[Contrastive study of thumb ossification composite index and Risser sign in evaluating the growth potential of adolescent idiopathic scoliosis].

Objective: To compare and analyze the correlations between thumb ossification composite index (TOCI), Risser sign and digital skeletal age (DSA) scores and to verify the possibility of TOCI as a supplementary to Risser sign in the evaluation of growth potential of adolescent idiopathic scoliosis (AIS) patients. Methods: Forty-nine AIS patients undergoing bracing treatment between May 2006 and May 2014 were selected from Nanjing Drum Tower Hospital. The follow-up interval was 4-6 months. The following data at each visit were routinely collected, including TOCI and DSA scores, as well as chronologic age and standing height. The height velocity (HV) at each visit was calculated based on the above data. All results were analyzed by Spearman correlation with TOCI and Risser sign. Results: There were strong correlations between TOCI and Risser sign and DSA scores (r=0.962, 0.813, both P<0.01). In AIS patients whose Risser sign were 0-1, the correlation between TOCI and DSA scores was more pronounced, compared with the correlation between Risser sign and DSA scores (0.918 vs 0.792, P<0.01). The HV averaged (7.1±2.1) cm/year in TOCI 5, significantly larger than these in other TOCI scores (all P<0.01). Conclusions: The TOCI 5 can be a sign of high height velocity and high growth potential in AIS patients. TOCI is a valid indicator of skeletal maturity evaluation and can be used as a helpful supplementary to Risser sign, whose predictive ability may be better than Risser sign.

[Efficacy of sequential correction based on satellite rod techniquein degenerative scoliosis with B-type coronal imbalance].

Objective: To evaluate the radiographic and clinical outcomes of sequential correction based on satellite rod technique in degenerative scoliosis (DS) with B-type coronal imbalance, and to investigate the efficacy of sequential correction in this cohort. Methods: Twenty-one DS patients with B-type coronal imbalance applying sequential correction from December 2015 to July 2017 in Nanjing Drum Tower Hospital were retrospectively reviewed. There were 4 males and 17 females in this group, the average age was (63±8) years. The coronal parameters including Cobb angle of main curve and distance between C(7) plumb line and center sacral vertical line (C(7)PL-CSVL), as well as sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were assessed pre-operatively, post-operatively and at the last follow-up. The Scoliosis Research Society-22 (SRS-22) questionnaire was fulfilled before the operation and at each follow-up to evaluate the quality of life. Paired t test was performed for statistical analysis. Results: The patients were followed-up for (20±8) months. The post-operative Cobb angle of main curve was significantly improved from 52°±12° to 19°±7° (t=13.886, P<0.01), and it was 19°±8° at the last follow-up and no significant correction loss was attained (t=1.101, P=0.284). The values of C(7)PL-CSVL before the operation, after the operation and at the final follow-up were (46±11) mm, (12±7) mm and (12±7) mm, respectively; significant post-operative improvement achieved (t=19.718, P<0.01) while there was no correction loss at last follow-up (t=-1.393, P=0.179). After sequential correction, 20 patients (95.2%) improved to A-type coronal imbalance while 1 patient (4.8%) remained with B-type coronal imbalance. Significant post-operative improvements were found in terms of GK and SVA and no significant correction loss was found during follow-up. The scores of pain and self-image showed significant improvement at the last follow-up (t=8.706, 3.104, both P<0.01). In addition, there was no implant failure during follow-up. Conclusion: The sequential correction based on satellite rod technique in DS patients with B-type coronal imbalance corrects the deformity, relieves the clinical symptoms, improves the quality of life, and decreases the rates of post-operative coronal imbalance as well as implant-related complications.

[Efficiency of preoperative Halo-gravity traction in severe kyphoscoliosis secondary to neurofibromatosis type â ].

Objective: To evaluate the efficiency of preoperative Halo-gravity traction (HGT) in the treatment of severe kyphoscoliosis secondary to neurofibromatosis type Ⅰ (NF1). Methods: A retrospective review was conducted on patients with severe kyphoscoliosis secondary to NF1 at Department of Spinal Surgery, Drum Tower Hospital, Medical School of Nanjing University between July 2007 and May 2016. A total of 29 patients including 17 males and 12 females were finally enrolled and the age was (13.7±2.9) years. The Cobb angle of major coronal curve and global kyphosis were measured before and after HGT. The forced vital capacity (FVC)and forced expiratory volume in 1 second (FEV(1)) before and after traction were also recorded. The paired t test was used for comparison analysis. Results: The average maximum traction weight of HGT was (12.2±2.8) kg and the traction duration was (10.2±6.6) weeks. The coronal Cobb angle before HGT was (87.5±36.5)°, which improved to (68.4±25.9)° after HGT with a correction rate of (21.9±12.1)% (t=9.14, P<0.001); the average global kyphosis before HGT was (79.1±27.1)°, which improved to (59.9±19.4)° after HGT and the correction rate was (20.2±14.1)% (t=8.55, P<0.001). One patient had transient brachial plexus palsy which resolved completely after reducing the traction weight. After HGT treatment, FVC increased from (0.83±0.16) L to (0.89±0.19) L (t=1.48, P=0.12) and FEV(1) increased from (0.72±0.16) L to (0.78±0.20) L (t=0.49,P=0.63). FVC predicted and FEV(1) predicted improved from (42.9±20.1)% and (40.6±19.6)% to (46.9±20.5)% (t=0.98,P=0.33) and (43.6±25.8)% (t=1.24,P=0.22), respectively. Conclusion: Preoperative HGT in the treatment of severe kyphoscoliosis secondary to NF1 can improve spinal deformity and pulmonary function to some extent, which can further benefit the patients by improving their surgical tolerance.

[Reliability and repeatability analysis of simplified skeletal maturity scoring and thumb ossification composite index in the assessment of skeletal maturity inadolescent idiopathic scoliosis].

Objective: To compare the reliability and repeatability of simplified skeletal maturity scoring (SSMS) and thumb ossification composite index (TOCI) in the assessment of skeletal maturity in adolescent idiopathic scoliosis(AIS) and their clinical utilization. Methods: A review was conducted on 500 AIS patients treated between October 2006 and August 2013 in Nanjing Drum Tower Hospital and one follow-up of each patient was randomly selected for this study.Based on SSMS and TOCI, the radiographs of the left palm were assessed by three observers independently with an interval of 2 weeks.The inter-observer reliability and intra-observer repeatability of two methods were analyzed by using Kappa value. Results: A total of 3 000 measurements were performed by the 3 surgeons for each method.For SSMS, 50 cases were described as stage 1 258 cases as stage 2 962 cases as stage 3 340 cases as stage 4 315 cases as stage 5 304 cases as stage 6 589 cases as stage 7 and 182 cases as stage 8.The inter-observer and intra-observer agreements was 76.8%-82.0% (Kappa value 0.716-0.778) and 75.8%-82.4% (Kappa value 0.705-0.782), respectively.For TOCI, 27 cases were described as stage 1 183 cases as stage 2 167 cases as stage 3 171 cases as stage 4 745 cases as stage 5 536 cases as stage 6 410 cases as stage 7 and 761 cases as stage 8.The inter-observer and intra-observer agreements was 91.6%-92.4% (Kappa value 0.897-0.907) and 90.4%-92.0%(Kappa value 0.882-0.902), respectively. Conclusions: The two methods of SSMS and TOCI have substantial inter-observer reliability and intra-observer reproducibility for the assessment of skeletal maturity in AIS.TOCI has relatively higher reliability and repeatability when compared with SSMS.

[Value of thumb ossification composite index for predicting peripubertal growth potential in girls with adolescent idiopathic scoliosis].

Objective: To evaluate the predictive value of thumb ossification composite index (TOCI) for growth potential in female adolescent idiopathic scoliosis (AIS) patients and to analyze its correlation with several other indicators of growth potential. Methods: A retrospective review was conducted on 45 girls with AIS who underwent standard bracing treatment between October 2006 and August 2013 in Nanjing Drum Tower Hospital. All patients were regularly followed up with an interval of 3-6 months until brace weaning. At each visit, the following data were collected and recorded: chronologic age, stage of menses, standing height, Cobb angle of main curve, TOCI score, digital skeletal age (DSA) score and radius, ulna and small bones (RUS) score. The height velocity (HV) at each visit were calculated. The correlations analysis between TOCI and other indicators including DSA scores and RUS scores were studied. Results: The average age at initial visit was (10.9±1.3) years. The mean age of menarche was (12.6±1.3) years. The mean peak height velocity (PHV) was (7.5±1.5) cm/year and the mean age of PHV was (12.0±0.9) years. A total of 71.8% AIS girls attained their PHV at TOCI 5. The Spearman correlation analysis showed that TOCI was highly correlated with the DSA and RUS scores (r=0.95 and 0.96, both P<0.001). Chi-square test showed that TOCI 5 accurately predicted the occurrence of PHV (Cramer V=0.531, P=0.007). Conclusion: The TOCI 5 indicates high HV and high growth potential in AIS patients with bracing treatment. TOCI can thus serve as a good indicator for growth potential in braced AIS girls.

Biomass viability: An experimental study and the development of an empirical mathematical model for submerged membrane bioreactor.

This study investigates the influence of key biomass parameters on specific oxygen uptake rate (SOUR) in a sponge submerged membrane bioreactor (SSMBR) to develop mathematical models of biomass viability. Extra-cellular polymeric substances (EPS) were considered as a lumped parameter of bound EPS (bEPS) and soluble microbial products (SMP). Statistical analyses of experimental results indicate that the bEPS, SMP, mixed liquor suspended solids and volatile suspended solids (MLSS and MLVSS) have functional relationships with SOUR and their relative influence on SOUR was in the order of EPS>bEPS>SMP>MLVSS/MLSS. Based on correlations among biomass parameters and SOUR, two independent empirical models of biomass viability were developed. The models were validated using results of the SSMBR. However, further validation of the models for different operating conditions is suggested.

New proposed conceptual mathematical models for biomass viability and membrane fouling of membrane bioreactor.

The production and accumulation of soluble microbial products (SMP), extracellular polymeric substances (EPS) and colloidal inert compounds within a membrane bioreactor (MBR) may greatly affect the biomass viability and subsequently the permeability of the membrane. This paper aims at presenting new mathematical models of biomass viability and membrane fouling that has been conceptually developed through establishing links between these biomass parameters and operating parameters of the MBR. The proposed models can be used to predict the biomass viability and membrane fouling at any state of operation of MBR. Meanwhile, easily measurable parameters of the proposed model can also serve to estimate SMP/EPS concentration in the supernatant of MBR without the tedious and expensive measurement.

Inhibiting the color formation by gradient temperature-elevating Maillard reaction of soybean peptide-xylose system based on interaction of l-cysteine and Amadori compounds.

Light color and savory flavor enhancer are attractive for consumers and food producers. The effect of addition time of l-cysteine on inhibiting color formation was investigated in soybean peptide-xylose system, and the possible pathway was explored. Once dicarbonyl compounds were formed during the Maillard reaction, the addition of l-cysteine had no color-inhibiting effect; if l-cysteine was added immediately after the Amadori compound was formed, the extraordinary color-inhibiting effect was observed. Therefore, an improved way to inhibit color formation was proposed on the basis of the interaction of l-cysteine and Amadori compounds by controlling the addition time of l-cysteine through gradient temperature-elevating Maillard reaction. The system was heated at 80 °C for 60 min to form Amadori compounds, followed by the addition of L-cysteine, and the temperature was raised to 120 °C and held for 110 min. Compared with traditional products, the lightest color product was found desirable by GC/MS analysis and sensory evaluation. The novel method proposed can be a guide for the industrial preparation of light-colored products.

Adsorption of copper(II) onto sewage sludge-derived materials via microwave irradiation.

The materials with adsorbent properties were produced from urban sewage sludge by two different procedures via microwave irradiation: (1) by one single pyrolysis stage (SC); (2) by chemical activation with ZnCl(2) (SZ). The BET, SEM and FT-IR have been used to evaluate the pore structural parameters and surface chemistry of the adsorbents, respectively. Subsequently they were used for adsorption of Cu(II) from aqueous solutions. The effects of various experimental parameters, such as pH, temperature were investigated in a batch-adsorption technique. The results showed that the adsorption of Cu(II) was maximal at pH 5.0. The kinetic study demonstrated that the adsorption process was followed the second-order kinetic equation. The experimental adsorption isotherm data were well fitted with Langmuir model and the maximum adsorption capacity of Cu(II) were found to be 3.88 and 10.56 mg/g for SC and SZ, respectively, in the solution of pH 5.0. Thermodynamic parameters such as changes in the enthalpy (ΔH(0)), entropy (ΔS(0)) and free energy (ΔG(0)) indicate that Cu(II) adsorption onto SC and SZ is an endothermic and spontaneous process in nature at 15-45°C. These results indicate that the sewage sludge-derived material via microwave induced ZnCl(2) activation is an effective and alternative adsorbent for the removal of Cu(II) from aqueous solution.

Conjugation metabolism of acetaminophen and bilirubin in extrahepatic tissues of rats.

An anhepatic rat model was used to explore the extrahepatic conjugating metabolism of acetaminophen and serum bilirubin. The recovery of glucuronide- and sulfate-acetaminophen was 47.5% in normal control and 13.4% in model rats in the urine collected for 6 h after administration of acetaminophen 20 mg kg(-1). Following the increase of acetaminophen dose to 150 mg kg(-1), the recovery of urinary glucuronide-acetaminophen increased by 53.9% in normal control; but it decreased by 36.4% in model rats. In contrast to normal control, the pretreatment with phenobarbital did not affect acetaminophen and its metabolite levels in plasma and urine in model rats. After the establishment of anhepatic model the serum direct bilirubin rose dramatically. Urinary bilirubin test was positive in model rats, but not in normal control. No changes were observed in serum total bilirubin and ratio of direct/total bilirubin after the pretreatment with ranitidine or phenobarbital 50 mg kg (-1), i.p. for 5 days in model rats. The results indicate that the glucuronide- and sulfate-acetaminophen formed in the extrahepatic tissues of model rats is 28.2% of normal control, serum free bilirubin can be transformed into conjugated bilirubin in extrahepatic tissues, and the regulation mechanism of phase II conjugating enzymes is different between the hepatic and extrahepatic tissues.

Phenacetin O-deethylation in extrahepatic tissues of rats.

Phenacetin O-deethylation is a marker reaction of CYP450 1A2 activity. The drug-metabolizing enzyme is constitutively expressed in liver. In this study, an in vivo rat model for assessment of extrahepatic metabolism was used to investigate phenacetin O-deethylation and the alterations in the disposition of phenacetin due to the loss of liver function. Rats were divided into the model and normal control groups. The model was established according to our previously described method. The concentrations of phenacetin and its major metabolites acetaminophen, glucuronate-acetaminophen and sulfate-acetaminophen in plasma and urine were determined by HPLC. 30 min after intravenous administration of 0.16% phenacetin 10 mg x kg(-1), plasma acetaminophen in the model group was only 3.6% of that in the control group (0.09+/-0.04 microg x mL(-1) vs 2.49+/-0.85 microg x mL(-1), n = 8). 30 min after intragastric injection of 0.4% phenacetin 30 mg x kg(-1), plasma acetaminophen formation was very slight, about 8.6% of plasma phenacetin in the model group (0.74+/-0.43 microg x mL(-1) acetaminophen vs 8.57+/-8.42 microg x mL(-1) phenacetin) and 6.8% in the control group (1.06+/-0.59 microg x mL(-1) acetaminophen vs 15.47+/-7.21 microg x mL(-1) phenacetin, n = 8); no significant differences were observed in plasma phenacetin, total acetaminophen and the ratio of acetaminophen to phenacetin between control and model groups. In the urine collected for 3 h after intravenous administration of 0.16% phenacetin 10 mg x kg(-1), the total recovery of acetaminophen (as free, glucuronate- and sulfate-acetaminophen ) in the model group was 4.6% of that in the control group (4.47+/-4.27 microg vs 96.63+/-8.50 microg, n = 6), but phenacetin recovery in the model group was 9 times higher than that in the control group (15.03+/-17.72 microg vs 1.66+/-0.50 microg). The results indicate that phenacetin O-deethylation in the extrahepatic tissues and the first-pass metabolism of the probe compound seem to be negligible in rats, but the renal excretion of phenacetin, as a compensation, dramatically increases in model rats.

Simultaneous nitrogen and phosphorus removal under low dissolved oxygen conditions.

A full-scale test was operated by using low dissolved oxygen activated sludge process to enhance biological nitrogen and phosphorus removal. When the influent concentrations of CODcr, TN and TP varied in a range of 352.9 mg/L-1338.2 mg/L, 34.4 mg/L-96.3 mg/L, and 2.21 mg/L-24.0 mg/L, the average removal efficiencies were 94.9%, 86.7% and 93.0%, respectively. During the test period of two months, effluent means of CODcr, BOD5, NH3-N, TN and TP were below 50 mg/L, 25 mg/L, 10 mg/L and 1.0 mg/L, respectively. The low dissolved oxygen activated sludge process has a simple flow sheet, fewer facilities and high N and P removal efficiency. It is very convenient to retrofit the conventional activated sludge process with the above process.

Solid-phase synthesis of muramyl dipeptide (MDP) derivatives using a multipin method.

Solid-phase synthetic method of muramyl dipeptide derivatives is reported. A diverse library of muramyl dipeptides could be potentially synthesized by acylation, reductive alkylation, sulfonamide formation, urea formation, N-alkylation, amine addition, or component Ugi reactions based on this method for drug screening.

Markers in the promoter region of interleukin-10 (IL-10) gene in myasthenia gravis: implications of diverse effects of IL-10 in the pathogenesis of the disease.

Interleukin-10 (IL-10) is an important pleiotropic cytokine with both anti-inflammatory and B lymphocyte stimulating functions. The expression of IL-10 is tightly controlled. A bi-allelic polymorphism and 2 CA repeat microsatellites located in the promoter region of IL-10 gene were analysed in Swedish myasthenia gravis (MG) patients and ethnically matched healthy individuals. The prevalence of a 'high secretor' phenotype of IL-10 (IL-10 1 G/G) was higher in IL-1beta TaqI polymorphism allele 2 positive healthy individuals ('high secretor' phenotype for IL-1beta) than in healthy individuals negative for this allele. No such balance was found in MG patients. In one of the microsatellites, IL10.R, allele 112 was associated with patients having normal thymic histology. No relation of IL10.R allele 112 to proinflammatory cytokine gene polymorphisms and serum IgG, IgM and autoantibodies against nicotinic acetylcholine receptor (nAchR-Ab) was found. In another microsatellite, IL10.G, allele 134 was associated with patients having higher level of nAchR-Ab in their circulation. Our results demonstrated novel genetic markers within IL-10 gene indicating different mechanisms for IL-10 involved in the disease.

Genetic association of Ctla-4 to myasthenia gravis with thymoma.

Cytotoxic T lymphocyte associated antigen-4 (CTLA-4) plays a pivotal role in downregulating both the cellular and the humoral response by suppressing ongoing responses of activated T cells. Our earlier study showed that genetic variations in interleukin-1 genes confer susceptibility to myasthenia gravis, especially in patients having the lowest risk from major histocompatibility complex genes. Here we describe an association of Ctla-4 gene to the disease with thymoma and a higher prevalence of CTLA-4 gene polymorphism allele 104 in patients positive for IL-1beta TaqI allele 2, an IL-1beta 'high secretor' phenotype. There was no association in patients with hyperplasia and normal thymic histology. These results further advocate that MG is a polygenetic disease and suggest that co-stimulators such as CTLA-4 and CD28 might have an important role in the pathogenesis of the disease.