["Double Grooves-Double Rings" technique of transurethral Thulium laser enucleation of the prostate: learning curve of single surgeon].

Objective: To evaluate the learning curve of the "Double Grooves-Double Rings" (DGDR) technique of transurethral Thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH) by a single surgeon. From June 2021 to July 2022, 84 patients mean age (69.0±8.0) years,preoperative prostate volume (90.9±40.3)ml with BPH underwent ThuLEP in the Department of Urology, Peking University First Hospital.Performed by a single surgeon who had no experience of transurethral resection of prostate (TURP) and any laser surgeries. The case scatter plots with the best fitting line were drawn to analyze the learning curve. According to the date of the surgeries, the patients were equally divided into three learning stages (28 patients for each group). The T-PSA,prostate volume,operative time,enucleation time, enucleation efficiency,catheter indwelling time, hemoglobin drop and perioperative complications (including re-TURP, blood transfusion, stress incontinence≥3 months and urethral stricture) were compared among the groups. The learning curve was divided into three stages, and the cutting point was shown on the 14th case. Except the prostate volume [stage1 (75.7±30.7) ml, stage2 (93.40±39.6)ml, stage3 (103.5±46.2) ml, P<0.05], there was no significant difference of the baseline data between three groups (P>0.05). Compared with those of stage 1(100.6±24.7) min,(0.55±0.22) g/min, a statistically significant improvement was observed in both of the operative time and the enucleation efficiency among stage 2[(84.5±36.6) min, (0.87±0.33) g/min and stage 3 (71.2±26.3) min, (1.27±0.45) g/min, P<0.05]. The learning curve of the DGDR technique for ThuLEP can be divided into three stages. A ThuLEP beginner can preliminarily master this technique after completing 14 cases.

[Clinical analysis of 7 children infected with Talaromyces marneffei].

Objective: To investigate the clinical manifestations, treatments, and prognosis of pediatric patients with Talaromyces marneffei infection. Methods: In this retrospective study, 7 children diagnosed with Talaromyces marneffei infection in Shenzhen Children's Hospital from July 2017 to October 2021 were recruited. The clinical features, radiology, pathogen detection, immunological evaluation, treatments, and prognosis were analyzed. Results: In 7 cases, 5 were male, 2 were females. The age was from 0.75 to 8.75 years. The main clinical manifestations were fever in 7 cases, cough in 6 cases, malnutrition in 4 cases, papules in 2 cases and medical history of recurrent infection in 3 cases. Physical examination showed that all 7 patients had hepatosplenomegaly, 4 had superficial lymphadenopathy. Laboratory examination showed that 6 cases had decreased hemoglobin and 3 cases had decreased platelet. Chest CT showed that 4 cases had patchy shadows, pleural effusion, mediastinal or axillary lymph node enlargement, 3 had nodular shadows and 2 had cavities. The positive ratio of Talaromyces marneffei culture was 2/2 with tissue samples, 4/5 with bone marrow. The positive ratio was 3/4 by metagenomic next generation sequencing. The fungus was detected in 3 cases by smear microscopy of bone marrow and (or) peripheral blood. All patients were negative for human immunodeficiency virus by the immune function assay. However, 5 cases were confirmed as primary immunodeficiency disease, including 2 cases with high IgM syndrome, 2 with STAT1 gene variation, and the last with severe combined immunodeficiency (IL2RG gene variation). Exclude 1 case which gave up treatment due to acute intracranial infection, and the other patients received effective treatments along with amphotericin B, voriconazole, and itraconazole alone or in combination. Two cases relapsed after medication withdrawal, but 1 case got complete rehabilitation after hematopoietic stem cell transplantation. Conclusions: The clinical manifestations involve multisystem, the common charateristics are fever and cough. The chest CT imaging manifestations are diverse, it should be considered in differentiating tuberculosis. The amphotericin B, voriconazole and itraconazole are effective, but it will easily relapse when withdrawing those antifungal agents.

[The clinical phenotype and gene analysis of syndromic deafness with PTPN11 gene mutation].

Objective: To analyze the clinical phenotype and screen the genetic mutations of hereditary deafness in three deaf families to clarify their molecular biology etiology. Methods: From January 2019 to January 2020, three deaf children and family members were collected for medical history, physical examination, audiology evaluation, electrocardiogram and cardiac color Doppler ultrasound, temporal bone CT examination, and peripheral blood DNA was obtained for high-throughput sequencing of deafness genes. Sanger sequencing was performed to verify the variant sites among family members. The pathogenicity of the variants was evaluated according to the American College of Medical Genetics and Genomics. Results: The probands in the three families had deafness phenotypes. In family 1, proband had multiple lentigines, special facial features, growth retardation, pectus carinatum, abnormal skin elasticity, cryptorchidism and other manifestations. In family 2, proband had special facial features, growth retardation and abnormal heart, and the proband in family 3 had growth retardation and abnormal electrocardiogram. Genetic testing of three families detected three heterozygous mutations in the PTPN11 gene: c.1391G>C (p.Gly464Ala), c.1510A>G (p.Met504Val), c.1502G>A (p.Arg501Lys). All three sites were missense mutations, and the mutation sites were highly conserved among multiple homologous species. Based on clinical manifestations and genetic test results, proband 1 was diagnosed with multiple lentigines Noonan syndrome, and probands 2 and 3 were diagnosed with Noonan syndrome. Conclusion: Missense mutations in the PTPN11 gene may be the cause of the disease in the three deaf families. This study enriches the clinical phenotype and mutation spectrum of the PTPN11 gene in the Chinese population.

[Patient factors influencing preoperative expectations of patients undergoing total knee arthroplasty].

OBJECTIVE: To investigate the expectations of patients for total knee arthroplasty (TKA), and to analyze its influencing factors. METHODS: Experimental design: Single center, retrospective, multiple regression analysis. The data including the age, height, and weight of 108 patients undergoing unilateral TKA due to end-stage osteoarthritis were obtained. The patients' preoperative Hospital for Special Surgery (HSS) knee arthroplasty expectation score, the Western Ontario and McMaster Universities (WOMAC) score, Knee Society score (KSS), the MOS 36-item short-from health survey (SF-36) score, and visual analogue scale (VAS) were evaluated, and the 30-second chair-stand test (30-CST), 40-meter fast-paced walk test (40-FPWT), 12-level stair-climb test (12-SCT), 3-meter timed up-and-go test (TUG), 6-minute walk test (6-MWT), and recorded daily steps for 7 consecutive days were performed. The SPSS 22.0 software was used for statistical analysis. The observed values of various data were described. Pearson correlation analysis was used to evaluate the correlation between various parameters, and the multi-factor linear regression analysis was used to investigate the influencing factors of the patients preoperative expectation scores. RESULTS: The average expectation score of this group of patients was 58.98±5.44. In the Pearson correlation analysis, the patient's preoperative expectation had a weak correlation to the result of the patient's 12-SCT, TUG, 6-MWT, KSS function score, and SF-36 mental component score (correlation coefficient 0.1-0.3). The patient's preoperative expectation had a moderate correlation to the patient's daily average steps, 30-CST, 40-FPWT, KSS, WOMAC and its pain, stiffness, function scores, SF-36 physical functioning, role-physical, bodily pain, vitality, and physical component score (correlation coefficient 0.3-0.6). In the multivariate linear regression analysis, only the results of 30-CST and the role-physical, bodily pain and vitality in the SF-36 scale were related to the patient's expectation score (P < 0.05). CONCLUSION: The estimated expectation score of patients before TKA is not high. Patients with more severe preoperative pain, worse physical function, and lower overall health are more eager to improve after surgery. Thus surgeons must communicate fully with patients with unrealistic expectations before surgery in order to obtain more satisfactory results postoperatively.

[Immune checkpoint inhibitors in the treatment and management of hepatocellular carcinoma-related adverse reactions].

The application of immune checkpoint inhibitors has significantly improved the immunotherapy effect of a variety of solid tumors. With the US Food and Drug Administration's approval of nivolumab and pembrolizumab as second-line treatments for hepatocellular carcinoma, the application of immune checkpoint inhibitors, especially in combination with other treatment methods, has become more and more widely used in hepatocellular carcinoma. Notably, these drugs play a therapeutic role in tumor immunosuppression; however, they can also stimulate related side effects caused by autoimmunity, so their side effects are very different from traditional chemotherapy and targeted drugs. Therefore, effective monitoring, detection and intervention of immune-related side effects are obligatory assurances for patients to attain clinical benefits.

The significance of phase reversion-induced nanograined/ultrafine-grained (NG/UFG) structure on the strain hardening behavior and deformation mechanism in copper-bearing antimicrobial austenitic stainless steel.

The unique concept of phase reversion involving severe deformation of parent austenite into martensite, followed by annealing for a short duration, whereby the strain-induced martensite reverts to austenite, was adopted to obtain nano-grained/ultrafine-grained (NG/UFG) structure in a Cu-bearing biomedical austenitic stainless steel resulting in high strength-high ductility combination. Work hardening and accompanying deformation mechanism are two important aspects that govern the mechanical behavior of biomedical devices. Thus, post-mortem electron microscopy of the strained region was carried out to explore the differences in the deformation mechanisms induced by grain refinement, while the strain hardening behavior was analyzed by Crussard-Jaoul (C-J) analysis of the tensile stress-strain data. The strain hardening behavior consisted of four stages and was strongly affected by grain structure. Twinning-induced plasticity (TWIP) was the governing deformation mechanism in the NG/UFG structure and contributed to good ductility. In striking contrast, transformation-induced plasticity (TRIP) contributed to high ductility in the coarse-grained (CG) counterpart and was the governing strain hardening mechanism. When the grain size is less than ~1 µm, the increase in the strain energy and the austenite stability significantly reduce the possibility of strain-induced martensite transformation such that there is a distinct transition in deformation mechanism from nanoscale twinning in the NG/UFG structure to strain-induced martensite in CG structure. The differences in the deformation mechanisms are explained in terms of austenite stability - strain energy relationship.

[Status and influencing factors of knowledge awareness and service acceptance of HIV non-occupational post-exposure prophylaxis of men who have sex with men among college students among three cities of China, 2019].

Objective: To understand the knowledge awareness and service acceptance of HIV non-occupational post-exposure prophylaxis (nPEP) men who have sex with men (MSM) among college students in three cities of China. Methods: Male college students in 10 universities of Beijing, Shenzhen and Kunming aged 18 and above who had sex with men in the last 3 months were recruited as research objects by cluster stratified sampling from March 15, 2019 to April 14, 2019.Basic information, sexual behavior characteristics, knowledge, and service acceptance of nPEP were collected through online questionnaire survey. Multivariate dichotomy and unconditioned logistic regression model was used to explore related factors about knowledge awareness and service acceptance of nPEP. Results: A total of 293 MSM were surveyed. The average age was (21.0±0.2) years old, and 91.1% (267) were undergraduates. In the last 3 months before the survey, 54.3%(159) used condom each time of sex; 4.4%(13) had intercourse with the HIV infected men, and 9.2% (27)suffered STDs in the past 6 months. The 29.4% (86) had not received HIV testing in the past year. The nPEP knowledge awareness rate was 47.8% (140). The 21.2% (62) counseled nPEP services, and 9.9% (29) received nPEP services. After multiple logistic regression analysis, compared with those who not received HIV testing in the past year, OR (95%CI) value of those who received HIV testing for more than twice in the past year to aware the nPEP knowledge was 3.15 (1.01-9.86). Compared with those who not received HIV testing in the past year, OR (95%CI) value of those who received HIV testing for more than twice in the past year to counsel the nPEP services was 5.29 (1.51-18.51). Compared with those who never used rush in the last 3 months, OR(95%CI) value of those who ever used rush in the last 3 months to receive the nPEP services was 3.86 (0.99-14.98). Compared with those who not sexed with HIV infected in the last 3 months, OR (95%CI) value of those who sexed with HIV infected in the last 3 months to receive the nPEP services was 14.30 (3.35-61.03). Conclusion: The proportions of awareness of nPEP knowledge and acceptance of nPEP services are low. MSM among college students need further health education of the nPEP knowledge to improve the accessibility of services.

[Immunodeficiency diseases with interstitial lung disease as major clinical manifestations: report of six cases].

Objective: To summarize the clinical features of immunodeficiency diseases with interstitial lung disease (ILD) as major clinical manifestations and to improve understanding etiology of ILD. Methods: The clinical features and clinical clues for diagnosis of six cases with immunodeficiency presented with ILD in Shenzhen Children's Hospital from January 2014 to December 2016 were retrospectively analyzed. Results: The patients' age ranged from 3 months to 5 years and 9 months, 5 cases were male. All cases had cough and tachypnea, 3 cases had lung infection and respiratory failure, 2 cases had chronic hypoxia and one had clubbing. Three cases had skin rashes; 5 cases had failure to thrive. Chest CT scan showed diffuse ground glass opacity in all the 6 cases, and 2 cases had cystic changes and one had "crazy-paving" pattern. Five patients were suspected to have surfactant dysfunction and genetic testing was performed before diagnosis of immunodeficiency, of which the results were negative. With human immunodeficiency virus antibody test or immunologic laboratory testing and/or immune genetic panel, acquired immune deficiency syndrome was confirmed in one case, hyper-IgM syndrome was confirmed in two cases and hyper-IgE syndrome in one case, Wiskott-Aldrich syndrome in one and STAT3 gain of function genetic mutation in another. All cases had clinical clues indicative of underlying immunocompromise. Conclusions: The clinical features of immunodeficiency diseases with ILD are cough, tachypnea or hypoxia, respiratory failure with infection, diffuse ground glass opacity in Chest CT imaging. With thorough medical history and immunology screening, there would be clinical clues indicative of underlying immunocompromise. Screening for immunodeficiency disease should be emphasized in the differential diagnosis of ILD, otherwise it may lead to misdiagnosis or unnecessary testing.

[Effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand].

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions: The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.

[Clinical comparative study of caloric test with water or air in healthyindividuals and diagnosing study on air caloric test].

Objective:To explore the equivalence of the test results of the water or air caloric tests and the compliance of the test in the healthy individuals. To provide scientific basis for clinical standardization of caloric test.Method: Randomized crossover clinical trial, 60 healthy individuals were divided into group A and group B. Water caloric test was carried out first in group A, and air caloric test was carried out after elution effect(one day interval). The treatment of group B was opposite to group A. SPV(Slow Phase Velocity), CP(canal paralysis) and SPV and CP' s 95%CI were used as evaluation indexes to analyze the equivalence of water and air caloric test in healthy people and the clinical normal reference value and stability and compliance of the water and air caloric test. Result: ①60 cases of caloric test CP value of chi square test suggested that there was no statistical difference between two kinds of media in the examination of the vestibular function of healthy individuals, and the CP value of the two was 85%(51/60). ②the SPV value of the was obviously higher than that of the air caloric test. The SPV value at each temperature of the water caloric test stimulation is quite different from the air caloric test stimulation. ③The range of water caloric test stimulation CP 95%CI was 8%-12%, and the average value was 10%. The interval of air caloric test stimulation CP 95%CI was 10%-15% and the average value was 12%. ④This study provided the corresponding SPV 95%CI as the medical reference values. ⑤The subjects of 98.33%(59/60) of the questionnaire survey selecting air caloric test and the results of the observation indicated that the duration of the air caloric test was shorter and more comfortable. Conclusion: ①Air caloric test can satisfied the needs of clinical assessment of horizontal semicircular canal function, and can make patients feel more comfortable. However, due to the weak intensity of nystagmus, water caloric test has to be used when the SPV value is too low. ②In this study, the upper limit of the CP value of the air caloric test in healthy individuals was 0.21, which is quite different from the upper limit of the standard value was 0.25 of the water caloric test. Therefore, the laboratory should establish their own reference value of the laboratory caloric test, and should not blindly apply the standard value of the water caloric test as the standard of the hemiplegia of the unilateral semicircular canal. The results of this study suggest that air caloric test can be used instead of water caloric test in clinic. And if the patient has no contraindications, air caloric test can be used as a priority.

[Misdiagnosic analysis and treatment of pyriform sinus fistula in children].

Objective: To discuss the misdiagnosis of pyriform sinus fistula and to better understand this kind of illness. Methods: The analysis was based on twenty-eight patients with congenital pyriform sinus fistula aged from 11 months to 14 years, with the median age of 5 years, and who were surgically treated from January 2013 to January 2017 in Kunming Children's Hospital.Twenty patients were misdiagnosed in other hospital.After the routine examination of neck ultrasound and enhanced CT, internal fistula was found by self-retaining laryngoscope, traced by methylene blue, and excised by high ligation. Results: Twenty patients were misdiagnosed.The misdiagnosis time ranged from 6 months to 3 years.Under self-retaining laryngoscope, piriform fossa fistula were found in all patients.Nineteen fistula were found in the left and 1 in the right.The fistula in patients was unilateral.Seven cases were misdiagnosed as suppurative lymphadensitis, undergone abscess incisional drainage many times.Three cases were misdiagnosed as thyroglossal duct cyst and performed excision of thyroglossal duct cyst.One case was treated by extended Sistruck operation again because the doctor considered that excision of middle segment of hyoid bone was not enough and the fistula was not ligated completely.One case was misdiagnosed as second branchial cleft fistula on the right side of the neck.Nine cases were misdiagnosed as hyroid-associated diseases including 2 cases suppurative thyroiditis, 2 cases subacute thyroiditis and 5 cases thyroid neoplasms.Among them, 2 cases underwent partial thyroidectomy.All the patients were treated with high ligation of fistula under general anesthesia.The operation was smooth, and no hoarseness, bucking and pharyngeal fistula occurred after the operation.Postoperative follow-up time ranged from 12 months to 4 years and the median follow-up was 18 months without recurrence.The diagnosis was confirmed pathologically. Conclusions: Pyriform sinus fistula in children was uncommon and easily misdiagnosed in clinic.The majority of physician including some otolaryngologists were lack of understanding of the disease.It should be regarded as one of the important differential diagnosis of neck mass in children.Children with recurrent left neck infection and/or abscess should be highly suspected.Self-retaining laryngoscopic examination can make a definite diagnosis and high ligation of the fistula through the external neck approach can achieve good therapeutic effect.

[Long-term efficacy of cervical artificial disc replacement for cervical degenerative diseases].

Objective: To evaluate the long-term efficacy of cervical artificial disc replacement for patients with cervical disc herniation and degenerative cervical canal stenosis. Methods: Total of sixty-eight patients underwent single-level Bryan artificial disc replacement in Beijing Jishuitan Hospital from December 2003 to December 2007 with a minimum 10-year follow-up were retrospectively analyzed. There were 43 males and 25 females with a mean age of (46±8) years. According to preoperative CT and MRI, the patients were divided into two groups: 27 patients in cervical disc herniation group and 41 patients in degenerative cervical canal stenosis group. The evaluation indexes before surgery and at last follow-up were compared between two groups. The clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) and Odom's grade; and the radiological indexes included the global and segmental range of motion (ROM), Cobb's angle at operated level. The continuous variable data were analyzed by independent sample t test. Results: In cervical disc herniation group, the improvement rate of JOA score was 83%±22%, NDI% decreased by 14%±9%, and Odom's grade was excellent in 17 patients, good in 10 patients. In degenerative cervical canal stenosis group, the improvement rate of JOA was 68%±34%, NDI% decreased by 11%±7%, and Odom's grade was excellent in 19 patients, good in 18 patients, fair in 4 patients. The segmental ROM was 10°±4° and 7°±6° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.284, P=0.026). The global ROM was 50°±9° and 44°±14° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.112, P=0.038). Conclusions: Cervical artificial disc replacement has a favorable long-term efficacy in treating cervical degenerative diseases. The postoperative global and segmental ROM in patients with cervical disc herniation are better than those in patients with degenerative cervical canal stenosis.

Determination of the energy value of corn distillers dried grains with solubles containing different oil levels when fed to growing pigs.

This experiment used indirect calorimetry to determine the net energy (NE) content of five corn distillers dried grains with solubles (corn DDGS) containing different oil levels and to compare the NE obtained using indirect calorimetry with that calculated using previously published prediction equations. There were two samples of high-oil DDGS, one sample of medium-oil DDGS and two samples of low-oil DDGS. Twelve barrows (initial BW of 32.8 ± 2.0 kg) were used in a repeated 3 × 6 Youden square design with three periods and six diets. The diets were comprised of a corn-soybean meal basal diet and five diets containing 29.25% of one of the corn DDGS added at the expense of corn and soybean meal. During each period, the pigs were individually housed in metabolism crates for 16 days which included 7 days for adaption to feed and environmental conditions. On day 8, the pigs were transferred to respiration chambers and fed one of the six diets at 2300 kJ ME/kg BW0.6 /day. Faeces and urine were collected from day 9 to 13 and heat production (HP) was also measured. From day 14 to 15, the pigs were fed 893 kJ ME/kg BW0.6 /day to allow them to adapt from the fed to the fasted state. On the last day of each period (day 16), the pigs were fasted and fasting HP was measured. The digestible energy value was 16.0, 17.1 and 15.3 MJ/kg DM, the metabolizable energy value was 14.6, 15.5 and 13.7 MJ/kg DM and the NE value was 10.7, 11.0 and 9.4 MJ/kg DM, for the high-oil, medium-oil and low-oil corn DDGS, respectively. The NE obtained with indirect calorimetry in the present study did not differ from values calculated using previously published prediction equations.

Correlative study between the JAK2V617F mutation and thrombosis in patients with myeloproliferative neoplasm.

In this study, we investigated the correlation between the JAK2V617F mutation and thrombosis in patients with myeloproliferative neoplasm (MPN) using real-time fluorescence quantitative PCR. The incidence of thrombus was monitored and blood and coagulation were routinely assayed in patients with MPN. The JAK2V617F mutation was found in 8/68 individuals in the control group (11.8%); it was expressed in 44/68 patients with MPN (64.7%), suggesting that the rate of this mutation was significantly higher in patients with MPN than that in the control group. Twenty-six MPN patients (38.2%) showed symptoms of thrombosis; MPN patients with thrombosis showed a significantly higher rate of the JAK2V617F mutation, were of a greater age, and had higher blood pressure than MPN patients without thrombosis. In addition, the white blood cells (WBC) (21.98 ± 1.95) and platelets (364.68 ± 97.72) were significantly higher in patients, expressing the mutated gene, with polycythemia vera than in the patients without the mutation. The WBC (32.89 ± 4.25) and hemoglobin (161.92 ± 16.19) were significantly increased in the essential thrombocythemia patients with gene mutation compared with the patients without mutation. MPN patients showed higher blood clotting ability than the control subjects; moreover, MPN patients with the JAK2V617F mutation showed higher blood clotting ability than those without the mutation. The findings of this study indicate that the JAK2V617F mutation is correlated with the incidence of thrombosis, and analysis of this mutation has important clinical significance in the diagnosis and treatment of MPN.

Hormonal and reproductive factors and risk of esophageal cancer in women: a meta-analysis.

Currently published studies on the relationship between hormonal and reproductive factors and esophageal cancer (EC) risk in women have yielded contradictory findings. For a better understanding of this relationship, we first performed this meta-analysis by pooling all available publications. Sixteen independent studies were retrieved after a comprehensive search in PubMed and Embase databases. The pooled relative risks (RRs) with 95% confidence intervals (95% CIs) were calculated. The pooled RRs implicated that hormone replacement therapy was negatively associated with the risk of EC (RR = 0.72, 95% CI 0.60-0.86, P < 0.001) and esophageal squamous cell carcinoma (RR = 0.68, 95% CI 0.48-0.97, P = 0.031). Menopausal women were at an increased risk of EC (RR = 1.47, 95% CI 1.07-2.03, P = 0.018), particularly esophageal squamous cell carcinoma (RR = 1.66, 95% CI 1.12-2.48, P = 0.012). Additionally, decreased risk of EC (RR = 0.79, 95% CI 0.68-0.92, P = 0.003) and esophageal adenocarcinoma (RR = 0.66, 95% CI 0.53-0.82, P < 0.001) was demonstrated among women with breast-feeding history. Moreover, such associations were more significant among Caucasians, but not Asians. Our study suggests that menopause is an independent risk factor for EC, while hormone replacement therapy and breast-feeding history play a protective role against EC, particularly among Caucasians. All results are consistent with the hypothesis that effects of estrogen may lower the risk of EC in women.

[Vertigo and sensorineural hearing loss due to syphilis: differential diagnosis and treatment].

Objective:To analyze the etiology of repeatedly attacks of intractable vertigo and some types of sensorineural deafness whose clinical manifestation were not in conformity with the known spectrum diseases，and explore the screening method to prevent missed diagnosis or misdiagnosis, then provide references for clinical diagnosis and treatment for rare etiology. Method:The authors retrospectively analyzed the clinical manifestations, diagnosis, treatment and prognosis from 4 cases of vertigo sufferers and 2 cases of hearing impairment sufferers whose serological tests were positive for syphilis. All these 6 cases were treated with large doses of penicillin aqueous solutions (24 million U/d), multi-times intravenous infusion, the course of the treatment was 14 d. Result:The clinical manifestations of these 6 patients were lack of characteristic, as well as the results of hearing and vestibular function, imaging diagnosis. Positive syphilis detection of serology and cerebrospinal fluid tests were the main diagnostic basis. After anti-syphilis treatment, 5 cases got satisfied clinical symptoms improvement, 1 case suffered from low-tone sensorineural hearing loss, whose hearing fluctuated recurrently. Conclusion:Syphilis infection may damage the Ⅷ cranial nerve and then lead to vertigo and hearing loss, through chronic syphilitic osteitis of temporal bone, atrophy of organ of corti, osteolytic lesion surrounding the endolymphatic duct, and neurosyphilis. For patients presented with intractable vertigo, and those whose clinical manifestations are not in conformity with the known diseases of unilateral ear or bilateral ears rapidly progressive deafness, syphilis serology screening and validation tests are recommended in case of missed diagnosis or misdiagnosis.

Determination and prediction of energy values in corn distillers dried grains with solubles sources with varying oil content for growing pigs.

This study was conducted to determine the DE and ME content of 25 samples of corn distillers dried grains with solubles (DDGS) fed to growing pigs and to generate prediction equations for DE and ME based on chemical analysis. The 25 samples included 15 full-oil (no oil extracted; ether extract [EE] > 8%) DDGS and 10 reduced-oil (oil extracted; EE < 8%) DDGS collected from 17 ethanol plants in China. A corn­soybean meal diet constituted the basal diet and the other 25 diets replaced a portion of the corn, soybean meal, and lysine of the basal diet with 28.8% of 1 of the 25 corn DDGS sources. Seventy-eight barrows (initial BW = 42.6 ± 6.2 kg) were used in the experiment conducted over 2 consecutive periods (n = 6 per treatment) using a completely randomized design. For each period, pigs were placed in metabolism cages for a 5-d total collection of feces and urine following a 7-d adaptation to the diets. Among the 25 corn DDGS samples, EE, NDF, DE, and ME content (DM basis) ranged from 2.8 to 14.2%, 31.0 to 46.6%, 3,255 to 4,103 kcal/kg, and 2,955 to 3,899 kcal/kg, respectively. Using a stepwise regression analysis, a series of DE and ME prediction equations were developed not only among all 25 DDGS but also only within 15 full-oil DDGS and 10 reduced-oil DDGS samples. The best fit equations of DE (kcal/kg DM) for the complete set of 25 DDGS, 15 full-oil DDGS, and 10 reduced-oil DDGS were 2,064 ­ (38.51 × % NDF) + (0.64 × % GE) ­ (39.70 × % ash), ­(87.53 × % ADF) + (1.02 × % GE) ­ (22.99 × % hemicellulose), and 3,491 ­ (40.25 × % NDF) + (46.95 × % CP), respectively. The best fit equations for ME (kcal/kg DM) for the complete set of 25 DDGS, 15 full-oil DDGS, and 10 reduced-oil DDGS were 1,554 ­ (44.11 × % NDF) + (0.77 × % GE) ­ (68.51 × % ash), 7,898 ­ (42.08 × % NDF) ­ (136.17 × % ash) + (101.19 × % EE) (103.83 × % CP), and 4,066 ­ (46.30 × % NDF) + (45.80 × % CP) ­ (106.19 × % ash), respectively. Using the sum of squared residuals to compare the accuracy of the 3 groups of prediction equations revealed that separate equations for full-oil DDGS and reduced-oil DDGS each provided a better fit than a single equation for the entire set of DDGS sources. These results indicated that the DE and ME values in corn DDGS are related to the chemical composition, primarily the EE and fiber concentrations. Specific prediction equations derived from full-oil and reduced-oil DDGS are better than equations derived from the entire set of DDGS.

Association between TNFSF4 tagSNPs and myocardial infarction in a Chinese Han population.

Tumor necrosis factor superfamily member 4 (TNFSF4) plays an important role in atherosclerosis development. However, the biological significance of TNFSF4 variants on myocardial infarction (MI) pathogenesis remains poorly understood. We investigated the influence of 5 TNFSF4 tagging single nucleotide polymorphisms (rs3861950, rs17346501, rs7518045, rs1234313, and rs3850641) on individual susceptibility to MI in a Chinese population of 285 MI patients and 645 controls. Genotyping was performed using the polymerase chain reaction-ligase detection reaction method. In multivariate logistic regression analysis, only the TNFSF4 tagging single nucleotide polymorphism rs7518045 exhibited a significant effect on MI risk; A allele (odds ratio = 0.68, 95% confidence interval = 0.46-1.00, P = 0.048) and AA genotype (odds ratio = 0.64, 95% confidence interval = 0.42-0.97, P = 0.036) were associated with a decreased risk of MI compared with the G allele and the combined AG/GG genotype, respectively. Moreover, the haplotype rs3861950C-rs17346501C-rs7518045A-rs1234313G containing the rs7518045 A allele also exhibited a significant association with a decreased risk for MI (odds ratio = 0.42, 95% confidence interval = 0.21-0.84, P = 0.011). Our study showed that the A allele of the rs7518045 and haplotype rs3861950C-rs17346501C-rs7518045A-rs1234313G in the TNFSF4 gene were associated with decreased MI risk in a Chinese Han population. Further studies using larger sample sizes and in diverse ethnic populations are needed to confirm the general validity of our findings.

Analysis of key genes and pathways involved in acute lung injury in a mouse model.

A mouse model of acute lung injury (ALI) was chosen in this study to explore the key genes and pathways involved in the process of ALI with microarray technology. Gene expression microarray data were downloaded from the Gene Expression Omnibus database. Mice from the experimental group were further divided into 6 subgroups, which received octadecenoate treatments for 1, 1.5, 3, 4, 18, and 24 h. Differentially co-expressed genes were screened to uncover the pathogenesis of ALI. Almost all of the differentially co-expressed genes were identified at two times: 1.5 and 3 h. Functional analysis revealed that several inflammation-related pathways were significantly enriched. Ubiquitin-mediated proteolysis, hematopoietic cell lineage, and leukocyte transendothelial migration were enriched at 1.5 h. The B cell receptor signaling pathway, T cell receptor signaling pathway, natural killer cell-mediated cytotoxicity, Fc epsilon RI signaling pathway, and ubiquitin-mediated proteolysis were significantly enriched at 3 h. It could be inferred that ALI initiated at 1.5 h and lasted through 3 h. However, co-expression patterns were not found from 4 h onward. In conclusion, several key genes and pathways implicated in the development of ALI were found in this study using the mouse model, among which ubiquitin-mediated proteolysis appears to play an important role in the process.