Remarkable response to third-generation EGFR-TKI plus crizotinib in a patient with pulmonary adenocarcinoma harboring EGFR and ROS1 co-mutation: a case report.

Background: Driver oncogene mutations, such as c-ros oncogene 1 (ROS1) and epidermal growth factor receptor (EGFR) were previously believed to be mutually exclusive in non-small cell lung cancer (NSCLC). Only sporadic cases of ROS1 and EGFR co-mutations have been reported. Hence, appropriate treatment options for these patients are still controversial. Case presentation: A 48-year-old female patient presented at our hospital complaining of a persistent cough that had been ongoing for a month. A chest computed tomography showed a mass in the left lung along with hilar and mediastinal lymphadenopathy. Pathological analysis of bronchoscopic biopsy and lung mass puncture confirmed the presence of lung adenocarcinoma. The patient was diagnosed with stage IIIC left lung adenocarcinoma with a clinical stage of cT2N3M0. Next-generation sequencing analysis conducted at both puncture sites revealed an EFGR 19 deletion mutation combined with ROS1 rearrangement. The lung mass exhibited a higher mutation abundance. Treatment with a combination of third-generation EGFR tyrosine kinase inhibitors (TKIs) and crizotinib yielded satisfactory results. During the follow-up period, the mass significantly reduced and almost disappeared. Conclusion: The co-mutation of EGFR and ROS1 is a rare phenomenon. Nevertheless, the combination of EGFR-TKI and crizotinib treatment appears to hold promise in providing positive results for patients, with manageable side effects. This therapeutic approach has the potential to enhance patients' overall prognosis.

Diffuse infantile hepatic hemangioma successfully treated with propranolol orally: a case report and literature review.

Background: Infantile hepatic hemangioma (IHH) is a common vascular, fast-growing hepatic tumor that is usually accompanied by multiple cutaneous hemangiomas. Diffuse IHH (DIHH) is a rare type of IHH that exhibits many tumors with nearly complete hepatic parenchymal replacement. At present, there is no specific standardized treatment plan for DIHH. Herein, we present the case of a 2-month-old girl with DIHH and without cutaneous hemangioma who achieved complete remission after undergoing propranolol monotherapy. Case presentation: The infant with low birth weight was presented to the pediatric department with a 2-month history of persistent vomiting and feeding difficulty. Ultrasonography and abdominal magnetic resonance imaging revealed hepatomegaly and diffused intrahepatic lesions. A computed tomography-guided percutaneous liver biopsy was performed, and the pathological examination suggested the diagnosis was DIHH. The patient exhibited remarkably response to an increasing dose of oral propranolol, from 0.5 mg/kg to 2 mg/kg every day. The intrahepatic lesions were almost completely regressed after one year of treatment and no distinct adverse reaction was observed. Conclusion: DIHH can induce life-threatening complications that require prompt interventions. Propranolol monotherapy can be an effective and safe first-line treatment strategy for DIHH.

Pregnancy in women with autosomal recessive Alport syndrome caused by novel compound heterozygous mutations of COL4A3 gene: Two cases reports.

RATIONALE: Autosomal recessive Alport syndrome (ARAS) is an hereditary heterogeneous disease that poses a serious risk to pregnant women. PATIENT CONCERNS: We reported 2 cases of pregnancy with progressive proteinuria. The case 1 was a 21-year-old woman with 24-h proteinuria increased from 2.03 to 11.72 g at 13 to 35 weeks of gestation, and the case 2 was a 28-year-old woman with 24-h proteinuria increased from 2.10 to 9.32 g at 8 to 36 weeks of gestation. In advanced stage of pregnancy, the fetal development was smaller than the gestational age. DIAGNOSES: Sanger sequencing showed that novel compound heterozygous mutations [c.1315 G>T (p.G439C) and c.4847 G>A (p.C1616Y)] of the collagen type IV alpha 3 chain (COL4A3) gene were found in the 2 cases. Renal puncture pathology confirmed the diagnosis of ARAS. INTERVENTIONS: The 2 cases were treated with albumin, compounded amino acids, calcium, vitamin D, and low molecular weight heparin in addition to conventional treatment during pregnancy. Pregnancy was terminated by cesarean section at 36 to 37 weeks of gestation. After delivery, the patients were treated with Losartan for anti-proteinuric therapy for 1 year. OUTCOMES: The neonatal weights and Apgar scores were normal. The patients recovered well and 24-h proteinuria decreased to pre-pregnancy level. LESSONS: When pregnant women present with a persistent increasing proteinuria, ARAS needs to be considered. Sanger sequencing is useful to assist in the diagnosis of ARAS. Multidisciplinary treatments from nephrologists and gynecologists are needed to ensure the safety of pregnancy and the fetus.

Anemonin inhibits sepsis-induced acute kidney injury via mitigating inflammation and oxidative stress.

Elevated inflammation and oxidative stress (OS) are the main pathologic features of acute kidney injury (AKI)-caused by sepsis. Here, we made an investigation into the protective effects of the natural compound Anemonin (ANE) on sepsis-induced AKI both in vitro and in vivo. Lipopolysaccharide (LPS) was applied to construct an in vitro AKI model in renal tubular epithelial cells, and the septic C57BL/6J mouse model was constructed via cecal ligation and puncture (CLP). Cell viability and apoptosis were detected. The levels of p53, Bax, Bcl2, Caspase3, Caspase8, Caspase9, AMP-activated protein kinase (AMPK), Sirt-1, and forkhead box O3 were determined by Western Blot or RT-PCR. The reactive oxygen species level and OS markers were measured. Furthermore, the pathological changes of kidneys were evaluated by hematoxylin-eosin staining and immunohistochemistry. As per the information presented, ANE improved LPS-elicited apoptosis, inflammatory response, and OS in a dose-dependent pattern in renal tubular epithelial cells. Besides, ANE activated the AMPK/Sirt-1 pathway, and the AMPK inhibitor (Compound C) and Sirt-1 inhibitor (EX-527) significantly attenuated ANE-mediated protection on renal tubular epithelial cells. In vivo, ANE mitigated the levels of serum creatinine and urea nitrogen in the CLP-induced mouse sepsis model, reduced the renal tissue injury score, and attenuated OS, inflammation, and apoptosis levels in the kidney. Taken together, this study suggested that ANE has protective effects in sepsis-triggered AKI through repressing inflammation, OS, and cell apoptosis by activating the AMPK/Sirt-1 pathway.

Clinical Implication of Keratin-15 Quantification for Renal Cell Carcinoma Management: Its Dysregulation and Association with Clinicopathologic Characteristics and Prognostication.

Keratin-15 (KRT15) participates in the tumorigenesis of several cancers, especially in urinary tract carcinomas by regulating basal urothelial cell malignant proliferation and differentiation. This study intended to explore the association of KRT15 with tumor features and survival in renal cell carcinoma (RCC) patients. Totally, 210 RCC patients receiving surgical resection were retrospectively enrolled, and then, KRT15 was detected by immunohistochemistry (IHC) assay in the tumor and adjacent tissues. IHC score of KRT15 was increased in tumor tissues versus adjacent tissues (P < 0.001). Meanwhile, KRT15 was associated with RCC occurring in the left kidney (P = 0.024), tumor size > 10 cm (P = 0.035), higher N stage (P = 0.048), and higher tumor-node-metastasis (TNM) stage (P = 0.029). Additionally, high KRT15 (IHC score > 3) estimated poor disease-free survival (DFS) (P = 0.008) and overall survival (OS) (P = 0.011). In addition, multivariate regression analysis revealed that high KRT15 [hazard ratio (HR) = 1.719, P = 0.023], higher pathological grade (HR = 1.847, P < 0.001), and higher N stage (HR = 3.447, P < 0.001) were independently related to poor DFS; high KRT15 (HR = 1.796, P = 0.034), eastern cooperative oncology group performance status score (1 vs. 0) (HR = 1.734, P = 0.037), higher pathological grade (HR = 2.045, P < 0.001), and higher N stage (HR = 3.966, P < 0.001) were independently linked to unsatisfactory OS. Furthermore, data from Gene Expression Profiling Interactive Analysis suggested that KRT15 was linked to poor DFS (P = 0.037) and OS (P < 0.001); data from THE HUMAN PROTEIN ATLAS revealed that KRT15 was associated with shorter OS (P < 0.001) in RCC patients. In conclusion, KRT15 is increased in tumor tissues, and correlates with higher tumor stage and larger tumor size, along with poor prognosis for RCC.

Clinical Management of Embryonal Tumor with Multilayered Rosettes: The CCMC Experience.

OBJECTIVE: Embryonal tumors with multilayered rosettes (ETMRs) are highly aggressive pediatric brain tumors with poor prognosis. No standard treatment strategy for them exists because of their rarity. This study aimed to share experiences on the clinical diagnosis and treatment of ETMRs at China Children's Medical Center (CCMC). METHODS: Patients who received a diagnosis of an ETMR between January 2017 and June 2020 were included. Clinical characteristics, such as age of onset, tumor size, stage, tumor site, treatment strategy, and clinical outcome, were retrospectively analyzed. RESULTS: There were four boys and one girl within 4 years who received a diagnosis during this 4-year timeframe, and were thus included. The average age of morbidity was 29 months (range 16-66 months). The common clinical presentation was headaches and nausea caused by intracranial hypertension. All four patients were chromosome 19 microRNA cluster (C19MC) amplification positive. Two patients achieved complete remission, and one patient attained partial remission after multimodal treatment. Of the two deaths, one died from the rapid progression of the disease and another from tumor-related complications. CONCLUSION: ETMRs are extremely rare brain tumors with a high, early mortality in children. Surgery is the mainstream treatment for ETMRs. Some patients may also benefit from postoperative adjuvant chemotherapy and radiotherapy.

The Maternal-Neonatal Outcomes of Twin Pregnancies with Preeclampsia and Their Association with Assisted Reproductive Technology: A Retrospective Study.

Objective: This study aimed to investigate the maternal−neonatal outcomes of twin pregnancies of mothers with preeclampsia and their association with assisted reproductive technology (ART). Methods: A retrospective study on the clinical and maternal−neonatal outcome data of 698 women with twin pregnancies who delivered in our hospital from December 2013 to September 2021 was conducted. Continuous variables were analyzed using a Student's t-test or Wilcoxon rank-sum test. Categorical variables were analyzed using the Chi-square test. The risk factors of twin pregnancies with preeclampsia were analyzed by logistic regression. Results: The rate of twin pregnancy complicated by preeclampsia was 17.62% (123/698). Logistic regression analysis showed that ART increased the risk of preeclampsia in twin pregnancies (AOR: 1.868, 95% CI: 1.187−2.941). Mothers with preeclampsia carrying twins conceived with ART had a higher rate of delivery at gestational week < 34 (29.9% vs. 12.5%) and asphyxia of the neonate at 5 min after delivery (13.4% vs. 1.8%) than those with preeclampsia conceived without ART (p < 0.05). Conclusions: ART increases the risk of preeclampsia in twin pregnancies and the rate of adverse maternal−neonatal outcomes for twin pregnancies with preeclampsia. The policy of single embryo transfer is a method to reduce the adverse pregnancy outcomes of ART.

Diagnostic Ideas and Management Strategies for Thrombocytopenia of Unknown Causes in Pregnancy.

Objective: To summarize the clinical characteristics and treatment options together with the maternal and neonatal prognoses in women with different degrees of thrombocytopenia of unknown causes during pregnancy. Materials and Methods: One hundred twenty-nine cases meeting the inclusion and exclusion criteria were retrospectively analyzed. Patients were divided into group A (50*109/L) and group B (50*109/L to 100*109/L) according to the lowest level of platelet count during pregnancy. Patients were divided into those found to have thrombocytopenia in the relatively early, middle, and late stages according to the detection period of maternal thrombocytopenia during pregnancy. Results: There were 72 cases in group A, and 57 cases in group B. There existed statistically significant differences in terms of the proportion of primipara, the proportion with a history of thrombocytopenia, and the median length of pregnancy between the two groups (p < 0.05). The proportion of patients with severe thrombocytopenia as an indication for cesarean delivery was higher in group A than in group B (p < 0.05). More cases were detected at the relatively early stages of pregnancy in group A than in group B (p < 0.05). There was no difference in neonatal hemorrhage and events of thrombocytopenia between the two groups. Conclusion: Patients with platelet counts below 50*109/L were mostly primipara with a history of thrombocytopenia, most often detected at a relatively early stage of pregnancy, and continued pregnancy might lead to aggravation of the disease. Combination therapy was required for patients with platelet counts below 30*109/L to maintain the platelet counts within a safe range. Cesarean delivery was selected to terminate the pregnancies, and platelet counts should be raised above 50*109/L before surgery. Close monitoring was required for those with platelet counts above 30*109/L. There was no direct correlation between the maternal and neonatal platelet counts.

C:N:P stoichiometry responses to 10 years of nitrogen addition differ across soil components and plant organs in a subtropical Pleioblastus amarus forest.

How stoichiometry in different ecosystem components responds to long-term nitrogen (N) addition is crucial for understanding within-ecosystem biogeochemistry cycling processes in the context of global change. To explore the effects of long-term N addition on nutrient stoichiometry in soil and plant components in forest ecosystem, a 10-year N addition experiment using ammonium nitrate (NH4NO3) was conducted in a bamboo forest in the Rainy Zone of West China, where the background N deposition is the highest in the world. Four N treatment levels (+0, +50, +150, +300 kg N ha-1 yr-1) (CK, LN, MN, HN) were applied monthly since November 2007, and then, the C:N:P stoichiometry of soil, microbial biomass, and enzymes in rhizosphere soil and bulk soil, and plant organs were measured. N addition decreased the stoichiometry of C:N:P of soil, microbial biomass, and enzymes. Soil C:N:P change under N addition treatments was stronger in bulk soil, while C:N:P changes for microbial biomass and enzyme activity were significant in rhizosphere soil. N addition significantly decreased TOC in bulk soil. Changes in MBC:MBN:MBP in rhizosphere and bulk soil were mainly caused by MBN and MBP, and MBP performance was consistent with that of AP. The main variable leading to the change of enzyme C:N:P in rhizosphere soil was BG and AP, and in bulk soil was LAP + NAG activity. Plant root C:P and N:P increased with N addition, while those for leaves and twigs did not. N addition significantly reduced the pH of both rhizosphere and bulk soils. These results suggest that the stoichiometry responses of rhizosphere and bulk soils were different due to the influence of plant roots. Soil acidification, enhanced aluminum toxicity potential, decreased root biomass and enhanced microbial P limitation caused by N addition were the important mechanisms that promoted stoichiometry changes in this ecosystem. Under the chronic input of N deposition, the stoichiometry between plant and soil evolved in different directions, which may lead to the decoupling of plants from soils.

Meta-analysis of heparin combined with aspirin versus aspirin alone for unexplained recurrent spontaneous abortion.

BACKGROUND: Unexplained recurrent spontaneous abortion (URSA) frustrates women of childbearing age profoundly, and effective therapies are particularly important. OBJECTIVE: To compare the efficacy of heparin combined with aspirin and aspirin alone for URSA. SEARCH STRATEGY: Electronic databases (PubMed, Medline, Web of Science, Clinical key and Cochrane Library) were searched for relevant studies from database inception to August 2019. SELECTION CRITERIA: Studies of women of childbearing age with at least two consecutive abortions were included. DATA COLLECTION AND ANALYSIS: Relevant items were extracted, tabulated, and subjected to STATA for data analysis. Study women were divided into group A (taking heparin plus aspirin) and group B (taking aspirin alone). The primary outcome was the rate of live birth. MAIN RESULTS: Women from eight randomized controlled trials were included: 493 in group A and 501 in group B. The number of live births was significantly higher in group A (P=0.003). The result remained the same in subgroup analysis by presence of antiphospholipid antibodies. Among women who had a live birth, gestational age at delivery tended to be older in group B (P=0.054). No differences in birthweight or intrauterine growth restriction were observed. Adverse effects were sporadically reported. CONCLUSION: Among women with URSA, heparin combined with aspirin increased the live birth rate as compared with aspirin alone. There was a beneficial tendency of taking aspirin-only to prolong gestation week.

The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA).

BACKGROUND: Spinal cord injury without radiographic abnormality (SCIWORA) is a rare traumatic myelopathy. Although surgery is one of the most important treatments, the surgery for SCIWORA is controversial, especially the time of surgery is a topic of controversy. Here, we investigate the effects of difference in duration from injury to surgery on the outcome of SCIWORA. METHODS: This retrospective study was performed in all patients with spinal cord injury admitted to the Third Affiliated Hospital of Hebei Medical University from January 2013 to April 2017. Fifty-seven patients who met the study requirements were divided into 3 groups according to the duration from injury to surgery. Group A (surgery within 3 days of injury) had 18 patients, group B (surgery within 3-7 days) had 18 patients, and group C (surgery later than 7 days) had 21 patients. All the groups were compared with Mann-Whitney U test; the functional improvement of spinal cord was compared and analyzed using the ASIA sports score and ASIA Impairment Scale (AIS). RESULTS: There was a significant improvement in the long-term AIS (final follow-up) in all the 3 groups compared to before surgery. The final follow-up recovery rate of group C was worse than group A and group B. The curative effect of operation within 7 days was significantly better than the surgery done 7 days later. The recovery rate of group C was worse than group A and B. The ASIA sports score showed that recovery was quicker in the early stage and slow in the later stage. CONCLUSIONS: The optimal schedule of surgical treatment was 3-7 days after injury, which can significantly improve the short-term and long-term follow-up effects. Longer the time to surgery from the time of injury, the worse was the prognosis.

Melatonin suppresses epithelial­to­mesenchymal transition in the MG­63 cell line.

Epithelial­to­mesenchymal transition (EMT) is a major process involved in tumor progression and metastasis. Melatonin is secreted by the pineal gland and has been documented as a potential therapeutic agent for multiple tumors. However, the effects of melatonin on EMT during osteosarcoma (OA) development remain undefined. The present study explored the biological functions and effects of melatonin on EMT induced by transforming growth factor ß1 (TGF­ß1) and its underlying mechanisms in MG­63 cells. Using western­blotting and immunofluorescence, it was found that the switch in E­cadherin/N­cadherin and vimentin expression was induced by TGF­ß1, which was reversed by melatonin through the suppression of Snail and matrix metalloproteinase 9 (MMP­9), through hypoxia­inducible factor 1α (HIF­1α) inhibition. These findings demonstrated that the anticancer effects of melatonin against OA MG­63 cells is through the suppression of EMT via HIF­1α/Snail/MMP­9 signaling.

Episodic context reinstatement promotes memory retention in older but not younger elementary schoolchildren.

Previous studies have shown that reinstatement of spatial and temporal background information during learning can promote memory retention in adults. However, the effect in children is unclear. In order to explore the effect of episodic context reinstatement on the memory retention of different age groups, first-grade students, third-grade students, and third-year college students studied two word lists. When the words were presented mixed together, the participants were told to either restudy the words under intentional learning conditions or make list discrimination judgements by indicating the list from which each word had originated. Results revealed that the retrieval practice based on the episodic context reinstatement paradigm showed a phased development trend in the participants compared to restudy. Episodic context reinstatement only promoted memory retention in the third-grade children and college students, but not in the first-grade children. During the early elementary school years, children do not have relatively mature episodic memory ability and cannot output memories according to context clues. Our finding suggests important guidance for the age-appropriate use of tests as instructional tools in basic education. Statement of contribution What is already known on this subject? One recent theory of retrieval-based learning is the episodic context account; it promotes memory retention by reinstate the context of a prior learning episode. Previous studies have confirmed in the adults that the episodic context reinstatement was the main reason for retrieval practice to promote memory retention through the list discrimination tasks What does this study add? This study revealed that the retrieval practice based on the episodic context reinstatement paradigm showed a phased development trend in the participants. Episodic context reinstatement only promoted memory retention in the third-grade children and college students, but not in the first-grade children, and the results support the episodic context assumption, namely that episodic context reinstatement is the key factor in memory retention. The results of this study can explain why most prior work has observed the effect of retrieval practice in the groups above grade three.

Effect of Commercial Off-The-Shelf MAPS on γ-Ray Ionizing Radiation Response to Different Integration Times and Gains.

We report the γ-ray ionizing radiation response of commercial off-the-shelf (COTS) monolithic active-pixel sensors (MAPS) with different integration times and gains. The distribution of the eight-bit two-dimensional matrix of MAPS output frame images was studied for different parameter settings and dose rates. We present the first results of the effects of these parameters on the response of the sensor and establish a linear relationship between the average response signal and radiation dose rate in the high-dose rate range. The results show that the distribution curves can be separated into three ranges. The first range is from 0 to 24, which generates the first significant low signal peak. The second range is from 25 to 250, which shows a smooth gradient change with different integration times, gains, and dose rates. The third range is from 251 to 255, where a final peak appears, which has a relationship with integral time, gain, and dose rate. The mean pixel value shows a linear dependence on the radiation dose rate, albeit with different calibration constants depending on the integration time and gain. Hence, MAPS can be used as a radiation monitoring device with good precision.

Ferulic acid ameliorated placental inflammation and apoptosis in rat with preeclampsia.

Preeclampsia (PE) occurs specifically during pregnancy characterized by new-onset hypertension. The pathogenesis of PE was complicated, and inflammation may be central to the pathogenesis of PE. Ferulic acid (FA) is recognized to prevent cell damage and apoptosis induced by oxidative stress and inflammation. In our study, we used NG-nitro-l-arginine methyl ester (L-NAME)-induced rat model of PE to investigate whether FA improved PE and its possible mechanism. We found that FA significantly reduced blood pressure, urine volume, and urinary protein level in rats with PE. Meanwhile, FA decreased L-NAME induced higher expression of circulating TNF-α、IL-6、IL-1ß and PlGF, it reduced placental TNF-α and NF-κB p65. Furthermore, FA rescued L-NAME induced decreasing expression of IL-4 and IL-10 expression in the circulation and placenta of rats. FA also ameliorated placental apoptosis in L-NAME induced rats by increasing Bcl-2 whereas decreasing Bax expression in placenta. It suggested FA as a potential candidate for the treatment of various disorders including L-NAME induced preeclampsia in rats through decreasing placental inflammation and apoptosis.

Coding and Noncoding Variants in CFH Act Synergistically for Complement Activation in Immunoglobulin A Nephropathy.

BACKGROUND: In immunoglobulin A nephropathy (IgAN), complement activation occurs in both the systemic circulation and in situ (glomerular). A recent IgAN-genome-wide association study (GWAS) identified 1q32 as an IgAN susceptible locus that contained the complement regulatory protein coding gene complement factor H (CFH). Here, we explored the combined genetic effects of coding and noncoding variants in CFH, rs6677604 and rs800292 on complement activation in IgAN. METHODS: In total, 1,194 IgAN patients and 900 healthy controls who were the same as the Beijing Discovery Cohort in our recent IgAN-GWAS were recruited. The genotyping information of rs800292 and rs6677604 were extracted from GWAS data, while the information regarding plasma C3 levels and mesangial C3 deposits were collected from medical records. RESULTS: We found both rs800292-GG and rs6677604-GG were risk genotypes for complement activation in IgAN patients, as represented by lower plasma C3 levels in IgAN patients with rs800292-GG and a higher intensity of glomerular C3 deposits in those with rs6677604-GG, respectively. Additionally, IgAN patients with 2 risk genotypes (rs800292-GG and rs6677604-GG) showed a higher degree of complement activation compared to those with no risk genotypes (rs800292-AA/AG and rs6677604-AA/AG), as represented by both lower plasma C3 levels and a higher intensity of glomerular C3 deposits. Moreover, when compared to rs800292 or rs6677604 alone, the combined genetic effects of rs800292 and rs6677604 showed a stronger association with IgAN susceptibility. CONCLUSIONS: Our findings suggested that both coding and noncoding variants in CFH acted synergistically to regulate the degree of complement activation and thereby contributed to IgAN susceptibility.

[Screening, identification and antimicrobial activity of alkaloid produced by endophytic actinomycetes from Fritillaria unibracteata in western Sichuan plateau].

To explore the resource of endophytic actinomycete in Fritillaria unibracteata, and alleviate the shortage of F. unibracteata resource, using F. unibracteata as experimental materials which growth in the western Sichuan plateau and cut its healthy bulb. Pure culture, insert, TLC and Oxford cup were applied to observe the mycelial morphology, research the ability of producing alkaloid and its antibacterial activity. Totally, 14 endophytic actinomycete strains were isolated by using Gao culture media. Based on the color reaction, 5 typical strains were selected for producing alkaloid. Through the TLC technique, all strains produced 2 obvious alkaloids spots. Antibacterial activity determination showed that the antimicrobial effects of 2 strains is prominent, the diameter up to 11 mm.16S rRNA gene sequence comparison analysis showed that 5 strains belonging to the Streptomyces. The alkaloids produced by endophytic actinomycetes are not related to F. unibracteata, but its fermentation liquid has antibacterial effect, it is worthy of further study.

Three umbilical arteries resulting in a four-vessel umbilical cord in a stillbirth.

Here we first describe a four-vessel umbilical cord including three umbilical arteries and one vein in a stillbirth. A 28-year-old woman delivered a 2360 g stillbirth in the 33th week of gestation. The infant had no gross anomalies. The placenta was examined pathologically, and the cord was measured as 60.0 cm long, which has four vessels with three arteries and one vein throughout its whole length confirmed by direct and microscopic examination. Fibro-necrosis and dotted necrosis were found in the placenta. A pregnancy with three umbilical arteries may need fetal monitoring during the second trimester. Further observation and adequate investigation are needed in such cases.

[The association between body composition and bone stiffness in patients with stable chronic obstructive pulmonary disease].

OBJECTIVE: To determine the body composition and bone stiffness in patients with stable chronic obstructive pulmonary disease (COPD), and to explore the association between them. METHODS: Ninety-four male COPD patients in stable conditions and 47 healthy smokers were recruited from March 2013 to January 2014.Lung function, body composition and bone stiffness were measured.In COPD patients, the symptoms were assessed by COPD Assessment Test (CAT) and Modified British Medical Research Council (mMRC) respectively, and the acute exacerbation and hospitalization history in the previous 12 months were also recorded. RESULTS: The prevalence of muscle atrophy (FFMI<16 kg/m(2) ) and high risk of bone fracture (T<-1) were 24.5% and 72.3% respectively in stable male COPD patients. The patients with muscle atrophy, had lower FEV1%pred (39.0 ± 15.2) vs (50.1 ± 16.2), frequent acute exacerbations [1.0(0-3.0) vs 0 (0-1.0)] and lower bone stiffness index (75.5 ± 13.3) vs (85.5 ± 15.7), (test values were 2.904, -1.476, 2.728, all P < 0.05). Compared with patients with low risk of bone fracture(T ≥ -1), patients with high risk of bone fracture (T<-1) showed higher mMRC score [2.0(1.0-3.0) vs 1.0(0-2.0)] (Z = -2.297, P < 0.05). The FFMI correlated positively with SI (r = 0.294, P = 0.004) in COPD patients. CONCLUSIONS: Patients with stable COPD presented worse lung function and increased risk of future exacerbations when combined with muscle atrophy and high risk of bone fracture, and the two co-morbidities were correlated and should be assessed.