Identification of genetic causes in children with unexplained epilepsy based on trio-whole exome sequencing

Genotype and clinical phenotype analyses of 128 children were performed based on whole exome sequencing (WES), providing a reference for the provision of genetic counseling and the precise diagnosis and treatment of epilepsy. A total of 128 children with unexplained epilepsy were included in this study, and all their clinical data were analyzed. The children's treatments, epilepsy control, and neurodevelopmental levels were regularly followed up every 3 months. The genetic diagnostic yield of the 128 children with epilepsy is 50.8%, with an SNV diagnostic yield of 39.8% and a CNV diagnostic yield of 12.5%. Among the 128 children with epilepsy, 57.0% had onset of epilepsy in infancy, 25.8% have more than two clinical seizure forms, 62.5% require two or more anti-epileptic drug treatments, and 72.7% of the children have varying degrees of psychomotor development retardation. There are significant differences between ages of onset, neurodevelopmental levels and the presence of drug resistance in the genetic diagnostic yield (all p < 0.05). The 52 pathogenic/likely pathogenic SNVs involve 31 genes, with genes encoding ion channels having the largest number of mutations (30.8%). There were 16 cases of pathogenic/possibly pathogenic CNVs, among which the main proportions of CNVs were located in chromosome 15 and chromosome 16. Trio-WES is an essential tool for the genetic diagnosis of unexplained epilepsy, with a genetic diagnostic yield of up to 50.8%. Early genetic testing can provide an initiate appropriate therapies and accurate molecular diagnosis.

Genetic association of COVID-19 severe versus non-severe cases by RNA sequencing in patients hospitalised in Hong Kong

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has caused extensive disruption of public health worldwide. There were reports of COVID-19 patients having multiple complications. This study investigated COVID-19 from a genetic perspective.

METHODS

We conducted RNA sequencing (RNA-Seq) analysis of respiratory tract samples from 24 patients with COVID-19. Eight patients receiving mechanical ventilation or extracorporeal membrane oxygenation were regarded as severe cases; the remaining 16 patients were regarded as non-severe cases. After quality control, statistical analyses were performed by logistic regression and the Kolmogorov-Smirnov test to identify genes associated with disease severity.

RESULTS

Six genes were associated with COVID-19 severity in both statistical tests, namely RPL15, BACE1-AS, CEPT1, EIF4G1, TMEM91, and TBCK. Among these genes, RPL15 and EIF4G1 played roles in the regulation of mRNA translation. Gene ontology analysis showed that the differentially expressed genes were mainly involved in nervous system diseases.

CONCLUSION

RNA sequencing analysis showed that severe acute respiratory syndrome coronavirus 2 infection is associated with the overexpression of genes involved in nervous system disorders.

Inflammatory Studies of Dehydroandrographolide: Isolation, Spectroscopy, Biological Activity, and Theoretical Modeling

Dehydroandrographolide (DA) was isolated and experimentally characterized utilizing FT-IR, UV-Vis, and NMR spectroscopy techniques along with detailed theoretical modelled at the DFT/B3LYP-D3BJ/6-311 + + G(d,p) level of theory. Substantially, molecular electronic property investigations in the gaseous phase alongside five different solvents (ethanol, methanol, water, acetonitrile and DMSO) were comprehensively reported and compared with the experimental results. The globally harmonized scale (GHS), which is used to identify and label chemicals, was also utilized to demonstrate that the lead compound predicted an LD50 of 1190 mg/kg. This finding implies that consumers can safely consume the lead molecule. Notable impacts on hepatotoxicity, cytotoxicity, mutagenicity, and carcinogenicity were likewise found to be minimal to nonexistent for the compound. Additionally, in order to account for the biological performance of the studied compound, in-silico molecular docking simulation analysis was examined against different anti-inflammatory target of enzymes (3PGH, 4COX, and 6COX). From the examination, it can be inferred that DA@3PGH, DA@4COX, and DA@6COX, respectively, showed significant negative binding affinities of -7.2 kcal/mol, -8.0 kcal/mol, and - 6.9 kcal/mol. Thus, the high mean binding affinity in contrast to conventional drugs further reinforces these results as an anti-inflammatory agent.

Ten-year territory-wide trends in the utilisation and clinical outcomes of extracorporeal membrane oxygenation in Hong Kong

INTRODUCTION

The utilisation of extracorporeal membrane oxygenation (ECMO) has been rapidly increasing in Hong Kong. This study examined 10-year trends in the utilisation and clinical outcomes of ECMO in Hong Kong.

METHODS

We retrospectively reviewed the records of all adult patients receiving ECMO who were admitted to the intensive care units (ICUs) of public hospitals in Hong Kong between 2010 and 2019. Temporal trends across years were assessed using the Mann-Kendall test. Observed hospital mortality was compared with the Acute Physiology and Chronic Health Evaluation (APACHE) IV-predicted mortality.

RESULTS

The annual number of patients receiving ECMO increased from 18 to 171 over 10 years. In total, 911 patients received ECMO during the study period: 297 (32.6%) received veno-arterial ECMO, 450 (49.4%) received veno-venous ECMO, and 164 (18.0%) received extracorporeal cardiopulmonary resuscitation. The annual number of patients aged ≥65 years increased from 0 to 47 (27.5%) [P for trend=0.001]. The median (interquartile range) Charlson Comorbidity Index increased from 1 (0-1) to 2 (1-3) [P for trend<0.001] while the median (interquartile range) APACHE IV score increased from 90 (57-112) to 105 (77-137) [P for trend=0.003]. The overall standardised mortality ratio comparing hospital mortality with APACHE IV-predicted mortality was 1.11 (95% confidence interval=1.01-1.22). Hospital and ICU length of stay both significantly decreased (P for trend=0.011 and <0.001, respectively).

CONCLUSION

As ECMO utilisation increased in Hong Kong, patients put on ECMO were older, more critically ill, and had more co-morbidities. It is important to combine service expansion with adequate resource allocation and training to maintain quality of care.

Investigation on the molecular, electronic and spectroscopic properties of rosmarinic acid: an intuition from an experimental and computational perspective

Various drugs such as corticosteroids, salbutamol, and β2 agonist are available for the treatment of asthma an inflammatory disease and its symptoms, although the ingredient and the mode of action of these drugs are not clearly elucidated. Hence this research aimed at carrying out improved scientific research with respect to the use of natural product rosmarinic acid which poses minima, side effects. Herein, we first carried out extraction, isolation, and spectroscopic (FT-IR, 1H-NMR and 13C-NMR) investigation, followed by molecular modeling analysis on the naturally occurring rosmarinic acid extracted from Rosmarinus officinalis. A detailed comparison of the experimental and theoretical vibrational analysis has been carried out using five DFT functionals: BHANDH, HSEH1PBE, M06-2X, MPW3PBE and THCTHHYB with the basis set 6-311++G (d, p) to investigate into the structural, reactivity, and stability of the isolated compound. Frontier molecular orbital analysis and appropriate quantum descriptors were calculated. Results showed that the compound was more stable at M06-2X and more reactive at HSEH1PBE with an energy gap of 6.43441 eV and 3.8047 eV, respectively, which was later affirmed by the global quantum reactivity parameters. From natural bond orbital analysis, π* → π* is the major contributor to electron transition with the summation perturbation energy of 889.57 kcal/mol, while π → π* had the perturbation energy totaling of 145.3 kcal/mol. Geometry analysis shows BHANDH to have lower bond length values and lesser deviation from 120° in carbon-carbon angle. The potency of the title molecule as an asthma drug was tested via a molecular docking approach and the binding score of -8.2 kcal/mol was observed against -7.0 of salbutamol standard drug, suggesting romarinic acid as a potential natural organic treatment for asthma.Communicated by Ramaswamy H. Sarma.

A comprehensive analysis of nucleotide excision repair characteristics defines a novel prognostic signature for acute myeloid leukemia

OBJECTIVE

Nucleotide excision repair (NER) has been associated with various types of malignant tumors. However, the precise roles of nucleotide excision repair-related genes (NERGs) in acute myeloid leukemia (AML) remain incompletely understood. Hence, this study aimed to develop a prognostic signature incorporating NERGs in AML, which could potentially predict patient outcomes.

MATERIALS AND METHODS

By querying the Genotype-Tissue Expression (GTEx), The Cancer Genome Atlas (TCGA), and Gene Expression Omnibus (GEO) databases, we acquired RNA-seq data and clinical information pertaining to AML. To identify differentially expressed NERGs (DE-NERGs), we employed the Wilcoxon rank-sum test. Based on the expression patterns of DE-NERGs with prognostic significance, patients were categorized into two subgroups. A prognostic signature was developed through univariate Cox regression and least absolute shrinkage and selection operator (LASSO) analyses to compare the differentially expressed genes (DEGs) between these two groups. Additionally, a nomogram was constructed using multivariate analysis. The biological pathways involved were elucidated through Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, gene set variation analysis (GSVA), and gene set enrichment analysis (GSEA).

RESULTS

We developed a prognostic model based on an 11-gene signature. Furthermore, the risk score derived from this model was demonstrated to independently serve as a prognostic marker for patients diagnosed with AML.

CONCLUSIONS

Our prognostic model, based on NERGs, was developed and validated to provide insights into the onset and progression of AML and establish a foundation for more effective treatment. Our findings not only contribute to clinical decision-making but also underscore the significance of nucleotide excision repair. Furthermore, they may pave the way for the development of targeted therapeutic strategies specifically focused on this process.

Reliability and validity of prognostic indicators for Guillain-Barré syndrome in children

AIM

To explore the clinical characteristics and prognostic predictors of Guillain-Barré syndrome (GBS) in Chinese paediatric patients.

METHOD

The clinical features of children with GBS hospitalized in the Children's Hospital of Chongqing Medical University were summarized retrospectively. The correlation between the Erasmus GBS Outcome Score (EGOS)/modified Erasmus GBS Outcome Score (mEGOS), GBS disability score (GDS)/modified Rankin Scale (MRS), Erasmus GBS Respiratory Insufficiency Score (EGRIS), and mechanical ventilation were evaluated.

RESULTS

One hundred forty-two patients (86 males, 56 females; median 62.50 months [interquartile range 41.00-97.50]) with classic GBS were enrolled in the study. In the present GBS cohort, 134 (94.37%) patients could walk independently (GDS ≤2) and 121 (85.21%) could manage without assistance (MRS ≤2) at 6 months. Eighteen (12.68%) patients with GBS required mechanical ventilation. The performance of mEGOS on admission, mEGOS on day 7, and EGOS-predicted GDS outcome at 4 weeks, 3 months, and 6 months in the paediatric patients with GBS admitted within 2 weeks of disease onset and that of the MRS outcome were evaluated. The EGRIS in individuals who required mechanical ventilation was significantly higher than in patients without mechanical ventilation (median = 6 vs median = 3, p < 0.001).

INTERPRETATION

In Chinese paediatric patients with GBS who were admitted 2 weeks after disease onset, the mEGOS and EGOS are validated indicators for the prediction of clinical outcomes 6 months after onset. EGRIS is helpful in predicting the implementation of mechanical ventilation in the acute phase.

WHAT THIS PAPER ADDS

The Erasmus Guillain-Barré syndrome (GBS) Outcome Score (EGOS) and modified EGOS are reliable prognostic predictors in paediatric patients with GBS. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is an effective predictor of mechanical ventilation in paediatric patients with GBS. An EGRIS of ≥5 indicates a high risk of mechanical ventilation in the acute phase.

AMPK activation attenuates cancer-induced bone pain through reducing mitochondrial dysfunction mediated neuroinflammation

Bone metastasis of cancer cells leads to severe pain by disrupting bone structure and inducing central sensitization. Neuroinflammation in the spinal cord plays a decisive role in the maintenance and development of pain. In the current study, male Sprague-Dawley (SD) rats are used to establish a cancer-induced bone pain (CIBP) model by intratibial injection of MRMT-1 rat breast carcinoma cells. Morphological and behavioral analyses verify the establishment of the CIBP model, which represents bone destruction, spontaneous pain and mechanical hyperalgesia in CIBP rats. Activation of astrocytes marked by upregulated glial fibrillary acidic protein (GFAP) and enhanced production of the proinflammatory cytokine interleukin-1β (IL-1β) are accompanied by increased inflammatory infiltration in the spinal cord of CIBP rats. Furthermore, activation of the NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome is consistent with increased neuroinflammation. Adenosine monophosphate-activated protein kinase (AMPK) activation is involved in attenuating inflammatory pain and neuropathic pain. Intrathecal injection of the AMPK activator AICAR in the lumbar spinal cord reduces dynamin-related protein 1 (Drp1) GTPase activity and suppresses NLRP3 inflammasome activation. This effect consequently alleviates pain behaviors in CIBP rats. Cell research on C6 rat glioma cells indicates that AICAR treatment restores IL-1β-induced impairment of mitochondrial membrane potential and elevation of mitochondrial reactive oxygen species (ROS). In summary, our findings indicate that AMPK activation attenuates cancer-induced bone pain by reducing mitochondrial dysfunction-mediated neuroinflammation in the spinal cord.

[Association between coagulation function and prognosis in patients with acute pancreatitis]

OBJECTIVE

To explore the correlation of coagulation function with the severity and prognosis of acute pancreatitis (AP) and identify the laboratory markers for early prediction and dynamic monitoring of the prognosis of AP.

METHODS

We retrospectively analyzed the clinical data of patients with AP admitted less than 72 h after onset to our hospital from December 1, 2017 to November 30, 2018. The correlation of coagulation function-related markers at admission and their changes during hospitalization with the prognosis of the patients was analyzed.

RESULTS

We screened the data of a total of 1260 patients with AP against the inclusion and exclusion criteria, and eventually 175 patients were enrolled in this analysis, among whom 52 patients had severe AP (SAP) and 12 patients died. Logistic regression analysis identified vWF: Ag, PT, PC, AT Ⅲ and D-dimer markers at admission as independent risk factors for predicting SAP and death. Dynamic monitoring of the changes in coagulation function-related markers in the disease course had greater predictive value of the patients' prognosis, and the indicators including vWF: Ag_max, PT_max, APTT_max, TT_max, FIB_min, D-dimer_max, PLT_min, PC_min, PLG_min, AT Ⅲ_min, and their variations were all independent risk factors for predicting SAP and death. ROC analysis suggested that dynamic monitoring of the changes in the indicators, especially those of △vWF: Ag, △PT, △APTT, △FIB, △TT, △D-dimer, △PLT, △PC, △AT Ⅲ, △PLG, could effectively predict SAP and death in these patients (with AUC range of 0.63-0.84).

CONCLUSION

Patients with AP have vascular endothelial injuries and coagulation disorders. The markers including vWF: Ag, PT, PC, AT Ⅲ and D-dimer at admission are independent risk factors for predicting SAP and death, and dynamic monitoring of the changes in vWF: Ag、PT、APTT、TT、FIB、D-dimer、PLT、PC、AT Ⅲ and PLG can further increase the predictive value.

Evaluation of theTherapeutic Effect of the Hybrid Operation on Patients with Aneurysms Associated with Cerebral Arteriovenous Malformations with different Redekop Classifications

BACKGROUND

Intracranial aneurysms associated with cerebral arteriovenous malformations (AVMs) are a rare condition in the clinic, and treatment is very difficult due to their particular anatomical features. We present our experience in the treatment of intracranial aneurysms with AVMs and evaluate the effectiveness and safety of endovascular treatment combined with microsurgical resection (the hybrid operation).

METHODS

This was a single-center retrospective study in our neurosurgical department from January 2015 to January 2021. We collected clinical data from 48 patients with intracranial aneurysms associated with AVMs and categorized them according to Redekop classifications according to the results of cerebral imaging examination to compare the therapeutic effects of endovascular embolization and the hybrid operation.

RESULTS

Compared to nonaneurysmal AVMs, intracranial aneurysms with AVMs more often presented with intracranial hemorrhage (P<0.05). Massive hematoma and severe neurological impairment were more often found in patients with intracranial aneurysms with AVMs (P<0.05). For flow-related aneurysms, the hybrid surgery had a higher one-stage cure rate than endovascular embolization alone (P<0.05). Both treatment methods had similar effects on intranidal aneurysms (P>0.05). There were no significant differences in prognostic indicators between the two treatments. However, the recurrence rate of AVMs with proximal flow-related aneurysms was lower in patients who underwent the hybrid operation (P<0.05).

CONCLUSION

The hybrid operation was safe and effective for patients with intracranial aneurysms associated with AVMs. For flow-related aneurysms, the one-stage cure rate was higher and the recurrence rate was lower with the hybrid operation than with endovascular embolization alone.

AB0081 BIODISTRIBUTION OF NIPOCALIMAB (ANTI-HUMAN FcRn ANTIBODY) IN huFcRn TRANSGENIC MICE

Background

Nipocalimab (JNJ-80202135, M281) is a fully human IgG1 monoclonal antibody (mAb) designed to bind to the human FcRn receptor with high affinity at both neutral and acidic pH, and is currently in investigational clinical trials. The primary role of FcRn is to extend the half-life of IgG due to its ability to bind, salvage, and recycle IgG in the circulation. Nipocalimab specifically targets the FcRn IgG binding site, thereby interfering with the binding of native IgG, reducing IgG recycling and accelerating IgG clearance (1).

Objectives

To determine the biodistribution of nipocalimab compared to an isotype control IgG in huFcRn transgenic (Tg32) mice. This type of study is well suited to non-invasively determine the blood PK of labeled antibodies, as well as the kinetic biodistribution into various organ systems.

Methods

Four formulations were prepared for dosing: nipocalimab-VT680XL (N027a), nipocalimab-VT680XL plus 2x unlabeled nipocalimab (N027b), isotype control IgG-VT680XL and control vehicle. The biodistribution assessment experiments were performed in Tg32 mice (n=3/group, strain: B6.Cg-Fcgrttm1Dcr Tg(FCGRT)32Dcr/DcrJ). A time series of in vivo fluorescence-mediated tomography (FMT) imaging sessions of body and brain was collected to follow the biodistribution of antibodies (Abs) after single IV administration. In vivo, whole body fluorescence was assessed immediately after administration of each formulation, and at 1, 5, 24, 48, 72, 96 and 144 hrs post administration. Mice were sacrificed after the final in vivo imaging timepoint, followed by resection of tissues and ex vivo imaging. The in vivo tissues were also assessed ex vivo at the terminal time point by epifluorescence. Ex vivo epifluorescence measurements were obtained for gall bladder, muscle, spleen, pancreas, white blood cells, lymph nodes, and intestines, which were flushed prior to imaging to remove fecal material.

Results

Biodistribution of nipocalimab and control IgG1 mAb were similarly observed to exhibit 2-compartment blood pharmacokinetics, dominant liver accumulation with minimal kidney and bladder signal and a prolonged terminal half-life in circulation (70-90 h). Nipocalimab showed only subtle differences compared to IgG1 control antibody, attributed to specific binding to target antigen. Early tissue accumulation/binding was seen between 1 and 5 hrs post-injection, which yielded an apparent, modest increase in blood clearance and a slightly lower AUC as compared to control IgG. The bulk of increased tissue binding could be attributed to liver retention, with trends for lower accumulation/binding in other tissues, such as pancreas, lung, and muscle. Addition of 2-fold excess of unlabeled nipocalimab to the labeled nipocalimab yielded some small trends of changes in biodistribution of the labeled material.

Conclusion

Whole body biodistribution and blood pharmacokinetics of nipocalimab were similar to that observed for the isotype control IgG1 antibody. Nipocalimab exhibited a subtle trend towards higher liver distribution within the first 5 hours after dosing and a more rapid distribution phase compared to the control antibody. This is possibly related to its FcRn targeting and its shorter anticipated half-life compared to isotype control IgG or other human IgG mAbs. Overall results for both nipocalimab and control IgG were typical for IgG mAbs.

References

[1]Ling L. et al. M281, an Anti-FcRn Antibody: Pharmacodynamics, Pharmacokinetics, and Safety Across the Full Range of IgG Reduction in a First-in-Human Study. Clin. Pharm. Ther. 2019;105(4):1031-1039.

Acknowledgements

We would like to acknowledge Brigit Schultes and Sucharita Roy (Momenta Pharmaceuticals Inc.) and Jeff Peterson (Perkin Elmer) for their help with the execution of the study.

Disclosure of Interests

An Vermeulen Shareholder of: J&J participating in employee stock programs and full-time employee of Janssen Pharmaceuticals, a J&J company, Jocelyn H Leu Shareholder of: J&J participating in employee stock programs and full-time employee of Janssen Pharmaceuticals, a J&J company, Sandy Sipsey Shareholder of: J&J participating in employee stock programs and full-time employee of Janssen Pharmaceuticals, a J&J company, Stan Lee Shareholder of: J&J participating in employee stock programs and full-time employee of Janssen Pharmaceuticals, a J&J company, Leona Ling Shareholder of: J&J participating in employee stock programs and full-time employee of Janssen Pharmaceuticals, a J&J company

[The correlation between blood glucose level and muscle mass, strength and function in an elderly population]

Objective: To explore the correlation between blood glucose levels and the three factors of sarcopenia (muscle mass, strength and function) in older Chinese community dwellers. Methods: This is a retrospective study conducted by collecting the data of patients in Jiangsu Huaqiao Road Community Health Service Center from 2018 to 2019. Two hundred and fifty people aged 60 years or elder were selected. Among them, 101 were men and 149 were women. According to the American Diabetes Association diagnostic criteria for diabetes mellitus in 2018, they were divided into normal glucose tolerance (NGT) group, pre-diabetes group and diabetes group. The patients were assessed for sarcopenia as well. Results: Compared with those in the NGT group, muscle mass and upper limb muscle strength did not change in the diabetic group, but lower limb muscle strength and body function [walking speed, balance, short physical performance battery (SPPB)] decreased significantly in the diabetic group. Pearson correlation analyses showed that fasting plasma glucose(FPG) was negatively correlated with walking speed (r=-0.248, P=0.001), three-pose balance (r=-0.166, P=0.013) and SSPB (r=-0.213, P=0.001). Glycosylated hemoglobin A1c(HbA1c) was positively correlated with sitting and standing time (r=0.205, P=0.002), and negatively correlated with three-pose balance (r=-0.186, P=0.006) and SSPB (r=-0.154, P=0.024). Multiple regression analyses showed that FPG was negatively associated with walking speed (β=-0.125, P=0.005) and SPPB (β=-0.034, P=0.012), and that HbA1c was positively associated with sitting and standing time (β= 0.218, P =0.006) and negatively associated with three-pose balance (β=-0.143, P=0.012), and SPPB (β=-0.117, P =0.036). Conclusions: There is no significant correlation between blood glucose levels and muscle mass in the elderly; however, FPG is closely correlated with gait speed, and HbA1c is closely correlated with muscle strength of lower limbs and balance ability in the elderly.

Resveratrol modulates the gut microbiota of cholestasis in pregnant rats

This study aims to investigate the effect of resveratrol on intrahepatic cholestasis of pregnancy (ICP) and its effect on the gut microbiome profiles, thus contributing to the potential therapeutic strategies for ICP. ICP rat models were established by injecting 17α-ethinylestradiol (EE) subcutaneously from the thirteenth day of gestation for four days and then treated with EE (D group, n=5), resveratrol (R group, n=5), or ursodeoxycholic acid (UDCA; U group, n=5) from the seventeenth to the twentieth day of gestation. Fecal samples were analyzed with 16S ribosomal RNA (rRNA) sequencing. In results: the gut microbiota of pregnant rats was characterized with reduced alpha diversity (Chao1 index), and significant variation in the microbiota structure (ANOSIM) was also observed after being treated with EE. The richness of four phyla and ten genera was upregulated, and five phyla and ten genera were downregulated by EE treatment. The dysbiosis of Bilophila, Ruminococcus, and Actinobacteria caused by EE treatment was reversed by resveratrol administration. There was a correlation between total bile acid and alanine aminotransferase in ICP rats. The Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis results suggested that the secondary bile acid biosynthesis was decreased, and the alanine, aspartate, and glutamate metabolism was increased after being treated with EE in pregnant rats. In conclusion, EE treatment could lead to gut microbiome dysbiosis and bile acid metabolism dysregulation in pregnant rats. Resveratrol could partially rescue gut microbiota dysbiosis and improve the biochemical characteristics caused by EE treatment.

Belantamab mafodotin for the treatment of multiple myeloma

Multiple myeloma is the second most common hematologic malignancy worldwide. Despite the growing number of available therapeutic options and advances in the treatment since the 2000s, relapse of multiple myeloma is inevitable. Currently, the main therapeutic agents for multiple myeloma treatment include proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies and others. Patients who relapse or are refractory to the above-mentioned treatments have poor prognosis. B-cell maturation antigen (BCMA) is a cell-surface receptor which is expressed on the membrane of multiple myeloma cells, but absent on naive and memory B cells, making it an ideal target for multiple myeloma treatment. Belantamab mafodotin (GSK-2857916) is a first-in-class BCMA antibody-drug conjugate with an overall response rate of 32% in the phase II clinical trial DREAMM-2, which is a phase II study designed to investigate the efficacy and safety of belantamab mafodotin in relapsed/refractory patients with multiple myeloma. In August 2020, based on the results of this pivotal DREAMM-2 study, the U.S. Food and Drug Administration (FDA) approved belantamab mafodotin as a monotherapy for relapsed/refractory multiple myeloma. Thereafter, the European Medicines Agency (EMA) also approved this indication. Although belantamab mafodotin has demonstrated single-agent activity in relapsed/refractory multiple myeloma, further studies to evaluate its efficacy and its combinational use with other drugs are necessary and ongoing.

Determinants of nutritional status and outcome in adults with RCSE: a retrospective cohort study

Background

This study aimed to investigate the association between nutritional characteristics in patients with refractory convulsive status epilepticus.

Methods

We retrospectively enrolled 73 patients with refractory convulsive status epilepticus over 18 years of age at the West China Hospital between January 2017 and May 2019. All patients met the 2016 International League Against Epilepsy diagnostic criteria for refractory convulsive status epilepticus. A logistic regression model was used to evaluate the association between malnutrition and refractory convulsive status epilepticus.

Results

Of the 73 patients with refractory convulsive status epilepticus, 33 (45.21 %) suffered from malnutrition during hospitalization, and duration of hospitalization in days (OR = 1.251; 95 % CI,–1.067–1.384; P = 0.007), nasal feeding (OR = 22.623; 95 % CI: 1.091-286.899; P = 0.013), and malnutrition on admission (OR = 30.760; 95 % CI: 1.064–89.797; P = 0.046) were significantly associated with malnutrition in patients with refractory convulsive status epilepticus.

Conclusions

Malnutrition is a common complication during hospitalization in patients with refractory convulsive status epilepticus. The duration of hospitalization (days), nasal feeding, and malnutrition at admission are associated with malnutrition in patients with refractory convulsive status epilepticus. Further longitudinal studies are needed to identify the relationship between refractory convulsive status epilepticus and adverse outcomes.

Tranexamic acid in intracerebral hemorrhage: a meta-analysis

OBJECTIVE

Evidence-based medicine was used to evaluate the efficacy and safety of tranexamic acid in patients with intracerebral hemorrhage.

METHODS

Pubmed (MEDLINE), Embase, and Cochrane Library were searched from January 2001 to October 2020 for randomized controlled trials (RCTs), cohort studies, and retrospective case series .The Jadad scale and RevMan software version 5.3 were used for literature quality assessment and meta-analysis.

RESULTS

In total, 4 randomized controlled trials and 1 retrospective case series with 2808 participants were included in the meta-analysis. Compared with control intervention in intracerebral hemorrhage, tranexamic acid could significantly reduce growth of hemorrhagic mass (odds ratio (OR) =0.81; 95% confidence interval(CI)=0.68 to 0.99; p = 0.04) and Modified Rankin Scale score (MRS) at 90 days at 0-3 (OR = 1.20; 95% CI = 1.00 to 1.43; p = 0.05), mortality by day 90 (OR= 1.03; 95% CI= 0.85-1.25; p = 0.77) and major thromboembolic events (OR= 1.14; 95% CI= 0.73-1.77; p = 0.58).

CONCLUSIONS

Treatment with tranexamic acid could reduce hematoma expansion in intracerebral hemorrhage, and the treatment was safe with no increase in thromboembolic complications. But showed no notable impact on good functional outcomes and mortality.

[Spatiotemporal distribution and related factors of congenital syphilis in Guangdong province from 2005 to 2017: a spatial panel data analysis]

Objective: To explore the spatiotemporal distribution and macro-related factors of congenital syphilis in Guangdong province and provide suggestions and recommendations for prevention. Methods: Yearly reported cases of syphilis and some influencing factor data of Guangdong province were collected from 2005 to 2017. The spatiotemporal distribution of congenital syphilis was described. Meanwhile, the spatial panel data model was constructed to analyze the relationship between the incidence rates of congenital syphilis and related factors. Results: From 2005 to 2017, 13 361 cases of congenital syphilis were reported in Guangdong province. The number of congenital syphilis cases rose to its highest point during 2005-2011. A slow downward trend followed. The peaks of incidence were observed from August to December. The incidence of the non-Pearl River Delta region has experienced a process of rising first and then decreasing. The spatial panel data model results showed that congenital syphilis had significant positive spatial autocorrelation (P<0.001). The incidence of primary and secondary syphilis in women (β=0.822,P<0.001), gross domestic product per capita (β=3.511,P<0.001), net migrate rate (β=0.215,P=0.047) and maternal system management rate(β=0.017,P=0.021) were all positively correlated with the incidence rates of congenital syphilis. Registered population density (β=-1.167,P<0.001) and prenatal examination rate (β=-0.038,P=0.031) was negatively correlated with congenital syphilis. Conclusions: The incidence of congenital syphilis was spatially aggregated in Guangdong province from 2005 to 2017. The intensity of prevention might be strengthened in cities with developed economies and high net migration rates, which have high risks of congenital syphilis. Controlling the incidence of primary and secondary syphilis in women and increasing the prenatal examination rate for pregnant women appears effective prevention measures of congenital syphilis.

lncRNA MIR155HG Alleviates Depression-Like Behaviors in Mice by Regulating the miR-155/BDNF Axis

Depression is one of most common psychiatric disorders, and the detailed molecular mechanism remains to be fully elucidated. Brain-derived neurotrophic factor (BDNF) is a critical neurotrophic factor that is decreased and closely involved in the development of depression. Noncoding RNAs are central regulators of cellular activities that modulate target genes. However, the roles of long noncoding RNA (lncRNA) MIR155HG and miRNA-155 (miR-155) in the pathophysiology of depression are unclear. In the present study, we aimed to explore the effects of lncRNA MIR155HG and miR-155 on the development of depression and uncover the underlying molecular mechanism. Real-time quantitative polymerase chain reaction was used to examine the expression of MIR155HG and miR-155. Western blotting was applied to measure the expression of BDNF. A luciferase reporter assay was utilized to determine the regulatory relationship between MIR155HG and miR-155. Our current work found that lncRNA MIR155HG and BDNF levels decreased while miR-155 levels increased in the hippocampal region of CUMS (chronic unpredictable mild stress) mice, a well-accepted mouse model of depression. Moreover, MIR155HG rescued while miR-155 exacerbated the depression-like behaviors of CUMS mice. Through bioinformatics analysis and luciferase reporter assays, we found that MIR155HG directly bound to and negatively modulated the expression of miR-155. Moreover, increased miR-155 was found to repress the expression of BDNF, a critical neurotrophic factor that has been reported to alleviate the depression-like behaviors of CUMS mice. Our present study revealed that lncRNA MIR155HG protected CUMS mice by regulating the miR-155/BDNF axis. Our study aimed to understand the pathophysiology of depression and provided potential therapeutic targets to diagnose and treat depression.

Long noncoding RNA MIRG induces osteoclastogenesis and bone resorption in osteoporosis through negative regulation of miR-1897

OBJECTIVE

To investigate the expression of long noncoding RNA (LncRNA) MIRG and its potential functions in regulating osteoclastogenesis and bone resorption function through modulating miR-1897 in bone marrow macrophages (BMMs).

MATERIALS AND METHODS

qRT-PCR was performed to detect the expressions of MIRG and its co-expression mRNA NFATc1 at different stages during osteoclastogenesis. The CCK-8 assay was performed to evaluate cell proliferation and differentiation. The correlation between miR-1897 and MIRG was detected by statistical analysis. Bioinformatics and luciferase assay were performed to explore the interaction and binding site of MIRG and miR-1897. We also cloned the mice NFATc1 3'-UTR into the luciferase reporter vector and constructed miR-1897 binding mutants to validate the inhibited regulation of miR-1897 to the expression of NFATc1.

RESULTS

Results showed that expressions of MIRG and NFATc1 were upregulated during osteoclastogenesis. qRT-PCR and CCK-8 assay showed that MIRG expression is associated with osteoclastogenesis and bone resorption. The bioinformatics prediction and luciferase assay suggested that by interacting with miR-1897, MIRG acts as a molecular sponge for the miR-1897 target NFATc1, to partly modulate the inhibitory effect of miR-1897 on NFATc1.

CONCLUSIONS

We found that lncRNA-MIRG was upregulated in osteoclasts, which could promote osteoclastogenesis and bone resorption function as a molecular sponge by modulating the inhibitory effect of miR-1897 on NFATc1.

Impact of catheter ablation on HFpEF in people with comorbid atrial fibrillation and HFpEF using invasive haemodynamic testing

Background

The impact of catheter ablation (CA) for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) is unknown.

Objectives

To determine whether CA for AF reverses adverse haemodynamic changes associated with HFpEF.

Methods

Consecutive consenting patients with EF ≥50% scheduled for index CA underwent baseline exercise right heart catheterisation (exRHC), cardiac output (CO) measurement, cardiac MRI, echocardiogram, QOL questionnaires and BNP testing. HFpEF was defined by resting pulmonary capillary wedge pressure (PCWP) ≥15mmHg or peak exercise PCWP ≥25 mmHg during exRHC. Patients with HFpEF were offered follow-up exRHC ≥6 months post-CA.

Results

Of 252 patients scheduled for CA between April 2017 and Sept 2019, 131 (51.9%) qualified for inclusion, 65 (49.6%) consented to exRHC and 11 (16.9%) were excluded due to a subsequent decrease in EF (10) and uncontrolled hypertension (1). Fifty-four underwent exRHC, with 35 (65%) meeting criteria for HFpEF. Of them 26 (74.3%) who underwent CA, 20 (77%) had a follow up exRHC at 12±6 months follow-up, showing an overall decrease in peak exercise PCWP from 30.3±4.2 to 26.8±4.7 mmHg (p&lt;0.05). Patients without arrhythmia recurrence showed significant improvements in peak exercise PCWP (29.2±3.7 to 22.9±2.0 mmHg (p&lt;0.01). Their cardiac output increased from 10.3±3.0 to 12.1±4.0 mmHg p=0.1), and BNP decreased from (94.6±101.6 to 38.0±34.0 mmHg (p=0.06),whereas those with arrhythmia recurrence did not. Overall, 9 patients (45.0%) no longer met criteria for HFpEF.

Conclusion

There is a high prevalence of HFpEF in people referred for AF ablation. Successful CA for AF reverses the adverse haemodynamic changes associated with HFpEF

Changes in PCWP following AF ablation

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): NHMRC, NHF, RACP

Sleep difficulties and alcohol use behaviors in adolescents and young adults: a systematic review

Background

Sleep disturbances and substance abuse are prevalent in adolescents, often associated with adverse behavioral outcomes and daytime dysfunction. While sleep problems are often seen as consequences to alcohol use, they are risk factors for alcohol misuse and related consequences. However, current evidence in adolescents and young adults (AYA) is mostly observational and is not well-documented in recent years. This systematic review aims to assess the literature surrounding sleep difficulties and their effects on subsequent alcohol misuse in AYA.

Methods

Medline, PsycINFO, and EMBASE were searched for observational studies assessing alcohol consumption, alcohol-related consequences, and self-reported sleep difficulties in AYA aged 16-25. Studies with clinical samples and randomized trials were excluded. Data on measurement tools, measures of association, and sample characteristics were recorded using a standardized form. Associations between sleep difficulties and alcohol misuse were qualitatively summarized by study type (cross-sectional and longitudinal studies). Risk of bias was assessed using CLARITY tools.

Results

Of 7706 records retrieved from databases, 24 studies met the inclusion criteria. Cross-sectional studies (n = 17) found insomnia-like symptoms (difficulties falling/staying asleep, frequent night-time awakenings) were significantly associated with alcohol use frequency and intensity (n = 16) and subsequent intoxication (n = 6). Among longitudinal studies (n = 7), persistent erratic sleep behaviors at baseline were associated with frequent binge-drinking (n = 2) and increased odds of interpersonal problems (n = 2) and risky behaviors at follow-up (n = 1).

Conclusions

The present review assesses the role of sleep difficulties in alcohol use behaviors and related consequences in AYA. Sleep inadequacies are involved in alcohol misuse, prompting investigations to clarify sleep's etiological role in alcohol use behaviors to prevent negative consequences in AYA.

Key messages

Sleep disturbances need to be investigated further as possible risk factors for incident alcohol misuse in young adults. Addressing sleep hygiene and promoting healthy sleep behaviors are important in evaluating the overarching public health issue of alcohol addiction and misuse in adolescents.

Night shift work, sleep quality and risk of endocrine-related cancer: a systematic review

Background

Cancer is a major public health concern as it is a leading cause of death worldwide. The risk of endocrine-related cancers may be associated with suboptimal sleep quality due to disruptions in circadian rhythm. However, the extent of this relationship is not clear and warrants a review summarizing recent research findings. This systematic review aims to provide an updated summary of the literature surrounding the association between night shift work, sleep quality, circadian rhythm disruption and the risk of endocrine-related cancers.

Methods

MEDLINE, EMBASE, CINAHL, and Web of Science databases have been searched for related cohort, case-control, and cross-sectional studies. The search was limited to studies published in English, after the year 2000. Non peer-reviewed literature and randomized control trials, were excluded. Reviewers will independently extract data on study characteristics, sleep quality measures, circadian rhythm measures, cancer diagnosis, and outcome measures. Risk of bias assessment will be performed using the CLARITY tools.

Results

Data synthesis is ongoing. Associations between sleep quality, night shift work, circadian disruption and risk of endocrine-related cancer will be summarized and risk estimates will be reported for four endocrine-related cancers: breast, prostate, thyroid, ovarian, and endometrial cancer. If data are available, subgroup analyses will be carried out by cancer type, study design, and age group.

Conclusions

This review qualitatively synthesizes current literature to determine the extent of the association between sleep quality, night shift work, circadian rhythm disruption and the risk of endocrine-related cancers. These findings can contribute to population-level cancer prevention efforts and aid public health promotion of healthier sleep-related behaviours.

Key messages

The relationship between sleep quality and endocrine-related cancers should be explored further in public health research due to inconclusive evidence from current literature. The findings of this project can help promote healthy sleep behaviours and population-level cancer prevention.

Predisposing factors and prognosis of status epilepticus in patients with autoimmune encephalitis

The aim of this study was to study the predisposing factors and prognosis of status epilepticus (SE) in patients with autoimmune encephalitis (AE).A total of 227 cases of AE were collected from the inpatient department of West China Hospital of Sichuan University from January 2010 to May 2018. All patients met the 2015 criteria for the diagnosis of AE. The binary logistic regression model was used to multivariate and retrospective chart analysis the predisposition factors for SE and its prognostic factors.Of the 227 patients with AE, 50 (22.03%) had SE during hospitalization, and 19 patients with SE had a poor prognosis (modified Rankin score MRS = 3-6), and 7 patients with no SE had a poor prognosis. In the logistic regression model, electroencephalograms (EEGs) abnormalities (P = .000) and head magnetic resonance imaging (MRI) abnormalities (P = .003) were associated with a predisposition to SE, while Glasgow scores <8 (P = .027), abnormal EEG (P = .046), delayed immunotherapy (P = .012), and SE duration at admission lasting >30 minutes (P = .023) were risk factors for a poor prognosis of SE.SE is a common complication in patients with AE. EEG and MRI abnormalities may be predisposing factors for SE. Glasgow scores <8 points, abnormal EEG, delayed immunotherapy, and SE duration lasting >30 minutes at admission are risk factors for a poor prognosis in patients with SE.

Sustained IFN-I stimulation impairs MAIT cell responses to bacteria by inducing IL-10 during chronic HIV-1 infection

Mucosal-associated invariant T (MAIT) cells in HIV-1-infected individuals are functionally impaired by poorly understood mechanisms. Single-cell transcriptional and surface protein analyses revealed that peripheral MAIT cells from HIV-1-infected subjects were highly activated with the up-regulation of interferon (IFN)-stimulated genes as compared to healthy individuals. Sustained IFN-α treatment suppressed MAIT cell responses to Escherichia coli by triggering high-level interleukin-10 (IL-10) production by monocytes, which subsequently inhibited the secretion of IL-12, a crucial costimulatory cytokine for MAIT cell activation. Blocking IFN-α or IL-10 receptors prevented MAIT cell dysfunction induced by HIV-1 exposure in vitro. Moreover, blocking the IL-10 receptor significantly improved anti-Mycobacterium tuberculosis responses of MAIT cells from HIV-1-infected patients. Our findings demonstrate the central role of the IFN-I/IL-10 axis in MAIT cell dysfunction during HIV-1 infection, which has implications for the development of anti-IFN-I/IL-10 strategies against bacterial coinfections in HIV-1-infected patients.

Developments, applications, and prospects of cryo-electron microscopy

Cryo‐electron microscopy (cryo‐EM) is a structural biological method that is used to determine the 3D structures of biomacromolecules. After years of development, cryo‐EM has made great achievements, which has led to a revolution in structural biology. In this article, the principle, characteristics, history, current situation, workflow, and common problems of cryo‐EM are systematically reviewed. In addition, the new development direction of cryo‐EM—cryo‐electron tomography (cryo‐ET), is discussed in detail. Also, cryo‐EM is prospected from the following aspects: the structural analysis of small proteins, the improvement of resolution and efficiency, and the relationship between cryo‐EM and drug development. This review is dedicated to giving readers a comprehensive understanding of the development and application of cryo‐EM, and to bringing them new insights.

Risk factors for drug-resistant epilepsy: A systematic review and meta-analysis

BACKGROUND

Drug resistant epilepsy (DRE) is very common among children and adults and studies had found some related risk factors for DRE, while the results were not consistent. The aim of this study was to identify risk factors for drug-resistant epilepsy.

METHODS

Three electronic databases (Medline, Embase and Cochrane library) were searched to identify studies with a cohort design reporting on epidemiologic evidence regarding risk factors for DRE.

RESULTS

The pooled prevalence of DRE in newly diagnosed epilepsy patients was 25% (95% CI 17-32%). Abnormal electroencephalography (EEG) (both slow wave and epileptiform discharges) (RR 2.80; 95% CI 1.95-4.0), status epilepticus (SE) (RR 11.60; 95% CI 7.39-18.22), symptomatic etiology (RR 3.36; 95% CI 2.53-4.46), multiple seizure types (RR 3.66; 95% CI 2.37-5.64) and febrile seizures (RR 3.43; 95% CI 1.95-6.02) were identified as strong risk factors for DRE. In addition, firm conclusions cannot be drawn for poor short-term outcomes of therapy, neurodevelopment delay and high initial seizure frequency for the heterogeneity of study results. The predictive effect of focus onset seizure was not stable after removing one study and switching the effect model. Age of onset was not risk factors for DRE.

CONCLUSIONS

The current meta-analysis identified potential risk factors for DRE. The results may contribute to better prevention strategies and treatments for DRE.

Silencing of ATPase family AAA domain-containing protein 2 inhibits migration and invasion of colorectal cancer cells

Colorectal cancer is one of the most common malignant tumors with a high rate of distant metastasis, postoperative recurrence and mortality. ATPase family AAA domain-containing protein 2 (ATAD2), a member of ATPase family, is highly expressed in various cancers, including colorectal cancer. However, whether ATAD2 plays a role in the migration and invasion of colorectal cancer cells remains unknown. In this study, we established ATAD2 knockdown in colorectal cancer cell lines by RNA interference and found that silencing of ATAD2 inhibited the migration and invasion ability of Caco-2 and SW-480 cells. Moreover, ATAD2 silencing suppressed epithelial-mesenchymal transition (EMT), and reduced the expression and enzymatic activity of matrix metalloproteinases (MMPs) in Caco-2 and SW-480 cells. In summary, our results suggest that silencing of ATAD2 inhibits migration and invasion of colorectal cancer cells by suppressing EMT and decreasing the activity of MMPs. Hence, ATAD2 could be considered as a novel molecular marker of metastatic colorectal cancer, and it may provide new insights for clinical diagnosis and treatment of colorectal cancer.

Preparation and Characterization of CuO/ZnO/PVDF/PAN Nanofiber Composites by Bubble-electrospinning

BACKGROUND

Nanocomposites loaded with metal oxides, such as CuO and ZnO, have excellent optical, electrical, mechanical and chemical properties, which result in their great potential applications in optoelectronic devices, sensors, photocatalysts and other fields. Especially, electrospun metal- oxide-loaded nanofibers have attracted much attention in many fields. However, the single-needle Electrospinning (ES) inhibits the industrial application of these electrospun nanofiber composites. Bubble-Electrospinning (BE) is an effective free surface ES for mass production of nanofiber membranes loaded with metal oxide. Few relevant patents to the topic have been reviewed and introduced.

METHODS

The BE was used to prepare mass production of Cu(Ac)2 /Zn(Ac)2/ PVDF/ PAN Composite Nanofiber Membranes (CNFMs). Then PVDF/PAN CNFMs containing CuO and ZnO nanocrystals were obtained by heat-treatment. Finally, CuO nanosheets and ZnO nanorods were successfully grown on the surface of PVDF/PAN CNFMs using hydrothermal method. In addition, the morphology and crystal structure of CNFMs were investigated by scanning electron microscopy (SEM) and X-Ray Powder Diffractometer (XRD).

RESULTS

The morphology and crystal structure of the samples were characterized by SEM and XRD. The results showed the heat treatment temperature of 150oC and the hydrothermal temperature of 150oC were the optimal process parameters for the fabrication of PVDF/PAN CNFMs loaded with CuO and ZnO nanocrystals, and a higher heat treatment temperature results in higher crystallinity of ZnO and CuO.

CONCLUSION

CuO/ZnO/PVDF/PAN CNFMs were successfully prepared by a combination of BE, heattreatment and hydrothermal method. The ZnO/CuO beads obtained by heat treatment is the key point of growing ZnO/CuO nanocrystals, and the growth temperature has great effect on the morphology of ZnO/CuO nanocrystals.