New insights on the association of weight loss with the reduction in carotid intima-media thickness among patients with obesity: an updated systematic review and meta-analysis.

OBJECTIVES: Carotid intima-media thickness (CIMT) is a noninvasive marker of atherosclerosis, a typical pathologic process underlying cardiovascular diseases (CVDs). It is essential to explore the relationships between weight loss and the reduction of CIMT. STUDY DESIGN: This was an updated systematic review and meta-analysis. METHODS: A systematic literature search was conducted to collect relevant clinical trials. The pooled results of meta-analyses were assessed by weighted mean difference (WMD) and the corresponding 95 % confidence interval (95% CI). RESULTS: Thirty-three articles involving 2273 participants were collected in this meta-analysis. Among all participants with obesity, the pooled mean of weight loss was -23.26 kg (95% CI: -27.71 to -18.81), and the pooled mean change of CIMT was -0.06 mm (95% CI: -0.08 to -0.04). Compared with Non-surgical interventions, Surgical ones could lead to much higher weight loss (Pbetween groups < 0.001). A more significant CIMT reduction was identified among Surgical intervention patients than among Non-surgical intervention participants (Pbetween groups < 0.001). CONCLUSIONS: Effective interventions, especially Surgical interventions, could reduce the weight of patients with obesity, followed by the decline of CIMT, which might further disturb atherosclerosis progression and lower CVD risk.

Effects of Breathing Patterns on Amide Proton Transfer MRI in the Kidney: A Preliminary Comparative Study in Healthy Volunteers and Patients With Tumors.

BACKGROUND: The amide proton transfer-weighted (APTw) imaging for kidney diseases is important. However, the breathing patterns on APTw imaging remains unexplored. PURPOSE: This study aimed to investigate the effects of intermittent breath-hold (IBH) and free breathing (FB) on renal 3D-APTw imaging. STUDY TYPE: Healthy volunteers were enrolled prospectively, and renal clear cell carcinoma (RCCC) patients were included retrospectively. POPULATION: 58 healthy volunteers and 10 RCCC patients. FIELD STRENGTH/SEQUENCE: 3-T, turbo spin echo, and fast field echo. ASSESSMENT: 3D-APTw imaging was scanned using the IBH and FB methods in volunteers and using the IBH method in RCCC patients. The image quality was evaluated by three observers according to the 5-point Likert scale. Optimal images rated at three points or higher were used to measure the APT values. STATISTICAL ANALYSIS: The measurement repeatability was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. The APT values were analyzed using McNemar's test, one-way analysis of variance, and t test. RESULTS: 50 healthy volunteers and 8 RCCC patients were enrolled. Renal 3D-APTw imaging using the IBH method revealed a higher success rate (88% vs 78%). The ICCs were excellent in the IBH group (ICCs > 0.74) and were good in the FB group (ICCs < 0.74). No significant differences in the APT values among various zones using the IBH (P = 0.263) or FB method (P = 0.506). The mean APT value using the IBH method (2.091% ± 0.388%) was slightly lower than the FB method (2.176% ± 0.292%), but no significant difference (P = 0.233). The APT value of RCCC (4.832% ± 1.361%) was considerably higher than normal renal using the IBH method. CONCLUSIONS: The study demonstrated that the IBH method substantially increased the image quality of renal 3D-APTw imaging. Furthermore, APT values may vary between normal and tumor tissues. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

[Femtosecond laser-assisted minimally invasive lamellar keratoplasty for advanced keratoconus].

Objective: To evaluate the initial safety and efficacy of femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK) for advanced keratoconus. Methods: It was a case series study. Patients with advanced keratoconus who underwent FL-MILK between August 2017 and April 2020 at Shandong Eye Hospital were prospectively included. The femtosecond laser was used to create an intrastromal pocket in the recipient cornea and a lamellar cornea in the donor. The lamellar cornea was then gently inserted into the intrastromal pocket through the incision and flattened. Clinical measurements included best-corrected visual acuity, 3-mm anterior corneal mean keratometry, anterior and posterior central corneal elevation, central corneal thickness, corneal biomechanics, and endothelial cell density. The follow-up was conducted at 1 month, 12 months, and 24 months after the operation. Results: There were 33 patients (35 eyes) in the study. Twenty-six patients were male and 7 patients were female. The mean age was (20.34±5.24) years old. All patients completed 12 months of follow-up, and 25 patients (27 eyes) completed 24 months of follow-up. No epithelial ingrowth, infection, or allogeneic rejection was observed. Compared with the preoperative data, the anterior central corneal elevation significantly decreased (P<0.001), the mean keratometry significantly decreased (P<0.05), and the central corneal thickness significantly increased (P<0.001). The corneal biomechanical strength was significantly improved, with the deformation amplitude ratio at 2.0 mm decreasing from 1.39±0.14 preoperatively to 1.21±0.10 at 24 months postoperatively (P<0.001) and the stiffness parameter at the first applanation increasing from 41.49±11.47 preoperatively to 88.41±18.17 at 24 months postoperatively (P<0.001). There were no significant changes in the mean best-corrected visual acuity, posterior corneal elevation, mean spherical equivalent, and endothelial cell density (all P>0.05). Conclusions: FL-MILK may be a feasible option for advanced keratoconus. This procedure may provide a new resolution for keratoconus.

A hybrid approach for low-carbon transportation system analysis: integrating CRITIC-DEMATEL and deep learning features.

As supply chains, logistics, and transportation activities continue to play a significant role in China's economic and social developments, concerns around energy consumption and carbon emissions are becoming increasingly prevalent. In light of sustainable development goals and the trend toward sustainable or green transportation, there is a need to minimize the environmental impact of these activities. To address this need, the government of China has made efforts to promote low-carbon transportation systems. This study aims to assess the development of low-carbon transportation systems in a case study in China using a hybrid approach based on the Criteria Importance Through Intercriteria Correlation (CRITIC), Decision-Making Trial and Evaluation Laboratory (DEMATEL) and deep learning features. The proposed method provides an accurate quantitative assessment of low-carbon transportation development levels, identifies the key influencing factors, and sorts out the inner connection among the factors. The CRITIC weight matrix is used to obtain the weight ratio, reducing the subjective color of the DEMATEL method. The weighting results are then corrected using an artificial neural network to make the weighting more accurate and objective. To validate our hybrid method, a numerical example in China is applied, and sensitivity analysis is conducted to show the impact of our main parameters and analyze the efficiency of our hybrid method. Overall, the proposed approach offers a novel method for assessing low-carbon transportation development and identifying key factors in China. The results of this study can be used to inform policy and decision-making to promote sustainable transportation systems in China and beyond.

Bio-detoxification of Jatropha curcas L. cake by a soil-borne Mucor circinelloides strain using a zebrafish survival model and solid-state fermentation.

AIMS: The aims of the study were to (i) improve the evaluation criteria of detoxifying Jatropha curcas L. cake (JCC), (ii) isolate and characterize a JCC tolerant strain, (iii) explore its JCC detoxifying potential. METHODS AND RESULTS: The zebrafish was employed as a survival model to screen the strains capable of detoxifying JCC. A strain identified as Mucor circinelloides SCYA25, which is highly capable of degrading all toxic components, was isolated from soil. Different solid-state fermentation parameters were optimized by response surface methodology. The optimal values for inoculation amount, moisture content, temperature, and time were found to be 18% (1·8 × 106 spores g-1 cake), 66%, 26, and 36 days, respectively, to achieve maximum detoxification of the JCC (92%). Under optimal fermentation conditions, the protein content of JCC was increased, while the concentrations of ether extract, crude fiber, toxins, and anti-nutritional substances were all degraded considerably (P < 0·05). Scanning electron microscopy and Fourier transform infrared spectrometer analysis revealed that the fermentation process could disrupt the surface structure and improve the ratio of α-helix to ß-folding in the JCC protein, which may improve the digestibility when the detoxified JCC is used as a feedstuff. CONCLUSIONS: Our results indicate that M. circinelloides SCYA25 is able to detoxify JCC and improve its nutritional profile, which is beneficial to the safe utilization of JCC as a protein feedstuff. SIGNIFICANCE AND IMPACT OF THE STUDY: The newly identified M. circinelloides SCYA25 detoxified JCC in a safe manner to provide a potential alternative to soybean meal for the feed industry. These results also provide a new perspective and method for the toxicity evaluation and utilization of JCC and similar toxic agricultural by-products.

Adherence to antihypertensive medications for secondary prevention of cardiovascular disease events: a dose-response meta-analysis.

OBJECTIVES: The aim of the study was to explore the association between adherence to antihypertensive medications (AHMs) and the risk of recurrence of cardiovascular disease (CVD) events in patients with a history of CVD events from cohort studies. STUDY DESIGN: This is a dose-response meta-analysis. METHODS: PubMed and Embase databases were searched up to March 4, 2021, to identify English-language reports of cohort studies that assessed the association of AHM adherence with risk of recurrence of CVD events. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated by using a fixed- or random-effects model. Restricted cubic splines were used to evaluate the possible linear or non-linear association. RESULTS: We included nine cohort studies (54,349 patients) in the present meta-analysis. The pooled RR of CVD events was 0.66 (95% CI, 0.54-0.78) for the highest versus lowest AHM adherence category. We did not find any evidence of non-linearity association between AHM adherence and risk of CVD events (Pnon-linearity = 0.534); for patients with a history of CVD events, the risk of CVD events was reduced by 9% for each 20% increase in AHM adherence (RR, 0.91; 95% CI, 0.85-0.97). The results of sensitivity analysis and subgroup analysis were virtually unchanged. CONCLUSIONS: The high level of adherence to AHM is an effective strategy for preventing recurrence of CVD events. Patients with a history of CVD events should adhere to AHM.

Assessment of intraoperative use of indocyanine green fluorescence imaging on the incidence of anastomotic leakage after rectal cancer surgery: a PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: The current data on the intraoperative use of indocyanine green (ICG) fluorescence imaging to reduce the anastomotic leak (AL) rate in rectal cancer surgery remain controversial. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ICG fluorescence imaging in decreasing the AL rate after rectal cancer surgery. METHODS: Studies comparing ICG fluorescence imaging with standard care in patients with rectal cancer were systematically searched from PubMed, Embase, Web of Science and Cochrane Library through January 2020. The current meta-analysis was performed according to the preferred reporting items for systematic review and meta-analysis guidelines. A pooled analysis was performed for the available data regarding the baseline features, AL rate and other surgical outcomes. RevMan version 5.3 software was used for the present meta-analysis. RESULTS: Nine studies with a total of 2088 patients with rectal cancer (926 in the ICG group and 1162 in the control group) were included in the present study. In the pooled analysis, the available patient and tumour-related baseline data were all comparable and without significant heterogeneity. In the present pooled analysis, the AL rate in the ICG group was significantly lower (OR 0.34; 95% CI 0.22-0.52; p < 0.0001) than that in the control group. Additionally, intraoperative use of ICG was associated with a decreased overall complication rate (OR 0.57; 95% CI 0.42-0.78; p = 0.0003) and reduced reoperation rate (OR 0.26; 95% CI 0.08-0.86; p = 0.03) in patients who had rectal cancer surgery. CONCLUSIONS: The present study demonstrated the superiority of the intraoperative use of ICG in reducing the AL rate. However, considering the limitations of the included studies, more high-quality prospective studies and randomized controlled trials are needed.

[Clinical characteristics of 170 cases of macrodactyly].

OBJECTIVE: To analyze the clinical characteristics of 170 cases of macrodactyly. METHODS: Medical records of 170 macrodactyly patients at Beijing Jishuitan Hospital between March 2006 and October 2019, including demographic characteristics, clinical presentations, anatomical distributions, X-rays, pathological findings, and treatments, were reviewed. PIK3CA mutation analyses of 12 patients were also reviewed. RESULTS: Disease incidence was similar across sex and geographical regions. Multiple-digit involvement was 3.9 times more frequent than single-digit involvement. In upper deformit: ies, the index finger, middle finger and thumb were mostly involved, and the second and third toes were the most affected on the foot. Two digits were affected more often than three digits, with the affected multiple digits were adjacent most time. The cases of progressive macrodactyly, in which the affected digits grew at a faster rate than the unaffected digits, were found more than static type. Most of progressive macrodactyly were noticed at birth. In terms of nerve involvement, affected fingers mostly occurred in the median nerve innervation area (79.4%) accompanied by median nerve and brunches enlargement and fat infiltration, i.e., nerve territory oriented; affected toes mostly occurred in the medial plantar nerve innervation area (89.1%), marked with overgrowth of adipose tissue with a lesser degree of neural overgrowth, i.e., lipomatous. Only 17 cases had comorbid of syndactyly. The metacarpal bones were involved only in progressive type of macrodactyly. Ten of the 12 cases subjected to PIK3CA mutation analysis were positive. Among all tested specimens, PIK3CA mutation levels ranged from 7% to 27%. In terms of tissue sources in which a mutation was found, adipose tissue had the highest mutation detection rate, followed by nerve and skin. All the DNA samples of blood from the 12 PIK3CA mutation-positive patients were negative. CONCLUSION: Macrodactyly fingers mostly occurred in the median nerve innervation area accompanied by median nerve and brunches enlargement and fat infiltration. The index and middle fingers were mostly involved. Macrodactyly toes mostly occurred in the medial plantar nerve innervation area, marked with overgrowth of adipose tissue with a lesser degree of neural overgrowth. The second and third toes were the most affected on the foot. A high proportion (83%) of isolated macrodactyly patients carry activating PIK3CA mutations. Adipose, nerve, and skin tissues provide the highest PIK3CA mutation detection yield among all types of tissue studied.

Guidelines Insights: Hepatobiliary Cancers, Version 2.2019.

The NCCN Guidelines for Hepatobiliary Cancers provide treatment recommendations for cancers of the liver, gallbladder, and bile ducts. The NCCN Hepatobiliary Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's discussion and updated recommendations regarding systemic therapy for first-line and subsequent-line treatment of patients with hepatocellular carcinoma.

Hexarelin protects cardiac H9C2 cells from angiotensin II-induced hypertrophy via the regulation of autophagy.

Hexarelin is a synthetic growth hormone-releasing peptide that exerts cardioprotective effects. Regulation of autophagy is known to be cardioprotective so this study examined the role of autophagy and potential regulatory mechanisms in hexarelin-elicited anti-cardiac hypertrophic action in cardiomyocytes subjected to hypertrophy. H9C2 cardiomyocytes were subjected to hypertrophy by angiotensin-II (Ang-II). Autophagic light chain-3 (LC3) and cytoskeletal proteins were determined by immunofluorescence assay. Autophagy was also detected using monodansylcadaverine (MDC) for autophagic vacuole visualization and Cyto-ID staining for autophagic flux measurement. Molecular changes were analysed by Western blotting and qRT-PCR. Apoptosis was evaluated using flow cytometry and TUNEL assay. ATP content and CCK-8 assay were used in assessing enhanced cell survival whilst oxidative stress was analysed by measuring malondialdehyde(MDA) and superoxide dismutase(SOD) levels. Ang-II induced cardiomyocyte hypertrophy, oxidative stress, apoptosis and decreased cell survival, all of which were significantly suppressed by hexarelin treatment which also enhanced autophagy in hypertrophic H9C2 cells. Furthermore, inhibition of hexarelin induced autophagy by 3-methyladenine (3MA) abolished the anti-hypertrophic function of hexarelin and also abrogated the protection of hexarelin against cell survival inhibition and apoptosis. Conversely, the application of autophagy stimulator rapamycin in H9C2 hypertrophic cells inhibited apoptosis, cell survival and reduced cell size as well. Additionally, hexarelin regulated the upstream signalling of autophagy by inhibiting the phosphorylation of mammalian target of rapamycin(mTOR). We propose that hexarelin plays a novel role of attenuating cardiomyocyte hypertrophy and apoptosis via an autophagy-dependent mechanism associated with the suppression of the mTOR signalling pathway.

[Clinical characteristics of human adenovirus type 7 pneumonia and genetic characteristics of human adenovirus type 7].

Objective: To better understand the clinical features of human adenovirus type 7 (hAdV7) pneumonia and to identify whether there is a variation in the genome of the strain (CHN/BeiJing/2018) isolated during the small-scale epidemic. Method: Forty-two patients were diagnosed with hAdV7 pneumonia between October 27th, 2017 and February 28th, 2018. They were all males with an average age of (21±2) years. Demographic and clinical data were reviewed and analyzed in detail. The nucleic acid of the epidemic strain was extracted from a bronchoalveolar lavage fluid sample. Whole genome sequencing (WGS) was then performed and sequences were compared with other hAdV7 strains distributed globally. Phylogenetic tree analysis was conducted based on whole genome sequences of the epidemic strain. Results: Thirty-eight cases with hAdV7 pneumonia presented with influenza-like symptoms (90.5%) at the onset and 36 cases developed fever (85.7%), followed by cough (97.6%), expectoration (90.5%) and chest pain (28.6%). Five cases presented with tonsillitis(11.9%) and 4 had transient hemoptysis (9.5%), while 3 patients reported dyspnea (7.1%). Moist rales were only heard in 3 patients (7.1%). Notably elevated creatine kinase (CK) concentrations were observed in 8 patients (19.1%), but all returned to normal after treatment. Four cases developed hypoxemia (9.5%), but none of them progressed to respiratory failure or acute respiratory distress syndrome (ARDS). Chest CT imaging showed bilateral patchy parenchymal opacities with a random distribution with or without consolidation. Ten patients were co-infected with influenza virus (23.8%), while 32 patients developed atypical pneumonia (76.2%). Genomic analysis revealed that the strain isolated during this epidemic was 99% similar to the known hAdV7 strains (19BOVLB/Volgograd/Rus/2014 and 0901HZ/ShX/CHN/2009). Phylogenetic tree analysis suggested that the strain was closely related to the hAdV7 strain isolated in Jingmen China in 2012. Conclusions: Cases with hAdV7 pneumonia were generally mild. Symptomatic treatment was sufficient for a favorable prognosis. A good genome stability of the hAdV7 strain was observed, indicating that hAdV7 could remain stable for a long period and cause continuing sporadic cases and clusters.

Serum hepatitis B surface antigen correlates with fibrosis and necroinflammation: A multicentre perspective in China.

The kinetics of serum hepatitis B surface antigen (HBsAg) during the natural history of hepatitis B virus (HBV) infection has been studied, but the factors affecting them remain unclear. We aimed to investigate the factors affecting HBsAg titres, using data from multicentre, large-sized clinical trials in China. The baseline data of 1795 patients in 3 multicentre trials were studied, and the patients were classified into 3 groups: hepatitis B early antigen (HBeAg)-positive chronic HBV infection (n = 588), HBeAg-positive chronic hepatitis B (n = 596), and HBeAg-negative chronic hepatitis B (n = 611). HBsAg titres in the different phases were compared, and multiple linear progression analyses were performed to investigate the implicated factors. HBsAg titres varied significantly in different phases (P = .000), with the highest (4.60 log10 IU/mL [10%-90% confidence interval: 3.52 log10 IU/mL-4.99 log10 IU/mL]) in patients with HBeAg-positive chronic HBV infection. In all phases, age and HBV DNA were correlated with serum HBsAg level. In HBeAg-positive chronic hepatitis B patients, a negative correlation between HBsAg titres and fibrosis stage was observed. Alanine amonitransferase or necroinflammatory activity was also correlated with HBsAg titres in HBeAg-negative chronic hepatitis B patients. In conclusion, decreased HBsAg titres may be associated with advancing fibrosis in HBeAg-positive chronic hepatitis B patients or increased necroinflammation in those with HBeAg-negative chronic hepatitis B. Our findings may help clinicians better understand the kinetics of HBsAg and provide useful insights into the management of this disease.

Involvement of PKA signalling in anti-inflammatory effects of chitosan oligosaccharides in IPEC-J2 porcine epithelial cells.

Weaning is characterized by intestinal inflammation, which is a big challenge in pig industry. Control of intestinal inflammation is important for improvement of growth performance and health. Therefore, the study was focused on the anti-inflammatory activity of low-molecular-weight chitosan oligosaccharide (LCOS) in a porcine small intestinal epithelial cell line (IPEC-J2). The results showed that TNF-α, as inflammation inducer, significantly upregulated the mRNA expression of IL-8 and MCP-1. Afterwards, LCOS significantly attenuated mRNA expression of IL-8 and MCP-1 induced by TNF-α in the cells. Mannose (MAN), as ligand of mannose receptor, had no effect on the anti-inflammatory activity of LCOS, which suggested that mannose receptor may not involve in the anti-inflammatory activity of LCOS in IPEC-J2 cells. Interestingly, N-[2-(p-bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide 2HCl hydrate (H89), as PKA (protein kinase A)-specific inhibitor, reversed the mRNA expression of IL-8 when co-cultured with LCOS. Furthermore, LCOS concentration dependent downregulated the mRNA expression of claudin-1 compared with TNF-α treatment. However, the trans-epithelial electric resistance (TEER) was not affected by LCOS when co-cultured with TNF-α in 3 hr. In conclusion, LCOS have a potent anti-inflammatory activity, and as a feed additives, may be useful for the inhibition of inflammatory process in weaning period of pigs with intestinal inflammation occurring.

[Expression of Fermintin family homologous protein 2 in non-small cell lung cancer and its clinical significance].

Objective: To investigate the expression of Fermintin family homologous protein 2 (FERMT2) in non-small cell lung cancer and its clinical significance. Methods: Seventy-two patients with non-small cell lung cancer were collected at Xinxiang Central Hospital, Henan Province, from January 2015 to January 2017.There were 48 male and 24 female patients, the age ranged from 37 to 78 years (mean 58 years). The expression of FERMT2 in tumor samples and para-cancerous tissues were detected by immunohistochemistry. Protein and mRNA expression of FERMT2 were detected by Western blot and real-time fluorescence quantitative PCR, respectively. Western blot method was also used to detect integrin-related protein expression, including integrin beta 1 (CD29), vascular cell adhesion molecule (VCAM1), and mobile related protein-1 (MRP1). Results: Immunohistochemistry showed that the positive rates of FERMT2 expression were 81.9%(59/72)in carcinoma tissue and 15.4%(11/72) in para-cancerous tissues, and the difference was statistically significant (P<0.01). Positive FERMT2 expression was different in tumors at different tumor stages: 11/17 at stage Ⅰ, 16/20(80.0%)at stage Ⅱ, 17/20(85.0%)at stage Ⅲ, and 15/15 at stage Ⅳ, and there was a significant difference between each stage (P<0.01). By real-time PCR and Western blot, the expression of FERMT2 in non-small cell lung cancer tissues was significantly higher than that of para-cancerous tissue (P<0.01). The expression levels of integrin related proteins (integrin ß1, VCAM1 and MRP1) in tumor tissues were significantly higher than those in para-cancerous tissues, and positively correlated with the expression of FERMT2 (r=0.531, P<0.01; r=0.483, P<0.01; r=0.612, P<0.01). Conclusions: FERMT2 is highly expressed in non-small cell lung carcinomas. Its expression is closely correlated with the tumor clinical stage. It is hypothesized that FERMT2 may promote tumor metastasis through interactions with integrin-like protein.

[PIK3CA mutation analysis in isolated macrodactyly].

Objective: To systematically investigate PIK3CA mutations in isolated macrodactyly. Methods: Overgrowth tissues from 12 isolated macrodactyly patients who were treated at Department of Hand Surgery, Beijing Jishuitan Hospital from May to August 2017 were collected during operation.There were 6 male and 6 female patients with average age of 4.5 years. DNA was tested for PIK3CA mutation using a targeted Sanger DNA sequencing method.Samples with negative Sanger result were tested with a next generation DNA sequencing(NGS)panel targeting 47 cancer hotspot genes including PIK3CA. Results: By targeted Sanger sequencing, PIK3CA mutations were detected in 9 of the 12 patients, with mutation level ranging from 7% to 27%.The PIK3CA mutations observed were p. His1047Arg, p.His1047Leu, p.Glu545Lys, and p. Glu542Lys.NGS found p. Glu453Lys in one additional patient, allowing the total positive rate to 10/12.All PIK3CA mutations detected in the study were cancer hotspot mutations.Among all tissue types tested, adipose tissue had the highest mutation detection rate(9/9), followed by nerve(10/12) and skin(10/12). Conclusions: A high proportion of isolated macrodactyly patients carry a PIK3CA mutation.Adipose, nerve, and skin are ideal tissue resources for PIK3CA mutation detection.Targeted Sanger sequencing with reflex to NGS represents a cost-effective strategy to test PIK3CA mutations in isolated macrodactyly.

NCCN Guidelines Insights: Hepatobiliary Cancers, Version 1.2017.

The NCCN Guidelines for Hepatobiliary Cancers provide treatment recommendations for cancers of the liver, gallbladder, and bile ducts. The NCCN Hepatobiliary Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding locoregional therapy for treatment of patients with hepatocellular carcinoma.

Molecular mapping and candidate gene analysis for resistance to powdery mildew in Cucumis sativus stem.

Powdery mildew (PM) of cucumber (Cucumis sativus), caused by Podosphaera xanthii, is a major foliar disease worldwide and resistance is one of the main objectives in cucumber breeding programs. The resistance to PM in cucumber stem is important to the resistance for the whole plant. In this study, genetic analysis and gene mapping were implemented with cucumber inbred lines NCG-122 (with resistance to PM in the stem) and NCG-121 (with susceptibility in the stem). Genetic analysis showed that resistance to PM in the stem of NCG-122 was qualitative and controlled by a single-recessive nuclear gene (pm-s). Susceptibility was dominant to resistance. In the initial genetic mapping of the pm-s gene, 10 SSR markers were discovered to be linked to pm-s, which was mapped to chromosome 5 (Chr.5) of cucumber. The pm-s gene's closest flanking markers were SSR20486 and SSR06184/SSR13237 with genetic distances of 0.9 and 1.8 cM, respectively. One hundred and fifty-seven pairs of new SSR primers were exploited by the sequence information in the initial mapping region of pm-s. The analysis on the F2 mapping population using the new molecular markers showed that 17 SSR markers were confirmed to be linked to the pm-s gene. The two closest flanking markers, pmSSR27and pmSSR17, were 0.1 and 0.7 cM from pm-s, respectively, confirming the location of this gene on Chr.5. The physical length of the genomic region containing pm-s was 135.7 kb harboring 21 predicted genes. Among these genes, the gene Csa5G623470 annotated as encoding Mlo-related protein was defined as the most probable candidate gene for the pm-s. The results of this study will provide a basis for marker-assisted selection, and make the benefit for the cloning of the resistance gene.

Influence of dietary rapeseed meal levels on growth performance, organ health and standardized ileal amino acid digestibility in meat ducks from 15 to 35 days of age.

This study was conducted to investigate the effects of dietary rapeseed meal (RSM) inclusion levels on growth performance, organ health and standardized ileal amino acid digestibility (SIAAD) in meat ducks from 15 to 35 days of age. Six hundred and eighty 15-days-old ducks were randomly allotted to five treatments based on body weight. Five isonitrogenous and isoenergetic diets were formulated on a digestible amino acid basis by replacing 0% (the control), 25%, 50%, 75% and 100% (based on fresh) of protein from soya bean meal (SBM) with protein from RSM. The corresponding levels of RSM in experimental diets were 0%, 6.66%, 13.32%, 19.98% and 26.64% respectively. With increasing dietary RSM levels, body weight (BW) and average daily gain (ADG) linearly decreased (p < 0.001), whereas feed-to-gain ratio (F: G) linearly increased (p = 0.0078). Ducks fed the diets with 13.32% or more RSM had significantly lower (p < 0.05) BW, ADG and ADFI, or higher F: G than ducks fed the control diet. The maximum limit of dietary RSM supplementation was estimated to range from 4.27% to maximize ADG for 15 to 35 days to 11.69% to maintain feed intake for 15 to 35 days on the basis of a broken-line model. At day35, the 4th primary wing feather length and SIAAD (except for Met, Thr and Val) linearly decreased (p < 0.001), and the thyroid glands weight (% of BW) linearly increased (p < 0.05) with increasing dietary RSM levels. Ducks fed the RSM inclusion diets had significantly lower (p < 0.0001) serum aspartate aminotransferase (AST) and alanine transaminase (ALT) activities than ducks fed the control diet. These results suggested that the maximum limit of dietary RSM containing 7.57 µmol/g glucosinolates was estimated to be 4.27% to avoid growth reduction.

[Bortezomib inhibits hypoxia-induced increase of Orai-1 expression in pulmonary arterial smooth muscle cell].

Objective: In this study, a primary culture system for the rat distal pulmonary arterial smooth muscle cell (PASMC) was established to observe the effect of Bortezomib a treatment on the basal intracellular calcium concentration ([Ca(2+) ](i)), store operated calcium entry (SOCE) and Orai-1 expression in rat PASMC. Methods: We employed the primary culture method for the rat distal PASMC including the enzymatically dissociation of PASMC from the freshly isolated distal pulmonary artery and the culture of PASMC. The In Cyte system was used to measure the basal [Ca(2+) ](i) and SOCE after substantial treatment.Orai-1 protein expression in rat pulmonary artery smooth muscle was detected by Western blot. Results: Compared with Hypoxia group, the basal [Ca(2+) ](i) were significantly reduced in Hypoxia+ BTZ group(P<0.01). The basal [Ca(2+) ](i) A340/A380 ratio of Normoxia group was(1.07±0.02). The basal [Ca(2+) ](i) of Hypoxia group was(1.49±0.03); The Hypoxia+ BTZ group was(1.17±0.03). Compared with Hypoxia group, the store operated calcium entry were significantly reduced in Hypoxia+ BTZ group(P<0.01). The SOCE A340/A380 ratio of Normoxia group was(0.56±0.02). The SOCE of Hypoxia group was(0.84±0.02); The Hypoxia+ BTZ group was(0.66±0.02). The level of Orail-1 protein in pulmonary artery smooth muscle of Hypoxia group was (181.5±12.7)% higher than control group which was(100±0)%, (P<0.05). In the Hypoxia+ BTZ group Orai-1 protein expression was recovered(146.7±15.1)%, (P<0.05). Conclusion: Bortezomib inhibit chronically hypoxic enhancement of Orail-1 protein expression, basal [Ca(2+) ](i) and SOCE in rat distal pulmonary arterial smooth muscle cells.

[Clinical efficacy of enhanced recovery after surgery in atrial caval shunting for type â ¡ Budd-Chiari syndrome].

Objective: To investigate the clinical efficacy of enhanced recovery after surgery(ERAS) in atrial caval shunting (ACS) for type Ⅱ Budd-Chiari syndrome(BCS). Methods: The clinical data of patients underwent ACS for type Ⅱ BCS in the Henan Province People's Hospital from January 2014 to June 2016 were prospectively analyzed.Randomized and single-blind, controlled study was performed among the patients, and all of them underwent ACS and were divided into control group (patients underwent traditional perioperative management) and ERAS group (patients underwent ERAS perioperative management) based on a random number table.Operational and postoperative data, levels of inflammatory cytokines, stress state evaluation and postoperative complications were observed.The comparison between the two groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact. Results: Eighty-two patients were screened for eligibility, and allocated into the control group (40 patients) and the ERAS group (42 patients). All patients underwent ACS successfully with no death.Comparison of intraoperative status: operation time, volume of intraoperative blood and number of patients receiving blood transfusion were (211.0±12.9) minutes vs. (207.7±10.7) minutes, (167.5±28.3) ml vs. (165.0±28.4) ml and 3 cases vs. 1 case between the control group and the ERAS group, respectively, showing no difference between the two groups (t=0.90, 0.29, χ2=0.32, all P>0.05). Comparison of postoperative status: time of gastric tube removal, time of catheter removal, time of chest tube, time to flatus, time of food intake, duration of postoperative infusion, duration of postoperative hospital stay and numeric rating scale were (3.7±0.5)days vs. (0.0±0.0)days, (2.3±0.7)days vs. (1.4±0.5)days, (3.7±0.7)days vs. (2.3±0.5)days, (75.2±3.8)hours vs. (46.6±4.2)hours, (75.7±4.7)hours vs. (21.4±2.1)hours, (10.0±1.0)days vs. (5.8±0.9)days, (11.4±1.0)days vs. (7.8±0.6)days, 2.9±0.4 vs. 1.9±0.6 between the control group and the ERAS group, respectively, with statistically differences (t=35.03, 4.36, 8.10, 22.89, 47.78, 14.75, 14.22, 6.13, all P<0.05). Stress state evaluation: the levels of IR were (2.7±0.1) vs.(2.7±0.1), (8.8±0.7) vs. (5.2±0.3), (11.0±0.5) vs. (7.3±0.5), (4.9±0.2) vs. (3.9±0.1), and the levels of C-reaction protein were (14.6±1.3)mg/L vs.(14.6±1.1) mg/L, (101.2±13.6) mg/L vs. (89.5±6.9) mg/L, (62.7±8.6) mg/L vs. (56.4±8.4) mg/L, (46.4±6.7) mg/L vs. (40.0±5.6) mg/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends(F=136.61, 4.97, both P<0.05). Comparisons of levels of inflammatory cytokines: the levels of IL-6 were (43.1±2.7) ng/L vs. (43.6±3.6) ng/L, (135.1±6.4) ng/L vs. (117.4±5.7) ng/L, (145.4±6.7) ng/L vs. (128.5±5.5) ng/L, (93.3±3.7) ng/L vs. (88.0±3.9) ng/L, and the levels of TNF-α were (10.4±0.3)mmol/L vs. (10.4±0.3) mmol/L, (14.4±0.4) mmol/L vs. (12.6±0.4) mmol/L, (15.6±0.4) mmol/L vs. (13.8±0.4) mmol/L, (12.3±0.7) mmol/L vs. (11.4±0.6) mmol/L from pre-operation to postoperative day 1, 3 and 5 between the control group and the ERAS group, respectively, with statistically significant differences in changing trends (F=15.15, 21.45, both P<0.05). Comparison of postoperative complications: incidence of complications was 30.0%(12/40) in the control group and 11.9%(5/42) in the ERAS group, and the numbers of patients with nausea and vomiting, respiratory complications and cardiovascular complications were 4, 3, 5 cases in the control group and 3, 1, 1 case in the ERAS group, respectively, showing statistically differences in the incidence of complications(χ2=4.08, P<0.05). All the 82 patients were followed up for 2 to 22 months (median time, 12 months), no patients received reoperation or re-admitted to the hospital duo to complications. Conclusion: ERAS management in the perioperative period of ACS for BCS is beneficial to postoperative recovery of patients, and can relieve postoperative stress state and inflammatory response, reduce the duration of hospital stay, and incidence of postoperative complications.