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Background The impact of Coronavirus disease (COVID-19) pandemic and its influence on personal hygiene behaviors and peritonitis rate in peritoneal-dialysis patients is unknown. Methods A multi-center retrospective study was conducted. We reviewed all the cases of peritoneal-dialysis (PD) patients from four major PD centers in Wuhan before and after COVID-19. There were 567 patients enrolled in total. Information was collected on personal hygiene behaviors, basic clinical characteristics, lab results, peritonitis details. We used Chi-square analysis to compare the personal hygiene behaviors, and used Chi-square goodness-of-fit analysis to compare the peritonitis rates before and after COVID-19. Multivariate logistic regression analysis was used to analyze the risk factors for peritonitis rate. Results There were no significant differences on peritonitis rates in six-month period before and after COVID-19 (p = 0.0756, Fig. 2 and Table 3). But Gram-positive infections decreased dramatically (p = 0.0041, Table 4). Personal hygiene behaviors such as length of time for washing hands when performing PD treatment, the frequency of washing hands before PD treatment and six general behaviors had significant differences (P

Objective To analyze the clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) and its influence on the distribution of lymph node metastasis at each lateral level of the neck to guide precise treatment of the lateral area. Methods The clinicopathological data of patients with PTC initially diagnosed and treated at our hospital from February 2014 to September 2021 were collected; the metastatic status of each lateral level was recorded, and correlations were analyzed. Results A total of 203 patients were enrolled in this study. There were 67 males and 136 females, with an average age of 41.1 years. In the lateral cervical area, lymph node metastasis was found at level IIa in 81 patients (39.9%); level III, 171 patients (84.2%); level IV, 122 patients (60%); and level Vb, 18 patients (8.9%). Correlation analysis showed that age (r = 0.198, P Conclusions For patients with pathological evidence of lateral metastasis, standard dissection of level IIa through Vb is recommended; selective dissection requires careful consideration. Patients with multifocal tumors have a high risk of metastasis at levels IIa and Vb, which requires special attention during the operation.

Background Hepatocellular carcinoma (HCC) is a major health problem and a primary cause of cancer‐related death worldwide. Although great advances have achieved recently by large‐scale high‐throughput analysis, the precise molecular mechanism underlying HCC progression remains to be clearly elucidated. We investigated the relationship between Tescalcin (TESC), a candidate oncogene, and clinicopathological features of HCC patients and explored the role of TECS in HCC development. Methods To identify new genes involved in HCC development, we analyzed The Cancer Genome Atlas liver cancer database, and TESC was selected for further investigation. HCC tissue microarray analysis for TESC and its association with clinicopathological features were performed to investigate its clinical significance. TESC was knocked down by using short‐hairpin RNAs. Cell proliferation was analyzed by WST‐1 assay and cell counting. Cell apoptosis was tested by fluorescence‐activated cell sorting. A subcutaneous xenograft tumor model in nude mice was established to determine the in vivo function of TESC. Affymetrix microarray was used to identify its molecular mechanism. Results TESC was significantly increased in HCC tissues compared with the adjacent normal liver tissues. High expression of TESC was detected in 61 of 172 HCC patients by tissue microarray. Large tumor (> 5 cm) and elevated total bilirubin were associated with high TESC expression (both P

Background Excessive intraoperative hemorrhage is a critical factor of poor prognoses after hepatectomy. Low central venous pressure during parenchymal transection is recognized to effectively reduce intraoperative hemorrhage in open procedures. However, the role of controlled low central venous pressure in laparoscopic hepatectomy is still controversial. Methods In the present randomized clinical trial, we set up a standard boundary of low central venous pressure according to our Pilot Study, then enrolled patients scheduled for elective laparoscopic hepatectomy and allocated them randomly to a group undergoing central venous pressure reduction by anesthesiologic interventions or a control group. The primary efficacy endpoint was total intraoperative blood loss and perioperative adverse events. Analyses were performed following the intention-to-treat principle, and patients and surgeons were blinded ( ClinicalTrials.gov , Number: NCT03422913 ). Results Between January 2017 and October 2018, 146 out of 469 patients were randomized and eligible for inclusion in the final analyses. Based on the retrospective training cohort, we set a central venous pressure of 5 cm H2O as a cutoff value (standard low central venous pressure). Compared with patients in the control group, those in the controlled low central venous pressure group had a significantly lower central venous pressure during resection (4.83 ± 3.41 cm H2O vs 9.26 ± 3.38 cm H2O; P Conclusion The safety and efficacy of controlled low central venous pressure were demonstrated in complex laparoscopic hepatectomy for the first time by our study, and this technique is recommended to be applied routinely in laparoscopic hepatectomy.

Background Reports indicate that those most vulnerable to developing severe coronavirus disease 2019 (COVID-19) are older adults and those with underlying illnesses, such as diabetes mellitus, hypertension, or cardiovascular disease, which are common comorbidities among patients undergoing maintenance hemodialysis. However, there is limited information about the clinical characteristics of hemodialysis patients with COVID-19 or about interventions to control COVID-19 in hemodialysis centers. Methods We collected data retrospectively through an online registration system that includes all patients receiving maintenance hemodialysis at 65 centers in Wuhan, China. We reviewed epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 between January 1, 2020 and March 10, 2020. Results Of 7154 patients undergoing hemodialysis, 154 had laboratory-confirmed COVID-19. The mean age of the 131 patients in our analysis was 63.2 years; 57.3% were men. Many had underlying comorbidities, with cardiovascular disease (including hypertension) being the most common (68.7%). Only 51.9% of patients manifested fever; 21.4% of infected patients were asymptomatic. The most common finding on chest computed tomography (CT) was ground-grass or patchy opacity (82.1%). After initiating comprehensive interventions-including entrance screening of body temperature and symptoms, universal chest CT and blood tests, and other measures-new patients presenting with COVID-19 peaked at 10 per day on January 30, decreasing to 4 per day on February 11. No new cases occurred between February 26 and March 10, 2020. Conclusions We found that patients receiving maintenance hemodialysis were susceptible to COVID-19 and that hemodialysis centers were high-risk settings during the epidemic. Increasing prevention efforts, instituting universal screening, and isolating patients with COVID-19 and directing them to designated hemodialysis centers were effective in preventing the spread of COVID-19 in hemodialysis centers.

To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease.The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone.Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue.Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.

Background Patients with hepatocellular carcinoma (HCC) undergoing surgical resection still have a high 5-year recurrence rate (~ 60%). With the development of laparoscopic hepatectomy (LH), few studies have compared the efficacy between LH and traditional surgical approach on HCC. The objective of this study was to establish a nomogram to evaluate the risk of recurrence in HCC patients who underwent LH. Methods The clinical data of 432 patients, pathologically diagnosed with HCC, underwent LH as initial treatment and had surgical margin > 1 cm were collected. The significance of their clinicopathological features to recurrence-free survival (RFS) was assessed, based on which a nomogram was constructed using a training cohort (n = 324) and was internally validated using a temporal validation cohort (n = 108). Results Hepatitis B surface antigen (hazard ratio [HR], 1.838; P = 0.044), tumor number (HR, 1.774; P = 0.003), tumor thrombus (HR, 2.356; P = 0.003), cancer cell differentiation (HR, 0.745; P = 0.080), and microvascular tumor invasion (HR, 1.673; P =0.007) were found to be independent risk factors for RFS in the training cohort, and were used for constructing the nomogram. The C-index for RFS prediction in the training cohort using the nomogram was 0.786, which was higher than that of the 8th edition of the American Joint Committee on Cancer TNM classification (C-index, 0.698) and the Barcelona Clinic Liver Cancer staging system (C-index, 0.632). A high consistency between the nomogram prediction and actual observation was also demonstrated by a calibration curve. An improved predictive benefit in RFS and higher threshold probability of the nomogram were determined by receiver operating characteristic curve analysis, which was also confirmed in the validation cohort compared to other systems. Conclusions We constructed and validated a nomogram able to quantify the risk of recurrence after initial LH for HCC patients, which can be clinically implemented in assisting the planification of individual postoperative surveillance protocols.

Dysregulated extravillous trophoblast invasion and proliferation are known to increase the risk of recurrent spontaneous abortion (RSA); however, the underlying mechanism remains unclear. Herein, in our retrospective observational case-control study we show that villous samples from RSA patients, compared to healthy controls, display reduced succinate dehydrogenase complex iron sulfur subunit (SDHB) DNA methylation, elevated SDHB expression, and reduced succinate levels, indicating that low succinate levels correlate with RSA. Moreover, we find high succinate levels in early pregnant women are correlated with successful embryo implantation. SDHB promoter methylation recruited MBD1 and excluded c-Fos, inactivating SDHB expression and causing intracellular succinate accumulation which mimicked hypoxia in extravillous trophoblasts cell lines JEG3 and HTR8 via the PHD2-VHL-HIF-1α pathway; however, low succinate levels reversed this effect and increased the risk of abortion in mouse model. This study reveals that abnormal metabolite levels inhibit extravillous trophoblast function and highlights an approach for RSA intervention., Abnormal placentation is associated with recurrent spontaneous abortion (RSA) risk. Here the authors report that low embryonic villous succinate level associates with risk of RSA in patients, and increasing succinate levels is sufficient to reduce the incidence rate in a mouse model of spontaneous abortion.

Congenital deafness is one of the most common causes of disability in humans, and more than half of cases are caused by genetic factors. Mutations of the MYO15A gene are the third most common cause of hereditary hearing loss. Using next-generation sequencing combined with auditory tests, two novel compound heterozygous variants c.2802_2812del/c.5681T>C and c.5681T>C/c.6340G>A in the MYO15A gene were identified in probands from two irrelevant Chinese families. Auditory phenotypes of the probands are consistent with the previously reported for recessive variants in the MYO15A gene. The two novel variants, c.2802_2812del and c.5681T>C, were identified as deleterious mutations by bioinformatics analysis. Our findings extend the MYO15A gene mutation spectrum and provide more information for rapid and precise molecular diagnosis of congenital deafness.

TcpC is a virulence factor of uropathogenic E. coli (UPEC). It was found that TIR domain of TcpC impedes TLR signaling by direct association with MyD88. It has been a long-standing question whether bacterial pathogens have evolved a mechanism to manipulate MyD88 degradation by ubiquitin-proteasome pathway. Here, we show that TcpC is a MyD88-targeted E3 ubiquitin ligase. Kidney macrophages from mice with pyelonephritis induced by TcpC-secreting UPEC showed significantly decreased MyD88 protein levels. Recombinant TcpC (rTcpC) dose-dependently inhibited protein but not mRNA levels of MyD88 in macrophages. Moreover, rTcpC significantly promoted MyD88 ubiquitination and accumulation in proteasomes in macrophages. Cys12 and Trp106 in TcpC are crucial amino acids in maintaining its E3 activity. Therefore, TcpC blocks TLR signaling pathway by degradation of MyD88 through ubiquitin-proteasome system. Our findings provide not only a novel biochemical mechanism underlying TcpC-medicated immune evasion, but also the first example that bacterial pathogens inhibit MyD88-mediated signaling pathway by virulence factors that function as E3 ubiquitin ligase., Author summary Toll/interleukin-1 receptor domain-containing protein encoded by E. coli (TcpC) is an important virulence factor in many strains of uropathogenic E. coli (UPEC). TcpC-mediated evasion of innate immunity plays an important role in the pathogenesis of UPEC caused urinary tract infection (UTI) including pyelonephritis. In the present study, we show TcpC is an E3 ubiquitin ligase that promotes ubiquitination and degradation of MyD88, hereby blocking the TLR signaling pathway. Our findings not only illuminate the novel biochemical mechanisms underlying TcpC-mediated evasion of innate immunity, but also provide the first example that bacterial pathogens can subvert TLR signaling pathway through virulence factors that function as MyD88-targeted E3 ubiquitin ligase.

Genetic testing is the gold standard for exploring the etiology of congenital hearing loss. Here, we enrolled 137 Chinese patients with congenital hearing loss to describe the molecular epidemiology by using 127 gene panel testing or 159 variant testing. Sixty-three deaf children received 127 gene panel testing, while seventy-four patients received 159 variant testing. By use of 127 gene panel testing, more mutant genes and variants were identified. The most frequent mutant genes were GJB2, SLC26A4, MYO15A, CDH23, and OTOF. By analyzing the patients who received 127 gene panel testing, we found that 51 deaf children carried variants which were not included in 159 variant testing. Therefore, a large number of patients would be misdiagnosed if only 159 variant testing is used. This study highlights the advantage of 127 gene panel testing, and it suggests that broader genetic testing should be done to identify the genetic etiology of congenital hearing loss.

HD care may experience great stress with the coronavirus disease 2019 (COVID‐19) pandemic. A modified HD modality named bed‐sided short‐duration renal replacement therapy (BSRRT) was used in noncritical maintenance HD (MHD) patients diagnosed with COVID‐19 in Wuhan due to extreme situation. To determine the safety and efficacy as a substitution for intermittent HD (IHD), we conducted this study. We used the data of 88 noncritical COVID‐19 MHD patients collected from 65 medical units at the hospitals in Wuhan, China, from January 1 to March 10, 2020. t‐test, Wilcoxon rank sum test, and Fisher exact probability method were used to compare the baseline characteristics, treatment, and death. Log‐rank test and Cox regression multivariate analysis was used to compare the survival of noncritical patients who were transferred to BSRRT modality versus those who were continued on the IHD. Univariate analysis showed the level of reported fatigue symptom at present, bilateral lung computed tomography infiltration and steroid treatment differed between the two groups. The outcome of death of the two groups did not show significant differences in univariate analysis (P = .0563). Multivariate Cox regression analysis dialysis showed modality of treatment after COVID‐19 diagnosis was not a significant predictor of death (P = .1000). These data suggest that for noncritical COVID‐19 MHD patients, the transfer from IHD to BSRRT does not have significant difference in the risk of death compared with IHD group. This finding suggests this modified modality could be an option for the substitution for IHD during the COVID‐19 pandemic period.

Preeclampsia (PE) is a pregnancy-specific syndrome that substantially leads to maternal and fetal mortality. Multiple factors contribute to the disease, but the exact pathogenesis still remains elusive. Here we explored the roles of lncRNA MALAT1 and miR-206 in PE. qRT-PCR was applied to measure mRNA levels of MALAT1 and miR-206 in the placenta of PE patients. Scratch wound healing assay and transwell invasion assay were conducted to test the effects of MALAT1 and miR-206 on migration and invasion of trophoblast cells. In addition, we validated MALAT1/miR-206 and miR-206/IGF-1 interactions with dual luciferase reporter assay. Western bot was used to detect protein expressions of IGF-1, p-PI3K, PI3K, p-Akt and Akt. We found that MALAT1 was decreased but miR-206 was increased in the placenta of patients with PE. Inhibition of MALAT1, knockdown IGF-1, or miR-206 mimics suppressed the trophoblast cells migration and invasion, while overexpression of MALAT1, IGF-1 or miR-206 inhibitors exhibited opposite effects. Further, miR-206 was confirmed as a direct target of MALAT1. Besides, miR-206 inhibited IGF-1 expression by directly binding to the 3'UTR. Mechanistically, our study demonstrated that MALAT1 regulates IGF-1/PI3K/Akt signaling via miR-206. Together, these results suggest that MALAT1 and miR-206 play important roles in PE. MALAT1 regulates miR-206/IGF-1 axis, thereby modulating trophoblast cells migration and invasion through PI3K/Akt signal pathway. These results show light on the underlying mechanisms of PE and provide potential targets for PE therapy.Abbreviations: PE: Preeclampsia; lncRNA: Long-non-coding RNA; MALAT1: Metastasis-associated lung adenocarcinoma transcript 1; IGF-1: Insulin-like growth factor 1; PI3k: Phosphatidylinositol-4, 5-bisphosphate 3-kinase; Akt: Protein kinase B; GAPDH: Glyceraldehyde 3-phosphate dehydrogenase; qRT-PCR: Quantitative Reverse Transcription polymerase chain reaction; shRNA: Short hairpin RNA; siRNA: Small interfering RNA; EMT: Epithelial-mesenchymal transition.

ObjectivesWe aimed to develop and validate a postoperative delirium (POD) prediction model for patients admitted to the intensive care unit (ICU).DesignA prospective study was conducted.SettingThe study was conducted in the surgical, cardiovascular surgical and trauma surgical ICUs of an affiliated hospital of a medical university in Heilongjiang Province, China.ParticipantsThis study included 400 patients (≥18 years old) admitted to the ICU after surgery.Primary and secondary outcome measuresThe primary outcome measure was POD assessment during ICU stay.ResultsThe model was developed using 300 consecutive ICU patients and was validated using 100 patients from the same ICUs. The model was based on five risk factors: Physiological and Operative Severity Score for the enumeration of Mortality and morbidity; acid–base disturbance and history of coma, diabetes or hypertension. The model had an area under the receiver operating characteristics curve of 0.852 (95% CI 0.802 to 0.902), Youden index of 0.5789, sensitivity of 70.73% and specificity of 87.16%. The Hosmer-Lemeshow goodness of fit was 5.203 (p=0.736). At a cutoff value of 24.5%, the sensitivity and specificity were 71% and 69%, respectively.ConclusionsThe model, which used readily available data, exhibited high predictive value regarding risk of ICU-POD at admission. Use of this model may facilitate better implementation of preventive treatments and nursing measures.

Background Endovascular treatment has been recognized as the first line therapy for renal artery aneurysm (RAA). However, RAA related with malignancies had been sporadically reported in the literature. Stent insertion should be contraindicated for RAAs with malignant etiology, whereas surgery be optimal. Case presentation A 40-year-old female underwent covered stent insertion to exclude the left RAA for suspected Takayasu arteritis in a reginal hospital. Three months later the RAA recurred with sign of threatened rupture, and the patient was transferred for salvage embolization with coils and thrombin injection. However, 20 days after the embolization procedure, multiple painful subcutaneous nodules developed in her flanks. Undifferentiated sarcoma was revealed by the pathological biopsy of the nodules. The RAA in this case was most likely related with the malignancy. Conclusion Malignancy was the most likely etiology behind recurrent aneurysm in this case. Definite diagnosis is mandatory for interventional radiologists before stent insertion for treatment of RAA.

Background The influence of perioperative blood transfusion (PBT) on postsurgical survival of patients with different stage of hepatocellular carcinoma (HCC) is not well clarified. This study aimed to evaluate the impact of PBT on survival outcomes of different stage of HCC patients. Methods Consecutive patients who underwent liver resection for HCC between January 2009 and November 2015 were identified from an HCC prospective database in authors’ center. The survival outcomes were compared between patients receiving PBT and those without PBT before and after propensity score matching (PSM) in different stage subsets. Cox regression analysis was performed to verify the impact of PBT on outcomes of HCC. Results Among 1255 patients included, 804 (64.1%) were Barcelona Clinic Liver Cancer (BCLC) stage 0-A, and 347 (27.6%) received PBT. Before PSM, patients with PBT had worse disease free survival (DFS) and overall survival (OS) compared with those without PBT in both BCLC 0-A subset and BCLC B-C subset (all P P = 0.001) Similar result was observed for OS (36.0 months vs. 96.0 months, P = 0.001). In the subset of BCLC B-C, both DFS and OS were comparable between patients with PBT and those without PBT. Cox regression analysis showed that PBT involved an increasing risk of DFS (HR = 1.607; P P P = 0.126) or OS (P = 0.139) for those with stage B-C HCC. Conclusions PBT negatively influenced oncologic outcomes of patient with BCLC stage 0-A HCC, but not those with stage B-C after curative resection.

To investigate the effects of 4-week moderate aerobic exercise plus diet control on serum levels of total insulin-like growth factor 1(IGF-1) and IGF-1 binding protein-3 (IGFBP-3) as well as IGF-1 activity (reflected by molar ratio of IGF-1/IGFBP-3) in female obese adolescents and youths, and their possible role on fat loss, and improvement of glucose and lipid metabolism.Nine female obese youths (age:18~19 y) and 30 female obese adolescents (age:14~16 y) were recruited and undertook 4-week aerobic exercise such as swimming and jogging (6 days/week, twice a day, 2 h/time with 5 min rest per 30 min exercise) with gradual increase of intensity from low (heart rate immediately post-exercise of 1st week:100~120 beats/min) to moderate (heart rate immediately post-exercise of 2①Compared with normal control, the serum levels of total IGF-1 and IGFBP-3 were decreased in the female obese youths and adolescents, and IGF-1 activity was reduced only in the obese female adolescents. ②The serum level of IGFBP-3 was down-regulated and IGF-1 activity was up-regulated while no change of serum total IGF-1 was induced by 4-week moderate aerobic exercise plus diet control, accompanied with significant decreases of body weight, BMI and waist circumference as well as improvement of glucose and lipid metabolism in the female obese youths and adolescents. Except for a positive association between the increased IGF-1 activity and the decreased waist circumference was found in the female obese youths by Pearson's correlation analysis, there was no relation of the decreased IGFBP-3, the increased IGF-1 activity with the improvements of anthropometric index and glucose and lipid metabolism in female obese youths and adolescents.The serum level of IGFBP-3 was down-regulated and the IGF-1 activity was up-regulated by 4-week moderate aerobic exercise plus diet control in female obese youths and adolescents. The increase of IGF-1 activity might be associated with the exercise-plus-diet-induced decrease of waist circumstance in female obese youths.

Recently, there has been a growing interest in the roles of androgen in the development of obesity and obesity-related diseases such as diabetes, metabolic syndrome, atherosclerosis (AS), hypertension and cardiovascular diseases, as well as in the disorders of glucose and lipid metabolism. Androgen exerts its biological role mainly through binding to the androgen receptor (AR), one of the nuclear receptors widely expressed in multiple tissues such as the skeletal muscle, liver, adipose tissue and brain. Low testosterone and AR deficiency result in obesity, obesity-related diseases and metabolic disorders. Androgen regulates almost all the intracellular transduction pathways related to glucose and lipid metabolism, including key metabolic enzymes/proteins, nuclear transcription factors (PPARγ, LXRα and FoxO1), inflammation, leptin sensitivity of hypothalamus, proliferation and differentiation of adipocyte, mitochondrial function and vascular endothelial function. In addition, females with high androgen are more likely to develop obesity as well as glucose and lipid metabolism disorders, while the underlying mechanisms remain unclear. This review focuses on the role and underlying mechanisms of androgen and AR in the development of obesity and obesity-related diseases as well as glucose and lipid metabolism disturbance in men.

PURPOSE: Slight changes in urinary incontinence severity may be difficult to notice, so that even high functioning patients are unable to detect if urinary incontinence is improving or worsening. We describe a recently released free software app, iDry®, that enables individuals with urinary incontinence to document incontinence symptoms, view progress, evaluate effectiveness of interventions and report status to their health care provider. MATERIALS AND METHODS: After 2 field trials, iDry was published as a free download from the Apple® App Store and was downloaded 1,231 times in the first 19 months. iDry also collects large quantities of anonymized usage data for research purposes. RESULTS: Data analysis shows that long-term users had significantly more severe urinary incontinence symptoms (p ≤0.01) than short-term users. Short-term users reduced pad use by 20% but long-term users’ pad use remaining unchanged. Average leakage was reduced 14.6 mg per day for short-term vs 4.5 mg per day for long-term users, but this difference was not statistically significant (p=0.93) due to high data variability (SD 611). There was no significant difference between long-term and short-term users in severity of self-reported stress and urge incontinence. Bladder training positively correlated with a reduction in pad use (p=0.03) and leakage amount (p=0.02). CONCLUSIONS: Overall our findings suggest that iDry is a useful, accessible and convenient tool to document urinary incontinence symptoms and improvement, but controlled studies are needed to assess its effectiveness.

Embryo implantation is essential for a successful pregnancy, and leads to the decidualization of endometrial stromal cells (ESCs) in the secretory phase of the menstrual cycle. It has previously been demonstrated that decidual stromal cells (DSCs) co-express interleukin (IL)-25/IL-17RB and that IL-25 further promotes the proliferation of DSCs via activating c-Jun n-terminal kinase and protein kinase B signals, therefore the present study primarily focused on the role of IL-25 in the process of decidualization in vitro. It was demonstrated that the expression of IL-25/IL-17RB in ESCs was decreased compared with DSCs. In addition, following decidualization, the expression levels of IL-25/IL-17RB in ESCs were significantly elevated. Recombinant human (rh) IL-25 promoted the decidualization of ESCs in the presence of 8-bromoadenosine 3′,5′-cyclic monophosphate sodium salt and 6α-methyl17α-acetoxyprogesterone, which was partially inhibited by anti-human IL-25 neutralizing antibody (anti-IL-25) or anti-IL-17RB. In addition, decidual natural killer (dNK) cells not only secreted IL-25, however also further accelerated the decidualization in vitro. Therefore, these findings indicated that ESCs differentiate into DSCs in the presence of ovarian hormones, resulting in the upregulation of IL-25/IL-17RB expression in ESCs. Furthermore, IL-25 secreted by ESCs and dNK cells further facilitates the decidualization of ESCs, which may form a positive feedback mechanism at the maternal-fetal interface and thus contribute to the establishment and maintenance of normal pregnancy.

To study clinical efficacy of manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided.From April 2013 to August 2016, 30 patients with metacarpal neck fractures were treated with manual reduction and traction fixation under ultrasound-guided, including 26 males and 4 females aged from 14 to 56 years old with an average of (25.6±1.6) years old, the courses of diseases ranged from 7 h to 5 d with an average of (2.7±0.6) d. Twenty patients were the fifth metacarpal neck fracture, 7 patients were the 4th and 5th metacarpal neck fractures, 3 patients were the second metacarpal neck fracture. Fracture healing, angle of bilateral head shaft angle and active range of metacarpophalangeal joints was measured, and DASH score was applied to evaluate function.Twenty-seven patients were followed up from 6 to 11 months with an average of(7.2±0.8) months. Fracture were healed from 5 to 8 weeks with an average of (5.6±0.4) weeks. The affected shaft angle was (15.1±1.8)°, and health head shaft angle was (13.5±2.8)°, while there was no significant difference (Manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided could dynamic observe fracture position in time, high patients' acceptability and is a feasible method for the treatment of metacarpal neck fracture.

Mammalian proprotein convertases (PCs) play an important role in folliculogenesis, as they proteolytically activate a variety of substrates such as the transforming growth factor beta (TGFβ) superfamily. PC subtilism/kexin 6 (PCSK6) is a member of the PC family and is ubiquitously expressed and implicated in many physiological and pathological processes. However, in human granulosa cells, the expression of the PC family members, their hormonal regulation, and the function of PCs are not clear. In this study, we found that PCSK6 is the most highly expressed PC family member in granulosa cells. LH increasedPCSK6mRNA level and PCSK6 played an anti-apoptosis function in KGN cells. Knockdown ofPCSK6not only increased the secretion of activin A and TGFβ2 but also decreased the secretion of follistatin, estrogen, and the mRNA levels of FSH receptor (FSHR) andP450AROM(CYP19A1). We also found that, in the KGN human granulosa cell line, TGFβ2 and activin A could promote the apoptosis of KGN cells and LH could regulate the follistatin level. These data indicate that PCSK6, which is regulated by LH, is highly expressed in human primary granulosa cells of pre-ovulatory follicles and plays important roles in regulating a series of downstream molecules and apoptosis of KGN cells.

To review intermediate-term clinical outcomes of microwave ablation (MWA) compared with open radial nephrectomy (ORN) in small renal cell carcinoma (RCC) patients and to identify prognostic factors associated with two techniques.This retrospective study was institutional review board-approved. A total of 163 patients (127 men and 36 women) with small RCC (≤4 cm) were included from April 2006 to March 2012. Sixty-five patients underwent MWA and 98 patients underwent ORN. Survival, recurrence, and renal function changes were compared between the two groups. Effect of changes in key parameters (ie, overall survival, RCC-related survival, and metastasis-free survival) was statistically analyzed with the log-rank test.Although overall survival after MWA was lower than that after ORN (P = .002), RCC-related survival was comparable to ORN (P = .78). Estimated 5-year overall survival rates were 67.3% after MWA and 97.8% after ORN; for RCC-related survival, estimated 5-year rates were 97.1% after MWA and 97.8% after ORN. There was one local tumor recurrence 32 months after MWA and none after ORN. Major complication rates were comparable (P = .81) between the two techniques (MWA, 2.5% vs ORN, 3.1%). The MWA group had less surgical time (P.001), estimated blood loss (P.001), and postoperative hospitalization (P.001). Multivariate analysis showed age (P = .014), tumor type (P = .003), postoperative urea nitrogen (P = .042), comorbid disease (P = .005), and treatment modality (P.001) may become survival rate predictors.In intermediate term, ultrasonographically guided percutaneous MWA and ORN provide comparable results in oncologic outcomes. MWA appears to be a safe and effective technique for management of small RCC in patients with little loss of renal function.

Purpose: To compare the therapeutic effects of different doses of intravenous esomeprazole on treating trauma patients with stress ulcer bleeding. Methods: A total of 102 trauma patients with stress ulcer bleeding were randomly divided into 2 groups: 52 patients were assigned to the high-dose group who received 80 mg intravenous esomeprazole, and then 8 mg/h continuous infusion for 3 days; 50 patients were assigned to the conventional dose group who received 40 mg intravenous esomeprazole sodium once every 12 h for 72 h. Results: Compared with the conventional dose group, the total efficiency of the high-dose group and conventional dose group was 98.08% and 86.00%, respectively (p < 0.05), the hemostatic time was 22.10 h ± 5.18 h and 28.27 h ± 5.96 h, respectively (p < 0.05). Conclusion: Both doses of intravenous esomeprazole have good hemostatic effects on stress ulcer bleeding in trauma patients. The high-dose esomeprazole is better for hemostasis.

Apoptosis is an essential process for the maintenance of liver physiology. The ability to noninvasively image apoptosis in livers would provide unique insights into its role in liver disease processes. In the present work, we established a stable mouse model by hydrodynamics methods to study the activity of caspase-3 and evaluate the effect of the apoptosis inhibitors in mouse livers under true physiological conditions by bioluminescence imaging. The reporter plasmid attB-ANLuc(DEVD)BCLuc that contains fragment of attB and ANLuc(DEVD)BCLuc was codelivered with the mouse-codon optimized φC31 (φC31o) integrase plasmids specifically to mouse liver by hydrodynamic injection procedure. Then, φC31o integrase mediated intramolecular recombination between wild-type attB and attP site in mice, and thus the reporter expression cassette attB-ANLuc(DEVD)BCLuc was integrated permanently into mouse liver chromosome. We used these mice to characterize in vivo activation of caspase-3 upon treatment with LPS/D-GalN. Our data show that liver apoptosis could be reflected by the activity of luciferase. The shRNA targeting caspase-3 protein or apoptosis inhibitors could effectively downregulate luciferase activity in vivo. Also, this model could be used to measure caspase-3 activation during inflammatory and infectious events in vivo as verified by infected with MHV-3. This model could be used for screening anti-apoptosis compounds target mouse livers.

A multicentre prospective cohort study was performed in 17 intensive care units (ICUs) in tertiary care hospitals in Hubei Province, China. Ventilator-associated pneumonia (VAP) was defined according to modified criteria from the published literature. Among 4155 ventilated patients, the crude incidence and incidence rate of VAP were 20.9% and 28.9 cases per 1000 ventilator-days. Multivariate analysis using logistic regression revealed risk factors including male sex [risk ratio (RR): 1.5; P0.001], coma (RR: 2.1; P0.001), chronic obstructive pulmonary disease (RR: 1.4; P0.001), infections at other sites (RR: 1.6; P=0.001), serious disease predating the onset of VAP (RR: 1.6; P0.001) and interventions including antacid treatment (RR: 1.4; P0.001), antimicrobial treatment (RR: 5.1; P0.001), bronchoscopy (RR: 1.5; P=0.041) and tracheostomy (RR: 1.4; P=0.014). The most frequently isolated causative pathogens were Pseudomonas aeruginosa and Acinetobacter baumannii. Of all Staphylococcus aureus isolates, 45.7% were meticillin resistant. Rates, risk factors and causal pathogens of VAP in ICUs in Hubei differ from those reported from developed countries. These data show the need for more effective infection control interventions in Hubei, China.

Objective To determine the major risk factors and their interactions of ischemic stroke (IS) and to develop a classification tree model to predict the incidence risk of IS for a Chinese population. Methods Exhaustive Chi-squared Automatic Interaction Detection (Exhaustive CHAID) algorithm of classification tree method was applied to build a prediction model for the incidence risk of IS under the design of 1:1 matched case-control study. The statistics of misclassification risk was used to evaluate the fitness of the model. Results In the prediction model, six variables of physical exercise, history of hypertension, tea drinking, HDL-c level, smoking status and educational level were in turn selected as the predictors of IS incidence risk. In the subgroup of lacking of physical exercise, individuals who had history of hypertension would have a significantly higher IS risk (92%) than that of the ones who had no history of hypertension (64%). The misclassification risk estimate of the prediction model was 0.21 with the standard error of 0.02, indicating that 79% of the cases could be classified correctly based on current prediction model. Conclusions Lacking of physical exercise and history of hypertension are identified to be the prominent predicting variables of IS risk for a hospital population of southern China. Although CHAID analysis could provide detailed information and insight about interactions among risk factors of IS, we still need to validate our model and improve the vascular risk prediction for Chinese subjects in further studies.

Successive point prevalence surveys were conducted in November 2007 and 2008 to monitor the prevalence of healthcare-associated infection (HCAI) in 13 grade III, 1st class hospitals in Hubei Province of China, using the case definition criteria established by the Ministry of Health in the People's Republic of China. In total, of 20 350 patients surveyed, 833 (4.09%) HCAIs were observed in 790 (3.88%) patients. There was no significant difference between the overall prevalence of HCAI in 2007 (4.14%) and 2008 (3.72%). Respiratory tract infection was the most common HCAI (63.15%), followed by surgical site infection (9.60%) and urinary tract infection (8.64%). Only 35.29% (294/833) of HCAI patients had positive microbiology results. Gram-negative bacteria were isolated most frequently and the most frequent organism was Pseudomonas aeruginosa, followed by Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus. Antibiotic use was documented for 10,344 (50.83%) patients, and cephalosporins, penicillins, and quinolones were the most commonly used agents for treatment or prophylaxis.

Objective: To investigate whether a super-high dose (SHD) of methylprednisolone (MP) improves its efficacy or induces glucocorticoid (GC) resistance, and to explore the potential mechanisms of GC resistance in experimental allergic encephalomyelitis (EAE). Methods: The therapeutic effects of SHD and low-dose MP were evaluated in EAE by analyzing clinical scores, pathological changes and cytokine production. Immunohistochemistry and RT-PCR were used to investigate the expression of GC receptor (GR) isoforms and splicing factor SRp30c. Results: Both MP doses had similar therapeutic effects. The ratio of GRα to GRβ was positively correlated with clinical score changes. However, there was no difference in the GRα/GRβ ratio between SHD and low-dose MP groups. SRp30c mRNA was correlated with GRβ expression. Conclusion: This study indicates that the GRα/GRβ ratio is associated with GC sensitivity, and SRp30c may play an important role in promoting alternative splicing of GR pre-mRNA to generate GRβ in EAE rats. Compared with low-dose MP, SHD MP does not improve efficacy or induce GC resistance.

Microrchidia2 (MORC2) is a member of the MORC protein family that is localized to both the nucleus and cytoplasm when transiently expressed in gastric cancer cells. We identified and analyzed the functional domains of MORC2, which has specific unique structural characteristics compared to the other MORC proteins. Our data showed that nuclear localization signals (NLS) of MORC2 was mainly dependent on the NLS amino acids (aa) 657-781 and cytoplasmic localization of MORC2 was attributed to the nuclear export signal (NES) aa 481-657. Moreover, the NLS appears to predominate over the NES in the localization of full-length human MORC2 indicating that MORC2 is localized mainly in the nucleus. Our results also demonstrated that the NLS (aa 657-781) and proline-rich domain within MORC2 C-terminus were required for the transcriptional repressive role in cancer cells.

Rationale and Objectives The aim of this study was to investigate whether using a fractal dimension as an objective index (quantitative measure) to assess and control the "visual" or "texture" similarity of reference-image regions selected by a content-based image retrieval (CBIR) scheme would (or would not) affect the performance of the scheme in classification between image regions depicting suspicious breast masses. Materials and Methods An image data set depicting 1500 verified mass regions and 1500 false-positive mass regions was used. Fourteen morphologic and intensity distribution features and a fractal dimension were computed. A CBIR scheme using a k -nearest neighbor classifier was applied, and two experiments were conducted. In the first experiment, the CBIR scheme was evaluated using all 15 features. In the second experiment, the fractal dimension was used as a prescreening feature to guide the CBIR scheme to search for the most similar reference images that had similar measures in the fractal dimension. Results The CBIR scheme achieved classification performance with areas under the receiver-operating characteristic curve of 0.857 (95% confidence interval [CI], 0.844–0.870) using 14 features and 0.866 (95% CI, 0.853–0.879) after adding the fractal dimension ( P = .005 for both results). After using the fractal dimension as a prescreening feature, the CBIR scheme achieved an area under the receiver-operating characteristic curve of 0.851 (95% CI, 0.837–0.864), without a significant difference from the previous result using the original 14 features ( P = .120). The difference of fractal dimension values between the selected similar reference images was reduced by 56.7%, indicating improvement in image texture similarity. In addition, more than half of references were discarded early, without similarity comparisons, indicating improvement in searching efficiency. Conclusions This study demonstrated the feasibility of applying a fractal dimension as an objective (quantitative) and efficient search index to assess and maintain the texture similarity of reference mass regions selected by a CBIR scheme without reducing the scheme's performance in classifying suspicious breast masses.

The clinical utility of interactive computer-aided diagnosis (ICAD) systems depends on clinical relevance and visual similarity between the queried breast lesions and the ICAD-selected reference regions. The objective of this study is to develop and test a new ICAD scheme that aims improve visual similarity of ICAD-selected reference regions.A large and diverse reference library involving 3,000 regions of interests was established. For each queried breast mass lesion by the observer, the ICAD scheme segments the lesion, classifies its boundary spiculation level, and computes 14 image features representing the segmented lesion and its surrounding tissue background. A conditioned k-nearest neighbor algorithm is applied to select a set of the 25 most "similar" lesions from the reference library. After computing the mutual information between the queried lesion and each of these initially selected 25 lesions, the scheme displays the six reference lesions with the highest mutual information scores. To evaluate the automated selection process of the six "visually similar" lesions to the queried lesion, we conducted a two-alternative forced-choice observer preference study using 85 queried mass lesions. Two sets of reference lesions selected by one new automated ICAD scheme and the other previously reported scheme using a subjective rating method were randomly displayed on the left and right side of the queried lesion. Nine observers were asked to decide for each of the 85 queried lesions which one of the two reference sets was "more visually similar" to the queried lesion.In classification of mass boundary spiculation levels, the overall agreement rate between the automated scheme and an observer is 58.8% (Kappa = 0.31). In observer preference study, the nine observers preferred on average the reference lesion sets selected by the automated scheme as being more visually similar than the set selected by the subjective rating approach in 53.2% of the queried lesions. The results were not significantly different for the two methods (P = .128).This study suggests that using the new automated ICAD scheme, the interobserver variability related issues can thus be avoided. Furthermore, the new scheme maintains the similar performance level as the previous scheme using the subjective rating method that can select reference sets that are significantly more visually similar (P.05) than when using traditional ICAD schemes in which the mass boundary spiculation levels are not accurately detected and quantified.

Arsenic trioxide (As(2)O(3)) has been found to be effective for relapsed or refractory acute promyelocytic leukaemia, but its clinical use is burdened by QT prolongation, Torsade de pointes tachycardias, and sudden cardiac death. The aim of the present study was to elucidate the ionic mechanisms of As(2)O(3)-induced abnormalities of cardiac electrophysiology and the therapeutic action of choline on As(2)O(3)-caused QT prolongation in guinea pig. Intravenous administration of As(2)O(3) prolonged the QT interval in a dose- and time-dependent manner in guinea pig hearts, and the QT prolongation could be modulated by choline. By using whole-cell patch clamp technique and confocal laser scanning microscopy, we found that As(2)O(3) significantly lengthened action potential duration measured at 50 and 90% of repolarization, enhanced L-type calcium currents (I(Ca-L)), inhibited delayed rectifier potassium currents (I(K)), and increased intracellular calcium concentration ([Ca(2+)](i)) in guinea pig ventricular myocytes. Choline corrected As(2)O(3)-mediated alterations of action potential duration, I(Ca-L) and [Ca(2+)](i), but had no effect on the I(K) inhibition. As(2)O(3) markedly disturbed the normal equilibrium of transmembrane currents (increasing I(Ca-L) and suppressing I(K)) in guinea pig cardiomyocyte, and induced prolongation of action potential duration, further degenerated into QT prolongation. Choline normalized QT interval abnormality and corrected lengthened action potential duration by inhibiting the elevated I(Ca-L) and [Ca(2+)](i) in ventricular myocytes during As(2)O(3) application.

A method for quantitatively estimating lesion "size" from mammographic images was developed and evaluated. The main idea behind the measure, termed "integrated density" (ID), is that the total x-ray attenuation attributable to an object is theoretically invariant with respect to the projected view and object deformation. Because it is possible to estimate x-ray attenuation of a lesion from relative film densities, after appropriate corrections for background, the invariant property of the measure is expected to result in an objective method for evaluating the "sizes" of breast lesions. ID was calculated as the integral of the estimated image density attributable to a lesion, relative to surrounding background, over the area of the lesion and after corrections for the nonlinearity of the film characteristic curve. This effectively provides a measure proportional to lesion volume. We computed ID and more traditional measures of size (such as "mass diameter" and "effective size") for 100 pairs of ipsilateral mammographic views, each containing a lesion that was relatively visible in both views. The correlation between values calculated for each measure from corresponding pairs of ipsilateral views were computed and compared. All three size-related measures (mass diameter, effective size, and ID) exhibited reasonable linear relationship between paired views (r2>0.7, P

The most optimal management for postoperative locoregional recurrence of oesophageal squamous cell carcinoma is still controversial. Several studies have reported the feasibility and efficacy of concurrent chemoradiotherapy (CCRT), mostly with three-weekly or four-weekly schedule of chemotherapy. However, treatment compliance was not quite satisfactory, probably due to treatment-related toxicities. Since CCRT with weekly chemotherapy regimens have demonstrated a favorable toxicity profile as well as promising survival in certain types of cancer, we aimed to evaluate the efficacy and toxicity of radiotherapy concurrently with weekly chemotherapy with 5-fluorouracil (5-FU) and platinum agents for patients with postoperative locoregional recurrence of oesophageal squamous cell carcinoma in our center. Twenty-seven consecutive patients who were diagnosed with postoperative locoregional recurrence of oesophageal squamous cell carcinoma and received CCRT with weekly chemotherapy of 5-FU and platinum agents were retrospectively analyzed. Our data showed that the present protocol of radiotherapy combined concurrently with weekly chemotherapy of 5-FU and platinum agents was a safe and effective salvage treatment for postoperative locoregional recurrence of oesophageal squamous cell carcinoma.

This study aimed to determine the prevalence rate of knee osteoarthritis (OA) and the risk factors for OA in hospitalized elderly patients. We conducted this retrospective study in elderly patients (aged 65 years and older) who were hospitalized in the Geriatric Ward of General Hospital of Guangzhou Military Command of the People's Liberation Army between January 2011 and June 2013, including general condition, present history, past history, physical examination, X-ray results, and disease diagnosis. The prevalence, awareness, and treatment rates of knee OA in hospitalized elderly patients were calculated. Risk factors were computed using multiple logistic regression analysis. Of a total of 267 (17.4%) hospitalized elderly patients diagnosed with knee OA, the prevalence rate of OA was 9.95% in males and 37.76% in females. The rate of awareness among those with OA was 51.68%; the rate of treatment was 83.33%; and the rate of control was 77.39%. The medical expenses for both females (1143±315 yuan month-1) and males (1192±357 yuan month-1) in knee OA patients are higher than that of the non-knee OA group (989±274 yuan month-1, 1038±295 yuan month-1). The risk factors for knee OA include gender (OR=2.448), age (OR=1.124), transportation mode (OR= 8.972), exercise (OR=7.374), bowel evacuation position (OR=5.767), family history of knee OA (OR=2.195), and body mass index (OR=2.469). The prevalence of knee OA is unexpectedly high in hospitalized elderly patients, and the rates of awareness and treatment are less than desirable. Prevention and control measures should be taken in patients with concomitant risk factors.

Objective To clarify the role and mechanism of interleukin (IL)-25 in regulating the biological functions of decidual stromal cells (DSCs) in human early pregnancy. Design Laboratory study of the effect of IL-25 induced by hCG on the proliferation of DSCs. Setting Research laboratories. Patient(s) Women aged 23–47 years with normal pregnancy and abortion. Intervention(s) None. Main Outcome Measure(s) Signal transduction from IL-25. Result(s) Here we show that DSCs coexpress IL-25/IL-17RB. Human chorionic gonadotropin promotes the expression of IL-25/IL-17RB. In contrast to anti-human IL-25 neutralizing antibody, recombinant human IL-25 (rhIL-25) significantly stimulates the proliferation of DSCs in dosage- and time-dependent manners. RhIL-25 promotes the phosphorylation of AKT, extracellular-signal-regulated kinases 1/2 (ERK1/2), c-Jun N-terminal kinases (JNK), and nuclear factor κB in DSCs. Interestingly, blocking JNK or AKT signal with inhibitors down-regulates the stimulatory effect on DSC proliferation induced by rhIL-25. In addition, the results of Western blot show that the expression of IL-25/IL-17RB in DSCs from normal pregnancy was higher than that from abortion. Conclusion(s) Our results have revealed that hCG derived of trophoblasts up-regulates the expression of IL-25/IL-17RB in DSCs and that IL-25 further stimulates the proliferation of DSCs through activating JNK and AKT signals, which finally contributes to the establishment and maintenance of physiological pregnancy.

To explore whether hypoxia and interleukin 8 (IL-8) regulate the viability and apoptosis of cervical carcinomas cells and the possible mechanism. We evaluated the expression of hypoxia inducible factor-1α (HIF-1α), IL-8 and its receptors (CXCR1 and CXCR2) in cervical cancer and cervicitis tissues by immunohistochemistry. Then the effects of hypoxia and IL-8 on the viability and apoptosis of HeLa and SiHa cells were detected by the SRB and apoptosis assays. Here we observed that the expression of HIF-1α, IL-8 and CXCR1 in cervical cancer tissues was significantly higher than that in cervicitis tissues. Hypoxic condition stimulated the secretion of IL-8 and the expression of CXCR1 and CXCR2 on HeLa and SiHa cells. Recombinant human IL-8 enhanced the viability and reduced the apoptosis in HeLa and SiHa cells. HeLa and SiHa cells cultured in 1% oxygen showed the increased viability and apoptosis, and the former effect could be partly reversed by anti-human IL-8 neutralizing antibody. This data suggested that IL-8 secreted by cervical carcinomas cells induced by hypoxia can stimulate the viability of cervical carcinomas cells in an autocrine dependent manner, and contribute to the pathogenesis of cervical cancer.

Erythroid differentiation-associated gene (EDAG) has been considered to be a transcriptional regulator that controls hematopoietic cell differentiation, proliferation, and apoptosis. The role of EDAG in erythroid differentiation of primary erythroid progenitor cells and in vivo remains unknown. In this study, we found that EDAG is highly expressed in CMPs and MEPs and upregulated during the erythroid differentiation of CD34+ cells following erythropoietin (EPO) treatment. Overexpression of EDAG induced erythroid differentiation of CD34+ cells in vitro and in vivo using immunodeficient mice. Conversely, EDAG knockdown reduced erythroid differentiation in EPO-treated CD34+ cells. Detailed mechanistic analysis suggested that EDAG forms complex with GATA1 and p300 and increases GATA1 acetylation and transcriptional activity by facilitating the interaction between GATA1 and p300. EDAG deletion mutants lacking the binding domain with GATA1 or p300 failed to enhance erythroid differentiation, suggesting that EDAG regulates erythroid differentiation partly through forming EDAG/GATA1/p300 complex. In the presence of the specific inhibitor of p300 acetyltransferase activity, C646, EDAG was unable to accelerate erythroid differentiation, indicating an involvement of p300 acetyltransferase activity in EDAG-induced erythroid differentiation. ChIP-PCR experiments confirmed that GATA1 and EDAG co-occupy GATA1-targeted genes in primary erythroid cells and in vivo. ChIP-seq was further performed to examine the global occupancy of EDAG during erythroid differentiation and a total of 7,133 enrichment peaks corresponding to 3,847 genes were identified. Merging EDAG ChIP-Seq and GATA1 ChIP-Seq datasets revealed that 782 genes overlapped. Microarray analysis suggested that EDAG knockdown selectively inhibits GATA1-activated target genes. These data provide novel insights into EDAG in regulation of erythroid differentiation. Stem Cells 2014;32:2278–2289

To investigate the incidence and clinical features of non-Clostridium difficile (C. difficile) associated nosocomial diarrhea in intensive care unit (ICU) caused by Klebsiella oxytoca and Clostridium perfringens.The faeces of 102 patients with non-C. difficile associated nosocomial diarrhea in ICU of West China Hospital, were collected during April to November, 2012. The target bacterial genes were detected by PCR amplification and sequencing, including toxic gene pehX of Klebsiella oxytoca, species-specific 16S rRNA gene and toxic gene cpa and cpe of Clostridium perfringens, species-specific 16S rRNA gene with mapA and toxic gene hipO of Campylobacter jejuni. Clinical features of the patients with positive results were summarized.Among 102 patients with non-C. difficile associated nosocomial diarrhea, 4 patients (3.9%) were detected with toxic Klebsiella oxytoca while 4 patients (3.9%) were detected with toxic Clostridium perfringens. No toxic Campylobacter jejuni was detected. Most of the patients had severe underlying diseases and poor final outcome, accepted potent antibiotics which disturbed intestinal flora obviously..Non-C. difficile associated nosocomial diarrhea in ICU caused by Klebsiella oxytoca is and Clostridium perfringens is associated with severe diseases and poor outcome, but the incidence in our hospital is relatively low in our hospital.

Endarterectomy and bypass surgery to treat renal artery stenosis are increasingly shunned these days due to high risks of complications during and after the surgery. Striving to find a sound alternative solution, we pioneered the construction of a tissue engineered renovascular graft that could immediately restore the normal blood flow to kidneys and sustain renal functions without suffering restenosis after the surgery. A highly porous scaffold was first constructed by electrospinning polycaprolactone, poliglecaprone, gelatin and elastin, giving the vast majority of non-woven fibers in the scaffold a diameter below 1200 nm. To recapitulate the anatomical and functional signatures of renal arteries, a bi-layer vasculature comprising a smooth muscle layer topped by an endothelial layer was built on the scaffold. The vasculature witnessed a sustained proliferation for up to 10 days in vitro and robustly secreted prostacyclin and endothelin-1, evidencing that the vasculature was functionally comparable to native renal arteries. After 30 days as a renovascular graft in mice, the luminal diameter of the graft remained clear without a restenosis and an increased confluence of the endothelial layer was observed. The tensile test confirmed that the renovascular graft was mechanically superior to native renal arteries and retained this advantage within 30 days in vivo. Also, this renovascular graft sustained renal functions as evidenced by normal levels of serum creatinine, urine creatinine and serum urea nitrogen and the lack of edema in the kidney cortex. These results demonstrate that this renovascular graft holds a great therapeutic promise for renal artery stenosis.

To investigate the curative effect of early enteral nutrition (EN) supplemented with probiotics (bifidobacterium) in patients with severe acute pancreatitis (ASP).Seventy SAP cases admitted from January 2005 to October 2012 were randomly assigned into parenteral nutrition (PN) group (n=22), EN group (n=25) and bifidobacterium added EN (P+EN) group (n=23). In P+EN group, patients were given their nutrition the same as that of EN, and also probiotics (bifidobacterium, 4 capsules every 12 hours, given through nasal gastric tube, each capsule weighing 210 mg). The routine treatment including anti-infection and anti-acid agents, and that of inhibition of pancreatic secretion were given, except for the different nutritional interventions in all groups. The blood samples were collected for e same measurements of interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) by enzyme linked immunosorbent assay (ELISA), and for the C-reactive protein (CRP), lactic acid dehydrogenase (LDH), white blood cell (WBC) count, amylase and lipase by biochemistry assay 1 day before intervention of nutrition, and 7 days and 14 days after intervention. Changes in organ function and outcome were also recorded at the same time points.The plasma levels of IL-8, TNF-α, CRP, LDH, WBC count, amylase and lipase were significantly reduced after nutritional intervention compared with their levels on day 1 before intervention in all three groups. The plasma IL-8, TNF-α, CRP, lipase, LDH at 14 days after intervention of nutrition in P+EN group were significantly lower than those in PN group and EN group (IL-8: 21.00 ± 7.07 μg/L vs. 48.00 ± 10.32 μg/L, 32.00 ± 9.30 μg/L; TNF-α: 44.3 ± 10.9 ng/L vs. 132.1 ± 34.1 ng/L, 67.8 ± 22.3 ng/L; CRP: 35.0 ± 12.4 mg/L vs. 103.2 ± 49.2 mg/L, 63.0 ± 29.2 mg/L; lipase: 269 ± 79 U/L vs. 670 ± 145 U/L, 310 ± 78 U/L; LDH: 21.8 ± 10.3 U/L vs. 78.1 ± 37.4 U/L, 37.9 ± 25.1 U/L, P0.05 or P0.01). The WBC count in P+EN group was significantly lower than that in PN group (5.9 ± 3.0 × 10⁹/L, 6.3 ± 3.2 × 10⁹/L vs. 9.6 ± 3.0 ×10⁹/L, both P0.05), but there was no significant difference in amylase between P+EN group and PN group (211 ± 49 U/L, 236 ± 52 U/L vs. 298 ± 71 U/L, P0.05). The gastrointestinal dysfunction score in P+EN, EN, PN groups 14 days after nutritional intervention was 0.28 ± 0.05, 0.43 ± 0.09, 0.71 ± 0.11, respectively, with statistically significant differences (all P0.01). Compared with PN and EN groups, the incidence of upper gastrointestinal bleeding (1 vs. 9, 2), infection and abscess (2 vs. 12, 5) was lower (all P0.01), and hospital day was significantly shortened in P+EN group (10.4 ± 3.9 days vs. 25.8 ± 6.4 days, 13.4 ± 5.2 days, both P0.01). There was no significant statistical difference in mortality rate among three groups.Our results indicated that early EN with addition of probiotics (bifidobacterium) resulted in significant lowering of the level of pro-inflammatory cytokines, earlier restoration of gastrointestinal function, decrease of complications such as infection, and shortening of hospital day in patients with SAP.

Background Despite the scale-up of prevention of mother-to-child transmission (PMTCT) programs worldwide, the translation from research studies into public health policy has been slow. This report details the experiences of a city-driven PMTCT program in China using existing health resources. Methods The PMTCT program was devised to hospital based and city-wide. It achieves full use of available resources: the local Centers for Disease Control and Prevention, the Infectious Disease Hospital, Maternal and Child Health Hospitals, and all qualified comprehensive hospitals. Results From 2000 to 2010, 1,843,122 pregnant women attended prenatal care or labor and delivery services. Overall, 97.4% received pretest HIV counseling, and 96.2% were tested for HIV. Among the 81.1% (1,495,122) of women who attended prenatal clinics, 97.2% (1,452,753) received pretest counseling and 95.7% (1,430,799) were tested for HIV. Among the 18.9% (348,000) of women with an undocumented HIV status at labor and delivery, 98.6% (343,038) received pretest counseling, and 98.1% (341,371) were tested for HIV. In total, 229 women were determined HIV positive for a prevalence of 1.3 per 10,000 pregnant women. Among the 107 HIV-infected women who carried to delivery, 87.9% received antiretroviral prophylaxis for themselves and their infants. Among the 58 women who were identified HIV positive at labor, 10.3% of mothers and 72.4% of infants received antiretroviral prophylaxis. The estimated mother-to-child transmission rate was 5.3% (95% confidence interval, 2.2%-10.7%). Conclusions With appropriate integration, existing health care resources are adequate for a comprehensive city-driven PMTCT program in an area with a low HIV prevalence.

To analyze the major complications of percutaneous cooled-tip microwave ablation for the treatment of primary liver cancer and the possible risk factors of severe complications in a series of 693 patients.The clinicopathological data of 693 patients with primary liver cancer who underwent ultrasound-guided percutaneous cooled-tip microwave (MW) ablation in our hospital over the past 5 years were retrospectively analyzed, and the risk factors of severe complications were explored.In a total of 693 patients with 898 primary liver tumors were treated and 1111 MW ablation sessions were performed. The mean diameter of tumors was (2.5 ± 1.2) cm and the range was 0.4 - 10.0 cm. Three deaths occurred in the peri-ablation period, including one case died of multiorgan failure, one case died of pulmonary embolism and one case died of hepatorenal syndrome. Major complications occurred in 27 (3.9%) patients, including 12 pleural effusion requiring thoracentesis (1.7%), 10 tumor seeding (1.4%), 3 liver abscess and empyema (0.4%), 1 hemorrhage requiring arterial embolization (0.1%), and 1 bile duct injury (0.1%). The Chi-square test results showed that the diameter of tumors, number of MW ablation sessions and histological type of tumor were significantly associated with the major complications rate (P0.05). The multiple variables 1ogistic regression analysis showed that only type of tumors was associated with the major complication rate (P0.05).Results of this study confirm that cooled-tip MW ablation is a relatively low-risk and effective minimally invasive procedure for the treatment of primary liver cancer. Proper direction for the treatment of cholangiocarcinoma (ICC) patients as well as fewer ablated tumor numbers during one hospital stay may help minimize the major complication rate in patients with primary liver cancer treated by ultrasound-guided percutaneous cooled-tip microwave ablation.

The effects of prenatal cocaine exposure on the development of the rabbit cerebral cortex were studied. Two cortical areas were compared: primary visual cortex (VC) and anterior cingulate cortex (ACC). ACC was selected because behavioral deficits observed in cocaine-exposed infants suggest the involvement of ACC. In addition, ACC receives dense dopaminergic innervation and cocaine's action in inhibiting the re-uptake of dopamine is believed to underly the rewarding properties of cocaine. VC was selected as a control area because there is no evidence of behavioral deficits associated with visual perception in cocaine-exposed infants, and because VC receives minimal dopaminergic innervation. Two aspects of cortical development were studied: (i) cortical morphology, growth and cytoarchitectonic organization; and (ii) the development of the GABAergic neurotransmitter system. Measures of postnatal cortical growth, including cortical lamination, cell number and soma size, were compared in cocaine-exposed or control (saline) rabbits aged P5-P60. There was no difference between cocaine and saline animals in any of these parameters, and cortical cytoarchitecture appeared normal. However, despite the absence of major abnormalities in cortical development, we found that the number of GABA-immunoreactive neurons in cocaine-exposed animals was significantly higher than normal in ACC. This effect was highly consistent, was present in all laminae and at all ages studied, and persisted into maturity (P60). In contrast, in VC, the number of GABA-immunoreactive neurons in cocaine-exposed animals did not differ from normal. We suggest that increased GABA immunoreactivity may reflect a compensatory response to excessive excitatory input to ACC. A change in the balance of excitation and inhibition in ACC, reflecting 'noisy' or dysfunctional intracortical circuitry, may underly the emotional lability and attentional deficits characteristically described in infants exposed in utero to cocaine.

To verify the feasibility of electroacupuncture analgesia applied to gynecologic outpatient operation.Two hundred patients were randomly divided into an electroacupuncture analgesia group and an intravenous anesthesia group, 100 cases in each group. Operation types included artificial abortion, diagnostic curettage and remove of intrauterine divice. The electroacupuncture analgesia group was treated with electroacupuncture at bilateral Hegu (LI 4) and Neiguan (PC 6), and the routine gynecologic outpatient operation was performed under patients' waking state. The intravenous anesthesia group was treated with routine gynecologic outpatient operation after intravenous injection of fentanyl and propofol.The excellent rate and the effective rate of analgesia were 88.0% (88/100) and 100.0% (100/100) in the electroacupuncture analgesia group, and 94.0% (94/100) and 100.0% (100/100) in the intravenous anesthesia group, with no statistically significant differences between the two groups (all P0.05). There was no adverse reaction in the electroacupuncture anesthesia group, but 11 cases of adverse reactions in the intravenous anesthesia group.Electroacupuncture analgesia can effectively alleviate the pain during gynecologic outpatient operation and it is simple and safe without adverse reactions.

To explore the influence of T lymphocyte activation on HIV-1 susceptibility of Han Chinese.In 2008, 37 HIV-1 highly exposed persistently seronegative individuals (ESNs) and 101 healthy controls were screened from Shenzhen. Flow cytometer was used to assay the expression difference of HIV-1 infection related co-receptor, the difference between the two groups were analyzed by Mann-Whitney U statistics methods.T cell HLA-DR(+) CD4 T cells and HLA-DR(+) expression of ESNs (12.64 (5.94 - 21.90), 21.12 (10.74 - 30.21)) were all significantly lower than that of healthy controls (22.52 (7.91 - 58.60), 32.28 (14.72 - 67.82)) (P values all0.05). T cell CD45RA-RO(+), CCR5(+)CD4 expression of ESNs (58.68 (49.06 - 72.44), 21.93 (15.84 - 25.89)) were all significantly higher than that of healthy controls (53.17 (42.63 - 63.21), 16.14 (11.94 - 21.98)) (P values all0.05). T cell CXCR4(+)CD4 T cells expression of ESNs (93.67 (92.17 - 94.96)) was significantly lower than that of healthy controls (95.16 (92.99 - 96.77)) (P values all0.05). Healthy controls and ESNs could be divided into low expression group and high expression group according to HLA-DR(+)CD8 T cells bimodal distribution. A total of 89.2% (33/37) ESNs fell into HLA-DR + CD8 low expression group, and 58.4% (59/101) of the healthy controls located in low expression group (P0.05).To Han Chinese, the low activation status of T lymphocyte has significant correlation with HIV-1 low susceptibility.

To investigate the epidemiological characteristics of HIV-1 subtype in Shenzhen from 1992 to 2008.489 HIV-1 positive plasma samples were collected from 1992 to 2008 in Shenzhen. HIV-1 env genes were amplified by nested-PCR from RNA. Phylogenetic analysis was performed on data regarding the nucleotide sequence.A total of 464 sequences were amplified and genotyped. Data from this study revealed that CRF01_AE was a predominant HIV-1 subtype in Shenzhen (64.4%, 299/464), followed by subtypes CRF_BC (17.5%, 81/464), B' (14.7%, 68/464) and B (2.4%, 11/464). Subtype C (0.4%, 2/464), A1 (0.2%, 1/464), CRF02_AG (0.2%, 1/464) and CRF06_cpx (0.2%, 1/464) were also prevalent in Shenzhen. CRF01_AE and CRF_BC were predominant among heterosexuals, homosexuals and injection drug users, while B' was predominant among blood donors. Results from phylogenetic tree analysis showed that some of the HIV-1 clusters had been defined in CRF01_AE strains at different time or groups with different transmission routes. Cross-infections were also seen.CRF01_AE was the predominant HIV-1 subtype in Shenzhen while CRF_BC, B, B', C, A1, CRF02_AG and a small amount of CRF06_cpx or recombinant subtypes were prevalent in this city. Different subtypes showed great variation in the process of epidemics.

To retrospectively review intermediate-term (median, 20.1 months) clinical outcomes after microwave ablation (MWA) of renal cell carcinoma (RCC).This retrospective study was approved by the institutional review board. The results from 46 patients with 49 RCC nodules (diameter, 0.6-7.7 cm; mean, 3.0 cm ± 1.5 [standard deviation]) treated with ultrasonography (US)-guided percutaneous MWA with cooled-shaft needle antenna from April 2006 to December 2010 were reviewed. One antenna was used for tumors smaller than 2 cm; two, for tumors 2 cm or larger. The patients were followed up with contrast material-enhanced US and computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter. The effect of changes in key parameters (including overall survival, disease-free survival, and local tumor progression rate) was statistically analyzed by using the log-rank test.Technical effectiveness (complete ablation at follow-up enhanced imaging 1 month after MWA) was achieved in 48 of 49 (98.0%) tumors, and the metastasis-free rate was 100% (46 of 46). The 1-, 2-, and 3-year local tumor progression rates were 4.6%, 7.7%, and 7.7%, respectively. The cancer-specific survival rate was 100% (46 of 46), and 1-, 2-, and 3-year overall survival rates were 100%, 100%, and 97.8%, respectively. The 1-, 2-, and 3-year disease-free survival rates were 95.4%, 92.3%, and 92.3%, respectively. No major complications occurred. Multivariate analysis showed that tumor number (P = .046), tumor growth patterns (P = .003), and ablation time (P = .04) were independent unfavorable prognostic factors.In the intermediate term, US-guided percutaneous MWA appears to be a safe and effective technique for the management of RCC, especially small RCC, in selected patients.