[An analysis on incidence of HIV-1 epidemics among men who have sex with men in Sichuan Province during 2011-2015]

The assay was used in HIV/AIDS surveillance sentinel sites to identify recent HIV-1 infection, to estimate HIV-1 incidence and understand the epidemic trends among men who have sex with men during 2011-2015. During 2011-2015, the HIV-1 incidence of men who have sex with men was 5.16%(95%CI: 4.65%-5.66%) in Sichuan Province. According to<Pilot study on classification criteria of AIDS epidemic in China>, a total of 9 cities had been divided into two type of regions: the first type(the proportion of live HIV/AIDS accounts for more than 0.1% of the permanent population, and the number of live HIV/AIDS has reached 500 cases and above) and the second type(the proportion of live HIV/AIDS accounts for 0.03% to 0.100% of the permanent population, and the number of live HIV/AIDS has reached 100-500 cases). During 2011-2015, the HIV-1 incidence of the second type was 4.24% (95%CI: 3.72%-4.76%). The HIV-1 incidence of men who have sex with men was at a high level. The spread of HIV-1 to the second region was possible.

[Survival analysis of people living with HIV/AIDS in Sichuan province, 1991-2017]

Objective: To analyze the survival time of people living with HIV/AIDS and related influencing factors in Sichuan province during 1991-2017. Methods: A retrospective cohort study was conducted to analyze the data of 143 988 HIV/AIDS cases. The data were collected from Chinese HIV/AIDS Comprehensive Information Management System. Life table method was used to calculate the survival proportion of the cases, and Cox proportion hazard regression model was used to identify the factors related with survival time. Results: Among 143 988 HIV/AIDS cases a total of 30 420 cases died of AIDS related diseases (21.1%) and the average survival time was 11.51 years (95%CI: 11.39-11.64). Multivariate Cox regression analysis showed that the influencing factors for the survival of HIV/AIDS cases were gender (male vs. female, HR=1.35, 95%CI: 1.32-1.40), education level (primary school or below vs. junior middle school: HR=1.15, 95%CI: 1.12-1.18), ethnic group (Han vs. other ethnic groups, HR=1.46, 95%CI: 1.41-1.52), occupation (farmer vs. other occupations: HR=1.26, 95%CI: 1.22-1.29), age (≥55 years old vs. 15-24 years old: HR=3.18, 95%CI: 3.02- 3.36), disease phase (AIDS vs. HIV infection: HR=1.44, 95%CI: 1.39-1.48), antiretroviral therapy (ART) (receiving ART vs. receiving no ART: HR=0.20, 95%CI: 0.19-0.20), and CD(4)(+)T cell counts at diagnosis (>500 cells/μl vs.<200 cells/μl: HR=0.42, 95%CI: 0.40-0.45). Conclusions: The average survival time of HIV/AIDS cases was 11.51 years in Sichuan during 1991- 2017. The risk factors for the survival of the cases were male, education level of primary school or below, Han ethnic group, farmer, old age at diagnosis, disease phase, The protective factors for the survival of HIV/AIDS cases were receiving ART and higher CD(4)(+) T cell counts at diagnosis.

[Association between the accumulation of metabolic syndrome abnormal components and arterial pulse wave velocity among adult individuals undergoing routine health examination]

Objective: To explore the association between the accumulation of metabolic syndrome (MS) components and abnormal brachial ankle pulse wave velocity (baPWV), and to investigate the effect of accumulation of abnormal metabolic components on abnormal baPWV among adult individuals undergoing routine health examination. Methods: It's a cross-sectional study. Data from 9 201 stratified sampled subjects, aged between 25 to 75 years old, who took part in the annual health checkups in 11 cities of Zhejiang Province from January to December 2016, were analyzed. Blood pressure(BP), fasting plasma glucose(FPG), waist circumference(WC), triglyceride(TG), high-density lipoprotein cholesterols(HDL-C) were defined as MS components. The baPWV was measured by VP-1000 (BP-203RPE Ⅲ) and ΔbaPWV (measured baPWV-reference baPWV/reference baPWV) ×100 (%)> 10% was defined as abnormal. The relationship between MS components and ΔbaPWV was analyzed by linear regression, and impact of accumulation of MS components on ΔbaPWV was analyzed by logistic regression, and the ΔbaPWV in subjects with different levels of MS components were analyzed by analysis of variance. Results: (1) The linear regression analysis demonstrated a positive correlation between ΔbaPWV and MS components including systolic blood pressure, diastolic blood pressure, WC, FPG, TG, while ΔbaPWV was negatively correlated with HDL-C. The β values were 0.518, 0.616, 0.208, 2.778, 1.862, -1.339, respectively (all P<0.001), indicating a strong association between ΔbaPWV and systolic blood pressure, diastolic blood pressure, and FPG. (2) The logistic regression analysis showed that the proportion of abnormal ΔbaPWV was 2.595 times higher in MS individuals than in non-MS individuals (P<0.001). Abnormal ΔbaPWV increased in proportion with increase in numbers of the metabolic components (OR=1.913, 2.884, 3.833, 6.161, 11.176 in individuals with 1,2,3,4,5 metabolic components, respectively, all P<0.001). (3) The logistic analysis suggested that each component of MS could affect baPWV,and OR was 4.68, 2.45 for systolic blood pressure and/or diastolic blood pressure and FPG. All combinations of 2 components of MS also significantly affected baPWV,and OR value was the highest (5.104(95%CI 4.281-6.085), P<0.001) for FPG+BP. All combinations of 3 components of MS significantly affected baPWV,and OR value was the highest(5.385(95%CI 4.245-6.831), P<0.001) for BP+FPG+TG. All combinations of 4 components of MS affected baPWV,and OR value was the highest (6.519(95%CI 4.731-8.984), P<0.001) for BP+FPG+WC+TG. (4) Finally, every component of MS was divided into 3 levels, their impact on abnormal ΔbaPWV was analyzed. Prevalence of abnormal ΔbaPWV significantly increased with the increasing levels of the metabolic components expect for HDL-C, the F values were 1 224.66, 832.89, 192.72, 112.79 and 56.22, respectively (all P<0.001), indicating that higher levels of metabolic components significantly affected the ΔbaPWV. Conclusions: MS and accumulation of abnormal MS components are closely related with abnormal ΔbaPWV, and the combination of BP and FPG have the greatest impact on the abnormal ΔbaPWV. Analysis on the accumulation of MS components might serve as an early indicator of arteriosclerosis.

Nanotechnology-based antimicrobials and delivery systems for biofilm-infection control

Bacterial-infections are mostly due to bacteria in their biofilm-mode of growth. Nanotechnology-based antimicrobials possess excellent potential in biofilm-infection control, overcoming the biological barriers of biofilms.

[Application of a multi-material artifact reduction algorithm in a wide-detector CT in the evaluation of the portal venous angiography of postoperative TIPS and embolization]

Objective: To assess the effect of monochromatic images and metal artifact reduction (MAR) on the image quality of spectral CT portal venous angiography in patients with operation of after the performing transjugular intrahepatic portosystemic stent shunt(TIPS) and embolization. Methods: From December 2017 to April 2018, the examination data of 28 patients with portal hypertension due to cirrhosis who underwent portal vein angiography 1 month after TIPS and embolization were prospectively collected. After spectral CT scanning in revolution CT, the monochromatic energy levels(60 keV, 120 keV), 60 keV + 120 keV, 120kV-like + 120 keV fused images combined with MAR algorithm were reconstructed. Quantitative parameters such as image artifact index (AI) and qualitative visual evaluation scores were recorded and compared. Results: The 120 keV monochromatic images showed the lowest AI value(30.8±8.5, 18.2±4.3) and highest metal artifacts reduction effect. The 60 keV monochromatic images showed the highest AI value (57.3±15.7, 32.1±7.9) and the lowest metal artifacts reduction effect. The AI value of 60 keV + 120 keV fused images was lower than that of 60 keV images(26.2%, 24.7%). The difference of AI value between each group was statistically significant(all P<0.05). The interobserver agreement in the subjective image scores was moderate with kappa value of 0.824. The overall image quality score of 60 keV + 120 keV fused image and the noise score of 120 kV-like+120 keV were higher than the remaining groups. The differences of the subjective scores among each group were statistically significant(all P<0.05). Conclusion: The spectral CT with MAR algorithm can effectively improve the image quality of portal vein angiography after the TIPS and embolization therapy and the 60 keV + 120 keV fused images can eliminate artifacts and ensure a clear display of blood vessels.

Using advanced mass spectrometry techniques to fully characterize atmospheric organic carbon: current capabilities and remaining gaps

Organic compounds in the atmosphere vary widely in their molecular composition and chemical properties, so no single instrument can reasonably measure the entire range of ambient compounds. Over the past decade, a new generation of in situ, field-deployable mass spectrometers has dramatically improved our ability to detect, identify, and quantify these organic compounds, but no systematic approach has been developed to assess the extent to which currently available tools capture the entire space of chemical identity and properties that is expected in the atmosphere. Reduced-parameter frameworks that have been developed to describe atmospheric mixtures are exploited here to characterize the range of chemical properties accessed by a suite of instruments. Multiple chemical spaces (e.g. oxidation state of carbon vs. volatility, and oxygen number vs. carbon number) were populated with ions measured by several mass spectrometers, with gas- and particle-phase α-pinene oxidation products serving as the test mixture of organic compounds. Few gaps are observed in the coverage of the parameter spaces by the instruments employed in this work, though the full extent to which comprehensive measurement was achieved is difficult to assess due to uncertainty in the composition of the mixture. Overlaps between individual ions and regions in parameter space were identified, both between gas- and particle-phase measurements, and within each phase. These overlaps were conservatively found to account for little (<10%) of the measured mass. However, challenges in identifying overlaps and in accurately converting molecular formulas into chemical properties (such as volatility or reactivity) highlight a continued need to incorporate structural information into atmospheric measurements.

Antimicrobial synergy of monolaurin lipid nanocapsules with adsorbed antimicrobial peptides against Staphylococcus aureus biofilms in vitro is absent in vivo

Bacterial infections are mostly due to bacteria in their biofilm-mode of growth, while penetrability of antimicrobials into infectious biofilms and increasing antibiotic resistance hamper infection treatment. In-vitro, monolaurin lipid nanocapsules (ML-LNCs) carrying adsorbed antimicrobial peptides (AMPs) displayed synergistic efficacy against planktonic Staphylococcus aureus, but it has not been demonstrated, neither in-vitro nor in-vivo, that such ML-LNCs penetrate into infectious S. aureus biofilms and maintain synergy with AMPs. This study investigates the release mechanism of AMPs from ML-LNCs and possible antimicrobial synergy of ML-LNCs with the AMPs DPK-060 and LL-37 against S. aureus biofilms in-vitro and in a therapeutic, murine, infected wound-healing model. Zeta potentials demonstrated that AMP release from ML-LNCs was controlled by the AMP concentration in suspension. Both AMPs demonstrated no antimicrobial efficacy against four staphylococcal strains in a planktonic mode, while a checkerboard assay showed synergistic antimicrobial efficacy when ML-LNCs and DPK-060 were combined, but not for combinations of ML-LNCs and LL-37. Similar effects were seen for growth reduction of staphylococcal biofilms, with antimicrobial synergy persisting only for ML-LNCs at the highest level of DPK-060 or LL-37 adsorption. Healing of wounds infected with bioluminescent S. aureus Xen36, treated with ML-LNCs alone, was faster when treated with PBS, while AMPs alone did not yield faster wound-healing than PBS. Faster, synergistic wound-healing due to ML-LNCs with adsorbed DPK-060, was absent in-vivo. Summarizing, antimicrobial synergy of ML-LNCs with adsorbed antimicrobial peptides as seen in-vitro, is absent in in-vivo healing of infected wounds, likely because host AMPs adapted the synergistic role of the AMPs added. Thus, conclusions regarding synergistic antimicrobial efficacy, should not be drawn from planktonic data, while even in-vitro biofilm data bear little relevance for the in-vivo situation.

[Epidemiological characteristics of Pneumocystis jirovecii infection and colonization in non-AIDS patients]

Objective: To analyze the epidemiological characteristics of Pneumocystis jirovecii infection and colonization in non-AIDS patients. Methods: From January 2010 to December 2017, bronchoalveolar lavage fluid (BALF) was detected by Grocott's methenamine silver (GMS) staining and real-time fluorescence quantitative PCR (qPCR) in non-AIDS patients with bronchoscopic alveolar lavage at Peking University First Hospital. At the same time, Pneumocystis jirovecii was detected in the environment of the hospital. Results: Within 8 years, Pneumocystis jirovecii were detected in BALF of a total of 1 407 non-AIDS patients. GMS staining was performed in all these 1 407 cases, of which 114 (8.10%) cases were with Pneumocystis jirovecii infection and 3 (0.21%) cases with colonization. There were totally 946 non-AIDS immunocompromised patients, of which 113 (11.95%) cases were infected and 2 (0.21%) cases with colonization; there were 461 non-AIDS immunocompetent patients, of which only 1 (0.22%) case was infected and 1 (0.22%) case with colonization. GMS staining and qPCR were both performed in 196 cases, of which 36 (18.37%) cases were infected and 33 (16.84%) cases with colonization. There were totally 175 non-AIDS immunocompromised patients, of which 36 (20.57%) cases were infected and 30 (17.14%) cases with colonization; there were 21 non-AIDS immunocompetent patients, of which no one was infected and 3 (14.29%) cases with colonization. By means of GMS staining and qPCR, no Pneumocystis jiroveci were detected in the environment of Peking University First Hospital. Conclusions:Pneumocystis pneumonia is rare in immunocompetent patients, but not in non-AIDS immunocompromised patients. And colonization is rare in both of them. There may be no Pneumocystis jiroveci in the environment.

Nanocarriers with conjugated antimicrobials to eradicate pathogenic biofilms evaluated in murine in vivo and human ex vivo infection models

Conventional antimicrobials are becoming increasingly ineffective for treating bacterial infection due to the emergence of multi-drug resistant (MDR) pathogens. In addition, the biofilm-mode-of-growth of infecting bacteria impedes antimicrobial penetration in biofilms. Here, we report on poly(ethylene)glycol-poly(β-amino esters) (PEG-PAE) micelles with conjugated antimicrobials, that can uniquely penetrate biofilms, target themselves to bacterial cell surfaces once inside the low-pH environment of a biofilm and release conjugated antimicrobials through degradation of their ester-linkage with PAE by bacterial lipases. In vitro, PEG-PAE micelles with conjugated Triclosan (PEG-PAE-Triclosan) yielded no inadvertent leakage of their antimicrobial cargo and better killing of MDR Staphylococcus aureus, Escherichia coli and oral streptococcal biofilms than Triclosan in solution. In mice, PEG-PAE-Triclosan micelles with conjugated Triclosan yielded better eradication efficacy towards a MDR S. aureus-infection compared with Triclosan in solution and Triclosan-loaded micelles at equal Triclosan-equivalent concentrations. Ex vivo exposure of multi-species oral biofilms collected from orthodontic patients to PEG-PAE-Triclosan micelles, demonstrated effective bacterial killing at 30-40 fold lower Triclosan-equivalent concentrations than achieved by Triclosan in solution. Importantly, Streptococcus mutans, the main causative organism of dental caries, was preferentially killed by PEG-PAE-Triclosan micelles. Thus PEG-PAE-Triclosan micelles present a promising addendum to the decreasing armamentarium available to combat infection in diverse sites of the body. STATEMENT OF SIGNIFICANCE: pH-adaptive polymeric micelles with conjugated antimicrobials can efficiently eradicate infectious biofilms from diverse body sites in mice and men. An antimicrobial was conjugated through an ester-linkage to a poly(ethylene glycol) (PEG)/poly(β-amino ester) block copolymer to create micellar nanocarriers. Stable micelle structures were formed by the hydrophobic poly(β-amino ester) inner core and a hydrophilic PEG outer shell. Thus formed PEG-PAE-Triclosan micelles do not lose their antimicrobial cargo underway to an infection site through the blood circulation, but penetrate and accumulate in biofilms to release antimicrobials once inside a biofilm through degradation of its ester-linkage by bacterial lipases, to kill biofilm-embedded bacteria at lower antimicrobial concentrations than when applied in solution. PEG-PAE-Triclosan micelles effectively eradicate biofilms of multi-drug-resistant pathogens and oral bacteria, most notably highly cariogenic Streptococcus mutans, in mice and men respectively, and possess excellent clinical translation possibilities.

[Inflammatory priming adipose derived stem cells significantly inhibit the proliferation of peripheral blood mononuclear cells]

OBJECTIVE

To explored whether adipose derived stem cells (ASCs) could inhibit the pro-liferation of peripheral blood mononuclear cells (PBMCs) and whether inflammatory priming could enhance this property of ASCs.

METHODS

We isolated ASCs using collagenase from adipose tissue and expanded them in vitro. Cells were induced to differentiate into adipogenic and osteogenic lineages. The cells at passage 3 to passage 5 were used for the experiments. After carboxy fluoresce in succinimidyl ester (CFSE) staining, PBMCs were co-cultured with inflammatory priming ASCs. The PBMCs cultured without ASCs or with non-treated ASCs defined as control groups. Then we used flow cytometry to detect the proliferation of PBMCs.

RESULTS

ASCs had fibroblast-like phenotype and were spindle shaped. They were able to differentiate into cells of adipogenic and osteogenic lineages in specific induction media. ASCs had the CD expression profile consistant with the International Federation for Adipose Therapeutics statement. The percentage of parent cells in PBMC after co-cultured with ASCs increased, though there was no statistical significance. However, when co-cultured with inflammatory priming ASCs, the percentage of parent cells significantly increased (with inflammatory priming ASCs group vs. without ASCs group, 38.7%±10.0% vs. 28.4%±8.9%, P<0.05). This indicated that inflammatory priming ASCs could significantly inhibit the proliferation of PBMCs.

CONCLUSION

Inflammatory cytokines can enhance the immunosuppressive ability of ASCs. Our findings may help the application of ASCs in tissue repairment with better results.

Prevalence of BRCA1/2 large genomic rearrangements in Chinese women with sporadic triple-negative or familial breast cancer

The prevalence of BRCA1/2 large genomic rearrangements (LGRs) and their underlying mechanisms have not been fully evaluated in Chinese women with breast cancer. In this study, we determined the prevalence of BRCA1/2 LGRs in 834 patients with familial breast cancer (FBC) and 660 patients with sporadic triple-negative breast cancer (TNBC) who were negative for BRCA1/2 small-range mutations using the multiplex ligation-dependent probe amplification method. We found that 20 index patients (2.4%) in the FBC group carried a BRCA1 or BRCA2 LGR, and the frequencies of BRCA1 and BRCA2 LGRs were 1.6% and 0.8%, respectively. Seven index patients (1.1%) carried a BRCA1 LGR in 660 sporadic TNBC patients, whereas no BRCA2 LGRs were found in these patients. Among the BRCA1/2 LGRs, 48.1% (13/27) were novel, and the breakpoints of the majority of the LGRs were identified. ΨBRCA1-mediated homologous recombination (HR) and Alu-mediated HR/non-homologous end-joining (NHEJ) accounted for 40% and 30% of the BRCA1 LGRs, respectively. Alu-mediated HR accounted for 71.4% of the BRCA2 LGRs, and the remaining one-third was generated through Long interspersed nuclear elements (LINE)-mediated NHEJ. Our findings suggest that both FBC patients and sporadic TNBC patients should be tested for BRCA1/2 LGRs.

Variability in the time to initiation of CPR in continuously monitored pediatric ICUs

AIM

To study the influence of patient characteristics and unit ergonomics and human factors on the time to initiation of CPR.

METHODS

A single center study of children, 0 to 21 years old, admitted to an ICU who experienced cardiopulmonary arrest (CPA) requiring >1 min of chest compressions. Time of CPA was determined by analysis of continuous ECG, plethysmography, arterial blood pressure, and end-tidal CO₂ (EtCO₂) waveforms. Initiation of CPR was identified by the onset of cyclic artifact in the ECG waveform. Patient characteristics and unit ergonomics and human factors were examined including CPA cause, identification on the High-Risk Checklist (HRC), existing monitoring, ICU type, time of day, nursing shift change, and outcome.

RESULTS

The median time from CPA to initiation of CPR was 50.5 s (IQR 26.5 to 127.5) in 36 CPAs. Forty-seven percent of patients experienced time from CPA to initiation of CPR of >1 min. There was no difference in CPA cause, ICU type, time of day, or nursing shift change.

CONCLUSION

Nearly half of pediatric patients who experienced CPA in an ICU setting did not meet AHA guidelines for early initiation of CPR. This is an opportunity to study the recognition phase of CPA using continuous monitoring data with the aim of improving the understanding of and factors contributing to delays in initiation of CPR.

[Incidence rates of HIV-1 epidemics among 4 high risk groups in Sichuan province during 2011-2015]

Objective: Data from the HIV/AIDS surveillance sentinel sites was used to identify the recent HIV-1 infections and to estimate the HIV-1 incidence and epidemic trends among intravenous drug users (IDU), MSM, female sex workers and men attending the sexually transmitted disease clinics in Sichuan province. Methods: Specimens collected from IDUs, MSM, female sex workers and men attending the sexually transmitted disease clinics sentinel sites were confirmed as HIV-1 positive and tested with BED-CEIA. Annual HIV-1 prevalence and incidence rates were calculated and the incidence was adjusted by McNermar method. Results: A total number of 194 223 serum specimens were collected and HIV antibody tested, with 5 297 HIV-1 positive. 4 640 of the positives underwent BED-CEIA, with 749 identified as recent infections. During 2011-2015, HIV-1 incidence rates of the four types of population appeared as 5.16% (95%CI: 4.65-5.66), 0.22% (95%CI:0.16-0.28), 0.57%(95%CI: 0.45-0.69), 7.53% (95%CI: 6.06-9.01) and 0.44% (95%CI: 0.36-0.53) respectively. Significant differences were seen in the HIV-1 incidence rates. Conclusions: The HIV-1 incidence rates of IDUs from other sentinel sites in Sichuan province, female sex workers and men attending the sexually transmitted disease clinics appeared low, showing that the AIDS prevention and control activities worked effectively. However, the HIV-1 incidence of MSM was still at high level and even rising, suggesting that HIV-1 transmission between MSM and IDUs was possible.