Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders.

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

Endoscopic Vision Augmentation Using Multiscale Bilateral-Weighted Retinex for Robotic Surgery.

Endoscopic vision plays a significant role in minimally invasive surgical procedures. The visibility and maintenance of such direct in situ vision is paramount not only for safety by preventing inadvertent injury but also to improve precision and reduce operating time. Unfortunately, the endoscopic vision is unavoidably degraded due to the illumination variations during surgery. This paper aims to restore or augment such degraded visualization and quantitatively evaluate it during robotic surgery. A multiscale bilateral-weighted retinex method is proposed to remove non-uniform and highly directional illumination and enhance surgical vision, while an objective no-reference image visibility assessment method is defined in terms of sharpness, naturalness, and contrast, to quantitatively and objectively evaluate the endoscopic visualization on surgical video sequences. The methods were validated on surgical data, with the experimental results showing that our method outperforms existent retinex approaches. In particular, the combined visibility was improved from 0.81 to 1.06, while three surgeons generally agreed that the results were restored with much better visibility.

Endoscopic video defogging using luminance blending.

Endoscopic video sequences provide surgeons with direct surgical field or visualisation on anatomical targets in the patient during robotic surgery. Unfortunately, these video images are unavoidably hazy or foggy to prevent surgeons from clear surgical vision due to typical surgical operations such as ablation and cauterisation during surgery. This Letter aims at removing fog or smoke on endoscopic video sequences to enhance and maintain a direct and clear visualisation of the operating field during robotic surgery. The authors propose a new luminance blending framework that integrates contrast enhancement with visibility restoration for foggy endoscopic video processing. The proposed method was validated on clinical endoscopic videos that were collected from robotic surgery. The experimental results demonstrate that their method provides a promising means to effectively remove fog or smoke on endoscopic video images. In particular, the visual quality of defogged endoscopic images was improved from 0.5088 to 0.6475.

Obstructive sleep apnoea and the incidence and mortality of cancer: a meta-analysis.

As there are conflicting reports regarding the association between obstructive sleep apnoea (OSA) and cancer incidence and mortality, a meta-analysis was performed to evaluate whether OSA is independently associated with cancer incidence and mortality. Pubmed, EMBASE and Web of Science were searched up until November 2014. Studies that assessed OSA and the future risk of cancer incidence or mortality were included. Pooled hazard ratios (HR) and corresponding 95% confidence intervals (CI) were calculated. Subgroup analysis was conducted based on the polysomnographic variable, apnoea-hypopnoea index. Six studies, which involved 114 105 participants, were pooled in this meta-analysis. Fixed-effects analysis showed the pooled adjusted HR of cancer incidence as 0.91 (95% CI, 0.74-1.13; P = 0.408) for mild OSA, 1.07 (95% CI, 0.86-1.33; P = 0.552) for moderate OSA and 1.03 (95% CI, 0.85-1.26; P = 0.743) for severe OSA. Random-effects analysis demonstrated neither mild OSA (adjusted HR, 0.79; 95% CI, 0.46-1.34; P = 0.381), moderate OSA (adjusted HR, 1.92; 95% CI, 0.63-5.88; P = 0.251) nor severe OSA (adjusted HR, 2.09; 95% CI, 0.45-9.81; P = 0.349) correlated with cancer mortality. This meta-analysis indicates that OSA is not independently associated with cancer incidence and mortality according to currently available data. Additional experimental and human research is required to determine the exact association between OSA and cancer.

Vascular endothelial growth factor levels in patients with obstructive sleep apnea: a meta-analysis.

Published articles regarding the blood levels of vascular endothelial growth factor (VEGF) in obstructive sleep apnea (OSA) patients are contradictory. The objective of this study was to explore whether VEGF levels is high or not in OSA subjects via quantitatively statistical analysis. The electronic databases of Pubmed, Web of Science, EMBASE were systematic searched. The VEGF levels and clinical characteristics of participants between OSA group and control group were extracted for analysis. Weighted mean difference (WMD) or standard mean difference (SMD) with 95 % confidence interval (CI) was calculated by fixed effects or random effects model. Appropriate statistical software was employed for data synthesis. Totaling 15 articles with 697 participants were included in this study. Pooled meta-analysis showed that blood VEGF concentrations were significantly higher in OSA patients than in control subjects (SMD 1.89, 95 % CI 0.92-2.87, p = 0.000). Subgroup analysis demonstrated that when compared with control group, OSA patients with age ≥50 years (SMD 2.54, 95 % CI 1.28-3.80, p = 0.000), apnea hypopnea index ≥30 events/h (SMD 2.47, 95 % CI 1.20-3.73, p = 0.000) had higher VEGF levels. Compared with control subjects, OSA patients had an elevated VEGF in serum (SMD 3.55, 95 % CI 1.82-5.28, p = 0.000) rather than in plasma. High blood VEGF concentrations were observed in OSA patients, particularly in the older and more serious patients.

Human chorionic gonadotropin increases ß-cleavage of amyloid precursor protein in SH-SY5Y cells.

Elevated levels of amyloid-ß (Aß) peptides, the main component of amyloid plaques in Alzheimer's disease, are the result of excessive ß- and γ-cleavage of the amyloid precursor protein (APP) and/or impaired Aß clearance in the brain. It has been suggested that high concentrations of luteinizing hormone (LH) in women contribute to increased Aß generation after menopause, but the mechanism for this is incompletely understood. We investigated the effect of human chorionic gonadotropin (hCG), an LH receptor agonist, on APP ß-cleavage in the SH-SY5Y neuroblastoma cell line. Treatment of these cells with hCG-induced elevated ß-cleavage in a dose-dependent manner: administration of 30 mIU but not 10 mIU/ml of hCG significantly increased sAPPß levels in the cell medium 1.7-fold as measured by ELISA. These results support the notion that LH contributes to elevated Aß levels at least in part by increasing ß-cleavage of APP by ß-site APP cleaving enzyme.

A continuous, fluorescence-based assay of µ-opioid receptor activation in AtT-20 cells.

Opioids are widely prescribed analgesics, but their use is limited due to development of tolerance and addiction, as well as high variability in individual response. The development of improved opioid analgesics requires high-throughput functional assays to assess large numbers of potential opioid ligands. In this study, we assessed the ability of a proprietary "no-wash" fluorescent membrane potential dye to act as a reporter of µ-opioid receptor (MOR) activation and desensitization via activation of G-protein-coupled inwardly rectifying potassium channels. AtT-20 cells stably expressing mouse MOR were assayed in 96-well plates using the Molecular Devices FLIPR membrane potential dye. Dye emission intensity decreased upon membrane hyperpolarization. Fluorescence decreased in a concentration-dependent manner upon application of a range of opioid ligands to the cells, with high-efficacy agonists producing a decrease of 35% to 40% in total fluorescence. The maximum effect of morphine faded in the continued presence of agonist, reflecting receptor desensitization. The effects of opioids were prevented by prior treatment with pertussis toxin and blocked by naloxone. We have demonstrated this assay to be an effective method for assessing ligand signaling at MOR, which may potentially be scaled up as an additional high-throughput screening technique for characterizing novel opioid ligands.

[Nutritional risk screening and nutrition assessment for gastrointestinal cancer patients].

OBJECTIVE: To investigate the nutritional status, and provide evidence for nutritional treatment option. METHODS: A total of 452 patients with gastrointestinal cancer were selected, including 156 gastric cancer,117 colon cancer, and 180 rectal cancer. The nutritional risk screening 2002(NRS2002) was applied to grade the nutritional risk. A multi-frequency bioelectrical impedance analysis was used to measure the patients' body composition. Albumin (Alb), prealbumin(PA), transferring(Tf), retinol binding protein(RBP), red blood cell(RBC), hemoglobin (Hb), haematocrit(Hct) were measured after fasting. RESULTS: The rate of patients with NRS2002 score more than 3 was 70.5%(110/156) for gastric cancer, 53.8%(63/117) for colon cancer, and 46.7%(86/180) for rectal cancer. The score for impaired nutritional status more than 1 for gastric cancer was higher than that for colorectal cancer(P<0.05), while patients with disease score more than 2 was less for gastric cancer(P<0.05). Body mass index(BMI), obesity degree, fat content, fat percentage, and arm circumference were lower in gastric cancer patients as compared to colorectal cancer patients(P<0.05); but protein percentage, muscle percentage, ratio of muscles of arm, and cell mass percentage were higher in gastric cancer patients(P<0.05). The proportions of patients with low Alb, PA, Tf, BC, Hb, Hct were higher for gastric cancer and colon cancer(P<0.05). CONCLUSION: Patients with gastric cancer are prone to fat loss and therefore have a higher nutritional risk and malnutrition than those with colorectal cancer. Combination of body composition analysis and laboratory examination may achieve comprehensive evaluation of the nutritional status of patients, and provide the evidence of nutritional therapy by being combined with NRS2002 score.

Metabolic disorders of fatty acids and fatty acid amides associated with human gastric cancer morbidity.

BACKGROUND: Gastric cancer (GC) is one of the most common types of cancer in the world. A change in the metabolism of lipids in tumor cells could lead to the pathogenesis of cancer. In this study, we investigated fatty acid and fatty acid amide metabolic perturbations associated with GC morbidity. METHODS: Gas chromatography/mass spectrometry (GC/MS) was utilized to analyze fatty acids (FAs) and fatty acid amides (FAAs) of GC tissues and matched normal mucosae from 30 GC patients. Acquired lipid data was analyzed using non parametric Wilcoxon rank sum test to find the differential biomarkers for GC and diagnostic models for GC were established by using orthogonal partial least squares discriminant analysis (OPLS-DA). RESULTS: A total of 13 FAs and 4 FAAs were detected using GC/MS and 5 differential FAs as well as oleamide were identified with significant difference (P<0.05). The OPLS-DA model generated from lipid profile showed adequate discrimination of GC tissues from normal mucosae while the OPLS-DA model failed to separate GC specimens of different TNM stages. A total of 8 variables were obtained for their most contribution in the discriminating model (Variable importance in the projection (VIP) value>1.0), five of which were detected with significant difference (P<0.05). CONCLUSIONS: FA and FAA metabolic profiles have great potential in detecting GC and helping understand perturbations of lipid metabolism associated with GC morbidity.

[Investigation on bone health conditions in 1637 aged women].

OBJECTIVE: To investigate bone health conditions in 1637 aged women. METHODS: From May 2004 to October 2008, Bone mineral density (BMD) of 1637 women at age of more than 60 years old were measured by Hologic DephiA dual energy X-ray absorptiometry (DXEA) in Huadong hospital affiliated to Fudan University. All data were compared and analyzed among each group which will be divided by every ten years. Those women were divided into groups on 10 years range. BMD of lumbar vertebral and hip bone, fracture incidence and bone turnover marker were compared and analyzed. RESULTS: (1) BMD: at age of ≥90, 80-89, 70-79, 60-69, BMD of the lumbar vertebral 2-4 (L2-4) values were (0.96±0.18), (0.90±0.20), (0.81±0.16), (0.83±0.14) g/cm2, respectively. There were significantly increased BMD of lumbar of women at the age of 80-89 and ≥90 year-old compared with those of 60-69 year-old (P<0.05). At age of ≥90, 80-89, 70-79, 60-69 BMD of femur neck, Total, Torch, Ward's trianger were (0.60±0.11), (0.65±0.11), (0.47±0.09), (0.37±0.09) g/cm2; at age of 80-89 BMD of FN, Total, Torch, Ward's trianger were (0.57±0.10), (0.68±0.13), (0.48±0.11), (0.35±0.10) g/cm2; at age of 70-79 BMD of FN, Total, Torch, Ward's trianger were (0.57±0.10), (0.69±0.12), (0.49±0.10), (0.36±0.11) g/cm2; at age of 60-69 BMD of FN, Total, Torch, Ward's trianger were (0.63±0.10), (0.76±0.12), (0.54±0.10), (0.45±0.15) g/cm2; There were significantly decreased in BMD of hip at the age of 70-79, 80-89, ≥90 year-old compared with those of 60-69 year-old (P<0.05). (2) Fracture incidence:one time fracture incidence at age of 60-69, 70-79, 80-89, ≥90 were 34.8% (242/695), 45.0% (296/658), 51.3% (137/267), 5/17. There were increasing trend of fracture in aged women. (3) Bone turnover marker of bone Gla protein (BGP) N-mid (N-midBGP) in serum and C-terminal telopeptide of type I collagen/Cr (CTX/Cr) in urine values were (17±5) µg/L, (106±56) µg/mmol at age of more than 90 years, (17±7) µg/L, (128±99) µg/mmol at age of 80-89 years, (21±14) µg/L, (182±173) µg/mmol at age of 70-79 years, (25±13) µg/L, (190±168) µg/mmol at age of 60-69 years. There were significant decreased trends of N-midBGP at age of 70-79, 80-89 compared with that of 60-year (P<0.05). There were significant decreased trends of CTX/Cr 80-89 compared with that of 60-year (P<0.05). CONCLUSIONS: There were significant decreased bone metabolism in aged women. The risk of hip fracture is significantly increased in aged women. Diagnosis of osteoporosis based on BMD of hip in aged women is more reliable.

[Influence of mutations in epidermal growth factor receptor gene on growth, metastasis and survival rate of non-small cell lung carcinoma].

OBJECTIVE: To evaluate the influence of mutations in epidermal growth factor receptor (EGFR) gene on the prognosis of non-small cell lung cancer (NSCLC). METHODS: A total of 107 NSCLC patients undergoing tumor resection from December 2005 to August 2009 at our hospital were recruited. Mutations of exons 18 - 21 of EGFR gene in patients were detected by polymerase chain reaction (PCR) amplification and gene sequencing. The influence of mutations in EGFR gene on the growth, metastasis and survival rate of NSCLC was evaluated. RESULTS: EGFR mutations were detected in 30 (28.0%) of 107 patients. The mutation distribution was as follows: exon 18 (n = 1), exon 19 (n = 8), exon 21 (n = 20), and exons 18 and 19 multiple (triple mutations, n = 1). NSCLC with EGFR mutations had a higher growth velocity than that without EGFR mutations [M(Q(1-3)): 0.42 (0.17 - 1.04) mm/d vs 0.21 (0.19 - 1.00) mm/d, P < 0.05]. EGFR mutations had no significant impaction on neither the lymph node metastasis of NSCLC (P > 0.05) nor on the tumor metastasis to other organs (P > 0.05). The mean survival time of patients with and without EGFR mutations were (18.2 ± 8.9) and (25.5 ± 7.8) months respectively. The 1, 2 and 3-year survival rate were 62.2% vs 72.2%, 47.7% vs 57.3% and 46.9% vs 56.3% respectively between patients with and without EGFR mutations. Log-rank test didn't show a significant difference among them (χ(2) = 0.59, P > 0.05). CONCLUSIONS: The EGFR mutations promote the growth of NSCLC. But it may not be a factor of predicting prognosis.

Assessment of the effect of betaine on p16 and c-myc DNA methylation and mRNA expression in a chemical induced rat liver cancer model.

BACKGROUND: The development and progression of liver cancer may involve abnormal changes in DNA methylation, which lead to the activation of certain proto-oncogenes, such as c-myc, as well as the inactivation of certain tumor suppressors, such as p16. Betaine, as an active methyl-donor, maintains normal DNA methylation patterns. However, there are few investigations on the protective effect of betaine in hepatocarcinogenesis. METHODS: Four groups of rats were given diethylinitrosamine (DEN) and fed with AIN-93G diets supplemented with 0, 10, 20 or 40 g betaine/kg (model, 1%, 2%, and 4% betaine, respectively), while the control group, received no DEN, fed with AIN-93G diet. Eight or 15 weeks later, the expression of p16 and c-myc mRNA was examined by Real-time PCR (Q-PCR). The DNA methylation status within the p16 and c-myc promoter was analyzed using methylation-specific PCR. RESULTS: Compared with the model group, numbers and areas of glutathione S-transferase placental form (GST-p)-positive foci were decreased in the livers of the rats treated with betaine (P < 0.05). Although the frequency of p16 promoter methylation in livers of the four DEN-fed groups appeared to increase, there is no difference among these groups after 8 or 15 weeks (P > 0.05). Betaine supplementation attenuated the down-regulation of p16 and inhibited the up-regulation of c-myc induced by DEN in a dose-dependent manner (P < 0.01). Meanwhile, increases in levels of malondialdehyde (MDA) and glutathione S-transferase (GST) in model, 2% and 4% betaine groups were observed (P < 0.05). Finally, enhanced antioxidative capacity (T-AOC) was observed in both the 2% and 4% betaine groups. CONCLUSION: Our data suggest that betaine attenuates DEN-induced damage in rat liver and reverses DEN-induced changes in mRNA levels.

[Anti-atherosclerotic effect of betaine in apolipoprotein E-deficient mice].

OBJECTIVE: To study the effect of betaine on the formation of atherosclerotic plaque in apolipoprotein E (ApoE)-deficient mice and explore its anti-inflammatory mechanism. METHODS: Seven-week-old ApoE-deficient mice (C57BL/6J background) were divided into four groups randomly based on body weight: model group and three betaine groups. Wild-type mice with the same age and genetic background were used as control group. The control group and model group were fed AIN-93G diet. Three betaine groups were fed AIN-93G diet supplemented with 1, 2, 4 g betaine/100 g diet, respectively. Serum tumor necrosis factor-alpha (TNF-alpha), monocyte chemoattractant protein-1, lipid levels and methylation status of TNF-alpha promotor in aorta were determined at 0, 7 and 14 weeks. The percentage of aorta sinus plaque to lumen area was measured at 14-week. RESULTS: The percentage of aorta sinus plaque to lumen area of 1% and 2% betaine groups were (11.43+/-2.65)% and (12.09+/-3.07)%, respectively, which were 41% and 33% smaller than that of the model group (t=3.117, 3.010, respectively, and P<0.01). Serum TNF-alpha level of three betaine groups were (56.33+/-3.86), (63.04+/-4.67) and (65.52+/-3.97) pg/ml, respectively, which were lower than that of the model group (79.40+/-4.68) pg/ml (t=9.270, 6.571 and 5.576, respectively, P<0.001), but there was no significant difference in the methylation status of TNF-alpha promotor among all five groups. CONCLUSION: Betaine could inhibit the development of atherosclerosis via anti-inflammation.

The Schizosaccharomyces pombe mgU6-47 gene is required for 2'-O-methylation of U6 snRNA at A41.

Through a computer search of DNA databases, we have identified the homologs of the mgU6-47 snoRNA gene from the yeast Schizosaccharomyces pombe, the fly Drosophila melanogaster and human. The three box C/D-containing snoRNA genes showed no significant similarity in their sequences except for an 11 nt long complementarity to U6 snRNA, suggesting that the mechanism of snoRNA guided snRNA methylation is conserved from mammals to yeast. The corresponding snoRNAs have been positively detected by reverse transcription and northern blotting. Taking advantage of the fission yeast system, we have disrupted the yeast mgU6-47 gene and demonstrated that it is absolutely required for site-specific 2'-O-methylation of U6 at position A41. No growth differences between mgU6-47 gene-disrupted and wild-type cells were observed, suggesting that the mgU6-47 gene, as for most rRNA methylation guides, is dispensable in yeast. Nevertheless, it was revealed by temperature shift assay that abolition of A41 methylation in yeast U6 snRNA might cause a small decrease in mRNA splicing efficiency. The timing of S.pombe U6 pre-RNA transport in the nucleus for splicing and methylation was also analyzed and is described.