Modulation of Placental Breast Cancer Resistance Protein by HDAC1 in Mice: Implications for Optimization of Pharmacotherapy During Pregnancy

Breast cancer resistance protein (BCRP/ABCG2) is a critical drug efflux transporters by limiting drugs’ transplacental transfer rates. More investigations on the regulation of placental BCRP offer great promise for enabling pronounced progress in individualized and safe pharmacotherapy during pregnancy. Histone deacetylases (HDACs) play an important role in epigenetic regulation of placental genes. It was reported recently by us that HDAC1 was involved in placental BCRP regulation in vitro. The aim of this study was to further explore the effect of HDAC1 on placental BCRP expression and functionality in animals. Randomly assigned C57BL pregnant dams received intraperitoneal injections of a negative control siRNA or Hdac1 siRNA from embryonic day 7.5 (E7.5) to E15.5, respectively. At E16.5, glyburide (GLB), a probe for evaluating placental BCRP efflux functionality, was injected via the tail vein. Animals were sacrificed through cervical dislocation at various times (5–180 min) after drug administration. The maternal blood, placentas, and fetal-units were collected. GLB concentrations were determined by a validated high-performance liquid chromatography/mass spectrometry (HPLC-MS) assay. Real-time quantitative PCR (qRT-PCR), Western blot, and immunohistochemical (IHC) analysis were employed to identify mRNA/protein levels and localization of gene expressions, respectively. It was noted that Hdac1 inhibition significantly decreased placental Bcrp expression, with markedly increases of GLB concentrations and area under the concentration-time curve (AUC) in fetal-units. Particularly, the ratios of fetal-unit/maternal plasma GLB concentrations were also significantly elevated following Hdac1 repression. Taken together, these findings suggested that HDAC1 was involved in positive regulation of placental BCRP expression and functionality in vivo.

Predictive Value of Serum Lipid for Intravenous Immunoglobulin Resistance and Coronary Artery Lesion in Kawasaki Disease

CONTEXT

Intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) prediction are pivotal topic of interests in Kawasaki disease (KD). However, data on the predictive value of lipid profile for both IVIG resistance and CALs are limited.

PURPOSE

To investigate the predictive validity of lipid profile for IVIG resistance and CALs in KD.

DESIGN

Prospective cohort study.

SETTING

West China Second University Hospital.

PATIENTS

363 KD patients were divided into the initial IVIG-resistant group and initial IVIG-responsive group; repeated IVIG-resistant group and repeated IVIG-responsive group; CAL+ group and CAL- group.

MAIN OUTCOME MEASURES

Validity of lipid profile in predicting IVIG resistance and CALs.

RESULTS

Triglycerides were significantly higher whereas total cholesterol (TC), high-densisty lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein A (Apo A) were significantly lower in initial IVIG-resistant subjects, with cut-off values of 1.625 mmol/L, 3.255 mmol/L, 0.475 mmol/L, 1.965 mmol/L, and 0.665 g/L, yielding sensitivities of 52%, 70%, 52%, 61%, and 50% and specificities of 68%, 53%, 78%, 71%, and 81%, respectively. TC, LDL-C, and Apo A levels were significantly lower in repeated IVIG-resistant subjects, with cut-off values of 3.20 mmol/L, 1.78 mmol/L, and 0.605 g/L, producing sensitivities of 91%, 70%, and 57% and specificities of 55%, 67%, and 70%, respectively. Apo A level was significantly lower in the CAL+ group, with cut-off value of 0.805 g/L, yielding sensitivity of 66% and specificity of 54%.

CONCLUSIONS

Lipid profiles were significantly dysregulated in KD patients suffering IVIG resistance and CALs. Some of them, such as LDL-C and Apo A, could serve as complementary laboratory markers for predicting both IVIG resistance and CALs.

Predictive value of coagulation profiles for both initial and repeated immunoglobulin resistance in Kawasaki disease: A prospective cohort study

BACKGROUND

Intravenous immunoglobulin (IVIG) resistance prediction remains substantial in Kawasaki disease (KD), with limited data on the predictive value of coagulation profile for IVIG resistance, particularly for repeated IVIG resistance. Therefore, the aim of our study was to testify the predictive validity of coagulation profile for both initial IVIG resistance and repeated IVIG resistance in KD.

METHODS

A total of 385 KD patients were prospectively recruited between April 2015 and May 2019. Coagulation and other profiles were evaluated between the IVIG-responsive and IVIG-resistant groups. Multivariate logistic regression analysis was applied to determine the association between coagulation profiles and IVIG resistance. ROC curves analysis was further performed to assess the validity of coagulation profiles in predicting both initial IVIG resistance and repeated IVIG resistance.

RESULTS

Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen degradation products (FDPs), and D-dimer were significantly increased in the initial IVIG-resistant group with antithrombin III (ATIII) and thrombin time (TT) significantly reduced. Meanwhile, ATIII was declined markedly in repeated IVIG-resistant patients. Multivariate logistic regression analysis showed that PT, APTT, D-dimer, and ATIII were independent risk factors for predicting initial IVIG resistance and ATIII for predicting repeated IVIG-resistant patients with KD. PT, APTT, D-dimer, and ATIII cutoff values of 13.95 s, 41.15 s, 1.48 mg/L, and 89.5% yielded sensitivities of 73%, 32%, 71%, and 81%, and specificities of 55%, 88%, 62%, and 51% for predicting initial IVIG resistance, respectively. The cutoff value of ATIII for predicting repeated IVIG resistance was 68.5%, with sensitivity of 71% and specificity of 55%.

CONCLUSIONS

KD patients who have hypercoagulation during the acute phase might be at higher risk of developing IVIG resistance.

Kawasaki Disease Complicated by Late-Onset Fatal Cerebral Infarction: A Case Report and Literature Review

Background: Cerebral infarction is a rare neurological complication of Kawasaki disease (KD) and occurs in the acute or subacute stage. There have been no reported cases of late-onset fatal cerebral infarction presenting over 1 year after the onset of KD. Case Presentation: A 5-month-old male patient with KD received timely intravenous immunoglobulin therapy; however, extensive coronary artery aneurysms (CAA) and coronary artery thrombosis (CAT) developed 1 month later. Anticoagulation and thrombolytic agents were suggested, but the child's parents refused. Fifteen months after KD onset, an attack of syncope left him with left hemiplegia; brain computerized tomography (CT) scans revealed cerebral infarction of the right basal ganglion without hemorrhage. Magnetic resonance angiography (MRA) revealed severe stenosis of the right middle cerebral artery, and a series of tests were performed to exclude other causes of cerebral infarction. Considering the cerebral infarction and CAT, combination therapy with urokinase and low-molecular-weight heparin (LMWH) was initiated within 24 h of syncope onset, together with oral aspirin and clopidogrel. Five days later, his clinical symptoms partially regressed and he was discharged. Unfortunately, 5 days after discharge, his clinical condition suddenly deteriorated. Repeat brain CT showed hemorrhagic stroke involving the entire left cerebral area, in addition to the previous cerebral infarction in the right basal ganglion, with obvious secondary cerebral swelling and edema, which might have been caused by previous thrombolysis. Severe cerebral hernias developed quickly. Regrettably, the patient's parents abandoned treatment because of economic factors and unfavorable prognosis, and he died soon after. Conclusions: Cerebral infarction and cerebral artery stenosis can develop late, even 1 year after the onset of KD. Pediatricians should be aware of the possibility of cerebrovascular involvement in addition to cardiac complications during long-term follow-up of KD patients. Prompt anticoagulation therapy and regular neuroimaging evaluation are essential for the management of patients with KD with giant CAA and/or CAT.

Reutilization of gangue wastes in underground backfilling mining: Overburden aquifer protection

Gangue backfilling mining (GBM) can effectively alleviate the gangue accumulation pollution and the overburden aquifer destruction. To efficiently evaluate the reutilization of gangue wastes by GBM and its advantage in overburden aquifer protection, non-Darcy hydraulic properties and deformation behaviors of granular gangues were studied through laboratorial, theoretical, and in-situ aspects. A series of compression and seepage tests on granular gangues under the variable original grain size grade (GSG) and stress rate were conducted. Laboratorial testing results convince that, hydraulic properties (porosity and permeability) of the granular gangue decline with the increasing original GSG and decreasing stress rate. The crushing ratio of the sample increases with the increase of original GSG and the decrease of stress rate. The fractal dimension reveals more obvious increases in the samples with the higher original GSGs and lower stress rates. The Kruger model (a classical theoretical model) was employed to predict the permeability evolution based on the porosity. However, the invalid pores in rocks would result in the model's underestimation. To this end, an improved model was established to predict the permeability evolution by the fractal dimension, and the improved Kruger model has better accuracy than the original one. Finally, according to the laboratorial testing and theoretical predicted results, friendly-environmental strategies for overburden aquifer protection were proposed. The effectiveness of these strategies was successfully verified by an in-situ application. It is concluded that the high filling stress, low gangue original GSG, and low filling stress rate in GBM can effectively reduce the risk of overburden aquifer destruction.

Clinical Characteristics of Personality and Conduct Disorders in Child Patients With Vasovagal Syncope: A Clinical Case-Control Study

Objective: To analyze the clinical characteristics of abnormal personality and conduct disorders (CDs) in pediatric patients with vasovagal syncope (VVS). Methods: In this study, we recruited patients diagnosed with VVS at Children's Heart Center from January 2018 to December 2020. Healthy children were recruited as controls. The Eysenck Personality Questionnaire-Child edition (EPQ-C) and Achenbach Child Behavior Checklist (CBCL) were used for the assessment. Results: One hundred and fifty-one VVS patients and 151 healthy controls were included in this study. Compared with the control group, patients in the VVS group had a higher incidence of abnormal personality and were more prone to suffer from CDs. Moreover, pediatric patients with VVS suffered more events of syncope recurrence if they had CDs. Conclusion: Abnormal personality and CDs are common clinical characteristics in pediatric patients with VVS.

[Expression and significance of chemokine CXCL12 and receptor CXCR4 in adenomyosis]

Objective: To observe the expression, correlation and significance of chemokine (C-X-C motif) ligand 12 (CXCL12) and chemokine (C-X-C motif) receptor 4 (CXCR4) in endometrium and myometrium of adenomyosis. Methods: Totally 38 patients were selected in this study, who underwent hysterectomy for adenomyosis at Beijing Obstetrics and Gynecology Hospital from October 2017 to December 2018 as the adenomyosis group, and, in the same period, selected 31 patients with cervical intraepithelial neoplasia Ⅲ or cervical cancer undergoing hysterectomy served as control group. The expression levels of mRNA and protein for CXCL12, CXCR4 in the endometrium and myometrium of the two groups were detected by immunohistochemistry and real-time PCR. Results: (1) The protein levels of CXCL12 and CXCR4 in endometrium in uterus with adenomyosis (0.229±0.025 and 0.226±0.016) were significantly higher than those in endometrium in uterus without adenomyosis (0.153±0.018 and 0.178±0.026); compared with each other, the differences were statistically significant (all P<0.05). And the expressions of CXCL12 and CXCR4 proteins in uterine myometrium of adenomyosis were 0.222±0.045 and 0.126±0.058, respectively, which were higher than those in the control group (0.091±0.029 and 0.099±0.020); compared with each other, the differences were statistically significant (all P<0.05). (2) The expression levels of CXCL12 and CXCR4 mRNA in endometrium of patients with adenomyosis were 6.31±0.12 and 8.49±0.21, respectively, which were higher than those in the control group (1.23±0.10 and 1.36±0.13); compared with each other, the differences were statistically significant (all P<0.05). Moreover, the expression levels of CXCL12 and CXCR4 mRNA in myometrium of patients with adenomyosis were 9.11±0.12 and 8.45±0.16, respectively, which were higher than those in the control group (1.18±0.08 and 1.46±0.13); compared with each other, the differences were statistically significant (all P<0.05). (3) In endometrium and myometrium of uterus with adenomyosis, CXCL12 and CXCR4 mRNA expression levels were positively associated (r=0.478, 0.542, all P<0.05). Conclusions: The levels of CXCL12 and CXCR4 in the endometrium and myometrium of adenomyosis are increased and positively correlated. The two chemokine may be involved in the development of adenomyosis.

Prediction of water inflow from fault by particle swarm optimization-based modified grey models

Water inflow from fault (WIF) and its secondary impacts are the main environmental challenges in the mining industry. Traditional prediction methods for WIF are exceedingly challenging and costly. In this article, two exponentially weighted moving average (EWMA) modified grey models (GMs, i.e., EGM and REGM) were established to predict the WIF. Particle swarm optimization (PSO) algorithm was employed to optimize parameters of the models. Based on actual WIF data from Buliangou coal mine, the optimized models (i.e., EGM-PSO, REGM-PSO) were used to obtain the prediction equations for WIF. To investigate the validity of the proposed models, the differences between actual values and predicted values were analyzed, and comparison results were obtained by the commonly used GM and GM-PSO. Results show that, for the sample with the larger initial particle swarm and smaller inertia weight, there is a faster convergence speed of the PSO algorithm. Particle search efficiency in the PSO-optimized EWMA-GM is higher than that in the GM-PSO. Through the predicted results of WIF, it is found that the REGM-PSO is the best choice for WIF prediction, and the more historical information, the higher the predicted accuracy. Besides, the parameter optimization by the PSO, the EWMA optimization method and optimization of residuals all can improve the predicted accuracy. Predicted results also show that WIF will have a substantial growth in the future. Therefore, reasonable measures (e.g., draining and grouting) need to be taken to mitigate the damage caused by fault water inflow.

A delayed diagnosis of late-onset pulmonary hemorrhage in a toddler with Henoch-Schönlein purpura after regression of skin rash: A case report and literature review

RATIONALE

Pulmonary hemorrhage is a rare but fatal complication of Henoch-Schönlein purpura (HSP), and more easily ignored in children than in adults due to the absence of clinically evident hemoptysis. Moreover, despite being sporadically reported, given that pulmonary hemorrhage may develop after regression and even disappearance of skin rash, the asynchronous progression of skin and lung lesions poses escalating challenges in the timely diagnosis. We herein presented a delayed diagnosis of late-onset pulmonary hemorrhage in a child with HSP after regression of purpuric rash.

PATIENT CONCERNS

A 6-year and 3-month child with a history of self-resolved purpuric rash three weeks ago, presented acutely with cough and dyspnea but without fever.

DIAGNOSES

The decreased hemoglobin and diffuse ground-glass opacities of both lungs on CT scan weren't comprehensively evaluated. The child was initially misdiagnosed as pneumonia.

INTERVENTIONS

Antibiotic treatment was initiated. However, no improvement of respiratory status was found following aggressive combination therapy. Bronchoscopy was subsequently performed.

OUTCOMES

An diffuse alveolar hemorrhage with low inflammatory profile was noted after a bronchoscopy. Considering the history of HSP, the diagnosis of HSP-associated pulmonary hemorrhage was ultimately confirmed and the patient received corticosteroids with satisfactory results.

LESSONS

Pulmonary hemorrhage could occur in children with HSP at late onset of disease after regression of skin rash. New-onset respiratory symptoms in patients with a history of HSP should heighten suspicion for pulmonary hemorrhage, particularly if presenting with lack of fever, sudden drop of hemoglobin, new pulmonary infiltrates and unresponsiveness to antibiotics therapy. Bronchoscopy should be performed early to confirm the diagnosis, specifically for children.

A severe coronavirus disease 2019 patient with high-risk predisposing factors died from massive gastrointestinal bleeding: a case report

Background

SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including nausea, diarrhea, and vomiting. Massive gastrointestinal bleeding, however, has rarely been reported.

Case presentation

We herein described a case of severe SARS-CoV-2 infected patient with several risk factors for poor prognosis, including male, hypertension, old age, mixed bacterial infection and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia was uncontrolled. The patient rapidly deteriorated, suffered from cardiac arrest, and expired.

Conclusions

Digestive symptoms could be severe in SARS-CoV-2 infected patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection through faecal-oral transmission should be implemented in the process of patient care and infection control.

Diagnostic value of combined nucleic acid and antibody detection in suspected COVID-19 cases

OBJECTIVES

Nucleic acid testing is the gold standard method for the diagnosis of coronavirus disease 2019 (COVID-19); however, large numbers of false-negative results have been reported. In this study, nucleic acid detection and antibody detection (IgG and IgM) were combined to improve the testing accuracy of patients with suspected COVID-19.

STUDY DESIGN

The positive rate of nucleic acid detection and antibody detection (IgG and IgM) were compared in suspected COVID-19 patients.

METHODS

A total of 71 patients with suspected COVID-19 were selected to participate in this study, which included a retrospective analysis of clinical features, imaging examination, laboratory biochemical examination and nucleic acid detection and specific antibody (IgM and IgG) detection.

RESULTS

The majority of participants with suspected COVID-19 presented with fever (67.61%) and cough (54.93%), and the imaging results showed multiple small patches and ground-glass opacity in both lungs, with less common infiltration and consolidation opacity (23.94%). Routine blood tests were mostly normal (69.01%), although only a few patients had lymphopenia (4.23%) or leucopenia (12.68%). There was no statistical difference in the double-positive rate between nucleic acid detection (46.48%) and specific antibody (IgG and IgM) detection (42.25%) (P = 0.612), both of which were also poorly consistent with each other (kappa = 0.231). The positive rate of combined nucleic acid detection and antibody detection (63.38%) was significantly increased, compared with that of nucleic acid detection (46.48%) and that of specific antibody (IgG and IgM) detection (42.25%), and the differences were statistically significant (P = 0.043 and P = 0.012, respectively).

CONCLUSIONS

Nucleic acid detection and specific antibody (IgG and IgM) detection had similar positive rates, and their combination could improve the positive rate of COVID-19 detection, which is of great significance for diagnosis and epidemic control.

Re-evaluation of the criteria for asymmetric amplatzer occluders in the closure of perimembranous ventricular septal defects: A case series report

RATIONALE

To discuss suitable criteria for the application of asymmetric Amplatzer occluders for perimembranous ventricular septal defects (pmVSDs).

PATIENTS CONCERNS AND DIAGNOSES

We retrospectively studied 18 children with perimembranous VSDs who underwent attempted asymmetric occluder closure between January 2015 and December 2018 in our center.

INTERVENTIONS

Asymmetric Amplatzer occluders were attempted to be placed to all the enrolled patients. We analyzed the diameter of the defects with the receiver operating characteristic curve (ROC) values, the size of the occluders attempted, the presence of aneurysm and the presence of aortic valve prolapse for each patient. Then, for patients who experienced successful device implantation, the therapeutic efficiency was evaluated by follow-up.

OUTCOMES

Only 5 out of a total of 18 patients completed successful device implantation. Compared with failed cases, successful cases demonstrated a significantly smaller VSD size (5.46 ± 1.03 mm vs. 8.73 ± 2.33 mm, P = 0.012) and had a low ratio of aortic valvar prolapse (20% vs. 76.92%, P = 0.026). Four out of 5 successful cases involved arrhythmia complications, but the rhythm of the heart recovered after drug treatment. According to the ROC and Youden analyses, the cut-off value of the defect size for successful asymmetric Amplatzer occluder implantation was no larger than 5.7 mm.

LESSONS

The application of an asymmetric Amplatzer occluder expands the range of indications for patients with superior localized VSD but is largely limited in cases with aortic valvar prolapse and large VSD sizes. All successful cases recovered from arrhythmia postprocedure.

Assessment of knee extensor and flexor function using isokinetic test in COPD: impact on exercise capacity

OBJECTIVE: To quantify the relationship between strength and endurance of knee extensor and flexor and exercise capacity in patients with chronic obstructive pulmonary disease (COPD).METHODS: A total of 108 patients with stable COPD (age: 65 years, IQR25-75: 59-72) were enrolled in this cross-sectional study. Knee extensor and flexor function was evaluated using the isokinetic test, and the parameters attained were considered as independent variables. Exercise capacity was evaluated using 6-minute walking test (6MWT) and 30-second sit-to-stand test (30s SST), and the results were considered as dependent variables. The association between lower-limb muscle function and exercise capacity was assessed using multiple regression analysis.RESULTS: The patients mostly had moderate-to-severe airflow obstruction with a post-bronchodilator forced expiratory volume in 1 second (FEV₁) of 57.87 ± 17.71% predicted. In multiple regression analysis, flexor total work (TW), extensor endurance ratio (ER), age and FEV₁%pred were significantly associated with 6MWT (adjusted R² = 0.455, P < 0.001). Flexor TW and age were significantly associated with 30s SST (adjusted R² = 0.355, P < 0.001).CONCLUSION: Knee endurance has a significant relationship with exercise capacity, and knee flexor endurance seems to be an important factor contributing to exercise capacity in COPD patients.

Transcriptomic changes in the nasal epithelium associated with diesel engine exhaust exposure

BACKGROUND

Diesel engine exhaust (DEE) exposure causes lung cancer, but the molecular mechanisms by which this occurs are not well understood.

OBJECTIVES

To assess transcriptomic alterations in nasal epithelium of DEE-exposed factory workers to better understand the cellular and molecular effects of DEE.

METHODS

Nasal epithelial brushings were obtained from 41 diesel engine factory workers exposed to relatively high levels of DEE (17.2-105.4 μg/m3), and 38 unexposed workers from factories without DEE exposure. mRNA was profiled for gene expression using Affymetrix microarrays. Linear modeling was used to identify differentially expressed genes associated with DEE exposure and interaction effects with current smoking status. Pathway enrichment among differentially expressed genes was assessed using EnrichR. Gene Set Enrichment Analysis (GSEA) was used to compare gene expression patterns between datasets.

RESULTS

225 genes had expression associated with DEE exposure after adjusting for smoking status (FDR q < 0.25) and were enriched for genes in pathways related to oxidative stress response, cell cycle pathways such as MAPK/ERK, protein modification, and transmembrane transport. Genes up-regulated in DEE-exposed individuals were enriched among the genes most up-regulated by cigarette smoking in a previously reported bronchial airway smoking dataset. We also found that the DEE signature was enriched among the genes most altered in two previous studies of the effects of acute DEE on PBMC gene expression. An exposure-response relationship was demonstrated between air levels of elemental carbon and the first principal component of the DEE signature.

CONCLUSIONS

A gene expression signature was identified for workers occupationally exposed to DEE that was altered in an exposure-dependent manner and had some overlap with the effects of smoking and the effects of acute DEE exposure. This is the first study of gene expression in nasal epithelial cells of workers heavily exposed to DEE and provides new insights into the molecular alterations that occur with DEE exposure.

Integrative Perinatal Management Enhanced the Advantage of Prenatal Diagnosis on Critical Pulmonary Valve Stenosis: An Observational Preliminary Study

Background: Percutaneous balloon valvuloplasty (PBPV) is recommended as a first-choice treatment for critical pulmonary stenosis (CPS). A concept of perinatal integrative management has been developed. Unfortunately, the evidence on the advantage of integrative management for CPS during the perinatal period is absent. Methods: Single-center, observational, preliminary research has been developed, and three groups have been enrolled. There were 42 children with CPS enrolled for this study between January 2014 and December 2017 in our center, and their follow-up duration is at least 1 year. Three groups were set up: the integrative perinatal management group (group I), who received prenatal diagnosis with perinatal management to maintain circulation and an optimized PBPV procedure; the prenatal diagnosis group (group PR), who received a diagnosis of pulmonary stenosis before birth without any monitoring and perinatal management; and the postnatal diagnosis group (group PO), who received the CPS diagnosis after birth. Result: There were 13 patients enrolled in group I, 11 babies enrolled in group PR, and 18 cases included in group PO. Integrative management helped to put the timing of PBPV in advance. The age for PBPV in group I was 9.38 ± 5.58 days, and groups PR and PO were 24.54 ± 4.87 and 49.11 ± 9.50 days, respectively. The average peak transvalvular gradient (PGs) of the perinatal management group (group I) and prenatal diagnosis group (group PR) remained at a stable level. However, the average PGs of group PO were progressively elevated during follow-up. Moreover, the follow-up data from group I revealed an advantage in RV development and functional restoration. There was no difference among the three groups in the ratio of reintervention and postoperative moderate pulmonary regurgitation during 1-year follow-up (p >0.05). Conclusion: Prenatal diagnosis helps to improve the outcomes of PBPV. Moreover, perinatal integrative medical management enhances the advantage of prenatal diagnosis. However, this research is still a small-size cohort study, and the limited population number and follow-up duration were the major limitations to expand the conclusions.

Cell-free Mycobacterium tuberculosis DNA test in pleural effusion for tuberculous pleurisy: a diagnostic accuracy study

OBJECTIVES

Tuberculous pleurisy (TP) diagnosis remains difficult, with the sensitivity of Xpert MTB/RIF (Xpert) and mycobacterial culture (culture) only about 30-50%. We aimed to assess the diagnostic performance of a cell-free Mycobacterium tuberculosis DNA test (cf-TB) in pleural effusion for TP.

METHODS

Adults (≥18 years) with suspected TP presenting with pleural effusion were consecutively recruited, and pleural effusion specimens were prospectively collected in Beijing Chest Hospital, Beijing, China. After centrifuging pleural effusion, sediments were used for culture, Xpert and T-SPOT.TB assay, whereas supernatants were used for cf-TB and adenosine deaminase assay. The diagnostic performance was assessed against a composite reference standard.

RESULTS

From June 2015 to December 2018, we prospectively evaluated 286 adults with suspected TP. One hundred twenty-two participants were classified as definite TP based on the prespecified composite reference standard. The cf-TB produced a sensitivity of 79.5% (97/122, 95% confidence interval (CI) 72.4- 86.7) for definite TP, which was superior to Xpert (38.5% (29.9-47.2); 47/122; p < 0.001) and culture (27.1% (19.2-34.9); 33/122; p < 0.001). With pleural effusion Xpert and/or culture as the reference standard, cf-TB showed 96.6% (57/59, 95% CI 92.0-100.0) sensitivity, which was also significantly higher than Xpert (79.7%, 95% CI 69.4-89.9; 47/59; p 0.004) and culture (55.9%, 95% CI: 43.3-68.6; 33/59; p < 0.001).

CONCLUSIONS

The cf-TB clearly showed improved sensitivity compared with Xpert and culture. We recommend cf-TB as the first-line test for TP diagnosis.

Erratum: LOXL1 regulates cell apoptosis and migration in human neuroglioma U87 and U251 cells via Wnt/β-catenin signaling

[This corrects the article on p. 2032 in vol. 11, PMID: 31938310.].

The Relationship Between the Expression of Serum S100A8/A9 and the Degree of Brain Injury in Rats After Cardiopulmonary Resuscitation

This study is to investigate the expression of serum S100A8/A9 in rats after cardiopulmonary resuscitation (CPR) and its correlation with brain injury after CPR. Thirty-six male SD rats were randomly divided into control group (n = 6), cardiopulmonary resuscitation group (n = 24) and sham operation group (n = 6). The cardiopulmonary resuscitation group was further divided into four subgroups according to the time after recovery of autonomous circulation: 6-hour group, 12-hour group, 24-hour group and 48-hour group, with 6 rats in each group. The rats in the cardiopulmonary resuscitation group was conducted by asphyxia then given cardiopulmonary resuscitation (CPR), while the rats in the sham operation group were given tracheal intubation without asphyxia. The rats in each group were assessed by modified Neurological Severity Score (mNSS). The vein blood from tail was collected to detect the expression of serum S100A8/A9. Then the brain tissue was taken to measure the water content. Our results showed that the neurological function of the sham-operated group and the control group was normal, the mNSS scores of which were 0. However, the neurological function score in the CPR group decreased gradually with time, but it was still significantly higher than that in the normal value until 48 hours (P < 0.05). There was no significant difference in brain water content between the sham-operated group and the control group (P > 0.05). The water content of brain tissue in sham-operated group was higher than that in control group at 6 h, and the amount was increasing as the time extended. The level reached the highest at 24 h and started to decrease at 48 h, but the it was still higher than that in sham-operated group (P < 0.05). The expression level of serum S100 A8/A9 in sham-operated group was slightly higher than that in control group, but there was no statistical difference (P > 0.05); The expression level of S100 A8/A9 in cardiopulmonary resuscitation group was significantly higher than that in control group at 6 h, and still increased at 24 h. Although the level decreased at 48 h, but was still higher than that in sham operation group (P < 0.05). The mNSS score and brain water content were significantly positively correlated with serum S100 A8/A9 (r = 0.48, P < 0.001; r = 0.63, P < 0.001). In conclusion, the level of serum S100A8/A9 in rats after cardiopulmonary resuscitation is significantly increased, which is positively correlated with the degree of brain injury in rats.

Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis

Background

Kawasaki disease (KD) is now the leading cause of acquired heart disease in children in developed countries. Intravenous immunoglobulin (IVIG) and aspirin were considered as the standard initial treatment of KD for decades. However, the optimal dose of aspirin has remained controversial. In recent years, many studies compared the efficacy of low-dose with high-dose aspirin in the acute phase of KD, but the results have not always been consistent. Therefore, we performed this meta-analysis to evaluate the efficacy of low-dose aspirin compared with high-dose for the initial treatment of KD.

Methods

Studies related to aspirin therapy for KD were selected from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Google scholar through Mar 25^th, 2019. Data were analyzed using STATA Version 15.1. Additionally, publication bias and sensitivity analysis were also performed by STATA version 15.1.

Results

Six studies were included in our analysis of the rate of coronary artery lesion (CAL), five reports for IVIG-resistant KD (rKD), and four for the duration of fever and hospitalization. However, no significant differences were found between low-dose and high-dose aspirin groups in the incidence of CAL (risk ratio (RR), 0.85; 95%CI (0.63, 1.14); P = 0.28), the risk of rKD (RR, 1.39; 95%CI (1.00, 1.93); P = 0.05), and duration of fever and hospitalization (the mean standard deviation (SMD), 0.03; 95%CI (-0.16, 0.22); P = 0.78).

Conclusion

Low-dose aspirin (3–5 mg·kg^-1·d^-1) may be as effective as the use of high-dose aspirin (≥30 mg·kg^-1·d^-1) for the initial treatment of KD. Further well-designed randomized clinical trials are needed to evaluate the efficacy of low-dose aspirin for the initial treatment of KD.

The role of gangue on the mitigation of mining-induced hazards and environmental pollution: An experimental investigation

Gangue, produced from coal mining and washing process, is a serious threat to the ground environment. Gangue backfilling mining method can solve this problem and reduce mining-induced hazards, e.g., controlling surface subsidence and preventing water inrush from seeping into goaf by cracks in overlying strata. In this paper, effects of the original particle size distribution (PSD) and water content on the particle crushing behavior and seepage properties of granular gangues were investigated. Experimental results show that the crushing behavior can promote the compaction of gangue particles; the variation of PSD after crushing reveals distinct fractal characteristics. With the increasing compression stress, the particle crushing ratio and fractal dimension increase, while the permeability decreases. Due to the rearrangement of particles and newly generated fine particles filled the gap among larger particles, it is difficult to reduce the permeability by increasing the compressive stress. In addition, the variation of fractal dimensions is similar to the crushing ratio, so the particle crushing can be illustrated by fractal dimensions. The relationship between porosity and permeability established by the Kozeny-Carman equation can model the effect of particle crushing in this research. The reliability of the equation is verified by the comparison of model result and experimental data. To increase the mitigation rate of mining-induced hazards and environmental pollution by GBM method, granular gangues can be crushed into smaller particles and dehydrated before backfilling.

Brain metastasis from early stage endometrial carcinoma 13 years after primary treatment: a case report and review of the literature

Brain metastases from endometrial adenocarcinoma are quite rare. Here, we report a case of a 64-year-old woman who presented with a history of left limb weakness of 45 days' duration. Her medical history was significant for the endometrial carcinoma diagnosed 13 years earlier, for which she had undergone a total hysterectomy. The patient received a craniotomy and was finally diagnosed with brain metastasis from endometrial adenocarcinoma. We performed a MEDLINE search of the pertinent literature, searching for information focusing on the diagnosis, mechanism, treatment, and prognosis of this rare tumor type.