Tumor burden score-AFP-albumin-bilirubin grade score predicts the survival of patients with hepatocellular carcinoma after liver resection.

PURPOSE: There is little information regarding the overall survival (OS) predictive ability of the combination of tumor burden score (TBS), α-fetoprotein (AFP), and albumin-bilirubin (ALBI) grade for patients with hepatocellular carcinoma (HCC). Here, we aimed to develop a model including TBS, AFP, and ALBI grade to predict HCC patient OS following liver resection. METHODS: Patients (N = 1556) from six centers were randomly divided 1:1 into training and validation sets. The X-Tile software was used to determine the optimal cutoff values. The time-dependent area under the receiver operating characteristic curve (AUROC) was calculated to assess the prognostic ability of the different models. RESULTS: In the training set, tumor differentiation, TBS, AFP, ALBI grade, and Barcelona Clinic Liver Cancer (BCLC) stage were independently related to OS. According to the coefficient values of TBS, AFP, and ALBI grade, we developed the TBS-AFP-ALBI (TAA) score using a simplified point system (0, 2 for low/high TBS, 0, 1 for low/high AFP and 0,1 for ALBI grade 1/2). Patients were further divided into low TAA (TAA ≤ 1), medium TAA (TAA = 2-3), and high TAA (TAA= 4) groups. TAA scores (low: referent; medium, HR = 1.994, 95% CI = 1.492-2.666; high, HR = 2.413, 95% CI = 1.630-3.573) were independently associated with patient survival in the validation set. The TAA scores showed higher AUROCs than BCLC stage for the prediction of 1-, 3-, and 5-year OS in both the training and validation sets. CONCLUSION: TAA is a simple score that has better OS prediction performance than the BCLC stage in predicting OS for HCC patients after liver resection.

Insights into the dewatering of excavated landfill sludge conditioned by polyferric silicate sulfate.

Large quantities of landfill sludge (LS) with higher water content (WC) were stored underground, and excavation and re-dewatering of LS is a sustainable and economic strategy to save landfill space and reduce the leaching of contaminants. In this study, polyferric silicate sulfate (PFSS) was first applied in the conditioning of excavated LS, and the effects of the Si/Fe mass ratio and PFSS dosage on physicochemical properties, dewaterability and rheological properties were investigated. At the best Si/Fe of 0.18, PFSS conditioning obtained compact aggregates with the strongest internal structure, thus achieving the lowest WC. Large sludge flocs were formed, and slime and loosely-bound extracellular polymeric substances were effectively removed with the PFSS dosage above 100 mg/g dried solids, which made the WC to be lower than 51.4%. The whole mechanical compression process of conditioned LS can be described by the modified Terzaghi-Voigt model, and increasing the PFSS dosage induced the release of bound water and migration of the consolidation stage from ternary to secondary. PFSS is an economically sustainable conditioner for LS, integrating multiple functions such as charge neutralization, particle aggregation, interparticle bridging and skeleton building in one chemical.

A full-scale survey of sludge landfill: sludge properties, leachate characteristics and microbial community structure.

In this study, a full-scale survey was conducted of a sludge landfill that had been sealed for 10 years to investigate sludge properties, leachate characteristics and microbial community structure. Vertical distribution of sludge and leachate pollutants in the landfill site showed that the sludge and soluble pollutants in the leachate were both distributed almost evenly even after long-term anaerobic digestion, and higher concentrations of soluble pollutants and richness of microbial community were observed at the middle layer. Compared to dewatered excess sludge generated from the activated sludge process before landfill, landfill sludge had a much lower organic content (28.1%), smaller particle size and worse dewaterability. Compared to municipal waste landfill, sludge landfill generated leachate with a lower concentration of organic substances, and comparable concentrations of nitrogenous and phosphorus pollutants. Bacterial community analysis by Illumina MiSeq sequencing showed that Proteobacteria, Firmicutes, Chloroflexi, Actinobacteria and Bacteroidetes were the major phyla, and some new genera (Methylocystaceae, Mariniphaga and Aminicenantes) were enriched in the sludge landfill. Archaeal community analysis showed that aceticlastic methanogenesis by Methanosaeta and Methanosarcina was the main pathway for methane production in the sludge landfill, in contrast to waste landfill with hydrogenotrophic methanogenesis as the main pathway.

Transient folate deprivation in combination with small-molecule compounds facilitates the generation of somatic cell-derived pluripotent stem cells in mice.

Induced pluripotent stem cells (iPSCs) can be propagated indefinitely, while maintaining the capacity to differentiate into all cell types in the body except for the extra-embryonic tissues. This iPSC technology not only represents a new way to use individual-specific stem cells for regenerative medicine but also constitutes a novel method to obtain large numbers of disease-specific cells for biomedical research. However, the low efficiency of reprogramming and genomic integration of oncogenes and viral vectors limit the potential application of iPSCs. Chemical-induced reprogramming offers a novel approach to generating iPSCs. In this study, a new combination of small-molecule compounds (SMs) (sodium butyrate, A-83-01, CHIR99021, Y-27632) under conditions of transient folate deprivation was used to generate iPSC. It was found that transient folate deprivation combined with SMs was sufficient to permit reprogramming from mouse embryonic fibroblasts (MEFs) in the presence of transcription factors, Oct4 and Klf4, within 25 days, replacing Sox2 and c-Myc, and accelerated the generation of mouse iPSCs. The resulting cell lines resembled mouse embryonic stem (ES) cells with respect to proliferation rate, morphology, pluripotency-associated markers and gene expressions. Deprivation of folic acid, combined with treating MEFs with SMs, can improve the inducing efficiency of iPSCs and reduce their carcinogenicity and the use of exogenous reprogramming factors.

Safety of nighttime elective hepatectomy for hepatocellular carcinoma patients: a retrospective study.

Purpose: This study aimed to investigate whether nighttime elective surgery influenced the short-term outcomes and prognosis of hepatocellular carcinoma (HCC) patients. Methods: The 1,339 HCC patients who underwent hepatectomy were divided into the daytime surgery group (8 a.m.-6 p.m., n = 1,105) and the nighttime surgery group (after 6 p.m., n = 234) based on the start time of surgery. The 1:2 propensity score matching (PSM) analysis was used to control confounding factors. The short-term outcomes of HCC patients in the 2 groups were compared before and after PSM. Factors associated with major complications (Clavien-Dindo grade, ≥III) and textbook oncologic outcomes (TOO) were separately identified by multivariable logistic regression based on variables screened via least absolute shrinkage and selection operator (LASSO). The Kaplan-Meier method was used to analyze overall survival (OS) and recurrence-free survival (RFS). Results: TOO was achieved after surgery in 897 HCC patients. HCC patients in the nighttime surgery group had a higher body mass index (P = 0.010). After 1:2 PSM, the baseline characteristics of patients between the 2 groups were similar. Short-term outcomes in HCC patients were comparable both before and after PSM (all Ps > 0.05), as were TOO in the 2 groups before (P = 0.673) and after PSM (P = 0.333). In our LASSO-logistic regression, nighttime surgery was not an independent factor associated with major complications or TOO. Both groups also had similar OS (P = 0.950) and RFS (P = 0.740) after PSM. Conclusion: Our study revealed the safety of nighttime elective hepatectomy for HCC patients.

PIVKA-II combined with tumor burden score to predict long-term outcomes of AFP-negative hepatocellular carcinoma patients after liver resection.

BACKGROUND: This study aimed to establish a simple prognostic scoring model based on tumor burden score (TBS) and PIVKA-II to predict long-term outcomes of α-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC) patients. METHODS: 511 patients were divided into the training cohort (n = 305) and the validation cohort (n = 206) at a ratio of 6:4. Receiver operating characteristic curves (ROC) were established to identify cutoff values of TBS and PIVKA-II. Kaplan-Meier curves were used to analyze survival outcomes. The multivariable Cox regression was used to identify variables independently associated with survival outcomes. The predictive performance of the TBS-PIVKA II score (TPS) model was compared with Barcelona clinic liver cancer (BCLC) stage and American Joint Committee on Cancer (AJCC TNM) stage. RESULTS: The present study established the TPS model using a simple scoring system (0, 1 for low/high TBS [cutoff value: 4.1]; 0, 1 for low/high PIVKA-II [cutoff value: 239 mAU/mL]). The TPS scoring model was divided into three levels according to the summation of TBS score and PIVKA-II score: TPS 0, TPS 1, and TPS 2. The TPS scoring model was able to stratify OS (training: p < 0.001, validation: p < 0.001) and early recurrence (training: p < 0.001; validation: p = 0.001) in the training cohort and the validation cohort. The TPS score was independently associated with OS (TPS 1 vs. 0, HR: 2.28, 95% CI: 1.01-5.17; TPS 2 vs. 0, HR: 4.21, 95% CI: 2.01-8.84) and early recurrence (TPS 1 vs. 0, HR: 3.50, 95% CI: 1.71-7.16; TPS 2 vs. 0, HR: 3.79, 95% CI: 1.86-7.75) in the training cohort. The TPS scoring model outperformed BCLC stage and AJCC TNM stage in predicting OS and early recurrence in the training cohort and the validation cohort. But the TPS scoring model was unable to stratify the late recurrence in the training cohort (p = 0.872) and the validation cohort (p = 0.458). CONCLUSIONS: The TPS model outperformed the BCLC stage and AJCC TNM stage in predicting OS and early recurrence of AFP-negative HCC patients after liver resection, which might better assist surgeons in screening AFP-negative HCC patients who may benefit from liver resection.

Under-loaded operation of an anaerobic-anoxic-aerobic system in dry and wet weather dynamics to prevent overflow pollution: Impacts on process performance and microbial community.

Effects of low hydraulic loading rate (HLR) in dry weather and high HLR in wet weather on pollutant removal, microbial community, and sludge properties of a full-scale wastewater treatment plant (WWTP) were extensively studied to explore the risk of under-loaded operation for overflow pollution control. Long-term low HLR operation had an insignificant effect on the pollutant removal performance of the full-scale WWTP, and the system could withstand high-load shocks in wet weather. Low HLR resulted in higher oxygen and nitrate uptake rate due to the storage mechanism under the alternating feast/famine condition, and lower nitrifying rate. Low HLR operation enlarged particle size, deteriorated floc aggregation and sludge settleability, and reduced sludge viscosity due to the overgrowth of filamentous bacteria and inhibition of floc-forming bacteria. The remarkable increase in Thuricola and the contract morphology of Vorticella in microfauna observation confirmed the risk of flocs disintegration in low HLR operation.

[Value of power Doppler ultrasound to evaluate acute kidney injury].

OBJECTIVE: To explore the value of power Doppler ultrasound (PDU) in the evaluation of acute kidney injury(AKI). METHODS: Renal blood flow of 40 AKI cases was monitored by power Doppler ultrasound and 4-level semiquantitative PDU score method employed. All cases were divided into 3 groups by PDU score. AKI stage and duration were compared. And the co-variables of death and (continuous renal replacement therapy) CRRT days (> 3) were also analyzed by Logistic regression analysis. RESULTS: A total of 40 AKI case were recruited. The 3-score group (n = 13)has lower mortality in intensive care unit and at 28 days than the 2-score group (n = 15) and the 1-score group (n = 12). The number of stage-3 AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 1, 4, 9 correspondingly, χ(2) = 16.103, degree of freedom = 4, P = 0.003). The number of persistent AKI in the 3-score group was less than that in the 2-score and 1-score groups (n = 3, 9, 10 correspondingly, P < 0.05). Age, APACHEII score and PDU score (< 3) were closely correlated with death while age, APACHEII score, level of serum creatinine and PDU score (< 3) with CRRT days (> 3) (P < 0.05). CONCLUSION: PDU may be used to monitor renal hemodynamics in AKI patients and its score helps clinicians to evaluate the severity and prognosis of AKI.

Umbilical acupuncture for insomnia: A protocol for systematic review and meta-analysis.

BACKGROUND: Insomnia is characterized by high incidence, easy recurrence, and difficulty in curing. Serious insomnia not only seriously affects the body organ function but also causes great damage psychological.Umbilical acupuncture (UA) has fewer side effects and is increasingly used to treat insomnia. This study aimed to systematically review the effectiveness and safety of UA in the treatment of insomnia. METHODS: Literature on UA for insomnia in PubMed, Excerpt Medica Database, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure Database, China Biomedical Literature Database, Chinese Scientific Journal Database, and Wan Fang Database were searched from the creation of these databases to October 3, 2021. In addition, the reference lists of studies meeting the inclusion criteria will also be searched to achieve a comprehensive retrieval of the maximum. All randomized controlled trials of UA for treating insomnia were included. Two reviewers will conduct literature screening, data extraction, and quality evaluation respectively. The main outcome was the Pittsburgh Sleep Quality Index, and the secondary outcomes included clinical efficacy, and safety. RevMan 5.4.1 software was used for mate analysis. RESULTS: This study aimed to evaluate the current status of UA treatment for insomnia, with the aim of illustrating the effectiveness and safety of UA. CONCLUSION: This study will provides a high-quality evidence to evaluate the effectiveness and safety of UA in treating insomnia. REGISTRATION: PROSPERO CRD42021283036.

Applying organic polymer flocculants in conditioning and advanced dewatering of landfill sludge as a substitution of ferric trichloride and lime: Mechanism, optimization and pilot-scale study.

In this study, poly dimethyl diallyl ammonium chloride (PDADMAC) and polyacrylamide (PAM) were applied to substitute ferric trichloride (FeCl3) and lime conditioning for advanced dewatering of landfill sludge (LS). Four response surface methodology (RSM) models were constructed for FeCl3-lime, FeCl3-PAM, PDADMAC-lime and PDADMAC-PAM, and identical dosages, namely 29.86, 57.91, 5.73 and 2.99 mg/g dry solids (DS) for FeCl3, lime, PDADMAC and PAM, were obtained by solving the system of four RSM equations at water content of 60% to investigate conditioning mechanisms. Compared to FeCl3-lime, PDADMAC-PAM conditioning had strong charge neutralization and bridging performance, and obtained conditioned LS with large flocs size, strong network structure and rapid dewatering rate. By integrating RSM with nonlinear programming for optimization, the total cost of PDADMAC-PAM route was saved by 7.9% and close to FeCl3-lime, and the optimized condition with dosages of 1.93 and 3.47 kg/t DS was further confirmed by pilot-scale experiments. The results indicated that PDADMAC-PAM was a feasible substitute for FeCl3-lime in sludge conditioning, and showed more advantage if dewatered sludge was further treated by incineration.

Coupling ammonia nitrogen adsorption and regeneration unit with a high-load anoxic/aerobic process to achieve rapid and efficient pollutants removal for wastewater treatment.

In this study, an ammonium nitrogen (NH4+-N) adsorption and regeneration (AAR) was constructed by a zeolite-packed column and NaClO-NaCl regeneration unit, and coupled with an anoxic/aerobic (AO) system to achieve efficient removal of carbon, nitrogen and phosphorus under short hydraulic retention time (HRT) and sludge retention time (SRT). Compared to conventional anaerobic/anoxic/aerobic (AAO) process, the proposed AO-AAR process achieved more efficient and stable nitrogen removal with greatly shorter HRT (5.6 h) and SRT (8 d) at 10.4 °C, with NH4+-N and total nitrogen in the effluent below 1.5 and 8.0 mg/L, respectively. The AO-AAR also obtained efficient phosphorus removal (<0.5 mg/L) by dosing aluminum in aerobic tank. High load and short SRT deteriorated sludge settleability and dewaterability, but enhanced methane production by improving sludge biodegradability. Dosing aluminum made the AO operating module more stable with improved settleability and dewaterability, and further enhanced methane production. Short HRT and SRT also resulted in the thriving of filamentous bacteria (Thiothrix) and heterotrophic nitrifiers (Acinetobacter, Pseudomonas and Rhodobacter) in the AO module, which helped in enhancing denitrification potential and nitrification efficiency under low temperature. Long-term operation showed that exchange capacity and physicochemical properties of zeolite were unchanged under NaClO-NaCl regeneration by introducing the tail gas from aerobic tank into the used regenerant to remove Ca2+ and Mg2+ exchanged from effluent of the AO module. Techno-economic analysis showed that the AO-AAR process is attractive and sustainable for municipal wastewater treatment by significantly improving nitrogen removal, greatly reducing land occupancy, enhancing methane production and achieving efficient reduction of carbon dioxide emission.

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure.

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Enhancing methane production of anaerobic sludge digestion by microaeration: Enzyme activity stimulation, semi-continuous reactor validation and microbial community analysis.

Effects of microaeration pretreatment on sludge hydrolysis, biogas production and microbial community structure in anaerobic digestion (AD) were investigated by bench-scale tests and semi-continuous experiments. Bench tests showed that microaeration led to the release of dissolved organic matters, generation of volatile fatty acids and stimulation of enzyme activity. Correlation analysis showed that methane production was significantly correlated with the activity of α-glucosidase at 0.01 level, and with protease activity, released polysaccharides and VFAs at 0.05 level. Semi-continuous experiments showed that microaeration accelerated the utilization of organic matters, increased biogas production by 16.4%, enhanced methane content in biogas, and improved sludge dewaterability. Microbial community structure analysis showed that microaeration promoted enrichment of hydrolytic and fermentative bacteria in AD reactor rather than methanogenic bacteria, and aceticlastic methanogenesis was the main methanogenic pathway for methane production.

Insights into conditioning of landfill sludge by FeCl3 and lime.

In this study, landfill sludge (LS) was excavated from a 10 year old full-scale sludge landfill and used to investigate effects of dosage on sludge dewaterability, rheological properties and extracellular polymeric substances (EPS) variations by FeCl3-lime conditioning. LS had lower content of organic matters (0.28) and smaller particle size than excess sludge (ES), and greatly lower viscosity and high flowability. The suitable concentration of LS for conditioning (107.2-118.6 g/L) was much higher than that of ES (34 g/L) by rheological analysis. Both FeCl3 and lime improved dewaterability of LS and caused decline of slime and loosely bound EPS (LB-EPS). FeCl3 destroyed proteins in slime and LB-EPS owing to coagulation and acidification effects, weakened internal structure strength, and thus improved dewaterability. Lime addition caused alkaline hydrolysis of polysaccharides in slime and LB-EPS, reduced viscosity and flowability, and improved flowability and dewaterability for LS. The optimal dosage for dewatering using 57.6 mg lime/g dried solids (DS) and 53.6 mg FeCl3/g DS was obtained by using an integrative response surface methodology (RSM) coupled nonlinear programming approach under water content constraint of 55%. The integrative optimization achieved 26.0% cost saving in comparison to RSM optimized condition.

Enhancement of sludge reduction by ultrasonic pretreatment and packing carriers in the anaerobic side-stream reactor: Performance, sludge characteristics and microbial community structure.

Effects of ultrasonic pretreatment and packing carriers on sludge reduction, settleability, dewaterability and microbial community structure in the anaerobic side-stream reactor (ASSR) were investigated with three anaerobic reactors operated in parallel. Ultrasonication from 3.65% in the ASSR to 5.08%, and packing carriers further enhanced the efficiency to 19.2%. Ultrasonic pretreatment of sludge decreased oxidation-reduction potential in ASSR and enhanced the release of intracellular substances. The deterioration of sludge settleability and dewaterability in the ASSR after ultrasonic pretreatment was improved by packing carriers. Illumina-MiSeq sequencing showed that microbial richness and diversity increased after ultrasonic pretreatment and packing carriers in the ASSR. Packing carriers favored the growth of slow grower (Dechloromonas), fermentative bacteria (Draconibacteriaceae, Fusibacter, Acidaminobacter) and floc-forming bacteria (Zoogloea), while hydrolytic and predatory bacteria (Saprospiraceae_unculture) and slow grower (Thauera) was enriched in the ASSR.

Sludge reduction and microbial structures of aerobic, micro-aerobic and anaerobic side-stream reactor coupled membrane bioreactors.

An anoxic/oxic membrane bioreactor (MBR) and three side-stream reactor (SSR) coupled membrane bioreactors were operated in parallel to investigate effects of dissolved oxygen (DO) level in SSR on sludge reduction and microbial community structure of SSR-MBRs. The four MBRs were equally efficient in COD and ammonium nitrogen removal. The anaerobic and micro-aerobic SSR favored nitrogen removal through denitrification, simultaneous nitrification and denitrification and autochthonous substrate release as carbon source. The micro-aerobic SSR achieved greatly higher sludge reduction efficiency (61.1%) than anaerobic (37.3%) and aerobic SSR (7.9%). Micro-aerobic SSR obtained the highest endogenous decay constant (0.035 d-1) compared to anaerobic (0.023 d-1) and aerobic SSR (0.015 d-1). High-throughput sequencing results revealed that anaerobic SSR enriched hydrolytic and fermentative bacteria, aerobic environment favored the growth of slow-growing bacteria, and micro-aerobic SSR stimulated biological activities of both anaerobic and aerobic bacteria.

Effects of hydraulic retention time on process performance of anaerobic side-stream reactor coupled membrane bioreactors: Kinetic model, sludge reduction mechanism and microbial community structures.

An anoxic/oxic membrane bioreactor (AO-MBR) and three anaerobic side-stream reactor (ASSR) coupled MBRs (ASSR-MBR) were operated to investigate the effects of hydraulic retention time of ASSR (HRTA) and to elucidate sludge reduction mechanisms in ASSR-MBRs. Increasing HRTA from 3.3 to 6.6 h improved nitrogen removal, and enhanced sludge reduction from 8.0% to 40.9% in ASSR-MBR. The sludge decay coefficient was 0.0221 d-1 in MBRs, and 0.0231-0.0345 d-1 in ASSRs. The measured lysis rate coefficient of heterotrophic biomass was 0.083-0.112 d-1 in MBRs and 0.079-0.111 d-1 in ASSRs. The hydrolysis rate coefficient of inactive particulate organic matters (POMs) in ASSRs significantly exceeded that in the MBR. At HRTA of 6.6 h, POMs hydrolysis in ASSR (38.6%) is the dominant route of sludge reduction, and cell lysis occurred principally in aerobic tanks. Illumina-MiSeq sequencing showed ASSR-MBRs enriched hydrolytic and fermentative bacteria, and confirmed that anaerobic hydrolysis contributed most to sludge reduction.

Sludge reduction and microbial community structure in an anaerobic/anoxic/oxic process coupled with potassium ferrate disintegration.

An anaerobic/anoxic/oxic (AAO) wastewater treatment system combining with a potassium ferrate (K2FeO4) oxidation side-stream reactor (SSR) was proposed for sludge reduction. Batch experiments showed that optimal K2FeO4 dosage and reaction time for sludge disintegration was 100mg/g suspended solids (SS) and 24h, respectively. Subsequently, an AAO-SSR and a conventional AAO were operated in parallel to investigate effects of K2FeO4 oxidation on process performance, sludge characteristics and microbial community structures. The AAO-SSR process operated under the optimized condition achieved efficient COD and NH4+-N removal, and reduced sludge by 47.5% with observed yield coefficient of 0.21gSS/g COD. K2FeO4 addition broke sludge particles, increased dissolved organic matters in the mixed liquor, and improved sludge dewaterability. Illumina-MiSeq sequencing results showed that K2FeO4 oxidation in the AAO-SSR decreased microbial richness and diversity, enriched slow growers (Dechloromonas), anaerobic fermentative bacteria (Azospira) and Fe(III)-reducing bacteria (Ferribacterium), but limited the growth of phosphate-accumulating organisms.

A new method for evaluating regional cerebral blood flow changes: Laser speckle contrast imaging in a C57BL/6J mouse model of photothrombotic ischemia.

The present study aimed to improve the processing of data acquired from laser speckle contrast imaging (LSCI) to provide a standardization method to explore changes in regional cerebral blood flow (rCBF) and to determine the correlations among rCBF, cerebral ischemic lesion volume and microvascular density over time in a focal ischemic region. C57BL/6J mice were subjected to focal photothrombotic (PT) ischemia. rCBF was measured using LSCI at different time points before and after PT ischemia through an intact skull. Standardized rCBF (SrCBF), defined as the ratio of rCBF measured in the ipsilateral region of interest (ROI) to that in the corresponding contralateral region, was calculated to evaluate potential changes. In addition, the volume of the ischemic lesion and the microvascular density were determined using Nissl staining and immunofluorescence, respectively. The relationships among the ischemic lesion volume, microvascular density and SrCBF were analyzed over time. The results showed that the cortical rCBF measured using LSCI following PT ischemia in the C57BL/6J mice gradually increased. Changes in the cerebral ischemic lesion volume were negatively correlated with SrCBF in the ischemic region. Changes in the microvascular density were similar to those observed in SrCBF. Our findings indicate that LSCI is a practical technique for observing changes in murine cortical rCBF without skull opening and for analyzing the relationships among the ischemic lesion volume, microvascular density and SrCBF following focal cerebral ischemia. Preliminary results also suggest that the use of LSCI to observe the formation of collateral circulation is feasible.

Effects of continuous positive airway pressure therapy on plasma aldosterone levels in patients with obstructive sleep apnea: A meta-analysis.

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular diseases. Aldosterone was reported to be increased in patients with OSA and correlated with OSA severity. Many studies investigated the effect of continuous positive airway pressure (CPAP) therapy on plasma aldosterone concentrations (PAC) in OSA patients. The results, however, were inconsistent. In the present study, we aimed to evaluate the effects of CPAP therapy on PAC by performing a meta-analysis. Literature search was carried out in electronic databases including PubMed/Medline, Cochrane Library, Embase and Web of Science. Eligible full-text articles were identified, and important data were extracted. Pooled analysis was performed using the STATA12.0 and RevMan 5.2. Standardized mean difference (SMD) was calculated to estimate the treatment effects. A total of eight studies involving 219 patients were included for our final analysis. PAC was found unchanged after CPAP treatment in OSA patients (SMD=-0.36, 95% CI:-0.91 to 0.18, Z=1.32, P=0.19). Meanwhile, CPAP therapy showed no impact on PAC (SMD=-0.21, 95% CI:-0.85 to 0.42, Z=0.66, P=0.51) in a separate meta-analysis including 3 randomized controlled trials. In conclusion, the evidence for the use of CPAP therapy to decrease PAC in OSA patients is low, and further studies are still warranted.