[Minimally invasive vitrectomy for the treatment of severe proliferative diabetic retinopathy].

Objective: To report the efficacy and safety of minimally invasive vitrectomy for the treatment of severe proliferative diabetic retinopathy (PDR) and the effect of preoperative retinal photocoagulation on prognosis. Methods: Case-series study and cohort study. This study included 48 severe PDR patients (53 eyes). There are 28 males and 20 females. The average age was 53.5 (range, 40.0 to 59.0) years old. Patients were divided into two groups according to whether preoperative retinal photocoagulation was performed. Under the guidance of the concept of minimally invasive vitrectomy, all patients received intravitreal injection of conbercept 3 days before standard pars plana vitrectomy with a 27G+ vitrectomy system. To relieve traction, the proliferative fibrovascular membrane was divided into islands as small as possible. It was not necessary to pursue a complete removal of the proliferative membrane. The 27G+ vitrector was flexibly applied as a multifunctional tool for membrane removal by reducing frequencies at which the device entered and left the eye. Intraocular retinal photocoagulation was performed in the main area. The primary outcome measures were best corrected visual acuity (BCVA) and retinal reattachment rate, and the secondary outcome measures were intraoperative and postoperative complications. Statistical analysis was performed using t test, rank sum test and χ² test. Results: All patients tolerated intravitreal conbercept, with no serious intraoperative or postoperative adverse events. Postoperative BCVA values were improved significantly compared with preoperative values (χ²=125.11, P<0.01). The mean logMAR BCVA improved from 1.90 (1.30, 2.30) preoperatively to 1.00 (0.70, 1.90) at 1 week postoperatively, 0.8 (0.5, 1.3) at 1 month postoperatively, 0.7 (0.40, 1.20) at 3 months postoperatively, and 0.70 (0.40, 1.20) at 6 months postoperatively. The visual function increased progressively with time. Postoperatively, the primary and final reattachment rates were 92.5% (50/53) and 96.2% (51/53), respectively. Abnormal intraocular pressure lasted for more than one week occurred in 2 eyes; Vitreous hemorrhage recurred in 5 eyes; Retinal detachment occurred in 4 eyes (7.5%); No postoperative endophthalmitis, choroidal detachment or incision related retinal hole occurred. The intraoperative and postoperative parameters in the preoperative retinal photocoagulation group were better than the preoperative non-photocoagulation group, but the difference was not significant (P>0.05). Conclusions: Minimally invasive vitrectomy is fully qualified for the management of severe PDR, with maximized benefits. (Chin J Ophthalmol, 2021, 57:440-446).

[The efficacy and safety of high dose versus standard dose radiotherapy in concurrent chemoradiotherapy for patients with esophageal squamous cell carcinoma].

Objective: To compare the efficacy and treatment-related toxicity of high dose versus standard dose radiotherapy in concurrent chemoradiotherapy (CCRT) for patients with esophageal squamous cell carcinoma (ESCC). Methods: From 2005 to 2012, 183 pairs of patients with esophageal squamous cell carcinoma in the Fourth Hospital of Hebei Medical University were enrolled, all had undergone CCRT based on three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT). A propensity score was constructed to match the cohort. The overall survival (OS), local control (LC) probability, as well as the acute and late toxicities between standard-dose and high-dose groups were compared. Results: Patients in the high-dose group had significantly better OS and LC probability compared with those in the standard-dose group: the 3-, 5- and 10-year LC rate were 60.9%, 57.6%, 52.3% versus 50.8%, 46.4%, 30.8%, respectively (P=0.032). The 3-, 5- and 10-year OS were 44.3%, 36.9% and 24.5% for high-dose group, and 31.7%, 20.6% and 14.1% for the standard-dose group, respectively(P=0.002). The incidence of acute radiation esophagitis (especially in grade 2 and 3) was 63.9% in high-dose group, which was significantly higher than that in the standard-dose group (59.6%). Severe (≥ grade 3) late-onset esophagitis was observed in neither group. The grade 4 acute esophagitis was rare. There was no significant difference in the incidence of radiation pneumonitis, gastrointestinal reactions or hematological toxicities between the two groups. Six patients in high-dose group and two patients in standard-dose group experienced ≥ grade 4 leukocytopenia, while no one experienced > grade 3 thrombocytopenia and anemia in both group. Conclusions: 60 Gy was the preferred dosage of CCRT in patients with ESCC. Compared with standard-dose, the high-dose CCRT yielded slightly increased mild to moderate acute radiation esophagitis, while life-threatening toxicities were not increased.

[New exploration of treatment target for proliferative diabetic retinopathy based on iTRAQ LC-MS/MS Proteomics].

Objective: To identify differentially expressed proteins between the patients with proliferative diabetic retinopathy (PDR) and vitreous floaters, and explore treatment target for PDR based on isobaric tags for relative and absolute quantification (iTRAQ) LC-MS/MS Proteomics. Method: Vitreous samples were collected from 28 eyes of patients with PDR and 4 eyes with vitreous floaters, which served as controls. For quantitative proteomics, vitreous samples were combined and proteins extracted and labeled with iTRAQ peptide-tagging reagents. Samples were fractionated by liquid chromatography (LC), analyzed by tandem mass spectrometry (MS/MS) and Gene Ontology (GO) analyses performed on differentially expressed proteins identified in the PDR samples. Results: In the PDR vitreous, 26 proteins were identified that were differentially expressed when compared to the controls. Of these, 7 showed a significant increase (P<0.05) and 19 a significant decrease (P<0.05)in expression in PDR patients. These included some high abundance proteins including Retinoic acid receptor reactive protein 2 (PDR 1=85.0, PDR 2=83.0, Control 1=119.6, Control 2=120.2, FC=0.710, P=0.001), Semaphorin-4B(PDR 1=64.4, PDR 2=68.8, Control 1=135.4, Control 2=146.0, FC=0.473, P=0.023), Apolipoprotein B (PDR 1=104.4, PDR 2=106.6, Control 1=89.0, Control 2=85.3, FC=1.211, P=0.024), and Heat shock protein 70 (PDR 1=69.3, PDR 2=75.0, Control 1=137.7, Control 2=138.3, FC=0.523, P=0.026), which are closely related to the pathological mechanism of PDR. GO analysis clustered the differentially expressed genes into three major functional domains: Biological Processes, Molecular Function and Cellular Component. Differential gene expression was found in the categories of cellular metabolism, organonitrogen compound and carbohydrate derivative metabolic processes, transferase activity and transmembrane signaling receptor activity. KEGG Pathway analysis indicate that Chemerin signaling through Akt, Sema4B signaling via PI3K, and HIF-1α signal pathways were all altered in the PDR samples. Conclusions: In this study we identified variations in expression of genes extensively involved in key biological processes in the retina including neovascularization, cellular metabolism and transmembrane signaling, which provide new insights into the pathophysiology of PDR. Extracellular matrix was degraded and endothelial cell migration was induced by Chemerin, in addition, the destruction of blood-retinal barrier and neuronal apoptosis were induced by ApoB. Chemerin and ApoB accelerated the development of PDR. Sema 4B participated in vascular protection, HSP70 conducted anti-apoptosis. These two cytokines protected the retinal neurovascular in PDR patients. Therefore, Chemerin, Sema 4B, ApoB and HSP70 may be the treatment target for PDR. (Chin J Ophthalmol, 2019, 55:769-776).

[Long-term outcomes of implanting drug-eluting stents for unprotected left main coronary artery disease patients with left ventricular systolic dysfunction].

Objective: To analyze the clinical characteristics and prognosis of implanting drug-eluting stents (DES) for unprotected left main (ULM) coronary artery disease patients with left ventricular systolic dysfunction (LVSD). Methods: A total of 511 ULM coronary artery disease patients who underwent DES implantation from January 2005 to January 2012 in Department of Cardiology, Beijing Anzhen Hospital were included in the study. Based on left ventricular ejection fraction (LVEF), the patients were divided into three groups: LVEF≤40% (n=104), 41%≤LVEF≤49% (n=137), and LVEF≥50% (n=270). The clinical characteristics of patients undergoing DES implantation were retrospectively compared, and the effects of LVSD on ULM coronary artery disease were analyzed. Results: After comparison of clinical baseline data among three different LVEF groups, the incidence of peripheral vascular diseases, old myocardial infarction (OMI), multi-vessel lesions, complete revascularization and chronic total occlusion (CTO) was statistically different (P=0.002, P<0.001, P<0.001, P=0.049, P=0.001, respectively). However, there was no significant difference in the incidence of other clinical characteristics (all P>0.05). In terms of survival analysis, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (both P<0.001). There was no statistical difference of total mortality between 41%≤LVEF≤49% group and LVEF≥50% group (P>0.05), while cardiac mortality was higher in LVEF≥50% group (P=0.027) . Besides, there was no significant difference among three groups in major adverse cardiac and cerebral events (MACCE), myocardial infarction(MI), cerebral infarction and target vessel revascularization (TVR) (all P>0.05). After adjusting for multiple clinical factors, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (P=0.002, P<0.001), while there were no statistical differences of total mortality and cardiac mortality between 41%≤LVEF≤49% group and LVEF≥50% group (both P>0.05). In terms of MACCE, MI, cerebral infarction and TVR, there were also no significant differences among three groups (all P>0.05). Conclusion: For ULM coronary artery disease patients with LVSD, implanting DES is safe and effective, but for those with severe LVSD (LVEF≤40%), DES implantation showed an increased risk of long-term death and therefore should be selected with great care.

[Predictive value of serial platelet function testing on outcome in patients undergoing complex percutaneous coronary intervention].

Objective: To observe the predictive value of serial platelet function testing (PFT) on outcome in patients undergoing complex percutaneous coronary intervention (PCI). Methods: Six hundred and two consecutive patients undergoing complex PCI in Anzhen hospital were enrolled during October 2011 to June 2012.Adenosine diphosphate(ADP)-induced platelet aggregation was measured by light transmission aggregometry on the first, sixth and twelfth month after PCI and the mean value was calculated.The cut-off value of high on-treatment platelet reactivity (HTPR) was defined as 40%.The primary endpoint was major adverse cardiovascular and cerebral event (MACCE). Clinical outcomes were analyzed by the Kaplan-Meier method and differences were compared using the log-rank test.Multivariate analyses by Cox proportion hazards regression were applied to identify variables independently associated with the adverse outcomes. Results: Five hundred and eighty-five patients (HTPR, n=285; non-HTPR, n=280) finished the follow-up ((28.47±7.45) months). A total of 33 cases of MACCE were observed during the follow-up, among which 29 cases(8.42%) were in HTPR group and 9 cases (3.21%) in the non-HTPR group.Kaplan-Meier analysis suggested that HTPR was associated with an increased incidence of MACCE (log-rank test, P=0.01). The Cox multivariate analysis indicated that HTPR was an independent risk factor of MACCE (HR=2.69, 95%CI 1.23-5.85, P=0.01) in patients undergoing complex PCI.Incidence of MACCE was similar between HTRP patients receiving standard dual antiplatelet therapy (DAPT) or prolonged DAPT (>12 months). Conclusion: Serial PFT could predict the long-term prognosis of patients underwent complex PCI.

Preparation of the acellular scaffold of the spinal cord and the study of biocompatibility.

STUDY DESIGN: Acellular spinal cord was prepared through chemical extraction, and its biocompatibility was studied. OBJECTIVE: Acellular scaffolds have been developed from various materials for tissue reconstruction, except for spinal cord. The objective of this study was to prepare acellular spinal cord and examine the biocompatibility of the scaffold. SETTING: This study was conducted at the Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China. METHODS: The morphology of the acellular segments was revealed by scanning electron microscopy, immunohistochemistry, and hematoxylin and eosin stain. Biocompatibility was studied by immunohistochemistry. RESULTS: Results show that in spinal cord scaffolds, cells, myelin sheath and axon of nerve fibers were eliminated, and three-dimensional supports of extracellular matrix were reserved. The component analytical results of the acellular spinal cord indicate that they contain laminin, fibronectin and collagen, which can facilitate and induce the regeneration of injured nerves, and enhance the adhesion and proliferation of cells. The acellular spinal cord has a three-dimensional structure and excellent biocompatibility. CONCLUSION: Our data indicate that acellular spinal cord has certain biological properties and it may be a potential alternative scaffold for spinal cord tissue engineering.

Post-earthquake outbreak of insecticide-associated conjunctivitis in a primary school of Lixian district, China: An epidemiological investigation.

OBJECTIVES: To describe the time course and characteristics of an insecticide-associated incident and highlight potential risks from similar outbreaks that may occur in other areas to enhance the preparedness of emergency physicians and other healthcare providers to deal with the sequelae of these events. STUDY DESIGN: Outbreak investigation METHODS: From 5 to 8 August 2008, an outbreak investigation was carried out among the affected primary school located in the refugee camp area of Lixian district, Sichuan, China. Affected pupils, parents, teachers and doctors working in the local medical stations were visited. Clinical checking, clinical treatment, epidemiological investigation and environmental investigation were undertaken. RESULTS: In total, 138 individuals were diagnosed with acute conjunctivitis, characterized by inflammation of the conjunctiva and intense ocular symptoms such as redness, itching and mucus discharge. According to the results, all risk factors (i.e. drinking water, indoor air and the materials used in camp classrooms) were excluded except insecticide exposure. The characteristics of symptoms, distribution of cases and records of irregular insecticide spraying support the assumption that the conjunctivitis outbreak was associated with synthetic pyrethroid alphacypermethrin exposure. CONCLUSION: The results suggest that non-standard operating procedures in pest control could lead to disease incidents. Medical rescue teams should receive training and education in preventive techniques.

Computer simulation of stress distribution in the metatarsals at different inversion landing angles using the finite element method.

Metatarsal fracture is one of the most common foot injuries, particularly in athletes and soldiers, and is often associated with landing in inversion. An improved understanding of deformation of the metatarsals under inversion landing conditions is essential in the diagnosis and prevention of metatarsal injuries. In this work, a detailed three-dimensional (3D) finite element foot model was developed to investigate the effect of inversion positions on stress distribution and concentration within the metatarsals. The predicted plantar pressure distribution showed good agreement with data from controlled biomechanical tests. The deformation and stresses of the metatarsals during landing at different inversion angles (normal landing, 10 degree inversion and 20 degree inversion angles) were comparatively studied. The results showed that in the lateral metatarsals stress increased while in the medial metatarsals stress decreased with the angle of inversion. The peak stress point was found to be near the proximal part of the fifth metatarsal, which corresponds with reported clinical observations of metatarsal injuries.

Fluoride removal from brackish groundwater by direct contact membrane distillation.

The direct contact membrane distillation (DCMD) applied for fluoride removal from brackish groundwater is presented. The self-prepared polyvinylidene fluoride membrane exhibited high rejection of inorganic salt solutes and a maximum permeate flux 35.6 kgm(-2) h(-1) was obtained. The feed concentration had no marked impact on the permeate flux and the rejection of fluoride. The precipitation of CaCO3 would clog the hollow fiber inlets and foul the membrane surface with the increase of concentration factor when natural groundwater was used directly as the feed, which resulted in a rapid decline of the module efficiency. This phenomenon was diminished by acidification of the feed. The experimental results showed that the permeate flux and the quality of obtained distillate kept stable before concentration factor reached 5.0 with the acidified groundwater as feed. The membrane module efficiency began to decline gradually when the feed continued to be concentrated, which can be mainly attributed to the formation of CaF2 deposits on the membrane surface. Finally, a 300 h continuous fluoride removal experiment on acidified groundwater was carried out with concentration factor at 4.0, the permeate flux kept stable and the permeate fluoride was not detected.

Desalination of brackish groundwater by direct contact membrane distillation.

The direct contact membrane distillation (DCMD) applied for desalination of brackish groundwater with self-made polyvinylidene fluoride (PVDF) membranes was presented in the paper. The PVDF membrane exhibited high rejection of non-volatile inorganic salt solutes and a maximum permeate flux 24.5 kg m(-2) h(-1) was obtained with feed temperature at 70 degrees C. The DCMD experimental results indicated that the feed concentration had no significant influence on the permeate flux and the rejection of solute. When natural groundwater was used directly as the feed, the precipitation of CaCO(3) would be formed and clog the hollow fibre inlets with gradual concentration of the feed, which resulted in a rapid decline of the module efficiency. The negative influence of scaling could be eliminated by acidification of the feed. Finally, a 250 h DCMD continuous desalination experiment of acidified groundwater with the concentration factor at constant 4.0 was carried out. The permeate flux kept stable and the permeate conductivity was less than 7.0 microS cm(-1) during this process. Furthermore, there was no deposit observed on the membrane surface. All of these demonstrated that DCMD could be efficiently used for production of high-quality potable water from brackish groundwater with water recovery as high as 75%.

Effects of Ginkgo biloba leaves (Ginkgo biloba) and Ginkgo biloba extract on nutrient and energy utilization of broilers.

An experiment using 112 21-day-old male Arbor Acres broilers that were randomly allocated to 7 treatments with 8 replicates in a completely randomized design was conducted to assess the effects of Ginkgo biloba leaves (Ginkgo biloba, GL) and Ginkgo biloba extract (EGB) on utilization of nutrients of broiler chickens. The dietary treatments were corn-soybean meal based diets: 1) T1, control diet; 2) T2, T1 + 20 g/kg GL; 3) T3, T1 + 40 g/kg GL; 4) T4, T1 + 60 g/kg GL; 5) T5, T1 + 0.4 g/kg EGB; 6) T6, T1 + 0.8 g/kg EGB; and 7) T7, T1 + 1.2 g/kg EGB. Endogenous losses were obtained from another 16 broilers. Excreta samples were collected to analyze the dry matter (DM), organic matter (OM), ether extract (EE), crude protein (CP), gross energy (GE), and amino acids (AA), and GE was analyzed for computation of AME and TME. As compared with those of the control treatment, the apparent digestibility (AD) and true digestibility (TD) of EE, CP, Thr, Val, Ile, Leu, Phe, Lys, His, and Arg were quadratically (P < 0.05) increased; moreover, the AD and TD of Met was linearly (P < 0.05) increased as the concentration of the EGB in the diet increased. Increasing GL from 0 to 60 g/kg of diet linearly (P < 0.05) increased the AD and TD of EE, Thr, Val, Leu, His, and Met and tended (0.05 < P < 0.1) to increase the TME, TMEn, and Arg. Supplementation of EGB increased (P < 0.05) AD and TD of EE, Thr, Val, Ile, Leu, Phe, His, and Arg and tended (0.05 < P < 0.1) to increase Lys as compared with those in the GL-supplemented groups. Dietary supplementation of GL and EGB improved the utilization of nutrients of broiler chickens in a dose-dependent manner, and the optimum supplementation levels of GL or EGB in the diet of broilers was 60 or 0.8 g/kg of diet, respectively.

First Report of Anthracnose Fruit Rot of Strawberry Caused by Colletotrichum acutatum in China.

In 2004, fruits showing dark and sunken necrotic lesions were observed on strawberries (Fragaria × ananassa Duch. cv. Mei No. 3) in a field in Shanghai, China. All isolates obtained from the infected fruits easily produced orange spore masses and developed orange colonies with orange reverse colony color; none formed setae or the ascigerous stage in culture or on the host. The conidia were hyaline, straight and fusiform, 8 to 16 × 2.5 to 4 µm, and produced melanized, ellipsoid, ball- or pear-shaped appressoria at the end of germ tubes. These isolates were similar to those described for Colletotrichum acutatum J. H. Simmonds. To confirm pathogenicity of the isolate, inoculum suspension with 4 × 106 conidia/ml was sprayed onto 10 fruiting strawberry plants until runoff. The inoculated plants were maintained at 25°C and 100% relative humidity in a growth chamber with a 12-h period of fluorescent light daily. Plants inoculated with sterilized water were controls. After 3 days, dark brown lesions appeared in the leaves, petioles, and fruits of all inoculated plants. The symptoms were similar to those observed on the strawberry fruit from which the isolate was originally isolated. The pathogen was consistently reisolated from the symptomatic fruit. No symptoms were observed on the control plants. To our knowledge, this is the first report of C. acutatum as the casual agent of anthracnose fruit rot of strawberry in China.

The TLR4/NF-κB signaling pathway mediates the growth of colon cancer.

OBJECTIVE: We studied the involvement of the TLR4/NF-κB pathway in the growth of colon cancer using human colon cancer specimens, human colon cancer SW620 cell line, and nude mouse xenograft model. MATERIALS AND METHODS: Tissue samples were surgically harvested. The human colon cancer SW620 cell line was pre-treated with the TLR4 inhibitor CRX-526 and stimulated with LPS. The nude mouse xenograft model was established by subcutaneous injection of SW620 cells with or without CRX-526, the TLR4 inhibitor. The study outcomes were mRNA and protein expressions of TLR4 and NF-κB p65 in specimens of colon cancer and adjacent normal tissue, SW620 cell line, and xenografts. In addition, we studied production of interleukin (IL)-6 and IL-8 in culture supernatants of LPS-stimulated SW620 cells. RESULTS: Both mRNA and protein expressions of TLR4 and NF-κB in colon cancer specimens were higher than those in the adjacent normal tissue. LPS up-regulated expression of TLR4 and NF-κB, and stimulated production of IL-6 and IL-8 in SW620 cells. These effects were attenuated by CRX-526. TLR4 inhibition was also effective in the nude mouse xenograft model, as tumor sizes were significantly smaller, and expressions of TLR4 and NF-κB significantly lower, in the mice treated with CRX-526. CONCLUSIONS: The TLR4/NF-κB signaling pathway is activated in colon cancer, causing production of IL-6 and IL-8, and, thereby, tumor growth and metastasization. Inhibition of TLR4 attenuates up-regulation of NF-κB and inhibits tumor growth.

Image-based midsole insert design and the material effects on heel plantar pressure distribution during simulated walking loads.

The primary objective of this paper is to study the use of medical image-based finite element (FE) modelling in subject-specific midsole design and optimisation for heel pressure reduction using a midsole plug under the calcaneus area (UCA). Plugs with different relative dimensions to the size of the calcaneus of the subject have been incorporated in the heel region of the midsole. The FE foot model was validated by comparing the numerically predicted plantar pressure with biomechanical tests conducted on the same subject. For each UCA midsole plug design, the effect of material properties and plug thicknesses on the plantar pressure distribution and peak pressure level during the heel strike phase of normal walking was systematically studied. The results showed that the UCA midsole insert could effectively modify the pressure distribution, and its effect is directly associated with the ratio of the plug dimension to the size of the calcaneus bone of the subject. A medium hardness plug with a size of 95% of the calcaneus has achieved the best performance for relieving the peak pressure in comparison with the pressure level for a solid midsole without a plug, whereas a smaller plug with a size of 65% of the calcaneus insert with a very soft material showed minimum beneficial effect for the pressure relief.

MRI image-based FE modelling of the pelvis system and bladder filling.

In this study, high-resolution magnetic resonance imaging was performed in the transaxial, coronal and sagittal planes to provide comprehensive structural details of the bladder and surrounding systems. Detailed finite-element (FE) models that were specific to each participant were developed by rendering the images, and the process of bladder filling was simulated. The overall model of bladder deformation was compared with repeated images of the filled bladder that were obtained using computed tomography to validate the FE models. The relationship between the changes in the key dimensions of the bladder and the increase in bladder volume during the filling process was also investigated. The numerical results showed that the bladder dimensions increased linearly with its volume during the filling process and the predicted coefficients are comparable to some of the published clinical results.

Synthesis of dihydrofolate reductase and metabolism of related RNA in a methotrexate resistant human cell line infected with herpes simplex virus type 2.

Using a human cell line with amplified gene copy for dihydrofolate reductase (DHFR) and permissive for herpes simplex virus type 2 (HSV-2), the effect of HSV-2 on DHFR synthesis and on the steady-state level of total cellular and nuclear DHFR RNA was examined. There was a reduction in DHFR synthesis accompanied by a proportional decrease in the levels of DHFR messenger RNA (mRNA) 1 hr after infection. Both effects could be induced by HSV pretreated with ultraviolet light and this early virus induced rapid turnover of DHFR mRNA was not dependent on de novo protein synthesis. Analysis of nuclear RNA (nRNA) from uninfected cells by Northern blot hybridization identified a large DHFR nRNA of about 23 kb which probably represents the primary transcript and four processed intermediates of DHFR mRNA ranging in size from 12 to 4.4 kb. The levels of these nRNAs were unchanged during the first hour; however, the 4.4-kb species accumulated in nuclei 2 hr after infection. This effect was induced in the absence of HSV gene expression.