Search

Bei-Xi Bao, Hui Yan, Jia-Guang Tang, Dao-Jing Qiu, Yu-Xuan Wu, Xiao-Kang Cheng Department of Orthopedic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of ChinaCorrespondence: Jia-Guang Tang, Department of Orthopedic Surgery, Beijing Tongren Hospital, Capital Medical University, No. 1 of Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, People’s Republic of China, Tel/Fax +86 13911003227, Email jgtang123@163.comObjective: To retrospectively analyze the risk factors for adding-on phenomena (AOP) after posterior hemivertebral resection (PHR) and pedicle screw fixation for the treatment of congenital scoliosis (CS) caused by hemivertebral (HV) malformation.Methods: Patients with CS who underwent surgery and were followed up for more than five years were included in this study. The d general data, such as gender, age, HV segment, Risser sign, and triangular cartilage, postoperative complications, and imaging data at different periods, including the standard anteroposterior and lateral x-rays of the total spine were collected.Results: In total, 58 patients were included in this study, of which 10 experienced AOP and 48 did not. The results of the single-factor analysis showed that there were statistically significant differences between the patients with AOP and those without in terms of the HV direction, lowest instrumented vertebra (LIV)–upper instrumented vertebra (UIV) (P < 0.05), and postoperative trunk shift (P < 0.05). The results of the logistic regression analysis showed that the HV direction and the postoperative trunk displacement distance were the main risk factors for postoperative AOP. The area under the receiver operating characteristic curve was 0.842 (P < 0.001). The best cut-off value of the adding-on index as an indicator of the occurrence of AOP after surgery was 0.67. When the adding-on index was > 0.67, the incidence of postoperative AOP was 90.0%, and the non-occurrence rate was 22.9%.Conclusion: PHR and pedicle screw fixation is an effective way to treat HV malformation in CS. The HV direction, LIV–UIV, and postoperative TS are risk factors for AOP in patients with CS treated with PHR and pedicle screw fixation. The adding-on index has a high degree of accuracy for the prediction of the occurrence of AOP after PHR and pedicle screw fixation.Keywords: congenital scoliosis, hemivertebral resection, adding-on phenomena

Study Design: Case report. Objective: To report a case of cervical myelopathy due to simultaneous anomalies at the level of atlas involving hypoplasia of the posterior arch of the atlas, partial ossification of the transverse atlantal ligament, and hypertrophy of the dens. Summary Of Background Data: Hypoplasia of the posterior arch of the atlas, ossification of the transverse atlantal ligament, and hypertrophy of the dens are all individually very rare clinical entities. We are not aware of previous reports describing the association of hypoplasia of the posterior arch of the atlas, partial ossification of the transverse atlantal ligament, and hypertrophy of the dens. Methods: The patient's medical history, physical examination, and radiographic evaluation are examined. Surgical treatment and clinical outcome are reported. In addition, available literature is also reviewed. Results: The patient's neurologic symptoms significantly improved after posterior decompressive surgery. Conclusion: We believe this is the first case of cervical myelopathy caused by simultaneous anomalies at the level of atlas involving hypoplasia of the posterior arch of the atlas, partial ossification of the transverse atlantal ligament, and hypertrophy of the dens. Surgical intervention improved the neurologic impairment. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to discuss the biomechanical effects of the sagittal vertical axis and different instrumented segments on distal adjacent segments after congenital scoliosis posterior hemivertebrectomy., Method: A case of congenital scoliosis caused by hemivertebra was selected for the reconstruction of the preoperative and postoperative 3D computed tomography data of the full spine. A finite element model of different fusion lengths and postoperative trunk shift (TS) values was established using the finite element method to compare the biomechanical effects of different models on the distal adjacent segment., Result: In the L1-L3 and T12-L1-L3-L4 fusion modes, the horizontal shift of the 1st vertebra below the lowest instrumented vertebra (LIV) increased with the trunk shift (TS) expansion after operation, and the imbalance between the left and right vertical stress of the 1st intervertebral disc below the LIV increased. With the decrease in fused segments in cases of TS = 10 mm and TS = 5 mm, the 1st vertebra below the LIV was subjected to a greater unbalanced force in the horizontal direction, and the 1st intervertebral disc below the LIV was subjected to a smaller imbalance between the left and right vertical stress after operation., Conclusion: When treating congenital scoliosis with hemivertebrectomy and pedicle screw fixation, fused segments can be properly extended and the postoperative TS shortened with a view of reducing the imbalance between the left and right stress of the 1st intervertebral disc below the LIV as well as the horizontal shift of the 1st vertebra below the LIV., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objective: We aimed to explore the heterogeneity of neurons in heart failure with dilated cardiomyopathy (DCM)., Methods: Single-cell RNA sequencing (scRNA-seq) data of patients with DCM and chronic heart failure and healthy samples from GSE183852 dataset were downloaded from NCBI Gene Expression Omnibus, in which neuron data were extracted for investigation. Cell clustering analysis, differential expression analysis, trajectory analysis, and cell communication analysis were performed, and highly expressed genes in neurons from patients were used to construct a protein-protein interaction (PPI) network and validated by GSE120895 dataset., Results: Neurons were divided into six subclusters involved in various biological processes and each subcluster owned its specific cell communication pathways. Neurons were differentiated into two branches along the pseudotime, one of which was differentiated into mature neurons, whereas another tended to be involved in the immune and inflammation response. Genes exhibited branch-specific differential expression patterns. FLNA, ITGA6, ITGA1, and MDK interacted more with other gene-product proteins in the PPI network. The differential expression of FLNA between DCM and control was validated., Conclusion: Neurons have significant heterogeneity in heart failure with DCM, and may be involved in the immune and inflammation response to heart failure., (© 2024. The Author(s).)

Fungi are microorganisms with biosynthetic potential that are capable of producing a wide range of chemically diverse and biologically interesting small molecules. Chemical epigenetic manipulation has been increasingly explored as a simple and powerful tool to induce the production of additional microbial secondary metabolites in fungi. This review focuses on chemical epigenetic manipulation in fungi and summarizes 379 epigenetic manipulation products discovered from 2008 to 2022 to promote the discovery of their medicinal value., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Context: Gastrointestinal symptoms are a common complication of influenza virus infection in children, which the gut-lung axis become involved in its biological progress. The protective effect of 999 XiaoErGanMao granules (XEGMG) on multi-organ injury in viral pneumonia remains unclear., Objective: To investigate the therapeutic effect of XEGMG on lungs and intestines injury in A/FM/1/47 (H1N1) influenza virus-infected mice., Materials and Methods: Male BALB/c mice were infected with the 2LD 50 H1N1 influenza virus and then treated with XEGMG (6 or 12 g/kg) intragastrically once a day for 4 days. The lung and colon samples were then collected for pathological observation, and assays for inflammatory cytokines and intestinal barrier. Mouse feces were collected to evaluate the intestinal microbiota., Results: Treating with XEGMG (12 g/kg) can mitigate body weight loss caused by 2LD 50 H1N1 infection. It can also reduce lung index and pathological damage with the decreased inflammatory cytokines such as IL-6 and IL-1β. Furthermore, XEGMG (12 g/kg) can maintain the goblet cell number in the colons to protect the intestinal barrier and regulate the major flora such as Firmicutes, Bacteroidetes, and Muribaculaceae back to normal. Meanwhile, the expression of IL-17A in the colon tissues was significantly lower in the group of XEGMG (6, 12 g/kg) compared to H1N1 group., Discussion and Conclusions: XEGMG can protect against H1N1 invasion involved in gut-lung axis regulation. The results provide new evidence for the protective effect of XEGMG, which is beneficial to vulnerable children.

Objective: To investigate early clinical efficacy of unilateral biportal endoscopy technique for the treatment of lumbar postoperative adjacent segmental diseases., Methods: Fourteen patients with lumbar postoperative adjacent segmental diseases were treated with unilateral biportal endoscopy technique from June 2019 to June 2020. Among them, there were 9 males and 5 females, aged from 52 to 73 years old, and the interval between primary and revision operations ranged from 19 to 64 months. Adjacent segmental degeneration occurred after lumbar fusion in 10 patients and after lumbar nonfusion fixation in 4 patients. All the patients received unilateral biportal endoscopy assisted posterior unilateral lamina decompression or unilateral approach to the contralateral decompression. The operation time, postoperative hospital stay and complications were observed. The visual analogue scale (VAS) of low back pain and leg pain, Oswestry Disability Index (ODI), modified Japanese Orthopaedic Association (mJOA) score were recorded before operation and at 3 days, 3 months, and 6 months after operation., Results: All procedures were successfully completed. Surgical duration ranged from 32 to 151 min. Postoperative CT showed adequate decompression and preservation of most joints. Out of bed walking 1 to 3 days after surgery, postoperative hospital stay was 1 to 8 days, and postoperative follow-up was 6 to 11 months. All 14 patients returned to normal life within 3 weeks after surgery, and VAS, ODI, and mJOA scores improved significantly at 3 days and 3, 6 months after surgery. One patient occurred cerebrospinal fluid leak after operation, received local compression suture, and the wound healed after conservative treatment. One patient occurred postoperative cauda equina neurologic deficit, which was gradually recovered about 1 month after rehabilitation therapy. One patients advented transient pain of lower limbs after surgery, and the symptoms were relieved after 7 days of treatment with hormones, dehydration drugs and symptomatic management., Conclusion: Unilateral biportal endoscopy technique has a good early clinical efficacy in the treatment of lumbar postoperative adjacent segmental diseases, which may provide a new minimally invasive, non-fixation option for the treatment of adjacent segment disease.

Hepatitis E is an emerging zoonotic disease, posing a severe threat to public health in the world. Since there are no specific treatments available for HEV infection, it is crucial to develop vaccine to prevent this infection. In this study, the truncated ORF2 encoded protein of 439aa∼617aa (HEV3-179) from HEV CCJD-517 isolates was expressed as VLPs in E. coli with diameters of approximate 20 nm. HEV3-179 protein was immunized with mice, and the results showed that a higher titre of antibody was induced in NIH mice in comparison with that of KM mice (P < 0.01) and BALB/c mice (P < 0.01). The induced antibody titer is much higher in subcutaneous immunization mice than that in the mice inoculated via abdominal immunization (P < 0.05) and muscles immunization (P < 0.01). Mice immunized with 12 μg and 6 μg candidate vaccine induced higher level of antibody titer than that of 3 μg dosage group (P < 0.01, P < 0.05). Antibody change curve showed that HEV IgG antibody titer increased from 14 days post immunization (dpi) to 1:262144 and reached the peak level on 42 dpi before gradually retreated with the same level antibody titer with 1:131072 until 84 dpi. Mice inoculated with HEV3-179 produced higher titer of cytokines than the mock group, and the concentration of IL-1β (P < 0.01) and IFN-γ (P < 0.01) further increased after stimulated by candidate vaccine. The result indicated that HEV3-179 possesses good immunogenicity, which could be used as a potential candidate for future HEV vaccine development., Competing Interests: Declaration of competing interest Declarations of interest: none., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Studies of flares of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination are limited by small sample size, short follow up or at risk of selection bias., Methods: A national retrospective cohort study of consecutive AIIRD patients ≥12 years old, across 8 hospitals who received at least one dose of a COVID-19 mRNA vaccine. Patients were included from the date of 1st vaccine dose and censored at the time of flare or on the date of the clinic visit at least 3 months from cohort entry, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis., Findings: 4627 patients (73% Chinese, 71% female) of median (IQR) age 61 (48, 70) years were included; 42% Rheumatoid arthritis, 14% Systemic lupus erythematosus and 11% Psoriatic arthritis. 47% were in remission, 41% low disease activity, 10% moderate disease activity and 1% in high disease activity. 18% patients flared, of which 11.7% were within the 3-month period of interest. 11.8% patients improved. Median (IQR) time-to-flare was 60 (30, 114) days. 25% flares were self-limiting, 61% mild-moderate and 14% severe. Older patients (53-65 years and >66 years) had a lower risk of flare [HR 0.6 (95% CI 0.5-0.8) and 0.7 (0.6-0.8) respectively]. Patients with inflammatory arthritis and with active disease had a higher risk of flare [HR 1.5 (1.2-2.0) and 1.4 (1.2-1.6), respectively]. Treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), immunosuppression and prednisolone was also associated with an increased risk of flare [HR 1.5 (1.1-2), 1.2 (1.1-1.4) and 1.5 (1.2-1.8) for prednisolone ≤7.5 mg respectively]., Interpretation: There was a moderately high rate of AIIRD flares after mRNA vaccination but also improvement in several patients. Severe flares and hospitalisation were rare. Thus, vaccination remains safe and highly recommended., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: HINT1 mutations cause an autosomal recessive axonal neuropathy with neuromyotonia. This is a first case report of coexistence of myasthenia gravis (MG) and HINT1-related motor axonal neuropathy without neuromyotonia., Case Presentation: A 32-year-old woman presented with recurrent ptosis for 8 years, diplopia for 2 years and limb weakness for 1 year and a half. Neostigmine test, elevated AChR antibody level and positive repetitive nerve stimulation supported the diagnosis of MG. Electroneurography (ENG) and electromyography (EMG) examinations revealed a motor axonal neuropathy without neuromyotonic or myokymic discharges. Next-generation sequencing and Sanger sequencing were performed to identify the gene responsible for suspected hereditary neuropathy. Genetic testing for a HINT1 mutation was performed and revealed a homozygous mutation at c.278G>T (p. G93V). The patient was treated with pyridostigmine, oral prednisolone and azathioprine. Her ptosis and diplopia have significantly improved at 6-month follow-up., Conclusions: Concurrence of MG and hereditary motor axonal neuropathy without neuromyotonia is quite rare. Detection of ptosis with or without ophthalmoplegia, distribution of limb weakness, and reflex can help in recognizing the combination of MG and peripheral neuropathy. Early diagnosis is important for initial treatment and prognosis. The novel homozygous variant c.278G>T(p.G93V) contributes to the pathogenic variants spectrum of the HINT1 gene., (© 2022. The Author(s).)

Background: Paroxysmal kinesigenic dyskinesia (PKD) is the most common type of paroxysmal dyskinesias. Only one-third of PKD patients are attributed to proline-rich transmembrane protein 2 (PRRT2) mutations., Objective: We aimed to explore the potential causative gene for PKD., Methods: A cohort of 196 PRRT2-negative PKD probands were enrolled for whole-exome sequencing (WES). Gene Ranking, Identification and Prediction Tool, a method of case-control analysis, was applied to identify the candidate genes. Another 325 PRRT2-negative PKD probands were subsequently screened with Sanger sequencing., Results: Transmembrane Protein 151 (TMEM151A) variants were mainly clustered in PKD patients compared with the control groups. 24 heterozygous variants were detected in 25 of 521 probands (frequency = 4.80%), including 18 missense and 6 nonsense mutations. In 29 patients with TMEM151A variants, the ratio of male to female was 2.63:1 and the mean age of onset was 12.93 ± 3.15 years. Compared with PRRT2 mutation carriers, TMEM151A-related PKD were more common in sporadic PKD patients with pure phenotype. There was no significant difference in types of attack and treatment outcome between TMEM151A-positive and PRRT2-positive groups., Conclusions: We consolidated mutations in TMEM151A causing PKD with the aid of case-control analysis of a large-scale WES data, which broadens the genotypic spectrum of PKD. TMEM151A-related PKD were more common in sporadic cases and tended to present as pure phenotype with a late onset. Extensive functional studies are needed to enhance our understanding of the pathogenesis of TMEM151A-related PKD. © 2021 International Parkinson and Movement Disorder Society., (© 2021 International Parkinson and Movement Disorder Society.)

Context: A host of microRNAs have been reported to suppress tumor growth, invasion, and metastasis and play roles in neurodegeneration disorders. Moreover, microRNA changes are found in the peripheral blood, cerebrospinal fluid (CSF), and brain tissues of central nervous system diseases, including glioma, Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis, and depression. Compared with other body fluids, CSF can reflect the brain pathological processes more accurately., Aims: To understand whether microRNA expression may be misregulated in patients with PD, and further discover potential diagnostic biomarkers and promising therapeutic targets for PD., Materials and Methods: Here, through real-time reverse-transcription polymerase chain reaction (RT-PCR), we compared CSF microRNA from 15 PD patients, 11 AD patients, and 16 controls with other neurologic disorders, such as encephalitis and Guillain-Barre syndrome., Results: Finally, we identified hsa-miR-626 changes in the CSF of PD patients. The mean expression level of hsa-miR-626 was significantly reduced in the CSF of PD patients compared with AD patients and controls., Conclusions: Our approach provides a preliminary research for identifying biomarkers in the CSF that could be used for the detection, diagnosis, and monitoring of PD., Competing Interests: None

Background: Paroxysmal kinesigenic dyskinesia is a spectrum of involuntary dyskinetic disorders with high clinical and genetic heterogeneity. Mutations in proline-rich transmembrane protein 2 have been identified as the major pathogenic factor., Objectives: We analyzed 600 paroxysmal kinesigenic dyskinesia patients nationwide who were identified by the China Paroxysmal Dyskinesia Collaborative Group to summarize the clinical phenotypes and genetic features of paroxysmal kinesigenic dyskinesia in China and to provide new thoughts on diagnosis and therapy., Methods: The China Paroxysmal Dyskinesia Collaborative Group was composed of departments of neurology from 22 hospitals. Clinical manifestations and proline-rich transmembrane protein 2 screening results were recorded using unified paroxysmal kinesigenic dyskinesia registration forms. Genotype-phenotype correlation analyses were conducted in patients with and without proline-rich transmembrane protein 2 mutations. High-knee exercises were applied in partial patients as a new diagnostic test to induce attacks., Results: Kinesigenic triggers, male predilection, dystonic attacks, aura, complicated forms of paroxysmal kinesigenic dyskinesia, clustering in patients with family history, and dramatic responses to antiepileptic treatment were the prominent features in this multicenter study. Clinical analysis showed that proline-rich transmembrane protein 2 mutation carriers were prone to present at a younger age and have longer attack duration, bilateral limb involvement, choreic attacks, a complicated form of paroxysmal kinesigenic dyskinesia, family history, and more forms of dyskinesia. The new high-knee-exercise test efficiently induced attacks and could assist in diagnosis., Conclusions: We propose recommendations regarding diagnostic criteria for paroxysmal kinesigenic dyskinesia based on this large clinical study of paroxysmal kinesigenic dyskinesia. The findings offered some new insights into the diagnosis and treatment of paroxysmal kinesigenic dyskinesia and might help in building standardized paroxysmal kinesigenic dyskinesia clinical evaluations and therapies. © 2020 International Parkinson and Movement Disorder Society., (© 2020 International Parkinson and Movement Disorder Society.)

Three types of graphene oxide/silver nanoparticles (GO/AgNPs) composite membranes were prepared to investigate size-effect of AgNPs on nanofiltration ability. The size of AgNPs was 8, 20, and 33 nm, which was characterized by UV-visible spectroscopy and transmission electron microscopy. The morphology and structure of GO and GO/AgNPs composite membranes were characterized by atomic force microscopy, scanning electron microscopy, and X-ray diffraction. The filtration performance of membranes were evaluated on a dead-end filtration device. When the size of AgNPs is 20 nm, the GO/AgNPs composite membrane has the highest water flux (106.1 L m -2 h -1 bar -1 ) and rejection of Rhodamine B (RhB) (97.73%) among three types of composite membranes. The effect of feed concentration of dye solution and the flux of common solvent was also investigated. The mechanism was discussed, which demonstrated that both interlaying spacing and defect size influence the filtration ability of membrane, which is instructive to future study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

microRNAs have been reported to suppress tumor growth, invasion, and metastasis and play roles in neurodegeneration disorders. Moreover, changes in microRNAs are found in the peripheral blood, cerebrospinal fluid (CSF), and brain tissues in patients of central nervous system diseases, including glioma, Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis and depression. Compared with other bodily fluids, CSF is the most accurate at representing the pathological processes of the brain. To understand whether microRNA expression may be dysregulated in the patients of PD, and to further discover potential diagnostic biomarkers and promising therapeutic targets for PD, we used real-time polymerase chain reaction (RT-PCR) to compare CSF microRNAs from 20 PD patients, 13 AD patients and 27 controls with other neurologic disorders such as encephalitis and Guillain-Barre syndrome. Finally, we found that the mean expression level of hsa-miR-626 was significantly reduced in the CSF of patients with PD compared with AD and controls. Our approach potentially identified a biomarker in CSF that upon further investigation, could be used for the detection, diagnosis, and monitoring of PD in combination with other PD biomarkers., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In order to solve the problem of odor pollution in drinking water effectively, the typical odorants 2-methylisoborneol (2-MIB) and Geosmin (GSM) were selected as target pollutants. The degradation effect and factors influencing these two typical odors by ultrasonically (US) activated persulfate (PS) advanced oxidation technology were systematically investigated in this work. When the sample was treated for 15 min, the application of US/PS combination technology increased the removal rates of 2-MIB and GSM by 57.0% and 63.6%, respectively, compared with sonication alone. Furthermore, the optimum removal rates of 2-MIB and GSM were 88.7% and 93.3% when the 2-MIB and GSM concentrations were 100 ng·L -1 . Moreover, the degradation rates of 2-MIB and GSM increased with increasing PS concentration (from 0.25 mmol·L -1 to 2 mmol·L -1 ) and US intensity (from 0.33 W·cm -2 to 0.53 W·cm -2 ). The presence of humic acid competes to consume free radicals to inhibit the degradation of odor. The addition of the radical scavengers methanol and tert-butanol can reduce the removal rates of 2-MIB and GSM. The presence of methanol had a stronger inhibition effect on odor degradation than tert-butanol, indicating that the odor removal was mainly caused by sulfate radicals and hydroxyl radicals in the combination US/PS technology.

In this work, graphene oxide (GO)/ethylene glycol (EG) membranes were designed by a vacuum filtration method for molecular separation and water purification. The composite membranes were characterized by scanning electron microscopy (SEM), field emission scanning electron microscopy (FESEM), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), atomic force microscopy (AFM) and X-ray photoelectron spectroscopy (XPS). The interlayer spacing of GO membranes (0.825 nm) and GO/EG membranes (0.634 nm) are measured by X-ray diffraction (XRD). Using the vacuum filtration method, the membrane thickness can be controlled by selecting the volume of the solution from which the membrane is prepared, to achieve high water permeance and high rejection of Rhodamine B (RhB). The membrane performance was evaluated on a dead-end filtration device. The water permeance and rejection of RhB of the membranes are 103.35 L m -2 h -1 bar -1 and 94.56% (GO), 58.17 L m -2 h -1 bar -1 and 97.13% (GO/EG), respectively. The permeability of GO/EG membrane is about 40 × 10 -6 L m -1 h -1 bar -1 . Compared with the GO membrane, the GO/EG membrane has better separation performance because of its proper interlayer spacing. In this study, the highest rejection of RhB (99.92%) is achieved. The GO/EG membranes have potential applications in the fields of molecular separation and water purification.

China has achieved significant progress on wastewater treatment and aquatic environmental protection. However, leakage (in- and exfiltration) of sewer systems is still an issue. By using the statistical data of water and wastewater in 2016 in China, and the person loads (PLs) of water and wastewater in Singapore, the leakage fractions of hydraulic flow, organic carbon (COD), nitrogen (N) and phosphorus (P) mass loading, and in-sewer COD biological removal in the sewer systems of China (except Hong Kong, Macau and Taiwan), Shanghai, Guangzhou and Beijing were reported for the first time. The fractions of hydraulic flow infiltration (13%, Shanghai and Guangzhou) and exfiltration (39%, China) were calculated. Except Beijing, whose sewer networks are under appropriate management with small leakage fractions, the exfiltration fractions of COD (including in-sewer biological COD removal) ranged from 41% (Shanghai) to 66% (China) and averaged 55%; N ranged from 18% (Shanghai) to 48% (China) and averaged 33%; and P ranged from 23% (Shanghai and Guangzhou) to 44% (China) and averaged 30%. The exfiltrated sewage, COD, N and P not only wastes resources, but also contaminates the aquatic environment (especially groundwater) and contributes to 'black and odorous water bodies'. In- and exfiltration in the sewer network leads to low influent COD concentration, C/N ratio and high inorganic solids and inert particulate COD concentrations of many municipal wastewater treatment plants (WWTPs) causing high cost for nutrient removal, poor resource recovery, additional reactor/settler volume requirement and other operational problems. Therefore, tackling sewer leakage is of primary importance to today's environment in China. Recommendations for the inspection of sewer systems and the rehabilitation of damaged sewers as well as the development of design and operation guidelines of municipal WWTPs tailored to the specific local sewage characteristics and other conditions are proposed.

Background: Antimicrobial de-escalation refers to starting the antimicrobial treatment with broad-spectrum antibiotics, followed by narrowing the drug spectrum according to culture results. The present study evaluated the effect of de-escalation on ventilator-associated pneumonia (VAP) in trauma patients., Methods: This retrospective study was conducted on trauma patients with VAP, who received de-escalation therapy (de-escalation group) or non-de-escalation therapy (non-de-escalation group). Propensity score matching method was used to balance the baseline characteristics between both groups. The 28-day mortality, length of hospitalization and Intensive Care Unit stay, and expense of antibiotics and hospitalization between both groups were compared. Multivariable analysis explored the factors that influenced the 28-day mortality and implementation of de-escalation., Results: Among the 156 patients, 62 patients received de-escalation therapy and 94 patients received non-de-escalation therapy. No significant difference was observed in 28-day mortality between both groups (28.6% vs. 23.8%, P = 0.620). The duration of antibiotics treatment in the de-escalation group was shorter than that in the non-de-escalation group (11 [8-13] vs. 14 [8-19] days, P = 0.045). The expenses of antibiotics and hospitalization in de-escalation group were significantly lower than that in the non-de-escalation group (6430 ± 2730 vs. 7618 ± 2568 RMB Yuan, P = 0.043 and 19,173 ± 16,861 vs. 24,184 ± 12,039 RMB Yuan, P = 0.024, respectively). Multivariate analysis showed that high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, high injury severity score, multi-drug resistant (MDR) infection, and inappropriate initial antibiotics were associated with patients' 28-day mortality, while high APACHE II score, MDR infection and inappropriate initial antibiotics were independent factors that prevented the implementation of de-escalation., Conclusions: De-escalation strategy in the treatment of trauma patients with VAP could reduce the duration of antibiotics treatments and expense of hospitalization, without increasing the 28-day mortality and MDR infection., Competing Interests: There are no conflicts of interest

Objective: To compare the effects of cardiopulmonary resuscitation by bending and pressing the lower extremities (BPLE-CPR) with standard cardiopulmonary resuscitation (S-CPR)., Methods: A multicenter prospective nonrandomized controlled study was performed. Patients with cardiac arrest (CA) treated in the emergency departments and intensive care units (ICU) of seven hospitals in Eastern China from January 2013 to February 2017 were enrolled. BPLE-CPR or S-CPR was used for resuscitation according to the patient's condition. Data registration was completed in Utstein style. The primary outcome was recovery of spontaneous circulation (ROSC) rate, and the secondary outcome included survival rate at discharge, the resuscitation time of ROSE patients, blood pressures during resuscitation, the survival rates within 24 hours and beyond 24 hours, and the cerebral performance categories (CPC) of discharged patients., Results: A total of 279 patients completed data registration, including 142 in the BPLE-CPR group and 137 in the S-CPR group. ROSC rate, survival rates over 24 hours and at discharge in BPLE-CPR group were significantly higher than those in S-CPR group [ROSC rate: 63.4% (90/142) vs. 29.2% (40/137), survival rate over 24 hours: 56.7% (51/90) vs. 45.0% (18/40), survival rate at discharge: 43.0% (61/142) vs. 20.4% (28/137), all P < 0.01]. The CPR duration of ROSC patients in BPLE-CPR group was significantly shorter than that in S-CPR group [minute: 10 (5, 15) vs. 20 (11, 30), P < 0.01], while systolic blood pressure during CPR was significantly higher than that in S-CPR group [mmHg (1 mmHg = 0.133 kPa): 92.0 (80.0, 110.0) vs. 73.5 (65.5, 80.0), P < 0.01]. In survival discharged patients, the proportion of CPC 1 patients in BPLE-CPR group was significantly higher than that in S-CPR group [24.6% (15/61) vs. 10.7% (3/28), P < 0.01]., Conclusions: BPLE-CPR is superior to S-CPR in terms of ROSC rate and discharge survival rate. In addition, the BPLE-CPR procedure is simple and easy to expand in public., Clinical Test Registration: Chinese Clinical Trial Registry, ChiCTR-TRC-13003150.

The aim of this study is to estimate the risk factors of both respiratory complication (RC) and mortality after acute traumatic cervical spinal cord injury (TCSCI). Between July 2005 and July 2015, in 181 patients (142 males and 39 females; mean age 41.0 years) with acute TCSCI, we compared the difference and odds ratio in RC group (n = 73) with that of non-RC group (n = 108), and also death group (n = 15) and survival group (n = 166). We collected injury-related information after half a year of injury, which is as follows: the causes of injury, time of surgery, ICU (intensive care unit) days, ventilator days, ASIA (American Spinal Injury Association) classification, neurological injury, CIPS (Clinical Pulmonary Infection Score), and BMI (body mass index). Besides these, we gathered the general information such as age, gender, smoking history, and use of steroids. The study compared perioperative parameters; surgery-related and instrumentation- and graft-related complication rates; clinical parameters; patient satisfaction; and radiologic parameters. Variations like gender (odds ratio [OR] = 1.269, 95% confidence interval [CI] [0.609-2.646]), smoking history (OR = 2.902, 95% CI [1.564-5.385]), AIS grade (grade A) (OR = 6.439, 95% CI [3.334-12.434]), neurological level (C1-C4) (OR = 2.714, 95% CI [1.458-5.066]), and steroid use (OR = 2.983, 95% CI [1.276-6.969]) have a facilitated effect on RC. When we estimated surgery-related affection, only the time of surgery and anterior approach compared with posterior has significant difference in RC (P < .05). Between death and survival group, the aspect of age, non-surgical, CPIS, AIS grade, and BMI have statistically significant difference. Survival analysis reveals significant difference in aforementioned groups. In patients suffering from acute TCSCI, those who are old, have long smoking history, complete spinal cord injury, C1-C4, high CPIS, and fat have high incidence of RC and mortality.

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a hereditary neurological disorder mostly manifested with a classical triad: progressive early-onset cerebellar ataxia, lower limb pyramidal signs, and peripheral neuropathy. We employed whole-exome sequencing and bioinformatics to identify the genetic cause in an ARSACS patient from a consanguineous family. Based on whole-exome sequences of the patient and her healthy parents, a novel homozygous deletion variant (NM&#95;014363: c.9495&#95;9508del; p.F3166Tfs*9) in the SACS gene was identified in the patient. This frameshift mutation is predicted to generate a truncated sacsin protein, which results in the loss of the C-terminal 1,406 amino acids. Our study provides a potential genetic diagnosis for the patient and expands the spectrum of SACS mutations., (© 2017 S. Karger AG, Basel.)

Loss-of-function mutations in gene encoding DJ-1 contribute to the pathogenesis of autosomal recessive early-onset familial forms of Parkinson's disease (PD). DJ-1 is a multifunctional protein and plays a protective role against oxidative stress-induced mitochondrial damage and cell death, but the exact mechanism underlying this is not yet clearly understood. Here, using coimmunoprecipitation (Co-IP) and immunofluorescence methods, we prove that Bcl-2-associated athanogene 5 (BAG5), a BAG family member, interacts with DJ-1 in mammalian cells. Moreover, we show that BAG5 could decrease stability of DJ-1 and weaken its role in mitochondrial protection probably by influencing dimerization in stress condition. Our study reveals the relationship of BAG5 and DJ-1 suggesting a potential role for BAG5 in the pathogenesis of PD through its functional interactions with DJ-1., Competing Interests: The authors have no actual or potential conflict of interests to report.

Background: Inflammation is supposed to play a key role in the pathophysiological processes of intestinal ischemia-reperfusion injury (IIRI), and Candida albicans in human gut commonly elevates inflammatory cytokines in intestinal mucosa. This study aimed to explore the effect of C. albicans on IIRI., Methods: Fifty female Wistar rats were divided into five groups according to the status of C. albicans infection and IIRI operation: group blank and sham; group blank and IIRI; group cefoperazone plus IIRI; group C. albicans plus cefoperazone and IIRI (CCI); and group C. albicans plus cefoperazone and sham. The levels of inflammatory factors tumor necrosis factor (TNF)-μ, interleukin (IL)-6, IL-1β, and diamine oxidase (DAO) measured by enzyme-linked immunosorbent assay were used to evaluate the inflammation reactivity as well as the integrity of small intestine. Histological scores were used to assess the mucosal damage, and the C. albicans blood translocation was detected to judge the permeability of intestinal mucosal barrier., Results: The levels of inflammatory factors TNF-μ, IL-6, and IL-1β in serum and intestine were higher in rats undergone both C. albicans infection and IIRI operation compared with rats in other groups. The levels of DAO (serum: 44.13 ± 4.30 pg/ml, intestine: 346.21 ± 37.03 pg/g) and Chiu scores (3.41 ± 1.09) which reflected intestinal mucosal disruption were highest in group CCI after the operation. The number of C. albicans translocated into blood was most in group CCI ([33.80 ± 6.60] ×102 colony forming unit (CFU)/ml)., Conclusion: Intestinal C. albicans infection worsened the IIRI-induced disruption of intestinal mucosal barrier and facilitated the subsequent C. albicans translocation and dissemination.

Background: Opportunistic infection of Candida albicans ( C. albicans ) has become a serious problem in immunocompromised patients. The study aimed to explore the mechanism of enterogenous infection of C. albicans in immunocompromised rats under severe acute pancreatitis (SAP)., Methods: Sprague Dawley (SD) rats ( n =100) were randomly assigned into 5 groups as the following: blank group, cyclophosphamide+ceftriaxone+SAP group, cyclophosphamide+ceftriaxone group, cyclophosphamide+SAP group, and cyclophosphamide group. The rats were sacrificed at 5 and 10 days, and their jejunum, colon, mesenteric lymph nodes, pancreas, intestinal content, and blood were quickly collected to detect C. albicans . A region of the 25S rRNA gene was chosen and amplified by polymerase chain reaction (PCR) to differentiate C. albicans genotypes. The amplified products were further sequenced and compared to judge their homology., Results: Compared with the Cyclophosphamide group, the combination of immunosuppressants and broad-spectrum antibiotics significantly increased the colonization of C. albicans in intestine in 5 and 10 days. Pure SAP stress did not increase the opportunistic infection of C. albicans . The PCR products of C. albicans isolates all belonged to the genotype A family, and sequence alignment showed that the amplified fragments were homologous., Conclusion: The damage of immune system and broad-spectrum antimicrobial agents are important risk factors for opportunistic fungal infection. Intestinal tract is an important source for genotype-A C. albicans to translocate and invade into bloodstream., Competing Interests: All authors have seen and approved the content of “Instructions to Authors” and the submission version of the paper. All authors declare that they have no conflict of interest.

Three unreported sesquiterpenes possessing two new skeletons, tabasesquiterpenes A-C (1-3), together with three known sesquiterpenes (3-6) were isolated from the leaves of Nicotiana tabacum. Their structures were determined mainly by spectroscopic methods, including extensive 1D- and 2D-NMR techniques. Compounds 1-6 were evaluated for their anti-tobacco mosaic virus (anti-TMV) activities. The results showed that compound 2 exhibited high anti-TMV activity with inhibition rate of 35.2%, which were higher than that of positive control (ningnanmycin). The other compounds also showed potential anti-TMV activity with inhibition rates in the range of 20.5-28.6%., (Copyright © 2015 Elsevier B.V. All rights reserved.)

MnO2 with urchin-like nano/micro hierarchical architecture was synthesized through an easy hydrothermal method at low temperature and used to prepare MnO2/graphene hybrid composite as electrode materials through an easy and efficient solution-based method. The MnO2 particles in the composite with 66.7% mass ratio could achieve specific capacitance as high as 451.5 F g(-1) at a scan rate of 10 mV s(-1) and exhibit good cycle stability with 93.8% capacitance retention over 2000 cycles. These properties result from the unique urchin-like nano/micro hierarchical structure of MnO2 as well as the function of graphene in enhancing the conductivity and utilization of MnO2.

Percutaneous block and neurotomy of the medial branch of the spinal dorsal ramus has shown excellent results in treating facet joint-mediated low back pain. This study aimed to describe the clinical anatomy of the medial branch and its measurements.We dissected the lumbar spine of 12 adult cadavers (24 sides) and measured the distances between the medial branch and various anatomical landmarks. The distances were compared between L1 and L5 vertebrae.The distance between the dorsal ramus bifurcation and the superior border of the root of the transverse process was 3.52 ± 1.15 mm, 3.63 ± 1.36 mm, 3.46 ± 1.31 mm, 3.38 ± 1.24 mm, and 1.87 ± 0.88 for L1 to L5, respectively. The medial branch of the dorsal ramus is enclosed in a fibro-osseous canal bounded by the accessory process, the mammillary process, and the mammilloaccessory ligament.For the percutaneous treatment of block and neurotomy, the first choice of target is the medial branch fibro-osseous canal near to the accessory process. The accessory process is not displayed in x-ray films; therefore, the junction of the superior articular process and the root of the transverse process can be targeted., Competing Interests: The authors have no funding and conflicts of interest to disclose.

The aim of this meta-analysis was to systematically evaluate the diagnostic accuracy of microRNAs (miRNAs) in distinguishing malignant thyroid lesions from benign ones and to determine the potential of miRNAs as diagnostic biomarkers for thyroid cancer. The random-effect model was used to summarize the pooled estimates of diagnostic accuracy, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). The summary receiver-operating characteristic curve (SROC) and area under the SROC curve (AUC) were used to further evaluate the overall diagnostic value. Overall, 20 studies from 7 articles, including 266 thyroid cancer patients and 277 controls with benign thyroid disease, were available for analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR were: 0.78 (95%CI = 0.74-0.81), 0.73 (95%CI = 0.69-0.77), 3.17 (95%CI = 2.28-4.40), 0.30 (95%CI = 0.23-0.39), and 12.6 (95%CI = 8.26-19.4), respectively, and the AUC value was 0.85. The multiple miRNA assay yielded better diagnostic performance than the single miRNA assay, with sensitivity of 0.90 versus 0.75, specificity of 0.86 versus 0.71, PLR of 6.14 versus 2.71, NLR of 0.13 versus 0.36, DOR of 44.5 versus 8.81, and AUC of 0.95 versus 0.82, suggesting that the multiple miRNA assay is a more credible method for thyroid cancer detection. In summary, miRNA assays, especially multiple miRNA assays, may play an important role as a second-line diagnostic tool to improve the diagnostic accuracy of fine needle aspiration biopsy in indeterminate lesions. However, further studies are warranted to confirm our findings.

Indian Hedgehog (HH) has been shown to be involved in osteoarthritis (OA) in articular joints, where there is evidence that Indian HH blockade could ameliorate OA. It seems to play a prominent role in development of the intervertebral disc (IVD) and in postnatal maintenance. There is little work on IHH in the IVD. Hence the aim of the current study was to investigate the role of Indian Hedgehog in the pathology of facet joint (FJ) OA. 24 patients diagnosed with lumbar intervertebral disk herniation or degenerative spinal stenosis were included. Preoperative magnetic resonance imaging (MRI) and Osteoarthritis Research Society International (OARSI) histopathology grading system was correlated to the mRNA levels of GLI1, PTCH1, and HHIP in the FJs. The Weishaupt grading and OARSI scores showed high positive correlation (r = 0.894) (P < 0.01). MRI Weishaupt grades showed positive correlation with GLI1 (r = 0.491), PTCH1 (r = 0.444), and HHIP (r = 0.654) mRNA levels (P < 0.05 in each case). OARSI scores were also positively correlated with GLI1 (r = 0. 646), PTCH1 (r = 0. 518), and HHIP (r = 0.762) mRNA levels (P < 0.01 in each case). Cumulatively our findings indicate that Indian HH signaling is increased in OA and is perhaps a key component in OA pathogenesis and progression.

Lumbar facet joint (LFJ) osteoarthritis (OA) is an important etiology of low back pain. Several animal models of LFJ OA have been established using intraarticular injection of various chemicals. This study aimed to establish a rat model of LFJ OA using urinary plasminogen activator (uPA). Sprague-Dawley rats were treated with intraarticular injection in the L5-L6 facet joints with uPA (OA group, n = 40) or normal saline (vehicle group, n = 40). Mechanical and thermal hyperalgesia in the ipsilateral hind paws were evaluated using von Frey hairs and a thermoalgesia instrument, respectively. Toluidine blue staining, hematoxylin-eosin staining, and immunohistochemical examination of the LFJ was performed. Treatment with uPA induced cartilage damage, synovitis, and proliferation of synovial cells in the fact joints. The OA group showed significantly higher hyperalgesia in the hind paws in comparison with the vehicle group and normal controls (P < 0.05). Expression of IL-1β, TNF-α, and iNOS in the LFJ cartilage in the OA group was significantly increased (P < 0.05). A rat model of LFJ OA was successfully established using intraarticular injection of uPA. This animal model is convenient and shows good resemblance to human OA pathology.

Five new biphenyls, tababiphenyls A-E (1-5), together with five known ones (5-10), were isolated from the leaves of Nicotiana tabacum, of which compound 1 possessed a seldom reported 6-carbons unit in biphenyls. Their structures were established on the basis of extensive spectroscopic analyses. All compounds were tested for their anti-tobacco mosaic virus (anti-TMV) activities. The results showed that compounds 3 and 5 exhibited high anti-TMV activities with inhibition rate of 48.4% and 32.1%, respectively, which were higher than that of positive control (ningnanmycin). The other compounds also showed potential anti-TMV activities with inhibition rates in the range of 18.6-28.7%, respectively., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Purpose: A comprehensive review of the literature in order to analyze data about the success rate of percutaneous resolution of the lumbar facet joint cysts as a conservative management strategy., Methods: A systematic search for relevant articles published during 1980 to May 2014 was performed in several electronic databases by using the specific MeSH terms and keywords. Most relevant data was captured and pooled for the meta-analysis to achieve overall effect size of treatment along with 95% confidence intervals., Results: 29 studies were included in the meta-analysis. Follow-up duration as mean ± sd (range) was 16±10.2 (5 days to 5.7 years). Overall the satisfactory results (after short- or long-term follow-up) were achieved in 55.8 [49.5, 62.08] % (pooled mean and 95% CI) of the 544 patients subjected to percutaneous lumbar facet joint cyst resolution procedures. 38.67 [33.3, 43.95] % of this population underwent surgery subsequently to achieve durable relief. There existed no linear relationship between the increasing average duration of follow-up period of individual studies and percent satisfaction from the percutaneous resolutions procedure., Conclusion: Results shows that the percutaneous cyst resolution procedures have potential to be an alternative to surgical interventions but identification of suitable subjects requires further research.

Introduction: Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment. We aimed to determine whether serum procalcitonin (PCT) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma., Methods: In this randomized controlled trial, a total of 216 patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and 169 completed the 12-month follow-up visit. Patients were randomized to either PCT-guided (PCT group) or standard (control group) antimicrobial therapy. In the control group, patients received antibiotics according to the attending physician's discretion; in the PCT group, patients received antibiotics according to an algorithm based on serum PCT levels. The primary end point was antibiotic exposure; secondary end points were clinical recovery, length of hospital stay, clinical and laboratory parameters, spirometry, number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma., Results: PCT guidance reduced antibiotic prescription (48.9% versus 87.8%, respectively; P < 0.001) and antibiotic exposure (relative risk, 0.56; 95% confidence interval, 0.44 to 0.70; P < 0.001) compared to standard therapy. There were no significant differences in clinical recovery, length of hospital stay or clinical, laboratory and spirometry outcomes in both groups. Number of asthma exacerbations, emergency room visits, hospitalizations and need for corticosteroid use due to asthma were similar during the 12-month follow-up period., Conclusion: A PCT-guided strategy allows antibiotic exposure to be reduced in patients with severe acute exacerbation of asthma without apparent harm., Trial Registration: Chinese Clinical Trial Register ChiCTR-TRC-12002534 (registered 26 September 2012).

Objective: To compare the clinical outcomes of intrasacrospinal muscular approach and posterior midline approach in treating far lateral lumbar disc herniation., Methods: The clinical data of 32 patients with far lateral lumbar disc herniation underwent transforaminal lumbar interbody fusion from January 2004 to January 2011 were retrospectively analyzed. The patients were divided into intrasacrospinal muscular approach group (11 males and 6 females ) and posterior midline approach group (10 males and 5 females). All patients were followed up from 12 to 18 months with an average of 15.3 months. Operative time, blood loss, postoperative draining volume were recorded and pre-and post-operative visual analog scale (VAS) and Oswestry Disability Index (ODI) were compared between two groups., Results: Operative time, blood loss, postoperative draining volume in intrasacrospinal muscular approach group was less than that of posterior midline approach group (P < 0.05). There was no significant difference in VAS at final follow-up between two groups (P > 0.05); and the mean ODI in intrasacrospinal muscular approach group was less than that of posterior midline approach group (P < 0.05)., Conclusion: For the treatment of far lateral lumbar disc herniation, intrasacrospinal muscular approach has less injury for paraspinal muscle and more satisfactory clinical outcome and is better method than posterior midline approach.

Post-translational modification by SUMO was proposed to modulate the pathogenesis of several neurodegenerative diseases. Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is an autosomal dominant neurodegenerative disease caused by polyQ-expanded ataxin-3. We have previously shown that ataxin-3 was a new target of SUMOylation in vitro and in vivo. Here we identified that the major SUMO-1 binding site was located on lysine 166. SUMOylation did not influence the subcellular localization, ubiquitination or aggregates formation of mutant-type ataxin-3, but partially increased its stability and the cell apoptosis. Our findings revealed the role of ataxin-3 SUMOylation in SCA3/MJD pathogenesis.

Parkinson's disease (PD) is the second most common neurodegenerative disorder, with approximately 5-10% of PD cases being linked to genetic factors. The Htra serine peptidase 2 (HTRA2) gene, also known as Omi, was found to be associated with PD in a cohort of German PD patients. However, subsequent studies have indicated that some variants of Omi/HTRA2 may not be related to PD. In order to investigate whether the Omi/HTRA2 gene is related to PD in Han Chinese PD patients, molecular analysis for the Omi/HTRA2 gene was performed in 404 Chinese PD patients and 504 normal individuals. Our present study revealed 2 novel variations. The IVS5+29T>A variant may be a risk factor for PD (P<0.05), while the c.G77A variant might be a pathogenic mutation. However, the findings need to be validated in a larger population using further functional studies., (Copyright © 2011 Elsevier B.V. All rights reserved.)