[Beneficial effects of extravascular lung water index-guided volum management in patients with cardiogenic shock]

Objective: To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock. Methods: This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment. Results: A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95%CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value (AUC=0.54, 95%CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion: EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.

Brightline-2: a phase IIa/IIb trial of brigimadlin (BI 907828) in advanced biliary tract cancer, pancreatic ductal adenocarcinoma or other solid tumors

Mouse double minute 2 homolog (MDM2) is a key negative regulator of the tumor suppressor p53. Blocking the MDM2-p53 interaction, and restoring p53 function, is therefore a potential therapeutic strategy in MDM2-amplified, TP53 wild-type tumors. MDM2 is amplified in several tumor types, including biliary tract cancer (BTC), pancreatic ductal adenocarcinoma (PDAC), lung adenocarcinoma and bladder cancer, all of which have limited treatment options and poor patient outcomes. Brigimadlin (BI 907828) is a highly potent MDM2-p53 antagonist that has shown promising activity in preclinical and early-phase clinical studies. This manuscript describes the rationale and design of an ongoing phase IIa/IIb Brightline-2 trial evaluating brigimadlin as second-line treatment for patients with advanced/metastatic BTC, PDAC, lung adenocarcinoma, or bladder cancer.

Evidence of the outcome and safety of upper pole vs. other pole access single puncture PCNL for kidney stones: which is better?

OBJECTIVE

The purpose of this study was to retrospectively assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) for upper urinary stones using upper pole access (UPA) and other (low or middle) pole access (OPA).

MATERIALS AND METHODS

A comprehensive literature review of articles investigating the clinical efficacy and safety of UPA and OPA was performed. The relevant literature was obtained from PubMed, EMBASE, Science Direct, Google Scholar and the Cochrane Library. The primary outcomes, including the stone-free rate, were evaluated using Review Manager 5.4 software. The secondary outcomes (peri- and postoperative complications and operative date) were also compared and analyzed.

RESULTS

Ten comparative studies involving 5,290 patients were included in the analysis. The pooled data showed that the UPA group had a stone-free rate (SFR) similar to that of the OPA group [odds ratio (OR) 1.38, 95% confidence interval (CI): 0.94 to 2.03; p=0.22] but a higher incidence of blood transfusion [OR: 1.50; 95% CI: (1.03, 2.19), p=0.04]. There was no statistically significant difference in operative time [mean difference (MD): -7.27; 95% CI: (-25.18, 10.65), p=0.43] or hospital stay [MD: -0.13; 95% CI: (-0.64, 0.37), p=0.60] between the two groups. In addition, the results support that UPA causes fewer complications than OPA.

CONCLUSIONS

Our findings suggest that UPA and OPA are both effective treatments for the management of upper urinary stones. Compared to OPA, UPA is associated with less need for blood transfusion and fewer complications. Nevertheless, the findings should be further confirmed by well-designed prospective randomized controlled trials (RCTs) with large samples and strict standards.

Modeling and maximum likelihood based inference of interval-censored data with unknown upper limits and time-dependent covariates

Due to the nature of study design or other reasons, the upper limits of the interval-censored data with multiple visits are unknown. A naïve approach is to treat the last observed time as the exact event time, which may induce biased estimators of the model parameters. In this paper, we first develop a Cox model with time-dependent covariates for the event time and a proportional hazards model with frailty for the gap time. We then construct the upper limits using the latent gap times to resolve the issue of interval-censored event time data with unknown upper limits. A data-augmentation technique and a Monte Carlo EM (MCEM) algorithm are developed to facilitate computation. Theoretical properties of the computational algorithm are also investigated. Additionally, new model comparison criteria are developed to assess the fit of the gap time data as well as the fit of the event time data conditional on the gap time data. Our proposed method compares favorably with competing methods in both simulation study and real data analysis.

[Fibroblasts overpressing WNT2b cause impairment of intestinal mucosal barrier]

OBJECTIVE

To investigate the mechanism by which fibroblasts with high WNT2b expression causes intestinal mucosa barrier disruption and promote the progression of inflammatory bowel disease (IBD).

METHODS

Caco-2 cells were treated with 20% fibroblast conditioned medium or co-cultured with fibroblasts highly expressing WNT2b, with the cells without treatment with the conditioned medium and cells co-cultured with wild-type fibroblasts as the control groups. The changes in barrier permeability of Caco-2 cells were assessed by measuring transmembrane resistance and Lucifer Yellow permeability. In Caco-2 cells co-cultured with WNT2b-overexpressing or control intestinal fibroblasts, nuclear entry of β-catenin was detected with immunofluorescence assay, and the expressions of tight junction proteins ZO-1 and E-cadherin were detected with Western blotting. In a C57 mouse model of dextran sulfate sodium (DSS)-induced IBD-like enteritis, the therapeutic effect of intraperitoneal injection of salinomycin (5 mg/kg, an inhibitor of WNT/β-catenin signaling pathway) was evaluated by observing the changes in intestinal inflammation and detecting the expressions of tight junction proteins.

RESULTS

In the coculture system, WNT2b overexpression in the fibroblasts significantly promoted nuclear entry of β-catenin (P < 0.01) and decreased the expressions of tight junction proteins in Caco-2 cells; knockdown of FZD4 expression in Caco-2 cells obviously reversed this effect. In DSS-treated mice, salinomycin treatment significantly reduced intestinal inflammation and increased the expressions of tight junction proteins in the intestinal mucosa.

CONCLUSION

Intestinal fibroblasts overexpressing WNT2b causes impairment of intestinal mucosal barrier function and can be a potential target for treatment of IBD.

[The value of a nomogram based on clinical data and contrast enhanced CT radiomics in the preoperative prediction of Epstein-Barr virus-associated gastric carcinoma]

Objective: To explore the value of a nomogram based on clinical data and enhanced CT radiomics in the prediction of Epstein-Barr virus-associated gastric carcinoma(EBVaGC). Methods: The data of 136 patients, including 100 males and 36 females, aged [M (Q₁, Q₃)] 65 (53, 71) years, with gastric cancer confirmed by surgery and pathology were retrospectively analyzed. According to Epstein-Barr virus-encoded small RNA (EBER) in situ hybridization, those patients were divided into Epstein-Barr virus (EBV) positive group (n=32) and EBV negative group (n=104). All patients underwent multi-phase enhanced CT scanning before surgery and randomly assigned to the training group (n=95) and validation group (n=41) in a ratio of 7︰3. MaZda software was used to extract radiomics features of enhanced CT images. The intra-group correlation coefficient (ICC), variance analysis and minimum absolute shrinkage and selection algorithm (LASSO) regression were used to reduce the dimensionality of the radiomics features, and then the radiomics score (Radscore) was calculated. The nomogram model was based on combined clinical data, morphological features and Radscore. The predictive power of the nomogram was evaluated according to the area under the receiver operating characteristic curve (AUC), and the net clinical benefit of the nomogram was evaluated by the decision curve and calibration curves were drawn according to the data of the training group and the validation group to analyze the consistency of the nomogram model. Results: After selection, six optimal radiomics features were obtained, including Mean, Skewness, S(1, 0) Sum entropy, S(1, 1) Contrast, 99% percentile and S(2, 2)Angular second moment. Radscore of EBV positive group were higher than that of the EBV negative group (training group: 3.78±0.83 vs 2.80±0.98; validation group: 3.81±0.47 vs 2.94±0.95) (both P<0.05) both in the training group and validation group. The AUC of the radiomics model in training group and validation group were 0.773(95%CI:0.612-0.962)and 0.792(95%CI:0.597-0.927)respectively,and the sensitivity and specificity were 63.6% and 93.1%, 70.0% and 87.1%, respectively. The AUC of the nomogram model based on clinical data and radiomics in the training group and the validation group were 0.883(95%CI:0.644-0.984) and 0.851(95%CI:0.715-0.996), respectively. The nomogram model showed superior predictive performance (both P<0.05). Conclusion: The nomogram model based on clinical data and radiomics has better efficacy in the prediction of Epstein-Barr virus associated gastric cancer.

Interface-exfoliated graphene-based conductive screen-printing inks: low-loading, low-cost, and additive-free

Paper diagnostics are of growing interest due to their low cost and easy accessibility. Conductive inks, necessary for manufacturing the next generation diagnostic devices, currently face challenges such as high cost, high sintering temperatures, or harsh conditions required to remove stabilizers. Here we report an effective, inexpensive, and environmentally friendly approach to graphene ink that is suitable for screen printing onto paper substrates. The ink formulation contains only pristine graphite, water, and non-toxic alkanes formed by an interfacial trapping method in which graphite spontaneously exfoliates to graphene. The result is a viscous graphene stabilized water-in-oil emulsion-based ink. This ink does not require sintering, but drying at 90 °C or brief microwaving can improve the conductivity. The production requires only 40 s of shaking to form the emulsion. The sheet resistance of the ink is approximately 600 Ω/sq at a thickness of less than 6 µm, and the ink can be stabilized by as little as 1 wt% graphite.

Efficacy of intrauterine perfusion of peripheral blood mononuclear cells (PBMC) for infertile women before embryo transfer: meta-analysis

This meta-analysis was intended to evaluate the effects of intrauterine perfusion of peripheral blood mononuclear cells (PBMC) on the pregnancy outcomes including clinical pregnancy rates, embryo implantation rates, live birth rates and miscarriage rates of infertile women who were undergoing in vitro fertilisation (IVF) treatment. By searching Pubmed, Embase database, five articles meeting the inclusion criteria were included, and 1173 women were enrolled (intrauterine PBMC group: n = 514; NO-PBMC group: n = 659). For the entire IVF/ICSI population and one or two embryo transfer failure patients, there was no significant difference in endometrial thickness, embryo implantation rates, live birth rates, and miscarriage rates between the PBMC group and NO-PBMC group. Although the clinical pregnancy rates of the PBMC group were higher than that of the NO-PBMC group, the confidence interval was close to the line of unity. As for the patients with three or more implantation failures, the clinical pregnancy rates, embryo implantation rates and live birth rates were much higher in the PBMC group than that of the NO-PBMC group. In summary, current evidence suggests that intrauterine perfusion of PBMC can significantly improve pregnancy outcomes in patients who have three or more implantation failures.Impact statementWhat is already known on this subject? An increasing number of studies have shown that immune cells play an important role in embryo transfer. There is no reliable evidence to confirm the clinical efficacy of intrauterine perfusion of PBMC.What do the results of this study add? The current evidence suggests that intrauterine perfusion of PBMC can significantly improve pregnancy outcomes in patients who have three or more implantation failures.What are the implications of these findings for clinical practice and/or further research? To the best of our knowledge, this meta-analysis is the first to evaluate the effect of intrauterine perfusion of PBMC on pregnancy outcomes before embryo transfer. Our study indicated that intrauterine perfusion of PBMC significantly increased clinical pregnancy rates, embryo implantation rates, and live birth rates in patients who failed more than three implants.

[Mucormycosis in patients with hematological diseases: seven cases reports and literature review]

目的

探讨血液病合并毛霉菌病患者的临床特征、诊治与转归，提高对该病的认识。

方法

回顾性分析2012年9月至2018年9月7例血液病合并毛霉菌病患者的临床资料，分析其临床特征、治疗过程和转归。

结果

7例血液病合并毛霉菌病患者中，男4例，女3例，中位年龄36（19~79）岁。基础疾病：急性髓系白血病2例，急性B淋巴细胞白血病、外周T细胞淋巴瘤、慢性髓性白血病急髓变、骨髓增殖性肿瘤及重型再生障碍性贫血（移植后）各1例。毛霉菌病临床类型：4例为肺型，1例为鼻眶脑型，1例为皮肤型，1例为播散型。7例患者均通过活检组织病理确诊。治疗药物为两性霉素B、两性霉素B脂质体及泊沙康唑。手术治疗4例，其中3例术中彻底清除病变组织，1例仅行局限性清除。治愈2例，好转1例，死亡4例。

结论

血液病合并毛霉菌病患者临床表现及影像学表现多样，死亡率高，确诊主要依赖于组织病理学。早期诊断、控制基础疾病、改善免疫抑制状态、尽早行有效的抗真菌药物治疗及彻底的手术清创治疗是提高血液病合并毛霉菌病患者生存率的关键。

Look before you leap: systematic evaluation of tree-based statistical methods in subgroup identification

Subgroup analysis, as the key component of personalized medicine development, has attracted a lot of interest in recent years. While a number of exploratory subgroup searching approaches have been proposed, informative evaluation criteria and scenario-based systematic comparison of these methods are still underdeveloped topics. In this article, we propose two evaluation criteria in connection with traditional type I error and power concepts, and another criterion to directly assess recovery performance of the underlying treatment effect structure. Extensive simulation studies are carried out to investigate empirical performance of a variety of tree-based exploratory subgroup methods under the proposed criteria. A real data application is also included to illustrate the necessity and importance of method evaluation.

Antagonism of cortistatin against cyclosporine-induced apoptosis in rat myocardial cells and its effect on myocardial apoptosis gene expression

OBJECTIVE

To investigate the role of cortistatin (CST) on cyclosporine A (CsA)-induced myocardial apoptosis in rats and determine its effect on the expressions of myocardial apoptosis genes.

MATERIALS AND METHODS

H9C2 cells were treated with different concentrations of CsA solution (0.04, 0.2, 1 and 5 μM) for 24, 48 and 72 h, respectively. The cell viability was detected via methyl thiazolyl tetrazolium (MTT) assay, and the appropriate dose and time were compared and determined. At the same time, CST in different concentrations (0.08, 0.04, 0.2, 1, 5 and 25 μM) was added into cell culture, and the appropriate dose was identified using MTT assay. The cellular morphology in each group was observed, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed for the detection of cell apoptosis. Moreover, in molecular mechanism research, the apoptosis-associated factors, factor associated suicide (Fas), Fas ligand (FasL) and B-cell lymphoma-2-associated X protein (Bax), were detected via quantitive Real-time polymerase chain reaction (qPCR). Finally, the levels of a protein related to myocardial apoptosis in rats were investigated via Western blotting.

RESULTS

The treatment with 1 μM CsA for 48 h caused significant apoptosis. The results of TUNEL staining showed the inhibitory role of CST on the myocardial apoptosis in rats induced by CsA. The detection of apoptosis factors via Real-time PCR revealed that after the induction of CsA, the expressions of Fas, FasL and Bax mRNA in cells were significantly higher than those in control group, but were significantly decreased after administration of CST. Western blotting showed that the protein expressions of Caspase 3 and Caspase 9 were remarkably elevated in cells after the use of CsA, but were significantly reduced after administration of CST (p < 0.01).

CONCLUSIONS

CST contributes to antagonistic function against the CsA-induced apoptosis of rat myocardial cells, and its effect is related to the down-regulation of expressions of apoptotic factors, Fas, FasL, Bax, Caspase 3, and Caspase 9.

The prevalence and determinants of genitourinary syndrome of menopause in Chinese mid-life women: a single-center study

OBJECTIVE

This study aimed to explore the prevalence and determinants of genitourinary syndrome of menopause (GSM) in Chinese mid-life women.

METHODS

A cross-sectional single-center study was performed among 40-65-year-old women who participated in physical examinations at Shanghai Jiao Tong University Affiliated Sixth People's Hospital from December 2015 to December 2016. The participating women were questioned about their genitourinary symptoms, and the relationships between these symptoms and the women's demographic characteristics were evaluated.

RESULTS

The prevalence of GSM was 30.8%, the most frequent symptom was decreased sexual desire (18.4%), and the frequency of vulvovaginal symptoms and lower urinary tract symptoms was 17.5% and 14.8%, respectively. In addition, most of the symptoms were mild. In postmenopausal women, the prevalences of GSM and the three aforementioned symptoms were higher than those in perimenopausal women (p < 0.05). Based on binary logistic regression analysis, GSM was found to be associated with postmenopause (p = 0.007; odds ratio (OR) 1.52), at least two abortions (p = 0.035; OR 1.42), body mass index (BMI) ≥ 30 kg/m² (p = 0.032; OR 1.91) and diabetes (p = 0.041; OR 1.94).

CONCLUSIONS

GSM is common in Chinese mid-life women, and associations between GSM and postmenopause, abortion, BMI and diabetes were identified. Health-care practitioners should actively discuss urogenital symptoms with middle-aged female patients and take appropriate interventions to improve the health of their urogenital tract and quality of life.

[Effect of single nucleotide polymorphisms of RS1826690 located in UGT2B4 gene on the pathological complete response to neoadjuvant chemotherapy in breast cancer patients]

Objective: To evaluate the association between single nucleotide polymorphisms (SNPs) of RS1826690 located in UGT2B4 gene and pathological complete response (pCR) to neoadjuvant chemotherapy in breast cancer patients. Methods: A total of 146 breast cancer patients were enrolled to detect the SNPs of RS1826690 by sequenom. The relationship between SNPs of RS1826690 and pCR, predictors of pCR were analyzed by univariate or multivariate analysis. Results: The frequency of CC, CT and TT genetype of RS1826690 was 20.6%, 39.7% and 39.7%, respectively. Of the 171 patients, pCR was achieved in 39 cases (26.7%), with CC allele in 14 cases, CT allele in 7 cases and TT allele in 18 cases, and statistically significant difference was observed (χ(2)=16.684, P=0.003). Multivariate logistic regression analysis showed that SNPs of RS1826690 was an independent predictor of pCR (95% CI: 2.311-28.810, P=0.001) . SNPs of RS1826690 was statistically associated with estrogen receptor (ER) status (χ(2)=7.872, P=0.020). Conclusion: SNPs of RS1826690 was associated with pCR, and breast cancer patients with CC allele were more likely to achieve pCR.

Cycle oxidation behavior and anti-oxidation mechanism of hot-dipped aluminum coating on TiBw/Ti6Al4V composites with network microstructure

Controlled and compacted TiAl₃ coating was successfully fabricated on the network structured TiBw/Ti6Al4V composites by hot-dipping aluminum and subsequent interdiffusion treatment. The network structure of the composites was inherited to the TiAl₃ coating, which effectively reduces the thermal stress and avoids the cracks appeared in the coating. Moreover, TiB reinforcements could pin the TiAl₃ coating which can effectively improve the bonding strength between the coating and composite substrate. The cycle oxidation behavior of the network structured coating on 873 K, 973 K and 1073 K for 100 h were investigated. The results showed the coating can remarkably improve the high temperature oxidation resistance of the TiBw/Ti6Al4V composites. The network structure was also inherited to the Al₂O₃ oxide scale, which effectively decreases the tendency of cracking even spalling about the oxide scale. Certainly, no crack was observed in the coating after long-term oxidation due to the division effect of network structured coating and pinning effect of TiB reinforcements. Interfacial reaction between the coating and the composite substrate occurred and a bilayer structure of TiAl/TiAl₂ formed next to the substrate after oxidation at 973 K and 1073 K. The anti-oxidation mechanism of the network structured coating was also discussed.

Study on titanium-magnesium composites with bicontinuous structure fabricated by powder metallurgy and ultrasonic infiltration

Titanium-magnesium (Ti-Mg) composites with bicontinuous structure have been successfully fabricated by powder metallurgy and ultrasonic infiltration for biomaterial potential. In the composites, Ti phase is distributed continuously by sintering necks, while Mg phase is also continuous, distributing at the interconnected pores surrounding the Ti phase. The results showed that the fabricated Ti-Mg composites exhibited low modulus and high strength, which are very suitable for load bearing biomedical materials. The composites with 100 µm and 230 µm particle sizes exhibited Young's modulus of 37.6 GPa and 23.4 GPa, 500.7 MPa and 340 MPa of compressive strength and 631.5 MPa and 375.2 MPa of bending strength, respectively. Moreover, both of the modulus and strength of the composites increase with decreasing of Ti particle sizes. In vitro study has been done for the preliminary evaluation of the Ti-Mg composites.

Association of body composition with menopausal symptoms in (peri-)menopausal women

OBJECTIVE

To explore the correlation of body composition with the severity of menopausal symptoms, as well as each classic menopausal symptom.

METHODS

A total of 758 (peri-)menopausal women were recruited (aged from 40 to 67 years) from the Menopause Clinic in the Shanghai Sixth People's Hospital. Different regions of fat mass, lean mass and fat-free mass were measured by bioelectrical impedance analysis, while menopausal symptoms were evaluated by valid modified Kupperman's index (KMI) in the Chinese version.

RESULTS

After adjusting for potential confounders, logistic regression revealed that trunk lean mass (odds ratio 0.29, 95% confidence interval 0.09-0.99) was the independent determinant of moderate to severe menopausal symptoms (KMI ≥ 16). In multiple regression analysis, significant relationships were found between body mass index and hot flushes/sweating and diabetes (p < 0.05). There was a significant relationship between lean mass and muscle/joint pain and sexual problems (p < 0.05). We also observed significant relationships between fat mass and hot flushes/sweating and muscle/joint pain.

CONCLUSIONS

Our findings indicated that trunk lean mass was an independent protective factor for moderate to severe menopausal symptoms. Strengthening the trunk lean mass may alleviate menopausal symptoms.

[The situation and associated factors of facility-based HIV testing among men who sex with men in Beijing]

Objective: To understand the prevalence of facility-based HIV testing and its associated factors among men who have sex with men (MSM) in Beijing city. Methods: An application-based cross-sectional survey was employed to understand HIV site test situation and associated factors. The survey was carried out from May 14(th) to 21(st), 2016. Users of a smart phone application for gay dating were recruited and those eligible for this survey were investigated with an online self-administered questionnaire. Information of demographics, sexual behaviors, facility-based HIV testing history and recreational drug abuses were collected. The multivariate logistic regression was used to make comparison among different groups and assess associated factors. Results: A total of 7 494 participants were enrolled in the survey with mean age of (28.81 ± 7.38) years, 87.14% (6 530/7 494) sought sexual partners through internet. The proportion of facility-based HIV testing in 1 year was 42.55% (3 189/7 494), MSM who were 25-29 years had higher proportion of facility-based HIV testing in 1 year, the proportion was 45.56%(1 104/2 423). Among MSM who could insist in using condom during anal sex (50.46% (1 539/3 050)), the proportion of HIV site testing in 1 year was higher. The MSM who reported seeking healthcare for symptoms of a sexually transmitted infections (STIs) in the past year or ever using recreational drug had higher proportion of facility-based HIV testing, the proportions were 56.81% (409/720) and 52.00% (1 340/4 917), respectively. Compared with alone cohabitation, cohabitating was associated with decreased odds of HIV facility-based testing in past 1 year(odds ratio (OR)= 0.79, P<0.001). Compared with homosexual sexual orientation, bisexual sexual orientation was associated with decreased odds of facility-based HIV testing (OR=0.83, P=0.004). With the increasing of number of male anal sex partners, the odds of HIV facility-based testing was increasing (OR=1.31, P<0.001) But with the decreasing of the frequency of condom using with male anal sex partners, the odds of facility-based HIV testing was decreasing (OR=0.85, P=0.014). Using recreational drugs (OR=1.36, P<0.001) and seeking healthcare for symptoms of a STI in the past 1 year (OR=1.73, P<0.001) were associated with decreased odds of HIV site testing. Conclusion: MSM in Beijing had lower proportion of facility-based HIV testing in past 1 year. Multiple anal sex partners, using recreational drugs, seeking healthcare for symptoms of a STI in the past year, cohabitating, bisexual sexual orientation, and lower frequency of condom using with male anal sex partners were associated with the odds of HIV facility-based testing in past 1 year.

[The outcome of trial of labor after cesarean section]

Objective: To explore the outcome of trial of labor after cesarean section(TOLAC). Methods: Totally 614 TOLAC were conducted in the First Affiliated Hospital of Kunming Medical University from July 2013 to June 2016. Among them, 586 cases of singleton pregnancy with one prior cesarean section(gestational age≥28 weeks)were studied retrospectively. The maternal and neonatal outcomes among the vaginal birth after cesarean(VBAC)group(481 cases), failed TOLAC group(105 cases)and the elective repeat cesarean section(ERCS)group(1 145 cases)were compared. Multiple logistic regression was used to determine the risk factors of admission to neonatal intensive care unit(NICU). Results: (1)The TOLAC rate was 29.62%(614/2 073)from July 2013 to June 2016, and the VBAC rate was 82.6%(507/614). The cesarean section rate was reduced by VBAC by 3.147%(507/16 112).(2)The comparison of adverse maternal outcomes: in the VBAC group, the postpartum hemorrhage volume was(431±299)ml, the rate of postpartum fever was 6.4%(31/481), the birth weight of the neonates was(3 085± 561)g, and the rate of large for gestational age was 2.9%(14/481). All were significantly lower than those in the failed TOLAC group and the ERCS group(P<0.05). There was no significant difference in other adverse maternal outcomes[the uterine rupture rate(0.2% ,1/481), the bladder injury rate(0), the proportion of postpartum hemorrhage volume≥1 500 ml(1.0%, 5/481), the blood transfusion rate(3.7%, 18/481)]and adverse perinatal outcomes[the rate of neonatal 5-minute Apgar score<7(0.4%, 21/481), the rate of umbilical arterial pH<7.0(0.6% , 3/481), the rate of the NICU admission and the perinatal mortality rate(12.3%, 59/481)]among the 3 groups(P>0.05). Multiple logistic regression showed no association between VBAC and admission to the NICU(OR=0.84, 95%CI: 0.58-1.21). The isolated risk factors for admission to the NICU were preterm birth(OR=16.71, 95% CI: 11.44-24.40), hypertensive disorder complicating pregnamcy(OR=3.89, 95% CI: 2.39-6.35), meconium stained amniotic fluid(OR=2.48, 95% CI: 1.62-3.80), small for gestational age(OR=2.00, 95% CI: 1.19-3.36)and diabetes mellitus(OR=1.69, 95% CI: 1.14-2.50). Conclusions: VBAC reduces cesarean section rate, with good outcomes in both mother and neonate. It is a safe and feasible way of labor in women with only one cesarean section history.

Butyrylcholinesterase regulates central ghrelin signaling and has an impact on food intake and glucose homeostasis

Background:

Ghrelin is the only orexigenic hormone known to stimulate food intake and promote obesity and insulin resistance. We recently showed that plasma ghrelin is controlled by butyrylcholinesterase (BChE), which has a strong impact on feeding and weight gain. BChE knockout (KO) mice are prone to obesity on high-fat diet, but hepatic BChE gene transfer rescues normal food intake and obesity resistance. However, these mice lack brain BChE and still develop hyperinsulinemia and insulin resistance, suggesting essential interactions between BChE and ghrelin within the brain.

Methods:

To test the hypothesis we used four experimental groups: (1) untreated wild-type mice, (2) BChE KO mice with LUC delivered by adeno-associated virus (AAV) in combined intravenous (i.v.) and intracerebral (i.c.) injections, (3) KO mice given AAV for mouse BChE (i.v. only) and (4) KO mice given the same vector both i.v. and i.c. All mice ate a 45% calorie high-fat diet from the age of 1 month. Body weight, body composition, daily caloric intake and serum parameters were monitored throughout, and glucose tolerance and insulin tolerance tests were performed at intervals.

Results:

Circulating ghrelin levels dropped substantially in the KO mice after i.v. AAV–BChE delivery, which led to normal food intake and healthy body weight. BChE KO mice that received AAV–BChE through i.v. and i.c. combined treatments not only resisted weight gain on high-fat diet but also retained normal glucose and insulin tolerance.

Conclusions:

These data indicate a central role for BChE in regulating both insulin and glucose homeostasis. BChE gene transfer could be a useful therapy for complications linked to diet-induced obesity and insulin resistance.

The miR-487b-3p/GRM3/TGFβ signaling axis is an important regulator of colon cancer tumorigenesis

Molecular targeting is an import strategy to treat advanced colon cancer. The current study demonstrates that expression of GRM3, a metabotropic glutamate receptor mainly expressed in mammalian central nervous system, is significantly upregulated in majority of human colonic adenocarcinomas tested and colon cancer cell lines. Knockdown of GRM3 expression or inhibition of GRM3 activation in colon cancer cells reduces cell survival and anchorage-independent growth in vitro and inhibits tumor growth in vivo. Mechanistically, GRM3 antagonizes TGFβ-mediated activation of protein kinase A and inhibition of AKT. In addition, TGFβ signaling increases GRM3 protein stability and knockdown of GRM3 enhances TGFβ-mediated tumor suppressor function. Further studies indicate that miR-487b-3p directly targets GRM3. Overexpression of miR-487b-3p mimics the effects of GRM3 knockdown and suppresses the tumorigenicity of colon cancer cells in vivo. Expression of miR-487b-3p is decreased in colon adenocarcinomas and inversely correlates with GRM3 expression. Taken together, these studies indicate that upregulation of GRM3 expression is a functionally important molecular event in colon cancer, and that GRM3 is a promising molecular target for colon cancer treatment. This is particularly interesting and important from a therapeutic standpoint because numerous metabotropic glutamate receptor antagonists are available, many of which have been found unsuitable for treatment of neuropsychiatric disorders for reasons such as inability to readily penetrate blood brain barriers. Since GRM3 is upregulated in colon cancer, but rarely expressed in normal peripheral tissues, targeting GRM3 with such agents would not likely cause adverse neurological or peripheral side effects, making GRM3 an attractive and specific molecular target for colon cancer treatment.