Mycoplasma pneumoniae lipids license TLR-4 for activation of NLRP3 inflammasome and autophagy to evoke a proinflammatory response

Mycoplasma pneumoniae is an obligate pathogen that causes pneumonia, tracheobronchitis, pharyngitis and asthma in humans. It is well recognized that membrane lipoproteins are immunostimulants exerting as lipopolysaccharides (LPS) and play a crucial role in the pathogenesis of inflammatory responses upon M. pneumoniae infection. Here, we report that the M. pneumoniae-derived lipids are another proinflammatory agents. Using an antibody-neutralizing assay, RNA interference or specific inhibitors, we found that Toll-like receptor 4 (TLR-4) is essential for M. pneumoniae lipid-induced tumour necrosis factor (TNF)-α and interleukin (IL)-1β production. We also demonstrate that NLR family pyrin domain containing 3 inflammasome (NLRP3) inflammasome, autophagy and nuclear factor kappa B (NF-κB)-dependent pathways are critical for the secretion of proinflammatory cytokines, while inhibition of TLR-4 significantly abrogates these events. Further characterization revealed that autophagy-mediated inflammatory responses involved the activation of NF-κB. In addition, the activation of NF-κB promoted lipid-induced autophagosome formation, as revealed by assays using pharmacological inhibitors, 3-methyladenine (3-MA) and Bay 11-7082, or silencing of atg5 and beclin-1. These findings suggest that, unlike the response to lipoprotein stimulation, the inflammation in response to M. pneumoniae lipids is mediated by the TLR-4 pathway, which subsequently initiates the activation of NLRP3 inflammasome and formation of a positive feedback loop between autophagy and NF-κB signalling cascade, ultimately promoting TNF-α and Il-1β production in macrophages.

[Analysis on the relationship between smoking status and the onset age of onset and the direct medical expenditure expenses of gastric cancer patients]

Objective: To investigate the relationship between smoking status and the onset age of stomach cancer patients and estimate the patients' direct medical cost burden of stomach cancer due to smoking in Anhui province. Methods: The information about the primary stomach cancer patients and their direct treatment expenditures in 10 cancer-registered areas in Anhui were collected in 2017. The association between smoking status and the age of onset of stomach cancer patients was analyzed by univariate regression and multivariate logistic regression models. The median and smoking-attributed risk method was used to describe the direct treatment expenditure of stomach cancer patients in Anhui due to smoking. Results: A total of 736 patients with stomach cancer were analyzed in this study. Univariate regression analysis showed that rural household registration (t=2.091, P=0.037), smoking (t=-2.357, P=0.001 9) and alcohol consumption (t=-2.036, P=0.042) were related to the age of onset of stomach cancer. After adjusting for gender, alcohol consumption, body mass index and household registration type, the risk of early stomach cancer in people who quitted smoking cessation was lower than that in smokers (OR=0.36, 95%CI: 0.17-0.75). The total direct medical cost burden of 736 newly diagnosed stomach cancer patients was 6.939 6 million RMB. The direct medical expenditure in stomach cancer patients who had smoking behavior was higher than that in stomach cancer patients who quitted smoking and never smoked. Conclusions: Smoking is one of the risk factors for the earlier onset of stomach cancer in Anhui. It is necessary to strengthen tobacco control to reduce the economic burden of patients with stomach cancer.

Lycopene protects myocardial ischemia injury through anti-apoptosis and anti-oxidative stress

OBJECTIVE

The aim of this research was to explore the protective effect of lycopene (Lyc) on myocardial ischemia injury through anti-apoptosis and anti-oxidative stress.

MATERIALS AND METHODS

75 rats were divided into 5 groups: sham operation group (control group), model group, low-dose group (Lyc+2 mg/kg), medium-dose group (Lyc+4 mg/kg) and high-dose group (Lyc+6 mg/kg). The rat model of myocardial ischemia was established by a subcutaneous injection of isoproterenol (85 mg/kg) for two consecutive days. Conventional HE staining and Masson staining were performed for pathological changes. Biochemical indicators were measured by the enzyme-linked immuno sorbent assay (ELISA). Western blotting was used to measure the levels of related proteins in JNK/STAT signaling pathway.

RESULTS

Compared to control group, the levels of CK-MB, TC, and TGs were significantly increased in model group. The levels of CK-MB, TC, and TGs in each Lyc-administered group were decreased. After Lyc was administered, the SOD, CAT, GSH-Px activities and MDA content were all restored. The serum levels of IL-1β, TNF-α and IL-6 in control group were significantly lower than in model group. When the Lyc was administered, the serum IL-1β, TNF-α and IL-6 levels in medium-dose group and high-dose group were significantly decreased. The levels of Bax/Bcl-2, Cyt-c, and Caspase-3 in model group were significantly higher than control group. Changes of Bax/Bcl-2, Cyt-c, and Caspase-3 in medium-dose and high-dose groups after the administration of Lyc were restored significantly. The levels of p-JNK/JNK, p-STAT1 (Tyr701)/STAT1, p-STAT1 (Ser727)/STAT1, p-STAT3 (Tyr705)/STAT3 were significantly increased, while p-STAT3 (Ser727)/STAT3 was significantly decreased. When Lyc was administered, the expression levels of p-JAK/JAK, p-STAT1 (Tyr701)/STAT1, p-STAT1 (Ser727)/STAT1, p-STAT3 (Tyr705)/STAT3 protein in medium-dose group and high-dose group were significantly decreased, and the expression level of p-STAT3 (Ser727)/STAT3 protein was significantly increased.

CONCLUSIONS

Lyc could show a protective effect on oxidative stress injury and anti-cardiomyocyte apoptosis of myocardial ischemia, and its possible mechanism was to attenuate the activation of JNK/ERK signaling pathway induced by myocardial injury.

Influences of hucMSC-exosomes on VEGF and BMP-2 expression in SNFH rats

OBJECTIVE

To investigate the influences of human umbilical cord mesenchymal stem cell-derived exosomes (hucMSC-exosome) on steroid-induced necrosis of the femoral head (SNFH) and the expressions of vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2) in rats.

PATIENTS AND METHODS

A total of 20 male Sprague-Dawley rats were randomly divided into SNFH group and SNFH + hucMSC-exosome group using a random number table. Prednisolone acetate (24.5 mg/kg) was injected twice a week to establish the rat model of SNFH, and hucMSC-exosome in a certain dose was additionally injected into the marrow cavity in SNFH + hucMSC-exosome group. After 3 weeks, the influences of hucMSC-exosome on the pathological changes and apoptosis of the femoral head in SNFH rats were detected via hematoxylin-eosin (H&E) staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. In addition, the expressions of cluster of differentiation 31 (CD31), VEGF, and BMP-2 in bone tissues in both groups were detected via immunohistochemical staining, and the messenger ribonucleic acid (mRNA) and protein expression levels of VEGF and BMP-2 in necrotic bone tissues in both groups were detected via Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Western blotting.

RESULTS

The results of H&E staining revealed that the fibrous callus formation was good, the new trabecular structure was more obvious, the number of vacuum cleft declined, and there were fewer enlarged adipocytes in SNFH + hucMSC-exosome group compared with SNFH group. The results of TUNEL staining showed that the number of apoptotic cells in femoral head tissues was smaller in SNFH + hucMSC-exosome group (p<0.05). According to the results of immunohistochemistry, hucMSC-exosome could increase the expression of vascular endothelial marker CD31 in SNFH rats (p<0.05). Besides, the results of RT-PCR, immunostaining and Western blotting manifested that both the mRNA and protein levels of BMP-2 and VEGF in femoral head tissues were significantly increased in SNFH + hucMSC-exosome group (p<0.05).

CONCLUSIONS

HucMSC-exosome can improve SNFH in rats, whose mechanism may be related to the up-regulation of VEGF and BMP-2 by exosomes.

Long noncoding RNA UCA1 regulates CCR7 expression to promote tongue squamous cell carcinoma progression by sponging miR-138-5p

Tongue squamous cell carcinoma (TSCC) is a malignant tumor. Long noncoding RNAs (lncRNAs) have been proved to be involved in the regulation of the progression of various cancers. However, the mechanism of lncRNA urothelial cancer-associated 1 (UCA1) in the progression of TSCC remains unclear. The expression levels of UCA1, microRNA-138-5p (miR-138-5p), and CC chemokine receptor 7 (CCR7) were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The proliferation, migration, and invasion were detected using colony formation assay and transwell assay, respectively. Western blot (WB) analysis was used to test the levels of proliferation and metastasis-related proteins and CCR7 protein. Moreover, the extracellular acidification rate (ECAR) of cells was measured by the Seahorse XF Extracellular Flux Analyzer, and the adenosine triphosphate (ATP) level, glucose uptake, and lactate produce of cells were tested by their corresponding assay kits. Further, the dual-luciferase reporter assay was used to confirm the interaction between miR-138-5p and UCA1 or CCR7. In addition, the effect of UCA1 on TSCC tumor growth in vivo was evaluated by animal experiments. We found that UCA1 and CCR7 were upregulated, while miR-138-5p was downregulated in TSCC tissues. Silenced UCA1 restrained the proliferation, migration, invasion, and glycolysis metabolism of TSCC cells. Similarly, knockdown of CCR7 also could suppress the progression of TSCC. Besides, UCA1 overexpression promoted TSCC progression, while this promotion effect could be reversed by CCR7 silencing. miR-138-5p could be sponged by UCA1 and could target CCR7. Additionally, miR-138-5p overexpression could reverse the promotion effect of overexpressed UCA1 on TSCC progression. Furthermore, the UCA1 knockdown reduced TSCC tumor growth in vivo. In conclusion, lncRNA UCA1 might function as an oncogene in TSCC through regulating the miR-138-5p/CCR7 axis, providing a new biomarker for TSCC treatment.

[The status and related factors of myopia for children and adolescents aged 5-18 years old in Shaanxi Province in 2018]

In 2018, the myopia detection rate of children and adolescents aged 5-18 years old in Shaanxi Province was 54.9% (11 060/20 144). The myopia detection rate of girls ［58.6%(5 830/9 949)］ was higher than that of boys ［58.6% (3 416/5 830)］ (P<0.001). In children and adolescents, the myopia detection rate increased with the age before their 16 years old, and saw a stable or downward trend after the age of 16. After adjusting the confounding factors, the myopia detection rate of children and adolescents from regions with per capita GDP>100 000 yuan was higherthan that of children and adolescents from regions with per capita GDP<50 000 yuan［OR (95%CI):1.58(1.34-1.87)］.

SAT0303 SINGLE-CELL DECONVOLUTION OF SKIN FIBROBLAST HETEROGENEITY IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Fibroblast heterogeneity and homeostasis has long been recognized in patients with systemic sclerosis (SSc). However, there is no common consensus on fibroblast subtypes, lineages, biological properties, signaling, and plasticity, which severely hampers our understanding of SSc pathogenesis.

Objectives:

This study is aimed to comprehensively classify skin fibroblast populations from SSc patients.

Methods:

We applied single-cell RNA sequencing on skin fibroblasts from two SSc patients and two health control (HC) with matched age and sex. Cell clustering were mainly determined by UMAP with batch effect correction. Differently expressed genes in each cell cluster was analyzed by Gene Set Enrichment Analysis (GSEA).

Results:

With an unbiased approach, single-cell transcriptome analyses showed classified and defined eight fibroblast types in SSc skin and six in normal skin. The cell types seldom overlapped between the patients and HC. Extracellular interaction and collagen production were remarkably stronger in SSc fibroblasts. A subgroup of dramatic cell proliferation and activation was defined only in SSc fibroblast. Two subtypes responding inflammatory stimuli were only found in SSc patients. Furthermore, delineation of their differentiation trajectory was achieved by a machine learning method.

Conclusion:

This collection of single-cell transcriptomes and the distinct classification of fibroblast subsets provide a new resource for understanding the fibroblast landscape and the roles of fibroblasts in SSc.

References:

N/A

Disclosure of Interests:

None declared

Post-traumatic maxillofacial reconstruction with vascularized flaps and digital techniques: 10-year experience

The aim of this study was to present a treatment protocol for the individual repair of post-traumatic maxillofacial bone defects with vascularized flaps assisted by digital techniques. This study reviewed 20 patients with post-traumatic maxillofacial bone defects who underwent reconstruction with composite vascularized bone flaps assisted by digital techniques between April 2009 and July 2019. Preoperative computed tomography (CT) data were imported into ProPlan CMF software to complete virtual fracture reduction and reconstruction. Surgical navigation, three-dimensionally (3D) printed surgical plates, and prefabricated titanium mesh/plates were used to guide the actual surgery. All patients underwent open reduction and internal fixation and reconstruction surgery in one stage. CT data obtained at 1 week postoperative were imported into Geomagic Control software to evaluate the accuracy of the virtual surgical plan. The mean follow-up interval was 24 months (range 6-96 months). Donor and recipient site morbidity and second-stage procedures to rehabilitate the dentition and cosmetic organs were recorded. The flap success rate was 100%. Nine patients had deep circumflex iliac artery flaps and eleven patients had fibula flaps. The accuracy of computer-assisted surgery was 4.4±0.8mm. There were no postoperative complications. This study is novel in presenting a treatment protocol for individual computer-assisted reconstruction for post-traumatic maxillofacial bone defects with vascularized flaps.

Digital scanned laser light-sheet fluorescence lifetime microscopy with wide-field time-gated imaging

We develop a multidimensional fluorescence imaging technique by implementing a wide-field time-gated fluorescence lifetime imaging into digital scanned laser light-sheet microscopy (FLIM-DSLM) to measure 3D fluorescence lifetime distribution in mesoscopic specimens with high resolution. This is achieved by acquiring a series of time-gated images at different relative time delays with respect of excitation pulses at different depths. The lifetime is determined for each voxel by iteratively fitting to single exponential decay. The performance of the developed system is evaluated with the measurements of a lifetime reference Rhodamine 6G solution and a subresolution fluorescent bead phantom. We also demonstrate the application performances of this system to ex vivo and in vivo imaging of Tg(kdrl:EGFP) transgenic zebrafish embryos, illustrating the lifetime differences between the GFP signal and the autofluorescence signal. The results show that FLIM-DSLM can be used for sample size up to a few millimetres and can be utilised as a powerful and robust method for biomedical research, for example as a readout of protein-protein interactions via Förster resonance energy transfer.

[A cross-sectional study on the prevalence and related factors of dyslipidemia among adults in Anhui province, in 2015]

Objective: Based on the data of chronic diseases and nutrition surveillance among Chinese adults in 2015, dyslipidemia and related factors were analyzed. Methods: Multi-stage stratified cluster random sampling was used to select participants who were aged 18 and over, with questionnaire survey and related measurements conducted. Prevalence rates of dyslipidemia among participants by different characteristics and influencing factors were analyzed, using the method of complex weighting and post-weighted stratification. Results: In all, 7 404 participants were included. The overall prevalence of dyslipidemia was 30.5% among the adults. The overall prevalence of dyslipidemia were 36.5% in males and 24.4% in females (P<0.05). The prevalence rates of hypercholesterolemia, hypertriglyceridemia, high LDL-C, and low HDL-C were 3.7%, 12.2%, 5.3%, and 19.4%, respectively. Results from the multivariate logistic regression model analysis showed that age (OR=1.009, 95%CI: 1.000-1.018), female (OR=0.501, 95%CI: 0.397-0.632), College degree or above (OR=1.728, 95%CI: 1.257-2.374), alcohol consumption 3 (OR=0.711, 95%CI: 0.536-0.943), central obesity (OR=1.868, 95%CI: 1.547-2.257), BMI (OR=1.141, 95%CI: 1.098-1.186), hypertension (OR=1.259, 95%CI: 1.077-1.473) and diabetes (OR=2.025, 95%CI: 1.446-2.835) were influencing factors on dyslipidemia. Conclusions: The prevalence of dyslipidemia seemed high among adults in Anhui. Risk factors should be closely monitored and under control, including those people with unhealthy lifestyles or being overweight, obesity, hypertensive and diabetic.

Prophylactic low-molecular-weight heparin administration protected against severe acute pancreatitis partially by VEGF/Flt-1 signaling in a rat model

BACKGROUND

The present study was aimed to explore the effects and the underlying mechanism of prophylactic low-molecular-weight heparin (LMWH) treatment on taurocholate-induced severe acute pancreatitis (SAP) in a rat model.

METHODS

Rat SAP model was induced by injection of 4% sodium taurocholate into the pancreatic duct. LMWH was applied half an hour before the induction of pancreatitis at the dose of 200 IU/kg subcutaneous injection. The rats were euthanized at 1 h, 6 h, and 12 h after taurocholate-induced SAP. The inflammatory and oxidative response markers were assessed. And the vascular endothelial growth factor (VEGF) and Fms-related tyrosine kinase 1 (Flt-1) expression were evaluated by immunohistochemistry (IHC) and western blot methods.

RESULTS

The expression of inflammatory and oxidative response markers increased after induction of SAP. IHC and western blot results showed the VEGF and Flt-1 expression were increased in SAP group. Prophylactic LMWH administration reduced the inflammatory and oxidative response markers expression and decreased the expression of VEGF and Flt-1.

CONCLUSIONS

This study suggested that prophylactic LMWH treatment mitigated the severity of pancreatitis in rat SAP model by anti-inflammation and oxidative response. The underlying mechanism may result from downregulating VEGF/Flt-1 signaling of LMWH in SAP rat model.

Matrix-material dependence on the elongation of embedded gold nanoparticles induced by 4 MeV C60 and 200 MeV Xe ion irradiation

We report the elongation of embedded Au nanoparticles (NPs) in three different matrices, i.e. amorphous carbon (a-C), crystalline indium tin oxide (In_xSn_1-xO_z; ITO) and crystalline calcium fluoride (CaF₂), under irradiations of 4 MeV C₆₀ ⁺ cluster ions and 200 MeV Xe¹⁴⁺ ions. Under 4 MeV C₆₀ cluster irradiation, strong sputtering is induced in CaF₂ layer so that the whole the layer was completely lost at a fluence of 5 × 10¹³ ions cm^-2. Au NPs were partly observed in the SiO₂, probably due to the recoil implantation. Amorphous carbon (a-C) layer exhibits low sputtering loss even under 4 MeV C₆₀ irradiation. However, the elongation in a-C layer was low. While the ITO layer showed a certain decrease in thickness under 4 MeV C₆₀ irradiation, large elongation of Au NPs was observed under both 4 MeV C₆₀ and 200 MeV Xe irradiation. The ITO layer preserved the crystallinity even after large elongation was induced. This is the first report of the elongation of metal NPs in a crystalline matrix.

Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct

BACKGROUND AND PURPOSE

Identifying the mere presence of carotid intraplaque hemorrhage would be insufficient to accurately discriminate the presence of acute cerebral infarct. We aimed to investigate the association between signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted MR imaging and acute cerebral infarct in patients with hemorrhagic carotid plaques using MR vessel wall imaging.

MATERIALS AND METHODS

Symptomatic patients with carotid intraplaque hemorrhage were included. The signal intensity ratios of carotid intraplaque hemorrhage against muscle on T1-weighted, TOF, and MPRAGE images were measured. The acute cerebral infarct was determined on the hemisphere ipsilateral to the carotid intraplaque hemorrhage. The association between signal intensity ratios of carotid intraplaque hemorrhage and acute cerebral infarct was analyzed.

RESULTS

Of 109 included patients (mean, 66.8 ± 9.9 years of age; 96 men), 40 (36.7%) had acute cerebral infarct. Patients with acute cerebral infarct had significantly higher signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted images than those without (Median, 1.44; 25-75 Percentiles, 1.14-1.82 versus Median, 1.27; 25-75 Percentiles, 1.06-1.55, P = .022). Logistic regression analysis revealed that the signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images was significantly associated with acute cerebral infarct before (OR, 4.08; 95% CI, 1.34-12.40; P = .013) and after (OR, 3.34; 95% CI, 1.08-10.31; P = .036) adjustment for clinical confounding factors. However, this association was not significant when further adjusted for occlusion of the carotid artery (P = .058) and volumes of intraplaque hemorrhage and lipid-rich necrotic core (P = .458).

CONCLUSIONS

The signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images is associated with acute cerebral infarct in symptomatic patients with carotid hemorrhagic plaques. This association is independent of traditional risk factors but not of the size of plaque composition. The possibility of applying T1 signals of carotid intraplaque hemorrhage to predict subsequent cerebrovascular ischemic events needs to be prospectively verified.

Noninvasive imaging evaluation of tumor immune microenvironment to predict outcomes in gastric cancer

BACKGROUND

The tumor immune microenvironment can provide prognostic and predictive information. A previously validated ImmunoScore of Gastric Cancer (IS_GC) evaluates both lymphoid and myeloid cells in the tumor core and invasive margin with immunohistochemical staining of surgical specimens. We aimed to develop a noninvasive radiomics-based predictor of IS_GC.

PATIENTS AND METHODS

In this retrospective study including four independent cohorts of 1778 patients, we extracted 584 quantitative features from the intratumoral and peritumoral regions on contrast-enhanced computed tomography images. A radiomic signature [radiomics ImmunoScore (RIS)] was constructed to predict IS_GC using regularized logistic regression. We further evaluated its association with prognosis and chemotherapy response.

RESULTS

A 13-feature radiomic signature for IS_GC was developed and validated in three independent cohorts (area under the curve = 0.786, 0.745, and 0.766). The RIS signature was significantly associated with both disease-free and overall survival in the training and all validation cohorts [hazard ratio (HR) range: 0.296-0.487, all P < 0.001]. In multivariable analysis, the RIS remained an independent prognostic factor adjusting for clinicopathologic variables (adjusted HR range: 0.339-0.605, all P < 0.003). For stage II and stage III disease, patients with a high RIS derived survival benefit from adjuvant chemotherapy {HR = 0.436 [95% confidence interval (CI) 0.253-0.753], P = 0.002; HR = 0.591 (95% CI 0.428-0.818), P < 0.001, respectively}, whereas those with a low RIS did not.

CONCLUSION

The RIS is a reliable tool for evaluation of immunoscore and retains the prognostic significance in gastric cancer. Future prospective studies are required to confirm its potential to predict treatment response and select patients who will benefit from chemotherapy.

Association of daytime napping with incident stroke in middle-aged and older adults: a large community-based study

BACKGROUND AND PURPOSE

There are conflicting reports on the association between daytime napping and incident stroke. This study was designed to investigate the relationship between daytime napping and stroke within a community-based cohort.

METHODS

The present prospective study was based on the Sleep Heart Health Study. Napping habits were assessed with a self-reported Sleep Habits Questionnaire. Participants with napping habits of different durations and frequencies were followed up until the first stroke occurred or the final censoring date. Cox proportional hazards models were used to estimate the relationship between napping habits and stroke.

RESULTS

A total of 4757 participants (2219 men, mean age 63.6 ± 11.1 years) were enrolled in this study. Compared with those taking no naps, multivariate proportional hazards models analysis indicated that individuals taking naps with a duration of >60 min [hazard ratio (HR), 2.460; 95% confidence interval (CI), 1.538-3.934] had a higher risk of stroke. There was also an increased risk of stroke among participants taking naps daily (HR, 1.563; 95% CI, 1.059-2.307) or five to six times/week (HR, 1.548; 95% CI, 1.026-2.335). After combining napping durations and frequencies, regular long naps (HR, 1.903; 95% CI, 1.182-3.065) and regular short naps (HR, 1.451; 95% CI, 1.010-2.084) were independent risk factors for incident stroke.

CONCLUSION

Daytime napping with a long duration (>30 min) or a high frequency (≥5 times/week) may increase the risk of stroke.

Application Prospects of Virtual Autopsy in Forensic Pathological Investigations on COVID-19

Abstract

Autopsy of patients who died of infectious diseases is of significance for public health management. Few forensic autopsies have been performed since the outbreak of the corona virus disease 2019 （COVID-19） due to some limitations, thus forensic pathological examination failed to contribute to the prevention and treatment of infectious diseases. Virtual autopsy has unique advantages in the forensic examination of patients who died of infectious diseases. Accumulated virtual autopsy image data are of great value to the study of the pathological mechanism and diagnosis of COVID-19. This article reviews the relationship between imaging changes and pathology of the COVID-19 as well as the application of virtual autopsy in autopsy of patients who died of infectious diseases, in order to provide reference for performing virtual autopsy in the outbreak of COVID-19.

[The performance of visual photoscreening for Chinese preschool children aged 4 to 5 years]

Objective: To assess the accuracy of photoscreening for detecting refractive amblyopia risk factors (ARFs) in Chinese preschool children aged 4 to 5 years. Methods: A cross-sectional study. Comprehensive ocular examinations were conducted for preschool children in Nanjing, China from September to December, 2016. Photoscreening (Plusoptix A12C) was applied for refractive screening without cycloplegia. Voluntary children and children suspected of eyes abnormalities received cycloplegic retinoscopy (CR). Results of photoscreening and CR were compared using Wilcoxon signed rank test, and Bland-Altman plot were used to assess the agreement between the photoscreener and CR. According to the updated preschool vision screening guidelines from American Association for Pediatric Ophthalmology and Strabismus (AAPOS) in 2013, CR was adopted for identifying children with ARFs, which was considered as a golden standard. Based on the golden standard, the accuracy of 5 sets of referral criteria (including sensitivity standard, Matta/Silbert standard, AAPOS2013 standard, Alaska Blind Child Discovery standard, specificity standard) for photoscreener were tested. Receiver operating characteristics curves were constructed applied to evaluate the quality of the photoscreener in refractive ARFs detection and to find probably the best cut-off points. Results: In total, 1 986 children [mean age, (4.57±0.29) years] received comprehensive examinations, including 1 084 boys and 902 girls. The test ability of photoscreening was 99.04% (1 967/1 986) in the preschool children, and 96.56%(1 827/1 892) of the children got a reliable result within three screening attempts. In 538 children who had data of CR, refractive error of one child exceeded the upper limit of the photoscreener value setting, which was directly categorized as hyperopia, so in the end, 537 children were included to analyze the comparison between the two tests. The measurement values of photoscreening were lower than those of CR in sphere, cylinder and spherical equivalent [(0.75 (0.50, 1.25) D vs. 1.25 (1.00, 1.75) D, Z=-10.36, P<0.01; -0.50 (-0.75, -0.25) D vs. -0.25 (-0.75, 0.00) D, Z=-11.10, P<0.01; 0.63 (0.38, 0.88) D vs. 1.00 (0.75, 1.50) D, Z=-13.33, P<0.01]. The 95% limit of agreement cover rates between the photoscreening and CR in sphere, cylinder and spherical equivalent was 96.28% (517/537), 95.34% (512/537) and 96.65% (519/537), respectively. Based on the golden standard, 47 (8.74%) children had refractive ARFs, and the range of sensitivity, specificity, Youden index, positive predictive values and negative predictive values for detecting refractive ARFs of the 5 common used referral criteria was from 63.83% to 97.87%, from 53.36% to 97.56%, from 0.51 to 0.80, from 16.73% to 74.51% and from 96.57% to 99.62%, respectively. Considering particular refractive ARFs on the basis of the receiver operating characteristic curves, the optimal cut-off point for astigmatism was set at 1.38 D. Conclusion: Photoscreening could be an applicable tool to detect refractive ARFs in preschool children. (Chin J Ophthalmol, 2020, 56: 189-196).

Government regulation and consumer evaluation after dairy products scandal in China

With the continuous expansion of the global dairy trade market, the quality and safety of the Chinese dairy market have a wide and far-reaching impact on the world. Based on the development of the dairy scandal in the past few years in China, this study illustrates the serious damage of melamine on human health and the negative impact on the dairy industry in China.

This study shows that the lack of effective government regulations is a key reason for dairy market failure. Consumers are lacking confidence in the quality of Chinese dairy products and the government's market regulations. The Chinese dairy market will continue to rely on imported dairy products. By analyzing the typical cases of the dairy market in China, this study aims to provide a guide for dairy industries in other countries.

Age-specific reference ranges of serum anti-müllerian hormone in healthy women and its application in diagnosis of polycystic ovary syndrome: a population study

OBJECTIVE

To establish the age-specific centiles of serum anti-müllerian hormone (AMH) levels in Chinese women, and to explore the use of multiples of median (MoM) AMH levels for the diagnosis of polycystic ovary syndrome (PCOS).

DESIGN

An observational study.

SETTING

University-affiliated hospitals and community clinics.

POPULATION

We included 3137 healthy women aged 20-44 years recruited prospectively or who had archived serum samples from previous research projects. Another validation cohort of 751 women with PCOS as well as ovulatory controls, which was a convenient sample of women attending for infertility or menstrual disorders, was also studied.

METHODS

The serum samples were assayed for AMH by the automated Access AMH assay.

MAIN OUTCOME MEASURES

Age-specific reference ranges were constructed on the primary cohort with the Lambda-Mu-Sigma method. The MoM AMH of each subject in the validation cohort was calculated.

RESULTS

Centile curves of serum AMH level against age were established. MoM AMH was significantly higher in women with PCOS than in controls (P < 0.05). The area under the ROC curve was 0.852 (95% confidence interval [CI] 0.825-0.877) (P < 0.0001) for discriminating women with PCOS from ovulatory controls by MoM AMH.

CONCLUSIONS

We established a set of year-by-year age-specific reference ranges of serum AMH levels in Chinese women. The MoM AMH derived from this set of reference ranges is a promising tool to replace antral follicle count in the diagnosis of PCOS.

TWEETABLE ABSTRACT

A set of age-specific reference ranges of AMH levels was established in Chinese women. Multiples of median AMH may be used to diagnose PCOS.

[Effect of mobile platform in improving compliance and efficacy of subcutaneous immunotherapy in children with allergic rhinitis]

Objective:To explore effect of mobile platform in improving compliance and efficacy of subcutaneous immunotherapy（SCIT） in children with allergic rhinitis（AR）. Method:From January to June 2018, 86 children diagnosed with AR and receiving SCIT were selected as research objects. According to the random sequence generated by the computer, the research objects were randomly assigned to the experimental group and the control group, with 43 cases in each group. The control group received conventional SCIT management, while the experimental group received mobile platform SCIT management relying on smart phones and computers. The SCIT shedding rate at the initial stage and the time taken to reach the maintenance period were compared between the two groups, as well as the visual simulation scale of rhinitis symptoms, four-point score and rhinoconjunctivia-related quality of life scores before and at the 6th month after the intervention. Result:There was no statistically significant difference in the initial SCIT shedding rate between the two groups（P>0.05）, and the average duration of the maintenance period of the experimental group was shorter than that of the control group, with statistically significant difference（P<0.05）. At the 6th month after intervention, there was no statistically significant difference in the scores of rhinitis symptoms by the four-point method between the two groups（P>0.05）, and there were statistically significant differences in the visual simulation scale of rhinitis symptoms and the scores of children's rhinoconjunctivia-related quality of life（P<0.05）. Conclusion:This study confirmed that the application of a mobile platform is of great significance for improving compliance and the treatment effects of SCIT in children with AR.

[Construction and analysis of competitive endogenous RNA regulatory network related to gastric cancer]

Objective: To construct the competitive endogenous RNA (ceRNA) network related to gastric cancer and explore the molecular mechanism. Methods: The expression profiles of lncRNA, miRNA and mRNA in gastric cancer and paracancer tissues were analyzed by biochip technology, edgeR package in R software was used to filtrate differential expression genes (multiple change of >1.5 times, P<0.05) and volcano map was drawn. Based on the online miRNA-lncRNA prediction tool lncBase database and the miRNA Target gene prediction database (miRTarBase, target-scan, miRDB, starBase), the relationship between miRNA, lncRNA and mRNA was predicted. Cytoscape software was used to construct lncRNA-miRNA-mRNA ceRNA network and key genes (hub genes) were identified based on cytohubba calculation of degree score of each node. Then Hub genes related to the prognosis of gastric cancer were verified in the TCGA database. The GO and KEGG enrichment analysis of differentially expressed mRNA was performed using the online biological information annotation database DAVID, P<0.05 and false discovery rate (FDR)<0.05 were used as cut-off criteria. R software was used to download the RNA sequencing data and mirna-seq data of gastric cancer and adjacent tissues in TCGA database, edgeR package was used to screen out differentially expressed mRNA, miRNA and lncRNA, and some differentially expressed genes in our data were verified. In OncoLnc database, STAD project of TCGA data was selected and hub gene was input. Patients were divided into two groups based on the median value for hub genes and Kaplan-meier analysis was performed. Results: The differentially expressed 766 mRNA, 110 lncRNA and 10 miRNA were screened out, among them 90 mRNA, 4 lncRNA and 6 miRNA were used to construct the ceRNA network, and 2 of the 20 hub genes were related to the prognosis of patients. MLK7-AS1, SPP1, SULF1, hsa-miR-1307-3p were upregulated in gastric cancer tissues from our biochip, while MT2A, MT1X were downregulated, which were consistent with the results of TCGA gastric cancer database. The differentially expressed mRNAs were significantly enriched in the biological process (BP) and the mineral absorption pathway. CHST1 was negatively correlated while miR-183-5p was positively corelated with the survival of patients. Conclusion: The establishment of ceRNA network for gastric cancer is conducive to further understanding of the molecular biological mechanism. CHST1 and miR-183-5p can be used as prognostic factors of gastric cancer.

[Analysis of magnetic resonance imaging characteristics in Chinese patients with myelin oligodendrocyte glycoprotein antibody associated disorders]

Objective: To investigate the magnetic resonance imaging (MRI) characteristics in the brain and spinal cord of Chinese patients with myelin oligodendrocyte glycoprotein antibodies associated diseases (MOGAD). Methods: Forty nine MOGAD patients with seropositive MOG-IgG and 58 AQP4-IgG positive patients were enrolled in this study. The characteristics of brain and spinal cord MRI were retrospectively analyzed. Results: There was no significant difference in the proportion of abnormal brain MRI of the two groups (69.4% vs 65.5%, P=0.177) , while the proportion of abnormal spinal cord MRI of the AQP4-IgG positive group was significantly higher than that in the MOG-IgG positive group (84.5% vs 36.7%, P=0.001) . The proportion of MOG-IgG positive patients with subcortical white matter lesions and large lesions in the brain MRI was significantly higher than that in AQP4-IgG positive group (48.9% vs 13.8%, P=0.003, 46.9% vs 12.1%, P=0.000) . The longitudinally extensive transverse myelitis in spinal cord MRI of AQP4-IgG positive group was significantly higher than that in the MOG-IgG group (70.7% vs 24.5%, P=0.002) . In addition, the proportion of MOG-IgG positive child patients with large lesions in the brain was significantly higher than that in AQP4-IgG positive child patients (76.9% vs 20.0%, P=0.047) . Conclusion: Demyelinating MRI lesions caused by MOG-IgG are heterogeneous, and could lead to a wide range of clinical phenotypes which is significantly different from those with AQP4-IgG.