Correlation of serum homocysteine and cystatin C levels with prognosis in heart failure with preserved ejection fraction patients.

OBJECTIVE: This study investigated the relationship of serum homocysteine (Hcy) and cystatin C (Cys C) levels with the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). METHODS: A total of 178 patients with HFpEF who were admitted to our hospital between December 2019 and November 2020 were included. Patients were grouped based on their serum Hcy and Cys C levels: high Hcy level, normal Hcy level, high Cys C level, and normal Cys C level. Cardiac function, ventricular remodeling indices, and prognosis were compared among patients in these groups. Additionally, the predictive value of serum Hcy and Cys C levels for adverse cardiovascular events in HFpEF patients was analyzed. RESULTS: Patients' mean age in the high Hcy level, normal Hcy level, high Cys C level, and normal Cys C level groups was 69.21 ± 4.17,67.74 ± 4.28,69.95 ± 4.98, and 67.06 ± 4.13 years old, respectively. The high Hcy level group exhibited a lower proportion of class II cardiac function according to the New York Heart Association (NYHA) classification and a higher proportion of class IV cardiac function than the normal Hcy level group, with statistically significant differences. Similarly, the high Cys C level group had a lower proportion of class II cardiac function and a higher proportion of class IV cardiac function compared with the normal Cys C level group, with statistically significant differences. Left ventricular end-diastolic internal diameter (LVEDD), left ventricular end-systolic internal diameter (LVESD), and left ventricular mass index (LVMI) were significantly higher in both the high Hcy level and high Cys C level groups compared with the normal group, with statistically significant differences. The rates of all-cause mortality and class I endpoint events were significantly higher in the high Hcy level and high Cys C level groups than in the normal group. Multifactorial logistic regression analysis demonstrated that adverse cardiovascular events were significantly associated with cardiac function class, LVEDD, LVESD, LVMI, Hcy, and Cys C in patients with HFpEF. The area under the curve (AUC) values for Hcy and Cys C, determined using receiver operating characteristic (ROC) curve analysis, were 0.778 (optimal critical value, 25.38) and 0.681 (optimal critical value, 1.56), respectively, for predicting adverse cardiovascular events. Both Hcy and Cys C serum levels were positively correlated with LVEDD, LVESD, LVMI, and NYHA classification. CONCLUSION: Serum levels of Hcy and Cys C were closely associated with cardiac function, ventricular remodeling indices, and prognosis in patients with HFpEF. These levels may serve as valuable indices for assessing HFpEF patients' health status and prognosis, providing important insights into their potential role as biomarkers for HFpEF management and prognosis.

From basic to clinical: Anatomy of Denonvilliers' fascia and its application in laparoscopic radical resection of rectal cancer.

The total mesorectal excision (TME) approach has been established as the gold standard for the surgical treatment of middle and lower rectal cancer. This approach is widely accepted to minimize the risk of local recurrence and increase the long-term survival rate of patients undergoing surgery. However, standardized TME causes urogenital dysfunction in more than half of patients, thus lowering the quality of life of patients. Of note, pelvic autonomic nerve damage during TME is the most pivotal cause of postoperative urogenital dysfunction. The anatomy of the Denonvilliers' fascia (DVF) and its application in surgery have been investigated both nationally and internationally. Nevertheless, controversy exists regarding the basic to clinical anatomy of DVF and its application in surgery. Currently, it is a hotspot of concern and research to improve the postoperative quality of life of patients with rectal cancer through the protection of their urinary and reproductive functions after radical resection. Herein, this study systematically describes the anatomy of DVF and its application in surgery, thus providing a reference for the selection of surgical treatment modalities and the enhancement of postoperative quality of life in patients with middle and low rectal cancer.

NOVA1 promotes SMN2 exon 7 splicing by binding the UCAC motif and increases SMN protein expression.

Spinal muscular atrophy (SMA) is a rare hereditary neuromuscular disease with a high lethality rate in infants. Variants in the homologous genes survival of motor neuron (SMN)1 and SMN2 have been reported to be SMA pathogenic factors. Previous studies showed that a high inclusion rate of SMN2 exon 7 increased SMN expression, which in turn reduced the severity of SMA. The inclusion rate of SMN2 exon 7 was higher in neural tissues than in non-neural tissues. Neuro-oncological ventral antigen (NOVA) is a splicing factor that is specifically and highly expressed in neurons. It plays a key role in nervous system development and in the induction of nervous system diseases. However, it remains unclear whether this splicing factor affects SMA. In this study, we analyzed the inclusion of SMN2 exon 7 in different tissues in a mouse model of SMA (genotype smn-/-SMN22tg/0) and littermate controls (genotype smn+/-SMN22tg/0). We found that inclusion level of SMN2 exon 7 was high in the brain and spinal cord tissue, and that NOVA1 was also highly expressed in nervous system tissues. In addition, SMN2 exon 7 and NOVA1 were expressed synchronously in the central nervous system. We further investigated the effects of NOVA1 on disease and found that the number of neurons in the anterior horn of spinal cord decreased in the mouse model of SMA during postnatal days 1-7, and that NOVA1 expression levels in motor neurons decreased simultaneously as spinal muscular atrophy developed. We also found that in vitro expression of NOVA1 increased the inclusion of SMN2 exon 7 and expression of the SMN2 protein in the U87MG cell line, whereas the opposite was observed when NOVA1 was knocked down. Finally, point mutation and RNA pull-down showed that the UCAC motif in SMN2 exon 7 plays a critical role in NOVA1 binding and promoting the inclusion of exon 7. Moreover, CA was more essential for the inclusion of exon 7 than the order of Y residues in the motif. Collectively, these findings indicate that NOVA1 interacts with the UCAC motif in exon 7 of SMN2, thereby enhancing inclusion of exon 7 in SMN2, which in turn increases expression of the SMN protein.

Pulsed xenon ultraviolet and non-thermal atmospheric plasma treatments are effective for the disinfection of air in hospital blood sampling rooms.

BACKGROUND AND OBJECTIVES: Non-thermal atmospheric plasma treatment and pulsed xenon ultraviolet (PX-UV) treatment are widely used in disinfection of hospital environments. However, their effectiveness has not been evaluated against a comparator. The objective of this study is to evaluate their effectiveness in the disinfection of pathogens in the air in hospital blood sampling rooms. METHODS: Samples were taken from the air before and after disinfection with PX-UV and non-thermal atmospheric plasma. We counted bacterial colonies and identified the types of bacteria. RESULTS: Non-thermal plasma treatment significantly reduced bacterial counts in the air, the median reduced from 1 before treatment to zero afterwards (p = 0.03). PX-UV treatment also significantly reduced bacterial counts in the air (p = 0.01), the median reduced from 1.5 before treatment to zero afterwards. Pathogens identified in the current study include nosocomial bacteria, such as Staphylococcus aureus, Staphylococcus epidermidis, and yeast. CONCLUSION: Disinfection of blood sampling sites is essential in a health service department. The efficiency of PX-UV and non-thermal atmospheric plasma treatment are comparable in air disinfection.

[Effects of luteinizing hormone supplementation on outcomes of in vitro fertilization and embryo transfer in patients undergoing GnRH-agonist long protocol].

OBJECTIVE: To compare the clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET) among patients in different conditions receiving luteinizing hormone supplementation in GnRH-agonist long protocol. METHODS: Between June, 2010 and December, 2015, 671 IVF-ET cycles with GnRH-agonist long protocol were performed at our center. These cycles were divided into group A with FSH only and group B with FSH and recombinant luteinizing hormone (r-LH) supplementation, and each group was divided into 4 subgroups according to age (<35 or ≥35) and the LH level on the initial day (<1.0 U/L or ≥1.0 U/L). The effects of LH supplementation on the clinical pregnancy rate and implantation rate were compared among different subgroups. RESULTS: No statistical significances were found between groups A and B in age, body mass index (BMI), basal FSH, basal LH, basal E2, Gn dosage, Gn day, LH on HCG day, E2 on HCG day, P on HCG day, number of oocytes, fertilization rate, available embryo rate or good quality embryo rate per oocyte, but the endometrium thickness on HCG day differed significantly between the two groups. In women below 35 years of age with a LH level on HCG day over 1.0 U/L, r-LH supplementation resulted in a clinical pregnancy rate of 60%, significantly lower than the rate of 79.55% in women without r-LH supplementation (P<0.05). In women over 35 years with a LH level below 1.0 U/L, r-LH supplementation resulted in an implantation rate of 44.74%, as compared with 24.74% in women without r-LH supplementation (P<0.05). CONCLUSION: In the long protocol, LH supplementation does not improve the oocyte number, fertilization rate, or good quality embryo per oocyte, and does not bring benefits to women below 35 years with a low LH level (<1.0 U/L) or those over 35 years with normal LH level (≥1.0 U/L) after GnRH-agonist administration. But for women over 35 years with low LH levels, r-LH supplementation may improve the clinical pregnancy rate and implantation rate of IVF-ET cycles.

Ideal cardiovascular health and the subclinical impairments of cardiovascular diseases: a cross-sectional study in central south China.

BACKGROUND: Ideal cardiovascular health (CVH) is related to a low cardiovascular disease risk profile. This study aimed to investigate CVH metrics with both the biomarkers and markers of subclinical impairments of cardiovascular diseases (CVDs) in subjects from central south China. METHODS: The ideal CVH score (non-smoking status; ideal body mass index; regular physical activity; healthy diet; and an optimal serum cholesterol, blood pressure, and glucose profile; 1 point for each; total score: 0-7) was collected from 3009 participants without a history of CVDs. Subclinical biomarkers were assessed using C-reactive protein, homocysteine, and microalbuminuria. The presence of subclinical disease markers was defined as having at least one of the following: increased carotid intima-media thickness, carotid plaque, left ventricular hypertrophy, left ventricular systolic dysfunction, or a reduced ankle-brachial index. The association of biomarkers and markers with the CVH score was evaluated using multivariate logistic regression and linear regression analyses. RESULTS: Only 0.2% of the study participants met all 7 ideal CVH metrics (CVH score = 7). Compared to the female participants, the male participants had poorer CVH profiles and a higher incidence of subclinical lesions (P < 0.05). In the fully adjusted models, per 1-unit increase in the CVH score was inversely associated with the biomarker levels (ß = -0.092 - -0.224, P < 0.05 for all) and the odds of the presence of markers (odds ratio, 0.808; 95% confidence interval, 0.755-0.865). Similar relationships were observed in the gender subgroups and were stronger in the females. CONCLUSION: A clear inverse association was observed between the biomarkers or markers of subclinical impairments and the CVH score in a central south Chinese population, implying the importance of ideal CVH for the primordial prevention of CVDs.

The efficacy of automated breast volume scanning over conventional ultrasonography among patients with breast lesions.

OBJECTIVE: To compare the efficacy of automated breast volume scanning (ABVS) with that of conventional ultrasonography in the detection of breast cancer lesions. METHODS: In a retrospective study, patients aged 18-78 years who had breast cancer, had undergone screening using ABVS and conventional ultrasonography, and provided a biopsy sample at a center in Changsha, China, between July 22, 2011, and September 20, 2014, were identified. Results of ultrasonography and ABVS were compared. RESULTS: A total of 417 lesions were detected among 300 patients. Ultrasonography detected 326 lesions, whereas ABVS detected all 417 (P<0.001). ABVS detected all 32 malignant lesions and ultrasonography detected 31 (P=0.158). Conventional ultrasonography identified microcalcifications in only two cases, whereas ABVS reported these in eight cases (P<0.001). CONCLUSION: ABVS detects significantly more breast lesions than conventional ultrasonography does.

Expression of ki67 in papillary thyroid microcarcinoma and its clinical significance.

PURPOSE: To investigate the expression of Ki67 protein in papillary thyroid microcarcinoma(PTMC), and to analyze its clinical significance. MATERIALS AND METHODS: Ki67 protein expression was evaluated in the tissues of 108 human PTMC and 50 other benign papillary hyperplasia of thyroid specimens using immunohistochemistry. RESULTS: The expression intensity of Ki67 in PTMC and benign papillary hyperplasia of thyroid specimens were 1.45±1.83% and 0.46±0.46%.The positive expression rates were 46.3% and 14%. There were significant differences between these two groups (p<0.01). There was no significant variation of the expression intensity and positive expression rates of Ki67 in PTMC with gender, age, position of the tumor and the level of TSH pre-operation (p>0.05), but these parameters varied with tumor size, invasion by membrane and cervical lymph node metastasis (p<0.05 or p<0.01). CONCLUSIONS: The expression of Ki67 in PTMC was related to tumor size, invasion by membrane and cervical lymph node metastasis, and could be the important indicator for judging clinical progress and estimating prognosis.

Correlations between brachial endothelial function and cardiovascular risk factors: a survey of 2,511 Chinese subjects.

OBJECTIVE: We examined the relationship of several cardiovascular risk factors (CVRF) to brachial artery flow-mediated dilatation (FMD) in Chinese subjects. METHODS: This was a cross-sectional study. In 2,511 Chinese adults (age 46.86±9.52 years, 1,891 men and 620 women) recruited from people who underwent health screening at The Third Xiangya Hospital, patients' CVRF [age, body mass index (BMI), waist circumference (WC), blood pressure (BP), cholesterol parameters, creatinine (Cr), uric acid (UA), glucose level and smoking] and prevalence of present disease (hypertension, diabetes mellitus, coronary heart disease and hyperlipidemia) were investigated. RESULTS: Multivariate analysis revealed that FMD negative correlated with age (ß=-0.29, P<0.001), gender (ß=-0.12, P<0.001), BMI (ß=-0.12, P=0.001), WC (ß=-0.10, P=0.011), systolic BP (SBP) (ß=-0.12, P<0.001), fasting glucose (ß=-0.04, P=0.009), total cholesterol (TC) (ß=-0.04, P=0.014), smoking (ß=-0.05, P=0.003), and baseline brachial artery diameter (ß=-0.35, P<0.001). FMD decreased with increasing age in both genders. In women, FMD was higher than men and age-related decline in FMD was steepest after age 40; FMD was similar in men above 55 years old. CONCLUSIONS: In Chinese subjects, FMD may be a usefully marker of CVRF. Age, gender, BMI, WC, SBP, fasting glucose, TC, smoking, and baseline brachial artery diameter were independent variables related to the impairment of FMD. The influence of CVRF on endothelial function is more in women than men.

Robotic thyroidectomy versus endoscopic thyroidectomy: a meta-analysis.

BACKGROUND: To conduct a meta-analysis to determine the relative merits of robotic thyroidectomy (RT) and endoscopic thyroidectomy (ET). METHODS: A literature search was performed to identify comparative studies reporting peri-operative outcomes for RT and ET. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence interval (95% CI) were calculated using either a fixed-effects or a random-effects model. RESULTS: Six studies matched the selection criteria, which reported on 2048 subjects, of whom 978 underwent RT and 1070 underwent ET. Comparing the outcomes of RT with ET, this meta-analysis indicated that RT was associated with more complications (WMD = 1.51, 95% CI 1.18 to 1.94) and greater amount of drainage fluid (WMD = 17.10, 95% CI 5.69 to 28.51). Meanwhile, operating time (WMD = 1.50, 95% CI -39.59 to 42.58), conversion (WMD = 0.63, 95% CI 0.07 to 6.17), post-operative hospital stay (WMD = -0.05; 95% CI -0.18 to 0.08), and the number of lymph nodes harvested (WMD = 0.62, 95% CI -0.29 to 1.53) were similar for both procedures. CONCLUSION: The results of this meta-analysis indicated that RT is associated with an increased risk of complications and a greater amount of drainage fluid. Therefore, RT does not appear to have any advantage over ET. Further studies are required to confirm these results.

Use of the composite membrane of poly(ether-block-amide) and carbon nanotubes (CNTs) in a pervaporation system incorporated with fermentation for butanol production by Clostridium acetobutylicum.

Fermentation incorporated with pervaporation was regarded as an efficient way to relieve the feedback inhibition of butanol in acetone-butanol-ethanol (ABE) fermentation. The addition of CNTs (carbon nanotubes) to PEBA (poly(ether-block-amide)) could greatly enhance the removal flux of solvents (acetone, butanol and ethanol) in a model solution test. The butanol removing rate results in a 61% increase in the batch with PEBA+CNTs (5%) membrane compared with that of the batch with PEBA alone. Besides the increase of removal flux, the addition of CNTs enforces the mechanical strength of the pervaporation membrane, which leads to more resistance for a longer operational time. The combination of a 5-L fermenter with the pervaporation membrane of PEBA+CNTs (10%) indicates a 20% increase both in productivity and yield compared to using PEBA. In conclusion, the addition of CNTs to a PEBA pervaporation membrane has great potential when applied in the ABE fermentation industry.

Serological thymidine kinase 1 is a biomarker for early detection of tumours--a health screening study on 35,365 people, using a sensitive chemiluminescent dot blot assay.

Serological thymidine kinase 1 (STK1) is a reliable proliferation marker for prognosis, monitoring tumour therapy, and relapse. Here we investigated the use of STK1 in health screening for early detection of pre-malignant and malignant diseases. The investigation was based on 35,365 participants in four independent health screening studies in China between 2005-2011. All participants were clinically examined. The concentration of STK1 was determined by a sensitive chemiluminescent dot blot ECL assay. The ROCvalue of the STK1 assay was 0.96. At a cut-off STK1 value of 2.0 pM, the likelihood (+) value was 236.5, and the sensitivity and the specificity were 0.78 and 0.99, respectively. The relative number of city-dwelling people with elevated STK1 values (≥2.0 pM) was 0.8% (198/26,484), while the corresponding value for the group of oil-field workers was 5.8% (514/8,355). The latter group expressed significantly higher frequency of refractory anaemia, fatty liver, and obesity, compared to the city dwellers, but no cases of breast hyperplasia or prostate hyperplasia. Furthermore, people working in oil drilling/oil transportation showed higher STK1 values and higher frequency of pre-malignancies and benign diseases than people working in the oil-field administration. In the STK1 elevated group of the city-dwelling people, a statistically significantly higher number of people were found to have malignancies, pre-malignancies of all types, moderate/severe type of hyperplasia of breast or prostate, or refractory anaemia, or to be at high risk for hepatitis B, compared to people with normal STK1 values (<2.0 pM). No malignancies were found in the normal STK1 group. In the elevated STK1 group 85.4% showed diseases linked to a higher risk for pre-/early cancerous progression, compared to 52.4% of those with normal STK1 values. Among participants with elevated STK1 values, 8.8% developed new malignancies or progress in their pre-malignancies within 5 to 72 months, compared to 0.2% among people with normal STK1 values. People who showed elevated STK1 values were at about three to five times higher risk to develop malignancies compared to a calculated risk based on a cancer incidence rate of 0.2-0.3%. We conclude that serological TK1 protein concentration is a reliable marker for risk assessment of pre/early cancerous progression.

Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer.

AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies reporting perioperative outcomes for RS and LS for rectal cancer. Pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. RESULTS: Eight studies matched the selection criteria and reported on 661 subjects, of whom 268 underwent RS and 393 underwent LS for rectal cancer. Compared the perioperative outcomes of RS with LS, reports of RS indicated favorable outcomes considering conversion (WMD: 0.25; 95% CI: 0.11-0.58; P = 0.001). Meanwhile, operative time (WMD: 27.92, 95% CI: -13.43 to 69.27; P = 0.19); blood loss (WMD: -32.35, 95% CI: -86.19 to 21.50; P = 0.24); days to passing flatus (WMD: -0.18, 95% CI: -0.96 to 0.60; P = 0.65); length of stay (WMD: -0.04; 95% CI: -2.28 to 2.20; P = 0.97); complications (WMD: 1.05; 95% CI: 0.71-1.55; P = 0.82) and pathological details, including lymph nodes harvested (WMD: 0.41, 95% CI: -0.67 to 1.50; P = 0.46), distal resection margin (WMD: -0.35, 95% CI: -1.27 to 0.58; P = 0.46), and positive circumferential resection margin (WMD: 0.54, 95% CI: 0.12-2.39; P = 0.42) were similar between RS and LS. CONCLUSION: RS for rectal cancer is superior to LS in terms of conversion. RS may be an alternative treatment for rectal cancer. Further studies are required.

Age-related changes of serum bone alkaline phosphatase and cross-linked C-telopeptides of type I collagen and the relationship with bone mineral density in Chinese women.

BACKGROUND: Previous studies have shown that bone turnover rate changes with age. At the same time, there is no definitive research regarding age-related changes of bone turnover level and its association with bone mineral density (BMD) in Chinese mainland women. METHODS: In a cohort of 663 Chinese mainland women aged 20-70 years, serum bone alkaline phosphatase (BAP) and serum cross-linked C-telopeptides of type I collagen (sCTX) were measured to evaluate the state of bone formation and resorption, respectively. BMD was measured in the posteroanterior spine, supine lateral spine, hip and forearm using a dual-energy X-ray absorptiometry. RESULTS: The cubic polynomial regression model best fit age-related changes in serum BAP (R2=0.398, p<0.001) and sCTX concentrations (R2=0.148, p<0.001) with largest R2 from comparison 8 different regression models. Their values reached a minimal level in the 30-39 years age group, and increased dramatically in the 40-59 years groups. There was a decreasing trend of BAP in women >60 years. The levels of BAP and sCTX were inversely correlated to BMD in various skeletal regions over the entire population (r=-0.096 to -0.357, p<0.05). sCTX was a significant predictor of a T-score< or =-2.5 of BMD in postmenopausal women with sCTX levels above mean+2 SD of women aged 30-39 years compared with other postmenopausal women, which indicated by odds ratios 1.9-3.7 (p<0.05) for various skeletal regions, especially for the lateral lumbar spine (2.2, p<0.01), Ward's triangle (3.7, p<0.01), and ultradistal end of radius + ulna (2.8, p<0.001). CONCLUSIONS: Age-dependent serum BAP and sCTX were inversely correlated to BMD, and sCTX was a useful parameter for the prediction of a low T-score of BMD at skeletal sites with abundant cancellous bone in postmenopausal women.