[Lung transplantation for pulmonary alveolar proteinosis: a case report and literature review]

Objective: To observe the efficacy of lung transplantation for pulmonary alveolar proteinosis (PAP) patients and to improve the understanding of the therapy. Methods: The clinical data of a patient with autoimmune PAP treated with sequential homogenous bilateral lung transplantation were described and the literatures were reviewed. Results: This 55-year-old female patient was diagnosed with autoimmune PAP and had been treated with whole lung lavage for 19 times, but only achieved short-term symptomatic relief after each operation. Inhalation of granulocyte macrophage colony stimulating factor occurred allergic reactions. Lung transplantation was performed on February 15, 2022, and a significant improvement in oxygenation and clinical symptoms were observed. The patient remained stable during follow-up. Conclusion: Treatment with lung transplantation is safe and effective for end-stage patients with PAP in the early phase, but the long-term effect remains to be observed.

[Clinical study of mesenchymal stem cells from third-party donors in the treatment of refractory late onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplanation]

Objective: To examine the efficacy and safety of third-party bone marrow-derived mesenchymal stem cells (MSCs) in the treatment of refractory delayed hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Twenty patients with refractory LOHC received conventional therapy combined with MSCs obtained from third-party donors' bone marrow (BM) . MSCs were given intravenously at a dose of 1 × 10(6) cells/kg once weekly until either the symptoms improved or no changes in LOHC were seen after continuous infusion four times. BK viruria (BKV) -DNA, JC viruria (JCV) -DNA, and CMV-DNA were detected by real-time quantitative PCR before and 8 weeks after the MSCs infusion. Results: ① Of the 20 patients with refractory LOHC, 15 were males, and 5 were females, and the median age was 35 (15-56) years. There were 5 cases of acute lymphoblastic leukemia (ALL) , 9 cases of acute myeloid leukemia (AML) , 5 cases of myelodysplastic syndrome (MDS) , and 1 case of maternal plasma cell like dendritic cell tumor (BPDCN) . There were 4 cases of HLA identical transplantation and 16 cases of HLA incomplete transplantation. ②The median number of MSC infusions for each patient was 3 (range: 2-8) . Seventeen patients achieved complete response, and one had a partial response after treatment. The overall response rate was 90%. Over a median follow-up period of 397.5 days (range 39-937 days) post-transplantations, 13 patients survived, and 7 died. The causes of death included aGVHD (1 case) , infections (5 cases) , and TMA (1 case) . ③The copy numbers of BKV-DNA and CMV-DNA in urine in the 8th week after MSCs infusion were significantly lower than those observed before treatment (11342.1×10(8) copies/L vs 5.2×10(8) copies/L, P=0.016; 3170.0×10(4) copies/L vs 0.2×10(4) copies/L, P=0.006, respectively) , while JCV-DNA did not significantly differ when compared to before treatment (P=0.106) . ④ No adverse reactions related to MSC infusion occurred in any of the 20 patients. Conclusion: Third-party bone marrow-derived MSC has significant efficacy and good safety in the treatment of refractory LOHC after allogeneic HSCT.

OP0093 INCREASED RISK OF SEVERE INFECTIONS AND MORTALITY IN PATIENTS WITH NEWLY DIAGNOSED ANTINEUTROPHIL CYTOPLASMIC ANTIBODY ASSOCIATED VASCULITIS: A POPULATION-BASED STUDY

Background

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are a group of multisystem inflammatory diseases of the small blood vessels, characterized by leukocytoclastic inflammation of small blood vessels and triggered by production of ANCA autoantibodies [1]. Due to the multiorgan involvement and relapsing nature, AAV is among the systemic autoimmune rheumatic diseases with the highest morbidity and mortality [1, 2].

Objectives

To evaluate the risk of severe infection and infection-related mortality among patients with newly diagnosed AAV.

Methods

We conducted an age- and gender- matched cohort study of all patients with incident AAV between January 1, 1997 and March 31, 2015 using administrative health data from British Columbia, Canada. Primary outcome was the first severe infection after AAV onset necessitating hospitalization or occurring during hospitalization. Secondary outcomes were total number of severe infections and infection-related mortality.

Results

We identified 549 AAV patients and matched them with 5,490 non-AAV individuals from the general population, yielding 184 and 509 first severe infections during 2,539 and 33,342 person-years follow-up, respectively. The crude incidence rate ratios for first severe infection and infection-related mortality were 5.03 (95% CI, 4.25-5.96) and 3.72 (95% CI, 2.44-5.67), respectively. The corresponding adjusted hazard ratios were 3.77 (95% CI 2.94-4.85) and 3.84 (95% CI, 2.13-6.91). AAV patients had an increased risk of a greater total number of severe infections with crude rate ratio of 4.99 (95% CI, 4.42-5.62) and adjusted rate ratio of 3.20 (95% CI, 2.73-3.74).

Conclusion

AAV is independently associated with increased risks of first severe infection (3.8-fold), a greater total number of severe infections (3.2-fold) and infection-related mortality (3.8-fold).

References

[1]Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013;65(1):1-11.

[2]Little MA, Nightingale P, Verburgh CA, et al. Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis. Ann Rheum Dis 2010;69(6):1036-43.

Table 1.

Risk of severe infection in AAV relative to non-AAV during follow-up

Post-AAV diagnosis first severe infectionAAV cohortNon-AAV cohortN=549N=5,490No. of events184509IR per 1,000 person-years72.4614.40IRR (95% CI)5.03 (4.25-5.96)1Age and gender adjusted HR (95% CI)5.29 (4.43-6.31)1All but GC adjusted HR (95% CI)3.32 (2.67-4.13)1Fully adjusted HR* (95% CI)3.77 (2.94-4.85)1Post-AAV total number of severe infectionsInfection episodes396868IR per 1,000 person-years116.4223.35IRR (95% CI)4.99 (4.42-5.62)1Age and gender adjusted rate ratio (95% CI)5.27 (4.78-5.93)1All but GC adjusted rate ratio (95% CI)3.13 (2.72-3.59)1Fully adjusted rate ratio* (95% CI)3.20 (2.73-3.74)1Infection-related mortalityNo. of infection-related death events2985IR per 1,000 person-years8.532.29IRR (95% CI)3.72 (2.44-5.67)1Age and gender adjusted HR (95% CI)4.43 (2.89-6.79)1All but GC adjusted HR (95% CI)3.67 (2.14-6.31)1Fully adjusted HR* (95% CI)3.84 (2.13-6.91)1

Abbreviations: AAV, Antineutrophil cytoplasmic antibody-associated vasculitides; IR, incidence rate; IRR, incidence rate ratio; HR, hazard ratio; CI, confidence interval.

*Adjusted for baseline covariates. All but GC HRs represent the total effect while fully adjusted HRs represent the direct effect of AAV.

Disclosure of Interests

None declared.

Open magnetic shielding for static and alternating field

To meet the increasing and various demands for low magnetic field measurement, an open magnetic shielding system created using a combination of copper coils and precisely designed superconducting closed coils is proposed. After testing, the prototype system showed a shielding factor of more than 10 000 in the direct current field and most importantly, a shielding factor of at least 100 in the alternating field from frequencies of 0.01-100 Hz in a 5 cm spherical volume. We interestingly found that the magnetic purity of the open system is capable of catching up with the magnetically shielded room with moderate performance. The structure and principle of the system are introduced in this paper. A key factor that makes the system possible is the decoupled interaction between the copper coils and superconducting coils. The limitations of this system and ways to improve its performance are discussed. This novel approach provides a more sophisticated and flexible way to achieve open magnetic shielding.

Deep Learning Assisted Diagnosis of Musculoskeletal Tumors Based on Contrast-Enhanced Magnetic Resonance Imaging

BACKGROUND

Misdiagnosis of malignant musculoskeletal tumors may lead to the delay of intervention, resulting in amputation or death.

PURPOSE

To improve the diagnostic efficacy of musculoskeletal tumors by developing deep learning (DL) models based on contrast-enhanced magnetic resonance imaging and to quantify the improvement in diagnostic performance obtained by using these models.

STUDY TYPE

Retrospective.

POPULATION

Three hundreds and four musculoskeletal tumors, including 212 malignant and 92 benign lesions, were randomized into the training (n = 180), validation (n = 62) and testing cohort (n = 62).

FIELD STRENGTH/SEQUENCE

A 3 T/T₁ -weighted (T₁ -w), T₂ -weighted (T₂ -w), diffusion-weighted imaging (DWI), and contrast-enhanced T1-weighted (CET₁ -w) images.

ASSESSMENT

Three DL models based, respectively, on the sagittal, coronal, and axial MR images were constructed to predict the malignancy of tumors. Blinded to the prediction results, a group of specialists made independent initial diagnoses for each patient by reading all image sequences. One month after the initial diagnoses, the same group of doctors made another round of diagnoses knowing the malignancy of each tumor predicted by the three models. The reference standard was the pathological diagnosis of malignancy.

STATISTICAL TESTS

Sensitivity, specificity, and accuracy (all with 95% confidential intervals [CI]) corresponding to each diagnostic test were computed. Chi-square tests were used to assess the differences in those parameters with and without DL models. A P value < 0.05 was considered statistically significant.

RESULTS

The developed models significantly improved the diagnostic sensitivities of two oncologists by 0.15 (95% CI: 0.06-0.24) and 0.36 (95% CI: 0.24-0.28), one radiologist by 0.12 (95% CI: 0.04-0.20), and three of the four orthopedists, respectively, by 0.12 (95% CI: 0.04-0.20), 0.29 (95% CI: 0.18-0.40), and 0.23 (95% CI: 0.13-0.33), without impairing any of their diagnostic specificities (all P > 0.128).

DATA CONCLUSION

The DL models developed can significantly improve the performance of doctors with different training and experience in diagnosing musculoskeletal tumors.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 2.

[Clinical research progress on disappearing colorectal liver metastases]

Colorectal cancer is currently one of the most common digestive system tumors, and the liver is the most common metastatic site of colorectal cancer. In recent years, with the continuous development of the multidisciplinary treatment for colorectal cancer patients, there are quite a few cases of disappearing liver metastases (DLM) after receiving preoperative chemotherapy (or combined targeted drug therapy), and the diagnosis and treatment of DLM is currently still a very challenging and controversial topic. This article sorts out the related researches on DLM in recent years, mainly including the following 4 aspects: (1) The factors associated with DLM, including the size and number of liver metastases, chemotherapy regimens and cycles, targeted therapy drugs, and the pattern of liver metastases, Ras/Braf status and the location of the primary lesion. (2) The relationship between DLM and true complete response (pathological complete response and persistent clinical complete response), and the related predictive factors of pathological complete response. (3) Clinical evaluation of DLM: preoperative evaluation includes ultrasound, CT, MRI, and PET, while intraoperative evaluation includes intraoperative exploration, intraoperative ultrasound, and augmented reality. (4) DLM treatment strategies, including surgical treatment, local treatment, non-surgical treatment and individualized treatment.

Effects of powder size and preset thickness on the microstructure and properties of Ni35 thin coating prepared by laser cladding

Ni35 thin coatings were prepared on 40Cr steel by preset powder laser cladding technology. The effects of powder size and preset thickness on the dilution rate, microstructure, and properties of the coating were systematically studied. The results showed that the coating with smaller powder size and larger preset thickness had smaller grain size, denser microstructure, a flatter bottom of the molten pool, and lower dilution rate. The micro-hardness of the coating with large powder size and preset thickness was higher. The friction coefficient of the coating with small powder size and small preset thickness was smaller, but the latter had larger curve fluctuation and wear volume loss. The corrosion rate of the coating was high during the first 24 h, then relatively stable after 68 h, and the corrosion rate and loss of the coating with small powder size and large preset thickness were smaller.

Reconfigurable artificial microswimmers with internal feedback

Self-propelling microparticles are often proposed as synthetic models for biological microswimmers, yet they lack the internally regulated adaptation of their biological counterparts. Conversely, adaptation can be encoded in larger-scale soft-robotic devices but remains elusive to transfer to the colloidal scale. Here, we create responsive microswimmers, powered by electro-hydrodynamic flows, which can adapt their motility via internal reconfiguration. Using sequential capillary assembly, we fabricate deterministic colloidal clusters comprising soft thermo-responsive microgels and light-absorbing particles. Light absorption induces preferential local heating and triggers the volume phase transition of the microgels, leading to an adaptation of the clusters' motility, which is orthogonal to their propulsion scheme. We rationalize this response via the coupling between self-propulsion and variations of particle shape and dielectric properties upon heating. Harnessing such coupling allows for strategies to achieve local dynamical control with simple illumination patterns, revealing exciting opportunities for developing tactic active materials.

Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis

Background

A defective nutrient foramen in the fovea capitis femoris was hypothesized to reflect the blood circulation pattern of the femoral head, leading to insufficient blood supply and causing osteonecrosis of the femoral head.

Methods

Normal and necrotic femoral head specimens were collected. The necrotic femoral head group was divided into a non-traumatic and traumatic subgroup. 3D scanning was applied to read the number, the diameter, and the total cross-sectional area of the nutrient foramina in the fovea capitis femoris. Chi-squared tests and independent t-tests were used to detect any differences in the categorical and continuous demographic variables. Logistic regression models were used to estimate the odds ratio (OR) for non-traumatic and traumatic osteonecrosis in different characteristic comparisons.

Results

A total of 249 femoral head specimens were collected, including 100 normal femoral heads and 149 necrotic femoral heads. The necrotic femoral head group revealed a significantly higher percentage of no nutrient foramen (p < 0.001), a smaller total area of nutrient foramina (p < 0.001), a smaller mean area of nutrient foramina (p = 0.014), a lower maximum diameter of the nutrient foramen (p < 0.001), and a lower minimum diameter of the nutrient foramen (p < 0.001) than the normal femoral head group. The logistic regression model demonstrated an increasing number of nutrient foramina (crude OR, 0.51; p < 0.001), a larger total area of nutrient foramina (crude OR, 0.58; p < 0.001), a larger mean area of nutrient foramina (crude OR, 0.52; p = 0.023), a greater maximum diameter of the nutrient foramen (crude OR, 0.26; p < 0.001), and greater minimum diameter of the nutrient foramen (crude OR, 0.20; p < 0.001) significantly associated with reduced odds of osteonecrosis of the femoral head (ONFH). The necrotic femoral head group was further divided into 118 non-traumatic and 31 traumatic necrotic subgroups, and no significant difference was observed in any characteristics between them.

Conclusions

Characteristics of the nutrient foramen in the fovea capitis femoris showed a significant defect of necrotic than normal femoral heads, and significantly reduced odds were associated with the higher abundance of the nutrient foramen in ONFH. Therefore, the condition of the nutrient foramen might be the indicator of ONFH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02564-6.

OP0043 INCREASED RISK OF SEVERE INFECTIONS AND MORTALITY IN PATIENTS WITH NEWLY DIAGNOSED SYSTEMIC LUPUS ERYTHEMATOSUS: A POPULATION-BASED STUDY

Background:

Systemic lupus erythematosus (SLE) is a chronic disease with a broad spectrum of autoantibodies and clinical manifestations. As much as 45% of SLE patients were reported to suffer from severe infections1,2. However, due to the high cost of recruiting patients, we still do not have a holistic picture of the SLE-infection association. Administrative data which encompass all provincially funded healthcare service data shows promising opportunities to advance the knowledge and management of the SLE patients which cannot be evaluated by the conventional clinical setting with small sample size and selective samples3,4,5.

Objectives:

To evaluate the risk of severe infection and infection-related mortality among patients with newly diagnosed systemic lupus erythematosus.

Methods:

We conducted an age- and gender- matched cohort study of all patients with incident SLE between January 1, 1997 and March 31, 2015 using administrative health data from British Columbia, Canada. Primary outcome was the first severe infection after SLE onset necessitating hospitalization or occurring during hospitalization. Secondary outcomes were total number of severe infections and infection-related mortality.

Results:

We identified 5,169 SLE patients and matched them with 25,845 non-SLE individuals from the general population, yielding 955 and 1,986 first severe infections during 48,367 and 260,712 person-years follow-up, respectively. The crude incidence rate ratios for first severe infection and infection-related mortality were 2.59 (95% CI, 2.39-2.80) and 2.20 (95% CI, 1.76-2.73), respectively. The corresponding adjusted hazard ratios were 1.82 (95% CI 1.66-1.99) and 1.61 (95% CI, 1.24-2.08). SLE patients had an increased risk of a greater total number of severe infections with crude rate ratio of 3.24 (95% CI, 3.06-3.43) and adjusted rate ratio of 2.07 (95% CI, 1.82-2.36).

Conclusion:

SLE is associated with increased risks of first severe infection (1.8-fold), a greater total number of severe infections (2.1-fold) and infection-related mortality (1.6-fold).

References:

[1]Yurkovich M, Vostretsova K, Chen W, Aviña-Zubieta JA. Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies. Arthritis Care Res (Hoboken) 2014;66(4):608-16.

[2]Petri M. Infection in systemic lupus erythematosus. Rheum Dis Clin North Am 1998;24(2):423-56.

[3]Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore) 2003;82(5):299-308.

[4]Goldblatt F, Chambers S, Rahman A, Isenberg DA. Serious infections in British patients with systemic lupus erythematosus: hospitalisations and mortality. Lupus 2009;18(8):682-9.

[5]Bosch X, Guilabert A, Pallares L, et al. Infections in systemic lupus erythematosus: a prospective and controlled study of 110 patients. Lupus 2006;15(9):584-9.

Disclosure of Interests:

None declared

Propofol improves intestinal ischemia-reperfusion injury in rats through NF-κB pathway

OBJECTIVE

The aim of this study was to investigate the effects of propofol on intestinal ischemia-reperfusion injury in rats through the nuclear factor-kappa B (NF-κB) pathway.

MATERIALS AND METHODS

A total of 24 Sprague-Dawley rats were selected and randomly divided into three groups, including sham operation group, ischemia group and propofol group. Rats in sham operation group were only treated with isolation of superior mesenteric artery, which was clipped for 1 h and reperfused for 2 h in ischemia group. Meanwhile, propofol (60 mg/kg) was injected into the femoral vein 1 h before ischemia in propofol group. TUNEL assay was performed to detect cell apoptosis of intestinal tissues. Real-time quantitative polymerase chain reaction (RT-qPCR) was conducted to measure the expression levels of malondialdehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), caspase-3 and B-cell lymphoma-2 (Bcl-2) in rats of each group. Western blotting was utilized to detect the protein expression levels of NF-κB pathway related molecules, such as myeloid differential protein-88 (MyD88), v-rel avian reticuloendotheliosis viral oncogene homolog A (RelA) and NF-κB. Furthermore, changes in plasma cytokine levels were determined via enzyme-linked immunosorbent assay (ELISA).

RESULTS

The number of apoptotic cells in ischemia group was remarkably higher than that in sham operation group (p<0.05). However, it decreased notably in propofol group compared with ischemia group (p<0.05). In comparison with sham operation group, significantly up-regulated expression of caspase-3 and down-regulated expression of Bcl-2 were observed in the intestinal tissues of rats in ischemia group (p<0.05). Caspase-3 was lowly expressed, while Bcl-2 was highly expressed in the intestinal tissues of rats in propofol group compared with ischemia group (p<0.05). In addition, no statistically significant differences were observed in the expression level of SOD among sham operation group, ischemia group and propofol group (p>0.05). The expression levels of MDA and MPO were overtly higher in the intestinal tissues of rats in ischemia group than those in sham operation group and propofol group (p<0.05). Besides, the protein expression levels of MyD88, RelA and NF-κB in the intestinal tissues of rats in ischemia group were remarkably higher than those in sham operation group and propofol group (p<0.05). The activity of the NF-κB pathway in the intestinal tissues of rats in propofol group significantly declined compared with ischemia group (p<0.05). Moreover, compared with sham operation group, plasma levels of TNF-α, interleukin (IL)-2, IL-6 and IL-4 increased significantly in rats of ischemia group (p<0.05). However, they were markedly lower in propofol group than those in ischemia group (p<0.05).

CONCLUSIONS

Propofol protects rats from intestinal ischemia-reperfusion injury through the NF-κB pathway.

Hsp60 expression and localization in different tissues and testis development of male cattle (cattle-yak and yak)

BACKGROUND

Heat shock protein 60 (Hsp60) play important roles in protecting testicular development and production of sperms. This study was conducted to investigate Hsp60 gene expression and localization in testicular development to ascertain its influence on infertility and in different tissues of the male cattle-yak and yak. A total of 54 cattle (24 cattle-yak and 30 yak) were examined.

MATERIALS AND METHODS

Hsp60 mRNA of cattle-yak was cloned first and amino acid variations were found leading to differences at protein spatial structure compare with the yak. Real-time quantitative PCR (RT-qPCR) analysis revealed that Hsp60 mRNAs expression were different in cattle-yak and yak.

RESULTS

The results showed disparity in Hsp60 expression among different tissues and in different developmental stages of the testis. High Hsp60 expression was observed in juvenile and adult testicles. Moreover, Hsp60 expression in cattle-yak was significantly higher than yak (p < 0.01). The location of Hsp60 in tissue and testis was detected by immunohistochemistry (IHC) and immunofluorescence (IF). The results demonstrated that Hsp60 proteins located in epithelial cells, spermatocytes, sperm cells and mesenchymal cells.

CONCLUSIONS

The Hsp60 proteins are expressed in different tissues, and the highest expression level was observed in the testis of the cattle-yak, which suggests that infertility of cattle-yak have some correlation with up-regulation of Hsp60.

Serum metabolic markers and metabolic pathways in rats with metabolomic cecal ligation and puncture-induced sepsis

The aim of this study was to explore the dynamic changes in characteristic serum metabolic markers and pathways during early sepsis in rats. By using cecal ligation and puncture (CLP), we made rat models of sepsis, which were randomly divided into 5 groups with 10 rats in each group: group A, group B, group C, group D, and group E. We collected 2 mL of arterial blood at 0, 6, 12, 24, and 48 hours from rats in group A-E respectively and isolated serum via centrifugation. Next, adopting metabolomics analysis methods, we screened for metabolites from the animal serum with statistically and biologically significant abundance changes, and used the KEGG database to analyze the respective metabolic pathways. In all, our findings reveal that D-glucosamine 6-phosphate, D-glucosamine phosphate, α-D-glucosamine 1-phosphate, D-glucosamine 1-phosphate, and 5-hydroxy isocyanate decline continuously from 12 hours, while L-phenylalanine, (S) -α-amino-β-phenylpropionic acid, 5-methoxy indole acetic acid salt, 5-methoxy indole acetic acid, goose deoxyglycolic acid salt, goose deoxyglycolic acid, and Chen's deoxygenated sugar alcohol started to decrease from 6 hours. Additionally, 3.2,3-Bis-O-(geranyl geranyl)-sn-glycerol- 1-phosphoric acid-L-serine levels rose continuously from 12 hours. We found 13 differentially regulated ions, primarily ones involved in pathways responsible for the metabolism of sugar, amino acids, and lipids, which are related to the disorder of energy metabolism. Our findings mark serum-derived D-glucosamine and its phosphorous derivatives as characteristic metabolic markers of sepsis in rats.

[Visualization analysis of liver fibrosis diagnosis based on Citespace software]

Objective: To explore the research hotspots and development trends in the field of liver fibrosis diagnosis by using visualization methods. Methods: The relevant literatures on liver fibrosis diagnosis were downloaded from the China National Knowledge Infrastructure database. CiteSpace 5.3.R6 software was used to analyze the authors, institutions and key node information to explore the main research groups, institutions and research hotspots and development trends of this field. Results: The analysis showed that the main research authors were Cai Weimin, Guo Qiyong, etc. The main research institutions included were Shengjing Hospital affiliated to China Medical University, Shenzhen Third People's Hospital, etc. The current diagnosis of liver fibrosis was mainly focused on invasive (liver biopsy) and non-invasive (serology, imaging) diagnosis. The non-invasive diagnosis may be the research hotspot and direction of liver fibrosis in the future. Conclusion: The visualization analysis of liver fibrosis diagnosis by CiteSpace software can quickly and intuitively understand the basic knowledge and evolution of this field, as well as the main research directions, hot spots and future development trends.

The histone deacetylase inhibitor chidamide induces intermittent viraemia in HIV-infected patients on suppressive antiretroviral therapy

OBJECTIVES

To evaluate the safety and efficacy of chidamide to reverse HIV-1 latency in vivo and to compare the effects of four clinically tested histone deacetylase (HDAC) inhibitors on non-histone proteins in vitro.

METHODS

Participants received chidamide orally at 10 mg twice weekly for 4 weeks while maintaining baseline antiretroviral therapy. The primary outcome was plasma viral rebound during chidamide dosing and the secondary outcomes were safety, pharmacokinetic and pharmacodynamic profiles, changes in cell-associated HIV-1 RNA and HIV-1 DNA, and immune parameters. Western blotting was used to compare the in vitro effects of the four HDAC inhibitors on HSP90, NF-κB and AP-1.

RESULTS

Seven aviraemic participants completed eight oral doses of chidamide, and only grade 1 adverse events were observed. Cyclic increases in histone acetylation were also detected. All participants showed robust and repeated plasma viral rebound (peak viraemia 147-3850 copies/mL), as well as increased cell-associated HIV-1 RNA, during chidamide treatment. Furthermore, we identified an enhanced HIV-1-specific cellular immune response and a modest 37.7% (95% CI: 12.7-62.8%, P = 0.028) reduction in cell-associated HIV-1 DNA. Compared with the other three HDAC inhibitors, chidamide had minimal cytotoxicity in vitro at clinically relevant concentrations and showed mechanistically superior effects on non-histone proteins, including HSP90, NF-κB and AP-1.

CONCLUSIONS

Chidamide safely and vigorously disrupts HIV-1 latency in vivo, which makes it a promising latency-reversing agent.