Study on Treatment Expenditures of Urban Cancer Patients: An Evidence-Based Study From Jinan, China

Background: Cancer has become the leading cause of death in China. A recent systematic review showed that the data about economic burden of cancer in China were still very limited. Aim: This study aims to use the linked registry-claims data to analyze treatment expenditures among the patients diagnosed with lung, female breast, colorectal, and stomach cancer between 2011 and 2014 in Jinan of Shandong Province. Methods: A total of 410 urban patients were identified and selected in a tertiary hospital in Jinan of Shandong Province. We have linked the cancer registry data with health insurance claims and hospital discharge data. We were able to create the linked data of a total of 349 patients (85.1%). Inpatient, outpatient, and total treatment expenditure were computed. We also estimated the one-, two-, and three-year healthcare costs after cancer diagnosis. The local consumer price index (CPI) was used to adjust for inflation in medical expenses during the study period, and we calculated our estimates in terms of 2016 Chinese yuan (CNY). We generalized linear models to examine the factors that were associated with treatment expenditure. Results: The average total treatment expenditures of lung, female breast, colorectal, and stomach cancer were respectively 114,965, 115,344, 92,905, and 105,571 CNY. The one-, two-, and three-year total treatment expenditures of all four cancers were 78,801, 101,370, and 113,024 CNY respectively. For patients enrolled in Urban Employee Basic Insurance, 68.1%, of total expenditures were paid by the insurance. In contrast, Urban Resident Basic Insurance and New Rural Cooperative Medical Scheme only paid 46.7% and 39.1% of total expenditures of their beneficiaries. After adjusting for other control variables, health insurance type, receipt of surgery, and length of hospital stay were statistically significant associated with healthcare expenditures in male patients. For female patients, clinical stage, number of hospitalizations, and length of stay were statistically significant factors. Conclusion: The average total treatment expenditures of urban cancer patients were over two times of local disposable income per capita of urban residents in 2016. So, it makes economic sense to invest in cancer prevention and control in China, and the reimbursement gaps between different social insurance plans should be narrowed.

The prevalence of sufficient physical activity among primary and high school students in Mainland China: a systematic review and meta-analysis

OBJECTIVES

This study aims to estimate the prevalence of sufficient physical activity (PA) for primary and high school students in China.

STUDY DESIGN

This is a meta-analysis study.

METHODS

The literature search was carried out using both English and Chinese online databases, including articles published from January 2005 to May 2018. Statistical analyses were performed with STATA 13.0.

RESULTS

Of 1439 articles initially retrieved, 18 studies met the inclusion criteria. The prevalence of sufficient PA among Chinese students varied from 8.96% to 56.02%. With meta-analysis, the sufficient PA prevalence was 31.1% (27.1%-35.2%). Boys were more likely to achieve sufficient PA compared to girls (boys vs girls: 42.4% vs 31.5%, P < 0.001), while urban students engaged in more sufficient PA than their rural counterparts (urban vs rural: 42.7% vs 38.5%, P < 0.001). Primary school students spent more time in overall PA than junior (primary vs junior: 45.4% vs 40.6%, P < 0.001) or senior high school students (primary vs senior: 45.4% vs 27.9%, P < 0.001). Students tended to be more physically active on weekdays than weekends (weekdays vs weekend: 57.2% vs 45.2%, P < 0.001).

CONCLUSIONS

The prevalence of sufficient PA was 31% among Chinese students. Intervention campaigns are needed for promoting PA level among students in China.

[Predict response to decitabine in patients with myelodysplastic syndrome and related neoplasms]

目的

探索预测骨髓增生异常综合征（MDS）及相关肿瘤地西他滨治疗反应的临床及分子学指标。

方法

回顾性分析109例接受地西他滨治疗的MDS及相关肿瘤患者临床资料，采用二代测序检测MDS常见突变基因的突变情况，分析患者临床特征及基因突变与地西他滨临床反应的关系。

结果

地西他滨中位疗程数为4（2~11）个，共74例（67.9%）患者获得治疗反应，其中30例（27.5%）获得完全缓解（CR）；35例（32.1%）患者无反应。单因素分析结果显示，国际预后积分系统（IPSS）中危2+高危、复杂核型、单体核型、7号染色体异常及1个疗程后PLT倍增的患者可获得更高的CR率。66.7%（14/21）的复杂核型患者、58.8%（10/17）的单体核型患者及66.7%（10/15）的TP53基因突变患者获得CR；TP53基因突变常合并复杂核型及单体核型；多因素分析显示TP53突变、1个疗程后PLT倍增及复杂核型是预测地西他滨治疗获得CR的独立预后因素，其中TP53突变是最强的预测因子（OR=4.39，95%CI 1.20~16.06，P=0.026）。

结论

TP53基因突变、1个疗程后PLT倍增及复杂核型可预测地西他滨完全缓解。

The relationship between socio-economic status and diagnosed Type 2 diabetes is changing with economic growth in Nanjing, China

AIM

In developed countries, the relationship between socio-economic status (SES) and Type 2 diabetes was positive several decades ago but is now negative. However, in developing societies such as China the relationship remains positive. It is likely that at some stage of economic development the SES-Type 2 diabetes association will become negative in developing communities. This study aimed to examine whether this inflexion is approaching in China.

METHODS

Two cross-sectional surveys were undertaken in Nanjing, China, in 2000 and 2011. The same sampling approach was used to randomly select participants. Diagnosed Type 2 diabetes was the outcome variable. SES was measured using monthly family average income and divided into thirds. Mixed-effects models were used to calculate the association between SES and Type 2 diabetes.

RESULTS

There were 19 861 (response rate, 90.1%) and 7824 (response rate, 82.8%) participants in 2000 and 2011, respectively. A 2.6-fold increase in Type 2 diabetes prevalence was observed from 3.0% (95% confidence interval 2.8%, 3.3%) in 2000 to 8.2% (7.7%, 8.8%) in 2011 (P < 0.01). After controlling for potential confounders, the odds ratios of having Type 2 diabetes decreased from 2.06 (95% CI 1.55, 2.73) and 1.83 (1.40, 2.37) in 2000 to 1.58 (1.23, 2.02) and 1.35 (1.06, 1.74) in 2011 for the higher and middle SES groups respectively, compared with those in the lower SES category.

CONCLUSIONS

The SES-Type 2 diabetes association remained positive in Nanjing, China, in 2011 but the disparity diminished significantly compared with 2000. These results can inform the delivery of appropriate interventions to people at risk of developing Type 2 diabetes.

[Survey on the prevalence of continuous blood purification in Chinese pediatric critical care]

Objective: To investigate the current application status of continuous blood purification (CBP) technology and equipment in pediatric intensive care unit (PICU) in China. Methods: A cross-sectional survey was conducted to understand the current popularization of CBP technology and equipment, the management of CBP equipment and consumables, and the application of CBP in different diseases. A questionnaire named Application Status of Continuous Blood Purification Technology was applied. Children's hospitals and polyclinic hospitals with the pediatric qualification (pediatric emergency or critical care unit members of Chinese Medical Association and Chinese Medical Doctor Association) were selected. Results: From December 2016 to February 2017, 53 hospitals completed the questionnaire, including 7 in northeast, 6 in north China, 16 in east China, 9 in south China, 5 in central China, 4 in the northwest, and 6 in the southwest region. Continuous renal replacement therapy (CRRT), the most widely used technology, was carried out in 51 hospitals. Other technologies were peritoneal dialysis (IPD) (n=37), artificial liver support (ALSS) (n=26) and blood adsorption (PA) (n=13). There were 107 CBP machines in the 51 hospitals used CBP technology, with an average of 2.10/hospital. In 36 hospitals CBP machines were managed independently by PICU (70%). Hospitals made their own displacement liquid (n=40, 78%), or purchased displacement liquid (n=11, 22%). Hospitals prepared dialysate on their own (n=38, 75%), or purchased dialysate (n=13 hospitals, 25%). In 46 (90%) hospitals, hemodialysis catheter was placed independently by PICU doctors. The routine operation and maintenance of CBP were mainly completed by the PICU nurses in 36 hospitals (71%). There were 39 hospitals (76%) where professional nurses manage and maintain CBP. Puncture sites were femoral vein (n=26, 51%), internal jugular vein (n=21, 41%) and venae subclavia (n=4, 8%). Forty-two hospitals (82%) selected B-mode ultrasound positioning and guidance when performing internal jugular vein puncture. A total of 40 (78%) hospitals have developed post dilution and combined dilution techniques during the implementation of CBP. The most common indications of CBP technology were different in different regions. They were sepsis in northeast (24.0%, 243/1 011) and east China region (32.0%, 982/3 069), multiple organ dysfunction syndrome in south China (29.2%, 444/1 520), north China (15.8%, 126/796), and southwest region (30.1%, 460/1 526), drug poisoning in central China region (21.6%, 325/1 506), and renal failure in northwest region (53.0%, 44/83). Conclusions: CBP technology is widely used in the field of pediatric severe diseases in China. The eastern regions possess more CBP equipment than the western regions. CBP is widely used in the treatment of sepsis.

Effect of a Combined Tai Chi, Resistance Training and Dietary Intervention on Cognitive Function in Obese Older Women

Cognitive decline in older adults is a major public health problem and can compromise independence and quality of life. Exercise and diet have been studied independently and have shown to be beneficial for cognitive function, however, a combined Tai Chi, resistance training, and diet intervention and its influence on cognitive function has not been undertaken. The current study used a 12-week non-randomized research design with experiment and control groups to examine the effect of a combined Tai Chi, resistance training, and diet intervention on cognitive function in 25 older obese women. Results revealed improvements in domain specific cognitive function in our sample. Baseline cognitive function was correlated with changes in dietary quality. These findings suggest that Tai Chi and resistance training combined with diet intervention might be beneficial for community-based programs aiming to improve cognitive function.

Necrotizing fasciitis after scrotum skin injury in an infant: A case report

RATIONALE

Necrotizing fasciitis (NF) is a life-threatening situation that is rare in children, especially infants, and early diagnosis is challenging. Timely identification and broad-spectrum antibiotic and supportive treatment before surgical debridement are very important for survival and may reduce scar formation.

PATIENT CONCERNS

A previously healthy 4-month-old infant was admitted to our pediatric intensive care unit (PICU) with a history of fever and cough for 5 days and extreme swelling of the scrotum for one day. Necrotic-like tissue without margins appeared on his scrotum and perineum in 24 hours.

DIAGNOSIS

NF was suspected, and the patient soon developed shock. The patient underwent surgical debridement after his condition stabilized. Pathological analysis confirmed the diagnosis of NF.

INTERVENTION

Broad-spectrum antibiotic, immediate fluid resuscitation, assistant ventilation, and vasoactive drugs were administered. Surgical debridement and autologous split-thickness skin grafting were performed.

OUTCOMES

The wound recovered well after 2 months. Ultrasound revealed normal testicles, and no anorectal injury was found.

LESSONS

Close clinical monitoring and timely treatment of skin injuries in sick children are very important. Sufficient antibiotic administration and supportive treatment before surgical debridement are crucial for survival from NF.

Abstract P3-03-04: Not presented

This abstract was not presented at the symposium.

Reflex bronchoconstriction evoked by inhaled nicotine aerosol in guinea pigs: role of the nicotinic acetylcholine receptor

Inhaled cigarette smoke stimulated vagal bronchopulmonary C fibers via an action of nicotine on neuronal nicotinic acetylcholine receptor (nAChR). Recent studies have reported that nicotine at high concentrations can also activate the transient receptor potential ankyrin 1 receptor (TRPA1) expressed in these sensory nerves. This study was performed to characterize the airway response to inhaled nicotine aerosol and to investigate the relative roles of nAChR and TRPA1 in this response. Guinea pigs were anesthetized and mechanically ventilated; one tidal volume of nicotine aerosol (2% solution) was diluted by an equal volume of air and delivered directly into the lung via a tracheal cannula in a single breath. Our results showed the following: 1) Inhalation of nicotine aerosol triggered an immediate and pronounced bronchoconstriction; the increase in total pulmonary resistance reached a peak of 588 ± 205% (mean ± SE) in 10-40 s, which gradually returned to baseline after 1-5 min. 2) Pretreatment with either atropine (iv) or mecamylamine (aerosol) almost completely abolished the nicotine-induced bronchoconstriction; the mecamylamine pretreatment did not block the bronchoconstriction and bradycardia evoked by electrical stimulation of the distal end of one sectioned vagus nerve, indicating its minimal systemic effects. 3) Pretreatment with HC-030031, a selective TRPA1 antagonist, abolished the bronchoconstriction induced by allyl isothiocyanate, a selective TRPA1 agonist, but did not attenuate the nicotine-evoked bronchoconstriction. In conclusion, inhalation of a single breath of nicotine aerosol evoked acute bronchoconstriction mediated through the cholinergic reflex pathway. This reflex response was triggered by activation of nAChR, but not TRPA1, located in airway sensory nerves. NEW & NOTEWORTHY Recent reports revealed that nicotine at high concentration activated transient receptor potential ankyrin 1 receptor (TRPA1) expressed in vagal bronchopulmonary sensory nerves. This study showed that inhalation of a single breath of nicotine aerosol consistently evoked acute bronchoconstriction that was mediated through the cholinergic reflex pathway and triggered by activation of nicotinic acetylcholine receptor, but not TRPA1, located in these nerves. This is new and important information considering the recent rapid and alarming rise in the prevalence of e-cigarette use for nicotine inhalation.

[Prognosis and its risk factors in ANCA-associated glomerulonephritis patients treated with initial renal replacement therapy]

Objective: To explore the prognosis and its risk factors in anti-neutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AAGN) patients who needed initial renal replacement therapy (RRT). Methods: One hundred patients [54 females, 46 males, with a median age of 54(41, 60) years] with biopsy-proven AAGN and requiring initial RRT between January 1996 and December 2016 in Nanjing Jinling Hospital were included. Intensive immunotherapy indicated that the patients received corticosteroids in combination with cyclophosphamide or mycophenolate mofetil, or immunoadsorption (IA) or double filtration plasmapheresis (DFPP). The clinical and histological risk factors for renal survival were analyzed. Results: Forty-one patients were free of RRT after a median time of 1 (0.5, 2) month treatment (dialysis-independent group), and the remaining 59 patients were on maintenance dialysis (dialysis-dependent group). The multivariate logistic analysis revealed that the proportion of normal glomeruli <8% (OR=5.95, P=0.002) and global sclerotic glomeruli ≥50% (OR=4.87, P=0.003), and not receiving intensive immunotherapy (OR=7.81, P=0.004) were the risk factors for the renal recovery in these patients. During a median follow-up time of 22 (10, 50) months, 15 patients(36.6%) in the dialysis-independent group progressed into maintenance dialysis, and the 1 and 3 year renal survival rate were 86% and 60%, respectively. During a median follow-up time of 6 (2, 24) months, 12 (12%) patients died, among whom four patients died of therapy. The multivariate Cox regression analysis revealed that IA/DFPP treatment (HR=10.85, P=0.034) and low albumin level (HR=1.26, P=0.009) significantly associated with a higher risk of therapy-related death. Conclusions: The renal recovery rate in AAGN patients with initial RRT was low. The proportion of normal and global sclerotic glomeruli, receiving intensive immunotherapy or not were associated with renal outcome, and IA/DFPP treatment as well as lower albumin level were independently associated with therapy-related death.

Detection and genetic characterization of porcine deltacoronavirus in Tibetan pigs surrounding the Qinghai-Tibet Plateau of China

Porcine deltacoronavirus (PDCoV) is a recently discovered RNA virus that belongs to the family Coronaviridae and genus Deltacoronavirus. This virus causes enteric disease in piglets that is characterized by enteritis and diarrhoea. In our present investigation, 189 diarrhoeic samples were collected between July 2016 and May 2017 from Tibetan pigs inhabiting in three different provinces surrounding the Qinghai–Tibet Plateau of China. We then applied the molecular‐based method of reverse transcription polymerase chain reactions (RT‐PCRs) to detect the presence of PDCoV in collected samples, and RT‐PCR indicated that the prevalence of PDCoV was 3.70% (7/189) in Tibetan pigs. Four of 7 PDCoV‐positive pigs were monoinfections of PDCoV, three samples were co‐infections of PDCoV with porcine epidemic diarrhoea virus (PEDV), and 52 (27.51%) samples were positive for PEDV. Four strains with different full‐length genomes were identified (CHN/GS/2016/1, CHN/GS/2016/2, CHN/GS‐/2017/1 and CHN/QH/2017/1), and their genomes were used to analyse the characteristics of PDCoV currently prevalent in Tibetan pigs. We found a 3‐nt insertion in the spike gene in four strains in Tibetan pigs. Phylogenetic analysis of the complete genome and spike and nucleocapsid gene sequences revealed that these strains shared ancestors with the strain CHN‐AH‐2004, which was found in pigs from the Anhui province of China mainland. However, PDCoV strains from Tibetan pigs formed different branches within the same cluster, implying continuous evolution in the field. Our present findings highlight the importance of epidemiologic surveillance to limit the spread of PDCoV in livestock at high altitudes in China.

The morphological changes of bronchovascular bundles within subsolid nodules on HRCT correlate with the new IASLC classification of adenocarcinoma

AIM

To observe the morphological changes of bronchovascular bundles within subsolid nodules on high-resolution (HR) computed tomography (CT) and analyse the correlation with the new adenocarcinoma classification.

MATERIALS AND METHODS

Two hundred and sixteen lesions (absent consolidation on mediastinal window) were reviewed retrospectively. CT features including dimensions, contour, morphological changes of the blood vessels, and bronchi/bronchioles, vacuole signs, and their correlation with histopathology were evaluated.

RESULTS

Excluding nine non-cancerous lesions, 34 pre-invasive lesions (PILs) including 15 atypical adenomatous hyperplasias (AAHs) and 19 adenocarcinomas in situ (AISs), 21 minimally invasive adenocarcinomas (MIAs), and 152 invasive adenocarcinomas (IACs) were analysed. Lepidic, acinar, and papillary patterns were identified in this cohort of adenocarcinomas. IACs were grouped into three types: type I (lepidic pattern ≥80%, n=47), type II (lepidic pattern ≥50%, <80%, n=67), and type III (lepidic pattern <50%, n=38). The contour of lesions, and morphological changes in vessels and bronchi/bronchioles significantly correlated with the classification of PIL, MIA, and IACs (p=0.000, p=0.000, and p=0.017, respectively). In IACs, the prevalence of vascular abnormalities on HRCT significantly correlated with (p=0.000) the proportion of non-lepidic pattern (23.40% in type I, 58.21% in type II, and 76.32% in type III); the prevalence of bronchial/bronchiolar abnormalities was higher (p=0.008) in type II/III (20.95%) compared with type I (6.38%).

CONCLUSIONS

The morphological changes of vessels and bronchi/bronchioles within the subsolid nodules on HRCT help to differentiate IAC from PIL and MIA, and are more common in non-lepidic predominant adenocarcinomas.

A SUVmax-based propensity matched analysis of stereotactic body radiotherapy versus surgery in stage I non-small cell lung cancer: unveiling the role of 18F-FDG PET/CT in clinical decision-making

BACKGROUND

The value of maximum standard uptake value (SUV_max) was overlooked in current studies comparing stereotactic body radiotherapy (SBRT) versus surgery for stage I non-small cell lung cancer (NSCLC). Herein, we aimed to compare the 3-year outcomes based on patients for whom SUV_max were available, and to explore the role of SUV_max in clinical decision-making.

METHODS

From January 2010 to June 2016, data of eligible patients were collected. Patient variables and clinical outcomes were compared in both unmatched and matched groups using propensity score matching (PSM). Multivariate analysis was performed for predictors of poor outcome. The relationship between treatment approach and survival outcome was also evaluated in subgroup patients stratified by SUV_max level.

RESULTS

A total of 425 patients treated with either surgery (325) or SBRT (100) were included. Patients receiving SBRT were significantly older, had a higher level of SUV_max and were more likely to have tumor of centrally located. Multivariate analysis showed that SUV_max and tumor size were significant predictors for 3-year OS, LRC, and PFS, while better PFS was also related to peripheral tumor and surgery. The result of PSM analysis also showed that compared to SBRT, surgery could only achieve better PFS. Subgroup analysis indicated that surgery had added advantage of 3-year LRC and PFS for patients in high SUV_max group (SUV_max > 8), but not in low SUV_max group.

CONCLUSIONS

The study found a superior PFS after surgery while OS and LRC did not differ between SBRT and surgery. Surgery should be recommended for tumor of high SUV_max.

Outcome of postmastectomy radiotherapy after primary systemic treatment in patients with clinical T1-2N1 breast cancer

PURPOSE

The role of postmastectomy radiotherapy following primary systemic treatment in patients with clinical T1-2N1 breast cancer remains a controversial issue. The purpose of this study was to evaluate the benefit of postmastectomy radiotherapy following primary systemic treatment.

PATIENTS AND METHODS

Between 2005 and 2012, in two independent institutions, female patients with T1-2N1 breast cancer receiving primary systemic treatment followed by mastectomy and lymph node dissection because bad response, then treated with or without chest wall and regional lymph node irradiation have been studied retrospectively. The patients received normofractionated radiotherapy using 3D conformal photons or electron techniques. Locoregional recurrence-free survival, distant metastasis-free survival and disease-free survival were calculated using Kaplan-Meier method. Univariate analysis of potential prognostic factors was performed using log-rank test.

RESULTS

Eighty-eight patients have been studied. Of them, 75 patients received postmastectomy radiotherapy. At surgery, 53 patients achieved ypN0. Median follow-up was 67 months. Postmastectomy radiotherapy significantly improved locoregional recurrence-free survival, with a 5-year rate of 96.9% versus 78.6% in the group that did not have postmastectomy radiotherapy. In the subgroup of 53 patients achieving ypN0, postmastectomy radiotherapy improved locoregional recurrence-free survival (a 5-year rate of 94.7% vs. 72.9%), distant metastasis-free survival (a 5-year rate of 92.8% vs. 75%) and disease-free survival (a 5-year rate of 92.9% vs. 62.5%). By univariate analysis, postmastectomy radiotherapy was the only significant prognostic factor affecting locoregional recurrence-free survival.

CONCLUSIONS

For patients with clinical T1-2N1 disease, postmastectomy radiotherapy could significantly improve locoregional recurrence-free survival after primary systemic treatment and be even more therapeutic in the subgroup of patients with good response for primary systemic treatment by improving locoregional recurrence-free, distant metastasis-free and disease-free survival. Larger prospective studies are needed to confirm our findings.

Relationship between Diet Quality, Physical Activity and Health-Related Quality of Life in Older Adults: Findings from 2007-2014 National Health and Nutrition Examination Survey

BACKGROUND

A growing body of research shows that diet quality and physical activity (PA) are associated with health-related quality of life (HRQOL). However, no study to date has assessed this association using the Healthy Eating Index-2015 as a measure of diet quality. Furthermore, few studies have examined the association between PA dose and HRQOL among a nationally representative sample of older adults.

OBJECTIVES

To investigate the relationship between diet quality, physical activity, and HRQOL.

DESIGN

A cross-sectional analysis was conducted using data obtained from 5,311 adults aged 60+ years who took part in the National Health and Nutrition Examination Survey between 2007 and 2014.

MEASUREMENTS

HRQOL was assessed by general health status, and number of physically unhealthy days, mentally unhealthy days, and inactive days in past 30 days. Diet quality was assessed by the Healthy Eating Index-2015 using data generated by two 24-hour dietary recalls. PA was measured by the Global Physical Activity Questionnaire. Multivariate logistic/or linear regression models were used to examine the association between diet quality, PA and HRQOL controlling for confounders and accounting for complex sampling.

RESULTS

Approximately half of the participants (55.2%) were women, 45.1% met current PA recommendations, 65% had less healthful diets according to the Healthy Eating Index-2015. Diet quality was associated with HROQL. For every 1-point diet quality score increase, the likelihood of respondents rating their general health as being excellent/good increased by 3% (OR=1.03, 95%CI: 1.02, 1.04), and number of inactive days (β =-0.03, 95%CI: -0.05, 0.00) and mental unhealthy days (β =-0.03, 95%CI: -0.05, -0.01) declined by 0.03 days. PA was associated with all HROQL measures and respondents with high PA levels reported better general health (OR=3.53, 95%CI: 2.69, 4.63), fewer inactive days (β =-1.53, 95%CI: -2.11, -0.95), fewer physical unhealthy days (β =-1.88, 95%CI: -2.74, -1.02) than individuals with low PA levels but not fewer mentally unhealthy days.

CONCLUSIONS

Among older adults in this study, eating a healthier diet and being physically active were associated with better general health and reporting fewer physical unhealthy days and inactive days. Study results provide valuable information that could inform policies, programs and interventions designed to improve HRQOL in older adults and reduce potentially preventable health disparities.

Impact of varicocelectomy on the proteome profile of testicular tissues of rats with varicocele

Varicocele (VC) is a common cause of male infertility, but the molecular mechanisms involved in its pathogenesis are unknown. We investigated the impact of varicocelectomy (VCT) on proteome profiles in testicular tissues of rats with VC, and analysed associated target genes and signalling pathways. Sixty male rats with VC were divided into two groups: control (n = 30), and VCT (n = 30). Tissues were collected 4 weeks after sham or VCT surgery. Matrix-assisted laser desorption/ionisation time-of-flight/time-of-flight mass spectrometry (MALDI-TOF/TOF MS) was used to analyse the comparative proteome profiles. Kyoto Encyclopaedia of Genes and Genomes (KEGG) Orthology-Based Annotation System was used for bioinformatic analysis. Fifteen proteins were differentially expressed between control and VCT groups. These differentially expressed proteins are associated with several specific cellular processes associated with the pathogenesis of testicular growth arrest associated with VC. Furthermore, the evaluation by transmission electron micrograph showed that VCT could decrease apoptosis of spermatogenic cells in rats. Understanding such molecular pathways might provide physicians with a better insight into VC and with potential targets for treatment.

Childhood obesity prevention through a community-based cluster randomized controlled physical activity intervention among schools in china: the health legacy project of the 2nd world summer youth olympic Games (YOG-Obesity study)

Background:

Childhood obesity has been becoming a worldwide public health problem. We conducted a community-based physical activity (PA) intervention program aiming at childhood obesity prevention in general student population in Nanjing of China, the host city of the 2nd World Summer Youth Olympic Games (YOG-Obesity study).

Methods:

This was a cluster randomized controlled intervention study. Participants were the 4th (mean age±s.e.: 9.0±0.01) and 7th (mean age±s.e.: 12.0±0.01) grade students (mean age±s.e.: 10.5±0.02) from 48 schools and randomly allocated (1:1) to intervention or control groups at school level. Routine health education was provided to all schools, whereas the intervention schools additionally received an 1-year tailored multi-component PA intervention program, including classroom curricula, school environment support, family involvement and fun programs/events. The primary outcome measures were changes in body mass index, obesity occurrence and PA.

Results:

Overall, 9858 (97.7%) of the 10091 enrolled students completed the follow-up survey. Compared with the baseline, PA level increased by 33.13 min per week (s.e. 10.86) in the intervention group but decreased by 1.76 min per week (s.e. 11.53) in the control group (P=0.028). After adjustment for potential confounders, compared with the control group, the intervention group were more likely to have increased time of PA (adj. Odds ratio=1.15, 95% confidence interval=1.06–1.25), but had a smaller increase in mean body mass index (BMI) (0.22 (s.e. 0.02) vs 0.46 (0.02), P=0.01) and BMI z-score (0.07 (0.01) vs 0.16 (0.01), P=0.01), and were less likely to be obese (adj. Odds ratio=0.7, 95% confidence interval=0.6, 0.9) at study end. The intervention group had fewer new events of obesity/overweight but a larger proportion of formerly overweight/obese students having normal weight by study end.

Conclusions:

This large community-based PA intervention was feasible and effective in promoting PA and preventing obesity among the general student population in a large city in China. Experiences from this study are the lessons for China to control the childhood obesity epidemic.

Long noncoding RNA CASC2 inhibits metastasis and epithelial to mesenchymal transition of lung adenocarcinoma via suppressing SOX4

OBJECTIVE

Recently, long non-coding RNAs (lncRNAs) have caught more attention for their role in tumor progression. Lung adenocarcinoma (LAC) is one of these ordinary malignant tumors. This study aims to identify whether lncRNA CASC2 (cancer susceptibility candidate 2) can regulate the metastasis of LAC, and find out its potential mechanism.

PATIENTS AND METHODS

RT-qPCR was conducted to detect CASC2 expression level in 63 LAC tissues and 4 LAC cells. Besides, statistical methods were applied to analyze clinical data and prognosis in the 63 patients. Furthermore, function experiments were performed to determine the effect of CASC2 on LAC metastasis in vitro. The potential mechanism was further explored by RT-qPCR and Western blot assay.

RESULTS

In our study, CASC2 expression level was lower in LAC tissues than that in corresponding tissues. CASC2 expression was associated with lymph node metastasis, clinical stage and survival time of these patients. Moreover, overexpression of CASC2 inhibited migrated and invaded ability of LAC cells. Then, epithelial to mesenchymal transition (EMT) process of LAC cells and SOX4 expression was suppressed by upregulating CASC2.

CONCLUSIONS

These results indicate that CASC2 could inhibit metastasis and EMT of LAC via suppressing SOX4, which may offer a new vision for interpreting the mechanism of LAC metastasis.

The effect of Echinococcus granulosus on spleen cells and TGF-β expression in the peripheral blood of BALB/c mice

Cystic echinococcosis (CE) caused by the cestode Echinococcus granulosus (E. granulosus) is a zoonotic parasitic disease. The effective immune evasion mechanisms of E. granulosus allow it to parasitize its hosts. However, the status of the innate and adaptive immune cells and their contributions to E. granulosus progression remain poorly understood. In this study, we aimed to determine the impact of E. granulosus infection on T cells, NK cell responses and TGF-β expression during the early infection phase in BALB/c mice. In E. granulosus infections, there was an increasing tendency in the percentage of CD4⁺ CD25⁺ T cells and CD4⁺ Foxp3⁺ T cells and peripheral blood TGF-β levels and relative expression of the Foxp3 gene. Moreover, there were a decreasing tendency in the percentage of NK cells and NK cell cytotoxicity and the expression of NKG2D on NK cells. The TGF-β1/Smad pathway was activated by E. granulosus in mice. Above results can be reversed by the inhibitor SB-525334 (potent activin receptor-like kinase 5 inhibitor). These results suggest that the TGF-β/Smad pathway plays an important role in changes of T-cell or NK cell responses. These results may contribute to revealing the preliminary molecular mechanisms in establishing hydatid infection.

[Recombinant expression of hantaan virus protein N with application of Western-blot in detecting anti-hantavirus antibody]

Objective: S gene of hantavirus(HV) was expressed in insect cells by genetic engineering technology. The expression product of S gene was used as antigen to detect anti-HV specific antibody IgG in serum. Methods: Gene encoding NP of the strain HV-Z10 was amplified by PCR and then its eukaryotic expression system rBAC-Z10S-TN was constructed by using the routine genetic engineering method. SDS-PAGE was applied to measure the expression of rNP.Ion-exchange plus Ni-NTA-affinity chromatography was performed to purify the recombinant product. Indirect immuno-fluorescence assay (IFA) was used to determine the specific immune-reactivity of rNP. WB assay was established to detect the serum samples from 95 confirmed HFRS patients. Parameters related to the outcomes of detection were compared with the routine HV-IgG IFA method. Results: rBAC-Z10S-TN was able to express rNP with high efficiency. The purified rNP only showed a single protein fragment in the gel after SDS-PAGE. HV IgG could efficiently recognize rNP and hybridize with the recombinant protein. 97.67% of the serum samples from the HFRS patients were positive confirmed by WB. Conclusions: We successfully constructed a high efficient prokaryotic expression system of NP encoding gene from hantavirus strain HV-Z10. WB assay which was established in this study could be used as a new serological test for HFRS diagnosis, thanks to the simplicity, safety, sensitivity and specificity of this method.

Mesangial proliferative lupus nephritis with podocytopathy: a special entity of lupus nephritis

Mesangial proliferative lupus nephritis may coexist with podocytopathy, but its clinical-morphological features, treatment response and outcomes have not been compared with mesangial proliferative lupus nephritis without podocytopathy. In this study, 125 biopsies of lupus nephritis patients showing mesangial proliferation with mesangial immune deposits were collected and divided into podocytopathy group (defined as podocyte foot process effacement (FPE) >50% with nephrotic syndrome (NS)) and mesangial group (FPE ≤50%, or FPE >50% without NS). Mesangial proliferation and tubular- interstitial lesions were semi-quantitatively analyzed. We found that the incidence of renal involvement as the onset symptoms ( P < .001), nephrotic syndrome ( P < .001), acute kidney injury ( P < .001), the degree of acute tubular- interstitial lesions ( P < .001), and renal relapse (51.6% vs. 23.7%, P = .005) were significantly higher in the podocytopathy group than in the mesangial group. In contrast, the incidence of arthritis ( P < .001), fever ( P = .042), low serum C4 ( P = .008) and hematuria ( P = .033) was significantly lower in the podocytopathy group than in the mesangial group. No patients developed end stage renal disease or death during a median follow-up of 64 (interquartile range (IQR) 37-103) months in the podocytopathy group and 53 (IQR 30-83) months in the mesangial group. In conclusion, mesangial proliferative lupus nephritis with and without podocytopathy should be subdivided into two separate classes of lupus nephritis.

[Mass spectrometry combined with gene analysis for prenatal diagnosis of glutaric acidemia type Ⅰ]

Objective: To investigate the value of amniotic fluid metabolite detection by mass spectrometry combined with gene mutation analysis in the prenatal diagnosis of glutaric acidemia type Ⅰ (GA-Ⅰ). Method: From January 2009 to December 2016, Department of Pediatric Endocrinology and Genetic, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine carried out prenatal diagnosis for 24 cases of pregnant women with GA-Ⅰproband. 24 pregnant women without organic acidemia proband for conventional prenatal diagnosis at the same period were used as the control group. The pregnant women of the two groups had the amniocentesis at 16 to 20 weeks of gestation.The levels of glutaryl carnitine (C5DC) and octanoylcarnitine (C8) in amniotic fluid were detected by tandem mass spectrometry, and the levels of glutaric acid was determined by gas chromatography-mass spectrometry. All the amniotic fluid cells underwent GCDH gene testing. Result: A total of 4 cases of fetuses were diagnosed by gene mutation analysis combined with mass spectrometry detection, the levels of C5DC (1.58(0.89-2.85) μmol/L), C5DC/C8 (19.74(12.40-25.93))and glutaric acid (129.96 (90.09-66.02) mmol/mol Cr) were significantly higher than the upper limit of the reference, of which in one case with the proband only on mutation was detected, and in the amniotic fluid cells also only one mutation was detected, the diagnosis was made according to the significantly increased levels of amniotic fluid C5DC, C5DC/C8 and glutaric acid. Twenty cases of fetuses were identified as non-GA-Ⅰchildren, of whom in 2 cases of proband only one mutation was detected, and also in amniotic fluid cells one mutation was detected, in 2 cases the diagnosis was excluded because the normal levels of C5DC, C5DC/C8 and glutaric acid. There were 2 cases whose levels of C5DC or glutaric acid were slightly higher than the upper limit of the reference, but the diagnosis was excluded according to genetic testing. Conclusion: Prenatal diagnosis cannot be made by gene analysis when the proband mutation is not clear, and it cannot determine whether the fetus is patient when the mass spectrometry detection of amniotic fluid metabolite is mildly abnormal, while mass spectrometry detection of amniotic fluid C5DC, C5DC/C8 and glutaric acid levels combined with GCDH gene analysis can make up the deficiencies, and make the prenatal diagnosis of GA-Ⅰ more reliably.

Relevant researches on chronic viral myocarditis (CVMC) in children, complicated with arrhythmia and thyroid hormone level

OBJECTIVE

To analyze the correlation between chronic viral myocarditis (CVMC) in children, complicated with arrhythmia and thyroid hormone level.

PATIENTS AND METHODS

60 patients with CVMC complicated with arrhythmia were continuously selected (course of disease > 3 months) and they are were diagnosed with arrhythmia by the routine 18-lead electrocardiogram and 24-hour Holter; the average follow-up time is about 2 years, during which the left ventricular end-diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF), the occurrence rate of malignant arrhythmia events, immune state of T cell and thyroid hormone level (FT3, FT4, TSH, TGAb and TPOAb) were compared.

RESULTS

Among the selected 60 patients, 18 patients (30.0%) who were suffering from malignant arrhythmia have been taken as the observation group. When compared with the control group, the standard deviation normal to normal intervals (SDNN), LVEF, CD4 and CD4/CD8 were reduced and LVEDd and CD8 were increased in the observation group; the difference has statistical significance (p < 0.05). When compared with the control group, FT3 and FT4 are significantly reduced and TSH, thyroglobulin antibody TGAB and thyroid peroxidase antibodies (TPOAb) are significantly increased; the difference has statistical significance (p < 0.05). According to the logistic regression analysis, we can conclude that: SDNN, FT3, FT4, TSH, TGAb and TPOAb are the independent risk factors of malignant arrhythmia (p < 0.05).

CONCLUSIONS

Thyroid hormones and antibody level are helpful to the prognosis of malignant arrhythmia resulting from children chronic VMC complicated with arrhythmia complications.

Association of cytokine gene polymorphisms (IL‑6, IL‑12B, IL‑18) with Behcet's disease : A meta-analysis

PURPOSE

This study aims to investigate the association of cytokine gene polymorphisms with the risk of Behcet's disease (BD) via comprehensive meta-analysis.

METHODS

The Embase and PubMed databases covering the period from the earliest possible year to May 2015 were searched. A total of 13 eligible articles including 2,065 BD patients and 1,559 controls were recruited. Odds ratios (ORs) and 95 % confidence intervals (CIs) were used to assess the strength of the associations. Potential publication bias was evaluated using Egger's linear regression test.

RESULTS

Meta-analysis indicated associations between IL‑6 rs1800795, IL‑12B rs3212227, and IL‑18 rs1946518 in all study subjects: IL‑18 rs1946518 in the dominant model (IL‑18 rs1946518: OR = 0.48, 95 % CI: 0.34-0.70, P = 0.000) and the homozygote model (IL‑18 rs1946518: OR = 0.40, 95 % CI: 0.25-0.65, P = 0.000); and IL‑6 rs1800795 and IL‑12B rs3212227 in the dominant model (IL‑6 rs1800795: OR = 0.53, 95 % CI: 0.39-0.72, P = 0.000; IL‑12B rs3212227: OR = 1.26, 95 % CI: 1.06-1.48, P = 0.007; IL‑18 rs1946518: OR = 0.46, 95 % CI: 0.33-0.65, P = 0.000). No significant evidence for associations of IL‑18 rs187238 polymorphisms with BD susceptibility was detected.

CONCLUSION

In summary, this meta-analysis finds that IL‑6 rs1800795 and IL‑18 rs1946518 polymorphisms decrease the risk of BD. However, IL‑12B rs3212227 increases BD susceptibility. Further large-scale investigation of this association is necessary.

[Utilisation of electrical impedance tomography and/or ultrasound and mammography in breast disease diagnosis: a controlled study]

Objective: To investigate the diagnostic accuracy of electrical impedance tomography (EIT) for benign and malignant breast diseases incomparison to conventional ultrasonography and mammography. Methods: A total of 121 patients with 126 breast lesions who underwent mammography ultrasonography and EIT were enrolled in the study. All of these lessions were were confirmed by pathological biopsy. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EIT, ultrasonography and mammography were calculated with histology as the gold standard. Results: The accuracy of EIT, ultrasonography and mammography were 75.4%, 81.7% and 76.1% respectively. The sensitivity was 76.8%, 94.6% and 74.4% respectively. The specificity was 74.3%, 71.4% and 77.6% respectively. The accuracy, sensitivity and specificity of EIT combined with ultrasound in diagnosis of breast lesions were 91.3%, 98.2% and 85.7%, respectively. The accuracy(χ(2)=4.896, P=0.027) and specificity(χ(2)=4.242, P=0.039) ere significantly higher on EIT compared to ultrasound.The accuracy, sensitivity and specificity of EIT combined with mammography were 95.5%, 97.4% and 93.9%, respectively, which were significantly higher than those of mammography (χ(2)=13.474, P<0.001; χ(2)=8.573, P=0.003; χ(2)=5.333, P=0.021). Conclusion: When together with ultrasound or mammography, electrical impedance tomography (EIT) could be a valuable complementary examination in the diagnosis of breast diseases. Furthermore, EIT could provide very useful additional information for metabolic assessment of mammary glands, which may be used for early screening of breast diseases.

[Application of improved regional citrate anticoagulation in continuous hemofiltration in children]

Objective: To investigate the application of regional citrate anticoagulation with calcium hemofiltration basic solution in continuous hemofiltration in children. Method: The clinical data of 18 patients with citrate anticoagulation in continuous hemofiltration in children, excluding the hepatic failure and septic shock cases, were analyzed retrospectively, from September 2015 to August 2016 in Intensive Care Unit of the Children's Hospital of Chongqing Medical University.The commercial calcium hemofiltration basic solution was used as displacement liquid . The blood gas analysis, electrolyte, four coagulation tests during the treatment and the corresponding relations of quantity of blood flow(QB), quantity of citrate flow(QCi), quantity of sodium bicarbonate flow(QSB), quantity of calcium flow(QCa), quantity of filtered solution flow (Qf) were monitored. Meanwhile, the blood gas analysis, electrolyte, four coagulation tests, useful life of filter, bleeding and clotting events internal and external before, during and after the treatments were monitored, too. And the common complications of citrate anticoagulation, such as hypocalcaemia, metabolic alkalosis, citrate accumulation and hypernatremia were observed. Result: Continuous hemofiltration was applied in 18 patients for 734.5 hours, and the average useful life of filter was (25±11)h.There was no obvious clotting event. There were 168 groups of datum of the blood gas analysis, electrolyte, four coagulation tests during the treatment and the relationships of QB, QCi, QSB, QCa, Qf had been collected. The relationships of the initial parameter settings of QB, QCi, QSB, QCa and Qf were concluded as QCi=1.8×QB, QCa=0.12×QB, QSB=0.01×Qf . There were 150 times(89.3%)of extracorporeal ionized calcium(iCa(E)(2+)) and 162 times(96.4%) of intracorporal ionized calcium(iCa(I)(2+)) reached the anticoagulation target. Although all the comparisons of Na(+) ((136.2±4.1)vs.(138.2±2.4)vs.(138.5±3.9)mmol/L), iCa(2+) ((1.07±0.11)vs.(1.21±0.12)vs.(1.17±0.09)mmol/L), HCO(3)(-) ((22±4)vs.(28±5)vs. (26±4)mmol/L) among before, during and after treatment had significant difference(F=6.414, 18.950, 19.151; P=0.002, 0.000, 0.000). Each mean parameter was within the nearly normal range, except that the HCO(3)(-) increased slightly. High HCO(3)(-) was the most common complications, which happened 87 times (51.8%) during the treatment and 11 cases(37.9%) after the treatment. There was none with refractory hypocalcemia and total ionized calcium(TCa(2+) )/iCa(2+) above 2.5, which hints the accumulation of citrate. Conclusion: The commercialized displacement liquid containing calcium can be used in RCA-CHF in children safely and simply.

Trends of lack of health insurance among US adults aged 18-64 years: findings from the Behavioral Risk Factor Surveillance System, 1993-2014

OBJECTIVE

To examine the prevalence of lack of health insurance and its changes over time among adult residents (aged 18-64 years) in 50 states and the District of Columbia (DC).

STUDY DESIGN

Cross-sectional surveys.

METHODS

We aggregated annual state-based Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2014 to provide nationwide and state-based prevalence estimates for lack of insurance among adults aged 18-64 years. The adjusted prevalence was estimated using log-linear regression analyses with a robust variance estimator after controlling for demographic variables. The trend was assessed separately for the periods 1993-2010 and 2011-2014 due to methodologic changes in the BRFSS.

RESULTS

From 1993 through 2010, the adjusted prevalence of lack of health insurance increased by 0.54% (P < 0.0001) annually (range: 16.3% in 1995 to 19.1% in 2005); this prevalence decreased significantly in 2014 (15.1%). In 2014, Georgia, Mississippi, and Texas had the highest adjusted prevalences (range: 23.0-24.6%) of lack of health insurance, and DC, Massachusetts, and Rhode Island had the lowest (range: 6.2-10.1%). The changes in the prevalence of lack of insurance over time varied significantly by state.

CONCLUSIONS

The nationwide prevalence of lack of health insurance decreased significantly in the past few years, especially in 2014 when about one-seventh of Americans aged 18-64 years reported lack of health insurance coverage. The huge variations in the prevalence of lack of health insurance and its changes over time among states suggest continuing efforts to ensure healthcare access for all Americans are needed to improve the overall health of the population.

Anorectal manometry: Should it be performed in a seated position?

BACKGROUND

Anorectal manometry (ARM) is typically preformed in a lateral position. This non-physiological testing position has produced an unexpected negative rectoanal pressure gradient (RAPG, i.e. difference between rectal and anal pressure) with normal defecation. This study was designed (i) to study differences in ARM parameters between water-perfused and solid-state sensors and between lateral and seated positions and (ii) to investigate the roles of ARM parameters in predicting balloon expulsion.

METHODS

ARM was performed in 18 healthy volunteers (HV) and 60 patients with functional constipation (FC) under three randomized conditions: water-perfused in lateral position, solid-state in lateral position, and solid-state in seated position, followed by a balloon expulsion test in seated position.

KEY RESULTS

i) Under the same lateral position, solid-state sensors produced higher rectal resting pressure and RAPG than water-perfused sensors. ii) Using the solid-state sensors, ARM in the seated position revealed higher resting rectal pressure (34.9 vs 10.9 mmHg in HV, 30.9 vs 10.6 mmHg in FC, both P<.001) and higher RAPG (22.6 vs -6.2 mmHg in HV, 17.1 vs -8.1 mmHg in FC, both P<.001) than the lateral position. iii) When ARM was performed using solid-state sensors in seated position, RAPG was predictive of balloon expulsion; using 10 mmHg as a threshold, RAPG could predict balloon expulsion with specificity of 82% and sensitivity 77%.

CONCLUSIONS AND INFERENCE

ARM performed in a seated position using solid-state sensors seems more accurate in assessing rectal pressure, and the RAPG measured under these conditions is predictive of balloon expulsion in FC patients.