Zika virus NS5 protein antagonizes type I interferon production via blocking TBK1 activation

Zika virus (ZIKV) is a mosquito-borne positive-sense single-stranded RNA virus in the family of Flaviviridae. Unlike other flaviviruses, ZIKV infection of pregnant women may result in birth defects in their newborns, such as microcephaly or vision problem. ZIKV is known to antagonize the interferon (IFN) production in infected cells. However, the exact mechanism of this interference is not fully understood. Here, we demonstrate that NS5 protein of ZIKV MR766 strain antagonizes IFN production through inhibiting the activation of TANK-binding kinase 1 (TBK1), which phosphorylates the transcription activator IFN regulatory factor 3 (IRF3). Mechanistically, NS5 interacts with the ubiquitin-like domain of TBK1 and results in less complex of TBK1 and TNF (tumor necrosis factor) receptor-associated factor 6 (TRAF6), leading to dampened TBK1 activation and IRF3 phosphorylation. Our study provides insights into the mechanism of ZIKV evasion of IFN-mediated innate immunity.

Afatinib in advanced pretreated non-small-cell lung cancer- a Canadian experience

Background

Afatinib, an irreversible epidermal growth factor receptor tyrosine kinase inhibitor (egfr tki), is approved for first-line therapy in advanced EGFR mutation-positive non-small-cell lung cancer (nsclc) and has previously demonstrated activity after failure of chemotherapy and reversible egfr tkis, with improved response and progression-free survival, compared with placebo. Outcomes in pretreated patients with advanced nsclc receiving afatinib through a Canadian special access program (sap) are reported here.

Methods

Patients with nsclc progressing after at least 1 line of chemotherapy and an egfr tki were eligible to enrol in the sap. Characteristics of patients from the two largest accruing Canadian centres were retrospectively reviewed, including demographics, disease and treatment data, and patient outcomes.

Results

The 53 patients who received afatinib (57% women, 51% never-smokers, 26% of East Asian ethnicity, and 66% with adenocarcinoma) had a median age of 59 years. EGFR mutations were documented in 25%, and EGFR wild-type in 8%. All patients had received prior egfr tki treatment, with 42% achieving a response. Patients took afatinib for a median of 2 months (range: 0-26 months); 17% required 1 or more dose reductions. Of 47 evaluable patients receiving afatinib, 10 experienced tumour shrinkage, and 11, stable disease. Median survival from afatinib initiation was 5 months (95% confidence interval: 2 months to 8 months). Grade 3 or greater diarrhea, rash, paronychia, and stomatitis were seen in 9%, 11%, 6%, and 4% of patients respectively.

Conclusions

In an unselected population of pretreated patients with advanced nsclc after tki failure, median survival with afatinib therapy was 5 months. Through a sap, afatinib demonstrated activity in clinical practice, with manageable toxicity.

[Differences in anterior segment structure between Chinese Han people and American Caucasians]

Objective: To compare the difference of anterior segment structure between Chinese Han people and American Caucasians, and to explore the confounding factors of anterior chamber angle. Methods: Cross-sectional study. The study was designed to include two healthy groups of Chinese Han people (enrolled from Department of Ophthalmology, Peking University Third Hospital) and American Caucasians (enrolled from Department of Ophthalmology, University of California, San Francisco) from May 2008 to December 2010, each with approximately 120 participants, including 15 persons of each gender in each decade between 40 and 80 years of age. The parameters of the anterior segment were measured by the automatic refractive test, A-ultrasound and ultrasound biomicroscopy. Differences between the two groups were compared with the independent-sample t test or Wilcoxon two-sample test for continuous variable data and the χ(2) test for classified variable data. Multiple linear regression models were performed to analyze the associated factors of anterior chamber angle. Results: There were 118 subjects (118 eyes) and 117 subjects (117 eyes) enrolled in the Chinese and American Caucasians groups, respectively. Compared to Caucasians, Chinese had smaller A-ultrasound measured anterior chamber depth [(3.03±0.34) mm vs. (3.38±0.36) mm, t=-5.791, P<0.001], smaller relative lens position [0.227 (0.198, 0.256) vs. 0.235 (0.191, 0.262), Z=-3.063, P=0.002], smaller axial length [23.3 (20.9,28.3) mm vs. 24.2 (20.8,28.5) mm, Z=-5.510, P<0.001], smaller iris root distance [0.111 (0.000, 0.401) mm vs. 0.142 (0.000, 0.451) mm, Z=-3.188, P=0.001], smaller ciliary body thickness at 1 mm posterior to the scleral spur [0.661 (0.424, 0.892) mm vs. 0.716 (0.467, 0.942) mm, Z=-3.456, P=0.001], smaller trabecular ciliary process distance [0.780 (0.410, 1.400) mm vs. 0.930 (0.420, 1.470) mm, Z=-3.191, P=0.001], smaller trabecular ciliary process angle [73.4° (36.3°, 115.3°) vs. 81.1° (47.9°, 147.9°), Z=-3.407, P=0.001], smaller angle opening distance at 500 μm (AOD500) [0.181 (0.000, 0.703) mm vs. 0.264 (0.000, 0.806) mm, Z=-3.444, P=0.001], smaller angle recess area (ARA) [0.118 (0.011, 0.457) mm(2) vs. 0.179 (0.000, 0.626) mm(2), Z=-3.814, P<0.001], larger spherical equivalent [0.40 (-5.80, 4.00) D vs. -0.70 (-8.00, 4.00) D, Z=-5.454, P<0.001], larger lens thickness [(4.62±0.40) mm vs. (4.52±0.40) mm, t=2.077, P=0.039] and larger iris thickness [0.430 (0.280, 0.600) mm vs. 0.410 (0.240, 0.580) mm, Z=-2.263, P=0.024]. On average, with each decade of the increased age, Chinese had a greater decrease in the AOD500 than Caucasians (0.040 mm in Chinese vs. 0.030 mm in Caucasians), while the angle recess area decreased at the same rate (0.020 mm(2) in both groups). After adjusted for age, gender, spherical equivalent, axial length and other parameters of the anterior segment, the trabecular ciliary process angle [for AOD500, standardized regression coefficient (SRC)=0.487, R(2)=0.549, P<0.001; for ARA, SRC=0.372, R(2)=0.502, P<0.001] and anterior chamber depth (for AOD500, SRC=0.413, R(2)=0.476, P<0.001; for ARA, SRC=0.331, R(2)=0.403, P<0.001) were the main factors of anterior chamber angle parameters for Chinese and Caucasians, respectively. Conclusions: Compared with age and gender matched American Caucasians, Chinese Han people have more crowded anterior chambers and narrower anterior chamber angles. The more anteriorly positioned ciliary processes and shallower anterior chambers are the main factors that contributed to more crowded anterior chambers in Chinese Han people and American Caucasians, respectively. (Chin J Ophthalmol, 2018, 54: 820-826).

Mouse Avatar Models of Colorectal Cancer Liver Metastasis: The Molecularly Annotated Platforms for Preclinical Evaluation of Novel Therapeutics

Background: Liver is the most common metastatic site in advanced colorectal cancer. Most patients with colorectal cancer liver metastasis (CRLM) could not benefit from the current treatment. Patient-derived xenograft (PDX) models with definite molecular signature are attractive preclinical models and essential for development of novel drugs. Aim: This study was designed to focus on the establishment, characterization of pathologic and molecular features of PDX models. Furthermore, we also validate potential therapeutic targets and explore novel drug therapies guided by genotyping or expression profiling, leading to potential implications for precision medicine. Methods: CRLM PDX models were established and elucidated their possible implications for preclinical research and personalized treatment from their fidelity of clinicopathologic characteristics, genomic landscape, and antitumor activities of novel targeted drugs. Response biomarkers were also explored. Results: A total of 56 PDX models from CRLM were successfully established (transplantation success 76.7%, 56/73). The transplantation rate was higher than that of primary specimens (61.5%, 16/26). No differences were observed between latency period and characteristics except the level of CEA. Along with the passaging, latency period became shorter and shorter. PDXs from CRLM recapitulated the pathologic, genetic, and protein properties of corresponding parental tumors. Frequent altered genes showed high consistency compared with patients' genomic alterations, and were enriched in MAPK, ErbB, cell cycle, focal adhesion, adherence junction pathways. Several potential drug targets, such as KRAS, HER2 and FGFR2, were selected and validated by corresponding inhibitors. In addition, PDX models could also used for patients with no druggable alterations identified to screen the efficient regimen. Conclusion: In this study, we have successfully established and validated a large panel of molecularly annotated CRLM platforms for preclinical evaluation of novel therapeutics and biomarker discovery.

Overview of trends in cardiovascular and diabetes risk factors in Fiji

CONTEXT

Fiji has undergone an epidemiological transition, characterised by declining infectious disease and childhood mortality, that has been offset by rising cardiovascular disease mortality. Other Pacific Island states are in a comparable situation.

OBJECTIVE

With a focus on Fiji, this study reviews and contextualises research performed by the authors and others that examines cardiovascular disease (CVD) and type 2 diabetes (T2DM) and their risk factors in Pacific Island states.

METHODS

This overview covers evidence for the causes and consequences of CVD risk factors and the epidemiological transition and reflects on biological and evolutionary hypotheses. It is based on studies the authors carried out that synthesised disparate population-based CVD risk factor surveys conducted in Fiji over 1980-2012.

RESULTS

Prevalences of obesity, T2DM and hypertension continue to increase in the Fiji population. Tobacco smoking prevalence has decreased, but remains relatively high in men compared to many developed countries. T2DM and hypertension trends, and CVD consequences related to diet, exercise and tobacco smoking, have placed the Fiji population in a variant of the epidemiological transition manifesting as a plateau in life expectancy similar to that of numerous developed countries during the mid-20th century.

CONCLUSION

There is evidence that risk factors and consequent CVD mortality can be reduced in populations. Obesity and T2DM reductions have been observed only in populations surviving in dire circumstances. Interventions to lower the prevalence of CVD and T2DM risk factors in the Fiji population require multi-faceted approaches, with continual monitoring and evaluation for their impact on these risk factors and morbidity and mortality outcomes.

Regulation of geminin by neuropeptide Y in vascular smooth muscle cell proliferation : A current review

Geminin, a key regulator of DNA replication licensing in the cell cycle, plays an essential role in determining the fate of cells via suppression of cell proliferation and cellular differentiation. Neuropeptide Y (NPY) intensifies the proliferation of vascular smooth muscle cells (VSMCs) directly by binding with Y1 receptors. In vitro experiments have shown that stimulation of NPY on VSMCs via regulation of geminin is a double-edged sword. Given that the proliferation and the phenotypic transformation of VSMCs increase the risk for progression of atherosclerosis, we focus on the role of geminin interference in determining the fate of VSMCs. Furthermore, we discuss the therapeutic potential of peripheral neurotransmitter interference, thus pointing toward future research directions in the treatment of atherosclerosis.

Maximal distant entanglement in Kitaev tube

We study the Kitaev model on a finite-size square lattice with periodic boundary conditions in one direction and open boundary conditions in the other. Based on the fact that the Majorana representation of Kitaev model is equivalent to a brick wall model under the condition t = Δ = μ, this system is shown to support perfect Majorana bound states which is in strong localization limit. By introducing edge-mode fermionic operator and pseudo-spin representation, we find that such edge modes are always associated with maximal entanglement between two edges of the tube, which is independent of the size of the system.

Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan

System dynamics methods were used to explore effective implementation pathways for improving health systems performance through pay-for-performance (P4P) schemes. A causal loop diagram was developed to delineate primary causal relationships for service delivery within primary health facilities. A quantitative stock-and-flow model was developed next. The stock-and-flow model was then used to simulate the impact of various P4P implementation scenarios on quality and volume of services. Data from the Afghanistan national facility survey in 2012 was used to calibrate the model. The models show that P4P bonuses could increase health workers' motivation leading to higher levels of quality and volume of services. Gaming could reduce or even reverse this desired effect, leading to levels of quality and volume of services that are below baseline levels. Implementation issues, such as delays in the disbursement of P4P bonuses and low levels of P4P bonuses, also reduce the desired effect of P4P on quality and volume, but they do not cause the outputs to fall below baseline levels. Optimal effect of P4P on quality and volume of services is obtained when P4P bonuses are distributed per the health workers' contributions to the services that triggered the payments. Other distribution algorithms such as equal allocation or allocations proportionate to salaries resulted in quality and volume levels that were substantially lower, sometimes below baseline. The system dynamics models served to inform, with quantitative results, the theory of change underlying P4P intervention. Specific implementation strategies, such as prompt disbursement of adequate levels of performance bonus distributed per health workers' contribution to service, increase the likelihood of P4P success. Poorly designed P4P schemes, such as those without an optimal algorithm for distributing performance bonuses and adequate safeguards for gaming, can have a negative overall impact on health service delivery systems.

Prognostic implication of EGFR mutation status and subtype in resected lung adenocarcinoma patients irrespective of therapy

OBJECTIVE

This study aimed to investigate the pure prognostic role of epidermal growth factor receptor (EGFR) mutation status and subtype in lung adenocarcinoma patients irrespective of therapy.

MATERIALS AND METHODS

We retrospectively enrolled 119 cases of completely resected pathological stage I lung adenocarcinoma patients who received no postoperative chemotherapy or tyrosine kinase inhibitors. EGFR gene mutations from 18 to 21 exons were tested for all the patients. Disease-free survival (DFS) and overall survival (OS) were compared between patients with different EGFR mutation status and subtype using Kaplan-Meier methods.

RESULTS

EGFR mutations were detected in 54 (45.4%) patients including two common mutation subtypes: 32 in-frame deletion within exon 19 (19del) and 19 point mutation within exon 21 (L858R). The frequency of EGFR mutations was much greater for patients of non-smokers versus current or ever smokers (58.1 versus 24.4%, P = 0.000), and a little greater for females versus males (53.8 versus 35.2%, P = 0.042). The median follow-up duration was 43.5 months, and there were no differences on DFS (P = 0.461) and OS (P = 0.989) between patients with EGFR mutations and those without in univariate analysis. The patients harboring 19del mutation had a better DFS (P = 0.028) and OS (P = 0.001) than the patients harboring L858R mutation with significant statistical difference.

CONCLUSIONS

This study suggests that there is no difference on survival between patients with EGFR mutations and those without, but the patients harboring EGFR 19del mutation have survival advantage compared to those harboring EGFR L858R mutation.

[Effects of ammonium pyrrolidine dithiocarbamate (PDTC) on osteopontin expression and autophagy in tubular cells in streptozotocin-induced diabetic nephropathy rat]

Objective: To investigate the effects of ammonium pyrrolidine dithiocarbamate (PDTC) on tubulointerstitial inflammatory molecules and autophagy in diabetic nephropathy (DN) rats. Methods: Twenty-four male Sprague-Dawley rats were assigned to DN group (n=6) and DN+ PDTC group (n=6, PDTC, ip, 100 mg·kg^-1·d^-1), all received streptozotocin (STZ) 60 mg/kg intraperitoneally, and the other 12 rats were randomly divided into control group (n=6) and PDTC group (n=6). At the end of 12 weeks, after serum creatine (Scr) and 24-hour urinary protein were determined, rats were sacrificed to determined the renal pathological damages and the changes of nuclear factor (NF)-κB p65, p62, osteopontin (OPN), microtubule associated protein 1 light chain 3 (LC3)-Ⅱ/LC3-Ⅰ, nuclear p-NF-κB p65 by immunohistological stainning and Western blot, and ultrastructural changes of autophagic process was observed by electron microscopy (EM). Results: Scr was similar among the four groups (P>0.05). The levels of urinary protein in DN group and DN + PDTC group were significantly higher than the other two groups (all P<0.01), but the level of urinary protein in DN + PDTC group was lower than that of DN group (P<0.05). DN + PDTC group had less tubulointerstitial damage compared with DN group (P<0.05). Among the four groups, expressions of p62, p65, OPN of tubulointerstitial area in DN group were significantly higher than that of the other groups (all P<0.05), and Western blot showed that DN+ PDTC group had less expressions of NF-κB p65, nuclear p-p65, OPN and more expresssion of LC3-Ⅱ/LC3-Ⅰ compared with DN group (all P<0.05), which were consistent with the decreased autophagic vacuoles and increased mitochondria dysfunction revealed by EM. Correlation analysis showed that renal LC3-Ⅱ/LC3-Ⅰ was negatively correlated the expressions of nuclear p-p65 and OPN (r=-0.45, P=0.02; r=-0.50, P=0.01), and p62 was positively correlated the expressions of nuclear p-p65 and OPN (r=0.33, P=0.01; r=0.41, P=0.01). Conclusion: Tubular NF-κB activation is closely related to autophagy dysfunction in DN rats, and PDTC may enhance autophagy activity in tubule cells by blocking NF-κB activity.

Hepatitis E Virus: Isolation, Propagation, and Quantification

Hepatitis E virus (HEV) predominantly causes acute liver disease in humans and is transmitted via the fecal-oral route. HEV infection in pregnant women can result in grave consequences, with up to 30% fatality. The HEV strains infecting humans mainly belong to four genotypes. Genotypes 1 and 2 are restricted to human infection, while genotypes 3 and 4 are zoonotic. HEV genotype 3 (HEV-3) can cause both acute and chronic liver diseases. Several cell lines (mainly hepatocytes) have been developed for HEV propagation and biological study. However, HEV production in these cell lines is suboptimal and inefficient. Here, we present methods for the isolation, propagation, and quantification of HEV. © 2018 by John Wiley & Sons, Inc.

Biosorption of lead (II) from an aqueous solution using biosorbents prepared from water plants

Due to its toxicity causing serious health problems, persistence in the environment and non-biodegradability, lead (Pb) is considered as one of the most harmful metals on earth. In this study, dried aquatic plants as sorbents including Nymphoides peltata (NP), Typha laxmannii (TL), and Eichhornia crassipes (EC) were examined and compared to discover the best biosorption for Pb. The effect of physical and chemical parameters including pH (2.0–5.5), sorbent dosage (1–5 g/l), metal concentration (20–100 mg/l), and contact time (~240 min) were investigated to determine the optimal condition for Pb(II) biosorption. As a result, the optimum pH, sorbent dosage, and contact time were 5.0, 1 g/l, and 120 minutes, respectively. Pb2+ biosorption data were found to follow the Langmuir isotherm model while the kinetic biosorption data followed pseudo-second-order model. The maximum biosorption capacity from Langmuir model was calculated as 63.3, 82.9, and 51.9 mg/g for EC, NP, and TL, respectively. All the results showed that biosorption efficiencies of Pb(II) by different biosorbents were in following order NP>EC>TL.

Ceratocorys mariaovidiorum sp. nov. (Gonyaulacales), a new dinoflagellate species previously reported as Protoceratium reticulatum

The family Ceratocoryaceae includes the genera Ceratocorys, Protoceratium, and Schuettiella, whose phylogenetic relationships are poorly known. Here, the new non-yessotoxin-producing species of the genus Ceratocorys, Ceratocorys mariaovidiorum sp. nov., previously reported as the toxic Protoceratium reticulatum, is described from examinations by light and scanning electron microscopy, molecular phylogeny, and toxin analyses. The species description is made from culture samples of strains CCMP1740 and CCMP404 from USA waters. Ceratocorys mariaovidiorum is globular and has thick and strongly reticulated plates with one pore within each reticule, just like P. reticulatum, but the key difference between the two species is the presence of five precingular plates in C. mariaovidiorum instead of six as in P. reticulatum. The thecal plate formula is Po, 4', 0a, 5″, 6c, ~7s, 5‴, 0p, 2''''. The apical pore plate is oval with a λ-shaped pore. The first apical plate is narrow with a ventral pore on the right anterior side; it contacts the apical pore plate and its contact with the anterior sulcal plate is slight or absent. The fourth precingular plate of other Gonyaulacales is absent. Ceratocorys mariaovidiorum may have small spines on the second antapical plate. A phylogenetic study based on internal transcribed spacer/5.8SrDNA supports the morphological classification of C. mariaovidiorum as a new species of Ceratocorys and in a different clade from P. reticulatum.

[Prognostic significance of neoplastic central nervous system tumor classification for patients with low grade glioma]

Objective: To explore the prognostic impact of 2016 World Health Organization (WHO) classification of central nervous system (CNS) tumors on patients with low grade gliomas (LGG). Methods: A total of 482 patients diagnosed with LGG in Beijing Tiantan Hospital affiliated to Capital Medical University from January 2009 to May 2016 were pathologically reclassified and retrospectively reviewed. In the survival analysis, Kaplan-Meier Plot was used to univariate analysis and Cox proportional hazards model was used to multivariate analysis. Results: According to the 2016 WHO CNS criterion, a total of 232 LGG were reclassified as O 1p/19q-deleted and IDH-mutant, 134 as A IDH-mutant and 116 as A IDH-wildtype. Univariate analysis showed that 2016 WHO CNS divided LGG into three subgroups with distinct survival (P<0.001). Multivariate analysis showed that both 2007 WHO CNS and 2016 WHO CNS were independent prognostic factors, but the Hazard ratio (HR) of 2016 WHO CNS was significantly higher than that of 2007 WHO CNS (P<0.01). Conclusions: 2016 WHO CNS classification criteria can divide LGG into three subgroups with significantly distinct survival, which has further improved the clinical prognostic value of it and fully reflected its advantages in predicting prognosis.

Trends in Blind and Low Vision Registrations in Taipei City

Purpose

To determine the overall reported incidence and causes of registrable blindness and low vision in Taipei, Taiwan, that have occurred in the previous 10 years.

Methods

Study data were obtained from disability identification registration forms completed between January 1995 and December 2004. Definitions of low vision and blindness were defined by WHO criteria: low vision included visual acuity worse than 6/18 (20/60) to a lower limit of 3/60 (20/400). Blindness was defined as visual acuity worse than 3/60 (20/400) in the better eye with best possible correction.

Results

There were 3151 registrations for visual impairment during the study period. A total of 239 registrations were excluded due to insufficient data. Of the remaining 2912 (1518 males and 1394 females), 640 males and 647 females were legally blind (44.20%). A total of 878 males and 747 females were partially sighted. The six leading causes of low vision and blindness, in decreasing frequency, were glaucoma, optic neuropathy, diabetic retinopathy, retinitis pigmentosa, age-related macular degeneration, and myopic macular degeneration.

Conclusions

The proportions of new registrations owing to glaucoma, diabetic retinopathy, age-related macular degeneration, and myopic macular degeneration have changed significantly since 2000; the proportion due to diabetic retinopathy has increased.

Role of Central Corneal Thickness on Baseline Parameters and Progression of Visual Fields in Open Angle Glaucoma

Purpose

To evaluate the relationship of central corneal thickness (CCT) to baseline visual field parameters and visual field progression in patients with primary open-angle glaucoma (POAG).

Methods

Charts of consecutive patients with POAG were reviewed to obtain visual field data. Visual field was measured by standard threshold static perimetry. Variables analyzed included mean deviation (MD) and pattern standard deviation (PSD).

Results

A total of 121 eyes examined over 4 years were evaluated. A significant negative relationship between CCT and PSD (correlation coefficient: −0.02, p<0.05) was found. Analyses comparing CCT to change in PSD and MD (visual field progression) were statistically not significant.

Conclusions

Patients with thinner corneas initially present with a greater visual field defect, indicating that thin corneas may contribute to advanced glaucomatous damage at the time of diagnosis. However, CCT does not seem to be a significant risk factor for progression of the disease.

Does Intravenous Magnesium Benefit Patients of Cardiac Arrest? a Meta-Analysis

Objective

Evidence shows that magnesium has anti-arrhythmic roles. However, clinical trials suggest that there are conflicting outcomes of cardiac arrest patients given magnesium. The study aimed to examine the effects of magnesium sulfate therapy on cardiac arrest patients using a meta-analysis.

Methods

We searched the MEDLINE (1966-July 2011), OVID (1980-July 2011), EMBASE (1980-July 2011), Chinese bio-medical literature & retrieval system (1978-July 2011), Chinese medical current contents (1995-July 2011), and Chinese medical academic conference (1994-July 2011). Studies were included if (1) the study design was a randomised controlled trial (RCT); (2) the study population included cardiac arrest patients who received cardiopulmonary resuscitation and either intravenous magnesium or placebo (0.9% normal saline); (3) the study provided data on return of spontaneous circulation (ROSC) and survival to hospital discharge. Relative risk (RR) and 95% confidence interval (CI) were used to pool the effect.

Results

The study included six RCTs with a total of 531 participants from cardiac arrest. The pooled data demonstrated that ROSC and hospital discharge rates in patients treated with magnesium were 35.5% (95% CI=29.7%-41.3%) and 10.4% (95% CI=6.7%-14.1%) compared with placebo (ROSC rate: 31.3%, 95% CI=25.8%-36.8%; hospital discharge rate: 8.5%, 95% CI=5.2%-11.8%). Administration of intravenous magnesium sulfate could not significantly increase ROSC (RR=1.14, 95% CI=0.91-1.43, P=0.26) and survival to hospital discharge (RR=1.22, 95% CI=0.74-2.02, P=0.43) compared with placebo.

Conclusions

Administration of magnesium sulfate does not improve ROSC and survival to hospital discharge in patients of cardiac arrest.

Why are Follow-Up Clinic Services Required in Emergency Departments in Hong Kong?

To identify the roles of follow-up clinic (FUC) of emergency departments (ED), which is unique of the western medicine of Hong Kong, a study was conducted between 1998 to 1999 to collect data on the case-mix of the FUC patients, their satisfaction with the services, the waiting period of the specialist out-patient department (SOPD) and the functions of the FUC as viewed by the Emergency Physicians in the ED of Tuen Mun Hospital. One hundred and fifty-eight patients were surveyed. The majority was of musculoskeletal trauma. Most were satisfied with the services. The waiting period of the SOPD was in terms of month. The respondent doctors considered the functions of the FUC were to fill in the gaps bridging the specialist and primary health care as well as to provide training for the physicians for medium-term after-care.

Topological gapless phase in Kitaev model on square lattice

We study the topological feature of gapless states in the fermionic Kitaev model on a square lattice. There are two types of gapless states which are topologically trivial and nontrivial. We show that the topological gapless phase lives in a wide two-dimensional parameter region and are characterized by two vertices of an auxiliary vector field de-fined in the two-dimensional momentum space, with opposite winding numbers. The isolated band touching points, as the topological defects of the field, move, emerge, and disappear as the parameters vary. The band gap starts to open only at the merg-ing points, associated with topologically trivial gapless states. The symmetry protect-ing the topological gapless phase and the robustness under perturbations are also discussed.

Multiplex PCR system for the rapid diagnosis of respiratory virus infection: systematic review and meta-analysis

OBJECTIVES

To provide a summary of evidence for the diagnostic accuracies of three multiplex PCR systems (mPCRs)-BioFire FilmArray RP (FilmArray), Nanosphere Verigene RV+ test (Verigene RV+) and Hologic Gen-Probe Prodesse assays-on the detection of viral respiratory infections.

METHODS

A comprehensive search up to 1 July 2017 was conducted on Medline and Embase for studies that utilized FilmArray, Verigene RV+ and Prodesse for diagnosis of viral respiratory infections. A summary of diagnostic accuracies for the following five viruses were calculated: influenza A virus (FluA), influenza B virus, respiratory syncytial virus, human metapneumovirus and adenovirus. Hierarchical summary receiver operating curves were used for estimating the viral detection performance per assay.

RESULTS

Twenty studies of 5510 patient samples were eligible for analysis. Multiplex PCRs demonstrated high diagnostic accuracy, with area under the receiver operating characteristic curve (AUROC) equal to or more than 0.98 for all the above viruses except for adenovirus (AUROC 0.89). FilmArray, Verigene RV+ and ProFlu+ (the only Prodesse assay with enough data) demonstrated a summary sensitivity for FluA of 0.911 (95% confidence interval, 0.848-0.949), 0.949 (95% confidence interval, 0.882-0.979) and 0.954 (95% confidence interval, 0.871-0.985), respectively. The three mPCRs were comparable in terms of detection of FluA.

CONCLUSIONS

Point estimates calculated from eligible studies showed that the three mPCRs (FilmArray, Verigene RV+ and ProFlu+) are highly accurate and may provide important diagnostic information for early identification of respiratory virus infections. In patients with low pretest probability for FluA, these three mPCRs can predict a low possibility of infection and may justify withholding empirical antiviral treatments.

Construction and characterization of an improved DNA-launched infectious clone of duck hepatitis a virus type 1

Background

DNA-launched infectious system is a useful tool with high rescue efficiency that allows the introduction of mutations in specific positions to investigate the function of an individual viral element. Rescued virus particles could be harvested by directly transfecting the DNA-launched recombinant plasmid to the host cells, which will reduce labor and experimental cost by skipping the in vitro transcription assay.

Methods

A total of four overlapping fragments covering the entire viral genome were amplified and then were assembled into a transformation vector based on pIRES2-EGFP to establish the DNA-launched infectious system of duck hepatitis A virus type 1 (DHAV-1), named pIR-DHAV-1. Reverse transcription polymerase chain reaction (RT-PCR) detection, quantitative real-time polymerase chain reaction (qRT-PCR), western blotting assay and indirect immunofluorescence (IFA) were conducted for rescued virus identification. A total of 4.0 μg of recombinant plasmid of pIR-DHAV-1 and in vitro transcribed product of 4.0 μg of RNA-launched infectious clone named pR-DHAV-1 were transfected into BHK-21 cells to analyze the rescue efficiency. Following that, tissue tropism of rescued virus (rDHAV-1) and parental virus (pDHAV-1) were assayed for virulence testing in 1-day-old ducklings.

Results

Rescued virus particles carry the designed genetic marker which could be harvested by directly transfecting pIR-DHAV-1 to BHK-21 cells. The qRT-PCR and western blotting results indicated that rDHAV-1 shared similar growth characteristics with pDHAV-1. Furthermore, DNA-launched infectious system possessed much higher rescue efficiency assay compared to RNA-launched infectious system. The mutation at position 3042 from T to C has no impact on viral replication and tissue tropism. From 1 h post infection (hpi) to 48 hpi, the viral RNA copies of rDHAV-1 in liver were the highest among the six tested tissues (with an exception of thymus at 6 hpi), while the viral RNA copy numbers in heart and kidney were alternately the lowest.

Conclusion

We have constructed a genetically stable and highly pathogenic DNA-launched infectious clone, from which the rescued virus could be harvested by direct transfection with recombinant plasmids. rDHAV-1 shared similar growth characteristics and tissue tropism with pDHAV-1. The DNA-launched infectious system of DHAV-1 possessed higher rescue efficiency compared to the traditional RNA-launched infectious system.

Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis

BACKGROUND

The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.

METHODS

We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.

RESULTS

We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.

CONCLUSIONS

AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.

Dysregulation of both miR-140-3p and miR-140-5p in synovial fluid correlate with osteoarthritis severity

Objectives

This study looked to analyse the expression levels of microRNA-140-3p and microRNA-140-5p in synovial fluid, and their correlations to the severity of disease regarding knee osteoarthritis (OA).

Methods

Knee joint synovial fluid samples were collected from 45 patients with OA of the knee (15 mild, 15 moderate and 15 severe), ten healthy volunteers, ten patients with gouty arthritis, and ten with rheumatoid arthritis. The Kellgren–Lawrence grading (KLG) was used to assess the radiological severity of knee OA, and the patients were stratified into mild (KLG < 2), moderate (KLG = 2), and severe (KLG > 2). The expression of miR-140-3p and miR-140-5p of individual samples was measured by SYBR Green quantitative polymerase chain reaction (PCR) analysis. The expression of miR-140-3p and miR-140-5p was normalised to U6 internal control using the 2^-△△CT method. All data were processed using SPSS software.

Results

Expression of both miR-140-3p and miR-140-5p was downregulated in OA synovial fluid, showing a statistical difference between the OA and non-OA group, and increased OA severity was associated with a decreased expression of miR-140-3p or miR-140-5p. The Spearman rank correlation analysis suggested that the expression of miR-140-3p or miR-140-5p was negatively correlated with OA severity. In addition, the expression of miR-140-5p was 7.4 times higher than that of miR-140-3p across all groups.

Conclusion

The dysregulation of miR-140-3p and miR-140-5p in synovial fluid and their correlations with the disease severity of OA may provide an important experimental basis for OA classification, and the miR-140-3p/miR-140-5p are of great potential as biomarkers in the diagnosis and clinical management of patients with OA.

Cite this article: C-M. Yin, W-C-W. Suen, S. Lin, X-M. Wu, G. Li, X-H. Pan. Dysregulation of both miR-140-3p and miR-140-5p in synovial fluid correlate with osteoarthritis severity. Bone Joint Res 2017;6:612–618. DOI: 10.1302/2046-3758.611.BJR-2017-0090.R1.

[Damage-associated molecular patterns and liver failure]

Damage-associated molecular patterns (DAMPs) are a series of intracellular molecules with immunoregulatory activity which are released by the damaged or activated cells and can induce autoimmunity or immune tolerance via pattern recognition receptors. At present, the DAMPs which have been discovered include extracellular histone, high-mobility group box-1, chromosomal deoxyribonucleic acid, interleukin-18, interleukin-32, uric acid, and mitochondrial transcription factors. The discovery of DAMPs and clarification of their mechanisms of action help to know the pathophysiological process of liver failure and provide new thoughts for the diagnosis, prevention, and treatment of liver failure. This article briefly summarizes the concept of DAMPs and their mechanisms of action in the development and progression of liver failure.