[Analysis of the effects of low/intermediate dose of coagulation factor Ⅷ on 30 adult patients with severe hemophilia A in a single center]

Objective: To evaluate the clinical effects of low- and intermediate-dose factor Ⅷ (F Ⅷ) prophylaxis in Chinese adult patients with severe hemophilia A. Methods: Thirty adult patients with severe hemophilia A who received low- (n=20) /intermediate-dose (n=10) F Ⅷ prophylaxis at Nanjing Drum Tower Hospital affiliated with Nanjing University Medical College were included in the study. The annual bleeding rate (ABR), annual joint bleeding rate (AJBR), number of target joints, functional independence score of hemophilia (FISH), quality of life score, and health status score (SF-36) before and after preventive treatment were retrospectively analyzed and compared. Results: The median follow-up was 48 months. Compared with on-demand treatment, low- and intermediate-dose prophylaxis significantly reduced ABR, AJBR, and the number of target joints (P<0.05) ; the improvement in the intermediate-dose prophylaxis group was better than that in the low-dose prophylaxis group (P<0.05). Compared with on-demand treatment, the FISH score, quality of life score, and SF-36 score significantly improved in both groups (P<0.05), but there was no significant difference between the two groups (P>0.05) . Conclusion: In Chinese adults with severe hemophilia A, low- and intermediate-dose prophylaxis can significantly reduce bleeding frequency, delay the progression of joint lesions, and improve the quality of life of patients as compared with on-demand treatment. The improvement in clinical bleeding was better with intermediate-dose prophylaxis than low-dose prophylaxis.

[Tracing investigation and analysis of a Clostridium botulinum food poisoning incident in Bayingolin Mongolian Autonomous Prefecture, Xinjiang]

To analyze a suspected case of Clostridium botulinum food poisoning in Bayingolin Mongolian Autonomous Prefecture, Xinjiang and to help validating the diagnosis and providing technical support for clinical treatment. The basic information and clinical manifestations of food poisoning cases were investigated by using the epidemiological method of food safety accidents. The botulinum toxin genes in the samples were detected by real-time PCR and inoculation of KM mouse. The enriched bacteria were further purified and validated. PFGE and cluster analysis were performed on five isolates. Clostridium botulinum type A was detected in two homemade fermented bean samples and stool lavage fluid samples of three patients from enriched samples by toxin test and real-time PCR, and were further validated after isolation of Clostridium botulinum. PFGE showed 100% homology among five isolates. Five isolates of bacteria isolated from the stool lavage fluid of three patients and two homemade fermented bean curd were identified as the same source through PFGE. The cause of this food poisoning cases is food pollution of Clostridium botulinum type A.

Lipid status and linear relationship between total cholesterol and triglycerides in glycogen storage disease type I

OBJECTIVE

Glycogen storage disease type Ia (GSDIa) is a glucose metabolic disorder. GSDIa patients are characterized by hypoglycemia, hepatomegaly, hyperlipidemia, and hyperlactacidemia. This retrospective study aimed to review the lipid status, explore lipid treatment targets, and assess preferable lipid-lowering drugs.

PATIENTS AND METHODS

Clinical data on GSDIa patients' characteristics were collected. Most patients were followed-up once a year. Diet control and raw cornstarch treatment were used to maintain normal blood glucose and lipid levels. Some patients were given lipid-lowering drugs. We compared the lipid levels before and after each treatment.

RESULTS

A total of 163 GSDIa patients were enrolled in this study. After treatment with raw cornstarch, the total triglycerides (TG) level has significantly decreased by 30±50% (8.37±7.23 to 5.39±5.29 mmol/L, p<0.001). There was no change in the total cholesterol (TC) level. Fifteen patients regularly took atorvastatin, and 15 took fibrates for more than one year. The therapeutic effect of atorvastatin was better than fibrates. The TC was positively correlated with TG after treatment, resulting in the following linear equation: TG=1.63×TC-2.86. Using this equation and Chinese children's normal TC level of 5.18 mmol/L, we aimed to maintain the patients at TG < 5.58 mmol/L.

CONCLUSIONS

Patients with GSDIa have significant abnormalities in lipid metabolism. Because the complications of hyperlipidemia are caused mainly by TC, thereby, by maintaining it at a normal level, we could set a TG target by the linear equation that allowed a certain degree of hypertriglyceridemia. This study found that the therapeutic effect of atorvastatin was better than fibrates.

MiR-15a-3p suppresses the growth and metastasis of ovarian cancer cell by targeting Twist1

OBJECTIVE

To investigate the roles of miR-15a-3p in ovarian cancer cell growth and metastasis.

PATIENTS AND METHODS

A key role of miR-15a-3p was identified via gene profiling and bioinformatics analysis. The impact of miR-15a-3p on ovarian cancer cell growth, migration and invasion was measured by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT), wound-healing and transwell invasion assays. Bioinformatics and luciferase reporter assays were applied to identify that twist family BHLH transcription factor 1 (Twist1) was the target gene of miR-15a-3p. The miR-15a-3p level and the expression of Twist1 were detected using quantitative Real-time polymerase chain reaction (qRT-PCR) assay. The expressions of N-cadherin and E-cadherin were measured by immunofluorescence staining. Small interfering RNA targeting Twist1 and pCDNA3.1 containing Twist1 were applied to decrease and increase the expression of Twist1, respectively.

RESULTS

miR-15a-3p was markedly down-regulated in ovarian cancer. Exogenous up-regulation of miR-15a-3p inhibited the growth, colony formation, migration and invasion of ovarian cancer cell in vitro. Furthermore, a xenograft model indicated that miR-15a-3p inhibited tumour growth and the metastatic potential of ovarian cancer cell in vivo. We found that Twist1 was the direct target of miR-15a-3p in ovarian cancer and that its expression was negatively correlated with the level of miR-15a-3p in ovarian cancer tissues. Up-regulation of miR-15a-3p rescued the inhibitory impact of miR-15a-3p on ovarian cancer cell growth, migration and invasion. Finally, down-regulation of Twist1 mimicked the suppressive effects of miR-15a-3p on ovarian cancer cell.

CONCLUSIONS

We demonstrated that miR-15a-3p is down-regulated in ovarian cancer. Up-regulation of miR-15a-3p restrains the growth and metastasis of ovarian cancer cell by regulating Twist1.

[Suprapubic-assisted laparoendoscopic single-site surgery in nephroureterectomy A case series of 4 patients]

Objective: To evaluate the feasibility and clinical value of suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in nephroureterectomy using method of transvaginal natural orifice specimen extraction (NOSE) (SA-LESS+TV-NOSE NU). Methods: Four patients (three cases of renal pelvic carcinoma and one case of ureteral carcinoma) undergoing SA-LESS+TV-NOSE NU were enrolled between April 2015 and January 2016. After general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. Two trocars were inserted at the medial margin of umbilicus, and the third one was inserted into abdominal cavity at the superior margin of pubic symphysis. The operation was performed under a direct vision with a 5.4 mm 0° flexible-tip laparoscope. Firstly, the distal ureter was isolated completely and blocked by a Hem-O-lok clip. Then, the laparoscopic nephrectomy was performed according to the standard method. Finally, the bladder cuff excision was executed and the incision was sutured. The intact specimen was placed inside a homemade bag and removed through the incision at posterior vaginal fornix. Results: All the procedures were successfully performed. The median operative time was 150 (range: 120 to 210) minutes, and the median estimated blood loss was 180 (range: 80 to 350) ml. No major perioperative complications occurred. The mean visual analogue score (VAS) of 24 hours and 48 hours after operation were 3.25 (range: 2 to 5) and 2.25 (range: 2 to 3). All the patients resumed ambulation on postoperative day 1. Pelvic drainage tube was removed on postoperative day 2-4. On postoperative day 7, urethral catheter was removed. The patients were discharged on postoperative day 7-9. During the follow-up of 20-29 months, the patient recovered well with no case of incisional hernia and pelvic, abdominal infections. The vaginal fornix incision healed well, and the umbilical and suprapubic puncture scars were not obvious. All the patients completed the patient-assessed acromegaly symptom questionnaire PASQ. The average PSAQ score of 3 months after surgery was 34.5. Three of them restarted their sex lives, with an average female sexual function index score of 16.0, which was not significantly different with that of preoperation (15.6). There was no tumor recurrence, metastasis and implantation in all cases. Conclusion: SA-LESS+TV-NOSE NU is safe and feasible for upper tract urothelial carcinoma with faster postoperative recovery, less pain, shorter hospitalization time, better cosmetic results, and does not cause negative effect on the female sexual function.

Modified trapdoor procedures by surgical dislocation approach to treat chondroblastoma of the femoral head

AIMS

The aim of this study was to evaluate the efficacy of the surgical dislocation approach and modified trapdoor procedure for the treatment of chondroblastoma of the femoral head.

PATIENTS AND METHODS

A total of 17 patients (ten boys, seven girls; mean age 16.4 years (11 to 26)) diagnosed with chondroblastoma of the femoral head who underwent surgical dislocation of the hip joint, modified trapdoor procedure, curettage, and bone grafting were enrolled in this study and were followed-up for a mean of 35.9 months (12 to 76). Healing and any local recurrence were assessed via clinical and radiological tests. Functional outcome was evaluated using the Musculoskeletal Tumour Society scoring system (MSTS). Patterns of bone destruction were evaluated using the Lodwick classification. Secondary osteoarthritis was classified via radiological analysis following the Kellgren-Lawrence grading system. Steinberg classification was used to evaluate osteonecrosis of the femoral head.

RESULTS

The epiphyseal plate was open, closing, and closed in five, five, and seven patients, respectively. In total, eight, six, and three patients were classified as having Lodwick classification IA, IB, and IC, respectively. Allogeneic and autogenous bone grafting was used in 13 and four patients, respectively. All patients had good bone healing and no local recurrence was observed. One patient developed osteonecrosis of the femoral head (Steinberg IA) and one developed secondary osteoarthritis of the hip joint (Kellgren-Lawrence Grade II). The mean postoperative MSTS functional score was 27.7 (24 to 30).

CONCLUSION

Surgical dislocation and modified trapdoor procedures are safe and effective techniques for treating chondroblastoma in the femoral head. Cite this article: Bone Joint J 2019;101-B:732-738.

Subcapsular Implantation of Pancreatic Islets in Syngeneic, Allogeneic, and Xenogeneic Mice

BACKGROUND

Reliable and reproducible transplantation is essential to the success of a number of particular investigations. Renal subcapsule is the most selected site for islet transplantation mainly owing to its easy access, readiness for retrieval, and possibility of reimplantation.

METHODS

Syngeneic, allogeneic, and xenogeneic islets were transplanted into kidney capsules of Balb/C and C57BL/6J mice, and the blood glucose levels of the experimental animals were periodically monitored. Detailed procedures on mouse diabetic model and islet implantation are described.

RESULTS

The values of blood glucose measured under varied transplant circumstances are presented, covering syngeneic, allogeneic, and xenogeneic islet transplantations. The methodology is straightforward and has been proven to be practicable and reproducible.

CONCLUSIONS

The parallel observations in different transplant situations provide a valuable contribution to and useful information for diabetes-related studies.

[Predictive and prognostic value of monitoring lymphocyte subsets in peripheral blood before and after chemotherapy in patients with metastatic breast cancer]

OBJECTIVE

To detect the proportion of lymphocyte subsets in peripheral blood of the advanced breast cancer patients before and after chemotherapy with docetaxel and thiotepa, as well as the association between the proportion of peripheral blood lymphocyte subsets with the response rate and prognosis.

METHODS

The proportions of lymphocyte subsets (CD3+ T cell, CD3+/CD4+ T cell, CD3+/CD8+ T cell, CD3-/CD16+56+ NK cell, CD3+/CD16+56+ T cell, CD19+ B cell, CD4+/CD25+ T cell, CD8+/CD28- T cell, CD8+/CD28+ T cell) in the peripheral blood of 86 patients were analyzed with flowcytometry before and after chemotherapy. The result was analyzed in combination with clinicopathological data.

RESULTS

The proportion of regulatory T cells (Treg) after chemotherapy in the disease control patients decreased significantly compared with that of the progressive patients (P=0.034). The difference of the proportions of Treg before and after chemotherapy affected significantly the overall survival (OS). The OS of the patients with decreased proportion of Treg was significantly longer than that of the patients with increased proportion of Treg, which was 23.5 and 9.4 months respectively (P<0.05).

CONCLUSION

The patients with decreased proportion of Treg after chemotherapy had higher response rate and better survival benefit.

IMM-H004, a novel coumarin derivative compound, protects against amyloid beta-induced neurotoxicity through a mitochondrial-dependent pathway

We have investigated the effect of IMM-H004 (7-hydroxy-5-methoxy-4-methyl-3-(4-methylpiperazin-1-yl)-2H-chromen-2-one), a coumarin derivative, on the amyloid beta (Aβ)-induced neurotoxicity in primary culture cortical neurons and pheochromocytoma (PC12) cells. Our results showed that treatment with IMM-H004 markedly reduced the number of apoptotic cells after exposure to Aβ25-35 or Aβ1-42, determined by MTT, TUNEL staining and Flow cytometry. Further study indicated that IMM-H004 significantly inhibited Aβ-induced cytotoxicity and apoptosis by reversing Aβ-induced mitochondrial dysfunction, including MMP (mitochondrial membrane potential) decrease, reactive oxygen species production, and mitochondrial release of cytochrome c. IMM-H004 can regulate the interaction between Bax and Bcl-2, decreased levels of p53 and active caspase-3 protein induced by Aβ25-35. Furthermore, IMM-H004 also reduced translocation of AIF (apoptosis-inducing factor) induced by Aβ25-35. These results demonstrated that IMM-H004 was capable of protecting neuronal cells from Aβ-induced degeneration through a mitochondrial-dependent apoptotic pathway. The results of this study lend further credence to the notion that IMM-H004 is a 'multipotent therapeutic agrent' that reduces toxic levels of brain Aβ, and holds the potential to protect neuronal mitochondrial function in Alzheimer's disease.

Identification of the novel allele HLA-A*33:22 by sequence-based typing in a Chinese individual

The novel A*33:22 differs from A*33:03:01 by two nucleotides at position 12(A>G)and 19(T>G)of exon 3.

A new HLA-B*15 variant, B*15:144, identified by sequence-based typing in a Chinese individual

A novel human leukocyte antigen-B allele, officially named B*15:144 allele, the previous designation B*9544 allele, was found in a potential Chinese bone marrow donor when direct sequence-based typing was carried out. The novel B*15:144 is identical to B*15:02:01 with the exception of two base substitution at position 195 (C>T), 196 (T>G) of exon 3 resulting in codon #156 changed from CTG (Leu) to TGG (Trp).

Identification of the novel allele HLA-A*0131N by sequence-based typing in a Chinese individual

A novel human leukocyte antigen-A allele, officially named HLA-A*0131N allele, was found in a potential Chinese bone marrow donor when direct sequence-based typing was carried out. The novel A*0131N is identical to A*01010101 with an exception of one base substitution at position 178 (G>A) of exon 2 resulting in codon #60 changed from TGG (Trp) to TAG (stop codon).

Change of peripheral blood mononuclear cells IFN-gamma, IL-10, and TGF-beta1 mRNA expression levels with active human cytomegalovirus infection in orthotopic liver transplantation

AIM

To analyze the expression levels of interferon gamma (IFN-gamma), interleukin 10 (IL-10), and transforming growth factor beta 1 (TGF-beta1) mRNA in peripheral blood mononuclear cells (PBMCs) in liver transplanted recipients with active HCMV infection.

METHODS

PBMCs were isolated from 20 liver transplanted recipients with active HCMV infection and 20 recipients without HCMV infection. The expression levels of IFN-gamma, IL-10 and TGF-beta1 mRNA in PBMCs were measured by TaqMan real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The results were compared with that from 20 healthy individuals.

RESULTS

The expression level of TGF-beta1 mRNA was significantly increased in the active HCMV infection group compared with that in stable group or healthy group (P < .001). The expression level of IL-10 mRNA was significantly increased in the active HCMV infection group compared with the healthy group (P = .001). However, the IFN-gamma mRNA expression level was significantly decreased in the active HCMV infection group compared with that in the stable group or the healthy group (P < .05).

CONCLUSION

Cytokine production plays a role in the HCMV infection. This may provide an important clue to a better understanding of the pathogenesis in liver transplanted recipients with active HCMV infection.

Meta-analysis: incidence of endoscopic gastric and duodenal ulcers in placebo arms of randomized placebo-controlled NSAID trials

BACKGROUND

The safety of NSAIDs is often evaluated by comparison with placebo in clinical trials.

AIM

To investigate the incidence of gastric and duodenal ulcers (GDU) in placebo arms in NSAID trials over the last three decades.

METHODS

Randomized placebo-controlled trials of oral NSAIDs from 1975 to 2006 were systematically reviewed. The pooled incidence of GDU in placebo arms was calculated and compared. Meta-regression was used to identify risk factors related to the incidence of the placebo ulcer at the study level.

RESULTS

Thirty-six studies met inclusion criteria (duration of 6.5 days to 24 weeks). In total, 3.29% GDUs were reported in 36 placebo arms. The incidence of GDU in placebo arms was 0, 4.20% and 3.03% in the studies from 1975-1989, 1990-1999 and 2000-2006 respectively (P > 0.05). Eligible subjects with previous GI events and eligible subjects on co-therapy with low-lose aspirin/corticosteroids were associated with the increase in placebo ulcer incidence after adjusting for other factors.

CONCLUSIONS

The incidence of GDU in placebo arms has not changed significantly over the last three decades, although has decreased in the past 10 years. Studies show that previous GI events and co-therapy with low-dose aspirin/corticosteroids were associated with increasing GDU in placebo arms.

Identification of the novel allele HLA-B*4076 by sequence-based typing in a Chinese individual

A novel human leukocyte antigen-B allele, officially named B*4076 allele, was found in a potential Chinese bone marrow donor when direct sequence-based typing was carried out. The novel B*4076 is identical to B*400101 with an exception of one base substitution at position 239(C>A)of exon 2 resulting in codon #80 changed from AAC (Asn) to AAA (Lys).

Sequence-based typing reveals the novel HLA-DRB1*1467 allele in a Chinese individual

We report here a novel DRB1*1467 allele identified by sequence-based typing in a Chinese individual. The novel DRB1*1467 is identical to DRB1*140301 with an exception of one base substitution at position 186 (C>A) of exon 2 resulting in codon 67 changed from CTC (Leu) to ATC (Ile).

Identification of a novel HLA-B*54 allele, B*5411, by sequence-based typing in a Chinese individual

We report here a novel human leukocyte antigen (HLA)-B*5411 allele identified by sequence-based typing in a Chinese individual. The novel B*5411 is identical to B*5404, with the exception of four base substitutions at position 120 (A>C), 134 (G>C), 143 (C>G), and 156 (A>T) of exon 3 resulting in codon no. 131, changed from AGC (Ser) to CGC (Arg), and codon no. 143, changed from ACC (Thr) to TCC (Ser).

HLA-B*9518 allele identified in the Chinese population

We report here a novel HLA-B*9518 allele by sequence-based typing in the Chinese population. The new B*9518 is identical to B*150101 with an exception of one base substitution at position 19 of exon 3 where a 'G' change to 'T' resulting in codon 97 changed from AGG (Arg) to ATG (Met).

Chemokine receptor CXCR3 expression in inflammatory bowel disease

CD4+ T lymphocytes in the lamina propria (LP) of the gut play a central role in the immune response in inflammatory bowel disease (IBD). CXCR3 is a chemokine receptor expressed on activated T lymphocytes, and a key component for the recruitment of T helper (Th1) effector cells to the site of inflammation. To determine if CXCR3 is involved in localization of T cells to the gut in IBD patients, we investigated the expression of CXCR3 on CD4+ T lymphocytes in the LP and in the submucosa of resection specimens from 51 IBD patients and 15 control patients. Positive cells were microscopically scored using a semiquantitative analysis on a five-point scale. We found that CD4+ T cells, CXCR3+ cells, and CD4+CXCR3+ T cells in the LP were slightly increased in both IBD groups compared with control non-IBD specimens. In addition, CD4+ and CXCR3+ cells in the submucosa were significant increased in the CD group compared with the control group. CD4+ and CXCR3+ expression was not statistically different between CD and UC. Flow cytometry was used to analyze the percentage of CXCR3+ cells within the CD4+ T-cell population isolated from biopsy specimens and peripheral blood from IBD patients and control patients. There was no difference in the percentage of CD4+CXCR3+ cells between the different groups in the gut as well as in the circulation. These results suggest that CD4+CXCR3+ T cells migrate to the normal and inflamed intestinal mucosa, indicating a role in maintaining normal gut homeostasis. The selective expression of CXCR3+ cells in the submucosa of CD patients might also indicate that these cells play a role in inflammation.

[Alzheimer-like protein phosphatase deficiency leads to abnormal phosphorylation and accumulation of neurofilaments]

OBJECTIVE

To explore the effect of Alzheimer-like protein phosphatase deficiency on neurofilament phosphorylation.

METHODS

Cell culture, light microscopy, immunocytochemistry and biochemistry techniques were used to make a phosphatase deficient cell model, to detect cell morphology, neurofilament phosphorylation and distribution, cell viability and activity.

RESULTS

Non-phosphorylated neurofilament recognized by SMI32 was detected both in cell body and cell processes, it was extremely enriched in cell bodies; Phosphorylated neurofilament bound to SMI34 was mainly determined in cell processes and cell surface. After treatment with okadaic acid (OA), non-phosphorylation-dependent antibodies SMI32 staining was significantly decreased in the cell body, whereas phosphorylated neurofilament reacted with SMI34 was strikingly increased in immunocytochemistry and Western blot, and prominently accumulated to the same cell location. Accompanied with hyper-phosphorylation and accumulation of neurofilament, dose dependent cell toxicity was observed by okadaic acid treatment.

CONCLUSION

Deficiency in protein phosphatase induces in neuroblastoma cell line, neurofilament phosphorylation and accumulation, which is involved in Alzheimer neurofibrillary degeneration.

[Thermal decomposition kinetics of ribavirin and its stability]

AIM

To study Thermal stabilities and thermal decomposition process of ribavirin and establish thermal decomposition kinetics equation.

METHODS

Thermal weight loss curve was obtained by thermogravimetry balance. Thermal decomposition function mode was also determined by Achar differential method and Coats-Redfern integral method.

RESULTS

Thermal decomposition kinetics parameters and kinetics compensation parameters were calculated from thermogravimetry-differential thermogravimetry data. Activation energy deduced by extrapolation under heating rate of 0 degree C.min-1 was 188.04 kJ.mol-1. Thermal decomposition kinetics function expression was d alpha/dt = Ae [formula: see text] (1 - alpha)2 and the mathematic expression of the kinetic compensation effect is found to be InA = 0.2264 Ea - 5.4458.

CONCLUSION

Ribavirin has high thermal stability because of its high thermal decomposition activation energy. The thermal decomposition activation of capsule is little lower than that of material, which indicates no evident difference in thermal stability for capsules and material.