Prospective evaluation of first-trimester screening strategy for preterm pre-eclampsia and its clinical applicability in China

OBJECTIVES

To evaluate, in a Chinese population, the performance of a screening strategy for preterm pre-eclampsia (PE) using The Fetal Medicine Foundation (FMF)'s competing-risks model and to explore its clinical applicability in mainland China.

METHODS

This was a prospective, multicenter, observational cohort study including 10 899 women with singleton pregnancy who sought prenatal care at one of 13 hospitals, located in seven cities in mainland China, between 1 December 2017 and 30 December 2019. Mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and maternal serum levels of placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks' gestation were measured and converted into multiples of the median using Chinese reference ranges. Individualized risk for preterm PE was calculated using the FMF algorithm. Prior risk was calculated based on maternal demographic characteristics and obstetric history. We evaluated the efficiency of the screening strategy using various combinations of biomarkers and analyzed its predictive performance for a composite of placenta-associated adverse pregnancy outcomes, including PE, placental abruption, small-for-gestational age (SGA) and preterm birth, at fixed false-positive rates for preterm PE.

RESULTS

We identified 312 pregnancies that developed PE, of which 117 cases were diagnosed as preterm PE (< 37 weeks' gestation). There were 386 pregnancies complicated by severe composite placenta-associated adverse outcome, including preterm PE, 146 cases of severe SGA (birth weight < 3^rd percentile) neonate, 61 cases with placental abruption and 109 cases of early preterm birth < 34 gestational weeks. The triple-marker model containing biomarkers MAP, UtA-PI and PAPP-A achieved, at fixed false-positive rates of 10%, 15% and 20%, detection rates for preterm PE of 65.0%, 72.7% and 76.1%, respectively, and detection rates for severe composite placenta-associated adverse outcome of 34.7%, 41.7% and 46.4%, respectively. Replacing PAPP-A with PlGF or adding PlGF to the model did not improve the performance. Of women screening positive for preterm PE at a fixed 5% false-positive rate, an estimated 30% developed at least one placenta-associated adverse pregnancy outcome, including PE, placental abruption, SGA (birth weight < 10^th percentile) and preterm birth < 37 weeks.

CONCLUSIONS

The FMF competing-risks model for preterm PE was found to be effective in screening a mainland Chinese population. Women who screened positive for preterm PE had increased risk for other placenta-associated pregnancy complications. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Genetic stress-reactivity, sex, and conditioning intensity affect stress-enhanced fear learning

The Stress-Enhanced Fear Learning (SEFL) model of posttraumatic stress disorder (PTSD) reveals increased fear memory in animals exposed to stress prior to contextual fear conditioning (CFC), similar to the increased likelihood of developing PTSD in humans after prior stress. The present study utilized the SEFL model by exposing animals to restraint stress as the first stressor, followed by CFC using foot-shocks with 0.6 mA or 0.8 mA intensity. Adult males and females from the two nearly isogenic rat strains, the genetically more stress-reactive Wistar Kyoto (WKY) More Immobile (WMI), and the less stress-reactive WKY Less Immobile (WLI) were employed. Percent time spent freezing at acquisition and at recall differed between these strains in both prior stress and no stress conditions. The significant correlations between percent freezing at acquisition and at recall suggest that fear memory differences represent a true phenotype related to the stress-reactivity differences between the strains. This assumption is further substantiated by the lack of effect of either conditioning intensity on percent freezing in WLI males, while WMI males were affected by both intensities albeit with opposite directional changes after prior stress. Differences between the sexes in sensitivity to the two conditioning intensities became apparent by the opposite directional and inverse relationship between fear memory and the intensity of conditioning in WMI males and females. The present data also illustrate that although corticosterone (CORT) responses to prior stress are known to be necessary for SEFL, plasma CORT and percent freezing were positively correlated only in the stress less-reactive WLI strain. These differences in baseline fear acquisition, fear memory, and the percent freezing responses to the SEFL paradigm in the two genetically close inbred WMI and WLI strains provide a unique opportunity to study the genetic contribution to the variation in these phenotypes.

[Summary and prospect of early warning models and systems for infectious disease outbreaks]

This paper summarizes the basic principles and models of early warning for infectious disease outbreaks, introduces the early warning systems for infectious disease based on different data sources and their applications, and discusses the application potential of big data and their analysing techniques, which have been studied and used in the prevention and control of COVID-19 pandemic, including internet inquiry, social media, mobile positioning, in the early warning of infectious diseases in order to provide reference for the establishment of an intelligent early warning mechanism and platform for infectious diseases based on multi-source big data.

The impact of tooth colour on the perceptions of age and social judgements

OBJECTIVE

Psychological research has established that the presence of dental anomalies negatively impact social judgements. This study sought to determine the effects of tooth colour on the subjective ratings of social judgements in a group of Caucasian adults.

METHODS

A cross sectional experimental analogue design comprised fifty Caucasian adults: 25 women and 25 men. A total of 54 digitally modified photographs of Caucasian males and females (darkened, natural, whitened teeth) were evaluated. All participants evaluated each of the images on 12 characteristics: popularity, friendliness, social life, success, graduation, happiness, intelligence, perceived age, introversion/extraversion, self-confidence, attractiveness and satisfaction with the tooth shade. Analysis of variance (ANOVA) was used to compare ratings.

RESULTS

Participants associated darkened teeth with poorer subjective ratings, with the highest ratings been given to whitened teeth, and natural teeth being intermediate. These trends were similar across all participant age groups and gender. Further, the gender and age groups of the images had a significant effect on the appraisals. Faces of younger models received higher ratings than the faces of older models and female images were rated higher than the males.

CONCLUSION

In the absence of other information, tooth colour exerts an influence upon the appraisals made in social situations. It appears that whitened tooth appearance is preferred to natural tooth appearance, irrespective of age and gender of the judge. The faces with more whitened dentition are perceived to be younger across all age groups and gender of the judges. Participants dissatisfied with their own tooth shade drew out more stereotypic behaviour.

CLINICAL SIGNIFICANCE STATEMENT

This research used standardised tooth colour as a basis to investigate perceived age and social functioning. As clinicians face daily challenges to achieve patient satisfaction with respect to dental aesthetics, standardizing the colour may enhance the patients' satisfaction. Further, participants dissatisfied with their own tooth shade drew out more stereotypic behaviour. The whitened dentition may impair the psychological well-being of the individuals and is probably a reason for the increasing demand for cosmetic dental procedures. These results may be instructive for the development of a psycho-educational intervention to prevent any unrealistic expectations.

Molecular cloning and characterization of CD63 in common carp infected with koi herpesvirus

CD63 is a member of the four-transmembrane-domain protein superfamily and is the first characterized tetraspanin protein. In the present study, we cloned the common carp (Cyprinus Carpio) CD63 (ccCD63) sequence and found that the ccCD63 ORF contained 711 bp and encoded a protein of 236 amino acids. Homology analysis revealed that the complete ccCD63 sequence had 84.08% amino acid similarity to CD63 of Sinocyclocheilus anshuiensis. Subcellular localization analysis revealed that ccCD63 was localized in the cytoplasm. Quantitative real-time PCR (qRT-PCR) analysis indicated that ccCD63 was expressed in the gill, intestine, liver, spleen, brain and kidney, with higher expression in spleen and brain tissues than in the other examined tissues. After koi herpesvirus (KHV) infection, these tissues exhibited various expression levels of ccCD63. The expression level was the lowest in the liver and highest in the brain; the expression level in the brain was 8.7-fold higher than that in the liver. Furthermore, knockdown of ccCD63 promoted KHV infection. Moreover, ccCD63 was correlated with the regulation of RIG-I/MAVS/TRAF3/TBK1/IRF3 and may be involved in the antiviral response through the RIG-I viral recognition signalling pathway in a TRAF3/TBK1-dependent manner. Taken together, our results suggested that ccCD63 upregulated the interaction of KHV with the host immune system and suppressed the dissemination of KHV.

O33 Outcomes of patients undergoing emergency surgery during the first phase of national lockdown in the United Kingdom due to COVID-19 pandemic: experience at a district general hospital

Introduction

This study aimed to assess the impact of the COVID-19 pandemic on emergency operations during the first phase of lockdown in the United Kingdom, compared to the equivalent population in the same calendar period in 2019.

Method

We retrospectively reviewed patients undergoing surgery in emergency theatres at our district general hospital between March 23rd and May 11th in 2019 and 2020. Data collected included demographics, National Confidential Enquiry into Patient Outcome and Death (NCEPOD) category and procedure. The primary outcome was 90-day post-operative mortality; secondary outcomes included time to intervention and length of inpatient stay.

Result

132 patients (2020) versus 141 (2019) patients were included with no significant difference in age (P = 0.676), sex (P = 0.230), or overall 90-day postoperative mortality (P = 0.196). Notably, time to intervention was faster for NCEPOD code 3 patients in 2020 than 2019 (P = 0.027). Time to intervention in 2020 was longer for those dying within 90 days post-operatively compared to survivors (P = 0.02). There was no difference in length of stay between years, both overall and when comparing subgroups by NCEPOD category or procedures (fractured neck of femur (P = 0.776), laparoscopies (P = 0.866), laparotomies (P = 0.252)), except for upper limb trauma (P = 0.007).

Conclusion

This study is amongst the first describing the general case mix in emergency theatres in the UK. Patient pre-operative characteristics and demographics did not change. Our data confirms patient prioritisation according to NCEPOD recommendations and streamlining of surgical services, with no difference in overall mortality, time to intervention or length of stay compared to 2019.

Take-home Message

At this district general hospital, patients were appropriately prioritised, and our results show adaptation of hospital practice to emerging national guidelines during the first phase of lockdown. A national validation audit assessing morbidity and mortality outcomes for all NCEPOD patients may be facilitate further understanding of risks posed to patients requiring urgent surgery during these unprecedented times.

[A five-year prospective cohort study of HIV/HCV infections in community-related injecting drug users]

Objective: To explore incidences of HIV and HCV infections in injecting drug users (IDUs) in community. Methods: A community-based survey was conducted to recruit 200 HIV sero-negative IDUs for a prospective cohort study based on the local needle and syringe exchange program in Longyang district of Baoshan city, Yunnan province from June 2014 to June 2019, China. Follow-up was carried out every six month to investigate the prevalence of drug use behavior and sexual behavior in IDUs. Blood samples were collected from them to test HIV and HCV serum antibodies. The cohort was opened for recvuitment every year to replenish the cohort to 200 subjects. Results: A total of 231 IDUs were recruited after 5 years of follow-up. Cohort retention rate was 82.0% (164/200) in 5 years. No HIV sero-positive conversion was found during the 5-year study. There were 89 HCV negative IDUs. Totally, 384.6 person years were observed and the HCV sero-positive conversion in this cohort was 0.26 per 100 person-years. Conclusion: It was found that the incidences of HIV and HCV in IDUs in communities of the study area were at low levels, while comprehensive and effective intervention measures are still needed to control HIV and HCV infections in this population.

Comprehensive Analysis of Autophagy-Associated lncRNAs Reveal Potential Prognostic Prediction in Pancreatic Cancer

Pancreatic cancer (PC) is a highly malignant tumor in the digestive system. Both long noncoding RNAs (lncRNAs) and autophagy play vital roles in the development and progress of PC. Here, we constructed a prognostic risk score system based on the expression profile of autophagy-associated lncRNAs for prognostic prediction in PC patients. Firstly, we extracted the expression profile of lncRNA and clinical information from The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) databases. The autophagy-associated genes were from The Human Autophagy Database. Through Cox regression and survival analysis, we screened out seven autophagy-associated lncRNAs and built the risk score system in which the patients with PC were distinguished into high- and low-risk groups in both training and validation datasets. PCA plot displayed distinct discrimination, and risk score system displayed independently predictive value for PC patient survival time by multivariate Cox regression. Then, we built a lncRNA and mRNA co-expression network via Cytoscape and Sankey diagram. Finally, we analyzed the function of lncRNAs in high- and low-risk groups by gene set enrichment analysis (GSEA). The results showed that autophagy and metabolism might make significant effects on PC patients of low-risk groups. Taken together, our study provides a new insight to understand the role of autophagy-associated lncRNAs and finds novel therapeutic and prognostic targets in PC.

COVID-19 pandemic did not affect emergency theatre patient demographic and length of stay in the first phase of UK countrywide lockdown in a district general hospital

INTRODUCTION

We aim to identify any changes in outcome for patients undergoing nonelective surgery at the start of the UK pandemic in our district general hospital. This was a single-centre retrospective cohort review of a UK district general hospital serving a population of over 250,000 people.

METHODS

Participants were all patients undergoing a surgical procedure in the acute theatre list between 23 March to 11 May in both 2019 and 2020. Primary outcome was 90-day postoperative mortality. Secondary outcomes include time to surgical intervention and length of inpatient stay.

RESULTS

A total of 132 patients (2020) versus 141 (2019) patients were included. Although overall 90-day postoperative mortality was higher in 2020 (9.8%) compared with 2019 (5.7%), this difference was not statistically significant (p=0.196). In 2020, eight patients tested positive for COVID-19 either as an inpatient or within 2 weeks of discharge, of whom five patients died. Time to surgical intervention was significantly faster for NCEPOD (National Confidential Enquiry into Patient Outcome and Death) code 3 patients in 2020 than in 2019 (p=0.027). There were no significant differences in mean length of inpatient stay.

CONCLUSIONS

We found that patients were appropriately prioritised using NCEPOD classification, with no statistically significant differences in 90-day postoperative mortality and length of inpatient stay compared with the 2019 period. A study on a larger scale would further elucidate the profile and outcomes of patients requiring acute surgery to generate statistical significance.

[Research status of risk prediction and management of postoperative pancreatic fistula]

Pancreatic fistula is a common complication of pancreatic surgery and also a leading cause of postoperative death. The 2016 International Study Group on Pancreatic Surgery definition and grading criterion of postoperative pancreatic fistula (POPF) is instructive to clinical practice and scientific research. Although the criterion is widely applied, further optimization is required. It has established a variety of risk prediction models, which forwards the early diagnosis of POPF. However, the inconsistency of the criteria and the potential mutual influence of multiple factors hindered the model extrapolation. Moreover, it remains controversial in specific strategies of perioperative nutritional support, surgical methods, postoperative drainage, and somatostatin application in the prevention and treatment of POPF. Thus, more prospective studies are needed to explore safer, more effective and economical POPF prediction and intervention methods.

The Role of Mitochondria in the Chemoresistance of Pancreatic Cancer Cells

The first-line chemotherapies for patients with unresectable pancreatic cancer (PC) are 5-fluorouracil (5-FU) and gemcitabine therapy. However, due to chemoresistance the prognosis of patients with PC has not been significantly improved. Mitochondria are essential organelles in eukaryotes that evolved from aerobic bacteria. In recent years, many studies have shown that mitochondria play important roles in tumorigenesis and may act as chemotherapeutic targets in PC. In addition, according to recent studies, mitochondria may play important roles in the chemoresistance of PC by affecting apoptosis, metabolism, mtDNA metabolism, and mitochondrial dynamics. Interfering with some of these factors in mitochondria may improve the sensitivity of PC cells to chemotherapeutic agents, such as gemcitabine, making mitochondria promising targets for overcoming chemoresistance in PC.

Targeting hypoxic tumor microenvironment in pancreatic cancer

Attributable to its late diagnosis, early metastasis, and poor prognosis, pancreatic cancer remains one of the most lethal diseases worldwide. Unlike other solid tumors, pancreatic cancer harbors ample stromal cells and abundant extracellular matrix but lacks vascularization, resulting in persistent and severe hypoxia within the tumor. Hypoxic microenvironment has extensive effects on biological behaviors or malignant phenotypes of pancreatic cancer, including metabolic reprogramming, cancer stemness, invasion and metastasis, and pathological angiogenesis, which synergistically contribute to development and therapeutic resistance of pancreatic cancer. Through various mechanisms including but not confined to maintenance of redox homeostasis, activation of autophagy, epigenetic regulation, and those induced by hypoxia-inducible factors, intratumoral hypoxia drives the above biological processes in pancreatic cancer. Recognizing the pivotal roles of hypoxia in pancreatic cancer progression and therapies, hypoxia-based antitumoral strategies have been continuously developed over the recent years, some of which have been applied in clinical trials to evaluate their efficacy and safety in combinatory therapies for patients with pancreatic cancer. In this review, we discuss the molecular mechanisms underlying hypoxia-induced aggressive and therapeutically resistant phenotypes in both pancreatic cancerous and stromal cells. Additionally, we focus more on innovative therapies targeting the tumor hypoxic microenvironment itself, which hold great potential to overcome the resistance to chemotherapy and radiotherapy and to enhance antitumor efficacy and reduce toxicity to normal tissues.

Compact Dual-Polarized Vivaldi Antenna with High Gain and High Polarization Purity for GPR Applications

A compact ultra-wideband dual-polarized Vivaldi antenna is proposed for full polarimetric ground-penetrating radar (GPR) applications. A shared-aperture configuration comprising four Vivaldi elements for orthogonal polarizations is designed to reduce the low-end operating frequency and improve the port isolation with a compact antenna size. The directivity of the antenna is enhanced by the oblique position of the radiators and the implementation of a square loop reflector. Experimental results demonstrate that the antenna has very good impedance matching, port isolation, and dual-polarized radiation performance, with low dispersion characteristics across band of interest from 0.4 GHz to 3.0 GHz. GPR measurements with the designed antenna show that the antenna maintains good detection capability even for objects buried in a highly conductive soil.

Identifying key mononuclear Fe species for low-temperature methane oxidation

The direct functionalization of methane into platform chemicals is arguably one of the holy grails in chemistry. The actual active sites for methane activation are intensively debated. By correlating a wide variety of characterization results with catalytic performance data we have been able to identify mononuclear Fe species as the active site in the Fe/ZSM-5 zeolites for the mild oxidation of methane with H₂O₂ at 50 °C. The 0.1% Fe/ZSM-5 catalyst with dominant mononuclear Fe species possess an excellent turnover rate (TOR) of 66 mol_MeOH mol_Fe⁻¹ h⁻¹, approximately 4 times higher compared to the state-of-the-art dimer-containing Fe/ZSM-5 catalysts. Based on a series of advanced in situ spectroscopic studies and ¹H- and ¹³C- nuclear magnetic resonance (NMR), we found that methane activation initially proceeds on the Fe site of mononuclear Fe species. With the aid of adjacent Brønsted acid sites (BAS), methane can be first oxidized to CH₃OOH and CH₃OH, and then subsequently converted into HOCH₂OOH and consecutively into HCOOH. These findings will facilitate the search towards new metal-zeolite combinations for the activation of C–H bonds in various hydrocarbons, for light alkanes and beyond.

The monomeric Fe species in Fe/ZSM-5 have been identified as the intrinsic active sites for the low-temperature methane oxidation.

Novel therapies targeting hypoxia mechanism to treat pancreatic cancer

Pancreatic cancer (PC) is one of the deadliest malignancies. The high mortality rate of PC largely results from delayed diagnosis and early metastasis. Therefore, identifying novel treatment targets for patients with PC is urgently required to improve survival rates. A major barrier to successful treatment of PC is the presence of a hypoxic tumor microenvironment, which is associated with poor prognosis, treatment resistance, increased invasion and metastasis. Recent studies have identified a number of novel molecules and pathways in PC cells that promote cancer cells progression under hypoxic conditions, which may provide new therapy strategies to inhibit the development and metastasis of PC. This review summarizes the latest research of hypoxia in PC and provides an overview of how the current therapies have the capacity to overcome hypoxia and improve PC patient treatment. These findings will eventually provide guidance for future PC management and clinical trials and hopefully improve the survival of patients with PC.

Fragility fracture discriminative ability of radius quantitative ultrasound: a systematic review and meta-analysis

The fragility fracture discriminative ability of radius quantitative ultrasound (QUS) was evaluated in a systematic review of 13 studies, including 16,681 individuals and 1296 fractures. The radial speed of sound (SOS) per standard deviation (SD) decrease contributed to an increased risk of total and hip fracture by 32% and 66% in women. Osteoporotic fracture, as a devastating consequence of osteoporosis, brings severe socio-economic burden. The availability of dual-energy X-ray absorptiometry (DXA), as the gold standard of diagnosis, was quite limited in remote areas. Radius QUS measured by SOS shows potential in fracture discriminative ability where DXA equipment is not available. This study aimed to provide a comprehensive evaluation of the association between radius QUS and fracture risk. A detailed article search was carried out on PubMed, EMBASE, Cochrane Libraries, CNKI, Wan-Fang database, VIP, and SinoMed for studies published between January 1980 and February 2020. We determined the estimated relative risk (RR) for fracture per each radial SOS SD decrease. A meta-analysis of studies was performed under the random-effects model. A total of 16,681 individuals were included in this review. Among the participants, 5892 were male and 10,789 were female. A total of 1296 cases of fragility fracture were included. With each SD decrease in radial SOS, the risk of overall fragility fracture and hip fracture was increased by 21% and 55%, respectively. Particularly, the risk was increased by 32% and 66% for women. The association was even stronger for postmenopausal women. Radius QUS showed great potential as an effective tool for fracture risk evaluation, especially for women.