Search

Meng-Nan Xu,1,* Qian Wang,1,* Min Wang,1 Yuan Xu,1 Si-Ming Yuan1,2 1Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People’s Republic of China; 2Department of Plastic Surgery, Jinling Hospital, Nanjing School of Clinical Medicine, Southern Medical University, Nanjing, Jiangsu, 210002, People’s Republic of China*These authors contributed equally to this workCorrespondence: Si-Ming Yuan, Department of Plastic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, People’s Republic of China, Email yuansm@163.comBackground: Port wine stain (PWS) is a congenital skin lesion involving capillary malformations. Most PWS lesions will gradually become hypertrophic and appear nodular in contour. Current research shows that rapamycin, an mTOR inhibitor, is probably a promising adjunctive therapy for PWS, which suggests that the mTOR signaling pathway may play an important role in its pathological process.Methods: From January 2013 to January 2019, 13 samples were obtained during the surgical excision. Each sample was divided into 3 parts according to the type of lesion, namely, the flat, hypertrophic and nodular lesions. Pathologic structures of each type were observed under the microscope after HE staining. The expression of mTORC1, p70S6, p-p70S6, eIF4EBP1 and p-eIF4EBP1 was examined by immunohistochemical staining and western blotting. The location of the expression of mTORC1, p-p70S6 and p-elF4EBP1 was further detected by immunofluorescence staining.Results: Large amounts of dilated and malformed vessels were observed in all types of PWS lesions. Abundant hyperplastic hair follicles/glands were shown in the hypertrophic or nodular lesions. Phosphorylation level of p70S6 and elF4EBP1 in PWS was significantly higher than those in normal skin and increased accordingly in the progression of PWS. Activated molecules in mTOR signaling pathway were mostly located in the endothelium of malformed vessels. They were also located in the hyperplastic hair follicles/glands of hypertrophic and nodular lesions.Conclusion: The mTOR signaling pathway was increasingly activated during the progression of PWS. Enhanced activation of mTOR signaling pathway may contribute to the hypertrophy and nodularity of PWS. The results provide preliminary evidence for treating PWS and related syndromes by inhibiting mTOR signaling pathway.Keywords: port wine stain, mTOR signaling pathway

The bioavailable nitrogen fixed by diazotrophs is critical for sustaining productivity in the oligotrophic ocean. Despite this, understanding how diazotroph-derived nitrogen integrates into the nitrogen cycle within the euphotic zone remains unknown. Here, we investigated nitrogen fixation rates in the particulate and dissolved fractions within the euphotic zone of the North Pacific Subtropical Gyre. Our findings reveal the proportion of nitrogen fixation rates in the dissolved fraction increases with depth. Light manipulation experiments uncover that reduced light levels can stimulate the net release of diazotroph-derived nitrogen, aligning with our depth-related observations. Furthermore, we identify two distinct transfer pathways vertically associated with light-driven ecological niches. Specifically, the released diazotroph-derived nitrogen is transferred to non-diazotrophic plankton in the upper layers. Meanwhile, in the lower layers, it contributes to the nitrification process. Our results underscore the high bioavailability of diazotroph-derived nitrogen and its rapid integration into the nitrogen cycle through multiple pathways within the well-lit ocean., (© 2024. The Author(s).)

Nitrate and ammonium are primary nitrogen (N) contaminants in groundwater and effective restoration strategies depend on understanding the interactions of N transformation processes along redox gradients. Utilizing the 15 N tracing technique, we assess nitrate removal rates, focusing on denitrification and anammox in a N-rich groundwater of the Hetao Basin, a typical semiarid region in western China. Results showed that N removal rate (0.36-22.01 µM N d -1 ) was composed mainly of denitrification (73 ± 18 %), with rates increasing from upstream oxidizing environment to downstream reducing areas. In reducing downstream, both denitrification and anammox adhered to substrate-driven Michaelis-Menten kinetics. Integrating data on all source and sink rates of nitrate and ammonium pools (denitrification, anammox, dissimilatory nitrate reduction ammonia, nitrification, mineralization), we constructed a N-transfer-dynamics model based on chemical stoichiometry. This model effectively captured the observed spatial N transfer patterns and highlighted that the balance of oxidants and biodegradable organic N inputs influences N species retention and removal in groundwater. Our combined experimental and modeling approach underscores the importance of reducing organic N and/or adding oxidants to mitigate groundwater N pollution. These findings provide crucial insights for optimizing high N groundwater remediation strategies and potentially inform for wastewater management practices., 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 B.V. All rights reserved.)

Human papillomavirus (HPV) 11/16 E6/E7 proteins have been recognized to be pivotal in viral pathogenesis. This study sought to uncover the potential mechanisms of how HPV11/16 E6/E7-transfected keratinocytes inhibit cytokine secretion in peripheral blood mononuclear cells (PBMC). Upon co-culturing HPV11/16 E6/E7-transfected keratinocytes with PBMC in a non-contact manner, we observed a marked decrease in various cytokines secreted by PBMC. To determine if this suppression was mediated by specific common secreted factors, we conducted transcriptomic sequencing on these transfected cells. This analysis identified 53 common differentially secreted genes in all four HPV-transfected cells. Bioinformatics analysis demonstrated these genes were predominantly involved in immune regulation. Results from quantitative PCR (qPCR) and an extensive literature review suggested the downregulation of 12 genes (ACE2, BMP3, BPIFB1, CLU, CST6, CTF1, HMGB2, MMP12, PDGFA, RNASE7, SULF2, TGM2), and upregulation of 7 genes (CCL17, CCL22, FBLN1, PLAU, S100A7, S100A8, S100A9), may be crucial in modulating tumor immunity and combating pathogenic infections, with genes S100A8 and S100A9, and IL-17 signaling pathway being particularly noteworthy. Thus, HPV11/16 E6/E7 proteins may inhibit cytokine secretion of immune cells by altering the expression of host-secreted genes. Further exploration of these genes may yield new insights into the complex dynamics of HPV infection., (© 2024. The Author(s).)

Fish are vital in river ecosystems; however, traditional investigations of fish usually cause ecological damage. Extracting DNA from aquatic environments and identifying DNA sequences offer an alternative, noninvasive approach for detecting fish species. In this study, the effects of environmental DNA (eDNA), coupled with PCR and next-generation sequencing, and electrofishing for identifying fish community composition and diversity were compared. In three subtropical rivers of southern China, fish specimens and eDNA in water were collected along the longitudinal (upstream-downstream) gradient of the rivers. Both fish population parameters, including species abundance and biomass, and eDNA OTU richness grouped 38 sampling sites into eight spatial zones with significant differences in local fish community composition. Compared with order-/family-level grouping, genus-/species-level grouping could more accurately reveal the differences between upstream zones I-III, midstream zones IV-V, and downstream zones VI-VIII. From the headwaters to the estuary, two environmental gradients significantly influenced the longitudinal distribution of the fish species, including the first gradient composed of habitat and physical water parameters and the second gradient composed of chemical water parameters. The high regression coefficient of alpha diversity between eDNA and electrofishing methods as well as the accurate identification of dominant, alien, and biomarker species in each spatial zone indicated that eDNA could characterize fish community attributes at a level similar to that of traditional approaches. Overall, our results demonstrated that eDNA metabarcoding can be used as an effective tool for revealing fish composition and diversity, which is important for using the eDNA technique in aquatic field monitoring., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Human papillomavirus (HPV) infection poses a significant threat to public health worldwide. Targeting the function of HPV E6 and E7 proteins and activating the host immune response against these proteins represent promising therapeutic strategies for combating HPV-related diseases. Consequently, the efficient production of soluble, high-purity E6 and E7 proteins is crucial for function and host immune response studies. In this context, we selected the pMCSG19 protein expression vector for Escherichia coli to produce soluble MBP-His 6 tagged HPV11/16 E6/E7 proteins, achieving relatively high purity and yield. Notably, these proteins exhibited low toxicity to peripheral blood mononuclear cells (PBMCs) and did not compromise their viability. Additionally, the recombinant proteins were capable of inducing the secretion of multiple cytokines by immune cells in peripheral blood, indicating their potential to elicit immune responses. In conclusion, our study offers a novel approach for the production of HPV11/16 E6/E7 fusion proteins with relatively high purity and yield. The fusing HPV11/16 E6/E7 proteins to MBP-His 6 tag may serve as a valuable method for large-scale protein production in future research endeavors., (© 2024. The Author(s).)

The heavily human-perturbed coastal oceans are hotspots of nitrous oxide (N 2 O) emission to the atmosphere. The processes underpinning the N 2 O flux, however, remain poorly understood, leading to large uncertainties in assessing global N 2 O budgets. Using a suite of nitrogen isotope labeling experiments, we show that multiple processes contribute to N 2 O production throughout the estuarine-coastal gradient, sustaining intensive N 2 O flux to the atmosphere. Unexpectedly, denitrification, rather than ammonia oxidation as previously assumed, constitutes the major source of N 2 O in well-oxygenated coastal waters. Size-fractionated manipulation experiments with gene analysis further reveal niche partitioning of ammonia oxidizers and denitrifiers across the particle size spectrum; denitrification dominated on large particles and ammonia oxidizers on small particles. Total N 2 O production rate increases with substrate and particle concentrations, suggesting a crucial interplay between nutrients and particles in controlling N 2 O production. The controlling factors identified here may help understand climate feedback mechanisms between human activity and coastal oceans., (© 2023. The Author(s).)

Background: T helper (Th) cells are involved in the pathogenesis of pemphigus vulgaris (PV). However, the mechanism still needs more exploration., Aims: This study aimed to evaluate the molecular mechanism of the dysregulation of Th17 cells in the peripheral blood of patients with PV., Materials and Methods: Serum levels of IL-17 and anti-Dsg3 titres in patients with PV were analysed using ELISA. The mRNA expression of retinoic acid orphan receptor γt (RORγt) in CD4 + T cells was detected using reverse transcription-quantitative PCR (qPCR). The number of Th17 cells was examined using flow cytometry. Western blot analysis and immunofluorescent staining were also performed to investigate the expression levels of ERK/MAPK signalling proteins and Th17 lineage-associated proteins., Results: The proportion of Th17 cells and Th17 spectrum-associated proteins (p-STAT3, RORγt and IL-17) were upregulated in CD4+ cells in PV patients. The increased transcriptional levels of RORγt and IL-17 correlated positively with the severity of PV. Elevated phosphorylation of the ERK signalling factors was found in the collected CD4+ T cells in PV patients. The inhibition of the ERK signalling pathway significantly reduced the differentiation of Th17 cells in PV patients in vitro ., Conclusion: Th17 cells are essential in the dysregulation of PV, and ERK signalling is involved in Th17-type immunity and promotes the development of PV. The study here provides us with a potential therapeutic target for PV., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Dermatology.)

Ammonium (NH 4 + ) retention/removal processes in groundwater are of great interest because of the continuous increase in nitrogenous compound loading due to anthropogenic activities. However, the transition of multiple co-occurring transformation processes that determine the fate of NH 4 + in groundwater along a redox gradient remains underexplored. We selected a high nitrogen (N) groundwater system in the western Hetao Basin, China, to identify and quantify NH 4 + source and sink processes, including mineralization, dissimilatory nitrate reduction to ammonium (DNRA), nitrification, and anammox, to better understand the dynamics of NH 4 + . Based on redox-sensitive parameters, that is, the oxidation-reduction potential (ORP) and NH 4 + and nitrate (NO 3 - ) contents, etc., the groundwater system was classified into three zones from upstream to downstream: zone I (oxidizing), zone II (moderately reducing), and zone III (strongly reducing). Using the 15 N tracing technique, we found that NH 4 + was mainly produced by mineralization while < 2% was produced by DNRA throughout the study area. Mineralization increased downstream because the supply of biodegradable N-containing compounds was augmented, which created a strong redox gradient to host a serial reaction chain. In zone I, NH 4 + was mainly transferred to NO 3 - via nitrification, whereas in zones II and III, NH 4 + was mainly transferred to N 2 via anammox. The average NH 4 + production/consumption ratios (P/C) in zones I, II, and III were 0.7, 6.9, and 51.1, respectively. Obviously, the NH 4 + purification ability can only exceed the supply under aerobic conditions, thus suggesting that NH 4 + will accumulate without limitation and be retained in strongly reducing groundwater. The situation of NH 4 + accumulation would deteriorate over space and time in groundwater as human activities increase without an additional artificial supply of oxidants. The results provide mechanistic insights for quantitatively comprehending the dynamics and fate of NH 4 + in groundwater, shedding light on groundwater NH 4 + mitigation techniques., 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 © 2023. Published by Elsevier Ltd.)

Aim: To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments (RRDs) in the Wenzhou area in 2015 to 2019., Methods: All newly developed RRD cases among residents of the Wenzhou area, from January 2015 to December 2019, were retrospectively retrieved from hospital records. Annual population data were extracted from the Wenzhou Statistical Yearbook., Results: There were 3629 eligible cases. The average incidence of RRD was 7.79 cases per 100 000 population (95% confidence interval, 7.24-8.34), and the incidences were 7.99 and 7.56 for males and females, respectively. The annual incidence increased gradually from 7.26 cases per 100 000 in 2015 to 10.00 cases per 100 000 in 2019, with an overall increase of 37.74%. The highest rate of increase occurred in the age group from 60 to 69 years. Of 2750 eyes with axial length (AL) data, 1675 (60.91%) had an AL greater than 24 mm., Conclusion: A trend to increasing RRD incidence is observed in the Wenzhou area over the past 5-year period., (International Journal of Ophthalmology Press.)

Aim: To evaluate the role of internal limiting membrane (ILM) peeling in preventing secondary epiretinal membrane (ERM) formation in pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR)., Methods: This retrospective study analyzed the medical records of patients who underwent PPV for PDR and were followed up for minimum 3mo. ILM peeling was performed based on the intraoperative surgeons' judgments. ERM was assessed by optical coherence tomography photography. The relationship between ILM peeling and postoperative ERM was analyzed., Results: In total, 212 eyes from 197 patients were included in this study. The incidence of secondary ERM in the ILM non-peeling group was significantly higher than that in the ILM peeling group (37.0% vs 14.0%; P <0.001). Multivariate logistical regression revealed that ILM peeling was highly associated with the prevention of secondary ERM development [odds ratio 0.38; 95% confidence interval 0.17-0.86; P <0.05]., Conclusion: ILM peeling during PPV for PDRs can effectively reduce the incidence of secondary ERM development and is worth consideration by vitreoretinal surgeons., (International Journal of Ophthalmology Press.)

The reactive nitrogen (N) emitted from continents significantly perturbs the pristine N cycle around the land-ocean boundary resulting in eutrophication and hypoxia. As nutrients are transported downstream through an estuary, various types of biological processes co-occur to modulate nitrogen speciation to influence the biogeochemical habitats for downstream microorganisms. We surveyed the Pearl River Estuary to examine the N transfer dynamics among nitrogen species with considering process-specific oxygen production and consumption. By using 15 N pulse-tracing techniques, we measured ammonia oxidation and uptakes of ammonium, nitrite, and nitrate simultaneously under dark and light conditions in parallel. Light strongly inhibited nitrification but enhanced N uptake, and such light effect was further considered in the calculation for nitrogen transformation rates over a diel cycle. We found both oxidation and uptake of ammonium decreased seaward as substrate decreased. The nitrifier and phytoplankton work in antiphase to draw down incoming ammonium rapidly. Contrary to ammonium uptake, uptake of nitrite and nitrate showed a seaward increasing pattern. Such an inverse spatial pattern implies a shift in N preference for phytoplankton. Such high ammonium preference inhibits nitrate/nitrite uptake allowing them to behave conservatively in the estuary and to travel farther to outer estuary. By integrating oxygen consumption and production induced by N transformation processes over the diel cycle, oxygen was produced although allochthonous ammonium input is high (∼250 μM). For most stations, ammonium was completely consumed within 2 days, some stations even less than 0.5 days, implying that although the water residence time is short (2-15 days), tremendous input of ammonium N from upstream was transformed into particulate organic or nitrate forms during traveling to modulate the biogeochemical niche, including substrate, organics and oxygen, of coastal microbes in water column and sediments., (Copyright © 2022. Published by Elsevier Ltd.)

Information on the sources and transformations of particulate organic N (PN) and dissolved organic N (DON) at the coastal interface remains insufficient due to technological difficulties and complicated features of intensive physical mixing and rapid biological activities. Here, we investigated the spatial distribution of concentrations and isotopic compositions of PN and DON in the Changjiang plume during the summer flood period. In average, DON and PN accounted for 25.6 ± 12.1% and 8.1 ± 9.1% (n = 55), respectively, of the total N pool, with the remaining N primarily in the form of nitrate (NO 3 - ). Mean δ 15 N values were the lowest for DON (-0.1 ± 2.7‰, n = 58) and slightly higher for PN (2.0 ± 1.6‰, n = 101), and the highest for NO 3 - (6.5 ± 2.2‰, n = 67), suggesting multiple transformations had occurred to differentiate isotopic characteristics among the three N pools. By applying a conservative mixing model, we found DON deficits (-3.5 ± 3.7 μmol L -1 , n = 43) and negative shift in δ 15 N DON (-3.6 ± 2.2‰, n = 43) in the Changjiang plume, revealing nonconservative DON behaviors. In the offshore surface plume where Chlorophyll a was high, the most likely cause is the DON uptake by phytoplankton with a strong inverse isotope effect (around -40‰). This DON assimilation by phytoplankton contributed to ~16 ± 12% of the PN production, with the remaining supported by NO 3 - assimilation, producing an overall isotope effect of 4-9‰. However, in waters near the river mouth and at the bottom of the offshore plume where total suspended matter concentrations were high (>5 mg L -1 ), the DON deficit was most likely induced by the selective adsorption of 15 N enriched moieties of DON onto particulate surfaces (with an isotope effect of -20‰ to -5‰). Unlike dissolved organic carbon to behave conservatively in most estuaries, our results show that active transformations had occurred between the DON and PN pools in the Changjiang plume., 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 © 2021. Published by Elsevier B.V.)

Objectives: The optimal excision margin of primary cutaneous melanoma greater than 2 mm in thickness is still a controversial topic. The aim of the present study was to compare the long-term survival between narrow and wide excision margins in the surgical excision of patients with high-risk primary melanoma., Methods: We chose the patients with primary melanoma of the skin thicker than 2 mm in The Surveillance, Epidemiology, and End Results database. Patients were divided into a narrow margin group (1-2 cm) and a wide margin group (>2 cm) according to the resection margin information. The primary outcome was overall survival and disease-specific survival., Results: From 2004 to 2015, a total of 2,772 patients diagnosed as having melanoma of the skin were recruited into this study and were assigned to the narrow margin group (n = 1996) and the wide margin group (n = 776). A total of 1,098 patients died during the follow-up, and 681 of these were due to melanoma. There were 779 deaths in the narrow margin group and 319 deaths in the wide margin group (HR: 0.96, 95% CI: 0.84-1.10, p = 0.26). A total of 490 melanoma-specific deaths were reported in the narrow margin group and 191 were reported in the wide margin group (HR: 1.01, 95% CI: 0.85-1.19, p = 0.91)., Conclusions: Wider excision margin greater than 2 cm did not provide any additional therapeutic benefits compared to narrow excision margin between 1 and 2 cm. A 2-cm margin is adequate and safe for high-risk primary melanoma of the skin thicker than 2 mm., (© 2021 S. Karger AG, Basel.)

Aim: To investigate the safety and efficacy of sticky silicone oil (SSO) removal using a 22-gauge vein detained needle and inner limiting membrane (ILM) wrap-and-peel technique., Methods: This retrospective consecutive case series reviewed the records of patients with a history of retinal detachment who had received silicone oil and perfluorocarbon liquid (PFCL) as intraocular tamponades. Patients were included in the analysis if they exhibited SSO remnants during silicone oil removal. The aspiration of most of the SSO remnants was performed by a 22-gauge vein detained needle. The small amounts of droplets adhered to the macula and epi-macular membrane were subsequently removed by the ILM warp-and-peel technique. The anatomical and functional outcomes, and postoperative complications were recorded. In vitro experiments were performed to simulate the formation of SSO remnants in four groups., Results: Of 711 patients who underwent silicone oil removal during the study period, 9 patients exhibited SSO remnants and underwent follow-up for at least 3mo. Seven eyes (78%) underwent the ILM wrap-and-peel technique to completely remove small droplets of SSO that were glued to the macula and epi-macular membrane. No obvious complications occurred. Postoperative optical coherence tomography revealed normal retinal structure in all patients. In vitro analyses showed that balanced salt solution and prolonged vibration (for 1wk) had the strongest effects on silicone oil and PFCL compound opacities., Conclusion: SSO remnants could be removed in an intact manner and without complications, using a vein detained needle-assisted and ILM wrap-and-peel technique. The findings suggest that PFCL and infusion fluid should be completely removed before silicone oil injection to prevent SSO formation., (International Journal of Ophthalmology Press.)

Purpose: Zinc oxide nanoparticles (ZnO-NPs) have exerted antimicrobial properties. However, there is insufficient evaluation regarding the in vivo antifungal activity of ZnO-NPs. This study aimed to investigate the efficacy and mechanism of ZnO-NPs in controlling Candida albicans in the invertebrate Galleria mellonella . Methods: Galleria mellonella larvae were injected with different doses of ZnO-NPs to determine their in vivo toxicity. Non-toxic doses of ZnO-NPs were chosen for prophylactic injection in G. mellonella followed by C. albicans infection. Then the direct in vitro antifungal effect of ZnO-NPs against C. albicans was evaluated. In addition, the mode of action of ZnO-NPs was assessed in larvae through different assays: quantification of hemocyte density, morphology observation of hemocytes, characterization of hemocyte aggregation and phagocytosis, and measurement of hemolymph phenoloxidase (PO) activity. Results: Zinc oxide nanoparticles were non-toxic to the larvae at relatively low concentrations (≤20 mg/kg). ZnO-NP pretreatment significantly prolonged the survival of C. albicans- infected larvae and decreased the fungal dissemination and burden in the C. albicans- infected larvae. This observation was more related to the activation of host defense rather than their fungicidal capacities. Specifically, ZnO-NP treatment increased hemocyte density, promoted hemocyte aggregation, enhanced hemocyte phagocytosis, and activated PO activity in larvae. Conclusion: Prophylactic treatment with lower concentrations of ZnO-NPs protects G. mellonella from C. albicans infection. The innate immune response primed by ZnO-NPs may be part of the reason for the protective effects. This study provides new evidence of the capacity of ZnO-NPs in enhancing host immunity and predicts that ZnO-NPs will be attractive for further anti-infection applications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Xu, Li, Pan, Zheng, Wang, Peng, Dai, Tang, Zeng and Huang.)

The medial plantar artery (MPA) is often sacrificed as the vascular pedicle of the medial plantar flap (MPF). However, for patients with ankle soft tissue defect caused by traffic accident, the anterior tibial artery (ATA) could be damaged and the blood supply of the distal foot would only come from the MPA and the lateral plantar artery (LPA). In this case, sacrificing the MPA for the MPF means that the LPA will become the mainly source of blood supply of the distal foot. Whether the blood supply of the distal foot is adequately guaranteed remains to be discussed. A total of seven patients with ankle soft tissue defect and ATA injury were enrolled in the study. The digital subtraction angiography (DSA) was performed to observe the hemodynamics of the ipsilateral foot. The MPF was harvested only when the foot arterial network consisting of the MPA, the LPA, the deep plantar arch, and the deep plantar artery of DPA, and the blood redistribution existed. DSA results showed the blood from the posterior tibial artery was redistributed to the ipsilateral foot and the MPA is not the dominant artery in the foot. Seven MPFs were harvested, and all flaps survived completely. No complications, such as pain, ulcer, and necrosis, occurred in the ipsilateral toes. The DSA could accurately and intuitively evaluate the hemodynamics of foot in patients with ATA injury. The DSA data and clinical practice proved that the ATA injury is not the contraindication of the MPF., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Chromoblastomycosis is a chronic cutaneous fungal infection caused by dematiaceous fungi. It is a therapeutic challenge because of the lack of specific treatments. We describe a refractory case of chromoblastomycosis in which the lesion did not respond to initial treatment, but then use of topical imiquimod cured the lesion successfully.

Background and Objective: Defects resulted from the removal of large scars, benign tumors, severe pigmentation abnormalities, and vascular malformations, etc., in the scalp and face need to be repaired to restore the appearance. Here, the authors introduced the application of various expanded superficial temporal artery (STA) flaps in the repair of above defects., Methods: From Jan. 2015 to Dec. 2018, 19 patients with craniofacial secondary defects received the repair with expanded STA flaps in our clinic. The defects were resulted from the removal of scalp scar (n = 6), neurofibroma (n = 4), sebaceous nevus (n = 3), arteriovenous malformation (n = 2), facial scar (n = 2), and port-wine stain (n = 2). The expanded STA flaps included 14 cases of flaps pedicled by parietal branch of STA, 2 cases of flaps pedicled by parietal branch of STA combined with laser hair removal, 1 case of flaps pedicled by frontal branch of STA, and 2 cases of prefabricated expanded skin flap with the superficial temporal fascia in the neck., Results: The two-stage operation and water-filling expansion were accomplished in all patients. All flaps survived well, except one flap with venous congestion, which resolved after blood-letting and application of drugs promoting venous draining. In the three to six months follow-up, the flaps' color, texture, and thickness were satisfying., Conclusions: Individual application of different types of expanded STA flaps could achieve ideal results in repairing craniofacial secondary defects., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Purpose: Approximately 30% of patients with an open-globe injury (OGI) develop a secondary epiretinal membrane (ERM). This study was performed to assess whether internal limiting membrane (ILM) peeling in the treatment of posterior segment OGI prevents ERM formation., Methods: The medical records of 33 patients who underwent vitrectomy for posterior segment OGI from 2016 to 2019 were retrospectively analyzed. Of these patients, 17 underwent ILM peeling during the vitrectomy and 16 did not. The patients' demographic and surgical data were collected. The associations of ILM peeling with the preoperative findings of posterior segment OGI and development of a postoperative ERM were analyzed. Student's t -test was used to evaluate differences in continuous variables, and the chi-squared test or Fisher's exact test was used for categorical variables. Time-to-event curves were calculated from postestimation Cox proportional hazards models., Results: An ERM developed in three eyes (17.6%) in the ILM peeling group and in eight eyes (50.0%) in the nonpeeling group ( p < 0.05). There was no statistically significant difference between the groups in visual acuity at baseline (1.68 vs. 1.58 logMAR, p =0.68) or at final follow-up (0.72 vs. 0.78 logMAR, p =0.66). Median visual acuity significantly improved in both groups ( p < 0.001). In the multivariable models, ILM peeling (odds ratio, 0.19; 95% confidence interval, 0.04-0.91; p =0.04) and worse preoperative vision (odds ratio, 0.29; 95% confidence interval, 0.10-0.80; p =0.02) were associated with lower likelihood of ERM formation., Conclusion: Preventative treatment with ILM peeling contributed to decreased development of an ERM in patients with OGI involving areas near the fovea., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Wen-Long Wei et al.)

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy (DON). PubMed, EMBASE, the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcomes were the improvement in visual acuity and responder rate. Secondary outcomes were the proptosis reduction, change in diplopia, and clinical activity score (CAS). One randomized controlled trial, three retrospective case series and one prospective case series met the inclusion criteria. They were divided into intravenous high-dose glucocorticoids (ivGC) group and orbital decompression (OD) group. Both groups demonstrated improvement in visual acuity. In addition, the proportion of patients with improved vision in OD group was higher than that in ivGC group ( P <0.001). Post-treatment proptosis reduction was also reported in both groups. Overall, weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively. This study also presented results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in 5 included studies. The most common complication in ivGC group and OD group was Cushing's syndrome and epistaxis respectively. The present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing proptosis. However, high-quality, large-sample, controlled studies need to be performed in the future., (International Journal of Ophthalmology Press.)

We present geochemical analysis of 75 surface water samples collected in 2016 in Hong Kong coastal waters. We found that nitrogen distribution around Hong Kong can be characterized by two regimes driven by the influence of the Pearl River: 1) a regime where nitrate is the dominant species of nitrogen, associated with lower salinity and more faecal coliform and 2) a regime where dissolved organic nitrogen is dominant, associated with higher salinity and fewer faecal coliform. While the impact of the Pearl River on Hong Kong coastal waters is well characterized, we used the sharp contrast between the nitrogen regimes to produce new evidence about the role of the Pearl River on the generation of local hypoxia in Hong Kong. The impact of nitrate originating from the Pearl River on the generation of hypoxia in Hong Kong might be less important than previously thought, as no sign of eutrophication was found within the zones dominated by dissolved organic nitrogen and an historical decoupling of surface processes and bottom water oxygenation was observed. Moreover, we measured elevated ammonium levels and rapid cycling of ammonium and dissolved organic nitrogen in Victoria Harbour suggesting local sources, such as wastewater, might be rapidly oxidized and thus play an important role in the consumption of oxygen locally. A first-order calculation highlighted the potential for wastewater to drive the observed seasonal decline in oxygen. Taken together, these evidences suggest that eutrophication might not be the primary driver in the generation of seasonal hypoxia and that oxidation of ammonium released locally might play a bigger role than initially thought., 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 © 2021 Elsevier B.V. All rights reserved.)

Abstract: The reverse medial plantar flap (RMPF) raised from the nonweight-bearing region of the plantar foot represents a viable option for the soft tissue defect in planter forefoot. The anatomical basis of RMPF is the complex anastomotic branches between medial plantar artery (MPA) and deep plantar arch. Those anastomotic branches have high variation rate and may be damaged by trauma such as electric injury. Therefore, it is very important to know whether those anastomotic branches are present and intact before harvesting RMPF. Five patients with soft tissue defect in planter forefoot were enrolled into the study. The digital subtraction angiography (DSA) was performed to evaluate the plantar hemodynamics in the ipsilateral foot. The RMPF was harvested only after the anastomotic connections between MPA and deep plantar arch was confirmed. Anastomosis between superficial branch of MPA and deep plantar arch was observed in all DSA examinations. All 5 patients received the repair of soft tissue defect in plantar forefoot with RMPF. All flaps survived completely. The DSA can effectively evaluate the blood supply basis of RMPF and provide imaging evidence for the design and harvest of the flap. The main anatomical basis of RMPF is the anastomotic connections between superficial branch of MPA and deep plantar arch., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Commensal fungi are an important part of human microbial community, among which Candida albicans and Candida glabrata are two common opportunistic pathogens. Unlike the high pathogenicity of C. albicans, C. glabrata is reported to show low pathogenicity to the host. Here, by using a Galleria mellonella infection model, we were able to confirm the much lower virulence of C. glabrata than C. albicans . Interestingly, pre-exposure to live C. glabrata (LCG) protects the larvae against subsequent various lethal fungal infections, including C. albicans, Candida tropicalis, and Cryptococcus neoformans . Inconsistently, heat-inactivated C. glabrata (HICG) pre-exposure can only protect against C. albicans or C. tropicalis re-infection, but not C. neoformans . Mechanistically, LCG or HICG pre-exposure enhanced the fungicidal activity of hemocytes against C. albicans or C. tropicalis . Meanwhile, LCG pre-exposure enhanced the humoral immunity by modulating the expression of fungal defending proteins in the cell-free hemolymph, which may contribute to the protection against C. neoformans . Together, this study suggests the important role of C. glabrata in enhancing host immunity, and demonstrates the great potential of G. mellonella model in studying the innate immune responses against infections.

Venous malformations (VMs) are common slow-flow vascular malformations, which affect almost anywhere of the body. From January 2010 to October 2019, 126 patients with VMs who had complete imaging and follow-up data were enrolled into this study, including 75 males. The initial treatment age ranged from 5 to 72 years. The role of imaging results on the choice of treatment measures and the application were summarized. In this study, we retrospectively analyzed the imaging examinations, treatment measures, and follow-up results of the patients with VMs in our clinic. In this series, imaging examinations included ultrasound, magnetic resonance imaging, computed tomography (CT) scan and enhanced scan, percutaneous sinus angiography and three-dimensional CT imaging, plain film, CT venography, CT angiography, and digital subtraction angiography. Treatment measures included surgical excision (n = 20), sclerotherapy (n = 86, including absolute ethanol [n = 75], polidocanol [n = 8], and pingyangmycin [n = 3]), and combination treatment with intralesional copper wire retention and sclerotherapy(n = 20). After treatment, most of the lesions shrunk obviously or disappeared, and the symptoms were largely relieved. Comprehensive and accurate imaging assessment of VMs is necessary for selecting appropriate treatment. Individual strategy and sequential treatment can achieve effective results and avoid potential complications., (© 2020 Wiley Periodicals LLC.)

Objective: Infantile hemangiomas (IHs) are the most common benign tumor in infancy. Periorbital IHs may lead to visual dysplasia so prompt and effective treatment should be adopted. In this study, we retrospectively analyzed the diagnosis and treatment of periorbital IHs treated in our clinic and give the strategy for clinical practice., Methods: From Jan. 2006 to Dec. 2018, 35 patients with periorbital IHs were enrolled into this study, including 13 males. The initial age of treatment ranged from 0.6 to 7 months. The clinical manifestations, imaging examination results, treatment measures and follow-up results were analyzed. Then diagnosis and treatment strategy were summarized., Results: All patients were examined by ultrasound to confirm the depth of tumor, evaluate the effect of treatment and provide the evidence for drug withdrawal. For patients with deep hemangiomas, enhanced CT were added. Intralesional injection of glucocorticoids and oral propranolol were applied. All patients achieved good results. Ocular symptoms were avoided in most of the patients., Conclusion: Periorbital IHs have special growth features and can be diagnosed by the appearance, ultrasound, CT scan, and propranolol experimental therapy if necessary. In consideration of potential complications, oral propranolol is the first treatment option for periorbital IHs., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Ammonia-oxidizing archaea (AOA) are ubiquitous in diverse ecosystems and play a pivotal role in global nitrogen and carbon cycling. Although AOA diversity and distribution are widely studied, mainly based on the amoA (alpha subunit of ammonia monooxygenase) genotypes, only limited investigations have addressed the relationship between AOA genetic adaptation, metabolic features, and ecological niches, especially in estuaries. Here, we describe the AOA communities along the Jiulong River estuary in southern China. Nine high-quality AOA metagenome-assembled genomes (MAGs) were obtained by metagenomics. Five of the MAGs are proposed to constitute a new species, " Candidatus Nitrosopumilus aestuariumsis" sp. nov., based on the phylogenies of the 16S and 23S rRNA genes and concatenated ribosomal proteins, as well as the average amino acid identity. Comparative genomic analysis revealed unique features of the new species, including a high number of genes related to diverse carbohydrate-active enzymes, phosphatases, heavy-metal transport systems, flagellation, and chemotaxis. These genes may be crucial for AOA adaptation to the eutrophic and heavy-metal-contaminated Jiulong River estuary. The uncovered detailed genomic characteristics of the new estuarine AOA species highlight AOA contributions to ammonia oxidation in the Jiulong River estuary. IMPORTANCE In this study, AOA communities along a river in southern China were characterized, and metagenome-assembled genomes (MAGs) of a novel AOA clade were also obtained. Based on the characterization of AOA genomes, the study suggests adaptation of the novel AOAs to estuarine environments, providing new information on the ecology of estuarine AOA and the nitrogen cycle in contaminated estuarine environments., (Copyright © 2020 American Society for Microbiology.)

In the context of continuously increasing anthropogenic nitrogen inputs, knowledge of how ammonia oxidation (AO) in the ocean responds to warming is crucial to predicting future changes in marine nitrogen biogeochemistry. Here, we show divergent thermal response patterns for marine AO across a wide onshore/offshore trophic gradient. We find ammonia oxidizer community and ambient substrate co-regulate optimum temperatures (T opt ), generating distinct thermal response patterns with T opt varying from ≤14 °C to ≥34 °C. Substrate addition elevates T opt when ambient substrate is unsaturated. The thermal sensitivity of kinetic parameters allows us to predict responses of both AO rate and T opt at varying substrate and temperature below the critical temperature. A warming ocean promotes nearshore AO, while suppressing offshore AO. Our findings reconcile field inconsistencies of temperature effects on AO, suggesting that predictive biogeochemical models need to include such differential warming mechanisms on this key nitrogen cycle process.

Background: Lymphatic malformations (LMs) are congenital low-flow vascular anomalies resulting from abnormal embryogenesis. Clinical researches have shown that rapamycin, a specific inhibitor of mTOR, is effective in treating LMs. It suggests the abnormality of mTOR signal pathway in LMs. Methods and Results: From January 2009 to December 2018, 10 patients who accepted the resection of LMs were enrolled into the study. Samples of each subtype of LMs (macrocystic, microcystic, and mixed subtypes) were further investigated. Expression of molecules in mTOR signal pathway-mTORC1, p70 S6, p-p70 S6, elF4EBP1, and p-elF4EBP1-in LMs were investigated by immunohistochemical staining. Location of mTORC1, p70 S6, and elF4EBP1 in LMs were shown by immunofluorescence co-staining. Phosphorylation level of mTOR signal pathway in LMs was examined by Western blotting. Immunohistochemical staining showed the expression of mTORC1, p70 S6, p-p70 S6, eIF4EBP1, and p-eIF4EBP1 in LMs. Immunofluorescence staining further verified the co-expression of mTORC1, p70 S6, and eIF4EBP1 in the lymphatic endothelium of LMs. Western blotting analysis revealed obviously higher phosphorylation level of mTOR signal pathway in LMs than that in normal skins ( P  < 0.05). Conclusions: The results showed that the mTOR signal pathway was overactivated in LMs. The study provides compelling evidence for treating LMs or syndromes with lymphatic anomalies by inhibiting mTOR signaling.

Elevated nutrient inputs have led to increased eutrophication in coastal marine ecosystems worldwide. An understanding of the relative contribution of different nutrient sources is imperative for effective water quality management. Stable isotope values of nitrate (δ 15 N NO3- , δ 18 O NO3- ) can complement conventional water quality monitoring programs to help differentiate natural sources of NO 3 - from anthropogenic inputs and estimate the processes involved in N cycling within an ecosystem. We measured nutrient concentrations, δ 15 N NO3- , and δ 18 O NO3- in 76 locations along a salinity gradient from the lower end of the Pearl River Estuary, one of China's largest rivers discharging into the South China Sea, towards the open ocean. NO 3 - concentrations decreased with increasing salinity, indicative of conservative mixing of eutrophic freshwater and oligotrophic seawater. However, our data did not follow conservative mixing patterns. At salinities <20 psu, samples exhibited decreasing NO 3 - concentrations with almost unchanged NO 3 - isotope values, indicating simple dilution. At salinities >20 psu, NO 3 - concentrations decreased, while dual NO 3 - isotopes increased, suggesting mixing and/or other transformation processes. Our analysis yielded mean estimates for isotope enrichment factors ( 15 ε = -2.02‰ and 18 ε = -3.37‰), Δ(15,18) = -5.5‰ and δ 15 N NO3- - δ 15 N NO2-  = 12.3‰. After consideration of potential alternative sources (sewage, atmospheric deposition and groundwater) we concluded that there are three plausible interpretations for deviations from conservative mixing behaviour (1) NO 3 - uptake by assimilation (2) in situ NO 3 - production (from fixation-derived nitrogen and nitrification of sewage-derived effluents) and (3) input of groundwater nitrate carrying a denitrification signal. Through this study, we propose a simple workflow that incorporates a synthesis of numerous isotope-based studies to constrain sources and behaviour of NO 3 - in urbanized marine environments., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Infantile hemangioma can grow dramatically or typically locate on the face, which may lead to functional impairment, cosmetically disfiguring and exhibiting complications such as ulceration, bleeding, or infection. Early intervention is necessary. In this study, the authors chose individual treatment for different patients. From January 2012 to December 2016, 185 patients with hemangioma were enrolled into this study. Lesion area ranged from 0.5 cm × 0.5 cm to 9 cm × 12 cm. The initial treatment age ranged from 1 to 7 months with an average age of 3.9 months. Thirty-five children achieved the treatment of Intralesional Compound Betamethasone, 134 children achieved the treatment of oral propranolol, and 16 children achieved the treatment of topical carteolol. In the follow-up, the treatment could be repeated or switched to oral propranolol if the tumor tended to grow again. At the end of follow-up, 89% of the patients' tumors shrinked or involuted completely, 5 patients switched to oral propranolol. The adverse effects included soft tissue atrophy, moon face, diarrhea, heart rate reduction, and liver enzyme abnormalities. All of the patients recovered in a short period. Early treatment for hemangioma can achieve good results and avoid functional impairment. For different patients, the authors suggest individualized treatment according to the tumors' size and location.

Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible.

Objective: The aim of this study was to investigate the relationship between the length of surgery and the incidence of pressure ulcers (PrUs) in cardiovascular surgical patients., Methods: A retrospective analysis was performed among consecutive patients with cardiac surgery in 2012. Propensity score matching was used to control differences in the baseline characteristics between with and without surgery-related pressure ulcer (SRPU) groups., Results: A total of 286 patients with cardiac surgery were included in the study: 47 patients developed 57 SRPUs, with incidence of 16.4% (95% confidence interval, 12.3%-21.2%); 97.9% of SRPUs were Stage I, and the other 2.1% were Stage II. After propensity score matching, statistically significant difference of the length of surgery between the 2 groups was found (195 minutes [30-330 minutes] vs 240 minutes [125-675 minutes], P = .003). However, the length of cardiopulmonary bypass was found to be not statistically significantly different between the 2 groups (37 minutes [15-144 minutes] vs 44 minutes [16-107 minutes], P = .830). The curve fitting showed the SRPU incidence increased gradually with the extension of length of surgery., Conclusions: The authors' retrospective analysis showed the length of surgery was an important risk factor for PrUs in cardiovascular surgical patients, but not the length of cardiopulmonary bypass. The incidence of SRPUs increased gradually with the extension of length of surgery.

Objective: To observe the effect of Cordyceps sinensis (CS) powder on renal oxidative stress and mitochondria functions in 5/6 nephrectomized rats, and to primarily explore its possible mechanisms., Methods: Totally 30 male Sprague-Dawley rats were divided into the sham-operation group, the model group, and the treatment group by random digit table, 10 in each group. A chronic kidney disease (CKD) rat model was prepared by one step 5/6 nephrectomy. Rats in the treatment group were intragastrically administered with CS powder solution at the daily dose of 2 g/kg, once per day. Equal volume of double distilled water was intragastrically administered to rats in the sham-operation group and the model group. All medication lasted for 12 weeks. The general condition of rats, their body weight, blood pressure, 24 h proteinuria, urinary N-acetyl-β-D-glucosaminidase (NAG), serum creatinine (SCr) , and blood urea nitrogen (BUN) were assessed before surgery, at week 2, 4, 6, 8, 10, and 10 after surgery. Pathological changes of renal tissues were observed under light microscope. Morphological changes of mitochondria in renal tubular epithelial cells were observed under transmission electron microscope. Activities of antioxidant enzymes including reduced glutathione (GSH), manganese superoxide dismutase (MnSOD), and malondialdehyde (MDA) in fresh renal tissue homogenate were detected. Mitochondria of renal tissues were extracted to detect levels of mitochondrial membrane potential and changes of reactive oxygen species (ROS). And expressions of cytochrome-C (Cyto-C) and prohibitin in both mitochondria and cytoplasm of the renal cortex were also measured by Western blot., Results: (1) Compared with the sham-operation group, body weight was significantly decreased at week 2 (P <0. 01), but blood pressure increased at week 4 (P <0. 05) in the model group. Compared with the model group, body weight was significantly increased at week 12 (P <0. 01), but blood pressure decreased at week 8 (P < 0. 01) in the treatment group. (2) Compared with the sham-operation group, 24 h proteinuria, urinary NAG, blood SCr and BUN significantly increased in the model group (all P <0. 01). Compared with the model group, blood and urinary biochemical indices all significantly decreased in the treatment group (all P <0. 01). (3) Results of pathological renal scoring: Glomerular sclerosis index, scoring for tubulointerstitial fibrosis, degree of tubulointerstitial inflammatory infiltration were all obviously higher in the model group than in the sham-operation group (all P <0. 01). All the aforesaid indices were more obviously improved in the treatment group than in the model group (all P <0. 01). (4) Compared with the sham-operation group, activities of MnSOD and GSH-Px were significantly reduced, but MDA contents obviously increased in the renal cortex of the model group (all P <0. 01). Compared with the model group, activities of MnSOD and GSH-Px obviously increased (P <0. 05, P <0. 01), but MDA contents obviously decreased in the renal cortex of the treatment group (P <0. 01). (5) Compared with the sham-operation group, the mitochondrial membrane potential significantly decreased, but ROS levels significantly increased in the model group (all P <0.01). Compared with the model group, mitochondrial transmembrane potential increased in the treatment group, thereby inhibiting the tendency of increased production of ROS (both P < 0. 01). (6) Results of Western blot showed that, compared with the sham-operation group, expression levels of mitochondrial Cyto-C and Prohibitin were significantly reduced in the renal cortex (P <0. 01), but significantly elevated in the cytoplasm of the model group (P <0. 01). Compared with the model group, each index was obviously improved in the treatment group with statistical difference (P <0. 05, P <0. 01)., Conclusion: CS powder had renal protection, and its mechanism might partially depend on in- hibition of oxidative stress and protection for mitochondria.