[Effect of esmolol in septic shock patients with tachycardia: a randomized clinical trial]

Objective: To investigate the effect of esmolol in septic shock patients with tachycardia. Methods: A prospective randomized controlled trial was conducted. Screening septic shock patients that admitted to Department of General Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from June 2016 to August 2017. After 24 h resuscitation therapy, 100 cases of septic shock patients with tachycardia (heart rate>100 bpm) were divided into esmolol group (n=50) and control group (n=50) with random number table. Patients in esmolol group accepted standard treatment plus esmolol injection with an initial dose of 25 mg/h. Heart rate target is 80 to 100 bpm. Patients in esmolol group continued to use esmolol for 7 days or to the day the patient left the ICU when the heart rate didn't achieve the target. Patients in control group were given standard treatment. Primary outcome was 28 d mortality. Secondary outcomes included heart rate, norepinephrine dosages, lactate level, inflammatory markers in per day during the trial; acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) on day 1, 3, 5, 7; length of hospital stay, length of mechanical ventilation, medication time of vasoactive agent. The data were compared with t test or rank sum test between the two groups. Results: The 28 d mortality of esmolol group and control group was 62%, 68%, respectively(χ(2)=0.529, P=0.529). Logistic regression analysis showed that primary heart rate (increase of 10 bpm, OR=1.568, 95%CI: 1.039-1.238, P=0.027), primary APACHEⅡ (OR=1.134, 95%CI: 1.026-1.239, P=0.005), integral heart rate (per 10 bpm, OR=2.207, 95%CI: 1.400-3.479, P=0.001) were independent risk factors for 28 d mortality. Compared with control group, the esmolol group had a lower heart rate on day 1-7; but over all, there was no statistically significant difference in heart rate between the two groups (P>0.05). There was no significant difference in total does of norepinephrine, lactate level, inflammatory markers, APACHE Ⅱ, SOFA, length of hospital stay between the two groups (all P>0.05). Conclusion: Tachycardia significantly increases the risk of death in patients with septic shock, esmolol may decrease the mortality by controlling heart rate.

TT genotype of rs10036748 in TNIP1 shows better response to methotrexate in a Chinese population: a prospective cohort study

BACKGROUND

Methotrexate (MTX) is an efficacious treatment for psoriasis; however, its widespread application is limited by its unpredictable efficacy.

OBJECTIVES

To investigate the association of clinical factors and variants of psoriasis susceptibility genes with clinical responses to MTX in a prospective cohort.

METHODS

A total of 221 patients with psoriasis were recruited. Patients who achieved Psoriasis Area and Severity Index (PASI) improvement ≥ 75% at week 12 were defined as responders, whereas those with PASI improvement < 50% were defined as nonresponders. In 90 screening patients, genetic variants for 18 single-nucleotide polymorphisms in 14 susceptibility genes, and HLA-Cw6 status were initially compared for responders and nonresponders. Statistically significant associations in genetic variants were verified in all 221 patients.

RESULTS

Overall, 49% and 45% of patients achieved PASI 75 improvement during screening and verification stages, respectively. Concomitant arthritis with psoriasis and high body mass index (BMI) negatively affect the efficacy of MTX. TT genotype of rs10036748 in TNIP1 was significantly associated with PASI 75 response at week 12 (54% and 37%, P < 0·05). A significantly higher PASI 90 response was observed in patients with TT genotype of rs10036748 (27% vs. 12%, P < 0·01) and TC/TT genotype of rs4112788 in LCE3D (25% vs. 13%, P < 0·05) at week 12 compared with those who had other genotypes. After adjustment for all confounding factors, only BMI (P < 0·05), arthritis (P < 0·05) and genotype of rs10036748 (P < 0·05) were significantly associated with clinical responses to MTX.

CONCLUSIONS

Patients with psoriasis with TT genotype of rs10036748 in TNIP1, with lower BMI, without arthritis will achieve a better response to MTX.

[Three-level logistic analysis related to influencing factors on condom use among female sex workers aged 35 years and above in Qingdao]

Objective: To analyze the influencing factors on condom use among 35-years-or-older female sex workers (OFSWs) in Qingdao by using the three-level logistic model. Methods: From March to June 2014, OFSWs were recruited in Qingdao, using respondent-driven sampling. Related information on OFSWs and their recent five sexual partners (not including husband) were obtained by conducting a questionnaire survey on OFSWs. A Three-level logistic regression model was conducted to analyze the influencing factors of condom use between OFSWs and their sexual partners. Results: A total of 420 OFSWs participated the survey as well as information on 2 100 sexual partners. Results from the empty model showed that the use of condoms among OFSWs having an aggregation that related to the levels of working sites and their own behaviors. Results from the three-levels of logistic model analysis showed that, OFSWs that having had junior middle school education (OR=1.450, 95%CI: 1.054-1.994)/high school education or above (OR=2.264, 95%CI: 1.215-4.222), knowing the function of condom use (OR=2.004, 95%CI: 1.273-3.154) would have higher rates of condom use. OFSWs with higher score of attitude on condom use (OR=0.796, 95%CI: 0.745-0.849), having had syphilis infections in the past (OR=0.657, 95%CI: 0.478-0.902) would have lower rate of condom use. For the sexual partners, the rate of condom use among OFSWs' regular partners were higher than that of OFSWs' boyfriends (OR=15.291, 95%CI: 8.441-27.700; OR=29.032, 95%CI: 15.413-54.682). Conclusion: Condom use of OFSWs was affected by behaviors of both OFSWs themselves and their sexual partners. Prevention and control programs should focus on OFSWs and their sexual partners at the same time. The key intervention contents should include target populations as: OFSWs with low level of education, having had infections of syphilis, those who do not use condoms with their trusted partners.

[Significance of pelvic contrast enhanced MRA prior to prostatic artery embolization]

Objective: To assess the values of pelvic contrast enhanced magnetic resonance angiography (MRA) in detection of prostatic artery prior to prostatic arterial embolization(PAE). Methods: This multicenter, prospective study from 5 hospitals in China consisted of 47 patients (mean age (69±16) years, range 56-83 years) who underwent PAE for benign prostatic hyperplasia (BPH) between January 2016 and April 2018, preprocedural prediction of prostatic arteries were determined using contrast enhanced MRA.CE-MRA findings were compared with subsequent intraprocedural digital subtraction angiography (DSA) or DSA combined with cone-beam computed tomography (CT) to assess the sensitivity and specificity with which contrast enhanced MRA predicted the number and origins of prostatic artery, also to assess the optimal oblique projection of PA. Results: In total, 47 patients (94 pelvic sides) with 97 PAs confirmed by DSA or DSA combined with cone-beam CT at the time of embolization, MR angiography successfully identified 88 PAs and their origins , the sensitivity and specificity was 90.7% (88/97) and 93.6% (88/94), respectively.MR angiography correctly determined the bilateral prostatic artery origins in 36 (76.6%) cases.According to the optimal oblique projection of PAs suggested by MR angiography, the origins and trajectory of PAs of all patients underwent PAE with the same oblique projection (20°-45°ipsilateral anterior oblique direction) were clearly displayed when performed the first arteriography. Conclusion: Pelvic contrast enhanced MR angiography with high sensitivity and specificity in detection the origin, trajectory and number of PAs, and it could provide useful information regarding prostatic arteries before PAE.

Effect of γ-secretase inhibitor on Treg in PBMC of respiratory syncytial virus bronchiolitis children

Bronchiolitis is a widespread lower respiratory tract infection in infants and young children, and is closely related to the incidence of asthma, and T regulatory cells (Tregs) play a role in its pathogenesis.

[Development status of biliary tract imaging technology]

Structure of biliary system is complex as well as various, making troubles for optimal surgical treatment of biliary disease. Remarkable imaging of biliary system helps surgeon evaluating patients and planning surgeries. There are several methods to obtain accurate anatomical information of biliary system, such as X-ray fluoroscopy, MRI and fluorescence-based imaging. Each has its own advantages and disadvantages. Combination of multi-model imaging technologies may improve visual result of anatomical information of biliary tract. More resolvable, legible, and sequential imaging technology of biliary system remains further study. This article reviews various cholangiography methods widely used in the clinical setting.

Uptake and Translocation of Styrene Maleic Anhydride Nanoparticles in Murraya exotica Plants As Revealed by Noninvasive, Real-Time Optical Bioimaging

This work reports the in vivo uptake and translocation of PNPs in the one-year grown terrestrial plant, Murraya exotica ( M. exotica), as investigated by two-photon excitation and time-resolved (TPE-TR) optical imaging with a large field of view (FOV, 32 × 32 mm²) in a noninvasive and real-time manner. The PNPs (⟨ R_h⟩ = 12 ± 4.5 nm) synthesized from poly(styrene- co-maleic anhydride) (SMA) were Eu-luminescence labeled (λ_L ≈ 617 nm). On exposing the roots of living M. exotica plants to the colloidal suspension of SMA PNPs at different concentrations, the spatiotemporal evolution of SMA PNPs along plant stems (60 mm in length) were monitored by TPE-TR imaging, which rendered rich information on the uptake and translocation of PNPs without any interference from the autofluorescence of the plant tissues. The TPE-TR imaging combined with the high-resolution anatomy revealed an intercell-wall route in the lignified epidermis of M. exotica plants for SMA PNP uptake and translocation, as well as the similar accumulation kinetics at different positions along the plant stems. We modeled the accumulation kinetics with Gaussian distribution to account for the trapping probability of a SMA PNP by the lignified cell walls, allowing the statistical parameters, the average trapping time ( t_m) and its variance (σ), to be derived for the quantification of the PNP accumulation in individual plants. The TPE-TR imaging and the analysis protocols established herein will be helpful in exploring the mechanism of plant-PNP interaction under physiological condition.

[Study on the shift of ocular vestibular evoked myogenic potentials frequency tuning of Meniere's disease]

Objective: To study the shift of oVEMP frequency tuning of unilateral Meniere's disease, by analyzing oVEMP of air-conducted tone bursts in various frequencies. Methods: From May 2016 to October 2017, 33 patients with unilateral Meniere's from Aerospace Center Hospital were tested for oVEMP in 500 Hz and 1 000 Hz air-conducted tone bursts respectively, and 20 healthy subjects(40 ears), matched for age and sex, were used as healthy control. The amplitudes of the N1-P1 wave and the frequency amplitude ratios of 500/1 000 Hz in affected ears, unaffected ears and normal ears were compared; and receiver operating characteristic curve was analyzed for frequency amplitude ratios of 500/1 000 Hz. Results: By the 500 Hz tone-burst stimulus, the provocation rates of the oVEMP were 84.9%(28/33), 93.9%(31/33) and 97.5%(39/40) in affected ears, contralateral ears and the ears of normal controls, respectively. By the stimulus of 1 000 Hz tone-burst, the provocation rates of the oVEMP were 81.8%(27/33), 87.9%(29/33) and 82.5% (33/40) in affected ears, contralateral ears and normal control ears, respectively. Amplitudes of N1-P1 waveforms in 500 Hz air-conducted tone bursts in affected ears were under normal control ears and contralateral ears. There was significant difference between affected ears and healthy control ears (P<0.05). Amplitudes of N1-P1 waveforms in contralateral ears were also significantly smaller than those in normal control ears (P<0.05). There were no significant differences in amplitudes of N1-P1 waveforms between affected ears, contralateral ears and normal control ears in 1 000 Hz tone bursts stimulus(P>0.05). Frequency amplitude ratios of 500/1 000 Hz in affected ears were significantly under contralateral and normal control ears (P<0.05). According to ROC, the frequency amplitude ratio critical value of frequency tuning was set as 1.17, the positive rate of frequency tuning shift in affected ears was 54.5%(18/33) and significantly higher than in contralateral ears(18.2%, 6/33, χ(2)=9.429, P=0.002) and normal control ears (7.5%, 3/40, χ(2)=19.530, P=0.000). In contrast, there was no significant difference in the incidence of frequency tuning shift between contralateral ears and normal ears(χ(2)=1.909, P=0.167). Conclusions: Frequency tuning oVEMP with Meniere's disease will be changed.Frequency tuning of oVEMP with Meniere's disease shifts from low frequency region to high frequency region in comparison with healthy people. Frequency amplitude ratio is helpful for diagnosis of Meniere's disease.

[Risk factors for road traffic injury in agricultural vehicle drivers]

Objective: To examine the risk factors for road traffic injury in agricultural vehicle drivers. Methods: A total of 103 drivers (who had suffered agricultural vehicle road traffic injury within the past year based on the road traffic injury registrar from the Traffic Management Bureau) who were involved in the annual agricultural vehicle inspection from December 2014 to January 2015 were randomly sampled from the Yixing Agricultural Vehicle Station as the case group for this study. Based on a 1∶2 assignment ratio and matched for sex, age, and education, a total of 206 drivers who had not suffered any agricultural vehicle road traffic injury within the past year were selected as the control group. The general information, vehicle information, driving information, driving behavior, and accident details of the agricultural vehicle drivers were analyzed. Results: The incidence rate of road traffic injury was 7.24% given the 103 agricultural vehicle drivers who had suffered agricultural vehicle road traffic injury in the past year. Univariate logistic regression analysis showed that drinking, debt, pressure, history of car accident, history of drunk driving, smoking and phone use during driving, fatigue driving, and driving with illness were the risk factors for road traffic injury in agricultural vehicle drivers (OR=2.332, 2.429, 19.778, 5.589, 8.517, 2.125, 3.203, 10.249 and 5.639, respectively) . Multivariate logistic regression analysis also demonstrated that pressure, history of car accident, history of drunk driving, fatigue driving, and driving with illness were the risk factors for road traffic injury in agricultural vehicle drivers (OR=12.139, 11.184, 6.729, 5.939, and 6.544, respectively) . Conclusion: Pressure, history of car accident, history of drunk driving, fatigue driving, and driving with illness are the major risk factors for road traffic injury in agricultural vehicle drivers.

[Clinical analysis of one infantile nephrotic syndrome caused by COQ2 gene mutation and literature review]

Objective: To explore the clinical and genetic characteristics of infantile nephrotic syndrome caused by COQ2 variants. Methods: The clinical and genetic data of a patient with nephrotic syndrome caused by COQ2 variants diagnosed at pediatric department of Peking University First Hospital from February 2018 to March 2018 were retrospectively analyzed. Related literature retrieved from PubMed, CNKI and Wanfang databases were searched to date (up to July 2018) with "COQ2 gene" or "primary coenzyme Q10 deficiency" and "nephrotic syndrome" or "nephropathy" as key words. Results: A 14-month-old male, presented to local hospital at 11 months of age with edema and severe proteinuria, without hematuria, hypertension or renal dysfunction. He did not have infection or seizure in the course of the disease. He had no response to a more than four-week full-dose prednisone treatment. He had normal birth, mild motor development retardation and moderate language retardation. He was born to non-consanguineous healthy parents. He had two unaffected older sisters and one older sister died of "nephropathy" at one year of age. Genetic testing identified compound heterozygous variants in COQ2 gene: c.518G>A and c.973A>G, both could be predicted by in silico tools to be deleterious in protein function. These variants are not single nucleotide polymorphism and rare in normal populations. Both variants have previously been reported as pathogenic. These missense mutations were inherited from parents in autosomal recessive manner tested by Sanger sequencing. The patient was supplemented with high-dose of coenzyme Q10, at 30 mg/(kg·day) and glucocorticoid was withdrawn. Within three weeks of high dose coenzyme Q10 treatment, the edema disappeared. After seven weeks of high dose coenzyme Q10 treatment, the patient had decreased proteinuria and improved serum albumin levels. The urine protein to creatinine ratio decreased from 22.87 mg/mg to 1.98 mg/mg; Serum albumin increased from 14.2 g/L to 39.9 g/L, with normal kidney function and improved motor development. Primary CoQ10 deficiency is reported to be a rare autosomal recessive mitochondrial disorder with heterogeneous renal, neurologic, and muscular manifestations. To date, COQ2 variants have been reported in 14 children with glomerular involvement. Their age at onset ranged from neonatal period to 10-year-old (8 patients within the first year of life). Steroid resistant nephrotic syndrome (SRNS) is the most common phenotype. Some of these children also had progressing encephalopathy and myopathy, and seizures. Patients with COQ2 variants might show clinical improvement with early high-dose oral CoQ10 supplementation. Literature review revealed two Chinese articles, mainly about adults with neurologic symptoms. SRNS was previously not reported in Chinese pediatric patients. Conclusions: It is necessary to carry out genetic testing for infant with SRNS. The coexistence of some degree of encephalomyopathy, such as development retardation, should raise suspicion of a mitochondrial defect caused by COQ2 variants. Timely diagnostic genetic testing and early high dose of coenzyme Q10 supplement could significantly improve their prognosis.

[Comparison of safety between continued warfarin therapy and bridging anticoagulation therapy in patients undergoing coronary intervention]

Objective: To compare the safety of continued warfarin therapy and bridging anticoagulation therapy during hospital stay in patients undergoing percutaneous coronary intervention (PCI). Methods: We retrospectively analyzed patients on warfarin therapy referred for PCI in Beijing Anzhen Hospital from January 2008 to December 2016. The patients were divided into continued warfarin therapy (n=195) or bridging anticoagulation therapy (n=311) groups. After Propensity Score Matching, data from matched patients (n=123 in each group) were analyzed. Bleeding complications and major adverse cardiac events including death, myocardial infarction, target vessel revascularization, and stent thrombosis were assessed. Results: There were no significant difference in the rate of death (2.4%(3/123) vs. 1.6%(2/123),P=0.54), acute myocardial infarction (4.1%(5/123) vs. 4.9%(6/123), P=0.78),re-revascularization (0.8%(1/123) vs. 1.6%(2/123),P=0.16), stent thrombosis (1.6%(2/123) vs. 1.6%(2/123),P=1.00) and stroke between the two groups. Prevalence of minor bleeding complications was significantly higher in the bridging therapy group (15.4%(19/123) vs. 9.8%(12/123),P=0.01). Rate of access-site complications (hematoma:4.1%(5/123) vs. 2.4%(3/123),P=0.20; pseudoaneurysm:2.4%(3/123) vs. 2.4%(3/123),P=1.00; arteriovenous fistula:0.8%(1/123) vs. 1.6%(2/123),P=0.09; and retroperitoneal hematoma:0(0/123) vs. 0.8%(1/123),P=0.23) were similar between the two groups. Conclusion: For patients receiving chronic warfarin therapy, the uninterrupted oral anticoagulant treatment is as safe as bridging therapy in PCI patients.

[Clinical and immunological characteristics and predicted factors of vision outcome in patients with acute severe bilateral optic neuritis]

Objective: To analyze the clinical and immunological characteristics of acute severe bilateral optic neuritis, and to explore the predictive factors of vision outcome and relapse so as to save visual function and avoid or alleviate vision disability. Methods: Forty-eight inpatients confirmed with acute severe bilateral optic neuritis from January 2013 to June 2015 were included and followed up. The clinical features, immunological findings, optic nerve imaging, visual function outcome and predictors of relapse were statistically analyzed. Results: Acute severe bilateral optic neuritis accounted for 7.3% of the total number of optic neuritis in the same period. There were 35 cases (72.9%) with monophasic course, and 13 cases (27.1%) with recurrence or other central nervous system involvement during the follow-up period; 11 (22.9%) in 48 patients with positive AQP4-IgG; AQP4-IgG-positive patients had a higher recurrence rate (P<0.001) and poorer visual function prognosis (P=0.034) than antibody-negative patients; the baseline visual acuity (P=0.004), early treatment response (P=0.012) and number of involved optic nerve segments (P=0.016) were associated with end point visual function. Positive AQP4-IgG(OR 13.486, 95% CI 1.971-16.263)and combining with other autoimmune antibodies (OR 5.591, 95% CI 1.502-15.621)were independently associated with relapse. Conclusions: Acute severe bilateral optic neuritis is not unusual and may cause blindness or visual disability. The positive rate of AQP4-IgG and the recurrence rate of the disease are low in our study. The necessity for long-term immunotherapy requires individual consideration. The baseline visual acuity, involved segment number of optic nerve and response to early treatment are associated with prognosis of visual function. Patients with AQP4-IgG positive and other autoimmune antibodies are easy to relapse. Whether the antibody-negative bilateral optic neuritis is a heterogeneous disease and the relationship with classic NMO or NMOSD deserve further research.

[The analysis of clinical characteristics and disease activity in ankylosing spondylitis patients with hyperuircemia]

Objective: to investigate the clinical characteristics and disease activity in ankylosing spondylitis (AS) patients with hyperuricemia. Method: Laboratory tests, magnetic resonance imaging, disease activity and functional index of AS patients from Fudan University Zhongshan Hospital were collected. T test, square test were applied to investigate the difference between AS patients with hyperuricemia and AS patients with normal serum uric acid in clinical characteristics and disease activity in AS patients. Result: Among all the AS patients, 23.4% (22/94) patients accompanied with hyperuricemia. AS patients accompanied with hyperuricemia showed significant younger age (28.9±7.9 vs 35.8±11.1, P=0.002); higher serum alanine aminotransferase (33.6±23.6 vs 19.8±12.4, P=0.014), aspartate aminotransferase (23.8±8.7 vs 18.6±9.6, P=0.025) and creatinine (78.4±12.5 vs 69.8±13.3, P=0.009), lower Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (11.2±8.8 vs 17.9±12.0, P=0.027) and Bath Ankylosing Spondylitis Functional Index (BASFI) (0.7±0.9 vs 1.8±2.2, P=0.002) compared with AS patients whose serum uric acid level is normal. Conclusion: AS Patients with younger age, impaired hepatic and renal funtion and lower scores in BASDAI and BASFI tend to accompany with hyperuricemia.

[Four cases of acute respiratory distress syndrome patients transported with veno-venous extracorporeal membrane oxygenation]

Objective: To retrospectively review 4 cases diagnosed with pediatric acute respiratory distress syndrome (ARDS) who were transported with veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) from April 2016 to March 2017. Methods: Four patients were transported to Bayi Children's Hospital Afflicted to the PLA Army General Hospital, with V-V ECMO. Their vital signs, blood-gas analysis and chest X-ray before and after transportation were compared. The length of ECMO, pediatric intensive care unit (PICU) stay and hospitalization, and the prognosis were analyzed. Results: All the four cases were transported to our hospital successfully from distances between 1 000 km to 1 210 km. The 4 cases were 4 to 6 years old with the body weight of 19 to 35 kg, of whom 3 were boys and 1 was girl. The catheters were inserted in the right jugular vein and femoral vein. The vital signs and blood-gas analysis after transportation did not change significantly compared to baseline. The length of ECMO for the four patients were 48, 754, 157 and 438 hours. They stayed in the PICU for 10, 32, 14 and 19 days, respectively. At last, 2 of them were successfully discharged from hospital without any complications; however, the other 2 died of multiple organ failure. Conclusion: Transporting ARDS patients with a satisfactory cardiac function under VV-ECMO by an experienced ECMO team is safe.

[Coronary microvascular resistance and its relevant factors in patients with moderate coronary stenosis and chest pain]

Objective: To evaluate the impact of cardiovascular risk factors on index of microvascular resistance (IMR) and coronary flow reserve (CFR) and to explore the characteristics of IMR and CFR and the relationship between IMR and angiographic features in patients with intermediate coronary stenosis and chest pain. Methods: Fractional flow reserve (FFR), CFR, and IMR were measured in patients who underwent invasive coronary angiography with 40%-70% stenosis by visual assessment. All patients with FFR>0.75 were enrolled and grouped with the cut-off points of IMR≥25 and CFR≤2.0. Patients with IMR≥25 were group H, including two sub-groups (high IMR-low CFR, group H₁ and high IMR-high CFR, group H₂), while those with IMR<25 were group N. The thrombolysis in myocardial infarction (TIMI) frame were counted. Results: A total of 34 patients with FFR>0.75 were enrolled with 61.8%(21 cases) of males and 38.2% (13 cases) of females. The mean age was (57.3±8.1) years old. High IMR accounted for 47.1% of all cases. There was significant difference between group H and N in TIMI frame (33.0 vs. 20.8, P=0.031). There were significant differences between group H₁ and H₂ in homocysteine (17.8 µmol/L vs. 12.0 µmol/L, P=0.005) and IMR_corr (58.0 vs. 36.1, P=0.002). IMR_corr was correlated to TIMI frame (r=0.40, P=0.012) for all cases. The sensitivity and specificity of inferring IMR≥35.3 by TIMI frame were 0.75 and 0.65 (P=0.049) with TIMI frame over 40.5. Conclusions: High IMR may be one of the reasons for chest pain in patients with intermediate coronary stenosis. There is no correlation between vascular risk factors and IMR or CFR, while there is positive correlation between TIMI frame and IMR. The specificity is 65% for inferring IMR rise with TIMI frame over 40.5.

[Reliability and validity of Driving Anger Scale in professional drivers in China]

Objective: To assess the reliability and validity of the Chinese version of Driving Anger Scale (DAS) in professional drivers in China and provide a scientific basis for the application of the scale in drivers in China. Methods: Professional drivers, including taxi drivers, bus drivers, truck drivers and school bus drivers, were selected to complete the questionnaire. Cronbach's α and split-half reliability were calculated to evaluate the reliability of DAS, and content, contract, discriminant and convergent validity were performed to measure the validity of the scale. Results: The overall Cronbach's α of DAS was 0.934 and the split-half reliability was 0.874. The correlation coefficient of each subscale with the total scale was 0.639-0.922. The simplified version of DAS supported a presupposed six-factor structure, explaining 56.371% of the total variance revealed by exploratory factor analysis. The DAS had good convergent and discriminant validity, with the success rate of calibration experiment of 100%. Conclusion: DAS has a good reliability and validity in professional drivers in China, and the use of DAS is worth promoting in divers.

Multiple variants in 5q31.1 are associated with systemic lupus erythematosus susceptibility and subphenotypes in the Han Chinese population

BACKGROUND

A previous study provided evidence for a genetic association between PPP2CA on 5q31.1 and systemic lupus erythematosus (SLE) across multi-ancestral cohorts, but failed to find significant evidence for an association in the Han Chinese population.

OBJECTIVES

To explore the association between this locus and SLE using data from our previously published genome-wide association study (GWAS).

METHODS

Single-nucleotide polymorphisms (SNPs) rs7726414 and rs244689 (near TCF7 and PPP2CA in 5q31.1) were selected as candidate independent associations from a large-scale study in a Han Chinese population consisting of 1047 cases and 1205 controls. Subsequently, 3509 cases and 8246 controls were genotyped in two further replication studies. We then investigated the SNPs' associations with SLE subphenotypes and gene expression in peripheral blood mononuclear cells.

RESULTS

Highly significant associations with SLE in the Han Chinese population were detected for SNPs rs7726414 and rs244689 by combining the genotype data from our previous GWAS and two independent replication cohorts. Further conditional analyses indicated that these two SNPs contribute to disease susceptibility independently. A significant association with SLE, age at diagnosis < 20 years, was found for rs7726414 (P = 0·001). The expression levels of TCF7 and PPP2CA messenger RNA in patients with SLE were significantly decreased compared with those in healthy controls.

CONCLUSIONS

This study found evidence for multiple associations with SLE in 5q31.1 at genome-wide levels of significance for the first time in a Han Chinese population, in a combined genotype dataset. These findings suggest that variants in the 5q31.1 locus not only provide novel insights into the genetic architecture of SLE, but also contribute to the complex subphenotypes of SLE.

Association of NUDT15 c.415C>T allele and thiopurine-induced leukocytopenia in Asians: a systematic review and meta-analysis

BACKGROUND

Thiopurines, commonly used to treat autoimmune conditions and cancer, can be limited by life-threatening leucopenia. However, whether NUDT15 (nucleoside diphosphate-linked moiety X-type motif 15) is associated with thiopurine-induced leucopenia in Asians is controversial.

METHODS

Relevant studies in English that were published until July 10, 2016 were identified through PubMed, EMbase, and other web knowledge databases. Study quality was assessed according to the Newcastle-Ottawa Scale (NOS) criteria. Summary risk ratio (RR) and 95% confidence intervals (CI) were estimated based on a fixed-effects model or a random-effects model, depending on the absence or presence of significant heterogeneity.

RESULTS

Seven studies of 1138 patients met our inclusion criteria. Random-effects model meta-analysis provided evidence that T carriers of NUDT15 c.415C>T were significantly correlated with high incidences of thiopurine-induced leukocytopenia [CT + TT vs. CC: RR = 3.79, 95%CI (2.64 ~ 5.44), P < 0.00001]. This correlation was especially strong in TT patients, where it was found to be significantly increased by 6.54-fold compared with CC patients [TT vs. CC: RR = 6.54, 95%CI (3.34 ~ 12.82), P < 0.00001]. We also found that the NUDT15 c.415C>T variant was common in Asians and Hispanics, but rare in Europeans and Africans; the frequency of the NUDT15 c.415C>T distribution varied substantially by race/ethnicity.

CONCLUSION

The results of this meta-analysis confirm that NUDT15 c.415C>T may be an important predictor of thiopurine-induced leukocytopenia in Asians. Genotype targeting of NUDT15 c.415C>T before initiating thiopurine treatment may be useful to limit leukocytopenia.

Effect of developmental stage of embryos at freezing on live birth outcomes after frozen embryo transfer

　　Purpose Our objective was to evaluate the birth outcomes of FET from different developmental stage of embryo at freezing (Day 3, Day 5 and Day 6). Methods All vitrified-warmed day 3 (D3) and day 5/6 (D5, D6) embryo transfers during the time period from January 2013 until December 2015 were included in the study. The Birthweight, Low birthweight (LBW), sexual distinction, gestation and for singleton births and twins conceived by FET were compared retrospectively between three cryopreservation strategies utilizing either D3, D5 or D6 embryo freezing. All embryos were vitrified by Dimethylsulfoxide (DMSO), Ethylene glycol (EG) and Sucrose used as Cryoprotectants and using Cryoleaf as the receptacles. Results A total of 993 infants from 771 women. The length of embryos storage was 3-38 months, with a median of 8 months. For singleton, birthweight from D5 and D6 blastocysts transfers were significantly heavier than for D3 cleavage-stage embryos transfers (P =0.0065 P =0.0006). For twins, birthweight from D6 blastocysts transfers were significantly heavier than for D5 blastocysts transfers (P =0.0044), and children born after D3 were at a signigicantly increased risk of being born a LBW. Conclusions Birthweights from FET are influenced by developmental stage of embryos at freezing, which were lower for cleavage-stage embryos transfer than blastocysts transfer after FET in singletons. The birth rate of LBW infants was higher in the twins. The study was small so there may be other factors than cryopreservation which affected outcomes. A higher sample size or a multi-centre prospective randomized design could be used in future studies to corroborate the current findings.

[Effect of oxidative stress-associated damage to the lung tissue caused by different body mass index in the rat models]

Objective: To investigate the influence of different diets on serum protein expression levels of 4-hydroxynonenal (4-HNE), thioredoxin (Trx), thioredoxin reductase (TrxR) and the activities of Trx and TrxR, and to explore the effect of damage to the lung tissue and the underlying mechanisms of different body mass index caused by different diets in the rat models . Method: Healthy clean male SD rats were randomly divided into normal group, emaciation group and fat group, which were raised by different diets for 6 months.Then the rats were sacrificed and the serum and lung tissue were prepared. The levels of 4-HNE, Trx and TrxR in peripheral blood were quantitatively analyzed by enzyme-linked immunosorbent assay(ELISA), and the activities of Trx and TrxR were measured by chemical methods. Results: Compared with the normal group, the lung tissue had more apparent emphysema in the emaciation and the fat groups under light microscope, and more inflammatory cell infiltration in alveolar septum was observed in the fat group.The levels of 4-HNE in the fat group[(24.7±8.7)mg/L]was significantly higher than that in the normal group[(15.4±4.7)mg/L, P<0.05)], but there was no significant difference(P>0.05)in the levels of 4-HNE between the emaciation and the normal groups. The levels of TrxR in the emaciation group[(7.7±1.4)μg/ml]was significantly higher than that in the normal and the fat groups[(6.2±1.1), (4.9±1.4)μg/ml, all P<0.05)]. The level of TrxR in the fat group was significantly lower than that in the normal group(P<0.05); The differences in the levels of Trx among the 3 groups were not significant(P>0.05). The activity of Trx in the emaciation group[(32.4±8.5)×10^-3A·min^-1·mg^-1]was significantly higher than that in the normal group[(19.6±3.3)×10^-3A·min^-1·mg^-1]and the fat group[(11.3±7.5)×10^-3A·min^-1·mg^-1, all P<0.01]. The activity of Trx in the fat group was significantly lower than that in the normal group(P<0.05). The activity of TrxR in the emaciation group[(17.6±4.6)×10^-3A·min^-1·mg^-1]was significantly higher than that in the fat group[(7.8±2.3)×10^-3A·min^-1·mg^-1, P<0.01], but the TrxR activity of the 2 groups showed no significant difference as compared with the normal group(P>0.05). Conclusion: Both high BMI and low BMI can affect the oxidative stress of the body, resulting in increased oxidants and decreased antioxidants, and can cause damage to the lung tissue in the rat models.

[Study on correlation between retinal vessel morphology or ocular hemodynamic parameter and internal carotid artery stenosis]

Objective: To analyze the correlation between retinal vascular calibers, ocular blood flow parameters and internal carotid artery stenosis and to evaluate the effect of internal carotid artery stenosis on ocular blood vessels comprehensively. Methods: A retrospective case-control study. The clinical data of 141 patients who underwent head-and-neck computed tomography (CT) angiography examinations of the ICA were collected at Beijing Friendship Hospital, Capital Medical University from January 2014 to January 2016. According to diagnostic criteria, the patients were divided into four groups: the non-stenosis group, the mild stenosis group, the moderate stenosis group, and the severe stenosis andocclusion group. The retinal vascular caliber was measured in color fundus photograph by IVAN software. Color Doppler ultrasonography was used to measure the parameters of ocular blood flow, including the peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI). The enumeration data were analyzed with chi-square test, the measurement data were analyzed with rank-sum test, and the correlation test was performed with spearman. Results: The gender ratio of the patients without stenosis, mild stenosis, moderate stenosis, severe stenosis and occlusion was 12/7, 31/19, 28/25, 12/7, χ² test was not statistically significant (χ²= 0.79, P=0.85); There was no statistically significant difference between the different groups (χ²= 0.15, P=0.68), the age of four groups were (64.1±8.3), (54.3±14.3), (68.9±11.8) and (59.1±8.0) y, respectively. In the no internal carotid artery stenosis group, the arteries diameter is (164.5±15.6) μm ,the vein diameter is (245.6±20.0) μm and the arteriovenous ratio is 0.7±0.1. There is no difference among the mild stenosis group, moderate stenosis group and the severe stenosis (χ²_{artery calibe}r=6.92, P_{artery calibe}r=0.08; χ²_{vein diamete}r=4.16, P_{vein diamete}r=0.25; χ²_{arteriolar-venular ratio}=1.38,P_{arteriolar-venular ratio}=0.71) . The PSV of central retinal artery in the above groups were (14.6±3.6), (34.4±13.2), (35.7±14.6), (42.3±19.0)cm/s respectively, the data were analyzed by rank-sum test and there was a significant difference (χ²=13.44, P< 0.01) ; The PSV of the posterior ciliary artery in the above groups (17.6±6.5), (15.0±4.6), (13.4±4.3) and (11.0±3.2)cm/s respectively, the data were analyzed by rank-sum test and there was a significant difference (χ²=22.71, P<0.01) , EDV were (5.90±2.2), (5.1±2.1), (4.3±1.5) and (4.3±4.8)cm/s respectively and there was a significant difference (χ²=20.36, P<0.01) .There was a correlation between retinal artery diameter, PSV and EDV of the central retinal artery, PSV and EDV of the posterior ciliary artery and the diameter of the internal carotid artery but without linear correlation. (r_{artery calibe}r=-0.23, P_{artery calibe}r=0.01; r_{PSV of central retinal artery}= -0.29, P_{PSV of central retinal artery}<0.01; r_{PSV of posteri or ciliary artery}=-0.34, P_{PSV of posterior ciliary artery}<0.01, r_{EDV of posterior ciliary artery}=-0.35, P_{EDV of posterior ciliary artery}<0.01). Conclusions: There was a correlation between retinal artery diameter, PSV and EDV of the central retinal artery, PSV and EDV of the posterior ciliary artery and the diameter of the internal carotid artery. PSV of the central retinal artery, PSV and EDV of the posterior ciliary artery changed significantly when the internal carotid artery stenosis existed. (Chin J Ophthalmol, 2016, 52: 905-910).

MYBA2 gene involved in anthocyanin and flavonol biosynthesis pathways in grapevine

MYBA2 transcription factor (Myb-related gene) affects the coloring in grapevine berry and plays an important role in the biosynthesis of anthocyanin. The MYBA2 gene was cloned from Vitis vinifera L. cv. Cabernet Sauvignon and polyclonal antibodies for VvmybA2 were prepared. The VvmybA2 gene expression patterns were observed in seven tissues (the leaf, stem, flower, bud, root, berry, and tendril) and during the berry development stage at transcriptional and translational levels, respectively. The results indicated that the expression of VvmybA2 was approximately 11-fold higher in the berry than that in the other six tissues, and increased rapidly from 60 days after full bloom reaching a maximum on day 80. Furthermore, both the anthocyanin content and UDP-glucose:flavonoid-3-O-glucosyltransferase (UFGT) gene expression levels increased rapidly 60 days after full bloom. Moreover, correlation analysis indicated that the transcriptional and translational expression levels of the VvmybA2 gene were significantly positively correlated with not only UFGT and DFR genes but also with the anthocyanin content during berry development. These results suggested that VvmybA2 could not only regulate the transcription of both UFGT and DFR but also is involved in the expression of the UFGT gene associated with color determination in grape berries.

FBX8 is a metastasis suppressor downstream of miR-223 and targeting mTOR for degradation in colorectal carcinoma

F-box proteins are critical components of the SKP1-CUL1-F-box (SCF) E3 ubiquitin ligases and involved in the ubiquitin-dependent proteolytic pathway. Dysregulation of F-box protein-mediated proteolysis often leads to human malignancies. F-box only protein 8 (FBX8), a novel component of F-box proteins, is down-regulated in several tumors and closely correlates with tumor progression. However, little is known about its function, regulatory mechanisms and substrates in the progression of colorectal carcinoma (CRC). Combining microRNA (miRNA) assay, functional characterization, mechanistic studies with clinical validation, we identify FBX8 as a CRC metastasis suppressor downstream of miR-223, a metastasis promoting miRNA that is transcriptionally regulated by Myocyte enhancer factor (MEF2A). mTOR is a substrate of FBX8 for ubiquitin-mediated degradation and is required for FBX8 induced cell proliferation and invasion in CRC cells. FBX8 is down-regulated in human CRC tissues and correlates with MEF2A, miR-223 and mTOR expression levels. Notably, low FBX8 expression status in CRC tissues was a significant prognostic factor for poor overall survival of patients. These findings illustrate FBX8 as a metastasis suppressor that functions through mTOR signaling pathway and has significant prognostic power.