Pretransplant Homeostasis Model Assessment of Insulin Resistance and Fasting Plasma Glucose Predict New-Onset Diabetes After Renal Transplant in Chinese Patients

BACKGROUND AND AIM

The present study aims to determine if homeostasis model assessment of insulin resistance (HOMA-IR) index, fasting plasma glucose (FPG), and plasma insulin (Ins) are able to predict development of new onset diabetes after transplant (NODAT) for kidney recipients.

METHODS

We performed a single-center retrospective study of 123 nondiabetic patients receiving a first renal transplant. The NODAT was diagnosed between 1 month and 1 year post transplant. Both univariate and multivariable analyses, including logistic regression analysis and Cox proportional hazards model, were applied to dissect potential pretransplant risk factors of NODAT.

RESULTS

A total of 26.8% (33/123) of recipients developed NODAT in the first year post transplant. The NODAT patients showed higher HOMA-IR index and increased levels of FPG and Ins than non-NODAT. Interestingly, we consistently revealed that both FPG (logistic: odds ratio [OR], 3.17 [1.41-6.45]; P = .01; Cox: OR, 2.75 [1.26-4.56]; P = .02) and HOMA-IR index (logistic: OR, 1.73 [1.21-2.87]; P = .02; Cox: OR, 1.72 [1.21-2.46]; P = .002) robustly predicted the development of NODAT. However, these analyses showed that neither plasma Ins nor hemoglobin A_1c was associated with NODAT.

CONCLUSION

Our findings suggest that pretransplant HOMA-IR and FPG are independent predictors for the development of NODAT in Chinese nondiabetic patients receiving a first renal transplant.

[Visual-spatial and temporal characteristics related to infectious Tuberculosis epidemics in Guangxi Zhuang Autonomous Region, 2012-2015]

Objective: To study the spatial and temporal mode of infectious TB transmission in Guangxi Zhuang Autonomous Region (Guangxi). Methods: Data related to infectious TB case (Include smear and/or culture positive patients) in Guangxi were collected from the National Notifiable Disease Reported System (NNDRS) from 2010 to 2015. Spatial-temporal analysis and prediction were performed by SaTScan 7.0.2, GeoDa 1.8.12, R program v 3.3.1 and SPSS 19.0 software, using the time series model, Moran's I global and local spatial autocorrelation (Empirical Bayes adjustment). Kulldorff 's space-time scan statistics displayed by R software was used to identify the temporal and spatial trend of TB. Results: The total number of infectious TB cases, collected from NNDRS was 76 151, and showing a decreasing trend on annual incidence (value of Chi-square for Linear trend=3 464.53, P-value=0.000). The forecast value of TB cases in 2016 was 7 764 (4 971-10 557), with peak in March, analyzed through the Winters'multiplicative model. The Moran's I global Statistics was greater than 0 (0.257-0.390). TB cluster seemed to have been existed for several years. The most significant hot spots seemed to be mainly located in the central and western parts of Guangxi, shown by local spatial autocorrelation statistics and the result from space-time scanning.Counties or districts that located in the east parts of Guangxi presented the low-low relation (significant cold spots). The situation of infectious TB seemed migratory. Conclusions: Our data showed an annual decreasing trend of incidence on infectious TB with temporal concentration in spring and summer. Main clusters (hot spots) were found to be located in the central and western parts of Guangxi. Hopefully, our findings can provide clues to uncover the real mode of TB transmission at the molecular-biological level.

Increased Dental Use May Affect Changes in Treated and Untreated Dental Caries in Young Children

INTRODUCTION

From 1999-2004 to 2011-2014, untreated dental caries prevalence decreased among US children aged 2 to 5 y, regardless of family income. Policies were concurrently initiated for children to increase access to preventive dental services in dental, primary, and community settings and to restorative care in dental settings.

OBJECTIVES

We aimed to examine 1) whether changes in prevalence and severity of untreated and treated caries between the periods varied by family income and 2) to what degree increased past-year dental visit (PYDV) contributed to the changes.

METHODS

We used data for 3,822 children in the National Health and Nutrition Examination Survey 1999 to 2004 and 2011 to 2014. Caries prevalence included prevalence of untreated caries with ≥1 decayed teeth (dt) and prevalence of treated caries with ≥1 filled teeth (ft). Caries severity included number of dt and ft among those with ≥1 dt or ft. We estimated changes in caries outcomes among low- and higher-income children with models-one controlling for sociodemographics and another controlling for sociodemographics and PYDV. Significant changes ( P < 0.05) becoming insignificant after controlling for PYDV provide insight on the contribution of PYDV to changes in outcomes.

RESULTS

Prevalence of untreated caries decreased for low- and higher-income children, with a slightly larger decrease for low-income children; dt decreased only for low-income children; and estimated decreases did not vary by model. An increase in prevalence of treated caries was observed only among low-income children but became minimized and insignificant after controlling for PYDV. Similarly, after controlling for PYDV, the increase in ft among low-income children lost significance, whereas the increase among higher-income children remained.

CONCLUSION

Untreated caries among children aged 2 to 5 y declined from 1999-2004 to 2011-2014, with larger declines among low-income children. While changes in PYDV contributed to increases in treated caries, particularly for low-income children, additional factors appear to have contributed to decreased untreated caries.

KNOWLEDGE TRANSFER STATEMENT

For young children, the degree and direction of changes in caries over the last decade varied by outcome measure (e.g., untreated or treated) and family poverty status. Examining the effect of increased dental utilization on changes in untreated and treated caries outcomes can help identify those policies that contribute to changes in these outcomes and highlight the potential role of the different caries assessment criteria used in dental offices versus those in a population-based survey.

Characterization of bacteriophage HN48 and its protective effects in Nile tilapia Oreochromis niloticus against Streptococcus agalactiae infections

Streptococcus agalactiae is a causative agent responsible for massive mortalities of tilapia that has led to catastrophic losses to tilapia culture globally. Bacteriophages represent a new class of antimicrobials against bacteria. In this study, we characterized the bacteriophage HN48, which formed small and round-transparent plaques on a double-layer plate. With a hexagonal head and a long tail, this phage may belong to the Caudovirales according to the International Committee on Taxonomy of Viruses. HN48 was found to have a relatively wide and highly specific host range, to be sensitive to high temperature (60-80°C) and low pH (3-5), and to be relatively stable at alkaline pH (8-10). Intraperitoneal injection with HN48 had no adverse effects on tilapia and effectively inactivated the bacteria in the kidney. Fish that received phage therapy had 60% ± 3.3% survival rates and a delayed mean death time of about 3 days when compared to the control group. To the best of knowledge, this is the first study of tilapia streptococcal phage. Overall, the results indicated that phage HN48 could prevent tilapia from experimental S. agalactiae infection, suggesting it has the potential to control this disease.

Clinical Efficacy of Combination Intravenous and Intraperitoneal Chemotherapy in the Treatment of Gastric Cancer With Peritoneal Carcinomatosis

Background: Gastric cancer (GC) is prone to metastasis that typically resulted in peritoneal carcinomatosis (PC). GC patients with PC have an extremely poor clinic prognosis. Although GC is sensitive to chemotherapy, PC causes chemotherapy failure. Recent studies showed the combination of intravenous and intraperitoneal chemotherapy can significantly improve the survival rates in GC patients with PC. Aim: To identify the clinical and adverse effects of intravenous chemotherapy combined with intraperitoneal perfusion chemotherapy in the treatment of abdominal peritoneal carcinomatosis arising from gastric cancer. Methods: Retrospective analysis was performed on 49 patients with abdominal peritoneal carcinomatosis from gastric cancer who were treated at the Fujian Medical University Union Hospital between September 2010 and September 2015. The patients were divided into 2 groups based on treatment method: patients subjected to intravenous chemotherapy (n = 27), referred to as the simple group and patients subjected to combined intravenous and intraperitoneal chemotherapy (n = 22), referred to as the combination group. The short-term effects and adverse effects were evaluated based on treatment method, in conjunction with a related review of the results. The long-term effect was evaluated based on the survival rate and median survival time of both groups of patients at 12, 18, 24, 30, 36, and 60 months, as determined through follow-up. Results: Gender, age, ECOG scores before treatment, clinical stages, and the pathologic data of advanced GC patients of the 2 groups were equally distributed. The objective efficacy evaluation results showed that the objective response rate (ORR) and disease control rate (DCR) of the simple group after treatment were significantly lower than in the combination group. The median survival time (MST) of the simple group was (6.57 ± 0.75) months, which was significantly shorter than in the combination group (15.03 ± 2.31) months ( P < 0.05). In addition, the 12-, 18-, 24-, 30-, 36-, and 60-month survival rates of the simple group were all significantly lower than those of the combination group. Furthermore, combined therapy improved the physical condition of the patients. The incidence of adverse reactions in the 2 groups was not statistically significant; neither of the treatments resulted in severe complications. Conclusion: Compared with intravenous chemotherapy alone, the combined intravenous and intraperitoneal perfusion chemotherapy was more effective in improving quality of life and extending survival in time patients with abdominal peritoneal carcinomatosis from gastric cancer. In addition, the treatment produced only mild adverse effects, showing that it is tolerable and therefore worth further clinical study.

Exosomal neutral sphingomyelinase 1 suppresses hepatocellular carcinoma via decreasing the ratio of sphingomyelin/ceramide

Neutral sphingomyelinase 1 (NSMase1) mediates caspase-3 activation and apoptosis. However, the role of NSMase1, especially exosome-borne NSMase1 in hepatocellular carcinoma (HCC), remains unclear. We report that NSMase1, which converts sphingomyelin (SM) to ceramide, was significantly downregulated in HCC tissues. Low NSMase1 expression predicted poor long-term survival of HCC patients. NSMase1 downregulation in HCC resulted in increased SM and reduced ceramide (Cer) that led to an increased SM/Cer ratio. Interestingly, NSMase1 and NSMase activity were also decreased in exosomes isolated from HCC tissues and cell lines. Furthermore, NSMase activity increased in exosomes isolated from the culture medium of L02 cells transfected with pEGFP-C3-NSMase1 (NSMase1-Exo). NSMase1-Exo suppressed HCC cell growth and induced apoptosis via reduction of the SM/Cer ratio. Thus, NSMase1 in exosomes inhibits HCC growth by decreasing the SM/Cer ratio.

Enteric motor dysfunctions in experimental chronic pancreatitis: Alterations of myenteric neurons regulating colonic motility in rats

BACKGROUND

The mechanism underlying gastrointestinal (GI) dysmotility associated with chronic pancreatitis (CP) has not been fully elucidated, and enteric nervous system (ENS) has an important regulatory role in gastrointestinal motor function. The aim of this study is to investigate the effect of ENS in the colonic hypomotility induced by trinitrobenzene sulfonic acid (TNBS) infusion which mimics CP.

METHODS

Male Sprague-Dawley rats were submitted to CP which was induced by pancreatic infusion of 2% TNBS, or sham group with treatment of equal saline. Three weeks after induction of CP, we pathologically examined the inflammation of pancreas and counted the number of withdrawal events stimulated by Von Frey filaments to evaluate hyperalgesia. The gastrointestinal transit rate was measured using Carbon inkl driving test, and the contraction activities of colonic muscle strip were studied in an organ bath system. The expression of choline acetyltransferase (ChAT) and nitric oxide synthase (NOS) in colonic myenteric plexus (MP) of ENS were investigated by Western blotting and double immunofluorescence staining.

KEY RESULTS

In TNBS-treated group, rats had the signs of chronic pancreatitis 3 weeks after intraductal infusion and had increased sensitivity to mechanical stimulation of the abdomen. For rats with CP, the gastrointestinal transit rate was reduced; in addition, the contractile activities of longitudinal muscle (LM) and circular muscle (CM) strips of distal colon in TNBS group were lower than those in sham group. Immunofluorescence demonstrated that the percentage of ChAT-immunoreactive (IR) neurons in the MP was decreased, but the proportion of NOS-IR neurons in the MP was increased when compared with sham-operated group. Western blotting proved that TNBS infusion down-regulated ChAT but up-regulated NOS expression in the colon MP.

CONCLUSIONS & INFERENCES

Decreased ChAT-IR neurons and increased NOS-IR in the MP of colon ENS may contribute to the pathogenesis of colonic dysmotility in CP.

Clinical Outcomes of Endovascular Treatment within 24 Hours in Patients with Mild Ischemic Stroke and Perfusion Imaging Selection

BACKGROUND AND PURPOSE

Endovascular thrombectomy has been accepted as the standard of care for patients with acute ischemic stroke. Our aim was to investigate the clinical outcomes of patients with mild ischemic stroke with acute proximal large-vessel occlusion after endovascular treatment within 24 hours of symptom onset.

MATERIALS AND METHODS

Between January 2014 and August 2017, ninety-three Chinese patients with mild ischemic stroke (NIHSS scores, 0-8) and large-vessel occlusion with endovascular treatment were retrospectively enrolled from 7 comprehensive stroke centers. They were divided into 2 groups: ≤6 hours and 6-24 hours from symptom onset to groin puncture. We analyzed their modified Rankin Scale scores at 90 days, symptomatic intracranial hemorrhage at 48 hours, and mortality during 90 days. Multivariable linear regression analysis was used to identify predictors for NIHSS shift after discharge.

RESULTS

Twenty-nine patients received endovascular treatment within 6-24 hours after symptom onset and had an imaging mismatch based on perfusion CT or diffusion-weighted MR imaging. There were no substantial differences between the 2 groups in 90-day functional independence (P = .54) and the risks of the combination of symptomatic intracranial hemorrhage and death (P = .72). Two significant indicators of NIHSS shift were 48-hour symptomatic intracranial hemorrhage (unstandardized β = 7.28; 95% CI, 3.48-11.1; P < .001) and baseline systolic blood pressure (unstandardized β = 0.08; 95% CI, 0.03-0.14; P = .005).

CONCLUSIONS

Patients with mild ischemic stroke and large-vessel occlusion in the anterior circulation, an imaging mismatch, and endovascular treatment within 6-24 hours of initial symptoms showed no heterogeneity in the efficacy and safety outcome compared with those treated ≤6 hours from symptom onset.

[Development of a novel absorbable nanofiber chitosan-collagen membrane by electrospinning and the preliminary study on guided bone regeneration]

Objective: To evaluate the application effect of nanofiber chitosan-collagen membrane (NCM) on guided bone regeneration (GBR). Methods: The mixture of collagen, chitosan, polyethylene oxide was used to make up the NCM by electrospinning, then the NCM was crosslinked by glutaraldehyde vapor. The physical property of the NCM was measured by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). MC3T3-E1 osteoblasts were cultured on NCM to characterize the biocompatibility. The effectiveness of four groups [contrast group, Bio-gide membrane (BGM), compressed chitosan-collagen menbrane (CCM), NCM/CCM] on bone regeneration were evaluated in critical-sized defects (diameter=5 mm) in SD rats. Results: When the mixed solution consists of 4.0% collagen, 1.0% chitosan and 3.5% polyethylene oxide, the NCM could be validly fabricated by electrospinning. After cross-linking by glutaraldehyde vapor, the tensile strength and the stability of NCM in damp was enhanced. No cytotoxicity of the NCM was detected on MC3T3-E1 osteoblasts. In vivo study showed that the new bone regeneration ratio of NCM/CCM group was [(43.10±1.49)%], and this was similar to that of the group of BGM [(41.36±2.60)%] (P>0.05), but higher than that of the CCM group [(33.10±1.41)%] and the contrast group [(7.22±2.46)%] (P<0.05). Conclusions: The NCM can promote new bone regeneration effectively in GBR procedure.

Clinical observation and retrospective study of the influential factors of liver metastasis in 306 cases of colon cancer

PURPOSES/OBJECTIVES

By observing and analyzing the clinical features of the colon cancer and the influence factors of liver metastasis, we try to find out independent risk factors with significant influence on colon cancer liver metastasis as well as to provide reference for clinical treatment.

MATERIALS AND METHODS

A total of 306 cases of colon cancer patients' clinical data, including gender, age, primary focal size, primary focal intestinal segment, degree of differentiation, infiltration depth, level of serum carcinoembryonic antigen (CEA) before surgery, lymph node metastasis, liver basic diseases were collected and recorded. Single-factor Chi-square analysis and multifactor logistic regression analysis (SPSS 16.0 software) were used to retrospectively study the possible influence factors of colon liver metastases and to preliminary discuss the potential risk factors of liver metastasis in colon cancer patients.

RESULTS

The Chi-square analysis showed that patients' primary focal segment, degree of differentiation, infiltration depth, level of serum CEA before surgery, and states of hepatitis B does 2 half-and-half had significant effect on the incidence of liver metastasis. However, in the further logistic regression analysis, it showed that only the infiltration depth and the states of hepatitis B does 2 half-and-half were the independent risk factors that influence the hepatic metastases. What was more, the both subgroups of positive hepatitis B with infection and vaccine showed significant statistical differences when comparing with hepatitis B all negative in the event of the probability of liver metastases (P = 0.011 and 0.004).

CONCLUSIONS

The infiltration depth and the states of hepatitis B does 2 half-and-half were the independent risk factors on colon cancer patients' hepatic metastases. Those with the infiltration depth of T4 had a higher rate of hepatic metastases. Patients with does 2 half-and-half-positive hepatitis B (whether subgroup of hepatitis B virus infection or subgroup hepatitis B vaccine related) had a lower incidence rate of liver metastasis than those with hepatitis B all negative.

[Computer Aided Diagnosis system of breast ultrasound based on support vector machine: a clinical analysis]

Objective: To investigate the value of based on support vector machine (SVM) breast ultrasonography technology of Computer-Assisted diagnosis (CAD) for differential diagnosis of benign and malignant breast masses. Methods: Total of 143 patients who had 151 breast masses were collected in Fujian Maternity and Children Health Hospital or The Fist Affiliated Hospital of Fujian Medical University from June 2014 to December 2015. Based on pathological results as the gold standard, the diagnostic efficiency of CAD and ultrasonography were compared. Results: The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasonography were 80.1%, 71.0%, 76.8%, 80.0% and 72.1%, respectively. And the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CAD were 96.6%, 90.3%, 94.0%, 93.5% and 94.9%, respectively. The specificity, accuracy, positive predictive value and negative predictive of CAD technology were significantly higher than those of ultrasonography (P<0.05). The area under the receiver operator characteristic curve of ultrasonography and CAD were 0.759 and 0.935 respectively, with significant difference (P<0.05). Conclusions: CAD has a higher specificity and accuracy rate than ultrasonography in the diagnosis of breast masses. It could help to differentiate benign from malignant breast masses.

[Study of epidemiological characteristics and viral sources of dengue fever outbreak in Guangxi Zhuang Autonomous Region, 2014]

Objective: To understand the epidemiological characteristics and viral sources of dengue fever outbreak in Guangxi Zhuang Autonomous Region (Guangxi) in 2014. Methods: A combined analysis of epidemiological characteristics and genetic characteristics were performed in this study. The time, population and area distributions of the cases were analyzed. Serum samples were collected from dengue fever cases to detect NS1 antigen by using commercial ELISA kits according to the guideline of the manufacture. RT-PCR assay was conducted to detect dengue virus in NS1 positive samples. Phylogenetic tree based on E gene sequence of dengue virus were further analyzed. Results: During September-December 2014, an outbreak of dengue fever caused by dengue virus type 1 and 2 occurred in Guangxi, a total of 854 cases were reported without death, including 712 laboratory confirmed cases and 142 clinical diagnosed cases, in which 79.63% (680/854) occurred during 22 September-21 October 2014. All the cases had typical dengue fever symptoms. Most cases occurred in Nanning and Wuzhou, in which 83.61% (714/854) were in age group 15-59 years; 46.60% (398/854) were staff or people engaged in commercial service. A total 526 serum samples were tested for dengue virus serotype by RT-PCR assay. Among 414 positive samples, 345 were positive for dengue virus type 1 (DENV-1) and 69 were positive for dengue virus type 2 (DENV-2), no DENV-3 and DENV-4 were detected. The results of phylogenetic analysis of E gene sequence indicated that the sequences of 99.12%(113/114) of DENV-1 strains in Nanning in China shared 100.00% homology with the isolate (SG EHI D1/529Y13) from Singapore in 2013, which belonged to the genotype Ⅰ; All the DENV-2 isolates from Wuzhou shared 99.80% homology with the isolate (D14005) from Guangdong province, which belonged to genotype Cosmopolitan. Conclusions: The outbreak was caused by DENV-1 from Singapore and DENV-2 from Guangdong province in China. It is necessary to strengthen the surveillance and early warning for imported dengue fever, conduct vector control and improve the diagnosis of suspected dengue fever cases for the effective control of dengue fever outbreak.

[The study of wideband acoustic immittance normative data of young people]

Objective:To explore the normative data of wideband acoustic absorption rate of young people with normal hearing, and the related factors of wideband acoustic immittance.Method:Eighty six cases of young people with normal hearing (43 cases of male, 43 cases of female) were collected in the clinical audiology centers of Beijing Tongren Hospital, Capital University of Medical. The average age is (22.0±1.5) years. Pure tone audiometry in the range of 250 to 8 000 Hz in each octave is carried out, and the air conduction thresholds are less than 25 dB HL; 226 Hz tympanometry were type A. For all subjects, the wideband acoustic immittance measurement was conducted at 226-8 000 Hz, and a total of 107 frequency points were carried out.Result:The test results of 172 ears were statistically analyzed.①In the range of 250-8 000 Hz,acoustic absorption rate in the low frequency range increases gradually, and the peak is found in the range of 1 000 to 3 000 Hz;getting along with the increase of frequency and acoustic absorption rate gradually decreases slowly.②The acoustic absorption rate in the range of 4 200-4 900 Hzin female subjects was significantly higher than that in male subjects.③There was no significant relationship between gender, compliance, peak pressure, and width in 226 Hz tympanometry (P=0.319, 0.831, 0.786), however there was a significant relationship between gender and the ear canal volume (P<0.01).④There was no significant relationship between gender and the resonance frequency (P>0.05).⑤There was a significant correlation between height/weight and ear canal volume (P<0.05), and there was a significant relationship between the ear canal volume and the resonance frequency (P<0.05).Conclusion:The acoustic absorption rate of young people in the low frequency range was lower, then increases gradually, and the peak was found in the range of mid-high frequency. The difference in the wideband absorption rate between genders was significant. The height and weight had influence on the results of wideband acoustic immittance.