[Associations between indoor volatile organic compounds and nocturnal heart rate variability of young female adults: A panel study].

OBJECTIVE: To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults. METHODS: This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results. RESULTS: The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m2. During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m3, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) µg/m3, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m3 increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m3. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter. CONCLUSION: Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.

[The correlation between burst suppression on electroencephalogram during laparoscopic surgery and emergence delirium in elderly patients].

Objective: To investigate the relationship between intraoperative electroencephalogram burst suppression (BS) and emergence delirium (ED) in elderly patients undergoing elective laparoscopic surgery under total intravenous anesthesia (TIVA). Methods: From October 2017 to September 2019, a total of 358 elderly patients who underwent elective laparoscopic surgery under TIVA at Xiangya Hospital, Central South University, were included. Patients were divided into two groups based on the confusion assessment method for the intensive care unit (CAM-ICU) assessment conducted before leaving the post-anesthesia care unit (PACU): the ED group [n=63, 46 males, 17 females, average age of (70.8±0.6) years] and the non-ED group [n=295, 220 males, 75 females, average age of (69.7±0.2) years]. Preoperative general information, intraoperative conditions, and intraoperative electroencephalogram BS status were collected. A multivariate logistic regression model was employed to identify risk factors associated with ED. Results: In the ED group, the duration of surgery, intraoperative blood loss, the burst suppression ratio (BSR)>10% lasting for more than 1 minute were (224.4±9.6) min, (240.8±33.9) ml, 36.5% (23/63), respectively, which were higher than those of the non-ED group [(204.7±3.6) min, (150.5±9.2) ml, 21.7% (64/295), all P<0.05]. Multivariate logistic regression analysis revealed that a longer duration of education was a protective factor for ED (OR=0.904, 95%CI: 0.833-0.982,P=0.016), whereas increased intraoperative blood loss (OR=1.002, 95%CI: 1.000-1.003, P=0.013) and BSR>10% lasting for more than 1 minute (OR=2.131, 95%CI: 1.004-4.524,P=0.049) were identified as risk factors for ED. Conclusion: In elderly patients undergoing laparoscopic surgery under TIVA, intraoperative electroencephalogram BS may be a risk factor for ED.

[Analysis of factors associated with futile recanalization after endovascular treatment for acute ischemic stroke with large vessels occlusion in anterior intracranial circulation].

Objective: To analyze the related factors of futile recanalization (FR) after emergency endovascular treatment of large artery occlusion in anterior circulation. Methods: Three studies on endovascular treatment of acute anterior circulation large vessels occlusion stroke were selected, and their data were merged for retrospective analysis. Patients were divided into the FR group and favorable prognosis group according to the functional prognosis. Risk factor analysis was conducted using multivariate logistic regression. Results: A total of 1 581 patients were finally included, with 858 (48.9%) patients in favorable prognosis group and 926 (51.91%) patients in FR group. Among them, there were 939 males and 642 females, with a mean age of (65±12) years. Multivariate logistic regression analysis showed that National Institute of Health Stroke Scale (NIHSS) score (OR=1.089,95%CI:1.066-1.113), puncture to recanalization time (OR=0.756, 95%CI:0.586-0.971), age (OR=1.04,95%CI:1.029-1.051), serum glucose (OR=1.101,95%CI:1.062-1.143), systolic blood pressure (OR=1.005,95%CI:1.001-1.010), passes≥3(OR=1.941,95%CI:1.294-2.941)Alberta stroke program early CT (ASPECT) score (OR=0.919,95%CI:0.847-0.996), occlusion site (M1 segment of middle cerebral artery, OR=0.744,95%CI:0.565-0.980) and collateral circulation [(2 points, OR=0.757, 95%CI:0.581-0.985); (3-4 points, adjusted OR=0.640, 95%CI: 0.472-0.866)] were independent factors of FR. Conclusion: The incidence of FR in patients with large artery occlusion in anterior circulation who achieve satisfied reperfusion after endovascular treatment is high. Higher NIHSS score, longer puncture to recanalization time, older age, higher serum glucose and systolic blood pressure are risk factors, while lower ASPECTS, occlusion in cerebral middle M1 segment, better collateral circulation are protective factors.

[Efficacy and safety of intravitreal dexamethasone implant in diabetic macular edema patients with and without prior vitrectomy: a retrospective cohort study].

Objective: To evaluate the effectiveness and safety of intravitreal dexamethasone implant (IDI) in diabetic macular edema (DME) patients with and without prior vitrectomy. Methods: A retrospective cohort study was conducted on DME patients who received IDI treatment at the Aier Eye Hospital, Beijing from March 2018 to August 2020. Patients were divided into two groups according to whether they had undergone vitrectomy or not. Clinical and follow-up data, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), occurrence of ocular and systemic complications, and time to DME recurrence and retreatment, were collected before and after IDI injection at 15 days, 1, 2, 3, and 6 months. Statistical analyses were performed using t-test, Mann-Whitney U-test, χ2 test or Fisher's exact test, and generalized estimating equations. Results: Thirty-six patients (41 eyes) were included, with 19 patients (21 eyes) in the vitrectomy group and 17 patients (20 eyes) in the non-vitrectomy group. Compared with baseline, BCVA of eyes in the vitrectomy group was significantly improved at 15 days after IDI injection, with values of 1.00 (0.52, 1.31) and 0.61 (0.30, 1.00), respectively (Z=-2.10, P=0.036); BCVA of eyes in the non-vitrectomy group was significantly improved at 1 month after IDI injection, with values of 0.76 (0.60, 1.35) and 0.52 (0.10, 0.70), respectively (Z=-2.24, P=0.025). Compared with baseline, CMT of eyes in both groups was significantly reduced at all follow-up time points after 15 days of IDI injection (all P<0.05). In the vitrectomy group, CMT before and 15 days after injection were 487 (438, 661) µm and 389 (340, 553) µm, respectively (Z=-3.45, P<0.001); in the non-vitrectomy group, CMT before and 15 days after injection were 486 (410, 641) µm and 323 (290, 396) µm, respectively (Z=-4.07, P<0.001). There were no statistically significant differences in BCVA and CMT between the two groups at all follow-up time points (all P>0.05). The time to DME recurrence was 3.0 (3.0, 4.0) months in the vitrectomy group and 5.0 (4.0, 5.0) months in the non-vitrectomy group, with no significant difference between the two groups (P=0.675). Four eyes (19.0%) in the vitrectomy group and three eyes (15.0%) in the non-vitrectomy group had high IOP, with no significant difference (P=0.529). No severe ocular or systemic complications were observed in any patients. Conclusions: IDI treatment is safe and effective in DME patients with and without prior vitrectomy, with similar efficacy, but with faster onset of action in patients with prior vitrectomy. There was no significant difference in DME recurrence within 6 months after IDI injection between the two groups.

A further survey of the quantitative trait loci affecting swine body size and carcass traits in five related pig populations.

Breeding for good meat quality performance while maintaining large body size and desirable carcass traits has been the major challenge for modern swine selective breeding. To address this goal, in the present work we studied five related populations produced by two commercial breeds (Berkshire and Duroc) and two Chinese breeds (Licha black pig and Lulai black pig). A single-trait GWAS performed on 20 body size and carcass traits using a self-developed China Chip-1 porcine SNP50K BeadChip identified 11 genome-wide significant QTL on nine chromosomes and 22 suggestive QTL on 15 chromosomes. For the 11 genome-wide significant QTL, eight were detected in at least two populations, and the rest were population-specific and only mapped in Shanxia black pig. Most of the genome-wide significant QTL were pleiotropic; for example, the QTL around 75.65 Mb on SSC4 was associated with four traits at genome-wide significance level. After screening the genes within 50 kb of the top SNP for each genome-wide significant QTL, NR6A1 and VRTN were chosen as candidate genes for vertebrae number; PLAG1 and BMP2 were identified as candidate genes for body size; and MC4R was the strong candidate gene for body weight. The four genes have been reported as candidates for thoracic vertebrae number, lumbar vertebrae number, carcass length and body weight respectively in previous studies. The effects of VRTN on thoracic vertebrae number, carcass length and body length have been verified in Shanxia black pig. Therefore, the VRTN genotype could be used in gene-assisted selection, and this could accelerate genetic improvement of body size and carcass traits in Shanxia black pig.

[Clinicopathological features and prognostic impact of MELF pattern in 512 endometrioid adenocarcinoma].

Objective: To investigate the relationship of microcystic elongated fragmented (MELF) and clinicopathological features of patients with low grade endometrial endometrioid carcinoma, and to analyze its impact on prognosis. Methods: The clinical pathological data of 512 cases with low grade endometrial endometrioid adenocarcinoma were collected. The MELF invasive pattern in all of the sections were reappraised. The correlations between MELF pattern and clinicopathological features were analyzed by chi-square test, and the independent risk factor of lymph node metastasis were evaluated by Logistic multivariate regression analysis. Survival curves was drawn by Kaplan-Meier method, and Log-rank test was used to compare progression free survival (PFS) between patients with or without MELF pattern. Disease progression-related multivariate analysis was carried out by Cox proportional hazards model. Results: MELF pattern was observed in 12.9% (66/512) low grade endometrioid adenocarcinoma. It was significantly associated with cervical stroma invasion, more than half of the depth of myometrial invasion, lymph node metastasis and vessel invasion (P<0.05). In addition, MELF pattern was an independent risk factor for lymph node metastasis (P<0.05). The 5-year PFS of patients with and without MELF pattern were 95.0% and 96.0% respectively (P>0.05). Conclusions: The patients with MELF pattern are more likely accompany with cervical stroma and deeper myometrium invasion, vessel invasion, and lymph node metastasis, and it is an independent risk factor of lymph node metastasis. However, MELF pattern has no significant impact on prognosis of patients with endometrioid carcinoma.

[Analysis of hub genes and molecular mechanisms in non-alcoholic steatohepatitis based on the gene expression omnibus database].

Objective: To explore the hub genes and mechanisms in the pathological process of non-alcoholic steatohepatitis (NASH) by bioinformatics methods. Methods: Microarray datasets GSE89632 were downloaded from the Gene Expression Omnibus (GEO) database, which including 20 simple non-alcoholic fatty liver disease patients, 19 NASH patients and 24 healthy control individuals. The differentially expressed genes (DEGs) in patients with simple non-alcoholic fatty liver disease and NASH were compared with healthy control individuals respectively, and the intersection of the two groups of DEGs was taken. GO functional annotation and KEGG pathway enrichment analysis of DEGs were performed with DAVID 6.8 and KOBAS 3.0 separately. Protein-protein interaction network (PPI) was constructed by STRING database, then the mRNA hub genes were selected by Cytoscape software. The Attie Lab Diabetes database was used to verify the relative expression of hub genes mRNA in the liver of 4 groups of C57BL/6 mice (4-week-old normal group, 4-week-old obese group, 10-week-old normal group and 10-week-old obese group, 5 mice in each group). Spearman's correlation analysis was performed to analyze the correlation between hub gens and prognostic clinical parameters. Results: From the GSE89632 dataset, 365 common DEGs (115 up-regulated genes and 250 down-regulated genes) were identified in patients with simple non-alcoholic fatty liver disease and NASH patients compared with control individuals. GO analysis showed that DEGs were mainly enriched in biological processes such as inflammatory response and immune response. KEGG pathway analysis showed that up-regulated genes were mainly enriched in cholesterol metabolism, bile secretion and fat digestion and absorption signal pathways. Down-regulated genes were mainly enriched in interleukin-17 signaling pathway, tumor necrosis factor signaling pathway, advanced glycation end products and their receptors of diabetic complications. Seven key hub genes were identified by PPI analysis, which were FOS, EGR1, FOSB, JUNB, FOSL1, MYC and NR4A1.The mRNA relative expression levels of EGR1 and JUNB in the liver of 10-week-old obese mice were lower than those of normal mice (P<0.05).The relative expression levels of NR4A1 in the liver of obese mice at 4-and 10-week-old were lower than those of normal mice at the same age (P values<0.05). Spearman's correlation analysis showed that the expression of EGR1 was negatively correlated with the degree of hepatic steatosis (r=-0.785, P<0.001).The expression levels of FOSB, MYC and NR4A1 were negatively correlated with the level of alanine aminotransferase (r=-0.649, -0.597 and-0.580 respectively, all P values<0.001). Conclusion: EGR1, FOSB, MYC, JUNB and NR4A1 might be the hub genes in the pathological process of NASH and the inflammatory and immune response in hepatocytes, IL-17 signaling pathway and TNF signaling pathway might be the key molecular mechanisms in the occurrence and development of NASH.

[Effect of placental vascular distribution on residual anastomoses after fetoscopic laser surgery for twin to twin transfusion syndrome].

Objective: To investigate the effect of placental vascular distribution on residual anastomoses (RA) after fetoscopic laser occlusion of chorioangiopagous ressels (FLOC) for twin to twin transfusion syndrome (TTTS). Methods: A total of 57 cases of TTTS after laser surgery were retrospectively analyzed from April 2014 to April 2019 in Peking University Third Hospital. The patients were divided into RA group (24 cases) and non-RA group (33 cases) according to whether RA occurred in the placenta after laser surgery. The clinical characteristics, perioperative conditions, pregnancy outcomes and placental structure characteristics of the two groups were compared. Multivariate logistic regression was used to analyze the risk factors of placental vascular distribution for RA. The RA group was further divided into non-remission group and remission group, and the placental characteristics and pregnancy outcome of the two groups were compared. Results: (1)General clinical characteristics: the age, application of assisted reproductive technology, incidence of gestational hypertension, gestational diabetes mellitus, preoperative maximum amniotic fluid depth of the donor and recipient twins, Quintero stage and placental position of TTTS patients in the two groups were compared respectively, and there were no statistically significant differences (all P>0.05).The gestational age of patients received FLOC in the RA group was significantly higher than the non-RA group [(23.0±2.4) vs (21.9±2.7) weeks, P=0.033].(2) Perioperative conditions and pregnancy outcomes: the delivery gestational age of the RA group was significantly lower than that of the non-RA group (median:31.8 vs 34.4 weeks, P=0.002);The newborn birth weight in the RA group was significantly lower than that in the non-RA group [(1 648±597) and (2 013±481) g, P=0.003].The birthweight difference in the RA group was significantly higher than that in the non-RA group (median:0.30 vs 0.11, P=0.005). (3) The placental structure and the risk factors influencing RA happened: the differences in the proportion of four types of placental vascular distribution in the RA group and non-RA group were different significantly (χ²=10.214, P=0.012), with a detail of parallel type 29% (7/24) and 3% (1/33), staggered type 58% (14/24) and 76% (25/33), hybrid 8% (2/24) and 21% (7/33), monoamniotic membrane type 4% (1/24) and 0 respectively. Multivariate logistic regression analysis showed that parallel placental vascular distribution was an independent risk factor for RA after FLOC (OR=24.5, 95%CI 1.7-336.2, P=0.017). (4) Placental characteristics and pregnancy outcomes in the remission and non-remission groups of the RA group: the incidence of three kinds of anastomoses, the total number, total diameter and proportion of RA, and the placental territory discordance ratio were compared between the two groups, and there were no statistical significances (P>0.05);The birth weight difference ratio in the non-remission group was higher than that in the remission group (median:0.41 vs 0.28, P=0.036). Conclusion: The parallel type of placental vascular distribution may be an independent risk factor for RA in TTTS after laser surgery.

[Logistic regression analysis of risk factors for subretinal fluid after rhegmatogenous retinal detachment repair].

Objective: To identify factors associated with persistent subretinal fluid (SRF) after scleral buckling and to evaluate surgical outcomes of patients with primary rhegmatogenous retinal detachment (RRD). Methods: Cross-sectional study and cohort study. This study included 104 patients (104 eyes) who underwent scleral buckling for repair of RRD between January 2016 and June 2017. Several statistically significant risk factors associated with SRF were screened out with univariate analysis. Then independent risk factors were determined with multivariate stepwise logistic regression analysis. Examinations were taken preoperatively, at 1, 3, 6, and 12 months postoperatively, and thereafter every six months. Patients were divided into two groups depending on the presence or absence of persistent SRF on optical coherence tomography at 1 month. Results: Persistent SRF occurred in 69.2% (72/104) of patients. In multivariate analysis, younger age (OR=32.860, 95%CI=3.636-296.986, P=0.002), high myopia (OR=7.229, 95%CI=1.217-42.94, P=0.03) and macula-involving retinal detachment (OR=357.397, 95%CI=29.761-4292.0, P=0.000) were associated with persistent SRF. Best corrected visual acuity in patients with SRF at 1 month (0.71±0.18 vs. 0.58±0.11; t=4.047, P<0.01) and 3 months (0.55±0.15 vs. 0.43±0.12; t=3.914, P<0.01) was worse than that in patients with absence of SRF. Best corrected visual acuity in patients with SRF was 0.44±0.16 at 6 months, 0.37±0.12 at 12 months and 0.36±0.10 at the last follow-up, with no significant difference from patients without SRF at the three time points (0.39±0.13, 0.38±0.12 and 0.35±0.09; t=1.643, -0.202, 0.464; P>0.05). Conclusions: RRD patients with younger age, high myopia and macular involvement were more likely to develop persistent SRF after scleral buckling. The presence of persistent SRF slowed visual recovery but did not influence the final visual outcomes. (Chin J Ophthalmol, 2021, 57: 426-432).

Total glucosides of paeony (Paeonia lactiflora) alleviates blood-brain barrier disruption and cerebral ischemia/reperfusion injury in rats via suppressing inflammation and apoptosis.

At present it remains uncertain as to whether total glucosides of paeony (TGP) are able to mediate neuroprotection in the context of cerebral ischemia/reperfusion (CIR) injury, and if so, what mechanisms underlie such protection. We employed a rat model of middle cerebral artery occlusion and reperfusion, and then Evans blue (EB), hematoxylin and eosin, Nissl staining, TUNEL staining, ELISAs and immunohistochemistry were used. We observed marked reductions in infarct volume, neurological deficits, and CIR-associated histopathological changes following TGP treatment. We further found that TGP was associated with restoration of the BBB integrity, a reduction in levels of cerebral IL-1ß, IL-6 and TNF-α, and a decrease in overall neuronal apoptotic death that coincided with reduced Cleaved Caspase-3 and Bax expression, and elevated Bcl-2. These results demonstrate that TGP treatment is capable of reducing neurons damage and associated BBB dysfunction via anti-apoptotic and anti-inflammatory mechanisms in a rodent model of CIR injury.

Anti-inflammatory effects of ginsenoside Rg3 on the hypertrophic scar formation via the NF-κB/IκB signaling pathway in rabbit ears.

The anti-inflammatory effects of Rg3 on the hypertrophic scar (HS) formation remain relatively obscure. Hence, this study aimed to explore the anti-inflammatory effects of Rg3 on the HS formation using a rabbit ear model and we assessed the involvement of the NF-κ B/IκB signaling pathway in this process. We constructed the Newland white rabbit ear HS model and treated it with Rg3. Using histological analyses, we evaluated scar hypertrophy based on the hematoxylin and eosin staining. The degree of scarring was evaluated using the scar elevation index (SEI). In addition, collagen I and collagen III expression levels were assessed by immunohistochemistry, while fibroblast apoptosis was examined using TUNEL assays. While MPO, IL-1ß, IL-6, and TNF-α concentrations were quantified using ELISA, NF-κB and p-IκB activities were respectively measured using electrophoretic mobility shift assays (EMSAs) and western blots. SEI measurements and histological characteristics revealed that Rg3 could suppress the HS formation. Moreover, Rg3 could inhibit the HS formation by decreasing collagen I and collagen III synthesis and inducing fibroblast apoptosis. Besides, Rg3 treatment markedly inhibited the inflammatory cytokine production and ameliorated neutrophil infiltration. Notably, this study revealed that Rg3 inhibited NF-κB activation and the activity of p-IκB. Furthermore, this study suggested that the ability of Rg3 to decrease the scar formation might result from its ability to inhibit inflammation by modulating the NF-κB/IκB signaling. Overall, the findings of this study could support the use of Rg3 to prevent the HS formation.

[Clinical-pathological analysis of 71 cases of dermatosis papulosa nigra of Han Chinese people].

Objective: To analyze and summarize the clinical-pathological features of dermatosis papulosa nigra of Han Chinese people. Methods: We collected 71 cases of dermatosis papulosa nigra in the Third people's Hospital of Hangzhou Affiliated to Zhejiang Chinese Medical University of Department of Dermatology from January 2010 to January 2019 which were confirmed clinically and pathologically. The clinical and histopathological data of all patients were analyzed and summarized, and relevant literature were reviewed. Results: Among the 71 patients, 51 were female and 25 were male, their average age was (44±13) years, the average age of onset was (39±14) years, and the average time of diagnosis was (65±51) months. The lesions were multiple dark brown papules with smooth surface, and mostly distributed in the chest and abdomen, 46 cases (64.8%), followed by the back and neck. The mean diameter of the lesions was (1.76±0.99) mm. Meanwhile, the initial onset of pruritus was observed in 15 patients. The pathological features of all lesions were similar to seborrheic keratosis. According to pathological classification, there were 49 (69.0%) cases of the acanthotic type, 11(15.5%) cases of the hyperkeratotic type, 6 (8.5%) cases of spiroid type, 4 (5.6%) cases of irritated type, and 1 (1.4%) case of clonal type. Epidermal pigmentation and/or dermal papillary pigmented granules were observed in 56 cases (78.9%), of which 46 cases (64.8%) had basal layer pigmentation. In addition, inflammatory cell infiltration was found in the superficial dermis of lesions of 10 patients (14.1%) with symptom of itching. Conclusion: Dermatosis papulosa nigra of Han Chinese people has some unique clinical and pathological features.

[The correlation between gastric bubble size and laryngopharyngeal reflux pattern in patients with laryngopharyngeal reflux disease].

Objective: To investigate the correlation between gastric bubble size and laryngopharyngeal reflux pattern in patients with laryngopharyngeal reflux disease(LPRD). Methods: A total of 52 LPRD patients who underwent Dx-pH monitoring and anteroposterior chest radiography at the same time from February 2016 to November 2018 were retrospectively studied. Patients were devided into three position-related groups according to the Ryan score of upright and supine: isolated upright reflux(IUR), isolated supine reflux(ISR) and bipositional reflux(BR) groups. In addition, 13 healthy volunteers with negative pH monitoring were selected as the control group. Gastric bubble size and pH monitoring data among the four groups were compared. SPSS 24.0 was used for statistical analysis. Results: In all the 52 patients, 35 cases (67.3%) were classified as IUR, 9 cases (17.3%) as ISR, and 8 cases (15.4%) as BR. The height of gastric bubbles in the four groups were: IUR (26±14) mm, ISR (9±8) mm, BR (20±13) mm, control (17±15) mm, and statistical difference was found among the four groups(P=0.004). Post Hoc Multiple Comparisons found that IUR group had statistical difference between ISR group and control group (P=0.001, P=0.034 respectively). There was no statistical difference of gastric bubble width and area among the four groups(P=0.340, P=0.186 respectively). The ROC curve of the gastric bubble height with isolated upright and supine reflux patterns was obtained, and the optimal cutoff value of the gastric bubble height was 11 mm. Accordingly, we divided the patiens into two groups with high and low gastric bubble. LPRD reflux pattern distribution was significantly different between the two groups(P<0.001). The comparison of reflux parameters in pH monitoring also showed that the supine reflux parameters in the lower group were significantly higher than those in the higher group, and the upright reflux parameters in the higher group were significantly higher than those in the lower group(P<0.001). Conclusions: The height of gastric bubble is significantly correlated with the reflux patterns in LPRD patients. The gastric bubble of patients with IUR is significantly higher than that of patients with ISR. Taking 11 mm as the cutoff value, patients with higher gastric bubble are more prone to upright laryngopharyngeal reflux, while those with lower gastric bubble are more prone to supine laryngopharyngeal reflux.

[Study on corneal biomechanical properties of suspicious keratoconus patients in corneal topography].

Objective: To explore the characteristics and significance of corneal biomechanics in patients with suspicious total deviation value in Belin/Ambrosio Enhanced Ectasia Display of Pentacam corneal topography. Methods: In this cross-sectional study, 206 patients (325 eyes) with myopia or myopic astigmatism were collected from refractive surgery center of Tianjin Eye Hospital. Among them, 110 males(213 eyes) and 96 females (153 eyes) were aged (22.68±5.20) years. 57 patients (71 eyes) with a total deviation value of 1.6-3.0 in the Pentacam corneal topography were included in the suspicious group, and 149 patients (254 eyes) of<1.6 were included in the control group. The values of the first applanation time (A1-Time), first applanation length (A1-Length), first applanation velocity (A1-Velocity), second applanation time (A2-Time), second applanation length (A2-Length), second applanation velocity(A2-Velocity), highest concavity time (HC-time), highest concavity deformation amplitude (DA), highest concavity peak distance (PD), highest concavity radius (HC-Radius, RoC), intraocular pressure were measured using the corneal visualization Scheimpflug technology. The total deviation value in Belin/Ambrosio Enhanced Ectasia Display were measured with a Pentacam. The biomechanical parameters of the suspicious group were compared with the normal group by the two independent samples t test and the identity regression analyses. The data correlation was performed using Pearson linear correlation analysis. Results: Compared with the D normal group, the K1, K2 and Km of D suspicious group were significantly increased (P<0.001). A1-Velocity [(0.152±0.015) m/s] and DA[(1.050±0.090) mm] were significantly increased (t=4.348, 2.708; P<0.001, 0.007), while the CCT, A1-Length, A2-Length and RoC were significantly decreased (P<0.01) in suspicious group. In suspicious group, there was a significant correlation between A1-Time, A1-Length, A2-Length, A2-Velocity, IOP and CCT(r=0.305, 0.324, 0.238, 0.346, 0.316; P<0.05). There was a significant correlation between the anterior surface refractive power K1 and the A1-Length (r=-0.361, P=0.002), and there was a significant correlation between the A1-Length, RoC and anterior surface refractive power K2 (r=-0.369, -0.242; P=0.002, 0.043). There was a significant correlation between anterior surface refractive power Km and A1-Length (r=-0.373, P=0.001). After adjusting the confounding factors between two groups by the identity regression analyses, the A1-Length (P=0.003), A1-Velocity (P<0.001) and DA (P=0.002) were still significant differences. Conclusions: In total deviation value suspicious group, the corneal thickness was thinner, corneal curvature became steeper and the corneal biomechanical properties were weaker. It is important to screen keratoconus before corneal refractive surgery and choose a reasonable surgical procedure to reduce corneal dilatation after refractive surgery. (Chin J Ophthalmol,2019, 55: 442-447).

[Analysis of chromosome in 1 324 patients with oligozoospermia or azoosperm].

OBJECTIVE: To explore the incidience of chromosome abnormality of the patients with oligozoospermia or azoospermia and male infertility, to discuss the relationship between the quantitative and structural abnormality of chromosome and to lay the foundation for the clinical diagnosis and consultation. METHODS: A retrospective analysis was conducted from January 1, 2015 to May 1, 2016, in the Center for Reproduction Medicine, the Second Hospital of Jilin University, with male reproductive abnormalities history excluded. In the study, 1 324 cases were included with 448 cases of azoospermia and 876 cases of oligozoospermia. All the patients through ultrasound examination, color Doppler ultrasonography, the seminal plasma Zn determination, their hormone level determination, chromosome karyotype (the perinatal blood samples were obtained from the 1 324 patients with oligozoospermia or azoospermia for lymphocyte culture, then chromosomal specimens were prepared, G-banding analyses combined with clinical data were used to statistically analyze the incidence of chromosomal abnormality), Y chromosome azoospermia factor [PCR technique was used to detect SY157 locus, SY254 locus, and SY255 locus in male Y chromosome azoospermia factor (AZF) gene of the patients with oligozoospermia or azoospermia]. The relationship between chromosome abnormalities and oligozoospermia or azoospermia were analyzed. RESULTS: Among the 876 cases of oligospermia patients, 78 cases were chromosome number abnormality and chromosomal structural abnormality, the abnormal number of sex chromosomes in 22 cases, and sex chromosomes and chromosome structural abnormalities in 56 cases; in the 448 cases of azoospermia patients, 91 cases were chromosomal structural abnormality and chromosome number abnormality, of them, 78 cases were of abnormal number of sex chromosomes, and 13 cases were of abnormal structure. In addition, 137 cases were of chromosome polymorphism in all the 1 324 patients, The incidence of Y chromosome abnormality in azoospermatism was higher than that of the 43 patients with Y chromosome AZF microdeletion. In addition, the asthenospermia and recurrent spontaneous abortion were closely related to Y chromosome abnormality and the chromosome translocations and inversions. CONCLUSION: Oligozoospermia and azoospermia patients with abnormal chromosome karyotype have high incidence rate, and chromosome karyotype analyses were carried out on it, which is conducive to clinical diagnosis for the patients with abnormal chromosome karyotype. There is a close relationship between male infertility and abnormal karyotype. It is conducive to clinical diagnosis for the patients with infertility through chromosome karyotye analysis, which also provides evidence for genetic counseling.

Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis.

INTRODUCTION: Prior studies show promising results of the gastric peroral endoscopic pyloromyotomy (G-POEM) procedure for treatment of refractory gastroparesis. One major technical challenge involved in this procedure is identifying the pyloric muscular ring (PMR). The aim of this study is to establish a reliable method for identification of the PMR during G-POEM. METHODS: Fluoroscopy-guided G-POEM was performed by placing an endoclip at the 9 to 11'o clock position at the pylorus for identification of PMR. Conventional G-POEM was performed by observation of blue colored mucosa at the pylorus area as an indirect marker for PMR. The degree of the PMR identification was graded into well identified, identified, and not identified based on the appearance of the PMR. Procedure times were accurately documented. Gastroparesis cardinal symptoms index and gastric emptying scintigraphy were evaluated before and after the procedure. RESULTS: Fourteen patients were studied, seven underwent fluoroscopy-guided G-POEM, and seven patients underwent conventional G-POEM. All procedures achieved technical success and no adverse events occurred. In the seven patients who underwent fluoroscopy-guided G-POEM, the PMR was well identified in four patients and identified in three patients. In the seven patients who underwent conventional G-POEM, the PMR was identified in four patients and not identified in three patients. The average time to complete the fluoroscopy-guided G-POEM was significantly shorter than that of the conventional G-POEM. CONCLUSIONS: Fluoroscopy-guided G-POEM by placement of an endoclip at the pylorus was a reliable and safe method to direct the orientation of the submucosal tunnel, to facilitate the location of the PMR, and to shorten the procedure time.

[Clinical outcome and placenta characteristics of spontaneous twin anemia-polycythemia sequence].

Objective: To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods: Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed, retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. Results: (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks (31-37 weeks) . The pregnancies were terminated because 3 cases were sIUGR type Ⅰ, 1 case was sIUGR type Ⅱ, 1 case was sIUGR type Ⅲ, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1 797 g (940-2 620 g) , 1 648 g (980-2 500 g) ; P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient (P=0.000) and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was 1.1 mm (0.4-2.1 mm), including 0 (0-1) A-A anastomoses with 0.2 mm (0.0-0.9 mm) in diameter and 2 (0-5) A-V anastomoses with 0.7 mm (0.0-2.1 mm) in diameter. The placental territory discordance was 0.17 (0.02-0.40) and the ratio of umbilical cords insertion to the longest placental diameter was 0.82 (0.34-0.99). Conclusions: The pathogenesis of sTAPS might result from slow and chronic blood transfusion from donor to recipient through a few minuscule vascular anastomoses in the placenta. In all monochorionic twins, especially sIUGR cases, MCA doppler should be monitored closely in the second and third trimester, in order to diagnose and manage sTAPS in time.

[Effect of optical zone diameter on corneal biomechanical properties after small incision lenticule extraction].

Objective: To investigate the effect of optical zone diameter on corneal biomechanical properties after small incision lenticule extraction (SMILE). Methods: In this prospective case-control study, 62 eyes of 42 patients with myopia and myopic astigmatism that had undergone SMILE procedure were divided into 2 groups according to the optical zone (OZ) diameter: group A, 31 eyes of 19 patients, OZ= 6.5 mm; group B, 31eyes of 23 patients, OZ=6.0 mm. These patients were examined for corneal hysteresis (CH) and corneal resistance factor (CRF) with the Ocular Response Analyzer (ORA) preoperatively and at 1 week, 1 month and 3 months postoperatively; at the same time, the central corneal thickness-corrected indices of DifCH and DifCRF were calculated. Pearson correlation was applied to analyze the correlation between CH and CRF and central corneal thickness. Independent-samples t test was utilized to compare CH and CRF between the two groups. Repeated ANOVA was used to compare the difference of corneal biomechanical properties at different follow-up timepoints. Results: The preoperative mean CRF and CH values were (10.13±1.19) mmHg and (9.65±1.12) mmHg in group A and (10.34±0.89) mmHg and (10.04± 1.05) mmHg in group B, respectively, and no significant differences were found in CRF and CH between the two groups (CRF: t=-0.807, P=0.423. CH: t=-1.405, P=0.165). The mean CRF values in group A at postoperative 1 week and 3 months were (6.62 ± 1.09) mmHg and (6.83 ± 1.07) mmHg, respectively, which were significantly lower than the relevant mean CRF values in group B (t=-2.703, P=0.009. t=-3.733, P= 0.001). Meanwhile, the mean CH values at 1 week, 1 month and 3 months postoperatively in group A were (7.31±1.06) mmHg, (7.37±0.96) mmHg and (7.82±0.97) mmHg, respectively, which were significantly lower than those in group B (t=-2.415, P=0.019. t=-2.113, P=0.039. t=-2.67, P=0.01). Moreover, the DifCRF and DifCH values in group A were significantly lower than those in group B at 3 months postoperatively (t=-3.409, P=0.001. t=-2.064, P=0.044). The CRF and CH values in both groups showed a significant reduction at 1 week, 1 month and 3 months postoperatively (P<0.05). Conclusions: The size of optical zone has some effects on corneal biomechanical properties after SMILE. The smaller optical zone diameter has a relatively smaller effect. (Chin J Ophthalmol, 2017, 53:182-187).

Inhibition of FGF Signalling Pathway Augments the Expression of Pluripotency and Trophoblast Lineage Marker Genes in Porcine Parthenogenetic Blastocyst.

The consistent failure to isolate bona fide pluripotent cell lines from livestock indicates that the underlying mechanisms of early lineage specification are poorly defined. Unlike other species, the contrivances of segregation have been comprehensively studied in the mouse. In mouse, FGF/MAPK signalling pathway dictates the segregation of hypoblast (primitive endoderm). However, it is not evident whether this mechanism is also conserved in livestock. Here, in this study, we examined the roles of FGF/MAP kinase signalling pathways in porcine parthenogenetic embryos during the early development. Porcine parthenogenetic embryos were cultured in the medium addition with FGFR inhibitor BGJ398 (10 µm) or DEMOS. Pluripotency- and lineage-related gene expressions in the early porcine embryos were determined. Compared to control, total cell numbers on day 7 were significantly higher (55 ± 5.96 vs 47 ± 1.97, p < 0.05) in embryos cultured in the presence of BGJ398, but had no significant effect on the rate of blastocyst development (47% vs 44%, p > 0.05). Nonetheless, BGJ398 treatment significantly augmented the expression of pluripotency and trophoblast marker genes (SOX2, OCT4, KLF4 and CDX2), but did not significantly change the expression of NANOG and hypoblast marker gene (GATA4). Furthermore, the addition of FGF signalling agonist (FGF2) during the embryo development significantly decreased the expression of pluripotency and trophoblast marker genes (SOX2, NANOG, KLF4 and CDX2), but no significant effect on the expression of OCT4 and GATA4 was observed. Here, we exhibit that inhibition of FGF signalling could improve the quality of the porcine embryo and escalate the chance to capture pluripotency. Besides, it also promotes the trophoblast development of porcine parthenogenetic embryo. In addition, the data suggested that FGF signalling pathway is dispensable for the segregation of hypoblast and epiblast lineages in porcine embryo during the early development.

[Epidermal growth factor tyrosine kinase inhibitors used in the treatment of NSCLC patients with leptomeningeal metastasis].

Objective: The aim of this study was to identify the clinical features and prognostic factors of leptomeningeal metastasis (LM) in non-small cell lung cancer (NSCLC) patients undergoing treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). Methods: Twenty-five cases of NSCLC with LM, treated in our hospital during January 1, 2003 to October 31, 2013, were enrolled in this study. Medical records were reviewed for clinical features and treatments, and the survival and prognostic factors were analyzed. Results: NSCLC-LM were more common in female patients (64.0%), and most were adenocarcinomas (72.0%). Twenty (80.0%) patients underwent anti-cancer treatment, among them 17 patients underwent EGFR-TKIs treatment.The median overall survival (mOS) after the diagnosis of LM was 4.9 months for the whole group (25 cases). Patients receiving EGFR-TKIs treatment had a longer median survival than patients not receiving EGFR-TKIs (5.3 months vs. 1.2 months, P=0.022). Eleven patients who developed LM before the targeted therapy had a prolonged median survival of 8.1 months after EGFR-TKIs treatment. The univariate analysis showed that female gender and EGFR-TKIs treatment were favorable prognostic factors influencing the survival (P<0.05), while age, LM at the time of initial diagnosis, LM developed during the EGFR-TKIs treatment, whole-brain radiotherapy (WBRT), intrathecal chemotherapy, or systemic cytotoxic chemotherapy were not associated with mOS (P>0.05 for all). The multivariate analysis showed that female gender (P=0.012) and EGFR-TKIs treatment (P=0.008) were significant predictors of a good prognosis. Conclusions: EGFR-TKIs treatment may confer benefit for NSCLC-LM patients. Female patients and EGFR-TKIs treatment are favorable prognostic factors for survival.