Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment

INTRODUCTION

Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment.

METHODS

This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks).

RESULTS

Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes.

CONCLUSION

This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence.

CLINICAL TRIALS

NCT05660525.

Relativistic ultrafast electron diffraction at high repetition rates

The ability to resolve the dynamics of matter on its native temporal and spatial scales constitutes a key challenge and convergent theme across chemistry, biology, and materials science. The last couple of decades have witnessed ultrafast electron diffraction (UED) emerge as one of the forefront techniques with the sensitivity to resolve atomic motions. Increasingly sophisticated UED instruments are being developed that are aimed at increasing the beam brightness in order to observe structural signatures, but so far they have been limited to low average current beams. Here, we present the technical design and capabilities of the HiRES (High Repetition-rate Electron Scattering) instrument, which blends relativistic electrons and high repetition rates to achieve orders of magnitude improvement in average beam current compared to the existing state-of-the-art instruments. The setup utilizes a novel electron source to deliver femtosecond duration electron pulses at up to MHz repetition rates for UED experiments. Instrument response function of sub-500 fs is demonstrated with < 100 fs time resolution targeted in future. We provide example cases of diffraction measurements on solid-state and gas-phase samples, including both micro- and nanodiffraction (featuring 100 nm beam size) modes, which showcase the potential of the instrument for novel UED experiments.

[Efficacy of non-surgical comprehensive treatment for locally advanced hypopharyngeal carcinoma with cervical esophagus invasion]

Objective: To analyze the treatment effects and side effects of non-surgical comprehensive treatment for locally advanced hypopharyngeal carcinoma invading cervical esophagus. Methods: A retrospective analysis was performed on sixty-six patients with locally advanced hypopharyngeal carcinoma invade the esophagus. These patients were treated in the Department of Otolaryngology, Head and Neck Surgery of Chinese People's Liberation Army General Hospital between January 2011 and May 2022, including sixty-five males and one female, aged 43-71 years. Treatment regimen consisted of induction chemotherapy and concurrent chemoradiothrapy and epidermal growth factor receptor (EGFR)-targeted therapy, three of these cases were treated with programmed cell death 1 (PD-1) immunotherapy. The Kaplan-Meier method was used for survival analysis. Side effects were evaluated with the established CTCAE (Common Terminology Criteria for Adverse Events) 5.0 criteria. The factors affecting prognosis were analyzed by Cox multivariate regression analysis. Results: Sixty-four (97.0%, 64/66) patients completed the radiotherapy and chemotherapy plan. The most common grade three side effects were radioactive oropharyngeal mucositis (89.1%, 57/64) and leukopenia (23.4%, 15/64). Five (7.8%, 5/64) patients showed grade three hoarseness; two patients (3.1%, 2/64) suffered from grade three swallowing dysfunction and required feeding tube and intravenous nutrition; the remaining patients(89.1%) retained good vocal and swallowing functions. The overall survival (OS) of all patients was 81.5% after one year, 54.0% after three years, and 39.9% after five years; the progression-free survival (PFS) was 78.3% after one year, 54.9% after three years, and 42.6% after five years; local control rate (LCR) was 80.9% after one year, 62.5% after three years, and 52.0% after five years. T4a patients showed better OS, PFS and LCR than T4b patients, with statistically significant differences (χ2=8.10, 8.27, and 6.64, respectively, all P<0.05). Cox multivariate regression analysis showed that lymph node metastasis was an independent factor affecting prognosis (χ2=10.21, P<0.05). Conclusion: Non-surgical comprehensive treatment can provide with another option of radical treatment for locally advanced hypopharyngeal carcinoma with cervical esophagus invasion, offering the patients higher rate of larynx and esophageal preservation with tolerable side effects.

The alteration of serum bile acid profile among traumatic brain injury patients: a small-scale prospective study

Traumatic brain injury is one of the major causes of morbidity and mortality worldwide. With the development of bile acids as a potential treatment, to identify the influence of traumatic brain injury on bile acid metabolism shows growing importance. This present study did a preliminary exploration of the bile acid profile alteration among traumatic brain injury patients. In total, 14 patients and 7 healthy volunteers were enrolled. The bile acid profile of the blood samples were detected by an Ultra-performance Liquid Chromatography Mass Spectrometer/Mass Spectrometer system. It was found that 6 bile acids were statistically decreased in traumatic brain injury patients comparing with healthy volunteers: glycocholic acid (median level 44.4 ng/ml vs 98.7 ng/ml, p = 0.003), taurocholic acid (median level 10.9 ng/ml vs 19.5 ng/ml, p = 0.006), glycoursodeoxycholic acid (median level 17.4 ng/ml vs 71.4 ng/ml, p = 0.001), ursodeoxycholic acid (median level <1 ng/ml vs 32.4 ng/ml, p = 0.002), taurochenodeoxycholic acid (median level <1 ng/ml vs 53.6 ng/ml, p = 0.003) and glycochenodeoxycholic acid (GCDCA, median level 160 ng/ml vs 364 ng/ml, p<0.001). In conclusion, traumatic brain injury events are able to induce bile acid metabolism alteration in plasma and might cause reduction in glycocholic, taurocholic, glycoursodeoxycholic, ursodeoxycholic, taurochenodeoxycholic and glycochenodeoxycholic acid levels.

Altered dynamic functional topology in first-episode untreated patients with schizophrenia can aid in early diagnosis

Introduction

There is a growing consensus on brain networks that it is not immutable but rather a dynamic complex system for adapting environment. The neuroimaging research studying how brain regions work collaboratively with dynamic methods had demonstrated its effectiveness in revealing the neural mechanisms of schizophrenia.

Objectives

To investigate altered dynamic brain functional topology in first-episode untreated schizophrenia patients (SZs) and establish classification models to find objective brain imaging biomarkers.

Methods

Resting-state-functional magnetic resonance data for SZs and matched healthy controls were obtained(Table1).

Power-264-template was used to extract nodes and sliding-window approach was carried out to establish functional connectivity matrices. Functional topology was assessed by eigenvector centrality(EC) and node efficiency and its time-fluctuating was evaluated with coefficient of variation(CV). Group differences of dynamic topology and correlation analysis between Positive and Negative Syndrome Scale(PANSS) scores and topology indices showing group differences, which also were used in establishing classification models, was examed.

Results

The CV of node efficiency in angular and paracingulate gyrus was larger in SZs. There are 13 nodes assigned into several brain networks displaying altered CV of EC between groups(Figure1.A). Fluctuation of EC of the node in DMN, which was lower in SZs, showed negative correlation with PANSS total scores(Figure1.B). Dynamic functional topology of above nodes was used to train classification models and demonstrated 80% and 71% accuracy for support vector classification(SVC) and random forest(RF), respectively(Figure2).

Conclusions

Dynamic functional topology illustrated a capability in identifying SZs. Aberrated dynamics of DMN relevant to severity of patient’s symptoms could reveal the reason why it contributed to classification.

Disclosure

No significant relationships.

Brain controllability and clinical relevance in schizophrenia

Introduction

Apart from the psychiatric symptoms, cognitive deficits are also the core symptoms of schizophrenia. Brain network control theory provided information on the role of a specific brain region in the cognitive control process, helping understand the neural mechanism of cognitive impairment in schizophrenia.

Objectives

To characterize the control properties of functional brain network in first-episode untreated patients with schizophrenia and the relationships between controllability and psychiatric symptoms, as well as exploring the predictive value of controllability in differentiating patients from healthy controls (HCs).

Methods

Average and modal controllability of brain networks were calculated and compared between 133 first-episode untreated patients with schizophrenia and 135 HCs. The associations between controllability and clinical symptoms were evaluated using sparse canonical correlation analysis. Support vector machine (SVM) and SVM-recursive feature elimination combined with the controllability were performed to establish the individual prediction model.

Results

Compared to HCs, the patients with schizophrenia showed increased average controllability and decreased modal controllability in dorsal anterior cingulate cortex (dACC). Brain controllability predominantly in somatomotor, default mode, and visual networks was associated with the positive symptomatology of schizophrenia. The established model could identify patients with an accuracy of 0.68. Furthermore, the most discriminative features were located in dACC, medial prefrontal lobe, precuneus and superior temporal gyrus.

Conclusions

Altered controllability in dACC may play a critical role in the neuropathological mechanisms of cognitive deficit in schizophrenia, which could drive the brain function to different states to cope with varied cognitive tasks. As symptom-related biomarkers, controllability could be also beneficial to individual prediction in schizophrenia.

Disclosure

No significant relationships.

Hidden RNA pairings counteract the "first-come, first-served" splicing principle to drive stochastic choice in Dscam1 splice variants

Drosophila melanogaster Dscam1 encodes 38,016 isoforms via mutually exclusive splicing; however, the regulatory mechanism behind this is not fully understood. Here, we found a set of hidden RNA secondary structures that balance the stochastic choice of Dscam1 splice variants (designated balancer RNA secondary structures). In vivo mutational analyses revealed the dual function of these balancer interactions in driving the stochastic choice of splice variants, through enhancement of the inclusion of distal exon 6s by cooperating with docking site–selector pairing to form a stronger multidomain pre-mRNA structure and through simultaneous repression of the inclusion of proximal exon 6s by antagonizing their docking site–selector pairings. Thus, we provide an elegant molecular model based on competition and cooperation between two sets of docking site–selector and balancer pairings, which counteracts the “first-come, first-served” principle. Our findings provide conceptual and mechanistic insight into the dynamics and functions of long-range RNA secondary structures.

Traumatic Brain Injury Induces Gastrointestinal Dysfunction and Dysbiosis of Gut Microbiota Accompanied by Alterations of Bile Acid Profile

Gastrointestinal dysfunction is a common peripheral organ complication after traumatic brain injury (TBI), yet the underlying mechanism remains unknown. TBI has been demonstrated to cause gut microbiota dysbiosis in animal models, although the impacts of gut microbiota dysbiosis on gastrointestinal dysfunction were not examined. Bile acids are key metabolites between gut microbiota and host interactions. Therefore, the aim of this study was to investigate the mechanistic links between them by detecting the alterations of gut microbiota and bile acid profile after TBI. For that, we established TBI in mice using a lateral fluid percussion injury model. Gut microbiota was examined by 16S rRNA sequencing, and bile acids were profiled by ultra-performance liquid chromatography-tandem mass spectrometry. Our results showed that TBI caused intestinal inflammation and gut barrier impairment. Alterations of gut microbiota and bile acid profile were observed. The diversity of gut microbiota experienced a time dependent change from 1 h to 7 days post-injury. Levels of bile acids in feces and plasma were decreased after TBI, and the decrease was more significant in secondary bile acids, which may contribute to intestinal inflammation. Specific bacterial taxa such as Staphylococcus and Lachnospiraceae that may contribute to the bile acid metabolic changes were identifed. In conclusion, our study suggested that TBI-induced gut microbiota dysbiosis may contribute to gastrointestinal dysfunction via altering bile acid profile. Gut microbiota may be a potential treatment target for TBI-induced gastrointestinal dysfunction.

A Retrospective Clinical Analysis of the Serum Bile Acid Alteration Caused by Traumatic Brain Injury

Traumatic brain injury (TBI) can cause damage to peripheral organ systems, such as digestive organ system, and alterations of gut microbiota in addition to brain injury. Our previous study found that TBI induced gastrointestinal dysfunction accompanied by alterations of bile acid metabolism. Bile acid and its receptors have been reported to play important roles in various neurological diseases. To further examine the changes of bile acid metabolism in TBI patients, we performed a retrospective clinical analysis. In this study, 177 patients were included, and the results showed that TBI patients had more frequent antibiotic use compared with a control group. Regression analysis identified TBI as an independent factor for reduction of serum bile acid level (B = -1.762, p = 0.006), even with antibiotic use taken into a regression model. Sub-group regression analysis of TBI patients showed that antibiotic use was negatively associated with bile acid level, while creatinine and triglyceride were positively associated with bile acid level. In conclusion, these data indicated that TBI could greatly reduce serum bile acid. This study provided preliminary but novel clinical evidence of TBI interfering with bile acid metabolism, and further studies with large sample sizes are needed to validate these findings in the future.

Intron-targeted mutagenesis reveals roles for Dscam1 RNA pairing architecture-driven splicing bias in neuronal wiring

Drosophila melanogaster Down syndrome cell adhesion molecule (Dscam1) can generate 38,016 different isoforms through largely stochastic, yet highly biased, alternative splicing. These isoforms are required for nervous functions. However, the functional significance of splicing bias remains unknown. Here, we provide evidence that Dscam1 splicing bias is required for mushroom body (MB) axonal wiring. We generate mutant flies with normal overall protein levels and an identical number but global changes in exon 4 and 9 isoform bias (DscamΔ4D^-/- and DscamΔ9D^-/-), respectively. In contrast to DscamΔ4D^-/-, DscamΔ9D^-/- exhibits remarkable MB defects, suggesting a variable domain-specific requirement for isoform bias. Importantly, changes in isoform bias cause axonal defects but do not influence the self-avoidance of axonal branches. We conclude that, in contrast to the isoform number that provides the molecular basis for neurite self-avoidance, isoform bias may play a role in MB axonal wiring by influencing non-repulsive signaling.

Therapeutic Opportunities of Interleukin-33 in the Central Nervous System

Interleukin-33 (IL-33), a member of the IL-1 cytokine family, is involved in various diseases. IL-33 exerts its effects via its heterodimeric receptor complex, which comprises suppression of tumorigenicity 2 (ST2) and the IL-1 receptor accessory protein (IL-1RAP). Increasing evidence has demonstrated that IL-33/ST2 signaling plays diverse but crucial roles in the homeostasis of the central nervous system (CNS) and the pathogenesis of CNS diseases, including neurodegenerative diseases, cerebrovascular diseases, infection, trauma, and ischemic stroke. In the current review, we focus on the functional roles and cellular signaling mechanisms of IL-33 in the CNS and evaluate the potential for diagnostic and therapeutic applications.

Contribution of Patient Care Technicians to the Prevention of External Ventricular Drain Infection: A Retrospective Study

ABSTRACT

BACKGROUND: External ventricular drains (EVDs) are commonly used in neurosurgery. Preventing EVD-related infections is important, and nursing plays a significant role in infection control. However, because of the limited number of neurosurgical nurses and heavy workload in developing countries, well-trained patient care technicians (PCTs) might be able to assist nurses under this circumstance. METHODS: This study retrospectively screened patients who underwent EVD procedures in our medical center from January 2012 to June 2018. Clinical characteristics including EVD-related infection rates of patients with or without PCTs were compared. RESULTS: We analyzed 234 patients in total. There were 26 EVD infection cases, and the overall infection rate was 11.1%. There were 122 patients who were given additional care by PCTs. They were elder (58.1 ± 13.1 vs 49.9 ± 17.0 years old, P < .001) and had lower level preoperational Glasgow Coma Scale (7.04 ± 3.66 vs 13.5 ± 2.53, P < .001) and higher intubation rate (28.7% vs 3.6%, P < .001) than those without PCTs. They also had a longer drainage duration (10.3 ± 4.97 vs 8.01 ± 4.35, P < .001) as well as more cerebrospinal fluid sampling times (2.45 ± 2.00 vs 1.75 ± 1.83, P = .006) and were kept at artificial airway status for a longer duration (10.1 ± 18.7 vs 1.93 ± 7.86, P < .001). External ventricular drain-related infection rates were similar between 2 groups (11.5% vs 10.7%, P = .853). CONCLUSION: Patient care technicians with proper training are beneficial to the prevention of EVD-related infection as a measure of improving staffing adequacy.

[Surgical treatment of primary liver cancer:a report of 10 966 cases]

Objective: To summarize the experience of surgical treatment of primary liver cancer. Methods: The clinical data of 10 966 surgically managed cases with primary liver cancer, from January 1986 to December 2019 at Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The life table method was used to calculate the survival rate and postoperative recurrence rate. Log-rank test was used to compare the survival process of different groups, and the Cox regression model was used for multivariate analysis. In addition, 2 884 cases of hepatocellular carcinoma(HCC) with more detailed follow-up data from 2009 to 2019 were selected for survival analysis. Among 2 549 patients treated with hepatectomy, there were 2 107 males and 442 females, with an age of (56.6±11.1) years (range: 20 to 86 years). Among 335 patients treated with liver transplantation, there were 292 males and 43 females, with an age of (51.0±9.7) years (range: 21 to 73 years). The outcomes of hepatectomy versus liver transplantation, anatomic versus non-anatomic hepatectomy were compared, respectively. Results: Of the 10 966 patients with primary liver cancer, 10 331 patients underwent hepatectomy and 635 patients underwent liver transplantation. Patients with liver resection were categorized into three groups: 1986－1995(712 cases), 1996－2008(3 988 cases), 2009‒2019(5 631 cases). The 5-year overall survival rate was 32.9% in the first group(1986－1995). The 5-year overall survival rate of resected primary liver cancer was 51.7% in the third group(2009-2019), among which the 5-year overal survival rates of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer were 57.4%, 26.6% and 50.6%, respectively. Further analysis was performed on 2 549 HCC patients with primary hepatectomy. The 1-, 3-, 5-, and 10-year overall survival rates were 88.1%, 71.9%, 60.0%, and 41.0%, respectively, and the perioperative mortality rate was 1.0%. Two hundred and forty-seven HCC patients underwent primary liver transplantation, with 1-, 3-, 5-, and 10-year overall survival rates of 84.0%, 64.8%, 61.9%, and 57.6%, respectively. Eighty-eight HCC patients underwent salvage liver transplantation, with the 1-, 3-, 5-, and 10-year overall survival rates of 86.8%, 65.2%, 52.5%, and 52.5%, respectively. There was no significant difference in survival rates between the two groups with liver transplantation (P>0.05). Comparing the overall survival rates and recurrence rates of primary hepatectomy (2 549 cases) with primary liver transplantation (247 cases), the 1-, 3-, 5-, and 10-year overall survival rates in patients within Milan criteria treated with hepatectomy and transplantation were 96.3%, 87.1%, 76.9%, 54.7%, and 95.4%, 79.4%, 77.4%, 71.7%, respectively (P=0.754). The 1-, 3-, 5-year recurrence rates were 16.3%, 35.9%, 47.6% and 8.1%, 11.7%, 13.9%, respectively(P<0.01). The 1-, 3-, 5-, 10-year overall survival rates in patients with no large vessels invasion beyond the Milan criteria treated with liver resection and transplantation were 87.2%, 65.9%, 53.0%, 33.0% and 87.6%, 71.8%, 71.8%, 69.3%, respectively(P=0.003); the 1-, 3-, 5-year recurrence rate were 39.2%, 57.8%, 69.7% and 29.7%, 36.7%, 36.7%, respectively (P<0.01). The 1-, 3-, 5-, and 10-year overall survival rates in patients with large vessels invasion treated with liver resection and transplantation were 62.1%, 36.1%, 22.2%, 15.0% and 62.9%, 31.8%,19.9%, 0, respectively (P=0.387); the 1-, 3-, 5-year recurrence rates were 61.5%, 74.7%, 80.8% and 59.7%, 82.9%, 87.2%, respectively(P=0.909). Independent prognostic factors for both overall survival and recurrence-free survival rates of HCC patients treated with liver resection included gender, neoadjuvant therapy, symptoms, AST, intraoperative or postoperative blood transfusion, tumor number, tumor size, cirrhosis, macrovascular invasion, microvascular invasion, and pathological differentiation. Propensity score matching analysis of 443 pairs further showed that there was no significant difference in overall survival rate between anatomical liver resection and non-anatomical liver resection(P=0.895), but the recurrence rate of non-anatomical liver resection was higher than that of anatomical liver resection(P=0.035). Conclusions: In the past decade, the overall survival rate of HCC undergoing surgical treatment is significantly higher than before. For HCC patients with good liver function reservation, surgical resection can be performed first, and salvage liver transplantation can be performed after recurrence. The effect of salvage liver transplantation is comparable to that of primary liver transplantation. As for the choice of liver resection approaches, non-anatomical resection can reserve more liver tissue and can be selected as long as the negative margin is guaranteed.

Breed difference and regulatory role of CRTC3 in porcine intramuscular adipocyte

The cAMP responsive element binding protein (CREB)-regulated transcription coactivator 3 (CRTC3) is a member of the CRTC protein family and plays an important role in energy metabolism. The aim of this study was to determine if the expression of porcine CRTC3 is related to intramuscular fat (IMF) deposition and meat quality in Heigai pigs (a local fatty breed in China) and Duroc × Landrace × Yorkshire (DLY) pigs (a lean crossbred pig widely cultured in China). In addition, the effect of ectopic expression of CRTC3 on gene expression in porcine IMF adipocytes was also examined. Our results showed that Heigai pigs had lower lean percentage, thicker back fat thickness and smaller loin muscle area than DLY pigs. Compared with DLY pigs, Heigai pigs had higher marbling scores, better meat color and higher IMF contents and triglyceride concentrations. Higher levels of oxidative metabolic enzyme and expression of the slow oxidative muscle fiber-related genes were observed in longissimus dorsi muscle and psoas major muscle (P < 0.05) from Heigai pigs. Notably, CRTC3 and adipocyte-specific marker genes were highly expressed in muscle tissues of Heigai pigs. The expression of lipolysis-related genes ATGL and HSL were lower in Heigai muscles. Moreover, forced expression of CRTC3 promoted lipid accumulation and increased the expression of PPARγ, C/EBPα, leptin and FABP4 (P < 0.05), whereas it decreased the expression of ATGL and HSL in IMF adipocytes. These results suggest that CRTC3 expression is associated with lipid accumulation and IMF deposition in pigs.

Influence of Ward Environments on External Ventricular Drain Infections: A Retrospective Risk Factor Analysis

Background: Ventriculostomy-related infection (VRI) is one of the most severe and common complications of external ventricular drains (EVD). Ward environment is closely related to hospital-acquired infection, but its role in EVD infection is unclear. For some other recognized risk factors, clinical evidence also remains complicated and undetermined. We aimed to evaluate ward environment including multi-bed accommodation and intensive care unit (ICU) stay as potential risk factors for VRI, as well as to confirm those already known factors. Methods: We reviewed EVDs retrospectively in our center between January 2012 and January 2017. Univariable and logistic regression analysis were performed to identify risk factors for EVD-related infection. Results: A total of 284 patients who underwent EVD procedure were included. Thirty-six (12.7%) developed EVD-related infection. Univariable analysis revealed that the infection group had longer intensive care unit (ICU) stay (6.81 vs. 3.65 days, p = 0.045) but multi-bed accommodation showed no statistical difference between the two groups (p = 0.404). Univariable analysis also showed VRI patients had lower pre-operational Glasgow Coma Scale (6.89 vs. 9.32, p = 0.001), longer drainage placement duration (11.4 vs. 8.30 days, p < 0.001), greater numbers of cerebrospinal fluid (CSF) sampling (3.89 vs. 1.73, p < 0.001), higher percentage of pre-operational artificial airway status (50.0% vs. 18.1%, p < 0.001), and higher percentage of intracranial hemorrhage diagnosis (88.9% vs. 73.8%, p = 0.048). Logistic regression analysis demonstrated longer post-operational ICU stay (>5 days, odds ratio [OR] = 3.21, p = 0.026) as independent risk factor for EVD-related infection. Other independent risk factors included CSF sampling counts (>3, OR = 5.14, p <0.001), EVD duration (>7 days, OR = 3.85, p = 0.028), and pre-operational artificial airway status (OR = 2.85, p = 0.038). Conclusions: Longer post-operational ICU stay, frequent CSF sampling, longer duration of EVD placement, and pre-operational intubation are independent risk factors for EVD infection. Multi-bed accommodation and bilateral EVD placement have no substantial influence on VRI risk.

Predicting the outcomes of shunt implantation in patients with post-traumatic hydrocephalus and severe conscious disturbance: a scoring system based on clinical characteristics

Post-traumatic hydrocephalus is a common complication secondary to traumatic brain injury. It can cause cerebral metabolic impairment and dysfunction. Therefore, timely treatment with shunt implantation is necessary. However, the outcomes of shunt surgery in patients with post-traumatic hydrocephalus combined with disturbance of consciousness are doubtful. The objective was to develop a predictive model that uses the information available before surgery to predict the outcome of shunt implantation in such patients. Retrospectively collected data were used to develop a clinical prediction model. The model was derived from 59 patients using logistic regression analysis, and then it was evaluated by the area under the receiver operating characteristic curve and Hosmer-Lemshow test. A validation cohort verified the model. Four independent predictors were identified: age < 50 years, mild hydrocephalus, Glasgow Coma Scale scores 9-12 at the time of injury, and time interval from trauma to shunting < 3 months. We calculated the total score and defined the patients into three groups: low-probability (0-10 points), medium-probability (11-16 points), and high-probability (17-30 points). The rates of improved outcomes in the three groups were 14.3%, 52.6%, and 94.7%, respectively (P < 0.0001). The correlative rates of the validation cohort were 21.4%, 54.5%, and 85.7%. The prognostic model showed good discrimination (area under the receiver operating characteristic curve = 0.869) and calibration (Hosmer-Lemshow test, P = 0.391). The developed predictive model can identify patients with post-traumatic hydrocephalus combined with disturbance of consciousness who can benefit from shunt implantation. Therefore, our prognostic model can predict the outcomes of patients with post-traumatic hydrocephalus and disturbance of consciousness after shunt surgery.

[Value of index of microcirculatory resistance for early prediction of periprocedural myocardial microcirculatory injury after percutaneous coronary intervention in patients with coronary heart disease]

Objective: To explore the value of index of microcirculatory resistance (IMR) for early prediction of periprocedural myocardial injury (PMI) in patients with stable angina pectoris (SAP) and acute coronary syndrome (ACS) after PCI. Methods: It was a prospective study. One hundred and sixty-four patients who had single coronary lesion were consecutively enrolled from May 2014 to December 2017 at Nanjing Hospital affiliated to Nanjing Medical University. According to clinical manifestation, patients were divided into SAP group (n=81) and ACS group (n=83). IMR was determined by thermal dilution with pressure guide wire. Basic clinical characteristics, coronary angiographic results, PCI procedural details, IMR after PCI, ΔIMR (IMR=post-PCI-IMR pre-PCI), levels of myocardial biomarkers before and after PCI were compared between the two groups. Multivariate logistic regression was used to analyze the relation of PMI with IMR and ΔIMR, and the predictive ability was evaluated by receiver operating characteristic (ROC). Results: The levels of total cholesterol and low density lipoprotein cholesterol were significantly higher in ACS group than in SAP group (P<0.05), other clinical data at baseline were similar between the two groups (P>0.05). Quantitative coronary angiography (QCA) results and PCI related data were also similar between the two groups before PCI (P>0.05). Values of mean transit time (Tmn) of intracoronary injection with room temperature saline, post-PCI IMR and ΔIMR were significantly higher in ACS group than in SAP group after PCI (P<0.05). Plasma creatine kinase isoenzyme-MB difference (ΔCK-MB) (ΔCK-MB=CK-MB post-PCI-CK-MB pre-PCI) and cardiac troponin-I (cTnI) difference (ΔcTnI=cTnI post-PCI-cTnI pre-PCI) were significantly larger in ACS group than in SAP group (P<0.05). Multivariate logistic regression analysis showed that coronary artery disease (CHD) type (SAP and ACS) (OR=1.301, 95%CI 1.083-1.562), age (OR=1.007, 95%CI 1.000-1.013), ΔIMR (OR=1.009, 95%CI 1.000-1.017) and post-PCI IMR (OR=1.008, 95%CI 1.001-1.014) were independent predictors of PMI (P<0.05). The area under the ROC curve (AUC) of ΔIMR was 0.763 to predict PMI (P<0.05), the optimum cut-off value of ΔIMR was 5.485 with 70.0% sensitivity and 77.4% specificity. ΔIMR was positively correlated with ΔcTnI (r=0.592, P<0.05). Conclusions: ΔIMR serves as an early predictor of PMI in CHD patients after PCI. As compared with SAP patients, ACS patients are more likely to develop PMI.

[KLF3 regulates the movement, migration and invasion of breast cancer cells through STAT3]

Objective: To observe the effect of KLF3 on the expression of STAT3 in breast cancer cells, and to explore the potential mechanism of KLF3 affecting the movement, migration and invasion of breast cancer cells. Methods: Firstly, the expression of STAT3 was detected by Western blot, real-time fluorescent quantitative PCR, luciferase reporter system and chromatin immunoprecipitation in breast cancer cells. Secondly, the STAT3 promoter mutant was constructed. The plasmid further confirmed the effect of KLF3 on the activity of STAT3 promoter; the cell scratching test and Transwell method were used to detect the ability of cell movement, migration and invasion. Finally, animal experiments were conducted to verify the effect of knockdown of KLF3 on tumor metastasis in animals. Results: In breast cancer cells, knockdown of KLF3 promoted STAT3 protein expression. The mRNA level of STAT3 was increased by (3.58±0.65) fold after knockdown of KLF3 in MDA-MB-231 cells, while the mRNA level of STAT3 was increased by (2.28±0.19) fold after KLF3 knockdown in MCF-7 cells (P<0.001). KLF3 boundto the promoter region of STAT3. The transcriptional activity of STAT3 increased by (2.47±0.87) fold after knockdown of KLF3 in MDA-MB-231 cells, while the transcriptional activity of STAT3 increased by (2.63±0.65) fold after KLF3 knockdown in MCF-7 cells, P<0.01. KLF3 knockdown inhibitedthe movement,migrate and invade of breast cancer cells. Based on this, silence STAT3 partially reversed the function of KLF3. Knockdown of KLF3 promotedtumor metastasis in mice. Conclusions: KLF3 knockdown can promote the transcriptional activity of STAT3, which promotes the protein expression of the latter. KLF3 can affect the movement, migration and invasion of breast cancer cells through STAT3. KLF3 may be a potential target for the treatment of metastatic breast cancer.

Investigating Alterations in Caecum Microbiota After Traumatic Brain Injury in Mice

Increasing evidence shows that the microbiota-gut-brain axis plays an important role in the pathogenesis of brain diseases. Several studies also demonstrate that traumatic brain injuries cause changes to the gut microbiota. However, mechanisms underlying the bidirectional regulation of the brain-gut axis remain unknown. Currently, few models exist for studying the changes in gut microbiota after traumatic brain injury. Therefore, the presented study combines protocols for inducing traumatic brain injury using a lateral fluid percussion device and analysis of caecum samples following injury for investigating alterations in the gut microbiome. Alterations of the gut microbiota composition after traumatic brain injury are determined using 16S-rDNA sequencing. This protocol provides an effective method for studying the relationships between enteric microorganisms and traumatic brain injury.

[Correlation between serum inflammatory cytokine levels and fibrous cap thickness of fibrofatty plaque in coronary culprit lesions]

Objective: To identify the correlation between serum inflammatory cytokine levels including high sensitive C reactive protein (hs-CRP) and lipoprotein associated phospholipase (Lp-PLA2) and the fibrous cap thickness of fibrofatty plaque in coronary culprit lesions. Methods: Clinical data of 117 patients with selective coronary artery angiography diagnosed coronary artery disease admitted to our hospital from January 2015 to January 2016 were retrospective analyzed. According to type of coronary disease, patients were divided into 3 subgroups: SAP group (containing 47 stable angina patients), UAP group (containing 52 unstable angina patients), and NSTEMI group(containing 18 acute non ST segment elevation myocardial infarction patients). Serum hs-CRP and Lp-PLA2 levels were measured before subsequent procedures. The characteristics of the culprit lesions were detected by optical coherence tomogarpgy(OCT) before interventional treatment, and the correlation between hs-CRP and Lp-PLA2 and the fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were analyzed. Results: (1) The serum levels of hs-CRP (2.13(1.04, 4.75)μg/L vs. 1.02(0.60, 1.29)μg/L and 1.30(1.03, 1.96)μg/L, all P<0.05) and Lp-PLA2 ((394.8±61.4)mg/L vs. (140.1±40.4)mg/L and (284.5±93.6)mg/L, all P<0.05) were significantly higher in NSTEMI group than in SAP group and UAP group, and serum levels of hs-CRP and Lp-PLA2 were significantly higher in UAP group than in SAP group (all P<0.05). (2)The fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were smaller in NSTEMI group and UAP group than in SAP group(50(50, 60)μm and 60(50, 90)μm vs. 130(80, 190)μm, all P<0.05), and there was no significantly difference between NSTEMI group and UAP group(P>0.05). Proportion of thin-cap fibroatheroma plaque(82.35%(14/18) vs. 19.15%(9/47) and 63.46%(33/52), all P<0.05), plaque rupture(55.56%(10/18)vs. 6.38%(3/47) and 28.85%(15/52), all P<0.05) and thrombosis(33.33%(6/18) vs. 4.26%(2/47) and 9.26%(5/52), all P<0.05) were significantly higher in NSTEMI group than in SAP group and UAP group. Proportion of calcifiacation in plaque was lower in NSTEMI group than in SAP group (11.11%(2/18)vs. 42.55%(20/47), P<0.05), and there was no significantly difference between NSTEMI group and UAP group(P>0.05). (3) Pearson correlation analysis showed that serum levels of hs-CRP(r=-0.233, P<0.05) and Lp-PLA2(r=-0.465, P<0.01)were negatively correlated with fibrous cap thickness of fibrofatty plaques. Spearman correlation analysis showed that serum levels of hs-CRP were positively correlated with plaque rupture(r=0.409, P<0.01) and thrombosis (r=0.227, P<0.05), and serum levels of Lp-PLA2 were also positively correlated with plaque rupture(r=0.499, P<0.01) and thrombosis(r=0.263, P<0.01). (4)Multiple logistic regression analysis showed that serum levels of Lp-PLA2 at baseline was independently related to thin-cap fibroatheroma plaque(OR=1.017, P<0.01). Conclusions: The serum levels of hs-CRP and Lp-PLA2 in NSTEMI patients are much higher than that in SAP and UAP patients, higher in UAP patients than in SAP patients. Prevalence of thin-cap fibroatheroma plaque, plaque rupture and thrombosis was significantly higher in the NSTEMI patients, while the prevalence of calcification in plaque is more often in SAP patients. Increased serum levels of Lp-PLA2 are independent risk factor of thin-cap fibroatheroma plaque formation.

[Characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection in young female patients]

Objective: To investigate the characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection(SCAD) in young female patients. Methods: In this casecontrolstudy,127 young(≤55 years) female patients with acute myocardial infarction onset within 1 week in Nanjing first hospital, Xuzhou central hospital, affiliated hospital of Xuzhou medical university, and Lianyungang first people's hospital were enrolled between January 2013 and February 2017,and the clinical data were retrospectively analyzed. According to their clinical manifestations and coronary angiography(CAG) results,the patients were divided into coronary atherosclerosis disease(CAD) group(CAG evidenced atherosclerosis, n=83) and SCAD group(CAG detected coronary artery dissection,n=44).The SCAD patients were subdivided into definite group (the results affirmed from intravenous ultrasound or optical coherence tomography, n=21) and probable group (the CAG results highly confirmed to characteristics of SCAD,but no intravenous ultrasound or optical coherence tomography image affirmation,n=23). Then, according to the different treatment strategies, the SCAD patients were subdivided into conservative treatment group(treated with drugs,n=19) and interventional therapy group(treated with percutaneous coronary intervention,n=25). Results: (1)Compared to CAD group, patients in the SCAD group had less risk factors, such as hypertension history (25.0% (11/44) vs. 45.8% (38/83) , P=0.022) and diabetes history (6.8% (3/44) vs. 21.7% (18/83) , P=0.043),and had lower levels of fasting blood glucose (5.34(4.59,5.87) mmol/L vs. 7.12(5.18,8.60)mmol/L, P=0.001),total cholesterol((3.94±1.14) mmol/L vs. (4.91±1.50) mmol/L, P=0.001),triglyceride(1.42 (0.91,1.64) mmol/L vs. 1.89 (1.23,2.45) mmol/L, P=0.005),and low density lipoprotein cholesterol ((2.24±0.91) mmol/L vs. (2.94±1.16) mmol/L, P=0.001),CAG results showed that patients in the SCAD group had more single vessel lesion (88.6% (39/44) vs. 39.8% (33/83) , P=0.001), and their target lesion stenosis was less severe ( (79.2±22.4) % vs. (91.5±12.1) %, P=0.001). (2) The clinical risk factors such as hypertension history, diabetes history, smoking history, family history of cardiology disease, fasting blood glucose,total cholesterol,triglyceride and low density lipoprotein cholesterol were similar between definite group and probable group (all P>0.05). CAG results showed that prevalence of single vessel lesion (100% (21/21) vs. 78.3% (18/23) , P=0.050) and percent of target lesion stenosis ( (76.9±20.6) % vs. (81.2±24.1) %, P=0.529) were similar between definite group and probable group.(3)There were no significant difference in single vessel(84.0% (21/25) vs. 94.7% (18/19) , P=0.370), target lesion stenosis(85.0(70.0,100.0)% vs. 75.0(50.0,90.0)%, P=0.186),and survival rates in hospital(96.0% (24/25) vs. 100% (19/19) , P=1.000) between interventional therapy group and conservative treatment group. Conclusions: Prevalence of SCAD is highin young female patients with acute myocardial infarction. Acute myocardial infarction patients with less risk factors of CAD and with CAG showing smooth lesion of narrowing segment and normal finding in the other vessels, are more likely to be diagnosed with SCAD.Acute myocardial infarction patients caused by SCAD have high survival rate either receiving percutaneous coronary intervention or drug treatment.

Self-reported anxiety and depression unchanged after endoscopic sinus surgery for chronic rhinosinusitis

BACKGROUND

Prior research has established that anxiety and depression, as measured by the Hospital Anxiety Depression Score (HADS), are strongly correlated with disease-specific quality of life (Rhinosinusitis Disability Index - RSDI) in chronic rhinosinusitis (CRS). We hypothesized that anxiety and depression would decrease after functional endoscopic sinus surgery (FESS), and furthermore that HADS would predict improvement in RSDI following surgery.

METHODOLOGY

The study cohort from 2014 consisted of 99 CRS patients who underwent nasal endoscopy, RSDI, and HADS evaluation. The cohort was segregated by whether or not they underwent FESS and an updated HADS was administered. For 44 surgical patients, pre- and post-operative RSDI (n=38), Lund-Kennedy (LK) (n=34) and HADS (n=18) scores were compared. Delta RSDI was compared between patients with varying levels of anxiety and depression.

RESULTS

Lund-Kennedy scores improved from 5.8 ± 4.1 to 3.2 ± 2.6 following surgery, as did total RSDI (39.3 ± 26.8 to 24.6 ± 29.2). Total HADS (9.8 ± 6.4 to 11.3 ± 7.4) and depression and anxiety subscores were unchanged. Linear regression did not reveal a correlation between HADS and change in RSDI following FESS. Delta RSDI was not significantly different between patients with varying levels of anxiety and depression.

CONCLUSIONS

Despite improvements in objective evidence of sinonasal inflammation (LK) and disease-specific quality of life (RSDI), neither depression nor anxiety improved after FESS, nor did the magnitude of psychological comorbidity predict post-operative improvement in quality of life. Improvement in RSDI was not different among patients with varying levels of anxiety and depression. Levels of depression and anxiety may be hard-wired, and therefore not influenced by changes in objective or perceived sinonasal disease burden.

Polarization of Microglia to the M2 Phenotype in a Peroxisome Proliferator-Activated Receptor Gamma-Dependent Manner Attenuates Axonal Injury Induced by Traumatic Brain Injury in Mice

Increasing evidence indicates that activated microglia play an important role in the inflammatory response following traumatic brain injury (TBI). Inhibiting M1 and stimulating M2 activated microglia have demonstrated protective effects in several animal models of central nervous system diseases. However, it is not clear whether the polarization of microglia to M2 attenuates axonal injury following TBI. In this study, we used a lateral fluid percussion injury device to induce axonal injury in mice. Mice were randomly assigned to the sham, TBI, TBI + rosiglitazone (peroxisome proliferator-activated receptor gamma [PPAR-γ] agonist), and TBI + GW9662 (PPAR-γ antagonist) groups. Axonal injury was assessed using immunohistochemical staining for beta amyloid precursor protein. The inflammatory response was assessed by enzyme-linked immunosorbent assay, microglia polarization was assessed using specific markers of M1 and M2 microglia, and neurological function was assessed using the neurological severity score. Following TBI, microglia of the M1 phenotype increased significantly, while those of the M2 phenotype decreased. Rosiglitazone-induced PPAR-γ activation promoted microglia polarization to the M2 phenotype, which reduced the inflammatory response, attenuated axonal injury in the cerebral cortex, and improved neurological function. Conversely, GW9662 inhibited the polarization of microglia to M2 and aggravated inflammation and axonal injury. Our in vitro findings in lipopolysaccharide-induced microglia were consistent with those of our in vivo experiments. In conclusion, the polarization of microglia to the M2 phenotype via PPAR-γ activation attenuated axonal injury following TBI in mice, which may be a potential therapeutic approach for TBI-induced axonal injury.

Prevalence of and risk factors for recurrence of chronic subdural hematoma

BACKGROUND

Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice with substantial recurrence rate. We aimed to estimate recurrence rate of CSDH and to identify risk factors for CSDH recurrence.

METHODS

We retrospectively studied consecutive cases with CSDH and performed surgical therapy in our hospital. Univariate and multivariate logistic regression analyses were performed to identify factors associated with recurrence of CSDH.

RESULTS

A total of 226 patients with CSDH were included; 34 patients recurred after surgery with a recurrence rate of 15.0%. Univariate analysis showed that the recurrence group had more patients with homogenous hyper-dense hematoma (20.6 vs 6.3%, p = 0.035) and shorter duration of subdural drainage post-surgery (1.2 ± 1.4 vs 1.5 ± 0.9, p = 0.022) than the non-recurrence group. Logistic regression analysis revealed that duration of subdural drainage (OR = 0.66, p = 0.05) and hyper-dense of hematoma (OR = 4.94, p = 0.012) were independent predictors for CSDH recurrence.

CONCLUSIONS

Homogenous hyper-dense of hematoma and duration of subdural drainage post-surgery were independent predictors for CSDH recurrence; longer duration of postoperative subdural drainage was associated with lower risk of recurrence.

Hyperbaric Oxygen Therapy in Liver Diseases

Hyperbaric oxygen therapy (HBOT) is an efficient therapeutic option to improve progress of lots of diseases especially hypoxia-related injuries, and has been clinically established as a wide-used therapy for patients with carbon monoxide poisoning, decompression sickness, arterial gas embolism, problematic wound, and so on. In the liver, most studies positively evaluated HBOT as a potential therapeutic option for liver transplantation, acute liver injury, nonalcoholic steatohepatitis, fibrosis and cancer, especially for hepatic artery thrombosis. This might mainly attribute to the anti-oxidation and anti-inflammation of HBOT. However, some controversies are existed, possibly due to hyperbaric oxygen toxicity. This review summarizes the current understandings of the role of HBOT in liver diseases and hepatic regeneration. Future understanding of HBOT in clinical trials and its in-depth mechanisms may contribute to the development of this novel adjuvant strategy for clinical therapy of liver diseases.

Effect of β-carotene supplementation on the expression of lipid metabolism-related genes and the deposition of back fat in beef cattle

To evaluate the effects of β-carotene (βC) supplementation on lipid metabolism in the back fat of beef cattle, 120 continental crossbred (Simmental × local Luxi yellow cattle) steers were selected randomly from feedlots and allotted to four groups. Each steer was supplemented with 0, 600, 1200, or 1800 mg/day of βC for 90 days, and then received no βC for 60 days (depletion period). The βC levels significantly increased in steers supplemented with βC (P < 0.01), and then decreased to the control level by Day 150. Back fat thickness decreased slightly with increasing βC supplementation, and significantly differed among groups after supplementation ceased (P < 0.01 on Day 120, P < 0.05 on Day 150). Significant regression relationships between βC supplement level and both βC content in back fat tissue on Day 90 and back fat thickness on Days 90, 120, and 150 were established (P < 0.01). No significant differences in the dry matter intake or average daily gain were detected, but higher net meat percentages were observed in the 1200 and 1800 mg/day βC-supplemented groups compared with the control (P < 0.05). The mRNA expression of two fat synthesis-related genes, acetyl-CoA carboxylase and fatty acid synthase, were downregulated during the supplementation period, but upregulated during the next 60 days when the steers received no βC supplementation. In contrast, the expression of two fat hydrolysis-related genes, hormone-sensitive lipase and adipose triglyceride lipase, were upregulated during the supplementation period and downregulated in the subsequent 60 days. The results showed that βC supplementation suppresses back fat deposition in beef cattle by inhibiting fat synthesis and enhancing fat hydrolysis.

[The value of urinary neutrophil gelatinase-associated lipocalin for early diagnosis of contrast-induced nephropathy]

Objective: To explore the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) for early diagnosis of contrast-induced nephropathy (CIN) in patients who underwent percutaneous coronary angiography (CAG) or percutaneous coronary intervention (PCI). Methods: From May 2015 to January 2016, 506 consecutive patients who underwent CAG or PCI in our hospital were enrolled in this prospective study. Patients were divided into CIN group (n=47) and non-CIN group (n=459). Clinical and interventional data were compared between the two groups. Spearman ranking correlation coefficient was used to define the relation between NGAL and CIN, and multivariable logistic regression analysis was performed to identif independent predictors of CIN. Receiver-operator characteristic (ROC) curve was generated, and area under the curve (AUC) was calculated and sensitivity and specificity for CIN diagnosis were analyzed. Results: (1) Basic clinical and interventional data including age, incidence of diabetes, hypertension and chronic heart failure, level of systolic blood pressure, serum creatine before procedure, use of isotonic contrast agent, contrast volume, Mehran score, operation time, treatment number of coronary artery, hydration and medication were all similar between two groups (all P>0.05). (2) Urinary NAGL level at 24 and 48 h after procedure, serum creatinine (Scr) level at 48 h after procedure, and ΔNGAL_{24-0 h} were significantly higher in CIN group than in non-CIN group (all P<0.01), but the differences of urinary NGAL level before procedure, Scr level 24 h after procedure, and ΔNGAL_{48-24 h} were similar between two groups (all P>0.05). (3)The positive correlation was found by Spearman ranking correlation between ΔNGAL_{24-0 h} and CIN (r=0.478, P<0.001). (4) Multivariable logistic regression analysis showed that estimated glomerular filtration rate(OR=1.020, 95%CI 1.005-1.035, P=0.007) and ΔNGAL_{24-0 h} (OR=1.020, 95%CI 1.014-1.027, P<0.001) were the independent predictors of CIN.(5) ROC curve showed that the AUC of NGAL with the cutoff value 4.65 was 0.899(0.854, 0.944)for diagnosis of CIN (sensitivity 93.6%, and specificity 0.944). Conclusion: The rise of urinary NGAL level at 24 and 48 hours after CAG or PCI is suggestive of CIN and could be used as a reliable parameter for the early diagnose of CIN.

Application of 3D printing technology on the treatment of complex proximal humeral fractures (Neer3-part and 4-part) in old people

PURPOSE

This study was conducted to investigate the feasibility and clinical potential of using the 3D printing technology (3DPT) versus typical strategy (thin-layer CT scan) for the treatment of complicated proximal humeral fractures (PHFs) in old people.

METHODS

Sixty-six old patients age ranging from 61 to 76 years with persistent complicated PHFs were randomly assigned to two groups as per the controlled randomization table (34 cases in the test group and 32 cases in the control group). In the test group, 3DPT was applied to build the 3D facture model of a patient, according to the data acquired from the thin-layer CT scan and subsequently processed with Mimics software. This helped to confirm the diagnosis, design the individual operation plan, simulate the surgical procedures and perform the surgery as plan. In the control group, only thin-layer CT scan was applied for the design of the operation plan prior to the surgery. Here, parameters including surgery duration, blood loss volume during surgery, the number of fluoroscopy, time to union were statistically analyzed for two groups after the operation. The screw lengths designed before the surgery and measured during the surgery were compared.

RESULTS

The 3D PHF model generated using 3DPT was able to provide the visual display and omni-directional observation of the direction and severity of the fracture dislocation, which facilitated preoperative diagnosis, operation planning and design, data measurement, preselection of internal fixator and surgical outcome simulation. According to the follow-up ranging from 12∼28 months for the 66 patients, the results showed no significant difference in time to union between the two groups (P>0.05). Apart from that, less surgery duration, less blood loss during surgery, less number of fluoroscopy can be observed compared with the control group (P<0.05).

CONCLUSIONS

In this study, 3DPT showed great clinical feasibility of the treatment of complicated PHFs. The 3D-print PHF model had the ability to clearly display the fracture and thus was useful to determine the fracture classification and the magnitude of fracture injury. It benefited surgeons to gain a better understanding of complicated PHFs, design a most suitable operation plan prior to surgery and facilitate the doctor-patient communication. This therefore enabled the reduction of intraoperative injury and the optimization of surgical outcomes.

Intraventricular intracranial pressure monitoring improves the outcome of older adults with severe traumatic brain injury: an observational, prospective study

BACKGROUND

Intracranial pressure (ICP) monitoring is widely used in the management of patients with severe traumatic brain injury (TBI). However, there is limited evidence about the efficacy of ICP monitoring in older subjects (aged ≥65 years). This study evaluated the effect of intraventricular ICP monitoring on the outcome of older adults suffering from a severe TBI.

METHODS

This prospective, observational study included 166 older TBI patients (aged ≥65 years) with Glasgow Coma scale (GCS) scores lower than 9 at admission. The study cohort was divided into two groups, intraventricular ICP monitoring and non-ICP monitoring. The primary outcome was in-hospital mortality. The secondary outcomes included the Glasgow Outcome Scale (GOS) score 6 months after injury, the ICU and total hospital lengths of stay, and mechanical ventilation days.

RESULTS

There were 80 patients in the intraventricular ICP monitoring group and 86 patients in non-ICP monitoring group. There was no statistical difference between groups in demographics and severity of head injury. Patients treated with intraventricular ICP monitoring had lower in-hospital mortality (33.8 % vs 51.2 %, P < 0.05), a higher 6-month GOS score (3.0 ± 1.4 vs 2.5 ± 1.2 P < 0.05), and a lower dosage (514 ± 246 g vs 840 ± 323 g, P < 0.0001) and shorter duration (7.2 ± 3.6 days vs 8.4 ± 4.3 days, P < 0.01) of mannitol use. However, the ICU length of stay (14.3 ± 6.4 days vs 11.6 ± 5.8 days, P < 0.01) and mechanical ventilation days (6.7 ± 3.5 days vs 5.6 ± 2.4 days, P < 0.05) were longer in the ICP monitoring group. The total length of hospital stay did not differ between the two groups (28.5 ± 12.1 days vs 26.1 ± 13.5 days, P = 0.23).

CONCLUSIONS

Intraventricular ICP monitoring may have beneficial effects on the decreased in-hospital mortality and improved 6-month outcome of older patients with severe TBI. However, given that this was an observational study conducted in a single institution, further well-designed randomized control trials are needed to evaluate the effect of intraventricular ICP monitoring on the outcome of older severe TBI patients.

Variants in mitochondrial tRNA gene may not be associated with thyroid carcinoma

Thyroid cancer is a very common form of endocrine system malignancy. To date, the molecular mechanism underlying thyroid cancer remains poorly understood. Studies of oncocytic tumors have led to a hypothesis which proposes that defects in oxidative phosphorylation (OX- PHOS) may result in a compensatory increase in mitochondrial replication and gene expression. As a result, mitochondrial DNA (mtDNA) mutation analysis has become a useful tool to explore the molecular basis of this disease. Among these mutations, mitochondrial transfer RNAs (mttRNAs) are the hot spots for pathogenic mutations associated with thyroid cancer. However, due to its high mutation rate, the role of mt-tRNA variants in thyroid cancer is still controversial. To address this problem, in this study, we reassessed seven reported mt-tRNA variants: tRNA^Asp G7521A, tRNA^Arg T10411C and T10463C, tRNA^Leu(CUN) A12308G, tRNA^Ile G4292C and C4312T, and tRNA^Ala T5655C, in clinical manifestations of thyroid cancer. We first performed the phylogenetic conservation analysis for these variants; moreover, we used a bioinformatic tool to compare the minimum free energy (G) of mt-tRNA with and without mutations. Most strikingly, none of these variants caused the significant change of the G between the wild-type and the mutant form, suggesting that they may not play an important roles in thyroid cancer. In addition, we screened the frequency of the “pathogenic” A12308G alternation in 300 patients with thyroid cancer and 200 healthy controls. We found that there were five patients and three control subjects carrying this variant. It seemed that the A12308G variant may be a common polymorphism in the human population. Taken together, our study indicated that variants in mt-tRNA genes may not play active roles in patients with thyroid cancer.

Substitution of Wheat for Corn in Beef Cattle Diets: Digestibility, Digestive Enzyme Activities, Serum Metabolite Contents and Ruminal Fermentation

The objective of this study was to evaluate the effect of diets containing different amounts of wheat, as a partial or whole substitute for corn, on digestibility, digestive enzyme activities, serum metabolite contents and ruminal fermentation in beef cattle. Four Limousin×LuXi crossbred cattle with a body weight (400±10 kg), fitted with permanent ruminal, proximal duodenal and terminal ileal cannulas, were used in a 4×4 Latin square design with four treatments: Control (100% corn), 33% wheat (33% substitution for corn), 67% wheat (67% substitution for corn), and 100% wheat (100% substitution for corn) on a dry matter basis. The results showed that replacing corn with increasing amounts of wheat increased the apparent digestibility values of dry matter, organic matter, and crude protein (p<0.05). While the apparent digestibility of acid detergent fiber and neutral detergent fiber were lower with increasing amounts of wheat. Digestive enzyme activities of lipase, protease and amylase in the duodenum were higher with increasing wheat amounts (p<0.05), and showed similar results to those for the enzymes in the ileum except for amylase. Increased substitution of wheat for corn increased the serum alanine aminotransferase concentration (p<0.05). Ruminal pH was not different between those given only corn and those given 33% wheat. Increasing the substitution of wheat for corn increased the molar proportion of acetate and tended to increase the acetate-to-propionate ratio. Cattle fed 100% wheat tended to have the lowest ruminal NH₃-N concentration compared with control (p<0.05), whereas no differences were observed among the cattle fed 33% and 67% wheat. These findings indicate that wheat can be effectively used to replace corn in moderate amounts to meet the energy and fiber requirements of beef cattle.

Mitochondrial ND3 G10398A mutation: a biomarker for breast cancer

Mitochondrial DNA mutations have been found to play important roles in carcinogenesis. The most common G10398A mutation, a non-conservative amino acid substitution from Thr to Ala, seems to be involved in the tumorigenesis of breast cancer. Results from studies concerning this mutation remain inconclusive. In the current study, we first took clinical and molecular datasets from case-control studies to determine the association between the G10398A mutation and breast cancer. We further used the Phylotree to determine the haplogroups of this mutation. The frequencies of this mutation in 500 unrelated healthy controls were also screened. We found that this mutation is very common in the human population, and may be a polymorph.

Treatment of tibia avulsion fracture of posterior cruciate ligament with high-strength suture fixation under arthroscopy

Aim

To evaluate the outcome of arthroscopy treatment using high-strength line in the treatment of tibial avulsion fracture of posterior cruciate ligament.

Methods

Both the avulsed bone block and the tibia bone bed were refreshed. The procedure was completed with the assistance of PCL director drill guide. The reduction and fixation using high-strength line were used to fix the avulsed bone by from posterior middle portal. Rehabilitation began early postoperatively.

Results

From January 2010 to June 2012, a total of 18 arthroscopically treated cases of PCL tibial avulsion fracture were retrospectively evaluated. Reduction of the avulsion fragment was obtained in all cases. 16 cases were followed up for 7–30 months (average 13.6), and 2 cases were out of follow-up. In the 16 followed patients, flexion and extension were back to normal within 6 weeks, and return to normal walk in 12 weeks. The bone healing was good without any vascular or nerve complications. All the patients regained the preinjury activity level. The mean score (and standard deviation) increased from 38.9 ± 4.9 points to 95.2 ± 3.8 points with the system of Lysholm, from 57.1 ± 10.3 points to 94.3 ± 4.4 points with the system of IKDC. Post-test displacement of KT3000 declined from 3.6 ± 0.39 to 1.1 ± 0.27 mm.

Conclusion

Arthroscopic vertical fixation by high-strength line is a simple, safe, reliable, and micro-invasive treatment to PCL tibial avulsion fracture. It is a kind of real all arthroscopic technique, and good for early postoperative rehabilitation. The total stability of the knee could be gained, and the second operation to remove the internal fixation is avoided.

Effects of Three Feeding Systems on Production Performance, Rumen Fermentation and Rumen Digesta Particle Structure of Beef Cattle

The effects of three different feeding systems on beef cattle production performance, rumen fermentation, and rumen digesta particle structure were investigated by using 18 Limousin (steers) with a similar body weight (575±10 kg) in a 80-d experiment. The animals were equally and randomly divided into three treatment groups, namely, total mixed ration group (cattle fed TMR), SI1 group (cattle fed concentrate firstly then roughage), and SI2 group (cattle fed roughage firstly then concentrate). The results showed that the average daily gain was significantly higher in cattle receiving TMR than in those receiving SI1 and SI2 (p<0.05). Consumption per kg weight gain of concentrate, silage, and combined net energy (NEmf) were significantly decreased when cattle received TMR, unlike when they received SI1 and SI2 (p<0.05), indicating that the feed efficiency of TMR was the highest. Blood urea nitrogen (BUN) was significantly decreased when cattle received TMR compared with that in cattle receiving SI1 (p<0.05), whereas there was no difference compared with that in cattle receiving SI2. Ammonia nitrogen concentration was significantly lower in cattle receiving TMR than in those receiving SI1 and SI2 (p<0.05). The rumen area of cattle that received TMR was significantly larger than that of cattle receiving SI1 (p<0.05), but there was no difference compared with that of cattle receiving SI2. Although there was no significant difference among the three feeding systems in rumen digesta particle distribution, the TMR group trended to have fewer large- and medium-sized particles and more small-sized particles than those in the SI1 and SI2 groups. In conclusion, cattle with dietary TMR showed increased weight gain and ruminal development and decreased BUN. This indicated that TMR feeding was more conducive toward improving the production performance and rumen fermentation of beef cattle.

Feasibility of a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent in patients with complex anatomical and clinical scenarios

AIM

We aimed to investigate the feasibility, initial safety and efficacy of coronary intervention using FIREHAWK®, a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent (SES), in patients with complex anatomical and clinical scenarios.

METHODS

A total of 57 patients (79 lesions) with complex anatomical and clinical scenarios implanted with the FIREHAWK® SES between March and November 2014 were studied. The primary endpoint was target lesion failure (TLF), a composite endpoint of cardiac death, target vessel-myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (iTLR). Optical coherence tomography and intravascular ultrasound was performed according to the discretion of operators.

RESULTS

28.1% of patients presented acute myocardial infarction and all patients had at least one of the following anatomical and locational complexity: multi-vessel disease (64.9%), left main disease (24.6%), chronic total occlusion (17.5%), bifurcation (56.1%), and heavily calcified lesions (10.5%). One patients experienced coronary perforation during the procedure and resolved without any additional treatment. Device success was 100%, clinical success was 100%. There was 1 (1.8%) TLF occurred at follow-up of 150 ± 65 days. One patients had non-iTLR. Out of 2 non-Q-wave MI, 1 patient experienced TV-MI, but no death and stent thrombosis were reported. OCT and IVUS imaging showed a high rate of covered struts and low neointimal hyperplasia at follow-up.

CONCLUSION

The study showed the feasibility, initial safety and efficacy of coronary intervention using FIREHAWK® SES for treating patients with complex anatomical and clinical scenarios. The performance of the FIREHAWK® SES in complex patients justifies the conduct of a large, randomized trial.

Transcriptome profiling of muscle by RNA-Seq reveals significant differences in digital gene expression profiling between Angus and Luxi cattle

The development of massively parallel sequencing technologies enables the sequencing of total cDNA to identify unigene expression and to discover novel regions of transcription. Here, we report the first use of RNA sequencing (RNA-Seq) to find the digital gene expression profiles (DGEs) associated with the growth and development of muscle in Chinese Luxi and Angus beef cattle. More than 9 243 921 clean reads were found in samples of muscle tissue. We found 232 DGEs between Luxi cattle and Angus cattle (false discovery ratio ≤0.001 and |log2 ratio| ≥1). Among the DGEs, we determined that 147 genes were downregulated and 85 genes were upregulated. Gene Ontology and KEGG Pathway analyses were performed to analyse the biological role of the DGEs and determine their contribution to the differences seen in muscle growth and development between local Chinese Luxi cattle and the introduced Angus cattle. The results suggest that RNA-Seq is a useful tool for predicting differences in gene expression between Luxi and Angus beef cattle; moreover, our results provides unprecedented resolution of mRNAs that are expressed across the two breeds.

How accurate is the electronic health record? - a pilot study evaluating information accuracy in a primary care setting

BACKGROUND

Electronic health records (EHR) are increasingly used for both administrative and clinical tasks with major implications for patient safety and quality of care. This study aims to determine a baseline EHR level of accuracy present on measurable information fields within an Australian general practice.

METHODS

Quantitative and descriptive pilot study of patients attending a private general practice. Patients who consented to participate in the study had their patient records reviewed to determine how many items were correct, incorrect or not recorded in each EHR information field. Statistical analysis was performed on the data collected.

RESULTS

A total of 33 patients gave consent to participate in this study. High levels of accuracy were found in the area of demographic details (94%). Moderately high levels of accuracy were reported for allergies (61%) but also a considerable percentage of non-recorded information was present (36%). Inaccuracies in medication lists were reported in 51% of records reviewed with 32.1% of all medications being inaccurately recorded. While over 91% of participants had a history summary with eight or less items present, omissions were reported for one in every five participants. There were no significant associations present between inaccurate data and frequency of practice visits or those with more than five past medical conditions listed in the EHR.

CONCLUSION

The study has confirmed that errors and inaccuracies exist in EHR in our Australian pilot study. The pilot study has also allowed us to complete a trial ensuring that a study of this type can be done safely and with correct methodology. As health informatics plays an increasingly important role in health care, studies of this type will better inform practitioners/ researchers in designing systems to ensure quality electronic patient information.

[Septorhinoplasty for nasal deviation complicated with septal cartilage deformity]

OBJECTIVE

To investigate a method for safe, simple and effective correction of nasal deviation complicated with the deformity of nasal septal cartilage.

METHODS

From one side of the septal cartilage, the whole muco-perichondrium was separated, and from the other side a U-shaped muco-perichondrium was separated. The bottom of the septal cartilage was freed while a part of cartilage connected with the vomer was reserved.

RESULTS

12 patients were operated on with this technique for nasal deviation from March 1996 to August 1999. The follow-up period ranged from 1 to 12 months. The overall result was successful in all cases except one of recurrence.

CONCLUSION

This technique not only provides wide space for removing the spetal cartilage, but also creates a cartilaginous framework to support the septal cartilage in the middle without lowing the nasal tip, which avoids the tendency of migrating to its original position caused by external fixation. This technique also ensures replacing the septal cartilage in the midline regardless of the deformity of anterior nasal spine and the vomer.

[Cloning and primary expression analyses of down-regulated cDNA fragment in human gastric cancer]

OBJECTIVE

To identify human gastric cancer related genes.

METHODS

Specimens of paired tumor, paratumor and normal gastric mucosa tissues were collected from five patients (male 3, female 2, with average age 48.8 +/- 18.1 years) who suffered from stomach antrum adenocarcinoma. Total RNA samples were extracted from these specimens, then studied by fluorescent differential display reverse transcription polymerase chain reaction (DDRT- PCR) analysis. The differentially expressed bands of interest were recovered, purified and cloned, then they were analyzed by sequencing, Northern blot and RT-PCR. Through BLAST, the sequencing results were compared with GenBank database for homology analysis.

RESULTS

One of the interesting cDNA bands expressed much lower in all five tested tumor samples than in their normal and paratumor counterparts. This band was named W4. Northern blot analysis showed a consistent result with that of DDRT-PCR. W4 was cloned into pGEM-T easy vector. Sequence analysis showed that W4 consists of 712bp, this sequence was named W44. BLAST analysis revealed that W44 has extremely low sequence identity with any genes from GenBank and any sequences from EST database. This sequence data was submitted to GenBank with accession No. AF150631. RT-PCR analysis showed that W4 was expressed much lower in 11/15 gastric cancer tissue than in paratumor and normal samples.

CONCLUSION

A novel cDNA sequence related to human stomach adenocarcinoma was identified.

Flow cytometric analysis of androgen receptor expression in human prostate tumors and benign tissues

Androgen receptor (AR) plays an important role in growth and hormonal therapy of human prostate tumors. Immunohistochemical analysis of AR expression, a nonquantitative technique, is currently used for screening of receptor expression in prostate tissues. The present report describes a laser flow cytometric method for monitoring AR expression in human cell lines and in archival formalin-fixed paraffin-embedded prostate tissues and tumors. Multiparametric flow analysis can be used for simultaneous detection of other cellular markers (e.g., DNA aneuploidy), and by gated analysis, AR expression in subpopulations of a tumor can be quantitatively determined.

PAH emission from the industrial boilers

Polycyclic aromatic hydrocarbons (PAHs) emitted from 25 industrial boilers were investigated. The fuels used for these 25 boilers included 21 heavy oil, two diesel, a co-combustion of heavy oil and natural gas (HO+NG) and a co-combustion of coke oven gas and blast furnace gas (COG+BFG) boilers. PAH samples from the stack flue gas (gas and particle phases) of these 25 boilers were collected by using a PAH stack sampling system. Twenty one individual PAHs were analyzed primarily by a gas chromatography/mass spectrometer (GC/MS). Total-PAH concentration in the flue gas of 83 measured data for these 25 boiler stacks ranged between 29.0 and 4250 microg/m(3) and averaged 488 microg/m(3). The average of PAH-homologue mass (F%) counted for the total-PAH mass was 54.7%, 9.47% and 15.3% for the 2-ring, 3-ring and 4-ring PAHs, respectively. The PAHs in the stack flue gas were dominant in the lower molecular weight PAHs. The emission factors (EFs) of total-PAHs were 13,300, 2920, 2880 and 208 microg/kg-fuel for the heavy oil, diesel, HO+NG and COG+BFG fueled-boiler, respectively. Nap was the most predominant PAH occurring in the stack flue gas. In addition, the EF of 21 individual PAHs in heavy-oil boiler were almost the highest among the four various fueled-boilers except for those of FL and BkF in the diesel boiler. Furthermore, the EF of total-PAHs or BaP for heavy oil were both one order of magnitude higher than that for the diesel-fueled boiler.

Differential sensitivity of human mammary epithelial and breast carcinoma cell lines to curcumin

Curcumin has anti-inflammatory, antiproliferative, and antitumor effects. To understand the chemopreventive mechanism of curcumin against human malignancies, the cellular and molecular changes induced by this agent in human mammary epithelial (MCF-10A) and breast carcinoma (MCF- 7/TH) cell lines were investigated. The human multidrug- resistant breast cancer cell line was 3.5 fold more sensitive to curcumin than the mammary epithelial cell line. Even though both cell lines accumulated a similar amount of curcumin, a significantly higher percentage of apoptotic cells was induced in breast cancer cells compared to a very low percentage of apoptosis in mammary epithelial cells. Incubation of breast cancer cells with 20 and 40 microM curcumin for 24 h induced G2 block and sub-G0/G1 cell population, respectively. Curcumin treatment caused a reduction in the expression of Ki67, PCNA, and p53 mRNAs in breast cancer cells. The human mammary epithelial cell line showed a down-regulation of p21 mRNA and an up-regulation of Bax mRNA expression with curcumin treatment. The results suggest that apoptosis is involved in the curcumin-induced inhibition of tumor cell growth, and genes associated with cell proliferation and apoptosis may be playing a role in the chemopreventive action of curcumin.

Phorbol ester-induced P-glycoprotein phosphorylation and functionality in the HTB-123 human breast cancer cell line

The discordance between P-glycoprotein (P-gp) expression and functionality [as measured by the efflux of doxorubicin (DOX)] was analyzed in a DOX-sensitive human breast cancer cell line (HTB-123) with high reactivity against four P-gp specific monoclonal antibodies (C219, MRK-16, UIC2, and 4E3). Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting analyses confirmed the overexpression of MDR1 mRNA and P-gp in this cell line. However, incubation of cells with efflux blockers, verapamil (VPL) or dipyridamole (DPD), did not enhance cellular (DOX) accumulation or cytotoxicity. Upon incubation with 12-O-tetradecanoylphorbol-13-acetate (TPA), HTB-123 cells retained less DOX than control cells and were sensitive to the efflux blockers verapamil or dipyridamole. These observations suggest that 12-O-tetradecanoylphorbol-13-acetate-induced P-gp phosphorylation may be associated with induction of P-gp-mediated drug efflux in the HTB-123 cell line.

[Quantitative determination of ursolic acid in Herba cynomorii by ultraviolet spectrophotometry]

Ursolic acid was isolated form Herba Cynomorii by thin layer chromatography and was quantitatively determined by ultraviolet spectrophotometry. The results indicate that the content of ursolic acid is 0.78%. The average recovery rate of ursolic acid is 97.4%, RSD = 0.45% (n = 4).