Eliciting blinks by transcutaneous electric nerve stimulation improves tear fluid in healthy video display terminal users: A self-controlled study

We aimed to elicit strong blinks among healthy video display terminal (VDT) users by periorbital transcutaneous electric nerve stimulation (TENS) and evaluate its impact on the tear fluid and visual task. Appropriate TENS conditions were evaluated to evoke strong blinks under minimum discomfort. Seventeen healthy VDT users with noninvasive Keratograph first breakup time (NIKf-BUT) 5-15 s and Ocular Surface Disease Index (OSDI) scores < 15 were recruited in this study. Before the trial, noninvasive Keratograph average breakup time (NIKa-BUT), tear meniscus height (TMH) and OSDI scores were evaluated. Before each TENS session, the volunteers played Tetris while the corresponding blink rate and Tetris scores were recorded. Then, the participants underwent 30 minutes of TENS, which evoked blinking of their right eye 20 times per minute. Tetris scores were evaluated again during TENS. The Tetris scores and corresponding blink rate were assessed after each TENS session while NIKa-BUT, TMH and OSDI scores were recorded after the third and sixth TENS sessions. We found that OSDI scores declined significantly after the sixth TENS (P = .003). The NIKa-BUT of the right eye was promoted after the sixth TENS (P = .02), and the TMH was higher after the third and sixth TENS in both eyes (P = .03, P = .03 for right eyes respectively, P = .01, P = .01 for left eyes respectively). There was no significant difference between the adjusted Tetris scores before and during TENS (P = .12). The blink rate before and after TENS were unaffected after 6 sessions (P = .61). The results indicated that periorbital TENS effectively ameliorated ocular irritation and improved tear secretion and tear film stability by eliciting strong blinks in healthy VDT users without disturbing the visual task.     

Tension-free hiatal hernia repair with biological mesh: A real-world experience

Laparoscopic Nissen fundoplication and esophagoplasty are the standards for gastroesophageal reflux disease (GERD) and hiatal hernia (HH) repair. Biologically derived mesh is also associated with reduced recurrence. This study attempted to evaluate the effectiveness of a biological mesh in the 4K laparoscopic repair of HH. This retrospective study reviewed patients with a severe GERD complicated with HH from August 2019 to August 2020. All patients underwent the HH repair using a biological mesh under a 4K laparoscope accompanying Nissen fundoplication. Up to 16 months postoperatively, GERD-health-related quality-of-life (GERD-HRQL) scale, radiologic studies on HH recurrence, and symptoms were recorded. The mean surgical time and postoperative hospital stay were 70.9 ± 8.72 min, 4.8 ± 0.76 days, respectively. The postoperative symptom relief rate was 96.5%, and no recurrence exhibited during follow-up. Dysphagia occurred in 10 (9.43%) patients. There were no intraoperative vagus nerve injury or postoperative complications, mesh infection, and reoperation for mesh. The tension-free repair of HH with the biological mesh is an option for clinical use, with effectiveness and few short-term complications being reported.     

Triptolide and l-ascorbate palmitate co-loaded micelles for combination therapy of rheumatoid arthritis and side effect attenuation

Triptolide (TP) has its unique curative effect in the treatment of rheumatoid arthritis (RA), but its application is limited by the poor water solubility and multi-organ toxicity. We herein developed a novel nanoparticle platform composed of L-ascorbate palmitate (VP, vitamin C derivative) that can deliver TP to synergistically treat arthritis and inhibit the occurrence of oxidative stress. The TP-loaded nanoparticles (termed TP-VP NPs) showed the suitable particle size (about 145 nm) and good physical stability. TP-VP NPs effectively down-regulated IL-1β, IL-6 and TNF-α levels to inhibit the erosion of synovitis and bone tissue, and alleviate the swelling and deformation of CIA mice’s feet. Compared to the TP, TP-VP NPs could inhibit effectively the oxidative stress in liver, and alleviate significantly the triptolide-induced toxicity injury in liver, kidney and testicle. The results demonstrated that TP-VP NPs is a promising triptolide delivery system for the treatment of RA, which enhances the water solubility of TP and reduces the toxicity of TP in vivo.     

Enhanced stability and clinical absorption of a form of encapsulated vitamin A for food fortification

Food fortification is an effective strategy to address vitamin A (VitA) deficiency, which is the leading cause of childhood blindness and drastically increases mortality from severe infections. However, VitA food fortification remains challenging due to significant degradation during storage and cooking. We utilized an FDA-approved, thermostable, and pH-responsive basic methacrylate copolymer (BMC) to encapsulate and stabilize VitA in microparticles (MPs). Encapsulation of VitA in VitA-BMC MPs greatly improved stability during simulated cooking conditions and long-term storage. VitA absorption was nine times greater from cooked MPs than from cooked free VitA in rats. In a randomized controlled cross-over study in healthy premenopausal women, VitA was readily released from MPs after consumption and had a similar absorption profile to free VitA. This VitA encapsulation technology will enable global food fortification strategies toward eliminating VitA deficiency.

Vitamin A (VitA) plays an essential role in visual health, immune function, and fetal growth and development (1). VitA deficiency (VAD) arises from diets with insufficient fat-soluble micronutrients (MNs) and is currently estimated as the second most common cause of malnutrition, after iron, globally (2). VAD can lead to xerophthalmia (preventable childhood blindness) and weakened host resistance to infection, which can increase the risk of mortality from infectious diseases, such as measles and COVID-19 (3, 4). The WHO estimated that VAD affected 190 million preschool-age children (33.3% of the preschool-age population) and >19 million pregnant women (15.3% of the pregnant population) globally in the period spanning 1995–2005 (5). The most severely affected regions still reached VAD prevalence levels of 48% in sub-Saharan Africa and 44% in South Asia in children in 2013 (6). To reduce the high burden of VAD, a VitA supplementation program was implemented worldwide in 1990 that distributed high-dose VitA capsules every 4–6 mo to over 80% of the total child population in low-income countries (7). This project effectively reduced all-cause mortality caused by severe VAD by 12% (8). However, progress toward VAD elimination was limited to a rate of improvement of only ~0.3% per year from 1990 to 2007, showing that more impactful strategies are required (9, 10).To raise and maintain serum retinol levels, frequent intake of VitA at physiological doses is proven to be more effective than one or two high doses administered over 6 mo (11). However, VitA food fortification is challenging due to its poor stability, which can lead to poor bioavailability after degradation, and fat solubility, which limits the inclusion of VitA in water-based and dry food matrices (12). To prevent VitA degradation and improve miscibility, VitA has previously been encapsulated within matrices composed of polysaccharides (13), proteins (14), and/or lipids (15); however, these materials provide limited protection during storage and cooking (16 –18) and can take up to 3 h to release in the stomach (19). Poor protection and slow release of VitA prevent effective absorption. Therefore, the ideal microparticle (MP) platform for VitA fortification should meet these criteria: i) protect VitA against degradation during storage and cooking; ii) rapidly release VitA in the gastrointestinal tract with high absorption; and iii) readily mix with various food matrices at a tunable concentration to meet the dynamic needs of the target population.We hypothesized that by encapsulating VitA with a pH-responsive hydrophobic polymer, we could enhance stability during storage and cooking and ensure its rapid release in the gastrointestinal tract for subsequent absorption. A commercially available, FDA-approved basic methacrylate copolymer (BMC), also known as either Eudragit® E PO or GRAS-status Eudraguard®, was identified from our previous work (20). BMC is generally regarded as safe with an acceptable daily intake of 20 mg/kg body weight (21). VitA-encapsulated BMC MPs were prepared by emulsion at the laboratory scale and by a commercial process at the kilogram scale. Our VitA-BMC-S MPs readily mix with flour and bouillon cubes and demonstrate enhanced stability under cooking and long-term storage conditions (over 12 mo) in comparison to a leading commercial encapsulated VitA product. The bioavailability of VitA from VitA-BMC MPs was first demonstrated in a rodent model, resulting in a ninefold increase in the accumulation of VitA in the liver from cooked VitA-BMC MPs, as compared to cooked unencapsulated free VitA. In a human clinical study, the absorption of VitA from bread fortified with VitA-BMC-S MPs was investigated, with or without the codelivery of encapsulated iron sulfate (FeSO₄) and folic acid (FA), MNs that children and pregnant women globally are also often deficient in (22, 23). The results indicate that VitA is readily released and absorbed from VitA-BMC-S MPs, and the codelivery of encapsulated iron and free FA does not influence the absorption of VitA. In total, we demonstrated scalable production of MP-encapsulated VitA with enhanced stability and good bioavailability in humans, which could potentially mitigate the high burden of VAD and be codelivered with other MNs.     

A Study on the Acquirement Method of Mechanical Property Parameters in the Different Base Materials Composite Region of Clad Rebar

Clad rebar is one of the key structures of marine and construction services. Therefore, it is of great importance to acknowledge the mechanical property parameters of the composite region in the structural integrity evaluation of clad rebar. The different base materials of clad rebar (20MnSiV/316L steel, 35#/316L steel, 45#/316L steel, and 55#/316L steel) are researched in this study. The composite area is further refined, and simultaneously, a refinement model of the composite region of clad rebar is established. In view of the fact that a surface hardness experiment is quite easy to conduct, a proposed method consists of obtaining the mechanical property parameters of materials using the surface hardness test. The mechanical property parameters are acquired; moreover, the relationship between yield stress and surface hardness of the stainless steel clad rebar is set up. We used this method to acquire the mechanical parameters of a composite surface uneven area of clad rebar, and we established a mechanical parameters mathematics model of clad rebar, it is a significant basis for a structural integrity evaluation of cladding materials.     

Effect of national holidays on health outcomes of patients receiving peritoneal dialysis in a single center over a ten-year period

BackgroundNational holidays are associated with high mortality in some diseases, but little is known about patients undergoing peritoneal dialysis (PD). The research aimed to investigate the impact of national holidays on the health outcomes of PD patients.MethodsOver ten years, all episodes of unplanned hospitalization, death, and peritonitis in PD patients were collected in our center. Seven national holidays in China were chosen, and non-holiday days were selected as the control period. The effect of national holidays was observed by comparing the hospitalization, death, and peritonitis rates between holiday and non-holiday groups.ResultsThere were 297 events in all holiday periods and 1247 in non-holiday periods. There is no significant difference in hospitalization rate between holiday and non-holiday groups (32.4% ± 6.4% vs. 29.2% ± 3.4%, p = 0.175). So is the death rate [6.3% (4.8–12.3%) vs.5.0% (4.2–8.9%), p = 0.324] and peritonitis rate [0.19 (0.13–0.53) vs. 0.22 (0.18–0.27), p = 0.445] between the two groups. Significant differences were observed in the distribution of peritonitis causes between the two groups (p = 0.017). The rate of secondary to other infections in the holiday group was significantly higher than in the non-holiday group (25.0 vs. 10.3%, p = 0.015).ConclusionOur study suggested no national holiday effect on health outcomes of PD patients based on ten-year data in our center.     

Finite Element Analysis and Transiliac‐Transsacral Screw Fixation for Posterior Pelvic Ring with Sacrum Dysplasia

ObjectivePosterior pelvic ring sacroiliac screws are preferred by clinicians for their good biomechanical performance. However, there are few studies on mechanical analysis and intraoperative screw insertion of the dysplastic sacrum and sacroiliac screw. This study investigated the biomechanical performance of oblique sacroiliac screws (OSS) in S1 combined with transiliac‐transsacral screws (TTSs) in S2 for pelvic fracture or sacroiliac dislocation with dysplastic sacrum and evaluated the safety of screw placement assisted by the navigation template.MethodsSix models were established, including one OSS fixation in the S2 segment, one transverse sacroiliac screw (TSS) fixation in the S2 segment, one TTS fixation in the S2 segment, one OSS fixation in the S1 and S2 segments, one OSS fixation in the S1 segment and one TSS fixation in the S2 segment, one OSS fixation in the S1 segment and one TTS fixation in the S2 segment. Then, finite element analysis (FEA) was performed. Twelve dysplastic sacrum patients with pelvis fracture or sacroiliac dislocation underwent OSS insertion in the S1 combined with TTS insertion in the S2 under the assistance of the patient‐specific locked navigation template. Grading and Matta scores were evaluated after surgery.ResultsIn the one‐screw fixation group, the vertical displacements of the sacrum surface of S2 OSS, S2 TSS and S2 TTS were 1.23, 1.42, and 1.22 mm, respectively, and the maximum stress of screw were 139.45 MPa, 144.81 MPa, 126.14 MPa, respectively. In the two‐screw fixation group, the vertical displacements of the sacrum surface of the S1 OSS + S2 OSS, S1 OSS + S2 TSS and S1 OSS + S2 TTS were 0.91, 1.06, and 0.75 mm, respectively, and the maximum stress of screw were 149.26 MPa, 167.13 Pa, 136.76 MPa, respectively. Clinically, a total of 12 TTS and OSS were inserted under the assistance of navigation templates, with a surgical time of 55 ± 7.69 min, bleeding of 57.5 ± 18.15 ml and radiation times of 14.5 ± 4.95. One of the TTS and one of the OSS were grade 1, and the other screws were grade 0. The Matta scores of nine patients were excellent, and three patents were good.ConclusionOSS in the S1 combined with TTS in the S2 had the best mechanical stability in six models, and it is safe for screw insertion assisted by the patient‐specific locked navigation template.     

Acetylcholinesterase expression mediated by c-Jun-NH2-terminal kinase pathway during anticancer drug-induced apoptosis

It has been shown that acetylcholinesterase (AChE) expression was induced during apoptosis and the anti-sense oligonucleotides and siRNA of AChE may prevent apoptosis in various cell types. However, the mechanisms underlying AChE upregulation remain elusive. We demonstrated here that c-Jun NH2-terminal kinase (JNK) could mediate AChE expression. In this study, both etoposide and excisanin A, two anticancer agents, induced apoptosis in colon cancer cell line SW620 as determined by Annexin V staining, the cleavage of caspase-3 and the proteolytic degradation of poly (ADP-ribose) polymerase (PARP). The results showed that both the agents upregulated AChE in SW620 cells. In the meantime, JNK was also activated and the expression and phosphorylation of c-Jun increased in SW620 cells exposed to the two agents. The induced AChE mRNA and protein expression could be blocked by SP600125, a specific inhibitor of SAPK/JNK, and small interfering RNA directed against JNK1/2. Transfection with adenovirus-mediated dominant negative c-Jun also blocked the upregulation of AChE expression. Together, these results suggest that AChE expression may be mediated by the activation of JNK pathway during apoptosis through a c-Jun-dependent mechanism.     

曾俊辉主任医师辨治癫痫病经验

曾俊辉采用病因与症候特点相结合,将癫痫病分为风痫、痰痫、热痫、惊痫、郁痫、瘀痫、虚痫七个证型进行论治,同时提出对夹杂症候的处理当勿忽视,临床收到很好的效果。     

戈利木单抗改善难治性幼年型皮肌炎患儿肌力的疗效分析及文献复习

目的:探讨难治性幼年型皮肌炎(JDM)患儿应用戈利木单抗(GLM)的临床治疗效果。方法:收集2019年2月广州市妇女儿童医疗中心过敏免疫风湿科确诊的1例JDM患儿的临床资料,分析总结治疗效果并进行文献复习。结果:患儿,男,7岁,亚急性起病,病情迁延,以皮疹、肢体乏力和吞咽功能障碍为主要表现,查体见向阳疹及Gottron...