Exosomes derived from diabetic serum accelerate the progression of osteoarthritis

Diabetes mellitus (DM) has been demonstrated to accelerate the progression of osteoarthritis (OA) by largely unknown mechanisms. Studies have shown that DM dysfunctional adipocyte-derived exosomes play a crucial role in the pathogenesis of remote organ functions. The present study aimed to clarify whether and how diabetic adipocyte-derived exosomes mediate the pathological regulation of OA. We found that intraarticular injection of DM serum exosomes in the non-diabetic mice significantly exacerbated OA injury as evidenced by a rough and fractured cartilage surface as well as increased chondrocyte apoptosis, decreased mitochondrial membrane potential (△Ψ) and increased expression of cleaved caspase-3. Mechanistic investigation identified that miR-130b-3p was significantly increased in circulating exosomes derived from DM mice and exosomes derived from HG-treated normal adipocytes, and we demonstrated that transfection of miR-130b-3p mimics significantly exacerbated the mitochondrial function of chondrocytes. Our data also indicated that miR-130b-3p impaired the △Ψ, increased cleaved caspase-3 levels, and decreased the expression of 5'-adenosine monophosphate-activated protein kinase α1 (AMPKα1), Silent mating-type information regulation 2 homolog 1 (SIRT1), and peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) in chondrocytes. Pharmacologic activation of AMPKα1 using AICAR reversed the △Ψ and catabolic responses in chondrocytes transfected with miR-130b-3p mimics. Moreover, AICAR decreased the effects of miR-130b-3p mimics on chondrocytes transfected with SIRT1-siRNA or PGC-1α-siRNA. The current study demonstrated that adipocyte-derived exosomal miR-130b-3p under DM conditions suppresses mitochondrial function in chondrocytes through targeting the AMPKα1/SIRT1/PGC1-α pathway, thus exacerbating OA injury.

[Evaluation of the efficacy and safety of Nocardia rubra cell wall skeleton immunotherapy for cervical high-risk HPV persistent infection]

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ²=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ²=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate

Background: Myoma removal remains a challenge hysteroscopically including for the “IBS®” Intrauterine Bigatti Shaver technique. Objective: To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology. Materials and methods: This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions. Main outcome measures: Complete resection rates, total operation time, resection time and used fluid volume. Results: Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003). Conclusion: For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time. What is new? Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.

Intrauterine Bigatti Shaver (IBS ® ) successful placental remnants removal, after caesarean section for a cervical pregnancy with placenta accreta

Placenta accreta located in a caesarean section scar is difficult to remove. The Intrauterine Bigatti Shaver (IBS®) has already been proven to be effective in placental remnant removal. Our case report highlights that the IBS® is also a safe method to remove placental remnants attached to a previous caesarean section scar performed for a cervical pregnancy and associated with placenta accreta.

Area postrema syndrome as initial manifestation in neuromyelitis optica spectrum disorder patients: A retrospective study

BACKGROUND

Area postrema syndrome (APS) is recognized as a core feature in neuromyelitis optica (NMO) diagnosis. Isolated APS can occur at NMO onset and frequently results in a delay of diagnosis, along with devastating secondary neurologic deficits. To date, few studies have characterized APS-onset neuromyelitis optica spectrum disorder (APSO-NMOSD).

OBJECTIVE

We aimed to describe the clinical and radiologic features of patients with APSO-NMOSD who are initially misdiagnosed in a cohort of patients from Zhengzhou, China.

MATERIALS AND METHODS

We identified 15 patients who presented with APS as an initial manifestation, based on the 2015 international consensus diagnostic criteria for NMOSD, and reviewed their demographic, clinical, laboratory, and magnetic resonance imaging (MRI) data.

RESULT

Fifteen patients (3 men, 12 women) aged 14-50 years old were included in our study. All patients presented with APS that included intractable nausea, vomiting, or hiccups (INVH) as the initial manifestation; many experienced a delay in diagnosis. Serum AQP4 was positive in eleven patients and myelin oligodendrocyte glycoprotein (MOG) in one patient. All patients had a linear medullary lesion or a linear medulla-spinal lesion on sagittal MRI. An "inverted V sign" on axial medulla oblongata images, representing a lesion involving the area postrema, was noted in seven patients in this study.

CONCLUSIONS

APS can occur as a sole and initial manifestation of NMOSD, often leading to misdiagnosis in the early process of disease. Identifying patients with an "inverted V" sign and a linear medullary lesion upon MRI examination can help to quickly identify APS patients and avoid further diagnostic delays.

Hysteroscopic tissue removal systems for the treatment of intrauterine pathology: a systematic review and meta-analysis

BACKGROUND

The use of mechanical tissue removal systems is more frequently implemented as the first line approach for the treatment of intrauterine pathology. Scientific evidence is provided that their use is easier and faster than the conventional resectoscope. It is necessary to objectively evaluate the results on tissue removal systems for the treatment of endometrial pathology as the reports in the literature are still conflicting.

OBJECTIVE

To review and compare mechanical hysteroscopic tissue removal systems (Truclear®, Myosure® or IBS®) versus conventional bipolar and monopolar resectoscopy for the treatment of polyp and myoma removal. Operation time, completeness of tissue removal, complication rate, fluid deficit, tolerability and learning curve were evaluated.

METHODS

Electronic databases PubMed; Medline and Web of Science were searched for papers published from 1st January 2010 to 1st May 2019 using terms: ("hysteroscopic" or "hysteroscopy" or "hysteroscopic surgery") and ("myoma" or "polyps"). Studies were included if they were retrospective, observational and prospective randomized clinical controlled trials if they investigated the techniques between the tissue removal systems (Truclear®, Myosure® or IBS®) and conventional resectoscopy for the treatment of intrauterine pathology. Data were extracted from the included studies by two independent reviewers. Meta-analysis was performed by Rev Man 5 software (Cochrane Collaboration, London, UK). Results: Overall, 498 patients were analysed from five studies in which there was no difference in age and size of pathology treated either by the hysteroscopic tissue removal systems and the conventional resectoscope. Hysteroscopic tissue removal systems showed a significantly higher success rate of complete endometrial pathology removal (P=0.002) and a significantly shorter operation time for polyp removal (P<0.0001) compared to conventional resectoscopy. No significant differences, in terms of complications rate, were found (P=0.09). The fluid deficit was significantly higher in the tissue removal system group, compared to conventional resectoscopy (P=0.02).

CONCLUSION

Hysteroscopic tissue removal systems showed a major advantage in successful removal of the pathology and total operation time. It is likely that the tissue removal systems are more accessible and have a lower complication profile including perforation, via falsa and bleeding due to its specific action mechanism and shorter operation time but higher-quality trials will be required to confirm this hypothesis.

The 19 Fr. Intrauterine Bigatti Shaver (IBS®): a clinical and technical update

In this case report we describe the first two surgeries conducted with the 19 Fr. IBS®. The indication for operative hysteroscopy in both patients was the removal of polyps. The size of the polyps was between 15 mm and 20 mm with a mean resection time of 40 seconds. Normal saline solution (500 ml) was used with a negative fluid loss (100 ml). Both operations were successfully performed under general anaesthesia and no speculum, no tenaculum and no dilatation of the cervical canal were necessary.

[Efficacy and safety of low-dose levonorgestrel-releasing intrauterine system in Chinese women: a multicenter, single-arm, open labeled interventional trial]

Objective: To evaluate the efficacy, bleeding profile and safety of low-dose levonorgestrel-releasing intrauterine system (LNG-IUS 8) in Chinese healthy women of childbearing age. Methods: A multi-center, open-label, single-arm clinical trial conducted at 16 centres in China enrolled 773 healthy women of childbearing age (mean age 31.6 years old, range 18 to 40 years old) , who demanded contraception, from April 2006 to June 2013. All women placed LNG-IUS 8 for 3 years and then been followed up at 3, 6, 9, 12, 18, 24, 30, 36 months. The efficacy variables including pregnancy rate and expulsion rate were analyzed using life table, while observing adverse events (AE) to evaluate the safety. The bleeding profile happened during the study was assessed using 90-day reference intervals (World Health Organization criteria) . Results: Eight pregnancies occurred among 773 women, resulting in a overall Pearl index of 0.42 per 100 women years. The 3-year cumulative pregnancy rate was 0.37 per 100 women years and the 3-year cumulative expulsion rate was 1.99 per 100 women years. The number of women with bleeding/spotting reduced and the bleeding/spotting days declined over time. Totally 219 AE were reported related to LNG-IUS 8 placements. The most common AE were vaginal bleeding (8.2%, 63/773) and the ovarian cyst (6.2%, 52/773) . LNG-IUS 8 had an improving effect on dysmenorrhea that the percentage of women with dysmenorrhea as well as the days of dysmenorrhea decreased over time. The percentage of women satisfied or very satisfied with LNG-IUS 8 was 87.2% (622/713) . Conclusion: LNG-IUS 8 is highly effective and safe for Chinese healthy women of childbearing age.

[Effect of S1PR2 inhibition on epithelial ovarian cancer SKOV3 cell proliferation in vitro and in vivo]

Objective: To study the effect and mechanism of S1PR2 inhibition on epithelial ovarian cancer SKOV3 cell proliferation in vitro and in vivo. Methods: (1) A pair of S1PR2 gene small interference RNA (siRNA) , namely si-S1PR2, and a pair of negative control siRNA were designed. Western blot methods were used to detect the silence efficiency of the S1PR2 in the si-S1PR2 group, blank control group and negative control group. (2) Study in vitro: the experiment included three groups, namely si-S1PR2 group, blank control group and negative control group. Cell counting kit-8 (CCK-8) assay was used to detect the proliferation inhibition rates of the transfected cells. The cell cycles of the transfected cells were measured by flow cytometry. Western blot was used to detect the levels of phosph-extracellular regulated protein kinase 1/2 (p-ERK1/2) of the transfected cells. (3) Study in vivo:to establish intraperitoneal transplantation models, 8 mice in each group were intraperitoneally injected with 5×10(6) SKOV3 cells. Phosphate buffered saline (PBS) or JTE-013 were administered into mice twice per week starting on day 7 after the injection of the cancer cells. Twenty-eight days after nude mice intraperitoneal injection with JTE-013 or PBS, the mice were sacrificed and the number and the weight of visible tumors were calculated. Results: (1) The results of western blot showed that the relative S1PR2 protein expression levels were 0.24±0.04 in the si-S1PR2 group, which was lower than that in the blank control group (1.10±0.14, P<0.01) and negative control group (1.07±0.13, P<0.01) . (2) The results of CCK-8 assay indicated that after transfected for 24, 48 and 72 hours, the proliferation inhibition rate of si-S1PR2 group were respectively (26.6±3.3) %, (35.0±3.4) %, and (34.0±2.8) %, significantly lower than those in the blank control group (all 0; all P<0.01) and negative control group [ (1.7±0.9) %, (2.5±0.5) %,and (2.4±1.1) % respectively; all P<0.01]. The results of flow cytometry showed that the G(0)/G(1) ratio in the si-S1PR2 group [ (70.9±2.8) %] was significantly higher than those in the blank control group [ (61.7±2.4) %, P<0.01] and negative control group [ (62.1±3.3) %, P<0.01]. Western blot showed that the relative expression level of p-ERK1/2 in si-S1PR2 group (0.11±0.03) was significantly lower than those in the blank control group [ (0.62±0.09) , P<0.01] and negative control group [ (0.68±0.09) , P<0.01]. (3)Twenty-eight days after nude mice intraperitoneal injection with JTE-013 or PBS, the tumor number of the control group and JTE-013 group were respectively 15.4±4.3 and 8.2±3.7, the tumor weight were (0.45±0.12) and (0.21±0.07) g, respectively. The tumor number and weight in the JTE-013 group were significantly less than those in the control group (all P<0.01) . Conclusions: The growth of ovarian cancer cells could be decreased by S1PR2 inhibition in vitro and in vivo. One of the mechanisms of the growth inhibitory effect is probably that S1PR2 inhibition lower the phosphorylation level of extracellular regulated protein kinase 1/2 (ERK1/2) pathway, which prevent the transformation of ovarian cancer cells from phase G(1) to S.

[Investigation of health knowledge and behaviors on clonorchiasis sinensis of urban residents in Yanqing District, Beijing City]

Objective To understand the status of health knowledge and behaviors on clonorchiasis sinensis of urban residents in Yanqing District of Beijing City, China, so as to provide the targeted suggestions for further health education. Methods The communities/streets were selected as the investigation sites by using the stratified randomly sampling method. A total of 283 residents were randomly selected and investigated with the structural questionnaire designed by Beijing Center for Disease Control and Prevention. The fecal samples were collected and the eggs of Clonorchis sinensis were detected with Kato-Katz technique. Results All of the questionnaires were valid. The awareness rate about clonorchiasis was 25.09%. The rates of knowing clonorchiasis infection route, harm and prevention measures were 10.60%, 9.89% and 10.60% respectively. Totally 7.07% of the residents had the habits of eating raw or undercooked fresh water fish, and 2.47% of the residents had the behavior of eating sashimi. C. sinensis eggs were not found among the research objects. Conclusions The awareness rate about clonorchiasis is low among urban residents in Yanqing District. The focus of the future work is to extensively carry out the health education about clonorchiasis prevention and control and take relevant interventions.

Exogenous Catalase and Pyruvate Dehydrogenase Improve Survival and Regeneration and Affect Oxidative Stress in Cryopreserved Dendrobium nobile Protocorm-like Bodies

BACKGROUND

Reactive oxygen species (ROS)-induced oxidative damage is responsible for viability loss in plant tissues following cryopreservation. Antioxidants may improve viability by preventing or repairing the injury.

OBJECTIVE

This work aimed at studying the effect of catalase (CAT) and pyruvate dehydrogenase (PDH), which are involved in ROS metabolism and are differentially expressed during pollen cryopreservation, for cryopreservation of Dendrobium nobile Lindl. 'Hamana Lake Dream' protocorm-like bodies (PLBs).

MATERIALS AND METHODS

Different concentrations of exogenous CAT or PDH were added at the loading, PVS2 treatment, unloading steps during vitrification-cryopreservation of PLBs. Their survival and regeneration were evaluated and correlated with physiological oxidative indexes.

RESULTS

PLB survival increased significantly when CAT and PDH were added separately to the unloading solution at a suitable concentration. CAT at 400 U·ml^-1 increased PLB survival and regeneration by 33.5 and 14.6 percent respectively. It had no impact on the production of superoxide anion radical (·O2-) and on superoxide dismutase (SOD) activity, but it reduced the hydrogen peroxide (H₂O₂) and malondialdehyde (MDA) contents and enhanced ascorbic acid (AsA) and endogenous CAT levels compared to PLBs cryopreserved using the standard vitrification protocol (CK1). PDH at 0.1 U·ml^-1 significantly improved PLB survival (by 2.5 percent), but it had no marked effect on regeneration compared to the CK1 group. It induced the same variations in ·O2-, AsA and endogenous CAT levels that were observed following CAT addition. However, PDH did not affect the H₂O₂ and MDA content but significantly increased SOD activity.

CONCLUSION

These results indicate that the addition of 400 U·ml^-1 CAT and 0.1 U·ml^-1 PDH at the unloading step increased survival of cryopreserved PLBs and that this improvement was associated with scavenging of H₂O₂ and the repair of oxidative damage. Exogenous CAT also significantly improved PLB regeneration after cryopreservation, while PDH had no obvious effect. The effect of exogenous CAT on PLB survival and regeneration was stronger than that of PDH, which may be due to the increased SOD activity by PDH addition.