[Efficacy of two-lung ventilation with different tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing radical resection of esophageal cancer using combined laparoscopic and thoracoscopic approach].

Objective: To evaluate the efficacy of two-lung ventilation with different tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing radical esophagectomy using combined thoracoscopic and laparoscopic approach. Methods: One hundred and eighty patients undergoing radical esophagectomy using combined thoracoscopy and laparoscopy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University between February and September 2019 were randomly divided into three groups (group V1, V2, V3, n=60) according to the tidal volume (TV) used. The TVs of group V1-V3 were 4, 5, 7 ml/kg during thoracoscopic surgery, respectively. All the patients were intubated with a single-lumen endotracheal tube and underwent two-lung ventilation assisted by continuous positive pressure CO2 pneumothorax in group V1, V2 and V3, with the CO2 pressure of 10 mmHg (1 mmHg=0.133 kPa) and the frequency of 20 times/min. Mean arterial pressure (MAP) and heart rate (HR) were recorded before thoracoscopic surgery (T1), 30 minutes after thoracoscopic surgery (T2), at the end of thoracoscopic surgery (T3), after thoracoscopic surgery and 30 minutes after two-lung intermittent positive pressure ventilation, respectively. The results of arterial blood gas were collected at T1, T2, T3 and T4. Recovery time from anesthesia, consciousness recovery time, and lung collapse condition were recorded. Results: At T2, the value of MAP in group V1 was (81±10) mmHg, which was higher than those of group V2 [(69±7) mmHg] and group V3 [(71±8) mmHg], with a statistically significant difference (F=9.270, P<0.05). Meanwhile, at T2, the value of HR in group V1 was (83±7) times/min, which was higher than those of group V2 [(68±6) times/min] and group V3 [(71±7) times/min], and there was a statistically significant difference (F=23.460, P<0.05). However, at T2, the values of arterial partial pressure of oxygen (PaO2) in three groups were (262±16), (249±16) and (241±20) mmHg, respectively, with no statistically significant difference (F=1.929, P>0.05). At T3, the value of arterial partial pressure of carbon dioxide (PaCO2) in group V3 was (46±5) mmHg, which was lower than those of group V1 [(63±9) mmHg] and V2 [(62±10) mmHg], with a statistically significant difference (F=20.890, P<0.05). Moreover, at T3, the value of pH in group V3 was (7.35±0.04), which was higher than those of group V1 (7.28±0.04) and V2 (7.32±0.04), and there was a statistically significant difference (F=9.309, P<0.05). Additionally, the satisfaction rates of lung collapse in group V3 was 57.1%, which was lower than those of group V1 (94.7%) and group V2 (96.3%), with a statistically significant difference (χ²=7.601, P<0.05). There was no statistical significance in the time of awakening and consciousness recovery among three groups (F=1.020 and 1.110, both P>0.05). Conclusion: The two-lung ventilation with 5 ml/kg tidal volume assisted by CO2 pneumothorax has advantages in terms of hemodynamics and surgical field exposure, and is more suitable as the appropriate dose for respiratory management in patients undergoing radical resection of esophageal cancer using combined thoracoscopic and laparoscopic approach.

[Application of different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy].

Objective: To observe the application of three different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy. Methods: one hundred and eighty patients undergoing combined thoracoscopic and laparoscopic esophagectomy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University from February to September 2019 were randomly divided into three groups which include: double-lumen endotracheal intubation group (group S,n=60),single-lumen endotracheal intubation group (group D,n=60) and Coopdech occlusion of bronchial catheter combined with a single-lumen endotracheal intubation group (group C,n=60). The arterial blood samples were collected immediately after endotracheal intubation (T0), 30 min after artificial pneumothorax (single lung ventilation) (T1), 30 min after artificial pneumothorax (double lung ventilation) (T2), and 30 min after extubation (T3) to detect arterial blood gas. Patients' heart rate (HR), blood oxygen partial pressure (PaO2), blood carbon dioxide partial pressure (PaCO2) and airway pressure(Paw) were recorded at T0-T3.Completion time of endotracheal intubation, carbon dioxide intrathoracic inflation pressure, degree of lung collapse and incidence of postoperative 3-day pneumonia in three groups were recorded. The bronchoalveolar lavage fluid (BALF) of patients at T0, T2 and the end of the operation (T4) were collected to detect the levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in BALF by enzyme-linked immunosorbent assay (ELISA). Results: A total of 14 patients were excluded during the operation, of which 9 cases lasted longer than 6 hours, 3 cases had arrhythmia during the operation and 2 cases lasted less than 1 hour. Finally, 56 cases in group S, 54 cases in group D and 56 cases in group C completed the experiment. The satisfaction rates of lung collapse in group S, group D and group C were 85.7% (48/56), 100.0% (54/54), 89.2% (50/56), respectively, with no statistically significant difference (χ²=1.308, P>0.05). The intrathoracic inflation pressure of carbon dioxide in group D was (10.2±2.2) mmHg (1 mmHg=0.133 kPa), which was higher than (5.1±3.4) mmHg in group S and (5.6±3.1) mmHg in group C, the difference was statistically significant (F=-9.303, P<0.05). The incidence of postoperative 3-day pneumonia in group D was 14.8%, which was lower than 39.3% in group S and 17.8% in group C, the difference was statistically significant (χ²=8.300, P<0.05). At T4, the value of TNF-α in group D was (122.4±4.4) ng/L, which was lower than that in group S and group C, (257.9±6.3) and (185.8±5.6) ng/L, with statistically significant difference (F=69.020, P<0.05). At T4, the value of IL-6 in group D was (175.4±4.9) ng/L, which was lower than that of patients in group S and group C, (289.6±6.8) and (226.2±4.4) ng/L, with statistically significant difference (F=59.750, P<0.05). At T4, the value of IL-8 in group D was (303.1±7.2) ng/L, which was lower than in group S and group C, (595.4±22.1) and (436.8±10.9) ng/L, with statistically significant difference (F=55.359, P<0.05). Conclusion: All the three endotracheal intubations can produce satisfactory ventilation effect in the combined thoracoscopic and laparoscopic esophagectomy, however, single-lumen endotracheal intubation has less effect on lung injury.

Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study.

Human cadaveric study has indicated that the metacarpal head (MCH) is intracapsular in location. We hypothesized that exposure to the intra-articular inflammatory milieu in psoriatic arthritis (PsA) will lead to bone loss in the MCH. INTRODUCTION: To compare the bone structure and microstructure in the MCH between patients with PsA and healthy controls by high-resolution peripheral quantitative CT (HR-pQCT), and to ascertain factors associated with bone loss in PsA patients. METHODS: Sixty-two PsA patients without joint destruction and 62 age-, gender-, and body mass index-matched healthy subjects underwent HR-pQCT imaging of the second and third MCH (MCH 2&3). The number and volume of bone erosion and enthesiophytes, as well as volumetric bone mineral density (vBMD) and microstructure at the MCH 2&3, were recorded. Correlation analysis and multivariable linear regression models were used to determine the association of demographic and disease-specific variables with compromised bone structure and microstructure in PsA. RESULTS: At the MCH 2&3, bone erosion (p = 0.003) and enthesiophyte (p = 0.000) volumes in PsA patients were significantly larger than healthy controls. In PsA patients, older age was associated with a larger erosion and enthesiophyte volume. Concerning the mean vBMD and microstructure at the MCH 2&3, PsA patients had significantly lower mean vBMD (average vBMD - 6.9%, trabecular vBMD - 8.8%, peri-trabecular vBMD - 7.7%, meta-trabecular vBMD - 9.8%), trabecular bone volume fraction (- 8.8%), and trabecular thickness (- 8.1%) compared with control subjects. Multivariable regression analysis revealed that older age and a higher C-reactive protein level were associated with trabecular bone loss. CONCLUSIONS: PsA patients had a higher burden of bone damages (erosions and enthesiophytes) and trabecular bone loss compared with healthy control at the MCH. Inflammation contributed to the deterioration in trabecular microstructure in these patients.

[Efficacy of a novel fully covered radioactive stent for advanced esophageal and gastric cardia cancer: a retrospective controlled study].

Objective: To assess the feasibility, safety, and efficacy of a novel fully covered radioactive stent for the treatment of advanced esophageal and gastric cardia cancer. Methods: Data of 122 patients, who underwent esophageal radioactive stent placement for advanced esophageal or gastric cardia cancer between January 2012 and September 2017 in Zhongda Hospital, were retrospectively analyzed. Patients were divided into the novel stent group (n=59; 45 males, 14 females; mean age 73±10 years old) and the conventional stent group (n=63; 51 males, 12 females; mean age 72±9 years old), according to the types of radioactive stents. No significant difference was found between the two groups in baseline characteristics (all P>0.05). Outcomes were measured in terms of technical success, dysphagia score, stent restenosis, stent migration, major complications, and overall survival. Results: The technical success rate was 98.3% in the novel stent group, and 100.0% in the conventional stent group (P=0.484) . The dysphagia scores 3 days after surgery decreased from 3.27±0.45 and 3.37±0.49 to 1.25±0.66 and 1.32±0.50, respectively (all P<0.01), and the variances were comparable (P=0.709). Compared with conventional stents, novel stents were significantly associated with a decreased in the rate of stent restenosis, 11.9% vs 27.0%; cause-specific hazard ratio 0.387, 95%CI 0.160-0.934 (P=0.035); sub-distributional hazard ratio 0.401, 95%CI 0.167-0.963 (P=0.041), while the stent migration rate was statistically comparable (13.6% vs 6.3%, P=0.181). There was no significant difference between the novel stent group and the conventional stent group in major complications (all P>0.05), including moderate-severe chest pain (22.0% vs 25.4%), hemorrhage (11.9% vs 11.1%), fistula formation (1.7% vs 4.8%), and aspiration pneumonia (5.1% vs 6.3%). The median overall survival was 146(95%CI 115-177) days in the novel stent group, and 147(95%CI 98-196) days in the conventional stent group, and no significant difference was found (P=0.967). Conclusions: In patients with advanced esophageal or gastric cardia cancer,placement of a novel fully covered radioactive stent is safe and effective. This novel stent can relieve dysphagia rapidly and prevent stent restenosis effectively.

[The experiment study of endovascular denervation in treatment of cancer pain].

Objective: To assess the feasibility and safety of endovascular denervation (EDN) with a multi-electrode radiofrequency ablation catheter on beagles. Methods: A total of 18 beagles, (10.2±1.1) kg,of either gender,were provided by the Animal Center of Southeast University (SYXK (Su) 2016-0013). They were divided equally into three groups:the instant euthanizing group, the long-term follow-up group and the sham operation group. Beagles in the instant euthanizing group were euthanized immediately after EDN. Beagles in the long-term follow-up group were euthanized three months after EDN. Beagles in the sham operation group underwent sham operation and were euthanized three months later. Blood biochemistry was measured at baseline, and immediately, 15 days, 30 days and 90 days after the surgery. Computerized tomographic (CT) angiography was determined before the surgery and 60 days after the surgery. Digital subtraction angiography (DSA) was determined 90 days after the surgery. Histopathologic analyses were used to identify the changes of arterial wall and neuron cells. Results: Beagles in the long-term follow-up group and the sham operation group all underwent EDN successfully without accidental death. No abdominal aortic perforation and peripheral tissue necrosis were found at Necropsy. No vascular injuries were found by CTA and DSA in each group. There was no statistical difference in hematological analyses, 90 days after the surgery:white blood cell:(12.5±1.5)×10(9)/L vs (13.2±0.7)×10(9)/L, P=0.275; red blood cell:(7.0±0.6)×10(9)/L vs (6.3±0.4)×10(9)/L, P=0.089; total bilirubin:(2.9±0.4) µmol/L vs (3.0±0.6) µmol/L, P=0.681; glutamic-pyruvic transaminase:(40±11) U/L vs (37±6) U/L, P=0.168; glutamic oxalocetie transaminase:(51±11) U/L vs (48±9) U/L, P=0.221; urea nitrogen:(7.2±1.2) mmol/L vs (6.9±0.8) mmol/L, P=0.505; creatinine:(60±9) µmol/L vs (59±9) µmol/L, P=0.81; prothrombin time:(7.2±0.7) s vs (7.0±0.7) s, P=0.719. Histopathological analyses showed that there were hypercellular appearance of nerve bundle and thickened perineurium in EDN groups, while normal perineurium around nerve bundle in the sham operation group. Conclusion: EDN could be applied in beagles safely and feasibly.

[Effects of penehyclidine hydrochloride on Nrf2/ARE signaling pathway during endotoxin-induced acute lung injury in neonate rats].

Objective: To evaluate the effects of penehyclidine hydrochloride on the nuclear factor erythroid 2-related factor 2/antioxidant responsive element (Nrf2/ARE) signaling pathway during endotoxin-induced acute lung injury(ALI) in neonate rats. Methods: Forty 7-day-old Wistar rats weighing 12-18 g were randomly divided into 4 groups (n=10) using a random number table: normal saline group(NS group), acute lung injury(ALI group), penehyclidine hydrochloride group(PHC group) and penehyclidine hydrochloride+ Nrf2 siRNA plasmid group(PNS group). The ALI model was induced with intraperitoneal endotoxin (5.0 mg/kg) in groups ALI, PHC and PNS. In groups PHC and PNS, penehyclidine hydrochloride (2.0 mg/kg) was injected intraperitoneally at 1 h before ALI respectively, while the equal volume of normal saline was administered in groups NS and ALI. The animal of PNS group were inhaled adenovirus packaging of Nrf2-siRNA three times (one time a day) before modeling. At 4 h after endotoxin injection, the rats were sacrificed. The lungs were collected to determine the wet/dry(W/D) lung weight ratio. The expression of Nrf2 and heme oxygen and enzyme 1(HO-1) were determined by Western blotting, contents of tumor necrosis factor-alpha(TNF-α),interleukin10 (IL-10)were determined by enzyme-linked immunosorbent assay(ELISA). The cell apoptosis were determined by transferase-mediated deoxyuridine triphosphate-biotin nick end labeling(TUNEL),and the apoptotic index was calculated. Results: The W/D ratio in NS, ALI, PHC and PNS groups were (4.2±0.1), (9.6±0.7), (6.5±0.6), (8.3±1.3) respectively. The apoptotic index were (3.7±0.5)%, (31.5±3.2)%, (17.6±4.2)%, (28.1±3.5)%respectively.The contents of TNF-α were (10.3±1.6), (98.5±8.5), (68.5±6.7), (89.9±8.5) pg/ml respectively. The contents of IL-10 were (7.9±0.6), (102.8±9.3), (72.5±5.8), (97.7±9.1) pg/ml respectively.The expression of Nrf2 were (23.2±7.6), (79.8±13.0), (155.5±16.7), (12.0±3.3) respectively. The expression of HO-1 were (31.7±8.6), (90.8±10.3), (147.6±22.5), (61.4±9.7) respectively. There were statistically significant differences among different groups (F=86.013, 154.897, 328.810, 374.198, 333.965, 125.274, all P<0.05). Compared with group NS, the W/D ratio, apoptotic index and the contents of TNF-α, IL-10 increased, the expression of Nrf2 and HO-1 up-regulated in group ALI and group PHC (all P<0.05). Compared with group ALI, the W/D ratio, apoptotic index and the contents of TNF-α, IL-10 decreased, the expression of Nrf2 and HO-1 up-regulated in group PHC (all P<0.05). Compared with group ALI, no significant differences were found in the W/D ratio, apoptotic index and the contents of TNF-α, IL-10 in group PNS(all P>0.05), while the expression of Nrf2 and HO-1 down-regulated in group PNS (all P<0.05). Compared with group PHC, the W/D ratio,apoptotic index and the contents of TNF-α,IL-10 increased, the expression of Nrf2 and HO-1 down-regulated in group PNS (all P<0.05). Conclusion: Nrf2/ARE signaling pathway is involved in the reduction of ALI by penehyclidine hydrochloride in neonate rats.

[Implantation of the irradiation stent system intoportal vein: studies on normal beagles].

Objective: To assess the feasibility and safety of the irradiation stent system in portal vein on normal beagles. Methods: A portal vein irradiation stent system was composed of an Iodine-125 seeds-carrier and a conventional stent.Twenty beagle dogs were randomly assigned to receive treatment with a conventional stent (5 beagle dogs) or an irradiation stent system (15 beagle dogs in three groups received 11.1, 22.2, 33.3 MBq radioactivity, n=5 in each dose group). Follow-up methods included blood biochemical test, color Doppler sonographyand CT scan at 0, 15, 30, 60, and 120 days after implantation of irradiation stent system.Pathological tissues were obtained from sacrificed beagle dogs on the 120th day. Results: The portal vein irradiation stent systems and the conventional stents were successfully deployed into the targeted portal vein segment in all beagles, none was dislodged during the deployment or the follow-up period.Differences of blood biochemical indexes and portal vein flow volume measured by color Doppler sonography were not significant (P>0.05). Stent systems were morphologically intact and patent.None of the peripheral organs had hemorrhage, necrosis or perforation.Pathological tissues revealed that the systems were surrounded by fibrous tissues and a few inflammatory cells, but with no significant differences in all groups. Conclusion: It indicates that portal veinirradiation stent system is safe in all dose groups, and it is feasible to design a special irradiation stent system for each patient according to the size of the portal vein tumor thrombus.

[Effect of single lumen endobronchial tube and double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy].

Objective: To investigate the effect of the single lumen endobronchial tube and the double lumen endobronchial tube on ventilation and lung injury in patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy. Methods: Sixty patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy were divided into single lumen endobronchial tube group (D group, n=30) and double lumen endobronchial tube group (S, n=30) according to the random number table. Blood samples were harvested at the moment of tracheal intubation (T(0)), after artificial pneumothorax (one lung ventilation) 30 min (T(1)), after artificial pneumothorax (one lung ventilation) 90 min (T(2)), artificial pneumothorax over (double lung ventilation) 30 min (T(3)) and after extubation 30 min (T(4)) for arterial blood gas analysis. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO(2)), oxygen tension (PaO(2)), carbon dioxide partial pressure (PaCO(2)) and airway pressure (PAW) were recorded at T(0)-T(4). The incidences of pneumonia of two groups were record at 3 days after operation. Results: There were no obvious differences in HR, MAP, SpO(2), PaO(2), PaCO(2) between two groups at T(0)-T(4) (P>0.05). Compared with T(0), the levels of HR and PaO(2) were increased remarkably at T(1)-T(3) (P<0.05), the levels of PaCO(2) were increased remarkably at T(1)-T(4) (P<0.01), and the levels of Paw were increased remarkably at T(1)-T(3) (P<0.01). Compared with S group, the levels of Paw were decreased remarkably at T(1)-T(2) (29.5±3.7 vs 21.3±2.1, P=0.001; 30.7±4.8 vs 20.3±2.3, P=0.001). There were no obvious differences in the levels of TNF-α, IL-6, IL-8 in Bronchoalveolar Lavage Fluid (BALF) between two groups at T(0) (P>0.05). Compared with T(0), the levels of TNF-α, IL-6, IL-8 in BALF were increased remarkably at T(3), T(5) (P<0.05). Compared with S group, the levels of TNF-α, IL-6, IL-8 in D group in BALF were decreased remarkably at T(3), T(5) (P<0.05). Compared with S group, the incidence of pneumonia in D group were decreased remarkably at 3 days after operation (4(13.3%) vs 11(36.7%), P=0.017). Conclusion: The ventilation effect of the single lumen endobronchial tube on lung injury for patients with esophageal cancer undergoing combined thoracoscopic and laparoscopic esophagectomy is the same as that of the double lumen endobronchial tube, however the single lumen endobronchial tube has less injury on the lung.

A randomised, controlled trial of rectus sheath bupivacaine and intrathecal bupivacaine, without or with intrathecal morphine, vs. intrathecal bupivacaine and morphine after caesarean section.

We recruited 144 women of whom 131 underwent scheduled caesarean section and were allocated to intrathecal bupivacaine without (46) or with (47) morphine and postoperative rectus sheath bupivacaine; or intrathecal bupivacaine with morphine and postoperative rectus sheath saline (38). We measured postoperative pain with a 10-point numeric rating scale. The mean (SD) areas under the curve for pain on movement during 48 postoperative hours were 273.5 (63.6), 223.8 (80.7) and 223.8 (80.7), respectively, p = 0.008. There was no difference between women who had intrathecal morphine with or without rectus sheath bupivacaine, p = 1. The equivalent values for pain at rest were 160.8 (64.7), 85.8 (79.4) and 82.8 (74.3), respectively, p < 0.001. There was no difference between women who had intrathecal morphine with or without rectus sheath bupivacaine, p = 0.98.

MiR-214 regulates oral cancer KB cell apoptosis through targeting RASSF5.

Ras association domain family member 5 (RASSF5), a member of the Ras association domain family, induces cell apoptosis by phosphorylating FOXO3a, which triggers target gene BIM (pro-apoptotic factor) activation. MiR-214 is overexpressed in oral cancer tissue, indicating its possible involvement in oral cancer pathogenesis. Bioinformatics analysis has revealed a complimentary sequence between miR-214 and the 3'-UTR of RASSF5 mRNA. However, whether miR-124 regulates RASSF5 in oral cancer remains poorly understood. We aimed to investigate the role of miR-214 in RASSF5 expression regulation in oral cancer. Tumor and paracarcinoma tissues were obtained from 48 oral cancer patients to examine miR-214 and RASSF5 expression. The relationship between miR-214 and RASSF5 was investigated by dual luciferase reporter gene assay. Oral cancer KB cells were cultured in vitro and divided into inhibitor NC, miR-214 inhibitor, Scramble-pMD18, RASSF5-pMD18, and miR-214 inhibitor + RASSF5-pMD18 groups. Caspase 3 activity, cell apoptosis, and total protein expression were measured by spectrophotometry, flow cytometry, and western blot, respectively. MiR-214 expression was significantly increased, while that of RASSF5 decreased in oral cancer tumor tissues compared to paracarcinoma tissues. Luciferase assay showed that miR-214 suppressed RASSF5 expression by targeting its 3'-UTR. Down-regulation of miR-214 and/or enhancement of RASSF5 expression markedly increased FOXO3a phosphorylation, BIM expression, caspase 3 activity, and apoptosis. In conclusion, miR-214 expression was elevated and RASSF5 was down-regulated in oral cancer. Moreover, miR-214 regulated KB cell apoptosis through targeted inhibition of RASSF5 expression, FOXO3a phosphorylation, and BIM expression, suggesting its possible application as a novel therapeutic oral cancer target.

Diabetes incidence and prevalence in Hong Kong, China during 2006-2014.

AIMS: To estimate recent secular changes in the incidence and prevalence of diabetes and pre-diabetes among Hong Kong Chinese adults, and thus show possible future trends for developing mainland China. METHODS: Based on a complete census of the public sector health records of 6.4 million people from 2006 to 2014, diabetes cases were ascertained using different methods including the World Health Organization (WHO) 2011 guidelines (HbA1c , fasting plasma glucose and glucose tolerance test), American Diabetes Association (ADA) 2015 guidelines (plus random plasma glucose), and additionally recorded diagnosis codes and medication dispensation. Pre-diabetes was defined using ADA 2015 guidelines. RESULTS: We identified 697 201 people with diabetes (54.2% were incident cases); and 1 229 731 people with diabetes or pre-diabetes. In 2014, the overall incidence of diabetes was 9.46 per 1000 person-years [95% confidence interval (CI): 9.38 to 9.54], and overall prevalence was 10.29% (95% CI: 10.27% to 10.32%). Incidence of diabetes decreased significantly from 2007 to 2014 (quadratic trend, P < 0.001). From 2006 to 2014, the prevalence of diabetes increased significantly in both sexes and across all age groups (quadratic trend, P < 0.001). The overall incidence of pre-diabetes in 2014 was 18.88 per 1000 person-years (95% CI: 18.76 to 18.99), and the overall prevalence of pre-diabetes was 8.90% (95% CI: 8.87% to 8.92%). CONCLUSIONS: Similar to other developed western and Asian populations, diabetes (and pre-diabetes) incidence in Hong Kong Chinese appeared to have stabilized and there have been small declines during the period of observation. Ageing and survivorship will likely drive a continued increase in the prevalence of diabetes and pre-diabetes, albeit with a decelerating growth rate if past trends persist.

PPARα signal pathway gene expression is associated with fatty acid content in yak and cattle longissimus dorsi muscle.

Intramuscular fatty acid (FA) is related to meat qualities such as juiciness, tenderness, palatability, and shear force. PPARα plays an important role in lipid metabolism in the liver and skeletal muscle. This study investigated FA composition in yaks and cattle, in order to ascertain whether a correlation between PPARα signal pathway genes as candidate genes and meat FA composition in yaks and cattle exists. Statistical analyses revealed that levels of monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) in yaks were significantly higher than those in cattle (P < 0.01), whereas saturated fatty acid (SFA) levels were significantly lower than those in cattle (P < 0.05). The mRNA expression levels of FABP4 (P < 0.05), SCP2 (P < 0.05), and APOA1 (P < 0.01) in yaks were significantly lower than those in cattle. However, LPL expression in yaks was significantly higher than that in cattle (P < 0.05). In yaks, the expression levels of FABP3 (P < 0.05) and LPL (P < 0.01) were negatively correlated with MUFA, and those of FABP4 and SCD were positively correlated with PUFA (P < 0.01). In cattle, the mRNA level of PLTP was positively correlated with SFA (P < 0.05), and LPL was positively correlated with MUFA (P < 0.05). These results suggest that these genes may participate in the regulation and control of intramuscular FA metabolism in yaks, so they could be used as candidate markers to improve yak meat quality.

Vertebral body corner oedema vs gadolinium enhancement as biomarkers of active spinal inflammation in ankylosing spondylitis.

OBJECTIVE: To investigate the relative performance of T(2) weighted short tau inversion-recovery (STIR) and fat-suppressed T(1) weighted gadolinium contrast-enhanced sequences in depicting active inflammatory lesions in ankylosing spondylitis (AS). METHODS: Whole-spine MRI was performed on 32 patients with AS, who participated in a clinical trial of infliximab treatment, by STIR and contrast-enhanced sequences at baseline and after 30 weeks. The AS spine MRI-activity (ASspiMRI-a) scoring method was used. The images from these two imaging techniques were evaluated separately by two independent readers. RESULTS: For the pre-treatment lesion status, the intraclass correlation coefficients comparing STIR readings and contrast-enhanced readings were 0.69±0.23 for Reader 1 and 0.65±0.21 for Reader 2. At baseline, the mean ASspiMRI-a score was 15.4% and 17.7% higher for contrast-enhanced images than for STIR images for Reader 1 and Reader 2, respectively. After infliximab treatment, Reader 1 rated an ASspiMRI-a score reduction of 50.8±33.6% and 25.3±35.3% for STIR images and contrast-enhanced images, respectively, whereas Reader 2 rated an ASspiMRI-a score reduction of 42.4±50.4% and 32.9±35.6% for STIR images and contrast-enhanced images, respectively. CONCLUSION: While both contrast-enhanced and STIR sequences showed sensitivity to change over a short period of time after infliximab treatment, these two sequences may reflect different disease mechanisms.

Effects of rosuvastatin on subclinical atherosclerosis and arterial stiffness in rheumatoid arthritis: a randomized controlled pilot trial.

OBJECTIVE: To ascertain the effect of rosuvastatin on carotid atherosclerosis and arterial stiffness in patients with rheumatoid arthritis (RA). METHODS: Fifty RA patients were randomized in a double-blind placebo-controlled trial to receive 10 mg rosuvastatin (n = 24) or placebo (n = 26). Patients were followed prospectively every 3 months for 12 months. Intima-media thickness (IMT), augmentation index (AIx), and subendocardial viability ratio (SEVR) were measured at baseline, 6 and 12 months. RESULTS: Rosuvastatin resulted in statistically significant reductions of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and urate levels vs. placebo. However, rosuvastatin had no significant effect on changes in inflammatory markers, including C-reactive protein (CRP) levels [from 2.9 (1.4-11.0) to 3.1 (0.9-13.3) mg/L in the rosuvastatin group compared with from 5.8 (2.6-14.2) to 4.4 (1.2-12.3) mg/L in the placebo group]. Nonetheless, a significant improvement in the Disease Activity Score (DAS) and a reduction in fibrinogen level was observed at 6 and 12 months compared with baseline in the rosuvastatin group. The treatment group exhibited a significant increase in SEVR (from 157 ± 28% to 163 ± 33% in the rosuvastatin group compared with from 143 ± 18% to 143 ± 26% in the placebo group, p = 0.023), but no significant effect was observed in the changes in IMT and AIx. CONCLUSION: Our data suggest that rosuvastatin has a modest anti-inflammatory effect in RA patients with low disease activity in terms of reduction in DAS and fibrinogen level. Rosuvastastin may also improve subendocardial perfusion and lower the urate level.

Orthokeratinized odontogenic cyst in a Hong Kong community: the clinical and radiological features.

OBJECTIVES: The aim was to evaluate the principal clinical and conventional radiological features of a consecutive series of cases of orthokeratinized odontogenic cyst (OOC) affecting a Hong Kong Chinese community and to determine the outcome by follow-up. METHODS: All cases were accompanied by appropriate radiography and were confirmed by histopathology. RESULTS: The clinical and conventional radiological presentations, differential diagnoses and outcomes of follow-up of five consecutive OOCs were reviewed. There were two males and three females. All affected the posterior sextant. The mean age at first presentation was 33.5 years. The mean of their period of prior awareness was 0.11 years. Swelling was the most frequent presenting symptom. All presented as well-defined corticated radiolucencies; three were unilocular and two were multilocular and all displayed expansion. This resulted in displacement and erosion of the lower border of the mandible in one case and the downward displacement past the lower border of a lateral cortex in two others. The inferior dental canal in each mandibular case exhibited both displacement and absence. The antrum was affected in a sole maxillary case. Four patients were followed up for a mean of 8.5 years. The fifth patient discharged himself shortly after surgery. No lesions recurred. CONCLUSIONS: OOCs in this community displayed an expansile character, but did not recur after moderately long follow-up. The time between the prior awareness of their disease and their presentation for diagnosis and treatment was, so far, the shortest for any lesion affecting the jaw in this Hong Kong Chinese community.

Comparison of inter- and intraobserver agreement and reliability between three different types of placental volume measurement technique (XI VOCAL, VOCAL and multiplanar) and validity in the in-vitro setting.

OBJECTIVES: To compare XI VOCAL (eXtended Imaging Virtual Organ Computer-aided AnaLysis) for three-dimensional (3D) ultrasound volumetry of the placenta and of phantom objects with a rotational method using VOCAL and with the multiplanar method. METHODS: We acquired 3D volume datasets from 32 fetuses at 11-14 weeks' gestation. Placental volume was calculated twice by each of two observers using XI VOCAL (with 5, 10, 15 and 20 slices), multiplanar (1-mm interval) and VOCAL (with 12 degrees, 18 degrees and 30 degrees rotation) methods. In addition, validity was assessed using the in-vitro setting with three phantom objects of known volume. RESULTS: Both inter- and intraobserver reliabilities were very high for all three methods. There was no systematic bias between any two methods except between XI VOCAL (10 slices) and the multiplanar (1-mm interval) method, with a smaller volume using the former method. The limits of agreement were wide between any two of the three methods. In the in-vitro setting, there was a trend towards less valid measurements with the XI VOCAL technique and fewer slices. With the same number of steps, measurements made with VOCAL (12 degrees and 18 degrees) were more valid than were those made with XI VOCAL (15 and 10 slices, respectively). CONCLUSION: XI VOCAL cannot be used interchangeably with VOCAL or multiplanar techniques in measuring placental volume at 11-14 weeks' gestation.

Keratocystic odontogenic tumour in a Hong Kong community: the clinical and radiological features.

OBJECTIVES: The aim of this study was to evaluate the clinical and conventional radiological features of a consecutive series of cases of "keratocystic odontogenic tumour" (KCOT) affecting a Hong Kong Chinese community and to determine their outcome by follow-up. METHODS: All cases were accompanied by appropriate radiography and were histopathologically confirmed. RESULTS: 33 consecutive KCOTs were reviewed. 18 patients were male. The mean age at first presentation was 30.6 years. Swelling was the most frequent presenting symptom. Those patients first presenting with pain were significantly older, whereas those first presenting with a maxillary lesion were significantly younger. The maxilla and mandible were affected in 13 and 20 cases, respectively. KCOTs were most frequently confined to the posterior sextants of both jaws. KCOTs affecting the maxilla were mainly unilocular, whereas those affecting the mandible were multilocular. Patients with multilocular KCOTs were significantly older. Patients with KCOTs associated with root resorption were significantly older, whereas patients associated with unerupted teeth were significantly younger. 69% displaced teeth, 41% resorbed them and 56% were associated with unerupted teeth. All but two were followed up for at least 2 years. Three lesions recurred. CONCLUSIONS: KCOTs in this community displayed some differences from those reported in the literature.

Prenatal alcohol exposure alters the patterns of facial asymmetry.

Directional asymmetry, the systematic differences between the left and right body sides, is widespread in human populations. Changes in directional asymmetry are associated with various disorders that affect craniofacial development. Because facial dysmorphology is a key criterion for diagnosing fetal alcohol syndrome (FAS), the question arises whether in utero alcohol exposure alters directional asymmetry in the face. Data on the relative position of 17 morphologic landmarks were obtained from facial scans of children who were classified as either FAS or control. Shape data obtained from the landmarks were analyzed with the methods of geometric morphometrics. Our analyses showed significant directional asymmetry of facial shape, consisting primarily of a shift of midline landmarks to the right and a displacement of the landmarks around the eyes to the left. The asymmetry of FAS and control groups differed significantly and average directional asymmetry was increased in those individuals exposed to alcohol in utero. These results suggest that the developmental consequences of fetal alcohol exposure affect a wide range of craniofacial features in addition to those generally recognized and used for diagnosis of FAS.

Ossifying fibroma in a Hong Kong community: the clinical and radiological features and outcomes of treatment.

OBJECTIVES: The aim of this study was to evaluate the principal clinical and radiological features of a consecutive series of cases of ossifying fibroma (OF) affecting a Hong Kong Chinese community and to determine their outcome by follow-up. METHODS: All cases were accompanied by appropriate radiography and were histopathologically confirmed as fibro-osseous lesions. RESULTS: The clinical and radiological presentations, differential diagnoses and outcomes of follow-up of 24 consecutive patients with OFs were reviewed. All patients were female. The mean age at first presentation was 38.0 years. The oldest reported patient first presenting with OF was 80 years old. Most OFs (58%) were discovered incidentally. The maxilla and mandible were affected in 4 and 20 cases, respectively. Only 7 cases, out of the 15 cases for which provisional diagnosis was available, included OF. 16 patients were followed up for a mean of 5.3 years, of whom 12 discharged themselves after a mean of 3.0 years. Only one lesion recurred. CONCLUSIONS: OF in this community predominantly affects females. Although gynaecological history was not included in the clinical notes, there is a clear possibility of reactivation of OF growth at the menopause. Other potentially important contributing factors are "traditional Chinese medicine" and the progressive reduction in the degree of water fluoridation. Although most patients were followed up, this was only for a few years. Nevertheless, one case actually recurred during follow-up. Therefore, patients with OF should be encouraged to maintain follow-up for a longer period.

Fibrous dysplasia in a Hong Kong community: the clinical and radiological features and outcomes of treatment.

OBJECTIVES: To evaluate the principal clinical and radiological features of a consecutive series of cases of fibrous dysplasia (FD) affecting a Hong Kong Chinese community and to determine their outcome by follow-up. METHODS: All cases were accompanied by appropriate radiography and were histopathologically confirmed as fibro-osseous lesions. RESULTS: The clinical and radiological presentations, differential diagnoses and outcomes of follow-up of 21 consecutive FD cases were reviewed. Females were slightly more frequently affected, but there was no gender predilection for either jaw. The mean age at first presentation was 25 years, which upon adjustment for prior awareness fell to 21 years. The main symptom was swelling (including enlargement of the jaw). The maxilla and mandible were affected in 9 and 13 cases, respectively; both jaws were affected in 1 case. One case was of McCune-Albright syndrome. The sole provisional diagnosis for all lesions was FD; most lesions affected all or almost half the affected jaw. 17 patients were followed-up for a mean of 9 years. CONCLUSIONS: This very detailed consecutive series followed up over many years, in which a number of cases recurred or were reactivated in adulthood, firmly dispells the notion that FD is a simple hamartoma in all cases. This community was quite amenable to really long-term follow-up.