Transpancreatic Sphincterotomy After Double Guidewire Technique Was Noninferior to Primary Transpancreatic Sphincterotomy in Difficult Biliary Cannulation

BACKGROUND

When unintentional pancreatic duct access occurs during difficult biliary cannulation, the double guidewire (DGW) or transpancreatic sphincterotomy (TPS) may be utilized. DGW can be easily switched to TPS due to the existing guidewire in the pancreatic duct. However, the efficacy of TPS after DGW, named sequential DGW-TPS technique, versus primary TPS has not been assessed.

AIMS

Our aim was to compare the benefits and adverse events of sequential DGW-TPS technique and primary TPS.

METHODS

We performed a comparative retrospective cohort study that enrolled a total of 117 patients with native papillae. The patients were divided into one of 2 groups according to the primary bile duct access technique (sequential DGW-TPS or primary TPS), both with pancreatic stenting.

RESULTS

Between November 2017 and May 2023, a total of 84 patients were grouped into sequential DGW-TPS and 33 into primary TPS. The overall post-ERCP pancreatitis (PEP) rate was 4.3% in the entire cohort, with no statistical differences were observed between the groups in terms of PEP rates (P = 0.927), PEP severity (P = 1.000), first biliary cannulation success (P = 0.621), overall cannulation success (P = 1.000), hyperamylasemia incidence (P = 0.241), elevated amylase levels (P = 0.881), and postoperative hospital stay (P = 0.185). Furthermore, these results remained consistent in multivariable regression analysis.

CONCLUSIONS

The sequential DGW-TPS technique showed a comparable safety and biliary cannulation success rate to primary TPS in difficult biliary cannulation. Given the potential long-term complications associated with TPS, DGW should be first if inadvertent pancreatic access occurs, with TPS serving as second only if DGW fails.

A study of the attenuation stage of a global infectious disease

Introduction

Differences in control measures and response speeds between regions may be responsible for the differences in the number of infections of global infectious diseases. Therefore, this article aims to examine the decay stage of global infectious diseases. We demonstrate our method by considering the first wave of the COVID-19 epidemic in 2020.

Methods

We introduce the concept of the attenuation rate into the varying coefficient SEIR model to measure the effect of different cities on epidemic control, and make inferences through the integrated adjusted Kalman filter algorithm.

Results

We applied the varying coefficient SEIR model to 136 cities in China where the total number of confirmed cases exceeded 20 after the implementation of control measures and analyzed the relationship between the estimated attenuation rate and local factors. Subsequent analysis and inference results show that the attenuation rate is significantly related to the local annual GDP and the longitude and latitude of a city or a region. We also apply the varying coefficient SEIR model to other regions outside China. We find that the fitting curve of the average daily number of new confirmed cases simulated by the variable coefficient SEIR model is consistent with the real data.

Discussion

The results show that the cities with better economic development are able to control the epidemic more effectively to a certain extent. On the other hand, geographical location also affected the effectiveness of regional epidemic control. In addition, through the results of attenuation rate analysis, we conclude that China and South Korea have achieved good results in controlling the epidemic in 2020.

Saturation of Fishbone Instability by Self-Generated Zonal Flows in Tokamak Plasmas

Gyrokinetic simulations of the fishbone instability in DIII-D tokamak plasmas find that self-generated zonal flows can dominate the nonlinear saturation by preventing coherent structures from persisting or drifting in the energetic particle phase space when the mode frequency down-chirps. Results from the simulation with zonal flows agree quantitatively, for the first time, with experimental measurements of the fishbone saturation amplitude and energetic particle transport. Moreover, the fishbone-induced zonal flows are likely responsible for the formation of an internal transport barrier that was observed after fishbone bursts in this DIII-D experiment. Finally, gyrokinetic simulations of a related ITER baseline scenario show that the fishbone induces insignificant energetic particle redistribution and may enable high performance scenarios in ITER burning plasma experiments.

Natural Course of Common Bile Duct Microlithiasis

BACKGROUND

Common bile duct microlithiasis (CBDM) with a diameter of ≤ 3 mm can pass spontaneously without causing any symptoms, but in some cases, it can also cause severe cholangitis and pancreatitis. The optimal strategy for managing CBDM is yet to be determined.

METHODS

Data of 154 patients with CBDM were collected and divided into two groups: with endoscopic retrograde cholangiopancreatography (with ERCP, n = 82) and without ERCP (n = 72). Clinical outcomes, including the incidence of unfavorable outcomes (UOs), such as cholangitis and pancreatitis, were observed and compared between the two groups.

RESULTS

The incidence of UOs was significantly lower in the ERCP group than in the without ERCP group (3.7% vs. 23.6%, respectively, p < 0.001). Moreover, the total number of readmissions was also lower in the ERCP group than in the without ERCP group (p < 0.001). A multivariate analysis adjusted for age, sex, and the American Society of Anesthesiologists (ASA) class revealed that endoscopic sphincterotomy (EST) and cholecystectomy were associated with a lower risk of UOs.

CONCLUSION

The high rate of UOs in CBDM patients without ERCP suggests that its natural clinical course may not be as favorable as previously suggested. This finding implies that efforts should be made to clear the bile ducts.

Carbon dots, cellulose nanofiber, and essential oil from Torreya grandis aril added to fish scale gelatin film for tomato preservation

In this study, carbon dots (CDs), cellulose nanofibers (CNF) and essential oil nanoemulsion (EON) were extracted from the aril waste of Torreya grandis following nuts production. These three nanomaterials were formulated for the preparation of a composite film to be employed for postharvest tomato storage. Visual, microscopical and physicochemical properties of the prepared nanocomposite films were analyzed at different levels of CDs and CNF for optimization purposes. The UV absorption and antioxidant capacity of gelatin film with 10 % CDs (G/10CD) were enhanced compared with gelatin (G) film, concurrent with a reduction in water barrier capacity, water contact angle (WCA) and tensile strength (TS). Compared with G/10CD film, the WCA of gelatin film after incorporation of 10 % CDs and 3 % CNF (G/10CD/3CNF) was significantly increased by 14.5°at 55 s. In contrast, TS increased by 1.26 MPa, as well as the significant enhancement in water barrier capacity. The above composite film mixed with NEO (G/10CD/3CNF/EON) exerted further antimicrobial effects against Escherichia coli. G/10CD/3CNF/EON coating effectively extended tomato shift life compared with the control group. Therefore, this new eco-friendly film presents several advantages of biodegradability, sustainability as well as multifunctional properties posing it as potential packaging material for food applications.

[The comparison of modified ESUR score and Mehralivand grade based on biparametric MRI for assessing extracapsulare extension in prostate cancer]

Objective: To compare the value of the modified European Society of Urogenital Radiology (ESUR) score and Mehralivand grade based on biparametric MRI (bpMRI) in the assessment of extracapsular extension (ECE) in patients with prostate cancer (PCa). Methods: Data of 235 patients with postoperative pathology confirmed PCa, who underwent preoperative 3.0 T bpMRI examinations between March 2019 and March 2022 in the First Affiliated Hospital of Soochow University were retrospectively evaluated, including 107 ECE positive and 128 ECE negative cases, aged [M (Q₁, Q₃)] [71 (66, 75)] years. Reader 1 and 2 assessed the ECE using the modified ESUR score and Mehralivand grade, and the receiver operating characteristic curve and Delong test were used to evaluate the performance of the two scoring methods. Then, the statistically significant variables were included in multivariate binary logistics regression analysis to obtain the risk factors, which were combined with the scores of reader 1 to establish combined models. The assessment ability of the two combined models and the two scoring methods were compared subsequently. Results: The AUC of Mehralivand grade in reader 1 were higher than that of the modified ESUR score in reader 1 and 2 [0.746 (95%CI: 0.685-0.800) vs 0.696 (95%CI: 0.633-0.754) and 0.691 (95%CI: 0.627-0.749), both P<0.05]. The AUC of Mehralivand grade in reader 2 was higher than that of the modified ESUR score in reader 1 and 2 [0.753 (95%CI: 0.693-0.807) vs 0.696 (95%CI: 0.633-0.754) and 0.691 (95%CI: 0.627-0.749), both P<0.05]. The AUC of the combined model 1 based on the modified ESUR score and the combined model 2 based on Mehralivand grade were higher than that in the separate modified ESUR score [0.826 (95%CI: 0.773-0.879) and 0.841 (95%CI: 0.790-0.892) vs 0.696 (95%CI: 0.633-0.754), both P<0.001], and also higher than that in the separate Mehralivand grade [0.826 (95%CI: 0.773-0.879) and 0.841 (95%CI: 0.790-0.892) vs 0.746 (95%CI: 0.685-0.800), both P<0.05]. Conclusion: Based on bpMRI, the Mehralivand grade showed better diagnostic performance for assessing ECE preoperatively in patients with PCa than the modified ESUR score. The combination model of scoring methods and clinical variables can further enhance the diagnostic certainty in the assessment of ECE.

[The value of machine learning models based on biparametric MRI for diagnosis of prostate cancer and clinically significant prostate cancer]

Objective: To evaluate the value of machine learning (ML) models based on biparametric magnetic resonance imaging (bpMRI) for diagnosis of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). Methods: A total of 1 368 patients, aged from 30 to 92 (69.4±8.2) years, from 3 tertiary medical centers in Jiangsu Province were retrospectively collected from May 2015 to December 2020, including 412 cases of csPCa, 242 cases of clinically insignificant prostate cancer (ciPCa) and 714 cases of benign prostate lesions. The data of center 1 and center 2 were randomly divided into training cohort and internal testing cohort at a ratio of 7∶3 by random number sampling without replacement using Python Random package, and the data of center 3 were used as the independent external testing cohort. The training cohort includs 243 cases of csPCa, 135 cases of ciPCa and 384 cases of benign lesions, the internal testing cohort includs 104 cases of csPCa, 58 cases of ciPCa and 165 cases of benign lesions, and the external testing cohort includs 65 cases of csPCa, 49 cases of ciPCa and 165 cases of benign lesions. The radiomics features were extracted on T₂-weighted imaging, diffusion-weighted imaging and apparent diffusion coefficient map, and optimal radiomics features were selected by using Pearson correlation coefficient method and analysis of variance. The ML models were built using two ML algorithms, including support vector machine and random forest (RF) and were further tested in the internal testing cohort and external testing cohort. Finally, the PI-RADS scores evaluated by the radiologists were adjusted by the ML models which had superior diagnostic performance, namely adjusted PI-RADS. The receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of the ML models and PI-RADS. DeLong test was used to compare the areas under curve (AUC) of models with those of PI-RADS. Results: For PCa diagnosis, in internal testing cohort, the AUC of ML model using RF algorithm and PI-RADS were 0.869 (95%CI: 0.830-0.908) and 0.874 (95%CI: 0.836-0.913), respectively, and the difference between the model and PI-RADS did not reach to the statistical significance (P=0.793). In the external testing cohort, the AUC of model and PI-RADS were 0.845 (95%CI: 0.794-0.897) and 0.915 (95%CI: 0.880-0.951), respectively, and the difference was statistically significant (P=0.01). For csPCa diagnosis, the AUC of ML model using RF algorithm and PI-RADS were 0.874 (95%CI: 0.834-0.914) and 0.892 (95%CI: 0.857-0.927), respectively, in internal testing cohort, and the difference between the model and PI-RADS was not statistically significant (P=0.341). In the external testing cohort, the AUC of model and PI-RADS were 0.876 (95%CI: 0.831-0.920) and 0.884 (95%CI: 0.841-0.926), respectively, and the difference between the model and PI-RADS was not statistically significant (P=0.704). When PI-RADS assessment was adjusted with the assistance of ML models, the specificities increased from 63.0% to 80.0% in the internal testing cohort and from 92.7% to 93.3% in the external test group in diagnosing PCa. In diagnosing csPCa, the specificities increased from 52.5% to 72.6% in the internal testing cohort and from 75.2% to 79.9% in the external testing cohort. Conclusions: The ML models based on bpMRI showed comparable diagnostic performance to PI-RADS assessed by senior radiologists and achieved good generalization ability in both diagnosing PCa and csPCa. The specificities of the PI-RADS were improved by ML models.

[Clinical features of IgG4-related lung disease]

Objective: To explore the clinical features of IgG4-related lung disease. Methods: The clinical data of 60 patients diagnosed with IgG4-related lung disease in Peking University People's Hospital from February 2012 to May 2021 were retrospectively collected. Analysis was made to explore the features of clinical manifestation, laboratory, imaging, prognosis and other characteristics of the disease. Results: A total of 60 patients were included, with 40 males, age of (58.2±12.9) years, an age of onset of (57.1±13.2) years, and 31.7% (19 cases) of the patients had a history of allergic disease. 36.7% (22 cases) of the patients had respiratory symptoms during the disease. 94.6% (53/56) of patients had serum IgG4>1.35 g/L, 24.1% (14/58) of patients had increased eosinophils, 79.2% (38/48) of patients had increased IgE level, and 53.7% (29/54) of patients had decreased C3 or C4. Common imaging findings included nodular changes (38 cases, 63.3%), mediastinal and/or hilar lymphadenopathy (34 cases, 56.7%), and ground glass opacities (31 cases, 51.7%). Fifty-three cases (88.3%) showed two or more imaging changes. The pathological examination of the patient was mainly characterized by lymphoplasmacytic infiltration and fibrosis, with only one case of phlebitis obliterans. Compared with the asymptomatic group (38 cases), patients with respiratory symptoms (22 cases) showed higher level of serum total IgG and eosinophils (43.2 vs 17.8 g/L, 0.30×10⁹/L vs 0.14×10⁹/L, P<0.05), lower proportion of allergic diseases, and higher proportion of consolidation shadows on chest CT (P<0.05). There were no significant differences in serum IgG4, IgE, complement levels, and imaging outcomes after treatment between the two groups (P>0.05). Conclusions: The clinical manifestations of IgG4-related lung disease are atypical, and asymptomatic patients account for a high proportion. The imaging of the disease is highly heterogeneous, and patients are prone to show coexisted multiple imaging changes. The main clinical features and imaging outcomes of patients with and without respiratory symptoms are not significantly different.

[Analysis of clinical and pathological features of chronic hepatitis B combined with metabolic-associated fatty liver disease]

Objective: To analyze the clinical and histopathological features of patients with chronic hepatitis B (CHB) combined with metabolic-associated fatty liver disease (MAFLD). Methods: Clinical data of 529 cases who had liver biopsies at the First Affiliated Hospital of Zhengzhou University between January 2015 and October 2021 were collected. Among them were 290 cases with CHB, 155 cases with CHB combined with MAFLD, and 84 cases with MAFLD. Three groups of patients clinical data, including general information, biochemical indicators, FibroScan indicators, viral load, and histopathology, were analyzed. A binary logistic regression analysis was used to explore the factors influencing MAFLD in patients with CHB. Results: (1) Age, male status, proportion of hypertension and diabetes, body mass index, fasting blood glucose, γ-glutamyl transpeptidase, low-density lipoprotein, cholesterol, triglycerides, uric acid, creatinine, and the controlled attenuation parameter for hepatic steatosis were higher in CHB combined with MAFLD than in CHB patient groups. In contrast, the high-density lipoprotein, HBeAg positivity rate, viral load level, and liver fibrosis grade (S stage) were lower in CHB patients, and the differences were statistically significant (P < 0.05). (2) Alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, triglycerides, uric acid, creatinine, and the controlled attenuation parameter for hepatic steatosis in CHB combined with the MAFLD were lower than those in MAFLD patient groups, while high-density lipoprotein was higher than that of MAFLD patients, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the grade of liver inflammation and fibrosis (GS stage) between the two groups (P > 0.05). Binary multivariate logistic regression analysis showed that overweight/obesity, triglycerides, low-density lipoprotein, the controlled attenuation parameter for hepatic steatosis, and HBeAg positivity were independent influencing factors for MAFLD in CHB patients. Conclusion: Patients with CHB combined with metabolic disorders are prone to developing MAFLD, and there is a certain correlation between HBV viral factors, the degree of liver fibrosis, and the fatty degeneration of hepatocytes.

Emotional responses of piglets under long-term exposure to negative and positive auditory stimuli

The stress caused by sound is inevitable. The stress caused by noise and the positive effects of music can affect the endocrine of animals and their welfare. In this study, a total of 72 hybrid piglets (Large White × Duroc × Min pig) were randomly divided into 3 groups, including music (Mozart K.448, 60-70 dB), noise (recorded mechanical noise, 80-85 dB), and control (natural background sound, <40 dB) groups. S-IgA (secretory immunoglobulin A), IL-6 (interleukin-6), IL-8 (interleukin-8), and positive emotion-related behaviors were used as indicators to discuss whether noise induced stress and inflammation in piglets or whether music could have positive effects. Six hours of auditory exposure were given daily (10:00-16:00), which lasted for 56 days. Behavioral responses of the piglets were observed, and the concentrations of salivary S-IgA and serum IL-6 and IL-8 were measured. The results showed that the concentration of S-IgA increased in the noise and control groups on the 57th day (P < 0.05); S-IgA concentration in the music group was unchanged after long-term music exposure. The concentrations of IL-6 and IL-8 showed that long-term noise exposure might lead to stress and inflammation in piglets. Tail-wagging and play behaviors of the piglets in the music group were significantly greater than those in the noise and control groups, which implied that long-term music exposure improved the emotional state of the piglets in a restricted and barren environment.

Interobserver Agreement among Cytopathologists in False-Negative Cases by Cytological Diagnosis with Endoscopic Ultrasound-Guided Fine Needle Aspiration in Solid Pancreatic Lesions

INTRODUCTION

Early detection and accurate pathological assessment are critical to improving prognosis of pancreatic cancer. EUS has been widely used in diagnosing pancreatic lesions and can obtain histological diagnosis by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, comprehensive assessment of the interobserver agreement (IOA) among cytopathologists evaluating EUS-FNA specimens is still limited. Therefore, this study evaluated IOA among cytopathologists for EUS-FNA specimens of solid pancreatic lesions, especially in false-negative cases of cytological diagnosis and analyzed the factors that influence cytological diagnosis of EUS-FNA so as to improve the diagnostic efficiency of EUS-FNA.

METHODS

We retrieved EUS-FNA samples of pancreatic solid lesions from 2017 to 2021 and collected their clinical/cytological data. Two cytopathologists independently reviewed these cases using a quoted, novel standardized cytology scoring tool. Ultimately, we calculated IOA among cytopathologists and performed a binary logistic regression analysis to evaluate factors influencing the cytological diagnosis of EUS-FNA.

RESULTS

161 patients were included, and 60 cases with a clinical diagnosis of pancreatic cancer but a cytological diagnosis of benign and atypical constituted the false-negative group. IOAs for cytological diagnosis of overall patients and the false-negative group were in perfect/moderate agreement with Kendall's W values of 0.896 and 0.462, respectively. The number of diagnostic cells in the scoring tool had the highest level of agreement (κ = 0.721) for overall patients. There was at best moderate agreement on other quantity and quality parameters for both all cases and false-negative group. Logistic regression analysis showed the number of diagnostic cells (OR = 6.110, p < 0.05) and amount of blood (OR = 0.320, p < 0.05) could influence cytological diagnosis.

CONCLUSIONS

The false-negative rate of our study as high as 37.26% (60/161) is mainly related to strict standards of cytopathologists, and their ability to standardize pancreatic cytology is still improving. Suboptimal agreement among cytopathologists for cytological diagnosis and the number of diagnostic cells may be associated with the occurrence of false-negative diagnosis. Further regression analysis confirmed that the number of diagnostic cells and obscuring blood were important factors in cytological diagnosis. Therefore, refinement of cytological diagnostic criteria, standardization of specimen quality evaluation, and training of cytopathologists may improve the agreement of cytopathologists, thus improving the repeatability of cytological diagnosis and reducing the occurrence of false-negative events.

Semen parameters and sex hormones as affected by SARS-CoV-2 infection: A systematic review

Background

Impaired semen quality and reproductive hormone levels were observed in patients during and after recovery from coronavirus disease 2019 (COVID-19), which raised concerns about negative effects on male fertility. Therefore, this study systematically reviews available data on semen parameters and sex hormones in patients with COVID-19.

Methods

Systematic search was performed on PubMed and Google Scholar until July 18th, 2022. We identified relevant articles that discussed the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on male fertility.

Results

A total number of 1,684 articles were identified by using a suitable keyword search strategy. After screening, 26 articles were considered eligible for inclusion in this study. These articles included a total of 1,960 controls and 2,106 patients. When all studies were considered, the results showed that the semen parameters and sex hormone levels of patients infected with SARS-CoV-2 exhibited some significant differences compared with controls. Fortunately, these differences gradually disappear as patients recover from COVID-19.

Conclusion

While present data show the negative effects of SARS-CoV-2 infection on male fertility, this does not appear to be long-term. Semen quality and hormone levels will gradually increase to normal as patients recover.

Efficacy and safety of HDL/apoA-1 mimetics on human and mice with atherosclerosis: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the National Natural Science Foundation of China

Background

Low high-density lipoprotein cholesterol (HDL-C) level as a residual risk factor of cardiovascular disease (CVD) is still causing concern, although using chemical drugs for raising HDL-C level failed. The effect of high-density lipoprotein/ apolipiproteinA-1(HDL/apoA-1) mimetics on atherosclerosis is controversial.

Aim

In this meta-analysis we analyzed the effect of high-density lipoprotein/ apolipiproteinA-1(HDL/apoA-1) mimetics on atherosclerotic lesion both in human and mice.

Methods

We systematically searched PubMed, Cochrane, Web of Science and EMBASE databases up to June 6, 2020 for eligible studies using wide search terms and included all the publications meet the including criteria. The methodological quality of the human studies was assessed using Review Manager (RevMan) software (version 5.3.). The methodological quality of the mice studies was assessed by using stair list. WMD(SMD) with 95% CI was used as a measure of the association between HDL/apoA-1 mimetics and plaque regression in human (in mice), after pooling data across trials in a random effect model. Sensitivity and subgroup analyses were used to explore sources of heterogeneity and the effect of potential confounders. STATA (version 14.0) was used to conduct all statistical analyses.

Results

We identified 15 randomized controlled trials in which 6 trails including 754 ACS (HDL/apoA-1 mimetics = 414, placebo = 340) patients used for efficacy analysis and all of 15 trails used for safety analysis and 17 controlled trials for animal study. The pooled results showed that the use of HDL/apoA-1 mimetics did not significant decreased the percent atheroma volume(p = 0.494) and total atheroma volume(p = 0.560) in patients with acute coronary syndrome (ACS). However, HDL/apoA-1 mimetics (or gene transfection) was significant associated with all of final percent lesion area, final lesion area and changes in lesion area (SMD, -1.75; 95% CI: -2.21∼-1.29, p = 0.000; SMD, -0.78; 95% CI: -1.18∼-0.38, p = 0.000; SMD: -2.06; 95% CI, -3.92∼-0.2, p = 0.03) in mice.

Conclusions

In human, HDL/apoA-1 mimetics cannot significantly improve atheroma volume in artery, although it is safe. However, in animal, the results suggest HDL/apoA-1 mimetics (or gene transfection) can decrease lesion area. So additional studies are needed to further investigate and explain the different efficacy of HDL/apoA-1 mimetic peptides between human and animal. Abstract Figure. Forest plots of human studies

Periodontitis Salivary Microbiota Worsens Colitis

Evidence suggests that periodontitis contributes to the pathogenesis of inflammatory bowel disease, including Crohn's disease and ulcerative colitis. However, few studies have examined the role of swallowing and saliva in the pathogenesis of gastrointestinal diseases. Saliva contains an enormous number of oral bacteria and is swallowed directly into the intestine. Here, we explored the influence of periodontitis salivary microbiota on colonic inflammation and possible mechanisms in dextran sulfate sodium (DSS)-induced colitis. The salivary microbiota was collected from healthy individuals and those with periodontitis and gavaged to C57BL/6 mice. Periodontitis colitis was induced by DSS for 5 d and ligature for 1 wk. The degree of colon inflammation was evaluated through hematoxylin and eosin staining, ELISA, and quantitative real-time polymerase chain reaction. Immune parameters were measured with quantitative real-time polymerase chain reaction, flow cytometry, and immunofluorescence. The gut microbiota and metabolome analyses were performed via 16S rRNA gene sequencing and liquid chromatography-mass spectrometry. Although no significant colitis-associated phenotypic changes were found under physiologic conditions, periodontitis salivary microbiota exacerbated colitis in a periodontitis colitis model after DSS induction. The immune response more closely resembled the pathology of ulcerative colitis, including aggravated macrophage M2 polarization and Th2 cell induction (T helper 2). Inflammatory bowel disease-associated microbiota, such as Blautia, Helicobacter, and Ruminococcus, were changed in DSS-induced colitis after periodontitis salivary microbiota gavage. Periodontitis salivary microbiota decreased unsaturated fatty acid levels and increased arachidonic acid metabolism in DSS-induced colitis, which was positively correlated with Aerococcus and Ruminococcus, suggesting the key role of these metabolic events and microbes in the exacerbating effect of periodontitis salivary microbiota on experimental colitis. Our study demonstrated that periodontitis contributes to the pathogenesis of colitis through the swallowing of salivary microbiota, confirming the role of periodontitis in systemic disease and providing new insights into the etiology of gastrointestinal inflammatory diseases.

Prognostic nutritional index as a prognostic factor in lung cancer patients receiving chemotherapy: a systematic review and meta-analysis

OBJECTIVE

Lung cancer is one of the leading causes of morbidity and mortality in the world. In the past decade, numerous studies focus on the prognostic nutritional index (i.e., a measure of serum albumin and lymphocyte in peripheral circulation) as a possible biomarker to predict the survival outcomes in cancer patients undergoing chemotherapy. Prognostic nutritional index can reliably predict the survivability outcomes by effectively quantifying the nutritional and immunological status of cancer patients. To date, only one review has attempted to evaluate the impact of the prognostic nutritional index on the survival outcomes in lung cancer patients with certain limitations. The goal of the present systematic review and meta-analysis is to bridge the gap in the literature and evaluate the capacity of the prognostic nutritional index for predicting the survivability outcomes in lung cancer patients undergoing chemotherapy. The aim of the study is to evaluate the impact of prognostic nutritional index scoring on survival outcomes in lung cancer patients undergoing chemotherapy.

MATERIALS AND METHODS

 A systematic academic literature search was performed based on the PRISMA guidelines across Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE databases. A random-effect meta-analysis was performed to evaluate the impact of prognostic nutritional index scoring (i.e., high/low) on survival outcomes (i.e., progression-free survival, overall survival) in lung cancer patients undergoing chemotherapy.

RESULTS

 From 963 studies, 16 eligible studies with 4250 lung cancer patients (62.32 ± 5.08 years) undergoing chemotherapy were included. Our meta-analysis revealed worse mortality outcomes in terms of progression-free survival (HR: 1.31) and overall survival (1.21) for the group with a low prognostic nutritional index score as compared to the group with a high prognostic nutritional index score in lung cancer patients undergoing chemotherapy. Subsequent subgroup analyses further demonstrated markedly worse outcomes for progression-free survival (1.32) and overall survival (1.52) in non-small lung cancer patients with lower prognostic nutritional index scores.

CONCLUSIONS

 We provide preliminary evidence suggesting that lower prognostic nutrition index scores are associated with worse survivability outcomes (progression-free survival and overall survival) in lung cancer patients undergoing chemotherapy. We also show that lower prognostic nutrition index scores correlate with even worse survival outcomes in patients with non-small lung cancer histological subtype of lung cancer. These findings should help clinicians to stratify the risks associated with the chemotherapeutic management of lung cancer patients.

Low dietary phosphorus impairs keel bone health and quality in laying hens

1. Phosphorus (P) is a necessary nutrient for egg production and bone quality in poultry diets. To investigate the effects of low dietary available P (avP) on keel bone, 180 laying hens were fed either a control (C, 0.3% avP) or low phosphorus (LP, 0.15% avP) diet from 20-36 weeks of age (WOA). Each diet was replicated in six cages with 15 birds per cage. Keel samples were collected at 24, 28, 32, and 36 WOA to measure indicators.2. The incidence of keel bone damage in the LP group was higher than C group and increased with age throughout the experiment period. Keel bone length from laying hens in the LP group was shorter than C group (P < 0.05) at 32 and 36 WOA.3. The mRNA expression of receptor activator of nuclear factor kappa-B ligand (RANKL) and ratio of RANKL to osteoprotegerin (OPG) were upregulated (P < 0.05), and that of sclerostin and OPG was downregulated (P < 0.05) in the LP group in comparison to hens in the C group. Meanwhile, mRNA expression of the integrin-binding sialoprotein was increased at 24 and 28 WOA (P < 0.05), and decreased at 32 and 38 WOA (P < 0.05) in the LP group.4. Laying hens in LP group had increased trabecular separation and bone surface fraction (P < 0.05), decreased bone volume, bone volume fraction, trabecular number and thickness, and bone mineral density (P < 0.05) at 32 WOA. The LP-fed hens had increased K, Ti, Mn, Fe, Zn, Se, Sr and Pb bone concentrations (P < 0.05), and decreased P and TI bone concentrations (P < 0.05) at 36 WOA.5. Feeding hens a P-deficient diet with 0.15% avP and 3.37% Ca during the laying period impaired keel bone quality, which could be related to the osteoporosis.

[High-fat diet promotes the impact of periodontitis on gut microbiota and glucose metabolism]

Objective: To study whether high-fat diet could aggravate the effect of periodontitis on gut microbiota and glucose metabolism. Methods: Twenty-four male SD rats were randomly and equally divided into four groups based on table of random numbers (n=6 in each group): control group, in which rats were given normal chow diet; periodontitis group, in which periodontitis was induced by ligating bilateral maxillary second molars with 5-0 silk thread; high-fat diet group, in which rats were given high-fat diet; high-fat diet+periodontitis group, in which rats were given high-fat diet and periodontitis was induced at the end of the 8th week. Fasting blood glucose and glucose tolerance were measured at the end of the 12th week. Then the rats were euthanized and the cecum content was collected. The microbial 16S rRNA gene sequencing was performed on the Illumina MiSeq platform. The taxonomy of the sequences was analyzed through RDP Classifier (http://rdp.cme.msu.edu/) against the SILVA (SSU123) 16S rRNA database. Pearson correlation analysis was performed to analyze the correlation between changes in gut microbiota and blood glucose. Results: After 4 weeks of periodontitis induction, the fasting blood glucose levels of the periodontitis group and the high-fat diet group were (4.93±0.28) and (5.25±0.24) mmol/L, respectively, which were significantly higher than that of the control group [(4.56±0.20) mmol/L] (P<0.05) with glucose intolerance. The fasting blood glucose level of high-fat diet+periodontitis group [(5.53±0.14) mmol/L] was significantly higher than that of periodontitis group and high-fat diet group, respectively (P<0.05), with the glucose tolerance curve higher than that of periodontitis group. The 16S rRNA gene analysis revealed that the Bacteroides/Firmicutes ratio in the periodontitis group is (0.37±0.23), which was significantly lower than that of the control group (0.68±0.05) (P<0.05). The relative abundance of Lachnospiraceae_NK4A136_group in the periodontitis group was (14.03±6.38)%, which was significantly lower than that of the control group [(28.21±4.82)%] (P<0.05). The relative abundance of Allobaculum [(4.27±2.67)%], Ruminococcaceae_UCG_005 [(3.70±0.90)%], Blautia [(0.63±0.45)%] in the periodontitis group were significantly higher than those of the control group [(0.60±0.72) %, (0.43±0.16) %, (0.13±0.13) %, respectively](P<0.05). Compared with periodontitis group, the relative abundance of Proteobacteria in high-fat diet+periodontitis group [(3.06±0.90)%] was significantly higher than that of the periodontitis group [(1.40±0.98)%] (P<0.05). The principal coordinate analysis and similarity analysis based on the Bray-Curtis distance showed that samples of the high-fat diet+periodontitis group clustered separately from the periodontitis group and the high-fat diet group. The results of correlation analysis showed that the abundance of Lachnospiraceae_NK4A136_group was negatively correlated with fasting blood glucose and glucose levels after loading for 60 and 120 minutes (r=-0.56, -0.50, -0.42, respectively) (P<0.05). The abundance of Allobaculum, [Eubacterium]_coprostanoligenes_group, Peptococcaceae_uncultured, [Ruminococcus]_torques_group, and several genera belonging to the Proteobacteria were positively correlated with glucose levels after loading for 120 minutes (P<0.05). Conclusions: Periodontitis might be closely related to impaired gut microbiota and glucose metabolism, and the effect could be aggravated by high-fat diet.

Metabolic syndrome-related SNPs in HLA and TNF7L2 may be risk factors for generalized pustular psoriasis in Chinese Han population

Background

Generalized pustular psoriasis (GPP) is a rare and severe type of psoriasis. Previous studies have reported that metabolic syndrome and its components have been associated with psoriasis.

Objective

To investigate the association of metabolic syndrome‐related single‐nucleotide polymorphisms (SNPs) and GPP in Chinese Han population.

Materials and Methods

One hundred and thirty‐six (136) GPP patients and 965 healthy controls were recruited in the study. Approximately, 4 ml peripheral venous blood was collected from each participant. After collection, second‐generation sequencing was used to detect genetic polymorphism of 15 SNPs. The plink 1.07 software package was used for statistical analysis.

Results

Rs805303 (p = 0.01, OR = 0.70) and rs3177928 (p = 3.18E−07, OR = 2.66) in HLA were significantly different between the two groups. Moreover, rs4506565 (p = 1.41E−03, OR = 2.72) and rs7901695 (p = 9.39E−04, OR = 2.82) in TCF7L2 were significantly associated with GPP in patients without a previous history of PsV. Genotype analysis of rs4506565 and rs7901695 showed that under the recessive model, genotype frequencies of rs4506565 (p = 0.00, OR = 18.52) and rs7901695 (p = 0.00, OR = 18.44) were significantly different between GPP patients and healthy controls.

Conclusion

Rs805303 and rs3177928 in HLA may increase the risk of GPP in the Chinese Han population. TCF7L2 may be a risk factor for GPP in patients without a previous history of PsV.

High-fat diet exacerbates periodontitis: is it because of dysbacteriosis or stem cell dysfunction?

Previous studies have shown that high-fat diet (HFD) may aggravate periodontitis, however the underlining mechanism remains to be further clarified. This study aims to explore whether HFD promotes periodontitis by inducing periodontal microbiota dysbiosis or stem cell dysfunction. A high-fat diet was given to four-week-old male Sprague-Dawley rats for 12 weeks. Periodontitis was induced during the latter 4 weeks. At the end of the 12th week, samples were collected after euthanasia. Maxillae were harvested for histological or microbial analysis. The microbial 16S rRNA gene sequencing was performed with the Illumina MiSeq platform. The data was analyzed through RDP Classifier against the SILVA database. The mandible molars were harvested for isolating periodontal ligament stem cells (PDLSCs). The protein level of p27, p21, and p16, which are negative regulators of the cell cycle, in PDLSCs were detected. Markers of osteogenic differentiation and pro-inflammatory mediators were detected by real-time polymerase chain reaction. Activation of pro-inflammatory signaling pathways was detected by Western blotting. We found that HFD significantly increased ligature-induced alveolar bone loss. HFD resulted in a less diverse periodontal microbiota, with increased proportions of Lactococcus, Bacillus, Alloprevotella, Carnobacterium, and Exiguobacterium and decreased proportion of Nitrospira. HFD increased the protein levels of p27, p16, and p21, and upregulated the expression of osteogenic biomarkers, IL-1β and IL-10 with the ERK1/2 signaling pathway activated in PDLSCs.

Gut Microbiota May Mediate the Influence of Periodontitis on Prediabetes

Mounting evidence has shown that periodontitis is associated with diabetes. However, a causal relationship remains to be determined. Recent studies reported that periodontitis may be associated with gut microbiota, which plays an important role in the development of diabetes. Therefore, we hypothesized that gut microbiota might mediate the link between periodontitis and diabetes. Periodontitis was induced by ligatures. Glycemic homeostasis was evaluated through fasting blood glucose (FBG), serum glycosylated hemoglobin (HbA1c), and intraperitoneal glucose tolerance test. Micro-computed tomography and hematoxylin and eosin staining were used to evaluate periodontal destruction. The gut microbiota was analyzed using 16S ribosomal RNA gene sequencing and bioinformatics. Serum endotoxin, interleukin (IL) 6, tumor necrosis factor α (TNF-α), and IL-1β were measured to evaluate the systemic inflammation burden. We found that the levels of FBG, HbA1c, and glucose intolerance were higher in the periodontitis (PD) group than in the control (Con) group (P < 0.05). When periodontitis was eliminated, the FBG significantly decreased (P < 0.05). Several butyrate-producing bacteria were decreased in the gut microbiota of the PD group, including Lachnospiraceae_NK4A136_group, Eubacterium_fissicatena_group, Eubacterium_coprostanoligenes_group, and Ruminococcaceae_UCG-014 (P < 0.05), which were negatively correlated with serum HbA1c (P < 0.05). Subsequently, the gut microbiota was depleted using antibiotics or transplanted through cohousing. Compared with the PD group, the levels of HbA1c and glucose intolerance were decreased in the gut microbiota-depleted mice with periodontitis (PD + Abx) (P < 0.05), as well as the serum levels of endotoxin and IL-6 (P < 0.05). The serum levels of IL-6, TNF-α, and IL-1β in the PD + Abx group were higher than those of the Con group (P < 0.05). Antibiotics exerted a limited impact on the periodontal microbiota. When the PD mice were cohoused with healthy ones, the elevated FBG and HbA1c significantly recovered (P < 0.05), as well as the aforementioned butyrate producers (P < 0.05). Thus, within the limitations of this study, our data indicated that the gut microbiota may mediate the influence of periodontitis on prediabetes.

Expression and functional characterization of INPP4B in gallbladder cancer patients and gallbladder cancer cells

Background

Inositol polyphosphate 4-phosphatase type II (INPP4B) is a negative regulator of the PI3K-Akt signalling pathway and plays a contradictory role in different types of cancers. However, the its biological role played by INPP4B in human gallbladder cancer (GBC) has not been elucidated. In this study, we investigated the expression, clinical significance and biological function of INPP4B in GBC patients and cell lines.

Methods

The INPP4B protein expression levels in gallbladder cancer tissues and normal gallbladder tissues were detected by immunohistochemistry, and the clinical significance of INPP4B was analysed. Knockdown and overexpression of INPP4B in GBC-SD and SGC-996 cells followed by cell proliferation, clonogenic, apoptosis detection, scratch wound-healing and transwell assays were used to identify INPP4B function in vitro.

Results

INPP4B was up-regulated in human GBC tissues compared with normal gallbladder tissues and was related to histopathological differentiation (p = 0.026). Here, we observed that INPP4B was highly expressed in high-moderately differentiated tumours compared with low-undifferentiated tumours (p = 0.022). Additionally, we found that INPP4B expression was not associated with overall survival of GBC patients (p = 0.071) and was not an independent prognostic factor. Furthermore, when we stratified the relationship between INPP4B expression and the prognosis of GBC based on histopathological differentiation, we found that INPP4B played a contradictory role in GBC progression depending on the degree of differentiation. In addition, INPP4B knockdown inhibited the proliferation, colony formation, migration and invasion in GBC cells, while INPP4B overexpression had the opposite effects in vitro, which indicates its role as an oncoprotein.

Conclusions

These findings suggested that INPP4B may play a dual role in the prognosis of GBC depending on the degree of differentiation and that INPP4B might act as an oncogene in gallbladder cancer cells.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08143-6.

Keel-bone fractures are associated with bone quality differences in laying hens

This study aimed to investigate the relationship between bone quality in terms of metabolism, homeostasis of elements, bone mineral density (BMD), and microstructure and keel-bone fractures in laying hens (Gallusgallusdomesticus). One hundred and twenty 17 week old Lohmann White laying hens with normal keel bones were individually housed in furnished cages for 25 weeks. Birds were then euthanased and dissected to assess keel-bone status at 42 weeks. Serum and keel-bone samples from normal keel (NK) and fractured keel (FK) hens were collected to determine the previously mentioned bone quality parameters. The results showed FK hens to have higher levels of the components of osteocalcin, greater alkaline phosphatase activity in serum and keel bones, and greater tartrate-resistant acid phosphatase (TRAP) activity in keel bones, compared to NK hens. Additionally, FK hens also had higher concentrations of Li, B, K, Cu, As, Se, Sn, Hg, and Pb, but lower concentrations of Na, P, and Ca. Moreover, FK hens showed decreased bone microstructural parameters including bone volume/tissue volume, trabecular number, degree of anisotropy, connectivity density, and BMD, but increased trabecular separation. Meanwhile, no differences were detected in serum TRAP activity, trabecular thickness, bone surface, or bone surface/bone volume. Results showed laying hens with keel-bone fractures to have differences in bone metabolism, elements of homeostasis, bone microstructure parameters, and BMD. These results suggest that keel-bone fractures may be associated with bone quality.

Hypoxia Inducible Factor-1alpha (HIF-1A) plays different roles in Gallbladder Cancer and Normal Gallbladder Tissues

Purpose: Hypoxia-inducible factor-1alpha (HIF-1A) is a transcription factor that plays an “angiogenic switch” role especially under hypoxia microenvironment in solid tumor. However, the functions and clinical significance of HIF-1A in gallbladder cancer (GBC) are still controversial, and it has not been studied in normal gallbladder tissues. In this study, we sought to clarify the role of sub-cellular localization of HIF-1A expression in GBC and normal gallbladder tissues.

Methods: The expressions of HIF-1A and CD34 in 127 GBC and 47 normal gallbladder tissues were evaluated by immunohistochemistry. Cox's proportional hazards model analysis and Kaplan-Meier method analysis were used to assess the correlations between these factors and clinicopathological features and prognosis.

Results: HIF-1A was expressed in both cytoplasm and nucleus of GBC and normal control tissues, and was significantly correlated with microvessel density (MVD). GBC tissues with positive nuclear HIF-1A expression had higher MVD compared to that with positive cytoplasmic HIF-1A expression; however, in normal gallbladder tissues, samples with positive cytoplasmic HIF-1A had higher MVD compared to that with positive nuclear HIF-1A expression. Moreover, GBC with nuclear HIF-1A expression tended to be more poorly differentiated and had larger tumor size compared to that with cytoplasm HIF-1A expression. Furthermore, GBC patients with nuclear HIF-1A positive were significantly correlated with worse overall survival (OS) compared with cytoplasmic HIF-1A positive. Multivariate Cox regression analysis identified lymph node metastasis and nuclear HIF-1A expression to be independent prognostic parameter in GBC.

Conclusions: Our findings provide evidence for the first time that HIF-1A is expressed in normal gallbladder tissues. Nuclear HIF-1A and cytoplasm HIF-1A plays different roles in GBC and normal gallbladder tissues.

Blood-brain barrier amenable gold nanoparticles biofabrication in aged cell culture medium

Green fabrication of nanoscale materials is highly desirable because of associated adverse effects with conventional nanomaterial biomedical applications. Moreover, the higher selective nature of the blood-brain barrier (BBB) limits the brain ailments treatment through conventional chemotherapy, thus providing room for nanotechnology-based modalities for BBB traversing. In this contribution, we have biosynthesized gold nanoparticles from the HAuCl4 solution in the aged cells culture medium. This approach is highly facile without any other chemical utilization. The cell culture medium age and cell number can tune the Au nanoparticles (AuNPs) size from 2 to several hundred nm. The 24 h MTT assay and cell uptake studies in vitro and murine models' vital organs (liver, kidney, spleen, lung, and heart) study up to 48 h demonstrated that biosynthesized AuNPs were biocompatible and BBB amenable. Interestingly, the transferrin and cell culture medium isolated proteins were found factors responsible for HAuCl4 solution biomineralization and size control. Moreover, the protein corona on biosynthesized AuNPs could help them traverse BBB both in vitro and in vivo, suggesting their potential applications for brain disease theranostics. In conclusion, the biosynthesis of AuNPs from aged cells medium is highly facile, green, and biocompatible for brain disease theranostics.

Effects of environment and breed on growth performance and meat quality of fattening pigs

Meat quality is not only influenced by breed but also rearing environment. The aim of this study was to evaluate the influence of different housing environments on growth performance, carcase traits, meat quality, physiological response pre-slaughter and fatty acid composition in two pig breeds. A total of 120 growing pigs at 60–70 days of age were arranged in a 2 × 2 factorial design with the breeds (Duroc × Landrace × Large White [D × L × LW] and Duroc × Landrace × Min pig [D × L × M]) and environmental enrichment (barren concrete floor or enriched with straw bedding) as factors. Each treatment was performed in triplicate with ten pigs per replicate. The pigs housed in the enriched environment exhibited a higher average daily gain, average daily feed intake, saturated fatty acid percentage and backfat depth than the pigs reared in the barren environment. Plasma cortisol levels were lower and growth hormone higher in enriched compared to barren pens. The D × L × M pigs showed lower cooking loss compared with the D × L × LW pigs. Moreover, the D × L × M pigs exhibited poor growth performance but had a better water-holding capacity. Only carcase traits and meat quality interaction effects were observed. We concluded that an enriched environment can reduce pre- slaughter stress and improve the growth performance of pigs and modulate the fatty acid composition of pork products.

Increased expression of RBMS3 predicts a favorable prognosis in human gallbladder carcinoma

Multiple regions in the short arm of chromosome 3 are frequently deleted in a variety of solid tumors including gallbladder carcinoma (GBC). RNA binding motif, single‑stranded interacting protein 3 (RBMS3), a tumor suppressor gene (TSG), is located in this region. However, the role of RBMS3 in GBC remains unclear. Reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and western blotting were performed to evaluate the mRNA and protein expression levels of RBMS3 in 41 fresh frozen GBC tissues and paired normal tissues. An immunohistochemical assay was performed on a tissue microarray (TMA, consisting of 125 cases GBC and 47 normal controls). Microvessel density (MVD) counts were determined using CD34 immunohistochemical staining. Moreover, univariate and multivariate analyses were performed to determine the correlations between RBMS3 expression, MVD and patient prognosis. Cellular functions including proliferation, clonogenicity and apoptosis, were assessed to further identify in vitro roles of RBMS3. It was revealed that both mRNA and protein expression levels of RBMS3 were significantly lower in GBC tissues than in normal controls. Multivariate Cox regression analyses demonstrated cytoplasmic RBMS3 expression as an independent prognostic factor correlated with GBC angiogenesis, histopathological differentiation and TNM stage. Kaplan‑Meier curves revealed that patients with lower cytoplasmic RBMS3 levels had a significantly worse OS than patients with higher cytoplasmic RBMS3 expression. Additionally, ectopic expression of RBMS3 markedly suppressed GBC cell proliferation and clonogenicity and promoted apoptosis in vitro. These findings indicated the potential of cytoplasmic RBMS3 as a tumor prognostic biomarker and a promising therapeutic target for GBC.

Curbing the diabetes and tuberculosis co-epidemic: the potential role of China

China has been playing an increasingly important role in global health in recent decades. Substantial progress and reform has been made in the country's health care system, but China still hosts one third of the world's diabetes mellitus (DM) patients and one fifth of the world's tuberculosis (TB) patients. Recent economic and public health advancements have provided tools for new drug development and facilitated the implementation of novel strategies. However, a unique set of challenges exist, including regulatory barriers, ethical concerns and the lack of a unified system and approaches across disease areas. This article analyses the current disease situation in China and discusses China's potential role in the global battle against the TB and DM co-epidemic.

Comparison of Experimental Infection of Normal and Immunosuppressed Chickens with Mycoplasma gallisepticum

Four different models of infection of chickens with Mycoplasma gallisepticum (MG) were evaluated. Normal or immunosuppressed chicks (10 days old) were infected with the MG R_low strain via eye and nasal drops or by direct air sac injection. Bacterial load in the lungs was quantified and air sac and tracheal lesion scores, tracheal mucosal thickness and humoral immune responses were assessed. Serum antibody responses were assessed by use of a serum plate agglutination test. Three days post infection (dpi), all immunosuppressed chicks had developed significant respiratory signs. Chicks infected via air sac injection had significant differences in serum antibody and gross lesion scores at 5 dpi. All chicks had developed pathological changes by 7 dpi. Air sac inoculation of immunosuppressed chicks produced more significant (P ≤0.05) lesions, and these birds had the highest bacterial load in the lungs compared with other groups.

[Predictive value of umbilical arterial cord pH on complications during hospitalization in neonates after cesarean section]

OBJECTIVE

To analyze the predictive value of umbilical arterial cord pH on complications of hospitalized neonates after cesarean section.

METHODS

This was a retrospective cohort study and carried out in Peking University First Hospital from January 1, 2017 to June 30, 2017. Neonates who were delivered by cesarean section were enrolled. The primary endpoint was the incidence of complications during in-hospital stay (including infection, aspiration pneumonia, myocardial damage, etc.). The subjects were divided into two groups:with or without complication. The umbilical arterial cord pH values were compared between the two groups. Perinatal baseline characteristics of maternal and neonatal data were recorded. The ROC curve was used to analyze the value of umbilical arterial cord pH in predicting neonatal complications during hospitalization. Multivariate Logistic regression was employed to analyze the potential risk factors of neonatal complications.

RESULTS

In the study, 872 neonates were included in the final analysis (541 in elective surgery and 331 in emergency surgery). The overall incidence of neonatal complications during hospitalization was 14.1%. The first three higher incidences were infection, aspiration pneumonia and myocardial damage. The average pH value in neonates without complication was 7.31 while 7.29 in neonates with complication. There was statistical significance between the two groups (P<0.001). The overall incidence of pH≤7.20 was 3.1% (27/872). The patients in neonates without complication had higher incidence of pH≤7.20 than those in neonates with complication (1.6% vs. 12.2%, P<0.001). Multivariate Logistic regression showed 6 risk factors of neonatal hospitalized complications including preterm delivery (OR=8.224, 95%CI: 4.910-13.777, P<0.001), pregnancy-induced hypertension (OR=1.886, 95%CI: 1.004-3.546, P=0.049), intrauterine growth restriction (OR=4.429, 95%CI: 1.280-15.330, P=0.019), emergency cesarean section (OR=2.711, 95%CI: 1.682-4.369, P<0.001), umbilical arterial blood gas pH≤7.20 (OR=7.420, 95%CI: 2.951-18.655, P<0.001) and 5-minute Apgar score <10 scores (OR=11.849, 95%CI: 3.977-35.128, P<0.001). The areas under the ROC curve of umbilical arterial blood gas pH in all neonatal, elective and emergency cesarean section were 0.570 (95%CI: 0.508-0.633, P=0.012), 0.559 (95%CI: 0.465-0.652, P=0.189) and 0.617 (95%CI: 0.538-0.697, P=0.002), respectively.

CONCLUSION

Umbilical arterial cord pH≤7.20 was related with increased incidence of neonatal complications after cesarean section,but ROC curve analysis showed a lower predictive value.

Resolvin D1 Resolve Inflammation in Experimental Acute Pancreatitis by Restoring Autophagic Flux

BACKGROUND

Acute pancreatitis (AP) is a common acute gastrointestinal disorders. Increasing evidence indicated that autophagy is involved in the development of AP. Resolvin D1 is an endogenous pro-resolving lipid mediator, which can protect mice from cerulein-induced acute pancreatitis and facilitate autophagy in macrophage, but its mechanism remians unclear.

AIMS

To investigate the effect of resolvin D1 on autophagy in mouse models of cerulein-induced AP.

METHODS

C57BL/6 mice were randomly divided into control group, AP group and resolvin D1 group. The models of cerulein-induced AP were constructed by intraperitoneally cerulein. Resolvin D1 group was established by intraperitoneally resolvin D1 based on AP models, simultaneously, control group received normal saline. The severity of AP, the level of inflammatory cytokines, the number of autophagic vacuoles, and the expression of autophagy-related markers were evaluated among three groups.

RESULTS

The AP models were established successfully. Compared to control group, the number of autophagic vacuoles and expressions of autophagy-related markers including Beclin-1, p62 and LC3-II were increased in AP models, In contrast, the degree of inflammation and levels of inflammatory cytokines in AP models were reduced after resolvin D1 treatment. Moreover, resolvin D1 attenuated the number of autophagic vacuoles and expressions of autophagy-related markers.

CONCLUSIONS

Autophagic flux is impaired in cerulein-induced AP. Resolvin D1 ameliorate the severity of mice with cerulein-induced acute pancreatitis, possible attributing to its reducing impaired autophagy and restoring autophagic flux.

Clinical efficacy of tacrolimus for treating myasthenia gravis and its influence on lymphocyte subsets

BACKGROUND

This study aimed to determine the clinical efficacy and effects of tacrolimus in treating myasthenia gravis (MG).

METHODS

A total of 45 outpatients and inpatients were divided into a tacrolimus group (n=15) and non-tacrolimus group (n=30): those in the former group were treated with 3mg/day of tacrolimus for 24 weeks, while those in the latter (control) group took other immunosuppressants (prednisone, azathioprine combined with prednisone). Each group was evaluated at weeks 4, 8, 12, 16, 20 and 24 by Myasthenia Gravis Foundation of America Quantitative Myasthenia Gravis (MGFA-QMG) Test, activities of daily living (ADL) profiles, and manual muscle (MMT) and fatigue tests. Dynamic changes in CD4⁺CD25^+high cells were tested by flow cytometry. Inflammatory cytokines were also evaluated in the tacrolimus group.

RESULTS

Efficacy index scores decreased significantly compared with baseline at every test week in both groups (P<0.01), although improvements were more evident with than without tacrolimus treatment (F=9.312, P<0.01 vs. F=24.551, P<0.01 and F=10.710, P<0.01). At week 24, peripheral blood CD4⁺CD25^+high T cells with tacrolimus decreased significantly (P<0.01), but increased significantly without tacrolimus (P<0.01). During treatment, CD19⁺BAFF-R B cells in peripheral blood decreased in both groups (P<0.05). Interferon (IFN)-γ concentrations in peripheral blood also diminished significantly with tacrolimus (P<0.01).

CONCLUSION

A relatively low dose of tacrolimus can affect multiple immune-system targets and, thus, can treat MG effectively in terms of both clinical symptoms and immunological responses.

Cytochrome P450 1A1 (CYP1A1) Catalyzes Lipid Peroxidation of Oleic Acid-Induced HepG2 Cells

Nonalcoholic fatty liver disease (NAFLD) is a chronic hepatic disease associated with excessive accumulation of lipids in hepatocytes. As the disease progresses, oxidative stress plays a pivotal role in the development of hepatic lipid peroxidation. Cytochrome P450 1A1 (CYP1A1), a subtype of the cytochrome P450 family, has been shown to be a vital modulator in production of reactive oxygen species. However, the exact role of CYP1A1 in NAFLD is still unclear. The aim of this study was to investigate the effects of CYP1A1 on lipid peroxidation in oleic acid (OA)-treated human hepatoma cells (HepG2). We found that the expression of CYP1A1 is elevated in OA-stimulated HepG2 cells. The results of siRNA transfection analysis indicated that CYP1A1-siRNA inhibited the lipid peroxidation in OA-treated HepG2 cells. Additionally, compared with siRNA-transfected and benzo[a]pyrene (BaP)-OA-induced HepG2 cells, overexpression of CYP1A1 by BaP further accelerated the lipid peroxidation in OA-treated HepG2 cells. These observations reveal a regulatory role of CYP1A1 in liver lipid peroxidation and imply CYP1A1 as a potential therapeutic target.

Conducting high-quality tuberculosis clinical trials in China: opportunities and challenges

Tuberculosis (TB) is an ancient disease that is a devastating threat to public health. As the country with the second highest number of TB cases and the highest number of multidrug-resistant TB cases in the world, China is now striving to be at the forefront of TB research and drug development. This article is based on the observations made by the authors during the recent partnership initiative between the National Institutes of Health and the Chinese TB community, as well as an extensive literature review. The article examines the advantages and challenges of conducting large-scale international multicenter TB clinical trials in China. China is becoming an excellent location for new TB drug trials, especially in collaboration with international organizations that bring considerable technical assistance, quality control, training, and oversight with these partnerships.

Abstract P4-02-05: Diagnostic value of breast MRI in evaluating total extent of disease when non-calcified DCIS is present in stereotactic core biopsy samples

PURPOSE

To compare the extent of disease as seen on mammography, breast MRI and final surgical pathology in all patients with non-calcified DCIS identified on stereotactic core biopsy. Can MRI provide useful diagnostic information to the surgeon when mammographically occult DCIS is present.

METHOD AND MATERIALS

All patients with stereotactic core biopsies performed at the University of Chicago from 2010 to 2017 were retrospectively reviewed. Patients with pathology demonstrating DCIS in non-calcified cores on stereotactic biopsy were further selected based on whether they had a subsequent breast MRI and definitive surgical treatment. A total of 76 patients met these criteria. All patients undergoing stereotactic core biopsy had at least six 9-gauge cores removed, all of which were radiographed and separated based on whether calcifications were present or absent. Select patients with documented DCIS in the non-calcified cores had a MRI. All patients with MRI underwent a routine diagnostic protocol consisting of one pre- and five post-contrast bilateral, fat suppressed T1 sequences along with a non-fat suppressed T2 sequence. Final surgical treatment was subsequently determined and performed by the breast surgeon.

RESULTS

76 women met all criteria for this study. In 16/76 (21%) of the cases, MRI revealed greater extent of disease than was detected via mammography, and led to change in management in half of those cases (8/76 - 11%). In all 16 of these cases, final surgical pathology confirmed the MRI-detected extent of disease. In 52/76 (68%) of the cases, MRI confirmed the extent of disease detected on mammography and final surgical pathology. In 8/76 (11%) of the cases, MRI showed little to no abnormal enhancement at site of mammographically detected calcifications, even though final surgical pathology confirmed presence of residual disease.

CONCLUSION

The presence of non-calcified DCIS in stereotactic core biopsy samples raises the suspicion for the presence of mammographically occult disease. Breast MRI performed in this setting shows that in majority (82% -68/76) of the cases, MRI can either confirm or even advantageously reveal greater extent of disease than was initially detected on mammography. Furthermore, there can be a change in management due to the breast MRI findings.

CLINICAL RELEVANCE/APPLICATION

Breast MRI can be a useful diagnostic tool for the surgeon when non-calcified DCIS is present in stereotactic core biopsy samples.

Citation Format: Sheth D, Bao J, Abe H, Jaskowiak N. Diagnostic value of breast MRI in evaluating total extent of disease when non-calcified DCIS is present in stereotactic core biopsy samples [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-05.

[Applied research of "quadri-low" combined with automatic tube current modulation and iterative model reconstruction technology in head and neck CT angiography]

Objective: To investigate the feasibility of low tube voltage, low contrast medium concentration, injection rate and volume (quadri-low) combined with automatic tube current modulation (ATCM) and iterative model reconstruction (IMR) technology in head and neck CT angiography (CTA). Methods: A total of 70 patients whose body mass index (BMI)<25 kg/m(2) underwent head and neck CTA and digital subtraction angiography (DSA) from January to July 2017 were enrolled in this prospective study. According to random number table, patients were divided into two groups: group A (n=35) was scanned according to the protocol of 120 kV, 150 mAs, 50 ml and 5 ml/s iopromide (370 mg/ml) and filtered back projection (FBP) reconstruction; group B (n=35) was scanned with 80 kV, ATCM with mean tube current of 100 mAs, 30 ml and 3 ml/s iohexol (300 mg/ml) and IMR; the other parameters kept consistent between the two groups. The maximum transverse neck diameter at the level of the hyoid bone, artery CT value and image noise were measured, signal to noise ratio (SNR), contrast to noise ratio (CNR) and figure of merit (FOM) were calculated, and the image quality was evaluated subjectively and compared with those reconstructed by DSA. Scan length, volume CT dose index (CTDIvol) and dose length product (DLP) were recorded, and the effective dose (ED) was calculated. The chi-square and independent-sample t tests were used to compare the inter-group differences in these aforementioned data. Resutls: No significant difference was found in general information between the two groups. No significant difference existed in artery CT value, image noise, SNR and CNR between the two groups (t=-1.170-1.365, all P>0.05); however, the FOM of group B (74±40) was significantly higher than that in group A (12±4) (Z=-7.195, P=0.000). The image quality of the two groups met the requirement of clinical diagnosis[(4.1±0.7) vs (4.2±0.8) points, Z=-0.592, P>0.05], no significant difference was found in subjective evaluation and diagnostic efficacy. The CTDIvol, DLP and ED in group B were all significantly lower than those in group A (Z=-7.728, -7.202, -7.206, all P<0.05). The iodine load and iodine delivery rate (IDR) of group B was lower than that of group A (18.5 g vs 9.0 g, 1.85 mg/s vs 0.90 mg/s), and they were reduced for 51.4% in group B. Conclusions: For patients of BMI <25 kg/m(2,) low tube voltage, low contrast medium concentration, injection rate and volume combined with ATCM and IMR technology can significantly decrease radiation dose, iodine load and IDR while maintain the image quality in head and neck CTA examination.

Mechanism of Anti-rotavirus Synergistic Activity by Epigallocatechin Gallate and a Proanthocyanidin-Containing Nutraceutical

Epigallocatechin gallate (EGCG) of green tea and the nutraceutical CystiCran^®-40 (containing 40% proanthocyanidins) of the cranberry plant have been associated with antiviral activity. The purpose of this work was to determine the mechanism of antiviral synergy between each compound. Coliphage T4II (phage T4) and the rotavirus strain SA-11(RTV) were used as model virus systems. Individual and combined flavonoids structural and molecular weight analyses were performed by NMR and HPCL/MS, respectively. A suboptimal concentration of EGCG or C-40 alone or in combination reduced phage infectivity by ≤10%. Similarly, EGCG (30 µg/ml) and C-40 (25 µg/ml), respectively, reduced RTV titers by 3 and 13%. However, RTV titers were reduced by 32% (p < .05) with both flavonoids used in combination. RTV was not recognized in host cells by electron microscopy 24-h post-inoculation. NMR and HPLC/MS findings revealed significant structural and potential changes in molecular weight of the flavonoids in complex.