What is an appropriate caesarean delivery rate for China: a multicentre survey

Objective

To assess the current status of caesarean delivery (CD) in China, propose reference CD rates for China overall, and by regions, investigate the main indications for CDs and identify possible areas for safe reduction.

Design

A multicentre cross‐sectional study.

Setting

A total of 94 hospitals across 23 provinces in China.

Population

A total of 73 977 randomly selected deliveries.

Methods

We used a modified Robson classification to characterise CDs in subgroups and by regions, and the World Health Organization (WHO) C‐Model to calculate reference CD rates.

Main outcome measures

CD rates in China.

Results

In 2015–2016, the overall CD rate in China was 38.9% (95% CI 38.6–39.3%). Considering the obstetric characteristics of the population, the multivariable model‐based reference CD rate was estimated at 28.5% (95% CI 28.3–28.8%). Accordingly, an absolute reduction of 10.4% (or 26.7% relative reduction) may be considered. The CD rate varied substantially by region. Previous CD was the most common indication in all regions, accounting for 38.2% of all CDs, followed by maternal request (9.8%), labour dystocia (8.3%), fetal distress (7.7%) and malpresentation (7.6%). Overall, 12.7% of women had prelabour CDs, contributing to 32.8% of the total CDs.

Conclusions

Nearly 39% of births were delivered by caesarean in China but a reduction of this rate by a quarter may be considered attainable. Repeat CD contributed more than one‐third of the total CDs. Given the large variation in maternal characteristics, region‐specific or even hospital‐specific reference CD rates are needed for precision management of CD.

Tweetable abstract

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

The caesarean rate in 2015–2016 in China was 38.9%, whereas the reference rate was 28.5%.

Linked article This article is commented on by M Varner, p. 148 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16953.

Pyroptosis: the pathological process that dominates granulomatous lobular mastitis

The aim of this study is to explore the pathogenesis of granulomatous lobular mastitis (GLM) via pathology and molecular biology. This single-center study included 28 female patients who received a diagnosis of pathologically confirmed GLM from January 2020 to September 2020 at Dongzhimen Hospital of Beijing University of Chinese Medicine. Tissue samples and serum were collected during radical surgery. Western blot and immunohistochemistry were employed to determine caspase-1 and gasdermin D (GSDMD). Transmission electron microscopy (TEM) was used to observe the ultrastructure of cells. Finally, the results were analyzed. The expression of activated GSDMD and caspase-1 were all increased in the lesion group (P < 0.05). The TEM results showed clear features of pyroptosis. We concluded that pyroptosis was important in the development of GLM and inhibitad apoptosis to some degree. The inhibition of pyroptosis response may help to discover new drugs for GLM.

Development of an 11-channel multi wavelength imaging diagnostic for divertor plasmas in MAST Upgrade

Divertor detachment and alternative divertor magnetic geometries are predicted to be promising approaches to handle the power exhaust of future fusion devices. In order to understand the detachment process caused by volumetric losses in alternative divertor magnetic geometries, a Multi-Wavelength Imaging (MWI) diagnostic has recently been designed and built for the Mega Amp Spherical Tokamak Upgrade. The MWI diagnostic will simultaneously capture 11 spectrally filtered images of the visible light emitted from divertor plasmas and provide crucial knowledge for the interpretation of observations and modeling efforts. This paper presents the optical design, mechanical design, hardware, and test results of an 11-channel MWI system with a field of view of 40°. The optical design shows better than 5 mm FWHM spatial resolution at the plasma on all 11 channels across the whole field of view. The spread of angle of incidence on the surface of each filter is also analyzed to inform the bandwidth specification of the interference filters. The results of the initial laboratory tests demonstrate that a spatial resolution of better than 5 mm FWHM is achieved for all 11 channels, meeting the specifications required for accurate tomography.

The cross-polarization scattering system for the magnetic fluctuation measurement in the Experimental Advanced Superconducting Tokamak

The cross-polarization scattering (CPS) system for magnetic fluctuation measurements in the Experimental Advanced Superconducting Tokamak (EAST) has been designed and installed. Different from the Doppler reflectometer (DR) system, the CPS system detects the perpendicular polarization of the electromagnetic wave induced by magnetic fluctuations B̃. The CPS system in the EAST has been developed from the existing Doppler reflectometer system, and they are integrated together for simultaneous measurement of magnetic and density fluctuations. Ray-tracing simulations are used to calculate the scattering locations and the wavenumber coverage of the magnetic fluctuation for CPS. In the experiments, the CPS and DR system data were different in Doppler shift, amplitude, and spectrum broadening. In this article, the hardware design, the ray tracing, and the preliminary results of the system in the EAST are presented.

Manipulation of host ecdysteroid hormone levels facilitates infection by the fungal insect pathogen, Metarhizium rileyi

Entomopathogenic fungi such as Metarhizium rileyi and Beauveria bassiana are widely used insect biological control agents. Little, however, is known concerning genetic or enzymatic factors that differentiate the mechanisms employed by these two fungal pathogens to infect target hosts. Infection by either of these organisms is known to increase levels of the growth and molting hormone, ecdysone, which also regulates the expression of a number of innate immune pathways. M. rileyi, but not B. bassiana, has apparently evolved an ecdysteroid-22-oxidase (MrE22O) that inactivate ecdysone. We show that deletion of MrE22O impaired virulence compared with the wild-type strain, with an increase in ecdysone titer seen in hosts that was coupled to an increase in the expression of antimicrobial genes. An M. rileyi strain engineered to overexpress MrE22O (MrE22O^OE ), as well as trans-expression in B. bassiana (Bb::MrE220^OE ) resulted, in strains displaying enhanced virulence and dampening of host immune responses compared with their respective wild-type parental strains. These results indicate that ecdysone plays an important role in mediating responses to fungal infection and that some insect pathogenic fungi have evolved mechanisms for targeting this hormone as a means for facilitating infection.

[Progress of researches on animal models of Blastocystis hominis infections]

Blastocystis hominis is a common parasitic protozoa in human and animal intestines; however, its pathogenicity remains controversial. Construction of animal models is of great significance to investigate the pathogenicity, pathogenic mechanisms and drug screening of B. hominis. Experimental animals, mode of infections, parasite strains and host immune status are important factors affecting the successful modeling of B. hominis infections in animals. Hereby, we review the progress of researches on animal models of B. hominis infections, and summarize the influencing factors and application of animal models of B. hominis infections, in order to provides insights into the selection of animals models of B. hominis infections.

[Progress of researches on global prevalence of Blastocystis hominis human infections and its subtypes]

Blastocystis hominis is a parasite that parasitizes in the intestines of humans and animals, and is closely related to a variety of gastrointestinal diseases such as abdominal pain and diarrhea. B. hominis is distributed worldwide, and the prevalence of B. hominis infections and dominant subgenotypes vary in countries and in regions from the same country. This paper reviews the global prevalence of B. hominis human infections, its subtypes and geographical distribution, so as to provide insights into the understanding of the global epidemiology of B. hominis and the management of B. hominis infections.

ORAOV1-B Promotes OSCC Metastasis via the NF-κB-TNFα Loop

Metastasis, a powerful prognostic indicator of oral squamous cell carcinoma (OSCC), is chiefly responsible for poor cancer outcomes. Despite an increasing number of studies examining the mechanisms underlying poor outcomes, the development of potent strategies is hindered by insufficient characterization of the crucial regulators. Long noncoding RNAs (lncRNAs) have recently been gaining interest as significant modulators of OSCC metastasis; however, the detailed mechanisms underlying lncRNA-mediated OSCC metastasis remain relatively uncharacterized. Here, we identified a novel alternative splice variant of oral cancer overexpressed 1 (ORAOV1), named as ORAOV1-B, which was subsequently validated as an lncRNA and correlated with OSCC lymph node metastasis; significantly increased invasion and migration were observed in ORAOV1-B-overexpressing OSCC cells. RNA pulldown and mass spectrometry identified Hsp90 as a direct target of ORAOV1-B, and cDNA microarrays suggested TNFα as a potential downstream target of ORAOV1-B. ORAOV1-B was shown to directly bind to and stabilize Hsp90, which maintains the function of client proteins, receptor-interaction protein, and IκB kinase beta, thus activating the NF-κB pathway and inducing TNFα. Additionally, TNFα reciprocally enhanced p-NF-κB-p65 and the downstream epithelial-mesenchymal transition. ORAOV1-B effects were reversed by a TNFα inhibitor, demonstrating that TNFα is essential for ORAOV1-B-regulated metastatic ability. Consistent epithelial-mesenchymal transition in the ORAOV1-B group was demonstrated via an orthotopic model. In the metastatic model, ORAOV1-B significantly contributed to OSCC-related lung metastasis. In summary, the novel splice variant ORAOV1-B is an lncRNA, which significantly potentiates OSCC invasion and metastasis by binding to Hsp90 and activating the NF-κB-TNFα loop. These findings demonstrate the versatile role of ORAOV1 family members and the significance of genes located within 11q13 in promoting OSCC. ORAOV1-B might serve as an attractive OSCC metastasis intervention target.

Research progress in structural and nutritional characterization and technologically processing impact on cool-season adapted oat and barley cereal kernels with wet chemistry and advanced vibrational molecular spectroscopy

This study aims to provide research progress and update on structural, physicochemical, nutritional characteristics and technologically processing impact on cool-season adapted oat and barley cereal kernels. The study focused on cool-season adapted oats grain production and nutrition in ruminant systems and strategies to improve the utilization of the oat grain through processing techniques. The updated evaluation methods and advanced molecular spectroscopy techniques to study molecular structures with attenuated total reflectance Fourier transform infrared spectroscopy, synchrotron-based Fourier transform infrared microspectroscopy were reviewed. This study summarizes the methods and provides a potential approach on how to use vibrational molecular spectroscopy to study molecular chemistry and molecular structure and molecular nutrition interaction of grain.

Spectroscopic Determination of Key Energy Scales for the Base Hamiltonian of Chromium Trihalides

The van der Waals (vdW) chromium trihalides (CrX₃) exhibit field-tunable, two-dimensional magnetic orders that vary with the halogen species and the number of layers. Their magnetic ground states with proximity in energies are sensitive to the degree of ligand-metal (p-d) hybridization and relevant modulations in the Cr d-orbital interactions. We use soft X-ray absorption (XAS) and resonant inelastic X-ray scattering (RIXS) spectroscopy at Cr L-edge along with the atomic multiplet simulations to determine the key energy scales such as the crystal field 10 Dq and interorbital Coulomb interactions under different ligand metal charge transfer (LMCT) in CrX₃ (X= Cl, Br, and I). Through this systematic study, we show that our approach compared to the literature has yielded a set of more reliably determined parameters for establishing a base Hamiltonian for CrX₃.

[Emergency laboratory construction and reflection in infectious hospital under the epidemic situation]

Emerging infectious diseases are a common type of public health emergencies, which occur frequently around the world in recent years, seriously threatening the safety of human life and property. In the process of dealing with epidemic situation, medical laboratories have played an important role in disease diagnosis, treatment, efficacy evaluation and prognosis judgment and so on. Beijing Youan Hospital, as the designated hospital of the coronavirus disease 2019 (COVID-19), has set up an emergency laboratory in the capital for the prevention and control of the COVID-19 by carrying out routine tests and virus nucleic acid tests, it provides timely and effective evidence for clinical diagnosis and treatment. To provide ideas and references for the building of the Emergency Laboratory in infectious hospitals. This article discuss how to set up an independent emergency laboratory efficiently, strengthen the cooperation with the Center for Disease Control and Prevention, make the best use of all resources, and share the enlightenment gained in the process of construction.

Time-resolved RIXS experiment with pulse-by-pulse parallel readout data collection using X-ray free electron laser

Time-resolved resonant inelastic X-ray scattering (RIXS) is one of the developing techniques enabled by the advent of X-ray free electron laser (FEL). It is important to evaluate how the FEL jitter, which is inherent in the self-amplified spontaneous emission process, influences the RIXS measurement. Here, we use a microchannel plate (MCP) based Timepix soft X-ray detector to conduct a time-resolved RIXS measurement at the Ti L₃-edge on a charge-density-wave material TiSe₂. The fast parallel Timepix readout and single photon sensitivity enable pulse-by-pulse data acquisition and analysis. Due to the FEL jitter, low detection efficiency of spectrometer, and low quantum yield of RIXS process, we find that less than 2% of the X-ray FEL pulses produce signals, preventing acquiring sufficient data statistics while maintaining temporal and energy resolution in this measurement. These limitations can be mitigated by using future X-ray FELs with high repetition rates, approaching MHz such as the European XFEL in Germany and LCLS-II in the USA, as well as by utilizing advanced detectors, such as the prototype used in this study.

Micro/nanoscale magnetic robots for biomedical applications

Magnetic small-scale robots are devices of great potential for the biomedical field because of the several benefits of this method of actuation. Recent work on the development of these devices has seen tremendous innovation and refinement toward ​improved performance for potential clinical applications. This review briefly details recent advancements in small-scale robots used for biomedical applications, covering their design, fabrication, applications, and demonstration of ability, and identifies the gap in studies and the difficulties that have persisted in the optimization of the use of these devices. In addition, alternative biomedical applications are also suggested for some of the technologies that show potential for other functions. This study concludes that although the field of small-scale robot research is highly innovative ​there is need for more concerted efforts to improve functionality and reliability of these devices particularly in clinical applications. Finally, further suggestions are made toward ​the achievement of commercialization for these devices.

Publisher Correction: Electronic structure of the parent compound of superconducting infinite-layer nickelates

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

[Efficacy of esophageal cancer screening program on population at high risk: a survey carried out in people aged 40-69 years in Yangzhong, Jiangsu province]

Objective: To understand the incidence of esophageal cancer in population at high risk in Yangzhong of Jiangsu province. Methods: Cluster random sampling method was conducted to select several natural villages from the high risk area of esophageal cancer in Yangzhong during 2011-2017. Local residents aged 40-69 years were selected as the target population and a total of 14 687 persons were diagnosed esophageal cancer by endoscopy and pathology. Results: Precancerous lesions were detected in 341 persons, with the detection rate as 2.32% (341/14 687). Among them, there were 234 (1.59%) cases with mild and 107 (0.73%) cases with moderate esophageal hyperplasia. There were 77 positive cases with esophageal hyperplasia and the detection rate was 0.52%. Among these positive cases, 41 showed severe esophageal hyperplasia/carcinoma in situ (0.28%), with another 19 as early esophageal cancer (0.13%) and 17 with invasive carcinoma (0.12%). The overall early detection rate of positivity through active screening was 77.92% (60/77), with trends of upwarding and then downwarding. The detection rate of esophageal lesions in men was higher than that in women (P<0.05), but without significant gender specific differences seen in the detection rates of early esophageal cancer or invasive carcinoma (P>0.05). The detection rates of all lesions other than invasive carcinoma, gradually increased with age (P<0.05). The detection rate of invasive carcinoma reached the highest (0.39%, 10/2 547) in the age group of 60-years and slightly decreased in the age group of 65-years old. Conclusions: Considerable numbers of patients with cancer and precancerous lesions in groups at high-risk can be found through the screening program for esophageal cancer, suggesting that the screening program is of great significance in improving the survival rate and quality of life. Attention should be paid to men, with elderly groups in particular, at high-risk in order to increase the detection rate of early cases.

THU0076 SONIC HEDGEHOG PROMOTES SYNOVIAL HYPERPLASIA AND BONE DAMAGE THROUGH P38 MAPK SIGNALING IN EXPERIMENTAL ARTHRITIS

Background:

Abnormal activation of sonic hedgehog (SHH) signaling has been found in synovium from patients with rheumatoid arthritis (RA). Inhibition of SHH signaling is reported to attenuate inflammation and cartilage damage in adjuvant-induced arthritis (AIA). Previously we have demonstrated that SHH signaling promoted the tumor-like behavior of fibroblast-like synoviocytes (FLSs) through p38 MAPKin vitro.

Objectives:

In the current study, we aim to further explore the role of SHH-p38 MAPK signaling in regulating synovial hyperplasia and bone erosion in experimental arthritis.

Methods:

Collagen-induced arthritis (CIA) mouse model was induced and the mice were injected with adenovirus associated virus (AAV) overexpressing SHH or treated with small molecule inhibitors GDC-0449. SB203580 was administrated for the inhibition of p38 MAPK. The severity of paw inflammation was graded and serum levels of TNFα, IL-6 were detected. The histological features of arthritis were evaluated by H&E staining. The bone erosion was identified by micro-CT assessment and the number and function of osteoclasts were determined.

Results:

Blockade of SHH by GDC-0449 significantly alleviated the symptoms and decreased the synovial hyperplasia, inflammatory infiltration, cartilage and bone damage in ankles of CIA. The bone erosions in the area of the metatarsophalangeal and ankle joints and production of TNFα, IL-6 were decreased by SHH inhibition. In addition, the administration of GDC-0449 significantly decreased the number of TRAP positive cells and the expression of NFATc1. On the contrary, SHH overexpression led to increased severity of arthritis and pathological changes. We also observed the accelerated bone injury accompanied with increased number and activity of osteoclasts and increased production of serum IL-6 in mice with upregulation of SHH expression. Of note, the administration of p38 MAPK inhibitor reversed the effects of SHH overexpression, with a reduction of joint swelling and histological scores. Inhibition of p38 MAPK prevented the bone erosion and decreased the number of TRAP positive cells and the expression of NFATc1, which were promoted by SHH overexpression.

Conclusion:

The study indicates that SHH promotes the synovial hyperplasia and bone erosion of CIA in a p38 MAPK-dependent manner. SHH-p38 MAPK signaling could be a potential target for the treatment of RA.

Acknowledgments:

This work was supported by grants from the National Natural Science Foundation of China (81571584, 81701609).

Disclosure of Interests:

None declared

[Effects of dynamic contrast enhancement on diffusion weighted imaging score of 3 in prostate imaging reporting and data system version 2 of peripheral zone]

Objective: To investigate the effects and value of dynamic contrast-enhanced (DCE) on diffusion-weighted imaging (DWI) score 3 in the prostate imaging data and reporting system version 2(PI-RADS V2)of peripheral zone. Methods: A retrospective study of consecutive 204 cases of prostate disease in peripheral zone was conducted from January 2015 to January 2018, including 169 cases of prostate cancer and 35 cases of non-prostate cancer. All cases were examined multi-parametric MR imaging on a 3-T MR scanner and confirmed by pathology. Images were analyzed according to PI-RADS V2.Inter-reader agreement of scores was evaluated by kappa coefficient. The constituent ratio of clinically significant prostate cancer (csPCa) in PI-RADS V2 overall scores 3, 3+1 and 4 were calculated and analyzed by non-parametric Chi-square test to determine whether the difference in composition ratio was significant. The positive rate of DCE in diffusion weighted imaging (DWI) score 3 and 4 were calculated. Results: There were 68.6%(140/204) cases in 204 patients with peripheral prostate disease who scored PI-RADS V2 overall score of 3,3+1 and 4. Kappa value was higher for the PI-RADS V2 overallscore of 4 than 3 or 3+1 in the PZ (k values of 0.802 vs 0.737 or 0.591, respectively; all P<0.01). The constituent ratio of csPCa in PI-RADS V2 overallscore of 3, 3+1 and 4 were 16.7%(3/18),43.2%(19/44),78.2%(61/78), the difference of which was significant (χ(2)=29.839, P<0.05).There was also a significant difference between the constituent ratio of csPCa in the score of 3+1 and 4 (χ(2)=15.286, P<0.01).The positive rate of DCE in cases of PI-RADS V2 overall score 3,3+1 and 4 was 76.4%(107/140).The positive rate of DCE incases of DWI score 3 and 4 were 71.0%(44/62), 80.8%(63/78),respectively. Conclusion: DCE has a certain value in PI-RADS V2 due to its high positive rate in the detection of prostate cancer in peripheral zone.DCE is helpful to DWI score 3 to improve the detection rate of csPCa.The PI-RADS V2 overall score 3+1 and 4 in the peripheral zone maybe need to be distinguished due to the different detection of csPCa.

Implication of Modified Chemical Profiles of Different Seed Proteins through Heat-Related Processing to Protein Nutrition and Metabolic Characteristics in Ruminant Systems

The objectives of this study were to reveal the implication of modified chemical profiles of protein in cool-season-adapted cereal seeds through heat-related processing to protein nutrition and metabolic characteristics in ruminant systems. The parameters of protein-related chemical and nutritive profiles modified by heat-related processing included (a) chemical and nutrient profiles, (b) degradation kinetics (K_d and BCP), (c) digestion (IDP and TDP), (d) degraded protein balance (DPB/OEB value), and (e) metabolizable protein (MP, DVE, and FMV values). The seeds used in this study included cool-season-adapted wheat (CSW), triticale (CST), and corn (CSC). Each grain source had 3 consecutive year-replicated samples and were subjected to different heat-related processing: dry heating (DH) and moist heating (MH). The results showed that (1) the heat-related processing significantly modified metabolic characteristics of protein in the seeds (p < 0.05), (2) in comparison to DH, MH had a dramatic improvement (p < 0.05) in protein utilization profiles (decreased rumen degradation and increased intestinal digestion), (3) the seeds had significant (p < 0.05) difference in rumen degradation and intestinal digestion, (4) among the seeds, the CSW had the highest milk value (FMV; p < 0.05) and was increased by MH application (p < 0.05), and (5) the results showed that the seeds responded independently to different heat-related processing. MH-related processing had a more profound impact on CSW and CST in chemical profiles and nutrition. The CSC had less response to the heat-related processing.

GPR39 Overexpression in OSCC Promotes YAP-Sustained Malignant Progression

The clinical outcome of oral squamous cell carcinoma (OSCC) has not improved in recent years, mainly due to the limited effective targeted therapy that has been applied. Recently, a transcriptional coactivator, YAP, has been shown to have a key regulatory role in malignant progression in multiple cancers, including OSCC. But pharmacologically targeting YAP or the Hippo pathway, which is the main signaling pathway regulating YAP, has been proven to be challenging. Therefore, uncovering YAP upstream regulators in cancer would identify novel therapeutic targets for treatment of YAP-sustained cancers. Here, we showed that YAP was overactivated in OSCC and that high YAP activity in patients with OSCC was associated with malignant progression and poor survival. We uncovered that GPR39 (a G protein-coupled receptor) was overexpressed in OSCC, that the expression level of GPR39 was correlated with the activity level of YAP, and that the high GPR39 expression was associated with malignant progression and poor survival in patients with OSCC. Moreover, we found that GPR39 regulated YAP through a Gαq/11-RhoA-dependent signaling pathway. Importantly, inhibition of GPR39 resulted in YAP-sustained OSCC growth inhibition. Our findings suggest that GPR39 is a potential therapeutic target for OSCC treatment with itself as a biomarker.

Electronic structure of the parent compound of superconducting infinite-layer nickelates

The search continues for nickel oxide-based materials with electronic properties similar to cuprate high-temperature superconductors^1-10. The recent discovery of superconductivity in the doped infinite-layer nickelate NdNiO₂ (refs. ^11,12) has strengthened these efforts. Here, we use X-ray spectroscopy and density functional theory to show that the electronic structure of LaNiO₂ and NdNiO₂, while similar to the cuprates, includes significant distinctions. Unlike cuprates, the rare-earth spacer layer in the infinite-layer nickelate supports a weakly interacting three-dimensional 5d metallic state, which hybridizes with a quasi-two-dimensional, strongly correlated state with [Formula: see text] symmetry in the NiO₂ layers. Thus, the infinite-layer nickelate can be regarded as a sibling of the rare-earth intermetallics^13-15, which are well known for heavy fermion behaviour, where the NiO₂ correlated layers play an analogous role to the 4f states in rare-earth heavy fermion compounds. This Kondo- or Anderson-lattice-like 'oxide-intermetallic' replaces the Mott insulator as the reference state from which superconductivity emerges upon doping.

Estimation of error variance via ridge regression

We propose a novel estimator of error variance and establish its asymptotic properties based on ridge regression and random matrix theory. The proposed estimator is valid under both low- and high-dimensional models, and performs well not only in nonsparse cases, but also in sparse ones. The finite-sample performance of the proposed method is assessed through an intensive numerical study, which indicates that the method is promising compared with its competitors in many interesting scenarios.

Mitochondrial dysfunction is involved in aristolochic acid I-induced apoptosis in renal proximal tubular epithelial cells

Aristolochic acid (AA) is a compound extracted from the Aristolochia species of herbs. AA exposure is associated with kidney injury known as aristolochic acid nephropathy (AAN). Proximal tubular epithelial cell (PTEC) is the primary target of AA and rich in mitochondria. Recently, increasing evidence suggests that mitochondrial dysfunction plays a critical role in the pathogenesis of kidney disease. However, the status of mitochondrial function in PTEC after exposure to AA remains largely unknown. The aim of this study was to explore the effect of aristolochic acid I (AAI) on cell apoptosis and mitochondrial function in PTEC. Normal rat kidney-52E (NRK-52E) cells were exposed to different concentrations of AAI for different time periods. Cell viability was detected by 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide, cell apoptosis was analyzed by flow cytometry, and the expression of cleaved caspase-3 by Western blotting. Mitochondrial function was evaluated by reactive oxygen species (ROS), mitochondrial membrane potential (MMP), mitochondrial DNA (mtDNA) copy number, and adenosine triphosphate (ATP). It was found that AAI reduced cell viability and increased cell apoptosis in a dose- and time-dependent manner. In parallel to increased apoptosis, NRK-52E cell manifested signs of mitochondrial dysfunction in response to AAI treatment. The data indicated that AAI could increase ROS level, lower MMP, decrease mtDNA copy number, and reduce ATP production. In addition, Szeto-Schiller 31, a mitochondria-targeted antioxidant peptide, attenuated AAI-induced mitochondrial dysfunction and apoptosis. Our study depicted significant aberrant of mitochondrial function in AAI-treated NRK-52E cell, which suggested that mitochondrial dysfunction may be involved in AAI-induced apoptosis in PTEC.

Evolving Practice Patterns Over Two Decades (1993-2013) in the Management of Desmoid-type Fibromatosis in British Columbia

AIMS

Due to the rarity and varied natural history of desmoid-type fibromatosis, evidence-based treatment standards for this disease remain lacking. This study evaluated outcomes in patients with desmoid-type fibromatosis managed at a Canadian institution over two decades.

MATERIALS AND METHODS

Records of 227 patients with desmoid-type fibromatosis referred from 1990 to 2013 were retrospectively reviewed to investigate management strategies including active surveillance, surgery, radiation therapy, cryoablation, and systemic therapy, including tamoxifen and chemotherapy.

RESULTS

Thirty-two per cent of cases were men, median age 40 years, median tumour size 5.4 cm. Initial treatments were surgery (79%), tamoxifen (13%), radiation therapy (5.0%), chemotherapy (1.8%) and cryoablation (1.2%). Active surveillance was used upfront in 26% of cases, most after 2005. At a median follow-up of 77 months, one patient died of disease, 13 died of unrelated causes and the remainder were alive with no evidence of disease (56%), stable/responding disease (33%) or progressive disease (4%). The recurrence rate was 25% after upfront surgery. Response rates and disease control rates were 40% and 76% for active surveillance; 68% and 96% for radiation therapy; 31% and 67% for tamoxifen; and 53% and 80% for chemotherapy. On univariable analysis, factors associated with a higher recurrence after initial surgery were young age (P = 0.012), male gender (P = 0.012) and extremity location (P = 0.005). On multivariable analysis, only young age was significantly associated with recurrence risk (P = 0.010).

CONCLUSIONS

Active surveillance was associated with spontaneous regression and long-term disease control consistent with other studies. Primary radiation therapy appeared to provide a similar response and disease control compared with systemic treatments and may be a viable option for patients who are not candidates for surgery or active surveillance.

Metabolic syndrome and renal cell cancer risk in Chinese males: a population-based prospective study

Background

Metabolic syndrome (MetS) is now a common public health problem. Few researches have reported the relationship between MetS and the risk of renal cell cancer (RCC). To investigate the association of metabolic syndrome and its components with the risk of RCC in Chinese males, the study was performed in the Kailuan male cohort, a large prospective cohort study.

Methods

A total of 104,333 eligible males enrolled in the every 2-year health checkup were involved in the Kailuan male cohort study (2006-2015). Information on demographic and socioeconomic characteristics, lifestyle, medical history and laboratory tests at baseline entry was obtained. Univariable and multivariable Cox proportional hazards regression models were used to estimate the association between MetS and the RCC risk.

Results

During a median follow-up of 8.9 years, 131 RCC cases were verified over a total of 824,211.96 person-years. Among the 5 single MetS components, hypertension (Systolic/diastolic blood pressure≥130/85 mm Hg or antihypertensive drug treatment of previously hypertension) (HR = 2.35, 95%CI:1.48-3.72) and elevated triglyceride (TG) (≥1.7mmol/L) (HR = 1.78, 95%CI:1.23-2.56) showed significant risk for RCC. Multivariate analysis showed that compared to those who did not meet MetS diagnostic criteria (number of abnormal MetS components&lt;3), HR of RCC risk for participants with MetS was 1.95 (95% CI 1.35-2.83). The number of abnormal MetS components was linearly associated with an increased risk of RCC (P trend&lt;0.001), and the HRs of RCC risk for males with 1, 2 and ≥3 MetS components were 1.27 (0.56-2.90), 2.42 (1.12-5.20) and 3.32 (1.56-7.07), respectively, compared with subjects without MetS components.

Conclusions

MetS was inversely associated with of RCC risk in males.

Key messages

MetS might be one of the scientific and important predictors of RCC. Controlling metabolic syndrome may potentially have key scientific and clinical significance for RCC prevention.

Overexpression of paralogues of the wheat expansin gene TaEXPA8 improves low-temperature tolerance in Arabidopsis

Low temperature is one of the important factors limiting wheat yield in cold regions. Expansins are nonenzymatic proteins that loosen cell walls and play important roles in diverse biological processes related to cell wall modification, including development and stress tolerance. Many studies have shown that expansins are involved in resistance to various abiotic stresses, such as heat and drought. However, the role of expansins in response to low-temperature stress remains unclear. Based on our previous transcriptome data of a winter wheat cultivar Dongnongdongmai 2 (DN2), we found that one of the expansin genes, TaEXPA8, was significantly induced by low temperature, indicating a role for TaEXPA8 in cold resistance. In this study, the paralogous TaEXPA8 genes TaEXPA8-A, TaEXPA8-B and TaEXPA8-D were cloned by RT-PCR. These three genes were then transformed into Arabidopsis by the floral dip method. Expression patterns of TaEXPA8 genes in different tissues and in response to several abiotic stresses and hormones were detected by quantitative real-time PCR (qRT-PCR). The results showed that TaEXPA8-A and TaEXPA8-B were expressed mainly in roots, while TaEXPA8-D was expressed predominantly in flowers. TaEXPA8 genes were induced by low-temperature and drought. The overexpression of TaEXPA8-B and TaEXPA8-D enhanced low-temperature resistance and had increased superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) activity and soluble protein, MDA and proline content. In summary, our study suggested that the expansins TaEXPA8-B and TaEXPA8-D are involved in the response to low temperature and possibly play a role in cold resistance by activating the protective enzyme system.

[MicroRNA-1 regulates fibronectin expression in human trabecular meshwork cells under oxidative stress]

Objective: To investigate the expression of microRNA-1 (miR-1) and its regulatory function on fibronectin (FN) in human trabecular meshwork cells (HTMC) under oxidative stress. Methods: Experimental study. After HTMC were treated with 0, 60, 100, 200, 400 μmol/L hydrogen peroxide (H(2)O(2)) for 6 h, respectively, the cells were placed in culture medium for 24 h. The expression of miR-1 and FN mRNA in these cells were detected by real-time quantitative PCR. According to bioinformatics analysis, the target gene of miR-1 is predicted to be FN; pcDNA3/pri-miR-1 vectors, pcDNA3/enhanced green fluorescent protein (EGFP)-FN-3'UTR vectors and pcDNA3/EGFP-FN-3'UTRmut vectors were constructed. pcDNA3/pri-miR-1 were co-transfected with pcDNA3/EGFP-FN-3'UTR or pcDNA3/EGFP-FN-3'UTRmut respectively into HTMC. pDsRed2-N1 was taken as internal reference. After 48 h transfection, the absorbance of EGFP and red fluorescent protein (REP) was detected with fluorescence spectrophotometer to explore the effect of miR-1 on FN expression. HTMC was stimulated with 200 μmol/L H(2)O(2) for 24 h after overexpression plasmid of miR-1 was transfected into it, and then FN mRNA and protein levels were detected via real time PCR, Western blotting and immunofluorescence. Data were analyzed via one-way analysis of variance or t test. Results: With the increase of H(2)O(2) concentration, miR-1 decreased (F=390.80, P<0.01) while FN increased (F=13.16, P<0.01). The level of miR-1 in HTMC stimulated by 200 μmol/L and 400 μmol/L H(2)O(2) decreased to 0.608±0.014 (t=21.67, P<0.01) and 0.409±0.020 (t=29.91, P<0.01), respectively, compared with untreated control cells (1.000); whereas, the mRNA levels of FN increased to 1.630±0.233 (t=4.47, P=0.011) and 1.903±0.246 (t=6.15, P=0.003), respectively, compared with untreated control cells(1.000). Through bioinformatics analysis, miR-1 might have candidate binding site in FN mRNA 3'-UTR. Meanwhile, these cells co-transfected with pcDNA3/pri-miR-1 and pcDNA3/EGFP-FN-3'UTRmut (0.562±0.018) had higher EGFP expression than cells co-transfected with pcDNA3/pri-miR-1 and pcDNA3/EGFP-FN-3'UTR (0.329±0.015) (t=17.39, P<0.01). Compared with the control (1.000), after overexpressing miR-1 the mRNA expression and the protein level of FN decreased to 0.294±0.081 (t=11.01, P<0.01) and 0.584±0.022 (t=5.57, P<0.01), respectively. Conclusions: MiR-1 decreases while FN increased in HTMC under oxidative stress. MiR-1 inhibits FN expression through targeting FN 3'-UTR. (Chin J Ophthalmol, 2019, 55: 355-360).

[Olfaction and sinonasal symptoms in CRSwNP patients with or without atopy]

Objective: Olfactory impairment is commonly observed in chronic rhinosinusitis with nasal polyps(CRSwNP) and has a significant impact on quality of life. However, the risk factors for olfactory impairment have not been fully understood, and whether atopy is predisposed to olfactory impairment in CRSwNP patients remains unclear. The present study aims to unveil differences in olfaction and sinonasal symptoms between CRSwNP with and without atopy by means of a hospital-based, cross-sectional survey. Method: In this study, 288 CRSwNP patients ready for sinus surgery were consecutively enrolled, and atopy, olfaction, sinonasal symptoms and CT scores were evaluated. Result: We found 71.3% of CRSwNP patients presented olfactory loss and 34.5% of them presented olfactory complaint in this cohort (In this study, olfactory impairment has been defined when VAS≥1 and olfactory dysfunction has been defined when VAS≥5）.The decreased olfactory function was associated with sinonasal symptoms(nasal congestion and rhino rhea) and total CT scores (P<0.01), but not with atopy. Multivariate logistic regression revealed that nasal congestion score and total CT score were risk factors for olfactory dysfunction (OR, 1.293 and 1.349; P<0.01) in CRSwNP patients. Conclusion: Our findings indicate atopic condition may not directly cause olfactory impairment, and physician should pay attention to the surgical treatment for local disease severity to improve the olfactory function and quality of life..

Human Umbilical Cord Mesenchymal Stem Cells Alleviate Myocardial Endothelial-Mesenchymal Transition in a Rat Dilated Cardiomyopathy Model

BACKGROUND

Human umbilical cord-derived mesenchymal stem cells (HuMSCs) have been shown to suppress cardiac fibrosis; however, the underlying mechanisms are not fully understood. Recent studies have shown that endothelial-mesenchymal transition (EndMT) plays a crucial part in myocardial fibrosis. In the present study, we investigated the suppressive role of HuMSCs in cardiac fibrosis and related mechanisms in a rat dilated cardiomyopathy (DCM) model.

METHODS

Male Lewis rats were randomly divided into 3 groups. Rats without any treatment served as a negative control group, while the DCM rats, which were generated by immunization with porcine myosin, were divided into 2 groups: a HuMSC group, in which HuMSCs (1 × 10⁶ cells/rat) were injected intravenously, and a vehicle group, in which rats were injected with volume-matched solution containing no HuMSCs. Histologic and immunofluorescent measurements were used to evaluate the effects of HuMSCs on cardiac fibrosis and EndMT.

RESULTS

We observed a significant increase in myocardial fibrosis, and elevated EndMT in rats of the vehicle group were observed compared with those in the negative control group along with the increased activity of transforming growth factor (TGF)-β1/extracellular signal-regulated kinase (ERK) 1/2 signaling. Treatment with HuMSCs repressed the increase in myocardial fibrosis and EndMT observed in DCM rats, which correlated with decreased activity of TGF-β1/ERK1/2 signaling.

CONCLUSION

The HuMSCs attenuated cardiac fibrosis at least partly through the inhibition of TGF-β/ERK-induced EndMT.

Management and population dynamics of diamondback moth (Plutella xylostella): planting regimes, crop hygiene, biological control and timing of interventions

Using an age-structured process-based simulation model for diamondback moth (DBM), we model the population dynamics of this major Brassica pest using the cropping practices and climate of Guangdong, China. The model simulates two interacting sub-populations (demes), each representing a short season crop. The simulated DBM abundance, and hence pest problems, depend on planting regime, crop hygiene and biological control. A continuous supply of hosts, a low proportion of crop harvested and long residue times between harvest and replanting each exacerbate pest levels. Biological control provided by a larval parasitoid can reduce pest problems, but not eliminate them when climate is suitable for DBM and under certain planting practices. The classic Integrated Pest Management (IPM) method of insecticide application, when pest threshold is reached, proved effective and halved the number of insecticide sprays when compared with the typical practice of weekly insecticide application.

[Research progress in prognostic factors of hepatitis B virus-associated end-stage liver disease]

Hepatitis B remains a worldwide health problem with a high mortality rate associated with end-stage liver diseases. The Model for End-Stage Liver Disease and Child-Pugh score is still widely used as the prognostic model for liver cirrhosis and inflammatory reaction, B-type natriuretic peptide and portal vein thrombosis are independent risk factors. Many new models have been proposed for liver failure, including a new model HINAT ACLF. HINAT ACLF is better than its preceding models and increased neutrophil-to-lymphocyte ratio is a single factor to promote thyroid hormone, cholinesterase, and antiviral treatment response in this model. HBV DNA is frequently involved in the predictive model of liver cancer, but with widespread use of antiviral drugs, the value of its long-term prognostication has gradually reduced. Therefore, liver stiffness value instead of HBV DNA shows apparent advantages in mREACH-B. ALBI has good median survival prediction value for hepatocellular carcinoma patients. Alpha-fetoprotein and staging method, which is based on tumor number and size, are still independent risk factors for liver cancer.

Evaluation of Diffusional Kurtosis Imaging in Sub-acute Ischemic Stroke: Comparison with Rehabilitation Treatment Effect

Stroke is a serious worldwide medical condition that causes neurological function disability. Diffusional kurtosis imaging, which measures the non-Gaussianity of water diffusion, has been demonstrated to be a sensitive biomarker in many neuro-pathologies. This study explores the relationship between neural function recovery and transformation of the ischemic lesion and/or corticospinal tract during the sub-acute phase after stroke by using diffusional kurtosis imaging. We performed a prospective study of function recovery and K metrics of 43 patients with sub-acute ischemic stroke in the middle cerebral artery territory. The effect of rehabilitation treatment was evaluated using both the Fugl-Meyer motor function score and modified Barthel index score at post-treatment compared with admission, and patients were allocated to two groups: good and poor rehabilitation effect (GRE and PRE). Metrics of diffusional kurtosis imaging within ischemic lesion and along the corticospinal tract were acquired, respectively. All three relative axial diffusional kurtoses (rKas) along the corticospinal tract in the GRE group ( n = 21) were significantly larger than those of the PRE group ( n = 22), including rKa in the posterior limb of internal capsule, rKa in the cerebral peduncle, and rKa in the basal part of the pons ( p = 0.014, 0.005, and 0.021, respectively). This multi-parametric magnetic resonance imaging study showed that diffusional kurtosis imaging has the potential to complement existing stroke imaging techniques and revealed its own advantages in elucidating the possible biophysical mechanism of functional restoration underlying ischemic stroke.

[Efficacy analysis of LVIS and Enterprise stent assisted coil in the treatment of vertebral artery dissection aneurysm]

Objective: To observe and evaluate the therapeutic efficacy of LVIS stent and Enterprise stent assisted coil in embolization of vertebral artery dissection aneurysm (VDA). Methods: Clinical data of 96 patients with VDAs treated by LVIS stent and Enterprise stent assisted coil were analyzed retrospectively between January, 2013 and June, 2017.Of all, the LVIS stent assisted coil was performed in 28 patients (LVIS-stent group) and Enterprise in 68 patients (Enterprise-stent group). The clinical and imaging follow-up were performed. The instant embolization rate, complications, and recurrence rate were analyzed and compared between the two groups. Results: Instant angiographic results:in the LVIS stent group, complete occlusion was achieved in 17 VDAs (60.7%), near-complete occlusion in 10VDAs (35.7%), and partial occlusion in 1 VDA (3.6%). In the Enterprise stent group, complete occlusion was achieved in 27 VDAs (39.7%), near-complete occlusion in 34VDAs(50.0%), partial occlusion in 7VDAs (10.3%). Procedure-related complications occurred in 3 patients (10.7%) in LVIS stent group and 3 patients (4.4%) in Enterprise stent group. DSA follow-up was performed during 6 to 12 months after surgery, and 10 patients with vertebral artery dissection aneurysm recurred, 2 in the LVIS group and 8 in the Enterprise stent group. The latest modified Rankin Scale score was 0 in 55 patients,1 in 13, 2 in 1, 3 in 1, and 6 in 1. Among them, all follow-up patients in the LVIS stent group had good prognosis, while in the Enterprise stent group, 50 patients (94.4%) had a good prognosis. Conclusions: The stent-assisted coils have a higher degree of embolization in the vertebral artery dissection aneurysms, a higher rate of near-total embolization, a lower incidence of neurological complications, and a good prognosis. The complete andnear-complete occlusion rates and the incidence of neurological complicationsin the LVIS group was higher than that in the Enterprise groupand the recurrence ratesin the LVIS group was lower than that in the Enterprise group,both with no statistically significant difference.

Vitamin D-supplemented yogurt drink reduces Candida infections in a paediatric intensive care unit: a randomised, placebo-controlled clinical trial

BACKGROUND

The prevalence of Candida infections in paediatric intensive care units (PICUs) has dramatically increased as a result of resistance to conventional anti-fungal treatments. Because vitamin D has been shown to exhibit fungicidal activity against Candida infection in an in vitro antimicrobial screening, we aimed to investigate the effect of vitamin D on Candida infections in the PICU.

METHODS

Four hundred sixteen eligible children aged between 12 months to 5 years old admitted to the PICU, who were on broad-spectrum antibiotic therapy, participated in the study. Patients were randomly assigned to two study groups, receiving a plain yogurt drink (placebo group) or supplemented with 300 IU day^-1 vitamin D (VD group). Primary outcome was defined as the incidences of Candida colonisation (Candida isolated from rectal swab) 14 days after enrollment. Secondary outcome measures were Candida growth in blood (candidaemia) and urine (candiduria).

RESULTS

The prevalence of candiduria as well as candidaemia was significantly lower in the VD-treated group (26 cases) than in the placebo group (62 cases). The mean (SD) length of PICU stay was obviously lowered in the VD group [11.8 (1.2) days] compared to the placebo group [15.2 (2.3 days)], whereas cases of patient death were similar between the two groups.

CONCLUSIONS

Supplementation of vitamin D effectively reduces infections of Candida in children who were critically ill and on broad-spectrum antibiotic treatment.