Healthcare utilisation and economic burden of migraines among bank employees in China: a probabilistic modelling study.

BACKGROUND: Despite the recognised high prevalence of migraines among bank employees, yet their healthcare utilisation patterns and the economic burden of migraines remain underexplored. AIM: To examine migraine-related healthcare utilisation among bank employees in China, and to estimate the economic burden of migraines. METHODS: A cross-sectional survey was conducted in Guizhou province, China between May and October 2022. The HARDSHIP questionnaire was used to identify migraine-positive individuals and enquire about their healthcare utilisation and productivity losses. A probabilistic decision-analytic model with a micro-costing approach was used to estimate the economic burden from the perspectives of the healthcare system, employers, and society. All costs were expressed in 2022 United States dollars. One-way and probabilistic sensitivity analyses were performed. RESULTS: Nearly half of individuals with migraines reported not seeking medical care. Only 21.8% reported seeking outpatient consultations, 52.5% reported taking medicines, and 27.1% reported using complementary therapies. Chronic migraine patients had significantly higher healthcare utilisation than episodic migraine patients. Among individuals with a monthly migraine frequency of 15 days or more, 63.6% took inappropriate treatments by excessively using acute medications. Migraines in the banking sector in Guizhou cost the healthcare system a median of $7,578.0 thousand (25th to 75th percentile $4,509.2-$16,434.9 thousand) per year, employers $89,750.3 thousand (25th to 75th percentile $53,211.6-$151,162.2 thousand), and society $108,850.3 thousand (25th to 75th percentile $67,370.1-$181,048.6 thousand). The median societal cost per patient-year is $3,078.1. Migraine prevalence and productivity losses were identified as key cost drivers. CONCLUSIONS: The study points to the need to raise awareness of migraines across all stakeholders and to improve the organisation of the migraine care system. A substantial economic burden of migraines on the healthcare system, employers, and society at large was highlighted. These cost estimates offer evidence-based benchmarks for assessing economic savings from improved migraine management, and can also draw the attention of Chinese policymakers to prioritise migraine policies within the banking and other office-based occupations.

Employees of the banking sector in Guizhou Province in China: prevalence of migraine, symptoms, disability and occupational risk factors.

BACKGROUND: Although studies have identified a high prevalence of migraine among employees in the banking sector, the symptoms of migraine, related disability and occupational risk factors are not well understood. AIMS: To determine migraine prevalence, symptoms and disability among bank employees in Guizhou province in China and to examine occupational risk factors associated with migraine positivity and symptoms. METHODS: In a cross-sectional survey, two-stage probability sampling was used to select bank employees in Guizhou province, China. From May to October 2022, uniformly trained interviewers conducted face-to-face interviews using the HARDSHIP questionnaire. Logistic regression was used to examine factors associated with migraine positivity and symptoms. RESULTS: Of 1,985 contactable eligible subjects, 1,929 (male 45.4%, female 54.6%) completed the survey. The one-year prevalence of migraine was 27.2% (95% CI 25.2-29.2%). Of migraine-positive individuals, 11.2% had a monthly frequency ≥ 15 days, 11.8% had an attack duration > 72 h, and 14.9% had severe pain intensity. The median of days lost from work, housework and social activities due to migraine during a three-month period was 4, 3 and 2 days, respectively, with more than half (52.8%) patients reporting Grade III or IV disability. In multivariable analyses, positions in data analysis (OR = 1.8 [95% CI 1.2-2.8], p < 0.01) and information technology (OR = 3.8 [95% CI 1.7-8.3], p < 0.01) were occupational risk factors for migraine positivity. It was also found that professional positions were predictive of migraine attacks ≥ 15 days per month, administrative positions were predictive of duration > 72 h and severe pain intensity of migraine attacks, and working in remote branches was predictive of duration > 72 h. CONCLUSIONS: Migraine is prevalent among employees in the banking sector in Guizhou province in China, with a large proportion of sufferers carrying a high burden of symptoms and disability. The practical implication of this study is that the risk factors identified here could be translated to the focus of workplace monitoring and interventions to manage and prevent migraine.

Novel breeding approach for Japanese flounder using atmosphere and room temperature plasma mutagenesis tool.

BACKGROUND: Artificial induction of mutagenesis is effective for genetic resource innovation and breeding. However, the traditional mutation methods for fish breeding are not convenient or safe for daily use. Hence, development of a simple, safe and effective mutagenesis method with a high mutation rate and applicability to multiple fish species, is needed. RESULTS: We reported the first successful mutagenesis in a marine aquaculture fish species, Japanese flounder, Paralichthys olivaceus, using a novel atmosphere and room temperature plasma (ARTP) mutagenesis tool. ARTP treatment time was optimized for the fertilized eggs and sperm, respectively. Eggs fertilized for 60 min were treated by ARTP with a radio-frequency power input of 120 W, and the ARTP treatment time was 25 min. Under an ARTP radio-frequency power input of 200 W, the optimal treatment time for sperm diluted with Ringer's solution by 1:40 v/v was 10 min. The ARTP-treated group presented differences in morphological traits such as body height, total length among individuals at day 90 after hatching. Whole-genome sequencing was used to reveal the mutation features of ARTP-treated individuals collected at day 120 after hatching. In total, 69.25Gb clean data were obtained from three controls and eight randomly selected ARTP-treated individuals, revealing 240,722 to 322,978 SNPs and 82,149 to 86,798 InDels located in 17,394~18,457 and 12,907~13,333 genes, respectively. The average mutation rate reached 0.064% at the genome level. Gene ontology clustering indicated that genes associated with cell components, binding function, catalytic activity, cellular process, metabolic process and biological regulation processes had higher mutation rates. CONCLUSIONS: ARTP mutagenesis is a useful method for breeding of fish species to accelerate the selection of economically important traits that would benefit the aquaculture industry, given the variety of mutations detected.

[Explorations of epileptic network with cortico-cortical evoked potential].

OBJECTIVE: To evaluate the cortico-cortical evoked potential (CCEP) in exploring the network in epileptics. METHODS: Two patients with intractable epilepsy underwent chronic intracranial electrode placement. According to the distribution of icta onset zones and the functional brain mapping, alternating 1 Hz electrical stimuli were delivered to the target electrodes. And CCEPs were recorded by averaging electrocorticograms time-locked to stimuli from subdural electrodes. Then icta onset zones, eloquent areas identified by electrical cortical mapping and CCEP distributions were compared. RESULTS: Typical CCEP responses were observed. The data of one patient was useful for investigating the connectivity associated with various brain networks while another patient was useful for evaluating the cortical excitability. CONCLUSION: The exploration of epileptic network is achieved through cortico-cortical evoked potential by investigating the connectivity associated with various brain networks and cortical excitability.

Elemental distributions of solid waste collected from the germanium extraction process.

The solid waste produced from the germanium extraction process has attached much attention to its potential germanium sources. However, the elemental distribution of solid waste is still unclear. Therefore, the solid waste was studied using a sequential extraction procedure and characterizations including XRD, FTIR, XPS, SEM-EDS, and XAFS. It has been found that Ca, S, Fe, and Si could present crystal occurrence forms such as calcium sulfate, iron oxide hydroxide, or quartz. Furthermore, Si and Al can form a certain amount of amorphous substance. Accordingly, the sequential leaching results tell that Ca and S can be mostly leached out in pure water or weak acid solution, and more than 50% of Fe, Al, and Si were leached out in the reducible or oxidizable environment. Additionally, a part of S could be associated with Pb, generating a mostly Pb-bearing sulfate structure. Most of Zn was leached out from the reducible step, and only a very small part of Zn presented in the residual state, indicating that the majority of Zn might exist in an oxidation state and a small amount of Zn is associated in the amorphous phase. In terms of Ge, As, and Cr, almost all of them existed in the residual state. Ge should be in the occurrence of Si/Al amorphous structure. Similarly, Cr should be most likely to associate with silicates. Furthermore, As is mainly associated with iron mineral through the formation of the binuclear bidentate corner-sharing complex.

IL-10 promoter polymorphisms affect IL-10 production and associate with susceptibility to acute myeloid leukemia.

We investigated the possible association of Interleukin-10 (IL-10) single nucleotide polymorphisms (SNPs) and susceptibility to acute myeloid leukemia (AML) in 115 AML patients and 137 gender- and age-matched controls. Genetic analysis of IL-10 SNPs at -819 and -592 was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results revealed that the -819AA genotype frequencies and the -819A allele frequencies of AML group were higher than the controls (59.1% vs 40.9%; 75.6% vs 63.9%, respectively); there were remarkable differences in -819T/C and -592A/C gene distribution (P<0.05) and the TA haploid frequencies were higher in AML group (75.6% vs 63.9%, P<0.05). The IL-10 mRNA expression of AML patients and controls with different genotype was detected by Real-time quantitative Polymerase Chain Reaction (RT-PCR). IL-10 mRNA expression in incipient AML patients increased obviously compared with the non-tumor group and remission group (P<0.05). Further analysis suggested that the IL-10 mRNA expression of TA/TA genotype was the lowest and CC/CC genotype was the highest; the haploid TA and genotype TA/TA may be associated with AML. The research suggested the IL-10 SNPs at -819 and -592 sites were associated with AML and may affect the IL-10 mRNA expression in AML patients in Han people of Hunan province.

Effects of a feedback intervention on antibiotic prescription control in primary care institutions based on a Health Information System: a cluster randomized cross-over controlled trial.

OBJECTIVES: Overuse and misuse of antibiotics are major factors in the development of antibiotic resistance in primary care institutions of rural China. In this study, the effectiveness of a Health Information System-based, automatic, and confidential antibiotic feedback intervention was evaluated. METHODS: A randomized, cross-over, cluster-controlled trial was conducted in primary care institutions. All institutions were randomly divided into two groups and given either a three-month intervention followed by a three-month period without any intervention or vice versa. The intervention consisted of three feedback measures: a real-time pop-up warning message of inappropriate antibiotic prescriptions on the prescribing physician's computer screen, a 10-day antibiotic prescription summary, and distribution of educational manuals. The primary outcome was the 10-day inappropriate antibiotic prescription rate. RESULTS: There were no significant differences in inappropriate antibiotic prescription rates (69.1% vs. 72.0%) between two groups at baseline (P = 0.072). After three months (cross-over point), inappropriate antibiotic prescription rates decreased significantly faster in group A (12.3%, P < 0.001) compared to group B (4.4%, P < 0.001). At the end point, the inappropriate antibiotic prescription rates decreased in group B (15.1%, P < 0.001) while the rates increased in group A (7.2%, P < 0.001). The characteristics of physicians did not significantly affect the rate of antibiotic or inappropriate antibiotic prescription rates. CONCLUSION: A Health Information System-based, real-time pop-up warnings, a 10-day prescription summary, and the distribution of educational manuals, can effectively reduce the rates of antibiotic and inappropriate antibiotic prescriptions.

Development and Application of a Reference Manual for Diagnosis and Rational Use of Antimicrobial Agents for Outpatient Primary Care (Digestive System Part): A Delphi Study.

Purpose: To establish a concise and easy-to-understand reference manual for outpatient primary care providers, promoting correct diagnosis of digestive system diseases and rational antimicrobial use. Methods: The establishment of the manual encompassed two processes: the development of a draft manual and the validation of the manual. The development process was based on a literature review and expert discussion. The manual comprises portions for disease diagnosis and rationality of antimicrobial use. The validation process employed a two-round Delphi technique, collecting consensus through paper-based or mail-based communications. The response of the Delphi group was assessed by the level of authority and commitment of the panelists and the degree of agreement among them. Furthermore, the manual was preliminarily applied among primary care physicians. Results: A total of 29 panelists completed the Delphi working process. They were authoritative in their professional fields with authority coefficients of 0.813 and 0.818 for the two portions of the manual, respectively. The level of commitment of the panelists was measured by response rates, which were 100.00% and 96.67% for Round 1 and 2. After two rounds, a consensus was achieved with the consensus rates for the two portions of the manual being greater than 65% and 70%, respectively. Kendall W-tests had P-values < 0.001 in both rounds. This reference manual provides 200 diagnostic indicators for 29 common digestive diseases and recommendations for the rational use of antimicrobial agents for 13 categories of digestive diseases. The primary care physicians who used the reference manual reported high satisfaction and frequent usage. Conclusion: Based on a collective consensus of professionals, a reference manual has been established, to provide a concise and easy-to-understand guide specifically for physicians and pharmacists in outpatient primary care. It could facilitate rapid learning to improve the accuracy of diagnosis and treatment for digestive disorders.

Association between Migraine and Workplace Social Support in the Social Context of China: Using a Validated Chinese Version of the DCSQ.

BACKGROUND: Workplace social support might have a protective function against migraine in the social context of China, as close co-worker relationships and collectivism are acknowledged as work values in Chinese society. OBJECTIVES: This paper aimed to analyse the association between migraine and workplace social support. The validity and reliability of the Chinese version of the Support scale of the Demand-Control-Support Questionnaire (DCSQ) used were also determined. METHODS: Following international guidelines, this study was carried out in two stages. Stage I involved translations and pilot testing to assess content and face validity of the Chinese version of the DCSQ Support scale. Stage II was a cross-sectional survey (N = 677 bank employees) to evaluate structural validity, internal consistency and test-retest reliability of the Support scale, as well as to examine the association between workplace social support and a migraine-positive diagnosis. RESULTS: A high level of social support in the workplace was associated with a 74% decreased likelihood of migraine (adjusted OR = 0.26, 95%CI: 0.14-0.46). Of the six aspects of workplace social support, co-worker support had the greatest protective effect (adjusted OR = 0.49, 95% CI: 0.39-0.60). The Chinese version of the DCSQ Support scale established satisfactory content and face validity (I-CVIs ≥ 0.78; S-CVIAVE ≥ 0.90). Confirmatory factor analysis verified its one-dimensional theoretical factor, with adequate internal consistency (Cronbach's α 0.98; item-total correlations ≥ 0.80) and test-retest reliability (weighted Kappa coefficients 0.81-0.87; percentages agreement 85.23-88.92%). CONCLUSIONS: In the Chinese social context, workplace social support could protect against migraine, with the strongest benefit coming from co-workers. This study also provides a Chinese-language DCSQ Support scale as a valid and reliable instrument for measuring workplace social support.

Trends and Patterns of Antibiotic Prescriptions in Primary Care Institutions in Southwest China, 2017-2022.

Purpose: To explore the prescription patterns and usage trends of antibiotics within primary care institutions located in underdeveloped regions of China from 2017 to 2022. Methods: A retrospective analysis of antibiotic prescriptions was conducted from 25 primary care institutions in Guizhou Province during the period of 2017-2022. Antibiotic prescriptions were categorized into appropriate and inappropriate use. Appropriate use is further categorized into preferred medication, and antibiotics can be used or substituted. Inappropriate use is further categorized into unnecessary use, incorrect spectrum of antibiotics and combined use of antibiotics. Factors associated with inappropriate use were investigated using generalized estimation equations. Holt-Winters and SARIMA models were employed to predict the number of inappropriate antibiotic prescriptions as the alternative model. Results: A total of 941,924 prescriptions were included, revealing a decreasing trend in both the number and inappropriate rates of antibiotic prescriptions from 2017 to 2022. Diseases of the respiratory system (70.66%) was the most frequent target of antibiotic use, with acute upper respiratory infections of multiple and unspecified sites representing 52.04% of these cases. The most commonly used antibiotics were penicillins (64.44%). Among all prescriptions, inappropriate antibiotic prescriptions reached 66.19%. Physicians aged over 35, holding the title of associate chief physician and possessing more than 11 years of experience were more likely to prescribe antibiotics inappropriately. The phenomenon of inappropriate antibiotic use was commoner among children aged five or younger. By comparing model parameters, it was determined that the SARIMA model outperforms the Holt-Winters model in predicting the number of inappropriate antibiotic prescriptions among primary care institutions. Conclusion: The number and inappropriate rates of antibiotic prescriptions in southwest China exhibited a downward trend from 2017 to 2022, but inappropriate prescription remains a serious problem in primary care institutions. Therefore, future efforts should focus on strengthening physician education, training, and clinical practice. Additionally, physicians' awareness of common misconceptions about inappropriate antibiotic use must be improved, and the prescribing behavior of physicians who fulfill patients' expectations by prescribing antibiotics needs to be modified.

Validation studies on migraine diagnostic tools for use in nonclinical settings: a systematic review.

BACKGROUND: Migraine underdiagnosis and undertreatment are so widespread, that hence is essential to diagnose migraine sufferers in nonclinical settings. A systematic review of validation studies on migraine diagnostic tools applicable to nonclinical settings can help researchers and practitioners in tool selection decisions. OBJECTIVE: To systematically review and critically assess published validation studies on migraine diagnostic tools for use in nonclinical settings, as well as to describe their diagnostic performance. METHODS: A multidisciplinary workgroup followed transparent and systematic procedures to collaborate on this work. PubMed, Medline, and Web of Science were searched for studies up to January 17, 2022. The QUADAS-2 was employed to assess methodological quality, and the quality thresholds adopted by the Global Burden Disease study were used to tail signaling questions. RESULTS: From 7,214 articles identified, a total of 27 studies examining 19 tools were eligible for inclusion. There has been no high-quality evidence to support any tool for use of migraine diagnosis in nonclinical settings. The diagnostic accuracy of the ID-migraine, structured headache and HARDSHIP questionnaires have been supported by moderate-quality evidence, with sensitivity and specificity above 70%. Of them, the HARDSHIP questionnaire has been the most extensively validated. The remaining 16 tools have provided poor-quality evidence for migraine diagnosis in nonclinical populations. CONCLUSIONS: Up till now, the HARDSHIP questionnaire is the optimal choice for diagnosing migraine in nonclinical settings, with satisfactory diagnostic accuracy supported by moderate methodological quality. This work reveals the crucial next step, which is further high-quality validation studies in diverse nonclinical population groups.

ANTECEDENTES: O sub-diagnóstico e o subtratamento da enxaqueca são tão difundidos que, portanto, é essencial para diagnosticar os portadores de enxaqueca em ambientes não-clínicos. Uma revisão sistemática dos estudos de validação das ferramentas de diagnóstico da enxaqueca aplicáveis a ambientes não-clínicos pode ajudar os pesquisadores e profissionais nas decisões de seleção de ferramentas. OBJETIVO: Revisar sistematicamente e avaliar criticamente estudos de validação publicados sobre ferramentas de diagnóstico da enxaqueca para uso em ambientes não-clínicos, bem como descrever seu desempenho diagnóstico. MéTODOS: Um grupo de trabalho multidisciplinar seguiu procedimentos transparentes e sistemáticos para colaborar neste trabalho. PubMed, Medline e Web of Science foram pesquisados por estudos até 17 de janeiro de 2022. O QUADAS-2 foi empregado para avaliar a qualidade metodológica, e os limites de qualidade adotados pelo estudo da Global Burden Disease foram usados para responder a questões de sinalização. RESULTADOS: De 7.214 artigos identificados, um total de 27 estudos examinando 19 ferramentas foram elegíveis para inclusão. Não houve evidência de alta qualidade para apoiar qualquer ferramenta para o uso de diagnóstico de enxaqueca em ambientes não clínicos. A precisão diagnóstica do ID-Migraine, questionário de dor de cabeça estruturada e questionário HARDSHIP foram apoiados por evidências de qualidade moderada, com sensibilidade e especificidade acima de 70%. Deles, o questionário HARDSHIP foi o mais amplamente validado. As 16 ferramentas restantes forneceram provas de má qualidade para o diagnóstico de enxaqueca em populações não-clínicas. CONCLUSõES: Até agora, o questionário HARDSHIP é a escolha ideal para o diagnóstico da enxaqueca em ambientes não-clínicos, com precisão diagnóstica satisfatória apoiada por uma qualidade metodológica moderada. Este trabalho revela o próximo passo crucial, que é a realização de mais estudos de validação de alta qualidade em diversos grupos populacionais não-clínicos.

[Effects of spectral resolution and noise on the measurement of indices].

In the present paper, we analysed the effects of spectral resolutions and signal-to-noise ratios (SNRs) on 19 atomic absorption line indices of Lick index system. First of all, adopting method of convolving a spectrum with a Gaussian profile, we transformed spectra into those under different resolutions and then measured the line indices on them. Comparisons of the indices under various resolutions allow to investigate the impact of spectral resolution change on the accuracy of measurements of indices. Secondly, by adding random noises with different Gaussian distribution to a spectrum, the authors transformed theoretical spectra with no noises into those under diverse SNRs and then measured line indices on them. Comparisons of the indices under different SNRs greatly helped analyse the influence of SNR on the precision of the measurements of line indices. It comes from comparisons and analysis that the spectral resolution change can cause an index measurement change depending on the extent of the change of spectral resolution. Such a kind of change relationship varies with the indices. The lower the SNR, the less precise the measurements of indices. The effect of SNR on the measurements of indices can be ignored if SNR is larger than 25.

Visual quality analysis using the Chinese Catquest-9SF scale following different spherical aberration IOL implantation.

Purpose: Based on the Chinese version of the Catquest-9SF scale, the contrast sensitivity meter and wavefront aberrometer were used to evaluate the visual quality of cataract patients implanted with different spherical aberrations IOL. Design: Retrospective Observational Study. Methods: Patients who had the lens implantation in our department from January 2020 to December 2021 were enrolled. All patients underwent uncorrected visual acuity, best corrected visual acuity and slit lamp microscope, high-order aberrations and contrast sensitivity test. The KR-1W wavefront analyzer (Topcon Medical System, Tokyo, Japan) was used to measure wavefront aberrations post-operation. The Chinese Catquest-9SF scale was used to score the postoperative visual satisfaction of the patients. Results: 145 patients were screened according to the exclusion criteria, including 51 patients in the zero aspherical IOL (SOFTEC HD) group, 42 patients in the negative aspherical IOL (ZCB00) group, and a total of 52 patients in the spherical IOL (HQ-201HEP) group. The score was the highest in the zero spherical aberration group, followed by the negative spherical aberration group with the lowest scores in the spherical IOL group. Higher-order aberrations are relatively low in eyes implanted with the zero spherical aberration group. Contrast sensitivity with spherical lenses under glare-free and glare conditions was lower than those with aspheric lenses, and at higher frequencies the zero-aberration aspheric lens performed the best. Conclusion: The Chinese Catquest-9SF scale provides an indication of visual quality after aspheric IOL implantation.

Unveiling the risks and critical mechanisms of polyhexamethylene guanidine on the antibiotic resistance genes propagation during sludge fermentation process.

This study mainly investigated the environmental risks of polyhexamethylene guanidine (PHMG) occurred in waste activated sludge (WAS) on the antibiotic resistance genes (ARGs) spread during anaerobic fermentation, and disclosed the critical mechanisms. The total ARGs abundance was increased by 32.2-46.4% at different stressing levels of PHMG. The main resistance mechanism categories of ARGs shifted to the target alternation and efflux pump. PHMG disintegrated WAS structure and increased the cell permeability, which benefitted the mobile genetic elements (MGEs) release and horizontal transfer of ARGs. Besides, PHMG induced the enrichment of potential ARGs hosts (i.e., Burkholderia, Bradyrhizobium and Aeromonas). Moreover, PHMG upregulated the metabolic pathways (i.e., two-component system, quorum sensing, and ATP-binding cassette transporters) and critical genes expression (i.e., metN, metQ, rpfF, rstA and rstB) related with ARGs generation and dissemination. Structural equation model analysis revealed that microbial community structure was the predominant contributor to the ARGs propagation.

Protective effect of paeoniflorin against oxidative stress in human retinal pigment epithelium in vitro.

PURPOSE: This study was conducted to determine whether paeoniflorin (PF) could prevent H2O2-induced oxidative stress in ARPE-19 cells and to elucidate the molecular pathways involved in this protection. METHODS: Cultured ARPE-19 cells were subjected to oxidative stress with H2O2 in the presence and absence of PF. The preventive effective of PF on reactive oxygen species (ROS) production and retinal pigment epithelium (RPE) cell death induced by H2O2 was determined by 2',7'- dichlorodihydrofluorescein diacetate (H2DCFDA) fluorescence and 3-(4, 5-dimethylthiazol-2-yl)-2, 5 diphenyl tetrazolium bromide (MTT) assay. The ability of PF to protect RPE cells against ROS-mediated apoptosis was assessed by caspase-3 activity and 4', 6-diamidino-2-phenylindole (DAPI) staining. Furthermore, the protective effect of PF via the mitogen-activated protein kinase (MAPK) pathway was determined by western blot analysis. RESULTS: PF protected ARPE-19 cells from H2O2-induced cell death with low toxicity. H2O2-induced oxidative stress increased ROS production and caspase-3 activity, which was significantly inhibited by PF in a dose-dependent manner. Pretreatment with PF attenuated H2O2-induced p38MAPK and extracellular signal regulated kinase (ERK) phosphorylation in human RPE cells, which contributed to cell viability in ARPE-19 cells. CONCLUSIONS: This is the first report to show that PF can protect ARPE-19 cells from the cellular apoptosis induced by oxidative stress. The results of this study open new avenues for the use of PF in treatment of ocular diseases, such as age-related macular degeneration (AMD), where oxidative stress plays a major role in disease pathogenesis.

Clinical analysis of misdiagnosis in 70 children with primary hypothyroidism.

OBJECTIVE: To analyze the causes of misdiagnosis of primary hypothyroidism (PH), with an attempt to reduce the misdiagnosis or mistreatment. METHODS: Totally 70 PH children with a history of misdiagnosis but whose conditions were confirmed in Peking Union Medical College Hospital and the First Hospital of Jilin University from July 2000 to May 2009 were enrolled in this study. The clinical data were collected and the causes of misdiagnoses were analyzed. RESULTS: Of these 70 patients, 19 were misdiagnosed as anaemia and dystrophy, 18 as pituitary tumors, 10 as adiposities, 6 as myocarditis or pericardial effusion, 4 as Downs syndrome, 3 as hepatitis, 3 as amyasthenia, 3 as cerebral palsy, 2 as cystis thyrolingualis, and 2 as congenital megacolon. The duration of misdiagnoses ranged from 6 to 72 months. The clinical manifestations of these patients were complicated, involving multiple organs and systems. CONCLUSIONS: PH has complicated clinical manifestations and individual variations, and therefore can be easily misdiagnosed. Good knowledge, sufficient history-taking, and cautious physical examinations can help avoid misdiagnosis. Neonatal screening is helpful for diagnosis and treatment of congenital hypothyroidism.

Surgical treatment of patients with drug-resistant hypermotor seizures.

PURPOSE: To describe the clinical, electrophysiologic, neuroradiologic, and histologic findings in our patients with drug-resistant hypermotor seizures (HMSs) and to evaluate the outcome of their surgical treatment. METHODS: Twenty-three patients were identified by criteria for drug-resistant HMS. Surgical treatment and presurgical evaluation modalities including semiology, magnetic resonance imaging (MRI), interictal/ictal scalp video-EEG (electroencephalography), and intracranial recording were analyzed retrospectively. RESULTS: The common seizure frequency of 60-300 per month was observed among 15 patients. Sixteen patients (69.6%) experienced auras such as fear and palpitation. Marked agitation was observed in 12 patients and mild agitation in 11 patients. Groaning/shouting and asymmetric posturing were common accompanying symptoms. Asymmetric posturing was observed more often in patients with mild agitation than in those with marked agitation (p = 0.027). MRI detected focal abnormalities in six patients. Intracranial recording was conducted in 16 patients. The origins of seizures were localized in mesial frontal cortex in four patients, dorsolateral frontal cortex in four patients, and mesial temporal cortex in two patients. The epileptogenic zones (EZs) were resected from the frontal lobe in 21 patients and from the temporal lobe in 2 patients. The follow-up ranged from 12-60 months. Seventeen patients (73.9%) had been seizure-free, 11 of whom had presented with marked agitation (11 of 12) and 6 with mild agitation (6 of 11) (p = 0.069). Histologic examinations demonstrated focal cortical dysplasia (FCD) in 18 patients. DISCUSSION: The HMSs can originate from both the mesial and dorsolateral frontal cortex, and occasionally from the temporal lobe. Patients with drug-resistant HMSs should be recommended for resective surgical treatment.

Substrate elasticity regulates vascular endothelial growth factor A (VEGFA) expression in adipose-derived stromal cells: Implications for potential angiogenesis.

Adipose-derived stromal cells (ASCs) have potential in bioengineering angiogenesis due to their paracrine role in supporting endothelial tubulogenesis and vascular network formation. However, the precise mechanism of the inner angiogenic capacity of ASCs determined by the biophysical properties of the extracellular matrix needs to be further elucidated. In the current study, we fabricated two silicon-based elastomer polydimethylsiloxane (PDMS) substrates with different stiffnesses (stiff substrate, E = 195 kPa and soft substrate, E = 15 kPa) and found there were cytoskeletal changes in ASCs in response to different substrate stiffnesses. We then showed the expression of vinculin in focal adhesion plaques was enhanced and the nuclear translocation of ß-catenin signaling was increased in ASCs on the stiff substrate relative to those on the soft substrate. We next used bioinformatics and found the downstream proteins of ß-catenin signaling had binding sites in the promoter of vascular endothelial growth factor A (VEGFA), which is responsible for angiogenesis; then, we further confirmed the enhanced endogenous VEGFA expression in ASCs on the stiff substrate relative to that on the soft substrate. Finally, by using ectogenic VEGFA, we showed the stiff substrate could promote angiogenesis of ASCs in the form of more ring-like formations in 2D and vessel-like structure formations in 3D under VEGFA induction compared to that of the soft substrate. This study not only indicates the inner angiogenic capacity of ASCs but also elucidates the influence of substrate elasticity on ASC differentiation in bioengineering angiogenesis.

Significance of radiology in the diagnosis and management of ruptured left gastric artery aneurysm associated with acute pancreatitis: Case report.

RATIONALE: Left gastric artery aneurysms are very rare which progresses into hemorrhagic shock and diagnosis is very challenging particularly in patients with acute pancreatitis and cholecystitis whose vitals become unstable suddenly. PATIENT CONCERNS: A 72-year-old female has presented with severe progressing abdominal pain was treated with total parenteral nutrition for acute pancreatitis based on preliminary work up, but suddenly became unstable with dropping vitals over the ensuing 48 hours. Physical examination has a positive Murphy sign and appeared lethargic. She has no past history of any chronic systemic illness or malignancy. DIAGNOSES: Ruptured left gastric artery aneurysm and left hepatic artery aneurysm with intraperitoneal hemorrhage associated with acute pancreatitis and cholecystitis. INTERVENTIONS: Emergency interventional surgery was performed to embolize both the aneurysms and the giant aneurysmal sac of the left gastric artery was secured with a micrometallic occluding coil which eventually controlled the active hemorrhage. OUTCOMES: The patient became stable and was discharged after 15 days without any recurrence or complications during the 6-month follow-up. LESSONS: This case is a peculiar example of a missed diagnosis of left gastric artery aneurysm associated with acute pancreatitis and cholecystitis with deteriorating clinical condition. Exhaustive radiological investigations are necessary for early diagnosis correlating with presenting clinical situations. Radiologists should be familiar with the challenges in diagnosis and management.

[Construction of CyclinD (-/-)/Patched (+/-) double knockout mice].

OBJECTIVE: To construct CyclinD (CycD) (-/-)/Patched (Ptc) (+/-) double knockout mice to study the relationship between Hedgehog and Rb signaling pathways. METHODS: Amphimixis was performed between female heterozygote CycD knockout mice CycD (+/-) and male heterozygote Ptc knockout mice Ptc (+/-), thus CycD (+/-)/Ptc (+/-) double knockout mice were obtained. These mice underwent secondary matched and thus construct CycD (-/-)/Ptc (+/-) double knockout mice. RESULTS: CycD (-/-)/Ptc (+/-) double knockout mice, CycD (+/-)/Ptc (+/-) heterozygote double knockout mice, and CycD knockout mice CycD (-/-)/Ptc (+/+) were gained. CONCLUSION: The method of amphimixis can construct CycD (--)/Ptc (+/-) double knockout mice that can be used to disclose the regulation between Ptc gene and CycD gene and the relativity between Hedgehog and Rb pathways in mammals.