Effectiveness and safety of REBACIN as a non-invasive intervention for persistent high-risk human papillomavirus infection: A real-world prospective multicenter cohort study

BACKGROUND

We previously reported that REBACIN effectively eliminates persistent high-risk human papillomavirus (hrHPV) infection. Here, we conducted a prospective multicenter cohort study to evaluate the safety and effectiveness of REBACIN, taking into account factors such as specific hrHPV subtype and patient's age.

METHODS

According to inclusion/exclusion criteria and participant willingness, 3252 patients were divided into REBACIN group while 249 patients into control group. Patients in REBACIN group received one course treatment of intravaginal administration of REBACIN while no treatment in control group. After drug withdrawal, participants in both groups were followed up.

RESULTS

The clearance rate of persistent hrHPV infection in REBACIN group was 60.64%, compared to 20.08% in control group. Specifically, the clearance rates for single-type infection of HPV16 or HPV18 were 70.62% and 69.23%, respectively, which was higher than that of HPV52 (59.04%) or HPV58 (62.64%). In addition, the single, double, and triple/triple+ infections had a clearance rate of 65.70%, 53.31%, and 38.30%, respectively. Moreover, 1635 patients under 40 years old had a clearance rate of 65.14%, while it was 55.08% for 1447 patients over 40 years old. No serious adverse effects were found.

CONCLUSION

This study confirmed that REBACIN can effectively and safely eliminate persistent hrHPV infection, which the clearance rate of HPV16/18 is higher than that of HPV52/58, the clearance rate of single-type infection is higher than that of multiple-type infections, and the clearance rate in young patients is higher than that in elder patients, providing a guidance for REBACIN application in clearing hrHPV persistent infection in real-world settings.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry Registration Number: ChiCTR1800015617 http://www.chictr.org.cn/showproj.aspx?proj=26529 Date of Registration: 2018-04-11.

[Clinical features of young inpatients with angle-closure glaucoma]

Objective: To analyze the composition of diagnosis in young inpatients with angle-closure glaucoma and to compare the clinical characteristics between primary angle-closure glaucoma (PACG) and secondary angle-closure glaucoma (SACG). Methods: This was a retrospective case series study. Angle-closure glaucoma patients aged 40 years or younger and hospitalized in Zhongshan Ophthalmic Center from January 2012 to December 2019 were included. The clinical diagnosis, gender, onset age, and results of general ophthalmic examination, A-scan ultrasonography measurements, ultrasound biomicroscopy, optical coherence tomography and visual field were recorded. The proportions and composition of PACG and SACG, as well as the misdiagnosis ratio, were analyzed. The onset age, visual acuity, visual field, and ocular parameters were compared between patients with PACG and SACG. Non-normally distributed data were represented by M (Q₁, Q₃). The difference between groups were compared by Mann-Whitney U test, Chi square test, and independent sample t test. Results: A total of 243 patients (243 eyes) were included in this study. The mean onset age was (28±9) years, and the male-to-female ratio was 1∶1.79. There were 93 patients (38.3%) in PACG group and 150 (61.7%) in SACG group. The age of PACG [34(28, 38)] was older than that of SACG [28(19, 34)], and the proportion of males in the SACG group (44.0%, 66/150) was significantly higher than that in the PACG group (22.6%, 21/93) (Z=-5.34, χ²=11.46; both P<0.01). Nanophthalmos (22.7%, 34 cases), autosomal recessive bestrophinopathy (ARB) (19.3%, 29 cases), uveitis (18.7%, 28 cases) and retinitis pigmentosa (14.0%, 21 cases) were the most common causes of SACG. The best corrected visual acuity (logarithm of the minimum angle of resolution) was 0.10 (0.00, 0.48) and 0.40 (0.06, 1.00), mean deviation of visual field was -8.07 (-27.49, -2.09) and -15.04 (-28.75, -5.97) dB, and subfoveal choroidal thickness was (452.3±130.7) and (396.3±120.9) μm in the PACG and SACG groups, respectively. The differences were statistically significant (Z=-4.86, -2.14; t=2.37; all P<0.05). There was no statistical difference in intraocular pressure, cup-to-disc ratio, extent of peripheral anterior synechia, central anterior chamber depth, lens thickness, mean retinal nerve fiber layer thickness between these two groups (all P>0.05). The misdiagnosis ratio was 10.7% (26/243) in all patients, while the misdiagnosis ratio of the SACG group (16.7%, 25/150) was higher than that of the PACG group (1.1%, 1/93) (χ²=14.61, P<0.001). Conclusions: PACG, nanophthalmos and ARB are the most common etiologies in young inpatients with angle-closure glaucoma. Compared to PACG, patients with SACG are younger, with worse visual acuity and more severe visual field defects, and easier to be misdiagnosed.

[An investigation of reproductive health in female workers engaged in administrative management]

Objective: To investigate the reproductive health status of female workers engaged in administrative management, and to provide a reference for protecting the reproductive health of female workers. Methods: From April to November, 2016, a cross-sectional survey was performed for 2717 female workers aged 18-60 years and engaged in administrative management from 13 cities and provinces in China, and a questionnaire was used to investigate their general information, occupational hazards in workplace, and reproductive health status, and the reproductive health status of female workers was analyzed. Results: Of all 2 717 female workers, 1 170 had gynecological diseases or symptoms, resulting in an incidence rate of 43.06%, and among these workers, 11.15% had abnormal menstruation, 34.64% had infertility, and 38.76% had a history of abortion. There were significant differences in the rates of abnormal results of gynecological examination, abnormal menstruation, abortion, and infertility between the female workers in different age groups (P<0.01) . Unhealthy living habits and major events were risk factors for gynecological diseases, abnormal menstruation, and abortion (P<0.05) ; bad working status was a risk factor for gynecological diseases and abortion (P<0.05) ; exposure to harmful factors was a risk factor for gynecological diseases and abnormal menstruation (P<0.05) . Conclusion: Living habits, major events, working status, and occupational harmful factors have certain influence on reproductive health of female workers engaged in administrative management. Occupational health protection should be strengthened, working patterns should be improved, self-protection awareness should be raised, and health protection should be enhanced for women of childbearing age to protect and promote the reproductive health of female workers.

[Role of nitric oxide in cholecystokinin octapeptide alleviation of tumor necrosis factor alpha induced changes in rabbit pulmonary arterial reactivity]

To explore the mechanism underlying cholecystokinin octapeptide (CCK-8) induced attenuation in pulmonary arterial hypertension (PAH) in endotoxic shock (ES), the effect of CCK-8 on the changes in rabbit pulmonary arterial reactivity induced by tumor necrosis factor-alpha (TNF-alpha) was observed with isolated arterial ring technique and by examination of nitric oxide synthase (NOS). The contractile response to 10(-6) mol/L phenylephrine (PE) and the endothelium dependent relaxation response to 10(-6) mol/L acetylcholine (ACh) were not affected by TNF-alpha (4000 U/ml) after incubation for 2 h; the relaxation response was decreased significantly when the incubation was prolonged to 7 or 14 h, which, however, could be reversed by a concomitant exposure to CCK-8 (0.5 microgram/ml), but the incubation of pulmonary arterial rings with CCK-8 (0.5 microgram/ml) alone did not bring out any contractile responses. The endothelium dependent relaxation response to 10(-6) mol/L ACh was restored by L arginine in the TNF-alpha group which had been incubated for 7 h, but was not affected by AG in each group, while the contractile response to 10(-6) mol/L PE increased significantly in the TNF-alpha group. The relaxant response to 10(-6) mol/L ACh changed into a contractile response after preincubation with L-NNA in each group, while the contraction response to 10(-6) mol/L PE increased significantly. The NOS activity increased in the TNF-alpha and the TNF alpha+CCK-8 groups, while no significant difference was observed between the vehicle and the CCK-8 groups. These results suggest that CCK-8 prevents TNF-alpha induced impairment in endothelium dependent relaxation response, and the effects of both CCK-8 and TNF-alpha are related to NO.

[Endotoxin-induced generation of peroxynitrite in bovine pulmonary arterial endothelial cells]

AIM

To explore the significance of bovine pulmonary arterial endothelial cell (BPAEC) to produce peroxynitrite (ONOO-).

METHODS

The contents of nitrotyrosine (NT), a marker of ONOO- generation in vivo,were quantitatively measured with flow cytometric and immunofluorescent technique in cultured BPAEC induced by lipopolysaccharide (LPS), a major component of bacterial endotoxin. In addition, effect of ONOO- on micromorphologic features of BPAEC was observed.

RESULTS

LPS caused significant increase of NT in BPAEC in a dose-dependent manner, which was in part reversed by aminoguanidine, a selective inhibitor of inducible nitric oxide synthase. Exposure of BPAEC to exogenous ONOO- resulted in the cellular retro-contraction with diminished cellular body and increased width of cellular junction.

CONCLUSION

LPS may induce the ONOO- formation of BPAEC. Endothelial cell-derived ONOO- may mediate the deleterious effect of LPS on BPAEC per se.

Effect of cholecystokinin on cytokines during endotoxic shock in rats

AIM: To study the effect of cholecystokinin-octapeptide (CCK-8) on systemic hypotension and cytokine production in lipopolysaccharide (LPS)-induced endotoxic shock (ES) rats.

METHODS: The changes of blood pressure were observed using physiological record instrument in four groups of rats: LPS (8 mg•kg¯¹, iv) induced ES; CCK-8 (40 μg•kg¯¹, iv) pretreatment 10 min before LPS (8 mg•kg¯¹); CCK-8 (40 μg•kg¯¹, iv) or normal saline (control) groups. Differences in tissue and circulating specificity of the proinflammatory cytokines (TNF-α, IL-1β and IL-6) were assayed with ELISA kits.

RESULTS: CCK-8 reversed LPS-induced decrease of mean artery blood pressure (MABP) in rats. Compared with control, LPS elevated the serum level of IL-6 significantly (3567 ± 687) ng•L¯¹vs 128 ± 22 ng•L¯¹, P < 0.01), while contents of TNF-αβ elevated significantly (277 ± 86 ng•L¯¹vs not detectable and 43 ± 9 ng•L¯¹vs not detectable, P < 0.01) but less extent than IL-6. CCK-8 significantly inhibited the LPS-induced increase in serum TNF-α, IL-1β and IL-6. LPS elevated spleen and lung content of IL-1β significantly (5184 ± 85 ng•L¯¹vs 1047 ± 21 ng•L¯¹ and 4050 ± 614 ng•L¯¹vs not detectable, P < 0.01), while levels of TNF-α and IL-6 also rose significantly but in less extent than IL-1β. CCK-8 inhibited the LPS-induced increase of the cytokines in spleen and lung. In the heart, CCK-8 significantly inhibited LPS-induced increase of TNF-α (864 ± 123 ng•L¯¹ in CCK-8 + LPS group vs 1599 ± 227 ng•L¯¹ in LPS group, P < 0.01), and IL-1β (282 ± 93 ng•L¯¹ in CCK-8+LPS group vs 621 ± 145 ng•L¯¹ in LPS group, P < 0.01).

CONCLUSION: CCK-8 reverses ES, which may be related to its inhibitory effect on the overproduction of cytokines.

[Properties of peroxynitrite-induced relaxation in rabbit pulmonary artery in vitro]

Vasodilatory properties of exogenous peroxynitrite (ONOO(-)) and effects of endothelial cells on ONOO(-) induced relaxation were investigated in isolated rabbit pulmonary arterial rings (PARs). In pre-contracted PARs, ONOO(-) gave rise to vasodilation in a dose-dependent manner, which was significantly higher than that of decomposed ONOO-. In contrast, relaxation of PARs to ONOO(-) was lower, as compared with sodium nitroprusside (SNP) or acetylcholine(ACh). ONOO(-) induced more significant relaxation in denuded endothelial PARs than in intact endothelial PARs. Relaxation of PARs to repetitively administered ONOO(-) appeared progressively decreased. Under this experimental condition, relaxation of PARs to ACh remained unchanged after administrating ONOO(-). These results suggest that ONOO(-) causes weak relaxation in pulmonary artery, which is down regulated by endothelium and is of tachyphylaxis.

[MK-801 attenuates NOS expression and NO content in the spinal cord of rats with inflammatory pain]

Using NADPH-d histochemistry, the effect of NMDA receptor antagonist MK-801 on the expression of nitric oxide synthase (NOS) in the dorsal horn of the spinal cord was investigated during inflammatory pain and hyperalgesia induced by injection of formalin into the right hind paw. The course of the change in the nitric oxide (NO) content of the lumbar intumescence was observed by measuring the ratio of nitrate/nitrite (NO3T/NO2T) and also the end product of NO. The results showed that the NOS expression and NO contents significantly increased 24 h after formalin injection, which were substantially inhibited when MK-801 was intrathecally injected 15 min prior to formalin injection or 12 h after formalin injection. The results suggest that the increases in the expression of NOS and NO contents in the dorsal horn of the spinal cord are mediated by activation of NMDA receptors during pain and hyperalgesia after formalin injection.

[Cholecystokinin-octapeptide alleviates tumor necrosis factor-alpha induced changes in rabbit pulmonary arterial reactivity and injuries of endothelium in vitro]

To explore the mechanism underlying cholecystokinin-octapeptide (CCK-8) induced attenuation of pulmonary arterial hypertension (PAH) in endotoxic shock, the effects of CCK-8 on the changes in rabbit pulmonary arterial reactivity induced by tumor necrosis factor-alpha (TNF-alpha) were observed with the isolated arterial ring technique, and the ultrastructure of pulmonary arterial endothelium was observed under a scanning electron microscope. The contractile response to -adrenoceptor agonist phenylephrine (PE), the endothelium-dependent relaxation response to acetylcholine (ACh) and the endothelium-independent relaxation response to sodium nitroprusside (SNP) were not affected by TNF-alpha (4000 U/ml) after incubation for 2 h, while, if the incubation time was prolonged to 7 or 14 h, the relaxation response of pulmonary artery to ACh was depressed significantly, which, however, could be reversed by concomitant exposure to CCK-8 (0.5 microgram/ml). Incubation of pulmonary artery with CCK-8 (0.5 microgram/ml) alone did not bring out any contractile responses. Moreover, CCK-8 (0.5 microgram/ml) alleviated the ultrastructural lesions induced by TNF-alpha (4000 U/ml). These results suggest that CCK could protect pulmonary arterial endothelium against the detrimental effects by TNF-alpha.

A review of 5 years' experience in the use of botulinium toxin A in the treatment of sixth cranial nerve palsy at the Singapore National Eye Centre

INTRODUCTION

This retrospective study reports our experience on the use of botulinum toxin A (BTXA) in the treatment of sixth cranial nerve palsy at the Singapore National Eye Centre. BTXA is derived from clostridium botulinum; it causes temporary paralysis of the extraocular muscle (medial rectus) into which it is injected, thus preventing its contracture and allows the antagonist lateral rectus muscle to take up the slack and reduce or correct the ocular misalignment.

METHODS

Nineteen patients had BTXA injection for estropia due to sixth cranial nerve palsy during the period September 1992 to August 1997. The sixth cranial nerve palsy was related to nasopharyngeal carcinoma in 76.7% of cases. Follow-up after the last injection ranged from zero (defaulted) to 21 months (mean 8, median 6 months).

RESULTS

A total of 25 injections were given to 19 patients. Seven patients (36.8%) had final ocular alignment within 10 prism dioptres of orthotropia of which six achieved fusion at primary gaze position. There was no correlation between the number of injections per patient and the size of strabismus or grade of lateral rectus muscle function. The incidence of ptosis was 48%, subconjunctival haemorrhage 16% and hypertropia 16%.

DISCUSSION

Our results suggest that those patients with smaller strabismus and a shorter time interval between onset of strabismus and botulinum injection tend to achieve better outcome in terms of fusion or ocular alignment within 10 prism dioptres of orthotropia. The treatment of strabismus with BTXA is an acceptable approach in selected patients. The procedure is simple, safe, cheap, effective, and avoids the risks of general anaesthesia. It can substitute for or eliminate the need for strabismus surgery in some cases of sixth nerve palsy.

[Effects of endogenous nitric oxide on pulmonary artery hypertension and lung injury induced by endotoxin]

Changes in mean artery pressure (MAP), pulmonary artery pressure (PAP) and nitric oxide (NO) contents in inflow and outflow pulmonary blood(IPB,OPB) were observed after endotoxin lipopolysacchride (LPS) was injected i.v. in rabbits. Changes of PAP and lung injury were also observed after inhibitor of NO synthesis L-NNA or inhibitor of inducible NO synthesis AG was pre-injected by vein. The results showed that MAP decreased significantly after LPS administration, and 0.5-2h later PAP showed some increase (P<0.05) being maximum at PAP (1h) during which the content of NO in IPB was detectably decreased but NO in OPB did not. NO contents in OPB at 3h and in IPB and OPB at 5h increased significantly following LPS administration as compared with control.PAP correlated negatively with NO in IPB at the time before and 1h after LPS injection, which did not exist at 3 and 5h after LPS injection. After L-NNA pretreatment, when PAP elevated significantly, the MDA content in IPB and OPB also showed significant increase, while animal survival rate fell significantly. Light microscopic examination showed severe alveolar atelectasis, significant congestion and sequestration of leukocytes in lung tissue. When pretreated with AG, MAP elevated significantly in 3-5h, PAP remained unchanged. The MDA content in blood was lower at 5h in the LPS injected group with less pathological changes in lung tissue at 5h compared with the LPS group. The above results suggested that there was pulmonary hypertension in the early stage after endotoxin administration. The decrease of NO content in IPB may be one of the mechanisms underlying pulmonary artery hypertension(PAH).NO seemed to alleviate PAH and lung injury at the early stage after endotoxin administration. When iNOS was induced at the later stage, NO contributed to lung injury caused by endotoxin.

Molecular studies of loss of heterozygosity in retinoblastoma

Retinoblastoma (Rb) is a paediatric intraocular tumour in which predisposition can be inherited. Cases of Rb tumours can be divided into three types: familial cases, sporadic bilateral cases and sporadic unilateral cases. Familial and sporadic bilateral cases are usually categorised as hereditary while sporadic unilateral cases as non-hereditary. In both familial and non-familial forms of Rb, loss of heterozygosity of the Rb locus has been reported although its frequency in tumours has not so far been accurately determined. The cloning of the gene responsible for retinoblastoma (Rb1) has facilitated DNA studies and genetic counselling of patients. We have examined forty-five cases of retinoblastoma at five intragenic sites of the Rb1 locus, namely intron 1/BamH1, intron 17/Xba1, intron 24/TthIII1, intron 25/Dra1 and Rb1.20 VNTR. Thirty-six out of the forty-five cases (80%) were informative for these markers. Comparison of results between genomic DNA from peripheral blood and from tumours revealed that loss of heterozygosity of alleles could be detected in 50% of cases studied in which tumour samples were available. Investigation of parental origin of retained alleles showed that in all these cases, the paternal alleles were preferentially retained. The analysis of the genetic origin of mutations predisposing to retinoblastoma can facilitate new approaches for identifying recessive mutant genes that lead to cancer as well as to provide a conceptual basis for accurate prenatal predictions of cancer predisposition.

Retinoblastoma in Singapore: 1976 to 1995

There were at least 56 local and 42 foreign patients seen in Singapore between 1976 and 1995 inclusively. The local incidence rate is 1 in 15789 live-births, and there appears to be no predilection for sex and race. Ninety-eight per cent presented before the age of five with the average age at diagnosis being 18 months. Bilateral cases were diagnosed earlier than unilateral cases. At least 17% are hereditary, with only 2 of these with positive family histories. Of the 41 patients studied for presenting complaints, 82.9% had leukocoria, 19.5% had strabismus and 12.2% had decreased visual acuity. The main mode of treatment was enucleation alone in unilateral disease; in bilateral cases, the main mode was enucleation of the more badly affected eye together with radiotherapy and cryotherapy of the fellow eye. Ninety per cent of all patients who underwent treatment have had enucleation done. Four patients defaulted treatment--with counselling of the parents of these patients, this number could be reduced or at least kept low. Patients with early diagnosis and treatment are more likely to survive. Eight of the 56 patients died. However, with better treatment modalities, the prognosis for both life and vision have, in recent years, improved significantly.

[Cholecystokinin-octapeptide (CCK-8) reverses experimental endotoxin shock]

The effects of CCK-8 on the mean arterial pressure (MAP), blood components and path-morphological changes during endotoxin shock (endotoxin, 8 mg/kg b.w.iv.) in rats, as well as on the 24 h mortality rate (MR) of the lead-sensitized rats in endotoxin shock (endotoxin 1 microgram/100 g b.w.iv.) were observed. The results showed that injection of CCK in ES rats led to an increase in MAP, and a reduction of hematocrit and platelet as well as white cell count; the mortality rate decreased and the lesion in main organs lessened. It is suggested that release of endogenous CCK has important protective action during endotoxin shock.

Growth of the internal and external eye in term and preterm infants

BACKGROUND

Better knowledge of the growth patterns of the external and internal eyes of neonates would permit more accurate diagnosis of disorders that affect ocular size such as infantile glaucoma and microphthalmos. Such disorders preferentially may affect certain parts of the internal eye but not other parts. No previous study statistically has evaluated internal ocular growth in preterm newborns.

METHODS

A-scan ultrasonography was applied directly to the corneas of 101 healthy preterm and term newborns to determine axial length, anterior chamber depth, lens thickness, and vitreous chamber depth. The growth of these structures was evaluated by correlation and regression analyses.

RESULTS

At term, the mean measurements were axial length, 16.2 mm; anterior chamber depth, 2.0 mm; lens thickness, 3.8 mm; and vitreous chamber depth, 10.5 mm. Postconceptional age correlated to axial length (P < 0.001), anterior chamber depth (P = 0.032), and vitreous chamber depth (P < 0.001), but not to lens thickness (P = 0.48). By regression analysis, the eyes of males grew faster than those of females (P < 0.001) mainly due to the vitreous chamber.

CONCLUSION

In the last trimester and first 2 postnatal months, lens thickness remains constant, while the anterior chamber and, especially, the vitreous chamber deepen.

Changes in pulmonary Cu-Zn contents in superior mesenteric artery occlusion shock of rabbit

Contents of Cu and Zn of into-pulmonary blood (IPB), out-pulmonary blood (OPB), Lung tissue, and supernatant and macrophages of Lung Lavage were determined in superior mesenteric artery occlusion (SMAO) shock of rabbits. Zn of pulmonary tissue was 11.42 +/- 0.60 and 14.52 +/- 1.78 (micrograms/g wet wt) in SMAO shock and control groups, respectively. Content of Zn was found to be lower, Cu was not changed, and Cu/Zn ratio increased in lung tissue in SMAO shock. Contents of Cu and Zn in other samples were not changed. The results suggest that lower Zn in lung tissue related to acute lung injury.