Functional meniscus reconstruction with biological and biomechanical heterogeneities through topological self-induction of stem cells

Meniscus injury is one of the most common sports injuries within the knee joint, which is also a crucial pathogenic factor for osteoarthritis (OA). The current meniscus substitution products are far from able to restore meniscal biofunctions due to the inability to reconstruct the gradient heterogeneity of natural meniscus from biological and biomechanical perspectives. Here, inspired by the topology self-induced effect and native meniscus microstructure, we present an innovative tissue-engineered meniscus (TEM) with a unique gradient-sized diamond-pored microstructure (GSDP-TEM) through dual-stage temperature control 3D-printing system based on the mechanical/biocompatibility compatible high Mw poly(ε-caprolactone) (PCL). Biologically, the unique gradient microtopology allows the seeded mesenchymal stem cells with spatially heterogeneous differentiation, triggering gradient transition of the extracellular matrix (ECM) from the inside out. Biomechanically, GSDP-TEM presents excellent circumferential tensile modulus and load transmission ability similar to the natural meniscus. After implantation in rabbit knee, GSDP-TEM induces the regeneration of biomimetic heterogeneous neomeniscus and efficiently alleviates joint degeneration. This study provides an innovative strategy for functional meniscus reconstruction. Topological self-induced cell differentiation and biomechanical property also provides a simple and effective solution for other complex heterogeneous structure reconstructions in the human body and possesses high clinical translational potential.

[Sequence analysis of Paragonimus internal transcribed spacer 2 and cyclooxygenase 1 genes in freshwater crabs in Henan Province]

OBJECTIVE

To investigate the sequences of internal transcribed spacer 2 (ITS2) and cyclooxygenase 1 (COX1) genes of Paragonimus metacercariae in freshwater crabs in Henan Province, identify the species of Paragonimus and evaluate its genetic relationships with Paragonimus isolates from other provinces in China.

METHODS

Freshwater crabs were collected from 8 survey sites in Zhengzhou, Luoyang, Pingdingshan, Nanyang and Jiyuan cities of Henan Province from 2016 to 2021, and Paragonimus metacercariae were detected in freshwater crabs. Genomic DNA was extracted from Paragonimus metacercariae, and the ITS2 and COX1 genes were amplified using PCR assay, followed by sequencing of PCR amplification products. The gene sequences were spliced and aligned using the software DNASTAR, and aligned with the sequences of Paragonimus genes in the GenBank. Phylogenetic trees were created using the MEGA6 software with the Neighbor-Joining method based on ITS2 and COX1 gene sequences, with Fasciola hepatica as the outgroup.

RESULTS

The detection rates of Paragonimus metacercariae were 6.83% (11/161), 50.82% (31/61), 18.52% (5/26), 8.76% (12/137), 14.29% (9/63), 17.76% (19/105), 18.50% (32/173) and 42.71% (41/96) in freshwater crabs from 8 survey sites in Zhengzhou, Luoyang, Pingdingshan, Nanyang and Jiyuan cities of Henan Province, with a mean detection rate of 19.46% (160/822), and a mean infection intensity of 0.57 metacercariae/g. The amplified ITS2 and COX1 gene fragments of Paragonimus were approximately 500 bp and 450 bp in lengths, respectively. The ITS2 gene sequences of Paragonimus metacercariae from 8 survey sites of Henan Province showed the highest homology (99.8% to 100.0%) with the gene sequence of P. skrjabini (GenBank accession number: MW960209.1), and phylogenetic analysis showed that the Paragonimus in this study was clustered into the same clade with P. skrjabini from Sichuan Province (GenBank accession number: AY618747.1), Guangxi Zhuang Autonomous Region (GenBank accession number: AY618729.1) and Hubei Province (GenBank accession number: AY618751.1), and P. miyazaki from Fujian Province (GenBank accession number: AY618741.1) and Japan (GenBank accession number: AB713405.1). The COX1 gene sequences of Paragonimus metacercariae from 8 survey sites of Henan Province showed the highest homology (90.0% to 100.0%) with the gene sequence of P. skrjabini (GenBank accession number: AY618798.1), and phylogenetic analysis showed that the Paragonimus in this study was clustered into the same clade with all P. skrjabini and clustered into the same sub-clade with P. skrjabini from Hubei Province (GenBank accession numbers: AY618782.1 and AY618764.1).

CONCLUSIONS

Paragonimus species from freshwater crabs in Henan Province were all characterized as P. skrjabini, and the ITS2 and COX1 gene sequences had the highest homology to those of P. skrjabini from Hubei Province. The results provide insights into study of Paragonimus in Henan Province and China.

[Mechanism of hepatic fibrosis associated with Echinococcus: a review]

Echinococcosis is a zoonotic parasitic disease caused by Echinococcus infections, and this disorder may cause fibrosis of multiple vital organs, which may further progress into cirrhosis. Early-stage hepatic fibrosis is reversible, and unraveling the mechanisms underlying hepatic fibrosis induced by Echinococcus infections is of great significance for the prevention and treatment of early-stage hepatic fibrosis. Recently, the studies pertaining to hepatic fibrosis associated with Echinococcus infections focus on cytokines and immune cells. This review summarizes the advances in the mechanisms underlying host immune cells- and cytokines-mediated hepatic fibrosis in humans or mice following Echinococcus infections.

Advances in the study of molecular identification technology of Echinococcus species

The larvae of Echinococcus (hydatidcyst) can parasitize humans and animals, causing a serious zoonotic disease-echinococcosis. The life history of Echinococcus is complicated, and as the disease progresses slowly after infection, early diagnosis is difficult to establish. Due to the limitations of imaging and immunological diagnosis in this respect, domestic and foreign scholars have established a variety of molecular detection techniques for the pathogen Echinococcus over recent years, mainly including nested polymerase chain reaction (PCR), multiplex PCR, real-time quantitative PCR, and nucleic acid isothermal amplification technology. In this article, the research progress of molecular detection technology for Echinococcus infection currently was reviewed and the significance of these methods in the detection and diagnosis of hydatid and hydatid diseases was also discussed.

AB0227 TREATMENT SEQUENCING PATTERNS AND COMPARATIVE EFFICACY IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM A REAL-WORLD SETTING

Background

The European League Against Rheumatism (EULAR)1 recently provided updated guidelines regarding the initiation and modification of disease-modifying antirheumatic drug (DMARD) therapy in patients with Rheumatoid Arthritis (RA). Therefore, real-world evidence studies are warranted to provide insights into first-line DMARD utilization and durability of response in the second-line setting.

Objectives

To analyze RA treatment patterns in real-world data and compare durability of response between second-line DMARDs + anti-TNF (TNFi) therapies vs. TNFi monotherapy.

Methods

Electronic health records (EHRs) from a large health system in the Northeast US were used to identify RA patients. Lines of therapy were defined based on confirmed prescriptions for DMARDs and TNFi therapies. Time to next treatment (TTNT) was the primary outcome to estimate durability of response. Time-to-event analyses were performed using Kaplan-Meier and log-rank test methods. In addition, a Cox Proportional-Hazards (CoxPH) model was used to evaluate covariates as independent predictors of disease progression.

Results

Our study cohort consisted of 8,040 patients who had at least one line of therapy for RA. Conventional synthetic DMARDs (csDMARDs) were the predominant first line of therapy in this dataset (71.3%), followed by TNFi alone (11.1%) or TNFi combined with csDMARD (9.1%) (Figure 1).

For patients who had csDMARD as their first line of therapy, 22.93% progressed to second line treatment. Among them 36.2% patients were TNFi with or without in combination with csDMARDs. In the second-line, TNFi + csDMARDs were associated with a longer TTNT (median time: 13.1 months vs 6.1 months, P < 0.005) compared to TNFi monotherapy. The multiple variable CoxPH model (adjusted for age, gender, and race) demonstrated that second-line TNFi + csDMARDs had a lower hazard rate when compared to TNFi monotherapy (HR = 0.74, 95% CI: 0.36 - 1.12, p < 0.005).

Conclusion

We demonstrated the first comprehensive treatment sequencing patterns in RA from a real-world setting. As a second-line therapy for patients with inadequate response to csDMARDS, the TNFi + csDMARDs combination may improve duration of response when compared to TNFi monotherapy. Results from this study will inform future sequencing strategies to improve patient outcomes.

References

[1]Smolen, Josef S., Robert B. M. Landewé, Johannes W. J. Bijlsma, Gerd R. Burmester, Maxime Dougados, Andreas Kerschbaumer, Iain B. McInnes, et al. 2020. “EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update.” Annals of the Rheumatic Diseases 79 (6): 685–99.

Disclosure of Interests

Lei Ai: None declared, Mitchell Higashi: None declared, Kyeryoung Lee: None declared, Zongzhi Liu: None declared, Lan Jin: None declared, Kalpana Raja: None declared, Yun Mai: None declared, Tomi Jun: None declared, William Oh Consultant of: Janssen

Pfizer, Aviva Beckmann: None declared, Emilio Schadt: None declared, Zachary Schadt: None declared, Rick Wallsten: None declared, Ediz Calay: None declared, Andrew Kasarskis: None declared, Qi Pan: None declared, Eric Schadt Speakers bureau: Eli Lilly, Consultant of: SAB of Eli Lilly

Celgene, Xiaoyan Wang: None declared

Impedance matching system using triple liquid stub tuners for high-power ion cyclotron resonance heating in EAST tokamak

Ion cyclotron resonance heating (ICRH), one of the main auxiliary methods, for high-power and long-pulse plasma heating had been developed in Experimental Advanced Superconducting Tokamak (EAST). An impedance matching system, one important part of ICRH, had been developed for high-power injection and transmitter protection by reducing the reflected power from the antenna. The input impedance in the outlet of the stub tuner can be measured by voltage-current probes installed on the coaxial transmission line between the antenna and triple liquid stub tuners, and the optimum liquid levels in the stub tuners can be calculated based on the input impedance. The calculation and adjustment process of the optimum liquid levels are described comprehensively in this article. Finally, impedance matching had been achieved between two shots during EAST experiments. In the near future, a real-time impedance matching system will be developed to prevent large variations of the ICRH antenna impedance and achieve steady-state and long-pulse operation with the ICRH system.

[Establishment of a fluorescent recombinase-aided isothermal amplification assay for nucleic acid detection of Paraginiumus skrjabini and preliminary evaluation of its detection efficiency]

OBJECTIVE

To establish a nucleic acid assay for detection of Paragonimus skrjabini based on the recombinase-aided isothermal amplification (RAA) technique, and to preliminarily evaluate its detection efficiency.

METHODS

The metacercariae of P. skrjabini, P. westermani and Euparagonimus cenocopiosus were isolated from crabs, and genomic DNA was extracted for molecular characterization. The cytochrome coxidase 1 (cox1) gene sequence of P. skrjabini was selected as the target gene fragment, and the primers and probes were designed, screened and synthesized for RAA assay. The genomic DNA of P. skrjabini metacercariae from Jiyuan City and Yiyang County of Luoyang City, Henan Province were used as templates for verification of the fluorescent RAA assay. The fluorescent RAA assay was performed to detect different concentrations of plasmids containing target gene fragment and P. skrjabini metacercariae genomic DNA to determine the sensitivity. Fluorescent RAA assay was performed with recombinant plasmids containing P. skrjabini cox1 gene sequences at different concentrations and P. skrjabini genomic DNA as templates to evaluate its sensitivity, and the genomic DNA of P. westermani, E. cenocopiosus, Clonorchis sinensis and Schistosoma japonicum was detected with fluorescent RAA assay to evaluate its specificity.

RESULTS

P. skrjabini, P. westermani and E. cenocopiosus metacercariae were isolated from crabs, respectively. Molecular characterization and phylogenetic analysis confirmed their homology with the genes sequences of standard Paragonimus strains in GenBank. A fluorescent RAA assay was successfully established for nucleic acid detection of P. skrjabini, and the genomic DNA of P. skrjabini metacercariae from Jiyuan City and Yiyang County of Luoyang City, Henan Province was amplified using the fluorescent RAA assay within 5 min, while the negative control was not amplified. If the recombinant plasmid containing P. skrjabini cox1 gene sequences was used as templates, the fluorescent RAA assay showed the lowest detection limit of 10 copies/μL, and positive amplification was observed within 5 min. If genomic DNA was used as templates, the fluorescent RAA assay showed the lowest detection limit of 10 pg/μL, and all positive amplifications were found within 5 to 10 min. In addition, the fluorescent RAA assay was tested negative for P. westermani, E. cenocopiosus, C. sinensis and S. japonicum.

CONCLUSIONS

A rapid, sensitive and specific fluorescent RAA assay is successfully established for nucleic acid detection of P. skrjabini, which has potential values in rapid field detection and species identification in freshwater crabs in areas endemic for P. skrjabini.

[Construction of a cDNA library for Sparganum mansoni and screening of diagnostic antigen cadidates]

OBJECTIVE

To construct a cDNA library of Sparganum mansoni and immunoscreen antigen candidates for immunodiagnosis of sparganosis mansoni.

METHODS

Total RNA was extracted from S. mansoni, and reversely transcribed into cDNA, which was ligated into the phage vector. These recombinant vectors were packaged in vitro to construct the SMART cDNA library of S. mansoni. Then, the cDNA library was immunoscreened with sera from patients with sparganosis mansoni to yield positive clones. The inserted fragments of positive clones were sequenced and subjected to homology analyses, and the structure and functions of the coding proteins were predicted.

RESULTS

The SMATR cDNA library of S. mansoni was successfully constructed. The titer of the cDNA library was 6.25 × 10⁶ pfu/mL, with a recombinant efficiency of 100%, and the mean length of the inserted fragments in the library was larger than 1 100 bp. A total of 12 positive clones were obtained by immunoscreening, and were categorized into Sm-I (Sm60-1), Sm-II (Sm58-1), Sm-III (Sm20-1) and Sm-IV (Sm22-3), with 1 134, 1 063, 883 bp and 969 bp long inserted fragments. Their coding proteins were highly homologous with the Spirometra erinaceieuropaei antigenic polypeptide, cytoplasmic antigen, ribosomal protein S4-like protein and unnamed protein product, respectively.

CONCLUSIONS

A SMART cDNA library of S. mansoni has been successfully constructed and 4 categories of positive clones have been identified, which provides a basis for further studies on diagnostic antigens for sparganosis mansoni.

Dendritic cell TLR4 induces Th1-type immune response against Cryptosporidium parvum infection

The objective of this study was to investigate the mechanism of Toll-like receptor (TLR4)- mediated dendritic cell (DC) immune against Cryptosporidium parvum infection. C. parvum sporozoites were labeled with 5,6-carboxyfluorescein diacetate succinimidyl ester. Murine bone marrow-derived DCs were isolated, and divided into TLR4 antibody blocking (TAB; infected with 2 × 10⁵ labeled sporozoites and 0.5 μg TLR4 blocking antibody), TLR4 antibody unblocking (TAU; infected with 2 × 10⁵ labeled sporozoites), and blank control (BC; with 1.5 mL Roswell Park Memorial Institute 1640 medium) groups. The adhesion of Cryptosporidium sporozoites to DCs and CD11c⁺ levels were examined by fluorescence microscopy and flow cytometry. Male KM mice were orally injected with C. parvum. The proliferation of T lymphocytes in spleen, expression of cytokines in peripheral blood, and TLR4 distribution features in different organs were further determined by immunohistochemistry. A significantly higher expression of CD11c⁺ and higher C. parvum sporozoite adhesion were found in the TAU group compared with other groups. The expression of CD4⁺CD8^- /CD8⁺CD4^- in the spleen were obviously differences between the TAB and TAU groups. The expression of TLR4, interleukin IL-4, IL-12, IL-18 and IFN-γ improved in the TAU group compared with TAB group. Higher expression of TLR4 was detected in the lymph nodes of mice in the TAU group, with pathological changes in the small intestine. Hence, TLR4 could mediate DCs to recognize C. parvum, inducing Th1 immune reaction to control C. parvum infection.

microRNAs expression profiles in Schistosoma japonicum of different sex 14 and 28 days post-infection

Different miRNAs are involved in the life cycles of Schistosoma japonicum. The aim of this study was to examine the expression profile of miRNAs in individual S. japonicum of different sex before and after pairing (18 and 24 dpi). The majority of differential expressed miRNAs were highly abundant at 14 dpi, except for sja-miR-125b and sja-miR-3505, in both male and female. Moreover, it was estimated that sja-miR-125b and sja-miR-3505 might be related to laying eggs. sja-miR-2a-5p and sja-miR-3484-5p were expressed at 14 dpi in males and were significantly clustered in DNA topoisomerase III, Rap guanine nucleotide exchange factor 1 and L-serine/L-threonine ammonia-lyase. Target genes of sja-miR-2d-5p, sja-miR-31- 5p and sja-miR-125a, which were expressed at 14 dpi in males but particularly females, were clustered in kelch-like protein 12, fructose-bisphosphate aldolase, class I, and heat shock protein 90 kDa beta. Predicted target genes of sja-miR-3483-3p (expressed at 28 dpi in females but not in males) were clustered in 26S proteasome regulatory subunit N1, ATPdependent RNA helicase DDX17. Predicted target genes of sja-miR-219-5p, which were differentially expressed at 28 dpi in females but particularly males, were clustered in DNA excision repair protein ERCC-6, protein phosphatase 1D, and ATPase family AAA domaincontaining protein 3A/B. Moreover, at 28 dpi, eight miRNAs were significantly up-regulated in females compared to males. The predicted target genes of these miRNAs were significantly clustered in heat shock protein 90 kDa beta, 26S proteasome regulatory subunit N1, and protein arginine N-methyltransferase 1. To sum up, differentially expressed miRNAs may have an essential role and provide necessary information on clarifying this trematode's growth, development, maturation, and infection ability to mammalian hosts in its complex life cycle, and may be helpful for developing new drug targets and vaccine candidates for schistosomiasis.

[Prevalence and risk factors of Blastocystis infections among primary school students in Jiangjin District, Chongqing City]

OBJECTIVE

To investigate the prevalence and risk factors of Blastocystis infections among primary school students in Jiangjin District, Chongqing City.

METHODS

A cross-sectional questionnaire survey was conducted among students sampled from a primary school in Jiangjin District, Chongqing City on April, 2018, and their stool samples were collected for microscopic examinations, in vitro culture and PCR assays to analyze the prevalence of Blastocystis infections and subtype of the parasite. In addition, the risk factors of Blastocystis infections among primary school students were identified using univariate analysis and multivariate logistic regression analysis.

RESULTS

A total of 466 primary students were surveyed, and the subjects had a mean age of (9.81±1.66) years and included 236 males (50.64%) and 230 females (49.36%). The prevalence of Blastocystis infections was 15.24% (71/466) among the study students, and there was no significance difference in the prevalence between male and fe- male students (16.52% vs. 13.91%; χ2 = 0.616, P = 0.433). In addition, there was a significant difference in the prevalence of Blastocystis infections among grade 1 (6.35%, 4/63), grade 2 (5.17%, 3/58), grade 3 (21.74%, 15/69), grade 4 (25.30%, 21/83), grade 5 (10.19%, 11/108) and grade 6 students (20.00%, 17/85) (χ2 = 15.410, P = 0.009). There were four Blastocystis subtypes characterized (ST1, ST3, ST6 and ST7), in which ST6 was the most common subtype (45.07%, 32/71), followed by ST3 (25.35%, 18/71). Multivariate logistic regression analysis revealed that minority ethnicity [odds ratio (OR) = 4.259, 95% confidential inter- val (CI) : (1.161, 15.621)] and low maternal education level (primary school and below) [OR = 9.038, 95% CI: (1.125, 72.642)] were identified as risk factors of Blastocystis infection among primary school students in Jiangjin District, Chongqing City.

CONCLUSIONS

There is a high prevalence of Blastocystis infections detected among primary school students in Jiangjin District, Chongqing City, and ST6 and ST3 are predominant subtypes. Minority ethnicity and low maternal education level (primary school and below) are risk factors for Blastocystis infections in primary school students.

[Progress of researches on Blastocystis infections in humans and animals in China]

Blastocystis is a unicellular, anaerobic, intestinal protozoan that infects humans and a variety of animals, which is widely prevalent across the world. Blastocystis infections have been detected in healthy populations, children, students, outpatients and inpatients, as well as diarrhea patients in China. High prevalence of Blastocystis infections has been reported in immunocompromised patients, and relatively high prevalence was seen in individuals living in Guangxi and Yunnan regions. Based on the small subunit ribosomal RNA (SSU rRNA) gene sequence, a total of 17 subtypes (ST1 to ST17) of Blastocystis have been characterized until now, among which ST1 to ST9 and ST12 infect humans and animals, and ST10 to ST17 only infect animals. In China, ST1 to ST3 are predominant human Blastocystis subtypes, and ST1/ST3, ST1/ST2 and ST2/ST3 mixed infections have been also identified. This review mainly describes the epidemiology and genotypes of Blastocystis in humans and animals in China.

[Establishment of a recombinase-aided isothermal amplification assay for nucleic acid detection of Echinococcus multilocularis and its preliminary application]

OBJECTIVE

To establish a rapid nucleic acid detection technique for identification of Echinococcus multilocularis based on the recombinase aided isothermal amplification assay (RAA) and assess its diagnostic efficiency.

METHODS

The mitochondrial gene sequence of E. multilocularis (GenBank accession number: AB018440) was used as a target sequence. The primers were designed according to the RAA reaction principle and synthesized, and RAA was performed using the generated primers. E. multilocularis genomic DNA at various concentrations and the pMD19-T (Simple) vector containing various copies of the target gene fragment were amplified using RAA to evaluate its sensitivity for detection of E. multilocularis, and RAA was em- ployed to detect the genomic DNA of E. granulosus G1 genotype, Taenia saginata, T. asiatica, T. multiceps, Dipylidium caninum, Toxocara canis, Trichuris trichiura, Giardia lamblia, Fasciola hepatica, Paragonimus westermani, Fasciola gigantica and Clonorchis sinensis to evaluate its specificity. In addition, the optimized RAA was employed to detect nine tissue specimens of E. granulosus-infected animals, 3 fecal samples from E. granulosus-infected dogs and 2 fecal samples from field infected dogs to examine its reliability and feasibility.

RESULTS

The established RAA was able to detect the specific target gene fragment of E. multilocularis within 40 min. The lowest detect limit of RAA was 10 pg if E. multilocularis genomic DNA served as a template. If the re- combinant plasmid was used as a template, the minimally detectable copy number of RAA was 104. In addition, RAA was nega- tive for the genomic DNA of E. granulosus G1 genotype, T. saginata, T. asiatica, T. multiceps, D. caninum, T. canis, T. trichiura, G. lamblia, F. hepatica, P. westermani, F. gigantica and C. sinensis. The established RAA was positive for detection of the tissue specimens of infected animals, and simulated and field dog stool samples.

CONCLUSIONS

A rapid, sensitive and specific RAA is established, which shows promising values in identification of E. multilocularis and gene diagnosis of alveolar echinococcosis.

Parasitological and molecular detection of human fascioliasis in a young man from Guizhou, China

A 24-year-old man born in Guizhou province was diagnosed with obstructive jaundice and bile duct stones in 2013. Four living trematodes were found during laparotomy and cholecystectomy. Based on the morphology and molecular genetics analysis of internal transcribed spacer and pcox1 genes of the flatworm specimens, the trematodes from the patient were confirmed to be Fasciola hepatica. This report provided the clinical and molecular diagnosis information on human fascioliasis, which is an emerging sanitary problem still ignored in China. Human fascioliasis constantly occurs due to climatic changes and frequency of human travel. Therefore, it deserves more attention from physicians working in both developing and developed countries.

[The application of rapid rehabilitation model of multidisciplinary cooperation in cesarean section and the evaluation of health economics]

Objective: To explore the application value of multiple disciplinary team Enhanced recovery after surgery (MDT-ERAS) in cesarean section and evaluate its health economic benefits. Methods: A total of 572 cases of pregnant women undergoing cesarean section in obstetrics department of Jiaxing Maternity and Child Health Care Hospital from March 2018 to March 2019 were selected and randomly divided into experimental group and control group, 286 cases in each group. The control group was treated with traditional rehabilitation mode, and the experimental group was treated with MDT-ERAS intervention to compare the difference of rehabilitation index and health economics index between the two groups, and to evaluate the application value and health economics benefit of MDT-ERAS. Results: The VAS scores of the two groups at 1 day after operation were higher than those at the time of returning to the ward after operation(1.81±0.40 VS. 1.58±0.39, 3.78±0.89 VS. 3.22±0.83, all P<0.05). The VAS scores at 2 days and 3 days after operation were lower than those at the time of returning to the ward(0.58±0.09 VS. 1.58±0.39, 1.02±0.15 VS. 1.58±0.39; 1.88±0.37 VS. 3.22±0.83, 2.67±0.44 VS. 3.22±0.83, all P<0.05). The VAS scores of the experimental group at each time point after operation were lower than those of the control group(1.58±0.39 VS. 3.22±0.83, 1.81±0.40 VS. 3.78±0.89, 1.02±0.15 VS. 2.67±0.44, 0.58±0.09 VS. 1.88±0.37), and these differences were statistically significant (P<0.05). The anal exhaust time, indwelling catheterization time, first time out of bed and first time eating time of the experimental group were lower than those of the control group, with statistical significance (P<0.05). Postpartum hemorrhage rate and neonatal milk addition rate in the experimental group were significantly lower than those in the control group (all P<0.05). The hospitalization time and hospitalization expenses of the experimental group were lower than those of the control group(all P<0.05), and the health economics benefit of the experimental group was significantly higher than that of the latter (P<0.05). Conclusion: MDT-ERAS can effectively improve the recovery rate of the parturient after cesarean section, ensure the analgesic effect and improve the maternal and infant outcomes, and has higher health and economic benefits, which is worthy of promotion.

Ion cyclotron emission diagnostic system on the experimental advanced superconducting tokamak and first detection of energetic-particle-driven radiation

A passive and noninvasive diagnostic system based on high-frequency B-dot probes (HFBs) has been designed and developed for the measurement and identification of ion cyclotron emission (ICE) in the Experimental Advanced Superconducting Tokamak (EAST). Details of the hardware components of this system including HFBs, direct current blockers, radio frequency splitters, filters, and power detectors as well as data acquisition systems are presented. A spectrum analyzer is used in addition to the ordinary speed acquisition card for data registration and analysis. The reliability of a HFB based diagnostic system has been well validated during the 2018 spring experiments on the EAST. ICE signals corresponding to fundamental cyclotron frequency of hydrogen ions and harmonics of deuterium ions were observed in experiments where deuterium plasmas were heated with deuterium neutral beams. The field dependence of ICE has been verified by recent experiments with three different background magnetic fields. The observed ratio of the ICE frequency is consistent with the ratio of the magnetic field intensity within measurement errors of a few percent.

The oral microbiota - a mechanistic role for systemic diseases

Human oral microbiota is the ecological community of commensal, symbiotic, and pathogenic microorganisms found in the oral cavity. Oral microbiota generally exists in the form of a biofilm and plays a crucial role in maintaining oral homeostasis, protecting the oral cavity and preventing disease development. Human oral microbiota has recently become a new focus research for promoting the progress of disease diagnosis, assisting disease treatment, and developing personalised medicines. In this review, the scientific evidence supporting the association that endogenous and exogenous factors (diet, smoking, drinking, socioeconomic status, antibiotics use and pregnancy) modulate oral microbiota. It provides insights into the mechanistic role in which oral microbiota may influence systemic diseases, and summarises the challenges of clinical diagnosis and treatment based on the microbial community information. It provides information for noninvasive diagnosis and helps develop a new paradigm of personalised medicine. All these benefit human health in the post-metagenomics era.

Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and 11C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas

BACKGROUND AND PURPOSE

Both ¹¹C-methionine PET/CT and DSC-PWI could be used to differentiate radiation injury from recurrent brain tumors. Our aim was to assess the performance of MET PET/CT and DSC-PWI for differentiation of recurrence and radiation injury in patients with high-grade gliomas and to quantitatively analyze the diagnostic values of PET and PWI parameters.

MATERIALS AND METHODS

Forty-two patients with high-grade gliomas were enrolled in this study. The final diagnosis was determined by histopathologic analysis or clinical follow-up. PWI and PET parameters were recorded and compared between patients with recurrence and those with radiation injury using Student t tests. Receiver operating characteristic and logistic regression analyses were used to determine the diagnostic performance of each parameter.

RESULTS

The final diagnosis was recurrence in 33 patients and radiation injury in 9. PET/CT showed a patient-based sensitivity and specificity of 0.909 and 0.556, respectively, while PWI showed values of 0.667 and 0.778, respectively. The maximum standardized uptake value, mean standardized uptake value, tumor-to-background maximum standardized uptake value, and mean relative CBV were significantly higher for patients with recurrence than for patients with radiation injury. All these parameters showed a high discriminative power in receiver operating characteristic analysis. The optimal cutoff values for the tumor-to-background maximum standardized uptake value and mean relative CBV were 1.85 and 1.83, respectively, and corresponding sensitivities and specificities for the diagnosis of recurrence were 0.97 and 0.667 and 0.788 and 0.88, respectively. Areas under the curve for the tumor-to-background maximum standardized uptake value and mean relative CBV were 0.847 ± 0.077 and 0.845 ± 0.078, respectively. Combined assessment of the tumor-to-background maximum standardized uptake value and mean relative CBV showed the largest area under the curve (0.953 ± 0.031), with corresponding sensitivity and specificity of 0.848 and 1.0, respectively.

CONCLUSIONS

Both ¹¹C-methionine PET/CT and PWI are equally accurate in the differentiation of recurrence from radiation injury in patients with high-grade gliomas, and a combination of the 2 modalities could result in increased diagnostic accuracy.

New Anti-Schistosoma Approaches in The People's Republic of China: Development of Diagnostics, Vaccines and Other New Techniques Belonging to the 'Omics' Group

A new national schistosomiasis elimination programme will be implemented for the period 2016-20. To support this approach, we have performed a systematic review to assess anti-schistosome approaches in The People's Republic of China and defined research priorities for the coming years. A systematic search was conducted for articles published from January 2000 to March 2015 in international journals. Totally 410 references were published in English between 2000 and 2015 related to schistosomiasis after unrelated references and reviews or comments were further excluded. A set of research priorities has been identified for the near future that would improve the progress toward schistosomiasis elimination in The People's Republic of China. In particular, there is a lack of sensitive and specific tests for the detection of schistosomiasis cases with low parasite burdens, as well as an effective vaccine against schistosomiasis, and there is a need for surveillance tools that can evaluate the epidemic status for guiding the elimination strategy. Hence, we think that schistosomiasis control and elimination will be improved in The People's Republic of China through development of new tools.

The oocyte-to-baby rate of day 2, day 3 versus day 5 embryo transfer: a retrospective study

OBJECTIVES

To investigate whether the time of embryo transfer (ET) affect the oocyte-to-baby rate.

MATERIALS AND METHODS

The database was retrospectively analyzed including total number of oocytes collected and corresponding oocyte-to-live baby born (LBB) rate. Then the relationship between different time of embryo transfer and oocyte-to-baby rate was compared. In a year period all patients undergoing infertility treatment were included in the study. The outcome parameters were total number of oocytes collected and corresponding oocyte-to-LBB.

RESULTS

For patients under the age of 35 years, there was no increase in oocyte-to-LBB regardless of the time of ET. For patients older than 35 years, the oocyte use rate increased significantly when embryo was transferred on day 2. Oocyte-to-baby rates were also analyzed after grouping patients on the number of oocytes retrieved per cycle. For patients < 35 years, the oocyte- to -LBB rate increased significantly on day 3 if < ten oocytes were obtained. whereas for patients > 35 years, the oocyte-to-baby rate was best on day 2 when about 15 oocytes were retrieved.

CONCLUSIONS

This retrospective analysis demonstrated the relationship between the time of ET and ooctye-to-baby rate that is indicative of a more biologically efficient reproductive system.

Differentiation between brain glioblastoma multiforme and solitary metastasis: qualitative and quantitative analysis based on routine MR imaging

BACKGROUND AND PURPOSE

The differentiation between cerebral GBM and solitary MET is clinically important and may be radiologically challenging. Our hypothesis is that routine MR imaging with qualitative and quantitative analysis is helpful for this differentiation.

MATERIALS AND METHODS

Forty-five GBM and 21 solitary metastases were retrospectively identified, with their preoperative routine MR imaging analyzed. According to the comparison of the area of peritumoral T2 prolongation with that of the lesion, the tumors were classified into grade I (prolongation area ≤ tumor area) and grade II (prolongation area > tumor area). The signal intensities of peritumoral T2 prolongation were measured on T2WI and normalized to the values of the contralateral normal regions by calculating the ratios. The ratio (nSI) of both types of tumors was compared in grade I, grade II, and in tumors without grading. The best cutoff values to optimize the sensitivity and specificity were determined for optimal differentiation.

RESULTS

The nSI of GBM was significantly higher than that of MET without T2 prolongation grading (P < .001), resulting in AUC = 0.725. The difference was significant (P = .014) in grade I tumors (GBM, 38; MET, 9), with AUC = 0.741, and in grade II tumors (GBM, 7; MET, 12), with AUC = 0.869 (P = .017). Both types of tumors showed a different propensity in T2 prolongation grading (χ(2) = 12.079, P = .001).

CONCLUSIONS

Combined with qualitative and quantitative analysis of peritumoral T2 prolongation, routine MR imaging can help in the differentiation between brain GBM and solitary MET.

Directional diffusivity changes in the optic nerve and optic radiation in optic neuritis

OBJECTIVE

Optic neuritis (ON) is defined as an inflammation of the optic nerve and provides a useful model for studying the effects of inflammatory demyelination of white matter. The aim of this study was to assess the diffusion changes in both the optic nerve and optic radiation in patients with acute and chronic ON using diffusion tensor (DT) MRI.

METHODS

33 patients with idiopathic demyelinating optic neuritis (IDON) and 33 gender- and age-matched healthy controls were examined with DT-MRI and with T(1) and T(2) weighted MRI.

RESULTS

Compared with controls, both first-episode and recurrent patients with IDON in the acute stage showed significantly increased radial diffusivity (λ(⊥)) and decreased mean fractional anisotropy (FA) in the affected nerves. Reduced FA, increased λ(⊥), mean diffusivity (MD) and axial diffusivity (λ(∥)) were determined in patients with subacute IDON. We found no significant difference in the directional diffusivity of optic radiation in patients whose disease had lasted less than 1 year compared with healthy controls. However, significant changes in the FA and λ(⊥) of the optic radiation were detected in patients with disease duration of more than 1 year.

CONCLUSION

These results show the great potential and capacity of DT-MRI measures as useful biomarkers and indicators for the evaluation of myelin injury in the visual pathway.

Genetic diversity and relatedness of Fasciola spp. isolates from different hosts and geographic regions revealed by analysis of mitochondrial DNA sequences

The present study examined sequence variability in a portion of the mitochondrial cytochrome c oxidase subunit 1 (pcox1) and NADH dehydrogenase subunits 4 and 5 (pnad4 and pnad5) among 39 isolates of Fasciola spp., from different hosts from China, Niger, France, the United States of America, and Spain; and their phylogenetic relationships were re-constructed. Intra-species sequence variations were 0.0-1.1% for pcox1, 0.0-2.7% for pnad4, and 0.0-3.3% for pnad5 for Fasciola hepatica; 0.0-1.8% for pcox1, 0.0-2.5% for pnad4, and 0.0-4.2% for pnad5 for Fasciola gigantica, and 0.0-0.9% for pcox1, 0.0-0.2% for pnad4, and 0.0-1.1% for pnad5 for the intermediate Fasciola form. Whereas, nucleotide differences were 2.1-2.7% for pcox1, 3.1-3.3% for pnad4, and 4.2-4.8% for pnad5 between F. hepatica and F. gigantica; were 1.3-1.5% for pcox1, 2.1-2.9% for pnad4, 3.1-3.4% for pnad5 between F. hepatica and the intermediate form; and were 0.9-1.1% for pcox1, 1.4-1.8% for pnad4, 2.2-2.4% for pnad5 between F. gigantica and the intermediate form. Phylogenetic analysis based on the combined sequences of pcox1, pnad4 and pnad5 revealed distinct groupings of isolates of F. hepatica, F. gigantica, or the intermediate Fasciola form irrespective of their origin, demonstrating the usefulness of the mtDNA sequences for the delineation of Fasciola species, and reinforcing the genetic evidence for the existence of the intermediate Fasciola form.

Clival invasion on multi-detector CT in 390 pituitary macroadenomas: correlation with sex, subtype and rates of operative complication and recurrence

BACKGROUND AND PURPOSE

Clival invasion, a rare but potentially significant complication of pituitary adenoma, is difficult to detect on MR imaging. Because CT is widely used in adjunct guidance of pituitary surgery and it has recently been suggested that preoperative CT may add useful diagnostic information in addition to pituitary MR imaging, we performed the first large cross-sectional imaging study to define the image attributes, clinical correlates, and prognostic implications of clival invasion on CT for pituitary adenoma surgical guidance.

MATERIALS AND METHODS

Preoperative CT images from 390 patients with histopathologically diagnosed pituitary macroadenoma were reviewed retrospectively and classified by the presence and degree of clival invasion. Tumor volume, tumor subtype, patient sex, operative complication, and recurrence rates were compared between groups.

RESULTS

After we corrected for multiple correlations, the most significant independent risk factor for clival invasion was female sex (OR=3.62, P=.014, multinomial logistic regression), followed by large tumor volume (OR=1.08, P<.001), and null-cell subtype (OR=5.47, P<.001). Larger tumor volume correlated with null-cell subtype (Mann-Whitney U test, P=.006), incidence of clival invasion (P<.001), and extent of clival invasion (P=.038). Clival invasion was associated with a significantly higher ratio of operative complications (15.63%, χ(2)=7.067, P=.008) and recurrence (57.14%, χ(2)=10.739, P=.001).

CONCLUSIONS

CT detection of clival invasion by pituitary macroadenoma is significantly more common in women, in patients with large tumors, and in patients with null-cell tumors, and it is associated with a higher rate of operative complications and recurrences. Attention to the presence of clival invasion on preoperative CT and prospective investigation of its prognostic significance are indicated. Attention to this finding on pituitary guidance CT is warranted.

Sensitive and rapid detection of Paragonimus westermani infection in humans and animals by loop-mediated isothermal amplification (LAMP)

In the present study, a loop-mediated isothermal amplification (LAMP) assay was developed and validated for the detection of Paragonimus westermani adults, metacercariae, and eggs in human and animal samples. The LAMP amplification can be finished in 45 min under isothermal condition at 60°C by employing a set of four species-specific primer mixtures and the results can be checked by naked-eye visualization. No amplification products were detected with deoxyribunucleic acid (DNA) of related trematode species including Fasciola hepatica, Fasciola gigantica, Clonorchis sinensis, Opisthorchis viverrini, Schistosoma mansoni, and Schistosoma japonicum. The method was further validated by examining P. westermani DNA in intermediate hosts including freshwater crabs and crayfish, as well as in sputum and pleural fluid samples from patients of paragonimiasis. These results indicated that the LAMP assay was highly specific, sensitive, and rapid, and it was approximately 100 times more sensitive than conventional specific PCR. The LAMP assay established in this study provides a rapid and sensitive tool for the detection of P. westermani DNA in freshwater crabs, crayfish, sputum, and pleural fluid samples, which has important implications for effective control of human paragonimiasis.

Specific PCR-based assays for the identification of Fasciola species: their development, evaluation and potential usefulness in prevalence surveys

Among the helminths infecting ruminants in China are three taxa belonging to the genus Fasciola: F. hepatica, F. gigantica and the so-called 'intermediate form' that appears to lie between these two species. Based on the sequences of the second internal-transcribed spacers (ITS-2) within the parasites' nuclear ribosomal DNA (rDNA), a pair of primers (DSJf/DSJ3) specific for F. hepatica and a pair (DSJf/DSJ4) specific for F. gigantica were designed and used to develop PCR-based assays. These assays allowed the identification and differentiation of F. hepatica, F. gigantica and the 'intermediate' Fasciola, with no amplicons produced from heterologous DNA samples. The results of sequencing confirmed the species-specific identity of the amplified products. The assays showed good sensitivity, giving positive results with as little as 0.11 ng of F. hepatica DNA and 0.35 ng of F. gigantica DNA. This meant that the DNA from a single Fasciola egg or a single infected snail was sufficient for identification of the Fasciola taxon. The developed PCR assays could provide useful tools for the detection, identification and epidemiological investigation of Fasciola infection in humans, other mammals and snails.

Combined mitochondrial 16S and 12S rDNA sequences: an effective genetic marker for inter-species phylogenetic analysis of zoonotic trematodes

The present study studied the genetic variation among Schistosoma japonicum isolates from different endemic regions in mainland China and examined the phylogenetic relationships of zoonotic trematodes using the combined mitochondrial 16S and 12S ribosomal DNA sequences. The fragments of 16S and 12S rDNA were amplified from 22 S. japonicum isolates, and sequenced, and the relevant sequences of other nine trematode species belonging to six genera in four families were downloaded from GenBank, and their phylogenetic relationships were re-constructed by unweighted pair-group method with arithmetic averages analyses using the combined 16S and 12S rDNA sequences, with Trichinella spiralis as outgroup. The results showed that the partial sequences of mitochondrial 16S and 12S rDNA of S. japonicum were 757 and 797 bp, respectively, and they were quite conserved among the S. japonicum isolates. Phylogenetic analysis revealed that the combined 16S and 12S rDNA sequences were not able to distinguish S. japonicum isolates in mountainous areas from those in lake/marshland areas in mainland China. However, the combined sequences could distinguish different species of zoonotic trematodes. Therefore, the combined mitochondrial 16S and 12S rDNA sequences provide an effective molecular marker for the inter-species phylogenetic analysis and differential identification of zoonotic trematodes.

alpha7 Nicotinic receptor gene delivery into mouse hippocampal neurons leads to functional receptor expression, improved spatial memory-related performance, and tau hyperphosphorylation

Brain alpha7 nicotinic receptors have become therapeutic targets for Alzheimer's disease (AD) based on their memory-enhancing and neuroprotective actions. This study investigated the feasibility of increasing neuronal alpha7 receptor functions using a gene delivery approach based on neuron-selective recombinant adeno-associated virus (rAAV)-derived vectors. In order to determine whether alpha7 receptor-mediated cytotoxicity was dependent on receptor density, rat alpha7 nicotinic receptors were expressed at high concentrations in GH4C1 cells as measured with nicotine-displaceable [3H]methyllycaconitine (MLA) binding. The potency of GTS-21 (an alpha7 receptor agonist) to induce cell loss was similar in these cells to that seen in pheochromocytoma (PC12) cells expressing nine-times-lower receptor levels, suggesting that cytotoxicity was more dependent on agonist concentration than receptor density. Hippocampal transduction with rat alpha7 nicotinic receptors increased [3H]MLA binding in this region in wild type and alpha7 receptor-knockout (KO) mice without apparent cytotoxicity. No difference was observed in Kd values for MLA binding between endogenous and transgenic receptors. Single cell recordings demonstrated that dentate granule cells that normally have no alpha7 receptor response did so following alpha7 receptor gene delivery in wild type mice. Recovery of alpha7 function was also observed in stratum oriens and stratum radiatum neurons of KO mice following gene delivery. Wild type mice exhibited improved acquisition performance in the Morris water task 1 month after bilateral hippocampal transductions with the rat alpha7 receptor gene compared with green fluorescent protein-transduced controls. However, both groups reached similar training levels and there was no difference in subsequent probe performance. Finally, this gene delivery approach was used to test whether alpha7 receptors affect tau-phosphorylation. Chronic (i.e. 2 month but not 2 week) expression of high levels of alpha7 receptors in hippocampus increased AT8 staining characteristic of hyperphosphorylated tau in that region, indicating that endogenous agonist-mediated receptor activation may be able to modulate this process.

Practical PCR tools for the delineation of Contracaecum rudolphii A and Contracaecum rudolphii B (Ascaridoidea: Anisakidae) using genetic markers in nuclear ribosomal DNA

Using genetic markers defined previously in the internal transcribed spacers (ITS-1 and ITS-2) of nuclear ribosomal DNA (rDNA), PCR-coupled restriction fragment length polymorphism (PCR-RFLP) and specific PCR assays were established for the specific detection of each of two morphologically indistinguishable operational taxonomic units (Contracaecum rudolphii A and Contracaecum rudolphii B) within Contracaecum rudolphii (s.l.) and their differentiation from Contracaecum septentrionale, a closely related congener. Application of these tools to C. rudolphii (s.l.) adults from Phalacrocorax carbo sinensis (the Eurasian subspecies of the great cormorant) from Qinghai Lake in China, revealed C. rudolphii B to infect this host. This is the first report of C. rudolphii B in P. carbo sinensis outside of Europe (where it was originally detected), supporting the proposal that this species has a broad geographical distribution. Together with other methods, each of these molecular tools will be useful for investigating the ecology of C. rudolphii A and C. rudolphii B as well as C. septentrionale.

[Significance of amnioinfusion and amniotic fluid exchange under continuous internal fetal heart rate monitoring for management of fetal distress during labor]

OBJECTIVE

To discuss the significance of amnioinfusion and amniotic fluid exchange under continuous internal fetal heart rate (FHR) monitoring for management of fetal distress during labor.

METHODS

136 cases with frequent variable deceleration (VD) and meconium stained amniotic fluid during labor were divided into two groups: the study group (68 cases) and the control group (68 cases). The former were treated by amnioinfusion and amniotic fluid exchange, while oxygen inhalation, change of body position, and intravenous infusion for the control group.

RESULTS

In the study group, VD disappeared or relieved in 62 cases obviously, and the efficacy rate reached 91.2% (62/68). 48 cases with II degree meconium stained amniotic fluid were treated by amniotic fluid exchange, amniotic fluid became clear or turned to I degree stained in 39 cases. In the control group, VD relieved in 20 cases, the efficacy rate was 19.4%, significantly lower than that of the study group (P < 0.01). In the study group, cesarean section rate was 14.7% neonatal asphyxia 7.4% while they were 47.1% and 48.5% in the control group respectively (P < 0.01; P < 0.01). Neonatal pneumonia caused by meconium aspiration occurred in 13 cases, meconium aspiration syndrome (MAS) 8 cases, with 5 newborns died in the control group, while there was no neonatal death in the study group. There was no significant difference on puerperal morbidity between the 2 groups (P > 0.05).

CONCLUSIONS

Amnioinfusion and AF exchange during labor are one of the effective treatment methods for fetal distress and prevention for MAS.

Mitochondrial DNA 3394 mutation in the NADH dehydrogenase subunit 1 associated with non-insulin-dependent diabetes mellitus

Mitochondrial DNA (mtDNA) mutation is associated with a subtype of non-insulin-dependent diabetes mellitus (NIDDM). We identified two homoplasmic mtDNA mutations at the positions of 3394 (T-C) and 3423 (G-T) in a NIDDM patient with clinical features of mitochondrial encephalopathy. The mtDNA 3394T-C mutation changed a conserved tyrosine to a histidine in NADH dehydrogenase subunit 1. The frequency of mtDNA 3994 T-C mutation was determined with Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) in general NIDDM patients and nondiabetic control subjects. The mutation was seen in 4.9% of NIDDM patients and 1.3% of nondiabetic controls. It is indicated that the mtDNA 3394 T-C mutation is associated with NIDDM in Japan.