Voltage-gated sodium channel gene mutation and P450 gene expression are associated with the resistance of Aphis spiraecola Patch (Hemiptera: Aphididae) to lambda-cyhalothrin

Aphis spiraecola Patch is one of the most economically important tree fruit pests worldwide. The pyrethroid insecticide lambda-cyhalothrin is commonly used to control A. spiraecola. In this 2-year study, we quantified the resistance level of A. spiraecola to lambda-cyhalothrin in different regions of the Shaanxi province, China. The results showed that A. spiraecola had reached extremely high resistance levels with a 174-fold resistance ratio (RR) found in the Xunyi region. In addition, we compared the enzymatic activity and expression level of P450 genes among eight A. spiraecola populations. The P450 activity of A. spiraecola was significantly increased in five regions (Xunyi, Liquan, Fengxiang, Luochuan, and Xinping) compared to susceptible strain (SS). The expression levels of CYP6CY7, CYP6CY14, CYP6CY22, P4504C1-like, P4506a13, CYP4CZ1, CYP380C47, and CYP4CJ2 genes were significantly increased under lambda-cyhalothrin treatment and in the resistant field populations. A L1014F mutation in the sodium channel gene was found and the mutation rate was positively correlated with the LC50 of lambda-cyhalothrin. In conclusion, the levels of lambda-cyhalothrin resistance of A. spiraecola field populations were associated with P450s and L1014F mutations. Our combined findings provide evidence on the resistance mechanism of A. spiraecola to lambda-cyhalothrin and give a theoretical basis for rational and effective control of this pest species.

A COVID-19 screening method based on eyes photographs and artificial intelligence

Background

SARS-CoV-2 can spread both from symptomatic and asymptomatic individuals. Ocular manifestations due to SARS-CoV-2 have been described, being conjunctival inflammation the most common affectation. Evidence shows that conjunctivitis could be the first and/or only manifestation of COVID-19. This study aimed to develop and validate a COVID-19 screening method based on eyes photographs and artificial intelligence.

Methods

In this multicentre study, 1,200 participants were enrolled from Shanghai Public Health Clinical Center (SPHCC) Fudan University, AIMOMICS LAB and La Fe University and Polytechnic Hospital (LFUPH) of Valencia (Spain). Pictures of participants' ocular surface were taken in four different positions with mobile phone cameras, and a Deep Learning System (DLS) was developed through machine learning to identify characteristic conjunctival inflammation patterns. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committees of SPHCC and LFUPH.

Results

The area under the receiver-operating-characteristic curve (AUC), sensitivity, specificity, and accuracy were calculated according to the results of our binary classification network. Bootstrapping with 1,000 replicates was used to estimate 95% confidence intervals of the performance metrics, with photography as the resampling unit. On the subject-level classification, the network achieved the AUC of 0.976 (95% CI 0.965-0.988) among Asian population and 0.892 (95% CI 0-763-1.000) among Caucasian population.

Conclusions

Preliminary results show that this DLS performed well in identifying probable asymptomatic COVID-19 cases through the analysis of participants' eyes pictures. This method could be an innocuous, accessible, low cost and quick COVID-19 screening method. Eventually, it could potentially contribute to pandemic control.

Key messages

In the context of the COVID-19 pandemic it would be useful to have a screening method to easily and quickly detect asymptomatic individuals, in addition to using temperature control. Preliminary results show that this Deep Learning System (DLS) based on eyes pictures taken with mobile phone cameras could be an innocuous, accessible, low cost and quick COVID-19 screening method.

[Key points and skills of assistant in robotic radical gastrectomy for gastric cancer]

An excellent assistant for robotic radical gastrectomy can play an important role in the operation, especially in a initial team. In robotic gastric cancer surgery, an excellent assistant should actively participate in the operation process, choose the appropriate trocar position according to patient's body habitus. Moreover, he should master various surgical instruments skillfully and switch instruments fluently to assist the surgeon to expose key parts during operation, and provide effective help in the operative details, so that the whole operation process can run more smoothly and the operation efficiency and quality will be greatly improved. The growth of the assistants needs constant practice and summary of experience. Meanwhile, the encouragement of the chief surgeon also plays a positive role in promoting the development of the assistants.

P1499 A case of missing left ventricular apex

Introduction

Isolated left ventricle (LV) apical hypoplasia is a rare congenital anomaly. Echocardiographic diagnosis is challenging if one is not aware of this condition. It can masquerade as LV non-compaction or apical aneurysm. Multimodality imaging with cardiac magnetic resonance (CMR) can be useful to secure the diagnosis.

Case description

An asymptomatic 18-year-old man, with no significant personal or family medical history, was referred to cardiology clinic due to abnormal electrocardiogram (ECG) during routine cardiac screening. ECG showed right axis deviation and delayed precordial QRS-transition. He had excellent effort tolerance during treadmill exercise test (standard Bruce Protocol stage 6). Ambulatory ECG monitoring was within normal limits.

Transthoracic echocardiogram showed a truncated appearance of LV apex with increased apical trabeculation, and bulging right ventricle apex (see image A and B). LV ejection fraction was preserved. The LV appearance was initially thought to be due to foreshortened apical view. A diagnosis of LV non-compaction cardiomyopathy was also inaccurately considered.

He was further evaluated with CMR imaging. The study showed a truncated LV apex and apical insertion of the papillary muscles. RV apex was seen wrapping around the LV (see image C and D). Both the LV and RV function were normal. There was no late gadolinium enhancement (LGE). The morphological abnormalities were consistent with the diagnosis of isolated LV apical hypoplasia.

Patient continued to be physically active and asymptomatic. Follow up CMR five years later showed similar findings of preserved biventricular functions and no fibrosis on LGE imaging.

Discussion

We described a rare case of isolated LV apical hypoplasia with longitudinal clinical and cardiac imaging follow up. Initial diagnosis from transthoracic echocardiogram was elusive, and supportive findings from CMR helped to secure the diagnosis.

In the literature, the clinical presentation ranges from chest pain syndrome, arrhythmias, heart failure or as incidental finding during cardiac imaging, as in our case. It is commonly diagnosed as nonspecific cardiomyopathy when the clinician is not aware of this condition.

Being a rare congenital anomaly, the prognosis is not well established. Our patient remained asymptomatic clinically with preserved biventricular function in his 5 years follow-up.

Abstract P1499 Figure. Echo and CMR imaging

A Review of Three Commonly Used Herbs Which Enhance Memory and New Evidences Which Show Their Combination Could Improve Memory in Young Animals

BACKGROUND

This review looks into the herbs Gingko biloba, Polygala tenuifolia, and Lycii fructus for their widely studied neuroprotective properties. In particular, we investigated memory enhancing effect of these herbs, and their potential synergetic effect on memory with new data. Sixmonth treated mice demonstrated shorter escape latency in water maze and shorter arrival time in a consolidated memory task. Immunochemistry showed evident increase in superoxide dismutase activities in the prefrontal cortex, implying protection against free radicals during aging. Discrete increase of catecholaminergic neurons was found in the prefrontal cortex, hippocampus, corpus striatum, and midbrain, suggesting better memory and better control on mood and behavior. Necrotic cells in the brain decreased as indicated by immunocytochemistry of lactic dehydrogenase. Terminal deoxynucleotidyl transferase dUTP nick end labeling showed no apoptotic cells in most brain areas in high dose group. Biochemistry revealed increase of dopaminergic cells in treatment groups at prefrontal cortex, and in the hippocampus and cerebellum of the high dose group. Most 6-month groups showed increase of serotonin in all three areas. For the high dose group, GABA increased in the hippocampus but not prefrontal cortex, which would help induce sleep at night. Protein kinase C increased in most groups at prefrontal cortex, hippocampus and cerebellum, signifying increase of possible signal transduction pathways for memory or other nervous activations.

CONCLUSION

Our results intimate that the interaction of the three herbs exerts beneficial effects on memory, associated cognitive function, and necrosis. Future investigations based on the present data shall aid development of clinically relevant medication.

Three months of methoxetamine administration is associated with significant bladder and renal toxicity in mice

CONTEXT.: Methoxetamine is a ketamine analogue that has recently emerged as a novel psychoactive substance. Chronic ketamine use is associated with significant bladder and renal toxicity. Methoxetamine has been marketed as "bladder friendly", but there is no data to be able to substantiate this claim.

OBJECTIVE

To characterise the patterns of bladder and renal toxicity associated with 3 months of methoxetamine administration in an animal model.

MATERIALS AND METHODS

Two-month-old Institute of Cancer Research mice were administered 30 mg/kg methoxetamine intraperitoneally (n = 5) or saline (n = 3 control) for 3 months. The animals were then sacrificed and histological examination, immuno-cytochemistry using polyclonal anti-CD4 antibodies and sirius-red staining for collagen were performed.

RESULTS

The kidneys of methoxetamine-treated animals showed inflammatory cell infiltration, tubular cell necrosis and glomerular damage (1.9 ± 0.3% shrunken glomeruli in control, 9.8 ± 0.8% in methoxetamine-treated mice (p < 0.0001); 2.9 ± 0.3% tubular cell degeneration in control, 20.4 ± 1.1% in methoxetamine-treated mice (p < 0.0001)). There was a greater density of mononuclear cells in the bladder lamina propria and submucosa in methoxetamine-treated mice (43.0 ± 2.1 per 250 × 250 μm) than controls (7.1 ± 1.2 per 250 × 250 μm), p < 0.001. CD4-positive staining was seen in the bladder submucosa and lamina propria of all methoxetamine-treated mice and muscle-layer of two methoxetamine-treated mice; these changes were not seen in the control mice. There was an increase in sirius-red collagen in the bladder sub-mucosa and muscle-layer in the methoxetamine-treated mice compared with control mice.

DISCUSSION

This study has shown that 3 months of daily 30 mg/kg intra-peritoneal methoxetamine results in significant bladder and renal toxicity in mice. Changes in the bladder included inflammatory changes with subsequent fibrosis and changes in the kidney were seen at both a tubular and glomerular level. These changes are similar to those seen in comparable animal models of chronic ketamine administration. Further work is required to determine the time course of the onset of these effects and whether the effects are reversible with methoxetamine cessation.

Long term ketamine and ketamine plus alcohol toxicity - what can we learn from animal models?

This review addressed the adverse effects of the frequently-used recreational drug, ketamine through using mice and monkey models. Our laboratory has documented initially that ketamine can induce the formation of hyperphosphorlated tau (hypertau), which is a hallmark of Alzheimer's disease (AD), in the cerebral cortex of both mice and monkeys as well as apoptosis in neurons in these species. Besides the cerebral cortex, other centers in the central nervous system (CNS) and peripheral nervous system (PNS) are also influenced by ketamine. Cerebellum was found to be down-regulated in both mice and humans after long-term of ketamine administration and it was caused by the apoptosis of Purkinje cells. Deleterious effects in other organs reported in long-term ketamine users include of kidney dysfunction leading to proteinuria, fibrosis of the urinary bladder and reduction in size of the urinary bladder leading to frequent urination, increase of liver fibrosis and cardiac problems such as premature ventricular beats. Moreover, ketamine is usually co-administrated with other chemicals such as caffeine or alcohol. It has been reported increased harmful effects when ketamine was used in combination with the above substances. Mechanisms of damages of ketamine might be due to 1) up-regulation of NMDA receptors leading to overestimation of glutamatergic system or 2) the metabolite of ketamine which was a hydroquinone exerted toxicity.

Intestinal and liver changes after chronic ketamine and ketamine plus alcohol treatment

The effects of long-term chronic ketamine treatment on the intestine and the liver were studied in the ICR mice which had daily intraperitoneal injection of ketamine at 30 mg/kg per day for 7 months. The intestine showed no significant pathology after treatment but had a decrease of the positive sites of proliferative cell nuclear antigen in the mucosae of the intestines after ketamine and ketamine plus alcohol (added in the last month) treatment. No significant apoptosis (via TUNEL) nor necrosis (via lactic acid dehydrogenase) was detected in the intestines of all control and ketamine-treated groups, with the exception of an increase of lactic acid dehydrogenase in the mucosae of the intestines of the ketamine plus alcohol group. In the liver, loss of glycogen was observed in animals after ketamine and ketamine plus alcohol treatment, in addition to the pathology reported in a previous work. The decrease in quantity of glycogen in the liver reflected either a failure of glycogen synthesis from glucose or an increase of glycogenolysis in the liver.

Permanent deficits in brain functions caused by long-term ketamine treatment in mice

Ketamine, an injectable anesthetic, is also a popular recreational drug used by young adults worldwide. Ketamine is a non-competitive antagonist of N-methyl-d-aspartate receptor, which plays important roles in synaptic plasticity and neuronal learning. Most previous studies have examined the immediate and short-term effects of ketamine, which include learning and cognitive deficits plus impairment of working memory, whereas little is known about the long-term effects of repeated ketamine injections of common or usual recreational doses. Therefore, we aimed to evaluate the deficits in brain functions with behavioral tests, including wire hang, hot plate and water maze tests, plus examine prefrontal cortex apoptotic markers, including Bax, Bcl-2 and caspase-3, in mice treated with 6 months of daily ketamine administration. In our study, following 6 months of ketamine injection, mice showed significant deterioration in neuromuscular strength and nociception 4 hours post-dose, but learning and working memory were not affected nor was there significant apoptosis in the prefrontal cortex. Our research revealed the important clinical finding that long-term ketamine abuse with usual recreational doses can detrimentally affect neuromuscular strength and nociception as part of measurable, stable and persistent deficits in brain function.

Clinical features and outcome of emergency percutaneous intervention of left main coronary artery occlusion in acute myocardial infarction

INTRODUCTION

Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion carries a grave prognosis. Large series reporting on the outcome of emergency revascularisation (percutaneous or surgical) of acute LMCA occlusion have been scarce. We seek to identify, in our local population, the clinical presentation and outcome of this group of patients.

METHODS

From January 2000 to December 2005, a total of 1,539 patients underwent primary percutaneous coronary angioplasty for AMI in our institution. 11 patients (0.8 percent) underwent percutaneous intervention to the LMCA. These patients became the subjects of our study. Data on demography, clinical features and outcome was collected from all in-hospital and clinical notes. One sub-investigator, who was blinded to the study outcome, assessed the angiographical features.

RESULTS

The overall inpatient mortality was 82 percent (9 out of 11). Nine out of 11 patients presented with cardiogenic shock. All patients presented with shock died during the hospital stay. All patients required intra-aortic balloon counter pulsation insertion. Of the two patients who survived till discharge, one had angioplasty followed by bypass surgery. The remaining one had angioplasty and stenting to the left main artery. Both survivors have been doing well without further major adverse cardiac event after an average of 64 months of follow-up.

CONCLUSION

Percutaneous revascularisation of acute LMCA occlusion is feasible and the best outcome is seen in stable patients. Prognosis is still poor in patients with unfavourable clinical features.

Electrocardiographical case. Beware of this ECG in patients presenting with cardiogenic shock

A 64-year-old Chinese man presented to the Accident and Emergency Department with chest pain and was found to be in cardiogenic shock. The electrocardiogram (ECG) showed features of acute myocardial infarction due to left main coronary artery occlusion,which had no ST elevation in precordial leads. Emergency coronary angiogram revealed left main coronary artery complete occlusion. Percutaneous intervention of the left main coronary artery was carried out. The epidemiology and clinical features of a left main occlusion were briefly described, and ECG features of a left main occlusion were discussed.

Organization of human cardiovascular-expressed genes on chromosomes 21 and 22

The recent availability of the sequenced and annotated DNA sequences of chromosomes 21 and 22 has initiated the next phase in the human genome project: the application of this resource. One facet of these data is that they provide a list of ordered genes along the chromosome that can be capitalized upon to determine gene position effects. Specifically, the physical position and distribution of genes along the chromosomes may be related to gene expression in specific organs or organ systems. In this report we index the subset of genes constituting the human "cardiovascular genome" on chromosomes 21q and 22q as well as report the identification of several "cardiovascular gene" clusters. These gene clusters are suggestive of a higher order of tissue-specific gene regulation at the chromosomal level.

Identification, characterization, and mapping of expressed sequence tags from an embryonic zebrafish heart cDNA library

The generation of expressed sequence tags (ESTs) has proven to be a rapid and economical approach by which to identify and characterize expressed genes. We generated 5102 ESTs from a 3-d-old embryonic zebrafish heart cDNA library. Of these, 57.6% matched to known genes, 14.2% matched only to other ESTs, and 27.8% showed no match to any ESTs or known genes. Clustering of all ESTs identified 359 unique clusters comprising 1771 ESTs, whereas the remaining 3331 ESTs did not cluster. This estimates the number of unique genes identified in the data set to be approximately 3690. A total of 1242 unique known genes were used to analyze the gene expression patterns in the zebrafish embryonic heart. These were categorized into seven categories on the basis of gene function. The largest class of genes represented those involved in gene/protein expression (25.9% of known transcripts). This class was followed by genes involved in metabolism (18.7%), cell structure/motility (16.4%), cell signaling and communication (9.6%), cell/organism defense (7.1%), and cell division (4.4%). Unclassified genes constituted the remaining 17.91%. Radiation hybrid mapping was performed for 102 ESTs and comparison of map positions between zebrafish and human identified new synteny groups. Continued comparative analysis will be useful in defining the boundaries of conserved chromosome segments between zebrafish and humans, which will facilitate the transfer of genetic information between the two organisms and improve our understanding of vertebrate evolution.

Optimal low dosage of acetylsalicylic acid (ASA) for the prevention and treatment of ischemic cerebrovascular disease in geriatric patients

A series of 108 geriatric patients with ischemic cerebrovascular disease were treated with low dose aspirin (acetylsalicylic acid, ASA). Daily doses of 100 mg, 50 mg and 25 mg were administered to three groups of 36 patients. Changes in platelet aggregation responses were dynamically observed in 64 (22 normal subjects, 42 patients). Monitoring of 22 normal subjects revealed inhibition of platelet aggregation at a dose of 300 mg or 100 mg which could last as long as 7 days. This suggests that 100 mg or less could be clinically effective. Satisfactory inhibitory effects on platelet aggregation were observed in all three groups, with 14 patients in each group given daily doses of 100 mg, 50 mg and 25 mg during four weeks' observation. The most effective inhibition was obtained in the 50 mg group. Therefore, the authors recommend 50 mg/d as the optimal dosage for low dose aspirin therapy in geriatric patients.

[Analysis of 59 cases of non-traumatic sudden death in various neurological diseases]

Sudden death is a common complication of myocardial infarction, necrotic pancreatitis and other diseases. Physicians usually neglect the possibility of neurological disorders. 59 cases of sudden death among 314 autopsied cases with neurological diseases were analyzed. The most frequent cause of neurological sudden death was cerebrovascular disease (CVD). It was present in 53 (89.9%) cases. 48 of them had hemorrhagic CVD. 37 of these 48 cases were due to hypothalamic lesions. In 37 cases general autopsy was performed; pathological abnormalities of heart, lungs, stomach etc, were found in 28 of them. In conclusion, the size and location of the lesion correlated with the prognosis of the disease. Concomitant multiple organ damage may deteriorate the lesion. Awareness of sudden death resulting from CVD may elevate the rate of correct diagnosis.