[Clinical effect of superior oblique re-tucking for recurrent or residual compensatory head position]

Objective: To evaluate the effects of re-tucking the superior oblique muscle on recurrent or residual compensatory head position. Methods: A retrospective case series study was conducted. 12 recurrent or residual compensatory head position patients (12 eyes) with congenital superior oblique palsy who underwent superior oblique re-tucking in Tianjin Eye Hospital from March 2015 to February 2021 were included. All patients had a history of superior oblique tucking procedure and showed signs of superior oblique muscle palsy without inferior oblique muscle overaction. During surgery, the Guyton forced duction test is used to evaluate the relaxation of the superior oblique muscle tendon, which affects the re-tucking length of the muscle.Their head position, vertical deviation, eye movement, fovea-disa angle, and Bielschowsky head tilt test were assessed pre-and post-surgery. Statistical analysis was performed using ttest and paired samples Wilcoxon signed rank test. Results: Out of the 12 patients, 8 were male and 4 were female, aged between 2 and 9 years. The initial surgery was done at age 6, with a superior oblique recession length of (7.17±1.03) mm. Recurrent head tilt occurred in 11 patients after (3.82±0.98) months postoperatively, and 1 patient had residual head tilt, with a followup period of six months or more. Ocular motility examination revealed underaction of the superior oblique muscle, positive Bielschowsky's head tilt test, and Guyton forced duction tese indicating relaxation of the paralyzed superior oblique muscle tendon. Scar adhesion was observed at the stop of the superior oblique muscle, as well as the previous sutures. The scar and the sutures around the stop of the superior oblique muscle were released, the mean re-tucking amount was(7.83±1.59)mm. Follow-up at 12 to 18 months postoperatively showed disappearance of compensatory head position, significant improvement in superior oblique muscle lag, normal ocular motility, and no occurrence of Brown syndrome. The results of Bielschowsky head tilt were negative in 9 cases and still positive in 3 cases after superior oblique re-tucking. The primary vertical deviation was 2.5 (2.0, 5.3) prism diopter pre-operatively and 1 (0, 1) prism diopter post-operatively, respectively. The difference was statistically significant (U=6.00, P<0.001). The total amount of FDA in both eyes was (-22.04±5.47)° and (-15.27±6.08)° pre-and post-operatively, respectively. The difference was statistically significant (t=2.87, P=0.009). All 12 patients have normal eye movement after superior oblique re-tucking procedure. All patients had no compensatory head position at last follow-up. Conclusions: Superior oblique re-tucking is suitable for patients with relaxation of the superior oblique muscle tendon and extrocular rotation as the main sign. It can effectively and safely correct the recurrent or residual compensatory head position after re-tucking the superior oblique muscle.

[Clinical pathological and genetic mutation characteristics of conjunctival lymphoepithelial carcinoma]

Objective: To analyze the clinical pathological and genetic mutation characteristics of conjunctival lymphoepithelial carcinoma. Methods: A retrospective case series study was conducted. Data from three patients diagnosed with conjunctival lymphoepithelial carcinoma and treated with tumor resection surgery at Tianjin Eye Hospital from January 2006 to December 2022 were collected. Four paraffin specimens (including one patient undergoing two surgeries) were subjected to immunohistochemical staining for epithelial antigen and lymphocytic antigen. Epstein-Barr virus (EBV)-encoded RNA (EBER) was detected using in situ hybridization, and whole-exome sequencing was performed on three specimens from two patients using next-generation sequencing methods. Results: All three patients were males aged over 65, with a disease duration ranging from 3 to 44 months. The tumors were unilateral, located on the bulbar or limbal conjunctiva, appearing red, with a maximum diameter of 4-20 mm. Imaging examinations revealed anterior location of the tumors with no involvement of the orbital bone, extraocular muscles, optic nerve, or paranasal sinuses. No local lymph node metastasis was observed in any patient. Pathological findings included undifferentiated carcinoma nests with significant reactive lymphocytic and plasma cell infiltration. Tumor cells were positive for pan-cytokeratin (CK-pan), epithelial membrane antigen (EMA), tumor protein 40 (p40), and tumor protein 63 (p63), with a cell proliferation index (Ki67) exceeding 80%. Cluster of differentiation 20 (CD20), CD3, and CD8 were positive for lymphocytes. In situ hybridization showed partial tumor cell expression of EBER in two specimens of one patient. Whole-exome sequencing revealed 58, 50, and 36 mutated genes in the three specimens, with enriched signaling pathways including melanoma signaling pathway, Notch1 signaling pathway, and RHOQ GTP cycle; enriched biochemical processes included amino acid starvation response, programmed cell death, regulation of lipid synthesis, sodium ion transport, and chromosome segregation. The common mutated gene in all three specimens was SZT2, and SZT2 was involved in the amino acid starvation response. One patient underwent a second complete resection surgery 40 months after partial excision, while the other two underwent complete resection surgery without recurrence. Two patients did not undergo radiation or chemotherapy, and one was lost to follow-up. Conclusions: Conjunctival lymphoepithelial carcinoma is associated with prominent lymphocytic and plasma cell infiltration, some cases are associated with EBV infection, and SZT2 mutations are present in conjunctival lymphoepithelial carcinoma.

[Long-term high-fat diet's impact on synaptic plasticity in the visual cortex and hippocampus neurons: an experimental study]

Objective: To investigate the effects and mechanisms of long-term high-fat diet on synaptic plasticity in the visual cortex and hippocampus neurons of juvenile mice. Methods: This was an experimental study. Twenty-four 4-week-old male C57BL/6J mice were randomly divided into two groups, using a randomized numerical table, with 12 mice in each group. The ND group was fed a normal diet, while the HFD group was fed a high-fat diet. After 12 weeks of feeding, mouse body weight, body fat percentage, glucose tolerance, and blood lipid levels were recorded. Six mice from each group were randomly selected using a randomized numerical table, and long-term potentiation (LTP) in the lateral geniculate nucleus (LGN)-primary visual cortex binocular zone (V1B area) and hippocampus CA3-CA1 were recorded in vitro. Field excitatory postsynaptic potentials (fEPSPs) were measured, and the normalized fEPSP slope was calculated to evaluate changes in cortical synaptic plasticity. Subsequently, brain tissue was collected for Golgi staining to observe the development of pyramidal neurons in layers Ⅱ-Ⅲ of the primary visual cortex and CA1 region of the hippocampus, and changes in dendritic spine morphology and quantity were compared. The remaining six mice from each group were euthanized, and brain tissue was collected for transmission electron microscopy to observe ultrastructural changes in the visual cortex V1B area and hippocampus CA1 region neurons. Independent samples t-test was used for statistical analysis. Results: After 12 weeks of feeding, the body weight of mice in the HFD group was (29.17±1.63) g, significantly lower than the ND group which was (37.99±6.87) g (t=4.33, P<0.001). The body fat percentage in the HFD group was 1.09%±0.22%, which was higher than the ND group with 0.85%±0.09% (t=2.50, P=0.032). HFD mice showed a significant increase in blood glucose level 30 minutes after glucose injection, reaching (17.80±3.94) mmol/L, compared to the ND group with (23.10±1.48) mmol/L (t=3.07, P=0.013). At 60 minutes after glucose injection, the difference in blood glucose levels between the ND group [(13.58±2.39) mmol/L] and the HFD group [(23.70±3.56) mmol/L] was statistically significant (t=5.40, P<0.001). Subsequently, both groups showed a decline in blood glucose levels, and at 120 minutes after glucose injection, the blood glucose level in the ND group decreased to (8.50±1.05) mmol/L, while the HFD group remained at a higher level of (16.03±4.17) mmol/L, showing a statistically significant difference (t=3.91, P=0.004). The serum total cholesterol levels in the ND and HFD groups were (4.08±0.35) mmol/L and (10.80±0.90) mmol/L, respectively, with the HFD group higher than the ND group (t=15.23, P<0.001). However, there was no significant difference in triglyceride levels (P>0.05). The high-density lipoprotein cholesterol level in the ND group was (2.12±0.57) mmol/L, while in the HFD group, it was (1.28±0.15) mmol/L, with the HFD group lower than the ND group (t=3.15, P=0.014). Non-high-density lipoprotein cholesterol level in the HFD group was (11.06±1.46) mmol/L, significantly higher than the ND group with (2.28±0.43) mmol/L (t=12.88, P<0.001). In the hippocampal CA3-CA1 pathway, the fEPSP slope increased by 239.1%±88.8% of baseline in the ND group, while in the HFD group, it was only 147.6%±31.6% of baseline, indicating lower LTP compared to the ND group (t=7.20, P<0.001). For the LGN-V1 pathway, the fEPSP slope increased by 204.8%±67.0% of baseline in the ND group, while in the HFD group, it was 121.1%±15.7% of baseline, showing reduced LTP compared to the ND group (t=9.11, P<0.001). Regarding the visual cortex, in the V1B area of the ND group, the number of dendritic spines per 10 μm was (1.31±1.14), while in the HFD group, it was (0.77±0.43), demonstrating a significant decrease in dendritic spine density (t=3.45, P<0.001). The proportion of mature dendritic spines in the ND group was 69.98%, while non-mature dendritic spines accounted for 30.02%. In contrast, the HFD group had 45.76% mature dendritic spines and 54.24% non-mature dendritic spines. Regarding changes in hippocampal CA1 pyramidal neurons, the cell bodies and axons were not damaged, but HFD group neurons exhibited simplified dendritic structures with reduced branching. The number of dendritic spines per 10 μm was (10.25±3.84) in the HFD group and (25.22±8.21) in the ND group, indicating significantly lower dendritic spine density in the HFD group (t=12.42, P<0.001). The proportion of mature dendritic spines in the ND group was 70.88%, while non-mature dendritic spines accounted for 29.12%. In contrast, the HFD group had 47.37% mature dendritic spines and 52.63% non-mature dendritic spines. Moreover, the ultrastructure of neurons in the visual cortex V1B area and hippocampus CA1 region of HFD mice showed evident damage, with disrupted cell structures, swollen and vacuolated mitochondria, reduced or even disappeared mitochondrial cristae, and decreased synaptic quantity with damaged structure. Conclusions: Long-term high-fat diet in juvenile mice leads to abnormal development and functional maturation of synapses in the visual cortex and hippocampal regions. Dendrites, as the foundation of synaptic structures, undergo abnormal development, which can cause alterations in synaptic plasticity of related neural circuits.

[Experimental study on developmental changes of synaptic currents in V1B cortical layer Ⅳ pyramidal neurons in C57BL/6J mice]

Objective: To investigate the developmental changes of miniature excitatory and inhibitory postsynaptic currents (mEPSCs and mIPSCs) of layer Ⅳ pyramidal neurons in the primary visual cortex binocular zone (V1B) of C57BL/6J wild-type mice at different developmental stages. Methods: Sixteen male C57BL/6J mice of specific-pathogen-free grade were selected and divided into 4 groups according to their postnatal age: P14 group (before and after eye opening), P28 group (the peak of the critical period), P35 group (the end of the critical period), and P130 group (fully adult). Whole-cell patch-clamp technique was used to record the frequency and amplitude of mEPSCs and mIPSCs of layer Ⅳ pyramidal neurons in V1B of each group, and to analyze their differences and changes. Results: The frequency of mEPSCs of layer Ⅳ pyramidal neurons in V1B of mice in the four groups was statistically different (F=9.46, P<0.001), with the P35 group being higher than the P28 group [P28 and P35 groups were (8.72±1.34) and (13.28±4.05) Hz, t=3.39, P=0.012], and the P130 group being lower than the P35 group [P35 and P130 groups were (13.28±4.05) and (5.82±1.98) Hz, t=5.21, P<0.001]; the amplitude of mEPSCs of layer Ⅳ pyramidal neurons in V1B of mice in the four groups was not statistically different (F=2.84, P=0.055). The frequency of mIPSCs of layer Ⅳ pyramidal neurons in V1B of mice in the four groups was statistically different (F=8.14, P<0.001), with the P130 group being higher than the P14 group [P14 and P130 groups were (5.22±1.33) and (12.03±3.94) Hz, t=4.678, P<0.001]; the amplitude of mIPSCs of layer Ⅳ pyramidal neurons in V1B of mice in the four groups was statistically different (F=7.06, P=0.001), with the P35 group being higher than the P28 group [P28 and P35 groups were (20.07±3.56) and (28.47±5.98) pA, t=3.66, P=0.006], and the P130 group being lower than the P35 group [P35 and P130 groups were (28.47±5.98) and (20.32±3.55) pA, t=3.33, P=0.014]. Conclusions: The excitatory synaptic development of layer Ⅳ pyramidal neurons in V1B of mice is in a vigorous growth state during development and gradually weakens with age, while the inhibitory synaptic development gradually strengthens with increasing postnatal age, and both of them rapidly develop during the critical period.

[Characteristics of visual function in children with autism complicated with mental retardation]

Objective: To explore the characteristics of visual function and eye diseases in children with autism spectrum disorder (ASD) and mental retardation. Methods: It was a cross-sectional study. Two hundred and ninety-two cases (584 eyes) of children with ASD combined with mental retardation from 7 special education schools in Chaoyang District of Beijing, including 235 males (80.48%) and 57 females (19.52%); The age ranged from 2 to 18 years old. Subjective far and near vision, near stereoacuity, objective vision, diopter, anterior segment and fundus were examined. In addition, 300 students with normal intelligence level, aged 2 to 18 years, were included as controls. LogMAR was used to record vision examination. Subjective, objective vision and diopter were examined. Mann Whitney U test or Kruskal Wallis H test was used for the data of children with different genders, different age. Results: Among 584 eyes of children with ASD and mental retardation, 272 eyes (47.22%) were ametropia, 260 eyes (45.14%) were astigmatism, 29 eyes (5.03%) were hyperopia, 10 eyes (1.74%) were myopia, and 47 eyes (8.16%) were amblyopia risk factors. Among 292 children, there were 20 cases of strabismus (6.85%), 3 cases of color weakness (1.03%), and 4 cases of external eye abnormalities (1.37%). Two hundred and eleven children completed near stereopsis examination, of which 54 (25.59%) were within 100″ and 157 (74.41%) were within 200″ to 900″. Two hundred and seventy-two eyes with ametropia, 157 eyes (57.72%) needed correction but did not. The median and quartile of subjective and objective logMAR visual acuity were 0.22(0.10, 0.35), 0.10(0.00, 0.22), respectively; There were no significant differences in far visual acuity, near visual acuity, objective visual acuity, diopter, and near stereoacuity between different genders of ASD children with mild or moderate mental retardation (all P>0.05); There was a statistically significant difference in ASD children with mild mental retardation at different age rangs (H=21.453, P<0.001). There was a statistically significant difference in subjective tests such as far visual acuity and near visual acuity, for children with moderate mental retardation (Z=-3.508, -4.503; P<0.001). There was no statistically significant difference in objective visual acuity, diopter and near stereo acuity(all P>0.05). There are 300 healthy children as the control group, with LogMar's subjective far vision is 0.10(0.00, 0.22), and the objective vision is 0.00(0.00, 0.10), diopter 0.25 (-0.25, 0.50) D. Compared with healthy children, ASD children with mental retardation had a significant difference in subjective far vision and objective vision (Z=-8.527, -10.393; P<0.001). There was no significant difference in diopter (Z=-1.274, P=0.203). Conclusions: The subjective and objective visual acuity of children with ASD combined with mental retardation was lower than that of healthy children. The prevalence and uncorrected rate of refractive errors, strabismus, amblyopia and other eye diseases were significantly higher than those of healthy children. Their refractive errors were mainly astigmatism, and the rates of correction and treatment were low.

[Effects of celastrol on autophagy and endoplasmic reticulum stress-mediated apoptosis in a mouse model of nonalcoholic fatty liver disease]

Objective: To investigate the effect of celastrol (CEL) on autophagy and endoplasmic reticulum stress-mediated apoptosis in a mouse model of nonalcoholic fatty liver disease (NAFLD). Methods: Eighteen male C57BL/6J mice were randomly divided into normal control (NC, n=6), high-fat diet (HFD, n=6) and celastrol group (HFD+CEL, n=6). The normal control group was fed with regular diet, and the high-fat diet and celastrol group were fed with high-fat diet for 12 weeks. After successful modeling, celastrol group were injected with 100 μg⋅kg^-1⋅d^-1 celastrol intraperitoneally for 4 weeks, and NC and HFD group were injected intraperitoneally with the same doses of normal saline. Serum concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured in mouse after 4-weeks of intervention. HE and Oil Red O staining were used to observe the pathomorphological changes and lipid droplet deposition in mouse liver, and the findings were scored according to NAFLD activity score (NAS). Western blot was used to detect the expression levels of liver microtubule associated protein 1 light chain 3 (LC3), P62, glucose-regulated protein 78 (GRP78), protein kinase R-like endoplasmic reticulum kinase (PERK), phosphorylated PERK (p-PERK), activated transcription factor 4 (ATF4), C/EBP homologous protein (CHOP), cleaved Caspase-3(cleaved caspase-3), B-cell lymphoma-2 (Bcl-2) and Bcl-2 related X protein (Bax).TUNEL staining was used to observe the apoptosis of hepatocytes. One-way analysis of variance was used for the intergroup comparison. Results: Serum levels of ALT (68.71±8.57) U/L, AST (209.63±28.64) U/L, TG (0.97±0.14) mmol/L, TC (4.12±0.64) mmol/L, and LDL -C (0.40±0.06) mmol/L were lower in celastrol group mouse than HFD group [(110.19±10.79) U/L, (399.72±73.47) U/L, (1.44±0.13) mmol/L, (5.65±0.54) mmol /L, (0.61±0.07) mmol/L] (P<0.05); while the serum HDL-C level (1.29±0.17) mmol/L was higher in celastrol than HFD group (0.72±0.13) mmol/L (P<0.05). HE and Oil Red O staining showed that lipid deposition and intralobular inflammation were apparent in the liver tissue of HFD group mouse, and the NAS score was significantly increased, while the hepatocyte steatosis and intralobular inflammation were alleviated after celastrol intervention, and the NAS score was decreased significantly (P<0.05). Compared with HFD group, the ratio of LC3II/I was significantly increased in the liver of celastrol group mouse, and the P62 was significantly decreased (P<0.05). Meanwhile, the expression level of GRP78, p-PERK/PERK , ATF4, and CHOP was significantly lower in celastrol than HFD group (P<0.05). In addition, the expressions of cleaved caspase-3 and Bax were significantly lower in celastrol than HFD group, and the expression of Bcl-2 was significantly increased (P<0.05). At the same time, the apoptosis rate of hepatocytes was also significantly lower in celastrol than HFD group (P<0.05). Conclusion: Celastrol can effectively alleviate the lipid deposition, protect hepatocytes and delay the progression of non-alcoholic fatty liver disease in mouse liver with non-alcoholic fatty liver disease. In addition, its mechanism of action may be related to the induction of autophagy, inhibition of endoplasmic reticulum stress PERK/ATF4/CHOP pathway and its mediated apoptosis.

[The progress and challenges in immunotherapy for the difficulty- to- treat liver diseases]

As a digestive organ, the liver has the functions of metabolism, synthesis, and detoxification. It is also an immune organ and plays an important role in maintaining anti-infection, autoimmune stability, and anti-tumor. In particular, the liver has unique immunological advantages. Its immune cells can maintain the liver's immune homeostasis and participate in immunoregulation. A variety of immunotherapy is used in clinical trials for the treatment of difficult and critical liver diseases. This review mainly summarizes the recent clinical trials of immunotherapy in chronic hepatitis B, cirrhosis, hepatocellular carcinoma, and autoimmune liver disease.

Knockdown of long non-coding RNA VIM-AS1 inhibits glioma cell proliferation and migration, and increases the cell apoptosis via modulation of WEE1 targeted by miR-105-5p

OBJECTIVE

Glioma including glioblastoma is the main type of primary brain tumors worldwide. LncRNAs have participated in glioma formation. This study aims to investigate the underlying mechanism for VIM-AS1/miR-105-5p/WEE1 signaling in glioma.

PATIENTS AND METHODS

The clinical tumors and adjacent tissues were collected from 24 patients with glioma in the Shang Luo Central Hospital. Then, the clinical samples were subjected to hematoxylin-eosin staining (H&E). VIM-AS1, miR-105-5p, and WEE1 levels were measured using real-time PCR. The protein levels of WEE1, Cyclin A1, PCNA, N-cadherin, Vimentin, and Bcl-2, E-cadherin, and Bax were analyzed using Western blot. The overall survival of glioma patients was evaluated using the Kaplan-Meier analysis. The interaction between VIM-AS1 and miR-105-5p was determined using RIP assay and Dual-Luciferase reporter assay, and the binding between miR-105-5p and WEE1 was also detected by Dual-Luciferase reporter assay. Cell proliferation, colony formation, cell cycle, apoptosis, and migration were confirmed using CCK-8, colony formation assay, flow cytometry, and transwell assay, respectively.

RESULTS

VIM-AS1 was elevated in cancer tissues, and high level of VIM-AS1 was positively correlated with poor overall survival. Then, VIM-AS1 could bind to and downregulate miR-105-5p. Furthermore, the knockdown of VIM-AS1 significantly suppressed tumor growth in vivo. The knockdown of VIM-AS1/overexpression of miR-105-5p inhibited glioma cell growth, colony formation, and migration, and enhanced the cell apoptosis by inhibiting expression of Cyclin A1, PCNA, Vimentin, N-cadherin, and Bcl-2, and by increasing the expression of Bax and E-cadherin. Interestingly, the overexpression of VIM-AS1 reversed the tumor-suppressing role of miR-105-5p in glioma cells. Besides, the expression of WEE1 was synergistically regulated by VIM-AS1 and miR-105-5p. Consequently, VIM-AS1 promoted glioma progression via upregulating WEE1 or downregulating miR-105-5p.

CONCLUSIONS

VIM-AS1/miR-105-5p/WEE1 signaling may be a promising target for glioma treatment.

[Establishment and clinical testing of pancreatic cancer Faster R-CNN AI system based on fast regional convolutional neural network]

Objective: To investigate the effectiveness of an enhanced CT automatic recognition system based on Faster R-CNN for pancreatic cancer and its clinical value. Methods: In this study, 4 024 enhanced CT imaging sequences of 315 patients with pancreatic cancer from January 2013 to May 2016 at the Affiliated Hospital of Qingdao University were collected retrospectively, and 2 614 imaging sequences were input into the faster R-CNN system as training dataset to create an automatic image recognition model, which was then validated by reading 1 410 enhanced CT images of 135 cases of pancreatic cancer.In order to identify its effectiveness, 3 750 CT images of 150 patients with pancreatic lesions were read and a followed-up was carried out.The accuracy and recall rate in detecting nodules were recorded and regression curves were generated.In addition, the accuracy, sensitivity and specificity of Faster R-CNN diagnosis were analyzed, the ROC curves were generated and the area under the curves were calculated. Results: Based on the enhanced CT images of 135 cases, the area under the ROC curve was 0.927 calculated by Faster R-CNN. The accuracy, specificity and sensitivity were 0.902, 0.913 and 0.801 respectively.After the data of 150 patients with pancreatic cancer were verified, 893 CT images showed positive and 2 857 negative.Ninety-eight patients with pancreatic cancer were diagnosed by Faster R-CNN.After the follow-up, it was found that 53 cases were post-operatively proved to be pancreatic ductal carcinoma, 21 cases of pancreatic cystadenocarcinoma, 12 cases of pancreatic cystadenoma, 5 cases of pancreatic cyst, and 7 cases were untreated.During 5 to 17 months after operation, 6 patients died of abdominal tumor infiltration, liver and lung metastasis.Of the 52 patients who were diagnosed negative by Faster R-CNN, 9 were post-operatively proved to be pancreatic ductal carcinoma. Conclusion: Faster R-CNN system has clinical value in helping imaging physicians to diagnose pancreatic cancer.

Effects of Secreted frizzled-related protein 1 on inhibiting cardiac remodeling

OBJECTIVE

To investigate the effect of Secreted frizzled-related protein 1 (Sfrp1) on myocardial fibroblasts through Wnt/β-catenin signaling pathway.

MATERIALS AND METHODS

Rat myocardial fibroblasts were cultured and divided into control group, proliferation group (TGF-β1 group), and Sfrp1 transfection group (TGF-β1 + Ad-Sfrp1 group). The control group received no treatment. The TGF-β1 group was stimulated with TGF-β1 10 ng/mL for 12 h to establish a proliferation model. The TGF-β1 + Ad-Sfrp1 group was first transfected with Ad-Sfrp1 virus. On day 3, TGF-β1 was added at 10 ng/mL to stimulate 12 h. The β-catenin and the marker protein α-SMA of myofibroblast (MyoFB) differentiation were detected by Western blotting method. In addition, we used MTT to test cell proliferation and flow cytometry to test cell cycle. At the same time, we used enzyme-linked immunosorbent assay (ELISA) to detect the collagen I and collagen III content of the cell supernatant and used quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) to test the expression of apoptotic factors and Dvl-1 and Cyclin D1.

RESULTS

In TGF-β1 group, the β-catenin, and α-SMA protein expressions were all upregulated, the OD value and collagen I and collagen III contents were increased, but the apoptosis rate was decreased. On the contrary, the expression of β-catenin and α-SMA proteins in the TGFβ1 + Ad-Sfrp1 group were all downregulated, the OD value, collagen I and collagen III content, and percentage of S-phase cells were reduced, but the percentage of G0/G1, G2/M-phase cells, and the apoptotic rate increased.

CONCLUSIONS

Sfrp1 can effectively inhibit myocardial fibroblast proliferation, collagen synthesis, promote fibroblast apoptosis, and inhibit the transformation of fibroblasts into myofibroblasts by inhibiting Wnt/β-catenin signaling pathway.

P4770Antithrombotic challenge in the clinical dilemma of high-risk patients with atrial fibrillation: one-year result from ChiOTEAF Registry

Background

The antithrombotic treatment is the main goal of management on atrial fibrillation (AF). However, the optimal thrombophylaxis still remains the problem in the “high-risk” population, such as the elderly, with renal/liver dysfunction, malignancy, stent implantation, etc.

Objectives

The present study aims to explore the optimal antithrombotic strategy in a “high-risk” population with multiple comorbidities.

Methods

The ChiOTEAF (Ethic approval number of Central Medical Ethic Committee of General PLA Hospital: S2014–065–01) is a prospectively, multi-center (44 research centers), real-world registry across China. The protocol was seen in BMJ Open (Guo Y, et al. 2018). A Cox proportional hazard model analysis was performed for the outcome of antithrombotic therapy among this high-risk population.

Results

6148 patients with AF (mean age 74 years old, female 39.4%), were enrolled into ChiOTEAF study between Oct 2014 to Dec 2018. The use of non-vitamin K antagonist oral anticoagulants (NOACs), warfarin, and antiplatelet were 1444 (23.5%), 1300 (21.1%), and 2521 (41.0%), respectively, in this high-risk AF population. During one-year follow-up, there were 186 (3.0%) all-cause death.

In this AF cohort, the patients with chronic kidney disease (CKD)/liver disease were 878 (14.3%), with malignancy were 555 (9.0%), with prior thromboembolism (TE) were 1538 (25%), with prior haemorrhage were 348 (5.7%), and current anemia were 859 (14.0%), respectively. Stent implantation (coronary artery, aortic or peripheral artery) were 671 (10.9%). CHA2DS2-VASc and HAD-BLED scores (mean±standard deviation) were 3.8±1.7, and 2.0±1.1, respectively.

Among the above “clinical dilemma”, the antiplatelet use was common in patients with CKD/Liver disease and stent implantation (43.5%, 56.9%, respectively, p<0.05), the oral anticoagulants (OACs) combined with antiplatelet was most seen in patients with stent implantation (15.4%, p<0.05), OACs alone were highest in patients with prior TE (38.1%, p<0.05), while patients with malignancy and prior bleeding far less received any antithrombotic drugs (41.8%, 31.3%, respectively, p<0.05) (Figure 1).

However, after adjusting baseline characteristics, OACs reduced the risk for all-cause death (hazard ratio, HR, 95% confidential interval, CI) for the patients with CKD/liver disease (HR, 95% CI, 0.28, 0.11–0.69, p=0.006), and for patients with prior TE (HR, 95% CI, 0.43, 0.21–0.91, p=0.028), respectively.

Conclusion

Although suboptimal anticoagulants were common in the “high-risk” AF patients, OACs demonstrated the benefit for AF patients with CKD/liver disease, etc., while more evidences would be needed to optimise the antithrombotic strategy in different complex clinical settings.

Acknowledgement/Funding

The study was supported by Beijing Natural Science Foundation (Z1411ehz745.11462114050) and National Natural Science Foundation of China (H2501)

Identification of a Panax ginseng fruit fingerprint by HPLC-ESI-MS

Over many years, parts of Panax ginseng (root and rhizome) have been identified and applied for medical purposes as traditional Chinese herbal medicine. Recently, research has indicated that ginseng fruit also contains similar compounds and is as rich as the other parts of the ginseng. This discovery may dramatically improve the efficient of outputs derived from ginseng products. Here, a new technique combining high-performance liquid chromatography (HPLC) with electrospray ionization tandem mass spectrometry (ESI-MS) was employed to identify the fingerprint of P. ginseng fruit. Using HPLC, compounds that are important for medical purposes were extracted and purified. Combined with ESI-MS, the characteristic peaks (nine common peaks) of those compounds were identified, and the accuracy was confirmed by analysis using the Chromatographic Fingerprint Similarity Evaluation System (2004A edition). Overall, 15 batches of ginseng fruit had a similarity of more than 0.80, 13 batches of samples had a similarity between 0.97 and 0.99, and two batches had a similarity less than 0.90. The test solution and mobile phase selection was discussed. The HPLC-ESI-MS method can produce repeatable and reliable results and can be applied in the quality control of P. ginseng fruit.

Analysis of antithrombotic therapy in elderly patients with atrial fibrillation

This study aimed to analyze the impact factors and outcome of antithrombotic therapy in elderly patients over 65 years old that suffered from atrial fibrillation (AF). A total of 256 elderly patients with AF over 65 years old were divided into 3 groups: 65-74 years old (N = 86), 75-84 years old (N = 122), and over 85 years old (N = 48). The clinical characteristics, antithrombotic therapy, and its related impact factors were retrospectively analyzed. Of all patients, 187 received antithrombotic therapy. In the 65-74 year-old group, 78 patients received antiplatelet treatment (90.7%) and 5 patients received anticoagulation treatment (5.8%). In the 75-84 year-old group, 76 patients received antiplatelet treatment (62.3%) and 14 patients received anticoagulation treatment (11.5%). In the group of over 85 year-olds, 33 patients received antiplatelet therapy (68.8%) and 4 patients received anticoagulation treatment (8.3%). Eleven patients had deep vein thrombosis and atrial thrombosis during antiplatelet therapy (5.9%), 5 patients had gastrointestinal hemorrhage after antiplatelet therapy (2.7%), 2 patients had gastrointestinal bleeding, and 3 patients had brain hemorrhage after anticoagulation treatment (21.7%). Suboptimal antithrombotic therapy was observed in the elderly patients with AF, partly owing to the risks of both thromboembolism and bleeding.

Confocal laser endomicroscopy for superficial esophageal squamous cell carcinoma

BACKGROUND AND STUDY AIMS

Confocal laser endomicroscopy (CLE) allows subsurface imaging of gastrointestinal mucosa in vivo. The goal of the present study was to compare the endomicroscopic characteristics of cells and intrapapillary capillary loops (IPCLs) in normal and superficial esophageal squamous cell carcinoma (SESC).

PATIENTS AND METHODS

We recruited consecutive patients with SESC diagnosed by conventional endoscopy and confirmed by histopathology between July 2006 and May 2008. The confocal endoscopic images of these patients were collected and compared with the corresponding histology. The characteristic patterns of cells and IPCLs was then analyzed from these images of malignant and normal mucosa. The quality of images and interobserver variations of two endoscopists were also evaluated.

RESULTS

Overall, 64 samples from 57 subjects (27 SESCs, 30 controls) were examined by CLE. The confocal images corresponded to the hematoxylin and eosin staining from the same sites. The confocal images showed that there was a significantly higher proportion of squamous epithelial cells with irregular arrangement (79.4 % vs. 10.0 %, P < 0.001), increased diameter of IPCLs (26.0 microm vs. 19.2 microm, P < 0.001), and irregular shape IPCLs (82.4 % vs. 36.7 %, P = 0.0002) in the SESC group compared with the controls. Massive IPCLs with tortuous vessels (44.1 % vs. 0 %, P < 0.0001), and long branching IPCLs (23.5 % vs. 3.3 %, P = 0.0204) were frequently observed in the SESC group. In this study, about 35.5 % of images were graded as good quality, and the interobserver agreement for the prediction of cancerous mucosa was graded as substantial.

CONCLUSIONS

CLE can be used to distinguish cancerous from normal epithelium, which gives it potential value for early detection of esophageal carcinoma. The difficulty in obtaining good images in the esophagus by CLE is a latent problem.

Diagnosis of gastric intestinal metaplasia with confocal laser endomicroscopy in vivo: a prospective study

BACKGROUND AND STUDY AIMS

Gastric intestinal metaplasia (GIM) is a risk factor for development of intestinal-type gastric cancer. We aimed to assess the usefulness of confocal laser endomicroscopy (CLE) in diagnosing GIM.

PATIENTS AND METHODS

28 patients with known GIM underwent CLE, and CLE criteria for diagnosis of GIM were developed. In addition, 53 consecutive patients with known or suspected GIM were prospectively evaluated.

RESULTS

GIM was identified if any of the following three features were present in an image field: goblet cells, columnar absorptive cells and brush border, and villiform foveolar epithelium. GIM was then classified as complete or incomplete according to the shape of the goblet cells, the presence of absorptive cells or brush border, and the architecture of vessels and crypts. In a prospective study, a total of 13 670 CLE images were obtained. Among 267 sites from 53 patients, 160 from 36 patients were diagnosed histopathologically as GIM. The sensitivities of conventional endoscopy and CLE for GIM were 36.88 % vs. 98.13 %, and the specificities were 91.59 % vs. 95.33 %, respectively. The kappa value for the correlation with histological findings was 0.25 for conventional endoscopy vs. 0.94 for CLE. The sensitivity and specificity of CLE were 68.03 % and 89.66 %, respectively, for the diagnosis of complete GIM, and 68.42 % and 83.41 %, respectively, for incomplete GIM; the kappa value for the correspondence between CLE and histological findings was 0.67.

CONCLUSION

CLE is a useful and potentially important method for the diagnosis and classification of GIM in vivo.

Alterations of food antigen-specific serum immunoglobulins G and E antibodies in patients with irritable bowel syndrome and functional dyspepsia

BACKGROUND

Post-prandial worsening of symptoms as well as adverse reactions to one or more foods are common in the patients with functional gastrointestinal diseases, such as irritable bowel syndrome (IBS) and functional dyspepsia (FD). However, the role played by true food allergy in the pathogenesis of these diseases is still controversial and there are no well-established tests to identify food allergy in this condition.

OBJECTIVE

To investigate serum food antigen-specific IgG, IgE antibody and total IgE antibody titres in controls and patients with IBS and FD, and to correlate symptoms with the food antigen-specific IgG titres in IBS and FD patients.

METHODS

Thirty-seven IBS patients, 28 FD patients and 20 healthy controls participated in this study. Serum IgG and IgE antibody titres to 14 common foods including beef, chicken, codfish, corn, crab, eggs, mushroom, milk, pork, rice, shrimp, soybean, tomatoes and wheat were analysed by ELISA. Serum total IgE titres were also measured. Last, symptomatology was assessed in the study. Results IBS patients had significantly higher titres of IgG antibody to crab (P=0.000), egg (P=0.000), shrimp (P=0.000), soybean (P=0.017) and wheat (P=0.004) than controls. FD patients had significantly higher titres of IgG antibody to egg (P=0.000) and soybean (P=0.017) than controls. The percentage of individuals with detectable positive food antigen-specific IgE antibodies of the three groups did not show any significant differences (P=0.971). There were no significant differences between IBS patients, FD patients and controls in the serum total IgE antibody titres (P=0.978). Lastly, no significant correlation was seen between symptom severity and serum food antigen-specific IgG antibody titres both in IBS and FD patients.

CONCLUSION

Serum IgG antibody titres to some common foods increased in IBS and FD patients compared to controls. But there is no significant correlation between symptom severity and elevated serum food antigen-specific IgG antibodies in these patients.

Effects of Veratrum nigrum alkaloids on central catecholaminergic neurons of renal hypertensive rats

AIM

To study the central hypotensive mechanism of Veratrum nigrum L var ussurience Nakai alkaloids (VnA) in renal hypertensive rats(RHR).

METHODS

The quantitative method of immunocytochemistry (ICC) was used to observe and detect the effect of VnA (30 micrograms.kg-1, i.v.) on activity of central catecholaminergic (CA) neurons of C1, C2, A1, and A5 areas in RHR.

RESULTS

VnA increased the immunoreactivity (IR) of tyrosine 3-monooxygenase (TM)-immunopositive (IP) neurons of C1, C2, and A5 areas in RHR experimental group compared with RHR control group [positive units: (1.9 +/- 0.4), (1.18 +/- 0.23), (1.2 +/- 0.4) vs (0.15 +/- 0.22), (0.31 +/- 0.16), (0.69 +/- 0.20), respectively]; IR of TM-IP neurons of C1 and C2 areas in RHR control group was decreased compared with sham-operated group [positive units: (0.15 +/- 0.22), (0.31 +/- 0.16) vs (1.45 +/- 0.29), (1.36 +/- 0.25), respectively].

CONCLUSION

VnA increased the activity of central CA neurons in RHR to exert its hypotensive effect.

Components of the ether-insoluble resin glycoside fraction from the seed of Cuscuta australis

An ether-insoluble resin glycoside fraction was obtained from the seeds of Cuscuta australis. Identification and characterization of alkaline hydrolysis products by means of GC, FABMS, and 1H, 13C, and 2D NMR revealed the material to be composed of three new glycosidic acids, cuscutic acids A1-A3 (1-3); triglycosides with (11S)-jalapinolic or (11S)-convolvulinolic acid as the aglycon; and acetic, isobutyric, (2S)-2-methylbutyric, tiglic, and (2R,3R)-nilic acids. The resin glycoside is considered to be a complex mixture of glycosidic ester-type oligomers (up to heptamers) with a core consisting of a number of the above cuscutic acids each acylated with one or two carboxylic acid moieties.

Components of the ether-insoluble resin glycoside-like fraction from Cuscuta chinensis

A trisaccharide and four new glycosidic acids, named cuscutic acids A-D, along with known organic acids, acetic acid, propionic acid, (2S)-2-methylbutyric acid, tiglic acid, (2R, 3 R)-nilic acid, (11S) convolvulinolic acid and (11S)-jalapinolic acid have been isolated from the alkaline hydrolysate of the ether-insoluble resin glycoside-like fraction of the seeds of Cuscuta chinensis. The compounds were characterized on the basis of chemical and physical data.