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Objective: To measure the psychological well-being of healthcare workers (HCWs) during this COVID-19 pandemic and examine the experiences of the subgroup of participants who were also HCWs during the 2003 SARS epidemic., Design: Anonymous online survey adapted from a similar study conducted during the SARS epidemic, disseminated from July 2020 to August 2020., Setting: Nine healthcare institutions across Singapore ranging from primary care, community care, tertiary care and specialised referral centres., Participants: Employees working in the participating healthcare institutions., Results: Of 3828 survey returns, 3616 had at least one completed item on the questionnaire. Majority were female (74.7%), nurses (51.7%), foreign-born (53.2%) and not working in the tertiary care setting (52.1%). The median score on the Impact of Events Scale (IES) was 15 (IQR 23) and 28.2% of the sample scored in the moderate/severe range. 22.7% of the participants were also HCWs during SARS and more than half of them felt safer and better equipped in the current pandemic. 25.2% of SARS HCWs and 25.9% of non-SARS HCWs had moderate/severe IES scores (p=0.904). After adjusting for age, marital status, parity and length of work experience, racial minority groups and living apart from family were independent predictors of high IES regardless of prior SARS epidemic experience. Daily exposure to confirmed or suspect COVID-19 cases increased the odds of high IES for non-SARS HCWs only., Conclusions and Relevance: Overall, while 28% of HCWs in our study suffered from significant trauma-related psychological symptoms regardless of prior experience with the SARS epidemic, those with prior experience reported feeling safer and better equipped, finding the workload easier to manage, as well as having more confidence in their healthcare leaders. We recommend for more trauma-informed support strategies for our HCWs especially those from racial minority groups, who are foreign-born and isolated from their families., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

So far, diabetes mellitus has become a health threat to society all over the world. Especially, people with diabetes have always coped with complications related to this disease and unexpected side effects of synthetic drugs. Thus, there has been a current trend for researchers to find out new natural ingredients which were safer and still effective in the treatment of diabetes. Gomphogyne bonii Gagnep. extract ( G. bonii extract) was an herbal-derived product of the Pharmacy Department, Vietnam University of Traditional Medicine. This study was designed to assess the antidiabetic effect of G. bonii extract on a high-fat diet (HFD) and alloxan-induced diabetes in mice. Mice were first fed a high-fat diet for 8 weeks and then given an intraperitoneal injection of alloxan (ALX) at the dose of 180 mg/kg b.w. After the diabetic mice model was successfully established, mice were administered orally with G. bonii extract at two doses of 4 mL/kg b.w/day and 12 mL/kg b.w/day for 2 weeks. The results revealed that G. bonii extract at both doses ameliorated the effects of ALX on the concentration of glucose, total cholesterol (TC), triglyceride (TG), and low-density lipoprotein-cholesterol (LDL-C) and microhistological images of livers. Besides, the antidiabetic effect of G. bonii extract at the dose of 12 mL/kg b.w/day was better than that at the dose of 4 mL/kg b.w/day. This suggested that G. bonii extract could be a potential agent for treating diabetes mellitus in clinical practice., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2021 Pham Quoc Binh et al.)

The kainic acid (KA)-induced epilepsy experimental model is widely used to study the mechanisms underlying this disorder. Recently, the blood-brain barrier (BBB) has become an innovative alternative treatment target for epilepsy patients. KA causes neuronal injury and BBB damage in this experimental epilepsy model but the mechanisms underlying epilepsy-related neuronal injury, autophagy, and BBB damage remain unclear. Therefore, the present study investigated the relationships among neuronal injury, the expressions of autophagy-related proteins, and changes in BBB-related proteins during the acute phase of epilepsy to further understand the mechanisms and pharmacotherapy of epilepsy. NeuN immunohistochemistry and Fluoro-Jade B (FJ-B) staining in the hippocampal CA3 region revealed that neuronal death induced by intraventricular injections of 10 μg/kg KA was greater than that induced by 3 μg/kg KA. In addition, there were transient increases in the levels of microtubule-associated protein light chain 3-II (LC3I/II) and Beclin-1, which are autophagy-related proteins involved in neuronal death, in this region 24 h after the administration of 10 μg/kg KA. There were also morphological changes in BBB-related cells such as astrocytes, endothelial cells (ECs), and tight junctions (TJs). More specifically, there was a significant increase in the activation of astrocytes 72 h after the administration of 10 μg/kg KA as well as continuous increases in the expressions of platelet endothelial cell adhesion molecule-1 (PECAM-1) and BBB-related TJ proteins (Zonula occludens-1 and Claudin-5) until 72 h after KA treatment. These results suggest that the overexpression of autophagy-related proteins and astrocytes and transient increases in the expressions of BBB-related TJ proteins may be closely related to autophagic neuronal injury. These findings provide a basis for the identification of novel therapeutic targets for patients with epilepsy.

Background: Aging is an inevitable process which results in many changes. These changes are closely related to the hippocampus which is in charge of long-term learning and episodic memory., Aim: This study was to investigate age-related changes of the cell proliferation, neuroblast differentiation and Akt/mTOR signaling in the hippocampal alveus of aged mice., Methods: In the present study, we compared the differences of neurogenesis in the hippocampal alveus between adult (postnatal month 6) and aged (postnatal month 24) mice using immunohistochemistry and western blot analysis., Results: The cell proliferation, neuroblast differentiation, and the increased astrocyte activation in the hippocampal alveus of mice were decreased in an age-dependent manner. In addition, during normal aging, the protein level of AKT, mTOR and the phosphorylation of mTOR were all decreased. However, the protein level of AKT was increased., Discussion: These results indicate the neurogenesis in the immature neurons in the hippocampal alveus of aged mice was closely related to the normal aging process. In addition, during normal aging, the increased AKT phosphorylation and decreased mTOR phosphorylation in the hippocampus may play a role in aging development., Conclusion: The result indicates that increased activation of astrocyte, increased phosphorylation of AKT and decreased phosphorylation of mTOR may be involved in the decreased cell proliferation and neuroblast differentiation in the alveus of hippocampus of aged mice.

Some anticonvulsant drugs are associated with cognitive ability in patients; Topiramate (TPM) is well known as an effective anticonvulsant agent applied in clinical settings. However, the effect of TPM on the cognitive function is rarely studied. In this study, we aimed to observe the effects of TPM on cell proliferation and neuronal differentiation in the dentate gyrus (DG) of the D-galactose-induced aging mice by Ki-67 and doublecortin (DCX) immunohistochemistry. The study is divided into four groups including control, D-galactose-treated group, 25 and 50 mg/kg TPM-treated plus D-galactose-treated groups. We found, 50 mg/kg (not 25 mg/kg) TPM treatment significantly increased the numbers of Ki-67 + cells and DCX immunoreactivity, and improved neuroblast injury induced by D-galactose treatment. In addition, we also found that decreased immunoreactivities and protein levels of antioxidants including superoxide dismutase and catalase induced by D-galactose treatment were significantly recovered by 50 mg/kg TPM treatment in the mice hippocampal DG (P < 0.05). In conclusion, our present results indicate that TPM can ameliorate neuroblast damage and promote cell proliferation and neuroblast differentiation in the hippocampal DG via increasing SODs and catalase levels in the D-galactose mice.

We report an unusual and dramatic presentation of a rare form of cutaneous lymphoma, known as subcutaneous panniculitis-like T-cell lymphoma (SPTCL). This patient presented with a pruritic, florid and purpuric rash that was diagnosed as lobular panniculitis and treated with oral steroids for 1 year with no success. His skin lesions would return each time oral corticosteroids were being weaned off. Upon presentation to our clinic, repeated deep skin biopsies with immunohistochemical analysis coupled with the clinical history of persistent B symptoms and the presence of pancytopenia helped clinched the rare diagnosis of SPTCL with hemophagocytosis. The patient was then started on cyclosporine and dexamethasone before definitive chemotherapy. This rare and diagnostically challenging condition is commonly misdiagnosed as benign panniculitis or eczema, and highlights the importance of repeated skin biopsies.

Objective: To determine whether the matrix metalloproteinase 9 gene (MMP9) polymorphism is associated with the onset or progression of adolescent idiopathic scoliosis (AIS) in Chinese Han female., Methods: Three single nucleotide polymorphisms (SNPs) (rs17576, rs2250889, rs1805088) were genotyped through TaqMan-based real-time PCR assay in 190 AIS patients and 190 controls, all of whom were females from Chinese Han population with matched age. Analyses performed included Hardy Weinberg equilibrium test, Pearson chi-square test, Logistic regression analysis, linkage disequilibrium analysis and haplotype analysis. The mean maximum Cobb angles with different genotypes in case-only dataset were also compared., Results: All 3 SNPs have reached Hardy-Weinberg equilibrium in the controls. Genotype and allele frequencies of all SNPs were found similar between cases and controls by Pearson chi-square test and Logistic regression. Genotype-phenotype analysis showed that patients with CC genotype in rs2250889 featured larger maximum Cobb angles., Conclusion: MMP9 may not be a predisposition gene of AIS in Han female. However, homozygous mutation in rs2250889 can render scoliosis more severe, implying that MMP9 defect may result in deterioration of AIS.

Objective: To investigate the prevalence of adolescent scoliosis in Guangzhou for development of effective prevention and treatment program to the disease., Methods: From November 2007 to July 2009, 30 142 students between 7 to 20 years old in primary and junior middle schools received physical check-up for detection of scoliosis through physical and radiographic examination., Results: 211 cases were diagnosed as scoliosis (Cobb angle ≥ 10°), with the prevalence rate as 0.70%. 192 patients with idiopathic scoliosis (IS) were detected, accounting for 91.00%. There were 19 cases of congenital scoliosis, accounting for 9.00%. Sex ratio of scoliosis was 180/31. The prevalence of scoliosis was significantly lower in boys than that in girls (χ(2) = 112.332, P < 0.001)., Conclusion: The crude prevalence of adolescent scoliosis was 0.70% in Guangzhou with majority of idiopathic scoliosis. Investigation on scoliosis among school-age population seemed to be important for the purposes of early diagnosis, selection of effective prevention and treatment.

Objective: To investigate the effect and mechanism of Scutellaria Baicalensis Stem-leaf Total Flavonoid (SSTF) on lipid metabolism in hyperlipidemic rat., Method: On the basis of establishing hyperlipidemia rat model, blood lipids, lipid metabolic enzyme, antioxidative capacity were investigated after 30 days feeding of fatty emulsion., Result: SSTF significantly reduced the serum TC, TG, LDL-C, ApoB concentration and increased HDL-C and ApoAI levels, improved the activity of lecithin cholesterol acyltransferase (LCAT). SSTF was shown to decreased MDA content in both serum and liver, increased serum SOD activity., Conclusion: SSTF could remarkably modulate the lipid metabolic disorder in hyperlipidemic rats, and has a certain regulating function on lipoprotein, inferring that it could reduce the occuring of atherosclerosis. The mechanism of regulating lipid metabolism might be related with the increasing activity of LCAT and antioxidative capacity.

This study was to explore the relationships between (-511)T>C and (+3954)C>T single nucleotide polymorphisms(SNP) in IL-1beta gene with lumbar intervertebral disc disease. We analyzed (-511)T>C and (+3954)C>T SNP in IL-1beta gene by the polymerase chain reaction-restriction fragment length polymorphism and electrophoresis methods respectively in 81 cases with lumbar disc disease and 101 healthy controls. The relationship between (-511)T>C and (+3954)C>T SNP in IL-1beta gene and lumbar disc disease in two groups was measured, so does the relationship between (-511)T>C and (+3954)C>T SNP in IL-1beta gene and intervertebral disc degeneration in those younger than 45-year-old. The results showed there were (-511)T>C and (+3954)C>T SNP in IL-1beta gene. There was a significant difference in the distribution of TT, TC and CC genotype or T, C genotype of (-511)T>C of IL-1beta in two groups. And there was no significant difference in the distribution of (+3954)C>T SNP in IL-1beta gene in two groups. There was no significant difference between the distribution of (-511)T>C and (+3954)C>T SNP in IL-1beta gene and intervertebral disc degeneration in those younger than 45-year-old. It suggested (-511)T>C SNP in IL-1beta gene be one of the susceptible alleles for Lumbar disc disease.

Objective: To explore the polymorphisms of vitamin D receptor (VDR) gene Tru I polymorphisms and the influence of this variation on Bsm I polymorphisms in Han nationality., Methods: Venous blood samples from 80 healthy individuals of Han nationality were collected and genomic DNA was extracted, VDR Bsm I and Tru I were tested by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to analyze the polymorphisms of VDR gene; After using another primers to test VDR Bsm I in the same samples, the consistence of each method was assessed., Results: The frequencies of the VDR Tru I genotype in the groups were: TT 68.7%, Tt 26.3%, tt 5.0%; VDR Bsm I were: BB 6.2%, Bb 52.5%, bb 41.3%; Both polymorphisms were under Hardy-Weinberg equilibrium. After using another pair of primer, the frequencies of Bsm I genotype were BB 20.0%, Bb 26.2%, bb 53.8%, 22 genotype Bb changed to genotype BB or genotype bb in comparison with the result of first detection., Conclusion: The VDR Tru I polymorphism is found in the Han nationality, the distribution of this site's polymorphism is different from that of other nationalities. The presence of Tru I variation can result in some allele of Bsm I genotype drop-out in some study.

Objective: To analyze the risk factors of heterotopic (HO) ossification after total lumbar disc replacement and probe the preventive strategies for it., Methods: The radiographs and clinical data of 78 discs in 65 patients who received artificial lumbar disc replacement (ADR) from April 1998 to December 2003 were analyzed retrospectively by two radiologists and one orthopaedic surgeon and then postoperative HO were graded according to McAfee system. The bony formations in disc spaces, time of HO were found, and range of motion (ROM) of the operated levels were measured on radiographic films. In addition, the risk factors such as preoperative peri-annulus ossification, bony endplates injuries, and subsided or mal-position of the prostheses were also analyzed by Logistic regression analysis., Results: Postoperative HO was found in 10 spaces of 9 cases. Class I of HO were occurred in 7 patients at means 2.1 years postoperatively with normal range of motion preserved. Three of them turned into class II or III with 10 degrees of mean ROM in the following 2.5 years. Another 2 (2/9) cases with preoperative peri-annulus ossification had bridging trabecular bone (class III) between the endplates and 9 degrees of ROM 2 years after surgery, then turned into class IV at 6 years with 0 degrees and 4 degrees of motion in the operated levels. As the risk factors of HO, preoperative annulus ossification (2 cases), bony endplates injuries (5 cases), mal-positioned prostheses (2 cases) and subsided prostheses (2 cases) were found simultaneity with significant positive relation to HO occurred (P < 0.05)., Conclusions: Factors such as preoperative ossification of annulus, endplate injuries, prosthesis subsided and mal-position would have higher risks to have HO occurred after ADR, but ROM of most affected levels are preserved. Strict control indication and avoid all above risk factors can prevent HO occurring effectively.

Objective: To probe the accuracy and safety of using an aiming device in the transpedicular fixation of cervical spine., Methods: Eight cervical specimens were obtained. We used the computed tomography (CT) to scan C3 to C7, measured the medial angle of the pedicle, and determined the location of the pedicle projecting on the articular process. Then we took the oblique X-ray film, measured the cephalic/caudal angle of the pedicle, and determined the location of the pedicle projecting on the articular process. All the specimens were equally divided into two groups. Screws of 2.8 mm x 30 mm, were used. Specimens in one group were inserted with the transpedicular screw manually, while specimens in the other one inserted with the transpedicular screw using a self-designed aiming device that can be modulate at the three dimensions according to the angles of the pedicles., Results: The first group totally had 40 screws from C3 to C7. There were 13 screws in the pedicle, 9 violated the walls of the pedicle but not involved the adjunct structure, and 18 injured the important structure such as spinal cord, verteberal artery, or nerve root. In the other group, only 4 screws violated the walls of the pedicle but not involved the adjunct structure, and the others all in the pedicles. The difference was of statistical significance (P < 0.01)., Conclusion: In the cervical spine, transpedicular fixation using an aiming device can improve the accuracy and safety during operation.