The true incidence of chromosomal mosaicism after preimplantation genetic testing is much lower than that indicated by trophectoderm biopsy

STUDY QUESTION

What is the true incidence of chromosomal mosaicism in embryos analyzed by preimplantation genetic testing (PGT).

SUMMARY ANSWER

The true incidence of chromosomal mosaicism is much lower than we usually surmise.

WHAT IS KNOWN ALREADY

In recent years, contemporary methods for chromosome analysis, along with the biopsy of more than one cell, have given rise to an increased rate of chromosomal mosaicism detection after preimplantation genetic testing for aneuploidy. However, the exorbitant incidence of mosaicism represents a dilemma and imposes restrictions on the application of PGT treatment. Concern has been raised about the possibility that the incidence of chromosomal mosaicism is overestimated and quite a few of the results are false-positive errors. However, studies verifying the diagnosis of chromosomal mosaicism and assessing the true incidence of chromosomal mosaicism are limited.

STUDY DESIGN, SIZE, DURATION

A total of 1719 blastocysts from 380 patients who underwent PGT treatment were retrospectively analyzed to evaluate the typical incidence of mosaicism. Then 101 embryos donated by 70 couples were re-biopsied and dissected into three portions if available: trophectoderm (TE), inner cell mass (ICM), and the remaining portions. All the portions were tested using next-generation sequencing (NGS), and the results were compared to the original diagnosis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The setting for this study was a university-affiliated center with an in-house PGT laboratory. All samples were amplified with multiple annealing and looping-based amplification cycles (MALBACs) and the NGS was carried out on a Life Technologies Ion Proton platform.

MAIN RESULTS AND THE ROLE OF CHANCE

A clinical TE biopsy revealed an incidence of 11.9% for diploid-aneuploid mosaicism (DAM), 17.3% for aneuploid mosaicism (AM) and 29.1% in total. After rebiopsy, 94.1% whole-chromosome aneuploidies and 82.8% segmental-chromosome aneuploidies were confirmed in the embryos. As for the mosaic errors, only 32 (31.7%) out of 101 embryos presented with uniform chromosomal aberrations in agreement with the original biopsy results, 15 (14.8%) embryos presented with de novo chromosomal aberrations, and 54 (53.5%) embryos showed a euploid profile in all portions. Among the 32 uniform embryos, the true mosaicism was confirmed in only 4 cases, where a reciprocal chromosomal aberration was identified; 14 embryos presented with identical mosaicism, providing the moderate evidence for true mosaicism; and 14 embryos displayed uniform full aneuploidies in all portions of embryo, revealing a high-grade mosaicism or a false-negative diagnosis. Logistical regression analysis revealed that the concordance rate with ICM was associated with the type and level of mosaicism. The concordance rate of segmental-chromosome mosaicism was significantly lower than whole-chromosome mosaicism (adjusted Odds Ratio (aOR): 5.137 (1.061, 24.876), P = 0.042) and compared to DAM, the concordance rate of AM was significantly higher (aOR: 6.546 (1.354, 31.655), P = 0.019). The concordance rate also increased with increasing levels of mosaicism (P < 0.001).

LIMITATIONS, REASONS FOR CAUTION

This study was limited by a small sample size and the use of a single whole-genome amplification (WGA) method and NGS platform. These findings are only applicable to samples subjected to MALBAC amplification and Ion Proton platform, and studies involving larger sample sizes and multiple WGA methods and NGS platforms are required to prove our findings.

WIDER IMPLICATIONS OF THE FINDINGS

TE biopsy is reliable to detect whole-chromosome aneuploidies, but the ability to diagnose mosaicism is doubtful. More attention should be paid to false-positive and false-negative errors in NGS-based PGT, especially for laboratories using less stringent criteria for mosaicism classification (i.e. 20-80%), which might be subject to a much higher false-positive mosaicism rate in the practice.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by grants from the National Key R&D Program of China (No. 2016YFC1000206-5) and the National Natural Science Foundation of China (No. 81701509).

TRIAL REGISTRATION NUMBER

N/A.

[Epidemiological profiles of echinococcosis cases reported in the National Notifiable Disease Report System in non-endemic areas of China from 2004 to 2016]

OBJECTIVE

To investigate the epidemiological profiles of echinococcosis cases reported in non-endemic areas of China in the National Notifiable Disease Report System from 2004 to 2016, so as to provide insights into the development of effective surveillance and response measures.

METHODS

The data pertaining to the echinococcosis cases reported in the National Notifiable Disease Report System in 22 non-endemic provinces of China from 2004 to 2016 were collected, and the epidemiological profiles of the reported echinococcosis cases were descriptively analyzed.

RESULTS

A total of 462 echinococcosis cases were reported in the 22 non-endemic provinces of China from 2004 to 2016, and the number of reported cases increased with time (χ² = 4.516, P = 0.034). During the 13-year period from 2004 to 2016, the highest number of echinococcosis cases was reported in central and eastern China (56.49%), followed by in northern and northeastern China (30.30%), and the highest number of echinococcosis cases was reported in Henan Province (99 cases). Among the 462 echinococcosis cases reported, there were 234 men and 228 women, and the mean age was (41.42 ± 16.03) years (range, 4 to 86 years), with the highest number of echinococcosis cases reported at ages of 20 to 50 years (63.20%). The highest proportion of occupations was farmers and herdsmen (36.15%), and the greatest source was from echinococcosis-endemic provinces (50.43%); in addition, 97.40% of the echinococcosis cases were reported by hospitals.

CONCLUSIONS

Echinococcosis cases were reported in all 22 non-endemic provinces of China in the National Notifiable Disease Report System from 2004 to 2016, and the number of reported cases appeared an overall tendency for sporadicity and local increase with time. Screening of echinococcosis is recommended among famers and herdsmen at ages of 20 to 50 years from endemic regions by medical institutions in non-endemic regions for timely identification and treatment of echinococcosis cases.

Racial residential segregation and economic disparity jointly exacerbate COVID-19 fatality in large American cities

The disproportionately high rates of both infections and deaths among racial and ethnic minorities (especially Blacks and Hispanics) in the United States during the COVID-19 pandemic are consistent with the conclusion that structural inequality can produce lethal consequences. However, the nature of this structural inequality in relation to COVID-19 is poorly understood. Here, we hypothesized that two structural features, racial residential segregation and income inequality, of metropolitan areas in the United States have contributed to health-compromising conditions, which, in turn, have increased COVID-19 fatalities; moreover, that these two features, when combined, may be particularly lethal. To test this hypothesis, we examined the growth rate of confirmed COVID-19 cases and deaths in an early 30-day period of the outbreak in the counties located in each of the 100 largest metropolitan areas in the United States. The growth curves for cases and deaths were steeper in counties located in metropolitan areas where Blacks and Hispanics are residentially segregated from Whites. Moreover, the effect of racial residential segregation was augmented by income inequality within each county. These data strongly suggest that racial and economic disparities have caused a greater death toll during the current pandemic. We draw policy implications for making virus-resilient cities free from such consequences.

[Volume management of hypertension in patients with chronic kidney disease]

Chronic kidney disease (CKD) and hypertension are two closely interlinked public health problems. Kidney is an important organ for regulating blood pressure. Renal lesions may lead to increased blood pressure, and hypertension further accelerates the progression of renal disease, thereby forming a vicious circle which affects the prognosis of patients. Volume overload is an important mechanism in the development of hypertension in patients with CKD. Therefore, more emphasis should be put on volume management of CKD patients with hypertension.

[Progress in the diagnosis and treatment strategies of caries-derived dental pulp diseases]

Caries-derived dental pulp diseases are characterized with high incidence and serious endangerment. Considering the complexity of the pulpal infection and the limitation of the pulp self-repairing capability, it is still an urgent problem that how to eradicate infection and to promote tissue regeneration subsequently for dental clinicians. This review discusses and prospects on the pathogenesis, diagnosis and treatment strategies of caries-derived dental pulp diseases, so as to provid a reference on diagnosis and treatment of such diseases for the clinicians.

[Association of blood lead level with cognition impairment among elderly aged 65 years and older in 9 longevity areas of China]

Objective: To investigate the association between blood lead concentrations and cognition impairment among Chinese older adults aged 65 or over. Method: Data was collected in 9 longevity areas from Heathy Aging and Biomarkers Cohort Study between 2017 and 2018. This study included 1 684 elderly aged 65 years and older. Information about demographic characteristics, socioeconomic factors, health status and cognitive function score of respondents were collected by questionnaire survey and physical examination. Venous blood of the subjects was collected to detect the blood lead concentration. Subjects were stratified into four groups (Q₁-Q₄) by quartile of blood lead concentration. Multivariate logistic regression model was used to analyze the association between blood lead concentration and cognitive impairment. The linear or non-linear association between blood lead concentration and cognitive impairment were described by restrictive cubic splines (RCS). Results: Among the 1 684 respondents, 843 (50.1%) were female and 191 (11.3%) suffered from cognition impairment. After adjusting for confounding factors, the OR value and 95%CI of cognition impairment was 1.05 (1.01-1.10) for every 10 μg/L increase in blood lead concentration in elderly; Compared with the elderly in Q₁, the elderly with higher blood lead concentration had an increased risk of cognitive impairment. The OR value and 95%CI of Q₂, Q₃ and Q₄ groups were 1.19 (0.69-2.05), 1.45 (0.84-2.51) and 1.92 (1.13-3.27), respectively. Conclusion: Higher blood lead concentration is associated with cognitive impairment among the elderly aged 65 years and older in 9 longevity areas in China.

The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies

BACKGROUND

Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice.

OBJECTIVE

We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice.

DESIGN

A systematic review and Meta-analysis of 16 cohort studies.

PARTICIPANTS

Patients with COVID-19.

METHODS

A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects.

RESULTS

According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay.

CONCLUSIONS

In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all- cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.

Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China

AIMS

Coronavirus disease 2019 (COVID-19) pandemic is a major public health concern all over the world. Little is known about the impact of COVID-19 pandemic on mental health in the general population. This study aimed to assess the mental health problems and associated factors among a large sample of college students during the COVID-19 outbreak in China.

METHODS

This cross-sectional and nation-wide survey of college students was conducted in China from 3 to 10 February 2020. A self-administered questionnaire was used to assess psychosocial factors, COVID-19 epidemic related factors and mental health problems. Acute stress, depressive and anxiety symptoms were measured by the Chinese versions of the impact of event scale-6, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Univariate and hierarchical logistic regression analyses were performed to examine factors associated with mental health problems.

RESULTS

Among 821 218 students who participated in the survey, 746 217 (90.9%) were included for the analysis. In total, 414 604 (55.6%) of the students were female. About 45% of the participants had mental health problems. The prevalence rates of probable acute stress, depressive and anxiety symptoms were 34.9%, 21.1% and 11.0%, respectively. COVID-19 epidemic factors that were associated with increased risk of mental health problems were having relatives or friends being infected (adjusted odds ratio = 1.72-2.33). Students with exposure to media coverage of the COVID-19 ≥3 h/day were 2.13 times more likely than students with media exposure <1 h/day to have acute stress symptoms. Individuals with low perceived social support were 4.84-5.98 times more likely than individuals with high perceived social support to have anxiety and depressive symptoms. In addition, senior year and prior mental health problems were also significantly associated with anxiety or/and depressive symptoms.

CONCLUSIONS

In this large-scale survey of college students in China, acute stress, anxiety and depressive symptoms are prevalent during the COVID-19 pandemic. Multiple epidemic and psychosocial factors, such as family members being infected, massive media exposure, low social support, senior year and prior mental health problems were associated with increased risk of mental health problems. Psychosocial support and mental health services should be provided to those students at risk.

The treatment of menopausal symptoms by traditional Chinese medicine in Asian countries

Menopausal symptoms (or climacteric syndrome) refer to a series of symptoms that occur during the perimenopausal and early postmenopausal period. About 80% of women will have various degrees of menopausal symptoms, and most of them need associated treatment. Asian women are more inclined to choose traditional Chinese medicine (TCM) in terms of therapeutic method, and menopausal hormone therapy has low acceptance because the women have been misinformed about the side effects of hormones. Therefore, TCM is used for menopausal symptoms in women in most Asian countries, including China, Japan, Vietnam, and South Korea. In the basic theory of TCM, the menopause is classified as the Kidney deficiency and imbalance of Yin and Yang; therefore, the treatment methods in either Chinese patent medicine or Chinese herbal medicine are aimed at supplementing the Kidney function and rebalancing Yin and Yang. It is believed that TCM treatment is suitable for patients with mild or moderate menopausal symptoms. The incidence rate of adverse reactions in terms of breast tenderness and irregular vaginal bleeding is lower than that of hormone therapy. However, there are few randomized, double-blind, placebo-controlled studies on TCM treatment of menopausal syndrome. Future studies should be undertaken to confirm its merits.

Xiangshao granules can relieve emotional symptoms in menopausal women: a randomized controlled trial

OBJECTIVE

This study aimed to investigate the safety and efficacy of Xiangshao granules for treating emotional disorders in perimenopausal and postmenopausal women.

METHODS

The current investigation was a double-blind, randomized, placebo-controlled, multicenter trial that included 300 perimenopausal and postmenopausal Chinese women aged 40-60 years. Participants received either a placebo (n = 150) or Xiangshao granules (n = 150) for 8 weeks. Outcome measures included Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) scores, which were assessed at baseline, 4 weeks, and 8 weeks. The primary efficacy variables were changes in HAMD and HAMA scores after 8 weeks.

RESULTS

After 8 weeks, the mean HAMD scores decreased from 15.0 to 7.9 in the Xiangshao group and from 16.3 to 10.0 in the placebo group, and the respective mean reductions in HAMA scores were from 16.0 to 8.5 and from 17.1 to 10.9. Clinical improvements in symptoms of both depression and anxiety after 8 weeks differed significantly in the two groups (p < 0.05). The cure rate was significantly higher in the Xiangshao group. There were no significant differences in the rates of adverse events in the two groups.

CONCLUSIONS

Xiangshao granules can relieve symptoms of depression and anxiety significantly and safely.

Betulin attenuates pneumolysin-induced cell injury and DNA damage

AIMS

Pneumolysin, a pore-forming toxin, is an important virulence factor of Streptococcus pneumoniae with multiple biological activity, such as cell lysis and DNA damage. Thus, targeting this toxin is alternative strategy for the treatment of S. pneumoniae infection.

METHODS AND RESULTS

Haemolysin assay was performed to identify the potential PLY inhibitor. The mechanism by which betulin, a natural compound from birch bark, against PLY was determined via MICs determination, western blot analysis and oligomerization analysis. Cytotoxicity and Immunofluorescence assays were further used to evaluate the protection of betulin against PLY-induced cell injury and DNA damage. Here, betulin, a natural compound from birch bark, was indentified as an effective inhibitor of PLY. Importantly, at the concentrations required for such inhibition, betulin has no influence on S. pneumoniae viability or PLY production. The interaction of betulin with PLY restrict the olgomerizaiton of this toxin and, thus, directly neutralizing the activity of PLY. Additionally, betulin treatment alleviate PLY induced cells injury and DNA damage in the co-culture system of PLY and A549 cells.

CONCLUSIONS

Betulin could be used as a promising leading compound against S. pneumoniae virulence by directly targeting PLY without antibacterial activity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results presented in this work provided a novel strategy and candidate for S. pneumoniae infection.

Relational Mobility Predicts Faster Spread of COVID-19: A 39-Country Study

It has become increasingly clear that COVID-19 is transmitted between individuals. It stands to reason that the spread of the virus depends on sociocultural ecologies that facilitate or inhibit social contact. In particular, the community-level tendency to engage with strangers and freely choose friends, called relational mobility, creates increased opportunities to interact with a larger and more variable range of other people. It may therefore be associated with a faster spread of infectious diseases, including COVID-19. Here, we tested this possibility by analyzing growth curves of confirmed cases of and deaths due to COVID-19 in the first 30 days of the outbreaks in 39 countries. We found that growth was significantly accelerated as a function of a country-wise measure of relational mobility. This relationship was robust either with or without a set of control variables, including demographic variables, reporting bias, testing availability, and cultural dimensions of individualism, tightness, and government efficiency. Policy implications are also discussed.

[Experts consensus on MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement]

The document represented the consensus amongst the professionals from the Society of TMD & Occlusion, Chinese Stomatological Association and provided guidelines with the MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement.