Dynamic changes of interferon gamma release assay results with latent tuberculosis infection treatment

OBJECTIVES

Using QuantiFERON-TB Gold In-Tube (QFT-GIT) for monitoring tuberculosis (TB) and latent TB infection treatment effect is controversial. The present study aimed to evaluate the dynamic changes of interferon gamma (IFN-γ) levels along with latent TB infection treatment via a randomized controlled study.

METHODS

A total of 910 participants treated with 8 weeks of once-weekly rifapentine plus isoniazid (group A), 890 treated with 6 weeks of twice-weekly rifapentine plus isoniazid (group B) and 818 untreated controls (group C) were followed for 2 years to track active TB development. QFT-GIT tests were repeated three times for all groups: before treatment (T0), at completion of treatment (T1) and 3 months after completion of treatment (T2).

RESULTS

Similar rates of persistent QFT-GIT reversion were observed in groups A (19.0%, 173/910), B (18.5%, 165/890) and C (20.7%, 169/818) (p 0.512). The dynamic changes of IFN-γ levels were not statistically significant among the three groups. In treated participants, individuals with higher baseline IFN-γ levels showed increased TB occurrence (1.0%, 9/896) compared to those with lower baseline levels (0.2%, 2/904) (p 0.037). A similar but statistically insignificant trend was also observed in untreated controls (1.8% (7/400) vs. 0.5% (2/418), p 0.100). When TB cases were matched with non-TB cases on baseline IFN-γ levels, no significant differences were found with respect to the dynamic changes in IFN-γ levels with time, regardless of whether they received treatment.

CONCLUSIONS

QFT-GIT reversion or decreased IFN-γ levels should not be used for monitoring host response to latent TB infection treatment.

Outcome of Weekly Carboplatin-Paclitaxel-based Definitive Chemoradiation in Oesophageal Cancer in Patients Not Considered to be Suitable for Platinum-Fluoropyrimidine-based Treatment: A Multicentre, Retrospective Review

AIMS

Although cisplatin-fluoropyrimidine-based definitive chemoradiotherapy (dCRT) is a standard of care for oesophageal cancer, toxicity is significant and limits its use in elderly and frail patients. Weekly carboplatin-paclitaxel-based dCRT provides a viable alternative, although prospective data are lacking in the dCRT setting. Here we report the results of a national, multicentre retrospective review of outcome in patients treated with weekly carboplatin-paclitaxel-based dCRT.

MATERIALS AND METHODS

In this multicentre retrospective study of nine radiotherapy centres across the UK we evaluated the outcome of patients who had non-metastatic, histologically confirmed carcinoma of the oesophagus (adenocarcinoma, squamous cell or undifferentiated; World Health Organization performance status 0-2; stage I-III disease) and had been selected to receive weekly carboplatin-paclitaxel-based dCRT as they were considered not suitable for cisplatin-fluoropyrimidine-based dCRT. dCRT consisted of carboplatin AUC 2 and paclitaxel 50 mg/m2 (days 1, 8, 15, 22, 29) and the recommended radiation dose was 50 Gy in 25 daily fractions. We assessed overall survival, progression-free survival (PFS; overall, local and distant), proportion of patients who were failure free at the response assessment (12 weeks after dCRT), treatment compliance and toxicity.

RESULTS

In total, 214 patients from nine UK centres were treated between 15 February 2013 and 19 March 2019: 39.7% of patients were ≥75 years; 18.7% ≥ 80 years. Indications for weekly carboplatin-paclitaxel-based dCRT were comorbidities (47.2%), clinician choice (36.4%) and poor tolerance/progression on cisplatin-fluoropyrimidine induction chemotherapy (15.8%). The median overall survival was 24.28 months (95% confidence interval 20.07-30.09) and the median PFS was 16.33 months (95% confidence interval 14.29-20.96). Following treatment, 69.1% (96/139) had a combined complete response on endoscopy with non-progression (complete response/partial response/stable disease) on imaging. The 1- and 2-year overall survival rates for this patient group were 81.9% (95% confidence interval 75.6-86.8%) and 50.6% (95% confidence interval 40.5-60.0%), respectively. Thirty-three per cent (n = 70) of patients experienced at least one grade 3 + acute toxicity (grade 3/4 haematological: 10%; grade 3/4 non-haematological: 32%) and there were no treatment-related deaths. 86.9% of patients completed at least four cycles of concomitant weekly carboplatin-paclitaxel-based chemotherapy and planned radiotherapy was completed in 97.7% (209/214).

CONCLUSION

Weekly carboplatin-paclitaxel-based CRT seems to be well tolerated in elderly patients and in those with comorbidities, where cisplatin-fluoropyrimidine-based dCRT is contraindicated. Survival outcomes are comparable with cisplatin-fluoropyrimidine-based dCRT.

A Multicentre UK Study of Outcomes of Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy ± Chemotherapy

AIMS

To report the outcomes of nasopharyngeal carcinoma in adults across three large centres in a non-endemic region in the era of intensity-modulated radiotherapy (IMRT).

MATERIALS AND METHODS

Adult patients with nasopharyngeal carcinoma treated in three large cancer centres with IMRT ± chemotherapy with curative intent between 2009 and 2016 were identified from institutional databases. Radiotherapy was delivered with 70 Gy in 33-35 daily fractions. A univariable analysis was carried out to evaluate the relationship of patient, tumour and treatment factors with progression-free survival (PFS) and overall survival.

RESULTS

In total, 151 patients were identified with a median follow-up of 5.2 years. The median age was 52 years (range 18-85). Seventy-five per cent were of Caucasian origin; 75% had non-keratinising tumours; Epstein Barr virus status was only available in 23% of patients; 74% of patients had stage III or IV disease; 54% of patients received induction chemotherapy; 86% of patients received concurrent chemotherapy. Five-year overall survival, PFS, local disease-free survival, regional disease-free survival and distant disease-free survival were 70%, 65%, 91%, 94% and 82%, respectively. Keratinising squamous cell carcinoma, older age, worse performance status, smoking and alcohol intake were associated with inferior overall survival and PFS.

CONCLUSIONS

Local, regional and distant disease control are relatively high following IMRT ± chemotherapy in a non-endemic population. There was considerable heterogeneity in terms of radiotherapy treatment and the use of chemotherapy, encouraging the development of treatment protocols and expert peer review in non-endemic regions.

P6342Subcutaneous delivery of NPA7, first-in-class novel bispecific designer peptide: enhances cardiorenal function and suppresses renin and aldosterone in vivo and in vitro

Introduction

The rapid increase of patients of heart failure (HF) is a major health burden worldwide. Most importantly is the need to develop innovative new drugs for treatment of HF, such as sacubitril/valsartan which in part functions by enhancing the natriuretic peptides (NPs). We engineered NPA7 as a novel 30 amino acid bispecific designer peptide which activates the particulate guanylyl cyclase A receptor (pGC-A)/cGMP and for which the NPs both ANP and BNP are ligands and the Mas-receptor (MasR)/cAMP pathways for Angiotensin 1–7 (Ang1–7) is the endogenous ligand. We previously reported that acute intravenous (IV) administration of NPA7 shows cardiorenal protective and renin-aldosterone suppressing actions that go beyond the native peptides, BNP or Ang 1–7, which may have therapeutic potential for HF.

Purpose

To support the clinical development of NPA7 as a potential therapy in HF which promotes NP and MasR pathways, we investigated the actions and stability of subcutaneous (SQ) administration of NPA7 in normal canines. We also defined NPA7's peptide stability and metabolites in canine plasma.

Methods

Plasma and urinary cGMP, cardiorenal and renin-aldosterone responses to SQ injection (10μg/kg) were determined over 4 hours in normal canines (n=5) in vivo. Ex vivo, we established stability of NPA7 and key metabolites in canine serum using liquid chromatography-mass spectrometry (LC-MS). Data are expressed as mean ± SEM. * P<0.05 vs. BL.

Results

In vivo, SQ NPA7 resulted in a sustained increase at 2 hours in plasma (BL: 10±3; 120 min: 30±6* pmol/ml) and urinary (BL: 1033±198; 120 min: 5792±857* pmol/min) cGMP, GFR (BL: 29±6; 120 min: 70±12* ml/min) and sodium excretion (BL: 18±10; 120 min: 144±33* ueq/min). We observed a gradual reduction in BP at 60 min (BL: 109±4; 60 min: 99±7* mmHg) with a sustained decrease in PCWP at 4 hours (BL: 5±0.9; 240 min: 3.1±0.6* mmHg). SQ NPA7 also suppressed plasma renin and aldosterone up to 3 hours after SQ injection. LC-MS revealed that NPA7 was highly stable with both the pGC-A and MasR activating moieties intact ex vivo in canine serum with a disappearance time of 2 hours. We also identified 2 major NPA7 metabolites NPA71–27 and NPA71–28.

Conclusions

SQ NPA7 possesses cGMP activating, cardiac unloading, diuretic, natriuretic, and renin-aldosterone suppressing actions in normal canines. NPA7 is also highly stable in serum. These studies support SQ administration as an effective delivery strategy for NPA7, a first-in-class innovative bispecific dual pGC-A/MasR activator now in preclinical development for HF.

Effects of gangliosides on expressions of caspase-3 and NGF in rats with acute spinal cord injury

OBJECTIVE

To investigate the effects of ganglioside [monostalotetra-hexosylganglioside (GM1)] on the expressions of caspase-3 and nerve growth factor (NGF) in rats with acute spinal cord injury (SCI).

MATERIALS AND METHODS

Male Sprague- Dawley (SD) rats were selected and randomly divided into Sham group, SCI group and GM1 administration group. The rats in Sham group, SCI group and GM1 group were subjected to behavioral examinations of Basso Beattie Bresnahan (BBB) and oblique-plate test at 1, 7 and 14 d after operation. The content of methylene dioxyamphetamine (MDA) and the activity of superoxide dismutase (SOD) of every rat in each group were measured by enzyme-linked immunosorbent assay (ELISA). Immunofluorescence staining assay was used to detect the expression levels of caspase-3 and NGF of rats in each group. The messenger ribonucleic acid (mRNA) and protein expressions of caspase-3 and NGF of rats in Sham group, SCI group and GM1 group were detected using reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blotting assay.

RESULTS

The BBB scores and the results of oblique-plate test in Sham group, SCI group and GM1 group at 1, 7 and 14 d showed that the BBB scores and the results of oblique-plate test of rats in each group were significantly decreased at 1 d after SCI, and had different degrees of recovery at 7 and 14 d after injury. The results of ELISA detection revealed that SCI group had increased content of MDA and clearly decreased activity of SOD in comparison with Sham group; at the same time, MDA content in GM1 group was overtly lower than that in SCI group, while SOD activity was enhanced evidently in GM1 group compared with that in SCI group. According to immunofluorescence assay, significantly increased expression of caspase-3 and distinctly decreased expression of NGF were found in SCI group. However, this phenomenon was significantly reversed by GM1. RT-PCR and Western blotting assay severally proved that the mRNA and protein expressions of caspase-3 were raised in SCI group and decreased clearly after the administration of GM1; while the mRNA and protein expressions of NGF was significantly reduced in SCI group and overtly elevated after the administration of GM1. ANOVA showed that there were statistically significant differences in expressions of caspase-3 and NGF among Sham group, SCI group and GM1 group (p<0.05).

CONCLUSIONS

GM1 has an evident effect on the expressions of caspase-3 and NGF in rats with acute SCI, and is able to down-regulate the expression of caspase-3 and up-regulate the expression of NGF, so as to achieve its therapeutic effect on SCI.

Prolonged dengue outbreak at a high-rise apartment in Petaling Jaya, Selangor, Malaysia: A case study

There was an increasing trend in dengue infection in Malaysia with many outbreaks that occurred in Petaling District, Selangor in 2013 - 2014. A high rise apartment in Petaling Jaya reported ten episodes of dengue outbreaks from June 2013 to June 2014. We studied the prolonged dengue hotspot at this residential complex in Petaling Jaya, Selangor and made recommendations to prevent future prolonged dengue outbreaks. This was a retrospective exploratory study by analysing secondary data on dengue outbreaks from years 2013 to 2014. Small group discussions, interview sessions with staff and site visits were carried out to obtain necessary information. Two hundred and ninety-one cases were notified during the dengue outbreaks from Epid week (EW) 25 in 2013 to EW 26 in 2014 with no mortality reported. Information entered into dengue databases might be incomplete or mixed up. Active case detection and environmental risks assessment based on cases were not carry out due to the massive outbreak. Basic information on the population in the outbreak locality was unavailable. Various control activities were carried out with varying outcomes. Community participation was poor with little cooperation from residents during health education and community-based mosquito breeding prevention activities. To ensure better management of dengue outbreaks and to prevent prolonged dengue outbreaks in the future, integrated case findings, effective control activities, extensive environmental assessment on the outbreak locality and adopting innovative community outreach initiative with sufficient staff are required to curb dengue vector.

[Association between serum lipid level and depression in patients with chronic heart failure]

Objective: To investigate the association between serum lipid level and depression in patients with chronic heart failure (CHF). Methods: A total of 348 patients with CHF from the First department of Cardiology of the people's hospital of Shaanxi province from September 2016 to June 2017 were included.The Hamilton Depression Scale (HAMD) was used to evaluate the degree of depression and some related clinical data were tested.The serum lipid level and depression scores in the patients were analyzed using Pearson correlation analysis, and Logistic regression analysis was used to analyze the confounding factors of depression. Results: There was significant difference in the proportion of depression between normal serum lipid group and dyslipidemia group (P=0.044). Pearson correlation analysis showed that depression score was linearly related to total cholesterol (r=0.326, P<0.001) and low density lipoprotein cholesterol (r=0.354, P<0.001), and Logistic regression analysis showed that after adjusting for age, BMI, triglyceride, low density lipoprotein cholesterol, creatinine, total bilirubin, albumin, B type natriuretic peptide, total cholesterol (OR=3.523, P=0.007) and high density lipoprotein cholesterol (OR=0.205, P=0.041) were associated with depression in CHF patients. Conclusion: Total cholesterol can increase the risk of depression, and high density lipoprotein cholesterol can reduce the risk of depression in CHF patients.

Temporal expression of interleukin-22, interleukin-22 receptor 1 and interleukin-22-binding protein during experimental periodontitis in rats

BACKGROUND AND OBJECTIVE

Interleukin-22 (IL-22), mainly produced by CD4+ T-helper subtypes and innate lymphoid cells at barrier surfaces, is found to involve in several diseases, including diabetes, rheumatoid arthritis, peri-implantitis and chronic rhinosinusitis with nasal polyps. The purpose of this study was to investigate histological changes and the levels of interleukin-22, interleukin-22 receptor 1 (IL-22R1) and interleukin-22-binding protein (IL-22BP) in experimental periodontitis.

MATERIAL AND METHODS

Sixty male 8-week-old Sprague Dawley rats were randomly allocated to six groups of 10 rats each. In the periodontitis groups, experimental periodontitis was established and the rats were killed on days 3, 5, 7, 11 and 15 after ligation, while the rats without ligation were killed on day 0, representing the healthy control group (day 0 group). Histopathologic changes were detected by hematoxylin and eosin (H&E) staining, and alveolar bone loss was determined by micro-computed tomography (micro-CT). Tartrate-resistant acid phosphatase (TRAP) staining was used to investigate osteoclast formation. Real-time quantitative PCR (qPCR) and immunohistochemistry were used to investigate the expression and location of IL-22, IL-22R1 and IL-22BP in gingival tissues.

RESULTS

H&E staining showed increasingly severe destruction of the epithelial layer between day 3 and day 7, and the hyperplasia of pocket epithelium and the formation of periodontal pockets could be detected from day 11 to day 15. Micro-CT indicated an exponential increase in alveolar bone loss from day 3 to day 11 (P < .01). Bone resorption tended to be stationary after this period. TRAP staining showed that the number of multinucleate osteoclasts peaked at day 3 (P < .001, compared with day 0) and decreased at subsequent time points between day 5 and day 15. IL-22BP was expressed strongly under steady-state conditions in epithelial cells. IL-22-positive cells could be clearly observed both in the epithelial layer and around the lamina propria, whereas IL-22R1 was mainly localized in the epithelial layer of the damage period. Real-time qPCR revealed up-regulation of IL-22 and IL-22R1, as well as down-regulation of IL-22BP in gingival tissues during the destructive phase of periodontitis.

CONCLUSION

This study shows the expression and localization of IL-22, IL-22R1 and IL-22BP, as well as the relevant histopathological alterations during the development of experimental periodontitis.

The HMGB1 is increased in CSF of patients with an Anti-NMDAR encephalitis

BACKGROUND

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder of the central nervous system (CNS). Interleukin (IL)-6 and IL-17A may play important roles in the pathogenesis of this disease. High-mobility group box protein 1 (HMGB1), a small but highly conserved ubiquitous protein, is recognized to be a potent innate inflammatory mediator that can activate the nuclear factor light chain enhancer of activated B cells and release cytokines such as IL-6 and IL-17A when released extracellularly. However, whether cerebrospinal fluid (CSF) HMGB1 levels are altered in anti-NMDAR encephalitis is still unclear.

OBJECTIVE

The aim of this study was to determine whether a correlation exists between the CSF concentrations of HMGB1 and IL-6 and IL-17A in anti-NMDAR encephalitis patients. We also sought to assess whether HMGB1 influences the clinical outcomes in anti-NMDAR encephalitis patients.

METHODS

Thirty-three patients with anti-NMDAR antibodies and 38 controls were recruited. CSF HMGB1 was measured using an enzyme-linked immunosorbent assay. The main clinical outcomes were evaluated using the modified Rankin scale (mRS). The data were extracted using microarray analysis software.

RESULTS AND CONCLUSION

Our results showed significant increases in CSF HMGB1, IL-6, and IL-17A (P < .05) in anti-NMDAR encephalitis patients. But between 3 months' mRS scores in anti-NMDAR encephalitis patients and CSF data, there was no correlation. Our study suggests that HMGB1 CSF levels are increased in patients with anti-NMDAR encephalitis and reflect the underlying neuroinflammatory process.

The role of extracellular matrix metalloproteinase inducer glycosylation in regulating matrix metalloproteinases in periodontitis

BACKGROUND AND OBJECTIVE

Extracellular matrix metalloproteinase inducer (EMMPRIN) is a transmembrane glycoprotein that may induce activation of matrix metalloproteinases (MMPs) and lead to the destruction of periodontal tissue. The level of EMMPRIN glycosylation might be involved in this process. This study aims to investigate the role of EMMPRIN glycosylation in regulating MMP-2 and MMP-9 during the progression of periodontitis.

MATERIAL AND METHODS

Gingival tissues were collected from patients with chronic periodontitis and from patients undergoing crown-lengthening procedures (healthy gingival tissue). Tissues were used for immunohistochemistry and double immunofluorescence. A human immortalized oral epithelial cell (HIOEC) line was stably transfected by an N-acetylglucosaminyltransferase-V (GnT-V) RNA interference (RNAi) lentivirus to suppress EMMPRIN glycosylation. Gene silence efficiency was detected by western blot, quantitative real-time PCR and immunofluorescence (IF) staining. An HIOEC/human gingival fibroblast (HGF) co-culture model and an individual culture model were used in this study. After exposure of cells to Porphyromonas gingivalis lipopolysaccharide (Pg. LPS), the expression of EMMPRIN, MMP-2 and MMP-9 were assessed by western blot, quantitative real-time PCR and IF, and the secretion of MMP-2 and MMP-9 were detected by gelatin-degradation assays.

RESULTS

Compared with the periodontally healthy group, patients with periodontitis showed increased expression of EMMPRIN on the gingival epithelial cell membrane. GnT-V, a key regulator of EMMPRIN glycosylation, was co-expressed with EMMPRIN in gingival epithelial cells in patients with periodontitis. Knockdown of GnT-V reduced the level of EMMPRIN glycosylation in HIOECs. Furthermore, in the HIOEC/HGF co-culture model, stimulation with Pg. LPS (10 μg/mL, 4 hours) promoted EMMPRIN glycosylation and increased the activities of MMP-2 and MMP-9, while suppression of EMMPRIN glycosylation by GnT-V knockdown reduced the synthesis and activities of MMP-2 and MMP-9 under Pg. LPS stimulation. Moreover, the gelatin-degradation assay showed that inhibition of EMMPRIN glycosylation suppressed the Pg. LPS-induced degradation of gelatin in the co-culture model.

CONCLUSION

We conclude that EMMPRIN glycosylation participates in the regulation of MMP-2 and MMP-9 production through mediating the interaction of HIOECs and HGFs. Inhibiting EMMPRIN glycosylation can reduce the activation of MMP-2 and MMP-9 and suppress the degradation of extracellular matrix (ECM) in the HIOEC/HGF co-culture model. Therefore, this study suggests that EMMPRIN glycosylation may affect the host immune-inflammatory response by regulating MMPs in periodontitis.

Comparison of hemodynamic effects of sevoflurane and ketamine as basal anesthesia by a new and direct monitoring during induction in children with ventricular septal defect: A prospective, randomized research

BACKGROUND

Sevoflurane and ketamine are commonly used to obtain sedation and facilitate intravenous anesthetic induction in children undergoing cardiac surgery who are uncooperative. We used a new and direct systemic hemodynamic monitoring technique pressure recording analytical method and compared the hemodynamic effects of sevoflurane and ketamine to facilitate intravenous anesthetic induction.

METHODS

Forty-four children with ventricular septal defect (2.2 ± 1.2 years) were enrolled and randomized to receive sevoflurane (Group S) or intramuscular ketamine (Group K) for sedation, followed by intravenous midazolam-sufentanil induction and tracheal intubation. Recorded parameters included heart rate (HR), arterial pressures, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) after sedation obtained with sevoflurane or ketamine, 1, 2, 5 minutes after midazolam-sufentanil, 1, 2, 5, and 10 minutes after tracheal intubation. Rate-pressure product (RPP) and cardiac power output (CPO) were calculated.

RESULTS

As compared with Group S, Group K had faster decreases during intravenous anesthetic induction in arterial pressures (P < .01 for all), higher HR, arterial pressures, SVRI, dp/dtmax, RPP, lower SVI, CI, CPO (P < .05 for all) during the study period.

CONCLUSION

As compared with sevoflurane, ketamine facilitated intravenous anesthetic induction exerts unfavorable effects on systemic hemodynamic and myocardial energetic in children with ventricular septal defect.

Different predictivity of fluid responsiveness by pulse pressure variation in children after surgical repair of ventricular septal defect or tetralogy of Fallot

BACKGROUND

Pulse pressure variation derived from the varied pulse contour method is based on heart-lung interaction during mechanical ventilation. It has been shown that pulse pressure variation is predictive of fluid responsiveness in children undergoing surgical repair of ventricular septal defect. Right ventricle compliance and pulmonary vascular capacitance in children with tetralogy of Fallot are underdeveloped as compared to those in ventricular septal defect. We hypothesized that the difference in the right ventricle-pulmonary circulation in the two groups of children would affect the heart-lung interaction and therefore pulse pressure variation predictivity of fluid responsiveness following cardiac surgery.

METHODS

Infants undergoing complete repair of ventricular septal defect (n=38, 1.05±0.75 years) and tetralogy of Fallot (n=36, 1.15±0.68 years) clinically presenting with low cardiac output were enrolled. Fluid infusion with 5% albumin or fresh frozen plasma was administered. Pulse pressure variation was recorded using pressure recording analytical method along with cardiac index before and after fluid infusion. Patients were considered as responders to fluid loading when cardiac index increased ≥15%. Receiver operating characteristic curves analysis was used to assess the accuracy and cutoffs of pulse pressure variation to predict fluid responsiveness.

RESULTS

The pulse pressure variation values before and after fluid infusion were lower in tetralogy of Fallot children than those in ventricular septal defect children (15.2±4.4% vs 19.3±4.4%, P<.001; 11.6±3.8 vs 15.4±4.3%, P<.001, respectively). In ventricular septal defect children, 27 were responders and 11 nonresponders. Receiver operating characteristic curve area was 0.89 (95% confidence interval, 0.77-1.01) and cutoff value 17.4% with a sensitivity of 0.89 and a specificity of 0.91. In tetralogy of Fallot children, 26 were responders and 10 were nonresponders. Receiver operating characteristic curve area was 0.79 (95% CI, 0.64-0.94) and cutoff value 13.4% with a sensitivity of 0.81 and a specificity of 0.80.

CONCLUSION

Pulse pressure variation is predictive of fluid responsiveness in ventricular septal defect and tetralogy of Fallot patients following cardiac surgery.