial infarction in these patients. Most of them did not experience ischemic symptoms. Totally 76.7% of the AMI occurred within 3 days of surgery; and the in-hospital mortality rate was 10.4%. Conclusions: Perioperative elevation of troponin is common in patients undergoing orthopaedic surgery. Most postoperative AMI were NSTEMI and with absent or atypical ischemia symptoms. Monitoring troponin levels and electrocardiograph in at-risk patients is needed to find most of the AMI.

[Full Sibling Identification by IBS Scoring Method and Establishment of the Query Table of Its Critical Value]

OBJECTIVES

To establish a query table of IBS critical value and identification power for the detection systems with different numbers of STR loci under different false judgment standards.

METHODS

Samples of 267 pairs of full siblings and 360 pairs of unrelated individuals were collected and 19 autosomal STR loci were genotyped by Goldeneye™ 20A system. The full siblings were determined using IBS scoring method according to the 'Regulation for biological full sibling testing'. The critical values and identification power for the detection systems with different numbers of STR loci under different false judgment standards were calculated by theoretical methods.

RESULTS

According to the formal IBS scoring criteria, the identification power of full siblings and unrelated individuals was 0.764 0 and the rate of false judgment was 0. The results of theoretical calculation were consistent with that of sample observation. The query table of IBS critical value for identification of full sibling detection systems with different numbers of STR loci was successfully established.

CONCLUSIONS

The IBS scoring method defined by the regulation has high detection efficiency and low false judgment rate, which provides a relatively conservative result. The query table of IBS critical value for identification of full sibling detection systems with different numbers of STR loci provides an important reference data for the result judgment of full sibling testing and owns a considerable practical value.

Role and timing of second-line therapies for patients with recurrent platinum-resistant ovarian epithelial cancer

OBJECTIVE

To explore the regimens and prognoses of second-line therapies for recurrent platinum-resistant ovarian epithelial cancer (OEC).

MATERIALS AND METHODS

The clinical profiles and second-line regimens were retrospectively analyzed for 65 recurrent platinum-resistant OEC patients treated at Zhejiang Provincial Tumor Hospital during January 2003 to January 2013. In conjunction with literature reviews, the second-line therapies for platinum-resistant recurrent OEC were discussed.

RESULTS

Their average age was 55.2 years. The stages were I (n=4), II (n=3), III (n=45), and IV (n=13). The predominant type was serous adenocarcinoma (n=47, 72.3%). Chemotherapy was refused (n=14) and resistant (n=5 1). One case was lost to follow-up and another three withdrew early. An average of four chemotherapeutic courses were offered in 61 cases. Among them, five cases selected chemotherapy after a second operation. The average therapy-free interval (TFI) was 3.5 months. The efficacies were evaluated for 61 cases. CR (n=5) and partial remission (PR, n=22). The overall survival (OS) rate was 43.6% and average progression-free survival (PFS) was 15.44 months.

CONCLUSION

The efficacy of second-line therapy for recurrent platinum-resistant OEC is rather poor and the feasibility and efficacy of second operation are to be further explored.

Association of CX3CR1 (V249I and T280M) polymorphisms with age-related macular degeneration: a meta-analysis

OBJECTIVE

Studies investigating the associations between CX3CR1 genetic polymorphisms and age-related macular degeneration (AMD) have reported controversial results. Therefore, this meta-analysis aims to clarify the effects of CX3CR1 T280M and V249I polymorphisms on AMD risk.

DESIGN

Meta-analysis.

PARTICIPANTS

Results from six studies were pooled in the meta-analysis.

METHODS

Relevant studies were selected through an extensive search of PubMed, EMBASE, and the Web of Science databases. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random-effects model.

RESULTS

Six studies with were included in this systematic review and meta-analysis. There was no significant association between CX3CR1 T280M polymorphism and risk of AMD under all genetic models (TT vs

CC/CT

OR = 1.57, 95% CI = 0.87-2.84; CC vs TT/CT: OR = 0.75, 95% CI = 0.54-1.06; TT vs CC: OR = 0.58, 95% CI = 0.30-1.144; CT vs CC: OR = 1.25, 95% CI = 0.91-1.70). The CX3CR1 V249I polymorphism also did not significantly affect the AMD risk (AA vs

GG/AG

OR = 1.23, 95% CI = 0.98-1.55; AG/AA vs GG: OR = 0.56, 95% CI = 0.29-1.07; AA vs GG: OR = 1.43, 95% CI = 0.97-2.09; AG vs GG: OR = 1.07, 95% CI = 0.85-1.36).

CONCLUSIONS

This meta-analysis suggested that CX3CR1 T280M and V249I polymorphisms may not be associated with an increased risk of AMD based on current published data. Given the limited sample size, the finding on CX3CR1 polymorphisms needs further investigation.

Evaluation of Cellular Antioxidant and Antiproliferative Activities of Five Main Phyllanthus Emblica L. Cultivars in China

The cell-based antioxidant activity assay as more biological relevant assay was considered to be more accurate to predict antioxidant activity in vivo than chemical activity assays. In the present study, the five main Phyllanthus emblica L. cultivars in China were subjected for cellular antioxidant activity based on HepG2 cells as well as antiproliferative activity. Total phenolics, total flavonoids and oxygen radical absorbance capacity were also measured. The results showed that Qingyougan, Binggan and Boligan (832±100, 774±52 and 704±28 μmol of quercetin equivalents/100 g) had higher cellular antioxidant activity than Tianyougan and Yougan (553±50 and 457±24 μmol of quercetin equivalents/100 g) in phosphate buffered saline wash protocol whereas, Boligan (3735±217 μmol of quercetin equivalents/100 g) had the highest cellular antioxidant activity and Tianyougan (2025±171 μmol of quercetin equivalents/100 g) had the lowest cellular antioxidant activity in no phosphate buffered saline wash protocol. The highest and lowest antiproliferative activities were observed in Binggan and Tianyougan (median effective dose: 6.95±0.11 and 14.03±0.10 mg/ml), respectively. The significant correlation was only observed between total flavonoids and cellular antioxidant activity from no phosphate buffered saline wash protocol (R(2) =0.908, P<0.05), and total flavonoids and antiproliferative activity (R(2) =0.887, P<0.05), suggesting the major contribution of flavonoids to the bioactivities of emblica. Overall, the data obtained revealed that different Phyllanthus emblica L. cultivars had strong cellular antioxidant and antiproliferative activities, thus should be recommended to increase consumption for health.

Association of TCF4 polymorphisms and Fuchs' endothelial dystrophy: a meta-analysis

Background

Studies investigating the associations between transcription factor 4 (TCF4) genetic polymorphisms and Fuchs’ endothelial dystrophy (FED) have reported controversial results. Therefore, this meta-analysis aims to clarify the effects of TCF4 polymorphisms on FED risk.

Methods

A meta-analysis was conducted to assess the association between four single nucleotide polymorphisms (SNPs) inTCF4 and the risk of FED. Relevant studies were selected through an extensive search of PubMed, EMBASE, and the Web of Science databases. Pooled odds ratio (OR) and 95 % confidence interval (CI) were calculated using the random-effects model.

Results

Thirteen studies were included in this systematic review and meta-analysis. The pooled results showed that there was a strong positive association between the TCF4 rs613872 polymorphism and FED risk in all the genetic models tested (G allele vs. T allele: OR = 4.19, 95 % CI = 3.53–4.97; GG vs. GT/TT: OR = 4.27, 95 % CI = 2.54–7.19; GG/GT vs. TT: OR = 6.29, 95 % CI = 4.23–8.93; GG VS. TT: OR = 10.64, 95 % CI = 5.28–21.41; GT VS. TT: OR = 6.08, 95 % CI = 4.28–8.64). Statistic evidence was also detected for a significant association between three other SNPs and the risk of FED.

Conclusions

This meta-analysis suggested a genetic association between four TCF4 polymorphisms (rs613872, rs2286812, rs17595731, and rs9954153) and the risk of FED.

[Decline of ATP-binding cassette transporter G1 expressions with a liver X receptor-independent pathway in patients with type 2 diabetes]

OBJECTIVE

To examine the cholesterol efflux and the expressions of ATP-binding cassette transporter G1 (ABCG1) in macrophages of diabetic patients and the roles of liver-X receptor (LXR) in regulation of ABCG1 expressions.

METHODS

Blood was collected from patients with type 2 diabetes mellitus and healthy controls. The peripheral blood monocytes were differentiated into macrophages with macrophage colony stimulating factor (M-CSF). The cells were radio labeled with [(3)H] cholesterol and were performed with cholesterol efflux assays. Quantitative real-time PCR (qRT PCR) and Western blot were performed to measure the mRNA and protein expressions of ABCA1 and ABCG1. To test the effects of LXR on ABCG1 expressions, inhibition of LXRα and LXRβ by siRNA were performed. The DNA-protein complex of LXR and LXR element (LXRE) located in the promoter region of ABCG1 gene were detected with electrophery mobility supershift assay (EMSA).

RESULTS

Macrophage ABCG1 expressions and high-density lipoprotein (HDL) induced cholesterol efflux were significantly reduced (19.0%±1.2% vs. 12.8%±3.6%, t=2.532, P=0.016) in the diabetic subjects whereas ABCA1 expressions and apolipoprotein A1 (ApoA1) induced cholesterol efflux were comparable (12.0%±1.2% vs. 10.2%±2.3%, t=1.771, P=0.109) between the diabetic patients and healthy subjects. The mRNA expressions of LXRα and LXRβ had no changes between the diabetes subjects and healthy controls (t=1.025, P=0.315; t=-0.531, P=0.600). The LXR-LXRE DNA-protein complex detected by EMSA were also similar between the diabetes subjects and healthy controls (t=1.483, P=0.164). Moreover, ABCG1 expressions were not altered by inhibition of LXRα/β siRNA (t=2.143, P=0.061).

CONCLUSION

Our data indicated that expression of ABCG1 and HDL induced cholesterol efflux were reduced in type 2 diabetic patients. However, the LXR mRNA expression and binding complex of LXR and ABCG1 promoter were not changed. The impairment of cholesterol efflux and ABCG1 gene expressions might be regulated via an LXR-independent pathway.

Summer Blight of White Clover (Trifolium repens) Caused by Rhizoctonia solani AG-1-IB in China

White clover (Trifolium repens), also known as Dutch clover (family Fabaceae), is an herbaceous, perennial plant, widely planted as pasture crop and occasionally used as lawn plant. From June to September in 2012 and 2013, approximately 5 to 8% of the plants as garden lawn were infected in the areas surveyed in Tonghua County, Jinlin Province. Ash green and water-soaked lesions appeared initially on the petiole and leaves. Subsequently, petioles collapsed with soft watery rot followed by collapse of leaves and eventually the entire plant. Aerial hyphae appeared on all the infected parts, followed by production of light brown to brown sclerotia. Seven isolates with the morphological characteristics of Rhizoctonia solani Kühn were isolated from symptomatic petioles and leaves which were surface disinfested in 70% alcohol for 30 s and 0.5% sodium hypochlorite for 1 min and plated on potato dextrose agar (PDA). Hyphal tips were transferred to a fresh plate of PDA and the cultures were examined for morphological characters microscopically. Mycelia of all isolates were branched at right angles with a septum near the branch and a slight constriction at the branch base. Hyphal cells were determined to be multinucleate when stained with 1% safranin O and 3% KOH solution (1) and examined at 400× magnification with a microscope. The internal transcribed spacer (ITS) region of the nuclear rDNA was amplified by using the primers ITS4 and ITS5 (2). The ITS sequences of isolates BSYJ₁₄ (GenBank Accession No. HF678123), BSYJ₃₁ (HF571130), BSYY₂₁ (HF678126), and BSY₂₂ (KC572140) exhibited 100% identity with that of R. solani AG 1-1B (AB122138 and HQ185364). ITS sequences of another three isolates, BSYJ₁₁ (HF678122), BSYJ₃₂ (HF678125), and BSYJ₁₂ (HF678121) exhibited 99% identity with the ITS sequence of R. solani AG 1-1B. Pathogenicity tests were performed on healthy, potted T. repens. Five potted plants were inoculated at the base of the petiole with a 0.6-cm diameter mycelial plug from 3-day-old PDA cultures for each isolate, and the inoculation sites were covered with moistened sterile absorbent cotton. Another five potted plants were inoculated with sterile PDA plugs as controls. All plants in the experiments were covered with plastic bags and kept in a greenhouse at 20 to 25°C for 72 h, then the plastic bags were removed. After 5 to 7 days, the symptoms of watery rot were observed on petioles and leaves of all plants inoculated with these isolates, while control plants remained healthy. R. solani AG 1-IB was re-isolated from all plants inoculated with the isolates. The isolates were confirmed by morphological characteristics of the hyphae and hyphal fusions with the original isolates. The pathogenicity test was carried out twice with similar results. R. solani has been reported to cause root rot on T. pratense in northwestern China (4) and summer blight on T. pratense in Japan (3). To our knowledge, this is the first report of R. solani AG 1-IB causing summer blight on T. repens in China. References: (1) R. J. Bandoni. Mycologia 71:873, 1979. (2) D. E. L. Cooke et al. Mycol. Res. 101:667, 1997. (3) T. Tsukiboshi et al. Bull. Natl. Grassl. Res. Inst. 39:50, 1988. (4) W.-Y. Zhuang (ed.). Fungi of Northwestern China. Mycotaxon Ltd. Ithaca, NY, 2005.

Reversible acetylation regulates salt-inducible kinase (SIK2) and its function in autophagy

Salt-inducible kinase 2 (SIK2) is a serine/threonine protein kinase belonging to the AMP-activated protein kinase (AMPK) family. SIK2 has been shown to function in the insulin-signaling pathway during adipocyte differentiation and to modulate CREB-mediated gene expression in response to hormones and nutrients. However, molecular mechanisms underlying the regulation of SIK2 kinase activity remains largely elusive. Here we report a dynamic, post-translational regulation of its kinase activity that is coordinated by an acetylation-deacetylation switch, p300/CBP-mediated Lys-53 acetylation inhibits SIK2 kinase activity, whereas HDAC6-mediated deacetylation restores the activity. Interestingly, overexpression of acetylation-mimetic mutant of SIK2 (SIK2-K53Q), but not the nonacetylatable K53R variant, resulted in accumulation of autophagosomes. Further consistent with a role in autophagy, knockdown of SIK2 abrogated autophagosome and lysosome fusion. Consequently, SIK2 and its kinase activity are indispensable for the removal of TDP-43Δ inclusion bodies. Our findings uncover SIK2 as a critical determinant in autophagy progression and further suggest a mechanism in which the interplay among kinase and deacetylase activities contributes to cellular protein pool homeostasis.

Gene expression analysis of host spleen responses to Marek's disease virus infection at late tumor transformation phase

Marek's disease is a viral neoplastic disease of chickens caused by Marek's disease virus (MDV). Gene expression patterns have been investigated at different MDV infection stages, but there is limited research about the late tumor transformation phase. In this experiment, 44K Agilent chicken genome-wide expression microarrays were used to profile differential expression in tumorous spleens (TS) from severely morbid chickens and apparently normal spleens from survivors (SS) after MDV infection and expression in noninfected spleens (NS) from controls. There were 4,317 differentially expressed (DE) genes in TS versus NS. However, no DE genes were detected in SS versus NS, suggesting that maintenance of, or return to, homeostasis of gene activity in survivor spleens. Downregulated genes in tumorous spleens mainly enriched in the cytokine-cytokine receptor interaction pathway, and commonly investigated genes in Marek's disease study, IL6, IL18, IFNA, and IFNG were nondifferentially expressed, which indicates host inflammatory response was impaired. The IL10 and TNFRSF8 genes were upregulated in tumorous spleens. We speculated that IL10 might be exploited by MDV to escape from host immune surveillance, as reported for Epstein-Barr virus, which stimulated T cells secreting IL10 to subvert immune response. Previous study reported that transcription from TNFRSF8 promoter could be enhanced by MDV oncogene Meq. In this study, the increased expression of TNFRSF8 indicated interaction between MDV and TNFRSF8, which might facilitate pathogenesis and tumor transformation. The expression of many members in IGF system was changed in tumorous compared with noninfected spleens. The downregulation of IGFBP7 was considered to be associated with MD lymphoma transformation. Gene expression change of multiple regulatory pathways indicated their involvements in facilitating tumor transformation.

Atomic ordering kinetics of FePt thin films

In the present study, the nucleation and growth kinetics of the L1(0) ordered domains in FePt thin films were studied by using X-ray diffraction (XRD) measurements combined with transmission electron microscopy (TEM). A small nucleation activation energy En = (0.5 +/- 0.1) eV and a relatively large growth activation energy Eg = (0.9 +/- 0.1) eV for the L1(0) ordered domains are separately determined. The high ratio Eg/En > 1 yields an understanding of a high L1(0) ordering temperature for the FePt thin films used for magnetic recording media.

Calcium-permeable presynaptic kainate receptors involved in excitatory short-term facilitation onto somatostatin interneurons during natural stimulus patterns

Schaffer collateral synapses in hippocampus show target-cell specific short-term plasticity. Using GFP-expressing Inhibitory Neuron (GIN) transgenic mice that express enhanced green fluorescent protein (EGFP) in a subset of somatostatin-containing interneurons (SOM interneurons), we previously showed that Schaffer collateral synapses onto SOM interneurons in stratum (S.) radiatum have unusually large (up to 6-fold) paired-pulse facilitation. This results from a low initial release probability and the enhancement of facilitation by synaptic activation of presynaptic kainate receptors. Here we further investigate the properties of these kainate receptors and examine their effects on short-term facilitation during physiologically derived stimulation patterns, using excitatory postsynaptic currents recorded in S. radiatum interneurons during Schaffer collateral stimulation in acute slices from juvenile GIN mice. We find that GluR5 and GluR6 antagonists decrease short-term facilitation at Schaffer collateral synapses onto SOM interneurons with no additive effects, suggesting that the presynaptic kainate receptors are heteromers containing both GluR5 and GluR6 subunits. The calcium-permeable receptor antagonist 1-napthyl acetyl spermine (NASPM) both mimics and occludes the effect of the kainate receptor antagonists, indicating that the presynaptic kainate receptors are calcium permeable. Furthermore, Schaffer collateral synapses onto SOM interneurons show up to 11-fold short-term facilitation during physiologically derived stimulus patterns, in contrast to other interneurons that have less than 1.5-fold facilitation. Blocking the kainate receptors reduces facilitation in SOM interneurons by approximately 50% during the physiologically derived patterns and reduces the dynamic range. Activation of calcium-permeable kainate receptors containing GluR5/GluR6 causes a dramatic increase in short-term facilitation during physiologically derived stimulus patterns, a mechanism likely to be important in regulating the strength of Schaffer collateral synapses onto SOM interneurons in vivo.

Non-Markovian quantum jump with generalized Lindblad master equation

The Monte Carlo wave function method or the quantum-trajectory-jump approach is a powerful tool to study dissipative dynamics governed by the Markovian master equation, in particular for high-dimensional systems and when it is difficult to simulate directly. We extend this method to the non-Markovian case described by the generalized Lindblad master equation. Two examples to illustrate the method are presented and discussed. The results show that the method can correctly reproduce the dissipative dynamics for the system. The difference between this method and the traditional Markovian jump approach and the computational efficiency of this method is also discussed.

Biomembrane mimetic polymer poly (2-methacryloyloxyethyl phosphorylcholine-co-n-butyl methacrylate) at the interface of polyurethane surfaces

Polyurethane (PU) is widely used to make artificial heart and blood vessel wells; however, its thrombogenicity in vivo is still in question. The biomembrane-mimetic and water-soluble polymers, poly (2-methacryloyloxyethyl phosphorylcholine-co-n-butyl methacrylate) (PMB), were used to modify polyurethane (PU) surfaces for improving their hemocompatibility. The morphologies of the PMB modified PU surfaces were examined by using atomic force microscopy and the parameters of the PMB absorption kinetics were extracted from dynamic water contact angle measurements. Two-phase domains, the hard and soft segment phases, were observed on the PU surfaces under the aqueous conditions. The absorbed PMB molecules formed the isolated layers first on the hydrophobic hard segments, and subsequently networked as the PMB concentration increased. The increments of PMB concentration led to the decrement of the effective molar activation (wetting) free energy DeltaG.

Ferrophilic characteristics of Vibrio vulnificus and potential usefulness of iron chelation therapy

We determined the ferrophilic characteristics of Vibrio vulnificus to evaluate the potential usefulness of iron chelation therapy for the prevention of V. vulnificus infection. Readily available non-transferrin-bound iron (NTBI) is required for the initiation of V. vulnificus growth under in vitro iron-limited conditions and human ex vivo conditions. NTBI aided efficient transferrin-bound iron (TBI) use by V. vulnificus, and the vulnibactin-mediated iron-uptake system was expressed after bacterial growth had been started by NTBI. V. vulnificus required higher NTBI levels for the initiation of growth, produced siderophores at lower levels, and used TBI less efficiently than other bacteria. In addition, the growth of V. vulnificus was inhibited by deferiprone, a clinically available iron chelator. These results show that V. vulnificus is a ferrophilic bacterium that requires higher NTBI levels than other pathogens and that iron chelation therapy might be an effective means of preventing the in vivo growth of V. vulnificus in susceptible patients.

Myostatin expression in ventricular myocardium in a rat model of volume-overload heart failure

BACKGROUND

Mechanical stress increases myocardial myostatin expression. However, the expression of myostatin in chronic heart failure resulting from volume-overload and after treatment with beta-blockers is little known. The authors hypothesize that myostatin plays a role in the failing myocardium because of volume-overload.

MATERIALS AND METHODS

Aorto-caval shunt was created over a 4-week period in adult Sprague-Dawley rats to induce volume-overload heart failure.

RESULTS

Heart weight and body weight ratio significantly increased after shunting. The left ventricular end-diastolic dimension also significantly increased. Treatment with carvedilol in the shunt group reversed the increase in heart weight and ventricular dimension to the baseline values. Myocardial and skeletal myostatin proteins were up-regulated in the shunt group. The mRNA of myocardial myostatin also increased in the shunt group. Treatment with carvedilol reversed both protein and mRNA of myocardial myostatin to the baseline values. Treatment with N-acetylcysteine and doxazosin partially decreased myostatin mRNA and protein expression as compared with the shunt group. Carvedilol normalized the increased immunohistochemical labelling of myocardial myostatin in the shunt group.

CONCLUSION

Myocardial myostatin mRNA and protein expression were up-regulated in the rat model of volume-overload heart failure. Treatment with carvedilol is associated with a limitation of increased myostatin expression in the failing ventricular myocardium.

Vibrio vulnificus metalloprotease VvpE has no direct effect on iron-uptake from human hemoglobin

This study was designed to determine whether or not Vibrio vulnificus metalloprotease VvpE can promote iron uptake via the proteolytic cleavage of human hemoglobin. We found that V. vulnificus utilized hemoglobin as an iron source more efficiently via the vulnibactin-mediated iron-uptake system than via the HupA-mediated iron-uptake system and, of the proteases produced by V. vulnificus, VvpE was found to be the only protease capable of destroying hemoglobin. However, VvpE expression, on both the transcriptional and protein levels, was suppressed in iron-limited media. However, vvpE transcription, but not extracellular VvpE production, was reactivated by the addition of hemoglobin or inorganic iron into iron-limited media. Moreover, vvpE transcription began only in the late growth phase when V. vulnificus had already consumed most of the iron for growth. In addition, neither vvpE mutation nor in trans vvpE complementation affected the ability of V. vulnificus to acquire iron or to grow in iron-limited media or in cirrhotic ascites containing hemoglobin. Hemoglobin added into iron-limited media was not destroyed, but gradually formed an insoluble aggregate during culture; this aggregation of hemoglobin occurred regardless of vvpE mutation or complementation. These results indicate that VvpE is not required for efficient iron uptake from hemoglobin. On the contrary, hemoglobin or iron is required for efficient vvpE transcription. In addition, a discrepancy exists between vvpE transcription and extracellular VvpE production in iron-limited media containing inorganic iron or hemoglobin, which suggests that additional unknown posttranscriptional events may be involved in the extracellular production of VvpE.

Vibrio vulnificus vulnibactin, but not metalloprotease VvpE, is essentially required for iron-uptake from human holotransferrin

The roles of metalloprotease (VvpE) and catechol-siderophore (vulnibactin) in the uptake of iron from human transferrins by Vibrio vulnificus have been determined using different experimental conditions and methods. Therefore, in this study, we attempted to elucidate the roles of VvpE and vulnibactin using the same methods and experimental conditions, in an in vitro and a human ex vivo system, and in accordance with the molecular version of Koch's postulates. Neither vvpE mutation nor in trans vvpE complementation affected vulnibactin production, iron-assimilation from human holotransferrin (HT), and bacterial growth in a HT-containing deferrated Heart-Infusion medium (HT-DF-HI) or a HT-containing cirrhotic ascites (HT-CA). In contrast, the mutation of fur gene encoding Fur, a repressor regulating expression of the vulnibactin-mediated iron-uptake system, derepressed vulnibactin production, and facilitated iron-assimilation from HT and bacterial growth in HT-DF-HI or HT-CA. The mutation of vis gene encoding isochorismate synthase required for vulnibactin synthesis abolished vulnibactin production, iron-assimilation from HT and bacterial growth in HT-DF-HI or HT-CA. These results demonstrate that vulnibactin is essentially required for iron-assimilation from transferrin, and that VvpE has no direct effect on facilitating vulnibactin-mediated iron-assimilation from transferrin in vitro or in a human ex vivo system.

Suppression and inactivation ofVibrio vulnificushemolysin in cirrhotic ascites, a humanex vivoexperimental system

To elucidate the mechanisms underlying the in vivo suppression and inactivation of Vibrio vulnificus hemolysin (VvhA), we used cirrhotic ascites fluid as a human ex vivo experimental system. VvhA expression was suppressed in proportion to the amount of cirrhotic ascites. The expression of vvhA in undiluted cirrhotic ascites could be suppressed further by the addition of glucose, a constituent of cirrhotic ascites. VvhA was readily inactivated in the presence of cirrhotic ascites by a cholesterol-mediated oligomerization and interaction with an undefined constituent(s) of cirrhotic ascites. These results indicate that the expression of vvhA can be suppressed and that any VvhA produced is inactivated by the constituents of cirrhotic ascites. Our results suggest that only a very small portion of the VvhA that is produced in human body fluids may actually contribute to the pathogenesis of V. vulnificus septicemia. It is suggested that cirrhotic ascites could be used as a human ex vivo experimental system for the studies on the in vivo expression and the significance of V. vulnificus virulence factors.

Effect of the crp mutation on the utilization of transferrin-bound iron by Vibrio vulnificus

Cyclic AMP-cAMP receptor protein (CRP) complex plays an essential role in the global regulation of Vibrio vulnificus virulence. We found that growth retardation of V. vulnificus caused by mutation of the crp gene encoding CRP was exacerbated under iron-limited conditions. Accordingly, we investigated the effect of crp mutation on the expression of the vulnibactin-mediated iron-uptake system and the ability of V. vulnificus to utilize transferrin-bound iron, and thus to grow in cirrhotic ascites, a human ex vivo system. The production of vulnibactin was suppressed, and the transcription of the vis and vuuA genes, which encode an enzyme required for vulnibactin synthesis and vulnibactin receptor protein, was also suppressed in the crp mutant. Moreover, the crp mutant could not utilize transferrin-bound iron, and its growth was severely suppressed both on transferrin-bound iron and in cirrhotic ascites. All the defects in the crp mutant were recovered by the in trans complementation of the wild-type crp gene. Putative CRP-binding sequences were found in the regulatory regions of the fur, vis and vuuA genes. These results indicate that crp mutation attenuates the ability to grow on transferrin-bound iron and in a human body fluid by down-regulating the vulnibactin-mediated iron-uptake system.

Comparison of haemodynamic responses to orotracheal intubation with GlideScope® videolaryngoscope and fibreoptic bronchoscope

BACKGROUND AND OBJECTIVE

The GlideScope videolaryngoscope is a newly developed laryngoscope for tracheal intubation recently introduced into clinical anaesthesia. In this randomised clinical study, we compared the haemodynamic responses to orotracheal intubation using a GlideScope videolaryngoscope and a fibreoptic bronchoscope.

METHODS

Fifty-six adult patients, ASA I-II scheduled for elective plastic surgery under general anaesthesia requiring orotracheal intubation were randomly allocated to either the GlideScope videolaryngoscope group or the fibreoptic bronchoscope group. After a standard intravenous anaesthetic induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before and after induction, at intubation and for 5 min after intubation at 1 min intervals.

RESULTS

As compared with the post-induction values the orotracheal intubations using a fibreoptic bronchoscope and a GlideScope videolaryngoscope resulted in the significant increases in blood pressures which did not exceed their baseline values. In the two groups, heart rates at intubation and within 2 min after intubation were significantly higher than their baseline values. However, there were no significant differences in blood pressures and heart rates at all time points, their maximal values and maximal percent changes during the observation and the times required to reach their maximal values between the two groups.

CONCLUSIONS

The orotracheal intubations using a fibreoptic bronchoscope and a GlideScope videolaryngoscope produce similar haemodynamic responses.

Blood pressure and heart rate changes during intubation: a comparison of direct laryngoscopy and a fibreoptic method

Blood pressure and heart rate changes during nasotracheal intubation under general anaesthesia were studied in 100 patients who were randomly allocated to fibreoptic bronchoscope or direct laryngoscopy intubation. Noninvasive blood pressure and heart rate were recorded before and immediately after anaesthesia induction, at anaesthesia intubation and every minute thereafter for 5 min. Nasotracheal intubation was accompanied by significant increases in blood pressure and heart rate compared to baseline values in both groups. Blood pressure and heart rate at intubation, and the maximum values of blood pressure during the observation were significantly higher in the fibreoptic bronchoscope group. However, the maximum values of heart rate were not significantly different between the two groups. Fibreoptic nasotracheal intubation may result in more severe pressor and tachycardiac responses than direct laryngoscopic nasotracheal intubation.

Swarming differentiation of vibrio vulnificus downregulates the expression of the vvhBA hemolysin gene via the LuxS quorum-sensing system

Swarming has proven to be a good in vitro model for bacterial surface adherence and colonization, and the swarming differentiation of a bacterium has been shown to be coupled with changes in the expression of virulence factors associated with its invasiveness, particularly in the early stages of infection. In this study, we attempted to determine whether the expression of vvhA, which encodes for hemolysin/cytolysin (VvhA), is either upregulated or downregulated during the swarming differentiation of V. vulnificus. The insertional inactivation of vvhA itself exerted no detectable effect on the expression of V. vulnificus swarming motility. However, in our lacZ-fused vvhA transcriptional reporter assay, vvhA expression decreased in swarming V. vulnificus as compared to non-swarming or planktonic V. vulnificus. The reduced expression of vvhA in swarming V. vulnificus increased as a result of the deletional inactivation of luxS, a gene associated with quorum sensing. These results show that vvhA expression in swarming V. vulnificus is downregulated via the activity of the LuxS quorum-sensing system, suggesting that VvhA performs no essential role in the invasiveness of V. vulnificus via the adherence to and colonization on the body surfaces required in the early stages of the infection. However, VvhA may play a significant role in the pathophysiological deterioration occurring after swarming V. vulnificus is differentiated into planktonic V. vulnificus.