Identity of the holotype and type locality of Rhabdophis leonardi (Wall, 1923) (Colubridae: Natricinae), with notes on the morphology and natural history of the species in southwestern China.

The original description of Natrix leonardi (currently Rhabdophis leonardi) by Frank Wall in 1923, based on a specimen from the "Upper Burma Hills," lacked important morphological details that have complicated the assignment of recently collected material. Furthermore, although the holotype was never lost, its location has been misreported in one important taxonomic reference, leading to further confusion. We report the correct repository of the holotype (Natural History Museum, London), together with its current catalog number. We also describe key features of that specimen that were omitted from the original description, and provide new details on the morphology of the species, including sexual dichromatism unusual for the genus, based upon specimens from southern Sichuan, China. Rhabdophis leonardi is distinguished from its congeners by the following characters: 15 or 17 DSR at midbody and 6 supralabials; distinct annulus around the neck, broad and red in males, and narrow and orange with a black border in females; dorsal ground color light green or olive; some lateral and dorsal scales possessing black edges, the frequency of black edges gradually increasing from anterior to posterior, forming irregular and ill-defined transverse black bands; eye with prominent green iris; black ventral spots with a red edge, most numerous at midbody but extending halfway down the length of the tail. In southwestern China, this species is frequently found at 1730-2230 m elevation. It has been documented to prey upon anuran amphibians, including toads. A recently published phylogenetic analysis showed this species to be deeply nested with the genus Rhabdophis, as a member of the R. nuchalis Group. That analysis also revealed the existence of two closely related but geographically distinct subclades in the molecular analysis, one of which may represent an unnamed taxon.

MiR-24-3p Attenuates Doxorubicin-induced Cardiotoxicity via the Nrf2 Pathway in Mice.

OBJECTIVE: The nuclear factor erythroid 2 (NFE2)-related factor 2 (Nrf2) is associated with doxorubicin (DOX)-induced cardiac injury. It has been reported that microRNA-24-3p (miR-24-3p) may regulate the Keapl by mRNA degradation, whereas Keapl can suppress the activation of Nrf2. However, the role of miR-24-3p in DOX-related cardiotoxicity remains unclear. METHODS: The mice receiving DOX were used as cardiac injury model. In this study, an adenoassociated virus 9 system was used to deliver miR-24-3p or miR-scramble to mice hearts. The echocardiographic and hemodynamic analyses were used to evaluate the effects of miR-24-3p on cardiac function under DOX stimulation. ELISA and RT-PCR were used to detect protein or mRNA expressions associated with cardiac injury, inflammation response, apoptosis and oxidative stress. Western Blot were used for quantitative analysis of the roles of miR-24-3p in regulating Nrf2 expression. H9C2 cells used to verify the role of miR-24-3p in vitro. RESULTS: We found that miR-24-3p mRNA was significantly decreased in DOX-treated mice and cardiomyocytes. Overexpression of miR-24-3p blocked cardiac injury caused by DOX injection, as reflected by the reduction in the levels of cardiac troponin I, creatinine kinase isoenzyme MB and the N-terminal pro brain natriuretic peptide. Furthermore, miR-24-3p reduced oxidative stress and cell loss without affecting the inflammation response. As expected, we found that Nrf2 was upregulated by miR-24-3p supplementation, and that the protective efforts of miR-24-3p supplementation were abolished when Nrf2 was silenced. CONCLUSION: The results from this study suggest that miR-24-3p protects cardiomyocytes against DOX-induced heart injury via activation of the Nrf2 pathway. miR-24-3p supplementation may be a novel strategy to counteract the cardiac side effects of DOX treatment.

Comparison of 3-Dimensional Pelvic Floor Ultrasonography and Defecography for Assessment of Posterior Pelvic Floor Disorders.

PURPOSE: The aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders. METHODS: Eligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms. RESULTS: There were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography. Agreement of the 2 diagnostic tests was confirmed using Cohen's kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement. CONCLUSION: This study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.

A scale for prediction of response to AEDs in patients with MRI-negative epilepsy.

OBJECTIVES: Antiepileptic drugs (AEDs) are the first choice in magnetic resonance imaging (MRI)-negative patients with epilepsy, although the responses to AEDs are diverse. Preoperative evaluation and postoperative prognosis in MRI-negative epilepsy have been reported. However, there are few tools for predicting the response to AEDs. Herein, we developed an AED response scale based on clinical factors and video-electroencephalography (VEEG) in MRI-negative patients with epilepsy. METHODS: A total of 132 consecutive patients with MRI-negative epilepsy at the Epilepsy Center of Henan Provincial People's Hospital between August 2016 and August 2018 were included. Patients were further divided into drug-responsive epilepsy ([DSE-MRI (-)]; n = 101) and drug-resistant epilepsy ([DRE-MRI (-)]; n = 31) groups. The clinical and VEEG factors were evaluated in univariate analyses and multivariate logistic regression analyses. A scale was derived and the scores categorized into 3 risk levels of DRE-MRI (-). RESULTS: A scale was established based on 4 independent risk factors for DRE-MRI (-). The scale had a sensitivity of 83.87%, specificity of 80.20%, positive likelihood ratio of 4.24, negative likelihood ratio of 0.20, and showed good discrimination with the area under the curve (AUC) of 0.886 (0.826-0.946). The categorization of the risk score based on this scale was: low risk (0-3 points), medium risk (3-5 points), and high risk (>5 points). CONCLUSION: We established a DRE-MRI (-) scale with a good sensitivity and specificity, which may be useful for clinicians when making medical decisions in patients with MRI-negative epilepsy.

High risk of anxiety and depression in caregivers of adult patients with epilepsy and its negative impact on patients' quality of life.

OBJECTIVE: The objective of this study was to assess the anxiety and depression of caregivers of adult patients with epilepsy (PWE) and evaluate its effect on patient quality of life (QOL). METHOD: One hundred sixty pairs of adult PWE and their caregivers were enrolled in our study. Quality of life in adult PWE was evaluated with the Quality of Life in Epilepsy Inventory-31 scale (QOLIE-31). Symptoms of anxiety and depression in caregivers were assessed with the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) respectively. Correlation and stepwise multiple liner regression analyses were used as statistical analysis. RESULTS: Of the caregivers, 41 (31.30%) had anxiety symptoms (HAM-A scores > 6) and 44 (33.59%) had depression symptoms (HAM-D scores > 6). Caregiver anxiety was significantly associated with poorer adult PWE QOL scores in four of the seven subscales and the QOLIE-31 total score. Caregiver depression was significantly associated with poorer adult PWE QOL in all seven subscales as well as the QOLIE-31 total score. Caregiver depression was an independent predictor of the QOLIE-31 total score and five subscales: seizure worry, emotional wellbeing, energy/fatigue, cognitive, and medication effects. CONCLUSION: Caregivers of adult PWE are at high risk of experiencing anxiety and depression. Caregiver psychological status, especially depression, was an independent predictor of poorer QOL for adult PWE.

[Analysis of Greenhouse Gas Emission Characteristics and Their Influencing Factors in the Algae Zone of Lake Taihu].

In order to identify CH4 and CO2 emission flux characteristics and their impact factors in the algal lake zone of Lake Taihu, CH4 and CO2 fluxes were observed by the improved closed chamber method in Meiliang Bay in Lake Taihu. The relationships between CH4 and CO2 flux and meteorological factors were analyzed. The results showed that CH4 and CO2 fluxes had obvious diurnal variations. The CH4 flux in the daytime was higher than that in the nighttime in spring; however, the CH4 flux in the nighttime was higher than that in the daytime in summer. The CO2 uptake flux in the daytime was higher than that in the nighttime in spring and summer. The algae zone of Lake Taihu was a CH4 source for the atmosphere. The average CH4 flux was 4.047 nmol ·(m2 ·s)-1 and 40.779 nmol ·(m2 ·s)-1 in spring and summer, respectively. The zone was the CO2 sink for the atmosphere in spring and summer. The average CO2 flux was -0.160 µmol ·(m2 ·s)-1 and -0.033 µmol ·(m2 ·s)-1 in spring and summer, respectively. On an hourly scale, the CH4 emission flux was positively correlated with air temperature and water temperature (r=0.20, P<0.01 and r=0.34, P<0.01, respectively). When wind speed was lower than 6 m ·s-1, the CH4 flux was positively correlated with wind speed (r=0.71, P<0.01). The CO2 uptake flux had a significant positive correlation with air temperature and wind speed (r=0.14, P<0.01 and r=0.33, P<0.05, respectively). However, the CO2 uptake flux was negatively correlated with air pressure and solar radiation (r=-0.41, P<0.01 and r=-0.35, P<0.01, respectively). The CO2 efflux had a significant positive correlation with wind speed (r=0.40, P<0.05). The CO2 efflux was negatively correlated with solar radiation (r=-0.35, P<0.01). On a daily scale, the CH4 emission flux had a significant positive correlation with air temperature and water temperature (r=0.83, P<0.01 and r=0.78, P<0.01, respectively).

Laparoscopic Posterolateral Rectopexy for the Treatment of Patients With a Full Thickness Rectal Prolapse: Experience With 63 Patients and Short-term Outcomes.

PURPOSE: Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients. METHODS: Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients' satisfaction scores (0-10), and the occurrence of constipation. RESULTS: No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation. CONCLUSION: LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.

Laparoscopic Vaginal Suspension and Rectopexy for Rectal Prolapse.

PURPOSE: Laparoscopic procedures for the treatment of patients with a rectal prolapse have gained increasing worldwide acceptance because they have lower recurrence and better functional outcome than perineal procedures. Nevertheless, ideal surgical methods are still not available. We propose a new surgical technique, laparoscopic vaginal suspension and rectopexy, for correcting a full-thickness rectal prolapse and/or middle-compartment prolapse. This study assessed the short-term outcomes for patients who underwent laparoscopic vaginal suspension and rectopexy. METHODS: Between April 2014 and April 2016, 69 female patients underwent laparoscopic vaginal suspension and rectopexy to correct a rectal prolapse. Demographics, medical histories, and surgical and follow-up details were collected from their medical records. In addition to the clinical outcome, we repeated defecation proctography and a questionnaire regarding functional results three months after surgery. RESULTS: No major morbidities or no mortalities occurred. The defecation proctography confirmed excellent anatomical result in all cases. Of 7 patients with combined middle-compartment prolapses, we observed good anatomical correction. During follow-up, full-thickness recurrence occurred in one patient. Preoperative fecal incontinence was improved significantly at 3 months (mean Wexner score: 12.35 vs. 7.71; mean FISI: 33.29 vs. 21.07; P < 0.001). Analysis of responses to the fecal incontinence quality of life (FIQOL) questionnaire showed overall improvement at 3 months compared to the preoperative baseline (mean pre- and postoperative FIQOL scores: 12.11 vs. 14.39; P < 0.004). CONCLUSION: Laparoscopic vaginal suspension and rectopexy is a new combined procedure for the treatment of patients with rectal prolapses. It has excellent functional outcomes and minimal morbidity and can correct and prevent middlecompartment prolapses.

A rat model of vascular dementia for evaluating Chinese medicine prescriptions.

OBJECTIVE: To develop a new model of vascular dementia for evaluating Chinese medicine prescriptions. METHODS: Eighty-eight male Wistar rats were randomly divided into 4 groups. At d00, d42, d70, d98 (ni=20, 20, 24, 24) during fatty-feeding, rats in each group were further divided into 10 or 12 subgroups (ni=2), respectively. Lacunar stroke were replicated with the injection of thrombi which coagulated artificially from itself blood. The median lethal doses (LD50) were regressed from accumulative mortality in each geometric thrombus doses (k=0.75, 0.5, 0.85, 0.85), respectively. The degree of vascular dementia was evaluated as exploratory, learning and memorizing abilities. The median effective dose of thrombus for replicating rat model was regressed from dementia scores which were derived from the abilities. The linear correlation was regressed between the values of LD50 or effective dose (ED50) and the durations (days) of hypercholesterolemia. This model of vascular dementia was pathologically confirmed as the neural injuries from lacunar stroke in rats. RESULTS: The hypercholesterolemia was indicated as elevated total cholesterol, triglyeerides low-density lipoprotein cholesterol, and decreased high-density lipoprotein cholesterol. The values of LD50 with its 95% confidence intervals (CI) were 1525.0 (1361.0-1709.0), 584.3 (490.1-696.6), 168.7 (163.7-173.8), or 62.4 (59.5-65.4) mg/mL, at d00, d42, d70, and d98, respectively. There is a linear regression between the values of LD50 and the durations of hypercholesterolemia (y=-15.33x+1390.0, r=0.963, P<0.05). The values of ED50 with its 95% CI were 528.8 (340.5-821.4), 217.0 (20.84-2259.0), 96.3 (23.4-402.6), or 47.0 (43.7-50.6) mg/mL from dementia score, at d00, d42, d70, and d98, respectively. There is a linear regression between the values of ED50 and the durations of hypercholesterolemia (y=-4.992x+484.2, r=0.965, P<0.05). The neural injuries were demonstrated as neural degeneration and necrosis. CONCLUSIONS: For evaluating Chinese medicine, a model of vascular dementia in rats is set up with the lacunar stroke from self-thrombosis during hypercholesterolemia. This model from lacunar stroke is useful to investigate the pathogenesis and treatment of vascular dementia.

Glycyrrhizinate reduces portal hypertension in isolated perfused rat livers with chronic hepatitis.

AIM: To investigate the effects of diammonium glycyrrhizinate (Gly) on portal hypertension (PHT) in isolated portal perfused rat liver (IPPRL) with carbon tetrachloride (CCl4)-induced chronic hepatitis. METHODS: PHT model was replicated with CCl4 in rats for 84 d. Model was identified by measuring the ascetic amounts, hepatic function, portal pressure in vivo, splenic index, and pathological alterations. Inducible nitric oxide synthase (iNOS) in liver was assessed by immunohistochemistry. IPPRLs were performed at d0, d28, d56, and d84. After phenylephrine-induced constriction, Gly was geometrically used to reduce PHT. Gly action was expressed as median effective concentration (EC50) and area under the curve (AUC). Underlying mechanism was exploited by linear correlation between AUC values of Gly and existed iNOS in portal triads. RESULTS: PHT model was confirmed with ascites, splenomegaly, serum biomarkers of hepatic injury, and elevated portal pressure. Pathological findings had shown normal hepatic structure at d0, degenerations at d28, fibrosis at d56, cirrhosis at d84 in PHT rats. Pseudo lobule ratios decreased and collagen ratios increased progressively along with PHT development. Gly does dose-dependently reduce PHT in IPPRLs with CCl4-induced chronic hepatitis. Gly potencies were increased gradually along with PHT development, characterized with its EC50 at 2.80 × 10⁻¹°, 3.03 × 10⁻¹¹, 3.77 × 10⁻¹¹ and 4.65×10⁻¹¹ mol/L at d0, d28, d56 and d84, respectively. Existed iNOS was located at hepatocyte at d0, stellate cells at d28, stellate cells and macrophages at d56, and macrophages in portal triads at d84. Macrophages infiltrated more into portal triads and expressed more iNOS along with PHT development. AUC values of Gly were positively correlated with existed iNOS levels in portal triads. CONCLUSION: Gly reduces indirectly PHT in IPPRL with CCl4-induced chronic hepatitis. The underlying mechanisms may relate to rescue NO bioavailability from macrophage-derived peroxynitrite in portal triads.

The Early Experience of Laparoscopy-assisted Gastrectomy for Gastric Cancer at a Low-volume Center.

PURPOSE: Laparoscopy-assisted gastrectomy (LAG) has become a technically feasible and safe procedure for early gastric cancer treatment. LAG is being increasingly performed in many centers; however, there have been few reports regarding LAG at low-volume centers. The aim of this study was to report our early experience with LAG in patients with gastric cancer at a low-volume center. MATERIALS AND METHODS: The clinicopathologic data and surgical outcomes of 39 patients who underwent LAG for gastric cancer between April 2007 and March 2010 were retrospectively reviewed. RESULTS: The mean age was 68.3 years. Thirty-one patients had medical co-morbidities. The mean patient ASA score was 2.0. Among the 39 patients, 4 patients underwent total gastrectomies and 35 patients underwent distal gastrectomies. The mean blood loss was 145.4 ml and the mean operative time was 259.4 minutes. The mean time-to-first flatus, first oral intake, and the postoperative hospital stay was 2.8, 3.1, and 9.3 days, respectively. The 30-day mortality rate was 0%. Postoperative complications developed in 9 patients, as follows: anastomotic leakage, 1; wound infection, 1; gastric stasis, 2; postoperative ileus, 1; pneumonia, 1; cerebral infarction, 1; chronic renal failure, 1; and postoperative psychosis, 1. CONCLUSIONS: LAG is technically feasible and can be performed safely at a low-volume center, but an experienced surgical team and careful patient selection are necessary. Furthermore, for early mastery of the learning curve for LAG, surgeons need education and training in addition to an accumulation of cases.