Diagnostic value of combined nucleic acid and antibody detection in suspected COVID-19 cases

OBJECTIVES

Nucleic acid testing is the gold standard method for the diagnosis of coronavirus disease 2019 (COVID-19); however, large numbers of false-negative results have been reported. In this study, nucleic acid detection and antibody detection (IgG and IgM) were combined to improve the testing accuracy of patients with suspected COVID-19.

STUDY DESIGN

The positive rate of nucleic acid detection and antibody detection (IgG and IgM) were compared in suspected COVID-19 patients.

METHODS

A total of 71 patients with suspected COVID-19 were selected to participate in this study, which included a retrospective analysis of clinical features, imaging examination, laboratory biochemical examination and nucleic acid detection and specific antibody (IgM and IgG) detection.

RESULTS

The majority of participants with suspected COVID-19 presented with fever (67.61%) and cough (54.93%), and the imaging results showed multiple small patches and ground-glass opacity in both lungs, with less common infiltration and consolidation opacity (23.94%). Routine blood tests were mostly normal (69.01%), although only a few patients had lymphopenia (4.23%) or leucopenia (12.68%). There was no statistical difference in the double-positive rate between nucleic acid detection (46.48%) and specific antibody (IgG and IgM) detection (42.25%) (P = 0.612), both of which were also poorly consistent with each other (kappa = 0.231). The positive rate of combined nucleic acid detection and antibody detection (63.38%) was significantly increased, compared with that of nucleic acid detection (46.48%) and that of specific antibody (IgG and IgM) detection (42.25%), and the differences were statistically significant (P = 0.043 and P = 0.012, respectively).

CONCLUSIONS

Nucleic acid detection and specific antibody (IgG and IgM) detection had similar positive rates, and their combination could improve the positive rate of COVID-19 detection, which is of great significance for diagnosis and epidemic control.

AB1311-HPR RHEUMATIC AND MUSCULOSKELETAL DISEASES MANAGEMENT TOOL HELPS TO IMPROVE TREAT-TO-TARGET THERAPY AND PATIENTS’ ADHERENCE TO TREATMENT

Background:

Many of the rheumatic and musculoskeletal diseases (RMD) are long term, painful, and function affecting, which takes both the doctors and patients a lot of time and effort. The number of Rheumatologists are not sufficient for the huge population of RMD patients in China. The doctor patient ratio is as low as 1:1000. Relatively inadequate medical resources, traffic inconvenience in rural area, and patients’ insufficient understandings of the RMD may cause delayed medical intervention and poor prognosis. Effective RMD patient management tools which provide disease monitoring and enough doctor-patient communication is essential to improve the patients’ adherence to treatment. We designed an RMD management app according to the social, cultural and economic situation of Chinese patients, which helps to facilitate shared decision making and relieve the pressure of insufficient medical resources.

Objectives:

We aim to investigate the effect of RMD patient management app on treat-to-target therapy and patients’ adherence and satisfaction to treatment.

Methods:

An observational survey was administrated using a RMD patient management app. The app was designed and improved by Rheumatologist, orthopedics, nurses, patients, and app technical experts. Patients were offered with a questionnaire in regard to satisfaction with the app and their attitudes about the disease. General therapeutic principles, rehabilitation exercise videos and follow-up information were distributed through the app. Warning signals were sent whenever there was a flag sign of exacerbation. The demographic and clinical data, social and economic status, and drug retention rates of the patients were documented. The survey was designed by clinical experts from relevant departments and developed by both doctors and patients.

Results:

All patients were supervised by the rheumatologist and orthopedist when using the app. In all the patients included, there were cases of rheumatoid arthritis (35.3%), osteoarthritis (32.4%), ankylosing spondylitis (26.5%), and other chronic arthritis (5.8%). The mean age 38.5±15.8 years old, with 52.9% male and 47.1% female. Most of the patients (85.3%) believed that the app was helpful. Young patients were more likely to respond to the survey than older patients. Some patients (79.4%) had increased compliance because the app offered more chances to communicate with the doctors, which increase their understanding and confidence about the disease. Three patients received flag signs of exacerbation much earlier than they could get to the hospital. From the feedback of the patients, we realized that the patient would like to have more information to keep them from stepping on the trap of false advertisement for therapy (which is very commonly seen in China).

Conclusion:

RMD patient need to manage disease activity, daily function and mental state. Insufficient medical resources and patients’ knowledge about the disease may lead to poor adherence and prognosis. RMD patient management tool on app was a feasible and cost-effective approach for data collection and patient education. The app increased treat-to-target therapy and patients’ adherence to treatment.

References:

None.

Disclosure of Interests:

None declared

[HIV/AIDS related frailty syndrome in the elderly and related research progress]

Frailty syndrome, caused by degenerative changes in the body and the body vulnerability due to a variety of chronic diseases, is associated with adverse outcomes, such as fall, disability and mortality. With the development of antiretroviral therapy, the average life span of HIV/AIDS patients is extended, the number of elderly living with HIV/AIDS has increased, resulting the increase of the incidence of frailty syndrome in this population. The incidence of frailty syndrome in the elderly is associated with HIV infection and adverse reaction of antiretroviral therapy. Early assessment and intervention of frailty syndrome in elderly HIV/AIDS patients can reduce adverse clinical events and improve the quality of life.

Streptomyces-derived actinomycin D inhibits biofilm formation via downregulating ica locus and decreasing production of PIA in Staphylococcus epidermidis

AIM

The objective of this study was to investigate the biofilm inhibitory activity of Streptomyces-derived actinomycin D against biofilm formation by Staphylococcus epidermidis.

METHODS AND RESULTS

The microtitre plate method and microscopy were used to detect the biofilm formation of S. epidermidis. And an attempt was made to detect the effect of actinomycin D on important biofilm components, exopolysaccharides (EPS) in S. epidermidis using precolumn derivation HPLC. Also cell surface hydrophobicities of S. epidermidis were assessed to explore action mechanisms. The qPCR was performed to demonstrate the genetic mechanisms of biofilm formation by S. epidermidis. Unlike other antibiotics, actinomycin D (1·5 μg ml^-1 ) from Streptomyces luteus significantly inhibited biofilm formation by S. epidermidis. Additionally, it effectively inhibited S. epidermidis cells from adhering to glass slides. Actinomycin D downregulated ica locus and then the reduced polysaccharide intercellular adhesin production caused S. epidermidis cells to become less hydrophobic, thus supporting its anti-biofilm effect.

CONCLUSION

Streptomyces-derived actinomycin D is active in inhibiting the biofilm formation of S. epidermidis.

SIGNIFICANCE AND IMPACT OF THE STUDY

Actinomycin D can be used as a promising antibiofilm agent in inhibiting S. epidermidis biofilm formation. The study is also the first insight into how actinomycin D inhibited the biofilm formation of S. epidermidis. Actinomycin D could potentially be used to reduce the risk of biofilm-associated infections. Our study also suggests that the metabolites from Actinomycete strains keep further attention as potential antibiofilm agents against biofilm formation of S. epidermidis, even biofilm infections of the other bacteria.

172 Effects of net energy levels on feed intake pattern and growth performance of growing-finishing gilts monitored using a computerized feed intake recording system

This study evaluated the effects of dietary net energy concentrations on feeding behavior and growth performance of growing-finishing pigs monitored using a feed intake recording equipment (FIRE). Two hundred and sixteen (48.8 ± 5.6 kg) gilts were blocked by bodyweight and assigned randomly to 1 of 3 dietary treatments, which included low (2,350 kcal/kg), medium (2,450 kcal/kg), and high (2,550 kcal/kg) dietary NE levels. Pigs were housed in 18 pens for 68 d in four phases with 12 pigs and one FIRE station per pen. Bodyweight, feed consumption, and the amount of time and visit at the station of individual pigs were monitored every day by using FIRE. Pigs fed low NE diet spent more time (min) at the station during the first two weeks and visited the station more times with fewer amounts of time (min) per visit after two weeks compared with pigs fed medium and high levels of NE diets (P < 0.05). The speed (g/min) and amount (g/visit) of feed intake were lower (P < 0.05) during phase 3 and the overall period in low NE diet compared with pigs fed medium NE diet. Pigs fed medium NE diet tended to have a greater (P = 0.066) average daily feed intake at phase 4 than pigs fed low NE diet. Increasing NE levels linearly improved (P < 0.05) average daily gain, feed conversion ratio, and final BW during phase 3 and the overall period. However, the overall energy efficiency (Mcal NE/ kg gain) was linearly decreased with increasing NE levels. In conclusion, decreasing dietary NE to 2350 Mcal/kg resulted in more visits to feeders with slow ingestion speed compared with pigs fed diets with 2450 or 2550 Mcal/kg NE. Increasing dietary NE levels linearly improved daily gain and feed conversion ratio, but linearly decreased energy efficiency.

MiR-212-5p regulates the proliferation and apoptosis of AML cells through targeting FZD5

OBJECTIVE

To explore the effects of microRNA-212-5p (miR-212-5p) on biological functions of acute myeloid leukemia (AML) and to find the potential molecular mechanism.

PATIENTS AND METHODS

We measured the expression level of miR-212-5p in 35 AML patients and 20 patients with idiopathic thrombocytopenic purpura (ITP) as control cases. Besides, the miR-212-5p expression at cellular level was checked as well. In order to screen the functional targets of miR-212-5p, online prediction software was used and gene frizzled class receptor 5 (FZD5) attracted our attention. The effects of miR-212-5p on biological functions of AML cell line (Kasumi-1) were analyzed by subsequent experiments. The mRNA and protein expressions of FZD5 were detected by quantitative Real-time polymerase chain reaction (qRT-PCR) and Western blotting (WB) analysis, respectively. Cell proliferation was tested by cell counting kit-8 (CCK-8) assay. Cell cycle and apoptosis were measured by flow cytometry. Finally, protein expression of β-catenin was analyzed by WB assay.

RESULTS

In AML cases and cells, miR-212-5p was found to be lowly expressed. The potential target of miR-212-5p was predicated in three public databases. Through a series of experiments including qRT-PCR, WB and luciferase assay, we identified FZD5 as a functional target of miR-212-5p. In further cellular functional experiments on Kasumi-1, we found overexpression of miR-212-5p in Kasumi-1 cells greatly inhibited the cell viability and proliferation. The ratio of cells in G0/G1 phase and the proportion of apoptotic cells increased after miR-212-5p overexpression. Furthermore, Wnt/β-catenin signal pathway was the most apparent pathway that was regulated by miR-212-5p according to WB results. However, the effects of miR-212-5p were suppressed after restoring the expression of FZD5.

CONCLUSIONS

Expression of miR-212-5p was significantly lower in AML patients and cell lines, indicating that miR-212-5p served as a tumor-suppressor gene in AML. According to our in vitro experiments, miR-212-5p/FZD5 was likely to become a new therapeutic target for AML.

Sex-specific association of metabolic risk factors with brain ischemic lesions by severity and location

Background

Males and females exhibit significant differences in metabolism and in brain ischemic stroke and different features of brain ischemic lesions are related to different health outcomes. It is critical to understand sex differences in their associations to optimize prevention and intervention for both sexes. We aimed to investigate the sex-specific association of metabolic risk factors with brain ischemic lesions by severity and location.

Methods

Five thousand seven hundred ninety-one participants who underwent comprehensive health examinations between Jan. 1, 2017, and Dec. 31, 2017, were enrolled. Clinical and laboratory data about metabolic risk factors were obtained. Brain ischemic lesions were further categorized by severity (mild ischemic lesions or severe infarct lesions) and location (strictly lobar or deep brain/infratentorial areas) based on brain magnetic resonance imaging reports. Sex- and age-specific detected rates were calculated, and generalized linear models and multinomial logistic regression were used to analyze the associations between metabolic risk factors and the presence, severity, and location of ischemic lesions stratified by sex.

Results

A total of 2712 (46.8%) participants had at least one brain ischemic lesions. Age (adjusted OR, 1.10 [1.10–1.11], p < 0.001) and hypertension (adjusted OR, 1.42 [1.22–1.64], p < 0.001) were generally associated with higher risks of brain ischemia in both sexes. Metabolic syndrome was associated with greater adjusted ORs for brain ischemia with different severity and location in men (adjusted ORs between 1.23 and 1.49) but not in women. Overweight and obesity were related to lesions located strictly in lobar in men (adjusted OR, 1.23 and 1.33, respectively) and lesions located in deep brain/infratentorial areas in women (adjusted OR, 1.57 and 2.26, respectively).

Conclusions

Metabolic syndrome was associated with brain ischemic lesions in men but not in women. Higher body mass index was related to ischemic lesions located in lobar in men and in deep brain/infratentorial areas in women. Its mechanisms remain to be further investigated.

Modified trapdoor procedures by surgical dislocation approach to treat chondroblastoma of the femoral head

AIMS

The aim of this study was to evaluate the efficacy of the surgical dislocation approach and modified trapdoor procedure for the treatment of chondroblastoma of the femoral head.

PATIENTS AND METHODS

A total of 17 patients (ten boys, seven girls; mean age 16.4 years (11 to 26)) diagnosed with chondroblastoma of the femoral head who underwent surgical dislocation of the hip joint, modified trapdoor procedure, curettage, and bone grafting were enrolled in this study and were followed-up for a mean of 35.9 months (12 to 76). Healing and any local recurrence were assessed via clinical and radiological tests. Functional outcome was evaluated using the Musculoskeletal Tumour Society scoring system (MSTS). Patterns of bone destruction were evaluated using the Lodwick classification. Secondary osteoarthritis was classified via radiological analysis following the Kellgren-Lawrence grading system. Steinberg classification was used to evaluate osteonecrosis of the femoral head.

RESULTS

The epiphyseal plate was open, closing, and closed in five, five, and seven patients, respectively. In total, eight, six, and three patients were classified as having Lodwick classification IA, IB, and IC, respectively. Allogeneic and autogenous bone grafting was used in 13 and four patients, respectively. All patients had good bone healing and no local recurrence was observed. One patient developed osteonecrosis of the femoral head (Steinberg IA) and one developed secondary osteoarthritis of the hip joint (Kellgren-Lawrence Grade II). The mean postoperative MSTS functional score was 27.7 (24 to 30).

CONCLUSION

Surgical dislocation and modified trapdoor procedures are safe and effective techniques for treating chondroblastoma in the femoral head. Cite this article: Bone Joint J 2019;101-B:732-738.

Use of a water-cooled Nd: YAG pulsed laser in the treatment of giant gingival pyogenic granulomas during pregnancy

Pyogenic granuloma is a benign growth characterized by active vascular proliferation and is prone to occurring during pregnancy. Given the complicated conditions of this special group of patients, it is controversial to perform removal therapy before delivery. Here, two giant pregnancy pyogenic granulomas of a patient at 34 weeks gestation were safely, completely and minimally invasively removed by water-cooled Nd: YAG laser without anesthetic agents, suturing or antibiotics. No recurrence was observed after 1 year. This removal therapy immediately relieved the problem of patient nutrition intake and greatly improved the quality of her prenatal preparation. Thus, this report highlights that complete excision of pyogenic granulomas during pregnancy can be performed before delivery when urgent circumstances are considered, and a water-cooled Nd: YAG laser can be applied as a powerful tool in this treatment.

[The subgroup analysis of the prognostic value of the intraductal carcinoma of the prostate in patients with metastatic prostate cancer]

Objective: To determine the prognostic value of the intraductal carcinoma of the prostate IDC-P in metastatic prostate cancer (mPCa) patients of different subgroups. Methods: Data of 582 de novo mPCa patients between January 2011 and December 2017 diagnosed at Departments of Urology, West China Hospital, Sichuan University were retrospectively analyzed. The age was (70±8) years (range: 45 to 89 years). IDC-P was identified from 12-core prostate biopsy. The prognostic role of IDC-P was assessed by Kaplan-Meier curves and Cox regression. Subgroup analysis was conducted by the forest plot. The endpoints were castration-resistant prostate cancer free survival (CFS) and overall survival (OS). Results: In total, 177/582 (30.4%) patients harbored IDC-P. Patients with IDC-P had poorer CFS and OS than those without IDC-P (mCFS: 12.1 months vs. 16.9 months, P=0.000; mOS: 39.7 months vs. not reached, P=0.000). Multivariate Cox regression analysis indicated that, the existence of IDC-P was an independent prognosticator of both CFS (HR=1.40, 95% CI: 1.10 to 1.79, P=0.006) and OS (HR=1.51, 95% CI: 1.02 to 2.25, P=0.041). Subanalysis indicated that, in most subgroups, IDC-P was an adverse prognosticator of both CFS and OS. Even in subgroups with adverse clinicopathological features, e.g. Gleason score 9 to 10 (CFS: HR=1.467, P=0.007; OS: HR=1.807, P=0.013), baseline prostate specific antigen≥50 μg/L (CFS: HR=1.616, P=0.000; OS: HR=1.749, P=0.006), anemia (CFS: HR=1.653, P=0.036; OS: HR=2.100, P=0.038), alkaline phosphatase≥160 U/L (CFS: HR=1.326, P=0.038; OS: HR=1.725, P=0.010) or abnormal lactate dehydrogenase level (CFS: HR=1.614, P=0.001; OS: HR=1.900, P=0.003), IDC-P was still closely associated with shorter CFS and OS. Conclusions: The presence of IDC-P was closely related to poor survival outcomes for patients with mPCa. IDC-P was an adverse prognosticator in most subgroup patients. The description of IDC-P in the pathological report of prostate biopsy would help clinicians to evaluate the prognosis of mPCa patients more accurately and make better treatment choices.

New Strategy of Acute Graft-vs-Host Disease: Investigation of a Reduced Dose of Antithymocyte Globulin in Haploidentical Hematopoietic Stem Cell Transplantation

Graft-vs-host disease (GVHD) is one of the biggest challenges in haploidentical hematopoietic stem cell transplantation. Antithymocyte globulins (ATGs) are widely used to overcome GVHD, but excessive immunosuppression increases the chances of relapse and infection following transplantation. No defined standard of the appropriate dose of ATG usage is recognized. The study included 11 patients who were treated with a reduced dose of ATG to prevent GVHD in haploidentical hematopoietic stem cell transplantation. A reduced dose of ATG-Thymoglobulin (total dose of 5 mg/kg) was used in the pretreatment protocol for 2 consecutive days. All patients had successful transplantation. The median time of neutrophil engraftment was 12 days. All chimerism tests passed on day 30, 60, and 90 post transplantation. None of the patients had acute GVHD, while only 2 patients had I to II degree chronic GVHD (18.2%). No transplantation-related deaths were observed. The current findings suggest that the reduced dose of ATG can effectively prevent the incidence of acute GVHD in haploidentical hematopoietic stem cell transplantation.

[All levels miniplate fixation and a modified hybrid fixation method in expansive open-door cervical laminoplasty: a retrospective comparative study]

OBJECTIVE

To retrospectively compare the effect of alternate levels miniplate and anchor fixation with the effect of all levels miniplate fixation in expansive open-door cervical laminoplasty (EOLP).

METHODS

Patients with cervical spondylosis underwent EOLP between July 2015 and June 2016 were included in the study. There were 33 patients in the alternate group (alternate levels miniplate and anchor fixation group) and 34 patients in the miniplate group (all levels miniplate fixation group). Neurological function was evaluated with the Japanese Orthopedic Association (JOA) score and degree of pain was assessed with the visual analogue scale (VAS) score. Basic clinical and surgical data, complication rates and medical costs of the two groups were compared. In addition, radiological examinations were performed pre- and post-operatively and at the final follow-up. Relative imaging data such as anteroposterior diameter (APD), cervical curvature index (CCI) and open angle were collected and compared.

RESULTS

(1) The mean follow-up time was 18.6 months in the alternate group and 18.9 months in the miniplate group. There were no significant differences in operation time, intraoperative blood loss, perioperative complication rates, post-operative hospital stays, VAS scores and neurological recovery rates preoperatively and at the final follow-up between the two groups. (2) Additionally, no obvious differences were observed about CCIs and APDs at the three follow-up time points between the two groups. Post-operative open angles at C4 and C6 in the alternate group were significantly smaller than those in the miniplate group. However, there were no significant differences in C3, C5 and C7 open angles between the two groups post-operatively. Notably, no significant differences were detected about the open angles at all levels between the two groups at the final follow-up. (3) When comparing radiologic data at different time points in each group, CCIs and open angles at each level had no significant differences, but APDs after surgery and at the final follow-up were significantly larger than pre-operative APDs. (4) Total costs in the alternate group were significantly lower than those in the miniplate group.

CONCLUSION

The two surgical methods showed almost the same neurological recovery rates and complication rates. However, use of alternate levels miniplate and anchor fixation in EOLP can reduce medical expenses.

[Clinical significance of exosomal miR-1231 in pancreatic cancer]

Objective: To investigate the expression and clinical significance of exosomal miR-1231 in plasma of pancreatic cancer (PC) patients and pancreatic cancer cells. Methods: A total of 16 patients who were diagnosed with pancreatic cancer in Hunan Cancer Hospital were collected from April 2016 to August 2017. Meanwhile, 16 healthy volunteers were recruited as the healthy control group at the same period. The plasma exosomes were extracted, and the levels of miR-1231 were detected by qRT-PCR in PC and healthy control groups. Moreover, the clinicopathological significance of exosomal miR-1231 expression was analyzed. Furthermore, the expression of exosomal miR-1231 was detected in several pancreatic cancer cells (MIA PaCa-2, PANC-1, SW1990, AsPC-1 and BxPc-3) and two normal pancreatic epithelial cells (HPDE and human primary pancreatic epithelial cell). Results: qRT-PCR results showed that the expression level of miR-1231 in plasma exosomes of pancreatic cancer patients (1.06±0.46) was significantly lower than that in healthy controls (2.30±0.99; P<0.05). The levels of exosomal miR-1231 in patients with stage Ⅰ-Ⅱ (1.515±0.531), no distant metastasis (1.236±0.461) and no lymph node metastasis (1.337±0.522) were significantly higher than those with stage Ⅲ-Ⅳ (0.848±0.224), distant metastasis (0.757±0.278) and lymph node metastasis (0.838±0.261), respectively (P<0.05 for all). In addition, there were no correlation between exosomal miR-1231 expression and age, sex, smoking history, CA19-9 levels and tumor sites (P>0.05). Furthermore, the expression level of exosomal miR-1231 in pancreatic cancer cell lines (0.142±0.135) was significantly lower than that in normal epithelial cells (1.127±0.179; P<0.05). Conclusions: The downregulation of exosomal miR-1231 in plasma of pancreatic cancer patients and pancreatic cancer cells suggests that it is related to the initiation and development of PC. It may be a new diagnostic and prognostic marker for PC.

The clinical significance of perineural invasion in patients with de novo metastatic prostate cancer

BACKGROUND

The clinical value of perineural invasion (PNI) in patients with localized prostate cancer (PCa) is widely explored. However, its role in metastatic PCa (mPCa) remains unknown.

OBJECTIVES

We aim to investigate the clinical significance of PNI in patients with mPCa.

MATERIALS AND METHODS

Data of 515 mPCa patients between 2012 and 2018 were retrospectively studied. PNI and its intensity were identified by prostate biopsy. The prognostic value of PNI was evaluated by Kaplan-Meier curves and Cox proportional-hazards model.

RESULTS

Perineural invasion was detected in 170/515 (33.0%) cases. Among them 73/170 (42.9%) and 97/170 (57.1%) harbored unifocal PNI (uni-PNI) and multifocal PNI (multi-PNI), respectively. Compared to patients without PNI, those with PNI had statistically shorter castration-resistant PCa-free survival (CFS) and numerically shorter overall survival (OS) (mCFS: 15.4- vs. 18.5-Mo, p = 0.015; mOS: 63.8- vs. 71.4-Mo, p = 0.108). Patients harboring multi-PNI were associated with poorer clinical outcomes than those with uni-PNI (mCFS: 12.4- vs. 18.0-Mo, p = 0.040; mOS: 39.7-Mo vs. NR, p = 0.018) or those without PNI (mCFS: 12.4- vs. 18.5-Mo, p = 0.002; mOS: 39.7- vs. 71.4-Mo, p = 0.002). Totally, neither uni-PNI nor multi-PNI was an independent risk factor impacting survival outcomes in multivariate analyses. While remarkably, for patients with favorable/intermediate-risk mPCa, multi-PNI was an independent adverse prognosticator for both CFS and OS (CFS: HR: 1.705, 95% CI: 1.029-2.825, p = 0.038; OS: HR: 3.294, 95% CI: 1.464-7.413, p = 0.004).

DISCUSSION AND CONCLUSION

This study filled the blank of the clinical significance of PNI in mPCa. We found that multi-PNI could distinguish men with relatively poor prognosis from patients initially regarded as with favorable survival outcomes by other prognosticators, and thus, avoid disease underestimation in this group of patients. Our finding would help physicians have a deeper understanding of the heterogeneity of mPCa and make better individualized therapeutic strategy.

Cathepsin L is involved in proliferation and invasion of breast cancer cells

Cathepsin L(CTSL), a lysosomal endopeptidase was found overexpressed in Breast cancer (BC). The purpose of this work was to investigate the possible role of CTSL in the development of BC. RNA interference(RNAi) with a CTSL small hairpin RNAs(CTSL-shRNA) and plasmid with CTSL were used to identify the effects of CTSL on malignant behaviors of BC. MCF-7 and SKBR-3 were selected as cell models in vitro and in vivo. The results showed that down-regulation of CTSL can significantly inhibit the proliferative and invasive ability of MCF-7 cell, while up-regulation of CTSL in SKBR-3 cells had opposite effects. Comparing to parental BC cells, CTSL knockdown cells exhibited attenuated capacities in developing tumor in nude mice, furthermore, the growth of these xenografts were dramatically regressed. In conclusion, our findings suggest that CTSL contributes to the proliferation and metastasis of BC and might be a potent molecular target for BC treatment.

[A preliminary study on the outcome of lower-risk myelodysplastic syndrome by low-dose decitabine]

目的

评价小剂量地西他滨治疗较低危骨髓增生异常综合征（MDS）患者的初步疗效及安全性，探讨MDS相关基因突变的临床意义。

方法

纳入浙江省4所医院收治的62例较低危MDS患者，治疗分2组，地西他滨组（地西他滨12 mg·m⁻²·d⁻¹，连续5 d）和支持治疗组，检测与MDS预后相关的15项基因突变情况。比较两组患者的总体有效率（ORR）和无进展生存（PFS）时间，分析其与基因突变的相关性。

结果

62例患者中，可评估患者51例，其中地西他滨组24例，支持治疗组27例。与支持治疗组相比，地西他滨组的ORR（66.7%对29.6%，χ²=6.996，P=0.008）和中位PFS时间显著改善（未达到对13.7个月，P=0.037）。51例患者中20例（39.2%）检测到基因突变阳性，其中4例患者单纯SF3B1阳性，均在支持治疗组。与基因突变阴性患者相比，16例基因突变阳性（除单纯SF3B1阳性）患者中位PFS时间显著缩短（9.2个月对18.5个月，P=0.008），其中地西他滨组8例患者中6例有效，支持治疗组无一例（0/8）有效。地西他滨治疗期间主要不良反应为3~4级粒细胞减少（45.8%），3~4级感染发生率为33.3%（8/24）。

结论

该研究小系列患者的初步结果表明应用小剂量地西他滨治疗较低危MDS患者可能有效，对于基因突变患者也可获益，且患者耐受，值得临床试验进一步明确其临床意义。

Volatile flavour components, microbiota and their correlations in different sufu, a Chinese fermented soybean food

AIM

To investigate the volatile flavour components (VFCs), microbiota and their correlations of three categories of sufu, a Chinese fermented soybean food.

METHODS AND RESULTS

The VFCs were analyzed by headspace solid-phase micro-extraction (HS-SPME) combined with gas chromatography and mass spectrometry. A total of 141 VFCs were tentatively identified, in which 12 esters, eight aldehydes, five alcohols and nine miscellaneous compounds were recognized as the characteristic VFCs through the relative odour activity value. The complex microbial community was revealed by Illumina MiSeq sequencing. Among the total 202 bacteria and 125 fungi species identified, 16 bacteria and 7 fungi species were revealed as dominant community members. Furthermore, the VFC-microbiota correlation was characterized by Spearman's rank correlation coefficients (ρ). Based on the positive VFC-microbiota correlation, two bacterial species and three fungal species were selected as potential flavour-producing microbiota.

CONCLUSIONS

A variety of VFCs and complicated microbiota were observed in the three categories of sufu. Lactococcus lactis, Sphingobacterium sp., Pichia fermentans, Kodamaea ohmeri and Saccharomyces rouxii were the potential flavour-producing microbiota.

SIGNIFICANCE AND IMPACT OF THE STUDY

The preliminary results would be useful for designing starter cultures to produce sufu with desirable sensory properties, consistent flavour and shorter ripening time. Furthermore, these results will also provide a new insight to improve the flavour quality of traditional fermented soybean food.

Investigation of the multiplet features of SrTiO3 in X-ray absorption spectra based on configuration interaction calculations

Synchrotron-based L_2,3-edge absorption spectra show strong sensitivities to the local electronic structure and chemical environment. However, detailed physical information cannot be extracted easily without computational aids. Here, using the experimental Ti L_2,3-edges absorption spectrum of SrTiO₃ as a fingerprint and considering full multiplet effects, calculations yield different energy parameters characterizing local ground state properties. The peak splitting and intensity ratios of the L₃ and L₂ set of peaks are carefully analyzed quantitatively, giving rise to a small hybridization energy around 1.2 eV, and the different hybridization energy values reported in the literature are further addressed. Finally, absorption spectra with different linearly polarized photons under various tetragonal crystal fields are investigated, revealing a non-linear orbital-lattice interaction, and a theoretical guidance for material engineering of SrTiO₃-based thin films and heterostructures is offered. Detailed analysis of spectrum shifts with different tetragonal crystal fields suggests that the e_g crystal field splitting is a necessary parameter for a thorough analysis of the spectra, even though it is not relevant for the ground state properties.

A cosmopolitan late Ediacaran biotic assemblage: new fossils from Nevada and Namibia support a global biostratigraphic link

Owing to the lack of temporally well-constrained Ediacaran fossil localities containing overlapping biotic assemblages, it has remained uncertain if the latest Ediacaran (ca 550-541 Ma) assemblages reflect systematic biological turnover or environmental, taphonomic or biogeographic biases. Here, we report new latest Ediacaran fossil discoveries from the lower member of the Wood Canyon Formation in Nye County, Nevada, including the first figured reports of erniettomorphs, Gaojiashania, Conotubus and other problematic fossils. The fossils are spectacularly preserved in three taphonomic windows and occur in greater than 11 stratigraphic horizons, all of which are below the first appearance of Treptichnus pedum and the nadir of a large negative δ¹³C excursion that is a chemostratigraphic marker of the Ediacaran-Cambrian boundary. The co-occurrence of morphologically diverse tubular fossils and erniettomorphs in Nevada provides a biostratigraphic link among latest Ediacaran fossil localities globally. Integrated with a new report of Gaojiashania from Namibia, previous fossil reports and existing age constraints, these finds demonstrate a distinctive late Ediacaran fossil assemblage comprising at least two groups of macroscopic organisms with dissimilar body plans that ecologically and temporally overlapped for at least 6 Myr at the close of the Ediacaran Period. This cosmopolitan biotic assemblage disappeared from the fossil record at the end of the Ediacaran Period, prior to the Cambrian radiation.

[The clinical characteristics, diagnosis and treatment of patients with gout in China]

Objective: To investigate the demographic characteristics, clinical features, diagnosis and treatment of patients with gout in China. Methods: Clinical data of 6 814 patients with gout from 100 hospitals in 27 provinces, municipalities or autonomous regions in China were collected and analyzed. Results: (1) The ratio of male to female in patients with gout was 14.7∶1. The mean age of onset was (48.8±15.1) years old. Mean serum urate level was (526.7±132.3) μmol/L. Patients' education background was of U-shaped distribution; (2) Hypertension was the most common comorbidity [15.8%(1 079/6 814)], then overweight or obesity [51.9%(3 536/6 814)]; (3) Alcohol and high-purine food intake were dominant triggering factors in men. The diagnosis of gout was made after onset in majority of patients with cardinal symptom arthralgia. Most patients had the disease less than 5 years, and the longer the course, the more flares in the previous year of entry; (4) Febuxostat was the mostly used urate-lowering medication. 20.7%(1 412/6 814), 10.8%(739/6 814) and 3.9%(265/6 814) of patients were followed up in 4 weeks, 12 weeks and 24 weeks after registration, and 18.9%(267/1 412), 29.1%(215/739) and 38.1%(101/265) of them reached the control target of serum urate levels, respectively. After treatment, patients' liver function was not affected, but serum creatinine levels decreased significantly. Conclusions: The proportion of gout patients who reach target serum urate level is very low. Further steps including education and survey need to be carried on.

Author Correction: Metabolic Biomarkers for Prognostic Prediction of Pre-diabetes: results from a longitudinal cohort study

A correction to this article has been published and is linked from the HTML version of this paper. The error has been fixed in the paper.

[The analysis of anesthetic management for renal cell carcinoma with associated inferior vena cava tumor thrombus]

Objective: To explore the key points of anesthetic management for renal cell carcinoma combined with inferior vena cava (IVC) tumor thrombus. Methods: Twenty-seven cases of renal cell carcinoma with inferior vena cava (IVC) tumor thrombus underwent radical nephrectomy and inferior caval venous thrombectomy were reviewed retrospectively during January 2014 to January 2017 in our hospital.Analyzed data includs demographics, classification of tumor, perioperative anesthetic management and monitoring approaches, IVC clamping time , vital signs during cardiopulmonary bypass(CPB), estimated blood loss (EBL), usage of blood products, hospitalization time and ICU time , as well as postoperative outcomes. Results: Clinical staging revealed 5 patients(18.5%) with classⅠtumor thrombus, 11 patients(40.7%) with levelⅡtumor thrombus, 6 patients (22.2%) with level Ⅲ tumor thrombus and 5 patients (18.5%) with level Ⅳ tumor thrombus. All patients had underwent a balanced general anesthesia technique with volatile agents, opioids and muscle relaxants. In addition to standard ASA monitors, all patients had direct arterial pressure and central venous pressure monitoring, and blood warming and infusing system. TEE was utilized in 9(33.3%)patients and in which contains all 5 patients(100%)with level Ⅳ tumor thrombus. Intraoperative TEE guidance resulted in a significant surgical plan modification in 1 patient(11.1%). Compared to patients with class Ⅰ(313 (136, 346) min), classⅡ(302(245, 393)min)and classⅢthrombus tumor(391(272, 505)min), patients with Class Ⅳ had longer operating time (525(481, 647)min, P<0.05). Compared to patients with Class Ⅰ(600(500, 850)ml), Class Ⅱ(1 700(750, 3 000)ml), and Class Ⅲ(1 775(1 500, 3 000)ml), patients with Class Ⅳ had more blood loss(4 000(2 000, 7 000)ml, P<0.05). The clamping time of Class Ⅰ, Class Ⅱ and Class Ⅲ was 8(8, 9)min, 20(13, 26)min and 10(6, 25)min, respectively, and there is no significant difference (P>0.05) within theses group. The probability of pumping norepinephrine of Class Ⅰ(8(8, 9)min), Class Ⅱ(20(13, 26)min), and Class Ⅲ(10(6, 25)min)had no significant difference (χ(2)=5.147, P>0.05). Perioperative mortality was 7.4%. Conclusions: The anesthetic management of Inferior vena cava (IVC) tumor thrombus is rather challenging.The preoperative evaluation with accurate classification of the tumor and the intraoperative intense monitoring of vital signs with appropriate reaction are the key points of anesthetic management for this kind of surgery.

[The association between aflatoxin exposure and primary hepatocellular carcinoma risks: a case-control study in Chongqing]

Objective: To investigate the association between aflatoxin exposure and primary hepatocellular carcinoma (PHC) development. Methods: From December 2013 to May 2016, we selected 214 patients newly diagnosed with PHC as cases, and 214 patients as controls from three hospitals in Chongqing. Cases were confirmed with PHC diagnosis standard. And cases caused by clear reasons such as drug-induced liver injury, alcoholic liver damage, fatty liver and gallstones etiology, were excluded. Controls were included with no cancer and no digestive system disease, and recruited simultaneously with cases. Cases and controls were frequency-matched (1∶1) by same gender and age (±3 years). Peripheral blood and random urine samples were collected and analyzed for serum HBsAg status by biochemistry analyzer, and serum AFB(1)-ALB adduct and urinary AFB(1)-N(7)-GUA adduct by ELISA. Basic information, living habits and history of disease for patients were obtained by questionnaires. We used wilcoxon rank sum test to compare the median of serum AFB(1)-ALB adduct and urinary AFB(1)-N(7)-GUA adduct in cases and controls. Logistic regression analyses were performed to assess risk factors for PHC, and synergism index (S) of aflatoxin with other factors was estimated by the method of Andersson. Results: There was no significant difference in age between PHC cases (50.74±9.67) years and controls (51.15±9.90) years. Logistic regression showed that the odds ratio of HBV infection for PHC development was 46.3 (95% CI: 23.3-88.0). There was a significant difference in median concentrations of serum AFB(1)-ALB adduct (cases vs controls: 146.23 vs 74.42 ng/g albumin, P<0.001), but no difference in median concentrations of urinary AFB(1)-N(7)-GUA adduct was observed (cases vs controls: 0.17 vs 0.14 ng/mg creatinine, P<0.210). The odd ratios for PHC risk after adjustment were 1.9 (95%CI: 1.1-3.4) for AFB(1)-ALB adduct, and 2.1 (95%CI: 1.0-4.2) for AFB(1)-N(7)-GUA adduct. Moreover, we observed a positive interaction of aflatoxin exposure with HBV, alcohol drinking, and diabetes. The S was 4.7 (95%CI: 2.8-7.9), 3.5 (95%CI: 1.0-12.0), and 12.4 (95%CI: 1.8-84.2), respectively for serum AFB(1)-ALB adduct with each of the three factors mentioned, and was 1.9 (95%CI:1.1-3.1), 2.0 (95%CI: 1.1-3.6), and 2.0 (95%CI: 1.1-3.6), respectively for urinary AFB(1)-N(7)-GUA adduct with each of the three factors mentioned. Conclusion: HBV was still the main risk factor, and AFB(1) exposure was also an independent risk factor for PHC in Chongqing. There was a positive interaction of aflatoxin with HBV, alcohol drinking, and diabetes.

[Application of intraoperative cell salvage combined with leukocyte depletion filter on radical nephrectomy for renal carcinoma with inferior vena cava tumor thrombus: 2 case reports]

Intraoperative cell salvage (IOCS) has been widely used to reduce allogeneic blood transfusion and prevent blood transfusion related complications during surgery. However, due to the risk of transfusion related reaction, contamination, and immunological reaction, its use for tumor patients has been controversial and limited. To explore the feasibility of the application of IOCS in cancer patients, we reported 2 cases of renal cell carcinoma (RCC) with tumor embolism in IVC that underwent radical nephrectomy,and inferior caval venous thrombectomy receiving IOCS combined with leukocyte depletion filter (LDF) from August 2016 to November 2016 in our hospital. The cell saver blood salvage (Haemonetics, 5+) was used for these 2 cases. The salvaged blood was filtered through the LDF before infusion. For case 1 (male 45-year-old) the total operation time was 505 min, and the estimated blood loss was 4 500 ml. A total of 1 000 mL autologous blood, 12 u allogeneic packed red blood cells (PRBC), 1 200 mL fresh frozen plasma (FFP) were infused during the procedure. The patient was discharged from hospital after 75 days without complications. The postoperative follow-up for 3 months showed no tumor recurrence or metastasis. For case 2 (a male patient, aged 51 years), the total operation time was 490 min, and the estimated (blood loss was 7 000 mL. the patient received 2 700 mL autologous blood transfusion, 12 u allogeneic packed red blood cells (PRBC), and 2 400 mL fresh frozen plasma (FFP). The patient was discharged from hospital after 86 days without severe complications. the postoperative follow-up for 6 months showed no tumor recurrence or metastasis for this patient. Other relevant retrospective studies with this technique showed that cell salvage could be used safely in many kinds of cancer patients, for example, bladder cancer, liver cancer and kidney cancer. Furthermore,numerous researches have proved the safety and efficacy of the combination of these two techniques, the intraoperative cell salvage technique and leucocyte depletion filter in cancer patients. Here we only reported two cases using IOCS and LDF. Further work is needed to determine whether the use of intraoperative cell salvage combined with leukocyte depletion filter can be used safely for patients with HCC.

Metabolic Biomarkers for Prognostic Prediction of Pre-diabetes: results from a longitudinal cohort study

To investigate the metabolic biomarkers of predicting the transition from pre-diabetes (pre-DM) to normal glucose regulation (NGR) and diabetes (DM) in a longitudinal cohort study. 108 participants with pre-DM were followed up for ten years and divided into 3 groups according to different glycemic outcomes. 20 participants progressed to DM, 20 regressed to NGR, and 68 remained at pre-DM. Alterations in plasma metabolites in these groups were evaluated by untargeted ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS). Twenty three metabolites related to glycerophospholipid metabolism, oxidation and antioxidation were associated with the process from pre-DM to NGR, while twenty two metabolites related to amino acid metabolism, glycerophospholipid metabolism and mitochondrial β-oxidation played important roles in the progression to DM. Results from stepwise logistic regression analysis showed that five biomarkers (20-Hydroxy-leukotriene E4, Lysopc(20:4), 5-methoxytryptamine, Endomorphin-1, Lysopc(20:3)) were good prediction for the restoration to NGR, and five biomarkers (Iso-valeraldehyde, linoleic acid, Lysopc(18:1), 2-Pyrroloylglycine, Dityrosine) for the development of DM. The findings suggest that the combination of these potential metabolites may be used for the prognosis of pre-DM. Targeting the pathways that involved in these prognostic biomarkers would be beneficial for the regression to NGR and the early prevention of DM among pre-DM.

[Anesthetic choice for patients undergoing cesarean section complicated with placenta implantation]

OBJECTIVE

To investigate the anesthetic choice for patients undergoing cesarean section complicated with placenta implantation.

METHODS

A retrospective case review of the patients with placenta implantation between 2008 and 2013 at Peking University Third Hospital was conducted in the International Classification of Diseases (ICD)-9 codes, excluding natural birth and not first diagnosed in our hospital, a total of 96 cases were incorporated into this study. According to the degree of implantation, they were divided into three groups: accreta group, increta group and percreta group. We analyzed the time from the start of surgery to baby delivery and the anesthetic technique.

RESULTS

The accreta group included 49 cases, the increta group 33 cases, and the percreta group 14 cases. The average time from the start of surgery to fetus delivery in the three groups were (6.7±3.0) min, (7.2±4.6) min, and (11.9±4.9) min, and the percreta group was significantly different from the accreta group and the increta group (P<0.05). There were significant differences among the three groups in anesthetic choices (P<0.001): in the accreta group, 45 cases (91.8%) underwent spinal anesthesia, 2 cases (4.1%) underwent general anesthesia, and 2 cases (4.1%) were converted to general anesthesia after spinal anesthesia during the operation; in the increta group, 22 cases (66.7%) underwent spinal anesthesia, 4 cases (12.1%) underwent general anesthesia, and 7 cases(21.2%) were converted to general anesthesia after spinal anesthesia; in the percreta group, 2 cases (14.3%) underwent spinal anesthesia, 2 cases (14.3%) underwent general anesthesia, and 10 cases (71.4%) were converted to general anesthesia after spinal anesthesia.

CONCLUSION

Spinal anesthesia can be used as the first choice of cesarean section complicated with placenta implantation and general anesthesia should be considered in placenta percreta.

Tumour-activated liver stromal cells regulate myeloid-derived suppressor cells accumulation in the liver

Regulating mechanisms underlying hepatic myeloid-derived suppressor cell (MDSC) accumulation remain to be described. Here, we provide evidence for the involvement of tumour-activated liver stromal cells in the process of hepatic MDSCs migration and accumulation. Our data showed an elevated frequency of MDSCs in the liver of tumour-bearing mice. Moreover, tumour-activated liver stromal cells promote MDSC migration into the liver site. Further investigation indicated higher levels of cytokine and chemokine expression in liver stromal cells after exposure to the tumour-conditioned supernatant. Notably, the expression levels of proinflammatory factors, mainly including macrophage colony stimulating factor (M-CSF), transforming growth factor-β (TGF-β), monocyte chemotactic protein-1 (MCP-1) and stromal-derived factor-1 (SDF-1), increased after treatment with tumour-conditioned supernatant, and blockade of MCP-1 or SDF-1 decreased the proportion of tumour infiltrated MDSCs in mice co-transplanted with liver stromal cells and tumour cells, but not in mice with only tumour cells injection. These findings demonstrate that tumour-activated liver stromal cells produce higher levels of chemokines and cytokines, which may contribute to MDSC accumulation into the liver site in patients with liver cancer.

[Current status of antiarrhythmic drug use and safety assessment in Chinese patients with atrial fibrillation]

Objective: To investigate the current status of antiarrhythmic drugs (AADs) use in Chinese patients with atrial fibrillation(AF) and assess the safety of AADs in this patient cohort. Methods: From January 2011 to December 2013, a total of 4 008 AF patients treated with AADs was enrolled in this study and patients were followed up for 24 months. Detailed information of prescribed drug, the causes of drug discontinuation and side effects were recorded. Results: Amiodarone was prescribed to 64.3%(2 579 cases) and propafenone to 31.1%(1 247 cases) of the enrolled patients, only 148 patients(3.7%) were treated with sotalol and 34 patients (0.8%) were treated with moracizine. The prevalence of heart failure (4.0%(102/2 579) vs. 1.4%(17/1 247, P<0.001), coronary heart disease (13.5% (348/2 579) vs. 7.4%(93/1 247), P<0.001) and non-ischemic cardiomyopathy (3.1%(78/2 579) vs. 0.7%(9/1 247), P<0.001) was significantly higher in patients treated with amiodarone than in the patients treated with propafenone. During the follow-up period, the discontinuation rate of amiodarone, propafenone, sotalol and moracizine was 28.8%(743/2 579), 25.1%(313/1 247), 14.2%(21/148) and 32.4%(11/34) respectively. The reasons of discontinuing amiodarone were: follow physicians' decision (75.7%, 563 cases), no effect (3.0%, 22 cases), side effects (4.3%, 32 cases) and patients' own decision (17.0%, 126 cases). The side effects of amiodarone included thyroid dysfunction (56.3%, 18 cases), bradycardia (12.5%, 4 cases), interstitial pneumonitis/pulmonary interstitial fibrosis (6.2%, 2 cases) and others (gastrointestinal symptom, rash, hepatic dysfunction, etc.). Conclusions: Amiodarone and propafenone are the most common AADs used in Chinese patients with atrial fibrillation. The prescription of AADs is essentially in accordance to the guideline of AF treatment. However, the discontinuation rates of AADs are high in Chinese AF patients. Lacking of better AADs is still a major problem in AF pharmacotherapy. Clinical Trial Registry Chinese Clinical Trial Registry, ChiCTR-OCH-13003729.

[Comparison of severity and clinical outcomes between hypertriglyceridemic pancreatitis and acute pancreatitis due to other causes]

OBJECTIVE

To investigate the difference in severity and clinical outcomes between hypertriglyceridemic pancreatitis (HTGP) and acute pancreatitis (AP) of other causes, and to analyze the correlation between the serum triglyceride (TG) level <24 h after onset and the disease severity.

METHODS

Patients were selected from the AP database of the First Affiliated Hospital of Nanchang University, who were admitted between January 2005 and December 2013, aged ≥18 and ≤85 years, excluding pregnant or lactating women. Severity and etiology of AP were classified according to the latest relevant guidelines. The severity and clinical outcomes of HTGP patients (HTGP group) were compared with those of patients with AP of other causes (non-HTGP group). Among the HTGP patients, those admitted within 24 hours of onset were selected for comparison of serum TG levels on the first day of hospitalization day among patients with mild, moderate, and severe HTGP, and the correlation between the serum TG level and the severity was analyzed.

RESULTS

Altogether 3 558 AP patients were selected, of which 623 (17.5%) were HTGP, and 2 935 (82.5%)were non-HTGP patients. Compared with the non-HTGP group, the HTGP group had higher incidence of pancreatic necrosis (28.3% vs 18.1%), infected pancreatic necrosis (6.1% vs 3.7%), organ failure(35.8% vs 29.1%), and persistent organ failure(24.4% vs 16.5%), with all the differences being statistically significant (all P<0.01). The mortality and average stay in intensive care unit were also higher in the HTGP group than in the non-HTGP group (all P<0.05). There were 291 patients with HTGP who were admitted to hospital within 24 hours of onset. The serum TG levels <24 h after onset were (9.38±9.00) mmol/L, (11.90±9.02) mmol/L, and (16.47±11.75) mmol/L in patients with mild, moderate, and severe HTGP, respectively (P<0.01). Spearman's correlation analysis showed a positive correlation between TG level <24 h after onset and disease severity (r=0.26, P<0.01).

CONCLUSIONS

Compared with AP of other causes, HTGP patients have more severe clinical course and worse clinical outcomes. The serum TG level within 24 hours of onset may be positively correlated with the severity of HTGP.

[Anesthesia management of caesarean section for pregnant women complicated with Takayasu's arteritis]

Takayasu's arteritis is a rare, idiopathic, chronic inflammatory disease. Its course is unpredictable, but slow progression is usual, leading to stenosis, occlusion, or aneurismal degeneration of the aorta or its major branches. We present the anesthesia management of pregnancy in four women admitted to Peking University Third Hospital for caesarean section from year 2006 to 2015 complicated with Takayasu's arteritis and review this disease with special reference to natural history, diagnostic criteria, classification, prognostic factors, and anesthesia considerations. Anesthesiological data were retrospectively analyzed for clinical manifestations, anesthesia process, perioperative complications, and pregnancy outcome. One patient received only epidural anesthesia, while the other three patients received combined spinal and epidural anesthesia (CSEA). Surgeries for all the four patients were successful with stable vital signs. We found comprehensive examinations including whether the disease was in the active phase and the clinical classification of the disease before conception was recommended for patients diagnosed with Takayasu's arteritis. CSEA and continuous epidural block could be both used as anesthesiological method in patients with Takayasu's arteritis. During the surgery, to avoid rapid hemodynamic fluctuations and protect the major organs' function is very essential to allow for a satisfactory outcome.