Effectiveness and feasibility of nerve real-time monitoring and intermittent monitoring in endoscopic thyroidectomy: A multicenter retrospective cohort study of 1621 patients.

BACKGROUND: Protecting recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN), a crucial indicator for assessing the quality of thyroid surgery, poses a challenge in endoscopic thyroidectomy. The aim of this study was to investigate the effectiveness and feasibility of nerve real-time monitoring and intermittent monitoring in endoscopic thyroidectomy. METHODS: In this retrospective cohort study, patients underwent endoscopic thyroidectomy were included, and the characteristics and outcomes of real-time monitoring and intermittent monitoring groups were compared. Thereafter, the outcomes of four surgical types (unilateral lobectomy, total thyroidectomy, unilateral lobectomy + lymph node dissection (LND), and total thyroidectomy + LND) were compared in both groups. RESULTS: A total of 1621 patients were enrolled. Compared to intermittent monitoring group, real-time monitoring group significantly shortened operation durations in the four surgical types (30.8 ± 6.1 min vs. 35.7 ± 5.7 min, 54.7 ± 4.4 min vs. 59.1 ± 5.2 min, 39.3 ± 4.6 min vs. 42.0 ± 4.7 min, 59.1 ± 4.9 min vs. 66.0 ± 5.8 min, respectively). As for surgical complications, compared to intermittent monitoring group, real-time monitoring group had lower rates of transient vocal cord paralysis among the four surgical types (0.0% vs. 3.3%, 0.0% vs. 4.0%, 0.8% vs. 3.2%, 2.8% vs. 6.7%, respectively), and lower rates of EBSLN injury (1.1% vs. 4.4%, 0.0% vs. 12.0%, 0.8% vs. 3.8%, 0.9% vs. 4.8%, respectively). Clinicopathologic characteristics and postoperative inflammatory reactions were similarly paralleled in both groups. CONCLUSION: Implementation of real-time monitoring in endoscopic thyroidectomy effectively protects the RLN and EBSLN while shortening operation duration, demonstrating its feasibility and efficacy in enhancing nerve protection and surgical efficiency.

Response of Arctic Black Carbon Contamination and Climate Forcing to Global Supply Chain Relocation.

Black carbon (BC) plays a vital role in Arctic warming. Extensive investigations have been conducted to elucidate the source-receptor relationships of BC between the Arctic and mid-/high-latitude sources. However, it is unclear to what extent source relocation under globalization could disturb Arctic BC contamination and climate forcing from anthropogenic BC emissions. Here, we show that the global supply chain (GSC) relocation featured by the southward shift of industries from high-latitude developed countries to low-latitude developing countries markedly reduces the BC burden in the Arctic using a global chemical transport model (GEOS-Chem) and a multiregional input-output analysis (MRIO). We find that Arctic annual mean BC concentration associated with the GSC relocation drops by ∼15% from the case without the GSC relocation. The total net BC level declines 7% over the entire Arctic and 16% in the European Arctic. We also observed markedly declining BC deposition as well as direct and snow albedo radiative forcing in the Arctic. We show that the Arctic BC burden would be further reduced by decreasing BC emissions in China, attributable to its emission reduction and ongoing shift of the GSC from China to southern and southeastern Asia.

Effects of African BaP emission from wildfire biomass burning on regional and global environment and human health.

The vegetation burning caused by wildfires can release significant quantities of aerosols and toxic chemicals into the atmosphere and result in health risk. Among these emitted pollutants, Benzo(a)pyrene (BaP), the most toxic congener of 16 parent PAHs (polycyclic aromatic hydrocarbons), has received widespread concerns because of its carcinogenicity to human health. Efforts have been made to investigate the environmental and health consequences of wildfire-induced BaP emissions in Africa. Still, uncertainties remain due to knowledge and data gaps in wildfire incidences and biomass burning emissions. Based on a newly-developed BaP emission inventory, the present study assesses quantitatively the BaP environment cycling in Africa and its effects on other continents from 2001 to 2014. The new inventory reveals the increasing contribution of BaP emission from African wildfires to the global total primarily from anthropogenic sources, accounting for 48% since the 2000 s. We identify significantly higher BaP emissions and concentrations across sub-Saharan Africa, where the annual averaged BaP concentrations were as high as 5-8 ng/m3. The modeled BaP concentrations were implemented to estimate the lifetime cancer risk (LCR) from the inhalation exposure to BaP concentrations. The results reveal that the LCR values in many African countries exceeded the acceptable risk level at 1 × 10-6, some of which suffer from very high exposure risk with the LCR>1 × 10-4. We show that the African BaP emission from wildfires contributed, to some extent, BaP contamination to Europe as well as other regions, depending on source proximity and atmospheric pathways under favorable atmospheric circulation patterns.

LGR5 enhances the osteoblastic differentiation of MC3T3-E1 cells through the Wnt/ß-catenin pathway.

Leucine-rich repeat-containing G-protein coupled receptor 5 (LGR5) is a Wnt-associated gene that contributes to cell proliferation and self-renewal in various organs. LGR5 is expressed in Ewing sarcoma, and LGR5-overexpressing mesenchymal stem cells promote fracture healing. However, the effects of LGR5 on osteoblastic differentiation remain unclear. The aim of the present study was to explore the function of LGR5 in osteoblastic differentiation. LGR5 was overexpressed or knocked down in the MC3T3-E1 pre-osteoblastic cell line via lentiviral transfection and its function in osteoblastic differentiation was investigated. The mRNA expression levels of the osteoblast differentiation markers alkaline phosphatase (ALP), osteocalcin and collagen type I a1 were determined, and ALP and Alizarin red staining were performed. In addition, the effects of LGR5 modulation on ß-catenin and the expression of target genes in the Wnt pathway were investigated. The results revealed that the overexpression of LGR5 promoted osteoblastic differentiation. This was associated with enhancement of the stability of ß-catenin and its levels in the cell nucleus, which enabled it to activate Wnt signaling. By contrast, the inhibition of LGR5 decreased the osteogenic capacity of MC3T3-E1 cells. These results indicate that LGR5 is a positive regulator of osteoblastic differentiation, whose effects are mediated through the Wnt/ß-catenin signaling pathway. This suggests suggesting that the regulation of LGR5/Wnt/ß-catenin signaling has potential as a therapy for osteoporosis.

Bioinspired Synthesis of Ce1-x O2:x%Cu2+ Nanobelts for CO Oxidation and Organic Dye Degradation.

Ce1-x O2:x%Cu2+ nanobelts were bioinspired, designed, and fabricated using commercial filter papers as scaffolds by adding Cu(NO3)2 in the original sol solution of CeO2 nanobelts, which display excellent catalyst properties for CO oxidation and photocatalytic activity for organic dyes. Compared with pure CeO2, CuO belts were synthesized using the same method and the corresponding Ce0.5O2:50%Cu2+ bulk materials were synthesized without filter paper as scaffolds; the synthesized Ce1-x O2:x%Cu2+ nanobelts, especially Ce0.5O2:50%Cu2+ nanobelts, can decrease the reaction temperature of CO to CO2 at 100 °C with the conversion rate of 100%, much lower than the formerly reported kinds of Ce1-x O2:x%Cu2+ catalysts. Meanwhile, the synthesized Ce1-x O2:x%Cu2+ nanobelts also display better photocatalytic activity for organic dyes. All of these results provide useful information for the potential applications of the synthesized Ce1-x O2:x%Cu2+ nanobelts in catalyst fields.

Epigallocatechin Gallate Preferentially Inhibits O6-Methylguanine DNA-Methyltransferase Expression in Glioblastoma Cells Rather than in Nontumor Glial Cells.

OBJECTIVE: O6-methylguanine (O6-meG) DNA-methyltransferase (MGMT) is a main regulator of temozolomide (TMZ) resistance in glioblastomas. Some MGMT inhibitors have been studied in clinical trials but with very little success, because their inhibiting effects were not tumor-selective, and often cause severe toxicity in normal tissues in the presence of TMZ. The goal of this study is to explore whether Epigallocatechin gallate (EGCG), a natural small molecule, could preferentially modulate MGMT in glioblastoma cells. METHODS: Two MGMT-positive glioblastoma cell lines (GBM-XD and T98G) and one nontumor glial cell culture (GliaX) were included in this study. The MGMT promoter methylation status, mRNA abundance, and protein levels were determined before and after EGCG treatment. The mechanisms were characterized. RESULTS: EGCG substantially suppressed mRNA and protein expression of MGMT, and reversed TMZ resistance in MGMT-positive GBM-XD and T98G cells via the WNT/ß-catenin pathway. EGCG prevented ß-catenin translocation into the nucleus and might directly inhibit the transcription factors TCF1 and LEF1. Meanwhile, EGCG enhanced the MGMT expression in the nontumor glial cells, through inhibition of the DNMT1 and demethylation of MGMT promoter. CONCLUSIONS: EGCG preferentially inhibits MGMT and enhances TMZ cytotoxicity in glioblastoma cells rather than in nontumor glial cells.

FM19G11 inhibits O6 -methylguanine DNA-methyltransferase expression under both hypoxic and normoxic conditions.

FM19G11 is a small molecular agent that inhibits hypoxia-inducible factor-1-alpha (HIF-1α) and other signaling pathways. In this study, we characterized the modulating effects of FM19G11 on O6 -methylguanine DNA-methyltransferase (MGMT), the main regulator of temozolomide (TMZ) resistance in glioblastomas. This study included 2 MGMT-positive cell lines (GBM-XD and T98G). MGMT promoter methylation status, mRNA abundance, and protein levels were determined before and after FM19G11 treatment, and the roles of various signaling pathways were characterized. Under hypoxic conditions, MGMT mRNA and protein levels were significantly downregulated by FM19G11 via the HIF-1α pathway in both GBM-XD and T98G cells. In normoxic culture, T98G cells were strongly positive for MGMT, and MGMT expression was substantially downregulated by FM19G11 via the NF-κB pathway. In addition, TMZ resistance was reversed by treatment with FM19G11. Meanwhile, FM19G11 has no cytotoxicity at its effective dose. FM19G11 could potentially be used to counteract TMZ resistance in MGMT-positive glioblastomas.

A novel biochar derived from cauliflower (Brassica oleracea L.) roots could remove norfloxacin and chlortetracycline efficiently.

The biochar was prepared by pyrolyzing the roots of cauliflowers, at a temperature of 500 °C under oxygen-limited conditions. The structure and characteristics of the biochar were examined using scanning electron microscopy, an energy dispersive spectrometer, a zeta potential analyzer, and Fourier transform infrared spectroscopy. The effects of the temperature, the initial pH, antibiotic concentration, and contact time on the adsorption of norfloxacin (NOR) and chlortetracycline (CTC) onto the biochar were investigated. The adsorption kinetics of NOR and CTC onto the biochar followed the pseudo-second-order kinetic and intra-particle diffusion models. The adsorption isotherm experimental data were well fitted to the Langmuir and Freundlich isotherm models. The maximum adsorption capacities of NOR and CTC were 31.15 and 81.30 mg/g, respectively. There was little difference between the effects of initial solution pH (4.0-10.0) on the adsorption of NOR or CTC onto the biochar because of the buffering effect. The biochar could remove NOR and CTC efficiently in aqueous solutions because of its large specific surface area, abundant surface functional groups, and particular porous structure. Therefore, it could be used as an excellent adsorbent material because of its low cost and high efficiency and the extensive availability of the raw materials.

Tarlov Cyst Is Correlated with a Short Broad Terminal of the Thecal Sac.

Background In clinical practice, we noted that the end section of the thecal sac is apparently different in patients with Tarlov cyst compared with that of the normal population. We conducted this clinical study based on magnetic resonance imaging (MRI). Methods Our study included 30 patients with Tarlov cyst and 30 healthy volunteers as the control. The L4, L5 cross-section areas, the L4, L5 anteroposterior diameters, and the terminal length of the thecal sac were measured from the lumbosacral spine MRI. Results The L4, L5 cross-section areas and the L4, L5 anteroposterior diameters are larger for the Tarlov cyst patients than the controls, but the terminal length of the thecal sac is shorter. Conclusion The Tarlov cyst is correlated with a short broad end of the thecal sac. Possibly, this anatomical variant is a causative factor of Tarlov cyst.

[Adsorption Characteristics of Norfloxacin by Biochars Derived from Reed Straw and Municipal Sludge].

Two types of biochars were prepared by pyrolyzing reed straw and municipal sludge at the temperature of 500 degrees C. The structure and properties of biochars were characterized by BET, scanning electron microscope (SEM), energy dispersive spectroscopy (EDS) and fourier transform infrared spectroscopy ( FTIR ). The effects of pH value, adsorption time, temperature and initial concentration of norfloxacin (NOR) on the adsorption behaviors were determined by single factor experiments, which were used to preliminarily discuss adsorption mechanism. The results showed that the adsorption of NOR onto biochars derived from reed straw and municipal sludge could reach 70% and 60% of the total adsorption within 12 h, respectively; the maximum adsorption capacities of the two biochars were 2.13 mg x g(-1) (biochar derived from reed straw) and 2.09 mg x g(-1) (biochar derived from municipal sludge). The quantities of both absorptions increased with the decreasing solution pH. The two adsorption kinetics of NOR onto biochars followed the pseudo second order kinetic equations, and adsorption isotherms fitted well with the Langmuir equations. Adsorption thermodynamics parameters such as Gibbs free energy (AG), enthalpy (AH) and entropy (AS) indicated that the two adsorptions were endothermic reactions. Infrared spectroscopy analysis indicated that oxygen-containing functional groups on biochars provided NOR molecules with adsorptive sites, which facilitated the formation of hydrogen bonds between NOR and the biochars.

Association of MSH6 mutation with glioma susceptibility, drug resistance and progression.

MutS homolog 6 (MSH6) is one of the mismatch repair proteins and is encoded by the MSH6 gene, which is located on chromosome 2 and is 23,806 bp in length, including 10 exons and 83 untranslated regions. The MSH6 protein consists of 1,358 amino acid residues and forms a heterodimer with another mismatch repair protein, MSH2. The MSH2-MSH6 heterodimeric complex is able to recognize base-base substitution and single-base insertion/deletion mismatches. Germline mutations of MSH6 lead to high susceptibility to glioma, as well as a number of benign or malignant tumors in other organs. However, somatic MSH6 mutations are not associated with susceptibility to glioma. Somatic MSH6 mutations usually follow temozolomide treatment and result in resistance to temozolomide. Subsequently, MSH6 mutations cause a hypermutation in the glioma cell genome, which may accelerate tumor progression.

Good Surgical Outcomes of Hemifacial Spasm Patients with Obvious Facial Nerve Indentation and Color Change.

OBJECTIVES: Hemifacial spasm results from vascular compression of the facial nerve. It remains controversial whether severe compression and subsequent nerve indentation predict a good or a poor surgical outcome. Here, to illustrate the relationship between the degree of neurovascular compression and surgical outcome, we conducted a retrospective case-cohort study focused on patients whose facial nerve was seriously compressed. METHODS: This study included 2 groups. The nerve-indentation group included 48 patients with hemifacial spasm whose facial nerves had obvious indentation and color change at the site of neurovascular conflict. The control group included 48 randomly selected patients with hemifacial spasm without facial nerve indentation or color change who were surgically treated by the same team during the same period. The surgical findings, intraoperative lateral spread response results, and clinical outcomes were compared. RESULTS: Single-vessel compression was found more frequently in the nerve-indentation group (87.5%) than in the control group (60.4%, P < 0.05). The lateral spread response (LSR) resolution rate of the nerve-indentation group was 91.7%, and that of the control group was 87.5% (P > 0.05). The rates at which the microvascular decompression procedure was successful were equal in the nerve-indentation and the control groups (93.8% vs. 91.7%, P > 0.05). CONCLUSIONS: Severe vascular compression and subsequent nerve indentation were correlated with a greater possibility of single compression and a lower incidence of multiple neurovascular conflicts in patients with hemifacial spasm, making the microvascular decompression procedure more accurate and easier. Therefore nerve indentation might predict good surgical outcomes.

Balloon-Assisted Fistula Sealing Procedure for Symptomatic Tarlov Cysts.

OBJECTIVE: Tarlov cyst is an abnormal expansion of the spinal nerve sleeve, and it communicates with the subarachnoid cavity via a perineural fistula. This study presents our experience of a balloon-assisted fistula sealing procedure in treating Tarlov cyst. METHODS: Twenty-two patients with symptomatic Tarlov cysts were surgically treated. An emulsion balloon was placed into the lumbar subarachnoid cistern through a trocar, so as to temporarily block cerebrospinal fluid flow, then the thecal sac was opened and the inlet of the fistula was sealed by suture of a muscular patch and reinforced by fibrin glue. Finally, the cyst wall was imbricated and the bony cavity was filled with pedicled muscle flaps. RESULTS: Comparing the preoperative and postoperative pain scores according to visual analog scale, 2 patients were slightly improved and 18 patients were substantially improved, including 3 completely pain-free cases. Only 2 patients were unchanged in pain, and both of them had multiple cysts. As a whole, the postoperative pain score was much better than the preoperative score (2.4 vs. 7.5; P < 0.01). Bladder weakness was slightly improved, and bowel dysfunction was almost unchanged after operation. During follow-up, cyst recurrence was found in 1 patient. CONCLUSIONS: The balloon-assisted fistula sealing procedure is safe and effective for Tarlov cyst, especially for the single cyst. It is a good complement to the cyst wall imbricating procedure.