[Research advances in myopic children with dry eye]

Myopia is a global public health issue, particularly prevalent in China, with a rising trend in recent years. The increased use of computers, smartphones, and video display terminals has led to frequent dry eye symptoms, such as blinking, among myopic students. Studies have revealed a higher incidence of dry eye in myopic children compared to emmetropic children, significantly impacting their learning and quality of life. However, ophthalmologists have traditionally focused more on the prevention and control of myopia, often neglecting ocular surface health awareness in children. It is essential to understand the potential impact of myopia on dry eyes in children and whether there is a difference in dry eye prevalence. This article reviews the current state of research on childhood myopia-related dry eye, encompassing epidemiology, pathogenesis, and risk factors, aiming to provide clinical reference for intervention, prevention, and precise treatment of dry eyes in myopic children.

[Investigation and analysis of airborne allergenic pollen in 4 districts and 5 counties of Hohhot City]

Objective: To investigate the species, concentration and seasonal trends of main airborne allergenic pollen in 4 districts and 5 counties of Hohhot City. Methods: The Department of allergy, Beijing Shijitan Hospital Affiliated to Capital Medical University conducted a cross-sectional study about monitoring the airborne allergenic pollen from August 1, 2021 to July 31, 2022 by the gravitational method in 4 districts and 5 counties of Hohhot City, which include Yuquan District, Xincheng District, Huimin District, Saihan District, Tuoketuo County, Helingeer County, Tumotezuoqi County, Wuchuan County and Qingshuihe County. Daily pollens were counted and identified by optical microscopy, and the data were analyzed. Results: The airborne allergenic pollen was collected every month all year round in 4 districts and 5 counties of Hohhot city. Through the whole year of the total quantity of pollens ranged from 24 850 to 50 154 grains per 1 000 mm2 and two peaks of pollen concentration in air were observed,which happened in spring (from March to May) and in summer and autumn (from July to September). In spring, the main pollens were tree pollens, which principally distributed in Populus pollen (18.29%), Ulmus pollen (8.36%), Pinus pollen (6.20%), Cupressaceae pollen (5.23%), Betulaceae pollen (2.73%), Salix pollen (1.80%) and Quercus pollen (1.16%). In summer and autumn, the main pollens were weed pollens, which mainly included Artemisia pollen (42.73%), Chenopodiaceae pollen or Amaranthaceae pollen (7.46%), Poaceae pollen (2.26%), Humulus pollen or Cannabis pollen (0.60%). Conclusion: There were two peaks of main airborne allergenic pollen in 4 districts and 5 counties of Hohhot City. In the spring peak of pollen, the main airborne pollens were tree pollens. In the summer and autumn peak of pollen, the main airborne pollens were weed pollens. The Artemisia pollen was the most major airborne pollen in this area.

[Efficacy and prognostic analysis of orthopedic surgery in patients with newly diagnosed multiple myeloma]

Objective: To evaluate the efficacy and prognosis of orthopedic surgical resection surgery in patients with newly diagnosed multiple myeloma (NDMM). Methods: This retrospective cohort study collected clinical data of patients with NDMM who underwent surgery due to spinal cord compression or pathological long-bone fractures at the Peking Union Medical College Hospital from 1 January 2003 to 31 December 2021. Patients who received biopsy or vertebroplasty/kyphoplasty were excluded and patients with the same degree of bone disease and who did not undergo any surgical intervention were selected as controls. Visual analogue scale (VAS) and physical status (ECOG) scores, progression-free survival (PFS), and overall survival (OS) were compared. Statistical analysis included the χ²-test, t-test, and Kaplan-Meier methods. Results: Baseline data were compared between the surgical group (n=40 with 43 interventions) and the non-surgical group (n=80), and included sex, age, paraprotein type, International Staging System (ISS), number of lytic lesions, cytogenetic abnormalities, first-line treatment, and the proportion of patients receiving autologous stem cell transplantation (ASCT) (all P>0.05). Serum M protein levels in the surgical group were significantly lower than those of the non-surgical group [(21.95±16.44) g/L vs. (36.18±20.85) g/L, P=0.005]. The surgical lesions involved the axial skeleton (79.1%, 34/43) or the extremities (20.9%, 9/43). VAS and ECOG scores improved significantly after surgery (VAS: 2.30±0.80 vs. 6.60±1.50, P<0.001; ECOG: 2.09±0.59 vs. 3.09±0.73, P<0.001). The median follow-up time was 51 months. Kaplan-Meier survival analysis suggested that the median PFS (25 vs. 29 months) and OS (46 vs. 60 months) were comparable between the surgical and non-surgical intervention groups (both P>0.05). Subgroup analysis showed that among patients with ISS Ⅰ or those who had received ASCT, PFS in the surgical group was similar to that of the non-surgical intervention group (both P>0.05), while OS was worse (P=0.005, 0.017). Patients with ISS Ⅱ/Ⅲ scores or without ASCT had similar PFS and OS between the surgical and non-surgical intervention groups (all P>0.05). Cox multivariate analysis suggested that ISS and ASCT were independent prognostic factors for OS (ISS: HR=0.42, 95%CI 0.19-0.93, P=0.031; ASCT: HR=0.41, 95%CI 0.18-0.97, P=0.041), while orthopedic surgery did not influence survival (P=0.233). Conclusion: For patients with NDMM, orthopedic surgical resection decreased bone-related complications and improved quality of life, but did not affect survival.

[The influencing factors of renal response in newly diagnosed multiple myeloma patients with renal impairment]

Objective: To investigate the causative factors of renal function in newly diagnosed multiple myeloma (MM) patients with renal inadequacy. Methods: 181 MM patients with renal impairment from August 2007 to October 2021 at Peking Union Medical College Hospital were recruited, whose baseline chronic kidney disease (CKD) stage was 3-5. Statistical analysis was performed based on laboratory tests, treatment regimens, hematological responses, and survival among various renal function efficacy groups. A logistic regression model was employed in multivariate analysis. Results: A total of 181 patients were recruited, and 277 patients with CKD stages 1-2 were chosen as controls. The majority choose the BCD and VRD regimens. The progression-free survival (PFS) (14.0 months vs 24.8 months, P<0.001) and overall survival (OS) (49.2 months vs 79.7 months, P<0.001) of patients with renal impairment was considerably shorter. Hypercalcemia (P=0.013, OR=5.654) , 1q21 amplification (P=0.018, OR=2.876) , and hematological response over a partial response (P=0.001, OR=4.999) were independent predictive factors for renal function response. After treatment, those with improvement in renal function had a longer PFS than those without (15.6 months vs 10.2 months, P=0.074) , but there was no disparity in OS (56.5 months vs 47.3 months, P=0.665) . Conclusion: Hypercalcemia, 1q21 amplification, and hematologic response were independent predictors of the response of renal function in NDMM patients with renal impairment. MM patients with CKD 3-5 at baseline still have worse survival. Improvement in renal function after treatment is attributed to the improvement in PFS.

[Considering the influence of age-related factors on the strategy and satisfaction of refractive surgery]

With the rapid development of materials, equipment and technology related to refractive surgery, the number of people who choose refractive surgery to take off glasses keeps increasing. People at different ages have different needs for refractive surgery with varying effects. How to improve the long-term postoperative satisfaction of patients at different ages should be the focus of refractive surgeons. Age-related factors are not only among the key considerations in the preoperative design of refractive surgery, but also the focus of preoperative communication and education and postoperative follow-up. By analyzing and discussing the influence of age-related factors on the strategy of refractive surgery, this article emphasizes that it is important to pay attention to age-related factors and strengthen perioperative education in ametropic patients, so as to obtain long-term ideal postoperative visual quality and improve patient satisfaction throughout the life cycle.

Association between pulmonary hemorrhage and CPAP failure in very preterm infants

BACKGROUND

Pulmonary hemorrhage (PH) in neonates is a life-threatening respiratory complication. We aimed to analyze the perinatal risk factors and morbidity with PH among very preterm infants in a large multicenter study.

METHODS

This was a multicenter case-control study based on a prospective cohort. Participants included 3,680 in-born infants with a gestational age at 24-32 weeks (birth weight <1,500 g) who were admitted between January 1, 2019, and October 31, 2021. All infants were divided into two groups, namely, the PH and no-PH groups, at a ratio of 1:2 according to the following factors: gestational age (GA), birth weight (BW), and the Score for Neonatal Acute Physiology with Perinatal extension II (SNAPPE II). Perinatal factors and outcomes were compared between the two groups by logistic regression analyses.

RESULTS

A total of 3,680 infants were included in the study, and the number of identified cases of PH was 262 (7.1%). The incidence was 16.9% (136/806) for neonates with extremely low BW (BW < 1,000 g) infants. The multivariate analysis showed that CPAP failure (OR 2.83, 95% CI 1.57, 5.08) was significantly associated with PH. PH was associated with a high likelihood of death (OR 3.81, 95% CI 2.67, 5.43) and bronchopulmonary dysplasia (BPD) (≥grade II) (OR 1.58, 95% CI 1.00, 2.48).

CONCLUSIONS

In this multicenter case-control study based on a prospective cohort, PH to be common among VLBW infants. PH is associated with significant morbidity and mortality, and perinatal management, especially CPAP failure. Respiratory management strategies to decrease the risk of PH should be optimized.

[Anterior segment OCT-assisted PTK combined with PRK in the treatment of myopia associated with cornea macula: a case report]

Nowadays, myopia morbidity keeps increasing in China. As the improvements of technique and safety in corneal refractive surgeries, an increasing number of patients with refractive error tend to choose these treatments. The 26-year-old woman with myopia in this case, whose UCVA was 0.1 in OD and 0.2 in OS, had corneal macula in the nasal side of the left eye owing to a corneal trauma occurred more than 10 years ago. After sufficient preoperative examinations, FS-LASIK was performed on the right eye and PTK combined with PRK was performed on the left eye. The UCVA was 1.2 in both eyes 3 months postoperatively, and the corneal macula was mostly cleared in the left eye. It is demonstrated that PTK combined with PRK is an effective and safe way to correct the diopter as well as remove the lesions for the lowly or moderately myopic patients accompanied with superficial corneal opacity. (Chin J Ophthalmol, 2021, 57: 614-617).

[Thought of corneal collagen cross-linking combined with excimer laser ablation for irregular corneas in keratoconus]

The concept of diagnosis and treatment of keratoconus is constantly updated. Today, we are not only concerned with how to delay the progress of the disease, but also with the preservation of useful vision for patients as well as improvement of visual quality. With the precise and individualized application of excimer laser and femtosecond laser technology in ophthalmology, corneal cross-linking combined with excimer laser ablation for the irregular cornea has become a new strategy for keratoconus. However, questions have been raised and caused ophthalmologists' thinking. Are patients with keratoconus who have progressively thinned corneas suitable for excimer laser ablation? Which is better when the combined strategy is applied, simultaneous or sequential surgery? Based on the research data from home and abroad, we comprehensively sort out various treatment methods for the focus issues. It is hoped that this article can provide guidance for the rational selection of an optimal clinical solution to keratoconus. (Chin J Ophthalmol, 2021, 57:251-253).

[Regulation of bFGF and TGF-β2 in human scleral fibroblasts by the lumican gene mutation associated with myopia]

Objective: To investigate the regulation of basic fibroblast growth factor (bFGF) and transforming growth factor (TGF)-β2 in human scleral fibroblasts (HSFs) by the adenovirus-mediated Lumican gene mutation, and to illustrate the effect of this mutation on myopia. Methods: Experimental study. The HSFs were isolated and cultured from human scleral tissues. The 3rd to 5th generation HSFs were transduced with Lumican mutant (c.596T>C) adenovirus, Lumican wild-type adenovirus, and defective adenovirus as the mutant group, wild group, and negative control group, respectively. Untransduced HSFs were defined as control group. The operation was conducted three times in each group. The expression levels of Lumican, bFGF and TGF-β2 were detected by qPCR. Statistical analysis of gene expression differences between groups was performed by fold changes. The differences were analyzed by one way ANOVA combined with LSD-t test. Results: The expressions of Lumican in the mutant group and the wild group were 103.146-fold and 398.646-fold increased compared to the control group with significant difference (t=-16.641, -21.729; P<0.05). There was no statistical difference between the negative control group and the control group (t=1.689, P>0.05). The expressions of bFGF and TGF-β2 in the mutant group were 2.812-fold and 2.346-fold increased compared to the control group with significant difference, and higher than the other groups (t=-3.921, -4.851; P<0.05). There was no significant difference among the wild group, negative control group and control group (P>0.05). Conclusions: The Lumican mutation (c.596T>C) increased the expressions of bFGF and TGF-β2 in HSFs. It indicates that the Lumican mutation (c.596T>C) may change the metabolism of extracellular matrix in the sclera by regulating bFGF and TGF-β2 to participate in scleral remodeling during the process of myopia. (Chin J Ophthalmol, 2021, 57:277-283).

MicroRNA-1274a serves as a prognostic biomarker in patients with osteosarcoma and is involved in tumor progression via targeting ADAM9

Osteosarcoma (OS) is the most frequent primary malignancy in bone, and commonly occurs in children and adolescents. The aim of this study was to assess the aberrant expression of miR-1274a in OS patients, and to evaluate the role of miR-1274a as a prognostic biomarker and tumor suppressor in OS progression. miR-1274a expression was estimated using quantitative real-time polymerase chain reaction. The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic value of miR-1274a in OS. Gain- and loss-of-function in vitro experiments were used to explore the functional role of miR-1274a in OS progression. A target gene of miR-1274a was analyzed using a dual-luciferase reporter assay. miR-1274a expression was decreased in OS tissues and associated with distant metastasis and clinical stages in OS patients. Low miR-1274a could predict poor overall survival and disease-free survival in OS. The overexpression of miR-1274a could inhibit OS cell proliferation, migration and invasion. Additionally, ADAM9 was demonstrated to serve as a direct target of miR-1274a in OS cells. In conclusion, reduced miR-1274a predicts poor prognosis and serves as a potential tumor suppressor in OS. ADAM9 is a target of miR-1274a, which may mediate the functional role of miR-1274a in OS progression.

[Strengthening the safety of phakic intraocular lens implantation for myopia and astigmatism]

With the improvement of intraocular lens materials and function design, phakic intraocular lens implantation has been widely carried out for myopia and astigmatism and achieved satisfactory clinical results at home and abroad. The range of corrected myopia diopters has gradually changed from previous super-high and high myopia to low myopia. With the expansion of the scope of indications and applications, it is necessary to strengthen the standardization of phakic intraocular lens implantation for myopia and astigmatism, and it is particularly important to further improve its safety and quality control. This article discusses how to rationally select indications, increase the accuracy of the design, and effectively prevent surgical complications, providing a reference for further improvement of clinical safety and quality control. (Chin J Ophthalmol, 2021, 57: 86-89).

[Observation on the distribution of nerve fibers and neural cells morphology in Aspidogaster conchiola]

OBJECTIVE

To understand the distribution of nerve fibers and the types of neural cells in Aspidogaster conchiola.

METHODS

Whole worms were subjected to silver staining, histochemical staining and hematoxylin-eosin (HE) staining, and the nervous systems of the worms were observed.

RESULTS

There were 3 types of neural cells in the worm head near the cerebral ganglion, including unipolar, bipolar and multipolar neurons, which were divided into 7 types according to the morphology. There was a nerve network on the surface of pharynx and intestinal tract, as well as the reproductive organ, including testis, ovary, lower uterus and penis sac. The nerve network was consisted of circular and longitudinal nerve fibers, and the structure of the nerve network around the mouth was similar to central nerve.

CONCLUSIONS

The structure of the A. conchiola central nervous system is very complicated, and the neural networks may be associated with the physiologic activity of the worm. Different neural cells may have diverse functions.

[Analysis of sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome]

Objective: To investigate the sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome(OSAHS). Method: We summarized the characteristics of 250 children withsevere OSAHS diagnosed by polysomnography（PSG）in our hospital from January 1, 2017 to December 31, 2017. According to AHI, the patients were divided into three groups, 159 in group A with 20 < AHI≤0, 57 in group B with 40 < AHI≤60, and 34 in group C with AHI > 60. We collected the basic data, sleep parameters (sleep efficiency, latency, sleep stage, sleep index, etc.), preoperative arterial blood gas test results (awake and postsleep state), echocardiographic findings of the three groups. Statistical comparisons between groups were performed with SPSS19.0. Result: BMI, AHI, OAHI, LSaO₂ was significantly different with among the three groups (all P<0.01), and there was a linear correlation between BMI and AHI (r=0.251). There was significant differences in sleep efficiency (SE), sleep latency (SO), and rapid eye movement (REM) latency among the three groups. Compared with group A, the proportion of sleep in stage 1 increased by 38%, the proportion of sleep in stage 3+4 was decreased by 19%, and the proportion of REM was decreased by 14% in group C. There was no significant difference between group A and B. There was a significant linear correlation between AHI and ODI in NREM and REM, respectively (r¹=0.663, r₂=0.499, P< 0.001), and the ODI in REM (63.8±35.0) was significantly higher than that in NREM (29.7±36.0), accounting for 68% of the sleep. Sixty-five children had received preoperative arterial blood gas test (awake and post-sleep state). There was a significant negative correlation between AHI and SaO₂ after sleep (r=-0.444, P=0.000), and no significant correlation in awake state. Forty-four patients underwent preoperative echocardiographic examination. There was significant differences between group A and C in interventricular septum thickness, left ventricular diameter, and main pulmonary artery diameter (P<0.05). There was no significant difference between group A and B. There were no significant differences in aortic annulus diameter, left atrial diameter, left ventricular end diastolic dimension (LVEDD), ejection fraction(EF), and right ventricular anteroposterior diameter among the groups (P>0.05). Conclusion: Obesity is an important factor affecting the severity of OSAHS. As the severity of disease increased, the proportion of awakening time and stage 1 of sleep increased, but stage 3, 4 and REM decreased significantly. The SE, SO, and REM latency were significantly associated with the severity of OSAHS. The severity of hypoxemia is significantly related to AHI, and mainly occur in REM stage. Severe OSAHS is risk factor for cardiovascular complications.

[Research advances in corneal and scleral collagen cross-linking with ultraviolet A and riboflavin]

In recent years, the use of collagen cross-linking with ultraviolet A and riboflavin is being developed universally due to its significance in the improvement of the mechanical strength of collagen fibers in clinical and basic research. It has been used in treating some corneal diseases including keratoconus, keratectasia and keratohelcosis. Thus, it might become a new treatment to prevent progressive myopia by strengthening scleral tissue. This article focuses on the effectiveness and safety of ultraviolet A-riboflavin cross-linking, and discusses the application prospect, focal points and problems related to cross-linking therapy. (Chin J Ophthalmol, 2018, 54:948-953).

[Differential expression of small leucine-rich proteoglycans gene in Lumican transgenic mouse cornea]

Objective: To investigate the differential expression of small leucine-rich proteoglycans at mRNA level in Lumican transgenic mouse cornea with Real-time Quantitative PCR Detecting System. Methods: Experimental research. Ten Lumican transgenic mice (5 male and 5 female) were chosen as experimental group and 10 wild mice (5 male and 5 female) were chosen as control group. All the mice were killed and enucleated both eyes at eight weeks of age. Gene expression levels of Lumican, Decorin, Biglycan, Keratocan, Fibromodulin in the excised corneas were analyzed by real-time quantitative polymerase chain reaction (RT-Q-PCR) using Real-time Quantitative PCR Detecting System. Differential expression within each group were analysed by fold changes and independent t-test. Results: There were statistic different expression level of Lumican, Decorin, Biglycan and Keratocan mRNA between experimental and control group. The expression level of Lumican RNA was found to be 1.497-fold increased relative to the control (t=4.34, P<0.05) , while Decorin, Biglycan, Keratocan were 0.648-fold (t=-9.98, P<0.05) , 0.522-fold (t=-7.74,P<0.05), 0.323-fold (t=-95.94, P<0.05)decreased in transgenic mice. Fibromodulin mRNA up regulated 1.193-fold in transgenic mice without statistic difference (t=1.66, P>0.05). Conclusions: Lumican gene mutation(cDNA 569T>C) results in abnormal SLRP expression in transgenic mouse cornea at mRNA level, which may indicate that this mutation changes the structure of Lumican and impairs the function of regulating SLRP expression. Also, Lumican gene mutation leads to amio acid exchanging(L199P), which may hinder Lumican from binding to collagens and result in abnormal expression of SLRP at mRNA level. (Chin J Ophthalmol, 2018, 54:911-917).

Ultrasound Risk Assessment Combined with Molecular Markers of Galectin-3, c-MET, HBME-1 and CK19 for Diagnosis of Malignant and Benign Thyroid Nodules

To investigate the effect of ultrasound combined with expression of Galectin-3, c-Met, HBME-1 and CK19 in differentiating malignant from benign thyroid nodules. Forty-six patients with thyroid nodules were studied with ultrasound and immunohistochemical staining of excised thyroid nodules. The data were classified and compared. The immunohistochemical staining revealed 8 benign and 41 malignant thyroid lesions. In ultrasound risk assessment, the malignancy risk was low in four nodules, medium in five and high in 37 with lymphatic metastasis in 26. A significant (P < 0.05) association existed in the expression of Galectin-3 with nodule boundary and lymphatic metastasis, in HBME-1 with nodule micro-calcification and in c-Met with nodule micro-calcification and lymphatic metastasis. CK19 expression was not significantly (P > 0.05) associated with any of ultrasound features of nodule. Galectin-3, c-Met, HBME-1 and CK19 were significantly (P < 0.05) different in malignant and benign thyroid lesions, with a significant (P < 0.01) tendency in all the molecular markers in predicting the malignant from benign lesions. The ultrasound characteristics could significantly (P < 0.001) predict malignant nodules with a significant (P < 0.05) prediction tendency. The scores of Galectin-3, c-Met and CK19 significantly (P < 0.05) increased with increase of ultrasound malignancy risk degree. In malignant and benign lesions differentiated by ultrasound, no significant (P > 0.05) difference existed in HBME-1 expression, however, with ultrasound malignancy risk increase, the score of HBME-1 expression increased significantly (P = 0.03). Galectin-3, c-Met, HBME-1 and CK19 have significantly greater expressions in thyroid malignant than benign lesions and their expression increases with increase of ultrasound malignancy risk. The combination of both ultrasound and molecular markers can be used to differentiate malignant and benign thyroid lesions.

[Carefully performing the phakic intraocular lens implantation for moderate and low myopia]

The refractive surgery is improved and updated with time. In recent years, the phakic intraocular lens has been continuously modified and innovated in materials and design. With advantages such as less high-order aberrations, reversible lens and good visual quality, it has led to a new trend of refractive surgery, which attract an increasing number of high myopic persons received phakic intraocular lens implantation instead of corneal refractive surgery, particularly to further expand the applying for moderate and low myopia. This article focuses on the rational selection of moderate and low myopia to receive laser correction vision or phakic lens, and elaborates the different characteristics with advantages and disadvantages of corneal refractive surgery and phakic intraocular lens implantation, which suggest to perform the phakic intraocular lens implantation for moderate and low myopia cautiously and standardize surgical indications strictly. It is necessary to continuously strengthen the standardization and safety of laser corneal refractive surgery and phakic intraocular lens implantation in order to improve the visual quality and satisfaction further for myopic patients in clinic. (Chin J Ophthalmol, 2018, 54: 726-728).

[Expert consensus on the diagnosis and treatment of cryptococcal meningitis]

Cryptococcal meningitis is a common and refractory central nervous system infection, with high rates of mortality and disability. The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion. Based on the current situation of cryptococcal meningitis in China, the management of cryptococcal meningitis includes 6 aspects: introduction, microorganism identification, clinical manifestations and diagnosis, principles of antifungal therapy, treatment of refractory and recurrent meningitis, treatment of intracranial hypertension. There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis. This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines. The importance of early diagnosis, combined long-term antifungal therapy, control of intracranial hypertension are emphasized.

[The value of brachial artery peak velocity variation during the Valsalva maneuver to predict fluid responsiveness]

Objective: To evaluate whether brachial artery peak velocity variation(ΔVp) during a Valsalva maneuver(VM) could predict fluid responsiveness in spontaneously breathing patients. Methods: Ninety-six patients required radial artery catheter for elective surgery of Ningbo Yinzhou People's Hospital from December 2014 to June 2016 were enrolled. The brachial artery Doppler signal was recorded to measure the ΔVp while the VM was performed.Then doing the volume expansion (VE) , the cardiac output variation (ΔCO) before and after VE were measured.Pearson correlational analyses were conducted between ΔVp and ΔCO. Also the sensitivity and specificity of ΔVp were determined in predicting fluid responsiveness by the receiver operating characteristic (ROC) curve. Results: Patients were classified as group responders (n=24) and group non-responders (n=72). Responder was defined as cardiac output increased≥15% after VE.The ΔVp correlated well with ΔCO (r=0.792, P<0.01). The area under ROC curve was 0.903, with the ΔVp cut-off of 33%, the sensitivity of 87% and the specificity of 82%(P<0.01). Conclusion: Brachial artery peak velocity variation during a valsalva maneuver is a feasible method for predicting fluid responsiveness in spontaneously breathing patients.

[Advantages and disadvantages of femtosecond laser assisted LASIK and SMILE]

With the development of excimer laser and femtosecond laser equipment, application of diversified and customized surgical decision in modern corneal refractive surgery has been an inevitable trend. However, how to make a personalized decision with an accurate surgical design to achieve better visual quality becomes the main focus in clinical applications. Small-incision lenticule extraction (SMILE) and femtosecond assisted laser in situ keratomileusis (FS-LASIK) have been commonly acknowledged as the mainstream of corneal refractive surgery for ametropia correction nowadays. Both methods have been verified by clinical practice for many years. This article compares and elaborates the different characteristics with advantages and disadvantages of the two methods so as to provide some reasonable treatment options for refractive surgery. (Chin J Ophthalmol, 2018, 54: 7-10).

Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study

BACKGROUND

We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America.

METHODS

We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs).

RESULTS

We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions.

CONCLUSIONS

Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.

[Changes of ocular biological parameters and Lumican expression in the monocularly deprivation myopic model of mutant Lumican transgenic mice]

Objective: To investigate ocular changes in the monocularly deprivation myopic model of mutant Lumican transgenic mice. Comparing influences on biological parameters and sclera development between Lumican transgenic and form deprivation mice, and to prepare for further study of pathogenesis of pathological myopia (PM). Methods: Experimental research. Lumican transgenic mice and wild mice were monocularly lid-sutured at ten days after birth. All eyes were divided into 6 groups, group A(32 eyes): control eyes in transgenic mice; group B(34 eyes): sutured eyes in transgenic mice; group C(34 eyes): fellow eyes in transgenic mice; group D(28 eyes): control eyes in wild mice; group E(32 eyes): sutured eyes in wild mice; group F(32 eyes): fellow eyes in wild mice. Refraction was measured by streak retinoscopye and axial length was measured by vernier caliper at 8 weeks (56 days) after birth. Lumican expression was detected by quantitative real-time PCR in all groups. Results: The refraction in group B and group E were (-0.38±1.10) D and (0.14±1.26)D respectively, which were significantly different compared with contralateral groups and normal control groups (F=9.525, 10.067; P<0.01). The mean axial length were also increased in group B ((3.28 ± 0.07)mm and group E (3.24 ± 0.09)mm, (F=7.183, 6.671; P<0.05). Expression level of Lumican mRNA in sclera was increased in group B, which was significantly different from group A and group C (F= 6.262; P<0.05). The expression of Lumican mRNA was increased in group B and C when compared with group E and F (t=4.772, 2.218, P<0.05). Conclusions: Form-deprivation in mutant Lumican transgenic mice causes myopic changes in deprived eyes. The gene expression level of Lumican in sclera of transgenic mice is significantly increased compared with contralateral eyes or that of wild group. Lumican mutation may effect the development of PM, and the interaction of genetic and environmental factors may lead to development of PM. (Chin J Ophthalmol, 2016, 52: 850-855).

[Advocating standardization and customization of corneal refractive surgery in Chinese domestic situation]

With the improvement and application of excimer laser and femtosecond laser equipment in clinical ophthalmology, the diversified strategies for corneal refractive surgery candidates have been provided. Based on the trend of " all-laser treatment", it is very necessary to take the domestic situation into consideration when a standard and customized choice is made according to the indications of each specific surgical type. The characteristics and limitations of various surgeries are elucidated and commented here in order to provide some reasonable treatment options for refractive surgery. (Chin J Ophthalmol, 2016, 52: 481-485).

Tanshinone ⅡA inhibits human esophageal cancer cell growth through miR-122-mediated PKM2 down-regulation

Pyruvate kinase M2 (PKM2) plays a pivotal role in the growth, survival and metabolic reprogramming of cancer cells. Here, we presented for the first time that tanshinone ⅡA inhibited human esophagus cancer cell growth through miR-122-mediated PKM2 down-regulation pathway. Tanshinone ⅡA inhibited cell proliferation and induced cell cycle arrest in S phase in human Ec109 cells. As expected, tanshinone ⅡA down-regulated PKM2 mRNA and protein expression in Ec109 cells. Given these findings, we further investigated microRNAs regulation of PKM2 and confirmed miR-122 for targeting PKM2. Moreover, we found that tanshinone ⅡA-induced up-regulation of miR-122 expression inhibited PKM2 expression in Ec109 cells. Meanwhile, tanshinone ⅡA inhibited proliferation through miR122-medated PKM2 down-regulation. It was demonstrated that the anticancer activity of tanshinone ⅡA was targeted at metabolic regulation of miR-122/PKM2 in human esophagus cancer cells. Taken together, our results revealed tanshinone ⅡA targeting at PKM2-mediated metabolic reprogramming play an important role in inhibition of esophageal cancer cell growth.

Sevoflurane promotes the expansion of glioma stem cells through activation of hypoxia-inducible factors in vitro

BACKGROUND

Growing evidences indicate that inhalational anaesthetics can enhance the growth and malignant potential of tumour cells and may affect tumour recurrence after surgery. Tumour stem cells play a vital role in tumour recurrence. This study investigates the effect of sevoflurane on glioma stem cells (GSCs) in vitro and the underlying molecular mechanisms in this process.

METHODS

Cultured GSCs were exposed to clinically relevant concentrations and durations of sevoflurane exposure. Cell proliferation and self-renewal capacity were determined. Expression of the stem cell marker CD133, vascular endothelial growth factor (VEGF), hypoxia-inducible factors (HIFs), and phosphorylated Akt, which is a protein kinase invoved in multiple cellular processes, were measured using western blotting. Small interfering RNAs and an Akt inhibitor were used to investigate specific pathways.

RESULTS

Compared with controls, cells exposed to 2% sevoflurane for 6 h induced a larger number of proliferated cells (31.2±7.6% vs 19.0±5.8%; P<0.01). Levels of CD133, VEGF, HIF-1α, HIF-2α, and p-Akt were up-regulated by sevoflurane in a time- and concentration-dependent manner. Small interfering RNA against HIFs decreased the percentage of proliferating GSCs after sevoflurane exposure and pre-treatment of cells with an Akt inhibitor abrogated the expression of HIFs induced by sevoflurane.

CONCLUSIONS

Sevoflurane can promote the expansion of human GSCs through HIFs in vitro. Inhaled anaesthetics may enhance tumour growth through tumour stem cells.

[Effects of shade and competition of Chenopodium album on photosynthesis, fluorescence and growth characteristics of Flaveria bidentis]

It is necessary to elucidate its growth mechanism in order to prevent and control the further spread of Flaveria bidentis, an invasive plant in China. The effects of shading (shading rate of 0, 50% and 80%, respectively) and planting pattern (single cropping of F. bidentis, single cropping of Chenopodium album and their intercropping) on germination rate, fluorescence characteristics and growth characteristics of the two plants were investigated. The results showed that moderate shading contributed to emergence rate, but emergence rate of F. bidentis was not uniform, which was one of important factors as a stronger invader. With the increasing light intensity, net photosynthetic rate (Pn), photochemical quenching (qP), electron transport rate of PS II (ETR), quantum yield of PS II (Y), non-photochemical quenching (qN), water use efficiency (WUE), shoot bio-mass rate (SMR), crown width (CW) and dry biomass (DM) increased, specific leaf area (SLA) decreased, LMR of F. bidentis significantly increased, LMR of C. album changed insignificantly, and the increment of DM of F. bidentis was higher than that of C. album. In 80% shade treatment, Pn and DM of F. bidentis were lower than those of C. album. In natural light treatment, Pn, qN, WUE and relative competitive index (RCI) were the highest, CW and DM of intercropped F. bidentis and Pn, Y of C. album were significantly lower than that of the respective single treatment. F. bidentis had higher light saturation point (LSP) and light compensation point (LCP). In conclusion, the shade-tolerant ability of F. bidentis was weaker than that of C. album, but it was reversed in natural light treatment. The two plants adapted to the weak light in 80% shade treatment by increasing SLA and decreasing LMR. F. bidentis improved competition under natural light by increasing SMR and decreasing CW.

Gas chromatograph-surface acoustic wave for quick real-time assessment of blood/exhaled gas ratio of propofol in humans

BACKGROUND

Although pilot studies have reported that exhaled propofol concentrations can reflect intraoperative plasma propofol concentrations in an individual, the blood/exhaled partial pressure ratio RBE varies between patients, and the relevant factors have not yet been clearly addressed. No efficient method has been reported for the quick evaluation of RBE and its association with inter-individual variables.

METHODS

We proposed a novel method that uses a surface acoustic wave (SAW) sensor combined with a fast gas chromatograph (GC) to simultaneously detect propofol concentrations in blood and exhaled gas in 28 patients who were receiving propofol i.v. A two-compartment pharmacokinetic (PK) model was established to simulate propofol concentrations in exhaled gas and blood after a bolus injection. Simulated propofol concentrations for exhaled gas and blood were used in a linear regression model to evaluate RBE.

RESULTS

The fast GC-SAW system showed reliability and efficiency for simultaneous quantitative determination of propofol in blood (correlation coefficient R(2)=0.994, P<0.01) and exhaled gas (R(2)=0.991, P<0.01). The evaluation of RBE takes <50 min for a patient. The distribution of RBE in 28 patients showed inter-individual differences in RBE (median 1.27; inter-quartile range 1.07-1.59).

CONCLUSIONS

Fast GC-SAW, which analyses samples in seconds, can perform both rapid monitoring of exhaled propofol concentrations and fast analysis of blood propofol concentrations. The proposed method allows early determination of the coefficient RBE in individuals. Further studies are required to quantify the distribution of RBE in a larger cohort and assess the effect of other potential factors.

CLINICAL TRIAL REGISTRATION

ChiCTR-ONC-13003291.

Effects of temperature-humidity index and chromium supplementation on antioxidant capacity, heat shock protein 72, and cytokine responses of lactating cows

Heat stress adversely affects the productivity and immune status of dairy cows. The temperature-humidity index (THI) is commonly used to indicate the degree of heat stress on dairy cattle. We investigated the effects of different THI and Cr supplementation on the antioxidant capacity, the levels of heat shock protein 72 (Hsp72), and cytokine responses of lactating cows. The study used a total of 24 clinically healthy uniparous midlactation Holstein cows, which were randomly divided into 2 groups (n = 12 per group), and was conducted in 3 designated THI periods: low THI period (LTHI; THI = 56.4 ± 2.5), moderate THI period (MTHI; THI = 73.9 ± 1.7), and high THI period (HTHI; THI = 80.3 ± 1.0). The 2 groups of cows were fed corn and corn silage based basal diet supplemented chromium picolinate to provide 3.5 mg of Cr/cow daily (Cr+) or basal diet with no Cr (Cr-). The experiment was a 3 × 2 factorial design. The numbers of leukocytes (P < 0.05) and serum levels of glucose (P < 0.001) were lower; however, the serum levels of blood urea nitrogen (BUN; P < 0.001) and creatinine (P < 0.001) were greater in the MTHI and HTHI than in LTHI. The total antioxidant capacity in the serum was unaltered; an increase in superoxide dismutase activity (P < 0.001) and in serum malondialdehyde concentration (P < 0.001) was observed in the MTHI and HTHI compared with the LTHI. The high THI led to increases in serum concentrations of tumor necrosis factor-α (TNF-α; P < 0.001) and IL-10 (P < 0.05). Cows supplemented with Cr had lower (P = 0.009) serum concentrations of cholesterol but greater (P < 0.001, respectively) serum levels of Hsp72 and IL-10 compared with those without Cr supplementation in the HTHI. Western blot analysis revealed that cows supplemented with Cr had greater (P = 0.038) expression of the inhibitor of nuclear factor kappa B α (IκBα) in peripheral blood mononuclear cells (PBMC) compared with those without Cr supplementation in the HTHI, whereas the expression of Hsp72 in PBMC was unaltered. Data indicate that there is a decrease in glucose and increases in BUN and creatinine in the serum of midlactation cows under hot conditions during the summer and that these cows have a lowered oxidative capacity but an elevated antioxidant capacity. In addition, Cr may play an anti-inflammatory role in lactating cows by promoting the release of Hsp72, increasing the production of IL-10, and inhibiting the degradation of IκBα under hot conditions during the summer.

Spinal ephrinB/EphB signalling contributed to remifentanil-induced hyperalgesia via NMDA receptor

Background

One of the major unresolved issues in treating pain is the paradoxical hyperalgesia produced by opiates, and accumulating evidence implicate that EphBs receptors and ephrinBs ligands are involved in mediation of spinal nociceptive information and central sensitization, but the manner in which ephrinB/EphB signalling acts on spinal nociceptive information networks to produce hyperalgesia remains enigmatic. The objective of this research was to investigate the role of ephrinB/EphB signalling in remifentanil-induced hyperalgesia (RIH) and its downstream effector.

Methods

We characterized the remifentanil-induced pain behaviours by evaluating thermal hyperalgesia and mechanical allodynia in a rat hind paw incisional model. Protein expression of EphB1 receptor and ephrinB1 ligand in spinal dorsal horn cord was determined by Western blotting, and Fos was determined by immunohistochemistry assay, respectively. To figure out the manner in which ephrinB/EphB signalling acts with N-methyl-d-aspartic acid (NMDA) receptor, we used MK-801, an antagonist of NMDA receptor, trying to suppressed the hyperalgesia induced by ephrinB1-Fc, an agonist of ephrinB/EphB.

Results

Continuing infusion of remifentanil produced a thermal hyperalgesia and mechanical allodynia, which was accompanied with increased protein expression of spinal-level EphB1 receptor, ephrinB1 ligand and Fos; what appeared above was suppressed by pretreatment with EphB1-Fc, an antagonist of ephrinB/EphB or MK-801, and increased pain behaviours induced by intrathecal injection of ephrinB1-Fc, an agonist of ephrinB/EphB, were suppressed by MK-801.

Conclusions

Our findings indicated that ephrinB/EphB signalling is involved in RIH. EphrinB/EphB signalling might be the upstream of NMDA receptor.

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Immunogenicity and protective efficacy conferred by a novel recombinant Mycobacterium bovis bacillus Calmette-Guérin strain expressing interleukin-12p70 of human cytokine and Ag85A of Mycobacterium tuberculosis fusion protein

Mycobacterium bovis bacillus Calmette-Guérin (BCG) immunization provides protection against tuberculosis (TB) in infants, but the antituberculosis protective immunity wanes gradually after initial immunization and lasts less than 15 years. Therefore, more efficacious vaccines are urgently needed. In this study, we constructed a new tuberculosis vaccine of recombinant BCG strain (rBCG-IA), which could express IL-12p70 of human cytokine and Ag85A of M. tuberculosis fusion protein, and investigated its immunogenicity in BALB/c mice by measuring antibody titres, proliferation rate of splenocytes, ratios of CD4(+) T and CD8(+) T cells stimulated by specific antigens and levels of IFN-γ production in antigen-stimulated splenocyte cultures. Meanwhile, we evaluated its protective efficacy against M. tuberculosis H37Rv infection through detecting lung histopathology, organ bacterial loads and lung acid-fast stain. Immunogenicity experiments illustrated that from 2nd to 8th week after immunization, the rBCG-IA vaccine was able to induce the highest level of antibody titres, proliferation rate of splenocytes and IFN-γ production among groups and gained improved ratio of CD4(+) T and CD8(+) T cells from 6th to 8th week after vaccination. And from 2nd to 8th week after M. tuberculosis H37Rv infection, the score of pathology and bacterial loads in the rBCG-IA group were obviously lower than that in rBCG-I group, rBCG-A group or control group (PBST group), but similar to that in BCG group. This study suggested that rBCG-IA was able to elicit stronger humoral and cellular immune responses, but could only confer similar protective efficacy compared with its parental BCG vaccine.

[Construction and characterization of EGFP reporter gene labeled Sindbis virus]

OBJECTIVE

To construct and characterize EGFP reporter gene labeled Sindbis virus (SINV).

METHODS

The reporter gene EGFP was inserted into the genome of infectious clone pBR-XJ160 by using multi-fusion long fragment PCR method. Then apply reverse genetic manipulation technique to rescue and obtain EGFP labeled SINV.

RESULTS

We successively obtained labeled SINV, which has good fluorescent expression characteristics and genetic stability.

CONCLUSION

The labeled virus can be seen in living cells and living body, and this serves as a good tool for cell and tissue tropism and biological function study of viruses. This study laid a foundation for further studying the cell tropism, biological functions and infection mechanism of SINV.

Usefulness of specific OA biomarkers, thrombin-cleaved osteopontin, in the posterior cruciate ligament OA rabbit model

OBJECTIVE

We undertook this study to determine whether thrombin-cleaved osteopontin (OPN) in synovial fluid (SF) represents a useful marker of osteoarthritis (OA) progression in the posterior cruciate ligament transection (PCLT) OA rabbit model.

METHOD

PCLT was performed on the right knee joints of 48 rabbits. The rabbits were then sacrificed separately at 4, 8, 16, and 24 weeks post-surgery, when the joint was harvested and macroscopic and histological assessments of articular cartilage were performed. Thrombin-cleaved OPN product in SF was determined using Western blotting and the levels were measured using an enzyme-linked immunoassay.

RESULTS

The macroscopic and histological scores for PCLT knees were already elevated 4 weeks after surgery and increased with time. Western blotting showed the presence of thrombin-cleaved OPN in SF from PCLT knees. Thrombin-cleaved OPN levels in SF were elevated at 4 weeks (P < 0.001) and were elevated peaking at 24 weeks (P < 0.00001) after PCLT compared to baseline. A positive significant correlation was found between thrombin-cleaved OPN levels and the macroscopic scores (8 weeks: ρ = 0.695, P = 0.012; 16 weeks: ρ = 0.751, P = 0.005; 24 weeks: ρ = 0.660, P = 0.020). Furthermore, the same correlation was noted between thrombin-cleaved OPN levels and the histological scores (4 weeks: ρ = 0.609, P = 0.036; 8 weeks: ρ = 0.662, P = 0.019; 16 weeks: ρ = 0.827, P = 0.001; 24 weeks: ρ = 0.813, P = 0.001).

CONCLUSION

In this rabbit model of PCLT, thrombin-cleaved OPN levels in SF appear to provide a useful marker of OA disease severity and progression.

Immuno-PCR for one step detection of H5N1 avian influenza virus and Newcastle disease virus using magnetic gold particles as carriers

Detecting avian influenza virus (AIV) and Newcastle disease virus (NDV) at low concentrations from tracheal and cloacal swabs of avian influenza- and Newcastle disease-infected poultry was carried out using a highly sensitive immunological-polymerase chain reaction (immuno-PCR) method. Magnetic gold particles were pre-coated with a capture antibody, either a monoclonal anti-AIV/H5 or monoclonal anti-NDV/F and viruses serially diluted ten-fold from 10(2) to 10(-5)EID(50)/ml. A biotinylated detection antibody bound to the viral antigen was then linked via a streptavidin bridge to biotinylated reporter DNA. After extensive washing, reporter DNA was released by denaturation, transferred to PCR tubes, amplified, electrophoresed and visualized. An optimized immuno-PCR method was able to detect as little as 10(-4)EID(50)/ml AIV and NDV. To further evaluate the specificity and the clinical application of this IPCR assay for AIV H5N1 and NDV, the tracheal swab specimens, taken from chickens which were infected with H5N1/AIV, H9N2/AIV, H7N2/AIV, NDV, IBDV, IBV/H(120), were detected by IPCR. Our data demonstrated that this monoclonal antibody-based immuno-PCR method provides a platform capable of rapid screening of clinical samples for trace levels of AIV H5 and NDV in one step.

Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD)

OBJECTIVES

Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes.

METHODS

Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (> or = 3, 1-2 or <1) or CD4 (> or = 3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively.

RESULTS

Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and 'Other' HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting 'Other' HIV exposures experienced reduced suppression (OR=0.28; P<0.001).

CONCLUSION

Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year.

Deferred modification of antiretroviral regimen following documented treatment failure in Asia: results from the TREAT Asia HIV Observational Database (TAHOD)

OBJECTIVE

The aim of the study was to examine the rates and predictors of treatment modification following combination antiretroviral therapy (cART) failure in Asian patients with HIV enrolled in the TREAT Asia HIV Observational Database (TAHOD).

METHODS

Treatment failure (immunological, virological and clinical) was defined by World Health Organization criteria. Countries were categorized as high or low income by World Bank criteria.

RESULTS

Among 2446 patients who initiated cART, 447 were documented to have developed treatment failure over 5697 person-years (7.8 per 100 person-years). A total of 253 patients changed at least one drug after failure (51.6 per 100 person-years). There was no difference between patients from high- and low-income countries [adjusted hazard ratio (HR) 1.02; P=0.891]. Advanced disease stage [Centers for Disease Control and Prevention (CDC) category C vs. A; adjusted HR 1.38, P=0.040], a lower CD4 count (>or=51 cells/microL vs. <or=50 cells/microL; adjusted HR 0.61, P=0.022) and a higher HIV viral load (>or=400 HIV-1 RNA copies/mL vs. <400 copies/mL; adjusted HR 2.69, P<0.001) were associated with a higher rate of treatment modification after failure. Compared with patients from low-income countries, patients from high-income countries were more likely to change two or more drugs (67%vs. 49%; P=0.009) and to change to a protease-inhibitor-containing regimen (48%vs. 16%; P<0.001).

CONCLUSIONS

In a cohort of Asian patients with HIV infection, nearly half remained on the failing regimen in the first year following documented treatment failure. This deferred modification is likely to have negative implications for accumulation of drug resistance and response to second-line treatment. There is a need to scale up the availability of second-line regimens and virological monitoring in this region.

Composite microspheres induce the sustained release and the control of the initial release of water soluble drugs

Although epidural analgesia may provide adequate pain relief and minimize systemic side effects, long-term, even permanent placement of epidural catheter for chronic or cancer-related pain management carries a potential risk of both superficial and deep infection. The development of antibiotics microspheres that could be dwelled in epidural drug-delivery devices is likely to achieve a significant advance allowing antibiotics given by the intradiscal route to control catheter-related infections. In the present study, the composite microspheres composed of double-walled microcapsules and PLGA were constructed for encapsulating water-soluble antibiotics, cefazolin. The results show that these microspheres could efficiently control the initial release of drug, which was only 3.0% at 2 h. Cefazolin encapsulated in the composite microspheres released gradually nearly in a constant rate in the first 16 days, and still maintained a relative fast rate in the next 14 days, indicating that composite microspheres could improve the incomplete release of entrapped drugs.

7H-benzo[c]fluorene: a major DNA adduct-forming component of coal tar

Coal tar is a complex mixture that exhibits high carcinogenic potency in lungs of animals when administered in the diet. Studies have noted that lung tumor induction does not correlate with the benzo[a]pyrene content of coal tar, suggesting that other hydrocarbons may be involved in the observed tumorigenicity. Our previous studies have demonstrated that a major 'unknown' chemical-DNA adduct is formed in the lung of mice exposed to coal tar. We have used an in vitro rat microsomal activation system to generate the 'unknown' adduct with neat coal tar and fractions of coal tar obtained by chemical fractionation and HPLC. Chemical-DNA adduct formation was evaluated by (32)P-postlabeling using both multi-dimensional TLC and HPLC. GC-MS analysis of the coal tar fractions obtained from HPLC, which produced the 'unknown' adduct in vitro, demonstrated that the adducting hydrocarbon had a mass of 216. A careful evaluation of candidate hydrocarbons led to the conclusion that a benzofluorene derivative may be responsible for forming the 'unknown' chemical-DNA adduct. Comparative in vitro and in vivo studies on the adducting properties of all three isomers of benzofluorene indicated that 7H-benzo[c]fluorene is responsible for producing the 'unknown' adduct observed in the lung of mice ingesting coal tar. Animal feeding studies also demonstrated that 7H-benzo[c]fluorene formed considerably more lung DNA adducts than 11H-benzo[a]fluorene and 11H-benzo[b]fluorene. These data indicate that the four-ring polycyclic aromatic hydrocarbon 7H-benzo[c]fluorene, a hydrocarbon not previously shown to form DNA adducts in lung, is in fact a potent lung DNA adductor and is a candidate PAH for causing lung tumors in animals treated with coal tar.

New synthetic approaches to polycyclic aromatic hydrocarbons and their carcinogenic oxidized metabolites: derivatives of benzo[s]picene, benzo[rst]pentaphene, and dibenzo[b,def]chrysene

A new synthetic approach to polycyclic aromatic compounds is described that entails in the key steps double Suzuki coupling of PAH bisboronic acid derivatives with o-bromoaryl aldehydes to furnish aryl dialdehydes that are converted to larger polycyclic aromatic ring systems by either (a) conversion to diolefins by Wittig reaction followed by photocyclization or (b) reductive cyclization with triflic acid and 1,3-propanediol. This synthetic method provides convenient access to as many as three different polycyclic aromatic ring systems from a single Suzuki coupled intermediate. It was utilized to synthesize substituted derivatives of benzo[s]picene, benzo[rst]pentaphene, dibenzo[b,def]chrysene, and 13,14-dihydro-benz[g]indeno[2,1-a]fluorene, as well as the putative carcinogenic bisdihydrodiol metabolites of benzo[s]picene, benzo[rst]pentaphene, and dibenzo[b,def]chrysene.

Mutagenicity of benzo[a]pyrene-deoxyadenosine adducts in a sequence context derived from the p53 gene

Mutations in the human p53 tumor suppressor gene are prominently linked to sporadic cancers in breast, lung and other tissues. Recent research has shown that tobacco-associated cancer in the human lung is related to mutation of the p53 gene mediated by the carcinogen benzo[a]pyrene (BaP), and the mutations are targeted to DNA "hot spots" at specific codons. In order to gain insight into the relation between the structures of the adducts formed by BaP at these sites and their mutagenic activities, we have synthesized site-specifically modified oligo-nucleotide adducts of the active BaP diol epoxide metabolite (anti-BaPDE). This manuscript reports on the mutagenic consequences of replication past anti-BaPDE-deoxyadenosine adducts located within a sequence context related to codon 157 in exon 5 of the p53 gene. In this sequence context, the adduct derived from the carcinogenic 7R,8S-dihydrodiol 9S,10R-epoxide was much more active as a mutagen than the adduct derived from the noncarcinogenic 7S,8R-dihydrodiol 9R,10S-epoxide and the mutation found most frequently was an A-->G transition. Since previous studies in other sequence contexts have yielded somewhat different findings, these studies further emphasize the key role played by sequence context in determining the mutational properties of carcinogen-DNA adducts.

Bioorganic chemistry of cyclic ADP-ribose (cADPR)

The objective of this brief review is to present an overview of the bioorganic chemistry of cyclic-ADP-ribose (cADPR) with special emphasis on the methodology used for the synthesis of analogues of cADPR. New structural analogues of cADPR can be prepared using either the biomimetic method or ADP-ribosyl cyclase from Aplysia californica. For the most part, both procedures give similar product profiles, but higher yields are generally obtained with the enzymatic method. These synthetic methodologies have allowed the transformation of a variety of structurally modified analogues of NAD+ into their corresponding cyclic nucleotides. Several of these novel analogues are more potent than cADPR in inducing calcium release and are also more stable towards degradative enzymes. They could serve as valuable affinity probes for the isolation of cADPR-binding proteins.

Reactions of dihydrodiol epoxides of 5-methylchrysene and 5, 6-dimethylchrysene with DNA and deoxyribonucleotides

Both syn and anti dihydrodiol epoxides from 5-methylchrysene (5-MCDE) and 5,6-dimethylchrysene (5,6-DMCDE) were reacted under the same conditions with native DNA, denatured DNA, and purine deoxyribonucleotides, and the products were quantified. The extents of reaction with the deoxyribonucleotides were consistently greater for 5,6-DMCDE than for 5-MCDE. The yield of adducts in the reaction with DNA ranged from being a few-fold to 50-fold greater than those found in the corresponding deoxyribonucleotide reactions for both 5-MCDE and 5,6-DMCDE. The DNA-dependent enhancement of product yield was greater for 5-MCDE than for 5,6-DMCDE with a few exceptions among cis and trans deoxyadenosine adducts. The most substantial differences in DNA-dependent enhancement were found for deoxyguanosine adducts; thus, steric hindrance between the 6-methyl group in the 5,6-DMCDE and the minor groove in the DNA double helix may account for the greater DNA-dependent enhancement found in the 5-MCDE reactions.