Sex-Specific Associations of Dietary Iron Intake with Brain Iron Deposition on Imaging and Incident Dementia: A Prospective Cohort Study

OBJECTIVES

The study aimed to evaluate the association of dietary iron intake with incident dementia and brain iron deposition.

DESIGN/SETTING/PARTICIPANTS

We included dementia-free participants from the UK Biobank who completed at least one 24-hour dietary recall at study baseline (2009-2012) and were followed up to 2021. Incident dementia was determined through linkage to medical records and death registries. Brain MRI was conducted in a subgroup of participants since 2014, with T2* measurements being used as indicators of brain iron deposition.

MEASUREMENTS

Cox proportional hazard models were used to assess the associations of high (top quintile) and low (bottom quintile) versus medium (quintile 2 to 4) level of dietary iron intake with incident dementia, respectively. Linear regression was applied to assess the relations between dietary iron intake and brain T2* measurements.

RESULTS

During follow-up (mean = 9.5 years), a total of 1,454 participants (650 women and 804 men) developed dementia among 191,694 participants (55.0% female; mean age, 56.2 years). When adjusted for sociodemographic, lifestyle, and other dietary factors, participants with low dietary iron intake (< 10.05 mg/day) had a significantly higher dementia risk (hazard ratio [HR], 1.50, 95% confidence interval [CI], 1.19-1.89), while the relation for high intake (> 16.92 mg/day) was non-significant (HR, 1.16, 95% CI, 0.92-1.46). A significant gender difference (P-interaction < 0.001) was observed, with a U-shaped association in male participants (HR for low vs. medium, 1.56, 95% CI, 1.14-2.13; HR for high vs. medium, 1.39, 95% CI, 1.03 - 1.88; P-nonlinearity < 0.001) and no significant association in females, regardless of their menopause status. In general, dietary iron intake was not related to T2* measurements of iron deposition in most brain regions.

CONCLUSION

Our findings suggested a U-shape relationship between dietary iron intake and risk of dementia among males, but not females.

Association between the Lymphocyte-to-C-Reactive Protein Ratio and Survival Outcomes in Cancer Patients with GLIM-Defined Malnutrition: A Multicenter Study

BACKGROUND AND AIMS

This study assessed the prognostic value of LCR in patients with cancer-associated malnutrition (CAM). Systemic inflammatory markers, particularly the lymphocyte-to-C-reactive protein ratio (LCR), are related to the survival of patients with CAM. The present retrospective analysis based on a prospective multicenter cohort study, which involved 1,437 hospitalized patients with CAM.

METHODS

The area under the receiver operating characteristic curve (AUC) of ten inflammatory indicators-LCR, advanced lung cancer inflammation index, neutrophil-to-lymphocyte ratio, prognostic nutritional index, modified Glasgow prognostic score, systemic immune-inflammation index, albumin-to-globulin ratio, LCR score, glucose-to-lymphocyte ratio, and platelet-to-lymphocyte ratio-were constructed. Nutritional status, blood markers, and quality of life (QoL) were evaluated within 48 h of admission. The overall survival (OS) was evaluated from September 1 to December 29, 2021.

RESULTS

A total of 1,431 cancer patients diagnosed with malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Male patients were 62.8% of all, and the mean age was 60.66 years old. The AUC of LCR was higher than that of other inflammatory markers. The restricted cubic spline (RCS) of the Hazard ratios (HRs) showed an inverse L-shaped relationship with LCR. In addition, patients with low LCR had significantly poorer OS than those with high LCR. The addition of LCR to the model increased the predictive ability of 1-year mortality (AUC increase of 0.036), 3-year mortality (AUC increase of 0.038), and 5-year mortality (AUC increase of 0.031).

CONCLUSIONS

Assessing the LCR can help the medical staff identify cancer patients with nutritional deficiency at high risk of oncological outcomes and develop individualized therapeutic strategies.

Effects of dietary betaine supplementation on growth performance, meat quality, muscle fatty acid composition and antioxidant ability in slow-growing broiler chickens

1. This study investigated the effects of dietary betaine supplementation on growth performance, meat quality, muscle fatty acid composition and antioxidant ability in slow-growing broiler chickens.2. In total, 400, one-day-old female Xueshan broiler chicks were randomly divided into five groups with eight replicates of ten chickens each for 102 d. Broilers were fed a basal diet supplemented with 0, 125, 250, 500 or 1,000 mg/kg betaine.3. Broilers fed betaine had better feed conversion efficiency and weight gain (P < 0.05) and increased meat redness and yellowness 24 h after slaughter. Supplementation linearly decreased cooking loss and drip loss from breast muscle (P < 0.05). Muscular resilience was improved and tenderness increased (P < 0.05). Intra-muscular saturated fatty acids decreased, while total monounsaturated fatty acids and polyunsaturated fatty acids increased (P < 0.05). Betaine increased activities of glutathione peroxidase (GPx) and total superoxide dismutase (SOD), glutathione (GSH) level, ratio of reduced glutathione/oxidised glutathione, and activity of scavenging hydroxyl radicals. It increased the activity of total antioxidant capacity (T-AOC) in the breast muscle (P < 0.05). Moreover, supplementation up-regulated (P < 0.05) mRNA expression levels of blood and antioxidant markers.4. In conclusion, 1000 mg/kg betaine can be recommended as a supplement for slow-growing, Xueshan chicken.

[Validation of a hyperkalemia prediction model in chronic kidney disease]

Objective: To validate the accuracy and consistency of a previously established prediction model for the occurrence of hyperkalemia in non-dialytic chronic kidney disease (CKD) patients. Methods: All patients diagnosed with CKD from Outpatient Department of Shanghai Changzheng Hospital during the 4th quarter of 2020 were recruited. Demographic data, clinical characteristics and prediction model-related parameters of the patients were collected and analyzed. Receiver operating characteristic (ROC) curve was drawn to evaluate the effectiveness of the model, and the specificity and sensitivity were calculated based on the cut-off value of 4 obtained from the previous model. The improved Hanley method was used to compare the area under the curve (AUC) between the previously established model and current validation dataset. The calibration curve was drawn to verify the model calibration degree. Results: A total of 434 patients diagnosed with non-dialytic CKD were enrolled, among whom 233 were males and 201 were females, with an average age of (55±16) years. According to the measured serum potassium values, the prevalence of hyperkalemia was 7.6%. And 33 patients were allocated to the hyperkalemia group and 401 patients were to the normal potassium group. There was no significant difference in age and sex between the two groups (both P>0.05). A combination of hyperkalemia and heart failure (27.3% vs 3.7%, P<0.001), diabetes (42.4% vs 19.7%, P=0.002), and acidosis (51.5% vs 7.0%, P<0.001) were more frequently in the hyperkalemia group, compared with the normal serum potassium group. Patients in the hyperkalemia group were more likely to have a past history of serum potassium ≥5.0 mmol/L (48.5% vs 2.5%, P<0.001). For the drugs that could increase serum potassium levels, there was a significant correlation between Chinese herbal medicine and the occurrence of hyperkalemia, while renin-angiotensin-aldosterone system inhibitor (RAASi) and potassium supplementation showed no significant difference between the two groups. The results of ROC curve analysis showed that the AUC was 0.914, with the sensitivity of 84.8% and the specificity of 79.8% with the cut-off value of 4. The difference of AUC between the previously established risk assessment model of hyperkalemia in patients with non-dialytic CKD and current validation dataset was not statistically significant (Z=1.924, P=0.054), indicating the good accuracy and consistency of the prediction model. In the calibration curve, when the predicted risk of patients was below 0.4 or above 0.6, the prediction effect of the model was better. Conclusion: The previously-constructed hyperkalemia prediction model in non-dialytic CKD patients had good accuracy and consistency, and could be used to evaluate the risk of hyperkalemia in all stages of non-dialytic CKD patients.

A DNA Nanoflower-Assisted Separation-Free Nucleic Acid Detection Platform with a Commercial Pregnancy Test Strip

There is a constant drive for affordable point-of-care testing (POCT) technologies for the detection of infectious human diseases. Herein, we report a simple platform for DNA detection that takes advantage of four techniques: commercially available pregnancy test strips (PTS), amplicon generation via loop-mediated isothermal amplification (LAMP), toehold-mediated strand displacement, and noncovalent immobilization of DNA on paper surface with DNA nanoflowers. This simple, separation-free platform is highly specific, as demonstrated with the detection of rtL180M, a single-nucleotide polymorphism observed in hepatitis B virus (HBV) associated with antiviral drug resistance. It is very sensitive, capable of detecting the targeted mutation at 2 copies μL^-1 . It is able to correctly identify the unmutated and rtL180M genome types of HBV in clinical samples. Given its wide adaptability, we expect this platform can be easily modified for the detection of genetic variations associated with various pathogens and human diseases.

[HCV and Treponema pallidum infection status in HIV/AIDS cases in Yunnan province, January-June, 2020]

Objective: To understand the infection status of HCV and Treponema pallidum (TP) in HIV/AIDS cases in Yunnan province,and identify the risk factors. Methods: Between January 1 and June 30 in 2020,a cross-sectional survey was conducted in Yunnan. Two enzyme-linked immunosorbent assay (ELISA) kits were used to detect anti-HCV, the positive results of both two kits indicated HCV infection. ELISA and syphilis toluidine red untreated serum test were applied to identify TP infection. Both Excel 2016 and SPSS 22.0 software were used for statistical analysis, and logistic regression model was conducted to identify the relevant factors of HCV and TP infection. Results: A total of 5 922 HIV/AIDS cases were included in this study, the infection rates of HCV and TP were 6.5% (383/5 922) and 5.8% (344/5 922) respectively. The co-infection rate of HCV and TP was 0.4% (22/5 922). The risk for HCV infection in HIV/AIDS cases was higher in younger age groups compared with age group ≥50 years (15-19:aOR=3.53;20-29:aOR=3.02;30-39:aOR=2.91;40-49:aOR=3.61), in males than in females (aOR=2.31), in the married and unmarried than in the divorced or widowed (married:aOR=1.61;unmarried:aOR=1.63), in other ethnic groups than in Han ethnic group (aOR=1.70), in people with lower education level than in people with education level of college and above (primary school degree and below:aOR=4.69;middle school:aOR=3.96), in people living in the central and western Yunnan than in people living in eastern Yunnan (central Yunnan:aOR=2.46; western Yunnan:aOR=7.08), in injection drug users than in MSM (aOR=131.08). The risk of TP infection in HIV/AIDS cases was higher in people with education level of college and primary school than in middle school degree (primary school and below:aOR=1.73;college and above:aOR=1.77), in people with other occupations than in farmers (aOR=1.39), in people living in eastern Yunnan than in people living in western Yunnan (aOR=1.75); in MSM than in people with heterosex (aOR=9.75). Conclusions: A certain proportion of HIV/AIDS cases reported between January and June in 2020 in Yunnan were co-infected with HCV and TP, many factors were associated with the co-infection. It is suggested to strengthen HCV and TP tests in HIV/AIDS cases and conduct active treatment of the co-infection.

A longitudinal study on PRRSV detection in swine herds with different demographics and PRRSV management strategies

Porcine reproductive and respiratory syndrome virus (PRRSV) has been one of the major health-related concerns in the swine production industry. Through its rapid transmission and mutation, the simultaneous circulation of multiple PRRSV strains can be a challenge in PRRSV diagnostic, control and surveillance. The objective of this longitudinal study was to describe the temporal detection of PRRSV in swine farms with different production types and PRRS management strategies. Tonsil scraping (n = 344) samples were collected from three breeding and two growing herds for approximately one year. In addition, processing fluids (n = 216) were obtained from piglet processing batches within the three breeding farms while pen-based oral fluids (n = 125) were collected in the two growing pig farms. Viral RNA extraction and reverse-transcription quantitative PCR (RT-qPCR) were conducted for all samples. The sample positivity threshold was set at quantification cycle (Cq) of ≤ 37. Statistical analyses were performed using generalized linear modelling and post hoc pairwise comparisons with Bonferroni adjustments using R statistical software. The results suggested a higher probability of detection in processing fluids compared to tonsil scraping specimens [odds ratio (OR) = 3.86; p = .096] in breeding farms whereas oral fluids were outperformed by tonsil scrapings (OR = 0.26; p < .01) in growing pig farms. The results described herein may lead to an improvement in PRRSV diagnostic and surveillance by selecting proper specimens.

Evaluation of a lateral-flow nanoparticle fluorescence assay for TB infection diagnosis

BACKGROUND:

Programmatic management of TB infection is a critical component of the WHO End TB Strategy. Interferon-gamma release assays (IGRAs) overcome some limitations of the tuberculin skin test, but implementation of IGRA testing in low-resource settings is challenging.

METHODS:

In this feasibility study, we evaluated performance of a novel digital lateral-flow assay, the QIAreach® QuantiFERON® TB (QIAreach-QFT) test, against the QuantiFERON®-TB Gold Plus (QFT-Plus) assay. A population with a mix of risk factors for TB infection (111 donors) were sampled over multiple days. A total of 207 individual blood samples were tested according to the manufacturer’s instructions.

RESULTS:

The overall percentage agreement was 95.6% (two-sided 95% CI 91.8–98), with a positive percentage agreement (i.e., sensitivity) of 100% (95% CI 94.7–100) and a negative percentage agreement (i.e., specificity) of 95.6% (95% CI 90.6–98.4). All QFT-Plus positive specimens with TB1-Nil and TB2-Nil values less than 1 IU/ml tested positive on QIAreach-QFT.

CONCLUSIONS:

QIAreach QFT is a deployable, accurate testing solution for decentralised testing. It has the potential to overcome key hurdles for TB infection screening in high-burden settings thus helping to achieve the WHO End TB programme goals.

[Fluid resuscitation strategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups]

Objective: To explore the fluid resuscitation strategy in shock stage in severely burned children with different burn areas in different age groups, and to evaluate the curative effect. Methods: A retrospective cohort study was conducted. From January 2015 to June 2020, 235 children with severe and above burns who met the inclusion criteria were hospitalized in the First Affiliated Hospital of Nanchang University, including 150 males and 85 females, aged 3 months to 12 years. After admission, it was planned to rehydrate the children with electrolyte, colloid, and water according to the domestic rehydration formula for pediatric burn shock, and the rehydration volume and speed were adjusted according to the children's mental state, peripheral circulation, heart rate, blood pressure, and urine output, etc. The actual input volume and planned input volume of electrolyte, colloid, water, and total fluid of all the children were recorded during the 8 hours since fluid replacement and the first and second 24 hours after injury. According to urine output during the 8 hours since fluid replacement, all the children were divided into satisfactory urine output maintenance group (119 cases) with urine output ≥1 mL·kg^-1·h^-1 and unsatisfactory urine output maintenance group (116 cases) with urine output <1 mL·kg^-1·h^-1, and the electrolyte coefficient, colloid coefficient, and water coefficient of the children were calculated during the 8 hours since fluid replacement. According to the total burn area, children aged <3 years (155 cases) and 3-12 years (80 cases) were divided into 15%-25% total body surface area (TBSA) group and >25%TBSA group, respectively. The electrolyte coefficient, colloid coefficient, water coefficient, and urine output of the children were calculated or counted during the first and second 24 hours after injury, and the non-invasive monitoring indicators of body temperature, heart rate, respiratory rate, and percutaneous arterial oxygen saturation and efficacy indicators of hematocrit, platelet count, hemoglobin, albumin, creatinine, and alanine aminotransferase (ALT) of the children were recorded 48 hours after injury. The prognosis and outcome indicators of all the children during the treatment were counted, including complications, cure, improvement and discharge, automatic discharge, and death. Data were statistically analyzed with independent sample or paired sample t test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. Results: During the 8 hours since fluid replacement, the actual input volume of electrolyte of all the children was significantly more than the planned input volume, and the actual input volumes of colloid, water, and total fluid were significantly less than the planned input volumes (Z=13.094, 5.096, 13.256, 7.742, P<0.01). During the first and second 24 hours after injury, the actual input volumes of electrolyte of all the children were significantly more than the planned input volumes, and the actual input volumes of water and total fluid were significantly less than the planned input volumes (Z=13.288, -13.252, 3.867, 13.183, -13.191, 10.091, P<0.01), while the actual input volumes of colloid were close to the planned input volumes (P>0.05). During the 8 hours since fluid replacement, compared with those in unsatisfactory urine output maintenance group, there was no significant change in electrolyte coefficient or colloid coefficient of children in satisfactory urine output maintenance group (P>0.05), while the water coefficient was significantly increased (Z=2.574, P<0.05). Among children <3 years old, compared with those in >25%TBSA group, the electrolyte coefficient and water coefficient of children were significantly increased and the urine output of children was significantly decreased in 15%-25%TBSA group during the first and second 24 hours after injury (Z=-3.867, -6.993, -3.417, -5.396, -5.062, 1.503, P<0.05 or P<0.01), while the colloid coefficient did not change significantly (P>0.05); the levels of efficacy indicators of hematocrit, platelet count, and hemoglobin at 48 h after injury were significantly increased, while ALT level was significantly decreased (Z=-2.720, -3.099, -2.063, -2.481, P<0.05 or P<0.01); the levels of the rest of the efficacy indicators and non-invasive monitoring indicators at 48 h after injury did not change significantly (P>0.05). Among children aged 3-12 years, compared with those in >25%TBSA group, the electrolyte coefficient and water coefficient of children in 15%-25%TBSA group were significantly increased during the first and second 24 hours after injury, the colloid coefficient during the second 24 h was significantly decreased (Z=-2.042, -4.884, -2.297, -3.448, -2.480, P<0.05 or P<0.01), while the colloid coefficient during the first 24 hours after injury, urine output during the first and second 24 hours after injury, and the non-invasive monitoring indicators and efficacy indicators at 48 hours after injury did not change significantly (P>0.05). Complications occurred in 17 children during the treatment. Among the 235 children, 211 cases were cured, accounting for 89.79%, 5 cases were improved and discharged, accounting for 2.13%, 16 cases were discharged automatically, accounting for 6.81%, and 3 cases died, accounting for 1.28%. Conclusions: The electrolyte volume in early fluid resuscitation in severely burned children exceeding the volume calculated by the formula can obtain a good therapeutic effect. Among children <3 years old, the volume of fluid resuscitation should be appropriately increased in children with extremely severe burns compared with children with severe burns during fluid resuscitation; among children aged 3-12 years, the colloid volume should be appropriately increased in children with extremely severe burns compared with children with severe burns during fluid resuscitation; non-invasive monitoring indicators can be used to monitor hemodynamics and guide fluid resuscitation in severely burned children.

[Attenuated Herpes simplex virus 1 vector expressing oncomodulin effectively allieviates mechanical optic nerve injury in rats]

OBJECTIVE

To evaluate the efficacy and safety of attenuated Herpes simplex virus 1 (HSV-1) vector expressing oncomodulin (OCM) for treatment of mechanical optic nerve injury in rats.

METHODS

The proliferation characteristics and OCM expression of the recombinant HSV-1 vector (1716-OCM) was assessed in cultured Vero cells. Twelve-week-old SD rats were randomly divided into control group, 1716-OCM injection group and wild-type virus corneal infection group, and at 7, 14, 30 and 60 days post-infection (3 rats in each group at each time point), the expressions of OCM and HSV-1 structural protein gB in the retina and the hypothalamus of the rats were detected using immunofluorescence assay. Another 20 rats were randomized into sham operation group, PBS treatment group, 1716-OCM infection group and 1716-OCM infection with cAMP sensitization group (n=5), and in the latter 3 groups, rat models of optic nerve injury models were established followed by intravitreal injection of PBS, 1716-OCM or cAMP as indicated. At 45 days after the treatments, the rats were examined for visual electrophysiological function using FVEP method, and the number of retinal ganglion cells (RGCs) and the expression of myelin basic protein in the optic nerve were detected using immunofluorescence assay.

RESULTS

The recombinant 1716-OCM vector was capable of mediating effective expression of OCM in Vero cells in vitro, but its proliferation rate was much lower than that of the wild-type virus. In SD rats, the recombinant virus could mediate the expression of OCM in the RGC layer and choroid layer of the eyes without inducing significant structural damage of the eyes as compared with the wild-type virus. In rat models of optic nerve injury, 1716-OCM combined with cAMP significantly promoted the survival of retinal RGCs (P= 0.007) and inhibited demyelination of the optic nerve (P=0.03) as compared with the mock treatment. FVEP analysis showed that 1716-OCM combined with cAMP significantly promoted the recovery of the peak amplitude of ΔN1-P1 in the rats (P < 0.0001).

CONCLUSION

Attenuated recombinant 1716-OCM vector can mediate OCM expression in the retina of rats, and in rat models of mechanical optic nerve injury, intravitreal injection of 1716-OCM combined with cAMP can effectively alleviate optic nerve injuries.

[Epidemiology of uncorrected refractive errors in type 2 diabetics aged 50 and above in Funing County, China: the Jiangsu Diabetic Eye Study]

Objective: To estimate the prevalence of uncorrected refractive errors among people aged 50 years and above in Funing county, Jiangsu province. Methods: Randomly cluster sampling was used in selecting individuals aged ≥50 years in 82 clusters from Funing County Center for Disease Prevention and Control. Uncorrected refractive error was defined as an improvement of at least 2 lines in best corrected visual acuity compared with presenting visual acuity in the better eye. The mean±standard deviation was used to describe the continuous data, and the rate or composition ratio was used to represent the classified data. Univariate and multivariate logistic regression analyses were used to analyze the prevalence of uncorrected refractive errors in different ages, genders, educational levels, durations of diabetes and levels of glycosylated hemoglobin. Statistical significance was defined as P<0.05. Results: A total of 2 067 persons were enumerated, and 1910 (92.4%) participants were in the statistical analyses. The prevalence of uncorrected refractive error was 25.63%. The prevalence of uncorrected refractive error for myopia only, hyperopia only, astigmatism only, myopia with astigmatism and hyperopia with astigmatism was 72.55% (37/51), 46.77% (58/124), 17.81% (13/73), 63.95% (94/147) and 51.98% (100/194), respectively. The results showed that the older age, level of glycosylated hemoglobin, myopia and lens state were the independent influencing factors of uncorrected refractive error. The odds ratio (OR) for people aged 70 to<80 years and ≥80 years was 1.81 and 1.90, respectively, with statistical significance compared to people younger than 60 years. Compared with the level of glycosylated hemoglobin less than 5.6%, the OR with glycosylated hemoglobin from7.1% to 8.0% and more than 10% was 1.84 (P<0.05) and 1.82 (P<0.05), respectively. The OR of myopia, low myopia, moderate myopia and high myopia was 2.98 (P<0.01), 6.94 (P<0.01), 42.43 (P<0.01) and 77.85 (P<0.01), respectively. The OR of opacity of the eye lens was 7.60 (P<0.01). Conclusions: Uncorrected refractive error is one of the important causes of visual impairment in diabetic patients aged 50 and above in Funing county, Jiangsu province; the important influencing factors were age, glycosylated hemoglobin concentration, myopia and lens status. Relevant health departments should popularize the eye health for diabetic patients and conduct regular optometry and fundus examination. (Chin J Ophthalmol, 2021, 57: 757-765).

[Concordant systemic and local eosinophilia relates to poorer disease control in patients with nasal polyps]

Objective: To explore whether blood and polyp tissue eosinophil numbers are independent risk factors for poor disease control in patients with nasal polyp. Methods: By using the electronic medical records database and manual evaluation, 183 nasal polyp patients who had undergone endoscopic sinus surgery at least one year prior to the study with complete data of tissue specimens, baseline blood routine test, nasal endoscopy and sinus computed tomography, were identified and recruited to assess disease control based on the criteria of a European Position Paper on Rhinosinusitis and Nasal Polyps 2012 (EPOS 2012). Multiple logistic regression model was used to determine the association between blood and tissue eosinophil numbers and risk of poor disease control by adjusting for demographics and comorbidities. Results: We broke down the cohort into 4 groups according to blood (0.3×10⁹/L) and tissue (10%) eosinophils. The patients without eosinophilic inflammation represented the largest group (41.5%). The group with concordant blood and tissue eosinophilia represented the second largest (31.2%), and the patients with isolated tissue (15.3%) or blood (12.0%) eosinophilia were relatively rare. Multiple logistic regression models found blood eosinophil count and tissue eosinophil percentage were independently associated with increased risk for poor disease control after adjustments for covariates related to poor treatment outcome. Furthermore, subjects with concordant blood and tissue eosinophilia had a higher risk for poor disease control than those with isolated blood or tissue eosinophilia. Conclusion: Concordant blood and tissue eosinophilia relates to a higher likelihood of poor disease control than isolated blood or tissue eosinophilia after adjustment of potential confounders in nasal polyp patients.

[Clinicopathological characteristics and prognosis of patients with sporadic multiple primary gastrointestinal stromal tumors]

Objective: To investigate the clinicopathological characteristics and prognosis of sporadic multiple primary gastrointestinal stromal tumor (GIST). Methods: A retrospective cohort study was conducted. Case inclusion criteria: (1) postoperative pathological diagnosis of GIST; (2) primary GIST with single lesion or sporadic multiple primary GIST (sporadic GIST was defined as primary GIST other than familial and syndrome-related GIST, and multiple primary GIST was defined as the number of primary GISTs in the same patient ≥ 2); (3) patients with complete clinicopathological data. Those with tumor recurrence or distant metastasis, and with other malignancies were excluded. Medical records of patients with primary GIST who underwent surgical resection in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2010 to December 2020 were collected. Patients were divided into sporadic multiple primary GIST group and single primary GIST group according to the number of primary GIST lesions. The clinicopathological data and prognosis of the two groups were observed and compared. Results: A total of 1200 patients with primary GIST were enrolled in this study, including 628 males (52.3%) and 572 females (47.7%), with a median onset age of 58 (19-93) years. Among them, 1165 cases (97.1%) were sporadic primary GIST with single lesion; 35 cases (2.9%) were sporadic multiple primary GIST. Among 35 cases of sporadic multiple primary GIST, 3 cases (8.6%) had acid reflux as the first symptom, which was higher than the single primary GIST group (22/1165, 1.9%) (χ(2)=7.437, P=0.006). There were no significant differences in other clinical characteristics between the two groups (all P>0.05). Patients in the sporadic multiple primary GIST group contained a total of 80 primary tumors. Compared with the single primary GIST group, the sporadic multiple primary GIST group had a higher proportion of tumors originating in the stomach [87.5% (70/80) vs. 59.1% (689/1165)], lower proportion of spindle cell in histology [85.0% (68/80) vs. 93.7% (1092/1165)], higher proportion of positive CD34 [97.5% (78/80) vs. 87.6% (1021/1165)], smaller maximum diameter [maximum diameter ≤2.0 cm: 61.2% (49/80) vs. 28.8% (335/1165)], lower mitotic rate [≤5/50 high-power fields (HPF): 93.8% (75/80) vs. 74.5% (868/1165)], lower risk of recurrence [60.0% (48/80) vs. 23.3% (271/1165)], and the differences were all statistically significant (all P<0.05). The 3-year recurrence-free survival rate in the sporadic multiple primary group and the single primary GIST group was 96.6% and 89.3% respectively (P=0.160), and the 3-year overall survival rate was 100.0% and 92.8%, respectively (P=0.088). Conclusions: The most common type of sporadic multiple primary GIST is multiple tumors originating in the stomach at the same time. Compared with primary GIST with single lesion, sporadic multiple primary GIST presents smaller maximum diameter and lower mitotic rate. The prognosis of patients between two groups is not significantly different.

Quantum oscillations in an optically-illuminated two-dimensional electron system at the LaAlO3/SrTiO3interface

We have investigated the illumination effect on the magnetotransport properties of a two-dimensional electron system at the LaAlO₃/SrTiO₃interface. The illumination significantly reduces the zero-field sheet resistance, eliminates the Kondo effect at low-temperature, and switches the negative magnetoresistance into the positive one. A large increase in the density of high-mobility carriers after illumination leads to quantum oscillations in the magnetoresistance originating from the Landau quantization. The carrier density (∼2 × 10¹² cm^-2) and effective mass (∼1.7m_e) estimated from the oscillations suggest that the high-mobility electrons occupy thed_xz/yzsubbands of Ti:t_2gorbital extending deep within the conducting sheet of SrTiO₃. Our results demonstrate that the illumination which induces additional carriers at the interface can pave the way to control the Kondo-like scattering and study the quantum transport in the complex oxide heterostructures.

SARS-CoV-2 Point-of-Care (POC) Diagnosis Based on Commercial Pregnancy Test Strips and a Palm-Size Microfluidic Device

Coronavirus diseases such as the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), pose serious threats. Portable and accurate nucleic acid detection is still an urgent need to achieve on-site virus screening and timely infection control. Herein, we have developed an on-site, semiautomatic detection system, aiming at simultaneously overcoming the shortcomings suffered by various commercially available assays, such as low accuracy, poor portability, instrument dependency, and labor intensity. Ultrasensitive isothermal amplification [i.e., reverse transcription loop-mediated isothermal amplification (RT-LAMP)] was applied to generate intensified SARS-CoV-2 RNA signals, which were then transduced to portable commercial pregnancy test strips (PTSs) via ultraspecific human chorionic gonadotropin (hCG)-conjugated toehold-mediated strand exchange (TMSE) probes (hCG-P). The entire detection was integrated into a four-channel, palm-size microfluidic device, named the microfluidic point-of-care (POC) diagnosis system based on the PTS (MPSP) detection system. It provides rapid, cost-effective, and sensitive detection, of which the lowest concentration of detection was 0.5 copy/μL of SARS-CoV-2 RNA, regardless of the presence of other similar viruses, even highly similar severe acute respiratory syndrome coronavirus (SARS-CoV). The successful detection of the authentic samples from different resources evaluated the practical application. The commercial PTS provides a colorimetric visible signal, which is instrument- and optimization-free. Therefore, this MPSP system can be immediately used for SARS-CoV-2 emergency detection, and it is worthy of further optimization to achieve full automation and detection for other infectious diseases.

Genetic parameters and weighted single-step genome-wide association study for supernumerary teats in Holstein cattle

Supernumerary teats (SNT) are a common epidermal abnormality of udders in mammals. The SNT negatively affect machine milking ability, udder health, and animal welfare and sometimes act as reservoirs for undesirable bacteria, resulting in economic losses on calves and lactating cows due to the cost of SNT removal surgery, early culling, and low milk yield. This study aimed to analyze the incidence and genetic parameter of SNT and detect SNT-related genes in Chinese Holstein cattle. In this study, the incidence of SNT was recorded in 4,670 Chinese Holstein cattle (born between 2008 and 2017) from 2 farms, including 734 genotyped cows with 114,485 SNPs. The SNT had a total frequency of 9.8% and estimated heritability of 0.22 (SE = 0.07), which were obtained using a threshold model in the studied Chinese Holstein population. Furthermore, we calculated approximate genetic correlations between SNT and the following indicator traits: 12 milk production, 28 body conformation, 5 fertility and reproduction, 5 health, and 9 longevity. Generally, the estimated correlations, such as 305-d milk yield for third parity (-0.55; SE = 0.02) and age at first calving in heifer (0.19; SE = 0.03), were low to moderate. A single-step GWAS was implemented, and 10 genes associated with SNT located in BTA4 were identified. The region (112.70-112.90 Mb) on BTA4 showed the highest genetic variance for SNT. The quantitative trait loci on BTA4 was mapped into the RARRES2 gene, which was previously shown to affect adipogenesis and hormone secretion. The WIF1 gene, which was located in BTA5, was also considered as a candidate gene for SNT. Overall, these findings provide useful information for breeders who are interested in reducing SNT.

P–199 A case report to suggest that there must be other mutations than PATL2 or TUBB8 to cause oocyte maturation arrest

Study question

What causes our patient’s repeated almost complete oocyte maturation arrest (OMA)?

Summary answer

Since we did not detect PATL2 and TUBB8 mutations, both known to cause OMA, this case was likely caused by mutations in HUS1 and ITGB3

What is known already

OMA has been associated with loss-of-function in key genes, such as PATL2 and TUBB8. Such patients have, however, uniformly have been unable to conceive with IVF

Study design, size, duration

We here report the case of repeatedly presenting patient between 2009 until 2020 (age 30 at 1st and 41 at last visit).

Participants/materials, setting, methods

The couple underwent 7 IVF treatments under several ovarian stimulation protocols at different gonadotropin dosages and in different preparations to try to recruit mature eggs. She conceived in her 2nd IVF cycle in 2009 and delivered uneventfully in 2010. She then conceived spontaneously and delivered a healthy boy in 2014. The couple since then has been attempting another pregnancy. Remarkably, in all IVF cycles all eggs but one arrested at prophase.

Main results and the role of chance

The female demonstrates abnormally high ovarian reserve for age (AMH=5.9 ng/mL in 2019) (mean, 10.6 oocytes). In all cycles, all but one retrieved were immature. In vitro maturation rate for the GV oocytes was 28%. Resultant M2s, however, demonstrated morphological abnormalities, such as giant polar bodies. In vivo M2s, in contrast, were always morphologically unremarkable, and their fertilization rate was 85%. Embryo morphology deteriorated appreciatively with advancing age. Sanger sequencing for TUBB8 and PATL2 genes were unremarkable. Whole genome sequencing of her and her sister (who had no fertility problems) revealed mutations of genes belonging to the integrin family (ITGB3) and DNA repair checkpoint (HUS1), both of which could be determinants in the observed maturation arrest.

Limitations, reasons for caution

A functional study, coupled with imaging of the discarded material, will likely offer further information regarding the mechanisms leading to OMA in this female.

Wider implications of the findings: This case report represents a new phenotype of female infertility, characterized by almost complete maturation arrest which, however, still offers opportunity for pregnancy. Further isolation of underlying mutation(s) may offer additional insights about checkpoints required for the transition of prophase to metaphase in human oocytes.

Trial registration number

NA

Feasibility of unilateral hemilaminectomy utilizing a Williams retractor for the resection of intradural-extramedullary spinal neoplasms

BACKGROUND

While open approaches have historically been used in the surgical treatment of intradural-extramedullary spine tumors, minimally-invasive surgical (MIS) techniques are frequently applied to minimize post-operative complications associated with open surgery. Tubular retractor systems in particular have been employed in combination with the unilateral hemilaminectomy (UHL) approach. Here we describe the use of a Williams retractor as a safe and effective minimally-invasive alternative to tubular retractor systems with similar post-operative outcomes.

METHODS

We retrospectively reviewed a cohort of eight patients who underwent unilateral hemilaminectomy using a Williams retractor for the minimally-invasive resection of intradural-extramedullary neoplasms at a large tertiary academic center from 2017 to 2019. Patient demographics, pathologic specimens, radiographic studies, and intraoperative parameters were collected and analyzed.

RESULTS

In our series, gross total resection was achieved in all cases. Average operative time was 158±40minutes, the mean estimated blood loss (EBL) was 44.4±30.4mL, and mean length of stay was three days. All patients reported symptomatic improvement at follow-up as reported by Visual Analog Scale scores.

CONCLUSION

A Williams retractor yields similar outcomes with respect to post-operative pain, operative time, and EBL as it maintains the advantages of the UHL approach in the resection of intradural-extramedullary spine tumors while enhancing feasibility and providing significant cost savings.

MiR-145-5p promotes myocardial cell apoptosis in rats with myocardial infarction through PI3K/Akt signaling pathway

OBJECTIVE

The aim of this study was to explore the influence of micro ribonucleic acid (miR)-145-5p on myocardial cell apoptosis in rats with myocardial infarction (MI) through the phosphatidylinositol 3-hydroxy kinase/protein kinase B (PI3K/Akt) pathway.

MATERIALS AND METHODS

In this study, Sprague-Dawley rats were used as research objects to establish the acute MI model in vivo. Infarction tissues and non-infarction tissues were both collected from rats. The expression level of miR-145-5p was determined using quantitative Polymerase Chain Reaction (qPCR), and the pathological changes in myocardial tissues of rats were observed through hematoxylin-eosin (HE) staining. In addition, H9c2 rat myocardial cells were cultured under hypoxia or normal oxygen concentration to simulate hypoxia in MI tissues. The changes in the expression of miR-145-5p in H9c2 cells in normal oxygen and hypoxia were determined. Meanwhile, the ratio of apoptotic cells to viable cells, and the changes in the expressions of proteins B-cell lymphoma 2 (Bcl-2), Bcl-2 associated X protein (Bax), Caspase-3 and Caspase-9 were evaluated through flow cytometry assay and Western blotting, respectively. The expression levels of crucial proteins in the PI3K/Akt pathway were measured as well. Additionally, H9c2 cells were transfected with miR-145-5p control and miR-145-5p mimic to evaluate cell apoptosis.

RESULTS

QPCR results revealed that the expression level of miR-145-5p was substantially elevated in MI tissues (p<0.05). HE results indicated that the soma exhibited deformation after MI, suggesting that there were more necrotic and apoptotic cells. Compared with those cultured under normal oxygen concentration, H9c2 cells cultured in hypoxia environment exhibited significantly upregulated expression level of miR-145-5p, downregulated expression level of anti-apoptosis protein Bcl-2, upregulated level of pro-apoptosis protein Bax, activated Caspase-3 and Caspase-9, and downregulated expression level of functional proteins in the PI3K/Akt pathway (p<0.05). Furthermore, the expression levels of apoptosis-associated proteins significantly rose in H9c2 cells transfected with miR-145-5p mimic compared with those transfected with miR-145-5p control, showing statistically significant differences (p<0.05).

CONCLUSIONS

MiR-145-5p is notably raised in MI tissues of rats. After infarction, there are evidently more apoptotic myocardial cells. The expression of miR-145-5p is markedly elevated in H9c2 rat myocardial cells in hypoxia. Compared with those cultured in normal oxygen, H9c2 cells cultured in hypoxia showed increased apoptosis. The apoptosis of myocardial cells transfected with miR-145-5p mimic is notable higher than that of myocardial cells transfected with miR-145-5p control. Moreover, the expressions of active Akt and PI3K proteins decrease remarkably. The results of this study demonstrate that miR-145-5p inactivates the PI3K/Akt pathway to promote the apoptosis of MI cells.