Structural and Functional Changes in the Cerebellum and Brainstem in Patients with Benign Paroxysmal Positional Vertigo.

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular diseases. Since the peripheral vestibular system connects with the cerebellum via the brainstem, repeated episodic vertigo may result in progressive structural and functional changes in the cerebellum and brainstem. In the present work, voxel-based morphometry (VBM) of T1-weighted images and resting-state functional magnetic resonance imaging (fMRI) in 32 patients with BPPV and 32 matched healthy controls were used to assess cerebellar and brainstem anatomical and spontaneous resting-state brain activity alterations associated with BPPV. We used a spatially unbiased infratentorial template toolbox in combination with VBM to analyze cerebellar and brainstem gray matter volume (GMV), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo). Patients with BPPV showed decreased GMV in the right cerebellum posterior lobe/cerebellar tonsil extending to the cerebellum anterior lobe and pons relative to healthy controls. BPPV patients also exhibited significantly higher fALFF values in the right pons and left pons and higher ReHo values in the left cerebellum posterior lobe/Crus2 than the controls. Furthermore, the fALFF z-scores in the pons were positively correlated with the duration of vertigo at baseline and dizziness visual analog scale scores 1 week after canalith repositioning procedures (CRPs). BPPV patients exhibited structural and functional changes in the cerebellum and pons, which may reflect the adaptation and plasticity of these anatomical structures after repeated attacks of episodic vertigo. These results indicate that the changes in pons function may be closely related to residual dizziness after CRPs.

Genetic programs in human and mouse early embryos revealed by single-cell RNA sequencing.

Mammalian pre-implantation development is a complex process involving dramatic changes in the transcriptional architecture. We report here a comprehensive analysis of transcriptome dynamics from oocyte to morula in both human and mouse embryos, using single-cell RNA sequencing. Based on single-nucleotide variants in human blastomere messenger RNAs and paternal-specific single-nucleotide polymorphisms, we identify novel stage-specific monoallelic expression patterns for a significant portion of polymorphic gene transcripts (25 to 53%). By weighted gene co-expression network analysis, we find that each developmental stage can be delineated concisely by a small number of functional modules of co-expressed genes. This result indicates a sequential order of transcriptional changes in pathways of cell cycle, gene regulation, translation and metabolism, acting in a step-wise fashion from cleavage to morula. Cross-species comparisons with mouse pre-implantation embryos reveal that the majority of human stage-specific modules (7 out of 9) are notably preserved, but developmental specificity and timing differ between human and mouse. Furthermore, we identify conserved key members (or hub genes) of the human and mouse networks. These genes represent novel candidates that are likely to be key in driving mammalian pre-implantation development. Together, the results provide a valuable resource to dissect gene regulatory mechanisms underlying progressive development of early mammalian embryos.

[Differentiation of embryonic stem cells from the embryos of the couples with male asthenozoospermia and Robertsonian translocation into germ cells].

OBJECTIVE: To assess the risk of male infertility in the offspring conceived through assisted reproductive technology (ART) byin vitroinductionof the differentiation of embryonic stem cells (ESCs) derived from the embryos of the couples with male asthenozoospermia and Robertsonian translocation (RT) into germ cells. METHODS: We established a CCRM16ESC line with the karyotype of 46, XY, +14, rob(13; 14) (q10; q10) from the embryo donated by a patientwithasthenozoospermiaand RT and his wife by isolation of the inner cell mass of blastula, culturing, passaging, and amplification,followed by in vitro induction and differentiationof the ESCs into germ cells with ratinoic acid(RA) at 2 mol/L. Then, we analyzed the process of differentiation and the expressions of its related genes and compared them with those in the normal CCRM23ESCs. RESULTS: CCRM16 showed the typical characteristics of ESCs, expressing the pluripotency makers of NANOG, OCT4, TRA-1-181 and SSEA4, forming embryoid bodies, and differentiating into three germlayer tissues in vitro and in vivo. Intervention with 2 mol/LRAinduced direct differentiation of the ESCs into germ cells. The expressions of the primordial germ cell marker geneDAZLand the meiosis marker geneSCP3were markedly decreased in the CCRM16 as compared with those in the normal CCRM23 ESCs. CONCLUSIONS: The CCRM16ESC linewith the karyotype of46, XY, +14, rob(13; 14) (q10; q10) has thetypical characteristics of ESCs but an abnormal process of differentiation into germ cells in the early stage. In vitroinductionof the differentiation of ESCs into germ cells can be used for assessing the risk of male infertility in the offspring conceived through ART for asthenozoospermia patients.

Coracoid bone graft resorption after Latarjet procedure is underestimated: a new classification system and a clinical review with computed tomography evaluation.

BACKGROUND: This study proposes a simple and reliable classification system to evaluate the severity of the bone resorption of the transferred coracoid bone block after the Latarjet procedure. The incidence and severity of the graft resorption was also investigated. METHODS: Between January 2009 and January 2012, 63 patients underwent an open Latarjet procedure and were included. Four independent surgeons used the classification system we proposed to evaluate the severity of the graft resorption on the computed tomography scan performed 1 year postoperatively. Each surgeon did the evaluation twice at a 3-month interval. The interobserver and intraobserver reliability of the classification system were analyzed using intraclass correlation coefficients. Among these 63 patients, 57 patients were available for clinical evaluation at 2 years postoperatively. RESULTS: The American Shoulder and Elbow Surgeons score, Constant-Murley score, and Rowe score were improved significantly after the surgery. No redislocation occurred during follow-up. The incidence of graft resorption was 90.5% based on the computed tomography evaluation. The coracoid graft resorption was classified as grade 0 in 6 patients, grade I in 26, grade II in 25, and grade III in 6. The classification system had excellent interobserver and intraobserver reliability. CONCLUSION: The open Latarjet procedure is effective in treating anterior shoulder instability with marked glenoid bone loss. The incidence of the graft resorption at 1 year postoperatively is high. Our classification system on the graft resorption after Latarjet procedure has good interobserver and intraobserver reliability.

[Effect of Compound Tongfu Granule on Intestinal Permeability in Elderly Sepsis Patients].

OBJECTIVE: To explore the effect of Compound Tongtu Granule (CTG) on intestinal permeability in elderly sepsis patients. METHODS: Eighty elderly sepsis patients were randomly assigned to the experimental group and the control group by randomized double blinded method, 40 in each group. On the basis of conventional antiseptic treatment program, patients in the experimental group took CTG, while those in the control group took placebos. The dosage for CTG or placebos was 14.3 g each package, one package each time, twice daily for 14 successive days. Patients' abdominal symptoms and signs, levels of serum inflammatory factors (high-sensitivity C-reactive protein and procalcitonin), levels of plasma endotoxin, and the intestinal permeability (IP, represented by urinary lactulose/mannitol excretion rate) were compared between the two groups before and after treatment. RESULTS: After 14-day treatment, patients in the experimental group had improved abdominal symptoms, increased frequency of defecation, significantly decreased levels of plasma endotoxin and IP, when compared with the control group (P < 0.05). CONCLUSION: CTG could improve the intestinal barrier function in elderly sepsis patients.

Effect of the serum 25-hydroxyvitamin D level on risk for short-term residual dizziness after successful repositioning in benign paroxysmal positional vertigo stratified by sex and onset age.

Objective: A low serum 25-hydroxyvitamin D (25(OH)D) level is relevant to both the occurrence and recurrence of benign paroxysmal positional vertigo (BPPV). However, whether it also contributes to residual dizziness (RD) after successful repositioning maneuvers is unknown. Therefore, this study aimed to explore the correlation between the serum 25(OH)D level and short-term RD severity in patients with BPPV after successful repositioning maneuvers. Methods: In total, 251 patients with BPPV after successful repositioning were enrolled and prospectively followed up for 1 week (W1). Serum 25(OH)D values were detected by chemiluminescence immunoassay at enrollment (W0). In addition, we explored the relationship between 25(OH)D values at baseline and RD severity at W1 in different subgroups stratified by sex and onset age (early-onset, ≤50 years; late-onset, >50 years). Results: The serum 25(OH)D level of female patients was significantly lower than that of male patients (15.9 ± 6.8 vs. 19.8 ± 6.6 ng/ml, p < 0.001). Its level also decreased in early-onset patients compared to late-onset ones (15.3 ± 5.9 vs. 18.0 ± 7.3 ng/ml, p = 0.003). In addition, early-onset female patients had lower 25(OH)D values than late-onset female patients (14.0 ± 5.5 vs. 17.1 ± 7.2 ng/ml, p = 0.004). However, this difference was not observed between early- and late-onset male patients. Among early-onset female patients, the 25(OH)D values of the moderate-to-severe RD group were lower than those of the minor or no RD group (10.9 ± 3.3 vs. 14.7 ± 5.7 vs. 15.0 ± 5.9 ng/ml, p = 0.046). Multivariate analysis found that decreased 25(OH)D values were related to the occurrence of moderate-to-severe RD in early-onset female patients (OR = 0.801; p = 0.022). This effect did not exist in late-onset female or male patients with BPPV. Conclusions: Age and sex differences in serum 25(OH)D levels exist in patients with BPPV. A decreased 25(OH)D level in early-onset female patients may increase the odds of moderate-to-severe RD 1 week after successful repositioning maneuvers.

[Primary shoulder arthroplasty for treatment of complex proximal humeral fractures with the trabecular metal prosthesis].

OBJECTIVE: To evaluate the clinical results of primary shoulder arthroplasty for the treatment of complex proximal humeral fractures with the trabecular metal prosthesis. METHODS: In the study, 57 consecutive patients with complex proximal humeral fractures underwent primary shoulder arthroplasty with the trabecular metal prosthesis, of whom 45 patients were available for the final follow-up (78.9%), and were retrospectively assessed. There were 15 men and 30 women with the average age of (64.9±10.6) years (range: 45 to 85 years), and 14 left shoulders and 31 right shoulders were involved. The mean time from injury to surgery was (10.2±4.8) days. According to Neer's classification, there were 3 patients with a three-part fracture, 4 with a three-part dislocation, 2 with a four-part fracture, 22 with a four-part dislocation, 4 with a four-part valgus-impaction, and 10 with a head splitting. Thirty-nine patients were treated with hemiarthroplasty, and the rest with total shoulder arthroplasty. RESULTS: After a mean follow-up time of (18.7±8.1) months (range: 12 to 41 months), the average range of motion of patients were 130.4°±36.5° for forward elevation, 37.6°±16.6° for external rotation and L3 level (±3 vertebrae) for internal rotation. The average VAS pain score, ASES score, Constant-Murley score and UCLA score were 0.5±1.2 (0-4), 81.4±13.9 (43-100), 81.6±13.6 (52-100) and 28.5±5.1 (16-35), respectively. The average patient satisfaction rate was 95.6%. The greater tuberosity healed anatomically in 42 patients, which was confirmed by the postoperative radiographs, while the greater tuberosity nonunion was found in the other three patients. Superior migration of humeral head was found in two patients. There were no complications, such as infection, prosthetic loosening or neurovascular injury, related to the surgery. CONCLUSION: Primary shoulder arthroplasty for complex proximal humeral fractures with the trabecular metal prosthesis could yield good clinical results. The healing rate of the greater tuberosity was 93.3%.

[Preliminary histological and biomechanical study about the timing of surgical repair for acute rotator cuff tears in rabbits].

OBJECTIVES: To establish the animal model of acute rotator cuff tear in rabbits, and study the effect of timing of surgical repair on healing of tendon-bone interface, formation and distribution of collagens in the supraspinatus tendon insertion and biomechanical properties of supraspinatus. METHODS: Supraspinatus tenotomy was performed in the right shoulder of 90 skeletally matured male New Zealand white rabbits to establish the animal model of acute rotator cuff tear. The rabbits were randomly divided into 3 groups : group of early repair, repaired at 1 week after tenotomy; group of late repair, repaired at 4 weeks after tenotomy; and group without repair, used as control. At 2 weeks, 4 weeks and 8 weeks after repair, healing of tendon-bone interface was observed by HE staining. Collagens were observed by Sirius Red F 3B (SR) in saturated carbazotic acid staining. The areas of type I and III collagens were measured by using imaging analysis software and the ratio of type I and III collagens were calculated. Failure loads of supraspinatus on both sides were measured. The percentage of failure loads of the surgical side was calculated and contralateral supraspinatus were uninjured. RESULTS: There was no obvious fatty infiltration and muscle atrophy in supraspinatus in all groups. At 8 weeks, the formation of a new enthesis of supraspinatus in groups of early and late repair were observed. In groups of early and late repair, the ratio of areas of type I and III collagens at 8 weeks (2.02 ± 0.77 and 2.06 ± 0.58) was larger than that at 2 weeks (1.10 ± 0.24 and 1.14 ± 0.50, t = 3.082, 3.655, P < 0.01). At 2, 4 and 8 weeks, the percentages of failure loads of the surgical side and uninjured contralateral supraspinatus in group of early repair(38% ± 11%, 66% ± 7%, 89% ± 4%) and group of late repair (41% ± 16%, 63% ± 7%, 89% ± 9%) were both higher than that in group without repair (14% ± 6%, 32% ± 4%, 56% ± 12%); the differences were all statistically significant (group of early repair: t = 3.311, 8.549, 5.719; group of late repair: t = 3.713, 8.063, 6.044; P < 0.01). The percentage of failure loads of the surgical side and uninjured contralateral supraspinatus at 8 weeks was higher than those at 4 weeks (t = 3.878 - 4.613, P < 0.01) and 2 weeks (t = 7.158 - 10.024, P < 0.01) in all groups. CONCLUSIONS: Surgical repair within 4 weeks of acute rotator cuff tear lead to formation of a new enthesis of supraspinatus, improvement of both ratio of type I collagen in the supraspinatus tendon insertion and biomechanical properties of supraspinatus.

Association Between Pulse Pressure With All-Cause and Cardiac Mortality in Acute Coronary Syndrome: An Observational Cohort Study.

Background: Pulse pressure (PP) is a surrogate of aortic stiffness, and reflects cardiac performance and stroke volume. Previous studies have indicated that PP was a robust predictor of cardiovascular outcomes and mortality. However, results have been mixed, and very few studies have focused on the association of PP with mortality in acute coronary syndrome (ACS). Thus, we aimed to investigate the relationship between admission PP and the prognosis of patients with ACS. Methods: This cohort study included 10,824 patients diagnosed with ACS from the Cardiovascular Center Beijing Friendship Hospital Database Bank (CBDBANK) from January 2013 to October 2018. Patients with cardiogenic shock, malignancy, severe trauma and, no PP at admission were excluded. Restricted cubic spline and Cox proportional hazards regression were used to evaluate the association between PP and 1-year all-cause and cardiac mortality. Results: In the whole cohort, a total of 237 (2.19%) all-cause deaths were reported at 1-year follow-up. Restricted cubic spline analysis suggested a J-shaped relationship between PP and mortality. Among patients with ACS, both lower and higher PP levels were related to an increased risk of mortality (P non-linear < 0.001); with a PP level of 30 or 80 mmHg, as compared with 50 mmHg, the adjusted hazard ratios for 1-year all-cause mortality were 2.02 (95% CI, 1.27-3.22) and 1.62 (95% CI, 1.13-2.33), respectively, after adjustments for potential confounders. Similar results were observed for cardiac deaths. The J-shaped relationship between PP and mortality remained in a series of subgroup analyses. Conclusion: Our results suggested that both low and high PP were associated with an increased risk of mortality in patients with ACS.

Building contrast-enhanced CT-based models for preoperatively predicting malignant potential and Ki67 expression of small intestine gastrointestinal stromal tumors (GISTs).

PURPOSE: To assess contrast-enhanced computed tomography (CE-CT) features for predicting malignant potential and Ki67 in small intestinal gastrointestinal stromal tumors (GISTs) and the correlation between them. METHODS: We retrospectively analyzed the pathological and imaging data for 123 patients (55 male/68 female, mean age: 57.2 years) with a histopathological diagnosis of small intestine GISTs who received CE-CT followed by curative surgery from May 2009 to August 2019. According to postoperatively pathological and immunohistochemical results, patients were categorized by malignant potential and the Ki67 index, respectively. CT features were analyzed to be associated with malignant potential or the Ki67 index using univariate analysis, logistic regression and receiver operating curve analysis. Then, we explored the correlation between the Ki67 index and malignant potential by using the Spearman rank correlation. RESULTS: Based on univariate and multivariate analysis, a predictive model of malignant potential of small intestine GISTs, consisting of tumor size (p < 0.001) and presence of necrosis (p = 0.033), was developed with the area under the receiver operating curve (AUC) of 0.965 (95% CI, 0.915-0.990; p < 0.001), with 91.53% sensitivity, 96.87% specificity, 96.43% PPV, 92.54% NPV, 94.31% diagnostic accuracy. For high Ki67 expression, a model made up of tumor size (p = 0.051), presence of ulceration (p = 0.054) and metastasis (p = 0.001) may be the best predictive combination with an AUC of 0.785 (95% CI, 0.702-0.854; p < 0.001), 63.33% sensitivity, 76.34% specificity, 46.34% PPV, 86.59% NPV, 73.17% diagnostic accuracy. Ki67 index showed a moderate positive correlation with mitotic count (r = 0.578, p < 0.001), a weak positive correlation with tumor size (r = 0.339, p < 0.001) and with risk stratification (r = 0.364, p < 0.001). CONCLUSION: Features on CE-CT could preoperatively predict malignant potential and high Ki67 expression of small intestine GISTs, and Ki67 index may be a promising prognostic factor in predicting the prognosis of small intestine GISTs, independent of the risk stratification system.

Genetic analysis of potential biomarkers and therapeutic targets in ferroptosis from psoriasis.

Introduction: Ferroptosis is associated with multiple pathophysiological processes. Inhibition of ferroptosis has received much concern for some diseases. Nonetheless, there is no study comprehensively illustrating functions of ferroptosis-related genes (FRGs) in psoriasis. Methods: In this study, FRGs together with psoriasis-associated data were obtained in Ferroptosis Database (FerrDb) and gene expression omnibus (GEO) database separately. This work identified altogether 199 psoriasis-associated DE-FRGs, and they were tightly associated with immunity and autophagy modulation. Thereafter, the present study utilized SVM-RFE and LASSO algorithms to identify NR5A2, CISD1, GCLC, PRKAA2, TRIB2, ABCC5, ACSF2, TIMM9, DCAF7, PEBP1, and MDM2 from those 199 DE-FRGs to be marker genes. As revealed by later functional annotation, the marker genes possibly had important effects on psoriasis through being involved in diverse psoriasis pathogenesis-related pathways such as cell cycle, toll-like receptor (TLR), chemokine, and nod-like receptor (NLR) pathways. Moreover, altogether 37 drugs that targeted 11 marker genes were acquired. Besides, based on CIBERSORT analysis, alterations of immune microenvironment in psoriasis cases were possibly associated with PRKAA2, PEBP1, CISD1, and ACSF2. Discussion: Taken together, this work established the diagnostic potency and shed more lights on psoriasis-related mechanism. More investigations are warranted to validate its value in diagnosing psoriasis before it is applied in clinic.

Clinical and cVEMP Evaluation Predict Short-Term Residual Dizziness After Successful Repositioning in Benign Paroxysmal Positional Vertigo.

Objective: Residual dizziness (RD) is a frequent symptom with unknown pathogenesis, often complained about by the patients with benign paroxysmal positional vertigo (BPPV), even after a successful canalith repositioning procedure (CRP). This study aims to quantitatively evaluate the short-term RD severity and its risk factors in patients with BPPV after successful CRPs. Methods: In total two hundred and twenty patients with BPPV after successful CRPs (W0) were prospectively followed up for 1 week (W1). Besides demographics and serial neuropsychological assessments (including dizziness handicap inventory-DHI, etc.), patients also received cervical/ocular vestibular evoked myogenic potential (c/oVEMP) evaluation. RD was defined as patients with dizziness or imbalance, dizziness visual analog scale (VAS) >1, and without positional vertigo or nystagmus at W1. Demographic, clinical, and VEMPs differences were compared among the three groups: patients with minor (dizziness VAS 1-3) and moderate-to-severe RD (dizziness VAS > 3) and without RD. Results: The total frequency of RD at W1 was 49.1% (n = 108), with 32.3% (n = 71) minor, and 16.8% (n = 37) moderate-to-severe RD. Logistic regression analyses revealed that RD was closely associated with DHI status (OR = 2.101, P = 0.008) at W0, this effect was not present for minor RD. In addition to DHI score > 30 (OR = 4.898, P < 0.001) at W0, bilateral cVEMP absence (OR = 4.099, P = 0.005) was also an independent influential factor of moderate-to-severe RD. Conclusion: Our study highlights the importance of RD quantified evaluation. DHI score >30 and bilateral cVEMP absence could increase the risk of short-term moderate-to-severe RD.

Reducing Nav1.6 expression attenuates the pathogenesis of Alzheimer's disease by suppressing BACE1 transcription.

Aberrant increases in neuronal network excitability may contribute to cognitive deficits in Alzheimer's disease (AD). However, the mechanisms underlying hyperexcitability of neurons are not fully understood. Voltage-gated sodium channels (VGSC or Nav), which are involved in the formation of excitable cell's action potential and can directly influence the excitability of neural networks, have been implicated in AD-related abnormal neuronal hyperactivity and higher incidence of spontaneous non-convulsive seizures. Here, we have shown that the reduction of VGSC α-subunit Nav1.6 (by injecting adeno-associated virus (AAV) with short hairpin RNA (shRNA) into the hippocampus) rescues cognitive impairments and attenuates synaptic deficits in APP/PS1 transgenic mice. Concurrently, amyloid plaques in the hippocampus and levels of soluble Aß are significantly reduced. Interfering with Nav1.6 reduces the transcription level of ß-site APP-cleaving enzyme 1 (BACE1), which is Aß-dependent. In the presence of Aß oligomers, knockdown of Nav1.6 reduces intracellular calcium overload by suppressing reverse sodium-calcium exchange channel, consequently increasing inactive NFAT1 (the nuclear factor of activated T cells) levels and thus reducing BACE1 transcription. This mechanism leads to a reduction in the levels of Aß in APP/PS1 transgenic mice, alleviates synaptic loss, improves learning and memory disorders in APP/PS1 mice after downregulating Nav1.6 in the hippocampus. Our study offers a new potential therapeutic strategy to counteract hippocampal hyperexcitability and subsequently rescue cognitive deficits in AD by selective blockade of Nav1.6 overexpression and/or hyperactivity.

Effect of estradiol on proliferation and differentiation of side population stem/progenitor cells from murine endometrium.

BACKGROUND: In our previous study, endometrium side population cells (SP cells) were isolated from postpartum murine uterus, and characterized by a heterogeneous population of stem/progenitor cells. In this study, we investigated the effect of estrogen on the proliferation and differentiation of SP cells. METHODS: SP and non-SP cells of postpartum murine endometrium were isolated by DNA dye Hoechst 33342. The expression of estrogen receptor 1 (ESR1) was measured by reverse transcription polymerase chain reaction (RT-PCR), Real-time PCR, Western blot, immunofluorescence and immunohistochemistry. The proliferation and differentiation of SP cells treated with different concentrations [10(-8) M-10(-6) M] of estradiol (E2) and E2+ ICI182780 (Faslodex, inhibitor of ESR1) were measured by 3-(4, 5-dimethylthiazoly1-2)-2,5-diphenyltetrazolium bromide(MTT) and clonogenic assays. RESULTS: (1) SP cells expressed ESR1 at a higher level than non-SP cells. (2) The level of E2 in the serum and the expression of ESR1 in the uterus of postpartum murine changed in the same manner with the ratio of SP cells to total uterus cells at a different postpartum time point. ESR1, as ABCG2 is also predominantly located in the stroma and the glandular epithelium of the uterus. (3) 10(-6) M E2 notably promoted the proliferation of SP cells after treatment for 24 h. This effect could be inhibited by ICI182780. E2 at the concentration of 10(-7) M or 10(-8) M was sent to impair the large cloning efficiency (CE) of SP cells. CONCLUSIONS: The effect of estrogen on the proliferation and differentiation of endometrium SP cells via ESR1 was observed and it was in a concentration dependent fashion. Clearly, more work is needed to understand the in vivo effect of E2 at the physiological concentration on the differentiation of SP cells.

[Clinical follow-up study of combined tenodesis for long head of biceps tendon lesion with massive rotator cuff tear].

OBJECTIVE: To evaluate the combined tenodesis for long head of bicep tendon lesion with massive rotator cuff tear. METHODS: From January 2004 to June 2009, 41 patients of long head of bicep tendon lesion with massive rotator cuff tear were treated by arthroscopy. The follow-up period was over 12 months. There were 19 males and 22 females with an average age of 57 ± 11 year old. All patients were treated by arthroscopy with double row technique for rotator cuff tear repair and tenodesis for lesions of long head of bicep tendon. It combined the long head of bicep tendon with anterior edge of rotator cuff. The mean visual analogue scale (VAS) was 5.1 ± 23, the range of forward flexion (100 ± 55)°, external rotation (27 ± 24)° and internal rotation up to T(12) (T(5)-S(1)) level pre-operation on average. The Constant-Merly score was 50 ± 23, the University of California at Los Angeles (UCLA) score 14 ± 6 and the simple shoulder test (SST) score 4.0 ± 2.7 pre-operation on average. The strength of flexed elevation was (17 ± 20)% and strength of elbow flexion (101 ± 16)% versus the other side. RESULTS: All patients healed without any complication. Their outcomes improved significantly (P < 0.01). The mean VAS score improved to 1.5 ± 1.8, forward flexion (155 ± 21)°, external rotation (37 ± 24)° and post-operative internal rotation up to T(10) (T(4)-L(3)) on average. The mean Constant improved to 87 ± 13, mean UCLA 29 ± 5 and mean SST 9.3 ± 2.4. The strength of flexed elevation recovered to (68 ± 21)% post-operation. Significant differences were found in range of motion, VAS, strength and functional score (P < 0.01). No difference was observed for Mayo elbow performance score (MEPS) and elbow flexion strength at pre-operation versus post-operation. CONCLUSION: The combined tenodesis with double row rotator cuff repair is an effective approach for treating lesion of long head of bicep tendon with massive rotator cuff tear.

[Clinical results after all arthroscopic reduction and fixation of bony Bankart lesion].

OBJECTIVE: To investigate the shoulder function after arthroscopic reduction and internal fixation in patients with bony Bankart lesion. METHODS: Between May 2004 and May 2008, 45 patients with bony Bankart lesion who were treated with all arthroscopic reduction and internal fixation with metal anchors were included in this study. Among them 40 patients were male and 5 patients were female. The average age at the surgery was 27.6 years (16.5 - 50.1 years). The average duration of follow-up was 29.7 months (24.8 - 49.0 months). A history of recurrent dislocation of affected shoulder was found in all patients. Metal anchors were used to fix the bony Bankart lesion during the surgery. Hill-Sachs remplissage technique was used to treat the Engaging Hill-Sachs lesion. The preoperative American Shoulder and Elbow Society (ASES) score, Constant-Murley score, Rowe score and the VAS score for instability were 84 ± 14, 95.1 ± 4.6, 39.4 ± 2.9 and 5 ± 3 respectively. RESULTS: No significant change was found regarding active forward elevation, external rotation and internal rotation after the surgery. The ASES score, Constant-Murley score, Rowe score and the VAS score of stability were 95 ± 7, 98.3 ± 2.2, 84.5 ± 22.0 and 1 ± 2, improved significantly higher after the surgery (P < 0.01). One subluxation and 3 redislocation were happened during follow-up. The overall failure rate was 8.9% (4/45). CONCLUSIONS: All arthroscopic reduction and fixation of bony Bankart lesion can achieve a good result.

Exploring the genes involved in biosynthesis of dihydroquercetin and dihydromyricetin in Ampelopsis grossedentata.

Dihydroquercetin (DHQ), an extremely low content compound (less than 3%) in plants, is an important component of dietary supplements and used as functional food for its antioxidant activity. Moreover, as downstream metabolites of DHQ, an extremely high content of dihydromyricetin (DHM) is up to 38.5% in Ampelopsis grossedentata. However, the mechanisms involved in the biosynthesis and regulation from DHQ to DHM in A. grossedentata remain unclear. In this study, a comparative transcriptome analysis of A. grossedentata containing extreme amounts of DHM was performed on the Illumina HiSeq 2000 sequencing platform. A total of 167,415,597 high-quality clean reads were obtained and assembled into 100,584 unigenes having an N50 value of 1489. Among these contigs, 57,016 (56.68%) were successfully annotated in seven public protein databases. From the differentially expressed gene (DEG) analysis, 926 DEGs were identified between the B group (low DHM: 210.31 mg/g) and D group (high DHM: 359.12 mg/g) libraries, including 446 up-regulated genes and 480 down-regulated genes (B vs. D). Flavonoids (DHQ, DHM)-related DEGs of ten structural enzyme genes, three myeloblastosis transcription factors (MYB TFs), one basic helix-loop-helix (bHLH) TF, and one WD40 domain-containing protein were obtained. The enzyme genes comprised three PALs, two CLs, two CHSs, one F3'H, one F3'5'H (directly converts DHQ to DHM), and one ANS. The expression profiles of randomly selected genes were consistent with the RNA-seq results. Our findings thus provide comprehensive gene expression resources for revealing the molecular mechanism from DHQ to DHM in A. grossedentata. Importantly, this work will spur further genetic studies about A. grossedentata and may eventually lead to genetic improvements of the DHQ content in this plant.

Clinical and Oculomotor Correlates With Freezing of Gait in a Chinese Cohort of Parkinson's Disease Patients.

Accumulating evidence suggests that freezing of gait (FOG) is a unique gait disturbance in Parkinson's disease (PD), and its pathophysiology is not fully elucidated. The present study aims to investigate the clinical and oculomotor associations with FOG in Chinese PD patients. From Jan 2017 to Dec 2019, a total of 210 PD patients were consecutively registered for FOG evaluation based on item-3 of the Freezing of Gait Questionnaire (FOGQ). We explored the demographic, motor, and non-motor symptom differences in FOG positive (PD+FOG, n = 45) vs. negative (PD-FOG, n = 165) group. In addition, 40 PD patients and 37 healthy controls (HC) also underwent oculomotor test via videonystagmography (VNG). Visually guided saccade (VGS) latency, saccade accuracy and gain in smooth pursuit eye movement (SPEM) at three frequencies of horizontal axis were compared among PD+FOG (n = 20), PD-FOG (n = 20), and HC (n = 37). Compared with PD-FOG, PD+FOG had longer disease duration, more severe motor symptoms, lower cognitive scores, more severe depressive and autonomic impairments, as well as higher daily levodopa equivalent dosage. FOG occurred more frequently in patients with wearing-off. VNG subgroup analysis demonstrated that PD+FOG had prolonged saccade latency and decreased saccade accuracy relative to PD-FOG or HC. SPEM gain at 0.1 and 0.2 Hz was also decreased in PD+FOG compared with HC. Furthermore, prolonged saccade latency was correlated with higher FOGQ scores in PD patients. Our results verify that PD with FOG patients suffer from more severe motor and non-motor symptoms, indicating more extensive neurodegeneration. Prolonged saccade latency could be a practical oculomotor parameter both for identification and progression of FOG in PD.

Distribution and development of the TCM syndromes in psoriasis vulgaris.

OBJECTIVE: To study the distribution and development rules of the TCM syndromes in psoriasis vulgaris. METHODS: Based on the clinical epidemiologic mass survey, the study was carried out by means of a status survey, multi-center and large-sample research. The data base was set up by EPIINFO6.0. The SPSS was used to do the statistical analyses in 2651 cases of psoriasis vulgaris to study the correlations among the distribution and development of the TCM syndromes, the stages of the disease, nationality, psoriasis history, family history, smoking history, alcohol drinking history, and severity of the disease. RESULTS: The TCM syndromes in psoriasis vulgaris mainly include the blood-heat syndrome (53.8%), blood-dryness syndrome (27.4%), and blood-stasis syndrome (18.1%). Other syndromes were rarely seen, covering 0.6%. The concurrent syndromes mainly involve dampness, heat, blood stasis and toxin. The distribution differences of the main syndromes at different stages of the disease had statistical significance (P < 0.01). The syndrome distribution is not related with nationality and family history (P > 0.05), but it was closely related with the psoriasis history, smoking history, alcohol drinking history, and severity of the disease (P < 0.01). CONCLUSION: At the initial stage, psoriasis vulgaris usually manifests itself as the blood-heat syndrome, and later it may be improved or turn into the blood-dryness or blood-stasis syndrome. Smoking, alcohol consumption, and severity of the disease may play a role in the syndrome's transformation.

Reliability of the measurement of glenoid bone defect in anterior shoulder instability.

BACKGROUND: The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability. However, the reliability of glenoid bone defect measurement is controversial. The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements. METHODS: The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017. The glenoid bone defect was measured by three surgeons on 'self-confirmed' and 'designated' 3-D en-face views, and repeated after an interval of 3 months. Measurements included the ratio of the defect area to the best-fit circle area, and the ratio of the defect width to the diameter of the best-fit circle. The inter- and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients (ICCs). The maximum absolute inter- and intra-observer differences and the cumulative percentages of cases with inter- and intra-observer differences greater than these respective levels were calculated. RESULTS: Almost all linear defect values were bigger than the areal defect values. The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the 'self-confirmed' group and 0.549 and 0.431 in the 'designated' group. The inter-observer reliabilities for the linear defect were moderate or fair in the 'self-confirmed' group (ICC = 0.446, 0.374) and 'designated' group (ICC = 0.402, 0.327). The ICCs for intra-observer measurements were higher than those for inter-observer measurements. The respective maximum inter- and intra-observer absolute differences were 13.9% and 13.2% in the 'self-confirmed' group, and 15.8% and 9.8% in the 'designated' group. CONCLUSIONS: The areal measurement of the glenoid bone defect is more reliable than the linear measurement. The reliability of the glenoid defect areal measurement is moderate or worse, suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination. Subjective factors affecting the glenoid bone loss measurement should be minimized.