Expression of interferon-γ and its effect on cough hypersensitivity in chronic refractory cough patients

Chronic refractory cough (CRC) is characterised by cough hypersensitivity. Interferon-γ (IFN-γ) has been reported to induce calcium influx, action potentials of vagal neurons in vitro and cough response in guinea pigs. While the effect of IFN-γ in CRC patients remains unknown. Here, via flow-cytometry and inhalation cough challenge, we found CRC patients had significantly increased levels of sputum IFN-γ⁺CD4⁺ T cells, IFN-γ⁺CD8⁺ T cells as well as supernatant of IFN-γ. The average number of coughs in CRC patients increased as the concentration of inhaled IFN-γ went up in IFN-γ cough challenge. Two or more coughs and five or more coughs elicited by inhaled IFN-γ in CRC patients occurred in 7 of 10 and 2 of 10, respectively. Preinhaled IFN-γ (100 µg/mL) increased the capsaicin cough sensitivity in CRC patients but not healthy volunteers. Targeting IFN-γ may be a potential effective anti-tussive strategy in CRC patients.

Green Preparation of Robust Hydrophobic β-Cyclodextrin/Chitosan Sponges for Efficient Removal of Oil from Water

A relatively straightforward green method to fabricate robust hydrophobic sponges for effective removal of oil pollutants and other organic contaminants was developed. These sponges were constructed from bio-sources: citronellal and palmitic acid-modified aminoethyl cyclodextrin-sodium phytate-chitosan (ACCTCS). The modified sponge exhibited desirable mechanical properties and strong hydrophobicity with a water contact angle (WCA) of 147.8°. Scanning electron microscopy showed that the ACCTCS sponge had a highly porous structure that was particularly suitable for organic component absorption. The sponge exhibited excellent absorption capacities for n-hexane, trichloromethane, vacuum pump oil, and peanut oil (47.9, 32.3, 32.6, and 32.2 g/g, respectively). The removal rate of oil was more than 80% (>26.2 g/g) after 10 absorption-desorption cycles. The ACCTCS sponge also showed good oil/water and organic components/water separation performance. The bio-source materials, green preparation method, and new absorbed-oil recovery strategy provided a novel pathway to construct multifunctional absorbents for oil/water separation in industrial wastewater.

Transmission, viral kinetics and clinical characteristics of the emergent SARS-CoV-2 Delta VOC in Guangzhou, China

BACKGROUND

A novel variant of SARS-CoV-2, the Delta variant of concern (VOC, also known as lineage B.1.617.2), is fast becoming the dominant strain globally. We reported the epidemiological, viral, and clinical characteristics of hospitalized patients infected with the Delta VOC during the local outbreak in Guangzhou, China.

METHODS

We extracted the epidemiological and clinical information pertaining to the 159 cases infected with the Delta VOC across seven transmission generations between May 21 and June 18, 2021. The whole chain of the Delta VOC transmission was described. Kinetics of viral load and clinical characteristics were compared with a cohort of wild-type infection in 2020 admitted to the Guangzhou Eighth People's Hospital.

FINDINGS

There were four transmission generations within the first ten days. The Delta VOC yielded a significantly shorter incubation period (4.0 vs. 6.0 days), higher viral load (20.6 vs. 34.0, cycle threshold of the ORF1a/b gene), and a longer duration of viral shedding in pharyngeal swab samples (14.0 vs. 8.0 days) compared with the wild-type strain. In cases with critical illness, the proportion of patients over the age of 60 was higher in the Delta VOC group than in the wild-type strain (100.0% vs. 69.2%, p = 0.03). The Delta VOC had a higher risk than wild-type infection in deterioration to critical status (hazards ratio 2.98 [95%CI 1.29-6.86]; p = 0.01).

INTERPRETATION

Infection with the Delta VOC is characterized by markedly increased transmissibility, viral loads and risk of disease progression compared with the wild-type strain, calling for more intensive prevention and control measures to contain future outbreaks.

FUNDING

National Grand Program, National Natural Science Foundation of China, Guangdong Provincial Department of Science and Technology, Guangzhou Laboratory.

Glial activation and inflammation in the NTS in a rat model after exposure to diesel exhaust particles

Airway pollution can affect the central nervous system, but whether this causes glial activation and inflammation in the nucleus of solitary tract (NTS) remains unclear. We used a rat model with exposure to diesel exhaust particulate matter (DEP) at 200 μg/m3 (low exposure) and 1000 μg/m3 (high exposure) for 14 days. Activation of microglia and astrocytes in the NTS was assessed using Iba-1 and glial fibrillary acidic protein (GFAP) staining. The expression of neurotrophic factors including brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), and nerve growth factor (NGF) in the NTS were evaluated by immunofluorescence. Changes in the intracellular structure of NTS neurons were observed via electron microscopy. Inflammatory cytokines and oxidant stress levels in the medulla were also measured. Exposure to DEP can cause NTS inflammation as well as airway inflammation, especially in the H-exposure group. We showed that the numbers of microglia and astrocytes in the NTS, as well as NGF expression in the NTS, were significantly higher in both exposure groups than in controls, but BDNF or GDNF expression was not detected. Exposure to DEP induced ultrastructural changes in NTS neurons as reflected by endoplasmic reticulum dilation, ribosomal loss, mitochondrial vacuolization, and a sparse myelin sheath. Medulla inflammation and an imbalance of oxidants and antioxidants also resulted from exposure to DEP. The H-exposure group showed an imbalance of oxidants and antioxidants with decreased levels of SOD and GSH and increased levels of MDA and ROS compared to the control group (both p < 0.01) in the medulla. Inflammatory cytokines (IL-1β, IL-6, and TNF-α) were also significantly increased in the H-exposure group. Fourteen days of exposure to DEP can affect the NTS neurons in rat. Glial activation and inflammation may play important roles in the response of the NTS to DEP.

Cardiopulmonary exercise testing might be helpful for interpretation of impaired pulmonary function in recovered COVID-19 patients

We are grateful to have the opportunity for an in-depth discussion with Nusair [1] and D.G. Chapman and co-workers. We sincerely appreciate their insightful comments on our study about the impaired pulmonary function in coronavirus disease 2019 (COVID-19) patients [2, 3], which helps to interpret the parameters of abnormal lung diffusion capacity more accurately.

Besides the impaired lung diffusion capacity, impairment of exercise endurance in recovered patients with COVID-19 should also be consideredhttps://bit.ly/3qrzPDY

Detecting high-quality signals of adverse drug-drug interactions from spontaneous reporting data

As a medicine safety issue, Drug-Drug Interaction (DDI) may become an unexpected threat for causing Adverse Drug Events (ADEs). There is a growing demand for computational methods to efficiently and effectively analyse large-scale data to detect signals of Adverse Drug-drug Interactions (ADDIs). In this paper, we aim to detect high-quality signals of ADDIs which are non-spurious and non-redundant. We propose a new method which employs the framework of Bayesian network to infer the direct associations between the target ADE and medicines, and uses domain knowledge to facilitate the learning of Bayesian network structures. To improve efficiency and avoid redundancy, we design a level-wise algorithm with pruning strategy to search for high-quality ADDI signals. We have applied the proposed method to the United States Food and Drug Administration's (FDA) Adverse Event Reporting System (FAERS) data. The result shows that 54.45% of detected signals are verified as known DDIs and 10.89% were evaluated as high-quality ADDI signals, demonstrating that the proposed method could be a promising tool for ADDI signal detection.

Dental nerves: a neglected mediator of pulpitis

As one of the most densely innervated tissues, the dental pulp contains abundant nerve fibres, including sensory, sympathetic and parasympathetic nerve fibres. Studies in animal models and human patients with pulpitis have revealed distinct alterations in protein expression and histological appearance in all types of dental nerve fibres. Various molecules secreted by neurons, such as classical neurotransmitters, neuropeptides and amino acids, not only contribute to the induction, sensitization and maintenance of tooth pain, but also regulate non-neuronal cells, including fibroblasts, odontoblasts, immune cells and vascular endothelial cells. Dental nerves are particularly important for the microcirculatory and immune responses in pulpitis via their release of a variety of functional substances. Further, nerve fibres are found to be involved in dental soft and hard tissue repair. Thus, understanding how dental nerves participate in pulpitis could have important clinical ramifications for endodontic treatment. In this review, the roles of dental nerves in regulating pulpal inflammatory processes are highlighted and their implications for future research on this topic are discussed.

Public health initiatives from hospitalized patients with COVID-19, China

BACKGROUND

Since December 2019, when it first occurred in Wuhan, China, coronavirus disease 2019 (COVID-19) has spread rapidly worldwide via human-to-human transmission. We aimed to describe the epidemiological and demographic features of COVID-19 outside Wuhan.

METHODS

A single-center case series of 136 consecutive (from January 16 to February 17, 2020) patients with confirmed COVID-19 hospitalized in The First People's Hospital of Jingzhou, China, was retrospectively analyzed. Outcomes were followed up until February 19, 2020.

RESULTS

Of the 136 patients (median age, 49 years; interquartile range [IQR], 33-63 years; range, 0.3-83 years), 91 (67%) had been to Wuhan or contacted persons from Wuhan. Forty-five (33.1%) were familial clusters. The median incubation period was 6 days (IQR: 4-11 days). All children had an exact exposure history, family members with COVID-19, and "Mild/Moderate" symptoms at admission. Among the 64 elderly patients, 14 (21.9%) had no exposure history, and 43 (67.2%) had a chronic illness. All 11 (8.1%) "Severe/very severe" illness at onset cases and 5 (3.7%) fatal cases were elderly patients. The duration from symptom onset to admission was positively correlated with the duration from symptom onset to endpoint. Overall, patients with a longer incubation period had more severe outcomes.

CONCLUSION

As high-risk susceptible groups, strong protection should be implemented for children and the elderly. Universal screening should be performed for people with a clear exposure history, even lacking apparent symptoms. Given the rapid progression of COVID-19, people should be admitted quickly following symptom onset.

Aqueous synthesis of PEGylated Ag2S quantum dots and their in vivo tumor targeting behavior

With significantly decreased light scattering and tissue autofluorescence, fluorescence imaging in the second near infrared (NIR-II, 1000-1700 nm) region has been heavily explored in biomedical field recently. Silver sulfide quantum dots (Ag₂S QDs) with unique optical properties were one of the most classic NIR-II imaging probes. However, the Ag₂S QDs for in vivo purpose were mainly obtain by oil phase-based high-temperature route at present. Here, we proposed a mild aqueous route to prepare NIR-II emissive Ag₂S QDs for in vivo tumor imaging. Original Ag₂S QDs was obtained by mixing sodium sulfide and silver nitrate in a thiol-terminated polyethylene glycol (mPEG-SH) solution. Treating the original Ag₂S QDs with extra mPEG-SH ligands produced highly PEGyalted Ag₂S QDs. These re-PEGylated Ag₂S QDs exhibited much better blood circulation and tumor accumulation in vivo comparing with the original ones, which can serve as excellent tumor imaging probes. The whole-body blood vessel imaging of living mice was achieved with high resolution, the bio-distribution of these QDs were studied by NIR-II imaging as well. This work also highlighted the importance of ligand density for tumor targeting.

Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. The cumulative number of new confirmed cases and deaths are still increasing out of China. Independent predicted factors associated with fatal outcomes remain uncertain.

RESEARCH QUESTION

The goal of the current study was to investigate the potential risk factors associated with fatal outcomes from COVID-19 through a multivariate Cox regression analysis and a nomogram model.

STUDY DESIGN AND METHODS

A retrospective cohort of 1,590 hospitalized patients with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed by using Kaplan-Meier methods and a Cox proportional hazards model. A prognostic nomogram was formulated to predict the survival of patients with COVID-19.

RESULTS

In this nationwide cohort, nonsurvivors included a higher incidence of elderly people and subjects with coexisting chronic illness, dyspnea, and laboratory abnormalities on admission compared with survivors. Multivariate Cox regression analysis showed that age ≥ 75 years (hazard ratio [HR], 7.86; 95% CI, 2.44-25.35), age between 65 and 74 years (HR, 3.43; 95% CI, 1.24-9.5), coronary heart disease (HR, 4.28; 95% CI, 1.14-16.13), cerebrovascular disease (HR, 3.1; 95% CI, 1.07-8.94), dyspnea (HR, 3.96; 95% CI, 1.42-11), procalcitonin level > 0.5 ng/mL (HR, 8.72; 95% CI, 3.42-22.28), and aspartate aminotransferase level > 40 U/L (HR, 2.2; 95% CI, 1.1-6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with a C-index of 0.91 (95% CI, 0.85-0.97). The calibration plots also showed good consistency between the prediction and the observation.

INTERPRETATION

The proposed nomogram accurately predicted clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance, and appropriate therapy should be considered in patients at high risk.

Short-term outcomes of COVID-19 and risk factors for progression

Coronavirus disease 2019 (COVID-19) has now become a worldwide health concern. The severity of COVID-19 has been classified as mild, moderate, severe and critical [1]. To date, there have been a few studies focused on the clinical course and outcome of critical cases [2–4]. However, information regarding outcomes of mild-to-moderate cases is lacking, despite the fact that mild-to-moderate cases have accounted for approximately 80% of laboratory-confirmed patients [1, 5]. This study aimed to investigate short-term outcomes of patients rated with different severities on admission, and to identify risk factors for progression, thereby helping the management of COVID-19 in clinical practice.

With a median (IQR) follow-up time of 24.0 (17.5–30.0) days, progression occurred in 19.6% moderate, 27.8% severe and 66.7% critical COVID-19. Neutrophil-to-lymphocyte ratio ≥2.973, age ≥50 years, male sex and comorbidity were associated with progression.https://bit.ly/3crsJr0

Elevated Circulating CD4+CD25+CD127-/low Regulatory T Cells in Patients with Non-asthmatic Eosinophilic Bronchitis

PURPOSE

Non-asthmatic eosinophilic bronchitis (NAEB) is a common cause of chronic cough. It is characterized by sputum eosinophilia like asthma but lacks airway hyperresponsiveness. Regulatory T cells (Tregs) are recognized as immune suppressors and are involved in the pathogenesis of asthma. However, the relationship between Tregs and NAEB remains unknown. This study aimed to preliminarily explore the role of Tregs in NAEB by comparing circulating Tregs levels to asthma and healthy controls.

METHODS

Fractional exhaled nitric oxide (FeNO), spirometry with bronchial provocation test, sputum induction and blood routine test were performed in all subjects. Peripheral blood mononuclear cells were used to detect the Tregs (CD4⁺CD25⁺CD127^-/low) by flow cytometry. Relationship between the levels of circulating Tregs and clinical indexes was also observed.

RESULTS

A total of 15 patients with NAEB, 20 patients with asthma and 11 healthy controls were included. The absolute numbers of circulating Tregs in the NAEB group (49.8 ± 18.9 × 10³ cells/ml) and asthma group (53.3 ± 18.7 × 10³ cells/ml) were higher than that in healthy control group (32.7 ± 11.6 × 10³ cells/ml) (both P < 0.01). In total, the level of circulating Tregs showed positive correlation with FeNO (r = 0.30, P < 0.05).

CONCLUSION

Tregs may play a key role not only in asthmatic patients, but also in patients with NAEB, as reflected by the elevated Tregs in peripheral blood.

How many lymph nodes should be dissected in esophagectomy with or without neoadjuvant therapy to get accurate staging?

It is essential to dissect an adequate number of lymph nodes (LNs) to ensure staging accuracy during esophagectomy with or without neoadjuvant therapy. We developed a statistical model to quantify the probability of precise nodal staging based on previous studies. Esophageal cancer patients who underwent esophagectomy were retrospectively reviewed in the Surveillance, Epidemiology, and End Results database. A β-binomial distribution was adopted to estimate the number of understaged patients based on the numbers of positive and examined LNs. Using 6,252 patients, we estimated a 90% confidence of accurate N0 staging could be achieved by examining 17 LNs without neoadjuvant therapy. To obtain similar accuracy in N1 and N2, 20 and 25 LNs should be examined. For patients with neoadjuvant therapy, 18, 19, and 28 LNs could achieve the same accuracy. Staging accuracy was a significant prognostic factor. We found when 90% confidence had been achieved, patient survival did not improve with more LNs examined and the ratio and log odds of positive LNs did not have significant prognostic values. The statistical model we developed for precise staging in patients with different N stages is of great value in guiding lymphadenectomy. It provided risk assessment for underestimated LN metastases and guided subsequent adjuvant treatment.

Arnold Nerve Reflex: Vagal Hypersensitivity in Chronic Cough With Various Causes

BACKGROUND

A higher incidence of Arnold nerve reflex (ANR) has been observed in patients with chronic cough. However, the different ANR response in various causes of chronic cough remains unclear. Furthermore, it is unknown whether ANR will change after effective treatment.

METHODS

Patients with chronic cough were enrolled in the Guangzhou Institute of Respiratory Health. The causes of chronic cough were diagnosed via a validated management algorithm. Patients underwent an assessment of ANR response before and after 1 month of etiologic treatment.

RESULTS

A total of 127 patients with chronic cough and 55 healthy control subjects were enrolled. The positive response, defined as cough-only ANR or urge-to-cough (UTC), was present in 14.8% of patients with cough variant asthma (CVA), 11.1% of patients with upper airway cough syndrome, 15.4% of patients with gastroesophageal reflex related cough (GERC), 4.8% of patients with eosinophilic bronchitis, and 26.9% of patients with unexplained cough (UC). No ANR or UTC was found in the healthy control subjects. The incidence of the positive response was higher in subjects with CVA, GERC, and UC compared with healthy control subjects (all P < .05). No difference was observed among the different causes of chronic cough (all P > .05). After 1 month of treatment, 87.5% of patients identified with a positive response changed to a negative response. In a subgroup analysis, an increased cough sensitivity to capsaicin was found in the patients with a positive response compared with the patients with a negative response (P < .05).

CONCLUSIONS

A positive ANR appears to be a sign of vagal hypersensitivity and can be reversed after effective treatment of chronic cough. However, although various causes of chronic cough share a similar feature of an elevated ANR response in a minority of patients, there appears to be limited usefulness in assessing ANR because it does not appear to be a valid predictor of etiology of chronic cough or outcome of treatment.

Pickering emulsions with enhanced storage stabilities by using hybrid β-cyclodextrin/short linear glucan nanoparticles as stabilizers

Stable Pickering emulsions were prepared by using hybrid β-cyclodextrin/short linear glucan nanoparticles (β-CD/SLG NPs). The β-CD/SLG NPs displayed spherical shape and with an average size at around 60 nm. Newly formed SLG-β-CD structure in the nanoparticles was thought the main reason for the improved thermal stability, alleviated aggregation, and improved dispersity in aqueous systems. Depending on the contact angle and zeta-potential results, unique emulsifying mechanism of β-CD/SLG NPs was existed. The formation of inclusion complex between β-CD and oil molecules accelerated the adsorption of the whole nanoparticles at the oil-water interface, while the swelling of SLG contributed to the long-term stability (6 months) of emulsions. Once the hybrid ratio of β-CD/SLG NPs reached saturation (1:1), excess β-CD led to co-emulsifying effect of both the hybrid regions and easily dissociated β-CD regions. These hybrid β-CD/SLG NPs showed superiority with great potential in applications to the food, cosmetic, and pharmaceutical industries.

Clinical utility of ultrahigh fractional exhaled nitric oxide in predicting bronchial hyperresponsiveness in patients with suspected asthma

BACKGROUND

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker for airway eosinophilic inflammation. However, the clinical value of ultrahigh FeNO (≥100 parts per billion (ppb)) in predicting asthma is never explored. We aimed to investigate the value of ultrahigh FeNO as a predictor of bronchial hyperresponsiveness (BHR), an important index for asthma diagnosis.

METHODS

A retrospective cohort study was conducted on 259 patients with suspected asthma who received the examination of FeNO, spirometry, bronchial provocation test (BPT) and differential cell count of induced sputum. Patients were stratified by FeNO value: ultrahigh (group A:≥100 ppb), high (group B: 50-99 ppb), intermediate (group C: 26-49 ppb) and normal (group D:≤25 ppb). The positive rates of BPT and sputum eosinophils percentage (Eos%) were compared among four cohorts. The correlations between FeNO and sputum Eos% were measured.

RESULTS

A significant higher positive rate of BPT was observed in group A (90.91%) than all others (B: 51.43%, C: 31.43%, D: 28.13%, all p<0.01). Referring to group D, the ORs of positive BPT in groups A, B and C were 26.84, 2.84 and 1.05. Sputum Eos% in group A (19.75 (7.00, 46.25)) is higher than that in others (B: 3.50 (1.00, 12.75), C: 1.13 (0.06,3.50), D: 0.50 (0.00, 2.13)). FeNO correlates with sputum Eos% in groups A and B, but not group C or D.

CONCLUSIONS

Ultrahigh FeNO correlates with BHR and could serve as a practical alternative to methacholine challenge to support an asthma diagnosis in patients with suspected asthma in primary care.

Turn-Number-Dependent Motion Behavior of Catalytic Helical Carbon Micro/Nanomotors

Helical micro/nanomotors (MNMs) can be propelled by external fields to swim through highly viscous fluids like complex biological environments, which promises miniaturized robotic tools to perform assigned tasks at small scales. However, the catalytic propulsion method, most widely adopted to drive MNMs, is seldom studied to actuate helical MNMs. Herein, we report catalytic helical carbon MNMs (CHCM) by sputtering Pt onto helical carbon nano-coils (HCNC) that are in bulk prepared by a thermal chemical vapor deposition method. The Pt-triggered H₂ O₂ decomposition can drive the MNMs by an electrokinetic mechanism. The MNMs demonstrate versatile motion behaviors including both directional propulsion and rotation depending on the turn number of the carbon helix. Besides, due to the ease of surface functionalization on carbon and other properties such as biocompatibility and photothermal effect, the helical carbon MNMs promise multifunctional applications for biomedical or environmental applications.

Intelligent polymer-MnO2 nanoparticles for dual-activatable photoacoustic and magnetic resonance bimodal imaging in living mice

Herein, we report a dual-activatable MRI/PAI strategy for bimodal tumor imaging using an intelligent platform based on degradable MnO₂ and a near-infrared absorptive polymer conjugated with BODIPY molecules. We believe the smart platform could promote the advance of numerous dual-activatable bimodal imaging techniques for biological applications.