Types IIa Research Articles

Identification of Differentially Expressed Genes in Different Types of Broiler Skeletal Muscle Fibers Using the RNA-seq Technique.

The difference in muscle fiber types is very important to the muscle development and meat quality of broilers. At present, the molecular regulation mechanisms of skeletal muscle fiber-type transformation in broilers are still unclear. In this study, differentially expressed genes between breast and leg muscles in broilers were analyzed using RNA-seq. A total of 767 DEGs were identified. Compared with leg muscle, there were 429 upregulated genes and 338 downregulated genes in breast muscle. Gene Ontology (GO) enrichment indicated that these DEGs were mainly involved in cellular processes, single organism processes, cells, and cellular components, as well as binding and catalytic activity. KEGG analysis shows that a total of 230 DEGs were mapped to 126 KEGG pathways and significantly enriched in the four pathways of glycolysis/gluconeogenesis, starch and sucrose metabolism, insulin signalling pathways, and the biosynthesis of amino acids. Quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to verify the differential expression of 7 selected DEGs, and the results were consistent with RNA-seq data. In addition, the expression profile of MyHC isoforms in chicken skeletal muscle cells showed that with the extension of differentiation time, the expression of fast fiber subunits (types IIA and IIB) gradually increased, while slow muscle fiber subunits (type I) showed a downward trend after 4 days of differentiation. The differential genes screened in this study will provide some new ideas for further understanding the molecular mechanism of skeletal muscle fiber transformation in broilers.

Diagnosis and classification of Mirizzi syndrome

Objective. To determine the factors, predisposing to development of Mirizzi syndrome; to improve diagnosis and classification of it, taking into account of these factors and possibilities to apply a definite kind of endoscopic or operative treatment.
 Materials and methods. Retrospective analysis was done for results of treatment of 21 patients with Mirizzi syndrome: Type I in accordance to classification of McSherry (1982) was present in 7 patients, while a Type II - in 14.
 Results. There was established, that atypia (the variant anatomy) of the ductus cysticus localization predisposes for contact between hepaticocholedochus and a gallbladder of with ductus cysticus, leading to development of Mirizzi syndrome Types I and II. Squeezing (Type I) or fistula (Type II) are observed on any level of hepaticocholedochus. In syndrome of Mirizzi Type II the duct distal to fistula may be not dilated (Subtype IIA) or dilated (Subtype IIB).
 Conclusion. Atypia (the variant anatomy) of the ductus cysticus duct constitute a factor, promoting development of Mirizzi syndrome. While diagnostic process for Mirizzi syndrome it is necessary to take into account a localization of squeezing of hepaticocholedochus or of fistula, presence of atypia of the ductus cysticus and its stump localization, character of the gallbladder inflammation, quantity and size of calculi. Proposition to include the Types IIA and IIB II in Mirizzi syndrome, depending on the dilation degree present in hepaticocholedochus distally, to the fistula, constitutes a substantiated principle, because it takes into account a possibility to perform endoscopic lithoextraction and to impact the choice of the surgical treatment method.

Management of the bone loss by metaphyseal sleeves in primary and revision knee arthroplasty: clinical experience and outcome after forty three cases.

Management of metaphyseal bone loss in complex primary and revision TKA is a challenge for surgeons. Out of various types of bony defects, large metaphyseal bone loss (AORI types IIB and III) requires special augments in the form of cones or sleeves. The aim of this study is to assess the reliability of metaphyseal sleeves, in dealing with massive bone defects to provide stability for immediate weight bearing and also to check short to mid-term survivorship of metaphyseal sleeves in Asian population by assessing various parameters and complications. This is a retrospective study that includes 36 patients (43 knees), operated from 2011 to 2019. Patients with AORI type IIB (large metaphyseal bone defect) and AORI type III (metaphyseal defect with compromised collateral ligaments) were included. We included both the primary and revision knee arthroplasties in our study. Our interest in this study was to look for incidence of intra-operative iatrogenic fracture on the one hand, and post-operative complications in the form of peri-prosthetic joint infection and aseptic loosening on the other hand. Knee Society Score (KSS) was used to assess improvement in patient's clinical outcome. SPSS version 23 was used to process data. The average age of patients in our study was 59.4 (SD 9.78) years. Male to female ratio was 21:15. The average follow-up was 5.42 (SD 2.24) years with the longest follow up of nineyears. Metaphyseal sleeves were used in 12 primary TKA and 31 revision TKA. During surgery, iatrogenic fracture of tibial condyle was encountered in three patients (6.9%), all were managed without any intervention and union was achieved in all cases. There was not a single case with aseptic loosening as per radiological criteria in our study. Peri-prosthetic joint infection (PJI) was encountered in a single case (2.3%). Pre-op Knee Society Score (KSS) was 36.21 (SD 7.43) where as it improved to 92.00 (SD 5.66),sixmonths after surgery. Also the range of flexion was increased from 76.83o (SD 14.07o) to 122.91o (SD 4.84o). In our study, metaphyseal sleeves showed excellent short to mid-term survivorship in AORI types IIB and III boneloss in Asian population. These results are comparable to various studies conducted on North American and European population. Metaphyseal sleeve is a reliable tool in the armamentarium ofthe arthroplasty surgeon. It is user friendly implant and provides immediate stability to allow full weight-bearing mobilization.

Anterior Clinoidal Meningiomas: Meningeal Anatomical Considerations and Surgical Implications.

Objective: Surgical removal of anterior clinoidal meningiomas (ACMs) remains a challenge because of its complicated relationship with surrounding meninges, major arteries and cranial nerves. This study aims to define the meningeal structures around the anterior clinoid process (ACP) and its surgical implications.Methods: Five dry skulls and 19 cadavers were used in the anatomical study. Cadavers were prepared as transverse, coronal, and sagittal plastinated sections, and the meningeal architecture around the ACP was studied with dissecting and confocal microscopies. The database of meningiomas in one single center was retrospectively reviewed, and the patients with ACMs were collected for clinical analysis.Results: The superior, lateral, medial surfaces, and the tip of ACP were covered by different layers and types of meninges. The ACMs were classified into four main types based on the sites of origin, possible extending pathways following meningeal dura. In the retrospective cohort of 131 ACMs, the percentage of types I, IIa, IIb, III, and IV were 42.0% (55/131), 19.8% (26/131), 9.2% (12/131), 16.8% (22/131), and 12.2% (16/131), respectively. We found that types IIa and I had higher chances for achieving Simpson grade 1–2 resection (92.3 and 85.4%, respectively), followed by type III (54.5%) and type IV (31.3%), while type IIb showed little chance of Simpson grade 1–2 resection. Univariate and multivariate analyses revealed ACM classification and tumor size (<3 cm) to be independent risk factors for achieving more extensive resection.Conclusion: The meningeal architecture around the ACP may guide and determine the origin and extension of ACMs. The classification based on the meningeal architecture helps to understand surgical anatomy as well as predicting surgical outcomes.

Anatomical and clinical study of a new mallet fracture classification method.

BackgroundMallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a bony fragment. This study was performed to evaluate the anatomical characteristics of mallet fractures, investigate a new mallet fracture classification system using anatomical and imaging methods, and discuss the treatment schemes for different types of mallet fracture.MethodsSixty-four fresh cadaveric fingers were divided into four groups, and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%, 50%, 75%, and 100% of the bilateral collateral ligaments. The effect of mallet fractures on the stability of the distal interphalangeal joint was then observed. The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture, the thickness of fracture, the untreated time after injury, and the complication of distal interphalangeal joint palmar subluxation. Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion, the Ishiguro method, or single Kirschner wire fixation.ResultsThe established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral ligaments were cut off by 25% (t = –0.415, P = 0.684) and significantly unstable when this range was ≥50% (50% transection: t = –6.363, P < 0.001; 75% transection: t = –17.036, P < 0.001; 100% transection: t = –30.977, P < 0.001, respectively). The mallet fractures were divided into Types I, II, and III (fracture involving <20%, 20%–50%, and >50% of the joint surface, respectively). Type II was further divided into Types IIa and IIb according to whether the course of injury was < or ≥2 weeks, respectively. The mean post-operative flexion of the distal interphalangeal joint was 63.4° ± 7.9°, and the mean extension lag was 6.7° ± 4.6°.ConclusionsThe lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint. Classification that combines the involvement of the joint surface in the fracture, the thickness of the fracture, and the untreated time after injury is reasonable and will help to choose an appropriate operational method.

Outcomes and Review of Periprosthetic Tibial Fractures.

Periprosthetic fractures around total knee arthroplasties (TKA) are well documented in the literature. Fractures of the tibial side occur least frequently and often pose reconstructive challenges to the treating surgeon. As use of arthroplasty continues to rise, periprosthetic fractures of the tibia will likely become more prevalent. Periprosthetic fracture management is based on recommendations (Mayo classification) made 20 years ago. With newer design technology, the adjuvant use of locking plates in the presence of implant stable periprosthetic tibial fractures (Felix types IIA and IIIA) is unknown. The authors retrospectively reviewed 19 patients who sustained periprosthetic Felix type IIA or IIIA fractures that were treated with operative stabilization using plate and screw constructs. Union rate, time to union, incidence of need for revision on an acute or delayed basis, and restoration of ambulation were investigated. Fourteen patients were followed for the entire course of treatment. Preoperative range of motion was unable to be obtained due to the nature of the injuries. After primary surgical stabilization, 78.6% of the patients obtained successful union of their fracture at a mean of 25 months, but no arthroplasty component revision was necessary in any patient. Three (21.4%) patients required revision surgery, resulting in an overall union rate of 92.9%. Mean time to union in this cohort was 8.4±3.4 months, and the overall complication rate was 28.6%. Treatment of periprosthetic (TKA) tibial fractures carries a relatively high risk of complications and nonunion after primary stabilization, and patients should be counseled accordingly. [Orthopedics. 2020;43(3):182-186.].

Outcomes of Tension Band Fixation in Olecranon Fractures and Osteotomies With Sutures: A Metal-free Solution

To restore the extensor function of the elbow, tension band wiring is a commonly used technique in managing stable olecranon fractures and osteotomies with excellent results. However, the outcome and patient satisfaction are marred with high rates of hardware-related complications requiring reoperation. To diminish the risk of these complications, we employed sutures for tension band fixation instead of wires in open reduction and internal fixation of Mayo types IA and IIA olecranon fractures and olecranon osteotomies in 15 of our patients. All patients achieved the radiologic union of the fractures and osteotomies by 12 weeks, except for 1 patient who developed fibrous union at the osteotomy site. None of the patients had any functional limitations at discharge and had good to excellent outcomes on the Mayo Elbow Performance Score. There were no complications related to hardware and the need for reoperation. The use of sutures in tension band fixation of olecranon fractures and osteotomies replicates the results of the highly successful technique of tension band wiring while significantly reducing the hardware-related complications.

Differential Expression Hallmarks of Interneurons in Different Types of Focal Cortical Dysplasia.

Focal cortical dysplasia (FCD) is the main cause of medically intractable pediatric epilepsy. Previous studies have suggested that alteration of cortical interneurons and abnormal cytoarchitecture have been linked to initiation and development for seizure. However, whether each individual subpopulation of cortical interneurons is linked to distinct FCD subtypes remains largely unknown. Here, we retrospectively analyzed both control samples and epileptic specimens pathologically diagnosed with FCD types Ia, IIa, or IIb. We quantified three major interneuron (IN) subpopulations, including parvalbumin (PV)-, somatostatin (Sst)-, and vasoactive intestinal peptide (Vip)-positive INs across all the subgroups. Additionally, we calculated the ratio of the subpopulations of INs to the major INs (mINs) by defining the total number of the PV-, Sst-, and Vip-INs as mINs. Compared with the control, the density of the PV-INs in FCD type IIb was significantly lower, and the ratio of PV/mINs was lower in the superficial part of the cortex of the FCD type Ia and IIb groups. Interestingly, we found a significant increase in the ratio of Vip/mINs only in FCD type IIb. Overall, these results suggest that in addition to a reduction in PV-INs, the increase in Vip/mINs may be related to the initiation of epilepsy in FCD type IIb. Furthermore, the increase in Vip/mINs in FCD type IIb may, from the IN development perspective, indicate that FCD type IIb forms during earlier stages of pregnancy than FCD type Ia.

The use of intraoperative ultrasound in patients with focal cortical dysplasia: preliminary observations

Introduction . The cessation of epileptic seizures after surgical treatment of focal epilepsy is the main objective of the surgeon. When a neurosurgeon operates focal cortical dysplasia (FCD), he/she faces difficulties with the radical removal of pathological tissue, which looks similar to healthy one. Using the neuronavigation system may not be helpful because of errors caused by displacement of brain tissues after opening the dura mater and resection of pathological foci. Intraoperative MRI examination requires significant financial expenses. One alternative is the intraoperative ultrasound (US) test, which allows one to visualize areas of pathological tissue in real time. The aim of this study is to assess the feasibility of using intraoperative US test. Materials and methods . We conducted a retrospective analysis of 20 cases of pharmacoresistant epilepsy that involved US examination during surgical operation for epilepsy caused by focal cortical dysplasia. In the preoperative period, all patients underwent EEG video monitoring in which at least three seizures were detected. In addition, three patients underwent invasive EEG video monitoring as well as preoperative and postoperative brain MRI. Based on histological verification, the distribution of patients was as follows: Ia type – 1 case (5%); Ib type – 4 cases (20%); Ic type –3 cases (15%); IIa type –3 cases (15%); IIb type – 8 cases (40%); IIIa type – 1 case (5%). Postoperative follow-up continued for 14±10 months (min – 2 months, max – 31 months). Results . Twenty (100%) patients underwent intraoperative US examination where signs of an altered cortex were found in locations similar to those revealed with preoperative MRI scans. Based on the US images, radical resection of pathological tissues was performed in these patients. In 15 (75%) patients, the seizures stopped (Engel class I). According to the US data, FCD had the following characteristics: hyperechogenicity as compared to the brain parenchyma; uneven, fuzzy, irregularly shaped contours; lack of a clear border between the white and gray matter. Conclusion . Intraoperative ultrasound is a safe, inexpensive and effective method for intraoperative imaging of FCD. The authors declare the absence of conflict of interest with respect to this publication. All authors contributed equally to this article.

UNIVERSAL THEORY OF ATHEROSCLEROSIS PATHOGENESIS

The paper shows that atherosclerosis results from disturbed cholesterol homeostasis in the body, the development of systemic stromal-vascular lipid-protein dystrophy (or lipidosis, or cholesterolosis) complicated by extracellular focal lipid deposits with a predominant cholesterol in the interstitial tissue of the inner arterial and aortic layer. These deposits are foreign to this body tissue. They induce the development of chronic productive granulomatous inflammation in it – granulomatosis around endogenous foreign bodies. Cholesterol deposition is promoted by a positive cholesterol balance in the body; increased permeability of the endothelium in hemodynamically vulnerable parts of the arteries, where blood components, including LP, infiltrate their wall; a lack of hydrolytic enzymes in the cell lysosomes that could destroy the steroid nucleus of the cholesterol molecule. Being essential for each specific organism (for building membranes, the formation of bile acids, the synthesis of steroid hormones, vitamin D3), cholesterol, if exceeded, can increase the probability of developing atherosclerosis. Genetic mechanisms are implicated in the disturbed lipid protein metabolism in the human body. Hyperlipoproteinemias (HLPs) are known to be the most common metabolic disorders. The dystrophy under consideration results from primary HLP types IIa, IIb, III, IV, V, as well as secondary HLPs in patients with various medical conditions associated with an increase in blood LDL and / or VLDL and/or a decrease in HDL. A reduced cholesterol efflux from peripheral tissues due to a decreased HDL content and the development of lipidosis are seen in diabetes, obesity, physical inactivity, stress, puberty, menopause, hypertriglyceridemia, cigarette smoking, uremia, treatment with anabolic steroids, beta-adrenergic blocking agents, gestagens, and the use of contraceptives. The most pronounced manifestations of dystrophy are characteristic of HLP types IIA, IIb, III, but its moderate development complicated by atherosclerosis also occurs in types IV and V, which are accompanied by increased blood VLDL. Mutations of LDL receptor genes, apoprotein genes lead to the development of stromal vascular dystrophy and atherosclerosis. A number of rare genetic disorders of sterol metabolism accompany impaired metabolism of cholesterol and its esters: hepatic lipase deficiency (with accumulation of VLDL and IDLs); a deficiency in lysosomal hydrolase of cholesterol esters with impaired LDL metabolism (Wolman disease); cholesterol ester accumulation disease; cerebrotendinous xanthomatosis; cerebral cholesterolosis; Toichlander and Hand Schüler Christian syndromes. The main factor contributing to the development of inflammation in the inner vascular wall of arteries and aorta in atherosclerosis is the cyclic hydrocarbonic structure of cholesterol, which cannot be cleaved in the lysosomes of MPs. The leading role of the cyclic hydrocarbonic structure of cholesterol, which is insoluble and indestructible by MPs, in the induction of atherosclerosis-related inflammation is confirmed by the fact of the atherogenic action of cholesterol derivatives having its structure. An important factor in inflammatory morphogenesis is the lipoprotein dyscolloidosis occurring in the arterial intima and the physical and chemical metamorphosis of cholesterol. A colloidal solution, solid crystals of free cholesterol and liquid crystals of cholesterol esters have a pronounced phlogogenic and sclerogenic effect on the interstitial tissue of the arterial intima.

Downregulation of activin-signaling gene expression in passaged normal human dermal fibroblasts.

Activins are members of the transforming growth factor-β (TGF-β) superfamily and play important roles in proliferation, differentiation, and apoptosis of various target cells. We investigated changes of activin, activin receptor (ActR), and Smad-signaling gene expression with increasing passage number in normal human dermal fibroblasts. The expression of mRNA and protein was measured by reverse transcription-quantitative polymerase chain reaction and immunoblot analysis from passage numbers 5 to 15. Activin A and follistatin transcript levels increased with increasing passage number. ActR types IA, IB, IIA and IIB mRNA levels decreased at high passage number. The levels of Smad2, 3 and 4 protein decreased with increasing passage number, which also attenuated phosphorylation of Smad2 and 3 protein expression. Smad7 was enhanced with increasing passage number. These results suggest that expression of activin-signaling in aging normal human dermal fibroblasts increases activin A and follistatin, whereas ActR-Smad signaling is decreased.

Multistage W-mineralization and magmatic-hydrothermal fluid evolution: Microtextural and geochemical footprints in scheelite from the Weondong W-skarn deposit, South Korea

Weondong deposit is one of the W-skarn deposits in South Korea, and main ore mineral is scheelite (CaWO4). Scheelite occurs in both a massive skarn zone (MSZ; Type I) and a quartz porphyry fracture zone (QPFZ; Type II), forming solid solution with powellite (CaMoO4). We examined the relationship between the evolution of ore-forming fluids and formation of multistage scheelites based on microtextural and geochemical features. Type I scheelites can be divided into Type Ia and Type Ib. Type Ia scheelites are characterized by complex internal textures with oscillatory zoning. The texturally associated clinopyroxene (diopside), garnet (andradite), and magnetite strongly suggest an oxidized prograde skarn origin. They are also characterized by enriched light rare earth elements (LREEs) and a negative Eu anomaly. Type Ib scheelites are W-enriched (74–81 wt% of WO3) with no internal zoning. Relict grossular garnet, calcite, pyrrhotite, serpentine, and vesuvianite indicate its relatively reduced retrograde skarn origin. Their rare earth element (REE) pattern is flat with a negative Eu anomaly. Type II scheelites can further be divided into Types IIa and IIb based on textural and geochemical differences. The former largely exhibit patchy zoning with minor oscillatory zoning that normally occurs along microfractures in association with fluorite. Type IIa scheelites show REE fractionation between W- and Mo-enriched zones (i.e., those containing 60–71 wt% of WO3 and 15–25 wt% of MoO3, respectively). Tungsten enriched scheelites show middle rare earth element (MREE)-enriched patterns with a strong negative Eu anomaly; Mo-rich zones are MREE-depleted and show a weak negative Eu anomaly. Type IIb scheelites are W-rich and rarely have zoned texture, similar to Type Ib scheelites. Type IIb scheelites generally coexists with sulfide minerals, indicating a relatively high sulfur fugacity (fS2) retrograde conditions. The REE pattern is flat with a negative Eu anomaly. These results indicate that Type Ia and Type IIa scheelites were formed during prograde conditions at each stage, followed by Type Ib and Type IIb in retrograde conditions. Type Ia scheelites have LREE-enriched patterns, which mimic the REE profile of juvenile magmatic fluids under open systems. Type IIa scheelites have MREE-enriched fractionation patterns that likely reflect a highly evolved magmatic fluid origin in a closed system. The flat REE pattern in Type Ib and IIb scheelites is due to meteoric water in retrograde conditions. This causes changes in the trace element composition of scheelites that reflect differences in the fluid origin and stages of evolution. The geochemical characteristics of both scheelite types match well with their microtextural features and provide crucial evidence for understanding the multistage formation of the Weondong W-skarn.

GATORopathies: The role of amino acid regulatory gene mutations in epilepsy and cortical malformations.

The mechanistic target of rapamycin (mTOR) pathway has been implicated in a growing number of malformations of cortical development (MCD) associated with intractable epilepsy. Mutations in single genes encoding mTOR pathway regulatory proteins have been linked to MCD such as focal cortical dysplasia (FCD) types IIa and IIb, hemimegalencephaly (HME), and megalencephaly. Recent studies have demonstrated that the GATOR1 protein complex, comprised of DEPDC5, NPRL3, and NPRL2, plays a pivotal role in regulating mTOR signaling in response to cellular amino acid levels and that mutations in DEPDC5, NPRL3, or NPRL2 are linked to FCD, HME, and seizures. Histopathological analysis of FCD and HME tissue specimens resected from individuals harboring DEPDC5, NPRL3, or NPRL2 gene mutations reveals hyperactivation of mTOR pathway signaling. Family pedigrees carrying mutations in either DEPDC5 or NPRL3 share clinical phenotypes of epilepsy and MCD, as well as intellectual and neuropsychiatric disabilities. Interestingly, some individuals with seizures associated with DEPDC5, NPRL3, or NPRL2 variants exhibit normal brain imaging suggesting either occult MCD or a role for these genes in non-lesional neocortical epilepsy. Mouse models resulting from knockdown or knockout of either Depdc5 or Nprl3 exhibit altered cortical lamination, neuronal dysmorphogenesis, and enhanced neuronal excitability as reported in models resulting from direct mTOR activation through expression of its canonical activator RHEB. The role of the GATOR1 proteins in regulating mTOR signaling suggest plausible options for mTOR inhibition in the treatment of epilepsy associated with mutations in DEPDC5, NPRL3, or NPRL2.

Changes in masseter muscle fibers by liquid diet rearing in rabbits and recovery by chewing of solid diet

ObjectiveTo investigate the effects of liquid diet on the development of masseter muscle fibers and whether the changes in the masseter muscle can be recovered by chewing of solid diet. DesignMasseter muscles from 40 rabbits (solid- and liquid-diet groups, n = 30; unweaned group, n = 5; recovery group, n = 5) were histochemically examined at 4, 12, 18, and 33 weeks after birth. Six fiber types (I, IC, IIC, IIA, IIAB, and IIB) were distinguished via mATPase staining. Muscle fiber diameter and fiber type composition were measured and compared between groups. ResultsIn the liquid diet group, the diameter of types IIAB (solid group: 81.7 μm, liquid group: 60.9 μm) and IIB (solid group: 89.3 μm, liquid group: 68.8 μm) and the fiber type composition of type I (solid group: 18.4%, liquid group: 9.6%) decreased significantly at 33 weeks of age. In the recovery group, the fiber type composition of type I fibers recovered to 16.5%, while no recovery of type IIAB (56.6 μm) and IIB (64.6 μm) fiber diameter was observed. ConclusionsLiquid diet caused atrophy of muscle fibers and an increase in the proportion of fast-twitch fibers. Although the diameter and ratio of slow-twitch fibers were recovered by chewing of solid diet, recovery was not observed for fast-twitch fibers. Our findings are relevant for dental medicine as it explored the possibility of masticatory muscle function recovery by hard food.

String geometry and nonperturbative formulation of string theory

We define string geometry: spaces of superstrings including the interactions, their topologies, charts, and metrics. Trajectories in asymptotic processes on a space of strings reproduce the right moduli space of the super-Riemann surfaces in a target manifold. Based on the string geometry, we define Einstein–Hilbert action coupled with gauge fields, and formulate superstring theory nonperturbatively by summing over metrics and the gauge fields on the spaces of strings. This theory does not depend on backgrounds. The theory has a supersymmetry as a part of the diffeomorphisms symmetry on the superstring manifolds. We derive the all-order perturbative scattering amplitudes that possess the super moduli in type IIA, type IIB and SO(32) type I superstring theories from the single theory, by considering fluctuations around fixed backgrounds representing type IIA, type IIB and SO(32) type I perturbative vacua, respectively. The theory predicts that we can see a string if we microscopically observe not only a particle but also a point in the space–time. That is, this theory unifies particles and the space–time. This paper is a summary version of Ref. 1.

Subclassification and Treatment Results of Ethanol Embolotherapy of Type II Arteriovenous Malformations of the Extremity and Body

To evaluate the safety and efficacy of ethanol and coil embolization of type II arteriovenous malformation (AVM) according to a new subtype classification. Eighty-four type II AVMs in the body or extremity of 79 patients who underwent AVM treatment from 1996 to 2017 were retrospectively subclassified according to the angiographic morphology of the draining vein as type IIa (arterioles shunt to focal segment of single draining vein), type IIb (arterioles shunt to venous sac with multiple draining veins), and type IIc (arterioles shunt along long segment of draining vein). Coil and ethanol embolization of the focal or long segment of the draining vein or the venous sac was performed with direct puncture or transvenous approach according to subtype. Treatment outcomes, number of treatment sessions, and complications were analyzed. AVM cure (ie, complete embolization) rates were 95%, 76%, and 65% in types IIa, IIb, and IIc AVMs, respectively. The cure rate of type IIa AVMs was significantly better than that of type IIc AVMs (P= .015). Median numbers of treatment sessions were 1 in types IIa and IIb AVMs and 2.5 in type IIc AVMs, with a significant difference between type IIc and the other 2 types (P < .05). Minor complications occurred in 20% of patents and major complications occurred in 7%. The cure rate of type IIa AVMs was significantly better than that of type IIc AVMs, which also required significantly more treatment sessions than the other 2 types.

Characterization of a novel, type II staphylococcal cassette chromosome mec element from an endemic oxacillin-resistant Staphylococcus lugdunensis clone in a hospital setting.

Staphylococcus lugdunensis is a significant pathogen that causes community-acquired and nosocomial infections. The high prevalence of oxacillin-resistant S. lugdunensis (ORSL) is of major concern. Resistance to β-lactams is caused by acquisition of the staphylococcal cassette chromosome mec (SCCmec) element. The cassette is highly diverse, both structurally and genetically, among CoNS. Isolates carrying SCCmec II-ST6 are the major persistent clones in hospitals. To investigate the structure and evolutionary origin of a novel type II SCCmec element in an endemic ST6 S. lugdunensis clone. The structure of the SCCmec II element carried by ST6 strain CGMH-SL118 was determined by WGS and compared with those reported previously. A novel 39 kb SCCmec element, SCCmecCGMH-SL118, with a unique mosaic structure comprising 41 ORFs integrated into the 3' end of the rlmH gene, was observed. Some regions of SCCmecCGMH-SL118 were homologous to SCCmec IIa of the prototype MRSA strain N315. The structure of SCCmecCGMH-SL118 was similar to that of SCCmec IIb of the MRSA strain, JCSC3063, mainly lacking the aminoglycoside resistance determinant pUB110 in the J3 region but containing the insertion sequence IS256 in the J2 region. Notably, SCCmecCGMH-SL118 deletions in the J1 region compared with SCCmec types IIa and IIb, and a high homology to SCCmec elements of Staphylococcus aureus JCSC4610 and Staphylococcus haemolyticus strain 621 were found. The genetic diversity of the type II SCCmec element in ORSL suggests that CoNS is a potential reservoir for interspecies transfer of SCCmec to S. aureus in hospitals.

Effects of winds on the leftover hydrogen in massive stars following Roche lobe overflow

We find that applying a theoretical wind mass-loss rate from Monte Carlo radiative transfer models for hydrogen-deficient stars results in significantly more leftover hydrogen following stable mass transfer through Roche lobe overflow than when we use an extrapolation of an empirical fit for Galactic Wolf-Rayet stars, for which a negligible amount of hydrogen remains in a large set of binary stellar evolution computations. These findings have implications for modelling progenitors of Types Ib and IIb supernovae. Most importantly, our study stresses the sensitivity of the stellar evolution models to the assumed mass-loss rates and the need to develop a better theoretical understanding of stellar winds.

Correlation between endocapillary proliferative and nephrotic-range proteinuria in children with Henoch-Schönlein purpura nephritis.

The endocapillary proliferative (EP) lesion is not included in theInternational Study of Kidney Disease in Children(ISKDC) pathological classification of Henoch-Schönlein purpura nephritis (HSPN). The main objective of the study was to determine the pathological importance of EP in the development of proteinuria in children with Henoch-Schönlein purpura nephritis (HSPN). The pathological features of 148 HSPN children with nephrotic-range proteinuria were investigated retrospectively. Urinary IgG, transferrin, and albumin levels were measured by immunonephelometry. The correlations between EP lesion and 24-h proteinuria, urinary IgG, urinary transferrin, and urinary albumin were analyzed. Renal biopsy specimens were immunohistochemically stained for nephrin and podocalyxin. Of the total 581 cases of children with HSPN who underwent renal biopsy, 148 cases (25.5%) presented with nephrotic-range proteinuria. The pathological types of HSPN with nephrotic-range proteinuria were categorized as IIb, IIIa, IIIb, IIIb with diffuse EP, IVb, pure focal EP type, and pure diffuse EP type. Among these types, pure diffuse EP type accounted for 7.4%. The levels of 24-h proteinuria and urinary albumin were the highest in pure diffuse EP type among all pathological types, and the percentage of EP correlated with 24-h proteinuria and urinary albumin levels. 24-h proteinuria was significantly higher in pure diffuse EP type relative to HSPN IIb type, and significantly higher in IIIb with EP, compared with HSPN IIIb. Nephrin, but not podocalyxin, was downregulated in EP segment. EP is an independent pathogenic factor in HSPN with nephrotic-range proteinuria. Downregulation of nephrin in EP segment is a potential molecular mechanism of nephrotic-range proteinuria. Albumin is the major urinary protein component in HSPN with EP.

Using a Bilobed Trapezius Myocutaneous Flap and a Scapula Osteomyocutaneous Flap to Reconstruct Through-and-Through Defects of the Hemimandible After Debridement of Advanced Mandibular Osteoradionecrosis.

The purpose of this study was to evaluate the outcomes of reconstructing through-and-through defects of the hemimandible after debridement of advanced mandibular osteoradionecrosis (ORN) with bilobed trapezius myocutaneous flaps and scapula osteomyocutaneous flaps. Six patients with grade III mandibular ORN were treated with debridement of lesions. Type IIb soft tissue and type H hemimandible defects after surgery were reconstructed using bilobed trapezius myocutaneous flaps and scapula osteomyocutaneous flaps including the acromion, spine, and part of the medial scapular border based on the transverse cervical vessels. No flap failure occurred. Two patients experienced minor complications; one showed wound dehiscence at the donor site, and one showed minor plate exposure. No patient required nasogastric tube feeding or a permanent tracheotomy. The appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion in the upper limb. The patients were followed for 8 to 22 months; at the end of follow-up, all patients were living with no recurrence evidence of mandibular ORN or nasopharyngeal carcinoma. The bilobed trapezius myocutaneous flap and scapula osteomyocutaneous flap based on transverse cervical vessels may be an effective approach to reconstruct through-and-through defects of the hemimandible and to provide satisfactory or acceptable functional and esthetic outcomes after debridement of advanced mandibular ORN.