[The effect of the ratio of aneurysm sac diameter to patient age on the long-term efficacy of different surgical methods for infrarenal abdominal aortic aneurysm].

Objective: To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA). Methods: This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R, and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher 's exact test was used for categorical variables, and independent sample t test or Wilcoxon rank sum test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results: After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%,χ2=7.600，P=0.006),complication rate (44.7% vs.26.3%, χ2=4.025，P=0.045), and secondary intervention rate (31.6% vs.13.2%, χ2=4.910，P=0.027) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%, χ2=0.109，P=0.741), complication rate (28.6% vs.35.7%, χ2=0.507，P=0.477) and secondary intervention rate (14.3% vs.21.4%, χ2=0.353，P=0.552) between the two groups. Conclusions: When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.

[Study on epidemiological status of e-cigarette use among adolescent in Zhejiang province, China].

Objective: To describe the prevalence of e-cigarette use among adolescent in Zhejiang province, and to analyze its distribution of different genders and school types to provide evidence for controlling the use of e-cigarette among adolescent. Methods: A total of 7 663 students from 60 middle schools through stratified multi-stage cluster sampling methods from Zhejiang province were surveyed by using questionnaire. Indicators as tried to use e-cigarette rate, current e-cigarette using rate, and other indicators were collected. All data were weighted by age proportions of adolescent in Zhejiang. Results: The prevalence of tried to use and current using e-cigarettes among middle school students were 6.99% and 1.45%, respectively; and there were 4.19% juniors who were susceptibility to future e-cigarette use. The rate of tied to use e-cigarette, current using e-cigarette and susceptibility to future e-cigarette use were higher in boys than in girls. The rate of current using e-cigarette was 2.07% for rural and 0.48% for urban. Technical secondary school students had the highest rate of tried to use e-cigarette and susceptibility to future e-cigarette use (13.53%, 6.91%). Junior school students (2.96%) had the lowest level of susceptibility to future tobacco use. The rate of tried e-cigarette use and current e-cigarette use and susceptibility to future e-cigarette use were higher in the group of "One of students' parents was smoker" (8.63%, 2.19%, 5.23%). The highest rate of current smoking was found in the group of "Weekly allowance more than 50 Yuan" (10.02%, 2.54%, 6.29%). Compared to technical secondary school students, senior school student (OR=0.57) and junior school students (OR=0.45) were less likely to try to use e-cigarette. Students whose weekly allowance were less than 20 Yuan were less likely to try to use e-cigarette (OR=0.49). Students who were boys (OR=5.44) and one of their parents was smoker (OR=1.59) were more likely to try to use e-cigarette. Conclusions: There were middle school students with tried e-cigarette use and current e-cigarette use, especially in technical secondary schools. The prevalence of e-cigarette using among middle school students increased with age. It is important to further spread of e-cigarette knowledge widely and deeply, and reduce the susceptible population of adolescents using e-cigarettes.

Correlations of changes in inflammatory factors, glucose and lipid metabolism indicators and adiponectin with alterations in intestinal flora in rats with coronary heart disease.

OBJECTIVE: The aim of this study was to explore the correlations of changes in inflammatory factors, glucose and lipid metabolism indicators and adiponectin with alterations in intestinal flora in rats with coronary heart disease. MATERIALS AND METHODS: A total of 30 male specific pathogen-free rats were randomly assigned into two groups, including: blank group (n=15) and coronary heart disease group (n=15). The rats in the coronary heart disease group were given high-fat diets and pituitrin to establish the model of coronary heart disease. Meanwhile, rats in the blank group were administered with an equal volume of double-distilled water. The alterations in the intestinal flora of rats were detected in the two groups, respectively. In addition, the changes in the levels of inflammatory factors, glucose and lipid metabolism indicators, adiponectin, creatine kinase (CK) and its isoenzyme, as well as troponin, were also examined. RESULTS: Statistically, significant differences in the levels of glucose and lipid metabolism indicators low-density lipoprotein (LDL) (p=0.040), total cholesterol (TC) (p=0.039), high-density lipoprotein (HDL) (p=0.044), triglyceride (TG) (p=0.000) and blood glucose (p=0.046) were observed between the rats in the coronary heart disease group and blank group. The content of all the glucose and lipid metabolism indicators (except HDL) in coronary heart disease group was significantly higher than the blank group (p<0.05). The rats in the coronary heart disease group had evidently higher levels of CK (p=0.000) and its isoenzyme (p=0.019), as well as troponin (p=0.021), than those in the blank group. The level of serum adiponectin in rats in coronary heart disease group was distinctly lower than that in the blank group, showing statistically significant differences (p<0.05). Besides, the levels of the inflammatory factors interleukin (IL)-2 (p=0.011), transforming growth factor (TGF)-ß (p=0.048), tumor necrosis factor-α (TNF-α) (p=0.025) and IL-6 (p=0.038) in rats in the coronary heart disease group were dramatically higher than those in blank group. Rats in coronary heart disease group had remarkably more Actinobacteria, Desulfovibrio, Aristipus and Escherichia coli in the intestine. Meanwhile, the abundance of Flavobacterium, Burkhofer and some probiotics increased significantly in the intestine of rats in blank group (p<0.05). The changes in the abundance of Actinobacteria, Desulfovibrio, Aristipus and Escherichia coli in the intestine of rats were probably correlated with increased levels of glucose and lipid metabolism indicators, inflammatory factors and adiponectin in coronary heart disease group. Moreover, the abundance of intestinal probiotics such as Bifidobacterium and Lactobacillus in rats in coronary heart disease group was notably lower than that in blank group (p<0.05). The decline in the abundance of such intestinal probiotics as Bifidobacterium and Lactobacillus was correlated with the changes in the levels of glucose and lipid metabolism indicators, inflammatory factors and adiponectin. In addition, decreased levels of probiotics weakened normal physiological functions of the intestine and promoted disease progression. CONCLUSIONS: Inflammatory factors, glucose and lipid metabolism indicators and adiponectin have evident changes in rats with coronary heart disease, which may be correlated with the alterations in the intestinal flora.

Biodiversity and Biogeography of Chthamalid Barnacles from the North-Eastern Pacific (Crustacea Cirripedia).

The biogeography and ecology of the species of Chthamalus present on the west coast of America are described, using data from 51 localities from Alaska to Panama, together with their zonation on the shore with respect to that of other barnacles. The species present were C. dalli, Pilsbry 1916, C. fissus, Darwin, 1854, C. anisopoma Pilsbry 1916 and four species in the C. panamensis complex. The latter are C. panamensis Pilsbry, 1916, C. hedgecocki, Pitombo & Burton, 2007, C. alani nom. nov. (formerly C. southwardorum Pitombo & Burton, 2007) and C. newmani sp. nov.). These four species were initially separated by enzyme electrophoresis. They could only be partially separated by DNA bar coding but may be separated using morphological characters.

HBV-induced ROS accumulation promotes hepatocarcinogenesis through Snail-mediated epigenetic silencing of SOCS3.

Interleukin-6 (IL-6) has been demonstrated to be involved in Hepatitis B virus (HBV)-associated hepatocarcinogenesis through activation of the STAT3 pathway. The sustained activation of the IL-6/STAT3 pathway is frequently associated with repression of SOCS3, which is both a target gene and a negative regulator of STAT3. However, the silencing mechanism of SOCS3 in hepatocellular carcinoma (HCC) remains to be elucidated. Here, we showed that the repression of SOCS3 and sustained activation of IL-6/STAT3 pathway in HBV-producing HCC cells were caused by HBV-induced mitochondrial ROS accumulation. Mechanistic studies revealed that ROS-mediated DNA methylation resulted in the silencing of SOCS3. Decreased SOCS3 expression significantly promoted the proliferation of HCC cells and growth of tumor xenografts in mice. Further studies revealed that HBV-induced ROS accumulation upregulated the expression of the transcription factor, Snail, which bound to the E-boxes of SOCS3 promoter and mediated the epigenetic silencing of SOCS3 in association with DNMT1 and HDAC1. In addition, we found that the expression of Snail and SOCS3 were inversely correlated in HBV-associated HCC patients, suggesting that SOCS3 and/or Snail could be used as prognostic markers in HCC pathogenesis. Taken together, our data show that HBV-induced mitochondrial ROS production represses SOCS3 expression through Snail-mediated epigenetic silencing, leading to the sustained activation of IL-6/STAT3 pathway and ultimately contributing to hepatocarcinogenesis.

Accuracy of low-field MRI on meniscal tears.

This study aimed to verify the accuracy of low-field-intensity magnetic resonance imaging (MRI) in diagnosing meniscus tears. A total of 171 patients were examined through low-field-intensity MRI to detect meniscus injuries. These patients were then diagnosed through arthroscopy. Examination results were recorded and compared. The accuracy of the diagnosis for internal and external meniscus tears through low-field-intensity MRI was 95.91% and 95.91%, respectively, the sensitivities were 95.60% and 96.47%, respectively, and the specificities were 96.25% and 95.35%, respectively. Low-field-intensity MRI is an accurate and cost-effective method for diagnosing meniscus tears.

Effects of minimally invasive percutaneous and trans-spatium intermuscular short-segment pedicle instrumentation on thoracolumbar mono-segmental vertebral fractures without neurological compromise.

OBJECTIVE: To compare the outcomes of minimally invasive percutaneous short-segment pedicle instrumentation (SSPI) with that of trans-spatium intermuscular SSPI on thoracolumbar mono-segmental vertebral fracture without neurological compromise. METHODS: A total of 39 patients with thoracolumbar mono-segmental vertebral fracture without neurological deficit receiving treatment between January 2009 and July 2011 were enrolled. Percutaneous SSPI was performed for 18 patients (the percutaneous group), and trans-spatium intermuscular SSPI was performed for 21 patients (the trans-spatium intermuscular group). Peroperative indices, intraoperative radiation exposure time, postoperative and follow-up lumbodorsal pain, function scores, and radiological data were compared. RESULTS: The percutaneous group had significantly less intraoperative blood loss and less severe postoperative pains, but suffered significantly longer fluoroscopy time and higher hospitalization costs compared with the trans-spatium intermuscular group. No significant difference was observed in operating time. All patients were followed up for 17.3 ± 9.2 months (ranging from 5 to 35 months). No significant differences were observed between the two groups in terms of postoperative relative vertebral height (RVH) and regional kyphotic angle (RKA), as well as last follow-up RVH, RKA, lumbodorsal pain, and Oswestry disability index. CONCLUSION: Percutaneous SSPI has the virtues of less intraoperative blood loss and less severe pains in the treatment of thoracolumbar mono-segmental vertebral fracture without neurological deficit. When compared with trans-spatium intermuscular SSPI, it results in longer intraoperative radiation exposure time and a higher surgery cost. To us, percutaneous SSPI has no advantage over trans-spatium intermuscular SSPI in therapeutic outcomes. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Impact of a pharmacist consult clinic on a hospital-based geriatric outpatient clinic in Singapore.

INTRODUCTION: We study the impact of a pharmacist consult clinic on the care of elderly outpatients based on the Health Belief Model that the perceived benefits (improvement in medication knowledge, clinical status and perception) and attached barriers (cost and number of medication and adverse drug reactions) can influence health behaviour (medication compliance). MATERIALS AND METHODS: A randomised controlled study of 136 eligible patients with risk factors for non-compliance, using Zelen's design, was conducted in a hospital-based geriatric outpatient clinic from November 2001 to June 2002. All patients were assessed for outcome variables at baseline and 2 months later. RESULTS: One hundred and twenty-six patients were included in the intention-to-treat analysis. There were 104 pharmacist interventions with a physician acceptance rate of 76%. There was a significant improvement in medication knowledge with regards to indication (P = 0.03) and the composite dose, frequency and indication score (P = 0.06), as well as a decrease in residual adverse drug reactions that persisted at month 2 and cost avoidance of dollars 387.28 over 2 months. There was no significant difference in perception, clinical status or decrease in number of medications. The intervention group showed an improvement in adjusted compliance (odds ration [OR] = 2.52; 90% confidence interval [CI], 1.09 to 5.83) based on the ordered logistic regression model. Perception of severity of illness at baseline (OR = 1.30; 90% CI, 1.04 to 1.62), number of medication remembering methods (OR = 1.87; 90% CI, 1.08 to 3.25) and the use of routine habits (OR = 4.48; 90% CI, 1.51 to 13.28) and medication aids (OR = 3.68; 90% CI, 1.04 to 13.06) significantly affected compliance. CONCLUSION: The addition of a pharmacist consult clinic to the management of selected geriatric outpatients can improve compliance, with the attendant benefits of improving medication knowledge, cost avoidance and reducing residual adverse drug reactions.

Genetic characterization of the rotaviruses associated with a nursery outbreak.

G1P[6] rotaviruses were demonstrated previously to be associated with the neonatal nursery outbreak of gastroenteritis in Changhua Christian Hospital that is located in the central region of Taiwan, from September 1994 to May 1995. Meanwhile, rotaviruses were detected in children hospitalized for acute gastroenteritis. Our study characterizes the rotaviruses associated with the nursery outbreak by using genetic approaches. Nucleotide sequence analysis revealed that the VP7 genes of the nursery rotaviruses were distinct from those of the strains circulating in the community. The G1P[6] rotaviruses recovered from the nursery were closely related to another neonatal G1P[6] strain from the northern region of Taiwan in both the VP4 and VP7 genes. The VP4 genes of these nursery strains differed from those of the P[6] human reference strains 1076, M37, RV3, and ST3. Apparently, these nursery rotaviruses were distinct from the strains circulating in the community and seemed to be a variant when compared with P[6] strains reported previously.

NSP4 gene analysis of rotaviruses recovered from infected children with and without diarrhea.

The transmembrane glycoprotein NSP4 functions as a viral enterotoxin capable of inducing diarrhea in young mice. It has been suggested that NSP4 may be a key determinant of rotavirus pathogenicity and a target for vaccine development. Twenty two G1P[6] rotaviruses from babies with and without diarrhea were comparatively analyzed along with reference strains and another 22 Taiwanese human rotaviruses of G and P combination types different from the G1P[6] type. The sequence variations in the NSP4 genes were studied by direct sequencing analysis of the amplicons of reverse transcription-PCR. Two genetic groups could be identified in this analysis. While the majority of these strains were closely related to the Wa strain, the G2 viruses were closely related to the S2 strain. Furthermore, phylogenetic analysis of the NSP4 gene among the G2 rotaviruses revealed three distinct lineages associated with DS-1, S2, and E210, respectively, as has been reported previously for the VP7 gene. However, we found no apparent correlation in the deduced amino acid sequences corresponding to the proposed enterotoxic peptide region between the rotaviruses recovered from individuals with and without diarrhea. The NSP4 gene product being a pathogenic determinant may not be a generalized phenomenon.

Effects of fenfluramine combined with electroacupuncture on monoamine release in periaqueductal gray of rat brain.

AIM: To study the changes of monoamines in ventrolatoral periaqueductal gray of rat brain before and after electroacupuncture (EA) analgesia (EAA) was enhanced by fenfluramine (Fen), a 5-hydroxytryptamine (5-HT) releaser. METHODS: Monoamines were collected by in vivo microdialysis and measured by HPLC connected with electrochemical detector. RESULTS: The level of norepinephrine (Nor) after EA was decreased (P < 0.05 vs NS group). The contents of 5-HT, 5-hydroxyindol acetic acid (5-HIAA), dopamine (DA), and homovanillic acid (HVA) in periaqueductal gray dialysate were increased (P < 0.05 vs NS group). When Fen was combined with EA, the level of 5-HT and 5-HIAA were further increased (P < 0.05 vs NS + EA group). There was no obvious change of Nor, DA, and HVA. CONCLUSION: Fen potentiating EAA may be related to further activation of serotoninergic system.

Outbreak and control of a rotaviral infection in a nursery.

Neonatal rotaviral infection generally causes an asymptomatic or mild illness. Once introduced into a nursery, it is very difficult to eradicate. We prospectively studied an outbreak of rotavirus infection in a normal newborn nursery from October 1994 through May 1995. Stool samples from infants more than 24 hours old were tested for rotaviral infection, either weekly, biweekly, or monthly. Rotavirus was identified in 164 (16%) of 1,037 tested neonates. Ninety-four (57%) rotavirus-positive neonates became symptomatic: 56 had diarrhea, 26 developed fever (rectal temperature > 38 degrees C), 25 experienced vomiting, 17 showed poor feeding, and 14 had an elevated core temperature. In total, 24 neonates were evaluated for suspected sepsis. RNA electropherotyping of samples from 91 neonates revealed infection by the same rotavirus strain in all cases. This strain differed from that isolated from 64 rotavirus-infected infants and toddlers in the pediatric ward during the same period. Infection control procedures (hand washing, isolation of infected neonates, and careful management of diapers) and early discharge of uninfected neonates were instituted, and the outbreak was eradicated 8 months after the onset. Our findings indicate that many rotavirus-infected term neonates become symptomatic and have signs suggestive of sepsis. Extended hospital stay may be an important factor in promoting rotaviral transmission. Thus, early discharge may be an additional effective method of controlling rotavirus outbreaks in a nursery.

Treatment of childhood acute lymphoblastic leukemia with protocol TCL-842 in Taiwan: the Taiwan Children's Cancer Study Group.

From March 1984 to May 1988, 212 children with acute lymphoblastic leukemia were enrolled on Protocol TCL-842. In all, 68 patients were classified as standard risk (SR), 56 as intermediate risk (IR), and 88 as high risk (HR) groups. Remission induction for all three groups consisted of vincristine (VCR), prednisolone (PRED) and L-asparaginase (L-Asp). One consolidation course with cyclophosphamide (CP) and cytarabine (AraC) was used for the SR and IR groups, and two courses were given to patients in the HR group. Central nervous system prophylaxis was randomized using either cranial irradiation 18 Gy + 5 intrathecal methotrexate (IT MTX) or triple IT with maintenance. Reinforcement cycles were employed periodically during maintenance therapy (basically 6-mercaptopurine+MTX) and varied among the three groups. Four-week oral PRED every 16 weeks was the sole reinforcement agent for SR. Two-week VCR+dexamethasone (DEX)+adriamycin CP cycles were used to reinforce IR and HR at different intervals. Five third-form cycles with VCR+DEX+AraC were used only for HR. Treatment was discontinued after three years in patients who achieved continuous complete remissions (CCR). Eight patients died during the induction phase and eight failed to achieve complete remission (CR). The CR rate for SR was 97%, for IR was 98% and for HR was 83.3%; the overall rate was 91.8%. As of 30 June 1991, 33 patients had dropped out, 12 had died during remission, and 52 had relapsed. Twenty-eight SR, 26 IR, and 29 HR patients remained in CCR with a median follow-up duration of 66 months (38-88 months).(ABSTRACT TRUNCATED AT 250 WORDS)

[The analysis of prognostic factors of primary hepatocellular carcinoma with Cox model].

This paper reports the application of Cox regression model in prognostic factors analysis of Primary Hepatocellular Carcinoma (PHC), based on the data obtained from 1618 registered of cases PHC and 432 hospitalized patients of PHC in ZhongShan City from 1980 to 1989. The result shows that there is an association between PHC and the following factors: extrahepato metastasis, therapeutic method, clinical stage, alpha-fetoprotein, gamma-glutamyl-transpeptidase, the number of tumors in the liver, the size of the tumor, icteric index and history of cirrhosis. Among these factors, clinical stage III, large liver cancer are unfavorable factors for PHC prognosis, while hepatectomy, hepatic artery catheterization chemotherapy, are favorable prognostic factors.

The effects of selenium on gestation, fertility, and offspring in mice.

Supplementation of mice from 22 d old with the K-Selenocarrageenan (0.25 ppm Se) in drinking water reduced gestation period by 3.2 d. Selenium supplementation increased litter size by 53.8% and average litter weight by 5%. Continuous supplementation with selenium (0.25 ppm) of mice until the age of 50-56 d significantly increased the concentration of selenium and the glutathione peroxidase activity in whole blood and liver. In serum, fluorescent peroxidized lipid products were decreased by 22% and reducing sugar was decreased by 16% compared to unsupplemented controls. In whole blood of young mice, collagen was increased by 14%. IR differential spectra of whole blood show strong absorption at the acrylamide band, suggesting a role of selenium in preventing lipid peroxidation, as well as a stabilizing effect on blood proteins.