Mortality and prognostic factors in Chinese patients with systemic lupus erythematosus

Objectives

To investigate the mortality and causes of death in Chinese patients with systemic lupus erythematosus.

Methods

We collected the clinical data of all consecutive adult systemic lupus erythematosus patients at the Rheumatology department of Peking University First Hospital between January 2007 and December 2015. The primary causes of death were identified, the standardized mortality ratio and years of life lost were calculated, and the survival and variables associated with mortality were determined by Kaplan–Meier and Cox regression analysis respectively.

Results

The mean age of all 911 patients (814 females and 97 males) was 37.8 ± 14.7 years, the median disease duration at recruitment was 2.6 (0.5–7.0) years, and the median follow-up duration was 3.0 (1.4–5.1) years. Among the 911 patients who were successfully followed up, 45 patients died. Infection (31.1%) was the leading cause of death followed by renal failure, pulmonary arterial hypertension and cerebrovascular diseases. The overall age and sex-adjusted standardized mortality ratio was 3.2 (95% confidence interval 2.4–4.0), and the years of life lost for women and men were 29.8 and 9.4 respectively. Overall survival at 1, 5 and 10 years was 98.2%, 95.3% and 93.7% respectively. Older age at disease onset, infection, autoimmune hemolytic anemia, thrombocytopenia and pulmonary arterial hypertension were independent risk factors for the mortality of systemic lupus erythematosus patients, and longer disease duration at recruitment was an independent protective factor.

Conclusions

Mortality of systemic lupus erythematosus patients in China was substantial, especially in females, with infection the leading cause of death. Older age at disease onset, infection, autoimmune hemolytic anemia, thrombocytopenia and pulmonary arterial hypertension were associated with poor outcomes.

All-optical multilevel amplitude regeneration in a single nonlinear optical loop mirror

We experimentally demonstrate all-optical amplitude regeneration of 4-level pulse amplitude modulated signals (PAM4) based on a single nonlinear optical loop mirror (NOLM). Four power-plateau regions are achieved using return-to-zero (RZ) pulses of narrow pulse-width, enabling large nonlinear phase shifts within the highly nonlinear fiber (HNLF). We quantify noise suppression characteristics at each amplitude level and obtain an overall EVM improvement of 0.92dB by optimizing input power and distortion strength. A theoretical analysis has been also carried out matching the experimental results and revealing the design characteristics of the regenerator's nonlinear transfer function.

Development of an Open Metadata Schema for Prospective Clinical Research (openPCR) in China

Objectives: In China, deployment of electronic data capture (EDC) and clinical data management system (CDMS) for clinical research (CR) is in its very early stage, and about 90% of clinical studies collected and submitted clinical data manually. This work aims to build an open metadata schema for Prospective Clinical Research (openPCR) in China based on openEHR archetypes, in order to help Chinese researchers easily create specific data entry templates for registration, study design and clinical data collection.

Methods: Singapore Framework for Dublin Core Application Profiles (DCAP) is used to develop openPCR and four steps such as defining the core functional requirements and deducing the core metadata items, developing archetype models, defining metadata terms and creating archetype records, and finally developing implementation syntax are followed.

Results: The core functional requirements are divided into three categories: requirements for research registration, requirements for trial design, and requirements for case report form (CRF). 74 metadata items are identified and their Chinese authority names are created. The minimum metadata set of openPCR includes 3 documents, 6 sections, 26 top level data groups, 32 lower data groups and 74 data elements. The top level container in openPCR is composed of public document, internal document and clinical document archetypes. A hierarchical structure of openPCR is established according to Data Structure of Electronic Health Record Architecture and Data Stand -ard of China (Chinese EHR Standard). Meta-data attributes are grouped into six parts: identification, definition, representation, relation, usage guides, and administration.

Discussions and Conclusion: OpenPCR is an open metadata schema based on research registration standards, standards of the Clinical Data Interchange Standards Consortium (CDISC) and Chinese healthcare related stand -ards, and is to be publicly available throughout China. It considers future integration of EHR and CR by adopting data structure and data terms in Chinese EHR Standard. Archetypes in openPCR are modularity models and can be separated, recombined, and reused. The authors recommend that the method to develop openPCR can be referenced by other countries when designing metadata schema of clinical research. In the next steps, openPCR should be used in a number of CR projects to test its applicability and to continuously improve its coverage. Besides, metadata schema for research protocol can be developed to structurize and standardize protocol, and syntactical interoperability of openPCR with other related standards can be considered.

Bone mass loss is associated with systolic blood pressure in postmenopausal women with type 2 diabetes in Tibet: a retrospective cross-sectional study

We conducted an observational cross-section study to investigate the status of bone mineral mass of Tibetan postmenopausal women with type 2 diabetes and the possible predictors for osteoporosis. We found that prevalence of osteoporosis was 27.0% and blood pressure was an independent risk factor for bone mass loss.

INTRODUCTION

The aims of this study is to investigate the prevalence of osteoporosis in postmenopausal women with type 2 diabetes dwelling in Tibet and the possible risk factors for bone mass loss.

METHODS

We recruited 99 Chinese Tibetan postmenopausal women with type 2 diabetes from the department of endocrinology of People's Hospital Tibet Autonomous Region. Multiple sites of bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry (DXA). The subjects were divided into three groups based on BMD T-score: osteoporosis, osteopenia, and normal. The clinical characteristics were compared between groups. The risk factors for bone mass loss were assessed by multiple linear regression analysis.

RESULTS

Among diabetic postmenopausal women dwelling in high altitude, mean age was 62 ± 8 years, the median postmenopausal period was 12 years (5, 20), the median duration of diabetes mellitus was 3 years (1, 8), and mean BMI was 27.6 ± 4.2 kg/m². Patients (52.5%) had hypertension. The percentages of patients with osteoporosis, osteopenia and normal BMD were 27.3, 42.4, and 30.3%, respectively. HbA1c and systolic blood pressure (SBP) were independently associated with T-scores of spine; ages and SBP were independently associated with T-scores of femoral neck or hip.

CONCLUSIONS

Among diabetic postmenopausal women dwelling in high altitude, 27.3% patients have osteoporosis, 42.4% patients have osteopenia, and 30.3% are normal. The BMD T-score of spine was inversely associated with SBP and positively associated with HbA1c, while the BMD T-score of femoral neck or hip was inversely associated with ages and SBP.

Modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy: early outcomes and technical details

Thoracoscopic intrathoracic esophagogastrostomy is a technically demanding operation; these technical requirements restrict the extensive application of minimally invasive Ivor-Lewis esophagectomy. In an attempt to reduce the difficulty of this surgical procedure, this study developed a modified anastomotic technique for thoracolaparoscopic Ivor-Lewis esophagectomy. During the entirety of this modified approach, neither technically challenging operations such as intrathoracic suturing or knotting, nor special instruments such as an OrVil system or a reverse-puncture head are required. Between October 2015 and January 2016, 15 consecutive patients with cancer in the distal third of the esophagus or the gastric cardia underwent this modified surgical procedure. The good short-term outcomes that were achieved suggest that the modified anastomotic technique is safe and feasible for thoracolaparoscopic Ivor-Lewis esophagectomy.

Stimuli-responsive NLO properties of tetrathiafulvalene-fused donor–acceptor chromophores

Tetrathiafulvalene-fused electron donor–acceptor dyads display second order nonlinear optical properties that can be triggered by a pH or a redox stimulus.

Human umbilical cord mesenchymal stem cells ameliorate experimental cirrhosis through activation of keratinocyte growth factor by suppressing microRNA-199

OBJECTIVE

Keratinocyte growth factor (KGF) has a demonstrated role in the prevention of cirrhosis during liver regeneration. Previous studies have shown that transplantation of human umbilical cord mesenchymal stem cells (HUCMSCs) reduces the development of cirrhosis after liver injury. However, whether KGF may be involved in the underlying molecular mechanisms remains unknown. Here we addressed this question.

MATERIALS AND METHODS

We did HUCMSC transplantation in mice that had developed cirrhosis by carbon tetrachloride (CCl4). The effects of UCMSC transplantation on KGF levels and liver damage were examined. The level of a KGF-targeting microRNA, miR-199, was examined. The regulation of KGF by miR-199 was studied by bioinformatics analyses and luciferase reporter assay.

RESULTS

HUCMSC transplantation significantly ameliorated the severity of liver fibrosis, reduced portal hypertension and sodium retention that were induced by CCl4. HUCMSC transplantation significantly increased the levels of KGF in the injured liver, seemingly through suppression of miR-199, which targeted 3'-UTR of KGF mRNA to inhibit its protein translation.

CONCLUSIONS

HUCMSCs may ameliorate cirrhosis through activation of KGF by suppressing miR-199.

Insight into mechanics of AFM tip-based nanomachining: bending of cantilevers and machined grooves

Atomic force microscope (AFM) tip-based nanomachining is currently the object of intense research investigations. Values of the load applied to the tip at the free end of the AFM cantilever probe used for nanomachining are always large enough to induce plastic deformation on the specimen surface contrary to the small load values used for the conventional contact mode AFM imaging. This study describes an important phenomenon specific for AFM nanomachining in the forward direction: under certain processing conditions, the deformed shape of the cantilever probe may change from a convex to a concave orientation. The phenomenon can principally change the depth and width of grooves machined, e.g. the grooves machined on a single crystal copper specimen may increase by 50% on average following such a change in the deformed shape of the cantilever. It is argued that this phenomenon can take place even when the AFM-based tool is operated in the so-called force-controlled mode. The study involves the refined theoretical analysis of cantilever probe bending, the analysis of experimental signals monitored during the backward and forward AFM tip-based machining and the inspection of the topography of produced grooves.

Correction: Peculiarities of the magneto-optical response in dispersions of anisometric pigment nano-particles

Correction for ‘Peculiarities of the magneto-optical response in dispersions of anisometric pigment nano-particles’ by A. Eremin et al., RSC Adv., 2016, 6, 80666–80669.

Peculiarities of the magneto-optical response in dispersions of anisometric pigment nano-particles

We demonstrate an unusually strong magneto-optical response of elongated plate-shaped pigment particles in magnetic fields ranging from 0 to 25 T.

Molecular versus exciton diffusion in fluorescence-based explosive vapour sensors

The diffusion of p-nitrotoluene vapours into polymer or dendrimer sensing films follows Super Case II dynamics in which the quenching efficiency is strongly correlated to an accelerating analyte front propagating through the neat film rather than being reliant on exciton diffusion.

Evaluation of an antigen-capture EIA for the diagnosis of hepatitis E virus infection

An enzyme immunoassay (EIA) has been developed for hepatitis E virus (HEV) antigen (HEV-Ag) detection and marketed in China. This study aimed to evaluate the sensitivity of the assay and assess the value of HEV-Ag detection in the diagnosis of HEV infection in comparison with HEV RNA detection. Using serial dilutions of a genotype 4 HEV strain, significant correlation was found between the EIA (S/CO) and HEV RNA (IU/mL) concentration in the range 10(3.5) to 10(0.5) IU/mL HEV RNA, the Pearson correlation coefficient r approached 0.97. The EIA detection limit was 54.6 IU/mL, compared to 24 IU/mL for HEV RNA using real-time RT-PCR. In clinical samples from hepatitis E patients, the HEV-Ag and HEV RNA positivity rates were 55.6% (65/117) and 60.7% (71/117) in sera and 76.7% (56/73) and 84.9% (62/73) in stools, and the concordance of these two markers was 77.8% in sera and 80.8% in stools. In serum samples, the HEV-Ag positivity rate and the concordance between HEV-Ag and HEV RNA were inversely proportional to the presence of anti-HEV antibody. The presence of anti-HEV IgG could reduce the S/CO of the HEV-Ag EIA. These results reveal a significant correlation between the detection of HEV-Ag and HEV RNA. The sensitivity of the HEV-Ag EIA was lower than real-time RT-PCR but could be higher than conventional nested RT-PCR. Therefore, the detection of HEV-Ag in serum and faeces is valuable for the diagnosis and prognosis of HEV infection in developing regions where real-time RT-PCR is not available.

Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer

BACKGROUND

Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in certain types of human cancers. However, the value of PNI for predicting survival in patients with pancreatic cancer remains unknown. The goal of this study was to investigate the predictive significance of PNI in patients with advanced pancreatic cancer.

METHODS

A total of 321 consecutive patients with pathologically-confirmed locally advanced or metastatic pancreatic ductal adenocarcinoma (PDAC) were retrospectively recruited between January 2011 and August 2013. The patients were divided into a test set (n = 110) and a validation set (n = 211). We evaluated the association between PNI and overall survival (OS). The relationship between PNI and systemic inflammatory response markers, including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) was also assessed. In addition, the associations between PNI and the TNF-α were analyzed.

RESULTS

Kaplan-Meier analyses showed that a low PNI correlated significantly with a shorter OS in patients with advanced pancreatic cancer (190 days for patients with a low PNI vs. 290 days for patients with a high PNI, log-rank = 12.566, P < 0.001). Multivariate analysis identified PNI as an independent prognostic factor for OS (hazard ratio [HR]: 0.627, 95% confidence interval [CI]: 0.453-0.868, P = 0.003). PNI also correlated positively with NLR and PLR and negatively with LMR. Additionally, patients with a low PNI exhibited high levels of TNF-α.

CONCLUSIONS

Our results confirm that PNI is associated with the systemic inflammatory response and can be used to predict survival in advanced pancreatic cancer.

The left ventricular assist effect and biocompatibility study of a novel para-aortic counterpulsation device

OBJECTIVE

To evaluate the hemodynamic characteristics and biocompatibility of a new para-aortic counterpulsation device in animal experiment studies.

MATERIALS AND METHODS

Para-aortic counterpulsation device (PACD), a monoport device, consists of a blood chamber anastomosed to the descending aorta by means of a valveless graft and an air chamber connected to IABP machine. Hemodynamic parameters during the PACD-assisted beats were compared with those during the unassist beats. Acute heart failure was induced in all animals, and the hemodynamic effects of PACD were then reassessed.

RESULTS

We successfully induced heart failure in all cases, in conditions of which cardiac output (CO) and MAP decreased 17.6% and 27.7% respectively, and PCWP increased 57.7%. Hemodynamic indexes, cerebral and heart perfusion improved significantly after PACD assisting. PACD activation increased significantly CO and MAP 6.29% and 2.04% respectively. Both of SAP and DAP decreased significantly from 85.00 to 81.88 mmHg and 59.63 to 54.63 respectively, at the same time, MADP increased 19.4%, after PACD assist. The value of MDLMF, LMF and CSF was increased by 14.0%, 13.8% and 11.6% respectively. LCAF increased by 11.23%, after PACD assist. The PFH increased significantly in the first six hours. There was no statistically significant difference in the last two hours. When the acute animal experiments were completed, there were no infarct ischemic, thrombosis change in organs by Gross and histologic observation.

CONCLUSIONS

PACD with good biological compatibility significantly reduced the left ventricular afterload, increased diastolic arterial pressure and myocardial perfusion, improved heart function and cerebral perfusion.

Clinical implications of systemic inflammatory response markers as independent prognostic factors for advanced pancreatic cancer

BACKGROUND

Cancer-associated inflammation is a key molecular feature of pancreatic ductal adenocarcinoma. In this study, we systematically evaluated the prognostic relevance of systemic inflammatory response (SIR) markers in patients with advanced pancreatic cancer.

METHODS

A total of 321 consecutive patients with pathologically-confirmed locally advanced or metastatic pancreatic adenocarcinoma were retrospectively recruited. The patients were divided into a test set (n = 110) and a validation set (n = 211). The associations between overall survival (OS) and clinically available SIR markers including white blood cell (WBC) count, absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, platelet count, neutrophil-lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR) were analyzed using Kaplan-Meier curves and multivariate Cox proportional models.

RESULTS

High WBC count, neutrophil count, monocyte count, NLR, PLR and low LMR were significantly associated with decreased OS in the test set. Using the validation set for confirmation, we found also in multivariate analysis an independent value of WBC count (hazard ratio (HR): 2.176, 95% confidence interval (CI): 1.560-3.035, P < 0.001), neutrophil count (HR: 2.807, 95% CI: 2.000-3.940, P < 0.001), monocyte count (HR: 1.848, 95% CI: 1.315-2.598, P < 0.001), NLR (HR: 2.204, 95% CI: 1.590-3.055, P < 0.001), PLR (HR: 1.537, 95% CI: 1.114-2.122, P = 0.009) and LMR (HR: 0.569, 95% CI: 0.412-0.784, P = 0.001) for OS in patients with advanced pancreatic cancer.

CONCLUSIONS

Our study confirmed that SIR markers can be used to determine optimal therapeutic strategies for individual patients and to predict pancreatic cancer prognosis.

Detection of enterovirus 71 gene from clinical specimens by reverse-transcription loop-mediated isothermal amplification

PURPOSE

The objective of this study was to develop a sensitive, specific and rapid approach to diagnose hand foot and mouth disease (HFMD) for an early treatment by using loop-mediated isothermal amplification (LAMP) technique.

MATERIALS AND METHODS

A reverse-transcription loop-mediated isothermal amplification (RT-LAMP) for detecting EV71 virus was developed, the specificity and sensitivity of RT-LAMP was tested, and the clinical specimens was assayed by the RT-LAMP comparing with conventional reverse-transcription polymerase chain reaction (RT-PCR) and real-time PCR.

RESULTS

A total of 116 clinical specimens from the suspected HFMD individual were detected with the RT-LAMP. The detection rate for EV71 was 56.89% by RT-LAMP, 41.38% by real-time PCR and 34.48% by RT-PCR. The minimum detection limit of RT-LAMP was 0.01 PFU, both of RT-PCR and real-time PCR was 0.1PFU. Non-cross-reactive amplification with other enteroviruses was detected in the survey reports.

CONCLUSIONS

The effectiveness of RT-LAMP is higher than RT-PCR and real-time PCR. The protocol is easy to operate and time saving. It was not an expensive instrument, which was needed; it is an applicable method for rapid diagnosis of the disease, especially in resource-poor countries or in developing countries.

The non-aggregated aggrecan in the human intervertebral disc can arise by a non-proteolytic mechanism

Analysis of both the aggregated and non-aggregated fractions of aggrecan isolated from adult human intervertebral disc using immunoblotting with antibodies specific for the different domains constituting the aggrecan core protein or atomic force microscopy revealed that many components contained the G1 domain. However, little of the disc aggrecan was able to reform aggregates with hyaluronan, as determined by gel filtration chromatography, suggesting that the G1 domains had been rendered non-functional. Since previous studies have shown that disc aggrecan undergoes non-enzymatic glycation with age, the functional effect of such modification was investigated in vitro using bovine aggrecan isolated from young animals. Incubation of monomeric aggrecan with ribose to induce glycation rendered it unable to form complexes with hyaluronan stable to agarose gel electrophoresis or gel filtration chromatography. Similarly, extended treatment of intact proteoglycan aggregate with ribose resulted in destabilisation of the complex with separation of the aggrecan from the hyaluronan. Although it is clear that proteolysis occurs in the intervertebral disc and gives rise to some non-aggregating molecules, a different mechanism is required to explain the presence of many non-aggregating molecules bearing the G1 domain. The products of non-enzymatic glycation of the globular domains of aggrecan would account for this phenomenon and explain why some of the non-aggregating molecules are still large proteoglycans. While such molecules may be retained in the nucleus pulposus, they may be able to diffuse within it, reducing the ability of the tissue to resist compression under asymmetric loading such as bending and ultimately contributing to disc degeneration.

Inhibitory effect of dexamethasone on Lewis mice lung cancer cells

Recent studies have found that glucocorticoids are closely associated with oncogenesis and the development of many types of tumors. The aim of this study was to observe the effect of dexamethasone on the growth and angiogenesis of transplanted Lewis lung carcinoma in mice. Lewis lung carcinoma cells were inoculated subcutaneously into the right axilla of C57BL/6 mice, and the mice were randomly divided into 3 groups: the control group, cisplatin group, and dexamethasone group. From day 7 after inoculation, all the mice were given different treatments for 10 days, and changes in xenograft tumor volumes were monitored. All mice were sacrificed on day 17, and the tumors were obtained and weighed and the tumor inhibitory rate was calculated. The expression levels of hypoxia inducible factor 1α (HIF-1α) and vascular endothelial growth factor (VEGF), as well as the microvessel density (MVD) in the tumor mass, were measured by immunohistochemistry. Tumor growth was suppressed in the cisplatin group and dexamethasone group. The weights of tumors were markedly decreased in the cisplatin group and dexamethasone group compared with the control group (P < 0.05). The expression levels of HIF-1α and VEGF and the MVD were significantly lower in the cisplatin group and dexamethasone group than in the control group (P < 0.05). However, these levels were not significantly different between the cisplatin group and dexamethasone group (P > 0.05). Dexamethasone can effectively inhibit the growth and angiogenesis of Lewis lung carcinoma by inhibiting the expression of HIF-1α and VEGF.