Prediction model for EBV infection following HLA haploidentical matched hematopoietic stem cell transplantation

AIMS

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective treatment for hematological malignancies. However, viral infections, particularly EBV infection, frequently occur following allo-HSCT and can result in multi-tissue and organ damage. Due to the lack of effective antiviral drugs, these infections can even progress to post-transplant lymphoproliferative disorders (PTLD), thereby impacting the prognosis. In light of this, our objective is to develop a prediction model for EBV infection following allo-HSCT.

METHODS

A total of 466 patients who underwent haploidentical hematopoietic stem cell transplantation (haplo-HSCT) between September 2019 and December 2020 were included in this study. The patients were divided into a development cohort and a validation cohort based on the timing of their transplantation. Our aim was to develop and validate a grading scale using these cohorts to predict the risk of EBV infection within the first year after haplo-HSCT. Additionally, single-cell RNA sequencing (sc-RNAseq) data from the bone marrow of healthy donors were utilized to assess the impact of age on immune cells and viral infection.

RESULTS

In the multivariate logistic regression model, four predictors were retained: donor age, female-to-male transplant, graft MNC (mononuclear cell) dose, and CD8 dose. Based on these predictors, an EBV reactivation predicting score system was constructed. The scoring system demonstrated good calibration in both the derivation and validation cohorts, as confirmed by the Hosmer-Lemeshow test (p > 0.05). The scoring system also exhibited favorable discriminative ability, as indicated by the C statistics of 0.72 in the derivation cohort and 0.60 in the validation cohort. Furthermore, the clinical efficacy of the scoring system was evaluated using Kaplan-Meier curves based on risk ratings. The results showed significant differences in EBV reactivation rates between different risk groups, with p-values less than 0.001 in both the derivation and validation cohorts, indicating robust clinical utility. The analysis of sc-RNAseq data from the bone marrow of healthy donors revealed that older age had a profound impact on the quantity and quality of immune subsets. Functional enrichment analysis highlighted that older age was associated with a higher risk of infection. Specifically, CD8 + T cells from older individuals showed enrichment in the pathway of "viral carcinogenesis", while older CD14 + monocytes exhibited enrichment in the pathway of "regulation of viral entry into host cell." These findings suggest that older age may contribute to an increased susceptibility to viral infections, as evidenced by the altered immune profiles observed in the sc-RNAseq data.

CONCLUSION

Overall, these results demonstrate the development and validation of an effective scoring system for predicting EBV reactivation after haplo-HSCT, and provide insights into the impact of age on immune subsets and viral infection susceptibility based on sc-RNAseq analysis of healthy donors' bone marrow.

Donor CSF3R with the rs3917980A/G or G/G genotype is correlated with better leukemia-free survival after allogenic hematopoietic stem cell transplantation

Polymorphisms in the granulocyte colony-stimulating factor receptor gene (GCSFR, CSF3R) have been reported to be associated with peripheral blood stem cell enrichment and hematological diseases. The aim of our study was to investigate the effects of donor CSF3R allelic polymorphisms on the outcomes of allogeneic stem cell transplantation. A total of 273 patients who were diagnosed with hematological diseases and treated with allogeneic hematopoietic stem cell transplantation(allo-HSCT) were enrolled in this study. Single-nucleotide polymorphisms in CSF3R were genotyped by targeted next-generation sequencing. There were six types of CSF3R genotypes with percentages over 1%. LFS and OS analyses showed that recipients receiving grafts from healthy donors with a rs3917980 G/G or A/G genotype had higher LFS rates than those receiving grafts from donors carrying a rs22754272 T/C genotype and the double-negative group (p = 0.036). Univariate cox analysis showed that donor CSF3R with the rs2275472 T/C genotype was associated with higher transplantation-related mortality (TRM) rates (HR = 2.853, 95% CI: 1.405-5.792, p = 0.00371) and lower rates of leukemia-free survival (LFS) (HR = 1.846; 95% CI: 1.018-3.347, p = 0.0435). In addition, donor CSF3R with the rs3917980G/G or A/G genotype was associated with better overall survival (OS) rates (HR = 0.560, 95% CI: 0.3162-0.9916, p = 0.047) and lower TRM rates (HR = 0.497, 95% CI: 0.2628-0.9397, p = 0.0315). Furthermore, multivariate cox analysis found that rs2275472 T/C genotype was an independent risk factors for TRM rates (HR = 3.210, 95% CI: 1.573-6.55, p = 0.001), while no statistical difference was found between rs3917980G/G or A/G genotype and clinical outcomes. Our findings demonstrate the important prognostic value of genetic variations in donor CSF3R to predict clinical outcomes in patients undergoing allo-HSCT.

Functional Competence of NK Cells via the KIR/MHC Class I Interaction Correlates with DNAM-1 Expression

The interaction of inhibitory receptors with self-MHC class I (MHC-I) molecules is responsible for NK cell education. The intensity of DNAM-1 expression correlates with NK cell education. However, whether DNAM-1 expression directly influences the functional competence of NK cells via the KIR/MHC-I interaction remains unclear. Based on allogeneic haploidentical hematopoietic stem cell transplantation, we investigated the intensity of DNAM-1 expression on reconstituted NK cells via the interaction of KIR with both donor HLA and recipient HLA at days 30, 90, and 180 after hematopoietic stem cell transplantation. The reconstituted NK cells educated by donor and recipient HLA molecules showed the highest DNAM-1 expression, whereas DNAM-1 expression on educated NK cells with only recipient HLA molecules was higher than that on educated NK cells with only donor HLA molecules, indicating that NK cells with donor or recipient HLA molecules regulate DNAM-1 expression and thereby affect NK cell education. Additionally, the effects of recipient cells on NK cell education were greater than those of donor cells. However, only when the DNAM-1, NKP30, and NKG2D receptors were blocked simultaneously was the function of educated and uneducated NK cells similar. Therefore, activating receptors may collaborate with DNAM-1 to induce educated NK cell hyperresponsiveness. Our data, based on in vitro and in vivo studies, demonstrate that the functional competence of NK cells via the KIR/MHC-I interaction correlates with DNAM-1 expression in human NK cells.

Donor activating killer cell immunoglobulin-like receptors genes correlated with Epstein-Barr virus reactivation after haploidentical haematopoietic stem cell transplantation

Natural killer (NK) cells exert anti-viral effects after haematopoietic stem cell transplantation (HSCT). The balance between inhibition and activation of NK cells determined by the inherited repertoire of killer cell immunoglobulin-like receptors (KIR) genes may influence Epstein-Barr virus (EBV) reactivation after transplantation. To evaluate the relative contributions of KIR genotypes to EBV reactivation, we prospectively enrolled 300 patients with malignant haematological disease who were suitable for haploidentical HSCT. Univariate analysis showed that donors with KIR2DS1, KIR2DS3 or KIR3DS1 genes were associated with an increased risk of EBV reactivation [hazard ratio (HR) 1·86, 95% confidence interval (CI) 1·19-2·9, P = 0·0067; HR 1·78, 95% CI 1·07-2·97, P = 0·027; HR 1·86, 95% CI 1·19-2·91, P = 0·0065 respectively]. Multivariate analysis revealed that the presence of KIR2DS1, KIR2DS3 or KIR3DS1 genes was associated with increased EBV reactivation after HSCT. This effect was more evident in the absence of the cognate ligands for the corresponding activating receptors. Our present data firstly showed that donors with activating KIR genes, specifically activating KIR2DS1, KIR2DS3 and KIR3DS1, had an increased risk of EBV reactivation. Precaution for patients whose donors carry activating genes will help prevent EBV reactivation and improve patient prognosis after HSCT.

[Prevalence of deep venous thrombosis in chronic refractory wounds and its influencing factors]

Objective: To investigate the incidence and risk factors of lower extremities deep venous thrombosis (DVT) in patients with chronic refractory wounds (chronic wounds). Methods: A retrospective analysis of 722 cases of chronic wounds admitted to the First People's Hospital of Zhengzhou from January 1, 2015 to December 31, 2018 was carried out, and clinical data such as gender, age, wound involves the lower extremities, wound type, duration of wound, D-dimer level and complicated diabetes, hypertension, coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock were collected. The patients were divided into DVT group and non-DVT group according to the color ultrasound test. Multivariate binary logistic regression analysis was used to screen the independent risk factors of DVT in patients with chronic wounds. Results: There were 55 (7.6%) patients in DVT group, of which 44(80.0%) were diagnosed as chronic DVT by conventional lower extremities venous color ultrasound screening at admission, and the remaining 11(20.0%) were newly diagnosed during hospitalization. There were no significant differences in gender, wound involves the lower extremities, duration of wound, complicated diabetes and hypertension between DVT group and non-DVT group (all P>0.05); and the differences were statistically significant in age, wound type, D-dimer level, complicated coronary heart disease, cerebral infarction, pneumonia and sepsis/septic shock (all P<0.05). Multivariate binary logistic regression analysis showed age [OR=2.260 (95%CI: 1.584-3.224)], D-dimer level [OR=14.201 (95%CI: 6.101-33.055)], complicated coronary heart disease [OR=2.731 (95%CI: 1.210-6.162)] and sepsis/septic shock [OR=3.170 (95%CI: 1.115-9.016)] were independent risk factors for DVT (all P<0.05). Conclusion: Chronic wounds patients have a higher incidence of DVT, most of which are chronic DVT, and age, D-dimer level, complicated coronary heart disease and sepsis/septic shock are independent risk factors for DVT in chronic wounds.

Delay expression of NKp30 on NK cells correlates with long-term mycophenolate mofetil treatment and higher EBV viremia post allogenic hematological stem cells transplantation

Mycophenolate mofetil (MMF) is an immunosuppressive agent that is widely used in graft-versus-host disease prophylaxis because of its inhibitory function on T cells and B cells. However, the effect of MMF on natural killer cell reconstitution after allogenic hematological transplantation is largely unknown. The present study examined the effects of different MMF administration durations after haploidentical allo-HSCT on NK cell reconstitution. Ninety patients were enrolled in this study and defined into two groups in term of MMF duration. We found that MMF patients in the long-term MMF group were associated with a poor reconstitution of NK cells and a significantly lower cytotoxicity from day 30 to day 180 post-transplantation. Especially, the long-term MMF group inhibits reconstitution of NKp30 NK subsets, which correlated with higher risk of EBV viremia. Multivariate analysis showed that a better reconstitution of NKp30 cells was associated with lower EBV viremia (HR0.957, p = .04). In vitro experiments demonstrated that the active metabolite of MMF, mycophenolic acid (MPA), inhibited the proliferation and cytotoxicity of NK cells from healthy donors or patients at day 30 post-transplantation. In summary, our findings demonstrated that long-term MMF administration delayed the quality and quantity of NK cells, especially NKp30 subpopulations, which was associated with decreased EBV viremia post allogeneic HSCT.

Effect of developmental stage of embryos at freezing on live birth outcomes after frozen embryo transfer

　　Purpose Our objective was to evaluate the birth outcomes of FET from different developmental stage of embryo at freezing (Day 3, Day 5 and Day 6). Methods All vitrified-warmed day 3 (D3) and day 5/6 (D5, D6) embryo transfers during the time period from January 2013 until December 2015 were included in the study. The Birthweight, Low birthweight (LBW), sexual distinction, gestation and for singleton births and twins conceived by FET were compared retrospectively between three cryopreservation strategies utilizing either D3, D5 or D6 embryo freezing. All embryos were vitrified by Dimethylsulfoxide (DMSO), Ethylene glycol (EG) and Sucrose used as Cryoprotectants and using Cryoleaf as the receptacles. Results A total of 993 infants from 771 women. The length of embryos storage was 3-38 months, with a median of 8 months. For singleton, birthweight from D5 and D6 blastocysts transfers were significantly heavier than for D3 cleavage-stage embryos transfers (P =0.0065 P =0.0006). For twins, birthweight from D6 blastocysts transfers were significantly heavier than for D5 blastocysts transfers (P =0.0044), and children born after D3 were at a signigicantly increased risk of being born a LBW. Conclusions Birthweights from FET are influenced by developmental stage of embryos at freezing, which were lower for cleavage-stage embryos transfer than blastocysts transfer after FET in singletons. The birth rate of LBW infants was higher in the twins. The study was small so there may be other factors than cryopreservation which affected outcomes. A higher sample size or a multi-centre prospective randomized design could be used in future studies to corroborate the current findings.

Direct high-precision measurement of the effective optical path length of multi-pass cell with optical frequency domain reflectometer

Multi-pass cells (MPCs) are commonly used in trace-gas detection and weak spectrum measurement. It is essential to accomplish a high-precision measurement of MPCs' effective optical path length (EOPL). A direct high-precision measuring method of MPCs' EOPL with optical frequency domain reflectometer (OFDR) was reported and demonstrated in this paper. Several important parameters of a MPC, such as EOPL and base length, were derived with high-precision by identifying the complicated signal of OFDR. The MPC's EOPL was also verified with the prevailing absorbance method. The results showed that the MPC's EOPL measured by each of these two methods is highly consistent. However, the relative uncertainty with the OFDR dramatically decreased 2 orders of magnitude (about 0.0085%) than that with the absorbance method. It demonstrated that the OFDR method with fewer measurement links is more conducive to a direct measurement. The performances of beam spread and stray light in the White-cell were also evaluated with the method.

Initiation of active immunization against testosterone during early puberty alters negative feedback regulation of the hypothalamic-pituitary-testicular axis in rabbits

To investigate the effects of antitestosterone immunization, initiated during early puberty, on hypothalamic-pituitary-testicular feedback in rabbits, 16 early pubertal male rabbits were randomly allocated into 2 groups (n = 8), control or immunized against testosterone-3(O-carboxymethyl)oxime-BSA in Freund adjuvant at 4 mo of age (with a booster immunization 4 wk later). Blood samples (for antibody titers and hormone concentrations) were collected at 2- or 4-wk intervals after immunization. Compared with controls, antitestosterone immunization triggered: a substantial and sustained antibody response (P < 0.01); increases in serum concentrations of luteinizing hormone (LH) and testosterone and testis weight and volume (P < 0.05); hyperplasia of testicular interstitial tissue with clustered and hypertrophic Leydig cells; and greater (P < 0.05) enzyme protein and messenger RNA (mRNA) expression levels for testicular cholesterol side-chain cleavage cytochrome P-450, 17α-hydroxylase cytochrome P-450, and 3β-dydroxysteroid dehydrogenase. Furthermore, immunoneutralization of testosterone upregulated mRNA expressions for genes in sex steroid negative feedback loops, including androgen receptor (AR), estrogen receptor alpha (ER-α), kisspeptin encoded gene (kiss-1) and kisspeptin receptor (G-coupled receptor 54) and gonadotropin-releasing hormone (GnRH) in the hypothalamic arcuate nucleus, GnRH receptor and LH-β in pituitary, and AR, inhibin-α and βA subunits in testes (P < 0.05). However, immunization did not affect mRNA expressions for follicle-stimulating hormone β, AR, and ER-α in pituitary, or ER-α in testes. We concluded that antitestosterone immunization in male rabbits, initiated during early puberty, increased GnRH mRNA expression, and in turn LH synthesis by reducing testicular feedback signaling. Reduction of direct steroidal effects on the testis may also have increased testosterone secretion. Consequently, there was an accelerated testicular development during puberty and enhanced testicular function after puberty, which likely conferred prolonged reproductive advantages.

Degradation of nitenpyram pesticide in aqueous solution by low-temperature plasma

In order to study the new technique of plasma wastewater treatment, the degradation behaviour ofnitenpyram (NTP) pesticide was investigated in a low-temperature plasma formed during a dielectric barrier discharge process. The reactor was a radial flow sedimentation tank centred around the water inlet. We studied the effect of pesticide concentration and input power of the dielectric barrier discharge, together with the effect of external factors on the degradation of nitenpyram pesticide wastewater such as conductivity and the use of various of catalysts, and the reaction products were analyzed by high-performance liquid chromatography mass spectrometry (HPLC-MS). The results showed that NTP could be effectively removed from aqueous solution by low-temperature plasma. Increasing the input power could improve the efficiency of degradation, conforming to a first-order kinetic model. Use of a suitable catalyst clearly improved the degradation process, as also did low conductivity. The pH of NTP was reduced with discharge time.

[Determination of puerarin in xinmaitong oral liquid by HPLC]

OBJECTIVE

To develop a method to determine the content of puerarin in Xinmaitong oral liquid.

METHODS

HPLC method was used. The separation was performed on Suntek kromasil C18 column with methanol-water containing 0.5% acetic acid (25:75) as a mobile phase and the wavelength of UV detector was 250 nm.

RESULTS

The linearity of puerarin was good and average recovery was 97.8%.

CONCLUSION

The method is simple, reliable and sensitive. It also shows good resolation. It can be used in quality control of Xinmaitong oral liquid.

Race-specific HIV-1 disease-modifying effects associated with CCR5 haplotypes

Genetic variation in CC chemokine receptor 5 (CCR5), the major HIV-1 coreceptor, has been shown to influence HIV-1 transmission and disease progression. However, it is generally assumed that the same CCR5 genotype (or haplotype) has similar phenotypic effects in different populations. To test this assumption, we used an evolutionary-based classification of CCR5 haplotypes to determine their associated HIV-1 disease-modifying effects in a large well-characterized racially mixed cohort of HIV-1-seropositive individuals. We demonstrate that the spectrum of CCR5 haplotypes associated with disease acceleration or retardation differs between African Americans and Caucasians. Also, we show that there is a strong interactive effect between CCR5 haplotypes with different evolutionary histories. The striking population-specific phenotypic effects associated with CCR5 haplotypes emphasize the importance of understanding the evolutionary context in which disease susceptibility genes are expressed.

Selective total vascular occlusion for major hepatic resection

Selective total vascular occlusion for the resection of large tumors on the right lobe of the liver or central hepatic tumors was described. The occlusion of the portal triad, infrahepatic vena cava and the total hepatic circulation was selectively used in combination to control bleeding in the process of hepatectomy. Within a year, major resection was successfully performed with this technique on 10 patients (extended right lobectomy 4 patients, right lobectomy 4, central segmentectomy 2). The mean duration of total vascular exclusion was 19.35 +/- 19.32 minutes and mean blood transfusion requirement was 7 +/- 4.5 units during surgery.

[Determination of neuropeptide Y concentration in the cerebrospinal fluid in patients with cerebrovascular diseases and its significance]

Concentration of neuropeptide Y (NPY) in the cerebrospinal fluid (CSF) of patients with cerebrovascular diseases was measured by using radioimmunoassay. The results showed that NPY concentration in CSF in patients with hemorrhagic cerebrovascular diseases (HCVD) was 4148 +/- 397.2 pg/ml, being significantly higher than the control level of 1083.7 +/- 245.8 pg/ml. While the NPY concentration in CSF of patients with ischemic cerebrovascular diseases (ICVD) was 2214 +/- 289.2 pg/ml, being not significantly different from the level in the control group. The effect of NPY in vasospasm after HCVD was preliminarily discussed.

[Modified normothermic avascular hepatic resection]

The conventional Heaney's avascular hepatic resection was modified based on an experimental study on normothermic total hepatic vascular exclusion in dog. The modification was cancellation of simultaneous exclusion of the abdominal aorta and proper prolongation of total hepatic vascular exclusion time. The method was successfully used in 3 patients, 2 with primary hepatocellular carcinoma involving the second porta hepatis and 1 with a huge hepatic cavernous hemangioma in segments VII and VIII. The clinical application of this method is presented and discussed. The modified Heaney's technique, being simpler and safer than the conventional one, may increase the resection rate for central hepatic tumors (segments I, IV, V and VIII according to Couinaud's classification).

Experimental research on utilization of bioluminescent technique to substitute the current viability count for BCG vaccine

The possibility of using the bioluminescent (BL) technique to substitute the traditional viability count of colony forming units (CFU) of BCG vaccine was investigated. The results showed there is a significant dose-dependent correlation between the concentration of standard adenosine triphosphate (ATP) and ATP BL value. The ultrasonic-chloroform method designed by us yielded the best results. The correlation coefficient values (r) of BL of the liquid and lyophilized vaccine were found to be 0.8 155 and 0.8 484 respectively (P less than 0.05). The coefficient of variation (CV) between the BL value of different lots of ATP obtained was 3.2-4.4%, much lower than that of CFU (CV = 10.4-11.2%). The presence of bacterial clumps within the vaccine had great influence on the bacterial ATP value and on the CFU viability count. 2.8 fg of ATP was found in each CFU formed in the vaccine with clumps, while it was only 0.94 fg in the vaccine without clumps, indicating the superiority of the BL method. The BL method has shown a high sensitivity, good reproducibility and simplicity in handling with quick results and high accuracy. Therefore, we consider that the BL method can be used to substitute the CFU method.