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BACKGROUND: Intrahepatic cholangiocarcinoma (ICCA) with hepatic hilus involvement is a more aggressive type of cholangiocarcinoma with worse outcomes.1,2 Surgical resection with negative margins is the only effective treatment for ICCA.3,4 Neoadjuvant therapy is considered to improve the possibility of surgery for patients;5,6 however, laparoscopic radical resection after neoadjuvant therapy for ICCA with hepatic hilus involvement remains at the exploratory stage due to technical challenges.7 METHODS: A 19-year-old man presented with an ICCA on the left side of the liver invading the blood vessels and bile ducts in the hepatic hilum. Five courses of neoadjuvant therapy were administered after a multidisciplinary team determined that the tumor was extremely difficult and risky to operate on. A laparoscopic left hepatectomy plus caudal lobectomy was performed to complete the resection of the negative margins. Three-dimensional visualization enabled precise preoperative planning and intraoperative guidance, including visualization of the tumor location, simulation of bile duct and vessel dissection steps, as well as determining the extent of liver resection. Vascular skeletonization, lymphadenectomy and biliary reconstruction were performed during operation. RESULTS: The operation time was 415 min with a blood loss of 100 mL. Postoperative pathohistology confirmed cholangiocarcinoma with low to intermediate differentiation. The resection margin was negative (R0) and lymph node pathology was tumor-negative (0/10). The patient was discharged on postoperative day 10 without complications. CONCLUSION: Laparoscopic radical resection after neoadjuvant therapy for ICCA with hepatic hilus involvement is safe and feasible in a large-throughput hepatic surgery center.
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OBJECTIVE: To assess the association of C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene with autistic behavior and inheritance pattern of children patients. METHODS: Ninety three autism patients were selected as the study group, whilst 93 healthy children were selected as the control group. The C677T genotype of the MTHFR gene was determined, and the correlation between the genotype and the autistic behavior and inheritance pattern were investigated. RESULTS: MTHFR gene C677T locus revealed three genotypes CC, CT and TT. Compared with the control group, the study group had fewer CC genotype but more TT genotype (P<0.05). Individuals with the three genotypes showed a statistically significant difference in the frequencies of four problem behaviors (P<0.05). Regression analysis showed that at least one T allele encoding the degree of 1 and 2 for the 4 problem behaviors that were statistically different. MTHFR gene C677T genotype was associated with autism under the recessive inheritance model and allelic inheritance model (P<0.05). CONCLUSION: The C677T polymorphism of the MTHFR gene is associated with autistic behaviors. Children with the TT genotype or T allele are at higher risk of developing autism, particularly direct gaze, complex limb movements, self-injurious behavior and hyperactivity 1 and 2 related with the degree of coding.
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Trastorno Autístico , Problema de Conducta , Trastorno Autístico/genética , Niño , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Patrón de Herencia , Metilenotetrahidrofolato Reductasa (NADPH2)/genéticaRESUMEN
A new type of liquid crystal microlens array (LCMLA) constructed by a single-layered LC material is proposed. The basic dual-mode integrated LC microlens includes a concentric microhole electrode and a central plate electrode. Compared with traditional LC microlenses driven electrically, the dual-mode integrated LC microlens presents a better light control effect, such as being flexibly adjusted between the beam convergence and divergence modes, enlarging both the tunable range of the signal voltage and the focal length and also reducing the focal spot assisted by a convex electric-field generated by the central plate electrode, acquiring a sharper beam diverging microring formed by the concave LC microlens assisted by a concave electric-field generated by the microhole electrode. At the same time, we have also verified that the electric-field filling factor of the dual-mode integrated LCMLA can be obviously increased through jointly tuning the signal voltages applied independently over both the microhole electrode and the central plate electrode. This research has laid a solid foundation for continuously developing LCMLA technology.
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BACKGROUND: Building an equitable health care system involves both the promotion of social justice in health and people's subjective perception of the promotion. This study aimed to analyze the overall status and associated factors of the perceived equity of the Chinese health care system, and then to offer policy recommendations for health care reform. METHODS: Information on the perceived equity score (scale 0 to 10) of 10,243 valid cases in total were derived from the data set of Chinese Social Survey 2015. Univariate analysis methods were applied to present respondents' overall perceived equity of the Chinese health care system. Multivariate linear regression method was used to explore the associated factors of the perceived equity and examine their independent effect. RESULTS: The respondents gave positive but relatively low marks (6.7 ± 2.6, 95% CI: = 6.64~6.74) of the equity of the Chinese health care system. Younger respondents reported a higher score of perceived equity than their elder counterparts (ß = - 0.132, 95% CI: - 0.203~ - 0.062, P < 0.001). Respondents with lower education level were significantly more likely to consider the Chinese health care system equitable (ß = - 0.104, 95% CI: - 0.153~ - 0.056, P < 0.001). Respondents satisfied with the Social Health Insurance reimbursement ratio tended to score the system higher in the survey (ß = 0.044, 95% CI: 0.024~0.063, P < 0.001). Respondents residing in eastern China and rural areas were significantly more likely to consider the Chinese health care system equitable (ß = - 0.268, 95% CI: - 0.338~ - 0.199, P < 0.001). Meanwhile, rural respondents reported higher scores of the perceived equity than urban respondents did (ß = 0.348, 95% CI: 0.237~0.458, P < 0.001). Respondents from regions with adequate GPs scored the system higher in this survey (ß = 0.087, 95% CI: 0.008~0.165, P < 0.001). The present study found no influence of gender, economic status, Social Health Insurance coverage, or satisfaction with the latest treatment on perceived equity. CONCLUSIONS: Eliminating the sense of inequity among a range of populations should be prioritized in health care reform. A national-level investigation system to rate residents' perceived equity was necessary for global health care reform.
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Atención a la Salud/organización & administración , Reforma de la Atención de Salud , Equidad en Salud/organización & administración , Adolescente , Adulto , China , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Sophorolipids (SLs) are surface active compounds that have excellent surface-lowering properties. SLs were produced by Starmerella bombicola (CGMCC1576) yeast with sunflower seed oil, fried waste oil, cooked tung oil and raw tung oil used as hydrophobic carbon sources. The results showed that the strain could use sunflower seed oil and fried waste oil as hydrophobic carbon sources to produce SLs, and the yields were 44.52 and 39.09 gl-1. It could not be used as cooked tung oil and raw tung oil. The analysis by high-performance liquid chromatography/high resolution mass spectrometry (HPLC-MS/MS) showed that the main composition and structure of SLs produced by fermentation using fried waste oil were similar to that of sunflower seed oil as hydrophobic carbon source. The yield of SLs was the highest when the fried waste oil was used as hydrophobic carbon source, glucose (8%), waste oil (6%) and yeast (0.3%). When fried waste oil was used as a hydrophobic carbon source in a parallel 4-strand fermentation tank (FT), the combination with the largest yield and the most cost saving was that 3% of fried waste oil was added into the initial medium, and another 3% was again added after 72 h of fermentation. The total yield of SLs was 121.28 gl-1, and the yield of lactone SLs was 48.07 gl-1.
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Ácidos Oléicos , Saccharomycetales , Espectrometría de Masas en Tándem , Levaduras , Fermentación , Aceite de Girasol , CarbonoRESUMEN
OBJECTIVE: To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio. METHODS: This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes. RESULTS: In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p > .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (-40.7%) yuan and 394.2 (-27.7%) yuan, respectively (p < .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (-28.5%) yuan (p < .05), and the per capita annual total out-of-pocket expenditure by 201.9 (-29.9%) yuan (p < .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p < .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p > .05). CONCLUSION: Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.
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Financiación Personal/estadística & datos numéricos , Hipertensión/economía , Pacientes Internos/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Población Rural , Anciano , Presión Sanguínea , China , Femenino , Gastos en Salud , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Puntaje de Propensión , Mecanismo de ReembolsoRESUMEN
BACKGROUND: SIRT4 is a member of the sirtuin family of nicotinamide adenine dinucleotide-dependent enzymes located in the mitochondria, and is involved in regulating energy metabolism, stress response, and cellular lifespan in mammalian cells. However, its function in human neuroblastoma (NB) remains unexplored. METHODS: Expression of SIRT4 in 158 pairs of human NB tumor tissues and adjacent normal tissues collected from March 2009 to October 2012 was analyzed by immunohistochemistry, Western blotting, and real-time fluorescence quantitative PCR. For in vitro study, SIRT4 was overexpressed in SH-SY5Y, SK-N-BE, and IMR-32 cells to study the effects of SIRT4 expression on proliferation, invasion, and migration of human NB cells and on mitochondrial function. RESULTS: SIRT4 gene expression in human NB tumor tissues was significantly lower than that in adjacent normal tissues (P<0.001). SIRT4 expression was lower in NB patients with higher International Neuroblastoma Staging System stage (P=0.018), with lymph node metastasis, than patients without lymph node metastasis (P<0.001). Survival times of NB patients with low expression of SIRT4 were significantly shorter than those of patients with high expression of SIRT4 (P=0.0036). Overexpression of SIRT4 significantly reduced the proliferation, invasion, and migration ability of NB cells as well as mitochondrial energy production, and caused SIRT1 upregulation and mitochondrial damage in NB cells. CONCLUSION: SIRT4 exhibits a tumor suppressor function in human NB and inhibits mitochondrial metabolism and SIRT1 expression in tumor cells, thereby reducing the energy metabolism of tumor cells. These results suggest that SIRT4 may be a new therapeutic target for human NB.
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With the commercialization of transgenic cotton that expresses Bt (Bacillus thuringiensis) insecticidal proteins, mirid bugs have become key pests in cotton and maize fields in China. Genetically engineered (GE) crops for controlling mirids are unavailable owing to a lack of suitable insecticidal genes. In this study, we developed and validated a dietary exposure assay for screening insecticidal compounds and for assessing the potential effects of insecticidal proteins produced by GE plants on Apolygus lucorum, one of the main mirid pests of Bt cotton and Bt maize. Diets containing potassium arsenate (PA) or the cysteine protease inhibitor E-64 were used as positive controls for validating the efficacy of the dietary exposure assay. The results showed that with increasing concentrations of PA or E-64, A. lucorum larval development time was prolonged and adult weight and fecundity were decreased, suggesting that the dietary exposure assay was useful for detecting the toxicity of insecticidal compounds to A. lucorum. This assay was then used to assess the toxicity of Cry1Ab, Cry1Ac, Cry1F, Cry2Aa, and Cry2Ab proteins, which have been transformed into several crops, against A. lucorum. The results showed that A. lucorum did not show a negative effect by feeding on an artificial diet containing any of the purified Cry proteins. No significant changes in the activities of digestive, detoxifying, or antioxidant enzymes were detected in A. lucorum that fed on a diet containing Cry proteins, but A. lucorum fitness was reduced when the insect fed on a diet containing E-64 or PA. These results demonstrate that A. lucorum is not sensitive to the tested Cry proteins and that the dietary exposure assay is useful for evaluating the toxicity of insecticidal compounds to this species.
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Bioensayo/métodos , Exposición Dietética/análisis , Heterópteros/fisiología , Insecticidas/toxicidad , Animales , Bacillus thuringiensis , Proteínas Bacterianas , China , Productos Agrícolas , Dieta , Endotoxinas , Fertilidad/efectos de los fármacos , Proteínas Hemolisinas , Insecticidas/análisis , Plantas Modificadas Genéticamente , Zea maysRESUMEN
Cry1A and Cry2A toxins, which are widely used in Bt transgenic crops, can specifically bind to insect midguts and exert their insecticidal effects. There are interactions between insect midgut-binding proteins and Cry1A toxins; however, little is known about the insect protein that specifically binds to Cry2A. Midgut membrane-bound alkaline phosphatases (ALPs), which are important for the binding of proteins to Cry1A, play dominant roles in Cry1A-mediated toxicity in some lepidopteran larvae. In this study, we cloned and expressed one partial ALP2 peptide from susceptible Spodoptera exigua larvae and studied the binding characteristics of SeALP2 with Cry2Aa. The ALPs proteins was expressed at all larval stages and highly expressed in the first and second instar larvae. The heterologously expressed SeALP2 peptide bound specifically to Cry2Aa with a high affinity. Knocking down ALP2 in vivo revealed that it plays an important role in the susceptibility of S. exigua to Cry2Aa. Based on these findings, we propose that ALP2 in S. exigua serves as a functional receptor for Cry2Aa.
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Fosfatasa Alcalina/genética , Proteínas Bacterianas/farmacología , Endotoxinas/farmacología , Proteínas Hemolisinas/farmacología , Proteínas de Insectos/genética , Spodoptera/genética , Fosfatasa Alcalina/metabolismo , Animales , Toxinas de Bacillus thuringiensis , Clonación Molecular , ADN Complementario/genética , ADN Complementario/metabolismo , Proteínas de Insectos/metabolismo , Larva/genética , Larva/crecimiento & desarrollo , Larva/metabolismo , Larva/microbiología , Análisis de Secuencia de ADN , Spodoptera/crecimiento & desarrollo , Spodoptera/metabolismo , Spodoptera/microbiologíaRESUMEN
A pyramid strategy combining the Cry1A and Cry2A toxins in Bt crops has been widely used throughout the world to delay pest adaption to transgenic crops and broaden the insecticidal spectrum. Midgut membrane-bound cadherin (CAD), aminopeptidase-N (APN) and alkaline phosphatase (ALP) are important for Cry1A toxicity in some lepidopteran larvae, but the proteins that bind Cry2A in the midgut of target insects and their role in the Cry2A mechanism of action are still unclear. In this study, we found that heterologously expressed CAD, APN4 and ALP2 peptides from the midgut of Helicoverpa armigera could bind to the Cry2Aa toxin with a high affinity. Additionally, the efficiency of Cry2Aa insecticidal activity against H. armigera larvae was obviously reduced after the genes encoding these proteins were silenced with specific siRNAs: CAD- and ALP2-silenced larvae showed significantly similar reductions in mortality due to the Cry2Aa toxin (41.67% and 43.06%, respectively), whereas a larger reduction in mortality was observed in APN4-silenced larvae (61.11%) than in controls. These results suggest that CAD, APN4 and ALP2 are involved in the mechanism of action of Cry2Aa in H. armigera and may play important functional roles in the toxicity of the Cry2Aa toxin.
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Fosfatasa Alcalina/metabolismo , Bacillus thuringiensis , Proteínas Bacterianas/farmacología , Antígenos CD13/metabolismo , Cadherinas/metabolismo , Endotoxinas/farmacología , Proteínas Hemolisinas/farmacología , Proteínas de Insectos/metabolismo , Insecticidas/farmacología , Intestinos , Mariposas Nocturnas/metabolismo , Animales , Toxinas de Bacillus thuringiensis , Larva/metabolismoRESUMEN
A novel series of oligomers consisting of thiophene as a p-type unit and oxadiazole as an n-type unit were separately synthesized. On the basis of the characterization of photophysical and electrochemical properties, the structure-property relationships of the oligomers were investigated. Cyclic voltammogram studies showed that changing the number of thiophene and oxadiazole units could effectively modulate the electronic properties of the p-n diblock and triblock oligomers. The effect of molecular regiochemistry on electronic properties is also investigated. The observed electronic properties were consistent with theoretical calculations. These systems serve as excellent examples, demonstrating the band gap control principle in the p-n heterostructure oligomers.