[Effect of nasal microbial diversity on postoperative prognosis of patients with chronic sinusitis and nasal polyp].

Objective: To investigate the nasal microbial diversity in patients with chronic sinusitis with nasal polyps (CRSwNP), as well as the nasal microbiome characteristics, inflammatory cells and factors in postoperative relapses, in order to understand the effects of microbiome factors on the postoperative prognosis of CRSwNP. Methods: The nasal secretions and nasal polyp tissues from 77 patients with CRSwNP were collected in Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University from December 2017 to December 2018. The cohort consisted of 34 males and 43 females, aged from 29 to 76 years. Microbial DNA was extracted from cotton swabs for high-throughput sequencing based on 16SrRNA to detect bacterial community composition, and Luminex was used to analyze cytokines such as IL-5, IL-8, IL-17a, IL-17e, IL-18, IL-27, and IFN-γ in polyp tissue. Eosinophils and neutrophils in peripheral blood and polyp tissue were counted. Patients with CRSwNP were followed up for 1 year after surgery, and the recurrence of nasal polyps was recorded. The correlation between the recurrence of nasal polyps and inflammatory cytokines, inflammatory cell counts and nasal microbial diversity was analyzed. Chi-square test was used for bicategorical variables, Mann-Whitney U test was used for continuous variables, and Wilcoxon rank sum test was used to compare the difference in average relative abundance between the two groups. Results: At the one year follow-up, 12 patients experienced a recurrence, including 5 males and 7 females. There was no significant difference in age, sex, asthma, allergic rhinitis and eczema between the relapsing group and the non-relapsing group. The total nasal symptoms score (TNSS) in the recurrent group [42.3 (30.2, 67.1), M (Q1, Q3)] was significantly higher than that in the non-recurrent group [37.8 (29.4, 50.3)]. In nasal polyp tissue, the number of eosinophils [40.83 (22.33, 102.00)/HP] and neutrophils [30.83 (20.33, 56.44)/HP] in the recurrent group were significantly higher than those in the non-recurrent group [13.72 (13.50, 48.33)/HP] and [18.50 (12.00, 26.08)/HP], Z-values were -6.997 and -8.243, respectively, all P<0.001. The expression levels of IFN-γ, IL-17A, IL-17E and IL-18 in relapsed group were significantly higher than those in non-relapsed group, but there was no significant difference in positive rates. At the generic level, the mean relative abundance of Corynebacterium in the nasal passage of CRSwNP patients in the non-relapses group was (11.90±20.31)%, higher than that in the relapses group (0.15±0.20)%, but the difference was not statistically significant after correction (FDR P=0.638). The mean relative abundance of staphylococcus in the non-relapsed group was (8.17±27.70)%, significantly lower than that in the relapsed group (8.99±15.89)%, but the difference was not statistically significant (FDR P=0.638). Conclusions: Neutrophil-mediated inflammatory responses are associated with recurrent nasal polyps. The recurrence of nasal polyps after endoscopic surgery may be related to the decrease in the abundance of protective microorganisms and the increase in the number of pathogenic microorganisms.

[Analysis of clinical characteristics of persistent HBeAg positivity in patients with chronic hepatitis B treated with nucleos(t)ide analogues].

Objective: To explore the clinical characteristics of persistent HBeAg positivity in patients with chronic hepatitis B treated with nucleos(t)ide analogues. Methods: A retrospective analysis was performed according to different data types. An independent sample t-test, Mann-Whitney U test, chi-square test, or Fisher's exact probability method were used. Chronic hepatitis B patients followed up for four years were collected from the follow-up case database of the Department of Infectious Diseases of Zhongshan Third Hospital from January 2009 to December 2018 and were divided into two groups, A and B, with 87 and 145 cases respectively, according to the duration of HBeAg-negativity≤ 3 and persistent positivity >3 years. Statistical analysis was conducted on the age, gender, family history, baseline, follow-up visit duration, liver function, and other data among the two patient groups. Results: There were no statistically significant differences in gender, age, family history of liver cirrhosis, family history of liver cancer, liver cirrhosis condition before treatment, fatty liver disease combined condition before treatment, baseline HBsAg, anti-HBc, alanine aminotransferase, albumin, or total bilirubin between the two groups of patients (P > 0.05). HBV DNA and HBeAg were significantly higher in group B than those in group A at baseline, with P≤0.001. Aspartate aminotransferase and γ-glutamyl transferase were significantly higher in group A than those in group B at baseline. The proportion of family history of hepatitis B was significantly higher in group B (69.0%) than that in group A (50.6%) among the two groups of patients, and the difference was statistically significant (P = 0.005). The proportion of mothers with hepatitis B was significantly higher in group B (25.5%) than in group A (11.5%), P = 0.010. During the treatment process, the HBV DNA quantification was significantly higher in group B than that in group A at 0.5 and 1 years (P≤0.002). The proportion of HBV DNA <100IU/ml was also significantly different at six months and one year (χ(2)=30.327, P < 0.001 and χ(2)=11.779, P = 0.001). The HBsAg level was higher in group B than that of group A in the second and fourth years, P < 0.05. During the entire treatment process, the HBeAg level was significantly higher in group B than that in group A (P < 0.001). A total of seven cases developed liver cirrhosis or cancer during follow-up, including three cases in group A and four cases in group B (P > 0.05). Conclusion: HBeAg-positive patients with chronic hepatitis B have persistent HBeAg positivity when treated with long-term nucleos(t)ide analogues. Accordingly, a greater proportion of this kind of patient family and mothers have a remarkable history of hepatitis B and a reduced HBV DNA relapse rate in the early stages (within a year or less).

[Analysis of the types and functions of CD34+ cells in full-thickness skin defect wounds of normal mice and diabetic mice by single-cell RNA sequencing].

Objective: To analyze the types and functions of CD34+ cells in full-thickness skin defect wounds of normal mice and diabetic mice by single-cell RNA sequencing. Methods: This study was an experimental study. The CD34+ cell lineage tracing mouse was produced, and the visualization of CD34+ cells under the fluorescent condition was realized. Six male CD34+ cell lineage tracing mice aged 7-8 weeks (designated as diabetic group) were intraperitoneally injected with streptozotocin to establish a diabetic model, and full-thickness skin defect wounds were prepared on their backs when they reached 13 weeks old. Another 6 male CD34+ cell lineage tracing mice aged 13 weeks (designated as control group) were also subjected to full-thickness skin defect wounds on their backs. On post-injury day (PID) 4, wound tissue was collected from 3 mice in control group and 2 mice in diabetic group, and digested to prepare single-cell suspensions. CD34+ cells were screened using fluorescence-activated cell sorting, followed by single-cell RNA sequencing. The Seurat 4.0.2 program in the R programming language was utilized for dimensionality reduction, visualization, and cell clustering analysis of CD34+ cell types, and to screen and annotate the marker genes for each CD34+ cell subpopulation. Kyoto encyclopedia of genes and genomes (KEGG) and gene ontology (GO) enrichment analysis was performed to analyze the differentially expressed genes (DEGs) of CD34+ fibroblasts (Fbs), smooth muscle cells (SMCs), keratinocytes (KCs), and chondrocyte-like cells (CLCs) in the wound tissue of two groups of mice for exploring cellular functions. Results: On PID 4, CD34+ cells in the wound tissue of both groups of mice were consisted of 7 cell types, specifically endothelial cells, Fbs, KCs, macrophages, T cells, SMCs, and CLCs. Among these, Fbs were further classified into 5 subpopulations. Compared with those in control group, the proportions of CD34+ endothelial cells, Fbs subpopulation 1, Fbs subpopulation 4, KCs, and CLCs in the wound tissue of mice were increased in diabetic group, while the proportions of CD34+ Fbs subpopulation 2, Fbs subpopulation 3, and SMCs were decreased. The marker genes for annotating CD34+ CLCs, endothelial cells, Fbs subpopulation 1, Fbs subpopulation 2, Fbs subpopulation 3, Fbs subpopulation 4, Fbs subpopulation 5, KCs, macrophages, SMCs, and T cells were respectively metastasis-associated lung adenocarcinoma transcript 1, fatty acid binding protein 4, Gremlin 1, complement component 4B, H19 imprinted maternally expressed transcript, Dickkopf Wnt signaling pathway inhibitor 2, fibromodulin, keratin 5, CD74 molecule, regulator of G protein signaling 5, and inducible T-cell co-stimulator molecule. KEGG and GO enrichment analysis revealed that, compared with those in control group, DEGs with significant differential expression (SDE) in CD34+ Fbs from the wound tissue of mice in diabetic group on PID 4 were significantly enriched in terms related to inflammatory response, extracellular matrix (ECM) organization, regulation of cell proliferation, and aging (with Pvalues all <0.05), DEGs with SDE in CD34+ SMCs were significantly enriched in terms related to cell migration, apoptotic process, positive regulation of transcription, and phagosome (with P values all <0.05), DEGs with SDE in CD34+ KCs were significantly enriched in terms related to mitochondrial function, transcription, and neurodegenerative diseases (with P values all <0.05), and DEGs with SDE in CD34+ CLCs were significantly enriched in terms related to rhythm regulation, ECM, and viral infection (with P values all <0.05). Conclusions: CD34+ cells display high heterogeneity in the healing process of full-thickness skin defect wounds in both normal mice and diabetic mice. The significantly enriched functions of DEGs with SDE in CD34+ cell subpopulations in the wound tissue of the two mouse groups are closely related to the wound healing process.

A hybrid piezoelectric and triboelectric nanogenerator with lead-free BZT-BCT/PDMS composite and PVA film for scavenging mechanical energy.

A hybrid piezo/triboelectric nanogenerator (H/P-TENG) is designed for mechanical energy harvesting using polymer ceramic composite films; polydimethylsiloxane/Ba(Zr0.2Ti0.8)O3-0.5(Ba0.7Ca0.3)TiO3 (PDMS/BZT-BCT) and polyvinyl alcohol (PVA). A lead-free BZT-BCT piezoelectric ceramic was prepared via solid-state method and blended into PDMS to form a series of polymer-ceramic composite films, ranging from 5% to 30% by weight. The films were forward/reverse poled with corona poling and their electrical properties were compared to non-poled samples. The H/P-TENG constructed with forward-poled 15 wt% BZT-BCT in PDMS achieved the highest open-circuit voltage, V oc of 127 V, short-circuit current density, J sc of 67 mA m-2, short-circuit charge density, Q sc of 118 µC m-2, and peak power density of 7.5 W m-2, an increase of 190% over pristine PDMS-based TENG. It was discovered that incorporating BZT-BCT into the PDMS matrix improved the triboelectric properties of PDMS. The overlapping electron cloud (OEC) model was used to explain the enhancement and the effect of poling direction of the PDMS/BZT-BCT composite used in H/P-TENG, providing fundamental knowledge of the influence of piezoelectric polarisation on contact electrification.

Newer therapeutic approaches towards the management of diabetes mellitus: an update.

Diabetes mellitus is a chronic metabolic condition characterized by an elevation of blood glucose levels, resulting from defects in insulin secretion, insulin action, or both. The prevalence of the disease has been rapidly rising all over the globe at an alarming rate. Despite advances in the management of diabetes mellitus, it remains a growing epidemic that has become a significant public health burden due to its high healthcare costs and its complications. There is no cure has yet been found for the disease, however, treatment modalities include insulin and antidiabetic agents along with lifestyle modifications are still the mainstay of therapy for diabetes mellitus. The treatment spectrum for the management of diabetes mellitus has rapidly developed in recent years, with new class of therapeutics and expanded indications. This article focused on the emerging therapeutic approaches other than the conventional pharmacological therapies, which include stem cell therapy, gene therapy, siRNA, nanotechnology and theranostics.

A case of Multisystem Inflammatory Syndrome in adults in Malaysia.

Multisystem Inflammatory Syndrome in Adults (MIS-A) is a rare but potentially life-threatening complication following SARS-CoV-2 infection. We present a Malaysian case of MISA in a 45 year old gentleman who developed cardiogenic shock following a mild SARS-CoV-2 infection.

Comparing fixed and auto adjusting continuous positive airway pressure (CPAP) amongst symptomatic Obstructive Sleep Apnoea patients - A randomised controlled trial.

INTRODUCTION: Continuous Positive Airway Pressure (CPAP) is required for obstructive sleep apnoea (OSA). Thisstudy compares the efficacy between Fixed Pressure CPAP (Fixed CPAP) and Auto-adjusting Pressure (APAP) based on Apnoea Hypopnoea Index (AHI), Epworth Sleepiness Score (ESS) among patients with symptomatic OSA and to ascertain their CPAP preference. METHODS: This is a prospective, randomised, crossover, single-blinded study conducted from February 2018 to February 2019 among adult subjects attending respiratory clinic Universiti Kebangsaan Malaysia Medical Centre (UKMMC). RESULTS: Forty-six subjects were recruited with 27 males (58.7%). The mean age was 54 (+11) year old. The baseline median Body Mass Index (BMI) was 34.2 kg/m2 (Interquartile Range IQR: 30.8 kg/m2 -41.7 kg/m2); baseline median AHI 28.8 /hour (IQR 21.2/hour-54.0/hour); andbaseline median ESS 15 (IQR 13-16). After intervention, the median AHI was 5.0 / hour (IQR 4.2/hour-6.0/hour) at fixed CPAP arm; APAP arm was 5.5/ hour (IQR 4.2/hour-6.3/hour); p<0.01. The median ESS at fixed CPAP arm was 2 (IQR 0-3); APAP arm was 2 (IQR 1-3); p < 0.01. Those who preferred APAP were 22 subjects (47.8%) and had median optimal CPAP pressure 13.0 cmH2O (IQR 12.0 cmH2O -13.5 cmH2O); 24 subjects (52.2%) who preferred Fixed CPAP had median optimal CPAP pressure 8.0 cmH2O (IQR 6.3 cmH2O -8.7 cmH2O); p<0.01. Median baseline BMI was 37.6 kg/m2 (IQR 30.8 kg/m2 -43.0 kg/m2) for those who preferred APAP and 32.3 kg/m2 (IQR 30.8 kg/m2 - 38.4 kg/m2) for subjects preferred Fixed CPAP; p=0.03. DISCUSSION: Fixed CPAP maybe considered as first line therapy for symptomatic moderate and severe OSA with titrated optimal CPAP pressure less than 8 cmH2O and BMI less than 32.3 kg/m2; based on subjects' preference. Baseline AHI and average daily CPAP usage was not statisticallysignificant in affecting patient preference between fixed and auto adjusting CPAP. This is the first study of its kind conducted in Malaysia.

A short review of undergraduate occupational medicine training.

BACKGROUND: Medical schools worldwide allocate little time and utilize varying formats in the teaching of occupational medicine (OM) to undergraduate medical students. AIMS: To identify undergraduate OM teaching formats and highlight key findings in these different methods. METHODS: A limited literature search conducted on PubMed and Scopus identified relevant articles published in English and between the years 2009 and 2018. Our inclusion criteria were papers containing the key words ('occupational medicine' AND ('medical students' OR 'undergraduate medical')) OR ('occupational medicine' AND ('training' OR 'education' OR 'teaching')) in the title or abstract and those that specifically discussed OM education. RESULTS: The literature search yielded 1479 papers. Seven of them fulfilled the inclusion criteria and were reviewed in full. Formats in OM education of undergraduate medical students include, either singly or in combination, the use of case studies, didactic sessions, workplace visits, text-based readings and pro forma. CONCLUSIONS: OM education has a very small footprint in most undergraduate medical curricula. The studies show that different teaching formats are utilized, often in combination. Case-based discussions and workplace visits are frequently used with good qualitative results. Text-based readings will serve well to build good foundational knowledge, though there is no conclusive evidence that students will perform better.

Small RNA sequencing reveals miRNAs important for hypoxic adaptation in the Tibetan chicken.

1. The Tibetan chicken, which is an indigenous breed living on the Tibetan Plateau, exhibits hypoxic adaptations to its high-altitude environment. However, the molecular mechanism behind this hypoxic adaptation is still unclear. This study aimed to investigate differentially expressed miRNAs involved in hypoxic adaptation through high-throughput RNA sequencing. 2. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to verify the differentially expressed miRNAs and their target genes in chicken embryonic heart tissues and fibroblasts. Luciferase reporter assays were performed to confirm the relationship between miRNAs and target genes. 3. The study identified 37 differentially expressed miRNAs in Tibetan chicken embryonic heart tissues, including 20 up- and 17 down-regulated miRNAs, compared to those found in lowland chickens. Differentially expressed miRNAs were mainly involved in biological processes, such as cell cycle arrest, toll-like receptor signalling pathways, and I-kappa B kinase/NF-kappa B signalling. The data showed that gga-miR-34 c-5p was significantly upregulated in Tibetan chicken tissues and hypoxic fibroblasts, while EHHADH, a target gene of gga-miR-34 c-5p, was downregulated. Moreover, gga-miR-34 c-5p dramatically decreased the luciferase activity of the wild EHHADH, whereas no effect on the mutational EHHADH was found. 4. This study identified miRNA expression profiles in the Tibetan chicken and suggested that miR-34 c-5p acts as a novel miRNA associated with hypoxic adaptation. This facilitates the understanding of molecular mechanisms that underlie long-term exposure to hypoxia.

Thermal behavior of spin-current generation in PtxCu1-x devices characterized through spin-torque ferromagnetic resonance.

High temperature studies of spin Hall effect have often been neglected despite its profound significance in real-world devices. In this work, high temperature spin torque ferromagnetic resonance measurement was performed to evaluate the effects of temperature on the Gilbert damping and spin Hall efficiency of PtxCu1-x. When the temperature was varied from 300 K to 407 K, the Gilbert damping was relatively stable with a change of 4% at composition x = 66%. Alloying Pt and Cu improved the spin Hall efficiency of Pt75Cu25/Co/Ta by 29% to a value of 0.31 ± 0.03 at 407 K. However, the critical switching current density is dependent on the ratio between the Gilbert damping and spin Hall efficiency and the smallest value was observed when x = 47%. It was found that at this concentration, the spin transparency was at its highest at 0.85 ± 0.09 hence indicating the importance of interfacial transparency for energy efficient devices at elevated temperature.

Structural control of the dielectric, pyroelectric and ferroelectric properties of poly(vinylidene fluoride-co-trifluoroethylene) thin films.

The effects of solvents and temperature on the crystal formation were investigated for vinylidene fluoride/trifluoroethylene copolymer P(VDF-TrFE). Highly crystalline P(VDF-TrFE) thin films were fabricated by spin-casting using various polar solvents such as diethyl carbonate (DEC), methyl ethyl ketone (MEK), N,N-dimethylformamide (DMF) and dimethyl sulfoxide (DMSO). Ferroelectric polarisation reversal of the P(VDF-TrFE) was evidenced by a displacement (D)-electric field (E) hysteresis loop measurement and supported by the presence of pyroelectric activity. The samples which were annealed above 100 °C gave elongated rod-like crystalline structures and the highest crystallinity, Xc of 83% was formed at 120 °C. Consequently, remnant polarisation (85 mC m-2) and the pyroelectric coefficient (30 µC m-2 K-1) were enhanced. Thus, annealing plays a substantial role in controlling the crystalline structure of P(VDF-TrFE) films regardless of the choice of solvent. Although, the crystalline structure control is almost independent of the solvent's polarity, the choice of solvent is essential in preparing a smoother film surface. Molecular dynamics of P(VDF-TrFE) are discussed from the observation of two dielectric relaxation processes, ß and γ related to the segmental micro-Brownian and local modes, respectively. The complete ferroelectric polarization reversal caused a reduction in the dielectric polarization and reduced the lattice spacing of the 110/200 planes.

Author Correction: High velocity domain wall propagation using voltage controlled magnetic anisotropy.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Spin structure and spin Hall magnetoresistance of epitaxial thin films of the insulating non-collinear antiferromagnet SmFeO3.

We report a combined study of imaging the antiferromagnetic (AFM) spin structure and measuring the spin Hall magnetoresistance (SMR) in epitaxial thin films of the insulating non-collinear antiferromagnet SmFeO3. X-ray magnetic linear dichroism photoemission electron microscopy measurements reveal that the AFM spins of the SmFeO3(1 1 0) align in the plane of the film. Angularly dependent magnetoresistance measurements show that SmFeO3/Ta bilayers exhibit a positive SMR, in contrast to the negative SMR expected in previously studied collinear AFMs. The SMR amplitude increases linearly with increasing external magnetic field at higher magnetic fields, suggesting that field-induced canting of the AFM spins plays an important role. In contrast, around the coercive field, no detectable SMR signal is observed, indicating that the SMR of the AFM and canting magnetization components cancel out. Below 50 K, the SMR amplitude increases sizably by a factor of two as compared to room temperature, which likely correlates with the long-range ordering of the Sm ions. Our results show that the SMR is a sensitive technique for non-equilibrium spin systems of non-collinear AFMs.

High velocity domain wall propagation using voltage controlled magnetic anisotropy.

The use of voltage-controlled magnetic anisotropy (VCMA) via the creation of a sloped electric field has been hailed as an energy-efficient approach for domain wall (DW) propagation. However, this method suffers from a limitation of the nanowire length which the DW can propagate on. Here, we propose the use of multiplexed gate electrodes to propagate DWs on magnetic nanowires without having any length constraints. The multi-gate electrode configuration is demonstrated using micromagnetic simulations. This allows controllable voltages to be applied to neighboring gate electrodes, generating large strength of magnetic anisotropy gradients along the nanowire, and the results show that DW velocities higher than 300 m/s can be achieved. Analysis of the DW dynamics during propagation reveals that the tilt of the DW and the direction of slanted gate electrode greatly alters the steady state DW propagation. Our results show that chevron-shaped gate electrodes is an effective optimisation that leads to multi-DW propagation with high velocity. Moreover, a repeating series of high-medium-low magnetic anisotropy regions enables a deterministic VCMA-controlled high velocity DW propagation.

[Clinical features of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusions-single-center study].

Objective: To analyze the clinical characteristics, treatment methods and prognosis of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusions (Xp11.2 tRCC). Methods: From January 2007 to February 2018, 48 patients were diagnosed with Xp11.2 tRCC at Nanjing Drum Tower Hospital. The epidemiological features, treatment methods and long-term follow-up results were retrospectively reviewed. Results: Of the 48 patients, 20 cases were female and 28 cases were male, aged from 2 to 72 years. Gross hematuria and flank pain were the most frequent symptoms, which occurred on 14 cases and 8 cases respectively. The mean tumor size of 48 cases was (5.3±2.5)cm. Among the 34 cases who were classified as stageⅠ/Ⅱ, 14 cases received laparoscopic nephron-sparing surgery(NSS)and 20 cases received radical nephrectomy(RN). The other 14 cases who were classified as stage Ⅲ/Ⅳ received RN but one case received target therapy. On univariate analysis, tumor diameter, adjuvant treatment, AJCC stage, lymph node metastasis and vein tumor thrombosis showed association with progression-free survival (PFS) and overall survival (OS) (P<0.05). Multivariate analysis indicated that AJCC stage (P=0.023, 95% CI: 0.048-0.081)and vein tumor thrombosis (P=0.046, 95% CI: 1.004-1.590)were independent prognostic factors of PFS. Conclusions: Xp11.2 tRCC mainly occurs in females. RN was the major method for Xp11.2 tRCC. However, NSS can also receive satisficed results for stage T1a case. High AJCC stage and the occurrence of vein tumor thrombosis indicated poor prognosis.