The clinical applications of D-type parastomal hernia repair surgery.

OBJECTIVE: This study investigated the use of a modified laparoscopic repair of paraostomy hernia technique, called "D-Type parastomal hernia repair surgery" which combines abdominal wall and extraperitoneal stoma reconstruction, in patients with parastomal hernia (PSH) following colorectal stoma surgery. The aim was to determine whether D-type parastomal hernia repair surgery is a promising surgical approach compared to the traditional laparoscopic repair technique (Sugarbaker method) for patients with PSH. METHODS: PSH patients were selected and retrospectively divided into two groups: the study group underwent D-type parastomal hernia repair, while the control group underwent laparoscopic Sugarbaker repair. Clinical data from both groups were analyzed. RESULT: Compared to control group (n = 68), the study group undergoing D-type stoma lateral hernia repair had significant increase in total operative time (98.82 ± 12.37 min vs 124.61 ± 34.99 min, p < 0.001). The study group also showed better postoperative stoma bowel function scores in sensory ability, frequency of bowel movements, and clothing cleanliness without a stoma bag (p = 0.037, 0.001, 0.002). The treatment cost was significantly higher in the control group (3899.97 ± 260.00$ vs 3215.91 ± 230.03$, p < 0.001). The postoperative recurrence rate in the control group was 26.4%, while in the study group, it was 4.3%, with a significant statistical difference (p = 0.024). In terms of long-term postoperative complications, the study group had an overall lower incidence compared to the control group (p = 0.035). Other parameters showed no significant differences between the two groups. CONCLUSION: The study suggests that D-type parastomal hernia repair surgery is a safe and feasible procedure. Compared to traditional surgery, it can reduce the recurrence of lateral hernia, improve postoperative stoma bowel function, and save medical resources.

[Using the external auditory canal skin graft of the healthy side to treat unilateral congenital aural atresia: preliminary results of clinical research].

Objective: To investigate whether the contralateral normal external auditory canal (EAC) skin graft can maintain the ear canal health after EAC reconstruction in unilateral congenital aural atresia (CAA) cases. Methods: A Zelen design randomized controlled study was used to collect unilateral CAA patients for EAC reconstruction prospectively (clinical trial registration number: ChiCTR2000032103). The patients were randomly divided into the control group and the trial group. The trial group used the contralateral normal EAC skin graft group (transplant part of the contralateral normal EAC skin to repair the atresia side for unilateral CAA patients), the control group all used scalp blade thick skin. We observed the EAC health and hearing results of the two groups after EAC reconstruction. Results: A total of 13 cases were enrolled from July 2020 to August 2021. There were eight patients in the trial group, including six males and two females, with an average age of 22.3 years (14-36 years). There were two patients with CAA on the left and six patients on the right. The average follow-up time was 8.8 months (4-14 months). There were five patients in the control group, all cases were male with an average age of 16.2 years (12-20 years). There were four patients with CAA on the left and one patient on the right. The average follow-up time was 7.0 months (2-14 months). In the trial group, eight cases of reconstructed EAC epithelium were healthy, one patient had cicatricial stenosis of EAC opening and lateralization of the tympanic membrane. The other patient had cicatricial stenosis of reconstructed EAC, this case also had scar hyperplasia of the contralateral EAC opening but recovered after soft packing and triamcinolone acetonide injection treatment. The healthy side EAC of the rest trial group had no scarring stenosis or local bone hyperplasia during long-term follow-up. In the control group, one patient was lost to follow-up and the other four patients had dry ears of reconstructed EAC, but easily to form crusts and needed to be cleaned repeatedly, one patient had lateralization of the tympanic membrane, the EAC epithelium was not healthy for long-term follow-up. The incidence of complications related to EAC reconstruction was lower than previous studies (χ²=5.55, P=0.018), and the average postoperative Air-Bone Gap increased (18.8±10.0)dB. Conclusion: By optimizing the EAC reconstruction technology, the health of the reconstructed EAC is improved compared with the previous study. After active intervention and treatment, there should be no scarring stenosis or local bone hyperplasia on the contralateral side EAC.

[Correction of severe cup ears using postauricular tongue-shaped flap combined with deep fascial suspension].

Objective: To investigate the effect and satisfaction of using the postauricular tongue-shaped flap combined with deep fascia suspension in correcting severe cup ear malformation. Methods: Between August 2018 and November 2019, nine cases (10 ears) of Tanzer type Ⅲ severe cup ear malformation were treated with postauricular tongue-shaped flap combined with deep fascia suspension in this study. Results: Nine cases primary healed without hematoma, infection or skin necrosis, except one case with postoperative incision dehiscence. The cup ear deformity was significantly improved after the operation, the helix was intact, and the anti-helix was visible. The length, width, and circumference of the auricle were significantly enlarged three months following surgeries. There were no other complications except 1 patient recurrence 12 months after surgery. The patients were highly satisfied with the results of the surgery. Conclusions: Although the aesthctic of the reconstructed auricle is insufficient, this new technology makes full use of the autologous auricle tissue to correct severe cup ear malformation with good results.

The effect of Casitas b-lineage lymphoma b on regulating T follicular helper in lupus nephritis.

OBJECTIVE: The purpose of this study was to investigate the effect of Casitas b-lineage lymphoma b (Cblb) on the regulation of T follicular helper (Tfh) in the development of lupus nephritis. MATERIALS AND METHODS: The Tfh (CD4+CXCR5+PD-1+) cells in peripheral blood were analyzed by flow cytometry. Forty mice were divided into 4 groups (10/group), WT, lpr, Cblb-/- and lpr.Cblb-/-. Urine protein, serum creatinine, blood urea nitrogen (BUN), dsDNA, and antinuclear antibody (ANA) titer of mice were monitored once every four weeks. Peripheral blood mononuclear cells (PBMCs) from mice were collected to assess circulating Tfh. The expressions of Cblb in Tfh cells were regulated by transfecting siRNA and overexpression plasmid approach in vitro. RESULTS: The patients with lupus nephritis (LN) had abnormal renal clinical manifestations compared with healthy volunteers. The peripheral Tfh cells were increased and the expression of Cblb were downregulated in patients with LN (p<0.05). Both lpr mice and lpr.Cblb-/- mice had LN symptoms. LN symptoms were more serious in lpr.Cblb-/- mice compared with that in lpr mice (p<0.05). The number of Tfh cells in peripheral blood from lpr.Cblb-/- mice was significantly higher than that from lpr mice (p<0.05). Overexpression of Cblb in Tfh cells led to reduction of IgG expression, while the knockdown of Cblb in Tfh cells was accompanied by increased expression of immunoglobulin (IgG) (p<0.05). CONCLUSIONS: Cblb showed a negative regulatory effect on Tfh. The deletion of Cblb may be a key factor in progression of renal injury.

[Correlation study of peripheral blood inflammatory factors in patients with sudden deafness].

Objective:The aim of this study is to compare the difference of inflammatory factors in peripheral blood between sudden deafness patients and normal people, and to evaluate the predictive value of inflammatory factors in hearing recovery of sudden deafness patients. Method:Seventy-two inpatients with sudden deafness and 19 healthy persons were included. At the beginning of treatment in our hospital, audiometry was performed and peripheral blood was collected. The levels of IL-1ß, IL-6, IL-17α, TGF-ß1 and TNF-α in peripheral blood were detected by ELISA. The treatment was intravenous steroid（not applied if patients with contraindication of systemic steroid application）+ intratympanic steroid injection+ microcirculation improvement or neurotrophic therapy+ hyperbaric oxygen. At the end of the treatment, audiometry was performed again. A total of 26 patients were collected to test the levels of inflammatory factors in peripheral blood again at the end of the treatment. Result:The mean levels of inflammatory factors IL-1ß, IL-6, IL-17α, TGF-ß1 and TNF-α in peripheral blood of patients were （2.66±9.57） pg/ml, （4.71±6.91） pg/ml, （19.33±32.27） pg/ml, （50 018.37±14 660.72） pg/ml, （1.52±2.40） pg/ml, respectively. And the level of these five inflammatory factors in normal persons were （3.61±9.82） pg/ml, （3.58±4.49） pg/ml, （11.64±13.29） pg/ml, （45 199.98±11 956.09） pg/ml，（1.09±1.08） pg/ml respectively. Statistical analysis showed no significant difference between these two groups. A total of 45 cases were effective（hearing threshold increased ≥15 dB） and 27 cases were ineffective（hearing threshold increased<15 dB）. There was no significant difference in the levels of inflammatory factors between the two groups. Among 26 patients with blood samples before and after treatment, the level of TGF-ß1 after treatment was significantly lower than that before treatment. Conclusion:The levels of these five inflammatory factors including IL-1ß, IL-6, IL-17α, TGF-ß1 and TNF-αin peripheral blood could not predict the recovery of sudden hearing loss. The role of inflammation in the development of sudden deafness needs further confirmation. TGF-ß1 may be involved in the development of sudden deafness.

[Incremental cost-effectiveness of the second Xpert MTB/RIF assay for detection of Mycobacterium tuberculosis].

Objective: To study the incremental cost-effectiveness of the second Xpert assay in detection of Mycobacterium tuberculosis (Mtb) and rifampicin (RIF) resistance. Methods: We continuously collected 2 896 specimens from suspected tuberculosis patients who had undergone 2 Xpert tests in a week from March 2015 to March 2018, including 2 402 suspected tuberculosis patients with 1 523 males and 879 females, with an average age of 50 years. Among them, 2 144 specimens of sputum and 258 cases of bronchoalveolar lavage fluid were collected. We also enrolled 494 patients with suspected extrapulmonary tuberculosis, 318 males and 176 females, with an average age of 42 years. Among them, 157 pleural effusion specimens, 106 cerebrospinal fluid specimens, 34 urine specimens and 197 pus specimens were collected. All specimens were subjected to two Xpert tests, smear microscopy, liquid rapid culture (BACTEC MGIT 960), and positively cultured bacteria were tested for drug susceptibility. Results: Among the 2 896 specimens from suspected tuberculosis patients, either one of the two Xpert test results was positive (including both tests were positive, the same below) in 1 639 patients, and 1 502 (91.6%) were positive in the first Xpert tests. The additional 137 (8.4%) test results were positive in the second tests. According to the smear test results, all specimens were divided into the smear negative group and the smear positive group. The second Xpert test was significantly higher than the smear-positive group (14.86%, 3.2%, P<0.001), and the extrapulmonary tuberculosis group was higher than the tuberculosis group (11.2%, 8.0%, P=0.12).Of the susceptibility test results, a total of 371 were rifampicin-resistant specimens. The first Xpert detected 91.4% (339/371), and the second Xpert detected the additional 8.1% (30/371).The cost increase of the second test was very significant. Tests were calculated at 650 yuan per time, the tuberculosis group was 1 184 yuan and 13 696 yuan(P<0.001); the extrapulmonary tuberculosis group was 1 755 yuan and 13 961 yuan(P<0.001). In the test of specimens of tuberculosis and extrapulmonary tuberculosis, the smear-negative specimen cost increase of the second Xpert test was lower than that of the smear-positive specimen. Conclusion: The second xpert test showed significant value-added cost-effectiveness in the diagnosis of tuberculosis.

[Effect of alcohol drinking on sputum conversion at the end of second month and outcome of smear-positive pulmonary tuberculosis patients].

Objective: To explore the effect of alcohol drinking on sputum culture conversion at the end of second month and outcome of smear-positive pulmonary tuberculosis (PTB) patients. Methods: Total 2 067 patients aged 18 years and above diagnosed and treated from 2008 to 2011 in 49 TB institutions from 8 provinces, antonomous regions and municipalities were enrolled, according to tuberculosis situation and regional distribution in China. Those patients were divided into three groups according to alcohol drinking, including never alcohol drinker group, ever-alcohol drinker group and current alcohol drinker group, respectively. Chi-square test was used to compare the following variables among the three groups: adverse action, lesions absorption, cavity size, sputum-culture results at the end of the 2(nd) month of treatment, and treatment outcome. Multivariate Logistic regression was used to explore that whether alcohol drinking was risk factor of poor treatment effect. Results: Among the 2 067 smear-positive PTB patients, never drinkers, ex-drinkers and current drinkers account for 55.2% (1 140/2 067), 36.5% (755/2 067), 8.3% (172/2 067), respectively. Among patients of never drinkers, ex-drinkers and current drinkers groups, sputum-culture conversion rate at the end of the 2(nd) month of treatment were 86.1%, 81.3% and 83.0%, respectively (χ(2)=6.782, P=0.033); the difference in treatment outcome was significant (χ(2)=13.620, P=0.034). Treatment success rate were 83.9%, 81.1% and 79.7%, respectively; failure rate was 6.4%, 10.3% and 9.9%, respectively, and fatality rate were 2.1%, 2.3% and 4.1%, respectively. Multivariate Logistic regression analysis showed that non-sputum conversion of the end of 2(nd) month and fatality rate of ex-drinkers were 1.431 and 1.668 times higher than never drinkers, respectively; non-sputum conversion of the end of 2(nd) month of current drinkers was 1.256 times higher than never drinkers. Conclusion: Alcohol drinking affects the treatment effectiveness of tuberculosis, which increased risk of culture-positive rate of the end of 2(nd) month and fatality rate.

[Evaluation of a high-intensity fluorescent fluorophage method for diagnosis of drug-resistance in tuberculosis].

Objective: To evaluate the high-intensity green fluorescent protein fluorophage Φ(2)GFP10 method for drug susceptibility testing of tuberculosis for isoniazid(INH), rifampin(RIF), and streptomycin(SM). Methods: A total of 128 clinical M. tuberculosis strains were isolated from patients with suspected drug-resistant tuberculosis visiting Beijing Chest Hospital (Beijing, China) from April to June 2014.All of the isolates were tested by the phage assay, while conventional drug susceptibility tests were performing on Lwenstein-Jensen culture medium as reference. Results: The sensitivities of Φ(2)GFP10 assay for INH, RIF, and SM resistance detection were 100.0%, 98.1%(53/54), and 92.6%(50/54), respectively, while their specificities were 84.8%(56/66), 91.9%(68/74), and 91.9%(68/74), respectively. The agreement between the phage assay and the conventional assay for detecting INH, RIF, and SM resistance was 0.92, 0.95 and 0.92, respectively. The Φ(2) GFP10-phage assay could be done within 2 days for RIF and SM, and 3 days for INH. Conclusions: The Φ(2)GFP10-phage method for drug susceptibility test is very sensitive and specific. The method has the potential to be a valuable, rapid and economical screening method for detecting drug-resistant tuberculosis.

Relationship between C-reactive protein levels and obstructive sleep apnea syndrome.

This study aims to determine the relationship between C-reactive protein levels and obstructive sleep apnea syndrome (OSAS). We recruited 30 OSAS patients into the observation group (OSAS group), and subdivided them into mild, moderate and severe groups according to the apnea hypopnea index. In addition, 20 normal individuals were included in the control group. Plasma CRP levels of two groups were measured. As compared with the control group, the CRP levels in the OSAS group were significantly increased (P < 0.05). ANOVA showed that CRP levels in the three subgroups differ; statistically significant differences between the mild and severe OSA patients were observed (P < 0.05). It was hypothesized that OSAS patients show elevated serum CRP levels, and that serum CRP levels are associated with OSAS severity.

A novel chemical uncoupler ameliorates obesity and related phenotypes in mice with diet-induced obesity by modulating energy expenditure and food intake.

AIMS/HYPOTHESIS: Decreasing mitochondrial coupling efficiency has been shown to be an effective therapy for obesity and related metabolic symptoms. Here we identified a novel mitochondrial uncoupler that promoted uncoupled respiration in a cell type-specific manner and investigated its effects on modulation of energy metabolism in vivo and in vitro. METHODS: We screened a collection of mitochondrial membrane potential depolarising compounds for a novel chemical uncoupler on isolated skeletal muscle mitochondria using a channel oxygen system. The effect on respiration of metabolic cells (L6 myotubes, 3T3-L1 adipocytes and rat primary hepatocytes) was examined and metabolic pathways sensitive to cellular ATP content were also evaluated. The chronic metabolic effects were investigated in high-fat diet-induced obese mice and standard diet-fed (SD) lean mice. RESULTS: The novel uncoupler, CZ5, promoted uncoupled respiration in a cell type-specific manner. It stimulated fuel oxidation in L6 myotubes and reduced lipid accumulation in 3T3-L1 adipocytes but did not affect gluconeogenesis or the triacylglycerol content in hepatocytes. The administration of CZ5 to SD mice increased energy expenditure (EE) but did not affect body weight or adiposity. Chronic studies in mice on high-fat diet showed that CZ5 reduced body weight and improved glucose and lipid metabolism via both increased EE and suppressed energy intake. The reduced adiposity was associated with the restoration of expression of key metabolic genes in visceral adipose tissue. CONCLUSIONS/INTERPRETATION: This work demonstrates that a cell type-specific mitochondrial chemical uncoupler may have therapeutic potential for treating high-fat diet-induced metabolic diseases.

3-D imaging and illustration of the perfusive mouse islet sympathetic innervation and its remodelling in injury.

AIMS/HYPOTHESIS: Sympathetic nerves influence islet hormone levels in the circulation. Insights into islet sympathetic innervation and its remodelling in diabetes may impact future therapeutics. However, standard immunohistochemistry and microtome-based microscopy cannot provide an integral view of the islet neurovascular complex. We prepared transparent islet specimens to investigate the spatial relationship between sympathetic nerves, blood vessels and islet cells in normal, streptozotocin-injected and non-obese diabetic mouse models. METHODS: Cardiac perfusion of fluorescent lectin was used to label pancreatic blood vessels. Tyrosine hydroxylase and nuclear staining were used to reveal islet sympathetic innervation and microstructure. Optical clearing (i.e. use of immersion solution to reduce scattering) was applied to enable 3-dimensional confocal microscopy of islets to visualise the sympathetic neurovascular complex in space. RESULTS: Unlike previously reported morphology, we observed perfusive intra-islet, perivascular sympathetic innervation, in addition to peri-islet contacts of sympathetic nerves with alpha cells and sympathetic fibres encircling the adjacent arterioles. The intra-islet axons became markedly prominent in streptozotocin-injected mice (2 weeks after injection). In non-obese diabetic mice, lymphocytic infiltration remodelled the peri-islet sympathetic axons in early insulitis. CONCLUSIONS/INTERPRETATION: We have established an imaging approach to reveal the spatial features of mouse islet sympathetic innervation. The neurovascular complex and sympathetic nerve-alpha cell contact suggest that sympathetic nerves modulate islet hormone secretion through blood vessels, in addition to acting directly on alpha cells. In islet injuries, sympathetic nerves undergo different remodelling in response to different pathophysiological cues.

Simultaneous determination of residues of trichlorfon and dichlorvos in animal tissues by LC-MS/MS.

Trichlorfon is a thermally unstable insecticide that can be easily decomposed to dichlorvos at high temperatures. In this study, a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for simultaneous determination of the residues of trichlorfon and dichlorvos in animal tissues. Trichlorfon and dichlorvos in animal tissues were extracted with dichloromethane, homogenized/shaken, concentrated, and determined by LC-MS/MS. The two insecticides can be effectively separated and individually determined. The limits of detection (LODs) of trichlorfon and dichlorvos were 0.04 and 0.07 microg kg(-1), respectively; the limits of quantification (LOQs) of the two insecticides were both 5 microg kg(-1). The average recoveries for three spiked blank samples at 10, 20 and 40 microg kg(-1) were in the range 85-106%, with relative standard deviations (RSDs) below 10.6%, which falls in a reasonable range for the analysis of the two insecticides in animal-derived foods. The method is fit-for-purpose for the simultaneous determination of residues of trichlorfon and dichlorvos in animal tissues.

Postpartum social support experience while "doing the month" in Taiwanese women.

The aim of this investigation was to explore the social support experience while "doing the month" in Taiwanese women. A convenience sample of one hundred and eighty-six Taiwanese primiparas was recruited during the fourth week after giving birth. The Postpartum Social Support Questionnaire (PSSQ) was used to measure the degree of postpartum social support. The results showed that postpartum women would like themselves and their babies to be close to their husbands and their own parents while "doing the month". The level of social support depended on where postpartum women stayed and the key person who looked after them. The ritual of "doing the month" may provide valuable social support for Taiwanese postpartum women. However, the support while "doing the month" needs to be evaluated by postpartum women. It seems that an alternative concept of rite considering the individual expectations of postpartum women is needed.

[Reconstruction of forearm function by fibular transfer with vascular anastomoses].

OBJECTIVE: To analyse and report the reconstruction of forearm function by fibular transfer with vascular anastomoses. METHODS: Fourteen cases of forearm function dismissed due to defects of bone were managed by fibular transfer with vascular anastomoses. RESULTS: All cases obtained satisfactory effects, and recovered their normal function. CONCLUSION: The vascularized fibular transfer is a good method to reconstruct the forearm function with defects of bone resulting from injury or tumor.

Genomic sequence and transcription start site for the human gamma-glutamyl carboxylase.

The human gene for gamma-glutamyl carboxylase is 13 kb in length and contains 15 exons. Transcription starts at a cytosine 217 base pair upstream of the first codon. There are two major transcripts in all tissues examined. They are distinguished by the presence of an Alu sequence in the 3' nontranslated end of the longer species. Relative mRNA levels for 12 bovine tissues are presented.

Indirect effect of insulin to suppress endogenous glucose production is dominant, even with hyperglucagonemia.

Suppression of endogenous glucose production (EGP) is one of insulin's primary metabolic effects and failure of this action is a major contributor to fasting hyperglycemia of type 2 diabetes mellitus. Classically, insulin was thought to suppress the liver directly, via hyperinsulinemia in the portal vein. Recently, however, we and others have demonstrated that at least part, and possibly most of insulin's action to suppress EGP is normally mediated via an extrahepatic (i.e., indirect) mechanism. We have suggested that this mechanism involves insulin suppression of adipocyte lipolysis, leading to lowered FFA and reduced EGP ("Single Gateway Hypothesis"). Previous studies of the indirect insulin effect from this laboratory were done under conditions of lowered portal glucagon. Because of the possibility that the direct (i.e., portal) effect of insulin may have been underestimated with hypoglucagonemia, these studies examined the relative importance of portal insulin, versus peripheral insulin (administered at one-half the dose to equalize peripheral insulin levels) at four rates of portal glucagon infusion: 0, 0.65 (under-), 1.5 (basal-), and 3.0 ng/kg per min (over-replacement). Portal versus peripheral insulin suppressed steady-state EGP to the same extent (52%), confirming that the primary effect of insulin to suppress EGP is via the peripheral mechanism. This conclusion was maintained regardless of portal glucagonemia, although there was some evidence for an increase in the direct insulin effect at hyperglucagonemia. The indirect effect of insulin is the primary mechanism of steady-state EGP suppression under normal conditions. The direct effect increases with hyperglucagonemia; however, the indirect effect remains predominant even under those conditions.

[Risk factors of lung cancer--follow-up studies in Nagoya Japan].

A population-based follow-up study on the relationships between various environmental factors and risks of lung cancer has been conducted in Nagoya, Japan involving 24,489 inhabitants aged 40 or older. The baseline survey was conducted in 1985, using a self-recorded questionnaire. From a 10 year follow-up study, 161 cases with a newly diagnosed lung cancer (120 male cases and 41 female cases) were identified. Various environmental factors were related to the subsequent risk of lung cancer incidence. Causal relationship between smoking and lung cancer was noticed for current male smokers (RR = 5.72; 95% CI = 2.50-13.08) and for current female smokers (RR = 2.05%; 95% CI = 0.97-4.32). However, relative risks for other environmental factors were not statistically significant except increased risk for frequent coffee drinking in males (aRR = 2.02; 95% CI = 1.34-3.05) and decreased risk for frequent intake of green/yellow vegetables in females (aRR = 0.47; 95% CI = 0.23-0.94).