[Clinical application of non-invasive prenatal testing for twin pregnancies].

OBJECTIVE: To evaluate the feasibility of non-invasive prenatal testing (NIPT) for the screening of fetal chromosome aneuploidies in twin pregnancies. METHODS: A total of 2 745 women with twin-pregnancies were subjected for NIPT screening. Chromosomal karyotyping and chromosomal microarray analysis (CMA) were carried out on amniotic fluid samples from those with a high risk for fetal chromosome aneuploidies, and the diagnosis and pregnancy outcome were followed up. The sensitivity, specificity, positive predictive value and false positive rate of the NIPT were calculated. RESULTS: Compared with other chromosomal abnormalities, NIPT had a higher efficacy for trisomy 21 and sex chromosomal aneuploidy (SCA) in twin pregnancies (with sensitivity being 100%, 100%, and specificity being 99.93%, 99.9%, respectively). It is difficult to evaluate the efficacy for trisomies 18 and 13 due to the limited data. For chromosome microdeletions and microduplications spanning 15 ~ 21 Mb, NIPT also had a certain detection rate. Compared with women with natural conception, NIPT had a higher detection rate for those with twin pregnancies by assisted reproduction (P < 0.05). CONCLUSION: It is feasible to use NIPT for the detection of chromosome aneuploidies in women with twin pregnancies.

α-Helix-Mediated Protein Adhesion.

Proteins have been adopted by natural living organisms to create robust bioadhesive materials, such as biofilms and amyloid plaques formed in microbes and barnacles. In these cases, ß-sheet stacking is recognized as a key feature that is closely related to the interfacial adhesion of proteins. Herein, we challenge this well-known recognition by proposing an α-helix-mediated interfacial adhesion model for proteins. By using bovine serum albumin (BSA) as a model protein, it was discovered that the reduction of disulfide bonds in BSA results in random coils from unfolded BSA dragging α-helices to gather at the solid/liquid interface (SLI). The hydrophobic residues in the α-helix then expose and break through the hydration layer of the SLI, followed by the random deposition of hydrophilic and hydrophobic residues to achieve interfacial adhesion. As a result, the first assembled layer is enriched in the α-helix secondary structure, which is then strengthened by intermolecular disulfide bonds and further initiates stepwise layering protein assembly. In this process, ß-sheet stacking is transformed from the α-helix in a gradually evolving manner. This finding thus indicates a valuable clue that ß-sheet-featuring amyloid may form after the interfacial adhesion of proteins. Furthermore, the finding of the α-helix-mediated interfacial adhesion model of proteins affords a unique strategy to prepare protein nanofilms with a well-defined layer number, presenting robust and modulable adhesion on various substrates and exhibiting good resistance to acid, alkali, organic solvent, ultrasonic, and adhesive tape peeling.

Coronavirus disease 2019 death prediction by electrocardiographic abnormalities and elevated D-dimer levels.

Background: Electrocardiography (ECG) plays a very important role in various cardiovascular diseases and elevated D-dimer in serum associated with thrombosis. In patients with coronavirus disease 2019 (COVID-19), immense pieces of evidence showed that ECG abnormalities or elevated D-dimer in serum occurred frequently. However, it remains unclear whether ECG abnormalities combined with elevated D-dimer could be a new risk predictor in patients with COVID-19. Methods and results: This retrospective cohort study enrolled 416 patients with COVID-19 at Wuhan Tongji Hospital from 1 February to 20 March 2020. ECG manifestations, D-dimer levels, and in-hospital deaths were recorded for all patients. Logistic regression analysis was performed to examine the association between ECG manifestations and in-hospital mortality in patients with elevated D-dimer levels. In patients hospitalized for COVID-19, ST-T abnormalities (34.3%) were the most frequent ECG manifestations, whereas sinus tachycardia (ST) (13.3%) and atrial arrhythmias with rapid rhythms (8.5%) were the two most common cardiac arrhythmias. Compared to severely ill patients with COVID-19, ST-T abnormalities, ST and atrial arrhythmias (p<0.001) with rapid rhythms, D-dimer levels, and in-hospital deaths were significantly more frequent in critically ill patients with COVID-19. Moreover, elevated D-dimer levels were observed in all the patients who died. In the subgroup of 303 patients with elevated serum D-dimer levels, the patient's age, the incidence of ST-T abnormalities, ST, atrial fibrillation (AF), and atrial premature beat were significantly higher than those in the non-elevated D-dimer subgroup. Multivariate logistic regression analysis further revealed that ST and AF were risk factors for in-hospital mortality in COVID-19 patients with elevated D-dimer levels. Conclusions: ECG abnormalities and elevated D-dimer levels were associated with a higher risk of critical illness and death in patients hospitalized for COVID-19. ECG abnormalities, including ST and AF, combined with elevated D-dimer levels, can be used to predict death in COVID-19.

Determining nitrate sources in storm runoff in complex urban environments based on nitrogen and oxygen isotopes.

Urban storm runoff, as the primary transport medium for nutrients entering urban rivers, contributes to urban water contamination. Accurate source identification is critical for controlling water pollution. Although some studies have used nitrate isotopic composition (δ15N-NO3- and δ18O-NO3-) to identify nitrate (NO3--N) in urban storm runoff, the relatively low frequency of collecting samples in surface runoff within a single functional area hinders the understanding of spatial variations and dynamic process of NO3--N sources over the runoff process. This study investigated the nitrogen (N) concentrations and analyzed dynamic changes of NO3--N sources in surface runoff in different urban functional areas, drainage pipeline runoff, and channels during the complete runoff process in Wuxi, east China. The results showed that N concentrations in pipeline runoff and channels were higher than those in surface runoff, indicating that high concentration of N pollutants were accumulated in drainage pipelines. Information of δ15N-NO3- and δ18O-NO3- suggested that the main NO3--N source varied between runoff stages. NO3--N contribution from atmospheric deposition decreased in the order: surface runoff (57%) > residential pipeline runoff (25%) > channels (14%), while the opposite trend was observed for the contributions from sewage, increasing from 10%, 26% to 39%. In urban storm runoff, more sewage, fertilizers, and soil N were carried into the surface runoff after 30% of cumulative runoff ratio and carried into pipeline runoff in the initial 25% of cumulative runoff ratio in the residential area. As the first attempt to identify nitrate sources over the cumulative runoff in different urban functional areas, this work expands our understanding of the primary nitrate source in urban storm runoff. The findings provide important insights for developing strategies to mitigate non-point source water pollution.

Efficient and genotype independent maize transformation using pollen transfected by DNA-coated magnetic nanoparticles.

Current gene delivery methods for maize are limited to specific genotypes and depend on time-consuming and labor-intensive tissue culture techniques. Here, we report a new method to transfect maize that is culture-free and genotype independent. To enhance efficiency of DNA entry and maintain high pollen viability of 32%-55%, transfection was performed at cool temperature using pollen pretreated to open the germination aperture (40%-55%). Magnetic nanoparticles (MNPs) coated with DNA encoding either red fluorescent protein (RFP), ß-glucuronidase gene (GUS), enhanced green fluorescent protein (EGFP) or bialaphos resistance (bar) was delivered into pollen grains, and female florets of maize inbred lines were pollinated. Red fluorescence was detected in 22% transfected pollen grains, and GUS stained 55% embryos at 18 d after pollination. Green fluorescence was detected in both silk filaments and immature kernels. The T1 generation of six inbred lines showed considerable EGFP or GUS transcripts (29%-74%) quantitated by polymerase chain reaction, and 5%-16% of the T1 seedlings showed immunologically active EGFP or GUS protein. Moreover, 1.41% of the bar transfected T1 plants were glufosinate resistant, and heritable bar gene was integrated into the maize genome effectively as verified by DNA hybridization. These results demonstrate that exogenous DNA could be delivered efficiently into elite maize inbred lines recalcitrant to tissue culture-mediated transformation and expressed normally through our genotype-independent pollen transfection system.

Coupling isotopic analysis and Ecopath model to detect the ecosystem features based on functional groups of the southwestern Yellow Sea, China.

The paper evaluates the species richness, material transfer, energy flow, and system function of the southwestern Yellow Sea Ecosystem (SYSE) indicating intensive human intervention affecting this large marine ecosystem. Twenty functional groups were chosen to represent the basic components of the SYSE for Ecopath modeling based on offshore surveys, annual bird observations, and the China Fisheries Statistical Yearbooks. Forty-nine species based on 15 functional groups of Ecopath model were assessed by stable isotopic analysis (SIA) to verify ecosystem features, energy flow, and trophic structure of the SYSE derived from Ecopath model. Results showed there was a clear correlation of the estimated trophic structure calculated from SIA and the Ecopath model with R2=0.7184. The SYSE Ecopath model was still at an immature and unstable stage according to outputs of the modeling parameters. This paper provides a verification method of detecting the ecosystem features and maturity, stability, and resilience of marine ecosystems by comparing outputs from Ecopath models with SIA.

Transesophageal electrophysiology study in the diagnosis of dual atrioventricular nodal nonreentrant tachycardia.

"Double fire" is generally characterized by 1:2 atrioventricular conduction of sinus beats traveling down fast and slow pathways that result in double ventricular response. When this phenomenon repeats rapidly, dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) occurs. We report a case of an irregular tachycardia with a comprehensive record that includes an electrocardiogram, a transesophageal electrophysiology study, and an intracardiac electrophysiology study. This is the first report of transesophageal electrophysiology study in the diagnosis of DAVNNT. A diagnosis of DAVNNT was deduced, and the patient was successfully treated with radiofrequency ablation of the slow pathway.

Risk factors for treatment failure of heated humidified high-flow nasal cannula as initial respiratory support for preterm infants. / æ—©äº§å„¿åŠ æ¸©æ¹¿åŒ–é«˜æµé‡ç»é¼»å¯¼ç®¡é€šæ°”åˆå§‹å‘¼å¸æ”¯æŒå¤±è´¥çš„å±é™©å› ç´ åˆ†æž.

OBJECTIVES: To study the risk factors for treatment failure of heated humidified high-flow nasal cannula (HHHFNC) as initial respiratory support for preterm infants. METHODS: A retrospective analysis was performed on the medical data of the preterm infants who were admitted from January 2018 to April 2021 and received HHHFNC for initial respiratory support after birth. According to whether it was necessary to upgrade to noninvasive continuous positive airway pressure or invasive mechanical ventilation within 72 hours after treatment, they were divided into a failure group and a success group. Univariate and multivariate logistic regression analyses were used to determine the risk factors for failure of HHHFNC as initial respiratory support. RESULTS: A total of 166 preterm infants were included, among whom 48 (28.9%) experienced the treatment failure of HHHNFC as initial respiratory support. The univariate analysis showed that compared with the success group with 118 infants, the failure group had significantly lower gestational age and birth weight and a significantly higher proportion of infants with fraction of inspired oxygen >35%, flow rate >6 L/minute, patent ductus arteriosus (PDA), respiratory distress syndrome (RDS), or use of pulmonary surfactant (P<0.05). The multivariate logistic regression analysis showed that gestational age <32 weeks, PDA (>1.5 mm and left atrium/aorta diameter ratio >1.4), fraction of inspired oxygen >35%, flow rate >6 L/minute, and presence of RDS were risk factors for the treatment failure of HHHNFC as initial respiratory support (P<0.05). CONCLUSIONS: The preterm infants with a gestational age of <32 weeks or the presence of RDS tend to have a high risk of failure of HHHNFC as initial respiratory support. The risk of failure of HHHFNC as initial respiratory support increases in infants with oxygen concentration >35% and/or flow rate >6 L/minute, or the presence of PDA, suggesting an upgrade of respiratory support should be considered. Citation.

Quantitative identification of non-point sources of nitrate in urban channels based on dense in-situ samplings and nitrate isotope composition.

Quantitative identification of non-point sources of nitrate in urban channels plays a critical role in effective nutrient management in urban regions. This is an emerging issue due to fast urbanization and the resultant complicated hydrological and hydraulic conditions in urban areas. In this study, we examine spatial-temporal characteristics of nitrogen concentration in urban channels based on dense in-situ samplings during a one-year period over a small urban catchment in China. We quantitatively identify nitrate sources into urban channels based on dual-isotope analyses and Bayesian isotope mixing model. Results show that nitrogen concentration peaks in winter as well as in urban channels and land surfaces in the urban core region. Sewage (47%) is the dominate contributor to NO3--N in urban channels, followed by NH4+ in fertilizer (30%) as the second contributor. Sewage (NH4+ in fertilizer) contributes more NO3--N to channels in winter (summer) with the proportion of 65% (44%), and more NO3--N to urban core (suburban) channels with the proportion of 59% (42%). The rainfall and distribution of rainwater drains explain the monthly and spatial variations of contribution of NO3--N sources well, respectively. In addition, less NO3--N in the urban channels derives from nitrification, which is consistent with the results of high properties of NH4+-N/TN in this region. Our results highlight the key roles of land use types and rainfall in NO3--N source apportionment, and provide support for the nitrogen management practices in urbanized regions.

Automatic multilabel electrocardiogram diagnosis of heart rhythm or conduction abnormalities with deep learning: a cohort study.

BACKGROUND: Market-applicable concurrent electrocardiogram (ECG) diagnosis for multiple heart abnormalities that covers a wide range of arrhythmias, with better-than-human accuracy, has not yet been developed. We therefore aimed to engineer a deep learning approach for the automated multilabel diagnosis of heart rhythm or conduction abnormalities by real-time ECG analysis. METHODS: We used a dataset of ECGs (standard 10 s, 12-channel format) from adult patients (aged ≥18 years), with 21 distinct rhythm classes, including most types of heart rhythm or conduction abnormalities, for the diagnosis of arrhythmias at multilabel level. The ECGs were collected from three campuses of Tongji Hospital (Huazhong University of Science and Technology, Wuhan, China) and annotated by cardiologists. We used these datasets to develop a convolutional neural network approach to generate diagnoses of arrythmias. We collected a test dataset of ECGs from a new group of patients not included in the training dataset. The test dataset was annotated by consensus of a committee of board-certified, actively practicing cardiologists. To evaluate the performance of the model we assessed the F1 score and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, as well as quantifying sensitivity and specificity. To validate our results, findings for the test dataset were compared with diagnoses made by 53 ECG physicians working in cardiology departments who had a wide range of experience in ECG interpretation (range 0 to >12 years). An external public validation dataset of 962 ECGs from other hospitals was used to study generalisability of the diagnostic model. FINDINGS: Our training and validation dataset comprised 180 112 ECGs from 70 692 patients, collected between Jan 1, 2012, and Apr 30, 2019. The test dataset comprised 828 ECGs corresponding to 828 new patients, recorded between Sept 11, 2012, and Aug 30, 2019. At the multilabel level, our deep learning approach to diagnosing heart abnormalities resulted in an exact match in 658 (80%) of 828 ECGs, exceeding the mean performance of physicians (552 [67%] for physicians with 0-6 years of experience; 571 [69%] for physicians with 7-12 years of experience; 621 [75%] for physicians with more than 12 years of experience). Our model had an overall mean F1 score of 0·887 compared with 0·789 for physicians with 0-6 years of experience, 0·815 for physicians with 7-12 years of experience, and 0·831 for physicians with more than 12 years of experience. The model had a mean AUC ROC score of 0·983 (95% CI 0·980-0·986), sensitivity of 0·867 (0·849-0·885) and specificity of 0·995 (0·994-0·996). Promising F1 scores were also obtained from the external public database using our proposed model without any model modifications (mean F1 scores of 0·845 in multilabel and 0·852 in single-label ECGs). INTERPRETATION: Our model is more accurate than physicians working in cardiology departments at distinguishing a range of distinct arrhythmias in single-label and multilabel ECGs, laying a promising foundation for computational decision-support systems in clinical applications. FUNDING: National Natural Science Foundation of China and Hubei Science and Technology Project.

Zeolite-Enhanced Sustainable Pd-Catalyzed C-C Cross-Coupling Reaction: Controlled Release and Capture of Palladium.

Supported palladium catalysts have attracted significant attention for use in cross-coupling reactions due to their recyclability. However, the inevitable progressive loss of Pd that occurs in the catalytic process deactivates the catalysts, which hinders their sustainable application. Herein, we report a zeolite-enhanced sustainable Pd catalyst for C-C cross-coupling reactions. Zeolite does a good job of acting as a sink for Pd2+ ions. This catalyst exhibits an excellent homogeneous catalytic performance by releasing Pd species from zeolite. In addition, the Pd2+ ions were successfully recaptured in a controlled catalytic system by combining the uniform microporous structure and good adsorption features of zeolite. The release/capture mechanism of the Pd species guaranteed the high loading and high dispersion of Pd on the recycled catalyst. The 0.84%Pd@USY catalysts were reused at least 10 times in water without an appreciable reduction in activity. This study presents a new perspective toward the design of a highly efficient and sustainable supported metal catalyst.

The complete genome sequence of the algicidal bacterium Bacillus subtilis strain JA and the use of quorum sensing to evaluate its antialgal ability.

We describe the isolation of Bacillus subtilis strain JA and demonstrate that this bacterium exhibited strong algicidal effects on the algae Alexandrium minutum with an inhibition rate exceeding 80 % within 48 h. B. subtilis JA significantly reduced the photosynthetic efficiency of A. minutum and caused extensive morphological damage to the algae. Genomic analysis of B. subtilis JA demonstrated that a putative AI-2 type quorum sensing (QS) gene (LuxS) is present in its genome cluster, which is regulate pheromone biosynthesis. Interestingly, the exogenous addition of a QS-oligopeptide (ComX-pheromone) improved the algicidal efficiency of B. subtilis JA, thus indicating that the algicidal activity of this bacterium is potentially regulated by QS. Collectively, our data describe a potential antialgal bacterium and speculated that its behavior can be modulated by QS signal. B. subtilis JA may therefore represent a valuable tool for the development of novel chemical-ecological methods with which to control harmful algae.

Temporal Variability of Virioplankton during a Gymnodinium catenatum Algal Bloom.

Viruses are key biogeochemical engines in the regulation of the dynamics of phytoplankton. However, there has been little research on viral communities in relation to algal blooms. Using the virMine tool, we analyzed viral information from metagenomic data of field dinoflagellate (Gymnodinium catenatum) blooms at different stages. Species identification indicated that phages were the main species. Unifrac analysis showed clear temporal patterns in virioplankton dynamics. The viral community was dominated by Siphoviridae, Podoviridae, and Myoviridae throughout the whole bloom cycle. However, some changes were observed at different phases of the bloom; the relatively abundant Siphoviridae and Myoviridae dominated at pre-bloom and peak bloom stages, while at the post-bloom stage, the members of Phycodnaviridae and Microviridae were more abundant. Temperature and nutrients were the main contributors to the dynamic structure of the viral community. Some obvious correlations were found between dominant viral species and host biomass. Functional analysis indicated some functional genes had dramatic response in algal-associated viral assemblages, especially the CAZyme encoding genes. This work expands the existing knowledge of algal-associated viruses by characterizing viral composition and function across a complete algal bloom cycle. Our data provide supporting evidence that viruses participate in dinoflagellate bloom dynamics under natural conditions.

Complete genome sequence of Acinetobacter baumanni J1, a quorum sensing-producing algicidal bacterium, isolated from Eastern Pacific Ocean.

The Acinetobacter baumanni J1 isolated from surface water of the Eastern Pacific Ocean, demonstrated significant algicidal activity on the algae Alexandrium tamarense. Interestingly, this strain showed the ability to produce an acyl-homoserine lactone (AHL) quorum sensing molecule. To better understand its AHL producing mechanism and its ecological functions, the genome of A. baumanni strain J1 was completely sequenced. The genome contained a circular chromosome of 3,948,465 bp with an average GC content of 39.9 mol%. A total of 3707 protein coding genes, 41 tRNA genes and 16 rRNA genes were obtained. In silico genome annotation identified a LuxI putative gene located on contig 4. Subsequent thin-layer chromatography analysis indicated that C8-AHL could be produced by A. baumanni J1, which confirmed the authenticity of the LuxI gene. Taken together, this work describes an algicidal bacterium that is capable of producing an AHL molecule, which may represent a valuable tool for developing microbial methods to control harmful algae.

miR-374a Inhibitor Enhances Etoposide-Induced Cytotoxicity Against Glioma Cells Through Upregulation of FOXO1.

Glioma is a commonly diagnosed brain tumor that shows high mortality rate. Despite the great advancement of cancer therapy in recent years, chemotherapy is still an important approach for treatment of glioma. However, long-term chemotherapy usually causes serious side effects or complications. It is desirable to take strategies to enhance the efficacy of current chemotherapy. In the present study, we observed obvious upregulation of miR-374a in glioma cells. More importantly, we found that knockdown of miR-374a was able to enhance the etoposide-induced cytotoxicity against glioma cells. Mechanically, we demonstrated that FOXO1 was the target of miR-374a in glioma. Treatment with miR-374a inhibitor induced overexpression of FOXO1, and thus promoted the expression of Bim and Noxa. Since Bim and Noxa act as key proapoptotic proteins in mitochondrial apoptosis, miR-374a inhibitor was able to enhance the etoposide-induced apoptosis pathway in glioma.

Multi-inch single-crystalline perovskite membrane for high-detectivity flexible photosensors.

Single crystalline perovskites exhibit high optical absorption, long carrier lifetime, large carrier mobility, low trap-state-density and high defect tolerance. Unfortunately, all single crystalline perovskites attained so far are limited to bulk single crystals and small area wafers. As such, it is impossible to design highly demanded flexible single-crystalline electronics and wearable devices including displays, touch sensing devices, transistors, etc. Herein we report a method of induced peripheral crystallization to prepare large area flexible single-crystalline membrane (SCM) of phenylethylamine lead iodide (C6H5C2H4NH3)2PbI4 with area exceeding 2500 mm2 and thinness as little as 0.6 µm. The ultrathin flexible SCM exhibits ultralow defect density, superior uniformity and long-term stability. Using the superior ultrathin membrane, a series of flexible photosensors were designed and fabricated to exhibit very high external quantum efficiency of 26530%, responsivity of 98.17 A W-1 and detectivity as much as 1.62 × 1015 cm Hz1/2 W-1 (Jones).

lncRNA GHET1 down-regulation suppresses the cell activities of glioma.

Long noncoding RNAs (lncRNAs) are emerging as new modulators in cancer origination and progression. The previous study found lncRNA gastric carcinoma highly expressed transcript 1 (GHET1) was significantly up-regulation in the gastric cancer. In our present study, we studied the GHET1 expression in glioma and its effects to biological activities of glioma in vitro and vivo studies. In the clinical analysis, the results were shown that lncRNA GHET1 was significantly up-regulation and the Numb protein expression was significantly down-regulation in glioma tissues. In vitro and vivo studies, the results were shown that lncRNA GHET1 knock-down had effects to inhibit biological activities by regulation Numb and down-stream genes P53 and MMP2/9. The results suggested that GHET1 is a novel tumor oncogene by Numb in glioma. LncRNA GHET1 may serve as a potential biomarker and therapeutic target for glioma.

Transcriptional mutagenesis mediated by 8-oxoG induces translational errors in mammalian cells.

Reactive oxygen species formed within the mammalian cell can produce 8-oxo-7,8-dihydroguanine (8-oxoG) in mRNA, which can cause base mispairing during gene expression. Here we found that administration of 8-oxoGTP in MTH1-knockdown cells results in increased 8-oxoG content in mRNA. Under this condition, an amber mutation of the reporter luciferase is suppressed. Using second-generation sequencing techniques, we found that U-to-G changes at preassigned sites of the luciferase transcript increased when 8-oxoGTP was supplied. In addition, an increased level of 8-oxoG content in RNA induced the accumulation of aggregable amyloid ß peptides in cells expressing amyloid precursor protein. Our findings indicate that 8-oxoG accumulation in mRNA can alter protein synthesis in mammalian cells. Further work is required to assess the significance of these findings under normal physiological conditions.

Deceleration capacity-a novel measure for autonomic nervous system in patients with vasovagal syncope on tilt-table testing.

This study was to investigate the changes of autonomic nerve function and hemodynamics in patients with vasovagal syncope (VVS) during head-up tilt-table testing (HUT). HUT was performed in 68 patients with unexplained syncope and 18 healthy subjects served as control group. According to whether bradycardia, hypotension or both took place during the onset of syncope, the patients were divided during the test into three subgroups: vasodepressor syncope (VD), cardioinhibitory syncope (CI) and mixed syncope (MX) subgroups. Heart rate, blood pressure, heart rate variability (HRV), and deceleration capacity (DC) were continuously analyzed during HUT. For all the subjects with positive responses, the normalized low frequency (LFn) and the LF/HF ratio markedly decreased whereas normalized high frequency (HFn) increased when syncope occurred. Syncopal period also caused more significant increase in the power of the DC in positive groups. These changes were more exaggerated compared to controls. All the patients were indicative of a sympathetic surge in the presence of withdrawal vagal activity before syncope and a sympathetic inhibition with a vagal predominance at the syncopal stage by the frequency-domain analysis of HRV. With the measurements of DC, a decreased vagal tone before syncope stage and a vagal activation at the syncopal stage were observed. The vagal tone was higher in subjects showing cardioinhibitory responses at the syncopal stage. DC may provide an alternative method to understand the autonomic profile of VVS patients.

Californium-252 neutron brachytherapy combined with external pelvic radiotherapy plus concurrent chemotherapy for cervical cancer: a retrospective clinical study.

BACKGROUND: Cervical cancer is the sixth most common cancer in Chinese women. A standard treatment modality for cervical cancer is the combination of surgery, chemotherapy, external-beam radiotherapy and intracavitary brachytherapy. The aim of this study was to retrospectively assess the long-term treatment outcomes of patients with cervical cancer who were treated with californium-252 neutron brachytherapy combined with external-beam radiotherapy plus concurrent chemotherapy. METHODS: We retrospectively analyzed the medical records of 150 patients with primary stages IB-IVB cervical cancer who received neutron brachytherapy combined with external-beam radiotherapy concurrently with cisplatin chemotherapy. All patients were followed up. Using an actuarial analysis, patient outcomes and treatment-related adverse effects were evaluated and compared. RESULTS: The median overall survival (OS) was 33.2 months. The 3-year progression-free survival rates for patients with stages I-II, III, and IV diseases were 81.0% (68/84), 65.0% (39/60), and 0% (0/6), respectively; the 3-year OS rates were 90.5% (76/84), 85.0% (51/60), and 16.7% (1/6), respectively. Vaginal bleeding was controlled within the median time of 4.0 days. One month after treatment, 97.3% of patients achieved short-term local control. The local recurrence rates for patients with stages I-II, III, and IV disease were 4.8% (4/84), 11.7% (7/60), and 33.3% (2/6), respectively, and the occurrence rates of distant metastasis were 16.7% (14/84), 25.0% (15/60), and 100.0% (6/6), respectively. Cancer stage, tumor size, and lymph node metastasis were identified as prognostic risk factors, but only lymph node metastasis was found to be an independent prognostic factor. The most common adverse effects during treatment were grades 1 and 2 irradiation-related proctitis and radiocystitis. CONCLUSION: For patients with cervical cancer, neutron brachytherapy combined with external-beam radiotherapy plus concurrent chemotherapy produces a rapid response and greatly improves local control and long-term survival rates with tolerable adverse effects.