Functions of a C-type lectin with a single carbohydrate-recognition domain in the innate immunity and movement of the red flour beetle, Tribolium castaneum

C-type lectins (CTLs) are a superfamily of proteins found in almost all vertebrates and invertebrates. They play an important role in innate immune defences, development and epidermal structure. Here, a CTL with one carbohydrate-recognition domain containing a highly conserved Gln-Pro-Asp (QPD) motif was identified in Tribolium castaneum and given the name TcCTL5. Spatiotemporal analyses showed that Tcctl5 was highly expressed in the late pupa stage and mainly existed in the central nervous system and haemolymph. The transcript level of Tcctl5 was prominently induced after bacterial infection. Recombinant TcCTL5 proteins (rTcCTL5) were found to bind to lipopolysaccharide, peptidoglycan and tested bacteria and induce microbial agglutination in the presence of Ca²⁺ . Interestingly, when Tcctl5 was knocked down, the transcript level of antimicrobial peptides (AMPs) (attacin1, defensins3, coleoptericin1 and cecropins3) was prominently downregulated after induction with Gram-negative Escherichia coli. More interestingly, Tcctl5 was knocked down, leading to increased mortality and loss of locomotor activity, which exhibited less travel distances among early adults. These results demonstrate that Tcctl5 plays an important role in the innate immune reaction and the movement of T. castaneum. Thus, it may represent an alternative molecular target for pest control and thus reduce the use of pesticides in agricultural production.

Comparative efficacy of respiratory personal protective equipment against viral respiratory infectious diseases in healthcare workers: a network meta-analysis

OBJECTIVE

With the epidemic of coronavirus disease 2019 (COVID-19), the healthcare workers (HCWs) require proper respiratory personal protective equipment (rPPE) against viral respiratory infectious diseases (VRIDs). It is necessary to evaluate which type of mask and manner of wearing is the best suitable rPPE for preventing the VRID.

STUDY DESIGN

A Bayesian network meta-analysis was performed to comprehensively analyze the protective efficacy of various rPPE.

METHODS

This network meta-analysis protocol was registered in an international prospective register of systematic reviews (CRD42020179489). Electronic databases were searched for cluster randomized control trials (RCTs) of comparing the effectiveness of rPPE and wearing manner in preventing HCWs from VRID. The primary outcome was the incidence of laboratory-confirmed viral respiratory infection reported as an odds ratio (OR) with the associated 95% credibility interval (CrI). The secondary outcome was the incidence of clinical respiratory illness (CRI) reported as an OR with the associated 95% CrI. Surface under the cumulative ranking curve analysis (SUCRA) provided a ranking of each rPPE according to the primary outcome and the secondary outcome as data supplement.

RESULTS

Six studies encompassing 12,265 HCWs were included. In terms of the incidence of laboratory-confirmed viral respiratory infection, the continuous wearing of N95 respirators (network OR, 0.48; 95% CrI: 0.27 to 0.86; SUCRA score, 85.4) showed more effective than the control group. However, in terms of reducing the incidence of CRI, there was no rPPE showing superior protective effectiveness.

CONCLUSIONS

There are significant differences in preventive efficacy among current rPPE. Our result suggests that continuous wearing of N95 respirators on the whole shift can serve as the best preventive rPPE for HCWs from the VRID.

[Epidemic situation of malaria in Jiangsu Province in 2019]

OBJECTIVE

To analyze the epidemic situation of malaria in Jiangsu Province in 2019, so as to provide the scientific basis for the development of the strategy for the prevention of re-introduction of imported malaria.

METHODS

The malaria case report information, epidemiological case investigation information, epidemic foci investigation and management report in Jiangsu Province in 2019 were collected, and all epidemiological data were descriptively analyzed.

RESULTS

A total of 244 malaria cases were reported in Jiangsu Province in 2019, and all cases were laboratory-confirmed overseas imported cases, including 4 cases with vivax malaria, 206 cases with falciparum malaria, 12 cases with malariae malaria and 22 cases with ovale malaria. In 2019, there were 12 malaria cases progressing into severe cases in Jiangsu Province, with one death. Nanjing, Nantong, Lianyungang, Taizhou and Changzhou cities contributed the largest number of malaria cases in 2019, with the number of malaria cases accounting for 59.84% of total cases in Jiangsu Province. The infections occurred in Papua New Guinea (2 cases), Pakistan (1 case) and 27 African countries (241 cases), including Angola, the Democratic Republic of the Congo, Nigeria, Equatorial Guinea, Cote d'Ivoire and so on. There were 77 cases (31.55%) with a visit to doctor on the day of onset, and 146 cases (59.84%) within 1 to 3 days after onset. In addition, there were 149 cases (61.06%) with definitive diagnosis at the first visit and 77 cases (31.55%) diagnosed within 1 to 3 days after the visit, and the mean duration from the visit to definitive diagnosis was (0.80 ± 1.59) d, which significantly shortened as compared to that (1.34 d ± 2.59 d) in 2018 (U = 2.53, P < 0.05).

CONCLUSIONS

Intensifying the surveillance and management of imported malaria and improving the diagnostic capability of imported malaria and the treatment of severe malaria cases are required to consolidate the achievements of malaria elimination in Jiangsu Province.

Isolation, identification and characterization of phenolic acid-degrading bacteria from soil

AIMS

To isolate, identify and characterize phenolic acid-degrading bacteria and reduce plant growth inhibition caused by phenolic acids.

METHODS AND RESULTS

A total of 11 bacterial isolates with high phthalic acid (PA)-degrading ability were obtained using mineral salt medium (MSM) medium containing PA as sole carbon source. These isolates were identified as Arthrobacter globiformis, Pseudomonas putida and Pseudomonas hunanensis by sequence analyses of the 16S rRNA gene. Among them, five Pseudomonas strains could also effectively degrade ferulic acid (FA), p-hydroxybenzoic acid (PHBA) and syringic acid (SA) in MSM solution. P. putida strain 7 and P. hunanensis strain 10 showed highly efficient degradation of PA, SA, FA and PHBA, and could reduce their inhibition of lily, watermelon, poplar and strawberry seedling growth in soils respectively. These two strains could promote plant growth in soil with phenolic acids.

CONCLUSIONS

In this study, bacterial strains with highly efficient phenolic acid-degrading abilities could not only effectively reduce the autotoxicity of phenolic acids on plants but also were able to promote plant growth in soil with phenolic acids.

SIGNIFICANCE AND IMPACT OF THE STUDY

In this study, Pseudomonas can promote plant growth while degrading phenolic acids. Our results provide new choices for the biological removal of autotoxins.

Low-dose intravenous dexmedetomidine reduces shivering following cesarean delivery: a randomized controlled trial

BACKGROUND

Intravenous dexmedetomidine 30 µg reduces shivering after cesarean delivery but can result in sedation and dry mouth. We hypothesized that prophylactic administration of 10 µg of IV dexmedetomidine would reduce the patient-reported severity of shivering after cesarean delivery, without an increased incidence of side effects.

METHODS

After institutional review board approval and informed written consent, women undergoing scheduled cesarean delivery with spinal or combined spinal-epidural anesthesia were randomized to receive either intravenous normal saline or dexmedetomidine 10 µg immediately after delivery. The primary outcome was a patient-rated subjective shivering score using a 10-cm visual analog scale at 30 and 60 min after arrival in the Post-Anesthesia Care Unit. Secondary outcomes included subjective scores for pain, nausea, itching, dry mouth, and sedation, as well as 24-h medication administration and investigator-rated observations of shivering, vomiting, pruritus, and sedation. Repeated measures ANOVA with Tukey-Kramer multiple-comparison test was applied for primary outcomes.

RESULTS

One hundred patients were enrolled, and 85 completed the study and were included in analysis. The mean ± SD shivering score in the dexmedetomidine group was significantly lower by repeated measures analysis than among controls across the first 60 min (P=0.0002), and individually at both 30 and 60 min (placebo 1.8 ± 2.6 vs. dexmedetomidine 0.6 ± 1.4 at 30 min; 1.2 ± 2.1 vs. 0.3 ± 0.6 at 60 min; both P <0.01). Patient-rated and observer-rated side effects did not significantly differ between groups.

CONCLUSIONS

Prophylactic administration of intravenous dexmedetomidine 10 µg after delivery reduces shivering without notable side effects.

Molecular Surveillance and in vitro Drug Sensitivity Study of Plasmodium falciparum Isolates from the China-Myanmar Border

The emergence and spread of resistance in Plasmodium falciparum to the frontline treatment artemisinin-based combination therapies in Southeast Asia require close monitoring of the situation. Here, we collected 36 clinical samples of P. falciparum from the China-Myanmar border in 2014-2016, adapted these parasites to continuous culture, and performed in vitro drug assays on seven antimalarial drugs. Data for 23 parasites collected in 2010 and 2012 from the same area reported in an early study were used to assess longitudinal changes in drug sensitivity. Parasites remained highly resistant to chloroquine (CQ) and pyrimethamine, whereas they were generally sensitive to mefloquine (MFQ), lumefantrine (LMF), naphthoquine (NQ), and pyronaridine (PND). Parasites showed a similar temporal trend in sensitivity to CQ, NQ, and PND, with gradual reduction in the half-maximal inhibitory concentrations (IC₅₀s) after 2012. The IC₅₀s to the aminoalcohol drugs MFQ, LMF, and quinine (QN) all significantly declined in 2014, followed by various degrees of increase in 2016. Pyrimethamine displayed a continuous increase in IC₅₀ over the years. The Dd2-like P. falciparum chloroquine-resistant transporter mutations were fixed or nearly fixed in the parasite population. The P. falciparum multidrug resistance 1 F1226Y mutation was detected in 80% parasites in 2016 and associated with reduced sensitivity to LMF and QN (P < 0.05). The N51I in P. falciparum dihydrofolate reductase and K540E/N and A581G in P. falciparum dihydropteroate synthase that are associated with antifolate resistance were either fixed or were approaching fixation in recent years. This study provides an updated picture and temporal trend of antimalarial drug resistance in the China-Myanmar border region, which will serve as a reference for antimalarial treatment.

Genomic epidemiology of Corynebacterium striatum from three regions of China: an emerging national nosocomial epidemic

BACKGROUND

Corynebacteritum straitum has been considered as an emerging multi-drug-resistant (MDR) pathogen. Isolation of MDR C. striatum as the only organism from respiratory samples from hospitalized patients is increasing in China.

AIM

To elucidate the genomic epidemiology and evolution of C. striatum in China.

METHODS

A total of 260 isolates from 2016 to 2018 were collected from three hospitals in three regions of China. Antibiotic sensitivity testing was performed on all isolates. Whole-genome sequencing was applied to all isolates to assess their genomic diversity and relationships and detect the presence of antimicrobial resistance genes (ARG) and ARG cassettes.

FINDINGS

Almost all isolates (96.2%, 250/260) showed multi-drug-resistance. Genome sequencing revealed four major lineages with lineage IV emerging as the epidemic lineage. Most of the diversity was developed in the last 6 years. Each hospital has its own predominant clones with potential spread between Hebei and Guangdong hospitals. Genomic analysis further revealed multiple antimicrobial resistance genes.

CONCLUSIONS

Our results suggested that four lineages of C. striatum have spread in parallel across China, causing persistent and extensive transmissions within hospitals. MDR C. striatum infection has become a national epidemic. Antibiotic-driven selection pressure may have played significant roles in forming persistent and predominant clones. Our data provide the basis for surveillance and prevention strategies to control the epidemic caused by MDR C. striatum.

Acute Marjolin's Ulcer in Chronic Foot Wounds with Previous Negative Biopsy: Report of Two Cases

Marjolin’s ulcer is a rare and often overlooked diagnosis which can be encountered by a variety of specialities. Majority of the literatures describe long latency period of 11 to 75 years. The authors present two unusual cases of rapid progression to Marjolin’s ulcer in patients with previously negative biopsy 8- and 10-month prior. This highlights the importance for clinicians to have a high degree of suspicion when encountered with any non-healing wound, especially one who’s symptomatology and morphological features have undergone an acute change. Even with previous negative biopsy, patients should still be followed-up closely and clinicians should not hesitate to perform re-biopsy if the suspicion arises.

Physiologically-based pharmacokinetic (PBPK) exploration of extrinsic factors influencing vericiguat pharmacokinetics

Introduction

Vericiguat is a once daily, novel oral stimulator of soluble guanylate cyclase (sGC) that showed clinical benefit in the Phase III VICTORIA study in heart failure patients with reduced ejection fraction (HFrEF, NCT02861534). Nonclinical and clinical studies demonstrated that the primary route of elimination of vericiguat was glucuronidation to an inactive metabolite M-1 (N-glucuronide). This glucuronidation was catalyzed by uridine 5'-diphospho-glucuronosyltransferases (UGT)1A9 as well as UGT1A1, thus vericiguat may have a potential for victim drug-drug interaction (DDI) when co-administered with potent UGT inhibitors.

Purpose

In a clinical DDI study with mefenamic acid as an UGT1A9 inhibitor no clinically relevant increase in vericiguat exposure in healthy subjects was observed (EudraCT 2014–000764–17). This analysis aims to prospectively investigate as extrinsic factors the DDI potential with atazanavir as a selective UGT1A1 inhibitor via full dynamic physiologically-based pharmacokinetic (PBPK) modelling.

Methods

A PBPK model for vericiguat and M-1 in healthy adults was built with PK-Sim (PBPK platform as part of the Open Systems Pharmacology Suite) by integrating physicochemical, in vitro metabolism and transporter data as well as PK data from clinical pharmacology studies in order to assess the victim DDI potential of vericiguat when co-administered with UGT inhibitors. First, PBPK models for mefenamic acid and atazanavir were separately developed and verified using published literature data. The PBPK model for vericiguat was then verified with regard to its fraction of metabolism by UGTs by comparing simulated and observed data of the clinical mefenamic acid DDI study. Finally, the UGT1A1 DDI potential of vericiguat was prospectively predicted by simulating an in silico study between the UGT1A1 inhibitor atazanavir and vericiguat.

Results

In line with the results of the clinical DDI study with mefenamic acid, an increase in total vericiguat exposure by 14% (area under the concentration time curve ratio (AUCR) of 1.14 (geoCV 5.3%; 90% population interval: 1.06 to 1.25) and peak exposure increase by 6% (CmaxR of 1.06; geoCV 5.9%; 90% population interval: 1.01 to 1.20) was simulated using the PBPK model. A prospective prediction of a virtual DDI trial between the UGT1A1 inhibitor atazanavir yielded an AUCR of 1.12 (geoCV 2.9%; 90% population interval: 1.07 to 1.17) and a CmaxR of 1.04 (geoCV 1.1%; 90% population interval: 1.03 to 1.06). The proposed population intervals for AUCR and CmaxR for both DDI studies lie within the default no-effect boundary of 0.80 to 1.25 according to the to January 2020 FDA DDI guideline.

Conclusion(s)

Results of UGT1A9-DDI simulations were consistent with those of the clinical study-The prospective UGT1A1-DDI simulation results suggest a low potential for vericiguat to be subject to DDI when co-administered with UGT1A1 inhibitors.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Funding for this research was provided by Bayer and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA

PARP inhibitors as maintenance therapy in newly diagnosed advanced ovarian cancer: a meta-analysis

BACKGROUND

Up to 70% of patients with advanced ovarian cancer have a relapse after primary therapy. New agents and approaches are urgently needed to avoid or slow down this recurrence.

OBJECTIVES

To investigate the efficacy of PARP inhibitors (PARPis) as maintenance treatment in patients with newly diagnosed advanced ovarian cancer.

SEARCH STRATEGY

PubMed, MEDLINE, EMBASE, Cochrane Library and Web of Science databases.

SELECTION CRITERIA

All randomised clinical trials (RCTs) that compared PARPis with placebo as first-line maintenance therapy in ovarian cancer.

DATA COLLECTION AND ANALYSIS

Two reviewers extracted data. Pooled hazard ratio (HR) and risk ratio (RR) with 95% confidence interval (CI) were calculated.

MAIN RESULTS

PARPis were associated with significant improvement of progression-free survival (PFS) in advanced epithelial ovarian cancer (AeOC) (HR = 0.53, 95% CI 0.40-0.71; P < 0.0001). The benefit was not only in women with BRCA mutations (HR = 0.35, 95% CI 0.29-0.42; P < 0.00001) and homologous recombination deficiency (HRD) (HR = 0.43, 95% CI 0.32-0.60; P < 0.00001), but also in those with nonmutated BRCA (HR = 0.72, 95% CI 0.63-0.82; P < 0.00001) and even non-HRD (HR = 0.83, 95% CI 0.70-0.99; P = 0.04).

CONCLUSIONS

PARP inhibitors are effective as maintenance therapy among patients with newly diagnosed advanced ovarian cancer after platinum-based chemotherapy, regardless of BRCA mutation or HRD status.

TWEETABLE ABSTRACT

PARPis provide a significant PFS benefit as first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer.

Research Progress on the Relationship between Genetic Polymorphism and Violent Behavior of Patients with Schizophrenia

Abstract

Schizophrenia is a common disease characterized by thinking obstructions and accompanied by cognitive, emotional and behavioral disorders. Under the control of psychiatric symptoms, patients with schizophrenia may self-injure or impulsively wound others, resulting in public risk and increase in the burden of family and society. In recent years, many studies have shown that the violent behavior of patients with schizophrenia is related to genetic factors. This article reviews the research progress on the relationship between genetic polymorphism and violent behavior of patients with schizophrenia, analyzes the possible mechanism of the correlation between the two, puts forward the limitations of current research and the directions of future research, and provides scientific basis for risk assessment and prevention of violent behavior of patients with schizophrenia.

[A prospective cohort study on blood pressure control and risk of ischemic stroke in patients with hypertension]

Objective: To explore the association between blood pressure control and risk of ischemic stroke (IS) in patients with hypertension. Methods: A total of 5 488 patients with hypertension from 60 communities were randomly selected from 101 communities in 8 streets of Nanshan District in Shenzhen City by using two-stage sampling method. The social demographic characteristics, behavior and life style, coronary heart disease and diabetes were collected and the physical condition, blood pressure and blood biochemical indexes were measured. From April 1, 2010 to August 31, 2017 as the follow-up period, the incidence of IS was annually collected by using telephone survey. Cox proportional hazard regression model was used to analyze the relationship between blood pressure control, systolic blood pressure (SBP), diastolic blood pressure (DBP) and the risk of IS. Results: The age of all patients was (58.50±12.14) years old, including 2 712 males (49.42%) and 3 112 patients with well-controlled blood pressure (56.71%). During the follow-up period, 358 new cases of IS were confirmed, and the incidence density was 1 346.27/100 000 person-years. Cox proportional hazard regression model analysis showed after adjusting for confounding factors, unstable blood pressure control, SBP≥150 mmHg (1 mmHg=0.133 kPa; compared with SBP<120 mmHg), and DBP≥95 mmHg (compared with DBP<80 mmHg) were associated with risk of IS. The HR (95%CI) was 1.29 (1.04, 1.59), 2.00 (1.26, 3.17) and 1.52 (1.01, 2.64), respectively. Subgroup analyses showed these associations only existed in female patients with hypertension. The HR (95%CI) was 1.39 (1.05, 1.85), 2.53 (1.41, 4.56) and 1.73 (1.00, 3.36), respectively. Conclusion: Unstable blood pressure control increases the risk of IS in female patients with hypertension.

Efficacy of directly-observed chloroquine-primaquine treatment for uncomplicated acute Plasmodium vivax malaria in northeast Myanmar: A prospective open-label efficacy trial

BACKGROUND

Chloroquine (CQ) and primaquine (PQ) remain the frontline drugs for radical cure of uncomplicated P. vivax malaria in the Greater Mekong Sub-region (GMS). Recent reports of decreased susceptibility of P. vivax to CQ in many parts of the GMS raise concerns.

METHODS

From April 2014 to September 2016, 281 patients with uncomplicated P. vivax infection attending clinics in border settlements for internally displaced people in northeast Myanmar were recruited into this study. Patients were treated with standard regimen of 3-day CQ and concurrent 14-day PQ (3.5 mg/kg total dose) as directly observed therapy, and followed for recurrent parasitemia within 28 days post-patency.

RESULTS

Within the 28-day follow-up period, seven patients developed recurrent parasitemia, resulting in a cumulative rate of parasite recurrence of 2.6%. Five of the seven parasitemias recurred within two weeks, and two of those failed to clear within seven days, indicating high-grade resistance.

CONCLUSION

Although failure of CQ/PQ treatment of P. vivax was relatively infrequent in northeast Myanmar, this study nonetheless confirms that CQ/PQ-resistant strains do circulate in this area, some of them of a highly resistant phenotype. It is thus recommended that patients who acquire vivax malaria in Myanmar be treated an artemisinin-combination therapy along with hypnozoitocidal primaquine therapy to achieve radical cure.