[Risk factors for metabolic bone disease of prematurity in very/extremely low birth weight infants: a multicenter investigation in China].

OBJECTIVE: To investigate the incidence rate and risk factors for metabolic bone disease of prematurity (MBDP) in very low birth weight/extremely low birth weight (VLBW/ELBW) infants. METHODS: The medical data of 61 786 neonates from multiple centers of China between September 1, 2013 and August 31, 2016 were retrospectively investigated, including 504 VLBW/ELBW preterm infants who met the inclusion criteria. Among the 504 infants, 108 infants diagnosed with MBDP were enrolled as the MBDP group and the remaining 396 infants were enrolled as the non-MBDP group. The two groups were compared in terms of general information of mothers and preterm infants, major diseases during hospitalization, nutritional support strategies, and other treatment conditions. The multivariate logistic regression analysis was used to investigate the risk factors for MBDP. RESULTS: The incidence rate of MBDP was 19.4% (88/452) in VLBW preterm infants and 38.5% (20/52) in ELBW preterm infants. The incidence rate of MBDP was 21.7% in preterm infants with a gestational age of < 32 weeks and 45.5% in those with a gestational age of < 28 weeks. The univariate analysis showed that compared with the non-MBDP group, the MBDP group had significantly lower gestational age and birth weight, a significantly longer length of hospital stay, and a significantly higher incidence rate of extrauterine growth retardation (P < 0.05). Compared with the non-MBDP group, the MBDP group had significantly higher incidence rates of neonatal sepsis, anemia, hypocalcemia, and retinopathy of prematurity (P < 0.05). The MBDP group had a significantly lower mean feeding speed, a significantly higher age when reaching total enteral feeding, and a significantly longer duration of parenteral nutrition (P < 0.05). The use rate of caffeine citrate in the MBDP group was significantly higher, but the use rate of erythropoietin was significantly lower than that in the non-MBDP group (P < 0.05). The multivariate logistic regression analysis showed that gestational age < 32 weeks, hypocalcemia, extrauterine growth retardation at discharge, and neonatal sepsis were risk factors for MBDP (P < 0.05). CONCLUSIONS: A lower gestational age, hypocalcemia, extrauterine growth retardation at discharge, and neonatal sepsis may be associated an increased risk of MBDP in VLBW/ELBW preterm infants. It is necessary to strengthen perinatal healthcare, avoid premature delivery, improve the awareness of the prevention and treatment of MBDP among neonatal pediatricians, and adopt positive and reasonable nutrition strategies and comprehensive management measures for preterm infants.

[Detection of periodental pathogens in atherosclerotic lesions in patients].

OBJECTIVE: To detect periodontopathic bacterial DNA in atherosclerotic vascular lesions in a group of Chinese patients by using polymerase chain reaction (PCR) techniques. METHODS: Ten human specimens of atherosclerotic plaque were obtained sterilely. The sclerotic lesions were blade into fine pieces and DNA was isolated from the samples. To detect Porphyromonas gingivalis(Pg), Tannerella forsythia(Tf), Aggregatibacter actinomycetemcomitans(Aa), Prevotella intermedia(Pi), Prevotella nigrescens(Pn), Treponema denticola(Td), Campylobacter rectus(Cr), PCR amplification of bacterial 16S ribosomal DNA (rDNA) was carried out. RESULTS: PCR assays for bacterial 16S rDNA indicated the presence of periodontal pathogens in 3 out of 10 surgical specimens. DNA of Pg were found in 3 samples, Tf was found only in one among the 3 samples and Pn was found in another sample among the 3 samples. CONCLUSION: The data confirm that DNA of periodontal pathogens present in atherosclerotic plaques. Pg, Tf, Pn may play a role in the development and progression of atherosclerosis in these Chinese patients. Further studies with large size samples are needed.

[Combination therapy of periodontal intrabony defects with demineralized freeze-dried bone powder and platelet-rich plasma].

OBJECTIVE: To evaluate the effect of decalcified freeze-dried bone allograft (DFDBA) and DFDBA with platelet-rich plasma (PRP) in the treatment of periodontal infrabony defects. METHODS: Fifteen periodontal infrabony defects (30 sites) in 12 patients with periodontitis (9 patients with chronic periodontitis and 3 patients with aggressive periodontitis) were selected. Three months after initial therapy, they were assigned to either the DFDBA group (10 defects with 20 sites) or the DFDBA with PRP group (5 defects with 10 sites). The patients were evaluated for plaque index (PI), bleeding index (BI), probing depths (PD) and clinical attachment loss (CAL) before the treatment and at 6 months after periodontal bone graft surgery. RESULTS: The PI, BI, PD and CAL in the DFDBA group were 1.7, 2.7, 6.0 mm and 7.0 mm at baseline; 1.5, 1.8, 3.9 mm and 4.4 mm at the 6 months after periodontal surgery. The PD, CAL and BI in DFDBA with PRP group at baseline were 6.2 mm, 7.1 mm and 2.9; 3.2 mm, 3.6 mm and 1.7 at the 6 months after periodontal surgery. The PI did not change significantly after surgery in both groups. While both groups showed significant improvement (P<0.01) in BI, PD and CAL, the improvement in the DFDBA with PRP group was significant greater than in the DFDBA group (P<0.05). CONCLUSION: DFDBA is an effective therapy for periodontal intrabony defects. DFDBA with PRP can significantly improve the clinical effect of periodontal infrabony defects.

[Evaluation of the in vitro quantitative measurement of II degree furcation involvements in mandibular molars by cone-beam computed tomography].

OBJECTIVE: To evaluate the accuracy of measurement of II degree furcation involvements in molars of dry mandibles by cone-beam computed tomography (CBCT). METHODS: Twenty molars with II degree furcation involvements in dry mandibles were examined directly and measured by CBCT. Eight parameters were selected to describe the exact appearance of each II degree furcation involvements, including vertical defect dimensions, horizontal defect dimensions and furcation entrance dimensions. The results were compared with the corresponding data obtained by probing and periapical radiograph. RESULTS: All furcation involvements could be correctly classified by CBCT. For 5 of 8 parameters, no significant difference was found between the data obtained by CBCT and probing measurements (P>0.05). The distances from furcation entrance to alveolar crest, to bottom of bone pocket, and to the deepest site of horizontal bone defect measured by CBCT were less than those probed directly (P<0.05), but the differences were less than 0.5 mm (0.21, 0.24, 0.35 mm, respectively). The localization of furcation entrance may cause the differences. Two out of 20 furcation involvements could not be detected on periapical radiographs, and only 2 of 8 parameters could be measured on periapical radiographs. CONCLUSION: CBCT could provide precise and detailed 3D images of II degree furcation involvements in vitro.

[Effect of periodontal initial therapy on the serum level of lipid in the patients with both periodontitis and hyperlipidemia].

OBJECTIVE: To observe the effect of periodontal initial therapy on the serum level of lipid in the patients with both periodontitis and hyperlipidemia. METHODS: Twenty patients with both hyperlipidemia and moderate to severe chronic periodontitis were enrolled in this study. Periodontal parameters [plaque index (PLI), bleeding on probing (BOP), bleeding index (BI), probing depth (PD) and attachment level (AL)] were evaluated prior to and 3 months after periodontal initial therapy. Simultaneously, the patients' serum levels of total cholesterol, triglyceride, high-lipoprotein cholesterol, low-lipoprotein cholesterol were also measured. RESULTS: (1) Three months after periodontal therapy, the periodontal infection and inflammation in patients reduced comparing with baseline. The PD, PLI, BI, and BOP decreased significantly (the PD, PLI, BI, and BOP reduced from 3.98+/-0.12 to 2.39+/-0.13, 1.23+/-0.10 to 0.84+/-0.08, 2.63+/-0.14 to 1.48+/-0.08 and 94.26+/-1.84 to 33.57+/-2.06, respectively; P<0.05), and the attachment level increased significantly after periodontal treatment (AL decreased from 5.17+/-0.21 to 3.92+/-0.16, P<0.05). (2) The total cholesterol and triglyceride levels in these patients also reduced significantly (reducing 0.25 mmol/L and 0.20 mmol/L respectively, P<0.05) at 3 month after periodontal therapy comparing with baseline. At the same time, high-lipoprotein cholesterol levels in these patients increased significantly (increasing 0.18 mmol/L, P<0.05). Eight out of 20 patients showed their serum levels of lipid down to the normal levels. CONCLUSION: Our observation indicated that periodontal initial therapy could reduce the serum lipid levels of patients with both periodontitis and hyperlipidemia, which might be helpful for decreasing risk of cardiovascular disease such as coronary heart disease.

[Association of Fc gamma receptors IIIA gene polymorphisms with the susceptibility to periodontitis in Chinese patients].

OBJECTIVE: Fc gamma receptors IIIA (Fc gamma RIIIA) mediates phagocytosis by macrophages, and cytokine production by NK cells and lymphocytes. The Fc gamma R IIIA-158V/F polymorphism may play a role in the pathogenesis of periodontitis. This study was to detect Fc gamma R IIIA-158V/F genotypes in Chinese patients with different forms of periodontitis. METHODS: Thirty aggressive periodontitis (AgP) patients (aged from 9 to 40, 13 males and 17 females), 131 chronic periodontitis (CP) patients (aged from 22 to 63, 76 males and 55 females), and 47 healthy subjects (H) (aged from 22 to 75, 21 males and 26 females) consented to participate in this study. Swabs were taken from each subject by ten strokes on the buccal mucosa. DNA was isolated from each swab by Chelex-100 methods. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)was performed to determine the Fc gamma R IIIA-158 genotypes in each groups of subject. RESULTS: The allele frequency was in Hardy-Weinberg equilibrium in our cohort for the V-158F polymorphism in Fc gamma R IIIA gene (P>0.05). The detected frequency of 158F/F in AgP patients was significantly higher than that in CP patients (16.7% vs 0.8%, P<0.05), and also higher than that in H subjects (16.7% vs 4.3%) but was not statistically significant. No significant difference in distribution of the Fc gamma R IIIA-158V/F genotype was found between CP and H groups (P>0.05). CONCLUSION: The distribution of Fc gamma R IIIA-158F/F genotype might have effects on the phenotypes of periodontitis.

Molecular cloning, characterization, and differential expression of a farnesyl-diphosphate synthase gene from the basidiomycetous fungus Ganoderma lucidum.

A farnesyl-diphosphate synthase gene, designated GlFPS, was isolated from a triterpene-producing basidiomycetous fungus, Ganoderma lucidum. The GlFPS cDNA was found to contain an open reading frame of 1,083 bp, encoding a protein of 360 amino acids with a calculated molecular mass of 41.27 kDa. The deduced amino acid sequence of the GlFPS cDNA exhibited a high homology with other fungal FPS genes, and contained four conserved domains. Phylogenetic analysis showed that GlFPS belonged to the basidiomycete FPS group. Competitive PCR revealed that GlFPS was constitutively expressed in the mycelium growth stage, whereas the transcripts of GlFPS accumulated to high levels rapidly during the process of mushroom primordia. Treatment of mycelia with exogenous methyl jasmonate also caused a large accumulation of GlFPS mRNA. Subsequently, promoter analysis indicated that the 5' upstream region of GlFPS possessed various potential regulatory elements associated with physiological and environmental factors. Functional complementation of GlFPS in an ERG20-disrupted yeast strain indicated that the cloned cDNA encoded a farnesyl-diphosphate synthase.

Cloning and characterization of a gene encoding HMG-CoA reductase from Ganoderma lucidum and its functional identification in yeast.

A gene encoding 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGR) was isolated from a triterpene-producing fungus, Ganoderma lucidum (Reishi or Lingzhi). This report provides the complete nucleotide sequence of the full-length cDNA encoding HMGR and its genomic DNA sequence. The cDNA of the HMGR (GenBank Accession no., EU263989) was found to contain an open reading frame (ORF) of 3,681 bp encoding a 1,226-amino-acid polypeptide, whereas the HMGR genomic DNA sequence (GenBank Accession no., EU263990) consisted of 4,262 bp and contained seven exons and six introns. The deduced amino acid sequence of G. lucidum HMGR showed significant homology to the known HMGRs from Ustilago maydis and Cryptococcus neoformans, and contained four conserved domains. Gene expression analysis showed that the expression level was relatively low in mycelia incubated for 10, 12, and 14 d, and reached the highest level in the primordia. Functional complementation of Gl-HMGR in a HMGR-deficient mutant yeast strain indicated that the cloned cDNA encoded a HMG-CoA reductase.

Oral Motor Intervention Improved the Oral Feeding in Preterm Infants: Evidence Based on a Meta-Analysis With Trial Sequential Analysis.

Oral feeding for preterm infants has been a thorny problem worldwide. To improve the efficacy of oral feeding in preterm infants, oral motor intervention (OMI), which consists of nonnutritive sucking, oral stimulation, and oral support, was developed. Published studies demonstrated that OMI may be as an alternative treatment to solve this problem; however, these results remain controversial. We conducted a meta-analysis with trial sequential analysis (TSA) to objectively evaluate the potential of OMI for improving the current status of oral feeding in preterm infants.A search of PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure was performed to capture relevant citations until at the end of October, 2014. Lists of references of eligible studies and reviews were also hand-checked to include any latent studies. Two independent investigators screened literature, extracted data, and assessed the methodology, and then a meta-analysis and TSA was performed by using Reviewer Manager (RevMan) 5.3 and TSA 0.9 beta, respectively.A total of 11 randomized controlled trials (RCTs), which included 855 participants, were incorporated into our meta-analysis. The meta-analyses suggested that OMI is associated with the reduced transition time (ie, the time needed from tube feeding to totally oral feeding) (mean difference [MD], -4.03; 95% confidence interval [CI], -5.22 to -2.84), shorten hospital stays (MD, -3.64; 95% CI, -5.57 to -1.71), increased feeding efficiency (MD, 0.08; 95% CI, 0.36-1.27), and intake of milk (MD, 0.14; 95% CI, 0.06-0.21) rather than weight gain. Results of TSA for each outcomes of interest confirmed these pooled results.With present evidences, OMI can be as an alternative to improve the condition of transition time, length of hospital stays, feeding efficiency, and intake of milk in preterm infants. However, the pooled results may be impaired due to low quality included, and thus, well-designed and large RCTs were needed to further established effects.

Role of Enteral Immunonutrition in Patients Undergoing Surgery for Gastric Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Gastric cancer (GC) is one of the most common upper gastrointestinal malignancies. Surgical resection remains the mainstay of curative treatment for GC. Enteral immunonutrition (EIN) has been increasingly used to enhance host immunity and relieve inflammatory response of patients undergoing surgery for GC; however, conclusions across studies still remain unclear. We aimed to evaluate the effects of EIN for such patients.We searched some electronic databases including PubMed, EBSCO-Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE to identify any latent studies which investigated the effects of EIN compared with standard EN on GC patients who undergoing surgery until the end of December 30, 2014. Relative risk (RR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI) were calculated and we also assessed heterogeneity by using Cochrane Q and I statistic combined with corresponding P-value.We included 9 eligible studies which included 785 patients eventually. The meta-analysis results shown that EIN increased level of IgA (MD, 0.31; 95% CI, 0.12-0.51), IgG (MD, 1.5; 95% CI, 0.73-2.28), IgM (MD, 0.22; 95% CI, 0.06-0.39), CD4 (SMD, 0.81; 95% CI, 0.53-1.09), CD3 (SMD, 0.68; 95% CI, 0.21-1.15), CD4/CD8 ratio (MD, 0.56; 95% CI, 0.12-1.01), and NK cell (MD, 2.35; 95% CI, 0.66-4.05); decreased IL-6 (MD, -98.22; 95% CI, -156.16 to -40.28) and TNF-α (MD, -118.29; 95% CI, -162.00 to -74.58), but not improve remained outcomes of interest involving postoperative complications, length of hospitalization, serum total protein, and CD8. Descriptive analysis suggested that EIN also increased the concentration of IL-2 but not CRP. Impact on lymphocytes remains inconsistent.EIN is effective for enhancing host immunity and relieving the inflammatory response in GC patients undergoing gastrectomy, but clinical outcomes cannot be benefit from it. Heterogeneity caused by different compositions and timing of administration of EIN regimes and not enough sample size and number of eligible studies in most of sensitive analyses with subgroup analysis may impaired the power of our study, and thus some large-scale and well-designed studies are warranted to further establish effects.

Immunonutrition Support for Patients Undergoing Surgery for Gastrointestinal Malignancy: Preoperative, Postoperative, or Perioperative? A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

Enteral immunonutrition (EIN) has been established to be as a significantly important modality to prevent the postoperative infectious and noninfectious complications, enhance the immunity of host, and eventually improve the prognosis of gastrointestinal (GI) cancer patients undergoing surgery. However, different support routes, which are the optimum option, remain unclear. To evaluate the effects of different EIN support regimes for patients who underwent selective surgery for resectable GI malignancy, a Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted. A search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was electronically searched until the end of December 2014. Moreover, we manually checked reference lists of eligible trials and review and retrieval unpublished literature. RCTs which investigated the comparative effects of EIN versus standard enteral nutrition (EN) or different EIN regimes were included if the clinical outcomes information can be extracted from it. A total of 27 RCTs were incorporated into this study. Pair-wise meta-analyses suggested that preoperative (relative risk [RR], 0.58; 95% confidence interval [CI], 0.43-0.78), postoperative (RR, 0.63; 95% CI, 0.52-0.76), and perioperative EIN methods (RR, 0.46; 95% CI, 0.34-0.62) reduced incidence of postoperative infectious complications compared with standard EN. Moreover, perioperative EIN (RR, 0.65; 95% CI, 0.44-0.95) reduced the incidence of postoperative noninfectious complications, and the postoperative (mean difference [MD], -2.38; 95% CI, -3.4 to -1.31) and perioperative EIN (MD, -2.64; 95% CI, -3.28 to -1.99) also shortened the length of postoperative hospitalization compared with standard EN. NMA found that EIN support effectively improved the clinical outcomes of patients who underwent selective surgery for GI cancer compared with standard EN. Our results suggest EIN support is promising alternative for operation management in comparison with standard EN, and perioperative EIN regime is the optimum option for managing clinical status of patients who underwent selective surgery for GI cancer.