Classification and clinical significance of immunogenic cell death-related genes in Plasmodium falciparum infection determined by integrated bioinformatics analysis and machine learning

BACKGROUND

Immunogenic cell death (ICD) is a type of regulated cell death that plays a crucial role in activating the immune system in response to various stressors, including cancer cells and pathogens. However, the involvement of ICD in the human immune response against malaria remains to be defined.

METHODS

In this study, data from Plasmodium falciparum infection cohorts, derived from cross-sectional studies, were analysed to identify ICD subtypes and their correlation with parasitaemia and immune responses. Using consensus clustering, ICD subtypes were identified, and their association with the immune landscape was assessed by employing ssGSEA. Differentially expressed genes (DEGs) analysis, functional enrichment, protein-protein interaction networks, and machine learning (least absolute shrinkage and selection operator (LASSO) regression and random forest) were used to identify ICD-associated hub genes linked with high parasitaemia. A nomogram visualizing these genes' correlation with parasitaemia levels was developed, and its performance was evaluated using receiver operating characteristic (ROC) curves.

RESULTS

In the P. falciparum infection cohort, two ICD-associated subtypes were identified, with subtype 1 showing better adaptive immune responses and lower parasitaemia compared to subtype 2. DEGs analysis revealed upregulation of proliferative signalling pathways, T-cell receptor signalling pathways and T-cell activation and differentiation in subtype 1, while subtype 2 exhibited elevated cytokine signalling and inflammatory responses. PPI network construction and machine learning identified CD3E and FCGR1A as candidate hub genes. A constructed nomogram integrating these genes demonstrated significant classification performance of high parasitaemia, which was evidenced by AUC values ranging from 0.695 to 0.737 in the training set and 0.911 to 0.933 and 0.759 to 0.849 in two validation sets, respectively. Additionally, significant correlations between the expressions of these genes and the clinical manifestation of P. falciparum infection were observed.

CONCLUSION

This study reveals the existence of two ICD subtypes in the human immune response against P. falciparum infection. Two ICD-associated candidate hub genes were identified, and a nomogram was constructed for the classification of high parasitaemia. This study can deepen the understanding of the human immune response to P. falciparum infection and provide new targets for the prevention and control of malaria.

Effect of occlusal stabilisation splint with or without arthroscopic disc repositioning on condylar bone remodelling in adolescent patients

The aim of this study was to investigate the treatment effects of a stabilisation splint (SS) with and without arthroscopic disc repositioning (ADR) on condylar bone remodelling in adolescent patients with anterior disc displacement without reduction (ADDwoR). Cone beam computed tomography and magnetic resonance imaging were used to analyse condylar bone remodelling, condyle position, and disc position. Twenty-two temporomandibular joints of 14 patients who underwent ADR (age range 12-20 years; mean follow-up 12.5 ± 7.8 months) and 21 temporomandibular joints of 14 patients who did not undergo ADR (age range 13-20 years; mean follow-up 11.1 ± 5.1 months) were included. The change in bone volume (P < 0.001), rate of bone volume change (P < 0.001), and change in condyle height (P = 0.031) were significantly greater in patients with ADR than in those without ADR. The changes in posterior joint space (P = 0.013), superior joint space (P = 0.020), and ratio of condyle sagittal position (P = 0.013) were significantly greater in patients with ADR than in those without ADR. All discs in patients who underwent ADR and one disc in those who did not undergo ADR were backward repositioned. In conclusion, in adolescent patients with ADDwoR, ADR with SS therapy achieved better condyle and disc position than SS therapy alone, and also induced bone generation.

Expression of water-soluble nucleocapsid protein of SARS-CoV-2 and analysis of its immunogenicity

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to be a major public health concern. Nucleocapsid (N) protein is the most abundant structural protein on SARS-CoV-2 virions and induces the production of antibodies at the early stage of infection. Large-scale preparation of N protein is essential for the development of immunoassays to detect antibodies to SARS-CoV-2 and the control of virus transmission. In this study, expression of water-soluble N protein was achieved through inducing protein expression at 25°C with 0.5 mM IPTG for 12 h. Western blot and ELISA showed that recombinant N protein could be recognized by sera collected from subjects immunized with Sinovac inactivated SARS-CoV-2 vaccine. Four monoclonal antibodies namely 2B1B1, 4D3A3, 5G1F8, and 7C6F5 were produced using hybridoma technology. Titers of all four monoclonal antibodies in ELISA reached more than 1.28×10 6.0. Moreover, all monoclonal antibodies could react specifically with N protein expressed by transfection of pcDNA3.1-N into BHK-21 cells in IPMA and IFA. These results indicated that water-soluble N protein retained high immunogenicity and possessed the same epitopes as that of native N protein on virions. In addition, the preparation of water-soluble N protein and its monoclonal antibodies laid the basis for the development of immunoassays for COVID-19 detection.

[Clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds]

Objective: To explore the clinical effects of scalp flaps pedicled with superficial temporal artery parietal branch in repairing facial destructive burn wounds. Methods: A retrospective observational study was conducted. From January 2016 to December 2021, 15 patients with facial destructive burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 11 males and 4 females, aged 22 to 79 years. Two patients were complicated with unilateral eyeball destructive burns, two patients were complicated with unilateral auricle defects, eight patients were complicated with lip and cheek defects, and three patients were complicated with lip, cheek, and unilateral nasal alar defects. The burn wound areas ranged from 9 cm×6 cm to 13 cm×10 cm. The scalp flaps pedicled with superficial temporal artery parietal branch, with the area of 10 cm×7 cm to 15 cm×11 cm, were designed, excised, and transferred for repairing burn wounds. The secondary wounds at the donor sites were repaired with medium-thickness scalp grafts. According to patient's needs, the hairs grew at the facial transplanted flap were removed by laser at 2 weeks after the flap was completely viable, or the expanded scalp flap was used to treat the secondary alopecia in the flap donor area of the head at 3 months after the primary wound repair. The survival of the flap/skin graft and the wound healing of the donor and recipient areas after the primary wound repair were recorded. During the follow-up, the appearance of the flap, the scar hyperplasia at the suture site, the repair effect of facial functional parts, the treatment effects of laser hair removal and secondary alopecia treatment at the flap donor site were observed; the patient's satisfaction with the overall repair effect was inquired. Results: After the primary wound repair, all the flaps transplanted to the burn wounds and the skin grafts transplanted to the secondary wounds of the flap donor sites survived well, and the wounds at the donor and recipient sites of flap healed well. The color, texture, and thickness of flap were basically the same as those of normal facial skin, and the scar at the suture site was slight during 3 to 18 months of follow-up period after the primary wound repair. In 11 patients complicated with lip defects, the oral integrity, and the opening and closing functions of mouth were restored with the mouth opening being 2.0-2.5 cm and no microstomia; all the patients could carry out basic language communication, 8 of them could take regular food, and 3 of them could take soft food. The wounds in two patients with unilateral eyeball destructive burns were repaired. In 2 patients complicated with auricle defects, the wounds were repaired, and the external auditory canals were normal. In 3 patients complicated with unilateral nasal alar defects, their noses had poor appearance with reduced nostrils. No hair growth was observed in the facial flap sites after treatment of laser hair removal in 8 patients. Five patients were successfully treated with expanded scalp flaps for secondary alopecia in the flap donor area of the head. The patients were all satisfied with the overall repair effect. Conclusions: The scalp flap pedicled with superficial temporal artery parietal branch has abundant blood supply and is suitable for repairing the wounds in facial destructive burns. It is easy to transfer and can better restore the appearance and function of the recipient area with minimal damage to the flap donor area, which is worthy of clinical promotion.

Octahedral Distortion and Displacement-Type Ferroelectricity with Switchable Photovoltaic Effect in a 3d^{3}-Electron Perovskite System

Because of the half-filled t_{2g}-electron configuration, the BO_{6} octahedral distortion in a 3d^{3} perovskite system is usually very limited. In this Letter, a perovskitelike oxide Hg_{0.75}Pb_{0.25}MnO_{3} (HPMO) with a 3d^{3} Mn^{4+} state was synthesized by using high pressure and high temperature methods. This compound exhibits an unusually large octahedral distortion enhanced by approximately 2 orders of magnitude compared with that observed in other 3d^{3} perovskite systems like RCr^{3+}O_{3} (R=rare earth). Essentially different from centrosymmetric HgMnO_{3} and PbMnO_{3}, the A-site doped HPMO presents a polar crystal structure with the space group Ama2 and a substantial spontaneous electric polarization (26.5  μC/cm^{2} in theory) arising from the off-center displacements of A- and B-site ions. More interestingly, a prominent net photocurrent and switchable photovoltaic effect with a sustainable photoresponse were observed in the current polycrystalline HPMO. This Letter provides an exceptional d^{3} material system which shows unusually large octahedral distortion and displacement-type ferroelectricity violating the "d^{0}-ness" rule.

[Clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns]

Objective: To explore the clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns. Methods: A retrospective observational study was conducted. From May 2018 to April 2021, 12 male patients with thumb destructive defects caused by electrical burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, aged 27 to 58 years, including 10 cases with degree Ⅲ thumb defect and 2 cases with degree Ⅳ thumb defect after thorough debridement. The thumb was reconstructed with free hallux-nail flap combined with composite tissue flap of the second phalangeal bone, joint, and tendon with skin island. The donor site of hallux-nail flap was covered with artificial dermis in the first stage and performed with continuous vacuum sealing drainage, and covered with medium-thickness skin graft from the groin site in the second stage. The donor site in the second toe was filled and fixed with iliac bone strips. The survival of reconstructed thumb was observed 1 week after the reconstruction surgery, the survival of skin graft in the donor site of hallux-nail flap was observed 2 weeks after skin grafting, and the callus formation of the reconstructed thumb phalanx and the second toe of the donor foot was observed by X-ray 6 weeks after the reconstruction surgery. During the follow-up, the shape of reconstructed thumb was observed and the sensory function was evaluated; the function of reconstructed thumb was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; whether the interphalangeal joints of the hallux and the second toe were stiff, the scar hyperplasia of the foot donor site, and whether the walking and standing functions of the donor feet were limited were observed. Results: One week after the reconstruction surgery, all the reconstructed thumbs of the patients survived. Two weeks after skin grafting, the skin grafts in the donor site of hallux-nail flap of 11 patients survived, while the skin graft in the donor site of hallux-nail flap of 1 patient was partially necrotic, which was healed completely after 10 days' dressing change. Six weeks after the reconstruction surgery, callus formation was observed in the reconstructed thumb and the second toe of the donor foot of 10 patients, the Kirschner wires were removed; while callus formation of the reconstructed thumb was poor in 2 patients, and the Kirschner wires were removed after 2 weeks of delay. During the follow-up of 6 to 24 months, the shape of reconstructed thumb was similar to that of the healthy thumb, the discrimination distance between the two points of the reconstructed thumb was 7 to 11 mm, and the functional evaluation results were excellent in 4 cases, good in 6 cases, and fair in 2 cases. The interphalangeal joints of the hallux and the second toe of the donor foot were stiff, mild scar hyperplasia was left in the donor site of foot, and the standing and walking functions of the donor foot were not significantly limited. Conclusions: The application of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns adopts the concept of reconstruction instead of repair to close the wound. It can restore the shape and function of the damaged thumb without causing great damage to the donor foot.

[A prospective randomized controlled study of the effectiveness of artificial dermis combined with split-thickness skin for repairing wounds with bone and tendon exposure in hands and feet]

Objective: To explore the clinical effects of artificial dermis combined with split-thickness skin for repairing wounds with bone and tendon exposure in hands and feet. Methods: A prospective randomized controlled study was conducted. From October 2018 to February 2020, 82 patients with bone and tendon exposed wounds in hands and feet admitted to the Department of Burns of Zhengzhou First People's Hospital who met the inclusion criteria were selected. All the patients were divided into flap group (41 cases, including 27 males and 14 females) and artificial dermis+split-thickness skin group (41 cases, including 29 males and 12 females) according to the random number table, with age of (37±7) years. After complete debridement of wounds of patients in the two groups, the wounds of patients in flap group were transplanted with anterolateral femoral free flaps; the wounds of patients in artificial dermis+split-thickness skin group were grafted with artificial dermis with continuous negative pressure suction applied, and then grafted with split-thickness skin from autologous lateral thigh once the vascularization of artificial dermis was completed. One week after autologous skin graft/flap grafting, the survival of wound graft was observed and the graft survival rate was calculated. The complete wound healing time, number of operation, length of hospital stay, hospitalization cost, and the occurrence of surgery-related complications during hospitalization after autologous skin graft/flap grafting were recorded, and the incidence of complications was calculated. Six months after autologous skin graft/flap grafting, the scar hyperplasia of recipient area was evaluated by Vancouver Scar Scale (VSS), while the recovery of hand and foot function was evaluated by Total Action Mobility (TAM) System Rating method and American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Function Scale (AOFAS-AHS), respectively. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and independent sample t test. Results: One week after autologous skin graft/flap grafting, the survival rates of wound grafts were similar in the two groups (P>0.05). The complete wound healing time and length of hospital stay were (29±5) and (35±5) d for patients in artificial dermis+split-thickness skin group, respectively, which were significantly longer than (22±4) and (28±5) d in flap group (t=6.96, 6.22, P<0.01). Compared with those in flap group, the number of operations was fewer (t=7.39, P<0.01), the incidence of surgery-related complications during hospitalization after autologous skin graft/flap grafting was lower (P<0.01), but there was no significant change in hospitalization cost of patients in artificial dermis+split-thickness skin group (P>0.05). Six months after autologous skin graft/flap grafting, the VSS scores of recipient area of patients in the two groups were similar (t=0.32, P>0.05); the TAM score of hand function and AOFAS-AHS score of foot function of patients in artificial dermis+split-thickness skin group were 40±6 and 62±12, respectively, which were significantly higher than 34±6 and 53±11 of flap group (t=4.66, 3.41, P<0.01). Conclusions: The combined application of artificial dermis and split-thickness skin results in fewer number of operation compared with using flaps in the repair of wounds with bone and tendon exposure in hands and feet, reducing the incidence of surgery-related complications and improving the postoperative hand and foot joint function of patients, without significant scar hyperplasia, although it may also prolong the wound healing time and length of hospital stay accordingly.

[Epidemiological characteristics of imported malaria in Zhengzhou City from 2016 to 2020]

OBJECTIVE

To analyze the epidemiological characteristics of reported imported malaria cases in Zhengzhou City from 2016 to 2020, so as to provide insights into the management of imported malaria in the city.

METHODS

All data pertaining to cases with definitive diagnosis of malaria in Zhengzhou City from 2016 to 2020 were captured from the National Notifiable Disease Report System and the Information Management System for Parasitic Disease Control in China, including individual demographic data, and malaria onset, initial diagnosis and definitive diagnosis data. All data were descriptively analyzed. The duration from malaria onset to initial diagnosis, from initial diagnosis to definitive diagnosis and from onset to definitive diagnosis was compared among cases. In addition, the diagnoses of imported malaria cases in which definitive diagnosis was made were compared with the reexaminations by Zhengzhou Municipal Malaria Diagnosis Reference Laboratory.

RESULTS

A total of 302 cases with definitive diagnosis of malaria were reported in Zhengzhou City from 2016 to 2020, and all were imported cases, with Plasmodium falciparum malaria as the predominant type (230 cases, 76.2%). There were 293 malaria cases imported from Africa (293 cases, 97.0%), which mainly included Nigeria (48 cases, 15.9%), Angola (40 cases, 13.2%), and the Democratic Republic of the Congo (29 cases, 9.6%). There was no obvious seasonality found in the date of malaria onset and time of reporting malaria. The ratio of male to female malaria cases was 49.3:1, and there were 103 cases (34.1%) with the current residency address in Zhengzhou City, 193 cases (63.9%) with the current residency address in other cities of Henan Province and 6 cases (2.0%) in other provinces of China. There were 271 cases (89.7%) seeking initial diagnosis in medical institutions, and the diagnostic accuracy of malaria was 56.6% (171/302) at initial diagnosis institutions. A total of 122 cases (40.4%) sought medical care on the day of malaria onset, and 252 cases (86.4%) within 3 days; however, only 22 cases (7.3%) were definitively diagnosed on the day of onset, and 162 cases (53.6%) diagnosed within 3 days. There were no significant differences between malaria cases seeking initial diagnosis at medical institutions and disease control and prevention institutions in terms of the duration from malaria onset to initial diagnosis (Z = -1.663, P > 0.05), from initial diagnosis to definitive diagnosis (Z = -0.413, P > 0.05) or from malaria onset to definitive diagnosis (Z = -0.838, P > 0.05). The median duration (interquartile range) from initial diagnosis to definitive diagnosis of malaria was 3.00 (2.00), 3.00 (6.00), 2.00 (4.00) d and 1.00 (1.00) d among cases seeking medical care at township-level and lower, county-, city- and province-level medical institutions, and the median duration from initial diagnosis to definitive diagnosis of malaria was significantly longer among cases seeking medical care at township-level and lower medical institutions than at city (Z = -3.286, P < 0.008 33) and province-level medical institutions (Z = -9.119, P < 0.008 33), while the median duration from initial diagnosis to definitive diagnosis [1.00 (3.00) d vs. 2.00 (4.00) d; Z = -4.099, P < 0.016] and from malaria onset to definitive diagnosis [3.00 (4.00) d vs. 4.00 (5.00) d; Z = -2.868, P < 0.016] among malaria cases with the current residency address in Zhengzhou City was both shorter than in other cities of Henan Province. The diagnostic accuracy was 89.1% (269/302) among malaria cases in which definitive diagnosis was made, and the accuracy of malaria reexaminations was 94.0% (284/302) in Zhengzhou Municipal Malaria Diagnosis Reference Laboratory.

CONCLUSIONS

P. falciparum malaria was predominant among reported imported malaria cases in Zhengzhou City from 2016 to 2020, and these imported malaria cases were predominantly diagnosed at medical institutions; however, the diagnostic capability of malaria is poor in township-level and lower medical institutions. Strengthening the collaboration between medical institutions and disease control and prevention institutions and improving the diagnostic capability building at medical institutions are recommended to consolidate malaria elimination achivements.

[Effects of intestinal flora on the degree of infiltration of tumor-infiltrating lymphocytes in breast cancer]

Objective: To investigate whether the abundance or diversity of intestinal flora in breast cancer (BC) patients effects on the degree of tumor infiltration lymphocytes in breast cancer tissues. Methods: Between March 2017 and October 2017, a total of 80 biopsy-confirmed female patients with BC were enrolled in the present study at the Breast Center of the Fourth Hospital of Hebei Medical University (Shijiazhuang, China), age distribution ranged from 37 to 74 years, which were divided into three groups based on the infiltration of tumor-infiltrating lymphocytes, as follows: high infiltration of TILs (TIL-H) 25 cases, medium infiltration of TILs (TIL-M) 34 cases and low infiltration of TILs (TIL-L) 21 cases. DNA of the intestinal flora was determined by Illumina sequencing and taxonomy of 16S ribosomal RNA genes. Compare the differences in the abundance or diversity of intestinal flora between these three groups. The relationship between tumor-infiltrating lymphocytes and clinical characteristics was analyzed by χ² tested, and the relationship with intestinal flora was analyzed by β diversity. Results: There were 3, 174, 2, 996, and 2, 877 different OUTs in the TIL-H, TIL-M, and TIL-L groups. The β-diversity distribution was statistically significant (weighted UniFrac, P<0.01; unweighted UniFrac, P<0.01) when comparing the three groups (TIL-H vs. TIL-M vs. TIL-L), the differences between TIL-L and TIL-H groups were greatest. Conclusions: The infiltration level of tumor-infiltrating lymphocytes in breast cancer patients was closely related to the diversity of intestinal flora.

[Effects of wedge-shaped heel pad in the treatment of extremely severe burn patients with foot drop deformity]

Objective: To explore the effects of wedge-shaped heel pad in the treatment of foot drop deformity in extremely severe burn patients. Methods: A retrospective cohort study method was conducted. From March 2015 to July 2016, 33 patients with foot drop deformity caused by extremely severe burn scar who met the inclusion criteria were admitted to the Department of Burn Rehabilitation of Kunshan Rehabilitation Hospital, including 18 males and 15 females, aged (38±9) years. Patients received comprehensive post-burn rehabilitation treatment after admission, and the wedge-shaped heel pad with appropriate height was placed under the patients' insole, according to the degree of the foot drop deformity in patients. Standing, squatting, and walking exercises were performed after putting on shoes with wedge-shaped heel pad. Before and immediately after the first treatment (hereinafter referred to as before and immediately after treatment), and in 1 month after treatment with wedge-shaped heel pad, the Simple Balance Scale was used to evaluate the standing balance ability of patients. In 1, 3, and 12 months after treatment, active ranges of motion (AROMs) of bilateral ankle joint dorsiflexion and knee joint flexion were measured with joint motion range measuring ruler, the shortest distance between buttocks of patients and the ground when squatting and walking distance in 1 min of patients were measured with measuring tape, and the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of activity of daily living (ADL) in patients were evaluated with modified Barthel index. Data were statistically analyzed with Friedman test, Wilcoxon rank sum test, unequal interval analysis of variance for repeated measurement, and Bonferroni correction. Results: Immediately after treatment, the standing balance ability of patients was 2.0 (1.0, 2.0) levels, which was significantly higher than 1.0 (0, 1.0) level before treatment (Z=-5.568, P<0.01); in 1 month after treatment, the standing balance ability of patients was 3.0 (2.5, 3.0) levels, which was significantly higher than that immediately after treatment (Z=-5.303, P<0.01). In 3 and 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and the left and right knee joint flexion in patients were significantly increased compared with those in 1 month after treatment (Z=-4.860, -4.836, -4.965, -4.909, -5.037, -5.025, -5.020, -4.942, P<0.01); in 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and knee joint flexion in patients were significantly increased compared with those in 3 months after treatment (Z=-5.062, -4.962, -5.017, -4.944, P<0.01). In 3 and 12 months after treatment, the shortest distances between buttocks of patients and the ground were (67±11) and (57±11) cm, which were significantly shorter than (72±11) cm in 1 month after treatment (P<0.01), respectively; in 12 months after treatment, the shortest distance between buttocks of patients and the ground was significantly shorter than that in 3 months after treatment (P<0.01). In 3 and 12 months after treatment, the walking distances within 1 min of patients were significantly longer than that in 1 month after treatment (Z=-5.043, -5.016, P<0.01); in 12 months after treatment, the walking distance within 1 min of patients was significantly longer than that in 3 months after treatment (Z=-5.025, P<0.01). In 3 and 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-4.472, -4.025, -4.707, -4.565, -3.994, -4.777, P<0.01); in 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-3.827, -3.358, -3.557, P<0.01). Conclusions: After using the wedge-shaped heel pad, the standing balance ability, ankle joint dorsiflexion range of motion, walking ability are significantly improved, and the independent levels of movement items in ADL are significantly increased in extremely severe burn patients with foot drop deformity.

[Effect of gMDSCs on natural killer cell functionality in chronic hepatitis C patients treated with direct-acting antiviral agents]

Objective: To investigate the changes of natural killer(NK) cell function, and clarify the effect of granulocytic myeloid derived suppressor cells (G-MDSCs) on NK cell functionality in patients with treatment-naive chronic hepatitis C (CHC) who were cured by direct-acting antiviral agents (DAAs). Methods: Thirteen treatment-naive CHC patients and 13 healthy controls were prospectively included in this study from March 2016 to January 2017. They were divided into case group and control group, respectively. The patients of case group,6 males and 7 females aged 21-65 years old with an average of (37±14),were treated with daclatasvir and asunaprevir combination (DCV/ASV) at the Department of Infectious Diseases, Fifth Medical Center of Chinese PLA General Hospital. While 13 healthy individuals, 6 males and 7 females aged 21-57 (36±11) years old, were enrolled as healthy controls(control group). Flow cytometry was used to determine the immunological characteristics of peripheral blood NK cells subset, and detect the frequencies of gMDSCs in peripheral blood of people in two groups. It was specifically notes that CHC patients of case group would be detected before, during and after treatment. The correlations between gMDSCs and each NK cell subset function were also examined. The impact of gMDSCs on NK cell functionalities and the relevant regulatory mechanisms were explored using co-culture experiments of sorted NK cells and gMDSCs in vitro. Results: Compared with healthy controls, the decreased IFN-γ production[M(Q1,Q3)] [3.182 (2.757, 4.237) vs 6.675 (4.476, 8.280),1.434 (1.127, 2.434) vs 3.045 (1.680, 4.856), 2.611 (1.749, 3.498) vs 5.160 (4.232, 7.683)] and increased CD107a degranulation [9.314 (7.838, 13.543) vs 3.480 (2.938, 6.824), 2.544 (1.366, 4.768) vs 0.552 (0.408, 1.560), 10.339 (9.145, 12.534) vs 3.488 (3.117, 5.651)] (all P<0.05) were found on NK cell and its subsets. The frequencies of gMDSCs and plasma concentration of arginase-1 in CHC patients was significantly higher than that in healthy controls [7.050 (4.180, 12.538) vs 1.440 (0.444, 2.261), 114.278 (68.492, 163.724) vs 64.753 (50.809, 93.278)](all P<0.05). The production of IFN-γ was increased and the secretion of CD107a was decreased in NK cell and its subsets after DAAs treatment (P<0.05). The frequencies of gMDSCs and plasma arignase I levels were also decreased in CHC patients treated with DAAs (P<0.05).The results of the study indicated that the frequencies of G-MDSCs were inversely associated with the levels of IFN-γproduction of NK cells and CD56^dim NK cells in CHC patients (r=0.668, -0.750, respectively, both P<0.05). In addition, the frequencies of gMDSCs were positively associated with the expression of CD107a in the CD56^bright NK cell subset (r=0.711, P=0.021). In vitro, the inhibition of gMDSCs on the IFN-γ production of NK cells was demonstrated in the co-culture experiments of sorted NK cells and gMDSCs, and blocking arginase I can significantly increase the ability of NK cells to produce IFN-γ, restore NK cell IFN-γ production. Conclusions: gMDSCs in peripheral blood of CHC patients has been shown to suppress NK cell IFN-γ production in an arginase I-dependent manner. Direct-acting antiviral-mediated clearance of HCV is associated with the normalization of NK cell function and gMDSCs frequency.

[Occupational activity disorders of extremely severe mass burn patients in recovery period after injury: a cross-sectional survey]

Objective: To observe the distribution of occupational activity disorders of extremely severe mass burn patients in recovery period after injury. Methods: From December 2014 to December 2015, 65 extremely severe burn patients conforming to the inclusion criteria involved in August 2 Kunshan factory aluminum dust explosion accident were admitted to Kunshan Rehabilitation Hospital. They received comprehensive rehabilitation treatment after burns, including wearing pressure clothes, ultrasound treatment, semiconductor laser and red light irradiation, motor function training, and so on. Over 2 years after injury, a cross-sectional survey was conducted on the patients' occupational activity disorders. Modified Barthel index (MBI) was used to assess the degree of activities of daily living (ADL) disorder of patients and to grade the independent level of completing each item of MBI, and then the independent level of patients completing self-care MBI items (bathing, dressing, grooming, eating, going to the toilet, urine control, and stool control) was compared with that of mobility items (going up and down stairs, bed and chair transfer, and walking). The Canadian Occupational Performance Measure (COPM) was used to assess the distribution of occupational activity disorders of patients. The distribution of the five most serious occupational activity disorders was counted, then the frequency and probability of which with frequency greater than or equal to 16 times were calculated. Data were processed with Pearson Chi-square test. Results: Over 2 years after injury, the MBI score of patients was (76±22) points, and the ADL of 83.08% (54/65) patients reached completely self-care or light ADL disorder level. The MBI items arranged according to the completing independent level of patients from high to low were urine control/stool control, walking, bed and chair transfer, going up and down stairs, going to the toilet, eating, grooming, dressing, and bathing. The independent level of patients completing self-care MBI items was lower than that of mobility items (χ(2)=62.298, P<0.001). Over 2 years after injury, the five most serious occupational activity disorders in COPM dimension were mainly concentrated in the self-care dimension, accounting for 55.38% (180/325), followed by 22.46% (73/325) of production activities and 22.15% (72/325) of recreational activities, and the centrally distributed item was the personal self-care item under self-care dimension, accounting for 42.46% (138/325). Over 2 years after injury, the five most serious occupational activity disorders with frequency greater than or equal to 16 times were dressing and undressing, bathing, perineal cleaning, wearing pressure clothes, caring for children, visiting relatives and friends, 31, 25, 16, 17, 18, and 22 times respectively, with a probability of 47.69%, 38.46%, 24.62%, 26.15%, 27.69%, and 33.85% respectively. Conclusions: Over 2 years after injury, most of the patients with extremely severe burns caused by the aluminum dust explosion were completely or basically self-care in their daily life. The disorder of self-care ADL was more serious than that of mobility, and the disorder of individual self-care activity was still the most serious occupational activity disorder of patients in this stage. Clinical trial registration: Chinese clinical trial registry, ChiCTR-OOC-16009188.

[HCV infection and specific T lymphocyte immunity]

Adaptive immunity, especially the cellular immunity mediated by T lymphocytes, plays an important role in the body's fight against hepatitis C virus (HCV) infection. The clearance of HCV requires a strong, sustained, and multi-epitope response from specific T lymphocytes, and the dysfunction of specific T lymphocytes is the major reason for chronic infection. Effective treatment can restore the function of specific T lymphocytes to a certain extent. This article reviews the features and related mechanisms of immune response from specific T lymphocytes when the prognosis of patients with HCV infection is different.

[The study of genistein attenuating genioglossus muscle fatigue under chronic intermittent hypoxia]

OBJECTIVE

To investigate the effects of genistein on genioglossus muscle function and nuclear factor erythroid 2 related factor 2(Nrf-2)/antioxidant responsive element(ARE) signaling pathway in rats under chronic intermittent hypoxia(CIH) condition in order to find medication treatment of obstructive sleep apnea/hyponea syndrome.

METHODS

Thirty female Sprague-Dawley(SD) rats (8 weeks old) were randomly(random number table) divided into three groups 1 week after ovariectomy: control group(NC group), CIH group, and CIH+genistein treatment group(T group). Rats in the latter two groups were exposed to CIH for 8 h/d for 5 weeks. Electrophysiological method was used to detect the change of genioglossus muscle function, and real-time reverse transcription(RT)-PCR and Western blotting were used to determine the level of Nrf-2 gene and protein.

RESULTS

Compared to NC group, the contractive properties of genioglossus muscle fatigue test at every time set was significantly decreased in CIH group(P<0.05). Compared to CIH group, the contractive properties was significantly increased in T group(P<0.05). The level of Nrf-2 gene and protein were less in CIH group(0.54±0.11 and 0.35±0.13) than in NC group(1.00±0.001.00±0.00)(P<0.05). Compared to CIH group the level of Nrf-2 gene and protein were increased in T group (0.76 ± 0.16 and 0.63 ± 0.14) (P<0.05), however, it was still less than the level in NC group(P<0.05).

CONCLUSIONS

CIH attenuates genioglossus muscle fatigue resistance under chronic intermittent hypoxia through Nrf-2/ARE signaling pathway. Genistein protects genioglossus muscle function through up-regulation of the level of Nrf-2 gene and protein.

Comparison of molar intrusion efficiency and bone density by CT in patients with different vertical facial morphology

The purpose of this study is to examine the relationship between molar intrusion efficiency and bone density in patients with different vertical facial morphology. Thirty-six female patients, with overerupted upper first molars, were divided into two groups according to mandiblular plane angle (FH-MP): hyperdivergent, FH-MP>30° (G1), hypodivergent, FH-MP<22° (G2). Mini-screw implants with elastic chains were used to intrude upper first molars. Spiral CT was used to measure the intrusion degree of upper first molar and bone density, and molar intrusion efficiency was calculated as amount/duration (mm month(-1) ). In addition, each tooth was divided into three portions (cervical, furcation and apical) to measure the bone density. It was found in this study that treatment duration was 3·13 and 4·71 months in G1 and G2 and that the intrusion efficiency was 1·57 and 0·81 in G1 and G2 with significant difference (P < 0·05). There were significant differences in cervical, furcation and apical bone density between two groups (P < 0·05). The bone density was significantly reduced after molar intrusion. In addition, the bone density change was greater in G1 than in G2 (P < 0·05). It was concluded that molars were more easily to be intruded in hyperdivergent than in hypodivergent patients. The difference of bone density and bone density changes during intrusion may account for the variation of molar intrusion efficiency.

Molecular Characterization and Expression Pattern of Gene IGFBP-5 in the Cashmere Goat (Capra hircus)

Insulin-like growth factor-binding protein-5 (IGFBP-5) is one of the six members of IGFBP family, important for cell growth, apoptosis and other IGF-stimulated signaling pathways. In order to explore the significance of IGFBP-5 in cells of the Inner Mongolian Cashmere goat (Capra hircus), IGFBP-5 gene complementary DNA (cDNA) was amplified by reverse transcription polymerase chain reaction (RT-PCR) from the animal’s fetal fibroblasts and tissue-specific expression analysis was performed by semi-quantitative RT-PCR. The gene is 816 base pairs (bp) in length and includes the complete open reading frame, encoding 271 amino acids (GenBank accession number JF720883). The full cDNA nucleotide sequence has a 99% identity with sheep, 98% with cattle and 95% with human. The amino acids sequence shares identity with 99%, 99% and 99%, respectively. The bioinformatics analysis showed that IGFBP-5 has an insulin growth factor-binding protein homologues (IB) domain and a thyroglobulin type-1 (TY) domain, four protein kinase C phosphorylation sites, five casein kinase II phosphorylation sites, three prenyl group binding sites (CaaX box). The IGFBP-5 gene was expressed in all the tested tissues including testis, brain, liver, lung, mammary gland, spleen, and kidney, suggesting that IGFBP-5 plays an important role in goat cells.

Effects of cell surface loading and phase of growth in cold atmospheric gas plasma inactivation of Escherichia coli K12

AIMS

To determine the effects of surface cell concentration and phase of growth on the inactivation of Escherichia coli cells using an atmospheric nonthermal plasma.

METHODS AND RESULTS

Cells of E. coli K12 were deposited onto the surface of membrane filters and exposed to the plume from a cold atmospheric gas plasma. Scanning electron microscopy revealed severe loss in structural integrity of plasma-treated cells, and optical emission spectra indicated that inactivation was brought about by reactive plasma species. The survival of E. coli cells was found to depend on the cell surface density: as the surface density increased from 10(7) to 10(11) CFU cm(-2), the rate constant in the Baranyi inactivation model decreased from 19.59 to 1.03 min(-1). Cells harvested from mid-exponential, late exponential and stationary phases of growth displayed differences in their resistances to the effects of the plasma however, exponential phase cells were not more susceptible than those from the stationary phase.

CONCLUSIONS

High surface concentrations of cells affects the penetration of plasma species and treatment effectiveness. The physiological state of cells, as determined by phase of growth, affects their resistance to plasma inactivation.

SIGNIFICANCE AND IMPACT OF THE STUDY

In designing inactivation treatments, surface concentration and cell physiology need to be taken into account.

Evolution of discharge structure in capacitive radio-frequency atmospheric microplasmas

Conventional radio-frequency (rf) nonthermal atmospheric plasmas are generated in a millimeter gap. In this Letter, we present a self-consistent numerical study of rf atmospheric microplasmas in a submillimeter gap comparable to their sheath thickness. It is shown that the narrow electrode gap deforms the discharge structure, ultimately removing the bulk-plasma region and disabling electron trapping. Significantly, these properties permit rf atmospheric microplasmas to operate at very high current densities thus simultaneously achieving higher stability and greater chemical reactivity.

Differential expression of prostaglandin E receptor subtype EP2 in rat uterus during early pregnancy

PGE2 is essential for mammalian female reproduction. This study was to examine the expression of EP2 gene in the rat uterus during early pregnancy, delayed implantation and artificial decidualization by in situ hybridization and immunohistochemistry. There was no detectable EP2 mRNA expression in the uterus from days 1 to 4 of pregnancy (day 1 = day of vaginal sperm). A low level of EP2 immunostaining was observed in the luminal and glandular epithelium from days 1 to 4 of pregnancy. Both EP2 mRNA and protein expression were highly detected in the luminal epithelium at implantation sites on day 6 of pregnancy. EP2 expression decreased from day 7 of pregnancy and was undetectable on days 8 and 9 of pregnancy. After delayed implantation was terminated by estrogen treatment and the embryo implanted, both EP2 mRNA and protein expression were strongly observed in the luminal epithelium at the implantation site. There was no detectable EP2 expression in both control and decidualized uteri. In conclusion, these data suggest that EP2 expression at implantation site may play an important role during embryo implantation in rats.

Expression of Norwalk virus capsid protein in transgenic tobacco and potato and its oral immunogenicity in mice

Alternatives to cell culture systems for production of recombinant proteins could make very safe vaccines at a lower cost. We have used genetically engineered plants for expression of candidate vaccine antigens with the goal of using the edible plant organs for economical delivery of oral vaccines. Transgenic tobacco and potato plants were created that express the capsid protein of Norwalk virus, a calicivirus that causes epidemic acute gastroenteritis in humans. The capsid protein could be extracted from tobacco leaves in the form of 38-nm Norwalk virus-like particles. Recombinant Norwalk virus-like particle (rNV) was previously recovered when the same gene was expressed in recombinant baculovirus-infected insect cells. The capsid protein expressed in tobacco leaves and potato tubers cosedimented in sucrose gradients with insect cell-derived rNV and appeared identical to insect cell-derived rNV on immunoblots of SDS/polyacrylamide gels. The plant-expressed rNV was orally immunogenic in mice. Extracts of tobacco leaf expressing rNV were given to CD1 mice by gavage, and the treated mice developed both serum IgG and secretory IgA specific for rNV. Furthermore, when potato tubers expressing rNV were fed directly to mice, they developed serum IgG specific for rNV. These results indicate the potential usefulness of plants for production and delivery of edible vaccines. This is an appropriate technology for developing countries where vaccines are urgently needed.

[Nosocomial transmission of Helicobacter pylori through fiberoptic gastroscopy]

The relationship of nosocomial transmission of Helicobacter pylori (Hp) by fiberoptic gastroscopy was investigated. Hp was cultured from the materials obtained from the suction/biopsy channel (4/12 times) and biopsy forceps (3/10 times). The positive rate of Hp was increased with times undertaking endoscopy in the past in elder patients with chronic gastritis. The rate from Hp negative transforming into positive also increased with the times of receiving endoscopic follow-up in the past in patients with Hp negative chronic gastritis. The average age of Hp positive patients were older in those patients under follow-up studies than that in randomly age-matched normal or chronic gastritis controls. The results suggested that the contamination of gastroscopic equipment played a potential role as vehicle causing nosocomial infection of Hp. The risks of Hp transmission correlated with times of undertaking endoscopy, especially in the elderly.

The effect of low dose propofol for prevention of nausea and vomiting during spinal anesthesia for cesarean section

In order to investigate the possible antiemetic property of propofol at subhypnotic dosage, fifty patients scheduled for elective cesarean section under spinal anesthesia were accepted into the study. Patients were randomly given intravenous propofol 10 mg (group I) or 1 ml intralipid (group II) after delivery of the infant. Overall incidence of nausea (24% in group I and 40% in group II) and vomiting (16% in group I and 20% in group II) were not statistically different in the two groups. However, onset time to the appearance of nausea and vomiting were longer in group I (14 +/- 5.8 min vs 5.4 +/- 3.6 min). In conclusion, low dose propofol (10 mg) administered during spinal anesthesia for cesarean section failed to reduce the incidence of emesis.

Combined spinal and epidural anesthesia for abdominal hysterectomy in a patient with myotonic dystrophy. Case report

BACKGROUND AND OBJECTIVES

The authors report a case of myotonic dystrophy in a 34-year-old woman who presented for total abdominal hysterectomy. The goal of anesthetic management is to prevent the known triggers of myotonic crisis, such as hypothermia, shivering, and hyperkalemia; and to avoid depolarizing muscle relaxants and anticholinesterase agents.

METHODS

In this patient, the authors used combined spinal and epidural block for intraoperative anesthesia and postoperative analgesia.

RESULTS

The advantages of the combined technique offers rapid onset and good muscle relaxation from subarachnoid block, with the ability to supplement analgesia through the epidural catheter both during and after surgery. In addition, the potential complications associated with general anesthesia, including respiratory insufficiency, aspiration pneumonia, cardiac arrhythmia, and heart failure can be avoided. The other measures were directed toward the prevention of shivering, a common problem encountered with general or regional anesthesia.

CONCLUSIONS

After the postoperation, optimal analgesia was obtained by infusing local anesthetic (0.125% bupivacaine) via the epidural catheter. No obvious side effects occurred. The authors believe combined spinal and epidural block provides a safe alternative, to other techniques, and minimizes the potential hazards of myotonic dystrophy, while offering effective intraoperative anesthesia and postoperative analgesia.

Continuous succinylcholine infusion and phase II block in short surgical procedures

The study was designed to observe continuous succinylcholine infusion and phase II block in short surgical procedures (duration < 90 min). The characteristics of neuromuscular blockade produced by continuous succinylcholine infusion were observed in 15 adult patients anesthetized with nitrous-oxide-isoflurane (0.7% end tidal concentration) and fentanyl, and were compared with the single-dose technique (n = 13) in recovery time. Ulnar nerve was stimulated supramaximally with repeated train-of-four (interval = 10 sec, frequency = 2 Hz) via surface electrodes at the wrist using an electromyographic monitor (Datex, Relaxograph, Finland). The infusion rate was adjusted to maintain the height of the first twitch (T1) in each train of four at 5-10% of control twitch height. The mean duration of infusion was 50.74 +/- 18.06 minutes. The steady state infusion rate required to maintain 90% to 95% twitch depression was 83.5 +/- 21.4 micrograms/kg/min. Five patients developed phase II block (T4/T1 < 0.5) designated as IB. The other ten did not develop phase II block as IA. Recovery times (T1 = 10.50%, 10-100%) between IA and IB were not statistically significantly different. The recovery time of train-of-four fade (T1 = 10% to T1 = 100% and train of four > 75%) was 5.73 +/- 0.43 minutes. However, recovery times between continuous infusion group and single dose group were significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Validity and feasibility of nasopharyngeal end-tidal carbon dioxide tension monitorings: a novel approach in spontaneous breathing patients

Conventional end-tidal CO2 (Pe'CO2) monitoring is difficult and impractical in nonintubated patients who are either sedated or anesthetized while spontaneous respiration is maintained. An alternative technique using nasopharyngeal end-tidal carbon dioxide tension (PNe,CO2) has been developed. The present study evaluates the feasibility and validity of PNe,CO2 as a reliable respiratory monitoring method. Sixty patients in ASA class status I or II and scheduled for elective surgery were divided into two groups. In group 1 (n = 30), conventional Pe'CO2 was used in intubated patients under general anesthesia. In group 2 (n = 30), PNe,CO2 monitoring was used in patients under regional anesthesia with spontaneous respiration maintained. A 12 FG suction catheter, connected to the sampling tube of a CO2 analyzer, was inserted via the nasal airway to within 1 cm of the nasopharyngeal orifice. Arterial blood gas (PaCO2) was sampled 25 minutes after the operation began, Pe'CO2 (group 1) and PNe,CO2 (group 2) were recorded simultaneously. In both groups, PaCO2 was highly correlated with Pe'CO2 (r = 0.6938) and PNe,CO2 (r = 0.8613). The difference between the two values, (a-e')PCO2 = 0.35 +/- 0.33kPa and (a-Ne')PCO2 = -0.1 +/- 0.51kPa, indicates that PNe,CO2 is more closely correlated to PaCO2 than conventional Pe'CO2. The reduced (a-Ne')PCO2 in group 2 may be explained by CO2 rebreathing and a reduced respiratory deadspace during anesthesia and spontaneous breathing. Interestingly, 60% of the (a-Ne')PCO2 measurements were negative values, suggesting that PNe,CO2 and a spatial V/Q mismatch is caused by sedation; higher CO2 production and CO2 rebreathing may explain the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the combined effects of atropine and neostigmine with atropine and edrophonium on the occurrence of postoperative nausea and vomiting

To investigate the effects of different types of anticholinesterase on the incidence of the postoperative nausea and vomiting, 100 ASA class I-II adult premenopausal female patients undergoing elective lower abdominal surgery were randomized into two groups. In both groups, anesthesia was induced with thiopental and fentanyl and 50% nitrous oxide and 0.5-1.5% of isoflurane were used for anesthetic maintenance with succinylcholine 1 approximately 1.5 mg/kg for intubation and atracurium 0.3 mg/kg/hr for maintenance of muscle relaxation. Patients received reversal agents for neuromuscular blockade after operation when the evoked train-of-four (TOF) count returned to four visual responses. A mixture of atropine 8 micrograms/kg and edrophonium 0.75 mg/kg was given to the first group of patients while atropine 15 micrograms/kg and neostigmine 40 micrograms/kg was given to another group of patients. All the patients were observed for the occurrence of nausea or vomiting for 2 hours after the operation in the recovery room. The incidence of nausea was not statistically significantly different in both groups (20% in neostigmine group and 26% in edrophonium group). The occurrence of vomiting was also similar in both groups (8% in neostigmine group and 6% in edrophonium group). We concluded that there were no difference in the incidence of postoperative nausea or vomiting with the use of either neostigmine or edrophonium with atropine for antagonizing neuromuscular blockade after the lower abdominal surgery.