Thoracic paravertebral nerve block combined laryngeal mask airway with preservation of spontaneous breathing can accelerate postoperative recovery.

OBJECTIVE: This study aimed to examine the potential benefits of Thoracic Paravertebral Nerve Block (TPVB) coupled with Laryngeal Mask Airway (LMA) and the maintenance of spontaneous breathing anesthesia, in contrast to general anesthesia utilizing double-lumen endobronchial intubation, on promoting recovery following thoracoscopic surgery. PATIENTS AND METHODS: A randomized controlled trial was carried out involving sixty patients set for Video-Assisted Thoracoscopic Surgery (VATS) at the Affiliated People's Hospital of Jiangsu University from February 2021 to January 2022. Patients were randomized to either the TPVB and LMA with spontaneous breathing anesthesia group (non-intubation group, NI group) or the general anesthesia with double-lumen endobronchial intubation group (Intubation group, I group). The primary outcome measured was the duration of hospitalization. Secondary outcomes included early postoperative rehabilitation indicators, postoperative complications, Visual Analogue Score (VAS), and inflammatory response markers. RESULTS: Patients in the NI group experienced significantly shorter hospital stays than those in the I group (p < 0.05). Early postoperative recovery, assessed by metrics including the first exhaust time, food intake time, first ambulation time, and duration of chest-tube placement, was superior in the NI group (p < 0.05). Postoperative complications such as nausea and vomiting, pulmonary infection, atelectasis, sore throat, and hoarseness, along with cortisol and C-reactive protein (CRP) levels at the end of the operation and 24 h post-operation, and VAS values within the first 12 h post-operation, were significantly lower in the NI group (p < 0.05). However, blood loss, operation time, and VAS values at 24 h and 48 h post-surgery showed no significant differences between the two groups. CONCLUSIONS: Our findings suggest that TPVB, in conjunction with LMA and spontaneous breathing anesthesia, may expedite postoperative recovery in patients undergoing VATS.

[Analysis of risk factors for gestational diabetes mellitus in elderly multipara women in the next pregnancy].

Objective: To investigate the risk factors for gestational diabetes mellitus (GDM) in elderly multipara women in the next pregnancy. Methods: A total of 219 elderly multipara women with 2 consecutive delivery records in Tianjin Binhai New Area Tanggu Obstetrics and Gynecology Hospital from January 2018 to May 2019 were included. Among them, 141 had normal glucose tolerance (NGT) and 78 of them had GDM. The clinical data of the previous and current pregnancy were collected to analyze the risk factors of GDM in elderly multipara women. Results: The average ages of 219 elderly women in previous pregnancy and this pregnancy were (31.9±2.2) and (36.7±1.5) years old, and the prevalence of GDM was 35.62% (78 cases). Compared to NGT group, GDM patients had higher fasting blood glucose(previous (5.51±1.43) vs (4.63±0.62) mmol/L; current (5.26±0.63) vs (4.59±0.30) mmol/L, 1 h blood glucose(previous (11.74±2.36) vs (9.50±1.82) mmol/L; current (11.03±2.03) vs (9.51±1.14) mmol/L) in 75 g oral glucose tolerance test (OGTT) in both previous and current pregnancy. The rates of cesarean section, in both previous and current pregnancy were higher in GDM group (previous 34.6% vs 4.3%; current 52.6% vs 22.0%). Furthermore, prenatal weight and body mass index (BMI) of the previous pregnancy, pre-pregnancy weight and BMI, and prenatal BMI of this pregnancy were also higher in GDM group, and the differences were all statistically significant (all P<0.05). Logistic multivariate regression analysis indicated cesarean section history (OR=10.80, 95%CI: (4.09-28.54)), GDM history of previous pregnancy (OR=10.64, 95%CI: (4.02-28.20)), 75 g OGTT fasting blood glucose≥ 4.86 mmol/L (OR=2.70, 95%CI: (1.27-5.70)), 1 h blood glucose after glucose administration ≥ 8.45 mmol/L (OR=1.78, 95%CI: (1.37-2.31)) were risk factors for GDM in elderly multipara women of this pregnancy. Conclusion: The risk of GDM in elderly multipara women with a history of cesarean section and GDM increases significantly. Results of OGTT in previous pregnancy also has predictive value.

[Influence of base materials on stress distribution in endodontically treated maxillary premolars restored with endocrowns].

OBJECTIVE: To evaluate the influence of base materials on stress distribution in endodontically treated maxillary premolars restored with endocrowns using three-dimensional finite element analysis. METHODS: A maxillary second premolar was scanned by Micro-CT and a three-dimensional finite element model of ceramic endocrown with 1 mm thickness of base was established. A model without base was also established as a negative control. Four kinds of conventional base materials with different elastic modulus were adopted: light cure glass ionomer(3M Vitrebond, 3 657 MPa), flowable composite resin(3M Filtek Z350XT Flowable Restorative, 7 300 MPa), high strength glass ionomer(GC Fuji Ⅸ, 13 130 MPa), and posterior composite resin(3M Filtek P60, 19 700 MPa). With a 200 N force loaded vertically and obliquely, the distribution and magnitude of stress in the tooth tissue and adhesive layer were investigated by three-dimensional finite element analysis. RESULTS: The maximum von Mises stress values(vertical/oblique) in dentin and adhesive layer were measured as follows: (1) no base material: 19.39/70.49 MPa in dentin and 6.97/17.97 MPa in adhesive layer; (2) light cure glass ionomer: 19.00/69.75 MPa in dentin and 6.87/16.30 MPa in adhesive layer; (3) flowable composite resin: 18.78/69.33 MPa in dentin and 6.79/16.17 MPa in adhesive layer; (4) high strength glass ionomer: 18.71/69.20 MPa in dentin and 6.74/16.07 MPa in adhesive layer; (5) posterior composite resin: 18.61/69.03 MPa in dentin and 6.70/16.01 MPa in adhesive layer. Under the same loading condition, models with different elastic moduli of base materials had similar stress distribution patterns. The von Mises stress of tooth tissue was mainly concentrated in the tooth cervix. Under oblique load, the regions where von Mises stress concentrated in were similar to those under a vertical load, but the values increased. The stress concentration in the tooth cervix was alleviated in models with base materials compared with the model without base material. The maximum von Mises stress in the tooth tissue and adhesive layer decreased when the elastic modulus of base materials increased and got close to that of dentin. CONCLUSION: The posterior composite resin of which the elastic moduli is high and close to that of dentin is recommended as base material for premolar endocrowns to alleviate the concentration of stress in tooth cervix and adhesive layer.

[Clinical features and prognosis of patients with leptomeningeal metastases].

Objective: To describe the clinical manifestations, neuroimaging, cerebrospinal fluid(CSF) cytology and prognosis of Leptomeningeal metastases(LM). Methods: The clinical manifestations, imaging features and CSF cytology of LM patients admitted to Henan Provincial People's Hospital from May 1, 2015 to May 31, 2020 were retrospectively analyzed. The overall survival (OS) was evaluated by the time from the diagnosis of LM to death. Results: A total of 88 patients with LM were enrolled in the study, and the median age was 59 years (range:28-78 years). There were 42 males (47.7%) and 46 females (52.3%). According to the pathological classification, it was lung cancer in 58 cases (65.9%), gastric cancer in 13 cases (14.8%), breast cancer in 7 cases (8.0%), melanoma in 1 case, esophageal cancer in 1 case, gallbladder cancer in 1 case, renal cell carcinoma in 1 case, double source cancer in 2 cases, and unknown source in 4 cases. The median Karnofsky Performance Scale (KPS) score was 50. LM was the initial manifestation of cancer in 34 patients. All patients had LM-related clinical symptoms, including headache in 73 cases (83.0%), nausea and vomiting in 63 cases (71.6%), abnormal physical and mental behaviors in 37 cases (42.0%), seizure in 41 cases (46.6%). Cranial nerve involvement was observed in 23 patients (39.0%) and spinal nerve involvement in 20(33.9%). There were 61 patients (83.6%) who showed neuroimaging features of LM. Tumor cells or atypical cells were found in 90.8% of patients for the first time, and activated monocytes in 47 cases (54.7%). The median OS was 13.0 weeks (95%CI:2.9-23.1) with the 1-year survival rate of 19.1%. Univariate analysis of survival indicated that lung cancer, lower KPS score, tyrosine kinase inhibitors (TKIs) and whole brain radiotherapy were favorable predictors of survival (P<0.05). Conclusions: The overall prognosis of LM is poor. Good physical condition, TKIs treatment and whole brain radiotherapy might improve clinical outcomes of LM patients.

[The early and midterm results of coronary endarterectomy combined with coronary artery bypass grafting for diffuse coronary artery stenosis].

Objective: To examine the early and mid-term results of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) in the treatment of diffuse coronary artery stenosis. Methods: The clinical data and follow-up results of 248 patients who underwent CE+CABG surgery from January 2010 to January 2019 at Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University was analyzed retrospectively. There were 201 males and 47 females, aged (65.6±8.5) years (range: 43 to 79 years). The on-pump group included 156 patients and the off-pump group included 92 patients. CABG was performed after CE. CE was performed on 248 patients who represented 269 target coronary lesions, of which 108 were located on the left anterior descending artery and sub-branches, 140 were located on the right coronary artery and sub-branches, and 21 were located on the left circumflex artery and obtuse marginal artery. A total of 872 bypass grafts were performed, including 248 left internal thoracic arteries, 48 radial arteries, and 576 great saphenous veins, with (3.5±0.8) grafts (range:2 to 6 grafts) per patient.The grafts had satisfactory bridge blood flow after CE, with the graft flow rates of (26±8) ml/min (range: 13 to 59 ml/min) and the pulsatility index value of 3.1±0.8 (range: 2.0 to 6.7). The t test and χ2 test was used to compare the surgical results and graft patency rate between patients in on-pump and off-pump group, respectively. Results: The number of graft vessels of on-pump group and off-pump group was 3.6±0.9 and 3.2±0.7, respectively(t=1.637, P=0.085). There were 3 deaths during the perioperative period, with a mortality rate of 1.2%. Two people died of renal failure, and one case was due to postoperative refractory low cardiac output. Perioperative myocardial infarction occurred in 9 cases. The follow-up time was (41.8±21.4) months (range:1 to 68 months). The all graft patency rate was 78.4%(812/232) in 1 year and 69.8%(162/232) in 3 years postoperatively. The left coronary graft patency rate was significantly higher than the right coronary graft patency rate(1-year: 87.4% vs.73.1%, χ²=6.533, P=0.011, 3-year: 78.2% vs. 64.8%, χ²=4.588, P=0.032). There was no significant difference in graft patency rates between the on-pump group and off-pump group (1-year: 80.0% vs. 76.9%, χ²=0.277, P=0.599, 3-year:71.5% vs. 67.9%, χ²=0.300, P=0.584). Conclusions: CE+CABG is a safe and feasible technique for patients with diffuse coronary artery disease to get more satisfied complete revascularization, with good early and medium-term results and graft patency rates. The outcomes of on-pump or off-pump CE+CABG are similar.

[Clinical analysis of surgical treatment of post-infarction left ventricular aneurysm: a series of 254 patients].

Objective: To examine the efficacy of two surgical procedures on post-infarction left ventricular aneurysm. Methods: The clinic data of 254 patients with post-infarction left ventricular aneurysm, who underwent surgical ventricular reconstruction between January 1997 and December 2019 in Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University was analyzed retrospectively. There were 183 males and 71 females aged from 31 to 81 years, with a median age of 64.6 years. Based on the size of the ventricular aneurysm, there were 73 patient received linear reconstruction (linear group) and 181 patients received endoventricular patch plasty technique (patch plasty group). Ejection fraction, left ventricular systolic and end diastolic volume and left ventricular systolic and end diastolic volume index were recorded preoperatively, 2-week, 3-month, 1-year and 5-year after operation. The survival curves were plotted with Kaplan-Meier method and the survival rates were compared by Log-rank test. Results: All patients underwent surgery with a mean cardiopulmonay bypass duration of (92±32) minutes (44 to 196 minutes) and aortic cross clamp duration of (67±22) minutes (33 to 152 minutes).There were 9 perioperative deaths with a mortality rate of 3.5%. Angina pectoris of other cases are relief and heart function improved greatly. Five years after operation, the percentage of cardiac function (New Yord Heart Association) class Ⅲ to Ⅳ patients decreased from 96.1%(244/254) to 9.9%(16/161). There was no significant difference in survival rate between linear group and patch plasty group at 1-, 3-, 5-years postoperatively (96%, 91%, 77% vs. 96%, 90%, 79%, P=0.562). Ejection fraction increased from (39±10)% (range: 22% to 50%) preoperatively to (46±6)% (range: 39% to 54%) 1-year postoperatively in the linear group, while increased from (38±13)% (range: 26% to 51%) preoperatively to (50±6)% (range: 39% to 55%) in the patch plasty group. Conclusions: Left ventricular reconstruction is quite effective for patients with post-infarction left ventricular aneurysm. The choice of operative approaches is determined by the size and range of ventricular aneurysm. Both linear reconstruction and endoventricular patch plasty technique can got similarly surgical outcomes with near and late curative effect.

[The study of exposure levels of dioxin-like compounds in cord blood of newborns in an e-waste dismantling area in Guangdong Province].

Objective: To study the pollution status of polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCB), polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in cord blood of newborns in an e-waste dismantling area of Guangdong Province. Methods: We recruited 20 eligible mothers and newborns who could meet the inclusion criteria in local hospitals of Guiyu in 2007. The inclusion criteria included directly engaged in dismantling e-waste during pregnancy and within 1 year before pregnancy; living in the e-waste dismantling workshops or the distance between living place and the e-waste dismantling areas was ≤200 m; the father of newborn was directly engaged in electronic waste dismantling for more than 1 year; the frequency of visiting the e-waste dismantling workshop during pregnancy was ≥3 times in a week. Questionnaires and physical examinations were performed on maternal and neonatal, and cord blood was collected from newborns to detect PCDD/Fs, PCB and PBDE. The concentration level of organic pollutants was corrected by the blood lipid content, and the total toxicity equivalent was calculated. The correlation between three compounds was analyzed by Spearman correlation. Results: The mothers of the 20 newborns were (23.45±3.27) years old and lived for more than 5 years. The number of one parent engaged in e-waste dismantling, the mother or father smoking, and parent engaged in e-waste dismantling work were 3, 13, 15 and 19, respectively. The weight of newborns ranged from 2.5 to 3.6 kilogram and the Apgar score was 10 points. No adverse birth outcomes such as preterm birth, malformation or stillbirth were found. The median (maximum, minimum) concentration of PCBs, PCDD/Fs and PBDEs in cord blood were 263.22 (328.29, 244.19), 38.42 (147.49, 12.68), 39.33 (265.11, 14.81) pg/g lipid, respectively. The median (maximum, minimum) of toxic equivalence concentrations of PCDD/Fs and PCB were 3.94 (9.24, 2.69) and 15.95 (26.64, 9.28) pg TEQ/g lipid. PBDE, the proportion of PBDE, PCB and PCDD/Fs in cord blood was 50.41%, 49.25% and 0.34%, respectively. PCBs and PBDEs were positively correlated (r=0.733, P=0.039). Conclusion: The high concentrations of PCDD/Fs, PCB, and PBDE were detected in the e-waste dismantling area. It is recommended that the risk of such substances on the health of local people should be assessed in a timely manner.

Investigation of serum miR-411 as a diagnosis and prognosis biomarker for non-small cell lung cancer.

OBJECTIVE: Biomarkers in blood have become increasingly appreciated in the diagnosis and prognosis of non-small cell lung cancer (NSCLC). The purpose of the current study was to explore potential diagnostic and prognostic value of serum miR-411 in NSCLC patients. PATIENTS AND METHODS: 153 patients with NSCLC and 75 healthy controls were enrolled in the study. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was performed to determine the expression level of serum miR-411 in NSCLC patients and healthy controls. The association of miR-411 expression with clinicopathological factors or the prognosis of NSCLC patients was also analyzed. Patient survival was determined by telephone interview, and survival curves were plotted by using the Kaplan-Meier method and compared by the Log-rank test. Receiver operating characteristic curves was used to evaluate the sensitivity and specificity of serum miR-411. RESULTS: Our data showed that serum miR-411 levels were significantly greater in NSCLC patients than healthy controls (p < 0.001). High serum miR-411 expression was significantly associated with TNM stage (p = 0.018), lymph node status (p = 0.006) and differentiated degree (p < 0.015). Kaplan-Meier analysis showed that high serum miR-411 expression levels predicted poor survival (p = 0.0053). The area under the curve (AUC) of high expression of serum miR-411 to diagnose NSCLC was 0.835 (95% CI: 0.737-0.933, p < 0.001). Univariate and multivariate analyses suggested that high expression of miR-411 was an independent poor prognostic indicator for NSCLC patients. CONCLUSIONS: The present results suggested that detection of serum miR-411 levels may have clinical potentials as a non-invasive diagnostic/prognostic biomarker for NSCLC patients.

[Co-culture with endometrial stromal cells promotes the differentiation of menstrual blood-derived mesenchymal stem cells into endometrial epithelial cells].

Objective: To study the potential of differentiation of menstrual blood-derived mesenchymal stem cells (MenSC) into endometrial epithelial cells (EEC) in vitro. Methods: Endometrial stromal cells (ESC) and MenSC were cultured and identified by certain methods.MenSC were co-cultured with ESC, added 10 ng/ml TGF-ß1, 10 ng/ml EGF, 10 ng/ml PDGF-BB and 1×10(-7) mol/L 17-ß-estradiol.The expression of cytokeratin, which was marker of EEC, was tested by immunofluorescence in differentiated MenSC. Results: MenSC proliferated quickly in vitro, and showed fusiform shape and clear structure within 10 generations.The expression rate of superficial markers of MenSC, CD44, CD90, CD73, and CD29, were 98.4%, 90.77%, 94.75% and 97.01% respectively.The expression of vimentin, which was stromal marker, was positive in cultured ESC (P3). After co-cultured with ESC for 3 weeks, MenSC morphology changed from fibroblast-like cells into epithelial-like cells.Immunofluorescence assay showed that the differentiated MenSC expressed cytokeratin. Conclusion: Under the condition of co-culture with ESC, MenSC has the ability to differentiate into endometrial epithelial cells. Cell growth factor and estrogen play the important roles in this process.

[Efficacy of mitral valve repair versus replacement in severe ischemic mitral regurgitation].

Objective: To compare the mortality, survival rate and the therapeutic efficacy between mitral valve repair and replacement as treatment for severe ischemic mitral regurgitation (IMR), and explore the middle- and long-term outcomes. Methods: Between January 2000 and January 2016, 378 patients with severe IMR underwent coronary artery bypass grafting (CABG) combined with mitral valve repair (n=162) or mitral valve replacement (n=216) in the Department of Cardiovascular Surgery of Nanjing First Hospital. Clinical data, in-hospital morbidity and mortality of patients were retrospectively reviewed. The patients were followed up for the long term survival rate, heart function and re-admission. Results: No statistically significant differences of baseline data and operation details were found between the two groups except for left ventricular end-diastolic diameter[(61.3±10.2)mm in replacement group vs (56.2±9.0)mm in repair group, P<0.001]. Seven patients died during the perioperative period, with a total operation mortality of 1.9%.No significant difference of mortality was found between the two groups (5 cases in the replacement group and 2 cases in the repair group). The early outcome after the surgery showed that the rate of low cardiac output and ventricular arrhythmia of patients were significantly higher in the replacement group compared with the repair group (both P<0.05). The mortality of patients received mitral valve replacement was better than who received mitral valve repair when left ventricular end-diastolic diameter was over 65 mm (5.9% vs 10.0%, P=0.036). No significant differences were observed between the two groups in the middle- and -long term survival rate (87% for replacement group vs 85% for repair group, P=0.568). The follow-up time was 1-85 (52.8±21.5) months and the follow-up rate was 93%. The rate of valve-related complications was significantly higher in the repair group compared with the replacement group (8.82% vs 3.82%, P=0.003). Conclusions: We should choose the surgical methods carefully (replacement or repair) for severe IMR patients according to degree of left ventricular remodeling and pathological changes of mitral valve. Mitral valve replacement with preservation of the subvalvular apparatus is a safe and effective surgical alternative for mitral valve repair, especially for patients with complications or complex reflux.

[Accuracy of CT colonography for the detection of colorectal neoplasm: a subgroup Meta-analysis].

Objective: To assess the accuracy of computed tomographic colonography (CTC) for detection of colorectal neoplasm. Methods: Publications prior to January 2016 from the Medline, Embase, CNKI, WANFANG, and VIP literature databases were systematically reviewed. A QUADAS checklist was used to assess the quality of the studies. According to the sizes of tumor (≥6 mm or ≥10 mm), diagnostic test accuracy indexes (area under the curve, sensitivity and specific) were pooled and stratified. Spearman correlation and curve of summary receiver operating characteristic (SROC) were applied to comprehensively assess the threshold effect. A bi-variate mixed-effects model was used for testing the overall merging value and heterogeneity. Results: A total of 19 articles (n=11 540) were included in the analysis. A total of 18 studies were from Europe and Unite States, with 1 from Asia. Numbers of studies regarding information on general population, high-risk groups and clinical symptoms were 9, 5 and 5, respectively. In 19 articles, data on the accuracy of CTC diagnosis (≥6 mm group) was recorded, with another 17 on the group ≥10 mm. Area under the SROC curve in the ≥6 mm group was 0.92 (95% CI: 0.92-0.94). It was estimated that the pooled sensitivity and specificity were 0.80 (95% CI: 0.73-0.86) and 0.89 (95% CI: 0.86-0.92) respectively. In area under the SROC curve, the pooled sensitivity and specificity in ≥10 mm group were 0.87(95%CI:0.80-0.92), 0.97(95%CI:0.95-0.98), respectively. Results from the subgroup showed that the sensitivity of with or without the fecal tagging groups were 0.84 and 0.67 in the ≥6 mm group, 0.92 and 0.76 in the ≥10 mm group. It was also found that in the experienced or less experienced readers, rates of sensitivity were 0.83 and 0.75 in the ≥6 mm group, 0.91 and 0.79 in the ≥10 mm group. Conclusions: CTC had high diagnostic efficiency for colorectal neoplasm, especially in the ≥10 mm group. Fecal tagging and experience of the reasers can improve the diagnostic sensitivity.

Detection methods of Cyprinid herpesvirus 2 infection in silver crucian carp (Carassius auratus gibelio) via a pORF72 monoclonal antibody.

Cyprinid herpesvirus 2 (CyHV-2) is the main pathogen responsible for causing haematopoietic necrosis disease in Carassius auratus gibelio. Although many nucleic acid-based diagnostic methods have been applied, no stable and sensitive immunological diagnostic approaches have been reported. In this study, to detect CyHV-2 in clinical samples using immunological methods, recombinant ORF72 protein (pORF72), encoded by the CyHV-2 ORF72 gene, was used as a capture antigen to identify blood and tissues infected with CyHV-2. First, ORF72 gene was amplified from the CyHV-2 genome and cloned into a PGEX-4t-3 expression vector to produce pORF72 in Escherichia coli. The purified pORF72 was used as an immunogen to prepare monoclonal antibodies. The Western blotting assays revealed that the monoclonal antibody could specifically identify the pORF72. Furthermore, an immunohistochemical protocol and a blood smear method were established to detect CyHV-2 in carps. The results indicate that the monoclonal antibody against pORF72 could be utilized as an effective detection tool for haematopoietic necrosis disease in Carassius auratus gibelio.

[Late reoperations after repaired Stanford type A aortic dissection].

Objective: To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection. Methods: From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years. In these patients, first time operations were ascending aorta replacement procedure in 3 patients, ascending aorta combined with partial aortic arch replacement in 4 patients, aortic root replacement (Bentall) associated with Marfan syndrome in 3 patients, aortic valve combined with ascending aorta replacement (Wheat) in 1 patient, ascending aorta combined with Sun's procedure in 1 patient, Wheat combined with Sun's procedure in 1 patient, Bentall combined with Sun's procedure in 1 patient. The interval between two operations averaged 0.3 to 10.0 years with a mean of (4.8±3.1) years. The reasons for reoperations included part anastomotic split, aortic valve insufficiency, false aneurysm formation, enlargement of remant aortal and false cavity. The selection of reoperation included anastomotic repair, aortic valve replacement, total arch replacement and Sun's procedure. Results: Of the 14 patients, the cardiopulmonary bypass times were 107 to 409 minutes with a mean of (204±51) minutes, cross clamp times were 60 to 212 minutes with a mean of (108±35) minutes, selective cerebral perfusion times were 16 to 38 minutes with a mean of (21±11) minutes. All patients survived from the operation, one patient died from severe pulmonary infection 50 days after operation. Three patients had postoperative complications, including acute renal failure of 2 patients and pulmonary infection of 1 patient, and these patients were recovered after treatment. Thirteen patients were finally recovered from hospital. The patients were followed up for 16 to 45 months, and no aortic rupture, paraplegia and death were observed in the follow-up. Conclusions: Patients for residual aortic dissection after initial operations on Stanford type A aortic dissection should be attached great importance and always need emergency surgery, but the technique is demanding and risk is great for surgeons and patients, which need enough specification and accurate on aortic operation. More importantly, the Sun's procedure also should be performed on the treatment of residual aortic dissection or distal arch expansion, and obtains the short- and long-term results in the future.

[Mutation screening for the causative gene in a four-generation Chinese pedigree with progressive cardiac conduction defect].

OBJECTIVE: To define the potential causative gene mutation in a Chinese pedigree with progressive cardiac conduction defect (PCCD). METHODS: Sanger sequencing was performed to define potential causative gene mutation in a four-generation family with 68 members including seven PCCD patients (5 male) from 2010 to 2015.No causative gene was detected by screening known candidate genes related to PCCD including SCN5A, NKX2.5 and LMNA.High-throughput sequencing technology on exon-enriched DNA was then used to search the causative genes in 2 patients and one normal family member. RESULTS: Eight new non-synonymous single nucleotide variants including AQP7 gene (exon5: c.T343C: p.Y115H), CACNA1B gene (NM_001243812: exon19: c.A2986G: p.T996A), CATSPERB gene (exon27: c.C3254G: p.P1085R), CLCA2 gene (exon11: c.G1725T: p.W575C), CLCA3P gene (ncRNA_intronic), MYLK-AS1 gene (ncRNA_intronic), TTN gene (ncRNA_UTR3), LMNA gene (LMNA: NM_170708: exon5: c.C922T: p.Q308X) were identified by comparing and filtering the results with known public databases.Then, more detailed biological analysis on these 8 genes was conducted.Traditional Sanger sequencing validated the exome sequencing results, and found that the mutation c. 1725Gï¹¥T in gene CLCA2 segregated with the phenotype of this PCCD pedigree.The mutation c. 1725Gï¹¥T in gene CLCA2 was thus be considered as the causative PCCD gene in this pedigree from the perspective of genetics and genomics. CONCLUSION: The heterozygote mutation c. 1725Gï¹¥T in gene CLCA2 might be causative gene in this PCCD pedigree.This finding adds new gene mutation variant responsible for PCCD.

Redox Imbalance in the Peripheral Mechanism Underlying the Mirror-Image Neuropathic Pain Due to Chronic Compression of Dorsal Root Ganglion.

Reactive oxygen species (ROS) play a critical role in the pathogenesis of neuropathic pain, but few studies have examined the role of oxidative stress in the mirror-image neuropathic pain (MINP). The present study was to investigate the role of ROS in MINP caused by chronic compression of the dorsal root ganglion (DRG) (CCD) in a rat model. SD rats were randomly divided into sham group and CCD group. CCD was conducted to induce MINP. CCD rats were intraperitoneally injected with α-Phenyl-N-tert-butyl-nitrone (PBN) at 7 days after surgery. Paw withdrawal mechanical threshold (PWMT) was measured at -1, 1, 3, 5 and 7 days after surgery in sham group and CCD group, and at 8 time points after PBN injection. Rats were sacrificed at 3 and 7 days after surgery in sham group and CCD group and at 0.5 and 2 h after PBN injection, and the superoxide dismutase (SOD) and catalase activities, as well as hydrogen peroxide (H2O2) and malonaldehyde (MDA) contents were determined in the contralateral DRGs. Results showed bilateral PWMT reduced significantly in sham group and CCD group, but it returned to nearly normal level in sham group. MDA content, H2O2 content and SOD activity increased significantly, while catalase activity remained unchanged in CCD rats. PBN at 100 mg/kg significantly attenuated bilateral mechanical hyperalgesia accompanied by the improvement of oxidative stress in the contralateral DRGs. Our results demonstrate that ROS produced in the contralateral DRG are involved in the pathogenesis of CCD induced MINP, and ROS scavenger may be a promising drug for the therapy of MINP.

LY2109761 inhibits metastasis and enhances chemosensitivity in osteosarcoma MG-63 cells.

OBJECTIVE: Studies have shown that transforming growth factor-beta (TGF-ß) is associated with metastasis and chemoresistance of osteosarcoma. The TGF-ß kinase inhibitor LY2109761 could inhibits metastasis and enhances chemosensitivity in several cancers, but its role and mechanisms in osteosarcoma (OS) is unclear. Here, we investigated the role and mechanism of LY2109761 on metastasis and chemosensitivity of OS MG-63 cells. MATERIALS AND METHODS: MG-63 cells were treated with LY2109761 or/and cisplatin. The cell viability and apoptosis of MG-63 cells were detected by MTT and ELISA. Matrigel invasion assay was used to detect cell invasion in vitro. pSMAD2 and S100A4 was detected by western blot assay. Furthermore, the efficacy of LY2109761 combined with S100A4 cDNA plaismid transfection on cell viability, apoptosis and chemosensitivity to cisplatin in OS MG-63 cells was further examined. RESULTS: LY2109761 was sufficient to induce apoptosis and inhibited growth of MG-63 cells in vitro. Combination with LY2109761 significantly augmented the cytotoxicity of cisplatin in MG-63 cells. LY2109761 significantly inhibited invasion of MG-63 cells in vitro. The LY2109761-induced increase in cell apoptosis and the cytotoxicity of cisplatin, and decrease in cell invasion was blocked completely when S100A4 expression was restored in the MG-63 cells by S100A4 cDNA plasmid transfection. CONCLUSIONS: Our data indicate that LY2109761 suppresses OS metastasis and enhanced chemosensitivity by targeting S100A4. LY2109761 may have important implications for the development of strategies for inhibiting metastasis and overcoming OS cell resistance to chemotherapy.

Variants in mitochondrial tRNA gene may not be associated with thyroid carcinoma.

Thyroid cancer is a very common form of endocrine system malignancy. To date, the molecular mechanism underlying thyroid cancer remains poorly understood. Studies of oncocytic tumors have led to a hypothesis which proposes that defects in oxidative phosphorylation (OX- PHOS) may result in a compensatory increase in mitochondrial replication and gene expression. As a result, mitochondrial DNA (mtDNA) mutation analysis has become a useful tool to explore the molecular basis of this disease. Among these mutations, mitochondrial transfer RNAs (mttRNAs) are the hot spots for pathogenic mutations associated with thyroid cancer. However, due to its high mutation rate, the role of mt-tRNA variants in thyroid cancer is still controversial. To address this problem, in this study, we reassessed seven reported mt-tRNA variants: tRNAAsp G7521A, tRNAArg T10411C and T10463C, tRNALeu(CUN) A12308G, tRNAIle G4292C and C4312T, and tRNAAla T5655C, in clinical manifestations of thyroid cancer. We first performed the phylogenetic conservation analysis for these variants; moreover, we used a bioinformatic tool to compare the minimum free energy (G) of mt-tRNA with and without mutations. Most strikingly, none of these variants caused the significant change of the G between the wild-type and the mutant form, suggesting that they may not play an important roles in thyroid cancer. In addition, we screened the frequency of the "pathogenic" A12308G alternation in 300 patients with thyroid cancer and 200 healthy controls. We found that there were five patients and three control subjects carrying this variant. It seemed that the A12308G variant may be a common polymorphism in the human population. Taken together, our study indicated that variants in mt-tRNA genes may not play active roles in patients with thyroid cancer.

Mitochondrial ND3 G10398A mutation: a biomarker for breast cancer.

Mitochondrial DNA mutations have been found to play important roles in carcinogenesis. The most common G10398A mutation, a non-conservative amino acid substitution from Thr to Ala, seems to be involved in the tumorigenesis of breast cancer. Results from studies concerning this mutation remain inconclusive. In the current study, we first took clinical and molecular datasets from case-control studies to determine the association between the G10398A mutation and breast cancer. We further used the Phylotree to determine the haplogroups of this mutation. The frequencies of this mutation in 500 unrelated healthy controls were also screened. We found that this mutation is very common in the human population, and may be a polymorph.

Genetic diversity and differentiation of the endangered and endemic species Sauvagesia rhodoleuca in China as detected by ISSR analysis.

Sauvagesia rhodoleuca (Ochnaceae) is an endangered plant that is endemic to southern China. The levels of genetic variation and patterns of population structure in S. rhodoleuca were investigated using inter-simple sequence repeat markers. Eleven primers were used to amplify DNA samples from 117 individuals, and a total of 92 loci were detected. Our results indicated that genetic diversity was quite low both at the species level (percentage of polymorphic bands (PPB) = 41.30%, Nei's gene diversity (h) = 0.1331, and Shannon information index (I) = 0.2028) and the population level (PPB = 16.30-28.26%, h = 0.0496-0.1012, and I = 0.0756-0.1508). A high level of genetic differentiation among populations was detected based on Nei's genetic diversity analysis (0.4344) and analysis of molecular variance (47.03%). The low genetic diversity within population and high population differentiation of S. rhodoleuca were assumed to result largely from limited gene flow, genetic drift, inbreeding, and clonal growth. Conservation strategies for this endangered species are proposed based on the genetic data.

Pathway-based association analysis of two genome-wide screening data identifies rheumatoid arthritis-related pathways.

The pathways can explain molecular mechanisms of complex diseases from the perspective of biology function. We carried out a genome-wide pathway-based association analysis to identify the risk pathways of rheumatoid arthritis (RA). First, we performed two genome-wide association studies using two RA data sets from GAW16 (Genetic Analysis Workshop 16) and the Wellcome Trust Case Control Consortium, and obtained risk P-value for each single-nucleotide polymorphism (SNP). Next, we mapped all the SNPs to genome-wide autosomal genes and calculated gene-wise risk values by minimum P-value method. We calculated the KEGG (Kyoto Encyclopedia of Gene and Genomes) pathway risk scores according to Fisher combination method and identified the significant pathways by permutation test. At last, we merged the results from the two pathway-based genome-wide association analyses to identify the high-risk pathways, which were found in both the data sets. The results showed that there were nine pathways, focal adhesion pathway, extracellular matrix-receptor interaction pathway, calcium signaling pathway, dopaminergic synapse pathway, long-term potentiation pathway, retrograde endocannabinoid signaling pathway, glutamatergic synapse pathway, cholinergic synapse pathway and morphine addiction pathway, associated with susceptibility to RA. Among these pathways, four pathways were reported as RA-risk pathways in the previous literatures. We also inferred that other five pathways may be related to RA. Further researches of these pathways will help us to understand the molecular mechanisms of RA.