[Application of aldosterone/direct renin ratio before drug washout in the screening of primary aldosteronism]

Objective: To explore the cut-off point of aldosterone/direct renin ratio (ADRR) before drug washout in the screening for primary aldosteronism (PA) in the Chinese population and reduce the potential risk caused by drug washout during PA screening. Methods: Hospitalized hypertensive patients in the Hypertension Ward of Fuwai Hospital, Chinese Academy of Medical Sciences from January 2017 to October 2019 were enrolled. PA was diagnosed according to the criterion of 2016 American Guideline and 2016 Chinese Consensus for PA. The plasma aldosterone concentration (PAC), direct renin concentration (DRC) and ADRR before and after drug washout were measured. The receiver operating characteristic (ROC) curve of ADRR was drawn and the maximal Youden index was used to determine the best cut-off value. Results: A total of 542 hypertensive patients were included, with 467 patients diagnosed with essential hypertension (EHT) (297 males and 170 females), and 75 patients diagnosed with PA (51 males and 24 females). Patients with PA had higher PAC and ADRR before and after drug washout than those with EHT(150.0 (130.0, 210.0) vs 120.0 (80.0, 170.0) ng/L, 170.0 (120.0, 260.0) vs 130.0 (90.0, 180.0) ng/L; 28.9 (15.9, 63.5) vs 4.3 (1.9, 11.8) (ng/L) / (mU/L) , 55.6 (39.0, 109.0) vs 9.8 (4.5, 21.3) (ng/L) /(mU/L), all P<0.001). However, DRC of PA patients before and after washout were lower than those with EHT (4.0 (2.0, 10.0) vs 27.0 (10.0, 64.0) mU/L, 3.0 (2.0, 4.0) vs 12.2 (5.0, 27.0) mU/L, P<0.001). In EHT and PA groups, PAC and ADRR significantly increased (P=0.001, P<0.001) , but DRC significantly decreased after drug washout (all P<0.001) . The area under the ROC curve of ADRR before drug washout was 0.868 (95%CI 0.836-0.895) with the best cut-off value of 7.8 (ng/L) / (mU/L) for the screening of PA .The sensitivity and specificity was 94.7% and 66.8%, respectively, with the maximal Youden index of 0.615. Conclusion: ADRR before drug washout > 7.8 (ng/L) / (mU/L) can be used as an alternative cut-off point to screen PA when drug washout is not available.

[Application of dynamic CT scan in the three-dimensional dynamic morphology changes of laryngeal soft tissue in unilateral vocal fold paralysis patients]

Objective: To explore the dynamic changes of three-dimensional morphology of laryngeal soft tissue and its clinical value in the unilateral vocal fold paralysis (UVFP) patients through dynamic CT scanning during the process from inspiration to phonation. Methods: From October 2017 to July 2019, a retrospective study was performed in 18 patients with UVFP (10 males and 8 females with the range of age from 29 to 75 years old) and 10 normal subjects (5 males and 5 females with the range of age from 25 to 58 years old) in Department of Voice-Otolaryngology Head and Neck Surgery, Section Two, Zhongshan Hospital Xiamen University. The laryngeal dynamic computed tomography (CT) of cine mode was performed. Ten dynamic sequence images of vocal folds movements were obtained during the process from inspiration to phonation. Based on the dynamic changes of glottic area and the displacement of cricoid cartilage. The above dynamic sequence images were divided into inspiratory phase and phonation phase as well as open phase and closed phase. The soft tissue parameters were measured respectively, including vocal folds length, width, thickness and subglottal convergence angle. Independent-sample t test was used to analyze between UVFP group and control group. Results: During the process from inspiration to phonation, the morphology of vocal folds in control group was relatively stable at inspiratory phase and closed phase in phonation. When open phase and closed phase of phonation were switching, the morphology of vocal folds changed obviously. The length of vocal folds became longer (1.19±0.10) mm, the width became wider (2.19±0.17) mm, the thickness became thinner (2.66±0.56) mm, and the subglottal convergence angle decreased (31.45±4.78)°. Compared with the controll group, in the open phase, the thickness and width of the vocal fold on affected side in the UVFP group were thinner (t=10.25, P<0.001) and wider (t=5.25, P<0.001).While in the closed phase, the subglottal convergence angle was larger (t=4.41, P=0.001).The width of the healthy side vocal fold in the UVFP was wider (t=2.54, P=0.026) than that in the control group. The differences in other parameters were not statistically significant. Conclusions: Dynamic laryngeal CT scanning provides a simple and non-invasive method for the objective and quantitative measurement of the dynamic changes of laryngeal morphology from inspiration to phonation. Compared with the control group, the characteristic dynamic changes among UVFP were observed during this particular process, which included changes of subglottal convergence angle and thickness of vocal muscle due to denervation. In addition, in UVFP group, the width of the vocal fold healthy side in the closed phase may be used to assess its compensatory function.

PEAR1 rs12041331 polymorphisms and the risk of adverse cardiovascular outcomes in patients with acute coronary syndrome and/or percutaneous coronary intervention: a systematic review and meta-analysis

Background

Platelet endothelial aggregation receptor-1 (PEAR1), expressed in endothelium, platelets, and other tissues, is a platelet transmembrane tyrosine kinase receptor involved in platelet aggregation and platelet-platelet contact. The minor allele (A) in intron 1 of the PEAR1 gene (rs12041331, G&gt;A) is associated with an reduced PEAR1 protein expression and suppressed platelet aggregation response toward multiple agonists. But current evidences on the association between PEAR1 rs12041331 polymorphisms and cardiovascular outcomes in patients with acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) are discordant.

Purpose

To characterize and quantify the association between PEAR1 rs12041331 polymorphisms and cardiovascular outcomes in patients with ACS and/or PCI.

Methods

We conducted a systematic review and meta-analysis by searching MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SinoMed, CNKI, and Wanfang Data before Dec 7, 2019 to identify studies evaluating the association between PEAR1 rs12041331 polymorphisms and cardiovascular outcomes in patients with ACS and/or PCI. The primary outcome was the major adverse cardiovascular outcomes (MACEs) defined by each study. We adopted the Mantel-Haenszel method to calculate the relative risks (RRs) with 95% confidence intervals (CIs) and the corresponding P values using the random effect model. To assess the effect of ethnicity, we performed the subgroup analyses per ethnic population using the fix effect model.

Results

Among 542 citations identified along with 1 from additional sources, we included 4 studies, which documented 218 MACEs in 8180 patients. The A allele frequency in each study was comparable with that reported in the 1000 Genome Project, but varied among ethnic populations, that is 45.8% in East Asians, 46.5% in American Africans, and 9.2% in Caucasians, adopted from the 1000 Genome Project. A-allele carriers are associated with a 54% increase in MACEs than non-A-carriers (RR, 1.54; 95% CI, 1.10–2.16; P=0.01) with a low but non-significant heterogeneity. Subgroup analyses showed that A-allele carriers tend to have more MACEs than non-A-allele carriers despite of ethnicity, that is 1.32-fold increase in East Asians (RR, 1.32; 95% CI, 0.99–1.77; P=0.06), 2.43-fold in Caucasians (RR, 2.43; 95% CI, 0.99–5.98; P=0.05), and 3.56-fold (RR, 3.56; 95% CI, 1.08–11.70; P=0.04) in American Africans.

Conclusions

Our study indicates that the PEAR1 rs12041331 is prognostic in patients with ACS and/or PCI and treated with DAPT, which might be not caused by the associations with pharmacological response to antiplatelet agents. Further investigations are thus required to address the unrevealing mechanisms of PEAR1, especially on the development of atherosclerosis and the occurrence of acute adverse ischemic events.

Figure 1

Funding Acknowledgement

Type of funding source: None

Non-invasive mid-term ECG monitoring for the detection of atrial fibrillation in an outpatient population

Background

Atrial fibrillation (AF) is a common arrhythmia with significant morbidity due to an increased risk of ischemic stroke. Outpatient electrocardiogram (ECG) monitoring is an integral part of the diagnosis of AF. Conventional 24 hour Holter monitoring can be cumbersome and often fails to diagnose patients with paroxysmal AF. Spyder ECG is a non-invasive ECG monitoring device that allows wireless transmission of ECG information for analysis. It is small and comfortable, allowing for easy application for the screening and detection of AF over a mid-term duration.

Purpose

This study aims to evaluate the incidence of AF in patients with no prior AF and CHADsVASC score of at least 1 with the use of the Spyder ECG mid-term ECG monitoring device.

Methods

Patients aged 21 to 85 years old with no prior history of AF and CHADsVASC score of at least 1 were recruited from outpatient clinics of 3 large tertiary hospitals in Singapore from December 2016 to April 2019. Patients wore the Spyder ECG device for up to 2 weeks, during which continuous ECG information was uploaded onto a central cloud database and analysed.

Results

There were 363 patients recruited. The mean age was 61±10.0 years and 65.1% were male. There were 80.3% Chinese, 11.6% Malay, 7.5% Indian and 20.6% of other races. 68.3% of the patients were non-smokers and 74.0% of them were non-alcohol drinkers. The mean BMI of 25.5±4.7 kg/m2. The patient population had significant co-morbidities. 76.3% of the patients had hypertension, 69.4% of them had hyperlipidemia and 40.5% of them had diabetes mellitus. 10.0% of them had congestive cardiac failure and 56.7% had ischaemic heart disease. 11.3% of patients had a previous stroke and 20.4% had a prior myocardial infarction. 7.8% of the patients had asthma, 5.8% of them had thyroid disease and 9.9% of them had chronic kidney disease. They were monitored for a mean of 5.4±2.9 days each. There were 15 (4.1%) patients in whom AF was detected. The patients with AF wore the device for a mean of 5.7±2.0 SD days. The mean burden of AF was 9.0% of monitored time. 46.7% of the patients with AF had detection of AF on the first day, 26.7% on the second day, 13.3% on the third day and 13.3% on the seventh day. The mean duration of the first episode of AF was 251±325 minutes. 7 out of 15 (46.7%) of patients had first episodes of AF lasting less than 10 minutes.

Conclusion

Continuous mid-term ECG monitoring was able to detect AF in 15 (4.1%) of a population of 363 patients with no prior AF and CHADsVASC score of at least one, monitored for a mean of 5.4 days. Most episodes (53.3%) of AF were detected after the first day of ECG monitoring.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Duke-NUS Medical School Singapore

Abscisic acid and hydrogen peroxide are involved in drought priming-induced drought tolerance in wheat (Triticum aestivum L.)

Drought is one of the major stress factors in wheat production on a global scale. Drought priming during the early growth stage can enhance drought tolerance in wheat (Triticum aestivum L.). Abscisic acid (ABA) and hydrogen peroxide (H₂ O₂ ) are important signal molecules in the adaptation of plants to drought stress. However, the roles of ABA and H₂ O₂ in drought priming-induced drought tolerance are not clear. In the present study, we evaluated the responses of wheat to an ABA inhibitor, H₂ O₂ scavenger and an inhibitor to investigate the (i) relationship between ABA and H₂ O₂ in osmotic adjustment after drought priming in the vegetative stage and (ii) responses to drought stress during grain filling. In the drought priming alone treatments, chemical application resulted in the scavenging of ABA and H₂ O₂ , weakening the alleviation effects of drought priming on drought stress, as demonstrated by the lower leaf water potential and grain yield. The ABA inhibitor completely inhibited accumulation of ABA and H₂ O₂ ; the ABA inhibitor inhibited respiratory burst oxidase homologue expression, whereas the H₂ O₂ inhibitor resulted in higher 9-cis-epoxycarotenoid dioxygenase expression and ABA concentration in primed plants, indicating that ABA scavenging inhibited H₂ O₂ biosynthesis while H₂ O₂ scavenging did not inhibit ABA biosynthesis. The results further demonstrated that NADPH oxidase-mediated H₂ O₂ production functions downstream of ABA, which induces osmolyte transcript expression and accumulation, and thus contributes to drought priming-induced stress tolerance. These results provide a theoretical basis for a better understanding of the mechanisms involved in drought priming-induced tolerance in wheat plants.

Profiling the effects of physicochemical indexes on the microbial diversity and its aroma substances in pit mud

Microbial diversity of pit mud (PM) plays a significant role in Baijiu's flavour. Here we explored the microbial community structures and aroma substances of Wenwang Winery with high-throughput sequencing coupling with headspace solid-phase microextraction-gas chromatography-mass spectrometry. We discovered that the odorant was mainly derived from 14 aroma compounds because of their OAVs ≥ 1 (OAV, the ratio of substance concentration to aroma threshold; s, on behalf of the plural), such as ethyl hexanoate (2438), ethyl octanoate (975), caproic acid (52) and etc. Moreover we also revealed that Lactobacillaceae (97·08%) was the mainly bacterial microbial community in 2-year-old PM, companied by the primarily fungi including Aspergillaceae (55·45%), Unclassified Ascomycota (11·13%) and Dipodascaceae (5·72%). Compared with the 2-year-old PM, bacterial floras in 20-year-old PM and 30-year-old PM were more abundant (i.e. Dysgonomonadaceae, Clostridium and Synerggstaceas), while no fungi were detected. Besides, the physicochemical analysis showed that the content of Lactobacillaceae was inversely associated with moisture, pH and ammonia nitrogen. By further Spearman's correlation coefficient analysis, we verified that the content of Lactobacillaceae was positively correlated with ethyl hexanoate, while negatively correlated with ethyl octanoate and caproic acid. Meanwhile, ethyl octanoate and caproic acid were positively correlated with most flora including Ruminococcaceae, Dysgonomonadaceae and Clostridiacea, which were related to physicochemical indexes. This work demonstrates promise for adjusting the physicochemical indexes of PM to affect the micro-organisms and aroma, which may provide a reference for the production of high-quality Baijiu.

[The role of macrophage polarization in parasitic infections: a review]

Macrophages are important members of innate immunity and play an extremely important role in the host defense against pathogenic infections, tumors, and allergic diseases. Macrophages have a high degree of plasticity, and may be polarized into classical activated macrophages (M1 macrophages) and alternative activated macrophages (M2 macrophages) under the stimulation of different environments. M1 macrophages are found to promote inflammatory responses, which facilitates the clearance of pathogens, while M2 macrophages may inhibit inflammatory responses, which facilitates the survival and reproduction of pathogens. This review summarizes the role of macrophage polarization in parasitic infections, so as to provide insights into the prevention and treatment of parasitic diseases.

Bio-detoxification of Jatropha curcas L. cake by a soil-borne Mucor circinelloides strain using a zebrafish survival model and solid-state fermentation

AIMS

The aims of the study were to (i) improve the evaluation criteria of detoxifying Jatropha curcas L. cake (JCC), (ii) isolate and characterize a JCC tolerant strain, (iii) explore its JCC detoxifying potential.

METHODS AND RESULTS

The zebrafish was employed as a survival model to screen the strains capable of detoxifying JCC. A strain identified as Mucor circinelloides SCYA25, which is highly capable of degrading all toxic components, was isolated from soil. Different solid-state fermentation parameters were optimized by response surface methodology. The optimal values for inoculation amount, moisture content, temperature, and time were found to be 18% (1·8 × 10⁶ spores g^-1 cake), 66%, 26, and 36 days, respectively, to achieve maximum detoxification of the JCC (92%). Under optimal fermentation conditions, the protein content of JCC was increased, while the concentrations of ether extract, crude fiber, toxins, and anti-nutritional substances were all degraded considerably (P < 0·05). Scanning electron microscopy and Fourier transform infrared spectrometer analysis revealed that the fermentation process could disrupt the surface structure and improve the ratio of α-helix to β-folding in the JCC protein, which may improve the digestibility when the detoxified JCC is used as a feedstuff.

CONCLUSIONS

Our results indicate that M. circinelloides SCYA25 is able to detoxify JCC and improve its nutritional profile, which is beneficial to the safe utilization of JCC as a protein feedstuff.

SIGNIFICANCE AND IMPACT OF THE STUDY

The newly identified M. circinelloides SCYA25 detoxified JCC in a safe manner to provide a potential alternative to soybean meal for the feed industry. These results also provide a new perspective and method for the toxicity evaluation and utilization of JCC and similar toxic agricultural by-products.

[Evaluation of the safety of diphtheria, tetanus and acellular pertussis containing combination vaccines in Chengdu, 2015-2019]

Objective: To evaluate the safety of diphtheria, tetanus and acellular pertussis (DTaP) containing combination vaccines used in Chengdu. Methods: The AEFI reports data of DTaP vaccine, DTaP-Haemophilus influenza type b combined vaccine (DTaP-Hib) and DTaP-inactivated poliovirus-Hib combined vaccine (DTaP-IPV-Hib) in Chengdu from 2015 to 2019 were collected through the national immunization management system. Description epidemiological method was used to analyze the data. Results: From 2015 to 2019, a total of 8 234 cases of AEFI of DTaP containing combination vaccines were reported in Chengdu, with a reported incidence of 194.55/100 000 doses, including 7 897 cases of common adverse reaction (168.59 per 100 000) and 234 cases of rare adverse reaction (5.53 per 100 000). The DTaP vaccine reported 4 240 cases AEFI (140.63 per 100 000), the DTaP-Hib vaccine reported 2 490 cases AEFI (399.09 per 100 000) and the DTaP-IPV-Hib vaccine reported 1 504 cases AEFI (253.49 per 100 000). All the three vaccines had the highest incidence for the booster doses; the rare adverse reaction were mainly Anaphylactic Reaction (6.27 per 100 000). Conclusions: The AEFI monitor system had high sensitivity, and the rare adverse reaction rate was extremely low, all the vaccines had good safety profiles. The Thrombocytopenic purpura and Laryngeal Edema should be paid more attention to.

Low body mass index is associated with ectopic pregnancy following assisted reproductive techniques: a retrospective study

OBJECTIVE

To investigate the association between body mass index (BMI) and ectopic pregnancy (EP) following embryo transfer (ET).

DESIGN

Retrospective cohort study.

SETTING

University-affiliated hospital.

POPULATION

A total of 16 378 pregnancies derived from either fresh ET or frozen-thawed ET between January 2008 and December 2017.

METHODS

We used the generalised estimating equation (GEE) to analyse the association between BMI categories and EP, as one woman may contribute to more than one pregnancy. Generalised additive models were also used to demonstrate the non-linear association. Models were adjusted for age, parity, gravidity, previous history of ectopic pregnancy, duration of infertility, polycystic ovary syndrome, endometriosis, diagnosis of tubal problems, ovarian reserve markers, ovarian stimulation parameters, insemination protocol, endometrial thickness and embryo transfer policies.

MAIN OUTCOME MEASURES

Ectopic pregnancy.

RESULTS

According to the WHO criteria, the number of cycles with low (<18.5 kg/m² ), normal (18.5-24.9 kg/m² ) and high (≥25 kg/m² ) BMI were 2155, 13 447 and 776, respectively. In comparison with the normal BMI group, the rate of EP was significantly increased in the low BMI group (2.92% versus 2.02%, relative risk 1.45, 95% CI 1.11-1.90), but not in the high BMI group (2.84%, relative risk 1.41, 95% CI 0.92-2.20). Adjusted for confounding factors, the odds ratio for EP comparing low BMI versus normal BMI was 1.61 (95% CI 1.19-2.16) and that comparing high BMI versus normal BMI was 1.12 (95% CI 0.72-1.76).

CONCLUSIONS

Low BMI is associated with an increased risk of EP.

TWEETABLE ABSTRACT

The ectopic pregnancy rate after embryo transfer for lean women is higher than that for women of normal weight.

Tocilizumab in the treatment of a critical COVID-19 patient: a case report

In December 2019, Coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China and the rest of the world. COVID-19 is currently a global pandemic. There are cytokine storms in severe COVID-19 patients. Interleukin-6 plays an important role in cytokine storm. Tocilizumab is a blocker of interleukin-6 receptor, which is likely to become an effective drug for patients with severe COVID-19. Here, we reported a case in which tocilizumab was effective for a critical COVID-19 patient.

The tumor suppressor NOR1 suppresses cell growth, invasiveness, and tumorigenicity in glioma

Oxidored-nitro domain-containing protein 1 (NOR1) is a tumor suppressor downregulated in various human cancers, including nasopharyngeal carcinoma (NPC), lung cancer, and testicular cancer. NOR1 protein is highly expressed in the normal brain; however, its role in brain tumors remains unknown. In this study, we demonstrated that the NOR1 protein level was decreased in glioma tissue samples as compared to its normal counterpart. Exogenously expressed NOR1 protein in glioma U251 cells inhibits tumor cell proliferation, migration, and invasion. Re-expression of NOR1 induced cell cycle S to G2 phase arrest and suppressed its tumorigenicity in nude mice. Overexpression of NOR1 in U251 cells also led to a decrease of Ki67 expression in xenografts. Transcriptomic analysis revealed that NOR1 expression altered the expression of genes favored cell proliferation. Among the differentially expressed genes, FOXR2, a member of the FOX gene family, which promotes glioma progression, was decreased in NOR1 expressing cells. The downregulation of FOXR2 by NOR1 was validated in vitro and in vivo. Our findings suggest for the first time that NOR1 suppresses glioma progression via modulating the FOXR2 expression.

[Characteristics of rare diseases in Zhejiang province, 2007-2017]

Objective: To understand the characteristics of 24 388 inpatients with rare diseases in Zhejiang province during 2007-2017 and provide evidence for rare disease prevention and control. Methods: Inpatient data of rare diseases and the number of hospitalization in each year were collected in 10 hospitals of class Ⅲ (A) in Zhejiang province from 2007 to 2017, and descriptive statistical analysis was used. Results: A total of 24 388 cases of rare diseases were found, accounting for 2.69‰ (24 388/9 054 201) of total hospitalized cases. The top 3 types of rare diseases were "diseases of blood and blood-forming organs and certain disorders involving immune mechanism" (32.81%, 8 001/24 388), "congenital malformations, deformations and chromosomal abnormalities" (24.87%, 6 065/24 388) and "diseases of the nervous system" (19.01%, 4 635/24 388). The number of rare disease cases increased year by year from 2007 to 2017 with an average annual growth of 19.69%, however, the proportion of rare disease cases in the annual number of hospitalized cases only showed upward trend during 2016-2017, the time distribution of different types of rare diseases had different characteristics. The male to female ratio of rare diseases cases was 1.35∶1(13 990/10 398), "diseases of the digestive system" (4.45∶1, 1 180/265), "consequences of injury, poisoning and other external causes" (3.51∶1, 281/80) and "diseases of the nervous system" (2.26∶1, 3 213/1 422) had the highest male to female ratio. The distributions of rare disease types and diseases of different types in different age groups varied. The top 10 rare diseases accounted for 53.55% (13 060/24 388) of the total cases, and the top 3 diseases were adult idiopathic neutropenia (14.41%, 3 515/24 388), corticobasal degeneration (7.60%, 1 854/24 388) and henock-schoenlein purpura (6.01%, 1 466/24 388). Conclusion: The analysis on the characteristics of 24 388 rare disease cases in Zhejiang during 2007-2017 provided reference evidence for the promotion of rare disease research, monitoring, building registration database, and development of the prevention and control strategy for rare diseases in China.

Applications of Ultrafine Limestone Sorbents for the Desulfurization Process in CFB Boilers

With the stringent emission regulation taking effect, it is difficult for the conventional desulfurization technology in circulating fluidized bed (CFB) boilers to meet the requirements of ultralow SO₂ emission. Therefore, in this paper, the application of natural ultrafine limestone, with a Sauter mean diameter of less than 20 μm, was tested by conducting bench-scale, pilot-scale, and commercial-scale experiments to realize highly efficient desulfurization in CFB furnaces. In the past, such small-size limestone was considered unsuitable for CFB boilers. However, as demonstrated by bench-scale results, the desulfurization performance was clearly superior to that of coarse limestone, especially at low SO₂ concentrations. In a 3 MW_th pilot-scale CFB boiler, the ultrafine limestone exhibited competent desulfurization efficiency to that of the coarse limestone but clearly less significant catalytic effects on NOx formation. As revealed by field tests in four commercial-scale CFB boilers, when high-efficiency cyclones were applied to CFB boilers, the mass inventory of ultrafine particles was significantly increased and the residence time would be extended accordingly; thus, the ultrafine limestone can be used to achieve high desulfurization efficiency and even ultralow SO₂ emission with a favorable Ca/S ratio. Furthermore, a technical roadmap was drawn for the cost-effective control of SO₂ emission.