Extended Very-High-Energy Gamma-Ray Emission Surrounding PSR J0622+3749 Observed by LHAASO-KM2A

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E>25  TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160  TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

Ultrahigh-energy photons up to 1.4 petaelectronvolts from 12 γ-ray Galactic sources

The extension of the cosmic-ray spectrum beyond 1 petaelectronvolt (PeV; 10¹⁵ electronvolts) indicates the existence of the so-called PeVatrons-cosmic-ray factories that accelerate particles to PeV energies. We need to locate and identify such objects to find the origin of Galactic cosmic rays¹. The principal signature of both electron and proton PeVatrons is ultrahigh-energy (exceeding 100 TeV) γ radiation. Evidence of the presence of a proton PeVatron has been found in the Galactic Centre, according to the detection of a hard-spectrum radiation extending to 0.04 PeV (ref. ²). Although γ-rays with energies slightly higher than 0.1 PeV have been reported from a few objects in the Galactic plane^3-6, unbiased identification and in-depth exploration of PeVatrons requires detection of γ-rays with energies well above 0.1 PeV. Here we report the detection of more than 530 photons at energies above 100 teraelectronvolts and up to 1.4 PeV from 12 ultrahigh-energy γ-ray sources with a statistical significance greater than seven standard deviations. Despite having several potential counterparts in their proximity, including pulsar wind nebulae, supernova remnants and star-forming regions, the PeVatrons responsible for the ultrahigh-energy γ-rays have not yet been firmly localized and identified (except for the Crab Nebula), leaving open the origin of these extreme accelerators.

A Niemann-pick C1 disease child with BCG-itis: a case report and analysis

Background

Niemann-Pick C disease is a rare autosomal recessive lysosomal lipid storage disorder. Some primary immunodeficiency diseases patients developed regional disease or disseminated disease after vaccinating BCG. It is unclear whether NPC gene deficiency is associated with Mycobacteria infection.

Case presentation

We report and discuss a case of a child who presented at the age of 6 months with NPC1 and BCG-itis. The patient was treated with Miglustat and the symptom of lymphadenopathy was improved.

Conclusions

We reasonably speculate that NPC1 is a susceptibility gene of Mtb infection and mainly affects innate immunity. Once diagnosed, the infant should not be vaccinated with BCG and early treated.

[Relationship between C genotype HBV mutation and intrauterine transmission]

Objective: To analyze the virus genome mutation of mothers with C genotype HBV and explore its relationship with HBV intrauterine transmission. Methods: A total of 399 mothers carrying HBV and their newborns hospitalized in the obstetrics department of the Third People's Hospital of Taiyuan from 2011 to 2013 were selected. Necessary information about mothers and children was obtained through a questionnaire survey and medical records. HBV DNA and HBV serological markers were detected by quantitative fluorescence PCR and electrochemiluminescence. Within 24 hours after birth and before active/passive immunization, those with positive HBsAg and/or HBV DNA in femoral venous blood were determined as HBV intrauterine transmission. According to the requirements of cloning and sequencing, mothers' HBV DNA load should be ≥10⁶ IU/ml. Among 54 cases of HBV intrauterine transmission, 22 pairs of mothers and their newborns meeting the requirements of cloning and sequencing were used as the intrauterine transmission group. The same number of mothers and their newborns without intrauterine transmission was selected as the random seed method's control group. After PCR amplification of HBV DNA, gene cloning, and sequencing, the gene mutation analysis of mothers with C genotype HBV was performed. Results: Among the 44 samples, 39 (88.63%, 39/44) were genotype C, 2 were genotype B, and 3 were mixed genotype B, and C. A total of 406 clone beads from 42 mothers with C genotype HBV were analyzed for gene mutation, including 204 in the intrauterine transmission group and 202 in the control group. The base substitution mutation rate of PreS1, S, C, and P regions in the HBV intrauterine transmission group were significantly lower than those in the control group (χ² ranged from 8.67 to 40.73, P<0.05). The mutation rate of base deletion in PreC and X regions in the HBV intrauterine transmission group was lower than that in the control group (χ² values were 17.82 and 34.78, P<0.001). Two clones in the X region had 31 bp insertion mutations between nt1644 and nt1645, and two clones had 27 bp insertion mutations between nt1649 and nt1650, all of which took place in the control group. Conclusions: The base substitution mutations in the PreS1, S, C, and P segments of the HBV genome in mothers with C genotype HBV were associated with the occurrence of intrauterine transmission of HBV. Deletion mutations in the PreC region, insertion and deletion mutations in the X region may reduce intrauterine transmission risk.

[Incidence and influencing factors of AIDS-related and non-AIDS-related deaths after receiving antiretroviral therapy among HIV-positive individuals in Dehong Dai and Jingpo Autonomous Prefecture, 2010-2019]

Objective: To explore the changing trends and influencing factors of AIDS-related and non-AIDS-related deaths after receiving antiretroviral therapy (ART) among HIV-positive individuals in Dehong Dai Jingpo autonomous prefecture (Dehong) from 2010 to 2019. Methods: Based on the Chinese National treatment database, HIV patients who initiated ART from 2010 to 2019 were included in the analysis. The cumulative incidence function was used to estimate the cumulative incidence of AIDS-related death and non-AIDS-related death, respectively. The Fine-Grey model was used to compare the differences between AIDS-related and non-AIDS-related deaths and analyze its influencing factors. Results: A total of 7 068 HIV-positive individuals were included, of which 388 were AIDS-related deaths and 570 were non-AIDS-related deaths. The cumulative mortality rate at years 1, 2, 3, 4, 5, 7 and 9 after receiving ART were 2.27%, 3.46%, 4.47%, 5.03%, 5.84%, 6.61%, 7.40% for AIDS-related deaths, and 1.63%, 3.11%, 4.68%, 6.02%, 7.42%, 10.49%, 12.75% for non-AIDS-related deaths, respectively. In the Fine-Grey model, older age at ART initiation, male, unmarried, injection drug use as the transmission route, lower baseline BMI, lower baseline CD4⁺ T cell counts, baseline FIB-4 score >3.25, and baseline anemia were risk factors for AIDS-related death. In contrast, age at ART initiation ≥45 years, male, Dai, and Jingpo minority ethnicities, unmarried, injection drug use as the transmission route, lower baseline BMI, baseline FIB-4 score >3.25, baseline eGFR <60 ml·min^-1·1.73 m^-2, and baseline anemia were risk factors for non-AIDS-related deaths. Conclusions: The cumulative mortality rate was low among HIV-positive individuals after receiving ART in Dehong during 2010-2019. The mortality of non-AIDS-related deaths was higher than that of AIDS-related deaths. There were also differences in the factors influencing AIDS-related and non-AIDS-related deaths and interventions should be intensified to target the influencing factors for non-AIDS-related deaths.

[Related factors and interaction on hepatitis C virus infection in patients receiving methadone maintenance treatment in Taiyuan]

Objective: To explore the prevalence of hepatitis C virus (HCV) infection, influence factors and interaction on HCV infection in patients receiving methadone maintenance treatment (MMT) in Taiyuan. Methods: Between April-June 2019, three MMT clinics in Taiyuan were selected to conduct a face-to-face questionnaire survey among MMT patients to collect the information about their socio-demographic characteristics, drug use, MMT, sexual behavior and health status. Software EpiData 3.1 was used for real-time double entry to establish the database. Software SAS 9.4 was used to analyze the data, and χ² test was used for univariate analysis and logistic regression model was used for multivariate and interaction analyses. Results: A total of 903 subjects were surveyed among MMT patients, the male to female ratio of was 7.21∶1(743∶103), and the rate of HCV infection was 12.53% (106/846). After adjusting for the confounding factors, being women (OR=1.936, 95%CI: 1.023-3.662), having sex with drug users (OR=2.073, 95%CI: 1.110-3.871) and injection drug use (OR=7.737, 95%CI: 4.614-12.973) might be the risk factors for HCV infection in patients receiving MMT. The results showed that there were multiplicative interactions among women, having sex with drug user and injection drug use on HCV infection. Conclusions: Being women, having sex with drug user and injection drug use were associated with higher risk for HCV infection in patients receiving MMT in Taiyuan. There were multiplication interactions between being women and having sex with drug user, being female and injection drug use, and having sex with drug use and injection drug use on HCV infection.

Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial

Importance

There is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors.

Objective

To evaluate the clinical benefits of sequential chemoradiation (SCRT) and concurrent chemoradiation (CCRT) compared with radiation alone (RT) as a postoperative adjuvant treatment in early-stage cervical cancer.

Design, Setting, and Participants

After radical hysterectomy at 1 of 8 participating hospitals in China, patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB to IIA cervical cancer with adverse pathological factors were randomized 1:1:1 to receive adjuvant RT, CCRT, or SCRT. Data were collected from February 2008 to December 2018.

Interventions

Patients received adjuvant RT (total dose, 45-50 Gy), CCRT (weekly cisplatin, 30-40 mg/m2), or SCRT (cisplatin, 60-75 mg/m2, plus paclitaxel, 135-175 mg/m2) in a 21-day cycle, given 2 cycles before and 2 cycles after radiotherapy, respectively.

Main Outcomes and Measures

The primary end point was the rate of disease-free survival (DFS) at 3 years.

Results

A total of 1048 women (median [range] age, 48 [23-65] years) were included in the analysis (350 in the RT group, 345 in the CCRT group, and 353 in the SCRT group). Baseline demographic and disease characteristics were balanced among the treatment groups except that the rate of lymph node involvement was lowest in the RT group (18.3%). In the intention-to-treat population, SCRT was associated with a higher rate of DFS than RT (3-year rate, 90.0% vs 82.0%; hazard ratio [HR], 0.52; 95% CI, 0.35-0.76) and CCRT (90.0% vs 85.0%; HR, 0.65; 95% CI, 0.44-0.96). Treatment with SCRT also decreased cancer death risk compared with RT (5-year rate, 92.0% vs 88.0%; HR, 0.58; 95% CI, 0.35-0.95) after adjustment for lymph node involvement. However, neither DFS nor cancer death risk was different among patients treated with CCRT or RT.

Conclusions and Relevance

In this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, SCRT, rather than CCRT, resulted in a higher DFS and lower risk of cancer death than RT among women with early-stage cervical cancer.

Trial Registration

ClinicalTrials.gov Identifier: NCT00806117.

[Folic acid supplementation before and during pregnancy and the risk of preeclampsia]

Objective: To investigate the relationship between folic acid supplementation and the risk of preeclampsia (PE). Methods: A total of 9 048 pregnant women were selected from the First Hospital of Shanxi Medical University in Taiyuan from March 2012 to September 2016. Among them, 882 pregnant women with PE were divided into case group, and 8 166 pregnant women without PE were divided into control group. Information on demographic characteristics, folic acid supplementation, maternal complications, and other factors were collected by face-to-face interviews after child birth in the hospital. Unconditional logistic regression analyses were used to investigate the relationship between folic acid supplementation and the risk of PE and the effects of pre-pregnancy BMI on the relationship of folic acid supplementation with the risk of PE. Results: Compared with nonusers, folic acid supplement users had reduced risk of PE (OR=0.79, 95%CI: 0.64-0.96). Folic acid supplementation before and during pregnancy were negatively related with the risk of PE (OR=0.63, 95%CI: 0.49-0.81). Pregnant women who used folic acid tablets only or used both folic acid tablets and multivitamin containing folic acid had reduced risk of PE (OR=0.81, 95%CI: 0.66-0.99; OR=0.64, 95%CI: 0.49-0.85). No significant relationship was observed in the multivitamin group. Supplemental folic acid doses of <400, 400, and >400 μg/d were related with reduced risk of PE (OR=0.62, 95%CI: 0.42-0.91; OR=0.81, 95%CI: 0.66-0.99; OR=0.68, 95%CI: 0.49-0.94). After stratified by pre-pregnancy BMI, pregnant women who used folic acid supplementation, those with pre-pregnancy BMI<24.0 kg/m(2) had reduced risk of PE (OR=0.75, 95%CI: 0.59-0.96). However, no significant relationship was observed in women with pre-pregnancy BMI≥24.0 kg/m(2). Conclusions: Folic acid supplementation before and during pregnancy were related with reduced risk of PE. Pre-pregnancy BMI might affect the relationship between folic acid supplementation and the risk of PE. Appropriate folic acid supplementation should be recommend for women with different pre-pregnancy BMI.

High alcohol-producing Klebsiella pneumoniae causes fatty liver disease through 2,3-butanediol fermentation pathway in vivo

High alcohol-producing Klebsiella pneumoniae (HiAlc Kpn) in the gut microbiota had been demonstrated to be the causative agent of fatty liver disease (FLD). However, the catabolic pathways for alcohol production in vivo remain unclear. Here, we characterized the genome of HiAlc and medium alcohol-producing (MedAlc) Kpn and constructed an adh (an essential gene encoding alcohol dehydrogenase) knock-out HiAlc Kpn W14 strain (W14Δadh) using CRISPR-Cas9 system. Subsequently, we established the mouse model via gavage administration of HiAlc Kpn W14 and W14 Δadh strains, respectively. Proteome and metabolome analysis showed that 10 proteins and six major metabolites involved in the 2,3-butanediol fermentation pathway exhibited at least a three-fold change or greater during intestinal growth. Compared with HiAlc Kpn W14-fed mice, W14Δadh-fed mice with weak alcohol-producing ability did not show apparent pathological changes at 4 weeks, although some steatotic hepatocytes were observed at 12 weeks. Our data demonstrated that carbohydrate substances are catabolized to produce alcohol and 2,3-butanediol via the 2,3-butanediol fermentation pathway in HiAlc Kpn, which could be a promising clinical diagnostic marker. The production of high amounts of endogenous alcohol is responsible for the observed steatosis effects in hepatocytes in vivo.

[Relationship between mutations of HBV basal core promoter region in HBsAg-positive mothers and intrauterine transmission]

Objective: To analyze the relationship between maternal mutations in basal core promoter region of hepatitis B virus (HBV) genotype C and intrauterine transmission. Methods: We collected information on general demographic characteristics and process of delivery among 399 pairs of consecutive HBsAg-positive mothers and their neonates, from the Third People's Hospital of Taiyuan in Shanxi province, China. Fluorescence quantitative polymerase chain reaction (FQ-PCR) and Electro-chemiluminescence immuno-assay (ECLIA) kits were used to detect both maternal and neonatal HBV DNA and serological markers in the peripheral blood. From 113 mothers with HBV DNA load ≥10(6) IU/ml, we selected 22 mothers whose neonates were with intrauterine transmission and randomly selected the same number of mothers whose neonates were without intrauterine transmission, as controls. The whole-length HBV DNA were extracted, amplified, cloned, sequenced and genotyped. Finally, a total of 39 mothers with genotype C of HBV were selected for mutation analysis. Results: Thirty-nine cases of genotype C (88.63%) were finally included in the study, with 19 cases in the intrauterine transmission group and 20 cases as controls. Rates of A1762T/G1764A double mutations were significantly different between the intrauterine transmission group and the control group (7.53% vs. 27.72%, P<0.001). Results from the multivariate analysis showed that the A1762T/G1764A double mutations had reduced the risk of intrauterine transmission (aOR=0.065, 95%CI: 0.006-0.746, P=0.028). Maternal A1762T/G1764A double mutations appeared to be possibly associated with neonatal HBeAg (P=0.050). Conclusion: A1762T/G1764A double mutations of HBV DNA from the genotype C of those HBsAg-positive mothers could reduced the risk of HBV intrauterine transmission during pregnancy.

[Characteristics of methadone maintenance treatment clinic patients and influencing factors for HBsAg positivity based on Bayesian network model]

Objective: To understand the characteristics and explore the influencing factors of HBsAg positivity in methadone maintenance treatment (MMT) clinic patients. Methods: A face to face interview and medical record review were conducted in 1 040 patients at three MMT clinics in Guangxi from September to November in 2014. The questionnaire information included general demographic characteristics, drug use history, MMT status, sexual behaviors, and health status, etc. Blood samples were collected from the patients at the same time for the detections of the level of HBsAg, anti-HBs and anti-HCV. By using χ(2) test, unconditional logistic regression model and Bayesian network model the influencing factors for HBsAg positivity in MMT clinic patients and the complex network relationship among these factors were explored. Results: A total of 1 031 MMT clinic patients were surveyed, the HBsAg positive rate was 11.35% (117/1 031). The anti-HCV positive rate was 71.77% (740/1 031), among the anti-HCV positive patients, the HBsAg positive rate was 10.27% (76/740). After adjusting for the confounding factors, anti-HBs positive persons might not be HBsAg positive (OR=0.05, 95%CI: 0.03-0.09), and anti-HCV positive persons might not be HBsAg positive too (OR=0.30, 95%CI: 0.17-0.52) compared with anti-HBs negative and anti-HCV negative persons, respectively. The persons with family history of hepatitis B virus infection were more likely to be HBsAg positive compared those with no such family history (OR=5.30, 95%CI: 2.68-10.52). Bayesian network model analysis results showed that family history of hepatitis B virus infection and anti-HBs were directly related with HBsAg positivity. Anti-HCV, intravenous drug use in the past three months and other drug using during treatment were indirectly related with HBsAg positivity. Conclusions: Anti-HBs, family history of hepatitis B virus infection, anti-HCV, intravenous drug use in past three months and other drug use during treatment were related with the HBsAg positivity in MMT clinic patients. So, it is necessary to enhance health education, improve health awareness and decrease high risk behaviors to reduce the rate of HBV infection.

ATM-CHK2-Beclin 1 axis promotes autophagy to maintain ROS homeostasis under oxidative stress

The homeostatic link between oxidative stress and autophagy plays an important role in cellular responses to a wide variety of physiological and pathological conditions. However, the regulatory pathway and outcomes remain incompletely understood. Here, we show that reactive oxygen species (ROS) function as signaling molecules that regulate autophagy through ataxia-telangiectasia mutated (ATM) and cell cycle checkpoint kinase 2 (CHK2), a DNA damage response (DDR) pathway activated during metabolic and hypoxic stress. We report that CHK2 binds to and phosphorylates Beclin 1 at Ser90/Ser93, thereby impairing Beclin 1-Bcl-2 autophagy-regulatory complex formation in a ROS-dependent fashion. We further demonstrate that CHK2-mediated autophagy has an unexpected role in reducing ROS levels via the removal of damaged mitochondria, which is required for cell survival under stress conditions. Finally, CHK2^-/- mice display aggravated infarct phenotypes and reduced Beclin 1 p-Ser90/Ser93 in a cerebral stroke model, suggesting an in vivo role of CHK2-induced autophagy in cell survival. Taken together, these results indicate that the ROS-ATM-CHK2-Beclin 1-autophagy axis serves as a physiological adaptation pathway that protects cells exposed to pathological conditions from stress-induced tissue damage.

Effects of post-hatch brooding temperature on performance of starter and growing Pekin ducks

An experiment was conducted to investigate the effects of post-hatch brooding temperature on the growth performance of starter Pekin ducks from hatch to 14 D of age and the subsequent growth performance and carcass trait of growing ducks from 15 to 42 D of age. A total of 360 one-day-old male White Pekin ducks were allocated randomly to 6 environment-controlled chambers with ambient temperature set at 26, 28, 30, 32, 34, and 36°C from hatch to 7 D of age, respectively, and then decreased gradually to 26°C at 14 D of age. At 14 D of age, all ducks from all chambers were transferred to a duck barn with ambient temperature maintaining from 26 to 22°C and these birds continued to be raised from 14 to 42 D of age. At 14 D of age, body weight, weight gain, and feed intake decreased linearly or quadratically as initial brooding temperature increased (P < 0.05) and these performance traits were reduced when initial brooding temperature increased to 36°C (P < 0.05). There was no difference in growth performance between ducks fed at brooding temperature regimen starting at 26, 28, 30, and 32°C (P > 0.05). According to broken-line regression, the upper critical temperatures of the initial brooding temperature during the starter period for body weight, weight gain, and feed intake were 31.3, 31.3, and 31.1°C, respectively. On the other hand, the growing ducks brooded initially at 26 or 36°C had lower body weight, weight gain, and feed intake as compared to other birds brooded starting from 28 to 34°C (P < 0.05), but the initial brooding temperature had no effects on carcass traits (P > 0.05). It was concluded that the upper critical temperature of the initial brooding temperature for starter Pekin ducks was 31.3°C and too low initial brooding temperature could lead to growth depression during the subsequent growing period.

[Association between maternal dietary intake and the incidence of babies with small for gestational age]

Objective: To investigate the relations between dietary intake during pregnancy and the incidence of their babies with small for gestational age (SGA). Methods: Data on demographics, dietary intake of protein, fat, and carbohydrates of the pregnant mothers during the first, second and third trimester, were collected. Information related to birth weight and gestational age of the infants were also gathered. A total of 8 102 women, who delivered their babies at the First Affiliated Hospital of Shanxi Medical University from March 2012 to September 2016, were enrolled in this project. Among them, 961 mothers had infants with SGA but the other 7 141 of them having normal infants. Unconditional logistic regression model was used to analyze the effect of dietary nutrient intake on SGA the first, second and third trimester. Results: We found that low dietary intake of protein during the first trimester and following trimesters during pregnancy were positively associated with higher risk of SGA (OR=1.534, 95%CI: 1.217-1.934; OR=1.268, 95%CI: 1.005-1.599; OR=1.310, 95%CI: 1.036-1.655). When adjusting for maternal pre-pregnancy BMI, we found that when mothers were with a pre-pregnancy BMI less than 18.5 or with low maternal intake of protein during the first trimester, positive association with higher risk of SGA (OR=1.872, 95%CI: 1.033-3.395; OR=1.754, 95%CI: 1.125-2.734), was noticed. However, for mothers with a pre-pregnancy BMI between 18.5 and 24.0 or with low protein intake during the first trimester, significant association with higher risk of SGA (OR=1.465, 95%CI: 1.089-1.972) was found. Conclusions: Through our observation, maternal dietary intake during pregnancy seemed to be associated with the risk of SGA but the effects of dietary intake were different, according to the BMI of pre-pregnancy population. Early pregnancy appeares as the key period for dietary intake which may influence the SGA.

[The 470th case: recurrent vomiting]

Patients with cyclic vomiting syndrome usually have comorbid psychological disorders, the trigger and aggravating factors of gastrointestinal symptoms. It may decrease the quality of life and the response to the conventional therapies, bring the patients to seek medical care frequently and perform unnecessary examinations, result in the waste of medical resources. We reported a 20-year-old woman with complaint of recurrent vomiting since infant, and less response to symptomatic and supportive treatment. Her vomiting relieved with antidepressant after consultation with gastroenterological specialist and psychologist. Physicians should pay more attention to recognize the comorbid psychological disorders in patients with functional gastrointestinal disorders (FGIDs), including cyclic vomiting syndrome. It is important to refer the patients with refractory symptoms to the psychologists for further professional evaluation and antidepressants.

Effects of vitamin A on growth performance and tissue retinol of starter White Pekin ducks

A dose-response experiment with 8 supplemental vitamin A levels (0, 500, 1,000, 1,500, 2,500, 3,500, 7,000, and 14,000 IU/kg) were conducted to examine the effects of vitamin A on growth performance and tissue retinol of starter White Pekin ducks. A total of 512 one-day-old male Pekin ducks were randomly divided into 8 treatments and each treatment contained 8 replicate pens of 8 ducks. All these ducks were reared in raised wire-floor pens from hatch to 21 D of age. At 21 D of age, growth performance and retinol concentration in plasma and liver were measured. Among all ducks, the birds fed basal diet with no supplemental vitamin A had the lowest weight gain, feed intake, and plasma and liver retinol (P < 0.05). As supplemental vitamin A increased, weight gain and feed intake increased quadratically (P < 0.05) and plasma and liver retinol increased linearly or quadratically (P < 0.05). The weight gain and plasma retinol showed broken-line response to increasing supplemental vitamin A (P < 0.05). According to broken-line regression, the minimum supplemental vitamin A requirements for weight gain and plasma retinol were 2606 and 4371 IU/kg, respectively. It was concluded that vitamin A deficiency could lead to a reduction in growth performance and tissue retinol retention and plasma or liver retinol was available biomarker to assess duck vitamin A status.

[Detection of axillary nerve multisegment motor nerve conduction using magnetic stimulation]

Objective: To establish a method for detecting multi-segmental motor nerve conduction of axillary nerve using magnetic stimulation technique, and to preliminarily discuss its clinical application value. Methods: From April 2017 to February 2018, 80 healthy volunteers, 40 male and 40 female, were included and divided into five groups according to age and gender (groupⅠwere <35 years old; groupⅡwere 35-44 years old; group Ⅲ were 45-54 years old; groups Ⅳ were 55-64 years old; groups Ⅴ aged 65-74). Axillary nerve recording electrodes were placed in the deltoid muscle belly, reference electrode was placed in the deltoid muscle check point. Using the magnetic stimulation coil, stimulation was released at spots which were, respectively, 2 fingers from the lateral side of subscapular fossa, 2 fingers from the lateral side of infraclavicular fossae, and Erb's point. The latency, amplitude, detection distance (stimulation to recording electrode) were recorded at each spot, and the height and arm length were also measured. Results: The detection rate of axillary nerve waveform in healthy volunteers was 97.2%. There were no statistically significant differences in latency and amplitude in the different sides, gender (P>0.05).The latency corresponding to different detection distances was compared, and the difference was statistically significant (P<0.05).Height and arm length in different age groups were significantly increased in groupsⅠ, Ⅱ and Ⅲ compared with groups Ⅳ and Ⅴ, with statistical significance (P<0.05). When compared among different age groups, the latency and amplitude of group Ⅳand Ⅴ (more than 55 years old and over) were significantly prolonged and decreased, with statistically significant differences (P<0.05). Conclusions: The method of detecting multi-segmental magnetic stimulation of axillary nerve is stable and the result is reliable, which makes the evaluation of the proximal nerve of upper limbs be possible. However, the biological effects of age on nerve conduction should be carefully considered.

[Comparison of intraocular pressure reduction in eyes with different intraocular tamponades after pars plana vitrectomy by 20% mannitol]

Objective: To investigate the efficacy of 20% mannitol in reducing intraocular pressure (IOP) in eyes with different intraocular tamponades after pars plana vitrectomy (PPV). Methods: Retrospective case-control study. Sixty-eight patients were administered with 20% mannitol and IOP was noted at regular intervals after simple PPV with ocular hypertension, including 24 males (26 eyes) and 44 females (46 eyes), aged (45.6±19.3) years. These cases were divided into three groups according to different tamponades: silicon-oil tamponade, 23 eyes; gas tamponade, 30 eyes; balanced salt solution (BSS), 19 eyes. The data were analyzed using the t test, variance and q test. Results: There was a significant decrease in IOP in all patients after using 20% mannitol. The IOP in the group of silicon-oil decreased from (33.25±2.56) mmHg (1 mmHg=0.133 kPa) to (23.21±1.85) mmHg, with a maximum decrease of 30.10%; the reduction in the group of C(3)F(8) was from (33.25±2.84) mmHg to (12.15±1.12) mmHg, with a maximum decrease of 33.44%. The IOP of the two groups dropped to a minimum both at 75 minutes. In the group of BSS, the IOP decreased from (32.95±2.33) mmHg to (17.50±1.35) mmHg, and the maximum extent of the decrease was 45.82% at 45 minutes. The difference in the IOP among the three groups at 20 min, 30 min, 45 min and 60 min was statistically significant (F=34.02, 112.68, 122.07, 34.83, all P=0.00). There were significant differences between the BSS group and the silicone-oil group (q=6.44, 13.04, 15.00, 17.11, all P=0.00), and between the BSS group and the C(3)F(8) group (q=7.68, 12.56, 12.93, 13.61, all P=0.00). Conclusion: In eyes with different intraocular tamponades, 20% mannitol was useful for short-term IOP reduction after vitrectomy, especially in those with BSS within one hour. But after 75 minutes, there was no statistically significant difference between groups. (Chin J Ophthalmol, 2019, 55:289-293).

[Related factors and interaction on HIV/HCV co-infection of patients access to methadone maintenance treatment]

Objective: To estimate the prevalence of HIV/HCV co-infection and explore the influence factors and their interaction on HIV/HCV co-infection of patient's access to methadone maintenance treatment (MMT). Methods: A face to face interviews were conducted among 750 patients at two MMT clinics in Guangxi Zhuang Autonomous Region. The questionnaires information included demographic characteristics, HIV and HCV infection status, history of drug abuse, urine test for morphine, high risk sex behaviors, needle sharing, dropped out etc. Methods of χ(2) test one-way, multivariate logistic regression and interactions were used to analyze the related factors of HIV/HCV co-infection. Results: The study subjects included 750 participants, 18.31% (127/691) of patients were co-infected with HIV and HCV. The HIV/HCV co-infection rate in patients who shared needles with others or dropped out of treatment was 35.84% (81/226) and 19.88% (64/322) respectively, which were higher than those who have never shared needles or dropped out (9.89%, 46/465 and 17.07%, 63/369). Logistic regression analysis results showed that after adjusted for confounding factors, patients who shared needles (OR=4.50, 95%CI: 2.72-7.43) and dropped out of treatment (OR=1.71, 95%CI: 1.04-2.80) were more likely to be infected with HIV/HCV. Interaction analysis showed that sharing needles and dropping out of treatment exist additive effect on co-infection of HIV and HCV (RERI=4.21, AP=0.44, SI=1.95). Conclusions: Needle sharing and dropping out of treatment are associated with HIV/HCV co-infection. Health education, psychological counseling and other measures should be taken to reduce needle sharing and dropping out of MMT.

[Assessment of renal function with intravoxel incoherent motion and diffusion tensor imaging in type 2 diabetic patients]

Objective: To evaluate the application value of intravoxel incoherent motion (IVIM) and diffusion tensor imaging (DTI) in detecting early-stage diabetic nephropathy and to assess the damage of ralated renal function. Methods: A total of 52 patients with type 2 diabetes diagnosed in Zhongda Hospital were collected from April 2016 to May 2017 and were assigned to DM group (diabetes without nephropathy, n=32) and DN group (diabetes with nephropathy, n=20) according to detection of microalbuminuria, a cohort of healthy recipients were included as control group (n=27) in the meantime. All of the subjects underwent IVIM and DTI examination. The cortical and medullary parameters[IVIM: perfusion fraction f, tissue diffusivity D, pseudodiffuvisity D(*;) DTI: fractional anisotropy FA, apparent diffusion coefficient ADC, principal diffusivities (λ1, λ2, λ3)]were obtained respectively and were compared among groups. The relationship between MRI related parameters and estimated glomerular filtration rate (eGFR) were statistically investigated; and diagnostic performance of IVIM and DTI in discriminating DM and DN group was evaluated by receiver operating characteristic analysis. Results: The cortical and medullary f, D values in DN group were lower than those in DM group and control group (F=17.32, 15.69, 6.71, 10.94, all P<0.05). D values of all subjects showed positive correlations with eGFR (cortex r=0.518, medulla r=0.538, both P<0.05). The diagnostic efficiency of cortical f values to discriminate diabetes and diabetic nephropathy was 0.817, the cut-off value was 0.205. The medullary FA value in DM group was lower than that in control group ((0.371±0.051 vs 0.423±0.043, t=4.188, P<0.05); and the medullary FA value in DN group (0.315±0.062) was lower than that in control and DM group (F=25.08, P<0.05). The medullary λ3 values in DM group and DN group were all significantly higher than that in control group (F=7.86, P<0.05). The diagnostic efficiency of medullary FA values to discriminate diabetes and diabetic nephropathy was 0.763, the cut-off value was 0.344. Conclusion: IVIM and DTI can reflect the abnormal perfusion and diffusion during early-stage diabetic nephropathy and have the potential value to assess the damage of ralated renal function.

Apatinib combined with oral etoposide in patients with platinum-resistant or platinum-refractory ovarian cancer (AEROC): a phase 2, single-arm, prospective study

BACKGROUND

Anti-angiogenic therapy combined with chemotherapy could improve the outcomes of patients with platinum-resistant ovarian cancer. Apatinib is an oral tyrosine kinase inhibitor that selectively inhibits VEGF receptor 2. We assessed the efficacy and safety of the combination therapy of apatinib and oral etoposide, considering the potential advantage of home administration without hospital admission, in patients with platinum-resistant or platinum-refractory ovarian cancer.

METHODS

In this phase 2, single-arm, prospective study, we recruited patients aged 18-70 years with platinum-resistant or platinum-refractory ovarian cancer at the Sun Yat-sen University Cancer Center (China). The treatment consisted of apatinib at an initial dose of 500 mg once daily on a continuous basis, and oral etoposide at a dose of 50 mg once daily on days 1-14 of a 21-day cycle. Oral etoposide was administered for a maximum of six cycles. Treatment was continued until disease progression, patient withdrawal, or unacceptable toxic effects. The primary endpoint was the proportion of patients achieving an objective response according to Response Evaluation Criteria in Solid Tumors, version 1.1. We used Simon's two-stage design, and analysed efficacy in the intention-to-treat and per-protocol populations. Safety analyses included enrolled patients who had received at least one dose of study medication, but excluded those without any safety data. This study is registered with ClinicalTrials.gov, number NCT02867956.

FINDINGS

Between Aug 10, 2016, and Nov 9, 2017, we screened 38 and enrolled 35 patients. At the data cutoff date (Dec 31, 2017), 20 (57%) patients had discontinued the study, and 15 (43%) patients remained on treatment. Objective responses were achieved in 19 (54%; 95% CI 36·6-71·2) of 35 patients in the intention-to-treat population and in 19 (61%; 42·2-78·2) of 31 patients in the per-protocol population. The most common grade 3 or 4 adverse events were neutropenia (17 [50%]), fatigue (11 [32%]), anaemia (ten [29%]), and mucositis (eight [24%]). Serious adverse events were reported in two patients who were admitted to hospital (one patient had anaemia and anorexia; the other patient had increased ascites due to disease progression). No treatment-related deaths were recorded.

INTERPRETATION

The combination of apatinib with oral etoposide shows promising efficacy and manageable toxicities in patients with platinum-resistant or platinum-refractory ovarian cancer, and further study in phase 3 trials is warranted.

FUNDING

None.

[The colonoscopic characteristics of colorectal endometriosis: a single-centered retrospective study]

Objective: To reinforce the awareness of colorectal endometriosis (EM) in colonoscopy examination. Methods: Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study. The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group. Results: A total of 34 cases were included with average age of (38.3±8.9) years old. All EM lesions located within rectum and sigmoid colon. The endoscopic lesions manifested as protrusion in 21 cases (61.8%) and protrusion-depression in 13 cases (38.2%), local stenosis in 8 cases (23.5%); erosive surface in 33 cases (97.1%) with local spontaneous hemorrhage in 4 cases (11.8%); nodal surface in 23 cases (67.6%), and lymphangiectasis base in 9 cases (26.4%). Endoscopic biopsy specimens were obtained in all cases with average 3 (2, 4) pieces. Positive results were found only in 4 patients (11.8%) with 3 endometriosis and one (endometrial) adenosarcoma. Compared with negative group, spontaneous hemorrhage was more frequent in positive group (2/4 vs. 2/30, P=0.013). Mean biopsy sample number was significantly larger in positive group (5 vs. 3, P=0.004). Conclusions: Colorectal endometriosis is mostly located within rectosigmoid region. Endoscopic features mainly include protrusion or protrusion-depression lesions with erosive and nodular surface, or local stenosis. Spontaneous hemorrhage under colonoscopy yields higher positive rate for biopsy, thus increasing biopsy sample numbers may improve pathology results.

Facilitating the measurement of circulatory hydrogen sulfide with fluorescence probe-coated microplates

OBJECTIVE

The hydrogen sulfide (H₂S) role in pathogenesis of various diseases were wildly addressed in recent decade. The circulatory (plasma or serum) and biological fluid H₂S measurement is still an enormous issues due to the technical limitation. This paper aimed to develop a novel measurement method based on fluorescence probe.

METHODS

Firstly, 20 μL ethanol was used to dissolve 100 pmol fluorescence probe, then added in a 96-well plate. An equal volume of ethanol was also added to the blank well of the plate. The plate was placed in a dark room for about 1 h until the fluorescence probe was evenly coated in the 96-well microplate and dried. The plate was frozen at -20 °C for later use. Secondly, the plasma or serum sample was added with saturated ammonium sulfate buffer (pH 7.8) and then centrifuged to remove the proteins. The equal volume supernatant liquid was added to the probe-coated well and the probe-uncoated well. The plate was incubated in a dark environment at 37 °C for 2 h. Finally, after incubation, the fluorescence density was acquired at Λ_Ex/Λ_Em 340/445 nm in a microplate reader. The differences of the fluorescence density values between the probe-coated well and probe-uncoated well were counted and H₂S concentration of plasma/serum was calculated by standard curve with NaHS.

RESULTS

The method had high sensitivity (from 0.3 to 100 μmol/L) and specificity for measuring H₂S as compared with other biologically relevant reactive sulfur species and sulfur-containing amino acid. Serum H₂S concentrations were assayed in 188 health volunteers using this method [(12.1±3.5) μmol/L, 95%CI: 4.6-19.8 μmol/L], and the frequency distribution showed a normal tendency(one-sample Kolmogorov-Smirnov test, P>0.1). The serum H₂S concentrations in 30 hypertension patients were decreased compared with 22 age- and gender-matched health individuals (paired-samples t test, t=9.937, P<0.001). There were no differences of H₂S concentration in serum [(19.66±2.32) μmol/L] or plasma [(18.67±2.07) μmol/L], between the samples acquired from artery [(19.34±0.51) μmol/L] or vein [(18.99±0.50) μmol/L] of male Wistar rats (repeated measurement of ANOVA, P=0.38). One week frozen samples did not affect the detection. The values of the repeated measurement did not differ (two-way ANOVA, P>0.05).

CONCLUSION

The present method is easily performed with high sensitivity, specificity and repeatability for circulatory H₂S. It is also quick and may apply for large samples.

Distinct patterns of serum hepatitis B core-related antigen during the natural history of chronic hepatitis B

Background

The current clinical practice on chronic hepatitis B (CHB) requires better on-treatment monitoring of viral persistence. Quantified assays for hepatitis B surface antigen (HBsAg) and core-related antigen (HBcrAg) hold promise for further optimization of therapy. Here, we aimed to characterize HBcrAg during the natural course of CHB.

Methods

Four-hundred and forty four treatment naïve CHB patients, who all underwent liver histology examination, were enrolled in this cross-sectional study. Their HBV DNA, HBsAg, HBeAg and HBcrAg titres were quantified and analyzed in the context of four distinct clinical phases. Correlation of HBcrAg and HBsAg with other markers were performed. The relationship between liver and serum antigen levels were also assessed.

Results

HBcrAg, like HBsAg, exhibited high degree of correlation with HBV DNA. However, a more significant linear relationship was found between HBcrAg and HBeAg titre in immune tolerant (IT) and immune clearance (IC) phases, while in HBeAg negative hepatitis (ENH) group, HBV DNA is a major determinant of HBcrAg. Significant difference was observed in liver HBcAg score and HBcrAg level in both IT and IC phases whereas barely significant positive correlations between liver HBsAg score and HBsAg titre was documented.

Conclusion

HBcrAg titre exhibited distinct correlative profile in a phase-specific manner. In addition, its level is well-related to the intrahepatic expression of core antigen. It has a considerable utility in monitoring and refining antiviral therapy.