[Effects of postoperative urine protein levels on predicting acute kidney injury in critically ill patients undergoing non-cardiac surgery].

Objective: To investigate the predictive value of postoperative urine protein level in critically ill patients undergoing non-cardiac surgery with acute kidney injury (AKI). Methods: A total of 661 critically ill patients undergoing non-cardiac surgery, who visited the Department of Critical Care Medicine of Peking University First Hospital from May 20, 2019 to November 24, 2020, were enrolled in this prospective study. The clinical data of the patient's age, gender, body mass index, laboratory examination, surgical status, etc. were collected. AKI diagnostic criteria of the 2012 KDIGO guidelines were used to diagnose the occurrence of AKI after surgery. The independent predictors of AKI were determined by multivariate logistic regression. Results: The age of this patient cohort was (69±15) years. The prevalence of AKI was 45.4% (300/661). Multivariate logistic regression showed that urine protein semi-quantitative ≥2+(OR=2.62, 95%CI: 1.05-6.56, P=0.039) was independent factor for postoperative AKI in critically ill patients undergoing non-cardiac surgery, other independent factors include higher age (OR=1.04, 95%CI: 1.02-1.06, P=0.001), higher body mass index (BMI) (OR=1.12, 95%CI: 1.04-1.21, P=0.004), lower plasma hemoglobin level (OR=0.98, 95%CI: 0.97-1.00, P=0.019), lower central venous pressure (OR=0.89, 95%CI: 0.83-0.97, P=0.005) and lower total hypotension time (OR=1.01, 95%CI: 1.00-1.01, P=0.041). Conclusions: Urine protein semi-quantitative ≥2+after surgery is an independent predictive factor for the occurrence of postoperative AKI in critically ill patients undergoing non-cardiac surgery. It is important to check urine routine immediately after surgery to detect and deal with high-risk patients.

[Prevalence and trend analysis of severe multiple disabling birth defects in Chongqing City from 2007 to 2020].

Objective: To explore the prevalence and change trend of severe multiple disabling birth defects in Chongqing City from 2007 to 2020, and to provide a basis for comprehensive prevention and control measures of severe multiple disabling birth defects. Methods: Based on hospital monitoring data, 1 103 children with severe multiple disabling birth defects monitored by all birth defects monitoring institutions in Chongqing City from January 2007 to December 2020 were included in the study. They were grouped by year, perinatal gender, maternal permanent residence (urban/rural), maternal age, different regions and other categories. Chi-square test was used to analyze the differences in the incidence of severe multiple disabling birth defects in different categories, and linear trend test was used to analyze the change trend. Results: From 2007 to 2020, a total of 1 022 314 perinatal births and 1 103 severe multiple disabling birth defects were monitored in Chongqing City, with an incidence of 10.79/10 000, including 11.47/10 000 in urban areas and 9.48/10 000 in rural areas, with an incidence higher in urban areas than in rural areas(χ2=8.424,P=0.004). Male was 10.47/10 000, female was 10.97/10 000, there was no significant difference between male and female(χ2=0.606,P=0.436). The incidence of maternal in different age groups was u-shaped, and there was statistical difference in incidence among different age groups (χ2=59.465, P<0.001). The incidence of maternal in<20 years old and ≥35 years old was higher, and in 25-29 years old was lower. The incidence rate was 17.96/10 000 in 2007 and 7.18/10 000 in 2020, which decreased by 60.02% in 2007-2020. The incidence of neural tube defect, chromosome syndrome, limb shortening and abdominal wall defect decreased by 78.12%, 77.38%, 80.55% and 91.30%, respectively. Severe Congenital heart disease rose by 456.16%. From 2007 to 2020, the overall incidence of the disease showed a decreasing trend (χ2trend =117.046, P<0.001), except for the rise of severe congenital heart disease, (χ2trend=8.744, P=0.003), the other four types of diseases were on the decline (neural tube defects χ2trend =48.618, P<0.001; chromosome syndrome χ2trend=50.999, P<0.001; limb shortening χ2trend=73.464, P<0.001; abdominal wall defect χ2trend=79.863, P<0.001). Conclusion: From 2007 to 2020, the incidence of severe disabling birth defects in Chongqing City showed a downward trend, and there were regional and age differences. The incidence of severe congenital heart disease is on the rise.

[Sinusitis, otitis media and diffuse bronchiectasis in both lungs].

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive or X-linked biallelic mutations inherited disease, characterized by motile cilia dysfunction. Typical manifestations include bronchiectasis, secretory otitis media, sinusitis, situs inversus, and infertility. PCD often needs to be differentiated from cystic fibrosis (CF) because of similar clinical manifestations. In this paper, a juvenile female who presented with recurrent cough and expectoration with fever since early childhood, had a history of secretory otitis media and sinusitis, and had been considered for the diagnosis of CF. After the discovery of compound heterozygous mutations in PCD related pathogenic genes by gene sequencing, combined with the clinical manifestations and imaging characteristics, PCD was finally diagnosed.

[Effect of gMDSCs on natural killer cell functionality in chronic hepatitis C patients treated with direct-acting antiviral agents].

Objective: To investigate the changes of natural killer(NK) cell function, and clarify the effect of granulocytic myeloid derived suppressor cells (G-MDSCs) on NK cell functionality in patients with treatment-naive chronic hepatitis C (CHC) who were cured by direct-acting antiviral agents (DAAs). Methods: Thirteen treatment-naive CHC patients and 13 healthy controls were prospectively included in this study from March 2016 to January 2017. They were divided into case group and control group, respectively. The patients of case group,6 males and 7 females aged 21-65 years old with an average of (37±14),were treated with daclatasvir and asunaprevir combination (DCV/ASV) at the Department of Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital. While 13 healthy individuals, 6 males and 7 females aged 21-57 (36±11) years old, were enrolled as healthy controls(control group). Flow cytometry was used to determine the immunological characteristics of peripheral blood NK cells subset, and detect the frequencies of gMDSCs in peripheral blood of people in two groups. It was specifically notes that CHC patients of case group would be detected before, during and after treatment. The correlations between gMDSCs and each NK cell subset function were also examined. The impact of gMDSCs on NK cell functionalities and the relevant regulatory mechanisms were explored using co-culture experiments of sorted NK cells and gMDSCs in vitro. Results: Compared with healthy controls, the decreased IFN-γ production[M(Q1,Q3)] [3.182 (2.757, 4.237) vs 6.675 (4.476, 8.280),1.434 (1.127, 2.434) vs 3.045 (1.680, 4.856), 2.611 (1.749, 3.498) vs 5.160 (4.232, 7.683)] and increased CD107a degranulation [9.314 (7.838, 13.543) vs 3.480 (2.938, 6.824), 2.544 (1.366, 4.768) vs 0.552 (0.408, 1.560), 10.339 (9.145, 12.534) vs 3.488 (3.117, 5.651)] (all P<0.05) were found on NK cell and its subsets. The frequencies of gMDSCs and plasma concentration of arginase-1 in CHC patients was significantly higher than that in healthy controls [7.050 (4.180, 12.538) vs 1.440 (0.444, 2.261), 114.278 (68.492, 163.724) vs 64.753 (50.809, 93.278)](all P<0.05). The production of IFN-γ was increased and the secretion of CD107a was decreased in NK cell and its subsets after DAAs treatment (P<0.05). The frequencies of gMDSCs and plasma arignase I levels were also decreased in CHC patients treated with DAAs (P<0.05).The results of the study indicated that the frequencies of G-MDSCs were inversely associated with the levels of IFN-γproduction of NK cells and CD56dim NK cells in CHC patients (r=0.668, -0.750, respectively, both P<0.05). In addition, the frequencies of gMDSCs were positively associated with the expression of CD107a in the CD56bright NK cell subset (r=0.711, P=0.021). In vitro, the inhibition of gMDSCs on the IFN-γ production of NK cells was demonstrated in the co-culture experiments of sorted NK cells and gMDSCs, and blocking arginase I can significantly increase the ability of NK cells to produce IFN-γ, restore NK cell IFN-γ production. Conclusions: gMDSCs in peripheral blood of CHC patients has been shown to suppress NK cell IFN-γ production in an arginase I-dependent manner. Direct-acting antiviral-mediated clearance of HCV is associated with the normalization of NK cell function and gMDSCs frequency.

[Analysis of genotypes, EEG and phenotypes of tuberous sclerosis complex patients].

Objective: Tuberous sclerosis complex (TSC) is a multi-system disease with TSC1 and TSC2 genes as the pathogenic genes. The purpose of our study was to analyze the gene mutation in patients with TSC with epilepsy as the main clinical manifestation. The relationship between genotype and phenotype, scalp EEG in patients was analyzed. Methods: The peripheral blood was extracted from 43 patients and their families. TSC gene was detected by second-generation sequencing. Long-term video EEG monitoring and MRI examination were performed to determine the onset area, seizure type and location of nodules. Results: 39 patients had TSC gene mutation, 4 patients did not detect the gene mutation.11 had TSC1 mutations and 28 had TSC2 mutations. 22 mutations were de novo. Patients with TSC2 mutations had earlier seizure and more nodules than patients with TSC1 mutations, but no significant difference in intelligence and spasm were observed. 28 patients had focal origin of scalp EEG, of which 85.7% of TSC2 mutations patients had focal origin. Conclusions: Patients of TSC2 mutations always has an early onset age. Although MRI shows multiple nodules, the onset of EEG is mainly focal origin.

[Prognostic value of myocardial injury in patients with COVID-19].

Objective: To analyze the prognostic value of myocardial injury in patients with COVID-19. Method: Confirmed cases of COVID-19 patients admitted from January 31st to February 5th at isolation ward of Renmin Hospital of Wuhan University were divided into non-survival group and survival group according to the clinical outcomes 5 weeks after admission. Data including demographics, comorbidities, vital signs, laboratory results were obtained. Cardiac injury was defined as serum concentration of high sensitivity cardiac troponin I (hs-cTnI) above 0.04 µg/L. Univariate and multivariate Cox regression were used to analyze the prognostic value of myocardial injury in patients with COVID-19. Kaplan-Meier analysis was used to plotted survival curve and analyze the impact of myocardial injury on the survival outcome of COVID-19 patients. Results: A total of 202 patients were included, the age was 63 (51, 70) years old, 88 (43.6%) of them were male, 85 (42.1%) of them had comorbidities, 125 (61.9%) of them were severely to critically ill. Till March 11, 33 patients died, all of them were critically ill patients. The age, proportion of males, comorbidities, respire rate, serum levels of hs-cTnI and incidence of heart failure in the non-survival group were significantly higher than those in the survival group (all P<0.05). The hospitalization time of non-survival group was significantly shorter than that of survival group (6(4, 9) vs. 32(23, 36), P<0.001). Myocardial injury was an important prognostic factor of COVID-19 (HR=5.382, 95%CI 2.404-12.05, P<0.001). Kaplan-Meier survival analysis showed that the presence of myocardial injury was significantly associated with the reduced survival rate among COVID-19 patients (P<0.001). Conclusion: Myocardial injury is an important prognostic factor of COVID-19, COVID-19 patients with myocardial injury face a significantly higher risk of death.

[Prognostic value of myocardial injury in patients with COVID-19].

Objective: To analyze the prognostic value of myocardial injury in patients with COVID-19. Method: Confirmed cases of COVID-19 patients admitted from January 31st to February 5th at isolation ward of Renmin Hospital of Wuhan University were divided into non-survival group （33 cases）and survival group (169 cases)according to the clinical outcomes 5 weeks after admission. Data including demographics, comorbidities, vital signs, laboratory results were obtained. Cardiac injury was defined as serum concentration of high sensitivity cardiac troponin I (hs-cTnI) above 0.04 µg/L. Univariate and multivariate Cox regression were used to analyze the prognostic value of myocardial injury in patients with COVID-19. Kaplan-Meier analysis was used to plotted survival curve and analyze the impact of myocardial injury on the survival outcome of COVID-19 patients. Results: A total of 202 patients were included, the age was 63 (51, 70) years old, 88 (43.6%) of them were male, 85 (42.1%) of them had comorbidities, 125 (61.9%) of them were severely to critically ill. Till March 11, 33 patients died, all of them were critically ill patients. The age, proportion of males, comorbidities, respire rate, serum levels of hs-cTnI and incidence of heart failure in the non-survival group were significantly higher than those in the survival group (all P<0.05). The hospitalization time of non-survival group was significantly shorter than that of survival group (6(4, 9) vs. 32(23, 36), P<0.001). Myocardial injury was an important prognostic factor of COVID-19 (HR=5.382, 95%CI 2.404-12.050, P<0.001). Kaplan-Meier survival analysis showed that the presence of myocardial injury was significantly associated with the reduced survival rate among COVID-19 patients (P<0.001). Conclusion: Myocardial injury is an important prognostic factor of COVID-19, COVID-19 patients with myocardial injury face a significantly higher risk of death.

[Application value of shear wave elastography technique in qualitative and quantitative diagnosis of breast masses].

Objective: To explore the value of shear wave elastography(SWE)stiff rim sign and SWE stiff rim sign combined with BI-RADS classification in qualitative diagnosis and multiple SWE parameters in quantitative diagnosis of benign and malignant breast masses. Methods: One hundred and eighty-eight patients, 18-83 (44±14) years old, with 199 breast masses (maximum diameter, 0.4-5.0 (2.1±1.0) cm) by ultrasound were selected.Qualitative diagnosis was made by SWE stiff rim sign, and SWEmax, SWEmean, SWEmin, SWE1max, SWE2max, SWE3max, SWE1mean, SWE2mean, SWE3mean were obtained. The ROC of each quantitative parameter was drawn, then the AUC was calculated. Results: There were 75 malignant masses and 124 benign masses in 199 breast masses confirmed by pathology. Qualitative diagnosis of BI-RADS classification (χ(2)=155.181) and of SWE stiff rim sign (χ(2)=117.304)and quantitative diagnosis of SWEmax, SWEmean (t=6.869,6.305), SWE1max, SWE2max, SWE3max (t=8.768,9.059,9.180), SWE1mean, SWE2mean, SWE3mean (t=10.041,10.312,10.576) were all statistically significant (all P<0.01). But there was no statistically significance in quantitative diagnosis of SWEmin (P>0.05). The AUC value of qualitative diagnosis of SWE stiff rim sign combined with BI-RADS classification was 0.967, and the sensitivity was 92.0%.For BI-RADS 4a masses,the positive rate of puncture could be increased from 15.3% to 77.8% by combination of SWE hard ring sign. Conclusions: Qualitative diagnosis of SWE stiff rim sign and quantitative diagnosis of multiple SWE parameters are of high accuracy in differentiating benign or malignant breast masses. The combination of SWE stiff rim sign and BI-RADS classification could further improve the sensitivity of qualitative diagnosis, and increase the positive rate of puncture for 4a masses.

[Correlation between single nucleotide polymorphisms of rs4778137 located in OCA2 gene and clinical response of breast cancer patients receiving neoadjuvant chemotherapy].

Objective: To evaluate the correlation between single nucleotide polymorphisms (SNPs) of rs4778137 located in OCA2 gene and clinical response of breast cancer patients receiving neoadjuvant chemotherapy. Methods: A total of 140 breast cancer patients receiving neoadjuvant chemotherapy were enrolled to detect DNA in blood sample by DNA extraction kit and the rs4778137 polymorphism by sequenom. The relationship between SNPs of rs4778137 and pathologic complete response (pCR) were analyzed. Results: The frequency of CC, GC and GG genetype of rs4778137 was 48.6%, 31.4% and 20.0%,respectively. Thirty cases (21.4%) achieved pCR with CC allele in 9 cases(13.2%),GC allele in 10 cases (22.7%) and GG allele in 11 cases (39.3%),respectively,with a statistically significant difference(P<0.05). When conducting stratified analysis in accordance with the estrogen receptor (ER) status,only in ER negative group pCR was significantly associated with SNPs of rs4778137 (P<0.05). SNPs of Rs4778137, targeted therapy,subtypes,tumor stage were independent predictors of pCR in multivariate logistic regression analysis (P<0.05),and SNPs of rs4778137 was an independent predictors of pCR in ER negative group (P<0.05), but not in ER positive group group (P>0.05). Conclusion: SNPs of rs4778137 was associated with pCR only in ER negative patients receiving neoadjuvant therapy, and breast cancer patients with the GG allele were more likely to achieve pCR.

[The application of stereo-electroencephalography guided radiofrequency thermocoagulation in refractory temporal epilepsy].

Objective: To investigate the clinical value of stereo-electroencephalography guided radiofrequency thermos-coagulation (RFTC) in drug resistant temporal epilepsy. Methods: The clinical data of 12 patients with refractory temporal epilepsy who underwent implantation of SEEG electrodes and radiofrequency thermos-coagulation from July 2016 to November 2017 were analysed retrospectively. Results: The mean follow-up time was 6.4±4.6 months after thermos-coagulation, and 10.2±3.5 months after resection. Engel Ⅰa was observed in 9 cases, with Ⅱa, Ⅲa and Ⅳa 1 cases respectively. Nine patients experienced a ≥50% decrease of seizure frequency after RFTC (R+ , 75%), of whom one had got a sustained seizure free for 15 months and the other with decrease of seizure frequency by over 90% for 14 months. There was a statistical significance in seizure frequency between pre- and post-thermo-coagulation (P=0.008). Ten cases underwent open surgery following SEEG-guided RFTC, of them 8 cases got seizure free. RFTC was effective in 6 of 8 cases. In our group, all patients have not suffered from any neurologic and cognitive deficiency, and even several patients have some improvements on memory quotient. Conclusions: Although it is less effective than resective surgery, SEEG-guided RFTC can be a relatively safe, effective treatment because of its precision and minimal invasion for patients with complex drug resistant temporal epilepsy, especially for impossible any cortical resection. In addition, its effect may be a predictor of outcome after conventional cortectomy.

[The transformation of microcystin-LR during tap water treatment process and analysis of its degradation products].

Objective: To establish a liquid chromatography-tandem mass spectrometry (LC/MS/MS) method for the determination of microcystin-LR (MC-LR) in drinking water, investigate its removal efficiency during tap water advanced treatment process and analyze its degradation products in the tap water. Methods: Two parallel water samples were collected from each point of tap water advanced treatment process in September 2015, November 2015 and January 2016, respectively, and treated by mixing, filtration, concentration, elution, nitrogen blow and re-dissolvement. The samples were analyzed by LC/MS/MS to determine the MC-LR concentration and its removal efficiency during treatment process. The combination of actual water enrichment (including source water enrichment of 50 times and 1 500 times concentrated, finished water enrichment of 50 times and 2 500 times concentrated) and laboratory simulated water (including the mixture of MC-LR and liquid chlorine in the mass ratio of 1∶10, 1∶20, 1∶100 and 1∶1 000, respectively) were used to qualitative analyze the MC-LR degradation products by Orbitrap mass spectrometry. Results: The linearity of MC-LR ranged from 2 to 200 µg/L with the detection limit of 0.007 9 µg/L and the limit of quantification of 0.026 3 µg/L. The recovery rate of MC-LR from different contration in drinking water were from 94.88%-101.47%. The intra-day precision was 2.51%-7.93% and the intra-day precision was 3.24%-8.41%. The average concentration of MC-LR in source water was (0.631±0.262) µg/L, 94.0% of which can be removed by ozone exposure while the concentrate was (0.038±0.016) µg/L, biological pre-treatment and chlorination. The remaining can hardly be removed by sand filtration, ozone exposure, activated carbon, ultrafiltration and other processes. The MC-LR average concentration in the finished water maintained at about (0.036±0.016) µg/L. Degradation products including hydroxy-microcystin, methyl-hydroxy-microcystin, methyl-microcystin were identified in the laboratory simulated water of the mixture of MC-LR and liquid chlorine in the mass ratio of 1∶10. Conclusion: The established MC-LR detection method can be well applied to the monitoring of MC-LR in drinking water due to its simple pre-treatment process and good methodological validation parameters. The degradation products of treatment processes was different.

[Effect of preoperative monocyte-lymphocyte ratio on prognosis of patients with resectable esophagogastric junction cancer].

Objective: To investigate the associations between various blood test parameters including MLR (monocyte-lymphocyte ratio) and prognosis in post-operative esophagogastric junction cancer patients. Methods: We retrospectively studied the preoperative and postoperative data of 309 patients who underwent radical surgery for esophagogastric junction cancer. The relationship between MLR, neutrophil lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and overall survival (OS) was analyzed. Results: The cutoff values of MLR、NLR and PLR were 0.201, 1.697 and 96.960, respectively. The median OS was 51.4 months for all the patients in the study group (n=309). MLR in patients with esophagogastric junction carcinoma was associated with gender, depth of invasion, histological grade, TNM stage, NLR and PLR (P<0.05). PLR was associated with tumor size, TNM stage, NLR and MLR (P<0.05). NLR was associated with gender, tumor size, TNM stage, PLR and MLR (both P<0.05). Univariate analysis showed that tumor size, depth of tumor invasion, metastasis of lymph nodes, pathological grading, nerve infiltration, lymphovascular invasion, TNM staging, PLR and MLR were associated with the median overall survival time (P<0.05). Multivariate analysis showed that TNM stage, nerve infiltration and MLR were independent prognostic predictors for patients with esophagogastric junction cancer (P<0.05), but not PLR or NLR. Setting the optimal cut-off value of the MLR in 0.201, the area under the curve was 0.603, significantly larger than that of PLR and NLR (P<0.05). Conclusions: Preoperative MLR is a very useful predictor of patients with esophagogastric junction cancer who underwent radical rescetion. Preoperative MLR> 0.201 is an independent risk factor for postoperative survival in patients with esophagogastric cancer, and PLR> 96.960 may predict a poor prognosis risk.

The first genetic map of a synthesized allohexaploid Brassica with A, B and C genomes based on simple sequence repeat markers.

KEY MESSAGE: We present the first genetic map of an allohexaploid Brassica species, based on segregating microsatellite markers in a doubled haploid mapping population generated from a hybrid between two hexaploid parents. This study reports the first genetic map of trigenomic Brassica. A doubled haploid mapping population consisting of 189 lines was obtained via microspore culture from a hybrid H16-1 derived from a cross between two allohexaploid Brassica lines (7H170-1 and Y54-2). Simple sequence repeat primer pairs specific to the A genome (107), B genome (44) and C genome (109) were used to construct a genetic linkage map of the population. Twenty-seven linkage groups were resolved from 274 polymorphic loci on the A genome (109), B genome (49) and C genome (116) covering a total genetic distance of 3178.8 cM with an average distance between markers of 11.60 cM. This is the first genetic framework map for the artificially synthesized Brassica allohexaploids. The linkage groups represent the expected complement of chromosomes in the A, B and C genomes from the original diploid and tetraploid parents. This framework linkage map will be valuable for QTL analysis and future genetic improvement of a new allohexaploid Brassica species, and in improving our understanding of the genetic control of meiosis in new polyploids.

[Functional mapping of the insular and opercular cortex: A study using SEEG electrical stimulation in epileptic patients].

OBJECTIVE: Insular and opercular cortex is involved in complicated physiological function.Insular seizures involve extensive epileptic network, which results in the complex and diverse semiology.Electrical cortical stimulation(ECS) can explore the functional mapping and symptomatogenic zone. METHODS: The clinical presurgical evaluation and ECS data of 20 patients whose electrode contacts were located in the insular and opercular were analyzed retrospectively.CT scan/3D MRI data fusion was performed in order to accurately identify and locate each contact and check the electrode trajectory by the MRI images performed after the electrodes were removed.ECS was applied between two contiguous contacts.Stimulation usually lasted for 5 s at 50 Hz(pulse width=0.3 ms). Depending on the area of stimulated cortex, the stimulation intensities ranged from 0.2 to 3.0 mA.The classification of the insular were anterior short gyrus, middle short gyrus, precentral gyrus, postcentral gyrus, posterior long gyrus and insular pole.The classification of the opercular were orbital, frontal, precentral, central, parietal and temporal opercular. RESULTS: One hundred and six contacts were located in the insular and 51 responses were evoked (48.11%). Four hundred eighteen contacts were located in the insular and 132 responses were evoked (31.58%). We classified the principal responses as somatosensory, pain, auditory, oropharyngeal, speech disturbances and neurovegetative response.Somatosensory responses were mainly evoked in parietal opercular and postcentral gyrus, while pain response distributed sporadically.Auditory were only evoked in temporal opercular(transverse temporal gyri) and posterior long gyrus.Oropharyngeal symptoms were only evoked in central opercular.Speech disturbances were located in precentral and central opercular and neurovegetative responses were mainly evoked in insular pole and middle short gyrus. CONCLUSIONS: These findings may indicate a functional specificity for the insular gyrus and opercular, which contribute to the understanding of anatomo-functional organization and the role in insular and opercular epileptic network.Moreover, it could optimize the implantation strategy for exploring these structures.

Hydrogen sulfide alleviates lead-induced photosynthetic and ultrastructural changes in oilseed rape.

The role of hydrogen sulfide (H2S) in alleviating lead (Pb) induced stress in oilseed rape (Brassica napus L.) was studied under laboratory conditions. Plants were grown hydroponically in greenhouse conditions under three levels (0, 100, and 400 µM) of Pb and three levels (0, 100 and 200 µM) of H2S donor, sodium hydrosulfide (NaHS). Application of H2S significantly improved the plant growth, root morphology, chlorophyll contents and photosynthetic activity in leaves of B. napus under Pb stress. Moreover, exogenously applied H2S significantly lowered the Pb concentration in shoots and roots of plants under Pb stress. The microscopic examination indicated that application of exogenous H2S enabled a clean mesophyll cell having a well developed chloroplast with thylakoid membranes and starch grains. A number of modifications could be observed in root tip cell i.e. mature mitochondria, long endoplasmic reticulum and golgibodies under combined application of H2S and Pb. On the basis of these findings, it can be concluded that application of exogenous H2S has a protective role on plant growth, net photosynthesis rate and ultrastructural changes in B. napus plants under high Pb exposures.

Effects of female body mass index on pregnancy during in vitro fertilization-embryo transfer.

OBJECTIVE: To investigate the effect of different body mass index (BMI) on transplantation and pregnancy outcomes during assisted reproductive therapy (ART). PATIENTS AND METHODS: This study assessed the data on embryo transplantation from April 1, 2016, to March 31, 2021, at the Hangzhou Women's Hospital. According to the women's BMI, they were divided into three groups: the overweight, normal weight, and overweight groups. The differences in general clinical data, embryo transfer, pregnancy outcome and newborn birth weight were analyzed. RESULTS: There was no difference in clinical pregnancy rate between the three groups, but a positive correlation between multiple pregnancy rates and BMI in the fresh cycle was observed. Although there was no significant difference in live birth rates among the three groups (p = 0.291), the average birth weight of newborns among the three groups was different (p < 0.05). Furthermore, the mean birth weight of a single fetus was positively correlated with maternal BMI, and the mean birth weight of twins was lower than that of single twins (p < 0.001). CONCLUSIONS: The BMI of women treated with ART did not affect clinical pregnancy outcomes and live birth rates after embryo transfer, but differences in preterm birth rates and newborn birth weight were observed.

Prognostic impact of anatomical extent of metastatic lymph node on gastric cancer: a propensity score matching study.

PURPOSE: Current gastric cancer staging systems overlook the anatomic extent of metastatic lymph nodes (AEMLNs). This study aimed to analyze the prognostic impact of AEMLNs on gastric cancer (GC). METHODS: GC patients with metastatic lymph nodes (MLNs) undergoing curative surgery were retrospectively reviewed and assigned to perigastric (MLNs in station 1-6, PG) and extraperigastric group (7-12, with or without MLNs in PG area, EPG). Overall survival (OS), disease-free survival (DFS) and recurrence patterns were compared before and after 1:1 propensity score matching (PSM). RESULTS: 662 patients were enrolled, 341 (51.5%) and 321 (48.5%) of whom were in the PG and EPG, respectively. After PSM (n = 195), EPG showed poorer 5-year OS (43.4% vs 54.5%, p = 0.014) and DFS (65.0% vs 73.4%, p = 0.068) than PG. EPG had higher incidence of peritoneal recurrence (PR) than PG (19.4% vs 7.4%, p = 0.002). Multivariate analysis identified AEMLNs as prognostic factor for OS [HR = 1.409, 95% confidence interval (CI) 1.062-1.868), DFS (HR = 1.600, 95% CI 1.059-2.416) and PR (HR = 3.708, 95% CI 1.685-8.160). CONCLUSIONS: The anatomic extent of metastatic lymph nodes has an independent prognostic role for GC. Including this element may improve the accuracy of current staging systems.

The clinical characteristic of biliary-hyperlipidemic etiologically complex type of acute pancreatitis: a retrospective study from a tertiary center in China.

OBJECTIVE: Biliary and hyperlipidemic acute pancreatitis (AP) has become the second most common AP in China. Currently, AP is exclusively diagnosed as biliary or hyperlipidemic AP. However, as suggested by some reports, biliary and hyperlipidemic AP might coexist in a single patient. Moreover, acute lipotoxicity was shown to regulate the severity of biliary AP in the mouse model. Thus, whether these two etiologies coexist in AP patients and potentially worsen the clinical course remains unclear. To elucidate the clinical feature of a new complex type of acute pancreatitis with both biliary and hyperlipidemic etiologies. PATIENTS AND METHODS: This retrospective study included AP patients who were admitted into our department within 7 days after the onset of the disease. 267 AP patients were enrolled in this study and were classified as BAP (biliary acute pancreatitis, n=153), HLAP (hyperlipidemic acute pancreatitis, n=65) and BHAP (biliary-hyperlipidemic acute pancreatitis, n=49). All the enrolled patients met the classification criteria of biliary etiology, hyperlipidemic etiology, and both etiologies, respectively. BHAP was compared with BAP and HLAP in terms of general information, inflammatory biomarkers, organ dysfunction, disease severity and clinical outcomes. RESULTS: BHAP (41 vs. 53) patients were younger than BAP patients. Serum procalcitonin of BHAP patients was higher than BAP and HLAP patients. Serum CRP of BHAP patients was higher than BAP patients. BHAP patients had the highest diagnosis rate of severe acute pancreatitis (SAP) (46.9% vs. 17.6% or 21.5%) compared to BAP and HLAP. Prevalences of persistent respiratory, acute renal, and circulatory failure were highest in BHAP patients (44.9%, 28.6%, 12.2%, respectively). Requirements for mechanical ventilation, renal replacement therapy and vasoactive agents were also highest in BHAP patients (36.7%, 34.7%, 12.2%, respectively). Hospital stay was longer in BHAP patients (33 days) compared with BAP patients (24 days). CONCLUSIONS: Patients with both biliary and hyperlipidemic etiologies suffer from more severe clinical course of the disease and have worse prognosis than single-etiology BAP or HLAP patients in the early stage of AP (within 7 days). It should be recognized as a new etiological type named biliary-hyperlipidemic acute pancreatitis (BHAP).

Aberrant human leucocyte antigen-G expression and its clinical relevance in hepatocellular carcinoma.

The clinical relevance of human leucocyte antigen-G (HLA-G) has been postulated in malignancies. Hepatocellular carcinoma (HCC) is a major contributor to cancer incidence and mortality worldwide; however, potential roles of HLA-G in HCC remain unknown. In the current study, HLA-G expression in 219 primary HCC lesions and their adjacent non-tumourous samples was analysed with immunohistochemistry. Correlations among HLA-G expression and various clinical parameters were evaluated. Meanwhile, functional analysis of transfected cell surface HLA-G expression on NK cell cytolysis was performed in vitro. HLA-G expression was observed in 50.2% (110/219) of primary HCC lesions, and undetectable in corresponding adjacent normal liver tissues. HLA-G expression was found in 37.8%, 41.9% and 71.4% of stage I, II and III HCC lesions, respectively. Data revealed that HLA-G expression in HCC was strongly correlated to advanced disease stage (I versus II, P= 0.882; I versus III, P= 0.020; II versus III, P= 0.037). HLA-G expression was also more frequently observed in elder patients (≥median 52 years, 57.5%versus 43.4%, P= 0.004). Meanwhile, plasma soluble HLA-G in HCC patients was significantly higher than that in normal controls (median, 92.49U/ml versus 9.29U/ml, P= 0.000). Functional assay showed that HLA-G expression in transfected cells could dramatically decrease the NK cell cytolysis (P= 0.036), which could be markedly restored by the blockade of HLA-G (P= 0.004) and its receptor ILT2 (P= 0.019). Our finding indicated that HLA-G expression was strongly correlated to advanced disease stage, and more frequently observed in elder patients. Its relevance to HCC progression might be result from the inhibition of NK cell cytolysis.