Molecular epidemiology and clinical characteristics of Clostridioides difficile infection in patients with inflammatory bowel disease from a teaching hospital.

BACKGROUND: Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is of increasing concern. This study aimed to investigate the molecular epidemiology and antimicrobial susceptibilities of toxigenic C. difficile isolated from IBD patients and to evaluate the risk factors for CDI in IBD population. METHODS: Loose or watery stools from IBD patients were tested for glutamate dehydrogenase, C. difficile toxins A&B and anaerobic culture. Toxigenic C. difficile isolates were characterized by multi-locus sequence typing, ribotyping and antimicrobial susceptibility testing. RESULTS: The prevalence of CDI in IBD patients was 13.6% (43/317). The dominant sequence types (STs) were ST35 (20.9%), ST2 (18.6%) and ST37 (16.3%). The most common ribotypes (RTs) were RT 017 (18.6%), RT 012 (14.0%), and RT 220 (14.0%), whereas RT 027 and RT 078 were not detected in this study. All the isolates were susceptible to vancomycin and metronidazole. The multidrug resistance rate of C. difficile RT 017 was higher (p < 0.01) than that of other RT strains. Recent hospitalization, use of corticosteroids and proton pump inhibitors were related to increased risk of CDI in IBD patients; of these, recent hospitalization and proton pump inhibitors use were independent risk factors. CONCLUSION: Patients with IBD have a relatively high incidence rate of CDI. C. difficile RT 017 is most frequently isolated from IBD patients in this region and warrants more attention to its high resistance rate. Clinicians should pay greater attention to CDI testing in IBD patients with diarrhea to ensure early diagnosis and initiation of effective treatment.

Second-Order Nonlinear-Optical-Active Selenide Borate YSeBO2: Featuring a [YSeBO2]n Planar Belt.

Chalcogenide borates were very rarely investigated in the past. As the second selenide borate, YSeBO2 obtained by a high-temperature solid-state reaction crystallizes in the noncentrosymmetric orthorhombic space group Cmc21 with a novel structure type. Its structure consists of two basic building units, [BO3]3- planar triangles and [YO3Se4]11- pentagonal bipyramids, and features the [YSeBO2]n planar belt. Second-harmonic-generation measurement shows its phase-matchable activity. YSeBO2 has an optical energy gap of 3.45 eV. Density functional theory calculation is also performed, addressing the electronic structure and nonlinear-optical property.

[Prostate Cancer Prevention Trial risk calculator for evaluating the risk of prostate cancer in the high-risk Chinese population].

OBJECTIVE: The Prostate Cancer Prevention Trial risk calculator (PCPT-RC) is an online tool for assessing the risk of prostate cancer (PCa) based on age, race, serum PSA, biopsy history, family history, and other factors. This study aimed to investigate the value, sensitivity and specificity of the PCPT-RC 2.0 in assessing the risk of PCa in the Chinese high-risk population. METHODS: This study included 622 patients with the high risk of PCa characterized by high serum PSA (PSA >3 µg/L) or abnormality in digital rectal examination or imaging of the prostate. According to the results of prostate biopsy, we divided the patients into a PCa and a non-PCa group and used the PCPT-RC 2.0 for evaluation of all the cases followed by statistical analysis. RESULTS: PCa was detected in 264 (42.4%) of the 622 patients, including 126 cases of high-grade malignancy. Compared with the non-PCa group, the PCa patients showed a significantly older age (ï¼»68.40 ± 7.30ï¼½ vs ï¼»72.80 ± 7.20ï¼½ yr, P <0.001), higher serum PSA level (ï¼»11.20 ± 7.76ï¼½ vs ï¼»15.06 ± 10.65ï¼½, P <0.001), and higher PCPT risk score (ï¼»37.0 ± 10.8ï¼½% vs ï¼»44.4 ± 12.6ï¼½%, P <0.001). The PCPT risk score exhibited a greater area under the ROC curve than the level of serum PSA in evaluating the risk of PCa (0.67 vs 0.61, P <0.05), but no statistically significant difference between the two in predicting the risk of high-grade malignancy (0.67 vs 0.66, P >0.05). CONCLUSIONS: The PCPT risk score is valuable in predicting the risk of PCa in China, which may play a better role than the serum PSA level in screening PCa and avoid unnecessary prostate biopsy, though its advantage is not so obvious in identifying high-grade malignancy. A prediction tool needs to be established for evaluating the risk of PCa in the Chinese population.

Reducing the gastroesophageal reflux with lip-type reinforcement technique during intrathoracic esophagogastrostomy.

BACKGROUND/AIMS: Gastroesophageal reflux is a significant problem after esophagogastrostomy, and impact considerably upon the quality of patients' lives. Aims of this study were to evaluate the operative effects in prevention of reflux with lip-type reinforcement during intrathoracic esophagogastric anastomosis. METHODOLOGY: From January 2005 to December 2009, 216 patients received circular stapled esophagogastrostomy with lip-type reinforcement (LR group), and 69 patients with standard reinforcement (SR group) at our hospital. Major observation parameters were symptoms of reflux and dysphagia. RESULTS: No differences in clinicopathologic characteristics between two groups, in addition to the incidence of anastomotic leakage was less in LR group (p = 0.039). Grade of dysphagia and anastomotic stricture also were not different between two groups (p >0.05). Symptoms of reflux were better controlled in patients with lip-type reinforcement than standard reinforcement (p <0.001). In LR group, 71.3% were asymptomatic with respect to reflux compared to 29.7% in SR group (p <0.001). The incidence of reflux esophagitis was 23.5% in LR group and 58.3% in SR group (p <0.001). There was a significant correlation between reflux symptoms and endoscopic findings of reflux esophagitis (p = 0.001). CONCLUSIONS: Lip-type reinforcement is simple to perform, and effective in controlling gastroesophageal reflux and decreasing anastomotic leakage in majority of patients after esophagogastrostomy.

The value of sonoelastography scores and the strain ratio in differential diagnosis of azoospermia.

PURPOSE: We evaluated the diagnostic performance of real-time elastography for differentiating nonobstructive from obstructive azoospermia. MATERIALS AND METHODS: We evaluated 1,192 testes, including 584 with nonobstructive azoospermia, 408 with obstructive azoospermia and 200 controls, from men with a mean ± SD age of 30 ± 5 years. Two radiologists evaluated the testes using a 5-degree elastography score system. The strain ratio was calculated on line. Of 156 azoospermic testes 78 were diagnosed by bilateral testicular biopsy for diagnostic purposes or sperm harvesting. RESULTS: In our software system a score of 3 indicated average strain, and scores 4 and 5 indicated low strain. Average or low strain (score 3 to 5) was seen in 477 of 584 testes with nonobstructive azoospermia (81.7%). This rate was significantly higher than the rate in obstructive azoospermic and control testes (68 of 408 or 16.3% and 30 of 200 or 15.0%, p <0.001). The strain ratio significantly differed for nonobstructive and obstructive azoospermia (median 0.490 and 0.340, Z = -20.560, p <0.001). CONCLUSIONS: Real-time elastography is a promising imaging method with great potential for the differential diagnosis of azoospermia.

[Quantitative analysis by real-time elastosonography for the differential diagnosis of azoospermia: preliminary application].

OBJECTIVE: To evaluate the quantitative analysis by real-time elastosonography in the differential diagnosis of obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). METHODS: We evaluated the elastosonographic images of 200 cases of OA, 300 cases of NOA and 100 normal healthy controls, calculated the strain ratio of the testis to the scrotal skin and the median strain ratio among the three groups, and analyzed the best cut-off point for differentiating OA and NOA by the receiver operation characteristic (ROC) curve. RESULTS: The median strain ratio of NOA was 0.49 +/- 0.43, while that of OA was 0.35 +/- 0.31, with significant difference between the two groups (Z = - 19.173, P = 0.000 < 0.017). According to the results of ROC curve analysis, the area under the curve was 0.857 +/- 0.012 and the best cut-off point for differentiating OA and NOA was 0.395 (sensitivity = 84.5%, specificity = 74.5%, accuracy = 80.5%). CONCLUSION: Quantitative analysis by real-time elastosonography is a new valuable technique for the differential diagnosis of azoospermia.

[Ultrasonographic features of epididymides in obstructive azoospermia].

OBJECTIVE: To investigate the ultrasonographic features of epididymides in congenital obstructive azoospermia (COA) and acquired obstructive azoospermia (AOA). METHODS: A total of 211 infertile men with obstructive azoospermia were observed by scrotal ultrasonography, and the features of the epididymal ultrasonograms were compared between COA and AOA. RESULTS: COA exhibited significantly higher rates of ectasia in the epididymal head, cord-like changes, abrupt tapering and absence of the epididymal body and tail than AOA (P < 0.05), while AOA showed markedly higher rates of epididymal body and tail duct ectasia and epididymal inflammatory mass than COA (P < 0.01). Tubular ectasia of the epididymal duct in the head, body and tail were markedly higher in the COA (14 [5.9%], 41 [17.2%] and 20 [8.4%] cases in 236 epididymides) than in the AOA (P < 0.05). Retiform ectasia were markedly higher in the AOA (119 [64.0%], 142 [76.3%] and 109 [58.6%] cases in 186 epididymides) than in the COA (P < 0.05), with statistically significant differences between the two groups (P < 0.05). Ultrasonographically, the epididymides of the COA patients were characterized by irregular ectasia of the epididymal tube with decreased and unclear wall echoes (P < 0.05), and those of the AOA patients by regular ectasia with enhanced wall echoes (P < 0.01). CONCLUSION: The ultrasonographic epididymal features of COA are obviously different from those of AOA, which is of important clinical application value for distinguishing the two conditions from each other.

Establishment of two new predictive models for prostate cancer to determine whether to require prostate biopsy when the PSA level is in the diagnostic gray zone (4-10 ng ml-1).

Our goal was to establish two new predictive models of prostate cancer to determine whether to require a prostate biopsy when the prostate-specific antigen level is in the diagnostic gray zone. A retrospective analysis of 197 patients undergoing prostate biopsy with prostate-specific antigens between 4 and 10 ng ml-1 was conducted. Of these, 47 patients were confirmed to have cancer, while the remaining 150 patients were diagnosed with benign prostate disease after examining biopsy pathology. Two multivariate logistic regression models were established including age, prostate volumes, free/total prostate-specific antigen ratio, and prostate-specific antigen density using SPSS 19.0 to obtain the predicted probability and Logit P, and then, two receiver operating characteristic (ROC) curves were drawn to obtain the best cutoff value for prostate biopsy: one for the group of all the prostate cancers and one for the group of clinically significant prostate cancers. The best cutoff value for prostate biopsy was 0.25 from the multivariate logistic regression ROC curve model of all the prostate cancers, which gave a sensitivity of 75.4% and a specificity of 75.8%. The best cutoff value for prostate biopsy was 0.20 from the multivariate logistic regression model of clinically significant prostate cancers, which gave a sensitivity of 76.7% and a specificity of 80.1%. We identified the best cutoff values for prostate biopsy (0.25 for all prostate cancers and 0.20 for clinically significant prostate cancers) to determine whether to require prostate biopsy when the PSA level is in the diagnostic gray zone.

[Studies on chemical constituents from Pteris multifida].

OBJECTIVE: To investigate the chemical constituents of Pteris multifida. METHODS: All compounds were isolated and purified by normal column chromatography, paper thin layer chromatography and sephadex chromatography. The chemical structures were mainly elucidated by ESI mass and NMR spectra. RESULTS: Seven compounds were isolated from the methanol extracts of Pteris multifida. In addition to a glycoside of sesquiterpene pterosin C-3-O-beta-D-glucoside(1), six flavonoids were isolated from S. barbata as fouows: apigenin(2), luteolin(3), apigenin-7-O-beta-D-glucoside(4), apigenin-7-O-beta-D-glucosyl-4'-O-alpha-L-rhanrnoside(5), apigenin-4'-O-alpha-L-rhanrnoside(6) and luteolin-7-O-beta-D-glucoside(7). CONCLUSION: Compound(2), (3) and (5), (6) are isolated from Pteris multifida for the first time.

Neurological mechanism of Xiaochaihutang's antidepressant-like effects to socially isolated adult rats.

OBJECTIVES: Xiaochaihutang (XCHT) has antidepressant effects in multiple animal models of depression in our previous studies. But the antidepressant effects and exact mechanisms of XCHT in a rat model of chronic social isolation stress (CSIS) have never been studied. We therefore aimed to investigate the effects of XCHT on depressive/anxiety-related behaviours of CSIS-exposed rats and understand the neurological mechanism involving neurogenesis. METHODS: We established the CSIS model and then investigated the effects of XCHT on behavioural change. HPLC-MS/MS was adopted to quantify neurotransmitter levels in the cerebrospinal fluid (CSF). Immunofluorescence technology was used to study the effects of XCHT on neurogenesis; while expressions of 5-HT1A receptor signalling pathway in the hippocampus were measured using Western blotting. KEY FINDINGS: Xiaochaihutang significantly alleviated depressive/anxiety-like behaviours of CSIS-exposed rats. XCHT significantly regulated levels of monoamine neurotransmitters in the CSF without affecting Glu, GABA and ACh. XCHT also significantly increased neurogenesis in CSIS-exposed rats. Additionally, XCHT reversed CSIS-induced decrease of 5-HT1A receptor expression and promoted the expression of BDNF in the hippocampus. CONCLUSION: Our results suggest that XCHT could significantly regulate the depressive/anxiety-like behaviours induced by CSIS, which are likely attributed to the promotion of hippocampal neurogenesis and neurotrophin expressions through the activation of serotonergic system.

Chinese herbal medicine for osteoporosis: a systematic review of randomized controlled trails.

Background. Osteoporosis is a major health problem for the elderly population. Chinese herb may be beneficial to osteoporosis due to its capability. Objectives. This study was designed to evaluate the effectiveness of Chinese medicine treatment on the patients with osteoporosis. Search Methods. Randomized controlled trials were retrieved from different 9 databases. Results. This meta analysis included 12 RCTs involving 1816 patients to compare Chinese herbs with placebo or standard anti-osteoporotic therapy in the treatment of bone loss. The pooled data showed that the percent change of increased BMD in the spine is higher with Chinese herb compared to placebo (lumber spine: WMD = 0.07, 95% CI: 0.01-0.04). In the femoral, Chinese herb showed significantly higher increments of BMD compared to placebo (femoral neck: WMD = 0.06, 95% CI: -0.02-0.13). Compared to the other standard anti-osteoporotic drugs, Chinese herbs also show advantage in BMD change (lumber spine: WMD = 0.03, 95% CI: -0.01-0.08; femoral: WMD = 0.01, 95% CI: -0.01-0.02). Conclusions. Our results demonstrated that Chinese herb significantly increased lumbar spine BMD as compared to the placebo or other standard anti-osteoporotic drugs.

Chiral diene as the ligand for the synthesis of axially chiral compounds via palladium-catalyzed Suzuki-Miyaura coupling reaction.

The first palladium-diene-catalyzed asymmetric Suzuki-Miyaura coupling reaction has been achieved. A number of functionalized biaryls were obtained in high yields and in moderate to high enantioselectivities. The existence of an ortho-formyl group greatly improves the catalyst efficiency and permits further synthetic elaborations.

Highly practical catalytic asymmetric 1,4-addition of arylboronic acids in water using new hydrophilic chiral bicyclo[3.3.0] diene ligands.

The first Rh-diene-catalyzed aqueous asymmetric 1,4-addition of alpha,beta-unsaturated carbonyl compounds with arylboronic acids has been realized. By using a hydrophilic bicyclo[3.3.0] diene ligand, the reactions can be performed successfully in neat water at room temperature to afford the corresponding products in good yields and with very high enantioselectivities for both cyclic and linear substrates.

Easily accessible C2-symmetric chiral bicyclo[3.3.0] dienes as ligands for rhodium-catalyzed asymmetric 1,4-addition.

The synthesis of a new type of C(2)-symmetric chiral diene ligands with a nonbridged bicyclic [3.3.0] backbone was successfully introduced. Using highly efficient lipase-catalyzed transesterification and Suzuki-coupling strategies, a broad family of enantiopure 3,6-disubstituted bicyclo[3.3.0] dienes with different electronic and steric properties could be easily prepared. The application of these new diene ligands in the Rh-catalyzed asymmetric 1,4-addition of arylboronic acids to alpha,beta-unsaturated carbonyl compounds have been examined, and excellent enantioselectivities (up to 98 % ee) as well as good yields are achieved under very mild reaction conditions at room temperature.