Clinical characteristics and predictors of the duration of SARS-CoV-2 viral shedding in 140 healthcare workers

BACKGROUND

Epidemiological and clinical features of patients with COVID-19 have been reported, but none of them focused on medical staff, and few predictors of the duration of viral shedding have been reported. It is urgent to help healthcare workers prevent and recover quickly from the coronavirus disease 2019 (COVID-19).

METHODS

We enrolled 140 medical workers with COVID-19 in Wuhan. Epidemiological, demographic, clinical, laboratory, radiological treatment and clinical outcome data were collected, and predictors of the duration of viral shedding were explored through multivariable linear regression analysis.

RESULTS

The medical staff with COVID-19 presented mild clinical symptoms and showed a low frequency of abnormal laboratory indicators. All the medical staff were cured and discharged, of whom 96 (68.6%) were female, 39 (27.9%) had underlying diseases, the median age was 36.0 years, and 104 (74.3%) were infected whilst working in hospital. The median duration of viral shedding was 25.0 days (IQR:20.0-30.0). Multivariable linear regression analysis showed reducing viral shedding duration was associated with receiving recombinant human interferon alpha (rIFN-α) treatment, whilst the prolonged duration of viral shedding correlated with the use of glucocorticoid treatment, the durations from the first symptom to hospital admission and the improvement in chest computed tomography (CT) evidence. Moreover, infected healthcare workers with lymphocytes less than 1.1 × 10⁹ /L on admission had prolonged viral shedding.

CONCLUSION

Medical staff with timely medical interventions show milder clinical features. Glucocorticoid treatment and lymphocytes less than 1.1 × 109/L are associated with prolonged viral shedding. Early admission and rIFN-α treatment help shorten the duration of viral shedding.

Nomogram predicting early neurological improvement in ischaemic stroke patients treated with endovascular thrombectomy

BACKGROUND AND PURPOSE

Early neurological improvement (ENI) after endovascular thrombectomy (EVT) has been associated with favorable outcomes. This study aimed to identify the optimal definition of ENI and develop a nomogram for predicting ENI after EVT in acute ischaemic stroke.

METHODS

Patients with EVT were enrolled from a multicenter registry as the training cohort. The receiver operating characteristic curve was used to estimate the optimal threshold for ENI at 24 h of EVT. Logistic regression analysis was utilized to generate the best-fit nomogram for predicting ENI. The discrimination of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC). An additional 447 patients from two stroke centers were prospectively recruited as the test cohort for validating the nomogram.

RESULTS

A total of 612 patients with EVT were included in the training cohort. The optimal threshold for predicting 3-month favorable outcome (modified Rankin Scale 0-2) was an improvement of the National Institutes of Health Stroke Scale (NIHSS) score by ≥6 points (AUC 0.875; sensitivity 79.5%; specificity 90.7%). Age, blood glucose, recanalization, symptomatic intracranial hemorrhage (sICH) and baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were independently associated with ENI, and were incorporated in the nomogram. The AUC of the nomogram was 0.795 in the training cohort and 0.752 in the test cohort.

CONCLUSIONS

A reduction of NIHSS score ≥6 appeared to be the optimal definition of ENI. The nomogram composed of age, blood glucose, recanalization, sICH and baseline ASPECTS may predict the probability of ENI in ischaemic stroke patients treated with EVT.

[Debridement combined with negative-pressure wound therapy and local flap for treating a case of stingray sting]

On January 10, 2018, a 35-year-old male patient with a 3 day stingray stinger injury in his left thigh was admitted to Xuzhou Central Hospital. At the time of admission, the patient's left thigh was red, swollen, and painful. On the day of admission, the patient underwent emergency operation in the outpatient operating room for local debridement to remove the infected and necrotic tissue. After the routine dressing change and the wound got better, surgical debridement and negative-pressure wound therapy were performed, and finally local flap was used to repair the wound. On the 14th day after the flap repair operation, the suture was removed and the patient was discharged. After half a year follow-up, the appearance of the operation area recovered well. This case suggests that the timely and correct pre-hospital treatment, thorough and timely debridement, and systemic antibiotic application are important means to reduce further injury of toxin. The local flap can achieve satisfactory result on wound healing after the wound bed is prepared by negative-pressure wound therapy.

Increased long noncoding RNA LINC00511 is correlated with poor prognosis and contributes to cell proliferation and metastasis by modulating miR-424 in hepatocellular carcinoma

OBJECTIVE

Long noncoding RNAs (lncRNAs) have been reported to be abnormally expressed in human hepatocellular carcinoma (HCC) and associated with the progression of HCC. LncRNA LINC00511 (LINC00511) has been confirmed to act as a tumor promoter in several tumors. However, as a novel lncRNA, the specific effect of LINC00511 is still largely obscure. In this study, we aimed to evaluate the effect of LINC00511 in HCC behaviors and to elucidate the mechanism by which this occurs.

PATIENTS AND METHODS

The expressions of LINC00511 in HCC tissues and cell lines were evaluated by qRT-PCR. The correlations between LINC00511 expression and the clinicopathological parameters and prognosis of HCC patients were determined using several statistical methods. CCK-8 assay, colony formation assay, flow cytometry cell cycle, apoptosis assay, EdU assay, wound healing assay, and transwell assay were used to investigate the role of LINC00511 on the malignant phenotypes in vitro. Insights into the potential mechanisms of ceRNAs were determined by bioinformatics analysis, dual-luciferase reporter assays and RT-PCR.

RESULTS

LINC00511 expression was significantly up-regulated in HCC tissues and cell lines, and its high expression was distinctly associated with nodal metastasis, vascular invasion, and clinical stage. Furthermore, statistical assays revealed that HCC patients with higher LINC00511 expression levels had worse overall survival rates. Importantly, the multivariate analysis confirmed that LINC00511 expression was an independent prognostic factor of the overall survival in patients with HCC. Functionally, the inhibition of LINC00511 significantly suppressed the capability of proliferation, migration, and invasion in HCC cell lines. Bioinformatic tools predicted that miR-424 both targeted the 3'-UTR of LINC00511, which was confirmed using the luciferase reporter assay and RT-PCR.

CONCLUSIONS

LINC00511 plays an important role in the malignant progression of HCC via modulation of miR-424.

Abnormal processing of IL-1β in NLRP7-mutated monocytes in hydatidiform mole patients

NOD-like receptor pyrin 7 (NLRP7) has been identified as the major gene responsible for the recurrent hydatidiform mole (RHM). The immunological role of NLRP7 mutation in HM patients has not been conclusively demonstrated. Hence, we aim to demonstrate this role in our study. We followed 12 new patients with NLRP7 non-synonymous variations (NSVs) from date to date. Peripheral blood mononuclear cells (PBMCs) were collected separately from patients with and without NLRP7 mutation. Supernatant interleukin (IL)-1β secretion, intracellular pro-IL-1β and mature IL-1β expressions were measured after 24 h lipopolysaccharide (LPS) stimulation. Plasmids with corresponding NSVs were generated to evaluate the ability of processing pro-IL-1β into mature IL-1β in vitro. Homozygous or compound heterozygous NLRP7 mutations secreted less IL-1β in roots of abnormal intracellular pro-IL-1β or mature IL-1β, according to different domains. Plasmids with NSVs could also affect processing or/and trafficking together with caspase-1 and apoptosis-associated speck-like protein (ASC). Inflammasome-related NLRP7 mutation is a potential mechanism of RHM.

A novel nomogram to predict early neurological deterioration in patients with acute ischaemic stroke

BACKGROUND AND PURPOSE

Acute ischaemic stroke (AIS) is a vital cause of mortality and morbidity in China. Many AIS patients develop early neurological deterioration (END). This study aimed to construct a nomogram to predict END in AIS patients.

METHODS

Acute ischaemic stroke patients in Nanjing First Hospital were recruited as the training cohort. Additional patients in Nantong Third People's Hospital were enrolled as the validation cohort. Multivariate logistic regression was utilized to establish the nomogram. Discrimination and calibration performance of the nomogram were tested by concordance index and calibration plots. Decision curve analysis was employed to assess the utility of the nomogram.

RESULTS

In all, 1889 and 818 patients were recruited in the training and validation cohorts, respectively. Age [odds ratio (OR) 1.075; 95% confidence interval (CI) 1.059-1.091], diabetes mellitus (OR 1.673; 95% CI 1.181-2.370), atrial fibrillation (OR 3.297; 95% CI 2.005-5.421), previous antiplatelet medication (OR 0.473; 95% CI 0.301-0.744), hyper-sensitive C-reactive protein (OR 1.049; 95% CI 1.036-1.063) and baseline National Institutes of Health Stroke Scale (OR 1.071; 95% CI 1.045-1.098) were associated with END and incorporated in the nomogram. The concordance index was 0.826 (95% CI 0.785-0.885) and 0.798 (95% CI 0.749-0.847) in the training and validation cohorts. By decision curve analysis, the model was relevant between thresholds of 0.06 and 0.90 in the training cohort and 0.08 and 0.77 in the validation cohort.

CONCLUSIONS

The nomogram composed of hyper-sensitive C-reactive protein, age, diabetes mellitus, atrial fibrillation, previous antiplatelet medication and baseline National Institutes of Health Stroke Scale may predict the risk of END in AIS patients.

HER2 exon 20 insertions in non-small-cell lung cancer are sensitive to the irreversible pan-HER receptor tyrosine kinase inhibitor pyrotinib

BACKGROUND

Effective targeted therapy for non-small-cell lung cancer (NSCLC) patients with human epidermal growth factor receptor 2 (HER2) mutations remains an unmet need. This study investigated the antitumor effect of an irreversible pan-HER receptor tyrosine kinase inhibitor, pyrotinib.

PATIENTS AND METHODS

Using patient-derived organoids and xenografts established from an HER2-A775_G776YVMA-inserted advanced lung adenocarcinoma patient sample, we investigated the antitumor activity of pyrotinib. Preliminary safety and efficacy of pyrotinib in 15 HER2-mutant NSCLC patients in a phase II clinical trial are also presented.

RESULTS

Pyrotinib showed significant growth inhibition of organoids relative to afatinib in vitro (P = 0.0038). In the PDX model, pyrotinib showed a superior antitumor effect than afatinib (P = 0.0471) and T-DM1 (P = 0.0138). Mice treated with pyrotinib displayed significant tumor burden reduction (mean tumor volume, -52.2%). In contrast, afatinib (25.4%) and T-DM1 (10.9%) showed no obvious reduction. Moreover, pyrotinib showed a robust ability to inhibit pHER2, pERK and pAkt. In the phase II cohort of 15 patients with HER2-mutant NSCLC, pyrotinib 400 mg resulted in a objective response rate of 53.3% and a median progression-free survival of 6.4 months.

CONCLUSION

Pyrotinib showed activity against NSCLC with HER2 exon 20 mutations in both patient-derived organoids and a PDX model. In the clinical trial, pyrotinib showed promising efficacy.

CLINICAL TRIAL REGISTRATION

NCT02535507.

[Spatio-temporal distribution of Oncomelania hupensis snails along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal]

OBJECTIVE

To explore the spatio-temporal characteristics of Oncomelania hupensis snails along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, so as to provide scientific evidence for the dynamic assessment of the risk of snail spread in this region.

METHODS

O. hupensis snail status was collected in the plain regions with waterway networks in the study area from 2012 to 2017. The spatio-temporal variations of snail distribution were investigated along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal using buffer zone analysis, spatial autocorrelation, hotspot analysis and standard deviational ellipse with the geographical information system (GIS) tools.

RESULTS

The number of snail habitats showed a tendency towards a rise in the study area from 2012 to 2017, and snail habitats were predominantly distributed in the 1 000 m long buffer zone of the Danyang-Jintan-Liyang Canal, notably along the Jiuqu River at the junction between the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal. The distribution of snail habitats appeared spatial autocorrelations in 2014, 2016 and 2017, and the hotspot areas were mainly identified at the junction between the Danyang-Jintan-Liyang Canal and the Beijing-Hangzhou Grand Canal. In addition, the overall distribution of snail habitats was located in the northeastern-southwestern part of the study aera, and gradually shifted to the southern and northern parts with the time.

CONCLUSIONS

The spatial distribution of O. hupensis snails is complex along the Danyang section of the Beijing-Hangzhou Grand Canal and the Danyang-Jintan-Liyang Canal, and there is a risk of snail spread from the upper reaches to the lower reaches, where snail control needs to be intensified.

Long non-coding RNA CASC15 promotes proliferation and induces apoptosis of cervical cancer cells through targeting miR-101-3p

OBJECTIVE

Cervical cancer (CC) is a common type of fatal gynecological cancer worldwide. The aim of this study was to identify the exact role of lncRNA CASC15 in the progression of CC and to explore the possible underlying mechanism.

PATIENTS AND METHODS

Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) was used to detect CASC15 expression in 4 CC cell lines, and 54 paired CC tissue samples. The roles of CASC15 in CC were explored through apoptosis assay, colony formation assay, and proliferation assay in vitro, respectively. Furthermore, the underlying mechanism of CASC15 in CC was explored by luciferase reporter gene assay and RNA immunoprecipitation (RIP) assay.

RESULTS

CASC15 expression in CC tissues was remarkably higher than that of adjacent normal tissues. The knockdown of CASC15 significantly inhibited CC cell proliferation, whereas induced cell apoptosis in vitro. Meanwhile, CC cell proliferation was remarkably promoted, and cell apoptosis was inhibited by overexpression of CASC15 in vitro. In addition, miR-101-3p was up-regulated and down-regulated after knockdown and overexpression of CASC15 in vitro, respectively. Furthermore, bioinformatics analysis and mechanism assays revealed that miR-101-3p was a direct target of CASC15 in CC tumorigenesis.

CONCLUSIONS

CASC15 could promote proliferation and inhibit apoptosis of CC cells by targeting miR-101-3p. Our findings suggested that CASC15 might offer a new therapeutic intervention for CC patients.

The correlation between estrogen receptor gene polymorphism and osteoporosis in Han Chinese women

OBJECTIVE

To uncover the role of estrogen receptor gene polymorphism in the onset of osteoporosis in Han Chinese women.

PATIENTS AND METHODS

A total of 122 osteoporosis woman patients who were admitted to this hospital between April 2016 and April 2017 were enrolled in this study as the case group, and during the same period, 106 healthy counterparts who took physical examination as the control group. With the genetic samples collected from subjects in two groups, we detected the polymorphisms of Pvu II and Xba I in the estrogen receptor alpha (ERα) gene and the Rsa-I and Aiu-I polymorphisms in the ERβ gene by Restriction Fragment Length Polymorphism (RFLP), and the related-alleles frequency in subjects carrying the genotype of Pvu-1I and Xba-I polymorphisms in the ERα gene or the genotype of Rsa-I and Alu-I polymorphisms in the ERβ gene in the two groups.

RESULTS

Comparison of genotype frequencies pp, Pp, and PP of ERα Pvu-II polymorphisms between the case group and the control group showed the differences were statistically significant (p < 0.05), in which the P allele in the case group had a higher frequency than that in the control group (p < 0.05). However, comparisons of the genotype frequencies of xx, Xx, and XX of ERα Xba-I polymorphisms between the case group and the control group showed no statistically significant differences (p > 0.05), and similar results were also found in comparison of the genotype frequencies of rr, Rr, and RR of Rsa-I polymorphisms (p > 0.05). By the comparison of genotype frequencies of ERβ Alu-I and Rsa-I polymorphisms in the case group with those in the control group, and by the comparison of genotype frequencies aa, Aa, and AA of ERβ Alu-I polymorphisms in the case group with those in the control group, all the differences were statistically significant (p < 0.05 ).

CONCLUSIONS

In Han Chinese women, susceptibility to osteoporosis may be affected by ERα Pvu-II polymorphisms and ERβ Alu-I polymorphisms; those carrying genotypes containing A and P alleles may have a higher risk in osteoporosis.

[Surveillance of soil-borne nematodiasis in Danyang City from 2012 to 2018]

OBJECTIVE

To monitor the epidemic status of human soil-borne nematodiasis in Danyang City, so as to provide scientific evidence for formulating control measures.

METHODS

The soil-borne nematode infections were tested using a modified Kato-Katz technique among residents aged more than 3 years living in Danyang City from 2012 to 2018, and the Enterobius vermicularis eggs were detected using the transparent adhesive tape anal swab method among children at ages of 3 to 12 years.

RESULTS

A total of 13 540 residents were monitored for soil-borne nematode infections from 2012 to 2018, and the prevalence of human soil-borne nematode infections was 0.45%. The prevalence of Ascaris lumbricoides, Trichuris trichura and Enterobius vermicularis infections was 0.32%, 0.12% and 0.01%, respectively, and a single parasite infection was predominant. There were significant differences in the prevalence of soil-borne nematode (χ² = 42.610, P < 0.05), A. lumbricoides (χ² = 26.276, P < 0.05) and T. trichura (χ² = 20.692, P < 0.05). The prevalence of human soil-borne nematode infections was 0.45% in males and 0.47% in females, and lower prevalence was found in local residents than in floating population (0.28% vs. 0.66%; χ² = 10.561, P < 0.05). The highest infection was found in subjects at ages of 31 to 40 years (0.59%), followed by in subjects at ages of 41 to 50 years (0.56%), and the lowest infection was seen in children at ages of 3 to 5 years (0.27%). In addition, the prevalence of human soilborne nematode infections varied significantly in occupation (χ² = 75.692, P < 0.05), with the highest infection seen in boatmen. Among the 5 078 children monitored, the prevalence of E. vermicularis infection was 0.37%, and the prevalence of E. vermicularis infection varied significantly in year (χ²= 15.466, P < 0.05).

CONCLUSIONS

The human soil-borne nematode infection is at a low level in Danyang City; however, the surveillance of soil-borne nematodiasis remains to be intensified in children living in rural areas and immigrant populations.

Genome-wide analysis of differentially expressed lncRNA in sporadic parathyroid tumors

Diagnosis of parathyroid carcinoma on histological examination is challenging. Thousands of differentially expressed lncRNAs were identified on the microarray data between parathyroid cancer and adenoma samples. Four lncRNAs were significantly dysregulated in further validation. The "lncRNA score" calculated from these lncRNAs differentiated parathyroid carcinomas from adenomas. LncRNAs serve as biomarkers for parathyroid cancer diagnosis.

INTRODUCTION

Diagnosis of parathyroid carcinoma (PC) on histological examination is challenging. LncRNA profile study was conducted to find diagnostic biomarkers for PC.

METHODS

LncRNA arrays containing 91,007 lncRNAs as well as 29,857 mRNAs were used to assess parathyroid specimen (5 carcinomas and 6 adenomas). Bioinformatics analyses were also conducted to compare the microarray results between parathyroid carcinomas and adenomas (PAs). Differentially expressed lncRNAs of 11 PCs and 31 PAs were validated by real-time quantitative PCR.

RESULTS

On the microarray data between PC and PA samples (fold change ≥ 2, P < 0.05), 1809 differentially expressed lncRNAs and 1349 mRNAs also were identified. All carcinomas were clustered in the same group by clustering analysis using dysregulated lncRNAs or mRNAs. Four lncRNAs (LINC00959, lnc-FLT3-2:2, lnc-FEZF2-9:2, and lnc-RP11-1035H13.3.1-2:1) identified were significantly dysregulated in further RT-PCR validation. The global "lncRNA score" calculated from the lncRNAs above also differentiated parathyroid carcinomas from adenomas.

CONCLUSIONS

LncRNA profiling shows distinct differentially expressed lncRNAs in parathyroid neoplasm. They may play a key role in parathyroid cancer and serve as potential biomarkers to distinguish parathyroid cancers from parathyroid adenomas.

Clinical characteristics and treatments of patients with alpha-fetoprotein producing gastric carcinoma

Alpha-fetoprotein (AFP) is a well-known tumor marker of hepatic carcinoma and yolk sac tumor. Alpha-fetoprotein producing gastric carcinoma (AFPGC) is a rare type of gastric cancer with high malignancy and poor prognosis, which make it different from other types of gastric cancer. This rare gastric cancer patient subgroup is likely frequently misdiagnosed which may be related to lack of knowledge of the disease. The purpose of this article is to summarize the mechanism of AFP positive gastric cancer, classification, biological behavior and treatment, in order to assist clinical practitioners to detect AFPGC earlier and treat it better. Previous studies have showed that AFPGC has a complex pathophysiology mechanism. AFPGC is more aggressive and characterized by stronger proliferation, neovascularization, lymphatic invasion and distant metastasis. Furthermore, so far there has been no standard treatment for patients with AFPGC. Nevertheless, our present study summarizes some effective treatments based on previous research outcome. In conclusion, the present study demonstrates that the importance of detecting AFP routinely in serum and tissues in gastric cancer cases, which will greatly improve the diagnosis rate of AFPGC, and in regards to treatment, surgery, chemotherapy, targeted therapy and interventional treatment may have positive impacts on AFPGC treatment outcome. However, further study with a larger sample is required to confirm the reliability and validity of these methods.