The regulation of intestinal flora on host's genes may play an essential role in the development of endometrial hyperplastic processes in yang deficiency individuals.

Yang-deficiency constitution (YADC) is linked to a higher vulnerability to various diseases, such as cold coagulation and blood stasis (CCBS) syndrome and infertility. Endometrial hyperplastic processes (EHPs) are a leading cause of infertility in women and are characterized by CCBS. However, it remains unclear whether YADC is related to the development of EHPs. METHODS: We recruited 202 EHPs patients including 147 with YADC (YEH group) and 55 with non-YADC (NYEH group). Fecal samples were collected from 8 YEH patients and 3 NYEH patients and analyzed using 16S rRNA V3-V4 sequencing for gut microbiota analysis. We obtained constitution survey data and a differential gut microbiota dataset from the literature for further analysis. Bioinformatics analysis was conducted using gut microbiota-related genes from public databases. RESULTS: YADC was significantly more prevalent in EHPs than non-YADC (P < 0.001), suggesting it as a potential risk factor for EHPs occurrence (ORpopulation survey = 13.471; ORhealthy women = 5.173). The YEH group had higher levels of inflammation, estrogen, and tamoxifen-related flora compared to NYEH and healthy YADC groups. There was an interaction between inflammation, estrogen, differential flora, and EHPs-related genes, particularly the TNF gene (related to inflammation) and the EGFR gene (related to estrogen), which may play a crucial role in EHPs development. CONCLUSION: YEH individuals exhibit significant changes in their gut microbiota compared to NYEH and healthy YADC. The interaction between specific microbiota and host genes is believed to play a critical role in the progression of EHPs.

[Remediation of Three Oxidants on Polycyclic Aromatic Hydrocarbons in Coking Contaminated Soil and Its Response to Indigenous Microorganisms].

To explore the influences of chemical oxidation on the physiological and ecological functions of indigenous microorganisms during contaminated soil remediation, three oxidants, including KMnO4, Na2S2O8, and O3, were selected to investigate their remediation effects on PAHs and the responses to indigenous microorganisms under different liquid-solid ratios, in this study. The results showed that:when the ΣPAHs concentration was 679.1 mg·kg-1 and the dosage of KMnO4 and Na2S2O8 was 1%, the removal efficiency of ΣPAHs reached up to 96.9% and 95.7% under the liquid-solid ratio of 6:1; for the O3 treatment, the removal efficiency of ΣPAHs was the highest(82.3%) at the O3 dosage and the liquid-solid ratio of 72 mg·min-1 and 8:1, respectively. The removal efficiency of low ring(3-4 rings) PAHs was higher than that of high ring(5-6 rings) PAHs under different liquid-solid ratios. The highest removal efficiencies were observed for phenanthrene and acenaphthene, whereas for benzo[a]pyrene, only the KMnO4treatment provided an effective performance, showing the highest removal efficiency of 97.4%. The microbial quantity analysis indicated that the quantity of soil microorganisms in the soil dropped sharply after being treated with KMnO4, decreasing from 108 copies·g-1 to 105 copies·g-1, whereas it changed only slightly after being treated with Na2S2O8 and O3. The community structure analysis showed that Proteobacteria were predominant in the contaminated soil, with the relative abundance of 99.5%. The addition of KMnO4 and Na2S2O8 significantly increased the microbial diversity; in particular, the relative abundance of a variety of microorganisms(such as Ralstonia and Acinetobacter) that can degrade PAHs was remarkably increased. The analysis of microbial metabolic function pathways revealed that chemical oxidation could simultaneously increase the relative abundance of PAHs-degrading bacteria and improve the ability of organic metabolism. Overall, the KMnO4 treatment greatly altered the quantity of microorganisms and the structure of the microbial community and the relative abundance of PAHs-degrading microorganisms at the liquid-solid ratio of 6:1.

[Spatio-temporal Change in City-level Greenhouse Gas Emissions from Municipal Solid Waste Sector in China During the Last Decade and Its Potential Mitigation].

The waste sector is a significant source of greenhouse gas(GHG) emissions and clarifying its emission trends and characteristics is the premise for formulating GHG emission reduction strategies. Using the IPCC inventory model, the GHG emissions from the municipal solid waste(MSW) sector in China during 2010 to 2020 were estimated. The results showed that GHG emissions increased from 42.5 Mt in 2010 to 75.3 Mt in 2019, then decreased to 72.1 Mt in 2020. MSW landfills were the main source of GHG emissions. Further, with the increase in the proportion of waste incineration, the proportion of GHG incineration increased rapidly from 16.5% in 2010 to 60.1% in 2020. In terms of regional distribution, East and South China were the regions with the highest emissions, and Guangdong, Shandong, Jiangsu, and Zhejiang were the provinces with the largest GHG emissions. Implementing MSW classification, changing the MSW disposal modes from landfilling to incineration, improving the LFG collection efficiency of landfills, and using biological functional materials as the cover soil to strengthen the methane oxidation efficiency are the main measures to achieve GHG emission reduction in waste sectors.

The surgical strategy and technical nuances of in situ side-to-side bypass for the management of complex intracranial aneurysms.

Background: Despite continuous advances in microsurgical and endovascular techniques, the treatment of complex aneurysms remains challenging. Aneurysms that are dilemmatic for conventional clipping or endovascular coiling often require bypass as part of a strategy to reduce the risk of ischemic complications. In anatomically favorable sites, the intracranial-intracranial in situ bypass may be an appealing choice. This article details the surgical strategies, operative nuances, and clinical outcomes of this technique with a consecutive series in our department. Methods: A retrospective review of a prospectively maintained neurosurgical patient database was performed to identify all patients treated with side-to-side in situ bypass from January 2016 to June 2022. In total, 12 consecutive patients, including 12 aneurysms, were identified and included in the series. The medical records, surgical videos, neuroimaging studies, and follow-up clinic notes were reviewed for every patient. Results: Of the 12 aneurysms, there were 5 middle cerebral artery aneurysms, 4 anterior cerebral artery aneurysms, and 3 posterior inferior cerebellar artery aneurysms. The morphology of the aneurysms was fusiform in 8 patients and saccular in the remaining 4 patients. There were 3 patients presented with subarachnoid hemorrhage. The treatment modality was simple in situ bypass in 8 cases and in situ bypass combined with other modalities in 4 cases. Bypass patency was confirmed in all cases by intraoperative micro-doppler probe and (or) infrared indocyanine green (ICG) video angiography intraoperatively and with digital subtraction angiography (DSA) or computed tomography angiography (CTA) postoperatively. None of the patients developed a clinically manifested stroke due to the procedure though a callosomarginal artery was intentionally removed in one patient. The median follow-up period was 16.2 months (6-36). All patients had achieved improved or unchanged modified Rankin scale scores at the final follow-ups. Conclusion: Cerebral revascularization technique remains an essential skill for the treatment of complex aneurysms. The in situ bypass is one of the most effective techniques to revascularize efferent territory when vital artery sacrifice or occlusion is unavoidable. The configuration of in situ bypass should be carefully tailored to each case, with consideration of variations in anatomy and pathology of the complex aneurysms.

Inhibition of DRP1-dependent mitochondrial fission by Mdivi-1 alleviates atherosclerosis through the modulation of M1 polarization.

BACKGROUND: Inflammation and immune dysfunction with classically activated macrophages(M1) infiltration are important mechanisms in the progression of atherosclerosis (AS). Dynamin-related protein 1 (DRP1)-dependent mitochondrial fission is a novel target for alleviating inflammatory diseases. This study aimed to investigate the effects of DRP1 inhibitor Mdivi-1 on AS. METHODS: ApoE-/- mice were fed with a high-fat diet supplemented with or without Mdivi-1. RAW264.7 cells were stimulated by ox-LDL, pretreated with or without MCC950, Mito-TEMPO, or Mdivi-1. The burden of plaques and foam cell formation were determined using ORO staining. The blood lipid profles and inflammatory cytokines in serum were detected by commercial kits and ELISA, respectively. The mRNA expression of macrophage polarization markers, activation of NLRP3 and the phosphorylation state of DRP1 were detected. Mitochondrial reactive oxygen species (mito-ROS), mitochondrial staining, ATP level and mitochondrial membrane potential were detected by mito-SOX, MitoTracker, ATP determination kit and JC-1 staining, respectively. RESULTS: In vivo, Mdivi-1 reduced the plaque areas, M1 polarization, NLRP3 activation and DRP1 phosphorylation at Ser616. In vitro, oxidized low-density lipoprotein (ox-LDL) triggered M1 polarization, NLRP3 activation and abnormal accumulation of mito-ROS. MCC950 and Mito-TEMPO suppressed M1 polarization mediated foam cell formation. Mito-TEMPO significantly inhibited NLRP3 activation. In addition, Mdivi-1 reduced foam cells by inhibiting M1 polarization. The possible mechanisms responsible for the anti-atherosclerotic effects of Mdivi-1 on reducing M1 polarization were associated with suppressing mito-ROS/NLRP3 pathway by inhibiting DRP1 mediated mitochondrial fission. In vitro, similar results were observed by DRP1 knockdown. CONCLUSION: Inhibition of DRP1-dependent mitochondrial fission by Mdivi-1 alleviated atherogenesis via suppressing mito-ROS/NLRP3-mediated M1 polarization, indicating DRP1-dependent mitochondrial fission as a potential therapeutic target for AS.

Mechanism of immune attack in the progression of obesity-related type 2 diabetes.

Obesity and overweight are widespread issues in adults, children, and adolescents globally, and have caused a noticeable rise in obesity-related complications such as type 2 diabetes mellitus (T2DM). Chronic low-grade inflammation is an important promotor of the pathogenesis of obesity-related T2DM. This proinflammatory activation occurs in multiple organs and tissues. Immune cell-mediated systemic attack is considered to contribute strongly to impaired insulin secretion, insulin resistance, and other metabolic disorders. This review focused on highlighting recent advances and underlying mechanisms of immune cell infiltration and inflammatory responses in the gut, islet, and insulin-targeting organs (adipose tissue, liver, skeletal muscle) in obesity-related T2DM. There is current evidence that both the innate and adaptive immune systems contribute to the development of obesity and T2DM.

Indirect Ventral Brainstem Decompression by Posterior C1-C2 Distraction and Fixation for Basilar Invagination.

OBJECTIVE: Basilar invagination usually shows a decrease of clivus axis angle (CAA), which could give rise to progressive neural compression. Exploring a safe and effective fixation technique to achieve atlantoaxial stability and neural decompression remains necessary. In this study, we introduce a modified posterior C1-C2 distraction and fixation technique by which we obtained indirect ventral neural decompression and atlantoaxial stability in a series of patients with decreased CAA. METHODS: Thirty patients of basilar invagination were enrolled in our series. All patients underwent thin-slice computed tomography (CT) scan, magnetic resonance imaging, and dynamic plain radiography examinations before surgery, at discharge and during the follow-ups. Posterior C1-C2 facet joint release and intraoperative reduction by fastening rods were performed in all patients. The CAA was measured on midsagittal CT scans. Patients' neurologic status was evaluated by the Japanese Orthopaedic Association score. RESULTS: No neurovascular injury and serious postoperative complication occurred in all patients. Complete ventral brainstem decompression was achieved in 20 patients and partial in 10 patients. The mean postoperative CAA significantly improved to 132.6 degrees compared with the preoperative 123.6 degrees (P < 0.01). The bone fusion was confirmed in all patients on the basis of the last follow-up spine CT scans. CONCLUSIONS: Indirect ventral brainstem decompression by posterior C1-C2 distraction and fixation is a safe and effective technique for treatment of basilar invagination.

Serum exosomal microRNA-146a as a novel diagnostic biomarker for acute coronary syndrome.

BACKGROUND: Circulating microRNAs (miRNAs) have emerged as potential biomarkers for cardiovascular diseases. However, few studies have focused on the role of exosomal miRNAs in acute coronary syndrome (ACS). The purpose of this study was to explore weather serum exosomal microRNA-146a (exo-miR-146a) could be used as a novel diagnostic biomarker for ACS and to investigate its relationship with inflammatory response. METHODS: A total of 63 ACS patients and 25 patients with normal coronary arteries (Control) were enrolled respectively. The serum exosomes were isolated and then identified by transmission electron microscopy (TEM), western blot, and nanoparticle tracking analysis (NTA). The expression levels of exo-miR-146a in serum were detected by real-time quantitative polymerase chain reaction (RT-qPCR) and the expression levels of interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in serum were assessed by enzyme-linked immunosorbent assay (ELISA). Spearman's correlation analysis was used to appraise the potential factors related to serum exo-miR-146a and receiver operating characteristic (ROC) curve analysis was applied for predicting the accuracy of ACS via the area under curve (AUC). RESULTS: Exosomes isolated from serum were of typical cup-like shape, with 50-150 nm diameter, and expressed CD9, CD63, CD81, and HSP70. The expression levels of serum exo-miR-146a, IL-1ß, IL-6, and TNF-α were significantly increased in ACS patients compared with the control group, Spearman's correlation analysis indicated that exo-miR-146a expression was markedly positively correlated with IL-1ß, IL-6, and TNF-α. The ROC curve analyses revealed that exo-miR-146a could distinguish ACS patients from their normal controls. CONCLUSIONS: The serum exo-miR-146a may be used as a novel diagnostic biomarker for ACS patients, and it is also associated with inflammatory response.

Association Between Depression and Clinical Outcomes in Patients With Hypertrophic Cardiomyopathy.

Background Hypertrophic cardiomyopathy (HCM) is considered to be the most common cause of sudden death in young people and is associated with an elevated risk of mood disorders. Depression has emerged as a critical risk factor for development and progression of coronary artery disease; however, the association between depression and HCM outcomes is less clear. We sought to examine the impact of depression on clinical outcomes in patients with HCM. Methods and Results Between January 2014 and December 2017, 820 patients with HCM were recruited and followed for an average of 4.2 years. End points were defined as sudden cardiac death (SCD) events and HCM-related heart failure events. A Chinese version of the Structured Clinical Interview followed the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition and was used to diagnose depression. During the follow-up period, SCD events occurred in 75 individuals (21.8 per 1000 person-years), and HCM-related heart failure events developed in 149 individuals (43.3 per 1000 person-years). Kaplan-Meier cumulative incidence curves showed a significant association of depression disorders with SCD events (log-rank P=0.001) and HCM-related heart failure events (log-rank P=0.005). A multivariate Cox regression analysis indicated that depression was an independent predictor of SCD events and HCM-related heart failure events (41.9 versus 21.7 per 1000 person-years; adjusted hazard ratio [HR], 1.9; 95% CI, 1.6-2.3; P<0.001; and 69.9 versus 38.6 per 1000 person-years; HR, 1.8; 95% CI, 1.6-2.1; P<0.001, respectively). Conclusions Depression is common among patients with HCM. The diagnosis of depression is significantly and independently associated with an increased risk of SCD events and heart failure events in patients with HCM.

The role of pineal microRNA-325 in regulating circadian rhythms after neonatal hypoxic-ischemic brain damage.

Circadian rhythm disorder is a common, but often neglected, consequence of neonatal hypoxic-ischemic brain damage (HIBD). However, the underlying molecular mechanisms remain largely unknown. We previously showed that, in a rat model of HIBD, up-regulation of microRNA-325 (miR-325) in the pineal gland is responsible for the suppression of Aanat, a key enzyme involved in melatonin synthesis and circadian rhythm regulation. To better understand the mechanism by which miR-325 affects circadian rhythms in neonates with HIBD, we compared clinical samples from neonates with HIBD and samples from healthy neonates recruited from the First Affiliated Hospital of Soochow University (Dushuhu Branch) in 2019. We found that circulating miR-325 levels correlated positively with the severity of sleep and circadian rhythm disorders in neonates with HIBD. Furthermore, a luciferase reporter gene assay revealed that LIM homeobox 3 (LHX3) is a novel downstream target of miR-325. In addition, in miR-325 knock-down mice, the transcription factor LHX3 exhibited an miR-325-dependent circadian pattern of expression in the pineal gland. We established a neonatal mouse model of HIBD by performing double-layer ligation of the left common carotid artery and exposing the pups to a low-oxygen environment for 2 hours. Lhx3 mRNA expression was significantly down-regulated in these mice and partially rescued in miR-325 knockout mice subjected to the same conditions. Finally, we showed that improvement in circadian rhythm-related behaviors in animals with HIBD was dependent on both miR-325 and LHX3. Taken together, our findings suggest that the miR-325-LHX3 axis is responsible for regulating circadian rhythms and provide novel insights into the identification of potential therapeutic targets for circadian rhythm disorders in patients with neonatal HIBD. The clinical trial was approved by Institutional Review Board of Children's Hospital of Soochow University (approval No. 2015028) on July 20, 2015. Animal experiments were approved by Animal Care and Use Committee, School of Medicine, Soochow University, China (approval No. XD-2016-1) on January 15, 2016.

A Supplemental Technique for Preoperative Evaluation of Giant Intracranial Aneurysm.

BACKGROUND: Preoperative planning mainly relies on digital subtraction angiography (DSA) and computed tomography angiography. However, neither technique can reveal thrombi in giant intracranial aneurysms (GIAs). In this study, we aimed to reconstruct the circulating and noncirculating parts of GIAs with the time-of-flight (TOF) and motion-sensitized driven-equilibrium (MSDE) sequences with 3D Slicer to reveal an integrated presentation of GIAs, compare its accuracy, and validate the usefulness for preoperative planning. MATERIAL AND METHODS: Patients with GIAs who were treated with microsurgery in our department were included in this study. Both the TOF and MSDE sequence data for each patient were loaded into 3D Slicer for reconstruction and segmentation. The parameters measured by 3D Slicer were compared with those measured by DSA. RESULTS: The mean diameter for all GIAs was 28.7 ± 1.5 mm (range, 25.9-31.9 mm). The mean diameter for all GIAs measured by DSA and 3D Slicer was 24.46 ± 5.25 and 28.66 ± 1.48 mm, respectively (t = 4.948, p < 0.01). When only the nonthrombotic GIAs were included, the mean diameter measured by DSA and 3D Slicer was 28.69 ± 2.03 and 28.97 ± 1.79 mm, respectively (t = 1.023, p = 0.323). The mean aneurysmal volume was 8,292.6 ± 1,175.1 mm3 and the mean thrombotic volume was 3,590.0 ± 1,003.7 mm3. CONCLUSION: The MSDE sequence brings diagnostic benefits as a comparison to other MRI sequences. Reconstruction of GIAs with 3D Slicer is a low-cost, dependable, and useful supplemental technique for surgical planning.

Long noncoding RNA XIST regulates the EGF receptor to promote TGF-ß1-induced epithelial-mesenchymal transition in pancreatic cancer.

BACKGROUND: This study focuses on the lncRNA XIST (X inactive-specific transcript), an lncRNA involved in multiple human cancers, and investigates the functional significance of XIST and the molecular mechanisms underlying the epithelial-mesenchymal transition (EMT) in pancreatic cancer (PC). METHODS: Clinical specimens from 25 patients as well as 5 human PC cell lines were analyzed for XIST, YAP, and microRNA(miR)-34a by quantitative real-time PCR (qRT-PCR) and immunohistochemistry. To investigate how XIST influences cell proliferation, invasiveness, and apoptosis in PC, we performed the CCK-8 assays, Transwell assays, and flow cytometry. Luciferase reporter assays, qRT-PCR, and Western blot were applied to prove that miR-34a directly binds to XIST. RESULTS: Up-regulation of XIST and Yes associated protein (YAP) and down-regulation of miR-34a were consistently observed in the clinical specimens and PC cell lines. Silencing XIST reduced the expression of YAP and suppressed transforming growth factor (TGF)-ß1-induced EMT, while over-expression of XIST increased the expression of YAP and promoted EMT. In addition, inhibition of epidermal growth factor receptor (EGFR) hampered the XIST-promoted EMT. The results from the luciferase reporter assays confirmed that miR-34a directly targets XIST and suggested that XIST regulates cell proliferation, invasiveness, and apoptosis in PC by sponging miR-34a. CONCLUSIONS: XIST promotes TGF-ß1-induced EMT by regulating the miR-34a-YAP-EGFR axis in PC.

Draft genome sequence analysis of a high carbapenem-resistant Klebsiella quasipneumoniae subsp. quasipneumoniae strain isolated from an HIV-positive patient with pneumonia.

OBJECTIVES: The rapid spread of Klebsiella spp. is recognised as a major threat to public health owing to a rise in the number both of healthcare- and community-acquired infections. Here we report the draft genome sequence of a high carbapenem-resistant Klebsiella quasipneumoniae subsp. quasipneumoniae strain (Cln185) isolated from a human immunodeficiency virus (HIV)-positive patient with pneumonia. METHODS: Classical microbiological methods were applied to isolate and identify the strain. Genomic DNA was sequenced using an Illumina HiSeq platform and the reads were de novo assembled into contigs using CLC Genomics Workbench. The assembled contigs was annotated and whole-genome sequencing (WGS) was performed. RESULTS: WGS analysis revealed that the genome comprised a circular chromosome of 5 406 774bp with a GC content of 57.73%. Three important antimicrobial resistance genes (blaIMP-38, blaOKP-B-6 and blaDHA-1) were detected. In addition, genes conferring resistance to aminoglycosides, ß-lactams, fluoroquinolones and tetracycline were also identified. CONCLUSION: The draft genome sequence reported here will lay the foundation for future research on antimicrobial resistance and pathogenic mechanisms in K. quasipneumoniae subsp. quasipneumoniae and also will promote comparative analysis with genomic features among different sources of clinically important multidrug-resistant strains.

Effects of transverse connector on reduction and fixation of atlantoaxial dislocation and basilar invagination using posterior C1-C2 screw-rod technique.

BACKGROUND CONTEXT: The mechanical strength provided by internal fixation is crucial for maintaining reduction and facilitating bony fusion. Though satisfactory results with the C1-C2 technique have been acquired in most clinical reports, the related problems of fusion delay and pseudarthrosis still exist. To increase the chance of bony fusion, a transverse connector (TC) is frequently used to augment torsional stiffness of thoracolumbar screw/rod constructs. Nevertheless, the clinical implication of TC in the management of atlantoaxial dislocation (AAD) and basilar invagination (BI) remains largely unknown. PURPOSE: To evaluate the effects of TC application on C1-C2 screw-rod constructs based on consecutive adult patients with AAD and BI in a single institution over a 10-year period. STUDY DESIGN: A retrospective study. PATIENT SAMPLE: Patients with AAD and BI, who were treated with posterior C1-C2 screw-rod technique with or without TC usage from June 2007 to June 2017 at a single institution. OUTCOME MEASURES: The radiological measurements included the anterior atlantodental interval (AADI), posterior atlantodental interval (PADI), height of odontoid process above Chamberlain line, and cervicomedullary angle (CMA). Patients' neurologic status was evaluated with the Japanese Orthopaedic Association (JOA) score. Fusion status was evaluated at different follow-up periods. METHODS: We compared the difference of clinical, radiological, and surgical outcomes between the TC and NTC groups postoperatively. RESULTS: In total, there were 149 consecutive patients in the TC group and 168 patients in the NTC group. On average, 1.2 TCs per patient were used in the TC group. No significant differences were identified for operative time and blood loss between groups. There was also no statistical difference in the radiological measurements of AADI, PADI, Chamberlain line, and CMA between the TC and NTC groups preoperatively and postoperatively. A significantly higher JOA score was obtained in the TC group than that in the NTC group postoperatively. The fusion rates were higher in the TC group than those in the NCT group at the early stage postoperatively (3 and 6 months; p<.01). CONCLUSIONS: Use of TCs seems to improve bony fusion and neurologic outcomes in the treatment of AAD and BI with C1-C2 screw-rod technique.

Change of Anatomical Location of the Internal Carotid Artery Relative to the Atlas with Congenital Occipitalization and the Relevant Clinical Implications.

INTRODUCTION: The occipitalization of the atlas (OA) is always associated with multiplanar dislocation and olisthy of the C1 over C2 facets, which may change the anatomical relationship between the internal carotid artery (ICA) and the atlas. The purpose of this current study is to identify the location of the ICA relative to the anterior aspect of the atlas in patients with OA and define the clinical implications for screw placement. METHODS: We retrospectively reviewed the computed tomography angiography data of 86 patients with OA and 86 control subjects. Several parameters were also measured to quantitatively evaluate the mutual relationship. RESULTS: In the OA group, 25.6% of ICAs were located in area 3 and 74.4% in area 2, whereas the percentages were 57.4% and 42.6%, respectively, in the control group. There were 73 (42.4%) ICAs in which the shortest distance between the dorsal surface of the ICA and the ventral cortex of the atlas was less than 4 mm in the OA group and only 50 (29.1%) in the control group. The ideal angulation of C1 screw trajectory was about 5 degrees more medial in the OA group than that in the control group (P < 0.01). CONCLUSIONS: The risk of ICA injury is much higher in OA patients than in non-OA patients during the C1 screw placement. A mean medial angulation about 20 degrees will permit a long and safe screw purchase, but should be individualized. We recommend careful preoperative computed tomography angiography evaluation in all patients before surgery.

Three-Dimensional Evaluation and Classification of the Anatomy Variations of Vertebral Artery at the Craniovertebral Junction in 120 Patients of Basilar Invagination and Atlas Occipitalization.

BACKGROUND: Patients with basilar invagination and atlas occipitalization usually present abnormal anatomy of the vertebral arteries (VAs) at the craniovertebral junction (CVJ). OBJECTIVE: To describe and further classify different types of VA variations at the CVJ with 3D visualization technology. METHODS: One hundred twenty patients with basilar invagination and atlas occipitalization who had undergone 3-dimensional computed tomographic angiography (3D-CTA) were retrospectively studied. Imaging data were processed via the separating, fusing, opacifying, and false-coloring-volume rendering technique. Abnormal anatomy of the VA at the CVJ was categorized and related anatomic parameters were measured. RESULTS: Seven different types were classified. Type I, VAs enter the cranium after leaving VA groove on the posterior arch of atlas (26.7% of 240 sides); Type II, VAs enter an extraosseous canal created in the assimilated atlas lateral mass-occipital condyle complex before reaching the cranium (53.3%); Type III, VA courses above the axis facet or curves below the atlas lateral mass then enter the cranium (11.7%); Type IV, VAs enter the spinal canal under the axis lamina (1.3%); Type V, high-riding VA (31.3%); Type VI, fenestrated VA (2.9%); Type VII, absent VA (4.2%). Distance from the canal of Type II VA to the posterior facet surface of atlas lateral mass (5.51 ± 2.17 mm) means a 3.5-mm screw can be safely inserted usually. Shorter distance from the midline (13.50 ± 4.35) illustrates potential Type III VA injury during exposure. Decreased height and width of axis isthmus in Type V indicate increased VA injury risks. CONCLUSION: Seven types of VA variations were described, together with valuable information helpful to minimize VA injury risk intraoperatively.

The Special Considerations in the Surgical Management of Proximal Anterior Cerebral Artery Aneurysms.

BACKGROUND: Proximal anterior cerebral artery (A1) aneurysms are difficult to clip because of their frequent proximity to perforators, location behind the parent artery, or adherence to surrounding structures. METHODS: We retrospectively reviewed a consecutive series of patients with A1 aneurysms and report the clinical status, radiologic findings, treatment methods, and outcome. RESULTS: This series included 19 male and 12 female patients with a mean age of 50 years. The morphology of the A1 aneurysms was fusiform in 2 patients and saccular in the remaining 29 patients. Multiple aneurysms were presented in 9 patients (29.0%). On admission, 26 patients (83.9%) presented with subarachnoid hemorrhage, 3 of whom had an additional intracerebral hematoma. All surgeries were performed with a standard pteriomal craniotomy. The mean Glasgow Outcome Scale score at final follow-up was 4.8 (interquartile range, 5, 5), with 26 patients (83.9%) rated as 5. The mean follow-up time was 38.5 months (range, 12-60 months). CONCLUSIONS: A1 aneurysms are rare but have their own complex characteristics and are difficult to treat. Meticulous analysis of the relevant angiographs is needed for their diagnosis. An important consideration in surgery is the preservation of perforators and prevention of rupture. Wide opening of the sylvian fissure and temporary control of the parent artery can facilitate dissection of the A1 aneurysms dome. Multiple intraoperative monitoring methods, such as microvascular Doppler ultrasonography and somatosensory and motor evoked potential monitoring, can reduce the relevant complications of surgery.

Polymorphism of MTHFR 1298A>C in relation to adverse pregnancy outcomes in Chinese populations.

BACKGROUND: Adverse pregnancy outcomes (APOs) are involved in a series of abnormal pregnancies like embryo growth arrest, spontaneous abortion, premature birth, stillbirth, fetal malformation, birth defects and other pathological pregnancy, and childbirth complications. Polymorphism of methylenetetrahydrofolate reductase gene (MTHFR, 607093) is one of the main genetic causes of APO. However, there is still debate on whether MTHFR 1298A>C, rs1801131, polymorphism is related to APO. For the lack of extensive research in the Chinese population at present, the study aim to investigate the relationship between MTHFR 1298A>C polymorphism with APO through a large number of data. METHODS: A total of 241 samples from patients with APO and 117 healthy controls in Yunnan province were used for MTHFR gene polymorphism analysis, with double fluorescence quantitative polymerase chain reaction (PCR). In consideration of the low frequency of MTHFR 1298C/C genotype, which might affect the statistic results, further datasets of MTHFR 1298A>C polymorphism were collected from literature and analyzed. RESULTS: No statistical difference was detected in the frequency of MTHFR1298A>C polymorphism between two groups in Yunnan. Our data showed that the frequency of MTHFR 1298A/A genotype had the decreasing tendency among Chinese population from northern to southern, as well as eastern to western of China. The frequency of MTHFR 1298A/C and 1298C/C genotypes had the adverse tendency. The frequency of MTHFR 1298C/C genotype was significantly different between two groups in Chinese populations. The significant difference was also observed in the frequency of MTHFR 1298C/C polymorphism between two groups from central China and southern China. CONCLUSION: In summary, our data showed that MTHFR 1298C/C genotype was one of the important genetic factors of APO in China.

Biomechanical Rationale for the Development of Atlantoaxial Instability and Basilar Invagination in Patients with Occipitalization of the Atlas: A Finite Element Analysis.

OBJECTIVE: Occipitalization of the atlas (OA) often is associated with atlantoaxial dislocation and basilar invagination. The purpose of this study is to determine the biomechanical difference between normal and OA conditions in the craniovertebral junction and to further explore the rationale for development of atlantoaxial dislocation and basilar invagination using the finite element model (FEM). METHODS: A ligamentous, nonlinear, sliding-contact, 3-dimensional FEM of the occipitoatlantoaxial complex was generated. Validation of the model was accomplished by comparing kinematic predictions with experimental data. We defined the atlantooccipital joint as a tie contact to simulate the OA deformity. The range of motion and the value of the maximum Von Mises stress were compared between the intact and OA models. RESULTS: We found all of the predicted data in the intact FEM fell within 1 standard deviation of the cadaver data for all 6 loadings. The OA simulation significantly reduced the overall range of motion of the occipitoatlantoaxial complex at all loadings. The maximum Von Mises stress was predicted to increase at the transverse ligament and the superior articular facet of the axis for all the flexion, extension, lateral bending, and axial rotation loadings. CONCLUSIONS: The OA could result in hypermobility of the atlantoaxial segment and cause overstress in the transverse ligament and the lateral atlantoaxial joints. These changes explain the pathogenesis of atlantoaxial dislocation and basilar invagination associated with OA. Follow-up should be scheduled regularly due to the nature of the dynamic development of atlantoaxial dislocation and basilar invagination.

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus.

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.