[The role of intravoxel incoherent motion diffusion-weighted imaging in distinguishing diabetic nephropathy from non-diabetic renal disease in diabetic patients]

Objective: To investigate the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM). Methods: A diagnostic test. In this prospective study, patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled. IVIM-DWI parameters including perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured in the renal cortex, medulla, and parenchyma. Patients were divided into the DN group and NDRD group based on the renal biopsy results. IVIM-DWI parameters, clinical information, and diabetes-related biochemical indicators between the two groups were compared using Student's t-test or Mann-Whitney U test. The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman's correlation analyzes. The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic (ROC) curves. Results: A total of 27 DN patients and 23 NDRD patients were included in this study. The DN group comprised 19 male and 8 female patients, with an average age of 52±9 years. The NDRD group comprised 16 male and 7 female patients, with an average age of 49±10 years. The DN group had a higher D* value in the renal cortex and a lower f value in the renal medulla than the NDRD group (9.84×10-3 mm2/s vs. 7.35×10-3 mm2/s, Z=-3.65; 41.01% vs. 46.74%, Z=-2.29; all P<0.05). The renal medulla D* value was negatively correlated with DN grades, interstitial lesion score, and interstitial fibrosis and tubular atrophy (IFTA) score (r=-0.571, -0.409, -0.409; all P<0.05) while the renal cortex f value was positively correlated with vascular sclerosis score (r=0.413, P=0.032). The renal cortex D* value had the highest area under the curve (AUC) for discriminating between the DN and NDRD groups (AUC=0.802, sensitivity 91.3%, specificity 55.6%). Conclusion: IVIM-derived renal cortex D* value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.

[The Origin and Academic Characteristics of Xujiang School]

Xujiang School of acupuncture and moxibustion has a long history with distinctive academic characteristics and regional influence. Xujiang School, originated from Xi Hong in Song Dynasty, is the oldest acupuncture and moxibustion school recorded in Chinese history. Later, it was passed down from family to family for more than ten generations. The tenth generation Xi Xinqing passed it on to Chen Honggang and gradually evolved into a school of acupuncture and moxibustion with regional characteristics and a certain national influence. In terms of academic characteristics, doctors in Xujiang School kept innovating based on the Classics.Its acupuncture and moxibustion academic ideas including reinforcement and reduction , point selection and searching for the primary cause of disease in treatment have had an important impact on contemporary acupuncture in clinic.

Genome-Wide Characterization of Calmodulin and Calmodulin-like Protein Gene Families in Paulownia fortunei and Identification of Their Potential Involvement in Paulownia Witches' Broom

As significant Ca2+ sensors, calmodulin (CaM) and calmodulin-like proteins (CML), have been associated with a variety of environmental conditions in plants. However, whether CaMs/CMLs are related to the stress of phytoplasma infection has not been reported in Paulownia fortunei. In the current study, 5 PfCaMs and 58 PfCMLs were detected through a genome-wide investigation. The number of EF-hand motifs in all PfCaMs/CMLs varied. Bioinformatics analyses, including protein characteristics, conserved domain, gene structure, cis-elements, evolutionary relationship, collinearity, chromosomal location, post-translation modification site, subcellular localization and expression pattern analyses, represented the conservation and divergence of PfCaMs/CMLs. Furthermore, some PfCaMs/CMLs might be involved in plants' reaction to phytoplasma infection and exogenous calcium therapy, indicating these genes may play a role in abiotic as well as biotic stress responses. In addition, subcellular localization analysis showed that PfCML10 was located in the cell membrane and nucleus. In summary, these findings establish a stronger platform for their subsequent functional investigation in trees and further characterize their roles in Paulownia witches' broom (PaWB) occurrence.

N6-methyladenosine modification changes during the recovery processes for Paulownia witches' broom disease under the methyl methanesulfonate treatment

Phytoplasmas induce diseases in more than 1000 plant species and cause substantial ecological damage and economic losses, but the specific pathogenesis of phytoplasma has not yet been clarified. N ⁶-methyladenosine (m⁶A) is the most common internal modification of the eukaryotic Messenger RNA (mRNA). As one of the species susceptible to phytoplasma infection, the pathogenesis and mechanism of Paulownia has been extensively studied by scholars, but the m⁶A transcriptome map of Paulownia fortunei (P. fortunei) has not been reported. Therefore, this study aimed to explore the effect of phytoplasma infection on m⁶A modification of P. fortunei and obtained the whole transcriptome m⁶A map in P. fortunei by m⁶A-seq. The m⁶A-seq results of Paulownia witches' broom (PaWB) disease and healthy samples indicate that PaWB infection increased the degree of m⁶A modification of P. fortunei. The correlation analysis between the RNA-seq and m⁶A-seq data detected that a total of 315 differentially methylated genes were predicted to be significantly differentially expressed at the transcriptome level. Moreover, the functions of PaWB-related genes were predicted by functional enrichment analysis, and two genes related to maintenance of the basic mechanism of stem cells in shoot apical meristem were discovered. One of the genes encodes the receptor protein kinase CLV2 (Paulownia_LG2G000076), and the other gene encodes the homeobox transcription factor STM (Paulownia_LG15G000976). In addition, genes F-box (Paulownia_LG17G000760) and MSH5 (Paulownia_LG8G001160) had exon skipping and mutually exclusive exon types of alternative splicing in PaWB-infected seedling treated with methyl methanesulfonate, and m⁶A modification was found in m⁶A-seq results. Moreover, Reverse Transcription-Polymerase Chain Reaction (RT-PCR) verified that the alternative splicing of these two genes was associated with m⁶A modification. This comprehensive map provides a solid foundation for revealing the potential function of the mRNA m⁶A modification in the process of PaWB. In future studies, we plan to verify genes directly related to PaWB and methylation-related enzymes in Paulownia to elucidate the pathogenic mechanism of PaWB caused by phytoplasma invasion.

The stability of transcription factor PfSPL1 participates in the response to phytoplasma stress in Paulownia fortunei

The current understanding of the pathogenesis of phytoplasma is still very limited and challenging. Here, ceRNA regulatory network and degradome sequencing identified a PfmiR156f-PfSPL regulatory module in Paulownia fortunei infected by phytoplasma, and RLM-5'RACE and dual luciferase analyses verified the relationship. The PfmiR156 cleavage site was located at 1104 nt and 1177 nt of PfSPL1 and PfSPL10, respectively. MG132 and epoxomicin, two 26S proteasome inhibitors, significantly increased the accumulation of PfSPL1. PfSPL1 was also the attack target of phytoplasma effectors (Pawb 3/9/16/37/51) after the phytoplasma invaded Paulownia. Moreover, molecular docking implied that the effectors may interact with the conserved SBP domain of the target protein PfSPL1. Basically, these results indicated that the stability of PfSPL1 was regulated by PfmiR156 cleavage activity and/or the 26S proteasome pathway at the post-translation level. The PfSPL1, which is a transcription factor, was also the one of the targets of multiple effectors attacking Paulownia. This study provides a good scope to understand the paulownia phytoplasma infecting mechanism.

[Visceral leishmaniasis in Xinjiang Uygur Autonomous Region during the COVID-19 pandemic: a case report]

OBJECTIVE

To perform an epidemiological investigation on a case of visceral leishmaniasis reported from Shule County, Kashi Prefecture, Xinjiang Uygur Autonomous Region in 2021, so as to provide insights into differential diagnosis of visceral leishmaniasis during the COVID-19 pandemic.

METHODS

The epidemiological history of this case was collected, and the case was diagnosed for Leishmania infection with the immunochromatographic (rK39) strip test, bone marrow smear microscopy and PCR assay.

RESULTS

The patient had typical clinical symptoms of leishmaniasis, including irregular fever, hepatosplenomeg- aly, low serum albumin and elevated globulin. Bone marrow smear microscopy identified L. donovani amastigotes, and both rK39 strip test and PCR assay were positive, while the case was tested negative for SARS-CoV-2. COVID-19 was therefore excluded and visceral leishmaniasis was diagnosed. Standard full-dose treatment with sodium stibogluconate was given, and no Leishmania was found on blood smears during the reexamination. No recurrence was found during the followup after discharge for hospital.

CONCLUSIONS

During the COVID-19 pandemic, it is recommended to increase the perception of differential diagnosis of visceral leishmaniasis among first-contact doctors, and reinforce the capability of differential diagnosis and health education of visceral leishmaniasis among medical and healthcare institutions at all levels, to prevent missed diagnosis and misdiagnosis of visceral leishmaniasis.

Comprehensive analyses of the SPL transcription factor family in Paulownia fortunei and their responses to biotic and abiotic stresses

To study the molecular characteristics, phylogenetic evolution, and gene functions of the SQUAMOSA-PROMOTER BINDING PROTEIN-LIKE (SPL) genes in Paulownia fortunei, a whole genome sequence analysis was carried out, and a total of 23 PfSPL genes were identified. Tandem duplication and fragment replication were the main patterns of gene expansion in the PfSPL family. Phylogenetic analysis showed that the 23 identified PfSPLs formed seven subgroups, and the structures of the proteins in the same subgroup were similar. Functional analysis indicated that PfSPL11 may regulate flowering, PfSPL5 was involved in gibberellin signaling, PfSPL1/4/23 regulated branching, and PfSPL9/16/18 were related to pathogen resistance. Yeast one hybrid technology confirmed that PfSPL4 and PfSP23 can bind to the promoter of PfTCPa. The transcriptome analysis indicated that PfSPL10 was sensitive to both drought and salt stress. Ten PfSPLs that responded to phytoplasma infection were identified. Molecular docking showed that PfSPL10 and PfSPL 4/5/9/10/11/13 formed active pockets in the conserved SBP domain that could bind methyl methane sulfonate (MMS) and rifampicin (Rif) through stable hydrogen bonds, respectively. This study provides a basis for further studies on the functions of the PfSPL transcription factor family, and for genetic improvement and breeding of trees resistant to PaWB disease.

Genome-Wide Analysis of Specific PfR2R3-MYB Genes Related to Paulownia Witches' Broom

Paulownia witches' broom (PaWB), caused by phytoplasmas, is the most devastating infectious disease of Paulownia. R2R3-MYB transcription factors (TF) have been reported to be involved in the plant's response to infections caused by these pathogens, but a comprehensive study of the R2R3-MYB genes in Paulownia has not been reported. In this study, we identified 138 R2R3-MYB genes distributed on 20 chromosomes of Paulownia fortunei. These genes were classified into 27 subfamilies based on their gene structures and phylogenetic relationships, which indicated that they have various evolutionary relationships and have undergone rich segmental replication events. We determined the expression patterns of the 138 R2R3-MYB genes of P. fortunei by analyzing the RNA sequencing data and found that PfR2R3-MYB15 was significantly up-regulated in P. fortunei in response to phytoplasma infections. PfR2R3-MYB15 was cloned and overexpressed in Populus trichocarpa. The results show that its overexpression induced branching symptoms. Subsequently, the subcellular localization results showed that PfR2R3-MYB15 was located in the nucleus. Yeast two-hybrid and bimolecular fluorescence complementation experiments showed that PfR2R3-MYB15 interacted with PfTAB2. The analysis of the PfR2R3-MYB15 gene showed that it not only played an important role in plant branching, but also might participate in the biosynthesis of photosystem elements. Our results will provide a foundation for future studies of the R2R3-MYB TF family in Paulownia and other plants.

Identification and analysis of HD-Zip genes involved in the leaf development of Liriodendron chinense using multidimensional analysis

Homeodomain-leucine zipper (HD-Zip) proteins are plant-specific transcription factors that play important roles in different biological processes, especially leaf development. However, no studies to date have identified the HD-Zip genes in Liriodendron chinense nor characterized their functions. We identified the HD-Zip genes in L. chinense by analysing the phylogeny, chromosome location, structure, conserved motif, cis-regulatory elements, synteny, post-transcriptional regulation and expression patterns of these genes during leaf development. A total of 36 LcHD-Zip genes were identified and divided into four subfamilies (HD-Zip I to IV). Synteny analysis revealed that segmental duplication was the main force driving the expansion of LcHD-Zip genes. These 36 LcHD-Zip genes exhibited 11 different expression patterns. Pattern 1, 2, 3, 4, 6, 7, 8 and 9 genes may play important roles in leaf development, such as leaf initiation, leaf polarity establishment, leaf shape development, phytohormone-mediated leaf growth and leaf epidermal structure formation. Four HD-Zip III genes were targeted by microRNAs (miRNAs), and the miR165/166a-HD-Zip regulatory module formed regulated leaf initiation and leaf polarity establishment. Overall, LcHD-Zip genes play key roles in leaf development of L. chinense. This work provides a foundation for the functional verification of HD-Zip genes identified in this study.

[Analysis and management of delayed cerebrospinal fluid rhinorrhea after invasive pituitary adenoma surgery]

Objective: To investigate the related factors and treatments of delayed cerebrospinal fluid rhinorrhea (CFR) after invasive pituitary adenoma (IPA) surgery. Methods: One hundred and forty-two patients with IPA treated in Tianjin Huanhu Hospital from January 2014 to January 2019 were analyzed retrospectively, including 62 males and 80 females, aging from 38 to 67 years. The clinical data of patients before and after operation were collected. All patients with postoperative CFR underwent endoscopic CFR repair. During the operation, residual or recurrent pituitary adenomas were resected, the dura around the leak was enlarged and the necrotic tissue was removed. For those who still had fluid leakage after repair, the necrotic tissue was cleaned up, the leakage was filled and reinforced under endoscopy. Endoscopic rhinorrhea repair was performed if necessary. The cerebrospinal fluid leak was repaired with multi-layer materials. The related risk factors of delayed CFR after operation were analyzed. SPSS 19.0 software was used for statistical analysis. Results: Among the 142 patients in this group, 64 cases underwent total tumor resection and 78 cases underwent non-total tumor resection. They were followed up for 6 to 72 months. Thirty-one cases had delayed CFR, with an incidence of 21.83%, and occurred between 1 and 5 years postoperatively, with an average of 2.4 years. All 31 patients with delayed CFR underwent endoscopic CFR repair. The nasal endoscopy was rechecked at 2 weeks, 1 month, 3 months and 6 months after operation. Twenty-eight patients were repaired successfully after 1 operation, while 2 patients after 2 operations and 1 patient after 3 operations. These patients were followed up for 6 to 60 months, and no CFR occurred again. Univariate analysis showed that the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and operator experience were the risk factors of delayed CFR (all P<0.05). Multivariate analysis showed that the degree of tumor resection and recurrence were the highest independent risk factors for postoperative CFR, and tumor size, texture, postoperative radiotherapy and operator experience were the independent risk factors in this study. Conclusions: Delayed CFR after IPA is related to the degree of tumor resection, recurrence, size, texture, postoperative radiotherapy and the operator experience. It is necessary to completely remove the tumor under endoscope, to expand resection of the dura and necrotic tissue around the leak, to repair the defect with multi-layer materials, to follow-up closely and to repair timely after operation.

Conformational Changes in Three-Dimensional Chromatin Structure in Paulownia fortunei After Phytoplasma Infection

Higher-order chromatin structures play important roles in regulating multiple biological processes such as growth and development as well as biotic and abiotic stress response. However, little is known about three-dimensional chromatin structures in Paulownia or about whole-genome chromatin conformational changes that occur in response to Paulownia witches' broom (PaWB) disease. We used high-throughput chromosome conformation capture (Hi-C) to obtain genome-wide profiles of chromatin conformation in both healthy and phytoplasma-infected Paulownia fortunei genome. The heat map results indicated that the strongest interactions between chromosomes were in the telomeres. We confirmed that the main structural characteristics of A/B compartments, topologically associated domains, and chromatin loops were prominent in the Paulownia genome and were clearly altered in phytoplasma-infected plants. By combining chromatin immunoprecipitation sequencing, Hi-C signals, and RNA sequencing data, we inferred that the chromatin structure changed and the modification levels of three histones (H3K4me3/K9ac/K36me3) increased in phytoplasma-infected P. fortunei, which was associated with changes of transcriptional activity. We concluded that for epigenetic modifications, transcriptional activity might function in combination to shape chromatin packing in healthy and phytoplasm-infected Paulownia. Finally, 11 genes (e.g., RPN6, Sec61 subunit-α) that were commonly located at specific topologically associated domain boundaries, A/B compartment switching and specific loops, and had been associated with histone marks were identified and considered as closely related to PaWB stress. Our results provide new insights into the nexus between gene regulation and chromatin conformational alterations in nonmodel plants upon phytopathogen infection and plant disease resistance.

Genomic insights into the fast growth of paulownias and the formation of Paulownia witches' broom

Paulownias are among the fastest growing trees in the world, but they often suffer tremendous loss of wood production due to infection by Paulownia witches' broom (PaWB) phytoplasmas. In this study, we have sequenced and assembled a high-quality nuclear genome of Paulownia fortunei, a commonly cultivated paulownia species. The assembled genome of P. fortunei is 511.6 Mb in size, with 93.2% of its sequences anchored to 20 pseudo-chromosomes, and it contains 31 985 protein-coding genes. Phylogenomic analyses show that the family Paulowniaceae is sister to a clade composed of Phrymaceae and Orobanchaceae. Higher photosynthetic efficiency is achieved by integrating C3 photosynthesis and the crassulacean acid metabolism pathway, which may contribute to the extremely fast growth habit of paulownia trees. Comparative transcriptome analyses reveal modules related to cambial growth and development, photosynthesis, and defense responses. Additional genome sequencing of PaWB phytoplasma, combined with functional analyses, indicates that the effector PaWB-SAP54 interacts directly with Paulownia PfSPLa, which in turn causes the degradation of PfSPLa by the ubiquitin-mediated pathway and leads to the formation of witches' broom. Taken together, these results provide significant insights into the biology of paulownias and the regulatory mechanism for the formation of PaWB.

[Effect analysis on endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base]

Objective: To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy. Methods: The total excision rate, postoperative complications and postoperative curative effect of 7 patients (4 males and 3 females, aging from 32 to 63 years old) who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed. All patients were followed up for 6 to 36 months. The postoperative MRI, clinical symptoms and recurrence were reviewed. Descriptive statistical methods were used for analysis. Results: Among the 7 patients, there were total resection (complete resection of cyst contents and capsule) in 4 patients, near-total resection (complete resection of cyst contents, incomplete resection of cyst capsule) in 1 patient, and subtotal resection (incomplete resection of cyst contents and capsule) in 2 patients. The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms. One case had postoperative cerebrospinal fluid rhinorrhea, which was cured after lumbar drainage and nasal iodoform gauge packing. Up to now, 7 patients (including patients with partial resection) had no recurrence. Conclusion: Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.

Thumb lengthening using a three-dimensional half-ring distraction frame

The purpose of this study was to evaluate the use of a three-dimensional half-ring distraction frame for thumb phalangeal lengthening. From February 2009 to March 2015, 23 patients (23 thumbs) with thumb loss were treated with a half-ring distraction frame. Active movements of the metacarpophalangeal (MCP) joint were measured with a goniometer. These measurements were compared with the opposite hand. Differences were considered statistically significant at p<0.05. Clinical outcome was assessed based on the modified Mayo score. Bone union and good alignment were achieved in all patients. The mean distraction time was 44 days (range, 35-62 days). The mean time to union was 20 days (range, 49-86 days). The mean palmar and radial abduction of the thumb was 60° (range, 53°-65°) and 63° (range, 58°-70°), respectively; on the uninjured side, these measurements were 62° (range, 56°-65°) and 64° (range, 60°-73°), respectively (p>0.05). The mean extension-flexion arc of the MCP joint was 46° (range, 40°-50°); the measurement on the uninjured side was 48° (40°-54°) (p>0.05). The mean follow-up period was 51 months (4.25 years) (range, 48-65 months). The mean modified Mayo Score was 138 (range, 113-145). There were 19 excellent, 3 good, and 1 fair results. The half-ring distraction frame is a viable alternative for thumb lengthening as it provides stable, three-dimensional fixation, resulting in good hand function.

[Application of percutaneous dilatation tracheotomy in patients with difficult airway]

Objective:To explore the application of percutaneous dilatation tracheotomy for patients with difficult airway. Method:Retrospectively analyzed the clinical data of percutaneous dilatation tracheotomy in difficult airway patients, summarized the difficulties, technical points and advantages. Result:Collecting the clinical data of 28 patients with difficult airway, 20 cases were head and neck tumor recurrence after surgery, radiation and chemotherapy, 3 cases were cervical hematoma, 2 cases were laryngeal neoplasm with heart failure, 2 cases were mandatory spondylitis, and 1 case was airway stenosis. The difficult points for tracheotomy were unable to lie down, neck stiffness, displacement of the trachea, coagulation disorder, unclear neck structure, etc. All patients accepted percutaneous dilatation tracheotomy, including cone and forceps dilatation tracheotomy, with none complication. Conclusion:Percutaneous dilatation tracheotomy was a safe, rapid and minimally invasive surgical method for patients with difficult airway requiring tracheotomy, and could be used as the preferred solution.

[Sublingual immunotherapy of Dermatophagoides farinae drops in nasal cavity local allergy]

Objective:To investigate treatment effect of Sublingual immunotherapy of Dermatophagoides farinae drops in nasal cavity local allergy.MethodSelecting 60 patients as observation group,who had only nasal local allergy symptoms,allergen skin prick test and serum allergen specific IgE test were negative, but nasal secretions allergen specific IgE test and nasal mucous membrane excitation test were positive.Sublingual immunotherapy of Dermatophagoides farinae drops for three years were given to them.To detect symptom scores and VAS scores,eosinophilia counts in nasal secretion,nasal secretions allergen specific IgE test,nasal mucous membrane excitation test before treatment,after two years treatment,and three years treatment,the data of pre-therapy and post-therapy was taken for statistical analysis.ResultThere was difference(P<0.05) in the symptom scores and VAS scores of patients in observation group before treatment and after two years treatment.There was difference(P<0.05) in the eosinophilia counts in nasal secretion of patients before treatment and after two years treatment. There was difference(P<0.05) in the nasal secretions allergen specific IgE test of patients before treatment and after two years treatment. There was difference(P<0.05) in the nasal mucous membrane excitation test of patients before treatment and after two years treatment.There was no difference(P>0.05) Symptom scores and VAS scores in the patients after two years treatment and after three years treatment.Conclusion：For patients with the typical medical history and symptoms of AR,but with allergen SPT and serum allergen SIgE test negative,there was local specific hypersensitivity in nasal mucosa,but there was not accompanied by systemic sensitization.Combined with nasal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive,local allergic rhinitis can be diagnosed.Sublingual immunotherapy of Dermatophagoides farinae drops in nasal cavity local allergy was effective.

A comparison of the transcriptomes between diploid and autotetraploid Paulownia fortunei under salt stress

Paulownia is a tree species grown in many countries. Our previous study reveals that tetraploid Paulownia fortunei is more tolerant to salt stress than its corresponding diploid tree. To investigate the molecular mechanisms of salt stress tolerance in P. fortunei, the transcriptomes of normal and salt-stressed diploid and tetraploid were investigated. After assembling the clean reads, we obtained 130,842 unigenes. The unigenes were aligned against six public databases (Nr, Nt, Swiss-Prot, COG, KEGG, GO) to discover homologs and assign functional annotations. We retrieved 7983 and 15,503 differentially expressed unigenes (DEUs) between the normal and the salt-stressed diploid and tetraploid P. fortunei, respectively. We identified dozens of important DEUs including 3 related to photosynthesis, 10 related to plant growth and development and 11 related to osmolytes. Some of these DEUs were upregulated in tetraploid compared to diploid and others were upregulated under salt stress. Quantitative reverse transcriptase polymerase chain reaction verified the expression patterns of 15 unigenes. Our results provided insights into the molecular aspects why tetraploid is stronger and more energetic than diploid under saline environment. This study provides useful information for further studies on the molecular mechanisms of salt tolerance in other tree plants.

[Clinical symptoms and immunology inspection characteristics of nasal cavity local allergy]

Objective:To investigate the clinical symptoms and immunology inspection characteristics of nasal cavity local allergy. Method:Selected 60 patients as observation group, who had only nasal local allergy symptoms, allergen skin prick test and serum allergen specific IgE (SIgE) test were negative, 40 allergic rhinitis (AR) patients and 40 healthy volunteers as control groups. To detect Symptom scores and VAS scores, and eosinophilia counts in venous blood, allergen skin prick test (SPT), serum allergen SIgE test, nasal secretions allergen SIgE test, nasal mucous membrane excitation test in both observation group and AR group, eosinophilia counts in nasal secretion, taked the data for statistical analysis.Result:There was no difference (P> 0.05) in the symptom scores and VAS scores of observation group and the AR group. The eosinophilia counts in venous blood in the AR group were higher than in the observation group (P< 0.05). The eosinophilia counts in venous blood in the observation group were higher than in the healthy volunteers group (P< 0.05). The positive rate of nasal secretions dust mites and pollen allergen was 90% (54/60) in observation group. There was no significant difference (P> 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the AR group. There was significant difference (P< 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the healthy volunteers group. There were 6 patients in observation group whose nasal secretions allergen SIgE test and nasal mucous membrane excitation test were both negative, could be diagnosised as non-allergic rhinitis (NAR). According to eosinophilia counts in venous blood and nasal secretions, 4 patients were diagnosised as vasomotor rhinitis and 2 patients were diagnosised as NAR with eosinophilia syndrome. There were 54 patients in observation group whose nasal secretions allergen SIgE test and (or) nasal mucous membrane excitation test were positive, could be diagnosised as local allergic rhinitis. After three years, all of the observation group patients were detected with SPT and serum allergen SIgE test. Five patients diagnosed as local allergic rhinitis before three years were positive. Six patients diagnosed as NAR before three years were negative.Conclusion:For patients with the typical medical history and symptoms of AR, but allergen SPT and serum allergen SIgE test were negative, there was local specific hypersensitivity in nasal mucosa, but the reaction was not accompanied by systemic sensitization. Combined with nasal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive, could be diagnosed as local allergic rhinitis.

ceRNA Cross-Talk in Paulownia Witches' Broom Disease

Long noncoding RNA (lncRNA), circular RNA (circRNA), and microRNA (miRNA) are important in the regulation of life activities. However, their function is unclear in Paulownia fortunei. To identify lncRNAs, circRNAs, and miRNA, and investigate their roles in the infection progress of Paulownia witches’ broom (PaWB) disease, we performed RNA sequencing of healthy and infected P. fortunei. A total of 3126 lncRNAs, 1634 circRNAs, and 550 miRNAs were identified. Among them, 229 lncRNAs, 65 circRNAs, and 65 miRNAs were differentially expressed in a significant manner. We constructed a competing endogenous RNA (ceRNA) network, which contains 5 miRNAs, 4 circRNAs, 5 lncRNAs, and 15 mRNAs, all of which were differentially expressed between healthy and infected P. fortunei. This study provides the first catalog of candidate ceRNAs in Paulownia and gives a revealing insight into the molecular mechanism responsible for PaWB.

[The safety study of percutaneous dilational tracheostomy in a large sample]

Objective:The aim of this study is to analyze the safety of a large number cases of percutaneous dilatation tracheostomy. Method: Retrospective analyzed the clinical data of PDT (1 200 cases) and TT (326 cases) patients which were recruited. The postoperative complications were analyzed statistically. PDT and TT randomized controlled trials (PDT and TT) were conducted with 80 cases in each group. The intraoperative conditions (including operative time, intraoperative bleeding volume and incision size) and postoperative complications in the two groups were statistically analyzed. The data were analyzed by SPSS 17.0 software. Result:①Randomized controlled study: The blood loss, incision size and operative time of two groups have significant difference. Comparison of postoperative complications: the number of postoperative bleeding and the total number of complications were statistically significant difference (P<0.05). However, granulation formation, incision infection and subcutaneous emphysema showed no significant difference (P>0.05). ②Large sample study: The postoperative follow-up results showed that there were significant differences in postoperative bleeding, postoperative infection, subcutaneous emphysema and the total number of complications (P<0.05), but there was no significant difference in the formation of tracheal granulation (P>0.05). Conclusion:This study further validates that PDT is a safe method to establish long-term artificial airway through large sample and randomized controlled study, which accords with the direction of modern minimally invasive surgery. PDT not only short operation time, and is easy to grasp, but also safe and reliable. If there is no obvious operation contraindication, we can choose PDT first for critically ill patients who need tracheotomy, and the success rate and safety are high after mastering the operation skills.

Identification and characterization of long noncoding RNA in Paulownia tomentosa treated with methyl methane sulfonate

Paulownia is a tree native to China, with important ecological and economic value. Long noncoding RNAs (lncRNAs) are known to play important roles in eukaryotic gene regulation. However, no lncRNAs have been reported in Paulownia so far. We performed RNA sequencing of two Paulownia tomentosa lncRNA libraries constructed from the terminal buds of normal untreated seedlings and 60 mg L-1 MMS-treated seedlings, and obtained a total of 2531 putative lncRNAs. The average length of the lncRNA transcripts was much less than the average length of the mRNA transcripts in the P. tomentosa libraries. A few of the Paulownia lncRNAs were conserved among ten species tested. We identified seven lncRNAs as precursors of 13 known miRNAs, 15 lncRNAs may act as target mimics of 19 miRNAs, and 351 unique noncoding sequences belonging to 133 conserved lncRNA families. In addition, we identified 220 lncRNAs responsive to methyl methane sulfonate (MMS), including seven phytohormone-related lncRNAs and one lncRNAs involved in base excision repair. This is the first time that lncRNAs have been explored in Paulownia. The lncRNA data may also provide new insights into the MMS-response in P. tomentosa.

Abstract P3-12-09: CYP2D6*10 genotype was associated with worse outcome of premenopausal breast cancer patients receiving adjuvant tamoxifen but not toremifene: A single institution expericence

Background: Tamoxifen(TAM), a selective estrogen receptor modulator(SERM), is the most widely used adjuvant endocrine therapy for premenopausal breast cancer patients. Cytochrome P-450(CYP450) enzyme, CYP2D6, is involved in the conversion of tamoxifen to endoxifen which is one of the main active metabolites of tamoxifen in vivo. Variants of CYP2D6 gene may result in a decreased enzyme activity and lead to poor prognosis of the patients. Different from caucasians, the most common polymorphism among Chinese women is allelic variant *10, which generates a 188 C to T transition, resulting in a lower activity of the enzyme. Based on some retrospective studies, tamoxifen-treated patients with the CYP2D6*10 T/T genotype have a worse clinical outcome. Toremifene(TOR), another kind of SERM is not metabolited by CYP2D6 enzyme thus may not be influenced by its polymorphism. We conducted this study to validate the association between CYP2D6*10 genotype and the outcomes of patients receiving TAM and TOR respectively.

Methods: A total of 276 patients with primary early-stage ER-positive breast cancer received adjuvant tamoxifen (n=169) or toremifene (n=107) therapy at Natinal Cancer Center from 2004-2012 were analyzed. All patients had received 5-year endocrine therapy after completion of surgery. TaqMan SNP genotyping assays was performed on CYP2D6*10 from blood samples. The association of CYP2D6 *10 genotype with disease free survival (DFS) and clinicopathological characteristics was analyzed in patients receiving tamoxifen and toremifen.

Results: 32.6% (90 of 276) of the patients were homozygous for wild-type C/C genotype, 47.1% (130 of 276) were heterozygous for C/T genotype, and 20.3% (56 of 276) were homozygous for variant T/T genotype. The frequency of CYP2D6 *10 allele in our study was 43.8%. The 5-year DFS rate for tamoxifen and toremifene treatment group were 81.6% and 83.2% respectively. There was no significant difference of DFS between the two groups(P=0.274). Among 169 patients in tamoxifen group, 5-year DFS rate was considerably lower in patients with homozygous variant T/T genotype than those with wild-type C/C or C/T genotype (73.4% versus 83.2%, P=0.004). And the T/T genotype was found to be a significant prognostic marker for DFS in multivariate analysis (hazard ratio = 4.7; P&lt;0.001) after adjusting for patient's characteristics mentioned above. For the toremifene group, there was no difference of DFS between T/T genotype and the others(P=0.332). For all the 56 homozygous variant T/T genotype patients, patients receiving toremifene treatment had a much higher 5-year DFS rate than those receiving tamoxifen but unfortunately it was not statistically significant (90.0% versus 73.4%, P=0.192).

Conclusions: About one fifth of Chinese breast cancer patients had homozygous T/T genotype which might get less benefit from TAM adjuvant treatment. Toremifene may be a better option for this kind of patients. Further large-scale prospective clinical studies are warranted to validate this concept.

Citation Format: Lan B, Ma F, Fan Y, Zhai X, Xu B. CYP2D6*10 genotype was associated with worse outcome of premenopausal breast cancer patients receiving adjuvant tamoxifen but not toremifene: A single institution expericence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-09.

Quality of meta-analyses in major leading orthopedics journals: A systematic review

BACKGROUND

Meta-Analyses are the basis of professional and healthcare agencies recommendations and have a growing importance. Quality of meta-analyses has been investigated in some medical fields but to our best knowledge this issue remains under investigated in orthopedics. Therefore, we performed a systematic analysis to: 1) after the introduction of PRISMA statement as a comprehensive guideline and the use of the AMSTAR tool as the standard for sufficient review methodology, has the quality of MAs improved because of that? 2) have some general characteristics influenced the quality of MAs (country, funding source, number of authors)?

MATERIAL AND METHODS

We systematically searched the meta-analyses in the top four journals with the impact factor (2015) as following: JBJS, Osteoarthritis Cartilage Arthroscopy and Clin Orthop Relat Res from 2005 to 2008 and from 2012 to 2015. Likewise from 2012-2015, we also analyzed the meta-analyses from OTSR. Characteristics were extracted based on the PRISMA statement and the AMSTAR tool. Country, number of authors, funding source were also extracted.

RESULTS

A total of 154 meta-analyses were included in the present study. Score with PRISMA statement and the AMSTAR checklist were 20.86±3.04 out of a maximum of 27 and 7.86±1.55 out of a maximum of 11. The best journal was OTSR according to the PRISMA (23.06±1.92) and AMSTAR (9.13±0.87) scores. And the worst journal was Clin Orthop Relat Res according to the PRISMA score (19.4±2.70) and JBJS according to the AMSTAR score (6.78±1.65). Twelve items showed significant difference in the PRISMA statement, and five items in the AMSTAR checklist. Integral score of PRISMA statement and AMSTAR checklist has a significant difference between 2005-2008 and 2012-2015. The MAs reported from U.S. (56, 36.4%) were more than any other region in the world. And the MAs published by Asia/Oceania increased remarkably between these two period times [from (4, 10.8%) to (45, 38.5%)].

CONCLUSION

This study showed that methodological reporting quality of meta-analyses in the major orthopedics journals has improved after the publication of the PRISMA statement.

LEVEL OF EVIDENCE

Level III.

Genome-wide expression analysis of salt-stressed diploid and autotetraploid Paulownia tomentosa

Paulownia tomentosa is a fast-growing tree species with multiple uses. It is grown worldwide, but is native to China, where it is widely cultivated in saline regions. We previously confirmed that autotetraploid P. tomentosa plants are more stress-tolerant than the diploid plants. However, the molecular mechanism underlying P. tomentosa salinity tolerance has not been fully characterized. Using the complete Paulownia fortunei genome as a reference, we applied next-generation RNA-sequencing technology to analyze the effects of salt stress on diploid and autotetraploid P. tomentosa plants. We generated 175 million clean reads and identified 15,873 differentially expressed genes (DEGs) from four P. tomentosa libraries (two diploid and two autotetraploid). Functional annotations of the differentially expressed genes using the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes databases revealed that plant hormone signal transduction and photosynthetic activities are vital for plant responses to high-salt conditions. We also identified several transcription factors, including members of the AP2/EREBP, bHLH, MYB, and NAC families. Quantitative real-time PCR analysis validated the expression patterns of eight differentially expressed genes. Our findings and the generated transcriptome data may help to accelerate the genetic improvement of cultivated P. tomentosa and other plant species for enhanced growth in saline soils.

Quantitative proteome-level analysis of paulownia witches' broom disease with methyl methane sulfonate assistance reveals diverse metabolic changes during the infection and recovery processes

Paulownia witches' broom (PaWB) disease caused by phytoplasma is a fatal disease that leads to considerable economic losses. Although there are a few reports describing studies of PaWB pathogenesis, the molecular mechanisms underlying phytoplasma pathogenicity in Paulownia trees remain uncharacterized. In this study, after building a transcriptome database containing 67,177 sequences, we used isobaric tags for relative and absolute quantification (iTRAQ) to quantify and analyze the proteome-level changes among healthy P. fortunei (PF), PaWB-infected P. fortunei (PFI), and PaWB-infected P. fortunei treated with 20 mg L^-1 or 60 mg L^-1 methyl methane sulfonate (MMS) (PFI-20 and PFI-60, respectively). A total of 2,358 proteins were identified. We investigated the proteins profiles in PF vs. PFI (infected process) and PFI-20 vs. PFI-60 (recovered process), and further found that many of the MMS-response proteins mapped to "photosynthesis" and "ribosome" pathways. Based on our comparison scheme, 36 PaWB-related proteins were revealed. Among them, 32 proteins were classified into three functional groups: (1) carbohydrate and energy metabolism, (2) protein synthesis and degradation, and (3) stress resistance. We then investigated the PaWB-related proteins involved in the infected and recovered processes, and discovered that carbohydrate and energy metabolism was inhibited, and protein synthesis and degradation decreased, as the plant responded to PaWB. Our observations may be useful for characterizing the proteome-level changes that occur at different stages of PaWB disease. The data generated in this study may serve as a valuable resource for elucidating the pathogenesis of PaWB disease during phytoplasma infection and recovery stages.

Enzyme activation through the utilization of intrinsic dianion binding energy

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We consider 'the proposition that the intrinsic binding energy that results from the noncovalent interaction of a specific substrate with the active site of the enzyme is considerably larger than is generally believed. An important part of this binding energy may be utilized to provide the driving force for catalysis, so that the observed binding energy represents only what is left over after this utilization' [Jencks,W.P. (1975) Adv. Enzymol. Relat. Areas. Mol. Biol. , , 219-410]. The large ~12 kcal/mol intrinsic substrate phosphodianion binding energy for reactions catalyzed by triosephosphate isomerase (TIM), orotidine 5'-monophosphate decarboxylase and glycerol-3-phosphate dehydrogenase is divided into 4-6 kcal/mol binding energy that is expressed on the formation of the Michaelis complex in anchoring substrates to the respective enzyme, and 6-8 kcal/mol binding energy that is specifically expressed at the transition state in activating the respective enzymes for catalysis. A structure-based mechanism is described where the dianion binding energy drives a conformational change that activates these enzymes for catalysis. Phosphite dianion plays the active role of holding TIM in a high-energy closed active form, but acts as passive spectator in showing no effect on transition-state structure. The result of studies on mutant enzymes is presented, which support the proposal that the dianion-driven enzyme conformational change plays a role in enhancing the basicity of side chain of E167, the catalytic base, by clamping the base between a pair of hydrophobic side chains. The insight these results provide into the architecture of enzyme active sites and the development of strategies for the de novo design of protein catalysts is discussed.

The relationship between intracranial pressure and neurocognitive function before and after the repair of a skull injury

OBJECTIVE

This study examines the relationship between intracranial pressure (ICP) changes after skull injury repair and neurocognitive function before and after the repair.

PATIENTS AND METHODS

Sixty patients undergoing skull injury repair participated in the study. A non-invasive detection analyzer was used to detect the ICP 2 days before operation, 10 days after the operation and one month after the operation in all patients. Additionally, the mean cerebral blood flow velocities (MV) in the internal carotid and the medial cerebral arteries were detected using a transcranial Doppler ultrasound (TCD). The neurological and cognitive functions were assessed using the NIHSS and the MMSE scales, respectively. And finally, an ELISA assay was used to detect the plasma insulin-like growth factor (IGF)-1 and beta-amyloid peptide (Ab) levels.

RESULTS

The results showed that all parameters studied improved significantly and continuously after surgery.

CONCLUSIONS

We suggest that the improvement in the ICP values and the neurocognitive functions are related to the resulting decreased expression levels of IGF-1 and Abeta after the repair.

Hippocampal UCP2 is essential for cognition and resistance to anxiety but not required for the benefits of exercise

Uncoupling protein-2 (UCP2) reduces oxidative stress by facilitating the influx of protons into mitochondrial matrix, thus dissociating mitochondrial oxidation from ATP synthesis. UCP2 is expressed abundantly in brain areas and plays a key role in neuroprotection. Here, we sought to determine if UCP2 deficiency produces cognitive impairment and anxiety in young mice, and to determine if hippocampal UCP2 is essential for the beneficial effects of voluntary exercise. Antisense oligonucleotide (ASO) was used to produce UCP2 knockdown in mice. Our results firstly showed that UCP2-targeted ASO significantly reduced UCP2 mRNA and protein expression in the hippocampus. ASO treatment impaired learning and memory of the mice in Y-maze, T-maze, and object recognition tests (ORT). ASO-treated mice exhibited more anxiously in OPT, light/dark box test, and elevated plus maze (EPM) than the control mice. We also found that wheel running ameliorated cognitive dysfunction and anxiety-like behaviors in ASO-treated mice. Furthermore, voluntary exercise reversed ASO-induced changes in hippocampal levels of serotonin (5-HT), dopamine (DA), and norepinephrine (NE). However, UCP2 protein in the hippocampus was not correlated with cognitive and anxiolytic benefits of exercise. These findings suggest that hippocampal UCP2 is essential for cognitive function and the resistance to anxiety of mice, but not required for the beneficial effects of exercise.

Selective inhibition of protein kinase C β2 attenuates the adaptor P66 Shc-mediated intestinal ischemia-reperfusion injury

Apoptosis is a major mode of cell death occurring during ischemia–reperfusion (I/R) induced injury. The p66^Shc adaptor protein, which is mediated by PKCβ, has an essential role in apoptosis under oxidative stress. This study aimed to investigate the role of PKCβ₂/p66^Shc pathway in intestinal I/R injury. In vivo, ischemia was induced by superior mesenteric artery occlusion in mice. Ruboxistaurin (PKCβ inhibitor) or normal saline was administered before ischemia. Then blood and gut tissues were collected after reperfusion for various measurements. In vitro, Caco-2 cells were challenged with hypoxia–reoxygenation (H/R) to simulate intestinal I/R. Translocation and activation of PKCβ₂ were markedly induced in the I/R intestine. Ruboxistaurin significantly attenuated gut damage and decreased the serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Pharmacological blockade of PKCβ₂ suppressed p66^Shc overexpression and phosphorylation in the I/R intestine. Gene knockdown of PKCβ₂ via small interfering RNA (siRNA) inhibited H/R-induced p66^Shc overexpression and phosphorylation in Caco-2 cells. Phorbol 12-myristate 13-acetate (PMA), which stimulates PKCs, induced p66^Shc phosphorylation and this was inhibited by ruboxistaurin and PKCβ₂ siRNA. Ruboxistaurin attenuated gut oxidative stress after I/R by suppressing the decreased expression of manganese superoxide dismutase (MnSOD), the exhaustion of the glutathione (GSH) system, and the overproduction of malondialdehyde (MDA). As a consequence, ruboxistaurin inhibited intestinal mucosa apoptosis after I/R. Therefore, PKCβ₂ inhibition protects mice from gut I/R injury by suppressing the adaptor p66^Shc-mediated oxidative stress and subsequent apoptosis. This may represent a novel therapeutic approach for the prevention of intestinal I/R injury.

Coordinated evolution of the hepatitis B virus polymerase

The detection of compensatory mutations that abrogate negative fitness effects of drug-resistance and vaccine-escape mutations indicates the important role of epistatic connectivity in evolution of viruses, especially under the strong selection pressures. Mapping of epistatic connectivity in the form of coordinated substitutions should help to characterize molecular mechanisms shaping viral evolution and provides a tool for the development of novel anti-viral drugs and vaccines. We analyzed coordinated variation among amino acid sites in 370 the hepatitis B virus (HBV) polymerase sequences using Bayesian networks. Among the HBV polymerase domains the spacer domain separating terminal protein from the reverse-transcriptase domain, showed the highest network centrality. Coordinated substitutions preserve the hydrophobicity and charge of Spacer. Maximum likelihood estimates of codon selection showed that Spacer contains the highest number of positively selected sites. Identification of 67% of the domain lacking an ordered structure suggests that Spacer belongs to the class of intrinsically disordered domains and proteins whose crucial functional role in the regulation of transcription, translation and cellular signal transduction has only recently been recognized. Spacer plays a central role in the epistatic network associating substitutions across the HBV genome, including those conferring viral virulence, drug resistance and vaccine escape. The data suggest that Spacer is extensively involved in coordination of HBV evolution.