Analysis of clinical features of 153 patients with novel coronavirus pneumonia in Chongqing / 中华临床感染病杂志

Objective@#To analyze the clinical data of 153 patients with novel coronavirus pneumonia (COVID-19) in chongqing ,and provide reference and thinking for the diagnosis and treatment.@*Methods@#Analyze the clinical data, laboratory examination and chest imaging characteristics of 153 COVID-19 patients in Chongqing Public Health Medical Center from January 26 to February 5, 2020. According to the relevant diagnostic criteria ,patients were divided into non-severe group(n=132) and severe group(n=21),and analyze the correlation between serum index changes and disease severity.@*Results@#Combined with diabetes and chronic respiratory diseases, the severity of the disease was statistically significant (χ2=11.04和6.94, P<0.05). No symptoms were found in patients with mild illness (χ2=4.09, P<0.05) .The proportion of fever and muscle soreness in the severe group was higher than that in the non-severe group (χ2=4.40 and 22.67,P<0.05).Among the concomitant symptoms, the proportion of cough and shortness of breath in the severe group was higher than that in the non-severe group (χ2=8.46 and 4.80,P<0.05).C-reactive protein and d-dimer were higher in the severe group than in the non-severe group (t=43.44 and 37.13, P<0.05), and the number of CD3+T lymphocyte cells, CD4+T lymphocyte cells and CD8+T lymphocyte cells in the severe group was lower than that in the non-severe group (Z=27.25, 20.60 and 17.36, P<0.05).Compared with the non-severe group, both lungs and the right lung lower lobe were more susceptible to involved (χ2=6.95和20.39, P<0.05) .@*Conclusion@#Severity of COVID-19 was associated with underlying disease, symptoms, site of involvement, C-reactive protein, d-dimer, CD3+T lymphocyte count, CD4+T lymphocyte count, and CD8+T lymphocyte count. 

Clinical features of 153 patients with COVID-19 in Chongqing municipality / 中华临床感染病杂志

Objective:To analyze the clinical features of patients with COVID-19 in Chongqing Municipality.Methods:The clinical data, laboratory tests and chest imaging findings of 153 patients COVID-19 admitted in Chongqing Public Health Medical Center from January 26 to February 5, 2020 were retrospectively reviewed. According to the relevant diagnostic criteria, patients were divided into non-severe group (n=132) and severe group (n=21). The correlation between serum index changes and disease severity was analyzed.Results:The proportion of patients with underlying diabetes or chronic respiratory diseases in severe group was significantly higher than that in non-severe group ( χ2=11.04 and 6.94, P<0.05). The proportion of symptom-free patients in non-severe group was significantly higher than that in severe group ( χ2=4.09, P<0.05). The symptoms of fever, fatigue and muscle soreness in the severe group were more common than those in the non-severe group ( χ2=4.40, 14.42 and 22.67, P<0.05). Among the concomitant symptoms, the proportion of cough and shortness of breath in the severe group was higher than that in the non-severe group ( χ2=8.46 and 4.80, P<0.05). C-reactive protein and D-Dimer levels were higher in the severe group than those in the non-severe group ( Z=-4.39 and -1.96, P<0.05), and the number of CD3 + T lymphocyte cells, CD4 + T lymphocyte cells and CD8 + T lymphocyte cells in the severe group was lower than that in the non-severe group ( Z=27.25, 20.60 and 17.36, P<0.05). Compared with the non-severe group, both lungs and the right lung lower lobe were more susceptible to be involved( χ2=9.71和23.61, P<0.05). Conclusions:There are significant differences in underlying diseases, clinical symptoms, imaging manifestations and laboratory findings between severe and non-severe patients with COVID-19.

Clinical application of wire-guided percutaneous transhepatic biliary drainage / 中华消化内镜杂志

Objective To evaluate the feasibility and safety of guidewire guidance method in percutaneous transhepatic biliary drainage (PTBD). Methods A total of 174 consecutive patients with biliary diseases who underwent PTBD in Heilongjiang Provincial Hospital from January 2011 to December 2017 were enrolled in this retrospective study. There were 85 patients undergoing conventional PTBD ( the conventional group), and 89 wire-guided PTBD (the wire-guided group). In the wire-guided group, the contrast media was not injected immediately after puncture, on the contrary, the needle coat was inserted deeply along the bile duct thereafter, then the bile was extracted to reduce the pressure of bile duct, at last the contrast media was infused. The drainage success rate and incidence of cholangitis related with PTBD were compared between the two groups. Results The incidence of PTBD-related cholangitis of the wire-guided group was significantly lower compared with the conventional group [ 10. 1％ ( 9/89 ) VS 21. 2％( 18/85) ,χ2=5. 270, P=0. 022] , although the drainage success rate was not significantly different between the two groups [ 94. 4％ ( 84/89) VS 97. 6％ ( 83/85) ,χ2=1. 200, P=0. 273] . Conclusion Wire-guided PTBD may yield a similar success rate, but can reduce the incidence of cholangitis compared with conventional PTBD.

Acetabular liner wear of cross-linked versus conventional polyethylene for total hip arthroplasty:a meta-analysis / 中国组织工程研究

BACKGROUND: Aseptic loosening occurs after long-term total hip replacement, which directly affects the service life and prospective efficacy of artificial joints. The particles produced by artificial joint wear lead to the surrounding bone dissolved, further cause loosening, among which, polyethylene particles because of acetabular liner wear stand out. OBJECTIVE: To systematically assess the acetabular liner wear, loosening and osteolysis caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty. METHODS: A computer-based research of Medline, EMbase, CBM, CNKI, CqVip, WanFang databases before December 2015 and Cochrane (3rd issue, 2011) was performed in accordance with the retrieval strategy made by Cochrane collaboration. A manual retrieval of related bone journals and conference papers was conducted. Eleven randomized controlled trials about the wear caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty were enrolled based on inclusion criteria, followed by a Meta-analysis using RevMan 5.0 software. RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 952 patients were included. (2) Meta-analysis showed that the acetabular liner wear rate of cross-linked polyethylene was significantly lower than that of conventional polyethylene at 5 years postoperatively [MD=-0.07, CI(-0.09, -0.05), I2=93%, P < 0.00001]; the large heterogeneity was decreased [MD=-0.06, 95%CI (-0.07, -0.04), I2=39%, P < 0.00001] after three research removed through sensitivity analysis. (3) The osteolysis rate in the cross-linked polyethylene group was significantly lower than that in the conventional polyethylene group [RR=0.39, 95%CI (0.27, 0.57), I2=0%, P < 0.00001]. (4) These results suggest that the cross-linked polyethylene liners exhibit reduced radiological wear and osteolysis, but the mean follow-up of 5 years (1.8 to 8.0) cannot meet the long-term requirements. Therefore, multi-central, large sample size and high-quality randomized controlled trials are needed to testify the efficacy and safety of cross-linked polyethylene.BACKGROUND: Aseptic loosening occurs after long-term total hip replacement, which directly affects the service life and prospective efficacy of artificial joints. The particles produced by artificial joint wear lead to the surrounding bone dissolved, further cause loosening, among which, polyethylene particles because of acetabular liner wear stand out. OBJECTIVE: To systematically assess the acetabular liner wear, loosening and osteolysis caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty. METHODS: A computer-based research of Medline, EMbase, CBM, CNKI, CqVip, WanFang databases before December 2015 and Cochrane (3rd issue, 2011) was performed in accordance with the retrieval strategy made by Cochrane collaboration. A manual retrieval of related bone journals and conference papers was conducted. Eleven randomized controlled trials about the wear caused by cross-linked polyethylene or conventional polyethylene after total hip arthroplasty were enrolled based on inclusion criteria, followed by a Meta-analysis using RevMan 5.0 software. RESULTS AND CONCLUSION: (1) Eleven randomized controlled trials involving 952 patients were included. (2) Meta-analysis showed that the acetabular liner wear rate of cross-linked polyethylene was significantly lower than that of conventional polyethylene at 5 years postoperatively [MD=-0.07, CI(-0.09, -0.05), I2=93%, P < 0.00001]; the large heterogeneity was decreased [MD=-0.06, 95%CI (-0.07, -0.04), I2=39%, P < 0.00001] after three research removed through sensitivity analysis. (3) The osteolysis rate in the cross-linked polyethylene group was significantly lower than that in the conventional polyethylene group [RR=0.39, 95%CI (0.27, 0.57), I2=0%, P < 0.00001]. (4) These results suggest that the cross-linked polyethylene liners exhibit reduced radiological wear and osteolysis, but the mean follow-up of 5 years (1.8 to 8.0) cannot meet the long-term requirements. Therefore, multi-central, large sample size and high-quality randomized controlled trials are needed to testify the efficacy and safety of cross-linked polyethylene.

The value of biliary tumor markers for differentiatial diagnosis of benign and malignant biliary diseases / 中华消化内镜杂志

Objective To investigate the value of biliary tumor markers for differential diagnosis of the benign and malignant biliary tract diseases.Methods Tumor markers (CA19-9,CEA and CA242) examination and bacterial culture were performed in a total of 160 patients,who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for biliary diseases.Resuts There were significant differences between malignant group and benign group in bile and serum in the level of CA19-9,CEA and CA242 (P ＜0.05) ; Cut-off value,according to ROC curve,was 239 ku/l in CA19-9,40 ng/ml in CEA and 60 ku/ml in CA242,respectively.There were significant differences between the bile marker and the serum marker in sensitivity,accuracy,negative predicative value of CEA (P ＜ 0.05).No significant differences was found in specificity between the serum group and the bile group.There were significant differences in bile CA19-9 level between cholangiocarcinoma,pancreatic cancer,duodenal papilla carcinoma with carcinoma metastasizing to bile duct,and hepatocellular carcinoma (P ＜ 0.05).Both in benign group and malignant group,there were significant differences in CA19-9 level between infectious bile and noninfectious bile (P ＜ 0.05).Conclusion The level of CA19-9,CEA and CA242 in bile can be applied to differentiate benign and malignant biliary diseases.The bile tumor markers do not have advantage over serum tumor markers in specificity for diagnosis.Bile bacterial infection can result in the elevation of bile CA19-9 while it does not have impact on differential diagnosis.

Application of vitamin D in the treatment of patients with chronic obstructive pulmonary disease / 国际检验医学杂志

Objective To investigate the effect of vitamin D on pulmonary function in patients with chronic obstructive pulmona-ry disease,and to explore its possible mechanism.Methods Patients with chronic obstructive pulmonary disease admitted in the hospital were randomly divided into 2 groups,one group of patients were given regular COPD treatment (control group,30 cases), the other group of patients were given vitamin D on the basis of conventional therapy(experimental group,30 cases).Pulmonary function test and C reaction protein (CRP)determination in the 2 groups were performed,the contents of PaO2 ,PaCO2 were also determined.Results Compared with the control group,lung function improvement in experimental group were more obvious,and the the number of acute attack significantly reduced(P 0.05).Conclusion Vitamin D contributes to the improvement of pulmonary function in patients with COPD,and its mecha-nism might relate to the reduction of inflammatory reaction.

Long-term effect of surgical treatment in male infertility patients with varicocele / 中国综合临床

Objective To observe the long-term effect of surgical treatment in infertile varicocele patients. Methods 180 infertile patients with varicocele accepted modified Palomo operation (retroperitoneal high ligation of internal spermatic cord vein) from 2004 to 2007, and the long-term effect of thesurgery were analyzed retrospectively, such as semen parameters and spouse pregnancy. Results The operations were performed successfully in 180 cases, and semen parameters improved significantly after the surgery (Ps ＜ 0. 05 ).Among all patients, 10 cases had spouse pregnancy within 3 months after operation;47 cases had spouse pregnancy from 3 to 6 months after operation; 25 cases had spouse pregnancy from 6 to 12 months after operation;13 cases had spouse pregnancy from 12 to 24 months after operation. The fertility rate was 52. 8% (95/180) in total. Conclusion Surgical treatment of infertile male patients with varicocele has good long-term effects, made it the first choice in these patients.

Integrated intervention in management of type 2 diabetes / 中华内分泌代谢杂志

Objective To test the effectiveness of an integrated intervention to improve control and management of type 2 diabetic patients.Methods The study was designed as a randomized and multi-center clinic trial for 24 weeks.150 overweight patients from 2 companies and one hospital in Shanghai were recruited.The principal objective of the project was to compare the effectiveness of a structured diabetes management program consisting of 200 kcal breakfast as a meal replacement with low glycemic index (GI),scheduled blood glucose monitoring(6 times per week),low GI diet consulting,monitoring and medical check up and nutritional education (diet consulting,health education on nutrition and healthy lifestyle) in overweight individuals with type 2 diabetes.Results At 12th week,the level of fasting blood glucose(FBG) in both groups decreased by 16.5% and 10.6%,and at 24th week,the FBG also decreased by 25.0% in intervention group,but in control group FGB increased 2.8% (P＜0.01).Meanwhile,there were 8.2% and 11.1% reductions in HbA1C respectively at 12th week and at 24th week in intervention group,while the values were increased slightly in control group(P＜0.01).Compared with control group,waist circumference,hip circumference,and blood pressure were significantly reduced after treatment for 24 weeks in intervention group (P＜0.01).Conclusions Integrated intervention is an effective approach in managing FBG,HbA1C blood pressure,and weight control in overweight diabetic patients.

Survey on the Procreation and Procreative Health of Childbearing Disabled Women in Guangdong Province / 中国康复理论与实践

@#Objective To investigate the methods how to improve condition of procreative health of childbearing disabled women for planned parenthood and good procreation and good education.Methods The method of whole flock sampling of many stages and many layers were taken and the questionnaire and group interview were performed to collect the data of quantity and analyze the affect factors of disabled women about their marriage,procreation,procreative health,and knowledge about procreative health.Results There were 4 380 cases of validity questionnaire.62.33% of them married.In 3 005 procreated women,45.49% had one baby,45.49% had two babies and 8.95% had three babies or more.46.54% of them denied that they had infection of reproductive system.63.19% of them had been examined in department of gynecology.63.17% of them took birth control measure.29.70% of them were lost in taking birth control measure.50.24% of them could say three methods of birth control.37.39% of them could say three ways about AIDS infection.Conclusion Childbearing disabled women have some troubles in birth control,procreative health,and their knowledge about procreative health.

Ultrastructure of human epididymal spermatozoa after vasectomy / 中华泌尿外科杂志

Objective To investigate the epididymal sperm ultrastructure after vasectomy. Methods During the operation of vasovasostomy (38 cases, test group) and vasectomy (13 cases,control group,group A) the proximal vas deferens fluids were collected.The epididymal sperm morphology in the proximal vas deferens fluids was observed using optical and electronic microscopes.Data were analyzed by SPSS program. Results The data from group A showed that there was no significant difference between left and right side in the percentage of normal sperm morphology.The results from both optical and electronic microscopes showed that there was a significant difference in the percentage of normal sperm morphology (a),abnormal sperm head (b),sperm with neck defect (c) and sperm with tail defect (d) between group A and group B(5 years after vasectomy). (electronic microscopes:(a):(40.28?11.53)% vs (16.80?7.93)%,(6.29? 4.57 )%,( 4.63? 5.06 )%; (b):(35.00?14.18)% vs (59.05?14.44)%,(63.43?15.23)%,(82.05? 16.71 )%;(c):(20.83? 6.40 )% vs (13.60?6.78)%,( 14.71? 6.82)%,(9.00?7.18)%;(d):(3.89?4.44)% vs (10.55?11.73)%,(15.57?9.81)%,(4.32?7.65)%. optical microscopes:(a):(49.12?20.55)% vs (19.95?15.42)%,(10.00?9.50)%,(5.84?9.63)%; (b):(35.00?14.55)% vs (22.55?16.24)%,(14.71?15.78)%,(10.68?18.65)%; (d):(15.80?9.55)% vs (57.50?24.74)%,(75.29?23.90)%,(78.21?30.33)%.There existed multi-cell organ and multi-form abnormalities in the inner structures of sperm heads,necks and tails. Conclusions The epididymal sperm defect (including head, neck and tail) after vasectomy was demonstrated in the inner cell organs.The longer after vasectomy, the higher percentage of sperm with abnormality was found.

Comparison of sperm motion parameters in pre-freeze and post-thaw semen samples using computer-assisted sperm analysis / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe sperm motion parameters in pre-freeze and post-thaw semen samples using computer-assisted sperm analysis (CASA) system.</p><p><b>METHODS</b>Semen analyses of 238 samples before freezing and after thawing were separately performed by Hamilton-Thorne Sperm Analyzer.</p><p><b>RESULTS</b>Sperm motility in post-thaw samples was significantly decreased. There was significant correlation and difference between pre-freeze and post-thaw samples in sperm motion parameters, including average path velocity (VAP), straight line velocity (VSL), curvilinear velocity (VCL), amplitude of lateral head displacement (ALH), straightness (STR) and linearity (LIN), except heat cross frequency (BCF). The percentage of sperm movement velocity parameters (VAP, VSL and VCL) and moving pattern parameters (ALH) significantly decreased, while that of LIN and STR significantly increased in post-thaw samples.</p><p><b>CONCLUSION</b>CASA system is of clinically applied value and is a useful tool for evaluating sperm motion parameters in pre-freeze and post-thaw semen samples.</p>

Quality analysis of the primary semen samples from 512 donors / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the semen quality of the donors.</p><p><b>METHODS</b>The semen parameters of the primary samples of 512 donors were examined following the World Health Organization (WHO) guide and computer-aided sperm analysis (CASA, product by Harmilton Thorne) system.</p><p><b>RESULTS</b>Of the 246 (246/512, 48%) donors with potential fertility, only 146 (146/512, 28.5%) came up to the semen standard set by the Chinese Ministry of Health, while 266 (266/512, 52%) were below the WHO reference values of semen parameters.</p><p><b>CONCLUSION</b>Repeat semen analyses may increase the success rate in screening semen donors. The semen quality of the donors suggests that it is necessary to pay more attention to male reproductive health.</p>

Pedicle screw fixation in treatment of acute Hangmans fracture and spinal cord injury / 中华创伤骨科杂志

Objective To evaluate the clinical outcomes of pedicle screw fixation in the treatment of Hangmans fracture. Methods The 15 patients who had been treated for acute Hangmans fracture in our department after 1999 were retrospectively analyzed. 4 of them were type I, and 11 type II. All the patients presented symptoms of nerve system at different degrees. They were treated with AO pure titanium cortex screw through isthmus after skull traction replacement. Results All the patients were followed up for 12 to 60 months. According to Frankle classification, 6 cases of Grade D and 5 cases of Grade C recovered up to Grade E, 2 cases of Grade C recovered to Grade D, 1 case of Grade B recovered to Grade C and 1 case of Grade B recovered to Grade D. X ray showed all the fractures healed up without vertebra artery injury or other complications. Conclusion The outcomes of pedicle screw fixation and reduction in treatment of acute Hangmans fracture are satisfactory, for the clinic technique promotes functional recovery of spinal cord, decreases the rate of infection and scarcely affects the function of upper cervical spine.

Clinical Observation on Acupuncture Treatment of Post-windstroke Pseudobulbar Palsy / 针灸推拿医学（英文版）

In this research, X-ray photograph and kinescope were applied to observe the whole process of barium swallowing statically and dynamically before and after acupuncture treatment by the radiography of the upper alimentary tract (RART). The observation was made on the objective changes about the functional renovation of contractor muscle of pharynx and epiglottis muscle. Among 36 cases, function of speaking basically recovered in 3 cases, function of swallowing 16 cases,function of expectorating sputum 15 c ases, and for function of water drinking 13 cases. The total effective rate: 75.0% for function of speaking, 97.2% for function of swallowing, 75.0% for function of expectorating sputum, 97.2% for function of water drinking.

Changes in myocardial mitochondrial Ca2＋ concentration and its mechanism in the early stage of severe burn / 中国病理生理杂志

AIM：To investigate the change in myocardial mitochondrial Ca2＋ concentration (［Ca2+］m) and its mechanism in the early stage of severe burn. METHODS：An experimental model of 30%TBSA full-thickness skin scalding was reproduced in rats. ［Ca2+］m, cytosolic Ca2＋ concentration (［Ca2＋］c) and mitochondrial Ca2＋ transport velocity were determined. RESULTS: ① ［Ca2+］m increased evidently at 1st hour postburn, and continuously at 3rd hour, reached the peak at 6th hour postburn, then, it decreased at 12th and 24th hour, but remained in higher level than that of the control. ② There was no significant difference in ［Ca2＋］c between 1st hour postburn and the control, but ［Ca2＋］c increased evidently at 3rd, 6th, 12th, 24th hour postburn. ③ mitochondrial Ca2＋ uptake velocity at 1st hour postburn was higher than that of control, and Ca2＋ release velocity didn't change obviously, but both of them were decreased at 3rd, 6th, 12th, 24th hour postburn. ④ ［Ca2+］m was positive correlated with ［Ca2＋］c after burn, and negative correlated with mitochondrial Ca2＋ release velocity at 3rd, 6th, 12th, 24th hour postburn, respectively. CONCLUSION: There was obvious Ca2＋ overload in myocardial mitochondria after severe burn, the mechanism of which might include ascent of ［Ca2＋］c and disorder of Ca2＋ transport in mitochondria.

Involvement of mtNOS in the Ca~(2+)-induced damages of myocardial mitochondria during the early stage after severe burns / 中国病理生理杂志

AIM: To study the role of mitochondrial nitric oxide synthase (mtNOS) in the damages of myocardial mitochondria during the early stage after severe burns.METHODS: An experimental model of 30% TBSA full-thickness skin scalding was reproduced in rats. Myocardial mitochondria were isolated from control and burned rats at 1, 3, 6, 12 and 24 h postburn. The mitochondrial respiratory function, content of mitochondrial calcium([Ca 2+ ] m) and activities of mtNOS and cytochrome c oxidase were determined. RESULTS: (1) Myocardial mitochondrial respiratory control rate(RCR) at 1 h was evidently higher than that of control, but at 3, 6, 12 and 24 h postburn, it was significantly lower than that of the control. The changes in ST 3 is parallel to those of RCR, and ST 4 was evidently increased only at 3 h postburn. (2) [Ca 2+ ] m was higher at all time points postburn and the activity of mtNOS was higher significantly only at 3, 6, 12 and 24 h than that of the control. The activity of cytochrome c oxidase at the 3, 6, 12 and 24 h was low comparing to the control. (3) After severe burns, RCR was negatively correlated with mtNOS activity( r=0.9347, P

Investigation of low glycemic index diet on blood glucose,lipid profile and body weight control in patients with type 2 diabetes / 中华内分泌代谢杂志

A randomized crossover study was performed to compare the effects of low glycemic index diets (LGI)and high glycemic index diets(HGI)on blood glucose,lipid profile and control of body weight in patients with type 2 diabetes.Compared with HGI group,the fasting serum insulin,Homa-IR,LDL-C and body weight significantly decreased in LGI group(P

Changes in myocardial mitochondrial Ca~( 2+) concentration and its mechanism in the early stage of severe burn / 中国病理生理杂志

AIM:To investigate the change in myocardial mitochondrial Ca 2+ concentration ([Ca 2+ ] m) and its mechanism in the early stage of severe burn. METHODS:An experimental model of 30%TBSA full-thickness skin scalding was reproduced in rats. [Ca 2+ ] m, cytosolic Ca 2+ concentration ([Ca 2+ ] c) and mitochondrial Ca 2+ transport velocity were determined. RESULTS: ① [Ca 2+ ] m increased evidently at 1st hour postburn, and continuously at 3rd hour, reached the peak at 6th hour postburn, then, it decreased at 12th and 24th hour, but remained in higher level than that of the control. ② There was no significant difference in [Ca 2+ ] c between 1st hour postburn and the control, but [Ca 2+ ] c increased evidently at 3rd, 6th, 12th, 24th hour postburn. ③ mitochondrial Ca 2+ uptake velocity at 1st hour postburn was higher than that of control, and Ca 2+ release velocity didn't change obviously, but both of them were decreased at 3rd, 6th, 12th, 24th hour postburn. ④ [Ca 2+ ] m was positive correlated with [Ca 2+ ] c after burn, and negative correlated with mitochondrial Ca 2+ release velocity at 3rd, 6th, 12th, 24th hour postburn, respectively. CONCLUSION: There was obvious Ca 2+ overload in myocardial mitochondria after severe burn, the mechanism of which might include ascent of [Ca 2+ ] c and disorder of Ca 2+ transport in mitochondria. [