Association of Angiotensin II Type 1 Receptor Agonistic Autoantibodies With Outcomes in Patients With Acute Aortic Dissection.

Importance: Angiotensin II is significantly associated with the pathogenesis of acute aortic dissection. Angiotensin II type 1 receptor agonistic autoantibodies (AT1-AAs) can mimic the effect of angiotensin II. Objective: To investigate the association between AT1-AAs and all-cause and cause-specific mortality risk in patients with acute aortic dissection. Design, Setting, and Participants: A total of 662 patients with clinically suspected aortic dissection from 3 medical centers in Wuhan, China, were enrolled in this cohort study from August 1, 2014, to July 31, 2016. Of these, 315 patients were included in the 3-year follow-up study. Follow-up was mainly performed via telephone interviews and outpatient clinic visits. Data analysis was conducted from March 1 to May 31, 2020. Main Outcomes and Measures: The primary outcomes of interest were all-cause mortality, death due to aortic dissection, and late aortic-related adverse events. Results: The full study cohort included 315 patients with AAD (mean [SD] age, 56.2 [12.7] years; 230 men [73.0%]). Ninety-two patients (29.2%) were positive for AT1-AAs. The mortality of AT1-AA-positive patients was significantly higher than that of AT1-AA-negative patients (40 [43.5%] vs 37 [16.6%]; P < .001). The mortality risk in AT1-AA-positive patients was always significantly higher than that in AT1-AA-negative patients in patients with both type A and type B dissection. Multivariable analysis showed that the risk of AT1-AA-positive patients for type A dissection was significantly higher than that of AT1-AA-negative patients (odds ratio [OR], 1.88; 95% CI, 1.12-3.13; P = .02). The Cox proportional hazards regression model showed a significant increase of all-cause mortality risk (OR, 2.27; 95% CI, 1.44-3.57; P < .001) and late aortic-related adverse events (OR, 1.58; 95% CI, 1.06-2.36; P = .03) among AT1-AA-positive patients during the follow-up period compared with AT1-AA-negative patients. Conclusions and Relevance: This cohort study first detected AT1-AAs in patients with acute aortic dissection. The presence of AT1-AAs was associated with significantly higher all-cause and cause-specific mortality during a follow-up period of 3 years. The antibodies may be a risk factor for aortic dissection.

Uric acid as a prognostic factor and critical marker of COVID-19.

The purpose of this study is to explore whether uric acid (UA) can independently act as a prognostic factor and critical marker of the 2019 novel corona virus disease (COVID-19). A multicenter, retrospective, and observational study including 540 patients with confirmed COVID-19 was carried out at four designated hospitals in Wuhan. Demographic, clinical, laboratory data were collected and analyzed. The primary end point was in-hospital death of patients with COVID-19. The concentration of admission UA (adUA) and the lowest concentration of uric acid during hospitalization (lowUA) in the dead patients were significantly lower than those in the survivors. Multivariate logistic regression analysis showed the concentration of lowUA (OR 0.986, 95% CI 0.980-0.992, p < 0.001) was able to independently predict the risk of in-hospital death. The mean survival time in the low-level group of lowUA was significantly lower than other groups. When lowUA was ≤ 166 µmol/L, the sensitivity and specificity in predicting hospital short-term mortality were 76.9%, (95% CI 68.5-85.1%) and 74.9% (95% CI 70.3-78.9%). This retrospective study determined that the lowest concentration of UA during hospitalization can be used as a prognostic indicator and a marker of disease severity in severe patients with COVID-19.

Genome-wide identification and phylogenetic relationships of the Hsp70 gene family of Aegilops tauschii, wild emmer wheat (Triticum dicoccoides) and bread wheat (Triticum aestivum).

Heat shock protein 70 (Hsp70) plays an important role in plant development. It is closely related to the physiological process of cell development and the response to abiotic and biological stress. However, the classification and evolution of Hsp70 genes in bread wheat, wild emmer wheat and Aegilops tauschii are still unclear. Therefore, this study conducted a comprehensive bioinformatics analysis of Hsp70 gene in three species. Among these three species, 113, 79 and 36 Hsp70 genes were identified. They are divided into six subfamilies. Group vi-1 is different from Arabidopsis thaliana. It may be the result of early evolutionary segregation. The number of exons in different subfamilies (from 1 to 13) was different, but the distribution patterns of exons / introns in the same subfamily were similar. The results of Hsp70 promoter region analysis showed that the cis-regulatory elements of A. tauschii and wild emmer wheat were different from those of wheat. In addition, CpG island proportion of wild emmer Hsp70 was higher than that of wheat, which may be the molecular basis of heat resistance of wild wheat relative to cultivated wheat. Further comprehensive analysis of chromosome location and repeat events of Hsp70 gene showed that whole-genome duplication and tandem duplication events contributed to the evolution and expansion of Hsp70 gene in wheat. The results of non-synonymous substitution and synonymous substitution analysis showed that Hsp70 genes of three species had undergone purification selection. The expression profile analysis showed that Hsp70 gene was highly expressed in the roots during the vegetative growth period. In addition, TaHsp70 gene was highly expressed under various stress. The identification, classification and evolution of Hsp70 in wheat and its relatives provided a basis for further research on its evolution and its molecular mechanism in response to stress. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-021-02639-5.

Genome-wide identification, expression analysis, and functional study of the GRAS transcription factor family and its response to abiotic stress in sorghum [Sorghum bicolor (L.) Moench].

BACKGROUND: GRAS, an important family of transcription factors, have played pivotal roles in regulating numerous intriguing biological processes in plant development and abiotic stress responses. Since the sequencing of the sorghum genome, a plethora of genetic studies were mainly focused on the genomic information. The indepth identification or genome-wide analysis of GRAS family genes, especially in Sorghum bicolor, have rarely been studied. RESULTS: A total of 81 SbGRAS genes were identified based on the S. bicolor genome. They were named SbGRAS01 to SbGRAS81 and grouped into 13 subfamilies (LISCL, DLT, OS19, SCL4/7, PAT1, SHR, SCL3, HAM-1, SCR, DELLA, HAM-2, LAS and OS4). SbGRAS genes are not evenly distributed on the chromosomes. According to the results of the gene and motif composition, SbGRAS members located in the same group contained analogous intron/exon and motif organizations. We found that the contribution of tandem repeats to the increase in sorghum GRAS members was slightly greater than that of fragment repeats. By quantitative (q) RT-PCR, the expression of 13 SbGRAS members in different plant tissues and in plants exposed to six abiotic stresses at the seedling stage were quantified. We further investigated the relationship between DELLA genes, GAs and grain development in S. bicolor. The paclobutrazol treatment significantly increased grain weight, and affected the expression levels of all DELLA subfamily genes. SbGRAS03 is the most sensitive to paclobutrazol treatment, but also has a high response to abiotic stresses. CONCLUSIONS: Collectively, SbGRAs play an important role in plant development and response to abiotic stress. This systematic analysis lays the foundation for further study of the functional characteristics of GRAS genes of S. bicolor.

Genome-wide identification and expression analysis of the bHLH transcription factor family and its response to abiotic stress in sorghum [Sorghum bicolor (L.) Moench].

BACKGROUND: Basic helix-loop-helix (bHLH) is a superfamily of transcription factors that is widely found in plants and animals, and is the second largest transcription factor family in eukaryotes after MYB. They have been shown to be important regulatory components in tissue development and many different biological processes. However, no systemic analysis of the bHLH transcription factor family has yet been reported in Sorghum bicolor. RESULTS: We conducted the first genome-wide analysis of the bHLH transcription factor family of Sorghum bicolor and identified 174 SbbHLH genes. Phylogenetic analysis of SbbHLH proteins and 158 Arabidopsis thaliana bHLH proteins was performed to determine their homology. In addition, conserved motifs, gene structure, chromosomal spread, and gene duplication of SbbHLH genes were studied in depth. To further infer the phylogenetic mechanisms in the SbbHLH family, we constructed six comparative syntenic maps of S. bicolor associated with six representative species. Finally, we analyzed the gene-expression response and tissue-development characteristics of 12 typical SbbHLH genes in plants subjected to six different abiotic stresses. Gene expression during flower and fruit development was also examined. CONCLUSIONS: This study is of great significance for functional identification and confirmation of the S. bicolor bHLH superfamily and for our understanding of the bHLH superfamily in higher plants.

Nutritional risk and therapy for severe and critical COVID-19 patients: A multicenter retrospective observational study.

OBJECTIVE: To evaluate the nutritional risk and therapy in severe and critical patients with COVID-19. METHODS: A total of 523 patients enrolled from four hospitals in Wuhan, China. The inclusion time was from January 2, 2020 to February 15. Clinical characteristics and laboratory values were obtained from electronic medical records, nursing records, and related examinations. RESULTS: Of these patients, 211 (40.3%) were admitted to the ICU and 115 deaths (22.0%). Patients admitted to the ICU had lower BMI and plasma protein levels. The median Nutrition risk in critically ill (NUTRIC) score of 211 patients in the ICU was 5 (4, 6) and Nutritional Risk Screening (NRS) score was 5 (3, 6). The ratio of parenteral nutrition (PN) therapy in non-survivors was greater than that in survivors, and the time to start nutrition therapy was later than that in survivors. The NUTRIC score can independently predict the risk of death in the hospital (OR = 1.197, 95%CI: 1.091-1.445, p = 0.006) and high NRS score patients have a higher risk of poor outcome in the ICU (OR = 1.880, 95%CI: 1.151-3.070, p = 0.012). After adjusted age and sex, for each standard deviation increase in BMI, the risk of in-hospital death was reduced by 13% (HR = 0.871, 95%CI: 0.795-0.955, p = 0.003), and the risk of ICU transfer was reduced by 7% (HR = 0.932, 95%CI:0.885-0.981, p = 0.007). The in-hospital survival time of patients with albumin level ≤35 g/L was significantly decreased (15.9 d, 95% CI: 13.7-16.3, vs 24.2 d, 95% CI: 22.3-29.7, p < 0.001). CONCLUSION: Severe and critical patients with COVID-19 have a high risk of malnutrition. Low BMI and protein levels were significantly associated with adverse events. Early nutritional risk screening and therapy for patients with COVID-19 are necessary.

Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches.

PURPOSE: To demonstrate the feasibility, safety, and technical strategies of hand-assisted laparoscopic complete mesocolic excision (HAL-CME) and to compare oncological outcomes between HAL-CME and the open approach (O-CME) for right colon cancers. METHODS: Patients who were scheduled to undergo a right hemicolectomy were divided into HAL-CME and O-CME groups. Measured outcomes included demographic variables, perioperative parameters, and follow-up data. Demographic variables included age, sex distribution, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, previous abdominal surgery, tumor localization, and potential comorbidities. Perioperative parameters included incision length, operative time, blood loss, conversion rate, postoperative pain score, postoperative first passage of flatus, duration of hospital stay, total cost, number of lymph nodes retrieved, TNM classification, and postoperative complications. Follow-up data included follow-up time, use of chemotherapy, local recurrence rate, distant metastasis rate, and short-term survival rate. RESULTS: In total, 150 patients (HAL-CME, 78; O-CME, 72) were included. The groups were similar in age, sex distribution, BMI, ASA classification, history of previous abdominal surgeries, tumor localization, and potential comorbidities. Patients in the HAL-CME group had shorter incision lengths, longer operative times, less operative blood loss, lower pain scores, earlier first passage of flatus, shorter hospital stay, higher total costs, similar numbers of lymph nodes retrieved, similar TNM classifications, and a comparable incidence of postoperative complications. The 2 groups were also similar in local recurrence rate, distant metastasis rate, and short-term survival rate. CONCLUSION: The results demonstrate that the HAL-CME procedure is a safe, valid, and feasible surgical method for right hemicolon cancers.

A Modified Spontaneously Closed Defunctioning Tube Ileostomy After Anterior Resection of the Rectum for Rectal Cancer with a Low Colorectal Anastomosis.

The aim of this study is to introduce a new technique of modified spontaneously closed defunctioning tube ileostomy after anterior resection of the rectum for rectal cancer with a low colorectal anastomosis. Patients with rectal cancer who underwent anterior resection of rectum with a low colorectal anastomosis and chose a modified defunctioning tube ileostomy between March 2012 and August 2013 were retrospectively reviewed. Data on the success of the operation procedures, post-operative hospital stay, and post-operative tube ileostomy-related complications were analyzed. One hundred fifty-two patients (87 males and 65 females; 57.1 ± 17.4 years) undergoing the modified defunctioning tube ileostomy after anterior resection for rectal cancer were included. The post-operative hospital stay was 11.9 ± 3.2 days. The tube was removed on days 22.6 ± 4.1 after operation and the ileostomy wound closed spontaneously within 13.1 ± 1.9 days. Twenty-five patients felt tube-associated pain or discomfort, which was relieved after a period of adaptation and appropriate tube adjustment. Nine patients suffered from tube blockage and were treated successfully with saline irrigation. Two patients had intestinal obstruction, which was resolved with conservative treatment. Three patients developed leakage of the distal anastomosis: two were successfully treated with conservative measures and the other completely recovered after reoperation. The modified spontaneously closed defunctioning tube ileostomy appears efficacious and safe. This technique may be used to protect the distal anastomosis and simultaneously decrease the ileostomy complications, and minimize the morbidity and mortality associated with stoma takedown.

Multi-stage resection and repair for the treatment of adult giant sacrococcygeal teratoma: A case report and literature review.

Sacrococcygeal teratoma (SCT) is a sacrococcygeal neoplasm derived from more than one primitive germ layer and is only occasionally encountered in adults. The primary treatment for all primary SCTs is surgical excision. The present study reports the case of a giant SCT in a middle-aged female with a history lasting >3 decades. Multi-staged surgical treatment was performed, including ileostomy plus tumor excision, four debridement plus flap repair procedures, and closure of the ileostomy. Follow-up showed improved quality of life without evidence of local recurrence after resection. The study also presents a brief overview of the relevant literature. To the best of our knowledge, this is the first report of multi-staged surgical treatment for giant SCT in an adult patient.

Combined right hemicolectomy and pancreaticoduodenectomy for locally advanced right hemicolon cancer.

Extracolonic invasion of the duodenum and/or pancreatic head rarely occurs in patients with right hemicolon cancer. However, when necessary, combined radical operation is a challenge to the surgeon. We reported 7 patients with locally advanced right hemicolon cancer who underwent combined right hemicolectomy (RH) and pancreaticoduodenectomy (PD) due to direct involvement of the duodenum or pancreatic head. This study included four males and three females with a mean age of 66.9+/-5.9 years. Computed tomography (CT) scans revealed right hemicolon cancer with duodenal invasion (5 patients) and pancreatic invasion (2). The mean operation time was 410+/-64 minutes and the estimated blood loss was 514+/-157 mL. After the operation, the mean postoperative hospital stay was 22.1+/-7.2 days. Five patients had postoperative complications. The mean follow-up time was 16.4+/-5.9 months. During this period, three patients died from tumor recurrence, one from postoperative complications, one from pulmonary disease, and two survived until the last scheduled follow-up. Five patients survived more than one year. Combined RH and PD for locally advanced right hemicolon cancer can be performed safely, thus providing a long-term survival rate in selected patients in a high-volume center.

Combined general and regional anesthesia and effects on immune function in patients with benign ovarian tumors treated by laparoscopic therapy.

OBJECTIVE: Anesthesia has been shown to suppress immune function, which can negatively affect the treatment of patients with various tumors. Here, we assessed two different anesthesia methods, general versus combined regional/general, in treatment of benign ovarian tumor by laparoscopic therapy. METHODS: Out of 160 patients with benign ovarian tumors treated by laparoscopic therapy, 80 received general anesthesia combined with thoracic epidural anesthesia during surgery, and 80 received general anesthesia only. Venous blood samples were obtained at the following time points: before induction of anesthesia (T0), 2 hours after anesthesia, during operation, 3 days (d) after operation, 5 d after operation, and 7 d after operation. Percentages of CD3(+), CD4(+), and CD4(+)/CD8(+) T lymphocytes were determined at these time points by flow cytometry to assess immune function. RESULTS: For both groups, percentages of CD3(+), CD4(+), and CD4(+)/CD8(+) T cells decreased significantly from T0 to 2 hr after anesthesia (P < 0.05). These percentages decreased again during surgery. However, T cell percentages in patients receiving combined anesthesia returned to normal levels 5 d after surgery, and those receiving only intravenous anesthesia returned to normal by 7 d after surgery. There were no significant differences in CD3(+), CD4(+), or CD4(+)/CD8(+) T cell percentages between the two anesthesia groups at T0 and 7 d. However, significant differences in these percentages were observed between the two groups at all other time points. Interestingly, the decrease observed within the combined group were less dramatic than those observed within the intravenous-only group (P < 0.05). CONCLUSIONS: These findings indicate that, while any anesthesia may suppress immune function of patients treated by laparoscopic therapy, the effect of general anesthesia combined with thoracic epidural anesthesia on immune function was less than that produced by general anesthesia alone.

Centromere protein F and survivin are associated with high risk and a poor prognosis in colorectal gastrointestinal stromal tumours.

AIMS: Colorectal gastrointestinal stromal tumours (GISTs) are considered to be tumours with a relatively poor prognosis. Few reports have been performed to investigate the mechanisms behind their malignant behaviour and to identify new therapeutic strategies for their treatment. The authors conducted this study to explore potential targets for the treatment of colorectal GISTs (CRGISTs). METHODS: In the current study, the authors focused on centromere protein F and survivin, two markers that are known to affect the malignant behaviour of other tumours. Expression of centromere protein F and survivin was detected through the immunohistochemical staining of paraffin-embedded tumour tissues and then scored. The relationship between the expression of the two markers and their clinical parameters was analysed. Associated Survival analysis was available based on follow-up information. RESULTS: The authors demonstrated for the first time that centromere protein F and survivin expression were significantly associated with high risk and a poor prognosis (p<0.05) in CRGISTs. The authors also found that centromere protein F expression was more prevalent in males (p=0.002). CONCLUSIONS: The results suggest that centromere protein F and survivin are malignant behaviour markers for CRGISTs. The expression of centromere protein F or survivin points to a poor clinical outcome. Interfering with centromere protein F and/or survivin expression might be a potentially therapeutic strategy for treating malignant CRGISTs.

[Studies on the properties and co-immobilization of manganese peroxidase].

White-rot fungus manganese peroxidase (MnP) oxidizes a wide range of substrates, rendering it an interesting enzyme for potential applications. The stability of MnP can be improved by immobilization. With sodium alginate, gelatin, or chitosan as a carrier, and glutaraldehyde as the crosslinking agent, MnP was co-immobilized using the embed-crosslinked method and the adsorb-crosslinked method. The immobilization conditions and the partial properties of the three immobilized enzymes were investigated. When compared with the free enzyme, the optimum pH values and the temperatures of the three immobilized MnPs carried by alginate, gelatin, and chitosan were respectively shifted from 7.0 to 5.0, 5.0, 3.0 and from 35 degrees C to 75 degrees C , 55 degrees , 75 degrees C . The thermostabilities of the three immobilized MnPs were considerably better than that of the native enzyme. The chitosan-decreased by less than 5% even after repeated use for 6 - 9 times. The ability of decolorizing azo dyes in static and shaky situation by gelatin-immobilized MnP approached to the free enzyme, and there was no loss of enzyme activity during 2 repeated batch reactions.

Investigation of health and nutrition status of middle-aged and old residents in the urban district of Chongqing.

OBJECTIVE: To investigate the health and nutrition status in middle-aged and old people in the urban district of Chongqing City, China in order to provide a rational diet construction for the population. METHOD: This investigation was performed in 2004 and 1801 public officials both at post and retired in the urban district of Chongqinging City were enrolled in this investigation. Among them 96.7% were at age of over 40. The investigation was based on questionnaire, physical examination, laboratory biochemical test and bone density measurement. RESULT: In the incidences of nutrition-related non-communicable diseases, overweight/obesity accounted for 50.5%, hyperlipidemia 36.1%, hypertension 30.3%, fatty liver 22.3%, osteoporosis 16.1%, hyperuricemia 12.2%, and diabetes 11.2%, while the incidence of dystrophy is low. Correlation analysis of these diseases demonstrated that the rates of hypertension, hyperlipidemia, fatty liver, diabetes, coronary heart disease and gallstone were significantly higher in overweight or obesity than in normal-weight people. The rates of hypertriglyceride, hypercholesteremia, diabetes, hyperuricemia, coronary heart disease, and fatty liver were higher in people with hypertension than in people with normal blood pressure. The rates of hypertension, hypertriglyceride and hypercholesteremia, coronary heart disease and fatty liver were higher in diabetes than in non-diabetes people. CONCLUSION: Our study shows that health and nutrition status of the public officials of Chongqing city is not favourable. Overnutrition is the main problem.