Prognostic Value of a Long Non-coding RNA Signature in Localized Clear Cell Renal Cell Carcinoma

BACKGROUND

Long non-coding RNAs (lncRNAs) can be used as prognostic biomarkers in many types of cancer.

OBJECTIVE

We sought to establish an lncRNA signature to improve postoperative risk stratification for patients with localized clear cell renal cell carcinoma (ccRCC).

DESIGN, SETTING, AND PARTICIPANTS

Based on the RNA-seq data of 444 stage I-III ccRCC tumours from The Cancer Genome Atlas project, we built a four-lncRNA-based classifier using the least absolute shrinkage and selection operation (LASSO) Cox regression model in 222 randomly selected samples (training set) and validated the classifier in the remaining 222 samples (internal validation set). We confirmed this classifier in an external validation set of 88 patients with stage I-III ccRCC from a Japan cohort and using quantitative reverse transcription polymerase chain reaction (RT-PCR) in another three independent sets that included 1869 patients from China with stage I-III ccRCC.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Univariable and multivariable Cox regression, Harrell's concordance index (c-index), and time-dependent receiver operating characteristic curves were used to evaluate the association of the classifier with overall survival, disease-specific survival, and disease-free survival.

RESULTS AND LIMITATIONS

Using the LASSO Cox regression model, we built a classifier named RCClnc4 based on four lncRNAs: ENSG00000255774, ENSG00000248323, ENSG00000260911, and ENSG00000231666. In the RNA-seq and RT-PCR data sets, the RCClnc4 signature significantly stratified patients into high-risk versus low-risk groups in terms of clinical outcome across and within subpopulations and remained as an independent prognostic factor in multivariate analyses (hazard ratio range, 1.34 [95% confidence interval {CI}: 1.03-1.75; p=0.028] to 1.89 [95% CI, 1.55-2.31; p<0.001]) after adjusting for clinical and pathologic factors. The RCClnc4 signature achieved a higher accuracy (mean c-index, 0.72) than clinical staging systems such as TNM (mean c-index, 0.62) and the stage, size, grade, and necrosis (SSIGN) score (mean c-index, 0.64), currently reported prognostic signatures and biomarkers for the estimation of survival. When integrated with clinical characteristics, the composite clinical and lncRNA signature showed improved prognostic accuracy in all data sets (TNM + RCClnc4 mean c-index, 0.75; SSIGN + RCClnc4 score mean c-index, 0.75). The RCClnc4 classifier was able to identify a clinically significant number of both high-risk stage I and low-risk stage II-III patients.

CONCLUSIONS

The RCClnc4 classifier is a promising and potential prognostic tool in predicting the survival of patients with stage I-III ccRCC. Combining the lncRNA classifier with clinical and pathological parameters allows for accurate risk assessment in guiding clinical management.

PATIENT SUMMARY

The RCClnc4 classifier could facilitate patient management and treatment decisions.

[Analysis of infection and drug-resistance in 6 107 cases of extrapulmonary tuberculosis in Chengdu area]

Objective: To analyze the infection and drug resistance of extrapulmonary tuberculosis, in order to provide useful references for prevention and treatment of tuberculosis (TB). Methods: A total of 6 107 suspected cases of extrapulmonary tuberculosis, including lymph node, pleural, peritoneal, meningeal, urinary tract, and bone tuberculosis, were collected retrospectively from January 2013 to December 2015 in Public Health Clinical Center of Chengdu. There were 4 033 male and 2 074 female patients, and the average age was 37 years.The epidemiological data, infection and drug resistance were analyzed statistically. Results: There were 21 036 cases of mycobacterial culture from January 2013 to December 2015, of which 7 119 were positive(33.8%). Extrapulmonary tuberculosis was found in 6 107 cases, of which 896 were positive, accounting for 12.6% of the positive cases(896/7 119). Culture-positive cases of extra-pulmonary tuberculosis showed a rising trend from 2013 to 2015 (n=174, 310, 421, respectively), and the annual average increasing rate was over 50%.Cases were distributed at younger ages (21-40 years), with an average age of 34 years.There were more male patients, with a male to female ratio of 2.1∶1. The most common site of extrapulmonary tuberculosis was the bone(62/243, 25.5%), followed by lymph node(283/1 297, 21.8%), pleural(289/1 840, 15.7%), urinary tract(63/452, 13.9%), peritoneum(41/303, 13.5%), meningeal(156/1 915, 8.1%)and other types of tuberculosis(2/57, 3.5%). Drug sensitivity test of 896 extrapulmonary tuberculosis strains showed that the resistance rate (from high to low) was in the order of isoniazid, rifampicin, streptomycin, ofloxacin, ciprofloxacin, amikacin, capreomycin and ethambutol. Multidrug-resistant(MDR)and extremely-drug resistant (XDR) rate was 9.7 %(87/896)and 2.0%(17/896)respectively. Conclusions: Cases of extrapulmonary tuberculosis sent for bacterial culture and the positive rate showed a rising trend by years in Chengdu area.The drug resistance level was higher than that reported both in China and abroad.The prevention and treatment of extrapulmonary tuberculosis should be strengthened in this area.

KRT8 upregulation promotes tumor metastasis and is predictive of a poor prognosis in clear cell renal cell carcinoma

Keratin 8 (KRT8) plays an essential role in the development and metastasis of multiple human cancers. However, its role in clear cell renal cell carcinoma (ccRCC) remains unexplored. Here, we investigated the expression pattern, clinical significance, and function of KRT8 in ccRCC. KRT8 mRNA and protein levels were determined in two large cohorts using quantitative real-time polymerase chain reaction (qRT-PCR) and tissue microarray (TMA) immunohistochemistry (IHC), respectively. We found that KRT8 expression was upregulated in ccRCC and vein tumor thrombi (VTTs). KRT8 overexpression in ccRCC was significantly correlated with aggressive characteristics and was predictive of a poor prognosis in ccRCC patients. Moreover, KRT8 overexpression in renal cancer cell lines promoted cell migration and invasion. In contrast, KRT8 knockdown suppressed ccRCC metastasis both in vitro and in vivo. In addition, our findings showed that KRT8 promoted ccRCC metastasis by increasing IL-11 expression, causing IL-11 autocrine induction, and triggering STAT3 signaling. Overall, this study established the significance of KRT8-IL-11 axis activation in aggressive ccRCC and defined a novel critical signaling mechanism that drives human ccRCC invasion and metastasis.

Narcissus yellow stripe virus and Narcissus mosaic virus detection in Narcissus via multiplex TaqMan-based reverse transcription-PCR assay

AIMS

Development of a multiplex TaqMan RT-qPCR assay to simultaneously detect Narcissus yellow stripe virus (NYSV) and Narcissus mosaic virus (NMV), frequently causing mixed narcissus infection. Feasibility verification was confirmed in natural samples.

METHODS AND RESULTS

Primers and probes were designed based on the conserved CP gene regions of NYSV or NMV and their suitability for singleplex and multiplex TaqMan RT-qPCR assays as well as for conventional RT-PCR. Conventional RT-PCR, singleplex and multiplex TaqMan RT-qPCR assays proved to be NYSV and NMV specific. P-values and coefficients of variation of TaqMan RT-qPCR assays indicated high reproducibility. Significantly increased sensitivity was achieved compared to conventional RT-PCR. The detection limit of both viruses was 10³ copies with superior correlation coefficients and linear standard curve responses between plasmid concentrations and Ct values. NYSV and NMV infection of narcissus leaves, petals and bulbs could successfully be detected via our multiplex RT-qPCR method at 1·25 mg.

CONCLUSION

Our multiplex TaqMan RT-qPCR assay provides rapid, specific, sensitive and reliable testing to simultaneously detect NYSV and NMV, supplying useful routine monitoring for different narcissus samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

Efficient identification and discrimination of the narcissus viruses provides reliable information for scientists and conventional growers. Furthermore, it enriches the information of NYSV, NMV and other narcissus viruses.

[Correlation of the degree of band 3 protein absence on erythrocyte membrane by eosin-5'-maleimide binding test and clinical phenotype in hereditary spherocytosis]

目的

探讨伊红-5′-马来酰亚胺标记的流式细胞术（EMA结合试验）检测红细胞膜骨架带3蛋白缺失程度与遗传性球形红细胞增多症（hereditary spherocytosis，HS）临床表现型的关系。

方法

分析258例未行脾切除术治疗的HS患者临床和实验室特征，评估EMA结合试验结果与贫血程度、溶血和造血代偿参数的关系。

结果

258例HS患者中，男128例，女130例，中位年龄23（2~70）岁。代偿性溶血91例、轻度贫血53例、中度贫血78例、重度贫血36例。EMA结合试验荧光强度减低中位数为29.97%（16.09%~47.34%），平均数为（29.70±6.28）%。荧光强度减低程度与红细胞平均体积呈负相关（r=−0.343，P<0.001），与红细胞平均血红蛋白浓度呈正相关（r=0.223，P<0.001），与网织红细胞比例（r=−0.015，P=0.813）和绝对值（r=0.080，P=0.198）均无明显相关性，与血清间接胆红素水平无明显相关（r=−0.009，P=0.902），与HGB水平无明显相关性（r=−0.067，P=0.280）。按EMA标记缺失程度四分位区间分组，不同EMA标记缺失组与HS贫血严重程度分组亦无明显相关性（C=0.150，P=0.746）。

结论

EMA结合试验结果与HS贫血程度无关。

[Comparison of efficacy and safety of two different dose of recombinant human thrombopoietin regimens in severe aplastic anemia patients with immunosuppressive therapy]

目的

比较不同重组人TPO（rhTPO）方案联合免疫抑制剂治疗重型再生障碍性贫血（SAA）的近期疗效。

方法

回顾性分析接受一线免疫抑制治疗（IST）的61例成人SAA初诊患者资料，对比分析18例IST联合rhTPO每日1次（连续组）与43例IST联合rhTPO隔日1次（间日组）患者的疗效差异。

结果

两组患者在IST前基础临床特征差异无统计学意义。IST后3个月和6个月进行疗效评估，连续组与间日组患者总体血液学反应率比较差异无统计学意义（3个月：50.0%对51.2%，P= 0.934；6个月：77.8%对69.8%，P=0.525）。连续组IST后3个月良好血液学反应率明显高于间日组（38.9%对9.3%，P=0.011）。rhTPO应用后4周和8周两组脱离红细胞输注率差异无统计学意义（4周：22.2%对18.6%，P=0.736; 8周：55.6%对46.5%，P=0.519），而治疗后8周脱离血小板输注率连续组明显高于间日组（88.9%对48.8%，P=0.003）。每日连续应用rhTPO治疗并不增加不良反应事件的发生。

结论

每日1次较隔日1次应用rhTPO促进SAA造血恢复和减少血小板输注依赖更为有效。

[Analysis of the compliance of chronic rhinosinusitis surgical treatment for adults]

Objective:To investigate the factors which effect the compliance of treatment for chronic rhinosinusitis(CRS) patients. Method:Offering disease education to 386 patients who suffered from CRS, then find out the reason why some of them refuse to accept surgery through a half-year follow-up by phone and analysis the clinical information. Result:One hundred and ninety-seven accepted surgery while.Not among 386 patients the compliance rate was 51.04%，we found out that the factors affecting compliance were educational level and VAS scale using χ² test and logistic regression. Conclusion:Patients with higher educational level, lower VAS score,turned to be less compliable; and we should still work on how to improve the patients' compliance.

Effect of Cigarette Smoking on Risk of Hip Fracture in Men: A Meta-Analysis of 14 Prospective Cohort Studies

BACKGROUND

Several observational studies have suggested an association between cigarette smoking and risk of hip fracture. However, no formal systematic review or meta-analysis was performed to summarize this risk in men.

MATERIALS AND METHODS

A search was applied to MEDLINE, EMBASE, and web of science (up to November 1 2016). All prospective cohort studies assessing risk of hip fracture with the factor of cigarette smoking in men without language restriction were reviewed, and qualities of all included studies were assessed using the Newcastle-Ottawa Scale. Two authors independently assessed literatures and extracted information eligibility, and any disagreement was resolved by consensus. Newcastle-Ottawa quality assessment scale was used to evaluate studies' quality in meta-analyses. We calculated the RR with 95% CIs in a random-effects model as well as the fixed-effects model using the metan command in the STATA version 12.0 (StataCorp, USA).

RESULTS

Fourteen prospective cohort studies were eligible for the present analysis. A meta-analysis of 12 prospective studies showed that the relative risk (RR) for current male smoking was 1.47 [95% confidence interval (CI) (1.28-1.66), p = 0.54; I2 = 0%]. Subgroup analyses show study characteristics (including geography region, length of follow-up, size of cohorts and study quality) did not substantially influence these positive associations. Eight studies reported the RRs for former smokers compared with never smokers and the pooled RR was 1.15 [95% CI, (0.97-1.34), (I2 = 0%, p = 0.975)].

CONCLUSIONS

The present meta-analysis of 14 prospective studies suggests that, compared with never smokers, cigarette smoking increases risk of hip fracture in man, specifically in current smokers. However, further larger prospective cohorts with more power or meta-analysis of individual patient data are needed to confirm this association.

[Clinical characteristics and prognosis in 12 patients with adult T cell leukemia/lymphoma confirmed by HTLV-1 provirus gene detection]

Objective: To analyze the clinical characteristics and prognosis of adult T cell leukemia/lymphoma (ATLL). Methods: Peripheral blood samples from patients who were suspected as ATLL from March, 2013 to July, 2015, were collected for HTLV-1 provirus genes detection in genomic DNA extraction by PCR. Cases showing positive results were confirmed as ATLL. Clinical and laboratory characteristics, therapeutic outcomes and survival evaluation were collected. Results: 12 out of 23 suspected patients were confirmedly diagnosed as ATLL through HTLV-1 provirus genes detection by PCR. Eight patients were male and four patients were female. Median age was 51 (range 28-66) years old. All of those patients came from coastal cities of Fujian province where a HTLV-1 epidemic area locates. In the subtype classification of these 12 ATLL, 11 patients were classified as acute type and one case as lymphoma type ATLL. As one of the clinical characteristics of ATLL, ' flower cells ', with typical or atypical morphology had been observed in a high rate (81.8%). Clinical symptom such as hepatomegaly, splenomegaly and lymphadenectasis were detected in most of patients, and hypercalcemia and elevated LDH were also noted commonly. The ATLL cells immunophenotype were typical, and the major subtype was CD4+ CD8- type. Confection of hepatitis B virus was detected in a high rate (54.5%). Ten patients received chemotherapy, and 2 cases in complete remission after chemotherapy received allogeneic hematopoietic stem cell transplantation. At the end of the follow-up, 7 cases died, 4 cases survived, 1 case was lost, and the median survival was 2.8 (0.9-10.8) months. We found a case had HTLV-1 provirus negative after transplantation. Conclusion: In the coastal area of Fujian Province, ATLL is not rare. Characteristics of those ATLL are typical. But prognosis is still unsatisfactory.

Expression profile analysis of ascorbic acid-related genes in response to temperature stress in the tea plant, Camellia sinensis (L.) O. Kuntze

Ascorbic acid (AsA), also known as ascorbate or vitamin C, is a natural organic compound in green plants that has antioxidant properties, and is an essential nutrient for humans. The tea plant, Camellia sinensis (L.) O. Kuntze, is an important global economic crop. Here, the expression profiles of genes related to AsA biosynthesis and recycling were analyzed in tea plants in response to temperature stress. Eighteen genes involved in AsA biosynthesis and recycling pathways were identified based on the transcriptome database. The expression levels of CsPGI1 in two varieties of tea plants ('Yingshuang' and 'Huangjinya') increased, peaked at 4 h, and then decreased in response to cold stress. In 'Yingshuang', the genes involved in AsA biosynthesis pathway rapidly responded to heat stress and substantially increased their expression levels at 1 h. The expression levels of CsMDHAR, CsDHAR1, and CsDHAR2 increased sharply at 1 h in response to heat stress in 'Yingshuang'. In contrast, the expression levels of CsMDHAR, CsDHAR1, and CsDHAR2 in 'Huangjinya' gradually increased during heat treatment from 1 to 24 h. The expression trends of two DHAR isoforms differed in 'Huangjinya' during cold stress. The expression patterns of AsA-related genes differed in the different tea plant varieties and depended on temperature. The genes involved in AsA biosynthesis and recycling pathways were induced by heat and cold stress. Our study provides useful data with which to improve the resistance of tea plants to cold and heat stress.

[Application of three risk assessment models in occupational health risk assessment of dimethylformamide]

Objective: To investigate the application of United States Environmental Protection Agency (EPA) inhalation risk assessment model, Singapore semi-quantitative risk assessment model, and occupational hazards risk assessment index method in occupational health risk in enterprises using dimethylformamide (DMF) in a certain area in Jiangsu, China, and to put forward related risk control measures. Methods: The industries involving DMF exposure in Jiangsu province were chosen as the evaluation objects in 2013 and three risk assessment models were used in the evaluation. EPA inhalation risk assessment model: HQ=EC/RfC; Singapore semi-quantitative risk assessment model: Risk= (HR×ER) ^1/2; Occupational hazards risk assessment index=2^{Health effect level}×2^{exposure ratio}×Operation condition level. Results: The results of hazard quotient (HQ>1) from EPA inhalation risk assessment model suggested that all the workshops (dry method, wet method and printing) and work positions (pasting, burdening, unreeling, rolling, assisting) were high risk. The results of Singapore semi-quantitative risk assessment model indicated that the workshop risk level of dry method, wet method and printing were 3.5 (high) , 3.5 (high) and 2.8 (general) , and position risk level of pasting, burdening, unreeling, rolling, assisting were 4 (high) , 4 (high) , 2.8 (general) , 2.8 (general) and 2.8 (general) . The results of occupational hazards risk assessment index method demonstrated that the position risk index of pasting, burdening, unreeling, rolling, assisting were 42 (high) , 33 (high) , 23 (middle) , 21 (middle) and 22 (middle) . The results of Singapore semi-quantitative risk assessment model and occupational hazards risk assessment index method were similar, while EPA inhalation risk assessment model indicated all the workshops and positions were high risk. Conclusion: The occupational hazards risk assessment index method fully considers health effects, exposure, and operating conditions and can comprehensively and accurately evaluate occupational health risk caused by DMF.

[The expression of MiR-148a in nasopharyngeal carcinoma and its effect on tumor cell biology functions in nasopharyngeal carcinoma]

Objective:Nasopharyngeal carcinoma(NPC) is a common malignant tumor, in recent years,most of studies have found that micro RNA played an important role in the development of NPC.This study was to explore the expression level of MiR-148a and its effect on the biological functions of NPC cells.Method:The expression of MiR-148a in NPC cell line CNE2 was detected by Real-time PCR method.MTT,clone formation assay and flow cytometry were applied to detect cell proliferation and apoptosis. We predicted that EGFR was the downstream target genes of MiR-148a through the analysis of bioinformatics software. Then the expression change of EGFR was measured by Real-time PCR and Western blot.Result:Comparing with normal nasopharyngeal epithelial tissue cells,MiR-148a expression level was significantly reduced in NPC cell line CNE2.MTT,clone formation assay and flow cytometry test show that overexpression of MiR-148a can inhibit cell proliferation and promote cell apoptosis.Real-time PCR and Western blot test show that MiR 148a can reduce the expression of EGFR.Conclusion:MiR-148a can affect the proliferation and apoptosis of NPC cell,and it is likely to be involved in the development and progression of NPC.

ATF2 predicts poor prognosis and promotes malignant phenotypes in renal cell carcinoma

Background

Activating transcription factor 2 (ATF2) is a basic helix-loop-helix transcription factor, which has been shown to participate in the pathobiology of numerous cancers. However, the role of ATF2 in renal cell carcinoma (RCC) remains unclear.

Methods

ATF2 knockdown and overexpression studies were performed in RCC cells to evaluate changes in cell viability, cell cycle, apoptosis, migration and invasion. Xenograft models were used to examine the tumorigenic and metastatic capability of RCC cells upon ATF2 suppression. The expression of ATF2 in human RCC samples was determined using immunohistochemistry on a tissue microarray.

Results

ATF2 knockdown in RCC cells reduced their proliferative and metastatic potentials, whereas ATF2 overexpression enhanced these properties. Mechanistic studies revealed that the transcription of CyclinB1, CyclinD1, Snail and Vimentin was directly regulated by ATF2 in RCC cells. Moreover, ATF2 was shown to be highly expressed in RCC tissues, especially in tumors with metastases. High expression of ATF2 correlated with aggressive clinico-pathological characteristics and predicted poor prognosis of RCC patients.

Conclusions

ATF2 exerts an oncogenic role in RCC and could serve as an important prognostic biomarker.

Electronic supplementary material

The online version of this article (doi:10.1186/s13046-016-0383-2) contains supplementary material, which is available to authorized users.

Exosome-Transmitted lncARSR Promotes Sunitinib Resistance in Renal Cancer by Acting as a Competing Endogenous RNA

Sunitinib resistance is a major challenge for advanced renal cell carcinoma (RCC). Understanding the underlying mechanisms and developing effective strategies against sunitinib resistance are highly desired in the clinic. Here we identified an lncRNA, named lncARSR (lncRNA Activated in RCC with Sunitinib Resistance), which correlated with clinically poor sunitinib response. lncARSR promoted sunitinib resistance via competitively binding miR-34/miR-449 to facilitate AXL and c-MET expression in RCC cells. Furthermore, bioactive lncARSR could be incorporated into exosomes and transmitted to sensitive cells, thus disseminating sunitinib resistance. Treatment of sunitinib-resistant RCC with locked nucleic acids targeting lncARSR or an AXL/c-MET inhibitor restored sunitinib response. Therefore, lncARSR may serve as a predictor and a potential therapeutic target for sunitinib resistance.

[The clinical application of balloon dilation Eustachian tuboplasty in patients with Eustachian tube dysfunction]

Objective:To evaluate the clinical application of balloon dilation Eustachian tuboplasty (BET) in patients with Eustachian tube dysfunction (ETD). Method:Twenty-five patients who were diagnosed as ETD and reserved BET surgery were retrospectively analyzed in this study. Result:After 1-year's follow-up, among 25 ETD patients, the total cure rate was 55.9% and the effective rate was 85.3%. The cure rate and effective rate was 52.9% and 76.5% in the delayed opening of the ET group; 58.8% and 94.1% in the unopened group, which was higher than the other one. Conclusion:BET surgery is safe and effective in the treatment of BET patients.

The association between the -2518A/G polymorphism in the MCP-1 gene and the risk of pulmonary tuberculosis in Sichuan Chinese population

OBJECTIVE

The -2518A/G polymorphism in the Monocyte chemotactic protein-1 (MCP-1) gene may play an important role in regulating immunological reactions and may be associated with pulmonary tuberculosis (PTB). However, the relationship for the populations in Sichuan province of China remains unknown. The objective of the current study was to analysis that association.

PATIENTS AND METHODS

A total of 386 PTB patients and 398 controls were recruited. The genotypes were identified using PCR-RFLP and sequencing method. Data was analyzed using SPSS 11.0 software.

RESULTS

Significant association was found between the polymorphism and the risk of PTB: AG vs. AA: OR = 1.37, 95% CI = 0.98-1.92 and p = 0.06; GG vs. AA: OR = 1.69, 95% CI = 1.14-2.50 and p = 0.009; AG+GG vs. AA: OR = 1.47, 95% CI = 1.07-2.01 and p = 0.02; G vs. A: OR = 1.31, 95% CI = 1.08-1.60 and p = 0.007.

CONCLUSIONS

The current study suggested that the 2518A/G polymorphism in the MCP-1 gene was associated with risk of PTB in population of Sichuan province in China.

Adiponectin is associated with increased mortality in patients with already established cardiovascular disease: a systematic review and meta-analysis

BACKGROUND

The overall quantitative estimate on the possible association of adiponectin concentrations with mortality in patients with cardiovascular diseases (CVD) has not been reported.

METHODS

We performed a systematic review and meta-analysis of prospective studies to evaluate the overall quantitative estimates on the adiponectin levels for risk of mortality in patients with CVD. MEDLINE, EMBASE, CINAHL, and the Cochrane Library (up to Mar 22, 2014) were used to search for studies evaluating the effect of adiponectin levels on mortality in patients with CVD. Random-effect models were selected to estimate overall effect estimates.

RESULTS

Data from 14063 CVD patients enrolled in 15 prospective cohort and 1 nested case control studies were collated. The meta-analyses showed strong positive association of adiponectin with all-cause (n=14 studies, overall pooled effect estimate=1.45 [95% CI, 1.17-1.79]) and cardiovascular (n=11 studies, overall pooled effect estimate=1.69 [1.35-2.10]) mortality, for the highest tertile of adiponectin levels versus the lowest tertile. Subgroup analyses show study characteristics (including effect estimate, mean age, study location, sample sizes, gender, durations of follow-up, types of primary event, and acute or chronic CVD) did not substantially influence these positive associations.

CONCLUSIONS

Our results showed that increased baseline plasma adiponectin levels are significantly associated with elevated risk of all-cause and cardiovascular mortality in subjects with CVD. These positive associations may have been amplified by adjustment for potential intermediates or residual confounding, and their basis requires further investigation.

Clinical significance of colonoscopy in patients with upper gastrointestinal polyps and neoplasms: a meta-analysis

BACKGROUND

Some authors have studied the relationship between the presence of polyps, adenomas and cancers of upper gastrointestinal tract (stomach and duodenum) and risk of colorectal polyps and neoplasms; however, the results are controversial, which may be due to study sample size, populations, design, clinical features, and so on. No meta-analysis, which can be generalized to a larger population and could provide a quantitative pooled risk estimate of the relationship, of this issue existed so far.

METHODS

We performed a meta-analysis to evaluate risk of colorectal polyps or neoplasms in patients with polyps, adenomas or cancers in upper gastrointestinal tract comparing with controls. A search was conducted through PubMed, EMBASE, reference lists of potentially relevant papers, and practice guidelines up to 27 November 2013 without languages restriction. Odd ratios (ORs) were pooled using random-effects models.

RESULTS

The search yielded 3 prospective and 21 retrospective case-control studies (n = 37152 participants). The principal findings included: (1) OR for colorectal polyps was 1.15 (95% CI, 1.04-1.26) in the gastric polyps group comparing with control groups; (2) Patients with gastric polyps and neoplasms have higher risk (OR, 1.31 [95% CI, 1.06-1.62], and 1.72 [95% CI, 1.42-2.09], respectively) of colorectal neoplasms comparing with their controls; and (3) Positive association was found between the presence of colorectal neoplasms and sporadic duodenal neoplasms (OR, 2.59; 95% CI, 1.64-4.11).

CONCLUSIONS

Findings from present meta-analysis of 24 case-control studies suggest that the prevalence of colorectal polyps was higher in patients with gastric polyps than in those without gastric polyps, and the risk of colorectal neoplasms increases significantly in patients with gastric polyps, neoplasms, and duodenal neoplasms. Therefore, screening colonoscopy should be considered for patients with upper gastrointestinal polyps and neoplasms.

First Report of Coleus blumei viroid 5 from Coleus blumei in India and Indonesia

Coleus blumei, which was found originally in Indonesia, is an ornamental plant grown worldwide. It can be infected by several viroids of the genus Coleviroid, family Pospiviroidae. Six main viroids that infect coleus have been reported: Coleus blumei viroid 1 through 6 (CbVd-1 ~ CbVd-6). Although CbVd-1 was first reported in a commercial coleus in Brazil in 1989 (1), and then in Germany, Japan, Canada, Korea, China, and India, CbVd-5 was reported only in China in 2009 (2). Symptoms caused by CbVd-5 varied depending on different cultivars, and in case of an unknown cultivar of "Red with dark green edge," are very clear albino symptoms. From 2010 to 2011, 60 and 3 leaf samples of coleus were collected from Hyderabad, India, and Java, Indonesia, respectively, and subjected to low molecular weight RNA extraction according to Li et al. (3). The results of dot-blot hybridization using CbVd-5 cRNA probes and RT-PCR using CbVd-5 specific primers (CbVd-5-P_F: 5'-TGACTAGAACAGTAGTAAAG-3' / CbVd-5-P_R: 5'-AATTGAGGTCAAACCTCTTT-3') demonstrated that 28 out of the 60 samples from India and all three samples from Indonesia were positive for CbVd-5. The resulting RT-PCR fragments from one sample selected randomly from each country were cloned into the pMD18-T vector (Takara) and transformed into E. coli DH5α competent cells. Five positive clones of each sample were sequenced. The result of sequence analysis revealed that the similarities of CbVd-5 between the sequences we obtained and the reference sequence (GenBank Accession No. NC003683) were 97.8 to 100%. Bioassay using nine viroid-free coleus plants from three cultivars (three from each cultivar), inoculated with CbVd-5 infectious clones by stem slashing, demonstrated that CbVd-5 could induce albino symptom on the leaves of the unknown cultivar "Red with dark green edge" 2 months after inoculation. To our knowledge, this is the first report of CbVd-5 from India and Indonesia, and the second report of CbVd-5 in the world. Considering the effect of CbVd-5 on the appearance of coleus and its recombination ability, a certification program may be needed to control the spread of this viroid. References: (1) M. E. N. Fonseca et al. Fitopatol. Bras. 14:94, 1989. (2) W. Y. Hou et al. Arch. Virol. 154:315, 2009. (3) S. F. Li et al. Ann. Phytopathol. Soc. Jpn. 61:381, 1995.

First Report of Kudzu mosaic virus on Pueraria montana (Kudzu) in China

Kudzu (Pueraria montana), a weed widely distributed in southern China, is common in the Fuzhou region of Fujian Province, where many plants show yellow vein mosaic disease. In September 2008, four leaf samples from different plants exhibiting yellow vein mosaic symptom were collected in suburban district of Fuzhou (25°15' N, 118°08' E). Whitefly (Bemisia tabaci) infestation was also observed in this region. Total DNA was extracted from all samples using a CTAB method (4). Universal primers (PA/PB) were used to amplify part of the intergenic region and coat protein gene of DNA-A of begomoviruses (1). An amplicon of approximately 500 bp was obtained from all four samples and then sequenced. Comparison of 500-bp fragments (GenBank Accession Nos. FJ539016-18 and FJ539014) revealed the presence of the same virus (98.8 to 99.4%). A pair of back-to-back primers (Yg3FL-F: 5'-GGATCCTTTGTTGAACGCCTTTCC-3'/Yg3FL-R: 5'-GGATCCCACATGTTTAAAGTAAAGC-3') were designed to amplify the full-length DNA-A from the Chinese isolate identified as Yg3. Sequence analysis showed that full-length DNA-A of Yg3 isolate comprised 2,729 nucleotides (GenBank Accession No. FJ539014) and shared the highest nucleotide sequence identity (91.9%) with Kudzu mosaic virus (KuMV, GenBank Accession No. DQ641690) from Vietnam. To further test the association of DNA-B fragments with the four samples from southern China, rolling circle amplification (RCA) was performed (3). When RCA products were digested with Sph I, approximately 2.7 kb was obtained from all samples. Yg3 isolate was chosen to be sequenced. Sequence analysis showed that full-length DNA-B of Yg3 isolate comprised 2,677 nucleotides (GenBank Accession No. FJ539015) and shared the highest nucleotide sequence identity (76.8%) with KuMV DNA-B (GenBank Accession No. DQ641691) from Vietnam. Based on the current convention of begomovirus species demarcation of <89% sequence identity cut-off criterion (2), Yg3 was identified as an isolate of KuMV. To our knowledge, this is the first report of association of KuMV with yellow vein mosaic symptom of kudzu in China. References: (1). D. Deng et al. Annals Appl. Biol. 125:327, 1994. (2). C. M. Fauquet et al. Arch. Virol. 148:405, 2003. (3). D. Haible et al. J. Virol. Methods 135:9, 2006. (4). Y. Xie et al. Chinese Sci. Bull. 47:197, 2002.

N-Acetylcysteine supplementation for the prevention of atrial fibrillation after cardiac surgery: a meta-analysis of eight randomized controlled trials

BACKGROUND

Atrial fibrillation is the most common type of arrhythmia after cardiac surgery. An increasing body of evidence demonstrates that oxidative stress plays a pivotal role in the pathophysiology of atrial fibrillation. N-acetylcysteine (NAC) is a free radical scavenger, and may attenuate this pathophysiologic response and reduce the incidence of postoperative AF (POAF). However, it is unclear whether NAC could effectively prevent POAF. Therefore, this meta-analysis aims to assess the efficacy of NAC supplementation on the prevention of POAF.

METHODS

Medline and Embase were systematically reviewed for studies published up to November 2011, in which NAC was compared with controls for adult patients undergoing cardiac surgery. Outcome measures comprised the incidence of POAF and hospital length of stay (LOS). The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity.

RESULTS

Eight randomized trials incorporating 578 patients provided the best evidence and were included in this meta-analysis. NAC supplementation significantly reduced the incidence of POAF (OR 0.62, 95% CI 0.41 to 0.93; P = 0.021) compared with controls, but had no effect on LOS (WMD -0.07, 95% CI -0.42 to 0.28; P = 0.703).

CONCLUSIONS

The prophylactic NAC supplementation may effectively reduce the incidence of POAF. However, the overall quality of current studies is poor and further research should focus on adequately powered randomized controlled trials with POAF incidence as a primary outcome measure.

First Report of the Occurrence of Sweet potato leaf curl virus in Tall Morningglory (Ipomoea purpurea) in China

Natural occurrence of Sweet potato leaf curl virus (SPLCV) has been reported in Ipomoea batatas (sweet potato, Convolvulaceae) or I. indica (Convolvulaceae) in several countries including the United States, Sicily, and China (1-3). In September of 2007, while collecting samples showing begomovirus-like symptoms in the Chinese province of Fujian, we observed tall morningglory (I. purpurea (L.) Roth, also known as Pharbitis purpurea (L.) Voigt), plants with slightly yellow mosaic and crinkled leaves. Total DNA was extracted from leaves of these plants and tested by rolling circle amplification (4). Amplification products were digested by the restriction enzyme BamHI for 30 min. Restriction products (2.8 kb) were then cloned into pMD18T vector (Takara Biotechnology, China) and sequenced. Comparison of complete DNA sequences by Clustal V analysis revealed that these samples were infected by the same virus, and an isolate denoted F-p1 was selected for further sequence analysis. F-p1 was 2,828 nucleotides, with the typical genomic organization of begomoviral DNA-A (GenBank Accession No. FJ515896). F-p1 was compared with the DNA sequences available in the NCBI database using BLAST. The whole DNA sequence showed the highest nucleotide sequence identity (92.1%) with an isolate of SPLCV (GenBank Accession No. FJ176701) from Jiangsu Province of China. The result confirmed that the samples from the symptomatic tall morningglory were infected by SPLCV. To our knowledge, this is the first report of the natural occurrence of SPLCV in I. purpurea, a common weed species in China. References: (1). P. Lotrakul et al. Plant Dis. 82:1253, 1998. (2). R. W. Briddon et al. Plant Pathol. 55:286, 2006. (3) Y. S. Luan et al. Virus Genes 35:379, 2007. (4) D. Haible et al. J. Virol. Methods 135:9, 2006.