Increased di-(2-ethylhexyl) phthalate exposure poses a differential risk for adult asthma clusters

BACKGROUND

DEHP, a common plasticizer known for its hormone-disrupting properties, has been associated with asthma. However, a significant proportion of adult asthma cases are "non-atopic", lacking a clear etiology.

METHODS

In a case-control study conducted between 2011 and 2015, 365 individuals with current asthma and 235 healthy controls from Kaohsiung City were enrolled. The control group comprised individuals without asthma, Type 2 Diabetes Mellitus (T2DM), hypertension, or other respiratory/allergic conditions. The study leveraged asthma clusters (Clusters A to F) established in a prior investigation. Analysis involved the examination of urinary DEHP metabolites (MEHP and MEHHP), along with the assessment of oxidative stress, sphingolipid metabolites, and inflammatory biomarkers. Statistical analyses encompassed Spearman's rank correlation coefficients, multiple logistic regression, and multinomial logistic regression.

RESULTS

Asthma clusters (E, D, C, F, A) exhibited significantly higher ORs of MEHHP exposures compared to the control group. When considering asthma-related comorbidities (T2DM, hypertension, or both), patients without comorbidities demonstrated significantly higher ORs of the sum of primary and secondary metabolites (MEHP + MEHHP) and MEHHP compared to those with asthma comorbidities. A consistent positive correlation between urinary HEL and DEHP metabolites was observed, but a consistent negative correlation between DEHP metabolites and selected cytokines was identified.

CONCLUSION

The current study reveals a heightened risk of MEHHP and MEHP + MEHHP exposure in specific asthma subgroups, emphasizing its complex relationship with asthma. The observed negative correlation with cytokines suggests a new avenue for research, warranting robust evidence from epidemiological and animal studies.

[Application effects of rehabilitation care decision-making scheme based on case management model in severe burn patients]

Objective: To explore the application effects of application of rehabilitation care decision-making scheme based on case management model in severe burn patients. Methods: The study was a non-randomized historical control study. Thirty patients who met the inclusion criteria and received routine rehabilitation nursing in the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the hospital) from April 2021 to March 2022 were included in routine rehabilitation nursing group (26 males and 4 females, aged 48.50 (31.75, 56.25) years), and 30 patients who met the inclusion criteria and received case management rehabilitation nursing in the hospital from April 2022 to March 2023 were included in case management rehabilitation nursing group (22 males and 8 females, aged 46.00 (36.75, 55.25) years). The length of intensive care unit (ICU) stay, total hospitalization day, and total hospitalization cost of the patients in two groups were recorded. At admission, convalescence, discharge, and 6 months after injury, the patients' life quality was evaluated by the concise burn specific health scale, the sleep quality was evaluated by the Pittsburgh sleep quality index, and the functional independence was evaluated by the functional independence rating scale. At convalescence, discharge, and 6 months after injury, the patients' scar status was evaluated by the Vancouver scar scale. At 6 months after injury, a third-party satisfaction questionnaire was used to investigate the efficacy satisfaction of patients. Results: The length of ICU stay and total hospitalization day of patients in case management rehabilitation nursing group were both significantly shorter than those in routine rehabilitation nursing group (with Z values of -1.97 and -1.99, respectively, P<0.05), and the total hospitalization cost was less than that in routine rehabilitation nursing group (Z=-1.99, P<0.05). At discharge and 6 months after injury, the life quality scores of patients in case management rehabilitation nursing group were significantly higher than those in routine rehabilitation nursing group (with t values of -3.19 and -4.43, respectively, P<0.05), while the sleep quality scores were significantly lower than those in routine rehabilitation nursing group (with Z values of -2.18 and -3.33, respectively, P<0.05). There were no statistically significant differences in cognitive function scores of functional independence of patients between the 2 groups at admission, convalescence, discharge, and 6 months after injury (P>0.05). The exercise function scores and total scores of functional independence of patients in case management rehabilitation nursing group at convalescence, discharge, and 6 months after injury were significantly higher than those in routine rehabilitation nursing group (with Z values of -4.37, -2.73, -4.10, -4.37, -2.64, and -4.06, respectively, P<0.05). The scar pigmentation scores of patients in case management rehabilitation nursing group at 6 months after injury were significantly lower than those in routine rehabilitation nursing group (Z=-2.05, P<0.05), and the scar vascularity scores of patients in case management rehabilitation nursing group at discharge and 6 months after injury in case management rehabilitation nursing group were significantly lower than those in routine rehabilitation nursing group (with Z values of -3.16 and -2.07, respectively, P<0.05). The scar pliability scores (with Z values of -3.16, -2.45, and -4.38, respectively, P<0.05), thickness scores (with Z values of -2.56, -2.35, and -4.70, respectively, P<0.05), and total scores (with Z values of -3.77, -3.04, and -3.13, respectively, P<0.05) of patients in case management rehabilitation nursing group at convalescence, discharge, and 6 months after injury were significantly lower than those in routine rehabilitation nursing group. At 6 months after injury, the efficacy satisfaction scores of patients in case management rehabilitation nursing group were 4.00 (3.00, 4.25), which were significantly higher than 3.00 (2.00, 4.00) in routine rehabilitation nursing group (Z=-2.72, P<0.05). Conclusions: The implementation of rehabilitation care decision-making scheme based on case management model can optimize the cost efficiency, improve the effectiveness of clinical treatment, and enhance the life quality and satisfaction of the curative effect of severe burn patients.

[Phenotype and genotype analyses of two pedigrees with inherited fibrinogen deficiency]

Objective: To analyze the phenotype and genotype of two pedigrees with inherited fibrinogen (Fg) deficiency caused by two heterozygous mutations. We also preliminarily probed the molecular pathogenesis. Methods: The prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and plasma fibrinogen activity (Fg∶C) of all family members (nine people across three generations and three people across two generations) were measured by the clotting method. Fibrinogen antigen (Fg:Ag) was measured by immunoturbidimetry. Direct DNA sequencing was performed to analyze all exons, flanking sequences, and mutated sites of FGA, FGB, and FGG for all members. Thrombin-catalyzed fibrinogen polymerization was performed. ClustalX 2.1 software was used to analyze the conservatism of the mutated sites. MutationTaster, PolyPhen-2, PROVEAN, SIFT, and LRT online bioinformatics software were applied to predict pathogenicity. Swiss PDB Viewer 4.0.1 was used to analyze the changes in protein spatial structure and molecular forces before and after mutation. Results: The Fg∶C of two probands decreased (1.28 g/L and 0.98 g/L, respectively). The Fg∶Ag of proband 1 was in the normal range of 2.20 g/L, while it was decreased to 1.01 g/L in proband 2. Through genetic analysis, we identified a heterozygous missense mutation (c.293C>A; p.BβAla98Asp) in exon 2 of proband 1 and a heterozygous nonsense mutation (c.1418C>G; p.BβSer473*) in exon 8 of proband 2. The conservatism analysis revealed that Ala98 and Ser473 presented different conservative states among homologous species. Online bioinformatics software predicted that p.BβAla98Asp and p.BβSer473* were pathogenic. Protein models demonstrated that the p.BβAla98Asp mutation influenced hydrogen bonds between amino acids, and the p.BβSer473* mutation resulted in protein truncation. Conclusion: The dysfibrinogenemia of proband 1 and the hypofibrinogenemia of proband 2 appeared to be related to the p.BβAla98Asp heterozygous missense mutation and the p.BβSer473* heterozygous nonsense mutation, respectively. This is the first ever report of these mutations.

The Effectiveness of Music Interventions for Improving Anxiety Symptoms in Cancer Patients Undergoing Radiation Therapy

PURPOSE/OBJECTIVE(S)

Being alone in the treatment room during radiation therapy (RT) often causes anxiety which may lead to treatment failure. The benefit of music interventions in reducing anxiety among cancer patients during RT simulations is still controversial. The goal of this study is to evaluate the effect of music on anxiety symptoms among patients undergoing initial RT and a randomized trial was conducted.

MATERIALS/METHODS

Patients who received RT for the first time were enrolled and were randomly allocated into groups of experiment and control. The questionnaire of mood thermometer (BSRS-5), distress thermometer (DT), and the Beck Anxiety Inventory (BAI-C) and were given before and after RT. We also measured the changes in physiological symptoms for ten consecutive days since the first day of RT. The experimental group was given music during RT, while the control group was not. The generalized linear mixed model was used to estimate the pre-post difference of music interventions on the BSRS-5, DT, and BAI-C compared with control group after considering the random intercept and the unstructured residual variance-covariance matrix.

RESULTS

A total of 50 patients in the experimental group and 50 patients in the control group were enrolled in this study. The satisfaction degree of treatment in the experimental group was 100%, but it was 96% in control group (p = 0.0048). The pre-test BSRS-5 was 3.4±2.3 for the experimental group versus 2.6±2.3 for the control group (p = 0.0815), the post-test BSRS-5 score was significantly reduced in the experimental group (1.6±1.4 for experimental group versus 2.7±2.2 for the control group, p = 0.0057), the significant pre-post difference of BSRS-5 between group was found (p = 0.0024). When the experimental group withdrew from the music intervention, the BSRS-5 rebounded to 3.7±3.0. The pre-test DT was 4.3±1.5 and 3.4±1.7 in the experimental group and control group (p = 0.0051), and the post-test DT score was significantly reduced in the experimental group (2.7±1.2 for the experimental group and 3.5±1.3 for the control group, p = 0.0021), the significant pre-post difference of DT between group was found (p<.0001). When the experimental group withdrew from the music intervention, the DT rebounded to 3.7±1.4. The pre-test BAI-C was 6.7±11.7 and 7.8±8.5 in the experimental group and control group (p = 0.5878), and the post-test BAI-C score was significantly lower in the experimental group (1.7±3.7 for the experimental group and 7.4±8.0 for the control group, p<.0001), however, the pre-post difference of BAI-C between group was not significant (p = 0.0619). When the experimental group withdrew from the music intervention, the BAI-C rebounded to 6.5±8.7. There is a significantly increased systolic blood pressure in the control group compared with the patients had music intervention.

CONCLUSION

This study's results provide evidence that playing music routinely (music intervention) during RT can be an excellent way to relieve patients' anxiety and improve their comfort.

[Establishment and validation of a risk predictive model of preoperative drug-induced limitation of pupil dilation in type 2 diabetes mellitus patients with concomitant cataract]

Objective: To establish and validate a risk predictive model of preoperative drug-induced limitation of pupil dilation (PD) in type 2 diabetes mellitus (T2DM) patients with concomitant cataract. Methods: A cross-sectional study was performed, in which 376 T2DM patients with concomitant cataract who received cataract operation in the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2022 to March 2023 were randomly selected as the study subjects. Of the 376 patients, 268 who were admitted to the hospital from October to December 2022 served as the modeling group, and were divided into PD limited group (n=187) and PD unlimited group (n=81) based on whether they had drug-induced limitation of PD. Logistic regression was used to establish a risk predictive model, R software was used to draw the nomogram, Hosmer-Lemeshow test was utilized to judge the model's goodness of fit, and receiver operating characteristic (ROC) curve was adopted to validate the predicting efficacy of the model. Another 108 T2DM patients who received cataract operation in the same hospital from January to March 2023 served as the validation group, and Hosmer-Lemeshow test and ROC curve were used for the external validation of the model. Results: In the modeling group (n=268), there were 124 males and 144 females, with the mean age of (66.6±6.8) years, while in the validation group (n=108), there were 51 males and 57 females, with the mean age of (64.9±9.1) years. The incidence of preoperative drug-induced limitation of PD was 69.8% (187/268) in T2DM patients with concomitant cataract. T2DM disease course (OR=1.134, 95%CI: 1.074-1.198, P<0.001), body mass index (BMI) (OR=0.863, 95%CI: 0.767-0.972, P=0.015), glycohemoglobin (HbA1c) level (OR=1.397, 95%CI: 1.055-1.849, P=0.019) and baseline pupil dimeter (OR=0.089, 95%CI: 0.045-0.179, P<0.001) were the risk factors of drug-induced limitation of PD. Hosmer-Lemeshow test showed χ2=6.231 and P=0.621, the area under curve (AUC) of ROC curve was 0.897 (95%CI: 0.857-0.937, P<0.001), and when the Youden index was the maximum (0.655), the model's sensitivity and specificity was 0.877 and 0.778, respectively. The external validation results demonstrated that the AUC of ROC curve was 0.928 (95%CI: 0.875-0.981, P<0.001), the maximum Youden index was 0.761, the sensitivity was 0.932, the specificity was 0.829, and the overall accuracy was 89.8%. Conclusion: The risk predictive model established in the current study can provide reference for the clinical assessment of the risk of preoperative drug-induced limitation of PD in T2DM patients with concomitant cataract.

[A cross-sectional survey and influencing factors analysis of knowledge, attitude, and behavior of enteral nutrition implemented by nurses in burn intensive care unit]

Objective: To investigate the status of knowledge, attitude, and behavior of enteral nutrition implemented by nurses in burn intensive care unit (BICU) and analyze its influencing factors. Methods: A multi-center cross-sectional survey research method was used. On May 8th, 2022, 107 BICU nurses who met the inclusion criteria were selected from the burn departments of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Guangdong Provincial People's Hospital, the First Affiliated Hospital of Guangxi Medical University, the Affiliated Hospital of Qinghai University, the Second Affiliated Hospital of Air Force Medical University, the Affiliated Hospital of Nantong University, Guiyang Steel Factory Staff Hospital, and the Second Affiliated Hospital of Kunming Medical University. The self-made nurses' enteral nutrition nursing knowledge-attitude-behavior questionnaire for severely burned patients was used to investigate the nurses' gender, age, working years, professional title, position, highest educational background, and whether they received systematic training in knowledge of enteral nutrition, the scores of each factor, and the total scores of knowledge, attitude, and behavior dimensions of enteral nutrition in nurses. The nurses were classified according to the general data, and the total scores of their knowledge, attitude, and behavior of enteral nutrition were calculated. Data were statistically analyzed with independent sample t test, one-way analysis of variance, Mann-Whitney U test, and Kruskal-Wallis H test. According to the results of univariate analysis and combined with clinical experience and significance, the generalized linear model analysis was carried out to screen the independent influencing factors of the total scores of knowledge, attitude, and behavior of enteral nutrition in BICU nurses. Results: A total of 107 nurses were surveyed, and 107 valid questionnaires were collected, with an effective recovery rate of 100%. In the BICU nurses' enteral nutrition knowledge-attitude-behavior questionnaire, the total scores of knowledge, attitude, and behavior were 44±13, 87±15, and 70±19, respectively. Most of the BICU nurses in this survey were female, aged 22-48 (31±6) years, and the number of nurses worked for 1-5, 6-10, and ≥11 years was evenly distributed. The majority of the professional titles of nurses were nurses, positions were responsible nurses, and the highest educational background was undergraduate. Forty-four nurses received systematic training in knowledge of enteral nutrition. There were statistically significant differences in the total scores of knowledge of enteral nutrition among BICU nurses with different ages, working years, professional titles, positions, highest educational background, and whether they received systematic training in knowledge of enteral nutrition (with H values of 27.36, 15.27, and 10.19, respectively, Z values of -3.33, -2.59, and -6.46, respectively, P<0.05). There were no statistically significant differences in the total scores of attitude and behavior of enteral nutrition among BICU nurses with different gender, ages, working years, professional titles, positions, highest educational background, and whether they received systematic training in knowledge of enteral nutrition (P>0.05). Age (26-30, 31-35, and ≥36 years old), highest educational background (undergraduate), and the systematic training received in enteral nutrition knowledge were the independent influencing factors for the total score of knowledge of enteral nutrition in BICU nurses (with 95% confidence intervals of 0.12-0.36, 0-0.30, 0.03-0.31, 0.01-0.32, and 0.19-0.40, respectively, standardized regression coefficients of 0.24, 0.15, 0.17, 0.17, and 0.29, respectively, P<0.05). There were no independent influencing factors for the total scores of enteral nutrition attitude and behavior of BICU nurses in different characteristics (P>0.05). Conclusions: The BICU nurses have low cognitive level in the implementation of enteral nutrition, their concept needs to be updated in time, and their behavior needs to be further standardized. Age (26-30, 31-35, and ≥36 years old), highest educational background (undergraduate), and the systematic training received in enteral nutrition knowledge were the independent influencing factors for the knowledge of enteral nutrition in BICU nurses.

Efficacy and Safety of Anti-HER2 Targeted Therapy for Metastatic HR-Positive and HER2-Positive Breast Cancer: A Bayesian Network Meta-Analysis

Despite the development of HER2-targeted drugs, achieving favorable outcomes for patients with HR+/HER2+MBC remains challenging. This study utilized Bayesian Network Meta-analysis to compare the efficacy and safety of anti-HER2 combination regimens. The primary analysis focused on progression-free survival (PFS), while secondary analyses included objective response rate, overall survival (OS) and the incidence rate of grade 3/4 adverse events (AEs). A comprehensive search across seven databases identified 25 randomized controlled trials for inclusion in this meta-analysis. For patients eligible for endocrinotherapy, our findings revealed that dual-target combined endocrine therapy, such as Her2-mAb+Her2-mAb+Endo (HR = 0.38; 95%CrI: 0.16-0.88) and Her2-mAb+Her2-tki+Endo (HR = 0.45; 95%CrI: 0.23-0.89), significantly improved PFS compared to endocrine therapy alone. According to the surface under the cumulative ranking curves (SUCRAs), Her2-mAb+Her2-mAb+Endo and Her2-mAb+Her2-tki+Endo ranked highest in terms of PFS and OS, respectively. For patients unsuitable for endocrine therapy, anti-HER2 dual-target combined chemotherapy, such as Her2-mAb+Her2-mAb+Chem (HR = 0.76; 95%CrI: 0.6-0.96) and Her2-mAb+Her2-tki+Chem (HR = 0.48; 95%CrI: 0.29-0.81), demonstrated significant improvements in PFS compared to Her2-mAb+Chem. The results were the same when compared with Her2-tki+Chem. According to the SUCRAs, Her2-mAb+Her2-tki+Chem and Her2-mAb+Her2-mAb+Chem ranked highest for PFS and OS, respectively. Subgroup analyses consistently supported these overall findings, indicating that dual-target therapy was the optimal approach irrespective of treatment line.

[Prospective study on application of mind mapping combined with scenario simulation training on the ability training of junior nurses in hospital transfer of patients with critical burns and trauma]

Objective: To explore the application effects of mind mapping combined with scenario simulation training on the ability training of junior nurses in hospital transfer of patients with critical burns and trauma. Methods: A prospective randomized controlled study was conducted. From December 2019 to December 2020, 55 female junior nurses from the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) who met the inclusion criteria were enrolled in this study and divided into routine group (27 nurses, aged (24.0±0.9) years) and combined group (28 nurses, aged (24.2±0.8) years), according to the random number table. The nurses in routine group were trained with hospital transfer of patients with critical burns and trauma by theory combined with operational skill, and the nurses in combined group were trained with hospital transfer of patients with critical burns and trauma by mind mapping combined with scenario simulation training. Before and after the training, the self-made theoretical examination papers and skill assessment items were used for the examination and assessment to nurses, and their scores were calculated and compared. The self-made emergency ability scoring system was used to evaluate the emergency disposal ability of nurses from five dimensions, including team cooperation ability, emergency response ability, operative technique ability, specialized business ability, and nurse-patient communication ability, and their scores were calculated and compared. The non-standard implementation rates of transfer nursing measures, such as incomplete preparation of goods, poor communication effect of patients, inadequate pipeline nursing, unclear handover, and inadequate final treatment, were calculated and compared in the process of transporting highly simulated human (hereinafter referred to as simulated human) by nurses before and after training; and the rate of disease change and successful rate of transport of simulated human were calculated and compared after training. After assessment, self-made satisfaction questionnaire was used to compare nurses' satisfaction with the training mode, content, and effects. Data were statistically analyzed with independent sample t test, Pearson chi-square test, or Yates corrected chi-square test. Results: Fifty-five enrolled nurses were fully involved in the training, examination, assessment, and questionnaire filling. Before training, there were no statistically significant differences in theoretical examination and skill assessment scores between the 2 groups (P>0.05); After training, the theoretical examination and skill assessment scores of nurses in combined group were significantly higher than those in routine group (with t values of -3.89 and -4.24, respectively, P<0.05). Before training, there were no statistically significant differences in the scores of each item of emergency disposal ability between the 2 groups (P>0.05); after training, the scores in terms of team cooperation ability, emergency response ability, operative technique ability, specialized business ability, and nurse-patient communication ability of nurses in combined group were significantly higher than those in routine group (with t values of -6.49, -6.44, -2.21, -2.85, and -2.34, respectively, P<0.05). Before training, there were no statistically significant differences in the non-standard implementation rates of transfer nursing measures of nurses between the 2 groups (P>0.05); after training, the non-standard rates of incomplete preparation of goods, unclear handover, and inadequate final treatment of nurses in combined group were significantly lower than those in routine group (with t values of 3.87, 5.89, and 5.28, respectively, P<0.05). After training, the rate of disease change of simulated human of nurses in combined group was 7.14% (2/28), which was significantly lower than 33.33% (9/27) in routine group (χ2=5.89, P<0.05); the successful rate of transport was 96.43% (27/28), which was significantly higher than 74.07% (20/27) in routine group (χ2=3.87, P<0.05). After assessment, the total score of training satisfaction and scores of satisfaction with training mode and training effect of nurses in combined group were significantly higher than those in routine group (with t values of 5.22, 4.67, and 10.71, respectively, P<0.05). There was no statistically significant difference in the satisfaction score on training content between the two groups (P>0.05). Conclusions: Evidence-based mind mapping combined with scenario simulation training significantly improves the nursing skills and emergency handling capabilities of junior nurses in transferring patients with critical burns and trauma.

Environmental risks and sphingolipid signatures in adult asthma and its phenotypic clusters: a multicentre study

BACKGROUND

Adult asthma is phenotypically heterogeneous with unclear aetiology. We aimed to evaluate the potential contribution of environmental exposure and its ensuing response to asthma and its heterogeneity.

METHODS

Environmental risk was evaluated by assessing the records of National Health Insurance Research Database (NHIRD) and residence-based air pollution (particulate matter with diameter less than 2.5 micrometers (PM_2.5) and PM_2.5-bound polycyclic aromatic hydrocarbons (PAHs)), integrating biomonitoring analysis of environmental pollutants, inflammatory markers and sphingolipid metabolites in case-control populations with mass spectrometry and ELISA. Phenotypic clustering was evaluated by t-distributed stochastic neighbor embedding (t-SNE) integrating 18 clinical and demographic variables.

FINDINGS

In the NHIRD dataset, modest increase in the relative risk with time-lag effect for emergency (N=209 837) and outpatient visits (N=638 538) was observed with increasing levels of PM_2.5 and PAHs. Biomonitoring analysis revealed a panel of metals and organic pollutants, particularly metal Ni and PAH, posing a significant risk for current asthma (ORs=1.28-3.48) and its severity, correlating with the level of oxidative stress markers, notably Nε-(hexanoyl)-lysine (r=0.108-0.311, p<0.05), but not with the accumulated levels of PM_2.5 exposure. Further, levels of circulating sphingosine-1-phosphate and ceramide-1-phosphate were found to discriminate asthma (p<0.001 and p<0.05, respectively), correlating with the levels of PAH (r=0.196, p<0.01) and metal exposure (r=0.202-0.323, p<0.05), respectively, and both correlating with circulating inflammatory markers (r=0.186-0.427, p<0.01). Analysis of six phenotypic clusters and those cases with comorbid type 2 diabetes mellitus (T2DM) revealed cluster-selective environmental risks and biosignatures.

INTERPRETATION

These results suggest the potential contribution of environmental factors from multiple sources, their ensuing oxidative stress and sphingolipid remodeling to adult asthma and its phenotypic heterogeneity.

Phospholipid remodeling and its derivatives are associated with COVID-19 severity

BACKGROUND

Timely medical intervention in severe cases of coronavirus disease 2019 (COVID-19) and better understanding of the disease's pathogenesis are essential for reducing mortality, but early classification of severe cases and its progression is challenging.

OBJECTIVE

We investigated the levels of circulating phospholipid metabolites and their relationship with COVID-19 severity, as well as the potential role of phospholipids in disease progression.

METHODS

We performed nontargeted lipidomic analysis of plasma samples (n = 150) collected from COVID-19 patients (n = 46) with 3 levels of disease severity, healthy individuals, and subjects with metabolic disease.

RESULTS

Phospholipid metabolism was significantly altered in COVID-19 patients. Results of a panel of phosphatidylcholine (PC) and lysophosphatidylcholine (LPC) and of phosphatidylethanolamine and lysophosphatidylethanolamine (LPE) ratios were significantly correlated with COVID-19 severity, in which 16 phospholipid ratios were shown to distinguish between patients with severe disease, mild disease, and healthy controls, 9 of which were at variance with those in subjects with metabolic disease. In particular, relatively lower ratios of circulating (PC16:1/22:6)/LPC 16:1 and (PE18:1/22:6)/LPE 18:1 were the most indicative of severe COVID-19. The elevation of levels of LPC 16:1 and LPE 18:1 contributed to the changes of related lipid ratios. An exploratory functional study of LPC 16:1 and LPE 18:1 demonstrated their ability in causing membrane perturbation, increased intracellular calcium, cytokines, and apoptosis in cellular models.

CONCLUSION

Significant Lands cycle remodeling is present in patients with severe COVID-19, suggesting a potential utility of selective phospholipids with functional consequences in evaluating COVID-19's severity and pathogenesis.

Andrographolide Liquisolid using Porous-Starch as the Adsorbent with Enhanced Oral Bioavailability in Rats

Andrographolide (AGL) is the major component of Andrographispaniculata. The poor water solubility and low dissolution strongly affect its oral absorption. Liquisolid technology has been used to improve its dissolution and oral bioavailability. Liquisolid powders of AGL (AGL-LS-PSG) were obtained by firstly dissolving AGL in the mixture of NMP, PEG 6000 and Soluplus®, and solidified by absorption of the blend in porous starch. Angle of repose, Carr index and Hauser ratio presented good powder fluidity and compressibility characteristics of AGL-LS-PSG. The results of optical microscopic observation, PXRD and DSC analysis indicated that AGL has been completely adsorbed in porous starch granules and existed in an amorphous or molecularly dispersing state. AGL-LS-PSG can obviously increase the drug dissolution rate compared to commercial guttate pills and raw drug. In vivo pharmacokinetic behavior of AGL-LS-PSG was investigated following a single oral administration to rats. The C_max (0.37 ± 0.06 μg mL^-1) and AUC_0-2h (13.55 ± 2.67 μg h mL^-1) of AGL-LS-PSG were evidently increased compared to commercial guttate pills (C_max = 0.30 ± 0.21 μg mL^-1, AUC_0-2h = 9.88 ± 3.57 μg h mL^-1). This study indicated great potential of liquisolid technology in effectively improving the dissolution and bioavailability of AGL.

[Comparison of clinical features of JAK2V617F gene mutation and non-mutation in patients with Budd-Chiari syndrome]

Objective: To investigate the clinical features of JAK2V617F gene mutation and non-mutation in patients with Budd-Chiari syndrome (BCS). Methods: 17 and 127 BCS cases with JAK2V617F gene mutation (mutation group) and non-gene mutation (non-mutation group) who were continuously treated with interventional therapy between January 2016 to December 2020 in the Affiliated Hospital of Xuzhou Medical University were selected as the research object for a comparative study. The hospitalization and follow-up data of the two groups were analyzed retrospectively, and the deadline for follow-up was June 2021. Quantitative data group differences were analyzed using the independent sample t-test and Wilcoxon rank sum test. Qualitative data group differences were analyzed with χ² test or Fisher's exact test. Mann-Whitney U test was used to analyze the differences between groups in rank data. Kaplan-Meier method was used to calculate the patient survival and recurrence rate. Results: Age [(35.41±17.10) years vs. (50.09±14.16) years, t=3.915, P<0.001], time of onset (median duration: 3 months vs. 12 months), and the cumulative survival rate (65.5% vs 95.1%; χ²=5.21, P=0.022) were lower in mutation than non-mutation group. Aaspartate aminotransferase, alanine aminotransferase, prothrombin time, Child-Pugh score, Rotterdam score, Model for End-stage Liver Disease score, hepatic vein thrombosis incidence, and the cumulative recurrence rate after intervention were higher in mutation than non-mutation group. The above all indexes had statistically significant differences (P<0.05) between the groups. Conclusion: Younger age, acute onset, severe liver injury, high incidence of hepatic vein thrombosis, and poor prognosis are the features of patients with BCS with JAK2V617F gene mutation than non-mutation.

[Effects of pretreatment HIV drug resistance on the virological response of HIV-infected patients after 3-year antiretroviral therapy]

Objective: To investigate the impact of pretreatment drug resistance (PDR) on virological effect among HIV-infected patients having received antiretroviral therapy (ART) after three years. Methods: The baseline survey of PDR among HIV-infected patients was conducted in 2018, with a three-year follow up study. The clinic data and virological laboratory test variables were statistically analyzed. Results: Of the 2 433 participants, 41.6% (1 012/2 433) were aged between 18 and 34, 82.8% (2 015/2 433) were males, 46.9% (1 142/2 433) had education of high school or above, 22.4% (544/2 433) were farmers, 33.8% (823/2 433) were unmarried, 48.1% (1 169/2 433) were infected heterosexually and 41.3% (1 004/2 433) were with CRF07_BC. The prevalence of PDR was 4.5% (109/2 433). The prevalence of virological suppression failure (viral load ≥50 copies/ml) and drug resistance at three years follow up after ART was 8.1%(196/2 433) and 2.5%(60/2 433) respectively. The prevalence of virological suppression failure and drug resistance at three years follow up after ART were 18.3% (20/109) and 7.6% (176/2 324), and 4.6% (5/109) and 2.4% (55/2 324) among participants with PDR and non-PDR, respectively. The results of multivariate logistic regression model showed that illiteracy (aOR=3.26, 95%CI: 1.82-5.86), primary and junior high school education (aOR=1.54, 95%CI: 1.09-2.18), CD4⁺T lymphocyte count <200/μl (aOR=2.77, 95%CI: 1.75-4.37) and CD4⁺T lymphocyte count 200-499/μl (aOR=1.55, 95%CI: 1.10-2.18) at a three year follow up visit after ART, missed drugs in the past month (aOR=4.24, 95%CI: 2.92-6.17), and PDR (aOR=2.84, 95%CI: 1.67-4.85) were statistically significant with virological suppression failure on treatment. Conclusions: The prevalence of PDR in China at a low level currently, and the virological suppression failure rate is low after three years of ART. It is necessary to strengthen drug resistance monitoring of HIV-infected patients and pay attention to the influence of PDR on treatment effect.

[Factors associated with death and attrition in HIV-infected children under initial antiretroviral therapy in Guangxi Zhuang Autonomous Region, 2004 - 2019]

Objective: To investigate death and attrition in HIV-infected children under initial antiretroviral therapy (ART) and associated factors in Guangxi Zhuang autonomous region. Methods: This retrospective cohort study was conducted in HIV-infected children under initial ART in Guangxi from 2004 to 2019, data from ART information system of National comprehensive AIDS prevention and treatment information system. Cox proportional hazards models were used to assess factors associated with the death and attrition. Results: In 943 HIV-infected children, the overall mortality and attrition rates were 1.00/100 person-years and 0.77/100 person-years, respectively. The mortality and attrition rates within the first year of ART were 3.90/100 person-years and 1.67/100 person-years, respectively. The cumulative survival rate during the first, second, fifth and tenth year after ART was 96.14%, 95.80%, 93.68% and 91.54%, respectively. Multivariate Cox proportional hazards models results showed that being female (aHR=2.00, 95%CI: 1.17-3.40), CD4⁺T lymphocytes (CD4) counts before ART <200 cells/μl (aHR=2.79, 95%CI: 1.54-5.06), weight-for-age Z score before ART <-2 (aHR=2.38, 95%CI: 1.32-4.26), hemoglobin before ART <80 g/L (aHR=2.47, 95%CI: 1.24-4.92), initial ART with LPV/r (aHR=5.05, 95%CI: 1.15-22.12) were significantly associated with death; being female (aHR=2.23, 95%CI: 1.22-4.07) and initial ART with LPV/r (aHR=2.02, 95%CI: 1.07-3.79) were significantly associated with attrition. Conclusions: The effect of ART in HIV-infected children in Guangxi was better, but the mortality and attrition rates were high within the first year of treatment. It is necessary to strengthen the training in medical staff and health education in HIV-infected children and their parents in order to improve the treatment effect.

[Application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy of severe burn patients]

Objective: To explore the application effects of bundle nursing of citric acid extracorporeal anticoagulation on continuous renal replacement therapy (CRRT) of severe burn patients. Methods: A non-randomized controlled study was conducted. Forty-six patients who met the inclusion criteria and received regular nursing of citric acid extracorporeal anticoagulation during CRRT in the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from January to December 2017 were included in regular nursing group (30 males and 16 females, aged 42.0 (38.7,47.0) years, with 201 times of CRRT performed), and 48 patients who met the inclusion criteria and received bundle nursing of citric acid extracorporeal anticoagulation during CRRT in the same hospital from January to December 2018 were included in bundle nursing group (32 males and 16 females, aged 41.0 (36.0,46.0) years, with 164 times of CRRT performed). The clinical data of all the patients in the two groups were recorded, including the length of intensive care unit (ICU) stay, total cost of treatment in ICU, cost of CRRT, unplanned ending of treatment, ending of treatment due to operation (with the rates of unplanned ending of treatment and ending of treatment due to operation calculated), times of disposable hemodialysis filter and supporting pipeline filter (hereinafter referred to as filter) with use time>24 h, times of CRRT, and lifetime of filter. For the patients in both groups who continuously received CRRT for 3 days or more from the first treatment, the prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), total calcium, ionic calcium (with the difference of total calcium or ionic calcium between before and after treatment calculated), creatinine, urea, β2 microglobulin, cystatin C, platelet count, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid levels before the first treatment (hereinafter referred to as before treatment) and 3 days after the first treatment (hereinafter referred to as after 3 days of treatment). The treatment-related complications of all patients in the two groups were recorded during hospitalization. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. Results: Compared with those in regular nursing group, the length of ICU stay was significantly shortened (Z=-4.71, P<0.01), the total cost of treatment in ICU was significantly reduced (t=-1.39, P<0.01), the cost of CRRT had no significant change (P>0.05), the rates of unplanned ending of treatment and ending of treatment due to operation were both significantly decreased (with χ2 values of 12.20 and 17.83, respectively, P<0.01), the times of filter service time>24 h was increased significantly (Z=-5.93, P<0.01), the times of CRRT were significantly reduced (Z=-4.75, P<0.01), and the filter service life was significantly prolonged (Z=-9.24, P<0.01) among patients in bundle nursing group. Thirty-one patients in bundle nursing group and 28 patients in regular nursing group continuously received CRRT for 3 days or more from the first treatment. Before treatment, PT, APTT, and INR of patients in bundle nursing group were 24.10 (16.08, 39.20) s, 38.81 (32.32, 45.50) s, and 1.17 (1.12, 1.19), respectively, similar to 31.75 (22.99, 40.96) s, 41.82 (35.05, 48.06) s, and 1.15 (1.11, 1.19) of patients in regular nursing group (P>0.05); the levels of total calcium and ionic calcium of patients in the two groups were similar (P>0.05). After 3 days of treatment, PT, APTT, and INR of patients in bundle nursing group and regular nursing group were 29.06 (20.11, 39.46) s, 35.25 (30.06, 40.28) s, 1.13 (1.09, 1.17) and 36.51 (26.64, 42.92) s, 39.89 (34.81, 46.62) s, 1.14 (1.10, 1.18), respectively, similar to those before treatment (P>0.05); the level of ionic calcium of patients in regular nursing group was significantly higher than that before treatment (Z=-2.08, P<0.05); the levels of total calcium and ionic calcium of patients in bundle nursing group were both significantly higher than those before treatment (with Z values of -3.55 and -3.69, respectively, P<0.01); compared with those in regular nursing group, APTT of patients was significantly shorter (Z=-2.29, P<0.05), while the total calcium level of patients was significantly higher in bundle nursing group (Z=-2.26, P<0.05). The difference of total calcium between before and after treatment of patients in bundle nursing group was significantly higher than that in regular nursing group (Z=-3.15, P<0.01). The differences of ionic calcium between before and after treatment of patients in the two groups were similar (P>0.05). Before treatment, the level of β2 microglobulin of patients in bundle nursing group was significantly higher than that in regular nursing group (Z=-2.84, P<0.01), the platelet count of patients in bundle nursing group was significantly lower than that in regular nursing group (Z=-2.44, P<0.05), while the levels of creatinine, urea, cystatin C, mean arterial pressure, pH value, oxygenation index, bicarbonate radical, and lactic acid of patients in the two groups were similar (P>0.05). After 3 days of treatment, the levels of creatinine, urea, β2 microglobulin, cystatin C, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -2.10, -2.90, -3.11, -2.02, -2.34, -2.63, and -2.84, respectively, P<0.05 or P<0.01), while the levels of platelet count, oxygenation index, and mean arterial pressure of patients were all significantly higher than those before treatment in bundle nursing group (with Z values of -6.65 and -2.40, respectively, t=-9.97, P<0.05 or P<0.01); the levels of creatinine, urea, β2 microglobulin, cystatin C, platelet count, pH value, bicarbonate radical, and lactic acid of patients were all significantly lower than those before treatment (with Z values of -5.32, -2.31, -2.41, -2.21, -3.68, -2.93, -2.20, and -2.31, respectively, P<0.05 or P<0.01), while the oxygenation index and mean arterial pressure of patients were both significantly higher than those before treatment in regular nursing group (Z=-5.59, t=-7.74, P<0.01). After 3 days of treatment, compared with those in regular nursing group, the levels of creatinine, cystatin C, platelet count, oxygenation index, bicarbonate radical, and mean arterial pressure of patients were all significantly higher (with Z values of -2.93, -1.99, -6.39, -2.09, and -2.52, respectively, t=-3.28, P<0.05 or P<0.01), while the levels of urea, β2 microglobulin, pH value, and lactic acid of patients were all significantly lower (with Z values of -3.87, -2.58, -4.24, and -2.75, respectively, P<0.05 or P<0.01) in bundle nursing group. During hospitalization, there were no treatment-related bleeding events or hypernatremia related to citric acid treatment of patients in the two groups. The ratio of total calcium to ionic calcium in one patient in bundle nursing group was >2.5, but there was no manifestation of citric acid accumulation poisoning; 1 patient had hypoionic calcemia, and 1 patient had severe metabolic alkalosis. Five patients had hypoionic calcemia and 2 patients had severe metabolic alkalosis in regular nursing group. Conclusions: The implementation of bundle nursing of citric acid extracorporeal anticoagulation during CRRT for severe burn patients shortens the length of ICU stay, reduces the total cost of treatment in ICU and the occurrence of treatment-related complications, relieves the economic burden of patients, and improves the continuity and quality of treatment.

[Diagnosis and treatment status of perioperative anemia in patients with gastrointestinal neoplasms: a multi-center study in Hubei Province]

Objective: To investigate the incidence and treatment of perioperative anemia in patients with gastrointestinal neoplasms in Hubei Province. Methods: The clinicopathological data of 7 474 patients with gastrointestinal neoplasms in 62 hospitals in 15 cities (state) of Hubei Province in 2019 were collected in the form of network database. There were 4 749 males and 2 725 females. The median age of the patients was 62 years (range: 17 to 96 years). The hemoglobin value of the first time in hospital and the first day after operation was used as the criterion of preoperative anemia and postoperative anemia. Anemia was defined as male hemoglobin <120 g/L and female hemoglobin <110.0 g/L, mild anemia as 90 to normal, moderate anemia as 60 to <90 g/L, severe anemia as <60 g/L. The t test and χ² test were used for inter-group comparison. Results: The overall incidence of preoperative anemia was 38.60%(2 885/7 474), and the incidences of mild anemia, moderate anemia and severe anemia were 25.09%(1 875/7 474), 11.37%(850/7 474) and 2.14%(160/7 474), respectively. The overall incidence of postoperative anemia was 61.40%(4 589/7 474). The incidence of mild anemia, moderate anemia and severe anemia were 48.73%(3 642/7 474), 12.20%(912/7 474) and 0.47%(35/7 474), respectively. The proportion of preoperative anemia patients receiving treatment was 26.86% (775/2 885), and the proportion of postoperative anemia patients receiving treatment was 14.93% (685/4 589). The proportions of preoperative anemia patients in grade ⅢA, grade ⅢB, and grade ⅡA hospitals receiving treatment were 26.12% (649/2 485), 32.32% (85/263), and 29.93% (41/137), and the proportions of postoperative anemia patients receiving treatment were 14.61% (592/4 052), 22.05% (73/331), and 9.71% (20/206). The proportion of intraoperative blood transfusion (16.74% (483/2 885) vs. 3.05% (140/4 589), χ²=434.555, P<0.01) and the incidence of postoperative complications (17.78% (513/2 885) vs. 14.08% (646/4 589), χ²=18.553, P<0.01) in the preoperative anemia group were higher than those in the non-anemia group, and the postoperative hospital stay in the preoperative anemia group was longer than that in the non-anemia group ((14.1±7.3) days vs. (13.3±6.2) days, t=5.202, P<0.01). Conclusions: The incidence of perioperative anemia in patients with gastrointestinal neoplasms is high. Preoperative anemia can increase the demand for intraoperative blood transfusion and affect the short-term prognosis of patients. At present, the concept of standardized treatment of perioperative anemia among gastrointestinal surgeons in Hubei Province needs to be improved.

[Application of a standard communication system-based continuous home remote visit mode in the management of visits to severely burned patients in the post-pandemic era of coronavirus disease 2019]

Objective: To observe the application effects of a standard communication system-based continuous home remote visit mode in the management of visits to severely burned patients in the post-pandemic era of coronavirus disease 2019 (hereinafter referred to as post-pandemic era). Methods: A retrospective cohort study was conducted. A total of 69 severely burned patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from February to December, 2020 and their 69 family members were recruited into this study. According to the difference of visit model, 33 severely burned patients who were admitted into burn intensive care unit (BICU) from February to June, 2020 and received completely restricted visits according to the requirements for epidemic prevention and control and their corresponding 33 family members were included into conventional visit group; 36 severely burned patients who were admitted into BICU from July to December, 2020 and received the standard communication system-based continuous home remote visits and their 36 corresponding family members were recruited into remote visit group. The family members in conventional visit group could only communicate with the primary nurses by telephone, while the patients and family members in remote visit group could communicate with the primary nurses, responsible doctors, rehabilitation therapists, and nutrition therapists through WeChat video call. The survey results of general information questionnaire and Hamilton Anxiety Scale (HAMA) scores of two groups of patients and their family members at BICU admission of patients, HAMA scores of the two groups of patients and their family members in the second week of BICU admission and at discharge from BICU of patients, the scores of the Visiting Effect Evaluation Scale of the two groups of patients and their family members and the scores of Chinese version of Critical Care Family Satisfaction Survey (C-CCFSS) of the two groups of family members at discharge from BICU, and the scores of Satisfaction Survey and Evaluation Scale During Hospitalization of patients within the first week after the discharge of patients from BICU were compared. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Mann-Whitney U test. Results: In remote visit group, there were 29 males and 7 females in patients, aged 48 (34, 53) years, and 15 males and 21 females in family members, aged 45 (30, 48) years. In conventional visit group, there were 24 males and 9 females in patients, aged 49 (38, 54) years, and 9 males and 24 females in family members, aged 44 (35, 48) years. At BICU admission of patients, the HAMA scores of the two groups of patients and family members were both similar (P>0.05). The total HAMA scores of patients and family members in remote visit group were significantly lower than those in conventional visit group in the second week when the patients were admitted to BICU (Z=-3.195, -3.018, P<0.01) and discharged from BICU (Z=-2.118, -2.380, P<0.05). At discharge from BICU of patients, the scores of each dimension in Visiting Effect Evaluation Scale of the patients in the two groups were similar (P>0.05); while scores of 3 dimensions including patient safety information, diagnosis and treatment quality information, and psychological support information in Visiting Effect Evaluation Scale of family members in remote visit group were significantly higher than those in conventional visit group (Z=-2.372, -2.209, -2.174, P<0.05), and only the scores of visit perception of family members were close to those in conventional visit group (P>0.05). At discharge from BICU of patients, the C-CCFSS scores of the family members in remote visit group was 99 (98, 108), which were significantly higher than 98 (97, 100) in conventional visit group (Z=-2.545, P<0.05). Within the first week after the discharge of patients from BICU, the scores of Satisfaction Survey and Evaluation Scale During Hospitalization of patients in remote visit group were 99 (98, 100), which were significantly higher than 96 (94, 98) in conventional visit group (Z=-5.213, P<0.01). Conclusions: In the management of visits to severely burned patients in the post-pandemic era, application of the standard communication system-based continuous home remote visit mode can improve the visit effect and satisfaction, and effectively alleviate the anxiety of patients and their family members.

[Epidemiological characteristics and diagnosis of imported malaria cases in Zhejiang Province from 2017 to 2020]

OBJECTIVE

To analyze the epidemiological features and diagnosis of imported malaria cases in Zhejiang Province from 2017 to 2020, so as to provide the scientific evidence for the management of imported malaria in the province.

METHODS

The data of malaria cases reported in Zhejiang Province were captured from the Information Management System for Parasitic Disease Control of China Information System for Disease Control and Prevention from 2017 to 2020, and the temporal, spatial and human distribution, and initial and definitive diagnosis of imported malaria cases were descriptively analyzed.

RESULTS

A total of 593 malaria cases were reported in Zhejiang Province from 2017 to 2020, and all were overseas imported cases, including 532 men and 61 women, with a mean age of 41 years. There were 93.93% of the malaria cases from African countries, and the malaria parasites infecting these cases included Plasmodium falciparum, P. vivax, P. ovale, P. malariae and mixed infections, with P. falciparum as the predominant species (76.73%, 455/593). All malaria cases received totally correct initial diagnoses in county- and city-level centers for disease control and prevention (CDC) and entry-exit inspection and quarantine sectors, and the proportion of malaria cases with confirmation at the day of initial diagnosis was 41.48% (207/499) in medical institutions and 66.18% (45/68) in CDC (χ² = 14.779, P < 0.001). In addition, the median interval [M (Q_R)] of malaria cases was 1 (2) d from onset to initial diagnosis and 1 (2) d from initial diagnosis to confirmation in Zhejiang Province from 2017 to 2020, and the median interval [M (Q_R)] of severe malaria cases was significantly longer than that of non-severe cases [2 (3) d vs. 1 (2) d; Z = -3.002, P < 0.05].

CONCLUSIONS

Zhejiang Province faces great challenges of malaria control, and post-elimination surveillance of malaria still requires to be reinforced. Meanwhile, the awareness of seeking medical services requires to be improved among returners from malaria-endemic regions and the diagnostic capability of malaria requires to be improved among medical professionals.

[Effectiveness of TRB3 on human hepatocellular carcinoma cells proliferation, apoptosis and migration]

Objective: To explore the regulatory role and mechanism of tribbles pseudokinase 3 (TRB3) on hepatocarcinoma (HCC) cells proliferation, apoptosis and migration. Methods: Immunohistochemistry and Western blot were used to detect TRB3 expression in cancerous and adjacent cancerous liver tissues of HCC patients. TRB3 expression was detected in vitro in HepG2 and Huh7 hepatocarcinoma cell lines. Simultaneously, CCK8 and EdU were used to detect cell proliferation after TRB3 targeted inhibition with small interfering RNA. CCK8 and EdU were used to detect cell proliferation. Flow cytometry assay was used to detect apoptosis. Transwell assay was used to evaluate migration ability. Simultaneously, Western blot was used to detect changes in apoptosis, migration-related proteins and AKT phosphorylation activity. The mean comparison between the two groups was performed by t-test, and the comparison between multiple groups was performed by one-way analysis of variance. Results: Western blot showed that the expression of TRB3 was significantly up-regulated in HCC tissues. Compared with normal liver tissues adjacent to cancer, the relative expression levels were 0.78 ± 0.12 and 0.29 ± 0.09, respectively, P < 0.01, and the difference was statistically significant. After interfering siRNA inhibited TRB3, CCK8 and EdU tests showed that the proliferation activity of HepG2 and Huh7 cells were significantly weakened (P < 0.05). Flow cytometry results showed that the apoptotic proportions of HepG2 and Huh7 cells was significantly increased (P < 0.01). Western blot also showed that the expression of apoptosis regulatory proteins BAX and BIM were significantly increased (P < 0.01). Transwell assay results showed that the migration ability of HepG2 and Huh7 cells was decreased (P < 0.05), and the expression of migration regulatory proteins MMP4 and MMP9 was also significantly down-regulated. Western blot results showed that the AKT phosphorylation level was significantly increased. Conclusion: TRB3 regulates hepatocarcinoma cells proliferation, apoptosis and migration by inhibiting the AKT phosphorylation activity. Therefore, TRB3 may be a potential target site for the liver cancer treatment.

Dimethyl sulfoxide stimulates the AhR-Jdp2 axis to control ROS accumulation in mouse embryonic fibroblasts

The aryl hydrocarbon receptor (AhR) is a ligand-binding protein that responds to environmental aromatic hydrocarbons and stimulates the transcription of downstream phase I enzyme–related genes by binding the cis element of dioxin-responsive elements (DREs)/xenobiotic-responsive elements. Dimethyl sulfoxide (DMSO) is a well-known organic solvent that is often used to dissolve phase I reagents in toxicology and oxidative stress research experiments. In the current study, we discovered that 0.1% DMSO significantly induced the activation of the AhR promoter via DREs and produced reactive oxygen species, which induced apoptosis in mouse embryonic fibroblasts (MEFs). Moreover, Jun dimerization protein 2 (Jdp2) was found to be required for activation of the AhR promoter in response to DMSO. Coimmunoprecipitation and chromatin immunoprecipitation studies demonstrated that the phase I–dependent transcription factors, AhR and the AhR nuclear translocator, and phase II–dependent transcription factors such as nuclear factor (erythroid-derived 2)–like 2 (Nrf2) integrated into DRE sites together with Jdp2 to form an activation complex to increase AhR promoter activity in response to DMSO in MEFs. Our findings provide evidence for the functional role of Jdp2 in controlling the AhR gene via Nrf2 and provide insights into how Jdp2 contributes to the regulation of ROS production and the cell spreading and apoptosis produced by the ligand DMSO in MEFs.

[Whole lung lavage in an infant with pulmonary alveolar proteinosis and literature review]

Objective: To investigate the safety, feasibility and operation key points of whole lung lavage in infants with pulmonary alveolar proteinosis. Methods: The clinical manifestations, genetic screening, therapeutic interventions and outcome of an infant with pulmonary alveolar proteinosis complicated with respiratory failure who received whole lung lavage in November 2018 in Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were reported. Websites including PubMed, Springer Link, China National Knowledge Infrastructure (CNKI), Weipu Database, and Wanfang Database were searched using the key words of "whole lung lavage" "pediatric" and "pulmonary alveolar proteinosis" for articles published from their establishments to April 2019. Relevant literature was reviewed. Results: A 3-month-old boy had experienced cough, shortness of breath and cyanosis for 1 week prior to admission to pediatric intensive care unit. Physical examination showed hepatosplenomegaly. Complete blood cell count showed mild anemia (hemoglobin 96 g/L) and normal white blood cells. The patient had normal C-reactive protein and normal blood platelet. Biochemical panel showed hypoalbuminemia (31 g/L), mildly elevated glutamic oxaloacetic transaminase (115 U/L) and blood ammonia (165 μmol/L), extremely elevated lactate dehydrogenase (>6 600 U/L) and hyperferritinemia (>4 500 μg/L). Chest computed tomography (CT) revealed decreased transmittance of both lungs, patchy high density shadow and ground glass opacity. Genetic testing revealed a mutation of c.625+1G>A in SLC7A7. Schiff reaction (PAS staining) in bronchoalveolar lavage fluid was positive. The patient was diagnosed with severe pneumonia, respiratory failure, lysinuria urinary protein intolerance, and pulmonary alveolar proteinosis. The patient received sequential unilateral whole lung lavage in 2 days and was successfully weaned from ventilator. He was discharged home breathing room air. Eleven articles (11 in English and non in Chinese) were reviewed. Twenty-one patients were included. After whole lung lavage, 76% (16/21) of the patients had improvement in respiratory function. Conclusions: Whole lung lavage can effectively improve respiratory failure caused by pulmonary alveolar proteinosis in infant patients. The procedure is feasible and safe.

Particulate matter of 2.5 μm or less in diameter disturbs the balance of TH17/regulatory T cells by targeting glutamate oxaloacetate transaminase 1 and hypoxia-inducible factor 1α in an asthma model

BACKGROUND

Epidemiologic evidence suggests that exposure to particulate matter of 2.5 μm or less in diameter (PM2.5) aggravates asthma.

OBJECTIVE

We sought to investigate the underlying mechanisms between PM2.5 exposure and asthma severity.

METHODS

The relationship between PM2.5 exposure and asthma severity was investigated in an asthma model with CD4⁺ T cell-specific aryl hydrocarbon receptor (AhR)-null mice. Effects of PM2.5 and polycyclic aromatic hydrocarbons (PAHs) on differentiation of T_H17/regulatory T (Treg) cells were investigated by using flow cytometry and quantitative RT-PCR. Mechanisms were investigated by using mRNA sequencing, chromatin immunoprecipitation, bisulfite sequencing, and glycolysis rates.

RESULTS

PM2.5 impaired differentiation of Treg cells, promoted differentiation of T_H17 cells, and aggravated asthma in an AhR-dependent manner. PM2.5 and one of its prominent PAHs, indeno[1,2,3-cd]pyrene (IP), promoted differentiation of T_H17 cells by upregulating hypoxia-inducible factor 1α expression and enhancing glycolysis through AhRs. Exposure to PM2.5 and IP enhanced glutamate oxaloacetate transaminase 1 (Got1) expression through AhRs and accumulation of 2-hydroxyglutarate, which inhibited ten-eleven translocation methylcytosine dioxygenase 2 activity, resulting in hypermethylation in the forkhead box P3 locus and impaired differentiation of Treg cells. A GOT1 inhibitor, (aminooxy)acetic acid, ameliorated asthma by shifting differentiation of T_H17 cells to Treg cells. Similar regulatory effects of exposure to PM2.5 or IP on T_H17/Treg cell imbalance were noted in human T cells, and in a case-control design PAH exposure appeared to be a potential risk factor for asthma.

CONCLUSIONS

The AhR-hypoxia-inducible factor 1α and AhR-GOT1 molecular pathways mediate pulmonary responses on exposure to PM2.5 through their ability to disturb the balance of T_H17/Treg cells.

Incidence and mortality of nasopharyngeal carcinoma: interim analysis of a cluster randomized controlled screening trial (PRO-NPC-001) in southern China

BACKGROUND

Previous mass screening studies have shown that IgA antibodies against Epstein-Barr Virus (EBV) can facilitate early detection of nasopharyngeal carcinoma (NPC), but the impact of EBV-antibody screening for NPC-specific mortality remains unknown.

PATIENTS AND METHODS

A prospective, cluster randomized, controlled trial for NPC screening (PRO-NPC-001) was conducted in 3 selected towns of Zhongshan City and 13 selected towns of Sihui City in southern China beginning in 2008. Serum samples of the screening group were tested for two previously selected anti-EBV antibodies. Subjects with serological medium risk were subsequently retested annually for 3 years, and those with serological high risk were referred to otorhinolaryngologists for diagnostic check-up. An interim analysis was carried out to evaluate the primary end points of the NPC-specific mortality and the early diagnostic rate, and the secondary end point of the NPC incidence, through linkage with the database of Zhongshan City.

RESULTS

Among 70 296 total subjects, 29 413 screened participants (41.8% of the total subjects) in the screening group and 50 636 in the control group, 153 (43.3 per 100 000 person-year), 62 (55.3 per 100 000 person-year) and 99 (33.1 per 100 000 person-year) NPC cases were identified. The early diagnostic rates of NPC were significantly higher in the participants (79.0%, P < 0.0001) and the screening group (45.9%, P < 0.0001) compared with the control group (20.6%). Although no differences were found between NPC-specific mortality of the screening group and the control group [relative risk (RR)= 0.82, 95% confidence interval (CI) 0.37-1.79], lower NPC-specific mortality was noticed among participants from the screening group versus the control group (RR = 0.22, 95% CI 0.09-0.49).

CONCLUSION

IgA antibodies against EBV can identify high-risk population and was effective in screening for early asymptomatic NPC. Although the mortality reduction was not significant in the primary end point, we noted encouraging evidence of a mortality reduction in screening participants in this interim analysis.

CLINICAL TRIAL NUMBER

NCT00941538.

[β-catenin nuclear translocation represses thyroid cancer stem cells differentiating into cells with sodium-iodine symporter functional expression]

Objective: To confirm whether β-catenin nuclear translocation in thyroid cancer stem cells can differentiate into thyroid cancer cells without functional membrane expression of sodium-iodine transporter (NIS) and be resistant to iodide 131 treatment. Methods: Thyroid cancer stem cells were firstly isolated as a side population (SP) from human thyroid cancer cell line FTC133. The SP cells from FTC133 were transfected with β-catenin, and then differentiated. The cells were further collected for Western blot, Transwell and MTT assay to investigate the epithelial-mesenchymal transition (EMT) characteristics, tumor growth, invasion, and iodine uptake potency in vitro. Functional NIS expression and iodide uptake in differentiated cells were detected with immunofluorescent staining and iodide uptake assay, respectively. Subcutaneous severe combined immunodeficient (SCID) mice tumor model was induced with differentiated cancer cells to explore the in vivo effect of radioiodine treatment. Further immunohistochemical staining was performed to reveal the changes of functional proteins involved in tumor radioiodine treatment. Results: Side population was isolated from FTC133 accounting for about 0.03%, with high expression of stem cell markers and decreased expression of differentiated cell markers. Western blot showed prominent EMT phenotype in the differentiated cells from β-catenin transfected stem cell model, with absence of epithelial expression of E-cadherin and cytokeratin 18, as well as abnormal expression of vimentin,fibronectin and urokinase-type plasminogen activator. Moreover,compared with cells differentiated from untransfected or empty plasmid transfected stem cells, in vitro proliferation markedly increased 85.4% and 81.0%, respectively (both P<0.01); while in vitro invasion augmented 78.8% and 84.4%, respectively (both P<0.01). Immunofluorescent staining identified that, after transfected with β-catenin, differentiated cells underwent β-catenin nuclear translocation and NIS localization transferred from membrane to plasma, compared with cells from untransfected or empty plasmid transfected stem cells. Cell iodide uptake in vitro decreased about 52.8% and 45.2%, respectively (both P<0.01). Furthermore, in vivo experiment further demonstrated that, cells differentiated from β-catenin transfected stem cells were found with much higher tumor proliferation,tumor growth rate and larger tumor mass after radioiodine 131 treatment (both P<0.05). Conclusion: Induction of β-catenin nuclear translocation in stem cells may generate differentiated thyroid cancer cells that are not sensitive to radioiodine treatment.

[Application of pegylated recombinant human granulocyte colony-stimulating factor to prevent chemotherapy-induced neutropenia in patients with lymphoma: a prospective, multicenter, open-label clinical trial]

目的

评价聚乙二醇化重组人粒细胞刺激因子（PEG-rhG-CSF）预防淋巴瘤患者化疗后发生中性粒细胞减少症的有效性和安全性。

方法

本研究为多中心、开放、单臂、Ⅳ期临床试验。纳入410例淋巴瘤患者接受多周期化疗并预防性使用PEG-rhG-CSF。主要观察患者各化疗周期Ⅲ/Ⅳ度中性粒细胞减少症和发热性中性粒细胞减少（FN）的发生率，同时观察患者整个化疗期间抗生素的使用率。

结果

①410例患者中，违背入选标准8例（1.95%），失访35例（8.54%），发生不良事件19例（4.63%），出现符合终止研究标准者12例（2.93%），疾病进展或复发15例（3.66%），故最终321例（78.29%）进入符合方案集。②在第1~4个治疗周期，初级预防给予PEG-rhG-CSF后，Ⅳ度中性粒细胞减少症的发生率分别为19.14%（49/256）、12.50%（32/256）、12.18%（24/197）、13.61%（20/147），FN的发生率分别为3.52%（9/256）、0.39%（1/256）、2.54%（5/197）、2.04%（3/147）；次级预防给药后，Ⅳ度中性粒细胞减少症的发生率从61.54%（40/65）降至16.92%（11/65）、18.46%（12/65）、20.75%（11/53），FN的发生率从16.92%（11/65）降至1.54%（1/65）、4.62%（3/65）、3.77%（2/53）。③整个化疗期间接受抗生素治疗的受试者比例为34.39%（141/410）。④与PEG-rhG-CSF相关的不良事件发生率为4.63%（19/410），最常见的不良反应为骨痛[3.90%（16/410）]、乏力（0.49%）和发热（0.24%）。

结论

在淋巴瘤患者化疗过程中，预防性使用PEG-rhG-CSF能够有效降低化疗过程中Ⅲ/Ⅳ度中性粒细胞减少症和FN的发生率，确保淋巴瘤患者接受标准剂量化疗，提高治愈率。

[Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors]

Objective: To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors. Methods: A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study. Results: Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death. Conclusions: Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

[Screening of differentially expressed genes of allergic rhinitis with asthma]

Objective:To detect the differentially expressed genes of allergic rhinitis(AR) with asthma and screen the pathogenic genes. Method: Eight nasal mucosa tissue samples from patients with nasal septum deviation (healthy control group), eight nasal mucosa tissue samples from patients with allergic rhinitis（AR） and eight nasal mucosa tissue samples from patients with AR and asthma were collected. Allergy & Asthma PCR Array was used to analyze allergy related genes expression level. Result: Compared to the control group, there are 84 related genes were found and 15 genes were up-regulated, 69 genes were down-regulated. Furthermore, there are 17 genes（ADAM33, BCL6, IFNGR2, IL12A, IL12B, IL13RA1, IL17A, IL31, IL4R, IL5, KIT, LTB4R, MS4A2, RORC, STAT5A, STAT6, TBX21） differentially expressed. Compared AR with asthma group to the AR group, there was 1 gene differentially expressed(RORC). Conclusion: ADAM33, BCL6, IFNGR2, IL12A, IL12B, IL13RA1, IL17A, IL31, IL4R, IL5, KIT, LTB4R, MS4A2, RORC, STAT5A, STAT6, TBX21 are the possible pathogenic genes of AR with asthma. RORC may be the specific marker gene in asthma induced by allergic rhinitis.

Restoration of hydroxyindole O-methyltransferase levels in human cancer cells induces a tryptophan-metabolic switch and attenuates cancer progression

5-Methoxytryptophan (5-MTP) is a tryptophan metabolite with recently discovered anti-inflammatory and tumor-suppressing activities. Its synthesis is catalyzed by a hydroxyindole O-methyltransferase (HIOMT)-like enzyme. However, the exact identity of this HIOMT in human cells remains unclear. Human HIOMT exists in several alternatively spliced isoforms, and we hypothesized that 5-MTP-producing HIOMT is a distinct isoform. Here, we show that human fibroblasts and cancer cells express the HIOMT298 isoform as contrasted with the expression of the HIOMT345 isoform in pineal cells. Sequencing analysis of the cloned isoforms revealed that HIOMT298 is identical to the sequence of a previously reported truncated HIOMT isoform. Of note, HIOMT298 expression was reduced in cancer cells and tissues. Stable transfection of A549 cancer cells with HIOMT298 restored HIOMT expression to normal levels, accompanied by 5-MTP production. Furthermore, HIOMT298 transfection caused a tryptophan-metabolic switch from serotonin to 5-MTP production. To determine the in vivo relevance of this alteration, we compared growth and lung metastasis of HIOMT298-transfected A549 cells with those of vector- or untransfected A549 cells as controls in a murine xenograft model. Of note, the HIOMT298-transfected A549 cells exhibited slower growth and lower metastasis than the controls. Our findings provide insight into the crucial role of HIOMT298 in 5-MTP production in cells and in inhibiting cancer progression and highlight the potential therapeutic value of 5-MTP for managing cancer.

Correction to: Aryl hydrocarbon receptor signaling promotes ORMDL3-dependent generation of sphingosine-1-phosphate by inhibiting sphingosine-1-phosphate lyase

In this article, published online 23 March 2018, the affiliation 10 of Zhou Y was incorrect. The affiliation should be "Children's Hospital and Institute of Biomedical Sciences, Fudan University. Key Laboratory of Neonatal Disease, Ministry of Health, 201102, Shanghai, China." The authors regret the errors.

[Clinical analysis of three cases with beta-thalassemia]

Objective: To study the diagnostic strategy of β-thalassemia through retrospective analysis of 3 cases of β-thalassemia. Methods: Three patients were admitted to the Department of Pediatrics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2014 to June 2015. The clinical manifestations, hemoglobin electrophoresis and gene detection of these patients and their parents were analyzed, diagnostic ideas and key points were discussed when beta thalassemia gene detection did not explain clinical manifestations or hemoglobin electrophoresis. Results: Case 1, boy, 5 years old, was diagnosed as compound heterozygotes of β41-42 and IVS-Ⅱ-654 with hereditary persistence of fetal hemoglobin(HPFH) according to the clinical manifestations of mild anemia, normal size of liver and spleen, 92.8% fetal hemoglobin (HbF) and gene analysis. Case 2, girl, 3 years old, was confirmed the diagnosis of thalassemia intermedia with β41-42 heterozygote compound and ααα^anti3.7 heterozygote in accordance with the manifestations of severe anemia, hepatosplenomegaly, 8.6% HbF, 4.1% hemoglobin A₂(HbA₂) and gene analysis. Case 3, girl, 3 years old, with severe anemia, hepatosplenomegaly, 51.2% HbF and 3.7% HbA₂, was diagnosed as thalassemia major with compound heterozygotes of PolyA (T→C) and β17 by DNA sequencing. Conclusion: The diagnosis of β-thalassemia should be confirmed by clinical manifestations of hemolytic anemia, hemoglobin electrophoresis, gene diagnosis and family survey.

A prominent air pollutant, Indeno[1,2,3-cd]pyrene, enhances allergic lung inflammation via aryl hydrocarbon receptor

Chronic exposure to ambient polycyclic aromatic hydrocarbons (PAHs) is associated with asthma, but its regulatory mechanisms remain incompletely defined. We report herein that elevated levels of urinary 1-hydroxypyrene, a biomarker of PAH exposure, were found in asthmatic subjects (n = 39) as compared to those in healthy subjects (n = 43) living in an industrial city of Taiwan, where indeno[1,2,3-cd]pyrene (IP) was found to be a prominent PAH associated with ambient PM2.5. In a mouse model, intranasal exposure of mice with varying doses of IP significantly enhanced antigen-induced allergic inflammation, including increased airway eosinophilia, Th2 cytokines, including IL-4 and IL-5, as well as antigen-specific IgE level, which was absent in dendritic cell (DC)-specific aryl hydrocarbon receptor (AhR)-null mice. Mechanistically, IP treatment significantly altered DC's function, including increased level of pro-inflammatory IL-6 and decreased generation of anti-inflammatory IL-10. The IP's effect was lost in DCs from mice carrying an AhR-mutant allele. Taken together, these results suggest that chronic exposure to environmental PAHs may pose a significant risk for asthma, in which IP, a prominent ambient PAH in Taiwan, was shown to enhance the severity of allergic lung inflammation in mice through, at least in part, its ability in modulating DC's function in an AhR-dependent manner.

Aryl hydrocarbon receptor signaling promotes ORMDL3-dependent generation of sphingosine-1-phosphate by inhibiting sphingosine-1-phosphate lyase

Aryl hydrocarbon receptor (AhR), a cellular chemical sensor, controls cellular homeostasis, and sphingosine-1-phosphate (S1P), a bioactive intermediate of sphingolipid metabolism, is believed to have a role in immunity and inflammation, but their potential crosstalk is currently unknown. We aimed to determine whether there is a functional linkage between AhR signaling and sphingolipid metabolism. We showed that AhR ligands, including an environmental polycyclic aromatic hydrocarbon (PAH), induced S1P generation, and inhibited S1P lyase (S1PL) activity in resting cells, antigen/IgE-activated mast cells, and mouse lungs exposed to the AhR ligand alone or in combination with antigen challenge. The reduction of S1PL activity was due to AhR-mediated oxidation of S1PL at residue 317, which was reversible by the addition of an antioxidant or in cells with knockdown of the ORMDL3 gene encoding an ER transmembrane protein, whereas C317A S1PL mutant-transfected cells were resistant to the AhR-mediated effect. Furthermore, analysis of AhR ligand-treated cells showed a time-dependent increase of the ORMDL3-S1PL complex, which was confirmed by FRET analysis. This change increased the S1P levels, which in turn, induced mast cell degranulation via S1PR2 signaling. In addition, elevated levels of plasma S1P were found in children with asthma compared to non-asthmatic subjects. These results suggest a new regulatory pathway whereby the AhR-ligand axis induces ORMDL3-dependent S1P generation by inhibiting S1PL, which may contribute to the expression of allergic diseases.

Inhibition of cancer cell epithelial mesenchymal transition by normal fibroblasts via production of 5-methoxytryptophan

We reported previously that human fibroblasts release 5-methoxytryptophan (5-MTP) which inhibits cancer cell COX-2 overexpression and suppresses cancer cell migration and metastasis. To determine whether fibroblasts block cancer cell epithelial mesenchymal transition (EMT) via 5-MTP, we evaluated the effect of Hs68 fibroblasts (HsFb) on A549 cancer cell EMT in a two-chamber system. Co-incubation of A549 with HsFb prevented TGF-β1-induced reduction of E-cadherin and increase in Snail and N-cadherin. Transfection of HsFb with tryptophan hydroxylase-1 siRNA, which inhibited tryptophan hydroxylase-1 protein expression and 5-MTP release in HsFb abrogated the effect of HsFb on A549 EMT. Direct addition of pure 5-MTP to cultured A549 cells followed by TGF-β1 prevented TGF-β1-induced reduction of E-cadherin, and elevation of Snail, vimentin and matrix metalloproteinase 9. Administration of 5-MTP to a murine xenograft tumor model reduced vimentin protein expression in the tumor tissues compared to vehicle control which was correlated with reduction of metastasis in the 5-MTP treated mice. Our experimental data suggest that 5-MTP exerted its anti-EMT actions through inhibition of p38 MAPK activation, p65/p50 NF-κB nuclear translocation and transactivation without the involvement of COX-2 or p300 histone acetyltransferase. Our findings indicate that fibroblasts release a tryptophan metabolite, 5-MTP, to reduce cancer cell EMT, migration, invasion and metastasis.

The Relationship between Emergency Response Time and Out-Of-Hospital Cardiac Arrest Prognosis: A Meta-Analysis

Objective

To assess the relationship between emergency response time and prognosis of patients with out-of-hospital cardiac arrest.

Design

Systematic review.

Methods

Relevant observational studies were identified by a search of PubMed and ISI databases to 30 January 2014. Primary outcome was survival to discharge. The weighted mean differences (WMD) for response time were calculated for those survivals to discharge and death in hospital. We also carried out a dose response meta-analysis for assessing summary odds ratio (OR) of survival by response time.

Results

A total of 13 studies with 804,998 patients included in the meta-analysis. The WMD of response time between survivals to discharge group and death in hospital group was 1.976 (95% confidence interval [CI] = 1.161-2.792; p<0.001). Sensitivity analyses by only included prospective cohorts showed the WMD of response time between two groups was 1.115 (95% CI=0.508-1.723; p<0.001). Dose-response relationship between response time and survival to discharge risk was observed statistically significant (χ2=39.86, p<0.001). In linear model, the summary OR was 0.914 (95% CI=0.889-0.940) for every 1 minutes delay in response time. In spline model, the survival OR decreased along with the response time, especially when response time less than 7 minutes.

Conclusions

Emergency response time is an important risk factor for prognosis after OHCA in adults. The EMS team must arrive as soon as possible to the site of the event. (Hong Kong j.emerg.med. 2015;22:345-351)

CYP4A in tumor-associated macrophages promotes pre-metastatic niche formation and metastasis

Tumor-associated macrophages (TAMs) play an essential role in metastasis. However, what enables TAMs to have a superior capacity to establish pre-metastatic microenvironment in distant organs is unclear. Here we have begun to uncover the effects of cytochrome P450 (CYP) 4A in TAMs on lung pre-metastatic niche formation and metastasis. CYP4A⁺ TAM infiltration was positively associated with metastasis, pre-metastatic niche formation and poor prognosis in breast cancer patients. The pharmacological inhibition of CYP4A reduced lung pre-metastatic niche formation (evidenced by a decrease in vascular endothelial growth factor receptor 1 positive (VEGFR1⁺) myeloid cell recruitment and pro-metastatic protein expression) and metastatic burden, accompanied with TAM polarization away from the M2 phenotype in spontaneous metastasis models of 4T1 breast cancer and B16F10 melanoma. Co-implantation of 4T1 cells with CYP4A10^high macrophages promoted lung pre-metastatic niche formation and metastasis. Depletion of TAMs disrupted lung pre-metastatic niches and thereby prevented metastasis. Treatment with the CM from CYP4A10^high M2 macrophages (M2) increased pre-metastatic niche formation and metastatic burden in the lungs, whereas CYP4A inhibition attenuated these effects. In vitro TAM polarization away from the M2 phenotype induced by CYP4A inhibition decreased VEGFR1⁺ myeloid cell migration and fibronectin expression, accompanied with downregulation of STAT3 signaling. Conversely, overexpression of CYP4A or exogenous addition of 20-hydroxyeicosatetraenoic acid promoted M2 polarization and cytokine production of macrophages and thereby enhanced migration of VEGFR1⁺ myeloid cells, which were reversed by siRNA or pharmacological inhibition of STAT3. Importantly, a combined blocking M2 macrophage-derived factors TGF-β, VEGF and SDF-1 abolished VEGFR1⁺ myeloid cell migration and fibroblast activation induced by CYP4A. In summary, CYP4A in TAMs is crucial for lung pre-metastatic niche formation and metastasis, and may serve as a potential therapeutic target in human cancer.

Transcriptome analysis of peach (Prunus persica L. Batsch) during the late stage of fruit ripening

Fruit ripening is a complex developmental process, the details of which remain largely unknown in fleshy fruits. In this paper, the fruit flesh of two peach varieties, "Zhongyou9" (a nectarine; Prunus persica L. Batsch) and its mutant "Hongyu", was analyzed by RNA-seq technology during two stages of ripening at 20-day intervals. One hundred and eighty significant upregulated and two hundred and thirty-five downregulated genes were identified in the experiment. Many of these genes were related to plant hormones, chlorophyll breakdown, accumulation of aroma and flavor volatiles, and stress. To the best of our knowledge, this is the first transcriptome analysis of peach ripening, and our data will be useful for further studies of the molecular basis of fruit ripening.

Factors influencing aversive learning in the oriental fruit fly, Bactrocera dorsalis

Parameters such as the intensity of conditioned and unconditioned stimuli, the inter-trial interval, and starvation time can influence learning. In this study, the parameters that govern aversive learning in the oriental fruit fly, Bactrocera dorsalis, a serious pest of fruits and vegetables, were examined. Male flies were trained to associate the attractive odorant methyl eugenol, a male lure, with a food punishment, sodium chloride solution, and the conditioned suppression of the proboscis-extension response was investigated. We found that high methyl eugenol concentrations support a stronger association. With increasing concentrations of sodium chloride solution, a steady decrease of proboscis-extension response during six training trials was observed. A high level of learning was achieved with an inter-trial interval of 1-10 min. However, extending the inter-trial interval to 15 min led to reduced learning. No effect of physiological status (starvation time) on learning performance was detected, nor was any non-associative learning effect induced by the repeat presentation of odor or punishment alone. The memory formed after six training trials could be retained for at least 3 h. Our results indicate that aversive learning by oriental fruit flies can be affected by odor, punishment concentration and inter-trial interval.

NDC80 promotes proliferation and metastasis of colon cancer cells

Chromosome instability is a common feature of tumor cells, and may be an important mechanism in tumor formation. Nuclear division cycle 80 (NDC80) is closely associated with the stability of chromosomes. Therefore, we investigated the relationship between NDC80 and development of colon cancer using a range of methods. Western blotting and immunohistochemistry were employed to determine the expression of this protein in different colon cells and tissues, cell proliferation was measured with an MTT assay, levels of proliferating cell nuclear antigen were examined by immunofluorescence, and cell migration was observed using wound healing tests. Our results showed that the expression of NDC80 in colon cancer cells (CACO2, HCT8, HCT116, and SW480) and tissues (from 20 patients) was higher than that in controls. Moreover, cell proliferation and migration rates were elevated in cells transfected with NDC80 compared to control groups. In summary, NDC80 promotes the proliferation and metastasis of colon cancer cells, and may constitute a new target for gene therapy in treating this disease. Combined with clinicopathological grading, measurement of positive NDC80 expression may be helpful in diagnosing and estimating the prognosis of colon cancer patients.

Effective nonlinear optical properties and optical bistability in composite media containing spherical particles with different sizes

We study the effective nonlinear optical properties of composite media in which identical nonlinear nanospheres are randomly embedded in the linear host medium. In the weakly-nonlinear case, we aim at the effective linear permittivity and effective third-order nonlinear susceptibility with effective medium theory combined with the linear Mie theory. We show that large enhancement of optical nonlinear susceptibility can be achieved at the surface plasmon resonant wavelength, which can be tuned by changing the size of nanoparticles. Our numerical results are compared with those in the quasistatic limit or/and from Comsol simulations, good agreement is found. In the strong-nonlinear case, based on nonlinear Mie theory and self-consistent mean-field method, we study the optical bistability of the composite media. The optical bistability and tristability are found, and the bistable threshold fields are found to be strongly dependent on the sizes of nanoparticles and the incident wavelength. Such nonlinear nanocomposites with large optical nonlinearity and tunable bistable behavior are envisioned for use as nonlinear optical nanodevices such as optical nanoswitches, optical nanomemories and so on.

Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update

Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

Identification of natural recombinants derived from PCV2a and PCV2b

Porcine circovirus type 2 (PCV2) is considered to be the main pathogen in PC-associated diseases, and significantly affects the global pig-producing industry. PCV2 continuously evolves by point mutations and genome recombinations. In the present study, we aimed to further identify recombinant PCV2 strains. We used polymerase chain reaction to detect PCV2 in the carcasses of pigs with suspected infections from different regions of Guangdong Province in China. DNA was extracted from samples with confirmed infection and full- genome amplification, sequencing, phylogenetic tree construction, gene recombination detection, and sequence alignment were performed in gene recombination analysis. Our results show that recombination occurred between the strains SHC (DQ104421) and ZhuJi2003 (AY579893). The recombination resulted in three recombinants: GD003 (KM503044), GD005 (KM487708), and GD008 (KM487709). Further analyses revealed that these novel recombinants appeared to result from recombination between the PCV2a and PCV2b strains, with crossover regions located in ORF2. This study was a comprehensive analysis that used several different methods, which demonstrated that a cluster of PCV2 strains resulted from the same type of inter-genotypic recombination pattern, with a breakpoint in the structural protein coding region. The results of our study provide both information on the recombination mechanism and disease pathogenesis and useful data for the prevention of PCV2 in the swine industry.

Correction: Real-space evidence of the equilibrium ordered bicontinuous double diamond structure of a diblock copolymer

Correction for 'Real-space evidence of the equilibrium ordered bicontinuous double diamond structure of a diblock copolymer' by C. Y. Chu et al., Soft Matter, 2015, 11, 1871-1876.

Real-space evidence of the equilibrium ordered bicontinuous double diamond structure of a diblock copolymer

The ordered bicontinuous double diamond (OBDD) structure has long been believed to be an unstable ordered network nanostructure, which is relative to the ordered bicontinuous double gyroid (OBDG) structure for diblock copolymers. Using electron tomography, we present the first real-space observation of the thermodynamically stable OBDD structure in a diblock copolymer composed of a stereoregular block, syndiotactic polypropylene-block-polystyrene (sPP-b-PS), in which the sPP tetrapods are interconnected via a bicontinuous network with Pn3̄m symmetry. The OBDD structure underwent a thermally reversible order-order transition (OOT) to OBDG upon heating, and the transition was accompanied with a slight reduction of domain spacing, as demonstrated both experimentally and theoretically. The thermodynamic stability of the OBDD structure was attributed to the ability of the configurationally regular sPP block to form helical segments, even above its melting point, as the reduction of internal energy associated with the helix formation may effectively compensate the greater packing frustration in OBDD relative to that in the tripods of OBDG.

Tunablity of the unconventional Fano resonances in coated nanowires with radial anisotropy

We establish full-wave electromagnetic scattering theory to study the near-field and far-field spectra of radially anisotropic coated nanowires. For coated nanowires containing radially anisotropic core and plasmonic shell, unconventional Fano resonances are predicted due to the interference between dipole cloaking mode and dipole resonant mode. In contrast to Z-shaped Fano profile with small modulation depth for coated nanospheres in Argyropoulos et al, Phys. Rev. Lett. 108, 263905 (2012), we predict S-shaped Fano profile with high depth for coated nanowires. An off-resonance field enhancement in the radially anisotropic core is found at the Fano dip, and its' magnitude is approximately the same as that the one at the low-energy resonant wavelength. Furthermore, with our adjustment of the inner size and the permittivity elements of the anisotropic core, tunable Fano-like profiles can be realized. These results may be useful for potential applications in different fields of nanotechnology.

Prostacyclin and PPARα agonists control vascular smooth muscle cell apoptosis and phenotypic switch through distinct 14-3-3 isoforms

We hypothesized that prostacyclin (PGI₂) protects vascular smooth muscle cell (VSMC) against apoptosis and phenotypic switch through peroxisome proliferator-activated receptor-α (PPARα) activation and 14-3-3 upregulation. Here we showed that transfection of rat aortic VSMC, A-10, with PGI₂-producing vectors, Ad-COPI, resulted in attenuated H₂O₂-induced apoptosis accompanied by a selective increase in 14-3-3β and 14-3-3θ expression. Carbaprostacyclin (cPGI₂) and Wy14,643 exerted a similar effect. The effects of PGI₂ were abrogated by MK886, a PPARα antagonist, but not GSK3787, a PPARδ antagonist. PPARα transfection upregulated 14-3-3β and θ expression and attenuated H₂O₂-induced apoptosis. H₂O₂-induced 14-3-3β but not 14-3-3θ degradation was blocked by a caspase 3 inhibitor. Furthermore, 14-3-3β but not 14-3-3θ overexpression reduced, while 14-3-3β siRNA aggravated apoptosis. VSMC contractile proteins and serum response factor (SRF) were reduced in H₂O₂-treated A-10 cells which were concurrently prevented by caspase 3 inhibitor. By contrast, PGI₂ prevented H₂O₂-induced SM22α and Calponin-1 degradation without influencing SRF. cPGI₂ and Wy14,643 also effectively blocked VSMC phenotypic switch induced by growth factors (GFs). GFs suppressed 14-3-3β, θ, ε and η isoforms and cPGI₂ prevented the decline of β, θ and η, but not ε. 14-3-3θ siRNA abrogated the protective effect of cPGI₂ on SM22α and Calponin-1 while 14-3-3 θ or 14-3-3β overexpression partially restored SM22α. These results indicated that PGI₂ protects VSMCs via PPARα by upregulating 14-3-3β and 14-3-3θ. 14-3-3β upregulation confers resistance to apoptosis whereas 14-3-3θ and β upregulation protects SM22α and Calponin-1 from degradation.

Improved methane production from waste activated sludge with low organic content by alkaline pretreatment at pH 10

Sludge with low organic content always results in an unsatisfactory performance, even failure of anaerobic digestion. The alkaline pretreatment effect on anaerobic digestion of sludge with low organic content has seldom been studied although it gives many benefits for sludge with high organic content. In this study the influence of alkaline pretreatment (pH 10, an effective alkaline pH) on the solubilization and methane production from waste activated sludge (WAS) with low organic content was investigated. Results from biochemical methane potential (BMP) experiments showed that anaerobic biodegradability of WAS was greatly improved by alkaline pretreatment at pH 10. Methane production from the current WAS under conditions of pretreatment time 4 h and digestion time 15 d was 139.6 mL/g VS (volatile solids), much higher than that from the unpretreated WAS with digestion time of 20 d (75.2 mL/g VS). Also, the solubilization of WAS was significantly accelerated by alkaline pretreatment. Mechanism exploration indicated that the general activities of anaerobic microorganisms, specific activities of key enzymes and the amounts of methanogens were enhanced by alkaline pretreatment at pH 10, showing good agreement with methane production.

Protective effect of oleanolic acid against beta cell dysfunction and mitochondrial apoptosis: crucial role of ERK-NRF2 signaling pathway

Pancreatic beta cell dysfunction is a hallmark of diabetes. Our previous results have shown that oleanolic acid (OA) has anti-diabetic potential. However, there is little literature reporting the effect of OA on beta cell dysfunction. The present study was designed to investigate the protective effect of OA against lipotoxicity and the underlying mechanisms. Lepr (db/db) diabetic mice were subjected to fasting blood glucose measurement, intraperitoneal glucose tolerance test after the administration of OA for two weeks. Histopathological observation was conducted by HE staining and transmission electron microscopy assay. Pancreatic islets were isolated from db/db diabetic mice and C57BL/6J mice. Palmitic acid (PA) was used to induce lipotoxicity in vitro. Apoptosis was evaluated in pancreatic islets in diabetic mice and in isolated pancreatic islets and beta-TC3 cells by TUNEL assay. Cellular ATP content, mitochondrial function and redox balance were examined. Phosphorylation of c-Jun NH2-terminal kinase (JNK) and extracellular signal-regulated kinase (ERK) and the activation of nuclear erythroid factor 2 p45-related factor 2 (Nrf2) signaling were evaluated by western blotting. In db/db mice, OA significantly protects beta cell function against lipotoxicity, evidenced by inhibition of apoptosis and improvement of glucose tolerance. In cells, OA administration may protect against PA-induced apoptosis and decrease of GSIS, in which process the activation of Nrf2 is essential. Once Nrf2 is activated, OA could induce GCLc expression, promote the production of GSH, and thus inhibit JNK phosphorylation and solid the antioxidant defense of mitochondria, leading to the inhibition of mitochondrial apoptosis. ERK signaling pathway is responsible for OA-induced activation of Nrf2 and the protective effect of OA. Overall, our study enhances the understanding of the protective effect of OA on beta cell and provides clues for further studies on the underlying mechanisms.