Medical services provided on the 'Harmonious Mission-2017' Peace Ark from China

INTRODUCTION

The Chinese Naval ship Peace Ark provided humanitarian medical services to people in eight low-income countries in Africa and Asia during the 2017 "Harmonious Mission'. The expedition lasted 155 days. Our study aimed to analyse the details of the medical services provided including outpatient care, medical patrol, operations, examinations and medications.

METHOD

The patient demographic data and medical information were extracted from electronic medical records. The diagnoses and procedures aboard were coded by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The sociodemographic data of the medical staff aboard were collected via questionnaire. Descriptive statistics and statistical software (SAS, V.9.4) were used to analyse the data.

RESULTS

In total, 115 Chinese military medical personnel participated in the mission, completing a total of 50 758 outpatient visits, 10 232 medical patrols and 252 operations. The five most frequently used outpatient departments were ophthalmology, general surgery, general internal medicine, orthopaedics and traditional Chinese medicine. The five most common operations were lipoma excision, cataract extraction, skin tissue removal (such as warts and cysts), pterygium transposition and herniorrhaphy.

CONCLUSIONS

Our study revealed the medical services in demand during the 'Harmonious Mission-2017'. It is essential to report their experiences so that future ventures can provide medical services more effectively.

Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

BACKGROUND

Advances in lung cancer therapy have resulted in improved clinical outcomes. Unfortunately, advances can come at a financial cost to patients and their families that poses a significant risk to overall quality of life (QoL). Financial distress has been shown to be associated with increased symptom burden and decreased treatment compliance but the magnitude of financial distress is not well characterized in lung cancer populations.

PATIENTS AND METHODS

Patients with stage II-IV newly diagnosed lung cancer and starting first-line therapy were recruited at a tertiary academic institution between July 2018 and April 2019. The comprehensive score for financial toxicity (COST) was used to assess financial toxicity and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to assess QoL. Associations between financial toxicity and baseline variables were assessed using multivariable linear regression and correlations were assessed using the Pearson correlation.

RESULTS

In this study, 143 consecutive patients were approached and 91.6% agreed to participate (N = 131). The median age was 65 years (35-90); 52.7% were male (n = 69), and 75.6% were white (n = 99). The inability to afford basic necessities and having <1 month of savings was associated with increased financial toxicity (P < 0.001) after adjusting for other factors such as age, race, insurance, and income. There was also a trend toward increased financial toxicity among those who were employed but on sick leave (P = 0.06). Increased financial toxicity was correlated with a decrease in QoL (correlation coefficient 0.41, P < 0.001). Patients' anticipated out-of-pocket (OOP) expenses for the upcoming 6 months ranged from $0 to $50 000 (median $2150). However, there was no correlation between anticipated OOP expenses and either financial toxicity or QoL.

CONCLUSIONS

These data identify key factors for identifying at-risk patients and builds a framework for exploring the benefit of financial counseling interventions, which may improve QoL and oncologic outcomes.

Elevated Serum Pentraxin-3 Levels is Positively Correlated to Disease Severity and Coagulopathy in COVID-19 Patients

BACKGROUND

Coronavirus disease 2019 (COVID-19) is highly contagious and deadly and is associated with coagulopathy. Pentraxin-3(PTX3) participates in innate resistance to infections and plays a role in thrombogenesis.

PURPOSE

The present study aimed to investigate the role of PTX3 in coagulopathy in patients with COVID-19.

METHODS

A retrospective study, including thirty-nine COVID-19 patients, enrolled in Hunan, China, were performed. The patients were classified into the D-dimer_L (D-dimer <1mg/L) and D-dimer_H (D-dimer≥1mg/L) groups basing on the plasma D-dimer levels on admission. Serum PTX3 levels were detected by enzyme-linked immunosorbent assays and compared between those two groups, then receiver operating characteristic (ROC) curve analysis, correlation analysis, and linear regression models were performed to analyze the association between PTX3 and D-dimer.

RESULTS

Our results showed that serum PTX3 levels (median values, 10.21 vs. 3.36, P<0.001), computerized chest tomography (C.T.) scores (median values, 10.0 vs. 9.0, P<0.05), and length of stay (LOS) (mean values, 16.0 vs. 10.7, P=0.001) in the D-dimer_H group were significantly higher than that in D-dimer_L group. ROC curve analysis revealed that the AUC of white blood corpuscle counts, C-reaction protein, erythrocyte sedimentation rate, and PTX3 for COVID-19 were 0.685, 0.863, 0.846, and 0.985, respectively. Correlation analysis showed that there was a positive relationship between PTX3 and D-dimer (r=0.721, P<0.001), chest CT imaging score (r=0.418, P=0.008), and LOS (r=0.486, P=0.002). Multiple linear regression analysis showed that the coefficient of determination was 0.657 (P < 0.001).

CONCLUSION

Serum level of PTX3 was positively correlated with disease severity and coagulopathy. Detection of serum PTX3 level could help identify severer patients on admission and may be a potential therapeutic target for coagulopathy in patients with COVID-19.

Protective effects of Lactobacillus plantarum strain P1 against toxicity of the environmental oestrogen di-n-butyl phthalate in rats

Phthalates are contaminants widely distributed in the food-chain, and they are considered as important environmental oestrogens in our lives. In the present study, eight strains of lactic acid bacteria were isolated for their ability to adsorb di-n-butyl-phthalate (DBP), and one of the strains, Lactobacillus plantarum strain P1, was selected for more detailed analyses of its phthalate adsorption capacity in vitro. This study also evaluated the in vivo protective effects of strain P1 against DBP toxicity in rats. Sixteen rats were divided into four groups, and animals received by oral gavage every other day for a period of one month saline with or without strain P1 at 2×10¹¹ cfu/kg followed by maize oil with or without DBP (50 mg/kg). Strain P1 could adsorb more DBP than saline alone, and the concentration of mono-n-butyl phthalate in urine was decreased in animals receiving P1. Furthermore, oestrogenic effects of the different treatments were assessed through counting of sperm and observation of testis, and strain P1 could protect the sexual organs of male rats. Our results suggested that P1 is effective against phthalate toxicity due to its ability to adsorb DBP in vivo and could be considered as a new dietary therapeutic strategy against environmental phtalate toxicity.

Small RNA sequencing reveals miRNAs important for hypoxic adaptation in the Tibetan chicken

1. The Tibetan chicken, which is an indigenous breed living on the Tibetan Plateau, exhibits hypoxic adaptations to its high-altitude environment. However, the molecular mechanism behind this hypoxic adaptation is still unclear. This study aimed to investigate differentially expressed miRNAs involved in hypoxic adaptation through high-throughput RNA sequencing. 2. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to verify the differentially expressed miRNAs and their target genes in chicken embryonic heart tissues and fibroblasts. Luciferase reporter assays were performed to confirm the relationship between miRNAs and target genes. 3. The study identified 37 differentially expressed miRNAs in Tibetan chicken embryonic heart tissues, including 20 up- and 17 down-regulated miRNAs, compared to those found in lowland chickens. Differentially expressed miRNAs were mainly involved in biological processes, such as cell cycle arrest, toll-like receptor signalling pathways, and I-kappa B kinase/NF-kappa B signalling. The data showed that gga-miR-34 c-5p was significantly upregulated in Tibetan chicken tissues and hypoxic fibroblasts, while EHHADH, a target gene of gga-miR-34 c-5p, was downregulated. Moreover, gga-miR-34 c-5p dramatically decreased the luciferase activity of the wild EHHADH, whereas no effect on the mutational EHHADH was found. 4. This study identified miRNA expression profiles in the Tibetan chicken and suggested that miR-34 c-5p acts as a novel miRNA associated with hypoxic adaptation. This facilitates the understanding of molecular mechanisms that underlie long-term exposure to hypoxia.

Automatic Machine Learning to Differentiate Pediatric Posterior Fossa Tumors on Routine MR Imaging

BACKGROUND AND PURPOSE

Differentiating the types of pediatric posterior fossa tumors on routine imaging may help in preoperative evaluation and guide surgical resection planning. However, qualitative radiologic MR imaging review has limited performance. This study aimed to compare different machine learning approaches to classify pediatric posterior fossa tumors on routine MR imaging.

MATERIALS AND METHODS

This retrospective study included preoperative MR imaging of 288 patients with pediatric posterior fossa tumors, including medulloblastoma (n = 111), ependymoma (n = 70), and pilocytic astrocytoma (n = 107). Radiomics features were extracted from T2-weighted images, contrast-enhanced T1-weighted images, and ADC maps. Models generated by standard manual optimization by a machine learning expert were compared with automatic machine learning via the Tree-Based Pipeline Optimization Tool for performance evaluation.

RESULTS

For 3-way classification, the radiomics model by automatic machine learning with the Tree-Based Pipeline Optimization Tool achieved a test micro-averaged area under the curve of 0.91 with an accuracy of 0.83, while the most optimized model based on the feature-selection method χ2 score and the Generalized Linear Model classifier achieved a test micro-averaged area under the curve of 0.92 with an accuracy of 0.74. Tree-Based Pipeline Optimization Tool models achieved significantly higher accuracy than average qualitative expert MR imaging review (0.83 versus 0.54, P < .001). For binary classification, Tree-Based Pipeline Optimization Tool models achieved an area under the curve of 0.94 with an accuracy of 0.85 for medulloblastoma versus nonmedulloblastoma, an area under the curve of 0.84 with an accuracy of 0.80 for ependymoma versus nonependymoma, and an area under the curve of 0.94 with an accuracy of 0.88 for pilocytic astrocytoma versus non-pilocytic astrocytoma.

CONCLUSIONS

Automatic machine learning based on routine MR imaging classified pediatric posterior fossa tumors with high accuracy compared with manual expert pipeline optimization and qualitative expert MR imaging review.

Wnt/beta-Catenin Signaling Contributes to Vincristine-Induced Neuropathic Pain

Chemotherapy-induced neuropathic pain (CNP) is the major dose-limiting factor in cancer chemotherapy. However, the mechanisms underlying CNP remain elusive. In the present study, CNP was induced by repeated intraperitoneal injection of vincristine (VCR) into male C57BL/6J mice. VCR administration caused significant activation of Wnt/beta-catenin signaling, which led to the activation of astrocytes, microglia, the release of inflammatory cytokines tumour necrosis factor (TNF)-alpha, monocyte chemoattractant protein-1 (MCP-1) and the activation of subsequent mitogen-activated protein kinase (MAPK)/extracellular signal-regulated protein kinase (ERK) signaling pathway in CNP mice. Blocking Wnt/beta-catenin signaling by intrathecal administration of the inhibitors of Wnt response (IWR) effectively attenuated VCR-induced neuropathic pain. Furthermore, IWR inhibited the activation of astrocytes, microglia, TNF-alpha, MCP-1 and MAPK/ERK signaling in the spinal cord, which was triggered by VCR-induced Wnt/beta-catenin signaling upregulation. These results suggest that Wnt/beta-catenin signaling plays a critical role in VCR-induced neuropathic pain and provides evidence for potential interfering with Wnt/beta-catenin signaling to ameliorate VCR-induced neuropathic pain.

Spatial genetic structure and historical demography of East Asian wild boar

Pleistocene climatic fluctuations may have had a profound impact on the evolutionary history of many species. The geographical pattern of European wild boar (Sus scrofa) is clearly studied, and it was greatly influenced by ancient climatic events, especially the Last Glacial Maximum. Previous research on genetic variation has mainly focused on the origin and distribution histories of domestic pigs. However, some questions have not been answered, including those concerning the genetic diversity, geographical pattern and possible historic influence of climate on East Asian wild boar (EAWB). Employing the control region of mtDNA (511 bp), we investigated the contributions of historic climate, which possibly shaped the genetic pattern of wild boar. Given that the level of genetic diversity of wild boars is higher in East Asia than in Europe, 172 haplotypes were detected from 680 individuals. Phylogenetic analysis demonstrated the complex phylogeographic structure of EAWB. Mismatch analysis, neutrality tests and the Bayesian Skyline Plot results all retrieved signals of a rapid population expansion, which might have played an important role in driving the formation of complex spatial genetic structure. Genetic data and species distribution modelling showed that the Last Glacial Maximum had weak effect on the distribution of the EAWB. We suggest that, in shaping spatial genetic structure in East Asian, long-term gene flow and population history played more important roles than Pleistocene climate fluctuations.

FRI0367 ADALIMUMAB IS MORE EFFECTIVE THAN ETANERCEPT AT PREVENTING TNF-ENHANCED OSTEOCLAST DEVELOPMENT THROUGH DOWNREGULATION OF PRO-OSTEOCLASTOGENIC FACTORS ICAM-1 AND IGFBP2 AND UPREGULATION OF ANTI-OSTEOCLASTOGENIC FACTOR FABP4

Background:

TNF has been shown to contribute to osteoclastogenesis independently and in conjunction with M-CSF and RANKL. We have previously demonstrated that TNF enhances the kinetics of RANKL-induced human osteoclastogenesis and that its effects are mitigated more effectively by the anti-TNF biologic adalimumab (ADA) as compared to etanercept (ETN).

Objectives:

To determine the mechanism responsible for the difference in effectiveness between the two biologics, a label-free quantitative proteomics study was conducted on TNF-activated human osteoclasts (OC) upon biologic treatment.

Methods:

Human bone marrow-derived OC precursors (OCP, 3 donors) were exposed for 5 days to M-CSF, M-CSF+RANKL (RANKL) alone or in combination with 100 ng/mL TNF +/- 5 ug/mL ADA, ETN or human IgG1 (IGG) as pre-formed complexes. OC differentiation was confirmed by measuring TRAP5b activity. Shotgun proteomics was performed on peptides generated from detergent based cell extracts subjected to methanol/chloroform precipitation and trypsin/Lys-C digestion. Data acquisition was performed with Orbitrap Q Exactive™ HF-X mass spectrometer. MaxQuant was utilized to quantify proteins based on MS1 peak intensities. Data matrix was normalized, imputed and subjected to differential expression analysis by limma. DAVID pathway analysis (DPA) was used to identify pathways impacted by various treatment conditions based on proteins exhibiting significant (p<0.05) 1.2-fold change in expression as compared to RANKL. Protein levels within culture supernatant or cell lysate were verified by ELISA or MSD.

Results:

Principle component analysis (PCA) of the proteomic profiling data for the 3 donors indicated that exposure of OCP to TNF induced a distinct profile from that of M-CSF and RANKL. The addition of ADA:TNF complexes restored the profile to that of RANKL, whereas those exposed to ETN:TNF complexes exhibited an intermediate profile matching differences observed in TRAP 5b activity levels. DPA identified 3 pathways most associated with osteoclastogenesis: receptor-mediated endocytosis (e.g. CD163, IGFBP2), oxidation-reduction process (e.g. FABP4), and cell adhesion (e.g. ICAM-1, TGFBI) that were significantly impacted by TNF with ADA:TNF being more effective than ETN:TNF in restoring most pathway-associated proteins to RANKL levels. Based on ELISA, two pro-osteoclastogenic factors IGFBP2 and ICAM-1 were increased 2-fold in OCP culture supernatants in response to TNF with only ADA:TNF complexes reducing these levels of both to RANKL. TNF-induced reduction of intracellular levels of CD163, an M2 macrophage polarization marker, and TGFBI were not only restored to RANKL levels by ADA:TNF but brought to a level closer to M-CSF alone, unlike ETN:TNF. One anti-osteoclastogenic factor FABP4 was found to be increased intracellularly above that of RANKL only following exposure to ADA:TNF complexes.

Conclusion:

Shotgun proteomic profiling of human OCP differentiatedin vitrowith TNF revealed at least 3 novel pathways by which TNF exerts its pro-osteoclastogenic effects. Only with the addition of ADA:TNF, not with ETN:TNF, were most pathway-associated proteins significantly restored to RANKL levels including pro-osteoclastogenic factors ICAM-1 and IGFBP2. Moreover, ADA:TNF complexes enhanced the intracellular levels of CD163 and the anti-osteoclastogenic factor FABP4, suggesting these complexes are exerting an effect on OCP beyond simple TNF neutralization. Additionalin vitroandin vivostudies need to be performed to verify our findings.

Acknowledgments:

The authors thank Drs. Jochen Salfeld, Yonghao Cao and Dhaval Nanavati for their critical review of our data, and Yucheng Zhang for her technical support.

Disclosure of Interests:

Bohdan Harvey Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Liang Jin Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., John Maull Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Chenqi Hu Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Yu Tian Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc., Zehra Kaymakcalan Shareholder of: AbbVie, Inc., Employee of: AbbVie, Inc.

Upregulation of SNHG12 accelerates cell proliferation, migration, invasion and restrain cell apoptosis in breast cancer by enhancing regulating SALL4 expression via sponging miR-15a-5p

Breast cancer (BC) is malignant cancer that threatens the health of millions of females worldwide. Long non-coding RNA (lncRNA) small nucleolar RNA host gene 12 (SNHG12) has been identified as an oncogene in multiple cancers. However, the regulatory role of SNHG12 in BC cell progression is still obscured. The levels of SNHG12, miR-15a-5p, and Sal-like 4 (SALL4) in BC tumor tissues and cells were measured by qRT-PCR. Cell viability, apoptosis, migration, and invasion were examined by CCK8, flow cytometry, and transwell assay, respectively. The interaction between miR-15a-5p and SNHG12 or SALL4 was evaluated by dual-luciferase reporter assay. Protein expression of SALL4 was analyzed by western blot. Xenograft mice were established by subcutaneously injecting BC cells stably transfected with sh-SNHG12 and sh-NC. SNHG12 and SALL4 expressions were upregulated whereas miR-15a-5p was downregulated in BC tumors compared with normal tissues. Besides, miR-15a-5p was correlated with SNHG12 and SALL4 inversely as calculated by Pearson's correlation coefficient. More importantly, SNHG12 knockdown attenuated BC tumor growth in vitro and in vivo. Subsequently, dual-luciferase reporter assay confirmed the interaction between miR-15a-5p and SNHG12 or SALL4. The rescue experiments revealed that miR-15a-5p inhibitor restored SNHG12 silencing induced inhibition on BC cell proliferation, migration, invasion, and promotion of apoptosis. Additionally, SNHG12 was found to accelerate BC cell progression by absorbing miR-15a-5p to enhance SALL4 expression. SNHG12 promotes cell proliferation, migration, and invasion but suppresses apoptosis in BC by upregulating SALL4 expression via sponging miR-15a-5p, representing potential targets for the development of novel diagnosis and treatment methods.

[Preliminary efficacy analysis of Cheng's Giraffe reconstruction after proximal gastrectomy in adenocarcinoma of esophagogastric junction]

Objective: To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG). Methods: Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux. Result: All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9. Conclusion: Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.

Associations of eczema phenotypes with emotional and behavioural problems from birth until school age. The Generation R Study

Background

Eczema phenotypes and emotional and behavioural problems are highly prevalent in childhood, but their mutual relationship is not fully clear.

Objectives

To examine the associations of eczema phenotypes with school‐age emotional and behavioural problems, and the bidirectional associations of eczema and emotional and behavioural problems from birth until 10 years.

Methods

This study among 5265 individuals was embedded in a prospective population‐based cohort study. Never, early transient, mid‐transient, late transient and persistent eczema phenotypes were identified based on parent‐reported, physician‐diagnosed eczema from age 6 months until 10 years. Emotional (internalizing) and behavioural (externalizing) problems were measured repeatedly using the Child Behavior Checklist from age 1·5 to 10 years. Cross‐lagged models were applied for bidirectional analyses.

Results

All eczema phenotypes were associated with more internalizing problems and attention problems at age 10 years, compared with never having eczema: range of Z‐score differences 0·14 [95% confidence interval (CI) 0·01–0·27] to 0·39 (95% CI 0·18–0·60). Children with early transient eczema had more aggressive behaviour symptoms at age 10 years (Z = 0·16, 95% CI 0·05–0·27). Bidirectional analysis showed that eczema at 0–2 years was associated with more internalizing and externalizing problems at ages 3–6 and 10 years, while, inversely, only internalizing problems at 0–2 years were associated with an increased risk of eczema at age 10 years.

Conclusions

Eczema phenotypes are very modestly associated with more somatic symptoms and attention problems at school age. Early transient eczema is associated with more aggressive behaviour symptoms. Directional effects seem to occur from early‐life eczema to later‐life internalizing and externalizing problems, rather than the reverse.

What's already known about this topic?

Previous cohort studies using non‐data‐driven methods to define eczema phenotypes observed that children with early‐onset and persistent eczema had a higher risk of emotional and behavioural problems in preadolescence.

Alternatively, previous cohort studies showed that children with emotional and behavioural problems had more severe eczema and eczema exacerbations in childhood.

The direction of effects between eczema and emotional and behavioural problems is not fully clear.

What does this study add?

Taking the variability of eczema onset and persistence within and between children over time into account, all identified eczema phenotypes were very modestly associated with more somatic symptoms and attention problems at school age.

Directional effects seem to occur from eczema leading to emotional and behavioural problems, rather than the reverse.

Future research should focus on the effect of early optimal eczema management on mental health disorders in children later in life.

Plain language summary available online

MiR-200a improves respiratory distress syndrome in newborn rabbits via the Wnt/β-catenin signaling pathway

OBJECTIVE

The aim of this study was to investigate the effect of micro-ribonucleic acid (miR)-200a on respiratory distress syndrome (RDS) in newborn rabbits by regulating the Wnt/β-catenin signaling pathway.

MATERIALS AND METHODS

In this work, newborn rabbits aged three days were selected from our laboratory as research objects. The messenger RNA (mRNA) and protein expression levels of miR-200a, β-catenin and interleukin-10 (IL-10) in blood samples of healthy newborn rabbits and newborn rabbits with RDS were determined by fluorescence quantitative Polymerase Chain Reaction (PCR) and Western blotting, respectively. Lentivirus-packaged plasmids containing miR-200a were then injected into newborn rabbits suffering from RDS. After 2 d, the mRNA and protein expression levels of miR-200a, β-catenin and IL-10 in blood samples of newborn rabbits in different treatment groups were measured. Meanwhile, lung sections were collected from newborn rabbits in different treatment groups. After that, the sections were observed via hematoxylin and eosin (H&E) staining. At the same time, lung coefficient of newborn rabbits in different treatment groups was also measured.

RESULTS

Compared with healthy newborn rabbits, the mRNA and protein expression levels of miR-200a and IL-10 in the blood of newborn rabbits with RDS decreased significantly (p<0.05), while β-catenin increased markedly (p<0.05). The mRNA and protein expression levels of β-catenin and IL-10 in newborn RDS rabbits with miR-200a over-expression and knockout were detected as well. The results revealed that lowly expressed miR-200a could remarkably promote the expression level of β-catenin, whereas inhibiting the expression of IL-10. However, highly expressed miR-200a could significantly inhibit the expression level of β-catenin and promote the expression level of IL-10. H&E staining results manifested that miR-200a knockout markedly promoted the increase of pulmonary alveoli with increased lung coefficients. However, the up-regulation of miR-200a could reduce lung coefficients and remarkably improve RDS.

CONCLUSIONS

MiR-200a regulates RDS in newborn rabbits by regulating the Wnt/β-catenin signaling pathway.

[Effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults - A meta-analysis of randomized controlled trials with trial sequential analysis]

OBJECTIVES

To compare the effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults, and to investigate the influence of protein intake upon the outcome effects of hypocaloric feeding.

DESIGN

A meta-analysis of randomized controlled trials (RCTs) and trial sequential analysis (TSA) were carried out.

SETTING

Intensive Care Unit (ICU).

PATIENTS

Or participants Critically ill adults.

INTERVENTIONS

Hypocaloric enteral feeding versus standard enteral feeding.

MAIN VARIABLES OF INTEREST

The primary outcomes were all-cause short-term mortality and the incidence of nosocomial infection.

RESULTS

Eleven RCTs met the inclusion criteria; of these trials, two were judged as having low risk of bias. Compared with standard enteral feeding, hypocaloric enteral feeding had no benefits in terms of reducing short-term mortality, the incidence of nosocomial infection, or long-term mortality, though it had a positive impact upon the incidence of gastrointestinal intolerance. The TSA further confirmed these results. In turn, hypocaloric enteral feeding had no effects upon the incidence of bloodstream infection, pneumonia, hypoglycemia or the duration of mechanical ventilation, ICU stay, or in-hospital stay. The above results remained unchanged in the sub-analysis of trials with a low risk of bias, trials administering a similar dose of protein, or trials administering different doses of protein.

CONCLUSIONS

Compared with standard enteral feeding, hypocaloric enteral feeding was not associated with better clinical outcomes in critically ill adults, except for a lower risk of gastrointestinal intolerance. The difference in protein intake between groups might have no influence on the outcome effects of hypocaloric enteral feeding. High quality randomized controlled trials are needed to confirm this, however.

Relationship between CT angiography-derived collateral status and CT perfusion-derived tissue viability

AIM

To explore the relationship between computed tomography (CT) angiography (CTA)-derived collateral status and CT perfusion (CTP)-derived tissue viability.

MATERIALS AND METHODS

Patients having middle cerebral artery (MCA) M1/M2 segment and/or internal carotid artery (ICA) occlusion and within 12 hours of onset were included. Collateral was graded from 0 to 3 on maximum intensity projection (MIP) images of CTA. The area with relative cerebral blood flow (rCBF) <30% or time-to-maximum (Tmax) >10 or >12 or >14 seconds was defined as the infarct core, and Tmax >6 seconds as the penumbra. Kruskal-Wallis and Spearman's correlation tests were performed to assess the correlation between collateral grade and infarct size or mismatch ratio.

RESULTS

Eighty-three patients were enrolled and 52 of them met the inclusion criteria. Infarct size defined by rCBF <30% or Tmax >10 or >12 or >14 seconds and mismatch ratios were significantly different among the four groups. The correlation between collateral grades and infarct core using rCBF <30% (ρ=-0.814, p<0.01) was better than that defined by Tmax >10s, >12s or >14s. Mismatch ratio for the infarct core defined by rCBF <30% (ρ=0.945, p<0.01) had the best correlation with collateral grades.

CONCLUSION

Patients with good collaterals show a smaller infarct core and higher mismatch ratio. Infarct size defined by rCBF <30% and mismatch ratio defined by rCBF <30% and Tmax >6 seconds appear to be more correlated with collaterals in AIS patients.