SPI1 exacerbates iron accumulation and promotes osteoclast formation through inhibiting the expression of Hepcidin

BACKGROUND

Osteoporosis (OP) can be caused by an overactive osteoclastic function. Anti-osteoporosis considerable therapeutic effects in tissue repair and regeneration because bone resorption is a unique osteoclast function. In this study, we mainly explored the underlying mechanisms of osteoclasts' effects on osteoporosis.

METHODS

RAW264.7 cells were used and induced toward osteoclast and iron accumulation by M-CSF and RANKL administration. We investigated Hepcidin and divalent metal transporter 1 (DMT1) on iron accumulation and osteoclast formation in an ovariectomy (OVX)-induced osteoporosis. Osteoporosis was induced in mice by OVX, and treated with Hepcidin (10, 20, 40, 80 mg/kg, respectively) and overexpression of DMT1 by tail vein injection. Hepcidin, SPI1, and DMT1 were detected by immunohistochemical staining, western blot and RT-PCR. The bioinformatics assays, luciferase assays, and Chromatin Immunoprecipitation (ChIP) verified that Hepcidin was a direct SPI1 transcriptional target. Iron accumulation was detected by laser scanning confocal microscopy, Perl's iron staining and iron content assay. The formation of osteoclasts was assessed using tartrate-resistant acid phosphatase (TRAP) staining.

RESULTS

We found that RAW264.7 cells differentiated into osteoclasts when exposed to M-CSF and RANKL, which increased the protein levels of osteoclastogenesis-related genes, including c-Fos, MMP9, and Acp5. We also observed higher concentration of iron accumulation when M-CSF and RANKL were administered. However, Hepcidin inhibited the osteoclast differentiation cells and decreased intracellular iron concentration primary osteoclasts derived from RAW264.7. Spi-1 proto-oncogene (SPI1) transcriptionally repressed the expression of Hepcidin, increased DMT1, facilitated the differentiation and iron accumulation of mouse osteoclasts. Overexpression of SPI1 significantly declined luciferase activity of HAMP promoter and increased the enrichment of HAMP promoter. Furthermore, our results showed that Hepcidin inhibited osteoclast differentiation and iron accumulation in mouse osteoclasts and OVX mice.

CONCLUSION

Therefore, the study revealed that SPI1 could inhibit Hepcidin expression contribute to iron accumulation and osteoclast formation via DMT1 signaling activation in mouse with OVX.

Actively Learned Optimal Sustainable Operation of Plasma-Catalyzed Methane Bireforming on La0.7Ce0.3NiO3 Perovskite Catalyst

Plasma-catalytic bireforming of methane was studied and actively optimized using a La0.7Ce0.3NiO3 perovskite catalyst via experimentation in tandem with response surface modeling. Plasma power, inlet flow rate, temperature, CO2/CH4 ratio, and steam concentration were tuned to maximize a variety of process- and sustainability-based metrics. Analysis of the optimal conditions (with respect to different metrics) with and without the catalyst reveals that dry reforming is driven largely via noncatalytic reactions, while steam reforming and water gas shift reactions require the catalyst. The experimental outcome demonstrated that under optimum reaction conditions using the La0.7Ce0.3NiO3 catalyst it is possible to minimize global warming potential (GWP), in terms of inferred CO2 footprint normalized to hydrogen throughput, resulting in maximizing hydrogen yield through steam reforming (and water gas shift reactions) at an SEI of ≈12 eV/molecule. Furthermore, the highest CH4 conversion reached was 87% while the catalyst showed good activity stability in DBD plasma experiments.The actively learned iterative optimization procedure developed in this work allows for a direct juxtaposition of thermal (heat needed to make steam and heat the plasma reactor) and electrical (power requirement for plasma generation) carbon footprints in a highly nonlinear multivariate process. Furthermore, the corresponding GWP was calculated using a conventional electricity mix, wind electricity, and solar electricity, allowing a direct sustainability assessment in catalyst-assisted plasma conversion of carbonaceous feedstock to H2 and CO.

Pregnancy and lactation-associated osteoporosis with pyogenic spondylitis: A case report

BACKGROUND

This case report presents a patient with pyogenic spondylitis (PS) associated with lactation-related osteoporosis during pregnancy. The 34-year-old female patient experienced low back pain for one month, beginning one month postpartum, with no history of trauma or fever. Dual-energy X-ray absorptiometry of the lumbar spine revealed a Z-score of -2.45, leading to a diagnosis of pregnancy and lactation-associated osteoporosis (PLO). The patient was advised to cease breastfeeding and take oral calcium and active vitamin D. Despite these interventions, her symptoms worsened, and she had difficulty walking one week later, prompting her to revisit our hospital.

CASE SUMMARY

Lumbar magnetic resonance imaging (MRI) scans showed abnormal signals in the L4 and L5 vertebral bodies and intervertebral space, while an enhancement scan displayed abnormal enhanced high signals around the L4/5 intervertebral disc, suggesting a lumbar infection. A needle biopsy was performed for bacterial culture and pathological examination, culminating in a final diagnosis of pregnancy and lactation-related osteoporosis with PS. Following treatment with anti-osteoporotic medications and antibiotics, the patient’s pain gradually subsided, and she returned to normal life within five months. PLO is a rare condition that has garnered increasing attention in recent years. Spinal infections during lactation in pregnancy are also relatively uncommon.

CONCLUSION

Both conditions primarily manifest as low back pain but require distinct treatments. In clinical practice, when diagnosing patients with pregnancy and lactation-associated osteoporosis, the possibility of spinal infection should be considered. A lumbar MRI should be conducted as needed to prevent delays in diagnosis and treatment.

Machine learning accurately quantifies epicardial adipose tissue from non-contrast CT images in coronary artery disease

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Industry Alignment Fund – Pre-positioning Programme

Background

Epicardial adipose tissue (EAT) is the visceral fat deposit within the pericardium that surrounds the heart and the coronary arteries. EAT volume measured from non-contrast CT (NCCT) has been demonstrated to be significantly associated with adverse cardiovascular risk,1 particularly in patients with coronary artery disease.2 However, routine measurement of EAT volume is still challenging in clinical practice, as it is a tedious manual process and prone to human error.

Purpose

We aimed to develop a fully automated AI toolkit (i.e., AI EAT) for the quantification of EAT from routine NCCT scans and assess its performance in reference to clinical ground truth.

Methods

This is a multicenter study which performs CT scans in 5000 Asian Admixture patients (APOLLO study NCT05509010). In the current stage of this study, NCCT data analysis were conducted in 551 patients with 26,037 images. AI EAT was developed via a novel deep learning framework using an ensemble region-based UNet. The region-based UNet uses 2 component UNet models to perform segmentation of pericardium at the apex region and non-apex region (middle and basal). EAT volume was obtained by automated thresholding of the voxels (-190 to -30 Hounsfield Unit) within the pericardium (Figure 1). The network was trained in 501 patients with 23,712 NCCT images and tested in 50 patients with 2,325 NCCT images. The performance of AI EAT was evaluated with respect to clinical ground truth using Dice similarity coefficient (DSC), Pearson correlation, and Bland-Altman analysis.

Results

The AI EAT quantification process took less than 10 seconds per subject, compared with 20-30 minutes for expert readers. Compared to clinical ground truth, our AI EAT achieved a DSC of 0.96±0.01 and 0.91±0.02 for pericardium and EAT segmentations, respectively. There was strong agreement between the AI EAT and clinical ground truth in deriving the EAT volume (r=0.99, P<0.001) with minimal error of 7±5%.

Conclusion

End-to-end deep learning system accurately quantifies epicardial adipose tissue in standard NCCT images without manual segmentation.

Quick balance skill improvement after short-term training with error amplification feedback for older adults

This study investigated behavioral and cortical mechanisms for short-term postural training with error amplification (EA) feedback in the elderly. Thirty-six elderly subjects (65.7 ± 2.2 years) were grouped (control and EA, n = 18) for training in stabilometer balance under visual guidance. During the training session (8 training rounds of 60 s in Day 2), the EA group received visual feedback that magnified errors to twice the real size, whereas the control group received visual feedback that displayed real errors. Scalp EEG and kinematic data of the stabilometer plate and ankle joint were recorded in the pre-test (Day 1) and post-test (Day 3). The EA group (-46.5 ± 4.7%) exhibited greater post-training error reduction than that of the control group (-27.1 ± 4.0%)(p = 0.020), together with a greater decline in kinematic coupling between the stabilometer plate and ankle joint (EA: -26.6 ± 4.8%, control: 2.3 ± 8.6%, p = 0.023). In contrast to the control group, the EA group manifested greater reductions in mean phase-lag index (PLI) connectivity in the theta (4-7 Hz)(p = 0.011) and alpha (8-12 Hz) (p = 0.027) bands. Only the EA group showed post-training declines in the mean PLI in the theta and alpha bands. Minimal spanning tree analysis revealed that EA-based training led to increases in the diameter (p = 0.002) and average eccentricity (p = 0.004) of the theta band for enhanced performance monitoring and reduction in the leaf fraction (p = 0.030) of the alpha band for postural response with enhanced automaticity. In conclusion, short-term EA training optimizes balance skill, favoring multi-segment coordination for the elderly, which is linked to more sophisticated error monitoring with less attentive control over the stabilometer stance.

The fibrosis-4 score is associated with long-term mortality in different phenotypes of acute heart failure

BACKGROUND

Fibrosis-4 score (FIB4) was a non-invasive surrogate to estimate the amount of liver scarring in chronic hepatitis. Considering the presence of increased central venous pressure and congestive hepatopathy in patients with decompensated heart failure, we therefore investigated the prognostic values of FIB4 in acute heart failure (AHF) patients.

METHOD

Patients hospitalised primarily for HF were drawn from an intramural registry. FIB4 was calculated according to age, aspartate aminotransferase, alanine aminotransferase and platelet count. All-cause mortality up to 5 years after discharge was obtained by linking to the national death registry.

RESULTS

Among a total of 1854 participants, 940 patients died during a mean follow-up of 28.3 ± 21.8 months. FIB4 score was related to mortality and the composite of cardiovascular death or HF rehospitalisation, independent of age, sex, left ventricular ejection fraction, left atrial dimension, sodium and haemoglobin levels, estimated glomerular filtration rate, comorbidities, and medications [hazard ratio and 95% confidence interval of mortality: 1.009 (1.002-1.015), and the composite of cardiovascular death or HF hospitalisation: 1.020 (1.010-1.031)]. The prognostic value of FIB4 was predominantly in the subjects with heart failure and preserved or mildly reduced ejection fraction (HFpEF and HFmrEF), or coronary artery disease (CAD) than the counterparts [interaction p-value <0.001, and 0.004, respectively].

CONCLUSIONS

FIB4 was an independent predictor of survival in AHF patients, irrespective of the phenotypes of HF. The higher predictive value of mortality of FIB4 was observed in the subjects with HFpEF, HFmrEF or CAD.

Tissue inhibitor of metalloproteinase (TIMP)-1 predicts negative remodeling and recovery of ejection fraction in acute heart failure with reduced ejection fraction

Background

Heart failure with recovered ejection fraction (HFrecEF) is a recently identified phenotype of heart failure, which had lower rates of mortality, heart failure hospitalization, ventricular assist device placement, and heart transplantation compared to heart failure with reduced ejection fraction (HFrEF). Several predictors of HFrecEF had been proposed such as female gender, lower HF duration, nonischemic cause, no left bundle branch block (LBBB), lower EF, and lower N-terminal pro-brain natriuretic peptide (NT-proBNP) in the previous studies. Tissue inhibitors of metalloproteinase-1 (TIMP-1) was a biomarker that regulated the activity of metalloproteinases (MMPs). TIMP-1 was up-regulated during HF and was associated with ventricular remodeling and poor prognosis. However, the predictive value of TIMP-1 and MMP-9 in recovery of EF was yet to be investigated.

Purpose

The present study aimed at investigating the predictive value of TIMP-1 and MMP-9 of recovery of EF.

Methods

Subjects with acute decompensated heart failure and reduced left ventricular ejection fraction were eligible for this study. HFrEF was defined as EF &lt;40% and HFrecEF was defined as follow-up EF ≥40% and ≥10% improvement from baseline EF. The biomarkers including NT-proBNP, plasma MMP-9 and serum TIMP-1 were measured in all enrolled subjects at admission. The receiver operating characteristic (ROC) curves and Youden index were used to select the model variables and cutoff values. Binary logistic regression analysis assessed the association between the biomarkers and recovery ejection fraction.

Results

Among a total of 91 AHF with reduced ejection fraction subjects (70.1±16.2 years, baseline EF 28.9±7.6%), 19 (20.8%) HFrecEF and 72 (79.2%) persistent HFrEF were found at 6 months. TIMP-1 and NT-proBNP were significantly higher in persistent HFrEF compared to HFrecEF. MMP-9 was similar between these two phenotypes of HF. The area under the ROC curve for recovery of ejection fraction of TIMP-1, MMP-9 and NT-proBNP were 0.69, 0.52, and 0.65, respectively. The optimal cutoff value of TIMP-1 according to Youden index was 200.68 ng/ml. In binary logistic regression analysis, TIMP-1 was negatively correlated with recovered ejection fraction as continuous variables [per 1-SD=8.96 ng/ml, odds ratio and 95% confidence interval: 0.99 (0.98–1.00)] and categorical variables [cutoff value 200.68 ng/ml, odds ratio and 95% confidence interval: 0.16 (0.05–0.54)] after adjusting age, gender, EF, acute myocardial infarction, LBBB and NT-proBNP.

Conclusions

In AHF subjects with HFrEF, TIMP-1 was negatively correlated to the recovery of EF and could be a potential biomarker for the prediction of the recovery of EF.

Funding Acknowledgement

Type of funding sources: None.

Short term outcomes of extremely low birth weight infants from a multicenter cohort study in Guangdong of China

With the increase in extremely low birth weight (ELBW) infants, their outcome attracted worldwide attention. However, in China, the related studies are rare. The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units in Guangdong Province of China during 2008-2017 were analyzed. A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76% to 62.02%. Increased survival is closely related to birth weight (BW), regional economic development, and specialized hospital. The incidence of complications was neonatal respiratory distress syndrome (85.2%), oxygen dependency at 28 days (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days). A total of 768 ELBW infants died after treatment withdrawal, for reasons of economic and/or poor outcome. The number of ELBW infants is increasing in Guangdong Province of China, and the overall survival rate is improving steadily.

ATF1/miR-214-5p/ITGA7 axis promotes osteoclastogenesis to alter OVX-induced bone absorption

Background

The dynamic balance of osteoblast and osteoclast is critical for bone homeostasis and overactive osteoclastic function may lead to osteoporosis. Activating transcription factor 1 (ATF1) is involved in osteoclastogenesis. However, the detailed mechanisms remain to be explored.

Methods

RAW264.7 cells were used and induced toward osteoclast by RANKL administration. We performed flow cytometry, CCK-8 assay and tartrate-resistant acid phosphatase (TRAP) staining to examine cell apoptosis, proliferation and differentiation of RAW264.7 cells, respectively. Mice were subjected to ovariectomy to induce osteoporosis. Micro CT, HE staining and TRAP staining were performed to evaluate bone loss in the OVX mouse model. Bioinformatics methods, luciferase assays and Chromatin Immunoprecipitation (ChIP) were used to predict and validate the interaction among ATF1, miR-214-5p, and ITGA7.

Results

ATF1 and miR-214-5p were up-regulated while ITGA7 was inhibited in RANKL-induced osteoclasts. MiR-214-5p was transcriptionally activated by ATF1. ATF1 knockdown suppressed osteoclast formation by miR-214-5p inhibition. ITGA7 was the direct target of miR-214-5p. Knockdown of miR-214-5p abolished osteoclastogenesis, which was reversed by ITGA7 knockdown. In OVX model, miR-214-5p knockdown suppressed osteoclast differentiation and prevented bone loss.

Conclusion

ATF1/miR-214-5p/ITGA7 axis regulated osteoclast formation both in vivo and in vitro, thereby affecting OVX-induced bone resorption in mice. Knockdown of ATF1 might be a promising strategy to manage osteoporosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10020-022-00476-7.

The Survival Rate of Extremely Low Birth Weight Infants Improved in Guangdong Province, China.. [DOI: 10.21203/rs.3.rs-1019118/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background With the increase in extremely low birth weight (ELBW) infants, their outcomes received special attention. However, in China, studies of the outcomes of ELBW infants are rare. Methods The hospitalized records of ELBW infants discharged from twenty-six neonatal intensive care units were reviewed and analyzed. Results A total of 2575 ELBW infants were enrolled and the overall survival rate was 55.11%. From 2008 to 2017, the number of ELBW infants increased rapidly from 91 to 466, and the survival rate improved steadily from 41.76–62.02%. The survival rate rose with increasing BW, the ascending level of regional economic development and specialist hospitals. The incidence of complications was neonatal respiratory distress syndrome (85.2%), bronchopulmonary dysplasia (63.7%), retinopathy of prematurity (39.3%), intraventricular hemorrhage (29.4%), necrotizing enterocolitis (12.0%), and periventricular leukomalacia (8.0%). Among the 1156 nonsurvivors, 90.0% of infants died during the neonatal period (≤ 28 days), and the other died after the neonatal period. A total of 768 ELBW infants died after medical care withdrawal, with economic factors and expected outcome being important causes. Conclusion The number of ELBW infants is increasing in China, and the overall survival rate is still low but is improving steadily.

[Investigation on awareness of schistosomiasis control knowledge among residents going to Africa in Taizhou City]

OBJECTIVE

To understand the awareness of schistosomiasis control knowledge among people going to Africa in Taizhou City, to provide insights into the development of control measures for imported schistosomiasis.

METHODS

During the period from July to October, 2019, a face-to-face questionnaire survey was conducted among people that had gone to African countries between 2015 and 2018 and return to China now, including awareness of schistosomiasis control knowledge, type of living and drinking water and contact with river and lake water.

RESULTS

A total of 573 peoples going to Africa were investigated, and 572 eligible questionnaires were recovered. Among the 572 people interviewed, senior high school and above was the predominant education level (509 people, 89.0%), labor was the predominant aim (543 people, 94.9%), and Angola (52.3%) and Algeria (15.9%) were predominant destiny countries. There were 7.2% of the interviewees hearing about African schistosomiasis, 19.8% knowing infections by contact with infested water, and 36 people with a history of contact with river and lake water. In addition, 270 interviewees used running water as drinking water and 276 used running water as living water.

CONCLUSIONS

The awareness rate of schistosomiasis control knowledge is low among people going to Africa in Taizhou City. Health education pertaining to schistosomiasis control is required to be improved among those going to Africa in Taizhou City to increase the awareness of schistosomiasis prevention and avoid parasitic infections.

[Clinical study on early loading restoration of superhydrophilic implants]

Objective: To study the clinical effect of early loading restoration a superhydrophilic implant after 1 year, so as to provide reference evidence for clinical practice. Methods: A total of 41 patients with dental defects, including 20 males and 21 females [age (52.3±13.1) years old], were enrolled in the Department of VIP, Hangzhou Dental Hospital (Pinghai Hospital) from July 2017 to January 2019. A total of 74 superhydrophilic implants were implanted, including 27 maxillary implants and 47 mandiolar implants. All patients without bone augmentation or soft tissue transplantation, the maxilla was taken impression 4 weeks after implant implantation, with 6 weeks of loading, the mandible was taken impression 2 weeks after implant implantation, with 4 weeks of loading. The stability of the implant was measured by resonance frequency analyzer before implant implantation, impression and loading. Periapical radiograph were taken immediately after mold removal, immediately after loading and reexamination 1 year after loading, to measure and record the changes in the bone level of the mesial and distal margins of the implant. Results: No biological complications occurred in all implants before loading restoration, and the implant survival rate was 100%(74/74). In 2 cases, the implant stability quotient (ISQ) value of the implant at the mandibular site was lower than 65 at 2 weeks after surgery, and the restoration was delayed. The ISQ values of the other 72 implants at the time of implantation (75.22±4.32) were not significantly different from those at the time of modeling (75.13±4.23) (P>0.05), but the ISQ values at the moment of weight loading (76.46±3.73) were significantly higher than those at modeling (P<0.05). All the early loading implants were reviewed 1 year after early loading, and none of them were loose or fell off, and the implant survival rate was 100%(72/72). X-ray measurement and evaluation showed that after 1 year of early loading restoration, the mean marginal bone absorption of 72 implants was (0.18±0.06) mm, among which the mandibular was (0.17±0.06) mm and the maxillary was (0.19±0.06) mm, showing no statistical difference (P>0.05). After 1 year of early loading restoration, the mean marginal bone absorption of 72 implants was (0.17±0.05) mm, including (0.17±0.06) mm for mandibular and (0.16±0.05) mm for maxillary, showing no statistical difference (P>0.05). Conclusions: In the limited scope of this clinical study, it has been proved that early loading of superhydrophilic implant is a safe and feasible treatment scheme, and the bone resorption at the implant edge after long-term early loading restoration needs further follow-up study.

[Alveolar capillary dysplasia with misalignment of the pulmonary veins: a case report and literature review]

Objective: To investigate the clinical, pathological and genetic characteristics of neonatal alveolar capillary dysplasia with misalignment of the pulmonary veins (ACDMPV). Methods: The clinical manifestations, radiographic examinations, pathology and parental genetic analysis of a newborn with FOXF1 variation induced ACDMPV, who was hospitalized in the Department of Neonatology of Shenzhen Children's Hospital in January 2020, were extracted and analyzed. Related literature up to March 2020 with the key words of "Alveolar capillaries dysplasia" "Alveolar capillary dysplasia with misalignment of the pulmonary veins" "FOXF1" in PubMed, CNKI, Wanfang, CQVIP database and Leiden Open Variation database (LOVD) were searched. Results: A full-term male newborn （1 hour of age） was admitted due to anal atresia. Surgical repair of anal atresia and omphalocele was performed on the first day of life, and gallbladder absence and Meckel's diverticulum were identified during the operation. Respiratory distress with hypoxemia developed at about 6 hours of life, and persistent pulmonary hypertension developed and progressed after surgery, with poor response to mechanical ventilation and pulmonary vasodilators. This infant passed away at 26 days of life. Lung biopsy showed decreased alveolar units and thickened interalveolar septa, reduced alveolar capillary density and thickened walls of peripheral pulmonary arteries, and misaligned pulmonary veins adjacent to the pulmonary arterioles, which were consistent with ACDMPV. The whole exome sequencing revealed a heterozygous novel frameshift of FOXF1 gene located in chromosome 16q24.1 c376_377insT; p.(Pro126fs). According to the bioinformatics analysis, this variation was likely to be pathogenic as it was associated with coding disorder of FOXF1 Pro126, resulting in truncation of the encoded protein. This novel variation had not been reported in the human gene mutation database (HGMD), ESP6500siv2_ALL, 1000g2015aug_ALL or dbSNP147 database. Previous 6 literatures reported 54 variants, including 28 missense, 10 nonsense, 11 frameshift, 2 deletion, 1 synonymous, and 2 extensions. Only three of the reported 45 cases （24 males, 21 females） were still alive as of the time of this study. Conclusions: Typically, ACDMPV is a catastrophic disease in neonatal period with high mortality. Lung biopsy and genetic testing should be considered in infants who present with persistent pulmonary hypertension and refractory hypoxemia, especially when combined with extrapulmonary abnormalities.

Potential Motor Benefits of Visual Feedback of Error Reduction for Older Adults

This study investigated how visual feedback of virtual error reduction (ER) modified the visuomotor performance of older adults with limited attentional capacity. Error structures of young and older adults during birhythmic force tracking were contrasted when the visualized error size was exact or half of the actual size. As compared with full-size error feedback, ER feedback improved the force tracking symmetry of older adults, but undermined that of young adults. Extended Poincaré analysis revealed that young adults presented greater short-term error variability (mean value of κ-lagged SD1 of the error signal) with ER feedback, which led to a smaller mean value of κ-lagged SD1 of the error signal for older adults. The ER-related task improvement of the older adults was negatively correlated with the size of the tracking errors with real error feedback and positively correlated with ER-related increases in force spectral symmetry and decreases in the mean value of κ-lagged SD1 of the error signal. ER feedback could advance visuomotor tasks for older adults who perform worse with full-size visual feedback by the enhancement of self-efficacy and stabilization of negative internal feedback.

P923Feasibility of the transcatheter mitral valve repair as the rescue therapy for patients with severe mitral regurgitation and endangered heart failure

Background

For those who carry high or prohibitive surgical risk, the transcatheter edge-to edge mitral valve repair using MitraClip has been a safe and effective treatment for severe mitral regurgitation (MR). In patients with severe MR and cardiogenic shock under hemodynamic supporting devices, emergent surgical mitral valve interventions carry extremely high risk for peri-operative morbidities and mortalities. The feasibility and efficacy of emergent MitraClip to rescue patients in critical conditions remains elucidate.

Methods

Patients with severe MR were evaluated by the heart team and those with high or prohibitive surgical risks were referred to receive MitraClip procedures. Emergent MitraClip were conducted in patients with unstable hemodynamics and under mechanical or inotropic support. The hemodynamic measures, transthoracic echocardiography, transesophageal echocardiography, and blood tests were performed before MitraClip procedures. Procedural success was defined as having mild mitral regurgitation immediately after MitraClip, and patients were free from in-hospital mortality. Clinical and echocardiographic outcomes were followed by telephones and clinics.

Results

Among 50 consecutive patients (74.7±11.2 years, 74% male), 8 emergent MitraClip procedures were conducted to rescue patients with cardiogenic shock. Extracorporeal membrane oxygenation were used in 2 patients and intra-aortic balloon pump were applied in 4 patients (50%). The rest of 4 patients received continuous inotropic agent administration. Compare to those who underwent elective procedures, patients underwent emergent MitraClip had higher surgical risk profile (Euroscore II 34.8% vs 5.1% and STS score 19.7% vs 5.1%), poorer renal function and higher right atrial pressure. There was no peri-procedural death, myocardial infarction, stroke or any adverse events requiring emergent cardiac surgery in both groups. Mild mitral regurgitation was achieved in 87.5% patients from the emergent group and 95.2% patients in the elective group (P=0.514). In follow up, there were 5 deaths (three in the emergent group), including 2 non-cardiovascular deaths. The Kaplan-Meier analysis showed patients who underwent emergent procedures have poorer long-term survival rate as compare to those who received elective procedures. (P value = 0.008).

Conclusions

When open-heart surgery is not feasible and deferred due to excessive risk, trans-catheter mitral valve repair is an alternative way to rescue patients in cardiogenic shock status. The emergent MitraClip procedure may provide comparable safety and efficacy in treating patients with severe MR and unstable hemodynamics.

[The prognostic value of the international prognostic index, the national comprehensive cancer network IPI and the age-adjusted IPI in diffuse large B cell lymphoma]

Objective: To explore the prognostic value of the international prognostic index (IPI), the national comprehensive cancer network IPI(NCCN-IPI)and the age-adjusted IPI (aa-IPI) in diffuse large B cell lymphoma. Methods: A total of 311 patients with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2003 to 2012 in Nanfang hospital were included. All patients were divided into CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) and R-CHOP (rituximab, CHOP) groups. Survival analysis was compared among IPI, NCCN-IPI and aa-IPI models. Discrimination of three different prognostic models was assessed using the Harrell's C statistic. Results: A total of 311 patients were analyzed. Among them, 128 patients were treated with CHOP regimen and other 183 patients were treated with R-CHOP regimen. In CHOP groups, both NCCN-IPI (5-year OS: 59.7% vs 26.8%, P<0.001) and aa-IPI (5-year OS: 71.0% vs 25.0%, P<0.001) showed better risk stratification for low-intermediate and high-intermediate group than the IPI (5-year OS: 47.6% vs 36.6%, P=0.003). However, in the patients treated with R-CHOP, NCCN-IPI showed better risk stratification in low, low-intermediate, high-intermediate groups (5-year OS: 96.0% vs 83.0% vs 66.5%, P=0.009). According to the Harrell's C statistic, C-index of IPI, NCCN-IPI and aa-IPI for overall survival (OS) were 0.546, 0.667, 0.698 in CHOP group and 0.611,0.654, 0.695 in R-CHOP group respectively. In patients younger than 60 years old, C-index of IPI, NCCN-IPI and aa-IPI for OS were 0.534, 0.675, 0.698 in CHOP group and 0.584, 0.648, 0.695 in R-CHOP respectively. Conclusion: The NCCN-IPI is more powerful than IPI and aa-IPI in DLBCL patients receiving R-CHOP. aa-IPI is a preferable model in predicting prognosis than IPI and NCCN-IPI in anthracycline-based chemotherapy without rituximab.

High-risk human papilloma virus infection and cervical neoplasm in female inflammatory bowel disease patients: a cross-sectional study

Background and aim

This cross-sectional study investigated the prevalence and risk factors of high-risk human papilloma virus (HPV) infection, especially types 16 and 18, and cervical neoplasia in female Inflammatory bowel disease (IBD) patients.

Methods

From July 2014 to January 2017, sexually active, female, Chinese IBD patients (21–60 years) and age-matched controls underwent cervical ThinPrep cytology testing (TCT) and high-risk HPV-DNA detection, and completed questionnaires about awareness of cervical cancer and HPV. Cervical dysplasia was categorized as cervical intraepithelial neoplasia (CIN) 1, 2 and 3.

Results

Of 124 IBD patients (30 ulcerative colitis and 94 Crohn’s disease), 17 (13.7%) had high-risk HPV among whom 9 (7.3%) had HPV 16/18 infection and 4 (3.2%) had cervical CIN (3 CIN 3, 1 CIN 1) by pathology. Among 372 controls, 33 (8.9%) had high-risk HPV and only 1 (0.3%) had HPV 16 infection. Cervical TCT detected atypical squamous cells of unknown significance in one control; no control had CIN. The HPV 16/18 infection rate and CIN prevalence were significantly higher in IBD patients than controls (both P < 0.001). The HPV-infection rate was higher in patients administered methotrexate [P = 0.005, odds ratio (95% confidence interval) 4.76 (1.471–15.402)] or more than two immunosuppressants [P = 0.013, odds ratio (95% confidence interval) 3.64 (1.255–10.562)]. Thiopurine, steroid, infliximab and disease behavior/location were not associated with HPV infection. Only 29.3% of patients had undergone cervical-cancer screening. Awareness of HPV infection and HPV-related cervical cancer was poor (28.2%).

Conclusions

Female IBD patients are at increased risk of high-risk HPV infection and cervical neoplasia, which may be associated with immunosuppressants. Education and routine follow-up with HPV-DNA testing and TCT are recommended, especially in female Chinese IBD patients.

[Clinical value of droplet digital PCR in rapid diagnosis of invasive fungal infection in neonates]

OBJECTIVE

To evaluate the clinical value of droplet digital PCR (ddPCR) in rapid and accurate diagnosis of invasive fungal infection (IFI) in neonates.

METHODS

The highly conserved sequence of fungi 18S RNA was selected as the target sequence, and primers were designed to establish a ddPCR fungal detection system. Blood samples were collected from 83 neonates with high-risk factors for IFI and/or related clinical symptoms in the neonatal intensive care unit (NICU) of a hospital in Shenzhen, China. Blood culture and ddPCR were used for fungal detection.

RESULTS

The ddPCR fungal detection system had a specificity of 100% and a sensitivity of 3.2 copies/μL, and had a good reproducibility. Among the 22 blood samples from neonates with a confirmed or clinical diagnosis of IFI, 19 were detected positive by ddPCR. Among the 61 blood samples from neonates who were suspected of IFI or had no IFI, 2 were detected positive by ddPCR.

CONCLUSIONS

The ddPCR technique can be used for the detection of neonatal IFI and is a promising tool for the screening and even diagnosis of neonatal IFI.

[Effects of Yinzhihuang oral liquid and Lonicera japonica extract on hemolysis and hyperbilirubinemia in rats with glucose-6-phosphate dehydrogenase deficiency]

OBJECTIVE

To investigate the effects of different doses of Yinzhihuang oral liquid and different concentrations of Lonicera japonica extract on hemolysis and hyperbilirubinemia in rats with glucose-6-phosphate dehydrogenase (G6PD) deficiency.

METHODS

Male Wistar rats were randomly divided into 10 groups (n=10 each): normal control group (untreated), negative control group (saline-treated), positive control group (primaquine-treated), low-, medium- and high-dose Yinzhihuang oral liquid groups (13.4, 26.8, and 53.6 mL/kg, respectively), and low-, medium-, high-, and very-high-concentration Lonicera japonica groups (6.7 mL/kg administered, containing 8, 40, 80, and 160 mg/mL Lonicera japonica extract, respectively). A rat model of acetylphenylhydrazine-induced G6PD deficiency was established in all groups except the normal control group, as confirmed by the morphological changes in erythrocytes observed using Wright's stain. After treatment, routine blood and biochemical tests were conducted to measure hemolytic indices, as well as changes in total and indirect bilirubin levels.

RESULTS

Rats with G6PD deficiency demonstrated irregular erythrocytes with a lighter-staining center. In the positive control group, the red blood cell count decreased, while the free hemoglobin count and the reticulocyte percentage increased, as compared with before treatment (P<0.05); in all the Yinzhihuang oral liquid groups and Lonicera japonica extract groups, all the above indices except reticulocyte percentage returned to the levels before treatment (P<0.05). Compared with the positive control group, all the Yinzhihuang oral liquid groups had significantly reduced total and indirect bilirubin levels (P<0.05), and all the Lonicera japonica group had significantly reduced indirect bilirubin levels (P<0.05). However, the total bilirubin level was significantly higher in the Lonicera japonica groups than in the Yinzhihuang oral liquid groups (P<0.05). The low-dose Yinzhihuang oral liquid group demonstrated a significantly greater decrease in total bilirubin level than the medium- and high-dose Yinzhihuang oral liquid group (P<0.05).

CONCLUSIONS

Administration of high-dose Yinzhihuang oral liquid and different concentrations of Lonicera Japonica extract do not cause hemolysis in rats with G6PD deficiency. Yinzhihuang oral liquid is more effective in treating hyperbilirubinemia than Lonicera Japonica extract. However, the efficacy of Yinzhihuang oral liquid may not be dose-dependent.

Metagenomic analysis of oral microbiome in young children aged 6-8 years living in a rural isolated Chinese province

BACKGROUND

The mixed dentition is an important transition period from primary teeth to permanent teeth. However, the caries prevalence of first permanent molar in mixed dentitions was about 30%, which almost represent the caries rate of permanent teeth in this period of time. Therefore, we assessed the oral bacterial profiles in young children (age 6-8) with mixed dentition with or without first molar caries for providing the research basis of caries etiology.

METHODS

We collected samples of supragingival plaque and saliva from the children living in Guizhou, a rural isolated province in China. Then, we performed DNA extraction and purification followed by 454 pyrosequencing of the V1-V3 hypervariable regions of the 16S rRNA and compared our results with those of previous research.

RESULTS

(i) We analyzed 48,320 unique sequences that represented 18 phyla, 29 classes, 44 orders, 74 families, 129 genera, 15,003 species-level OUT in plaque and saliva samples; (ii) longitudinally, there was the "healthy core microbiome" between healthy deciduous dentition and early mixed dentition, for example, Neisseria, Porphyromonas, Selenomonas etc.; (iii) horizontally, there also existed the "healthy core microbiome" in early mixed dentition, for example, Neisseria, Streptococcus, Prevotella etc.; (iv) the dominant bacteria detected by Lefse in caries group including Actinomycetaceae, Streptobacillus (p < 0.05) and those in caries-free group including Gammaproteobacteria, Pasteurellaceae, Aggregatibacter, Chloroflexi, (p < 0.05).

CONCLUSIONS

The oral cavity is a highly heterogeneous ecosystem with the "healthy core microbiome" in children, although microbial composition shifts along with aging. In addition, the abundance and diversity of microbiota vary between caries and caries-free groups verify the ecological plaque hypothesis.

[Effect of rhubarb on neonatal rats with bronchopulmonary dysplasia induced by hyperoxia]

OBJECTIVE

To study the effect of rhubarb on neonatal rats with bronchopulmonary dysplasia (BPD) induced by hyperoxia.

METHODS

A total of 64 rats (postnatal day 4) were randomly divided into four groups: air control, rhubarb control, hyperoxia model, and hyperoxia+rhubarb (n=16 each). The rats in the hyperoxia model and hyperoxia+rhubarb groups were exposed to hyperoxia (60% O2) to establish a BPD model. The rats in the rhubarb control and hyperoxia+rhubarb groups were given rhubarb extract suspension (600 mg/kg) by gavage daily. The pathological changes of lung tissue were evaluated by hematoxylin-eosin staining on postnatal days 14 and 21. The content of malondialdehyde (MDA) and the activity of superoxide dismutase (SOD) were measured by spectrophotometry. The mRNA and protein expression levels of tumor necrosis factor-alpha (TNF-&alpha;) and interleukin-6 (IL-6) were determined by RT-PCR and Western blot respectively.

RESULTS

The hyperoxia model group showed reduced alveolar number, increased alveolar volume, and simplified alveolar structure, which worsened over the time of exposure to hyperoxia. These pathological changes were significantly reduced in the hyperoxia+rhubarb group. On postnatal days 14 and 21, compared with the air control and rhubarb control groups, the hyperoxia model group had significantly reduced radical alveolar count (RAC), significantly reduced activity of SOD in the lung tissue, and significantly increased content of MDA and mRNA and protein expression levels of TNF-&alpha; and IL-6 (P&lt;0.05). Compared with the hyperoxia model group, the hyperoxia+rhubarb group had significantly increased RAC, significantly increased activity of SOD in the lung tissue, and significantly reduced content of MDA and mRNA and protein expression levels of TNF-&alpha; and IL-6 (P&lt;0.05).

CONCLUSIONS

Rhubarb may play a protective role in rats with BPD induced by hyperoxia through inhibiting inflammatory response and oxidative stress.

Posterior Lumbar Interbody Fusion with Interspinous Fastener Provides Comparable Clinical Outcome and Fusion Rate to Pedicle Screws

OBJECTIVE

To investigate the clinical feasibility and validity of interspinous fastener (ISF) for lumbar degenerative diseases.

METHODS

From October 2013 to March 2014, a total of 46 patients suffering from lumbar degenerative diseases underwent posterior lumbar interbody fusion (PLIF) randomly augmented by ISF or pedicle screws. The clinical outcome was primarily measured by Oswestry Disability Index (ODI) score. The minimal clinical important difference (MCID) was defined as an eight-point decrease in ODI. The second clinical outcome measurement was Japanese Orthopedic Association (JOA) score. Interbody fusion rates were evaluated by lumbar plain radiograph and computed tomography (CT) scan. Complications were also compared between groups. Statistical analyses were performed by SPSS version 13.0. Sample size calculation was performed before the study. The type I error α was set at 0.05 and the type II error β at 0.1. Based on these assumptions and adding 10% for possible drop-outs, sample size calculations indicated that a total of 46 patients were required for the study. Parametric data was compared by independent t-test and categorical variables were compared using χ² -tests or Fisher exact tests depending on the sample size. A P-value of less than 0.05 was considered significantly statistically different. Fleiss kappa coefficients were calculated for intra-observer and inter-observer reliability.

RESULTS

A total of 43 patients completed the follow-up, with 22 cases in the ISF group and 21 patients in the pedicle screws group, respectively. Less intraoperative blood loss and shorter operation time were observed in the ISF group. The mean ODI significantly declined in both groups, with the ISF group's decreasing from preoperative 43.3 ± 8.2 to 21.4 ± 3.5 at 24-month follow-up and the pedicle screws group's decreasing from preoperative 42.9 ± 7.9 to 22.5 ±3.8 at 24-month follow-up, respectively. The ODI changes between groups had no statistical difference (P > 0.05). Of the 43 patients, 33 patients achieved an MCID. The bone fusion rate was 77.3% according to X-rays and 68.2% according to CT scans in the ISF group, and 81.0% according to X-rays and 76.2% according to CT scans in the pedicle screws group at the final follow-up. The intra-observer and inter-observer reliability assessed by the kappa value were 0.93 and 0.89, respectively. One patient in the pedicle screws group demonstrated screw loosening at the 6-month follow-up but was asymptomatic. One patient with spondylolisthesis in the ISF group demonstrated cage subsidence during the follow-up but also without related symptoms.

CONCLUSION

The less invasive ISF combined with PLIF provided comparable clinical outcome and a similar bone fusion rate to pedicle screws. The ISF could potentially serve as a new alternative for lumbar degenerative diseases.

[A comparative analysis of neonatal critical illness score and score for neonatal acute physiology, perinatal extension, version II]

OBJECTIVE

To investigate the accuracy and clinical utility of neonatal critical illness score (NCIS) and score for neonatal acute physiology, perinatal extension, version II (SNAPPE-II) in predicting the "dead and abandoned" risk in critically ill neonates.

METHODS

A total of 269 critically ill neonates were divided into two groups according to their prognosis: dead/abandoned and improved/cured. The accuracy of these two scoring systems, NCIS and SNAPPE-II, in predicting the "dead and abandoned" risk was compared.

RESULTS

The dead/abandoned group had a significantly higher SNAPPE-II score than the improved/cured group (P<0.001), while there was no significant difference in the NCIS score between the two groups (P=0.091). The children who were in line with the individual indicator in the NCIS results had a significantly higher "dead and abandoned" risk than those who were not (P=0.005).

CONCLUSIONS

SNAPPE-II is more accurate in early prediction of the "dead and abandoned" risk in critically ill neonates compared with NCIS. NCIS has the ability to predict the "dead and abandoned" risk in children in line with the individual indicator.

[A comparative analysis of neonatal critical illness score and score for neonatal acute physiology, perinatal extension, version II]

OBJECTIVE

To investigate the accuracy and clinical utility of neonatal critical illness score (NCIS) and score for neonatal acute physiology, perinatal extension, version II (SNAPPE-II) in predicting the "dead and abandoned" risk in critically ill neonates.

METHODS

A total of 269 critically ill neonates were divided into two groups according to their prognosis: dead/abandoned and improved/cured. The accuracy of these two scoring systems, NCIS and SNAPPE-II, in predicting the "dead and abandoned" risk was compared.

RESULTS

The dead/abandoned group had a significantly higher SNAPPE-II score than the improved/cured group (P<0.001), while there was no significant difference in the NCIS score between the two groups (P=0.091). The children who were in line with the individual indicator in the NCIS results had a significantly higher "dead and abandoned" risk than those who were not (P=0.005).

CONCLUSIONS

SNAPPE-II is more accurate in early prediction of the "dead and abandoned" risk in critically ill neonates compared with NCIS. NCIS has the ability to predict the "dead and abandoned" risk in children in line with the individual indicator.

Alterations in Neural Control of Constant Isometric Contraction with the Size of Error Feedback

Discharge patterns from a population of motor units (MUs) were estimated with multi-channel surface electromyogram and signal processing techniques to investigate parametric differences in low-frequency force fluctuations, MU discharges, and force-discharge relation during static force-tracking with varying sizes of execution error presented via visual feedback. Fourteen healthy adults produced isometric force at 10% of maximal voluntary contraction through index abduction under three visual conditions that scaled execution errors with different amplification factors. Error-augmentation feedback that used a high amplification factor (HAF) to potentiate visualized error size resulted in higher sample entropy, mean frequency, ratio of high-frequency components, and spectral dispersion of force fluctuations than those of error-reducing feedback using a low amplification factor (LAF). In the HAF condition, MUs with relatively high recruitment thresholds in the dorsal interosseous muscle exhibited a larger coefficient of variation for inter-spike intervals and a greater spectral peak of the pooled MU coherence at 13-35 Hz than did those in the LAF condition. Manipulation of the size of error feedback altered the force-discharge relation, which was characterized with non-linear approaches such as mutual information and cross sample entropy. The association of force fluctuations and global discharge trace decreased with increasing error amplification factor. Our findings provide direct neurophysiological evidence that favors motor training using error-augmentation feedback. Amplification of the visualized error size of visual feedback could enrich force gradation strategies during static force-tracking, pertaining to selective increases in the discharge variability of higher-threshold MUs that receive greater common oscillatory inputs in the β-band.

Effect of Information Service Competence and Contextual Factors on the Effectiveness of Strategic Information Systems Planning in Hospitals

Many hospitals in Taiwan have started to encounter new and fierce competition as a result of the enactment of the National Health Insurance Policy in 1995. Hospitals should strive to use information technology (IT) strategically to improve their competitive advantage and meet the dynamic challenges in this competitive environment. This study adopts the Technology-Organization-Environment framework to understand the effects of contextual factors (e.g., environmental uncertainty and information intensity) and information service competence on the effectiveness of strategic information systems planning (SISP) to improve hospital management efficiency. A field survey was conducted using questionnaires distributed to accredited hospitals that serve patients from different regions/districts and with academic teaching qualifications/capabilities. These hospitals represent approximately a quarter of all hospitals in Taiwan. The findings show that the environmental unpredictability and business competence of IS executives are negatively related to the two SISP constructs: IT participation in the hospital planning and alignment of the IT plan with the comprehensive hospital plan. In addition, the findings demonstrate that information intensity has a significantly positive relation to both aforementioned SISP constructs. Finally, both constructs justify the significant positive correlations with the use of IT in increasing competitive advantages and improving the satisfaction of customers and end users. This research intends to guide the healthcare industry in raising competitive advantages to improve the operational efficiency of hospital management in today's highly digitalized environment.

Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents

OBJECTIVES

The aim of this study is to identify factors accounting for the variation in 25-hydroxyvitamin D levels in a pediatric obese population.

PATIENTS AND METHODS

One hundred and forty-nine obese children and adolescents (BMI ≥95th percentile) were evaluated in a pediatric endocrine office. Acanthosis nigricans (AN) skin lesions were rated on a 4-point scale.

RESULTS

The 25-hydroxyvitamin D levels were significantly different between those without AN and those with any severity of AN (p=<0.001). Insulin levels were only significantly different between those with no and severe AN (p=0.007). A general linear model showed that month of visit predicted 19.0% of the variation and AN an additional 2.2%. When AN was dropped from the full model, log-transformed HOMA-IR remained insignificant (p=0.164).

CONCLUSIONS

Season of evaluation was the main determinant of 25-hydroxyvitamin D levels. Severity of AN was a stronger predictor of 25-hydroxyvitamin D level variation than the measure of insulin resistance HOMA-IR.

Increased hunger and speed of eating in obese children and adolescents

OBJECTIVES

This quality improvement program examined self-reported hunger, over-eating, and eating speed in obese and normal-weight children and adolescents prior to an interventional component.

PATIENTS AND METHODS

Food frequency questionnaires were presented to 127 obese and 42 normal-weight patients, and perceived hunger, food intake and eating speed were rated.

RESULTS

Obese patients reported significantly greater hunger than normal-weight patients (62.2% vs. 21.4%, p<0.001) and faster eating (55.7% vs. 23.3%, p<0.001). Patients reporting being "always" or "often hungry" were more than six times likely to be obese (OR=6.49, 2.86-14.73, p<0.001), while rapid speed of eating yielded a four-fold increase in likelihood of obesity (OR=4.15, 1.77-9.72, p<0.001). Hunger and speed of eating were also highly associated (p<0.001).

CONCLUSIONS

Increased hunger and eating speed were highly prevalent in these obese pediatric patients and may reflect abnormalities of satiety and satiation.

An empirical analysis of executive behaviour with hospital executive information systems in Taiwan

Existing health information systems largely only support the daily operations of a medical centre, and are unable to generate the information required by executives for decision-making. Building on past research concerning information retrieval behaviour and learning through mental models, this study examines the use of information systems by hospital executives in medical centres. It uses a structural equation model to help find ways hospital executives might use information systems more effectively. The results show that computer self-efficacy directly affects the maintenance of mental models, and that system characteristics directly impact learning styles and information retrieval behaviour. Other results include the significant impact of perceived environmental uncertainty on scan searches; information retrieval behaviour and focused searches on mental models and perceived efficiency; scan searches on mental model building; learning styles and model building on perceived efficiency; and finally the impact of mental model maintenance on perceived efficiency and effectiveness.

A simulation framework for estimating wall stress distribution of abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) rupture is believed to occur when the mechanical stress acting on the wall exceeds the strength of the wall tissue. In endovascular aneurysm repair, a stent-graft in a catheter is released at the aneurysm site to form a new blood vessel and protect the weakened AAA wall from the pulsatile pressure and, hence, possible rupture. In this paper, we propose a framework to estimate the wall stress distribution of non-stented/stented AAA based on fluid-structure interaction, which is utilized in a surgical simulation system (IRAS). The 3D geometric model of AAA is reconstructed from computed tomography angiographic (CTA) images. Based on our experiments, a combined logarithm and polynomial strain energy equation is applied to model the elastic properties of arterial wall. The blood flow is modeled as laminar, incompressible, and non-Newtonian flow by applying Navier-Stokes equation. The obtained pressure of blood flow is applied as load on the AAA meshes with and without stent-graft and the wall stress distribution is calculated by fluid-structure interaction (FSI) solver equipped in ANSYS. Experiments demonstrate that our analytical results are consistent with clinical observations.

[Levels of cytokines in peripheral blood of premature infants with chronic lung disease]

OBJECTIVE

This study examined the levels of interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor alpha (TNF-α) in peripheral blood of premature infants with chronic lung disease (CLD) in order to investigate the possible role of immunologic factors in CLD.

METHODS

Twenty-six premature infants who had been admitted to the neonatal intensive care unit for 28 days were classified into CLD (n=14) and non-CLD (control, n=12) groups. IL-1β, IL-6, IL-8 and TNF-α concentrations in peripheral blood were measured by multiplex technique (Bio-plex).

RESULTS

There were no significant differences in peripheral blood levels of IL-1β, IL-6, IL-8 and TNF-α between the two groups.

CONCLUSIONS

There are no significant changes in peripheral blood levels of IL-1β, IL-6, IL-8 and TNF-α in premature infants with CLD on the non-acute phase. Immunologic factors might not play a key role in CLD on the phase.

[Risk factors for adverse neonatal outcomes in 254 twins]

OBJECTIVE

The aim of this study was to identify the risk factors for adverse neonatal outcome in twins in order to provide a basis for the improvement of the survival and neonatal outcomes of twins.

METHODS

Data from 254 twins admitted to Nanfang Hospital of Southern Medical University From January 2005 to December 2009 were retrospectively studied. Risk factors for adverse neonatal outcomes were assessed by logistic regression analysis.

RESULTS

Of the 254 twins, 84 (33.1%) had an adverse outcome, including 10 (3.9%) neonatal deaths. Logistic regression analysis demonstrated that gestational age (≤34 weeks), cord abnormalities, meconium-stained amniotic fluid and 5-min Apgar scores (≤7) were independent risk factors for adverse neonatal outcomes (OR=4.434, 4.731, 3.424, 18.958, respectively; P=0.021, 0.001, 0.037, 0.011, respectively). Conception by assisted reproductive technology was shown as a protective factor for adverse neonatal outcomes (OR=0.389, P=0.037).

CONCLUSIONS

The twins with gestational age ≤34 weeks, cord abnormalities, meconium-stained amniotic fluid or 5-min Apgar scores (≤7) are subject to adverse neonatal outcome.

In-situ observation of transition between surface relief and wrinkling in thin film shape memory alloys

Significant surface morphology evolution between relief and wrinkling was observed on a 3.5 microm thick TiNiCu film sputter-deposited on a silicon substrate. At room temperature, variation in surface relief morphology (from separated martensite crystals embedded in amorphous matrix to fully interweaved martensite plates) was observed with slight change in film composition. The phenomenon was attributed to variations in crystallization temperatures of as-deposited amorphous films during annealing because of the compositional difference. During thermal cycling between room temperature and 100 degrees C, reversible surface morphology changes can be observed between surface relief and wrinkling patterns. The formation of the surface wrinkling is attributed to the large compressive stress in the film during high temperature post-annealing and crystallization, whereas surface relief is caused by the martensitic transformation to relieve the large tensile stress in the film. Compositional effect on this surface morphology evolution is discussed. Results also indicate that there is a critical dimension for the wrinkling to occur, and a small circular island can only relax by in-plane expansion.

Robotic system for no-scar gastrointestinal surgery

INTRODUCTION

Flexible endoscopy allows diagnostic and therapeutic interventions on the gastrointestinal (GI) tract. Simple procedures can be performed endoscopically using currently available tools. More advanced endoscopic surgical interventions are much desired and anticipated, yet they await improvements in instrumentation.

METHODS

Presented here is a master-slave robotic system designed for use with flexible endoscopy. The slave is a cable-driven flexible robotic manipulator that can be attached to an endoscope, allowing two-handed endoscopic manipulation with 9-12 degrees of freedom (DOF).

RESULTS

Feasibility has been demonstrated in a porcine intragastric model.

CONCLUSIONS

Further studies should determine whether this novel device can overcome some of the instrumentation-related challenges that have heretofore limited the development of natural orifice transluminal endoscopic surgery.

Bone growth in zebrafish fins occurs via multiple pulses of cell proliferation

Fin length in the zebrafish is achieved by the distal addition of bony segments of the correct length. Genetic and molecular data provided evidence that segment growth uses a single pulse of growth, followed by a period of stasis. Examination of cell proliferation during segment growth was predicted to expose a graphical model consistent with a single burst of cell division (e.g., constant, parabolic, or exponential decay) during the lengthening of the distal-most segment. Cell proliferation was detected either by labeling animals with bromodeoxyuridine (during S-phase) or monitoring histone3-phosphate (mitosis). Results from both methods revealed that the number of proliferating cells fluctuates in apparent pulses as a segment grows (i.e., during the growth phase). Thus, rather than segment size being the result of a single burst of proliferation, it appears that segment growth is the result of several pulses of cell division that occur approximately every 60 microns (average segment length approximately 250 microns). These results indicate that segment lengthening requires multiple pulses of cell proliferation.

Isomorphic pressures, institutional strategies, and knowledge creation in the health care sector

BACKGROUND

Health care organizations are facing surprisingly complex challenges, including new treatment and diagnostic technologies, ongoing pressures for health care institutional reform, the emergence of new organizational governance structures, and knowledge creation for the health care system. To maintain legitimacy in demanding environments, organizations tend to copy practices of similar organizations, which lead to isomorphism, and to use internal strategies to accommodate changes. A concern is that a poor fit between isomorphic pressures and internal strategies can interfere with developmental processes, such as knowledge creation.

PURPOSES

The purposes of this article are to, first, develop a set of propositions, based on institutional theory, as a theoretical framework that might explain the influence of isomorphic pressures on institutional processes through which knowledge is created within the health care sector and, second, propose that a good fit between isomorphic pressures factors and health care organizations' institutional strategic choices will enhance the health care organizations' ability to create knowledge.

METHOD

To develop a theoretical framework, we developed a set of propositions based on literature pertaining to the institutional theory perspective of isomorphic pressures and the response of health care organizations to isomorphic pressures.

FINDINGS

Institutional theory perspectives of isomorphic pressures and institutional strategies may provide a new understanding for health care organizations seeking effective knowledge creation strategies within institutional environment of health care sector.

PRACTICE IMPLICATIONS

First, the ability to identify three forces for isomorphic change is critical for managers. Second, the importance of a contingency approach by health care managers can lead to strategies tailoring to cope with uncertainties facing their organizations.

Pilot on-site tests to evaluate the permeability of infiltration gutters

This study assessed the performance and developed a simple approach for estimating infiltration capacity of two infiltration gutters by using on-site tests. Permeable-brick and redbrick infiltration gutters were constructed on-site. Water infiltrated from the surfaces of two vertical sides (NFS-2S), bottom (NFS-B), and three faces (NFS-3S) of two gutters were measured under nonflowing and steady-state conditions. Tests results from NFS-2S and NFS-3S indicate that the permeability and water depth for both gutters are linearly dependent on each other. Experimental results also indicate that, when the bottom of the gutter is clogged, the permeable-brick gutter still retains approximately 93 and 79% for redbrick gutter of their infiltration capacity for NFS-3S. On the whole, permeable-brick gutter has an advantage over redbrick gutter in stormwater infiltration. Based on these results, the permeability for different water depths and widths of these two gutters can be obtained.

[Preparation and in vitro and in vivo evaluations of topically applied capsaicin transfersomes]

AIM

To prepare capsaicin transfersomes and evaluate them in vitro and in vivo.

METHODS

Capsaicin transfersomes were prepared by high shear dispersing machine and evaluated by entrapment efficiency, release rate, in vitro skin permeation and distribution in different tissues in vivo.

RESULTS

Capsaicin transfersomes were composed of single unilamellar vesicles with an average diameter of 150.6 nm. Capsaicin entrapment efficiency increased distinctly with increasing of concentration of lecithin and entrapment efficiency is 96.7% while concentration of lecithin to 8%. Cumulative release amount of capsaicin is in direct proportion to the ethanol concentration in the receptor medium. In vitro capsaicin cumulative penetration amount showed higher levels in transfersomes than cream and suspension in rat abdominal skin. Abdominal skin cumulative penetration amount in vitro of capsaicin transfersomes in mouse was significantly higher than that from rat and men. In the same way, abdominal skin epidermal membrane cumulative penetration amount in vitro of capsaicin transfersomes was significantly higher than that from derma and full skin in human abdominal skin. The capsaicin tissue distribution of capsaicin injection by multiple celiac injections in rats is different: bone > plasma > skin > muscle. There is a similar result by multiple thigh topical application of capsaicin transfersomes: bone > skin > plasma > muscle.

CONCLUSION

Entrapment efficiency of capsaicin transfersomes reached the criterion of China Pharmacopoeia (> 80%) and capsaicin skin penetration can be increased by capsaicin transfersomes. It should be noted that the diverse characters and levels of skin may probably affect the permeating capability of capsaicin. Capsaicin tissue distribution in bone and muscle is similar and is different in plasma and skin by multiple injections and topical skin apply.

Knowledge creation in the healthcare sector: a legitimation strategy

There are two purposes of this study: 1. to examine the legitimacy-gaining model (the relationship between legitimation strategies and legitimacy) in the context of the hospital industry; 2. to explore the influence of the legitimacy-gaining model on the process through which knowledge is created within the hospital industry. This paper proposes a legitimacy-gaining model as the determinant of hospitals' knowledge-creation activities. We further suggest managerial and theoretical implications at the end of this paper.

Total Anomalous Pulmonary Venous Draining to Inferior Vena Cava

A 12-year-old girl complained of tachycardia and dyspnea after exertion but without cyanosis. Her echocardiogram showed an ASD and a widened inferior vena cava. A difference in PO2 between inferior and superior vena cava was evident. An anastomosis between left atrium and pulmonary vein, and a long oval pericardium to cover the opening of the descending vein and ASD into left atrium were performed during cardiopulmonary bypass. The patient recovered without complications.

Analysis of a Leptospira interrogans locus containing DNA replication genes and a new IS, IS1502

A region of the Leptospira interrogans serovar pomona genome encoding DNA replication genes was characterized. This region, designated the ppa-ntrC locus, includes 19 open reading frames and a new insertion sequence, IS1502. Although this locus resembles replication origins from many eubacteria, it lacks several genes common to homologous loci. Some replication-related genes were previously located near rrf, and may have been moved to that location by homologous recombination between short sequence elements common to both loci. Further analysis showed that the ppa-ntrC region has undergone substantial change during spirochete evolution. Transcription analysis using RT-PCR revealed uniquely organized polycistronic mRNAs in the ppa-ntrC locus. The dnaN and recF intergenic region of serovar pomona was different from the homologous sites of 41 L. interrogans serovars by the presence of IS1502. The distribution of IS1502 throughout pathogenic Leptospira species varies. This result suggests that IS1502 may have been recently introduced into Leptospira.