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Objective: To investigate the effectiveness and clinical efficacy of tension-free vaginal tape (TVT) surgery in treating female recurrent stress urinary incontinence (rSUI)., Methods: A retrospective analysis was conducted on 24 patients who experienced recurrence of mid-urethral sling failure and were treated with TVT surgery at Beijing Chao-Yang Hospital from January 2016 to June 2020. Basic patient information was collected. The International Consultation on Incontinence questionnaire-short form (ICI-Q-SF) was used to record urinary incontinence symptom scores preoperatively, 1-year postoperatively, and more than three years postoperatively. The changes in various ICI-Q-SF scores and total scores were compared. Additionally, clinical symptom severity of urinary incontinence was recorded and compared preoperatively and more than three years postoperatively., Results: Among the 24 patients included in the follow-up, one patient was lost to follow-up due to death from a cerebrovascular accident one year postoperatively, leaving 23 patients with a follow-up period ranging from 3.9 to 7.3 years, with an ave-rage follow-up time of (5.2±1.1) years. Preoperatively, the median ICI-Q-SF total score was 20.0 (16.0, 21.0); at the 1-year follow-up, the median ICI-Q-SF total score was 5.0 (1.5, 7.8) ( P < 0.001); at an average follow-up of five years, the median ICI-Q-SF total score was 6.0 (3.0, 9.0), still showing a statistically significant difference compared with preoperative scores ( P < 0.001). The individual ICI-Q-SF scores were significantly lower at the 1-year and average five-year follow-ups compared with preoperative scores ( P < 0.001). Regarding the severity of urinary incontinence, all the patients had moderate to severe urinary incontinence preoperatively; Five years postoperatively, 87.0% (20/23) of the patients had no or only mild urinary incontinence, and 13.0% (3/23) had recurrent moderate to severe urinary incontinence ( P < 0.001)., Conclusion: TVT surgery is effective in treating female recurrent stress urinary incontinence, with an average 5-year cure and improvement rate of 87.0%.

Antimony （Sb） is a major pollutant that poses a serious threat to the environment in the mining and processing of nonferrous metals, coexisting with sulfide and oxide of arsenic （As）. Microorganisms play an important role in the migration, transformation, and repair of metals in soil. The ecological effects of bioavailable Sb and As on the microbial community in antimony mining areas（mining and smelting areas）are still poorly understood. The Wenzel method and high-throughput 16S rDNA amplicon were used to characterize soil pollution characteristics in different functional areas, and the relationship between the bacterial community and bioavailable concentrations have been investigated comprehensively. The results showed that： Chemical speciation of Sb and As were amorphous, and poorly crystalline hydrous oxides of Fe and Al （F3） &gt; well-crystallized hydrous oxides of Fe and Al （F4） &gt; residual phases （F5） &gt; specifically adsorbed （F2） &gt; non-specifically adsorbed （F1）. According to the estimation of the potential ecological risk index （RI） and geo-accumulation index （ I geo ）, the Sb pollution degree was： smelting area &gt; mining area &gt; contrast area, in which the smelting area showed serious pollution, and the mining area showed moderate to severe pollution. The As pollution degree was： mining area &gt; smelting area &gt; contrast area, in which the mining area and smelting area showed moderate to severe pollution. High-throughput 16S rDNA amplicon showed that Proteobacteria was the most abundant phylum in mining and smelting areas； Kaistobacter , Pseudomonas , Sphingomonas , and Lysobacter were the most abundant microbial genera； Geobacter and Luteolibacter had a high LDA score in mining areas； and Thiobacillus had a high LDA score in antimony-contaminated areas. Spearman correlation analysis, variation partitioning analysis （VPA）, and random forest （RF） analysis showed that Sb, As, bioavailable antimony [Sb （Bio）], and bioavailable arsenic [As （Bio）]were the main factors affecting the microbial community structure in different functional areas of antimony ore. Redundancy analysis （RDA） indicated that Sb and its bioavailable concentrations showed uniformly negative associations with the relative abundance of bacteria Nitrospirae and showed a significant positive correlation with Thiobacillus （ P <0.05）. The in-depth research on the ecological effects of bioavailable Sb and As on the bacterial community provides references and new perspectives for environmental monitoring and management.

Objective: To investigate the predictive value of left ventricular global longitudinal peak strain (GLPS) for the prognosis of septic patients., Methods: A prospective cohort study was conducted. Patients diagnosed with sepsis and admitted to the intensive care unit (ICU) of the First Affiliated Hospital, Sun Yat-sen University from December 2018 to November 2019 were enrolled. The patient characteristics, cardiac ultrasound parameters [left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), four-dimensional ejection fraction (4DEF), GLPS] and cardiac biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT)] within 24 hours of ICU admission, organ support therapies, severity of illness, and prognostic indicators were documented. The differences in clinical parameters between patients with varying outcomes during ICU hospitalization were assessed. Pearson correlation analysis was employed to explore the correlation between GLPS and other cardiac systolic parameters, as well as the associations between various cardiac systolic parameters and sequential organ failure assessment (SOFA) score. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive capacity of cardiac ultrasound parameters and cardiac biomarkers for death during ICU hospitalization in septic patients., Results: A total of 50 septic patients were enrolled, with 40 surviving and 10 dying during ICU hospitalization, resulting in a mortality of 20.0%. All patients in the death group were male. Compared with the survival group, the patients in the death group were older, had a higher prevalence of diabetes mellitus, and received continuous renal replacement therapy (CRRT) more frequently, additionally, they exhibited more severe illness and had longer length of ICU stay. The levels of GLPS and cTnT in the death group were significantly elevated as compared with the survival group [GLPS: -7.1% (-8.5%, -7.0%) vs. -12.1% (-15.5%, -10.4%), cTnT (μg/L): 0.07 (0.05, 0.08) vs. 0.03 (0.02, 0.13), both P < 0.05]. However, no statistically significant difference was found in other cardiac ultrasound parameters or cardiac biomarkers between the two groups. Pearson correlation analysis revealed a negative correlation between GLPS and LVEF (r = -0.377, P = 0.014) and 4DEF (r = -0.697, P = 0.000), while no correlation was found with RVEF (r = -0.451, P = 0.069). GLPS demonstrated a positive correlation with SOFA score (r = 0.306, P = 0.033), while LVEF (r = 0.112, P = 0.481), RVEF (r = -0.134, P = 0.595), and 4DEF (r = -0.251, P = 0.259) showed no significant correlation with SOFA score. ROC curve analysis indicated that the area under the ROC curve (AUC) of GLPS for predicting death during ICU hospitalization in septic patients was higher than other cardiac systolic parameters, including LVEF, RVEF, and 4DEF, as well as cardiac biomarkers NT-proBNP and cTnT (0.737 vs. 0.628, 0.556, 0.659, 0.580 and 0.724). With an optimal cut-off value of -14.9% for GLPS, the sensitivity and negative predictive value reached to 100%., Conclusions: GLPS < -14.9% within 24 hours of ICU admission in septic patients indicated a reduced risk of death risk during ICU hospitalization, while also correlating with the severity of organ dysfunction in this patient population.

Objective To evaluate the effects of heme oxygenase-1 (HO-1) gene deletion on immune cell composition and inflammatory injury in lung tissues of mice with lipopolysaccharide (LPS)-induced acute lung injury (ALI). Methods C57BL/6 wild-type (WT) mice and HO-1 conditional-knockout (HO-1 -/- ) mice on the same background were randomly divided into four groups (n=5 in every group): WT control group, LPS-treated WT group, HO-1 -/- control group and LPS-treated HO-1 -/- group. LPS-treated WT and HO-1 -/- groups were injected with LPS (15 mg/kg) through the tail vein to establish ALI model, while WT control group and HO-1 -/- control group were injected with an equivalent volume of normal saline through the tail vein, respectively. Twelve hours later, the mice were sacrificed and lung tissues from each group were collected for analysis. Histopathological alterations of lung tissues were assessed by HE staining. The levels of mRNA expression of tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 were determined by PCR. The percentages of neutrophils (CD45 + CD11b + Ly6G + Ly6C - ), total monocytes (CD45 + CD11b + Ly6C hi ), pro-inflammatory monocyte subsets (CD45 + CD11b + Ly6C hi CCR2 hi ) and total macrophages (CD45 + CD11b + F4/80 + ), M1 macrophage (CD45 + CD11b + F4/80 + CD86 + ), M2 macrophage (CD45 + CD11b + F4/80 + CD206 + ), total T cells (CD45 + CD3 + ), CD3 + CD4 + T cells, CD3 + CD8 + T cells and myeloid suppressor cells (MDSCs, CD45 + CD11b + Gr1 + ) were detected by flow cytometry. Results Compared with the corresponding control groups, HE staining exhibited increased inflammation in the lung tissues of both LPS-treated WT and HO-1 -/- model mice; mRNA expression levels of TNF-α, IL-1β and IL-6 were up-regulated; the proportions of neutrophils, total monocytes, pro-inflammatory monocyte subsets, MDSCs and total macrophages increased significantly. The percentage of CD3 + , CD3 + CD4 + and CD3 + CD8 + T cells decreased significantly. Under resting-state, compared with WT control mice, the proportion of neutrophils, monocytes and pro-inflammatory monocyte subset increased in lung tissues of HO-1 -/- control mice, while the proportion of CD3 + and CD3 + CD8 + T cells decreased. Compared with LPS-treated WT mice, the mRNA expression levels of TNF-α and IL-1β were up-regulated in lung tissues of LPS-treated HO-1 -/- mice; the proportion of total monocytes, pro-inflammatory monocyte subsets, M1 macrophages and M1/M2 ratio increased greatly; the percentage of CD3 + CD8 + T cells decreased significantly. Conclusion The deletion of HO-1 affects the function of the lung immune system and aggravates the inflammatory injury after LPS stimulation in ALI mice.

Objectives: This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence navigation in laparoscopic lateral pelvic lymph node dissection (LLND) and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes (LPLNs). Methods: The clinical and pathological characteristics, surgical outcomes, lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed. The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement (MRI showed the maximum short axes of the LPLNs were ≥5 mm and <10 mm at first visit). Results: All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND. Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND. The lateral pelvic sentinel lymph nodes (SLNs) were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%. Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations. Among the 14 patients in whom lateral pelvic SLNs were detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs. The specificity, sensitivity, negative predictive value, and accuracy was 85.7%, 100%, 100%, and 100%, respectively. Conclusions: This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy. This technique may replace preventive LLND for locally advanced lower rectal cancer.

The launch of the national carbon emissions trading market in China is a policy to carry out the Beautiful China initiative and to establish a low-carbon economic development system that promotes carbon emission and waste reduction. In order to detect the carbon metabolic processes of the pilot and nonpilot municipalities or provinces in the northern region of China， the theory of urban carbon metabolism and the methods of input-output analysis and ecological network analysis were introduced and used. The results showed that the direct carbon emissions of Beijing and Tianjin had decreased， but their embodied carbon emissions had increased since 2012. The direct and embodied carbon emissions of the pilot sectors in Beijing and Tianjin had the same trend； specifically， the emissions of the sectors of mining and washing of coal， extraction of petroleum and natural gas， and manufacture of non-metallic mineral products decreased significantly， but the sectors of production and supply of electric power and steam with high carbon emission increased. The same trend of the embodied carbon emission intensities of sectors with that of their embodied carbon emissions verified that the embodied added values were not growing with the promotion of the carbon emission trading market. Subsequently， the embodied carbon emission of the pilot sectors in all the municipalities and provinces of the northern region were all contributed mainly by the emissions embodied by a path length less than 6； therefore， it showed that more attention should be paid to the trade among sectors with a path length less than 6 and reducing their carbon emissions. Furthermore， from 2007 to 2012， products or service trading among sectors mostly concentrated on sectors within one municipality or province， and these products or services had the characteristics of low carbon emission. Since 2012， the integration development of the Beijing-Tianjin-Hebei urban agglomeration and the new regional economic patterns established in the northern region both promoted the trading across provinces and across sectors. This research is based on the background of the carbon emission trading policy and aims to build a methodology to identify the key actors and paths in a metabolic system. This could provide a scientific basis for regional policy implementation and regional long-term sustainable development.

Objective: To obtain skin-derived induced pluripotent stem cells (iPSCs) from an Osteogenesis imperfecta (OI) patient carrying WNT1 c.677C>T mutation in order to provide a new cell model for investigating the underlying molecular mechanism and stem cell therapy for OI., Methods: The pathogenic variant of the patient was identified by Sanger sequencing. With informed consent from the patient, skin tissue was biopsied, and primary skin fibroblasts were cultured. Skin fibroblasts were induced into iPSCs using Sendai virus-mediated non-genomic integration reprogramming method. The iPSC cell lines were characterized for pluripotency, differentiation capacity, and karyotyping assay., Results: The patient was found to carry homozygous missense c.677C>T (p.Ser226Leu) mutation of the WNT1 gene. The established iPSC lines possessed self-renewal and capacity for in vitro differentiation. It also has a diploid karyotype (46,XX)., Conclusion: A patient-specific WNT1 gene mutation (WNT1 c.677C>T ) iPSC line was established, which can provide a cell model for the study of OI caused by the mutation.

With the development of modern sequencing techniques and bioinformatics, genomes that were once thought to be noncoding have been found to encode abundant functional micropeptides (miPs), a kind of small polypeptides. Although miPs are difficult to analyze and identify, a number of studies have begun to focus on them. More and more miPs have been revealed as essential for energy metabolism homeostasis, immune regulation, and tumor growth and development. Many reports have shown that miPs are especially essential for regulating glucose and lipid metabolism and regulating mitochondrial function. MiPs are also involved in the progression of related diseases. This paper reviews the sources and identification of miPs, as well as the functional significance of miPs for metabolism-related diseases, with the aim of revealing their potential clinical applications.

Objective: By analyzing the prevalence and influencing factors of thyroid nodules (TN) among a population undergoing physical examinations in Nantong region, this study aims to provide theoretical basis for early prevention and intervention of TN. Methods: A cross-sectional study was conducted, including 6 950 participants who underwent physical examinations at the Affiliated Hospital of Nantong University from January 2017 to April 2020. All participants underwent high-resolution ultrasound examination of the thyroid, and measurements of height, body mass index (BMI), blood pressure. Fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), uric acid (UA), homocysteine (HCY) and other metabolic indicators were detected. Data analysis was performed using SPSS 26.0 statistical software. The numerical variables with normal distribution were expressed as mean±standard deviation (x¯±s), and the t -test was used for comparison between the two groups. Numerical variables with non-normal distribution were expressed as median (interquartile range), namely M ( Q 1 , Q 3 ). The Mann-Whitney U test was used for comparison between two groups, and the Kruskal-Wallis test was used for comparison between multiple groups. Results: The prevalence of thyroid nodules among the 6 950 participants was 53.97% (3 751/6 950), with a rate of 47.08% (2 218/4 711) in males and 68.47% (1 533/2 239) in females, which was significantly higher in females than in males (χ 2 =278.575, P <0.001). The prevalence of TN increased with age both overall (χ 2 =552.145, P <0.001), in males (χ 2 =304.086, P <0.001), and in females (χ 2 =202.178, P <0.001). The prevalence of TN was higher in females than in males across different age groups ( P <0.05). In the comparison between males in the TN and non-TN groups, significant differences were found in terms of alcohol consumption history, BMI, blood pressure, HCY, and FBG (all P <0.05). In the comparison between females in the TN and non-TN groups, significant differences were found in terms of BMI, blood pressure, HCY, FBG, TC, TG, LDL-C, and UA (all P <0.05). Univariate logistic regression model showed that FBG<6.1 mmol/L ( P <0.001) and TC<5.2 mmol/L ( P =0.013) were protective factors for TN. Normal UA ( P =0.013) was a risk factor for TN. After adjusting for gender, smoking, alcohol consumption, BMI, and blood pressure, multivariate logistic regression analysis revealed that FBG<6.1 mmol/L ( OR : 0.713, 95% CI : 0.621-0.817, P <0.001) was a protective factor against TN. Conclusion: The prevalence of TN is relatively high in the Nantong region. Gender, age, blood pressure, BMI, and FBG are important influencing factors for TN. Health screening and management should be strengthened for the physical examination population with abnormal indicators.

Background: Lung adenocarcinoma (LUAD) is the most common type of non-small cell lung cancer, and any change of miRNAs expression will affect the degree of target regulation, thus affecting intracellular homeostasis. This study verified that miR-186-5p could inhibit the proliferation, migration and invasion of LUAD cells by regulating PRKAA2., Methods: Previous investigations found that the expression of miR-186-5p was markedly suppressed in LUAD. Bioinformatics method is used to predict the target protein related to ferroptosis downstream and inquire about its expression level in LUAD and its influence on the survival of patients. Double luciferase verified the binding site of PRKAA2 and miR-186-5p. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot were used to detect the expression of PRKAA2. The effects of miR-186-5p of LUAD cells as well as the mechanism by which miR-186-5p inhibits Fer-1's sensitivity to ferroptosis were confirmed by EdU, Transwell, and scratch assays. The effect of miR-186-5p on the amount of reactive oxygen species (ROS) in LUAD cells was discovered using ROS experiment. Malondialdehyde (MDA) and glutathione (GSH) experiments were used to detect the effects of miR-186-5p and PRKAA2 on ferroptosis index of LUAD cells. The concentration of lipid ROS (L-ROS) in LUAD cells were measured using the L-ROS tests to determine the effects of miR-186-5p and PRKAA2., Results: The expression of PRKAA2 is up-regulated, and a high level of PRKAA2 expression was associated with a poor prognosis for patients with LUAD. Overexpression of miR-186-5p decreased the gene and protein expression of PRKAA2. By promoting ferroptosis, miR-186-5p overexpression prevented lung cancer cells from proliferating, invading, and migrating. ROS could be produced in higher amounts in LUAD cells due to miR-186-5p. Overexpression of miR-186-5p and knockdown PRKAA2 up-regulated MDA content and reduced GSH content in LUAD cells, respectively. miR-186-5p could increase the content of L-ROS and promote the ferroptosis sensitivity of LUAD cells by targeting PRKAA2., Conclusions: miR-186-5p promotes ferroptosis of LUAD cells through targeted regulation of PRKAA2, thus inhibiting the proliferation, invasion and migration of LUAD.
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Objective: To explore the pathogenic variants and clinical classification of two fetuses with Short-rib thoracic dysplasia with or without polydactyly (SRTD)., Methods: With informed consent obtained, the phenotypic characteristics of the fetuses were comprehensively examined, and genomic DNA was extracted from fetal skin tissue and peripheral blood samples of the parents with conventional phenol-chloroform method. Whole exome sequencing (WES) was carried out on both fetuses, and the candidate variants were validated by Sanger sequencing. The pathogenicity of the candidate variants was analyzed using bioinformatic software VarCards, and the impact of the variants on the protein structure was predicted with Swiss-Pdb-viewer., Results: Both fetuses were found to harbor compound heterozygous variants of the DYNC2H1 gene, including c.515C>A (p.Pro172Gln) and c.5983G>A (p.Ala1995Thr) in fetus 1, and c.5920G>T (pGly1974) and c.9908T>C (p.He3303Thr) in fetus 2. The parents of both fetuses were heterozygous carriers., Conclusion: The compound heterozygous variants of the DYNC2H1 gene probably underlay the SRTD3 in the two fetuses.

Stevens-Johnson syndrome is a type of severe drug eruption, which is characterized by rapid onset and rapid progress. If not treated in time, it can develop into toxic epidermal necrolysis, even life-threatening. Common sensitizing drugs include sulfa, carbamazepine, etc. In China, reports and studies of carbamazepine causing Stevens-Johnson syndrome mainly focus on the HLA-B * 1502 gene, and there are no reports of HLA-A * 3101 gene positive. We reported a patient who got Stevens-Johnson syndrome with HLA-A * 3101 gene positive caused by carbamazepine. She took carbamazepine for trigeminal neuralgia and had never taken the drug before. After 2 weeks, papules and edematous target-like erythema gradually appeared on the trunk and limbs, surface blisters and scabs, and the oral, eyes, and vulvar mucosa appeared erosion, accompanied by fever and pain, with an area of about 3% exfoliation. She was diagnosed with Stevens-Johnson syndrome and admitted to Peking University Third Hospital on March 24, 2020. After admission, in order to identify the sensitizing drugs, We performed a genetic test on her for carbamazepine-related drugs. The results showed that the HLA-A * 3101 gene was positive, and the HLA-B * 1502 and HLA-B * 5801 genes were negative. In terms of treatment, the patient was systematically given a single intravenous infusion of 300 mg of infliximab, and symptomatic treatment and care of the oral, eye, and vulvar mucosa. After 6 days, the rash on the trunk and limbs subsided, and the mucosa returned to normal and was discharged from the hospital. Retrieving domestic and foreign literature, it is not uncommon to report that carbamazepine causes drug eruption, including severe drug eruption, and there are obvious ethnic differences in the pathogenicity of HLA genotyping. In China and Asia, stu-dies on carbamazepine causing Stevens-Johnson syndrome emphasized that the adverse reactions were strongly related to the HLA-B * 1502 gene. However, there is a strong correlation with HLA-A * 3101 gene in people suffering from the disease in Europe and Japan. In this case report, the HLA-B * 1502 gene was negative and the HLA-A * 3101 gene was positive. This is the first domestic report that carba-mazepine causes HLA-A * 3101 positive for Stevens-Johnson syndrome. This report reminds that HLA-A * 3101 gene testing should be taken seriously besides HLA-B * 1502 gene.

Objective: To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods: Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results: Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion: Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To explore the genetic basis for three Chinese patients with McCune-Albright syndrome (MAS)., Methods: Three children who had respectively presented at Shandong Provincial Hospital in April 2019 and Peking Union Medical College Hospital in August 2020 and May 2021 were selected as the research subjects. Peripheral blood samples of the probands and their family members were taken for the extraction of genomic DNA. Potential variants were screened by whole exome sequencing (WES), and candidate variants were validated by Sanger sequencing of the patients and their family members., Results: The proband from family 1 was found to harbor a heterozygous c.601C>T (p.R201C) missense variant in exon 8 of the GNAS gene, whilst the probands from families 2 and 3 were both found to harbor a heterozygous c.602G>A (p.R201H) missense variant in exon 8 of the GNAS gene. Both variants were known to be pathogenic, and all probands were found to be mosaics for the corresponding variants but with various degrees., Conslusion: WES can effectively diagnose MAS and other somatic genetic disorders. In this study, the combined WES and Sanger sequencing have verified the degree of mosaicisms of pathogenic variants in the three MAS patients, albeit no apparent correlation was found between the degree of mosaicisms and the phenotype of patients. Above finding has provided a basis for genetic counseling and prenatal diagnosis for the affected families.

The multiple myeloma (MM), the second most common hematologic malignancy, is malignant proliferative disease of plasma cells. Although the application of many targeted drugs has significantly prolonged the survival time of MM patients, it is still an incurable disease. In recent years, the immunosuppression caused by interaction between tumor microenvironment(TME) and tumor cells has attracted people's attention gradually. As a kind of immunosuppressive cells in TME, regulatory T cells (Treg) play an important role in the progress of MM. Treg is related to the proliferation and metastasis of tumors, and can lead to the progress of MM by promoting the angiogenesis and generating immunosuppressive TME. In this review, we briefly summarized the latest research progress on the impact of Treg on the pathogenesis of MM.

Objective: To investigate the prevalence and independent risk factors of non-alcoholic fatty liver disease (NAFLD) and advanced chronic liver disease among the type 2 diabetes mellitus (T2DM) population in the Shenyang community, so as to provide evidence for the prevention and control of T2DM combined with NAFLD. Methods: This cross-sectional study was conducted in July 2021. 644 T2DM cases from 13 communities in Heping District, Shenyang City were selected. All the surveyed subjects underwent physical examination (measurements of height, body mass index, neck circumference, waist circumference, abdominal circumference, hip circumference, and blood pressure), infection screening (excluding hepatitis B and C, AIDS, and syphilis), random fingertip blood glucose, controlled attenuation parameter (CAP), and liver stiffness measurement (LSM). The study subjects were divided into the non-advanced chronic liver disease group and the advanced chronic liver disease group according to whether the LSM value was greater than 10 kPa. Cirrhotic portal hypertension development was indicated in patients with LSM ≥ 15 kPa. The comparison of multiple mean values among the sample groups was performed by analysis of variance when the normal distribution was met. Results: In the T2DM community population, there were 401 cases (62.27%) combined with NAFLD, 63 cases (9.78%) combined with advanced chronic liver disease, and 14 cases (2.17%) combined with portal hypertension. There were 581 cases in the non-advanced chronic liver disease group and 63 cases (9.78%) in the advanced chronic liver disease group (LSM ≥10 kPa), including 49 cases (7.61%) with 10 kPa≤LSM<15 kPa, 11 cases (1.71%) with 15 kPa ≤LSM<25 kPa, and 3 cases (0.47%) with LSM ≥ 25 kPa. Age, body mass, body mass index, neck circumference, waist circumference, hip circumference, waist-to-height ratio, systolic blood pressure, and CAP were all statistically different between the non-advanced chronic liver disease group and the advanced chronic liver disease group ( F =-1.983,-2.598,-4.091,-2.062,-3.909, -4.581,-4.295,-2.474, and -5.191, respectively; P <0.05). There was a statistically significant difference in terms of whether or not there was combined cerebrovascular disease (2=4.632, P =0.031); however, there were no statistically significant differences in terms of lifestyle, diabetes complications, and other complications ( P >0.05). Conclusion: Patients with T2DM have a higher prevalence of NAFLD (62.27%) than those with advanced chronic liver disease (9.78%). 2.17% of T2DM cases in the community may not have had early diagnosis and early intervention, and they might have been combined with cirrhotic portal hypertension. So, the management of these patients should be strengthened.

Objective: To investigate the clinical diagnostic value of multi-target stool fecal immunochemical test-DNA (FIT-DNA) test in colorectal cancer (CRC) and advanced adenoma (AA). Methods: A total of 235 patients who were undergoing colonoscopy or colorectal cancer surgery in the Cancer Hospital, Chinese Academy of Medical Sciences from April 2021 to January 2022 were prospectively enrolled. There were 141 males and 94 females, with an average age of (55±13) years (22-86). The patients were divided into two groups, including 215 patients who were first diagnosed but not treated (86 cases of CRC, 12 cases of AA, 25 cases of non-advanced adenoma, 8 cases of hyperplastic or other polyps and 84 apparently healthy cases) and 20 patients in the intervention group (2 cases with a history of CRC surgery, 6 cases with a history of endoscopic surgery, 4 non-CRC patients with special diseases and 8 cases with a history of neoadjuvant chemoradiotherapy). Fresh stool samples were collected before intestinal preparation or surgery for FIT-DNA test using the matching kit for sample processing and nucleic acid purification. KRAS mutation and methylation of BMP3 and NDRG4 genes were detected by fluorescence probe method, and FIT method was employed to detect fecal occult blood. Colonoscopy or pathological biopsy results were used as the gold standard. And the screening and diagnostic efficacy of FIT-DNA test for colorectal cancer and advanced adenoma were evaluated by receiver operating curve (ROC). Results: The sensitivity of FIT-DNA test for early colorectal cancer and advanced adenoma was 7/7 and 8/12, respectively. And the negative predictive value was 98.1% (104/106) and 93.7% (104/111), respectively. The overall screening sensitivity for both early colorectal cancer and advanced adenoma was 15/19, and the negative predictive value was 96.3% (104/108). Besides, the area under the curves (AUCs) were 0.982 (95% CI : 0.960-1.000, P <0.05), 0.758 (95% CI : 0.592-0.924, P <0.05) and 0.841 (95% CI : 0.724-0.957, P <0.05), respectively. Moreover, the diagnostic sensitivity of FIT-DNA test was 98.8% (85/86) for colorectal cancer, 8/12 for advanced adenoma, and 94.9% (93/98) for both colorectal cancer and advanced adenoma, with a specificity of 88.9% (104/117). The AUCs were 0.968 (95% CI : 0.937-0.997, P <0.05), 0.758 (95% CI : 0.592-0.924, P <0.05) and 0.942 (95% CI : 0.905-0.979, P <0.05), respectively. After the inclusion of intervention group, the overall diagnostic sensitivity and specificity of FIT-DNA test was 91.6% (98/107) and 89.1% (114/128), respectively. Conclusion: FIT-DNA test has a high early screening and diagnostic efficacy for colorectal cancer.

Objective: To investigate the association between peripheral blood mitochondrial DNA copy number (mtDNAcn) and incident risk of liver cancer. Methods: At the baseline of Dongfeng-Tongji (DFTJ) cohort, 27 009 retirees were recruited from Dongfeng Motor Corporation in 2008. After excluding people without baseline DNA, with current malignant tumor and loss of follow-up, 1 173 participants were randomly selected into a sub-cohort by age-and gender-stratified sampling method at a proportion of 5% among all retirees. A total of 154 incident liver cancer cases identified from the cohort before December 31, 2018 (4 cases had been selected into the sub-cohort) were selected to form the case cohort of liver cancer. For the above 1 323 participants, their baseline levels of mtDNAcn in peripheral blood cells were measured by using quantitative real-time PCR method. The restricted cubic spline analysis was used to fit the shape of the association between baseline mtDNAcn and incident risk of liver cancer. The weighted Cox proportional hazards model was used to estimate the hazard ratio ( HR ) and 95% CI . Results: In this case-cohort study, the median follow-up time was 10.3 years. The restricted cubic spline analysis indicated that the relationship between peripheral blood mtDNAcn and incident risk of liver cancer followed a U -shaped pattern ( P non-linear <0.05). All case-cohort population were divided into four subgroups by sex-specific quartiles of mtDNAcn levels among sub-cohort participants, when compared to participants in the Q 2 subgroup of mtDNAcn, those in the Q 1 subgroup ( HR= 2.00,95% CI :1.08-3.70) and Q 4 subgroup ( HR= 4.11,95% CI :2.32-7.26) both had a significantly elevated risk of liver cancer, while those in the Q 3 subgroup ( HR= 1.05,95% CI :0.54-2.05) had not. There were no significant multiply interaction effects of aging, gender, tobacco smoking, alcohol drinking and history of chronic hepatitis on the above association ( P interaction >0.05). Conclusion: Both extremely low and high baseline level of mtDNAcn in peripheral blood cells are associated with an increased risk of incident liver cancer, but the underlying mechanisms need to be further clarified.

To study the molecular mechanism of salt stress response of peanut small GTP binding protein gene AhRabG3f , a 1 914 bp promoter fragment upstream of the start codon of AhRabG3f gene ( 3f -P) from peanut was cloned. Subsequently, five truncated fragments ( 3f -P1- 3f -P5) with lengths of 1 729, 1 379, 666, 510 and 179 bp were obtained through deletion at the 5' end, respectively. Plant expression vectors where these six promoter fragments were fused with the gus gene were constructed and transformed into tobacco by Agrobacterium -mediated method, respectively. GUS expression in transgenic tobacco and activity analysis were conducted. The gus gene expression can be detected in the transgenic tobacco harboring each promoter segment, among which the driving activity of the full-length promoter 3f -P was the weakest, while the driving activity of the promoter segment 3f -P3 was the strongest. Upon exposure of the transgenic tobacco to salt stress, the GUS activity driven by 3f -P, 3f -P1, 3f -P2 and 3f -P3 was 3.3, 1.2, 1.9 and 1.2 times compared to that of the transgenic plants without salt treatment. This suggests that the AhRabG3f promoter was salt-inducible and there might be positive regulatory elements between 3f -P and 3f -P3 in response to salt stress. The results of GUS activity driven by promoter fragments after salt treatment showed that elements included MYB and GT1 between 1 930 bp and 1 745 bp. Moreover, a TC-rich repeat between 682 bp and 526 bp might be positive cis -elements responsible for salt stress, and an MYC element between 1 395 bp and 682 bp might be a negative cis -element responsible for salt stress. This study may facilitate using the induced promoter to regulate the salt resistance of peanut.

In recent years, natural orifice specimen extraction surgery (NOSES) has been widely used in surgery of colorectal cancer. The rapid development of NOSES is mainly attributed to its own great advantages and values, including the reduction of surgical trauma, the acceleration of postoperative recovery and the reduction of adverse psychological reactions for patients. These advantages of NOSES are also important embodiment and perfect interpretation of the organ functional protection. Organ functional preservation is a hot topic in surgery today, and it is also an inevitable requirement for minimally invasive surgery. Essentially, NOSES and organ functional preservation are proposed in the same background, and the goals are highly compatible. NOSES is an important practitioner of organ functional preservation, and organ functional preservation is also the vane of the development of the theoretical system of NOSES. These two items complement each other and together constitute the important element in the development of modern minimally invasive surgery. In order to comprehensively discuss the relationship between NOSES and organ functional protection, we elaborate the important role and value of functional protection in NOSES from five key procedures of colorectal surgery, namely surgical approach, extent of resection, lymph node dissection, digestive tract reconstruction and specimen extraction.

Mesenchymal stem cells (MSCs) are a class of pluripotent cells that can self-renew and differentiate. Numerous studies have shown that MSCs have important roles in areas such as regenerative medicine and tissue engineering. However, it is worth noting that MSCs will gradually age during long-term in vitro expansion with decreased stemness such as weakened migration ability, slowed proliferation rate and decreased differentiation potential, which greatly hinders the application of MSCs. Currently, the microenvironment for cell growth is recognized as one of the factors causing senescence in MSCs. Recent studies point out that the latest technologies such as exogenous administration, oxygen concentration regulation and extracellular matrix (ECM) construction can delay stem cell senescence by simulating or regulating the microenvironment. Here, we review the current knowledge of the characteristics and molecular mechanisms of senescent MSCs and microenvironment strategies to maintain MSCs stemness, which can provide a reference for future large-scale application of MSCs preparations in tissue engineering and clinical studies.

O 6 -carboxymethyl guanine(O 6 -CMG) is a highly mutagenic alkylation product of DNA that causes gastrointestinal cancer in organisms. Existing studies used mutant Mycobacterium smegmatis porin A (MspA) nanopore assisted by Phi29 DNA polymerase to localize it. Recently, machine learning technology has been widely used in the analysis of nanopore sequencing data. But the machine learning always need a large number of data labels that have brought extra work burden to researchers, which greatly affects its practicability. Accordingly, this paper proposes a nano-Unsupervised-Deep-Learning method (nano-UDL) based on an unsupervised clustering algorithm to identify methylation events in nanopore data automatically. Specially, nano-UDL first uses the deep AutoEncoder to extract features from the nanopore dataset and then applies the MeanShift clustering algorithm to classify data. Besides, nano-UDL can extract the optimal features for clustering by joint optimizing the clustering loss and reconstruction loss. Experimental results demonstrate that nano-UDL has relatively accurate recognition accuracy on the O 6 -CMG dataset and can accurately identify all sequence segments containing O 6 -CMG. In order to further verify the robustness of nano-UDL, hyperparameter sensitivity verification and ablation experiments were carried out in this paper. Using machine learning to analyze nanopore data can effectively reduce the additional cost of manual data analysis, which is significant for many biological studies, including genome sequencing.

Objective: To summarize the clinical and pathological features of intravascular NK and T cell lymphoma for better understanding of such disease to reduce misdiagnosis and miss-diagnosis. Methods: Clinical and pathological features were analyzed retrospectively in one case of intravascular peripheral T-cell lymphoma, not otherwise specified (IVPTCL, NOS) , with literatures review. Results: The case presented in this study was a 66-year-old man. PET/CT scan showed multiple lymph nodes enlargement throughout the body. Normal lymph node structure could not be observed by tissue biopsy, while lymph follicles were partially disrupted. High-power light microscope revealed a large number of blood vessels with diffuse proliferation and dilation, where atypical lymphoid cell mass was restricted in the lumen and partially infiltrated the large blood vessel wall. These tumor cells were medium to large with moderate cytoplasm. The nucleus was irregular, single or multiple nucleoli could be seen, chromatin was condensed, some were empty and bright, and mitotic figures could be seen. Immunohistochemical staining showed that the neoplastic cells were positive for expression of CD3, CD43, CD8, GrB, TIA-1 and perforin. EBER in situ hybridization result was negative. Polymerase chain reaction test identified a clonal gene rearrangement of T-cell receptor γ. The patient was treated with CHOP in combination with chidamide, but died of infection and cardiopulmonary failure within 2 months. 56 cases of intravascular NK/T cell lymphoma with definite classification were collected from relevant literatures, including 47 cases with nasal type of extranodal NK/T cell lymphoma (27 were male and 20 were female) , 8 cases with anaplastic large cell lymphoma (3 males and 5 females) , and only one case with de nova IVPTCL, NOS in brain. We report the second case of IVPTCL,NOS, and notably originated from lymph node for the first time. Conclusions: Intravascular NK/T cell lymphoma is a highly aggressive disease with no effective treatment at present. Involvement of Lymph node has rarely been reported, and further studies on more cases are necessary.

Objective: To screen and analyze the prognostic protein biomarkers of DLBCL, and to explore their value in the prognostic evaluation. Methods: 163 cases of confirmed DLBCLs from January 2011 to December 2016 were collected with their clinical, pathological and follow-up data, which were all from our hospital. The expression of protein markers were tested using immunohistochemical staining (IHC) . The immune phenotypes independent of the International Prognostic Index (IPI) that affect overall survival (OS) and progression-free survival (PFS) of DLBCL were explored by COX regression model, and the effect of their co-expression on the prognosis were also analyzed. Result: BCL6 negative (PFS: HR =1.652, 95% CI 1.030-2.649, P =0.037) , P53 positive (OS: HR =1.842, 95% CI 1.008-3.367, P =0.047) , and BCL2 strong positive expressions (S+) (OS: HR =2.102, 95% CI 1.249-3.537, P =0.005; PFS: HR =2.126, 95% CI 1.312-3.443, P =0.002) are adverse prognostic factors of DLBCL that are independent of IPI. BCL6(-) (PFS: HR =2.042, 95% CI 1.021-4.081, P =0.043) , P53(+) (OS: HR =3.069, 95% CI 1.244-7.569, P =0.015) and BCL2(S+) (OS: HR =2.433, 95% CI 1.165-5.082, P =0.018; PFS: HR =3.209, 95% CI 1.606-6.410, P =0.001) are adverse prognostic factors in the group of age≤60-year-old; in the group of IPI score 0-2, cases with BCL6(-) (OS: HR =2.467, 95% CI 1.322-4.604, P =0.005; PFS: HR =2.248, 95% CI 1.275-3.965, P =0.005) and BCL2(S+) (PFS: HR =2.045, 95% CI 1.119-3.735, P =0.020) have worse prognosis. The co-expression of BCL6(-) and BCL2(S+) has significant influence on prognosis of DLBCL ( P =0.005 and P <0.001) , in which BCL6(+)/non-BCL2(S+) ( n =86) has the best prognosis[3-year-OS (71.6±4.9) %, 3-year-PFS (67.0±5.1) %], and BCL6(-)/BCL2(S+) ( n =10) has the worst prognosis[3-year-OS (20.0±12.6) %, 3-year-PFS (10.0±9.5) %]; the co-expression of BCL6(-) and P53(+) has no significant influence on prognosis ( P =0.061 and P =0.089) , however, those cases with BCL6(+)/P53(-) ( n =98) often get better prognosis[3-year-OS (70.6±4.7) %, 3-year-PFS (64.6±4.9) %] than others; the co-expression of P53(+) and BCL2(S+) has significant influence on prognosis of DLBCL ( P <0.001 and P <0.001) , and P53(+)/BCL2(S+) ( n =5) has the worst prognosis (3-year-OS and 3-year-PFS are both 0) ; BCL2(S+) cases get shorter OS and PFS, regardless of the expression of BCL6 and P53. Conclusion: The expression and co-expression of BCL6 negative, P53 positive and BCL2(S+) have certain value in the prognostic evaluation of DLBCL, especially in the group of age≤60-year-old and IPI score 0-2.

Objective: To observe the effect of electroacupuncture (EA) intervention on postoperative sore throat (POST) and postoperative nausea and vomiting (PONV) after endotracheal intubation and general anesthesia., Methods: According to the random number table, 60 patients of gastrointestinal surgery under general anesthesia with tracheal intubation were randomly divided into EA group (30 cases) and control group (30 cases). Patients in the EA group were given acupuncture at Shaoshang (LU11) 30 minutes before general anesthesia, and EA at Chize (LU5) and Hegu (LI4) continued until the operation was completed. The incidence and severity of POST and visual analogue scale (VAS) score at 12, 24, and 48 h after surgery, and the incidence and severity of PONV at 12, 24 h after surgery were analyzed, respectively., Results: The incidence and severity of POST and PONV, and VAS score in the EA group were significantly lower than those in the control group 12 h and 24 h after surgery (P<0.05). Both groups had significant reductions in VAS score at 24 h and 48 h after surgery compared with that at 12 h (P<0.05)., Conclusion: EA can significantly improve the prognosis of patients on sore throat and reduce the incidence of PONV.

Transgenic technology has developed rapidly in recent years. The environmental risk of the release of transgenic organisms is still a key issue. Research on the impacts on biodiversity is an effective way to objectively evaluate the risk. By taking transgenic maize HGK60 with insect-resis-tant gene Cry1Ah and common maize Zheng58 as control, we examined the diversity of arthropods and weeds in spring and winter of 2018 in Hainan Province. 43753 arthropods belonging to 69 species, 19 families, and 7 orders were obtained. There was no significant difference in arthropod community composition, structure and ecological indices between HGK60 and Zheng58. Compared with Zheng58, the transgenic insect-resistant maize HGK60 had obvious resistance to wood boring beetles. 16 species of weeds belonging to 8 families were recorded in the field. There was no significant difference in the density and ecological indices of weeds between HGK60 and Zheng58, with almost the same change trends in the whole growth period. Our results suggested that planting transgenic maize HGK60 with insect-resistant gene Cry1Ah did not affect biodiversity of arthropods and weeds. The results provided scientific support for the further studies of environmental risk of transgenic crops.

Objective: To analyze the relationship between D-lactate, intestinal fatty acid binding protein (I-FABP) and the severity as well as the prognosis of patients in intensive care unit (ICU)., Methods: Using a retrospective approach, the data derived from a prospective, randomized, single-blind, multicenter clinical study published earlier by our group were further analyzed to evaluate the effect of fat-modified enteral nutrition (EN) suspension on the intestinal barrier in ICU patients. In this study, a total of 141 patients were recruited from 7 ICUs in South China, and 15 healthy volunteers were included as healthy control group. Clinical data of patients were collected, including gender, age, disease severity related indicators such as acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), C-reactive protein (CRP) and initial ICU diagnosis, as well as prognostic indicators such as length of stay in ICU, length of stay in hospital and prognosis of patients at 28 days. To compare the difference of serum D-lactate and I-FABP between ICU patients and healthy control group on day 0 (the day before EN reached 500 mL) and day 5 (EN ≥ 2 092 kJ/d for 5 days). According to the hemodynamic and/or mechanical ventilation status on day 5 (compared with day 0), 141 patients were divided into the improvement group (101 cases) and the non-improvement group (40 cases), and the changes of D-lactate and I-FABP in the two groups were observed. Spearman correlation analysis was used to analyze the correlation between serum D-lactate, I-FABP and the severity of the disease, as well as the predictive value of dynamic changes of D-lactate and I-FABP on the prognosis of 28 days., Results: Compared with the healthy volunteers, the serum D-lactate and I-FABP levels of ICU patients on day 0 were significantly increased [D-lactate (mg/L): 10.82 (3.31, 25.48) vs. 6.63 (1.54, 17.70), I-FABP (ng/L): 519.60 (159.06, 1 362.14) vs. 84.40 (30.78, 108.57), both P < 0.01], and D-lactate and I-FABP on day 5 were both decreased compared with the levels on day 0, but still higher than the healthy volunteers. I-FABP in the improvement group was significantly lower than that in the non-improvement group on day 0, and there was no significant difference in D-lactate levels between the two groups, D-lactate and I-FABP in both groups were significantly lower on day 5 than those on day 0, and D-lactate and I-FABP in the improvement group on day 5 were significantly lower than those in the non-improvement group [D-lactate (mg/L): 7.61 (1.71, 27.22) vs. 9.38 (2.09, 20.56), I-FABP (ng/L): 378.65 (152.56, 864.62) vs. 521.21 (205.93, 1 413.11), all P < 0.05]. Correlation analysis showed that D-lactate was significantly positively correlated with APACHE II score and SOFA score on day 0 and day 5 (R 1 2 = 0.367, P < 0.001; R 2 2 = 0.240, P = 0.012); I-FABP was significantly positively correlated with APACHE II score on day 0 (R 2 = 0.264, P = 0.004); D-lactate on day 5 and I-FABP on day 0 and day 5 were significantly negatively correlated with prognosis on day 28 (R 1 2 = -0.203, P = 0.022; R 2 2 = -0.208, P = 0.023; R 3 2 = -0.211, P = 0.021). The area under curve (AUC) analysis showed that D-lactate on day 5 and I-FABP on day 0 and day 5 had independent predictive value for 28-day prognosis, with AUC of 0.634, 0.638 and 0.652, P values of 0.023, 0.024 and 0.017, 95% confidence intervals (95%CI) of 0.533-0.734, 0.523-0.754 and 0.525-0.778, respectively. When the cut-off values were 7.71 mg/L, 593.55 ng/L and 468.10 ng/L, the sensitivity were 51.5%, 68.5% and 75.3%, and the specificity were 91.0%, 60.0% and 60.0%, respectively., Conclusions: Serum D-lactate and I-FABP were increased significantly and decreased with the improvement of the condition, and these two molecular biomarkers have certain value in predicting the prognosis of ICU patients.

Objective: To examine the effects of ethyl pyruvate (EP) on mitochondrial dynamics and cell apoptosis in lipopolysaccharide (LPS)-induced human kidney-2 (HK-2) cells., Methods: HK-2 cells were divided into three groups: HK-2 cells were challenged with LPS (800 μg/L) for 24 hours as LPS group, or LPS mixed with EP (0.25 mmol/L) for 24 hours as EP group. Cells were incubated with normal saline for 24 hours as control group. The levels of malondialdehyde (MDA), superoxide dismutase (SOD), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and intracellular adenosine triphosphate (ATP) were detected by enzyme linked immunosorbent assay (ELISA). JC-1 staining and Annexin V-fluorescein isothiocyanate/propidium iodide (FITC/PI) assays were used to evaluate mitochondrial membrane potential and cell apoptosis, respectively. Western Blot was used to evaluate the protein expressions of mitochondrial dynamics, including death-associated protein kinase 2 (DAPK-2), mitofusin (Mfn-1 and Mfn-2), and apoptotic associated biomarkers, including caspase-3, caspase-9, Bcl-2, Bcl-xL, cytochrome C (Cyt C), and DNA repair enzyme poly ADP-ribose polymerase (PARP)., Results: Compared with the NC group, MDA, IL-6, TNF-α of LPS group were significantly increased, the expression of SOD, mitochondrial membrane potential and ATP level were significantly decreased, the expression of mitochondrial fission protein DAPK-2 was significantly increased, and mitochondrial fusion proteins Mfn-1 and Mfn-2 were significantly decreased, cell apoptosis and apoptotic protein caspase-3, caspase-9 and Cyt C were increased, and anti-apoptotic protein Bcl-2, Bcl-xL, PARP were significantly decreased. Compared with the LPS group, the oxidative activities and inflammatory factors above were inhibited in EP group [MDA (μmol/L): 12.35±2.21 vs. 45.95±1.76, SOD (kU/L): 54.68±1.42 vs. 40.73±1.60, IL-6 (ng/L): 67.87±2.61 vs. 338.92±20.91, TNF-α (ng/L): 19.23±1.80 vs. 180.69±6.51], mitochondrial membrane potential and ATP level were significantly increased [mitochondrial membrane potential: (99.43±0.25)% vs. (69.40±0.75)%, ATP (×10 6 RLU): 0.19±0.01 vs. 0.12±0.05], the expression of mitochondrial fission protein was significantly decreased (DAPK-2/β-actin: 0.03±0.01 vs. 0.61±0.02), mitochondrial fusion proteins were significantly increased (Mfn-1/β-actin: 0.43±0.04 vs. 0.17±0.01, Mfn-2/β-actin: 0.201±0.004 vs. 0.001±0.001), percentage of cell apoptosis was significantly decreased [(5.25±0.17)% vs. (34.42±0.64)%], the expressions of apoptotic proteins were significantly decreased (caspase-3/β-actin: 0.25±0.15 vs. 1.76±0.01, caspase-9/β-actin: 0.09±0.02 vs. 1.52±0.12, Cyt C/β-actin: 0.001±0.001 vs. 0.350±0.030), and the expressions of anti-apoptotic proteins and PARP were significantly increased (Bcl-2/β-actin: 0.500±0.010 vs. 0.009±0.004, Bcl-xL/β-actin: 0.550±0.010 vs. 0.009±0.001, PARP/β-actin: 0.94±0.01 vs. 0.16±0.13), with statistically significant differences (all P < 0.05)., Conclusions: There are enhanced mitochondrial fission and diminished mitochondrial fusion in LPS-induced HK-2 cells. EP can protect mitochondria functions by regulate mitochondrial dynamics, and reducethe apoptosis of LPS-induced HK-2 cells.

Objective: The authors aim to provide genetic counselling and prenatal gene diagnosis to the families with osteogenesis imperfecta(OI), based on the identification of pathogenetic mutations in large cohort genetic testing. Methods: DNA was extracted from the peripheral blood of parents of the fetuses, and from the villi tissue, amniotic fluid or cord blood of the fetuses using a standard sodium dodecyl sulfate-proteinase K-phenol/chloroform extraction method. PCR combined with Sanger DNA sequencing was performed to validate the pathogenic mutations of 200 fetuses at risk of OI and their parents from 158 families. Allelic analysis of microsatellite markers was applied to exclude the false positive caused by maternal DNA contamination, when both the fetus and the mother harbored the same pathogenic genotype. Results: A total of 83 affected fetuses (83/200, 41.5%) and 12 (12/200, 6.0%) recessive carriers were identified among the 200 fetuses. The 83 affected fetuses included 78 heterozygotes (45 of COL1A1 , 32 of COL1A2 , one of IFITM5 ), and 5 compound heterozygotes or homozygotes of recessive OI (two of FKBP10 , one of SEC24D , one of WNT1 and one of CRTAP ); The 12 recessive carriers included 7 of WNT1 , 4 of SERPINF1 and one of SERPINH1 . Maternal DNA contamination was excluded from the genomic DNA samples of OI fetuses when their mother with the same affected genotypes. Conclusion: In this study, the authors used an optimized gene diagnosis system of OI to perform prenatal genetic diagnosis to 200 fetuses at high risk of OI, and provided precisely genetic counselling to the OI families.

Objective: To explore the application value of elastic ultrasound (EUS) and contrast-enhanced ultrasonography (CEUS) in detecting the changes of testicular blood supply after blockage of the vas deferens artery., Methods: This study included 11 cases of microscopic varicocele ligation. We obtained the EUS and CEUS values of the patients before and after blocking the vas deferens artery and analyzed the data by paired comparison., Results: After the blockage of the vas deferens artery, the testicular hardness was reduced across the tunica albuginea and within the testis, with Ave decreased from 11.44 ± 2.52 before to 6.21 ± 1.16 after the blockage of the vas deferens artery across the tunica albuginea (P < 0.01) and from 3.99 ± 1.03 before to 3.27 ± 0.70 after the blockage within the testis (P = 0.012). The AUC in the epididymis was reduced from 80.98 ± 60.74 before to 42.82 ± 16.01 after the blockage (P = 0.021), and the AWi in the central testis from 17.19 ± 11.09 before to 11.03 ± 8.58 after the blockage (P = 0.034). No statistically significant differences, however, were observed in the values obtained close to the tunica albuginea or in the Awi and Awo in the testis after the blockage (P > 0.05)., Conclusions: Elastic ultrasound and contrast-enhanced ultrasonography play important roles in evaluating the changes of testicular blood supply in different states.

Objective: To evaluate trough serum vancomycin concentrations and identify their influencing factors in critically ill neurosurgical patients., Methods: A retrospective study was conducted. Adult patients who received vancomycin with at least one appropriate monitoring of trough serum vancomycin concentration and admitted to neurosurgical intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from November 2017 to July 2019 were enrolled. General information including gender, age, comorbidities, etc., trough serum vancomycin concentrations, vancomycin dosage, duration of vancomycin therapy, urine output, serum creatinine (SCr), concurrent medications (including mannitol,diuretic, vasopressors, non-steroidal anti-inflammatory drugs, polymyxin, aminoglycosides and contrast medium, etc.) were collected for analysis. Trough serum vancomycin concentrations were evaluated and their influencing factors were analyzed by multiple linear regression method., Results: In total, 81 trough serum vancomycin concentration data sets obtained from 28 patients were evaluated. (1) The initial daily dose of vancomycin was 2.00 (2.00, 2.00) g/d. After 4-6 doses, the trough serum vancomycin concentration obtained from initial blood draw was 10.99 (6.98, 16.25) mg/L, of which only 17.9% (5/28) achieving targeted concentrations (15-20 mg/L), 71.4% (20/28) subtherapeutic level and 10.7% (3/28) supratherapeutic level. (2) The duration of vancomycin therapy was 8.0 (6.0, 15.0) days. With average daily dose of 2.00 (1.75, 3.00) g/d, targeted trough vancomycin concentrations were achieved in only 30.9% (25/81) of all cases, subtherapeutic concentrations in 49.4% (40/81) and supratherapeutic concentrations in 19.7% (16/81). (3) There were significant differences in age, comorbidities, vancomycin dosage, diuretics use and mannitol dosage, etc. among different vancomycin concentration groups. Multiple linear regression analysis suggested that the trough serum vancomycin concentration increased by 0.14 mg/L [95% confidence interval (95%CI) was 0.06-0.22] for every 1 year increase in age, increased by 7.22 mg/L (95%CI was 2.08-12.36) in patients with multiple comorbidities (concomitant hypertension, diabetes and coronary heart disease) compared with those without comorbidities, increased by 2.78 mg/L (95%CI was 0.20-5.35) in patients treated with diuretics compared with those without diuretics. The effect of other variables was not statistically significant. It suggested that age, multiple comorbidities (concomitant hypertension, diabetes and coronary heart disease), and diuretic usage affected trough serum vancomycin concentrations., Conclusions: Targeted trough serum vancomycin level is not often achieved in neurosurgical ICU patients following standard dosing. Younger patients are associated with lower trough serum vancomycin concentrations, while diuretic usage, combined with multiple comorbidities are associated with higher trough serum vancomycin concentrations.

Objective: To evaluate cerebrospinal fluid (CSF) vancomycin concentrations and identify factors influencing CSF vancomycin concentrations in critically ill neurosurgical patients., Methods: A retrospective study was conducted. Adult patients who received vancomycin treatment and CSF vancomycin concentrations monitoring admitted to neurosurgical intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from January 2016 to June 2019 were enrolled. General information, vancomycin dosing regimens, CSF vancomycin concentrations, CSF drainage methods and volume of the previous day, and concurrent medications, etc. were collected for analysis. CSF vancomycin concentrations of patients with definite or indefinite central nervous system (CNS) infection, different vancomycin dosing regimens and their influencing factors were analyzed., Results: A total of 22 patients were included. 168 CSF specimens were collected for culture, 20 specimens of which were culture positive, with a positive rate of 11.9%. Sixty cases of CSF vancomycin concentration were obtained. Among the 22 patients, 7 patients (31.8%) were diagnosed with proven CNS infection, 11 patients (50.0%) clinically diagnosed, 2 patients (9.1%) diagnosed with uncertain CNS infection, and 2 patients (9.1%) diagnosed without CNS infection. Intravenous (IV) administration of vancomycin alone was used in 15 cases (25.0%), intrathecal injection in 17 cases (28.3%), IV+intrathecal injection in 23 cases (38.3%), and IV+intraventricular administration in 5 cases (8.3%). The CSF vancomycin concentrations ranged from < 0.24 to > 100 mg/L, with an average level of 14.40 (4.79, 42.34) mg/L. (1) Administration methods of vancomycin affected CSF vancomycin concentrations. The CSF vancomycin concentration with intrathecal injection or intraventricular administration was higher than that of IV administration alone [mg/L: 25.91 (11.28, 58.17) vs. 2.71 (0.54, 5.33), U = 42.000, P < 0.01]. (2) When vancomycin was administered by IV treatment alone, CSF vancomycin concentrations were low in both groups with definite CNS infection (proven+probable) and indefinite CNS infection (possible+non-infection), the CSF vancomycin concentrations of which were 4.14 (1.40, 6.36) mg/L and 1.27 (0.24, 3.33) mg/L respectively, with no significant difference (U = 11.000, P = 0.086). (3) CSF vancomycin concentrations rose with the increased dose of vancomycin delivered by intrathecal injection or intraventricular administration. According to the dose of vancomycin administered locally on the day before therapeutic drug monitoring (TDM), cases were divided into the following groups: 0-15 mg group (n = 22), 20-35 mg group (n = 33), and 40-50 mg group (n = 5), the CSF vancomycin concentrations of which were 4.14 (1.09, 8.45), 30.52 (14.31, 59.61) and 59.43 (25.51, 92.45) mg/L respectively, with significant difference (H = 33.399, P < 0.01). Moreover, the cases of CSF vancomycin concentration of ≥ 10 mg/L accounted for 18.2%, 84.8% and 100% of these three groups, respectively. CSF vancomycin concentrations mostly reached target level when dose of vancomycin administered locally were 20 mg/L or more., Conclusions: It is difficult to reach target CSF vancomycin concentration for critically ill neurosurgical patients with or without CNS infection by IV treatment. Local administration is an effective treatment regimen to increase CSF vancomycin concentration.

Objective: To study the influential factor of hyperlactatemia after the brain tumor craniotomy., Methods: Patients who underwent selective brain tumor (including glioma, meningioma and acoustic schwannoma) craniotomyin the neurosurgery intensive care unit (NSICU) of the First Affiliated Hospital, Sun Yat-sen University from December 1st 2018 to May 20th 2019 were enrolled. The incidence of hyperlactatemia after the brain tumor craniotomy was investigated. Univariate and multivariate linear regression analysis were performed to identify the association of initial artery lactate with the operation duration, the intraoperative blood loss, the total intraoperative fluid infusion, intraoperative ringer lactate fluid infusion, intraoperative urine volume, intraoperative fluid balance, the total intraoperative corticosteroids dosage and the tumor type. Pearson method was used to analyze the correlation between lactate in arterial blood and independent related factors., Results: A total of 148 patients were enrolled including 45 patients (30.41%) with glioma, 64 patients (43.24%) with meningioma, and 39 patients (26.35%) with acoustic schwannoma. The initial lactate level in arterial blood increased significantly in 148 patients, with a median of 4.80 (3.68, 5.90) mmol/L. Among them, 78 patients (52.70%) had mild elevation of lactate in arterial blood (2 mmol/L < lactate ≤ 5 mmol/L), 61 patients (41.22%) had significant elevation of lactate in arterial blood (5 mmol/L < lactate ≤ 10 mmol/L), and 2 patients (1.35%) had serious elevation of artery lactate (> 10 mmol/L). And only 7 patients (4.73%) had normal level of lactate in arterial blood (≤ 2 mmol/L). Univariate analysis showed that initial postoperative artery lactate was positively correlated with the operation duration [β = 0.556, 95% confidence interval (95%CI) was 0.257-0.855, P < 0.001] and the total intraoperative corticosteroids dosage (β = 0.477, 95%CI was 0.174-0.779, P = 0.002). There was no significant correlation between the initial postoperative artery lactate and tumor types, the intraoperative blood loss, the total fluid infusion, the ringer lactate fluid infusion, urine volume, and the fluid balance. Further multivariate linear regression analysis showed that the operation duration (β = 0.499, 95%CI was 0.204-0.795, P = 0.001) and the total intraoperative corticosteroids dosage (β = 0.407, 95%CI was 0.111-0.703, P = 0.008) were independent risk factors affecting the initial postoperative artery lactate. The correlation analysis showed that there was a significant positive correlation between lactate in arterial blood and operation time and total hormone dosage during operation (r 1 = 0.289, r 2 = 0.248, both P < 0.01)., Conclusions: Initial artery lactate after brain tumor craniotomy is associated with surgery duration and exogenous administration of corticosteroids.

Objective: To determine the CGG repeat number and methylation status of FMR1 gene for fetuses whose mothers have carried a FMR1 mutation., Methods: For 30 pregnant women, the fetal CGG repeat number was determined with a GC-rich PCR system by using chorionic villus, amniotic fluid or umbilical blood samples. The methylation status of the FMR1 gene was confirmed with Southern blotting., Results: In total 30 prenatal diagnoses were performed for 29 carriers of FMR1 gene mutations and 1 with FMR1 gene deletion mosaicism. Three fetuses were found to carry premutations, 9 were with full mutations and 1 with mosaicism of premutation and full mutations. Eighteen fetuses were normal., Conclusion: Considering the genetic complexity of Fragile X syndrome (FXS), single method may not suffice accurate determination of their genetic status. The pitfalls and technical limitations of protocols requires adoption of personalized strategy for its prenatal diagnosis.

Objective: To investigate the relationship between plasma oxidative stress factors levels and organ damage parameters as well as prognosis in patients with sepsis., Methods: A case-control study was conducted. Twenty-five patients admitted to surgical intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from March to December in 2016 and diagnosed as sepsis were enrolled as study subjects. Another 15 patients without sepsis admitted to surgical ICU in the same period were enrolled as controls. General demographic data, main diagnoses, acute physiology and chronic health evaluation II (APACHE II) score within 24 hours, clinical laboratory indicators [alanine aminotransferase (ALT), aspartate transaminase (AST), serum creatinine (SCr), blood urea nitrogen (BUN), C-reactive protein (CRP), procalcitonin (PCT), white blood count (WBC)] and oxidative stress indicators [superoxide dismutase (SOD), malondialdehyde (MDA) and nitric oxide (NO)] as well as length of ICU stay, total hospital stay and 28-day mortality were recorded. Spearman or Pearson correlation method was used to analyze the correlation between oxidative stress indicators and organ damage indicators as well as prognosis in patients with sepsis. Receiver operator characteristic (ROC) curve was plotted to evaluate the predictive value of oxidative stress indicators for 28-day mortality in patients with sepsis., Results: The length of ICU stay in sepsis group was significantly longer than that in non-sepsis group [days: 7.0 (5.5, 11.0) vs. 4.0 (1.0, 11.0), P < 0.05], and AST, BUN, CRP, PCT, plasma MDA and NO levels were significantly higher than those in non-sepsis group [AST (U/L): 50.76±19.53 vs. 28.53±14.02, BUN (mmol/L): 9.99±5.26 vs. 6.97±4.32, CRP (mg/L): 109.28±42.79 vs. 60.33±46.68, PCT (μg/L): 5.4 (0.3, 24.0) vs. 0.6 (0.1, 1.5), MDA (ng/L): 488.31±76.68 vs. 399.30±50.23, NO (ng/L): 5.08±0.89 vs. 4.42±0.88, all P < 0.05]. There was no significant difference in gender, age, APACHE II score, total hospital stay, 28-day mortality, ALT, SCr, WBC or plasma SOD activity between the two groups. The correlation analysis between oxidative stress parameters and organ damage parameters as well as prognosis in patients with sepsis showed that MDA and NO were positively correlated with SCr (r value was 0.426 and 0.431, respectively, both P < 0.05), and there was a positive correlation between MDA and NO (r = 0.990, P < 0.01); plasma SOD activity was negatively correlated with 28-day mortality (r = -0.468, P < 0.05), while MDA and NO levels were positively correlated with 28-day mortality (r value was 0.598 and 0.611, respectively, both P < 0.01). ROC curve analysis showed that plasma SOD, MDA and NO levels had a good independent predictive effect on 28-day mortality, the area under ROC curve (AUC) was 0.816±0.087, 0.904±0.078 and 0.912±0.071, and the best cut-off value was 40.76% (sensitivity 68.4%, specificity 100%), 487.93 ng/L (sensitivity 83.3%, specificity 89.5%) and 5.31 ng/L (sensitivity 83.3%, specificity 89.5%), respectively., Conclusions: The plasma levels of oxidative stress factors in patients with sepsis are significantly increased, which is closely related to organ damage and poor prognosis. The plasma SOD, MDA and NO levels can be used as independent bio-marker to predict the 28-day mortality of patients with sepsis.

Objective: To explore the suitable process for prenatal screening and diagnosis for women with advanced maternal age., Methods: From January 2014 to November 2017, the indications and distributions of prenatal diagnosis for women with advanced maternal age only or accompanying with positive maternal serum test screening and non-invasive prenatal testing (NIPT), abnormal fetal ultrasound, one harboring chromosomal abnormalities or anomalous reproductive history were analyzed. The rate of fetal chromosomal abnormalities was compared between different groups., Results: The 351 pregnant women with fetal chromosomal abnormalities have included 196 cases with advanced maternal age, 26 with positive maternal serum test, 96 with high-risk by NIPT, 14 with abnormal fetal ultrasound, 15 with one partner harboring chromosomal abnormalities, and 4 with anomalous reproductive history. Assuming that all pregnant women had undergone maternal serum test screening or NIPT without amniocentesis, the detection rate of fetal chromosome abnormality would be 51.0% and 69.2%, respectively. However, should these women have received both tests, the detection rate would be as high as 84.6%. Should those with one partner harboring chromosomal abnormalities undergone maternal serum test screening or NIPT without amniocentesis, the detection rate of fetal chromosomal abnormality would only be 6.7%., Conclusion: Should pregnant women with advanced maternal age undergo both maternal serum test and NIPT, the detection rate of fetal chromosomal abnormality will be higher than those receiving only maternal serum test screening or NIPT. Couples with one partner harboring chromosomal abnormalities should undergo prenatal diagnosis by amniocentesis.

China is highly rich of medicinal plants. Traditional Chinese medicine(TCM) has a long history and is important traditional resources in China. As one of the important strategic resources and the link among all the countries along the ancient "Silk Road", TCM has played important role in economy, politics, society and ecology. With the initiative of the "Belt and Road" in recent years, many natural resources of TCM now are facing the risk of extinction due to more and more frequent trade between China and other countries, also the increase of export has influenced to the stock of TCM. In order to prevent the loss of the resources, strengthen the protection and sustainable use of TCM, our study provided the strategies to the natural resources of TCM's entry-exit supervision from nine aspects, like law and regulation system, based on the analysis of current supervision status quo.

Effective early screening and primary prevention is one of the major initiatives to decrease the morbidity and mortality of colorectal cancer in China. As a new non-invasive screening method for colorectal cancer in recent years, fecal DNA test detects colorectal cancer by analyzing gene mutations from intestinal tumor cells in the feces. The most widely used method among fecal DNA test is multi-target stoolDNA test (MT-sDNA). Many studies abroad on this emerging technique have been carried out to verify its high sensitivity, and it is gradually used in the clinic with continuous improvement and development of technology. Meanwhile, domestic MT-sDNA is still in the prototype stage, and more researches from Chinese population are needed. Compared with traditional screening methods, MT-sDNA technology has the advantages of non-invasiveness, painlessness and convenience. But its defects exist, such as high cost and low specificity. MT-sDNAis in accordance with precision medicine, and can largely make up for the shortcomings of traditional screening methods for colorectal cancer. It also holds a great promise for promoting the screening for colorectal cancer. This paper is aimed to discuss the application value of fecal DNA test by introducing its related researches at home and abroad,and summarizing its merits and demerits.

Mesophyll conductance (g m ) refers to the diffusion capacity of CO 2 inside mesophyll cells, which is the reciprocal of resistance of mesophyll cells. In the early stage of photosynthesis research, mesophyll diffusion resistance to CO 2 was usually assumed to be zero, namely the g m was infinite. In recent studies, however, the g m was found to be limited and changed with external environments. As g m directly determines CO 2 diffusion and affects leaf photosynthetic efficiency, it is of great significance to mechanestic research of photosynthesis. Presently, simultaneous chlorophyll fluorescence and gas exchange, the curve-fitting and instantaneous carbon isotope ( 13 CO 2 ) discrimination are commonly used to estimate g m , but few literature have been introduced on those methods in China. Therefore, it is particularly necessary to elaborate the principles and processes of these methods and to compare their advantages and disadvantages. We synthesized the relevant literature, and introduced the three methods in detail from the aspects of principle, derivation process and advantages and disadvantages, aiming to provide a methodological basis to promote the research on g m in China. The curve-fitting method was easy to understand and operate. Its fitting model varied with the status of photosynthesis, which is needed to be divided strictly by researchers. Consequently, it was not conducive to be widely used. Although the instantaneous carbon isotope ( 13 CO 2 ) discrimination method improved the accuracy of results, it was complex in measurement and strict in operation. Furthermore, it was less sensitive to test errors with low reliability. Compared with the above two methods, simultaneous chlorophyll fluorescence and gas exchange was more operable and reliable, and was more conducive to the observation and analysis for large samples with multi-processing and multi-repetition. In addition, the use of chlorophyll fluorescence technology not only simplified the test procedures, but also reduced the accidental errors, making the results more scientific. Chlorophyll fluorescence technology also provided saturated pulse activation energy to maximize leaf photosynthetic potential. But this method also had many problems, for instance, to improve the accuracy of chlorophyll fluorescence parameters, a lower gas flow rate was needed, which would increase the risk of gas diffusion and leakage. Thus, this method had a high requirement for a reasonable gas flow rate. In general, simultaneous chlorophyll fluorescence and gas exchange method was most widely used in the actual determination of plant g m .

Stable carbon isotope composition can accurately indicate ecosystem carbon cycling and provide key information for the study of the influence of forest succession on the carbon cycling and carbon sequestration potential. We measured the δ 13 C values and carbon and nitrogen contents of leaf, trunk, root, litter, and soil along a forest successional gradient in Changbai Mountain, which included a middle-aged poplar-birch secondary forest, a mature poplar-birch secondary forest, and an old-growth broad-leaved Korean pine forest. The results showed that leaf δ 13 C reduced with their position from the upper canopy to lower canopy, bark δ 13 C was less than xylem, fine root δ 13 C was less than course root. In contrast to the secondary forests, δ 13 C of the undecomposed litter layer was less than that of the semi-decomposed layer and decomposed litter layer in the broad-leaved Korean pine forest. Soil δ 13 C increased with depth. The ascending order of mean δ 13 C was leaf, litter, root, trunk, and soil, indicating that there is obvious fractionation among different organs of plants and among different parts of a specific organ. In addition, plant δ 13 C first decreased and then increased with the succession process, but soil δ 13 C increased with the succession processes. The different patterns of the changes of plant and soil δ 13 C along forest succession could be explained by the relationship between nitrogen content and carbon isotope fractionation effect, indicating that carbon isotope fractionation was affected by the change of dominant tree species and the variation of carbon turnover rate.

We integrated the meteorological records from 36 national weather stations and CN05.1 gridded daily observation dataset to analyze the climate change characteristics of Changbai Mountain eco-functional area. Linear tendency estimation, Mann-Kendall mutation test, cumulative anomaly method and Morlet wavelet analysis were used to investigate the temporal and spatial variation of temperature (annual temperature, seasonal temperature, extreme temperature), moisture (annual precipitation, seasonal precipitation, relative humidity), radiation (sunshine duration, sunshine percentage) and wind speed from 1961 to 2016. The results showed that, during 1961-2016, the temperature of this area increased, the radiation and wind speed decreased, and the precipitation varied periodically. Specifically, winter temperature [0.45 ℃·(10 a) -1 ] and the lowest temperature [0.74 ℃·(10 a) -1 ] significantly increased. The mean annual wind speed significantly decreased [-0.21 m·s -1 ·(10 a) -1 ]. No abrupt climate change was observed. The annual precipitation days decreased considerably [-7.01 d·(10 a) -1 ], which was different from the climate change pattern of Northeast China. The annual precipitation trend coefficient of this area was 16.06 mm·(10 a) -1 , which could not be simply depicted by increase or decrease in trend. The precipitation change in this area was dominated by periodically patterns, and the period was 26 years and 3 years. Our results would be instructive to the regional ecological assessment, and the research on ecosystem responses to climate change and phenological changes.

We synthesized the scientific research carried out in Changbai Mountain from 1956 to 2018 by mapping knowledge domains and bibliometrics based on the literature from international database (WOS) and domestic databases (CNKI and CSCD). The results showed that natural science research in Changbai Mountain underwent three stages during 1956-2018, including embryo stage, growing stage, and rapid development stage. The natural research in Changbai Mountain could be divided into five fields, i.e., forest and ecological science, volcano and geology science, environmental change science, resource sciences and utilization, animal and microbial science, with a total of 20 main research directions. Since 2000, forest and ecological science, volcano and geological science, environmental change science dominated the natural science research in Changbai Mountain. The researches in recent 20 years mainly concentrated on the following seven disciplines: community ecology, forest management, soil ecology, ecosystem ecology, eco-climatology, forest responses to environmental change, and volcanic geology. International researches showed a trend of strong integration of different disciplines. We forecast that the natural science research in the Changbai Mountain would deepen its research in the next decade. Moreover, other fields such as old-growth forest and large-scale ecosystem carbon processes, forest-altitude-climate change, soil fauna and microorganisms, forest management and human activities, biodiversity, volcanic origin and eruption history, volcanic eruption dynamics and volcanic monitoring will emerge as the new research focus. Scale polarization, elements diversification, discipline crossing, and research deepening would be the future trend of natural science research in Changbai Mountain.

Objective: To analyze the 20-year survival rate, causes of death and predictors of systemic lupus erythematosus (SLE). Methods: A retrospective analysis was performed on 217 newly SLE patients who were diagnosed and treated by Peking University People's Hospital before June 2008. The clinical features and serologic data were studied. Survival rate of SLE patients over time, living conditions, causes of death and prognostic indicators of mortality were studied. Results: The 10-, 15-and 20-year cumulative survival rate was 90.3%,88.1%and 79.6%, respectively. Infection and lupus encephalopathy were the main causes of death. Cox regression analysis revealed that lupus nephritis, neuropsychiatric systemic lupus erythematosus and age at the diagnosis were independent risk determinants for mortality. Conclusion: Prognosis of SLE remains to be improved. Early diagnosis, control of SLE organ damage and infection prevention are critical to improve survival of SLE patients.

Objective: To better define the effect of JAK2V617F mutant allele burden on clinical presentation of patients with essential thrombo cythamia (ET), especially thrombosis., Methods: Two ml of heparin anti-coagulated bone marrow was collected from 229 ET cases, who were diagnosed and treated in the First People's Hospital of Yunnan Province during 2013.10 to 2016.12. and then the mononuclear cells were separated by Red Blood Cell Lysis Buffer, genomic DNA was extracted from mononuclear cells by using a commercial DNA isolation kit and amplified by allele specific polymerase chain reaction (PCR). According to the size of molecular weight, the amplified products were separated by electrophoresis on a 2% agarose gel to screen the JAK2V617F mutation, then the JAK2V617F mutation burden was detected by real-time polymerase chain reaction (RT-PCR) in 120 patients with JAK2V617F mutation. Meanwhile, these samples were sequenced in order to verify the accuracy of the PCR screewing., Results: ET patients with thrombotic events had significantly higher JAK2V617F allele burden than those without thrombosis (23.2% vs 14.2%) ( P<0.05). Meanwhile, ET patients showed increased JAK2V617F allele burden in the group with higher leukocytosis (WBC > 10×10 9 /L) (P<0.001) and hemoglobin (> 150 g/L) (P<0.05). JAK2V617F mutation burden in 17 patients with splenomegaly was higher than that in 45 patients without splenomegaly (28.1% vs 11.8%) (P<0.05). but the JAK2V617F mutation burden was regatively correlated with platelet count (P<0.05). On the other hand, no correlation was found between JAK2V617F mutation burden and sex (P > 0.05). Univariate analysis showed that the JAK2V617F allele burden did not affect survival. Multivariable analysis showed that prognostic variable including WBC counts, hemoglobin level, age, sex, and splenomegaly not affected survival, (P > 0.05)., Conclusion: The clinical presentations of ET patients, such as WBC counts, hemoglobin level and splenomegaly, are influenced by the JAK2V617F mutation burden. ET patients with thrombotic events has significantly higher JAK2V617F allele burden than those in ET palients without thrombosis.JAK2V617F mutation burden has no relations with sex and age..

Objective: The aim of this study was to explore the clinical safety and feasibility of intracorporeal delta-shaped anastomosis in total laparoscopic left hemicolectomy. Methods: From January 1, 2017 to October 1, 2017, 11 patients who were diagnosed with left colon cancer and underwent total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis were retrospectively enrolled in this study. Clinicopathologic characteristics, surgical and postoperative outcomes were collected and analyzed. Results: The median operation time was 121.8 minutes and the median time for anastomosis was 14.9 minutes. The median intraoperative blood loss was 45.5 ml. The lengths of the upper and lower segments of resection from colon cancer were 11.4 cm and 8.5 cm, respectively. The median number of lymph nodes retrieved was 29.5. The median time to ground activities, time to flatus, time to fluid diet intake and length of hospital stay were 1.4 days, 3.0 days, 3.8 days and 6.9 days, respectively. Only one patient suffered from incision infection during his hospitalization due to preoperative long-term smoking history. No mobility related to the anastomosis such as anastomotic bleeding, stenosis, obstruction and leakage occurred in any patients. Conclusion: Total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect.

Objective: To evaluate the efficiency of clear aligners in treating bimaxillary protrusion patients with first premolar extractions. Methods: Eleven patients with bimaxillary protrusion were selected in this study. All of them were treated by using clear aligners with four first premolar extractions and need maximal anchorage. Cephalometric analysis was carried out before and after treatment. Results: Cephalometric analysis results showed that significant changes in teeth and profile could be detected after clear aligner treatment and no change could be found in skeletal pattern. Upper and lower anterior teeth were retracted. The control of anterior torque and posterior anchorage were effective. The soft tissue analysis showed that position of upper and lower lip was significantly changed which improve the profile of patients. After treatment, the distance of U1 to NA and L1 to NB reduced by (5.19±4.12) mm and (4.53±1.20) mm, respectively. The differences were statistically significant ( P <0.01). Conclusions: Bimaxillary protrusion patients who needed premolar extractions and maximal anchorage could be treated with clear aligners.

Objective: To investigate the feasibility and diagnostic value of preoperative transthoracic echocardiography guided three dimensional printing model (TTE Guided 3DPM) on the assessment of structural heart disease (SHD). Methods: From February 2016 to October 2016, 44 patients underwent cardiac surgery in Tianjin Chest Hospital, forty-four patients were assessed preoperatively using TTE Guided 3DPM, including 25 males and 19 females, aged 3-75 years, with an average of (44±22) years. compared to conventional three dimensional transthoracic echocardiography (3D-TTE), and took direct intraoperative findings as "Golden Standard" simultaneously. There are twelve patients with SHD, including four cases with mitral prolapse, two cases with partial endocardial cushion defect, two cases with secondary atrial septal defect, two cases with rheumatic mitral stenosis, one case with tetralogy of Fallot, one case with ventricular septal defect (VSD), thirty-two patients without SHD were designed as negative control. Results: The sensitivity and specificity of TTE Guided 3DPM were greater than or equal to 3D-TTE, P value of McNemar test of 3D-TTE was greater than 0.05, the difference was not statistically significant, kappa =0.745, P <0.01, indicated that the results of 3DTTE and the gold standard were generally consistent. P value of McNemar test of TTE Guided 3DPM was greater than 0.05, the difference was not statistically significant, kappa =0.955, P <0.01, indicated that the results of TTE Guided 3DPM and gold standards were consistent. Compared with 3D-TTE and TTE Guided 3DPM, P value was greater than 0.05, the difference was not statistically significant, kappa =0.879, P <0.01, indicated that the results of 3D-TTE and TTE Guided 3DPM were consistent. TTE Guided 3DPM displayed the three-dimensional structure of SHD cardiac lesions clearly, which were consistent with intraoperative findings. Conclusion: TTE Guided 3DPM provides essential information for the preoperative evaluation and decision of SHD.