The AP2/ERF transcription factor MdDREB2A regulates nitrogen utilisation and sucrose transport under drought stress.

Drought stress is one of the main environmental factors limiting plant growth and development. Plants adapt to changing soil moisture by modifying root architecture, inducing stomatal closure, and inhibiting shoot growth. The AP2/ERF transcription factor DREB2A plays a key role in maintaining plant growth in response to drought stress, but the molecular mechanism underlying this process remains to be elucidated. Here, it was found that overexpression of MdDREB2A positively regulated nitrogen utilisation by interacting with DRE cis-elements of the MdNIR1 promoter. Meanwhile, MdDREB2A could also directly bind to the promoter of MdSWEET12, which may enhance root development and nitrogen assimilation, ultimately promoting plant growth. Overall, this regulatory mechanism provides an idea for plants in coordinating with drought tolerance and nitrogen assimilation to maintain optimal plant growth and development under drought stress.

Can the parkland grading scale predict the difficulty of laparoscopic cholecystectomy? A new approach to validation.

BACKGROUND: The Parkland Grading Scale (PGS) is an intraoperative grading scale to stratify gallbladder disease severity during laparoscopic cholecystectomy (LC). We evaluated the usefulness of the PGS in predicting the difficulty levels of LC procedures using a novel approach. METHODS: A total of 261 patients diagnosed with cholelithiasis and cholecystitis who underwent LC were assessed. The PGS and the surgical difficulty grading system were used to evaluate surgical procedures by reviewing the operation videos. Clinical baseline characteristics and post-treatment outcomes were also recorded. Differences between the five PGS grades in terms of surgical difficulty scores were analyzed using the Jonckheere-Terpstra test. The relationship between PGS grades and surgical difficulty scores was assessed using Spearman's Rank correlation. Finally, the linear trends between morbidity scores and PGS grades were evaluated using the Mantel-Haenszel test. RESULTS: There was a significant difference in the surgical difficulty scores for the five PGS grades (p < 0.001). In pairwise comparison, each grade (1-5) was significantly different from the others (p < 0.05) in terms of surgical difficulty, except Grade 2 vs. 3 (p = 0.07) and Grade 3 vs. 4 (p = 0.08). There was a significant correlation between PGS grades and surgical difficulty scores (rs = 0.681, p < 0.001). There was also a significant linear association between morbidity and PGS grades (p < 0.001). Spearman's R value was 0.176 (p = 0.004). CONCLUSION: The PGS can accurately assess the surgical difficulty level of LC. The precision and conciseness of the PGS make it suitable for use in future research.

Increased difficulty and complications of delayed laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage in acute cholecystitis: a retrospective study.

BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) is a relatively less invasive alternative treatment to cholecystostomy. However, the influence of the difficulty of delayed laparoscopic cholecystectomy (DLC) after PTGBD on clinical outcomes remains unknown. This study aimed to evaluate the clinical effects of DLC following PTGBD. METHODS: The clinical data of 113 patients diagnosed with moderate (grade II) acute cholecystitis according to the 2018 Tokyo Guidelines in the acute phase and who underwent DLC in our hospital from January 2018 to February 2022 were retrospectively collected and separated into two groups according to whether they received PTGBD treatment in the acute stage. The PTGBD group comprised 27 cases, and the no-PTGBD group included 86 cases. The TG18 difficulty score was used to evaluate every surgical procedure in the cases by reviewing the surgical videos. The clinical baseline characteristics and post-treatment outcomes were also evaluated. RESULTS: Both groups showed significant differences in length of postoperative stay, blood loss, operation time, and difficulty score. The PTGBD group showed a significantly longer postoperative stay and operation time, more blood loss, and a much higher difficulty score than the no-PTGBD group. Conversion rates did not differ. The morbidity rate in the PTGBD group was statistically higher. CONCLUSIONS: PTGBD is an efficient way to relieve the symptoms of acute cholecystitis. However, it may increase the difficulty and complications of DLC.

The impact of COVID-19 pandemic on the treatment of acute appendicitis in China.

OBJECTIVE: This research aims to analyze the impact of the novel coronavirus pandemic on the hospital visits of patients with acute appendicitis. METHODS: The retrospective analysis was designed to look at the treatment of acute appendicitis in the Department of General Surgery in Beijing Jishuitan Hospital before and during the COVID-19 pandemic (2019-2020). Data was analyzed by the numbers of patients, sex, age, onset time, fever or not, laboratory examination, imaging test, and treatment. And we analyzed the differences between the "pre-COVID group" and "during-COVID group". RESULTS: Compared with the year 2019, the number of acute appendicitis patients has diminished substantially during the COVID-19 pandemic (2020), but the number elevated with the control of the pandemic. Even if we did not find the differences of the treatment before and during the pandemic (P = 0.932), the onset time to emergency was significantly longer (P < 0.001), and more patients had showed fever (P < 0.001) during the COVID-19 pandemic. And the total number of white blood cells and C reactive protein level were significantly higher in 2020 than those in 2019 (P = 0.006, 0.003). And the same result was found in patients with appendiceal fecalith (P = 0.047). CONCLUSION: During the pandemic of the new coronavirus pneumonia, the number of patients with acute appendix treatment dropped significantly, mainly because it took longer than before, and the condition was more severe. It can be seen that the new coronary pneumonia has a great impact on the patients' medical treatment behavior, and the active prevention and treatment of the new coronavirus pneumonia is currently an important and urgent issue.

Topological boundary states of two-dimensional restricted isosceles triangular photonic crystals.

We propose an all-media photonic crystal (PC) composed of isosceles triangle dielectric cylinders that realizes the topological phase transition by simply rotating the isosceles triangular dielectric cylinders. Additionally, the topological phase transition is closely linked with the size parameters and rotation angle of the isosceles triangle. The topological boundary states with lossless transmission are constructed on the interface of two different topological structures, and the optical quantum spin Hall effect is simulated. Further, we verified that the boundary state is unidirectional and immune to disorder, cavity, and sharp bend defects. By rotating the angle of the triangle to control the transmission path of the pseudo-spin state, we realize diverse transport pathways of light, such as the "straight line" shape, "Z" shape, "U" shape, and "Y" shape. This topological system shows a higher degree of freedom, which can promote the research on topological boundary states and the development of topological insulators in practical applications.

Clinical features and endovascular treatment of intracranial arteriovenous malformations in pediatric patients.

PURPOSE: The purpose of this study was to characterize clinical features and evaluate the clinical outcome of endovascular embolization treatment intracranial arteriovenous malformations in pediatric patients. METHODS: A cohort of children (age ≤ 18 years) with arteriovenous malformations (AVMs) from 2000 to 2012 was included. Predictors studied included patient gender, age, and angioarchitectural features, including AVM location, nidus morphology and size, venous drainage, and associated aneurysms. Treatment method, complications and outcomes were recorded. The features of AVMs were evaluated before the treatment. RESULTS: One hundred twenty-seven children (77 males, mean age 13.2 years) were included; 90/127 (70.9 %) children were presented with hemorrhage. AVM size and deep venous drainage were independently associated with hemorrhage; 66/127 patients (52 %) treated with endovascular embolization. Complete obliteration at the end of all endovascular procedures was achieved in 14/66 patients (21.2 %), with an average of 78 % (range, 20-100 %) volume reduction. A mean of 2.9 (range, 1-9) feeding pedicles was embolized per patient. Overall, nine complications occurred in a total of 123 procedures (7.3 %). There was no procedure-related death in this study population. There was no significant difference between patients with and without complications in terms of AVM grade, demographic characteristics, or embolization features. CONCLUSIONS: AVM size and deep venous drainage were independently associated with hemorrhage in pediatric patients. Endovascular procedure is feasible and safe for pediatric AVMs, and complete embolization can be achieved in small AVMs, while large AVMs can be adequately reduced in size for additional microsurgery or stereotactic radiosurgery.

Brassinosteroids biosynthetic gene MdBR6OX2 regulates salt stress tolerance in both apple and Arabidopsis.

Salt stress is a critical limiting factor for fruit yield and quality of apples. Brassinosteroids (BRs) play an important role in response to abiotic stresses. In the present study, application of 2,4- Epicastasterone on seedlings of Malus 'M9T337' and Malus domestica 'Gala3' alleviated the physiological effects, such as growth inhibition and leaf yellowing, induced by salt stress. Further analysis revealed that treatment with NaCl induced expression of genes involved in BR biosynthesis in 'M9T337' and 'Gala3'. Among which, the expression of BR biosynthetic gene MdBR6OX2 showed a three-fold upregulation upon salt treatment, suggesting its potential role in response to salt stress in apple. MdBR6OX2, belonging to the CYP450 family, contains a signal peptide region and a P450 domain. Expression patterns analysis showed that the expression of MdBR6OX2 can be significantly induced by different abiotic stresses. Overexpressing MdBR6OX2 enhanced the tolerance of apple callis to salt stress, and the contents of endogenous BR-related compounds, such as Typhastero (TY), Castasterone (CS) and Brassinolide (BL) were significantly increased in transgenic calli compared with that of wild-type. Extopic expression of MdBR6OX2 enhanced tolerance to salt stress in Arabidopsis. Genes associated with salt stress were significantly up-regulated, and the contents of BR-related compounds were significantly elevated under salt stress. Our data revealed that BR-biosynthetic gene MdBR6OX2 positively regulates salt stress tolerance in both apple calli and Arabidopsis.

[An unsupervised method of extracting constructions from color remote sensed image based on mean shift and neutrosophic set].

The diversity of spectral and textural information of constructions has become an obstacle in automatically detecting buildings. To overcome that, a method to detect constructions based on remote sensed images is proposed. It synthesizes neutrosophic set and mean shift algorithms to segment images transformed to neutrosophic set domain. After segmentation, an image is generated whose pixels mainly describe spectral categories based on main land features. Constructions can be extracted by generated spectral information. The algorithm overcomes the shortcomings of low stability, spectral discontinuity and complicated spectral information by enhancing and segmenting image in neutrosophic set domain. It avoids operations of extracting connected area before recognizing land features as well. Experiments show that the proposed algorithm can not only extract entire constructions steadily, precisely, completely and simply but also satisfies the demand of extracting constructions from high resolution remote sensing images.

Genome-wide analysis of the 6B-INTERACTING PROTEIN1 gene family with functional characterization of MdSIP1-2 in Malus domestica.

Trihelix transcription factors consist of five subfamilies, including GT-1, GT-2, SH4, GTγ, and SIP1, which play important roles in the responses to biotic and abiotic stresses, however, seldom is known about the role of the SIP1 genes in apples. In this study, 12 MdSIP1 genes were first identified in apples by genome-wide analysis, and contained conserved MYB/SANT-like domains. Expression patterns analyses showed that the MdSIP1 genes had different tissue expression patterns, and different transcription levels in response to abiotic stresses, indicating that MdSIP1s may play multiple roles under various abiotic stresses. Among them, the MdSIP1-2 gene was cloned and ectopic transformed into Arabidopsis, and its biology function was identified. The subcellular localization showed that MdSIP1-2 protein was specifically localized in the nucleus, and that overexpression of MdSIP1-2 promoted the development of lateral roots, increased abscisic acid (ABA) sensitivity, and improved salt and drought tolerance. These findings suggested that MdSIP1-2 plays an important role in root development, ABA synthesis, and salt and drought stress tolerance. In conclusion, these results lay a solid foundation for determining the role of MdSIP1 in the growth and development and abiotic stress tolerance of apples.

[Influences of compound whole grain on oxidative stress to hyperlipidemia population].

OBJECTIVE: To explore the influence of compound whole grain complex antioxidant chain on oxidative stress to the hyperlipidemia population. METHODS: From March 2008 to March 2009, 418 hyperlipemia residents (45 to 75 years of age) of Han group were screened from 3 main districts in Nanjing, according to the community, blood lipids and oxidative indicators, stratified into intervention and control group by quasi-experimental design. The intervention group (212 individuals) were provided with compound whole grain and health education while only health education was provided for the control group (206 individuals). Body mass index (BMI), waist-to-hip ratio (WHR), total cholesterol (TC), triglyceride (TG) and high density lipoprotein cholesterol (HDL-C) and oxidative indicators (including T-AOC, MDA, SOD, GSH-Px) were measured before and after the one-year intervention period. Analyses of the correlation between posture, biochemical markers and oxidative stress indicators before and after intervention were carried out. RESULTS: After intervention, BMI ((25.53 ± 2.77) kg/m(2)), WHR (0.82 ± 0.03), TC ((4.60 ± 0.98) mmol/L), TG ((1.26 ± 0.88) mmol/L) in the intervention group were decreased significantly compared to the levels of BMI ((26.60 ± 3.18) kg/m(2)), WHR (0.93 ± 0.05), TC ((4.97 ± 1.02) mmol/L), TG ((1.98 ± 1.11) mmol/L) in the control group (all P values < 0.05); while HDL-C ((1.34 ± 0.26) mmol/L) in the intervention group was increased significantly compared to the level of HDL-C ((1.18 ± 0.17) mmol/L) in the control group (P < 0.05); After intervention, levels of T-AOC (19.52 ± 0.81), SOD ((85.42 ± 21.65) U/ml) and GSH-Px ((128.26 ± 33.65) µmol/L) were increased significantly compared to the levels of T-AOC (11.11 ± 1.30), SOD ((78.68 ± 30.48) U/ml) and GSH-Px ((118.48 ± 24.19) µmol/L) in the control group (all P values < 0.05); while MDA ((1.78 ± 1.16) nmol/ml) decreased significantly compared to the level of MDA ((2.12 ± 1.37) nmol/ml in the control group (P < 0.05); Pearson product moment correlation analysis showed that: T-AOC with TC, TG, BMI showed a negative correlation (r values were -0.258, -0.266, -0.230, respectively, all P values < 0.05), while with HDL-C was a positive correlation (r values was 0.194, P < 0.05); SOD with TC, TG, BMI showed a negative correlation (r values were -0.282, -0.311, -0.217, respectively, all P values < 0.05), while with HDL-C was a positive correlation (r values was 0.169, P < 0.05). CONCLUSION: Compound whole grain could improve lipid metabolism to the hyperlipidemia population. There was a correlation between common human metabolism and the levels of oxidative stress.

Complete colonic duplication presenting as hip fistula in an adult with pelvic malformation: A case report.

BACKGROUND: Alimentary tract duplication (ATD) is a rare congenital anomaly. Thus, a case of ATD with a complete colonic duplication isolated in the abdominal cavity with a fistula and multiple malformations is very distinctive. These characteristics show the variability of this disease and explain why it tends to be challenging to diagnose and treat. CASE SUMMARY: A 25-year-old woman with a history of a fistula opening in her right hip since birth presented with the irregular discharge of foul fluid from the fistula and intermittent abdominal pain. Contrast-enhanced computed tomography and magnetic resonance imaging findings revealed a duplicated tube isolated in her abdominal pelvic cavity along with a pelvic malformation and double ureter. Right foot radiographic examination showed pes cavus. During surgery, the tube appeared to be an almost complete colonic structure and was verified to be connected to the fistula. All of the involved tissue and fistula were removed, and the defect in the pelvic floor was closed by suturing after surgery. After 8 mo, the postoperative follow-up has been uneventful. CONCLUSION: ATD may be a differential diagnosis in sinus tract cases. Laparoscopy combined with open surgery is a viable treatment option.

The clinical significance of body mass index in the early evaluation of acute biliary pancreatitis.

Objective: Obesity has increased across the globe in recent years and is considered an established risk factor for many diseases. The main objective was to investigate the early assessment value of Body Mass Index (BMI) in the prediction of severity in acute biliary pancreatitis (ABP) and by using BMI to evaluate the severity of ABP. Methods: The retrospective analysis was designed to assess the relationship between Body Mass Index and the severity of acute pancreatitis in Beijing Jishuitan Hospital from January 2019 to December 2021. The SPSS 24.0 software was used for statistical analysis, Logistic Regression, and ROC curve for the factors affecting the severity of acute biliary pancreatitis. Results: A total of 259 ABP patients were analyzed in our study. The BMI was significantly correlated with the Ranson scoring and MCTSI scoring (p = 0.000, 0.000). The difference in BMI in different severity of ABP patients was statistically significant (p = 0.000). The Logistic Regression analyses confirmed that BMI was an independent risk factor for the severity of ABP (p = 0.035). Combined detection of BMI, WBC, serum calcium, and SAMY in prognosis of the severity of acute pancreatitis positive rate is higher than single positive rate. Conclusion: The BMI gradually increased with the severity of acute pancreatitis and was an independent risk factor for the condition. Combined detection of BMI and medical tests can effectively improve acute pancreatitis patients' clinical diagnostic accuracy and early treatment, and help to reduce complications.

Excessive proliferation and apoptosis of parathyroid cells contribute to primary hyperparathyroidism in rabbit model.

To explore the molecular pathogenesis of primary hyperparathyroidism (PHPT), we investigated the proliferation and apoptosis of parathyroid cells in a rabbit model of diet-induced PHPT. A total of 120 adult Chinese rabbits were randomly divided into normal diet (Ca:P, 1:0.7) group (control group) or a high-phosphate diet (Ca:P, 1:7) group (experimental group). The thyroid and parathyroid complexes were harvested for 1-month interval from month 1 to month 6. The expression of proliferation markers, including proliferating cell nuclear antigen (PCNA) and cyclin-D1, and B cell lymphoma-2 (Bcl-2), were evaluated by immunohistochemistry in thyroid and parathyroid tissues. Apoptosis was quantified by DNA-fragment terminal labeling. Our results demonstrated that parathyroid cells in the experimental group started proliferating from the end of the 2nd month, the expression of PCNA, Bcl-2, and cyclin-D1 were significantly higher in the PHPT group than those of the control group (p<0.05). Furthermore, the apoptosis index (AI) was positively correlated with the glandular cell count and expression of PCNA in the 6th month in the PHPT group. Overall, our results suggested that excessive proliferation and apoptosis of parathyroid cells may contribute to the pathogenesis of PHPT through PCNA-related, Bcl-2-related, and cyclin-D1-related pathways.

[Initial research on Fourier transform infrared spectroscopy for the diagnosis of colon neoplasms].

To explore the feasibility of Fourier transform infrared spectrometry (FTIR) for the diagnosis of colon neoplasms, fresh samples of eighteen cancers and ten adenomas were collected during colon surgery and were measured by FTIR via probe of attenuated total reflection (ATR). The peak position and the intensity of all bands were measured and compared between the malignant and benign groups. Results show that the FTIR of malignant neoplasm was different from that of benign one. (1) For the bands related to lipid: The ratio of I2 925 /I1 460 (p = 0.018) and I1 740/I1 460 (p = 0.009) decreased in cancer FTIR spectrum, indicating the lower relative quantity of lipid in malignant neoplasm. (2) For the bands related to protein: The ratios of I3 375/ I1 460 (p = 0.012) and I1 550/I1 460 (p = 0.041) increased in cancer, which shows that the relative quantity of protein was more in cancer than that in adenoma. (3) For the band related to nucleic acid: In malignant tissue the peak position in 1 080 cm(-1) shifted toward a higher wave number (p = 0.039), compared with that in benign one. And the ratio of I1 083/I1 460 increased significantly (p = 0.036), illustrating the higher relative quantity of nucleic acid to lipids in malignancy. (4) The peak position of 1 305 cm(-1) shifted to a lower wavenumber (p = 0.041), which should be determined in further research It is concluded that our initial research showed that the FTIR maybe develops into a promising method for rapid differential diagnosis of colon malignant and benign neoplasms.

Evaluation of therapeutic effect and health economics of general anesthesia and routine outpatient dental treatment in children with severe early child caries.

OBJECTIVES: To evaluate the efficacy and health economics of the comprehensive therapy for the children with severe early child caries (S-ECC) under dental general anesthesia (DGA) and conventional outpatient treatment to provide references for dentists and parents in the choice of clinical treatment. METHODS: A retrospective cohort study was conducted on S-ECC children aged 36-71 months and who received dental treatment under general anesthesia or routine outpatient situation. The filled tooth survival rate, treatment cost, and cost-filled tooth survival time of the two groups were compared, and the curative effect and health economics was evaluated. RESULTS: The filled tooth survival rate of the DGA group was higher than that of the routine outpatient group (P<0.05). The average direct medical cost per filled tooth was significantly higher in the DGA group than in the routine outpatient group (P<0.05). The direct medical cost-filled tooth survival time ratio in the DGA group was higher than that in the routine outpatient group (P<0.05), but no significant difference was observed in the total medical cost-filled tooth survival time ratio (P>0.05). CONCLUSIONS: Compared with the conventional outpatient treatment group, the treatment outcomes of S-ECC under general anesthesia were better, and the costs were higher. However, no significant difference was observed in the total medical cost-filled tooth survival time between these two groups, and the conventional outpatient treatment did not have evident economic advantages.

[Fourier transform infrared spectroscopic study on gallbladder carcinoma].

Fourier transform infrared (FTIR) spectroscopy with an attenuated total reflection(ATR) probe was used to study the benign and malignant tissues of gallbladder. FTIR spectra of 18 tissues of gallbladder carcinoma and 139 benign tissues were collected and analyzed. The results demonstrated that bands related to lipid, carbohydrate, and nucleic acid from malignant samples were significantly different from those of benign ones: (1) The peak positions of 1 167 and 1 123 cm(-1) shifted toward lower wave number (P < 0.05) but that of 1 309 cm(-1)' to the higher one (P < 0.05); (2) The relative intensity ratios of I2 856/I1 461, I1 167/ I1 461, I1 123/I1 461, I1 082/I1 461, increased significantly (P < 0.05) (3) The half-widths of 1 167 and 1 082 cm(-1) increased significantly (P < 0.05), whereas the half-width of 1 461 cm(-1) decreased significantly (P < 0.05). (4) The probability of 1 750 cm(-1) band of gallbladder carcinoma tissues increased significantly (P < 0.05).

[Surface detection of thyroid cancer by Fourier transform infrared spectroscopy].

OBJECTIVE: To explore a novel non-invasive method in detection of thyroid cancer by Fourier transform infrared (FTIR) spectroscopy. METHODS: Surface FTIR spectra of 15 cases of thyroid cancer and 51 cases of normal subjects were collected. 22 variables of 11 bands including peak positions and relative intensities were measured and all data were statistically analyzed. RESULTS: In the cancer group: (1) the peak position of 1743 cm(-1) was shifted toward higher wave number (P < 0.05), and that of 1250 cm(-1) to the lower (P < 0.05), when compared to those of normal ones. (2) The relative intensity ratios of I(1546)/I(1460), I(1250)/I(1460), I(1120)/I(1460), I(1080)/I(1460) were significantly increased (P < 0.05). (3) The presence rate of band of 1340 cm(-1) was significantly decreased (P < 0.05). CONCLUSION: FTIR surface spectra may become a novel powerful non-invasive approach of detecting thyroid cancer in regular routine check-up.

[Investigation on Fourier transform infrared spectrum of freshly resected cholangiocarcinoma tissue].

To explore the feasibility of quick intraoperative in situ and noninvasive diagnosis of cholangiocarcinoma by Fourier transform infrared (FTIR) spectroscopy, 26 samples of freshly resected cholangiocarcinoma tissues and 43 samples of benign bile duct tissue were collected during surgery. And all fresh samples were measured by FTIR spectroscopy via probe of attenuated total reflection (ATR) without pretreatment immediately after resection. For each spectrum, 12 bands were identified and assigned between 3 800 and 1 000 cm(-1). The peak position was found, and the intensity and area of the bands were measured; The ratios of the intensity and area were calculated. Standard statistic analysis was performed. The results illustrated that the FTIR spectra of malignant tissue were significantly different from those of benign tissue: 1. The bands related to lipid: The peak of 2 925 cm(-1) shifted to lower wave number significantly (P = 0.033); 2. The bands related to nucleic acid and lipids: the ratios of I1 083/ I1 460 (P = 0.005), S1 083 /S1 460 (P = 0.001) and S1 240/S1 460 (P = 0.025) raised significantly, indicating that the relative quantity of nucleic acid to lipids had evidently increased in malignancy. 3. The bands related to protein: The ratios of I1 550/I1 083 (P = 0.000) and S1 550/S1 083 (P = 0.000) reduced significantly, implying that the relative quantity of protein to nucleic acid in malignancy decreased significantly and the secondary structure of protein changed probably. Our primary result illustrated that the FTIR spectroscopy technique maybe a promising method for in situ and quick intraoperative diagnosis of cholangiocarcinoma and has great value for clinical application.

[Investigation on Fourier transform infrared spectrum of metastatic lymph node in thyroid cancer].

The aim of the study is to explore the possibility of detecting metastatic lymph nodes by FTIR spectra during the surgery of thyroid cancer. The FTIR spectra of 20 metastatic lymph nodes and 69 non-metastatic ones were collected via an ATR (attenuated total reflectance) probe. For each spectrum, 28 variables of 13 bands including peak positions and relative intensities were measured. The variables of metastatic lymph node were compared to those of non-metastatic ones using standard statistic methods. The results indicated that the FTIR spectra of metastatic lymph nodes were significantly different from non-metastatic ones in the bands related to protein, lipid, nucleic acid and carbohydrate. (1) Variations of bands related to protein: The relative intensity ratios of I3 280 /I1 460, I1 640 /I1 460 and I1 546/I1 460 increased significantly (P < 0.05); (2) Variations of bands related to lipid: The relative intensity ratios of I1 743 /I1 460 decreased significantly (P < 0.05). On the contrary, I 400 /I1 460 increased significantly (P < 0.05); (3) The peak positions of 1 165 and 1 120 cm(-1) which were all assigned to carbohydrate shifted toward higher wave number (P < 0.05). The relative intensity ratio of I1 165 /I1 460 decreased significantly (P < 0.05); (4) The peak positions of 1 085 cm(-1) related to nucleic acid shifted to the lower wave number (P < 0.05); (5) Other undetermined bands: The relative intensity ratios of I1 303 /I1 460 and I1 303 /I1 240 increased significantly (P < 0.05). FTIR spectroscopy could be a reliable and practicable method for metastatic lymph nodes diagnosis in the operation of thyroid cancer. It could be applied in detecting metastatic lymph nodes which can not be determined by palpation in surgery.

Protective effect of intraoperative re-dose of prophylactic antibiotics on surgical site infection in diabetic patients: a retrospective cohort study.

BACKGROUND: Surgical site infection (SSI) has a high incidence in diabetic surgical patients. Preoperative antibiotic prophylaxis followed by an intraoperative re-dose was a common strategy in diabetic prolonged procedures. However, there were lacking studies on the relative benefits of this strategy on SSI. Our study aimed to clarify the effect of intraoperative re-dose of prophylactic antibiotics on SSI in diabetic patients. METHODS: A total of 1,840 diabetic patients with prolonged surgeries were included and Cefazolin was the only type of antibiotic prophylaxis. We assessed the relationship between intraoperative re-dose of cefazolin and 30-day incidence of SSI using a retrospective cohort study method. RESULTS: There were 361 diabetic cases with preoperative antibiotics only and 1,479 cases with pre- plus intraoperative antibiotics, in which 60 subjects suffered from SSI. Pre- plus intraoperative prophylaxis group had a lower rate of SSI in the overall and subgroup analyses when compared with preoperative only group. Operation location, combined with hypertension, poor blood glucose control, high WBC count and ASA score >2 were significantly associated with an increased risk of SSI for diabetic surgical patients (all P<0.05). Intraoperative re-dose of prophylactic antibiotics was statistically related to a lower incidence rate of SSI than preoperative prophylaxis alone (crude RR =0.47; 95% CI, 0.27-0.82; P<0.01), while the association remained significant even after adjusting the potential confounders (adjusted RR =0.51; 95% CI, 0.29-0.90; P=0.02). CONCLUSIONS: For diabetic patients, intraoperative re-dose of prophylactic antibiotics may be an independent protective factor for the prevention of SSI. A specific perioperative antibiotics injection strategy should be encouraged for diabetic patients with prolonged surgeries to minimize the possibility of SSI.