Conversion THA With Concomitant Removal of Orthopaedic Hardware Should Be Reclassified as a Revision Surgery in the Medicare Severity Diagnosis-Related Group Coding Scheme: An Analysis of Cost and Resource Use

BACKGROUND

Conversion THA, which we defined for this study as THA with concomitant removal of preexisting orthopaedic hardware, has been associated with increased hospital costs and perioperative complications compared with primary THA. Yet, conversion THA is classified as a primary procedure under the Medicare Severity Diagnosis-Related Group coding scheme, and hospitals are reimbursed based on the resource use expected for a routine primary surgery. Prior authors have argued for conversion THA to be reclassified as a revision procedure. Although prior research has focused on comparisons between conversion THAs and primary arthroplasties, little is known about the resource use of conversion THA compared with that of revision THA.

QUESTIONS/PURPOSES

(1) Do inpatient hospital costs, estimated using cost-to-charge ratios, differ between conversion THA and revision THA? (2) Do the median length of stay, intensive care unit use, and likelihood of discharge to home differ between conversion and revision THA?

METHODS

This was a retrospective study of the Medicare Provider Analysis and Review Limited Data Set for 2019. A total of 713,535 primary and 74,791 revision THAs and TKAs were identified initially. Exclusion criteria then were applied; these included non-fee-for-service hospitalizations, nonelective admissions, and patients with missing data. Approximately 37% (263,545 of 713,535) of primary and 34% (25,530 of 74,791) of revision arthroplasties were excluded as non-fee-for-service hospitalizations. Two percent (13,159 of 713,535) of primaries and 11% (8159 of 74,791) of revisions were excluded because they were nonelective procedures. Among the remaining 436,831 primary and 41,102 revision procedures, 31% (136,748 of 436,831) were primary THAs and 36% (14,774 of 41,102) were revision THAs. Two percent (2761 of 136,748) of primary THAs involved intraoperative removal of hardware and were classified as conversion THAs. After claims with missing data were excluded, there were 2759 conversion THAs and 14,764 revision THAs available for analysis. Propensity scores were generated using a multivariate logistic regression model using the following variables as covariates: gender, age, race, van Walraven index, hospital setting, geography, hospital size, resident-to-bed ratio, and wage index. After matching, 2734 conversion THAs and 5294 revision THAs were available for analysis. The van Walraven index, which is a weighted score of patient preoperative comorbidities, was used to measure patient health status. Hospital costs were estimated by multiplying cost-to-charge ratios obtained from the 2019 Impact File by total hospital charges. This methodology enabled the use of a large national database to mitigate the random effects of individual hospitals' unique practices and patient populations. Multivariable regression was performed after matching to determine the independent effects of surgery type (that is, conversion versus revision THA) on hospital cost, length of stay greater than 2 days, intensive care unit use, and discharge to home.

RESULTS

There was no difference in the estimated hospital cost between conversion THA and revision THA (β = 0.96 [95% confidence interval 0.90 to 1.01]; p = 0.13). Patients undergoing conversion THA had increased odds of staying in the hospital for more than 2 days (odds ratio 1.12 [95% CI 1.03 to 1.23]; p = 0.01), increased odds of using the intensive care unit (OR 1.24 [95% CI 1.03 to 1.48]; p = 0.02), and decreased odds of being discharged to home (OR 0.74 [95% CI 0.67 to 0.80]; p < 0.001).

CONCLUSION

The inpatient hospital cost of conversion THA is no different from that of revision THA, although patients undergoing conversion surgery have modestly increased odds of prolonged length of stay, intensive care unit use, and discharge to a nonhome location. These findings support the conclusion that reclassification of conversion THA is warranted. Orthopaedic surgeons must advocate for the reclassification of conversion THA using data-backed evidence or run the risk that orthopaedic procedures will be given decreased reimbursement.

LEVEL OF EVIDENCE

Level III, economic and decision analysis.

Developmental Anatomy of the Radial Bow in Pediatric Patients using 3D Imaging

BACKGROUND

While radial bow shape is well characterized in adults, its development in children is not well understood. Previous studies on the radial bow use radiographs, thus, rotational positioning of the forearm could alter bowing measurements. This study used 3D imaging to better assess the pediatric radial bow.

METHODS

Computed tomography scans from the New Mexico Decedent Image Database were obtained for ages 2 to 16 (females) and 18 (males) (n=152). 3D models were generated using Slicer and Rhino software. Length of the entire radial bow (bicipital tuberosity to sigmoid notch), maximum radial bow, location of the maximum radial bow (bicipital tuberosity to the point of maximum bowing), and distal, middle, and proximal third radial bows were measured.

RESULTS

The length of the entire bow increased with age, with a strong correlation with age (r=0.90, P<0.01). The maximum bow increased with age, with a strong correlation with age (r=0.78, P<0.01). The maximum bow normalized to the length of the entire bow increased mildly with age, mean 0.059 ± 0.012 (r=0.24, P=0.0024), but seems to plateau around age 8. The location of the maximum bow increased with age (r=0.85, P<0.01). The normalized location of the maximum bow remained constant between ages, with a mean of 0.41 ± 0.10 (r=0.12, P=0.14). The normalized distal third bow mildly increased with age (r=0.34, P<0.01), the normalized middle third bow mildly increased with age (r=0.25, P<0.01), and the normalized proximal third bow remained constant between ages (r=0.096, P=0.24).

CONCLUSIONS

Normalized values for maximum, distal third, and middle third radial bow increase with age, while normalized values for location and proximal third radial bow remain relatively constant, suggesting the proportional shape of the radius changes during development, although qualitatively plateaus after age 8.

LEVEL OF EVIDENCE

Retrospective comparative study, Level-III.

Impact of Patient-Reported Allergies on Post-operative Complications and Healthcare Utilization Following Carpal Tunnel Release

INTRODUCTION

Open carpal tunnel release (O-CTR) is associated with high patient satisfaction and low complication rates. Risk factors for complications are well-established. Recent studies have found that patient-reported allergies (PRAs) and psychiatric comorbidities may be associated with increased complication rates. The impact of these factors after elective hand surgery has not been evaluated. This study sought to identify whether PRAs and psychiatric comorbidities are associated with complications after O-CTR and to evaluate their association with prolonged follow-up and the need for post-operative occupational therapy (OT).

METHODS

Patient demographics, PRAs, Patient Health Questionnaire-2 score, Charlson Comorbidity Index, Carpal Tunnel Symptoms-6 score, postoperative complications, OT utilization, and time to final follow-up were recorded for patients who underwent elective O-CTR between 2014 and 2022. Multivariable binomial logistic regression analysis was used to determine pre-operative variables associated with increased risk for complication.

RESULTS

About 250 patients met the inclusion criteria. Fifty-one (20.4%) patients developed minor complications, including scar tenderness (N=34, 13.6%), superficial wound dehiscence (N=9, 3.6%), and superficial infection (N=8, 3.2%). There were no major complications. Independent risk factors for complications included PRAs (OR 1.80, p<0.01) and PHQ-2 score (OR 1.39, p=0.04). Five or more PRAs and PHQ-2 score ≥3 are significant independent risk factors for increased post-operative complications. Increased PRAs and PHQ-2 scores were associated with longer follow-up (p=0.01 and p<0.01, respectively) but not increased OT utilization.

CONCLUSION

An increased number of PRAs and higher PHQ-2 scores are significant, independent risk factors for minor complications following O-CTR. Risk adjustment and peri-operative counseling should incorporate and account for these variables.

Correlations Between Eight Comprehensive Skeletal Maturity Systems in a Modern Peripubertal Pediatric Population

BACKGROUND

Several skeletal maturity systems allow for accurate skeletal age assessment from a wide variety of joints. However, discrepancies in estimates have been noted when applying systems concurrently. The aims of our study were to (1) compare the agreement among 8 different skeletal maturity systems in modern pediatric patients and (2) compare these discrepancy trends qbetween modern and historic children.

METHODS

We performed a retrospective (January 2000 to May 2022) query of our picture archiving and communication systems and included peripubertal patients who had at least two radiographs of different anatomic regions obtained ≤3 months apart for 8 systems: (1) proximal humerus ossification system (PHOS), (2) olecranon apophysis ossification staging system (OAOSS), (3) lateral elbow system, (4) modified Fels wrist system, (5) Sanders Hand Classification, (6) optimized oxford hip system, (7) modified Fels knee system, and (8) calcaneal apophysis ossification staging system (CAOSS). Any abnormal (ie, evidence of fracture or congenital deformity) or low-quality radiographs were excluded. These were compared with a cohort from a historic longitudinal study. SEM skeletal age, representing the variance of skeletal age estimates, was calculated for each system and used to compare system precision.

RESULTS

A total of 700 radiographs from 350 modern patients and 954 radiographs from 66 historic patients were evaluated. In the modern cohort, the greatest variance was seen in PHOS (SEM: 0.28 y), Sanders Hand (0.26 y), and CAOSS (0.25 y). The modified Fels knee system demonstrated the smallest variance (0.20 y). For historic children, the PHOS, OAOSS, and CAOSS were the least precise (0.20 y for all). All other systems performed similarly in historic children with lower SEMs (range: 0.18 to 0.19 y). The lateral elbow system was more precise than the OAOSS in both cohorts.

CONCLUSIONS

The precision of skeletal maturity systems varies across anatomic regions. Staged, single-parameter systems (eg, PHOS, Sanders Hand, OAOSS, and CAOSS) may correlate less with other systems than those with more parameters.

LEVEL OF EVIDENCE

Level III-retrospective study.

Association of Tibial Tubercle-Trochlear Groove Distance With Risk of ACL Graft Failure

Background

Limited evidence suggests a positive correlation between tibial tubercle-trochlear groove (TT-TG) distance and the risk of native anterior cruciate ligament (ACL) tear. The relationship between TT-TG distance and the risk of ACL graft failure is unknown.

Hypothesis

TT-TG distance is independently associated with risk of ACL graft failure.

Study Design

Cohort study; Level of evidence, 3.

Methods

All patients who underwent ACL revision surgery between 2010 and 2018 at a single institution were identified. A control cohort underwent primary ACL reconstruction (ACLR) between 2006 and 2015, with no evidence of graft failure at 8.1 ± 2.5 years postoperatively. Record review included anthropometrics, graft type, and estimated Tegner activity score at ≥6 months after primary ACLR. Magnetic resonance imaging (MRI) scans after native ACL tear (controls) or graft failure (revision cohort) were assessed for (1) TT-TG distance, (2) proximal tibial slopes, (3) depth of tibial plateau concavity, and (4) tunnel position (revision cohort). Associations between ACL graft failure and MRI measurements, surgical variables, and patient characteristics were evaluated with logistic regression analyses. Sensitivity analyses, excluding patients with tunnel malposition, were performed to confirm multivariable results in patients with "ideal" tunnel placement.

Results

Participants included 153 patients who underwent revisions and 144 controls. Controls were older than the patients who underwent revision (26.6 ± 8.8 vs 20.6 ± 7.3 years; P < .001). The mean TT-TG distance and lateral posterior tibial slope (PTS) were smaller for the control group than for the revision group (TT-TG: 9.3 ± 3.9 vs 11.2 ± 4.2 mm; P < .001; lateral PTS: 6.2° ± 3.3° vs 7.2° ± 3.6°; P = .01). TT-TG distance, lateral PTS, and age were associated with risk of ACL graft failure by multivariable analysis (OR, 1.15; 95% CI, 1.07-1.23; P < .001; OR, 1.13; 95% CI, 1.04-1.22; P = .004; and OR, 0.90; 95% CI, 0.87-0.94; P < .001, respectively). With sensitivity analyses, TT-TG distance, lateral PTS, and age at index surgery remained significantly and independently associated with ACL graft failure.

Conclusion

Increased TT-TG distance, increased lateral PTS, and younger age are independently associated with increased odds of ACL graft failure. Patients with these characteristics may require a more comprehensive strategy to reduce the risk of ACL reinjury.

Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures

BACKGROUND

The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes.

METHODS

We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication.

RESULTS

Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%).

CONCLUSIONS

Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.

Applicability of Shoulder, Olecranon, and Wrist-based Skeletal Maturity Estimation Systems to the Modern Pediatric Population

BACKGROUND

The proximal humerus ossification system (PHOS), olecranon apophyseal ossification system (OAOS), and modified Fels wrist skeletal maturity system (mFWS) were recently developed or updated using a historical, mostly White, pediatric population. These upper extremity skeletal maturity systems have demonstrated skeletal age estimation performance superior or equivalent to Greulich and Pyle in historical patients. Their applicability to modern pediatric populations has not yet been evaluated.

METHODS

We reviewed anteroposterior shoulder, lateral elbow, and anteroposterior hand and wrist x-rays of 4 pediatric cohorts: White males, Black males, White females, and Black females. Peripubertal x-rays were evaluated: males 9 to17 years and females 7 to 15 years. Five nonpathologic radiographs for each age and joint were randomly selected from each group. Skeletal age estimates made by each of the 3 skeletal maturity systems were plotted against the chronological age associated with each radiograph and compared between cohorts, and with the historical patients.

RESULTS

Five hundred forty modern radiographs were evaluated (180 shoulders, 180 elbows, and 180 wrists). All radiographic parameters had inter- and intra-rater reliability coefficients at or above 0.79, indicating very good reliability. For PHOS, White males had delayed skeletal age compared with Black males (Δ-0.12 y, P=0.02) and historical males (Δ-0.17 y, P<0.001). Black females were skeletally advanced compared with historical females (Δ0.11 y, P=0.01). For OAOS, White males (Δ-0.31 y, P<0.001) and Black males (Δ-0.24 y, P<0.001) had delayed skeletal age compared with historical males. For mFWS, White males (Δ0.29 y, P=0.024), Black males (Δ0.58 y, P<0.001), and Black females (Δ0.44 y, P<0.001) had advanced skeletal age compared with historical counterparts of the same sex. All other comparisons were not significant (P>0.05).

CONCLUSIONS

The PHOS, OAOS, and mFWS have mild discrepancies in skeletal age estimates when applied to modern pediatric populations depending on the race and sex of the patient.

LEVEL OF EVIDENCE

Level III - retrospective chart review.

Value Challenge: A Bottoms-Up Approach to Minimizing Cost and Waste in Orthopaedic Surgery

Astronomical increases in medical expenses and waste produce widespread financial and environmental impacts. Minor changes to minimize costs within orthopaedics, the most used surgical subspecialty, could result in substantial savings. However, few orthopaedic surgeons are educated or experienced to implement cost containment strategies. This study aims to investigate cost containment opportunities and provide a framework for educating and incorporating residents into cost-saving initiatives.

Methods

Orthopaedic surgical residents from an academic program with a Level I trauma center were queried during 2019 to 2022 regarding suggestions for cost containment opportunities. Based on feasibility and the estimated impact, 7 responses were selected to undergo cost-saving analyses.

Results

The proposed initiatives fell into 2 categories: minimizing waste and optimizing patient care. Eliminating nonessential physical therapy/occupational therapy consults led to the greatest estimated savings ($8.6M charges/year), followed by conserving reusable drill bits ($2.2M/year) and reducing computed tomography scans on lower extremity injuries ($446K/year).

Conclusion

Current medical training provides limited formal education on cost-effective care. Efforts to mitigate the growing financial and environmental costs of health care should include encouraging and incorporating resident feedback into cost reduction strategies. This tactic will likely have a positive impact on the behavior of such resident surgeons as they enter practice and have more awareness of costs and value.

Level of Evidence

V (cost-minimization study).

[Analysis of 1 case of convulsion death caused by large dose of diquat poisoning]

A retrospective analysis of a case of death from sudden convulsions caused by oral high-dose diquat was conducted, and the mechanism and treatment of central damage caused by diquat were investigated to lay the foundation for increasing the success rate of treatment of high-dose diquat poisoning. At the same time, at the same time, our clinical treatment experience has also been accumulated.

Thyroid Ultrasound Reports: Will the Thyroid Imaging, Reporting, and Data System Improve Natural Language Processing Capture of Critical Thyroid Nodule Features?

BACKGROUND

Critical thyroid nodule features are contained in unstructured ultrasound (US) reports. The Thyroid Imaging, Reporting, and Data System (TI-RADS) uses five key features to risk stratify nodules and recommend appropriate intervention. This study aims to analyze the quality of US reporting and the potential benefit of Natural Language Processing (NLP) systems in efficiently capturing TI-RADS features from text reports.

MATERIALS AND METHOD

This retrospective study used free-text thyroid US reports from an academic center (A) and community hospital (B). Physicians created "gold standard" annotations by manually extracting TI-RADS features and clinical recommendations from reports to determine how often they were included. Similar annotations were created using an automated NLP system and compared with the gold standard.

RESULTS

Two hundred eighty-two reports contained 409 nodules at least 1-cm in maximum diameter. The gold standard identified three nodules (0.7%) which contained enough information to calculate a complete TI-RADS score. Shape was described most often (92.7% of nodules), whereas margins were described least often (11%). A median number of two TI-RADS features are reported per nodule. The NLP system was significantly less accurate than the gold standard in capturing echogenicity (27.5%) and margins (58.9%). One hundred eight nodule reports (26.4%) included clinical management recommendations, which were included more often at site A than B (33.9 versus 17%, P < 0.05).

CONCLUSIONS

These results suggest a gap between current US reporting styles and those needed to implement TI-RADS and achieve NLP accuracy. Synoptic reporting should prompt more complete thyroid US reporting, improved recommendations for intervention, and better NLP performance.

Randomized Clinical Trial on Sodium Fluoride with Tricalcium Phosphate

This 24-mo randomized controlled trial was based on a double-blind parallel design, and it compared the effectiveness of 2 fluoride application protocols in arresting dentine caries in primary teeth. Three-year-old children with active dentine caries were recruited and randomly allocated to 2 treatment groups. Children in group A received a semiannual application of a 25% silver nitrate (AgNO₃) solution followed by a commercially available varnish with 5% sodium fluoride (NaF) on the carious tooth surfaces. Children in group B received a semiannual application of a 25% AgNO₃ solution followed by another commercially available varnish with 5% NaF containing functionalized tricalcium phosphate (fTCP). Carious tooth surfaces that were hard when probing were classified as arrested. Intention-to-treat analysis and a hierarchical generalized linear model were undertaken. A total of 408 children with 1,831 tooth surfaces with active dentine caries were recruited at baseline, and 356 children (87%) with 1,607 tooth surfaces (88%) were assessed after 24 mo. At the 24-mo evaluation, the mean (SD) number of arrested carious tooth surfaces per child were 1.8 (2.2) and 2.6 (3.3) for group A (without fTCP) and group B (with fTCP), respectively (P = 0.003). The arrest rates at the tooth surface level were 42% for group A and 57% for group B (P < 0.001). Results of the hierarchical generalized linear model indicated that protocol B (with fTCP) had a higher predicted probability (PP = 0.656) in arresting dentine caries than protocol A (without fTCP; PP = 0.500) when the carious lesions were on buccal/lingual surfaces, were on anterior teeth, had dental plaque coverage, and were in children from low-income families (P = 0.046). In conclusion, protocol B, which applied a 25% AgNO₃ solution followed by a commercially available 5% NaF varnish with fTCP semiannually, is more effective in arresting dentine caries in primary teeth as compared with protocol A, which applied a 25% AgNO₃ solution followed by another commercially available 5% NaF varnish without fTCP semiannually (ClinicalTrials.gov NCT03423797).

[Effect of different medication time prior to corneal refractive surgery on tear film stability]

Objective: To investigate the effect of different medication time prior to corneal refractive surgery on tear film stability. Methods: Prospective cohort study. A total of 60 patients (60 eyes), including 38 males (63.3%) and 22 females (37.7%) with an average age of (24.2±5.1) years (form 18 to 37 years), who had planned for corneal refractive surgery with normal ocular surface disease index score were included in this study. The patients were divided into 1d group (medication of 1 day, 30 eyes) and 3d group (medication of 3 days, 30 eyes) randomly. The first tear break up time (FBUT), the average tear break up time (AVBUT) and the dry eye grade score were recorded on the examination day and the operation day with Keratograph 5M. The difference of FBUT and AVBUI between the two groups was compared with the independent sample t test. The difference of FBUT and AVBUT between the examination day and the operation day was compared with the paired t test. The difference of the dry eye classification between the two groups was compared using chi-square test. Results: The FBUT and AVBUT of 1d group and 3d group were (10.89±5.19)s and (10.88±6.82)s, (16.24±3.62)s and (16.21±4.74)s respectively in preoperative examination, and (10.65±6.03)s and (8.14±5.75)s, (15.14±5.30)s and (12.86±5.92)s respectively in operation day. There was no significant difference in FBUT and AVBUT between the two groups (t=0.01, 1,47, 0.02, 1.44; P>0.05). However, in the 3d group, the AVBUT of operation day decreased as compared with that of the examination day, and the difference was statistically significant (t=2.31, P<0.05). There was no significant difference in the distribution of dry eye classification between the two groups (χ(2)=0.07, 3.36; P>0.05). Conclusion: Both of medication of 1 day and medication of 3 days prior to corneal refractive surgery can provide a similar tear film stability, however more attention should be paid to the medication for patients with asymptomatic but abnormal BUT. (Chin J Ophthalmol, 2018, 54: 744-747).

Effect of pre-slaughter shackling and wing flapping on plasma parameters, postmortem metabolism, AMPK, and meat quality of broilers

The objective of this study was to determine the effects of shackling and wing flapping on stress, postmortem metabolism, AMP-activated protein kinase (AMPK), and quality of broiler pectoralis major. Before slaughter, a total of 80 Arbor Acres broilers was randomly categorized into 2 replicate pens (40 broilers per pen) and each pen randomly divided into 2 groups (shackling, T; control, C). Corticosterone, creatine kinase, and lactate dehydrogenase were determined on blood plasma parameters. Pectoralis major were removed after evisceration and used for determination of energy metabolism, meat quality, and AMPK phosphorylation. In this study, shackling and wing flapping increased (P < 0.05) plasma corticosterone level, creatine kinase activity, and lactate dehydrogenase activity. Shackling and wing flapping increased (P < 0.05) AMPKα(Thr172) and acetyl-CoA carboxylase (ACC) phosphorylation, followed by rapid glycolysis and accumulation of lactic acid, and leading to a fast pH decline in the initial postmortem meat. Shackling and wing flapping have an adverse effect on final meat quality, which increased (P < 0.05) muscle lightness, drip loss, and cooking loss. The results indicate that antemortem shackling and wing flapping increased stress and AMPKα(Thr172) phosphorylation, which may accelerate glycolysis and lead to a low water-holding capacity of broiler meat.

Tunable quantum dot arrays as efficient sensitizers for enhanced near-infrared electroluminescence of erbium ions

Under electrical pumping conditions, high-efficiency Si-based near-infrared light generation and amplification on a chip have long been pursued for future optical interconnection technology. However, the overall performance of Si-based near-infrared electroluminescence (EL) devices, including the overall efficiency, turn-on voltage and stability under operational conditions, can rarely meet the requirements of monolithic optoelectronic integration. In this work, we designed a confined crystallization growth strategy for fabricating metal oxide quantum dot (QD) arrays embedded in Si-based films as sensitizers of Er³⁺ ions. Through the precise control of particle size and number density of QD sensitizers, the near-infrared photoluminescence (PL) emission of Er³⁺ ions can be enhanced by more than three orders of magnitude. More significantly, such hierarchical control over the regular arrangement of QD arrays not only considerably enhances the resonance energy transfer efficiency, but also offers an effective conduction path for carrier transport. Therefore, the corresponding near-infrared EL device exhibits a decreased turn-on voltage of 4.5 V, a high external quantum efficiency of 0.7%, and a long operational lifetime of more than 1000 hours, making this device superior to most Si-based on-chip near-infrared EL devices. This well-controlled metal oxide QD array represents an ideal sensitizer to effectively promote the EL emission of rare earth ions and reduce the turn-on voltage. Meanwhile, the analysis of the carrier transport mechanism paves the way for future research into resonance energy transfer under electrical pumping conditions.

The effects of electrical stunning voltage on meat quality, plasma parameters, and protein solubility of broiler breast meat

This study was designed to compare the effects of different stunning voltages of pulsed direct current on meat quality of broilers. For this purpose, plasma parameters, blood loss, carcass damage, and meat water holding capacity, color, shear force, pH, and protein solubility were analyzed. A total of 400 broilers were divided into 5 treatment groups and stunned with 5, 15, 25, 35, and 45 V at 750 Hz and 10 s, respectively. Blood samples were collected immediately after cutting the neck. Pectoralis major muscles were removed from the carcass after chilling and placed on ice. Breast muscle pH and meat color were determined at both 2 and 24 h postmortem. Dripping loss, cooking loss, pressing loss, and cooked breast meat shear values were determined after 24 h postmortem. The 5 V treatment significantly increased (P < 0.05) blood plasma corticosterone and lactate concentration compared with the other groups. The carcass damage of wings, Pectoralis major, and Pectoralis minor was significant in the 5, 35, and 45 V groups. The pH of 2 h postmortem in the 5 and 45 V groups was significantly lower (P < 0.05) than in the 15 and 25 V groups. In the 5 and 45 V groups, the protein solubility and shear force value were significantly lower (P < 0.05) and dripping loss was significantly higher (P < 0.05) than the other groups.

Effect of fast pH decline during the early postmortem period on calpain activity and cytoskeletal protein degradation of broiler M. pectoralis major

The objective of this study was to determine the effects of fast pH decline during the early postmortem period on calpain activity and the degradation of cytoskeletal proteins in broilers. Eighty broilers were randomly categorized into two groups: physical restraint (PR) and free struggle (FS). M. pectoralis major (PM) was used for determination of calpain activity, shear value, ultrastructure of myofibrils, and the degradation of desmin, titin, nebulin, and troponin-T. The pH (6.05) of FS group is significantly low than PR group (6.38) at 0.3 h postmortem. Fast pH decline during the early postmortem period led to a decrease of μ/m-calpain activities at 0.3 and 3 h postmortem (P < 0.05), but did not affect the ultimate μ/m-calpain activity. An initial fast decrease in pH increased the degradation of desmin, titin, nebulin, and increased the 30 kDa degradation fragments of troponin-T. Therefore, the fast pH decline during the early postmortem period decreased the μ/m-calpain activity and increased the degradation of cytoskeletal proteins in broiler muscle. It is possible that the fast pH decline experienced an earlier activation of calpains that resulted in earlier protein degradation and ultimately lower shear force.

Characterization of grass carp spleen transcriptome during GCRV infection

The aim of the study was to investigate the grass carp hemorrhagic infection pathway and its key-related genes. Grass carp reovirus (GCRV) might cause hemorrhagic disease in grass carps. Healthy grass carp fingerlings (N = 60) were divided into control and infected groups. Fish in the control group were intraperitoneally (ip) injected with 0.6% fish physiological saline; the infected group received 5,000,000 50% tissue culture infective doses of GCRV 873 standard strain, a double-stranded RNA (dsRNA) virus strain, ip, in 0.5 mL. Illumina HiSeqTM 2000 was used for transcriptome sequencing, and real-time polymerase chain reaction (PCR) used to detect complement factors II (C2), III (C3), and V (C5); profibrinolysin (PLG); and coagulation factor II (F2) expression. A total of 2,722,223 reads were detected in the control group, and 2,751,111 in the infected group. Among 11,023 unigenes obtained after transcriptome assembly, 10,021 unigenes were significantly differentially expressed. Gene ontology and KEGG analysis, a collection of databases dealing with genomes and biological pathways, were performed to classify unigenes into functional categories, to understand gene function and identify regulatory pathways. Real-time PCR analysis showed that C2, C3, C5, PLG, and F2 expression levels were down-regulated, confirming results of pathway-enrichment analysis. This is the first application of high-throughput sequencing technology to investigate the in vivo effects of GCRV, on genes and pathways involved in the immune response to infection in grass carp.

Cloning, characterization and expression analysis of coagulation factor II gene in grass carp (Ctenopharyngodon idella)

Here, we characterized the structure and function of the coagulation factor II (FII) gene in grass carp and determined its role in coagulation mechanisms. The FII gene EST was obtained using a constructed splenic transcriptome database; the full-length FII gene sequence was obtained by 3' and 5' RACE. The open reading frame (ORF) of FII was cloned and the full-length gene was found to be 1718 bp, with an ORF of 1572 bp; the gene contained a 25 bp 5'-untranslated region (UTR) and 108 bp 3'-UTR. The ORF encoded 524 amino acids, including 74 alkaline amino acids (arginine and lysine) and 69 acidic amino acids (aspartic acid and glutamic acid). The theoretical pI was 6.22. The calculated instability index (II) was 39.81, indicating that FII was a stable protein; the half-life period was predicted to be approximately 30 h. Amino acid sequence comparisons indicated that grass carp FII showed most similarity (71%) to FII of Takifugu rubripes, followed by Oplegnathus fasciatus (48% similarity) and Larimichthys crocea (47% similarity). A real-time reverse transcription PCR analysis showed that under normal circumstances, FII was most highly expressed in the liver, followed by the gill, spleen, thymus, and head-kidney (P < 0.001). After injection of the grass carp reovirus 873 (GCRV873), the pattern of FII expression was significantly altered (P < 0.001); gene expression was high after injection, suggesting a response involving the initiation of the coagulation system and defense of the body in combination with the platelet and complement system.

Epidemiological characteristics of malaria in Ningbo City, China 2000-2011

The objective of this study was to explore the trend and the epidemiological characteristics of malaria in Ningbo from 2000 through 2011 and provide scientific evidence for the prevention and control. Using the retrospective study, data relating to malaria epidemics during 2000-2011 in Ningbo were collected through the questionnaires of the cases and other important surveillance data. Adult mosquitoes were collected using CDC light traps baited with CO2. Results showed that Plasmodium vivax was the main species, and Anopheles sinensis was the only vector species of malaria. The annual incidence rates (per 100000) ranged from 0.156 to 3.224, and about 95.41% of the cases were imported. The cases occurred mainly between May and November and the incidence showed two peaks, and the local transmission of malaria was determined by vector density. Considering the vast majority of these infections were imported vivax malaria cases from domestic endemic areas (particularly Anhui province), and may lead to limited local transmission, strengthening the routine monitoring of imported malaria, ensuring timely diagnosis, improving case detection rate, giving a standardized treatment to patients and intensifying public health education on malaria prevention are extremely important to malaria prevention and control activities.

Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction

Amputation or degloving injuries of the thumb or index finger are highly disabling. We describe the use of twin dorsal middle finger flaps harvested from the dorsal aspects of the middle and ring fingers, and based on one palmar proper digital artery, its venae comitantes, and the dorsal branches of the palmar digital nerves of the middle and ring fingers, respectively. These flaps offer advantages when large soft tissue defects of the thumb or index finger are present. In this study, twin dorsal middle finger flaps were used in nine patients (six thumbs, three index fingers). All flaps completely survived. At the mean follow-up of 20 months, the appearance of the reconstructed thumbs or index fingers was acceptable, the length was maintained, and the mean static 2-point discrimination values were 10 mm in the palmar flap and 13 mm in the dorsal flap of the reconstructed digit. All patients were satisfied with the appearance and mobility of the donor fingers. All but one donor finger showed normal finger pulp sensibility, with a static 2-point discrimination between 3 and 6 mm.

Predicting beef tenderness using color and multispectral image texture features

The objective of this study was to investigate the usefulness of raw meat surface characteristics (texture) in predicting cooked beef tenderness. Color and multispectral texture features, including 4 different wavelengths and 217 image texture features, were extracted from 2 laboratory-based multispectral camera imaging systems. Steaks were segregated into tough and tender classification groups based on Warner-Bratzler shear force. The texture features were submitted to STEPWISE multiple regression and support vector machine (SVM) analyses to establish prediction models for beef tenderness. A subsample (80%) of tender or tough classified steaks were used to train models which were then validated on the remaining (20%) test steaks. For color images, the SVM model correctly identified tender steaks with 100% accurately while the STEPWISE equation identified 94.9% of the tender steaks correctly. For multispectral images, the SVM model predicted 91% and STEPWISE predicted 87% average accuracy of beef tender.

Broadband antireflection and absorption enhancement by forming nano-patterned Si structures for solar cells

In this letter, we report the antireflection and light absorption enhancement by forming sub-wavelength nano-patterned Si structures via nano-sphere lithography technique. It is found that the surface reflection can be significantly suppressed in a wide spectral range (400-1000 nm) and the weighted mean reflection is less than 5%. Meanwhile, the broad band optical absorption enhancement is achieved consequently. Heterojunction solar cells are prepared by depositing ultrathin amorphous Si film on the nano-patterned Si structures, the short circuit current density increases to 37.2 mA/cm(2)and the power conversion efficiency is obviously improved compared to the reference cell on flat Si substrate.

Enhanced electroluminescence from SiN-based multilayer structure by laser crystallization of ultrathin amorphous Si-rich SiN layers

Luminescent SiN-based multilayers were prepared in a plasma enhanced chemical vapor deposition system followed by subsequently laser crystallization of ultrathin amorphous Si-rich SiN sublayers. The cross-sectional TEM analysis reveals that grain size of Si nanocrystals embedded in the Si-rich SiN sublayers is independent of the laser fluence, while the grain density can be well controlled by the laser fluence. The devices containing the laser crystallized multilayers show a low turn-on voltage of 5 V and exhibit strong green light emission under both optical and electrical excitations. Moreover, the device after laser-irradiated at 554 mJ/cm(2) shows a significantly enhanced EL intensity as well as external quantum efficiency compared with the device without laser irradiation. The EL mechanism is suggested from the bipolar recombination of electron-hole pairs at Si nanocrystals. The improved performance of the devices was discussed.

Structural characteristic, Raman analysis and optical properties of indium-doped ZnO nanoparticles prepared by sol-gel method

Un-doped and indium (0-9 at.%) doped ZnO nanoparticles were prepared by the sol-gel method. The nanoparticles were heated at 700 degrees C-800 degrees C for 1 hour in air and then analyzed by X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive X-ray (EDS), Raman spectra and photoluminescence (PL). The results were compared to investigate the structural characteristics and physical properties. XRD patterns of the Indium-doped ZnO (IZO) nanoparticles were similar to those of the ZnO nanoparticles. Notably, the crystalline quality of the ZnO nanoparticles had reduced with increasing the concentration of indium doping. The In2O3 phase of IZO and the crystallized structures affected the UV emission band and the green emission band of PL. The Indium-doped (5 at.% - 7 at.%) ZnO nanoparticles possessed higher crystalline quality and better optical properties.

Electroluminescent devices based on amorphous SiN/Si quantum dots/amorphous SiN sandwiched structures

A single layer of dense Si quantum dots with average size of 4 nm sandwiched in amorphous SiN layers was prepared by laser crystallization of ultrathin amorphous Si film followed by subsequently thermal annealing. The electroluminescent diodes were fabricated by evaporating Al electrodes on back sides of p-Si substrates and the top surface of samples. Room temperature electroluminescence can be detected with applying the negative voltage around 10V on the top gate electrode and the luminescent intensity is increased with increasing the applied voltage. It was found that the integrated luminescent intensity is linearly proportional to the injection current which suggested the intensity depends on the concentrations of injected carriers after Fowler-Nordheim tunneling through amorphous SiN barriers. The influence of the amorphous SiN with different band gap on the device performance was also discussed briefly.

Genetic variation and phylogenetics of Lanyu and exotic pig breeds in Taiwan analyzed by nineteen microsatellite markers

The Lanyu pig is an indigenous miniature pig breed on Lanyu Islet near Taiwan, with a mitochondrial DNA genetic lineage remote from Asian and European pig breeds. The unknown population genetic structure and increased inbreeding among the small population of conserved Lanyu pigs is now of great conservation concern. Additionally, the presence for more than a century of exotic pig breeds in Taiwan has made gene introgression from exotic pig breeds into Lanyu pigs very possible. The present study thus aimed to investigate nuclear genetic variation within the conserved Lanyu pigs and the phylogenetic relationship and possible genetic introgression between Lanyu and exotic pig breeds by determining the polymorphism of 19 microsatellite loci. In the neighbor-joining tree constructed from 7 pig breeds based on Cavalli-Sforza and Edward chord genetic distances, 3 major clades were recognized, in which the Asian and European breeds were separately clustered into 2 clades with a 93.0 and 99.9% bootstrap confidence value, respectively. All individuals of the Lanyu breed formed a unique subclade within the Asian clade based on the distance of the proportion of shared alleles, -ln(ps), suggesting that the Lanyu breed possesses a unique nuclear genetic structure and that no nuclear gene introgression from exotic breeds into the conserved Lanyu pigs has occurred in recent history. Fifteen of 19 microsatellite loci deviated from Hardy-Weinberg equilibrium (by Wright's statistic), suggesting a significant loss of heterozygosity in the conserved population. The valuable nuclear genetic structure and phylogenetic information should assist future conservation and population management of Lanyu pigs.

Erratum: ZnO-based MIS photodetectors

[This corrects the article DOI: 10.1016/j.sna.2007.06.006.].

New self-limiting assembly model for Si quantum rings on Si(100)

We propose a new self-limiting assembly model for Si quantum rings on Si(100) where the ring's formation and evolution are driven by a growth-etching competition mechanism. The as-grown ring structure in a plasma enhanced chemical vapor deposition system has excellent rotational symmetry and superior morphology with a typical diameter, edge width, and height of 150-300, 10, and 5 nm, respectively. Based on this model, the size and morphology can be controlled well by simply tuning the timing procedure. We suggest that this growth model is not limited to certain material system, but provides a general scheme to control and tailor the self-assembly nanostructures into the desired size, shape, and complexity.

Initial ocular following in humans depends critically on the fourier components of the motion stimulus

Visual motion is sensed by low-level (energy-based) and high-level (feature-based) mechanisms. Our interest is in the motion detectors underlying the initial ocular following responses (OFR) that are elicited at ultrashort latencies by sudden motions of large images. OFR were elicited in humans by applying horizontal motion to vertical square-wave gratings lacking the fundamental. In the frequency domain, a pure square wave is composed of the odd harmonics--first, third, fifth, seventh, etc.--such that the third, fifth, seventh, etc., have amplitudes that are one-third, one-fifth, one-seventh, etc., that of the first, and the missing fundamental stimulus lacks the first harmonic. Motion consisted of successive quarter-wavelength steps, so the features and 4n+1 harmonics (where n = integer) shifted forward, whereas the 4n-1 harmonics--including the strongest Fourier component (the third harmonic)--shifted backward (spatial aliasing). Thus, the net Fourier energy and the non-Fourier features moved in opposite directions. Initial OFR, recorded with the search coil technique, had minimum latencies of 60 to 70 ms and were always in the direction of the third harmonic, for example, leftward steps resulted in rightward OFR. Thus, the earliest OFR were strongly dependent on the motion of the major Fourier component, consistent with mediation by oriented spatiotemporal visual filters as in the well-known energy model of motion detection. Introducing interstimulus intervals of 10 to 100 ms (during which the screen was uniform gray) reversed the initial direction of tracking, consistent with extensive neurophysiological and psychophysical data suggesting that the visual input to the motion detectors has a biphasic temporal impulse response.

Short-latency disparity vergence in humans: evidence for early spatial filtering

Our study was concerned with the disparity detectors underlying the initial disparity vergence responses (DVRs) that are elicited at ultrashort latencies by binocular disparities applied to large images. DVRs were elicited in humans by applying horizontal disparity to vertical square-wave gratings lacking the fundamental (termed here, the "missing fundamental"). In the frequency domain, a pure square wave is composed of odd harmonics--first, third, fifth, seventh, etc.--such that the third, fifth, seventh, etc., have amplitudes that are one-third, one-fifth, one-seventh, etc., that of the first, and the missing fundamental lacks the first harmonic. The patterns seen by the two eyes have a phase difference of one-quarter wavelength, so the disparity of the features and 4n + 1 harmonics (where n = integer) has one sign (crossed or uncrossed), whereas the 4n - 1 harmonics--including the strongest Fourier component (the third harmonic)--has the opposite sign (uncrossed or crossed): spatial aliasing. The earliest DVRs, recorded with the search-coil technique, had minimum latencies of 70 to 80 ms and were generally in the direction of the third harmonic, that is, uncrossed disparities resulted in convergent eye movements. In other experiments on the DVRs, one eye saw a missing fundamental and the other saw a pure sine wave with the contrast and wavelength of the third harmonic but differing in phase by one-quarter wavelength. This resulted in short-latency vergence in accordance with matching of the third harmonic. These data all indicate the importance of the Fourier components, consistent with early spatial filtering prior to binocular matching.

The initial ocular following responses elicited by apparent-motion stimuli: reversal by inter-stimulus intervals

Transient apparent-motion stimuli, consisting of single 1/4-wavelength steps applied to square-wave gratings lacking the fundamental ("missing fundamental stimulus") and to sinusoidal gratings, were used to elicit ocular following responses (OFRs) in humans. As previously reported [Sheliga, B. M., Chen, K. J., FitzGibbon, E. J., & Miles, F. A. (2005). Initial ocular following in humans: a response to first-order motion energy. Vision Research, in press], the earliest OFRs were strongly dependent on the motion of the major Fourier component, consistent with early spatio-temporal filtering prior to motion detection, as in the well-known energy model of motion analysis. Introducing inter-stimulus intervals (ISIs) of 10-200 ms, during which the screen was gray with the same mean luminance, reversed the initial direction of the OFR, the peak reversed responses (with ISIs of 20-40 ms) being substantially greater than the non-reversed responses (with an ISI of 0 ms). When the mean luminance was reduced to scotopic levels, reversals now occurred only with ISIs > or=60 ms and the peak reversed responses (with ISIs of 60-100 ms) were substantially smaller than the non-reversed responses (with an ISI of 0 ms). These findings are consistent with the idea that initial OFRs are mediated by first-order motion-energy-sensing mechanisms that receive a visual input whose temporal impulse response function is strongly biphasic in photopic conditions and almost monophasic in scotopic conditions.

Initial ocular following in humans: a response to first-order motion energy

Visual motion is sensed by low-level (energy-based) and high-level (feature-based) mechanisms. Ocular following responses (OFR) were elicited in humans by applying horizontal motion to vertical square-wave gratings lacking the fundamental ("missing fundamental stimulus"). Motion consisted of successive 1/4-wavelength steps, so the features and 4n+1 harmonics (where n=integer) shifted forwards, whereas the 4n-1 harmonics--including the strongest Fourier component (the 3rd harmonic)--shifted backwards (spatial aliasing). Initial OFR, recorded with the electromagnetic search coil technique, were always in the direction of the 3rd harmonic, e.g., leftward steps resulted in rightward OFR. Thus, the earliest OFR were strongly dependent on the motion of the major Fourier component, consistent with early spatio-temporal filtering prior to motion detection, as in the well-known energy model of motion analysis.

Risk factors for peptic ulcer disease in renal transplant patients--11 years of experience from a single center

BACKGROUND

Peptic ulcer disease is a common complication among renal transplant recipients and causes significant morbidity and mortality.

METHODS

From 1990 through 2000, 465 renal transplant patients were followed-up in our institute. Most patients received corticosteroids and cyclosporine-based immunosuppressive regimen. About one third (n = 156) of them received mycophenolate mofetil. Patients with endoscopy-proved peptic ulcer disease were identified by reviewing medical records. Possible risk factors were analyzed by univariate analysis and multiple logistic regression analysis.

RESULTS

Among 465 kidney transplant patients, there were 181 (38.9%) who suffered at least 1 episode of peptic ulcer disease. The most frequent types of peptic ulcer disease were gastritis, gastric ulcer, duodenal ulcer, esophagitis, duodenitis and esophageal ulcer. By multivariate analysis, the use of methylprednisolone pulse therapy (odds ratio = 3.954, 95% confidence interval = 3.154-18.312, p = 0.03) and history of pre-transplant peptic ulcer disease (odds ratio = 7.599, 95% CI = 1.211-12.905, p < 0.0001) were independent risk factors for posttransplant peptic ulcer disease.

CONCLUSIONS

Our findings demonstrated that renal transplant patients who undergo methylprednisolone pulse therapy for acute rejection or who have a history of pre-transplant peptic ulcer disease carry a high risk for the development of peptic ulcer disease and deserve intensive antiulcer treatment.

A panel study on the effects of a Chinese medicinal suppository, Vigconic VI-28, on insulin-like growth factor 1 and homocysteine in healthy men

Changes in serum homocysteine (Hcy), often related to stroke and vascular dementia, are negatively correlated with changes in serum insulin-like growth factor 1 (IGF-1) and growth hormone (GH) replacement decreases Hcy levels in men with GH deficiency. Very little information on the effects of Chinese medicines on GH and Hcy is available in the literature published in English. In this study, the effects of a Chinese medicine suppository, Vigconic VI-28 (VI-28), consisting of concentrated extracts of a composite mixture of herbal materials, on serum IGF-1 and Hcy were studied. In vivo observations after treatment with Chinese medicines have often indicated changes in biochemical profiles of measurable parameters related to those changes in endocrine secretions. Thirty six healthy males (age 47-66) were under observation over a 16-week schedule after using VI-28 suppository from 0 to 12 weeks. Blood specimens were taken monthly (except at the end of week 8) for analysis of Hcy and IGF-1 levels. Compared with week 0, IGF-1 levels (192.5 +/- 66.4 ng/ml) were significantly elevated at week 4 (211.7 +/- 80.5, p < 0.05) and week 12 (226.6 +/- 95.2 ng/ml, p = 0.01). No significant changes were observed for Hcy for the whole cohort from week 0 to week 16. When the cohort was divided into 2 groups using a Hcy level of 13.0 micro mol/l as the cut-off, a significant (p < 0.05) difference in IGF-1 was observed between the 2 groups at week 12 only. The mean IGF-1 of 14 subjects with higher Hcy levels was lower than that of the 22 subjects with lower Hcy. We believe that VI-28 may exert a regulatory effect on the relationship between Hcy and IGF-1, at least in subjects with relatively low levels of Hcy. In addition, we also observed an apparent association of hyperhomocysteinemia (Hcy> or =13.0 micromol/l) with decreased IGF-1.

Modeling head tracking of visual targets

Control of the head involves somatosensory, vestibular, and visual feedback. The dynamics of these three feedback systems must be identified in order to gain a greater understanding of the head control system. We have completed one step in the development of a head control model by identifying the dynamics of the visual feedback system. A mathematical model of human head tracking of visual targets in the horizontal plane was fit to experimental data from seven subjects performing a visual head tracking task. The model incorporates components based on the underlying physiology of the head control system. Using optimization methods, we were able to identify neural processing delay, visual control gain, and neck viscosity parameters in each experimental subject.

[The protective effects of yi-xin-kang capsule on the structure and function of rat myocardial mitochondria]

OBJECT

To observe the injury induced by Isoproterenol (ISO) on the structure and function of rat myocardial mitochondria and the protective effects of Yi-Xin-Kang Capsule (H303).

METHOD

After injection of ISO, rat myocardial mitochondria were isolated. The activities of phospholipidase A2(PLA2) and Ca(2+)-ATPase, the content of phospholipids (PL) and high-energy phosphates, membrane lipid fluidity (LFU) and respiration function were determined respectively.

RESULT

ISO induced severe injury to myocardial mitochondria. The activity of PLA2 was significantly activated. The intensity of LFU, the activity of Ca(2+)-ATPase, respiration function of mitochondria and the contents of PL and high-energy phosphates of myocardium tissue were significantly decreased. Oral administration of H303 significantly decreased the activity of PLA2. The contents of PL and LFU, the activity of Ca(2+)-ATPase were significantly increased. The respiration function of mitochondria was protected by accelerating III state respiration rate, improving ADP/O ratio and recovering the depressed respiration control rate.

CONCLUSION

H303 possessed protective effect on structural and functional injury of mitochondria induced by ISO.

Sesquiterpenes from the Formosan stolonifer Tubipora musica

Eight new sesquiterpenes, tubipolides A-G (1-7) and tubiporone (8) (novel carbon skeleton), and a known sesquiterpene, spirotubipolide, have been isolated from the Formosan stolonifer Tubipora musica. The structures of compounds 1-8 were determined by 1D and 2D NMR spectral analysis.

[Relationship between coronary angiography and syndrome differentiation type of TCM]

OBJECTIVE

To understand the relationship between the coronary Angiography (CA) reflected degree of coronary artery lesion and the TCM Syndrome Differentiation-type (TCM-SDT).

METHODS

Patients TCM-SDT were differentiated adopting the standard of Syndrome Differentiation for coronary artery diseases revised in 1990, and the comparison of TCM-SDT with the findings in CA was carried out.

RESULTS

CA examination showed that 29 patients (39.73%) were of one-artery lesion, 9 patients (12.33%) two-artery lesion and 35 patients (47.95%) three-artery lesion; the stenosis degree of them were: 54 arteries were mild stenosis, 38 moderate stenosis and 31 severe stenosis; 29 arteries were completely occluded, the sum total of affected artery was 152 (69.41%), and the other 67 arteries (30.59%) had no lesion. TCM-SDT showed that all the 73 patients had secondary Excess Syndrome, among them 73 patients (100%) with blood stasis Syndrome, 39 patients (53.4%) with Phlegm-Turbid Syndrome, 16 (21.0%) with Qi-stagnation Syndrome and 7 (9.6%) with Cold condensation Syndrome. 63 patients (86.3%) with obvious primary Deficiency Syndrome, among them, 57 (78.1%) were Qi-Deficiency, 18 (24.7%) Yang-Deficiency, 28 (38.4%) Yin-Deficiency and 5 (6.8%) Yang collapse. All patients had blood stasis of various degrees, manifesting on tongue proper prominently. In the 80.8% patients who had angina pectoris, 74.0% had their mouth, lips and gum dark red, dark purple or light dark in color. The comparison between TCM-SDT and Blood-Stasis score revealed that patients of Cold condensation-blood stasis Syndrome and Yang collapse-blood stasis Syndrome were serious. Patients of Qi stagnation-blood stasis Syndrome and Yin Deficiency-blood stasis Syndrome were mild cases, while patients of Phlegm Turbid-blood stasis Syndrome and Qi Deficiency-blood stasis Syndrome were moderate severity cases. The number of affected artery in Cold condensation patients was the most, and in Yin-Deficiency patients was the least. The coronary artery stenosis degree in patients of Qi-stagnation and Yin-Deficiency were milder than in those of Yang-collapse and Yang-Deficiency patients.

CONCLUSION

The more the number of arterial lesion, the severer the degree of stenosis and the higher the blood stasis score, then the more serious the degree of stasis.

[Effect of xiongshao capsule on vascular remodeling in porcine coronary balloon injury model]

OBJECTIVE

To study the effect of Xiongshao Capsule (XS) on vascular remodeling in porcine coronary balloon injury model.

METHODS

Restenosis model was established by oversized balloon injury at mid-region of the left anterior descending coronary artery. The effect of drugs on late lumen loss and vascular remodeling was evaluated with quantitative histological method by combining results from histopathological analysis and coronary arteriography.

RESULTS

Vascular remodeling explained (59 +/- 20)% of late lumen loss. All drugs significantly reduced late lumen loss 4 weeks after balloon injury (P < 0.05 or 0.01). Both low-dose and high-dose XS markedly reduced late lumen loss resulting from vascular remodeling, as compared with the control group (P < 0.05 and P < 0.01 respectively).

CONCLUSION

Vascular remodeling played an important role in late lumen stenosis after balloon injury of coronary artery. XS could significantly inhibit pathological vascular remodeling after balloon injury, thus reduce late lumen loss and prevent restenosis.

Ocular ischemic syndrome

BACKGROUND

The purpose of this study was to investigate the clinical features and management of ocular ischemic syndrome (OIS) and factors influencing its development.

METHODS

Ten patients (12 eyes) with OIS underwent detailed medical and ocular histories, complete ophthalmic evaluation including fluorescein angiography, internal carotid artery evaluation by duplex ultrasonography, and management. The following outcome measures were considered: visual acuity, anterior segment neovascularization, lens status, retinal and choroidal changes, and carotid artery stenosis or occlusion.

RESULTS

The mean age of the patients was 63 +/- 8 years. Presenting visual symptoms included gradual (82.5%) or sudden (17.5%) onset of vision loss. At initial visit, eyes with OIS had visual acuity less than or equal to counting fingers in 50%, iris neovascularization in 58%, and neovascular glaucoma in 42%. Initially associated systemic diseases in these patients included arterial hypertension (60%), diabetes mellitus (40%), coronary artery disease (20%), previous stroke (30%) and hemodialysis (10%). Complete occlusion or severe occlusion (70-99%) of the internal carotid artery was seen in 75% on the side of OIS. Panretinal photocoagulation did not prevent OIS from progressing but vitreous hemorrhage and rubeosis iris regressed. Carotid endarterectomy had some benefit in stabilizing or improving vision in patients with OIS.

CONCLUSION

OIS has a poor visual prognosis. It is imperative that the clinician be aware of the signs and symptoms of carotid disease in order to facilitate prompt diagnosis and appropriate referral, because OIS may be the presenting sign of serious ischemic cerebrovascular and ischemic heart disease.

[Protective effect of yixinkang capsule containing serum on oxygen stress damaged mitochondrial membrane potential in guinea-pig myocytes]

OBJECTIVE

To explore the protective effect and mechanism of Yixinkang (H303) capsule, a composite preparation of Chinese herbal medicine for antagonizing myocardial ischemia, containing serum on oxygen stress damaged mitochondrial membrane potential (MMP) in guinea-pig myocytes.

METHODS

Myocyte damage was induced by incubating myocytes with hydroxy free radical (Fe2+/H2O2) generating system for 30-60 mins, then H303-containing serum was added in to observe the protective effect. MMP was detected by laser scanning confocal microscopy.

RESULTS

After oxygen stress, the cytochrome oxidase (CCO) activity and MMP in mitochondria significantly decreased. These changes could be significantly lessened by H303-containing serum, demonstrated as obviously increase of CCO activity and myocyte survival rate. H303-containing serum also showed a significant protective effect on membrane potential of myocytes.

CONCLUSION

Oxygen stress could cause decrease of MMP in myocytes and H303-containing serum could protect it to maintain the membrane stability of mitochondria.

Central areolar choroidal and retinal pigment epithelial dystrophy: a family report

Central areolar choroidal and retinal pigment epithelial dystrophy (CACD) is a rare hereditary macular disease characterized by a bilateral, symmetric, and well-circumscribed solitary area in the macula with choroidal and retinal pigment epithelial atrophy. We report a family of CACD confirmed by both clinical presentation and hereditary pattern. Three members of the family were examined. They had noticed gradual visual deterioration with poor color discrimination since the fourth to fifth decades. All of them showed a bilaterally symmetric bull's-eye pattern of macular dystrophy with a sharp border of underlying large or middle choroidal vessels, which was unassociated with any surrounding lesions. Fluorescein angiography revealed a transmission window defect due to retinal pigment epithelial atrophy with remaining choriocapillaris intermingled with a hypofluorescent area of choriocapillaris atrophy. Electroretinography revealed a mild reduction in the photopic amplitude, while the scotopic response was normal. A normal electro-oculography was also noted. The family history indicated autosomal dominant inheritance. The loss of visual acuity was caused by progressive atrophy of both the retinal pigment epithelium and the choriocapillaris. It is important to detect CACD in the early stages, because this diagnosis can exert a considerable influence on a patient's subsequent life.