[Deep learning-assisted construction of three-dimensional face midsagittal plane based on point clouds]

Objective: To establish an intelligent registration algorithm under the framework of original-mirror alignment algorithm to construct three-dimensional(3D) facial midsagittal plane automatically. Dynamic Graph Registration Network (DGRNet) was established to realize the intelligent registration, in order to provide a reference for clinical digital design and analysis. Methods: Two hundred clinical patients without significant facial deformities were collected from October 2020 to October 2022 at Peking University School and Hospital of Stomatology. The DGRNet consists of constructing the feature vectors of key points in point original and mirror point clouds (X, Y), obtaining the correspondence of key points, and calculating the rotation and translation by singular value decomposition. Original and mirror point clouds were registrated and united. The principal component analysis (PCA) algorithm was used to obtain the DGRNet alignment midsagittal plane. The model was evaluated based on the coefficient of determination (R2) index for the translation and rotation matrix of test set. The angle error was evaluated on the 3D facial midsagittal plane constructed by the DGRNet alignment midsagittal plane and the iterative closet point(ICP) alignment midsagittal plane for 50 cases of clinical facial data. Results: The average angle error of the DGRNet alignment midsagittal plane and ICP alignment midsagittal plane was 1.05°±0.56°, and the minimum angle error was only 0.13°. The successful detection rate was 78%(39/50) within 1.50° and 90% (45/50)within 2.00°. Conclusions: This study proposes a new solution for the construction of 3D facial midsagittal plane based on the DGRNet alignment method with intelligent registration, which can improve the efficiency and effectiveness of treatment to some extent.

Bioinformatics-based design of a fusion vaccine with CTLA-4 variable region to combat Brucella

Brucellosis has become a global zoonotic disease, seriously endangering the health of people all over the world. Vaccination is an effective strategy for protection against Brucella infection in livestock in developed countries. However, current vaccines are pathogenic to humans and pregnant animals, which limits their use. Therefore, it is very important to improve the safety and immune protection of Brucella vaccine. In this study, different bioinformatics approaches were carried out to predict the physicochemical properties, T/B epitope, and tertiary structure of Omp2b and Omp31. Then, these two proteins were sequentially linked, and the Cytotoxic T lymphocyte associated antigen-4 (CTLA-4) variable region was fused to the N-terminal of the epitope sequence. In addition, molecular docking was performed to show that the structure of the fusion protein vaccine had strong affinity with B7 (B7-1, B7-2). This study showed that the designed vaccine containing CTLA-4 had high potency against Brucella, which could provide a reference for the future development of efficient brucellosis vaccines.

[Research progress on the role of type II innate lymphoid cells in liver diseases]

Type II innate lymphoid cell (ILC2) is a newly identified innate immunological cell that belongs to the lymphocyte lineage in cell morphology, resides in the body's mucosal tissues, and has the dual functions of innate and adaptive immunity to promote tissue remodeling and repair after injury. Additionally, it is involved in the occurrence and development of a variety of liver diseases and plays an important role in maintaining the immunological homeostasis of the liver region. This article reviews the differentiation, development, and biological functions of ILC2, with particular attention to the research progress in liver diseases.

[Study on the method of automatically determining maxillary complex landmarks based on non-rigid registration algorithms]

Objective: To explore an automatic landmarking method for anatomical landmarks in the three-dimensional (3D) data of the maxillary complex and preliminarily evaluate its reproducibility and accuracy. Methods: From June 2021 to December 2022, spiral CT data of 31 patients with relatively normal craniofacial morphology were selected from those who visited the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. The sample included 15 males and 16 females, with the age of (33.3±8.3) years. The maxillary complex was reconstructed in 3D using Mimics software, and the resulting 3D data of the maxillary complex was mesh-refined using Geomagic software. Two attending physicians and one associate chief physician manually landmarked the 31 maxillary complex datasets, determining 24 anatomical landmarks. The average values of the three expert landmarking results were used as the expert-defined landmarks. One case that conformed to the average 3D morphological characteristics of healthy individuals' craniofacial bones was selected as the template data, while the remaining 30 cases were used as target data. The open-source MeshMonk program (a non-rigid registration algorithm) was used to perform an initial alignment of the template and target data based on 4 landmarks (nasion, left and right zygomatic arch prominence, and anterior nasal spine). The template data was then deformed to the shape of the target data using a non-rigid registration algorithm, resulting in the deformed template data. Based on the unchanged index property of homonymous landmarks before and after deformation of the template data, the coordinates of each landmark in the deformed template data were automatically retrieved as the automatic landmarking coordinates of the homonymous landmarks in the target data, thus completing the automatic landmarking process. The automatic landmarking process for the 30 target data was repeated three times. The root-mean-square distance (RMSD) of the dense corresponding point pairs (approximately 25 000 pairs) between the deformed template data and the target data was calculated as the deformation error of the non-rigid registration algorithm, and the intra-class correlation efficient (ICC) of the deformation error in the three repetitions was analyzed. The linear distances between the automatic landmarking results and the expert-defined landmarks for the 24 anatomical landmarks were calculated as the automatic landmarking errors, and the ICC values of the 3D coordinates in the three automatic landmarking repetitions were analyzed. Results: The average three-dimensional deviation (RMSD) between the deformed template data and the corresponding target data for the 30 cases was (0.70±0.09) mm, with an ICC value of 1.00 for the deformation error in the three repetitions of the non-rigid registration algorithm. The average automatic landmarking error for the 24 anatomical landmarks was (1.86±0.30) mm, with the smallest error at the anterior nasal spine (0.65±0.24) mm and the largest error at the left oribital (3.27±2.28) mm. The ICC values for the 3D coordinates in the three automatic landmarking repetitions were all 1.00. Conclusions: This study established an automatic landmarking method for three-dimensional data of the maxillary complex based on a non-rigid registration algorithm. The accuracy and repeatability of this method for landmarking normal maxillary complex 3D data were relatively good.

[Preliminary study on three-dimensional morphological reconstruction method for external nose defect based on three-dimensional face template]

Objective: To provide a new solution for the digital design of nasal prostheses, this study explores the three-dimensional (3D) facial morphology completion method for external nasal defects based on the non-rigid registration process of 3D face template. Methods: A total of 20 male patients with tooth defect and dentition defect who visited the Department of Prosthodontics, Peking University School and Hospital of Stomatology from June to December 2022 were selected, age 18-45 years old. The original 3D facial data of patients were collected, and the 3D facial data of the external nose defect was constructed in Geomagic Wrap 2021 software. Using the structured 3D face template data constructed in the previous research of the research group, the 3D face template was deformed and registered to the 3D facial data of external nose defect (based on the morphology of non-defective area) by non-rigid registration algorithm (MeshMonk program), and the personalized deformed data of the 3D face template was obtained, as the complemented facial 3D data. Based on the defect boundary of the 3D facial data of the external nose defect, the complemented external nose 3D data can be cut out from the complemented facial 3D data. Then the nasofacial angle and nasolabial angle of the complemented facial 3D data and the original 3D facial data was compared and analyzed, the ratio between the nose length and mid-face height, nose width and medial canthal distance of the complemented facial 3D data was measured, the edge fit between the edge curve of the complemented external nose 3D data and the defect edge curve of the 3D facial data of external nose defect was evaluated, and the morphological difference of the nose between the complemented external nose 3D data and the original 3D facial data was analyzed. Results: There was no significant statistically difference (t=-0.23, P=0.823; Z=-1.72, P=0.086) in the nasofacial angle (28.2°±2.9°, 28.4°±3.5° respectively) and nasolabial angle [95.4°(19.2°), 99.9°(9.5°) respectively] between the 20 original 3D facial data and the complemented facial 3D data. The value of the ratio of nose length to mid-face height in the complemented facial 3D data was 0.63±0.03, and the value of the ratio of nose width to medial canthal distance was 1.07±0.08. The curve deviation (root mean square value) between the edge curve of the complemented external nose 3D data and the defect edge curve of the 3D facial data of external nose defect was (0.37±0.09) mm, the maximum deviation was (1.14±0.32) mm, and the proportion of the curve deviation value within±1 mm was (97±3)%. The distance of corresponding nose landmarks between the complemented facial 3D data and the original 3D facial data were respectively, Nasion: [1.52(1.92)] mm; Pronasale: (3.27±1.21) mm; Subnasale: (1.99±1.09) mm; Right Alare: (2.64±1.34) mm; Left Alare: (2.42± 1.38) mm. Conclusions: The method of 3D facial morphology completion of external nose defect proposed in this study has good feasibility. The constructed complemented external nose 3D data has good facial coordination and edge fit, and the morphology is close to the nose morphology of the original 3D facial data.

[The design method of the digital sequential tooth-sectioning guide for the extraction of mandibular impacted third molars]

Objective: To explore a method for digitally designing and fabricating a sequential tooth-sectioning guide that can assist in the extraction of mandibular horizontal impacted third molars, preliminarily evaluate its feasibility and provide a reference for clinical application. Methods: Twenty patients with mandibular low level impacted third molars who visited the Department of General Dentistry, Peking University School and Hospital of Stomatology from March 2021 to January 2022 were selected. Cone-beam CT showed direct contact between the roots and mandibular canal, and full range impressions of the patients' intraoral teeth were taken and optical scans of the dental model were performed. The patients' cone-beam CT data and optical scan data were reconstructed in three dimensions, anatomical structure extraction, registration fusion, and the design of the structure of the guide (including crown-sectioning guide and root-sectioning guide) by Mimics 24.0, Geomagic Wrap 2021, and Magics 21.0 software, and then the titanium guide was three dimension printed, and the guide was tried on the dental model. After confirmation, the guide was used to assist the dentist in the operation. We observed whether the guide was in place, the number of tooth splitting, the matching of tooth splitting with the preoperative design, the operation time, and whether there were any complications. Results: In this study, 20 sectioning guides were successfully printed, all of them were well fitted in the patients' mouth, the average number of section was 3.4 times, the tooth parts was better matched with the preoperative design, and the average operative time of the guides was (29.2±9.8) minutes without complications such as perforation of the bone cortex. Conclusions: The use of sequential sectioning guides to assist in the extraction of mandibular impacted third molars was initially validated to accurately replicate the preoperative sectioning design, and is expected to provide a digital solution to improve surgical precision and ensure safety. Further studies with larger sample sizes are needed to evaluate its accuracy and safety.

[Preliminary evaluation of the trueness of 5 chairside 3D facial scanning techniques]

OBJECTIVE

To quantitatively evaluate the trueness of five chairside three-dimensional facial scanning techniques, and to provide reference for the application of oral clinical diagnosis and treatment.

METHODS

The three-dimensional facial data of the subjects were collected by the traditional professional three-dimensional facial scanner Face Scan, which was used as the reference data of this study. Four kinds of portable three-dimensional facial scanners (including Space Spider, LEO, EVA and DS-FScan) and iPhone Ⅹ mobile phone (Bellus3D facial scanning APP) were used to collect three-dimensional facial data from the subjects. In Geomagic Studio 2013 software, through data registration, deviation analysis and other functions, the overall three-dimensional deviation and facial partition three-dimensional deviation of the above five chairside three-dimensional facial scanning technologies were calculated, and their trueness performance evaluated. Scanning time was recorded during the scanning process, and the subject's comfort was scored by visual analogue scale(VAS). The scanning efficiency and patient acceptance of the five three-dimensional facial scanning techniques were evaluated.

RESULTS

DS-FScan had the smallest mean overall and mean partition three-dimensional deviation between the test data and the reference data, which were 0.334 mm and 0.329 mm, respectively. The iPhone Ⅹ mobile phone had the largest mean overall and mean partition three-dimensional deviation between the test data and the reference data, which were 0.483 mm and 0.497 mm, respectively. The detailed features of the three-dimensional facial data obtained by Space Spider were the best. The iPhone Ⅹ mobile phone had the highest scanning efficiency and the highest acceptance by the subject. The average scanning time of the iPhone Ⅹ mobile phone was 14 s, and the VAS score of the subjects' scanning comfort was 9 points.

CONCLUSION

Among the five chairside three-dimensional face scanning technologies, the trueness of the scan data of the four portable devices had no significant difference, and they were all better than the iPhone Ⅹ mobile phone scan. The subject with the iPhone Ⅹ scanning technology had the best expe-rience.

MHD instability dynamics and turbulence enhancement towards the plasma disruption at the HL-2A tokamak

The evolutions of MHD instability behaviors and enhancement of both electrostatic and electromagnetic turbulence towards the plasma disruption have been clearly observed in the HL-2A plasmas. Two types of plasma disruptive discharges have been investigated for similar equilibrium parameters: one with a distinct stage of a small central temperature collapse ([Formula: see text] 5-10%) around 1 millisecond before the thermal quench (TQ), while the other without. For both types, the TQ phase is preceded by a rotating 2/1 tearing mode, and it is the development of the cold bubble from the inner region of the 2/1 island O-point along with its inward convection that causes the massive energy loss. In addition, the micro-scale turbulence, including magnetic fluctuations and density fluctuations, increases before the small collapse, and more significantly towards the TQ. Also, temperature fluctuations measured by electron cyclotron emission imaging enhances dramatically at the reconnection site and expand into the island when approaching the small collapse and TQ, and the expansion is more significant close to the TQ. The observed turbulence enhancement near the X-point cannot be fully interpreted by the linear stability analysis by GENE. Evidences suggest that nonlinear effects, such as the reduction of local [Formula: see text] shear and turbulence spreading, may play an important role in governing turbulence enhancement and expansion. These results imply that the turbulence and its interaction with the island facilitate the stochasticity of the magnetic flux and formation of the cold bubble, and hence, the plasma disruption.

[Analysis and significance of HBV DNA below the lower detection limit of HBV RNA levels after long-term NAs antiviral therapy in patients with hepatitis B virus cirrhosis]

Objective: To analyze the significance of HBV DNA below the lower detection limit of HBV RNA levels after long-term nucleos(t)ide analogues (NAs) antiviral therapy in patients with hepatitis B virus cirrhosis. Methods: 97 cases with hepatitis B virus cirrhosis treated with NAs antiviral therapy for at least 3 years between May 2018 to July 2019 were selected. High-sensitivity HBV DNA (<20 IU/ml), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), HBsAg, HBeAg and HBV RNA at least twice every 6 months were detected. According to Child-Pugh classification, HBeAg, HBsAg level, and HBV RNA level intergroup comparison was performed. Rank sum test, χ² test and linear regression analysis were performed on the data. Results: Compared with the HBV RNA level of child-Pugh class A patients, the HBV RNA level of Child-Pugh class B+C patients were significantly higher [4.1 (0,4.9) log₁₀ copies/ml and 2.0 (0,3.5) log₁₀ copies/ml], and the difference was statistically significant (Z=2.370, P<0.05). According to different HBeAg levels, they were divided into HBeAg positive and negative group, and the quantitative comparison of HBV RNA levels between the two groups were 2.0 (0, 4.5) log₁₀ copies/ml and 1.0 (1.0, 2.0) log₁₀ copies/ml, respectively, and the difference was statistically significant (Z=3.233, P<0.05). According to different HBsAg levels, they were divided into three groups: HBsAg≤100 IU/ml, 100<HBsAg<1 000 IU/ml, and HBsAg≥1 000 IU/ml, and the quantitative comparison of HBV RNA levels among the three groups were 0 (0, 2.0) log₁₀, 2.0 (0,4.6) log_10, and 2.2 (2.0, 4.7) log₁₀ copies/ml, respectively, and the difference was statistically significant (H=11.265, P<0.05). Gender, age, ALT, AST, GGT, HBsAg, and HBeAg were included for linear regression analysis, and the HBsAg and AST levels were correlated with HBV RNA quantification (P<0.05). Adverse events occurrence during 1-year follow-up were recorded. 19 (31.7%) out of 60 cases had adverse events with detectable HBV RNA, and 3 (8.1%) out of 37 cases had adverse events with undetectable HBV RNA, and the difference was statistically significant (χ²=7.24, P<0.05). Conclusion: HBV RNA can still be detected after HBV DNA falls below the detection limit in patients with hepatitis B virus cirrhosis treated with long-term NAs antiviral therapy. HBV RNA quantification level is higher in patients with Child Pugh class B and C. Patients with detectable HBV RNA has higher proportion of adverse events, and AST and HBsAg levels may be correlated with serum HBV RNA.

[Subcutaneous nodules, mediastinal and hilar lymphadenopathy]

A 52-year old man was admitted to our hospital because of dyspnea on exertion for 2 months and subcutaneous nodules for 1 month. Chest enhanced CT showed bilateral hilar and mediastinal lymphadenopathy. Bronchial alveolar lavage fluid revealed a CD₄⁺/CD₈⁺ T cell subsets ratio of 4.3 and culture for acid-fast bacillus (AFB) was negative. The pathology of skin nodules and transbronchial needle aspiration biopsy guided by endoscopic ultrasound (EBUS-TBNA) revealed non-caseating necrotizing epithelioid granulomas with negative acid-fast bacilli staining and periodic acid-Schiff staining, which was compatible with sarcoidosis. The patient was diagnosed as sarcoidosis and glucocorticoid was administrated. The subcutaneous nodules were improved. However, the lymph nodes were enlarged instead of shrinking after 6-month therapy. The failure to respond to glucocorticoids raised the possibility of sarcoidosis complicated with tuberculosis infection. The patient received anti-tuberculosis therapy. Lymphadenopathy responded within 4 months, and there was complete regression after 18-month treatment. The patient was followed up for 5 years and repeated chest CT scan showed that the sizes of bilateral hilar and mediastinal lymph nodes were normal.

[Value of tumor growth rate in evaluating the early therapeutic efficacy of neuroendocrine neoplasm]

Objective: To determinate the value of tumor growth rate (TGR) in evaluating the efficacy of early drug treatment for neuroendocrine neoplasm (NEN). Methods: Patients with NEN who treated at Chinese Academy of Medical Sciences Cancer Hospital from January 2010 to December 2018 were retrospectively enrolled. A total of 30 patients (16 males and 14 females, aged from 26 to 73 (53±11) years) were enrolled. The sum of largest diameter of target lesions and the interval time were measured, TGR of 3 months after the first treatment was calculated using a formula. Intraclass correlation coefficient (ICC) were used to test the repeatability of TGR. Receiver operating characteristic curve (ROC) analysis was used to determine the optimal cut-off values of TGR for predicting progression-free survival (PFS). Overall patients and SD patients assessed by RECIST were grouped by the optimal cut-off values of TGR. Kaplan-Meier method was used to estimate PFS rates and plot patient survival curves of patients at different group of TGR. Cox risk proportional hazard model was used to assess the effect of TGR on the prognosis. Results: The optimal cut-off value of TGR was -5.8(%/m), the area under the curve was 0.921 (95%CI: 0.824-0.999, P<0.001). Interobserver ICC was 0.955 (95%CI: 0.907-0.978,P<0.001). Multivariate Cox analysis showed that compared with the patients with TGR<-5.8, the patients with TGR ≥-5.8 had a higher risk of progression in either overall population (HR: 10.906, 95%CI: 1.953-60.898, P=0.006) or the SD population (HR: 14.354, 95%CI: 1.602-128.627, P=0.017); TGR ≥-5.8 was an independent risk factor affecting the prognosis of NEN. Conclusions: TGR can evaluate the efficacy of NEN's early anti-tumor drug treatment, and associate with prognosis.

[Preliminary study on the method of automatically determining facial landmarks based on three-dimensional face template]

Objective: To explore the establishment of an efficient and automatic method to determine anatomical landmarks in three-dimensional (3D) facial data, and to evaluate the effectiveness of this method in determining landmarks. Methods: A total of 30 male patients with tooth defect or dentition defect (with good facial symmetry) who visited the Department of Prosthodontics, Peking University School and Hospital of Stomatology from June to August 2021 were selected, and these participants' age was between 18-45 years. 3D facial data of patients was collected and the size normalization and overlap alignment were performed based on the Procrustes analysis algorithm. A 3D face average model was built in Geomagic Studio 2013 software, and a 3D face template was built through parametric processing. MeshLab 2020 software was used to determine the serial number information of 32 facial anatomical landmarks (10 midline landmarks and 22 bilateral landmarks). Five male patients with no mandibular deviation and 5 with mild mandibular deviation were selected from the Department of Orthodontics or Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June to August 2021. 3D facial data of patients was collected as test data. Based on the 3D face template and the serial number information of the facial anatomical landmarks, the coordinates of 32 facial anatomical landmarks on the test data were automatically determined with the help of the MeshMonk non-rigid registration algorithm program, as the data for the template method to determine the landmarks. The positions of 32 facial anatomical landmarks on the test data were manually determined by the same attending physician, and the coordinates of the landmarks were recorded as the data for determining landmarks by the expert method. Calculated the distance value of the coordinates of facial anatomical landmarks between the template method and the expert method, as the landmark localization error, and evaluated the effect of the template method in determining the landmarks. Results: For 5 patients with no mandibular deviation, the landmark localization error of all facial anatomical landmarks by template method was (1.65±1.19) mm, the landmark localization error of the midline facial anatomical landmarks was (1.19±0.45) mm, the landmark localization error of bilateral facial anatomical landmarks was (1.85±1.33) mm. For 5 patients with mild mandibular deviation, the landmark localization error of all facial anatomical landmarks by template method was (2.55±2.22) mm, the landmark localization error of the midline facial anatomical landmarks was (1.85±1.13) mm, the landmark localization error of bilateral facial anatomical landmarks was (2.87±2.45) mm. Conclusions: The automatic determination method of facial anatomical landmarks proposed in this study has certain feasibility, and the determination effect of midline facial anatomical landmarks is better than that of bilateral facial anatomical landmarks. The effect of determining facial anatomical landmarks in patients without mandibular deviation is better than that in patients with mild mandibular deviation.

[Diagnostic value of surgical lung biopsies for diffuse parenchymal lung disease: the change of disease spectrum in the past 28 years in a single institution in China]

Objective: To investigate the changes of disease spectrum in diffuse parenchymal lung disease (DPLD) diagnosed by surgical lung biopsy, and to explore the diagnostic value of surgical lung biopsy in DPLD. Methods: Four hundred and fifty-five consecutive DPLD patients, who underwent surgical lung biopsy in Peking Union Medical College Hospital during the past 28 years, were analyzed retrospectively. Results: There were 211 males and 244 females. The average age at biopsy was (45±14) years. Four hundred and eleven cases (90.3%) were diagnosed by pathologic findings. Four hundred and forty-one cases (96.9%) were diagnosed by clinical-radiologic-pathologic multidisciplinary discussion. The 30-day mortality and 90-day mortality were 2.4% and 3.3% respectively. The disease spectrum included interstitial pneumonia in 209 cases (45.9%) (nonspecific interstitial pneumonia in 105 cases, usual interstitial pneumonia in 33 cases), other miscellaneous DPLD in 166 cases (36.5%) (including hypersensitivity pneumonitis in 49 cases), tumor in 39 cases (8.6%), and infectious diseases in 27 cases (5.9%). In the three consecutive periods (1993-2002, 2003-2012 and 2013-2020), the number of biopsies was 76 (16.7%), 297 (65.3%) and 82 (18%) respectively. The disease spectrum changes over time: in the above three periods, the percentage of interstitial pneumonia in DPLD was 68.4%, 45.1% and 28%, other miscellaneous DPLDs were 22.4%, 39.4% and 39.0%, the tumors were 2.6%, 7.4% and 18.3%, the infectious diseases were 5.3%, 5.1% and 9.8%. Conclusions: This study presented the changes of disease spectrum in DPLD diagnosed by surgical lung biopsy through single center real-world data, reflecting the progress of clinicians' understanding of DPLD and interstitial pneumonia. Surgical lung biopsy is still valuable for some difficult and complicated DPLD cases.

Fungal Infections Caused by Kazachstania spp., Strasbourg, France, 2007-2020

Rare fungal pathogens are emerging as agents of invasive fungal infections. We analyzed 13 cases of fungal infections caused by Kazachstania (Arxiozyma) spp. in Strasbourg University Hospital, Strasbourg, France. Among the cases, 4 patients had proven fungal disease (3 cases of invasive fungal disease and 1 mucocutaneous infection) and 9 were colonized by Kazachstania (Arxiozyma) spp. Candida albicans was also isolated from 11 of the 13 patients. None of the patients with proven invasive fungal disease met host criteria, but most had underlying diseases. All strains were identified as K. telluris by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and 3 were confirmed as K. bovina by internal transcribed spacer sequencing. For all tested strains, the MICs for fluconazole were >2 μg/mL. Emergence of this rare fungal infection might be explained by the increasing number of patients with immunocompromised conditions and gastroesophageal diseases.

[Merkel cell carcinoma: a clinicopathological study of 10 cases]

Objective: To investigate the clinicopathological features, differential diagnosis and prognosis of Merkel cell carcinoma (MCC). Methods: The clinical and pathological data of 10 patients with MCC were collected at the 940th Hospital of PLA. The histological characteristics were examined. Immunohistochemical EnVision method was used to detect thyroid transcription factor-1 (TTF1), broad-spectrum cytokeratin (CKpan), CK20, S-100, Ki-67, CD56, chromogranin A, synaptophysin and other markers in the 10 cases. Results: Intradermal MCC of the skin showed a nested, cord-like, cribriform distribution, polygonal cells, uniform size, and lack of cytoplasm. Tumor cell nuclei were large and round, with clear nuclear membranes, fine and scattered chromatin, absence of nucleoli, and mitotic figures of 10 per 50 high power fields. Among them, one patient had sarcoma and squamous cell carcinoma in situ, one patient had squamous cell carcinoma in situ, and one patient had unique cell morphology. Immunohistochemical staining showed that all cancer cells expressed CKpan, synaptophysin and CD56. There were seven cases with perinuclear dot-like positivity of CK20. Six MCCs expressed chromogranin A to varying degrees, while 2 MCCs were weakly positive for p63. The nuclear positive index in the Ki-67 hotspot area was 60%. Conclusion: The histology of MCC varies. Rendering a correct diagnosis of MCC requires adequate sampling, close correlation with clinical history and rational use of immunohistochemical staining. The treatment requires standardized surgery, postoperative radiotherapy and multimodal chemotherapy. Immunotherapy may replace the traditional treatment in the future.

[Value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging and diffusion-weighted MR imaging in predicting microvascular invasion in hepatocellular carcinoma and the prognostic significance]

Objective: To investigate the combined value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in predicting pathological microvascular invasion (pMVI) preoperatively, and to determine the relationship between prediction results and prognosis in hepatocellular carcinoma (HCC) patients. Methods: A total of 181 newly diagnosed HCC patients were enrolled in this study. Imaging characteristics and the apparent diffusion coefficient (ADC) value of DWI were analyzed. The differences of imaging characteristics and ADC values between different pMVI groups were analyzed.Multivariate logistic regression and receiver operating characteristic (ROC) curve were used to analyze the value for pMVI prediction by using significant parameters. The patients were grouped based on MRI predicted MVI (mrMVI), and the relationship between mrMVI and recurrence free survival time (RFS) was analyzed. Results: Fifty-one patients were pMVI positive and 130 patients were pMVI negative. The ADC value in pMVI positive group were (1.10±0.17)×10(-3) mm(2)/s, significantly lower than (1.27±0.22)×10(-3) mm(2)/s of pEMVI negative group (P<0.001). The incidence rates of incomplete enhancing "capsule" , non-smooth tumor margin, arterial peritumoral enhancement, mosaic architecture and peritumoral hypointensity on hepatobiliary phase (HBP) in pMVI positive group were significantly higher than those of negative group (all P<0.05). Multivariate logistic regression analysis showed that tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value were independently associated with pMVI. ROC analysis showed that the area under curve, sensitivity and specificity of pMVI predicted by combined parameters were 0.830, 76.5% and 81.5%, respectively. The median RFS of mrMVI positive group was 23.6 months, significantly lower than 38.2 months of mrEMVI negative group (P=0.004). Conclusion: Tumor margin, arterial peritumoral enhancement, peritumoral hypointensity on HBP and ADC value are independent predictors of pMVI in HCC, and mrMVI is related with RFS.

Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in North-Eastern France, March 2020

Background

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization.

Aim

Our objective was to identify risk factors predictive of severe disease and death in France.

Methods

In this prospective cohort study, we included patients ≥ 18 years old with confirmed COVID-19, hospitalised in Strasbourg and Mulhouse hospitals (France), in March 2020. We respectively compared patients who developed severe disease (admission to an intensive care unit (ICU) or death) and patients who died, to those who did not, by day 7 after hospitalisation.

Results

Among 1,045 patients, 424 (41%) had severe disease, including 335 (32%) who were admitted to ICU, and 115 (11%) who died. Mean age was 66 years (range: 20–100), and 612 (59%) were men. Almost 75% of patients with body mass index (BMI) data (n = 897) had a BMI ≥ 25 kg/m² (n = 661). Independent risk factors associated with severe disease were advanced age (odds ratio (OR): 1.1 per 10-year increase; 95% CrI (credible interval): 1.0–1.2), male sex (OR: 2.1; 95% CrI: 1.5–2.8), BMI of 25–29.9 kg/m² (OR: 1.8; 95% CrI: 1.2–2.7) or ≥ 30 (OR: 2.2; 95% CrI: 1.5–3.3), dyspnoea (OR: 2.5; 95% CrI: 1.8–3.4) and inflammatory parameters (elevated C-reactive protein and neutrophil count, low lymphocyte count). Risk factors associated with death were advanced age (OR: 2.7 per 10-year increase; 95% CrI: 2.1–3.4), male sex (OR: 1.7; 95% CrI: 1.1–2.7), immunosuppression (OR: 3.8; 95% CrI: 1.6–7.7), diabetes (OR: 1.7; 95% CrI: 1.0–2.7), chronic kidney disease (OR: 2.3; 95% CrI: 1.3–3.9), dyspnoea (OR: 2.1; 95% CrI: 1.2–3.4) and inflammatory parameters.

Conclusions

Overweightedness, obesity, advanced age, male sex, comorbidities, dyspnoea and inflammation are risk factors for severe COVID-19 or death in hospitalised patients. Identifying these features among patients in routine clinical practice might improve COVID-19 management.

[Advances in the research on the interaction between human parasites and gut microbiota]

Human parasites may interact with the microbiome parasitizing in human and mammalian intestines. The interplay between intestinal parasites and gut microbiota and its potential impacts have been widely reported; however, some parasites that do not parasitize in intestines may also affect the characteristic of gut microbiota. Hereby, we review the advances in the research on the impacts of parasites inside and outside of human intestines on the gut microbiota.

[The differential diagnosis for novel coronavirus pneumonia and similar lung diseases in general hospitals]

Novel coronavirus pneumonia was a novel coronavirus infection that has dominated pulmonary infection since December 2019. The main manifestations were fever, dry cough, shortness of breath, normal or leukopenia in peripheral blood and changes in chest CT and in severe cases, multiple organ failure might occur. The National Health Commission, PRC has revised the consensus on diagnosis and treatment seven times in a short period of time, indicating the growing understanding of the disease. Patients with novel coronavirus pneumonia usually had history of travelling or living in the epidemic area including Wuhan within 14 days before onset, or have been exposed to patients who had fever or respiratory symptoms from the epidemic area, or had clustering diseases. However, novel coronavirus pneumonia was becoming more and more blurred after vanishing epidemic. The diagnosis and differential diagnosis of novel coronavirus pneumonia were challenges not only because of large number of tourists increasing dramatically after the relieving of epidemic, but also patients with other diseases from different areas to search for medical care. In this article, the clinical and chest imaging features of the novel coronavirus pneumonia were reviewed and compared with other infections and non-infectious diffuse pulmonary diseases. We try to find the similarities and differences among them, and to identify clues to the diagnosis of novel coronavirus pneumonia, so as to ensure accurate diagnosis and treatment.

[Predictive value of quantitative dynamic contrast-enhanced magnetic resonance imaging for the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer]

Objective: To investigate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters for the efficacy of neoadjuvant chemotherapy in locally advanced gastric cancer. Methods: Sixty-five patients with locally advanced gastric cancer (LAGC) confirmed by gastroscopy and received neoadjuvant chemotherapy (NCT) were enrolled in this study. Quantitative DCE-MRI was performed before NCT, and the quantitative parameters were measured, including volume transfer constant (K(trans)), rate constant (K(ep)), volume fraction of extravascular extracellular space (V(e)) and volume fraction of plasma (V(p)). After NCT, all patients received radical gastrectomy. According to postoperative pathological tumor regression grade, patients were divided into response group and non-response group, and the differences of DCE quantitative parameters between the two groups were compared. ROC curve was utilized to analyze the predictive efficacy of DCE quantitative parameters for NCT response of LAGC, and multivariate logistic regression analysis was performed to analyze the predictive efficacy of combined parameters. Results: Thirty-seven patients were in response group and 28 patients were in non-response group. The pretreatment K(trans) in the response group were [0.216 min(-1) (0.130 min(-1), 0.252 min(-1))], significantly higher than [0.091 min(-1) (0.069 min(-1), 0.146 min(-1))] of non-response group (P<0.001), and V(e) in the response group were [0.354(0.228, 0.463)], significantly higher than [0.200(0.177, 0.253)]of non-response group (P<0.001). ROC analysis showed the AUCS of K(trans) and V(e) in predicting NCT efficacy were 0.881 and 0.756, respectively. Multiple logistic regression analysis showed that the combination of the two parameters could improve the AUC to 0.921, with the sensitivity and specificity of 86.5% and 89.3%, respectively. Conclusion: DCE-MRI quantitative parameters could help to predict the NCT response of LAGC, and the combination of parameters could improve the predictive efficacy.

InAs/GaAs quantum dot semiconductor saturable absorber for controllable dual-wavelength passively Q-switched fiber laser

We experimentally demonstrate the first use of 1550-nm InAs/GaAs quantum dot semiconductor saturable absorber mirror (QD-SESAM) in the dual-wavelength passively Q-switched (QS) erbium doped fiber (EDF) laser. The dual-wavelength QS lasing was obtained at a pump threshold of 180 mW with the average output power of 2.2 mW and the spacing between the two lasing wavelengths is 14 nm. A large absorption ranging from 1520 to 1590 nm has been realized when no substrate rotation was employed during the molecular beam epitaxy growth of the QD-SESAM indicating the potential to generate a 60 nm spacing of the dual-wavelength QS lasing peaks by changing the positions in the QD-SESAM and replacing EDF by co-doped fiber as gain medium. These results have provided a new opportunity towards achieving the stable and wide wavelength-tunable dual-modes fiber lasers.

[Effects of glutamine on skeletal muscle membrane repair in severely burned mice and the functional mechanism]

Objective: To observe how glutamine affect the skeletal muscle membrane repair in severely burned mice through promoting the mitsugumin 53 (MG53) dimerization in skeletal muscle and to explore its functional mechanism. Methods: (1) Animal experiments. A total of 179 BALB/c male mice aged 6 to 8 weeks were divided into sham injury group (n=43), burn group (n=73) and burn+ glutamine group (n=63) according to the random number table (the same grouping method below). Mice in sham injury group were sham injured on the back, and mice in burn group and burn+ glutamine group were inflicted with 30% total body surface area full-thickness scald (hereinafter referred to as burn) on the back. Mice in burn+ glutamine group were intragastrically administered with glutamine (1 mg/kg), and the other two groups were given the same amount of amino acid solution once per day for 14 days. On post burn hour 12, 10 mice from burn group were taken for preparation of burn serum, which is used in the following cell experiments. Blood samples were collected from the hearts to prepare serum from 10 mice in sham injury group immediately after burn and from 10 mice in burn group and burn+ glutamine group on post burn day (PBD) 5, 10, and 14, respectively. And then the whole gastrocnemius muscle was harvested after the mice were sacrificed. On PBD 10, the whole flexor brevis digitorum was harvested from 6 mice in the 3 groups respectively after the mice were sacrificed. On PBD 5, 10, and 14, the whole gastrocnemius muscle tissue was harvested from another 9 mice in the 3 groups respectively after the mice were sacrificed. The mass of the whole gastrocnemius muscle of mice was weighed. The total protein content of gastrocnemius muscle of mice was detected by coomassie brilliant blue method. The repair function of myolemma of flexor brevis digitorum of mice was detected by two-photon laser fiber membrane perforating. The serum content of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) of mice was determined with radioimmunoassay. The expressions of MG53 dimer and monomer in gastrocnemius of mice were determined with non-reductive electrophoresis-Western blotting. The protein expressions of endoplasmic reticulum stress sign proteins CCAAT/enhancer binding protein homologous protein (CHOP) and glucose-regulated protein 78 (GRP78) in gastrocnemius of mice were determined with Western blotting. (2) Cell experiments. Mice skeletal muscle precursor cells C2C12 were cultured in vitro, and cells of the second passage were selected for the experiments. The cells were divided into normal control group, burn serum group, and burn serum+ glutamine group, with 3 dishes in each group and 1×10(3) cells in each dish. Cells in normal control group were cultured with 1 mL Dulbecco's modified Eagle medium (DMEM) with fetal bovine serum of volume fraction 10%, cells in burn serum group were cultured with 1 mL DMEM with burn serum of volume fraction 10%, and cells in burn serum+ glutamine group were cultured with 1 mL DMEM with burn serum of volume fraction 10% and 4 μL glutamine with a final molar concentration of 8 mmol/L. After 24 hours of culturing, the repair function of myocyte membrane after differentiation of skeletal muscle precursor cells in mice was detected with the same method before. Another cells were grouped and cultured as before, with 3 wells in each group and 1×10(5) cells in each well. After 24 hours of culturing, the expressions of MG53 dimer and monomer and endoplasmic reticulum stress marker proteins in the cells were detected as before. Data were processed with analysis of variance of factorial design, one-way analysis of variance, least significant difference t test, and Student Newman Keuls test. Results: Animal experiments. (1) Compared with those in sham injury group, the mass and total protein content of gastrocnemius muscle of mice in burn group were significantly decreased on PBD 5, 10, and 14 (P<0.05). Compared with those in burn group, the mass and total protein content of gastrocnemius muscle of mice in burn+ glutamine group were significantly increased on PBD 5, 10, and 14 (P<0.05). (2) Compared with that in sham injury group (0.9±0.4), the fluorescence intensity of FM1-43 in myofiber of mice in burn group (7.8±0.4) was significantly increased on PBD 10 (t=7.75, P<0.05). Compared with that in burn group, the fluorescence intensity of FM1-43 in myofiber of mice in burn+ glutamine group (4.0±0.4) was significantly decreased on PBD 10 (t=-4.31, P<0.05). (3) Compared with that in sham injury group, the serum content of TNF-α and IL-6 of mice in burn group was significantly increased on PBD 5, 10, and 14 (P<0.05). Compared with that in burn group, the serum content of TNF-α and IL-6 of mice in burn+ glutamine group was significantly decreased on PBD 5, 10, and 14 (P<0.05). (4) Compared with 56.97±2.82, 44.89±4.72, 42.46±1.06, 14.26±0.99, 62.36±2.74, and 29.45±0.84 in sham injury group, the expressions of MG53 dimer and monomer in gastrocnemius of mice were significantly decreased in burn group on PBD 5, 10, and 14 (6.16±0.25, 26.09±1.22, 28.86±1.53, 5.63±0.25, 26.74±0.79, 4.41±0.52, P<0.05). Compared with those in burn group, the expression of MG53 dimer of gastrocnemius of mice in burn+ glutamine group was significantly increased on PBD 10 and 14 (36.79±1.44, 43.96±1.62), and the expression of MG53 monomer of gastrocnemius muscle of mice in burn+ glutamine group was significantly increased on PBD 14 (13.16±2.17, P<0.05). Compared with those in sham injury group, the protein expressions of CHOP and GRP78 in gastrocnemius muscle of mice in burn group were significantly elevated on PBD 5, 10, and 14 (P<0.05). Compared with those in burn group, the protein expressions of CHOP and GRP78 in gastrocnemius of mice in burn+ glutamine group were significantly reduced on PBD 5, 10 (P<0.05). Cell experiments. (1) Compared with that in normal control group (1.76±0.25), the fluorescence intensity of FM1-43 in cells in burn serum group (9.46±1.22) was significantly increased after 24 hours of culturing (t=12.28, P<0.05). Compared with that in burn serum group, the fluorescence intensity of FM1-43 in cells in burn serum+ glutamine group (4.71±0.45) was significantly decreased after 24 hours of culturing (t=-7.59, P<0.05). (2) The expressions of MG53 monomer of cells were similar in normal control group, burn serum group, and burn+ glutamine group after 24 hours of culturing (P>0.05). Compared with 58.5±1.8 in normal control group, the expression of MG53 dimer of cells in burn serum group was significantly decreased after 24 hours of culturing (14.1±1.4, P<0.05). Compared with that in burn serum group, the expression of MG53 dimer of cells in burn serum+ glutamine group was significantly increased after 24 hours of culturing (30.9±0.6, P<0.05). Compared with those in normal control group, the protein expressions of CHOP and GRP78 of cells were significantly elevated in burn serum group after 24 hours of culturing (P<0.05). Compared with those in burn serum group, the protein expressions of CHOP and GRP78 of cells were significantly reduced in burn serum+ glutamine group after 24 hours of culturing (P<0.05). Conclusions: Glutamine can promote MG53 dimerization by alleviating endoplasmic reticulum stress in severely burned mice. Thus it can accelerate skeletal muscle membrane repair, reduce the local inflammatory reaction of skeletal muscle and consumption of skeletal muscle.

[Effects of dexmedetomidine on cerebral oxygen saturation and postoperative revival period in elderly patients with ovarian cancer]

Objective: To observe the effects of dexmedetomidine on cerebral oxygen saturation and postoperative recovery in elderly patients with ovarian cancer. Methods: Sixty elderly patients with ovarian cancer were randomly divided into two groups. Both groups were given total intravenous anesthesia. Patients in group D were given a loading dosage of dexmedetomidine 0.5 μg/kg, followed by continuous infusion 0.2 μg·kg(-1)·h(-1) until 30 minutes before the end of operation. Group C were given normal saline at the same time. The cerebral oxygen saturation was observed and recorded before anaesthesia (T0), an hour after operation (T1), the end of operation (T2) and 30 min after tracheal extubation (T3). The time of extubation and adverse reactions such as restlessness, shivering and respiratory inhibition were observed in both groups. Results: There was no significant difference in cerebral oxygen saturation between the two groups at different time points (P>0.05), and the degree of restlessness and its incidence in group D were lower than those in group C, and the adverse reactions such as shivering were lower (P<0.05). Conclusion: Dexmedetomidine has no obvious effect on cerebral oxygen saturation in elderly patients with ovarian cancer. It can effectively prevent and reduce postoperative restlessness, does not affect recovery time, and has fewer adverse reactions.

[Experience of 14 cases using hemi-semilaminectomy microsurgery treating by spinal dural arteriovenous fistula]

Objective: To explore the efficacy and feasibility of the hemi-semilaminectomy microsurgical operation treatment of spinal dural arteriovenous fistula (SDAVF). Methods: The clinical data of 32 patients with SDAVF were analyzed retrospectively. Before operation all patients were diagnosed by spinal MRI and spinal angiography, 14 patients were treated by hemi-semilaminectomy approach and other 18 patients were by traditional laminectomy approach. All the data were analyzed by T test and P<0.05 was considered to have significant difference. Results: The nidus of SDAVF located on thoracic segments in 18 cases, lumbar segments in 12 cases, and cervical segment in 2 cases, which was fed by single artery. The hemi-semilaminectomy microsurgical operation showed shorter operation time, less bleeding, less hospitalization time and cost. All the patients followed-up for 6 months-2 years. Symptoms of all the patients were improved compared with those before surgery. Conclusions: On the premise of spinal angiography accurately positioning the location of fistula, the hemi-semi-laminectomy approach microsurgery clipping operation is safe and feasible, and the operation has fewer traumas, also helps to maintain the stability of spine.

[Clinical application of oxycodone combined with dexmedetomidine in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas]

Objective: To explore the effects of oxycodone combined with dexmedetomidine in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas. Methods: Sixty patients who underwent percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas were randomly divided into fentanyl group (group A) and oxycodone group( group B), with 30 patients in each group. Patients in group A were injected with fentanyl (2 μg/kg), and patients in group B were injected with oxycodone (0.2 mg/kg). All the patients were injected with dexmedetomidine, with a loading dose of 0.5 μg/kg for 10 minutes and a continuous infusion rate of 0.2 μg·kg(-1)·h(-1) until the end of the operation. The changes of heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO(2)) and bispectral index (BIS) were monitored at different time points: time when patients entering the operating room (T0), the beginning of operation (T1), 10 minutes after operation (T2), the end of operation (T3), 15 minutes after the end of operation (T4). The incidence of side effects (nausea and vomiting, respiratory depression and body movements) was assessed. The visual analogue scale (VAS) scores were also recorded at T0, T3 and an hour postoperatively. Results: Five patients of Group A had the body movements during the operation, and it was improved after injecting with fentanyl 2 μg/kg. Compared with T0, HR in two groups decreased significantly at T2 (P<0.05). At each time point, the difference of MAP, HR, SPO(2) and BIS was not statistically significant in two groups. The incidence of Nausea and vomiting, body movements was lower in group B than that in group A(P<0.05). The VAS scores were lower in group B than that in group A at T3 and an hour postoperatively (P<0.05). Conclusion: The combination of oxycodone and dexmedetomidine can be used safely and effectively in percutaneous ultrasound-guided radiofrequency ablation of hepatocellular carcinomas, and it shows more effective analgesia and less side-effects.

[A new method of measuring leg length discrepancy on radiograph in patients undergoing total hip arthroplasty]

Objective: To investigate the reliability of the distance between the tip of the greater trochanter and inter-teardrop line (GT-IT) in evaluating the leg length discrepancy (LLD) in patients underwent total hip arthroplasty (THA). Methods: Patients who underwent THA in Xi'an Honghui Hospital from August 2015 to February 2016 were enrolled in this study.The patients were measured for bilateral hips anterior-posterior (AP) radiograph preoperatively and postoperatively.Four distances measured, included: GT-IT, the tip of lesser trochanter and bi-ischial line (LT-BI); LT-IT and the anterior superior iliac spine and the medial malleolus (ASIS-MM). Magnification factor was considered when calculating absolute values.Intraclass correlation coefficient (ICC) was used to detect the reliability of the measurement data.Single factor analysis and paired t test were performed to compare data among the methods. Results: The ICC values of the four groups were greater than 0.80, which showed excellent agreement in the measurements.Single factor analysis of variance showed there were no statistically significant differences in the LLDs of the four groups preoperatively and postoperatively (F=0.914, 0.886, both P>0.05). There was no significant differences in preoperative and postoperative LLD between group GT-IT and group ASIS-MM, LT-BI or LT-IT(t=-1.544-1.114, all P>0.05). The LLDs were comparable between group LT-BI, ASIS-MM and LT-IT both preoperatively and postoperatively (t=1.577, 0.976, 1.344, -0.087, all P>0.05). And the LLD in group LT-IT and ASIS-MM were equivalent preoperatively and postoperatively (t=0.130, 1.063, both P>0.05). Bland-Altman plot illustrated high level of agreements between the four methods. Conclusion: Great reliability can be obtained with the GT-IT in evaluating the LLD in patients undergoing THA.

[Effect of catheter choice during embryo transfer on the clinical outcome of in vitro fertilization-embryo transfer]

OBJECTIVE

To compare two flexible embryo catheters and determine whether clinical outcome differs in the in vitro fertilization-embryo transfer (IVF-ET) cycles.

METHODS

This prospective control study was conducted by one doctor between July 2012 and November 2013. In the study, 2 064 patients undergoing fresh embryo transfer by using IVF-ET/intracytoplasmic sperm injection (ICSI)-ET in Reproductive Medical Center of Peking University Third Hospital were recruited. The subjects were divided into two groups. Cook Sydney IVF embryo transfer catheters (product model: K-JETS-7019-SIVF) were used for embryo transfer in group 1 (n=949), and Frydman-CCD catheters (product model: 131230301) were used in group 2 (n=1 115). Pregnancy outcomes were compared between these two groups.

RESULTS

There was no significant difference in age, diagnosis for infertility and stimulation protocol used between the two groups. In addition, there was no difference in the number of oocytes collected and in the number and score of embryos transferred. The significantly higher implantation rate, clinical pregnancy rate, and live birth rate (34.40% vs. 26.92%, 51.21% vs. 41.52%, 42.57% vs. 33.09%, P<0.05) were observed in group 1 compared with group 2. The abortion rate was not significantly different between the two groups (11.93% vs. 15.98%, P>0.05). The proportion of difficult transfer was higher in group 1 than that in group 2 (5.27% vs. 3.41%, P<0.05). There was no difference in the clinical pregnancy rate and live birth rate between the two difficult transfer cycles.

CONCLUSION

The type of embryo transfer catheter affects the clinical outcome in IVF. Good clinical outcome can be obtained by using Cook Sydney IVF catheter, which is worthy of clinical promotion.

[Value of perineural invasion in prostatectomy specimen in the assessment on tumor progression and prognosis]

OBJECTIVE

To assess perineural invasion in prostatectomy specimen(PNIp)on tumor progression and prognosis after radical prostatectomy.

METHODS

Retrospective analysis including 502 prostate cancer patients admitted in Renji Hospital, School of Medicine, Shanghai Jiaotong University from December 2002 to May 2014 was studied.Differences of serum prostate specific antigen(PSA), Gleason score of prostate biopsy, Gleason score of prostatectomy specimen, tumor stage, capsular invasion, positive surgical margin, seminal invasion, pelvic lymph node metastasis, nadir PSA were analyzed in patients with PNIp and without PNIp. Logistic regression analysis, Log-rank test and Cox regression analysis was used to analyzed the data, respectively.

RESULTS

There were 91 patients with PNIp(18.1%) and 411 patients without PNIp(81.9%). Differences of serum PSA, Gleason score of prostate biopsy, Gleason score of prostatectomy specimen, tumor stage, capsular invasion, seminal invasion, nadir PSA between the two groups were found(all P<0.05). In the multivariable logistic regression analysis, PNIp was independent predictor of Gleason score of prostate biopsy, Gleason score of prostatectomy specimen, tumor stage, capsular invasion(OR=1.515, 1.955, 2.069, 1.859, all P<0.05). One hundred and twenty-one patients with biochemical serum recurrence(26.7%). Serum PSA, Gleason score of prostate biopsy, Gleason score of prostatectomy specimen, tumor stage, PNIp, seminal invasion were related to biochemical serum recurrence(P<0.05). In the multivariable cox regression analysis, serum PSA, Gleason score of prostate biopsy, PNIp, seminal invasion were independent predictors of biochemical serum recurrence(HR=1.021, 1.441, 1.663, 3.257, all P<0.05).

CONCLUSION

PNIp is the important predictor of the tumor progression and prognosis of prostate cancer.

Genome-Wide Identification of the AP2/ERF Gene Family Involved in Active Constituent Biosynthesis in

Tanshinones and phenolic acids are the major bioactive constituents in the traditional medicinal crop ; however, transcription factors (TFs) are seldom investigated with regard to their regulation of the biosynthesis of these compounds. Here a complete overview of the APETALA2/ethylene-responsive factor (AP2/ERF) transcription factor family in is provided, including phylogeny, gene structure, conserved motifs, and gene expression profiles of different organs (root, stem, leaf, flower) and root tissues (periderm, phloem, xylem). In total, 170 AP2/ERF genes were identified and divided into five relatively conserved subfamilies, including AP2 (25 genes), DREB (61 genes), ethylene responsive factor (ERF; 79 genes), RAV (4 genes), and Soloist (1 gene). According to the distribution of bioactive constituents and the expression patterns of AP2/ERF genes in different organs and root tissues, the genes related to the biosynthesis of bioactive constituents were selected. On the basis of quantitative real-time polymerase chain reaction (qRT-PCR) analysis, coexpression analysis, and the prediction of -regulatory elements in the promoters, we propose that two genes ( and ) regulate tanshinone biosynthesis and two genes ( and ) participate in controlling phenolic acid biosynthesis. The genes related to tanshinone biosynthesis belong to the ERF-B3 subgroup. In contrast, the genes predicted to regulate phenolic acid biosynthesis belong to the ERF-B1 and ERF-B4 subgroups. These results provide a foundation for future functional characterization of AP2/ERF genes to enhance the biosynthesis of the bioactive compounds of .

[Research progress of Merlin protein and its signal pathway in tumor]

Hippo signaling pathway was first found in drosophila, and was proved to participate in regulatory of cell proliferation, cell apoptosis and organ size in multicellular animals. Compared with Hippo/Mst to YAP/Yki phosphorylation of the core kinase cascade, upstream the protein interaction of Hippo kinase cascade has rarely been studied. Early studies in drosophila have shown that apical membrane associated FERM domain protein Merlin and its extension may be upstream of the Hippo pathway as a signaling pathway component. Recently, increasing researches showed that Merlin protein has a close relationship with tumor occurrence. As upstream regulatory molecule and the core in Hippo signaling pathway, the mutation or deletion of Merlin can increase oncogene Yap/Yki expression, and then contribute to tumor progression. It ultimately affects the patients' prognosis. To clarify the relationship between Merlin(NF2) and malignant tumor will be helpful for the prevention and treatment of cancer. This article revivewed the latest research progress of Merlin(NF2) protein.

Do the intestinal microbiotas differ between paddlefish (Polyodon spathala) and bighead carp (Aristichthys nobilis) reared in the same pond?

AIMS

A study was conducted to compare the intestinal microbial compositions of two fish species with similar feeding strategy; paddlefish (Polyodon spathala) and bighead carp (Aristichthys nobilis) reared in the same pond.

METHODS AND RESULTS

Age-0 paddlefish and bighead carp with mean average body lengths of 43·39 ± 2·78 and 19·33 ± 3·68 cm, respectively, were reared with natural prey items in the same pond (20 m(2)). After 30 days of rearing, the intestinal microbiota of the two fish species was assessed by pyrosequencing of 16S rRNA genes. Interestingly, deviations were observed in the microbial communities of the two fish species according to the alpha- and beta-diversity measurements and detrended correspondence analysis (DCA). Shannon diversity (P = 0·015) and Pielou.evenness (P = 0·035) revealed significant lower diversity of the intestinal microbiota of paddlefish. Moreover, different core intestinal microbiota was noticed in the two fish species. Proteobacteria (57·3%), Firmicutes (11·9%), Fusobacteria (8·9%), Planctomycetes (7·3%), Actinobacteria (6·0%) and Verrucomicrobia (3·2%) were detected in bighead carp, while the dominant phyla in paddlefish intestines were Bacteroidetes (37·0%), Fusobacteria (35·1%), Firmicutes (14·8%) and Proteobacteria (12·6%).

CONCLUSIONS

Our results revealed that the intestinal microbiota differed between paddlefish and bighead carp reared in the same pond when fed similar nature food. The potential host factors, such as the genetic background, gut histology and physiology are assumed to be involved in the intestinal bacterial compositions.

SIGNIFICANCE AND IMPACT OF THE STUDY

Considering the similar feeding strategy of paddlefish and bighead carp, this study presents basic knowledge for evaluation of the importance of host factors (genetic background and gut anatomy) on intestinal microbial composition.

Comparison and Confirmation of Quantitative Trait Loci Conferring Partial Resistance to Rice Sheath Blight on Chromosome 9

Sheath blight (SB), caused by Rhizoctonia solani, is one of the worst rice (Orzya sativa) diseases worldwide. Resistance to the SB disease in rice is a complex trait controlled by quantitative trait loci (QTLs). Through map integration, we found several previously identified SB resistance (SBR) QTLs reported in inconsistent regions on the long arm of chromosome 9. Five of them were detected on 'Jasmine 85' (J85), 'Minghui 63' (MH63), and 'Lemont' (LMNT) rice and were designated qSB-9^J85-1, qSB-9^J85-2, qSB-9^MH63-1, qSB-9^MH63-2, and qSB-9^LMNT, respectively, in the present study. To further verify and physically map the five potential SBR QTLs, we introduced these SBR QTLs into a common susceptible variety (LMNT) and developed a few chromosomal segment substitution lines through marker-assisted selection. After artificial inoculation with the SB fungus, we were able to validate qSB-9^J85-2 but not the other four SBR QTLs; whereas, on MH63, an SBR QTL designated qSB-9^MH63-3 was confirmed in the region defined by markers Y83 and Y91.8 that included qSB-9^J85-2, covering approximately 1,235 kb. Both qSB-9^J85-2 and qSB-9^MH63-3 appeared to be dominant resistance genes and contributed to similar levels to SB resistance, reducing SB disease severity by approximately 1.0 on a 0-to-9 SB disease rating system. After comparing with another confirmed SBR QTL (qSB-9^TQ) from 'Teqing' rice (TQ), we conclude that qSB-9^J85-2, qSB-9^MH63-3, and qSB-9^TQ are probably controlled by the same allelic resistance genes. These results will accelerate the utilization of this major SBR QTL and its map-based cloning.

Identification of the isoamylase 3 gene in common wheat and its expression profile during the grain-filling period

In higher plants, isoamylase-type starch debranching enzyme catalyzes the α-1,6-glucosidic linkages of glycogen and phytoglycogen. We cloned an isoamylase-type starch debranching enzyme ISA3 cDNA sequence (2883 bp), designated as TaISA3, from common wheat (Triticum aestivum), using the rapid amplification of cDNA ends method. The open reading frame of TaISA3 was found to have 2331 bp, and its deduced amino acid sequence was found to share high similarity with those of other gramineous plant ISA3 proteins. It contains a putative transit peptide (68 amino acids), N-terminus domain (107 amino acids), and a catalytic domain (173 amino acids). We extracted the expressed TaISA3 protein from Escherichia coli (BL21), and measured starch isoamylase activity. During the wheat grain-filling period, transcripts of the TaISA3 gene reached a maximum level at the early developmental stage, then declined, and increased again near the final maturation stage of the grain. We confirm that the ISA3 gene is present in common wheat; it appears to play a role in starch synthesis during early and late stages of the grain-filling period.

A multi-scale view of skin thermal pain: from nociception to pain sensation

All biological bodies live in a thermal environment, including the human body, where skin is the interface with a protecting function. When the temperature is out of the normal physiological range, skin fails to protect, and the pain sensation is evoked. Furthermore, in medicine, with advances in laser, microwave and similar technologies, various thermal therapeutic methods have been widely used to cure disease/injury involving skin tissue. However, the corresponding problem of pain relief has limited further application and development of these thermal treatments. Skin thermal pain is induced through both direct (i.e. an increase/decrease in temperature) and indirect (e.g. thermomechanical and thermochemical) ways, and is governed by complicated thermomechanical-chemical-neurophysiological responses. However, a complete understanding of the underlying mechanisms is still far from clear. In this article, starting from an engineering perspective, we aim to recast the biological behaviour of skin in engineering system parlance. Then, by coupling the concepts of engineering with established methods in neuroscience, we attempt to establish multi-scale modelling of skin thermal pain through ion channel to pain sensation. The model takes into account skin morphological plausibility, the thermomechanical response of skin tissue and the biophysical and neurological mechanisms of pain sensation.

Green fluorescent protein as a visual selection marker for papaya (Carica papaya L.) transformation

Chemical-based selection for plant transformation is associated with a number of real and perceived problems that might be avoided through visual selection. We have used green fluorescent protein (GFP), as a visual selectable marker to produce transformed papaya ( Carica papaya) plants following microprojectile bombardment of embryogenic callus. GFP selection reduced the selection time from 3 months on a geneticin (G418) antibiotic-containing medium to 3-4 weeks. Moreover, GFP selection increased the number of transformed papaya plants by five-to eightfold compared to selection in the presence of antibiotics. Overall, the use of GFP for selecting transgenic papaya lines improved our throughput for transformation by 15- to 24-fold while avoiding the drawbacks associated with the use of antibiotic resistance-based selection markers.

Effects of decreasing the frequency of ventilator circuit changes to every 7 days on the rate of ventilator-associated pneumonia in a Beijing hospital

INTRODUCTION

We investigated whether decreasing ventilator circuit changes from every 2 days to every 7 days would impact ventilator-associated pneumonia rates at our institution.

METHODS

All mechanically ventilated patients at Peking Union Medical College Hospital were studied over a 21 month period. From March 1998 to February 1999, ventilator circuits were changed every 2 days, and from June through December 1999, ventilator circuits were changed every 7 days. Nosocomial pneumonia was identified using the criteria of the Centers for Disease Control.

RESULTS

In the 2-day-change group, there were 2,277 ventilator-patient days and 38 patients developed pneumonia, resulting in a pneumonia rate of 16.7 cases per 1,000 ventilator days. The 7-day-change group accumulated 972 ventilator days and 8 patients contracted pneumonia, resulting in a pneumonia rate of 8.2 cases per 1,000 ventilator days. The pneumonia rate was significantly lower in the 7-day-change group (p = 0.007). To standardize for seasonal variability, we compared results from the same seasonal time frames (June to December 1998 for the 2-day-change group, and June to December 1999 for the 7-day-change group), and obtained similar findings: during those periods, pneumonia rates were 24.2 cases per 1,000 ventilator days for the 2-day-change group and 8.9 cases per 1,000 ventilator days for the 7-day-change group (p = 0.001).

CONCLUSIONS

A circuit change interval of 7 days had a lower risk of ventilator-associated pneumonia than a 2-day change interval. Therefore, ventilator circuits can be safely changed every 7 days in our setting.

Surface chemical characterization of 2.5-microm particulates (PM2.5) from air pollution in Salt Lake City using TOF-SIMS, XPS, and FTIR

Particulate matter with a diameter of 2.5 microm collected in Salt Lake City (SLC PM2.5) was studied using TOF-SIMS (time-of-flight secondary-ion mass spectrometry), XPS (X-ray photoelectron spectroscopy), and FTIR (Fourier transform infrared spectroscopy). The high spatial resolution and high surface sensitivity of TOF-SIMS allow the surfaces of individual particulates to be analyzed. The high mass-resolution of TOF-SIMS provides good separation of signals from different chemical species at the same nominal mass, and the extremely high detection sensitivity of TOF-SIMS makes the detection of trace elements possible. Metallic elements such as Li, Na, Mg, Al, K, Ca, Cr, Mn, Fe, Cu, Zn, Cs, and Bi were detected by TOF-SIMS on the surface of SLC PM25. The uranium ion U+ together with its oxide ions UO+ and UO2+ were also found. Inorganic compounds detected include oxides, hydroxides, nitrates, sulfates, silicates, borates, chlorides, etc. Organic compounds detected include hydrocarbons, alcohols, aldehydes, ethers, carboxylic acids, amines, amides, nitriles, etc. A number of polycyclic aromatic hydrocarbons (PAH) and nitrated polycyclic aromatic hydrocarbons were detected by TOF-SIMS. High-resolution XPS Cls spectrum shows functional groups such as C-O, CO2, C-CO2, C-C, and C-H and aromatic pi-pi* shake-up transitions. High-resolution XPS O 1s spectrum indicates the coexistence of different oxygen compounds on the surface of PM2.5. FTIR results confirm the presence of various organic compounds in SLC PM2.5 detected by TOF-SIMS and XPS.

[Analysis of new type composite antioxidant by HPLC/APCI-MS]

An effective method for the analysis of a new type composite antioxidant has been developed. High performance liquid chromatography (HPLC) with diode-array detection (DAD) interfaced to atmospheric pressure chemical ionization-mass spectrometry (APCI-MS) was used. In this paper, the major components of the composite antioxidant additive were identified by means of HPLC/APCI-MS with positive/negative ion scan modes and programmable in-source collision induced dissociation and infrared(IR) spectra. The results show that this method is rapid, convenient and very useful for the analysis of lubricant additives.

Fresh and nonfibrillar amyloid beta protein(1-40) induces rapid cellular degeneration in aged human fibroblasts: evidence for AbetaP-channel-mediated cellular toxicity

Alzheimer's disease (AD) is primarily nonfamilial or sporadic (SAD) in origin, although several genetic linkages are reported. Tissues from AD patients contain fibrillar plaques made of 39 to 43 amino acid-long amyloid beta peptide (AbetaP), although the mechanisms of AbetaP toxicity are poorly understood. AbetaP(1-40) is the most prevalent AbetaP present in the neuronal and non-neuronal tissues from SAD patients. AbetaP(1-40) toxicity has been examined mainly after prolonged incubation and correlates with the age and fibrillar morphology of AbetaP(1-40). Globular and nonfibrillar AbetaPs are released continually during normal cellular metabolism; they elevate cellular Ca(2+) and form cation-permeable channels. However, their role in cellular toxicity is poorly understood. We have used an integrated atomic force and light fluorescence microscopy (AFM-LFM), laser confocal microscopy, and calcium imaging to examine real-time and acute effect of fresh and globular AbetaP(1-40) on cultured, aged human, AD-free fibroblasts. AFM images show that freshly prepared AbetaP(1-40) in phosphate-buffered saline (PBS) are globular and do not form fiber for an extended time period. AbetaP(1-40) induced rapid structural modifications, including cytoskeletal reorganization, retraction of cellular processes, and loss of cell-cell contacts, within minutes of incubation. This led to eventual cellular degeneration. AbetaP(1-40)-induced degeneration was prevented by anti-AbetaP antibody, zinc, and Tris, but not by tachykinin neuropeptides. In Ca(2+)-free extracellular medium, AbetaP(1-40) did not induce cellular degeneration. In the presence of extracellular Ca(2+), AbetaP(1-40) induced a sustained increase in the cellular Ca(2+). Thus, short-term and acute AbetaP(1-40) toxicity is mediated by Ca(2+) uptake, most likely via calcium-permeable AbetaP pores. Such rapid degeneration does not require fibrillar plaques, suggesting that the plaques may not have any causative role.

Effects of inhaled low molecular weight heparin on airway allergic inflammation in aerosol-ovalbumin-sensitized guinea pigs

Low molecular weigh, heparin (LMWH) possesses multiple nonanticoagulant properties. In the present study, we observed its anti-airway allergic inflammatory effects by bronchoalveolar lavage in guinea pigs. Guinea pigs were sensitized by repeatedly inhaling aerosolized ovalbumin. LMWH (400 u/l, 800 u/l), dexamethasone (1.2 mg/1) or vehicle (normal saline) was inhaled for 7 days. Then the animals were sacrificed under anesthesia and then lavaged with ice-cold Hank's buffer immediately; bronchoalveolar lavage fluid (BALF) was prepared 24 h after the animals were challenged by antigen exposure. The effects of LMWH on total cell counts, absolute eosinophil counts and cell catalogues in BALF were studied; effects on the activity of eosinophil peroxidase (EPO) and the contents of histamine and eosinophil cationic protein (ECP) in BALF supernatant were detected. Our results showed that compared with the vehicle group, LMWH at 400 u/l and 800 u/1 could significantly reduce total cell counts, absolute eosinophil counts and percentage of eosinophils in BALF (P<0.05 and P<0.01, respectively); LMWH at 800 u/l markedly inhibited the activity of EPO in BALF supernatant (P<0.05); LMWH at 400 u/l and 800 u/l remarkably reduced the content of histamine in BALF supernatant (P<0.05 and P<0.01, respectively), LMWH at 800 u/l decreased the content of ECP (P<0.05) significantly. It suggested that LMWH exerted anti-airway allergic inflammatory action by inhibiting infiltration of inflammatory cells and reducing release of inflammatory mediators, as well as antagonizing their activities, and that LMWH could be developed as a potential anti-bronchial asthmatic drug.

Pyoderma gangrenosum with lung injury

A 24 year old woman with airway injury, lung infiltration and pleural effusion due to pyoderma gangrenosum is reported.

Amyloid beta protein (1-40) forms calcium-permeable, Zn2+-sensitive channel in reconstituted lipid vesicles

Amyloid beta protein (A beta P) forms senile plaques in the cerebrocortical blood vessels and brain parenchyma of patients with Alzheimer's disease (AD). The nonfamilial or sporadic AD (SAD), the most prevalent form of AD, has been correlated with an increased level of 40-residue A beta P (A beta P1-40). However, very little is known about the role of A beta P1-40 in AD pathophysiology. We have examined the activity of A beta P1-40 reconstituted in phospholipid vesicles. A combined light fluorescence and atomic force microscope (AFM) was used to image the structure of reconstituted vesicles and 45Ca2+ uptake was used as an assay for calcium permeability across the vesicular membrane. Vesicles reconstituted with fresh and globular A beta P1-40 contain a significant amount of A0 beta P and exhibit strong immunofluorescence labeling with an antibody raised against the N-terminal domain of A beta P, suggesting the incorporation of A beta P1-40 peptide in the vesicular membrane. Vesicles reconstituted with A beta P1-40 exhibited a significant level of 45Ca2+ uptake. The vesicular calcium level saturated over time, showing an important ion channel characteristic. The 45Ca2+ uptake was inhibited by (i) a monoclonal antibody raised against the N-terminal region of A beta P and (ii) Zn2+. However, a reducing agent (DTT) did not inhibit the 45Ca2+ uptake, indicating that the oxidation of A beta P or its surrounding lipid molecules is not directly involved in A beta P-mediated Ca2+ uptake. These findings provide biochemical and structural evidence that fresh and globular A beta P1-40 forms calcium-permeable channels and thus may induce cellular toxicity by regulating the calcium homeostasis in nonfamilial or sporadic Alzheimer's disease.

gamma-Radiation Synthesis of the Nanocrystalline Semiconductors PbS and CuS

The nanocrystalline semiconductors PbS and CuS were prepared by gamma-irradiation at room temperature in an ethanol system for the first time. Carbon disulfide was used as the sulfur source; lead acetate and copper chloride were used as metal ion sources. X-ray Powder Diffraction was used to characterize the products and Transmission Electron Microscopy to determine their morphology. The purity and compositions of the products were examined by X-ray photoelectron spectra. The photoluminescence property of as-prepared PbS was studied. A blue shift was observed in the PL spectra, indicating the quantum size effect on nanocrystalline PbS. Copyright 1999 Academic Press.

Effects of tetramethylpyrazine, a Chinese medicine, on plasma endothelin-1 levels during acute pulmonary hypoxia in anesthetized dogs

Our study was designed to elucidate the effects of tetramethylpyrazine (TMP), a Chinese medicine, on plasma endothelin-1 (ET-1) levels in dogs with acute pulmonary alveolar hypoxia. Anesthetized dogs were used under artificial ventilation with room air or a hypoxic gas mixture (10% O2 and 90% N2) (n = 10) for 60 min. Effects of TMP (80 mg/kg) were studied by i.v. injection of TMP before exposure to hypoxia (n = 8). Mean pulmonary arterial pressure (PAPm), systemic arterial pressure (SAPm), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and heart rate (HR) were measured. The pulmonary vascular resistance (PVR) was calculated by the equation of (PAPm-PCWP) x 8/CO. Plasma ET-1 levels were determined in the abdominal aorta and pulmonary artery by RIA. The effects of TMP on PAP and plasma ET-1 level were evaluated by using percent increase in PAPm and the change of Da-pET (delta ET) before and after hypoxia. Both PAPm and PVR were significantly elevated 5 min after acute hypoxia over a period of 60 min, whereas CO and PCWP did not change. Plasma ET-1 levels in the abdominal aorta and Da-pET showed a significant increase. Administration of TMP significantly decreased the hypoxia-induced increase in the PAPm, PVR, and delta ET. These results suggest that TMP could be a useful therapeutic agent in the treatment of pulmonary hypertension induced by acute hypoxia through decrease of plasma ET-1 levels.

Wild-type p53 gene increases MDR1 gene expression but decreases drug resistance in an MDR cell line KBV200

Inactivation of p53 gene and overexpression of MDR1 gene are both associated with drug resistance. Previous studies have suggested that p53 gene can modulate the expression activity of MDR1 gene promoter in a promoter-CAT system. In the present study, wild-type p53 gene cDNA was introduced into a multidrug-resistant cell line, KBv200, in which endogenous p53 gene is aberrant. In wt-p53 transfected cells, the expression of MDRI gene was significantly increased, accumulation of adriamycin (ADM) was decreased, and the sensitivity to vincristine (VCR), ADM and 5-fluorouracil (5-FU) was increased compared with the parent KBv200 cells. After treatment with ADM and VCR, the p53-transfectants were more susceptible to apoptosis. The results suggest that the increase in drug sensitivity of the cells may be, at least in part, due to p53-dependent apoptosis induced by anticancer agents.

Strained DNA is kinked by low concentrations of Zn2+

A novel atomic force microscope with a magnetically oscillated tip has provided unprecedented resolution of small DNA fragments spontaneously adsorbed to mica and imaged in situ in the presence of divalent ions. Kinks (localized bends of average angle 78 degrees) were observed in axially strained minicircles consisting of tandemly repeated d(A)5 and d(GGGCC[C]) sequences. The frequency of kinks in identical minicircles increased 4-fold in the presence of 1 mM Zn2+ compared with 1 mM Mg2+. Kinking persisted in mixed Mg2+/Zn2+ electrolytes until the Zn2+ concentration dropped below 100 microM, indicating that this type of kinking may occur under physiological conditions. Kinking appears to replace intrinsic bending, and statistical analysis shows that kinks are not localized within any single sequence element. A surprisingly small free energy is associated with kink formation.