Soluble CD14 Subtype in Peripheral Blood is a Biomarker for Early Diagnosis of Sepsis

OBJECTIVE

To study the value of serum soluble CD14 subtype (sCD14-ST) in early diagnosis of sepsis.

METHODS

Seventy-two patients were diagnosed with systemic inflammatory response syndrome, sepsis, or septic shock. Peripheral blood was collected at 0, 12, 24, and 48 hours after admission to the hospital. Levels of sCD14-ST, procalcitonin (PCT), hypersensitive C-reactive protein (CRP), and white blood cells (WBC) were determined.

RESULTS

Levels of sCD14-ST in the patients with septic shock were higher than those in the other patients (P < .01) and peaked at 48 h. PCT and CRP levels were similar in the patients at admission but increased by 5 times to 10 times in the next 48 h, especially in the patients with septic shock. WBC levels remained high and did not change dramatically. Receiver operating characteristic analysis revealed that the area under the curve, sensitivity, and specificity values of sCD14-ST to diagnose sepsis were much higher than those of the other markers.

CONCLUSION

Compared with PCT, CRP, and WBC, sCD14-ST is a better biomarker for the early diagnosis of sepsis.

Genome-wide survey of parent-of-origin-specific associations across clinical traits derived from electronic health records

Parent-of-origin (PoO) effects refer to the differential phenotypic impacts of genetic variants dependent on their parental inheritance due to imprinting. While PoO effects can influence complex traits, they may be poorly captured by models that do not differentiate the parental origin of the variant. The aim of this study was to conduct a genome-wide screen for PoO effects on a broad range of clinical traits derived from electronic health records (EHR) in the DiscovEHR study enriched with familial relationships. Using pairwise kinship estimates from genetic data and demographic data, we identified 22,051 offspring among 134,049 individuals in the DiscovEHR study. PoO of ~9 million variants was assigned in the offspring by comparing offspring and parental genotypes and haplotypes. We then performed genome-wide PoO association analyses across 154 quantitative and 611 binary traits extracted from EHR. Of the 732 significant PoO associations identified (p < 5 × 10^-8), we attempted to replicate 274 PoO associations in the UK Biobank study with 5,015 offspring and replicated 9 PoO associations (p < 0.05). In summary, our study implements a bioinformatic and statistical approach to examine PoO effects genome-wide in a large population study enriched with familial relationships and systematically characterizes PoO effects on hundreds of clinical traits derived from EHR. Our results suggest that, while the statistical power to detect PoO effects remains modest yet, accurately modeling PoO effects has the potential to find new associations that may have been missed by the standard additive model, further enhancing the mechanistic understanding of genetic influence on complex traits.

Glycyrrhizic acid, as an inhibitor of HMGB1, alleviates bleomycin-induced pulmonary toxicity in mice through the MAPK and Smad3 pathways

AIM

High-mobility group box 1 (HMGB1) protein has been noticed particularly for its pivotal role in several pathologies. However, the relevance between HMGB1 and pathological progress in lung toxicity still remains unclear. In the study, we evaluated the effect of glycyrrhizic acid as an HMGB1 inhibitor on the early inflammation and late fibrosis in bleomycin-induced pulmonary toxicity in mice.

METHODS

We established a bleomycin-induced pulmonary toxicity model to detect the relevance between HMGB1 and pathological changes in the early inflammatory and late fibrotic stages.

RESULTS

We found that bleomycin-induced increase in inflammatory cytokines interleukin (IL)-β1, tumor necrosis factor (TNF)-α, monocyte chemotactic protein (MCP)-1, and inflammatory lesions in lung tissue in the early stage of the model. However, markers of fibrosis such as transforming growth factor (TGF)-β1 and α-smooth muscle actin (α-SMA) were significantly elevated on day 7 after bleomycin instillation. Interestingly, HMGB1 also began to rise on day 7, rather than in the early inflammatory phase. However, early (from day 0 to 14 after bleomycin instillation) or late (from day 14 to 28) intervention with HMGB1 neutralizing antibody or glycyrrhizic acid alleviated inflammation and fibrosis through down-regulating the inflammatory signaling mitogen-activated protein kinase (MAPK) and fibrotic signaling Smad3 pathway.

CONCLUSION

Our results suggested that HMGB1 mediates both inflammation and fibrosis in this model. The development of high-potency and low-toxicity HMGB1 inhibitors may be a class of potential drugs for the treatment of pulmonary fibrosis.

The complete chloroplast genome and phylogenetic analysis of Syringa reticulata subsp. amurensis (Rupr.) P.S.Green & M.C.Chang from Qinghai Province, China

Syringa reticulata subsp. amurensis (Rupr.) P. S. Green & M. C. Chang (Oleaceae) is a shrub or tree with high medicinal value as well as great ecological significance as an urban garden plant. To better understand the molecular genetics and evolutionary of S. reticulata subsp. amurensis, its complete chloroplast genome was sequenced and annotated. The assembled chloroplast genome is a circular 156,141 bp sequence, consisting of 87,108 bp large single copy (LSC) region and 17,239 bp small single copy (SSC) region, which were flanked by a pair of 25,897 bp inverted repeats (IRs). The GC content of the chloroplast genome is 36.14%. Moreover, a total of 132 functional genes were annotated, including 88 protein-coding, 36 tRNA, and eight rRNA genes. Phylogenetic analysis showed that S. reticulata subsp. amurensis was most closely related to S. reticulata subsp. Pekinensis and the genus Syringa is paraphyletic group. This study provides important information for further phylogenetic studies on S. reticulata subsp. amurensis and its allies.

Two-Tier Synergic Governance of Greenhouse Gas Emissions and Air Pollution in China's Megacity, Shenzhen: Impact Evaluation and Policy Implication

Making a cost-effective governance of greenhouse gas (GHG) emissions and air pollution is of great importance for megacities to pursue a sustainable future. To achieve this, the present study advocates megacities to implement a two-tier synergic governance system consisting of both synergic governance between GHG and air pollutant emission reductions and between megacities and their surrounding regions. Based on the LEAP model and WRF-SMOKE-CMAQ simulation platform, this study found that climate governance of China's megacity, Shenzhen, could synergistically contribute to decreasing urban annual PM_2.5 concentration by 5.6% in 2030. Using synergic governance with surrounding regions could further help cap and then quickly decrease the megacity's GHG emissions and lower its PM_2.5 concentrations by an additional 11.8%. The results demonstrated the substantial effects of transdepartment and transregional synergic governance on Shenzhen's GHG emission reduction and air quality improvement. Furthermore, this study suggested road transportation and power generation and supply as the two priority fields for wide-ranging megacities to promote two-tier synergic governance, highlighting an integration of improved urban electrification with high-efficiency electricity use and a renewable-based power supply.

Sensorineural hearing loss may lead to dementia-related pathological changes in hippocampal neurons

Presbycusis contributes to cognitive decline and Alzheimer's disease. However, most research in this area involves clinical observations and statistical modeling, and few studies have examined the relationship between hearing loss and the molecular changes that lead to cognitive dysfunction. The present study investigated whether hearing loss contributes to dementia in the absence of aging and noise using a mouse model of severe bilateral hearing loss induced by kanamycin (1000 mg/kg) and furosemide (400 mg/kg). Immunohistochemistry, silver staining, immunofluorescence analysis, and Western blotting were used to observe pathological changes in different regions of the hippocampus in animals with hearing loss. Changes in the cognitive function of animals with hearing loss were assessed using the Morris water maze test. The results showed that neurons began to degenerate 60 days after hearing loss, and this degeneration was accompanied by structural disorganization and decreased neurogenesis. The level of phosphorylated tau increased over time. Increases in escape latency and distance traveled during the training phase of the Morris water maze test were observed 90 days after hearing loss. Activated microglia and astrocytes with increased levels of inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were detected in the hippocampus. These results suggest that hearing loss alone causes neuronal degeneration, inhibition of neurogenesis, increased tau protein phosphorylation, and increased neuroinflammation in the hippocampus. Early intervention in individuals with hearing loss may reduce the risk of cognitive decline.

A randomized, double-blinded, phase III study of icaritin versus huachashu as the first-line therapy in biomarker-enriched HBV-related advanced hepatocellular carcinoma with poor conditions: Interim analysis result

4077

Background: Many advanced hepatocellular carcinoma (aHCC) patients (pts) are often with more complicated clinical conditions such as damaged liver or blood function, poor physical conditions. Those aHCC pts are not suitable for molecular target drug like sorafenib or systemic chemotherapy and no standard or generally accepted treatment. Icaritin, a single molecule ( > 98% purity) derived from Epimedii herba (Traditional Chinese herbal medicine), is a novel immune-modulation anti-tumor agent. Preclinical studies demonstrated that Icaritin induced anti-HCC activities through targeting IL-6/JAK//STAT3 pathways and modulating inflammation-immune systems including Th1 cytokines, and down-regulation of alpha-fetoprotein (AFP). Prior phase II study demonstrated favorable overall survival (OS) improvement in aHCC pts with poor conditions and correlated with the combined serum biomarkers. The current phase III study was designed to confirm above clinical benefits and safety of Icaritin in those patients. Methods: An adaptive enrichment design was used in a multicenter randomized, double-blinded study of comparing Icaritin with Huachashu (a TCM formula commonly used in China) as first line therapy for those aHCC pts (NCT03236636). The primary endpoint was overall survival (OS) and secondary endpoints included time-to-progression (TTP), progression-free-survival (PFS), disease control rate (DCR), and safety. The pts were randomized (1:1) to receive either Icaritin at 600mg or Huachashu. Based on prior studies, a composite biomarker score (CBS) of AFP(≥400 ng/mL), TNF-a( < 2.5 pg/mL) and IFN-g(≥7.0 pg/mL) was used for pts selection and a CBS score of 2/3 was predefined positive. Patients with CBS-positive were applied in interim analysis according to the protocol and statistical analysis plan (SAP). Results: A total of 283 aHCC pts were enrolled and randomized from Sept. 2017, and 71 enriched pts was CBS-positive with combined risk/poor prognosis factors such as BCLC stage C, HBV infection, and thrombocytopenia etc.. Thirty-three and 38 CBS-positive aHCC pts were treated with Icaritin or Huachashu, respectively. With a median follow-up of 8.1 mo (cutoff date, Dec.30,2020), the treatment outcomes for Icaritin and Huachashu arm showed following, that is mOS, 13.54 vs. 7.06 mo (HR = 0.40, 95%CI 0.21-0.77, p = 0.0046), mTTP, 3.65 vs. 1.84 mo (HR = 0.67, 95%CI, 0.36-1.22), mPFS, 2.79 vs. 1.84 mo (HR = 0.75, 95%CI, 0.43-1.33), and DCR, 48.5% vs. 26.3, respectively. Treatment-related adverse event (AE≥3 grades) observed were 15.2% vs. 31.6%, respectively. Conclusions: Small molecule immunomodulation agent Icaritin could significantly improve the overall survival with favorable safety in a prospectively CBS-enriched HBV-related advanced HCC pts with poor conditions. Clinical trial information: NCT03236636.

Quantifying economic-social-environmental trade-offs and synergies of water-supply constraints: An application to the capital region of China

Sustainable water management is one of the sustainable development goals (SDGs) and is characterized by a high level of interdependencies with other SDGs from regional to global scales. Many water assessment studies are restricted to silo thinking, mostly focusing on water-related consequences, while lacking a quantification of trade-offs and synergies of economic, social, and environmental dimensions. To fill this knowledge gap, we propose a "nexus" approach that integrates a water supply constrained multi-regional input-output (mixed MRIO) model, scenario analysis, and multi-criteria decision analysis (MCDA) to quantify the trade-offs and synergies at the sectoral level for the capital region of China, i.e. the Beijing-Tianjin-Hebei urban agglomeration. A total of 120 industrial transition scenarios including nine major industries with high water-intensities and water consumption under current development pathways were developed to facilitate the trade-off and synergy analysis between economic loss, social goals (here, the number of jobs) and environmental protection (with grey water footprint representing water pollution) triggered by water conservation measures. Our simulation results show that an imposition of a tolerable water constraint (a necessary water consumption reduction for regional water stress level to move from severe to moderate) in the region would result in an average economic loss of 68.4 (± 16.0) billion Yuan (1 yuan ≈ 0.158 USD$ in 2012), or 1.3 % of regional GDP, a loss of 1.94 (± 0.18) million jobs (i.e. 3.5 % of the work force) and a reduction of 1.27 (± 0.40) billion m³ or about 2.2% of the regional grey water footprint. A tolerable water rationing in water-intensive sectors such as Agriculture, Food and tobacco processing, Electricity and heating power production and Chemicals would result in the lowest economic and job losses and the largest environmental benefits. Based on MCDA, we selected the 10 best scenarios with regard to their economic, social and environmental performances as references for guiding future water management and suggested industrial transition policies. This integrated approach could be a powerful policy support tool for 1) assessing trade-offs and synergies among multiple criteria and across multiple region-sectors under resource constraints; 2) quantifying the short-term supply-chain effects of different containment measures, and 3) facilitating more insightful evaluation of SDGs at the regional level so as to determine priorities for local governments and practitioners to achieve SDGs.

Exome Sequencing of 21 Bardet-Biedl Syndrome (BBS) Genes to Identify Obesity Variants in 6,851 American Indians

OBJECTIVE

In an ongoing effort to identify the genetic variation that contributes to obesity in American Indians, known Bardet-Biedl syndrome (BBS) genes were analyzed for an effect on BMI and leptin signaling.

METHODS

Potentially deleterious variants (Combined Annotation Dependent Depletion score > 20) in BBS genes were identified in whole-exome sequence data from 6,851 American Indians informative for BMI. Common variants (detected in ≥ 10 individuals) were analyzed for association with BMI; rare variants (detected in < 10 individuals) were analyzed for mean BMI of carriers. Functional assessment of variants' effect on signal transducer and activator of transcription 3 (STAT3) activity was performed in vitro.

RESULTS

One common variant, rs59252892 (Thr549Ile) in BBS9, was associated with BMI (P = 0.0008, β = 25% increase per risk allele). Among rare variants for which carriers had severe obesity (mean BMI > 40 kg/m² ), four were in BBS9. In vitro analysis of BBS9 found the Ile allele at Thr549Ile had a 20% increase in STAT3 activity compared with the Thr allele (P = 0.01). Western blot analysis showed the Ile allele had a 15% increase in STAT3 phosphorylation (P = 0.006). Comparable functional results were observed with Ser545Gly and Val209Leu but not Leu665Phe and Lys810Glu.

CONCLUSIONS

Potentially functional variants in BBS genes in American Indians are reported. However, functional evidence supporting a causal role for BBS9 in obesity is inconclusive.

Clinical significance of serum homocysteine as a biomarker for early diagnosis of diabetic nephropathy in type 2 diabetes mellitus patients

Objective

The aim of this study was to investigate the clinical significance of serum homocysteine (Hcy) as a biomarker for early diagnosis of diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) patients.

Methods

Fifty-five T2DM patients with DN and 51 T2DM patients without DN were prospectively recruited from January 2016 to May 2020 in our hospital. The serum Hcy was tested by electrochemiluminescence assay in DN and T2DM groups and compared. The diagnostic efficacy of serum Hcy as a biomarker for early diagnosis of DN was evaluated by calculating the diagnostic sensitivity, specificity and area under the ROC curve (AUC).

Results

The serum levels of Hcy were 15.49 ± 5.40 and 9.23 ± 3.15 μmol/L for DN and T2DM patients, respectively, with statistical difference (t = 7.21, P < 0.001). In the DN group, the serum Hcy levels for patients with hyperfiltration, intermittent proteinuria, microalbuminuria, macroalbuminuria and uremic were 10.99 ± 2.57, 13.90 ± 2.86, 15.38 ± 4.77, 18.98 ± 4.36 and 23.31 ± 5.22 μmol/L, respectively, which indicated that serum Hcy levels in DN were higher than those of T2DM patients and correlated with patient’s renal damage. Using the serum Hcy level as the reference, the diagnostic sensitivity, specificity and AUC were 84.31 (71.41–92.98)%, 74.55 (61.00–85.33)% and 0.85 (0.78–0.92)%, respectively, with the cutoff value of 12.08 between DN and T2DM. The serum Hcy also had relatively good differential diagnostic efficacy between different DN stages with high sensitivity, specificity and AUC.

Conclusion

Serum Hcy was obviously elevated in DN compared to T2MD and correlated with the renal damage severity, which can be applied as a potential serological marker for early diagnosis of DN.

How do socioeconomic factors influence urban PM2.5 pollution in China? Empirical analysis from the perspective of spatiotemporal disequilibrium

PM_2.5 pollution has harmed the health and social lives of residents, and although evidence of PM_2.5 pollution caused by human activities has been reported in a large body of literature, traditional econometric and spatial models can explain the contribution of a given factor from only a global perspective. Given this limitation, this study quantitatively investigated the effects of the spatiotemporal heterogeneity of various socioeconomic factors on PM_2.5 pollution in 273 Chinese cities from 2010 to 2016 by exploratory spatial data analysis (ESDA) and geographically weighted regression (GWR). The spatiotemporal distribution pattern and intrinsic driving mechanism of city-level PM_2.5 pollution were systematically examined. The results indicate the following: (1) The cities with high PM_2.5 pollution are located north of the Yangtze River and east of the Hu line. A notable positive spatial correlation was observed between these cities, and nearly one-third of the cities are in the HH clustering area. (2) From the global regression point of view, population size and economic development are the main factors causing the deterioration and spread of PM_2.5 pollution in Chinese cities, and population size undoubtedly exerts the strongest influence. Industrial structure, economic development, openness degree, urbanization and road intensity also play weak roles in promoting urban PM_2.5 pollution. (3) The socioeconomic factors influencing pollution exhibit significant spatial heterogeneity. Specifically, the cities in which pollution is promoted by economic development are mainly concentrated in the northeast and western regions. The cities in which population size exerts a positive driving effect are in most regions, except for a few central and western cities. Three targeted strategies for developing more sustainable cities are comprehensively discussed by building on the understanding of the socioeconomic driving mechanism for PM_2.5 pollution.

Gastroesophageal varices in a patient presenting with essential thrombocythemia: A case report

BACKGROUND

Gastroesophageal varices are a rare complication of essential thrombocythemia (ET). ET is a chronic myeloproliferative neoplasm (MPN) characterized by an increased number of blood platelets.

CASE SUMMARY

A 46-year-old woman, who denied a history of liver disease, was admitted to our hospital on presentation of hematemesis. Laboratory examination revealed a hemoglobin level of 83 g/L, and a platelet count of 397 × 10⁹/L. The appearance of gastric and esophageal varices with red colored signs as displayed by an urgent endoscopy was followed by endoscopic variceal ligation and endoscopic tissue adhesive. Abdominal computed tomography revealed cirrhosis, marked splenomegaly, portal vein thrombosis and portal hypertension. In addition, bone marrow biopsy and evidence of mutated Janus kinase 2, substantiated the onset of ET. The patient was asymptomatic with regular routine blood testing during the 6-mo follow-up period. Therefore, in this case, gastroesophageal varices were induced by ET.

CONCLUSION

MPN should be given considerable attention when performing differential diagnoses in patients with gastroesophageal varices. An integrated approach such as laboratory tests, radiological examination, and pathological biopsy, should be included to allow optimal decisions and management.

Neutrophil to lymphocyte and platelet to lymphocyte ratios as biomarkers to predict relapse and survival in posthepatectomy HBV-related hepatocellular carcinoma: a meta-analysis and preliminary immune perspective

Background

Hepatitis B virus (HBV) infection represents the major etiology of hepatocellular carcinoma (HCC) and results in poor outcomes. Accumulating evidence suggests that composite immune cell-based biomarkers such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have prognostic value in postoperative HCC patients. However, due to the complexity, differential etiology, and the presence of variable confounding factors in different studies, the relationship between these markers with clinical outcomes in HBV-related posthepatectomy HCC is unclear from an immune perspective. Thus, this meta-analysis was conducted to determine NLR and PLR and assess their relation to overall survival (OS) and recurrence-free survival (RFS) in patients with post-hepatectomy HCC with HBV infection.

Methods

The databases PubMed, Embase, Scopus, and Cochrane Library were searched using relevant keywords. We included studies which compared the outcomes of RFS and OS between different levels of NLR and PLR in HBV-related HCC patients who had undergone hepatectomy. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were considered as effective measures and were calculated by a pooled analysis. Evidence supporting the association of neutrophils, platelets, and lymphocytes with HBV infection, liver injury, and tumor progression in HCC was evaluated.

Results

A total of 11 cohort studies with 5083 patients were included. Elevated NLR was significantly associated with poor RFS (HR: 1.28, 95% CI: 1.09–1.50, P=0.000) and poor OS (HR: 1.64, 95% CI: 1.32–2.03, P=0.000). Decreased PLR was significantly associated with a low risk of posthepatectomy relapse (HR: 1.40, 95% CI: 1.28–1.53, P=0.000) and better survival (HR: 1.63, 95% CI: 1.42–1.87, P=0.000). The subgroup and sensitivity analysis showed consistent and stable results.

Conclusions

Both NLR and PLR can be used as biomarkers for the prediction of RFS and OS in patients with HBV-associated HCC after hepatectomy.

PRF1 is a prognostic marker and correlated with immune infiltration in head and neck squamous cell carcinoma

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The cytotoxic protein PRF1 is essentially involved in anti-tumour immunity.

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PRF1 is overexpressed in advanced HPV+ HNSCC and correlates with better OS.

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PRF1 expression correlates with tumour infiltrating CD8+ t cells and dendritic cells in HPV+ HNSCC.

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PRF1 expression correlates with gene markers of t cell exhaustion in HNSCC.

Purpose

Head and neck squamous cell carcinoma (HNSCC) is a highly invasive malignancy with poor survival. Perforin (PRF1) plays essential roles in host immunity. Our research intended to identify the correlations of PRF1 with clinical prognosis and tumor immune infiltration in HNSCC.

Methods

We explored PRF1 expression and its associations with the clinical features of HNSCC via the Tumor Immune Estimation Resource (TIMER), Oncomine and The Cancer Genome Atlas (TCGA) databases. The prognostic value of PRF1 for HNSCC was further explored by Kaplan–Meier plotter and TIMER. Finally, the relation between PRF1 and immune infiltration in HNSCC was estimated via CIBERSORT and TIMER.

Results

PRF1 expression was remarkably elevated in HNSCC and associated with clinical stage and HPV infection. High PRF1 expression predicted favorable outcomes in HNSCC, especially in HPV+ HNSCC. Moreover, higher infiltration of CD8+ T cells and CD4+ T cells were found in the PRF1^high group of HNSCC. PRF1 expression in HNSCC was strongly correlated with infiltrating CD8+ T cells and dendritic cells (DCs), with higher relevance in HPV+ HNSCC.

Conclusion

Our findings suggested that PRF1 could be a novel prognostic biomarker in HNSCC and that its expression was related to immune cell infiltration, which was impacted by HPV status.

The Immune System Can Hear Noise

As a stressor widely existing in daily life, noise can cause great alterations to the immune system and result in many physical and mental disorders, including noise-induced deafness, sleep disorders, cardiovascular diseases, endocrine diseases and other problems. The immune system plays a major role in maintaining homeostasis by recognizing and removing harmful substances in the body. Many studies have shown that noise may play vital roles in the occurrence and development of some immune diseases. In humans, both innate immunity and specific immunity can be influenced by noise, and different exposure durations and intensities of noise may exert various effects on the immune system. Short-term or low-intensity noise can enhance immune function, while long-term or high-intensity noise suppresses it. Noise can lead to the occurrence of noise-induced hearing loss (NIHL) through the production of autoantibodies such as anti-Hsp70 and anti-Hsp60 and exert adverse effects related to other immune-related diseases such as some autoimmune diseases and non-Hodgkin lymphoma. The neuroendocrine system, mainly including the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary (SAM) system, is involved in the mechanisms of immune-related diseases induced by noise and gut microbiota dysfunction. In addition, noise exposure during pregnancy may be harmful to the immune system of the fetus. On the other hand, some studies have shown that music can improve immune function and alleviate the adverse effects caused by noise.

[Progress of the diagnosis and treatment of congenital nasal dermoid sinus cysts]

Congenital midline nasal masses are rare. Nasal dermoid sinus cysts（NDSC） are the most common type of the congenital midline nasal masses in childhood. Clinical manifestations are midline nasal cysts, fistula and intracranial attachments. Nasal encephalocele and glioma should be included in the differential diagnosis. Radiologic images are instructive. NDSC are easily misdiagnosed, leading to recurrence and surgical trauma affecting the face. Early appropriate surgical excision is recommended. This article reviews the embryology pathogenesis, progress of diagnosis and treatment of congenital NDSC.

A proof-of-concept study of an automated solution for clinical metagenomic next-generation sequencing

AIMS

Metagenomic next-generation sequencing (mNGS) has been utilized for diagnosing infectious diseases. It is a culture-free and hypothesis-free nucleic acid test for diagnosing all pathogens with known genomic sequences, including bacteria, fungi, viruses and parasites. While this technique greatly expands the clinical capacity of pathogen detection, it is a second-line choice due to lengthy procedures and microbial contaminations introduced from wet-lab processes. As a result, we aimed to reduce the hands-on time and exogenous contaminations in mNGS.

METHODS AND RESULTS

We developed a device (NGSmaster) that automates the wet-lab workflow, including nucleic acid extraction, PCR-free library preparation and purification. It shortens the sample-to-results time to 16 and 18·5 h for DNA and RNA sequencing respectively. We used it to test cultured bacteria for validation of the workflow and bioinformatic pipeline. We also compared PCR-free with PCR-based library prep and discovered no differences in microbial reads. Moreover we analysed results by automation and manual testing and found that automation can significantly reduce microbial contaminations. Finally, we tested artificial and clinical samples and showed mNGS results were concordant with traditional culture.

CONCLUSION

NGSmaster can fulfil the microbiological diagnostic needs in a variety of sample types.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study opens up an opportunity of performing in-house mNGS to reduce turnaround time and workload, instead of transferring potentially contagious specimen to a third-party laboratory.

Association between past exposure to fine particulate matter (PM2.5) and peptic ulcer: A cross-sectional study in eastern China

Ambient fine particulate matter (particle diameter < 2.5 μm, or PM_2.5) is a major public health concern in China. Exposure to PM_2.5 has been associated with a wide range of adverse health outcomes. The current study aimed to estimate the association between exposure to PM_2.5 and the risk of peptic ulcer diseases (PUDs). We conducted a hospital-based cross-sectional study of seven major cities in Zhejiang Province, China (combined population > 57 million people), which included a total of 647,092 subjects who underwent gastroscopy examination (86,852 subjects were diagnosed with PUDs) recorded in 13 large hospitals from 2014 to 2018. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the relationship between PM_2.5 and PUDs, including duodenal ulcers (DUs) and gastric ulcers (GUs). The overall estimated OR (95% CI) associated with every 10-μg/m³ increase in the 1-month average PM_2.5 before the detection of PUDs was 1.050 (95% CI: 1.038, 1.063). The association between PM_2.5 concentration and the prevalence of PUDs tended to be attenuated but remained significant when considering different exposure periods (OR = 1.030, 95% CI = 1.018-1.043 for the 3-month moving average; OR = 1.020, 95% CI = 1.005-1.037 for the 6-month moving average). Stronger associations were observed for DUs than GUs. The observed positive association of PM_2.5 exposure with PUDs remained significant in the two-pollutant models after adjusting for other air pollutants. Our findings could provide scientific evidence for a more general adverse role of air pollution on PUDs.

Tuina for lumbar disc herniation: A protocol for systematic review and meta analysis

BACKGROUND

Lumbar disc herniation (LDH) is an important factor of causing leg pain and numbness. As a secondary discipline of Traditional Chinese Medicine, tuina is widely used for the treatment of LDH in China even in other nations while its clinical value is not acknowledged universally. So, we focus on this article aims to evaluate its efficacy and safety of LDH.

METHODS

Electronic databases involving Cochrane Library, PubMed, Web of Science, EMBASE, China Science and Technology Journal, China National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Database will be pertained with appropriate search strategy. And RevMan V.5.3.5 software will be conducted as the assessment tool for bias risk, data synthesis, subgroup analysis as well as meta-analyses.

RESULTS

This systematic review will provide a high-quality synthesis of current evidence of tuina for LDH.

CONCLUSION

This protocol will determine whether Tuina is an effective and safe treatment method for LDH.

Icaritin Induces Anti-tumor Immune Responses in Hepatocellular Carcinoma by Inhibiting Splenic Myeloid-Derived Suppressor Cell Generation

Recent studies have demonstrated that splenic extramedullary hematopoiesis (EMH) is an important mechanism for the accumulation of myeloid-derived suppressor cells (MDSCs) in tumor tissues, and thus contributes to disease progression. Icaritin, a prenylflavonoid derivative from plants of the Epimedium genus, has been implicated as a novel immune-modulator that could prolong the survival of hepatocellular carcinoma (HCC) patients. However, it is unclear whether icaritin achieves its anti-tumor effects via the regulation of MDSCs generated by EMH in HCC. Here, we investigated the anti-tumor potential of icaritin and its mechanism of action in murine HCC. Icaritin suppressed tumor progression and significantly prolonged the survival of mice-bearing orthotopic and subcutaneous HCC tumors. Rather than exerting direct cytotoxic activity against tumor cells, icaritin significantly reduced the accumulation and activation of tumoral and splenic MDSCs, and increased the number and activity of cytotoxic T cells. Mechanistically, icaritin downregulates the tumor-associated splenic EMH, thereby reducing the generation and activation of MDSCs. The inhibitory effects of icaritin on human MDSCs in vitro were verified in short-term culture with cord-blood derived hematopoietic precursors. Furthermore, icaritin synergistically enhanced the therapeutic efficacy of immune checkpoint blockade therapy in HCC mice. These findings revealed that icaritin dampens tumoral immunosuppression to elicit anti-tumor immune responses by preventing MDSC generation via the attenuation of EMH. Thus, icaritin may serve as a novel adjuvant or even a stand-alone therapeutic agent for the effective treatment of HCC.

Spatio-temporal variation and daily prediction of PM2.5 concentration in world-class urban agglomerations of China

The contradiction between the development of urban agglomerations and ecological protection has long been a challenging issue. China has experienced an astonishing expansion of its urban scale in the past 40 years, and nearly 783 million of the nation's people now live in cities. Beijing-Tianjin-Hebei, the Yangtze River Delta and the Pearl River Delta have been prioritized to become world-class clusters by 2020. The health effects of air pollution in these three urban agglomerations are becoming increasingly formidable. Given these conditions, using the daily mean PM_2.5 concentration in 40 cities from January 2014 to December 2016, this research explored the spatial-temporal characteristics of PM_2.5 concentrations in these three urban agglomerations. The annual mean PM_2.5 concentrations in Beijing-Tianjin-Hebei, the Yangtze River Delta and the Pearl River Delta are 35.39 µg/m³, 53.72 µg/m³ and 78.54 µg/m³, respectively. Compared with the other two urban agglomerations, abundant rainfall causes the Pearl River Delta to have the lowest PM_2.5 level. Furthermore, a general regression neural network (GRNN) method is developed to predict the PM_2.5 concentration in these clusters on the second day, with inputs including the average, maximum and minimum temperature; average, maximum and minimum atmosphere; total rainfall; average humidity; average and maximum wind speed; and the PM_2.5 concentration measured 1 day ahead. The results indicate that the GRNN method can precisely predict the concentration level in these clusters, and it is especially useful for the Pearl River Delta, as the underlying influence mechanism is more specified in this cluster than in the others. Importantly, this 1-day-ahead forecasting of PM_2.5 concentrations can raise awareness among the public to improve their precautionary behaviours and help urban planners to provide corresponding support.