Unexpected Stretching of Entangled Ring Macromolecules

In the melt state at equilibrium, entangled nonconcatenated ring macromolecules adapt more compact conformations compared to their linear analogs and do not form an entanglement network. We show here that, when subjected to uniaxial stretching, they exhibit a unique response, which sets them apart from any other polymer. Remarkably, whereas both linear and ring polymers strain-harden, the viscosity of the rings increases dramatically (the melt thickens) at very low stretch rates due to the unraveling of their conformations along the stretching direction. At high rates, stretching leads to viscosity thinning similar to that of entangled linear polymers, albeit with subtle differences.

Gut microbiota composition and bone mineral loss-epidemiologic evidence from individuals in Wuhan, China

We explored the association between gut microbiota composition and bone mineral loss in Chinese elderly people by high-throughput 16S ribosomal RNA (rRNA) gene sequencing. Compared with controls, a smaller number of operational taxonomic units (OTUs), several taxa with altered abundance, and specific functional pathways were found in individuals with low-bone mineral density (BMD).

INTRODUCTION

Gut microbiota plays important roles in human health and associates with a number of diseases. However, few studies explored its association with bone mineral loss in human.

METHODS

We collected 102 fecal samples from each eligible individual belonging to low-BMD and control groups for high-throughput 16S rRNA gene sequencing.

RESULTS

The low-BMD individuals had a smaller number of OTUs and bacterial taxa at each level. At the phylum level, Bacteroidetes were more abundant in the low-BMD group; Firmicutes were enriched in the control group; Firmicutes and Actinobacteria positively correlated and Bacteroidetes negatively correlated with the BMD and T-score in all subjects. At the family level, the abundance of Lachnospiraceae in low-BMD individuals reduced and positively correlated with BMD and T-score; meanwhile, BMD increased with increasing Bifidobacteriaceae. At the genus level, low-BMD individuals had decreased proportions of Roseburia compared with control ones (P < 0.05). Roseburia, Bifidobacterium, and Lactobacillus positively correlated with BMD and T-score. Furthermore, BMD increased with rising abundance of Bifidobacterium. Functional prediction revealed that 93 metabolic pathways significantly differed between the two groups (FDR-corrected P < 0.05). Most pathways, especially pathways related to LPS biosynthesis, were more abundant in low-BMD individuals than in control ones.

CONCLUSIONS

Several taxa with altered abundance and specific functional pathways were discovered in low-BMD individuals. Our findings provide novel epidemiologic evidence to elucidate the underlying microbiota-relevant mechanism in bone mineral loss and osteoporosis.

TT genotype of rs10036748 in TNIP1 shows better response to methotrexate in a Chinese population: a prospective cohort study

BACKGROUND

Methotrexate (MTX) is an efficacious treatment for psoriasis; however, its widespread application is limited by its unpredictable efficacy.

OBJECTIVES

To investigate the association of clinical factors and variants of psoriasis susceptibility genes with clinical responses to MTX in a prospective cohort.

METHODS

A total of 221 patients with psoriasis were recruited. Patients who achieved Psoriasis Area and Severity Index (PASI) improvement ≥ 75% at week 12 were defined as responders, whereas those with PASI improvement < 50% were defined as nonresponders. In 90 screening patients, genetic variants for 18 single-nucleotide polymorphisms in 14 susceptibility genes, and HLA-Cw6 status were initially compared for responders and nonresponders. Statistically significant associations in genetic variants were verified in all 221 patients.

RESULTS

Overall, 49% and 45% of patients achieved PASI 75 improvement during screening and verification stages, respectively. Concomitant arthritis with psoriasis and high body mass index (BMI) negatively affect the efficacy of MTX. TT genotype of rs10036748 in TNIP1 was significantly associated with PASI 75 response at week 12 (54% and 37%, P < 0·05). A significantly higher PASI 90 response was observed in patients with TT genotype of rs10036748 (27% vs. 12%, P < 0·01) and TC/TT genotype of rs4112788 in LCE3D (25% vs. 13%, P < 0·05) at week 12 compared with those who had other genotypes. After adjustment for all confounding factors, only BMI (P < 0·05), arthritis (P < 0·05) and genotype of rs10036748 (P < 0·05) were significantly associated with clinical responses to MTX.

CONCLUSIONS

Patients with psoriasis with TT genotype of rs10036748 in TNIP1, with lower BMI, without arthritis will achieve a better response to MTX.

Genome-wide association study identified genes in the response to Salmonella pullorum infection in chickens

Pullorum is a bacterial disease that threatens the modern poultry industry. Over the years, research on this topic has focused mainly on its epidemiology, whereas the hosts' genetic basis of infection is still vague. In order to identify chickens' genes associated with pullorum, we sequenced 300 New Pudong chicken by double digest genotyping-by-sequencing. We obtained 1 527 953 SNPs for a genome-wide association analysis, which identified 43 genome-wide significant markers. Most of the significant SNPs were in the interval of 57.7-59.0 Mb on chromosome 5. The gene set enrichment analysis suggests a potential manner for bacterial infection and remaining inside the host. This work provides basic data for the purification, prevention and treatment of pullorum disease.

[Analyses of clinical and radiological characteristics of IgG4-related rhinosinusitis]

Objectives: To discuss the clinical and radiological features of IgG4-related rhinosinusitis. Methods: In this retrospective research, the clinical data of 16 patients diagnosed with IgG4 related rhinosinusitis, who were enrolled in Beijing Tongren Hospital from November 2013 to September 2017, were collected. The clinical features, laboratory findings, radiological findings, histological features, treatment and prognosis were all summarized. Results: There were 12 males and 4 females among 16 patients, and male-to-female ratio was 3︰1. The age was between 30 to 70 years old, with median age of 52 years old. The chief nasal complaints were nasal obstruction and hyposmia, complicated with proptosis and eyelid swelling in 11 patients (11/16). Serum IgG4 levels were elevated in all patients and the value was over 1.44 g/L, and one patient serum IgG4 level was up to 49.70 g/L. Computed tomography (CT) showed the mainly affected sinuses were bilateral ethmoid sinus and olfactory cleft. The classic feature of CT scans was thickening of the involved bilateral ethmoid sinus mucous membrane with ethmoid bone absorption, which was mainly at midline. Histological features were severe inflammation of the mucosal tissue with mass of neutrophils and plasma cell infiltration. All patients were treated by methylprednisolone combined with cyclophosphamide or methotrexate. Remission of symptoms was detected in all patients. Conclusion: The clinical features of IgG4-related rhinosinusitis are often accompanied by orbital tissue involvement, elevated IgG4 serum concentration, associated sinus imaging changes, and sensitive glucocorticoid and immunosuppressive therapy.

Structural determinants of the interaction between influenza A virus matrix protein M1 and lipid membranes

Influenza A virus is a pathogen responsible for severe seasonal epidemics threatening human and animal populations every year. One of the ten major proteins encoded by the viral genome, the matrix protein M1, is abundantly produced in infected cells and plays a structural role in determining the morphology of the virus. During assembly of new viral particles, M1 is recruited to the host cell membrane where it associates with lipids and other viral proteins. The structure of M1 is only partially known. In particular, structural details of M1 interactions with the cellular plasma membrane as well as M1-protein interactions and multimerization have not been clarified, yet. In this work, we employed a set of complementary experimental and theoretical tools to tackle these issues. Using raster image correlation, surface plasmon resonance and circular dichroism spectroscopies, we quantified membrane association and oligomerization of full-length M1 and of different genetically engineered M1 constructs (i.e., N- and C-terminally truncated constructs and a mutant of the polybasic region, residues 95-105). Furthermore, we report novel information on structural changes in M1 occurring upon binding to membranes. Our experimental results are corroborated by an all-atom model of the full-length M1 protein bound to a negatively charged lipid bilayer.

DNA copy number imbalances in primary cutaneous lymphomas

BACKGROUND

Cutaneous lymphomas (CL) represent a clinically defined group of extranodal non-Hodgkin lymphomas harbouring heterogeneous and incompletely delineated molecular aberrations. Over the past decades, molecular studies have identified several chromosomal aberrations, but the interpretation of individual genomic studies can be challenging.

OBJECTIVE

With a comprehensive meta-analysis, we aim to delineate genomic alterations for different types of CL and propose a more accurate classification in line with their various pathogenicity.

METHODS

We searched PubMed and ISI Web of Knowledge for publications from 1996 to 2016 reporting the investigation of CL for genome-wide copy number alterations, by means of comparative genomic hybridization techniques and whole-genome sequencing and whole-exome sequencing. We then extracted and remapped the available copy number variation (CNV) data from these publications with the same pipeline and performed clustering and visualisation to aggregate samples of similar CNV profiles.

RESULTS

For 449 samples from 22 publications, CNV data were accessible for sample based meta-analysis. Our findings illustrate structural and numerical chromosomal imbalance patterns. Most frequent CNAs were linked to oncogenes or tumour suppressor genes with important roles in the course of the disease.

CONCLUSION

Summary profiles for genomic imbalances, generated from case-specific data, identified complex genomic imbalances, which could discriminate between different subtypes of CL and promise a more accurate classification. The collected data presented in this study are publicly available through the 'Progenetix' online repository.

Oswald IW, Ban W, Huang CL, Loganathan V, Hallas AM, Wilson MN, Luke GM, Harriger L, Huang Q, Li Y, Dzsaber S, Chan JY, Wang NL, Paschen S, Lynn JW, Nevidomskyy AH, Dai P, Si Q, Morosan E. Low-carrier density and fragile magnetism in a Kondo lattice system

Kondo-based semimetals and semiconductors are of extensive current interest as a viable platform for strongly correlated states in the dilute carrier limit. It is thus important to explore the routes to understand such systems. One established pathway is through the Kondo effect in metallic nonmagnetic analogs, in the so called half-filling case of one conduction electron and one 4f electron per site. Here, we demonstrate that Kondo-based semimetals develop out of conduction electrons with a low-carrier density in the presence of an even number of rare-earth sites. We do so by studying the Kondo material Yb3Ir4Ge13 along with its closed-4f -shell counterpart, Lu3Ir4Ge13. Through magnetotransport, optical conductivity, and thermodynamic measurements, we establish that the correlated semimetallic state of Yb3Ir4Ge13 below its Kondo temperature originates from the Kondo effect of a low-carrier conduction-electron background. In addition, it displays fragile magnetism at very low temperatures, which in turn, can be tuned to a Griffiths-phase-like regime through Lu-for-Yb substitution. These findings are connected with recent theoretical studies in simplified models. Our results can pave the way to exploring strong correlation physics in a semimetallic environment.

[Pulmonary cavities with Takayasu arteritis: report of 3 cases and literature review]

Objective: To analyze the clinical features of 3 cases of Takayasu arteritis(TA) with pulmonary cavities on chest computed tomography(CT). Methods: The clinical data of 3 TA patients with cavities on the chest CT who were admitted into Beijing Chaoyang Hospital were retrospectively analyzed. A literature search was performed with "Takayasu arteritis" and "pulmonary" as the key words in China Knowledge Resource Intergrated Database (CNKI) and Pubmed Database for publications from Jan 1, 2000 to Dec. 31,2017. The relevant literatures were reviewed. Results: Among the 3 patients, 2 were males and 1 was female, aging 49, 28 and 28 years, respectively. They presented with cough, fever and chest pain, and chest CT showed cavities, single or multiple, either with thick or thin wall, or wedge-shaped consolidation, residual stripes after being absorbed, and one case had pulmonary biopsy results which showed hemorrhagic infarction. They were all misdiagnosed before as pneumonia, pulmonary tuberculosis, pulmonary thromboembolism. After being treated by combination therapy of glucocorticoids and immunosuppressive agents, the disease improved significantly. A total of 777 cases with TA involving pulmonary arteries were reported, from which 13 cases with involvement of pulmonary parenchyma were described. Therefore total 16 cases including the 3 cases in this article were included for analysis. Twelve cases showed patchy or wedge-shaped ground-glass opacity and consolidation, and peripheral lung stripes remained after being absorbed. Two cases showed pleural effusion, and 4 cases showed cavities, 3 cases were misdiagnosed as pulmonary tuberculosis, 7 as pulmonary infection, and 5 as pulmonary thromboembolism. Conclusions: TA with pulmonary arteries involved is susceptible to be misdiagnosed and missed, and therefore, in patients with cough, hemoptysis, chest pain and cavities in pulmonary parenchyma, TA should be suspected. Early diagnosis and appropriate treatment can lead to a better prognosis.

Dicer regulates Nosema ceranae proliferation in honeybees

Nosema ceranae is a microsporidian parasite that infects the honeybee midgut epithelium. The protein-coding gene Dicer is lost in most microsporidian genomes but is present in N. ceranae. By feeding infected honeybees with small interfering RNA targeting the N. ceranae gene coding Dicer (siRNA-Dicer), we found that N. ceranae spore loads were significantly reduced. In addition, over 10% of total parasite protein-coding genes showed significantly divergent expression profiles after siRNA-Dicer treatment. Parasite genes for cell proliferation, ABC transporters and hexokinase were downregulated at 3 days postinfection, a key point in the middle of parasite replication cycles. In addition, genes involved in metabolic pathways of honeybees and N. ceranae showed significant co-expression. Furthermore, the siRNA-Dicer treatment partly reversed the expression patterns of honeybee genes. The honeybee gene mucin-2-like showed significantly upregulation in the siRNA-Dicer group compared with the infection group continually at 4, 5 and 6 days postinfection, suggesting that the siRNA-Dicer feeding promoted the strength of the mucus barrier resulted from interrupted parasite proliferation. As the gene Dicer broadly regulates N. ceranae proliferation and honeybee metabolism, our data suggest the RNA interference pathway is an important infection strategy for N. ceranae.

[Clinical research on surgical treatment of benign lesions in maxillary sinus by modified prelacrimal duct recess approach]

Objective:To explore the clinical effects, surgical procedure and indications of surgical treatment for benign lesions in maxillary sinus through modified prelacrimal duct recess approach. Method:All 21 patients in this study who diagnosed with benign lesions in maxillary sinus, received routine preoperational exam and underwent endoscopic maxillary sinus surgery through modified prelacrimal duct recess approach. Postoperatively patients received routine medical treatment, and regular follow-up for average 11.3 months(from 3 months to 16 months). Result:Among 21 patients, there were 9 cases diagnosed with maxillary sinus cyst, 6 cases diagnosed with maxillary sinus choanal polyps, and 5 cases diagnosed with maxillary sinus hemorrhagic and necrotic polyps, 1 case of maxillary sinus root cyst. During the operation, the roots of maxillary sinus cyst or polyps were found in anterior or inferior wall of maxillary sinus. All patients recovered very well without recurrence. Conclusion:Modified prelacrimal duct recess approach appears to be a safe and effective method to resect benign lesions in the maxillary sinus, especially when lesions involved in anterior and inferior wall of the maxillary sinus.

[Analysis of imaging features and treatment strategies of unilateral maxillary sinus and nasal diseases]

Objective: To analyze the imaging features of unilateral maxillary sinus nasal lesions and the selection of treatment strategies based on imaging findings for these lesions. Method: The CT and enhanced MRI data of 64 cases of unilateral maxillary sinus and nasal lesions were selected. The imaging findings and surgery approach were observed and recorded. To summarize the imaging characteristics and analyze the choice of treatment strategy. Result: All 64 Unilateral maxillary sinus nasal lesions presented a roughly uniform soft tissue density shadow on CT. In all benign lesions, there were 9 cases manifested maxillary sinus wall bone destruction and bone discontinuity(18.4%,9/49); There were 17 cases of bone hyperplasia (34.7%,17/49).Bone destruction was observed in 14 cases of all malignant lesions (93.3%, 14/15). The appearance is approximately uniform signal shadow on MRI T1WI images. The lesions with different properties of the enhanced T1 images showed the imaging manifestations with their own characteristics. According to the CT and enhanced MRI images, the designed treatment plan was divided into 5 types. The coincidence rate of operation and plan was 90.5%,there were 4 cases of temporary modification in operation. Conclusion: For unilateral lesions, preoperative enhanced MRI and CT scan should be included as routine examination. CT is clear for bone observation, and can be the nature of tumor and germinal center. Enhanced MRI can provide more accurate information on the lesion scope, blood supply and the relationship between mass and surrounding tissues. Combined with the preoperative imaging data, it can provide the basis for the operation plan and treatment strategy of unilateral lesions.

[The expression and prognostic significance of microRNA-34a in Uygur and Han patients with chronic lymphocytic leukemia in Xinjiang Uygur Autonomous Region in China]

To investigate the expression of microRNA-34a (miR-34a) in patients with chronic lymphocytic leukemia (CLL) in Xinjiang Uygur and Han nationalities and its prognostic significance. Our data showed that miR-34a expression in Uygur and Han CLL patients was significantly higher than that in their respective healthy controls, while miR-34a levels were similar between Uygur and Han patients. By comparing with known prognostic factors, receiver operating characteristic (ROC) curves showed that miR-34a was a good predictive factor for the prognosis of CLL (demarcation value was 3.567 6). Survival analysis was further performed according to miR-34a expression level, that low expression of miR-34a translated into poor prognosis.

[Clinical application of modified global osteitis score in chronic rhinosinusitis]

Objective:To compare GOSS and a newly proposed modified scoring system for assessment of CRS with osteitis.Method:Seventy-one CRS patients were enrolled prospectively.Their preoperative computed tomography (CT) were assessed for severity and extent of osteitis by two otolaryngologists using OsiriX DICOM Viewer software. The method of measurement was similar with GOSS, which retained scoring maxillary and sphenoid, producing a modified global osteitis score(rang: 0-20). Collected the history and completed VAS, SNOT-22, Lund-Kennedy, Lund-Mackay in preoperative. Postoperative follow-up mounted up to 12 months and evaluating CRS patients' outcome. Compared for test-retest and inter-rater reliability between the modified system and GOSS.Result:There is a significant linear positive correlation between Modified GOSS score and GOSS(r=0.913,P<0.001).And Modified GOSS had more association with pre and postoperative L-M and L-K scores than GOSS (r=0.316, 0.357). The modified GOSS showed the highest inter-rater and test-retest, interclass correlation coefficient (pre-ICC=0.947; post-ICC=0.943).Conclusion:Modified GOSS may be a more suitable and convenient scoring system for clinical practice to grading osteitis.

[Relevant molecular characteristics analysis on malignant transformation of interstitial cells induced by tumor stem cells in glioma microenvironment]

Objective: A variety of interstitial cells in tumor microenvironment (TME) based on glioma stem cells(GSC) have the function to promote malignant progression of tumors, but whether these interstitial cells have already undergone malignant transformation and their related molecular characteristics are still poorly understood. Methods: Human SU3-RFP glioma stem cells (GSC) stably transfected with red fluorescent protein (RFP) and interstitial cells from enhanced green fluorescent protein (EGFP) transgenic nude mice were co-cultured in vitro. SU3-RFP cells were also inoculated in different tissues of EGFP-Balb/c nude mice. Immortal EGFP(+) cells were monocloned either from co-culture cells in vitro, or from their xenografts in vivo. These immortal EGFP(+) cells were confirmed to bear characteristics of tumor cell via chromosomal analysis and tumorigenicity assay. Related molecular phenotypes of these cells were further detected through RT-PCR, flow cytometry and immunochemistry(IHC) techniques. Results: (1) Two EGFP(+) cell lines were obtained in vitro, and 5 EGFP(+) cell lines were obtained in vivo tumorigenic experiments. Seven EGFP(+) cell lines all have characteristics of self-renewal, heteroploid of chromosomes and 100% tumorigenicity. (2) Cell surface marker analysis showed cell origin of these cell lines were macrophages (tMΦ1 and tMΦ2 ), dendritic cells (tDC1 and tDC2), fibroblasts (tFB), oligodendrocytes (tOG) and BMSC cells (tBMSC), respectively. (3)All of these seven cell lines co-expressed Sca-1 and c-myc, and have Sox-2 or Nanog expression also, which suggest that they may bear molecular characteristics of mesenchymal stem cells or pluripotent stem cells. Conclusions: (1) Tumor stromal cells in TME have undergone malignant transformation, which is related to the tissue remodeling of TME by GSCs, and not limit to the specific type of their parasitic tissues. (2) Tumor cells originated from GSC and tumor interstitial cells, respectively, are two major types of tumor cells with different origins in glioma parenchyma, can not be simply regarded as tumor heterogeneity, transformed interstitial cells of TME may have the potential to serve as new targets for target diagnosis and therapy.

A Descriptive Review of the Community-Based Cervical Cancer Screening Programme at the Singapore Cancer Society

Background: Cervical cancer is the fourth common malignancy in women worldwide and clinical Papanicolaou (Pap) smear test is a relatively inexpensive yet efficacious screening method for the detection of precancerous or cancerous lesions. Aim: Herein, we sought to quantify the incidence and prevalence of abnormal cervical cytology in asymptomatic women who underwent routine Papanicolaou test screening at the community-based clinical setting of our Singapore Cancer Society's Multi-Service Centre. Methods: This retrospective study reviewed a total of 15,195 reports of cervical Pap smears performed from January 2015 to December 2017 to delineate epithelial abnormalities. Additionally, a descriptive cross-sectional analysis was carried out on the corroborative demographic and clinical data retrieved from the relevant case notes. Results: The mean age of women recruited for screening in this period was 49.0 ± 11.1 years. A total of 623 (4.1%) were identified with abnormal Papanicolaou test results viz., i. atypical squamous/glandular cells of undetermined significance (n=592; 3.9%), ii. low/high grade squamous intraepithelial lesions (n=28; 0.18%) and iii. high grade squamous intraepithelial lesion, suspicious of squamous cell carcinoma/adenocarcinoma (n=3; 0.02%). Clinical history in the latter two cohorts (n=31; 0.2%) revealed first sexual encounter at age ≤ 20 years (54.8%), ≥ 2 sexual partners (38.7%) or abnormal vaginal discharge (29.0%). An 80.6% and 6.5% had undergone Papanicolaou test or HPV - human papillomavirus - vaccination in the past. History of smoking, long-term contraceptive use and treatment of STI(s) were reported by 22.6%, 3.2% and 6.5% respectively. Conclusion: Cervical cancer originates in the transformation zone of the uterine cervix and screening for abnormal cytology is the cornerstone in early detection. The low percentage of epithelial cell abnormality identified in this large population sampling over three years confirms that routine Papanicolaou test testing would suffice as a cost-effective screening approach to detect precancerous cervical lesions. Where imperative, necessary follow-up on unsatisfactory Papanicolaou test result(s), HPV genotyping and/or due referral procedures would significantly aid in reducing the cervical cancer burden for women in the susceptible age range.

Development of broad-band high-reflectivity multilayer film for positron emission tomography system

The use of non-ideal reflective materials and low-precision manual manufacturing technologies is a fundamental technical obstacle blocking the positron emission tomography (PET) systems from achieving better performances. We propose to address that long-standing obstacle with advanced multilayer dielectric coating technologies. We designed an broad-band multilayer high-reflectivity (HR) film that can be coated directly on the surface of ultra-precision polished lutetiumyttrium oxyorthosilicate (LYSO) scintillators. The film consists of 48 layers of TiO2/SiO2/HfO2 which are deposited on LYSO scintillator crystal alternately using the electron beam evaporation method. The overall thickness of the HR film is about 3μm. The HR film combines 3 quarter wavelength reflective films, with the central wavelengths of 365 nm, 430 nm and 570 nm respectively, to match the emission spectrum of the LYSO scintillator. The optical experimental results show that the HR film achieved an excellent average reflectivity of 99.50% at 8° incident angle for incident lights with wavelengths between 360 to 620 nm. The average reflectivity at 60° incident angle is higher than 90%. The results of the hardness experiments and the adhesive strength experiments show that the HR film has an excellent mechanical strength. The HR coating technology developed in this study is very attractive because it allows to "print" high-performance reflectors on a scintillator directly with high-precision, instead of manually gluing reflective films on the scintillator. Thus, we conclude that the HR film provides a viable solution to the long standing technical bottleneck that limits the development of high-performance detectors for advanced PET imaging.

Expression of IL-17A, E, and F and their receptors in non-small-cell lung cancer

Lung cancer is the leading cause of cancer-related morbidity and mortality worldwide. Interaction of nascent or established lung tumour cells with various cytokines and infiltrating immune cells has been implicated in lung cancer pathogenesis. In this study, we systematically analysed immunoreactivity for IL-17A, IL-17E and IL-17F and their relevant receptors in the lung sections from non-small cell lung cancer (NSCLC) and normal control. Immunoreactivity for IL-17A, IL-17F, IL-17RA and IL- 17RC, but not IL-17RB was significantly elevated in NSCLC compared with controls, while IL-17E was reduced. The median numbers of infiltrating lymphocytes and neutrophils and global macrophage (CD68) immunoreactivity of phagocytes were also elevated in NSCLC compared with control tissue sections. Furthermore, correlation between the expression of IL-17A and its receptors IL-17RA and IL- 17RC varied according to NSCLC histopathological type. These data suggest that IL-17A, E, F and their receptors IL-17RA, RB, RC may be involved in the pathogenesis of NSCLC. Further understanding of the relationship between the IL-17/IL-17R axis and the tumour inflammatory microenvironment may reveal new therapeutic targets.

[Analysis of clinical characteristics and prognosis of neuromyelitis optic spectrum disease complicated with malignant tumor]

Objective: To investigate the clinical features of patients involved with both malignant tumors and neuromyelitis optica spectrum disorders (NMOSD). Methods: The clinical data of 473 patients with NMOSD admitted into the Third Affiliated Hospital of Sun Yat-sen University and the Department of Neurology, Affiliated Hospital of Guizhou Medical University from June 2012 to March 2017 were retrospectively analyzed. Eleven NMOSD patients complicated with malignant tumors were screened out (3 with breast cancer, 2 with cervical cancer, 2 with rectal cancer, 2 with leukemia, 1 with nasopharyngeal carcinoma, 1 with thyroid cancer). Fifty patients without NMOSD were included as controls. Results: Most of the NMOSD patients were complicated by low-moderately differentiated squamous cell carcinoma/adenocarcinoma, mainly seen in breast, reproductive system, digestive system and hematological system. In terms of sex ratio and autoantibodies, the NMOSD patients with and without malignant tumors showed no significant difference. However, comparing to the patients without malignant tumor, the ones with malignant tumor showed a tendency of lower rate of initial brain symptoms and relapse rate, while with older onset age, higher initial EDSS score, protein content in cerebrospinal fluid (CSF), higher rates of initial symptom resulted from the focus of posterior region of the medulla and of significant image focus. Of the 8 NMOSD patients who diagnosed as malignant tumors in our hospital, 2 with breast cancer and 1 with cervical cancer had a good prognosis (follow-up EDSS score <3). All the 3 patients received aggressive surgery and chemotherapy treatment. However, the other 5 patients had poor prognosis (follow-up EDSS score ≥3 points). All the 11 patients received anti-tumor therapy, 4 patients had first NMOSD attack after anti-tumor treatment and no relapse. Only one case from the remaining 7 patients had relapse; Among the 9 patients received immunosuppressive therapy, 7 patients had no relapse, and 8 cases maintained stable; while, among all the 9 patients received immunosuppressive agents and anti-tumor therapy, only one case had relapse. Conclusions: There are some differences in the clinical features between the NMOSD patients with malignant tumors and the NMOSD patients without malignant tumors. Immunosuppressive therapy can improve the prognosis of patients with NMOSD and tumor, without increasing the risk of malignant tumor. The pathological type, staging and antitumor therapy may influence the prognosis of NMOSD. NMOSD patients with malignant tumor could be treated with anti-tumor and immunosuppressive agents if needed.

IL-27 regulates HIF-1α-mediated VEGFA response in macrophages of diabetic retinopathy patients and healthy individuals

Human macrophages produce vascular endothelial growth factor A (VEGFA) for angiogenesis in diabetic retinopathy (DR). The regulatory function of IL-27 on human macrophages is not well understood. In particular, the effect of IL-27 on VEGFA response in human macrophages has not been investigated. We find that IL-27 suppresses VEGFA mRNA expression as well as protein secretion by human macrophages. The synergistic action of purinergic signaling and activation of hypoxia-inducible factor 1 alpha (HIF-1α) induces VEGFA production in a positive feedback loop. IL-27 signaling in human macrophages disrupts this positive feedback loop thus suppresses VEGFA production. Blockade of IL-27 signaling with a JAK2 antagonist reverses this downregulatory effect on HIF-1α and partially blocks the inhibitory effect on VEGFA production. Lastly, DR patient macrophages have a higher propensity to produce VEGFA and this is amplified by an in vitro challenge with the pro-inflammatory cytokine IL-1β. IL-27 suppresses VEGFA production by DR patient macrophages even in the presence of IL-1β challenge indicating a potential therapeutic use of IL-27 in the clinic.

Methotrexate restores the function of peripheral blood regulatory T cells in psoriasis vulgaris via the CD73/AMPK/mTOR pathway

BACKGROUND

Methotrexate (MTX) is used to treat psoriasis, a chronic inflammatory skin disease.

OBJECTIVES

To investigate the molecular mechanism of MTX in the treatment of psoriasis.

METHODS

Regulatory T cells (Tregs) and effector T (Teff) cells were isolated from the blood of patients with psoriasis and healthy controls. The proliferation of Teff cells was detected by carboxyfluorescein succinimidyl ester assay. The interferon (IFN)-γ and interleukin (IL)-17 levels were analysed by enzyme-linked immunosorbent assay. The expression of CD73 and FoxP3 were determined by flow cytometry. The expression of proteins in the AMPK/mTOR pathway were detected by Western blot analysis.

RESULTS

The data suggested that patients with psoriasis have Tregs with decreased immune suppression function and reduced expression of CD73 compared with healthy controls. Moreover, MTX could significantly restore the immunosuppressive function of IL-17-secreting Tregs. This, in turn, inhibits aberrant proliferation of Teff cells in patients with psoriasis, reverses downregulation of CD73, upregulates phosphorylated AMPK and inhibits phosphorylated mTOR, and downregulates IL-17 and IFN-γ levels.

CONCLUSIONS

We speculate that MTX can restore the immunosuppressive function of Tregs through upregulating CD73, activating AMPK and inactivating the mTOR pathway. These findings may partly explain the mechanism by which MTX treats psoriasis.

[Management of blood pressure in acute ischemic stroke: a meta-analysis]

Objective: We are aiming at conducting a meta-analysis of the literature to elucidate the efficacy and safety of anti-hypertension therapy in acute stage of ischemic stroke (AIS). Methods: Researches on the efficacy and safety of anti-hypertension therapy published on PubMed before 1st September 2017 were independently retrieved by two authors.Clinical benign prognosis and death measured as modified Rankin Scale (mRS) ≤2 and mRS=6 were taken as primary indicators of efficacy and safety, respectively.A meta-analysis of included randomized controlled trials (RCTs) was performed by RevMan 5.3 software, with funnel plot evaluating the publication bias.A systemic literature review was also made to illustrate the management of blood pressure in AIS. Results: Altogether 13 papers were included in the meta-analysis, among which 12 researches (including 7 596 versus 7 503 cases in the treatment and control group, respectively) based meta-analysis showed that anti-hypertensive therapy initiated within 72 h in AIS did not increase the rate of clinical benign prognosis (OR=1.01, 95%CI 0.94-1.08, P=0.79), and 11 studies (including 7 503 versus 7 369 cases in the treatment and control group, respectively) based analysis suggested there was no significant difference in mortality between the two groups (OR=1.03, 95%CI 0.92-1.15, P=0.59). No significant publication bias for the included studies was showed in the funnel plots. Conclusions: Despite a relative safe profile of anti-hypertensive therapy for AIS, the overall therapeutic efficacy was not improved.The efficacy of anti-hypertensive therapy may be associated with the status of recanalization of blood vessels, further researches are needed to validate the efficacy of anti-hypertension therapy in certain subgroups of IS.

[Efficacy and safety of mycophenolate mofetil in treating neuromyelitis optica spectrum disorder: a multicenter, prospective, self-control study in Guangzhou City]

Objective: To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in neuromyelitis optica spectrum disorder (NMOSD). Method: From September 2014 to February 2017, NMOSD patients with seropositive aquaporin4-IgG was enrolled through a multicenter, prospective study, and the annual recurrence rate (ARR), Expanded Disability Status Scale (EDSS) and MMF-related side effects before and after MMF treatment were compared. Results: Ninety patients were enrolled in the study. After being treated for a median of 12 months (1-30 months), the median ARR decreased from 1.1 pre-MMF to 0 post-MMF (P<0.001), and the median EDSS score decreased from 4.0 pre-MMF to 3.0 post-MMF (P<0.001). The EDSS score reduced significantly after 90 days' treatment (P<0.05). The main adverse events included the deranged liver enzymes (19%, 17/90), respiratory infection (11%, 10/90), urinary tract infection (6%, 5/90), varicella-zoster infection (6%, 5/90), anemia (6%, 5/90), leucopenia (6%, 5/90), diarrhea (2%, 2/90), hair loss (1%, 1/90); 11% (10/90) patients experienced severe adverse events, and 6% (5/90) patients discontinued MMF. Conclusions: MMF could significantly reduce the ARR and EDSS score of NMOSD. However, awareness on side effects should be raised.

[Clinical research of different characteristics of fungal ball sinusitis]

Objective:The aim of this study is to investigate the clinical features of different subtypes of fungal ball sinusitis. Method:Four hundred and forty-nine cases with fungal ball rhinosinusitis (FBS) were involved in this retrospective analysis. The clinical features including symptoms, signs, and imaging scans, pathological results were all collected for each patient and the patients were classified into different subtypes according to these clinical features and the follow-up treatment. Result:In this retrospective study, 449 patients who diagnosed with fungal ball sinusitis were involved. According to clinical features, these patients were divided into 5 subtypes respectively: ①Subtype 1 simple FBS: there were 299 patients in this subtype. Main symptoms were one side headache, purulent rhinorrhea, nasal obstruction. CT scans showed the classical features of FBS. ②Subtype 2 FBS with nasal polyps: there were 78 patients in this subtype. Main symptoms were bilateral or unilateral nasal obstruction, purulent rhinorrhea. Histopathologic results showed nasal polyps with acute or chronic inflammation by inflammatory cell infiltration. Eosinophils infiltration was the most common phenomenon. Postoperative therapy was as same as the treatment to chronic rhinosinusitis. ③Subtype 3 FBS with allergic rhinitis:there were 51 patients in this subtype. During the operation, infected nasal sinus mucosa with serious edema could be found, often with asubmucosa cyst. Postoperative medical therapy with antihistamines during follow-up. ④Subtype 4 FBS with purulent cyst: there were 6 cases. Main symptoms were nasal obstruction, purulent rhinorrhea and facial pain. Sinus CT scans showed that the typical features of both fungal ball sinusitis and mucous cyst. Antibiotic saline nasal irrigation should be used intraoperatively and postoperatively, other than systemic antibiotic treatment. ⑤Subtype 5 mixed type: there were 15 cases. All of these patients were diagnosed with fungal ball sinusitis with nasal polyps combined with allergic rhinitis. The clinical features of diagnosis and treatment were combination of the two types. Conclusion:According to the different clinical features, fungal ball sinusitis could be classified with five different clinical features. This classification would help to standardize the treatment, reduce the postoperative recurrence rate, and improve the prognosis.

Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter: A Multicenter, Randomized, Controlled Clinical Trial (PARAT)

BACKGROUND AND PURPOSE

Although flow diverters have been reported with favorable clinical and angiographic outcomes in various literatures, randomized trials determining their true effectiveness and safety are still in lack. The Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter (PARAT) trial was designed to evaluate the safety and efficacy of the Tubridge flow diverter in the treatment of large or giant aneurysms in comparison with Enterprise stent-assisted coiling.

MATERIALS AND METHODS

This prospective, multicenter, randomized trial was conducted at 12 hospitals throughout China. Enrolled adults with unruptured large/giant intracranial aneurysms were randomly assigned (1:1) to receive either Enterprise stent-assisted coiling or Tubridge flow diverter implantation. The primary end point was complete occlusion at 6-month follow-up, while secondary end points included technical success, mortality, target vessel-related stroke, aneurysm bleeding, in-stent stenosis, parent artery occlusion, and the frequency of all adverse events.

RESULTS

Among 185 enrolled subjects, 41 withdrew before procedure initiation. Overall, 82 subjects underwent Tubridge implantation, and 62 subjects were primarily treated with stent-assisted coiling. The results of 6-month follow-up imaging included complete occlusion rates of 75.34% versus 24.53% for the Tubridge and stent-assisted coiling groups, respectively, with a calculated common odds ratio of 9.4 (95% confidence interval, 4.14-21.38; P < .001). There was a higher, nonsignificant frequency of complications for Tubridge subjects. Multivariate analysis showed a decreased stroke rate at the primary investigational site, with a marginal P value (P = .051).

CONCLUSIONS

This trial showed an obviously higher rate of large and giant aneurysm obliteration with the Tubridge FD over Enterprise stent-assisted coiling. However, this higher obliteration rate came at the cost of a nonsignificantly higher rate of complications. Investigational site comparisons suggested that a learning curve for flow-diverter implantation should be recognized and factored into trial designs.

[Stratified sampling survey of major human parasitic diseases in Henan province]

Objective: To understand the prevalence of major human parasitic diseases and related factors in Henan province. Methods: This stratified sampling survey was carried out according to the requirement of national survey protocol of major human parasitic diseases, 2014-2015. The prevalence of soil-transmitted helminths infection, taeniasis and intestinal protozoiasis were surveyed in 104 sites selected from 35 counties (districts) and the prevalence of clonorchiasis was surveyed in 62 sites selected from 37 townships. In each survey spot, 250 persons were surveyed. A total of 26 866 persons and 15 893 persons were surveyed. Modified Kato-Katz thick smear was used to detect the eggs of intestinal helminthes. Tube fecal culture was used to identify the species of hookworm. The Enterobius eggs were detected in children aged 3 to 6 years by using adhesive tape. The cyst and trophozoite of intestinal protozoa were examined with physiological saline direct smear method and iodine stain method. Results: The overall infestation rate of intestinal parasites was2.02% in Henan, and the worm infection rate was higher than protozoa infection rate. Fourteen kinds of intestinal parasites were found, including nematode (5 species), trematode (2 species), and protozoan (7 species). The infection rate of Enterobius vermicularis was highest, and Qinba Mountain ecological area had the highest infestation rate of intestinal parasites in 4 ecological areas of Henan. There was no significant difference in intestinal parasite infection rate between males and females (χ(2)=3.630, P=0.057), and the differences in intestinal parasite infection rate among different age groups had significance (χ(2)=124.783, P=0.000 1). The infection rate reached the peak in age group ≤9 years and the major parasite was Enterobius vermicularis. Furthermore the overall human infection rate of parasite showed a downward trend with the increase of educational level of the people (χ(2)=70.969, P=0.000 1), the differences had significance (χ(2)=120.118, P=0.000 1). For different populations, the infection rate of intestinal parasites was highest among preschool children. The infection of intestinal helminth was mainly mild, only 2 severe cases were detected. The infection rate of Clonorchis sinensis in urban residents was only 0.006%. Logistic regression analysis showed that being preschool children (χ(2)=15.765, P=0.000 1) and drinking well water (χ(2)=45.589, P=0.000 1) were the risk factors for intestinal parasite infection, and annual income per capita of farmers was the protective factor against intestinal parasite infection. The infection rates of protozoa and intestinal parasites decreased sharply compared with the results of previous two surveys, and the rate of intestinal helminth infection also dropped sharply compared with the second survey. The numbers of protozoa, helminth and intestinal parasites detected in this survey were all less than the numbers found in the previous two surveys. Conclusions: Compared the results of three surveys in Henan, the infection rate of protozoa and intestinal parasites showed a downward trend. The prevention and treatment of Enterobius vermicularis infection in children should be the key point of parasitic disease control in the future.

[Blocking effects of serum antibodies against HBGA binding to norovirus GII.4 of population in oyster culture area of Guangdong Province]

Objective: Evaluate GII.4 norovirus infection and blocking effects of serum antibodies against HBGAs binding to GII.4 norovirus of population in oyster culture area, provide references for screening of fully human monoclonal antibody. Methods: Using a random survey method to collect blood and saliva samples in oyster culture area, select serum samples from the inland region of Guangdong as control group. Identification of salivary HBGA receptor phenotype and detection of serum antibody levels between two areas by ELISA. A vitro neutralization model was to determine the efficiency of serum antibodies blocking GII.4 norovirus and HBGA receptors binding. Results: The age were (50.68 ± 15.17), (52.52 ± 15.90) and (51.37 ± 13.32) years old of 2015, 2016 in experimental group, and in control group, respectively. Males accounted for 5.9% (70/195), 36.6%(60/164), 40.8% (69/169) (χ(2)=0.93, P=0.334). The mean value of serum antibodies Absorbance value was 2.521±0.05 of 2015 and was 2.583±0.045 of 2016 in oyster culture area, the mean value was 2.249±0.05 in control group, there was a statistical difference among three group (F=13.28, P<0.001). The antibody prevalence in the three groups was 100%. BT50 geometric mean titer (GMT) of oyster culture area in 2015 was 423.1±40.11, culture group was 248.2±25.63, there was a statistical difference (t=3.73, P<0.001). Conclusion: The population in oyster culture area does have more chance of exposure and infection GII.4 norovirus, Serum antibody of blocking ability in oyster culture areas is better than the general population in inland city. Suggesting that the population is more immunity resistant infected GII.4 norovirus.

The viable circulating tumor cells with cancer stem cells feature, where is the way out?

With cancer stem cells (CSCs) became the research hotspot, emerging studies attempt to reveal the functions of these special subsets in tumorigenesis. Although various approaches have been used in CSCs researches, only a few could really reflect or simulate the microenvironment in vivo. At present, CSCs theories are still difficult to apply for clinical remedy because CSCs subpopulations are always hard to identify and trace. Thus an ideal approach for clinicians and researchers is urgently needed. Circulating tumor cells (CTCs), as the method of noninvasive-liquid biopsy, could be detected in the peripheral blood (PB) from many tumors and even could be treated as procurators for CSCs deeper researches from patient-derived sample. However, CTCs, as a diagnostic marker, also raise much controversy over theirs clinical value. Mechanisms causing CTCs to shed from the tumor have not been fully characterized, thus it is unclear whether CTCs represent the entire makeup of cancer cells in the tumor or only a subset. The heterogeneity of CTCs also caused different clinical outcomes. To overcome these unsolved problems, recently, CTC researches are not just depend on enumerations, whereas those CTC subsets that could expand in vitro may play a pivotal role in the metastatic cascade. Here, we retrospect the CTC developmental history and discourse upon the enrichment of viable CTCs in functional assays, probe the further avenue at the crossroad.

Radiation-Tolerance Assessment of a Redundant Wireless Device

This paper presents a method to evaluate radiation-tolerance without physical tests for a commercial off-the-shelf (COTS)-based monitoring device for high level radiation fields, such as those found in post-accident conditions in a nuclear power plant (NPP). This paper specifically describes the analysis of radiation environment in a severe accident, radiation damages in electronics, and the redundant solution used to prolong the life of the system, as well as the evaluation method for radiation protection and the analysis method of system reliability. As a case study, a wireless monitoring device with redundant and diversified channels is evaluated by using the developed method. The study results and system assessment data show that, under the given radiation condition, performance of the redundant device is more reliable and more robust than those non-redundant devices. The developed redundant wireless monitoring device is therefore able to apply in those conditions (up to 10 M Rad (Si)) during a severe accident in a NPP.

Peripheral Blood Leukocyte Telomere Length Is Associated with Age but Not Renal Function: A Cross-Sectional Follow-Up Study

OBJECTIVES

We aimed to evaluate the relationship between baseline renal function and changes in telomere length in Han Chinese.

METHODS

The telomere restriction fragment (TRF) length of leukocytes in the peripheral blood was measured in healthy volunteers recruited in 2014. The estimated glomerular filtration rate (eGFR) was calculated based on serum creatinine (Scr) and serum cystatin C (CysC)-eGFRcys and eGFRScr-cys through the Cockcroft-Gault formula (eGFRC-G) or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI / eGFRCKD-EPI) equation. The correlation between telomere length changes over time and renal function was analyzed.

RESULTS

Leukocyte TRF lengths were negatively correlated to age (r = -0.393, p < 0.001) and serum CysC (r = -0.180, p < 0.01), while positively associated with eGFRCKD-EPI, eGFRC-G, eGFRcys, and eGFRScr-cys (r = 0.182, 0.122, 0.290, and 0.254 respectively, p < 0.01). The 3-year change of telomere length was 46 bp/years. When adjusted for age, the associations between telomere length changes and baseline, subsequent TRF lengths, and serum CysC were no longer present. No association was observed between TRF length changes and renal function.

CONCLUSION

The rate of telomere length changes was affected by age and baseline telomere length. The telomere length changes might be important markers for aging.

The Hierarchy of Proinflammatory Cytokines in Ocular Inflammation

PURPOSE

The concept of tissue-dependent cytokine hierarchy has been demonstrated in a number of diseases, but it has not been investigated in ophthalmic diseases. Here, we evaluated the functional hierarchy of interleukin-1β (IL-1β), IL-6, IL-17A, and tumor necrosis factor (TNF) in the induction of ocular inflammation.

MATERIALS AND METHODS

We delivered adeno-associated virus (AAV) vectors expressing IL-1β, IL-6, IL-17A, or TNF intravitreally in naïve C57/BL6 mice and compared and contrasted the inflammatory effects in the eye 5 weeks after AAV-mediated gene transfer. We also used an in vitro human system to test the effect of cytokines on barrier function.

RESULTS

We found that IL-1β had the highest ability to initiate ocular inflammation. The continuous overexpression of IL-1β resulted in a significant upregulation of additional proinflammatory mediators in the eye. Using scanning laser ophthalmoscope and optical coherence tomography imaging techniques, we showed that a low dose of AAVIL-1β was sufficient and was as pathogenic as a high dose of TNF in inducing vascular leakage, retinal degeneration, and cellular infiltration. Furthermore, only a marginal increase in IL-1β was enough to cause cellular infiltration, thus confirming the highly pathogenic nature of IL-1β in the eye. Contrary to our expectation, IL-6 or IL-17A had minimal or no effect in the eye. To examine the clinical relevance of our findings, we used an impedance assay to show that IL-1β alone or TNF alone was able to cause primary human retinal endothelial cell barrier dysfunction in vitro. Again, IL-6 alone or IL-17A alone had no effect on barrier function; however, in the presence of IL-1β or TNF, IL-17A but not IL-6 may provide additive proinflammatory effects.

CONCLUSIONS

Our studies demonstrate the existence of a functional hierarchy of proinflammatory cytokines in the eye, and we show that IL-1β is the most pathogenic when it is continuously expressed in the eye.

[Experimental study of glioma stem cell-mediated immune tolerance in tumor microenvironment]

Objective: To investigate the tumor microenvironment of immune tolerance induced by glioma stem cells (GSC). Methods: Human GSC SU3 cells transfected with red fluorescent protein (SU3-RFP) gene were implanted into the brain, subcutis (armpit and foot), liver and abdominal cavity of transgenic green fluorescence protein (GFP) nude mice to establish RFP(+) /GFP(+) dual fluorescence solid tumor model. The re-cultured cells derived from implanted tumor tissues, SU3-RFP cells co-cultured with peritoneal fluid of transgenic GFP nude mice and malignant ascites of tumor-bearing mice were observed by fluorescence microscopy and real-time video image tracing to analyze the microenvironment of immune tolerance mediated by RFP(+) /GFP(+) implanted tumor. Results: Dual fluorescence labeled frozen section showed that all of cells in the tumor microenvironment were GFP(+) , while the pressed tissue-patch showed that the tumor blood vessels exhibited a RFP(+) /GFP(+) double-positioning yellow. In the GFP single fluorescence labeled tumor tissue, all of cells in the microenvironment were green, including tumor edge, necrotic foci and blood vessel. Among them, CD68(+) , F4/80(+) , CD11c(+) , CD11b(+) and CD80(+) cells were observed. In the dual fluorescence labeled co-cultured cells, the phagocytosis and fusion between green host cells and red tumor cells were also observed, and these fusion cells might transfer to the malignant dendritic cells and macrophages. Conclusions: The tumor microenvironment of immune tolerance induced by GSC is not affected by the tissue types of tumor-inoculated sites, and the immune tolerance mediated by inflammatory cells is associated with the inducible malignant transformation, which may be driven by cell fusion.

Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty: a randomised clinical trial

AIMS

The aim of this study was to examine the efficacy and safety of multiple boluses of intravenous (IV) tranexamic acid (TXA) on the hidden blood loss (HBL) and inflammatory response following primary total hip arthroplasty (THA).

PATIENTS AND METHODS

A total of 150 patients were allocated randomly to receive a single bolus of 20 mg/kg IV TXA before the incision (group A), a single bolus followed by a second bolus of 1 g IV-TXA three hours later (group B) or a single bolus followed by two boluses of 1 g IV-TXA three and six hours later (group C). All patients were treated using a standard peri-operative enhanced recovery protocol. Primary outcomes were HBL and the level of haemoglobin (Hb) as well as the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) as markers of inflammation. Secondary outcomes included the length of stay in hospital and the incidence of venous thromboembolism (VTE).

RESULTS

The mean HBL was significantly lower in group C (402.13 ml standard deviation (sd) 225.97) than group A (679.28 ml sd 277.16, p < 0.001) or B (560.62 ml sd 295.22, p = 0.010). The decrease in the level of Hb between the pre-operative baseline and the level on the third post-operative day was 30.82 g/L (sd 6.31 g/L) in group A, 27.16 g/L (sd 6.83) in group B and 21.98 g/L (sd 3.72) in group C. This decrease differed significantly among the three groups (p < 0.01). The mean level of CRP was significantly lower in group C than in the other two groups on the second (p ≤ 0.034) and third post-operative days (p ≤ 0.014). The levels of IL-6 were significantly lower in group C than group A on the first three post-operative days (p = 0.023). The mean length of stay was significantly lower in group C than group A (p = 0.023). No VTE or other adverse events occurred.

CONCLUSION

Multiple boluses of IV-TXA can effectively reduce HBL following primary THA. A regime of three boluses leads to a smaller decrease in the level of Hb, less post-operative inflammation and a shorter length of stay in hospital than a single bolus. Cite this article: Bone Joint J 2017;99-B:1442-9.