Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample

BACKGROUND

Pemphigus and pemphigoid are blistering disorders associated with barrier disruption, immune dysregulation and use of immunosuppressing systemic therapy, all of which may predispose towards serious infections.

OBJECTIVES

To determine whether pemphigus and pemphigoid are associated with increased likelihood of serious infections and the impact of such infections on mortality and cost of care.

METHODS

We analysed data from the 2002 to 2012 Nationwide Inpatient Sample, including a representative 20% sample of all hospitalizations in the US (total n = 72 108 077 adults).

RESULTS

Overall, 54.6% (95% CI: 53.6-55.6%) and 50.4% (49.0-51.8%) of inpatients with either pemphigoid or pemphigus had a diagnosis of serious infection, respectively, compared with 25.4% (25.2-25.6%) in those without either diagnosis. In multivariable logistic regression models controlling for gender, age, race/ethnicity and insurance status, pemphigoid or pemphigus was associated with 26 or 21 of 48 infections examined, respectively. In particular, both pemphigoid and pemphigus were associated with higher odds of infections of the skin, bones, respiratory, gastrointestinal, genitourinary and central nervous system, septicaemia and antibiotic-resistant infections. Pemphigus was also associated with aspergillus, pharyngitis and Pneumocystis Carinii pneumonia. Associations of any serious infection in both pemphigoid and pemphigus patients were older age, non-White race, lower median household income, government or no insurance, higher number of chronic conditions, and those with a diagnosis of Cushing's syndrome, diabetes, cancer or autoimmune disease. The diagnosis of any serious infection vs. no infection was associated with increased inpatient mortality and costs in both pemphigoid (mortality: 7.85% vs. 2.84%; cost: $16 115 vs. $10 653) and pemphigus (mortality: 6.78% vs. 1.88%; cost: $17 707 vs. $11 545) inpatients (P < 0.0001 for all).

CONCLUSIONS

Adults with pemphigus or pemphigoid had increased cutaneous, respiratory, multi-organ and systemic infections, which were associated with considerable inpatient mortality and cost burden. Moreover, there were significant clinical and healthcare disparities with respect to infections in patients with pemphigus or pemphigoid.

Extended gamma-ray sources around pulsars constrain the origin of the positron flux at Earth

The unexpectedly high flux of cosmic-ray positrons detected at Earth may originate from nearby astrophysical sources, dark matter, or unknown processes of cosmic-ray secondary production. We report the detection, using the High-Altitude Water Cherenkov Observatory (HAWC), of extended tera-electron volt gamma-ray emission coincident with the locations of two nearby middle-aged pulsars (Geminga and PSR B0656+14). The HAWC observations demonstrate that these pulsars are indeed local sources of accelerated leptons, but the measured tera-electron volt emission profile constrains the diffusion of particles away from these sources to be much slower than previously assumed. We demonstrate that the leptons emitted by these objects are therefore unlikely to be the origin of the excess positrons, which may have a more exotic origin.

Differential expressions of MDM2 and TAP73 in cancer and cancer-adjacent tissues in patients with non-small-cell lung carcinoma

AIM

To investigate the differences in mRNA and protein expressions of MDM2 (mouse double minute 2 homolog) and P73 in cancer and cancer-adjacent tissues in patients with non-small-cell lung carcinoma (NSCLC).

MATERIALS AND METHODS

We compared the protein expressions of MDM2 and P73 in lung cancer and cancer-adjacent tissues in NSCLC patients by IHC (immunohistochemistry) and WB (Western blot). We divided the NSCLC patients into two subgroups, adenocarcinoma and squamous carcinoma. The mRNA expressions of two main isoforms of P73, TAP73 and DNP73, as well as the ratio of DNP73/TAP73 were analyzed by qPCR (quantitative real-time PCR) in the two tissues in all NSCLC patients and in patients with adenocarcinoma or squamous carcinoma, respectively.

RESULTS

WB results did not show significant differences in MDM2 and P73 protein expressions in lung cancer and cancer-adjacent tissues. However, IHC results indicated that MDM2 expression significantly increased in cancer tissues in female patients, but not male patients. In addition, TAP73 mRNA expression significantly increased in cancer tissues in all NSCLC patients (p=0.002) and in patients with adenocarcinoma (p=0.01); while there was no significant difference in DNP73 mRNA expression. Hence the fold-change of DNP73/TAP73 ratio significantly decreased (p=0.0003) in cancer tissues in all NSCLC patients and in patients with adenocarcinoma.

CONCLUSIONS

TAP73 mRNA expression significantly increased in cancer tissues than cancer-adjacent tissues in all NSCLC patients and in patients with adenocarcinoma. Meanwhile, the fold-change of DNP73/TAP73 ratio was similar to TAP73. MDM2 protein expression significantly increased in cancer tissues in female NSCLC patients.

[Polymorphisms of 19 STR Loci in Guizhou Han Population and Their Forensic Application]

OBJECTIVES

To investigate the allelic distribution of 19 autosomal STR loci in Guizhou Han population, and to estimate the forensic application value.

METHODS

The 19 autosomal STR loci in 520 unrelated healthy individuals from Guizhou Han population were studied using Goldeneye™ 20A kit. The 310 genetic analyzer was used for capillary electrophoresis, and the GeneMapper®ID v3.1 for genotyping.

RESULTS

The heterozygosis, the discrimination power, the probability of exclusion, the polymorphism information content, the cumulative discrimination power and the cumulative probability of exclusion of the 19 STR loci were 0.603 8-0.916 4, 0.790 0-0.985 6, 0.295 5-0.826 9, 0.553 5-0.908 9, 1-1.230 0×10⁻²² and 0.999 999 99, respectively. Compared with other five Han populations in pairwise allelic frequencies, Guizhou Han only had significant differences with Shandong Han, Liaoning Han and Shanxi Han.

CONCLUSIONS

The 19 autosomal STR loci such as D19S433 have a highly genetic polymorphic in Guizhou Han population, which have application values in the researches of population genetics and forensic genetics.

3D Imaging of a Dislocation Loop at the Onset of Plasticity in an Indented Nanocrystal

Structural quality and stability of nanocrystals are fundamental problems that bear important consequences for the performances of small-scale devices. Indeed, at the nanoscale, their functional properties are largely influenced by elastic strain and depend critically on the presence of crystal defects. It is thus of prime importance to be able to monitor, by noninvasive means, the stability of the microstructure of nano-objects against external stimuli such as mechanical load. Here we demonstrate the potential of Bragg coherent diffraction imaging for such measurements, by imaging in 3D the evolution of the microstructure of a nanocrystal exposed to in situ mechanical loading. Not only could we observe the evolution of the internal strain field after successive loadings, but we also evidenced a transient microstructure hosting a stable dislocation loop. The latter is fully characterized from its characteristic displacement field. The mechanical behavior of this small crystal is clearly at odds with what happens in bulk materials where many dislocations interact. Moreover, this original in situ experiment opens interesting possibilities for the investigation of plastic deformation at the nanoscale.

Enhanced polarization-sensitive terahertz emission from vertically grown graphene by a dynamical photon drag effect

Improving terahertz (THz) emission from graphene is a challenge for graphene-based THz photonics as graphene demonstrates a weak light-matter interaction. With a unique ultra-black surface structure, vertically grown graphene (VGG) is proposed to enhance the light-matter interaction and further enhance THz emission. Herein, enhanced THz radiation is observed by THz time-domain emission spectroscopy from VGG compared with single-layer graphene. The radiated THz amplitude shows a linear dependence on pump power, which demonstrates a second order nonlinear effect. Considering the symmetry of VGG on a substrate, we can exclude the optical rectification effect and photogalvanic effect (PGE) by the D_6h point group with centrosymmetry. Thus we analyze the transient photocurrent related to THz emission only by the photon drag effect (PDE). The polarization-sensitive THz radiation signals are wave-vector reliant and demonstrate cos 2φ and sin 2φ dependence on the polarization angles of the pump laser. This is consistent with the theoretical analysis of PDE. Our results show the enhanced, ultrafast, broadband THz radiation property of VGG, which paves the way for high performance THz emitters and THz detectors based on graphene materials.

The further exploration of hidden blood loss in posterior lumbar fusion surgery

PURPOSE

Hidden blood loss (HBL) plays an important role in lumbar fusion surgery. However, there was huge computation error when calculating hidden loss in previous studies because they regarded the volume of drainage as postoperative blood loss. We should not ignore the fact that the composition of drainage varies from person to person and also with time-lapse after operation. The purpose of this study was to demonstrate a more accurate HBL calculation formula by comparing it with previous formula and to address the importance of HBL in patients undergoing posterior lumbar fusion surgeries.

METHODS

For each patient, the HBL was calculated by previous formula and our recommendable formula. We compared the result of HBL calculated by two different methods. At the same time, we explored the HBL in patients undergoing posterior lumbar fusion surgeries with various levels.

RESULTS

In our study, the average total blood loss was 771ml. The mean intraoperative blood loss was 268ml, and the total volume of post-operative drainage is 276ml. The mean hidden loss of 90 patients calculated with previous method was 227ml and 29.4% of total loss. When taking change of drainage HCT into account, the mean hidden loss calculated with our recommendable method was 362.8ml and 47% of total loss. The results were significantly different (P<0.01). There was no significant difference in the percentage of the HBL between patients with single or multiple surgical levels.

CONCLUSIONS

There is often a substantial unmeasured blood loss in lumbar fusion surgeries. However, the component of drainage changed radically with time, we should take the true blood contained in drainage into considerations when calculating the HBL.

LEVEL OF EVIDENCE

Our research is a case-control study and the level of proof is III.

Evaluation of the Safety of Drugs and Biological Products Used During Lactation: Workshop Summary

This report serves as a summary of a 2-day public workshop sponsored by the US Food and Drug Administration (FDA) to discuss the safety of drugs and biological products used during lactation. The aim of the workshop was to provide a forum to discuss the collection of data to inform the potential risks to breastfed infants with maternal use of medications during lactation. Discussions included the review of current approaches to collect data on medications used during lactation, and the considerations for future approaches to design and guide clinical lactation studies. This workshop is part of continuing efforts to raise the awareness of the public for women who choose to breastfeed their infants.

Interface-induced terahertz persistent photoconductance in rGO-gelatin flexible films

Light-induced difference terahertz (THz) spectroscopy is used to investigate the dielectric characteristics of reduced graphene oxide-gelatin (rGO-Gel) flexible films. RGO-Gel films are observed to exhibit positive photoconductance under 800 nm laser illumination, resulting in the modulation depth of the THz transmission up to 33.5%. Moreover, persistent photoconductance (PPC), which is a prolonged light-induced conducting behavior, has been observed to last as long as tens of seconds in rGO-Gel films. The PPC phenomenon is due to the electrons trapped in the defects of rGO and in the interface between rGO and gelatin, and is enhanced by the strong interaction between rGO (a p-type semiconductor) and gelatin (electron donors). This work holds potential for creating optoelectronic devices based on rGO-Gel films, such as optical modulators, switches, photodetectors, photosensors, and persistent photonic memory devices in the THz region.

Isotope effect in superconducting n-doped SrTiO3

We report the influence on the superconducting critical temperature Tc in doped SrTiO3 of the substitution of the natural 16O atoms by the heavier isotope 18O. We observe that for a wide range of doping this substitution causes a strong (~50%) enhancement of Tc. Also the magnetic critical field Hc2 is increased by a factor ~2. Such a strong impact on Tc and Hc2, with a sign opposite to conventional superconductors, is unprecedented. The observed effect could be the consequence of strong coupling of the doped electrons to lattice vibrations (phonons), a notion which finds support in numerous optical and photo-emission studies. The unusually large size of the observed isotope effect supports a recent model for superconductivity in these materials based on strong coupling to the ferroelectric soft modes of SrTiO3.

KB scanning of X-ray beam for Laue microdiffraction on accelero-phobic samples: application to in situ mechanically loaded nanowires

A mapping technique has been developed where a sub-micrometer focused polychromatic X-ray beam is scanned across a stationary sample instead of scanning the sample in front of the X-ray microbeam. This method is applied to a gold nanowire during its mechanical loading using the tip of an atomic force microscope. During the loading process, such a sample is `accelero-phobic', i.e. the sample scanning stages must not to be moved to avoid parasitic additional load. Without beam scanning, only one single position within the sample can be probed during the test. The probed material point may even change because of drifts or movements induced by the test itself. The new scanning approach facilitates the in situ mapping of the entire wire giving access to the evolution of the wire shape as well as to the boundary conditions. This novel scanning technique opens promising perspectives for studies where sample motion is forbidden because of the sample environment.

The consumption of fish cooked by different methods was related to the risk of hyperuricemia in Japanese adults: A 3-year follow-up study

BACKGROUND AND AIMS

Fish consumption is a recognized risk factor for elevated serum uric acid (UA) levels, hyperuricemia, and gout. However, the relationship between the consumption of fish cooked by different methods and the risk of hyperuricemia is unclear. Therefore, we aimed to investigate the relationship between the consumption of fish cooked by different methods and the risk of hyperuricemia in Japanese adults.

METHODS AND RESULTS

A 3-year follow-up study was conducted with 424 Japanese adults aged 29-74 years. Fish consumption was assessed using a validated self-administered dietary history questionnaire, and hyperuricemia was defined as serum UA ≥7 mg/dL in men and ≥6 mg/dL in women or the use of any anti-gout treatment. During the 3-year follow-up period, we documented 30 newly diagnosed cases of hyperuricemia. After adjusting for potential confounders, multivariate logistic regressions analysis revealed a significant positive relationship between the risk of hyperuricemia and raw (sashimi and sushi) or roasted fish consumption, but not boiled or fried fish consumption. The odds ratios (95% CI) for hyperuricemia with increasing raw fish consumption were 1.00 (reference), 2.51 (0.85, 7.39), and 3.46 (1.07, 11.14) (P for trend: 0.036). Similarly, the odds ratios (95% CI) with increasing roasted fish consumption were 1.00 (reference), 3.00 (0.75, 11.89), and 5.17 (1.30, 20.62) (P for trend: 0.018).

CONCLUSION

This 3-year follow-up study showed that the consumption of raw or roasted fish, but not boiled or fried fish, was related with a higher risk of hyperuricemia in Japanese adults.

Efficacy and safety of once-weekly glucagon-like peptide-1 receptor agonists compared with exenatide and liraglutide in type 2 diabetes: a systemic review of randomised controlled trials

BACKGROUND

Once-weekly glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown promising results in the treatment of type 2 diabetes. Herein, we compared the efficacy and safety of once-weekly GLP-1RAs with exenatide and liraglutide separately.

METHODS

We systematically surveyed the pertinent literature using various databases. The randomised controlled trials that compared once-weekly GLP-1RAs with exenatide and liraglutide in type 2 diabetes were included. Our main end-points were control of glycaemia, body weight, hypoglycaemia and gastrointestinal adverse events (AEs).

RESULTS

Our analysis included eight trials involving 5531 patients. Exenatide-long-acting release (LAR), dulaglutide and taspoglutide were more effective than twice-daily exenatide in reducing glycosylated haemoglobin A1c (HbA1c) and fasting blood glucose (FBG) levels and achieving HbA1c targets (< 7.0% and ≤ 6.5%). Liraglutide was as effective as dulaglutide and more effective than exenatide-LAR and albiglutide in controlling glycaemia. With regard to the effectiveness in decreasing body weight, exenatide-LAR, dulaglutide and taspoglutide were similar to exenatide whereas exenatide-LAR, dulaglutide and albiglutide were inferior to liraglutide. Once-weekly GLP-1RAs, exenatide and liraglutide resulted in a similar incidence of hypoglycaemia and of gastrointestinal, serious, or other AEs.

CONCLUSIONS

Once-weekly GLP-1RAs were more effective in controlling glycaemia and equally effective in decreasing body weight than twice-daily exenatide but were inferior to liraglutide in controlling these two parameters (dulaglutide was similar with liraglutide in controlling glycaemia). Once-weekly GLP-1RAs, exenatide and liraglutide had a similar risk of causing AEs.

Comparative Efficacy of Four Treatments in Patients with Graves' Disease: a Network Meta-analysis

BACKGROUND

The question of which treatment should be preferred for the treatment of Graves' disease is debatable, and pairwise meta-analyses could not obtain hierarchies of these treatments. Our intention was to integrate the evidence to provide hierarchies of the comparative efficacy of 4 treatments (radioiodine, radioiodine+prednisone, antithyroid drugs and surgery).

METHODS

We conducted a Bayesian-framework network meta-analysis of randomized controlled trials (RCTs) to compare 4 treatments in patients with Graves' disease. The eligible RCTs were identified by searching Amed, the British Nursing Index, Embase, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Google scholar, SIGLE, the National Technical Information Service, the National Research Register (UK) and the Current Controlled Trials databases. The data for 2 outcomes (e.g., ophthalmopathy and recurrence) were independently extracted by 2 authors.

RESULTS

A total of 4 RCTs were ultimately included. Radioiodine+prednisone therapy showed statistical significance in reducing the incidence of new or deteriorative ophthalmopathy comparing with the other 3 therapies. Compared with radioiodine, therapy with antithyroid drugs therapy as well as surgery significantly decreased the incidence of new or deteriorative ophthalmopathy. Radioiodine therapy significantly reduced the rate of recurrence when compared to therapy with antithyroid drugs or surgery. For decreasing the incidence of new or deteriorative ophthalmopathy, the 4 treatments were ranked as follows: radioiodine+prednisone therapy, therapy with antithyroid drugs, surgery and radioiodine therapy. For reducing the rate of recurrence, 3 treatments were ranked as follows: radioiodine therapy, therapy with antithyroid drugs and surgery.

CONCLUSIONS

Radioiodine+prednisone therapy might have the least probability of leading to an exacerbation or new appearance of ophthalmopathy, and radioiodine therapy might have the least probability of causing a recurrence.

Phosphorylated STAT3 physically interacts with NPM and transcriptionally enhances its expression in cancer

The signal transducer and activator of transcription 3 (STAT3) can be activated by the tyrosine kinase domain of the chimeric protein nucleophosmin/anaplastic lymphoma kinase (NPM/ALK), and has a pivotal role in mediating NPM/ALK-related malignant cell transformation. Although the role of STAT3 and wild-type NPM in oncogenesis has been extensively investigated, the relationship between both molecules in cancer remains poorly understood. In the present study, we first demonstrate that STAT3 phosphorylation at tyrosine 705 is accompanied by a concomitant increase in the expression level of NPM. Nuclear co-translocation of phosphorylated STAT3 with NPM can be triggered by interferon-alpha (IFN-α) stimulation of Jurkat cells and phosphorylated STAT3 co-localizes with NPM in cancer cells showing constitutive STAT3 activation. We further demonstrate that STAT3 phosphorylation can transcriptionally mediate NPM upregulation in IFN-α-stimulated Jurkat cells and is responsible for maintaining its expression in cancer cells showing constitutive STAT3 activation. Inhibition of STAT3 phosphorylation or knockdown of NPM expression abrogates their simultaneous transnuclear movements. Finally, we found evidence for a physical interaction between NPM and STAT3 in conditions of STAT3 activation. In conclusion, NPM is a downstream effector of the STAT3 signaling, and can facilitate the nuclear entry of phosphorylated STAT3. These observations might open novel opportunities for targeting the STAT3 pathway in cancer.

Genetic variants of 17q21 are associated with childhood-onset asthma and related phenotypes in a northeastern Han Chinese population: a case-control study

A genome-wide association study (GWAS) suggested that variants on chromosome 17q21 were associated with childhood-onset asthma in white populations. Two replication studies had been conducted in southern Han Chinese population in 2009 and 2012. However, these two Chinese replication results were inconsistent. To further confirm the role of 17q21 common variants, an association study of 17q21 single nucleotide polymorphisms (SNPs) with the risk of childhood-onset asthma was performed in a Han population from northeastern China. In this study, rs3894194, rs12603332 and rs11650680 were genotyped in 435 asthmatic children and 601 healthy controls by using a SNaPshot method. Our data showed that the allelic frequency of rs12603332 and rs11650680 showed significant differences between asthmatic cases and healthy controls, with an odds ratio (OR) of 1.36 [95% confidence interval (CI) 1.12-1.65, P=0.002] and an OR of 1.36 (95% CI 1.07-1.74, P=0.01). Genotype distribution analysis also showed the significant associations of the above two loci with childhood asthma under dominant, recessive and additive model (dominant OR=1.57, 95% CI 1.04-2.36, P=0.032; recessive OR=1.41, 95% CI 1.09-1.83, P=0.009; additive OR=1.97, 95% CI 1.24-3.14, P=0.004; recessive OR=1.50, 95% CI 1.13-1.98, P=0.005). Besides, linear regression analysis showed that rs3894194 and rs12603332 were also significantly associated with asthma phenotypes such as log10 -transformed immunoglobulin E (IgE) level (IU/ml) and log10 -transformed eosinophil percentage (dominant, P=0.04; additive, P=0.01; recessive, P=0.04; recessive, P=0.03; additive, P=0.02). Collectively, our findings suggest that orosomucoid 1-like 3 (ORMDL3) locus on chromosome 17q21 is a risk factor for childhood-onset asthma in northeastern Han Chinese population. Further studies will be needed to elucidate the pathogenesis that ORMDL3 locus predisposes to childhood-onset asthma.