[Recommendations for diagnosis and treatment of systemic lupus erythematosus]

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with complicated pathogenesis and diverse clinical manifestations. The current recommendations of the Chinese Rheumatology Association are based on a comprehensive investigation of evidence based medicine, domestic and international guidelines for SLE, and experts' proposals, and aim to provide a more scientific and authoritative reference for the diagnosis and management of SLE. The recommendations focus on four aspects; clinical manifestations, laboratory evaluation, diagnosis and disease assessment, and disease treatment and monitoring. The goal of the recommendations is to standardize the diagnosis and treatment of SLE in China so as to improve the prognosis of SLE patients.

[Analysis on survival time and influencing factors among reported HIV/AIDS in Yunnan Province, 1989-2021]

Objective: To analyze the survival time of reported HIV/AIDS and influencing factors of Yunnan Province from 1989 to 2021. Methods: The data were extracted from the Chinese HIV/AIDS comprehensive response information management system. The retrospective cohort study was conducted. The life table method was applied to calculate the survival probability. Kaplan-Meier was used to draw survival curves in different situations. Furthermore, the Cox proportion hazard regression model was constructed to identify the factors related to survival time. Results: Of the 174 510 HIV/AIDS, the all-cause mortality density was 4.23 per 100 person-years, the median survival time was 20.00 (95%CI:19.52-20.48) years, and the cumulative survival rates in 1, 10, 20, and 30 years were 90.75%, 67.50%, 47.93% and 30.85%. Multivariate Cox proportional risk regression model results showed that the risk of death among 0-14 and 15-49 years old groups were 0.44 (95%CI: 0.34-0.56) times and 0.51 (95%CI:0.50-0.52) times of ≥50 years old groups. The risk for death among the first CD4⁺T lymphocytes counts (CD4) counts levels of 200-349 cells/μl, 350-500 cells/μl and ≥501 cells/μl groups were 0.52 (95%CI: 0.50-0.53) times, 0.41 (95%CI: 0.40-0.42) times and 0.35 (95%CI: 0.34-0.36) times of 0-199 cells/μl groups. The risk of death among the cases that have not received antiretroviral therapy (ART) was 11.56 (95%CI: 11.26-11.87) times. The risk for death among the cases losing to ART, stopping to ART, both losing and stopping ART was 1.66 (95%CI:1.61-1.72) times, 2.49 (95%CI:2.39-2.60) times, and 1.65 (95%CI:1.53-1.78) times of the cases on ART. Conclusions: The influencing factors for the survival time of HIV/AIDS cases were age at diagnosis in Yunnan province from 1989 to 2021. The first CD4 counts levels, antiretroviral therapy, and ART compliance. Early diagnosis, early antiretroviral therapy, and increasing ART compliance could extend the survival time of HIV/AIDS cases.

[Analysis of characteristics of drug resistance gene mutation in HBV RT region of hepatitis B infected patients]

Objective: This article investigated the clinical characteristics and distribution of drug resistance mutation sites in HBV RT region of hepatitis B infected patients. Methods: Retrospective analysis was made on 1 948 patients with HBV infection, who had been tested for NAs resistance mutation and had a medical history of NAs in the Laboratory Department of the Fifth Medical Center of the PLA General Hospital from January 2020 to December 2021. Basic clinical information and drug resistance related mutation information were recorded. Meanwhile, the serological index data of hepatitis B were collected. Drug resistance gene mutant group and non-mutated group were grouped according to whether the drug resistance genes had a mutation in HBV RT region, and the clinical characteristics and genotype distribution of the two groups were statistically analyzed. The pattern of drug resistance gene mutation, number of mutation sites, drug resistance type and mutation of NAs resistance-related sites were analyzed in 917 patients with drug resistance gene mutation in HBV RT region. χ² Inspection was used for counting data. Meanwhile, two independent samples t-test and Wilcoxon rank sum test were used for measurement data. Results: Among the 1 948 patients with chronic HBV infection, 917 patients had drug resistance gene mutation in RT region (47.07%). The proportion of patients with acute hepatitis B and CHB in HBV RT resistance gene mutant group was lower than that in the non-mutated group, while the proportion of patients with HBV-related cirrhosis was higher than that in the non-mutated group, these differences were statistically significant. Compared with the non-mutated group in HBV RT region, the age, the positive rates of HBeAg and HBV DNA, and HBV DNA load of these patients were increased in drug resistance gene mutant group, these differences were statistically significant. Genotypes of patients in both groups were dominated by C, followed by B and D. The proportion of patients with genotype C in HBV RT drug resistance gene mutant group was higher than that of non-mutated group, the difference was statistically significant. There were 53 gene mutation patterns in 917 patients with drug resistance gene mutation in HBV RT region, and the main pattern was rtL180M+rtM204V+rtS202G (9.70%). The mutation sites were dominated by 3 (20.74%). There were 5 types of drug resistance, LAM+Ldt (21.25%) was the most. Among the 18 sites that were clearly associated with LAM, ADV, ETV and Ldt resistance in the HBV RT region, 14 sites were mutated, and the most common mutation sites were rtL180M, rtM204V, rtM204 and rtS202G. what's more, the proportion of patients with NAs drug resistance was LAM>Ldt>ETV>ADV. Conclusion: In order to prevent adverse consequences of this study such as disease recurrence or disease progression caused by HBV drug resistance, HBV infected patients, who have long-term use of NAs antiviral therapy, should monitor the level of HBV DNA and drug resistance genes in HBV RT region in order to optimize the treatment plan in time or guide individualized treatment.

[Recombinant Schistosoma japonicum egg ribonuclease SjCP1412 inhibits the activation of LX-2 hepatic stellate cells in vitro]

OBJECTIVE

To investigate the effect of recombinant Schistosoma japonicum egg ribonuclease SjCP1412 (rSjCP1412) on proliferation, cell cycle, apoptosis and activation of human hepatic stellate cells LX-2 in vitro, and explore the underlying mechanisms.

METHODS

The rSjCP1412 protein was expressed in Escherichia coli BL21 by prokaryotic expression, and the highly purified soluble rSjCP1412 protein was prepared by Ni NTA affinity chromatography and urea gradient refolding dialysis. Yeast RNA was digested using 12.5, 25.0, 50.0 µg rSjCP1412 proteins at 37 °C for 2, 3, 4 h, and the enzymatic products were electrophoresed on 1.5% agarose gel to observe the RNAase activity of rSjCP1412 protein. The proliferation of LX-2 cells stimulated by different doses of rSjCP1412 protein for 48 hours was measured using CCK-8 assay, and the apoptosis of LX-2 cells stimulated by different doses of rSjCP1412 protein for 48 hours was detected using the Annexin V-FITC/PI double staining, while the percentage of LX-2 cells at G0/G1, S and G2/M phases of cell cycle following stimulation with different doses of rSjCP1412 protein for 48 h was detected by DAPI staining. The type I collagen, type III collagen and α-smooth muscle actin (α-SMA) mRNA expression was quantified using quantitative florescent real-time PCR (qPCR) assay and Western blotting at transcriptional and translational levels in LX-2 cells following stimulation with different doses of rSjCP1412 protein for 48 h, while soluble egg antigen (SEA) served a positive control and PBS without rSjCP1412 protein as a normal control in the above experiments. The expression of collagen I, α-SMA and Smad4 protein was determined using Western blotting in LX-2 cells following stimulation with rSjCP1412 protein, transforming growth factor-β1 (TGF-β1) alone or in combination, to examine the signaling for the effect of rSjCP1412 protein on LX-2 cells.

RESULTS

The rSjCP1412 protein was successfully expressed and the highly purified soluble rSjCP1412 protein was prepared, which had a RNase activity. Compared with the normal group, the survival rates of LX-2 cells significantly decreased post-treatment with 12.5, 25.0, 50.0 µg/mL rSjCP1412 protein and SEA for 48 h (F = 22.417 and 20.448, both P values < 0.05). The apoptotic rates of LX-2 cells significantly increased post-treatment with 12.5, 25.0, 50.0 µg/mL rSjCP1412 protein for 48 h (F = 11.350, P < 0.05), and treatment with 12.5, 25.0, 50.0 µg/mL rSjCP1412 protein for 48 h resulted in arrest of LX-2 cells in G0/G1 phase (F = 20.710, P < 0.05). Treatment with 12.5, 25.0, 50.0 µg/mL rSjCP1412 protein for 48 h caused a significant reduction in relative expression levels of collagen I (F = 11.340, P < 0.05), collagen III (F = 456.600, P < 0.05) and α-SMA mRNA (F = 23.100, P < 0.05) in LX-2 cells, and both rSjCP1412 protein and SEA treatment caused a significant reduction in collagen I (F = 1 302.000, P < 0.05), α-SMA (F = 49.750, P < 0.05) and Smad4 protein expression (F = 52.420, P < 0.05) in LX-2 cells. In addition, rSjCP1412 protein treatment inhibited collagen I (F = 66.290, P < 0.05), α-SMA (F = 31.300, P < 0.05) and Smad4 protein expression (F = 27.010, P < 0.05) in LX-2 cells activated by TGF-β1.

CONCLUSIONS

rSjCP1412 protein may induce apoptosis of LX-2 cells and inhibit proliferation, cell cycle and activation of LX-2 cells through down-regulating Smad4 signaling molecules.

[Urethroplasty technological changes for the treatment of male urethral stricture]

Urethroplasty is an important method to treat male urethral stricture. Nowadays, urethroplasty mainly includes two types: anastomotic urethroplasty and substitution urethroplasty. Anastomotic urethroplasty mainly includes primary anastomosis urethroplasty and non-transecting anastomotic urethroplasty. Substitution of urethroplasty mainly includes staged urethroplasty and one-stage urethroplasty. Substitution materials always are chosen by pedicle skin flap and free mucosal graft. Anastomosis urethroplasty has shown good results in short bulbar urethral stricture and posterior urethral stricture after pelvic fracture. Among them, non-transecting anastomosis urethroplasty has become a new surgical method for iatrogenic, single, short or non-occluded stenosis. At present, the one-stage substitution urethroplasty is the most widely used. However, there are still many complicated cases that must be solved by staged urethroplasty. Pedicle skin flap and oral mucosa are widely used as substitutes at present. How to select the best surgical procedure and substitute materials individually would be the problem worthy of attention in the future. Accumulating more long-term follow-up data is helpful for objective comparison of various surgical procedures and grafts.

Associations between severe pulmonary function and residual CT abnormalities in rehabilitating COVID-19 patients

OBJECTIVE

Coronavirus disease 2019 (COVID-19) spread around the world in 2020. Abnormal pulmonary function and residual CT abnormalities were observed in COVID-19 patients during recovery. Appropriate rehabilitation training is around the corner. The correlation between spirometric impairment and residual CT abnormality remains largely unknown.

PATIENTS AND METHODS

A cross-sectional study conducted on the pulmonary function of 101 convalescent COVID-19 patients before discharge. Multivariate analysis was used to establish a scoring system to evaluate the spirometric abnormality based on residual chest CT.

RESULTS

Lung consolidation area >25% and severe-type COVID-19 were two independent risk factors for severe pulmonary dysfunction. Besides, a scoring system was established. People scoring more than 12 points have more chances (17 times) to get severe pulmonary function impairment before discharge.

CONCLUSIONS

For the first time, a chest CT characteristics-based grading system was suggested to predict the pulmonary dysfunction of COVID-19 patients during convalescence in this study. This study may provide suggestions for pulmonary rehabilitation.

[Analysis on the proportion of men who have sex with men and related factors among male over 15 years old in Kunming]

Objectives: To investigate the proportion of MSM among males over 15 years old and analyze its related factors to provide a reference for estimation of MSM size. Methods: Using cross-sectional survey design, multi-stage sampling method, and street interception survey method, a survey was conducted on males over 15 years old in Kunming from October to December 2019, with an estimated sample size of 9 908. Results: Totally, 10 707 males were recruited from 30 sites in 5 counties, and 10 283 were effectively surveyed with a response rate of 96.0%. Respondents aged 16 to 40 accounted for 75.3% (7 748), senior high school or above 71.1% (7 312), and unmarried 49.8% (5 121). The proportion of homosexual behavior in the past half-year was 1.06% (95%CI: 0.86%-1.26%), and the age-adjusted rate was 0.97% (95%CI: 0.78%-1.16%). And multivariate logistic regression showed the associated factors for homosexual behavior as following: proportion of main urban area was 2.217 times (95%CI:1.004-4.895) that of the outer suburbs, registered residence outside Kunming was 0.421 times (95%CI:0.260-0.682) that of in Kunming, having been in Kunming ≤6 months was 2.282 times (95%CI:1.262-4.126) that of >6 months, senior middle school or above was 0.336 times (95%CI:0.228-0.495) that of junior middle school and below, and being married was 0.462 times (95%CI:0.303-0.705) that of unmarried. Conclusions: The proportion of over 15-year-old males who have recently practiced male-male behavior was close to 1.00% in Kunming. The relevant factors included survey areas with a permanent residency of Kumming, short-time residency, education level, and marital status. This study obtained the data and related factors, which provided a reference for estimating MSM size in Yunnan province.

[Status on the use of anti-hypertensive drugs in the southwest areas of China]

Objective: To understand the current status of anti-hypertensive drug use in patients with hypertension in the Southwest areas of China. Methods: Based on the Program of Screening and Intervention Subjects with High Risk Cardiovascular Diseases, this study presented information on adults aged 35-75 in Southwest China by convenient sampling method, from January 2016 to November 2018. Basic information and cardiovascular related data were collected. Data on hypertensive patients were recorded, including names, doses and frequency of anti-hypertensive drugs they used. Information on the use of anti-hypertensive drugs among different hypertension subgroups, potential related characteristics, types and combination patterns of drugs, etc., were analyzed. Results: A total of 394 957 subjects were included in the study, with 159 014 identified as being hypertensive [mean age (58.8±9.5) years, 40.2% male]. 29.8% of them ever received antihypertensive drugs. A total of 30 445 of the patients reported detailed information of the drugs they ever used and 22.5% of them received therapy of combined drugs. Rates of using combination therapy were consistent among subgroups with different age, gender, blood pressure level and history of cardiovascular and cerebrovascular diseases. Results from the multivariate logistic regression analysis showed that patients with previous cardiovascular and cerebrovascular events, obesity or diabetes were more likely to have received combined therapy, while patients with less education or lower income were in the opposite. Calcium antagonists (58.6%) were the main drugs being used in single drug therapy, while traditional fixed-dose combination drugs (31.4%) were the most common ones in the drug-combination therapy, followed by angiotensin converting enzyme inhibitor/angiotensin receptor blocker combined with calcium antagonists (22.4%). Angiotensin converting enzyme inhibitor/angiotensin receptor blocker combined with beta blocker was the main drug used in patients with coronary heart disease. Conclusions: Treatment programs using the antihypertensive drugs for hypertensive patients in Southwest China needs to be improved, since the irrational use of antihypertensive drugs still exists. However, we would encourage the use of combination therapy for hypertensive patients.

[Clinicopathological features and prognosis of 488 patients with neuroendocrine tumors]

Objective: To investigate the clinicopathological features and prognosis of patients with neuroendocrine tumors (NETs). Methods: The clinicopathologic data of enrolled patients with NETs between October 2012 and October 2017 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results: Among the 488 NETs patients, the average age was (51.0±15.8) years, and the sex ratio (male/female) was 1∶1.1. Of the NETs, 370 were located in the digestive system (75.8%), 63 were pulmonary (12.9%), 14 were mediastinal (2.9%), 7 were of unknown primary origin (1.4%), and 34 were located in other sites (7.0%). Among the NETs, the pancreas, rectum and stomach were the most common sites. In the digestive system NETs, the most common tumor grade was G1 (190 cases, 51.4%), followed by G2 (143 cases, 38.6%) and NET-G3 (37 cases, 10.0%). In pulmonary NETs, typical and atypical carcinoid tumors was 47.6% and 52.4%, respectively. There were 310 patients at stage Ⅰ/Ⅱ, 53 at stage Ⅲ, 69 at stage Ⅳ and 56 at stage undiagnosed, respectively. The relationships among age, stage, grade, metastasis, treatment and prognosis were analyzed. All these factors could influence the survival rate of NET patients. Multivariate Cox analysis showed that age (>50 years old) (HR=2.831, 95%CI:1.414-7.029, P=0.025) and distant metastasis (HR=10.208, 95%CI:4.110-25.355, P<0.001) were independent risk factors. Conclusions: The most common primary sites of NETs are the pancreas, rectum, and stomach. Age and distant metastasis are independent risk factors for the prognosis of NETs.

[A large scale cohort study on AIDS in communities in Dali, Yunnan province, 2014-2015]

Objective: To understand HIV incidence in community residents and epidemiological characteristics of newly detected HIV infection cases in Dali, Yunnan province. Methods: A cohort study was conducted among 146 720 community residents who were tested to be HIV negative during 2010-2011, they were followed-up from June 1, 2014 to May 31, 2015. Results: A total of 136 356 community residents received follow up (92.9%). The follow-up time was 0.23-5.40 years (medium: 3.43 years), cumulatively 459 675 person years, and 78 people were found to be HIV positive. The incidence rate of HIV infection was 0.170/1 000 person years. The incidence rate was 0.037/1 000 person years in age group 15-29 years, 0.288/1 000 person years in age group 30-44 years, 0.210/1 000 person years in age group 45-59 years, 0.204/1 000 person years in age ≥60 years; 0.213/1 000 person years in males, 0.130/1 000 person years in females; 0.248/1 000 person years in Han ethnic group, 0.149/1 000 person years in Minorities; 0.194/1 000 in people with education level ≤ junior middle school, 0.046/1 000 person years in people with education level > junior middle school; 0.070/1 000 person years in the unmarried, 0.194/1 000 person years in the married and 0.425/1 000 person years in the divorced/widowed. Cox proportional hazards regression analysis showed that being male (HR=1.731), aged 30-44 years (HR=13.158), aged 45-59 years (HR=10.329), aged ≥60 years (HR=8.291), unmarried (HR=3.162) and divorced/widowed (HR=2.689) were the risk factors for HIV infection, while the education level > junior middle school (HR=0.132) was the protective factor for HIV infection. Conclusions: By medium 3.43 years follow up, the cohort study showed that incidence rate HIV infection was 0.170/1 000 person years in the community residents in Dali. Male, middle aged and old people, people with low education level, the unmarried and the divorced/widowed had relatively higher risk to be infected with HIV, Close attention should be paid to the prevention and control of AIDS in these populations.

[Analysis of antimicrobial resistance and risk factors of community-onset methicillin-resistant staphylococcus aureus infection]

Objective: To analyze risk factors and drug resistance of community-onset methicillin-resistant staphylococcus aureus (CO-MRSA) infection through the investigation of patients infected with CO-MRSA. Methods: The clinical data of 97 cases infected with community-onset staphylococcus aureus (COSA) was collected in this hospital from July 2016 to June 2017. Epidemiological survey method and the variables were determined according to expert consultation, literature and practical work experience. Results: Among 97 patients infected with COSA, the diagnosis rate of CO-MRSA was 21.65%(21/97). The drug sensitivity results showed that: CO-MRSA was high resistant to erythromycin, tetracycline and clindamycin, and the drug resistance rate exceeded 50%. Multiple variables were analyzed by Logistic regression. The usage of antimicrobial agents in the past three months and the history of hospitalization within one year were the independent risk factors. The MRSA infection rate was 57.89%(11/19) of the persons who had taken antibacterial agents in the recent three months.The MRSA infection rate was 48.28%(14/29) of the persons who had been hospitalized in the past one year. OR value of two risk factors was respectively 10.006(95%CI: 2.200-45.519, P=0.030) and 11.519(95%CI: 2.405-55.177, P=0.002). Conclusions: Most COSA is sensitive to methicillin, but CO-MRSA is multidrug resistant and has more risk factors. The clinicians should reasonably use the antibacterial agents according to the drug sensitivity in order to prevent the occurrence of multidrug resistant MRSA.

A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese

This study described a modified quantitative morphometry (mQM) system adapted to specific reference values for Mainland Chinese population. The mQM system is validated using the Genant Semiquantative system and is sensitive for detecting vertebral height changes and predicting cement leakage after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compressive fracture (OVCF).

INTRODUCTION

OVCF is a manifestation of osteoporosis. To improve clinical management of osteoporosis, the quantitative morphometry (QM) system has been widely used for the early diagnosis and precise classification of OVCF in developed countries. Here, we present an mQM system and validated its use in detecting OVCF in Mainland Chinese.

METHODS

Using our mQM system, the pre- and post-operative values of vertebral heights were measured and evaluated in 309 Mainland Chinese who received percutaneous kyphoplasty (PKP) as OVCF treatment. Measurements and classification of fractures from the mQM system were validated by comparing to values obtained by the Genant semiquantative (SQ) method. Moreover, we evaluated the sensitivity of the mQM system by its ability to detect restoration of vertebral heights and predict cement leakage after PKP.

RESULTS

The five classification of fractures, No deformity (ND), anterior wedge (AW), posterior wedge (PW), biconcavity (BC), and compression (CP), evaluated by the mQM method shared similar distribution characteristics compared to those obtained by the SQ method. In addition, mQM evaluation showed that the vertebra height of all fracture types showed significant restoration after PKP. The incidence of cement leakage was most common in CP (37.5%), followed by AW (31.6%), BC (26.5%), ND (23.7%), and PW (0.0%).

CONCLUSIONS

Our mQM system is suitable for classification of fractures, detection of vertebral height restoration, and correlation of cement leakage after PKP in Mainland Chinese population.

[Knowledge, related behavior and on AIDS/HIV infection among rural adults with Derung minority, in Yunnan province, 2016]

Objective: To understand the related risk behaviors, knowledge and status of HIV/AIDS infection among rural adults of Derung minority, to provide relevant messages for the development of HIV/AIDS intervention strategy in this minority group. Methods: We used system sampling method to conduct a cross-sectional survey in 6 administration villages of Derung Township, Gongshan Derung and Nu Autonomous County in Nujiang Lisu Autonomous Prefecture of Yunnan Province, with a sample size estimated as 383. Adult residents with Derung minority in six villages of Gongshan County were involved, with relevant information collected through door-to-door visit. HIV antibody was tested and SPSS 17.0 was used for statistical analysis. Results: Information on 394 valid respondents was collected, with age as between 18 and 65 (34.39±9.74), 80.7% (318/394) as married, 54.0% (213/394) having had primary school education, 13.2% (52/394) as migrant workers. In this population, the overall HIV infection rate appeared as 0.5% (2/400), mainly through sexually transmission. The rate of awareness on HIV/AIDS was 69.8% (275/394), mainly through free publicized materials 50.0% (197/394). Rates on premarital sexual behavior on multiple sexual partners in the past year, on temporary sexual partners in the past year, having commercial sexual experiences in the past year and ever used condoms when engaging in casual sex, were 6.4% (60/366), 18.0%(66/366), 5.7%(21/366), 1.9%(7/366) and 8.0%(25/311), respectively. Conclusions: Few numbers of HIV infections were identified among the migrating workers with Derung minority, with sexual transmission as the major route, along with the increased number of rural migrant workers and the low rates both on AIDS knowledge and condom use, accompanied by the high risk sexual behavior appeared in this rural adult residents of Derung minority. Relative strategies on HIV/AIDS intervention and control should be developed.

Circulating miR-199a-3p in plasma and its potential diagnostic and prognostic value in glioma

OBJECTIVE

The present study aimed to examine the possibility of using plasma miR-199a-3p as a biomarker for glioma.

PATIENTS AND METHODS

Plasma miR-199a-3p expression glioma patients and normal healthy controls were quantified by Quantitative reverse transcription PCR. Then, the associations of serum miR-199a-3p level with clinicopathological factors or survival of glioma patients were further evaluated. Receiver operating characteristics (ROC) and area under the ROC curve (AUC) were used to validate the diagnostic value of miR-199a-3p. Univariate and multivariate Cox regression analyses were finally performed to analyze the independent factors for overall survival.

RESULTS

The qRT-PCR results showed that the miR-199a-3p expression was significantly downregulated in glioma tissues compared with the adjacent non-tumor tissues (p<0.01). Furthermore, plasma miR-199a-3p level was significantly lower in glioma patients when compared with healthy controls (p<0.01). ROC curve analysis showed that plasma miR-199a-3p was a useful marker for discriminating cases from healthy controls, with an area under the ROC curve (AUC) of 0.8466 (95% confidence interval (CI) 0.772 to 0.9211, p<0.001). Moreover, miR-199a-3p expression was associated with various clinicopathological parameters, including WHO grade (p=0.001) and KPS score (p=0.008). We found that glioma patients with low miR-199a-3p expression level had distinctly shorter overall survival than patients with high miR-199a-3p expression level (p=0.0067). Univariate and multivariate analysis suggested that miR-199a-3p expression was an independent predictor of poor prognosis.

CONCLUSIONS

These findings indicated that the circulating miR-199a-3p could be used as a promising novel biomarker for the diagnosis and prognosis of glioma.

Calpain-activated mTORC2/Akt pathway mediates airway smooth muscle remodelling in asthma

BACKGROUND

Allergic asthma is characterized by inflammation and airway remodelling. Airway remodelling with excessive deposition of extracellular matrix (ECM) and larger smooth muscle mass are correlated with increased airway responsiveness and asthma severity. Calpain is a family of calcium-dependent endopeptidases, which plays an important role in ECM remodelling. However, the role of calpain in airway smooth muscle remodelling remains unknown.

OBJECTIVE

To investigate the role of calpain in asthmatic airway remodelling as well as the underlying mechanism.

METHODS

The mouse asthma model was made by ovalbumin sensitization and challenge. Calpain conditional knockout mice were studied in the model. Airway smooth muscle cells (ASMCs) were isolated from smooth muscle bundles in airway of rats. Cytokines IL-4, IL-5, TNF-α, and TGF-β1, and serum from patients with asthma were selected to treated ASMCs. Collagen-I synthesis, cell proliferation, and phosphorylation of Akt in ASMCs were analysed.

RESULTS

Inhibition of calpain using calpain knockout mice attenuated airway smooth muscle remodelling in mouse asthma models. Cytokines IL-4, IL-5, TNF-α, and TGF-β1, and serum from patients with asthma increased collagen-I synthesis, cell proliferation, and phosphorylation of Akt in ASMCs, which were blocked by the calpain inhibitor MDL28170. Moreover, MDL28170 reduced cytokine-induced increases in Rictor protein, which is the most important component of mammalian target of rapamycin complex 2 (mTORC2). Blockage of the mTORC2 signal pathway prevented cytokine-induced phosphorylation of Akt, collagen-I synthesis, and cell proliferation of ASMCs and attenuated airway smooth muscle remodelling in mouse asthma models.

CONCLUSIONS AND CLINICAL RELEVANCE

Our results indicate that calpain mediates cytokine-induced collagen-I synthesis and proliferation of ASMCs via the mTORC2/Akt signalling pathway, thereby regulating airway smooth muscle remodelling in asthma.

[HIV prevalence and risk factors among left-behind women in high HIV epidemic rural areas of Yunnan province]

OBJECTIVE

To understand the status of HIV infection and risk factors among those left-behind women (LBW) in high HIV epidemic rural areas.

METHODS

A cross-sectional investigation was conducted between March and May, 2015 in Dehong and Lincang prefectures, Yunnan province, where HIV appeared highly epidemic. Probability Proportion to Size (PPS) sampling method was used, and 500 cases were involved and tested for HIV antibody.

RESULTS

The total rate of HIV infection among LBW was 8.2% (41/500). The rate of HIV infection among LBWs whose husbands were on medication was 22.7% (30/132). Data from Multi-factor logistic regression analysis showed that the risk factors of HIV infection were: being minorities, education background lower than junior high school, widowed, living in Lincang prefecture, husband infected with HIV but did not consistently use condoms,etc. The rate of HIV infection among other LBWs was 2.8% (10/363). Data from Multi-factor logistic regression analysis showed that the risk factors of HIV infection would include: aged between 30-40 years, being minorities, education background lower than junior high school, divorced, living in Dehong prefecture, having had multiple-sex partners, husband coming home less than once a year,etc. The rate of HIV infection among drug users whose husbands did not take HIV medication was 20.0% (1/5).

CONCLUSION

HIV prevalence among LBWs in highly HIV epidemic areas was high, and the major risk factors related to their husbands were: being drug users or with HIV infected. Further effort should be made on consistently use of anti-HIV drugs and prevention of inter-marital sexual transmission. Comprehensive intervention should be carried out for LBWs who were having lower education background, being minority and having multiple-sex partners.

Mechanism of SEMA3B gene silencing and clinical significance in glioma

The aim of the current study was to explore mechanisms of SEMA3B gene expression and its clinical significance in glioma, and provide a theoretical foundation for investigating individualized treatment in glioma. Paraffin-embedded tissues from 43 patients with a confirmed clinical diagnosis of glioma following neurosurgery at the First Affiliated Hospital of Zhengzhou University from December 2013 to April 2014 were selected randomly. An additional three normal brain tissues were obtained following encephalic decompression excision due to acute craniocerebral injury in the same period, which were used as the control group. Immunohistochemical staining for vascular endothelial growth factor was performed on the glioma tissues from the 43 patients. Genomic DNA was extracted for bisulfate conversion and sequencing. SEMA3B was fully expressed in the three normal brain tissues, and incompletely expressed in the 43 glioma tissues, with a lack of expression in 48.8% (21/43) of samples. Moreover, 58% of high-grade gliomas (grade III and IV) lacked SEMA3B expression, which was significantly more than those that lacked expression (20%) in low-grade gliomas (grade I and II), indicating that, as the clinical pathological grade increased, SEMA3B expression decreased. The occurrence and development of malignant tumors is a product of multiple genes and other factors. Here, we provide theoretical basis for glioma development and prognosis involving DNA-methylation driven silencing of SEMA3B, and thus, SEMA3B is a potential target for directed treatments against glioma.

DLC-1 is an independent prognostic marker and potential therapeutic target in hepatocellular cancer

BACKGROUND

The 5-year survival rate of patients with hepatocellular cancer (HCC) was very low because of invasion and metastasis in the early stage. Biomarkers might help predict early occurrence of invasion and metastasis. Accumulating evidence has shown that deleted in liver cancer-1 (DLC1) may be considered as a metastasis suppressor gene in numerous solid and hematological cancers. However, its prognostic role and mechanisms that regulate and coordinate these activities remain poorly understood.

METHODS

With the method of immunohistochemistry, the expression of DLC-1 as well as Rho A, ROCK2, moesin had been characterized in 80 HCC tissues and adjacent noncancerous tissues. The correlation between their expression and their relationships with clinicopathological characteristics of HCC were also investigated. In addition, the prognostic value of DLC1 expression within the tumor tissues was assessed by Cox regression and Kaplan-Meier analysis.

RESULTS

DLC1 expression was significantly lower in HCC tissues than in adjacent noncancerous tissues, and DLC-1 expression was found to be negatively correlated with tumor differentiation, TNM stage and lymph node metastasis. Furthermore, DLC-1 expression was found to inversely correlate with Rho A, ROCK2 and moesin which were all highly expressed in HCC tissues. Kaplan-Meier analysis showed that significantly longer 5-year survival rate was seen in HCC patients with higher DLC1 expression, compared to those with lower expression of DLC1. Multivariate Cox proportional hazard analyses revealed that DLC1 was an independent factor affecting the overall survival probability.

CONCLUSION

DLC1 could be served as a tumor suppressor gene in the progression especially in the invasion and metastasis of HCC. DLC1 perhaps played its role by regulating the expression of Rho A, ROCK2 and moesin. Evaluation of the expression of DLC-1 might be a good prognostic marker for patients with HCC.

Caffeine inhibits the growth of glioblastomas through activating the caspase-3 signaling pathway in vitro

OBJECTIVE

To study the effects and associated mechanisms of caffeine on cell viability, cycle dynamics, proliferation and apoptosis both in glioblastoma C6 and U87MG cells.

MATERIALS AND METHODS

Cell livability in presence or absence of caffeine was detected by the methyl thiazolyl tetrazolium (MTT) colorimetric assay. Flow cytometric analysis was conducted to investigate the cell cycle dynamics and Cell Counting Kit-8 (CCK-8) was used to further study the proliferation of C6 and U87MG glioblastoma cells after treated with caffeine or DMSO. To study the influence of caffeine on apoptosis of glioblastoma C6 and U87MG cells, the value of apoptosis ratio (AR) was calculated by flow cytometry detection. Western blot analysis was used to detect the expression of apoptosis-related factors, including Caspase-3, Cyt-C, Bax and Bcl-2.

RESULTS

Caffeine at 1 mM reduced the cell viability of the both rat C6 and human U87MG glioblastoma cells to less than 70%. Flow cytometry detection found that caffeine remarkably arrested the C6 and U87MG cells in G0/G1 phase (C6, U87MG: p<0.01, p<0.05). Nevertheless, the percentage of cells in S phase obviously decreased in the caffeine-treated group, when comparing to that of the normal control (C6, U87MG: p<0.01, p<0.01). CCK-8 assay demonstrated that significant decreases in the number of glioblastoma cells were observed in caffeine treatment group, when comparing to that of the normal control (C6, U87MG: p<0.01, p<0.05). Flow cytometric analysis also found that the application of caffeine induced much higher apoptosis of glioblastoma cells, compared with the normal control (C6, U87MG: p<0.01, p<0.05). Furthermore, caffeine markedly reduced the expression of Bcl-2 (C6, U87MG: p<0.01, p<0.01), and promoted the expression of Cyt-C (C6, U87MG: p<0.05, p<0.01) and Caspase-3 (C6, U87MG: p<0.01, p<0.01), comparing to the normal control.

CONCLUSIONS

Caffeine inhibits proliferation and induces apoptosis of C6 and U87MG cells, leading to an imbalance in the ratio of proliferation and apoptosis. The apoptosis might be promoted by the motivation of the caspase-3 signaling pathway, which is induced by the release of Cyt-C as well as the elevated rate of Bax/Bcl-2.

Effects of corn and soybean meal types on rumen fermentation, nitrogen metabolism and productivity in dairy cows

Twelve multiparous Holstein dairy cows in mid-lactation were selected for a replicated 4×4 Latin square design with a 2 ×2 factorial arrangement to investigate the effects of corn and soybean meal (SBM) types on rumen fermentation, N metabolism and lactation performance in dairy cows. Two types of corn (dry ground [DGC] and steam-flaked corn [SFC]) and two types of SBM (solvent-extracted and heat-treated SBM) with different ruminal degradation rates and extents were used to formulate four diets with the same basal ingredients. Each period lasted for 21 days, including 14 d for adaptation and 7 d for sample collection. Cows receiving SFC had a lower dry matter (DM) and total N intake than those fed DGC. However, the milk yield and milk protein yield were not influenced by the corn type, resulting in higher feed and N utilization efficiency in SFC-fed cows than those receiving DGC. Ruminal acetate concentrations was greater and total volatile fatty acids concentrations tended to be greater for cows receiving DGC relative to cows fed SFC, but milk fat content was not influenced by corn type. The SFC-fed cows had lower ruminal ammonia-N, less urea N in their blood and milk, and lower fecal N excretion than those on DGC. Compared with solvent-extracted SBM-fed cows, cows receiving heat-treated SBM had lower microbial protein yield in the rumen, but similar total tract apparent nutrient digestibility, N metabolism measurements, and productivity. Excessive supply of metabolizable protein in all diets may have caused the lack of difference in lactation performance between SBM types. Results of the present study indicated that increasing the energy degradability in the rumen could improve feed efficiency, and reduce environmental pollution.

Comparison of intramuscular compound betamethasone and oral diclofenac sodium in the treatment of acute attacks of gout

INTRODUCTION

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of acute gouty arthritis but have the risk of gastrointestinal bleeding and cardiovascular toxicity. Glucocorticoid was as effective as oral NSAIDs in the initial treatment of gout arthritis of patients intolerant of NSAIDs. However, whether glucocorticoid has the same or preferable effect as oral NSAIDs on patients with acute gouty arthritis irrespective of gastrointestinal and cardiovascular risks factor remains unknown. This study was to compare the efficacy, safety and tolerance of compound betamethasone (diprospan) 7 mg intramuscular injection (i.m.) once for all during the study with diclofenac sodium 75 mg twice a day in the treatment of acute gouty arthritis.

METHODS

Sixty patients with acute gouty arthritis were randomised (1 : 1) to receive compound betamethasone 7 mg i.m. once for all during the study or diclofenac sodium 75 mg twice a day for 7 days in this open-label study. Pain intensity, tenderness, swelling and global assessment of response to therapy were collected as end-points for the treatment.

RESULTS

The mean change in pain intensity from baseline to Day 3 and Day 7 in both treatment groups demonstrated that compound betamethasone had preferable efficacy over diclofenac sodium on Day 3 and comparable efficacy on Day 7. The compound betamethasone group had fewer adverse effects (AEs) than diclofenac sodium group. No statistically significant differences were observed about serum uric acid levels at different pain intensity at baseline.

CONCLUSIONS

A single dose of compound betamethasone may be better than diclofenac sodium for the treatment of acute gouty arthritis.

Analysis of 15 patients with systemic lupus erythematosus manifesting with negative immunofluorescence anti-nuclear antibodies after treatment

The purpose of this study was to investigate the clinical and laboratorial characteristics of patients with systemic lupus erythematosus (SLE) manifesting with negative immunofluorescence anti-nuclear antibodies (IFANA) after treatment for the better understanding of negative conversion of IFANA. Demographic characteristics, clinical and laboratory data of hospitalized SLE patients between March 2006 and May 2011 were retrospectively reviewed. Fifteen cases with negative IFANA were identified in 960 patients. All of the 15 patients were severe, 11 patients manifested with nephritic range proteinuria and hypoalbuminemia, 8 patients were complicated with severe infection and all of the patients had been treated with glucocorticoid and immunosuppressant. Anti-ENA antibodies were positive in 4 of 15 patients. Eight patients died after average 1-year follow-up. Collectively, negative IFANA is mainly attributed to nephritic-range proteinuria; and large-dose glucocorticoid, immunosuppressant and severe infection are also important factors for negative IFANA. Antinuclear antibody can be detected in some SLE patients with negative IFANA by changing the detection method and titer. Negative conversion of IFANA often indicates unfavorable prognosis for severe patients.

Different bladder defects reconstructed with bladder acellular matrix grafts in a rabbit model

OBJECTIVE

To evaluate the potential use of the bladder acellular matrix graft (BAMG), two different bladder defects in the rabbit model were reconstructed.

MATERIALS AND METHODS

Two groups of rabbits underwent partial bladder wall cystectomy (group A, 30-40%; group B, 70-60%) and reconstruction of the defects with an equally sized BAMG. After 4, 12, and 24 weeks, bladder cystographs were performed. Then the rabbits were killed after uneventful postoperative periods, and the grafts were harvested for H&E staining and immunohistochemical staining.

RESULTS

Two rabbits died on the postoperative days 3 and 6 in group A due to urinary peritonitis. At 24 weeks, in group A, the reconstructed bladders reached a mean volume of 94.39±0.54% of the precystectomy bladder capacity. Histologically, complete regeneration of smooth muscle and urothelium tissue was evident. Regenerated SMCs and urothelium stained positive for α-smooth muscle actin and AE1/AE3. In group B, the mean bladder volume was 64.5±3.19% of the precystectomy volume. Histologically, group B was characterized by multilayered urothelium without organized muscle tissue.

CONCLUSION

The BAMG was an effective scaffold for bladder wall regeneration in the rabbit model. However, the use of BAMG reconstruction in larger bladder defects did not induce the same quality and quantity of bladder regeneration as the reconstruction of smaller bladder defects.

Sexual function and health-related quality of life following anterior vaginal wall surgery for stress urinary incontinence and pelvic organ prolapse

To assess female sexual function (FSF) and health-related quality of life (HRQOL) following anterior vaginal wall surgeries for stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The retrospective study consisted of 116 patients. Chinese translations of the modified Lemack Questionnaire (not validated) and Pelvic Floor Distress Inventory-Short Form 20 were used to assess FSF and HRQOL, 3 months pre-operatively and 12-24 months (mean 16.8 months) post-operatively. Sixty-one (52.6%, 29 in SUI group and 32 in POP group) of patients were sexually active before and after the operation. Overall, 12 (19.7%, six in SUI group and six in POP group) reported an improvement in overall intercourse satisfaction, 21 (34.4%, 8 in the SUI and 13 in the POP group) were decreased and 28 (45.9%, 15 in SUI group and 13 in POP group) were unchanged. Incidence of coital incontinence decreased significantly in SUI group. Frequency of intercourse decreased, vaginal dryness and pain due to it and asymptomatic vaginal narrowing increased significantly, following the surgery in POP group. There were no statistically significant differences in the frequency of intercourse in SUI group, patients' perception of intercourse, frequency of orgasm and the importance of sex life in both groups. Partner discomfort remained unchanged. HRQOL improved significantly after the operation in both groups. There was no association between HRQOL and FSF in the post-operative period. In most patients, overall FSF did not impaired. All trans-anterior vaginal wall surgery positively impacted on the patients' HRQOL. A prospective study with validated questionnaire is necessary in future.

High-resolution diffusion-weighted MR imaging of the human lumbosacral plexus and its branches based on a steady-state free precession imaging technique at 3T

3D diffusion-weighted steady-state free precession imaging (3D DW-SSFP) with isotropic resolution was performed to delineate structures of the human lumbosacral plexus (LSP). 3D DW-SSFP clearly revealed detailed anatomy of the LSP and its branches. Our data suggest that the sequence based on 3D DW-SSFP can be used for high-resolution MR imaging of the peripheral nervous system.

A model utilizing adult murine stem cells for creation of personalized islets for transplantation

Clinical islet cell transplantation has demonstrated great promise for diabetes treatment. Two major obstacles are the organ donor shortage and the immunoresponse. The purpose of this study was to create a model using the patient's own adult stem cell sources, possibly in combination with non-self cells, such as pancreatic, hepatic, or embryonic stem cells, to create "personalized" islets. We hypothesize that the reconstructed islets have the normal capability to produce insulin and glucagon with reduced immunoresponses after transplantation. Stem cells are a proliferating population of master cells that have the ability for self-renewal and multilineage differentiation. The recently developed photolithograph-based, biologic, microelectromechanic system (BioMEMS) technique supplies a useful tool for biomedical applications. Our lab has developed a novel method that integrates the adult stem cell and BioMEMS to reconstruct personalized islets. We selected islet-derived progenitor cells (IPC) for repairing and reconstructing STZ-diabetic islets. A6(+)/PYY(+) or A6(+)/ngn3(+) cells were selected to manipulate the neoislets. After 3 to 4 weeks in culture, the reconstructed cells formed islet-like clusters containing insulin or glucagon producing cells. The pilot results showed the ability of these reconstructed islets to correct hyperglycemia when transplanted into a STZ-diabetic isograft mouse model. Although several technical problems remain with the mouse model, namely, the difficulty to collect enough islets from a single mouse because of animal size, the mouse isograft model is suitable for personalized islet development.

[Immunohistochemical detection of PCNA and p53 protein in the premalignant lesions and squamous cell carcinomas of the oral mucosa]

PCNA and p53 protein expression were detected by immunohistochemical technique in 39 oral premalignant and malignant lesion;which included 11 oral mucosal leukoplakia(LK),9 oral lichen planus (LP),7 in situ carcinomas(ISC) and 12 squamous cell carcinomas(SCC);in order to investigate the significance of PCNA and p53 Protein overexpression in predicting malignant transformation.The results showed that the gradual strong expression of PCNA and mutated p53 protein positive signal from premalignant to malignant lesions.The remarkable correlation were found on PCNA expression between LK and ISC; on p53 protein expression between SCC I grade and SCC II grade and on PCNA and p53 protein expression between premalignant and malignant lesions.The results imply that expression of PCNA and mutated p53 protein may be as indicators for potential malignant development in benign lesions of oral mucosa premalignant.

[A comparative study of the opinion on the image of nursing among the doctors, nurses, other hospital personnel and the general public]

The hospital is not the place for functional isolationalism, that is, for each department to do their own activities independently. Rather it is an organization in which each part is joined together and concentrating on the same objectives. The hospital must maintain a one-system-function, so that all the resources of the hospital may be used efficiently. Although we do not yet completely understand how the nursing image as perceived by the medical team and the other members of the interdisciplinary team affects nursing practice. It is important to identify how the client recognizes the nursing image as this will influence the growth of the nursing profession directly and indirectly. So we must reevaluate the nursing image as presented to the client and find the ways to present them with a better image of nursing. The study procedures were as follow: First, the image of nurses was analyzed. The subjects for this study were 270 nurses, 172 doctors, 237 hospital employees, and 240 patients and their families from 5 local branches of the Yonsei Medical Center. The four negative responses shown in this study are as follows: 1) Nurses don't listen to patients. 2) Nurses are self-centered. 3) Nurses and careless. 4) Nurses are mechanical. Second, the concrete causes of the four negative responses were analyzed. Third, the contribution of the nurses for clinical practice, research and education was analyzed. Data were collected by questionnaires all seps of the research. Data were analyzed by use of SPSS/PC+. In conclusion, the image of nurses differed according to which group, the respondents belonged. Generally, the public have a positive image of nurses, but hospital employees have a negative images of nurses. Further the nurses gave themselves a low grade. They showed negative as to the value of their job, professionality and their contribution to clinical practice when it was compared to that of the doctors.

Comparison of CD3 and CD2 activation pathways in T cells from young and elderly adults

The ability of purified T cells to be activated by immobilized anti-CD3 and soluble anti-CD2 monoclonal antibodies (mAbs) was compared using cells from young and old donors. Purified T cells from elderly humans activated with immobilized anti-CD3 mAb incorporated less [3H]thymidine (58,780 vs 92,258 cpm; p < 0.02) into cellular DNA, and secreted less IL-2 into the culture supernatants than did T cells from young donors. In contrast, T cells activated with anti-CD2 mAbs displayed no age-related differences in proliferation or IL-2 production. Anti-CD2 stimulation resulted in equal IL-2 synthesis by cells from young and old donors that was comparable to the amount produced by cells from elderly donors stimulated with immobilized anti-CD3. Northern blot analysis of early cell cycle gene expression by anti-CD2 activated T cells demonstrated no age differences in the expression of p55 IL-2R or c-myc specific mRNA, although T cells from elderly individuals activated with immobilized anti-CD3 showed statistically significant decreases in both mRNAs. T cell receptor beta chain mRNA levels did not differ between cells from young or old donors after activation by either anti-CD3 or anti-CD2. The discordance in proliferative ability, IL-2 secretion, and specific mRNA expression between T cells from elderly donors activated through the CD3-TCR complex or by soluble anti-CD2 mAbs provides additional evidence for a multifactorial causation of age-related T cell proliferative defects, and may indicate that the difference in proliferative ability is, in part, attributable to responsiveness to secreted IL-2.

[Abnormality of T cell subsets in patients with idiopathic thrombocytopenic purpura]

Fifty patients with idiopathic thrombocytopenic purpura (ITP) and 50 normal controls were studied for T cell subsets using OKT monoclonal antibodies. These patients were found to have lower proportions of OKT4+ subset and higher proportions of OKT8+ ratio than the healthy controls. The perturbation was more severe in patients with active disease. A significant increase of OKT 4+8+ double-labelled cells deduced by a subtraction method was also observed in the peripheral blood of patients and an inverse correlation was demonstrated between the proportions of OKT4+8+ subset and the platelet counts. Furthermore, a positive correlation between the proportions of OKT4-8+ subset and the platelet counts was also found in patients with active ITP. These data suggest that abnormalities of T cell subsets in the peripheral blood may play an important role in the pathogenesis of ITP.