Predictive factors and risk analysis of recurrent laryngeal nerve invasion in papillary thyroid carcinoma ≤ 1 cm

ABSTRACT Objective: The recurrent laryngeal nerve (RLN) may be involved by papillary thyroid carcinoma ≤ 1 centimeter (PTC ≤ 1 cm). Current study investigated the predictive factors of RLN invasion in PTC ≤ 1 cm, the risk factors of disease recurrence in RLN invaded cases and the results of surgical management for RLN invasion. Materials and methods: Data of 374 PTC ≤ 1 cm patients were retrospectively collected. We performed univariate and multivariate analysis to identify predictive factors of RLN invasion and risk factors of disease recurrence. The abilities of factors in predicting RLN invasion were evaluated. Surgical outcomes and recurrence free survival (RFS) of patients were analyzed. Results: A total of 28 patients suffered RLN invasion, among which seven had disease recurrence. Preoperative vocal cord palsy (VCP), gross extrathyroidal extension, larger tumor size and tumor on the dorsal side of thyroid were verified as predictive factors of RLN invasion. RLN involved patients had poorer RFS, but better than those who also had upper-aerodigestive tract invasion. Upper-aerodigestive tract invasion, lateral neck lymph nodes metastasis (LNM) and BRAF V600E mutation were independent risk factors of disease recurrence in RLN invaded cases. Tumor shaving showed better RLN function preservation without increasing recurrent risk. Conclusions: Current study confirmed the rarity of RLN invasion in PTC ≤ 1 cm. Various aggressive features were verified as predictive factors of RLN invasion. Tumor shaving showed superiority in preserving nerve function without increasing recurrent risk. Special attentions should be paid for disease recurrence when RLN invasion accompanied by upper-aerodigestive tract invasion, lateral neck LNM or BRAF V600E mutation.

Prevalence and treatment of anemia in chronic kidney disease patients based on regional medical big data / 中华流行病学杂志

Objective: To assess the prevalence, risk factors and treatment of anemia in patients with chronic kidney disease (CKD). Methods: A descriptive method was used to analyze the prevalence and treatment of anemia in CKD patients based on regional health data in Yinzhou District of Ningbo during 2012-2018. The multivariate logistic regression analysis was used to identify independent influence factors of anemia in the CKD patients. Results: In 52 619 CKD patients, 15 639 suffered from by anemia (29.72%), in whom 5 461 were men (26.41%) and 10 178 were women (31.87%), and anemia prevalence was higher in women than in men, the difference was significant (P<0.001). The prevalence of anemia increased with stage of CKD (24.77% in stage 1 vs. 69.42% in stage 5, trend χ2 test P<0.001). Multivariate logistic regression analysis revealed that being women (aOR=1.57, 95%CI: 1.50-1.63), CKD stage (stage 2: aOR=1.10, 95%CI: 1.04-1.16;stage 3: aOR=2.28,95%CI: 2.12-2.44;stage 4: aOR=4.49,95%CI :3.79-5.32;stage 5: aOR=6.31,95%CI: 4.74-8.39), age (18-30 years old: aOR=2.40,95%CI: 2.24-2.57, 61-75 years old: aOR=1.35,95%CI:1.28-1.42, ≥76 years old: aOR=2.37,95%CI:2.20-2.55), BMI (<18.5 kg/m2:aOR=1.29,95%CI: 1.18-1.41;23.0-24.9 kg/m2:aOR=0.79,95%CI: 0.75-0.83;≥25.0 kg/m2:aOR=0.70,95%CI: 0.66-0.74), abdominal obesity (aOR=0.91, 95%CI: 0.86-0.96), chronic obstructive pulmonary disease (aOR=1.15, 95%CI: 1.09-1.22), cancer (aOR=3.03, 95%CI: 2.84-3.23), heart failure (aOR=1.44, 95%CI: 1.35-1.54) and myocardial infarction (aOR=1.54, 95%CI:1.16-2.04) were independent risk factors of anemia in CKD patients. Among stage 3-5 CKD patients with anemia, 12.03% received iron therapy, and 4.78% received treatment with erythropoiesis-stimulating agent (ESA) within 12 months after anemia was diagnosed. Conclusions: The prevalence of anemia in CKD patients was high in Yinzhou. However, the treatment rate of iron therapy and ESA were low. More attention should be paid to the anemia management and treatment in CKD patients.

Application of oblique lateral interbody fusion in the treatment of lumbar intervertebral disc degeneration in patients with Modic change and endplate sclerosis / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis.@*METHODS@#A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L2,3 in 2 cases, L3,4 in 5 cases, and L4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed.@*RESULTS@#There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved.@*CONCLUSION@#As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.

Analysis of the causes and clinical results of vertebral fracture during oblique lateral lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To analyze the causes of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy, summarize the clinical results, and propose preventive measures.@*METHODS@#Retrospective analysis was made on the data of 8 cases of lumbar spondylopathy and vertebral fracture treated by oblique lateral interbody fusion in three medical centers from October 2014 to December 2018. All were female, aged from 50 to 81 years with an average of 66.4 years. Disease types included 1 case of lumbar degenerative disease, 3 cases of lumbar spinal stenosis, 2 cases of lumbar degenerative spondylolisthesis and 2 cases of lumbar degenerative scoliosis. Preoperative dual energy X-ray bone mineral density test showed that 2 cases had T-value >-1 SD, 2 cases had T-value -1 to -2.5 SD, and 4 cases had T-value <-2.5 SD. Single segment fusion was in 5 cases, two segment fusion in 1 case and three segment fusion in 2 cases. Four cases were treated with OLIF Stand-alone and 4 cases were treated with OLIF combined with posterior pedicle screw fixation. Postoperative imaging examination showed vertebral fracture, and all of them were single vertebral fracture. There were 2 cases of right lower edge fracture of upper vertebral body at fusion segment, 6 cases of lower vertebral body fracture at fusion segment, and 6 cases with endplate injury and fusion cage partially embedded in vertebral body. Three cases of OLIF Stand-alone were treated with pedicle screw fixation via posterior intermuscular approach, while one case of OLIF Stand-alone and four cases of OLIF combined with posterior pedicle screw fixation were not treated specially.@*RESULTS@#The 5 cases of initial operation and 3 cases of reoperation did not show wound skin necrosis or wound infection. The follow-up time was from 12 to 48 months with an average of 22.8 months. Visual analogue scale (VAS) of low back pain was preoperative decreased from 4 to 8 points (averagely 6.3 points) and postoperative 1 to 3 points (averagely 1.7 points) at the final follow-up. Oswestry disability index (ODI) was preoperative 39.7% to 52.4% (averagely 40.2%), and postoperative 7.9% to 11.2% (averagely 9.5%) at the final follow-up. During the follow-up, there was no loosening or fracture of the pedicle screw system, and no lateral displacement of the fusion cage;however, the fusion cage at the vertebral fracture segment had obvious subsidence. The intervertebral space height of vertebral fracture segment was preoperaive 6.7 to 9.2 mm (averagely 8.1 mm), and postoperative 10.5 to 12.8 mm (averagely 11.2 mm). The improvement rate after operation was 37.98% compared to preoperative. The intervertebral space height at final follow-up was 8.4 to 10.9 mm (averagely 9.3 mm), and the loss rate was 16.71% compared with that after operation. At the final follow-up, interbody fusion was achieved in all cases except for one that could not be identified.@*CONCLUSION@#The incidence of vertebral fracture during oblique lateral interbody fusion in the treatment of lumbar spondylopathy is lower, and there are many reasons for fracture, including preoperative bone loss or osteoporosis, endplate injury, irregular shape of endplate, excessive selection of fusion cage, and osteophyte hyperplasia at the affected segment. As long as vertebral fracture is found in time and handled properly, the prognosis is well. However, it still needs to strengthen prevention.

Psychological injuries in young boxers / Lesões psicológicas em jovens boxeadores / Lesiones psicológicas en jóvenes boxeadores

ABSTRACT Introduction: Boxing is a fighting sport, and many factors cause physical injuries in athletes because of how they compete and train. Injuries are common for athletes who usually participate in this sport. Based on this, the relationship between positive psychological quality at the sport level should be explored, providing a theoretical basis for cultivating optimistic personalities in young athletes. Objective: Analyze the psychological injuries in young boxers to establish a standard to improve the psychological quality evaluation system of young athletes in China. Methods: By comparing the characteristics of different injuries, the possibility of injury occurrence in different activities can be explored, providing a theoretical basis to guide injury prevention, then promoting sports injury prevention. Results: The study shows that through professional training methods to improve the psychological quality of young boxers, these sportsmen should also recognize the importance of psychological training. Conclusion: Technical help in this approach can complete healthy training, aiming to meet the demands of the sport and collaborate to achieve better results. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução: O boxe é um esporte de luta, havendo muitos fatores que causam lesões físicas nos atletas pelo modo de competição e treinamento. As lesões são comuns para os atletas que costumam participar desse esporte. Baseado nisso, a relação entre qualidade psicológica positiva ao nível esportivo deve ser explorada, fornecendo uma base teórica para o cultivo da personalidade otimista aos jovens atletas. Objetivo: Analisar as lesões psicológicas em jovens boxeadores visando embasar uma norma para melhorar o sistema de avaliação da qualidade psicológica dos jovens atletas na China. Métodos: Comparando as características de diferentes lesões, a possibilidade de ocorrência de lesões em diferentes atividades pode ser explorada, fornecendo uma base teórica para orientar a prevenção de lesões, promovendo então a prevenção de lesões esportivas. Resultados: O estudo mostra que através dos métodos de treinamento profissional para melhorar a qualidade psicológica dos jovens boxeadores, esses esportistas também devem reconhecer a importância do treinamento psicológico. Conclusão: O auxílio técnico nessa abordagem pode completar o treinamento saudável, visando atender as exigências do esporte e colaborar para o alcance de melhores resultados. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El boxeo es un deporte de lucha, y hay muchos factores que provocan lesiones físicas en los deportistas debido al modo de competición y entrenamiento. Las lesiones son comunes para los atletas que suelen participar en este deporte. En base a esto, se debe explorar la relación entre la calidad psicológica positiva a nivel deportivo, proporcionando una base teórica para el cultivo de la personalidad optimista a los jóvenes atletas. Objetivo: Analizar las lesiones psicológicas en jóvenes boxeadores con el fin de fundamentar una norma para mejorar el sistema de evaluación de la calidad psicológica de los jóvenes atletas en China. Métodos: Al comparar las características de las diferentes lesiones, se puede explorar la posibilidad de que se produzcan lesiones en diferentes actividades, lo que proporciona una base teórica para orientar la prevención de lesiones y, a continuación, promover la prevención de lesiones deportivas. Resultados: El estudio muestra que, a través de los métodos de entrenamiento profesional para mejorar la calidad psicológica de los jóvenes boxeadores, estos deportistas también deberían reconocer la importancia del entrenamiento psicológico. Conclusión: La ayuda técnica en este enfoque puede completar el entrenamiento saludable, con el objetivo de cumplir con las exigencias del deporte y colaborar para lograr mejores resultados. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Survival analysis of patients with subglottic squamous cell carcinoma based on the SEER database

Abstract Objective: This study aimed to investigate the demographic and clinicopathological characteristics, and survival outcomes of subglottic Squamous Cell Carcinoma (SCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Demographic and clinicopathological information, including age, sex, race, tumor size, histologic grade, clinical/TNM stage, tumor invasion extent, Lymph Node Metastasis (LNM) extent, size of metastatic lymph nodes, LNM ratio and treatment data, of 842 subglottic SCC patients diagnosed between 1996 and 2016 were acquired. Kaplan-Meier survival analyses were performed to assess the effects of clinicopathological characteristics, treatment modalities, surgical procedures, and adjuvant therapies on overall survival and cancer-specific survival. Results: Subglottic SCC was more frequent among males aged 60-70 years, with low-grade but locally advanced lesions without local or distant metastases. Age and several primary tumor/LNM related variables were independent risk factors for overall survival and cancer specific survival. Advanced-stage and high-grade disease led to unfavorable prognosis. The most common treatment modality and surgical procedure were surgery plus radiotherapy and total laryngectomy, respectively. Surgery plus radiotherapy provided favorable 5-year survival outcomes, while total laryngectomy had the worst. Surgery plus adjuvant therapy showed better survival outcomes than surgery alone. Conclusion: This study confirmed the rarity of subglottic SCC. Patients with subglottic SCCs suffered poor prognosis especially for those with advanced-stage or high-grade lesions. The prognosis of subglottic SCC remained poor over the years, despite recent progress in cancer therapies. Surgery plus adjuvant therapy improved the survival outcome. Although larynx preservation surgery was beneficial for early-stage disease, total laryngectomy was favored for patients with advanced tumors. Level of evidence: Level 4.

Clinical treatment outcomes and their changes in extremely preterm twins: a multicenter retrospective study in Guangdong Province, China / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical treatment outcomes and the changes of the outcomes over time in extremely preterm twins in Guangdong Province, China.@*METHODS@#A retrospective analysis was performed for 269 pairs of extremely preterm twins with a gestational age of <28 weeks who were admitted to the department of neonatology in 26 grade A tertiary hospitals in Guangdong Province from January 2008 to December 2017. According to the admission time, they were divided into two groups: 2008-2012 and 2013-2017. Besides, each pair of twins was divided into the heavier infant and the lighter infant subgroups according to birth weight. The perinatal data of mothers and hospitalization data of neonates were collected. The survival rate of twins and the incidence rate of complications were compared between the 2008-2012 and 2013-2017 groups.@*RESULTS@#Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of severe asphyxia and smaller head circumference at birth (P<0.05). The mortality rates of both of the twins, the heavier infant of the twins, and the lighter infant of the twins were lower in the 2013-2017 group compared with the 2008-2012 group (P<0.05). Compared with the 2008-2012 group, the 2013-2017 group (both the heavier infant and lighter infant subgroups) had lower incidence rates of pulmonary hemorrhage, patent ductus arteriosus (PDA), periventricular-intraventricular hemorrhage (P-IVH), and neonatal respiratory distress syndrome (NRDS) and a higher incidence rate of bronchopulmonary dysplasia (P<0.05).@*CONCLUSIONS@#There is a significant increase in the survival rate over time in extremely preterm twins with a gestational age of <28 weeks in the 26 grade A tertiary hospitals in Guangdong Province. The incidences of severe asphyxia, pulmonary hemorrhage, PDA, P-IVH, and NRDS decrease in both the heavier and lighter infants of the twins, but the incidence of bronchopulmonary dysplasia increases. With the improvement of diagnosis and treatment, the multidisciplinary collaboration between different fields of fetal medicine including prenatal diagnosis, obstetrics, and neonatology is needed in the future to jointly develop management strategies for twin pregnancy.

Comparative study of single and double ileal Yang-Monti duct controllable outflow tract in patients with urethral damage / 中华泌尿外科杂志

Objective:To evaluate the efficacy and safety of Yang-Monti tube in the operation of bladder controllable outflow tract, and to compare the efficacy of single and double segments Yang-Monti tube in patients with urethral damage.Methods:The clinical data of 27 patients who underwent Yang-Monti tube surgery in West China Hospital of Sichuan University from January 2009 to February 2018 were retrospectively analyzed, including 14 cases of single segment ileum (single segment group) and 13 cases of double segment ileum (double segment group). The age of single-segment group and double-segment group was (56.5±4.3) years and (50.2±6.8) years, respectively ( P=0.220). There were 2/12 and 3/10 males and females, respectively ( P=0.564). The body mass index (BMI) was (19.6±1.3) kg/m2 and (24.2±2.1) kg/m2, respectively ( P<0.001). The disease duration was 6 (3-24) months and 8 (3-48) months, respectively ( P=0.650). The preoperative quality of life (QOL) score was (46.7±1.7) and (45.5±1.7), respectively ( P=0.061). The number of patients with urinary tract infection before operation was 11 and 13, respectively ( P=0.480). In the single-segment group, a 2 cm ileum with mesangial vessels was cut at a distance of about 15 cm from the ileocecal part, and the intestine was cut longitudinally along the direction of the intestinal canal at the opposite mesangial margin. The intestinal piece was wrapped horizontally around the F12 urinary tube and wound into a Yang-Monti tube by intermittent suture with a 3-0 single thread. The bladder wall was cut anterolateral to the top wall of the bladder, about 1 cm in length, and the Yang-Monti tube was anastomosed end-to-end with the mucosal muscularis of the bladder wall. A circular incision with a diameter of about 1 cm was made at the level of the anterior superior iliac spine at the rectus abdominis muscle, and a tunnel was formed by puncture into the abdomen with curved forceps. The Yang-Monti tube was led out of the abdominal wall along the tunnel, and the tube opening was fixed with subcutaneous suture. At the same time, the tube wall was fixed in the peritoneum with 4-0 silk thread. In the double-segment group, two segments of 2 cm ileum were cut, and the intestinal tube was cut longitudes along the direction of the opposite mesangial margin. The intestinal piece was first sutured end to end, and then the tube was coiled and reconstructed to form a Yang-Monti tube with a diameter of 0.6-0.8 cm and a length of about 12 cm. The proximal end of the Yang-Monti tube was directly anastomosed with the mucosal muscle layer of the bladder. The operation time, intraoperative blood loss, postoperative catheterization interval, postoperative single catheterization volume, postoperative complications (bleeding, intestinal obstruction, anastomotic leakage, anastomotic stenosis, stoma infection, urinary tract infection, urinary tract infection) and QOL score were compared between the two groups. Results:The operation was successfully completed in both groups. The operation time of single-segment group and double-segment group were (165.8±17.8) min and (157.54±12.25) min, respectively ( P=0.302), and the intraoperative blood loss was (60.0±20.0) ml and (50.00±25.00) ml, respectively ( P=0.650). The postoperative recovery time was 3 (2-4) d and 3 (2-9) d, respectively ( P=0.790), and the postoperative hospital stay was 12 (9-40) d and 12 (10-32) d, respectively (P=0.259). The postoperative single catheterization volume was (240.4±42.7) ml and (261.5±36.3) ml ( P=0.186), and the postoperative QOL was (22.4±2.7) and (21.5±2.6), respectively ( P=0.325), and there was no significant difference. There were 2 cases of urinary tract infection in the single-segment group, and 1 case of urinary tract infection, postoperative bleeding, and intestinal obstruction in the double-segment group. There was no significant difference between the two groups ( P=0.222). The time interval of catheterization in single-segment group and double-segment group was (2.5±1.0) h and (3.5±1.3) h, respectively, and the difference was statistically significant ( P=0.029). The quality of life score after operation was statistically significant compared with that before operation ( P<0.001), and the incidence of urinary tract infection after operation was also statistically significant compared with that before operation ( P=0.011). Conclusions:Both single segment and double segment ileum Yang-Monti tube surgery are feasible surgical methods for patients with urethral damage. There was no difference in the effects of the two types of surgery, and both may improve the quality of life of patients.The postoperative QOL score could be greatly improved and the incidence of complications was low.

Effect of Fufang Shelong Capsules on Rats with Membranous Nephropathy Based on p38 MAPK Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the nephroprotective and anti-inflammatory effects of Fufang Shelong capsules （FFSL） in rats with membranous nephropathy （MN）， and the role of the p38 mitogen-activated protein kinase （MAPK） signaling pathway. MethodMale SD rats of SPF grade were divided into a normal group and an experimental group. The MN model was induced by tail vein injection of cationized bovine serum albumin in the experimental group. After screening， the eligible model rats were included and divided into a positive control group （tripterygium glycosides tablets） and low-， medium-， and high-dose FFSL groups （0.375， 0.75， 1.5g·kg-1）. The rats were treated correspondingly for eight weeks， and urine protein was detected during drug intervention. Renal function and inflammation-related indicators were detected after drug intervention. The changes in 24-hour urine total protein （24 h UP）， interleukin-6 （IL-6）， interleukin-8 （IL-8）， tumor necrosis factor-α （TNF-α）， creatinine （Cr）， blood urea nitrogen （BUN）， total protein （TP）， albumin （Alb）， and total cholesterol （TC） were detected. Flow cytometry was used to detect CD4+/CD8+ changes. Kidney tissues were collected to observe pathological changes under a light microscope and an electron microscope. The protein expression of p38 MAPK and phosphorylated p38 MAPK （p-p38 MAPK） in kidney tissues was detected by Western blot. ResultCompared with the normal group， the model group showed increased 24 h UP （P<0.01）， elevated serum Cr， BUN， TC， IL-6， IL-8， and TNF-α （P<0.05，P<0.01）， decreased serum Alb and TP levels （P<0.05，P<0.01）， increased CD4+/CD8+ in the peripheral blood （P<0.01）， and up-regulated protein expression of p38 MAPK and p-p38 MAPK in kidney tissues （P<0.05）. Additionally， in the model group， immune complex deposition and foot process fusion， accompanied by infiltration of inflammatory cells， were observed on the epithelial side of the basement membrane in the pathological kidney tissues. Compared with the model group， the groups with drug intervention showed declining 24 h UP levels at six weeks （P<0.05，P<0.01）， decreased serum Cr， BUN， TC， IL-6， IL-8， and TNF-α （P<0.05，P<0.01）， increased serum Alb and TP levels （P<0.05，P<0.01）， reduced CD4+/CD8+ in the peripheral blood （P<0.01）， improved renal pathological damage， and down-regulated p38 MAPK and p-p38 MAPK in kidney tissues （P<0.05，P<0.01）. ConclusionFFSL can decrease the expression of inflammatory factors， reduce proteinuria， delay kidney damage， and protect kidney function by inhibiting the expression of the p38 MAPK signaling pathway.

Myhre Syndrome Misdiagnosed as Marfan Syndrome: an Educational Presentation

Abstract A 32-month-old girl with patent ductus arteriosus, false tendon of left ventricle, mild pulmonary hypertension, and chronic cardiac insufficiency (cardiac function level I-II) was misdiagnosed with Marfan Syndrome and there was no improvement in her physical growth after operation for this disease. The preterm baby was finally diagnosed with Myhre Syndrome by clinical phenotypes and mutation of SMAD4 gene.

VEGF121 como Mediador de Efeitos Cardioprotetores Pós-Hipóxia via CaSR e via da Protease Dependente de Mitocôndria / VEGF121 Mediates Post-Hypoxia Cardioprotective Effects Via CaSR and Mitochondria-Dependent Protease Pathway

Resumo Fundamento: A doença cardiovascular é a principal causa de morte em todo o mundo. A apoptose mediada por hipóxia em cardiomiócitos é uma das principais causas de distúrbios cardiovasculares. O tratamento com a proteína do fator de crescimento endotelial vascular (VEGF, do inglês vascular endothelial growth factor) foi testado, mas as dificuldades operacionais limitaram seu uso. Entretanto, com os avanços da terapia gênica, aumentou o interesse na terapia gênica baseada no VEGF em doenças cardiovasculares. No entanto, o mecanismo preciso pelo qual a reposição de VEGF resgata os danos pós-hipóxia em cardiomiócitos não é conhecido. Objetivos: Investigar o efeito da expressão de VEGF121 pós-hipóxia utilizando cardiomiócitos de ratos neonatos. Métodos: Cardiomiócitos isolados de ratos neonatos foram utilizados para estabelecer um modelo in vitro de lesão cardíaca induzida por hipóxia. O efeito da superexpressão de VEGF, isolado ou em conjunto com inibidores de moléculas pequenas que têm como alvo os canais de cálcio, receptores sensíveis ao cálcio (CaSR, do inglês calcium-sensitive receptors) e calpaína, no crescimento e proliferação celular em lesão de cardiomiócitos induzidos por hipóxia, foram determinados com ensaio de MTT, coloração TUNEL, coloração com Anexina V/PI, lactato desidrogenase e atividade da caspase. Para análise estatística, um valor de p<0,05 foi considerado significativo. Resultados: Verificou-se que o efeito do VEGF121 foi mediado por CaSR e calpaína, mas não foi dependente dos canais de cálcio. Conclusões: Nossos resultados, mesmo em um ambiente in vitro, estabelecem as bases para uma validação futura e testes pré-clínicos da terapia gênica baseada em VEGF em doenças cardiovasculares.

Abstract Background: Cardiovascular disease is the major cause of death worldwide. Hypoxia-mediated apoptosis in cardiomyocytes is a major cause of cardiovascular disorders. Treatment with vascular endothelial growth factor (VEGF) protein has been tested but operational difficulties have limited its use. However, with the advancements of gene therapy, interest has risen in VEGF-based gene therapy in cardiovascular disorders. However, the precise mechanism by which VEGF replenishment rescues post-hypoxia damage in cardiomyocytes is not known. Objectives: To investigate the effect of post-hypoxia VEGF121 expression using neonatal rat cardiomyocytes. Methods: Cardiomyocytes isolated from neonatal rats were used to establish an in vitro model of hypoxia-induced cardiac injury. The effect of VEGF overexpression, alone or in combination with small-molecule inhibitors targeting calcium channel, calcium sensitive receptors (CaSR), and calpain on cell growth and proliferation on hypoxia-induced cardiomyocyte injury were determined using an MTT assay, TUNEL staining, Annexin V/PI staining, lactate dehydrogenase and caspase activity. For statistical analysis, a value of P<0.05 was considered to be significant. Results: The effect of VEGF121 was found to be mediated by CaSR and calpain but was not dependent on calcium channels. Conclusions: Our findings, even though using an in vitro setting, lay the foundation for future validation and pre-clinical testing of VEGF-based gene therapy in cardiovascular diseases.

Efficacy of Spleen-invigorating Chinese Medicinals in Repairing Intestinal Mucosal Barrier Injury： A Review / 中国实验方剂学杂志

As the first line of defense between the intestinal environment and the outside world， the intestinal mucosal barrier is essential for maintaining the intestinal homeostasis. The intestinal mucosal barrier injury will change the intestinal permeability and allow bacterial translocation and the entry of endotoxins into blood， thus triggering a series of inflammatory responses， followed by the injury of related tissues and the aggravation of primary diseases. The spleen， the acquired foundation， is responsible for maintaining the internal and external balance of the body and resisting external evils. Its physiological function is similar to that of the intestinal mucosal barrier. Spleen deficiency easily leads to intestinal mucosal barrier dysfunction. Therefore， replenishing Qi， invigorating spleen， and restoring the efficacy of spleen and stomach qi in defensing and governing transportation and transformation are the keys to prevent and treat intestinal mucosal barrier injury. In recent years， studies have shown that the spleen-invigorating Chinese medicinals repair the intestinal mucosal injury by promoting the expression of intestinal epithelial tight junction proteins， regulating the intestinal immune function， microbial flora， and metabolites， and supplementing the intestinal nutrition， enabling them to gradually become a research hotspot. After reviewing the relevant articles published in China and abroad， this paper expounded the common syndrome types of traditional Chinese medicine （TCM）， the changes in intestinal mucosal barrier induced by spleen deficiency， the repairing effects of spleen-invigorating Chinese medicinals on intestinal mucosal barrier injury， in order to provide some clues for the research on the treatment of intestinal mucosal barrier dysfunction-related diseases with spleen-invigorating Chinese medicinals.

Biocompatibility of extracellular matrix hydrogel with human iPSCs differentiated cardiomyocytes / 中华心血管病杂志

Objective: To observe the biocompatibility of porcine omental derived extracellular matrix (ECM) hydrogel with human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and the feasibility of ECM hydrogel as a delivery vector of cell transplantation. Methods: A series of chemical, physical and enzymatic methods were applied to acellularize the porcine omentum. Subsequently, the extracted ECM was prepared into thermosensitive hydrogel. The biochemical composition of the hydrogel was identified by histological staining. The microstructure was observed by scanning electron microscopy. The hydrogel was then injected into the myocardium of mice to observe its in situ gelation ability. Differentiation of human induced pluripotent stem cells into cardiomyocytes was achieved by small molecule induction, and then the obtained hiPSC-CMs were cultured. hiPSC-CMs cultured onto the prepared hydrogel were defined as the hydrogel group, while conventionally cultured hiPSC-CMs were defined as the control group. Cardiomyocyte viability and growth patterns were detected using live/dead staining, CCK-8 and phalloidin staining. Immunofluorescence staining and Western blot of cardiomyocytes were used to determine the survival and phenotypic maintenance markers of cardiomyocytes in materials. Results: The results of HE staining, oil red O staining and DAPI fluorescence staining showed that there was no significant cell debris, nucleus and lipid residue in the prepared ECM hydrogel. The Sirius red staining and Alcian blue staining showed that the hydrogel retained collagen and glycolaminoglycan, which were the main components of ECM. The prepared hydrogel behaves as a viscous liquid at 4 ℃ and as a gel state at 37 ℃. Scanning electron microscope results showed that the microstructure of the hydrogel was composed of irregular fibers and pores of different sizes. Under the guidance of ultrasound, the prepared ECM hydrogel could be successfully injected into the myocardium of mice. Immediately after the injection, the hyperechoic signal could be observed under ultrasound, suggesting that the hydrogel remained in the myocardium. HE staining of myocardial tissue evidenced that there was lump of gel in the injection area. The differentiated hiPSC-CMs were co-cultured with the prepared ECM hydrogel, and the results of live/dead staining showed that most of the hiPSC-CMs in the hydrogel group and the control group were alive, dead cells were scanty. The results of CCK-8 test showed that the absorbance values of the two groups were similar (P>0.05). The results of phalloidin staining showed that hiPSC-CMs could extend normally when co-cultured with ECM hydrogel. The cell morphology of the hydrogel group was similar with that of the control group, and there was no statistically significant difference in the F-actin coverage area per cell between the two groups (P>0.05). Immunofluorescence staining of cardiomyocyte markers showed that there was no significant difference in the coverage area of α-actinin and connexin-43 (Cx-43) per field between the hydrogel group and the control group (both P>0.05), the quantitative results of DAPI staining showed that there was no statistically significant difference in the number of cells between the two groups (P>0.05). Meanwhile, the results of Western blot showed that the expression levels of α-actinin and Cx-43 in cardiomyocytes in the hydrogel group were similar as those in the control group (both P>0.05). Conclusions: These results show that preparation of the ECM hydrogel from porcine omentum is successful. The hydrogel has good biocompatibility and no obvious cytotoxicity. Besides, the hydrogel can support the survival of hiPSC-CMs in vitro and maintain its phenotype. These properties make it a promising injectable cardiac tissue engineering material.

Current status and quality analysis of interventional therapy for patients with atrial fibrillation in China / 中华心血管病杂志

Objective: To define the current status and analyze the medical quality of interventional therapy for patients with atrial fibrillation (AF) in China. Methods: This survey was performed in all seven large regions of China, one to three regional major medical centers were selected from each region. Medical records of patients underwent interventional therapy for AF in the year 2017 were randomly inspected. CHA2DS2-VASc score, prescribed anticoagulant after ablation, indication of left atrial appendage occlusion (LAAO), and complications in the medical records were analyzed. Results: A total of 10 800 AF catheter ablations and 447 LAAOs were performed in 17 regional medical centers in 2017. There were 10/17 centers performing AF catheter ablation<500 cases and 7/17 centers performing LAAO<20 cases. A total of 1 347 cases of catheter ablation and 160 cases of LAAO were selected for further analysis. Among all selected cases, 15.8% (238/1 505) non-valvar AF cases recorded CHA2DS2-VASc scores. The anticoagulation rate after AF catheter ablation was 98.6% (1 328/1 347), anticoagulation rate was higher than 90% in 16 out of 17 centers. The complication and severe complication rates of AF catheter ablation were 0.9% (12/1 347) and 0.4% (5/1 347), respectively. The differences of complication and severe complication rates in AF catheter ablation were similar between centers performing<500 cases and centers performing ≥500 cases (0.5% (2/413) vs. 1.1% (10/934), P>0.05; 0.5% (2/413) vs. 0.3% (3/934), P>0.05). The coincidence rate of LAAO indication was 81.3% (130/160), and the rate was higher in center performing ≥20 cases than in centers performing<20 cases (84.8% (106/125) vs. 68.6% (24/35), P<0.05). The complication and severe complication rates of LAAO were 3.1% (5/160) and 1.9% (3/160). The rate of complications in LAAO was higher in center performing<20 cases than in centers performing ≥20 cases (8.6% (3/35) vs. 1.6% (2/125), P<0.05), and there was no significant difference in severe complication rate (5.7% (2/35) vs. 0.8% (1/125), P>0.05). Conclusions: Interventional therapy for AF in China is generally standardized and safe. The overall incidence of complications post AF interventional ablation is low, the anticoagulation rate after AF catheter ablation is high, and the adherence rate of LAAO indication is fair. The indicators mentioned above vary widely among centers.

Autophagy Regulates the Sensitivity of Acute Lymphoblastic Leukemia Cells to Ferroptosis Activator by Influencing Iron Homeostasis / 中国实验血液学杂志

OBJECTIVE@#To investigate the effect of autophagy to the ferroptosis in acute lymphocytic leukemia (ALL) cells and its mechanism.@*METHODS@#ALL cell lines (including Reh, Jurkat and CCRF-CEM) were selected. The cell viability was detected by MTS assay and trypan blue staining was used to evaluate the death of the cell. The expression of autophagy related protein (including p62, LC3I/II) and Ferritin in ALL cells were detected by Western blot. The alteration of labile iron pool (LIP) in ALL cells was evaluated by flow cytometry.@*RESULTS@#Reh cells showed sensitivity to ferroptosis activator Erastin, while Jurkat and CCRF-CEM cells showed resistant. Autophagy activator rapamycin could promote the sensitivity of Jurkat and CCRF-CEM cells to Erastin, and the ferroptosis of the cells (P<0.001). Autophagy inhibitor chloroquine could reduce the sensitivity of Reh cells to Erastin and resist the ferroptosis of the cells (P<0.001). The expression of Ferritin could be down-regulated after autophagy was activated in Jurkat and CCRF-CEM cells (P<0.05), while the level of LIP was significantly increased (P<0.05). Inhibiting the autophgy in Reh cells could up-regulate the expression of Ferritin (P<0.01),while decrease the level of LIP (P<0.001).@*CONCLUSION@#The iron homeostasis in cells could be regulated by autophagy through affecting Ferritin expression and LIP level. Autophagy can alter sensitivity of ALL cells to ferroptosis activator Erastin, which suggestes that combining autophagy regulator with ferroptosis activator may be a new strategy for the treatment of chemotherapy-resistant ALL.

Informal credit constraints and farmers' health: an empirical study of China / Restrições ao crédito e à saúde de agricultores: um estudo empírico da China

ABSTRACT: Based on survey data of the income distribution and living conditions of urban and rural residents collected by the China Economic Monitoring and Analysis Center in 2014, we investigated the mechanisms related to informal credit constraints on farmer health and then empirically analyzed the impacts of such constraints. Results showed that, in general, informal credit constraints significantly negatively impact farmer health. Compared with farmers whose credit was not informally constrained, the probability of farmers who faced informal credit constraints describing their self-rated health as "very good" fell by 6.64%. After controlling for endogenous problems, this proportion rose to 28.87%. Correspondingly, the probability of describing self-rated health as "very bad" increased by 0.45%. After controlling for endogenous problems, this proportion rose to 0.81%. The robustness test showed that our conclusions are strongly robust. Informal credit constraints significantly positively impacted the number of days of illness in 2013 in the sample of farmers, which means farmers who suffered from informal credit constraints required more sick days than those who did not experience informal credit constraints in 2013. As far as we know, this is the first study on the impact of informal credit constraints on Chinese farmer health.

RESUMO: Com base nos dados da pesquisa sobre a distribuição de renda e as condições de vida dos residentes urbanos e rurais coletados pelo Centro de Análise e Monitoramento Econômico da China em 2014, investigamos os mecanismos relacionados às restrições informais de crédito à saúde dos agricultores e, em seguida, analisamos empiricamente os impactos dessas restrições. Os resultados mostram que, em geral, as restrições informais de crédito afetam significativamente a saúde dos agricultores. Em comparação com os agricultores cujo crédito não foi informalmente restrito, a probabilidade de agricultores que enfrentaram restrições informais de crédito que descrevem sua auto-avaliação de saúde como "muito boa" caiu 6,64%. Após o controle de problemas endógenos, essa proporção subiu para 28,87%. Da mesma forma, a probabilidade de descrever a auto-avaliação de saúde como "muito ruim" aumentou 0,45%. Após o controle de problemas endógenos, essa proporção subiu para 0,81%. O teste de robustez mostrou que nossas conclusões são fortemente robustas. As restrições informais de crédito impactaram significativamente o número de dias de doença em 2013 na amostra de agricultores, o que significa que os agricultores que sofreram restrições informais de crédito permaneceram mais dias doentes do que aqueles que não tiveram restrições informais de crédito em 2013. Tanto quanto sabemos, este é o primeiro estudo sobre o impacto das restrições informais ao crédito na saúde dos agricultores chineses.

Channel-assisted fixation and interbody fusion in treating recurrent lumbar disc herniation by muscle-splitting approach / 中国骨伤

OBJECTIVE@#To explore the clinical value and safety of unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion by muscle-splitting approach treatment of recurrent lumbar disc herniation.@*METHODS@#The clinical data of 51 patients with recurrent lumbar disc herniation treated from June 2012 to December 2017 were retrospectively analyzed. There were 32 males and 19 females, aged 34 to 64 years with an average of (51.11± 7.28) years. Lesions invoved L@*RESULTS@#There was no statistical difference in operation time between two groups (@*CONCLUSION@#Muscle-splitting approach is feasible for thetreatment of recurrent lumbar disc herniation with pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion. Compared with the median incision approach, the muscle-splitting approach has the advantages of small incision, less trauma, less bleeding, rapid recovery. Also it can protect multifidus and do not increase the incidence of serious complications. Thus, it can be used as a choice for fixation and fusion of recurrent lumbar disc herniation.

Basic fibroblast growth factors protect chondrocytes by antagonizing extracellular inflammatory factors / 中国组织工程研究

BACKGROUND: Nowadays, there are many studies addressing basic fibroblast growth factor (bFGF) that promotes chondrocyte differentiation and inflammatory factors that damage chondrocyte structure, such as interleukin-1, but there are no reports on the combined effect of the two factors on chondrocytes. OBJECTIVE: To observe the effect of bFGF and inflammatory cytokines on growth characteristics and differentiation potential of chondrocytes. METHODS: Passage 3 chondrocytes from Sprague-Dawley rats cultured in vitro were divided into four groups: a blank control group in which chondrocytes were cultured alone, a negative control group in which chondrocytes were cultured with serum-free DMEM/F12 containing tumor necrosis factor-α, interleukin-1 and interleukin-6, a positive control group in which chondrocytes were cultured with serum-free DMEM/F12 containing bFGF, and an experimental group in which chondrocytes were cultured with serum-free DMEM/F12 containing bFGF, tumor necrosis factor-α, interleukin-1 and interleukin-6. At 3, 5, and 7 days after culture, the proliferative activity of chondrocytes was detected by cell counting kit-8 method; the levels of inflammatory cytokines were determined by ELISA method; and mRNA expression of collagen type II and proteoglycan in chondrocytes was measured by real-time PCR. Protein levels of collagen type II and proteoglycan were assessed by immunofluorescence assay at 7 days after culture. RESULTS AND CONCLUSION: At 3, 5, 7 days after culture, the proliferation of chondrocytes ranked as follows: positive control group > experimental group > blank control group > negative control group. Compared with the blank control group, the expressions of interleukin-1, interleukin-6 and tumor necrosis factor-α were significantly increased in the negative control group. However, compared with the negative control group, the expressions of the above three inflammatory cytokines in the experimental group showed a significant decline (P < 0.05). There was positive expression of collagen type II and proteoglycan in the blank control, positive control and experimental groups, especially in the negative control group. Compared with the blank control group, the expressions of collagen type II and proteoglycan were up-regulated significantly in the positive control and experimental groups. To conclude, the rationale use of bFGF can maintain the phenotype of chondrocytes, inhibit dedifferentiation and promote cell proliferation.

Livelihood capitals on income inequality among rural households: evidence from China / Efeito das capitais de subsistência na desigualdade de renda entre as famílias rurais: evidências da China

ABSTRACT: We used the data of the China Labor-force Dynamics Survey 2014 to examine the effects of livelihood capitals which include natural, material, human, financial, and social capitals on total household income, per capita income, agricultural income, wage income, operational income, and property income inequality among rural households in China. Results showed that different kinds of livelihood capitals have different effects on different types of rural households' income. Specifically; (1) although, the area of cultivated land reduces agricultural income inequality, it increases per capita income inequality. (2) Forest land area enlarges per capita income inequality and total household income inequality. (3) Tractor variable reduces inequality in agricultural income and total household income. (4) While reducing the property income inequality, education variable enlarges the wage income inequality, the per capita income inequality and the total household income inequality. (5) Book variable reduces property income inequality. (6) Loan variable increases inequality in agricultural incomes. (7) Party variable reduces the agricultural income inequality. (8) Although, the internet variable increases agricultural income inequality, and property income inequality, it reduces wage income inequality, operational income inequality, per capita income, and total household income inequality.

RESUMO: Utilizamos os dados da Pesquisa de Dinâmica da Força de Trabalho da China de 2014 para examinar os efeitos dos capitais de subsistência, que incluem capitais natural, material, humano, financeiro e social sobre a renda total da família, renda per capita, renda agrícola, renda salarial, renda operacional e desigualdade de renda da propriedade entre as famílias rurais da China. Os resultados mostraram que diferentes tipos de capitais de subsistência têm efeitos diferentes sobre os diferentes tipos de renda das famílias rurais. Especificamente, (1) embora a área de terra cultivada reduza a desigualdade de renda agrícola, aumenta a desigualdade de renda per capita. (2) A área florestal aumenta a desigualdade de renda per capita e a desigualdade total de renda familiar. (3) A variável trator reduz a desigualdade na renda agrícola e na renda familiar total. (4) Embora reduza a desigualdade de renda da propriedade, a variável educação aumenta a desigualdade de renda salarial, a desigualdade de renda per capita e a desigualdade total de renda familiar. (5) A variável contábil reduz a desigualdade de renda da propriedade. (6) A variável empréstimo aumenta a desigualdade na renda agrícola. (7) A variável partidária reduz a desigualdade de renda agrícola. (8) Embora a variável internet aumente a desigualdade de renda agrícola e a desigualdade de renda da propriedade, reduz a desigualdade de renda salarial, a desigualdade de renda operacional, a renda per capita e a desigualdade total de renda familiar.

Microrna-27a knockdown inhibits proliferation and metastasis in renal cell carcinoma through wnt/p-catenin signaling pathway / 中国药理学通报

Aim To explore the role of miR-27a on the proliferation and metastasis of renal cell carcinoma (RCC) and its mechanism. Methods The expression of miR-27a in RCC cancer tissues, para-carcinoma tissues, RCC cells (Caki-1, 786-0 and ACHN) and normal renal tubular epithelial cells ( HK2) were detected by RT-qPCR. After miR-27a-inhibitor transfect-ed into 786-0 and ACHN cells, cell proliferation was measured by CCK-8 assay; cell colony formation was detected by colony formation assay; cell migration and invasion were detected by cell wound healing assay and Transwell assay, respectively; the pretein expression of P-catenin was detected by Western blot. After trans-fected miR-27a inhibitor into ACHN cells then treated with LiCl (Wnt/p-catenin signal agonist), cell proliferation , migration and invasion were detected. Results The expression of miR-27a in RCC cancer tissues was significantly higher than that in para-carcinoma tissues, and increased with stage progression. Compared with HK-2 cells, the expression levels of miR-27a in RCC cells were elevated. After transfection with miR-27a inhibitor, the cell colony formation, cell prolifera-tion, invasion and migration ability of 786-0 and ACHN cells were significantly reduced. MiR-27a in-i hibitor reduced the expression of p-catenin in ACHN cells. LiCl promoted the proliferation, invasion and migration ability of ACHN cells transfected with miR-27a inhibitor. Conclusions MiR-27a is highly expressed in RCC cancer tissues and RCC cells, and knockdown of miR-27a inhibits proliferation and metastasis in RCC cells through Wnt/p-catenin signaling pathway.