Loss of GRB2 associated binding protein 1 in arteriosclerosis obliterans promotes host autophagy

Background:Arteriosclerosis obliterans (ASO) is a major cause of adult limb loss worldwide. Autophagy of vascular endothelial cell (VEC) contributes to the ASO progression. However, the molecular mechanism that controls VEC autophagy remains unclear. In this study, we aimed to explore the role of the GRB2 associated binding protein 1 (GAB1) in regulating VEC autophagy.Methods:In vivo and in vitro studies were applied to determine the loss of adapt protein GAB1 in association with ASO progression. Histological GAB1 expression was measured in sclerotic vascular intima and normal vascular intima. Gain- and loss-of-function of GAB1 were applied in VEC to determine the effect and potential downstream signaling of GAB1.Results:The autophagy repressor p62 was significantly downregulated in ASO intima as compared to that in healthy donor (0.80 vs. 0.20, t = 6.43, P < 0.05). The expression level of GAB1 mRNA (1.00 vs. 0.24, t = 7.41, P < 0.05) and protein (0.72 vs. 0.21, t = 5.97, P < 0.05) was significantly decreased in ASO group as compared with the control group. Loss of GAB1 led to a remarkable decrease in LC3II (1.19 vs. 0.68, t = 5.99, P < 0.05), whereas overexpression of GAB1 significantly led to a decrease in LC3II level (0.41 vs. 0.93, t = 7.12, P < 0.05). Phosphorylation levels of JNK and p38 were significantly associated with gain- and loss-of-function of GAB1 protein.Conclusion:Loss of GAB1 promotes VEC autophagy which is associated with ASO. GAB1 and its downstream signaling might be potential therapeutic targets for ASO treatment.     

Diagnosis of double-chambered left ventricle by echocardiogram and cardiac magnetic resonance imaging: A rare case in an adult

Double-chambered left ventricle (DCLV) is a very rare malformation which is congenital. In most cases, the left ventricle (LV) is divided into two parallel chambers by a septum or aberrant muscular structure, with fewer superior–inferior arrangement. Here, we present the case of an asymptomatic 25-year-old man who was diagnosed with superior–inferior arrangement DCLV on transthoracic echocardiography and cardiac magnetic resonance (CMR). DCLV generally does not cause serious outcomes. Owing to absence of any symptoms, no treatment was provided, and the patient was regularly followed up.     

Bronchogenic cyst of the stomach:A case report

BACKGROUND Gastric bronchogenic cysts(BCs)are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period.Gastric bronchial cysts are rare lesions first reported in 1956;as of 2019,only 37 cases are available in the MEDLINE/PubMed online databases.BCs usually have no clinical symptoms in the early stage,and their imaging findings also lack specificity.Therefore,they are difficult to diagnose before histopathological examination.CASE SUMMARY A 55-year-old woman presented at our hospital with intermittent epigastric pain.She had a slightly high level of serum carbohydrate antigen 72-4(CA 72-4).Endoscopic ultrasound found that a cystic mass originated from the submucosa of the posterior gastric wall near the cardia,indicating a diagnosis of cystic hygroma of the stomach.Furthermore,a computed tomography scan demonstrated a quasi-circular cystic mass closely related to the lesser curvature of the gastric fundus with a low density.Because the imaging examinations did not suggest a malignancy and the patient required complete resection,she underwent laparoscopic surgery.As an intraoperative finding,this cystic lesion was located in the posterior wall of the fundus and contained some yellow viscous liquid.Finally,the pathologists verified that the cyst in the fundus was a gastric BC.The patient recovered well with normal CA 72-4 levels,and her course was uneventful at 10 mo.CONCLUSION This is a valuable report as it describes an extremely rare case of gastric BC.Moreover,this is the first case of BC to present with elevated CA 72-4 levels.     

Comparison of visual outcomes after two types of mix-and-match implanted trifocal extended-depth-of-focus and trifocal intraocular lenses

Graefe's Archive for Clinical and Experimental Ophthalmology - To compare visual outcomes between two types of mix-and-match implanted trifocal extended-depth-of-focus (EDoF) and trifocal...     

Cardiac arrest caused by accidental severe hypothermia and myocardial infarction during general anesthesia

Therapeutic hypothermia is often used for traumatic brain injury because of its neuroprotective effect and decreased secondary brain injury. However, this procedure lacks clinical evidence supporting its efficacy, and adverse outcomes have been reported during general anesthesia. A 61-year-old man with a history of percutaneous coronary intervention (PCI) was admitted with traumatic brain injury. Immediately after admission, he underwent mild therapeutic hypothermia with a target temperature of 33.0°C for neuroprotection. During general anesthesia for emergency surgery because he developed a mass effect, hypothermic cardiac arrest occurred following an additional decrease in the core body temperature. Moreover, myocardial infarction caused by restenosis of the previous PCI lesion also contributed to the cardiac arrest. Although the patient recovered spontaneous circulation after an hour-long cardiopulmonary resuscitation with rewarming, he eventually died of subsequent repetitive cardiac arrests. When anesthetizing patients undergoing therapeutic hypothermia, caution is required to prevent adverse outcomes that can be caused by unintentional severe hypothermia and exacerbation of underlying heart disease.     

The Development and Operation of a Home Management System during the COVID-19 Pandemic: Experience of the Local Government Gyeonggi-do in Korea

During the three the coronavirus disease 2019 (COVID-19) surges in South Korea, there was a shortage of hospital beds for COVID-19 patients, and as a result, there were cases of death while waiting for hospitalization. To minimize the risk of death and to allow those confirmed with COVID-19 to safely wait for hospitalization at home, the local government of Gyeonggi-do in South Korea developed a novel home management system (HMS). The HMS team, comprised of doctors and nurses, was organized to operate HMS. HMS provided a two-way channel for the taskforce and patients to monitor the severity of patient''s condition and to provide healthcare counseling as needed. In addition, the HMS team cooperated with a triage/bed assignment team to expedite the response in case of an emergency, and managed a database of severity for real-time monitoring of patients. The HMS became operational for the first time in August 2020, initially managing only 181 patients; it currently manages a total of 3,707 patients. The HMS supplemented the government''s COVID-19 confirmed case management framework by managing patients waiting at home for hospitalization due to lack of hospital and residential treatment center beds. HMS also could contribute a sense of psychological stability in patients and prevented the situation from worsening by efficient management of hospital beds and reduction of workloads on public healthcare centers. To stabilize and improve the management of COVID-19 confirmed cases, governments should organically develop self-treatment and HMS, and implement a decisive division of roles within the local governments.     

Revision of failed metal-on-metal total hip arthroplasty using cemented arthroplasty: a mean 10-year follow-up of 157 consecutive patients

ObjectiveThis study was performed to assess the outcomes of Asian patients who underwent conversion from metal-on-metal total hip arthroplasty (MoM-THA) to cemented THA (CTHA).MethodsOne hundred and fifty-seven consecutive patients (157 hips) who underwent CTHA following primary MoM-THA from January 2005 to February 2015 were retrospectively analysed. The primary endpoints were the clinical outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every 2 years following revision of MoM-THA.ResultsThe mean follow-up after conversion was 10 years (range, 5–14 years). Statistically significant improvements in the mean Harris hip score were observed between the preoperative and final follow-up evaluations (62.71 ± 13.85 vs. 84.03 ± 16.21, respectively). The major orthopaedic complication rate was 16.5% (26/157). Six (3.8%) patients underwent revision at a mean of 3.5 ± 1.3 years after conversion, predominantly because of prosthesis loosening or recurrent dislocation. Nine (5.7%) patients developed prosthesis loosening at a mean of 2.6 ± 1.1 years following conversion, two of whom requested revision surgery. Eleven (7.0%) patients developed prosthesis dislocation, four of whom requested revision surgery.ConclusionCTHA may yield favourable functional outcomes and a reduced rate of major orthopaedic complications.     

慢性鼻窦炎伴鼻息肉患者嗅觉障碍的影响因素分析

目的分析慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者嗅觉障碍的影响因素。方法回顾性分析2014—2018年就诊于北京安贞医院行内镜鼻窦手术治疗的CRSwNP患者88例,男性22例,女性66例,年龄(48.1±11.3)岁(±s,下同)。所有入选患者均于术前行Sniffin′Sticks嗅觉测试、Lund-Mackay评分及改良鼻窦CT嗅区评分、鼻阻力及声反射检查、血常规及血生化等实验室检测、血清特异性IgE检测;术中取鼻息肉组织进行嗜酸粒细胞计数。根据Sniffin′Sticks嗅觉测试结果将患者分成嗅觉功能正常组和嗅觉功能障碍组,两组之间进行临床基线资料比较,根据单因素分析结果,结合临床有意义的指标进一步行多因素Logistic回归模型分析,并初步建立CRSwNP嗅觉障碍的预测模型。设P<0.05为差异有统计学意义。结果88例CRSwNP患者中,嗅觉正常32例(36.4%),嗅觉障碍56例(63.6%),其中嗅觉下降40例(45.5%)、失嗅16例(18.2%)。单因素分析发现,两组间组织嗜酸粒细胞数、血嗜酸粒细胞百分比、血尿素的差异存在统计学意义[12.7[2.0,52.3]个/高倍视野(M[P25,P75],下同)比38.6[16.2,87.0]个/高倍视野、2.75[1.60,4.80]%比4.35[2.50,6.60]%、(5.56±1.15)mmol/L比(4.98±1.33)mmol/L,P值均<0.05];改良鼻窦CT嗅区评分、除窦口鼻道复合体评分外的Lund-Mackay评分的差异均存在统计学意义(P值均<0.05)。多因素Logistic回归模型分析发现,改良鼻窦CT双侧嗅区总分和血尿素的差异具有统计学意义,其中双侧嗅区总分是嗅觉功能的危险因素(OR=2.108,95%CI:1.407~3.159,P<0.001);一定浓度的血尿素是嗅觉功能的保护因素(OR=0.461,95%CI:0.240~0.884,P=0.020)。进一步研究发现,由组织嗜酸粒细胞计数、血嗜酸粒细胞百分比、改良鼻窦CT双侧嗅区总分、总吸气、血尿素组成的预测模型受试者工作特征(ROC)曲线下面积(AUC)的值为0.888(P<0.01),对CRSwNP嗅觉障碍预测效果较好。结论改良鼻窦CT嗅区评分与CRSwNP患者的嗅觉障碍密切相关,一定程度的血尿素升高可能对CRSwNP患者的嗅觉功能有保护作用。     

Red cell distribution width is associated with hearing impairment in chronic kidney disease population: a retrospective cross-sectional study

European Archives of Oto-Rhino-Laryngology - Previous studies have shown that inflammatory markers are associated with hearing impairment in participants with inflammatory diseases. Therefore,...