Accuracy of Mean Value of Central Venous Pressure from Monitor Digital Display: Influence of Amplitude of Central Venous Pressure during Respiration

Background A simple measurement of central venous pressure(CVP)-mean by the digital monitor display has become increasingly popular.However,the agreement between CVP-mean and CVP-end(a standard method of CVP measurement by analyzing the waveform at end-expiration)is not well determined.This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude(ΔCVP=CVPmax-CVPmin)during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end.Methods In total,291 patients were included in the study.CVP-mean and CVP-end were obtained simultaneously from each patient.CVP measurement difference(|CVP-mean-CVP-end|)was defined as the difference between CVP-mean and CVP-end.TheΔCVP was calculated as the difference between the peak(CVPmax)and the nadir value(CVPmin)during the respiratory cycle,which was automatically recorded on the monitor screen.Subjects with|CVP-mean-CVP-end|≥2 mm Hg were divided into the inconsistent group,while subjects with|CVP-mean-CVP-end|2 mm Hg were divided into the consistent group.ResultsΔCVP was significantly higher in the inconsistent group[7.17(2.77)vs.5.24(2.18),P0.001]than that in the consistent group.There was a significantly positive relationship betweenΔCVP and|CVP-mean-CVP-end|(r=0.283,P 0.0001).Bland-Altman plot showed the bias was-0.61 mm Hg with a wide 95%limit of agreement(-3.34,2.10)of CVP-end and CVP-mean.The area under the receiver operating characteristic curves(AUC)ofΔCVP for predicting|CVP-mean-CVP-end|≥2 mm Hg was 0.709.With a high diagnostic specificity,usingΔCVP3 to detect|CVP-mean-CVP-end|lower than 2mm Hg(consistent measurement)resulted in a sensitivity of 22.37%and a specificity of 93.06%.UsingΔCVP8 to detect|CVP-mean-CVPend|8 mm Hg(inconsistent measurement)resulted in a sensitivity of 31.94%and a specificity of 91.32%.Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios.ΔCVP during the respiratory period is related to the variation of the two CVP methods.A highΔCVP indicates a poor agreement between these two methods,whereas a lowΔCVP indicates a good agreement between these two methods.

Nasal congestion caused by long-term retention of a nasal foreign body near the orbit:A case report

BACKGROUND Nasal trauma presents a risk of foreign body invasion into the nasal cavity.However,in the early treatment stage of nasal trauma,patients and doctors are not always aware of possible foreign body invasion,resulting in delayed detection.We describe the case of an adult patient admitted to the hospital due to left nasal congestion accompanied by yellow,purulent,and bloody discharge.CASE SUMMARY Consultation with the patient revealed a history of nasal trauma 30 years prior that did not receive thorough examinations and imaging during treatment,resulting in a glass fragment retained in the nasal cavity adjacent to the orbit.After admission,computerized tomography(CT)confirmed the presence of the foreign body in the patient’s left nasal–maxillary sinus.The nasal foreign body led to symptoms such as chronic sinusitis,nasal polyps,fungal infection,and deviated nasal septum.The foreign body was successfully removed by nasal endoscopy,polypectomy,sinus fungal removal,left middle turbinate conchoplasty,fenestration via the right inferior meatus,nasal endoscopic maxillary sinus cystectomy,and septolplasty.The operation was successful and without any complications.CONCLUSION CT scans should be performed in addition to necessary debridement sutures to avoid possible foreign body invasion during nasal trauma.Surgical planning should be tailored to the patient’s specific situation.The surgical method should be carefully selected,and sufficient preparation should be undertaken before the surgery to avoid possible displacement of the nasal foreign body.

Thoracic spine infection caused by Pseudomonas fluorescens:A case report and review of literature

BACKGROUND The clinical incidence of spinal infection is gradually increasing,and its onset is insidious,easily leading to missed diagnosis and misdiagnosis,which may lead to serious complications such as nervous system dysfunction,spinal instability and/or deformity,and cause a huge burden on society and families.Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients.At present,the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus,Streptococcus,Pneumococcus,Escherichia coli,and Klebsiella.There are no reports of spinal infection caused by Pseudomonas fluorescens.CASE SUMMARY We report a 32-year-old female patient with spinal infection.She presented with flank pain,initially thought to be bone metastases or bone tuberculosis,and had a family background of tumors.Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection.Histopathology of the lesion showed inflammation,tissue culture of the lesion was negative several times,and the possible pathogen-Pseudomonas fluorescens was found after gene sequencing of the lesion.The patient recovered completely after a full course of antibiotic treatment.CONCLUSION This report increases the range of pathogens involved in spinal infections,highlights the unique advantages of gene sequencing technology in difficult-todiagnose diseases,and validates conservative treatment with a full course of antibiotics for spinal infections without complications.

Pulmonary Nodules Developed Rapidly in Staffs in the Isolation Ward of a Chinese Hospital during the COVID-19 Epidemic

In December 2019,the novel 2019 coronavirus disease(COVID-19)emerged in Wuhan and spread all over the country.The Zibo Central Hospital had set up a febrile clinic and isolation ward for confirmed and suspected patients since January 23,2020.Suspected patients were hospitalized immediately to the isolation ward.Every healthcare staff was authorized to undergo low-dose computed tomography(LDCT)of the chest free of charge before and after their assignment in the isolation ward.

Designing a risk prognosis model based on natural killer cell-linked genes to accurately evaluate the prognosis of gastric cancer

Background:This study was aimed at identifying natural killer(NK)cell-related genes to design a risk prognosis model for the accurate evaluation of gastric cancer(GC)prognosis.Methods:We obtained NK cell-related genes from various databases,followed by Cox regression analysis and molecular typing to identify prognostic genes.Various immune algorithms and enrichment analyses were used to investigate the mutations,immune status,and pathway variations among different genotypes.The key prognostic genes were assessed using the least absolute shrinkage and selection operator(Lasso)regression analysis and univariate Cox regression analysis.Thereafter,the risk score(RS)prognosis model was constructed based on the selected important prognostic genes.A Receiver Operating Characteristics(ROC)curve was plotted for analyzing the robustness of the model.Subsequently,the decision and calibration curves were used for assessing the reliability and prediction accuracy of the proposed model.The‘pRRophetic’R software package was utilized for predicting the half-maximal inhibitory concentration(IC50)of immunotherapy and chemotherapy drugs.Results:We screened 21 prognostic genes and three molecular subtypes and found that the C1 subtype had the worst prognosis.Further,the pathways promoting tumor proliferation,such as epithelial-mesenchymal transition were significantly up-regulated.The results also showed that the macrophages in the M2 stage were significantly infiltrated in the C1 subtype,and there was significant overexpression in the C1 subtype,accompanied by a severe inflammatory reaction.The C1 was highly sensitive to drugs like 5-fluorouracil and paclitaxel.The ROC,calibration curve,and decision curve showed that the risk model was robust and strongly reliable.Conclusion:Overall,our proposed NK cell-related RS model can be used as a more accurate prediction index for GC patients,providing a valuable contribution to personalized medicine.

Percutaneous transhepatic cholangial drainage-guided methylene blue for fistulotomy using dual-knife for bile duct intubation: A case report

BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.

Loading uniform Ag_(3)PO_(4)nanoparticles on three-dimensional peony-like WO_(3)for good stability and excellent selectivity towards NH_(3)at room temperature

A heterojunction structure design is a very good method for improving the properties of semiconductors in many research fields.This method is employed in the present study to promote the gas-sensing performance of Ag_(3)PO_(4)nanocomposites at room temperature(25℃).A nanocomposite of Ag_(3)PO_(4)nanoparticles and three-dimensional peony-like WO_(3)(WO_(3)/Ag_(3)PO_(4))was successfully prepared by the precipitation method.The crystalline phases were analyzed by xray diffraction and the microstructure was characterized by scanning electron microscopy and transmission electron microscopy.The chemical bonding states were analyzed by x-ray photoelectron spectroscopy.The gas-sensing performance of WO_(3)/Ag_(3)PO_(4)sensors was systematically explored at room temperature.The composite sensors possessed a higher response and lower detection limit(1 ppm)to NH_(3)than those made of a single type of material;this is ascribed to the synergistic effect achieved by the heterojunction structure.Among the different composite sensors tested,gas sensor A5W5(Ag_(3)PO_(4):WO3mass ratio of 5:5)displayed the highest response to NH_(3)at room temperature.Interestingly,the A5W5 gas sensor exhibited relatively good stability and excellent selectivity to NH_(3).The A5W5 sensor also displayed a relatively good response under high humidity.The gas-sensing mechanism of the WO_(3)/Ag_(3)PO_(4)sensors is explained in detail.Taken together,the as-prepared sensor is highly efficient at detecting NH_(3)and could be suitable for practical applications.In addition,this study also provides a new method for developing Ag_(3)PO_(4)-based sensors in the gas-sensing field.

Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones

AIM To compare the efficacy of a session of extracorporeal shock wave lithotripsy(ESWL) before endoscopic retrograde cholangiopancreatography(ERCP) vs ERCP only for problematic and large common bile duct(CBD) stones.METHODS Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups,an "ESWL + ERCP group" and an "ERCP-only" group. For ESWL + ERCP cases,ESWL was performed prior to ERCP. Clearance of the CBD,complications related to the ESWL/ERCP procedure,frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups.RESULTS There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session(74.2% vs 71.0%,P = 0.135),but a higher clearance rate within the second treatment session(84.4% vs 51.6%,P = 0.018) and total stone clearance(96.0% vs 86.0%,P = 0.029). Moreover,ESWL prior to ERCP not only reduced ERCP procedure time(43 ± 21 min vs 59 ± 28 min,P = 0.034) and the rate of mechanical lithotripsy use(20% vs 30%,P = 0.025),but also raised the clearance rate of extremely large stones(80.0% vs 40.0%,P = 0.016). Post-ERCP complications were similar for the two groups.CONCLUSION Based on the higher rate of successful stone removal and minimal complications,ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones.

Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism

BACKGROUND The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation(LT).However,splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegaly.AIM To examine the feasibility of performing partial splenectomy during LT in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism.METHODS Between October 2015 and February 2019,762 orthotopic LTs were performed for patients with end-stage liver diseases in Tianjin First Center Hospital.Eighty-four cases had advanced cirrhosis combined with severe splenomegaly and hypersplenism.Among these patients,41 received partial splenectomy during LT(PSLT group),and 43 received only LT(LT group).Patient characteristics,intraoperative parameters,and postoperative outcomes were retrospectively analyzed and compared between the two groups.RESULTS The incidence of postoperative hypersplenism(2/41,4.8%)and recurrent ascites(1/41,2.4%)in the PSLT group was significantly lower than that in the LT group(22/43,51.2%;8/43,18.6%,respectively).Seventeen patients(17/43,39.5%)in the LT group required two-stage splenic embolization,and further splenectomy was required in 6 of them.The operation time and intraoperative blood loss in the PSLT group(8.6±1.3 h;640.8±347.3 mL)were relatively increased compared with the LT group(6.8±0.9 h;349.4±116.1 mL).The incidence of postoperative bleeding,pulmonary infection,thrombosis and splenic arterial steal syndrome in the PSLT group was not different to that in the LT group,respectively.CONCLUSION Simultaneous PSLT is an effective treatment and should be performed in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism to prevent postoperative persistent hypersplenism.

Huanglian decoction suppresses the growth of hepatocellular carcinoma cells by reducing CCNB1 expression

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most prevalent cancers in human populations worldwide.Huanglian decoction is one of the most important Chinese medicine formulas,with the potential to treat cancer.AIM To investigate the role and mechanism of Huanglian decoction on HCC cells.METHODS To identify differentially expressed genes(DEGs),we downloaded gene expression profile data from The Cancer Genome Atlas Liver Hepatocellular Carcinoma and Gene Expression Omnibus(GSE45436)databases.We obtained phytochemicals of the four herbs of Huanglian decoction from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform.We also established a regulatory network of DEGs and drug target genes and subsequently analyzed key genes using bioinformatics approaches.Furthermore,we conducted in vitro experiments to explore the effect of Huanglian decoction and to verify the predictions.In particular,the CCNB1 gene was knocked down to verify the primary target of this decoction.Through the identification of the expression levels of key proteins,we determined the primary mechanism of Huanglian decoction in HCC.RESULTS Based on the results of the network pharmacological analysis,we revealed 5 bioactive compounds in Huanglian decoction that act on HCC.In addition,a protein-protein interaction network analysis of the target genes of these five compounds as well as expression and prognosis analyses were performed in tumors.CCNB1 was confirmed to be the primary gene that may be highly expressed in tumors and was significantly associated with a worse prognosis.We also noted that CCNB1 may serve as an independent prognostic indicator in HCC.Moreover,in vitro experiments demonstrated that Huanglian decoction significantly inhibited the growth,migration,and invasiveness of HCC cells and induced cell apoptosis and G2/M phase arrest.Further analysis showed that the decoction may inhibit the growth of HCC cells by downregulating the CCNB1 expression level.After Huanglian decoction treatment,the expression levels of Bax,caspase 3,caspase 9,p21 and p53 in HCC cells were increased,while the expression of CDK1 and CCNB1 was significantly decreased.The p53 signaling pathway was also found to play an important role in this process.CONCLUSION Huanglian decoction has a significant inhibitory effect on HCC cells.CCNB1 is a potential therapeutic target in HCC.Further analysis showed that Huanglian decoction can inhibit HCC cell growth by downregulating the expression of CCNB1 to activate the p53 signaling pathway.

Effect of TRPC6 Knockdown on Puromycin Aminonucleoside-induced Podocyte Injury

This study was aimed to construct eukaryotic expression vectors carrying the small hairpin RNA （shRNA） targeting TRPC6 gene and investigate the effect of TRPC6 knockdown on puromucin aminonucleoside （PAN）-induced podocyte injury. Two DNA sequences containing the small hairpin structure targeting TRPC6 were designed, synthesized and then inserted into the green fluorescence protein （GFP）-contained plasmids （pGC） to establish the plasmids pGCsi-TRPC6A and pGCsi-TRPC6B. Plasmids expressing scrambled shRNA were used as negative control and named pGCsi-NC. These plasmids were transfected into a conditionally immortalized murine podocyte cell line by using liposome. Flow cytometry was used to examine the transfection efficiency. TRPC6 mRNA and protein ex-pression levels were detected by RT-PCR and Western blotting. Cultured podocytes were divided into four groups： control group, PAN treatment group, PAN＋TRPC6 shRNA transfected group and PAN＋scrambled shRNA transfected group. The paracelluar permeability to BSA was evaluated by Millicell-PCF Inserts and cell viability was measured by the trypan blue assay. Immunofluorescent assay was used to observe the distribution of α-actinin-4 and α-tubulin. The results showed that the transfection efficiency of the shRNA expression vector was about 45%. Expression levels of TRPC6 mRNA and protein were downregulated after transfection with pGCsi-TRPC6A and pGCsi-TRPC6B. Knocking down TRPC6 gene could effectively reverse the PAN-induced increase in the paracelluar permeability to BSA. The distribution of α-actinin-4 and α-tubulin was disrupted after treatment with PAN, which was reversed by knocking down TRPC6 gene. It was concluded that knocking down TRPC6 gene could effectively prevent podocytes from the permeability increase induced by PAN, which may be related to the regulation of podocyte cytoskeleton.

Exosomal microRNA-588 from M2 polarized macrophages contributes to cisplatin resistance of gastric cancer cells

BACKGROUND Gastric cancer is a prevalent malignant cancer with a high incidence and significantly affects the health of modern people globally.Cisplatin(DDP)is one of the most common and effective chemotherapies for patients with gastric cancer,but DDP resistance remains a severe clinical challenge.AIM To explore the function of M2 polarized macrophages-derived exosomal microRNA(miR)-588 in the modulation of DDP resistance of gastric cancer cells.METHODS M2 polarized macrophages were isolated and identified by specific markers using flow cytometry analysis.The exosomes from M2 macrophages were identified by transmission electron microscopy and related markers.The uptake of the PKH67-labelled M2 macrophages-derived exosomes was detected in SGC7901 cells.The function and mechanism of exosomal miR-588 from M2 macrophages in the modulation of DDP resistance of gastric cancer cells was analyzed by CCK-8 assay,apoptosis analysis,colony formation assay,Western blot analysis,qPCR analysis,and luciferase reporter assay in SGC7901 and SGC7901/DDP cells,and by tumorigenicity analysis in nude mice.RESULTS M2 polarized macrophages were isolated from mouse bone marrow stimulated with interleukin(IL)-13 and IL-4.Co-cultivation of gastric cancer cells with M2 polarized macrophages promoted DDP resistance.M2 polarized macrophagesderived exosomes could transfer in gastric cancer cells to enhance DDP resistance.Exosomal miR-588 from M2 macrophages contributed to DDP resistance of gastric cancer cells.miR-588 promoted DDP-resistant gastric cancer cell growth in vivo.miR-588 was able to target cylindromatosis(CYLD)in gastric cancer cells.The depletion of CYLD reversed miR-588 inhibition-regulated cell proliferation and apoptosis of gastric cancer cells exposed to DDP.CONCLUSION In conclusion,we uncovered that exosomal miR-588 from M2 macrophages contributes to DDP resistance of gastric cancer cells by partly targeting CYLD.miR-588 may be applied as a potential therapeutic target for the treatment of gastric cancer.

Effect of 5-LOX/COX-2 common inhibitor DHDMBF30 on pancreatic cancer cell Capan2

AIM: To study the effect of 5-lipoxygenase/cyclooxy- genase-2 (5-LOX/COX-2) dual inhibitor 7-tert-butyl-2, 3-dihydro-3, 3-dimethyl substituted dihydrofuran 30 (DHDMBF30) on proliferation and apoptosis of the pancreatic cancer cell line Capan-2 and the effect of DHDMBF30 on human pancreatic cancer in a nude mouse model. METHODS: Investigate the effect of 5-LOX/COX-2 dual inhibitor DHDMBF30 on proliferation and apoptosis of the pancreatic cancer cell line Capan-2 by RT-PCR, MTT assay, FCM and electron microscope. Cell line Capan-2 was inoculated percutaneously on the outer thigh of 12 nude mice. The VEGF mRNA of transplantation tumor was detected by RT-PCR. RESULTS: DHDMBF30 inhibits the proliferation of cell line Capan2, reduces the expression of 5-LOX, COX-2 and VEGF. After Capan2 was treated with DHDMBF30, we found that the apoptosis peak of the experimental group was significantly higher than that of the contrast group (3.08 ± 1.89 vs 27.67 ± 0.52, P < 0.001). The tumor weight of the DHDMBF30 group was significantly lower than PBS control groups (1.35 ± 0.47 vs 2.92 ± 0.73, P < 0.01). Expression of VEGF in the DHDMBF30 group was significantly decreased. CONCLUSION: DHDMBF30 inhibits the proliferation ofthe pancreatic cell line Capan2, and induces apoptosis and inhibits the growth of pancreatic cancer in nude mice.

Maisonneuve injury with no fibula fracture:A case report

BACKGROUND Ankle syndesmosis injury is difficult to diagnose accurately at the initial visit.Missed diagnosis or improper treatment can lead to chronic complications.Complete syndesmosis injury with a concomitant rupture of the interosseous membrane(IOM)is more unstable and severe.The relationship between this type of injury and Maisonneuve injury,in which the syndesmosis is also injured,has not been discussed in the literature previously.CASE SUMMARY A 16-year-old patient sustained left medial malleolar fracture,and the associated inferior tibiofibular syndesmotic instability was overlooked.After open reduction and internal fixation of the medial malleolar fracture,inferior tibiofibular syndesmosis diastasis with IOM rupture was detected by auxiliary imaging.Secondary surgical intervention was performed to reduce anatomically and fix with two trans-syndesmosis screws.Twelve weeks later,the screws were removed.At the 6-mo follow-up,the patient gained full range of motion of the ankle.CONCLUSION Complete syndesmosis injury with IOM rupture should be considered Maisonneuve-type injury.Open reduction and internal fixation could obtain good outcomes.

Expression of Netrin-1 in Diabetic Rat Retina

Purpose:.To detect the expression of Netrin-1 in the retinas of diabetic rats and evaluate the relationship between Netrin-1mRNA and diabetic retinopathy(DR).Methods:.Twenty healthy adult male Sprague-Dawley(SD)rats were randomly divided into a diabetic model group(DM)and a normal control group(NC), each group was composed of ten rats..Sreptozocin(STZ)was administered intraperitoneally at a single dose of 60 mg / kg to diabetic group. The control rats were injected only with citrate buffer. Collection of serum at 72 h after STZ treatment and measuring blood glucose levels confirmed the development of diabetes..The rats with blood glucose level 16.67 mmol / L or higher were considered to be diabetic and were used in the experiment. Retinal tissues were harvested and expression of netrin-1 mRNA and protein in the retina tissues was examined by reverse transcription polymerase chain reaction(RT-PCR) and western blot analysis, respectively.Results:.Diabetic rats showed classic symptoms of diabetes mellitus,.such as polydipsia,.polyphagia,.and polyuria.Cataract was seen in the DM group at 3 months after administration of STZ. Both netrin-1 mRNA and protein levels retina were dramatically increased in the DM rats compared to the NC group(P<0.05).Conclusion:Diabetic rats can be successfully established by intraperitoneal injection of streptozotocin(60 mg / kg). Netrin-1 may play an important role during the development of diabetic retinopathy.

Delayed complications of intradural cement leakage after percutaneous vertebroplasty:A case report

BACKGROUND Intradural cement leakage following percutaneous vertebroplasty is a rare but acute and devastating complication that usually requires emergent treatment.Here,we report a delayed complication of intradural leakage after percutaneous vertebroplasty.CASE SUMMARY A 71-year-old female patient with an L1 osteoporotic compression fracture underwent percutaneous vertebroplasty in 2014.She was referred to our hospital 5 years later due to complaints of progressive weakness and numbness in both legs combined with urinary incontinence and constipation.Initially,she was suspected to have a spinal meningioma at the level of L1 according to imaging examinations.Postoperative pathological tests confirmed that cement had leaked into the dura during the first percutaneous vertebroplasty.CONCLUSION Guideline adherence is essential to prevent cement from leaking into the spinal canal or even the dura.Once leakage occurs,urgent evaluation and decompression surgery are necessary to prevent further neurological damage.

Diagnostic value of orbicularis oculi muscle electromyography in functional epiphora

BACKGROUND Functional epiphora is a clinical condition which is not due to an anatomic defect.Most studies agree that it involves the action of the orbicularis oculi muscle,particularly its deeper segment(Horner’s muscle),but the exact mechanism is not clear.AIM To evaluate the orbicularis oculi muscle in functional epiphora patients using electromyography(EMG).METHODS A total of 8 Chinese patients(16 eyes)with functional epiphora were enrolled in this study,and ten volunteers(10 eyes)were included as normal controls.Five epiphora patients(five eyes)with facial palsy served as positive controls.Quantitative EMG was performed in the deeper segment of orbicularis oculi muscle.The average duration of each EMG waveform was measured.RESULTS The average duration of EMG waveforms in the normal control group,the functional epiphora group,and the facial palsy group were 6.39±0.73 ms,9.39±1.32 ms and 11.2±1.42 ms,respectively.The duration of EMG waveforms was significantly longer in the functional epiphora group than in the normal control group(P<0.05),and shorter than that in the facial palsy group(P<0.05).CONCLUSION These data indicate the presence of neurogenic orbicularis oculi muscle damage in epiphora patients,which may be the cause of functional epiphora.The etiology of neurogenic damage in the orbicularis oculi muscle requires further investigation.

Accelerated and enhanced osteointegration of MAO-treated implants:histological and histomorphometric evaluation in a rabbit model

Microarc oxidation（MAO） has become a promising technique for the surface modification of implants. Therefore, the aims of this study were to further quantitatively and qualitatively evaluate the osteointegration abilities of MAO-treated and smooth surface（SF） implants in vivo and to investigate the areas in which the superiority of MAO-treated implants are displayed. In a rabbit model,a comprehensive histomorphological, osteogenic, mineralizational, and integrative assessment was performed using light microscopy, fluorescence microscopy, confocal laser scanning microscopy, and radiographic analyses. Compared with the SF groups, the MAO-treated groups exhibited more active contact osteogenesis, as well as distant osteogenesis, under fluorescence examination, the mineral apposition rate was found to be greater for all of the MAO-treated implants, and the osteointegration index（OI） value was greater in the MAO-treated groups at different times. In conclusion, the calcium-rich amorphous layer created by MAO provided a better environment for osteointegration, with more active contact osteogenesis, a more rapid mineral apposition rate and greater OI values.

Prevalence of Congenital Heart Disease at Extremely High Altitudes in Tibet and the Establishment of a New Free Treatment Model

Background: This study aimed to illustrate the prevalence of CHD by screening children in extremely high-altitudeareas (over 4000 m to even 5000 m above sea level) and explore an aid model for early diagnosis and treatmentfor the Tibetan population. Methods: A total of 2242 students from different schools in Ngamring County,Xigaze City, Tibet from September 2019 to September 2020 were selected for screening. The students were examinedthrough the inquiry of their current medical history and family history, cardiac auscultation and a physicalexamination, in order to screen out the suspected cases of CHD, and then the suspected cases were confirmed bycardiac color ultrasound examinations. After that, positive patients were be transferred to Shandong Province forfree treatment. Results: The prevalence of CHD among children in Ngamring County was 3.70% (83 cases),which is the highest incidence rate ever reported. The most common type of CHD was patent ductus arteriosus(PDA), accounting for 55.42% of the total number of cases screened, followed by atrial septal defect (ASD) andventricular septal defect (VSD), accounting for 28.92% and 12.05%, respectively. The prevalence of CHD in childrenat high altitude was significantly higher than that in children at low altitude. The children with CHD weretransferred to Shandong Province for surgery, the operations were successful and their recoveries went well.Conclusions: The results show that high altitude is closely related to the prevalence of CHD, and the incidencein Ngamring County is much higher than that in previous reports.

Elevated serum growth differentiation factor 15 in multiple system atrophy patients:A case control study

BACKGROUND Multiple system atrophy(MSA) is a serious progressive neurodegenerative disease. Early diagnosis of MSA is very difficult, and diagnostic biomarkers are limited. Growth differentiation factor 15(GDF15) is involved in the differentiation and progression of the central nervous system, and is widely distributed in peripheral blood, which may be a novel biomarker for MSA.AIM To determine serum GDF15 levels, related factors and their potential diagnostic value in MSA patients, compared with Parkinson’s disease(PD) patients and healthy controls.METHODS A case-control study was conducted, including 49 MSA patients, 50 PD patients and 50 healthy controls. Serum GDF15 levels were measured by human enzymelinked immunosorbent assay, and the differences between the MSA, PD and control groups were analyzed. Further investigations were performed in different MSA subgroups according to age of onset, sex, clinical subtypes, diagnostic criteria, and disease duration. Receiver-operating characteristic curve analysiswas used to evaluate the diagnostic value of GDF15, especially for the differential diagnosis between MSA and PD.RESULTS Serum GDF15 levels were significantly higher in MSA patients than in PD patients and healthy controls(P = 0.000). Males and those with a disease duration of more than three years showed higher serum GDF15 levels(P = 0.043 and 0.000;respectively). Serum GDF15 levels may be a potential diagnostic biomarker for MSA patients compared with healthy controls and PD patients(cutoff: 470.42 pg/m L, sensitivity: 85.7%, specificity: 88.0%;cutoff: 1075.91 pg/m L, sensitivity:51.0%, specificity: 96.0%;respectively).CONCLUSION Serum GDF15 levels are significantly higher in MSA patients and provide suggestions on the etiology of MSA.