[Analysis on risk factors of positive vertical resection margin after endoscopic treatment of rectal neuroendocrine tumors].

Objective: To analyze the risk factors of positive vertical resection margin of the postoperative specimens after endoscopic treatment of rectal neuroendocrine tumors (NET). Methods: A case-control study was performed. Clinical data of patients with rectal NET (G1) undergoing endoscopic treatment between January 2015 and June 2018 at the Department of Gastroenterology, Beijing Tsinghua Changgung Hospital were retrospectively collected. Inclusion criteria: cases underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), whose mucosal specimens were pathologically confirmed as NET, and NET was confined to the rectum by nuclide imaging examination before endoscopic treatment. Those with incomplete clinical data or follow-up data were excluded. Resected specimen was fixed and sliced every 2 mm, and when tumor cells were found to infiltrate the vertical cutting edge, the positive vertical margin was defined. Associations of gender, age, resection method, tumor diameter, lesion morphology (nodular lesions, biopsy or post-treatment scar-like changes), mitotic figure, Ki-67 index, etc. and positive vertical margin were analyzed. Univariate analysis was performed using binary logistic analysis and multivariate analysis was performed using logistic regression model. Results: A total of 133 patients with rectal NET were enrolled, including 93 males and 40 females, with an average age of (50.0±10.7) years. Sixty-four patients received EMR treatment and 3 patients (4.7%) had positive vertical margins. While 69 patients received ESD treatment and 13 (18.8%) had positive vertical margins. After endoscopic treatment, 16 cases (12.0%) were vertical positive margin, including 11 males and 5 females with an average age of (52.4±10.4) years. The lesion diameter was (9.0±4.7) mm. Univariate analysis showed that lesion diameter ≥10 mm (χ(2)=5.575, P=0.018) and scar-like changes (χ(2)=3.894, P=0.048) were significantly associated with positive vertical margin. Multivariate analysis showed that the lesion diameter ≥10 mm (OR=10.136, 95%CI: 2.114 to 48.591, P=0.004) was an independent risk factor for positive vertical margin of the specimen after endoscopic treatment of rectal NET. Conclusion: The diameter of rectal NET ≥10 mm indicates a high risk for positive vertical margin after endoscopic treatment.

[Screening of the SETX gene in sporadic amyotrophic lateral sclerosis patients of Chinese origin].

Objective: To investigate all coding regions of amyotrophic lateral sclerosis (ALS)-related gene Senataxin (SETX) in sporadic amyotrophic lateral sclerosis patients of Chinese origin. Methods: From January 2010 to December 2014, the peripheral venous blood samples and clinical data were collected from 311 patients with sporadic amyotrophic lateral sclerosis (SALS) and 311 healthy controls who were of Chinese ancestry from the Department of Neurology, Chinese PLA General Hospital.Genomic DNA was extracted from peripheral venous blood of all participants using standard methods. The coding regions of SETX were amplified by polymerase chain reaction (PCR) and screened for mutations using next-generation sequencing technology. The online software SIFT and PolyPhen-2 were used to analyze the conservation of an altered amino acid and predict the potential pathogenicity of identified mutations. The SPSS 22.0 software was used to analyze the clinical feature of all participants. Results: Tenkinds of rare and one novel nonsynonymous mutations were identified and were absent in 311 controls. Twelve (3.86%) patients carried one SETX gene mutation. Five (1.61%) out of above-mentioned 12 patients carried highly pathogenic mutations including p. Pro1868Leu (c.5603G>A), p. Pro1331Leu (c.3992G>A), p. Glu756Val (c.2267T>A), p. Leu564Val (c.1690A>C), and p. Asn144Ser (c.431T>C). Patients carried SETX mutations were not different from other patients in onset age. Conclusion: Mutations in SETX are likely to be a pathogenesis for Chinese sporadic amyotrophic lateral sclerosis.

[Prevalence of thyroid function in pregnant and lactating women in areas with different iodine levels of Shanxi province].

Objective: To investigate the effects of high iodine intake on thyroid function in pregnant and lactating women. Methods: A cross sectional epidemiological study was conducted among 130 pregnant women and 220 lactating women aged 19-40 years in areas with high environment iodine level (>300 µg/L) or proper environment iodine level (50-100 µg/L) in Shanxi in 2014. The general information, urine samples and blood samples of the women surveyed and water samples were collected. The water and urine iodine levels were detected with arsenic and cerium catalysis spectrophotometric method, the blood TSH level was detected with electrochemiluminescence immunoassay, and thyroid stimulating hormone (FT(4)), antithyroid peroxidase autoantibody (TPOAb) and anti-thyroglobulin antibodies (TGAb) were detected with chemiluminescence immunoassay. Results: The median urine iodine levels of the four groups were 221.9, 282.5, 814.1 and 818.6 µg/L, respectively. The median serum FT(4) of lactating women in high iodine area and proper iodine area were 12.96 and 13.22 pmol/L, and the median serum TSH was 2.45 and 2.17 mIU/L, respectively. The median serum FT(4) of pregnant women in high iodine area and proper iodine area were 14.66 and 16.16 pmol/L, and the median serum TSH was 2.13 and 1.82 mIU/L, respectively. The serum FT(4) levels were lower and the abnormal rates of serum TSH were higher in lactating women than in pregnant women in both high iodine area and proper iodine area, the difference was statistically significant (FT(4): Z=-6.677, -4.041, P<0.01; TSH: Z=8.797, 8.910, P<0.01). In high iodine area, the abnormal rate of serum FT(4) in lactating women was higher than that in pregnant women, the difference was statistically significant (Z=7.338, P=0.007). The serum FT(4) level of lactating women in high iodine area was lower than that in proper iodine area, the difference was statistically significant (Z=-4.687, P=0.000). In high iodine area, the median serum FT(4) in early pregnancy, mid-pregnancy and late pregnancy was 16.26, 14.22 and 14.80 pmol/L, respectively, and the median serum TSH was 1.74, 1.91 and 2.38 mIU/L, respectively. In high iodine area, the serum FT(4) level in early pregnancy was higher than that in mid-pregnancy and late pregnancy, and the serum TSH level was lower than that in mid-pregnancy and late pregnancy, the difference was statistically significant (FT(4): Z=-2.174, -2.238, P<0.05; TSH: Z=-2.985, -1.978, P<0.05). There were no significant differences in the positive rates of serum thyroid autoantibodies among the four groups of women and women in different periods of pregnancy (P>0.05). The morbidity rates of subclinical hyperthyroidism in pregnant women and lactating women in high iodine area were obviously higher than those in proper iodine areas, the difference was statistically significant (χ(2)=5.363, 5.007, P<0.05). Conclusions: Excessive iodine intake might increase the risk of subclinical hypothyroidism in pregnant women and lactating women. It is suggested to strengthen the iodine nutrition and thyroid function monitoring in women, pregnant women and lactating women in areas with high environmental iodine.

[Analysis of a Chinese Charcot-Marie-Tooth disease type 2D pedigree].

Objective: To achieve definite diagnosis in a clinically diagnosed Charcot-Marie-Tooth disease (CMT) pedigree and broaden the mutational diversity of CMT-related mutations in Chinese Han population. Methods: Patients clinically diagnosed with CMT were recruited from Department of Neurology, Chinese PLA General Hospital between December, 2012 to June, 2016. Clinical examination, laboratory tests, nerve conduction studies, and molecular and bioinformatics analyses were performed on a clinically diagnosed CMT pedigree. Results: In the pedigree, a GARS mutation (c.794C>T, p. S265F) was identified and CMT2D was diagnosed. Conclusion: The newly identified GARS mutation has broaden the mutational diversity of CMT2D in Chinese Han population.

[Characteristics of repetitive nerve stimulation in 53 cases of amyotrophic lateral sclerosis].

Objective: To investigate the feature of repetitive nerve stimulation (RNS) in patients with amyotrophic lateral sclerosis (ALS) and correlation between RNS and clinical features and electromyography (EMG) findings of the corresponding muscle. Methods: Needle EMG and RNS were performed in 53 patients with ALS, who were recruited into Department of Neurology of Chinese PLA general hospital during April to December in 2016. Decrement of the compond muscle action potential (CMAP) in response to RNS of different nerves and stimulus frequencies was compared. The effects of gender, age of onset, disease duration, region of onset, ALS functional rating scale-revised (ALSFRS-R) and rate of disease progression (ΔFS) on the decrement were analyzed. Results: 49.1% of patients with ALS had decremental responses to low frequency RNS (LF-RNS) in accessory nerve, which was lower in ulnar nerve (4.3%) and common peroneal nerve (2.6%). Decremental responses of accessory nerve at 3 Hz were observed in 49.1% of patients with ALS, more frequent than 30.2% at 1 Hz. None of the patients had increased responses to high frequency RNS. Patients with upper-limb-onset, longer disease duration and lower ALSFRS-R tended to have more frequent decrement of CMAP in response to RNS. The decrement with LF-RNS of accessory nerve was in concert with neurogenic damage of sternocleidomastoid muscle with needle EMG (r=0.365, P=0.007). There were 3 patients who had decremental responses to LF-RNS in accessory nerve without clinical involvement and neurogenic damage of sternocleidomastoid muscle. Conclusions: There is significant decrement of CMAP in response to LF-RNS of accessory nerve in patients with ALS, which may reveal neuromuscular junction (NMJ) impairment. It may indicated a dying-back pattern of disease progression which derived from motor neuron terminal or NMJ to neuronal soma that some patients with ALS have decremental responses in RNS without clinical involvement and neurogenic damage of sternocleidomastoid muscle.

[An analysis of characteristics of nerve conduction in 154 cases of amyotrophic lateral sclerosis].

Objective: To analyze the features of nerve conduction in patients with amyotrophic lateral sclerosis (ALS), and explore the correlation between compound muscle action potential (CMAP) amplitude and disease duration and revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R). Methods: Standard motor and sensory nerve conduction studies were performed in 154 patients with ALS. The following parameters were collected including CMAP amplitude, distal motor latency (DML), motor conduction velocity, sensory conduction velocity and sensory nerve action potential amplitude. Regression study was done to explore the correlation between CMAP amplitude and disease duration and ALSFRS-R. Results: Motor nerve conduction abnormalities were presented in a majority of the patients with prolonged DML in the tibial nerve, median nerve and ulnar nerve as the most common form (61.06%-81.42%), followed by decreased CMAP amplitude (30.12%-53.98%), decreased MCV (12.05%-16.81%) and absence of CMAP (2.65%-9.73%). Sensory nerve conduction abnormalities were detected in a small proportion of patients and the decreased SCV, decreased SNAP amplitude and absence of SNAP in the sural nerve, median nerve and ulnar nerve were found in 1.22%-2.73%, 0-1.82% and 0-1.22% patients respectively. No correlation was found between CMAP of the common peroneal nerve, tibial nerve, median nerve and ulnar nerve and the disease duration (P>0.05), while significant positive correlation was established between CMAP amplitude of the median nerve and ulnar nerve and ALSFRS-R (r=0.273, P=0.016; r=0.357, P=0.001). Conclusions: Motor nerve conduction is abnormal in a majority of ALS patients with prolonged DML as the most common form, while abnormal sensory nerve conduction is only found in a few of ALS patients. CMAP amplitude of the median nerve and ulnar nerve might be of certain clinical value in evaluating the severity of ALS.

[Needle electromyography features and values of paraspinal muscle parameters in assessment of respiratory function of patients with amyotrophic lateral sclerosis].

Objective: To analyze the features of needle electromyography (EMG) in patients with amyotrophic lateral sclerosis (ALS), and explore the correlation between EMG parameters of the tenth thoracic paraspinal muscle and disease duration, rate of disease progression, forced vital capacity (FVC) and revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R). Methods: Standard EMG was recorded from unilateral sternocleidomastoid muscle and/or tongue muscles, upper and lower limbs muscles and the tenth thoracic paraspinal muscle in 112 patients with definite ALS between March 2012 and June 2013 in the Department of Neurology at Chinese PLA General Hospital. Parameters studies included spontaneous potentials, duration and amplitude of motor unit potentials (MUP), pattern of recruitment. Results: EMG revealed diffuse neurogenic changes in each case. Fibrillation potential or positive sharp waves were found in some muscles in all of patients, and both of them were found in most of the cases. Fasciculation potentials (FPs) were found in 8 patients and accompanied with fibrillation potential and positive sharp waves in 5 of them. Complex repetitive discharges (CRDs) were found in only 1 patient. Duration and amplitude of MUP was prolonged and increased in ALS patients, and the rate of high amplitude and decreased recruitment pattern were 35.71% and 72.32%, respectively. Logistic regression analysis revealed an association of the FVC loss with the drop of ALSFRS-R and peak amplitude of the tenth thoracic paraspinal muscle. Conclusions: The abnormal spontaneous activity with high frequency are fibrillation potentials and/or positive sharp waves. However, FPs is observed in a small number of patients and CRDs is rarely seen in ALS. The ALSFRS-R and peak amplitude of thetenth thoracic paraspinal muscle may be of certain clinical value in estimating the severity of disease especially the respiratory dysfunction in ALS patients.

Endoscopic submucosal dissection for laterally spreading tumors in the rectum ≥40 mm.

BACKGROUND: Endoscopic submucosal dissection (ESD) has been developed to allow en bloc resection of early neoplasia of the gastrointestinal tract, including colorectal tumors. The aim of the present study was to evaluate the safety and efficacy of ESD for laterally spreading tumors (LSTs) in the rectum with diameters of 40 mm or more. METHODS: Between January 2010 and October 2014, 35 patients with a total of 36 LSTs of the rectum measuring ≥40 mm were included in this study. Clinical and pathological characteristics and clinical outcomes were examined and analyzed. RESULTS: The mean operating time was 125.8 ± 61.4 min, and the mean size of the tumors was 59.4 ± 19.8 mm. The rate of en bloc resection and en bloc R0 resection were 91.7 % (33/36) and 88.9 % (32/36), respectively. Perforation occurred in three patients (8.6 %) and was managed conservatively. Postoperative bleeding occurred in one patient (2.9 %) and was treated by endoscopic hemostasis. Excluding five patients, who either underwent additional surgery (n = 1) or were lost to follow-up (n = 4), two patients in our cohort (6.7 %) presented with recurrence of a small adenoma. The remaining patients (n = 28) were free of recurrence during a mean follow-up period of 18.7 ± 4.2 months (range 12-43 months). CONCLUSIONS: Our results indicated that ESD is an effective and safe therapeutic option with high curative rates for LSTs in the rectum ≥40 mm. To prove its long-term efficacy, a large multicenter prospective study is required.

Erratum: 3,3'-(2,2'-Bi-1H-imidazole-1,1'-di-yl)dipropanamide. Corrigendum.

The list of authors in the paper by Zhi, Long, Chen & Ren [Acta Cryst. (2009), E65, o2008] is corrected and the acknowledgements are updated.[This corrects the article DOI: 10.1107/S1600536809028955.].

3,3'-(2,2'-Bi-1H-imidazole-1,1'-di-yl)dipropanamide.

In the title compound, C(12)H(16)N(6)O(2), the two imidazole rings are coplanar as a center of inversion exists midway along the C-C bond joining the two rings. In the crystal, inter-molecular N-H⋯O, N-H⋯N and C-H⋯O hydrogen bonds link adjacent mol-ecules into a two-dimensional layer structure parallel to (001).

Prevalence and types of androgenetic alopecia in Shanghai, China: a community-based study.

BACKGROUND: There are ethnic differences in the prevalence and types of androgenetic alopecia (AGA). Although there have been several reports on the prevalence and types of AGA in caucasian and Asian populations, there are very few data on a Chinese population that have been derived from a sufficient number of samples. OBJECTIVES: To estimate the prevalence and types of AGA in a Chinese population, and to compare the results with those in caucasians and Koreans reported previously in the literature. METHODS: A population-based cross-sectional study was carried out in 7056 subjects (3519 men and 3537 women) from May 2006 to December 2006 in a community of Shanghai. Questionnaires were completed during face-to-face interviews at the subjects' homes. The degree of AGA was classified according to the Norwood and Ludwig classifications. RESULTS: The prevalence of AGA in Chinese men was 19.9%, and the prevalence of female pattern AGA in men was 0.1%. The most common type in men was type III vertex (3.5%). The prevalence of AGA in women was 3.1%, while male pattern AGA was found in those aged over 50 years (0.4%), and the most common type was type I (Ludwig classification) (1.4%). A family history of AGA was present in 55.8% of men and 32.4% of women with AGA. CONCLUSIONS: The prevalence of AGA in Chinese men was lower than in caucasian men but was similar to that in Korean men; however, over the age of 60 years it was approaching that in caucasian men but was higher than that in Korean men. The most common type in Chinese men with AGA was type III vertex. Interestingly, the prevalence of AGA in Chinese women was lower than that in Korean women and caucasian women, and type I was the most common type (Ludwig classification).