Reconstruction and analysis of the aberrant lncRNA-miRNA-mRNA network in systemic lupus erythematosus

OBJECTIVE

A new perspective of determining the pathophysiology of systemic lupus erythematosus (SLE) development is required. The current study explores the aberrant expression of long non-coding RNAs (lncRNA), microRNA (miRNA) and mRNA. The study further constructs and analyses the lncRNA-miRNA-mRNA network to elucidate their gene regulation roles in SLE.

METHOD

We extracted mRNA, lncRNA and miRNA from the whole venous blood of 20 SLE patients and 20 normal control (NC) healthy individuals. A lncRNA-mRNA-miRNA network in SLE was constructed using a bioinformatics approach. Subsequently, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed using the Cytoscape plug-in BinGo, the DAVID database and Cytoscape software to explore the function of mRNAs in this network.

RESULT

A total of 855 mRNA, 7311 lncRNA and 134 miRNA with differentially expressed profiles were identified. Meanwhile, we established a competing endogenous RNA (ceRNA) subnetwork composed of 52 differentially expressed lncRNAs (DElncRNAs), seven differentially expressed miRNAs and 10 differentially expressed mRNAs. We extracted the subnetwork from the ceRNA network and found that three novel miRNAs were key: hsa-miR-145, hsa-miR-17 and hsa-miR-143. We also deduced that the DElncRNAs MIAT and NEAT1 might play crucial roles in the pathogenesis of SLE. The results were verified by bioinformatics analysis.

CONCLUSION

Our results provide a novel perspective for studying lncRNA-related and miRNA-related ceRNA networks in SLE.

[Analysis of mortality relative factors in patients with ventricular septal rupture complicating myocardial infarction]

Objective: To examine the mortality rate and relative factors associate with ventricular septal rupture in myocardial infarction patients. Methods: A total of 51 patients who suffered from myocardial infarction complicating with ventricular septal rupture received operative procedures between January 2005 and December 2018 in Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, were retrospectively analyzed. There were 34 males and 17 females, with an age of (63±8) years (range: 44 to 82 years). The time between ventricular septal rupture and surgical procedure was (44±39) days (range: 3 to 187 days). The t test and χ(2) test were used for univariate analysis, Logistics regression model was used for multivariate analysis of in-hospital mortality relative factors. Results: There were 8 patients dead in hospital, 43 patients survived, the overall mortality rate was 15.7% in hospital. The post-operation mortality rate was 2/3 of who suffered ventricular septal rupture and underwent operation within 1 week, but it's markedly decreased to 6.5% if the time over 4 weeks. Univariate analysis showed that renal failure before operation, creatinine before operation, left ventricular ejection fraction, cardiac function (New York Heart Association) grade Ⅳ, severe tricuspid regurgitation, dialysis post-operation, creatinine of the first day of post-operation, the time between and operation more than 4 weeks were in-hospital mortality relative factors. Multivariate analysis reflected that advanced age (OR=1.32, 95%CI: 1.05 to 1.75, P=0.033), cardiac function grade Ⅳ (OR=2.25, 95%CI: 1.62 to 2.82, P=0.003), severe tricuspid regurgitation (OR= 1.82, 95%CI: 1.31 to 2.43, P=0.001), renal failure before operation (OR=1.78, 95%CI: 1.26 to 2.32, P=0.015), the time between ventricular septal rupture and operation less than 1 week (OR=2.50, 95%CI: 1.52 to 2.98, P=0.012), were independent in-hospital mortality relative factors. Conclusions: The surgery operation is an effective way to deal with ventricular septal rupture combined with myocardial infarction. The independent relative factors of in-hospital mortality are advanced age, cardiac function grade Ⅳ, renal failure before operation, severe tricuspid regurgitation, the time between ventricular septal rupture and operation less than 1 week.

Expression and functions of cellular prion proteins in immunocytes

Prion diseases are fatal neurodegenerative processes caused by the accumulation of the pathological prion protein, PrP^Sc . While pathological lesions are limited to the central nervous system (CNS), disease-specific proteins accumulate and replicate in secondary lymphoid organs prior to neuroinvasion, and their replication there depends on the abundance of cellular prion protein (PrP^C ). PrP^C is expressed in both central and peripheral lymphoid tissues, and up- or downregulates innate and adaptive immune responses. In addition to prion diseases, PrP^C is also immunologically involved in other neurological disorders and infectious diseases, including Alzheimer's disease and human immunodeficiency virus infection. Herein, we summarize the expression and functions of PrP^C in various immunocytes, as well as its immunological and pathological roles in neurodegeneration and infection.

Second-generation Src/Abl inhibitor bosutinib effectively induces apoptosis in human esophageal squamous cell carcinoma (ESCC) cells via inhibiting Src/Abl signaling

Esophageal cancer is a prevalent type of cancer worldwide and is ranked sixth among cancer-associated mortalities. Aberrant activation of the non-receptor tyrosine kinase Src and c-Abl contribute to the progression of ESCC. Thus, targeting these kinases to treat ESCC is a promising strategy. In this paper, we report that the potent dual Src/Abl inhibitor bosutinib exerts anti-tumor effects on ESCC. Bosutinib inhibits ESCC cell proliferation in a dose-dependent manner. Furthermore, bosutinib suppresses the colony formation ability of ESCC cells. Mechanistically, bosutinib effectively inhibits c-Abl and Src and its downstream signaling pathways, PI3K/AKT/mTOR and JAK/STAT3. In addition, bosutinib enhances the cytotoxic effects of doxorubicin on ESCC cells. In summary, our results reveal that Src and Abl are potential therapeutic targets in ESCC and that the novel Src/Abl inhibitor bosutinib alone or in combination with other chemotherapeutic agents may be a viable option for treating ESCC patients.

[Progress of research on host immune responses induced by hookworm infection and its potential therapeutic values]

Hookworm infection remains a global health concern, which threatens human health. Hookworm infection is widely prevalent across the world, notably in tropical and subtropical areas. Recently, with the in-depth study of the immunity of parasitic infections, the"bidirectional effect"of host immune responses induced by helminth infections (including hookworm infections) has become increasingly prominent. On one hand, an immune response is induced in the host to kill the infected worms; on the other hand, the host produces a series of immunological changes that are conducive to the maintenance of parasite survival. The immune state of the host is regulated by various complicated mechanisms, and this may lead to the reduction in the incidence of allergic and autoimmune diseases or alleviation of the disease symptoms, which provide new insights into the management of these allergic and autoimmune diseases. The present article reviewed the advances of host immune responses induced by hook-worm infection and its potential values in the treatment of allergic asthma, inflammatory bowel disease and rheumatoid arthritis.

[Establishment and preliminary evaluation of recombinase aided isothermal amplification (RAA) assay for specific nucleic acid detection of Clonorchis sinensis]

OBJECTIVE

To establish a recombinase aided isothermal amplification (RAA) assay for detection of Clonorchis sinensis.

METHODS

The 18S ribosomal RNA (18S rRNA) sequence of C. sinensis was used as the target sequence, and specific primers and probes were designed, synthesized and screened to establish a rapid fluorescent RAA assay for the detection of C. sinensis. Then, the sensitivity of the fluorescent RAA assay was evaluated using the recombinant plasmids containing various copy numbers of DNA fragments and C. sinensis genomic DNA at various concentrations, and the specificity of the fluorescent RAA as say was evaluated using the genomic DNA of Ascaris lumbricoides, Echinococcus granulosus, Schistosoma japonicum, Ancylostoma duodenale and S. mansoni as templates. DNA samples were extracted from the feces containing C. sinensis eggs and freshwater fish containing metacercaria for the fluorescent RAA assay, and the performance for detection of C. sinensis-infected samples was preliminarily assessed in the field.

RESULTS

A fluorescent RAA assay for detection of C. sinensis was successfully established, which was feasible for specific amplification of C. sinensis genomic DNA at 39 °C within 20 min. The lowest detection limit was 10 copies/μL if the recombinant plasmid containing various copy numbers of DNA fragments was used as a template, and the lowest detection limit was 3 pg/μL if the C. sinensis genomic DNA at various concentrations served as a template. All detections were negative if the genomic DNA of A. lumbricoides, E. granulosus, S. japonicum, A. duodenale, and S. mansoni was used as templates. In addition, the fluorescent RAA assay showed a high performance for the detection of C. sinensis-infected samples in the field, which successfully detected C. sinensis-infected human and rat fecal samples and Pseudorasbora parva samples.

CONCLUSIONS

A fluorescent RAA assay is successfully established, which is simple, rapid, sensitivity and specific for detection of C. sinensis.

Local dermal application of a compound lidocaine cream in pain management of cancer wounds

The aim of this study was to explore the analgesic effect of local application of compound lidocaine/prilocaine cream on cancer wounds during wound care in order to reduce the amount of morphine intake or completely replace the systemic morphine administration and optimize the protocol for cancer wound pain management. All patients were enrolled with a visual analog scale (VAS) pain score ≥4. Before wound care, 60 patients were randomly divided into 2 groups of 30 each: morphine group (10 mg tablet); topical 5% compound lidocaine cream group (0.2 g/cm²). VAS scores, heart rate, and Kolcaba comfort level were recorded for the two groups 10 min before and 10, 15, 20, and 25 min after wound care and data were analyzed statistically. The means for the pain score and heart rate of the topical lidocaine/prilocaine cream group were lower than those of the morphine group (P<0.01) and the Kolcaba comfort level was higher (P<0.01). Local dermal application of the compound lidocaine cream can be used as an alternative to the systemic morphine administration in cancer wound care for its safety and effectiveness. In addition, it can improve the patients' comfort and quality of life.

Wheat-associated microbiota and their correlation with stripe rust reaction

AIMS

This study was aimed at revealing the composition of microbiota in leaves, roots and rhizosphere soil of wheat plants that are resistant or susceptible to stripe rust, one of the most widely destructive leaf diseases in wheat production.

METHODS AND RESULTS

A total of 36 wheat plants that showed resistant or susceptible reactions to stripe rust were sampled. Three compartments of each plant including leaves, roots and rhizosphere soil were used for whole-genomic DNA extraction and the DNA samples were subjected to high-throughput 16S rRNA gene sequencing. A total of 2885 operational taxonomic units (OTUs) were revealed from the sequencing, and they mainly distributed in the phylum of Proteobacteria. Twenty-nine OTUs formed the core microbiota of wheat plants. The differences between above- and below-ground environments could explain most of the dissimilarity of wheat-associated microbial communities. Therefore, those microbes that were able to adapt to the above-ground (leaf) environment might be more important resources for biocontrol agents against stripe rust, and they could be from genera Hymenobacter, Flavobacterium, Chitinophage, Flavisolibacter, Niastella, Mucilaginibacter, Pedobacter, Aquincola, Massilia, Citrobacter, Cronobacter, Ewingella, Acinetobacter and Pseudomonas. No matter the microbial taxa were significantly selected by the resistant or susceptible wheat plants, they contained the members with plant growth promoting (PGP) features and could be used as potential biocontrol agents to reduce stripe rust damage.

CONCLUSIONS

The core microbiota associated with wheat plants and microbial taxa that were significantly correlated with reactions to stripe rust were identified in this study.

SIGNIFICANCE AND IMPACT OF THE STUDY

Few studies had been done on the microbiota associated with wheat so far. Our study will not only provide fundamental knowledge about the composition of wheat-associated microbiota but also reveal the microbial taxa that have the potential to be integrated into the strategy of stripe rust management.

PCNA and GSK3β interact with each other to regulate H1299 lung adenocarcinoma cells apoptosis

Glycogen synthase kinase beta (GSK3β) is considered as a promising target for lung cancer treatment and its inhibitor lithium chloride (LiCl) is widely regarded as having potent anti-proliferative and apoptosis-modulating activities. Proliferating cell nuclear antigen (PCNA), as an auxiliary protein for DNA polymerase delta, which regulates DNA replication and repair, has been reported to play an important role in regulating apoptosis. Here, we showed that GSK3β interacted with PCNA in H1299 lung adenocarcinoma cells using GST pull-down and co-immunoprecipitation experiments. We discovered that their interaction can be enhanced within the first 3 h after UVC irradiation and decreased gradually with time. Overexpression of PCNA protein decreased GSK3β Ser9 phosphorylation, whereas knockdown of PCNA using small interfering RNA (siRNA) increased Ser9 phosphorylated GSK3β, which was attenuated by phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002 after UVC irradiation, indicating the involvement of the PI3K-AKT pathway. Functional analyses suggested that downregulation of PCNA sensitized H1299 cells to LiCl-induced apoptosis. Thus, our results unraveled a novel regulatory of GSK3β by PCNA and provided a promising direction for treatment of lung cancer.

[Genetic characteristics and clinical outcomes of pediatric acute myeloid leukemia with NUP98-NSD1 fusion gene]

Objective: To investigate the genetic characteristics and clinical outcomes of pediatric acute myeloid leukemia patients with NUP98-NSD1 fusion gene. Methods: A total of 80 pediatric AML patients were enrolled in this study, and bone marrow specimens were collected at initial diagnosis and relapse. NUP98-NSD1 was screened by fluorescence in situ hybridization (FISH) and PCR. Other laboratory test results and clinical outcomes were further analyzed for the NUP98-NSD1 positive cases. Results: A total of eight patients (10.0%) were positive for NUP98-NSD1, which were all fusions of NUP98 exon12 and NSD1 exon 6. There were two M2, three M4, and three M5 cases according to the French-American-British classification. Seven patients had karyotype results at the time of initial diagnosis, and none of them had complicated karyotype abnormalities. Among these patients, two cases had normal karyotype, three cases had trisomy 8, one case had trisomy 6, and two cases had anomalies involving 9q13 or 9q21. Additional karyotypic abnormalities and clonal evolutions were observed during disease progression or relapse, five cases had 9q13 or 9q32 abnormalities. Five cases (62.5%) were positive with FLT3-ITD mutation. Patients were treated with DAE/NAE/HAE/IA chemotherapy. Three cases did not achieve remission after several courses of chemotherapy, and five cases achieved remission but relapsed in 1 to 19 months. Five cases underwent salvage allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among whom, four died in 40 days to 4 months after transplantation, and one survived 8.5 months till the last follow-up. Conclusions: NUP98-NSD1 is a recurrent genetic abnormality with significant clinical prognostic significance, and this group of disease has unique clinical and genetic characteristics. NUP98-NSD1 should be screened by FISH or PCR for children with AML who are newly diagnosed or refractory and relapsed to identify the high-risk genetic marker.

P3422Contrasting the risk for atherosclerotic cardiovascular disease events among individuals with lower extremity peripheral artery disease, coronary heart disease and cerebrovascular disease

Background

Having more vascular conditions, including coronary heart disease (CHD), cerebrovascular disease and lower extremity artery disease (LEAD), may increase the risk for atherosclerosis cardiovascular disease (ASCVD) events. Specific vascular conditions may increase the ASCVD event rate more than others.

Purpose

To compare the risk for future ASCVD events associated with the number and type of vascular conditions among adults with a history of CHD, cerebrovascular disease and/or LEAD.

Methods

We analyzed data from US adults ≥19 years of age with commercial or Medicare health insurance who had a history of CHD, cerebrovascular disease and/or LEAD as of December 31, 2014 (N=901,391). Individuals were followed through December 31, 2016 (median follow-up: 2 years) for ASCVD events, including myocardial infarction, coronary revascularization, stroke, carotid revascularization and lower extremity amputation or revascularization.

Results

Among individuals included in the current analysis (mean age 63 years, 45% female), 70%, 23% and 7% had 1, 2 and 3 vascular conditions, respectively. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratio for ASCVD among individuals with 2 and 3 versus 1 vascular conditions was 1.88 (1.85, 1.92) and 2.93 (2.86, 3.00), respectively. Among individuals with 1 vascular condition, the rate of ASCVD events per 1,000 person-years was 46.5 (95% CI 44.1, 49.0), 29.6 (95% CI 29.0, 30.1) and 19.9 (95% CI 19.2, 20.8) for those with LEAD, CHD and cerebrovascular disease, respectively. The multivariable-adjusted hazard ratio (95% CI) for ASCVD events comparing individuals with LEAD only and CHD only versus those with cerebrovascular disease only was 1.84 (1.77, 1.92) and 1.12 (1.08, 1.16), respectively. Among individuals with 2 vascular conditions, the ASCVD event rate per 1,000 person-years was higher in those with LEAD and CHD (122.0, 95% CI 112.5, 132.2) and with LEAD and cerebrovascular disease (92.4, 95% CI 79.9, 106.4), versus those with CHD and cerebrovascular disease (59.1, 95% CI 54.8, 63.6). The multivariable-adjusted hazard ratio (95% CI) comparing individuals with LEAD and CHD and those with LEAD and cerebrovascular disease versus those with CHD and cerebrovascular disease was 1.48 (1.44, 1.53) and 1.49 (1.41, 1.58), respectively.

Conclusion

Among adults with vascular disease, having LEAD confers a higher risk for future ASCVD events than CHD or cerebrovascular disease and this group may benefit from more intensive risk reduction treatment.

Acknowledgement/Funding

Amgen Inc.

P652Lower use of statins among patients with peripheral artery disease compared with those with coronary heart disease

Background

Adults with atherosclerotic cardiovascular disease are recommended to take a statin to reduce their risk for future cardiovascular events. Prior studies suggest that statins are being taken by most adults with coronary heart disease (CHD). However, there are few data on the use of statins among adults with peripheral artery disease (PAD).

Purpose

To compare the use of statins among US adults with a history of PAD versus those with a history of CHD.

Methods

We conducted a retrospective cohort study among US adults ≥19 years of age with commercial or government health insurance who had a history of CHD or PAD as of December 31, 2014 (n=1,006,451, mean age 63 years, 47% male). We used pharmacy claims between January 1 and December 31, 2014 to identify use of any statin and of a high-intensity statin (i.e., atorvastatin 40–80 mg, rosuvastatin 20–40 mg, simvastatin 80 mg). Patients with a history of CHD without PAD (CHD only), both CHD and PAD, and PAD without CHD (PAD only) were analysed. Prevalence ratios for use of any statin and a high-intensity statin among those taking a statin were calculated after multivariable adjustment for sociodemographics and cardiovascular risk factors.

Results

Overall, 69.1% of patients included in the current analysis had CHD only, 21.4% had both CHD and PAD, and 9.5% had PAD only. Overall, 66.0%, 68.2% and 47.5% of patients with CHD only, CHD and PAD, and PAD only were taking a statin. After multivariable adjustment and compared to patients with CHD only, the prevalence ratio for statin use was 1.02 (95% CI 1.01, 1.02) for those with both CHD and PAD and 0.82 (95% CI 0.82, 0.83) for those with PAD only. Among patients taking a statin, 29.4% of those with CHD only, 28.6% of those with both CHD and PAD, and 17.3% of those with PAD only were taking a high-intensity dosage. Compared to patients with CHD only, the multivariable adjusted prevalence ratio for taking a high-intensity dosage was 1.05 (95% CI 1.04, 1.06) for those with both CHD and PAD and 0.71 (95% CI 0.70, 0.73) for those with PAD only.

Conclusion

Adults with PAD receive less intensive statin therapy compared with their counterparts who have CHD. Interventions aimed to increase statin use among patients with PAD are warranted.

Acknowledgement/Funding

This study was supported through a research grant from Amgen, Inc. (Thousand Oaks, CA, USA).

Rare genetic Creutzfeldt-Jakob disease with E196A mutation: a case report

Genetic Creutzfeldt-Jakob disease (gCJD) accounts for approximately 10-15% of human prion diseases. It is an autosomal dominant disease caused by missense or insertion mutations of the gene that encodes prion protein (PRNP). In general, the manifestations and neuropathological changes of gCJD are similar to those of sporadic CJD (sCJD), and the diagnostic sensitivities of cerebrospinal fluid (CSF) markers, electroencephalography (EEG), and magnetic resonance imaging (MRI) are generally lower in gCJD than sCJD. Here we report on a 56-year-old Chinese woman who was diagnosed with gCJD and suspected to have thyroid cancer. The patient carried the glutamate to alanine substitution at codon 196 (E196A) of PRNP, which is quite a rare mutation and has only been reported in China. To our knowledge, this is the fourth case of E196A gCJD in the world. Here, we compared the manifestations and assistant examinations of the current patient with those of three previously reported Chinese patients with E196A gCJD in order to illustrate the common features of E196A gCJD.

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.

[The effect of air test and methylene blue perfusion test on detecting the quality of anastomosis during laparoscopic rectal cancer excision (Dixon)]

Objective: To investigate the feasibility and safety of air test (AT) and methylene blue perfusion test (MBPT) to detect the quality of the anastomosis in laparoscopic rectal cancer excision (Dixon), and compare the two approaches. Methods: AT is performed by filling the pelvis with saline solution and insufflating the rectum with air through a size 22 G balloon catheter (Foley). MBPT is carried out by surrounding clean sponges around anastomosis and injecting methylene blue solution into the rectum as like as AT. The balloon catheter connected manometer,ensuring the pressure in rectum can reach 40 cmH(2)O during AT and MBPT. The presence of air bubbles and overt blue-stained spillage indicated anastomotic leaks which are were resolved during surgery. All 28 patients undergoing laparoscopic rectal excision received both AT and MBPT intraoperatively in a randomized fashion. The integrity of the anastomosis, postoperative vital signs, blood examination, drainage and postoperative imaging were analyzed. Results: All 28 patients received both tests successfully with no adverse event. MBPT Level 1 was detected in 15 cases, level 2 in 8 cases, level 3 in 5 cases. No MBPT level 4 was observed. AT level 1 was detected in 22 cases, level 2 in 5 cases, level 3 in 1 cases. No AT level 4 was founded. Three cases were diagnosed with postoperative anastomotic leakage (3/28, 10.71%), of which 2 cases were Grade B [definition and grading proposed by the international study group of rectal cancer (ISREC) in 2010]. One case was Grade C. The positive rate of MBPT was superior to AT (the McNemar testing, P<0.01). Conclusions: The two intraoperative tests are both technically feasible and safe. Compared to AT, MBPT has the advantage of localizing the leak site with a higher positive accuracy, and represents a promising standardized approach for intraoperative test of the anastomosis quality. Intraoperative repair is absolutely helpful for the level 3 and 4 intraoperative tests.

Simplified colonic dialysis with hemodialysis solutions delays the progression of chronic kidney disease

BACKGROUND

The colon plays a vital role in the disposal of nitrogenous waste products. Therefore, the colon may provide a therapeutic target for managing chronic kidney disease (CKD).

AIM

To evaluate the efficacy of a simplified model of colonic dialysis with hemodialysis solutions (SCD) to delay the progression of stages 3-5 CKD.

DESIGN

Retrospective study.

METHODS

We retrospectively analyzed 178 stages 3-5 CKD patients who did or did not receive SCD (SCD group, n = 88; control group, n = 90). The follow-up was 36 months. The outcome of CKD progression was defined as a decrease in 50% or more in estimated glomerular filtration rate, starting hemodialysis or peritoneal dialysis or undergoing transplantation. The Kaplan-Meier analysis was used to compare CKD progression between SCD and control groups as well as between subgroups at different CKD stages. Cox proportional hazard models adjusted for patients' characteristics were used to examine the association between SCD and the outcome.

RESULTS

For all patients, the outcome was significantly better in SCD group compared to control group (P < 0.05). The results were similar in the subgroups of patients at stage 4 (P = 0.001) and stage 5 (P = 0.000), but not in the subgroup of patients at stage 3 (P = 0.121). For all patients, SCD was associated with a lower risk of CKD progression after adjusted for patients' characteristics (adjusted hazard ratio, 0.373; 95% confidence interval, 0.201-0.694; P 0.002).

CONCLUSION

SCD is an effective supplementary therapy to delay the progression of stages 4-5 CKD.

[Real-world research on cervical cancer screening program and effect evaluation for Chinese population]

Objective: To evaluate the actual efficacy of cervical cancer and precancerous lesions screening approaches in real-world regions with different economic levels in China. Methods: The demonstrative application and effect evaluation of cervical cancer screening program were conducted in 21 hospitals nationwide from 2015 to 2018. Multi-stage sampling method was adopted to divide the country into 7 large areas according to geographical location. Two to four screening sites of two types of cancer (cervical cancer and breast cancer) were selected in each area, and the grassroots screening sites were implemented under the guidance of superior hospitals. In rural areas, women were initially screened using cytology, human papillomavirus (HPV) testing and visual inspection. The women with positive cytology or visual inspection were referred for colposcopy, and the women with positive HPV infection were randomly referred for reflex cytology or visual inspection, or direct colposcopy examination. In urban areas, women were primarily randomized into cytology or HPV testing groups. The women with abnormal cytology or positive HPV 16/18 infection were directly referred for colposcopy examination, whereas the women with positive infection of the other 12 high-risk subtypes of HPV were referred for reflex cytology or colposcopy. All of recruited women would be follow-up and screened by the baseline screening techniques in the third year while the positive women underwent colposcopy examination. The positive rates, referral rates, the detection rates of grade 2 and above of cervical intraepithelial neoplasia (CIN 2+ ) were compared. Results: A total of 63 931 women were recruited at the baseline. Among them, 11 rural sites included 33 823 women: 15 577, 11 157 and 7 089 women were screened by HPV testing, visual inspection via acetic acid or Lugol's iodine (VIA/VILI) and cytology, respectively. Additionally, 30 108 women were from 10 urban sites: 9 907 and 20 201 women were screened by cytology and HPV subtyping, respectively. The HPV positive rate for urban women was 9.34%, whereas that for rural women was 12.53%. The abnormal rate of cytology for urban women was 5.63%, and that for rural women was 4.24%. The positive rate of VIA/VILI in the rural women was 12.25% Furthermore, the detection rate of CIN2+ at the baseline was 0.56%, and that was statistically higher in HPV-positive group than cytology-positive group (P<0.05). Conclusions: All of screening sites completed the baseline screening tasks as expected. The prevalence of HPV infection is higher in rural women than urban women. The performance of HPV testing is better than cytology for detecting CIN2+ cases. This real-world demonstration study provides evidences for cervical cancer prevention and control in different regions.