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Aim Neurostimulation techniques are effective treatments for major depressive disorders (MDD). However, the optimal sequence of electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) as part of antidepressant treatment algorithm is unclear. We examined the cost-effectiveness of ECT and TMS in MDD. Methods A decision-analytic model was developed to determine total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) for 10 strategies. Each strategy comprised four treatment lines with ECT and TMS incorporated as second, third, or fourth line. A scenario analysis that explored the cost-effectiveness of maintenance approach by continuing ECT and TMS after acute treatment was performed. Results In the base case, fourth-line TMS after three preceding trials of antidepressants was least costly at US$ 5523 yielding 1.424 QALYs. Compared with this strategy, fourth-line ECT and third-line TMS followed by ECT were cost-effective with ICERs of US$ 7601 per QALY gained and US$ 11 388 per QALY gained, respectively. In the scenario analysis where continuation treatments of ECT and TMS were provided, third-line TMS followed by ECT was cost-effective, with an ICER of US$ 17 198 per QALY gained. Effectiveness of ECT and cost of managing severe depression were influential parameters affecting the cost-effectiveness results. Conclusions In acute treatment of MDD, fourth-line ECT was the most cost-effective strategy. In maintenance treatment, the strategy that incorporated third-line TMS and fourth-line ECT was cost-effective. The overall findings confirmed the value of neurostimulation therapies which should be offered early in the process of managing depression.

Workers of Apis cerana cerana undergo an in-hive nursing to outdoor foraging transition, but the genes underlying this age-related transition remain largely unknown. Here, we sequenced the head transcriptomes of its 7-day-old normal nurses, 18- and 22-day-old normal foragers, 7-day-old precocious foragers and 22-day-old over-aged nurses to unravel the genes associated with this transition. Mapping of the sequence reads to Apis mellifera genome showed that the three types of foragers had a greater percentage of reads from annotated exons and intergenic regions, whereas the two types of nurses had a greater percentage of reads from introns. Pair- and group-wise comparisons of the five transcriptomes revealed 59 uniquely expressed genes (18 in nurses and 41 in foragers) and 14 nurse- and 15 forager-upregulated genes. The uniquely expressed genes are usually low-abundance long noncoding RNAs, transcription factors, transcription coactivators, RNA-binding proteins, kinases or phosphatases that are involved in signaling and/or regulation, whereas the nurse- or forager-upregulated genes are often high-abundance downstream genes that directly perform the tasks of nurses or foragers. Taken together, these results suggest that the nurse-forager transition is coordinated by a social signal-triggered epigenetic shift from introns to exons/intergenic regions and the resulting transcriptional shift between the nurse- and forager-associated genes.

Background and Aim The high cost of chronic hepatitis C (HCV) direct-acting antivirals (DAAs) poses significant financial challenges for health payers, especially in Asia. A personalized treatment strategy based on individualized probability of virological response using oral DAAs as second-line therapy would seem practical but has not been studied. Methods We performed a Markov model to project health outcomes and costs for patients with genotype 1 HCV through 10 treatment strategies over a lifetime period. The implication of retreatment was also incorporated to reflect real-life situation. Results Using boceprevir and peginterferon/ribavirin (BOC/PR, the least costly treatment) as a base case, the all-oral therapies such as ombitasvir/paritaprevir/ritonavir-dasabuvir are cost-effective with an incremental cost-effective ratio of $US50 828. However, the all-oral DAAs would no longer be cost-effective compared with conventional therapies if retreatment were taken into account. A road map strategy using rapid virological response to guide use of BOC/PR and sofosbuvir/PR had the most favorable incremental cost-effective ratio ($US27 782) relative to BOC/PR. Nevertheless, the trade-off with the cost-effectiveness of the road map strategy is an increased number of liver-related deaths compared with all-oral DAAs (52 vs 10–20 per 10 000 patients) by incorporating retreatment. Conclusions The 12-week all-oral DAAs were cost-effective options using conventional drug-to-drug comparison. However, they cease to be cost-effective when treatment strategies incorporating DAA retreatment for interferon failures are incorporated. HCV management can be optimized by adopting individualized treatment algorithm providing a practical solution to health payers to make oral DAAs accessible to those who need them most.

Nitrogen (N) is the major nutrient limiting phytoplankton growth and productivity over large ocean areas. Dinoflagellates are important primary producers and major causative agents of harmful algal blooms in the ocean. However, very little is known about their adaptive response to changing ambient N. Here, we compared the protein profiles of a marine dinoflagellate Prorocentrum donghaiense grown in inorganic N-replete, N-deplete and N-resupplied conditions using 2-D fluorescence differential gel electrophoresis. The results showed that cell density, chlorophyll a and particulate organic N contents presented low levels in N-deplete cells, while particulate organic carbon content and glutamine synthetase (GS) activity maintained high levels. Comparison of the protein profiles of N-replete, N-deplete and N-resupplied cells indicated that proteins involved in photosynthesis, carbon fixation, protein and lipid synthesis were down-regulated, while proteins participating in N reallocation and transport activity were up-regulated in N-deplete cells. High expressions of GS and 60 kDa chaperonin as well as high GS activity in N-deplete cells indicated their central role in N stress adaptation. Overall, in contrast with other photosynthetic eukaryotic algae, P. donghaiense possessed a specific ability to regulate intracellular carbon and N metabolism in response to extreme ambient N deficiency.

Objectives To study E2F3a expression and its clinical significance in children with acute lymphoblastic leukemia (ALL). Methods We quantified E2F3a expression at diagnosis in 148 children with ALL by real-time PCR. In the test cohort (n = 48), receiver operating characteristic (ROC) curve was used to find the best cut-off point to divide the patients into E2F3a low- and high-expression groups. The prognostic significance of E2F3a expression was investigated in the test cohort and confirmed in the validation cohort (n = 100). The correlations of E2F3a expression with the clinical features and treatment outcome of these patients were analyzed. Results ROC curve analysis indicated that the best cut-off point of E2F3a expression was 0.3780. In the test cohort, leukemia-free survival (LFS) and event-free survival (EFS) of the low-expression group were lower than those of the high-expression group (log rank: P = 0.026 for both). This finding was verified in the validation cohort. LFS, EFS, and overall survival were also lower in the low-expression group than in the high-expression group (log rank, P = 0.015, 0.008, and 0.002 respectively). E2F3a low expression was correlated with the existence of BCR-ABL fusion. An algorithm composed of E2F3a expression and minimal residual disease (MRD) could predict relapse or induction failure more precisely than current risk stratification. These results were still significant in the ALL patients without BCR-ABL fusion. Conclusions Low expression of E2F3a was associated with inferior prognosis in childhood ALL. An algorithm composed of E2F3a expression and MRD could predict relapse or induction failure more precisely than that of the current risk stratification.

A tandem annulation of arylpropynols with disulfides has been developed for the synthesis of 2-sulfenylindenone derivatives. The reaction pathway involves one-pot tandem Meyer–Schuster rearrangement of arylpropynols and successive radical cyclization with disulfides. Various arylpropynols and disulfides with a number of functional groups are compatible in this reaction that affords the corresponding 2-sulfenylindenones in moderate to good yields.

Physical damage is one of the main factors that cause seedling mortality in many ecosystems. However, the impact of physical damage due to rainfall erosion on seedling mortality is seldom investigated. In this study, we ask the following question: how does rainfall erosion influence seedling damage and establishment in the Loess Plateau region of China? Seedling damage and establishment experiments under different patterns of simulated rainfall were conducted. The seedling damage rate, damage type and growth status were investigated. The seedling damage rate was influenced by rainfall intensity and duration and by the runoff volume. The mean damage rate of all three studied species did not exceed 15 per cent, and the highest damage rate of individual species under special rainfall events was approximately 30 per cent. The type of damage suffered by the seedlings of Sophora viciifolia (which produces large seeds) mainly took the form of striking down, whereas seedlings of Artemisia scoparia (which produces small seeds) suffered the highest rates of washing away among the three studied species. In the seedling establishment experiment, after 120 days with six rainfall events, S. viciifolia had the highest seedling establishment rate (80·1 ± 2·5 per cent), followed by Bothriochloa ischaemun (67·2 ± 2·2 per cent), and A. scoparia (28·1 ± 2·5 per cent). The seedling damage rate, damage type and establishment rate were also related to seed size. Whether physical damage to seedlings is a major factor limiting vegetation restoration in eroded environments requires further research. Copyright © 2012 John Wiley & Sons, Ltd.

The dynamic changes in the sediment discharge over 90 years from 1919 to 2008 in the Yellow River in China were assessed on the basis of annual rainfall series and annual sediment series in Shan County hydrological station. The key factors affecting sediment discharge, such as rainfall, and human activities were studied. Anomaly accumulation method and double mass curve were employed to test the stage changes of sediment discharge, and to determine the main factors of sediment decline. Results showed that the annual average sediment discharge under natural conditions was about 16 x 10(8) t, but the measured annual average sediment during 1919-2008 was 12.71 x 10(8) t. The highest annual average during the study period was 39.10 x 10(8) t in 1933 while the lowest was 1.77 x 10(8) t in 2008. Sediment discharge in the Yellow River experienced two low sediment stages (1924-1931 and 1979-2008) and a high sediment stage (1932-1971), respectively. Since 1979, there was a significant decreasing trend in the sediment discharge, and the main influencing factor was fierce human activities. Annual average sediment discharge in the post-development period (1979-2008) was 69.7% lower than that in the pre-development period (1919-1978), with average reduction of 81 and 19% caused by human activities and rainfall, respectively. These results provide important evidence for making protecting policy for water resources quality and environmental safety of the Yellow River.

Background: Listeria monocytogenes infection is not commonly reported in China. Increasing the awareness of neonatal listeriosis is necessary. Methods: Six cases of neonatal listeriosis were diagnosed in the neonatal intensive care unit at Beijing Obstetrics & Gynecology Hospital in 2008. We reviewed the clinical features, laboratory findings, timing of treatment, medications used, and the history of the mothers during pregnancy. Results: All six cases were preterm infants. Blood cultures were positive for L. monocytogenes. All of the mothers developed fever in the third trimester of pregnancy, and three of them ended their pregnancy the day the fever appeared. The severity of the clinical symptoms varied in each infant, and all cases were treated with antibiotics immediately after birth. All six cases were discharged from hospital in good health. Conclusions: Neonatal Listeria infection is generally a severe disease. Pregnant women must guard against fever and other manifestations, such as Listeria infection. Clinicians encountering such cases should be attentive to the patient's condition and should provide appropriate antibiotic treatment. Early detection and effective targeted treatment of listeriosis helps to improve the patient's survival and prognosis.

Aim Compared with second-generation durable polymer drug-eluting stents (DP-DES), the cost-effectiveness of biodegradable polymer drug-eluting stents (BP-DES) remains unclear in the real-world setting. We assessed the cost-effectiveness of BP-DES in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). Methods We developed a decision-analytic model to compare the cost-effectiveness of BP-DES to DP-DES over 1 year and 5 years from healthcare payer perspective. Relative treatment effects during the first year post-PCI were obtained from a real-world population analysis while clinical event risks in the subsequent 4 years were derived from a meta-analysis of published studies. Results At 1 year, based on the clinical data analysis of 497 propensity-score matched pairs of patients, BP-DES were associated with an incremental cost-effectiveness ratio (ICER) of USD20 503 per quality-adjusted life-year (QALY) gained. At 5 years, BP-DES yielded an ICER of USD4062 per QALY gained. At the willingness-to-pay threshold of USD50 400 (one gross domestic product per capita in Singapore in 2015), BP-DES were cost-effective. Sensitivity analysis showed that the cost of stents had a significant impact on the cost-effectiveness of BP-DES. Threshold analysis demonstrated that if the cost difference between BP-DES and DP-DES exceeded USD493, BP-DES would not be cost-effective in patients with 1 year of follow-up. Conclusions Biodegradable polymer drug-eluting stents were cost-effective compared with DP-DES in patients with coronary artery disease at 1 year and 5 years after PCI. It is worth noting that the cost of stents had a significant impact on the findings.

This study was carried out to evaluate progression in Parkinson's disease (PD) by analyzing time taken to transit from one Hoehn and Yahr (HY whereas the median time taken to progress from stage 3 to 4 and 4 to 5 were 24 and 26 months, respectively. Cox regression analysis revealed that older age-at-diagnosis, longer PD duration, and higher Unified Parkinson's Disease Rating Scale (UPDRS) motor scores at baseline were associated with a significantly faster progression through various H&Y stages. Gender and ethnicity were not associated with disease progression. In conclusion, H&Y transition time is a useful measure of disease progression in PD and may be utilized in clinical studies evaluating therapeutic interventions and prognostic factors in PD.

Studies have confirmed that TrkB plays important roles in facilitating metastasis in various types of malignant tumors. In the present study, 30 cases of colon cancer and matched non-tumors were examined for the expression of TrkB by Western blot. The expression of TrkB was also examined in 90 colon tumor sections by immunohistochemical methods, and D2-40 staining was used to evaluate the correlation between TrkB expression and lymphatic vessel density. To investigate the effects of TrkB on the progression of colon cancer, siRNA specific for TrkB was transfected into LoVo cells, and proliferation, apoptosis and invasion of transfected cells were examined using MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide], flow cytometry and Transwell assays, respectively. Our results showed that TrkB was up-regulated in colon tumors compared with the non-tumorous counterparts, and the overexpression of TrkB was closely correlated with lymphatic vessel density (LVD) and metastasis. Inhibition of TrkB by siRNA increased the apoptotic rates of transfected cells, while the numbers of proliferative and invasive cells were decreased. In summary, our data suggest that overexpression of TrkB in colon cancer possibly plays roles in inhibiting apoptosis, promoting proliferation and invasion, facilitating tumor progression by lymphangiogenesis-associated metastasis.

The title reaction with a variety of non-activated allylic ethers as coupling partners proceeds under mild conditions at 30°C whereas allylic thioethers require 80°C as reaction temperature.

In the Loess Plateau, China, arable cultivation of slope lands is common and associated with serious soil erosion. Planting trees or grass may control erosion, but planted species may consume more soil water and can threaten long-term ecosystem sustainability. Natural vegetation succession is an alternative ecological solution to restore degraded land, but there is a time cost, given that the establishment of natural vegetation, adequate to prevent soil erosion, is a longer process than planting. The aims of this study were to identify the environmental factors controlling the type of vegetation established on abandoned cropland and to identify candidate species that might be sown soon after abandonment to accelerate vegetation succession and establishment of natural vegetation to prevent soil erosion. A field survey of thirty-three 2 x 2-m plots was carried out in July 2003, recording age since abandonment, vegetation cover, and frequency of species together with major environmental and soil variables. Data were analyzed using correspondence analysis, classification tree analysis, and species response curves. Four vegetation types were identified and the data analysis confirmed the importance of time since abandonment, total P, and soil water in controlling the type of vegetation established. Among the dominant species in the three late-successional vegetation types, the most appropriate candidates for accelerating and directing vegetation succession were King Ranch bluestem (Bothriochloa ischaemum) and Lespedeza davurica (Leguminosae). These species possess combinations of the following characteristics: tolerance of low water and nutrient availability, fibrous root system and strong lateral vegetative spread, and a persistent seed bank.

Cell poking is an experimental technique that is widely used to study the mechanical properties of plant cells. A full understanding of the mechanical responses of plant cells to poking force is helpful for experimental work. The aim of this study was to numerically investigate the stress distribution of the cell wall, cell turgor, and deformation of plant cells in response to applied poking force. Furthermore, the locations damaged during poking were analyzed. The model simulates cell poking, with the cell treated as a spherical, homogeneous, isotropic elastic membrane, filled with incompressible, highly viscous liquid. Equilibrium equations for the contact region and the non-contact regions were determined by using membrane theory. The boundary conditions and continuity conditions for the solution of the problem were found. The force-deformation curve, turgor pressure and tension of the cell wall under cell poking conditions were obtained. The tension of the cell wall circumference was larger than that of the meridian. In general, maximal stress occurred at the equator around. When cell deformation increased to a certain level, the tension at the poker tip exceeded that of the equator. Breakage of the cell wall may start from the equator or the poker tip, depending on the deformation. A nonlinear model is suitable for estimating turgor, stress, and stiffness, and numerical simulation is a powerful method for determining plant cell mechanical properties. (Managing editor: Wei Wang)

Nogo-A is known to be a myelin-associated protein with strong inhibitory effect on neurite outgrowth and has been considered one of the major factors that hinder fiber regeneration in the central nervous system. Recent studies have demonstrated widespread occurrence of nogo-A mRNA and Nogo-A protein in neurons. Our concurrent immunohistochemical study substantiated the widespread distribution of neuronal Nogo-A. The present study was thus focused on its intraneuronal distribution in the central nervous system, using Western blotting, immunohistochemical, and immunogold electron microscopic techniques. Western blotting of the nucleus, cytoplasm, and membrane subcellular fractions of the cerebellum and spinal cord tissues demonstrated that all three fractions contained Nogo-A. Nogo-A immunoreactivity could be identified under confocal microscope in the nucleus, perikayon, and proximal dendrite and along the cell membrane. Under the electron microscope, the perikaryonal Nogo-A immunogold particles were mainly distributed at polyribosomes and rough endoplasmic reticulum, suggesting its relationship with translation process. The immunogold particles could also be found beneath or on the plasma membrane. In the nucleus, the Nogo-A immunogold particles were found to be localized at the chromatins of the nucleus, indicating its possible involvement in gene transcription. The presence of Nogo-A in the nucleus was further supported by transfection of COS-7L cells with nogo-A. This study provides the first immunocytochemical evidence for intraneuronal distribution of Nogo-A. Apparently, the significance of Nogo-A in the central nervous system is far more complex than what has been envisioned.

Aims The safety and efficacy of BP-DES compared to second-generation DP-DES remain unclear in the real-world setting. We compared the clinical outcomes of biodegradable polymer drug-eluting stents (BP-DES) with second-generation durable polymer drug-eluting stents (DP-DES) in an all-comer percutaneous coronary intervention (PCI) registry. Methods/results The study included a cohort of 1065 patients treated with either BP-DES or DP-DES from January 2009 through October 2015. Propensity score matching was performed to account for potential confounders and produced 497 matched pairs of patients. The primary endpoint was target lesion failure (TLF) at one-year follow-up. The rates of TLF were comparable between BP-DES and DP-DES (8.7% vs 9.1%, P = .823) at 1 year. The rates of stent thrombosis at 30 days (0.4% vs 0.4%, P = 1.00) and 1 year (0.8% vs 0.8%, P = 1.00) did not differ between BP-DES and DP-DES. There were no significant differences in other clinical outcomes including target vessel failure (8.9% vs 9.5%, P = .741), in-stent restenosis (1.8% vs 1.0%, P = .282), and cardiac death (6.4% vs 7.4%, P = .533) at 1 year. Multivariate cox regression analysis showed that the risk of TLF at one-year did not differ significantly between BP-DES and DP-DES (hazard ratio 0.94, P = .763). Conclusions Efficacy and safety of BP-DES were not better than DP-DES at one-year follow-up.

The pre-Botzinger complex (preBotC) in the ventrolateral medulla is thought to be the kernel for respiratory rhythm generation. Neurons in the preBotC contain intense neurokinin-1 receptor (NK1R) immunoreactivity. Some of these neurons in the adult preBotC are presumed to be the pre-inspiratory interneurons that are essential for generating respiratory rhythm in the neonate. Chloride-mediated synaptic inhibition is critical for rhythmogenesis in the adult. The present study used immunofluorescence histochemistry and immunogold-silver staining to determine the inhibitory synaptic relationship between glutamic acid decarboxylase (GAD)- or glycine transporter 2 (GlyT2)-immunoreactive (ir) boutons and NK1R-ir neurons in the preBotC of adult rats. Under the confocal microscope, we found that GAD- and GlyT2-ir boutons were in close apposition to NK1R-ir somas and dendrites in the preBotC. Under the electron microscope, GAD- and GlyT2-ir terminals were in close apposition to NK1R-ir somas and dendrites. Symmetric synapses were identified between GAD- or GlyT2-ir terminals and NK1R-ir neurons. A total of 51.6% GAD-ir and 38.2% GlyT2-ir terminals were found to contact or make synapses with NK1 R-ir profiles, respectively. GAD-and GlyT2-ir terminals synapsed not only upon NK1R-ir neurons but also upon NK1R immuno-negative neurons. NK1R-ir neurons received both symmetric (presumed inhibitory) and asymmetric (presumed excitatory) synapses. Thus, the present findings provide the morphological basis for inhibitory inputs to NK1R-ir neurons in the preBotC, consistent with the suggestion that chloride-mediated synaptic inhibition may contribute importantly to rhythm generation by controlling the membrane potential trajectory and resetting rhythmic bursting of the kernel neurons in the adult.

A novel fungitoxic compound, cepaciamide A, was isolated from Pseudomonas cepacia D-202. Its structure and stereochemistry were elucidated by the spectroscopic and synthetic methods.

The structure of cepaciamide A was revised to be (3 R ,3′ S ,2″ S ,11″ S ,12″ R )-3-[3′-(2″-hydroxy-11″,12″-methyleneoctadecanoyloxy)hexadecamido]-2-piperidinone with respect to the absolute configuration of the C 3′- and C 2″- positions and the position of the cyclopropane ring by using synthetic methods. The structure of cepaciamide B was also determined to be (3 R ,3′ S ,2″ S ,11″ Z )-3-[3′-(2″-hydroxy-11″-octadecenoyloxy)hexadecamido]-2-piperidinone.