Military Medical University Research Articles

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension*

BACKGROUNDModerate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVETo observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGNA randomized controlled trial. SETTINGDepartment of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALSTwenty healthy little pigs, either male or female, weighing 4.5 – 5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODSThe experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n = 10) and moderate hypothermia group (n = 10). (1) Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3-]. (2) Rectal temperature was monitored with mercurial thermometer. (3) Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. (4) Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3 and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 °C using ice bags, and the body temperature was maintained at 33 – 35 ºC for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES(1) MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; (2) Results of blood gases analysis in the moderate hypothermia group. RESULTSAll the 20 pigs were involved in the analysis of results. (1) MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ºC, P < 0.05]. (2) Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSIONModerate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.

Effects of different nerve autografts on greater auricular nerve deficit in rabbits

Effects of different nerve autografts on greater auricular nerve deficit in rabbits

Clinical prediction for outcomes of patients with acute-on-chronic liver failure associated with HBV infection: A new model establishment.

ObjectiveThe acute-on-chronic liver failure associated with hepatitis B virus (HBV-ACLF) was a type of clinical syndrome with rapid deterioration of liver function. It was characterized by short-term elevated bilirubin, ascites, prolonged clotting time, hepatic encephalopathy, organ failures, and high short-term mortality. It was important to predict and evaluate the disease early. This study intended to comprehensively analyze the prognostic factors of patients with ACLF associated with HBV DNA infection through clinical manifestations and laboratory tests, and to establish a corresponding prediction and evaluation model for further clinical guidance.MethodsA total of 220 patients were first diagnosed with HBV-ACLF and admitted to and treated at the Department of Infectious Diseases of the First Affiliated Changhai Hospital of the Second Military Medical University from 2009 to 2018. These patients’ records were collected and divided into two groups: (1) 120 patients who were improved and discharged were classified as good prognosis group and (2) 100 patients who died or underwent liver transplantation were classified as poor prognosis group. By analyzing baseline characteristics and clinical indicators of the two groups, the main potential factors affecting prognosis were identified and the corresponding prognostic evaluation model was established. This model’s advantages and disadvantages were compared with classic prognostic scoring systems.ResultsThe proportion of ascites and the proportion of hepatic encephalopathy of poor prognosis group were significantly higher than those of good prognosis group. The total bilirubin, creatinine, white blood cell count, and NEU (%) levels of poor prognosis group were significantly higher than those of good prognosis group, and the international normalized ratio, albumin (ALB), alanine aminotransferase, Na, Cl, RBC, and PLT levels of poor prognosis group were significantly lower than those of good prognosis group. A new prediction model LR(p) = 1/(1 + e −Z) was established, where z = 10.0127 + 0.3687 × NEUT (%) − 0.0082 × PLT + 1.8157 × hepatic encephalopathy. The area under receiver operating characteristic (ROC) curve was 0.89, specificity was 80.83%, and sensitivity was 81%. The newly established prognostic model was compared with other three scoring systems including model for end-stage liver disease (MELD), MELD-Na, and ALBI scores. The results showed that the specificity, sensitivity, and area under the ROC curve of the newly established model were significantly higher than the other three scoring systems.ConclusionHepatic encephalopathy, NEU (%), and PLT levels were independent risk factors for predicting the prognosis of HBV-ACLF. The new prediction model LR(p) had better prediction accuracy than the other three scoring models of MELD, MELD-Na, and ALBI and could more accurately assess the prognosis of HBV-ACLF, but in the later stage, it was still necessary to expand the sample size for verification.

First-aid Training for Combatants Without Systematic Medical Education Experience on the Battlefield: Establishment and Evaluation of the Curriculum in China

For combatants without systematic medical education experience (CSMEE), it is necessary to participate in first-aid on the battlefield, but currently there is no effective training curriculum for CSMEE in Chinese military. A list of first-aid techniques based on expert consensus was formed, and then a curriculum was established according to the list. The effectiveness of the curriculum was further evaluated by comparing the scores among group A (the reserve officers trained by this curriculum), group B (the reserve officers in the military medical college trained by professional medic training system), and group C (the fresh officers trained by the Outline of Military Training and Assessment of Chinese military), through a 5-station assessment in a simulated battlefield environment, which included the following 5 techniques: tourniquet for massive extremities hemorrhage, thyrocricocentesis, thoracentesis, fixation of long bone fractures, and wound dressing with hemostatic bandage. The training curriculum entitled "Implementation and Assessment Standards of First-aid Training for Combatants on the Battlefield" was established. The comparison of average scores in the 5-station assessment showed that group A had better scores than group C in tourniquet for massive extremity hemorrhage, thyrocricocentesis, and thoracentesis, with no significant differences compared with group B. Also, no significant difference between groups A and B in overall completion time and overall scores was observed, whereas an excellent candidate rate in overall score of group B was better than that of group A (87.4% vs. 80.9%, χ2=4.40, p=0.036), and group A was better than group C (80.9% vs. 37.5%, χ2=62.01, p<0.001). The established training curriculum is indeed effective, which improved the CSMEE's first-aid capacity on the battlefield, and is equivalent to the level of medics.

Dental injuries at the Xi'an, China Stomatological Hospital: A Retrospective Study.

In order to enrich epidemiological knowledge regarding traumatic dental injuries (TDI) in China, and to further improve the treatment, prevention and education of TDI, the aim of this study was to retrospectively analyze the TDI that presented to the emergency dental department at the Stomatological Hospital in Xi'an, China. This retrospective study included all first-visit patients who presented with TDI at the Stomatological Hospital affiliated with the Fourth Military Medical University in Xi'an, China, between January 2013 and June 2019. Data were extracted using the terms of diagnosis of TDI from the hospital database. Overall, 965 (606 males and 359 females) files were reviewed. The average age was 22.8±13.4years. Among the 2059 teeth injured (average of 2.1 teeth per patient), the maxillary incisors (1751; 85.0%) were the most prevalent teeth to present with injuries, while the main types of injuries were concussions (14.8%) enamel-dentin-fractures (14.50%) and enamel-dentin-pulp fractures (14.0%). After initial examination and diagnosis, 4.2% patients refused treatment. The epidemiological statistics of TDI in Xi'an, China show consistency with other studies from around the world, but they also vary in diagnosis proportion and the choice of treatments. This information may further instruct treatment, prevention and emergency resources distribution to target the high-risk groups.

Later approach sinus floor elevation using deproteinized bovine bone mineral with staged implant placement: follow-up for more than 3 years in a prospective clinical study

Objective: To evaluate clinical effect of deproteinized bovine bone for delayed implantation after fenestration. Methods: This trial is a continuation of a prospective clinical trial. From May 2011 to February 2015 in Department of Implantology, School of Stomatology, The Fourth Military Medical University after planting division of 55 cases of maxillary teeth missing area of residual alveolar bone height ≤5 mm patients. There were 21 female and 34 male patients, their average age were (55.2±7.1) years. A total of 62 side fenestration of maxillary sinus floor lift, clinical and imaging examination, evaluation of implant retention rate, complications, peripheral soft tissue health and marginal bone resorption. Results: A total of 82 implants were followed up in 41 patients. The average follow-up time was (51.8±14.3) months (36-78 months). The follow-up rate of the maxillary sinus was 75.8% (47/62), the follow-up rate of the implant was 73.9% (82/111), and the implant survival rate was 98.8% (81/82). The bone resorption results at the implant margins were (0.64±0.63) mm (-0.28 mm, 1.47 mm) in the near and (0.49±0.73) mm (-0.51 mm, 1.21 mm) in the far, the improved hemorrhage index was 0.46±0.72, the improved plaque index was 0.60±0.87, and the keratinized mucosa width was (2.14±1.22) mm. The incidence rate of peri-implant mucositis was 28.4% (23/81) among 23 implants, and there was no complication of peri-implant inflammation. Conclusions: This study shows that under the condition of insufficient sinus ridge spacing in the maxillary posterior area, it is feasible to use bovine bone alone to remove protein for delayed implantation of maxillary sinus floor elevation by windowing, and the clinical effect is reliable.

Application of a Faecalibacterium 16S rDNA genetic marker for species identification of dog fecal waste.

A dog-associated 16S rDNA genetic marker (ED-1) was designed to detect dog fecal contamination in water through a comparative bioinformatics analysis of Faecalibacterium sequences. For the dog fecal samples, ED-1 had 100% specificity, a high positive rate (89% in dog feces and 92.3% in dog fecal-contaminated water samples), and a low detection limit (107 copies/100mL) in dog-contaminated water samples. Detection of water samples from seven provinces or cities of China showed that ED-1 was stable enough to be applied in practice. Furthermore, the abundance and diversity of dog gut microbiota from two private house pets (PHP) and Third Military Medical University (TMMU) dogs were estimated by using operational taxonomic units, and the significant differences of dog feces were found, as the PHP dogs have a more diverse diet and closer contact with human than dogs in TMMU. However, ED-1 could detect the feces from the two regions, indicating that ED-1 has good reliability.

Inpatients Admitted with a Chief Complaint of Pain Have Lower In-Hospital Mortality: A Single-Center Study of 645,998 Inpatients

BackgroundThe relationship between pain and mortality risk has not been well established. AimsThis study aimed to assess the possible association between a chief complaint of pain and in-hospital mortality. DesignRetrospective cohort study using 11-year hospital administrative data. SettingSouthwest Hospital of Third Military Medical University (Chongqing, China). ParticipantsA total of 645,998 adult inpatients admitted without department limitation between January 1, 2003, and December 31, 2013. MethodsInformation on the chief complaint at admission was obtained, and the main outcome measure was in-hospital mortality. ResultsThe crude overall in-hospital mortality rate for patients admitted with chief complaint of pain was 958 (3.9%), which was significantly lower than that of patients without pain (1,970, 4.9%). The risk of hospital death for inpatients admitted with pain was 21% lower compared to inpatients admitted without pain (p < .001). Female patients with a chief complaint of pain had a lower risk of in-hospital mortality (p < .001) compared with male patients (p < .001). When stratified by location of pain, patients with chest pain had a significantly higher risk of in-hospital mortality compared with those without complaint of pain (p < .001), whereas for patients with a chief complaint of waist, abdominal, limb, or joint pain, the risk of hospital death was lower compared with cases without pain. ConclusionsThe present study suggested that inpatients admitted with a chief complaint of pain might have a significantly lower risk of in-hospital mortality compared with those admitted without a chief complaint of pain.

Clinical application effect of modified nasopharyngeal swab sampling for 2019 novel coronavirus nucleic acid detection

Objective: To study the clinical application effect of modified nasopharyngeal swab sampling for 2019 novel coronavirus nucleic acid detection. Methods: This study covered the period from January 14 to March 1, 2020.The supine position method and the protective face screen were used to collect nasopharyngeal swabs from February 24 onwards, before which, the nasopharyngeal swabs were collected by sitting position method. All the patients who were diagnosed with suspected/confirmed 2019 novel coronavirus infection were admitted from February 19 with the nasopharyngeal swabs collected outside the hospital before admission. (1) Thirty-four swabbing operators meeting the inclusion criteria of the study were recruited in this retrospective cohort study. They were grouped according to the collection method of nasopharyngeal swabs. Sixteen operators of Wuhan Taikang Tongji Hospital who applied the supine position method and the protective face screen were included in supine position method+ protective face screen group (15 males and 1 female, aged 34-49 years); 18 operators (12 from the First Affiliated Hospital of Army Medical University (the Third Military Medical University), 1 from Wuhan Jiangxia Mobile Cabin Hospital, 5 from the East District of People's Hospital of Wuhan University) who applied the traditional sitting position method were included in sitting position method group (2 males and 16 females, aged 25-49 years). In supine position method+ protective face screen group, when collecting sample, the patient lay flat and wore a special protective face screen for nasopharyngeal swab sampling, with neck slightly extending and face turning to the opposite side of the operator about 10°. The self-designed questionnaire was used to investigate the cooperation, the incidence of nausea, coughing, sneezing, and struggling of patients evaluated by the operators, the operation time for a single swab sample, the fear of operation and the perceived exposure risk of operators in the two groups. (2) Sixty-five patients (22 males and 43 females, aged 25-91 years) admitted to Wuhan Taikang Tongji Hospital who successively received the sitting position method and supine position method+ protective face screen for nasopharyngeal swabs sampling and with complete nucleic acid detection results were included. The positive rates of nucleic acid detection by the two sampling methods of nasopharyngeal swabs of the patients were statistically analyzed. (3) Forty-one patients who could express their feelings accurately were selected out of those 65 patients (12 males and 29 females, aged 27-83 years). The comfort of patients in the process of sampling by the two methods was investigated. (4) Thirty-four patients (10 males and 24 females, aged 25-83 years) with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method were selected from the above 65 patients. The positive rate of nucleic acid detection of nasopharyngeal swab of patients by supine position method+ protective face screen, i. e. negative to positive rate was statistically analyzed. Data were statistically analyzed with t test, Wilcoxon signed rank test, and chi-square test. Results: (1) Compared with those of sitting position method group, the cooperation score of patients evaluated by the operators in supine position method+ protective face screen group was significantly higher (Z=-4.928, P<0.01), the incidence of nausea, choking cough, sneezing, and struggling of patients evaluated by the operators, and the fear of operation score and the perceived exposure risk score of operators in supine position method+ protective face screen group were significantly lower (Z=-5.071, -5.046, -4.095, -4.397, -4.174, -5.049, P<0.01), and the operation time for a single swab sample in supine position method+ protective face screen group was significantly longer (t=223.17, P<0.01). (2) The positive rate of nucleic acid detection of nasopharyngeal swabs by supine position method+ protective face screen was 60.00% (39/65), which was obviously higher than 41.54% (27/65) by sitting position method (χ(2)=4.432, P<0.05). (3) The comfort score of the 41 patients during nasopharyngeal swabs sampling by supine position method+ protective face screen was significantly higher than that by sitting position method (Z=-5.319, P<0.01). (4) Of the 34 patients with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method, the rate of negative to positive of nucleic acid detection was 26.47% (9/34) after sampling by supine position method+ protective face screen. Conclusions: Compared with the traditional sitting position method, detection of 2019 novel coronavirus nucleic acids of nasopharyngeal swabs collected by supine method combined with protective face screen is worth promoting, because of its better comfort of patients, low exposure risk for operators, in addition to reducing in the false negative result to some extent, which may help reduce false recurrence of discharged patients.

Spindle cell/sclerosing rhabdomyosarcoma: a clinicopathological study of 20 cases

Objective: To study the clinicopathological features and immunophenotype of spindle cell/sclerosing rhabdomyosarcoma (SRMS) in adults and children, as well as its correlation with the expression and gene-mutations of MYOD1. Methods: Twenty cases of SRMS were collected at Xijing Hospital, Fourth Military Medical University from 2009 to 2019. These cases were evaluated for clinical, pathological, and immunohistochemical features. MYOD1 gene sequencing was performed on 12 cases with available tissue and sufficient DNA quantity using Sanger sequencing. Results: The 20 patients included 12 children and 8 adults, 11 males and 9 females, with an age range of 8 months to 85 years (mean 22 years). Most of them presented with a painless, progressively enlarged solid mass. The tumors occurred in head and neck (7 cases), abdominal and pelvic cavity (7 cases, including 4 in abdominal cavity, 2 in pelvic cavity, 1 in abdominal and left thoracic cavity), upper limb (5 cases, including 2 in left shoulder, 1 in right armpit, 1 in right humerus, and 1 in left forearm), and the back (1 case). The diameter of these tumors ranged from 2.5 to 20 cm, with a mean of 6.2 cm. Histologically, all of the tumors were mainly composed of spindle cells arranged in fascicles, and in 7 cases, at least in part, arranged in herringbone pattern, resembling adult fibrosarcoma. Foci reminiscent of interstitial sclerosing were presented in 4 cases, pseudovascular structures in 2 cases, loosely myxoid stroma in 4 cases, and varying degree of necrosis in 9 cases. A various number of spindled or polygonal rhabdomyoblasts were observed between spindle cells in 3 cases.Among them,16 cases showed spindle cell morphology, 2 cases showed scleroisng morphology, and 2 cases showed a hybrid phenotype of spindle, sclerosing and primitive undifferentiated areas. Immunohistochemically, the tumor cells were positive for desmin, Myogenin and/or MyoD1, but negative for CKpan, ALK1, CD34, EMA, HMB45, SMA, H-cald and S-100. Four cases (4/12) harbored a homozygous or heterozygous MYOD1 (p.L122R) mutation. MYOD1-mutant SRMS usually had diffuse and strong nuclear MyoD1 positivity. Follow-up was available in 12 cases, ranged from 1 to 51 months. At the end of follow-up period, 3 patients died of the disease, 3 patients developed local recurrences, 2 patients survived with disease. Conclusions: SRMS is a rare type of rhabdomyosarcoma, and more commonly occurs in the head and neck of children than adults. MYOD1-mutant SRMS usually had diffuse and strong nuclear MyoD1 positivity, frequently associated with a more aggressive behavior.

Clinical application of three cases of transcarotid artery revascularization

Objective: To investigate the surgical indications, preoperative evaluation, technical points, perioperative management and effect of transcarotid artery revascularization (TCAR) in the treatment of carotid stenosis. Methods: From March to April 2019, three patients with carotid stenosis undergoing TCAR in the Second Affiliated Hospital of Naval Military Medical University. With the common carotid artery approach, under the protection of the carotid-femoral vein reverse blood flow, the balloon dilatation of the internal carotid artery stenosis and stent implantation to achieve the purpose of carotid revascularization.The patient's general condition, preoperative evaluation, intraoperative operation, postoperative management and complications were recorded in detail. The clinical safety, efficacy and efficacy of TCAR in the treatment of carotid stenosis were evaluated. Results: All three operations were successful, including 2 cases of left carotid artery revascularization and 1 case of right carotid artery revascularization. A total of 3 carotid stents were implanted. The operation time was 65, 59, and 55 min,the intraluminal operation time was 13, 18, and 11 min, the common carotid artery blocked time was 15, 20, and 13 min, the contrast agent was 20, 25,15 ml, respectively. There was no death, no nervous system and other related complications during the perioperative period. Three patients were followed up for 7, 7, and 6 months without death, there were no nervous system diseases and other complications. All patients with ultrasound indicated that the carotid artery stent was patency. Conclusion: TCAR adopts the neuroprotection system of carotid-femoral vein continuous reverse blood flow to prevent transient ischemic attack (TIA) and stroke, and it is a safe and effective treatment for carotid artery stenosis.

Investigating the Relationship between Demographic Characteristics and Life Style of Medical University Students in a Military Medical University

Investigating the Relationship between Demographic Characteristics and Life Style of Medical University Students in a Military Medical University

Mechanism of transcriptional regulation of Meox1 by transforming growth factor β (1) and its effect on cell migration of adult human dermal fibroblasts

Objective: To explore the transcriptional regulation mechanism of transforming growth factor β(1) (TGF-β(1)) on Meox1 and its effect on cell migration of adult human dermal fibroblasts (HDF-a). Methods: (1) HDF-a cells were cultured in RPMI 1640 complete medium (hereinafter referred to as routinely cultured). The cells were divided into TGF-β(1) stimulation group and blank control group. The cells in TGF-β(1) stimulation group were stimulated with 10 μL TGF-β(1) in the mass concentration of 1 mg/μL, while the cells in blank control group were stimulated with the equal volume of phosphate buffer solution. After 72 hours in culture, partial cells in both groups were collected for transcriptome sequencing. The genes with differential expression ratio greater than or equal to 2 and P 0.05); the enrichment of Smad4 protein on the promoter of Meox1 in the cells of empty plasmid group was similar to that of Smad4 OE group (t=0.60, P>0.05). (5) Twenty-four hours after scratching, the scratch healing width of cells in siRNA-Meox1 group was narrower than that of negative interference group, while that of Meox1 OE group was wider than that of empty plasmid group. After 24 hours in culture, the number of migration cells in negative interference group was significantly higher than that in siRNA-Meox1 group (t=9.12, P<0.01), and that in empty plasmid group was significantly lower than that in Meox1 OE group (t=8.99, P<0.01). (6) The expression of Meox1 protein in the scar tissue was significantly higher than that in normal skin of patients with hypertrophic scars. Conclusions: TGF-β(1) transcriptionally regulates Meox1 expression via Smad2/3 in HDF-a cells, thus promoting cell migration.

Mutation profiles of classic myeloproliferative neoplasms detected by a customized next-generation sequencing-based 50-gene panel

Abstract Objective: A sequencing panel consisting of 50 genes was customized to reveal the potential molecular land-scapes of essential thrombocytosis, polycythemia vera, and primary myelofibrosis in Chinese patients with myeloproliferative neoplasm (MPN). Methods: Sixty-five MPN patients (38 with essential thrombocytosis, 21 with polycythemia vera, and 6 with primary myelofibrosis), including 12 triple-negative patients, were recruited and were screened for their mutational spectrum using next-generation sequencing technology in this retrospective observational study. This study was approved by the Institutional Review Board of Changhai Hospital, Naval Military Medical University, China. Results: In addition to the typical driver mutations in JAK2, CALR, and MPL, pathogenic mutations in 15 other genes were frequently detected among the 65 patients with MPN. The 15 mutated genes were TET2, EZH2, ASXL1, MIR662, MLH1, MLH3, SF3B1, MSH6, BARD1, DNMT3A, KIT, MSH2, RUNX1, TP53, and NRAS in this order according to the mutational frequency detected. The average number of mutated genes was 1.2 genes per patient, while in the 12 triple-negative patients with MPN (ie, patients that lack the JAK2, CALR, or MPL mutations), at least one of the 15 pathogenic mutations was detected for each patient. Interestingly, 4 single nucleotide polymorphisms (rs4858647, rs9376092, rs58270997, rs621940) that might be correlated to individual susceptibility to myeloproliferative neoplasm were identified among the 65 patients. We also found that single nucleotide polymorphism and/or single nucleotide variation mutations occurred in multiple loci of mismatch repair-related genes, which might contribute to the development of MPN. Conclusion: Our study confirms the importance of the previously known MPN relative genes and, more importantly, provides some new and potentially valuable information about mutations associated with MPNs.

Management of ophthalmic perioperative period during 2019 novel coronavirus disease outbreak

Objective To explore the perioperative management and infection prevention methods for acute eye diseases during the outbreak of 2019 novel coronavirus disease (COVID-19). Methods Since the COVID-19 was included in the Class B infectious diseases and was managed according to Class A infectious diseases in China, 127 patients who underwent ophthalmic surgery were enrolled at First Affiliated Hospital of Army Military Medical University from January 21 to February 19,2020. The perioperative management according to the national epidemic prevention and control requirements was summarized, and the perioperative clinical management that should be taken during the epidemic prevention period were discussed. Results One hundred and twenty-seven patients underwent ophthalmic surgeries, including emergency surgery, daytime surgery and other surgeries for sight-threatening diseases. The methods of anesthesia included general anesthesia, local anesthesia and ocular superficial anesthesia. According to the national epidemic prevention and control requirements, epidemic screening for these patients and infectious managing measures were performed during the perioperative period, including the sterilization of relevant environment and equipments, the personal medical prevention and protection for medical staffs and patients, which made surealltheoperationswent smoothlyand safely. There were no 2019-nCoV infection, surgical-relative infection, crossing infection and operation-related complications occurred. Meanwhile, there were not COVID-19-related infection events of medical staffs. The air sampling compliance rate in the operating room, ward, examination and other areas was 100%. Conclusions During the prevention and control period of the epidemic of COVID-19, strict adherence to the prevention and control measures can effectively ensure the smooth implementation of the operation and the perioperative safety of medical staff and patients. Key words: Corona virus disease-19; Eye diseases/surgery; Infectious management; Perioperative period; Opthalmology

Age progression from vicenarians (20-29year) to nonagenarians (90-99year) among a population pharmacokinetic/pharmacodynamic (PopPk-PD) covariate analysis of propofol-bispectral index (BIS) electroencephalography.

Pharmacokinetic/pharmacodynamic (PK/PD) modeling has made an enormous contribution to intravenous anesthesia. Because of their altered physiological, pharmacological and pathological aspects, titrating general anesthesia in the elderly is a challenging task. Eighty patients were consecutively enrolled divided by decades from vicenarians (20-29year) to nonagenarians (90-99year) into eight groups. Using target controlled infusion (TCI) and electroencephalographic (EEG)-derived bispectral index (BIS) we set propofol plasma concentration (Cp) to gradually reach 3.5μgmL-1 over 3.5-min. In each patient, we constructed a PK/PD model and conducted a population PK/PD (PopPK-PD) covariate analysis. Age was significant covariate for baseline BIS effect (E0), inhibitory propofol concentration at 50% BIS decline (IC50) and maximum BIS decline (Emax). First-order rate constant Ke0 of 0.47min-1 in vicenarians (20-29year) gradually increased with age-progression to 1.85min-1 in nonagenarians (90-99year). Simulation modelling showed that clinically recommended Cp of 3.5μgmL-1 for 20-29year BIS 50 should be reduced to 3.0 for 30-49year, 2.5 for 50-69year and 2.0 for 80-89year. We quantified and graded EEG-BIS age-progression among different age groups divided by decades. We demonstrated deeper BIS values with decades' age progression. Our data has important implications for propofol dosing. The practical information for physicians in their daily clinical practice is using propofol Cp of 3.5μgmL-1 might not yield BIS value of 50 in elderly patients. Our simulations showed that the recommended regimen of Cp 3.5μgmL-1 for 20-29year should be gradually decreased to 2.0μgmL-1 for 80-89year. European Community Clinical Trials Database EudraCT (http://eudract.emea.eu) initial trial registration number: 2011-002847-81, and subsequently registered at www.clinicaltrials.gov; trial registration number: NCT02585284. Xijing Hospital of Fourth Military Medical University ethics committee approval number 20110707-4.

Assessment of left ventricular dysfunction of sarcomere mutation carriers in hypertrophic cardiomyopathy by three-dimensional speckle tracking imaging combined with conventional echocardiography

Objective To explore the value of three-dimensional speckle tracking imaging (3D-STI) and conventional echocardiography in evaluating left ventricular function characteristics of sarcomere mutation carriers in hypertrophic cardiomyopathy. Methods Totally 91 subjects with sarcomere mutations in family HCM but without left ventricular hypertrophy (G+ /P- group), and 100 normal family members with gender and age matched as the control group (G-/P- group) were enrolled from the center of hypertrophic cardiomyopathy of Xijing Hospital affiliated to the Air Force Military Medical University from February 2013 to April 2017. They all received the comprehensive evaluation of 3D-STI and conventional echocardiography. The ultrasonic paramaters between the two groups were compared. And the diagnostic performance of these paramaters with sarcomere mutations was evaluated. Results Compared with the G-/P- group, the G+ /P-group had larger left atrial diameter (LAD), longer left ventricular isovolumic relaxation time (IVRT), reduced mitral annular systolic velocity (e′), elevated E/e′ ratio, as well as impaired left ventricular global longitudinal and radial strain(GLS and GRS) (P<0.05). Moreover, the GLS≤19.9%(AUC 0.861, sensitivity 61.4%, specificity 98.5%) and IVRT≥75.5 ms(AUC 0.762, sensitivity 61.4%, specificity 72.6%) showed the best diagnostic performance with sarcomere mutations (P<0.05). Conclusions In HCM family members, the sarcomere mutations carriers without left ventricular hypertrophy exhibit impaired left ventricular diastolic function, reduced longitudinal and radial systolic function.Moreover, the GLS and IVRT show the best diagnostic performance for those with sarcomere mutations. Key words: Three-dimensional speckle tracking imaging; Hypertrophic cardiomyopathy; Sarcomere mutation carriers; Ventricular function, left

Salivary Glycopatterns as Biomarkers for Differential Diagnosis of HBV-Induced Cirrhosis and Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, however, there has been little success in developing effective blood-based methods for early detection of HCC. The present study systematically investigated the alterations in salivary glycopatterns related to HBV-infected chronic liver diseases, and evaluated the possibility of saliva-based protein glycopatterns as potential biomarkers for diagnosis of HBV-induced cirrhosis (HC) and HCC. Methods: The correlation of alterations in salivary glycopatterns related to HBV-infected chronic liver diseases were investigated in the discovery cohort. The diagnostic models of HC and HCC were constructed based on the alterations of salivary glycopatterns in training and validation cohort. This study enrolled 491 patients with HBV-infected chronic liver diseases and 156 age- and sex-matched healthy volunteers between January 2010 and May 2017. The availability of the diagnostic models was confirmed by an independent test in a single-blind cohort with 104 subjects from January 2018 to January 2019. A small-scale lectin microarray based on the candidate lectins that exhibited significant alterations of protein glycopatterns in saliva with the development of HCC, and the constructed models of HC and HCC were used for diagnosis of HC and HCC. Findings: The diagnostic models of HC indicated that Model HC referred to three lectins (MAL-I, AAL and DSA) had higher diagnostic accuracy (AUC: 0·76, sensitivity: 0·82 and specificity: 0·73) in the validation cohort and a blind-test accuracy of 0·856 for distinguishing HC from HB and HCC patients. The diagnostic models of HCC indicated that Model HCC referred to four lectins (MAL-I, RCA120, LTL, and MAL-II) had higher diagnostic accuracy (AUC: 0·85, sensitivity: 0·71 and specificity: 0·82) in the validation cohort and a blind-test accuracy of 0·875 for distinguishing HCC from HB and HC patients. Notably, 20 cases of 21 HCC with AFP(-) were identified as HCC-positive by Model HCC. Interpretation: The salivary glycopatterns could be used as biomarkers for differential diagnosis of HBV-infected chronic liver diseases and should be further examined in larger studies. Funding Statement: This research is supported by National Natural Science Foundation of China (No. 81372365, to Li and 81670577, to Guo). Declaration of Interests: The authors declared no competing interests. Ethics Approval Statement: The collection and use of saliva for the research presented here were approved by the Ethical Committee of Northwest University, Shaanxi Provincial People’s Hospital, Xi’an Jiaotong University and Fourth Military Medical University (Xi’an, China). Written informed consent was received from participants.

The Prevalence of Single and Multiple Thyroid Nodules and Its Association with Metabolic Diseases in Chinese: A Cross-Sectional Study.

Purpose The present study aims to investigate the prevalence of single and multiple thyroid nodules and its association with metabolic diseases in subjects who participated in the heath examination in China. Methods This is a cross-sectional study. The participants who attend the physical examination at the Health Management Center of Southwest Hospital, Army Military Medical University, between January 2014 and December 2018, were included. Thyroid nodules were diagnosed by thyroid ultrasound. Multivariable logistic regression was used to investigate the association between metabolic diseases and nodular thyroid disease. Results A total of 9,146 subjects were included in this study; of them, 2,961 were diagnosed with thyroid nodules, with a prevalence of 32.4%. The prevalence in women was significantly higher than that in men (45.2% vs 26.0%; χ2 = 339.56, P < 0.001), and the prevalence was gradually increased with age (Z = 20.05, P < 0.001), and the prevalence was gradually increased with age (Conclusions The prevalence of thyroid nodules was relatively high. Age, female gender, and diabetes are positively associated with nodular thyroid disease. High LDL cholesterolemia is more likely to be associated with multiple thyroid sarcoidosis.

MPDZ As a Novel Epigenetic Silenced Tumor Suppressor Inhibits Growth and Progression of Lung Cancer Through the Hippo-YAP Pathway

MPDZ is involved in signal transduction mediated by the formation of protein complexes. However, the expression regulation, clinical significance, potential function and mechanism of this gene in lung cancer remain unclear. Methylation status of MPDZ was measured by methylation-specific PCR and bisulfite genomic sequencing. Kaplan-Meier and Cox regression analyses were performed to identify the prognostic value of MPDZ. The tumor suppressing effects of MPDZ were determined in vitro and in vivo. The target molecules and signaling pathway that mediated the function of MPDZ were also identified. MPDZ methylation was identified in 61.2% of primary lung cancer tissues and most lung cancer cell lines but not in normal lung tissues. MPDZ expression was significantly downregulated in lung cancer tissues and negatively associated with DNA hypermethylation, and attenuated MPDZ expression predicted a poor outcome. Furthermore, MPDZ overexpression prominently dampened cell growth, migration and invasion of tumor cells. Conversely, MPDZ knockdown promoted cell proliferation, migration and invasion in vitro and in vivo. Importantly, MPDZ promotes tumor suppressor ability depends on the Hippo pathway-mediated repression of YAP. MPDZ activates the phosphorylation of YAP (Ser127) and inhibits YAP expression through interaction with MST1/LATS/YAP complex. Moreover, MPDZ deficiency promotes tumor metastasis and reduces the survival of MPDZ knock-out mice. We first identified and validated that MPDZ methylation and expression could be a good diagnostic marker and independent prognostic factor for lung cancer. MPDZ functions as a tumor suppressor by inhibiting cell proliferation, migration and invasion through regulating the Hippo-YAP signaling pathway. Funding Statement: This work was supported by grants from the National Natural Science Foundation of China (No. 81573179 and 81573114). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study was approved by the Clinical Research Ethics Committee of the Third Military Medical University, and informed consent was obtained from all patients. All experimental animal procedures were approved by the Institutional Animal Care and Use Committee of Third Military Medical University, China.