Assessment of 13 essential and toxic trace elements in tumor and peritumoral brain tissues from human glioblastoma.

Trace elements within the brain are important for proper neurological function, but their imbalance has been rarely investigated in glioblastoma. This study enrolled a total of 14 patients with glioblastoma, and the tumor and peritumoral brain tissues were collected while undergoing surgery. The concentrations of Mg, Ca, Cr, Mn, Fe, Co, Cu, Zn, Se, As, Cd, Tl and Pb were determined using a well-evaluated ICP-MS method. The Cu- and Cd-binding proteomes were further analyzed using the anatomic transcriptional atlas from Ivy GAP. Histological evaluation was based on rubeanic acid staining and immunohistochemistry, respectively. The 13 trace element concentrations were obtained, and the highest were Ca, Mn, Fe, Zn and Cu, ranging from a few to dozens of ug/g. Correlation analysis suggested the existence of two intra-correlated clusters: essential metals (Cu-Ca-Zn-Mg) and heavy metals (Pb-As-Cd-Tl-Co-Cr-Mn). Compared to the tumor samples, significantly higher levels of Cu and Cd were observed in the peritumoral region. Further analysis of the Cu- and Cd-binding proteins from the anatomic view suggested that DBH and NOS1 were obviously increased in the leading edge than the central tumor region. Consistent with the above findings, histological evaluation of Cu and DBH further confirmed more copper and DBH expressions in the peritumoral area compared to the tumor core. Trace elements differ in tumor and peritumoral brain zone in glioblastoma, which may associate with tumor angiogenesis.

Scalp ripple rates for rapid epilepsy differentiation and seizure activity assessment: Applicability and influential factors.

OBJECTIVE: We aim to determine whether automatically detected ripple rate (ADRR) of 10-min scalp electroencephalography (EEG) during slow-wave sleep can be a useful tool for rapid epilepsy differentiation and seizure activity assessment, and we analyze the clinical factors that may affect the scalp ripple rates. METHODS: We retrospectively included 336 patients who underwent long-term video-EEG with a sampling rate ≥1000 Hz, and three groups were established based on their final clinical diagnosis (non-epilepsy; non-active epilepsy [epilepsy being seizure-free for at least 1 year]; and active epilepsy [epilepsy with one or more seizures in the past year]). ADRRs between groups were compared and diagnostic thresholds set according to the maximum of Youden index with the receiver-operating characteristic curve. RESULTS: The 336 patients comprised 49 non-epilepsy and 287 epilepsy patients (95 non-active epilepsy and 192 active epilepsy). The median ADRR of the epilepsy group was significantly greater than in the non-epilepsy group, with a diagnostic threshold of 4.25 /min (specificity 89.8%, sensitivity 47.74%, p<.001). Following stratification by age, the area under the curve was greatest in the 0-20 year subgroup, threshold 4.10 /min (specificity 100%, sensitivity 52.47%, p<.001). Regarding distinguishing active epilepsy from non-active epilepsy patients, the area under the curve was also greatest in patients 0-20 years of age, threshold 13.05/min (specificity 98.36%, sensitivity 35.64%, p<.001). Following stratification by epilepsy type, the diagnostic efficiency was best in children with developmental and epileptic encephalopathies/epileptic encephalopathies (DEEs/EEs) (threshold 5.20/min, specificity 100%, sensitivity 100%) and self-limited focal epilepsies (SeLFEs) (threshold 5.45/min, specificity 80%, sensitivity 100%). Multivariate analysis revealed that the influential factors of ADRRs were age, depth of epileptogenic lesion, and seizure frequency. SIGNIFICANCE: ADRR of scalp EEG can be a rapid and specific method to differentiate epilepsy and evaluate seizure activity. This method is especially suitable for young patients.

Nakagami statistics-based photoacoustic spectroscopy used for label-free assessment of bone tissue.

Quick identification of abnormal molecular metabolism of bone tissues is challenging. Photoacoustic (PA) spectroscopy techniques have great potential in molecular imaging. However, most of them are amplitude-dependent and easily affected by the light deposition, especially for bone tissues with high optical scattering. In this Letter, we propose a Nakagami statistics-based PA spectroscopy (NSPS) method for characterizing molecules in bone tissues. We indicate that the NSPS curve can intelligently identify changes in the content of molecules in bone tissues, with a high disturbance-resisting ability. The NSPS has remarkable potential for use in the early and rapid detection of bone diseases.

Characterization of multi-biomarkers for bone health assessment based on photoacoustic physicochemical analysis method.

Photoacoustic (PA) techniques are potential alternatives to histopathology. The physicochemical spectrogram (PCS) generated by the PA measurement at multiple wavelengths can presents the morphology and chemical composition target at multi-biomarkers simultaneously. In this work, via multi-wavelength PA measurements performed on rabbit bone models, we investigated the feasibility of using PCSs for bone health assessment. A comprehensive analysis of the PCSs, termed PA physicochemical analysis (PAPCA), was conducted. The "slope" and "relative content" were used as the PAPCA-quantified parameters to characterize the changes in the physical and chemical properties of bone tissue, respectively. The findings are consistent well with the gold-standard imaging results. It demonstrated that the PAPCA can be used to characterize both the microstructure and content of multi-biomarkers which highly related with bone health. Considering the PA technique is noninvasive and radiation-free, it has great potential in the implementation and monitoring of bone diseases progression.

Wavelet transform-based photoacoustic time-frequency spectral analysis for bone assessment.

In this study, we investigated the feasibility of using photoacoustic time-frequency spectral analysis (PA-TFSA) for evaluating the bone mineral density (BMD) and bone structure. Simulations and ex vivo experiments on bone samples with different BMDs and mean trabecular thickness (MTT) were conducted. All photoacoustic signals were processed using the wavelet transform-based PA-TFSA. The power-weighted mean frequency (PWMF) was evaluated to obtain the main frequency component at different times. The y-intercept, midband-fit, and slope of the linearly fitted curve of the PWMF over time were also quantified. The results show that the osteoporotic bone samples with lower BMD and thinner MTT have higher frequency components and lower acoustic frequency attenuation over time, thus higher y-intercept, midband-fit, and slope. The midband-fit and slope were found to be sensitive to the BMD; therefore, both parameters could be used to distinguish between osteoporotic and normal bones (p < 0.05).

Assessment of 12 Metals and Metalloids in Blood of General Populations Living in Wuhan of China by ICP-MS.

Assessment of trace element levels in general population from the specific area is of importance for nutritional and occupational monitoring. In the current study, baseline blood levels of 12 toxic and/or essential metals and metalloids, including arsenic (As), cadmium (Cd), lead (Pb), mercury (Hg), chromium (Cr), thallium (Tl), manganese (Mn), copper (Cu), Zinc (Zn), calcium (Ca), iron (Fe), and magnesium (Mg), in general populations (n = 477) of Wuhan in central China were investigated by using inductively coupled plasma mass spectrometry (ICP-MS). The geometric means for As, Cd, Pb, Hg, Cr, Tl, Mn, and Cu were measured as 2.25, 0.70, 17.84, 1.90, 0.36, < 0.05, 12.40, and 783.76 µg/L, respectively. The geometric means for Zn, Ca, Fe, and Mg were 5.85, 56.66, 488.98, and 39.44 mg/L, respectively. We found the men had higher blood As, Pb, Hg, Zn, Fe, and Mg levels but had lower blood Cu and Ca levels than the women (p < 0.05). Age-related difference were found for blood Cu, Zn, Ca, Mg, Pb, Mn, As, Cd, and Hg levels (p < 0.05). Moreover, many metal concentrations were found correlated, with the strongest correlations between the pairs Fe-Mg (r = 0.57), Fe-Zn (r = 0.42), As-Hg (r = 0.46), Ca-Cu (r = 0.34), Pb-Hg (r = 0.36), Pb-Cd (r = 0.31), Pb-As (r = 0.25), and Ca-Fe (r = - 0.23). Compared with reports from other countries, most of our results were consistent, except that As Pb, Hg, Mn, and Cu showed different blood levels with European, Korea, or Beijing areas. Our study would be of importance for nutritional, environmental, and/or occupational monitoring of these metals in human.

No need for use of drainage after minimally invasive unicompartmental knee arthroplasty: a prospective randomized, controlled trial.

OBJECTIVE: Drainage is a common procedure in unicompartmental knee arthroplasty (UKA), but evidence regarding its effectiveness is lacking. The aim of this study was to investigate the benefits of drainage after minimally invasive UKA with effective blood loss management. METHODS: This was a prospective, randomized, controlled trial to determine whether drainage after UKA provides benefits with respect to blood loss, drainage volume, complications, pain score, knee score, range of motion and cost. The 96 patients who underwent surgery between January 2012 and March 2013 were randomly divided into two groups: group A (n = 48) was treated without drainage, and group B (n = 48) with drainage. All UKA procedures were performed with the same minimally invasive surgical technique. Tranexamic acid and bone wax were used for the management of blood loss in all patients. The preoperative baseline parameters of the two groups did not differ significantly. RESULTS: The mean drainage volume in group B was 75.7 ± 51.2 mL when the drainage was present. Total blood loss in group A and group B was 240.3 ± 73.3 mL and 274.1 ± 99.5 mL, respectively. These amounts did not differ significantly but both were significantly lower than the data reported for total knee arthroplasty. There was no difference in mean postoperative hemoglobin and hematocrit between groups. Differences in wound infection, incidence of deep vein thrombosis, postoperative Hospital for Special Surgery knee score, visual analog score, and range of motion were not statistically significant between groups. Hospitalization costs for UKA were lower in the absence of drainage. CONCLUSIONS: The use of drainage in unilateral UKA provides no apparent advantage. With effective blood loss management and a minimally invasive procedure, blood loss and drainage volume in UKA are very low. Drainage does not improve the results. Foregoing non-drainage after UKA reduces both hospital costs and visible blood loss. Therefore, drainage is unnecessary in routine UKA.

Curriculum reform at Chinese medical schools: what have we learned?

INTRODUCTION: Curriculum reform at Chinese medical schools has attracted a lot of attention recently. Several leading medical schools in China have undergone exploratory reforms and in so doing, have accumulated significant experience and have made considerable progress. METHODS: An analysis of the reforms conducted by 38 Chinese medical colleges that were targeted by the government for upgrade was performed. Drawing from both domestic and international literature, we designed a questionnaire to determine what types of curricular reforms have occurred at these institutions and how they were implemented. Major questions touched upon the purpose of the reforms, curricular patterns, improvements in teaching methods post-reform, changes made to evaluation systems post-reform, intra-university reform assessment, and what difficulties the schools faced when instituting the reforms. Besides the questionnaire, relevant administrators from each medical school were also interviewed to obtain more qualitative data. RESULTS: Out of the 38 included universities, twenty-five have undergone major curricular reforms. Among them, 60.0% adopted an organ system-based curriculum model, 32.0% adopted a problem-based curriculum model, and 8.0% adopted a hybrid curriculum model. About 60.0% of the schools' reforms involved both the "pre-clinical" and the "clinical" curricula, 32.0% of the schools' reforms were limited to the "pre-clinical" curricula, and 8.0% of the schools' reforms only involved the "clinical" curricula. Following curricular reform, 60.0% of medical schools experienced an overall reduction in teaching hours, 76.0% reported an increase in their students' clinical skills, and 60.0% reported an increase in their students' research skills. DISCUSSION: Medical curricular reform is still in its infancy in China. The republic's leading medical schools have engaged in various approaches to bring innovative teaching methods to their respective institutions. However, due to limited resources and the shackle of traditional pedagogical beliefs among many faculty and administrators, progress has been significantly hindered. Despite these and other challenges, many medical schools report positive initial results from the reforms that they have enacted. Although the long term effects of such reforms remain unclear, curricular reform appears to be the inevitable solution to China's growing need for high-quality medical doctors.

Development of an economic and efficient strategy to detect HBsAg: application of "gray-zones" in ELISA and combined use of several detection assays.

BACKGROUND: ELISA and CMIA are commonly used for detection of HBsAg. However, few investigations have been performed to evaluate their value in clinical practice, especially when jointly used. A reasonable and economic HBsAg testing algorithm is in great need. METHODS: A total of 161,426 specimens in China were tested for 5 serum HBV markers with commonly used ELISA kits. 498 of these specimens were further tested for HBsAg by another ELISA kit, a CMIA kit and an HBsAg confirmatory assay. RESULTS: The sensitivities of the 2 ELISA kits were 76.21% and 88.42%, respectively. However, when using "gray-zones", the sensitivities were significantly improved to 97.43% and 96.43%. Furthermore, the combined use of the 2 ELISA kits and their "gray-zones" improved the sensitivity to 99.04%. Nevertheless, 2.91% of the samples with S/CO values below the lower "gray-zone" limits were reactive by the CMIA kit and then confirmed as HBsAg positive. However, 71.43% of the samples with HBsAg values within 0.05 and 0.10 IU/ml detected by the CMIA kit could not be confirmed. CONCLUSIONS: As a rational and economic strategy, combined use of "gray-zones" in ELISA and several different detection assays can significantly increase the efficiency of HBsAg detection.