[A multicenter study on respiratory pathogen detection with Mycoplasma pneumoniae pneumonia in children]

Objective: To analyze the status of respiratory pathogen detection and the clinical features in children with Mycoplasma pneumoniae pneumonia (MPP). Methods: A prospective, multicenter study was conducted to collect clinical data, including medical history, laboratory examinations and multiplex PCR tests of children diagnosed with MPP from 4 hospitals in China between November 15th and December 20th, 2023. The multiplex PCR results and clinical characteristics of MPP children in different regions were analyzed. The children were divided into severe and mild groups according to the severity of the disease. Patients in the severe group were further divided into Mycoplasma pneumoniae (MP) alone and Multi-pathogen co-detection groups based on whether other pathogens were detected besides MP, to analyze the influence of respiratory pathogen co-detection rate on the severity of the disease. Mann-Whitney rank sum test and Chi-square test were used to compare data between independent groups. Results: A total of 298 children, 136 males and 162 females, were enrolled in this study, including 204 children in the severe group with an onset age of 7.0 (6.0, 8.0) years, and 94 children in the mild group with an onset age of 6.5 (4.0, 7.8) years. The level of C-reactive protein, D-dimer, lactic dehydrogenase (LDH) were significantly higher (10.0 (5.0, 18.0) vs. 5.0 (5.0, 7.5) mg/L, 0.6 (0.4, 1.1) vs. 0.5 (0.3, 0.6) mg/L, 337 (286, 431) vs. 314 (271, 393) U/L, Z=2.02, 2.50, 3.05, all P<0.05), and the length of hospitalization was significantly longer in the severe group compared with those in mild group (6.0 (6.0, 7.0) vs. 5.0 (4.0, 6.0) d, Z=4.37, P<0.05). The time from onset to admission in severe MPP children was significantly shorter than that in mild MPP children (6.0 (5.0, 9.5) vs. 9.0 (7.0, 13.0) d, Z=2.23, P=0.026). All patients completed the multiplex PCR test, with 142 cases (47.7%) MPP children detected with 21 pathogens including adenovirus 25 cases (8.4%), human coronavirus 23 cases (7.7%), rhinovirus 21 cases (7.0%), Streptococcus pneumoniae 21 cases (7.0%), influenza A virus 18 cases (6.0%). The pathogens with the highest detection rates in Tianjin, Shanghai, Wenzhou and Chengdu were Staphylococcus aureus at 10.7% (8/75), adenovirus at 13.0% (10/77), adenovirus at 15.3% (9/59), and both rhinovirus and Haemophilus influenzae at 11.5% (10/87) each. The multi-pathogen co-detection rate in severe MPP children was significantly higher than that in mild MPP group (52.9% (108/204) vs. 36.2% (34/94), χ²=10.62,P=0.005). Among severe MPP children, there are 89 cases in the multi-pathogen co-detection group and 73 cases in the simple MPP group. The levels of LDH, D-dimer and neutrophil counts in the multi-pathogen co-detection group were significantly higher than those in the simple MPP group (348 (284, 422) vs. 307 (270, 358) U/L, 0.8 (0.5, 1.5) vs. 0.6 (0.4, 1.0) mg/L, 4.99 (3.66, 6.89)×109 vs. 4.06 (2.91, 5.65)×109/L, Z=5.17, 4.99, 6.11, all P<0.05). Conclusions: The co-detection rate of respiratory pathogens, LDH and D-dimer in children with severe MPP were higher than those with mild MPP. Among severe MPP children the stress response of children in co-detection group was more serious than that of children with simple MPP.

Rapid Phenotypic Antimicrobial Susceptibility Testing Using a Coulter Counter and Proliferation Rate Discrepancy

The rapid determination of antimicrobial susceptibility and evidence-based antimicrobial prescription is necessary to combat widespread antimicrobial resistance and promote effectively treatment for bacterial infections. This study developed a rapid phenotypic antimicrobial susceptibility determination method competent for seamless clinical implementation. A laboratory-friendly Coulter counter-based antimicrobial susceptibility testing (CAST) was developed and integrated with bacterial incubation, population growth monitoring, and result analysis to quantitatively detect differences in bacterial growth between resistant and susceptible strains following a 2 h exposure to antimicrobial agents. The distinct proliferation rates of the different strains enabled the rapid determination of their antimicrobial susceptibility phenotypes. We evaluated the performance efficacy of CAST for 74 clinically isolated Enterobacteriaceae subjected to 15 antimicrobials. The results were consistent with those obtained via the 24 h broth microdilution method, showing 90.18% absolute categorical agreement.

Antifungal susceptibility profiles and drug resistance mechanisms of clinical Candida duobushaemulonii isolates from China

Candida duobushaemulonii, type II Candida haemulonii complex, is closely related to Candida auris and capable of causing invasive and non-invasive infections in humans. Eleven strains of C. duobushaemulonii were collected from China Hospital Invasive Fungal Surveillance Net (CHIF-NET) and identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF), VITEK 2 Yeast Identification Card (YST), and internal transcribed spacer (ITS) sequencing. Whole genome sequencing of C. duobushaemulonii was done to determine their genotypes. Furthermore, C. duobushaemulonii strains were tested by Sensititre YeastOne™ and Clinical and Laboratory Institute (CLSI) broth microdilution panel for antifungal susceptibility. Three C. duobushaemulonii could not be identified by VITEK 2. All 11 isolates had high minimum inhibitory concentrations (MICs) to amphotericin B more than 2 μg/ml. One isolate showed a high MIC value of ≥64 μg/ml to 5-flucytosine. All isolates were wild type (WT) for triazoles and echinocandins. FUR1 variation may result in C. duobushaemulonii with high MIC to 5-flucytosine. Candida duobushaemulonii mainly infects patients with weakened immunity, and the amphotericin B resistance of these isolates might represent a challenge to clinical treatment.

First two fungemia cases caused by Candida haemulonii var. vulnera in China with emerged antifungal resistance

Candida haemulonii var. vulnera is a rare variant of C. haemulonii, which has been previously reported to cause human infections. Owing to the close kinship between C. haemulonii sensu stricto and C. haemulonii var. vulnera, accurate identification of C. haemulonii var. vulnera relied on DNA sequencing assay targeting, for example, rDNA internal transcribed spacer (ITS) region. In this work, two strains of C. haemulonii var. vulnera were collected from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET). The identification capacity of three matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and VITEK 2 YST ID biochemical methods were evaluated against ITS sequencing. In addition, antifungal susceptibility testing was performed using Sensititre YeastOne. Moreover, we comprehensively screened drug-resistant related genes by whole-genome sequencing. The two strains were not correctly identified to species variant level using MALDI-TOF MS and YST ID cards. Both strains were resistant to amphotericin B (minimum inhibitory concentration [MIC] > 2 μg/ml). Moreover, strain F4564 and F4584 exhibited high MIC to fluconazole (>256 μg/ml) and 5-flucytosine (>64 μg/ml), respectively, which were supposed to result from key amino acid substitutions Y132F and G307A in Erg11p and V58fs and G60K substitutions in Fur1p. The rare species C. haemulonii var. vulnera has emerged in China, and such drug-resistant fungal species that can cause invasive diseases require further close attention.

Morphologic identification of clinically encountered moulds using a residual neural network

The use of morphology to diagnose invasive mould infections in China still faces substantial challenges, which often leads to delayed diagnosis or misdiagnosis. We developed a model called XMVision Fungus AI to identify mould infections by training, testing, and evaluating a ResNet-50 model. Our research achieved the rapid identification of nine common clinical moulds: Aspergillus fumigatus complex, Aspergillus flavus complex, Aspergillus niger complex, Aspergillus terreus complex, Aspergillus nidulans, Aspergillus sydowii/Aspergillus versicolor, Syncephalastrum racemosum, Fusarium spp., and Penicillium spp. In our study, the adaptive image contrast enhancement enabling XMVision Fungus AI as a promising module by effectively improve the identification performance. The overall identification accuracy of XMVision Fungus AI was up to 93.00% (279/300), which was higher than that of human readers. XMVision Fungus AI shows intrinsic advantages in the identification of clinical moulds and can be applied to improve human identification efficiency through training. Moreover, it has great potential for clinical application because of its convenient operation and lower cost. This system will be suitable for primary hospitals in China and developing countries.

[The value of MR diffusion tensor imaging in assessing white matter changes in short-term methamphetamine withdrawal]

Objective: To explore the value of MRI diffusion tensor imaging (DTI) in the white matter changes of short-term methamphetamine (MA) abstinence. Methods: The data of DTI, demographics features, general information of addiction and impulsivity scale eleven (BIS-11) of 55 short-term MA addicts who were from Changsha, Zhuzhou and Yueyang compulsory detoxification centers in Hunan province, including 40 males and 15 females, aged 14-45 (37.24±7.31) years old, and 52 healthy controls, including 40 males and 12 females aged 18-59 (40.3±9.1) years were collected prospectively from August 2017 to December 2018. The differences of DTI indicators between the two groups were compared by tract-based spatial statistics (TBSS), and then the correlation between the different indicators and the age of first MA use, time of MA use, daily dose used, BIS-11 score were performed. Results: There were significant differences in BIS total score(P<0.001), BIS motivational impulsivity(P<0.001) and BIS attentional impulsivity(P=0.003) between MA group and healthy control group in short-term withdrawal. And compared with the healthy control group, the fractional anisotropy (FA) (0.58±0.02 vs 0.56±0.02,0.77±0.02 vs 0.75±0.04,0.79±0.04 vs 0.76±0.06; all P<0.05), axial diffusivity (AD) (0.57±0.01 vs 0.56±0.02,P=0.001) and mean diffusivity (MD) (0.66±0.02 vs 0.65±0.02,0.52±0.07 vs 0.51±0.06; both P<0.05)values in the MA group were all increased (P<0.05), but there was no significant difference in the radial diffusivity (RD) value (P>0.05). The white matter areas with increased FA value were located in the knee and body of corpus callosum, bilateral anterior corona radiata and left superior corona radiata; the areas with increased AD value were located in the knee, body and pressure of corpus callosum, bilateral anterior limb of internal capsule, posterior limb of internal capsule, anterior, superior and posterior corona radiata, external capsule and superior longitudinal fasciculus; and the areas with increased MD value were mainly located in the right superior longitudinal fasciculus, anterior and posterior limb of internal capsule. The corpus callosum, where there was a difference in FA between the two groups, was positively correlated with the daily dose of MA (r=0.301, P=0.026). Conclusion: MA addicted individuals with short-term withdrawal have white matter edema and damage, and the degree of corpus callosum damage is positively correlated with the daily dose of MA,which is helpful to understand the pathophysiological process of white matter damage in the nervous system and the potential mechanism of neuropsychiatric symptoms in short-term withdrawal MA addicted individuals.

[Study on the effect of AIDS preventive cascade services provided by social organizations for men who have sex with men in China]

Objective: To analyze the effect and main gaps of each stage in the AIDS prevention cascade for men who have sex with men (MSM) provided in intervention projects supported by the China AIDS Fund for non-governmental organizations (CAFNGO) and provide suggestions to improve the quality of cascade services and project management. Methods: Data were collected through the CAFNGO management information system and field interviews to analyze the differences in the number of MSM receiving HIV testing and confirming tests, the newly reported patients, and the number of antiviral treatment (ART) referrals of newly established reported patients among different social organization service areas. A service chain chart was also drawn. Results: Between 2016 and 2020, 1 508 MSM intervention projects were funded by CAFNGO, including 1 183 234 MSM being mobilized to receive HIV testing. However, only 68.8% (1 183 234/1 719 139) of the testing capacity of social organizations was covered by these projects. As a result, 55 783 HIV-positive MSM were detected in preliminary screening, and only 86.6% (48 327/55 783) received confirming tests. The proportion of newly reported infections was 3.8% (45 347/1 183 234). The ratio of antiviral treatment (ART) referrals for newly reported patients between 2017 and 2020 was 89.8% (32 719/36 444). 75.8%(1 143/1 508) of total MSM intervention projects were implemented by community-based organizations (Non-registered civil affairs departments). In comparison, organizations registered in civil affairs departments took up 24.2% (365/1 508) of the total MSM intervention projects. No significant difference was noticed in the proportion of newly reported infected (3.8% and 3.8%) and the ratio of ART referrals (89.7% and 89.9%) between community-based organizations and registered organizations' projects. But these two proportions are significantly different between these two types of organizations in some areas in China. Conclusions: The AIDS prevention cascade established in CAFNGO has effectively promoted the early detection and treatment of infected MSM. However, CAFNGO needs more financial support to extend testing coverage for MSM. Meanwhile, confirmation testing for positives in preliminary screening and ART referrals needs to be improved for newly reported patients. In addition, various capacity building needs to be provided for different social organizations.

[Analysis of clinical characteristics and related genetic variation of juvenile myasthenia gravis]

Objective: To analyze the clinical characteristics and related genetic variation of juvenile myasthenia gravis (MG) patients. Methods: We collected the clinical data of adolescent MG patients who were treated in the Department of Neurology of the First Affiliated Hospital of Sun Yat-sen University from June 2019 to May 2020. After obtaining the patient's informed consent, the blood samples were collected. The Whole Exome Sequencing (WES) was performed on peripheral blood samples. And use biological information software and SPSS 22.0 for data processing and result analysis. Results: According to the inclusion and exclusion criteria, 54 patients with juvenile MG were included, 28 males and 26 females. And the average age of onset was (3.79±0.89) years. Among the enrolled patients, there were 52 (96.3%) patients with ocular MG, the MG-ADL scores of 54 patients were (3.44±0.44) points, and the titer of AChR antibody was (5.88±2.45) nmol/L. Two patients had thymic hyperplasia, and 5 patients had a family history of MG.A total of 169 variant genes were found in 54 patients, of which TTN gene variants had the largest number, with a total of 17 variants (31.5%). In the TTN gene variant group, 7(41.2%) patients had eye fixation symptoms, and 4 (10.8%) patients in the non-mutation group had eye fixation symptoms. And The difference between the two groups was statistically significant (P=0.016). In addition, the synaptic nucleus envelope protein-1 (SYNE1) and the ryanodine receptor-1 (RYR1) gene variations were also found in 7 cases (13.2%), and no clear relationship between these gene variations and clinical manifestations of MG was found. Conclusions: The incidence of juvenile MG was preschoolers with no gender difference, and ocular MG was more common. The proportion of TTN gene variation in adolescent MG was higher, suggesting that this gene may be a potential therapeutic target for juvenile MG patients.

[Application of multidisciplinary treatment comprehensive management model for early-stage lung cancer]

Objective: To explore the application of multidisciplinary treatment (MDT) and comprehensive management model in the diagnosis and treatment of early-stage lung cancer, and analyze its clinical value and the feasibility and significance of promotion. Methods: A retrospective study of 470 patients in Xijing Hospital who underwent surgery after MDT from January 8, 2018 to December 31, 2019. There were 172 males and 298 females, aged from 23 to 79 (54.46±11.08) years. Basic diagnosis and treatment information as well as postoperative pathology were analyzed, of which 441 cases were recommended for surgery by MDT and 29 cases were subjectively requested for surgery. The patients' general condition, preoperative diagnosis and pathological results were compared, and the specific content of the MDT and comprehensive management model were summarized. We also explored the value of MDT integrated management model in early stage lung cancer treatment in the context of the current lung cancer incidence in China. Results: Among 470 surgical patients, the majority of males had solid nodules (69/172,40.1%), and the majority of females had ground glass nodules (135/298,45.3%). The distribution of nodules showed a trend of more upper lobe(277/470)than lower lobe(161/470) and more right lung(276/470) than left lung(194/470). Among the 441 patients recommended for surgery, 98.11% of males (156/159) and 97.87% of females (276/282) showed malignant pathology after surgery. Adenocarcinoma was the main pathological type (93.59% of males, 146/156; 97.46% of females, 269/276). Among the malignant pathological results, carcinoma in situ (42.31% of males, 66/156; 47.10% of females, 130/276) and stage I lung cancer (50.64% of males, 79/156; 47.46% of females, 131/276) were the most common. In all patients, 1.89% of the males (3/159) and 2.13% of the females (6/282) recommended for surgery showed benign postoperative pathology, of which tuberculosis and fungal infection were the main pathological types (66.67% for each gender, males 2/3, females, 4/6). The postoperative pathology of 29 patients who subjectively requested surgery was also tuberculosis and fungal infection as the main pathological types (69.23% of males, 9/13; 68.75% of females, 11/16). The MDT comprehensive management model made full use of a variety of auxiliary diagnostic technologies and combined the experience advantages of multidisciplinary participation to make up for the limitations of single-diagnosis. The overall diagnosis coincidence rate reached 98.09%, with strong consistency (Kappa>0.81). The positive predictive value (PPV) was 97.96%, the negative predictive value (NPV) was 100%, and the average patient diagnosis and treatment cycle was 24.28-26.51 days. Conclusions: The MDT comprehensive management model meets the consensus requirements. It has great advantages in diagnostic efficiency and diagnosis and treatment cycle, and has a high promotion and application value for the diagnosis and treatment of early-stage lung cancer. At the same time, tuberculosis and fungal infection should be regarded as an important differential diagnosis item.

Antifungal Susceptibility Profiles and Resistance Mechanisms of Clinical Diutina catenulata Isolates With High MIC Values

Diutina catenulata (Candida catenulata) is an ascomycete yeast species widely used in environmental and industrial research and capable of causing infections in humans and animals. At present, there are only a few studies on D. catenulata, and further research is required for its more in-depth characterization and analysis. Eleven strains of D. catenulata collected from China Hospital Invasive Fungal Surveillance Net (CHIF-NET) and the CHIF-NET North China Program were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry and internal transcribed spacer sequencing. The antifungal susceptibility of the Diutina catenulata strains was tested using the Clinical and Laboratory Standards Institute broth microdilution method and Sensititre YeastOne™. Furthermore, ERG11 and FKS1 were sequenced to determine any mutations related to azole and echinocandin resistance in D. catenulata. All isolates exhibited low minimum inhibitory concentration (MIC) values for itraconazole (0.06-0.12 μg/ml), posaconazole (0.06-0.12 μg/ml), amphotericin B (0.25-1 μg/ml), and 5-flucytosine (range, <0.06-0.12 μg/ml), whereas four isolates showed high MICs (≥4 μg/ml) for echinocandins. Strains with high MIC values for azoles showed common ERG11 mutations, namely, F126L/K143R. In addition, L139R mutations may be linked to high MICs of fluconazole. Two amino acid alterations reported to correspond to high MIC values of echinocandin, namely, F621I (F641) and S625L (S645), were found in the hot spot 1 region of FKS1. In addition, one new amino acid alteration, I1348S (I1368), was found outside of the FKS1 hot spot 2 region, and its contribution to echinocandin resistance requires future investigation. Diutina catenulata mainly infects patients with a weak immune system, and the high MIC values for various antifungals exhibited by these isolates may represent a challenge to clinical treatment.

[Etiology and clinical characteristics of acquired ptosis]

Objective: To evaluate the demographics, etiology composition, clinical characteristics and surgical outcomes of acquired ptosis patients. Methods: Retrospective case-series study. The clinical records of 176 consecutive patients (312 eyes) with acquired ptosis were reviewed from January 2009 to December 2018 in the Ophthalmology Department of Tianjin Medical University General Hospital. The demographics, etiology composition, clinical characteristics, surgical strategies and outcomes were analyzed. Results: There were 59 male (33.5%) and 117 female (66.5%) patients suffering acquired ptosis, with an average age of (64±7) years. The disease was bilateral in 136 cases and unilateral in 40 cases. There were four etiological components of acquired ptosis: 145 cases (82.4%) of aponeurotic ptosis, 17 cases (9.6%) of neurogenic ptosis, 10 cases (5.7%) of myogenic ptosis and 4 cases (2.3%) of traumatic ptosis. The clinical characteristics of acquired ptosis varied significantly depending on etiology. Ptosis surgeries were performed on 152 cases (279 eyes), and the success rate was 92.1% (140/152). Surgical procedures included levator aponeurosis surgeries on 148 cases (275 eyes), frontal muscle suspensions on 2 cases (2 eyes) and conjunctival-Müller's ectomies on 2 cases (2 eyes). Conclusions: Acquired ptosis is more likely to occur in senile and female populations with bilateral eyelids involved mostly. Aponeurotic ptosis is the predominant type of acquired ptosis. The treatment is performed according to the clear etiological diagnosis based on clinical features, and operations are efficient for most patients with acquired ptosis. (Chin J Ophthalmol, 2021, 57: 844-849).

Developing Two Rapid Protein Extraction Methods Using Focused-Ultrasonication and Zirconia-Silica Beads for Filamentous Fungi Identification by MALDI-TOF MS

Filamentous fungi identification by Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been challenging due to the lack of simple and rapid protein extraction methods and insufficient species coverage in the database. In this study, we created two rapid protein extraction methods for filamentous fungi: a one-step zirconia-silica beads method (ZSB) and a focused-ultrasonication method (FUS). The identification accuracy of two methods were evaluated with the VITEK MS, as well as number of spectra peaks and signal-to-noise ratio (S/N) with M-Discover 100 MALDI-TOF MS compared to the routine method. The better method was applied to build a filamentous fungi in-house spectra library for the M-Discover 100 MS, and then another one and routine method were performed in parallel to verify the accuracy and commonality of the in-house library. Using the two optimized methods, the dedicated operating time before MALDI-TOF MS analysis was reduced from 30 min to 7 (ZSB) or 5 (FUS) min per sample, with only a few seconds added for each additional strain. And both two methods identified isolates from most mold types equal to or better than the routine method, and the total correct identification rate using VITEK MS was 79.67, 76.42, and 76.42%, respectively. On the other hand, the two rapid methods generally achieved higher maximum and minimum S/N ratios with these isolates tested as compared to the routine method. Besides, the ZSB method produced overall mean of maximum and minimum S/N ratio higher than that by FUS. An in-house library of M-Discover MS was successfully built from 135 isolates from 42 species belonging to 18 genera using the ZSB method. Analysis of 467 isolates resulted in 97.22% correctly identified isolates to the species level by the ZSB method versus 95.50% by the routine method. The two novel methods are time- and cost-effective and allow efficient identification of filamentous fungi while providing a simplified procedure to build an in-house library. Thus, more clinical laboratories may consider adopting MALDI-TOF MS for filamentous fungi identification in the future.

GLUT3 as an Intersection of Glycerophospholipid Metabolism and the Innate Immune Response to Candida albicans

Immune cells can optimize the management of metabolic resources to balance their energy requirements in order to regulate immune responses. The interconnection between immunometabolism and fungal infections is becoming increasingly apparent. Using proteome and metabolome assays, we found that stimulation of primary human monocytes by Candida albicans was accompanied by upregulation of glucose transporter 3 (GLUT3) and activation of the glycerophospholipid metabolism pathway. Upregulated GLUT3 expression has been preliminarily confirmed in monocytes from patients with C. albicans bloodstream infection. Our findings support the importance of GLUT3 in the complex network of glycerophospholipid metabolism and the innate immune responses against C. albicans. In summary, this study might contribute to decipher the regulatory mechanism between the monocyte metabolic reprogramming and innate immune response and reveal potential targets for the antifungal treatments.

[Study on the demand of social organizations working for female sex workers regarding project management and capacity building of HIV prevention and treatment]

Objective: To understand the capacity building needs on social organizations providing HIV prevention and treatment services for female sex workers (FSW). Methods: Questionnaires and interview were conducted with the heads of social organizations participating in China AIDS Fund for Non-Governmental Organizations (CAFNGO) project 2017-2018. Data from the CAFNGO's information system were compiled and analyzed using Excel 2016 and SPSS 25.0 software. The distribution of social organizations, availability of funds, and social organizations' needs for capacity building were analyzed. Results: Nationwide, 184 social organizations were involved in project '2017-2018 CAFNGO's FSW field work'. Out of which, 156 answers were valid. Social organizations that participated in the implementation of fund projects were mainly concentrated in the western region, accounting for 44.0% (81/184), with Sichuan, Guangxi, and Yunnan being the majority. However, the eastern part received the most financial support. Social organizations expressed the highest demand for project data collection and analysis, accounting for 68.6% (107/156). Items on risk analysis, response, and quality control project ranked the second, accounting for 64.1% (100/156). Results showed that statistically significant differences were seen on capacity building needs among social organization leaders with different levels of training on management of planning and finance of the project (χ²=5.78,P=0.016;χ²=8.99,P=0.003). Conclusions: Currently, the number of social organizations and the related fund provision concerning HIV prevention and control among FSWs were not consistent in China. Thus, it is necessary to encourage, guide, and support the development of social organizations and satisfy social organizations' needs on capacity-building and planning.

Species distribution and antifungal susceptibilities of clinical isolates of Penicillium and Talaromyces species in China

Morphologically identified Penicillium (n = 103) and Talaromyces marneffei (n = 8) isolates were collected from various clinical sources between 2016 and 2017 at a medical centre in Beijing, China. Identification to species level was confirmed by sequencing of the internal transcribed spacer (ITS) region, β-tubulin gene (benA) and RNA polymerase II second largest subunit (RPB2) gene. Of the 111 isolates, 56 (50.5%) were identified as Penicillium spp. and 55 (49.5%) as Talaromyces spp. Eleven species of Penicillium were detected, of which Penicillium oxalicum was the commonest, accounting for 51.8% (29/56), followed by Penicillium rubens (10.7%; 6/56) and Penicillium citrinum (10.7%; 6/56). Among the 55 Talaromyces isolates, nine species were identified, with Talaromyces funiculosus (36.4%; 20/55), Talaromyces stollii (27.3%; 15/55) and Talaromyces marneffei (14.5%; 8/55) being the most common. Of note, 89.3% (50/56) of the Penicillium isolates and 98.2% (54/55) of the Talaromyces isolates exhibited growth at 37°C. The isolates were mainly recovered from patients with pulmonary disorders (56.8%; 63/111), autoimmune disease (12.6%; 14/111) and AIDS (5.4%; 6/111). The azoles and amphotericin B exhibited potent activity against T. marneffei, while various levels of activity were observed against Penicillium and other Talaromyces species The echinocandins had the lowest MECs (MEC_90, ≤0.12 mg/L) against most Penicillium and Talaromyces species, with the exception of T. marneffei whose MEC₉₀ (4 mg/L) was five or more dilutions higher than that of the other species tested. These data on the species distribution and antifungal susceptibility expand the current clinical knowledge of Penicillium and Talaromyces species.

Impact of lanadelumab on health-related quality of life in patients with hereditary angioedema in the HELP study

Background

An objective of the phase 3 HELP Study was to investigate the effect of lanadelumab on health‐related quality of life (HRQoL) in patients with hereditary angioedema (HAE).

Methods

Patients with HAE‐1/2 received either lanadelumab 150 mg every 4 weeks (q4wks; n = 28), 300 mg q4wks (n = 29), 300 mg every 2 weeks (q2wks; n = 27), or placebo (n = 41) for 26 weeks (days 0–182). The Angioedema Quality of Life Questionnaire (AE‐QoL) was administered monthly, consisting of four domain (functioning, fatigue/mood, fears/shame, nutrition) and total scores. The generic EQ‐5D‐5L questionnaire was administered on days 0, 98, and 182. Comparisons were made between placebo and (a) all lanadelumab‐treated patients and (b) individual lanadelumab groups for changes in scores (day 0–182) and proportions achieving the minimal clinically important difference (MCID, −6) in AE‐QoL total score.

Results

Compared with the placebo group, the lanadelumab total group demonstrated significantly greater improvements in AE‐QoL total and domain scores (mean change, −13.0 to −29.3; p < 0.05 for all); the largest improvement was in functioning. A significantly greater proportion of the lanadelumab total group achieved the MCID (70% vs 37%; p = 0.001). The lanadelumab 300 mg q2wks group had the highest proportion (81%; p = 0.001) and was 7.2 times more likely to achieve the MCID than the placebo group. Mean EQ‐5D‐5L scores at day 0 were high in all groups, indicating low impairment, with no significant changes at day 182.

Conclusion

Patients with HAE‐1/2 experienced significant and clinically meaningful improvements in HRQoL measured by AE‐QoL following lanadelumab treatment in the HELP Study.

Species identification and antifungal susceptibility testing of Aspergillus strains isolated from patients with otomycosis in northern China

BACKGROUND/PURPOSE

There are limited studies on species distribution and susceptibility profiles of Aspergillus strains isolated from patients with otomycosis in China.

METHODS

A total of 69 confirmed Aspergillus species isolates were obtained from ear swabs of patients diagnosed with otomycosis from 2017 to 2018 in northern China. Identification of these Aspergillus isolates at the species level was performed using conventional morphological methods and MALDI-TOF MS in combination with molecular sequencing, and in vitro susceptibility to nine antifungal agents was evaluated using the Sensititre YeastOne system.

RESULTS

The Aspergillus section Nigri had the greatest distribution of Aspergillus isolates. A. welwitschiae (n = 25) was the most predominant isolate in section Nigri, followed by A. tubingensis (n = 12) and A. niger (n = 11). Other Aspergillus species were also isolated, including A. terreus (n = 11), A. flavus/A. oryzae (n = 8), and A. fumigatus (n = 2). Amphotericin B, posaconazole, and echinocandins were highly in vitro active against all the isolates tested. 2.9% (2/69) of the isolates were resistant to azoles in our study, including one A. niger isolate with a high MIC value for itraconazole (ITR) (16 mg/L) and one A. tubingensis isolate cross-resistant to both voriconazole (VOR) (MIC >8 mg/L) and ITR (MIC >16 mg/L). One A. welwitschiae and one A. niger isolate both had increased MIC values of 4 mg/L against VOR.

CONCLUSIONS

A. welwitschiae was the most prevalent Aspergillus species isolated from patients with otomycosis. Our findings also indicated that the azole-resistant Aspergillus section Nigri should be utilized to guide clinical medication for Otomycosis.

Laboratory diagnosis of COVID-19 in China: A review of challenging cases and analysis

Since the initial emergence of coronavirus disease 2019 (COVID-19) in Wuhan, Hubei province, China, a rapid spread of the disease occurred around the world, rising to become an international global health concern at pandemic level. In the face of this medical challenge threatening humans, the development of rapid and accurate methods for early screening and diagnosis of COVID-19 became crucial to containing the emerging public health threat, and prevent further spread within the population. Despite the large number of COVID-19 confirmed cases in China, some problematic cases with inconsistent laboratory testing results, were reported. Specifically, a high false-negative rate of 41% on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection by real-time reverse transcription-polymerase chain reaction (qRT-PCR) assays was observed in China. Although serological testing has been applied worldwide as a complementary method to help identify SARS-CoV-2, several limitations on its use have been reported in China. Therefore, the use of both qRT-PCR and serological testing in the diagnosis of COVID-19 in China and elsewhere, presented considerable challenges, but when used in combination, can be valuable tools in the fight against COVID-19. In this review, we give an overview of the advantages and disadvantages of different molecular techniques for SARS-CoV-2 detection that are currently used in several labs, including qRT-PCR, gene sequencing, loop-mediated isothermal amplification (LAMP), nucleic acid mass spectrometry (MS), and gene editing technique based on clustered regularly interspaced short palindromic repeats (CRISPR/Cas13) system. Then we mainly review and analyze some causes of false-negative qRT-PCR results, and how to resolve some of the diagnostic dilemma.

Parameters optimization method for the time-delayed reservoir computing with a nonlinear duffing mechanical oscillator

Reservoir computing (RC) is a recently introduced bio-inspired computational framework capable of excellent performances in the temporal data processing, owing to its derivation from the recurrent neural network (RNN). It is well-known for the fast and effective training scheme, as well as the ease of the hardware implementation, but also the problematic sensitivity of its performance to the optimizable architecture parameters. In this article, a particular time-delayed RC with a single clamped-clamped silicon beam resonator that exhibits a classical Duffing nonlinearity is presented and its optimization problem is studied. Specifically, we numerically analyze the nonlinear response of the resonator and find a quasi-linear bifurcation point shift of the driving voltage with the driving frequency sweeping, which is called Bifurcation Point Frequency Modulation (BPFM). Furthermore, we first proposed that this method can be used to find the optimal driving frequency of RC with a Duffing mechanical resonator for a given task, and then put forward a comprehensive optimization process. The high performance of RC presented on four typical tasks proves the feasibility of this optimization method. Finally, we envision the potential application of the method based on the BPFM in our future work to implement the RC with other mechanical oscillators.

[Analysis of cases with maxillofacial arteriovenous malformation treated with balloon temporary block and percutaneous puncture sclerotherapy]

To analysis the treatment effectiveness of maxillofacial arteriovenous malformation (AVM) by means of temporary balloon block and percutaneous puncture sclerotherapy. The treatment outcomes of 20 patients with AVM of maxillofacial deformity, aged (26.8±3.0) 18-36 years, from Dec 2012 to Dec 2019 were collected and retrospectively analyzed. All patients had been diagnosed AVM by digital substraction angiography (DSA). All the cases were treated by using balloons to temporary block responsible artery of the AVM in order to change the high-flow malformations into low-flow venous malformation. Then injection of polyethylene foam cinnamyl alcohol was conducted via percutaneous puncturing for hardening the vascular malformation. Comparing the symptoms and imaging changes before treatment with those 1-6 months after treatment according to Achauer curative effect evaluation standard. Totally 60% (12/20) of the cases were type Ⅱa AVM, and their treatments were effective. However, the treatment effects of type Ⅲb and type Ⅳ patients were relatively poor. The clinical effective rate was 85% (17/20), and the clinical curative rate was 50% (10/20). No skin necrosis, organ damage and other serious complications were observed for the 20 patients. The AVM patients with a main supply artery treated by using a balloon artery temporary block to make high flow malformations into low-flow and followed by percutaneous puncture sclerotherapy, could get good curative effect. It seemed that this approach was safe and effective.

Antimicrobial activity of omadacycline in vitro against bacteria isolated from 2014 to 2017 in China, a multi-center study

BACKGROUND

Omadacycline (ZL-2401) is a semi-synthetic derivative of minocycline. It has a broadspectrum activity against Gram-positive and Gram-negative bacteria, and atypical pathogens. The objective of this study was to evaluate the antibacterial activity of omadacycline against recently collected bacterial isolates from Chinese patients.

RESULTS

Omadacycline showed potent activity against all Gram-positive pathogens: S. aureus MICs were low regardless of susceptibility to methicillin (methicillin-resistant Staphylococcus aureus, MRSA: N = 97, MIC_50/90 0.12/0.25 mg/L, 98.5% susceptible; methicillin-sensitive Staphylococcus aureus, MSSA: N = 100, MIC_50/90 0.12/0.12 mg/L, 100.0% susceptible). Omadacycline was also very effective against β-haemolytic streptococci (MIC_50/90, 0.06/0.12 mg/L), viridans group streptococci (MIC_50/90,<0.03/0. 06 mg/L), and enterococci (MIC_50/90, 0.03/0.12 mg/L). Against S. pneumoniae, omadacycline was highly active regardless of penicillin-resistance (MIC₉₀ 0.06 mg/L) and despite the fact that less than 10.0% of these strains were susceptible to tetracycline. Omadacycline exhibited good in vitro activity against Enterobacterales isolates (MIC_50/90, 2/8 mg/L), inhibiting 81.7% of the isolates at ≤4 mg/L. M. catarrhalis isolates (MIC_50/90, 0.12/0.25 mg/L) were fully susceptible to omadacycline at ≤0.5 mg/L.

CONCLUSIONS

Omadacycline showed potent in vitro activity against most common bacterial pathogens, and even against highly resistant problem pathogens, such as MRSA, penicillin-R and tetracycline-R S. pneumoniae and enterococci. The susceptibility rate of Chinese isolates was similar to those reported in other countries, but the decreased activity against K. pneumoniae isolates in the present study should be noted.

Lanadelumab demonstrates rapid and sustained prevention of hereditary angioedema attacks

Background

Lanadelumab demonstrated efficacy in preventing hereditary angioedema (HAE) attacks in the phase 3 HELP Study.

Objective

To assess time to onset of effect and long‐term efficacy of lanadelumab, based on exploratory findings from the HELP Study.

Methods

Eligible patients with HAE type I/II received lanadelumab 150 mg every 4 weeks (q4wks), 300 mg q4wks, 300 mg q2wks, or placebo. Ad hoc analyses evaluated day 0‐69 findings using a Poisson regression model accounting for overdispersion. Least‐squares mean monthly HAE attack rate for lanadelumab was compared with placebo. Intrapatient comparisons for days 0‐69 versus steady state (days 70‐182) used a paired t test for continuous endpoints or Kappa statistics for categorical endpoints.

Results

One hundred twenty‐five patients were randomized and treated. During days 0‐69, mean monthly attack rate was significantly lower with lanadelumab (0.41‐0.76) vs placebo (2.04), including attacks requiring acute treatment (0.33‐0.61 vs 1.66) and moderate/severe attacks (0.31‐0.48 vs 1.33, all P ≤ .001). More patients receiving lanadelumab vs placebo were attack free (37.9%‐48.1% vs 7.3%) and responders (85.7%‐100% vs 26.8%). During steady state, the efficacy of lanadelumab vs placebo was similar or improved vs days 0‐69. Intrapatient differences were significant with lanadelumab 300 mg q4wks for select outcomes. Lanadelumab efficacy was durable—HAE attack rate was consistently lower vs placebo, from the first 2 weeks of treatment through study end. Treatment emergent adverse events were comparable during days 0‐69 and 70‐182.

Conclusion

Protection with lanadelumab started from the first dose and continued throughout the entire study period.

[Investigation on Schistosoma japonicum infection in goats in Dantu District, Zhenjiang City from 2004 to 2019]

OBJECTIVE

To investigate the prevalence and changing patterns of Schistosoma japonicum infections in goats in Dantu District of Zhenjiang City, so as to provide the scientific data for the management of in livestock.

METHODS

The S. japonicum infections were detected using a miracidial hatching test (one test for one stool specimen) in goats grazed in settings with snail habitats in Dantu District of Zhenjiang City at spring and autumn of each year from 2004 to 2019, and the prevalence and intensity of S. japonicum infections were estimated.

RESULTS

A total of 21 836 goat stool samples were detected from 2004 to 2019, and 86 were positive for S. japonicum (0.39% prevalence). The highest prevalence of S. japonicum infections in goats was seen in 2004 (1.25%) and no infections were detected in goats since 2013. S. japonicum-infected goats were identified in marshland-type endemic areas and plain regions with waterway networks, and there was a significant difference in the prevalence of S. japonicum infections in goats between these two types of endemic areas (0.50% vs. 0.15%; χ² = 11.566, P < 0.05). The prevalence of S. japonicum infections was significantly greater in goats at ages of more than 10 months (0.51%) and over 10 months (0.44%) than in other goats (χ² = 13.088, P < 0.05), and higher prevalence was found in autumn than in spring (0.54% vs. 0.27%; χ² = 9.597, P < 0.05). In addition, there were 76.74% of S. japonicum-infected goats with intensity of"+++"and"++++".

CONCLUSIONS

Although the high prevalence of S. japonicum infections has been effectively controlled in goats in Dantu District, goat remains to be an important source of S. japonicum infections that should be given a high priority for control to consolidate the schistosomiasis control achievements.

Prevalence of nontuberculous mycobacteria in a tertiary hospital in Beijing, China, January 2013 to December 2018

BACKGROUND

To investigate the species distribution of non-tuberculous mycobacteria (NTM) among tuberculosis (TB) specimens collected from January 2013 to December 2018 at Peking Union Medical Hospital (Beijing), China. NTM species identification was carried out by DNA microarray chip.

RESULTS

Mycobacterial species were detected in 1514 specimens from 1508 patients, among which NTM accounted for 37.3% (565/1514), increasing from a proportion of 15.6% in 2013 to 46.1% in 2018 (P < 0.001). Among the 565 NTM positive specimens, the majority (55.2%) were from female patients. Furthermore, patients aged 45-65 years accounted for 49.6% of the total patients tested. Among 223 NTM positive specimens characterized further, the majority (86.2%) were from respiratory tract, whilst 3.6 and 3.1% were from lymph nodes and pus, respectively. Mycobacterium intracellulare (31.8%) and Mycobacterium chelonae / Mycobacterium abscessus (21.5%) were the most frequently detected species, followed by M. avium (13.5%), M. gordonae (11.7%), M. kansasii (7.6%), and others.

CONCLUSION

The proportion of NTM among mycobacterial species detected in a tertiary hospital in Beijing, China, increased rapidly from year 2013 to 2018. Middle-aged patients are more likely to be infected with NTM, especially females. Mycobacterium intracellulare and Mycobacterium chelonae/ Mycobacterium abscessus were the most frequently detected NTM pathogens. Accurate and timely identification of NTM is important for diagnosis and treatment.

[Molecular epidemiology of Japanese encephalitis viruses isolated in Yunnan province, 1977-2010]

Objective: To understand the genetic and molecular epidemiologic characteristics of 63 strains of Japanese encephalitis virus (JEV) isolated in Yunnan province, China during 1977-2010. Methods: Suckling mice were inoculated with viruses continuously and the viral nucleic acid were extracted from the brain-grinding supernatants of the infected and moribund mice, then the gene fragments of E region were amplified by RT-PCR. Bioinformatics (Clustal X, DNAstar, Mega 5.0 and other software) was used to analyze the nucleotide and deduced amino acid sequences and phylogenetic trees. Results: Yunnan strains of JEV could cause illness and deaths in suckling mice. The results of virus nucleic acid detection and sequencing indicated that nucleotide sequences of E gene of the 63 virus strains were obtained. Phylogenetic tree and homology analyses based on E genomes showed that 47 strains of the experimental virus belonged to genotype 1 (G-1) and 16 strains belonged to genotype 3 (G-3). The 47 isolates of G-1 were divided into 2 clades, of them, the earliest isolates of G-1 (M28, 1977 and BN82215, 1982) in Yunnan of China and the early isolates of G-1 (U70416, 1982; DQ084229, the year is unknown) in Thailand were in one clade, and the isolates of G-1 from 2007-2010 in Yunnan could be divided into 2 subgroups. The 16 isolates of G-3 from Yunnan were divided into 3 clades, among them, the isolates from 1970-1990s in Yunnan were in two clades, and the isolates from 2004 in Yunnan were in one clade. In addition, their main amino acid sites of antigenicity, pathogenic, virulence of both G-1 and G-3 had no significant change. Conclusion: JEV G-1 and G-3 co-circulated in Yunnan, and G-1 was predominant. The JEV strains isolated in different years and areas in Yunnan had different molecular epidemiologic characteristics and genetic diversity. The results of this study suggested that JEV G-1 might originate from Yunnan of China and adjacent Southeast Asia region.

Dark plasmonic mode based perfect absorption and refractive index sensing

Dark plasmonic resonances in metallic nanostructures are essential for many potential applications such as refractive index sensing, single molecule detection, nanolasers etc. However, it is difficult to excite the dark modes in optical experiments and thus the practical applications are severely limited. Herein, we demonstrate a simple method to experimentally excite the quadrupolar and higher-order plasmonic modes with normal incident light. By directionally depositing silver films onto the sidewalls of metal-covered one-dimensional grating, we have experimentally observed a series of asymmetrical resonances at the plasmonic ranges of silver gratings. Interestingly, both of the reflection and transmission coefficients of high-order plasmonic modes are reduced to around zero, demonstrating the perfect absorption very well. The corresponding numerical simulations show that these resonances are the well-known dark modes. Different from the conventional dark modes in plasmonic dimers, here the dark modes are the electric oscillations (as standing waves) within the silver sidewalls that are excited by charge accumulation via the bright plasmonic resonance of the top silver strips. In addition to the simple realization of perfect absorption, the dark modes are found to be quite sensitive to the environmental changes. The experimentally measured reflective index sensitivity is around 458 nm per RIU (refractive index unit), which is much higher than the sensitivity of the metal-covered grating without silver sidewalls. This research shall pave new routes to practical applications of dark surface plasmons.

[Comparative Studies on Soil Actinobacterial Biodiversity After Re-vegetation in the Urban and Rural Hydro-fluctuation Zone of the Three Gorges Reservoir Region]

This study aimed to understand the soil actinobacterial community diversity in the urban and rural hydro-fluctuation zone of the Three Gorges Reservoir region. The hydro-fluctuation zone of Chongqing Great Theatre in Jiangbei District and the Ruxi river basin in Zhong County, Chongqing, was chosen as the study area. Soil samples were collected in June 2015, to measure actinobacterial biodiversity using the terminal-restriction fragment length polymorphism (T-RFLP) molecular method. Results showed that:1 The actinobacterial biodiversity was different in the urban and rural hydro-fluctuation zone after artificial vegetation restoration. The actinobacterial biodiversity of the urban hydro-fluctuation zone was significantly higher than that of the rural hydro-fluctuation zone (P<0.05), which was most obvious in the surface soil. 2 The actinobacterial biodiversity of woodland was higher than that of grassland, but there was no significant difference in the actinobacterial biodiversity among the three soil layers in both the urban and rural hydro-fluctuation zone. 3 The dominant species of actinomycetes was different in different samples. 4 Redundancy analysis and the Monte-Carlo test revealed that water content and available nitrogen (AN) played a critical role in influencing actinobacterial biodiversity in the urban hydro-fluctuation zone (P<0.05). In contrast, the water content, organic matter (OM), available nitrogen (AN) and available phosphorus (AP) played a critical role in influencing actinobacterial biodiversity in the rural hydro-fluctuation zone of the Three Gorges Reservoir region (P<0.05). Thus, we concluded that the actinobacterial biodiversity of the urban hydro-fluctuation zone was significantly higher than that of the rural hydro-fluctuation zone in the Three Gorges Reservoir region, and such a result was attributed to the increased human disturbance and soil nutrients.

Hepcidin and iron metabolism associated with cardiometabolic risk factors in children: A case-control study

BACKGROUND AND AIMS

Iron metabolism plays a crucial role in the development of cardiometabolic disease; however, the association between cardiometabolic risk factors (CMRFs) and hepcidin as well as other iron parameters remains unclear in children. The aims of this study were to compare the circulating hepcidin levels and iron metabolism between children with and without CMRFs and to investigate the association between those iron parameters and CMRFs.

METHODS AND RESULTS

A case-control study was conducted among 1126 children aged 7-14 years in the case group (n = 563) with CMRFs and the healthy control group (n = 563). Iron parameters, lipids, and anthropometric characteristics were evaluated. The information on demographics, diet, and physical activities was either children reported or parent reported. Compared with the healthy controls, children with CMRFs had higher levels of hepcidin and lower levels of serum iron, transferrin, and soluble transferrin receptor (sTfR; P < 0.001). Besides, the odds ratios (ORs) for low levels of high-density lipoprotein (HDL) were 2.03, 0.21, and 0.33 in children with higher hepcidin, transferrin, and sTfR levels (P < 0.05). Furthermore, ORs for cardiometabolic risk were 0.50 (95% confidence interval (CI): 0.30-0.85, P < 0.05), 0.22 (95% CI: 0.12, 0.42, P < 0.01) and 0.19 (95% CI: 0.10, 0.36, P < 0.01) in children with higher serum iron, transferrin, and sTfR levels, respectively.

CONCLUSION

The levels of hepcidin were higher, while those of iron, transferrin, and sTfR were lower in children with CMRF. Hepcidin was positively associated with the risk of low HDL levels, whereas transferrin and sTfR levels negatively correlated with the risk of low HDL levels. In addition, serum iron, transferrin, and sTfR levels were negatively associated with cardiometabolic risk.

[The effect of phacoemulsification on intraocular pressure in eyes with primary angle closure glaucoma after trabeculectomy]

OBJECTIVE

To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in filtered eyes with primary angle closure glaucoma (PACG).

METHODS

In this retrospective case series, 47 eyes from 47 PACG patients who previously had trabeculectomy were consecutively enrolled. All patients had visually significant cataracts and phacoemulsification was performed at least 3 months after trabeculectomy. The IOPs were recorded preoperatively, 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, 12 months and 24 months after surgery. The best correct visual acuity (BCVA) , the number of glaucoma medications and the filtered bleb grade were recorded preoperatively and 24 months after phacoemulsification. IOP and BCVA before and after phacoemulsification were compared by student t test. The frequences of antiglaucoma medicine, bled grade and IOP control before and after phacoemulsification were compared by Mann-Whitney Test. Linear regression analysis, Pearson and Spearman were performed to assess the correlation between IOP change and other variants.

RESULTS

IOP was decreased significantly from (18.7±6.7) mmHg (1 mmHg=0.133 kPa) at baseline to 16.4±2.0 mmHg at final follow-up (t=2.54, P=0.015) . The median number of glaucoma medications was significantly decreased (P<0.01) at 2 years postoperatively. The magnitude of IOP reduction was significantly correlated with preoperative IOP (r=0.95, P<0.01). BCVA (LogMAR) was improved significantly at month 24 (t=5.62, P<0.01). Filtered bleb decreased insignificantly at 2 years postoperatively (P=0.113). Complete success, qualified success and failure rates in terms of IOP were 61.7%, 27.7% and 10.6% before surgery , 89.4%, 8.5%, 2.1% at 2 years postoperatively. In 29 patients with preoperative IOP≤21 mmHg, mean IOP increased insignificantly from (14.5±4.0) mmHg to (15.5 ± 2.3) (P=0.195) at 2 years. In the 18 patients with preoperative IOP> 21 mmHg, mean IOP decreased from (25.3 ± 4.4) mmHg preoperatively to (17.8 ± 2.4) mmHg (P<0.01).

CONCLUSIONS

Phacoemulsification reduces IOP and the number of glaucoma medications in previously filtered PACG eyes. The IOP remained normal in normal tension eyes after phacoemulsification in filtered PACG eyes but decreased significantly in hypertensive eyes.

Thrombin Activates Latent TGFβ1 via Integrin αvβ1 in Gingival Fibroblasts

Transforming growth factor β (TGFβ) regulates cell proliferation, differentiation, migration, apoptosis, and extracellular matrix production. It also plays a pivotal role in the pathogenesis of gingival overgrowth. Thrombin is a key player in tissue repair, remodeling, and fibrosis after an injury, and it exerts profibrotic effects by activating protease-activated receptors. Connective tissue growth factor (CTGF or CCN2) modulates cell adhesion, migration, proliferation, matrix production, and wound healing. It is overexpressed in many fibrotic disorders, including gingival overgrowth, and it is positively associated with the degree of fibrosis in gingival overgrowth. In human gingival fibroblasts, we previously found that TGFβ1 induced CCN2 protein synthesis through c-jun N-terminal kinase and Smad3 activation. Thrombin stimulates CCN2 synthesis through protease-activated receptor 1 and c-jun N-terminal kinase signaling. Curcumin inhibited TGFβ1- and thrombin-induced CCN2 synthesis. In this study, we demonstrated that thrombin and protease-activated receptor 1 agonist SFLLRN induced latent TGFβ1 activation and Smad3 phosphorylation in human gingival fibroblasts. Pretreatment with a TGFβ-neutralizing antibody, TGFβ type I receptor inhibitor SB431542, and Smad3 inhibitor SIS3 inhibited approximately 86%, 94%, and 100% of thrombin-induced CCN2 synthesis, respectively. Furthermore, blocking integrin subunits αv and β1 with antibodies effectively inhibited SFLLRN-induced Smad3 phosphorylation and CCN2 synthesis and increased activated TGFβ1 levels; however, similar effects were not observed for integrins αvβ3 and αvβ5. These results suggest that protease-activated receptor 1-induced CCN2 synthesis in human gingival fibroblasts is mediated through integrin αvβ1-induced latent TGFβ1 activation and subsequent TGFβ1 signaling. Moreover, curcumin dose dependently decreased thrombin-induced activated TGFβ1 levels. Curcumin-inhibited thrombin-induced CCN2 synthesis in human gingival fibroblasts is caused by the suppression of latent TGFβ1 activation.

Screening of highly informative and representative microsatellite markers for genotyping of major cultivated cotton varieties

We screened and assessed published cotton simple sequence repeat (SSR) primers to establish a set of core SSR markers suitable for cotton major cultivars in China and analyzed genetic diversity based on the core marker set. Using a stepwise screening strategy, 12 leading cultivars for preliminary screening and 96 cultivars for rescreening were evaluated. A total of 184 polymorphic SSR markers were initially screened from 3299 candidates, and a core set of 52 SSR markers with wide genome coverage (2 markers per chromosome) was obtained. Among 96 major cultivars, 273 amplification genotypes were generated using the core marker set. Polymorphism information content values ranged from 0.28-0.83, with an average value of 0.56. The core SSR marker set detected on denaturing polyacrylamide gel electrophoresis indicated that the band genotype was either a single or double band on conventional cultivars, while most were double bands (65.4%). Among 56 hybrids, the average heterozygosis rate was 35.8%, ranging from 7.1-55.4%. Eighteen of 96 cultivars had distinct band genotypes. The genetic diversity analyzed using the of NTSYS-pc V2.10 software indicated that the Yangtze River valley cotton region had the highest polymorphic level, followed by Xinjiang and then the Yellow River valley. The genetic basis of conventional cultivars was narrower than that of hybrids. The core marker set can be used for fingerprint construction, variety identification, and purity tests of major cotton cultivars in China.

Monocyte/macrophage β2-AR as a target of antisympathetic excitation-induced atherosclerotic progression

The aim of this study was to determine whether monocyte/macrophage β2-AR could act as the therapeutic target of antisympathetic excitation-induced atherosclerotic progression. Cultivated human THP-1 cells were divided into different groups and incubated with isoprenaline, metoprolol, propranolol or β2-AR blocker for 24 h, together with oxidized low-density lipoprotein (ox-LDL). Afterwards, each group was analyzed for C-C chemokine receptor type 2 (CCR2) expression, monocyte chemotactic protein 1 (MCP-1) release into medium and cell migration ability. In the isoprenaline group, CCR2 protein level was increased, as well as the secretion of MCP-1, and cell motility was enhanced, in a concentration-dependent manner. Propranolol and ICI 118,551 significantly reversed the stimulatory effect of isoprenaline on THP-1 cells induced by ox-LDL, but only high concentrations of metoprolol interfered significantly with the action of isoprenaline (P < 0.05). Isoprenaline or a β-AR blocker could mediate through β2-AR, affecting MCP-1 secretion, CCR2 protein expression and cell migration capacity of THP-1 cells. Therefore, monocyte-macrophage β2-AR may act as a target of antisympathetic excitation-induced atherosclerotic progression.

Construction of a primary DNA fingerprint database for cotton cultivars

Forty core primers were used to construct a DNA fingerprint database of 132 cotton species based on multiplex fluorescence detection technology. A high first successful ratio of 99.04% was demonstrated with tetraplex polymerase chain reaction. Forty primer pairs amplified a total of 262 genotypes among 132 species, with an average of 6.55 per primer and values of polymorphism information content varying from 0.340 to 0.882. Conflicting DNA homozygous ratios were found in various species. The highest DNA homozygous ratio was found in landrace standard cultivars, which had an 81.46% DNA homozygous ratio. The lowest occurred in a group of 2010 leading cultivars with a homozygous ratio of 63.04%. Genetic diversity of the 132 species was briefly analyzed using unweighted pair-group method with arithmetic means.

Different combinations of probiotics improve the production performance, egg quality, and immune response of layer hens

To evaluate the effects of different combinations of probiotics on performance, egg quality, and immune response of layer hens, a trial was carried out with 1,800 white feather layer hens of the Lohmann variety. The experiment was conducted by using a completely randomized design with 9 treatments, 4 replicates, and 50 hens in each replicate. Compared with the control group, group F, which added a composition of heat-inactivated Lactobacillus salivarius(CB) and Bacillus subtilis to the diets of layer hens, caused highly significant (P < 0.05) increases in egg production, daily egg yield, damaged egg ratio, combined with a significant (P < 0.05) decrease in feed conversion and damaged egg ratio. Group G, adding a combination of inactivated Lactobacillus salivarius and sodium butyrate, resulted in a significant increase (P < 0.05) in daily egg yield, feed conversion, damaged egg ratio and Haugh unit. Meanwhile, groups D and H had significantly decreased feed conversion (P < 0.05), and groups B, H, and I had a significantly decreased damaged egg ratio. In serum levels, no significant difference was observed except a significant decrease (P < 0.05) in total cholesterol (groups D, E, and G) and low-density lipoprotein cholesterol (group E and G) and a significant increase (P < 0.05) in total cholesterol (groups D, E, and G) compared with group A. According to the hemagglutination inhibition test, the antibody titer of antibody against the avian influenza virus was significantly (P < 0.05) higher in most treated groups such as groups B, C, E, G, and I after d 15 fed to layers with probiotics and groups B, C, D, E, F, G, and H after d 45 compared with the control group. No significant difference was observed in the antibody titer against the Newcastle disease virus at d 15, but significantly (P < 0.05) higher at d 45 in groups F and G. These results demonstrate that several combinations of probiotics used in this experiment have a positive impact on the performance, egg quality, and immune response of layer hens, and the following work will continue to focus on these groups.

C1 esterase inhibitor concentrate in 1085 Hereditary Angioedema attacks--final results of the I.M.P.A.C.T.2 study

BACKGROUND

The placebo-controlled study International Multicentre Prospective Angioedema C1-INH Trial 1 (I.M.P.A.C.T.1) demonstrated that 20 U/kg C1 esterase inhibitor (C1-INH) concentrate (Berinert®; CSL Behring, Marburg, Germany) is effective in treating acute abdominal and facial Hereditary Angioedema (HAE) attacks.

METHODS

I.M.P.A.C.T.2 was an open-label extension study of I.M.P.A.C.T.1 to evaluate the safety and efficacy of long-term treatment with 20 U/kg C1-INH for successive HAE attacks at any body location. Efficacy outcomes included patient-reported time to onset of symptom relief (primary) and time to complete resolution of all symptoms (secondary), analysed on a per-patient and per-attack basis. Safety assessments included adverse events, vital signs, viral safety and anti-C1-INH antibodies.

RESULTS

During a median study duration of 24 months, 1085 attacks were treated in 57 patients (10-53 years of age). In the per-patient analysis, the median time to onset of symptom relief was 0.46 h and was similar for all types of attacks (0.39-0.48 h); the median time to complete resolution of symptoms was 15.5 h (shortest for laryngeal attacks: 5.8 h; 12.8-26.6 h for abdominal, peripheral and facial attacks). Demographic factors, type of HAE, intensity of attacks, time to treatment, use of androgens and presence of anti-C1-INH antibodies had no clinically relevant effect on the efficacy outcomes. There were no treatment-related safety concerns. No inhibitory anti-C1-INH antibodies were detected in any patient.

CONCLUSIONS

A single dose of 20 U/kg C1-INH concentrate is safe and provides reliable efficacy in the long-term treatment of successive HAE attacks at any body location.

Exploring the binding features of polybrominated diphenyl ethers as estrogen receptor antagonists: docking studies

The polybrominated diphenyl ethers (PBDEs) accumulating in nature are known to be endocrine-disrupting compounds. Of first concern are those interacting with and altering activity of the human estrogen receptor alpha (hERalpha). In this study a docking study was carried out to explore the binding modes of PBDE compounds as hERalpha antagonists. It was found that some of the PBDE compounds with antiestrogenic activity extended into the channel of the estrogen receptor (ER), which is usually occupied by the alkylamine side chain of the ER antagonists raloxifene (RAL) and 4-hydroxytamoxifen (OHT), while most PBDE compounds without antiestrogenic activity adopted binding modes similar to that of ER agonist 17beta-estradiol (E2), located in the binding cavity and which did not protrude into the channel. The present study suggests that pose comparison based on docking is useful for discriminating whether or not PBDE compounds have antiestrogenic activity. Knowing the binding modes of compounds in hERalpha can help to screen out antiestrogenic compounds and further develop descriptive and predictive models in ecotoxicology.

Inhibition of 12-lipoxygenase during baicalein-induced human lung nonsmall carcinoma H460 cell apoptosis

Baicalein is known as a 12-lipoxygenase (12-LOX) inhibitor. The 12-LOX is found to be involved in the progression of human cancers and the inhibitor of 12-LOX offers a target for the prevention cancer. We demonstrated the inhibitory effect of baicalein on the gene and protein expression of 12-LOX in H460 human lung nonsmall carcinoma cell line. Treatment of baicalein inhibited the growth of H460 cells in a dose-dependent manner. Following 24h exposure to 50muM baicalein, cell cycle analysis revealed an increase in the cell population in S-phase. During the S-phase arrest, baicalein decreased the protein levels of cdk1 and cyclin B1, which are the regulating proteins of S-phase transition to G2/M-phase, in this study. Furthermore, baicalein induced the most of H460 cell apoptosis after treatment for 48h. H460 cells formed vesicles and apoptotic body, and then floated after treatment with baicalein. Baicalein-induced H460 cell apoptosis was confirmed by DNA condensation and fragmentation. Baicalein-induced apoptosis were also accompanied by decreasing in Bcl-2 and proform of caspase-3 and increasing p53 and Bax protein levels. Pretreatment with a specific caspase-3 inhibitor, Ac-DEVD-CHO, partially reduced baicalein-induced cell death, indicating baicalein induces apoptosis is partially dependent on caspase-3 pathway in H460 cells. These data suggest that baicalein, a 12-LOX inhibitor, inhibits the proliferation of H460 cells via S-phase arrest and induces apoptosis in association with the regulation of molecules in the cell cycle and apoptosis-related proteins.

In vitro study of ultrasound based real-time tracking for renal stones in shock wave lithotripsy: Part II--a simulated animal experiment

PURPOSE

We have previously developed and reported an ultrasound based real-time tracking system for renal stones. In the current study we continued to verify the reliability of this tracking system by a simulated animal test.

MATERIALS AND METHODS

We used 13 prerecorded ultrasound stone trajectories to test the system. The real-time tracking system was implemented on the Litemed 9200 electrohydraulic lithotriptor (LiteMed Co., Taipei, Taiwan). An artificial stone and tap water were sealed in a balloon. The balloon was inserted into the pelvis of a pig kidney. While the kidney was affixed to and moved by a simulator, it was immersed in a specifically designed simulated animal model tank containing tap water. The stone was localized by ultrasound. The kidney was moved by the simulator according to a prerecorded stone trajectory. A total of 3,000 shock waves were delivered to the stone. For each recorded stone trajectory experiments were done under nontracking and tracking conditions. We performed tests of the fragment-to-weight ratio, which denotes the performance of a shock wave lithotriptor when fragmenting a stone.

RESULTS

The mean fragment-to-weight ratio was 55.3% +/- 25.9% in the nontracking and 100% +/- 0% in the tracking group. The difference in these 2 groups was statistically significant (paired t test p <0.01).

CONCLUSIONS

The ultrasound based real-time tracking system proved to improve the performance of a shock wave lithotriptor significantly when fragmenting stones in a simulated animal test. We believe that the tracking system would greatly reduce the number of shocks and time needed for treating renal stones.

Extravesical cryosurgical approach for VX2 bladder tumor in rabbits

This study characterized the VX2 bladder cancer model in rabbits and tested the feasibility of treating bladder cancer by extravesical cryosurgery. After the growth characteristics of the VX2 bladder tumor model were determined, the VX2 tumor was inoculated into rabbits at the dome of the bladder. One week later, three freeze/thaw cycles were followed by immediate surgical repair. The control group underwent a sham operation without freezing. When the VX2 tumor is injected into the bladder wall, invasion and central necrosis occurred within I week, lymphatic metastases by 2 weeks, and lung metastases by 3 weeks after inoculation. By 4 weeks, all control rabbits had large VX2 tumors in their bladders and advanced lung metastases. Nine of the ten rabbits in the cryosurgical group had mild to moderate degrees of lung metastases, and six of them had relatively small local recurrences. One rabbit had no tumor in the bladder and only microscopic lung metastasis. The extravesical approach to cryosurgery employing bladder inversion is well tolerated. Cryosurgery exhibits modest efficacy in treating local tumors and delaying lung metastasis in this aggressive tumor model.

Food-dependent exercise-induced anaphylaxis

Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods within the preceding several hours. When patients present to the emergency department (ED) with allergic reactions, careful history regarding these 2 factors is required to establish the correct diagnosis. Correct diagnosis of FDEIA will allow patients to take control of their lifestyles and avert repeated events and ED visits. Two cases of FDEIA are presented, and the diagnosis, pathophysiology and therapy of food-dependent exercise-induced anaphylaxis are reviewed.

Transurethral microwave thermotherapy for symptomatic benign prostatic hyperplasia: long-term durability with Prostcare

OBJECTIVE

To evaluate the long-term durability of transurethral microwave thermotherapy (TUMT) with Prostcare for symptomatic benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

From August 1993 to July 1994, a total of 65 patients with symptomatic BPH who underwent TUMT using the Prostcare apparatus (Bruker Spectospin, Wissembourg, France) with low-energy protocol (maximal power 52 W) were enrolled into a short-term evaluation. Subsequent follow-up information was collected in July 1999. If patients had had any further therapy for BPH, the date of retreatment was considered as an endpoint of TUMT efficacy. If no further therapy for BPH had been needed, they were re-assessed for overall satisfaction.

RESULTS

The median follow-up period was 49 months. Twenty patients were excluded for various reasons, including 17 with loss of follow-up and 3 with new diseases that could affect the voiding status. Thirty-eight (84.4%) of 45 valuable patients had received further therapy for BPH, including medication (n = 21, 46.7%), and endoscopic surgery (n = 17, 37.7%). The times to pharmacologic or endoscopic retreatment after TUMT were 8.9+/-11.1 and 23.0+/-14.4 months, respectively (p = 0.0003, log rank test). Only 7 (15.5%) patients had no further treatment, with 3 having satisfactory improvements, but 4 feel dissatisfied yet not needing any further therapy. In addition, 2 patients complained of erectile dysfunction after TUMT and 1 was diagnosed with prostate cancer 50 months after TUMT. In addition, there was no significant difference for all baseline values among three groups with no retreatment or retreatment with medication or endoscopic surgery.

CONCLUSION

At the 5-year follow-up, the long-term durability of low-energy TUMT with Prostcare is only exhibited in a few patients and the overall retreatment rate was 84.4%. Thus, patient should be informed of the high probability of supplementary treatment after TUMT.

Internalization rates of murine and ovine gonadotropin-releasing hormone receptors

Rates of internalization of the murine GnRH receptor fused via its C-terminus to green fluorescent protein (GnRH-R-GFP) were examined in Chinese hamster ovary cells (CHO cells) and compared to those of native murine GnRH-R in a clonal murine gonadotroph cell line (LbetaT2 cells). The resulting rates of internalization of murine receptors were then compared with those of sheep GnRH-R in ovine gonadotrophs. Cells were incubated with radioiodinated [D-Ala6]GnRH on ice for 4 h to allow binding of the ligand to GnRH-R, then cells were warmed to 37 degrees C to permit internalization. Surface-bound radioligand began to decrease as soon as the cells were warmed and had decreased significantly within 20 min. A steady-state level of surface-bound radioligand was achieved after 60 min in both CHO cells and LbetaT2 cells (38% and 41%, respectively, of initial value; P < 0.05). Internalization of radioligand began immediately after warming the cells to 37 degrees C, and a significant proportion of surface ligand had been internalized by 20 min. A steady-state maximum of internalization was reached after 60 min in both CHO cells and LbetaT2 cells (29% and 28%, respectively, of total cell-associated ligand; P < 0.05). Changes in surface-bound radioligand and internalized radioligand in sheep pituitary cells were similar to those in CHO cells and LbetaT2 cells, but the amount of radioligand internalized after 60 min (40% of total cell-associated ligand) was 1.4 times higher than in CHO cells and LbetaT2 cells (P < 0.05). In a separate experiment, the effect of estradiol on the rate of internalization of GnRH-R in ovine pituitary cells was examined. Although treatment of ovine pituitary cells with estradiol approximately doubled the number of GnRH receptors, it did not alter either the rate or extent of receptor internalization. These results show that rates of internalization of recombinant murine GnRH-R-GFP in CHO cells and native murine and ovine GnRH-R in LbetaT2 cells and in sheep pituitary cells, respectively, are similar, but amounts of ovine GnRH-R internalized are greater than those for murine GnRH-R. Further, the rate of internalization of occupied receptor is similar in gonadotroph and nongonadotroph cells, and the addition of GFP to the C-terminus of the murine GnRH-R does not alter the rate of internalization.

Response of LNCaP spheroids after treatment with an alpha-particle emitter (213Bi)-labeled anti-prostate-specific membrane antigen antibody (J591)

A theoretical drawback to alpha-particle therapy with 213Bi is the short range of the particle track coupled with the short half-life of the radionuclide, thereby potentially limiting effective cytotoxicity to rapidly accessible, disseminated individual tumor cells (e.g., as in leukemia). In this work, a prostate carcinoma spheroid model was used to evaluate the feasibility of targeting micrometastatic clusters of tumor cells using 213Bi-labeled anti-prostate-specific membrane antigen (PSMA) antibody, J591. In prostate cancer, vascular dissemination of tumor cells or tumor cell clusters to the marrow constitutes an important step in the progression of this disease to widespread skeletal involvement, an incurable state. Such prevascularized clusters are ideal targets for radiolabeled antibodies because the barriers to antibody penetration that are associated with the capillary basal lamina have not yet formed. Beta- and gamma-emitting radionuclides such as 131I, which are widely used in radioimmunotherapy, are not expected to be effective when targeting single cells or small cell clusters. This is because the range of the emissions is one to two orders of magnitude greater than the target size, and the energy deposited per traversal is insufficient to produce any significant radiobiological effect. Spheroids of the prostate cancer cell line, LNCaP-LN3, were used as a model of prevascularized micrometastases; their response to an anti-PSMA antibody, J591, radiolabeled with the alpha-particle emitter 213Bi (T(1/2), 45.6 min.) has been measured. The time course of spheroid volume reductions was found to be sensitive to the initial spheroid volume. J591 labeled with 0.9 MBq/ml 213Bi resulted in a 3-log reduction in spheroid volume on day 33, relative to control, for spheroids with an initial diameter of 130 microm; 1.8 MBq/ml were required to achieve a similar response for spheroids with an initial diameter of 180 microm. Equivalent spheroid responses were observed after 12 Gy of acute external beam photon irradiation. Monte Carlo-based microdosimetric analyses of the 213Bi decay distribution in individual spheroids of 130-microm diameter yielded an average alpha-particle dose of 3.7 Gy to the spheroids, resulting in a relative biological effectiveness factor of 3.2 over photon irradiation. The activity concentrations used in the experiments were clinically relevant, and this work supports the possibility of using 213Bi-labeled antibodies not only for disseminated single tumor cells, as found in patients with leukemia, but also for micrometastatic tumor deposits up to 180 microm in diameter (1200 cells).

Transurethral microwave thermotherapy for symptomatic benign prostatic hyperplasia: short-term experience with Prostcare

PURPOSE

To assess our short-term experience with transurethral microwave thermotherapy (TUMT) for symptomatic benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

From August 1993 through July 1994, in total 65 patients with symptomatic BPH were enrolled into this study. The patients' ages ranged from 56 to 95 years with a mean of 70 years. Under local anesthesia with intraurethral instillation of Xylocaine jelly only, all patients received one session of TUMT for up to 60 min with Prostcare equipment. Uroflowmetry was performed and international prostatic symptom score (IPSS) determined before 3 and 6 months after TUMT for assessment of efficacy. All adverse events were recorded and evaluated for clinical relevance.

RESULTS

At 3 and 6 months following TUMT, the mean IPSS decreased from 19.7 +/- 6.8 (baseline) to 12.8 +/- 8.2 (-46%) and to 15.5 +/- 9.0 (-21%), respectively; the maximal urine flow rate at 3 and 6 months increased from 9.1 +/- 4.8 ml/s (baseline) to 11.0 +/- 4.9 ml/s (+21%) and to 10.9 +/- 5.6 ml/s (+19%), respectively. During TUMT, burning sensation was the most frequent complaint (38.5%), followed by urethral discomfort (29.2%) and urgency (9.2%). Two patients (3.1%) interrupted TUMT, because of intolerable pain. Following TUMT micturition pain (73.8%) and gross hematuria (45.9%) were the most adverse events. Most of these adverse events disappeared within 2 weeks. One patient suffered from skin erosion over the penoscrotal junction 1 week later. None had retrograde ejaculation; 1 patient complained of erectile dysfunction.

CONCLUSION

Although the efficacy of TUMT with Prostcare became less prominent 6 months after TUMT, TUMT was still a tolerable, safe alternative treatment of BPH, especially in patients who were not suitable for transurethral resection of the prostate or anesthesia.

Expression of nm23-H1 in transitional cell carcinoma of the upper urinary tract

Transitional cell carcinoma of the upper urinary tract is an uncommon neoplasm. Relatively little information is available regarding the clinical relevance of molecular markers. This study was performed to examine the importance of nm23-H1 gene expression (NM23-H1) in this type of tumors. Immunohistochemical expression of NM23-H1 was analyzed in 90 cases of upper urinary tract cancer, and was compared for its prognostic significance with conventional biological indicators. High expression of NM23-H1 was found in 7 cases (8%), intermediate expression in 32 cases (36%), and low expression in 51 cases (57%). Reduced NM23-H1 (defined as intermediate or low level of expression) was associated with a higher histological grading (p=0.002), invasive tumor growth (p=0. 002), or an increased proliferating cell nuclear antigen labeling index (p=0.004). NM23-H1 tended to inversely relate to later recurrence or long-term survival (p=0.06), but, only tumor staging was found to be significant in predicting clinical outcome (p=0.002). nm23-H1 appears to function as a tumor suppressor for upper urinary tract cancer, however, evaluation of NM23-H1 provides limited prognostic information.

An alpha-particle emitting antibody ([213Bi]J591) for radioimmunotherapy of prostate cancer

A novel alpha-particle emitting monoclonal antibody construct targeting the external domain of prostate-specific membrane antigen (PSMA) was prepared and evaluated in vitro and in vivo. The chelating agent, N-[2-amino-3-(p-isothiocyanatophen-yl)propyl]-trans-cyclohexane-1, 2-diamine-N,N',N',N'',N''-pentaacetic acid, was appended to J591 monoclonal antibody to stably bind the 213Bi radiometal ion. Bismuth-213 is a short-lived (t 1/2 = 46 min) radionuclide that emits high energy alpha-particles with an effective range of 0.07-0.10 mm that are ideally suited to treating single-celled neoplasms and micrometastatic carcinomas. The LNCaP prostate cancer cell line had an estimated 180,000 molecules of PSMA per cell; J591 bound to PSMA with a 3-nM affinity. After binding, the radiolabeled construct-antigen complex was rapidly internalized into the cell, carrying the radiometal inside. [213Bi]J591 was specifically cytotoxic to LNCaP. The LD50 value of [213Bi]J591 was 220 nCi/ml at a specific activity of 6.4 Ci/g. The potency and specificity of [213Bi]J591 directed against LNCaP spheroids, an in vitro model for micrometastatic cancer, also was investigated. [213Bi]J591 effectively stopped growth of LNCaP spheroids relative to an equivalent dose of the irrelevant control [213Bi]HuM195 or unlabeled J591. Cytotoxicity experiments in vivo were carried out in an athymic nude mouse model with an i.m. xenograft of LNCaP cells. [213Bi]J591 was able to significantly improve (P < 0.0031) median tumor-free survival (54 days) in these experiments relative to treatment with irrelevant control [213Bi]HuM195 (33 days), or no treatment (31 days). Prostate-specific antigen (PSA) was also specifically reduced in treated animals. At day 51, mean PSA values were 104 ng/ml +/- 54 ng/ml (n = 4, untreated animals), 66 ng/ml +/- 16 ng/ml (n = 6, animals treated with [213Bi]HuM195), and 28 ng/ml +/- 22 ng/ml (n = 6, animals treated with [213Bi]J591). The reduction of PSA levels in mice treated with [213Bi]J591 relative to mice treated with [213Bi]HuM195 and untreated control animals was significant with P < 0.007 and P < 0.0136, respectively. In conclusion, a novel [213Bi]-radiolabeled J591 has been constructed that selectively delivers alpha-particles to prostate cancer cells for potent and specific killing in vitro and in vivo.