Dose-response relationship between serum fibroblast growth factor 21 and liver fat content in non-alcoholic fatty liver disease

BACKGROUND & AIM

Although serum fibroblast growth factor 21 (FGF21) levels are associated with liver fat content in non-alcoholic liver fat disease (NAFLD), the precise nature of the association remains undetermined. Therefore, this study aimed to explore the potential dose-response relationship between FGF21 and liver fat content in NAFLD.

METHODS

For this exploratory study from a randomized trial, 220 NAFLD patients with central obesity were recruited via community-based screening and randomly assigned to either control, moderate or vigorous-moderate exercise groups for 12 months. After this exercise intervention, patients were followed-up for a further 12 months. Serum FGF21 levels were measured by ELISA. Intrahepatic triglyceride (IHTG) content was determined by proton magnetic resonance spectroscopy.

RESULTS

Of the 220 patients, 149 (67.7%) were female; mean age was 53.9 ± 7.1 years and mean BMI was 28.0 ± 2.9 kg/m² for all patients. Baseline IHGT increased gradually (P = 0.029 for trend) according to baseline serum FGF21 quartiles 1, 2, 3 and 4 (212.3, 358.9, 538.7 and 793.5 pg/mL, respectively). On grouping the distribution of serum FGF21 level changes into quartiles at month 12, the relative IHTG loss increased as serum FGF21 levels were reduced (P = 0.004 for trend). A similar trend was observed at month 24 (P = 0.006 for trend). Multivariate linear regression analysis revealed that changes in serum FGF21 levels were independently associated with changes in IHTG at both month 12 [β (SE), 0.136 (0.118); P = 0.048] and month 24 [β (SE), 0.152 (0.139); P = 0.041]. Using restricted cubic spline regression, changes in serum FGF21 were strongly and positively associated with their corresponding relative IHTG loss at both month 12 and follow-up (P_overall = 0.017, P_non-linear = 0.044 and P_overall = 0.020, P_non-linear = 0.361, respectively, for dose-response).

CONCLUSION

Serum FGF21 is strongly associated with liver fat content in a dose-response manner in centrally obese NAFLD patients. These findings support the use of serum FGF21 as a biomarker of liver fat content in NAFLD.

Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China

Background

This study attempts to understand coronavirus disease 2019 (COVID-19) vaccine demand and hesitancy by assessing the public’s vaccination intention and willingness-to-pay (WTP). Confidence in COVID-19 vaccines produced in China and preference for domestically-made or foreign-made vaccines was also investigated.

Methods

A nationwide cross-sectional, self-administered online survey was conducted on 1–19 May 2020. The health belief model (HBM) was used as a theoretical framework for understanding COVID-19 vaccination intent and WTP.

Results

A total of 3,541 complete responses were received. The majority reported a probably yes intent (54.6%), followed by a definite yes intent (28.7%). The perception that vaccination decreases the chances of getting COVID-19 under the perceived benefit construct (OR = 3.14, 95% CI 2.05–4.83) and not being concerned about the efficacy of new COVID-19 vaccines under the perceived barriers construct (OR = 1.65, 95% CI 1.31–2.09) were found to have the highest significant odds of a definite intention to take the COVID-19 vaccine. The median (interquartile range [IQR]) of WTP for COVID-19 vaccine was CNY¥200/US$28 (IQR CNY¥100–500/USD$14–72). The highest marginal WTP for the vaccine was influenced by socio-economic factors. The majority were confident (48.7%) and completely confident (46.1%) in domestically-made COVID-19 vaccine. 64.2% reported a preference for a domestically-made over foreign-made COVID-19 vaccine.

Conclusions

The findings demonstrate the utility of HBM constructs in understanding COVID-19 vaccination intent and WTP. It is important to improve health promotion and reduce the barriers to COVID-19 vaccination.

This study investigated vaccine demand and hesitancy by assessing the intention to vaccinate against COVID-19 and willingness-to-pay. We found that a considerable proportion of the public in China has a definite intention to receive the COVID-19 vaccine; a higher proportion expressed a probable intention. Perceived benefits and barriers to vaccination (namely vaccine efficacy and adverse event concerns) of the health belief model constructs were significant predictors of COVID-19 vaccination intent. A substantial proportion was concerned about fake or faulty COVID-19 vaccines; however, this was not a significant predictor of vaccination intention. The willingness-to-pay for the COVID-19 was determined and was found to be positively associated with income. Higher confidence in domestically-made COVID-19 vaccines was also found in this study. The preference for domestically-made over foreign-made COVID-19 vaccines indicates that a future COVID-19 vaccine developed by domestic companies will receive a favourable response from the public in China.The findings of this study provide useful guidance for tailored interventions to enhance the acceptance of a new COVID-19 vaccine once it is available. Promotional messages framing the benefit of vaccination and concerns about new vaccine safety to enhance vaccine uptake is warranted.

Cinnamic Acid Increased the Incidence of Fusarium Wilt by Increasing the Pathogenicity of Fusarium oxysporum and Reducing the Physiological and Biochemical Resistance of Faba Bean, Which Was Alleviated by Intercropping With Wheat

BACKGROUND

Continuous cropping has resulted in the accumulation of self-toxic substances in faba beans which has restricted their global production. Intercropping is widely used to alleviate these problems.

AIMS

To explore the role of cinnamic acid stress in faba bean physiology and disease resistance, and the potential mitigating effects of intercropping the faba bean with wheat.

METHODS

Faba bean seedlings were grown with or without wheat in both field and hydroponic conditions in the presence of different cinnamic acid concentrations and Fusarium oxysporum (FOF), the occurrence of. Fusarium-mediated wilt and oxidative stress, as well as plant growth indices and the anti-pathogen defense system were analyzed.

RESULTS

Cinnamic acid significantly increased Fusarium pathogenicity, inhibited the activity of defense enzymes and reduced the ability of plants to resist pathogens, indicating the importance of cinnamic acid in the promotion of Fusarium wilt resulting in reduced seedling growth. Intercropping with wheat improved plant resistance by alleviating cinnamic acid-induced stress, which promoted crop growth and decreased the incidence and disease index of Fusarium wilt.

CONCLUSION

Cinnamic acid promotes Fusarium wilt by stimulating pathogen enzyme production and destroying the defense capability of faba bean roots. Intercropping reduces Fusarium wilt by alleviating the damage caused by cinnamic acid to the defense system of the faba bean root system.

Replication, pathogenicity, and transmission of SARS-CoV-2 in minks

Minks are raised in many countries and have transmitted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to humans. However, the biologic properties of SARS-CoV-2 in minks are largely unknown. Here, we investigated and found that SARS-CoV-2 replicates efficiently in both the upper and lower respiratory tracts, and transmits efficiently in minks via respiratory droplets; pulmonary lesions caused by SARS-CoV-2 in minks are similar to those seen in humans with COVID-19. We further found that a spike protein-based subunit vaccine largely prevented SARS-CoV-2 replication and lung damage caused by SARS-CoV-2 infection in minks. Our study indicates that minks are a useful animal model for evaluating the efficacy of drugs or vaccines against COVID-19 and that vaccination is a potential strategy to prevent minks from transmitting SARS-CoV-2.

[Effect and mechanism of PRDX1 in epithelial mesenchymal transformationin of gastric cancer cells]

Objective: To explore the effect and mechanism of peroxiredoxin1 (PRDX1) in epithelial mesenchymal transformation (EMT) of gastric cancer cells. Methods: The expression of PRDX1 protein was detected by immunohistochemistry (IHC) in 70 paraffin specimens of cancer and normal mucosa adjacent to gastric cancer, and the relationship between PRDX1 protein and clinicopathological characteristics was analyzed. Then PRDX1-small interfering RNA (siRNA) was synthetized and transfected into human gastric cancer cell line AGS, and 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide (MTT) assay was used to test cell proliferation. Transwell chamber assay was employed to test invasion of cells. Real-time quantitative polymerase chain reaction (RT-qPCR) and western blot were utilized to test the expressions of PRDX1, E-cadherin, N-cadherin, vimentin, and claudin-1. Results: The positive rate of PRDX1 protein expression in gastric cancer was 81.4%, higher than that in normal mucosa (27.1%, P<0.05). The expression of PRDX1 protein was related to invasive depth and lymph node metastasis of gastric cancer (P<0.05). The expressions of PRDX1 mRNA and protein in AGS cells (2.216±0.445, 1.212±0.136), were higher than those in GES-1 cells (0.342±0.041, 0.328±0.038) (P<0.05). When PRDX1-siRNA was transfected into AGS cells, the proliferation of AGS cells was significantly inhibited (all P<0.05). The invasion and migration rate of AGS cells in the transfection group [(112.00±17.98), (50.87±9.79)%] were significantly lower than those of the negative control group [(192.50±22.02), (83.03±8.67)%] and blank control group [(193.83±22.40), (82.40±7.21)%] (all P<0.05). The expressions of mRNA and protein of N-cadherin, vimentin and claudin-1 decreased, while the expression of E-cadherin increased when PRDX1-siRNA was transfected into AGS cells (P<0.05). Conclusion: PRDX1 may promote the development of gastric cancer by regulating the EMT of gastric cancer cells.

Pyridoxine for prevention of hand-foot syndrome caused by chemotherapy agents: a meta-analysis

BACKGROUND

Hand-foot syndrome (HFS) is a common systemic skin toxicity syndrome caused by chemotherapy agents. However, there is no uniform clinical treatment for HFS. It is reported that pyridoxine (vitamin B6) can be used to prevent HFS, but the evidence is insufficient.

AIM

To determine whether pyridoxine can be used to prevent HFS caused by chemotherapy agents.

METHODS

Literature database searches were performed on PubMed, Web of Science, Embase, Cochrane Library and China National Knowledge Infrastructure. The efficacy of pyridoxine was evaluated by the incidence of HFS (any grade) or severe HFS (grade ≥ 2).

RESULTS

Fourteen studies involving 1570 patients were included in this meta-analysis. There were no significant differences between the pyridoxine and control groups in the prevention of HFS (OR = 0.84, 95% CI 0.67-1.05, P = 0.09) or in the incidence of grade ≥ 2 HFS (OR = 0.87, 95% CI 0.70-1.09, P = 0.39, respectively). The subgroup analysis of pyridoxine dose also showed no significant difference between the two groups in preventing HFS grade ≥ 2 (OR = 0.79, 95% CI 0.62-0.99, P = 0.30).

CONCLUSIONS

We did not find adequate evidence to support the idea that the use of pyridoxine can prevent HFS and reduce the incidence of HFS grade ≥ 2. However, the preventive use of pyridoxine might have a tendency to reduce the incidence of HFS.

Leukocyte immunoglobulin-like receptor A3 is increased in IBD patients and functions as an anti-inflammatory modulator

Growing evidence shows that a homozygous 6·7-kb deletion of the novel anti-inflammatory molecule leukocyte immunoglobulin-like receptor A3 (LILRA3) is associated with many autoimmune disorders. However, its effects on pathogenesis of inflammatory bowel disease (IBD) have yet not been clarified. LILRA3 is mainly expressed in monocytes, whereas its effects on biological behaviors of monocytes have not been systematically reported. In our study, to investigate the association between LILRA3 polymorphism and IBD susceptibility, LILRA3 polymorphism was assessed in 378 IBD patients and 509 healthy controls. Quantitative real time PCR (qRT-PCR), Western blot and immunohistochemistry (IHC) were employed to detect the LILRA3 expression in IBD patient blood and intestinal samples. The human U937 monocyte cell line was employed to establish LILRA3 over-expressing cells and the effects of LILRA3 on the biological behaviors of U937 cells were systematically explored. Although no association of the polymorphism with IBD development was found, LILRA3 expression was markedly increased in IBD patients compared with healthy controls. Over-expression of LILRA3 in monocytes led to significant decreases in secretion of interferon (IFN)-γ, tumor necrosis factor (TNF)-α and interleukin (IL)-6. Additionally, LILRA3 abated monocyte migration by reducing the expression of several chemokines and enhanced monocyte phagocytosis by increasing CD36 expression. Furthermore, LILRA3 promoted monocyte proliferation through a combination of Akt and extracellular receptor kinase/mitogen-activated protein kinase (Erk/MEK) signaling pathways. We report for the first time, to our knowledge, that LILRA3 is related to IBD and functions as an anti-inflammatory modulator in U937 cells.

The decision-making of treatment and outcome in elderly patients with symptomatic severe aortic stenosis

Background

The prevalence of aortic stenosis (AS) steadily increases with age. There is a consensus that intervention should be advised in patients with symptomatic severe AS. However, decision to operate raises complex issues in the elderly due to the increasing operative comorbidity and mortality. There is limited information regarding the characteristics and outcome of elderly patients with symptomatic severe AS who were denied intervention and the reasons leading to the denial.

Purpose

To analyze the decision-making and the prognosis in elderly patients with symptomatic severe AS.

Methods

In a cohort of 8929 patients aged ≥60 years with significant valvular heart disease, we divided patients with severe (valve area ≤1 cm2 or peak velocity ≥4.0 m/s or mean gradient ≥40 mmHg), symptomatic (angina or NYHA II-IV or syncope) AS into three groups by final treatment decision: intervention group, doctor-deny group, patient-deny group. The impact of characteristics on decision-making was evaluated and 1-year mortality among three groups were compared.

Results

Among 546 patients with severe symptomatic AS, the interventional decision was taken in 338 patients (61.9%), 134 patients (24.5%) were denied intervention by doctor after evaluation and 74 patients (13.5%) refused intervention due to personal preference. In multivariable analysis, age [OR=1.104, 95% CI (1.068–1.142)], multi-comorbidities [OR=4.706, 95% CI (2.355–9.403)] and left ventricular end-diastolic diameter (LVEDD) [OR=1.021, 95% CI (1.001–1.042)] were markedly associated with the conservative decision made by doctor, while LVEF &gt;50% [OR=0.260, 95% CI (0.082–0.823)] was significantly linked with the interventional decision. Lower mortality was observed in intervention group during 1-year follow-up compared with either doctor-deny group or patient-deny group (both P&lt;0.001 after adjustment). Further, diabetes [HR=2.513, 95% CI (1.243–5.084)], syncope [HR=2.856, 95% CI (1.338–6.098)], atrial fibrillation (AF) [HR=2.764, 95% CI (1.305–5.855)], stroke [HR=2.921, 95% CI (1.252–6.851)] and multi-comorbidities [HR=3.120, 95% CI (1.363–7.142)] were strong 1-year mortality predictors, whereas interventional treatment [HR=0.195, 95% CI (0.091–0.417)] and LEVF &gt;50% [HR=0.960, 95% CI (0.938–0.984)] were related to lower mortality.

Conclusions

Intervention was denied in about forty percent of elderly patients with symptomatic severe AS. Patients with advanced age, multi-comorbidities and increased LVEDD tended to be denied intervention by doctors, whereas interventions were more likely to be performed on patients with normal LVEF. Diabetes, syncope, AF, stroke and multi-comorbidities were the predictive factors of 1-year mortality. Elderly patients with symptomatic severe AS could benefit from intervention. Patient education needs to be strengthened, to encourage more patients accept the appropriate intervention.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Twelfth Five-year Science and Technology Support Projects by Ministry of Science and Technology of China

Optimal timing of delayed percutaneous coronary intervention in stable patients with ST-segment elevation myocardial infarction

Background

There is ongoing controversy and limited data about the optimal timing to perform delayed percutaneous coronary intervention (PCI) in stable ST-segment elevation myocardial infarction (STEMI) patients who have missed opportunities for acute reperfusion therapy and are in absence of ongoing ischemia.

Purpose

To evaluate the effects of timing of delayed PCI on short- and long-term safety outcomes in stable STEMI patients.

Methods

A cohort of 3,048 stable STEMI patients without acute reperfusion therapy who underwent delayed PCI were included in the study. Procedural timing was stratified into three groups: &lt;3d, 3–7d, &gt;7d. Primary outcomes were 30-day and 12-month major adverse cardiac events (MACE), a composite of death and reinfarction. Multivariate logistic and Cox regression models were performed.

Results

After multivariate adjustment, restricted cubic splines revealed a monotonic decrease in the risk of MACE with prolonged procedural timing (Figure-1). Delayed PCI on 3–7d and &gt;7d were strongly associated with lower risks of MACE at 30 days (3–7d: Hazard ratio (HR) 0.43 [95% Confidence interval (CI) 0.18–0.99], P=0.046; &gt;7d: HR 0.40 [95% CI 0.19–0.87], P=0.020) and 12 months (3–7d: HR 0.49 [95% CI 0.25–0.95], P=0.036; &gt;7d: HR 0.42 [95% CI 0.22–0.77], P=0.006) compared with that on &lt;3d. Delayed PCI on &gt;7d also showed improvement in 12-month mortality (HR 0.45 [95% CI 0.22–0.91], P=0.026) over that on &lt;3d, whereas procedure on 3–7d did not (HR 0.52 [95% CI 0.24–1.11], P=0.091). MI location and cardiac function had significant interactions with procedural timing for 12-month MACE (P-interaction=0.141 and 0.137). Procedural timing had more significant effects on MACE in patients with anterior MI or cardiac insufficiency.

Conclusion

Delayed PCI over a week after symptom onset had significant improvement in short- and long-term safety in stable STEMI patients especially with anterior MI or cardiac insufficiency. Decision-making on optimal timing should identify the high-risk individuals and balance between ischemic benefits and safety.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Twelfth Five-year Science and Technology Support Projects by Ministry of Science and Technology of China.

Progress and current status of molecule-targeted therapy and drug resistance in gastric cancer

Gastric cancer is one of the most common malignant tumors in the world. In China, its morbidity and mortality are second only to lung cancer. Chemotherapy combined with targeted therapy brings survival benefits to patients with advanced gastric cancer. Targets for targeted therapy of gastric cancer include human epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), vascular endothelial growth factor (VEGF), mammalian target of rapamycin (mTOR) and Claudin 18.2 (CLDN 18.2). The main challenge of tumor molecule-targeted drugs is resistance. The main mechanisms of drug resistance include tumor establishment of compensatory signaling pathways, target protein changes, tumor microenvironment changes, tumor heterogeneity and tumor adaptation to targeted drugs. The combined action of multiple drug resistance mechanisms promotes the development of targeted drug resistance. In order to attract the attention of researchers, this paper reviews the mechanisms of drug resistance in gastric cancer-targeted therapy. In addition, the research status of drug resistance in molecule-targeted therapy of gastric cancer is summarized. It is of great clinical significance to explore the drug resistance mechanisms of targeted drugs and reverse drug resistance in gastric cancer. Last, the future development of molecule-targeted therapy is prospected.

SARS-CoV-2 spike produced in insect cells elicits high neutralization titres in non-human primates

The current coronavirus disease 2019 (COVID-19) pandemic was the result of the rapid transmission of a highly pathogenic coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for which there is no efficacious vaccine or therapeutic. Toward the development of a vaccine, here we expressed and evaluated as potential candidates four versions of the spike (S) protein using an insect cell expression system: receptor binding domain (RBD), S1 subunit, the wild-type S ectodomain (S-WT), and the prefusion trimer-stabilized form (S-2P). We showed that RBD appears as a monomer in solution, whereas S1, S-WT, and S-2P associate as homotrimers with substantial glycosylation. Cryo-electron microscopy analyses suggested that S-2P assumes an identical trimer conformation as the similarly engineered S protein expressed in 293 mammalian cells but with reduced glycosylation. Overall, the four proteins confer excellent antigenicity with convalescent COVID-19 patient sera in enzyme-linked immunosorbent assay (ELISA), yet show distinct reactivities in immunoblotting. RBD, S-WT and S-2P, but not S1, induce high neutralization titres (>3-log) in mice after a three-round immunization regimen. The high immunogenicity of S-2P could be maintained at the lowest dose (1 μg) with the inclusion of an aluminium adjuvant. Higher doses (20 μg) of S-2P can elicit high neutralization titres in non-human primates that exceed 40-times the mean titres measured in convalescent COVID-19 subjects. Our results suggest that the prefusion trimer-stabilized SARS-CoV-2 S-protein from insect cells may offer a potential candidate strategy for the development of a recombinant COVID-19 vaccine.

Observation of the Doubly Cabibbo-Suppressed Decay D^{+}→K^{+}π^{+}π^{-}π^{0} and Evidence for D^{+}→K^{+}ω

Using 2.93  fb^{-1} of e^{+}e^{-} collision data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, the first observation of the doubly Cabibbo-suppressed decay D^{+}→K^{+}π^{+}π^{-}π^{0} is reported. After removing decays that contain narrow intermediate resonances, including D^{+}→K^{+}η, D^{+}→K^{+}ω, and D^{+}→K^{+}ϕ, the branching fraction of the decay D^{+}→K^{+}π^{+}π^{-}π^{0} is measured to be (1.13±0.08_{stat}±0.03_{syst})×10^{-3}. The ratio of branching fractions of D^{+}→K^{+}π^{+}π^{-}π^{0} over D^{+}→K^{-}π^{+}π^{+}π^{0} is found to be (1.81±0.15)%, which corresponds to (6.28±0.52)tan^{4}θ_{C}, where θ_{C} is the Cabibbo mixing angle. This ratio is significantly larger than the corresponding ratios for other doubly Cabibbo-suppressed decays. The asymmetry of the branching fractions of charge-conjugated decays D^{±}→K^{±}π^{±}π^{∓}π^{0} is also determined, and no evidence for CP violation is found. In addition, the first evidence for the D^{+}→K^{+}ω decay, with a statistical significance of 3.3σ, is presented and the branching fraction is measured to be B(D^{+}→K^{+}ω)=(5.7_{-2.1}^{+2.5}_{stat}±0.2_{syst})×10^{-5}.

[The value of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma]

Objective: To explore the role of the scoring and strain ratio methods of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Methods: A cross-sectional study. Twenty-five patients (25 eyes) with choroidal melanoma treated in the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University from July to October 2016 were included in this study. There were 13 males and 12 females, with an average age of (48±12) years old. Twenty-five patients (25 eyes) with choroidal hemangioma treated in the same period were selected for differential diagnosis, including 12 males and 13 females, with an average age of (37±13) years. The lesions were examined by ultrasound elastography and scored, and the strain ratio of the tumor to the orbital tissue was measured. Two independent sample t test was used to compare the difference in the elasticity score and strain ratio between choroidal melanoma and choroidal hemangioma. The sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were calculated to analyze the value of the two methods in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Results: The elastography score of choroidal melanoma was (3.48±0.77) points, including 2 points in 3 cases, 3 points in 8 cases, 4 points in 13 cases, and 5 points in 1 case. The elastography score of hemangioma was (2.28±0.46) points, including 2 points in 18 cases and 3 points in 7 cases. The difference in the elasticity score between patients with the two kinds of tumors was statistically significant (t=6.694, P<0.01). The strain ratio was 42.97±15.83 and 12.21±9.24 in the patients with choroidal melanoma and choroidal hemangioma, respectively, and the difference was statistically significant (t=8.392, P<0.01). Using 3 points as the diagnostic critical point of the elastography score, the sensitivity was 88.0%, the specificity was 72.0%, and the area under the ROC curve was 0.80 (95% cofidence interval: 0.663 to 0.900, P<0.01). Using 21.67 as the diagnostic critical point of the strain ratio, the sensitivity was 92.0%, the specificity was 92.0%, and the area under the ROC curve was 0.92 (95% cofidence interval: 0.808 to 0.978, P<0.01). Conclusions: Ultrasound elastography plays a role in the differential diagnosis of choroidal melanoma and choroidal hemangioma. The differential diagnostic value of the strain ratio method is higher than the scoring method. (Chin J Ophthalmol, 2020, 56: 676-680).

Melatonin inhibits the inflammation and apoptosis in rats with diabetic retinopathy via MAPK pathway

OBJECTIVE

To investigate the effect of melatonin on diabetic retinopathy rats through the mitogen-activated protein kinase (MAPK) pathway.

MATERIALS AND METHODS

A total of 48 Sprague Dawley (SD) rats were randomly divided into normal group (n=12), model group (n=12), melatonin group (n=12), and inhibitor group (n=12). The rats in normal group received no treatment. Those in model group, melatonin group, and inhibitor group were prepared into models of diabetic retinopathy and intraperitoneally injected with normal saline, melatonin, and SB 203580, respectively. After 7 days of intervention, the materials were taken. The expressions of B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) were detected through immunohistochemistry. Western blotting was employed to determine the protein expression levels of p38 MAPK, phosphorylated (p)-p38 MAPK, and cysteinyl aspartate specific proteinase-3 (Caspase-3). The messenger ribonucleic acid (mRNA) expression levels of Bax and Bcl-2 were measured via quantitative Polymerase Chain Reaction (qPCR). Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of serum interleukin-1β (IL-1β) and IL-18. The apoptosis was determined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL).

RESULTS

Based on immunohistochemistry, model group, melatonin group, and inhibitor group exhibited significantly increased positive expression of Bax but notably decreased positive expression of Bcl-2 in comparison with normal group (p<0.05). Compared with those in model group, the positive expression of Bax was clearly reduced, while the positive expression of Bcl-2 was overtly raised in melatonin group and inhibitor group (p<0.05). The results of Western blotting showed that there was no difference in the protein expression of p38 MAPK among all groups (p>0.05). Compared with normal group, the other three groups had remarkably elevated protein expressions of p-p38 MAPK and Caspase-3 (p<0.05). The protein expressions of p-p38 MAPK and Caspase-3 in melatonin group and inhibitor group were significantly lower than those in model group decreased (p<0.05). QPCR assay revealed that the mRNA expression of Bax was markedly lower in normal group than that in the other three groups, while the mRNA expression of Bcl-2 was significantly higher in normal group than that in the other three groups (p<0.05). Compared with model group, melatonin group, and inhibitory group showed clearly declined mRNA expression level of Bax and notably increased mRNA expression level of Bcl-2 (p<0.05). TUNEL results revealed that the apoptosis rate was remarkably elevated in the other three groups compared with that in normal group (p<0.05). In comparison with model group, melatonin group and inhibitor group exhibited significantly reduced apoptosis rate (p<0.05).

CONCLUSIONS

Melatonin inhibits the inflammation and apoptosis in rats with diabetic retinopathy by repressing the MAPK pathway.

Melatonin inhibits the inflammation and apoptosis in rats with diabetic retinopathy via MAPK pathway

The article "Melatonin inhibits the inflammation and apoptosis in rats with diabetic retinopathy via MAPK pathway, by Y. Ma, Q. Zhao, Y. Shao, M.-Z. Cao, M. Zhao, D. Wang, published in Eur Rev Med Pharmacol Sci 2019; 23 (3 Suppl): 1-8-DOI: 10.26355/eurrev_201908_18620-PMID: 31389568" has been withdrawn from the authors. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/18620.

Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID-19) in a Fangcang Hospital

OBJECTIVES

To describe the clinical characteristics of patients in a Fangcang Hospital.

METHODS

Non-critically ill individuals with positive SARS-CoV-2 RT-PCR tests admitted between 7 February and 12 February 2020 to Dongxihu Fangcang Hospital, which was promptly constructed because of the rapid, exponential increase in COVID-19 patients in Wuhan, China, were included; clinical course through to 22 February was recorded.

RESULTS

A total of 1012 non-critically ill individuals with positive SARS-CoV-2 RT-PCR tests were included in the study. Thirty (of 1012, 3.0%) individuals were asymptomatic on admission. During hospitalization, 16 of 30 (53.3%) asymptomatic individuals developed different symptoms. Fourteen of 1012 patients (1.4%) remained asymptomatic from exposure to the end of follow up, with a median duration of 24 days (interquartile range 22-27). Fever (761 of 1012, 75.2%) and cough (531 of 1012, 52.4%) were the most common symptoms. Small patchy opacities (355 of 917, 38.7%) and ground-glass opacities (508 of 917, 55.4%) were common imaging manifestations in chest CT scans. One hundred patients (9.9%) were transferred to designated hospitals due to aggravation of illness. Diarrhoea emerged in 152 of 1012 patients (15.0%). Male, older age, diabetes, cardiovascular diseases, chills, dyspnoea, So2 value of ≤93%, white blood cell counts of >10 × 109/L and large consolidated opacities on CT images were all risk factors for aggravation of illness.

CONCLUSIONS

Non-critically ill individuals had different clinical characteristics from critically ill individuals. Asymptomatic infections only accounted for a small proportion of COVID-19. Although with a low incidence, diarrhoea was observed in patients with COVID-19, indicating the possibility of faecal-oral transmission.

Σ^{+} and Σ[over ¯]^{-} Polarization in the J/ψ and ψ(3686) Decays

From 1310.6×10^{6}  J/ψ and 448.1×10^{6}  ψ(3686) events collected with the BESIII experiment, we report the first observation of Σ^{+} and Σ[over ¯]^{-} spin polarization in e^{+}e^{-}→J/ψ[ψ(3686)]→Σ^{+}Σ[over ¯]^{-} decays. The relative phases of the form factors ΔΦ have been measured to be (-15.5±0.7±0.5)° and (21.7±4.0±0.8)° with J/ψ and ψ(3686) data, respectively. The nonzero value of ΔΦ allows for a direct and simultaneous measurement of the decay asymmetry parameters of Σ^{+}→pπ^{0}(α_{0}=-0.998±0.037±0.009) and Σ[over ¯]^{-}→p[over ¯]π^{0}(α[over ¯]_{0}=0.990±0.037±0.011), the latter value being determined for the first time. The average decay asymmetry, (α_{0}-α[over ¯]_{0})/2, is calculated to be -0.994±0.004±0.002. The CP asymmetry A_{CP,Σ}=(α_{0}+α[over ¯]_{0})/(α_{0}-α[over ¯]_{0})=-0.004±0.037±0.010 is extracted for the first time, and is found to be consistent with CP conservation.

Global vaccine action plan lessons learned I: Recommendations for the next decade

The Global Vaccine Action Plan 2011-2020 (GVAP) was developed to realize the ambitions of the Decade of Vaccines - that all individuals and communities enjoy lives free from vaccine-preventable diseases. It included a comprehensive monitoring and evaluation/accountability framework to assess progress towards global targets with recommendations for corrective actions. While many of the GVAP targets are very unlikely to be met by the end of 2020, substantial progress has nevertheless been made, establishing a strong foundation for a successor global immunization strategy, the Immunization Agenda 2030 (IA2030). The Strategic Advisory Group of Experts on immunization has made a series of recommendations to ensure that the lessons learned from GVAP inform the development and implementation of IA2030.

Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia

HPV vaccine hesitancy in Asia is unique compared to Western countries due to multidimensional social-cultural norms that influence beliefs regarding vaccination. Reviews on HPV vaccine hesitancy in Asia lack of in-depth discussion regarding the traditional and social-cultural norms dimensions. This paper puts forward opinions in which culture, normative beliefs, and religion influence HPV vaccine hesitancy in Asian countries. Issues surrounding HPV hesitancy among parents, young adult women, adult women, men and the sexual and gender minority people in Asian countries were highlighted. The shortage of HPV vaccine supply would soon be reduced as some Asian countries are on the way to producing the HPV vaccine which production is currently dominated by Western European countries. The culture of favoring imported Western products among many in Asia and in addition to long-existing fake vaccine crisis pose a challenge for the newly emerging HPV vaccine produced in Asia. Some recommendations, research gaps, and future research needs were discussed.

Comprehensive evaluation of the antigenic impact of intra-genotypic human papillomavirus variant diversity on recognition by neutralizing monoclonal antibodies raised against lineage a L1 virus like particles

Introduction. Naturally-occurring variants of Human papillomavirus (HPV) genotypes have been defined as lineages and sub-lineages, but little is known about the impact of this diversity on protein function. We have previously demonstrated that variation within the major (L1) and minor (L2) capsid proteins impact the susceptibility of HPV to serum antibodies elicited by vaccination and natural infection. Higher resolution mapping of variant residues, however, requires the availability of appropriate tools, such as type-specific monoclonal antibodies (MAbs). These empirical data will improve our understanding of the consequences of natural variation on capsid antigenicity.

Methods. We investigated the susceptibility of 37 representative pseudovirus variants of HPV16, HPV18, HPV31, HPV33, HPV45, HPV52 and HPV58 to neutralization by type-specific murine MAbs raised against the A lineage of their respective genotypes. Homology models derived from available HPV L1 crystal structures were generated to permit mapping of variant residues onto the surface-exposed L1 protein for relevant variants

Results. Type-specific lineage A-specific MAbs demonstrated differential reactivity against some, but not all, variants within its respective genotype. Some of these differences were minor (<4 fold) while some variants displayed orders of magnitude reduced sensitivity. These differences in antigenicity were mapped to a limited number of variant residues on the capsid surface.

Conclusions. These data contribute to our understanding of HPV L1 variant antigenicity and may have implications for seroprevalence or vaccine immunity studies based upon L1 antigens.

[Pathological characteristics and survival analysis of 355 patients with gastroenteropancreatic neuroendocrine neoplasms]

Objective: Biological behavior, pathological characteristics and prognostic factors of 355 cases with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) were analyzed in this retrospective study. Methods: In our study, 355 patients pathologically diagnosed as GEP-NENs were identified from April 2006 to November 2017 in the Fourth Hospital of Hebei Medical University. The biological behavior, pathological characteristics and prognosis were analyzed retrospectively. Results: There were 355 patients (228 males and 127 females) with a mean age of 58.3±10.7 years. GEP-NENs were detected most frequently in the stomach (48.2%), followed by the pancreas (16.1%), colorectum (14.1%), esophagus (7.6%), duodenum/jejunum(5.6%), liver (4.2%), appendix (2.3%) and gallbladder/bile duct (2.0%). The main clinical manifestations of non-functional GEP-NENs were abdominal pain (88/350, 25.14%), ventosity (77/350, 22.00%) and dysphagia (68/350, 19.43%), which were generally lacking specificity at the first diagnosis. 295 patients were treated surgically, including 45 cases of endoscopic resection and 250 cases of laparoscopic operation. Concerning to pathological grading, there were 22.5% (80/355) patients in grade 1 (G1), 12.7% (45/355) in grade 2 (G2), and 58.9% (209/355) in grade 3 (G3). The median follow-up time was 34 months. Furthermore, the 1-, 3- and 5-year overall survival calculated by Kaplan-Meier method were 80.1%, 59.8%, and 57.5%, respectively. Univariate analysis revealed that tumor site, treatment, operation type, depth of tumor invasion, TNM staging, pathological grading, vascular embolus, lymph node metastasis, tumor size, preoperative leukomonocyte level and preoperative plasma albumin were associated with overall survival (all P<0.05). Multivariate analysis showed that treatment, operation type, depth of tumor invasion, TNM staging, pathological grading, vascular embolus, lymph node metastasis and tumor size were independent prognostic factors for GEP-NENs (all P<0.05). Conclusions: The clinicopathological characteristics of GEP-NENs should be mastered by clinicians, and the standard treatment measures were also needed to be formulated based on the prognostic factors in order to improve the prognosis of patients.

Study of Open-Charm Decays and Radiative Transitions of the X(3872)

The processes X(3872)→D^{*0}D[over ¯]^{0}+c.c.,γJ/ψ,γψ(2S), and γD^{+}D^{-} are searched for in a 9.0  fb^{-1} data sample collected at center-of-mass energies between 4.178 and 4.278 GeV with the BESIII detector. We observe X(3872)→D^{*0}D^{0}[over ¯]+c.c. and find evidence for X(3872)→γJ/ψ with statistical significances of 7.4σ and 3.5σ, respectively. No evident signals for X(3872)→γψ(2S) and γD^{+}D^{-} are found, and the upper limit on the relative branching ratio R_{γψ}≡{B[X(3872)→γψ(2S)]}/{B[X(3872)→γJ/ψ]}<0.59 is set at 90% confidence level. Measurements of branching ratios relative to decay X(3872)→π^{+}π^{-}J/ψ are also reported for decays X(3872)→D^{*0}D^{0}[over ¯]+c.c.,γψ(2S),γJ/ψ, and γD^{+}D^{-}, as well as the non-D^{*0}D^{0}[over ¯] three-body decays π^{0}D^{0}D^{0}[over ¯] and γD^{0}D^{0}[over ¯].

Measurements of Absolute Branching Fractions of Fourteen Exclusive Hadronic D Decays to η

Using 2.93  fb^{-1} of e^{+}e^{-} collision data taken at a center-of-mass energy of 3.773 GeV with the BESIII detector, we report the first measurements of the absolute branching fractions of 14 hadronic D^{0(+)} decays to exclusive final states with an η, e.g., D^{0}→K^{-}π^{+}η, K_{S}^{0}π^{0}η, K^{+}K^{-}η, K_{S}^{0}K_{S}^{0}η, K^{-}π^{+}π^{0}η, K_{S}^{0}π^{+}π^{-}η, K_{S}^{0}π^{0}π^{0}η, and π^{+}π^{-}π^{0}η; D^{+}→K_{S}^{0}π^{+}η, K_{S}^{0}K^{+}η, K^{-}π^{+}π^{+}η, K_{S}^{0}π^{+}π^{0}η, π^{+}π^{+}π^{-}η, and π^{+}π^{0}π^{0}η. Among these decays, the D^{0}→K^{-}π^{+}η and D^{+}→K_{S}^{0}π^{+}η decays have the largest branching fractions, which are B(D^{0}→K^{-}π^{+}η)=(1.853±0.025_{stat}±0.031_{syst})% and B(D^{+}→K_{S}^{0}π^{+}η)=(1.309±0.037_{stat}±0.031_{syst})%, respectively. The charge-parity asymmetries for the six decays with highest event yields are determined, and no statistically significant charge-parity violation is found.

Determination of Strong-Phase Parameters in D→K_{S,L}^{0}π^{+}π^{-}

We report the most precise measurements to date of the strong-phase parameters between D^{0} and D[over ¯]^{0} decays to K_{S,L}^{0}π^{+}π^{-} using a sample of 2.93  fb^{-1} of e^{+}e^{-} annihilation data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector at the BEPCII collider. Our results provide the key inputs for a binned model-independent determination of the Cabibbo-Kobayashi-Maskawa angle γ/ϕ_{3} with B decays. Using our results, the decay model sensitivity to the γ/ϕ_{3} measurement is expected to be between 0.7° and 1.2°, approximately a factor of three smaller than that achievable with previous measurements, based on the studies of the simulated data. The improved precision of this work ensures that measurements of γ/ϕ_{3} will not be limited by knowledge of strong phases for the next decade. Furthermore, our results provide critical input for other flavor-physics investigations, including charm mixing, other measurements of CP violation, and the measurement of strong-phase parameters for other D-decay modes.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

Rational design of a multi-valent human papillomavirus vaccine by capsomere-hybrid co-assembly of virus-like particles

The capsid of human papillomavirus (HPV) spontaneously arranges into a T = 7 icosahedral particle with 72 L1 pentameric capsomeres associating via disulfide bonds between Cys175 and Cys428. Here, we design a capsomere-hybrid virus-like particle (chVLP) to accommodate multiple types of L1 pentamers by the reciprocal assembly of single C175A and C428A L1 mutants, either of which alone encumbers L1 pentamer particle self-assembly. We show that co-assembly between any pair of C175A and C428A mutants across at least nine HPV genotypes occurs at a preferred equal molar stoichiometry, irrespective of the type or number of L1 sequences. A nine-valent chVLP vaccine-formed through the structural clustering of HPV epitopes-confers neutralization titers that are comparable with that of Gardasil 9 and elicits minor cross-neutralizing antibodies against some heterologous HPV types. These findings may pave the way for a new vaccine design that targets multiple pathogenic variants or cancer cells bearing diverse neoantigens.

[Surgical strategies and long-term outcomes of total arterial coronary artery bypass grafting: a series of 208 patients]

Objective: To examine the short and long-term clinical outcomes of total arterial coronary artery bypass grafting. Methods: Clinic data of 208 patients with left main and multiple vessel coronary artery disease and undertaken total arterial coronary artery bypass grafting from February 2009 to December 2019 in Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. There were 188 males and 20 females with an age of (54.7±10.7) years (range: 32 to 79 years). The harvest of arterial conduits and grafting strategies were depended upon the individual patient characteristics and surgeon's experience. Left internal thoracic artery (LITA) was applied in 207 cases, right internal thoracic artery (RITA) in 38 cases (bilateral internal thoracic artery (BITA) in 37 cases), and radial artery (RA) in 187 cases (188 grafts). The graft number per case was 2.6±0.7 (range: 2 to 4). Surgical procedures was completed with off-pump technique in 98.1% patients (204/208). Subgroup analysis was carried out between subgroup BITA (n=37) and subgroup SITA (single ITA+RA) (n=171). The t test, χ(2) test or Fisher exact test were used to compare the clinic characteristics between the two subgroups. The Kaplan-Meier curve was used to estimate the rate of late mortality, major adverse cardiac cerebrovascular event (MACCE), and target vessel revascularization (TVR). A Cox proportional hazards model was used to identify the independent prognosis factors of late mortality. Results: The overall mortality within 30 days postoperatively was 1.4%(3/208). The incidences of perioperative MACCE, re-operation for bleeding and deep sternal wound infection (DSWI) were 1.9%(4/208), 0.5%(1/208) and 1.4%(3/208), respectively. Perioperative myocardial infarction and TVR were not observed. There was no significant difference of 30-day mortality, MACCE, bleeding and DSWI between subgroup BITA and SITA+RA (all P>0.05). In a follow-up period of (5.4±2.8)years (range: 0.2 to 10.9 years), the incidence of all-cause mortality at 1-, 5- and 10-year was 2.3%, 3.4% and 6.9%, respectively. The incidence of MACCE was 3.9%,11.2% and 28.5%, respectively. The rate of TVR was 0.4%, 3.7% and 11.9%, respectively. Age>65 was an independent prognosis factor of late mortality (HR=1.125, 95% CI:1.050 to 1.205, P<0.01). Conclusions: Total arterial coronary bypass grafting is safe and achievable with proper patient selection and surgical strategies. It significantly decreases the risks of late mortality and repeated revascularization.

Chinese mothers' intention to vaccinate daughters against human papillomavirus (HPV), and their vaccine preferences: a study in Fujian Province

Little is known regarding Chinese mothers' intention to vaccinate their daughters against human papillomavirus (HPV) since the HPV vaccine was approved for use in China in 2016. The aim was to explore maternal HPV vaccination acceptance, preference for 2-, 4- or 9-valent HPV vaccine and acceptance of domestically manufactured HPV vaccines. Study participants were mothers of primary school children in Southeastern region of Fujian. An online cross-sectional survey was undertaken between June and August 2019. Among the total of 3,586 completed responses (response rate 28.5%), the intention to vaccinate daughter against HPV was high (83.3%). Higher maternal education and perceived benefit and barriers were associated with greater intention to vaccinate. Among mothers who did not intend to vaccinate their daughters, the three most common reasons were daughter being too young to receive HPV vaccination (40.6%), fear of side effects (31.9%) and vaccine price is too high (16.0%). The largest proportion (41.4%) preferred their daughter to be vaccinated with the 9-valent HPV vaccine (9vHPV). Greater preference for 9vHPVwas strongly associated with higher maternal education level and annual household income. The majority of mothers expressed a preference for imported HPV vaccine (56.3%). Our result indicates that lower intentions to vaccinate daughters against HPV among less educated and lower-income mothers may lead to significant social inequalities in HPV vaccine uptake in the country.

[The state of the art for arterial coronary artery bypass grafting]

The selection of conduit has always been one of the most perennially debated topic in the field of coronary artery bypass grafting (CABG) . Arterial grafts have demonstrated excellent biological characteristics and long-term patency in CABG. Clinical observations and randomized clinical trials over the past two decades have shown that the internal thoracic artery is the gold standard graft. Multi-arterial and total-arterial CABG significantly improves patients' long-term survival, but there are technical challenges and concerns of sternal complication. Currently multi-arterial and total-arterial CABG are strongly advocated and increasingly applied worldwide. Several guidelines have been published and updated, as well as Chinese expert consensus. Coronary surgery in China is paving anupper stage of quality improvement. Arterial coronary artery bypass grafting should be carried out more broadly in China as evidence accumulation and excellent long-term clinical results.

A novel vaccine candidate based on chimeric virus-like particle displaying multiple conserved epitope peptides induced neutralizing antibodies against EBV infection

Rationale: Epstein-Barr virus (EBV) is the causative pathogen for infectious mononucleosis and many kinds of malignancies including several lymphomas such as Hodgkin's lymphoma, Burkitt's lymphoma and NK/T cell lymphoma as well as carcinomas such as nasopharyngeal carcinoma (NPC) and EBV-associated gastric carcinoma (EBV-GC). However, to date no available prophylactic vaccine was launched to the market for clinical use.

Methods: To develop a novel vaccine candidate to prevent EBV infection and diseases, we designed chimeric virus-like particles (VLPs) based on the hepatitis B core antigen (HBc149). Various VLPs were engineered to present combinations of three peptides derived from the receptor binding domain of EBV gp350. All the chimeric virus-like particles were injected into Balb/C mice for immunogenicity evaluation. Neutralizing titer of mice sera were detected using an in vitro cell model.

Results: All chimeric HBc149 proteins self-assembled into VLPs with gp350 epitopes displayed on the surface of spherical particles. Interestingly, the different orders of the three epitopes in the chimeric proteins induced different immune responses in mice. Two constructs (149-3A and 149-3B) induced high serum titer against the receptor-binding domain of gp350. Most importantly, these two VLPs elicited neutralizing antibodies in immunized mice, which efficiently blocked EBV infection in cell culture. Competition analysis showed that sera from these mice contained antibodies to a major neutralizing epitope recognized by the strong neutralizing mAb 72A1.

Conclusion: Our data demonstrate that HBc149 chimeric VLPs provide a valuable platform to present EBV gp350 antigens and offer a robust basis for the development of peptide-based candidate vaccines against EBV.

Parallel PRC2/cPRC1 and vPRC1 pathways silence lineage-specific genes and maintain self-renewal in mouse embryonic stem cells

The transcriptional repressors Polycomb repressive complex 1 (PRC1) and PRC2 are required to maintain cell fate during embryonic development. PRC1 and PRC2 catalyze distinct histone modifications, establishing repressive chromatin at shared targets. How PRC1, which consists of canonical PRC1 (cPRC1) and variant PRC1 (vPRC1) complexes, and PRC2 cooperate to silence genes and support mouse embryonic stem cell (mESC) self-renewal is unclear. Using combinatorial genetic perturbations, we show that independent pathways of cPRC1 and vPRC1 are responsible for maintenance of H2A monoubiquitylation and silencing of shared target genes. Individual loss of PRC2-dependent cPRC1 or PRC2-independent vPRC1 disrupts only one pathway and does not impair mESC self-renewal capacity. However, loss of both pathways leads to mESC differentiation and activation of a subset of lineage-specific genes co-occupied by relatively high levels of PRC1/PRC2. Thus, parallel pathways explain the differential requirements for PRC1 and PRC2 and provide robust silencing of lineage-specific genes.

Observation of a Resonant Structure in e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}

A partial-wave analysis is performed for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} at the center-of-mass energies ranging from 2.000 to 2.644 GeV. The data samples of e^{+}e^{-} collisions, collected by the BESIII detector at the BEPCII collider with a total integrated luminosity of 300  pb^{-1}, are analyzed. The total Born cross sections for the process e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0}, as well as the Born cross sections for the subprocesses e^{+}e^{-}→ϕπ^{0}π^{0}, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), are measured versus the center-of-mass energy. The corresponding results for e^{+}e^{-}→K^{+}K^{-}π^{0}π^{0} and ϕπ^{0}π^{0} are consistent with those of BABAR with better precision. By analyzing the cross sections for the four subprocesses, K^{+}(1460)K^{-}, K_{1}^{+}(1400)K^{-}, K_{1}^{+}(1270)K^{-}, and K^{*+}(892)K^{*-}(892), a structure with mass M=(2126.5±16.8±12.4)  MeV/c^{2} and width Γ=(106.9±32.1±28.1)  MeV is observed with an overall statistical significance of 6.3σ, although with very limited significance in the subprocesses e^{+}e^{-}→K_{1}^{+}(1270)K^{-} and K^{*+}(892)K^{*-}(892). The resonant parameters of the observed structure suggest it can be identified with the ϕ(2170), thus the results provide valuable input to the internal nature of the ϕ(2170).

[Application of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of locally advanced gastric cancer]

Objective: To explore the clinical significance of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of patients with locally advanced gastric cancer. Methods: Inclusion criteria: (1) cancer confirmed by gastroscopy and pathology without preoperative anti-tumor treatment; (2) no distant metastases found in preoperative imaging examinations; (3) patients without surgical contraindications and being tolerant to surgery; (4) patients were willing to undergo laparoscopic exploration and abdominal exfoliative cytology examination, and signed informed consent. A retrospective cohort study method was used to collect and analyze the clinicopathological data of 225 patients with advanced gastric cancer based on the above inclusion criteria from a prospective, multicenter, open, randomized controlled phase III clinical trial (registration No. NCT01516944) conducted between February 2012 and December 2018 in The Fourth Hospital of Hebei Medical University, including 162 males and 63 females with age ranged from 23 to 78 years old. Forty-five patients (20.0%) were classified as Borrmann type I to II, and 180 (80.0%) were classified as type III to IV. All the patients underwent laparoscopy and peritoneal lavage cytology under general anesthesia. Laparoscopic exploration sequence: left and right diaphragm→liver and spleen→parietal peritoneum→pelvic cavity→greater omentum, small intestine, mesentery→transverse colon mesentery →stomach. Contents of exploration: (1) with or without ascites; (2) whether metastatic lesions existed in the peritoneum, mesentery, omentum and Douglas pouch; (3) whether metastasis existed on the liver surface; (4) whether the gastric lymph nodes were swollen; (5) whether infiltration occurred on the gastric serosa surface; (6) whether gastric wall was stiff. The left and right subphrenic, the abdominal and pelvic peritoneum, and the mesentery were rinsed with 500 ml of sterilized normal saline. Position of the reverse Trendelenburg was used in the Douglas pouch. The peritoneal lavage fluid under the liver and spleen fossa was collected. Cytological examination was carried out for exfoliative tumor cells. Evaluation criteria: (1) peritoneal metastasis (P): P0 meant no peritoneal metastasis, P1 meant peritoneal metastasis; (2) free peritoneal cancer cells (CY): CY0 meant no cancer cells in peritoneal lavage fluid cytology, CY1 meant cancer cells in peritoneal lavage fluid cytology. The results of patients undergoing laparoscopic exploration combined with abdominal exfoliative cytology, treatment options and prognosis were analyzed. Kaplan-Meier method was used to calculate the survival rate and a survival curve was drawn. Log-rank test was used for survival analysis. Results: After laparoscopic exploration in 225 patients, clinical staging was corrected in 68 (30.2%) patients, of whom 7 (3.1%) downstaged and 61 (27.1%) increased in staging. Of 164 patients evaluated as P0CY0 after the first laparoscopy and peritoneal cytology examination, 126 underwent radical D2 surgery, and the other 38 patients were found to have later local lesions or extensive fusion of local lymph nodes, so then received neoadjuvant chemotherapy. Twenty-nine patients evaluated as P1CY0 or P1CY1 and 32 patients as P0CY1 underwent intraperitoneal hyperthermic chemotherapy+conversion therapy, and then a second laparoscopic exploration was performed to determine the treatment plan. In total, the original treatment regimens were changed after laparoscopic exploration in 99(44.0%) cases. The follow-up period ended in January 2019. The overall 2-year survival rate of 225 patients was 64.0%. As for those who were evaluated as P0CY0, P0CY1 and P1CY0-1 after the first laparoscopic exploration, the 2-year overall survival rate was 70.7%, 65.6% and 24.1%, respectively (P=0.002). The stratified analysis showed that among 180 patients with stage III tumor, after laparoscopic exploration combined with abdominal exfoliative cytology, 125 patients were found to be P0CY0, 28 were P0CY1, and 27 were P1CY0-1, whose 2-year overall survival rates were 70.4%, 64.3%, and 29.6% respectively, and the difference among these 3 groups was statistically significant (P=0.009). Conclusion: Laparoscopic exploration combined with abdominal exfoliative cytology in patients with locally advanced gastric cancer has important clinical guiding significance in improving accurate staging, treatment options and prognosis evaluation, and can avoid non-therapeutic open-close abdominal surgery.

Ethanol combined with coil embolisation for the treatment of arteriovenous malformations in a patient with Parkes Weber syndrome

Parkes Weber syndrome is a rare congenital condition of the vascular system with severe symptoms and life-threatening complications. The challenge is to manage the arteriovenous malformations, and there is no consensus on optimal treatment. We report the case of an 18-year-old woman with Parkes Weber syndrome who was treated with ethanol combined with coil embolisation at an early stage. After two sessions of embolisation, a significant devascularisation was achieved. No sign of recurrence was observed two years after the initial procedure. The patient's symptoms and signs were greatly relieved during the follow-up period. This case raises awareness of Parkes Weber syndrome and highlights the importance of timely intervention, as well as offering a promising therapeutic option for this condition.

Efficacy evaluation of two live virus vaccines against an emerging pseudorabies virus variant

Since late 2011, porcine infections with highly virulent and antigenic variant of pseudorabies virus (PRV) cause great economic loss in the swine industry in China, and its emergence leads to variable protection efficacy of the commercially available PRV vaccine. In the present study, the potential cross-protective efficacy of two live virus vaccines, includ- ing a commercial vaccine, and an attenuated low pathogenic PRV variant (rPRVTJ-delTK/gE/gI) against a PRV variant Tianjing (TJ) was evaluated in piglets. Vaccination of piglets with the live vaccine Bartha-K61 could not reduce the clinical signs, and was partially efficacious in the reduc- tion of viral loads upon PRV variant TJ challenge, indicating that this live vaccine provided limited cross-protection efficacy against the PRV variant infection. Additionally, rPRVTJ-delTK/gE/gI appeared to exert some beneficial efficiency in shortening the period of clinical fever and improv- ing the growth performance of the challenged pigs. Our findings give a valuable guidance for the choice and use of PRV vaccines to control PRV variant infection in the field.

[HIV/AIDS related frailty syndrome in the elderly and related research progress]

Frailty syndrome, caused by degenerative changes in the body and the body vulnerability due to a variety of chronic diseases, is associated with adverse outcomes, such as fall, disability and mortality. With the development of antiretroviral therapy, the average life span of HIV/AIDS patients is extended, the number of elderly living with HIV/AIDS has increased, resulting the increase of the incidence of frailty syndrome in this population. The incidence of frailty syndrome in the elderly is associated with HIV infection and adverse reaction of antiretroviral therapy. Early assessment and intervention of frailty syndrome in elderly HIV/AIDS patients can reduce adverse clinical events and improve the quality of life.