Resumo Introdução: A função da metaloproteinase da matriz 2 e 9 nas metástases e no desenvolvimento de carcinoma hipofaríngeo ainda não foi esclarecida. Objetivos: Observar a relação entre a metaloproteinase da matriz 2 e 9 e as metástases e o desenvolvimento de carcinoma hipofaríngeo. Método: Este estudo incluiu 42 pacientes com câncer hipofaríngeo. Os níveis de expressão de mRNA e proteína de metaloproteinase da matriz 2 e 9 no carcinoma hipofaríngeo e nos tecidos paracancerígenos foram detectados por reação em cadeia da polimerase com transcrição reversa e Western blot. Resultados: A detecção por reação em cadeia da polimerase com transcrição reversa mostrou que o mRNA de metaloproteinase da matriz 2 e 9 foi expresso nos tecidos cancerígenos e do pericarcinoma, mas quase não foi expresso em tecidos de controle polipoides. A intensidade da expressão no tecido cancerígeno foi significativamente maior do que no tecido do pericarcinoma (metaloproteinase da matriz 2: t = 2,529, p = 0,015; metaloproteinase da matriz 9: t = 4,781, p = 0,001). A expressão do mRNA no tecido cancerígeno aumentou com o aumento do estágio clínico do tumor (metaloproteinase da matriz 2: F = 4,003, p = 0,026; metaloproteinase da matriz 9: F = 5,501, p = 0,008). Sua intensidade de expressão foi associada à metástase de linfonodos (estadiamento N) e aumentou com o grau de metástase linfática (metaloproteinase da matriz 2: F = 8,965, p = 0,005; metaloproteinase da matriz 9: F = 5,420, p = 0,025). Não houve alteração significativa no estadiamento T do tumor. Com o aumento do estágio patológico do tumor, a expressão do mRNA de metaloproteinase da matriz 2 e 9 foi aumentada (metaloproteinase da matriz 2: F = 3,884, p = 0,029; metaloproteinase da matriz 9: F = 3,783, p = 0,032). O nível de expressão proteica da MMP-2 e MMP-9 foi o mesmo do que o do mRNA. Conclusão: A expressão de metaloproteinase da matriz 2 e 9 no carcinoma hipofaríngeo foi significativamente maior do que a do tecido do pericarcinoma e se ampliou com o aumento do estágio clínico. O nível de expressão foi relacionado à metástase linfonodal e ao estágio patológico do tumor. Assim, a metaloproteinase da matriz 2 e 9 pode estar envolvida na ocorrência, no desenvolvimento, na invasão e metástase de carcinoma hipofaríngeo por meio de vários mecanismos.

Abstract Introduction: The role of matrix metalloproteinase-2 and 9 in the metastasis and development of hypopharyngeal carcinoma has not been clarified. Objectives: To observe the relationship between matrix metalloproteinase-2, matrix metalloproteinase-9 and the metastasis, development of hypopharyngeal carcinoma. Methods: This study included 42 hypopharyngeal cancer patients. The mRNA and protein expression levels of matrix metalloproteinase-2 and 9 in hypopharyngeal carcinoma and paracancerous tissues were detected by reverse transcription-polymerase chain reaction and Western blot. Results: Reverse transcription-polymerase chain reaction detection showed that the mRNA of matrix metalloproteinase-2 and 9 was expressed in both cancer and pericarcinoma tissues, but was almost not expressed in polypoid control tissues. The expression intensity in the cancer tissue was significantly higher than that in the pericarcinoma tissue (matrix metalloproteinase-2: t = 2.529, p = 0.015; matrix metalloproteinase-9: t = 4.781, p <0.001). The mRNA expression in the cancer tissue was enhanced with the increase of the tumor clinical stage (matrix metalloproteinase-2: F = 4.003, p = 0.026; matrix metalloproteinase-9: F = 5.501, p = 0.008). Its expression intensity was associated with the metastasis of lymph nodes (N staging) and increased with the degree of lymphatic metastasis (matrix metalloproteinases-2: F = 8.965, p = 0.005; matrix metalloproteinase-9: F = 5.420, p = 0.025). There was no significant change in T staging of tumor. With the increase of tumor pathological stage, the mRNA expression of matrix metalloproteinase-2 and 9 was strengthened (matrix metalloproteinase-2: F = 3.884, p = 0.029; matrix metalloproteinase-9: F = 3.783, p = 0.032). The protein expression level of matrix metalloproteinase-2 and 9 was the same as that of mRNA. Conclusion: The expression of matrix metalloproteinase-2 and 9 in hypopharyngeal carcinoma was significantly higher than that in pericarcinoma tissue, and it was enhanced with the increase of clinical stage. The expression level was related to lymph node metastasis and tumor pathological stage. Thus, matrix metalloproteinase-2 and 9 may be involved in the occurrence, development, invasion and metastasis of hypopharyngeal carcinoma through a variety of mechanisms.

Mental illnesses cause significant disease burden globally, with medicines being a major modality of treatment for most mental illnesses. Pharmacists are accessible and trusted healthcare professionals who have an important role in supporting people living with mental illness. This commentary discusses the role of pharmacists in mental healthcare, as part of multidisciplinary teams, the current evidence to support these roles, and the training, remuneration and policy changes needed to recognize these roles and embed pharmacists as core members of the mental healthcare team.

Abstract Background: Demethylzeylasteral (T-96) is a pharmacologically active triterpenoid monomer extracted from Tripterygium wilfordii Hook F (TWHF) that has been reported to exhibit anti-neoplastic effects against several types of cancer cells. However, the potential anti-tumour effects of T-96 against human Prostate cancer (CaP) cells and the possible underlying mechanisms have not been well studied. Results: In the current study, T-96 exerted significant cytotoxicity to CaP cells in vitro and induced cell cycle arrest at S-phase in a dose-dependent manner. Mechanistically, T-96 promoted the initiation of autophagy but inhibited autophagic flux by inducing ROS-mediated endoplasmic reticulum (ER) stress which subsequently activated the extrinsic apoptosis pathway in CaP cells. These findings implied that T-96-induced ER stress activated the caspase-dependent apoptosis pathway to inhibit proliferation of CaP cells. Moreover, we observed that T-96 enhances the sensitivity of CaP cells to the chemotherapeutic drug, cisplatin. Conclusions: Taken together, our data demonstrated that T-96 is a novel modulator of ER stress and autophagy, and has potential therapeutic applications against CaP in the clinic.

Abstract Objective: The aim of this study was to evaluate whether sufentanil can reduce emergence delirium in children undergoing transthoracic device closure of ventricular septal defect (VSD) after sevoflurane-based cardiac anesthesia. Methods: From February 2019 to May 2019, 68 children who underwent transthoracic device closure of VSD at our center were retrospectively analyzed. All patients were divided into two groups: 36 patients in group S, who were given sufentanil and sevoflurane-based cardiac anesthesia, and 32 patients in group F, who were given fentanyl and sevoflurane-based cardiac anesthesia. The following clinical data were recorded: age, sex, body weight, operation time, and bispectral index (BIS). After the children were sent to the intensive care unit (ICU), pediatric anesthesia emergence delirium (PAED) and face, legs, activity, cry, consolability (FLACC) scale scores were also assessed. The incidence of adverse reactions, such as nausea, vomiting, drowsiness and dizziness, was recorded. Results: There was no significant difference in age, sex, body weight, operation time or BIS value between the two groups. Extubation time (min), PEAD score and FLACC scale score in group S were significantly better than those in group F (P<0.05). No serious anesthesia or drug-related side effects occurred. Conclusions: Sufentanil can be safely used in sevoflurane-based fast-track cardiac anesthesia for transthoracic device closure of VSD in children. Compared to fentanyl, sufentanil is more effective in reducing postoperative emergence delirium, with lower analgesia scores and greater comfort.

Abstract Objective: To assess the effectiveness and safety of fast-track cardiac anesthesia using the short-acting opioid sufentanil in children undergoing intraoperative device closure of ventricular septal defect (VSD). Methods: This retrospective clinical study included 65 children who underwent intraoperative device closure of VSD between January 2017 and June 2017. Patients were diagnosed with isolated perimembranous VSD by transthoracic echocardiography. Then, they were divided into two groups, group F (n=30), whose patients were given sufentanil-based fast-track cardiac anesthesia, and group C (n=35), whose patients were given conventional cardiac anesthesia. Perioperative clinical data were analyzed. Results: No significant differences were found between the preoperative clinical parameters and intraoperative hemodynamic indices between the two groups. In group C, compared with group F, the postoperative duration of mechanical ventilation, the length of stay in the intensive care unit, the length of hospital stay, and the hospital costs were significantly increased. Conclusion: In this retrospective study at a single center, sufentanil-based fast-track cardiac anesthesia was shown to be a safe and effective technique for minimally-invasive intraoperative device closure of VSD in children, which was performed with reduced in-hospital costs.

BACKGROUND. Emergency medicine accounts for a large proportion of medical care in many low- and middle-income countries. a better understanding of the burden of disease will guide training and resource allocation priorities, but lack of electronic medical records and standardised data collection systems makes it difficult to obtain this information.OBJECTIVES. To draw attention to the proportionally large burden of trauma in emergency centres (ECs) throughout Eastern Cape Province, South Africa (SA), in the hope of influencing resource allocation and medical provider training protocols accordingly.METHODS. A secondary data analysis was performed from information gathered in HIV testing studies in two large tertiary care centres and one regional hospital in the Eastern Cape region of SA. All patients presenting to the ECs during the 6-week study period who met the inclusion criteria were approached and requested to provide consent for point-of-care HIV testing and collection of demographic information. Information collected included patient demographics, presenting complaints and final diagnoses. Simple descriptive statistics were used to analyse the data.RESULTS. Data were collected from 4 271 patients across three study sites: Frere Hospital (n=2 391), Nelson Mandela Academic Hospital (n=622) and Mthatha Regional Hospital (n=l 258). At the two tertiary care centres, most patients were between the ages of 18 and 30 years (41.2% and 32.6%, respectively) and male (57.8% and 60.2%), and 70.4% and 41.5% had traumatic injuries. The most common complaints were stab/gunshot wounds (18.3% and 20.2%). At the district hospital, the majority of patients were female (57.2%), 40.1% were between 18 and 30 years old, and 27.3% presented with traumatic injuries. Stab/gunshot wounds were the second most common complaint (7.2%) after lower respiratory tract infections (8.7%).CONCLUSIONS. From the proportion of presenting individuals sampled, we can conclude that a large proportion of care delivered in ECs in the Eastern Cape is for trauma. Local clinical capacitation efforts must focus on trauma training.

Abstract A new 3-node triangular hybrid displacement function Mindlin-Reissner plate element is developed. Firstly, the modified variational functional of complementary energy for Mindlin-Reissner plate, which is eventually expressed by a so-called displacement function F, is proposed. Secondly, the locking-free formulae of Timoshenko’s beam theory are chosen as the deflection, rotation, and shear strain along each element boundary. Thirdly, seven fundamental analytical solutions of the displacement function F are selected as the trial functions for the assumed resultant fields, so that the assumed resultant fields satisfy all governing equations in advance. Finally, the element stiffness matrix of the new element, denoted by HDF-P3-7β, is derived from the modified principle of complementary energy. Together with the diagonal inertia matrix of the 3-node triangular isoparametric element, the proposed element is also successfully generalized to the free vibration problems. Numerical results show that the proposed element exhibits overall remarkable performance in all benchmark problems, especially in the free vibration analyses.

ABSTRACT This study was conducted to isolate Lactobacillus salivarius and Pediococcus pentosaceus strains from cecal content and investigate their probiotic potential in specific pathogen free (SPF) chickens. L. salivarius and P. pentosaceus strains were isolated from the cecal content of SPF chickens and identified by 16s rDNA sequence analysis by BLAST analysis at the National Center for Biotechnology Information and phylogenetic analysis using DNAStar software. In an in vivo experiment, 180 7-day-old SPF chickens were randomly assigned into three groups. Group 1 served as a control that was fed a basal diet without probiotic supplementation, and groups 2 and 3 were fed the basal diets supplemented with L. salivarius and P. pentosaceus at 2×108 CFU/g, respectively. Body weight (BW), average daily gain (ADG), feed conversion ratio (FCR), dressing percentage (DP), and the apparent digestibility of crude protein (AD-CP) were calculated. We also determined meat color, fat content, shear force, water content and pH value of breast and thigh muscles; ammonia, urea nitrogen and uric acid content in plasma; fecal ammonia emission level and pH value; and Lactobacillus and Escherichia coli in ceca. Compared with the control group, L. salivarius and P. pentosaceus supplementation significantly increased BW, ADG, DP, AD-CP, fat content of meat, and the number of Lactobacillus in ceca (p<0.05), and decreased FCR, plasma ammonia content, fecal ammonia emission, and pH value and the number of E. coli in ceca (p<0.05). In the in vitro experiment, L. salivarius and P. pentosaceus treatments significantly decreased the ammonia content in medium compared with the control group without probiotic treatment (p<0.05). These results suggest that P. pentosaceus and L. salivarius strains show promising probiotic properties for improving growth, meat quality and microenvironment in chickens and decreasing ammonia content in the medium.

ABSTRACT This article presents two cases of phakic refractive lens (PRL) complications in China. Case 1 presents a highly myopic patient with PRL's footplate partly subluxated into the anterior cham-ber by blunt trauma one-year after implantation. The PRL was repositioned successfully without other complications. Case 2 represents a case of pigment dispersion glaucoma that developed seven years after PRL implantation. Intraocular pressure (IOP) lowering therapy was initiated and the IOP contin-ued to be in the normal range for both affected eyes with ongoing follow-up. In summary, a comprehen-sive ophthalmic evaluation is essential to optimize both patient and PRL selection to minimize the risk of potential complications and PRL implantation warrants long-term follow-up.

RESUMEN Este artículo presenta dos casos de complicaciones de lentes refractivos fáquicos (LRF) en China. El caso 1 presenta a un paciente altamente miope con reposapiés de LRF parcialmente subluxada en la cámara anterior por un traumatismo contuso un año después de la implantación. El LRF se reposicionó con éxito sin otras complicaciones. El caso 2 representa un caso de glaucoma de la dispersión del pigmento desarrollado siete años después de la implantación del LRF. Se inició la terapia para disminuir la presión intraocular (PIO), y la presión intraocular continuó en el rango normal para ambos ojos afectados con seguimiento permanente. En resumen, una evaluación oftálmica integral es esencial para optimizar la selección tanto del paciente como del LRF, con el fin de minimizar el riesgo de potenciales complicaciones y seguimiento a largo plazo de la garantía del implante de LRF.

ABSTRACT This study is a family survey based on a typical patient with seborrhoeic keratosis (SK). Family members comprised 47 people of four generations, including 22 affected members (12 males and 10 females). The 17 people of the fourth generation were aged less than 26 years old. The proband in this study had typical clinical manifestations and pathology of SK, and all affected members of the family had characteristic skin rash that was easy to be identified. The pattern is consistent with autosomal dominant inheritance and SK is indicated to have a certain age onset.

RESUMEN Este estudio es una encuesta familiar basada en un paciente típico con queratosis seborreica (QS). Los miembros de la familia comprendían 47 personas de cuatro generaciones, incluyendo a 22 miembros afectados (12 varones y 10 hembras). Las 17 personas de la cuarta generación tenían menos de 26 años de edad. El probando (caso índice) en este estudio tenía manifestaciones clínicas típicas y patología de QS, y todos los miembros afectados de la familia presentaban la erupción de la piel característica, fácil de identificar. El patrón concuerda con la herencia autosómica dominante, y se indica que QS tiene su inicio a una cierta edad.

Three hundred and nineteen ,Guanximiyou, pummelo (Citrus grandis) orchards from Pinghe county, the southern region of Fujian province, China, were selected for this study. The objectives were to determine (i) the soil and leafnutrient status, (ii) the relationships between leaf mineral elements and the corresponding soil elements, and (iii) the relationships between fruit quality and mineral nutrients. The results showed that soil acidification was a major problem in these orchards, with an average pH of 4.34. Soil acidification affected the availability of soil N, P, Ca, Mg, S, B, Cu and Zn and the levels of organic matter (OM) and cation exchange capacity (CEC), thus inducing soil and leaf nutrient imbalance. Indeed, severe nutrient imbalance existed in these orchard soils. 77.4% and 65.8% of soils were sub-optimum in exchangeable Mg and Ca, while 96.6% and 82.1% of soils were super-optimum in available S and P, respectively. Besides, severe nutrient deficiencies and excesses co-existed in leaves. 46.8% and 35.6% of leaves were deficient in N and Mg, while 74.8% and 70.4% of leaves were excess in B and Cu, respectively. Regressive analysis showed that leaf content of mineral elements was poorly related with the available content of the corresponding soil elements, respectively. In some orchards, severe juice sac granulation, an important factor affecting fruit quality, was observed. Regressive analysis indicated that Mg, S, Cu and Mn played a role in juice sac granulation of fruits. In conclusion, soil acidification might lead to severe soil nutrient imbalance, thus inducing leaf nutrient imbalance, eventually impairing fruit quality parameters such sac granulation.

A large number of natural wetlands in northeast China have been reclaimed as farmland in the last few decades, and soybean is the main rain-fed crop here. For the depth understanding of nitrous oxide (N2O) emission from reclaimed soybean fields, using static opaque chamber method, we conducted a four-year N2O flux measurement at two adjacent soybean fields cultivated after wetland drainage in 1987 and 1993, respectively, in the Sanjiang Plain of northeast China Using static opaque chamber method,. Both sites had two treatments including soybean cropped and bare soils (i.e., SF87, BS87, SF93 and BS93). The results showed that soil N2O emission from all of the plots was severely inhibited by the low temperature in winter (November to March), while a N2O emission pulse occurred during the spring thaw (April and May). Temporal variation of the N2O fluxes during the growing season varied over all the four years but was mainly affected by soil water-filled pore space (WFPS). Intense rainfall events increased the intensity and duration of N2O pulses during the growing season, and most high fluxes were occurred at WFPS > 45%. The mean annual N2O emission from all treatments over four years was 4.8 ± 1.2 kg N ha-1 (ranges: 1.9-19.8), and one third of the emission originated from the spring-thaw. In addition, soybean growth did not increase N2O emissions during the growing season, which support the cancellation of N2O emission calculations from nitrogen fixed by legumes in the 2006 IPCC Guidelines for National Greenhouse Gas Inventories.

Potassium utilization efficiency (KUE) for plants is related to genotype difference, soil characteristics, application of fertilizer and irrigation. Up to now, the KUE of different genotypes worldwide has been extensively studied, but the influence of environment stress on KUE of cotton is infrequently reported. Thus, we selected a high K utilization efficiency cotton genotype (HEG) and a low K utilization efficiency cotton genotype (LEG) as indicator plants. The results showed that both soil water stress and K stress limited the growth of cotton genotypes. The change of soil water levels had significant influence on yield, KUE, rates of fallen leaves and bolls (RF), biomass and potassium accumulation in cotton. Deficient of soil water restricted the uptake and translocation of K. The absence of soil K greatly increased the proportion of biomass of reproductive organs and K distribution to reproductive organs in this experiment. The HEG exhibited higher physiological compared with LEG under the stress conditions, especially under low K treatment.

ABSTRACT We report the case of a 45-year old woman with a painless soft tissue mass on the left side of her neck. At surgery, the lesion was solid and rubbery and revealed grey-white fibrous areas. It was pathologically confirmed as an elastofibroma, a rare, benign soft tissue tumour that is most commonly encountered in patients more than 55 years of age. Elastofibroma arising from connective tissue and usually found in the subscapular region is extremely rare in the neck. The pathogenesis of elastofibroma is still unclear but increased mechanical stress or nutritional derangement consequent to vascular involvement and hereditary factors may predispose to this lesion. Marginal excision is the treatment of choice in symptomatic patients.

RESUMEN Reportamos el caso de una mujer de 45 años con una masa de tejido suave sin dolor en el lado izquierdo del cuello. Al realizarse la cirugía, se halló que la lesión era sólida y gomosa, y presentaba áreas fibrosas de color gris-blanco. El análisis patológico confirmó que se trataba de un elastofibroma: un tumor del tejido blando, raro y benigno, que se encuentra más comúnmente en pacientes de más de 55 años de edad. Los elastofibromas que provienen del tejido conjuntivo y que generalmente se encuentran en la región subescapular, son extremadamente raros en el cuello. La patogénesis del elastofibroma no está todavía clara, pero el aumento del estrés mecánico o los desarreglos nutricionales consecuencia de problemas vasculares y factores hereditarios, pueden predisponer a esta lesión. La extirpación marginal es el tratamiento de elección en pacientes sintomáticos.

ABSTRACT In 2009, in Paraguay, 6,651 people were injured in traffic accidents. This amounts to 554 cases per month and 18 per days. 47% of the afflicted were riding a motorcycle (3). Posterior urethral ruptures occur in approximately 10% of all cases of traumatic pelvic fractures (4).The present case is about a male patient of 28 years old who suffered a motor vehicle accident, resulting in significant damage to soft tissue, bone and urethral bleeding. The suprapubic cystostomy was performed and the Miccional and retrograde Uretrocystographicy (UCM) later established the diagnosis of multiple urethra stenosis with a important spongiofibrosis in the affected area. During surgery, the stenotic lenghth turned out to be underestimate, with 4cm long including bulbous and membranous urethra so it had to be resected entirety, and the defect was replaced with an augmented anastomosis by dorsal and ventral buccal mucosa graft obtained from the patient in the same surgery. The result was a an anatomical and functional improvement , which could be assess 3 months later by Uretrocystography finding a complete permeable urethral lumen , and the maximum urinary flow was 18ml/seg found in the uroflowmetry. Key words: Urethral Trauma, Posterior Uretrha, Ventral Graft, Dorsal Graft.

RESUMEN En el año 2009, en Paraguay, 6.651 personas resultaron lesionadas en accidentes de tránsito. Esto equivale a 554 casos por mes y 18 por día. El 47% de los afligidos iban a bordo de una motocicleta. Las rupturas de uretra posterior se presentan aproximadamente en el 10% de todos los casos de fracturas pélvicas traumáticas. El caso a presentar es sobre un paciente de sexo masculino, 28 años de edad quien sufrió un accidente vehicular automotor, resultando con lesiones importantes en partes blandas, óseas y uretrorragia. Se le realizan una cistotomía suprapúbica por punción y una uretrocistografía miccional y retrograda con la cual se establece el diagnóstico de estrechez en uretral extensa con una espongiofibrosis importante en la zona afecta. En el acto quirúrgico, se comprueba que la longitud de zona estenótica fue subestimada y que abarca en forma discontinua tanto la uretra bulbar y membranosa con una longitud de aproximadamente 4cm, dicha zona se reseca en su totalidad y el defecto se reemplaza con una anastomosis aumentada mediante injerto dorsal y ventral de mucosa bucal obtenido del paciente en el mismo acto operatorio. El resultado con una mejoría anatómica y funcional que en 3 meses constata la permeabilidad uretral completa. En la flujometría libre se comprueba un flujo miccional máximo de 18ml/seg. Palabras clave: Traumatismo uretral, uretra posterior, injerto ventral, injerto dorsal.