Clinical characteristics and outcomes of myocardial infarction with nonobstructive coronary arteries

Background

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is caused by a heterogenous group of conditions with clinically significant sequelae.

Purpose

This study aims to compare the clinical characteristics and prognosis of MINOCA with myocardial infarction with obstructive coronary artery disease (MICAD).

Methods

Data was obtained from the Singapore Cardiac Longitudinal Outcomes Database (SingCLOUD), a national multicenter registry of patients with cardiovascular disease. Patients with a first presentation of acute myocardial infarction who underwent coronary angiography between 1 January 2011 and 31 December 2014 were extracted from the database. Follow up was conducted until 31 December 2017. Subjects were classified as having either MICAD or MINOCA based on angiographic findings. The primary outcomes were all-cause mortality and major adverse cardiac events (MACE) defined as a composite of all-cause mortality, recurrent myocardial infarction, hospitalization for heart failure and ischemic stroke.

Results

All 4124 patients who met the inclusion criteria were included in this study, of which 159 (3.9%) were diagnosed with MINOCA. Patients with MINOCA were more likely to be female, present with a non-ST elevation myocardial infarction (NSTEMI), have a higher left ventricular ejection fraction and less likely to have diabetes mellitus, previous ischemic stroke or smoking history. Over a mean follow-up duration of 4.5 years, MINOCA patients had a lower incidence of all-cause mortality (10.1% vs. 16.5%, p=0.030) and MACE (20.8% vs. 35.5%, p<0.0001) compared to patients with MICAD. On multivariable analysis, patients with MINOCA had a significantly lower risk of all-cause mortality (HR 0.42; 95% CI 0.21–0.82; p=0.011), MACE (HR 0.42; 95% CI 0.26–0.69; p=0.001) and recurrent myocardial infarction (HR 0.35; 95% CI 0.15–0.85; p=0.021). Within the MINOCA group, older age, higher creatinine, a STEMI presentation and the absence of antiplatelet use predicted all-cause mortality and MACE.

Conclusions

While patients with MINOCA had better clinical outcomes compared to MICAD patients, MINOCA is not a benign entity with about one in five patients experiencing a major adverse cardiovascular event in the mid-term.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council Project Grant

Pre-operative assessment of facial recess width in paediatric cochlear implant recipients: a radiological study

Background

The location of the vertical segment of the facial nerve varies greatly among patients undergoing otological surgery. Its position relative to the incus determines facial recess width, which has implications for ease of cochlear implantation.

Objective

To investigate the variation in facial nerve depth, relative to the incus, on pre-operative computed tomography in patients undergoing cochlear implantation.

Methods

A retrospective cohort study was conducted of paediatric patients undergoing cochlear implantation at a tertiary referral centre. Distance between the incus short process and facial nerve, in the transverse (medial-lateral) dimension, was measured at six imaging slices, ranging from 1.25 to 7.25 mm below the tip of the incus short process.

Results

Facial nerve depth relative to the incus short process demonstrated significant variability. Among all subjects and at all measurements taken inferior to the incus, the mean dimension between the facial nerve and the incus short process was 1.71 mm.

Conclusion

This paper presents a rapid, repeatable technique to assess the depth of the facial nerve vertical segment on pre-operative computed tomography, as measured relative to the tip of the incus short process. This allows the surgeon to anticipate facial recess width and round window access during cochlear implantation.

Multiscale Assessment of Agricultural Consumptive Water Use in California's Central Valley

Spatial estimates of crop evapotranspiration with high accuracy from the field to watershed scale have become increasingly important for water management, particularly over irrigated agriculture in semiarid regions. Here, we provide a comprehensive assessment on patterns of annual agricultural water use over California's Central Valley, using 30-m daily evapotranspiration estimates based on Landsat satellite data. A semiempirical Priestley-Taylor approach was locally optimized and cross-validated with available field measurements for major crops including alfalfa, almond, citrus, corn, pasture, and rice. The evapotranspiration estimates explained >70% variance in daily measurements from independent sites with an RMSE of 0.88 mm day-1. When aggregated over the Valley, we estimated an average evapotranspiration of 820 ± 290 mm yr-1 in 2014. Agricultural water use varied significantly across and within crop types, with a coefficient of variation ranging from 8% for Rice (1,110 ± 85 mm yr-1) to 59% for Pistachio (592 ± 352 mm yr-1). Total water uses in 2016 increased by 9.6%, as compared to 2014, mostly because of land-use conversion from fallow/idle land to cropland. Analysis across 134 Groundwater Sustainability Agencies (GSAs) further showed a large variation of agricultural evapotranspiration among and within GSAs, especially for tree crops, e.g., almond evapotranspiration ranging from 339 ± 80 mm yr-1 in Tracy to 1,240 ± 136 mm yr-1 in Tri-County Water Authority. Continuous monitoring and assessment of the dynamics and spatial heterogeneity of agricultural evapotranspiration provide data-driven guidance for more effective land use and water planning across scales.

Sirt3 Promoted DNA Damage Repair and Radioresistance Through ATM-Chk2 in Non-small Cell Lung Cancer Cells

Objective: Radiotherapy is an indispensable approach for lung cancer, especially for non-small cell lung cancer (NSCLC) with high incidence and mortality. However, cellular resistance to ionizing radiation often results in failure in treatment. In this study, we aimed to investigate the role of Sirt3 in radiotherapy on NSCLC. Materials and Methods: Resected samples from 80 pairs of lung cancer was used to prepare tissue array and Sirt3 was stained with immunochemical method. Cell survival as well as apoptosis assay were used to determine the cellular radiosensitivity. Moreover, DNA damage was evaluated by using γ-H2AX foci. Finally, an in situ lung cancer model to test the radiosensitivity in vivo. Results: Sirtuin 3 (Sirt3) was found upregulated in NSCLC cell lines, as well as lung cancer tissues compared with normal tissues. Knockdown of Sirt3 significantly increased radiation-induced cell apoptosis, and increased cell survival efficacy. In contrast, Sirt3 overexpression promoted radioresistance in lung cancer cells. Sirt3 knockdown also aggravated the G2/M cell cycle arrest caused by irradiation. Furthermore, Sirt3 was found to be critical for the activation of ATM-Chk2 pathway upon irradiation. Finally, our in vivo model showed that targeting Sirt3 significantly sensitized lung cancer to radiotherapy. Conclusion: In conclusion, our findings identified a significant role of Sirt3 in radioresistanct of NSCLC, which provides novel mechanism as well as target for radiotherapy.

Nuclear Transglutaminase 2 interacts with topoisomerase II⍺ to promote DNA damage repair in lung cancer cells

BACKGROUND

To block repairs of DNA damages, especially the DNA double strand break (DSB) repair, can be used to induce cancer cell death. DSB repair depends on a sequential activation of DNA repair factors that may be potentially targeted for clinical cancer therapy. Up to now, many protein components of DSB repair complex remain unclear or poorly characterized. In this study, we discovered that Transglutaminase 2 (TG2) acted as a new component of DSB repair complex.

METHODS

A bioinformatic analysis was performed to identify DNA damage relative genes from dataset from The Cancer Genome Atlas. Immunofluorescence and confocal microscopy were used to monitor the protein localization and recruitment kinetics. Furthermore, immunoprecipitation and mass spectrometry analysis were performed to determine protein interaction of both full-length and fragments or mutants in distinct domain. In situ lung cancer model was used to study the effects cancer therapy in vivo.

RESULTS

After DSB induction, cytoplasmic TG2 was extensively mobilized and translocated into nucleus after phosphorylated at T162 site by DNA-PKcs. Nuclear TG2 quickly accumulated at DSB sites and directly interacting with Topoisomerase IIα (TOPOIIα) with its TGase domain to promote DSB repair. TG2 deficient cells lost capacity of DSB repair and become susceptible to ionizing radiation. Specific inhibition of TG2-TOPOIIα interaction by glucosamine also significantly inhibited DSB repair, which increased sensitivity in lung cancer cells and engrafted lung cancers.

CONCLUSIONS

These findings elucidate new mechanism of TG2 in DSB repair trough directly interacting with TOPOIIα, inhibition of which provided potential target for overcoming cancer resistance.

[A brief history of intelligent medicine]

Intelligent medicine is a discipline system developed and established in the background of a rapid development of science and technology. Information technology represented by artificial intelligence, VR(virtual reality) technology and the 1G (first-generation) communication laid a foundation for intelligent medicine. Internet technology, such as 3D printing, robot system and wearable medical devices have helped to improve the development of intelligent medicine. The application of intelligent medicine infiltrated medical imaging, auxiliary diagnosis, surgical operation, hospital management, pharmaceutical development, healthcare system and other aspects of the medical system. Currently, the cutting-edge technologies such as 5G medical, medical cloud platform/big data, advanced material synthesis, 4D printing, AR(Augmented Reality)/MR(Mixed Reality), super intelligence and other technologies have comprehensively driven human society into the era of intelligent medicine.

LncRNA HMGA1P4 promotes cisplatin-resistance in gastric cancer

OBJECTIVE

Long non-coding RNA (lncRNA) HMGA1P4 has been previously reported to be upregulated in gastric cancer (GC). This study aims to investigate the role of HMGA1P4 in cisplatin (DDP)-resistant GC.

PATIENTS AND METHODS

HMGA1P4 levels in DDP-resistant GC tissues and cells were determined. Regulatory effects of HMGA1P4 on proliferative and apoptotic abilities in DDP-resistant GC cells and their parental cells were assessed. At last, expression levels of genes associated with multidrug-resistance (MDR) (MDR1, MRP1, mTOR and HIF-1α) and apoptosis (Bax, Bcl-2 and Caspase3) were determined in DDP-resistant GC cells.

RESULTS

Results revealed that HMGA1P4 was upregulated in DDP-resistant GC tissues and cells. Overexpression of HMGA1P4 stimulated proliferative rate and suppressed apoptosis in both DDP-resistant GC cells and their parental cells. Moreover, in DDP-resistant GC cells, overexpression of HMGA1P4 upregulated MDR-related genes and downregulated apoptosis-related genes.

CONCLUSIONS

HMGA1P4 is upregulated in DDP-resistant GC tissues and cells, and triggers the progression of DDP-resistance in GC.

[Analysis of the clinical confusion and controversy of esophagogastric junction tumor from basic anatomy]

There are still many controversies in the surgical treatment of esophagogastric junction tumors in terms of surgical approach, cleaning range, and resection scope. The reason is the confusion about the scope of the esophagogastric junction. The previous domestic and foreign anatomy descriptions of this part are not enough to solve the current problems. Based on a large number of basic anatomy and clinical operations, this article proposes that the esophagogastric junction may be wrapped by a complete and separate esophagogastric junction membrane with independent anatomy other than infracardiac bursa. The structure of the transitional tissue, mainly from the distribution of submucosal veins, explained the relationship and significance of tissue transitional changes and clinical operations, and made a reasonable analysis of the current controversy based on the anatomical characteristics, which is worthy of further investigation.

Associations of IL-18 and IL-9 expressions and gene polymorphisms with asthma

OBJECTIVE

To explore the associations of interleukin-18 (IL-18) and IL-9 gene polymorphisms with susceptibility to asthma, and to study the associations between IL-18 and IL-9 expression levels and polymorphisms.

PATIENTS AND METHODS

A total of 200 asthma patients in our hospital were collected as disease group, while 200 healthy people were taken as control group. The deoxyribonucleic acid (DNA) was extracted from peripheral blood and sent to the company for the detection of IL-18 and IL-9 gene polymorphisms via sequencing. The levels of serum IL-18 and IL-9 were determined using enzyme-linked immunosorbent assay (ELISA), and arterial blood gas analysis was performed for patients.

RESULTS

The allele distributions at IL-18 gene loci rs189667 and rs360715 had no differences between control group and disease group. The allele distributions at IL-9 gene loci rs1859430 and rs2066758 were different between the two groups (p=0.001, p=0.022), among which the G allele frequency was the highest in disease group [245 (0.613)], and the T allele frequency was also the highest in disease group [240 (0.600)]. There was a difference in the genotype distribution at IL-9 gene locus rs1859430 between the two groups, and the GG genotype frequency in disease group [82 (0.410)] was significantly higher than that in control group (p=0.005). The CC genotype frequency at rs2066758 was significantly lower in disease group [27 (0.135), p=0.044]. In disease group, the frequency of heterozygous model CT (p=0.047) at IL-18 gene locus rs360715, and recessive model GA+AA (p=0.021) and heterozygous model GA (p=0.031) at IL-19 gene locus rs1859430 was significantly lower than that in control group. In disease group, the AC haplotype frequency at IL-18 gene loci rs189667 and rs360715 was evidently lower than that in control group (p=0.048). Disease group had evidently lower AT haplotype frequency (p=0.006) and evidently higher GT haplotype frequency (p=0.000) at IL-9 gene loci rs1859430 and rs2066758. Moreover, the level of serum IL-18 in patients with TT genotype at IL-18 gene locus rs360715 was higher than that in those with other genotypes in disease group (p<0.05), and the level of serum IL-9 in patients with AG genotype at IL-9 gene locus rs1859430 was also higher than that in those with other genotypes in disease group (p<0.05). There was a remarkable association between CT genotype at IL-18 gene locus rs360715 and partial pressure of oxygen (PaO2) (p=0.035), and between CC genotype at IL-9 gene locus rs2066758 and partial pressure of carbon dioxide (PaCO2) (p=0.041).

CONCLUSIONS

The expression levels of serum IL-18 and IL-9 and their gene polymorphisms are significantly associated with asthma.

Depressive symptoms in Chinese adults with risk factors for diabetes: the Shanghai High-Risk Diabetic Screen (SHiDS) study

AIMS

To evaluate the relationship between newly diagnosed diabetes or prediabetes and depressive symptoms among individuals with risk factors for diabetes in China. We also investigated the associations of depressive symptoms with pancreatic β-cell function and insulin resistance.

METHODS

We used cross-sectional data from the Shanghai High-Risk Diabetic Screen (SHiDS) project. Between 2014 and 2017, a total of 1728 participants were enrolled in this study and underwent an oral glucose tolerance test to screen for diabetes and prediabetes. Insulin resistance was evaluated using the homeostatic model assessment of insulin resistance and the modified Matsuda index. Pancreatic β-cell function was calculated using the homeostatic model assessment of β-cell function, Stumvoll first- and second-phase indexes. Elevated depressive symptoms were determined using the Patient Health Questionnaire-9 (PHQ-9 score ≥ 10).

RESULTS

The prevalence of elevated depressive symptoms in the total study population was 4.8% (83 of 1728). Compared with the normal glucose tolerance group, individuals with newly diagnosed diabetes were less likely to have elevated depressive symptoms even after controlling for potential confounders [adjusted odds ratio (OR) 0.35, 95% confidence interval (CI) 0.18-0.68; P = 0.002]. However, prediabetes was not associated with depressive symptoms. The odds for elevated depressive symptoms were increased in individuals with higher levels of the Stumvoll first-phase index. No association was observed between depressive symptoms and insulin resistance.

CONCLUSION

Elevated depressive symptoms were less prevalent in Chinese individuals with newly diagnosed diabetes among a high-risk population for diabetes.

Effects of energy-restricted feeding during rearing on sexual maturation and reproductive performance of Rugao layer breeders

The aim of this study was to assess the effects of energy-restricted feeding during rearing on the sexual maturation and reproductive performance of Rugao layer breeders. A total of 2,400 8-wk-old Rugao layer breeders were randomly assigned to one of 5 groups (480 pullets per group) with eight replicates and were fed one of 5 diets that were nutritionally similar with the exception of apparent metabolizable energy corrected for nitrogen (AME_n) content (2,850, 2,750, 2,650, 2,550, and 2,450 kcal AME_n/kg) from 8 to 18 wks of age. The daily amount of feed was restricted to the absolute quantity of the diet consumed by laying hens fed 2,850 kcal AME_n per kg diet ad libitum (control). From 18 to 52 wks of age, all hens were fed basal diets ad libitum. The body weight of layer breeders at 18 wks of age decreased linearly with increasing energy restriction (P < 0.001), but caught up within 3 wks of ad libitum feeding (P = 0.290). The coefficient of variation of the body weight of the hens at 18, 21, and 24 wks of age decreased linearly (P = 0.010, 0.025, and 0.041, respectively) with increasing energy restriction during rearing. Energy-restricted feeding delayed sexual organ development at 18, 20, and 22 wks of age, including the number of large yellow follicles, oviduct length, oviduct length index, oviduct index, and ovary stroma index (P < 0.05), and delayed sexual maturity, including the age at laying the first egg and the age at 5% and 50% egg production (P = 0.042, 0.004, and 0.029, respectively). Consequently, egg number from 5% to 50% egg production decreased linearly as the degree of energy restriction increased (P = 0.001) and egg production of hens in the energy-restricted feeding groups was lower than that of hens in the ad libitum feeding group (6.36, 6.43, 6.4, and 4.61% vs. 14.29%; P < 0.05) from 18 to 20 wks of age. Furthermore, egg weight increased linearly as energy restriction increased (P < 0.001) and laying hens in the most severe energy-restricted feeding group had more setting eggs (normal eggs weighing >40 g) than hens in the ad libitum feeding and lighter energy-restricted feeding groups (149.57 vs. 144.34, 142.66, 143.63, and 141.78; P < 0.05). No significant differences were observed in fertility, hatchability of fertile eggs, and hatchability of setting eggs (P = 0.381, 0.790, and 0.605, respectively). In conclusion, moderate energy restriction (85.97%, 2,450 vs. 2,850 kcal AME_n/kg) from 8 to 18 wks of age increased egg weight as well as the production of setting eggs in native layer breeders throughout the laying period, without adverse effects on productive performance from 18 to 52 wks of age, or fertility and hatchability at 52 wks of age.

222 Rn emanation measurements for the XENON1T experiment

The selection of low-radioactive construction materials is of utmost importance for the success of low-energy rare event search experiments. Besides radioactive contaminants in the bulk, the emanation of radioactive radon atoms from material surfaces attains increasing relevance in the effort to further reduce the background of such experiments. In this work, we present the 222 Rn emanation measurements performed for the XENON1T dark matter experiment. Together with the bulk impurity screening campaign, the results enabled us to select the radio-purest construction materials, targeting a 222 Rn activity concentration of 10 μ Bq / kg in 3.2 t of xenon. The knowledge of the distribution of the 222 Rn sources allowed us to selectively eliminate problematic components in the course of the experiment. The predictions from the emanation measurements were compared to data of the 222 Rn activity concentration in XENON1T. The final 222 Rn activity concentration of ( 4.5 ± 0.1 ) μ Bq / kg in the target of XENON1T is the lowest ever achieved in a xenon dark matter experiment.

Occurrence, migration and health risk of phthalates in tap water, barreled water and bottled water in Tianjin, China

This study was to investigate the occurrence, migration and health risk of phthalic acid esters (PAEs) in tap water, barreled water and bottled water in Tianjin, China. Six priority controlled PAEs were measured, among which the detection frequency of butyl benzyl phthalate (BBP), dibutyl phthalate (DBP) and di(2-ethylhexyl) phthalate (DEHP) was 100%, while the others were not detected. The concentration of DEHP was higher than BBP and DBP in all the samples. The initial ∑₃PAEs concentrations in tap water, barreled water and bottled water were 2.409 ± 0.391 μg/L, 1.495 ± 0.213 μg/L and 1.963 ± 0.160 μg/L, respectively. Boiling tap water could reduce the PAEs content to an extent, but they increased significantly in hot tap water contacting with disposable plastic cups. The migration of PAEs in barreled water and bottled water were positively correlated with storage time and temperature, which could be described by exponential models. The hazard indexes of PAEs in different types of drinking water were very low. However, the human carcinogenic risks of DEHP will reach the maximum acceptable risk level of 10^-6 when bottled water is stored for 8.8 days at 40 °C, 7.7 days at 50 °C, or 6.1 days at 60 °C.

Grape Seed Proanthocyanidins play the roles of radioprotection on Normal Lung and radiosensitization on Lung Cancer via differential regulation of the MAPK Signaling Pathway

Radiation-induced lung injury (RILI) is a common serious complication and dose-limiting factor caused by radiotherapy for lung cancer. This study was to investigate radioprotective effects of grape seed proanthocyanidins (GSP) on normal lung as well as radiosensitizing effects on lung cancer. In vitro, we demonstrated radioprotective effects of GSP on normal alveolar epithelial cells (MLE-12 and BEAS/2B) and radiosensitizing effects on lung cancer cells (LLC and A549). In vivo, we confirmed these two-way effects in tumor-bearing mice. The results showed that GSP inhibited tumor growth, and played a synergistic killing effect with radiotherapy on lung cancer. Meanwhile, GSP reduced radiation damage to normal lung tissues. The two-way effects related to the differential regulation of the MAPK signaling pathway by GSP on normal lung and lung cancer. Moreover, GSP regulated secretion of cytokines IL-6 and IFN-γ and expression of p53 and Ki67 on normal lung and lung cancer. Our findings suggest that GSP is expected to be an ideal radioprotective drug for lung cancer patients who are treated with radiotherapy.

The relationship between HSP60 gene polymorphisms and susceptibility to atherosclerosis

OBJECTIVE

To explore the potential correlation between heat shock protein 60 (HSP60) gene polymorphisms and susceptibility to atherosclerosis.

PATIENTS AND METHODS

A total of 160 atherosclerosis patients treated in our hospital from February 2017 to February 2019 were randomly enrolled as case group, and 200 healthy adults receiving physical examination were selected as control group at the same period. Venous blood was drawn from all subjects to extract deoxyribonucleic acid (DNA). TaqMan probe technology was employed to genotype two loci rs2340690 and rs788016 of HSP60 gene in all 260 subjects. The correlations between HSP60 gene polymorphisms and the incidence rate and pathological grade of atherosclerosis were analyzed.

RESULTS

There were three genotypes (AA, AG, and GG) in HSP60 rs2340690 and three (GG, AG, and AA) in HSP60 rs788016. No significant differences in the frequency of each genotype were found between the two groups (p>0.05). HSP60 rs2340690 and HSP60 rs788016 had no significant associations with the incidence rate of atherosclerosis in the dominant, recessive, and additive genetic models. In the case of pathological grade IV, the proportion of atherosclerosis patients carrying GG genotype of HSP60 rs2340690 was higher than those carrying AA genotype and AG genotype of HSP60 rs2340690 (p<0.05). The probability in atherosclerosis patients carrying rs788016 A was higher than those carrying rs2340690 G (p<0.05). When atherosclerosis patients carried both genotype G of HSP60 rs2340690 and genotype A of HSP60 rs788016, the odds ratio (OR) was 1.721 (p=0.049).

CONCLUSIONS

The HSP60 gene polymorphisms are certainly correlated with the pathological grade and incidence rate of atherosclerosis.

Diet-Dependent Changes of the DNA Methylome Using a Göttingen Minipig Model for Obesity

Objective: Environmental factors can influence obesity by epigenetic mechanisms. The aim of this study was to investigate obesity-related epigenetic changes and the potential for reversal of these changes in the liver of Göttingen minipigs subjected to diet interventions. Methods: High-throughput liquid hybridization capture-based bisulfite sequencing (LHC-BS) was used to quantify the methylation status of gene promotor regions in liver tissue in three groups of male castrated Göttingen minipigs: a standard chow group (SD, N = 7); a group fed high fat/fructose/cholesterol diet (FFC, N = 10) and a group fed high fat/fructose/cholesterol diet during 7 months and reversed to standard diet for 6 months (FFC/SD, N = 12). Expression profiling by qPCR of selected metabolically relevant genes was performed in liver tissue from all pigs. Results: The pigs in the FFC diet group became morbidly obese. The FFC/SD diet did not result in a complete reversal of the body weight to the same weight as in the SD group, but it resulted in reversal of all lipid related metabolic parameters. Here we identified widespread differences in the patterning of cytosine methylation of promoters between the different feeding groups. By combining detection of differentially methylated genes with a rank-based hypergeometric overlap algorithm, we identified 160 genes showing differential methylation in corresponding promoter regions in the FFC diet group when comparing with both the SD and FFC/SD groups. As expected, this differential methylation under FFC diet intervention induced de-regulation of several metabolically-related genes involved in lipid/cholesterol metabolism, inflammatory response and fibrosis generation. Moreover, five genes, of which one is a fibrosis-related gene (MMP9), were still perturbed after diet reversion. Conclusion: Our findings highlight the potential of exploring diet-epigenome interactions for treatment of obesity.

[Novel vector preS1-tp fusion protein effectively inhibits hepatitis B virus replication and cccDNA synthesis by mediating hepatitis B virus targeting sequence small interfering RNA]

Objective: To study the use of preS1-tp fusion protein as a novel vector to mediate the entry of small interfering RNA (siRNA) targeting the carboxy-terminal nuclear localization signal (NLS) region of hepatitis B virus (HBV) core protein into HBV-infected hepatocytes, and to further explore the HBV replication inhibition and covalently closed circular DNA synthesis. Methods: HepG2.2.15 cells expressing the human sodium taurocholate co-transporting polypeptide were established on the basis of lentivirus infection system. siRNA against HBV NLS region was designed and synthesized. PreS1-tp fusion protein expression and purification was observed to test its ability to cell entry and DNA binding. NLS siRNA were delivered into HepG2.2.15- sodium taurocholate co-transporting polypeptide cells by preS1-tp fusion protein as a vector to observe the effects of NLS siRNA on HBV replication and covalently closed circular DNA levels. Analysis of variance was used for comparison between multiple groups, and the measurement data differences between groups were analyzed by t-test. Results: HepG2.2.15-sodium taurocholate co-transporting polypeptide cell line was successfully constructed. Screened synthetic HBV NLS siRNA had significantly inhibited HBV replication. The preS1-tp fusion protein was expressed and purified on a large-scale. The fusion protein as a vector for HBV NLS siRNA had targeted delivery. The result showed that the fusion protein had effectively targeted siRNA to Hepg2.2.15-sodium taurocholate co-transporting polypeptide cell, which not only had effectively inhibited the expression of HBV mRNA, HBsAg and HBeAg, but also had significantly reduced the levels of HBV DNA and covalently closed circular DNA. Conclusion: The preS1-tp fusion protein constructed in this study uses the dual functional characteristics of preS1 binding to hepatocyte HBV receptor, and tp binding to nucleic acids, and targets HBV NLS siRNA against HBV-infected cells and block rcDNA from being transported to nucleus. siRNA plays a role in inhibiting HBV replication and covalently close circular DNA synthesis, providing a new strategy for the treatment of chronic hepatitis B caused by HBV infection, and a new research perspective for the complete elimination of HBV from the body.