Management of Percutaneous Endoscopic Gastrostomy Site Gastric Ulcer in a Patient with an Esophageal Stricture and Hiatus Hernia

Percutaneous endoscopic gastrostomy (PEG) is commonly performed for feeding difficulties, in patients suffering from complications of nasopharyngeal carcinoma and its treatment, namely radiotherapy and surgery. This case report describes the challenges in hemostasis and subsequent re-establishment of enteral access for feeding, in an elderly patient with a history of NPC, treated surgically, followed by radiotherapy, who presented with massive hematemesis following reinsertion of her PEG shortly after an accidental dislodgement. Her previous nasopharyngectomy, wide field radiation therapy, and radical neck dissection precluded nasogastric tube feeding, and the presence of a large hiatus hernia made reinsertion of a new PEG technically challenging. This case highlights the methods used to overcome the above challenges.

The efficacy and safety of high-intensity focused ultrasound ablation of benign thyroid nodules

High-intensity focused ultrasound (HIFU) is a promising form of thermal ablation of benign thyroid nodules, but evidence supporting its use is scarce. The present review evaluated the efficacy and safety of single-session HIFU treatment of benign thyroid nodules. As reported in the literature, the extent of nodule shrinkage following treatment ranged from 48.8% to 68.8%. Like other forms of ablation, the shrinkage rate was greatest in the first 3-6 months, and the best responders were patients with small (≤10 mL) nodules. Complications were uncommon, but temporary vocal cord palsy occurred in 3%-4% of patients, and was related to the distance between the HIFU beam and the recurrent laryngeal nerve. Despite being safe and efficacious, a larger-scale prospective trial is required.

National experts consensus on clinical diagnosis and treatment of inhalation injury (2018 version) / 中华烧伤杂志

Inhalation injury is caused by inhalation of heat, toxic or irritating gases which lead to respiratory and pulmonary parenchyma damage. At present, the clinical understanding about it is still limited and lack of effective diagnosis and treatment standard. Based on the experience of diagnosis and treatment of domestic inhalation injury, combined with reports of international researches, criteria (expert consensus) for inhalation injury were systematically discussed from pathological and pathophysiological changes, clinical diagnosis and evaluation, and clinical treatment, which provides reference for clinical diagnosis and treatment of patients inflicted with inhalation injury.

National experts consensus on clinical diagnosis and treatment of inhalation injury (2018 version) / 中华烧伤杂志

Inhalation injury is caused by inhalation of heat, toxic or irritating gases which lead to respiratory and pulmonary parenchyma damage. At present, the clinical understanding about it is still limited and lack of effective diagnosis and treatment standard. Based on the experience of diagnosis and treatment of domestic inhalation injury, combined with reports of international researches, criteria (expert consensus) for inhalation injury were systematically discussed from pathological and pathophysiological changes, clinical diagnosis and evaluation, and clinical treatment, which provides reference for clinical diagnosis and treatment of patients inflicted with inhalation injury.

Experimental study on the transforming growth factor β3 combined with dental pulp stem cells in early bone integration of implant / 中华口腔医学杂志

To establish the experimental model of rabbit mandibular anterior implant repair and evaluate the effects of transforming growth factor (TGF)-β3 and dental pulp stem cells (DPSC) in promoting the bone integration of implant. The New Zealand rabbits were randomly divided into experimental group, control group and blank group (6 rabbits for each group) . In the experimental group, the implant area was filled with the mixture of TGF-β3, DPSC and Bio-oss powder. In the control group, the implant area was filled with the mixture of DPSC and Bio-oss powder. In the blank group, the implant area was filled with the mixture of phosphate buffer solution and Bio-oss powder. Eighteen New Zealand rabbits were sacrificed in 2 weeks after procedure. The treated alveolar bone tissue was observed. The bone tissue around the implant were estimated by HE staining, immunocytochemical staining and real-time quantitative PCR. The implants were no shedding nor loose. HE staining shows the blank group had a sparse trabecular bone and a small amount of blood vessel around the implant and no obvious new bone formation. The control group showed that the bone trabecula around the implant was sparse and slender, the osteoblasts were arranged linearly around the trabecular bone, a small amount of new bone formation was found around the implant. In the experimental group, there were more thick and dense trabecular bone around the implant, the surrounding osteoblasts were arranged in clusters. The osteoblasts were active and many new bone formed. Typical bone lacunae, bone cells and a large number of new blood vessels can be observed. Immunohistochemistry showed that the proportion of average positive area in the experimental group, control group, blank group were (24.6±5.3) %, (11.3±2.8) % and (7.6±3.8) % respectively. The expression of bone sialoprotein in experimental group were significantly higher than the other 2 groups(0.000). Real-time quantitative PCR results showed that the expression level of Runt-related transcription factor 2 (RUNX2), type Ⅰcollagen (COL-Ⅰ), alkaline phosphatase in the experimental group was higher than in the blank group. The expression level of RUNX2 and COL-Ⅰ in the experimental group was higher than that of the control group (0.023). TGF-β3 has potential to promote the transformation of DPSC into osteoblasts, which can promote the integration of bone around the implant.

Developmental programming of the metabolic syndrome: Next-generation sequencing analysis of transcriptome expression in a rat model of maternal high fructose intake / 生理学报

Excessive fructose intake is related to a high prevalence of metabolic syndrome, while little attention has been paid to the impact of maternal high-fructose (HF) intake on the development of metabolic syndrome and organ-specific transcriptome alterations in the offspring. We utilized RNA next-generation sequencing (NGS) technology to analyze the transcriptome expression in four organs (kidney, brain, heart, and urinary bladder) from 1-day, 3-week, and 3-month-old male offspring exposed to maternal HF diet. Maternal HF induced various phenotypes of metabolic syndrome in adult male offspring. We observed that maternal HF exposure induces long-term alterations of gene expression in the brain, heart, kidney, and urinary bladder in adult offspring. Different organs do not respond similarly to maternal HF intake. We found that changes in expression of Errfi1 and Ctgf were shared by four organs at 1 day of age. Also, a number of genes regulating fructose metabolism, glycolysis/gluconeogenesis, fatty acid metabolism, and insulin signalling appear to be regulated by maternal HF intake in different organs at 1 day of age. Our NGS results are of significance to the development of maternal interventions in the prevention of maternal HF-induced organ-specific programming, in order to reduce the global burden of metabolic syndrome.

[Development of an indirect ELISA for bovine mastitis using Sip protein of Streptococcus agalactiae]

The sip gene encoding for a conserved highly immunogenic surface protein of Streptococcus agalactiae was amplified using polymerase chain reaction [PCR] and subcloned into prokaryotic expression vector pET32a [+] and expressed as a recombinant protein in E. coli BL21 [DE3]. An indirect enzyme linked immunosorbent assay [ELISA] was developed using the purified Sip protein as a coating antigen, which could identify S. agalactiae specific antibody in sera. The coating antigen at a concentration of 3.125 µg/ml, serum diluted to 1:160, and HRP-conjugated secondary antibody concentration at 1:4000 was found to be most effective in exhibiting positive result. The ELISA was found to be highly specific for S. agalactiae that may be used for the detection of the pathogen in mastitis cases, for epidemiological studies and for surveillance.

Expression, purification and glycosylation analysis of chicken infectious bursal disease virus VP2 in yeast

Infectious bursal disease [IBD], a highly contagious and devastating disease in young chicken, is caused by infectious bursal disease virus [IBDV]. To improve the immunogenicity of recombinant IBDV subunit vaccine, an attempt was made to find a new way to prepare IBD vaccine containing glycosylated mVP[2] antigen. Firstly, IBDV mVP[2] gene [with a nucleic acid sequence encoding B cell epitope of IBDV [KFDQML] in the 5'-end of the VP[2], with a nucleic acid sequence encoding B cell epitope of IBDV [LASP] and [His] 6-tag in the 3'-end of the VP[2]] was cloned. Secondly, IBDV mVP[2] protein was expressed in the methylotrophic yeast Pichia pastoris which can secret glycosylated protein. The recombinant mVP[2] protein could be stained pink with periodic acid-schiff reagents [PAS], which showed that mVP[2] was glycosylated. Finally, IBDV mVP[2] protein was purified with His-Trap [1 mL] affinity chromatography. These results indicate that glycosylated IBDV VP[2] protein modified with epitope peptides can be expressed in Pichia pastoris, which lay the groundwork for the development of a recombinant infectious bursal disease vaccine with high immunogenicity

Ecotoxicity of chloramphenicol and Hg acting on the root elongation of crops in north China

Single and joint toxicity of chloramphenicol and Hg acting on wheat [Triticum aestivum L.] Chinese cabbage [Brassica campestris L.] and corn [Zea mays L.] were investigated. The results showed positive correlations between root elongation inhibition of three plants and concentrations of pollutants added to soil [P<0.01] in test concentration range. In terms of root elongation, wheat was the most sensitive to toxicity of chloramphenicol with an IC[50] [concentration when 50% plants show inhibition] value as high as 26.8 mg/kg and also was the most sensitive one to the toxicity of Hg with the IC[50] value as high as 300.8 mg/ kg. The toxicity of chloramphenicol to the plants is stronger than that of Hg. Chloramphenicol and Hg had an antagonistic effect on the inhibition of root elongation of the three plants when the concentration of added Hg reached 30 mg/kg. Chloramphenicol and Hg had significantly synergistic effects on the inhibition of root elongation when Hg concentration was up to 200 mg/kg [P<0.05]

Early and late outcomes in Hong Kong Chinese patients undergoing carotid endarterectomy / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To determine the benefit of carotid endarterectomy (CEA) for stroke prevention by reviewing the early and late outcomes of Hong Kong Chinese patients undergoing CEA who have a high reported incidence of intracranial atherosclerotic disease (IAD).</p><p><b>METHODS</b>Fifty-nine Chinese patients underwent 62 CEA. There were 48 males and 11 females, with a mean age of 70 +/- 7 years (range: 52 - 86 years). Twenty-one CEA (34%) were performed for asymptomatic disease. Duplex scan was the primary tool of evaluation prior to surgery. Preoperative angiography was done in 36 instances (58%). All CEA were performed under general anaesthesia with routine intraoperative shunting. The arteriotomy was closed primarily in all patients except three. Patients were followed up regularly with six-monthly Duplex scan surveillance.</p><p><b>RESULTS</b>There were 2 perioperative neurological events consisting of one transient ischemic attack and one minor stroke. There was no operative mortality or major morbidity such as bleeding or cranial nerve injury. Mean hospital stay was 6.5 +/- 4 days (range: 3 - 26 days). The patients were followed up for a mean interval of 24 +/- 17 months (range: 1 - 57 months). Seven patients died during follow-up and subsequent neurological events occurred in 5 patients, including 2 fatal strokes. The 3-year survival, freedom from stroke and stroke free survival were 86%, 87% and 83%, respectively. One recurrent stenosis of 80% was detected on follow-up Duplex scan.</p><p><b>CONCLUSIONS</b>Despite a high incidence of IAD, CEA in Hong Kong Chinese patients is associated with acceptable perioperative morbidity and mortality with satisfactory long-term efficacy in stroke prevention.</p>