Case of severe acute hepatitis A virus infection in United Nations peacekeepers in South Sudan

Hepatitis A virus (HAV) is a major cause of acute viral hepatitis, which can lead to severe cases and acute liver failure. A 41-year-old Chinese military officer of the United Nations peacekeeping forces in South Sudan manifested fever, jaundice and coagulation dysfunction. The patient initially had a negative anti-HAV IgM antibody test result but a positive anti-HAV-IgM antibody test result five days after his alanine aminotransferase (ALT) levels peaked. He was given telemedicine consultation and was transferred to a Chinese military hospital specialising in infectious diseases for treatment of severe acute HAV infection. The peak ALT, aspartate aminotransferase, total bilirubin and international standard ratio were 5410 U/L, 3475 U/L, 225.1 µmol/L and 2.12 during hospitalisation, respectively. Military personnel undergoing missions in areas with high prevalence of HAV should be tested for previous HAV infection before departure if they have not been previously vaccinated. If negative results are obtained, they should be vaccinated. Anti-HAV-IgM examination should be repeated after the first negative test result is obtained to eliminate the effects of a window period if a clinical suspicion exists. If a life-threatening case of HAV infection is present, the patient should be transported to a base military hospital specialising in infectious diseases for treatment.

Correlations of SOX9 expression with serum IGF1 and inflammatory cytokines IL-1α and IL-6 in skin lesions of patients with acne

OBJECTIVE

To study the correlations of sex determining region Y-box 9 (SOX9) expression with serum type-1 insulin-like growth factor (IGF-1), interleukin-1α (IL-1α), and interleukin-6 (IL-6) in skin lesion tissues of patients with acne.

PATIENTS AND METHODS

Six patients with acne who were treated for the first time in our outpatient clinic from June 2017 to July 2017 were selected as observation group, and 6 normal subjects were selected as control group. The expression of SOX9 was detected by immunohistochemistry. The protein expressions of IGF-1, IL-1α, and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA). SOX9 was detected by quantitative polymerase chain reaction (qPCR).

RESULTS

Compared with that in control group, the expression of SOX9 in observation group was significantly increased (p < 0.05). Compared with those in control group, the expressions of IGF-1, IL-1α and IL-6 in observation group were significantly increased (p < 0.05). Compared with that in control group, the mRNA expression of SOX9 in observation group was significantly increased (p < 0.05). SOX9 was positively correlated with IGF-1, IL-1α and IL-6.

CONCLUSIONS

The expressions of SOX9, IGF-1, IL-1α, and IL-6 in skin lesion tissues of patients with acne are increased, and SOX9 is positively correlated with IGF-1, IL-1α, and IL-6 and can be used as a target for the treatment of acne inflammation.

[Optimal energy supply in different age groups of critically ill children on mechanical ventilation]

Objective: To analyze the resting energy expenditure and optimal energy supply in different age groups of critically ill children on mechanical ventilation in pediatric intensive care unit (PICU). Methods: Patients on mechanical ventilation hospitalized in PICU of Beijing Children's Hospital from March 2015 to March 2016 were enrolled prospectively. Resting energy expenditure of patients was calculated by US Med Graphic company critical care management (CCM) energy metabolism test system after mechanical ventilation. Patients were divided into three groups:<3 years, 3-10 years, and >10 years. The relationship between the measured and predictive resting energy expenditure was analyzed with correlation analysis; while the metabolism status and the optimal energy supply in different age groups were analyzed with chi square test and variance analysis. Results: A total of 102 patients were enrolled, the measured resting energy expenditure all correlated with predictive resting energy expenditure in different age groups (<3 years (r=0.3, P=0.0) ; 3~10 years (r=0.6, P=0.0) ;>10 years (r=0.5, P=0.0) ) . A total of 40 cases in < 3 years group, including: 14 cases of low metabolism (35%), 14 cases of normal metabolism (35%), and 12 cases of high metabolism (30%); 45 cases in 3-10 years group, including: 22 cases of low metabolism (49%), 19 cases of normal metabolism (42%), 4 cases of high metabolism (9%); 17 cases in>10 years group, including: 12 cases of low metabolism (71%), 4 cases of normal metabolism (23%), 1 case of high metabolism (6%). Metabolism status showed significant differences between different age groups (χ(2)=11.30, P<0.01, r=-0.01). Infants had higher metabolic status, which lessened with aging. The total average actual energy requirement was (210±84) kJ/ (kg⋅d) . There were significant differences in actual energy requirement between age groups (F=46.57, P<0.001), with (277±77) kJ/ (kg⋅d) in<3 years group, (184±53) kJ/ (kg⋅d) in 3-10 years group, and (120±30) kJ/ (kg⋅d) in>10 years group. Conclusion: The resting energy metabolism of the critically ill children on mechanical ventilation is negatively related to the age. The actual energy requirement should be calculated according to different ages.

Dextran sulphate sodium (DSS) causes intestinal histopathology and inflammatory changes consistent with increased gut leakiness in chickens

1. The clinical severity, histological changes, indicators of gut leakiness and inflammatory cytokine profiles were studied in chickens with dextran sulphate sodium (DSS)-induced intestinal inflammation. 2. The experimental groups (1.25%, 1.5% and 2.5% DSS) showed clinical signs, such as loose stools and weight loss, which increased with additional treatment days and, as expected, the effects of DSS-induced intestinal inflammation were time and dose-dependent. 3. After 10 d, histological manifestations were evident, including goblet cell depletion, mucus layer loss, significantly shorter villi and a thinner total ileal mucosa. 4. The d(-)-lactate value, which was used as a gut leakiness indicator, was significantly increased in the 2.5% DSS group. 5. Expression of the inflammatory cytokines interleukin-1Beta, tumour necrosis factor alpha and interleukin-10 in the serum significantly increased with DSS treatment. 6. This study indicates that the experimental intestinal inflammation induced by DSS is an ideal model to study the pathogenic mechanisms of intestinal inflammation in chickens and to test the efficacy of therapies.

Effects of transdermal flunixin meglumine on pain biomarkers at dehorning in calves

The objective of this study was to evaluate the analgesic properties of transdermal flunixin meglumine when given at the time of dehorning on pain biomarkers. Twenty-four weaned male Holstein calves, 6 to 8 wk of age were enrolled into the study. The calves were randomly assigned to 1 of 3 treatment groups: 1) transdermal flunixin and dehorn (DH-FLU); 2) transdermal flunixin and sham dehorn (SHAM-FLU); and 3) placebo and dehorn (DH-PLBO). Transdermal flunixin at a label dose of 3.33 mg/kg (or placebo at an equivalent volume) was administered as a pour-on along the top-line of the calves in each treatment group concurrently with electrocautery dehorning or sham dehorning. Biomarker parameters collected and analyzed included: infrared thermography (IRT), mechanical nociception threshold (MNT), plasma cortisol, and substance P (SP). There were no differences in maximal temperatures detected for the IRT measurements of the medial canthus of the eye for the DH groups. Mean control point MNT measurements at 48 h were 3.14 kgF, 3.46 kgF, and 1.43 kgF for the DH-FLU, Sham-FLU, and DH-PLBO groups, respectively (P = 0.0001). No other differences of MNT were detected between the dehorned groups for the other test sites and time points. Plasma cortisol reached peak concentration at 20 min postdehorning for the DH-FLU and DH-PLBO groups and 10 min for SHAM-FLU group. Peak plasma cortisol concentrations were 32.0 ng/mL, 12.7 ng/mL, and 28.8 ng/mL for the DH-FLU, SHAM-FLU, and DH-PLBO groups, respectively. Cortisol concentrations were lower for the DH-FLU group at 90 min postdehorning compared to the SHAM-FLU and DH-PLBO groups ( = 0.04). Area under the effect curve (AUEC) were similar for all groups ( = 0.93). No statistical differences in SP concentrations between groups were detected for any of the time points. In conclusion, transdermal flunixin meglumine given at the time of dehorning did not provide substantial analgesia based on the pain biomarkers investigated. Further investigation into its role as part of a multimodal analgesic plan is warranted.

TLR-Induced SMPD3 Defects Enhance Inflammatory Response of B Cell and Macrophage in the Pathogenesis of SLE

B lymphocyte and macrophages may contribute to SLE pathogenesis through cytokine production after TLR stimulation. Emerging evidences suggested that defects of sphingolipid metabolism were responsible for SLE pathogenesis. However, it is not clear whether these defects exist in B cells and macrophages under SLE condition and whether TLR signalling pathway was related to the dysfunction of sphingolipid metabolism in SLE. Here, we demonstrated that the enzymes involved in the sphingolipid metabolism expressed abnormally in B cells from SLE patients and lupus-prone mice. Moreover, we found that TLR signalling induced the abnormal expression of sphingomyelin phosphodiesterase 3 (SMPD3), sphingosine-1-phosphate phosphatase 2 (SGPP2), ceramide kinase (CERK) and UDP glycosyltransferase 8 (UGT8), which were involved in sphingolipid metabolism. TLR signalling also induced the transportation of SMPD3 from Golgi apparatus. Furthermore, the dysfunction of SMPD3 enhanced TLR-induced inflammatory response of B cells and macrophages in turn. Thus, these findings provide an innovative direction and a new target for research and treatment of SLE.

[Efficacy and safety of drainage after total knee arthroplasty]

Objective: To determine whether suction drainage is safe and effective compared with no-drainage in total knee arthroplasty. Methods: The literature search was based on PubMed, MEDLINE, EMBASE, Highwire, the Cochrane Library, CBM, CNKI, VIP and WFSD.The data were analysed using RevMan 5.3.Fourteen randomised controlled trials involving 1 009 knees were included in our analysis. Results: Suction drainage increases the rate and volume of blood transfusion.No-drainage group increases the rate of wound problems (OR=1.92, 95%CI 1.21-3.04, P<0.05). No significant difference was observed in the incidence of periprosthetic infection (OR=0.68, 95%CI 0.20-2.30, P=0.54), VAS (OR=-0.09, 95%CI -0.32-0.14, P=0.46) and the length of stay (OR=0.41, 95%CI -0.21-1.03; P=0.19) when the drainage group was compared with the no-drainage group (P>0.05). Conclusions: No-drainage for easy total knee arthroplasty may be a better choice. However, orthopedic surgeon need to weigh the pros and cons of no-drainage in some complicated TKAs such as extra-articular deformity .

Xanthophylls increased HDLC level and nuclear factor PPARγ, RXRγ and RARα expression in hens and chicks

This study was designed to investigate effects of xanthophylls on serum lipid profile (triglyceride, TG; cholesterol, CHO; high-density lipoprotein cholesterol, HDLC; and low-density lipoprotein cholesterol, LDLC) and nuclear factor (peroxisome proliferator-activated receptor gamma, PPARγ; PPAR gamma coactivator 1 alpha, PGC1α; retinoid X receptor gamma, RXRγ; and retinoic acid receptor alpha, RARα) gene expression of breeding hens and chicks. In experiment 1, 432 hens were divided into three groups and fed diets supplemented with 0 (as control group), 20 or 40 mg/kg xanthophylls. Blood was sampled at 7, 14, 21, 28 and 35 days of trial. Liver, duodenum, jejunum and ileum were sampled at 35 days of trial. Results showed that serum HDLC level of hens was increased after dietary 40 mg/kg xanthophyll addition for 21, 28 and 35 days, while serum TG, CHO and LDLC were not affected. Xanthophyll addition also increased PPARγ expression in jejunum, RXRγ expression in duodenum and jejunum, and RARα expression in liver and duodenum. Experiment 2 was a 2 × 2 factorial design. Male chicks hatched from 0 or 40 mg/kg xanthophyll diet of hens were fed diet containing either 0 or 40 mg/kg xanthophylls. Liver, duodenum, jejunum and ileum were sampled at 0, 7, 14 and 21 days after hatching. Blood samples were also collected at 21 days. Results showed that in ovo xanthophylls elevated PPARγ in duodenum and jejunum, and RXRγ and RARα in liver of chicks mainly within 1 week after hatching, while dietary xanthophylls increased serum HDLC level and PPARγ and RXRγ in liver from 2 weeks onwards. In conclusion, our research suggested xanthophylls can regulate serum lipid profile and nuclear factor expression in hens and chicks.

Octadecyl Chains Immobilized onto Hyaluronic Acid Coatings by Thiol-ene "Click Chemistry" Increase the Surface Antimicrobial Properties and Prevent Platelet Adhesion and Activation to Polyurethane

Infection and thrombus formation are still the biggest challenges for the success of blood contact medical devices. This work aims the development of an antimicrobial and hemocompatible biomaterial coating through which selective binding of albumin (passivant protein) from the bloodstream is promoted and, thus, adsorption of other proteins responsible for bacterial adhesion and thrombus formation can be prevented. Polyurethane (PU) films were coated with hyaluronic acid, an antifouling agent, that was previously modified with thiol groups (HA-SH), using polydopamine as the binding agent. Octadecyl acrylate (C18) was used to attract albumin since it resembles the circulating free fatty acids and albumin is a fatty acid transporter. Thiol-ene "click chemistry" was explored for C18 immobilization on HA-SH through a covalent bond between the thiol groups from the HA and the alkene groups from the C18 chains. Surfaces were prepared with different C18 concentrations (0, 5, 10, and 20%) and successful immobilization was demonstrated by scanning electron microscopy (SEM), water contact angle determinations, X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared spectroscopy (FTIR). The ability of surfaces to bind albumin selectively was determined by quartz crystal microbalance with dissipation (QCM-D). Albumin adsorption increased in response to the hydrophobic nature of the surfaces, which augmented with C18 saturation. HA-SH coating reduced albumin adsorption to PU. C18 immobilized onto HA-SH at 5% promoted selective binding of albumin, decreased Staphylococcus aureus adhesion and prevented platelet adhesion and activation to PU in the presence of human plasma. C18/HA-SH coating was established as an innovative and promising strategy to improve the antimicrobial properties and hemocompatibility of any blood contact medical device.

Effects of school breaks on influenza-like illness incidence in a temperate Chinese region: an ecological study from 2008 to 2015

OBJECTIVE

To assess the effects of winter/summer school breaks on occurrences of influenza-like illness (ILI).

METHODS

We jointly analysed ILI surveillance data with the timing of school breaks in a temperate district in Beijing, China from 2008 to 2015. ILI incidence rate ratios (IRRs) of schoolchildren (5-14 and 15-24 years of age) to adults (25-59 and >60 years of age) were used to measure the age shift of ILI incidence before, during and after the 4-week winter/7-week summer breaks. Serfling-based Poisson regression model with adjustment for unmeasured confounders was built to further assess the effect of winter school breaks.

RESULTS

ILI incidences were consistently lower during winter breaks than before winter breaks for all age groups. IRRs of younger schoolchildren aged 5-14 to adults were higher during winter school breaks than before breaks, while the opposite was true for the IRRs of older schoolchildren aged 15-24 to adults. Schoolchildren-to-adults IRRs during summer breaks were significantly lower than before or after school breaks (p<0.001).

CONCLUSIONS

Both winter and summer breaks were associated with reductions of ILI incidences among schoolchildren and adults. Our study contributes additional evidence on the effects of school breaks on ILI incidence, suggesting school closure could be effective in controlling influenza transmission in developing countries.

TLR4 and Caveolin-1 in Monocytes Are Associated With Inflammatory Conditions in Diabetic Neuropathy

The purpose of this study was to investigate the expression of TLR4 and caveolin‐1 in monocytes among healthy volunteers as well as those with type‐2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN). Nineteen healthy control subjects, 18 patients with T2DM, and 20 patients with DPN were enrolled. Toll‐like receptor (TLR)4, caveolin‐1, MyD88, phosphorylated IκB, and plasma TNF‐α and interleukin (IL)‐6 were measured using real‐time polymerase chain reaction, Western blotting, and enzyme‐linked immunosorbent assay. Compared with the other two groups, the DPN group had higher expression of TLR4, MyD88, phosphorylated IκB, TNF‐α, and IL‐6, but significantly lower levels of caveolin‐1 and total IκB in monocytes. Plasma concentrations of TNF‐α and IL‐6 were positively correlated with TLR4 and negatively correlated with caveolin‐1 in patients with DPN. Plasma concentration of TLR4 was negatively correlated with caveolin‐1 in patients with DPN. Reduced expression of caveolin‐1 in monocytes could aggravate the TLR4‐mediated inflammatory cascade.

[Efficacy of GLIDE chemotherapy for patients with newly diagnosed advanced-stage or relapsed/refractory extranodal natural killer cell lymphoma]

目的

研究GLIDE（吉西他滨、门冬酰胺酶、异环磷酰胺、地塞米松、依托泊苷）方案治疗初发进展期及复发难治性结外鼻型NK/T细胞淋巴瘤（ENKL）患者的有效性及安全性。

方法

纳入2010年3月至2016年3月收治的初发进展期及复发难治性ENKL患者42例，给予GLIDE方案化疗，中位疗程数为3(2~6）个，评估化疗结束后缓解率及早期（2个疗程后）缓解率，采用Kaplan-Meier方法统计无进展生存（PFS）及总生存（OS），同时采用Cox回归方法进行多因素分析，寻找影响患者PFS及OS的独立预后因素。

结果

31例（73.8%）患者达到完全缓解（CR），其中22例（52.4%）为早期CR，31例CR患者中14例接受序贯自体造血干细胞移植（ASCT）。1年PFS与OS率分别为65.6％和82.7%，4年PFS与OS率分别为48.2％和63.1%，中位OS时间未达到，中位PFS时间为30.5个月。多因素分析提示美国东部肿瘤协作组体能状态评分（ECOG评分）0~1分以及CR后序贯ASCT为减少复发、延长患者生存的有利因素。

结论

GLIDE方案能够有效治疗初发进展期及复发难治性ENKL, ECOG评分0~1分及CR后序贯ASCT治疗是患者获得较长PFS和OS时间的独立预后因素。

Three-dimensional stress In vitro promotes the proliferation and differentiation of periodontal ligament stem cells implanted by bioactive glass

To analyze the biological and mechanical microenvironment on the directional differentiation of periodontal ligament stem cells (PDLSCs) In vitro. PDLSCs were cultured in three-dimensional stress system In vitro for 1, 2 and 3 weeks. Methods like immunohistochemistry and flow cytometry were adopted and the proliferation and differentiation situation of PDLSCs were determined. Bioactive glass (BAG) of 0%, 10%, 20%, 30% and 40% was implanted into PDLSCs with or without three-dimensional stress for 3 weeks, respectively. The proliferation and differentiation situation of PDLSCs were determined. The mRNA levels of Alkaline phosphatase (ALP), Type I Collagen (COL I), Type II Collagen (COL II), Bone sialoprotein (BSP), Osteocalcin (OCN) and Osteopontin (OPN) were determined by semi-quantitative RT-PCR. 30% BAG and three-dimensional stress for 3 weeks promoted the proliferation and differentiation of PDLSCs mostly. PDLSCs induced by BAG and 3D force and the control all expressed the mRNA of ALP, COLⅠand COL Ⅱ. The BAG and three-dimensional stress induced PDLSCs also expressed the mRNA of BSP, OCN and OPN. BAG and three-dimensional stress indicated microenvironment In vitro can promote the proliferation and differentiation of PDLSCs.