Biological Properties of 3D-Printed Zirconia Implants with p-Cell Structures

Research on 3-dimensional (3D) printed porous zirconia-based dental implants is still in its infancy. This study aimed to evaluate the biological responses of novel zirconia implants with p-cell structures fabricated by 3D printing. The solid zirconia samples exhibited comparable density, 3-point flexural strength, and accelerated aging properties compared to specimens prepared previously by conventional methods. Cell-based experiments showed that the p-cell structure promoted cell proliferation, adhesion, and osteogenesis-related protein expression. Mechanical tests showed that both p-cell and control implants could withstand a torque of 35 Ncm without breaking. The mean maximum breaking loads of p-cell and control implants were 1,222.429 ± 115.591 N and 1,903.857 ± 250.673 N, respectively, which were much higher than the human physiological chewing force and human mean maximum occlusal force. An animal experiment showed that the bone trabeculae around the implants were significantly thicker, more numerous, and denser in the p-cell group than in the control group. This work could provide promising guidance for further exploring 3D printing techniques for porous zirconia bionic implants in dentistry.

Lamina-Lifting Suspension Modification in Bridge Crane Technique in Treatment of Severe Thoracic Ossification of the Ligamentum Flavum (TOLF)

BACKGROUND The aim of this study was to investigate the effectiveness and potential complications of combining a lamina-lifting suspension system with the bridge crane technique in treating thoracic ossification of the ligamentum flavum (TOLF) with thoracic myelopathy. MATERIAL AND METHODS A patient with severe TOLF and myelopathy was treated using a lamina-lifting suspension system combined with bridge crane technique. The brief surgical procedure involved implantation of internal fixation, separation of laminae, installation of cross-bridges, reverse lifting, and fixation of cross-bridges. The modified Japanese Orthopaedic Association (mJOA) scale, Hirabayashi recovery rate, and ASIA grade of the patient were recorded. The canal occupation ratio (COR) and spinal cord status were evaluated by imaging data. RESULTS The surgical intervention significantly enhances the patient's lower limb function, as evidenced by an increase in mJOA score from 5 preoperatively to 11 at terminal follow-up. The Hirabayashi recovery rate after surgery ranges between 25% and 50%. Additionally, ASIA classification improved to grade E. Imaging data showed that the ossification of the thoracic vertebrae had subsided, while the volume of the local spinal canal had recovered and the spinal cord injury had been completely relieved. No adverse effects or complications were observed. CONCLUSIONS The lamina-lifting suspension system preserves the benefits of bridge crane technique while also augmenting the traction of a post laminae-OLF complex (LOC) suspension, rendering it more secure and manageable. Nevertheless, further sample analysis and research are required in the future.

PD-1 Inhibitors and Chemotherapy Combined with or without Radiotherapy for Patients with Oligometastatic Esophageal Cancer

PURPOSE/OBJECTIVE(S)

Oligometastatic esophageal cancer (OMEC) is an intermediate state between local advanced and widespread metastatic disease, which is associated with better prognosis compared to poly-metastatic esophageal cancer (EC). The previous studies demonstrated the survival benefit from local radiotherapy for OMEC patients. But the data of PD-1 inhibitors combined with radiotherapy for OMEC is still scarce. The purpose of the present study was to determine the efficacy and safety of PD-1 inhibitors plus radiotherapy in OMEC.

MATERIALS/METHODS

OMEC was defined as "up to five measurable metastatic lesions and up to three organs involved". Patients with OMEC receiving PD-1 inhibitors plus chemotherapy in a single center were retrospectively analyzed in this study. They were dichotomized according to whether or not they had received radiotherapy. The efficacy and safety of immunochemotherapy combined with radiotherapy (RT group) and immunochemotherapy alone (NRT group) were investigated.

RESULTS

A total of 226 patients were included; 108 patients received PD-1 inhibitors plus chemotherapy and radiotherapy, while other 118 patients were treated with immunochemotherapy alone. Baseline characteristics were well balanced between the groups. The overall response rate (ORR) was 58.3% in the RT group and 41.5% in the NRT group (P = 0.012), respectively. The median PFS was 13.5 months (95% CI, 10.0-17.1) for the RT group and 8.8 months (95% CI, 9.2-12.0) for the NRT group (P = 0.000). The addition of radiotherapy was the major prognostic factor for PFS (hazard ratio, 0.56; 95% CI, 0.406-0.761; P = 0.000) by univariate Cox regression analysis. Patients were well-tolerated, and the overall incidence of adverse events was similar between the RT group and NRT group. In addition, the incidence of treatment-related pneumonitis did not differ between the two groups. Grade 3-5 pneumonitis was observed in 3.7% and 5.1% of patients in the RT and NRT groups, respectively.

CONCLUSION

The additional of radiotherapy to PD-1 inhibitors and chemotherapy improved PFS of patients with OMEC and showed acceptable toxicity. Further prospective studies investigating the combination of immunochemotherapy and radiotherapy are warranted.

Outcome Supervised Deep Learning Model on Pathological Whole Slide Images for Survival Prediction of Immunotherapy in Non-Small Cell Lung Cancer Patients: A Multicenter Study

PURPOSE/OBJECTIVE(S)

Although PD-(L)1 inhibitors were marked by durable efficacy in non-small cell lung cancer patients (NSCLC), about 60% of patients still suffer from recurrence and metastasis after PD-(L)1 inhibitors treatment. And there were no robust biomarkers of the response of PD-(L)1 inhibitors. Whole slide images (WSIs) of H&E-stained specimens have been found to characterize the tumor microenvironment, and might be the potential prognostic predictors of NSCLC patients. To accurately predict the response to PD-(L)1 inhibitors, we presented the deep learning model based on WSI of H&E-stained specimens of NSCLC patients.

MATERIALS/METHODS

Two independent cohorts of NSCLC patients receiving PD-(L)1 inhibitors from two hospitals were enrolled for model training and testing respectively. The WSI images of H&E-stained histological specimens were obtained from these patients, and patched into 1024×1024 pixels. The labels of patched images were determined due to their progression free survival (PFS) with the interval of 4 months. The patch-level model was firstly trained based on Vit to identify the predictive patches in training cohort, and patch-level probability distribution was performed. Then we trained patient-level survival model-based Vit-RNN framework, and tested it in external validation cohort.

RESULTS

A total of 291 WSI images of H&E-stained histological specimens from 198 NSCLC patients in primary cohort and 62 WSI images from 30 NSCLC patients in testing cohort were included for model training and external validation. All patients were divided into 4 groups due to their PFS after PD-(L)1 inhibitors. There were 246,318 patches from 291 images in primary cohort after image pre-processing, and all images were randomly divided into train cohort and validation cohort with the proportion of 7:3. The patch-level Vit model with the highest accuracy was saved and the predictive patches were selected after 50 epochs training. All patches were ranked by the probability of correct prediction, and the first 50 top-ranked patches from each WSI image are sequentially passed to the patient-level Vit-RNN model. The Vit-RNN survival achieved an accuracy of 88.6% in the validation cohort, and an accuracy of 81% in the testing cohort. The multivariate cox analysis also indicated the Vit-RNN survival model remained a statistically independent predictor of survival from PD-(L)1 inhibitors (P = 0.0085).

CONCLUSION

The outcome supervised Vit-RNN survival model based on pathological WSIs could be used to predict the efficacy the PD-(L)1 inhibitors in NSCLC patients, laying the foundation for the deployment of computational pathomics in clinical practice of immunotherapy.

Development and validation of a risk prediction model for cage subsidence after instrumented posterior lumbar fusion based on machine learning: a retrospective observational cohort study

Background

Interbody cage subsidence is a common complication after instrumented posterior lumbar fusion surgery, several previous studies have shown that cage subsidence is related to multiple factors. But the current research has not combined these factors to predict the subsidence, there is a lack of an individualized and comprehensive evaluation of the risk of cage subsidence following the surgery. So we attempt to identify potential risk factors and develop a risk prediction model that can predict the possibility of subsidence by providing a Cage Subsidence Score (CSS) after surgery, and evaluate whether machine learning-related techniques can effectively predict the subsidence.

Methods

This study reviewed 59 patients who underwent posterior lumbar fusion in our hospital from 2014 to 2019. They were divided into a subsidence group and a non-subsidence group according to whether the interbody fusion cage subsidence occurred during follow-up. Data were collected on the patient, including age, sex, cage segment, number of fusion segments, preoperative space height, postoperative space height, preoperative L4 lordosis Angle, postoperative L4 lordosis Angle, preoperative L5 lordosis Angle, postoperative PT, postoperative SS, postoperative PI. The conventional statistical analysis method was used to find potential risk factors that can lead to subsidence, then the results were incorporated into stepwise regression and machine learning algorithms, respectively, to build a model that could predict the subsidence. Finally the diagnostic efficiency of prediction is verified.

Results

Univariate analysis showed significant differences in pre-/postoperative intervertebral disc height, postoperative L4 segment lordosis, postoperative PT, and postoperative SS between the subsidence group and the non-subsidence group (p < 0.05). The CSS was trained by stepwise regression: 2 points for postoperative disc height > 14.68 mm, 3 points for postoperative L4 segment lordosis angle >16.91°, and 4 points for postoperative PT > 22.69°. If the total score is larger than 0.5, it is the high-risk subsidence group, while less than 0.5 is low-risk. The score obtains the area under the curve (AUC) of 0.857 and 0.806 in the development and validation set, respectively. The AUC of the GBM model based on the machine learning algorithm to predict the risk in the training set is 0.971 and the validation set is 0.889. The AUC of the avNNet model reached 0.931 in the training set and 0.868 in the validation set, respectively.

Conclusion

The machine learning algorithm has advantages in some indicators, and we have preliminarily established a CSS that can predict the risk of postoperative subsidence after lumbar fusion and confirmed the important application prospect of machine learning in solving practical clinical problems.

Assessing the construction of a Healthy City in China: a conceptual framework and evaluation index system

OBJECTIVES

COVID-19 has brought challenges to the health of all mankind. It is particularly important to promote the construction of a 'Healthy China' and build a 'healthy community'. The aims of this study were to construct a reasonable conceptual framework for the Healthy City concept and to assess Healthy City construction in China.

STUDY DESIGN

This study combined qualitative and quantitative research.

METHODS

This study proposes the concept model of 'nature-human body-Healthy City' and accordingly constructs an evaluation index system for the construction of a Healthy City that integrates five dimensions, namely, the medical level, economic basis, cultural development, social services, and ecological environment to explore the spatial and temporal heterogeneity of Healthy City construction in China. Finally, the influencing factors of Healthy City construction patterns are explored using GeoDetector.

RESULTS

(1) The pace of Healthy City construction is generally on the rise; (2) the construction of Healthy Cities exhibits significant global spatial autocorrelation and gradually increasing agglomeration. The spatial distribution of cold hotspot areas was relatively stable; (3) medical and health progress is an important factor; the level of economic development is the leading support; the endowment of resources and environment is the basic condition; public service support provides important support; and scientific and technological innovation capabilities provide technical support for the construction of a Healthy City.

CONCLUSIONS

The spatial heterogeneity of Healthy City construction in China is evident, and the state of spatial distribution is relatively stable. The spatial pattern of Healthy City construction is shaped by a combination of factors. Our research will provide a scientific basis for promoting the construction of Healthy Cities and helping to implement the Health China Strategy.

[Clinical characteristics and prognosis of primary and secondary diffuse large B-cell lymphoma of the pancreas]

Objective: To analyze the clinical characteristics and prognosis of primary and secondary pancreatic diffuse large B-cell lymphoma (DLBCL) . Methods: Clinical data of patients with pancreatic DLBCL admitted at Shanghai Rui Jin Hospital affiliated with Shanghai Jiao Tong University School of Medicine from April 2003 to June 2020 were analyzed. Gene mutation profiles were evaluated by targeted sequencing (55 lymphoma-related genes). Univariate and multivariate Cox regression models were used to evaluate the prognostic factors of overall survival (OS) and progression-free survival (PFS) . Results: Overall, 80 patients were included; 12 patients had primary pancreatic DLBCL (PPDLBCL), and 68 patients had secondary pancreatic DLBCL (SPDLBCL). Compared with those with PPDLBCL, patients with SPDLBCL had a higher number of affected extranodal sites (P<0.001) and had higher IPI scores (P=0.013). There was no significant difference in the OS (P=0.120) and PFS (P=0.067) between the two groups. Multivariate analysis indicated that IPI intermediate-high/high risk (P=0.025) and double expressor (DE) (P=0.017) were independent adverse prognostic factors of OS in patients with pancreatic DLBCL. IPI intermediate-high/high risk (P=0.021) was an independent adverse prognostic factor of PFS in patients with pancreatic DLBCL. Targeted sequencing of 29 patients showed that the mutation frequency of PIM1, SGK1, BTG2, FAS, MYC, and MYD88 in patients with pancreatic DLBCL were all >20%. PIM1 (P=0.006 for OS, P=0.032 for PFS) and MYD88 (P=0.001 for OS, P=0.017 for PFS) mutations were associated with poor OS and PFS in patients with SPDLBCL. Conclusion: There was no significant difference in the OS and PFS between patients with PPDLBCL and those with SPDLBCL. IPI intermediate-high/high risk and DE were adverse prognostic factors of pancreatic DLBCL. PIM1, SGK1, BTG2, FAS, MYC, and MYD88 were common mutations in pancreatic DLBCL. PIM1 and MYD88 mutations indicated worse prognosis.

[Quality of life and risk factors in patients with herpes zoster]

Objective: To evaluate the quality of life and influencing factors of patients with herpes zoster (HZ) seen in hospitals. Methods: Based on Zoster Brief Pain Inventory (ZBPI) and Five-level EuroQol Five-dimensional Questionnaire (EQ-5D-5L), a cross-sectional survey was conducted to evaluate the pain severity and quality of life of 332 HZ cases seen in 22 hospitals of Lu'an City (Anhui Province), Zibo City (Shandong Province) and Tongchuan City (Shaanxi Province) from October to December 2021. The censored least absolute deviations (CLAD) model was used to analyze the related factors affecting the changes of patients' health utility values. Results: The 45.5% of 332 HZ cases were male. The median (Q₁,Q₃) age was 59 (50, 68) years. 59.64% of them assessed by ZBPI had moderate to severe pain in the past 24 hours (worst pain score≥5), and that of PHN cases was 84.8%(39/46). 77.7% (258/332), 77.4% (257/332) and 74.1% (246/332) of all patients reported that pain interfered with sleep, mood and general activities, respectively. Aging [β_40-49y (95%CI)=-0.11 (-0.15, -0.08); β_50-59y (95%CI)=-0.03 (-0.05, 0.00); β_60-69y (95%CI)=-0.09 (-0.12, -0.06); β_70-90y(95%CI)=-0.16 (-0.19, -0.12)], working status (unemployed) [β_farmer (95%CI)=0.15 (0.13, 0.18); β_retirees(95%CI)=0.21 (0.18, 0.24); β_employee (95%CI)=0.13 (0.10, 0.16) ], complications[β_PHN (95%CI)=-0.08 (-0.13, -0.04); β_{other complications} (95%CI)=-0.12 (-0.15, -0.08)], within 30 days after onset [β(95%CI)=-0.01 (-0.03, 0.01)] and treatment [β_{other complications} (95%CI)=-0.09 (-0.11, -0.06)] were related factors for the decline of health utility value (all P values <0.05). Conclusions: More than half of the patients with HZ had moderate to severe pain in the past 24 hours, which had a serious negative impact on the physical and mental health of the patients. Elderly patients, acute patients and patients with complications had lower health utility values and worse health status. We suggest that eligible people be vaccinated with HZ vaccine as soon as possible.

Impacts of international food and feed trade on nitrogen balances and nitrogen use efficiencies of food systems

International trade of agricultural products has greatly increased over time, but its impacts on sustainable development are debated. It may contribute to food security in importing countries, increases the dependency between countries, and has been implicated in displacement of environmental pollution and resource depletion. There is also discussion about the relationships between trade and nitrogen (N) balances and N use efficiencies (NUE). We explored relationships between changes in the trade of food and feed and in N balances and NUE of the food supply systems through simulation modeling and an analysis of empirical data of 115 countries (representing 91% of global population) for the period 1961-2011. In the empirical analysis, 64 main importing countries and 14 main exporting countries, were distinguished. Importing countries had on average a higher population density than exporting countries but rather similar protein intake and GDP per capita. The empirical analysis indicate that main importing countries had on average higher N fertilizer inputs to their food supply systems, and also higher N surpluses and higher NUE than main exporting countries. The overall mean NUE of the food supply system of main importing countries decreased with increasing import, but the relationships between import and NUE were diverse when these countries were grouped according to population density and GDP per capita. We compared N balances and partial N balances, and three methodologies commonly used for estimating NUE. We observed that NUE2 provides an unbiased estimate for both importing and exporting countries. Our study contributes to the understanding of the diverse relationships between international trade, N balances and NUE of food systems.

What Level Should Preoperative Albumin of Thoracic and Lumbar Tuberculosis Patients Be Reached: A Case-Controlled Study

Objective

To explore the risk factors of hypoalbuminemia in patients with thoracic and lumbar tuberculosis and develop a scoring scale, according to which the patients with thoracic and lumbar tuberculosis were divided into 2 groups to, respectively calculate the perioperative albumin changes and to find out the preoperative albumin recommended value.

Methods

A total of 166 patients with thoracic and lumbar tuberculosis, who underwent spinal focus debridement between January 2012 to May 2020, were identified into 2 groups: with and without postoperative hypoalbuminemia (n = 131 and n = 35, respectively), recording and analyzing clinical characteristics by multivariate analysis to establish a scoring scale. Using this scale, patients with spinal tuberculosis were divided into a high-risk group and a low-risk group, and then, calculated the average decrease of postoperative albumin in both groups. Combined with the diagnostic threshold of hypoalbuminemia, we proposed the preoperative albumin safe values of the patients with thoracic and lumbar tuberculosis.

Results

A total of 131 of 166 patients experienced postoperative hypoalbuminemia after spinal focus debridement. Multivariate binary logistic regression analysis identified pulmonary tuberculosis (adjusted odds ratio = 0.270, p = 0.012), pre-operative serum albumin value (adjusted odds ratio = 0.754, p < 0.001), and operation time (adjusted odds ratio = 1.017, p = 0.002) as independent risk factors for the occurrence of postoperative hypoalbuminemia in patients with thoracic and lumbar tuberculosis. According to the OR value, the risk factors are assigned to make the scoring scale, the receiver operating characteristic (ROC) curve indicates that postoperative hypoalbuminemia rises when the score is greater than or equal to 4 points. The scoring scale is tested in the derivation set (166 patients) showed: sensitivity-51.9%, specificity-91.4%, and in the validation set (102 patients) showed: sensitivity-63.6% and specificity-86.1%. The perioperative albumin decreased value is 4.71 ± 2.66 g/L in the low-risk group and 8.99 ± 3.37 g/L in the high-risk group (p < 0.001).

Conclusion

Complicated with pulmonary tuberculosis, low preoperative albumin value and long operation time can lead to postoperative hypoalbuminemia in patients with thoracic and lumbar tuberculosis. The scoring scale can effectively assist physicians to evaluate whether patients with thoracic and lumbar tuberculosis develop hypoalbuminemia after surgery. The scale is simple and reliable and has clinical guiding significance. For low-risk patients and high-risk patients, preoperative albumin values should reach 40 and 44 g/L, respectively, to effectively avoid postoperative hypoalbuminemia.

[Medial border of D3 lymphadenectomy for right colon cancer]

The extent of D3 lymphadenectomy for right colon cancer, especially the medial border of central lymph node dissection remains controversial. D3 lymphadenectomy and complete mesocolon excision (CME) are two standard procedures for locally advanced right colon carcinoma. D3 lymphadenectomy determines the medial border according to the distribution of the lymph nodes. The mainstream medial border should be the left side of superior mesenteric vein (SMV) according to the definition of D3, but there are also some reports that regards the left side of superior mesenteric artery (SMA) as the medial border. In contrast, the CME procedure emphasizes the beginning of the colonic mesentery and the left side of SMA should be considered as the medial border. Combined with the anatomical basis, oncological efficacy and technical feasibility of D3 lymph node dissection, we think that it is safe and feasible to take the left side of SMA as the medial boundary of D3 lymph node dissection. This procedure not only takes into account the integrity of mesangial and regional lymph node dissection, but also dissects more distant lymph nodes at risk of metastasis. It has its anatomical basis and potential oncological advantages. However, at present, this technical concept is still in the exploratory stage in practice, and the related clinical evidence is not sufficient.

Estimation of homocysteine concentration as an indicator of foetal death in pregnant Chinese women with preeclampsia: A case-control study

Introduction

This study evaluated whether changes in homocysteine concentrations in pregnant women with preeclampsia (PE) might be useful for predicting foetal death.

Materials and methods

This study evaluated 1,368 PE women at two Chinese centres. Medical records were reviewed to collect data regarding maternal age, homocysteine concentrations and other clinical parameters.

Results

Maternal serum homocysteine concentrations were significantly higher in the group with PE than control. Significant differences (p < 0.05) were also observed between the foetal death and survival groups in terms of body mass index, neonatal weight, previous deliveries, gestation length and adverse pregnancy history. Multivariate logistic regression analysis revealed that upper‐quartile homocysteine concentration was a significant risk factor of foetal death in the group with PE, and overall survival rate of patients with high homocysteine concentrations during pregnancy was significantly lower than those with low level (p < 0.05).

Conclusions

Our results indicate that foetal death was associated with upper‐quartile homocysteine concentrations in the group with PE, it can be an indicator of foetal death throughout the pregnancy.

[The role and mechanism of lncRNA C9ORF139 targeting miR-24-3P/TAOK1 in regulating the proliferation of acute myeloid leukemia cells]

Objective: To investigate the role and mechanism of long non-coding RNA (lncRNA) C9ORF139 targeting micro RNA(miR)-24-3P/TAOK1 in regulating the proliferation of acute myeloid leukemia (AML) cells. Methods: AML cells HL-60 and THP-1 were purchased from the Chinese Academy of Sciences and divided into 4 groups:group A was negative control group (siNC group), group B was interference C9ORF139 group (siC9ORF139 group), group C was siC9ORF139+miR-24-3p inhibitor group, and group D was miR-24-3P+TAOK1 overexpression group (oe-TAOK1 group). Real-time fluorescence quantitative reverse transcription PCR was used to detect the expression levels of AML cell lines of HL-60 and THP-1 in four groups. Cell Counting Kit-8 assay was performed to measure cell proliferation. Flow cytometry was applied to analyze cell apoptosis. Transwell test was applied to detect cell migration and invasion ability. Western blot was used to detect p-serine/threonine kinase (p-raf) and p-mitogen activation proteinkinase (p-MEK), p-extracellular regulatory protein kinase (p-ERK) expression. The luciferase reporter gene plasmid was constructed to verify the binding ability of C9ORF139,miR-24-3P and TAOK1.Nude mice were inoculated with subcutaneous tumor cells of HL-60 (group A) and HL-60 (group B). Results: After the C9ORF139 gene was knocked down and cultured for 120 h, The cell proliferation ability (0.62±0.02, 0.82±0.02), migration ability (0.22±0.03, 0.05±0.01), invasion ability (0.20±0.02, 0.13±0.03) of group B were all lower than that of group A (1.30±0.02, 1.83±0.07; 0.99±0.02, 0.99±0.02; 1.00±0.01, 1.00±0.01) (all P<0.05). When co-transfected with miR-24-3 inhibitor, cell proliferation ability, migration ability and invasion ability were all higher in group B (all P<0.05). When co-transfected with miR-24-3P and oe-TAOK1 plasmid, cell proliferation ability, migration ability and invasion ability were all higher than group B (all P<0.05).When the C9ORF139 gene in the cells was knocked down, the apoptosis level of group B (28.56±8.07, 17.74±1.91) were higher than those of group A (0.31±0.27, 2.49±0.33)(all P<0.05); when co-transfected with miR-24-3P inhibitor, the apoptosis level (2.34±0.09, 3.06±0.06) were lower than those in group B (all P<0.05); when co-transfected with miR-24-3P and oe-TAOK1 in the plasmid group, the apoptosis level (2.16±1.29, 4.80±0.37) were also lower than those of group B (all P<0.05). In HL-60 and THP-1 cells, when C9ORF139 was not mutated, the luciferase activity of miR-24-3P group was lower than that of the miR-NC group (P<0.05). When the binding site with miR-24-3p in C9ORF139 sequence was mutated, the luciferase activity in miR-24-3p group was equivalent to that in miR-NC group (P>0.05).When TAOK1 was not mutated; the luciferase activity of miR-24-3P group was lower than that of group A (P<0.05). When the binding site with miR-24-3p in TAOK1 sequence was mutated, the luciferase activity in miR-24-3p group was equivalent to that in miR-NC group (P>0.05).When the C9ORF139 gene in HL-60 cells was knocked down and cultured for 72 h, the phosphorylation expression levels of Raf, MEK and ERK molecules in group B were significantly lower than those in group A (all P<0.05). By day 14, the tumor volume in the group A was greater than the tumor cell volume in the group B [(284.49±57.61) vs (125.70±18.64) mm³, P=0.017]. The tumor weight of HL-60 in group A was heavier than that of group B [(847.80±159.36) vs (408.40±113.16) mg, P=0.001]. Conclusions: LncRNA C9ORF139 regulates TAOK1 by sponging miR-24-3P to promote the proliferation, invasion and migration of acute myeloid leukemiacell.In vivo experiments have confirmed that the expression of C9ORF139 can promote the growth of subcutaneous tumors in AML nude mice.

Evaluation of the efficacy of OLIF combined posterior internal fixation for single-segment lumbar tuberculosis: a single-center retrospective cohort study

Objective

To evaluate the clinical efficacy of oblique lateral interbody fusion (OLIF) combined posterior fixation for single-segment lumbar tuberculosis (TB).

Methods

The medical records of spinal TB patients who were admitted to our department from January 2016 to December 2018 were retrospectively reviewed, and those meeting the inclusion criteria were finally included for analysis. The operative time, operative blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle of surgical segment, bone graft fusion rate, erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), neurological function (ASIA grade) and complications of the included patients were all recorded and analyzed.

Results

Thirty-nine patients with lumbar TB were finally included. The mean operative time, operative blood loss, and hospital stay were 135.8 ± 19.2 min, 239.4 ± 84.7 ml, and 9.5 ± 2.7 days, respectively. The mean follow-up time was 26.3 ± 7.5 months. During the follow-up, both VAS score and ODI were significantly improved at 1 month, 3 months, 6 months, 1 year postoperative, and the last follow-up, compared with preoperative (P < 0.001). Cobb angle was significantly corrected at 1 month postoperatively (P < 0.001), however, from 3 months postoperative to the last follow-up, Cobb angle was getting lost (P < 0.01). Bone graft fusion rate at 3 months, 6 months, 1 year postoperative, and last follow-up were 66.67%, 87.18%, 94.88%, and 100%, respectively. Compared with preoperative, ESR and CRP were both showed significant decrease at 1 and 6 months postoperative, and the last follow-up (P < 0.001). At the last follow-up, all patients had improvement in ASIA grade compared with preoperative (P < 0.001). Six patients were found with postoperative complications, and all were cured after active treatment.

Conclusions

OLIF combined posterior internal fixation is safe and effective in the treatment of single-segment lumbar TB, with satisfactory pain relief, improvement of lumbar and neurological function, and deformity correction.

The risk factors of the postoperative poor wound healing in spinal tuberculosis patients: A single centre retrospective cohort study

The purpose of this study is to find out the risk factors of poor wound healing (PWH) in spinal tuberculosis (STB) patients. A total of 232 STB patients who underwent debridement surgery between January 2012 to June 2020 were included in this retrospective study. The study cohort was divided into two groups according to the presence or absence of PWH. The clinical characteristics of STB patients who developed PWH were evaluated, and risk factors were found using logistic regression analysis. Of the 232 patients, 30 developed PWH. Multivariate binary logistic regression analysis showed that pulmonary tuberculosis, long operation time and low postoperative albumin level were independent risk factors for PWH in STB patients. Receiver operating characteristic curve analysis showed that the optimal cutoff value of PWH in operation time and postoperative albumin are 200 minutes and 30 g/L, respectively. Pulmonary tuberculosis, long operation time and low postoperative albumin level are independent risk factors for PWH following surgery for STB. Curing pulmonary tuberculosis, controlling operation time and supervising postoperative serum albumin may decrease the risk of PWH among STB patients.

H1-Receptor Antagonist Olopatadine Inhibits MUC5AC Secretion by Conjunctival Goblet Cells

The study examined the effect of H1-receptor antagonist olopatadine on the secretory function of cultured rat conjunctival goblet cells (CGC) assessed by enzyme-linked lectin assay employing UEA-I lectin. The level of mRNA for membrane-bound protein MUC16 in histaminestimulated CGC was assayed by reverse transcription PCR in the control and after preliminary application of olopatadine. The intracellular calcium concentration [Ca²⁺]i was measured by the calcium colorimetric method using GENMED kits. The effects of histamine and olopatadine on p-ERK level were assessed by Western blotting. Histamine up-regulated secretion of mucin MUC5AC and expression of membrane-bound protein MUC16 in CGC. In addition, it increased both [Ca²⁺]i and the level of phosphorylated ERK. These effects were diminished by preliminary application of olopatadine that probably acted via the ERK signaling pathway. Thus, olopatadine reduced [Ca²⁺]i and down-regulated ERK phosphorylation by binding to H1-receptors, thereby inhibiting secretion of mucin from histamine-stimulated CGC.

What is an appropriate caesarean delivery rate for China: a multicentre survey

Objective

To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction.

Design

A multicentre cross‐sectional study.

Setting

A total of 94 hospitals across 23 provinces in China.

Population

A total of 73 977 randomly selected deliveries.

Methods

We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates.

Main outcome measures

CD rates in China.

Results

In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs.

Conclusions

Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD.

Tweetable abstract

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953.

Development of a scoring scale for predicting the risk of postoperative complications after spinal tuberculosis debridement: a retrospective cohort study of 233 patients

BACKGROUND

This investigation established a scoring scale for predicting the incidence of postoperative complications in patients after spinal tuberculosis debridement.

METHODS

A total of 232 spinal tuberculosis patients who underwent debridement surgery between January 2012 to May 2020 were included in this retrospective study. The study cohort was divided into 2 groups according to the presence or absence of postoperative complications. The complications were defined as abnormal or impaired body function caused by surgical factors (such as nerve injury and internal fixation looseness) or other factors (such as chemotherapy and bed stay). Clinical characteristics include age, body mass index (BMI), diabetes mellitus, pulmonary tuberculosis, smoking history, preoperative serum albumin, preoperative C-reactive protein (CRP), Cobb angle correction, surgical approach, operation time, etc. operative blood loss was recorded and analyzed. The clinical characteristics of spinal tuberculosis patients who suffered postoperative complications were evaluated, and a scoring scale was established using logistic regression analysis. The performance of this scoring scale was prospectively validated.

RESULTS

Out of 232 patients, a total of 188 (81.03%) suffered postoperative complications after surgery. Multivariate binary logistic regression analysis showed that diabetes mellitus [adjusted odds ratio (OR) =1.110, P=0.046], pulmonary tuberculosis (adjusted OR =1.181, P=0.002), low preoperative serum albumin (adjusted OR =0.789, P=0.005), anterior surgical approach (adjusted OR =5.934, P=0.035), and long operation time (adjusted OR =1.019, P<0.01) were independent risk factors of postoperative complications after spinal tuberculosis debridement surgery. The above independent risk factors were assigned to establish a scoring scale for predicting postoperative complications, and receiver operating characteristic (ROC) analysis showed that the optimal cut-off value for the scoring scale was 4 points. The sensitivity and specificity of the scoring scale were 60.8% and 81.8%, respectively, based on the validation set.

CONCLUSIONS

Using the scoring scale, spinal tuberculosis patients with a score between 4 to 9 would be considered at high risk of postoperative complications, while patients with a score of 0 to 3 would likely be at low risk of developing postoperative complications.

Low hemoglobin levels are associated with direct antiglobulin test positivity in patients with acute-on-chronic liver failure

BACKGROUND

Multiple factors contribute to anemia in patients with Hepatitis B virus (HBV)related acute-on-chronic liver failure (ACLF); however, the mechanism is unclear. The purpose of this study was to evaluate the clinical significance of the direct antiglobulin test (DAT) in patients with HBV related ACLF.

METHODS

DAT was used to detect immunoglobulins and/or complement proteins on the surface of erythrocytes.

RESULTS

We recruited 78 HBV-associated ACLF patients, 30 chronic hepatitis B(CHB)patients and 40 healthy people between October 2015 and May 2016. In HBV related ACLF patients, the hemoglobin concentration, number of erythrocytes, and hematocrit value were significantly lower, while the erythrocyte distribution width was significantly higher, compared to patients with CHB and healthy controls (HCs) (P < 0.001). The rates of DAT positivity in HBV related ACLF patients, CHB patients, and HCs were 62.8 %, 13.3 %, and 0%, respectively. DAT-positive ACLF patients exhibited lower Hb levels, older average age, as well as higher total bilirubin, alanine aminotransferase, and complement component 3 levels compared to DAT-negative patients.

CONCLUSIONS

HBV related ACLF patients showed significant alterations in erythrocyte parameters, possibly reflecting disease development and severity. The high presence of erythrocyte autoantibodies suggested that immunologic clearance of erythrocytes contributed to multifactorial anemia in HBV related ACLF patients.

Supine Cycling Exercise Enhances Cerebral Oxygenation of Motor-Related Areas in Healthy Male Volunteers

It has been reported that the cardiovascular response in the supine position is different from that in the sitting position. However, there are few reports on the effects of posture on cerebral oxygenation during exercise. Cycling exercises change oxygenated hemoglobin (O₂Hb) and deoxygenated hemoglobin (HHb) levels in motor-related areas. Therefore, this study compared O₂Hb levels at motor-related areas during recumbent versus supine cycling. Eleven healthy young male performed a 30-min cycling exercise protocol at 50% of the maximal oxygen uptake (VO₂ max) in the recumbent and supine positions. Near-infrared spectroscopy (NIRS) was used to measure exercise-induced O₂Hb and HHb changes in the right (R-PMA) and left premotor areas (L-PMA), supplementary motor area (SMA), and primary motor cortex (M1). In R-PMA, L-PMA and SMA, the O₂Hb obtained during supine cycling was significantly higher than that during recumbent cycling (R-PMA, 0.031 ± 0.01 vs. 0.693 ± 0.01; L-PMA, 0.027 ± 0.01 vs. 0.085 ± 0.013; SMA, 0.041 ± 0.011 vs. 0.076 ± 0.008 mM·cm, recumbent vs. supine position; p < 0.05). These results suggest that supine cycling exercise increases R-PMA, L-PMA, and SMA O₂Hb levels in healthy young men.

Café-au-lait macules overlying segmental macular hyperpigmentation in a pediatric patient: an early sign for mosaic neurofibromatosis type 1

The presentation of multiple café-au-lait macules (CALMs) in children is a common reason for referral to a dermatologist. Segmental CALMs, a subtype of CALMs, is usually limited to a specific part of the body. Mosaic neurofibromatosis type 1 (NF1; OMIM 162200) is a common congenital disorder associated with segmental CALMs with an incidence of about 1 case/40000 patients, which is lower than the prevalence of patients with germline NF1 mutations1,2 .

Quality assessment of randomized controlled trial abstracts on drug therapy of periodontal disease from the abstracts published in dental Science Citation Indexed journals in the last ten years

Background

Randomized controlled trials (RCTs) provide the highest level of evidence and are likely to influence clinical decision-making. This study evaluated the reporting quality of RCT abstracts on drug therapy of periodontal disease and assessed the associated factors.

Material and Methods

The Pubmed database was searched for periodontal RCTs published in Science Citation Indexed (SCI) dental journals from 2010/01/01 to 2019/07/17. Information was extracted from the abstracts according to a modified Consolidated Standards of Reporting Trials (CONSORT) guideline checklist. The data was analyzed using descriptive statistical analysis and the statistical associations were examined using the linear regression analysis (P <0.05).

Results

This study retrieved 1715 articles and 249 of them were finally included. The average overall CONSORT score was 15.6 ± 3.4, which represented 40.9% (±0.6) of CONSORT criteria filling. The reporting rate of some items (trial design, numbers analyzed, confidence intervals, intention-to-treat analysis or per-protocol analysis, harms, registration) was less than 30%. The adequate reporting rate of some items (participants, randomization, numbers analyzed, confidence intervals, intention-to-treat analysis or per protocol analysis) was no more than 4%. None of the abstracts reported funding. According to the multivariable linear regression results, number of authors (P=0.030), word count (P <0.001), continent (P=0.003), structured format (P <0.001), type of periodontal disease (P <0.001) and international collaboration (P=0.023) have a significant association with reporting quality.

Conclusions

The quality of RCT abstracts on drug therapy of periodontal disease in SCI dental journals remained suboptimal. More efforts should be made to improve RCT abstracts reporting quality.

Key words:Abstracts, RCT, drug therapy, periodontal disease, CONSORT, reporting quality assessment.

[Clinical characteristics and death risk factors of severe COVID-19]

Objective: To analyze the clinical features and death-related risk factors of COVID-19. Methods: We enrolled 891 COVID-19 patients admitted to the Affiliated Hospital of Jianghan University from December 2019 to February 2020, including 427 men and 464 women. Of the 891 cases, 582 were severe or critical, including 423(73%)severe and 159 (27%) critical cases. We compared the demographics, laboratory findings, clinical characteristics, treatments and prognosis data of the 582 severe patients. Univariate and multivariate logistic regression analysis was conducted to explore the risk factors associated with death in COVID-19 patients. Results: The 582 severe patients included 293 males and 289 females, with a median age of 64(range 24 to 106). Sixty-three patients died, including 45 males and 18 females, with a median age of 71(range 37 to 90). The average onset time of the 582 patients was 8 days, of whom 461 (79%) had fever, 358 (62%) dry cough, 274 (47%) fatigue. There were 206 cases with shortness of breath (35%), 155 cases with expectoration (27%), 83 cases with muscle pain or joint pain (14%), 71 cases with diarrhea (12%), and 29 cases with headache (4%). Underlying diseases were present in 267 (46%) patients, most commonly hypertension (194, 33%), followed by diabetes (69, 12%), coronary atherosclerotic heart disease (37, 6%), tumor (18, 3%), and chronic obstructive pulmonary disease (5, 1%). Chest CT showed bilateral lung involvement in 505 patients (87%). Upon admission, the median lymphocyte count of the 582 patients was 0.8(IQR, 0.6-1.1)×10(9)/L, the median D-dimer was 0.5 (IQR, 0.4- 0.8) mg/L, the median N-terminal brain natriuretic peptide precursor (NT-proBNP) was 433 (IQR, 141- 806) pg/L, and the median creatinine was 70.3 (IQR, 56.9-87.9) μmol/L. The death group had a median lymphocyte count of 0.5 (0.4-0.8)×10(9)/L, D-dimer 1.1 (0.7-10.0)mg/L, N-terminal brain natriuretic peptide precursor 1479(893-5 087) pg/ml, and creatinine 89.9(67.1-125.3) μmol/L. Multivariate logistic analysis showed that increased D-dimer (OR: 1.095, 95% CI: 1.045-1.148, P<0.001), increased NT-proBNP (OR: 4.759, 95% CI: 2.437-9.291, P<0.001), and decreased lymphocyte count (OR: 0.180, 95% CI: 0.059-0.550, P=0.003) were the risk factors of death in COVID-19 patients. Conclusions: The average onset time of severe COVID-19 was 8 days, and the most common symptoms were fever, dry cough and fatigue. Comorbidities such as hypertension were common and mostly accompanied by impaired organ functions on admission. Higher D-dimer, higher NT-proBNP, and lower lymphocyte count were the independent risk factors of death in COVID-19 patients.

Graphene Oxide Enables the Reosteogenesis of Previously Contaminated Titanium In Vitro

The main goal of peri-implantitis treatment is to control infection and arrest bone loss, which requires the removal of polymicrobial biofilms on the implant surface and the reduction of tissue invasion. Additionally, prognosis can be improved if reosseointegration occurs on previously contaminated implants. To evaluate whether graphene oxide (GO) can remove polymicrobial biofilms, biofilms were established on titanium surfaces in vitro and treated with different methods: group B, removed only with brushing; group G, treated with different GO concentrations (64, 128, 256, and 512 μg/mL); group GB, combined treatments of groups B and G; and group C, untreated. Subsequently, to evaluate reosteogenesis on previously contaminated titanium, 4 groups were used: groups C, B, GB-256, and GB-512 (treated with 256 and 512 μg/mL of GO, respectively). Intact clean titanium (IC) was used as a control. Additionally, cell behavior on IC treated with GB-256 (IGB-256) and GB-512 (IGB-512) was compared with that of the GB-256 and GB-512 groups, respectively. The results showed that at high concentrations (≥256 μg/mL), GO eliminated residual bacteria and inhibited biofilm reformation after brushing, whereas neither GO nor brushing alone could achieve this. Bone marrow-derived mesenchymal stem cell viability in groups GB-256 and IC was higher than that in groups GB-512, C, and B (P < 0.05). No significant difference was found between group GB-256 and group IC (P > 0.05). Osteogenic differentiation of bone marrow-derived mesenchymal stem cells in group GB-256 was higher than that in groups IC, GB-512, C, and B. No difference was found between groups IGB-256 and IGB-512 and groups GB-256 and GB-512, respectively (P > 0.05). In conclusion, 256 μg/mL of GO combined with brushing significantly removed polymicrobial biofilms that remained on the previously contaminated titanium surfaces. The bone marrow-derived mesenchymal stem cell osteogenic potential was regained or even enhanced on the titanium surfaces treated this way in vitro, which might provide a new idea for treating peri-implantitis.

[Coexisting mutations in NPM1-mutated elderly adults with acute myeloid leukemia]

Objective: To explore the coexisting mutations in NPM1 mutated elderly patients with acute myeloid leukemia(AML). Methods: The clinical data of 152 elderly adults(aged≥60 years) and 49 young adults(aged 18-45 years) with AML between June 2013 and December 2018 in outpatient and hospitalized patients of Changzhou Second People's Hospital and Wuxi Second People's Hospital were retrospectively analyzed. A total of 51 gene mutations were detected using targeted next-generation sequencing (NGS) and sanger sequencing. The general clinical characteristics, the occurrence of coexistence gene mutations, the correlation between coexistence gene mutations and some clinical parameters, and the initial induction remission rate between elderly and young adult AML patients with NPM1 mutations were analyzed and compared. Results: NPM1 mutations were detected in 46 of 152 elderly AML patients. Thirty eight patients (82.6%) with NPM1 mutations carried other gene mutations at the same time, among whom 8 patients (17.4%) carried NPM1 mutations alone, while 14(30.4%) carried 2, 16 (34.8%) carried 3, and 8 (17.4%) carried ≥ 4 mutations. NPM1 mutations frequently co-occurred with FLT3-ITD15 cases (32.6%) , DNMT3A10 (21.7%) , TET26 (13.4%) and FLT3-TKD5 (10.9%) . Compared with young adults with NPM1 mutations, elderly patients had higher TP53, FLT3-TKD rates, lower incidence of DNMT3A, RAS mutation (all P<0.05) and lower coexistence rate of 4 gene mutations (P=0.002).The presence of ≥ 4 mutations was found to be significantly associated with higher white blood level than those in patients with single, double and 3 mutations coexisted in elderly adults AML patients(all P<0.05). With the increase of the amount of mutations, the complete remission(CR) rate decreased gradually after the initial induction. Patients who carried 3 or more mutations showed a lower CR rate than those with single gene mutations (all P<0.05) . Patients who carried>4 genes also showed a significantly lower CR rate than those with double gene mutations (P=0.031). Patients with FLT3-ITD mutations exhibited higher white blood level and lower CR rate than that in nonmutant type group (all P<0.05). The CR rate of patients with DNMT3A mutation was also significantly lower than that with nonmutant type (P=0.033). However, patients with FLT3-TKD mutations showed a higher platelet level than that with nonmutant type (P=0.019). There was no significant difference in CR rate and peripheral blood cell level between TET2 mutated and nonmutant type. Conclusion: NPM1 mutated elderly patients with AML commonly show additional mutations, and the amount and type of coexisting mutations have an influence on the clinical features and CR rate of elderly patients with AML.

Normal-Appearing Cerebellar Damage in Neuromyelitis Optica Spectrum Disorder

BACKGROUND AND PURPOSE

The cerebellum plays an important role in motor and cognitive functions. However, whether and how the normal-appearing cerebellum is impaired in patients with neuromyelitis optica spectrum disorders remain unknown. We aimed to identify the occult structural damage of the cerebellum in neuromyelitis optica spectrum disorder and its possible causes at the level of substructures.

MATERIALS AND METHODS

Normal-appearing gray matter volume of the cerebellar lobules and nuclei and normal-appearing white matter volume of the cerebellar peduncles were compared between patients with neuromyelitis optica spectrum disorder and healthy controls.

RESULTS

The cerebellar damage of patients with neuromyelitis optica spectrum disorder in the hemispheric lobule VI, vermis lobule VI, and all cerebellar nuclei and peduncles was related only to spinal lesions; and cerebellar damage in the hemispheric lobules VIII and X was related only to the aquaporin-4 antibody. The mixed cerebellar damage in the hemispheric lobules V and IX and vermis lobule Crus I was related mainly to spinal lesions; and mixed cerebellar damage in the hemispheric lobule VIIb was related mainly to the aquaporin-4 antibody. Other cerebellar substructures showed no significant cerebellar damage.

CONCLUSIONS

We have shown that the damage in cerebellar normal-appearing white matter and normal-appearing gray matter is associated with aquaporin-4-mediated primary damage or axonal degeneration secondary to spinal lesions or both. The etiologic classifications of substructure-specific occult cerebellar damage may facilitate developing neuroimaging markers for assessing the severity and the results of therapy of neuromyelitis optica spectrum disorder occult cerebellar damage.

[Multi-level analysis on factors affecting the adherence to early antithrombotic therapy among people with acute ischemic stroke]

Objective: To explore the patient and hospital related determinants of adherence to early antithrombotic therapy among patients with acute ischemic stroke (AIS). Methods: AIS patients aged 50 years old or above who were eligible for early antithrombotic therapy, were included from the China National Stroke Registry Ⅱ (CNSR Ⅱ) project. Characteristics related to patients and hospitals were collected. Univariate analysis method was conducted to explore the correlation between hospital or patient-related determinants and early antithrombotic therapy. A 2-level logistic regression model was set up to identify patient and hospital-related variables that were associated with the adherence to early antithrombotic therapy, with patient as level 1 and hospital as level 2. Results: A total of 16 910 patients were included in the study, with 14 332 (84.75%) of them having received early antithrombotic therapy. Results from the univariate analysis showed that the patient determinants to early antithrombotic therapy would include age, type of health insurance, average income and history of dyslipidemia. Hospital determinants would include factors as: level and region of the hospital, academic status, with/without stroke unit, quality control on single disease and the percentage of neurological beds in total beds (P<0.05). Data on multilevel model showed that the patient-related determinants on early antithrombotic therapy would include age, gender, average income, history of hypertension, National Institutes of Health Stroke Scale (NIHSS) score at admission while hospital related determinants would include percentage of neurological beds in total beds, and region of the hospital (P<0.05). Conclusions: The quality of a hospital was associated with the adherence to early antithrombotic therapy. AIS patients at advanced age or with high NIHSS score at admission should be paid more attention.

Triptolide induces mitochondrial apoptosis through modulating dual specificity phosphatase 1/mitogen-activated protein kinases cascade in osteosarcoma cells

Due to chemoresistance and metastasis, the overall prognosis of osteosarcoma (OS) has not improved over the last two decades. Exploring novel therapeutic agents that can circumvent theses malignant phenotypes of OS would be essential to improve the survival of OS patients. Triptolide is a unique diterpene triepoxide that possesses potent antitumor activities.However, the effects and mechanism of triptolide on OS cells remain unknown. The effects of triptolide on viability, apoptosis, cell cycle distribution and migratory ability of OS cells were measured using MTT, flow cytometry and wound healing and transwell invasion assays. And an OS tumor xenograft mouse model was produced to further study the in vivo antitumor effects of triptolide. The expression of DUSP1 at the protein and mRNA level in OS cells was detected by western blot and qPCR. We report that triptolide exhibits multidimensional antitumor activities in OS cells, including the induction of apoptosis and G1 phase accumulation, inhibition of cell viability, migration, and invasion. We further demonstrate that triptolide inhibits the expression of dual-specificity protein phosphatase1 (DUSP1) through inhibiting its promoter activity, which causes sustained activation of three subfamilies of mitogen-activated protein kinase (MAPK). And the modulation of DUSP1/MAPK cascade is associated with the apoptosis of OS cells, since the ectopic expression of DUSP1 or the inhibition of MAPK using specific inhibitors can counteract triptolide-induced apoptosis. In addition, triptolide enhances doxorubicin-induced apoptosis. In summary, our study suggests that DUSP1 is an important cellular target of triptolide, and triptolide may be a promising treatment option for OS as a single agent or combined with other chemotherapeutics.

MiR-17-5p modulates mitochondrial function of the genioglossus muscle satellite cells through targeting Mfn2 in hypoxia

The root cause of obstructive sleep apnea-hypopnea syndrome (OSAHS) is repeated hypoxia during sleep. The genioglossus is one of the most important upper airway dilatation muscles and is important for maintaining normal oxygen supply during sleep. Hypoxia can directly affect the energy metabolism level of the genioglossus muscle, thereby weakening muscle function. MicroRNAs (miRNAs) can regulate mitochondrial function at the post-transcriptional level and achieve recovery or even enhancement of genioglossus function, but the specific mechanism is still unclear. In this study, an intermittent hypoxic cell model was established to detect the effects of hypoxia on the proliferation and apoptosis of Genioglossus muscle satellite cells (GG MuSCs), and the damage to the mitochondrial structure and function was assessed by transmission electron microscopy and mitochondrial membrane potential. Then, miR-17-5p was upregulated and downregulated by miRNA mimics and inhibitors, respectively, and bioinformatics analysis was used to predict and validate the target genes of miR-17-5p. The results showed that the hypoxic environment affected the proliferation of GG MuSCs and mitochondrial membrane potential, which promoted the occurrence of apoptosis and mitochondrial edema. After upregulation of miR-17-5p, cell proliferative capacity and mitochondrial function were restored. Bioinformatics prediction and gene and protein level analyses found that Mfn2 may be a target gene of miR-17-5p. .

Comparison of the gut microbiota composition between the wild and captive Tibetan wild ass (Equus kiang)

Aims

The gut microbiota has a great effect on the health and nutrition of the host. Manipulation of the intestinal microbiota may improve animal health and growth performance. The objectives of our study were to characterize the faecal microbiota between wild and captive Tibetan wild asses and discuss the differences and their reasons.

Methods and Results

Through high‐throughput sequencing of the 16S rRNA V4‐V5 region, we studied the gut microbiota composition and structure of Tibetan wild asses in winter, and analysed the differences between wild and captive groups. The results showed that the most common bacterial phylum in Tibetan wild ass faeces samples was Bacteroidetes, while the phylum Firmicutes was dominant in captive Tibetan wild ass faecal samples. The relative abundance of Firmicutes, Tenericutes and Spirochaetes were significantly higher (P < 0·01) than in the wild groups.

Conclusions

Captivity reduces intestinal microbial diversity, evenness and operational taxonomic unit number due to the consumption of industrial food, therefore, increasing the risk of disease prevalence and affecting the health of wildlife.

Significance and Impact of the Study

We studied the effect of the captive environment on intestinal micro‐organisms. This article provides a theoretical basis for the ex‐situ conservation of wild animals in the future.

Nutrient use efficiencies, losses, and abatement strategies for peri-urban dairy production systems

Manure management is an important aspect of urban livestock production that has a profound impact on metropolitan living. Data were collected from 28 dairy farms in peri-urban Beijing and analysed to determine farm nitrogen and phosphorus flows and costs associated with various manure management options to reduce nutrient losses. Dairy production in peri-urban Beijing was characterized by its use of high protein diets (16.3-17.0% crude protein), high reliance on imported feeds (92-98%), and low manure recycling (3.0-10.8%). Farms of 900-2000 cattle showed lower use efficiencies than farms of <900 cattle. Costs of manure handling ranged from 0.1 to 1.0 Yuan kg^-1 milk. Among various manure treatment options, biogas digesters with aerobic lagoons had the lowest N losses and costs, justifying their investments. In conclusion, peri-urban dairy production systems were contrasting with traditional systems and within their own systems in nutrient use efficiency and losses, which was mainly decided by their farm size. To improve the nutrient use efficiencies and reduce losses, farmers and managers of peri-urban dairy production system should have a full awareness of different feed intake and manure management.

Altered structural and functional connectivity of the insula in functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) is a common functional gastrointestinal disease. Neuroimaging studies have identified that insula is involved in the pathogenesis of FD. However, less is known about structural and functional connectivity of insula in FD.

METHODS

In this study, 67 FD patients and 46 healthy controls (HCs) underwent structural MRI, resting-state functional MRI, diffusion tensor imaging (DTI) scans, and clinical assessment. We used the 3 neuroimaging modalities to investigate structural and functional connectivity of insula between FD patients and HCs, and we examined relationships between the neuroimaging findings and clinical symptoms.

KEY RESULTS

Compared with HCs, (i) FD patients had decreased gray matter density in right insula according to voxel-based morphometry method, which region was targeted as region of interest for further analysis of structural and functional connectivity; (ii) FD patients had lower connection probability in right anterior insula with right thalamus, right internal capsule (IC), and right external capsule (EC); (iii) FD patients had decreased functional connectivity of the right anterior insula with right thalamus and right pregenual anterior cingulate cortex (pACC); and (iv) FD patients had negative correlation between disease duration and the functional connectivity of right anterior insula with thalamus.

CONCLUSIONS AND INFERENCES

The present findings reveal that alterations of structural and/or functional connectivity of right anterior insula with regions, including thalamus, IC, EC, and pACC, may be mainly implicated in abnormalities of visceral sensory processing and related affective responses in FD patients. Finally, this study could enhance understanding of the pathophysiology of FD.

The microRNA-1908 up-regulation in the peripheral blood cells impairs amyloid clearance by targeting ApoE

OBJECTIVE

To give a new insight into the mechanism of ApoE dysregulation and microRNA-1908 in Alzheimer's disease (AD).

METHODS

Plasma ApoE levels were measured in 20 AD patients and 20 healthy controls. THP-1 was maintained in RPMI1640 with 10% fetal bovine serum. Quantitative real-time polymerase chain reaction was performed to detect 13-microRNA and ApoE mRNA in cultured cell lines. Enzyme-linked immunosorbent assay was used to measure human ApoE in the plasma or culture medium of cell lines and also used to quantify the human Aβ42 in the culture medium of cell lines.

RESULTS

We found plasma ApoE level reduced in AD patients (2.28 vs 3.78 μg/mL, P < .001), and microRNA-1908 was up-regulated in AD patients and was negatively associated with plasma ApoE (r = -0.32, P = .012). In human macrophage cell line THP-1 and astrocytoma cell line U87, microRNA-1908 could inhibit the mRNA and protein levels of ApoE by targeting its 3'untranslated region. Consistently, microRNA-1908 inhibits the ApoE-mediated Aβ clearance.

CONCLUSIONS

Our study provides new insight into the mechanism of ApoE dysregulation in AD patients, and microRNA-1908 might be a therapeutic target for AD treatment.