Mendelian Randomization With Refined Instrumental Variables From Genetic Score Improves Accuracy and Reduces Bias

Mendelian randomization (MR) can estimate the causal effect for a risk factor on a complex disease using genetic variants as instrument variables (IVs). A variety of generalized MR methods have been proposed to integrate results arising from multiple IVs in order to increase power. One of the methods constructs the genetic score (GS) by a linear combination of the multiple IVs using the multiple regression model, which was applied in medical researches broadly. However, GS-based MR requires individual-level data, which greatly limit its application in clinical research. We propose an alternative method called Mendelian Randomization with Refined Instrumental Variable from Genetic Score (MR-RIVER) to construct a genetic IV by integrating multiple genetic variants based on summarized results, rather than individual data. Compared with inverse-variance weighted (IVW) and generalized summary-data-based Mendelian randomization (GSMR), MR-RIVER maintained the type I error, while possessing more statistical power than the competing methods. MR-RIVER also presented smaller biases and mean squared errors, compared to the IVW and GSMR. We further applied the proposed method to estimate the effects of blood metabolites on educational attainment, by integrating results from several publicly available resources. MR-RIVER provided robust results under different LD prune criteria and identified three metabolites associated with years of schooling and additional 15 metabolites with indirect mediation effects through butyrylcarnitine. MR-RIVER, which extends score-based MR to summarized results in lieu of individual data and incorporates multiple correlated IVs, provided a more accurate and powerful means for the discovery of novel risk factors.

Effects of PI3K/AKT/mTOR pathway regulation of HIF-1α on Lanthanum-induced neurotoxicity in rats

This study examined the effects of the AKT/mTOR/HIF-1α signaling pathway on learning and memory in offspring rats induced by lanthanum from neuroethology and molecular biology perspectives. 32 pregnant adult Wistar rats were divided into four groups randomly: control group (NC), 0.25%, 0.5% and 1.0% LaCl3 groups (n = 8). All rats were poisoned through free drinking from day 0 of pregnancy to postnatal day 21 (suckling period). All offspring rats were poisoned through free drinking from delactation to postnatal day 48. Offspring rats aged 49-days-old were used as sampling objects to construct an LaCl3 poisoning model of offspring rats. Changes in hippocampal neurons, apoptosis of hippocampal neurons, learning and memory abilities of LaCl3-poisoned animals were measured by Nissl staining, TUNEL method and the shuttle box test, respectively. Expressions of PI3K, AKT, and mTOR, HIF-1α, and VEGF in the hippocampus were tested by qPCR and Western blot. Distributions of PI3K and p-AKT in hippocampal neurons were observed through the immunohistochemical method. With increasing LaCl3 dose, lightning strike time and active avoidance incubation period of offspring rats in the different LaCl3 groups were significantly prolonged. The Nissl body positive neurons of hippocampal neurons gradually declined while apoptosis in cells increased. The expressions of both mRNA (PI3K, AKT, mTOR, HIF-1α, VEGF) and proteins (PI3K, p-AKT, p-mTOR, HIF-1α, VEGF) in the hippocampus of the LaCl3 groups were significantly lower than those of NC group (p < 0.05). LaCl3 poisoning can induce developmental injuries in hippocampal neurons and can increase cell apoptosis. As a result, learning and memory abilities of offspring rats, as well as the expressions of PI3K/AKT/mTOR, are decreased, thus inhibiting activation of HIF-1α and influencing the expression of the downstream VEGF gene.

The lab-confirmed interval of COVID-19 clusters and its application in the strength evaluation of prevention and control measures

BACKGROUND

The lab-confirmed interval is the date from lab confirmation in a core case (infector) to lab confirmation in a second case (infectee); however, its distribution and application are seldom reported. This study aimed to investigate the lab-confirmed interval and its application in the preliminary evaluation of the strength of disease prevention and control measures.

METHODS

Taking European countries and Chinese provinces outside Hubei as examples, we identified 63 infector-infectee pairs from European countries from Wikipedia, and 103 infector-infectee pairs from official public sources in Chinese provinces outside Hubei. The lab-confirmed intervals were obtained through analysis of the collected data and adopting the bootstrap method.

RESULTS

The mean lab-confirmed interval was 2.6 (95% CI: 2.1-3.1) days for Europe and 2.6 (95% CI: 1.9-3.3) days for China outside Hubei, which were shorter than the reported serial intervals. For index patients aged ≥60 years old, the lab-confirmed interval in Europe was slightly longer (mean: 2.9; 95% CI: 2.0-3.6) and obviously longer in China outside Hubei (mean: 3.8; 95% CI: 1.9-5.5) than that for patients aged < 60 years.

CONCLUSION

Investigation of the lab-confirmed interval can provide additional information on the characteristics of emergent outbreaks and can be a feasible indication to evaluate the strength of prevention and control measures. When the lab-confirmed interval was shorter than the serial interval, it could objectively reflect improvements in laboratory capacity and the surveillance of close contacts.

Characterisation of symptomatic intracranial plaque without substantial stenosis using high-resolution vessel wall MRI

AIM

To characterise symptomatic intracranial plaque without substantial stenosis using three-dimensional (3D) high-resolution contrast-enhanced black-blood magnetic resonance imaging (BBMRI) and to determine plaque features associated with recent cerebrovascular events.

MATERIALS AND METHODS

The institutional review board approved this retrospective study. The case notes from patients with evidence of intracranial atherosclerosis in a large intracranial artery with preceding BBMRI were reviewed retrospectively. Symptomatic and asymptomatic plaques with substantial luminal stenosis (<50%) were matched by plaque location and patient age. All MRI images were de-identified and interpreted by two neuroradiologists who were blinded to the history of symptoms. Qualitative analyses including the presence of intraplaque haemorrhage (IPH), eccentricity, surface irregularity, and grade of plaque enhancement were recorded. Quantitative analyses including normal wall index and degree of contrast enhancement were calculated. Multivariate regression analysis was performed to identify the association with cerebrovascular ischaemic events.

RESULTS

A total of 38 pairs of symptomatic and asymptomatic plaques from 74 patients were analysed. Compared to asymptomatic plaques, symptomatic plaques demonstrated higher degree of contrast enhancement (29.77 ± 19.23 versus 18.21 ± 12.18%, p=0.039) and presence of IPH (26% versus 8%, p=0.032). No significant differences were detected regarding eccentricity, surface irregularity, and normal wall index. Events were associated with contrast enhancement (OR, 1.212; 95% confidence interval [CI], 1.086-1.352) after controlling for age, sex, cardiovascular risk factors, and stenosis degree. IPH was not associated with events.

CONCLUSION

Contrast enhancement in the intracranial plaque without substantial stenosis is associated with previous events, and may serve as the vulnerable feature, thereby stratifying stroke risk not achievable by luminal stenosis.

MiR-188 inhibits proliferation and promotes apoptosis of lung adenocarcinoma cells by targeting SIX1 to negatively regulate ERK signaling pathway

OBJECTIVE

To explore the effects of micro ribonucleic acid (miR)-188 on proliferation and apoptosis of lung adenocarcinoma (LUAD) cells, and its potential mechanism.

MATERIALS AND METHODS

The expression level of miR-188 in LUAD cell lines was detected via quantitative Real Time-Polymerase Chain Reaction (PCR). The effects of miR-188 overexpression on proliferation and apoptosis of A549 cells were detected using methyl thiazolyl tetrazolium (MTT) assay, colony formation assay, and flow cytometry. The potential targets for miR-188 were predicted using the TargetScan Human database, and the interaction between miR-188 and target gene was determined through Dual-Luciferase reporter assay. Moreover, the associations of miR-188 and sine oculis homeobox homolog 1 (SIX1) with the extracellular signal-regulated kinase (ERK) pathway were detected via Western blotting.

RESULTS

The expression of miR-188 significantly declined in LUAD cell lines (p<0.05). The overexpression of miR-188 significantly reduced the proliferation rate of A549 cells and increased the percentage of apoptotic A549 cells (p<0.05). Similarly, it was found in colony formation assay that the overexpression of miR-188 inhibited the colony formation ability of A549 cells most significantly (p<0.05). SIX1 was a direct target for miR-188, and its mRNA and protein expressions were downregulated by the overexpression of miR-188. The remarkable downregulation of phosphorylated ERK was observed in A549 cells overexpressing miR-188, while the decline in phosphorylated ERK was reversed in A549 cells overexpressing miR-188 and SIX1.

CONCLUSIONS

The expression of miR-188 is downregulated in LUAD cell lines. The overexpression of miR-188 inhibits proliferation and promotes apoptosis of LUAD cells, whose functional mechanism may be related to its regulation on the ERK signaling pathway by targeting SIX1.

MiR-19 enhances pancreatic cancer progression by targeting PTEN through PI3K/AKT signaling pathway

OBJECTIVE

Abnormal expression of micro ribonucleic acids (miRNAs) has become an important marker of cancer. However, the exact molecular mechanisms of miRNAs were not very clear. Here, we decided to investigate the miR-19 effect and molecular mechanism on pancreatic cancer, which was blank until now.

PATIENTS AND METHODS

Quantitative real-time polymerase chain reaction (qRT-PCR) analysis was applied for testing miR-19 and gene of phosphate and tensin homolog deleted on chromosome ten (PTEN) expression. Western blot was used for detecting the protein expression. Methyl thiazolyl tetrazolium (MTT) assay and transwell assay were carried out to measure cell proliferation, invasion, and migration.

RESULTS

We showed that miR-19 expression was increased in cancerous tissues and was associated with the survival of patients, tumor node metastasis (TNM) stage, tumor size, and lymph node metastasis. MiR-19 mimic enhanced cell proliferation, invasion, and migration, while suppressing miR-19 cell progression was suppressed. With the help of TargetScanHuman and luciferase reporter assay, we verified PTEN as a specific target of miR-19. Moreover, PTEN expression was reduced by miR-19 mimic and was increased by miR-19 inhibitor. We next found that PTEN was elevated in cancerous tissues and its expression was negatively correlated with miR-19 expression. Furthermore, miR-19 regulated cell progression via activating phosphatidylinositol 3-hydroxy kinase/protein kinase B (PI3K/AKT) signaling pathway.

CONCLUSIONS

We demonstrated that miR-19 facilitated cell progression through modulating PI3K/AKT signaling pathway by targeting PTEN, which provided a potential therapeutic target for pancreatic cancer patients.

[Assessment of setup errors of IGRT combined with a six degrees of freedom bed for patients with primary rectal cancer]

Objective: To investigate the effect of six degree of freedom (6-DOF) bed combined with cone beam computed tomography (CBCT) in the on-line correction of setup errors in patients with primary rectal cancer. Methods: The clinicopathological data of 17 patients with primary rectal cancer in Department of Radiotherapy, Third Hospital of Peking University from July 2013 to January 2014 were collected. There were 14 males and 3 females, a median age of 65 years. The difference of CBCT and 6-DOF bed combined with CBCT online correction of patients with positioning error were retrospectively analyzed. Results: Before position correction, the first CBCT verification of setup errors in the three translation directions including X (left and right), Y (in and out) and Z (up and down) directions were (0.06±0.25) cm, (0.13±0.40) cm and (-0.28±0.31) cm, respectively. The setup errors of RX (rotation pitch), RY(rolling) and RZ (left and right rotation) directions were (0.62±1.15)°, (-0.19±0.99)°, and (-0.34 ± 0.84)°, respectively . After correction of IGRT combined with six freedom of bed, the setup errors of translation X, Y and Z were (0.01±0.09) cm, (-0.01±0.05) cm and (-0.03±0.08) cm, respectively, and the setup errors of rotation RX, RY and RZ directions were (-0.16±0.40)°, (0.36±0.31)°and (-0.01±0.25)°, respectively. There were significant differences in translation direction (X, Y and Z direction) and rotation direction (Rx, RY and RZ) before and after 6-DOF bed combined with CBCT correction (all P<0.05). In the translation direction, the higher frequency range of Z-direction error value was 0.20-0.79 cm. In the rotation direction, the frequency range of error in Rx direction was 0.20°-2.99°. There was no significant difference between bone mode and gray scale model registration (P>0.05). With the progress of radiotherapy, the setup errors of X, Z, Rx, RY and RZ directions increased except Y direction. Conclusions: In radiotherapy, six freedom bed combined with CBCT is helpful to correct the setup errors of patients with primary rectal cancer. Six freedom bed may be used to correct the setup errors of patients with primary rectal cancer online. Image-guided radiation therapy (IGRT) is recommended for bone pattern registration in patients with rectal cancer.

Studies on antimicrobial peptide-loaded nanomaterial for root caries restorations to inhibit periodontitis related pathogens in periodontitis care

AIMS

To prepare a novel antimicrobial peptide Nal-P-113 loaded poly (ethylene glycol) combined chitosan nanoparticles (Nal-P-113-PEG-CSNPs) for root caries restorations to control the periodontitis related pathogens in periodontitis care.

METHODS

Nanoparticles were prepared by simple polymerisation method and characterised using effective analytical methods (TEM, UV, etc.). The antimicrobial activity and biofilm formation of Nal-P-113-PEG-CSNPs was tested against periodontal bacterial pathogens by different in vitro methods.

RESULTS

The size of Nal-P-113 loaded PEG-Chitosn nanoparticles was 216.2 ± 1.6 nm. The drug encapsulation efficiency (%EE (w/w) of Nal-P-113-PEG-CSNPs was found to be 89.33 ± 1.67% (w/w). The antimicrobial examination showed that prepared NPs have effectively inhibited the growth of Fusobacterium nucleatum, Streptococcus gordonii, and Porphyromonas gingivalis with the MIC of 23 µg/mL, 6 µg/mL and 31 µg/mL, respectively.

CONCLUSIONS

The prepared antimicrobial peptide-loaded PEG-CSNPs provide excellent in vitro efficiency but, further studies are necessary to confirm its therapeutic efficacy on periodontitis care.

Association of Serum Mannose With Acute Respiratory Distress Syndrome Risk and Survival

IMPORTANCE

Acute respiratory distress syndrome (ARDS) confers high mortality risk among critically ill patients. Identification of biomarkers associated with ARDS risk may guide clinical diagnosis and prognosis.

OBJECTIVE

To systematically evaluate the association of blood metabolites with ARDS risk and survival.

DESIGN, SETTING, AND PARTICIPANTS

In this cohort study, data from the Molecular Epidemiology of ARDS (MEARDS) study, a prospective cohort of 403 patients with ARDS and 1227 non-ARDS controls, were analyzed. Patients were recruited in intensive care units (ICUs) at Massachusetts General Hospital and Beth Israel Deaconess Medical Center, both in Boston, Massachusetts, from January 1, 1998, to December 31, 2014. Data analysis was performed from December 9, 2018, to January 4, 2019.

MAIN OUTCOMES AND MEASURES

Participants were followed up daily for ARDS development defined by Berlin criteria, requiring fulfillment of chest radiograph and oxygenation criteria on the same calendar day during invasive ventilatory assistance. A 2-stage study design was used to explore novel metabolites associated with ARDS risk and survival.

RESULTS

Of the 1630 participants from MEARDS who were admitted to the ICU , 403 (24.7%) were diagnosed with ARDS (mean [SD] age, 63.0 [17.0] years; 251 [62.3%] male) and 1227 (75.3%) were at-risk but did not have ARDS (mean [SD] age, 62.3 [16.9] years; 753 [61.4%] male). Mendelian randomization suggested that genetically regulated serum mannose was associated with ARDS risk (odds ratio [OR], 0.64; 95% CI, 0.53-0.78; P = 7.46 × 10-6) in the discovery stage. In the functional validation stage incorporating 83 participants with ARDS and matched at-risk participants in the control group from the ICU, the protective association of mannose with ARDS risk was validated (OR, 0.67; 95% CI, 0.46-0.97; P = .03). Furthermore, serum mannose was associated with 28-day (OR, 0.25; 95% CI, 0.11-0.56; P = 6.95 × 10-4) and 60-day (OR, 0.36; 95% CI, 0.19-0.71; P = 3.12 × 10-3) mortality and 28-day (hazard ratio, 0.49; 95% CI, 0.32-0.74; P = 6.41 × 10-4) and 60-day (hazard ratio, 0.55; 95% CI, 0.37-0.80; P = 2.11 × 10-3) survival.

CONCLUSIONS AND RELEVANCE

In this study, genetically regulated serum mannose appeared to be associated with ARDS risk and outcome, and increased serum mannose at admission was associated with reduced ARDS risk and better survival. These findings could inform prevention and clinical intervention in ARDS cases, which have increased with the expansion of the coronavirus disease 2019 pandemic.

Association between aspirin use and lung cancer incidence depends on high-frequency use, bodyweight, and age in U.S. adults

Background

Chemoprevention of cancer with aspirin is controversial as a primary prevention strategy. We sought to investigate the association between aspirin frequency and risk of lung cancer in The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.

Methods

Using data from 101,722 participants in PLCO, we used a Cox regression model coupling with propensity score to detect the association between aspirin frequency and lung cancer risk.

Results

High-frequency aspirin use significantly increased risk of lung cancer by 28% compared to no use (HR =1.28; 95% CI, 1.14–1.45; P=3.37×10⁻⁵), especially for current smoker (HR =1.30; 95% CI, 1.07–1.57; P=6.82×10⁻³). However, the increased lung cancer risk due to high-frequency aspirin use significantly decreased with increasing bodyweight (HR_interaction =0.96; 95% CI, 0.94–0.99; P=1.26×10⁻²). Further, for participants with bodyweight <80 kg, high-frequency aspirin use showed an elevated risk at <76 years of age (HR_age<76 =1.47; 95% CI, 1.25–1.73; P=3.81×10⁻⁶). Our study used propensity score under various confounding and stratification analyses by cardio-cerebrovascular status, which all presented similar evidences.

Conclusions

High-frequency aspirin use is associated with the increased risk of lung cancer. Current smoker or people with age <76 years and bodyweight <80 kg should be more cautious to high-frequency aspirin use for lung cancer chemoprevention. This study provides a new insight for lung cancer chemoprevention.

Multidisciplinary collaborative integrated management of increasingly prominent HIV complications in the post-cART era

Objectives

With the prolonged survival time of AIDS patients, complications of various systems and organs of HIV infection are increasingly prominent. These diseases have become the major factors influencing the quality of life and prognosis of HIV‐infected persons, and multidisciplinary cooperation treatment is urgently needed.

Methods

The Chinese HIV/AIDS Clinical Trial Network has conducted a series of multicentre clinical cohort studies over the past 16 years, in which studies related to people living with HIV systemic complications. Based on the results of previous studies, this review establishes the complications of Chinese people living with HIV after long‐term cART.

Results

HIV’s direct damage to human cells, chronic abnormal inflammatory activation after HIV infection, long‐term drug side effects caused by cART and persistent reservoirs cause systemic complications in people living with HIV. We summarised the clinical characteristics of the complications of HIV infection in China from the aspects of the liver, cardiovascular, the nervous system, the kidney, bone metabolism, blood glucose, and lipid metabolism.

Conclusions

The management of the complications of HIV infection is a major link in improving the survival treatment and prognosis of patients in the future. The joint participation of doctors from different departments of general hospitals in the management of comorbidities is the main theme for future improvement of quality of life and prognosis for people living with HIV.

Experimental observations and density functional simulations on the structural transition behavior of a two-dimensional transition-metal dichalcogenide

In this work, we show an obvious evidence of nondestructive Raman spectra for the structural transition, i.e., the existence of a charge density wave (CDW) in monolayer 2H-TaS₂, which can exhibit a much higher transition temperature than bulk and results in additional vibrational modes, indicating strong interactions with light. Furthermore, we reveal that the degenerate breath and wiggle modes of 2H-TaS₂ originated from the periodic lattice distortion can be probed using the optical methods. Since recently several light-tunable devices have been proposed based on the CDW phase transition of 1 T-TaS₂, our study and in particular, the theoretical results will be very helpful for understanding and designing electronic devices based on the CDW of 2H-TaS₂.

Mouse nerve growth factor promotes neurological recovery in patients with acute intracerebral hemorrhage: A proof-of-concept study

BACKGROUND

ew drugs were confirmed to be effective in the treatments of neurological dysfunction caused by acute intracerebral hemorrhage (ICH). The present prospective clinical trial aims to evaluate the effect of mouse nerve growth factor (mNGF) on neurological function in patients with acute ICH.

METHODS

60 patients with acute spontaneous ICH were randomized to receive mNGF (mNGF group) and citicoline (control group) for 4 weeks within 24-72 h after onset, respectively. The primary outcome was difference in the neurological functional outcome at 3 months by the modified Rankin Scale score (mRS). The secondary outcomes were the changes in hematoma volume at 4 weeks and 3 months.

RESULTS

There were 55 patients receiving treatment (29 patients in the mNGF group, 26 patients in the control group). Among the patients, 46 patients finished the trial at 3 months; the odds of a shift towards death or dependence (mRS > 3) at 3 months in the mNGF group were lower than that in the control group with adjustment for age, sex, NIHSS at admission, and hematoma volume at admission (adjusted OR, 0.185; 95%CI, 0.059-0.582; P = 0.0039). The hematoma was gradually reduced in all 46 patients and absorbed after non-surgical treatment at 3 months. There was no significant difference in hematoma volume between the two groups. No serious adverse event was found.

CONCLUSIONS

The administration of mNGF and citicoline was well-tolerated in patients with acute ICH. mNGF was associated with improved neurological function and less disability in patients with ICH. Therefore, the quality of life of patients with ICH may be improved by mNGF.

TRIAL REGISTRATION

The trial is registered with the Chinese Clinical Trial Registry, number ChiCTR1800020258.

Plasma Insulin-like Growth Factor Binding Protein 7 Contributes Causally to ARDS 28-Day Mortality: Evidence From Multistage Mendelian Randomization

BACKGROUND

ARDS is a devastating syndrome with heterogeneous subtypes, but few causal biomarkers have been identified.

RESEARCH QUESTION

Would multistage Mendelian randomization identify new causal protein biomarkers for ARDS 28-day mortality?

STUDY DESIGN AND METHODS

Three hundred moderate to severe ARDS patients were selected randomly from the Molecular Epidemiology of ARDS cohort for proteomics analysis. Orthogonal projections to latent structures discriminant analysis was applied to detect the association between proteins and ARDS 28-day mortality. Candidate proteins were analyzed using generalized summary data-based Mendelian randomization (GSMR). Protein quantitative trait summary statistics were retrieved from the Efficiency and safety of varying the frequency of whole blood donation (INTERVAL) study (n = 2,504), and a genome-wide association study for ARDS was conducted from the Identification of SNPs Predisposing to Altered Acute Lung Injury Risk (iSPAAR) consortium study (n = 534). Causal mediation analysis detected the role of platelet count in mediating the effect of protein on ARDS prognosis.

RESULTS

Plasma insulin-like growth factor binding protein 7 (IGFBP7) moderately increased ARDS 28-day mortality (OR, 1.11; 95% CI, 1.04-1.19; P = .002) per log2 increase. GSMR analysis coupled with four other Mendelian randomization methods revealed IGFBP7 as a causal biomarker for ARDS 28-day mortality (OR, 2.61; 95% CI, 1.33-5.13; P = .005). Causal mediation analysis indicated that the association between IGFBP7 and ARDS 28-day mortality is mediated by platelet count (OR, 1.03; 95% CI, 1.02-1.04; P = .01).

INTERPRETATION

We identified plasma IGFBP7 as a novel causal protein involved in the pathogenesis of ARDS 28-day mortality and platelet function in ARDS, a topic for further experimental and clinical investigation.

[Effects on learning and memory and mitochondrial energy metabolism in hippocampus of mice by subacute exposure to n-hexane]

Objective: To study the effects on learning and memory, mitochondrial energy metabolism and ATPase activity of hippocampus in mice with subacute exposure to n-hexane. Methods: The SPF 40 Kunming mice were randomly divided into low, middle and high dose groups and control groups according to different dosages. Each group consisted of 10 mice. The mice were given n-hexane by gavage, the mice in the low, middle and high dose groups were given 0.2 ml/d of n-hexane at concentrations of 500, 1000 and 2000 mg/kg respectively, while the mice in the control group were given 0.2 ml/d of cooking oil once a day for 28 days. The y-type maze test, the activity of ATP Enzyme, mitochondrial respiratory chain enzyme complex Ⅰ-IV, the mrna of mitochondrial fusion gene (MFn1, Mfn2) and fission gene (FIs1) in brain tissues were performed. Results: Except for the wrong reaction times of low-dose exposure group in the first test, there existed significantly different in the first and second Y-maze tests in exposure groups and control group (P<0.05) ; in low, middle and high-dose group, the Na(+)-K(+)-ATPase activities were (8.27±2.65) , (5.38±1.55) , (3.55±1.69) μmol/gprot/h, and Ca(2+)-Mg(2+)-ATPase activities were (10.32±2.96) , (7.19±1.94) and (4.49±1.33) μmol/gprot/h, respectively. Compared with those in control group, the activities of Na(+)-K(+)-ATPase and Ca(2+)-Mg(2+)-ATPase decreased significantly in middle-dose group and high-dose group (P<0.05) . Compared with those in control group, the activities of mitochondrial respiratory chain enzyme complex I-IV in each dose group were significantly decreased (P<0.05) . The expressions of Mfn1mRNA and Mfn2mRNA in each dose group was significantly lower than those in control group (P<0.05) . Conclusion: Subacute exposure to n-hexane can result in the decrease of activities of mitochondrial respiratory chain enzyme complex in hippocampus of mice, which may lead to the disorder of mitochondrial energy metabolism by the decrease of ATPase activity and the imbalance of mitochondrial fusion-division, which must be one of the mechanisms of impairment of learning and memory of mice induced by n-hexane.

No pulsed radio emission during a bursting phase of a Galactic magnetar

Fast radio bursts (FRBs) are millisecond-duration radio transients of unknown physical origin observed at extragalactic distances^1-3. It has long been speculated that magnetars are the engine powering repeating bursts from FRB sources^4-13, but no convincing evidence has been collected so far¹⁴. Recently, the Galactic magnetar SRG 1935+2154 entered an active phase by emitting intense soft γ-ray bursts¹⁵. One FRB-like event with two peaks (FRB 200428) and a luminosity slightly lower than the faintest extragalactic FRBs was detected from the source, in association with a soft γ-ray/hard-X-ray flare^18-21. Here we report an eight-hour targeted radio observational campaign comprising four sessions and assisted by multi-wavelength (optical and hard-X-ray) data. During the third session, 29 soft-γ-ray repeater (SGR) bursts were detected in γ-ray energies. Throughout the observing period, we detected no single dispersed pulsed emission coincident with the arrivals of SGR bursts, but unfortunately we were not observing when the FRB was detected. The non-detection places a fluence upper limit that is eight orders of magnitude lower than the fluence of FRB 200428. Our results suggest that FRB-SGR burst associations are rare. FRBs may be highly relativistic and geometrically beamed, or FRB-like events associated with SGR bursts may have narrow spectra and characteristic frequencies outside the observed band. It is also possible that the physical conditions required to achieve coherent radiation in SGR bursts are difficult to satisfy, and that only under extreme conditions could an FRB be associated with an SGR burst.

[Airway parameters and reference value range of high-resolution CT reconstruction in general population]

Objective: To investigate the measurement of small airways by high-resolution CT and image post-processing software. Screen and analyze the reconstructed airway parameters in order to find the best imaging biomarker parameters of small airway changes and calculate the reference value range; meanwhile, explore its influencing factors. Methods: From a water plant and a medical school, 169 cases of the general population aged 20 to 60 were selected as research objects, and questionnaire surveys and CT tests were performed, and CT data were reconstructed with image post-processing software. The reference value range of the general population was evaluated, and a linear mixed effect model was used to adjust the age, gender, height, BMI, and smoking status, and analyze the influencing factors of airway parameters. Results: The ratio of sixth-grade tracheal wall area to total tracheal area in the Left B1+2 to carina was (53.01±13.35) %, Left B9 to carina was (50.44±12.98) %, Right B1 to carina was (52.73±12.22) %, and Right B9 to carina was (52.93±11.85) %. The ratio of nineth-grade tracheal wall area to total tracheal area in the Left B1+2 to carina was (44.08±14.66) %, Left B9 to carina was (42.44±15.89) %, Right B1 to carina was (46.51±14.03) %, and Right B9 to carina is (43.54±15.87) %. BMI affect the area of the tracheal wall, all p value<0.05. Conclusion: High-resolution CT small airway morphology can make a preliminary assessment of the susceptible population of small airway-related diseases based on a range of reference values, and prevent and control it in combination with influencing factors.

Effects of lncRNA HOTAIR on proliferation and apoptosis of myeloma cells through NF-κB pathway

OBJECTIVE

The aim of this study was to explore the influences of long non-coding ribonucleic acid (lncRNA) homeobox transcript antisense intergenic RNA (HOTAIR) on the proliferation and apoptosis of myeloma cells and its molecular mechanism.

MATERIALS AND METHODS

The myeloma cells were randomly divided into three groups, including: group A (myeloma cell group), group B [HOTAIR-small-interfering RNA (siRNA) group], and group C (HOTAIR negative control group). The Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was performed to detect the expression of lncRNA HOTAIR in myeloma cells. The flow cytometry was adopted to determine the apoptosis of myeloma cells. Meanwhile, the protein expression of nuclear factor-kappa-light-chain-enhancer of activated B cells (NF-κB) was detected via Western blotting. In addition, the activity of the myeloma cells was measured using methyl thiazolyl tetrazolium (MTT) assay.

RESULTS

The expression of HOTAIR in group A, group B, and group C was (2.19 ± 0.33), (1.37 ± 0.25), and (2.51 ± 0.27), respectively. Compared with group A and group C, the expression of HOTAIR was significantly downregulated in group B, in which the cells interfered with siRNAs. The expression of HOTAIR was significantly higher in group C than group A and group B (p<0.05). HOTAIR expression reached the highest level in group C, followed by group A and group B, respectively. The results of MTT indicated that the activity of the myeloma cells significantly increased at 24 h, 48 h, and 72 h in group C when compared with group A and group B. However, the activity of the myeloma cells was relatively low in group B, showing a slow rising trend. The activity of myeloma cells in group A remarkably increased when compared with group B, but it was lower than group C. Furthermore, the activity of the myeloma cells was higher in group C than group B (p<0.05). Western blotting indicated that the protein expression of NF-κB in group A, group B, and group C was (0.79 ± 0.22), (0.51 ± 0.17), and (0.95 ± 0.31), respectively. Compared with group A and group C, the protein expression of NF-κB was significantly downregulated in group B (the cells interfered with siRNAs) (p<0.05). Meanwhile, the protein expression of NF-κB was markedly higher in group C than in group A and group B (p<0.05). The protein expression of NF-κB was the highest in the cells of group C. Flow cytometry demonstrated that the apoptosis rate in group A, group B, and group C was (9.57 ± 1.71), (20.33 ± 1.63), and (8.74 ± 1.23), respectively. Compared with group A and group C, the apoptosis was significantly elevated in group B, in which the cells interfered with siRNAs (p<0.05). Compared with group A, the number of apoptotic myeloma cells significantly decreased in group C (p<0.05).

CONCLUSIONS

LncRNA HOTAIR activates the expression of NF-κB in myeloma cells and promotes the proliferation of myeloma cells.

[One case of extremely severe burn combined with stillbirth and multiple organ dysfunction syndrome in the third trimester of pregnancy]

One 24 years old female patient who suffered extremely severe burn in the third trimester of pregnancy was admitted to the Department of Burns and Skin Repair Surgery of the Third Affiliated Hospital of Wenzhou Medical University on 9th May, 2015. Intrauterine distress occurred after injury and stillbirth was confirmed within 12 hours. In cooperation with the obstetrician, the labor was induced on post injury day (PID) 5. Septic shock and multiple organ dysfunction syndrome occurred on PID 8. Through treatments including anti-infection, ventilator-assisted ventilation, cardiotonic diuresis, and escharectomy and skin grafting, the patient was finally cured. This case indicates that it is crucial to grasp the right time and choose a reasonable induction of labor to deal with stillbirth. The scheme of transvaginal induction of labor after shock is a worthy question to explore. The main characteristics of this patient include the extreme paroxysmal changes in breath, circulation, and urine volume within 24 hours after induced labor, which should be monitored dynamically for effective and timely adjustment of respiratory circulation support. This may be another key point for the rescue of this type of patient. To seize the opportunities to perform escharectomy, cover the wound with xenogenic skin graft, and perform skin grafting in time for wound repair remain the top priority.

Epigenetic-smoking interaction reveals histologically heterogeneous effects of TRIM27 DNA methylation on overall survival among early-stage NSCLC patients

Tripartite motif containing 27 (TRIM27) is highly expressed in lung cancer, including non-small-cell lung cancer (NSCLC). Here, we profiled DNA methylation of lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) tumours from 613 early-stage NSCLC patients and evaluated associations between CpG methylation of TRIM27 and overall survival. Significant CpG probes were confirmed in 617 samples from The Cancer Genome Atlas. The methylation of the CpG probe cg05293407_TRIM27 was significantly associated with overall survival in patients with LUSC (HR = 1.65, 95% CI: 1.30-2.09, P = 4.52 × 10^-5), but not in patients with LUAD (HR = 1.08, 95% CI: 0.87-1.33, P = 0.493). As incidence of LUSC is associated with higher smoking intensity compared to LUAD, we investigated whether smoking intensity impacted on the prognostic effect of cg05293407_TRIM27 methylation in NSCLC. LUSC patients had a higher average pack-year of smoking (37.49_LUAD vs 54.79_LUSC, P = 1.03 × 10^-19) and included a higher proportion of current smokers than LUAD patients (28.24%_LUAD vs 34.09%_LUSC, P = 0.037). cg05293407_TRIM27 was significantly associated with overall survival only in NSCLC patients with medium-high pack-year of smoking (HR = 1.58, 95% CI: 1.26-1.96, P = 5.25 × 10^-5). We conclude that cg05293407_TRIM27 methylation is a potential predictor of LUSC prognosis, and smoking intensity may impact on its prognostic value across the various types of NSCLC.

[Investigation on two family clusters of COVID-19 in a county of Baotou city in Inner Mongolia Autonomous Region]

Objective: To investigate the epidemiological characteristics and transmission chain of COVID-19 in two families, and to provide scientific evidence for effective prevention and control measures. Methods: Field epidemiological investigation was conducted for the COVID-19 cases occurred in two families and the close contacts in a county of Baotou city in Inner Mongolia Autonomous Region. Descriptive statistical analysis on epidemiological data was conducted. Results: The infection source of the COVID-19 cases in the two families was a man who had living history in Wuhan. After his return, his parents were infected by him. A few days later, the members of a neighbor family were found to be infected, and relatives of this family were also infected after dining together repeatedly. Finally, ten confirmed cases and three suspected cases of COVID-19 were detected in the two families. Conclusions: Human-to-human transmission of COVID-19 can occur not only in a family but also in neighborhoods. The cases in two families had close relationship, indicating the necessity to strengthen the health education about COVID-19 prevention and control and the management of groups at high risk to reduce the incidence of COVID-19 in families and neighborhoods.

Novel genetic variants of SYK and ITGA1 related lymphangiogenesis signaling pathway predict non-small cell lung cancer survival

Although lymphangiogenesis is a vital step in lung cancer metastasis, the association between lymphangiogenesis and non-small cell lung cancer (NSCLC) survival remains unclear. Since single-nucleotide polymorphisms (SNPs) have been reported to predict NSCLC survival, we investigated associations between SNPs in lymphangiogenesis-related pathway genes and NSCLC survival in a discovery genotyping dataset of 1,185 patients from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and validated the findings in another genotyping dataset of 984 patients from the Harvard Lung Cancer Susceptibility Study. We evaluated associations between 34,509 genetic variants (3252 genotyped and 31,257 imputed) in 247 genes involved in lymphangiogenesis-related pathway and NSCLC survival. After validation, we finally identified two independent SNPs (SYK rs11787670 A>G and ITGA1 rs67715745 T>C) to be significantly associated with NSCLC overall survival (OS), with adjusted hazards ratios of 0.77 and 0.83 (95% confidence interval =0.66-0.90, P=7.20×10^-4) and 0.84 (95% confidence interval =0.75-0.92, P=3.50×10^-4), respectively. Moreover, an increasing number of combined protective alleles of these two SNPs was significantly associated with an improved NSCLC OS and disease-specific survival (DSS) in the PLCO dataset (P _trend=0.011 and 0.006, respectively). Furthermore, the addition of these protective alleles to the prediction model for the 5-year survival increased the time-dependent area under the curve both from 87% to 87.67% for OS (P=0.029) and from 88.54% to 89.06% for DSS (P=0.022). Subsequent expression quantitative trait loci (eQTL) functional analysis revealed that the rs11787670 G allele was significantly associated with an elevated SYK mRNA expression in normal tissues. Additional analyses suggested a suppressor role for both SYK and ITGA1 in NSCLC survival. Collectively, these findings indicated that SYK rs11787670 A>G and ITGA1 rs67715745 T>C may be independent prognostic factors for NSCLC survival once further validated.

Co-expression network analysis identified atypical chemokine receptor 1 (ACKR1) association with lymph node metastasis and prognosis in cervical cancer

Cervical cancer (CC) is one kind of female cancer. With the development of bioinformatics, targeted specific biomarkers therapy has become much more valuable. GSE26511 was obtained from gene expression omnibus (GEO). We utilized a package called "WGCNA" to build co-expression network and choose the hub module. Search Tool for the Retrieval of Interacting Genes Database (STRING) was used to analyze protein-protein interaction (PPI) information of those genes in the hub module. A Plug-in called MCODE was utilized to choose hub clusters of PPI network, which was visualized in Cytoscape. Clusterprofiler was used to do functional analysis. Univariate and multivariate cox proportional hazards regression analysis were both conducted to predict the risk score of CC patients. Kaplan-Meier curve analysis was done to show the overall survival. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the predictive value of the patient outcome. Validation of the hub gene in databases, Gene set enrichment analysis (GSEA) and GEPIA were completed. We built co-expression network based on GSE26511 and one CC-related module was identified. Functional analysis of this module showed that extracellular space and Signaling pathways regulating pluripotency of stem cells were most related pathways. PPI network screened GNG11 as the most valuable protein. Cox analysis showed that ACKR1 was negatively correlated with CC progression, which was validated in Gene Expression Profiling Interactive Analysis (GEPIA) and datasets. Survival analysis was performed and showed the consistent result. GSEA set enrichment analysis was also completed. This study showed hub functional terms and gene participated in CC and then speculated that ACKR1 might be tumor suppressor for CC.

[Preventive medicine curriculum system in training program of clinical medicine in the era of Healthy China]

Objective: To understand the provision of preventive medicine curriculum system in the training programs of clinical medicine in the era of Healthy China. Methods: A total of 36 training programs of clinical medicine were selected from different areas of China for a statistical analysis on their basic information, involvement of concept of preventive medicine in program objectives, and provision of preventive medicine curriculum system. Results: Of all the 36 training programs of clinical medicine, 22(61%) have no mentions of prevention medicine in their program objectives; only one university's training program states preventive medicine together with basic medicine and clinical medicine as one of the three main disciplines. The total class hours for the core courses of preventive medicine (hygiene, medical statistics, epidemiology, evidence-based medicine, and social medicine) range from 80 to 252, with an average of (156.7±43.2) hours. The average percentage of class hours for preventive medicine courses among the total class hours is 4.3%±1.1% (range: 2.5%-7.5%), and obvious differences exist among universities. Conclusions: In current training programs of clinical medicine, the proportion of prevention medicine curriculum is insufficient, the percentage of hours for preventive medicine course is very low, and the differences among various universities are obvious. It is urgently needed to strengthen preventive medicine curriculum in training programs for clinical medical students in new era. It is suggested to further promote the concept of putting prevention first, improve the curriculum system of clinical medicine, intensify the integrated development preventive medicine and clinical medicine and pay attention to clinical research ability enhancement for the further improvement of training program of clinical medicine.

Solid Lipid Nanoparticles Enhanced the Neuroprotective Role of Curcumin against Epilepsy through Activation of Bcl-2 Family and P38 MAPK Pathways

Oxidative stress of neurons caused by a series of complex neuropathological processes will induce certain neurodegenerative disorders including epilepsy. Curcumin (Cur) is an effective natural antioxidant compound; however, the poor bioavailability obstructs its neural protective applications. In this study, Cur is encapsulated in solid lipid nanoparticles (SLNs) for better neuroprotective efficacy. In vitro study certified that Cur-SLNs functioned obviously better against neuronal apoptosis than Cur, by significantly decreasing the level of free radical and reversing mitochondrial function through the activation of the Bcl-2 family. In vivo experiments showed that SLNs transported Cur through the blood-brain barrier (BBB). The behavioral performance of epileptic mice was improved by Cur-SLNs, with more NeuN but less TUNEL positive cells observed in hippocampus. The in vivo mechanism was also explored. Cur-SLNs reduced neuronal apoptosis through Bcl2 family and P38 MAPK pathways. Overall, Cur-SLNs have better protective effects toward oxidative stress in neurons than free Cur both in vitro and in vivo, which suggests they may be a promising agent against neurodegenerative disorders including epilepsy.

Assessing the impact of drinking water iodine concentrations on the iodine intake of Chinese pregnant women living in areas with restricted iodized salt supply

PURPOSE

The supply of non-iodized salt and the water improvement project have been conducted to reduce the iodine concentration in drinking water in areas with elevated water iodine. We aimed to assess the impact of water iodine concentration (WIC) on the iodine intake of pregnant women in areas with restricted iodized salt supply, and determine the cutoff values of WIC in areas with non-iodized salt supply.

METHODS

Overall, 534 pregnant women who attended routine antenatal outpatient visits in Zibo Maternal and Child Health Hospital in Gaoqing County were recruited. The 24-h urine iodine excretion (UIE) in 534 samples and the iodine concentration in 534 drinking water samples were estimated. Urinary iodine excretion, daily iodine intake, and daily iodine intake from drinking water (WII) were calculated. The relationship between WIC and daily iodine take was analyzed.

RESULTS

The median WIC, spot urine iodine concentration (UIC), and 24-h UIE were 17 (6, 226) μg/L, 145 (88, 267) μg/L, and 190 (110, 390) μg/day, respectively. A significant positive correlation was found between WIC and UIE (R² = 0.265, p < 0.001) and UIC (R² = 0.261, p < 0.001). The contribution rate of WII to total iodine intake increased from 3.0% in the group with WIC of < 10 μg/L to 45.7% in the group with WIC of 50-99 μg/L.

CONCLUSION

The iodine content in drinking water is the major iodine source in pregnant women living in high-water iodine areas where iodized salt supply is restricted. The contribution rate of daily iodine intake from drinking water increases with the increase in water iodine concentration.

Attitude and knowledge for menopause management among health professionals in mainland China

OBJECTIVE

This study aims to understand the attitude of health-care professionals (HPs) in mainland China toward menopause management (MM) as well as the knowledge they have received regarding MM during training.

METHODS

An anonymous survey recruited 3709 medical workers nationwide (including physicians, orthopedists, obstetricians and gynecologists, and general practitioners) through online surveys and on-site interviews at professional meetings.

RESULTS

Of the 3709 questionnaires completed, 3426 questionnaires met the inclusion criteria. Of the participants, 1532 HPs had not received menopause management training (MMT) in nearly 1 year. Among the residents and physician assistants, 103 reported they were not familiar with MM. Satisfyingly, 98.3% of HPs considered it very important or essential to accept MM. Although most interviewees replied some correct menopausal knowledge, nearly half of them could not correctly identify the contraindications for menopause hormone therapy (MHT). Additionally, 73.1% of HPs would advise patients with premature ovarian insufficiency to receive hormone replacement therapy at least until the average age of menopause.

CONCLUSION

This survey indicated that HPs have some knowledge regarding MM, but a gap remains to master the basic theory of MHT. In order to manage the growing menopausal population in China, creating more in-depth educational MMT programs for HPs is necessary.

Effects of repetitive transcranial magnetic stimulation with different frequencies on post-stroke aphasia: A PRISMA-compliant meta-analysis

BACKGROUNDS

Previous studies indicated inconsistent results for the treatment effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasics. The study conducted a meta-analysis to evaluate whether the rTMS with different frequencies demonstrated any effect in patients with post-stroke aphasia.

METHODS

Electronic databases (PubMed, Web of Science, Medline, EMBASE, and Google Scholar) were searched for articles published before July 2019. Statistical analyses were made using STATA 12.0 software. Standard mean difference (SMD) with 95% confidence intervals (CI) were calculated for the treatment effect of rTMS on post-stroke aphasia.

RESULTS

Meta-analysis indicated significant treatment effects on naming of rTMS in post-stroke aphasics (SMD 0.76, 95%CI 0.16 to 1.36, I = 76.9%, P < .001). Subgroup analyses showed significant treatment effects on naming of low frequency (LF)-rTMS (SMD 0.40, 95%CI 0.10 to 0.69, I = 0.0%, P = .671). However, the changes in repetition and comprehension following stimulation were not significant.

CONCLUSIONS

In conclusion, we provide preliminary evidence that both LF-rTMS and high-frequency-rTMS might be relatively effective and safe treatment for post-stroke aphasics. However, LF-rTMS mainly plays a short-term role in subacute post-stroke aphasics. Longer-term and large-scale studies are essential to explore the effect of rTMS with different frequencies on post-stroke aphasia.

Epigenome-wide gene-age interaction analysis reveals reversed effects of PRODH DNA methylation on survival between young and elderly early-stage NSCLC patients

DNA methylation changes during aging, but it remains unclear whether the effect of DNA methylation on lung cancer survival varies with age. Such an effect could decrease prediction accuracy and treatment efficacy. We performed a methylation–age interaction analysis using 1,230 early-stage lung adenocarcinoma patients from five cohorts. A Cox proportional hazards model was used to investigate lung adenocarcinoma and squamous cell carcinoma patients for methylation–age interactions, which were further confirmed in a validation phase. We identified one adenocarcinoma-specific CpG probe, cg14326354_PRODH, with effects significantly modified by age (HR_interaction = 0.989; 95% CI: 0.986–0.994; P = 9.18×10–7). The effect of low methylation was reversed for young and elderly patients categorized by the boundary of 95% CI standard (HR_young = 2.44; 95% CI: 1.26–4.72; P = 8.34×10-3; HR_elderly = 0.58; 95% CI: 0.42–0.82; P = 1.67×10-3). Moreover, there was an antagonistic interaction between low cg14326354_PRODH methylation and elderly age (HR_interaction = 0.21; 95% CI: 0.11–0.40; P = 2.20×10−6). In summary, low methylation of cg14326354PRODH might benefit survival of elderly lung adenocarcinoma patients, providing new insight to age-specific prediction and potential drug targeting.

Effect of IF-WS2 Nanolubricant on R134a Boiling on a Reentrant Cavity Surface

This report quantifies the influence of inorganic fullerene-like tungsten disulfide (IF-WS₂) nanoparticles on the pool-boiling performance of R134a/polyolester mixtures on a commercial (Turbo-ESP) boiling surface. Tungsten disulfide nanoparticles, of roughly 150 nm, were used at a 15% mass fraction in a base polyolester lubricant to produce the test nanolubricant. The nanolubricant was mixed with R134a at a 1% mass fraction. The study showed that the nanolubricant caused an average 37% degradation in the boiling heat flux as compared to R134a/neat-lubricant boiling on a reentrant cavity surface at the same superheat. Similarly, boiling with R134a/neat-lubricant caused, on average, a 27% degradation in the boiling heat flux as compared to pure R134a boiling and the same superheat. An analysis was presented which showed that the nanoparticles were too large and too dense to promote a boiling enhancement. In addition, the fullerene-like structure and the large size encouraged nanoparticle settling, which presumably filled cavities of the boiling surface leading to additional boiling degradations.

0026 Strong Gene-Environment Interactions of Trank1 Gene Polymorphisms with Birth Difficulties in Kleine Levin Syndrome

Introduction

Kleine-Levin Syndrome (KLS) is a rare disorder affecting adolescents and characterized by relapsing-remitting episodes of severe hypersomnia, cognitive impairment, and behavioral disturbances such as hyperphagia and sexual disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas and in cortical areas during episodes. Familial occurrence is increased, and risk is associated with reports of complicated birth.

Methods

A worldwide Genome wide association (GWA) study was conducted in 673 KLS patients and ethnically matched 15,341 control individuals.

Results

We found a strong genome-wide significant association (OR=1.48 at rs150168018, p=8.6x10-9) with 24 single nucleotide polymorphisms (SNPs) encompassing a 35kb region located in the 5’ region of TRANK1 gene previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with TRANK1 had statistically increased reports of difficult birth. As perinatal outcomes have dramatically improved over the last 40 years, we further stratified our sample by birth years, and found that recent cases had a significantly reduced TRANK1 association. These findings were confirmed in an independent replication cohort of 171 new patients where polygenic risk scores constructed on the discovery cohort replicated (r2=0.15; p&lt;2.7x10-22 at p=0.1 threshold) and the TRANK1 association was found to be dependent on reports of birth difficulties (OR=1.54, p=0.01 versus OR=1.12, p=0.4). Pathway analysis of the overall GWAS association revealed significant association (p=0.02) with 19 genes in a pathway modulating rhythmic behaviors.

Conclusion

Our results demonstrate links between hypersomnia, behavioral rhythmicity and bipolar disorder and indicate that a polymorphism in the TRANK1 region affect brain development in the presence of a perinatal injury, with pathophysiological consequences such as KLS, bipolar disorder and schizophrenia.

Support

NIH NIMH 1R01MH080957 to EM PHRC 070138 to IA