[Preliminary application of postoperative fast track transfer to intensive care unit for the geriatric hip fractures under enhanced recovery after surgery]

Objective: To develop a fast track transfer to intensive care unit (ICU) for the perioperative high-risk elderly patients after hip fracture surgery and analyze the preliminary clinical effect of the application. Methods: From January 2014 to December 2017, before the application of postoperative fast track transfer to ICU, the clinical data of 195 elderly patients with hip fracture were included in a retrospective analysis. Among 195 hip fracture patients, 18 were transferred to ICU post operation (non-fast track group). Multivariate logistic regression analysis was applied to investigate relevant risk factors for transferring to ICU after hip fracture surgery. Based on risk factors acquired from the analysis and clinical experience, the fast track transfer to ICU for the perioperative high-risk elderly patients after hip fracture surgery was constructed according to the preliminary and experiential criteria. From January 2018 to December 2019, the clinical data of 70 patients (fast track group) who were transferred to ICU after hip fracture surgery through the fast track were collected and compared with non-fast track group. Results: Multivariate regression analysis revealed that American Society of Anesthesiologists classification(≥Ⅲ) (OR=4.260, 95%CI:1.157-15.683, P=0.029), pre-hospital stage (≥48 h) (OR=4.301, 95%CI:1.212-15.266, P=0.024), hemoglobin concentration at admission(<90 g/L) (OR=7.979, 95%CI:1.936-32.889, P=0.004), coronary heart disease as one comorbidity(OR=6.063, 95%CI:1.695-21.693, P=0.006) were independent risk factors for transferring to ICU after hip fracture surgery. There were no significant difference in gender, age, fracture type, hemoglobin concentration at admission and time of pre-hospital stage between the non-fast track group and fast track group(all P>0.05). However, the number of comorbidities in the fast track group was significantly higher than that in the non-fast track group (Z=-1.995, P=0.046). The time to surgery, postoperative hospital stay, and length of hospital stay in fast track group were all significantly less than those in non-fast track group (Z=-2.121, -2.726, -3.130, all P<0.05). Also, there were fewer medical consultations needed and fewer patients who stayed in ICU more than or equal to 2 nights in fast track group than that in non-fast track group(all P<0.05). There were no significant difference in the rate of patients who transferred from the general ward to ICU after transferring from ICU to the general ward, the proportion of patients who received more than or equal to 4 departments, operation time, hospitalization expense, mortality during hospitalization, 30-day mortality and 90-day mortality after operation between the two groups(all P>0.05). Conclusions: The fast track constructed in this study can reduce time to surgery, postoperative hospitalization stay and length of hospitalization stay for the perioperative high-risk elderly patients with hip fractures and is a specific clinical application of eras concept based on multidisciplinary team.

[Separation and determination of acesulfame-K in soy sauce by capillary electrophoresis with contactless conductivity detection using liquid-liquid extraction and field-amplified sample injection]

A new method was established for the sensitive determination of artificial synthetic sweetener acesulfame-K in soy sauce by capillary electrophoresis (CE) with field-amplified sample injection (FASI)and capacitively coupled contactless conductivity detection (C⁴D). Liquid-liquid extraction (LLE) technology was employed to eliminate the complex matrix interference co-existing in soy sauce. Ethyl acetate was used as the extraction solution. The pH of the sample solution was adjusted to 1.7, and both inorganic salts and organic compounds causing interferences were effectively removed by LLE. The type and volume of the extraction solvents, pH of the sample solutions, extraction method and extraction time were investigated in detail. Under the optimized experimental conditions, acesulfame-K in soy sauce was well separated and sensitively detected. The limit of detection and limit of quantification were 0.15 mg/kg and 0.48 mg/kg, respectively. The accuracy was tested by spiking acesulfame-K into soy sauce samples, and the recoveries ranged from 92.3% to 108.1%. The relative standard deviations were below 8.0%. The proposed method can meet the requirements for the fast screening and sensitive detection of acesulfame-K in soy sauce samples.

THU0270 ONLINE INTERACTION AND FREQUENT SELF-ASSESSMENTS PROMOTED TREAT-TO-TARGET FOR SLE VIA EMPOWERING PATIENTS: A COHORT STUDY FROM CHINA BY SMART SYSTEM OF DISEASE MANAGEMENT (SSDM)

Background:

Treating to target (T2T) is routine in RA, but no comparable standard has been defined for SLE. In 2015, the definition of Lupus Low Disease Activity State (LLDAS) was generated by Asia-Pacific Lupus Collaboration, and the preliminary validation demonstrated its attainment to be associated with improved outcomes in SLE. A SLEDAI-2K score lower than 4 is the main criteria for LLDAS. SSDM is an interactive mobile disease management application, including application systems for both the doctors and patients.

Objectives:

To evaluate the patterns of T2T and related influential factors among SLE patients after applying SSDM in real world.

Methods:

Patients were trained to master SSDM by healthcare professionals in clinics. The first assessment for SLEDAI-2K was performed as the baseline. Patients were required to perform repeated self-assessments after leaving the clinics. The data is synchronized to the SSDM of authorized rheumatologists. Based on the patients’ data, rheumatologists will provide medical advices to the patients.

Results:

From July 2015 to Jan 2020, 32,559 SLE patients enrolled in SSDM. The mean age is 36.35 years old and median disease duration is 3.85 years. Among them 1,937 SLE patients from 134 hospitals across China were followed up for more than 12 months, and the demographics were summarized in table 1.

Table 1.Baseline\Final follow-upn%x <= 4%5 <= x <= 9%10 <= x <= 14%15 <= x%x <= 4104053.69%82078.85%13512.98%504.81%353.37%5 <= x <= 935718.43%23064.43%6016.81%328.96%359.80%10 <= x <= 1422211.46%12054.05%3817.12%4018.02%2410.81%15 <= x31816.42%15649.06%4915.41%4714.78%6620.75%Total1937100%132668.46%28214.56%1698.72%1608.26%

The ratio of T2T achievers was 53.69% (1,040/1,937) at the baseline and improved significantly to 68.46% (1,326/1,937) after a 12-month follow-up, p<0.01. Among T2T achievers at the baseline, 78.85% (820/1,040) maintained T2T, and 21.15% (220/1,040) relapsed. Of patients who didn’t achieve T2T at baseline, 56.41% (506/897) of the patients achieve T2T after 12-month follow-up.

The impact of the online interaction and the frequency of self-assessment for SLEDAI-2K on T2T has been analyzed. Compared with 1,475 patients who didn’t interact online with their physicians through SSDM, 462 patients with online interaction achieved higher rate of T2T improvement (19.48% vs 13.29%, p<0.05). The more frequent of the self-assessments being performed by patients, the higher improvement of T2T rate will be. The improvement rates of T2T in the subgroups which self-assessed with SSDM by quarterly, bimonthly and monthly were 8.56%, 16.14% and 23.24% respectively. The improvement rate (y) of T2T was positively correlated with the frequency of self-assessment for SLEDAI-2K(x) independently, r = 0.9998. (Figure 1)

Conclusion:

After proactive disease management via SSDM for more than 12 months, the rate of T2T in SLE patients increased significantly. Online interaction between patients and physicians contributed in promoting T2T improvement rate. The patients who performed more self-assessments through SSDM had higher probability of T2T achievement. SSDM is a valuable tool for long term SLE follow-up through empowering patients.

References:

Acknowledgments:

SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

New Opportunities and Challenges for Forensic Medicine in the Era of Artificial Intelligence Technology

Abstract

Traditional forensic identification relies on forensic experts to manually extract information and provide identification opinions based on medicine, biology and other fields of knowledge combined with personal work experience, which is not only time-consuming and require great effort, but also affected by subjective factors that are difficult to overcome. In the era of big data, the booming development of artificial intelligence brings new ideas to forensic medicine. In recent years, forensic researchers at home and abroad have conducted many studies based on artificial intelligence technology, such as face recognition, age and gender identification, DNA analysis, postmortem interval estimation, injury and cause of death identification, showing the feasibility and advantages of using artificial intelligence technology to solve forensic identification problems. As a new means of technology that has adapted to the development of the times, artificial intelligence has brought new vitality to forensic medicine, but at the same time also some new challenges. How to deal with these challenges scientifically and form a new mode of 'artificial intelligence plus forensic medicine' with artificial intelligence and forensic medicine developing collaboratively is a new direction for the development of forensic medicine in the era of big data.

Effects of Lonicera confusa and Astragali Radix extracts supplementation on egg production performance, egg quality, sensory evaluation, and antioxidative parameters of laying hens during the late laying period

Lonicera confusa (LC) and Astragali Radix (AR) extracts have been shown to have antioxidant and anti-inflammatory activities in human. To determine whether LC or/and AR extracts had similar functions to improve the egg production and egg quality, 1,440 (52-wk-old) Lohmann pink-shell hens were randomly distributed into 4 treatments with nine replicates of 40 hens. The hens were fed a basal diet (CON) or the basal diet supplemented with 0.1% LC extracts, 0.1% AR extracts, or 0.1% LC extracts plus 0.1% AR extracts (LC-AR) for 12 wk. The eggs were collected on week 6 and 12 for analysis, and the plasma and ovaries were collected at end of trial. Dietary treatment did not influence (P < 0.05) egg production, egg weight, and feed conversion ratio. However, LC-AR addition increased (P < 0.02) yolk color and sensory quality of hard-boiled eggs compared to other groups. The LC-AR supplementation increased (P = 0.02), and LC addition tended to increase (P = 0.08) Haugh unit of eggs on week 12 compared to CON. The LC-AR supplementation decreased (P < 0.001), and LC or AR individual addition tended to decrease (P < 0.10) plasma malondialdehyde concentration compared to CON. Conversely, LC supplementation increased (P = 0.02) total superoxide dismutase activity, and LC or/and AR supplementation increased the activities of manganese-containing superoxide dismutase (MnSOD) (P < 0.08) and glutathione peroxidase (GSH-Px) (P < 0.01) in plasma, and the mRNA abundance of MnSOD, GSH-Px1, and catalase in ovaries (P < 0.05) compared to CON. The LC or/and AR supplementation decreased the concentrations of interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) in plasma (P < 0.05), and the mRNA abundance of IL-6 and TNF-α in ovaries (P < 0.04) compared to CON. These results suggested dietary inclusion of LC or/and AR improved the albumen quality, and a blend of LC and AR improved yolk color, which were associated with the enhancement of antioxidant capacity and the suppression of systemic inflammation in hens.

[Long-term efficacy analysis of laparoscopic-assisted anorectoplasty for high and middle imperforate anus]

Objective: To explore the long-term efficacy of laparoscopic-assisted anorectoplasty and conventional anorectoplasty in the treatment of children with high and middle anal atresia. Methods: A retrospective cohort study was used. Inclusion criteria: (1) children with high and middle anal atresia; (2) complicated with rectourethral or rectovesical fistula; (3) complete follow-up data. Exclusion criteria: (1) complicated with 21-trisomy; (2) cerebral palsy and other mentaldisabilities; (3) Currarino syndrome; (4) FG syndrome. Clinical data of 88 patients with middle and high anal atresia, who complicated with rectourethral fistula or rectovesical fistula, and underwent anoplasty at Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from January 2009 to June 2014 were enrolled in the study and analyzed. There were 24 cases with middle atresia and 64 cases with high atresia. All the cases were divided into 2 groups based on the operative method: laparoscopic group (laparoscopic-assisted anorectoplasty, 49 cases), pena group (posterior sagittal anorectoplasty, 39 cases). The demographic features of two groups were comparable. There were no statistically significant differences in gender, age, body mass, classification of anomaly types and sacral ratio (all P>0.05). Student t test and Chi square tests were used to compare the surgical conditions (operative time, postoperative hospital stay and complications), anal function (Kelly score), constipation (Krickenbeck constipation score) and anorectal pressure. Results: Children of both groups all completed operation ssuccessfully. There were no statistically significant differences between laparoscopic group and pena group in the operative time [(120±31) minutes vs. (112±23) minutes, t=1.343, P=0.091] and postoperative hospital stay [(7.1±2.3) days vs. (10.7±3.3) days, t=6.021, P=1.000]. Complications were more common in the pena group [16.3% (8/49) vs. 35.9% (14/39), χ(2)=4.436, P=0.035]. The main complications in laparoscopic group were anal prolapse (8.2%, 4/49) and anal stenosis (6.2%, 3/49), while in pena group were anal stenosis (12.8%, 5/39) and perioperative perianal skin erosion (10.3%, 4/39). As for the anal function, the degree of feces, defecation control and sphincter contractility, the single scoring differences of Kelly scoring system were not statistically significant between the two groups, but the proportion of good function in the laparoscopic group was higher than that in the pena group [67.3% (8/49) vs. 38.5% (15/39), χ(2)=7.308, P=0.007]. Constipation occurred in 6 (12.2%) patients in the laparoscopic group, of whom 5 were improved by diet regulation and 1 required laxatives, while 9 (23.1%) patients developed constipation in the pena group, of whom 4 were improved by diet regulation and 5 required long-term laxatives. The difference of constipation ratio was not statistically significant (χ(2)=1.802, P=0.180). There were no cases of Krickenbeck constipation grade 3. Compared to the pena group, the laparoscopic group had higher anal resting pressure [(33.35±9.69) mmHg vs. (27.68±10.74) mmHg, t=2.599, P=0.011], higher dilating pressure [(9.00±5.61) mmHg vs.(6.51±3.24) mmHg, t=2.462, P=0.016], higher maximal squeeze pressure [(65.80±17.23) mmHg vs. (56.74±18.93) mmHg, t=2.389, P=0.019] and longer maximal contraction time [(21.16±5.02) seconds vs. (18.44±7.24) seconds, t=2.079, P=0.041]. The rectal resting pressure [(5.36±3.00) mmHg vs. (4.61±3.93) mmHg, t=1.015, P=0.312] was not statistically significantly different. Conclusions: Compared with posterior sagittal anorectoplasty, laparoscopic-assisted anorectoplasty in the treatment of high and middle anal atresia has better long-term efficacy with less perioperative complications.

Detection of Ancestry Information of Urumqi Mongolians Based on the AIM-InDels Loci Multiplex System

Abstract

Objective To explore the genetic background and structure of Urumqi Mongolians, the previously developed 39-AIM-InDels panel for ancestry inference was utilized in the present study. Methods The blood samples of 145 unrelated healthy Urumqi Mongolian individuals were collected and genotyped. The compositions of ancestry information of Urumqi Mongolians were studied with 17 different populations from three continents （East Asia, Europe and Africa） as reference populations. Then, multiple population genetics and bioinformatics analysis methods were applied, the Fst and DA values between matched populations were compared and analyzed, PCA analysis was performed and a phylogenetic tree was constructed. The proportions of ancestry information components of Urumqi Mongolians were analyzed with Structure software, etc. Results The ancestry information components of Urumqi Mongolian group in different intercontinental populations accounted for 89%, 7%, and 3% of East Asian, European, and African populations, respectively. Compared with other intercontinental populations, Urumqi Mongolian group and East Asian populations have lower Fst and DA values, and they were in the same cluster in PCA analysis as well. In a phylogenetic tree, the Urumqi Mongolian group was in the same branch as East Asian populations. Conclusion Urumqi Mongolian group had relatively close genetic relationships with East Asian populations, and the proportion of its East Asian ancestry was about 89%.

MiR-223 promotes cardiomyocyte apoptosis by inhibiting Foxo3a expression

OBJECTIVE

MicroRNAs (miRs) are proven to possess diversified functions in the pathogenesis of cardiac diseases. The current study is designed aiming at determining the effect of miR-223 on oxidative stress induced apoptosis in cardiomyocytes.

MATERIALS AND METHODS

Mouse model of myocardial infarction (MI) was constructed, and endogenous level of miR-223 in the border zone of infarcted heart tissues was determined. Primarily cultured cardiomyocytes were exposed to H2O2 treatment to mimic the oxidative stress stimulation. Multiple approaches including quantitative reverse transcription polymerase chain reaction (qRT-PCR), cell viability assay, luciferase assay, Western blot assay and flow cytometry assay were employed to determine its expression, function and mechanism in apoptosis.

RESULTS

MiR-223 expression was significantly upregulated in the border zone of infarcted heart ventricular tissues and in cardiomyocytes treated with H2O2. Overexpression of miR-223 in cardiomyocytes promoted apoptosis, whereas inhibition of endogenous miR-223 protected cardiomyocytes from oxidative stress induced apoptosis. MiR-223 directly targets the 3'untranslated region (UTR) of Foxo3a mRNA. Overexpression of miR-223 inhibited Foxo3a protein expression, however, inhibition of miR-223 suppressed its expression. Silencing Foxo3a using small interfering RNA (siRNA) mimicked the effect of miR-223, indicating its functional significance.

CONCLUSIONS

MiR-223 is an important regulator of cardiomyocyte apoptosis under oxidative stress. Inhibition of the miR-223/Foxo3a signaling axis may be a potential therapeutic strategy for cardiac injuries.

Effect of LSR polymorphism on blood lipid levels and age-specific epistatic interaction with the APOE common polymorphism

The lipolysis stimulated lipoprotein receptor (LSR) is an apolipoprotein (Apo) B and ApoE receptor that participates in the removal of triglyceride-rich lipoproteins during the postprandial phase. LSR gene is located upstream of APOE, an important risk factor for cardiovascular disease (CVD). Since the APOE common polymorphism significantly affects the variability of lipid metabolism, this study aimed to determine the potential impact of a functional SNP rs916147 in LSR gene on lipid traits in healthy subjects and to investigate potential epistatic interaction between LSR and APOE. Unrelated healthy adults (N = 432) and children (N = 328, <18 years old) from the STANISLAS Family Study were used. Age-specific epistasis was observed between APOE and LSR, reversing the protective effect of APOE ε2 allele on cholesterol, ApoE and low-density lipoprotein levels (β: .114, P: .777 × 10^-8 , β: .125, P: .639 × 10^-3 , β: .059, P: .531 × 10^-3 , respectively). This interaction was verified in an independent adult population (n = 1744). These results highlight the importance of the LSR polymorphism and reveal the existence of complex molecular links between LSR and ApoE for the regulation of lipid levels, revealing potential new pathways of interest in type III hyperlipidemia and its involvement in CVD pathology.

[Study on the relationship between uncertainty in illness and caregiving burden in family members of patients with chronic wounds]

Objective: To investigate the current status of uncertainty in illness and caregiving burden in family members of patients with chronic wounds, and to analyze the relationship between them. Methods: A total of 180 patients with chronic wounds admitted to the Department of Emergency of our hospital from October 2017 to March 2018, conforming to the study criteria, were selected by adopting the convenience sampling method. Then one family member who took care of the patients for the longest time and conformed to the study criteria were included in this cross-sectional survey. General Information Questionnaire made by the authors was conducted to investigate the demographic data and wounds of patients, and demographic data of family members. Chinese version of Parent Perception of Uncertainty Scale-Family Member (PPUS-FM) and Caregiver Burden Inventory (CBI) were used to investigate the uncertainty in illness and caregiving burden. Data were processed with multiple linear regression analysis and partial correlation analysis. Results: The effective recovery rate of questionnaire was 91.7% (165/180). (1) The ages of patients were (71±17) years. Among them, there were 89 males and 76 females. The course of chronic wounds was 0.5 to 120.0 months. The wounds were mainly primary occurrence (86.1%, 142 patients), and the main type of wound was pressure ulcer (43.6%, 72 patients). Fifty-seven patients (34.5%) had wound infection. The ages of family members were (56±13) years, and 61.8% (102 people) of them were female. Their daily time of taking care of patients was (10±8) h. (2) The total scores of PPUS-FM of family members were 33 to 125 (88±17) points, mainly in medium level, in which the item score of unpredictability dimension was the highest. (3) The total scores of CBI of family members were 7 to 79 (43±14) points, in which the item score of time-dependence burden dimension was the highest. (4) Uncertainty in PPUS-FM could independently influence 10% of the total variation of caregiving burden in family members of patients (t=3.18, P<0.01). (5) The total scores of PPUS-FM of family members were in significantly positive correlation with the total scores of CBI and scores of physical burden, emotional burden, and social burden, respectively (r=0.33, 0.32, 0.25, 0.36, P<0.05 or P<0.01), while there was no obvious correlation between total scores of PPUS-FM of family members and time-dependence burden/developmental burden (r=0.14, 0.16, P>0.05). Conclusion: There is positive correlation between uncertainty in illness and caregiving burden.

The development of CotA mediator cocktail system for dyes decolorization

AIMS

The increasing use of dyes leads to serious environmental concerns, it is significant to explore eco-friendly and economic approaches for dye decolorization. This study aimed to develop mediator cocktail (AS and ABTS) for enhancing the capability of laccase-mediator system in the removal of dyes.

METHODS AND RESULTS

By mediator screening, the mediators of ABTS and AS (ABTS, 2, 2'-azino-bis-(3-ethylbenzothiazo-thiazoline-6-sulphonic acid); AS, acetosyringone) were combined for dyes decolorization. The Box-Behnken Design and response surface analysis was performed to optimize experiment conditions. Comparing the CotA-ABTS-AS cocktail system with CotA-single mediator system showed that the coupling of ABTS and AS could increase the decolorization rate 15 times higher, save a third of the cost and shorten the reaction time by 50%. In addition, our studies revealed that sequential oxidation may occur in CotA-ABTS-AS system.

CONCLUSIONS

Compared with CotA laccase-single mediator system, the CotA-ABTS-AS cocktail system showed advantages including higher efficiency, lower cost and shorter reaction time.

SIGNIFICANCE AND IMPACT OF THE STUDY

This was the first report on the dyes decolorization by laccase mediator cocktail system. These results paved the curb for the application of laccase mediator system in various industrial processes.

[Experimental studies on correlation between nucleolus spindle-related protein 1 and the malignant progression and prognosis of human glioblastoma multiforme]

Objective: To investigate the correlation between nucleolus spindle-related protein 1 (NUSAP1) and malignant progression and prognosis of human glioblastoma multiforme (GBM). Methods: RT-PCR and immunohistochemical technique were applied to analyze NUSAP1 expression level in GBM surgical specimens. Correlations between NUSAP1 expression and molecular classification and survival of patients with GBM were also investigated in TCGA database. The gene silencing technique was used to silence NUSAP1 expression in U87 cells, CCK-8 assay was used to detect cell proliferation, flow cytometry was used to detect cell cycle changes, and in vivo tumorigenicity was evaluated after NUSAP1 silencing in tumor-bearing mice. Results: NUSAP1 expression level in GBM was higher than that in non-tumor brain tissue. Survival curve analysis showed that the survival time of GBM patients with high NUSAP1 expression decreased significantly (P<0.01). NUSAP1 expression was relatively lower in mesenchymal and neural molecular subtypes of GBM, when compared with the other two molecular subtypes. And it was closely related with specific genetic aberrations (such as PTEN loss and IDH1 mutation). Silencing NUSAP1 inhibited G2/M cell cycle progression of GBM cells, and inhibited cell proliferation both in vitro and in vivo. Conclusion: Expression of NUSAP1 is closely related to progress and prognosis of GBM, and can be a biomarker reflecting GBM prognosis and act as a therapeutic target with potential clinical application value.

[Experimental study of glioma stem cell-mediated immune tolerance in tumor microenvironment]

Objective: To investigate the tumor microenvironment of immune tolerance induced by glioma stem cells (GSC). Methods: Human GSC SU3 cells transfected with red fluorescent protein (SU3-RFP) gene were implanted into the brain, subcutis (armpit and foot), liver and abdominal cavity of transgenic green fluorescence protein (GFP) nude mice to establish RFP(+) /GFP(+) dual fluorescence solid tumor model. The re-cultured cells derived from implanted tumor tissues, SU3-RFP cells co-cultured with peritoneal fluid of transgenic GFP nude mice and malignant ascites of tumor-bearing mice were observed by fluorescence microscopy and real-time video image tracing to analyze the microenvironment of immune tolerance mediated by RFP(+) /GFP(+) implanted tumor. Results: Dual fluorescence labeled frozen section showed that all of cells in the tumor microenvironment were GFP(+) , while the pressed tissue-patch showed that the tumor blood vessels exhibited a RFP(+) /GFP(+) double-positioning yellow. In the GFP single fluorescence labeled tumor tissue, all of cells in the microenvironment were green, including tumor edge, necrotic foci and blood vessel. Among them, CD68(+) , F4/80(+) , CD11c(+) , CD11b(+) and CD80(+) cells were observed. In the dual fluorescence labeled co-cultured cells, the phagocytosis and fusion between green host cells and red tumor cells were also observed, and these fusion cells might transfer to the malignant dendritic cells and macrophages. Conclusions: The tumor microenvironment of immune tolerance induced by GSC is not affected by the tissue types of tumor-inoculated sites, and the immune tolerance mediated by inflammatory cells is associated with the inducible malignant transformation, which may be driven by cell fusion.

Immunotolerant indoleamine-2,3-dioxygenase is increased in condyloma acuminata

BACKGROUND

The tryptophan-depleting enzyme indoleamine-2,3-dioxygenase (IDO) is critical for the regulation of immunotolerance and plays an important role in immune-associated skin diseases.

OBJECTIVES

To analyse the level of IDO in condyloma acuminata (CA) and its role in this condition.

METHODS

IDO expression was assessed in the skin and peripheral blood of healthy controls and patients with CA. To assess the role of skin IDO in immunity, the ability of isolated epidermal cells to metabolize tryptophan and the influence on polyclonal T-cell mitogen (PHA)-stimulated T-cell proliferation were explored.

RESULTS

IDO median fluorescence intensities in peripheral blood mononuclear cells from patients with CA were similar to those from healthy controls. Immunohistochemistry showed that IDO⁺ cells were rare in normal skin and the control skin of patients with CA, but were greatly accumulated in wart tissue. Most fluorescence signals of IDO⁺ cells did not overlap with those of CD1a⁺ Langerhans cells. Human papillomavirus (HPV) DNA probe in situ hybridization showed a large number of IDO⁺ cells in the HPV^- site. Keratinocytes in the skin of healthy controls and the circumcised skin of patients with CA could minimally transform tryptophan into kynurenine, but IDO-competent epidermal cells from warts could transform tryptophan. In addition, these IDO-competent epidermal cells could inhibit PHA-stimulated T-cell proliferation. The addition of an IDO inhibitor, 1-methyl-d-tryptophan, restored the inhibited T-cell proliferation.

CONCLUSIONS

Abnormally localized high IDO expression might be involved in the formation of a local immunotolerant microenvironment.

MicroRNA-155 is a biomarker of T-cell activation and immune dysfunction in HIV-1-infected patients

OBJECTIVES

MicroRNA-155 (miR-155) regulates T-cell differentiation and activation. It has also been associated with HIV infection. However, it remains unclear whether miR-155 is related to the T-cell response in HIV-infected individuals (e.g. T-cell activation and exhaustion).

METHODS

We performed a cross-sectional study involving 121 HIV-1-infected patients on highly active antiretroviral therapy (HAART) and 43 HAART-naïve patients. MiR-155 levels in the peripheral blood were determined by quantitative reverse transcription-polymerase chain reaction (PCR). T-cell immune activation, exhaustion, and homeostasis were measured by determining the expression of CD38, programmed death 1 (PD-1) and CD127 via flow cytometry.

RESULTS

The levels of miR-155 in total peripheral blood mononuclear cells, CD4 T cells and CD8 T cells from HIV-1-infected patients were increased (P < 0.01). Nonresponders and HAART-naïve patients also exhibited a higher percentage of CD8⁺ CD38⁺ T cells and a lower percentage of CD4⁺ CD127⁺ and CD8⁺ CD127⁺ T cells (P < 0.05). We also found higher levels of PD-1 expression on the CD4⁺ and CD8⁺ T cells of HIV-1-infected patients (P < 0.05).

CONCLUSIONS

Our findings suggest that miR-155 levels in the peripheral blood of HIV-1-infected patients are increased and associated with T-cell activation. Therefore, miR-155 is a potential biomarker of the immune response following HIV-1 infection.