[The significance of pedigree genetic screening and rapid immunological parameters in the diagnosis of primary hemophagocytic lymphohistiocytosis]

目的

探讨家系基因筛查及快速免疫学指标检测在原发性噬血细胞综合征（HLH）诊断中的意义。

方法

通过对伴有PRF1、UNC13D及SH2D1A基因突变的4例原发性HLH患者展开家系调查，分别完成基因筛查及各项免疫学指标检测（包括NK细胞活性、CD107a检测及HLH相关缺陷蛋白表达测定），评价各项检测指标在原发性HLH诊断中的意义并探讨各项指标间的相关性。

结果

4个家系基因突变分别为PRF1基因错义突变c.T172C（p.S58P）和非框架移码突变c.1083_1094del (p.361_365del）；PRF1基因错义突变c.C1349T（p.T450M）和框架移码突变c.1090_1091delCT (p.T364fsX93）；UNC13D基因错义突变c.G2588A（p.G863D）；SH2D1A基因半合子错义突变c.32T>G (p.I11S）。先证者及家系成员分别存在不同程度的NK细胞活性降低，其中PRF1基因及SH2D1A基因突变家系HLH相关基因编码穿孔素蛋白、信号淋巴细胞活化分子相关蛋白（SAP）表达水平下降，UNC13D基因突变先证者及与其存在完全相同突变位点的家系成员细胞毒脱颗粒功能（CD107a表达）显著减低。

结论

开展家系基因筛查及快速免疫学指标检测对诊断原发性HLH具有重要意义，两者具有较好的一致性，其中快速免疫学指标检测作为一种高效的检测手段，可为原发性HLH的早期诊断提供可靠依据。

[Risk factors for acute rejection in living-donor kidney transplant recipients in China: a subgroup analysis of a multi-center, registry study]

Objective: To evaluate pre-and early post-transplantation risk factors for acute rejection(AR) in kidney recipients. Methods: This subgroup analysis of a multi-center registry study was conducted on living-donor kidney transplant recipients in China with 10 years of follow-up. This study analyzed 1 255 recipients including 921 males(73.4%) and with a mean age of (33±10)years. Data from patients were first analyzed with univariate analysis and then multivariate analysis was used for finding out the potential risk factors of AR. Results: A total of 106(8.4%) patients were suspected with AR after kidney transplantation, while 1 149 patients were considered as non-AR. Multivariable analysis demonstrated a significant influence of recipient age and cold ischemia time(CIT) on the occurrence of AR(OR: 0.956, 95% CI: 0.923-0.990; OR: 1.006, 95% CI: 1.002-1.011, respectively). The frequency of severe infection was significantly higher in the AR group than non-AR group(38.7% vs 10.8%; P<0.000 1). The occurrence of new-onset diabetes mellitus and tumors was similar in the two groups. Conclusions: Recipient age and CIT are risk factors for AR after living-donor kidney transplantation. Reducing CIT and intensive management of younger recipient could benefit kidney transplant patients.

[Noninvasive diagnostic and predictive value in renal transplant recipients with acute rejection by measurement of urine Fractalkine]

Objective: To investigate the relationship between early-stage renal acute rejection(AR) and the level of Fractalkine in urine, explore the diagnostic and noninvasive monitoring value in early stage after transplantation by measurement of urine Fractalkine. Methods: Urine samples were examined from renal transplant patients between January 2006 and October 2009. A total of 155 patients were enrolled, including 49 with biopsy-proved AR, 58 patients with stable renal function and no abnormal histological findings, 10 patients with subclinical rejection in protocol biopsy, 9 patients with biopsy-proven acute tubular necrosis and 29 patients with biopsy-proven chronic allograft nephropathy. Additionally, urine samples were also collected from 40 healthy controls. Fractalkine was measured in urine samples using a commercial human Fractalkine enzyme-linked immunosorbent assay (ELISA) kit. Immunohistochemistry for Fractalkine expression was performed on biopsies from renal transplant patients with AR and non-AR. Results: Forty-nine patients with AR excreted urinary Fractalkine at a significantly higher level than levels in patients with stable renal function and healthy controls[(429.1±56.1)vs (94.6±8.4), (84.5±8.9)ng/mmol creatine, both P<0.001]. Patients with AR excreted urinary Fractalkine at a significantly higher level than levels in patients with acute tubular necrosis and chronic allograft nephropathy[(429.1±56.1)vs(133.0±9.8), (183.0±18.9)ng/mmol creatine, both P<0.001]. Receiver operating characteristic(ROC)curve was constructed to determine the discriminatory power of Fractalkine levels for diagnosis of AR. The area under ROC curve was 0.920(95% CI: 0.875-0.969, P<0.001), which showed that Fractalkine was a suitable marker for the diagnosis of AR. At a cut-off point of 157.5 ng/mmol creatinine, the sensitivity was 83.7% and the specificity was 84.5% (P<0.001). The dynamic level of urinary Fractalkine in AR patients within 3 weeks after transplantation fluctuated above 300 ng/mmol creatine, which is remarkably higher than patients with stable renal function (below 200 ng/mmol creatinine). Conclusions: As a noninvasive monitoring method, Fractalkine in urine may be a new approach for detection of AR as well as useful to predict response to antirejection therapy. It has good sensitivity and specificity. Besides, measurement of Fractalkine in urine is a simple, inexpensive method for the routine clinical monitoring after kidney transplantation.

Successful Management of New-Onset Diabetes Mellitus and Obesity With the Use of Laparoscopic Sleeve Gastrectomy After Kidney Transplantation-A Case Report

In kidney transplantation, obesity is associated with poorer graft survival and patient survival. Bariatric surgery may provide benefit for these patients, not only by inducing weight loss, but also via reduction of diabetes. We report a case of morbid obesity, poorly controlled new-onset diabetes mellitus, and gout after kidney transplantation that was treated with laparoscopic sleeve gastrectomy 3 years after kidney transplantation. After 1 year of follow-up, 76% excessive body weight loss was attained. No complications were noted. The operation also provided total remission of diabetes and gout as well as good graft survival. Based on our experience, laparoscopic sleeve gastrectomy may be a feasible treatment for obese patients after renal transplantation to help resolve obesity and control new-onset diabetes. However, the timing of operation and the long-term potential for graft and patient survivals with this operation require further study.

Charge-Dependent Directed Flow in Cu+Au Collisions at sqrt[s_{NN}]=200 GeV

We present the first measurement of charge-dependent directed flow in Cu+Au collisions at sqrt[s_{NN}]=200  GeV. The results are presented as a function of the particle transverse momentum and pseudorapidity for different centralities. A finite difference between the directed flow of positive and negative charged particles is observed that qualitatively agrees with the expectations from the effects of the initial strong electric field between two colliding ions with different nuclear charges. The measured difference in directed flow is much smaller than that obtained from the parton-hadron-string-dynamics model, which suggests that most of the electric charges, i.e., quarks and antiquarks, have not yet been created during the lifetime of the strong electric field, which is of the order of, or less than, 1  fm/c.

[Levels of dichlorodiphenyltrichloroethane internal exposure levels in pregnant women of Xiamen and influencing factors]

Objective: To investigate the level of and factors influencing internal exposure to dichlorodiphenyltrichloroethane (DDT) in pregnant women. Methods: In all, 1 064 pregnant women were recruited in a hospital of Xiamen. Participants were asked to complete a questionnaire to obtain data on sociodemographic characteristics and lifestyle. Peripheral venous blood and cord blood samples were collected. Of the 1 064 pregnant women, 600 were enrolled in this study after completing the questionnaire and providing peripheral venous blood and cord blood. Among those women, 150 were selected randomly using a systematic sampling method. A gas chromatography coupled electron capture detector was used to determine the concentration of six DDT homologues: p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), o,p'-dichlorodiphenyltrichloroethane (o,p'-DDT), p,p'-dichlorodiphenyldichloroethane (p,p'-DDD), o,p'-dichlorodiphenyldichloroethane (o,p'-DDD), p,p'-dichlorodiphenylethylene (p,p'-DDE), and o,p'-dichlorodiphenylethylene (o,p'-DDE) . Pregnant women were divided into two groups according to DDT concentration: a low concentration group (detection value≤P₅₀) and a high concentration group (detection value>P₅₀). multivariate logistic regression was used to analyze the association between the DDT levels and potential influencing factors which investigated in the questionnaire. Results: The detection rates of p,p'-DDT, o,p'-DDT, p,p'-DDD, o,p'-DDD, p,p'-DDE and o,p'-DDE in the peripheral venous blood samples from the 150 pregnant women were 83.3% (125), 29.3% (44), 58.0% (87), 24.0% (36), 82.0% (123), and 34.7% (52), respectively. The median concentrations were 1.56, 0.03, 0.07, 0.03, 0.93 and 0.03 μg/ml, respectively. The detection rates of p,p'-DDT, o,p'-DDT, p,p'-DDD, o,p'-DDD, p,p'-DDE and o,p'-DDE in the cord blood samples were 69.3% (104), 10.7% (16), 29.3% (44), 20.7% (31), 81.3% (122) and 45.3% (68), and the median concentrations were 0.41, 0.03, 0.03, 0.03, 0.42 and 0.03 μg/ml, respectively. The concentration ranges in the low and high DDT concentration groups which contained 75 respondents respectively were 0-3.69 and 3.74-82.09 μg/ml, respectively. In the single-factor analysis, the number (percentage) of those who consumed seafood " rarely" , "less than twice a week" , and " twice a week or more" was 15 (20.3%), 22 (29.7%), and 37 (50.0%), respectively, in the low concentration group, and 4(5.3%), 20(26.7% ), and 51(68.0% ) in the high concentration group (χ²=8.69, P=0.013). The results of the multivariate logistic regression analysis indicate that pregnant women who consume seafood less than twice a week, twice a week or more have higher peripheral blood DDT concentrations compared with those who rarely consume seafood. The OR (95% CI) values were 1.14 (1.08-1.21), 2.11 (1.55-2.85), respectively. Conclusion: The exposure level of pregnant women to DDTs in the Xiamen area is higher than that of women in other regions. High seafood intake is a risk factor for internal exposure to DDTs.

Increased risk of a suicide event in patients with primary fibromyalgia and in fibromyalgia patients with concomitant comorbidities: A nationwide population-based cohort study

An increased risk of suicide ideation and death has been reported in patients with fibromyalgia. This study aimed to evaluate the risk of a suicide event in patients with primary fibromyalgia and in fibromyalgia patients with comorbidities. We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese people from 2000 to 2005, to identify 95,150 patients with incident fibromyalgia (ICD-9-CM 729.0-729.1) and 190,299 reference subjects matched by sex, age, and index date of diagnosis, with a mean of 8.46 ± 2.37 years of follow-up until 2011. The risk of a suicide event (ICD-9-CM, External-Cause Codes 950-959) was analyzed with a Cox proportional hazards model. Stratification analysis was performed by separating fibromyalgia patients and reference subjects with respect to each comorbidity to determine the risk of suicide in fibromyalgia patients with or without comorbidity relative to subjects who had neither fibromyalgia nor comorbidity. In this Taiwanese dataset, there were 347 suicide events in patients with fibromyalgia (4.16 per 10 person-years) and 424 in matched reference subjects (2.63 per 10 person-years) with a significant crude hazard ratio (HR) of 1.58 (95% confidence interval [CI] 1.38-1.83) and an adjusted HR of 1.38 (95% CI 1.17-1.71) for fibromyalgia patients relative to the matched reference subjects. According to the 2 × 2 stratification analysis, we found that fibromyalgia patients without comorbidity had an independent but mild risk of a suicide event with adjusted HRs ranging from 1.33 to 1.69 relative to subjects with neither fibromyalgia nor comorbidity. Meanwhile, fibromyalgia patients with comorbidity led to a markedly enhanced risk of a suicide event relative to the matched reference subjects, with adjusted HRs ranging from 1.51 to 8.23. Our analysis confirmed a mild-to-moderate risk of a suicide event in patients with primary fibromyalgia. Attention should be paid to the prevention of suicide in fibromyalgia patients with concomitant comorbidities.

Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard

OBJECTIVE

To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies.

METHODS

Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study. Data from the Study for Updated Gout Classification Criteria (SUGAR) were randomly divided into development and test data sets. A data-driven case definition was formed using logistic regression in the development data set. This definition, along with definitions used in GUGC studies and the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout classification criteria were applied to the test data set, using monosodium urate crystal identification as the gold standard.

RESULTS

For all tested GUGC definitions, the simple definition of "self-report of gout or urate-lowering therapy use" had the best test performance characteristics (sensitivity 82%, specificity 72%). The simple definition had similar performance to a SUGAR data-driven case definition with 5 weighted items: self-report, self-report of doctor diagnosis, colchicine use, urate-lowering therapy use, and hyperuricemia (sensitivity 87%, specificity 70%). Both of these definitions performed better than the 1977 American Rheumatism Association survey criteria (sensitivity 82%, specificity 67%). Of all tested definitions, the 2015 ACR/EULAR criteria had the best performance (sensitivity 92%, specificity 89%).

CONCLUSION

A simple definition of "self-report of gout or urate-lowering therapy use" has the best test performance characteristics of existing definitions that use routinely available data. A more complex combination of features is more sensitive, but still lacks good specificity. If a more accurate case definition is required for a particular study, the 2015 ACR/EULAR gout classification criteria should be considered.

[Epidemic features of dyslipidemia among Uygur, Kazakh and Han ethnic groups in Urumqi]

Objective: To analyze the epidemic features of dyslipidemia among 39 980 Uygur, Kazak and Han ethnic groups in Urumqi, and to explore the methods of prevention and treatment on dyslipidemia. Methods: The differences of blood total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) of health examination population with different ethnics, genders, and ages were compared, from 2012 to 2014 in the First Affiliated Hospital of Xinjiang Medical University. Results: Among the Uygur, Kazak and Han ethnic groups, the positive rate was respectively 35.0%, 37.0%, 30.3% in TC; 34.5%, 30.1% and 32.0% in TG; 24.9%, 18.3%, and 18.2% in HDL-C; 30.1%, 31.6% and 23.3% in LDL-C. In the same ethnic group, the abnormality rate of blood lipid in the female was lower than that of the male (P<0.001). The blood lipid abnormality rate increased significantly in those with 30-39 years, and reached the highest value in the 50-59 years group, then it decreased in those aged over 60 years (P<0.001). Conclusion: The lipid abnormality rate of the Uygur and Kazak residents was higher than that of the Han nationality, and the abnormal levels of TC and LDL-C were particularly evident in Urumqi.

[Random clinical study about application value of oxycodone in radiofrequency ablation of hepatocellular carcinoma]

Objective: To evaluate the clinical effect and safety of oxycodone hydrochloride in the anesthesia for percutaneous radiofrequency ablation (PRFA) in hepatocellular carcinoma. Methods: Between March and December 2015, 60 cases of hepatocellular carcinoma patients undergoing percutaneous radiofrequency ablation surgery in Peking University Cancer Hospital were randomly divided into three groups: oxycodone group (group Q), fentanyl group (group F) and dezocine group (group D), 20 cases in each group. Respectively intravenously injection oxycodone 0.1 mg/kg, fentanyl 0.001 mg/kg, dezocine 0.1 mg/kg before surgery. After the surgeon completed puncture administer propofol to maintain anesthesia. Recorded mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂) changes in each group at entrance, beginning of radiofrequency ablation (T1), radiofrequency ablation began after 10 minutes (T2), the end of the surgical and awake. Observe the analgesia effect, respiratory depression, nausea, vomit and other complications. Postoperative pain scores were recorded.Using ANOVA, repeated measure variance analysis, SNK test, χ² test and other tests to evaluate the anesthetic effect indexes. Results: The observation completed in all patients. Patients of three groups had no significant differences in general information. No significant difference between MAP, HR and SpO₂ at each time points among the three groups. At the T1 time point (group Q: (11.7±1.6)/min, group D: (12.1±1.7)/min, group F: (10.3±2.3)/min, F=5.068, P=0.009) and T2 time point (group Q: (11.9±1.3)/min, group D: (12.2±1.4)/min, group F: (10.7±1.3)/min, F=7.024, P=0.002), RR in group F were lower than in group Q and group D. Pain visual analogue scores after waking (group Q: 0.2±0.7, group D: 0.3±0.7, group F: 1.7±1.5, F=12.981, P=0.000) and postoperative pain score of 1 hour (group Q: 2.0±0.9, group D: 1.8±0.8, group F: 4.3±0.9, F=42.362, P=0.000) in the group Q and group D were significantly lower than in group F. The body movements in group Q and group D were significantly less than in group F (3 cases, 3 cases, 9 cases, χ²=6.400, P=0.041 ). Intraoperative respiratory depression in group Q and group D were lower than group F (3 cases, 2 cases, 9 cases, χ²=8.012, P=0.018). Conclusions: Oxycodone hydrochloride can be used safely and effectively for radiofrequency ablation. It has favorable hemodynamic stability, lower incidence of respiratory depression, and advantage in terms of postoperative pain.

Effect of Systemic Lupus Erythematosus on the Risk of Incident Respiratory Failure: A National Cohort Study

Purpose

We conducted a nationwide cohort study to investigate the relationship between systemic lupus erythematosus (SLE) and the risk of incident respiratory failure.

Methods

From the National Health Insurance Research Database, we identified 11 533 patients newly diagnosed with SLE and 46 132 controls without SLE who were randomly selected through frequency-matching according to age, sex, and index year. Both cohorts were followed until the end of 2011 to measure the incidence of incident respiratory failure, which was compared between the 2 cohorts through a Cox proportional hazards regression analysis.

Results

The adjusted hazard ratio (aHR) of incident respiratory failure was 5.80 (95% confidence interval [CI] = 5.15–6.52) for the SLE cohort after we adjusted for sex, age, and comorbidities. Both men (aHR = 3.44, 95% CI = 2.67–4.43) and women (aHR = 6.79, 95% CI = 5.93–7.77) had a significantly higher rate of incident respiratory failure in the SLE cohort than in the non-SLE cohort. Both men and women aged <35 years (aHR = 31.2, 95% CI = 21.6–45.2), 35–65 years; (aHR = 6.19, 95% CI = 5.09–7.54) and ≥65 years (aHR = 2.35, 95% CI = 1.92–2.87) had a higher risk of incident respiratory failure in the SLE cohort. Moreover, the risk of incident respiratory failure was higher in the SLE cohort than the non-SLE cohort, for subjects with (aHR = 2.65, 95% CI = 2.22–3.15) or without (aHR = 9.08, 95% CI = 7.72–10.7) pre-existing comorbidities. In the SLE cohort, subjects with >24 outpatient visits and hospitalizations per year had a higher incident respiratory failure risk (aHR = 21.7, 95% CI = 18.0–26.1) compared with the non-SLE cohort.

Conclusion

Patients with SLE are associated with an increased risk of incident respiratory failure, regardless of their age, sex, and pre-existing comorbidities; especially medical services with higher frequency.

[Spontaneous intracranial hypotension: 12 case reports and follow-up]

Objective: To investigate the pathogenesis, clinical presentation, imaging features and prognosis of spontaneous intracranial hypotension. Methods: Clinical manifestation and imaging changes of 12 patients with spontaneous intracranial hypotension were reported. They were followed up regularly. The clinical and neuroimaging characteristics were summarized. Results: All the 12 cases were adults, presenting with orthostatic headache. They all recovered with conservative therapy. Head MRI demonstrated cerebral lobe hemorrhage, subdural hematoma, pituitary hyperemia, subarachnoid hemorrhage, enhancement of the pachymeninges, sagging of the brain, etc. Conclusions: Spontaneous intracranial hypotension is characterized by orthostatic headaches and is associated with compensatory changes following loss of CSF volume. The long-time prognosis is not bad.

[Determination of tert-butyl alcohol in the air of the workplace by solvent desorption gas chromatography]

Objective: To establish solvent desorption gas chromatographic method for determination of tert-butyl alcohol in the air of the workplace. Methods: After tert-butyl alcohol in the air of the workplace collected with activated carbon tube and desorbed with 2% 2-propanol in CS₂, and then separated with DB-FFAP capillary column and detected with flame ionization detector. Results: The linearity ranges were 0.6~2 264.0 mg/L. The limit of quantification was 0.6 mg/L. The determination has a good reproducibility. The intraassay and interassay precisions were 2.8%~3.2% and 3.8%~5.7%. The desorption efficiencies were 93.9%~98.1%. Absorption efficiencies were 95.8%~100.0%. The breakthrough volume was above 7.1 mg in 100mg activated carbon. The samples in activated carbon tube could be stored for at least 14 days at ambient temperature. Conclusion: The method is feasible for determination of tert-butyl alcohol in the air of the workplace.

[Comparison of efficacy between the serum cortisol and 24 hour urine free cortisol in combined dexamethasone suppression test in the diagnosis of Cushing syndrome]

OBJECTIVE

To compare the sensitivity and specificity between the 24 hour urine free cortisol (24 h UFC) and serum cortisol in dexamethasone suppression test (DST) in the diagnosis of Cushing syndrome (CS).

METHODS

Combined low dose DST (LDDST) and high dose DST (HDDST) were carried out in 67 cases of CS with surgically confirmed cases in recent 3 years(from January 2011 to November 2015). The serum cortisol and 24 h UFC were collected simultaneously for each subject and the sensitivity and specificity of serum cortisol and 24 h UFC were compared.

RESULTS

There were Cushing disease (CD) group (n=53), ectopic adrenocorticotropic hormone (ACTH) syndrome group (n=7) and ACTH-independent Cushing syndrome group (n=7) according to the etiology of hypercorticordism.There were no significant differences among 3 groups in gender and age.The sensitivity of serum cortisol of different cut off points(50, 110, 140 nmol/L and 50% of control)after LDDST was 97.01%, 86.57%, 83.58% and 70.15% respectively.Meanwhile, the sensitivity of cutoff point of 24 h UFC <32 nmol in combined LDDST was 92.54% in the diagnosis of Cushing syndrome.There was no significant differences in two groups between serum cortisol <110 nmol/L and 24 h UFC <32 nmol.However, the sensitivity of serum cortisol <50 nmol/L was significantly higher than 24 h UFC<32 nmol (P<0.05). Furthermore, in combined HDDST, if the suppression rate was ≥50%, the sensitivity of serum cortisol and 24 h UFC in differentiating the etiology of Cushing disease was 60.38% and 90.57%, and the specificity was 91.43% and 96.00% respectively.There were significant differences between serum cortisol and 24 h UFC in both of sensitivity and specificity (both P<0.05). In addition, if the suppression rate of 24 h UFC in HDDST was adjusted to 60.85% according to receiver operating characteristic (ROC) curve, it could have the best levels of sensitivity (92.6%) with the specificity of 85.7%. If the suppression rate of serum cortisol was adjusted to 61.53% in HDDST according to ROC curve, it could have the best sensitivity (64.8%) with the specificity of 78.6% accordingly.

CONCLUSION

In combined LDDST, the serum cortisol <50 nmol/L had a higher sensitivity than the 24 h UFC<32 nmol when they were used as the criteria in determining the diagnosis of CS.In HDDST, the sensitivity and specificity of suppression rate of 24 h UFC ≥50% were better than serum cortisol to differentiate the etiology of CS.

Study for Updated Gout Classification Criteria: Identification of Features to Classify Gout

OBJECTIVE

To determine which clinical, laboratory, and imaging features most accurately distinguished gout from non-gout.

METHODS

We performed a cross-sectional study of consecutive rheumatology clinic patients with ≥1 swollen joint or subcutaneous tophus. Gout was defined by synovial fluid or tophus aspirate microscopy by certified examiners in all patients. The sample was randomly divided into a model development (two-thirds) and test sample (one-third). Univariate and multivariate association between clinical features and monosodium urate-defined gout was determined using logistic regression modeling. Shrinkage of regression weights was performed to prevent overfitting of the final model. Latent class analysis was conducted to identify patterns of joint involvement.

RESULTS

In total, 983 patients were included. Gout was present in 509 (52%). In the development sample (n = 653), the following features were selected for the final model: joint erythema (multivariate odds ratio [OR] 2.13), difficulty walking (multivariate OR 7.34), time to maximal pain <24 hours (multivariate OR 1.32), resolution by 2 weeks (multivariate OR 3.58), tophus (multivariate OR 7.29), first metatarsophalangeal (MTP1) joint ever involved (multivariate OR 2.30), location of currently tender joints in other foot/ankle (multivariate OR 2.28) or MTP1 joint (multivariate OR 2.82), serum urate level >6 mg/dl (0.36 mmoles/liter; multivariate OR 3.35), ultrasound double contour sign (multivariate OR 7.23), and radiograph erosion or cyst (multivariate OR 2.49). The final model performed adequately in the test set, with no evidence of misfit, high discrimination, and predictive ability. MTP1 joint involvement was the most common joint pattern (39.4%) in gout cases.

CONCLUSION

Ten key discriminating features have been identified for further evaluation for new gout classification criteria. Ultrasound findings and degree of uricemia add discriminating value, and will significantly contribute to more accurate classification criteria.

Measurement of the Transverse Single-Spin Asymmetry in p^{↑}+p→W^{±}/Z^{0} at RHIC

We present the measurement of the transverse single-spin asymmetry of weak boson production in transversely polarized proton-proton collisions at sqrt[s]=500  GeV by the STAR experiment at RHIC. The measured observable is sensitive to the Sivers function, one of the transverse-momentum-dependent parton distribution functions, which is predicted to have the opposite sign in proton-proton collisions from that observed in deep inelastic lepton-proton scattering. These data provide the first experimental investigation of the nonuniversality of the Sivers function, fundamental to our understanding of QCD.

Beam Energy Dependence of the Third Harmonic of Azimuthal Correlations in Au+Au Collisions at RHIC

We present results from a harmonic decomposition of two-particle azimuthal correlations measured with the STAR detector in Au+Au collisions for energies ranging from sqrt[s_{NN}]=7.7 to 200 GeV. The third harmonic v_{3}^{2}{2}=⟨cos3(ϕ_{1}-ϕ_{2})⟩, where ϕ_{1}-ϕ_{2} is the angular difference in azimuth, is studied as a function of the pseudorapidity difference between particle pairs Δη=η_{1}-η_{2}. Nonzero v_{3}^{2}{2} is directly related to the previously observed large-Δη narrow-Δϕ ridge correlations and has been shown in models to be sensitive to the existence of a low viscosity quark gluon plasma phase. For sufficiently central collisions, v_{3}^{2}{2} persist down to an energy of 7.7 GeV, suggesting that quark gluon plasma may be created even in these low energy collisions. In peripheral collisions at these low energies, however, v_{3}^{2}{2} is consistent with zero. When scaled by the pseudorapidity density of charged-particle multiplicity per participating nucleon pair, v_{3}^{2}{2} for central collisions shows a minimum near sqrt[s_{NN}]=20  GeV.

Centrality and Transverse Momentum Dependence of Elliptic Flow of Multistrange Hadrons and ϕ Meson in Au+Au Collisions at √[sNN]=200 GeV

We present high precision measurements of elliptic flow near midrapidity (|y|<1.0) for multistrange hadrons and ϕ meson as a function of centrality and transverse momentum in Au+Au collisions at center of mass energy √[sNN]=200  GeV. We observe that the transverse momentum dependence of ϕ and Ω v2 is similar to that of π and p, respectively, which may indicate that the heavier strange quark flows as strongly as the lighter up and down quarks. This observation constitutes a clear piece of evidence for the development of partonic collectivity in heavy-ion collisions at the top RHIC energy. Number of constituent quark scaling is found to hold within statistical uncertainty for both 0%-30% and 30%-80% collision centrality. There is an indication of the breakdown of previously observed mass ordering between ϕ and proton v2 at low transverse momentum in the 0%-30% centrality range, possibly indicating late hadronic interactions affecting the proton v2.

Increased Risk of Stroke in Patients With Fibromyalgia: A Population-BASED Cohort Study

Neuropsychiatric diseases might enhance stroke development, possibly through inflammation and atherosclerosis. Approximately 25% to 40% of patients with stroke, largely younger patients, are not associated with any conventional stroke risk factors. In this research, we explored whether fibromyalgia (FM), a neuropsychosomatic disorder, increases stroke risk.From a claims dataset with one million enrollees sourced of the Taiwan National Health Insurance database, we selected 47,279 patients with FM and randomly selected 189,112 age- and sex-matched controls within a 3-year period from January 1, 2000 to December 31, 2002. Stroke risk was assessed using Cox proportional hazards regression.Comorbidities associated with increased stroke risk, such as hypertension, diabetes, hyperlipidemia, coronary heart disease, irritable bowel syndrome, and interstitial cystitis, were more prevalent in patients with FM and high stroke risk than in the controls. The overall stroke risk was 1.25-fold (95% confidence interval [CI]: 1.21-1.30) higher in the FM group than in the non-FM group. Even without comorbidities, stroke risk was higher in patients with FM than in the controls (adjusted hazard ratio [aHR] = 1.44, 95% CI: 1.35-1.53, P < 0.001). The relative risk of stroke was 2.26-fold between FM and non-FM groups in younger patients (age <35 years, 95% CI: 1.86-2.75).This is the first investigation associating FM with an increased risk of stroke development. The outcomes imply that FM is a significant risk factor for stroke and that patients with FM, particularly younger patients, require close attention and rigorous measures for preventing stroke.

Expression of CD4+CD25+ regulatory T cells and Foxp3 in peripheral blood of patients with gastric carcinoma

The aim of this research was to study the clinical significance and expression of CD4+CD25+ regulatory T cells (Tregs) and p3Forkhead transcription factor-3 (Foxp3) in peripheral blood of patients with gastric carcinoma (GC) and to investigate the effects in the occurrence and development process of GC, to further comprehend their clinical values and provide a theoretical basis for the early diagnosis and immunotherapy of GC. The expression levels of CD4+CD25+Foxp3+Tregs in GC patients, at TNM staging, differentiated degree, lymphatic metastasis, cancer sites and cancer diameter of GC, were analyzed within the groups. The comparison of the expression levels of CD4+CD25+Foxp3+Tregs in peripheral blood between the GC group and the healthy control group showed a statistically significant difference. At TNM staging within the groups, pairwise comparisons of the expression levels of CD4+CD25+Foxp3+Tregs indicated that differences among the stage I+II group, stage III group and stage IV group were statistically significant. The expression levels of CD4+CD25+Foxp3+Tregs are closely relative to the occurrence and development of GC, providing theoretical bases and evidence for the early diagnosis, prognosis evaluation and immunotherapy of GC.

Effect of Urate-Lowering Therapy on All-Cause and Cardiovascular Mortality in Hyperuricemic Patients without Gout: A Case-Matched Cohort Study

Objectives

An increased risk of mortality in patients with hyperuricemia has been reported. We examined (1) the risk of all-cause and cardiovascular disease (CVD) mortality in untreated hyperuricemic patients who did not receive urate-lowering therapy (ULT), and (2) the impact of ULT on mortality risk in patients with hyperuricemia.

Methods

In this retrospective case-matched cohort study during a mean follow-up of 6.4 years, 40,118 Taiwanese individuals aged ≥17 years who had never used ULT and who had never had gout were examined. The mortality rate was compared between 3,088 hyperuricemic patients who did not receive ULT and reference subjects (no hyperuricemia, no gout, no ULT) matched for age and sex (1:3 hyperuricemic patients/reference subjects), and between 1,024 hyperuricemic patients who received ULT and 1,024 hyperuricemic patients who did not receive ULT (matched 1:1 based on their propensity score and the index date of ULT prescription). Cox proportional hazard modeling was used to estimate the respective risk of all-cause and CVD (ICD-9 code 390–459) mortality.

Results

After adjustment, hyperuricemic patients who did not receive ULT had increased risks of all-cause (hazard ratio, 1.24; 95% confidence interval, 0.97–1.59) and CVD (2.13; 1.34–3.39) mortality relative to the matched reference subjects. Hyperuricemic patients treated with ULT had a lower risk of all-cause death (0.60; 0.41–0.88) relative to hyperuricemic patients who did not receive ULT.

Conclusion

Under-treatment of hyperuricemia has serious negative consequences. Hyperuricemic patients who received ULT had potentially better survival than patients who did not.

Observation of Transverse Spin-Dependent Azimuthal Correlations of Charged Pion Pairs in p^{↑}+p at sqrt[s]=200 GeV

We report the observation of transverse polarization-dependent azimuthal correlations in charged pion pair production with the STAR experiment in p^{↑}+p collisions at RHIC. These correlations directly probe quark transversity distributions. We measure signals in excess of 5 standard deviations at high transverse momenta, at high pseudorapidities η>0.5, and for pair masses around the mass of the ρ meson. This is the first direct transversity measurement in p+p collisions.

An Independent Risk of Gout on the Development of Deep Vein Thrombosis and Pulmonary Embolism: A Nationwide, Population-Based Cohort Study

Previous studies indicated that gout is a risk factor of cardiovascular diseases. This study aimed to determine if patients with gout have an increased risk of deep vein thrombosis (DVT) or pulmonary embolism (PE).We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese to identify 57,981 patients with gout and 115,961 reference subjects matched by sex, age, and entry date of diagnosis. The risk of DVT and PE was analyzed using the Cox proportional hazards model.In this Taiwanese dataset observed from 2000 to 2010, we found the incidence of DVT was 5.26 per 10 person-years in the gout cohort, which was twofold higher than the incidence of 2.63 per 10 person-years in the reference cohort. After adjusting for age, sex, and 9 comorbidities, the hazard ratio (HR) of developing DVT was 1.66 (95% confidence interval [CI] = 1.37-2.01). Among patients with gout, the youngest age group had the highest increase in the risk of developing DVT (HR [95% CI] = 2.04 [1.24-3.37] for ages 20 to 49 years, 1.80 [1.28-2.51] for ages 50 to 64 years, and 1.45 [1.11-1.91] for ages ≥65 years). The incidence of PE was about one-fifth that of DVT in gout patients, but the effect of gout on the risk was similar (HR [95% CI] = 1.53 [1.01-2.29]).Our analysis confirmed that gout increased the risk of DVT and PE. Further exploration is needed in the future.

Diagnostic Arthrocentesis for Suspicion of Gout Is Safe and Well Tolerated

OBJECTIVE

To determine the frequency of adverse events of diagnostic arthrocentesis in patients with possible gout.

METHODS

Consecutive patients underwent arthrocentesis and were evaluated at 6 weeks to determine adverse events. The 95% CI were obtained by bootstrapping.

RESULTS

Arthrocentesis was performed in 910 patients, and 887 (97.5%) were evaluated for adverse events. Any adverse event was observed in 12 participants (1.4%, 95% CI 0.6-2.1). There was 1 case (0.1%, 95% CI 0-0.34) of septic arthritis.

CONCLUSIONS

Diagnostic arthrocentesis is associated with a low frequency of adverse events. Septic arthritis rarely occurs.

Azimuthal Anisotropy in U+U and Au+Au Collisions at RHIC

Collisions between prolate uranium nuclei are used to study how particle production and azimuthal anisotropies depend on initial geometry in heavy-ion collisions. We report the two- and four-particle cumulants, v_{2}{2} and v_{2}{4}, for charged hadrons from U+U collisions at sqrt[s_{NN}]=193  GeV and Au+Au collisions at sqrt[s_{NN}]=200  GeV. Nearly fully overlapping collisions are selected based on the energy deposited by spectators in zero degree calorimeters (ZDCs). Within this sample, the observed dependence of v_{2}{2} on multiplicity demonstrates that ZDC information combined with multiplicity can preferentially select different overlap configurations in U+U collisions. We also show that v_{2} vs multiplicity can be better described by models, such as gluon saturation or quark participant models, that eliminate the dependence of the multiplicity on the number of binary nucleon-nucleon collisions.

Expression data analysis to identify key target genes in visceral fat tissue associated with obstructive sleep apnea

OBJECTIVE

The purpose of this study was to screen key genes related to mechanisms and consequences of obstructive sleep apnea (OSA)-induced perturbations in visceral fat tissue depots.

MATERIALS AND METHODS

Microarray data of GSE38792, comprising 10 visceral fat samples from OSA patients and 8 visceral fat samples from control subjects, was obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified in visceral fat samples from OSA patients compared with controls using Bioconductor package limma. Gene Ontology (GO) and pathway enrichment analyses were carried out to identify significantly altered biological functions. Furthermore, a protein-protein interaction (PPI) network was constructed with STRING database and visualized with Cytoscape software. Additionally, the transcriptional regulatory relationships were screened using UCSC ENCODE Genome Browser.

RESULTS

A total of 380 DEGs were identified, of which 188 were up-regulated and 192 were down-regulated. The DEGs were involved in different GO terms and pathways, mainly associated with metabolism such as proteolysis. PPI network analysis revealed that Actin, Alpha 1, Skeletal Muscle (ACTA1), Histone Deacetylase 2 (HDAC2), and Small Ubiquitin-Like Modifier 1 (SUMO1) were hub proteins. In addition, HDAC2 was shown to encode a transcription factor (TF) and it could regulate 3 DEGs.

CONCLUSIONS

Genes such as ACTA1, HDAC2, and SUMO1 were presumed to play critical roles in the mechanisms and consequences of OSA-induced perturbations in visceral fat tissue depots, which may be useful for deeply studying the mechanisms underlying OSA.

Risk relation between rhinitis and acute ischemic stroke

BACKGROUND AND PURPOSE

Chronic inflammation that triggers endothelial dysfunction and atherosclerosis may promote the evolution of cardiovascular diseases, including acute ischemic stroke (AIS). In this study, we assessed the association between rhinitis (RN), an immunoglobulin E-related atopic disease, and the risk of AIS.

METHODS

We used a Taiwan national insurance claims data set of 1 million enrollees to distinguish 61,899 patients with RN and 123,798 randomly selected age- and sex-matched controls from January 1, 2000, to December 31, 2010. Both cohorts were followed up until the occurrence of stroke or the end of follow-up. The risk of AIS was evaluated by using the Cox proportional hazards regression model.

RESULTS

After adjustment of the relevant covariates, the RN group showed a lower risk of AIS (adjusted hazard ratio [aHR] 0.74 [95% confidence interval {CI}, 0.70-0.79]) compared with the control cohort at the end of follow-up. Among the participants without comorbidities, the RN cohort still had a lower risk of AIS compared with the control cohort (aHR 0.69 [95% CI, 0.59-0.81]). Moreover, in the three stratified age groups, RN was associated with a significantly decreased risk of AIS (ages ≤49 years: aHR 0.77 [95% CI, 0.63-0.95]; ages 50-64 years: aHR 0.72 [95% CI, 0.64-0.81]; ages ≥65 years: aHR 0.78 [95% CI, 0.71-0.85]).

CONCLUSIONS

RN was associated with a decreased risk of developing AIS. Although a reduction in risk of AIS was observed, it warrants further consideration to prevent AIS in patients with RN.

Increased Risk of Coronary Heart Disease in Patients with Primary Fibromyalgia and Those with Concomitant Comorbidity-A Taiwanese Population-Based Cohort Study

OBJECTIVES

Fibromyalgia has seldom been associated with coronary heart disease (CHD). The aim of this study was to evaluate the risk of CHD in patients with fibromyalgia.

METHODS

We used a dataset of one million participants, systemically scrambled from the Taiwanese national insurance beneficiaries, to identify 61,612 patients with incident fibromyalgia (ICD-9-CM 729.0-729.1) and 184,834 reference subjects matched by sex, age and index date of diagnosis in a 1:3 ratio from 2000 to 2005, with a mean 8.86 ± 2.68 years of follow-up until 2011. Risk of CHD was analyzed by Cox proportional hazard modeling.

RESULTS

Patients with fibromyalgia had a mean age of 44.1 ± 16.5 years. CHD events developed in fibromyalgia patients (n = 8,280; 15.2 per 103 person-years) and reference subjects (n = 15,162; 9.26 per 103 person-years) with a significant incidence rate ratio of 1.64 (95% confidence interval: 1.61-1.68). The adjusted hazard ratio for CHD in fibromyalgia patients relative to reference subjects was 1.47 (1.43-1.51), after adjusting for age, gender, occupation, monthly income, traditional cardiovascular comorbidities, depression and anxiety. We noted that fibromyalgia and cardiovascular comorbidities had a significant interaction effect on CHD risk (p for interaction <0.01), which was markedly enhanced in fibromyalgia patients with concomitant comorbidities relative to patients with primary fibromyalgia and reference subjects (no fibromyalgia, no comorbidity).

CONCLUSIONS

Our report shows that fibromyalgia patients have an independent risk for CHD development. Fibromyalgia patients with concomitant comorbidities have markedly increased CHD risk relative to those with primary fibromyalgia.

Precision Measurement of the Longitudinal Double-Spin Asymmetry for Inclusive Jet Production in Polarized Proton Collisions at sqrt[s]=200 GeV

We report a new measurement of the midrapidity inclusive jet longitudinal double-spin asymmetry, A_{LL}, in polarized pp collisions at center-of-mass energy sqrt[s]=200  GeV. The STAR data place stringent constraints on polarized parton distribution functions extracted at next-to-leading order from global analyses of inclusive deep-inelastic scattering (DIS), semi-inclusive DIS, and RHIC pp data. The measured asymmetries provide evidence at the 3σ level for positive gluon polarization in the Bjorken-x region x>0.05.

Diffuse interstitial and multiple cavitary lung lesions due to Talaromyces marneffei infection in a non-HIV patient

A 57-year-old man presented with unproductive cough and dyspnea for 6 months in Fujian Province, China. His misuse of a large amount of steroids (accumulated dose equivalent to 3530 mg prednisolone) resulted in Talaromyces marneffei infection. Chest computed tomographic scan revealed diffuse interstitial and multiple cavitary lung lesions. Treatment with amphotericin B combined with itraconazole resulted in total recovery, with marked regression of lung lesions.

Effect of Urate-lowering Therapy on the Risk of Cardiovascular Disease and All-cause Mortality in Patients with Gout: A Case-matched Cohort Study

Objective.

To examine (1) the risk of death from cardiovascular disease (CVD) and from all causes in patients with gout who do not undergo urate-lowering therapy (ULT), and (2) the effect of ULT on mortality risk in patients with gout.

Methods.

In this prospective case-matched cohort study, 40,623 Taiwanese individuals aged ≥ 17 years were followed for 6.5 years. Mortality rate was compared between 1189 patients with gout who did not receive ULT and reference subjects (no gout, no ULT) matched for age, sex, and the index date of gout diagnosis (1:3 patients with gout/reference subjects), and between 764 patients with gout who received ULT and 764 patients with gout who did not receive ULT matched 1-to-1 based on their propensity score and the index date of ULT prescription. Cox proportional hazard modeling was used to estimate the respective risk of CVD (International Classification of Diseases, 9th ed. code 390–459) and all-cause mortality.

Results.

After adjustment, patients with gout not treated with ULT had an increased risk of CVD mortality (HR 2.43, 95% CI 1.33–4.45) and all-cause mortality (1.45, 1.05–2.00) relative to the matched reference subjects (no gout, no ULT). Patients with gout treated with ULT had a lower risk of CVD (0.29, 0.11–0.80) and all-cause mortality (0.47, 0.29–0.79) relative to patients with gout not treated with ULT. This survival benefit persisted for users of either allopurinol or benzbromarone.

Conclusion.

Patients with gout who received ULT had significantly better survival rates than those who did not. Thus, undertreatment of gout has serious negative consequences.

The MTA1-TG2 is involved in self-limitation of monosodium urate crystal-induced inflammation by upregulating the levels of active TGFβ1 leading to inhibition of JAK2 signaling (HUM1P.305)

Abstract Introduction: Transglutaminase 2 (TG2), a protein crosslinking enzyme with multiple biochemical functions, has been connected to various inflammatory processes. In this study, the involvement of TG2 in monosodium urate (MSU) crystal-induced inflammation was studied. Conclusions: These findings reveal an inherent regulatory role of the MTA1-TG2 pathway in the self-limitation of MSU crystal-induced inflammation via positively regulating the levels of active TGF-b in macrophages that opposes the MSU crystal- induced JAK2 -dependent pro-inflammatory cytokine formation.

A Nanoscale-Localized Ion Damage Josephson Junction Using Focused Ion Beam and Ion Implanter

High-T(c) Josephson junctions were fabricated by nanolithography using focused ion beam (FIB) milling and ion implantation. The junctions were formed in a YBa2Cu3O7-x, thin film in regions defined using a gold-film mask with 50-nm-wide (top) slits, engraved by FIB. The focused ion beam system parameters for dwell time and passes were set to remove gold up to a precise depth. 150 keV oxygen ions were implanted at a nominal dose of up to 5 x 10(13) ions/cm2 into YBa2Cu3O7-x microbridges through the nanoscale slits. The current-voltage curves of the ion implantation junctions exhibit resistive-shunted-junction-like behavior at 77 K. The junction had an approximately linear temperature dependence of critical current. Shapiro steps were observed under microwave irradiation. A 50-nm-wide slit and 0-20-nm-thick buffer layers were chosen in order to make Josephson junctions due to the V-shape of the FIB-milled trench.

[Characteristics and perioperative management of hemophilia patients with fractures]

OBJECTIVE

To investigate the characteristics and perioperative management of hemophilia patients with fracture.

METHODS

Retrospectively, we analyzed 8 patients with hemophilia combined with fracture, who were admittted to our department from 2005 to 2013. Six patients were with hemophilia A and two with hemophilia B; Based on the severity of hemophilia, 2 cases were light, 3 moderate and 3 severe; Based on the location of fracture, 4 cases were femoral neck fractures, 1 femoral intertrochanteric fracture, 1 bilateral distal femur fractures, 1 tibiofibula fracture, and 1 humerus intercondylar fracture. Blood coagulation factor replacement therapy was conducted preoperatively, intraoperatively and postoperatively, All the patients underwent closed or open reduction and internal fixation or joint replacement. Also, we analyzed the perioperative complications and observed whether the fracture healed.

RESULTS

The average age was 33.5 years (14 to 47 years); In 6 cases, fractures occurred at femur, accounting for 75% of all the fractures; Femoral neck fracture was treated by closed reduction and hollow screws fixation; Femoral intertrochanteric fracture, distal femur fracture, and tibiofibula fracture were treated by open reduction and internal fixation with plate; Humerus intercondylar fracture was treated by elbow joint replacement. Intraoperative bleeding was from 50 to 600 mL, an average of 262 mL; Perioperatively, the average use of FVIII/activated prothrombin complex concentrates (APCC) was 358 U/kg (125 to 554 U/kg). Postoperatively, poor wound healing was observed in 2 patients, and the condition improved after symptomatic treatment; In patients with internal fixation, all the fractures united, and the average healing time was 14 weeks. No complications such as fixation loosening or rupture occurred after internal fixation.

CONCLUSION

Hemophilia combined with fracture mainly occurred in the young, and the site of fracture was given priority to femur. With perfect preoperative preparation, on the basis of the replacement therapy, hemophilia combined with fractures was safe for surgical treatment, and postoperative fractures healing wasgood. But the risk of poor wound healing was high.

Molecular identity of ramie germplasms using simple sequence repeat markers

DNA identity is highly effective and efficient for distinguishing crop varieties regardless of their phenotypic similarities. To establish DNA identity in ramie, 21 simple sequence repeat primers were amplified in 108 accessions of domestic and exotic ramie germplasms. Sixty polymorphic bands were obtained, with an average of 2.9 bands per locus and 2-8 band types per primer locus (average of 5.19 band types). The Simpson's diversity index of the 21 simple sequence repeat loci ranged from 0.158 to 0.808 with an average of 0.612. There was large difference in the specific index in the germplasm tested, from 44.082 to 218.163, with an average of 83.620. Based on allele band type, 8 primer pairs were selected for DNA fingerprinting of the 108 genotypes. The combination of the 8 primer pairs were found to be very effective for distinguishing these genotypes, indicating that they can be used in the molecular DNA identity of ramie.

The metastatic tumor antigen 1-transglutaminase-2 pathway is involved in self-limitation of monosodium urate crystal-induced inflammation by upregulating TGF-β1

INTRODUCTION

Transglutaminase 2 (TG2), a protein crosslinking enzyme with multiple biochemical functions, has been connected to various inflammatory processes. In this study, the involvement of TG2 in monosodium urate (MSU) crystal-induced inflammation was studied.

METHODS

Immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR) were performed to detect TG2 expression in synovial fluid mononuclear cells (SFMCs) and synovial tissue from patients with gouty arthritis. MSU crystal-exposed RAW264.7 mouse macrophages were analyzed for interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), transforming growth factor β1 (TGF-β1) and TG2 expression by RT-PCR and enzyme-linked immunosorbent assay (ELISA). TG2 small interfering (si)-RNA-mediated silencing and overexpression in RAW264.7 cells were used to evaluate the involvement of TG2 in resolving MSU crystal-induced inflammation. The role of metastatic tumor antigen 1 (MTA1), a master chromatin modifier, was investigated by MTA1 si-RNA-mediated knockdown. In addition, the inflammatory responses were followed in wild type and TG2 null mice after being challenged with MSU crystals in an in vivo peritonitis model.

RESULTS

TG2 expression was up-regulated in the synovium tissue and SFMCs from patients with gouty arthritis. The levels of MTA1, TG2, TGF-β1, IL-1β and TNF-α mRNAs were consistently increased in MSU crystal-stimulated RAW264.7 cells. si-MTA1 impaired the basal, as well as the MSU crystal-induced expression of TG2 and TGF-β1, but increased that of IL-1β and TNF-α. TG2 overexpression dramatically suppressed MSU crystal-induced IL-1β and TNF-α, but significantly enhanced the TGF-β1 production. Neutralizing TGF-β antibodies or inhibition of the crosslinking activity of TG2 attenuated these effects. On the contrary, loss of TG2 resulted in a reduced TGF-β, but in an increased IL-1β and TNF-α production in MSU crystal-stimulated RAW264.7 cells and mouse embryonic fibroblasts (MEFs). MSU crystal-stimulated IL-1β production was Janus kinase 2 (JAK2)-signaling dependent and TG2-induced TGF-β suppressed the activity of it. Finally, TG2-deficient mice exhibited hyper inflammatory responses after being challenged with MSU crystals in an in vivo peritonitis model.

CONCLUSIONS

These findings reveal an inherent regulatory role of the MTA1-TG2 pathway in the self-limitation of MSU crystal-induced inflammation via positively regulating the levels of active TGF-β1 in macrophages that opposes the MSU crystal-induced JAK2-dependent pro-inflammatory cytokine formation.

ΛΛ Correlation function in Au+Au collisions at √[S(NN)]=200 GeV

We present ΛΛ correlation measurements in heavy-ion collisions for Au+Au collisions at sqrt[s_{NN}]=200  GeV using the STAR experiment at the Relativistic Heavy-Ion Collider. The Lednický-Lyuboshitz analytical model has been used to fit the data to obtain a source size, a scattering length and an effective range. Implications of the measurement of the ΛΛ correlation function and interaction parameters for dihyperon searches are discussed.

Performance of classification criteria for gout in early and established disease

OBJECTIVES

To compare the sensitivity and specificity of different classification criteria for gout in early and established disease.

METHODS

This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less.

RESULTS

Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease.

CONCLUSIONS

Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations.

Observation of D0 meson nuclear modifications in Au+Au collisions at sqrt[s(NN)] = 200 GeV

We report the first measurement of charmed-hadron (D(0)) production via the hadronic decay channel (D(0) → K(-) + π(+)) in Au+Au collisions at sqrt[s(NN)] = 200 GeV with the STAR experiment. The charm production cross section per nucleon-nucleon collision at midrapidity scales with the number of binary collisions, N(bin), from p+p to central Au+Au collisions. The D(0) meson yields in central Au + Au collisions are strongly suppressed compared to those in p+p scaled by N(bin), for transverse momenta p(T) > 3 GeV/c, demonstrating significant energy loss of charm quarks in the hot and dense medium. An enhancement at intermediate p(T) is also observed. Model calculations including strong charm-medium interactions and coalescence hadronization describe our measurements.

Beam energy dependence of moments of the net-charge multiplicity distributions in Au+Au collisions at RHIC

We report the first measurements of the moments--mean (M), variance (σ(2)), skewness (S), and kurtosis (κ)--of the net-charge multiplicity distributions at midrapidity in Au+Au collisions at seven energies, ranging from sqrt[sNN]=7.7 to 200 GeV, as a part of the Beam Energy Scan program at RHIC. The moments are related to the thermodynamic susceptibilities of net charge, and are sensitive to the location of the QCD critical point. We compare the products of the moments, σ(2)/M, Sσ, and κσ(2), with the expectations from Poisson and negative binomial distributions (NBDs). The Sσ values deviate from the Poisson baseline and are close to the NBD baseline, while the κσ(2) values tend to lie between the two. Within the present uncertainties, our data do not show nonmonotonic behavior as a function of collision energy. These measurements provide a valuable tool to extract the freeze-out parameters in heavy-ion collisions by comparing with theoretical models.

Measurement of longitudinal spin asymmetries for weak boson production in polarized proton-proton collisions at RHIC

We report measurements of single- and double-spin asymmetries for W^{±} and Z/γ^{*} boson production in longitudinally polarized p+p collisions at sqrt[s]=510  GeV by the STAR experiment at RHIC. The asymmetries for W^{±} were measured as a function of the decay lepton pseudorapidity, which provides a theoretically clean probe of the proton's polarized quark distributions at the scale of the W mass. The results are compared to theoretical predictions, constrained by polarized deep inelastic scattering measurements, and show a preference for a sizable, positive up antiquark polarization in the range 0.05<x<0.2.

Beam-energy dependence of charge separation along the magnetic field in Au+Au collisions at RHIC

Local parity-odd domains are theorized to form inside a quark-gluon plasma which has been produced in high-energy heavy-ion collisions. The local parity-odd domains manifest themselves as charge separation along the magnetic field axis via the chiral magnetic effect. The experimental observation of charge separation has previously been reported for heavy-ion collisions at the top RHIC energies. In this Letter, we present the results of the beam-energy dependence of the charge correlations in Au+Au collisions at midrapidity for center-of-mass energies of 7.7, 11.5, 19.6, 27, 39, and 62.4 GeV from the STAR experiment. After background subtraction, the signal gradually reduces with decreased beam energy and tends to vanish by 7.7 GeV. This implies the dominance of hadronic interactions over partonic ones at lower collision energies.

The risk of placental abruption and placenta previa in pregnant women with chronic hepatitis B viral infection: a systematic review and meta-analysis

INTRODUCTION

Several epidemiological studies have found a positive association between chronic hepatitis B virus (CHB) infection and the risk of placental abruption and placenta previa, but various studies have reported conflicting findings. The objective was to systematically review the literature to determine a possible association between CHB infection and these two placental complications.

METHODS

We conducted a computerized search in electronic database through March 1, 2014, supplemented with a manual search of reference lists, to identify original published research on placental abruption and placenta previa rates in women with CHB infection. Data were independently extracted, and relative risks were calculated. The meta-analysis was performed using Stata version 10.0 software.

RESULTS

Five studies involving 9088 placenta previa cases were identified. No significant association between CHB infection and placenta previa was identified (OR = 0.98, 95% CI = 0.60-1.62). Five studies involving 15571 placental abruption cases were identified. No significant association between CHB infection and placental abruption was identified (OR = 1.42, 95% CI, 0.93-2.15).

DISCUSSION

The immune response against the virus represents a key factor in determining infection outcomes. No observation of significant increased risk of the placental complications could be partially explained by the complex immune response during CHB infection.

CONCLUSIONS

Our meta-analysis found no evidence of significant associations between CHB infection and increased risk of placental abruption as well as placenta previa. Further well-designed studies were warranted to assess any potential association between CHB infection and increased risk of placental abruption as well as placenta previa.

Dielectron mass spectra from Au+Au collisions at √[s(NN)]=200 GeV

We report the STAR measurements of dielectron (e(+)e(-)) production at midrapidity (|y(ee)|<1) in Au+Au collisions at √[s(NN)]=200  GeV. The measurements are evaluated in different invariant mass regions with a focus on 0.30-0.76 (ρ-like), 0.76-0.80 (ω-like), and 0.98-1.05 (ϕ-like)   GeV/c(2). The spectrum in the ω-like and ϕ-like regions can be well described by the hadronic cocktail simulation. In the ρ-like region, however, the vacuum ρ spectral function cannot describe the shape of the dielectron excess. In this range, an enhancement of 1.77±0.11(stat)±0.24(syst)±0.33(cocktail) is determined with respect to the hadronic cocktail simulation that excludes the ρ meson. The excess yield in the ρ-like region increases with the number of collision participants faster than the ω and ϕ yields. Theoretical models with broadened ρ contributions through interactions with constituents in the hot QCD medium provide a consistent description of the dilepton mass spectra for the measurement presented here and the earlier data at the Super Proton Synchrotron energies.

Aspirin may modify tumor microenvironment via antiplatelet effect

High-quality evidence suggests that aspirin is a promising agent for cancer prevention and treatment. Direct inhibition of cyclooxygenase-2 (COX-2) pathway is generally thought to be the main mechanism by which aspirin inhibits cancer development. However, either pharmacological properties of aspirin or recent results of epidemiologic studies do not support that mechanism. To address this inconsistency, we hypothesize that antiplatelet effect of aspirin via inhibition of COX-1 may be one of potential mechanisms to inhibit carcinogenesis. Aberrant platelet activation will lead to promote hostility of tumor microenvironment by releasing an abundant array of angiogenesis regulators. Given the outstanding ability of antiplatelet, aspirin may restore balance of pro- and anti-angiogenic factors released from platelet to "normalize" tumor vasculature and shape tumor microenvironment to some extent, which will not only diminish tumor aggressiveness and progression, but also enhance the sensitivity to therapeutic treatment. Thus, targeting the platelet activation leading to alter tumor microenvironment may provide a novel way to tumor therapy.

Correlation between the NPPB gene promoter c.-1298 G/T polymorphism site and pulse pressure in the Chinese Han population

The aim of this study was to investigate the correlation between the natriuretic peptide precursor B (NPPB) gene single nucleotide polymorphism (SNP) c.-1298 G/T and pulse pressure (PP) of the Chinese Han population and the association between genotype and clinical indicators of hypertension. Peripheral blood was collected from 180 unrelated patients with hypertension and 540 healthy volunteers (control group), and DNA was extracted to amplify the 5'-flanking region and 2 exons of the NPPB gene by polymerase chain reaction; the fragment was sequenced after purification. The clinical data of all subjects were recorded, the distribution of the NPPB gene c.-1298 G/T polymorphism was determined, and differences in clinical indicators between the two groups were evaluated. The mean arterial pressure PP, and creatinine levels were significantly higher in the hypertension group than in the control group (P<0.05), but no other clinical indicators differed between the groups. There were no significant differences in genotype frequency and distribution of the NPPB gene c.-1298 G/T polymorphism between the hypertension group and the control group (P>0.05); in the control group, the mean PP of individuals with the SNP c.-1298 GG genotype was greater than that of individuals with the GT+TT genotype (P<0.05). In conclusion, there was no significant correlation between the NPPB gene c.-1298 G/T polymorphism and the incidence of essential hypertension in the Han population; however, the PP of the SNP c.-1298 GG genotype was greater than that of the GT+TT genotype in the control group.