[Clinical efficacy of resection of extramedullary subdural tumor in thoracic spinal canal via muscle-pedicle open-door laminoplasty approach].

In order to evaluate the efficacy of resecting extramedullary subdural tumors, located in the thoracic spinal canal, via the muscle-pedicle open-door laminoplasty approach, clinical data of fifteen patients with thoracic spinal tumors admitted to the Department of Spinal Surgery in the Affiliated Hospital of Qingdao University from December 2018 to June 2021 were analyzed retrospectively. All patients received surgical treatment to remove the tumors via the muscle-pedicle open-door laminoplasty approach. The clinical data of the patient was recorded. The Japanese Orthopedic Association (JOA) score, the thoracic kyphosis angle in the standing position before and after the operation, and the visual analog score (VAS) of thoracic back incision pain before and after the operation were compared. CT scan was performed three months after the surgery and at the last follow-up to measure the healing of the lamina. In addition, MRI was used to detect the healing of the posterior ligament at the last follow-up. The tumors of all fifteen patients were completely removed, the operating time was (91±15) minutes, blood loss was (117±56) ml. Cerebral spinal fluid leakage occurred in three patients, but the incisions healed smoothly following compression and no complication was observed. All patients were followed-ups for more than 6 months. The VAS score of thoracic back incision pain was (3±1.3) points at three days post operation and it dropped to (1.3±0.9) points three months post-operation. The JOA score improved significantly after the operation, it was (11.9±2.4) points before operation, and it was (14.0±1.6) points three months post operation and increased to (16.1±0.7) points at the last follow-up (both P<0.001). The Cobb angle was 10.1°±5.3° before the operation and it was 10.4°±6.2° at the last follow-up (P=0.420). Three months after operation, partial callus formation or even complete healing on the muscle pedicle side was observed on the CT scans of all patients. At the last follow-up, CT scans showed complete healing on the muscle pedicle side. There were different degrees of sclerosis and healing on the open-door side. There was no necrosis, displacement, or secondary spinal canal stenosis in any vertebral lamina. It indicated that the muscle-pedicle open-door laminoplasty approach is an effective way to resection extramedullary subdural tumors located in the thoracic spinal canal.

[Evaluation of severity and prognosis of acute pancreatitis by CT severity index and modified CT severity index].

Objectives: To explore the role of computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI) in assessing the severity of acute pancreatitis (AP) under the revised Atlanta classification (RAC) and predicting the clinical prognosis. Methods: Based on the prospectively entered AP database, the clinical data of consecutive adult AP inpatients admitted to the Department of Gastroenterology of the First Affiliated Hospital of Nanchang University from January 2012 to December 2020 were retrospectively screened. The imaging data were independently evaluated by two radiologists and entered to the database to calculate the CTSI and MCTSI scores. Their relationship with the difference of RAC severity grade and clinical prognosis was analyzed. Compared with Acute Physiology and Chronic Health Assessment Ⅱ (APACHE Ⅱ) score, the receiver operating characteristic curve was used to evaluate the predictive value of CTSI and MCTSI scores for persistent organ failure and infectious pancreatic necrosis (IPN). Results: A total of 2 612 patients with AP, aged (50±15) years, were included in the study, including 1 547 males (59.2%) and 1 065 females (40.8%). According to RAC standard, AP was divided into 699 cases (26.8%) of mild pancreatitis (MAP), 1 098 cases (42.0%) of moderately severe pancreatitis (MSAP), and 815 cases (31.2%) of severe pancreatitis (SAP). MCTSI judged AP severity similarly to RAC, with 668 cases of MAP (25.6%), 1 207 cases of MSAP (46.2%) and 737 cases of SAP (28.2%), while CTSI judged SAP patients less(400 cases, 15.3%). The severity of AP determined by CTSI and MCTSI scores was significantly correlated with clinical prognosis (r=0.06-0.43, all P<0.05). Compared with APACHE Ⅱ score, CTSI had the highest area under the curve (AUC) for predicting IPN (AUC=0.85, 95%CI: 0.83-0.87), followed by MCTSI (AUC=0.82, 95%CI: 0.80-0.85). APACHE Ⅱ was more accurate in predicting persistent organ failure than CTSI and MCTSI scores,with AUC of 0.73 (95%CI: 0.71-0.75), 0.72 (95%CI: 0.70-0.74) and 0.72 (95%CI: 0.70-0.74), respectively. Conclusions: AP severity judged by MCTSI is consistent with RAC, and SAP patients judged by CTSI are less than RAC. CTSI and MCTSI are significantly correlated with clinical prognosis. CTSI and MCTSI have higher accuracy in predicting IPN, but lower accuracy in predicting persistent organ failure than APACHE Ⅱ.

Axin2-lineage cells contribute to neonatal tendon regeneration.

PURPOSE: Tendon injuries are a challenging clinical problem with few treatment options. Identifying the molecular regulators of tendon is required for the development of new therapies. While the Wnt pathway is critical for the maintenance and differentiation of many tissues, the role of Wnt signaling in tendon cell biology remains largely unexplored. METHODS: The effects of Wnt activation were tested in vitro using neonatal tendon-derived cells cultured in 2D and 3D conditions. The inducible Axin2CreERT2 was then used to label Axin2+ cells in vivo and cells were traced during neonatal tendon regeneration. RESULTS: We showed that activation of Wnt signaling results in proliferation of neonatal tendon cells. While tendon marker expression was inhibited by Wnt activation under 2D conditions, Scx expression was not affected under 3D uniaxial tension, suggesting that the microenvironment contextualizes tendon cell response to Wnt signaling. Using an in vivo model of neonatal tendon regeneration, we further showed that Wnt signaling cells comprise a subpopulation of tenocyte and epitenon cells that proliferate after injury and are recruited during regeneration. DISCUSSION: Collectively, these studies suggest that Wnt signaling may play a role in tendon cell proliferation, differentiation, and regeneration.

[Follow-up study on natural course changes of obstructive sleep apnea hypopnea syndrome among young and middle aged patients].

Objective: To explore the natural course of obstructive sleep apnea-hypopnea syndrome (OSAHS) and its associated factors in young and middle-aged patients with OSAHS. Methods: A total of 52 young and middle-aged OSAHS patients were recruited in this study from West China Hospital of Sichuan University. All patients were performed twice overnight polysomnography (PSG) examinations. At the baseline, patients underwent the first PSG and clinical evaluation from September 2009 to September 2017 and the patients received the second PSG from January 2017 to January 2019. During the follow-up period, these patients had no treatment. All patients were categorized into two groups including mild-to-moderate [5/h≤ apnea-hypopnea index (AHI)<30/h] group and severe (AHI ≥ 30/h) group according to the baseline AHI value. Differences in the clinical characteristics and PSG variables between baseline and follow-up were compared in two groups separately using t-tests or Mann-Whitney U test. The general linear correlation analysis was used to explore the factors related to the severity of OSAHS including AHI, the mean oxyhemoglobin saturation and the minimal oxyhemoglobin saturation during the follow-up period. Results: This study recruited 28 OSAHS patients in mild-to-moderate group [mean age, (39.7±10.2) y] and 24 patients in severe group [mean age, (41.0±7.1) y]. Compared to the baseline, there was a significant increase in AHI value [(45.0±25.3) vs (33.6±27.3)/h, P<0.001] in all OSAHS patients. Notably, the increase of AHI was more significant in the mild-to-moderate OSAHS group [(32.1±22.2) vs (13.6±8.7)/h, P<0.05] but not in severe OSAHS patients [(60.7±19.5) vs (58.0±21.5)/h, P>0.05]. A person correlation analysis revealed that the AHI value was positively related to the age (r=0.531, P=0.004) in mild-to-moderate OSAHS patients. Conclusion: The severity of OSAHS is increased with the age in young and middle-aged patients with mild-to-moderate OSAHS, but not in those with severe OSAHS.

[Associations between objective sleepiness and cognition function before and after CPAP in obstructive sleep apnea patients].

Objective: To examine the association between objective sleepiness and neurocognitive function before and after continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. Methods: A total of 53 patients with overnight polysomnography (PSG) determined moderate-to-severe OSA (apnea hypopnea index (AHI) ≥15 events/h) and with overnight CPAP therapy from West China Hospital, Sichuan University within the period from Feb 2018 to Dec 2018 were enrolled in the study. At the baseline, all patients underwent overnight PSG study, multiple sleep latency test (MSLT), psychomotor vigilance test (PVT), and Epworth sleepiness score (ESS). After CPAP therapy, all patients underwent MSLT and PVT. Paired nonparametric test or t test were used to compare the differences between daytime sleepiness and PVT performance before and after CPAP. Results: Compared with baseline data, AHI [68.8(42.2, 80.0) vs 7.4(3.1, 11.1) events/h, P<0.05] decreased, the percentages of non-rapid eye movement stage 3 sleep time [0(0, 0.5%) vs 4.4%(1.9%, 11.3%), P<0.05] and the percentages of rapid eye movement sleep time [18.6%(13.2%, 22.7%) vs 25.4%(23.85, 30.3%), P<0.05] increased after CPAP therapy. The reaction time (RT) [353.0(317.5, 429.5) vs 333.6(309.7, 381.4) ms, P<0.05], the slowest 10% RT [602.9(473.2, 841.3) vs 505.5(431.6, 618.8) ms, P<0.05] and the fastest 10% RT [260.8(236.6, 300.6) vs 251.4(233.6, 283.2) ms, P<0.05] shortened, and the lapse [6.0(2.5, 16.5) vs 3.0(1.0, 8.5) events, P<0.05] decreased. The mean sleep latency (MSL) [5.8 (3.4, 8.3) vs 7.5(4.7, 12.4) min, P<0.05] increased. The changes in PVT parameters [ΔRT (r=0.20, P>0.05), Δslowest 10% RT (r=0.15, P>0.05), Δfastest 10% RT (r=0.24, P>0.05), and Δlapse (r=0.15, P>0.05)] were not correlated with the change in MSL. The significant association between the slowest 10% RT and ESS was found in baseline data. Conclusions: The change in MSL is not associated with the change in PVT performance before and after CPAP therapy. MSLT and PVT may be different in nature.

Co-delivery of immunomodulators in biodegradable nanoparticles improves therapeutic efficacy of cancer vaccines.

To improve the efficacy of cancer vaccines we aimed to modulate the suppressive tumor microenvironment. In this study, the potential of intratumoral immune modulation with poly (I:C), Resiquimod (R848) and CCL20 (MIP3α) was explored. Biodegradable polymeric nanoparticles were used as delivery vehicles for slow and sustained release of these drugs in the tumor area and were combined with specific immunotherapy based on therapeutic peptide vaccination in two aggressive murine carcinoma and lymphoma tumor models. Whereas nanoparticle delivery of poly (I:C) or R848 improved therapeutic efficacy, the combination with MIP3α remarkably potentiated the cancer vaccine antitumor effects. The long-term survival increased to 75-100% and the progression free survival nearly doubled on mice with established large carcinoma tumors. The potent adjuvant effects were associated with lymphoid and myeloid population alterations in the tumor and tumor-draining lymph node. In addition to a significant influx of macrophages into the tumor, the phenotype of the suppressor tumor-associated macrophages shifted towards an acute inflammatory phenotype in the tumor-draining lymph node. Overall, these data show that therapeutic cancer vaccines can be potentiated by the combined nanoparticle mediated co-delivery of poly (I:C), R848 and MIP3α, which indicates that a more favorable milieu for cancer fighting immune cells is created for T cells induced by therapeutic cancer vaccines.

[Association between mixed sleep apnea and treatment-emergent central sleep apnea].

Objective: To examine the association between mixed sleep apnea (MA) and treatment-emergent central sleep apnea (TE-CSA). Methods: A total of 256 patients meeting the diagnostic criteria of moderate to severe obstructive sleep apnea (OSA) based on overnight polysomnography (PSG) and receiving continuous positive airway pressure (CPAP) therapy in West China Hospital, Sichuan University during the period from August 2013 to November 2018 were enrolled in the study. Based on the mixed apnea index (MAI) and apnea-hypopnea index (AHI) in the baseline PSG study during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, the subjects were categorized into three groups of A (MAI=0/h, n=110), B (NREM-MAI≥5/h and REM-MAI<5/h, n=72) and C (REM-MAI≥5/h and NREM-MAI< 5/h, n=74). Sleep and breathing related parameters before and after CPAP therapy among three groups and the difference of TE-CSA incidence were analyzed. Results: The AHI [(44.2(26.8,64.5)/h,66.6(56.0,81.7)/h, 79.8(63.6, 88.3)/h], REM-AHI [50.0(34.7, 64.7)/h, 60.1(49.1, 70.0)/h, 66.3(56.1, 74.6)/h] and NREM-AHI[43.5(25.9, 65.1)/h,67.6(53.7, 82.4)/h,81.3(64.2, 91.5)/h]) were higher in group B and C compared to group A (all P<0.05),while the mean and lowest oxygen saturation [(92.6%±3.5%),(90.8%±3.6%),(87.3%±5.1%) and (70.6%±14.1%), (61.0%±16.0%), (47.9%±17.0%)] were lower in group B and group C compared to group A (all P<0.05). The incidence of TE-CSA after initial CPAP was 7.8% in all patients, and the incidence was significantly higher in group B of 14.1% compared to group C of 4.1% and group A of 2.7% (all P<0.05). Conclusions: TE-CSA is correlated with baseline MA, and baseline MA in NREM sleep can predict the incidence of TE-CSA after initial CPAP.

[Association between subjective and objective sleepiness in obstructive sleep apnea hypopnea syndrome patients].

Objective: To examine the association between subjective sleepiness and objective sleepiness in Chinese obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Methods: A total of 1 660 patients meeting the diagnostic criteria of OSAHS based on overnight polysomnography from West China Hospital, Sichuan University in the period from Jul 2010 to Jul 2014 were enrolled in the study. The Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) were to evaluate subjective and objective sleepiness, respectively. The subjects were categorized into quartiles [A (0-4) (n=406), B (5-7) (n=325), C (8-12) (n=443), D(13-24) (n=486) groups] based on the ESS score distribution. Survival analysis was used to characterize the association between the ESS score and the mean sleep latency (MSL). Results: The apnea hypopnea index (AHI) in D group was higher than other three groups [(58.7±26.1) vs (36.8±24.2), (42.6±26.7), (45.7±26.6) events/h, all P<0.05]. The mean sleep latency in D group was shorter than other three groups [(8.0±4.6) vs (10.9±4.4), (10.3±4.8), (9.4±4.5) min, all P<0.05]. The Kaplan-Meier survivor functions across the ESS score quartiles were distinct and fourth quartiles were progressively associated with a greater tendency for falling asleep (χ(2)=77.76, P<0.001 by Log-rank test) in the daytime (The percentages of awaking patients in fourth quartiles were progressively lower at the same time). The adjusted hazard ratios for sleep onset during the MSLT for the group B, C and D were 1.05 (95%CI: 0.90-1.22), 1.22 (95%CI: 1.07-1.40), and 1.38 (95%CI: 1.20-1.60), respectively, comparing to group A. Conclusion: Subjective report of daytime sleepiness is consistent with the objective sleepiness in OSAHS patients.

Serum total bilirubin levels are negatively correlated with metabolic syndrome in aged Chinese women: a community-based study.

We evaluated serum total bilirubin levels as a predictor for metabolic syndrome (MetS) and investigated the relationship between serum total bilirubin levels and MetS prevalence. This cross-sectional study included 1728 participants over 65 years of age from Eastern China. Anthropometric data, lifestyle information, and previous medical history were collected. We then measured serum levels of fasting blood-glucose, total cholesterol, triglycerides, and total bilirubin, as well as alanine aminotransferase activity. The prevalence of MetS and each of its individual component were calculated per quartile of total bilirubin level. Logistic regression was used to assess the correlation between serum total bilirubin levels and MetS. Total bilirubin level in the women who did not have MetS was significantly higher than in those who had MetS (P<0.001). Serum total bilirubin quartiles were linearly and negatively correlated with MetS prevalence and hypertriglyceridemia (HTG) in females (P<0.005). Logistic regression showed that serum total bilirubin was an independent predictor of MetS for females (OR: 0.910, 95%CI: 0.863-0.960; P=0.001). The present study suggests that physiological levels of serum total bilirubin might be an independent risk factor for aged Chinese women, and the prevalence of MetS and HTG are negatively correlated to serum total bilirubin levels.

[Gender differences of REM related obstructive sleep apnea-hypopnea syndrome].

Objective: To explore the gender differences of rapid-eye-movement (REM) related obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: Consecutive patients with primary complaint of snoring from Sleep Medicine Center of West China Hospital between January 2016 and November 2016 were included in the study. All participants underwent one night polysomnography (PSG) and Epworth sleep scale (ESS) was estimated. The patients diagnosed with OSAHS were classified as REM related OSAHS (REM-OSAHS group) and non-rapid-eye-movement (NREM) related OSAHS (NREM-OSAHS group) based on the PSG parameters. And the gender differences of demographic and polysomnograpic characteristics in both groups were compared. The associations between apnea-hypopnea index (AHI) and body mass index (BMI), neck circumference and waist circumference among patients with OSAHS were explored by multiple linear regression analysis. Results: A total of 1 258 patients were diagnosed with OSAHS. There were 997 (79.3%) male and 261 (20.7%) female among these patients, the mean age was (46.4±12.0) years old and mean BMI was (26.6±3.4) kg/m(2). There were 236 patients (18.8%) classified into REM-OSAHS group, and 1 022 patients (81.2%) classified into NREM-OSAHS group; the proportion of REM-OSAHS in female was significantly higher than that in male (34.1% vs 14.7%, P<0.001). After controlling for age, drinking, smoking, hypnotics, coffee, strong tea and sleep related parameters, in NREM-OSAHS group, AHI was positively correlated with BMI, neck circumference and waist circumference (P<0.001) both in male and female. In REM-OSAHS group, AHI was positively correlated with BMI, neck circumference and waist circumference in female (P<0.05), but only significantly correlated with BMI and waist circumference in male (P<0.05). Conclusions: REM-OSAHS is commonly seen in female OSAHS patients. Evaluation of the influences of anthropometric data on the severity of REM-OSAHS should consider the impact of gender.

[Association between daytime sleepiness and hypertension among patients with obstructive sleep apnea-hypopnea syndrome].

Objective: To assess the association between daytime sleepiness and hypertension among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: A total of 1 958 patients from Sleep Medicine Center of West China Hospital between January 2015 and January 2016 were included in the study. All subjects underwent one night polysomnography (PSG) and Epworth sleep scale (ESS) was estimated. The patients were divided into non-OSAHS group[apnea-hypopnea index (AHI)<5/h]and OSAHS group (AHI≥5/h) based on PSG, and then OSAHS group was further divided into those with and without daytime sleepiness groups according to ESS score (the cut point of ESS was 14). The association between blood pressure and risk of suffering from hypertension among patients with different degree of daytime sleepiness was explored by binary logistic regression. Results: There were 1 580 men and 378 women among the included patients, the mean age was (44.3±11.6) years old and the mean body mass index (BMI) was (26.4±3.8) kg/m2. Among these patients, there were 267 non-OSAHS and 1 691 OSAHS patients (1 275 without daytime sleepiness and 416 with daytime sleepiness). The prevalence of hypertension was higher among OSAHS patients (53.9%vs 28.8%) than non-OSAHS group, and OSAHS patients had higher systolic blood pressure (SBP)[(126.3±0.4) vs (116.3±4.9) mmHg], diastolic blood pressure (DBP)[(82.4±0.3) vs (78.1±3.7) mmHg]and mean arterial pressure (MAP)[(97.0±0.3) vs (90.9±3.9) mmHg]than non-OSAHS group. And OSAHS with daytime sleepiness also had elevated DBP[(84.5±0.6) vs (81.7±0.3) mmHg]and MAP[(98.8±0.6) vs (96.5±0.3) mmHg]than those without sleepiness (all P<0.05). After controlling for age, sex, BMI, smoking, drinking, AHI and related sleep parameters, OSAHS combined with daytime sleepiness increased the odds of hypertension by 23% (OR=1.23, 95% CI: 1.01-1.65) compared to OSAHS without daytime sleepiness. Conclusion: The daytime sleepiness is an independent risk factor of hypertension in OSAHS patients.

Isolation and characterization of two VpYABBY genes from wild Chinese Vitis pseudoreticulata.

The establishment of abaxial-adaxial polarity is an important feature of the development of lateral organs in plants. Members of the YABBY gene family may be specific to seed-plant-specific transcriptional regulators that play critical roles in promoting abaxial cell fate in the model eudicot, Arabidopsis thaliana. However, recent study has shown that the roles of YABBY genes are not conserved in the development of angiosperms. The establishment of abaxial-adaxial polarity has not been studied in perennial fruit crops. Grapes are an important fruit crop in many regions of the world. Investigating YABBY genes in grapevines should help us to discover more about the key genetic and molecular pathways in grapevine development. To understand the characterization of YABBY genes in grapevines, two YABBY genes, VpYABBY1 (GenBank accession No. KC139089) and VpYABBY2 (GenBank accession No. KC139090), were isolated from the wild Chinese species Vitis pseudoreticulata. Both of these encode YABBY proteins. Sequence characterization and phylogenetic analyses show that VpYABBY1 is group classified into the FIL subfamily while VpYABBY2 is a member of the YAB2 subfamily of Arabidopsis thaliana. Subcellular localization analysis indicates that VpYABBY1 and VpYABBY2 proteins are localized in the nucleus. Tissue specific expressional analysis reveals that VpYABBY1 is expressed strongly in young leaves of grape but only weakly in the mature leaves. Meanwhile, VpYABBY2 is expressed in grape stems, flowers, tendrils, and leaves. Transgenic Arabidopsis plants ectopically expressing VpYABBY1 caused the partial abaxialization of the adaxial epidermises of leaves, behaving similarly to those over-expressing FIL or YAB3 with abaxialized lateral organs. By contrast, ectopic expression of VpYABBY2 in Arabidopsis did not cause any alteration in the adaxial-abaxial polarity. Sequence characterization and phylogenetic analysis revealed that VpYABBY1 and VpYABBY2 are group-classified into two different subfamilies. They have diverged functionally in the control of lateral organ development. VpYABBY1 may have a function in leaf development, while VpYABBY2 may play a specific role in carpel development and grape berry morphogenesis. It is further possible that during the evolution of different species, YABBY family members have preserved different expression regulatory systems and functions.

Hepatocellular carcinoma with extrahepatic collateral arterial supply.

Haepatocellular carcinoma (HCC) is the most common primary liver malignancy, representing the fifth most common cancer in the world. Without treatment, the median survival of HCC patients has been reported to be 8 weeks from symptomatic presentation. Transarterial chemoembolisation is widely used to manage unresectable HCCs. However, when a tumour is large or locates near the liver capsule, it may receive supplies from vessels other than hepatic arteries. In this paper, we discuss the anatomy of possible extrahepatic collateral arterial supplies of HCCs.

Blocking the CC chemokine receptor 5 pathway by antisense peptide nucleic acid prolongs islet allograft survival.

Chemokines are important regulators in the development, differentiation, and anatomic location of leukocytes. The CC chemokine receptor 5 (CCR5) is the receptor for the proinflammatory chemokines and plays an important role in islet allograft rejection. Peptide nucleic acid (PNA) is a nucleic acid analog in which the sugar phosphate backbone of natural nucleic acid has been replaced by a synthetic peptide backbone. Studies indicate that PNA inhibits both transcription and translation of targeted genes. Fullly major histocompatibility complex (MHC)-mismatched murine islet transplant models were used to test the in vivo effect of PNA CCR5 by targeting CCR5 in acute allograft rejection. PNA CCR5-treated recipients demonstrated significant prolongation (12.0 +/- 1.75 days) of functional allograft survival compared with saline (6.5 +/- 0.58 days)- or PNA mismatch-treated recipients (6.5 +/- 0.50 days). The PNA CCR5 blocked the expression of CCR5 in spleen CD3+ T cells. Lymphocytes from PNA CCR5-treated mice exhibited a reduced degree of proliferation comparable to that of saline- and PNA mismatch-treated mice. The present study indicated that PNA CCR5 has a substantial therapeutic effect to inhibit acute allograft rejection.

Twenty-minute 50 mg 13C-urea breath test without test meal for the diagnosis of Helicobacter pylori infection in Chinese.

BACKGROUND: We have previously shown that the 75 mg 13C-urea breath test without citrate test meal is highly accurate for the diagnosis of Helicobacter pylori infection in Chinese subjects. A lower dose 50 mg 13C-urea breath test protocol with a sampling time at 20 min has not been validated previously. AIM: To investigate the accuracy of a 20-min 50 mg 13C-urea breath test protocol in Chinese subjects. METHODS: Consecutive dyspeptic patients referred for upper endoscopy were recruited. 13C-urea breath test was performed using (a) 75 mg and 50 mg of 13C-urea on two separate days without a test meal, and (b) 50 mg of 13C-urea with 2.4 g citrate as test meal, and compared with the gold standard [rapid urease test (CLO test) and histology]. Baseline, 20-min and 30-min breath samples were collected in all cases. RESULTS: Two hundred and six patients were tested. The accuracy of the 50 mg 13C-urea breath test (no citrate) at 20 min and 30 min was 98%, comparable to that of the 50 mg 13C-urea breath test with citrate (99.1%) and the 75 mg 13C-urea breath test without citrate (100%). CONCLUSIONS: A 20-min 50 mg 13C-urea breath test without citrate produced highly accurate results for the diagnosis of Helicobacter pylori infection and is more economical and convenient for the Chinese population.

[Studies on the chemical constituents of the seeds from Artabostrys hexapetalus (Annonaceae)].

AIM: To study the chemical constituents of the seeds from Artabotrys hexapetalus (L.f.) Bhandari (Annonaceae). METHODS: Various chromatographic techniques were used to separate and purify the constituents. Their structures were elucidated on the physico-chemical properties and spectral data. RESULTS: Eight compounds were isolated from the seeds of A. hexapetalus. They were identified as four neolignans: isoamericanin A (1), isoamericanol A (2), americanin B (3) and artabotrycinol (4), a semiterpenoid: (R)-artabotriol (5) and others: palmitic acid (6), beta-sitosterol (7) and daucosterol (8). CONCLUSION: Artabotrycinol (4) and (R)-artabotriol (5) are new compounds. Three other neolignans were isolated from this plant for the first time.

Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous frontalis suspension.

The frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the level of the eyebrow. Therefore, the superiorly based orbicularis oculi muscle flap, when advanced and attached to the tarsal plate, can dynamically elevate the upper lid and correct blepharoptosis with previous frontalis sling. Six patients with undercorrected blepharoptosis after frontalis sling suspension were included in this study. The superiorly based orbicularis oculi muscle flap was advanced to the tarsal plate in these patients and the redundant portion of the distal flap was resected. Postoperative results were satisfactory after 1-year follow-up.

A rapid method for determining the G+C content of bacterial chromosomes by monitoring fluorescence intensity during DNA denaturation in a capillary tube.

A simple and rapid method to determine the G+C content of bacterial chromosomal DNA was developed. It involves determination of Tm by a Light Cycler and calculation of the G+C content by an empirical formula relating Tm to G+C content. Instead of a conventional thermal denaturation method, which monitors the increase of absorbance at 260 nm, thermal denaturation was monitored by the decrease of fluorescence intensity in the presence of SYBR Green 1. In this method, the apparent Tm of DNA was influenced by the concentration of SYBR Green 1, DNA and salt. In addition, when the G+C content was calculated from a linear equation [(mol% G+Cx = mol% G+Cr+1.99(Tmx-Tmr), where x is the unknown organism and y is the reference organism], an error value was introduced among strains with extremely low or high G+C content. Based upon five standards (G+C contents in the range 33-66 mol%), a suitable equation was formulated for the capillary method: mol% G+Cx = mol% G+Cr+1.4652(Tmx-Tmr)+0.0063(Tmx2-Tmr2). To determine the Tm of organisms within this range of G+C contents, Escherichia coli ATCC 11775T was used as a DNA standard and fixed concentrations of SYBR Green 1, sodium citrate and DNA were used. The data from 37 bacterial strains indicated that this equation behaved well. Because it is rapid and simple, it may prove useful for bacterial identification.