ABSTRACT Purpose Targeted biopsy (TB) combined with systematic biopsy (SB) is an optimized mode of prostate biopsy but can often lead to oversampling and overdiagnosis accompanied by potential biopsy-related complications and patient discomfort. Here, we attempted to reasonably stratify the patient population based on multi-parameter indicators with the aim of avoiding unnecessary SB. Methods In total, 340 biopsy-naïve men with suspected lesions, prostate-specific antigen (PSA) < 20 ng/mL and prostate imaging-reporting and data system (PI-RADS) ≥ 3 enrolled for study underwent both TB and SB. The primary outcome was to determine independent predictors for a valid diagnosis, assuming that only TB was performed and SB omitted (defined as mono-TB), taking TB + SB as the reference standard. The secondary outcomes were exploration of the predictive factors of mono-TB and TB + SB in detection of prostate cancer (PCa) and clinically significant PCa (csPCa). Results The mean PSA density (PSAD) of patient group was 0.27 ng/mL/mL. Multiparametric MRI PI-RADS scores were 3-5 in 146 (42.94%), 105 (30.88%), and 89 (26.18%) cases, respectively. PCa and csPCa were detected in 178/340 (52.35%) and 162/340 (47.65%) patients, respectively. Overall, 116/178 (65.17%) patients diagnosed with PCa displayed pathological consistencies between mono-TB and TB + SB modes. PSAD and PI-RADS were independent predictors of valid diagnosis using mono-TB. Conclusions PSAD combined with PI-RADS showed utility in guiding optimization of the prostate biopsy mode. Higher PSAD and PI-RADS values were associated with greater confidence in implementing mono-TB and safely omitting SB, thus effectively balancing the benefits and risks.

Abstract In China, Scutellaria is used for treating inflammatory-related diseases. Baicalin is the main active component of Scutellaria and has protective effects on acute pancreatitis. However, the mechanism of Baicalin is still unclear. In this study, the protective effects of baicalin on acute pancreatitis induced by taurocholate and its mechanism are investigated. In this study, mice were randomly divided into three groups: sham operation, model, and treatment groups. Acute pancreatitis in mice was induced by intraperitoneal injection of taurocholate (35 mg/kg). The treatment group was given baicalin (100 mg/kg) 2 h before acute pancreatitis induction. The mRNA expression levels of miR-429, nuclear factor kappa B65(NF-kB65), toll-like receptor 4(TLR4), TNF receptor associated factor6 (TRAF6), NF-kappa-B inhibitor(IkB), Follistatin-like 1 (FSTL1), and interleukin-1 receptor-associated kinase (IRAK) in the liver tissues 24 h after intraperitoneal injection were detected by RT-PCR. Then, the expression levels of NF-kB65, p-NF-κB65, TLR4, TRAF6, IkB, FSTL1, IRAK, p- IRAK, and p- IkB-а proteins were detected by Western blot. IL-6, TNF-α and IL-1 β in plasma were measured by ELISA, and histopathological changes in the pancreases of the mice were observed. The results showed that after baicalin treatment, miR-429 expression in the pancreatic tissues and the expression levels of NF-kB65, TLR4, TRAF6, p-IkB-а, FSTL1, and p-IRAK decreased. Similarly, pancreatic myeloperoxidase (MPO) activity and the plasma levels of IL-6, TNF-а, IL-12, IL-1β1, endotoxin, serum amylase, and lipase were reduced. Thus, the pancreatic injury induced by taurocholate was alleviated. The present study indicates that pretreatment with Baicalin can alleviate acute pancreatic injury induced by taurocholate in mice. The mechanism may be associated with the decreased miR-429 expression, reduced FSTL1 signaling pathway activity, TLR4 and TLR4/MyD88 signaling pathway inhibition, and reduced pancreatic inflammation. FSTL1 is the regulatory target for miR-429.

Abstract Chinese quince fruits are rich in proanthocyanidins (PAs), which have antioxidant properties. This work describes a method to isolate PAs from Chinese quince fruits by a combination of ball-milling and enzyme hydrolysis pretreatments. The yield, total PA and total phenolic contents, structural characteristics, antioxidant activity, and α-amylase inhibitory activity of different pretreated PA samples were determined and analyzed. Among them, the ball-milling combined with multi-enzyme (cellulase, xylanase, and pectinase) hydrolysis pretreated sample (BEP-4) was the most outstanding. The yield of BEP-4 could be improved up to 7.72%, which was 2.51 times higher than that of the conventional organic solvent extraction method (3.02%). It had the highest total phenols and PAs content of 750.98 ± 6.95 and 948.72 ± 3.50 mg/g extract, respectively. The thermal stability and molecular weight (9610 Da) of BEP-4 were lower than other fractions. BEP-4 contained a high proportion of PC structure (98.35%) and flavan-3-ol content (87.88%). It also had the highest antioxidant capacity with IC50 values of 131.45 ± 0.97, 22.66 ± 0.32, 134.05 ± 0.71, and 182.07 ± 0.28 μg/mL for DPPH, ABTS, hydroxyl radical scavenging capacity, and α-amylase inhibiting capacity, respectively. These investigations provide a new, efficient way to isolate PAs from Chinese quince fruits, and reveal that Chinese quince fruits may be a good source of antioxidants, worthy of further development.

Abstract Background: Cervical cancer (CC) ranks third in the morbidity and mortality of female cancer around the world. Derlin1 has been found to be overexpressed in several human cancers. However, it is still unclear about its roles in CC. The research aims to explore the relationship between Derlin1 and CC. Methods: We purchased a human CC tissues microarray, which contained CC tissues and corresponding para-cancerous tissues from 93 patients with primary cervical squamous cell carcinoma. Immunohistochemical staining was used to confirm the expression of Derlin1 in these tissues. And we detected the differential expression of Derlin1 in cervical cancer cell lines and normal cervical epithelial cells (H8). Further, the cervical cancer cell lines SiHa and C33A were used as an in vitro model, which was down-regulated the expression of Derlin1 using siRNA interference technology. The effects of Derlin1 down-regulating in CC cell lines on cell proliferation and migration were detected by CCK8 assay and transwell assay, respectively. The effect of Derlin1 down-regulating on apoptosis was analyzed by flow cytometry, and apoptosis-related proteins were detected using western blotting. In-depth mechanisms were studied using western blotting. In addition, the effects of Derlin1 up-regulating in normal cervical epithelial cells also were exposed. Results: Derlin1 was significantly elevated in CC tissues (81.7%, 76/93), and the expression of Derlin 1 was positively correlated with the tumor size, pathological grade, and lymph node metastasis in CC patients. And Derlin 1 was high expressed in cervical cancer cell lines compared to H8 cells. Knockdown of Derlin 1 in cervical cancer cell lines inhibited cell proliferation and migration. Moreover, knockdown of Derlin 1 induced apoptosis and affected the expression of apoptosis-related proteins, including Bcl-2, Bax, Bim, caspase3 and caspase9. Further experiments showed that AKT/mTOR signal pathway might be involve in this processes that knockdown of Derlin 1 inhibited the expression of p-AKT and p-mTOR. Over-expression of Derlin 1 in H8 cells promoted cell proliferation and migration via up-regulated the expression of p-AKT and p-mTOR. Conclusion: Derlin 1 is an oncogene in CC via AKT/mTOR pathway. It might be a potential therapeutic target for CC.

Abstract Background: There are 6 species of venomous snakes in Taiwan. Two of them, Deinagkistrodon acutus (D. acutus) and Daboia siamensis (D. siamensis), can cause significant coagulopathy. However, a significant proportion of patients with snakebites cannot identify the correct snake species after envenomation, which hampers the application of antivenom. Hence, the differential diagnosis between the two snakebites by clinical presentations is important. This study aims to compare their clinical and laboratory features for the purpose of differential diagnosis between the two snakebites. Methods: We retrospectively reviewed the medical records of patients who arrived at the emergency department due to D. acutus or D. siamensis envenomation, between 2003 and 2016, in one medical center in eastern Taiwan. Since these snakebites are rare, we also included 3 cases reported from another hospital in central Taiwan. Results: In total, 15 patients bitten by D. acutus and 12 patients by D. siamensis were analyzed. Hemorrhagic bulla formation and the need for surgical intervention only presented for D. acutus envenomation cases (Both 53.3% vs. 0.0%, P= 0.003). As to laboratory features, lower platelet counts (20.0 × 103/μL [interquartile range, 14-66 × 103/μL] vs. 149.0 × 103/μL [102.3-274.3 × 103/μL], P = 0.001), lower D-dimer level (1423.4 μg/L [713.4-4212.3 μg/L] vs. 12,500.0 μg/L [2351.4-200,000 μg/L], P = 0.008), higher proportion of patients with moderate-to-severe thrombocytopenia (platelet count < 100 × 103/μL) (80% vs. 16.7%, odds ratio (OR) = 20.0, 95% CI, 2.77-144.31; P = 0.002), and lower proportion of patients with extremely high D-dimer (> 5000 ng/mL) (16.7% vs. 66.7%, adjusted OR = 0.1 (95% CI, 0.01-0.69; P = 0.036) were found among cases of D. acutus envenomation compared to D. siamensis envenomation. The combination of hemorrhagic bulla, thrombocytopenia, and a lack of extremely high D-dimer had good discriminatory power (area under the curve (AUC) = 0.965; 95% CI, 0.904-1.00) for distinguishing D. acutus from D. siamensis envenomation. Conclusions: The presentation of moderate to severe thrombocytopenia (platelet count < 100 × 103/μL) and hemorrhagic bulla formation may indicate D. acutus envenomation. However, the envenomed patient with extremely high D-dimer levels may indicate a D. siamensis envenomation. These findings may help diagnose and select the right antivenom in patients with unknown snakebites who present significant coagulopathy.

Land application of intensive swine farm wastewater has raised serious environmental concerns due to the accumulation and microbially mediated transformation of large amounts of swine wastewater organic C (SWOC). Therefore, the study of SWOC mineralization and dynamics of wastewater microorganisms is essential to understand the environmental impacts of swine wastewater application. We measured the C mineralization of incubated swine wastewaters with high (wastewater H) and low (wastewater L) organic C concentrations. The dynamics of bacteria metabolic profile and community structure were also investigated. The results showed that SWOC mineralization was properly fitted by the two-simultaneous reactions model. The initial potential rate of labile C mineralization of wastewater H was 46% higher than that of wastewater L, whereas the initial potential rates of recalcitrant C mineralization of wastewaters H and L were both around 23 mg L-1 d-1. The bacterial functional and structural diversities significantly decreased for both the wastewaters during SWOC mineralization, and were all negatively correlated to specific UV absorbance (SUVA254; P < 0.01). The bacteria in the raw wastewaters exhibited functional similarity, and both metabolic profile and community structure changed with the mineralization of SWOC, mainly under the influence of SUVA254 (P < 0.001). These results suggested that SWOC mineralization was characterized by rapid mineralization of labile C and subsequent slow decomposition of recalcitrant C pool, and the quality of SWOC varied between the wastewaters with different amounts of organic C. The decreased bio-availability of dissolved organic matter affected the dynamics of wastewater bacteria during SWOC mineralization.

Contexto: una escala de valoración del riesgo válida y fiable se considera una herramienta esencial en la prevención de úlceras por presión. Las escalas de valoración del riesgo de úlceras por presión que comúnmente se utilizan con los usuarios de la Unidad de Cuidados Intensivos (UCI) son la Escala de Braden y Escala Cubbin-Jackson. Objetivo: comparar y validar las escalas de riesgo de úlceras por presión de Braden y Cubbin-Jackson con los usuarios chinos en la UCI. Método: se propuso un proyecto de investigación longitudinal en el que la Escala de Braden y la Escala Cubbin-Jackson se utilizaron simultáneamente para recolectar datos de 139 usuarios de la UCI. El área bajo la curva (ABC o AUC en inglés) del método característico de funcionamiento del receptor (COR, o ROC en inglés) se utilizó para evaluar la validez total de las escalas. Resultados: once usuarios (7,91%) desarrollaron úlceras por presión. Basado en el valor límite de 16 puntos para la escala de Braden y 24 puntos para la escala Cubbin-Jackson, la sensibilidad, la especificidad, el valor predictivo positivo y valor predictivo negativo de la escala de Braden fue 91,7%, 63, 0%, 19,0%, 98,8%, respectivamente, y 33,3%, 95,3%, 40,0%, 93,8% para la escala Cubbin-Jackson. La ABC fue 0,155 para la Escala de Braden y 0,098 para la Escala de Cubbin-Jackson. Conclusión: la escala de Braden tiene una alta sensibilidad y previsión negativa, mientras que la Escala de Cubbin-Jackson tiene una alta especificidad. La escala de Braden es mejor que la Escala Cubbin-Jackson en términos de validez general.

Contexto: Uma escala de avaliação de risco válida e fidedigna é considerada uma ferramenta essencial na prevenção de úlceras de pressão. As escalas de risco de úlceras de pressão comumente utilizadas em utentes na Unidade de Cuidados Intensivos (UCI) são a Escala de Braden e a Escala de Cubbin & Jackson. Objectivo: Comparar e validar as escalas de risco de úlcera de pressão de Braden e Cubbin & Braden em utentes chineses da UCI. Método: Foi proposto um projecto de pesquisa longitudinal onde a Escala de Braden e a Escala de Cubbin & Jackson eram simultaneamente utilizadas para colher dados de 139 utentes da UCI. A área sob a curva (ASC) do método característico operacional do receptor (COR) foi utilizada para avaliar a validade total das escalas. Resultados: Onze utentes (7,91%) desenvolveram úlceras de pressão. Baseado no valor limite de 16 pontos para a Escala de Braden e de 24 pontos para a Escala de Cubbin & Jackson, a sensibilidade, a especificidade, valor preditivo positivo e valor preditivo negativo para a Escala de Braden foi de 91,7%, 63,0%, 19.0%, 98,8%, respectivamente, e 33,3%, 95.3%, 40.0%, 93.8% para a Escala de Cubbin & Jackson. A ASC foi 0,155 para a Escala de Braden e 0,098 para a Escala de Cubbin & Jackson. Conclusão: A Escala de Braden tem alta sensibilidade e previsão negativa, enquanto Cubbin & Jackson escala tem alta especificidade. A Escala de Braden é melhor do que a Escala de Cubbin & Jackson em termos de validade geral.

Context: A valid and reliable risk assessment scale is considered to be an essential tool in pressure ulcer prevention. The commonly used pressure ulcer risk scales in Intensive Care Unit (ICU) patients are the Braden Scale and the Cubbin & Jackson Scale. Aim: To compare and validate the Braden and Cubbin & Jackson pressure ulcer risk scales among Chinese ICU patients. Method: A longitudinal research design was proposed in which the Braden Scale and the Cubbin & Jackson Scale were simultaneously used to collect 139 ICU patients’ data. The area under the curve (AUC) of the receiver operating characteristic (ROC) method was employed to evaluate the overall validity of the scales. Results: Eleven patients (7.91%) developed pressure ulcers. Based on the cut-off point of 16 for the Braden Scale and 24 for the Cubbin & Jackson Scale, the sensitivity, specificity, positive predictive value and negative predictive value for the Braden Scale were 91.7%, 63.0%, 19.0%, 98.8%, respectively, and 33.3%, 95.3%, 40.0%, 93.8% for the Cubbin & Jackson Scale. The AUC was 0.155 for Braden scale and 0.098 for the Cubbin & Jackson Scale. Conclusion: The Braden Scale has high sensitivity and negative predictabiity, whereas the Cubbin & Jackson Scale has high specificity. The Braden Scale is better than the Cubbin & Jackson Scale in terms of overall validity.

OBJETIVO: A cirurgia torácica vídeo-assistida (CTVA) tem sido uma intervenção de escolha para o tratamento de pneumotórax espontâneo (PS) com bolha pulmonar. Nosso objetivo foi apresentar uma abordagem de CTVA uniportal unilateral para bulectomia bilateral e avaliar sua eficácia terapêutica. MÉTODOS: Entre maio de 2011 e janeiro de 2012, cinco pacientes foram submetidos a bulectomia bilateral por essa abordagem. Todos apresentavam PS bilateral. A TCAR pré-operatória mostrou que todos os pacientes tinham bolhas bilaterais no pulmão apical. As indicações cirúrgicas, os procedimentos de operação e os desfechos foram revisados. RESULTADOS: Todos os pacientes foram submetidos com sucesso a essa abordagem para bulectomia bilateral, sem complicações intraoperatórias. A mediana de tempo para a retirada do dreno torácico foi de 4,2 dias, e a mediana do tempo de hospitalização no pós-operatório foi de 5,2 dias. A mediana de seguimento pós-operatório foi de 11,2 meses. Um paciente teve recidiva de PE do lado esquerdo três semanas após a cirurgia e foi submetido a abrasão pleural. CONCLUSÕES: A bulectomia bilateral utilizando CTVA uniportal combinada com acesso contralateral ao mediastino anterior é tecnicamente confiável e promove desfechos favoráveis para pacientes com PS que desenvolvem bolhas bilaterais no pulmão apical. Entretanto, para a realização desse procedimento cirúrgico, são necessários cirurgiões com experiência em CTVA, instrumentos toracoscópicos longos, entre outras exigências.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.

BACKGROUND: It had been assumed that suppressing the undamaged contralesional motor cortex by repetitive low-frequency transcranial magnetic stimulation (rTMS) or increasing the excitability of the damaged hemisphere cortex by high-frequency rTMS will promote function recovery after stroke. OBJECTIVE: To assess the efficacy and safety of rTMS for improving function in people with stroke. METHODS: AUTHORS' CONCLUSIONS: Current evidence does not support the routine use of rTMS for the treatment of stroke. Further trials with larger sample sizes are needed to determine a suitable rTMS protocol and the long-term functional outcome.