Incisional hernias post renal transplant: a systematic review and meta-analysis

PURPOSE

Incisional hernia (IH) post renal transplant (RT) is relatively uncommon and can be challenging to manage clinically due to the presence of the kidney graft and patient immunosuppression. This systematic review and meta-analysis synthesises the current literature in relation to IH rates, risk factors and outcomes post RT.

METHODS

PubMed, EMBASE, and Cochrane Central Registry of Controlled Trials (CENTRAL) were searched up to July 2023. The most up to date Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed. Pertinent clinical information was synthesised. A meta-analysis of the pooled proportions of IH rates, the rates of patients requiring surgical repair and the rates of recurrence post RT are reported.

RESULTS

Twenty studies comprising 16,018 patients were included in this analysis. The pooled rate of IH occurrence post RT was 4% (CI 3-5%). The pooled rate of IH repair post RT was 61% (CI 14-100%). The pooled rate of IH recurrence after repair was 16% (CI 9-23%). Risk factors identified for IH development post RT are BMI, immunosuppression, age, smoking, incision type, reoperation, concurrent abdominal wall hernia, lymphocele formation and pulmonary disease.

CONCLUSIONS

IH post RT is uncommon and the majority of IH post RT are repaired surgically on an elective basis.

Efficient Production of 9,22-Dihydroxy-23,24-bisnorchol-4-ene-3-one from Phytosterols by Modifying Multiple Genes in Mycobacterium fortuitum

C19 steroids and C22 steroids are vital intermediates for the synthesis of steroid drugs. Compared with C19 steroids, C22 steroids are more suitable for synthesizing progesterone and adrenocortical hormones, albeit less developed. 9,22-dihydroxy-23,24-bisnorchol-4-ene-3-one(9-OHBA), due to its substituents at positions C-9 and C-22, is a beneficial and innovative steroid derivative for synthesizing corticosteroids. We focused on the C22 pathway in Mycobacterium fortuitum ATCC 35855, aiming to develop a productive strain that produces 9-OHBA. We used a mutant strain, MFΔkstD, that knocked out kstds from Mycobacterium fortuitum ATCC 35855 named MFKD in this study as the original strain. Hsd4A and FadA5 are key enzymes in controlling the C19 metabolic pathway of steroids in Mycobacterium fortuitum ATCC 35855. After knocking out hsd4A, MFKDΔhsd4A accumulated 81.47% 9-OHBA compared with 4.13% 9-OHBA in the strain MFKD. The double mutant MFKDΔhsd4AΔfadA5 further improved the selectivity of 9-OHBA to 95.13%, and 9α-hydroxy-4-androstenedione (9-OHAD) decreased to 0.90% from 4.19%. In the end, we obtained 6.81 g/L 9-OHBA from 10 g/L phytosterols with a molar yield of 80.33%, which showed the best performance compared with formerly reported strains.

Epigenetic Regulation of Ameloblast Differentiation by HMGN Proteins

Dental enamel formation is coordinated by ameloblast differentiation, production of enamel matrix proteins, and crystal growth. The factors regulating ameloblast differentiation are not fully understood. Here we show that the high mobility group N (HMGN) nucleosomal binding proteins modulate the rate of ameloblast differentiation and enamel formation. We found that HMGN1 and HMGN2 proteins are downregulated during mouse ameloblast differentiation. Genetically altered mice lacking HMGN1 and HMGN2 proteins show faster ameloblast differentiation and a higher rate of enamel deposition in mice molars and incisors. In vitro differentiation of induced pluripotent stem cells to dental epithelium cells showed that HMGN proteins modulate the expression and chromatin accessibility of ameloblast-specific genes and affect the binding of transcription factors epiprofin and PITX2 to ameloblast-specific genes. Our results suggest that HMGN proteins regulate ameloblast differentiation and enamel mineralization by modulating lineage-specific chromatin accessibility and transcription factor binding to ameloblast regulatory sites.

Phytosterol conversion into C9 non-hydroxylated derivatives through gene regulation in Mycobacterium fortuitum

Androst-4-ene-3,17-dione (AD) and 22-hydroxy-23,24-bisnorchol-4-ene-3-one (4-HBC) are important drug intermediates that can be biosynthesized from phytosterols. However, the C9 hydroxylation of steroids via 3-ketosteroid 9α-hydroxylase (KSH) limits AD and 4-HBC accumulation. Five active KshAs, the oxidation component of KSH, were identified in Mycobacterium fortuitum ATCC 35855 for the first time. The deletion of kshAs indicated that the five KshA genes were jointly responsible for C9 hydroxylation during phytosterol biotransformation. MFKDΔkshA, the five KshAs deficient strain, blocked C9 hydroxylation and produced 5.37 g/L AD and 0.55 g/L 4-HBC. The dual function reductase Opccr knockout and 17β-hydroxysteroid dehydrogenase Hsd4A enhancement reduced 4-HBC content from 8.75 to 1.72% and increased AD content from 84.13 to 91.34%, with 8.24 g/L AD being accumulated from 15 g/L phytosterol. In contrast, hsd4A and thioesterase fadA5 knockout resulted in the accumulation of 5.36 g/L 4-HBC from 10 g/L phytosterol. We constructed efficient AD (MFKDΔkshAΔopccr_hsd4A) and 4-HBC (MFKDΔkshAΔhsd4AΔfadA5) producers and provided insights for further metabolic engineering of the M. fortuitum ATCC 35855 strain for steroid productions. KEY POINTS: • Five active KshAs were first identified in M. fortuitum ATCC 35855. • Deactivation of all five KshAs blocks the steroid C9 hydroxylation reaction. • AD or 4-HBC production was improved by Hsd4A, FadA5, and Opccr modification.

[Comparison of 5-year follow-up outcomes between"one-stop"procedure and long-term oral anticoagulants after radiofrequency catheter ablation in patients with atrial fibrillation]

Objective: To compare the 5-year follow-up outcomes of radiofrequency catheter ablation (RFCA) combined with left atrial appendage closure (LAAC) and long-term oral anticoagulant (OAC) after RFCA in patients with atrial fibrillation. Methods: This retrospective cross-sectional study included patients with atrial fibrillation who underwent"one-stop"procedure in the First Affiliated Hospital of Ningbo University from September 2015 to December 2017 (RFCA+LAAC group). Baseline data of patients were collected. Propensity score matching at the ratio of 1∶1 was used to select patients with atrial fibrillation who took long-term OAC after RFCA (RFCA+OAC group). The maintenance rate of sinus rhythm and the incidence of adverse events during follow-up were compared between the two groups. Results: A total of 110 patients were enrolled in the RFCA+LAAC group and RFCA+OAC group, respectively. Age of patients was (67.4±8.8) years in RFCA+LAAC group, and there were 42 (38.2%) female patients. Age of patients was (67.3±7.9) years in RFCA+OAC group, and there were 47 (42.7%) female patients. The patients were followed up for mean of (5.3±1.1) years. There was no significant difference in the maintenance rate of sinus rhythm (log-rank: χ2=0.277, P=0.602) and incidence of ischemic stroke events (2.7% (3/110) vs. 4.5% (5/110), P=0.719) during follow-up between the two groups. The incidence of bleeding events (6.4% (7/110) vs. 18.2% (20/110), P=0.008) and major bleeding events (1.8% (2/110) vs. 8.2% (9/110), P=0.030) was significantly higher in the RFCA+OAC group than in the RFCA+LAAC group. Conclusion: There is no significant difference between RFCA+LAAC group and RFCA+OAC group in maintenance rate of sinus rhythm and incidence of ischemic stroke events. Patients in the RFCA+LAAC group have a lower risk of bleeding events compared to the RFCA+OAC group.

[Long-term outcome of transcatheter repair of paravalvular leak post surgical mitral valve replacement]

Objective: To explore the long-term clinical efficacy of transcatheter repair of mitral paravalvular leak (PVL) post surgical mitral valve replacement. Methods: This study is a retrospective study. Patients who completed transcatheter repair of paravalvular leak after surgical mitral valve replacement at Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine from March 2010 to December 2018 were included. Technical success was defined as the occluder being stably implanted in the paravalvular leak site without affecting the function of the mitral valve and surrounding tissues; and there were no intervention-related complications, such as new hemolysis or aggravated hemolysis, and echocardiography confirmed mitral paravalvular regurgitation reduced by more than 1 grade. Patients were followed up at 30 days, 1, and 3 years after the intervention. The main endpoints were all-cause death and re-surgery due to interventional failure or serious complications. The occurrence of occluder-mediated hemolysis and chronic renal insufficiency was recorded, and patients were monitored with echocardiography during follow up. Results: A total of 75 patients were included, aged (54.3±22.9) years old, and 38 patients were males. All patients had decreased cardiac function and/or hemolysis before intervention. Procedural success was achieved in 54 patients (72.0%). Incidence of device-mediated hemolysis was 18.7% (14/75). During the follow-up period, all-cause death occurred in 7 patients (9.3%), and 3 were cardiac deaths.The 3-year event-free survival rate was 81.3% (61/75). The need for cardiac surgery was 9.3% (7/75): 3 cases due to severe device-mediated hemolysis, 2 cases due to prosthetic valve failure and 2 cases due to moderate to severe residual regurgitation. The echocardiography follow-up results showed that the position of the occluder was stable, there was no impact on the artificial valve function and surrounding structures, and the residual regurgitation was stable without progressive increase in event-free patients. Compared with pre-intervention, the left ventricular end systolic diameter ((33.9±7.4)mm vs. (38.3±8.9) mm, P=0.036), end diastolic diameter ((53.7±8.3) mm vs. (58.4±9.1) mm, P=0.045) and left atrial diameter (59.3 (44.5, 90.7) mm vs. 64.3 (44.8, 96.6) mm, P=0.049) were significantly reduced, pulmonary artery systolic pressure was also significantly decreased ((36.5±15.8) mmHg vs. (46.3±14.9) mmHg, P=0.022, 1 mmHg=0.133 kPa). There was no significant difference between 3 years and 1 year after transcatheter repair of mitral paravalvular leak post surgical mitral valve replacement (all P>0.05). Conclusion: Transcatheter repair of mitral paravalvular leak post surgical mitral valve replacement is an effective treatment option in selective patients.

Developmental Manganese Exposure Causes Lasting Attention Deficits Accompanied by Dysregulation of mTOR Signaling and Catecholaminergic Gene Expression in Brain Prefrontal Cortex

Elevated manganese (Mn) exposure is associated with attentional deficits in children, and is an environmental risk factor for attention deficit hyperactivity disorder (ADHD). We have shown that developmental Mn exposure causes lasting attention and sensorimotor deficits in a rat model of early childhood Mn exposure, and that these deficits are associated with a hypofunctioning catecholaminergic system in the prefrontal cortex (PFC), though the mechanistic basis for these deficits is not well understood. To address this, male Long-Evans rats were exposed orally to Mn (50 mg/kg/d) over PND 1-21 and attentional function was assessed in adulthood using the 5-Choice Serial Reaction Time Task. Targeted catecholaminergic system and epigenetic gene expression, followed by unbiased differential DNA methylation and gene regulation expression transcriptomics in the PFC, were performed in young adult littermates. Results show that developmental Mn exposure causes lasting focused attention deficits that are associated with reduced gene expression of tyrosine hydroxylase, dopamine transporter, and DNA methyltransferase 3a. Further, developmental Mn exposure causes broader lasting methylation and gene expression dysregulation associated with epigenetic regulation, inflammation, cell development, and hypofunctioning catecholaminergic neuronal systems. Pathway enrichment analyses uncovered mTOR and Wnt signaling pathway genes as significant transcriptomic regulators of the Mn altered transcriptome, and Western blot of total, C1 and C2 phospho-mTOR confirmed mTOR pathway dysregulation. Our findings deepen our understanding of the mechanistic basis of how developmental Mn exposure leads to lasting catecholaminergic dysfunction and attention deficits, which may aid future therapeutic interventions of environmental exposure associated disorders.

Significance Statement

Attention deficit hyperactivity disorder (ADHD) is associated with environmental risk factors, including exposure to neurotoxic agents. Here we used a rodent model of developmental manganese (Mn) exposure producing lasting attention deficits to show broad epigenetic and gene expression changes in the prefrontal cortex, and to identify disrupted mTOR and Wnt signaling pathways as a novel mechanism for how developmental Mn exposure may induce lasting attention and catecholaminergic system impairments. Importantly, our findings establish early development as a critical period of susceptibility to lasting deficits in attentional function caused by elevated environmental toxicant exposure. Given that environmental health threats disproportionately impact communities of color and low socioeconomic status, our findings can aid future studies to assess therapeutic interventions for vulnerable populations.

[Development and validation of prognostic nomogram for malignant pleural mesothelioma]

Objective: To development the prognostic nomogram for malignant pleural mesothelioma (MPM). Methods: Two hundred and ten patients pathologically confirmed as MPM were enrolled in this retrospective study from 2007 to 2020 in the People's Hospital of Chuxiong Yi Autonomous Prefecture, the First and Third Affiliated Hospital of Kunming Medical University, and divided into training (n=112) and test (n=98) sets according to the admission time. The observation factors included demography, symptoms, history, clinical score and stage, blood cell and biochemistry, tumor markers, pathology and treatment. The Cox proportional risk model was used to analyze the prognostic factors of 112 patients in the training set. According to the results of multivariate Cox regression analysis, the prognostic prediction nomogram was established. C-Index and calibration curve were used to evaluate the model's discrimination and consistency in raining and test sets, respectively. Patients were stratified according to the median risk score of nomogram in the training set. Log rank test was performed to compare the survival differences between the high and low risk groups in the two sets. Results: The median overall survival (OS) of 210 MPM patients was 384 days (IQR=472 days), and the 6-month, 1-year, 2-year, and 3-year survival rates were 75.7%, 52.6%, 19.7%, and 13.0%, respectively. Cox multivariate regression analysis showed that residence (HR=2.127, 95% CI: 1.154-3.920), serum albumin (HR=1.583, 95% CI: 1.017-2.464), clinical stage (stage Ⅳ: HR=3.073, 95% CI: 1.366-6.910) and the chemotherapy (HR=0.476, 95% CI: 0.292-0.777) were independent prognostic factors for MPM patients. The C-index of the nomogram established based on the results of Cox multivariate regression analysis in the training and test sets were 0.662 and 0.613, respectively. Calibration curves for both the training and test sets showed moderate consistency between the predicted and actual survival probabilities of MPM patients at 6 months, 1 year, and 2 years. The low-risk group had better outcomes than the high-risk group in both training (P=0.001) and test (P=0.003) sets. Conclusion: The survival prediction nomogram established based on routine clinical indicators of MPM patients provides a reliable tool for prognostic prediction and risk stratification.

Functional analysis of acyl-CoA dehydrogenases and their application to C22 steroid production

Acyl-CoA dehydrogenase (ChsE) is involved in the steroid side-chain degradation process. However, their function in vivo remains unclear. In this study, three ChsE, ChsE1-ChsE2, ChsE3, and ChsE4-ChsE5, were identified in Mycolicibacterium neoaurum, and their functions in vivo are studied and compared with those from Mycobacterium tuberculosis in vitro. By gene knockout, complementation, and the bioconversion of phytosterols, the function of ChsE was elucidated that ChsE4-ChsE5 could utilize C27, C24, and C22 steroids in vivo. ChsE3 could utilize C27 and C24 steroids in vivo. ChsE1-ChsE2 could utilize C27, C24, and C22 steroids in vivo. What is more, the production strain of a C22 steroid, 3-oxo-4,17-pregadiene-20-carboxylic acid methyl ester (PDCE), is constructed with ChsE overexpression. This study improved the understanding of the steroid bioconversion pathway and proposed a method of the production of a new C22 steroid. KEY POINTS: • Three ChsE paralogs from M. neoaurum are identified and studied. • The function of ChsE is overlapped in vivo. • A C22 steroid (PDCE) producer was constructed with ChsE overexpression.

The serum anion gap is associated with the prognosis of coronary artery bypass grafting (CABG): analysis based on the MIMIC-IV database

OBJECTIVE

The serum anion gap (AG) has been reported to be an important prognostic indicator for patients in intensive care units. To explore the potential relationship between the serum AG and 30-day mortality in patients who underwent CABG.

PATIENTS AND METHODS

All data were collected from the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database. We divided patients into 3 groups according to AG tertiles. The primary outcome of our study was the 30-day mortality of patients who underwent CABG. The relationship between the serum AG and mortality in individuals who underwent CABG was estimated using Cox proportional hazard models. Subgroup analysis for effect modification was conducted with a likelihood ratio test.

RESULTS

A total of 5,102 eligible subjects were included in our analysis. After adjusting for confounding factors, every unit increase in the AG was associated with a 22% higher odds of 30-day mortality in patients who underwent CABG [hazard ratio (HR), 95% confidence interval (CI): 1.22, 1.13-1.33] When the AG was converted into a categorical variable, the high AG group had a higher risk of 30-day mortality than the low AG group in the fully adjusted model (HR, 95% CI: 3.99, 1.35-11.76). Tests for trends were statistically significant (p-value < 0.05). Subgroup analysis demonstrated that higher mortality was related to the subgroups of people ≥ 70 years and females.

CONCLUSIONS

The serum AG was an independent predictor of short-term prognosis in patients who underwent CABG. A high AG was associated with an increased risk of 30-day mortality after CABG.

[Value of clear cell likelihood score in differentiation between renal oncocytoma and clear cell renal cell carcinoma]

Objective: To evaluate the value of clear cell likelihood score (ccLS) in identifying renal oncocytoma (RO) and clear cell renal cell carcinoma (ccRCC). Methods: Retrospective data of pathologically confirmed 43 RO patients [24 men and 19 women, aged 22-77 (54±14) years] between February 2008 and September 2021 and 43 ccRCC patients [30 men and 13 women, aged 29-78 (56±12) years] between May and July 2021 were consecutively included in the department of radiology, Chinese PLA General Hospital. Two radiologists used ccLS to assess each case independently, and disagreements were resolved by consensus. The ability of ccLS to identify RO and ccRCC was examined by the receiver operating characteristic (ROC) curve which identified the best optimal diagnostic cut-off values, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results: The mean tumor diameter was 3.8 cm in RO patients and 3.7 cm in ccRCC patients. Central scar and segmental enhancement inversion (SEI) were more frequently observed in the RO group compared to the ccRCC group [53.5% (23∶43) versus 11.6% (5∶43) and 41.9% (18∶43) versus 7.0% (3∶43), respectively], with statistical differences (P<0.001). The ccLS scores in the RO group ranged from 1 to 4, while 79.0% of the cases were 3. The ccLS scores in the ccRCC group ranged from 2 to 5, while 72% of the cases were 4. The scores of the two groups were statistically different (P<0.001). The ccLS showed the best performance when the threshold was 4 according to the ROC curve. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ccLS for distinguishing RO from ccRCC were 83.7%, 90.7%, 87.2%, 90.0%, and 84.8%, respectively, and the area under the ROC curve value was 0.879. Conclusion: The ccLS has credible sensitivity and specificity in differentiating renal oncocytoma from clear cell carcinoma, which may be helpful for the preoperative diagnosis.

Auricular acupressure for treating early stage of knee osteoarthritis: a randomized, sham-controlled prospective study

OBJECTIVE

We examined whether auricular acupressure (AA) at four specifically preselected AA points can alleviate knee pain and decrease non-steroidal anti-inflammatory drugs (NSAIDs) consumption and its adverse effects for osteoarthritis patients.

METHODS

Sixty-two patients (more than 40 years) with knee osteoarthritis of Kellgren-Lawrence grades of I or II upon radiographic classification were enrolled in this randomized, sham-controlled prospective study, and divided into two groups (AA group and control group). The AA group received true AA by embedding vaccaria seeds at four specific AA points (knee joint, shenmen, subcortex and sympathesis) ipsilateral to the knee osteoarthritis site, while the control group received four nonacupuncture points on the auricular helix. Visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, the number of patients who needed celecoxib pills and adverse effects were recorded.

RESULTS

VAS and WOMAC scores in the AA group were significantly lower than that in the control group (P < 0.05) at Days 3 and 7 postsugery. The VAS and WOMAC score were significantly decreased after the treatment in the AA group compared with that before the treatment (P < 0.05). The use of celebrex is significantly lower in the AA group than in the control group (P < 0.05), no major side effects were observed during the auricular acupressure treatment.

CONCLUSION

Auricular acupressure plays a role in analgesic effect and can effectively decrease NSAIDs requirements without causing adverse events for the treatment of human knee osteoarthritis.

Short period-administration of myo-inositol and metformin on hormonal and glycolipid profiles in patients with polycystic ovary syndrome: a systematic review and updated meta-analysis of randomized controlled trials

OBJECTIVE

This meta-analysis aims to perform an updated meta-analysis to evaluate myo-inositol (myo-ins) and the classical insulin sensitizer metformin in terms of efficacy and safety for treating women with polycystic ovary syndrome (PCOS).

MATERIALS AND METHODS

A comprehensive literature search was performed using PubMed, Web of Science, EMBASE, Cochrane Library, PhRMA Clinical Study Results, Wan Fang, and CNKI databases; the database was searched from inception to June 2021. The random effects model was chosen to synthesize the effect sizes of individual trails. The registration number is CRD42021239786.

RESULTS

Nine randomized controlled trials (RCTs) and 612 patients were included in the analysis. Compared with metformin, myo-ins might be more effective in lowering triglycerides (TG) levels (SMD -0.49, 95% CI -0.74 to -0.24, p=0.0001, I2 = 0%) and avoiding side effects (RR=0.14, 95% CI 0.08-0.24, p<0.00001, I2 = 2%), while no significant differences were observed in other relevant indexes, such as total testosterone (TT) and sex-hormone binding globulin (SHBG).

CONCLUSIONS

Compared with metformin, the suitable supplemental dosage of myo-ins may be helpful in lowering levels of TG and avoiding adverse events (AEs).

Robust but weak winter atmospheric circulation response to future Arctic sea ice loss

The possibility that Arctic sea ice loss weakens mid-latitude westerlies, promoting more severe cold winters, has sparked more than a decade of scientific debate, with apparent support from observations but inconclusive modelling evidence. Here we show that sixteen models contributing to the Polar Amplification Model Intercomparison Project simulate a weakening of mid-latitude westerlies in response to projected Arctic sea ice loss. We develop an emergent constraint based on eddy feedback, which is 1.2 to 3 times too weak in the models, suggesting that the real-world weakening lies towards the higher end of the model simulations. Still, the modelled response to Arctic sea ice loss is weak: the North Atlantic Oscillation response is similar in magnitude and offsets the projected response to increased greenhouse gases, but would only account for around 10% of variations in individual years. We further find that relationships between Arctic sea ice and atmospheric circulation have weakened recently in observations and are no longer inconsistent with those in models.

Morphological classification and clinical significance of medial malleolus based on computed tomography three-dimensional reconstruction

BACKGROUND

Internal malleolus fractures and postoperative functional limitations are serious complications of deltoid ligament repair, reconstruction, while studies on conducting beak. Anatomical structure classification of medial malleolus at home and abroad is reported rarely. Hence, this morphological study is mainly designed to investigate the anatomical morphological classification and clinical significance of medial malleolus based on computed tomography (CT) three-dimensional reconstruction.

MATERIALS AND METHODS

From October 2018 to January 2021, 373 patients who underwent CT examination of malleolus medialis joint in the Jiang'an Hospital of Traditional Chinese Medicine were observed. The medial malleolus was observed and classified; then, geometric parameters were measured according to different medial malleolus types.

RESULTS

According to the results of 373 cases, medial malleolus can be divided into four types: omega type (66%), radical sign type (16%), inverted triangle type (14%), and wave type (4%).

CONCLUSIONS

There are four main shapes: omega, inverted triangle, radical sign, and wave in the medial malleolus of all normal ankles. The measurement of medial malleolus parameters according to medial malleolus in different shapes was of importance to guide smooth operation of medial malleolus fixation and deltoid ligament reconstruction and epidemiological.

Zoledronic acid and fracture risk: a meta-analysis of 12 randomized controlled trials

OBJECTIVE

Zoledronic acid is widely used in patients with osteoporosis, and this meta-analysis aims to explore the influence of zoledronic acid on fracture risk and mortality in patients with osteoporosis or osteopenia.

MATERIALS AND METHODS

We searched PubMed, Google Scholar, and Cochrane Library for randomized clinical trials comparing zoledronic acid with control intervention (i.e., placebo or nothing) for osteoporosis or osteopenia. The fracture and mortality were estimated using the random-effect model.

RESULTS

12 randomized trials were included in this meta-analysis. Compared to control intervention, zoledronic acid was associated with significantly reduced incidence of fracture at the follow-up of 12 months, 24 months, 36 months and 72 months. In addition, zoledronic acid could remarkably reduce mortality at 12 months and 24 months than control intervention but revealed no influence on mortality at 36 months or 72 months. In terms of adverse events, zoledronic acid might result in the increase in serious atrial fibrillation and death from stroke than control intervention.

CONCLUSIONS

Zoledronic acid is beneficial to reduce the incidence of fracture, while its benefits to reduce the mortality are only observed at the follow-up time of 24 months.

Actinoplanes aureus sp. nov., a novel protease-producing actinobacterium isolated from soil

A novel protease-producing actinobacterium, designated strain NEAU-A11^T, was isolated from soil collected from Aohan banner, Chifeng, Inner Mongolia Autonomous Region, China, and characterised using a polyphasic approach. The hydrolytic enzymes, such as proteases, played critical roles in destruction of fungi by degrading the protein linkages to disrupt integrity in the cell wall. This suggested that the isolate could be a good biocontrol candidate against pathogens to control fungal diseases. On the basis of 16S rRNA gene sequence analysis, strain NEAU-A11^T was indicated to belong to the genus Actinoplanes and was most closely related to Actinoplanes rectilineatus JCM 3194 ^T (98.9%). Cell walls contained meso-diaminopimelic acid as the diagnostic diamino acid and the whole-cell sugars were arabinose, xylose and glucose. The phospholipid profile contained diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol and two phosphatidylinositol mannosides. The predominant menaquinones were MK-9(H₄), MK-9(H₆) and MK-9(H₈). The major fatty acids were C_18:0, C_16:0, C_18:1 ω9c, C_17:0 and C_15:0. Genome sequencing revealed a genome size of 10,742,096 bp, a G + C content of 70.5% and 9,514 protein-coding genes (CDS), including 102 genes coding for protease. Moreover, Genome analysis showed that strain NEAU-A11^T contained 255 glycoside hydrolases (GHs), 152 glycosyl transferases (GTs), 40 carbohydrate esterases (CEs), 26 polysaccharide lyases (PLs), and 12 auxiliary activities (AAs) genes. Genome mining analysis using antiSMASH 5.0 led to the identification of 20 putative gene clusters responsible for the production of diverse secondary metabolites. Phylogenetic analysis using the 16S rRNA gene sequences showed that the strain formed a stable clade with A. rectilineatus JCM 3194 ^T in the genus Actinoplanes. Whole-genome phylogeny showed strain NEAU-A11^T formed a stable phyletic line with Actinoplanes lutulentus DSM 45883 ^T (97.6%). However, whole-genome average nucleotide identity value between strain NEAU-A11^T and its reference strains A. rectilineatus JCM 3194 ^T and A. lutulentus DSM 45883 ^T were found to be 81.1% and 81.6%, respectively. The levels of digital DNA-DNA hybridization between them were 24.6% (22.2-27.0%) and 24.8% (22.5-27.3%), respectively. The values were well below the criteria for species delineation of 70% for dDDH and 95-96% for ANI, suggesting that the isolate differed genetically from its closely related type strain. The content of G + C in genomic DNA was 70.5%, within the range of 67-76%. In addition, evidences from phenotypic, chemotaxonomic and genotypic studies indicated that strain NEAU-A11^T represents a novel species of the genus Actinoplanes, for which the name Actinoplanes aureus sp. nov. is proposed, with NEAU-A11^T (= CCTCC AA 2019063 ^T = JCM 33971 ^T) as the type strain.

[Imaging phenotypes of chronic obstructive pulmonary disease based on biphasic quantitative CT features]

Quantitative analysis was performed on the biphasic CT of 40 patients [43-80 (66.1±9.0) years old, including 37 males] with stable chronic obstructive pulmonary disease (COPD) to measure the percentage of emphysema (Emph%); the percentage of small airway disease (SAD%) and the square root of the wall area of hypothetical airway with internal perimeter of 10 mm (Pi10). Based on the cluster analysis of Emph%, SAD% and Pi10, the patients were divided into five imaging phenotypes including no obvious imaging abnormality type (n=11), small airway disease-dominant type (n=9), bronchial wall thickening-dominant type (n=8), emphysema-dominant type (n=6) and mixed type (n=6). Patients with the same Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade had similar degree of airflow limitation, but the lesion components were not identical. Being different from the traditional imaging classification, even in the cases of mild emphysema, they can be further divided into small airway disease-dominant type and bronchial wall thickening-dominant type according to the difference of airway disease.

Successful removal of a trapped epidural catheter facilitated by using a nickel/titanium alloy (nitinol) suture as a guidewire

Epidural catheters are often used in the provision of surgical anaesthesia and analgesia. These catheters need to be removed after a certain period, but difficulties may be encountered during this process. We present a case of difficult epidural catheter removal in an elderly woman who had undergone surgery for reduction and internal fixation of a comminuted intertrochanteric fracture at the left femur under combined spinal epidural anaesthesia. Anaesthesia was satisfactory during the operation; however, initial attempts to remove the catheter at the end of the procedure was met with significant resistance. Normal saline (5 ml) was injected through the catheter without difficulty, suggesting that the catheter was likely trapped and compressed but not obstructed. A nickel/titanium memory alloy suture was used as a guidewire to remove the catheter without damaging it. This case was analysed subsequently, and the management of future problematic removals is discussed herein. This article aims to raise awareness of, and to explore techniques for managing difficult epidural catheter removal.

The phytotoxin COR induces transcriptional reprogramming of photosynthetic, hormonal and defence networks in tomato

Coronatine (COR) is a non-host specific phytotoxin secreted by Pseudomonas syringae pv. tomato that can induce leaf chlorosis and increase the virulence of pathogens during plant-pathogen interactions. Studies have shown that COR can regulate multiple physiological processes in plants, but its involvement in bacterial pathogenesis and plant growth regulation is not well understood. In this study, transcriptome sequencing was carried out on 4-week-old tomato leaves that were either mock-treated or treated with COR. Transcriptome sequencing led to the identification of 6144 differentially expressed genes (DEGs), of which 4361 genes were downregulated and 1783 genes were upregulated upon COR treatment. To obtain functional information on the DEGs, we annotated these genes using GO and KEGG databases. Functional classification analysis showed that the DEGs were primarily involved in photosynthesis, chlorophyll and carotenoid biosynthesis, jasmonic acid (JA) synthesis and phenylpropane metabolism. A total of 23 genes related to chlorophyll biosynthesis had significant changes, of which 22 genes were downregulated and one gene was upregulated, indicating that chlorophyll biosynthesis was inhibited upon COR treatment. A total of 17 photosystem I related genes and 22 photosystem II related genes involving 20 protein subunits were also downregulated. In the JA synthesis pathway, 25 genes were up regulated, and six genes were downregulated in COR treated samples. COR was also involved in the regulation of multiple secondary metabolites. The identified DEGs will help us better understand the virulence effects and physiological functions of COR and provide a theoretical basis for breeding resistance into economically important crops.

[Predictive value of combination of MRI tumor regression grade and apparent diffusion coefficient for pathological complete remission after neoadjuvant treatment of locally advanced rectal cancer]

Objective: Pelvic high-resolution magnetic resonance imaging (MRI) has now become a standard method for evaluating the efficacy of neoadjuvant treatment for locally advanced rectal cancer (LARC). However, this traditional morphological qualitative assessment method based on T2-weighted imaging (T2WI) is not effective in predicting pathological complete remission (pCR). The purpose of this study is to investigate whether combining the magnetic resonance tumor regression grade (mrTRG) with apparent diffusion coefficient (ADC) can improve diagnostic value for pCR after preoperative neoadjuvant chemoradiotherapy (nCRT) of LARC. Methods: This was a diagnostic study. Clinicopathological data of 134 LARC patients who received nCRT and radical surgery in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed. All the patients underwent MRI which included T2WI and DWI sequences before and 8 weeks after nCRT. Two radiologists independently drew ROIs on T2WI and DWI to estimate mrTRG stage and calculate the mean ADC value. Receiver operating characteristics (ROC) method was applied to evaluate the predict value of mrTRG combined with mean ADC value for pCR. Results: Of 134 LARC patients, 85 were male and 49 were female with median age of 58 (28-82) years. After nCRT, MRI suggested 21 patients (15.7%) had clinical complete remission (cCR), e.g. mrTRG stage 1-2. Postoperative pathology revealed 31 (23.1%) patients had pCR. The evaluations of mrTRG and ADC value by the two readers were highly consistent, and the intra-group correlation coefficients were 0.83 (95% CI: 0.703-0.881) and 0.96 (95% CI: 0.989-0.996), respectively. There was a negative correlation between mrTRG and pCR (r(s)=-0.505, P<0.01), and a positive correlation between mean ADC value and pCR (r(s)=0.693, P<0.01). The ROC curve showed that mrTRG alone had a medium predictive value for pCR, with an area under the curve (AUC) of 0.832 (95% CI: 0.743-0.921); the mean ADC value had a higher predictive value for pCR, with AUC of 0.906 (95% CI: 0.869-0.962). The predictive value of the combined model of mrTRG and ADC value for pCR was significantly better than that of mrTRG alone (P=0.015), and the AUC was 0.908 (95% CI: 0.849-0.968). Conclusion: Both mrTRG and mean ADC value can be non-invasive methods to predict the efficacy of nCRT for LARC. Combining the mean ADC value with mrTRG can result in better pCR prediction.

Benchmark Experiment to Prove the Role of Projectile Excited States Upon the Ion Stopping in Plasmas

We report on a precision energy loss measurement and theoretical investigation of 100  keV/u helium ions in a hydrogen-discharge plasma. Collision processes of helium ions with protons, free electrons, and hydrogen atoms are ideally suited for benchmarking plasma stopping-power models. Energy loss results of our experiments are significantly higher than the predictions of traditional effective charge models. We obtained good agreement with our data by solving rate equations, where in addition to the ground state, also excited electronic configurations were considered for the projectile ions. Hence, we demonstrate that excited projectile states, resulting from collisions, leading to capture-, ionization-, and radiative-decay processes, play an important role in the stopping process in plasma.

Activation of central galanin receptor 2 mitigated insulin resistance in adipocytes of diabetic rats

PURPOSE

Our and other's studies showed that administration of neuropeptide galanin may mitigate insulin resistance via promoting glucose transporter 4 (GLUT4) expression and translocation in rats. The objective of this study is to investigate whether galanin receptor 2 (GAL2-R) in brain mediates the ameliorative effect of galanin on insulin resistance in adipose tissues of type 2 diabetic rats.

METHODS

In this study galanin, GAL2-R agonist M1145 and GAL2-R antagonist M871 were respectively or cooperatively injected into intracerebroventricles of type 2 diabetic rats once a day for successive fifteen days. Then the plasma and fat tissues of rats were used to estimate the alterations of insulin resistance indexes.

RESULTS

The central administration of galanin enhanced 2-deoxy-[³H]-D-glucose, peroxisome proliferator-activated receptor γ and adiponectin levels, food intake and body weight, GLUT4 mRNA expression and GLUT4 concentration in plasma membranes, as well as homeostasis model assessment-insulin resistance index. Those effects of galanin may be blocked by M817, and imitated by M1145 except for food intake and body weight.

CONCLUSION

Those results suggest that central GAL2-R mediates the beneficial effects of galanin on insulin sensitivity in type 2 diabetic rats. GAL2-R agonist may be taken as a potential antidiabetic agent to treat insulin resistance and type 2 diabetes.

[A prospective multi-center clinical investigation of HIV-negative pulmonary cryptococcosis in China]

Objective: To investigate the current status of the diagnosis and treatment of pulmonary cryptococcosis in respiratory medicine and improve the understanding of the clinical characteristics of HIV-negative pulmonary cryptococcosis in China. Methods: A prospective multi-center open cohort study was designed to screen for pulmonary cryptococcosis in the general wards and intensive care units of the Department of Respiratory Diseases in 22 hospitals. The HIV-negative patients with positive cryptococcal etiological diagnosis based on smear culture, antigen detection and histopathology were enrolled in the study. The clinical data of enrolled patients were collected and analyzed. Results: A total of 457 cases of pulmonary cryptococcosis were enrolled, among which 3.28% (15/457) were disseminated infections. The case fatality rate was 0.88% (4/457). The majority of the cases were diagnosed by histopathological examinations (74.40%, 340/457) and cryptococcus antigen detection (37.64%, 172/457). Patients with pulmonary cryptococcosis accounted for 2.04‰ (457/223 748) of the total hospitalized patients in the Department of Respiratory Diseases during the same period, and the ratio was the highest in south and east China. Meanwhile, 70.24% (321/457) of the patients had no underlying diseases, while 87.75% (401/457) were found to have immunocompetent status. Cough and expectoration were the most common clinical symptoms in patients with pulmonary cryptococcosis. However, 25.16% (115/457) of the patients had no clinical symptom or physical signs. In terms of imaging features on pulmonary CT, multiple pulmonary lesions were more common than isolated lesions, and there were more subpleural lesions than perihilar or medial lesions. Morphologically, most of the lesions were middle-sized nodules (1-5 cm) or small-sized nodules (3 mm to 1 cm). The sensitivity of serum cryptococcus antigen test was 71.99% (203/282). Moreover, antigen-positive patients differed from antigen-negative patients in terms of basic immune status, clinical symptoms, imaging features and infection types. Meanwhile, immunocompromised patients differed from immunocompetent patients in terms of clinical symptoms, physical signs, infection-related inflammation indicator levels, imaging features, serum cryptococcus antigen positive rate and prognosis. Conclusions: The majority of cases of HIV-negative pulmonary cryptococcosis in China had no underlying disease or immunocompromised status, and the overrall prognosis was favorable. However, early diagnosis of HIV-negative pulmonary cryptococcosis remains challenging due to the complicated manifestations of the disease.

[Clinicopathological features and differential diagnosis of eosionphilic chromophobe renal cell carcinoma]

Objective: To investigate the clinicopathological characteristics of eosionphilic Chromophobe renal cell carcinoma (eChRCC), and differences in morphology, immunophenotype and clinical prognosis betweeneChRCC, renal oncocytoma(RO) and classic Chromophobe renal cell carcinoma (cChRCC). Methods: The clinicopathologic data of 17 patients diagnosed as eChRCC from the Affiliated Hospital of Qingdao University (13 cases) and 971 Hospital of PLA Navy (4 cases) from October 2006 to February 2019 were collected. Immunohistochemical analysis was carried out to compare the immunophenotypes between 17 cases with ChRCC, 27 cases with RO and 30 cases with cChRCC. Resuls: Among the 17 patients, seven were males and ten were females, and the age ranged from 40 to 75 years (median 54 years). Clinically, 15 cases of 17 were found accidentally by physical examination. The tumor size ranged from 1.8 cm to 10.0 cm (average 5.7 cm) and the cut surface of 15 cases were solid, one case was solicl and cystic, and one was cystic. Most showed gray to red, and partially soft, gray to yellow appearances. Microscopically, most tumors presented solid growth pattern with vary number of alveolar structures (12 cases). Some were predominately characterized by cystic structure (3 cases), alveolar structure(1 case) and microcapsule structure (1 case). There were boundaries with varying degrees of clarity between tumor cells in 16 cases. The cytoplasm of tumor cells was eosinophilic and the nuclei were small round or irregular with focal perinuclear haloes in 14 cases. Large polygonal cells with light-stained cytoplasm appeared focally in 9 cases, and edematous areas with scarce tumor cells were found in 4 cases. Among 7 cases, 4 cases focally invaded peripheral renal parenchyma, 2 cases invaded adipose tissues outside the renal capsule, and 1 case presented invasion of renal sinus. Immunohistochemically, all cases were moderate to strong positive for EMA and claudin-7. CK7, CD117 and Ksp-cad were highly expressed with the expression rates of 12/17, 15/17, 14/17, respectively. Cyclin D1, AMACR, CD10, S100A1, and RCC were rarely expressed with the expression rates of 4/17, 3/17, 4/17, 1/17 and 1/17, respectively. On the contrary, all cases were negative for vimentin, CAⅨ, HMB45 and Melan A. The Ki-67 proliferation index of the 17 cases was 1%‒5%. Follow-up data were available for all 17 patients from 7 to 154 months. Among them, 15 patients were alive without tumor recurrence or metastasis, one patient died of pulmonary metastasis after 31 months of surgery and one patient died of hepatic metastasis after 38 months of surgery. Conclusion: eChRCC has overlapping morphology and immunophenotype with RO. eChRCC is characterized by solid nest or alveolar structure, distinct border between tumor cells, perinuclear halos and lacking of interstitial looseness and edema. Scattered large polygonal cells with light-stained cytoplasm in tumor tissue play a significant role in the diagnosis of eChRCC. The positive expression of CK7, CD117, claudin-7 and Ksp-cad, and negative expression of cyclin D1, S100A1 are helpful to the diagnosis and differential diagnosis of eChRCC. The prognosis of eChRCC after complete surgical resection is excellent and few cases may have long-term metastasis. There is no significant difference in prognosis between eChRCC and cChRCC, but eChRCC shows better outcome than RO.

The value of coronary artery calcium scores based on non-gated chest CT in predicting perioperative cardiovascular risk in patients with lower-risk lung cancer surgery

Objectives

This study evaluated whether coronary artery calcium scores (CACS) that were measured with non-gated chest CT predicted perioperative cardiovascular events in patients who were undergoing lower-risk lung cancer surgery.

Method

In this retrospective single center study, we evaluated 3112 consecutive lung cancer patients with non-gated chest CT before low-medium risk surgeries in 2017. We measured CACS and assessed clinical risk factors according to the revised cardiac risk index (RCRI) scores and predictable surgery factors. Perioperative cardiovascular events were defined as cardiac death, acute coronary syndrome, pulmonary edema, atrial and ventricular arrhythmia with hemodynamic compromise, and complete heart block during hospitalization.

Result

83 patients (2.7%) had perioperative cardiac events, 71 (85.5%) of them were atrial fibrillation. Coronary calcification CT findings were seen in 761 (24.5%) patients. CACS were associated with incidence of cardiac events (p&lt;0.001). In the receiver-operating characteristic (ROC) curve analysis of CACS for prediction of cardiac events, the cutoff value was 1 (sensitivity, 0.60; specificity, 0.75; area under the curve, 0.680). In the multivariate analysis, CACS &gt;1 (OR=1.75, 95% CI: 1.08–2.84, p=0.023), age (OR=1.06, 95% CI: 1.03–1.10, p&lt;0.001), pulmonary function classification (p&lt;0.001) and thoracotomy (OR=3.06, 95% CI: 1.78–5.26, p&lt;0.001) were predictive of cardiovascular complications.

Conclusion

Predicative value of CACS based on non-gated chest CT is high for perioperative cardiovascular risk in lung cancer patients with lower-risk lung surgery. It may be considered as a valuable tool for preoperative risk assessment in these patients without additional testing.

Funding Acknowledgement

Type of funding source: None

PEAR1 rs12041331 polymorphisms and the risk of adverse cardiovascular outcomes in patients with acute coronary syndrome and/or percutaneous coronary intervention: a systematic review and meta-analysis

Background

Platelet endothelial aggregation receptor-1 (PEAR1), expressed in endothelium, platelets, and other tissues, is a platelet transmembrane tyrosine kinase receptor involved in platelet aggregation and platelet-platelet contact. The minor allele (A) in intron 1 of the PEAR1 gene (rs12041331, G&gt;A) is associated with an reduced PEAR1 protein expression and suppressed platelet aggregation response toward multiple agonists. But current evidences on the association between PEAR1 rs12041331 polymorphisms and cardiovascular outcomes in patients with acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) are discordant.

Purpose

To characterize and quantify the association between PEAR1 rs12041331 polymorphisms and cardiovascular outcomes in patients with ACS and/or PCI.

Methods

We conducted a systematic review and meta-analysis by searching MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SinoMed, CNKI, and Wanfang Data before Dec 7, 2019 to identify studies evaluating the association between PEAR1 rs12041331 polymorphisms and cardiovascular outcomes in patients with ACS and/or PCI. The primary outcome was the major adverse cardiovascular outcomes (MACEs) defined by each study. We adopted the Mantel-Haenszel method to calculate the relative risks (RRs) with 95% confidence intervals (CIs) and the corresponding P values using the random effect model. To assess the effect of ethnicity, we performed the subgroup analyses per ethnic population using the fix effect model.

Results

Among 542 citations identified along with 1 from additional sources, we included 4 studies, which documented 218 MACEs in 8180 patients. The A allele frequency in each study was comparable with that reported in the 1000 Genome Project, but varied among ethnic populations, that is 45.8% in East Asians, 46.5% in American Africans, and 9.2% in Caucasians, adopted from the 1000 Genome Project. A-allele carriers are associated with a 54% increase in MACEs than non-A-carriers (RR, 1.54; 95% CI, 1.10–2.16; P=0.01) with a low but non-significant heterogeneity. Subgroup analyses showed that A-allele carriers tend to have more MACEs than non-A-allele carriers despite of ethnicity, that is 1.32-fold increase in East Asians (RR, 1.32; 95% CI, 0.99–1.77; P=0.06), 2.43-fold in Caucasians (RR, 2.43; 95% CI, 0.99–5.98; P=0.05), and 3.56-fold (RR, 3.56; 95% CI, 1.08–11.70; P=0.04) in American Africans.

Conclusions

Our study indicates that the PEAR1 rs12041331 is prognostic in patients with ACS and/or PCI and treated with DAPT, which might be not caused by the associations with pharmacological response to antiplatelet agents. Further investigations are thus required to address the unrevealing mechanisms of PEAR1, especially on the development of atherosclerosis and the occurrence of acute adverse ischemic events.

Figure 1

Funding Acknowledgement

Type of funding source: None

Left atrial appendage closure with zero fluoroscopic exposure via intracardiac echocardiographic guidance

Background

Percutaneous left atrial appendage closure (LAAC) is currently guided by fluoroscopy and transesophageal echocardiography (TEE).

Objective

We report an LAAC technique using intracardiac echocardiography (ICE) and electroanatomic mapping system (EAMS) under local anesthesia without fluoroscopy exposure.

Methods

Seven non-valvular atrial fibrillation (NVAF) patients with high risk of stroke and bleeding (male 5/7, aged 71.7±8.8 years, mean CHA2DS2-VASc score 5.1±2.1; mean HAS-BLED score 3.0±1.2) were enrolled. ICE probe was advanced into left atrium (LA) navigated by the EAMS. LAA sizing and LAmbreTM device implantation were guided by ICE following the orthogonal tri-axial algorithm (Axis-X: from left pulmonary veins [LPVs] to LAA; Axis-Y: from right PV ostium to LAA; Axis-Z: from lower LA to LAA).

Results

There were two cauliflower-like, two chicken-wing-like and three cactus-like LAAs. The mean diameters of ostia and landing zone were 21.4±3.9mm and 20.4±4.2mm, respectively. LAmbre devices with a mean umbrella diameter of 23.7±4.2mm and cover disc diameter of 29.4±3.6mm were successfully implanted and acute complete LAA sealing without peri-device leak (PDL) were achieved in all cases. The mean procedural duration was 73.0±21.4min. No fluoroscopy exposure nor contrast consumption were recorded. No procedure-related complications were documented. The PDL at 45-day follow-up was 1.7±0.8mm. No stroke or thromboembolic events were documented.

Conclusions

The fluoroscopic exposure could be minimized, even to zero, in the ICE-guided LAAC procedures feasibly and safely using LAmbre devices. The orthogonal tri-axial assessment is considered efficacious and safe for the procedures.

Orthogonal tri-axial algorithm

Funding Acknowledgement

Type of funding source: None

Retrospective Analysis of 2019-nCov-Infected Cases in Dongyang, Southeastern China

The 2019 novel coronavirus (2019-nCov) has caused increasing number of infected cases globally. This study was performed to analyze information regarding the transmission route and presence of viral nucleic acids on several clinical samples. Confirmed 2019-nCov-infected cases were identified in Dongyang and were treated according to guidelines for the diagnosis of 2019-nCov infection released by the National Health Commission. Information regarding the contacts that the infected people had was collected to determine whether it caused clustered cases. A series of successive nucleic acid examination of feces, oropharyngeal swabs, and sputum was also performed, and the results were analyzed. A total of 19 confirmed cases of 2019-nCov infection were identified in Dongyang, Zhejiang Province, China. Five cases showed severe symptoms, and the remaining ones showed mild manifestations. Ten cases infected from two asymptomatic individuals were clustered into two groups. Among 14 cases with consecutive nucleic acid test results, four patients showed positive results in feces after their negative conversion in oropharyngeal swabs. Asymptomatic individuals with the virus could cause 2019-nCov clustered cases, and the clustered cases may differ from sporadic cases on age and length of hospitalization. In addition, nucleic acids in feces last longer than those in oropharyngeal swabs.

MiR-1294 acts as a tumor inhibitor in cervical cancer by regulating FLOT1 expression

Recently, important regulatory mechanisms of microRNAs (miRNAs) have been widely reported in human cancers including cervical cancer. The purpose of this study is to preliminarily clarify the function of miR-1294 in cervical cancer. The expression of miR-1294 or FLOT1 was detected using RT-qPCR or Western blot analysis. MTT, Transwell and luciferase reporter assays were used to explore the functional mechanism of miR-1294. The results showed that miR-1294 expression was decreased in cervical cancer. Functionally, overexpression of miR-1294 restrained the viability and metastasis of cervical cancer cells. MiR-1294 can also block EMT and suppress β-catenin expression in cervical cancer cells. Additionally, FLOT1 was confirmed to be a direct target of miR-1294. The knockdown of FLOT1 impeded the progression of cervical cancer. More importantly, miR-1294 inhibited the occurrence of cervical cancer by interacting with FLOT1. In conclusion, miR-1294 inhibits cell viability, migration and invasion by suppressing FLOT1 expression.

MiR-543 functions as tumor suppressor in ovarian cancer by targeting TWIST1

MicroRNAs (miRNAs) have been demonstrated to have promoting or inhibiting effects on the tumorigenesis of multiple cancers, including ovarian cancer (OC), by regulating its downstream target genes. In the presented experiment, our aim was to explore the role of miR-543 in OC cell proliferation and invasion. Results of quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blot revealed that miR-543 have lower expression levels, while Twist homolog 1 (TWIST1) was expressed with higher levels in OC tissues and cells. Furthermore, the effects of abnormal miR-543 expression in OC cell proliferation and invasion were detected by CCK-8 and Transwell assay. According to luciferase reporter assay results, TWIST1 was identified as a downstream target of miR-543 in OC, and a negative correlation was observed between TWIST1 and miR-543 expression by Spearman's correlation analysis in OC tissues. In addition, TWIST1 may reverse the miR-543 suppression effect on OC cell proliferation and invasion. To sum up, miR-543 may promote OC cell proliferation and invasion by targeting TWIST1.

[Survey on situation and cognition of influenza vaccination among population in six provinces of China]

Objective: To understand the cognition on and status quo of influenza vaccination among all age groups in the survey areas from 6 provinces so as to explore the main factors related to influenza vaccination. Methods: A cross-sectional survey method was conducted to study the knowledge on influenza prevention and control, as well as on the status of influenza vaccination in Beijing, Inner Mongolia, Shanghai, Guangdong, Yunnan, and Gansu provinces through 12320 health hotline telephone with method of random number table in Mar-May 2018. The survey sample size was 9 438 respondents. Results: The survey response rate was 46.4%(10 045/21 658). A total of 10 045 respondents were surveyed. The awareness on flu-related knowledge "influenza is different from the common cold" was 75.3% (7 564/10 045), rate on "influenza virus will cause serious consequences" was 82.0% (8 241/10 045). The rate of health behavior such as frequent hand, washing hand, wearing masks and isolating themselves were 80.41% (7 936/9 873), 75.8% (7 506/9 899) and 73.6%(7 228/9 822) respectively when the influenza-like symptoms already started. The influenza vaccination rate in the past year was only 5.7% (570/10 037). Multivariate logistic analysis of influenza vaccination rate in the past year showed that respondents who were from Gansu province or Beijing, respondents occupations were as medical staff or full-time students, respondents who were living with more than 2 people at the same house, respondents who had had influenza symptoms without wearing masks, the influenza vaccination rates were higher in the past year. Conclusions: Rates regarding the awareness of influenza-related knowledge, health behavior when the influenza-related symptoms already started and having received the influenza vaccine vaccination in the past year should be further improved in the six provinces. Health education on influenza-related knowledge and vaccine vaccination should be strengthened, strategies including free vaccination are bound to be explored.

[The efficacy and safety of tiotropium/olodaterol fixed-dose combination in Chinese patients with chronic obstructive pulmonary disease: a pooled subgroup analysis of TONADO 1+2]

Objective: To compare the efficacy and safety profiles of tiotropium/olodaterol with the mono-components in Chinese and total study population from TONADO trial. Methods: In the replicate, double-blind, parallel-group, active-controlled, randomized, 52-week, Phase Ⅲ TONADO studies (TONADO 1+2), patients received tiotropium/olodaterol, tiotropium, or olodaterol via the Respimat(®) Inhaler (Boehringer Ingelheim, Germany). Primary end points were forced expiratory volume in 1 second (FEV(1)) area under the curve from 0 to 3 hours (AUC(0-3h)) response and trough FEV(1) response, and St George's respiratory questionnaire (SGRQ) total score at 24 weeks. Adverse events were also collected. This subgroup analysis only focused on the efficacy and safety of the drug at the approved dose in China. Results: 548 Chinese patients were randomized, aged 41 to 82 years [mean age, (63±8) years] and most were male (526, 96%), 111 received tiotropium/olodaterol 5/5 μg, and 127 received tiotropium 5 μg and 95 received olodaterol 5 μg. The baseline characteristics of these groups were similar. After 24 weeks, treatment with tiotropium/olodaterol 5/5 μg, tiotropium 5 μg and olodaterol 5 μg resulted in an adjusted mean FEV(1) AUC(0-3h) response of 0.240, 0.157 and 0.079 L, and trough FEV(1) response of 0.117, 0.068 and-0.001 L, respectively. Tiotropium/olodaterol 5/5 μg significantly improved SGRQ scores in Chinese patients compared with olodaterol 5 μg (32.729 and 37.202, respectively). Generally, the safety profile of tiotropium/olodaterol was comparable with mono-components in 52 weeks. Conclusion: Compared with tiotropium or olodaterol, tiotropium/olodaterol in Chinese patients provided significant improvement in lung function and quality of life, and the safety profiles were similar.

[A multivariate model for predicting induction response and prognosis in core binding factor acute myeloid leukemia]

Objective: To evaluate the efficacy and prognostic factors in core binding factor (CBF) acute myeloid leukemia (AML) under current therapy modalities, therefore optimizing the treatment strategies. Methods: Standard cytological and immune methods including next generation sequencing (NGS) were used for risk stratification. Complete remission (CR) rate, disease-free survival (DFS) and overall survival (OS) were assessed by multivariate Logistic and Cox regression models in a total of 206 adults (aged 16-65 years) with CBF-AML, including 152 AML patients with t(8;21) and 54 with inv(16). Results: The CR rate of inv(16) patients after first course was 54/54(100%), significantly higher than that of t(8;21) patients [127/147(86.4%), P=0.005]. The fusion transcript level and KIT mutation were independent factors related to CR rate in t(8;21) patients (P=0.044 and 0.027; respectively). DFS and OS in inv(16) patients tended to be more superior than that in t(8;21) patients (P=0.066 for DFS; P=0.306 for OS; respectively). Multivariate Cox identified negative expression of CD(19) and female gender the independent predictors of inferior DFS in t(8;21) patients (P=0.000 for CD(19); P=0.006 for sex; respectively). Analysis of combining CD(19) with gender indicated that females/CD(1)(9-)subpopulation had significantly poor DFS than did males/CD(19)(+) ones (Bonferroni-P<0.000 01). The number of mutations in each patient, FLT3-ITD and additional karyotype abnormalities did not affect CR rate and DFS (all P>0.05). Conclusions: Patients with inv(16) have better induction response than those with t(8;21). High level of fusion transcripts and positive KIT mutation are associated with low CR rate in t(8;21) patients. Negative CD(19) expression and female gender are independent predictors of inferior DFS in t(8;21) patients.

Cooperation between galanin and insulin in facilitating glucose transporter 4 translocation in adipose cells of diabetic rats

The glucose transporter 4 (GLUT4) translocation is a vital link of insulin-induced glucose uptake in adipose tissue and skeletal muscle. It is an important topic in anti-diabetic research to explore novel agents to facilitate the role of insulin. The aim of this study was to verify the hypothesis that neuropeptide galanin may enhance insulin-induced GLUT4 translocation to increase glucose uptake in adipose tissue of type 2 diabetic models. Insulin and/or galanin were injected respectively or cooperatively into type 2 diabetic rats once a day for fifteen days. The results showed that administration of galanin significantly enhanced insulin-induced GLUT4 and vesicle-associated membrane protein 2 (VAMP2) translocation, Akt phosphorylation and glucose uptake, but not GLUT4 mRNA and protein expression levels in adipose cells. The beneficial roles of galanin on insulin-induced events may be blocked by MK-2206, an Akt inhibitor, indicating that the Akt phosphorylation is essential for promoting impact of galanin on the insulin-induced events. These results suggest that galanin may benefit insulin-induced GLUT4 and VAMP2 translocation, and subsequent glucose uptake via the activated Akt-VAMP2-GLUT4 pathway in adipose cells. These findings deepen our understanding of the anti-diabetic effect of galanin and its mechanism.