[Poisonous substances and geographical distribution of poisoning in hospitalized children based on data from 25 hospitals in China from 2016 to 2020]

Objective: To investigate the poisonous substances and geographical distribution of poisoning in children in China. Methods: A cross-sectional study. The clinical data of 8 385 hospitalized children from January 2016 to December 2020 were extracted from the FUTang Updating Medical Records database. These children aged 0 to 18 years and were admitted due to poisoning. They were grouped according to age (newborns and infants, toddlers, preschoolers, school-age children, adolescents), place of residence (Northeast China, North China, Central China, East China, South China, Southwest China, Northwest China), and mode of discharge (discharge under medical advice, transfer to another hospital under medical advice, discharge without medical advice, death, other). The poisonous substance and causes of poisoning in different groups were analyzed. Results: Among these 8 385 children, 4 734 (56.5%) were male and 3 651 (43.5%) female, with a male-to-female ratio of 1.3∶1. The age was 3 (2, 7) years. The prevalence of poisoning was 51.8% (4 343/8 385) in toddlers, 16.5% (1 380/8 385) in adolescents, 14.8% (1 242/8 385) in preschoolers, 14.4% (1 206/8 385) in school-age children, and 2.5% (214/8 385) in newborns and infants. Drug poisoning accounted for 43.5% (3 649/8 385) and pesticide accounted for 26.8% (2 249/8 385). Drug poisoning was more common in adolescents (684/1 380, 49.6%) and toddlers (2 041/4 343, 47.0%); non-drug poisoning was more common in school-age children (891/1 206, 73.9%), of which carbon monoxide was mainly in newborns and infants (41/214, 19.2%) and food poisoning in children of school age (241/1 206, 20.0%). Regarding regional characteristics, drug poisoning was more frequent in South China (188/246, 64.2%) and non-drug poisoning was more frequent in Southwest China (815/1 123, 72.5%). For drugs, anti-epileptic drugs, sedative-hypnotic drugs and anti-Parkinson's disease drugs had a higher proportion of poisoning in North China (138/1 034, 13.0%) than that in other regions. For non-drug poisoning, pesticides (375/1 123, 33.3%), food poisoning (209/1 123, 18.6%) and contact with poisonous animals (86/1 123, 7.7%) were more common in Southwest China than in other regions; carbon monoxide poisoning was more common in North China (81/1 034, 7.6%) and Northwest China (65/1 064, 6.3%). In Central China, poisoning happened more in toddlers (792/1 295, 61.2%) and less in adolescents (115/1 295, 8.8%) than in other regions. Regarding different age groups, poisoning in adolescent happened more in Northeast China (121/457, 26.5%), North China (240/1 034, 23.2%), and Northwest China (245/1 064, 23.0%). The rate of discharge under medical advice, discharge without medical advice, and mortality rate within the 5 years were 77.0% (6 458/8 385), 20.8% (1 743/8 385), 0.5% (40/8 385), respectively. Conclusions: Poisoning is more common in male and toddlers. Poisonous substances show a regional characteristic and vary in different age groups, with drugs and insecticides as the most common substances.

[Lipoprotein apheresis in patients with familial hypercholesterolemia: a single center research]

Objective: We evaluated the safety and efficacy of lipoprotein apheresis (LA) in patients with familial hypercholesterolemia (FH) who can't reach low-density lipoprotein cholesterol(LDL-C) target goals with the maximal tolerated dose of lipid-lowering agents. Methods: This was a retrospective cross-sectional study. Between February 2015 and November 2019, patients with FH who were admitted in Fuwai hospital and treated with LA were consecutively enrolled. Based on intensive lipid-lowering agents, these patients received LA by double filtration plasma pheresis (DFPP) method. The changes of lipid levels such as LDL-C and lipoprotein(a)[Lp(a)] were compared before and after LA treatment, and the changes of immunoglobulin (Ig) concentration and LA-related adverse effects were also discussed. Results: A total of 115 patients with FH were enrolled in this study, of which 8 cases were homozygous FH and 107 cases were heterozygous FH. The age was (43.9±12.2) years and there were 75 (65.2%) males, and 108 (93.8%) with coronary artery disease. For pre-and immediately after LA treatment, the LDL-C was (5.20±2.94) mmol/L vs. (1.83±1.08) mmol/L, Lp(a) concentration was 428.70(177.00, 829.50)mg/L vs. 148.90(75.90, 317.00) mg/L (P<0.001), with a decrease of 64.2% and 59.8% respectively. The levels of IgG and IgA measured 1 day after LA treatment were both in the normal range and IgM concentration was below the reference value, the reductions of which were 15.1%, 25.0% and 58.7% respectively (P<0.001). Six patients had mild symptoms of nausea, hypotension dyspnea and palpitation, the symptoms were relieved by symptomatic treatment. Conclusion: For patients with FH who do not achieve LDL-C target goal with the maximal tolerated lipid-lowering agents, especially those with elevated Lp(a) levels, LA, which can significantly further reduce LDL-C and Lp(a) levels, is an effective and safe option.

[Exploratory study on detection of drug resistance of Mycobacterium tuberculosis in sputum specimens by next-generation sequencing]

Objective: To compare the diagnostic performance of next-generation sequencing (NGS) detection methods in sputum samples and Mycobacterium tuberculosis strains, in order to explore the feasibility of the NGS method to detect drug resistance in sputum specimens. Methods: In this retrospective study, the sputum specimens and corresponding clinical isolates of 50 pulmonary tuberculosis patients admitted to Beijing Chest Hospital from January 2017 to December 2017 were collected. The gene mutations of katG, inhA, rpoB, embA, embB, rpsL, rrs, gyrA, gyrB and tlyA in sputum specimens and corresponding clinical isolates were detected by NGS method. The phenotypic drug susceptibility test (DST) of the strains was carried out by the proportion method. Using DST results as a reference, the sensitivity, specificity, positive predictive value and negative predictive value of the NGS method for clinical strains and sputum specimens, as well as the consistency statistic (Kappa) with phenotype DST were calculated respectively. The Chi-square test was used to compare the accuracy of the NGS testing in sputum samples and strain samples. Results: The results showed that rpoB(63.83%, 30/47) and rrs(57.45%, 27/47) were the most common mutated genes, followed by katG(46.81%, 22/47), rpsL(29.79%, 14/47), gyrA(27.66%, 13/47), embB(21.28%, 10/47), tlyA(12.77%, 6/47), gyrB(8.51%, 4/47), and inhA promoter(19.15%, 9/47), embA promoter region (12.77%, 6/47) mutation. when the NGS method was compared with the resistance phenotype of isoniazid, rifampicin, ethambutol, second-line injectable drugs (streptomycin, capreomycin, kanamycin, amikacin), levofloxacin, the sensitivity were 85.71%, 91.67%, 77.78%, 81.82%, 100.00%, 87.50%, 100.00%, 69.23%, and the specificity were 100.00%, 94.12, 87.50%, 89.47%, 97.06%, 96.97%, 94.29%, 89.29% in sputum samples, while in strain samples, the sensitivity were 92.86%, 100.00%, 81.82%, 86.96%, 88.89%, 80.00%, 100.00%, 85.71%. The specificity were 100.00%, 92.86%, 87.10%, 94.74%, 100.00%, 100.00%, 97.14%, 92.86%. Compared with the phenotypic drug susceptibility results, the NGS method has better detection performance for isoniazid, rifampicin, capreomycin, kanamycin, and amikacin in sputum specimens (Kappa≥0.75); while among the strains, the NGS method had a good detection performance for isoniazid, rifampicin, streptomycin, capreomycin, kanamycin, amikacin and levofloxacin (Kappa≥0.75). With the accuracy of the NGS method for detecting strains as a reference, there was no statistically significant difference in the accuracy of all drug resistance detected between strains and sputum specimens. Conclusions: This study showed that the NGS technology was effective in predicting the resistance of isoniazid, rifampicin, and second-line injectable drugs (capreomycin, kanamycin and amikacin) by detecting sputum samples and strain genotypes, suggesting the feasibility and potential of direct detection of sputum samples by the NGS method as an early detection method for drug resistance.

[Clinical characteristics and prognostic analyses of cervical neuroblastoma]

Objective: To determine the characteristics of cervical neuroblastoma and the effect of resection extent on survival and outcomes. Methods: We performed a retrospective review of 32 children with cervical neuroblastoma treated at Beijing Children's Hospital between April 2013 and August 2020. Data were collected from the medical record. The individualized therapy was designed based on staging and risk group. Based on the extent of resection, patients were divided into incomplete and complete resection groups. Event free and overall survival rates were compared between two groups using the Kaplan-Meier method. Results: The ages of patients ranged from 1 month to 81 months, with a median age of 11 months, including 7 males and 15 females. Twenty-nine patients (90.6%) presented with cervical painless mass. The average diameter of the primary tumors was (5.12±1.43) cm. Tumors were located in the parapharyngeal space in 25 cases (78.1%) and in the root of the neck in 7 cases (21.9%). None had MYCN amplification. According to International Neuroblastoma Staging System (INSS), 15 patients (46.9%) were identified as stage 1, 11 patients (34.3%) as stage 2B, 3 patients (9.4%) as stage 3 and 3 patients (9.4%) as stage 4. There were 12 patients (37.5%) at low risk, 17 patients (53.1%) at intermediate risk and 3 patients at high risk according to Children's Oncology Group (COG) risk classification system. All patients underwent tumor resection. Postoperatively Horner's syndrome occurred in 13 patients (40.6%), pneumonia in 9 patients (28.1%), pharyngeal dysfunction in 8 patients (25.0%) and transient hoarseness in 4 patients (12.5%). At a median follow-up of 36.5 months, the overall survival rate was 96.4%, with no significant difference between incomplete and complete resection groups (100.0% vs. 96.3%, χ²=0.19, P=0.667); the event free survival rate was 78.1%, with a significant difference between the two groups (40.0% vs. 85.2%, χ²=6.71, P=0.010). Conclusions: Primary cervical neuroblastoma has a young onset age, mostly in low and medium risk groups, and represents favorable lesions with good outcomes after multidisciplinary therapy. Less aggressive surgery with preservation of important structures is recommended. Complete resection should not be attempted if it would compromise vital structures.

[Effectiveness of integrated schistosomiasis control in Changzhou City from 2015 to 2020]

OBJECTIVE

To evaluate the effectiveness of the integrated schistosomiasis control measures in Changzhou City from 2015 to 2020, so as to provide insights into the formulation of the strategy used to consolidate the schistosomiasis elimination achievements.

METHODS

The annual schistosomiasis control working report and integrated schistosomiasis control data were collected in Changzhou City from 2015 to 2020, and the prevalence of Schistosoma japonicum infections in humans and livestock and snail status were analyzed to evaluate the effectiveness of the integrated schistosomiasis control measures.

RESULTS

During the period from 2015 to 2020, a total of 112 061 person-time individuals received serological tests for S. japonicum infections in Changzhou City, and the sero-prevalence was 0.15% to 1.09% during the 6-year period, with a significant difference seen among years (χ² = 288.11, P < 0.05). From 2015 to 2020, a total of 13 435 person-time individuals received stool examinations, with no egg-positives identified; among 5 840 herd-time livestock receiving schistosomiasis examinations, no positives were detected, while a 100% coverage of fencing livestock was seen each year. During the 6-year period, a total of 38.40 hm² snail habitats were found, including 8.97 hm² emerging snail habitats, and among the 2 344 snails dissected, no S. japonicum infection was found. Chemical treatment covered an area of 385.71 hm², and environmental improvements covered an area of 200.39 hm². The mean density of living snails was less than 0.1 snails/0.1 m² in snail habitats found in Changzhou City each year from 2015 to 2020, and the coverage of harmless toilets was 100% in 2020. During the 6-year period, a total of 3.740 6 million person-time individuals were given schistosomiasis health education in Changzhou City.

CONCLUSIONS

Changzhou City is now at the post-elimination surveillance stage; however, there are still factors affecting schistosomiasis transmission. The schistosomiasis surveillance system remains to be improved to consolidate the schistosomiasis elimination achievements in Changzhou City.

[Analysis of a pedigree with inherited factor V deficiency caused by compound heterozygous mutation]

Objective: To explore the molecular pathogenesis of a family with hereditary factor Ⅴ (FⅤ) deficiency. Methods: All the exons, flanking sequences, 5' and 3' untranslated regions of the F5 of the proband, and the corresponding mutation sites of the family members were analyzed via direct DNA sequencing. The CAT measurement was used to detect the amount of thrombin produced. The ClustalX software was used to analyze the conservation of mutation sites. The online bioinformatics software, Mutation Taster, PolyPhen-2, PROVEAN, LRT, and SIFT were applied to predict the effects of mutation sites on protein function. The Swiss-PdbViewer software was used to analyze the changes in the protein model and intermolecular force before and after amino acid variation. Results: The proband had a heterozygous missense mutation c.1258G>T (p.Gly392Cys) in exon 8 of the F5, and a heterozygous deletion mutation c.4797delG (p.Glu1572Lys fsX19) in exon 14, which results in a frameshift and produces a truncated protein. Her grandfather and father had p.Gly392Cys heterozygous variation, whereas her maternal grandmother, mother, little aunt, and cousin all had p.Glu1572LysfsX19 heterozygous variation. The ratio of proband's thrombin generation delay to peak time was significantly increased. Conservation analysis results showed that p.Gly392 was located in a conserved region among the 10 homologous species. Five online bioinformatics software predicted that p.Gly392Cys was pathogenic, and Mutation Taster also predicted p.Glu1572Lys fsX19 as a pathogenic variant. Protein model analysis showed that the replacement of Gly392 by Cys392 can lead to the extension of the original hydrogen bond and the formation of a new steric hindrance, which affected the stability of the protein structure. Conclusion: The c.1258G>T heterozygous missense mutation in exon 8 and the c.4797delG heterozygous deletion mutation in exon 14 of the F5 may be responsible for the decrease of FⅤ levels in this family.

Effects of physical forms of starter feed on growth, nutrient digestibility, gastrointestinal enzyme activity, and morphology of pre- and post-weaning lambs

The physical form of starter feed may affect the gastrointestinal development and the performance of ruminant. However, little information is available on how changes in the physical forms of starter feed influence the performance of lambs, especially during the pre- and post-weaning periods. The aim of this study was to investigate the effects of different physical forms of starter feeds on growth performance, nutrient digestibility, gastrointestinal enzyme activity, and morphology of pre- and post-weaning lambs. Twenty-four 8-day-old male Hu lamb (5.04 ± 0.75 kg BW) were randomly assigned to one of two dietary treatments: 1) a pelleted starter (PS) feed and 2) a textured starter (TS) feed, which included coarse mashed steam-flaked corn. From eight to thirty-five days of age (pre-weaning), the lambs were bottle-fed milk replacer (MR) at 2% of BW measured on day 8. All lambs were weaned at day 35 when feeding of MR was stopped. Six lambs for each treatment were euthanized at 21 or 42 days of age for sampling. The following results are obtained by variance analysis: TS lambs had a greater (P < 0.05) final BW, higher apparent digestibility of starch and ether extract, activities of α-amylase pre- or post-weaning, and higher (P < 0.05) average dry matter intake and lipase post-weaning in small intestine contents and had a trend of significantly higher average daily gain post-weaning (P = 0.07). Rumen development analysis of TS lambs showed a significantly higher (P < 0.05) relative weight of rumen post-weaning, greater papillae length, increased circular and layered muscle, increased sectional area pre- and post-weaning, and increased rumen papillae width post-weaning. Textured starter treatment increased the villus height and villus width (except jejunum pre-weaning) of the whole small intestine and villus height to crypt depth ratio of jejunum and ileum during the whole period and tended to increase the relative weight of the rumen pre-weaning (P = 0.07). The results indicated that TS feeding is more beneficial to lambs over the weaning transition than PS in promoting gastrointestinal development, intestinal enzyme activities, nutrient digestibility, and growth performance. The findings provide new insights into the selection of physical forms of starter feeds in lamb production. Further research with more animals and female lambs is needed to obtain a more complete conclusion.

[Pepsin and bile acids detection in saliva for the diagnosis of gastroesophageal reflux disease]

Objective: To identify the value of the detection of pepsin and bile acids in saliva for the diagnosis of gastroesophageal reflux disease(GERD). Methods: From January 2018 to June 2019, 104 GERD patients and 43 healthy people in Guangdong Provincial People's Hospital were recruited. The 104 patients of GERD group were divided into four sub-groups, including esophageal symptoms GERD group, extraesophageal symptoms GERD group, anxiety or depression group, non-anxiety and non-depression group. Saliva was collected on waking in morning and 2 h after finishing lunch. The concentration of the total pepsin(TPP) and total bile acids(TBA) from saliva was detected by ELISA method. Receiver operating characteristics analysis was used to identify the sensitivity and specificity of the saliva pepsin and bile acids detection. Results: The concentration of TPP in morning waking samples and postprandial samples in the GERD group was 27.1(9.7,50.3) μg/L and 32.4(14.0,58.7) μg/L, the concentration of TBA in postprandial samples was (18.4±2.3)μmol/L, and these levels were significantly higher than that of the control group [7.0(5.1, 9.1) μg/L, 7.4(5.2, 9.4) μg/L, (12.6±5.0)μmol/L](P<0.01). The concentration of TBA in morning waking samples had no significant difference between these two groups(P>0.05). The concentration of TPP and TBA had no significant difference among the four GERD sub-groups(P>0.05).Pepsin in postprandial saliva samples had moderate diagnostic value for GERD, when the saliva pepsin concentration in postprandial samples was higher than 41.33 μg/L, it had a sensitivity of 82.8% and a specificity of 73.3%. The bile acids in saliva had no significant diagnostic value for GERD. Conclusions: Pepsin detection in saliva has a high level of sensitivity and specificity for diagnosing GERD. However, bile acids in saliva has no significant diagnostic value for GERD.

P3645Prognosis in relation to high-sensitivity C-reactive protein levels in patients with non-obstructive coronary artery disease

Background

It has been reported that coronary artery disease (CAD) is characterized by inflammation and non-obstructive CAD (NOCAD) increases the risk of cardiovascular events (CVEs) compared with ones with normal or near-normal coronary arteries (NNCA), even is similar to obstructive CAD (OCAD). We hypothesized that elevated high-sensitivity C-reactive protein (hs-CRP) may be linked to CVEs in those patients with NOCAD.

Purpose

To investigate the predictive role of hs-CRP in patients with NOCAD.

Methods

Of 7,746 consecutive patients with angina-like chest pain admissions, 4,662 eligible patients were enrolled who received coronary artery angiography (CAG) and followed up for the CVEs comprising all-cause mortality, myocardial infarction, stroke and late revascularization. According to the results of CAG, the patients were classified as NNCA group (<20% stenosis, n=698, 15.0%), NOCAD group (20–49% stenosis, n=639, 14.3%), and OCAD group (≥50% stenosis, n=3325, 70.7%). They were further subdivided into 3 groups according to baseline hs-CRP levels (<1, 1–3 and >3 mg/L). Proportional hazards models were used to assess the risk of CVEs in all patients enrolled.

Results

A total of 338 patients (7.3%) experienced CVEs during an average of 13403 person-years follow-up. Patients with NOCAD and OCAD had higher rates of CVEs compared to those with NNCA (p<0.05, respectively). In Cox's models after adjustment of confounders, the risk of CVEs elevated with the increasing degrees of CAD with hazard ratio of 2.01 [95% confidence interval (95% CI): 1.07–3.79, p=0.03] for patients with NOCAD and 2.81 (95% CI: 1.60–4.93, p<0.001) for patients with OCAD compared with the NNCA group. Moreover, elevated hs-CRP levels were associated with the severity of coronary lesions and an elevated increased risk of CVEs in patients with NOCAD and OCAD compared those with NNCA (p<0.05, respectively).

Conclusions

Patients with NOCAD had indeed worse outcomes and hs-CRP levels were positively in relation to the CVEs in those with NOCAD, which may help to the risk assessment in ones with NOCAD.

Acknowledgement/Funding

This study was partly supported by Capital Health Development Fund (201614035) and CAMS Innovation Fund for Medical Sciences (2016-I2M-1-011) awarded

P650Lipopolysaccharide-nuclear factor-kappa B pathway and lipoprotein apheresis effects in patients with familial hypercholesterolemia and coronary artery disease

Background

Inflammation may play an important role in atherosclerosis in familial hypercholesterolemia (FH). Lipopolysaccharide (LPS)-nuclear factor-kappa B (NF-κB) pathway is a routine signal process activated in inflammatory status.

Purpose

This study aimed to examine the LPS-NF-κB axis status and the impact of lipoprotein apheresis (LA) on this pathway in patients with FH and coronary artery disease (CAD).

Methods

In this matched case-control study a genetically diagnosed FH cohort who presented stable CAD (n=63) was compared with 63 non-FH CAD and 63 non-FH non-CAD controls matched by sex and age. Plasma LPS levels and NF-κB activity were compared among the three groups. In addition, we studied in vitro LPS-induced interleukin-6 (IL-6) production by mononuclear cells from 16 FH cases without previous statin use and compared them with their respective matched control groups. Subsequently, these 16 FH patients underwent LA. Blood samples were taken immediately before and regularly after LA for measuring LPS and NF-κB.

Results

FH plus CAD had higher LPS levels and NF-κB activity than CAD and non-CAD controls (all p values <0.01). LPS-induced IL-6 production by mononuclear cells of FH plus CAD was also much higher compared with CAD and non-CAD controls (both p values <0.01). Moreover, plasma LPS levels (p<0.001) and NF-κB activity (p<0.01) were dramatically reduced after apheresis in FH patients.

Conclusion

Genetically confirmed FH patients with CAD had a marked activation of LPS-NF-κB axis, while LA significantly attenuated this key inflammatory pathway, suggesting that inflammation may be an important therapeutic target for FH patients.

P848Prevalence and Prognosis of Familial Hypercholesterolemia (FH) with Acute Myocardial Infarction (AMI) in China: Chinese Acute Myocardial Infarction (CAMI) Registry

Background

The prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China is unclear.

Purpose

To invistigate the prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China.

Methods

In China Acute Myocardial Infarction (CAMI) Registry, 13,002 patients with age 18–80 were consecutively enrolled with first-onset acute myocardial infarction who were naïve to statin before admission from Januanry 1st, 2013 to October 31st, 2014. According to Dutch Lipid Clinical Network Criteria (DLCNC), the patients were divided to heterozygous familial hypercholesterolemia (HeFH) (definite or probable HeFH, possible HeFH) or no HeFH group. All the patients were followed up (average follow-up period, 24 months) and composite major adverse cardiovascular events (ENDPOINT) were recorded which were defined as all-cause death, non-fatal myocardial reinfarction and stroke. Cox regression was performed to analyze the difference of composite endpoint occurrence between HeFH group and no HeFH group.

Results

The number of the patients in the three groups was as following, 62 in definite or probable HeFH group, 484 in possible HeFH group, 12456 in no HeFH group. The prevalence of HeFH is 4.2% (including 0.47% of definite or probable HeFH, 3.73% of possible FH). The average age of onset of first-time AMI was 54±12,56±12,63±12 years old (p<0.0001) in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. The percentage of Killip III or above (8.1% vs 4.3% vs 6.3%, p=0.1629), cardiac arrest (1.6% vs 0.6% vs 0.9%, p=0.6990), and TIMI 0–2 grade after primary percutaneous cardiac intervention (PCI) (0% vs 6.8% vs 4.3%, p=0.5866) was not significantly different in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. After Cox proportional analysis adjusting multiple factors, the rate of composite endpoint during follow-up period was not significantly different (definite or probable HeFH group vs no HeFH group, HR 0. 853, 95% CI 0.381–1.910, p=0.699, possible HeFH group vs no HeFH group, HR1.076, 95% CI 0.795–1.458, p=0.635).

The prognosis of FH with AMI in China

Conclusions

In CAMI Registry, the prevalence of HeFH was 4.2%, the diagnosis of HeFH was not a dependent risk factor for the rate of composite cardiovascular events.

P2248Impact of Lipoprotein (a) levels on the presence and severity of coronary artery disease in female patients: a large cross-sectional Chinese cohort study

Background

Lipoprotein (a) [Lp(a)] is recently recognized as a risk factor of atherosclerosis, and the development of coronary artery disease (CAD) in women is not fully understood.

Purpose

The present study aimed to examine the association of Lp(a) levels with the presence and severity of (CAD) in female patients pre- and post-menopause.

Methods

A total of 3712 female patients who received coronary angiography were consecutively enrolled. The level of Lp(a) was measured and compared among patients with and without CAD or myocardial infarction (MI), pre- or post- menopause. The association of Lp(a) with the presence of CAD and the severity of coronary atherosclerosis assessed by Gensini Score were examined.

Results

The average of Lp(a) levels were elevated as age increased in female subjects. Notably, women after menopause had higher Lp(a) levels compared with that before menopause [16.8 mg/dL (IQR 7.54–41.12 mg/dL) vs. 14.7 mg/dL (IQR 6.72–30.82 mg/dL), p=0.002]. Furthermore, multiple logistic regression analysis identified that Lp(a) >30mg/dL was an independent risk factor of CAD in the postmenopausal female (OR1.38, 95% CI 1.13–1.69, p=0.002). Finally, Lp(a) had a positive correlation with Gensini score (r=0.11, p<0.001), and Lp(a) >30mg/dL was an independent risk factor for high Gensini score (OR 1.43, 95% CI 1.14–1.79, p<0.001). While such results were not observed in the premenopausal females.

Baseline characteristics of all patients Before menopause (n=525) Post menopause (n=3187) P value Age, (years) 46 (42–49) 62 (58–68) <0.001* Hypertension, n (%) 231 (44.00) 2097 (65.80) <0.001* Diabetes mellitus, n (%) 68 (12.95) 849 (26.64) <0.001* LDL-C (mmol/L) 2.73±1.05 2.77±0.99 0.366 Lp(a) (mg/dL) 14.7 (6.72–30.82) 16.8 (7.54–41.12) 0.002* Data are expressed as mean ± SD or median (interquartile range) and numbers (percentages). BMI, body mass index; TC, total cholesterol; TG, triglyceride; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein(a); HsCRP, high-sensitivity C-reactive protein. *Statistically significant differences exist between two groups. CAD, coronary artery disease.

Lp(a) in pre- and post-menopausal women

Conclusion

The present study indicated that circulating Lp(a) levels were independently associated with the presence and severity of CAD in the postmenopausal female, suggesting that further study may be needed to examine the role of Lp(a) in the development of CAD in female individuals with different menopausal status.

[Advances in surgical repair of ureteral injury]

Ureteral injury can be classified as iatrogenic or traumatic, which represents a rare but challenging field of reconstructive urology. Due to their close proximity to vital abdominal and pelvic organs, the ureters are highly susceptible to iatrogenic injury, while ureteral injury caused by external trauma is relatively rare. The signs of ureteric injury are difficult to identify initially and often present after a delay. The treatment of ureteral injury, which is depended on the type, location, and degree of injury, the time of diagnosis and the patient's overall clinical condition, ranges from simple endoscopic management to complex surgical reconstruction. And long defect of the ureter presents much greater challenges to urologists. Ureterotomy under endoscopy using laser or cold-knife is available for the treatment of 2-3 cm benign ureteral injuries or strictures. Pyeloplasty is an effective treatment for ureteropelvic junction obstruction and some improved methods showed the possibility of repairing long-segment (10-15 cm) stenosis. Proximal and mid-ureteral injuries or strictures of 2-3 cm long can often be managed by primary ureteroureterostomy. When not feasible due to ureteral defects of longer segment, mobilization of the kidney should be considered, and transureteroureterostomy is alternative if the proximal ureter is of sufficient length. And autotransplantation or nephrectomy is regarded as the last resorts. Most of the injuries or strictures are observed in the distal ureter, below the pelvic brim, and are usually treated with ureteroneocystostomy. A non-refluxing technique together with a ureteral nipple or submucosal tunnel method, is preferable as it minimizes vesico-ureteral reflux and the risk of infection. In order to cover a longer distance, ureteroneocystostomy in combination with a psoas hitch (covering 6-10 cm of defect) or a Boari flap (covering 12-15 cm) is often adopted. Among various ureteral replacement procedures, only intestinal ureteral substitution, which includes ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance when urothelial tissue is insufficient. Ileal ureter can be used to replace the ureter of >15 cm defect and even to replace the entire unbilateral ureter or bilateral ureter. Laparoscopic and robotic-assisted techniques are increasingly being employed for ureteral reconstruction and adopted with encouraging results.

[Effect of long-chain non-coding RNA-AC024560.2 on proliferation and invasion of prostate cancer cells by targeted regulation of miR-30a-5p]

Objective: To investigate the regulation of long-chain non-coding RNA-AC024560.2 transfection on the expression of miR-30a-5p and its effect on proliferation and invasion of prostate cancer cells. Methods: qRT-PCR was used to detect the expression of AC024560.2 in 16 prostate cancer tissues and adjacent normal tissues, prostate cancer cell lines and normal prostate epithelial cells. The cells with the lowest expression amount were transfected, and the prostate cancer cells were divided into control group (transfected with negative control plasmid) and experimental group (transfected with plasmid carrying AC024560.2). Bioinformatics predicted possible target genes for AC024560.2. qRT-PCR was used to detect the expression of AC024560.2 and target genes in the transfected cells. Western blot was used to detect the expression of downstream target proteins. Cell proliferation and invasion were analyzed by MTS assay and Transwell invasion assay. Results: The expression levels of AC024560.2 in prostate cancer tissues and adjacent tissues were 1.95±0.22 and 3.87±0.23, respectively (t=6.09, P<0.01). Compared with normal prostate epithelial cells, the expression of AC024560.2 in prostate cancer cell lines was significantly decreased (P<0.05), and the most significant decrease was observed in C4-2B cell lines (P<0.01). Bioinformatics predictions showed that AC024560.2 bond to miR-30a-5p, and miR-30a-5p bond to SIRT1 mRNA. The expression of AC024560.2 in the experimental group increased significantly (P<0.01), the expression of miR-30a-5p decreased significantly (P<0.01), and the expression of SIRT1 mRNA and protein increased significantly (P<0.01). After transfection with AC024560.2, the cell proliferation ability of the experimental group was significantly decreased from day 2 (P<0.05). The invasive numbers of C4-2B cells in the control group and the experimental group were 130.90±14.54 and 43.77±10.01, respectively (t=4.94, P<0.01). Conclusions: AC024560.2 is lowly expressed in human prostate cancer, and may inhibit the proliferation and invasion of prostate cancer cells by regulating the expression of miR-30a-5p and SIRT1 genes. AC024560.2 may be a potential target for the treatment of prostate cancer.

Tumor suppressor RKIP inhibits prostate cancer cell metastasis and sensitizes prostate cancer cells to docetaxel treatment

Raf kinase inhibitory protein (RKIP) is a well-established metastasis suppressor that is frequently down-regulated in aggressive cancers. However, the impact of RKIP on cancer cell invasion and metastasis in prostate cancer is still elusive. To this end, we overexpressed RKIP in two prostate cancer cell lines. We found that overexpression of RKIP inhibited prostate cancer cells proliferation, migration and invasion. Mechanistically, we found that RKIP overexpression led to down-regula- tion of the NF-kB signaling pathway and inhibition of the epithelial-to-mesenchymal transition, which is important step for cancer metastasis. In addition, overexpression of RKIP can promote drug effects of docetaxel on prostate cancer cell lines. In conclusion, overexpression of RKIP significantly inhibits prostate cancer cell migration and metastasis, and overexpression of RKIP could aid prostate cancer treatment and therapy.

[Efficacy of mesenchymal stem cells on systemic lupus erythematosus:a meta-analysis]

OBJECTIVE

Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement and several typical autoantibodies. Mesenchymal stem cells (MSC) are multipotent stem cells with low immunogenicity that can differentiate into various kinds of cells, such as bone, cartilage, fat and skin tissue. MSC have immunomodulatory and reparative properties through interactions with immune cells. MSC have been used in the treatment of refractory SLE and lupus nephritis patients for more than ten years. Most clinical studies were self-controlled studies and only a few were randomized controlled trials. The objective of this study was to use meta-analysis method to evaluate the efficacy and safety of MSC treatment in SLE patients.

METHODS

The PubMed, Cochrane Library, Wanfang and VIP databases were searched for published randomized controlled trials and self-controlled studies before June 1, 2018. The search terms included the Chinese and English versions of mesenchymal stem cells, Mesenchymal Stromal Cells [Mesh], systemic lupus erythematosus, lupus, Lupus Erythematosus, Systemic [Mesh]. Two authors independently screened the literatures, assessed the quality of the studies and collected data according to the inclusion and exclusion criteria. The endpoints were the SLE disease activity index, 24 h urine protein and complement C3. Meta-analysis was performed with the Revman 5.3 software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard.

RESULTS

Eight studies involving 213 patients were included and three of the studies were randomized controlled trials with 66 patients involved. The MSC group showed that the SLE disease activity index decreased significantly [standard mean difference (SMD)=-1.76, 95% confidence interval (CI): -2.00 to -1.51, P<0.001), the 24 h urine protein decreased significantly (SMD=-1.74, 95%CI: -2.46 to -1.03, P<0.001), as well as the complement C3 increased significantly (SMD=1.28, 95%CI: 0.93 to 1.62, P<0.001). Four studies reported adverse events including fever, diarrhea and headache during the infusion.

CONCLUSION

Current evidences showed that MSC could improve the disease activity, proteinuria and hypocomplementemia in SLE patients. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of MSC treatment in SLE patients.

[Protective effect of picroside Ⅱ on the brain tissue through antioxidation in stroke rats]

Objective: To investigate the effect and mechanisms of picroside Ⅱ on the brain tissue after cerebral ischemia reperfusion(I/R) in rats. Methods: The middle cerebral artery occlusion(MCAO) rat model was established by inserting a monofilament into middle cerebral artery. The experimental rats were treated by injecting picroside Ⅱ intraperitoneally. The modified neurological severity score (mNSS) and body weight were determined before modeling and after reperfusion of 22 h. The cerebral infarct volume was measured by TTC staining and the cerebral water content was measured in rats. At the same time, ROS content and NADPH oxidase activity were detected. The structure of neurons was observed by electron microscope and the mRNA and protein levels of Rac-1 and Nox2 were detected by RT-PCR and Western blotting. Results: After modeling, the mNSS score was significantly increased (12.6±1.3 vs 0, P<0.001), while the body weight was lost (13.3%±2.5% vs 4.9%±0.8%, P<0.01). The cerebral infarct volume increased obviously (33.5%±3.4% vs 0, P<0.001), brain water content increased significantly (81.5%±0.9% vs 77.7%±0.9%, P<0.05) and the structure of neuron was damaged obviously. The protein and mRNA levels of Rac-1 and Nox2 were significantly increased (P<0.05). After treatment with picroside Ⅱ, mNSS score decreased significantly (7.9±0.8 vs 12.6±1.3, P<0.05) and the body weight increased obviously (9.3%±1.1% vs 13.3%±2.5%, P<0.05). The infarct volume of brain was significantly reduced (18.2%±1.9% vs 33.5%±3.4%, P<0.05), brain water content decreased obviously (79.1%±0.7% vs 81.5±0.9%, P<0.05), the morphological structures of neurons was restored, and the expressions of Rac-1 and Nox2 were significantly decreased (P<0.05). Conclusion: It is suggested that picroside Ⅱ could exert antioxidation to protect the brain tissue through inhibiting the expression of Rac-1 and Nox2.

[Application of single nucleotide polymorphism array in prenatal diagnosis for fetuses with abnormal ultrasound findings]

Objective: To investigate the value of single nucleotide polymorphism array (SNP-array) for fetuses with abnormal ultrasound findings. Method: A total of 904 fetuses with abnormal ultrasound findings were enrolled in this study from May 2015 to November 2017, and 434 (48.0%) cases received conventional karyotyping analysis at the same time. According to different abnormal ultrasound category, 904 cases were divided into 5 groups: 280 cases (31.0%) in single system structural anomalies, 31 cases (3.4%) in multiple system structural anomalies, 331 cases (36.6%) in single ultrasound soft marker abnormalities without structural anomalies, 107 cases (11.8%) in multiple soft marker abnormalities and 155 cases (17.2%) in structural abnormalities combined with soft markers abnormalities. Abnormal detection rates by SNP-array among 5 groups of abnormal ultrasound category were calculated. Result: (1) Total SNP-array results: 171 (19.0%) cases out of 904 cases analyzed by SNP-array, presented chromosomal abnormalities. Pathogenic copy number variants were detected in 27 cases (3.0%) and variants of unknown significance were detected in 81 cases (7.8%) . In addition, 7 cases (26.0%) were found with new mutation by parental validation. (2) SNP-array of 5 groups: among the 5 groups of abnormal ultrasound category, chromosomal abnormalities were identified by SNP-array in 19.3% (54/280) with single system structural abnormalities, 25.8% (8/31) with multiple system structural abnormalities, 13.9% (46/331) with single nonstructural anomalies, 19.6% (21/107) with multiple nonstructural anomalies and 27.1% (42/155) with structural abnormalities combined with nonstructural anomalies. The differences were significant (P=0.010) . No chromosome abnormalities was identified in single soft marker abnormalities, such as choroid plexus cysts, echogenic foci in the heart, single umbilical artery and pyelectasis. (3) Chromosomal abnormalities: the abnormal detection rate of aneuploidy chromosomal abnormalities by SNP-array increased with the maternal age, decreased with the gestational weeks (all P<0.05) . However, the pathogenic copy number variants and variants of unknown significance rates did not change with maternal age and gestational weeks (all P>0.05) . (4) SNP-array and karyotyping: 434 cases were analyzed by conventional karyotyping and SNP-array respectively, 10.3% (43/419) of which presented chromosomal abnormalities by conventional karyotyping and 18.7% (81/434) of which presented chromosomal abnormalities by SNP-array. Conclusions: SNP-array could be a useful genetic analysis method in prenatal diagnosis for fetuses with abnormal ultrasound findings. For different abnormal ultrasound category, SNP-array has different detection rate. Compared with conventional karyotyping analysis, SNP-array can improve the detection rates for chromosomal abnormalities and find the chromosome abnormalities which can't be detected by conventional karyotyping analysis. In clinical prenatal genetic counseling, SNP-array should be selected rationally in combination with the various abnormal ultrasound category.

[Colorectal resection combined with simultaneous radiofrequency ablation in the treatment of synchronous colorectal liver metastases: a retrospective analysis]

Objective: To compare the efficacy and safety of colorectal resection combined with simultaneous radiofrequency ablation (RFA) in the treatment of synchronous colorectal liver metastases(SCRLM). Methods: This retrospective study involved the patients admitted between January 1st 2010 and September 1st 2013. A total of 20 patients who underwent colorectal resection combined with simultaneous RFA of SCRLM were enrolled. Those patients (RFA group) were matched with 20 patients (Resection group) who underwent simultaneous resections of colorectal cancer and SCRLM based on the propensity scores. Perioperative parameters and survival outcomes were compared between the two groups. Results: The RFA and Resection groups were comparable in demographics, cancer characteristics and chemotherapy treatment (all P>0.05). The estimated blood loss and intraoperative blood transfusions in the RFA group were significantly lower than those in the resection group [150.00(100.00-200.00) vs 200.00(112.50-650.00), 1 vs 7, all P>0.05]. The postoperative stay in the RFA group was significantly shorter than that in laparoscopic group [8.50(8.00-10.75) vs 11.00(8.25-14.25), P=0.043]. There was no significant difference in postoperative complications (P>0.05). The 3-year disease free survival rate was 14.00% in the RFA group, and 31.20% in the Resection group (P=0.047). However, the 3-year overall rates were similar between the two groups (P>0.05). Conclusions: Compared with simultaneous resections of colorectal cancer and SCRLM resections, colorectal resection combined with simultaneous RFA of SCRLM was associated with less surgical blood loss and shorter hospitalization. Although inferior to simultaneous resections of colorectal cancer and SCRLM resections in survival outcomes, this approach extends the capability of delivering potentially curative treatment for colorectal cancer patients with unresectable SCRLM.

[Prevalence and clinical features of familial hypercholesterolemia in Chinese patients with myocardial infarction]

Objective: To analyze the prevalence and clinical features of familial hypercholesterolemia (FH) in Chinese patients with myocardial infarction (MI). Method: This retrospective study recruited a total of 2 119 consecutive patients (age (56.7±10.9) years old) undergoing coronary angiography with first MI from April 2011 to December 2016. Patients were divided into 2 groups: premature MI (male<55 years old, female<60 years old) and non-premature MI. The diagnosis of FH was established according to Dutch Lipid Clinic Network (DLCN) diagnostic criteria and referred as definite/probable FH in our study. The prevalence and clinical features of FH, including lipid level, MI characteristics and stain therapy, were explored. Multivariable logistic regression analysis was used to assess the predictive value of FH for the presence of premature MI. Results: The prevalence of definite/probable FH was 3.68% (78/2 119) in MI patients and 7.28% (68/934) in premature MI patients. Onset of MI occurred 10 years earlier in patients with definite/probable FH than those without FH ((47.9±9.4) years vs. (58.8±10.7) years, P<0.01). Additionally, we found that the risk of premature MI was significantly and independently increased in definite/probable FH patients (OR=5.32, 95%CI 2.77-10.22, P<0.01). None of FH patients reached the target of LDL-C<1.8 mmol/L under statin therapy. Conclusions: The prevalence of FH in Chinese patients with MI is not rare. Clinically, FH is linked with the early onset of MI.

Accumulation of High Levels of Monocytic Myeloid-Derived Suppressor Cells Enhances Graft Survival in Almost-Tolerant Kidney Transplant Recipients

BACKGROUND

Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature cells that suppress immune responses during organ transplantation and participate in mediating long-term graft survival and immune tolerance in animal transplant models. However, their role in regulating transplant tolerance in human subjects is not well understood. In the present study, we investigated the role of MDSCs in mediating long-term graft survival in almost-tolerant kidney transplant recipients (ATKTRs) and the mechanism(s) responsible for increasing MDSC numbers in these recipients.

METHODS

Peripheral blood mononuclear cells (PBMCs) from whole blood samples were collected from 30 ATKTRs (graft survival, > 10 years after kidney transplant [KTx]) treated with low doses of immunosuppressive drugs and with stable kidney function, 10 short-term graft survival kidney transplant recipients (STKTRs; graft survival, ∼1-3 years post-KTx) with stable kidney function, and 10 healthy donors (HDs). MDSC and regulatory T cell (Tregs) levels were analyzed using multicolor flow cytometry in PBMCs.

RESULTS

ATKTRs had significantly higher levels of monocytic MDSCs (P < .001) and CD4⁺CD25⁺FoxP3⁺ Tregs than STKTRs and HDs. Furthermore, the M-MDSC levels correlated positively with the survival rates, estimated glomerular filtration rates (eGFRs) of grafts, and the levels of CD4⁺CD25⁺FoxP3⁺ Tregs in ATKTRs.

CONCLUSIONS

Accumulation of high levels of MDSCs was observed in ATKTRs. Changes in MDSC levels may play important roles in mediating transplant tolerance and regulating Tregs. Therefore, we propose that MDSCs may be potentially used for recognizing tolerant transplant recipients and guiding dosage reduction for immunosuppressive drugs for KTx.

[Effect of picroside Ⅱ on the expression of mitochondrial VDAC1 after cerebral ischemia/reperfusion in rats]

Objective: To explore the effect of picroside Ⅱ on the expression of mitochondrial voltage-dependent anion channel 1 (VDAC1) in rats after cerebral ischemiareperfusion. Methods: A total of 70 Wistar rats models with middle cerebral artery occlusionreperfusion (MCAO/R) were randomly divided into the sham group, model group, picroside (Picr) group, ruthenium red (RuR) group, RuR+ Picr group, Spermine (Sper) group, Sper+ Picr group (n=10 per group). Modified neurological severity scale (mNSS) was used to evaluated the neurobehavioral function, the expression of reactive oxygen species (ROS) in brain tissues were measured by enzyme-linked immunosorbent assay (ELISA), the morphology of brain tissues was observed by hematoxylin-eosin (HE) staining, the apoptotic cells were counted by terminal deoxynucleotidyl transferase dUTP nick end labeling assay (TUNEL), and the expressions of VDAC1 and endonuclease G (EndoG) were determined by immunohistochemical assay and Western blot. Results: Compared with the shame group, the mNSS scores (9.6±1.9), the expression of ROS[(47.6±2.7)U/ml], the apoptosis of neuron(23.8±2.8), and the expressions of VDAC1(0.94±0.06) and EndoG in cytoplasm (0.76±0.06) and nuclei(0.75±0.06)were enhanced in the model group (all P<0.05). The Picr group had obviously decreased mNSS scores (5.7±0.9), ROS expression[(35.6±2.2)U/ml], number of apoptotic cells (14.5±2.1), VDAC1 (0.63±0.06) and EndoG in cytoplasm (0.34±0.05) and nuclei (0.31±0.06)expressions compared to the model group (P<0.05). Conclusion: Picroside Ⅱ could attenuate cerebral I/R injury by down-regulating the expression of VDAC1 and inhibiting the EndoG release from mitochondria into cytoplasm.

[Effect of BCYRN1 on proliferation and migration of airway smooth muscle cells in rat model of asthma]

Objective: To detect the effect of brain cytoplasmic RNA 1 (BCYRN1) on the proliferation and migration of airway smooth muscle cells (ASMCs) in rat model of asthma. Methods: Male SD rats were randomly divided into control group and asthma group (n=10 each). The ovalbumin (OVA) model was constructed in asthma group. Real time-qPCR was performed to detect the level of BCYRN1 in the ASMCs separated from the airway tissue of these rats. Then 2-(4-iodophenyl)-3-(4-nitrophenyl)-5-(2, 4-disulfophenyl)-2H-tetrazolium (WST-1) assay, roche real-time cell analyzer assay and Transwell cell migration assay were performed to detect the viability/proliferation and migration of ASMCs which were transfected with Ad-BCYRN1.Platelet-derived growth factor (PDGF)-BB was used to treat ASMCs to induce proliferation and migration, and the level of BCYRN1 was examined.The viability/proliferation and migration of ASMCs treated with PDGF-BB and transfected with si-BCYRN1 were detected. Inspiratory resistance and expiratory resistance were measured in rats with BCYRN1 knockdown.Briefly, rats were randomly divided into four groups: control (group A), sensitization + Ad-GFP (group B), sensitization + AdSM22α-siBCYRN1 (group C), control + Ad-SM22α-siBCYRN1 (group D) (n=10 each). The corresponding adenovirus vectors were sent to lung of group B, group C and group D through nasal spray. The OVA model was constructed in group B and group C. The rats in group A and group D were treated with saline.After 24 h of the last treatment with OVA or saline, rats of each group were given tracheal intubation, connected with breathing machine. Rats were injected with methacholine to measure the inspiratory resistance and expiratory resistance. Results: The level of BCYRN1 in ASMCs separated from rats in asthma group and in ASMCs treated with PDGF-BB was 3.60±0.45 and 3.53±0.35, respectively, significantly higher than those of the corresponding control (both P<0.01). Ad-BCYRN1 significantly increased the expression of BCYRN1 in ASMCs. The cell viability and proliferation rates of ASMCs transfected with Ad-BCYRN1 increased 1.75-and 1.47-fold compared to those of the control group, respectively (P<0.01); mobility increased 2.42-fold compared to that of the control group (all P<0.01). BCYRN1 knockdown reversed the increasing proliferation and migration of ASMCs induced by PDGF-BB. The cell proliferation rate and cell migration number in the PDGF-BB treatment group were (4.87±0.21)% and 80.00±5.00, respectively, which were significant higher than those in the si-BCYRN1 transfected group ((3.63±0.21)% and 25.33±2.52, all P<0.01). BCYRN1 knockdown reduced the inspiratory resistance and expiratory resistance in sensitization + Ad-SM22α-siBCYRN1 group. When the concentration of acetylcholine reached 1 mg/kg, the inspiratory resistance in the group A, group B, group C, and group D were 8.27±0.21, 25.40±0.56, 12.07±0.67 and 8.40±0.46 cmH₂O·s·ml^-1, and expiratory resistance were 13.30±0.56, 38.37±1.33, 16.40±0.56 and 13.40±0.46 cmH₂O·s·ml^-1, respectively (all P<0.01). Conclusion: Overexpression of BCYRN1 promotes the proliferation and migration of ASMCs in rat model of asthma.

[Nuclear export signal of androgen receptor regulated of androgen receptor stability in prostate cancer]

OBJECTIVE

To investigate the mechanisms of nuclear export signal of androgen receptor (NES^AR) in the regulation of androgen receptor (AR) protein expression and stability in prostate cancer.

METHODS

The green fluorescent protein fusion protein expression vectors pEGFP-AR(1-918aa), pEGFP-NES^AR (743-817aa), pEGFP-NAR (1-665aa) and pEGFP-NAR-NES^AR, and lysine mutants of NES^AR pEGFP-NES^AR K776R, pEGFP-NES^AR K807R and pEGFP-NES^AR K776R/K807R, were transiently transfected into prostate cancer cell line PC3. Fluorescence microscopy, Western blot and immunoprecipitation were used to detect NES^AR regulation of androgen receptor stability.

RESULTS

Under the fluorescence microscope, NES^AR-containing fusion proteins were cytoplasmic localization, and their fluorescence intensities were much weaker than those without NES^AR. The expression levels of NES^AR-containing fusion proteins were significantly lower than those without NES^AR. The half-lives of GFP-NES^AR and GFP-NAR-NES^AR were less than 6 h, while the expression of GFP and GFP-NAR was relatively stable and the half-life was more than 24 h in the presence of cycloheximide. The expression levels of GFP-NES^AR were significantly increased by proteasome inhibitor MG132 treatment in a dose-dependent manner; in contrast, MG132 did not show any significant effect on the protein levels of GFP. When new protein synthesis was blocked, MG132 could also prevent the degradation of GFP-NES^AR in the transfected cells in the presence of cycloheximide, while it had no significant effect on GFP protein stability in the parallel experiment. GFP immunoprecipitation showed that the ubiquitination level of GFP-NES^AR fusion protein was significantly higher than that of the GFP control. The mutations of lysine sites K776 and K807 in NES^AR significantly reduced the level of ubiquitination, and showed increased protein stability, indicating that they were the key amino acid residues of NES^AR ubiquitination.

CONCLUSION

NES^AR was unstable and decreased the stability of its fusion proteins. NES^AR was the target of polyubiquitination and mediated the degradation of its fusion proteins through the ubiquitin-proteasome pathway in prostate cancer cells. Our research provides a new way to regulate the level and/or activity of AR proteins, thus helping us understand the molecular mechanisms of AR degradation and strict control of AR in the progression to castration-resistance.

[Study of neuron-protective effect and mechanism of neuregulin1β against cerebral ischemia reperfusion-induced injury in rats]

Objective: Thecurrent study is to explore the neuron-protective mechanism of neuregulin1β (NRG1β) in a rat model of middle cerebral artery occlusion/reperfusion (MCAO/R) through inhibiting the c-Jun phosphorylation. Methods: After 24 h of MCAO/R (referring to Longa's method), neurobehavioral function was measured by modified neurological severity score (mNSS) test; the cerebral infarction volume was detected by triphenyltetrazolium chloride (TTC) staining; the blood brain barrier (BBB) permeability was measured by Evans Blue (EB); the neuron morphology of brain tissue was observed by Nissl stain; the ultra-structures of the neurons were observed by transmission electron microscopy (TEM); the apoptotic neurons were counted by in situ cell death detection kit colocalized with NeuN; the expressions of phospho-c-Jun was determined by immunofluorescent labeling and Western blot analysis. Results: Compared with the sham-operation rats, the rats receiving MCAO/R showed increased mNSS (9.7±1.2), cerebral infarction volume (41.4±3.0)%, permeability of BBB, deformation of neurons, ischemia-induced apoptosis (0.63±0.04), and enhanced expression of phospho-c-Jun protein (0.90±0.07) (all P<0.05). Our data indicated that NRG1β attenuated neurologic deficits (6.4±0.9), decreased the cerebral infarction volume (10.4±0.5), reduced EB extravasation (1.55±0.13) and the deformation of neurons, protected the ultra-structure of neurons, blocked ischemia-induced apoptosis (0.23±0.02), through down-regulated phospho-c-Jun expression (0.40±0.03) in MCAO/R rats (P<0.05). Conclusion: NRG1β exerts neuron-protective effects against ischemia reperfusion-induced injury in rats through inhibiting the c-Jun phosphorylation.

[The validity and reliability of simplified Chinese version of the pediatric sleep questionnaire for screening children with obstructive sleep apnea syndrome in Beijing]

Objective: To evaluate the validity and reliability of the simplified Chinese version of pediatric sleep questionnaire (PSQ) used in screening obstructive sleep apnea syndrome (OSAS) of children in Beijing. Methods: Children with snoring who presented to the Sleep Center of Beijing Children's Hospital between August 2014 and July 2015 and healthy children were included in the study. All children underwent PSG and then were divided into OSAS group and control group based on the PSG and their guardians were asked to complete the simplified Chinese version of PSQ that was formed by both translation from PSQ and retroversion to PSQ. Structure validity evaluation included confirmatory factor analysis which used Amos structural equation model and exploratory factor analysis which used principal component analysis. Predictive validity were measured with Logistic regression model. Internal reliability and test-retest reliability were evaluated by Cronbach 's alpha coefficient and intra-class correlation coefficient (ICC), respectively. The screening efficiency was evaluated by the receiver operating characteristic curve (ROC). Results: The study included 235 children aged 3-16 years old, 145 children of them with the age of (5.8±2.1) in OSAS group and 90 children with the age of (7.7±3.3) in control group. Confirmatory factor analysis indicated most items belonging to individual factors with load coefficient ≥ 0.5. Predictive validity analysis revealed 13 items positively related to the diagnosis of OSAS (all OR>1, all P<0.05). Cronbach's alpha coefficients were respectively 0.703 (overall reliability), 0.767 (breathing factor), 0.849 (sleepiness factor) and 0.689 (behavior factor). The test-retest ICC reliability was 0.986 (PSQ), 0.991 (breathing factor), 0.727 (sleepiness factor), and 0.870 (behavior factor) with P<0.05. In receiver operating characteristic curve, the area under curve of simplified Chinese version PSQ score was 0.922 with P<0.05 and the cutoff value of PSQ score was 7 in 22 items with the sensitivity of 0.776, specificity of 0.867, positive predictive value of 0.868 and negative prediction value of 0.774. Conclusions: The simplified Chinese version of PSQ is suitable to the screen of OSAS for the children in Beijing area with good reliability and validity. It also has acceptable sensitivity and specificity for screening children with OSAS when the cutoff score is 7 points.

[Perioperational management of gynecological cancer patients with severe internal medical complications: a serial of 37 clinical cases]

Objective: To evaluate the effectiveness and safety of perioperational management of gynecological cancer patients with severe internal medical complications. Methods: We collected 37 cases of gynecological cancer patients with severe internal medical complications who were hospitalized in Peking University First Hospital from Jan. 2010 to Nov. 2014. All of the cases were planned to move to ICU right after operation based on the preoperational assessment of anesthetist and physician. The median age was 69.4 years, and 25 cases (68%,25/37) of them were over 70 years old. The pathological types, preoperational complications, preoperational preparation, process of anesthesia and surgery, post-operational short-term morbidity were retrospectively analyzed. Results: (1) Pathological type: among 37 cases of gynecological cancer patients, 16 cases of endometrial cancer, 12 cases of ovarian cancer, 5 cases of vulvar cancer, 3 cases of uterine sarcoma and 1 case of fallopian cancer. (2) Preoperational complication: all the patients had more than 2 types of internal complications, 34 cases (92%, 34/37)of them had no less than 3 types of internal complications. The preoperational complications mainly included 25 cases of hypertension, 13 cases of coronary heart disease and 5 cases of arrhythmia, 5 cases of history of cerebral infarction or hemorrhage, 19 cases of diabetes and 1 case of obesity, 6 cases of allergic asthma and history of pulmonary embolism. (3) Preoperational preparation: medication were taken according to internal physicians to make blood pressure lower than 140/90 mmHg(1 mmHg=0.133 kPa), fasting blood glucose lower than 8.0 mmol/L, postprandial blood glucose lower than 10.0 mmol/L and cardiac function return to a generally normal status. (4) Process of anesthesia and surgery: 37 cases completed operation successfully after preoperational anesthetic assessment and internal medication. No perioperational death was observed. (5) Post-operational morbidity: 17 cases of post-operational short-term morbidity were observed before discharge, including 9 cases of poor wound healing, 5 cases of gastro-intestinal dysfunction and 3 cases of pulmonary infection. All of them were improved or cured. Conclusion: Surgery is safe and applicable to gynecological cancer patients with severe internal medical complications on the compressive management of anesthesia assessment, perioperational internal adjustment and post-operational multi-discipline treatment.

Factors Affecting the Enhancement Patterns of Intrahepatic Cholangiocarcinoma (ICC) on Contrast-Enhanced Ultrasound (CEUS) and their Pathological Correlations in Patients with a Single Lesion

Purpose: To investigate the factors that influence the enhancement patterns of intrahepatic cholangiocarcinomas (ICC) on contrast-enhanced ultrasound (CEUS) and analyze the correlations between the enhancement patterns on CEUS and pathological findings. Materials and Methods: Ninety-six patients with 96 pathologically confirmed ICCs underwent CEUS. CEUS images were retrospectively evaluated for tumor enhancement patterns in the arterial, portal and late phases. The arterial enhancement patterns were correlated with clinicopathological factors. The possible influencing factors were correlated with pathologic findings. Results: Thirty-six patients with ICC demonstrated rim-like enhancement, and 60 exhibited non-rim-like enhancement in the arterial phase on CEUS. The incidence of non-rim-like-enhancing ICCs was higher in patients with cirrhosis and chronic viral hepatitis than patients with no chronic liver disease (p = 0.001). The sizes of the ICCs with homogeneous hyper-enhancement were significantly smaller than those with inhomogeneous hyper-enhancement (p = 0.007). Arterial non-rim-like-enhancing ICCs showed higher microvessel density (MVD) and arterial density (AD) and less fibrous stroma and necrosis than rim-like-enhancing ICCs. Arterial inhomogeneous-enhancing ICCs had lower MVD and AD and much more fibrous stroma and necrosis than homogeneous-enhancing ICCs. Conclusion: The enhancement pattern of ICCs in the arterial phase on CEUS was affected by a liver cirrhosis and chronic viral hepatitis and tumor size. The amount of MVD, AD, fibrous stroma and necrosis in ICC tumors may be responsible for the difference in the enhancement patterns.

[Feasibility study of transplantation of penile corpus cavernosum and major pelvic ganglion in renal subserous region]

OBJECTIVE

To study the feasibility of transplantation of normal rat penile corpus cavernosum and major pelvic ganglion (MPG) into the renal subserous region of a Nu/Nu mouse based on allograft technology.

METHODS

Penile corpus cavernosum and MPG, harvested from Sprague-Dawley (SD) rats under sterile condition, were transplanted underneath the kidney capsule of Nu/Nu mice through the microsurgery instruments and surgery microscope. The histopathologic changes and cellular proliferation in the transplanted penile corpus cavernosum and MPG were then analyzed at the end of 1week and 4 weeks after transplantation. Histological staining and immunohistochemical staining were used to evaluate the main outcome measures.

RESULTS

After 1 week, the tissue morphology of the transplanted corpus cavernosum underneath the kidney capsule of Nu/Nu mice was consistent with normal penile corpus cavernosum, and blood could be observed in the penis cavernous sinus of the graft; after 4 weeks, the mophorlogy of the tranplanted corpus cavernosum near the kidney was consistent with normal penile corpus cavernosum, while fibrosis was noteworthy in the graft away from the kidney, but blood could still be seen in the penis cavernous sinus. After 1 week, the tissue morphology of the transplanted MPG was consistent with normal MPG, multiple islet-like cell clusters could be seen in the transplanted MPG in the renal subserous region, and angiogenesis could be observed near the kidney; after 4 weeks, a network of blood vessels was clearly visible away from the kidney, and islet-like cell clusters were still clearly observed in the transplanted MPG. In addition, ki67 positive cells were observed in the transplanted penile corpus cavernosum and MPG after 4 weeks of transplantation, which indicated that there was still cell proliferation activity in the grafts.

CONCLUSION

The transplanted corpus cavernosum and MPG underneath the kidney capsule of Nu/Nu mice could survive at least 4 weeks. Moreover, the inner structure of the transplanted corpus cavernosum and MPG was close to the normal tissue. The underlining mechanism may be related to the local microenvironment underneath the kidney capsule of Nu/Nu mice and the neovascularization in the transplanted grafts.

[Study on the reliability of CardioChek PA for measuring lipid profile]

OBJECTIVE

To evaluate the clinical correlation between the CardioChek PA analyzer (CCPA) and a clinical laboratory reference method to use for screening program purposes.

METHODS

Fasting blood samples were collected on 325 patients (age: 23-86 years). One venous sample was collected using a serum tube for the evaluation on a Beckman reference analyzer. A second venous sample was collected in a lithium heparin tube and was evaluated on the CCPA analyzer. Linear regression analyses and Bland-Altman method were performed for each measured analyte: total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), triglycerides (TG) and low density lipoprotein-cholesterol (LDL-C).

RESULTS

Our results demonstrated a good clinical agreement for TC, HDL-C, TG and LDL-C(97.0%, 92.9%, 92.4% and 83.7%)in comparison with the CCPA to the reference analyzer. The correlation coefficients were 0.875, 0.813, 0.910, 0.864, respectively. P values all < 0.001. There was no significant difference in the detection rate of hyperlipidemia in TC, HDL-C and LDL-C.

CONCLUSION

We have identified the pre-analytic phase as an important step to guarantee the quality of results and indicated that the CCPA is a reliable lipid point-of-care testing system that can be used for the application of clinical screening anywhere.

[Sclerotherapy for faciocervical lymphatic malformations under digital subtraction angiography in children]

Objective:To investigate the efficacy and advantages of fluoroscopy sclerotherapy treatment for the faciocervical lymphatic malformations (LMs) under digital subtraction angiography (DSA) in children. Method:Retrospective analysis of 48 cases of lymphatic malfromations who were treated with intratumoral injection of Pingyangmycin and iohexol under DSA and fluoroscopy, and followed up in Kunming children's hospital. Result:Forty-eight cases of children were treated 1 to 5 intratumoral injection of Pingyangmycin and iohexol that carried out under DSA and fluoroscopy. Follow up ranged from 6 to 18 months, 22 cases (45.83%) were cured, 19 cases (39.85%) were markedly effective, 5 cases (10.42%) were effective and 2 cases (4.17%) were ineffective. The total effective rate was 95.83% with no scarring, pigmentation and significant postoperative complications. Conclusion:Intratumoral injection of Pingyangmycin under DSA is an effective and safe method for treatment of lymphatic malformations in children and has the advantages of positioning accuracy, less damage, fewer complication and no influence on apperarence and function.

[Combination measurement of liver and spleen stiffness with portal vein width to evaluate risk of bleeding in esophageal and gastric varices patients]

OBJECTIVE

To evaluate the utility of combined liver stiffness measurement (LSM) and spleen stiffness measurement (SSM), by transient elastography, along with measurement of portal vein width (PVW) for evaluating risk of bleeding in patients with esophageal and gastric varices (EV).

METHODS

A total of 73 patients with cirrhosis who were treated in the Department of Gastroenterology of the Second Affiliated Hospital of Xi'an Jiaotong University between April 2014 and March 2015 were included in the study. Child-Pugh classifications were obtained, portal vein widths were measured by ultrasound, liver and spleen stiffness were measured by transient elastography using FibroTouch®. Patients were examined by electronic endoscopy, upper abdominal computed tomography and standard serum testing. The serum indexes of fibrosis (aspartate aminotransferase (AST) to platelet ratio index (APRI), and AST to alanine aminotransferase ratio (AAR)) were calculated. Patients were grouped according to the results of gastroscopy, with severe (EV) and high risk of bleeding comprising group A and no or mild-to-moderate EV and low risk of bleeding comprising group B. Statistical analysis was carried out with t-test for continuous variables and χ(2) test for categorical variables to first screen out variables different between groups then the correlation with severe EV was assessed by generating receiver operating characteristic (ROC) curves. Lastly, binary logistic regression was used to evaluate the performance of combined variables for diagnosing severe EV and their predictive value for risk of bleeding.

RESULTS

Group A and B showed significant differences for LSM, SSM and PVW (all P < 0.05). The cutoff values for diagnosing severe EV were 23.4 kPa for LSM, 40.3 kPa for SSM and 11.5 mm for PVW, with areas under the ROC curve (AUROC) as 0.655, 0.788 and 0.709 respectively. For combined measurements, the AUROC was 0.773 for LSM plus PVW and 0.840 for LSM plus PVW (with highest diagnostic performance).

CONCLUSIONS

Combination of SSM plus PVW measurement shows high diagnostic performance for evaluating severe EV, and better performance than LSM plus SSM plus PVW and LSM plus PVW, with good predictive value for risk of EV bleeding.

Maternal psychologic problems increased the risk of childhood atopic dermatitis

BACKGROUND

Little is known about the effect of postnatal maternal psychologic problems on the development of childhood atopic disorders.

OBJECTIVES

To assess the association between early life maternal psychologic problems and atopic dermatitis (AD) in children in a national birth cohort.

METHODS

We used multistage, stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth registration. Maternal psychologic problems and potential confounders were gathered by the standard questionnaire at 6 months old. At 3 years of age, information about the development of AD was assessed by International Study of Asthma and Allergies in Childhood via home interviews. Multiple logistic regression analysis was performed to estimate the association of postnatal maternal psychologic problems (postpartum depression (PPD) and maternal mental health index) and AD.

RESULTS

The prevalence of physician-diagnosed AD was 10.5%. PPD increased the risk of subsequent physician-diagnosed AD in children after adjusting for potential confounders and other maternal mental health index (aOR = 1.42, 95% CI = 1.21-1.66). We observed that the risk of AD associated with PPD was not confounded by other social demographic factors such as maternal AD, maternal education, family income, breastfeeding, day care, and number of siblings.

CONCLUSIONS

Postpartum depression increased the risk of childhood AD even when other maternal mental health index and social demographic factors are considered. Early intervention of PPD might be helpful for AD prevention.

[Feasibility study of transplantation of penile corpus cavernosum and major pelvic ganglion in renal subserous region]

OBJECTIVE

To study the feasibility of transplantation of normal rat penile corpus cavernosum and major pelvic ganglion (MPG) into the renal subserous region of a Nu/Nu mouse based on allograft technology.

METHODS

Penile corpus cavernosum and MPG, harvested from Sprague-Dawley (SD) rats under sterile condition, were transplanted underneath the kidney capsule of Nu/Nu mice through the microsurgery instruments and surgery microscope. The histopathologic changes and cellular proliferation in the transplanted penile corpus cavernosum and MPG were then analyzed at the end of 1week and 4 weeks after transplantation. Histological staining and immunohistochemical staining were used to evaluate the main outcome measures.

RESULTS

After 1 week, the tissue morphology of the transplanted corpus cavernosum underneath the kidney capsule of Nu/Nu mice was consistent with normal penile corpus cavernosum, and blood could be observed in the penis cavernous sinus of the graft; after 4 weeks, the mophorlogy of the tranplanted corpus cavernosum near the kidney was consistent with normal penile corpus cavernosum, while fibrosis was noteworthy in the graft away from the kidney, but blood could still be seen in the penis cavernous sinus. After 1 week, the tissue morphology of the transplanted MPG was consistent with normal MPG, multiple islet-like cell clusters could be seen in the transplanted MPG in the renal subserous region, and angiogenesis could be observed near the kidney; after 4 weeks, a network of blood vessels was clearly visible away from the kidney, and islet-like cell clusters were still clearly observed in the transplanted MPG. In addition, ki67 positive cells were observed in the transplanted penile corpus cavernosum and MPG after 4 weeks of transplantation, which indicated that there was still cell proliferation activity in the grafts.

CONCLUSION

The transplanted corpus cavernosum and MPG underneath the kidney capsule of Nu/Nu mice could survive at least 4 weeks. Moreover, the inner structure of the transplanted corpus cavernosum and MPG was close to the normal tissue. The underlining mechanism may be related to the local microenvironment underneath the kidney capsule of Nu/Nu mice and the neovascularization in the transplanted grafts.

Relation of resistin to proprotein convertase subtilisin-kexin type 9 levels in coronary artery disease patients with different nutritional status

OBJECTIVE

To investigate the association of resistin with proprotein convertase subtilisin-kexin type 9 (PCSK9) levels, another novel regulator of atherosclerosis, in the condition of coronary artery disease (CAD).

RESEARCH DESIGN AND METHODS

We prospectively enrolled a total of 356 consecutive stable CAD patients who were not treated with lipid-lowering drugs in the present study. The baseline clinical characteristics were collected. Plasma PCSK9 and resistin levels were determined by ELISA. The relationship between plasma PCSK9 and resistin levels was investigated.

RESULTS

Overall, plasma resistin exhibited a positive nonparametric correlation with PCSK9 levels (r = 0.123, p = 0.02). When the patients were classified into groups based on body mass index (BMI), the resistin correlated significantly to the PCSK9 levels in patients with BMI < 25 kg/m(2) (r = 0.162, p = 0.026) but not in patients with BMI ≥ 25 kg/m(2) (r = 0.087, p = 0.205). Multivariate regression analysis corroborated the relation between the PCSK9 and an elevated resistin level in patients with BMI < 25 kg/m(2) independently of traditional parameters including age, sex, BMI, smoking, family history of CAD, systolic blood pressure, glucose, low density lipoprotein cholesterol, white blood cell, neutrophil to lymphocyte ratio, and high-sensitive C-reactive protein.

CONCLUSIONS

Plasma resistin was positively related to PCSK9 levels in CAD patients with normal weight, suggesting that the circulating resistin might represent a link with PCSK9 level variations in CAD progression of normal body weight.

Prenatal air pollutant exposure and occurrence of atopic dermatitis

BACKGROUND

Hereditary and environmental factors have been related to the occurrence of atopic dermatitis (AD) in early childhood. However, the role of prenatal and early postnatal exposure to air pollutants has not been totally elucidated.

OBJECTIVES

To evaluate the association between prenatal air pollutant exposure and occurrence of AD.

METHODS

In total 24 200 infant-mother pairs were recruited to participate in the Taiwan Birth Cohort Study in 2005 using multistage stratified sampling. Medical history, including physician-diagnosed AD, was inquired by questionnaire at the infant's age of 6 months. Monthly averages of five criteria air pollutants - NO2 , CO, O3 , SO2 and PM10 - were retrieved from 66 air-quality-monitoring stations, and interpolated to all administrative districts using the kriging method. Exposure data during each of the three gestational trimesters and three months after birth were calculated for each study subject, and odds ratios (ORs) of AD occurrence were calculated by logistic regression.

RESULTS

Among the participants, 16 686 mother-infant pairs were qualified for and included in the analysis. Among them, 1206 infants (7·2%) had been diagnosed as having AD before the age of 6 months, and the prevalence was higher in boys (8·3%) than in girls (6·1%). The occurrence of AD was significantly associated with CO exposure during the whole gestational period [adjusted OR (aOR) 1·37, 95% confidence interval (CI) 1·06-1·78] and the first trimester (aOR 1·51, 95% CI 1·16-1·97). We did not observe any significant association among the other air pollutants during either the whole gestational period or any period of the three trimesters and 3 months after birth.

CONCLUSIONS

Our study found a relationship between AD occurrence and gestational exposure to CO, where exposure during the first trimester seemed to be the most important.

Monocyte/macrophage β2-AR as a target of antisympathetic excitation-induced atherosclerotic progression

The aim of this study was to determine whether monocyte/macrophage β2-AR could act as the therapeutic target of antisympathetic excitation-induced atherosclerotic progression. Cultivated human THP-1 cells were divided into different groups and incubated with isoprenaline, metoprolol, propranolol or β2-AR blocker for 24 h, together with oxidized low-density lipoprotein (ox-LDL). Afterwards, each group was analyzed for C-C chemokine receptor type 2 (CCR2) expression, monocyte chemotactic protein 1 (MCP-1) release into medium and cell migration ability. In the isoprenaline group, CCR2 protein level was increased, as well as the secretion of MCP-1, and cell motility was enhanced, in a concentration-dependent manner. Propranolol and ICI 118,551 significantly reversed the stimulatory effect of isoprenaline on THP-1 cells induced by ox-LDL, but only high concentrations of metoprolol interfered significantly with the action of isoprenaline (P < 0.05). Isoprenaline or a β-AR blocker could mediate through β2-AR, affecting MCP-1 secretion, CCR2 protein expression and cell migration capacity of THP-1 cells. Therefore, monocyte-macrophage β2-AR may act as a target of antisympathetic excitation-induced atherosclerotic progression.

Maternal employment and atopic dermatitis in children: a prospective cohort study

BACKGROUND

Considering the early onset of atopic dermatitis (AD), which most often arises in the first year of life, risk factors occurring very early in life must be considered. Little is known about the effects of maternal occupational exposure on the development of atopic disorders in children.

OBJECTIVES

The aim of this study was to evaluate associations between maternal employment and childhood AD.

METHODS

We used multistage stratified systematic sampling to recruit 24,200 mother-newborn pairs from the Taiwan national birth register. Information on maternal occupation categories, work stress, working time, shift work and potential confounders during pregnancy was gathered by questionnaires after birth. At 3 years of age, information on the development of AD was assessed by home interviews. Multiple logistic regression analysis was performed to estimate the association of maternal employment and AD.

RESULTS

Overall, 11,962 out of 19,381 mothers (61·7%) worked during pregnancy. The children of mothers who worked during pregnancy had an increased risk of AD compared with those whose mothers did not work [odds ratio (OR) 1·38, 95% confidence interval (CI) 1·25-1·53]. The children of mothers with a professional or technical occupation had a higher risk of AD (OR 1·64, 95% CI 1·44-1·87). The risk of AD was found to increase with maternal work stress during pregnancy in a dose-response manner (P(trend)<0·01). The mothers of children with AD had a longer working time than those without AD (P<0·0001). However, no significant association between AD and maternal shift work was found.

CONCLUSIONS

Working in professional or technical occupations increased the risk of childhood AD in addition to work stress during pregnancy.

Analysis of one year follow-up of women with cervical cytology report of atypical squamous cells and the diagnostic role of high-risk HPV infection

OBJECTIVE

To investigate the risk of developing cervical intraepithelial neoplasia grade 2 (CIN2) or greater disease in patients with cytology report of atypical squamous cells of undetermined significance (ASC-US) or cannot exclude high-grade atypical squamous cells (ASC-H) in one year follow-up.

STUDY DESIGN

Analysis of colposcopy-directed multiple cervical biopsies in all patients. Patients without CIN2 or greater diseases were tested for human papillomavirus (HPV) DNA at the enrollment and at 12th month and followed up by cytology at the 6th and 12th month. Patients with repeated abnormal results were subjected to colposcopy-directed biopsy.

RESULTS

A total of 894 ASC-US and 101 ASC-H patients were enrolled. The rate of CIN2 or greater disease was 14.2% in ASC-US group and 46.5% in ASC-H group, at the first test respectively. A total of 65.0% of patients in ASC-US have completed the study and 47.5% repeatedly showed abnormal cytology, while the same rates in ASC-H were 62.7% and 50%. Only four cases were diagnosed with CIN2 in ASC-US group. The rate of HPV DNA becoming negative was 54.9% and 51.5% for ASC-US and ASC-H, respectively.

CONCLUSIONS

The diagnosis rate of CIN2 or greater lesions in ASC-US and ASC-H patients was about 15% and 46.5%, respectively, within one year.

Correlation of cervical intraepithelial neoplasia with expressions of p16 and Ki67 in exfoliated cervical cells in fluid-based thin-layer samples

OBJECTIVE

To understand the correlation of cervical intraepithelial neoplasia (CIN) with the expressions of p16 and Ki67 in exfoliated cervical cells obtained by fluid-based thin-layer technology.

STUDY DESIGN

The distributions ofpl6 and Ki67 positive cells in 116 patients with cytologically diagnosed atypical squamous cells of undetermined significance (ASC-US) or human papilloma virus (HPV) positive were examined by immunocytochemistry. Data were analyzed by the rank sum test, crosstab test, and receiver operating characteristic (ROC) curves.

RESULTS

When the thresholds for p16 and Ki67 positive were set as 6.5 and 4.5 positive cells per 100 exfoliated cervical cells, respectively, the expressions of Ki67 and P16 are significantly higher in the exfoliated cervical cells of patients with CIN II or greater compared with those in patients with CIN I or less.

CONCLUSION

Immunocytochemical examination of p16 and Ki67 expressions in the exfoliated cervical cells of fluid-based thin-layer samples could be used for the detection of CIN II or greater.

Magnetic resonance imaging of cerebellar liponeurocytoma. A case report and review of the literature

Cerebellar liponeurocytoma is a rare benign neuroepithelial tumour. We describe the case of a 50-year-old man presenting with signs of increased intracranial pressure and cerebellar dysfunction. Magnetic resonance imaging showed a heterogeneous, well-circumscribed cerebellar mass with a predominant adipose content. Diffusion-weighted imaging showed an isointense mass with a hyperintense rim. Craniotomy demonstrated a soft grey mass with intratumoral bright patchy yellow areas. Histological and immunohistochemical findings indicated an advanced neuronal, glial and focal lipomatous differentiation with a low level of mitotic activity.

Association of HLA-DRB alleles and pulmonary tuberculosis in North Chinese patients

Human leukocyte antigen (HLA) plays a central role in the regulation of the immune response. HLA class II molecules are essential for T cell-mediated adaptive immunity and present peptide antigens to CD4(+) T cells. Because of its important role in the immune response and its high degree of polymorphism, the HLA system is associated with many diseases. We examined the polymorphisms of HLA-DRB alleles and the sequences of the HLA-DRB promoter region in 97 unrelated patients with pulmonary tuberculosis and in 62 unrelated normal controls of the Han nationality from North China, using PCR with sequence-specific primers and PCR direct sequencing. We found that the frequency of HLA-DRB1*15 was significantly higher in the pulmonary tuberculosis group than in the healthy control group. The P value was 0.001, and the odds ratio was 3.793. The pulmonary tuberculosis group had the same HLA-DRB1 promoter region sequences as the control group. We concluded that the HLA-DRB1*15 allele is associated with pulmonary tuberculosis in the Han nationality from North China. The HLA-DRB1 promoter region sequences had no association with the development of pulmonary tuberculosis.

Twelve-month follow-up detection of high-risk human papillomavirus (HPV) DNA for 93 cases with cervical intraepithelial neoplasia grade 2 or 3 (CIN 2-3) after a loop electrosurgical excisional procedure (LEEP)

PURPOSE

The purpose of this study was to follow-up cervical intraepithelial neoplasia grades 2 or 3 (CIN2/3) cases after a loop electrosurgical excisional procedure (LEEP) by liquid-based cytology (LBC) and detection of HPV DNA.

METHODS

LEEP was performed for the first diagnosed CIN2/3 cases. Six and 12 months after LEEP, LBC and HPV DNA detection were performed.

RESULTS

The number of cases with CIN2 accounted for 64.5% (60/93) of the total cases before LEEP. Six months post LEEP, the number of cases with normal LBC and negative HPV DNA accounted for 63.4% (59/93). Cases with abnormal LBC accounted for 17.2 (16/93), and cases with persistent positive HPV DNA accounted for 11.8% (7/93). Two cases had both persistent positive HPV DNA and abnormal LBC. A vaginal intraepithelial neoplasm (VAIN2) was found in one of the HPV DNA persistent positive cases. Twelve months post LEEP, 4.3% (8/93) of the cases were HPV DNA positive. Abnormal LBC was observed in four cases (of which 2 cases were HPV DNA positive) with normal LBC and negative HPV DNA at six months post LEEP.

CONCLUSION

HPV DNA examination is instrumental for the detection of VAIN.

Associations of beta2-adrenergic receptor genotypes and haplotypes with wheezing illness in Taiwanese schoolchildren

BACKGROUND

Increasing attention was focused on the beta2-adrenergic receptor gene (ADRB2), whose genetic variability has been implicated as a risk factor for asthma-related phenotypes. However, only a few studies reported the associations by utilizing haplotypic approaches. We therefore examined the relationship of childhood wheezing illness with polymorphisms at codons 16 and 27, and evaluated the influence of polymorphisms individually and in combination as haplotypes.

METHODS

We conducted a genetic case-control study comprising 215 wheezing children and 183 nonwheezing controls, all of whom were selected from 2524 fourth- to ninth-grade schoolchildren in southern Taiwan.

RESULTS

All participants were homozygous at the ADRB2 Thr164 locus. After controlling for possible confounders, ADRB2 Glu27 allele was significantly associated with wheezing illness in all genetic models, but the risks on Arg16Gly genotypes were inconclusive. Estimated frequencies for the three main hyplotypes were Arg16/Gln27 57.2%, Gly16/Gln27 35.3%, Gly16/Glu27 7.4% in wheezing children, and Arg16/Gln27 56.3%, Gly16/Gln27 32.2%, Gly16/Glu27 10.4% in controls. The protective effect of Gly16/Glu27 haplotype remained relative to all other ADRB2 haplotypes [adjusted relative risk (aRR) = 0.58; 95% confidence interval (CI) 0.35-0.97]. As compared with children without Gly16/Glu27 haplotype, those with Gly16/Glu27 haplotype had a significantly lower risk for wheezing illness (aRR = 0.56; 95% CI 0.33-0.99). The copy numbers of Gly16/Glu27 haplotype also showed a clear dose-response relationship on the decreased risks. No significant association was found with the prevalence of wheezing illness for other haplotypes.

CONCLUSION

We concluded that ADRB2 Glu27 allele and Gly16/Glu27 haplotype were significantly protective factors for wheezing illness in Taiwanese schoolchildren.

Neuro-mediators as predictors of paediatric atopic dermatitis

BACKGROUND

Attempts to identify predictors of atopic dermatitis (AD) have focused on genetic and immunologic factors. However, the role of neuro-mediators remains to be elucidated.

OBJECTIVE

To evaluate nerve growth factor (NGF) and vaso-active intestinal peptide (VIP) in predicting paediatric AD and assess their correlation with intrinsic and extrinsic types of AD.

METHODS

We performed a nested case-control study in the prospective Taiwan birth panel cohort study. Cord and maternal plasma and questionnaires were gathered at birth. During follow-up, we identified 40 available AD cases, which were matched to 80 unaffected controls chosen from this cohort. The concentrations of IgE, NGF, and VIP in cord and maternal plasma of these subjects were performed by ELISA. Receiver-operating characteristic (ROC) curves were generated to see how well each biomarker could predict AD.

RESULTS

The NGF levels were significantly higher in AD patients than controls (mean+/-SD: 65.47+/-44.45 vs. 49.21+/-12.18 pg/mL for cord plasma and 89.68+/-41.04 vs. 66.96+/-23.05 pg/mL for maternal plasma) (P<0.05). VIP levels were also higher but not statistically significant. Plasma NGF may be a better biomarker than IgE in detecting paediatric AD (area under the ROC curve=0.65 vs. 0.61 for cord plasma and 0.69 vs. 0.61 for maternal plasma). Maternal NGF levels were significantly higher in patients with both intrinsic (96.18+/-48.15 pg/mL) and extrinsic (86.18+/-37.23 pg/mL) types of AD compared with controls (66.96+/-23.05 pg/mL) (P<0.05). We assessed a significant correlation between self-reported stress during pregnancy and maternal NGF levels (r=0.22, P=0.02).

CONCLUSION

Our results suggest that NGF is a good alternative biomarker in predicting children with a risk of AD.