RIPK1 is a negative mediator in Aquaporin 1-driven triple-negative breast carcinoma progression and metastasis

The triple-negative breast carcinoma (TNBC) is the most aggressive subtype of breast cancer. In TNBC, Aquaporin 1 (AQP1), a water-transporting transmembrane protein, is aberrantly enriched in cytoplasm and causes tumor cell death evasion. However, the carcinogenetic bioactivities of cytoplasmic AQP1 cannot be attributed to the canonical "osmotic engine model". In the present study, the receptor-interacting protein kinase 1 (RIPK1), a cell death regulator, was identified to negatively mediate AQP1-driven TNBC progression and metastasis. AQP1 overabundance and RIPK1 depletion occurred in TNBC, which were correlated with aggressive oncological features and poor prognosis. AQP1 bound with RIPK1, resulting in the inhibition of RIPK1/RIPK3/MLKL-mediated necroptosis and RIPK1/caspase-8/caspase-3-mediated apoptosis. Genetic inhibition of RIPK1 significantly exacerbated the pro-tumor effect of AQP1, while ectopic expression of RIPK1 notably blunted AQP1 signaling. Mechanistically, AQP1 binds to the D324 site of RIPK1, and facilitates RIPK1 cleavage and inactivation by excessively activating the caspase-8/RIPK1 negative feedback loop. RIPK1D324K overexpression significantly prevented RIPK1 cleavage and weakened the aggressiveness of AQP1-enriched TNBC cells. Overall, our findings clarify the underlying mechanism of cytoplasmic AQP1-driven TNBC progression and metastasis, in which RIPK1 exerts an essential role as a negative mediator and exhibits the potential as a therapeutic target for TNBC.

[Determination of chloroacetic acid in workplace air by silanization-gas chromatography]

Objective: A method to determine acrylic acid in workplace air was developed by silanization-gas chromatography. Methods: In March 2020, chloroacetic acid in air were absorbed by silica gel tube, the samples were dried, then were desorbed and silanized by acetonitrile: N, O-bis (trimethylsilane) trifluoroacetamide (2∶1, V/V) at room temperature, allowed quantitative analysis of chloroacetic acid as its silanization product by gas chromatography. Results: Calibration curve of the method was linear within the range 0-162.8 μg/ml and showed good linearity with linear equation: y=0.011 8x, r=0.999 7. The determination limit of the method was 0.8 μg/ml, and the minimum detection concentration was 0.05 mg/m(3) (collect 15 L air) . The relative standard deviation (RSD) was 0.5%-1.3% (n=5) . Recoveries were between 98.6%-101.2%. Conclusion: The results prove silanization-gas chromatography is an accurate, simple and high sensitive method for determining chloroacetic acid in workplace air.

[Analysis of integrated HCV surveillance in Shanghai, 2014-2019]

Objective: The purpose of this study is to analyze the surveillance data of the Integrated HCV surveillance in Shanghai and provide a scientific basis for HCV's elimination strategies. Methods: Descriptive statistical analysis and multivariate logistic regression analysis were performed using the multi-dimension results of the Integrated HCV surveillance in Shanghai from 2014 to 2019. Data related to reported HCV cases, HCV gene subtypes surveillance, HCV behavioral risk factors surveillance and HCV-antibody testing results of the community-based general population and high-risk/key populations. Results: The reported incidence rate of acute hepatitis C in Shanghai decreased from 2014 to 2019 (Z=-4.07, P<0.01); meanwhile, the reported incidence rate of chronic hepatitis C met an upward trend (Z=10.26,P<0.01), with an annual average, reported incidence rates of 0.18 per 100 000 and 8.60 per 100 000, respectively. Seven hundred forty-four blood samples were subtyped with 16 subtypes from 4 genotypes (GT1, GT2, GT3, and GT6). Among above, 1b (324 cases, 43.55%), 3a (121 cases, 16.26%), 3b (111 cases, 14.92%) and 6a (47 cases, 6.32%) were the principal subtypes. The composition of genotypes varied with decreased 1b and increased 3b and 6a. The major risk factors for HCV infection were blood transfusion (OR=4.18, 95%CI: 2.79-6.27), surgery (OR=1.63, 95%CI: 1.26-2.12), sharing syringe (OR=4.18, 95%CI: 2.75-6.34), pedicure (OR=2.01, 95%CI: 1.54-2.62), sharing razors (OR=4.09, 95%CI:1.24-13.51), and unsafe beauty practices (OR=3.15, 95%CI: 2.13-4.65). HCV antibody screening of 11 groups of high-risk/key populations showed that drug users had the highest HCV-antibody positive rate of 18.81% (1 008/5 358). The anti-HCV positive rate of the general population was 0.16% (7/4 268), which was significantly lower than that of high-risk/key populations from the same year, 2.50%(501/20 002) (χ²=94.04, P<0.01). Conclusions: Shanghai is a low-endemic area of HCV. Constantly carrying out integrated surveillance and analysis is of great value for early identification of HCV infected people and its risk factors, timely adjustment of prevention and control strategies, and eliminating the public health threat of HCV.

Spatiotemporal characteristics and factor analysis of SARS-CoV-2 infections among healthcare workers in Wuhan, China

BACKGROUND

Studying the spatiotemporal distribution of SARS-CoV-2 infections among healthcare workers (HCWs) can aid in protecting them from exposure.

AIM

To describe the spatiotemporal distributions of SARS-CoV-2 infections among HCWs in Wuhan, China.

METHODS

In this study, an open-source dataset of HCW diagnoses was provided. A geographical detector technique was then used to investigate the impacts of hospital level, type, distance from the infection source, and other external indicators of HCW infections.

FINDINGS

The number of daily HCW infections over time in Wuhan followed a log-normal distribution, with its mean observed on January 23rd, 2020, and a standard deviation of 10.8 days. The implementation of high-impact measures, such as the lockdown of the city, may have increased the probability of HCW infections in the short term, especially for those in the outer ring of Wuhan. The infection of HCWs in Wuhan exhibited clear spatial heterogeneity. The number of HCW infections was higher in the central city and lower in the outer city.

CONCLUSION

HCW infections displayed significant spatial autocorrelation and dependence. Factor analysis revealed that hospital level and type had an even greater impact on HCW infections; third-class and general hospitals closer to infection sources were correlated with especially high risks of infection.

Gas explosion-induced acute blast lung injury assessment and biomarker identification by a LC-MS-based serum metabolomics analysis

The objective of this study was to evaluate the histopathological effect of gas explosion on rats, and to explore the metabolic alterations associated with gas explosion-induced acute blast lung injury (ABLI) in real roadway environment using metabolomics analyses. All rats were exposed to the gas explosion source at different distance points (160 m and 240 m) except the control group. Respiratory function indexes were monitored and lung tissue analysis was performed to correlate histopathological effect to serum metabolomics. Their sera samples were collected to measure the metabolic alterations by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). HE staining in lung showed that the gas explosion caused obvious inflammatory pulmonary injury, which was consistent with respiratory function monitoring results and the serum metabolomics analysis results. The metabolomics identified 9 significantly metabolites different between the control- and ABLI rats. 2-aminoadipic acid, L-methionine, L-alanine, L-lysine, L-threonine, cholic acid and L-histidine were significantly increased in the exposed groups. Citric acid and aconitic acid were significantly decreased after exposure. Pathway analyses identified 8 perturbed metabolic pathways, which provided novel potential mechanisms for the gas explosion-induced ABLI. Therefore, metabolomics analysis identified both known and unknown alterations in circulating biomarkers, adding an integral mechanistic insight into the gas explosion-induced ABLI in real roadway environment.

Effectiveness of vortioxetine in real-world clinical practice: Interim results from the relieve study

Introduction

Vortioxetine has demonstrated sustained efficacy and favorable safety profile in multiple clinical trials.

Objectives

This study aims to describe the effectiveness and safety of vortioxetine in real-world clinical practice.

Methods

RELIEVE is a prospective, multi-national, observational cohort study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion and followed for 6 months. Data were collected at routine clinical visits. The primary outcome was functioning measured by Sheehan Disability Scale (SDS). Depressive symptoms measured by Patient Health Questionnaire 9-item (PHQ-9), cognitive symptoms measured by PDQ-5 and DSST were key secondary outcomes. Safety outcomes including adverse events were reported. This interim analysis presents results of 527 patients who completed the study and were followed for 6 months. Mixed models of repeated measures were used to assess improvements between baseline and month 6, adjusted for relevant confounders.

Results

A total of 527 patients (mean age, 50.2 years, 65% female) were enrolled from US, Canada, France and Italy, and included in the analysis. Mean SDS total score, PHQ-9, PDQ-5 scores decreased by 8.6, 7.4 and 4.7 respectively from baseline to last visit. Mean DSST score improved by 6.5 from baseline to last visit. Patients’ overall functioning and quality of life significantly improved, sick leave days and underproductive days (both absenteeism and presenteeism) decreased over the entire follow up period. The overall incidence of adverse events(AE) was 25%, with the most common AEs being nausea and headache.

Conclusions

The results confirm the effectiveness and good tolerability of vortioxetine in a broad range of patients in routine clinical practice.

Conflict of interest

Dr. Mattingly has served as researcher, consultant or speaker for Akili, Alcobra, Alkermes, Allergan, Axsome, Boehringer, Forum, Genentech, Jansen, Lundbeck, Medgenics, Merck, Neos, NLS Pharma, Otsuka, Reckitt Benckiser, Roche, Sage, Shire, Sunovion, Supe

Accurate diagnosis of colorectal cancer based on histopathology images using artificial intelligence

BACKGROUND

Accurate and robust pathological image analysis for colorectal cancer (CRC) diagnosis is time-consuming and knowledge-intensive, but is essential for CRC patients' treatment. The current heavy workload of pathologists in clinics/hospitals may easily lead to unconscious misdiagnosis of CRC based on daily image analyses.

METHODS

Based on a state-of-the-art transfer-learned deep convolutional neural network in artificial intelligence (AI), we proposed a novel patch aggregation strategy for clinic CRC diagnosis using weakly labeled pathological whole-slide image (WSI) patches. This approach was trained and validated using an unprecedented and enormously large number of 170,099 patches, > 14,680 WSIs, from > 9631 subjects that covered diverse and representative clinical cases from multi-independent-sources across China, the USA, and Germany.

RESULTS

Our innovative AI tool consistently and nearly perfectly agreed with (average Kappa statistic 0.896) and even often better than most of the experienced expert pathologists when tested in diagnosing CRC WSIs from multicenters. The average area under the receiver operating characteristics curve (AUC) of AI was greater than that of the pathologists (0.988 vs 0.970) and achieved the best performance among the application of other AI methods to CRC diagnosis. Our AI-generated heatmap highlights the image regions of cancer tissue/cells.

CONCLUSIONS

This first-ever generalizable AI system can handle large amounts of WSIs consistently and robustly without potential bias due to fatigue commonly experienced by clinical pathologists. It will drastically alleviate the heavy clinical burden of daily pathology diagnosis and improve the treatment for CRC patients. This tool is generalizable to other cancer diagnosis based on image recognition.

Non-Coding RNA and Diabetic Kidney Disease

Diabetic kidney disease (DKD) is one of the most common chronic microvascular complications of diabetes. In addition to the characteristic clinical manifestations of proteinuria, it also has a complex pathological process that results from the combined effects of multiple factors involving the whole renal structure such as glomeruli, renal tubules, and blood vessels. Non-coding RNAs (ncRNA) are transcripts with no or low coding potential, among which micro RNA (miRNA) has been widely studied as a functional miRNA involved in regulation and a potential biomarker for disease prediction. The abundance of long coding RNA (lncRNA) in vivo is highly expressed with a certain degree of research progress, but the structural similarity makes the research still challenging. The research of circular RNA (circRNA) is still in its early stages. It is more relevant to the study to provide a more relevant link between diseases in the kidney and other tissues or organs. This classification review mainly summarized the biogenesis characteristics, the pathological mechanism of ncRNA-regulating diseases, the ways of ncRNA in the clinical prediction as a potential biomarker, and the interaction networks of ncRNA.

[Diagnosis, treatment and prognosis evaluation of pancreatic cancer by microRNA]

Pancreatic cancer, with the characteristics of insidious onset, easy metastasis, chemotherapy resistance and poor prognosis, is a common malignant tumor of the digestive system. Early diagnosis and treatment of pancreatic cancer is one of the major problems in modern medicine, and there is an urgent need to find new diagnostic, prognostic biomarkers and therapeutic targets. MicroRNA (miRNA) is a small non-coding RNA which can regulate the expression of various genes. miRNAs have wide abnormal expressions in pancreatic cancer, and are closely related to the occurrence and development of pancreatic cancer. Thereby, miRNAs have the potential to become new diagnostic, prognostic and predictive biomarkers and therapeutic targets of pancreatic cancer. Many studies have initially shown that miRNAs have the application value in the diagnosis, treatment and prognosis evaluation of pancreatic cancer, but there are still some difficulties in the practical application and promotion. The mechanisms of miRNAs in pancreatic cancer remain to be further studied.

[Screening core genes and cyclin B2 as a potential diagnosis, treatment and prognostic biomarker of hepatocellular carcinoma based on bioinformatics analysis]

Objective: To screen out and explore the core gene (Hub gene) involvement and the potential role of cyclin B2 (CCNB2) in the development and prognosis of hepatocellular carcinoma (HCC) through bioinformatics methods. Methods: Four HCC-related datasets were screened, and downloaded from the GEO database. GEO2R tool was used to analyze data and identify the differentially expressed genes (DEGs). Gene Ontology (GO) and KEGG signal pathway enrichment analysis were completed using DAVID database and Cytoscape (ClueGO) plug-in, respectively. Protein-protein interaction network (PPI) of DEGs was established using the STRING database. Cytoscape software was used to visualize PPI network, key modules (cluster) construction and core genes identification. UCSC and UALCAN database were used to analyze the differential expression and survival of TCGA hepatocellular carcinoma core genes. Firebrowse, Oncomine and UALCAN databases were used to analyze the expression of core genes in multiple tumors including HCC. Real-time quantitative reverse transcription PCR (RT-qPCR) was used to detect the expression levels of candidate genes in HCC tissues and liver cancer cell lines. Results: A total of 73 DEGs were identified from the four datasets, including 15 up-regulated genes and 58 down-regulated genes. KEGG pathway enrichment analysis signal showed that DEGs were mainly enriched in tumor-related pathways. PPI network based on DEGs had screened the key modules and 10 core genes. CCNB2 and NCAPG were highly expressed in liver cancer tissues in multiple databases. CCNB2 was positively correlated with NCAPG and was considered as a key gene related to prognosis (P < 0.01). RT-qPCR results showed that CCNB2 was highly expressed in human HCC tissues and cell lines (P < 0.01). Conclusion: Successfully screened DEGs and core genes related to HCC. Among them, CCNB2 is highly expressed in HCC and is related to the survival and prognosis of patients, so it is expected to become a biomarker for the diagnosis and prognosis of HCC.

[Clinical cure strategy for hepatitis B: immunomodulatory therapy]

Chronic hepatitis B virus (HBV) infection remains a major world public health problem. Current guidelines of chronic hepatitis B (CHB) suggest the clinical cure as the ideal thearapeutic goal. Although the optimization of the existing antiviral treatment can make some patients achieve clinical cure, but for most patients with chronic hepatitis B, it is difficult to achieve clinical cure according to the existing antiviral treatment plan. The medical community has begun to work together to seek new treatment strategies, especially the immune intervention measures aimed at restoring the immune response in the liver microenvironment. Notably, immune antiviral response plays a crucial role in HBV clearance, and the clinical cure of chronic hepatitis B is finally achieved through the optimized combination of antiviral and immunomodulatory drugs.

Interleukin-35 has a tumor-promoting role in hepatocellular carcinoma

Hepatic inflammatory response is a risk factor for liver cancer initiation and progression. Interleukin (IL)-35 is the newest member of the IL-12 cytokine family, and has been reported to play an essential role in the immunosuppressive liver microenvironment. Herein we focus on the expression profiles of IL-35 in hepatocellular carcinoma (HCC) and effects on local immune status. HCC transcriptome array data were downloaded from Gene Expression Omnibus (GEO). Analysis was performed by BRB-Array Tools and Ingenuity Pathway Analysis (IPA) software. Serum IL-35 level was detected by AimPlet bead-based immunoassay. In-situ IL-35 detection was performed by immunohistochemical staining and Western blot. The n-vitro effect of IL-35 on CD4⁺ or CD8⁺ T cell function was detected by flow cytometry. Our results showed that there were large amounts of IL-35 expressed in HCC serum and tumor tissues. IL-35 expression affects the transcript of thousands of genes, most differentially expressed genes (DEGs), in tumor tissues correlated with T cell immunity. The IL-35 high-expression group exhibited enhancement of regulatory T cells (T_regs ) and impairment of cytolytic T cells. In-vitro experiments proved that exogenous IL-35 stimulated the expression of programmed cell death 1 (PD-1) and lymphocyte activation gene-3 (LAG3) in CD4⁺ and CD8⁺ T cells. In addition, the stimulating effect was time-dependent. Furthermore, IL-35 inhibited interferon (IFN)-γ secretion by CD4⁺ and CD8⁺ T cells. Elevated IL-35 had an immune suppressive role in HCC tumor microenvironments through affecting inhibitor receptor expression and cytokine secretion of CD4⁺ and CD8⁺ T cells. Dissection of the precise targets and underlying molecular mechanisms would mean alternative treatments for HCC patients.

IGF-1R/β-catenin signaling axis is implicated in streptozotocin exacerbating bone impairment in ovariectomized rats

OBJECTIVE

The aim of this study was to investigate the role of the insulin-like growth factor-1 receptor (IGF-1R)/β-catenin signaling axis in bone impairment induced by hyperglycemia in ovariectomized rats.

METHODS

Rats were divided into four groups. The sham group received sham operation and a single intraperitoneal administration of vehicle. The ovariectomy (OVX) group was subjected to bilateral OVX and vehicle injection. The streptozotocin (STZ) group received sham operation and a single STZ injection to induce hyperglycemia. The OVX + STZ group received bilateral OVX and a single STZ injection. Dual-energy X-ray absorptiometry measurement, bone biomechanics test, micro-computed tomography scan, and hematoxylin-eosin staining were performed to evaluate bone alteration in this model. The expression of relevant signals including IGF-1R, glycogen synthase kinase-3β (GSK-3β), and β-catenin were examined by quantitative real-time polymerase chain reaction and western blot.

RESULTS

The OVX, STZ, and OVX + STZ groups induced bone loss, attenuated bone strength, and impaired microarchitecture compared with the sham group, respectively. Compared with OVX, more serious bone damage was found in the OVX + STZ group, which showed enhanced phosphorylation of IGF-1R, GSK-3β, and β-catenin.

CONCLUSION

OVX plus STZ induced more serious bone impairment than OVX alone, which involves the IGF-1R/β-catenin signaling axis in the pathogenesis. This may provide a potential target for treatment of postmenopausal diabetic osteoporosis.

Inhibition of α1-adrenoceptor reduces TGF-β1-induced epithelial-to-mesenchymal transition and attenuates UUO-induced renal fibrosis in mice

Renal fibrosis is a common pathological hallmark of chronic kidney disease (CKD). Renal sympathetic nerve activity is elevated in patients and experimental animals with CKD and contributes to renal interstitial fibrosis in obstructive nephropathy. However, the mechanisms underlying sympathetic overactivation in renal fibrosis remain unknown. Norepinephrine (NE), the main sympathetic neurotransmitter, was found to promote TGF-β1-induced epithelial-mesenchymal transition (EMT) and fibrotic gene expression in the human renal proximal epithelial cell line HK-2. Using both genetic and pharmacological approaches, we identified that NE binds Gαq-coupled α1-adrenoceptor (α1-AR) to enhance EMT of HK-2 cells by activating p38/Smad3 signaling. Inhibition of p38 diminished the NE-exaggerated EMT process and increased the fibrotic gene expression in TGF-β1-treated HK-2 cells. Moreover, the pharmacological blockade of α1-AR reduced the kidney injury and renal fibrosis in a unilateral ureteral obstruction mouse model by suppressing EMT in the kidneys. Thus, sympathetic overactivation facilitates EMT of renal epithelial cells and fibrosis via the α1-AR/p38/Smad3 signaling pathway, and α1-AR inhibition may be a promising approach toward treating renal fibrosis.

The association of hematuria on kidney clinicopathologic features and renal outcome in patients with diabetic nephropathy: a biopsy-based study

PURPOSE

To investigate the relationships between hematuria, clinicopathological features and renal outcomes in patients with biopsy-proven diabetic nephropathy (DN).

METHODS

This cohort study included 261 patients with DN. Participants were divided into two groups according to number of red blood cells per high-power field (RBC/hpf) in urine sediment: the hematuria (-) group (≤ 3 RBC/hpf) and the hematuria (+) group (> 3 RBC/hpf). Basic clinical parameters were measured at the time of renal biopsy; relationships between hematuria and clinicopathological features and renal outcomes were analyzed.

RESULTS

Patients in the hematuria (+) group often had overt proteinuria. Interstitial inflammation was more severe in the hematuria (+) group than in the hematuria (-) group. Glomerular arteriolar hyalinosis, interstitial fibrosis and tubular atrophy were comparable between groups. For patients with early DN (eGFR ≥ 60 ml/min/1.73 m²), urinary RBC/hpf at baseline was positively correlated with glomerular classification, interstitial fibrosis/tubular atrophy scores and interstitial inflammation scores. In prognostic analysis, hematuria was associated with a higher risk of progression to end-stage renal disease. Hematuria remained an independent predictor after adjustment for confounding factors such as sex, age, duration of diabetes, serum glucose level, hypertension, cholesterol, eGFR and urine protein excretion, especially in patients with early DN and in male patients.

CONCLUSION

In this study, hematuria was associated with more severe renal pathologic lesions in patients with DN. The presence of hematuria could be an independent predictor of renal outcome in patients with early DN.

VASH-1 Regulates Oxidative Stress and Fibrosis in Diabetic Kidney Disease via SIRT1/HIF1α and TGFβ1/Smad3 Signaling Pathways

Aims: To investigate the role of Vasohibin-1 (VASH-1), silence information adjustment factor 2-related enzyme 1 (SIRT1)/hypoxic-inducible factor 1α (HIF1α) and transforming growth factor-β1 (TGFβ1) /Smad3 signaling pathways in oxidative stress and fibrosis of diabetic kidney disease (DKD).

Materials and Methods: A diabetic rat model was established in vivo and rat mesangial cells (RMCs) were cultured in vitro with high glucose via transfection with Vash1 small interfering RNA (siRNA), Hif1a siRNA, Sirt1 siRNA and TGFβ1/Smad3 pathway inhibitor (SB431542). Renal histology was used to detect renal changes. Real-time PCR and western blot were used to analyze the expression of VASH-1, SIRT1, HIF1α, TGFβ1, Smad3, vascular endothelial growth factor (VEGF), connective tissue growth factor (CTGF) and fibronectin (FN). Expression levels of tumor necrosis factor-α (TNFα), TGFβ1, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX), and malondialdehyde (MDA) in rat tissues and cell culture supernatant were detected by ELISA and chemiluminescence assay, while cell proliferation was detected by CCK-8.

Results: The level of VASH-1 in renal tissues of diabetic rats was decreased, while both high glucose and Vash1 siRNA inhibited the expression of VASH-1 and SIRT1, increased the levels of HIF1α, TGFβ1, and Smad3 in RMCs, thus up-regulating oxidative stress and fibrosis factors, and abnormally increasing cell proliferation activity (P < 0.05). However, inhibition of SIRT1/HIF1α signaling pathway only reduced TGFβ1 and Smad3 (P < 0.05), while VASH-1 remained unchanged (P > 0.05).

Conclusion: VASH-1 was under-expressed in renal tissues of diabetic rats and regulated the pathological process of oxidative stress and fibrosis in DKD via downstream SIRT1/HIF1α and TGFβ1/Smad3 signaling pathways.

Combination of pegylated interferon-alpha and nucleos(t)ide analogue treatment enhances the activity of natural killer cells in nucleos(t)ide analogue experienced chronic hepatitis B patients

A combination of pegylated interferon-alpha (peg-IFN-α) and nucleos(t)ides analogue (NA) therapy can effectively reduce hepatitis B surface antigen (HBsAg), especially in NA-experienced chronic hepatitis B (CHB) patients. However, the immune mechanism of this therapy is unclear. Forty NA-experienced CHB patients were enrolled into this study. The frequencies of peripheral blood natural killer (NK) cells, dendritic cells (DCs), CD4⁺ T cells, CD8⁺ T cells, T helper (Th) cells, regulatory T cells (T_reg ), B cells and follicular T helper (Tfh) cells were evaluated by flow cytometry. Seven of the 40 patients converted to peg-IFN-α combined with NA treatment, while the other 33 continued to NA therapy. The decrease in HBsAg was more pronounced in the combination treatment group, and only patients receiving combination treatment achieved HBsAg loss. The frequency and absolute number of CD56^bright NK cells in the combination treatment group increased significantly compared with the NA treatment group, whereas the CD56^dim NK cells were decreased. In the NA treatment group, the proportions of CD4⁺ T_N , CD8⁺ T_N , CD19⁺ B and cytotoxic T lymphocyte antigen-4 (CTLA-4)⁺ CD4⁺ T cells were increased, while the proportions of CD4⁺ T_EM , CD8⁺ T_EM , CD25⁺ CD4⁺ T_reg , CD25^high CD4⁺ T_reg , CD127^low CD25⁺ T_reg , programmed cell death 1 (PD-1)⁺ CD4⁺ T, PD-1⁺ CD8⁺ T, CTLA-4⁺ CD8⁺ T, CCR4⁺ CD25⁺ T_reg and CCR4⁺ CD25^high T_reg cells were decreased after therapy. For NA-experienced CHB patients who achieved low HBsAg levels, combination treatment is more likely to result in HBsAg decline and HBsAg clearance by increasing the activity of CD56^bright NK cells.

[The relationship between the index of lymph node metastasis and the prognosis of pancreatic cancer patients after R0 resection]

Objective: To investigate the prognostic values of three different staging schemes including the number of lymph node metastasis (N stage), lymph node ratio (LNR) and log odd of positive lymph nodes (LODDS) in pancreatic cancer patients after R0 resection. Methods: The clinical and pathological data of 307 pancreatic cancer patients who underwent R0 resection at Cancer Hospital of Chinese Academy of Medical Sciences from January 2010 to December 2018 were retrospectively analyzed. Kaplan-Meier and Cox proportional hazard regression models were used to analyze the independent prognostic factors. The area under the receiver operator characteristic curve (AUC) was used to compare the prognostic efficacy of different lymph node staging systems. Results: The median survival was 24.0 months, 1-year, 3-year, and 5-year survival rates were 72.0%, 35.5% and 24.0%, respectively. Multivariate analysis showed that CA199, differentiation, T stage, adjuvant therapy, N stage, LNR stage, and LODDS stage were independent prognostic factors for pancreatic cancer patients after R0 resection (P<0.05). The AUC values of the 1-year survival rate for N stage, LNR stage, and LODDS stage were 0.591, 0.592 and 0.609, respectively. The AUC values of the 3-year survival rate for N stage, LNR stage, and LODDS stage were 0.585, 0.588 and 0.593, respectively. The AUC values of the 5-year survival rate for N stage, LNR stage, and LODDS stage were 0.554, 0.557 and 0.589, respectively. The AUC values of the LODDS stage were the highest while the N stage were the lowest, but there was no significant difference among these three systems (P>0.05). For all patients, the LODDS staging system was slightly better than the N and LNR staging systems, but the difference was not statistically significant (P>0.05). For patients with N0 stage, the LODDS staging system showed better prediction performance than the N stage and LNR staging systems (P<0.05). Conclusions: The N stage, LNR stage, and LODDS stage are independent prognostic factors for pancreatic cancer patients after R0 resection. For patients without lymph node metastasis, LODDS staging system is superior to N and LNR staging systems in predicting prognosis.

[Neutralization of interleukin-6 alleviates acute liver injury in mice]

Objective: To study the role of interleukin 6 (IL-6) in the occurrence and development of acute liver injury. Methods: Twelve C57BL/6 male mice without specific pathogens were randomly divided into a control group and an acute liver injury model group, with six mice in each group. Control and model group were injected with an equal volume (dosage of 10 mg/kg) of phosphate-buffered saline (PBS) and concanavalin A (ConA) into the tail vein, respectively. Samples were collected at 6 h for liver HE staining. Transaminase assay was used to determine the success of the induction model. The expression of IL-6, IL-17, IL-1β, interferon (IFN) γ and tumor necrosis factor α were screened by quantitative fluorescence PCR (qPCR). The expressional condition of IL-6 and IFNγ were measured by enzyme-linked immunosorbent assay (ELISA). Subsequently, three control groups and three IL-6 neutralizing antibody groups were established for acute liver injury, respectively. Equal volumes of PBS or IL-6 neutralizing antibody (100 μg/body) were injected prior 30 minutes, followed by injection of ConA (10 mg/kg) into the tail vein. Blood sampled from eye and liver tissue were fetched at 6 h. Liver tissues were stained with HE and serum alanine aminotransferase (ALT) was determined. An independent sample T-test was used for data comparison. Results: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of the model group was significantly higher than control group [ALT: (2 618.99 ± 188.08) U/L and (43.34 ± 5.02) U/L, t = -13.69, P = 0.001; AST: (942.48 ± 150.44) U/L and (57.80 ± 4.84) U/L, t = -5.878, P = 0.01]. Liver HE staining showed that the structure of hepatocyte cord was disordered, the cytoplasm of hepatocyte was lightly stained, and large necrotic foci were gradually formed, accompanied by lymphocyte infiltration, and then a mouse model of acute liver injury was successfully established. Protein levels of IL-6 and IFN, and mRNA of the model group were significantly up-regulated, as compared to control group. IL-6 mRNA expression of the model group was increased 73.7 times that of the control group (t =-6.218, P < 0.001), and the serum IL-6 expression level was also higher than that of the control group (18 537.02 ± 92.57) pg/ml (t = -199.782, P < 0.001). IFNγ mRNA was 108.4 times higher than that of the control the group (t = -4.413, P = 0.003), and serum IFNγ concentration of the model group was also higher than the control group (12 068.30 ± 288.43) pg/ml (t = -41.748, P < 0.001). Among them, IL-6 level was obviously increased, suggesting that it could participate in the occurrence and development of liver injury. IL-6 neutralizing antibody was injected into the tail vein. ALT level of IL-6 neutralizing antibody was significantly lower than acute liver injury control group [(167.41 ± 47.80) U/L and (1 520.34 ± 190.21) U/L, t = 6.899, P = 0.015]. Liver tissue HE staining showed that hepatocyte necrosis and the number of necrotic foci was significantly alleviated after blocking serum IL-6.Immunohistochemical results showed that the expression of activated caspase3 and hepatocyte apoptosis in the IL-6 neutralizing antibody group was decreased. Conclusion: Neutralizing IL-6 can significantly reduce acute liver injury caused by concanavalin A.

Sdccag3 Promotes Implant Osseointegration during Experimental Hyperlipidemia

Hyperlipidemia adversely affects bone metabolism, often resulting in compromised osseointegration and implant loss. In addition, genetic networks associated with osseointegration have been proposed. Serologically defined colon cancer antigen 3 (Sdccag3) is a novel endosomal protein that functions in actin cytoskeleton remodeling, protein trafficking and secretion, cytokinesis, and apoptosis, but its roles in the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) and in implant osseointegration under hyperlipidemic conditions have not been uncovered. Here, we performed microarray and RNA sequencing analysis to determine the differential expression of the Sdccag3 gene and related noncoding RNAs (ncRNAs) and to assess the long noncoding RNA (lncRNA) MSTRG.97162.4-miR-193a-3p-Sdccag3 coexpression network in bone tissues within the region 0.5 mm around implants in hyperlipidemic rats. In this experiment, we found that Sdccag3 and the previously uncharacterized lncRNA-MSTRG.97162.4 were downregulated during hyperlipidemia, while miR-193a-3p was upregulated. Sdccag3 overexpression increased new trabecular formation, the bone volume/total volume (BV/TV) (1.24-fold), and bone-implant combination ratio (BIC%) (1.26-fold). An RNA pulldown experiment revealed that Sdccag3 protein targeted lncRNA-MSTRG.97162.4 nucleotides 361 to 389. In addition, lncRNA-MSTRG.97162.4 overexpression significantly enhanced Sdccag3 (2.78-fold) expression and increased BV/TV (1.45-fold) and BIC% (1.07-fold) at the bone-implant interface. Taken together, these findings indicate that Sdccag3 overexpression enhances implant osseointegration under hyperlipidemic conditions by binding to lncRNA-MSTRG.97162.4. Furthermore, miR-193a-3p overexpression inhibited lncRNA-MSTRG.97162.4 (0.63-fold) and Sdccag3 (0.88-fold) expression and induced poor implant osseointegration (BV/TV, 0.86-fold; BIC%, 0.82-fold), while miR-193a-3p downregulation produced the opposite results (lncRNA-MSTRG.97162.4, 10.69-fold; Sdccag3, 6.96-fold; BV/TV, 1.20-fold; BIC%, 1.26-fold). Therefore, our findings show that Sdccag3 promotes implant osseointegration, and its related lncRNA-MSTRG.97162.4 and miR-193a-3p play an important role in osseointegration during hyperlipidemia, which might be a promising therapeutic target for improving dental implantation success rates.

[Effect of sedation weaning pattern on withdrawal syndrome in pediatric intensive care unit]

Objective: To investigate the sedation weaning strategies in critically ill patients with mechanical ventilation in pediatric intensive care unit (PICU) and to explore the effect of different sedative weaning patterns on withdrawal syndrome. Methods: A single-center prospective cohort study was conducted from April 1, 2016 to April 30, 2017. One hundred and twelve patients who required mechanical ventilation and benzodiazepines and (or) opioids for at least 5 consecutive days in PICU of Shanghai Children's Medical Center were enrolled. Twenty patients (17.9%) had an intermittent weaning pattern, defined as a 50% or greater increase in daily benzodiazepine and (or) opioid dose after the start of weaning, and the remaining 92 cases (82.1%) had a steady weaning pattern. The demographic and clinical features, duration and dose of sedative and analgesics, and the incidence of withdrawal syndrome were evaluated. Mann-Whitney U test was used for comparison about clinical features between different weaning pattern groups and children with withdrawal syndrome or not. Logistic regression was used to explore the risk factors of withdrawal syndrome. Results: Among the 112 patients, 46 (41.1%) had withdrawal syndrome. The patients with the intermittent weaning pattern had a high score of pediatric risk of mortality Ⅲ (PRISM-Ⅲ) (10.0 (3.5, 12.0) vs. 6.0 (2.0, 10.0), U=654.50, P=0.043) and were prone to re-intubation (35.0% (7/20) vs. 7.6% (7/92), P=0.003). The patients with withdrawal syndrome had longer duration of sedation (19.5 (16.8, 24.3) vs. 10.0 (7.0, 17.3) days, U=743.50, P<0.01), higher incidence of intermittent weaning pattern (32.6% (15/46) vs. 7.6% (5/66),χ(2)=11.58, P=0.001), longer PICU hospitalization (19.0 (15.8, 25.3) vs. 12.0 (8.8, 17.0) days, U=755.00, P<0.01) and higher cost (89 (57,109) vs. 53 (32, 79) thousand yuan, U=804.00, P<0.01). Logistic regression showed that intermittent weaning pattern (odds ratio (OR)=4.85, 95% confidence interval (CI) 1.39-16.91, P=0.013), perioperative period of liver transplantation (OR=6.97, 95%CI 1.25-39.04, P=0.027) and a cumulative dose of midazolam ≥ 34.7 mg/kg (OR=8.12, 95%CI 3.09-21.37, P<0.01) were risk factors of withdrawal syndrome. Conclusions: Withdrawal syndrome is more likely to occur in children who are intermittently weaned from sedation. Steady weaning strategy may help prevent iatrogenic withdrawal syndrome.

A new adaptation for in vitro co-culture of single porcine parthenogenetic embryos using feeder cells

Feeder cells can promote cell proliferation and help overcome the developmental arrest of early embryos by producing growth factors. The objective of this study was to evaluate the effects of feeder cells on the development of all single porcine parthenogenetic embryos in vitro. Firstly, we showed that the cleavage and blastocyst formation rate of all single procine parthenogenetic embryos co-cultured with feeder cells increased in contrast to those cultured without feeder cells (p⟨0.05). However, no statistically significant differences were observed between the blastocyst formation rate in the embryos co-cultured with 3 different kinds feeder cells namely oviduct epithelial feeder cells, granulose feeder cells and porcine fetal fibroblast feeder cells (p>0.05). Secondly, highly significant differences were observed between the cleavage and blastocyst formation rate (p⟨0.05) when the embryos were co-cultured with oviduct epithelial feeder cells in different volume drops ranging from 3 to 20 μL and the cleavage rate were the highest when cultured in 5 μL drops. Thirdly, the tempospacial pattern of the development of single embryos co-cultured with oviduct epithelial feeder cells was consistent with that of traditional multi-embryo culture, indicating that the co-culturing does not affect the developmental competence of the porcine parthenogenetic embryos. Finally, highly significant differences were observed between the cleavage and blastocyst formation rate with and without zona pellucida in vitro (p⟨0.05). In this study, a new adaption of in vitro co-culture of single porcine parthenogenetic embryos using feeder cells has been successfully established and this will facilitate further investigations to discover the mechanistic mode of developmental arrest of porcine embryos.