A preliminary study: proteomic analysis of exosomes derived from thyroid-stimulating hormone-stimulated HepG2 cells

BACKGROUND

Thyroid-stimulating hormone (TSH) plays an important role in the regulation of lipid metabolism. However, little is known about the role that exosomes play in the process of TSH-induced lipotoxicity in non-alcoholic fatty liver disease (NAFLD). As a preliminary step, the present study set out to investigate alterations in protein expression in exosomes derived from TSH-stimulated HepG2 cells.

METHODS

HepG2 cells were treated with TSH, exosomes were collected, and proteins were identified by mass spectrometry (MS). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway analysis were performed to analyze the identified proteins.

RESULTS

TSH treatment significantly increased exosomal production and changed the exosomal proteomic profile in HepG2 cells. Among the 1728 proteins, 140 identified proteins were upregulated and seven proteins were downregulated. GO analysis and KEGG analysis revealed that these proteins were involved in multiple processes including metabolism, apoptosis, and inflammation.

CONCLUSION

Our preliminary study demonstrated that exosomes derived from TSH-stimulated hepatocytes were increased and showed a specific altered spectrum of proteins, many of which were involved in metabolism, signal transduction, apoptosis, and inflammation. This study offers new insights into the pathogenesis of TSH-induced lipotoxicity in NAFLD.

Correction to: Maternal Hypertension, Advanced Doppler Haemodynamics and Therapeutic Precision: Principles and Illustrative Cases

The original publication of this article, unfortunately, contains the following errors.

[Advances in researches of intrinsically photosensitive retinal ganglion cells]

Intrinsically photosensitive retinal ganglion cells (ipRGCs) are atypical photoreceptors that are different from classical cone and rod cells. The primary role of ipRGCs is to signal light for largely subconscious, non-image vision such as photoentrainment of circadian rhythm and pupillary light reflex. Recent researches have revealed additional roles for ipRGCs in communication with synapses around, conscious vision reception and pathogenesis of some diseases. Here we review the research advances of morphology, functions and clinical applications of ipRGCs. (Chin J Ophthalmol, 2020, 56: 308-312).

Topologically-tuned spin Hall shift around Fano resonance

The topological magnetoelectric effect is associated with the photonic spin-orbit interaction. However, due to the proportionate fine structure constant of the topological term, the topological magnetoelectric effect is usually weak. In this paper, we demonstrate that the axion term enables manipulation of the spin Hall shift of light around Fano resonance. And, the excited surface plasmon near the nanoparticle's interface could enhance the topological magnetoelectric effect for several orders. Numerical simulation of near field and far-field scattering confirms our theoretical results. Our work may pave the way to exploit the topological magnetoelectric effect in practical applications, such as optical sensing and nanoprobing.

Maternal Hypertension, Advanced Doppler Haemodynamics and Therapeutic Precision: Principles and Illustrative Cases

PURPOSE OF REVIEW

Maternal hypertension is a common and serious condition associated with increased maternal and foetal morbidity and mortality, with early detection and management improving outcomes.

RECENT FINDINGS

Blood pressure (BP) changes of pre-eclampsia are defined after 20 gestational weeks, while haemodynamic changes can be detected at 5-11 weeks using a specialised non-invasive Doppler stroke volume (SV) monitor. Thus, advanced haemodynamic monitoring allows for physiologically precise identification of circulatory abnormalities, and implementation of appropriate therapy within the first trimester. We measured the oscillometric BP and advanced haemodynamics (USCOM 1A) of 3 unselected women with singleton pregnancies, consecutively listed for therapeutic induction for maternal hypertension at 32-41 weeks gestational age. While the BP's of the patients varied, it was the haemodynamics, particularly SV, cardiac output, systemic vascular resistance, Smith Madigan Inotropy Index, and oxygen deliver, that identified differing patterns of circulatory dysfunction, therapeutic objectives, and predicted post-partum complications of the mother and child. First trimester screening of maternal haemodynamics may allow for earlier detection of circulatory derangements, selection of patient precise interventions, and improved maternal-foetal outcomes.

[Current global development of screening guidelines for hepatocellular carcinoma: a systematic review]

Objective: The objective of the study was systematically summarized the current status of the hepatocellular carcinoma (HCC) screening guidelines, and evaluated the HCC screening guidelines according to the authoritative framework of cancer screening guidelines of authoritative institutions, which provided important value for the formulation of HCC screening evidence-based guidelines. Methods: Literature search was conducted in multiple databases from their inception dates to January 3, 2019. In addition, we sought relevant websites further was searched to identify potentially eligible studies. Two reviewers independently screened literature and extracted data. Qualitative description of the basic information, recommendations of HCC screening, source of evidence and update progress of the HCC screening guidelines was conducted. Results: At present, there were no independent HCC screening guidelines worldwide. There were only 17 clinical practice HCC guidelines briefly provided the recommendation of HCC screening. Current HCC screening guidelines only recommended screening for high-risk groups of HCC. All guidelines have identified patients with chronic hepatitis B, hepatitis C and cirrhosis as high-risk groups for HCC. Most of guidelines recommended screening intervals was 6 months. The latest guidelines in Europe and the United States recommended ultrasound for screening HCC. The combination of ultrasound and AFP was recommended in the Asian guidelines. Currently, HCC screening guidelines mainly recommended screening strategies based on factors such as risk of HCC, accuracy of screening modality, screening cost, etc.. The key factors such as screening efficacy and safety have not yet been considered comprehensively. Conclusions: There were no independent HCC screening guidelines worldwide. Only some clinical practice HCC guidelines briefly mentioned HCC screening. Currently, the guidelines only recommend screening for high-risk groups of HCC, with a screening interval of 6 months. There are differences in screening modalities recommended by European, American and Asian guidelines for screening HCC. It is suggested that the relevant institutions should formulate the evidence-based HCC screening guidelines by referring to the theoretical framework of other authoritative other cancer screening guidelines.

[Anti-PD-1 therapy in advanced malignant liver tumor-induced type-1 diabetes mellitus: a case report]

Immune checkpoint inhibitor (ICI) has been emerged as a major breakthrough in tumor immunotherapy, but its unique mechanism of action has also led to a number of immune-related adverse events (irAE). Type 1 diabetes mellitus (T1DM) is one of the rarest irAEs. This paper reports a case of advanced malignant liver tumor-induced T1DM who received second-line anti-PD-1 therapy and showed initial symptoms of hyperosmolar coma and hyperglycemia. In addition, the relevant literature at home and abroad was collected and reviewed, and the clinical characteristics of T1DM induced by anti-PD-1 therapy were summarized with a view to achieve early detection, diagnosis and treatment.

Realizing optical bistability and tristability in plasmonic coated nanoparticles with radial-anisotropy and Kerr-nonlinearity

We theoretically study the optical bistability and tristability in plasmonic coated nanospheres containing the nonlinear plasmonic shell and the dielectric core with radial anisotropy. Based on self-consistent mean-field approximation, we establish the relationship between the local field in the shell and the applied incident field, taking into account the Lorentz local field. One or two optical bistabilities and even optical tristability can be observed. Especially, there are two critical geometric parameters between which two optical bistabilities exist. Physically, two optical bistablities result from the excitations of two surface plasmonic resonant modes in the inner and outer interfaces of coated nanospheres, which are well reflected from the spectral representation with two poles. Moreover, the involvement of the radial anisotropy is quite essential to realize the optical tristability. Further discussion on the field-induced tuning of the reflectance reveals the macroscopic properties of this nonlinear optical structure, which provides a potential candidate for designing multi-stable optical devices at the nanoscale.

Unexpected connections between type VI-B CRISPR-Cas systems, bacterial natural competence, ubiquitin signaling network and DNA modification through a distinct family of membrane proteins

In addition to core Cas proteins, CRISPR-Cas loci often encode ancillary proteins that modulate the activity of the respective effectors in interference. Subtype VI-B1 CRISPR-Cas systems encode the Csx27 protein that down-regulates the activity of Cas13b when the type VI-B locus is expressed in Escherichia coli. We show that Csx27 belongs to an expansive family of proteins that contain four predicted transmembrane helices and are typically encoded in predicted operons with components of the bacterial natural transformation machinery, multidomain proteins that consist of components of the ubiquitin signaling system and proteins containing the ligand-binding WYL domain and a helix-turn-helix domain. The Csx27 family proteins are predicted to form membrane channels for ssDNA that might comprise the core of a putative novel, Ub-regulated system for DNA uptake and, possibly, degradation. In addition to these associations, a distinct subfamily of the Csx27 family appears to be a part of a novel, membrane-associated system for DNA modification. In Bacteroidetes, subtype VI-B1 systems might degrade nascent transcripts of foreign DNA in conjunction with its uptake by the bacterial cell. These predictions suggest several experimental directions for the study of type VI CRISPR-Cas systems and distinct mechanisms of foreign DNA uptake and degradation in bacteria.

OP0042 THE TRANSCRIPTOME OF PAIRED MINOR AND MAJOR SALIVARY GLAND TISSUE IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME: TWO OF A KIND?

Background:

In patients with primary Sjögren’s syndrome (pSS), both minor and major salivary glands are targets of the disease. Infiltration of salivary glands by immune cells is characteristic for pSS. However, significant inter- and intra-individual variation exists in the size and composition of the infiltrates. Potential differences between minor and major salivary glands in immune cell presence and inflammatory pathway activation are unclear. This knowledge is essential for clinical trial design and precision therapy.

Objectives:

To compare the transcriptome of paired labial and parotid salivary gland tissue of patients with pSS and non-SS sicca controls.

Methods:

Thirty-nine pSS patients and 20 age- and sex-matched non-SS sicca controls, who participated in a prospective diagnostic cohort[1], were included. All pSS patients fulfilled 2016 ACR-EULAR criteria. RNA was isolated from formalin-fixed, paraffin-embedded labial and parotid gland tissue sections from the same individuals. Complementary DNA libraries were prepared and sequenced. Biopsies with evidence of sclerosing chronic sialoadenitis or mucosa-associated lymphoid tissue lymphoma were excluded in the current analysis. For differential gene expression analysis, patients were subdivided in four categories: I) non-SS sicca without lymphocytic infiltration, II) non-SS sicca with aspecific infiltration, III) pSS with negative biopsy (focus score<1), IV) pSS with positive biopsy (focus score≥1). For each differentially expressed gene (DEG), a false detection rate (FDR) was calculated. FDR<0.05 was considered significant.

Results:

Principal component analysis (PCA) showed that only pSS patients with a positive biopsy (group IV) could be separated from the non-SS sicca patients based on gene expression. When comparing the labial and parotid gland transcriptome, resp. 798 and 1461 DEGs (FDR-adjusted p-value<0.05, log2 fold change >1) were identified between groups I and IV. The top differentially regulated genes were mostly related to T and B cells.CXCL13, CCR6, MS4A1(CD20), FCRL4andDAZLwere among the genes with the highest positive fold change in both glands of biopsy-positive pSS patients. Overall, there was a moderate to strong correlation between fold changes in labial and parotid glands (R2=0.58, p-value<0.0001). Between biopsy-negative and biopsy-positive pSS (groups III and IV), 226 and 962 DEGs were identified for labial and parotid gland tissue, respectively. Interestingly, we could not identify DEGs between biopsy-negative pSS (group III) and non-SS sicca patients (group I).

Conclusion:

The transcriptome of labial and parotid gland tissue from pSS patients with a positive biopsy is overall comparable, while salivary gland tissue from biopsy-negative pSS patients shows a comparable gene expression profile to non-SS sicca controls. These results indicate that different treatment strategies may be necessary for biopsy-negative and biopsy-positive pSS patients.

References:

[1]van Nimwegen JF,et al.Validation of the ACR-EULAR criteria for primary Sjögren’s syndrome in a Dutch prospective diagnostic cohort.Rheumatology (Oxford) 2018;57:818–25.

Disclosure of Interests:

Gwenny M. Verstappen: None declared, Lu Gao Employee of: BMS, Sarah A. Pringle: None declared, Silvia C. Liefers: None declared, Bert van der Vegt Consultant of: Advisory board member for Philips and Visiopharm., Vishal Patel Employee of: BMS, Sarah Hu Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sumanta Mukherjee Employee of: BMS, Arjan Vissink: None declared, Hendrika Bootsma Grant/research support from: Unrestricted grants from Bristol-Myers Squibb and Roche, Consultant of: Consultant for Bristol-Myers Squibb, Roche, Novartis, Medimmune, Union Chimique Belge, Speakers bureau: Speaker for Bristol-Myers Squibb and Novartis., Frans G.M. Kroese Grant/research support from: Unrestricted grant from Bristol-Myers Squibb, Consultant of: Consultant for Bristol-Myers Squibb, Speakers bureau: Speaker for Bristol-Myers Squibb, Roche and Janssen-Cilag

1141 Daytime Napping Trajectory Over Time And Its Association With Cognitive Aging: A 13-year Community-based Longitudinal Study Of Older Adults

Introduction

Daytime napping is common in elderly adults and has been associated with cognitive impairment. Prior studies have assessed napping at one time point, making it difficult to examine the longitudinal progression of napping and its association with cognitive aging. We examined objectively measured daytime napping longitudinally across different stages of Alzheimer’s disease (AD): from no cognitive impairment (NCI), to mild cognitive impairment (MCI), and to Alzheimer’s dementia.

Methods

We studied 1,066 participants (female: 810; age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 13 years. Motor activities of up to 10 days were recorded annually and used to assess napping objectively. We defined daytime napping episodes as segments between 10AM and 7PM with continuous zero-activity for ≥10min but &lt;1h (to avoid off-wrist periods). Segments that were &lt;5min apart were merged. Cognitive and clinical evaluations were administered annually to render a clinical diagnostic classification of NCI, MCI, or Alzheimer’s dementia. To examine how napping duration and frequency change with the progression of AD, we performed linear mixed-effects models with 2 change points anchored at the diagnoses of MCI and AD while adjusted for age, sex, and education.

Results

At baseline, participants had 1.44±0.04 (mean±standard error) naps with an accumulated duration of 35.0±1.1 min per day. Napping duration increased by 5.2±0.3 min and frequency increased by 0.21±0.01 times every year (both p&lt;0.0001). The rate of increase was more than doubled after MCI diagnosis with an annual increase of 11.4±0.7 min in duration and 0.40±0.02 times in frequency (both p&lt;0.0001); these were doubled further after AD diagnosis with an annual change of 26.3±3.1 min in duration and 0.84±0.08 times in frequency (both p&lt;0.0001).

Conclusion

Daytime napping duration and frequency increase with aging, and the increase was accelerated with AD progression.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.

1159 Sleep Traits And Incident Delirium During A Decade Of Follow-up In 173,000 Participants

Introduction

Delirium is an acute decline in attention and cognition that is with associated long-term cognitive dysfunction in elderly patients. Accumulating evidence points to strong associations between sleep health and disorders of the brain. We tested whether baseline sleep duration, chronotype, daytime dozing, insomnia or sleep apnea predict incident delirium during hospitalization.

Methods

We studied participants from the UK Biobank who have been followed for up to 10 years until 2017. We included 173,221 participants (mean age 60±5; range 50-71 at baseline) who had at least one episode of hospitalization/surgery and were free from prior episodes of delirium. Delirium diagnosis, hospitalization and surgical events were derived using ICD-10 coding. Multivariate logistic regression models were performed to examine the associations of self-reported baseline sleep duration (&lt;6hrs/6-9h/&gt;9h), daytime dozing (often/rarely), insomnia (often/rarely) and presence of sleep apnea (ICD-10 and self-report) with incident delirium during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, and major confounders (number of hospitalizations/surgical procedures, BMI, diabetes, major cardiovascular diseases and risk factors, major neurological diseases, major respiratory diseases, cancer, alcohol, depression/anxiety, sedatives/sleep aides, antipsychotics, steroids and opioids).

Results

In total, 1,023 (5.7 per 1,000 subjects) developed delirium. A prior diagnosis of sleep apnea (n=1,294) saw almost a two-fold increased odds (OR 1.96, 95% CI: 1.30-2.30 p=0.001) while those who often had daytime dozing were also at increased risk (OR 1.35, 95% CI: 1.02-1.80, p=0.025). Both these effects were independent of each other. No independent effects on incident delirium were observed from sleep duration, insomnia, or chronotype.

Conclusion

Certain sleep disturbances, in particular sleep apnea and daytime dozing, are independently associated with an increased risk for developing delirium. Further work is warranted to examine underlying mechanisms and to test whether optimizing sleep health can reduce the risk of developing delirium.

Support

This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

1135 Longer And More Frequent Naps Predict Incident Alzheimer’s Dementia In Community-based Older Adults

Introduction

Excessive napping duration has been associated with cognitive decline. The effect of napping frequency is less understood, and little is known about the development of Alzheimer’s dementia associated with napping. We tested whether longer or more frequent naps in the elderly are linked to the development of incident Alzheimer’s dementia.

Methods

We studied 1,180 older adults (age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 14 years. Motor activities of up to 10 days were recorded at baseline to assess napping characteristics objectively. We defined daytime napping episodes as motor activity segments between 10AM and 7PM with continuous zero-activity for ≥10min but &lt;1h (to avoid off-wrist periods). Segments that were &lt;5min apart were merged. Alzheimer’s dementia diagnosis was determined using the criteria of the National Institute of Neurological and Communicative Disorders and Strone and the Alzheimer’s Disease and Related Disorders Association. Cox proportional hazards models were performed to examine the associations of daily napping duration and frequency with incident AD.

Results

Of 1,180 non-demented participants at baseline (including 264 with mild cognitive impairment), 277 developed Alzheimer’s dementia within 5.74±3.36 years. On average, participants napped for 38.3±1.0 (SE) min and1.56±0.04 (SE) times per day at baseline. After adjustment for age, sex, and education, every 30-min increase in daily napping duration was associated with a 20% increase in the risk of incident AD (95% confidence interval [CI]: 9%-31%; p=0.0002). One more nap per day was associated with a 19% increase in the risk of AD (95% CI: 8%-30%; p=0.0003). These associations remained after further adjustment for total sleep time.

Conclusion

Longer and more frequent daytime naps predict a higher risk of incident Alzheimer’s dementia. Future studies are needed to examine specific underlying mechanisms.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.

0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

Introduction

In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse.

Methods

We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases).

Results

In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia.

Conclusion

Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms.

Support

This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

Highly Parallel Profiling of Cas9 Variant Specificity

Determining the off-target cleavage profile of programmable nucleases is an important consideration for any genome editing experiment, and a number of Cas9 variants have been reported that improve specificity. We describe here tagmentation-based tag integration site sequencing (TTISS), an efficient, scalable method for analyzing double-strand breaks (DSBs) that we apply in parallel to eight Cas9 variants across 59 targets. Additionally, we generated thousands of other Cas9 variants and screened for variants with enhanced specificity and activity, identifying LZ3 Cas9, a high specificity variant with a unique +1 insertion profile. This comprehensive comparison reveals a general trade-off between Cas9 activity and specificity and provides information about the frequency of generation of +1 insertions, which has implications for correcting frameshift mutations.

[Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia]

Objective: To explore and analyze the possible mechanism of liver injury in patients with coronavirus disease 2019 (novel coronavirus pneumonia, NCP). Methods: The correlation between ALT, AST and other liver enzyme changes condition and NCP patients' disease status reported in the literature was comprehensively analyzed. ACE2 expression in liver tissue for novel coronavirus was analyzed based on single cell sequencing (GSE115469) data. RNA-Seq method was used to analyze Ace2 expression and transcription factors related to its expression in liver tissues at various time-points after hepatectomy in mouse model of acute liver injury with partial hepatectomy. t-test or Spearman rank correlation analysis was used for statistical analysis. Results: ALT and AST were abnormally elevated in some patients with novel coronavirus infection, and the rate and extent of ALT and AST elevation in severe NCP patients were higher than those in non-severe patients. Liver tissue results of single cell sequencing and immunohistochemistry showed that ACE2 was only expressed in bile duct epithelial cells of normal liver tissues, and very low in hepatocytes. In a mouse model of acute liver injury with partial hepatectomy, Ace2 expression was down-regulated on the first day, but it was elevated up to twice of the normal level on the third day, and returned to normal level on seventh day when the liver recovered and hepatocyte proliferation stopped. Whether this phenomenon suggests that the bile duct epithelial cells with positive expression of Ace2 participate in the process of liver regeneration after partial hepatectomy deserves further study. In RNA-Seq data, 77 transcription factors were positively correlated with the expression of Ace2 (r > 0.2, FDR < 0.05), which were mainly enriched in the development, differentiation, morphogenesis and cell proliferation of glandular epithelial cells. Conclusion: We assumed that in addition to the over activated inflammatory response in patients with NCP, the up-regulation of ACE2 expression in liver tissue caused by compensatory proliferation of hepatocytes derived from bile duct epithelial cells may also be the possible mechanism of liver tissue injury caused by 2019 novel coronavirus infection.

[Investigation and analysis on characteristics of a cluster of COVID-19 associated with exposure in a department store in Tianjin]

Objective: To describe the epidemiological characteristics of a cluster of COVID-19 cases reported in Baodi district of Tianjin as of 18 February, 2020, which might be associated with the exposure in a local department store, and provide suggestions for prevention and control strategy development. Methods: The basic characteristics, time and area distributions, clinical manifestations, epidemiological history and transmission mode of the COVID-19 cases associated with the department store exposure were analyzed. Results: A total of 40 COVID-19 cases were associated with the department store exposure, accounting for 75.47% of the total confirmed cases (53 cases) reported in Baodi district. The cases were mainly at the age of 60 years or older (35.00%) and farmers (40.00%). The main clinical manifestations included fever (95.00%), cough (35.00%), and diarrhea (15.00%). The proportion of confirmed severe cases was 32.50%. The incidence curve showed that the incidence peak occurred on 31 January, 2020. Among the 40 cases, 6(15.00%) were department store employees, 19 (47.50%) were customers and 15 (37.50%) were close contacts (secondary cases). The first case occurred on 21 January, 2020, this case was a department store employee who had a purchasing history at whole sale markets in other provinces and cities before the onset, and 3 employees were still on duty after symptom onsets. The median of the incubation period of customer cases was 6 days, and the median of the interval between onset and medical treatment of customer cases was 7 days. Conclusion: This was a cluster epidemic of COVID-19, which might be associated with the exposure in the department store. By now, the current prevention and control measures have achieved satisfied effects.

Accuracy of molecular diagnostic tests for drug-resistant tuberculosis detection in China: a systematic review

OBJECTIVE: To evaluate the accuracy of molecular diagnostics for the detection of drug-resistant tuberculosis (TB) in Chinese patients.METHOD: Seven databases were searched for eligible studies that evaluated the accuracy of molecular diagnostics against drug susceptibility testing (DST) for detecting drug resistance. A bivariate random-effects meta-analysis was conducted to pool sensitivity and specificity by the index test and drug resistance type.RESULTS: A total of 159 studies were included. Compared with DST (reference standard), Xpert^® could diagnose rifampicin (RMP) resistant TB accurately, with a pooled sensitivity and pooled specificity of 92% (95%CI 90-94) and 98% (95%CI 97-98), respectively. Line-probe assays (LPAs) also performed well for RMP resistance, with a pooled sensitivity of 91% (95%CI 88-93) and pooled specificity of 98% (95%CI 96-99), but not for isoniazid (INH) or second-line drugs due to lower sensitivity (<80%). The pooled sensitivity of GeneChip^® microarrays for RMP, INH and multidrug resistance was 89% (95%CI 86-91), 79% (95%CI 75-82) and 79% (95%CI 73-84), respectively, and the specificities were all >97%. Similarly, the MeltPro^® TB/STR assay had better sensitivity and specificity for first-line drugs, varying from 87% to 89% and 97% to 98%, respectively, than for second-line drugs.CONCLUSION: The Xpert assay, LPA, GeneChip assay, and MeltPro assay are credible methods with high accuracy for RMP resistance detection, but they may not be appropriate for other anti-tuberculosis drugs due to low sensitivity.

[Application of two-step approach for tuberculosis infection testing in tuberculosis control in schools]

Latent tuberculosis infection (LTBI) testing and treatment in high risk populations is an important tool for tuberculosis control. In China, tuberculin skin test (TST) has been recommended as a primary testing method for Mycobacterium tuberculosis (MTB) infection in new students and close contacts in schools, which laid a solid foundation for the early case finding and management. However, Due to the influence of multiple factors including BCG vaccination and nontuberculous mycobacteria infection, TST showed limitations in specificity for MTB infection detection. Guidelines issued by other countries showed that using the two-step approach (TST-IGRA) has advantages in improving diagnostic accuracy as compared with using TST alone. From the perspective of precise intervention, two-step approach for MTB infection testing might be a favorable choice for tuberculosis control in schools in China.

[Value of contrast - enhanced ultrasonography and acoustic radiation force impulse elastography in identification of boundary range and viability of hepatic alveolar echinococcosis]

OBJECTIVE

To investigate the biologic viability and boundary range of hepatic alveolar echinococcosis (HAE) by the contrast-enhanced ultrasonography (CEUS) and acoustic radiation force impulse elastography (ARFI).

METHODS

Totally 27 HAE patients confirmed by pathology underwent CEUS and ARFI examinations.

RESULTS

Gray scale sonography of HAE showed unclear boundary, inhomogeneous, and middle hyperechoic nodules, and the maximum area was (6.08 ± 4.47) cm² in 27 lesions. CEUS of HAE showed non-enhancement in three phases and black hole sign. Circumferential enhancement on the pe riphery of the lesion was synchronized with the liver parenchyma and showed "fast in and slow out". The maximum area was (8.87 ± 4.83) cm². The area of ECUS was larger than gray scale sonography in HAE (t = 2.20, P = 0.03). The mean shear wave velocities (SWVs) of the interior, the boundary range, and the surrounding liver tissues of HAE were statistically different by ARFI (F = 84.538, P < 0.001), and the interior had the highest values.

CONCLUSIONS

CEUS and ARFI examinations can detect the biologic viability and boundary range of migrating zone around HAE, which is valuable for guiding treatment, judging curative effect, and predicting prognosis.

[Efficacy and safety of Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension]

Objective: To study the efficacy and safety of Balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Patients who were diagnosed CTEPH in China-Japan Friendship Hospital from Feb 2018 to Sep 2019 were evaluated. The ineligibility for pulmonary endarterectomy (PEA) and the indication for BPA were decided on the basis of a consensus among the multidisciplinary team for all CTEPH patients. 6-min walk distance (6MWD), the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary artery pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were collected and analyzed before the first and the last BPA session. Results: A total of 67 BPA sessions were performed for 302 subsegmental pulmonary arteries in 25 inoperable CTEPH patients. 10 males (40.0%) and 15 females (60.0%), with the age of (57.8±7.1) years old. The median interval between CTEPH diagnosis and first BPA was 20.0 (9.0, 48.5) months. 18 patients were received more than 2 BPA sessions, the median follow-up time was 5.0 (3.5, 8.3) months. 6MWD, CI and the mixed venous oxygen saturation were significant improved after BPA [(425±74) vs (345±109) m, (1.99±0.45) vs (1.62±0.35) L·min(-1)·m(-2), (68.1%±6.5%) vs (61.2%±6.3%)](all P<0.05). The plasma level of NT-proBNP, mPAP and PVR were significantly decreased after BPA [259 (93, 739) vs 806 (148, 2 159) ng/L, (40.6±8.3) vs (47.3±10.7) mmHg (1 mmHg=0.133 kPa), (11.9±4.9) vs (17.2±6.5) WU (1 WU=80 dyn·s·cm(-5))](all P<0.05). Hemoptysis occurred in 5 sessions (7.5%) and reperfusion pulmonary edema (RPE) occurred in 2 sessions (1.5%), 1 patient needed non-invasive mechanical ventilation because of RPE, 1 patient died from right heart failure caused by hemoptysis during perioperative period. Conclusions: BPA can significantly improve the exercise tolerance and hemodynamic parameters for inoperable CTEPH patients, the risks of BPA are acceptable. BPA is an effective and relatively safe treatment for inoperable CTEPH patients.