Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas

Arteriovenous fistula (AVF) thrombosis is a common complication in patients undergoing hemodialysis, and early intervention is required. Urokinase has been used as a thrombolytic agent for declotting the thrombosed access. However, the optimal route for infusing urokinase remains to be determined. In the present retrospective observational study, 49 patients who underwent local venous infusion and 57 patients with peripheral venous infusion of urokinase were included. A urokinase dosage of 300,000 U was administered until successful thrombolysis, which was a maximum of three times. Age, sex, period of dialysis, time of AVF placement, systolic and diastolic blood pressure and thrombus age were similar between the two groups. The efficacy of urokinase infusion via the two routes in resolving thrombosed AVFs, defined as successful fibrinolysis, and the safety, defined as the number of bleeding events, was compared. The cumulative thrombolysis success rate following three sessions of thrombolytic therapy in the local venous thrombolysis group was higher compared with that in the peripheral venous thrombolysis group (85.7 vs. 68.4%; P=0.04). The local thrombolysis group exhibited less ecchymosis (4.1 vs. 14.0%; P=0.07), epistaxis (2.0 vs. 10.5%; P=0.08) and gingival bleeding (4.1 vs. 19.3%; P=0.02) events compared with the peripheral thrombolysis group. Further analyses demonstrated that systolic [odds ratio (OR)=1.10; 95% confidence interval (CI), 1.03-1.17; P<0.01] and diastolic (OR=1.08; 95% CI, 1.02-1.14; P<0.05) blood pressure were protective factors, whereas thrombus age (OR=0.91; 95% CI, 0.84-0.99; P<0.05) was a risk factor for thrombolysis success among patients who underwent local thrombolytic therapy. Overall, the results suggest that local venous infusion of urokinase is superior to peripheral venous infusion for the treatment of patients with thrombosed fistulas.

Partial aneurysmectomy for treatment of autologous hemodialysis fistula aneurysm is safe and effective

OBJECTIVE

The purpose of this study was to evaluate the outcome and the factors associated with stenosis after treatment using partial aneurysmectomy for aneurysm in autologous arteriovenous fistulas.

METHODS

This retrospective cohort study was conducted from July 2007 to June 2016 and included patients with complicated aneurysms in upper extremity autologous arteriovenous fistulas were treated by partial aneurysmectomy. Vascular ultrasound examination was performed every 6 months after the surgery.

RESULTS

Forty-one patients (median age, 37 years; 70.7% males) were included. Of the patients, 95.1% had a radial-cephalic fistula in the forearm and nearly 88% had 1 or 2 aneurysms in arteriovenous fistulas that had been created for 10 to 84 months. Technical success of partial aneurysmectomy was achieved in all patients. The access diameter (44.0 ± 5.1 mm vs 10.4 ± 1.8 mm; P < .01) and brachial artery blood flow (1618.2 ± 277.0 mL/min vs 772.1 ± 127.4 mL/min; P < .01) were significantly decreased after the surgery. The median follow-up time was 27 months (range, 12-43 months). The primary patency rates at 6 and 12 months were 100% and 95%, respectively. Loss of patency was due to stenosis of the remodeled fistulas, which occurred in seven patients (17%). Multivariate COX regression analysis revealed that diabetes (hazard ratio, 114.28; 95% confidence interval, 2.85-4583.94; P = .01) was a risk factor for the impaired primary patency rates. A larger postprocedure residual diameter trended to favor fistula patency (hazard ratio, 0.46; P = .07). Stenosis was successfully treated with percutaneous transluminal angioplasty.

CONCLUSIONS

Partial aneurysmectomy is an effective and safe method for treating aneurysm of upper extremity autologous arteriovenous fistulas, leading to good 12-month primary patency and no aneurysm recurrence. Using a larger catheter to size the revised fistula during aneurysmectomy may increase access patency.

SIRT7-mediated ATM deacetylation is essential for its deactivation and DNA damage repair

The activation of ataxia-telangiectasia mutated (ATM) upon DNA damage involves a cascade of reactions, including acetylation by TIP60 and autophosphorylation. However, how ATM is progressively deactivated after completing DNA damage repair remains obscure. Here, we report that sirtuin 7 (SIRT7)-mediated deacetylation is essential for dephosphorylation and deactivation of ATM. We show that SIRT7, a class III histone deacetylase, interacts with and deacetylates ATM in vitro and in vivo. In response to DNA damage, SIRT7 is mobilized onto chromatin and deacetylates ATM during the late stages of DNA damage response, when ATM is being gradually deactivated. Deacetylation of ATM by SIRT7 is prerequisite for its dephosphorylation by its phosphatase WIP1. Consequently, depletion of SIRT7 or acetylation-mimic mutation of ATM induces persistent ATM phosphorylation and activation, thus leading to impaired DNA damage repair. Together, our findings reveal a previously unidentified role of SIRT7 in regulating ATM activity and DNA damage repair.

Transcriptome Sequencing Identifies Novel Immune Response Genes Highly Related to the Severity of Human Adenovirus Type 55 Infection

Human adenovirus type 55 (HAdV-55) is considered a highly virulent pathogen causing severe and even deadly pneumonia in immunocompetent people. The mechanisms of HAdV-55-induced initiation and progression of severe pneumonia remain ambiguous. In the current study, we endeavored to identify novel immune response genes which are substantially involved in the pathogenesis of severe inflammation in HAdV-55-infected patients. HAdV-55-infected patients with upper respiratory tract symptoms (minor patients) and pneumonia (severe patients) were enrolled. Through transcriptome sequencing and quantitative real-time PCR, the peripheral blood mononuclear cells of the patients were analyzed. We found that the expression of eight genes, including Il18, Il36b, Il17rc, Tnfsf10, Tnfsf11, Tnfsf14, Tnfsf15, and Il1a, were closely correlated with the severity of HAdV-55 infection. Most of these genes belong to interleukin-1 family or tumor necrosis factor (TNF) superfamily, respectively. The changes in gene expression were confirmed by Western blot assay. Our data will be crucial for deepening the understanding of the pathogenic mechanisms of severe pneumonia in HAdV-55 infection.

Comparing the vascular thromboembolic events following arteriovenous fistula in Chinese population with end-stage renal diseases receiving Clopidogrel versus Beraprost sodium therapy: a retrospective cohort study

BACKGROUND

To assess the time to first on-study vascular thromboembolic events (VTEs) of clopidogrel (CL) or beraprost sodium (BPS) in Chinese population with end-stage renal disease (ESRD) treated with arteriovenous fistula (AVF) surgery.

METHODS

From Jan 2009 to May 2015, 346 ESRD cases suffering an AVF surgery and undergoing oral administration of 75 mg CL (initial dose of 300 mg), 1 time/day, for 4 weeks or 40 μg BPS, 3 times/day, for 4 weeks were retrospectively assessed. The primary outcome was time to first on-study VTE.

RESULTS

In total, 222 ESRD cases (CL, n = 112; BPS, n = 110) were assessed, with a median follow-up time of 38.1 months (range, 37-40 months). The mean time to first on-study VTE was 1.2 weeks (0.5-2.3) and 1.8 weeks (1.2-3.8) for CL and BPS, respectively (HR 0.27, 95% CI 0.16-1.45; P = 0.00). An increased incidence of VTEs was found during the 1th-month follow-up, with rates of 14.2 and 5.5% for CL and BPS, respectively (P = 0.03). The difference persisted over time, with rates of 24.1 and 11.8% at final follow-up, respectively (P = 0.02).

CONCLUSION

CL with an increased risk of VTEs tended to have a VTE within the 1st month after cessation compared with BPS.

Bloodstream infection due to Escherichia coli in liver cirrhosis patients: clinical features and outcomes

OBJECTIVES

The study aimed to investigate the clinical characteristics and antibiotic management, as well as independent indicators for survival within 30 days for Escherichia coli bloodstream infection (BSI) in liver cirrhosis.

RESULTS

Hospital-acquired BSI accounted for 60.07%, with prolonged hospital stay (P = 0.000). The prevalence of Extended Spectrum Beta-Lactamases (ESBL) producing bacteria was 48.26%, which correlated with ICU admission (P = 0.015) and high model for end-stage liver disease (MELD) score at onset of BSI (P = 0.035). Moreover, ESBL producing pathogens showed a high resistant to the common antibiotic families and 27.5% pathogens were confirmed as multidrug-resistant (MDR). MDR infection was significantly correlated with ESBL production, ICU admission, inappropriate empiric therapy, resistance to firstly selected antibiotic, and infection duration (P < 0.05 for all). In addition, appropriate empiric therapy within 48 h (HR = 2.581, 95% CI = 1.166-5.715), ICU admission (HR = 4.434, 95% CI = 2.130-8.823), HE (HR = 2.379, 95% CI = 1.115-5.073) and final MELD (HR = 1.074, 95% CI = 1.044-1.106) were independent indicators for 30-day mortality.

MATERIALS AND METHODS

The clinical data were collected from 288 eligible patients, and compared according to survival status and sites of infection acquisition. Drug resistance was recorded according to ESBL. In addition, cox regression analysis model was applied to evaluate the risk factors for 30-day mortality.

CONCLUSIONS

ESBL production can promote resistance to antibiotics in Escherichia coli. Antibiotic regimens, ICU admission, HE and MELD score can help identify the risk individuals who will benefit from the improved therapeutic regimens.

Hemodialysis reinitiation using a resurrected mummy fistula: a case report

Background

Kidney allograft loss becomes an important cause of end-stage kidney disease and requires dialysis reinitiation. We report a case of a patient who restarted hemodialysis after his second kidney graft failure using a long-discarded autologous arteriovenous fistula.

Case presentation

A 62-year-old man was diagnosed with end-stage renal disease 20 year ago, and a native arteriovenous fistula was created for hemodialysis. After the patient received his first kidney transplantation, the hemodialysis fistula was discarded and chronically thrombosed for 13 years. When the patient experienced his second kidney graft loss and presented with uremia again, dialysis restart was needed. Under vascular ultrasound, but not x-ray, guidance, we successfully revascularized the patient’s chronically occluded, long-discarded arteriovenous fistula access and used it for hemodialysis. The resurrected fistula remained patent and clinically useable for hemodialysis up to 18 months.

Conclusions

This report provides the feasibility of ultrasound-guided transluminal angioplasty for the treatment of a mummy hemodialysis fistula, which could be considered when managing patients who need dialysis reinitiation.

Electronic supplementary material

The online version of this article (10.1186/s12882-018-1089-9) contains supplementary material, which is available to authorized users.

Low-p_{T} e^{+}e^{-} Pair Production in Au+Au Collisions at sqrt[s_{NN}]=200 GeV and U+U Collisions at sqrt[s_{NN}]=193 GeV at STAR

We report first measurements of e^{+}e^{-} pair production in the mass region 0.4<M_{ee}<2.6  GeV/c^{2} at low transverse momentum (p_{T}<0.15  GeV/c) in noncentral Au+Au collisions at sqrt[s_{NN}]=200  GeV and U+U collisions at sqrt[s_{NN}]=193  GeV. Significant enhancement factors, expressed as ratios of data over known hadronic contributions, are observed in the 40%-80% centrality of these collisions. The excess yields peak distinctly at low p_{T} with a width (sqrt[⟨p_{T}^{2}⟩]) between 40 and 60  MeV/c. The absolute cross section of the excess depends weakly on centrality, while those from a theoretical model calculation incorporating an in-medium broadened ρ spectral function and radiation from a quark gluon plasma or hadronic cocktail contributions increase dramatically with an increasing number of participant nucleons. Model calculations of photon-photon interactions generated by the initial projectile and target nuclei describe the observed excess yields but fail to reproduce the p_{T}^{2} distributions.

Structural Diversity of Six Coordination Polymers Based on the Designed X-Shaped Ligand 1,1,1,1-Tetrakis[(3-pyridiniourea)methyl]methane

In this study, six coordination polymers (CPs), {[Ag₂(L)(CF₃SO₃)]·CF₃SO₃·2H₂O·DMF}_n (1), {[Ag(L)]·SbF₆·4DMF·H₂O}_n (2), {[Zn(L)_0.5(I)₂]·3.75H₂O}_n (3), {[Cd₂(L)(I)₄(H₂O)(DMF)]·4H₂O·3DMF}_n (4), {[Hg₂(L)(I)₄]·H₂O·4DMF}_n (5) and {[Hg₂(L)(Cl)₄]·2H₂O·3DMF}_n (6), were obtained based on the designed X-shaped urea-based ligand. X-ray single crystal diffraction analysis revealed that complex 1 displayed a 3D (3,4)-connected {6·8²}{6⁴·8²}-tcj net. Complex 2 featured a 2D 4-connected {4³·6³} sheet. Complexes 3 and 5 exhibited a 1D polymeric loop chain. Complex 4 displayed a 1D polymeric fishbone chain. Complex 6 showed a 2D 4-connected {4⁴·6²}-sql sheet. Structural comparison revealed that not only the metal ions, but also the anions played crucial roles in the control of final structures.

Effect of continuous positive airway pressure on allergic rhinitis in patients with obstructive sleep apnea-hypopnea syndrome

BACKGROUND

The effect of continuous positive airway pressure (CPAP) on nasal symptoms in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) remains controversial. In addition, possible mechanism(s) remains unclear.

OBJECTIVE

To examine whether CPAP contributes to the onset and exacerbation of allergic rhinitis (AR) in OSAHS patients based on patient-reported changes in nasal symptoms with and without CPAP therapy and the detection of house dust mites (HDMs) in CPAP filters and household environments.

MATERIALS AND METHODS

In a cohort of OSAHS patients, 350 patients who were undergoing CPAP therapy and 100 patients who declined CPAP therapy were retrospectively analyzed. These patients were contacted by telephone and asked to compare their nasal symptoms before and after CPAP therapy. HDMs in air conditioner and CPAP device filters and in household dust samples were detected using enzyme-linked immunosorbent assays.

RESULTS

The prevalence of AR was higher in the CPAP group vs the non-CPAP group (15.8% vs 7.0%, respectively; P = 0.025). The onset of AR among the OSAHS patients with no previous history of AR significantly increased within the first year of CPAP therapy compared with the control group (5.7% vs 0%, respectively; P = 0.031). Meanwhile, the patients with a history of AR were more likely to experience exacerbated rhinitis symptoms within the second year of treatment compared with the control group (7.5% vs 0%, respectively; P = 0.005). There was no significant difference in HDM concentrations between the CPAP and air conditioner filters, yet the concentrations in both the filters were higher than the concentrations in the bedroom dust samples (all P < 0.05).

CONCLUSION

CPAP is associated with the onset and exacerbation of AR in OSAHS patients. Long-term exposure to high concentrations of HDM allergens may be a significant factor.

9 kilowatt-level direct-liquid-cooled Nd:YAG multi-module QCW laser

An average 9 kilowatt-level direct-D₂O-cooled side-pumped Nd:YAG multi-disk laser resonator at QCW mode with a pulse width of 250μs is presented, in which the straight-through geometry is adopted the oscillating laser propagates through 40 Nd:YAG thin disks and multiple cooling D₂O flow layers in the Brewster angle. Much attention has been paid on the design of the gain module, including an analysis of the loss of the laser resonator and the design of the Nd:YAG thin disk. Experimentally, laser output with the highest pulse energy of more than 20 J is obtained at a repetition frequency of 10 Hz. At high repetition frequency, the average output power 9.8 kW with η_o-o = 26% and 9.1 kW with η_o-o = 21.8% are achieved in the stable resonator and unstable resonator, respectively, and in the corresponding beam quality factor β_stable= 14.7 and β_unstable= 9.5 respectively. To the best of our knowledge, this is the first demonstration of a 9 kilowatt-level direct-liquid-cooled Nd:YAG thin disk laser resonator.

Stair-Step Pattern of Soil Bacterial Diversity Mainly Driven by pH and Vegetation Types Along the Elevational Gradients of Gongga Mountain, China

Ecological understandings of soil bacterial community succession and assembly mechanism along elevational gradients in mountains remain not well understood. Here, by employing the high-throughput sequencing technique, we systematically examined soil bacterial diversity patterns, the driving factors, and community assembly mechanisms along the elevational gradients of 1800–4100 m on Gongga Mountain in China. Soil bacterial diversity showed an extraordinary stair-step pattern along the elevational gradients. There was an abrupt decrease of bacterial diversity between 2600 and 2800 m, while no significant change at either lower (1800–2600 m) or higher (2800–4100 m) elevations, which coincided with the variation in soil pH. In addition, the community structure differed significantly between the lower and higher elevations, which could be primarily attributed to shifts in soil pH and vegetation types. Although there was no direct effect of MAP and MAT on bacterial community structure, our partial least squares path modeling analysis indicated that bacterial communities were indirectly influenced by climate via the effect on vegetation and the derived effect on soil properties. As for bacterial community assembly mechanisms, the null model analysis suggested that environmental filtering played an overwhelming role in the assembly of bacterial communities in this region. In addition, variation partition analysis indicated that, at lower elevations, environmental attributes explained much larger fraction of the β-deviation than spatial attributes, while spatial attributes increased their contributions at higher elevations. Our results highlight the importance of environmental filtering, as well as elevation-related spatial attributes in structuring soil bacterial communities in mountain ecosystems.

[Clinical features of community-acquired bloodstream infection due to Gram-negative bacilli in patients with liver cirrhosis]

Objective: o investigate the features of pathogenic bacteria for community-acquired bloodstream infection due to Gram-negative bacilli in patients with liver cirrhosis and optimal therapeutic strategy. Methods: A retrospective analysis was performed for the clinical data of patients with liver cirrhosis who were admitted to 302 Hospital of PLA due to community-acquired bloodstream infection from January 2010 to December 2015, and a statistical analysis was performed for their clinical features, pathogenic bacteria, and results of drug sensitivity test. The Pearson chi-square test was used for comparison of rates, and the Wilcoxon rank sum test was used for comparison of ranked data. Results: A total of 240 patients (including 178 male patients) with liver cirrhosis caused by various reasons were enrolled, with a mean age of 51.7 ± 11.1 years, an overall clinical remission rate of 80.42%, and an ineffective/mortality rate of 19.58%. The patients who used sensitive antibiotics within 12 hours after the onset of community-acquired bloodstream infection achieved a significantly higher improvement rate than those who used such drugs at more than 12 hours after onset (88.2% vs 58.1%, P < 0.001). The improvement rate achieved by the application of sensitive antibiotics at more than 12 hours after onset decreased with the increase in the Child-Pugh grade (P < 0.05). A total of 245 strains of Gram-negative bacilli were isolated, among which the six most common ones were 135 strains of Escherichia coli (55.1%), 62 strains of Klebsiella pneumoniae (25.3%), 16 strains of Aeromonas (6.5%), 4 strains of non-typhoidal Salmonella (1.6%), 3 strains of Enterobacter cloacae (1.2%), and 2 strains of Acinetobacter baumannii (0.8%). These Gram-negative bacilli had the highest sensitivity to meropenem (98.5%), followed by imipenem (97.9%), amikacin (97.5%), piperacillin/tazobactam (94.7%), cefmetazole (93.7%), and cefoperazone/sulbactam (93%). Different bacteria had different sensitivities to antibiotics. Conclusion: Once community-acquired bloodstream infection occurs in patients with liver cirrhosis, highly sensitive antibiotics should be used as early as possible. Cefoperazone/sulbactam, piperacillin/tazobactam, imipenem, and meropenem can be used as first-line empirical antibiotics, and drug combination should be considered when necessary.

Infection and depletion of CD4+ group-1 innate lymphoid cells by HIV-1 via type-I interferon pathway

Innate lymphoid cells (ILCs) are severely depleted during chronic HIV-1 infection by unclear mechanisms. We report here that human ILC1s comprising of CD4⁺ and CD4^- subpopulations were present in various human lymphoid organs but with different transcription programs and functions. Importantly, CD4⁺ ILC1s expressed HIV-1 co-receptors and were productively infected by HIV-1 in vitro and in vivo. Furthermore, chronic HIV-1 infection activated and depleted both CD4⁺ and CD4^- ILC1s, and impaired their cytokine production activity. Highly active antiretroviral (HAART) therapy in HIV-1 patients efficiently rescued the ILC1 numbers and reduced their activation, but failed to restore their functionality. We also found that blocking type-I interferon (IFN-I) signaling during HIV-1 infection in vivo in humanized mice prevented HIV-1 induced depletion or apoptosis of ILC1 cells. Therefore, we have identified the CD4⁺ ILC1 cells as a new target population for HIV-1 infection, and revealed that IFN-I contributes to the depletion of ILC1s during HIV-1 infection.

Innate lymphoid cells (ILCs), including ILC1, ILC2 and ILC3 populations, represent a novel cellular family of the immune system and have potentials to produce large amounts of T cell-associated cytokines in response to innate stimulation in the absence of specific antigen stimulation. ILCs have emerged as central players in homeostatic and inflammatory conditions, and correlated with the pathogenesis and progression of multiple human diseases. It is reported that ILCs are depleted in HIV-1 infected patients. However, it is not clear whether HIV-1 can infect ILCs and how ILCs are depleted during HIV-1 infection. Here, we find that ILC1s consist CD4⁺ and CD4^- subsets and both are present in various human lymphoid organs. We show that HIV-1 can directly infect CD4⁺ ILC1s. HIV-1 infection leads to activation, depletion and functional impairment of ILC1s in humans and in humanized mice in vivo. Blocking IFN-I signaling prevents HIV-1-induced apoptosis of ILC1s both in vitro and in humanized mice in vivo. Our study reveals the CD4⁺ ILC1 population as a new target for HIV-1 infection and identifies an IFN-I mediated mechanism of ILC1 depletion during chronic HIV-1 infection.

Investigation on outcomes and bacterial distributions of liver cirrhosis patients with gram-negative bacterial bloodstream infection

Objective

The study aimed at analyzing the epidemiology and outcomes of liver cirrhosis patients undergoing gram-negative bacterial bloodstream infection.

Results

Totally 508 eligible patients were collected, with 25.79% 30-day mortality, and 58.86% patients were confirmed as nosocomial infection. The most common isolates were Escherichia coli (48.29%) and Klebsiella pneumoniae (19.29%), and multidrug-resistant isolates accounted for 36.61%. The bacterial distributions were similar between survivors and non-survivors (P>0.05), but showed close association with acquisition sites of infection (P<0.05). Nosocomial infection (HR=1.589, 95% CI=1.004-2.517), Child-Pugh grade (HR=2.471, 95% CI=1.279-4.772), septic shock (HR=1.966, 95% CI=1.228-3.146), complications (HR=3.529, 95% CI=2.140-5.818), and WBC (HR=1.065, 95% CI=1.018-1.114) were independent indicators for 30-day mortality. β-lactamase inhibitor antibiotics exerted a high antibacterial activity.

Methods

The inpatients with liver cirrhosis developed gram-negative bacterial bloodstream infection were collected. The clinical characteristics, bacterial distribution and drug sensitivity results of patients were compared according to their 30-day survival status and acquisition sites of infections. Cox regression model was applied to evaluate the risk factors for 30-day mortality.

Conclusion

Escherichia coli and Klebsiella pneumoniae are frequently isolated from gram-negative bacterial bloodstream infection episodes in cirrhosis patients. Acquisition site of infection can influence clinical characteristics and etiological distribution. β-lactamase inhibitor antibiotics may be the first choice for empirical treatments.

Dichotomous Roles of Programmed Cell Death 1 on HIV-Specific CXCR5+ and CXCR5- CD8+ T Cells during Chronic HIV Infection

Background

CXCR5⁺CD8⁺ T cells have been demonstrated to play an important role in the control of chronic viral replication; however, the relationship between CXCR5⁺CD8⁺ T cells, HIV disease progression, and programmed cell death 1 (PD-1) expression profile on CXCR5⁺CD8⁺ T cells during HIV infection remain poorly understood.

Methods

We enrolled a total of 101 HIV patients, including 62 typical progressors, 26 complete responders (CRs), and 13 immune non-responders (INRs). Flow cytometric analysis, immunohistochemical staining, and relative function (i.e., cytokine secretion and PD-1 blockade) assays were performed to analyze the properties of CXCR5⁺CD8⁺ T cells.

Results

HIV-specific CXCR5⁺CD8⁺ T cells in the peripheral blood and distribution of CXCR5⁺CD8⁺ T cells in the lymph node (LN) were negatively correlated with disease progression during chronic HIV infection. PD-1 was highly expressed on CXCR5⁺CD8⁺ T cells and positively associated with peripheral CD4⁺ T cell counts. Functionally, IFN-γ and TNF-α production of CXCR5⁺CD8⁺ T cells were reduced by PD-1 pathway blockade, but the production of IFN-γ and TNF-α from CXCR5^-CD8⁺ T cells increased in response to TCR stimulation. Interestingly, PD-1 expression was constantly retained on CXCR5⁺CD8⁺ T cells while significantly decreased on CXCR5^-CD8⁺ T cells after successful antiretroviral treatment in chronic HIV-infected patients.

Conclusion

PD-1⁺CXCR5⁺CD8⁺ T cells are functional cytotoxic T cells during chronic HIV infection. PD-1⁺CXCR5⁺CD8⁺ T cells may represent a novel therapeutic strategy for the disease.

Bacterial distributions and prognosis of bloodstream infections in patients with liver cirrhosis

Bloodstream infections (BSIs) are a frequently observed complication in liver cirrhosis patients. This study aimed to investigate the microbiological characteristics and outcomes of BSIs in patients with liver cirrhosis. We retrospectively studied 852 patients with liver cirrhosis who developed a BSI. Patient outcome was evaluated using 30-day mortality and assessed using multivariate stepwise logistic regression analysis. Antibiotic sensitivity of the pathogens was tested. Gram-negative bacteria were responsible for 59.6% of BSIs, and Gram-positive bacteria caused 40.4% of the episodes among liver cirrhosis patients. The bacterial distribution significantly differed between hospital-acquired and community-acquired infections, especially in cases caused by Gram-negative pathogens. The results of the drug sensitivity test suggested that amikacin, cefoperazone/sulbactam, and piperacillin/tazobactam highly suppressed Gram-negative infections, while vancomycin and teicoplanin strongly inhibited Gram-positive BSIs. Liver failure, liver cancer, complications, Child-Pugh grade, septic shock, administration of appropriate antibiotics within 24 h, ICU admission, nosocomial infection, and Gram nature of the bacteria were independent risk factors for 30-day mortality (P < 0.05). The choice of initial empirical antibiotics should be based on the type, severity and origin of infection and on the local epidemiological data on antibiotic resistance. Accurate evaluation of risk factors for mortality may improve appropriate therapeutic choice.

HIV-1 infection depletes human CD34+CD38- hematopoietic progenitor cells via pDC-dependent mechanisms

Chronic human immunodeficiency virus-1 (HIV-1) infection in patients leads to multi-lineage hematopoietic abnormalities or pancytopenia. The deficiency in hematopoietic progenitor cells (HPCs) induced by HIV-1 infection has been proposed, but the relevant mechanisms are poorly understood. We report here that both human CD34+CD38- early and CD34+CD38+ intermediate HPCs were maintained in the bone marrow (BM) of humanized mice. Chronic HIV-1 infection preferentially depleted CD34+CD38- early HPCs in the BM and reduced their proliferation potential in vivo in both HIV-1-infected patients and humanized mice, while CD34+CD38+ intermediate HSCs were relatively unaffected. Strikingly, depletion of plasmacytoid dendritic cells (pDCs) prevented human CD34+CD38- early HPCs from HIV-1 infection-induced depletion and functional impairment and restored the gene expression profile of purified CD34+ HPCs in humanized mice. These findings suggest that pDCs contribute to the early hematopoietic suppression induced by chronic HIV-1 infection and provide a novel therapeutic target for the hematopoiesis suppression in HIV-1 patients.

Finite element analysis of auditory characteristics in patients with middle ear diseases

CONCLUSION

This study validates that a finite element model of the human ossicular chain and tympanic membrane can be used as an effective surgical assessment tool in clinics.

OBJECTIVE

The present study was performed to investigate the application of a finite element model of ossicular chain and tympanic membrane for fabrication of individualized artificial ossicles.

METHODS

Twenty patients (20 ears) who underwent surgery for middle ear disease (n = 20) and 10 healthy controls (10 ears) were enrolled in the hospital. Computed tomography (CT) and pure tone audiometry were performed before and after surgery. A finite element model was developed using CT scans, and correlation analysis was conducted between stapes displacement and surgical methods. An audiometric test was also performed for 14 patients before and after surgery.

RESULTS

Stapes displacement in the healthy group (average = 3.31 × 10^-5 mm) was significantly greater than that in the impaired group (average = 1.41 × 10^-6 mm) prior to surgery. After surgery, the average displacement in the impaired group was 2.55 × 10^-6 mm, which represented a significant improvement. For the patients who underwent the audiometric test, 10 improved hearing after surgery, and stapes displacement increased in nine of these 10 patients.

Clinical efficacy and safety of integrated traditional Chinese and Western medicine in elderly autoimmune liver disease patients with gastritis

AIM

To evaluate the clinical efficacy and safety of integrated traditional Chinese and Western medicine in elderly autoimmune liver disease patients with gastritis.

METHODS

From January 2010 to June 2016, 56 elderly autoimmune liver disease patients with gastritis were randomly divided into a control group (n = 28) and an observation group (n = 28). Both groups were treated by Western medicine symptomatic support, and the observation group was additionally given Chinese medicine decoction. The clinical efficacy and safety of the two groups were compared.

RESULTS

Before treatment, there was no significant difference in alanine transaminase (ALT) or glutamyl transpeptidase (GGT) between the two groups (P > 0.05). After treatment, ALT (45.31 IU/L ± 10.04 IU/L vs 68.42 IU/L ± 11.46 IU/L) and GGT (41.46 IU/L ± 10.24 IU/L vs 52.17 IU/L ± 11.25 IU/L) were significantly lower in the observation group than in the control group (P < 0.05). There was no significantly difference in the rate of adverse effects between the two groups (P > 0.05).

CONCLUSION

Traditional Chinese medicine decoction combined with Western medicine symptomatic support can improve the liver function of elderly autoimmune liver disease patients with gastritis, without increasing the rate of adverse effects.

Long noncoding RNA MALAT1 affects the efficacy of radiotherapy for esophageal squamous cell carcinoma by regulating Cks1 expression

OBJECTIVE

Long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been well studied in the progression of many malignancies. However, its association with the radioresistance of tumors has not been well understood yet. This study tried to explore the role of MALAT1 in regulating the radiosensitivity of esophageal cancer (EC), especially esophageal squamous cell carcinoma (ESCC), involving its regulation on Cks1 expression.

METHODS

KYSE150 cells were subcutaneously inoculated into nude mice to establish ESCC xenografts. Real-time PCR and Western blot analysis were performed to detect the expression of MALAT1 and Cks1 in irradiated xenografts and cells. Functional analysis was performed in both EC9706 and KYSE150 cells via the transfection of corresponding plasmids or small interfering RNAs (siRNAs). Irradiation-induced damage was examined by the detection of cell viability and apoptosis using MTT and TUNEL assays, respectively.

RESULTS

Both MALAT1 and Cks1 were downregulated in irradiated xenografts and cells. Cks1FER1L4 showed significant downregulation. Overexpression of MALAT1 inhibited irradiation-induced decrease in cell viability, increase in apoptosis, and downregulation of Cks1. Cks1 expression was also downregulated by MALAT1 siRNA, while Cks1 siRNA strongly recovered MALAT1-induced radioresistance in vitro. Moreover, better tumor growth, accompanied by Cks1 upregulation, was observed in KYSE150 xenografts with MALAT1 overexpression, especially under radiation treatment.

CONCLUSION

MALAT1 acted as one positive regulator of the radioresistance of ESCC, at least partly due to its promotion on Cks1 expression. Furthermore, MALAT1-targeted therapies showed great potential in enhancing the radiotherapeutic effect on ESCC.