[Sorafenib combined with chemotherapy and donor lymphocyte infusion as salvage therapy in patients with FLT3-positive acute myeloid leukemia relapse after allogeneic hematopoietic stem cell transplantation]

To explore the efficacy of sorafenib combined with chemotherapy and donor lymphocyte infusion (DLI) in patients with FLT3-positive acute myeloid leukemia (AML) relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Of the 14 patients relapsed after allo-HSCT, 9 achieved complete remission after salvage therapy of sorafenib combined with chemotherapy and DLI, 6 with complete molecular remission, 2 with partial remission, and 3 with no response. With a median follow up of 220 (range, 30-1 782) days after post-transplantation relapse, 7 patients were still alive and 7 died. Salvage therapy of sorafenib combined with chemotherapy and DLI shows a decent therapeutic effect for FLT3-positive AML relapsed after allo-HSCT.

Increased oestradiol in hepatitis E virus-infected pregnant women promotes viral replication

Hepatitis E virus (HEV) infection causes subclinical diseases, leading to high mortality (>25%) in pregnant women. HEV replication is aggressively escalated in pregnant women, especially in the third trimester of pregnancy. Oestrogen plays an important role in pregnancy. However, the pathogenesis of HEV in pregnant women or immunosuppressive pregnant women (such as HIV-infected or organ-transplanted pregnant women) remains unclear. We investigated the role of oestradiol in HEV infection in a cell culture system. HEV-infected pregnant women had significantly higher oestradiol levels compared with uninfected individuals. HEV infection was significantly increased in cells treated with analogues of oestradiol, diethylstilbestrol (DES) or 17β-oestradiol in a dose-dependent way. However, tamoxifen, an antagonist oestrogen, inhibited HEV replication. HEV infection inhibits oestrogen receptor (ER-α) expression. Immunofluorescence and co-immunoprecipitation assays indicated that ER-α interacted with the helicase of HEV ORF1 indirectly. More importantly, HEV infection was exacerbated in immunosuppressive cells treated with an inhibitor of PI3K-AKT-mTOR signal pathway (LY296004) and supplemented with pregnant women serum with high oestradiol simultaneously. These results strongly suggest that pregnant women with high oestradiol and/or immunosuppression will be vulnerable to HEV infection.

[Comparison of clinical manifestations according to HLA-B(27) genotype in ankylosing spondylitis patients: real-world evidence from smart management system for spondyloarthritis]

Objective: The aim of this study was to set up a large, longitudinal and prospective database to compare the clinical manifestations in human leucocyte antigen (HLA)-B(27) positive and negative patients with ankylosing spondylitis(AS) based on real-world evidence in Chinese population. Methods: A total of 897 outpatients with confirmed AS were recruited consecutively by smart management system for spondyloarthritis (SMSP) from April 13, 2016 to June 6, 2017 in Chinese PLA General Hospital from 30 provinces and autonomous regions. 801 patients with HLA-B(27) data were included in the analysis. Demographic and clinical parameters including Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), ankylosing spondylitis disease activity score (ASDAS), arthritis, enthesitis, Bath ankylosing spondylitis metrology index (BASMI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between HLA-B(27) positive and negative groups. Results: A total of 801 patients were included in the analysis with an average age of (30.7±8.8) years. There were 659 males and 142 females and HLA-B(27) was present in 88.0%(705/801). Males were significantly more in HLA-B(27) positive patients [83.3%(587/705) vs. 75.0%(72/96); P=0.047].The average age at disease onset was (22.3±7.6)years in HLA-B(27) positive patients and (24.4±8.7) years in HLA-B(2)7 negative ones (P=0.028).There was significant difference in diagnose delay between two groups [14.3(2.5,43.6)months in HLA-B(27) positive patients vs. 20.3(5.0,67.4) months in HLA-B(27) negative ones, P=0.041]. Anterior uveitis was found to be significantly more common in HLA-B(27) positive patients [18.9% (133/705)vs.7.3%(7/96),P=0.005], and knee involvement less common in HLA-B(27) positive patients [4.0%(27/682) vs.10.0%(9/90), P=0.010], conversely. CRP[6.5(3.0, 16.4)mg/L vs. 3.5(1.6, 12.3)mg/L] and ESR[11.0(4.0, 24.0)mm/1h vs. 7.0(3.0, 16.0)mm/1h] were significantly higher in HLA-B(27) positive patients(P=0.005,0.013, respectively).But no differences in BASDAI,ASDAS,BASFI and BASMI were obtained between two groups. Conclusions: HLA-B(27) positive patients had a higher proportion of males, a younger age of onset and a greater risk for occurrence of anterior uveitis, suggesting a poorer prognosis.

Comprehensive Protocol to Sample and Process Bone Marrow for Measuring Measurable Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia

Response criteria in acute myeloid leukemia (AML) has recently been re-established, with morphologic examination utilized to determine whether patients have achieved complete remission (CR). Approximately half of the adult patients who entered CR will relapse within 12 months due to the outgrowth of residual AML cells in the bone marrow. The quantitation of these remaining leukemia cells, known as minimal or measurable residual disease (MRD), can be a robust biomarker for the prediction of these relapses. Moreover, retrospective analysis of several studies has shown that the presence of MRD in the bone marrow of AML patients correlates with poor survival. Not only is the total leukemic population, reflected by cells harboring a leukemia associated immune-phenotype (LAIP), associated with clinical outcome, but so is the immature low frequency subpopulation of leukemia stem cells (LSC), both of which can be monitored through flow cytometry MRD or MRD-like approaches. The availability of sensitive assays that enable detection of residual leukemia (stem) cells on the basis of disease-specific or disease-associated features (abnormal molecular markers or aberrant immunophenotypes) have drastically improved MRD assessment in AML. However, given the inherent heterogeneity and complexity of AML as a disease, methods for sampling bone marrow and performing MRD and LSC analysis should be harmonized when possible. In this manuscript we describe a detailed methodology for adequate bone marrow aspirate sampling, transport, sample processing for optimal multi-color flow cytometry assessment, and gating strategies to assess MRD and LSC to aid in therapeutic decision making for AML patients.

P2Y12 deficiency in mouse impairs noradrenergic system in brain, and alters anxiety-like neurobehavior and memory

Purinergic receptor P2Y₁₂ (P2Y₁₂ ), a G protein-coupled purinergic receptor, is widely distributed in nervous system and involved in the progression of neurological diseases such as multiple sclerosis and neuropathic pain. The central noradrenergic system actively participates in a number of neurophysiological processes. Nevertheless, whether there is any direct relevance between P2Y₁₂ and noradrenergic signal transduction remains unknown. In the present study, we tested the hypothesis that lack of P2Y₁₂ impaired noradrenergic signal transduction in mouse brain. Our results showed that P2Y₁₂ knockout (KO) mice exhibited increased anxiety-like behavior in the open-field test (OFT) and elevated plus maze test and displayed deficits in memory in the radial-arm maze test (RAMT) and Morris water maze test (MWMT). They also exhibited reduced locomotion in the OFT and MWMT. Moreover, loss of P2Y₁₂ decreased the level of noradrenaline and the expression of noradrenergic α receptors, subtypes α2 (ARα2b) in mouse cerebellum and hippocampus. Meanwhile, it hampered the protein kinase A (PKA)/cAMP response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF) signaling pathway in these brain regions. Taken together, our results showed for the first time that P2Y₁₂ KO altered the anxiety, memory and locomotion of mice, which was closely associated with abnormal state of noradrenergic system in the brain. The findings implicate that P2Y₁₂ plays an indispensable role in noradrenergic signal transduction; its deficit is insufficient to limit anxiety responses or supports cognitive performance and activity.

Clinicopathological and prognostic significance of platelet count in patients with ovarian cancer

AIM

Increasing evidence indicates that platelet count is a useful biomarker of long-term outcomes in patients with ovarian cancer. However, the prognostic value of platelet count in patients with ovarian cancer remains controversial. We therefore conducted a meta-analysis aimed to investigate the prognostic role of the platelet count in patients with ovarian cancer.

METHOD

A comprehensive search was performed from the databases of PubMed, Embase and the Cochrane Library until June 20, 2017. A total of 18 studies with 6754 patients were included. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) and odds ratios and 95% CIs from each study were pooled.

RESULTS

The results demonstrated that elevated pretreatment platelet count was significantly related to poor survival from ovarian cancer; the pooled HRs for overall, progression-free and disease-free survival were 1.81 (95% CI 1.52-2.15), 1.48 (95% CI 1.24-1.75) and 1.39 (95% CI 1.19-1.61), respectively. Subgroup analyses were divided by ethnicity, sample size, FIGO stage, cut-off value of the platelet count, analysis method and Newcastle Ottawa Scale score, but the results did not show any significant change in the main results. Increased platelet count was also significantly associated with the FIGO stage, tumor differentiation, ascites, residual tumor mass, CA125 level, recurrence and metastasis.

CONCLUSION

This meta-analysis revealed that an elevated platelet count pretreatment denotes a predictive factor of poor prognosis and unfavorable clinicopathological parameters for ovarian cancer patients.

[The safety and efficacy of golimumab in treatment of 25 patients with active ankylosing spondylitis]

Objective: To evaluate the efficacy and safety of golimumab in patients with active ankylosing spondylitis (AS). Methods: This was a randomized, double-blind, placebo-controlled trial. The subjects were randomized to receive either golimumab 50mg subcutaneously or placebo every 4 weeks. Patients in both groups received golimumab 50mg from week 24 to week 48. The primary endpoint was the proportion of at least 20% improvement in the Assessment of Spondyloarthritis International Society (ASAS20) at week 14. The secondary endpoints included at least 40% improvement in the Assessment of Spondyloarthritis International Society (ASAS40), ASAS partial-remission, Bath AS functional index, Bath AS disease activity index, Bath AS metrology index, enthesitis index and Jenkins sleep evaluation questionnaire. Results: A total of 25 subjects were included in this study, 13 with golimumab and 12 with placebo. At Week 14, 6(46.2%) subjects achieved ASAS20 in golimumab group and 2(16.7%) in placebo group. Significant improvements of other efficacy endpoints were also found in golimumab group. Golimumab was safe and well to lerated. Most of the adverse events were slightly impaired liver function, where as elevated aspartate aminotransferase and/or alanine aminotransferase returned to normal without drug with drawal. Conclusion: Golimumab improves AS activity, clinical symptoms and sleep disturbance in patients with active AS with good safety and tolerability.

Phase IIa study of dabigatran etexilate in children with venous thrombosis: pharmacokinetics, safety, and tolerability

Essentials Dabigatran etexilate may provide a new treatment option for pediatric venous thromboembolism. Children aged 1 to < 12 years were given dabigatran etexilate in an open-label, single-arm study. The pharmacokinetic-pharmacodynamic relationship was similar to that seen in adult patients. There were no serious adverse events, bleeding events or recurrent venous thromboembolism.

SUMMARY

Background The current standard-of-care treatments for pediatric venous thromboembolism (VTE) have limitations. Dabigatran etexilate (DE), a direct thrombin inhibitor, may offer an alternative therapeutic option. Objectives To assess the pharmacokinetics, pharmacodynamics, safety, and tolerability of a DE oral liquid formulation (OLF) in pediatric patients with VTE. Patients/Methods Patients who had completed planned treatment with low molecular weight heparin or oral anticoagulants for VTE were enrolled in two age groups (2 to < 12 years and 1 to < 2 years), and received a DE OLF based on an age-adjusted and weight-adjusted nomogram. Originally, patients were to receive a DE OLF twice daily for 3 days, but the protocol was amended to a single dose on day 1. The primary endpoints were pharmacokinetics/pharmacodynamics-related: plasma concentrations of DE and its metabolites; activated partial thromboplastin time (APTT), ecarin clotting time (ECT), and dilute thrombin time (dTT); and pharmacokinetic (PK)-pharmacodynamic (PD) correlation. Safety endpoints included incidence rates of bleeding events and all other adverse events (AEs). Results Eighteen patients entered the study and received the DE OLF (an exposure equivalent to a dose of 150 mg twice daily in adults). The projected steady-state dabigatran trough concentrations were largely comparable between pediatric patients and adults. The PK/PD relationship was linear for ECT and dTT, and non-linear for APTT. No serious or severe AEs, bleeding events, or recurrent VTEs were reported. Mild AEs were reported in three patients in the single-dose group (screening period) and in one patient in the multiple-dose group (on-treatment period). Conclusion The current study supports the further evaluation of DE OLFs in pediatric patients with VTE.

Measurement of the ν μ energy spectrum with IceCube-79: IceCube Collaboration

IceCube is a neutrino observatory deployed in the glacial ice at the geographic South Pole. The ν μ energy unfolding described in this paper is based on data taken with IceCube in its 79-string configuration. A sample of muon neutrino charged-current interactions with a purity of 99.5% was selected by means of a multivariate classification process based on machine learning. The subsequent unfolding was performed using the software Truee. The resulting spectrum covers an E ν -range of more than four orders of magnitude from 125 GeV to 3.2 PeV. Compared to the Honda atmospheric neutrino flux model, the energy spectrum shows an excess of more than 1.9 σ in four adjacent bins for neutrino energies E ν ≥ 177.8 TeV . The obtained spectrum is fully compatible with previous measurements of the atmospheric neutrino flux and recent IceCube measurements of a flux of high-energy astrophysical neutrinos.

[The epidemiological characteristics and drug resistance of mycoplasma pneumoniae in patients with community-acquired pneumonia during 2011-2015 in 5 sentinel hospitals in Beijing]

Objective: To analyze the prevalence and drug resistance of mycoplasma pneumoniae in patients with community-acquired pneumonia during 2011-2015 in Beijing. Methods: Totally 2 272 mycoplasma pneumoniae samples were collected from patients with community-acquired pneumonia in 5 sentinel hospitals during 2011-2015. Mycoplasma pneumoniae were detected by real-time PCR. 142 copies of positive samples with Ct value under 30 were cultured to get the strains so that the genotypes based on the P1 gene sequence and the drug resistance based on the in vitro drug resistance test could be conducted. χ(2) test was used to compare the detection rates of mycoplasma pneumoniae among different age groups and different onset-phase. Results: The positive rate of mycoplasma pneumoniae was 13.6%(308 cases). The positive rate in groups aging (5-14), (15-24) and ≥60 years old were separately 24.4% (67/275), 24.4% (38/156) and 3.9% (28/727) (χ(2)=1.22, P<0.001). The annual detection rate of mycoplasma pneumoniae in 2011-2015 were 14.6% (73/501), 10.2% (36/353), 26.4% (101/383), 10.3% (41/398), 9.0% (57/637),respectively (χ(2)=72.65, P<0.001). Seasonally, the peak of positive rate was between October and December (17.5%, 122/699) and the lowest positive rate was between April and June (8.6%, 43/502). 36 strains were isolated from 142 swabs and 23 (63.9%) were P1-Ⅰ and 13 (36.1%) were P1-Ⅱ by genotyping. All isolates were susceptible to the fluoroquinolones (levofloxacin, ciprofloxacin, and gatifloxacin) and tetracycline. All P1-Ⅱ strains were susceptible to macrolides while most of the P1-Ⅰ strains (22 strains) were macrolide-resistant. Conclusion: People aging (5-14) and (15-24) years old were more susceptible to mycoplasma pneumoniae in patients with community-acquired pneumonia in Beijing between 2011 and 2015. The highest positive rate of mycoplasma pneumoniae was in 2013 and the case distributed in all seasons. The major popular genotype was P1-Ⅰ, whose strains were mostly macrolide-resistant.

Computational design of a specific heavy chain/κ light chain interface for expressing fully IgG bispecific antibodies

The use of bispecific antibodies (BsAbs) to treat human diseases is on the rise. Increasingly complex and powerful therapeutic mechanisms made possible by BsAbs are spurring innovation of novel BsAb formats and methods for their production. The long-lived in vivo pharmacokinetics, optimal biophysical properties and potential effector functions of natural IgG monoclonal (and monospecific) antibodies has resulted in a push to generate fully IgG BsAb formats with the same quaternary structure as monoclonal IgGs. The production of fully IgG BsAbs is challenging because of the highly heterogeneous pairing of heavy chains (HCs) and light chains (LCs) when produced in mammalian cells with two IgG HCs and two LCs. A solution to the HC heterodimerization aspect of IgG BsAb production was first discovered two decades ago; however, addressing the LC mispairing issue has remained intractable until recently. Here, we use computational and rational engineering to develop novel designs to the HC/LC pairing issue, and particularly for κ LCs. Crystal structures of these designs highlight the interactions that provide HC/LC specificity. We produce and characterize multiple fully IgG BsAbs using these novel designs. We demonstrate the importance of specificity engineering in both the variable and constant domains to achieve robust HC/LC specificity within all the BsAbs. These solutions facilitate the production of fully IgG BsAbs for clinical use.

Possible involvement of orphan receptors GPR88 and GPR124 in the development of hypertension in spontaneously hypertensive rat

Hypertension (HBP) is a chronic disease characterized by increased blood pressure, which despite several treatments maintains a high morbi-mortality, which suggests that there are other mechanisms involved in this pathology, within which the orphan receptors could be candidates for the treatment of the HBP; these receptors are called orphan receptors because their ligand is unknown. These receptors have been suggested to participate in some pathologies because they are associated with various systems such as GPR88, which has been linked to the dopaminergic system, and GPR124 with angiogenesis, suggesting that these receptors could take part in HBP. Hence, the aim of this work was to study the expression of orphan receptors GPR88 and GPR124 in various tissues of normotensive and hypertensive rats. We used Wistar Kyoto (WKY) and spontaneously hypertensive rat (SHR) of 6-8 and 10-12 weeks of age and we determined systolic blood pressure (SBP), heart rate, as well as mRNA of GPR88 and GPR124 receptors by reverse transcription polymerase chain reaction (RT-PCR) in the aorta, heart, kidney, and brain. Our results showed that GPR88 and GPR124 were expressed in all analyzed tissues, but their expression is dependent on the age and development of HBP because their expression tends to be modified as HBP is established. Therefore, we conclude that GPR88 and GPR124 receptors may be involved in the development or maintenance of high blood pressure.

Limited fertility of the subcutaneous cysts of Echinococcus multilocularis

Echinococcus multilocularis is a tiny devastating worm that causes alveolar echinococcosis in humans. This disease mainly occurs in the liver but rarely in other organs. We report the subcutaneous encystment of E. multilocularis metacestodes in experimentally infected mice. Subcutaneous cysts had remarkably fewer protoscoleces (2.05 ± 1.47, n = 20) and small irregular-shape vesicles (ISVs) in the lumen as compared to liver cysts (69.6 ± 55.65, n = 10). Moreover, abnormal development of a protoscolex was also observed in a subcutaneous cyst. The results suggest that subcutaneous encystment may have potential adverse effects on the reproductivity and development of protoscoleces, providing potential explanations for high tissue preference of metacestode encystment.

An epidemiological survey of echinococcosis in intermediate and definitive hosts in Qinghai Province, China

In order to understand the epidemiological status of alveolar and cystic echinococcosis in intermediate and definitive hosts in Qinghai Province, China, during the period 2007-2011, we investigated the infection in humans and animals, including yaks, Tibetan sheep, Tibetan dogs, and wild foxes distributed in different counties around the province. Sera from local residents were examined using a rapid serodiagnostic kit to detect specific antibodies against Echinococcus. Seropositive samples were confirmed with B-scan ultrasonography and X-ray examinations. Yaks and Tibetan sheep were checked at slaughterhouses, and cysts and suspicious lesions were collected for analysis. A rapid diagnostic strip was used to detect Echinococcus adults in Tibetan dogs. Positive dogs were dewormed and the parasites collected. Wild foxes were trapped and necropsies performed with particular attention to the intestine. Forty-eight of 735 (6.4%) humans tested were positive and 475 of 854 (55.6%) Tibetan sheep and 85 of 352 (24.15%) yaks were infected with Echinococcus. Across different counties, 214 of 948 (22.57%) Tibetan dogs were positive, and five of 36 (13.9%) wild foxes were infected with Echinococcus. Molecular studies showed that all the infections detected in humans, domestic yaks, and Tibetan sheep were the G1 genotype (E. granulosus), whereas the parasites from Tibetan foxes and Tibetan dogs were E. shiquicus and E. multilocularis, respectively. In conclusion, Echinococcosis is hyperendemic in Qinghai Province in both its intermediate and definitive hosts and the G1 genotype of cystic Echinococcus is the dominant strain.

Prognostic Factors for Survival in Node-Negative Gastric Cancer Patients Who Underwent Curative Resection

BACKGROUND AND AIM

Lymph node involvement is the strongest prognostic factor for patients with gastric cancer; patients with node-negative gastric cancer present with better survival. However, some patients develop recurrent gastric cancer. The aim of this study was to review the clinicopathological characteristics and factors for prognosis in patients with node-negative gastric cancer who underwent curative resection.

METHODS

Between January 2004 and December 2015, the clinicopathological characteristics of 302 patients with node-negative gastric cancer who underwent curative gastrectomy in our hospital were retrospectively analyzed.

RESULTS

The 1-, 3-, and 5-year overall survival rates for patients with node-negative gastric cancer were 80.0%, 69.0%, and 63.0%, respectively. Univariate analysis showed that tumor size, histologic type, and depth of invasion had significant effects on survival (p < 0.05). Multivariate analysis showed that tumor size (hazard ratio: 1.83%, 95.0% confidence interval: 1.13-2.96, p = 0.014), histologic type (hazard ratio: 1.57%, 95.0% confidence interval: 1.01-2.44, p = 0.042), and depth of invasion (hazard ratio: 1.38%, 95.0% confidence interval: 1.14-1.67, p = 0.001) were independent prognostic factors.

CONCLUSION

Tumor size, histologic type, and depth of invasion are important prognostic factors in patients with node-negative gastric cancer. These parameters should be considered to stratify patients for therapy and follow-up strategies.

DNA photonic nanowires with tunable FRET signals on the basis of toehold-mediated DNA strand displacement reactions

A DNA photonic nanowire with tunable FRET signals was fabricated on the basis of cascaded toehold-mediated DNA strand displacement reactions. Different DNA inputs were added to trigger the reaction network, and the corresponding FRET signals were obtained. Compared to the direct hybridization, this design is sensitive for 2 nM targets within 20 min and also causes color changes of the solution with blue-light excitation. It could also be applied in live cells to monitor MicroRNA with a simple modification which might become a low-cost method for further application in the future.

[The multicenter study on the registration and follow-up of low anticoagulation therapy for the heart valve operation in China]

OBJECTIVE

To investigate the optimal anticoagulation methods and monitoring strategy for Chinese patients undergoing heart valve replacement, which is potentially quite different from western populations.

METHODS

In this multicenter prospective cohort study, the anticoagulation and monitoring strategy data was acquired from 25 773 in-hospital patients in 35 medical centers and 20 519 patients in outpatient clinic in 11 medical centers from January 1st, 2011 to December 31th, 2015.

RESULTS

As for in-hospital patients, mean age of study population was (48.6±11.2) years old; main etiology of valve pathology was rheumatic (87.5%) origin among study cohort; 94.8% of study population received mechanical valve implantation; international normalized ratio (INR) monitoring (in all the study centers) and low-intensity anticoagulation strategy (31 hospitals chose target INR range of 1.5-2.5, and actual values of INR among 89.2% of 100 069 in-hospital monitoring samples were 1.5-2.5), with mean actual INR values of 1.84±0.53, and warfarin dosage of (2.82±0.93) mg/d were widely adopted among the study centers; strategies of in-hospital warfarin administration were similar in all the study centers; complication rates of low-intensity anticoagulation strategy were low in severe hemorrhage (0.02%), thrombosis (0.05%), and thromboembolism (0.05%) events, without anticoagulation-related death.As for 18 974 outpatient clinic patients, the follow-up rate was 92.47%, with a total of 30 012 patient-years (Pty). Anticoagulation-related morbidity and mortality rates were 0.67% and 0.15% Pty; major hemorrhage morbidity and mortality rates were 0.25% and 0.13% Pty; thromboembolism morbidity and mortality rates were 0.45% and 0.03% Pty.The mean dosage of warfarin daily dosage was (2.85±1.23) mg/d and INR value was 1.82±0.57.No significant regional difference in the intensity of anticoagulation therapy was noted during the study.

CONCLUSIONS

INR can be used as a normalized indicator for intensity of anticoagulation therapy in China.The optimal anticoagulation intensity with INR range from 1.5 to 2.5 is safe and effective for Chinese patients with heart valve replacement, and there is no significant regional difference in the intensity of anticoagulation therapy.

Influence of Regional Difference in Bone Mineral Density on Hip Fracture Site in Elderly Females by Finite Element Analysis

Hip fracture is a kind of osteoporotic fractures in elderly patients. Its important monitoring indicator is to measure bone mineral density (BMD) using DXA. The stress characteristics and material distribution in different parts of the bones can be well simulated by three-dimensional finite element analysis. Our previous studies have demonstrated a linear positive correlation between clinical BMD and the density of three-dimensional finite element model of the femur. However, the correlation between the density variation between intertrochanteric region and collum femoris region of the model and the fracture site has not been studied yet. The present study intends to investigate whether the regional difference in the density of three-dimensional finite element model of the femur can be used to predict hip fracture site in elderly females. The CT data of both hip joints were collected from 16 cases of elderly female patients with hip fractures. Mimics 15.01 software was used to reconstruct the model of proximal femur on the healthy side. Ten kinds of material properties were assigned. In Abaqus 6.12 software, the collum femoris region and intertrochanteric region were, respectively, drawn for calculating the corresponding regional density of the model, followed by prediction of hip fracture site and final comparison with factual fracture site. The intertrochanteric region/collum femoris region density was [(1.20 ± 0.02) × 10(6)] on the fracture site and [(1.22 ± 0.03) × 10(6)] on the non-fracture site, and the difference was statistically significant (P = 0.03). Among 16 established models of proximal femur on the healthy side, 14 models were consistent with the actual fracture sites, one model was inconsistent, and one model was unpredictable, with the coincidence rate of 87.5 %. The intertrochanteric region or collum femoris region with lower BMD is more prone to hip fracture of the type on the corresponding site.

Cultivation of Chlorella sp. with livestock waste compost for lipid production

Cultivation of microalgae Chlorella sp. with livestock waste compost as an alternative nutrient source was investigated in this present study. Five culture media with different nutrient concentrations were prepared. The characteristics of algal growth and lipid production were examined. The results showed that the specific growth rate together with biomass and lipid productivities was different among all the cultures. As the initial nutrient concentration decreased, the lipid content of Chlorella sp. increased. The variations in lipid productivity of Chlorella sp. among all the cultures were mainly due to the deviations in biomass productivity. The livestock waste compost medium with 2000mgL^-1COD provided an optimal nutrient concentration for Chlorella sp. cultivation, where the highest productivities of biomass (288.84mgL^-1day^-1) and lipid (104.89mgL^-1day^-1) were presented.

Constraints on Ultrahigh-Energy Cosmic-Ray Sources from a Search for Neutrinos above 10 PeV with IceCube

We report constraints on the sources of ultrahigh-energy cosmic rays (UHECRs) above 10^{9}  GeV, based on an analysis of seven years of IceCube data. This analysis efficiently selects very high- energy neutrino-induced events which have deposited energies from 5×10^{5}  GeV to above 10^{11}  GeV. Two neutrino-induced events with an estimated deposited energy of (2.6±0.3)×10^{6}  GeV, the highest neutrino energy observed so far, and (7.7±2.0)×10^{5}  GeV were detected. The atmospheric background-only hypothesis of detecting these events is rejected at 3.6σ. The hypothesis that the observed events are of cosmogenic origin is also rejected at >99% CL because of the limited deposited energy and the nonobservation of events at higher energy, while their observation is consistent with an astrophysical origin. Our limits on cosmogenic neutrino fluxes disfavor the UHECR sources having a cosmological evolution stronger than the star formation rate, e.g., active galactic nuclei and γ-ray bursts, assuming proton-dominated UHECRs. Constraints on UHECR sources including mixed and heavy UHECR compositions are obtained for models of neutrino production within UHECR sources. Our limit disfavors a significant part of parameter space for active galactic nuclei and new-born pulsar models. These limits on the ultrahigh-energy neutrino flux models are the most stringent to date.

Reversible Modulation of DNA-Based Hydrogel Shapes by Internal Stress Interactions

We present the assembly of asymmetric two-layer hybrid DNA-based hydrogels revealing stimuli-triggered reversibly modulated shape transitions. Asymmetric, linear hydrogels that include layer-selective switchable stimuli-responsive elements that control the hydrogel stiffness are designed. Trigger-induced stress in one of the layers results in the bending of the linear hybrid structure, thereby minimizing the elastic free energy of the systems. The removal of the stress by a counter-trigger restores the original linear bilayer hydrogel. The stiffness of the DNA hydrogel layers is controlled by thermal, pH (i-motif), K⁺ ion/crown ether (G-quadruplexes), chemical (pH-doped polyaniline), or biocatalytic (glucose oxidase/urease) triggers. A theoretical model relating the experimental bending radius of curvatures of the hydrogels with the Young's moduli and geometrical parameters of the hydrogels is provided. Promising applications of shape-regulated stimuli-responsive asymmetric hydrogels include their use as valves, actuators, sensors, and drug delivery devices.

Maternal anti-HBVs suppress the immune response of infants to hepatitis B vaccine

It is still controversial whether maternal anti-HBV antibodies (anti-HBVs) affect the infants' immune response to hepatitis B virus (HBV) vaccination. This multicentre study aims to address this question. First, we determined whether the transplacental transfer of maternal anti-HBVs occurs by measuring the titres of 90 anti-HBVs-positive pregnant women and their newborns. The anti-HBVs-positive rates of newborns ranged from 89.7% to 100.0%, depending on the maternal anti-HBVs titres. Secondly, we investigated the effects of maternal anti-HBVs on the immune response of infants to HBV vaccination. A total of 1063 mother-and-infant pairs were enrolled and divided into three groups with maternal anti-HBVs titres of <10 IU/L (negative - 37.9%), 10-499 and ≥500 IU/L. The infants' anti-HBVs-positive rate and titres were negatively correlated with maternal anti-HBVs titres: the anti-HBVs-positive rate of infants were 88.9% (360/405), 84.5% (381/451) and 77.3% (160/207) in mothers with low, intermediate and high antibody titres, respectively, P<.0001. Median titres of anti-HBVs (IU/L) among infants were 169.1, 141.0 and 79.4, respectively, P=.020. One hundred and sixty-two infants were negative for anti-HBVs after the standard vaccination, and 120 of 131 of these infants (91.6%) reached anti-HBVs positivity after the first "booster" dose. The maternal anti-HBVs titres did not significantly affect infant response to this booster. In summary, transplacental transfer of anti-HBVs occurs and high titres of maternal anti-HBVs may suppress the immune response of infants to the standard HBV vaccination. The current schedule of the 0, 1 and 6 month may not be the optimal choice of infants with anti-HBVs-positive mothers.

Correction: A photostable AIE fluorogen for lysosome-targetable imaging of living cells

Correction for 'A photostable AIE fluorogen for lysosome-targetable imaging of living cells' by Xiaoding Lou et al., J. Mater. Chem. B, 2016, 4, 5412-5417.

[The specificity and limitations of sacroiliac joint magnetic resonance imaging in the diagnosis of axial spondyloarthritis in patients with chronic low back pain]

Objective: To evaluate the specificity and limitations of sacroiliac joint magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (SpA)in patients with chronic low back pain. Methods: We retrospectively analyzed clinical data of 390 patients with chronic low back pain in Department of Rheumatology, the PLA General Hospital from January 2013 to December 2015, including clinical manifestations, laboratory examinations and MRI data of sacroiliac joints. Results: There were 238 men and 152 women recruited. A total of 326 cases were diagnosed as axial SpA, including 216 men and 110 women with mean age (27.10±8.64) years and mean duration (7.64±3.50) months. Among these 326 patients, 243 (74.5%) were HLA-B₂₇ positive. The other 64 patients were considered as diagnoses rather than SpA (non-SpA), consisting of 22 men and 42 women with mean age (31.29±7.76) years and mean duration (5.75±2.90)months. Non-SpA group had 10 (15.6%) patients with HLA-B₂₇ positive. There were 68.1% and 65.0% SpA patients showing bone marrow edema and bone erosion of sacroiliac joint in MRI imaging respectively. Although there were 25.0% non-SpA patients with bone marrow edema and 7.8% with bone erosion in MRI of sacroiliac joint, the scores of bone marrow edema 0.00(0.00, 0.75) and bone erosion [0.00(0.00, 0.00)] were significantly lower compared with those in axial SpA group [bone marrow edema scores 2.00(0.00, 4.00), bone erosion scores 1.00(0.00, 3.00); P<0.05]. The scores of fat infiltration [1.00(0.00, 4.25), 1.00(0.00, 4.00)] and bone sclerosis [0.00(0.00, 1.00), 0.00(0.00, 1.75)] were not statistically different between two groups. Diagnostic sensitivity of bone marrow edema and bone erosion for axial SpA were 56.4% and 64.1% respectively, specificity were 93.8% and 92.2% respectively. The positive predictive value of bone marrow edema and bone erosion for axial SpA were 9.09 and 8.21, negative predictive value were 0.46 and 0.38.Diagnositic sensitivity of fatty infiltration and bone sclerosis for axial SpA group were 29.1% and 57.7%, specificity were 64.1% and 46.9%.The positive predictive value of fatty infiltration and bone sclerosis for axial SpA were 0.81 and 1.08, negative predictive value were 1.10 and 0.90. Conclusion: Sacroiliac joint MRI is a valuable method to diagnose axial SpA in patients with chronic low back pain. Yet it still has some limitations. Clinical presentations and spinal MRI would be helpful in some patients.

[Comparative study of different grading criteria of sacroiliac joint computed tomogrphy in ankylosing spondylitis]

Objective: To assess the value of different grading criteria of sacroiliac joint (SIJ) computed tomogrphy (CT) in ankylosing spondylitis (AS). Methods: Patients who had received SIJ CT examinations from June 2012 to December 2015 were enrolled.The CT scans were read by one rheumatologist.The difference between patients with sacroiliitis or without sacroiliitis was compared.The 1984 revision of modified New York (mNY) criteria, the criteria established by Lee (Lee criteria) and the Innsbruck criteria were used to evaluate SIJs on CT in patients with sacroiliitis. Results: Totally 2 714 patients were enrolled in this study.Thereinto 509 patients including 324 male and 185 female were detected with SIJs abnormality.The proportions of SIJs graded 3 or 4 by these three criteria were 79.37%, 82.91% and 76.32%, respectively.The consistency of grading between mNY criteria and Lee criteria was good (k=0.767, P<0.01). The correlation between Innsbruck criteria and other two criteria were satisfactory (r=0.866 and 0.839, respectively). There were more SIJs graded 3 by Lee criteria (64.44%), comparing with mNY criteria (60.90%). Forty five SIJs graded 1-3 by mNY criteria were graded 0 by Lee criteria, indicating that the latter criteria may have a better specificity. When evaluating the severity of SIJs, Innsbruck criteria has a better discrimination capability and the proportions of SIJs graded Ⅱ (A) to Ⅳ (B) were 10.71%, 8.94%, 26.82%, 20.92%, 10.12%, respectively. Conclusions: Lee criteria has a better diagnostic specificity with a reduction of difficulty in assessing procedure, while Innsbruck criteria is a more detailed grading system with a possibility to reflect the development of sacroiliitis.