Resistance of black soldier fly (Diptera: Stratiomyidae) larvae to combined heavy metals and potential application in municipal sewage sludge treatment

Treating municipal sewage sludge (MSS) sustainably and economically in China remains a challenge because of risks associated with the heavy metals it contains. In this study, black solider fly larvae (BSFL) were used for MSS treatment. The resistance of larvae to combined heavy metals and their potential use in conversion of MSS were investigated. The results indicated that seven MSS samples contained large amounts of heavy metals, with the lead and nickel contents of several samples exceeding Chinese national discharge standards. BSFL were highly tolerant to an artificial diet spiked with combined heavy metals. Principal component analysis revealed that high concentrations of lead, nickel, boron, and mercury potentially interfered with larval weight gain, while zinc, copper, chromium, cadmium, and mercury slightly reduced larval survival. The addition of chicken manure and wheat bran as co-substrates improved the conversion process, which was influenced by the nature and amount of added co-substrate and especially the quantity of nitrogen added. With the amended substrate, the BSFL accumulated heavy metals into their bodies but not into extracted larval oil. The heavy metal content of the treatment residue was lower than that considered safe for organic-inorganic compound fertilizers standards in China and the harvested larvae could be used as a source of oil for industrial application.

[Application of Metagenomics in Forensic Identification]

With the development of molecular biology and genomics, metagenomics is playing a more important role in forensic science and forensic identification. In recent years, as a branch discipline studying the composition profile and diversity of microbe flora as well as studying the interaction within microbe and with environment, the application of metagenomics has gradually risen and brought new opportunities for forensic identification-related area. In this review, strategy of metagenomics and its application in forensic identification including individual identification, origin determination of biological stain in crime scene and drug abuse detection are summarized. This article aims to elucidate the role and application value of metagenomics in forensic science.

Expressions of IL-6, TNF-α and NF-κB in the skin of Chinese brown frog (Rana dybowskii)

The cytokine interleukin-6 (IL-6) mediates a wide range of inflammatory and immune responses. Tumor Necrosis Factor α (TNF-α) has a myriad of pro-inflammatory effects on the skin. Nuclear factor κB (NF-κB) is a transcriptional factor that regulates a battery of genes that are critical to immune system. In this study, we investigated the localizations and expression levels of IL-6, TNF-α and NF-κB in the skin of Rana dybowskii during the breeding period and pre-hibernation. Histologically, the skin of Rana dybowskii consisted of epidermis and dermis. Four kinds of cells were identified in the epidermis, while the dermis was composed of homogenous gel, mucous glands and granular glands. IL-6, TNF-α and NF-κB were immunolocalized in the epithelial and glandular cells in both periods. Western blotting showed that IL-6, TNF-α and NF-κB were significantly higher in the pre-hibernation compared to the breeding period. Real- Time PCR revealed that the relative mRNA levels of IL-6 and NB-κB in the pre-hibernation increased significantly compared with the breeding period, while the TNF-α mRNA expression levels were not significantly different between these two periods. These results suggested that IL-6, TNF-α and NF-κB might collectively be involved in the skin immune system of Rana dybowskii during the breeding period and pre-hibernation.

[The efficacy of thyroid hormone replacement therapy in patients with hypothyroidism and OSAHS: a Meta analysis]

Objective:To systematically evaluate the impact of thyroid hormone replacement in patients with OSAHS and hypothyroidism.Method:The related case-control study of thyroid hormone replacement in patients with OSAHS and hypothyroidism had been searched from Cochrane Library, PubMed, CNKI, Chinese Biomedical Literature Database, Wanfang Resource Database.The case-control study which were in line with the condition need to be evaluated the quality and to be extracted in literature. The RevMan 5.3 and STATA softwares were applied to carry out the Meta analysis.Result:Seven literatures of case-control study were included. The Meta analysis showed that: After the thyroid hormone replacement, the patient's AHI index, TSH index, LSaO₂ index were significantly improved (P< 0.05). The AHI index statistical results of the patients were [SMD= 3.15, 95%CI: (4.36-1.94), P< 0.000 01; I²= 96%], TSH index were [SMD= 4.15,95%CI: (1.15-7.15), P= 0.007; I²= 99%], LSaO₂ index were [SMD=-1.08, 95%CI: (-1.46--0.70), P< 0.000 01, I²= 68%].Conclusion:The use of thyroid hormone replacement can effectively reduce the patient's hypothyroidism symptoms and AHI symptoms.

[Degeneration and regeneration characteristics of nerves and muscles after recurrent laryngeal nerve injury]

Objective:We investigated the degeneration and regeneration characteristics of nerves and muscles after different degrees of recurrent laryngeal nerve (RLN) injury, and then discussed the possible relations between them. Method:Ninety-five Sprague Dawley (SD) rats were used in this study, 2 rats died of infection, 2 died during surgery and 1 died in transit. The rest 90 SD rats were classified as having complete injuries (transection,43 rats), incomplete injuries (crush, 43 rats) and conrtol group (4 rats). The characteristics of nerve injuries were evaluated by endoscopic examination, laryngeal electromyography (LEMG), and histopathologic examination at 6 hours, 12 hours, 1 day, 3 day, 5 day, 1 week, 2 weeks, 3 weeks and 4 weeks after the injury. Result:All the vocal folds kept fixation in the completely injury group, where as 41/43 vocal folds in imcompletely injury group got normal activity 2 weeks after surgery, 1 at 3 weeks and 1 at 4 weeks. Fibrillation potentials were found 1 day after transection, and rennervation potentials appeared 4 weeks after transection. LEMG was normal 3 weeks after RLN was crushed. The average muscle fiber number of the left thyroarytenoid (TA) decreased with the time in the completely injury group, which increased in the second week after crush. Degeneration appeared more seriously in the distal region after transaction, and a small amount of large myelinated nerve fibers appeared at 4 weeks after injury. The most serious nerve degeneration appeared in the first day after crush, and 1 week later the ultrastructures of RLN were almost normal. The phagocytosis of Schwann cells occurred within 2 weeks after injury, 3 weeks later we found the apperance of Schwann cells who did not wrap around nerve fibers, especially in the proximal region. In the crush group, the phagocytosis of Schwann cells occurred within 1 week after injury, apoptosis and degeneration appered occasionally. Inflammatory response was more severe in the transection group, the number of fibroblasts and collagen fibers in the mesenchy increased. Conclusion:The degeneration is more severe in the distal nerve when RLN is traversed. Nerve regeneration appears in the fourth week after RLN is traversed. Injuried nerve has the ability to repair itself. Schwann cells play a role in phagocytosis after injury, and immature Schwann cells are found. Nerve fiber disintegration product can accelerate the migration of macrophage activation.

Targeting C3a/C5a receptors inhibits human mesangial cell proliferation and alleviates immunoglobulin A nephropathy in mice

Complement activation has a deep pathogenic influence in immunoglobulin (Ig)A nephropathy (IgAN). C3a and C5a, small cleavage fragments generated by complement activation, are key mediators of inflammation. The fragments exert broad proinflammatory effects by binding to specific receptors (C3aR and C5aR, respectively). However, no studies thus far have investigated the effects of C3a, C5a and their receptors on IgAN. We observed that C3aR and C5aR antagonists repressed IgA-induced cell proliferation and interleukin (IL)-6 and monocyte chemotactic protein 1 (MCP-1) production in cultured human mesangial cells (HMCs). Furthermore, an IgAN mouse model induced by Sendai virus infection was employed to investigate the effects of C3aR and C5aR on IgAN in vivo for the first time. Wild-type (WT) and several knock-out mouse strains (C3aR^-/- or C5aR^-/- ) were immunized intranasally with increasing doses of inactivated virus for 14 weeks and were subjected to two intravenous viral challenges during the time-period indicated. In the Sendai virus-induced IgAN model, C3aR/C5aR-deficient mice had significantly reduced proteinuria, lower renal IgA and C3 deposition, less histological damage and reduced mesangial proliferation compared with WT mice. Both C3aR deficiency and C5aR deficiency, especially C3aR deficiency, inhibited renal tumour necrosis factor (TNF)-α, transforming growth factor (TGF)-β, IL-1β, IL-6 and MCP-1 expression significantly. However, C3aR/C5aR-deficient and WT mice with IgAN did not differ with respect to their blood urea nitrogen (BUN) and serum creatinine levels. Our findings provide further support for the idea that C3aR and C5aR are crucially important in IgAN, and suggest that pharmaceutically targeting C3aR/C5aR may hold promise for the treatment of IgAN.

Spodoptera litura autophagy-related protein 1 interacts with autophagy-related protein 5 and enhances its degradation

It is known that the autophagy-related protein 1 (ATG1) plays critical roles in the regulation of autophagy in mammals and yeast, whereas the function of ATG1 in lepidopteran insects is not well elucidated. Here Spodoptera litura ATG1 (SlATG1) and its interactions with other ATG proteins were characterized. Alternative splicing of SlAtg1 produced at least four transcript variants. Over-expression and RNA interference knockdown of SlAtg1 demonstrated that SlATG1 enhanced autophagy. SlATG1A-Green fluorescent protein (GFP) tagged localized in the cytoplasm and formed some punctuate dots, which were colocalized with red fluorescent protein mCherry tagged Spodoptera exigua ATG5 (SeATG5). SlATG1A-GFP over-expression reduced the nuclear abundance of mCherry-SeATG5 but increased its cytoplasmic abundance. Pull-down, co-immunoprecipitation and bimolecular fluorescence complementation assays showed that SlATG1A bound to SeATG5 through the N-terminus of SlATG1A. The over-expression of FLAG epitope tagged SlATG1A significantly increased the accumulation of the cleaved GFP from GFP-SeATG5, suggesting the enhanced degradation of GFP-SeATG5. In addition, we confirmed that the interactions of SlATG1 with other autophagy-related proteins were conserved. These results provide the first evidence that ATG1 interacts with ATG5 and enhances its degradation in lepidopteran insect cells, which may have important physiological functions.

Abstract P3-04-12: Both spliced and unspliced XBP1 regulates breast cancer cell fate response to antiestrogen via NFkappaB signaling

Unfolded protein response (UPR), a stress-induced survival mechanism, may be used by cancer cells to avoid cell death. Antiestrogen therapy, widely applied in the treatment of estrogen receptor-positive (ER+) breast cancer, induces endoplasmic reticulum stress (EnR stress) that leads to activation of each of the three arms of the UPR. One critical prosurvival activator that is regulated by two arms of the UPR is the transcription factor X-box binding protein 1 (XBP1). XBP1 exists in two isoforms, the transcriptionally inactive unspliced XBP1(U) and the spliced, active XBP1(S). Overexpression of XBP1(S) confers estrogen independence and antiestrogen resistance in ER+ breast cancer cells and XBP1(S) expression correlates with poor clinical responsiveness to Tamoxifen in ER+ breast tumors. However, the underlying signaling mechanisms regulated by XBP1, which may mediate its effects on antiestrogen resistance, are unknown. We show that depletion of endogenous XBP-1 by siRNA increases apoptosis, decreases autophagy, requires down-regulation of p65/RelA, a component of the pro-survival NFκB complex. Using novel spliced and non-spliceable forms of XBP1, we show that XBP1(U) and XBP1(S) both regulate NFκB activity via ERα signaling in breast cancer cells. XBP1(S), but not XBP1(U), also can regulate p65/RelA expression independent of ERα. Antiestrogen resistance as conferred by XBP1 overexpression in MCF-7 cells requires the activation of NFκB signaling; inhibition of NFκB signaling by either the small molecule NFκB inhibitor Parthenolide or p65/RelA siRNA sensitizes XBP1 overexpressing cells to Tamoxifen. The activation of XBP1 and the downstream NFκB signaling is likely to contribute to the TMEM33 overepxression induced apoptosis, as both NFκB signaling and XBP1(S) are elevated in TMEM33 overexpressed MCF7 cells. Thus, we have identified a critical regulatory link between the UPR/XBP1 pathway and pro-survival NFκB signaling that is a major contributor to endocrine responsiveness in ER positive breast cancer.

Citation Format: Clarke R, Hu R, Warri A, Jin L, Zwart A, Riggins R, Fang H-b. Both spliced and unspliced XBP1 regulates breast cancer cell fate response to antiestrogen via NFkappaB signaling [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-04-12.

Abstract P4-10-02: Transmembrane protein 33 (TMEM33) induces apoptosis via UPR signaling and autophagy in breast cancer cells

Breast cancer is the most common cancer diagnosed in women. Endoplasmic reticulum stress (EnR stress) and the related unfolded protein response (UPR) are activated in breast cancer cells and can promote cell survival and endocrine resistance. TMEM33 is a novel transmembrane protein that resides in the endoplasmic reticulum (EnR) and has been shown to activate the PERK and IRE1α branches of the UPR. However, the underlying mechanism of action of this EnR resident protein TMEM33 and the cellular functions that it regulates remain largely unknown. In this study, we show that overexpression of TMEM33 induces robust cell death in breast cancer cells. TMEM33 overexpression strongly activates UPR associated pro-death JNK-p53 signaling. We also observed a significant inhibition of the downstream survivin, which blocks cell death activation by binding to caspases and inhibiting their activation. We further show that the blockage of JNK activation with either an inhibitor or overexpression of survivin, protects cells against TMEM33 induced apoptosis. In addition, we show that TMEM33 overexpression induces autophagy in breast cancer cells. Inhibition of autophagy with using either the inhibitor chloroquine or knockdown of the Atg5 gene, further sensitizes breast cancer cells to the effects of TMEM33 overexpression. Cell death induced by TMEM33 is also decreased by overexpression of the autophagy gene Beclin 1. The findings in this study demonstrate that the novel EnR resident protein TMEM33 induces cell death by activating IRE1α-JNK-p53-survivin signaling in breast cancer cells. Concurrently, autophagy is also activated by TMEM33, and functions as a pro-survival mechanism. Cell fate reflects the balance between the pro-death and pro-survival activities as regulated by TMEM33.

Citation Format: Clarke R, Hu R, Zhang X, Hilakivi-Clarke L, Kasid U. Transmembrane protein 33 (TMEM33) induces apoptosis via UPR signaling and autophagy in breast cancer cells [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-10-02.

BN nanoflake quantum-dot arrays: structural stability, and electronic and half-metallic properties

One-dimensional arrays constructed by triangular h-BN nanoflakes are studied. It is found that the linking manner plays a crucial role in electronic and half-metallic properties and the traversed electric field further enhances half-metallicity.

Immunoreactivities of NF-κB, IL-1β and IL-1R in the skin of Chinese brown frog (Rana dybowskii)

The cytokine interleukin-1 beta (IL-1β) is an evolutionarily conserved molecule that was originally identified in the immune system. Nuclear factor κB (NF-κB) plays a critical role in the activation of immune cells by upregulating the expression of many cytokines. In this study, we investigated the localization and expression level of IL-1β, its functional membrane receptor type I (IL-1R1) and NF-κB in the skin of Rana dybowskii during the breeding period and pre-hibernation. Histologically, the skin of Rana dybowskii consists of epidermis and dermis, and four kinds of cells were identified in the epidermis during the breeding period and pre-hibernation, while the dermis was composed of homogenous gel, mucous glands and granular glands. IL-1β, IL-1R1 and NF-κB were immunolocalized in the epithelial and glandular cells in both periods. Western blotting showed that there was no significant difference in the expression of IL-1β between the breeding period and pre-hibernation, whereas IL-1R1 and NF-κB were significantly higher in the pre-hibernation compared to the breeding period. These results suggested that IL-1β and NF-κB may collectively play important roles in the skin immune system of Rana dybowskii during the breeding period and pre-hibernation.

[The relevance between obstructive sleep apnea hypopnea syndrome andchronic obstructive pulmonary disease in China: A Meta-analysis]

Objective:To assess the correlation between obstructive sleep apnea hypopnea syndrome(OSAHS) and chronic obstructive pulmonary disease(COPD).Method: Databases such as Chinese Biomedical Literature Database, PubMed, Chinese Academic Journals full-text database, Wanfang Resource Database and Chongqing VIP have been searched to collect literatures about the relationship between OSAHS and COPD. The literature in conference proceedings and certain unpublished articles were also manually retrieved. RCT conformed to the condition was evaluated according to the standards of literature assessment, and the data has been extracted. The RevMan5.3 software was applied to carry out the same Metaanalysis.Result: Totally 19 articles were included, and Metaanalysis reveal that overlap syndrome(OS) patient's apnea hypopnea index is significantly higher than those of OSAHS patients［WMD=7.56, 95%CI（4.19,10.94）, P<0.01］; The LSaO₂ of OS patients is significantly lower than OSAHS patients［WMD=-10.50, 95%CI(-11.58, -6.08),P<0.01］; OS patients' FEV₁/FVC is significantly lower than COPD patients［WMD=4.65,95%CI（1.15,8.15）,P<0.01］.The results revealed that subgroup analysis according to the sample volume, age, body mass index(BMI) and FEV₁/FVC between OS patients and OSAHS patients has heterogeneity, but when analysis with the score of ESS the heterogeneity does not exist. Further, the subgroup analysis according to the sample volume, BMI, AHI,LSaO₂ and the time of Oxygen is lower than 90%(T90) those index between OS patients and COPD patients has heterogeneity, and the heterogeneity does not exist when subgroup is analyses with neck circumference. The funnel schema was nearly symmetry with little bias.Conclusion:The experimental results indicate that OSAHS is significantly related with COPD, and they may be the mutual risk factor for each other..

The expression of prostaglandin-E2 and its receptor in the oviduct of Chinese brown frog (Rana dybowskii)

The Chinese brown frog (Rana dybowskii) has one special physiological phenomenon, which is that its oviduct expands prior to hibernation rather than in the breeding period. In this study, we investigated the immunolocalization and expression levels of prostaglandin-E2 (PGE2), cyclooxygenase (COX)-1 and COX-2, as well as one of its receptor subtypes 4 (EP4) in the oviduct of Rana dybowskii during the pre-hibernation and breeding period. PGE2, COX-1, COX-2 and EP4 have been observed in glandular and epithelial cells in the breeding period, whereas only in the epithelial cells during the pre-hibernation. Consistently, the protein levels of COX-2 and EP4 were higher in the pre-hibernation as compared to the breeding period, but the diversity of COX-1 was not obvious. In addition, oviductal PGE2 concentration was also significantly higher in the pre-hibernation. These results suggested that prostaglandin-E2 may play an important autocrine or paracrine role in oviductal cell proliferation and differentiation of Rana dybowskii during pre-hibernation.

Immunoreactivities of IL-1β and IL-1R in oviduct of Chinese brown frog (Rana dybowskii) during pre-hibernation and the breeding period

The Chinese brown frog (Rana dybowskii) has one special physiological phenomenon, which is that its oviduct goes through expansion prior to hibernation instead of during the breeding period. In this study, we investigated the localization and expression level of interleukin-1 (IL-1β) and its functional membrane receptor type I (IL1R1) proteins in the oviduct of R. dybowskii during pre-hibernation and the breeding period. There were significant differences in both oviductal weight and pipe diameter, with values markedly higher in pre-hibernation than in the breeding period. Histologically, epithelium cells, glandular cells and tubule lumen were identified in the oviduct during pre-hibernation and the breeding period, while sizes of both cell types are larger in the pre-hibernation than those of the breeding period. IL-1β was immunolocalized in the cytoplasm of epithelial and glandular cells in both periods, whereas IL-1R1 was observed in the membrane of epithelial and glandular cells in the breeding period, whereas only in epithelial cells during pre-hibernation. Consistently, the protein levels of IL-1β and IL-1R1 were higher in pre-hibernation as compared to the breeding period. These results suggested that IL-1β may play an important autocrine or paracrine role in oviductal cell proliferation and differentiation of R. dybowskii.

Cyclic adenosine monophosphate-protein kinase A signal pathway may be involved in pulmonary aquaporin-5 expression in ischemia/reperfusion rats following deep hypothermia cardiac arrest

We investigated the effects of cyclic adenosine monophosphate-protein kinase A (cAMP-PKA) on the expression of aquaporin 5 (AQP5) in ischemia/reperfusion (I/R) rats following deep hypothermia cardiac arrest. Wistar rats were randomly divided into: a sham control group (subjected to a sham operation); an I/R group (subjected to occlusion of the bronchial arteries and the left inferior pulmonary artery); an H89 group (subjected to occlusion of the bronchial arteries and the left inferior pulmonary vein and artery, and treated with 5 mg/kg H89 for 2 days before the study); and a forskolin group (subjected to occlusion of the bronchial arteries and the left inferior pulmonary vein and artery, and treated with 5 mg/kg forskolin for 2 days before the study). Expression levels of AQP5 mRNA and protein were determined using reverse transcription-polymerase chain reaction and western blotting. Decreased expression of AQP5 was noted in the pulmonary tissues of the I/R group compared with the sham controls. Compared to that in the control group, there was a notable decrease in AQP5 expression in the I/R group. After treating with forskolin, AQP5 expression increased in the forskolin group compared with the I/R group. In the H89 group, AQP5 expression decreased compared with the I/R group. The decreased expression of AQP5 was possibly associated with acute pulmonary injury induced by I/R. The cAMP-PKA signal pathway may be involved in the expression of AQP5 in I/R rats after deep hypothermia cardiac arrest.

Glycemic control and self-monitoring of blood glucose in Chinese patients with type 2 diabetes on insulin: Baseline results from the COMPASS study

AIMS

Self monitoring of blood glucose (SMBG) is not widely utilized in insulin-treated patients with type 2 diabetes. In this analysis, we evaluated the current state of SMBG in Chinese adults with type 2 diabetes treated with insulin.

METHODS

The 2-phase COMPASS study involved 24 centers across 10 provinces and cities in China. In the first phase, a cross sectional survey was carried out in type 2 diabetes patients receiving insulin treatment. The inclusion criteria for the study subjects in the first phase were: type 2 diabetes, insulin treatment for ≥ 3 months, and age ≥ 18 years. Evaluation was made on the status of SMBG and insulin therapy in these patients by a questionnaire.

RESULTS

A total of 2819 patients (age 58.2 ± 10.8 years; 49.6% females; BMI 24.6 ± 3.4 kg/m(2)) with insulin-treated type 2 diabetes were recruited in phase I of this study. The majority of patients (80.4%) were receiving insulin treatment for at least 6 months. At baseline, the mean HbA1c was 8.5 ± 1.9% and 54.6% of patients had an HbA1c above 8%. 50.4% of the cohort had diabetes for at least 10 years, and fewer of these patients achieved HbA1c <7.0% (53 mmol/mol). At baseline, 65.8% of patients reported that daily SMBG frequency was performed on a random basis. 59.2% of patients reported that they occasionally, rarely or never follow their physician's instructions regarding SMBG. Hypoglycemia occurred in over 50% of patients, although in 71.8% of patients this was a rare occurrence.

CONCLUSIONS

There is low utilization of SMBG in Chinese adults with insulin-treated type 2 diabetes, with approximately two-thirds of patients reporting irregular use of SMBG. This is in line with an overall poor level of glycemic control.

Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes mellitus: Results from the COMPASS study

AIMS

To evaluate the effect of structured self-monitoring of blood glucose (SMBG) regimen on quality of life (QoL) in poorly controlled insulin-treated patients with type 2 diabetes.

METHODS

Phase II of the COMPASS trial was a 6-month, multicenter, prospective, single-arm, interventional study. This study recruited 820 outpatients from 19 clinical sites in China who met the following inclusion criteria: type 2 diabetes, insulin treatment for ≥ 3 months, and age 18-65 years, an HbA1c >8.0% (64 mmol/mol), and willingness to perform SMBG. Subjects were advised to follow a structured SMBG regimen specific to their insulin regimen, and were trained to respond to SMBG readings via lifestyle changes and insulin dose self-adjustment. QoL assessments (SF-36) were performed at baseline and 6 months.

RESULTS

Patients with a mean age of 55.13 ± 9.77 years had an average diabetes duration of 9.83 ± 7.05 years and had been receiving insulin therapy for a mean of 45.4 ± 46.79 months. All QoL parameters were significantly improved following structured SMBG after 6 months, most notably the physical role functioning (p<0.0001) and emotional role functioning (p<0.0001) component scores. Overall, 40.6% of patients rated their overall QoL as 'a bit' or a lot better' after structured SMBG compared with 16.5% prior to the intervention (p<0.0001). SMBG also improved overall feelings of wellbeing, with 39.13% of patients believing that their health was deteriorating prior to SMBG compared with only 14.4% of patients after the intervention (p<0.0001).

CONCLUSIONS

The structured SMBG program in insulin-treated Chinese outpatients with type 2 diabetes significantly improved QoL outcomes. Physical and emotional role functioning are the 2 QoL scales that demonstrate the largest improvement with SMBG.

Time to positivity of blood culture and its prognostic value in bloodstream infection

The purpose of this study was to investigate the relationship between the time to positivity (TTP) of blood cultures and outcome in patients with bloodstream infections (BSIs). Between January 1st, 2011 and December 31st, 2013, the blood cultures of inpatients with BSI or catheter-related BSI were collected at Peking University Third Hospital. The TTP of different isolates was analyzed, and the relationship between the TTP of isolates and outcome of patients with Enterobacter BSI was retrospectively analyzed. We analyzed the TTP of 886 isolates. Escherichia coli has the shortest (11.97 ± 10.06 h) and Candida has the longest first TTP (61.62 ± 42.77 h). 68.01 % of isolates reached positivity within 24 h and 88.33 % within 48 h. Over 90 % of E. coli isolates reached positivity within 24 h. Over 50 % of Candida isolates reached positivity within 48 h. The TTP differed significantly between cultures that were single or double positive for coagulase-negative staphylococci isolates, Enterobacteriaceae, and Pseudomonas aeruginosa, and between aerobic and anaerobic cultures of E. coli (p < 0.05). However, the TTP did not differ significantly between coagulase-negative staphylococci (double positivity) and Staphylococcus aureus. The best TTP threshold for prediction of mortality from Enterobacter species BSI was 16.3 h [area under the curve (AUC) 0.730, 95 % confidence interval (CI) 0.557, 0.864, sensitivity 100 %, specificity 44.4 %]. The TTP of clinical isolates may represent a valuable marker of the clinical significance of BSIs. Laboratories and clinics should consider using the TTP to predict the prognosis of patients with BSI by bacteria, including Enterobacter and other species.