A Phase-III Noninferiority, Randomized Controlled Trial of Letibotulinum Toxin A for the Improvement of Moderate-to-Severe Glabellar Wrinkles in China

Background

Letibotulinum toxin A has an established efficacy and safety profile for aesthetic treatment of glabellar wrinkles. This study was conducted to demonstrate the noninferiority of letibotulinum toxin A versus onabotulinum toxin A in improving the appearance of moderate-to-severe glabellar wrinkles in Chinese patients.

Methods

This phase-III multicenter, randomized, parallel positive control, double-blinded study compared the efficacy and safety of letibotulinum toxin A and onabotulinum toxin A. Eligible participants were randomized 3:1 to receive 20 U of letibotulinum toxin A or onabotulinum toxin A and were observed for 16 weeks postinjection. The primary endpoint was noninferiority in the proportion of study participants receiving a score of 0 or 1 for glabellar wrinkles on a four-point photographic evaluation scale, as assessed by an institution evaluator at maximum frown at week 4. Secondary endpoints included assessments at rest, photographic assessment of efficacy, and subjective self-assessment of the study participants.

Results

The proportion of participants (N = 500) receiving a score of 0 or 1 at maximum frown by the institution evaluator at week 4 was 88.49% for letibotulinum toxin A and 87.39% for onabotulinum toxin A (difference, 1.10%; 95% confidence interval, -5.02 to 8.82; P = 0.7469). No significant differences were observed between the treatments for secondary efficacy or safety endpoints. Participants' self-assessment and satisfaction tended to be higher for letibotulinum toxin A than onabotulinum toxin A.

Conclusion

Letibotulinum toxin A is noninferior to onabotulinum toxin A in improving the appearance of moderate-to-severe glabellar wrinkles in Chinese patients.

ABHD2 deficiency aggravates ovalbumin-induced airway remodeling through the PI3K/Akt pathway in an animal model of chronic asthma

Airway remodeling is a major pathological characteristic of chronic obstructive pulmonary disease (COPD). This study aimed to investigate the effect of Abhd2 deficiency on ovalbumin (OVA)-induced airway remodeling and inflammation in vivo. Abhd2-deficient mice were used to establish an OVA-induced asthma model. Lung tissues were analyzed using hematoxylin and eosin (HE) staining, Masson staining, immunohistochemistry, quantitative reverse transcription- polymerase chain reaction (qRT-PCR), and western blotting were used to determine the role of Abhd2 in the regulation of OVA-induced airway remodeling and inflammation. Our findings revealed that the RNA expression of inflammatory factors, including IL-1β, IL-6, IL-4, and IL-13, was significantly increased in OVA-induced Abhd2 Gt/Gt asthmatic mice. The expression of IFN-γ was decreased significantly in OVA-induced Abhd2 Gt/Gt asthmatic mice. The protein expression of airway remodeling factors, including α-SMA, type I collagen, and Ki67, was also increased in OVA-induced Abhd2 Gt/Gt asthmatic mice compared to that in OVA-induced wild-type (WT) mice. Additionally, Abhd2 deficiency promoted the expression of p-Akt in tissues of the asthma model. These results suggest that Abhd2 deficiency exacerbates airway remodeling and inflammation through the PI3K/Akt pathway in chronic asthma.

[Distribution and gene characteristics of H3, H4 and H6 subtypes of low pathogenic avian influenza viruses in environment related avian influenza viruses during 2014-2021 in China]

Objective: To analyze the characteristics of low pathogenic H3, H4 and H6 subtypes of avian influenza viruses in environment related avian influenza viruses in China from 2014 to 2021. Methods: Surveillance sites were located in 31 provinces, autonomous region and municipalities to collect environmental samples related to avian influenza, detect the nucleic acid detection of influenza A virus, isolate virus, deeply sequence, analyze pathogenicity related molecular sites, and determine the distribution and variation characteristics of common H3, H4 and H6 subtypes of avian influenza virus in different regions, places and sample types. Results: A total of 388 645 samples were collected. The positive rate of low pathogenic H3 (0.56‰) and H6 (0.53‰) was higher than that of H4 (0.09‰). The positive rate of H4 subtype virus in live poultry market was higher than that in other places, and the difference was statistically significant. The positive rate of H3 and H6 subtypes in sewage samples was higher than that in other samples, and the difference was statistically significant. The positive rate of H3, H4 and H6 viruses in the south was higher than that in the north, and the difference was statistically significant. December was the most active time for virus. The analysis of pathogenicity related molecular sites showed that H3, H4 and H6 subtypes of viruses combined with avian influenza virus receptors, and some gene sites related to increased pathogenicity had mutations. Conclusion: The H3, H4 and H6 subtypes of low pathogenic avian influenza viruses have a high isolation positive rate in the live poultry market and sewage. The distribution of the three subtypes of viruses has obvious regional and seasonal characteristics, and the genetic characteristics still show the feature of low pathogenic avian influenza.

Innovative development ideas of web-based medical teaching during the COVID-19 epidemic

OBJECTIVE

In response to the sudden COVID-19 epidemic outbreak, China's Ministry of Education proposed "continuing teaching and learning regardless of suspending classes" to provide "available courses and teachers" for students. Web-based teaching has become the main teaching method of medical colleges and universities during the COVID-19 epidemic period. Before the outbreak, the concept and technology of web-based teaching had been partially implemented. The epidemic situation has promoted the implementation of large-scale web-based teaching and the multidimensional development of education in China. Furthermore, there are higher requirements for information teaching. Teachers and students cannot adapt to the web-based teaching mode. The lack of interaction is a problem in the web-based teaching. To adapt to the rapid development of information technology, medical colleges and universities must consider the COVID-19 epidemic as an opportunity to quickly update educational concepts, train teachers' Internet thinking, innovate the web-based teaching mode, and make full use of the network platform to provide better teaching and services. Moreover, medical colleges and universities should eliminate the weaknesses of web-based teaching and improve the quality and connotation of teaching.

Effects of the prebiotic inulin-type fructans on post-antibiotic reconstitution of the gut microbiome

AIMS

Interventions using prebiotic inulin-type fructans (ITFs) are widely prescribed to modulate the gut microbiota composition and activity to promote health. However, the impacts of ITFs on post-antibiotic reconstitution of the gut microbiome remain incompletely understood. The aim of the present study was to investigate the effects of ITFs supplementation on intestinal inflammation, the composition of the intestinal microbiota and the colonic transcriptome after antibiotic treatment.

METHODS AND RESULTS

Male BALB/c mice were subjected to an antibiotic cocktail (ABx) treatment for 7 days, and their microbiomes were then reconstituted either spontaneously or with ITFs supplementation (5%) for 14 days. Our data showed that ITFs supplementation delayed the recovery of antibiotic-induced colitis compared with the spontaneous recovery. Neither ITFs supplementation nor spontaneous recovery could restore the microbial community composition at the genus level back to its initial composition. ITFs supplementation increased the relative abundance of some beneficial bacteria and butyrate levels, but resulted in selective blooms of some opportunistic pathogens and elevated the pathways associated with diseases linked to gut microbiota function. Both ITFs supplementation and spontaneous recovery could restore the colonic transcriptome nearly to the initial profile to a certain extent; however, ITFs supplementation delayed the restoration of the immunoglobulin genes compared to spontaneous recovery.

CONCLUSION

These data showed that post-antibiotic ITFs consumption did not always lead to beneficial effects but might lead to potential adverse effects in the context of dysbiosis.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings highlighted that caution is required when supplementing ITFs to restore intestinal homeostasis in the context of dysbiosis resulting from broad-spectrum antibiotics.

Post-mortem findings in a patient with avian influenza A (H5N6) virus infection

Avian influenza A (H5N6) has been found to infect humans, and has resulted in ten cases with six deaths in China since 2014. Here, we describe the systematic post-mortem pathology of a patient fatally infected with H5N6 virus and evaluate the associated pathogenesis compared with H1N1 pdm09 fatal cases. The most prominent histopathological features were diffuse alveolar damage and pulmonary vasculitis in the lungs of the patient. The virus disseminated to extrapulmonary organs, including the brain. Compared with H1N1 pdm09 fatal infection, H5N6 infection induced a more exacerbated immune response involving overt pulmonary inflammation, which led to alveolar damage and respiratory failure.

Lymphatic drainage of the skull base: comparative anatomic and advanced imaging studies in the rabbit and human with implications for spread of nasopharyngeal carcinoma

This preliminary study investigated the lymphatic drainage and distribution of lymphatic structures in the skull base. Characteristics of the rabbit skull base were analyzed and compared correspondingly with those of the human skull. The lymphatic circulation in the rabbit cranial base was detected by digital subtraction angiography (DSA), and lymph drainage in the human skull base was illustrated by interstitial magnetic resonance lymphography (MRL). Lymphatic structures and their distribution in MRL were identified by comparing with contrast-enhanced MRI and clinical data on basilar metastasis of nasopharyngeal carcinoma (NPC) in the human skull base. Anatomic similarity was found between the rabbit and human basilar regions. Well-visualized lymphatic pathways were found in the rabbit cranial base, and human lymphatic structures showed high signal intensity in enhanced T1-weighted MRL images. Lymphatic tissues in the human basilar region were found mainly distributed in the areas of the jugular foramen, foramen lacerum, and petrosal section of the internal carotid artery (ICA). Their distribution in the human basilar region was similar to the distribution in the rabbit basilar region and consistent with our clinical findings of the predilection sites of NPC metastasis in the skull base. Our studies show that bilateral symmetrical lymphatic structures were distributed along the ICA, internal jugular vein, and dura of cranial base in the central part of the middle and posterior skull base.

Elevated expression of transmembrane IL-15 in immune cells correlates with the development of murine lupus: a potential target for immunotherapy against SLE

Presentation in trans by the Interleukin-15 receptor alpha chain (IL-15Ralpha) has been suggested as the main mechanism for IL-15 anchoring to the cell surface, but it is also evident that IL-15 can exist as a transmembrane protein. We herein demonstrate that replacement of the first 41 residues of human IL-15 (hIL-15) with Igkappa chain leader sequence resulted in secretion of most of the recombinant hIL-15 expressed in transfectant cells, thus identifying the transmembrane region of IL-15. A fusion protein (hIL-15Ralpha-Fc) between the extracellular domain of hIL-15Ralpha and the Fc fragment of IgG1 was prepared and shown to be able to bind with transmembrane IL-15 (tmIL-15). The level of tmIL-15 expression in macrophages, activated T cells and B cells from 6-month-old BXSB male mice, an animal model for systemic lupus erythematosus (SLE), was significantly increased compared with that from BXSB females or young males. In addition, hIL-15Ralpha-Fc was able to block the T cell stimulating and anti-apoptotic effect of the tmIL-15-positive BXSB macrophages in vitro. Intravenous administration of hIL-15Ralpha-Fc reduced the titre of autoantibodies against dsDNA and also proteinuria in aged BXSB males, implying that neutralization of IL-15 activity in vivo may be an effective way of treating SLE.

[Influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients]

OBJECTIVE

To assess the influence of the subglottic secretion drainage on the morbidity of ventilator associated pneumonia in mechanically ventilated patients.

METHODS

All cases requiring intubation in SICU were intubated with a special type endotracheal tube which has a small-bore cannula in its wall for subglottic secretion drainage. They were randomly divided into two groups received subglottic secretion drainage(SSD) and usual care(NON-SSD) respectively. Bacterial culture of samples from the oropharynx, subglottic secretions and lower respiratory tract were obtained periodically. The amount of subglottic secretion aspirated daily, ventilated days and the number of cases with VAP were recorded. Etiologic diagnosis of VAP was based on the quantitative bacterial culture of secretions obtained by protected specimen brush(PSB).

RESULTS

The morbidity of VAP in the SSD group (n = 35) (23%) was lower than that in the NON-SSD group (n = 33) (45%) (P < 0.05). The difference was due to the significant reduction of VAP caused by gram-positive cocci and Haemophilus influenzae organisms. However, no difference was observed in the incidence of VAP caused by non-fermental bacteria. After intubation the onset of VAP was delayed in SSD group (14 +/- 8 day) as compared with the NON-SSD group (6 +/- 4 day) (P < 0.05). The same organisms were isolated by PSB among 61% (14/23) patients with VAP as what were previously isolated from the subglottic secretions.

CONCLUSIONS

The presence of subglottic secretion may be an origin of the pathogenetic organisms of VAP. The morbidity of VAP in mechanically ventilated patients can be reduced by SSD, especially for VAP caused by gram-positive cocci and Haemophilus influenzae organisms. SSD may be a simple and effective method for prevention of VAP.

[Observation of biofilms inside tracheal tubes by electron microscopy and the relationship between biofilms and VAP]

OBJECTIVE

To observe the formation of biofilms inside tracheal tubes and to evaluate the effect of biofilm on the development of ventilator associated pneumonia (VAP).

METHODS

Biofilms inside tracheal tubes from intubated patients were observed by scanning electron microscopy and transmission electron microscopy, meanwhile bacteria were detected in the specimens from the lower respiratory tract and the inside of tracheal tubes.

RESULTS

76% (19/25) of inner surface of tracheal tubes was coated with a confluent amorphous matrix by scanning electron microscopy. The average duration of trach-intubation in this group [(10.7 +/- 7.9) days] was longer than that in the other group [(2.1 +/- 0.8) days] in which tracheal tubes were not coated with the confluent amorphous matrix (P < 0.05). The presence of many bacteria(14/18) within these amorphous matrix was confirmed by transmission electron microscopy. Of the sixteen tracheal tubes, eleven tubes grew the same organisms that had been isolated from the secretions of the lower respiratory tract before extubation. In some VAP patients (7/8), organisms isolated from tracheal tubes were the same organisms which were pathogenic organisms of VAP.

CONCLUSIONS

There was a close connection between the formation of bacterial BF and the long-term indwelling tracheal tubes. The presence of bacterial BF in the inner of tracheal tubes might be associated with the pathogenic organisms of VAP.

Heart rate variability following cardiac surgery fails to predict short-term cardiovascular instability

The heart rate variability of 40 patients has been examined by spectral analysis following cardiac surgery. The heart rate variability was measured upon patient arrival in ICU in both a resting supine position, and following passive straight-leg raising. After 12 hours in ICU, the patients were classified as having been cardiovascularly stable or unstable according to a specially devised inventory. Their heart rate variability data was then examined to seek any predictor of instability. Passive straight-leg raising induced a decrease in spectral power across all of the component frequency bands. The LF/HF ratio rose with passive straight-leg raising, but failed to reach significance. None of these changes were sustained. There was no significant difference in heart rate variability patterns between the stable and unstable groups, and so no predictor was identified. Initial clinical assessment was also studied, and it too provided no reliable prediction of short-term cardiovascular instability.

Variability of R-R, P wave-to-R wave, and R wave-to-T wave intervals

We analyzed the effect of changing posture from supine to standing on the variability of R-R, P-R, and R-T intervals in 10 healthy volunteers using power spectral analysis. An electrocardiogram and respiratory trace were recorded before and after posture change. Variability in the P-R and R-T intervals was much less than in the R-R interval and demonstrated a lower-frequency (LF)-to-high-frequency (HF) ratio. Changing from a supine to a standing position showed no change in indexes of vagal influence on the P-R and R-T variability, in contrast to the well-documented decrease in the indexes of vagal influence on the R-R variability (HF power decreased from 2.33 to 0.41 ms2, P = 0.003; amplitude of the respiration-to-heart rate impulse response decreased from 31.6 to 14.4 ms.ml-1.s-1, P = 0.03; and LF/HF increased from 1.96 to 5.22, P = 0.005). We concluded from this study that the effects of standing were an observed reduction in vagal influence on the heart rate variability of the R-R interval and maintenance of lung volume-related vagal modulation of the P-R and R-T intervals.