LTA and PGN from Bacillus siamensis can alleviate soybean meal-induced enteritis and microbiota dysbiosis in Lateolabrax maculatus

An eight-week feeding trial was designed to assess which component of commensal Bacillus siamensis LF4 can mitigate SBM-induced enteritis and microbiota dysbiosis in spotted seabass (Lateolabrax maculatus) based on TLRs-MAPKs/NF-кB signaling pathways. Fish continuously fed low SBM (containing 16 % SBM) and high SBM (containing 40 % SBM) diets were used as positive (FM group) and negative (SBM group) control, respectively. After feeding high SBM diet for 28 days, fish were supplemented with B. siamensis LF4-derived whole cell wall (CW), cell wall protein (CWP), lipoteichoic acid (LTA) or peptidoglycan (PGN) until 56 days. The results showed that a high inclusion of SBM in the diet caused enteritis, characterized with significantly (P < 0.05) decreased muscular thickness, villus height, villus width, atrophied and loosely arranged microvillus. Moreover, high SBM inclusion induced an up-regulation of pro-inflammatory cytokines and a down-regulation of occludin, E-cadherin, anti-inflammatory cytokines, apoptosis related genes and antimicrobial peptides. However, dietary supplementation with CW, LTA, and PGN of B. siamensis LF4 could effectively alleviate enteritis caused by a high level of dietary SBM. Additionally, CWP and PGN administration increased beneficial Cetobacterium and decreased pathogenic Plesiomonas and Brevinema, while dietary LTA decreased Plesiomonas and Brevinema, suggesting that CWP, LTA and PGN positively modulated intestinal microbiota in spotted seabass. Furthermore, CW, LTA, and PGN application significantly stimulated TLR2, TLR5 and MyD88 expressions, and inhibited the downstream p38 and NF-κB signaling. Taken together, these results suggest that LTA and PGN from B. siamensis LF4 could alleviate soybean meal-induced enteritis and microbiota dysbiosis in L. maculatus, and p38 MAPK/NF-κB pathways might be involved in those processes.

[Disease burden of colorectal cancer attributable to dietary risk factors from 1990 to 2019 in China]

Objective: To analyze the trend of mortality rate and disability-adjusted life year (DALY) of colorectal cancer attributable to dietary risk factors from 1990 to 2019 in China. Methods: Mortality rate and DALY rate of colorectal cancer attributable to dietary risk factors (diet high in processed meat, diet high in red meat, diet low in calcium, diet in low in fiber, diet low in milk, diet low in whole grains, dietary risks) were collected from the Global Burden of Disease study 2019 (GBD2019). Joinpoint regression model was selected to analyze the trend and an age-period-cohort model was used to estimate the effects of age, period and birth cohort. Results: Joinpoint regression analysis showed that the age-standardized mortality rate and age-standardized DALY rate of colorectal cancer attributable to diet high in processed meat, diet high in red meat, diet low in milk, diet low in whole grains and dietary risks showed an upward trend (P<0.05) from 1990 to 2019, while those attributable to diet low in calcium and diet low in fiber showed a downward trend (P<0.05). The mortality rate and DALY rate of colorectal cancer attributable to diet high in processed meat, diet high in red meat, diet low in milk, diet low in whole grains and dietary risks in age groups from 65 to 79 years showed a quicker upward trend than those in age groups from 25 to 64 years. The mortality rate and DALY rate attributable to diet low in calcium and diet low in fiber in age groups from 65 to 79 years showed a slower downward trend than those in age groups from 25 to 64 years. The mortality rate and DALY rate of colorectal cancer attributable to diet high in processed meat, diet high in red meat, diet low in calcium, diet low in fiber, diet low in milk, diet low in whole grains, and dietary risks increased with age after adjusting for period effect and cohort effect (P<0.05). The mortality rate and DALY rate attributable to diet high in processed meat, diet high in red meat, diet low in calcium, diet low in milk, diet low in whole grains and dietary risks increased with period or cohort, while those attributable to diet low in fiber decreased with period or cohort. Period and cohort effect of dietary risk factors in this study were statistically significant (P<0.001). Conclusions: Disease burden of colorectal cancer attributable to dietary risk factors in China showed an upward trend in general. Elderly population is high at risk and more attention should be paid to science popularization and education on dietary risk factors in prevention and treatment of colorectal cancer.

Paraprobiotic and postbiotic forms of Bacillus siamensis improved growth, immunity, liver and intestinal health in Lateolabrax maculatus fed soybean meal diet

Live commensal Bacillus siamensis LF4 showed reparative potentials against high SM-induced negative effects, but whether its paraprobiotic (heat-killed B. siamensis, HKBS) and postbiotic (cell-free supernatant, CFS) forms had reparative functions and potential mechanisms are not yet known. In this study, the reparative functions of HKBS and CFS were investigated by establishing an injured model of spotted seabass (Lateolabrax maculatus) treated with dietary high soybean meal (SM). The results showed that HKBS and CFS effectively mitigated growth suppression, immune deficiency, and liver injury induced by dietary high SM. Simultaneously, HKBS and CFS application positively shaped intestinal microbiota by increased the abundance of beneficial bacteria (Fusobacteria, Firmicutes, Bacteroidota, and Cetobacterium) and decreased harmful bacteria (Proteobacteria and Plesiomonasare). Additionally, HKBS and CFS improved SM-induced intestinal injury by restoring intestinal morphology, upregulating the expression of tight junction proteins, anti-inflammatory cytokines, antimicrobial peptides, downregulating the expression of pro-inflammatory cytokines and apoptotic proteins. Furthermore, HKBS and CFS intervention significantly activated TLR2, TLR5 and MyD88 signaling, and eventually inhibited p38 and NF-κB pathways. In conclusion, paraprobiotic (HKBS) and postbiotic (CFS) from B. siamensis LF4 can improve growth, immunity, repair liver and intestinal injury, and shape intestinal microbiota in L. maculatus fed high soybean meal diet, and TLRs/p38 MAPK/NF-κB signal pathways might be involved in those processes. These results will serve as a base for future application of paraprobiotics and postbiotics to prevent and repair SM-induced adverse effects in fish aquaculture.

CRISPR/Cas9-Mediated Generation of Mutant Lines in Medicago truncatula Indicates a Symbiotic Role of MtLYK10 during Nodule Formation

CRISPR/Cas9 systems are commonly used for plant genome editing; however, the generation of homozygous mutant lines in Medicago truncatula remains challenging. Here, we present a CRISPR/Cas9-based protocol that allows the efficient generation of M. truncatula mutants. Gene editing was performed for the LysM receptor kinase gene MtLYK10 and two major facilitator superfamily transporter genes. The functionality of CRISPR/Cas9 vectors was tested in Nicotiana benthamiana leaves by editing a co-transformed GUSPlus gene. Transformed M. truncatula leaf explants were regenerated to whole plants at high efficiency (80%). An editing efficiency (frequency of mutations at a given target site) of up to 70% was reached in the regenerated plants. Plants with MtLYK10 knockout mutations were propagated, and three independent homozygous mutant lines were further characterized. No off-target mutations were identified in these lyk10 mutants. Finally, the lyk10 mutants and wild-type plants were compared with respect to the formation of root nodules induced by nitrogen-fixing Sinorhizobium meliloti bacteria. Nodule formation was considerably delayed in the three lyk10 mutant lines. Surprisingly, the size of the rare nodules in mutant plants was higher than in wild-type plants. In conclusion, the symbiotic characterization of lyk10 mutants generated with the developed CRISPR/Cas9 protocol indicated a role of MtLYK10 in nodule formation.

Mo-doping heterojunction: interfacial engineering in an efficient electrocatalyst for superior simulated seawater hydrogen evolution

Exploring economical, efficient, and stable electrocatalysts for the seawater hydrogen evolution reaction (HER) is highly desirable but is challenging. In this study, a Mo cation doped Ni0.85Se/MoSe2 heterostructural electrocatalyst, Mox-Ni0.85Se/MoSe2, was successfully prepared by simultaneously doping Mo cations into the Ni0.85Se lattice (Mox-Ni0.85Se) and growing atomic MoSe2 nanosheets epitaxially at the edge of the Mox-Ni0.85Se. Such an Mox-Ni0.85Se/MoSe2 catalyst requires only 110 mV to drive current densities of 10 mA cm-2 in alkaline simulated seawater, and shows almost no obvious degradation after 80 h at 20 mA cm-2. The experimental results, combined with the density functional theory calculations, reveal that the Mox-Ni0.85Se/MoSe2 heterostructure will generate an interfacial electric field to facilitate the electron transfer, thus reducing the water dissociation barrier. Significantly, the heteroatomic Mo-doping in the Ni0.85Se can regulate the local electronic configuration of the Mox-Ni0.85Se/MoSe2 heterostructure catalyst by altering the coordination environment and orbital hybridization, thereby weakening the bonding interaction between the Cl and Se/Mo. This synergistic effect for the Mox-Ni0.85Se/MoSe2 heterostructure will simultaneously enhance the catalytic activity and durability, without poisoning or corrosion of the chloride ions.

Probiotic components of Bacillus siamensis LF4 mitigated β-conglycinin caused cell injury via modulating TLR2/MAPKs/NF-κB signaling in Lateolabrax maculatus

β-conglycinin is a recognized factor in leading to intestinal inflammation and limiting application of soybean meal in aquaculture. Our previous study reported that heat-killed B. siamensis LF4 could effectively mitigate inflammatory response and apoptosis caused by β-conglycinin in spotted seabass (Lateolabrax maculatus) enterocytes, but the mechanisms involved are not fully understood. In the present study, therefore, whole cell wall (CW), peptidoglycan (PG) and lipoteichoic acid (LTA) and cell-free supernatant (CFS) have been collected from B. siamensis LF4 and their mitigative function on β-conglycinin-induced adverse impacts and mechanisms underlying were evaluated. The results showed that β-conglycinin-induced cell injury, characterized with significantly decreased cell viability and increased activities of lactate dehydrogenase, glutamic oxaloacetic transaminase, glutamic propylic transaminase (P < 0.05), were reversed by subsequent heat-killed B. siamensis LF4 and its CW, LTA, PG and CFS treatment. Enterocytes co-cultured with heat-killed B. siamensis LF4 and its CW, LTA, PG and CFS (especially PG) significantly increased expressions of anti-inflammatory genes (IL-2, IL-4, IL-10 and TGF-β1), tight junction proteins (ZO-1, occludin and claudin-b) and antimicrobial peptides (β-defensin, hepcidin-1, NK-lysin and piscidin-5), and decreased expressions of pro-inflammatory genes (IL-1β, IL-8 and TNF-α) and apoptosis-related genes (caspase 3, caspase 8 and caspase 9) (P < 0.05), indicating their excellent mitigation effects on β-conglycinin-induced cell damages. In addition, heat-killed B. siamensis LF4 and its CW, LTA, PG and CFS significantly increased TLR2 mRNA level (especially in PG treatment), and decreased MAPKs (JNK, ERK, p38 and AP-1) and NF-κB related genes expressions. In conclusion, heat-killed B. siamensis LF4 and its CW, LTA, PG and CFS could modulating TLR2/MAPKs/NF-κB signaling and alleviating β-conglycinin-induced enterocytes injury in spotted seabass (L. maculatus), and PG presented the best potential.

[Landmark vessel in membrane anatomy-based colorectal surgery]

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.

Commensal Bacillus siamensis LF4 ameliorates β-conglycinin induced inflammation in intestinal epithelial cells of Lateolabrax maculatus

β-conglycinin and glycinin, two major heat-stable anti-nutritional factors in soybean meal (SM), have been suggested as the key inducers of intestinal inflammation in aquatic animals. In the present study, a spotted seabass intestinal epithelial cells (IECs) were used to compare the inflammation-inducing effects of β-conglycinin and glycinin. The results showed that IECs co-cultured with 1.0 mg/mL β-conglycinin for 12 h or 1.5 mg/mL glycinin for 24 h significantly decreased the cell viability (P < 0.05), and overstimulated inflammation and apoptosis response by significantly down-regulating anti-inflammatory genes (IL-2, IL-4, IL-10 and TGF-β1) expressions and significantly up-regulated pro-inflammatory genes (IL-1β, IL-8 and TNF-α) and apoptosis genes (caspase 3, caspase 8 and caspase 9) expressions (P < 0.05). Subsequently, a β-conglycinin based inflammation IECs model was established and used for demonstrating whether commensal probiotic B. siamensis LF4 can ameliorate the adverse effects of β-conglycinin. The results showed β-conglycinin-induced cell viability damage was completely repaired by treated with 10⁹ cells/mL heat-killed B. siamensis LF4 for ≥12 h. At the same time, IECs co-cultured with 10⁹ cells/mL heat-killed B. siamensis LF4 for 24 h significantly ameliorated β-conglycinin-induced inflammation and apoptosis by up-regulating anti-inflammatory genes (IL-2, IL-4, IL-10 and TGF-β1) expressions and down-regulated pro-inflammatory genes (IL-1β, IL-8 and TNF-α) and apoptosis genes (caspase 3, caspase 8 and caspase 9) expressions (P < 0.05). In summary, both β-conglycinin and glycinin can lead to inflammation and apoptosis in spotted seabass IECs, and β-conglycinin is more effective; commensal B. siamensis LF4 can efficiently ameliorate β-conglycinin induced inflammation and apoptosis in IECs.

Commensal Bacillus siamensis LF4 induces antimicrobial peptides expression via TLRs and NLRs signaling pathways in intestinal epithelial cells of Lateolabrax maculatus

Antimicrobial peptides (AMPs) play an important role in modulating intestinal microbiota, and our previous study showed that autochthonous Baccilus siamensis LF4 could shape the intestinal microbiota of spotted seabass (Lateolabrax maculatus). In the present study, a spotted seabass intestinal epithelial cells (IECs) model was used to investigate whether autochthonous B. siamensis LF4 could modulate the expression of AMPs in IECs. And then, the IECs were treated with active, heat-inactivated LF4 and its supernatant to illustrate their AMPs inducing effects and the possible signal transduction mechanisms. The results showed that after 3 h of incubation with 10⁸ CFU/mL B. siamensis LF4, lactate dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT), glutamic propylic transaminase (GPT) activities in supernatant decreased significantly and obtained minimum values, while supernatant alkaline phosphatase (AKP) activity, β-defensin protein level and IECs Na⁺/K⁺-ATPase activity, AMPs (β-defensin, hepcidin-1, NK-lysin, piscidin-5) genes expression increased significantly and obtained maximum values (P < 0.05). Further study demonstrated that the active, heat-inactivated LF4 and its supernatant treatments could effectively decrease the LDH, GOT, and GPT activities in IECs supernatant, increase AKP activity and β-defensin (except LF4 supernatant treatment) protein level in IECs supernatant and Na⁺/K⁺-ATPase and AMPs genes expression in IECs. Treatment with active and heat-inactivated B. siamensis LF4 resulted in significantly up-regulated the expressions of TLR1, TLR2, TLR3, TLR5, NOD1, NOD2, TIRAP, MyD88, IRAK1, IRAK4, TRAF6, TAB1, TAB2, ERK, JNK, p38, AP-1, IKKα, IKKβ and NF-κB genes. Treatment with B. siamensis LF4 supernatant also resulted in up-regulated these genes, but not the genes (ERK, JNK, p38, and AP-1) in MAPKs pathway. In summary, active, heat-inactivated and supernatant of B. siamensis LF4 can efficiently induce AMPs expression through activating the TLRs/NLRs-MyD88-dependent signaling, active and heat-inactivated LF4 activated both the downstream MAPKs and NF-κB pathways, while LF4 supernatant only activated NF-κB pathway.

[Diagnostic value of rapid exchange test in patients with peritoneal dialysis catheter dysfunction]

A total of 36 patients with suspected peritoneal dialysis (PD) catheter dysfunction in the First Hospital of China Medical University from June 2020 to August 2022 were included, and five patients with normal PD catheter were also included as the control group. There were 22 males and 19 females, and aged (45±21) years. The volume of rapid-phase drainage in the control and dysfunction groups was (2 086±65) and (1 181±637) ml, and the total drainage time was (15.2±1.3) and (38.3±14.9) min, respectively. The volume of rapid-phase drainage in the dysfunction group was reduced and the total drainage time was longer than that in the control group (both P<0.05). Compared with group with PD catheter migration, the duration of new bag instillation was prolonged, the drainage volume in the rapid-phase was reduced, the total drainage duration was prolonged, and the ultrafiltration volume was decreased in the group with PD catheter obstruction (all P<0.05). The rapid exchange test can provide an early preliminary diagnosis of PD catheter dysfunction and identify the type of catheter dysfunction.

BDNF gene hydroxymethylation in hippocampus related to neuroinflammation-induced depression-like behaviors in mice

BACKGROUND

Neuroinflammation is a multifactorial condition related to glial cells and neurons activation, and it is implicated in CNS disorders including depression. BDNF is a crucial molecule that related to the pathology of depression, and it is the target of DNA methylation. DNA hydroxymethylation, an active demethylation process can convert 5-mC to 5-hmC by Tets catalyzation to regulate gene transcription. The regulatory function for BDNF gene in response to neuroinflammation remains poorly understood.

METHODS

Neuroinflammation and depressive-like behaviors were induced by lipopolysaccharide (LPS) administration in mice. The microglial activation and cellular 5-hmC localization in the hippocampus were confirmed by immunostaining. The transcripts of Tets and BDNF were examined by qPCR method. The global 5-hmC levels and enrichment of 5-hmC in BDNF gene in the hippocampus were analyzed using dot bolt and hMeDIP-sequencing analysis.

RESULTS

LPS administration induced a spectrum of depression-like behaviors (including behavioral despair and anhedonia) and increased expression of Iba-1, a marker for microglia activation, in hippocampus, demonstrating that LPS treatment cloud provide stable model of neuroinflammation with depressive-like behaviors as expected. Our results showed that Tet1, Tet2 and Tet3 mRNA expressions and consequent global 5-hmC levels were significantly decreased in the hippocampus of LPS group compared to saline group. We also demonstrated that 5-hmC fluorescence in the hippocampus located in excitatory neurons identified by CaMK II immunostaining. Furthermore, we demonstrated that the enrichment of 5-hmC in BDNF gene was decreased and corresponding BDNF mRNA was down-regulated in the hippocampus in LPS group compared to saline group.

CONCLUSION

Neuroinflammation-triggered aberrant BDNF gene hydroxymethylation in the hippocampus is an important epigenetic element that relates with depression-like behaviors.

[Exploration on acupuncture treatment ideas for knee osteoarthritis from the perspective of Dongyuan needling technology]

The treatment ideas with acupuncture for knee osteoarthritis (KOA) are explored on the base of Dongyuan needling technology. Regarding the rules of acupoint selection, Zusanli (ST 36) is predominant, the back-shu points are used for the disorders related to the invasion of exogenous factors, and the front-mu points are for the cases caused by internal injury. Besides, the xing-spring points and shu-stream points are preferred. In treatment of KOA, besides the local points, the front-mu points, i.e. Zhongwan (CV 12), Tianshu (ST 25) and Guanyuan (CV 4), are selected specially to tonifying the spleen and stomach. The earth points and acupoints on the earth meridians (i.e. Yinlingquan [SP 9], Xuehai [SP 10], Liangqiu [ST 34], Dubi [ST 35], Zusanli [ST 36] and Yanglingquan [GB 34]) are optional to coordinate yin and yang, essence and qi , and regulate the qi movement of spleen and stomach. The shu-stream points of liver, spleen and kidney meridians (Taichong [LR 3], Taibai [SP 3] and Taixi [KI 3]) are chosen to promote meridian circulation and regulate zangfu functions.

[Impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease]

Objective: This study sought to investigate the impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease. Methods: We retrospectively analyzed clinical data of male patients diagnosed with suspected coronary microvascular dysfunction (CMD) in the First Hospital of Shanxi Medical University between December 2015 and August 2021. All patients underwent the one-day rest and stress ¹³N-ammonia positron emission tomography myocardial perfusion imaging. Overall obesity was defined by body mass index (BMI) ≥28 kg/m² and abdominal obesity was defined by waist circumference ≥90 cm. Hyperemic myocardial blood flow (MBF)<2.3 ml·min^-1·g^-1 or coronary flow reserve (CFR)<2.5 were referred as CMD. All patients were grouped based on their BMI and waist circumference. MBF, CFR, the incidence of CMD, hemodynamic parameters, and cardiac function were compared among the groups. Results: A total of 136 patients were included. According to BMI and waist circumference, patients were categorized into 3 groups: control group (n=45), simple abdominal obesity group (n=53) and compound obesity group (n=38). Resting MBF did not differ between groups (F=0.02,P=0.994). Compared with the control group, hyperemic MBF was significantly lower in the simple abdominal obesity and compound obesity groups ((2.82±0.64) ml·min^-1·g^-1, (2.44±0.85) ml·min^-1·g^-1 and (2.49±0.71) ml·min^-1·g^-1, both P<0.05, respectively). Hyperemic MBF was comparable among the groups of patients with obesity (P=0.772). CFR was significantly lower in the simle abdominal obesity group compared with the control group (2.87±0.99 vs. 3.32±0.62,P=0.012). Compared with the control group, CFR tended to be lower in the compound obesity group (3.02±0.91 vs. 3.32±0.62,P=0.117). The incidence of CMD was significantly higher in both the simple abdominal obesity and compound obesity groups than in the control group (62.3%, 52.6% vs. 22.2%, both P<0.01, respectively). Waist circumference was an independent risk factor for male CMD (OR=1.057, 95%CI: 1.013-1.103, P=0.011). Conclusions: In male patients with non-obstructive coronary artery disease, abdominal obesity is associated with decreased coronary microvascular function. Male patients with simple abdominal obesity face the highest risk of CMD.

The Medicago truncatula hydrolase MtCHIT5b degrades Nod factors of Sinorhizobium meliloti and cooperates with MtNFH1 to regulate the nodule symbiosis

Nod factors secreted by nitrogen-fixing rhizobia are lipo-chitooligosaccharidic signals required for establishment of the nodule symbiosis with legumes. In Medicago truncatula, the Nod factor hydrolase 1 (MtNFH1) was found to cleave Nod factors of Sinorhizobium meliloti. Here, we report that the class V chitinase MtCHIT5b of M. truncatula expressed in Escherichia coli can release lipodisaccharides from Nod factors. Analysis of M. truncatula mutant plants indicated that MtCHIT5b, together with MtNFH1, degrades S. meliloti Nod factors in the rhizosphere. MtCHIT5b expression was induced by treatment of roots with purified Nod factors or inoculation with rhizobia. MtCHIT5b with a fluorescent tag was detected in the infection pocket of root hairs. Nodulation of a MtCHIT5b knockout mutant was not significantly altered whereas overexpression of MtCHIT5b resulted in fewer nodules. Reduced nodulation was observed when MtCHIT5b and MtNFH1 were simultaneously silenced in RNA interference experiments. Overall, this study shows that nodule formation of M. truncatula is regulated by a second Nod factor cleaving hydrolase in addition to MtNFH1.

Ethnicity and paediatric healthcare utilisation: Improving the quality of quantitative research

Background

The COVID-19 pandemic highlighted the stark health inequities affecting minority ethnic populations in Europe. However, research on ethnic inequities and healthcare utilisation in children has seldom entered the policy discourse. A scoping review was conducted in the UK, summarising and appraising the quantitative evidence on ethnic differences (unequal) and inequities (unequal and unfair or disproportionate to healthcare needs) in paediatric healthcare utilisation.

Methods

Embase, Medline and grey literature sources were searched for studies published 2001-2021. Studies that found differences and inequities were mapped by ethnic group and healthcare utilisation outcome. They were appraised using the National Institute for Health and Care Excellence appraisal checklists. The distribution of studies was described across various methodological parameters.

Results

Of the 61 included studies, most found evidence of ethnic variations in healthcare utilisation (n = 54, 89%). Less than half attempted to distinguish between ethnic differences and inequities (n = 27, 44%). Studies were concentrated on primary and preventive care and hospitalisation, with minimal evidence on emergency and outpatient care. The quality of studies was often limited by a lack of theory underpinning analytical decisions, resulting in conflation of difference and inequity, and heterogeneity in ethnic classification. The majority of studies examined children's ethnicity but overlooked parent/caregiver ethnicity, and also didn't investigate patterns across age, year or location.

Conclusions

To improve the validity, generalisability and comparability of research on ethnicity and paediatric healthcare utilisation, findings from this scoping review were used to develop recommendations for future research. These lessons could be applied more broadly across the European context to improve evidence generation and evidence-based policy-making to reduce inequities in healthcare.

Key messages

• Quantitative studies of ethnicity and paediatric healthcare utilisation in the UK lack the use of sound theoretical frameworks, and often do not distinguish between ethnic differences and inequities.

• The quality of future studies can be improved with greater attention to how ethnicity is classified and analysed, alongside specific considerations for examining healthcare utilisation in children.

PAX9 functions as a tumor suppressor gene for cervical cancer via modulating cell proliferation and apoptosis

To investigate the effect of PAX9 on the progression of cervical cancer (CC). PAX9 expression was quantified in CC tissues and adjacent normal tissues, as well as human CC cell lines and human cervical epithelial cells (HCerEpiC). PAX9-overexpression lentiviral vectors were transfected into CC cell lines, followed by the measurement of proliferation and apoptosis and the quantification of apoptosis-related proteins. In vivo, mice were subcutaneously injected with CaSki cells transfected with PAX9-overexpression lentiviral vectors and control vectors. Then, the volume and weight of tumors were measured followed by hematoxylin and eosin (HE) staining, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, and immunohistochemistry. PAX9 expression in the CC tissues was lower than that in the adjacent normal tissues, which was correlated with the FIGO stage, tumor size, infiltration depth, parametrium invasion, lympho-vascular space invasion tumor-positive lymph nodes, and prognosis. Furthermore, PAX9 in CC cell lines was also lower than in HCerEpiC. PAX9 inhibits the CC cell proliferation and promotes the apoptosis, with the up-regulations of caspase-3, poly(ADP-ribose) polymerase (PARP), and Bax and the down-regulation of Bcl-2. In vivo experiments demonstrated that in the PAX9 group, the tumor weight and volume were lower than those in the vector group accompanying the decreased Ki-67, cleaved-caspase-3, and Bax expressions and the increased TUNEL and Bcl-2 expression. PAX9 was lowly expressed in the CC tissues and associated with the clinicopathological characteristics and prognosis. PAX9 could inhibit proliferation of CC cell lines and promote the apoptosis, thus suppressing the tumor growth in vivo, indicating its potential therapeutic role for CC treatment.

[Study on the mechanism of resistance to cypermethrin in Culex pipiens pallens using proteomics]

OBJECTIVE

To compare the differentially expressed proteins between cypermethrin-resistant and -sensitive Culex pipiens pallens, so as to unravel the mechanism underlying the resistance to cypermethrin in Cx. p. pallens.

METHODS

A quantitative proteomic analysis was performed among cypermethrin-sensitive and -resistant isolates of Cx. p. pallens using isobaric tags for relative and absolute quantification (iTRAQ) labeling coupled with liquid chromatography with tandem mass spectrometry (LC-MS/MS).

RESULTS

A total of 164 differentially expressed proteins were identified between cypermethrin-sensitive and -resistant isolates of Cx. p. pallens, including 54 up-regulated proteins and 110 down-regulated proteins. A large number of cuticular proteins, larval cuticular proteins, pupal cuticular proteins and cuticular structural constituent proteins, which are associated with cytoskeletal structure and components, were differentially expressed between cypermethrin-sensitive and -resistant isolates of Cx. p. pallens. Thirteen proteins, which were involved in energy production and conversion, translation, ribosomal structure and biogenesis, lipid transport and metabolism, post-translational modification, protein turnover, chaperones, cytoskeleton and intracellular transportation, were validated to be differentially expressed between cypermethrin-sensitive and -resistant isolates of Cx. p. pallens, which may serve as potential markers of cypermethrin resistance.

CONCLUSIONS

Multiple insecticide resistance mechanisms contribute to the resistance to cypermethrin in Cx. p. pallens, including cuticular resistance and metabolic resistance, and the cuticular protein genes and cytochrome P450 enzymes may play an important role in the resistance of Cx. p. pallens to cypermethrin.

[Central nervous system toxicity caused by bortezomib: five case reports and a review of literature]

目的

探讨硼替佐米中枢神经系统（CNS）毒性的临床特点、诊断和治疗。

方法

报道5例由硼替佐米引起的CNS毒性患者并结合现有文献探讨其临床特点。

结果

5例患者中有4例在应用硼替佐米后出现了中枢性发热，主要表现为持续性高热、周身无汗、未能找到感染病灶、对退热药不敏感，停用硼替佐米后症状好转。4例患者中有3例伴随顽固性低钠血症，1例明确诊断为抗利尿不当综合征（SIAD），可能是硼替佐米同时影响了下丘脑体温调节中枢和抗利尿激素神经分泌细胞所致。1例患者诊断为可逆性后部脑病综合征（PRES），表现为应用硼替佐米后出现意识障碍，头CT示双侧半卵圆中心白质密度减低，停用硼替佐米后患者症状消失且未再复发。此外，我们还发现血小板计数可能与硼替佐米CNS毒性的严重程度相关。

结论

硼替佐米的CNS毒性非常罕见，表现为3种形式：SIAD、PRES和中枢性发热，及时识别和治疗对于预防不可逆的神经并发症非常重要。

Effects of feeding corn bran and soybean hulls on nutrient digestibility, rumen microbial protein synthesis, and growth performance of finishing lambs

Some grain processing by-products rich in digestible fiber are good feed resources for ruminants. This experiment was conducted to investigate the effects of replacing a portion of corn and corn stover with the combinations of corn bran and soybean hulls in the diet of fattening lambs on nutrient digestion, rumen microbial protein synthesis, and growth performance. A total of 36 Dorper × Small Thin-Tailed crossbred ram lambs (BW = 22.2 ± 0.92 kg; mean ± SD) were randomly divided into three groups, and each group was fed 1 of 3 treatment diets: 1) 0% corn bran and soybean hulls (control); 2) 9% corn bran and 9% soybean hulls (18MIX); and 3) 17% corn bran and 17% soybean hulls (34MIX). The feeding experiment was conducted for 70 days, with the first 10 days for adaption. The DM intake was higher for 34MIX (1635.3 g/d) than for control diet (1434.7 g/d; P = 0.001). Lambs fed 18MIX and 34MIX diets (230.2 and 263.6 g/d, respectively) had higher average daily gain and feed efficiency than those fed control diet (194.8 g/d; P < 0.01). Dry matter and NDF digestibility for 34MIX group (60.9 and 49.5%) were higher than for control (55.2 and 41.3%; P < 0.01). No difference was observed in nitrogen digestibility among treatment diets (P = 0.778). The lambs fed 34MIX diet excreted more urinary purine derivatives, indicating that more microbial protein was yielded than those fed control diet (P < 0.01), while 18MIX was not different from the other two diets (P > 0.05). The metabolizable protein supplies were improved with increasing co-products inclusion rate. The results indicated that corn bran and soybean hulls in combination can effectively replace a portion of corn and corn stover in the ration of finishing lambs with positive effect on nutrient digestion and growth performance.

Effects of melatonin administration to cashmere goats on cashmere production and hair follicle characteristics in two consecutive cashmere growth cycles

The objective of the study was to determine the long-term effects of melatonin treatment on cashmere production and hair follicle populations in cashmere goats and their activity in two consecutive cashmere growth cycles. Twenty-four female Inner Mongolian Cashmere goats were randomly allocated to two groups (n = 12), one of which received melatonin implants, the other being an untreated control group. Melatonin implants were subcutaneously inserted behind the ear at a dose of 2 mg/kg live weight on two occasions -April 30 and June 30, 2016. Hair samples were collected by combing in April of 2017 and 2018, and the weight, staple length, and diameter of the cashmere fibers were measured. Blood and skin samples were collected monthly between April and September 2016, and in April and September in 2017 for the analysis of melatonin concentration and the characteristics of secondary hair follicle populations, respectively. The results indicated that serum melatonin concentration in the treated goats was elevated (P < 0.05) relative to that of the control group, but only during the first growth cycle. Melatonin treatment of cashmere goats in one cashmere growth cycle increased the weight, staple length, and density (all P < 0.05) of the cashmere fibers and decreased fiber diameter (P < 0.01), but did not affect the characteristics of cashmere production in the subsequent annual cycle. Melatonin treatment had no effect on the population of skin secondary hair follicles for two consecutive cycles. However, in the first growth cycle after treatment, it advanced the onset of activity of skin secondary hair follicles by 2 mo (P < 0.05), and it increased the number of follicles that were active (P < 0.05). In summary, the melatonin treatment of cashmere goats in one cashmere growth cycle improved cashmere production for that cycle only, with no residual effects on the subsequent cycle, a technique acceptable to the cashmere goat industry. The enhancement of cashmere production after the treatment of goats with melatonin appears to involve the acceleration of the annual regeneration of skin secondary hair follicles and increased population of active secondary hair follicles in the skin of cashmere goats.

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.

Comparison of the Clinical Characteristics and Severity of Influenza and Non-influenza Respiratory Virus-Related Pneumonia in China: A Multicenter, Real-World Study

Purpose

Respiratory viruses are important etiologies of community-acquired pneumonia (CAP). However, the impact of different RVs on the outcomes of CAP is not well elucidated. This study aims to compare the clinical features and severity of influenza (Flu-p) and non-influenza respiratory viruses-related pneumonia (NIRVs-p) onset in the community among immunocompetent adults.

Methods

The data of the patients hospitalized with laboratory-confirmed RVs-p were retrospectively reviewed from five teaching hospitals in China from January 2013 to May 2019. Univariate and multivariate logistic regressions were performed to compare the clinical characteristics and outcomes between Flu-p and NIRVs-p.

Results

A total of 1079 patients with Flu-p and 341 patients with NIRVs-p were included in this study. A multivariate logistic regression model revealed chronic pulmonary disease [odd ratio (OR) 0.341, 95% confidence interval (CI) 0.225–0.515, p < 0.001], solid malignant tumor (OR 0.330, 95% CI 0.163–0.668, p = 0.002), myalgia (OR 1.697, 95% CI 1.236–2.330, p < 0.001), lymphocytes <0.8×10⁹/L (OR 10.811, 95% CI 6.949–16.818, p < 0.001) and blood albumin <35 g/L (OR 0.327, 95% CI 0.242–0.442, p < 0.001) were predictors for Flu-p. After adjusting for confounders, the multivariate logistic regression analysis confirmed that influenza B-related pneumonia (FluB-p) (OR 0.419, 95% CI 0.272–0.646, p < 0.001) and NIRVs-p (OR 0.260, 95% CI 0.158–0.467, p < 0.001) were associated with a decreased risk of 30-day mortality compared with the influenza A-related pneumonia (FluA-p).

Conclusion

Our results showed that patients with FluA-p experience a more severe disease than those with FluB-p and NIRVs-p. Some clinical features are helpful to distinguish between NIRVs-p and Flu-p.

Replacing soybean meal with flax seed meal: effects on nutrient digestibility, rumen microbial protein synthesis and growth performance in sheep

Flax seed meal (FSM) is rich in various nutrients, especially CP and energy, and can be used as animal protein feed. In animal husbandry production, it is a long-term goal to replace soybean meal (SBM) in animal feed with other plant protein feed. However, studies on the effects of replacing SBM with FSM in fattening sheep are limited. The aim of this experiment was to study the effects of replacing a portion of SBM with FSM on nutrient digestibility, rumen microbial protein synthesis and growth performance in sheep. Thirty-six Dorper × Small Thin-Tailed crossbred rams (BW = 40.4 ± 1.73 kg, mean ± SD) were randomly assigned into four groups. The dietary treatments (forage/concentrate, 45 : 55) were isocaloric according to the nutrient requirements of rams. Soybean meal was replaced with FSM at different levels (DM basis): (1) 18% SBM (18SBM), (2) 12% SBM and 6% FSM (6FSM), (3) 6% SBM and 12% FSM (12FSM) and (4) 18% FSM (18FSM). The rams were fed in individual pens for 60 days, with the first 10 days for adaptation to diets, and then the digestibility of nutrients was determined. There was no significant difference in DM intake, but quadratic (P < 0.001) effects on the average daily gain and feed efficiency were detected, with the highest values in the 6FSM and 12FSM groups. For DM and NDF digestibility, quadratic effects were observed with the higher values in the 6FSM and 12FSM groups, but the digestibility of CP linearly decreased with the increase in FSM in the diet (P = 0.043). There was a quadratic (P < 0.001) effect of FSM inclusion rate on the estimated microbial CP yield. However, the values of intestinally absorbable dietary protein decreased linearly (P < 0.001). For the supply of metabolisable protein, both the linear (P = 0.001) and quadratic (P = 0.044) effects were observed with the lowest value in the 18FSM group. Overall, the results indicated that SBM can be effectively replaced by FSM in the diets of fattening sheep and the optimal proportion was 12.0% under the conditions of this experiment.

[The fundus autofluorescence of retinal astrocytic hamartomas in tuberous sclerosis complex]

Objective: To investigate the autofluorescence findings of retinal astrocytic hamartoma (RAH) in patients with tuberous sclerosis complex (TSC). Methods: It was a retrospective case series study. Twenty-three patients (35 eyes) who were referred to Department of Internal Medicine and Department of Ophthalmology, Peking Union Medical College Hospital between November 2012 and June 2018 with established TSC-associated RAH diagnosis were included. The findings of fundus autofluorescence, fundus photos and spectral-domain optical coherence tomography (SD-OCT) were retrospectively reviewed. RAH lesions were classified into three types based on the morphology shown in fundus photos. The fundus autofluorescence features of TSC-associated RAH were described. The Welch's test and Fisher's exact test were used for statistical analysis. Results: The patients were 8 males and 15 females aged (28±9) years old (range, 15-55 years). Seventy-two RAH lesions were examined, including 59 type 1 RAHs, 7 type 2 RAHs and 6 type 3 RAHs. According to fundus autofluorescence, type 1 RAHs could be further divided into reduced, speckled and background autofluorescence patterns, among which the hypoautofluorescence pattern accounted for the majority (69.5%, 41/59), while the speckled pattern was usually accompanied by outer retinal disorganization and discontinuation of photoreceptor outer segment as revealed by SD-OCT. No significant difference was revealed in tumor thickness for reduced, speckled and background autofluorescence patterns of type 1 RAHs [(490.2±97.9) vs. (589.2±221.6) vs. (463.0±76.2) μm respectively, F=1.426, P=0.283]. Among type 1 RAHs, the number of reduced autofluorescence pattern lesions found in perifoveal, peripapillary, inferonasal, inferotemporal, superonasal, superotemporal quadrants were 9, 4, 4, 7, 4, 13 respectively, while that of speckled autofluorescence pattern lesions were 3, 0, 3, 2, 3, 2 and background autoflurorescence pattern lesions 3, 0, 1, 1, 0, 0. No significant difference was revealed in location distribution (P=0.452) either. Type 2 RAHs featured numerous hyperautofluorescent spots or plaques, and calcification in type 2 RAHs varied in autofluorescence intensity. Type 3 RAHs, combining the features of type 1 and 2 RAHs, were characterized by central hyperautofluorescent spots and hypoautoflurescent rim, but the area of hyperautofluorescence was smaller than that of calcification as shown in fundus photos. Conclusions: In TSC, the fundus autofluorescence of RAHs varies from hypoautofluorescence to hyperautofluorescence patterns according to RAH types. The retinal involvement and calcification degree of TSC-associated RAHs could be reflected on the autofluorescence, which was beneficial to the full assessment. (Chin J Ophthalmol, 2020, 56: 211-216).

Severity and outcomes of influenza-related pneumonia in type A and B strains in China, 2013-2019

Background

Inconsistencies exist regarding the severity of illness caused by different influenza strains. The aim of this study was to compare the clinical outcomes of hospitalized adults and adolescents with influenza-related pneumonia (Flu-p) from type A and type B strains in China.

Methods

We retrospectively reviewed data from Flu-p patients in five hospitals in China from January 2013 to May 2019. Multivariate logistic and Cox regression models were used to assess the effects of influenza virus subtypes on clinical outcomes, and to explore the risk factors of 30-day mortality for Flu-p patients.

Results

In total, 963 laboratory-confirmed influenza A-related pneumonia (FluA-p) and 386 influenza B-related pneumonia (FluB-p) patients were included. Upon adjustment for confounders, multivariate logistic regression models showed that FluA-p was associated with an increased risk of invasive ventilation (adjusted odds ratio [aOR]: 3.824, 95% confidence interval [CI]: 2.279–6.414; P <  0.001), admittance to intensive care unit (aOR: 1.630, 95% CI: 1.074–2.473, P = 0.022) and 30-day mortality (aOR: 2.427, 95% CI: 1.568–3.756, P <  0.001) compared to FluB-p. Multivariate Cox regression models confirmed that influenza A virus infection (hazard ratio: 2.637, 95% CI: 1.134–6.131, P = 0.024) was an independent predictor for 30-day mortality in Flu-p patients.

Conclusions

The severity of illness and clinical outcomes of FluA-p patients are more severe than FluB-p. This highlights the importance of identifying the virus strain during the management of severe influenza.

[Incidence and risk factors for cardiovascular events in patients hospitalized with community-acquired pneumonia]

Objective: To explore the incidence, risk factors of cardiovascular events (CVE) and their impact on 30-day mortality in patients hospitalized with community-acquired pneumonia (CAP). Methods: This is a multicenter, retrospective study. Patients hospitalized with CAP from 5 teaching hospitals in Beijing, Shandong and Yunnan provinces during 1 January 2013 to 31 December 2015 were included and clinical data were retrieved from the Hospital Information System (HIS), and patients were divided into CVE group and non-CVE group. Age, sex, comorbidities, pneumonia severity index(PSI)/CURB-65 score, routine blood test, biochemical examinations, radiological findings on admission and mortality on 30-day after admission were analyzed. The primary endpoint was acute CVE during hospitalization, the secondary endpoint was 30-day death after admission. Multivariate Cox regression analysis was used to explore the risk factors for CVE. Kaplan-Meier survival curve was used to compare the difference on 30-day mortality between CVE patients and non-CVE patients by Log-rank test. Multivariate Cox regression model was used to assess the impact of CVE on the 30-day mortality among CAP patients after adjustment with age, sex, comorbidities, PSI/CURB-65 score. Results: A total of 3 561 CAP patients were included into the final analysis, including 210 (5.9%) patients in CVE group and 3 351 (94.1%) patients in non-CVE group. Compared with patients in non-CVE group, patients in CVE group were older (P<0.001), prevalence of hypertension, coronary heart disease, chronic heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, aspiration risk and bedrid were significantly higher (all P<0.001); prevalence of CURB-65 score 3-5 and PSI risk class Ⅳ/Ⅴ were also significantly higher (both P<0.001). The proportion of axillary temperature<36 ℃, respiratory rate≥30 beats/minutes, confusion, leukocytes>10×10(9)/L, hemoglobin<100 g/L, platelets>300×10(9)/L, albumin<35 g/L, blood urea nitrogen>7 mmol/L, fasting blood glucose>11 mmol/L, serum C-reaction protein>100 mg/L, serum procalcitonin≥2 μg/L, arterial pH<7.35, arterial PO(2)/FiO(2)≤300 mmHg (1 mmHg=0.133 kPa), and multilobar infiltrates and pleural effusion on chest X-ray or CT scan were significantly higher in CVE group than in non-CVE group(all P<0.05); the 30-day mortality was significantly higher in CVE group than in non-CVE group(P<0.001). The incidence of CVE was significantly higher in patients with cardiovascular and cerebrovascular disease(CVD) than in patients without CVD (13.9%(150/1 079) vs. 2.4%(60/2 482), χ(2)=178.737, P<0.001). Meanwhile, the incidence of CVE increased with PSI in patients with Ⅰ/Ⅱ, Ⅲ and Ⅳ/Ⅴ class, respectively(χ(2)=228.350, P<0.001); and CURB-65 score 0-1, 2 and 3-5, respectively (χ(2)=387.154, P<0.001). Cox regression analysis revealed that age (HR=1.05, 95%CI 1.02-1.09, P=0.002), coronary heart disease (HR=1.88, 95%CI 1.01-3.51, P=0.048), chronic heart failure (HR=4.25, 95%CI 1.89-9.52, P<0.001), PSI risk class (HR=1.66, 95%CI 1.50-2.62, P=0.029) and serum procalcitonin≥ 2 μg/L (HR=3.72, 95%CI 1.60-8.66, P=0.002) were independent risk factors for CVE in CAP patients. Kaplan-Meier curve showed that the survival probability of patients with CVE was significantly lower than patients without CVE (P<0.001). After adjustment for age, sex, comorbidities and PSI/CURB-65 score, Cox regression model showed that CVE was associated with increased 30-day mortality in CAP patients (HR=6.05, 95%CI 3.11-11.76, P<0.001). Conclusions: Although the incidence of CVE is not high in Chinese patients hospitalized with CAP, CVE is common in patients with severe pneumonia and in patients with CVD. Age, cardiovascular disease, PSI risk class and serum procalcitonin are the risk factors for CVE in this patient cohort. CVE is related to increased 30-day mortality in CAP patients.

[Transmission electron microscopic observation on gonad of Oncomelania hupensis offspring bred in Weishan Lake areas]

OBJECTIVE

To observe the morphological changes in the testes and ovaries of adult 12th-generation Oncomelania hupensis bred for 12 winters in Weishan Lake areas.

METHODS

The offspring of the adult O. hupensis snails bred in the Weishan Lake that were originated from the Yangzhou section of the Yangtze River was defined as the experiment group, while uninfected, adult O. hupensis snails captured from the marshland of the Yangzhou section of the Yangtze River served as the control group. Snails were dissected and intact testicular and ovarian specimens were sampled, routinely fixed, dehydrated, embedded, polymerized in an oven and sliced on an ultramicrotome. The sections were visualized under a transmission electron microscope, and the ultrastructure of the snail gonad was compared between the experiment and control groups.

RESULTS

Transmission electron microscopy showed "9 + 2" microtubules on the transverse sections of the tails of sperm cells in the testes of male snails in the control group, with triangular acrosomes and spiral, dense nuclei seen in the tip, while in the experiment group, the "9 + 2" microtubules disappeared on the transverse sections of the tails of sperm cells in the testes of male snails, with low chromatin density found in the tip. Transmission electron microscopy revealed clear nucleolus and nuclear membranes in the ova of female snail ovaries, and displayed yolk body, liposomes and endoplasmic reticulum in the cytoplasm, bilayer twists of nuclear membrane and a uniform nucleolus in the control group, while in the experiment group, smooth nuclear membrane and unclear nucleolus were observed in the ova of female snail ovaries, with few contents seen within cells.

CONCLUSIONS

Following breeding for 12 winters in the Weishan Lake, the 12th-generation O. hupensis snails fail to fully adapt to the natural environment in northern China, and the remarkable changes in the ultrastructure of the snail gonad may be a cause of gradual decline and even extinction of O. hupensis in the Weishan Lake areas.

The protective role of DMBT1 in cervical squamous cell carcinoma

To explore the possible influence of deleted in malignant brain tumor 1 (DMBT1) in cervical squamous cell carcinoma (CSCC). DMBT1 expression was detected by Real-time reverse transcription PCR (qRT-PCR) and immunohistochemistry in CSCC and adjacent normal tissues from 167 CSCC patients, and its relationship with clinicopathological features and prognosis was analyzed. Besides, the in vitro experiments, including MTT, Cell-Light EdU, Wound-healing, Transwell invasion, Annexin V-FITC/PI staining, qRT-PCR, and Western blot, were performed in SiHa and CaSKi cells, which were both divided into Blank, Vector, and DMBT1 groups. The mRNA level and the positive expression rate of DMBT1 in CSCC tissues were lower than the adjacent normal tissues. Moreover, DMBT1 positive rate was linked to FIGO stage, tumor diameter, lymph node metastasis, and tumor differentiation of CSCC. Besides, patients with positive DMBT1 expression had higher 5-year survival rate than those negative ones. According to the in vitro experiments, SiHa and CaSKi cells with overexpressed DMBT1 showed the inhibition of proliferative ability and the enhancement of apoptosis with the upregulated pro-apoptosis proteins (Bax and Cleaved caspase-3) and down-regulated anti-apoptosis protein Bcl-2. Moreover, compared with Blank group, DMBT1 group presented decrease in the migration and invasion of SiHa and CaSKi cells with the down-expression of interstitial markers (N-cadherin and Vimentin) and the up-expression of epithelial marker E-cadherin. DMBT1 was decreased in CSCC, whereas its overexpression can not only inhibit the proliferation, migration, and invasion, but induce the apoptosis of human CSCC cells, being a novel strategy for CSCC treatment.

[Study on insecticide resistance of Culex pipiens pallens in southwest region of Shandong Province]

OBJECTIVE

To explore the sensitivity of Culex pipiens pallens to common chemical insecticides in the southwestern region of Shandong Province, so as to provide a theoretical basis for the development of reasonable and effective mosquito control measures.

METHODS

The resistance of Cx. pipiens pallens larvae to 5 chemical insecticides, such as cypermethrin, deltamethrin, DDVP, propoxur, and acetofenate were tested by using the WHO biological test method in 2018, and the co-toxicity coefficients after compounding the above-mentioned insecticides were tested by using a drug compounding method.

RESULTS

The resistance indexes of Cx. pipiens pallens to cypermethrin, deltamethrin, DDVP, propoxur, and acetofenate in 3 cities were 144.43-557.54, 118.17-445.33, 6.44-19.00, 2.37-8.10, and 0.88-2.98, respectively, and expect the difference between the DDVP resistances of Cx. pipiens pallens in Jining City and Heze City was not statistically significant (P > 0.05), all the other differences were statistically significant (all P < 0.05). The synergistic coefficients of cypermethrin + DDVP, cypermethrin + propoxur, DDVP + acetofenate, and propoxur + acetofenate were 199.58 - 456.95, 190.56 - 292.37, 123.32 - 319.24, and 192.31 - 367.32, respectively. The lower synergism was observed by using the mixture of DDVP + propoxur (synergistic coefficient: 99.87-108.36) .

CONCLUSIONS

After decades of chemical control, Cx. pipiens pallens in the southwestern region of Shandong Province has produced different degrees of resistance to common chemical insecticides. Therefore, comprehensive control measures should be taken to control mosquito breeding and prevent the development of insecticide resistance.

Role of DNA hypomethylation in lateral habenular nucleus in the development of depressive-like behavior in rats

BACKGROUND

Lateral habenula nucleus (LHb) has recently been noted for its role in stress-induced depressive disorder. Yet little is known about the mechanisms by which external stimuli or depression induces pathological alteration in the LHb.

METHODS

Chronic unpredictable mild stress (CUMS) was employed to model depressive-like behaviors in adult rats. We examined expressions of DNA methyltransferases (Dnmts) mRNA and protein and global DNA methylation levels in LHb of CUMS-induced depressive rats. Then 5-aza-2'-deoxycytidine (5-aza), a Dnmts inhibitor, was infused into the LHb of native rats to test the effects of hypomethylation in the LHb. The gene expressions in the LHb and the levels of 5-HT and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) in dorsal raphe nucleus (DRN) were examined in 5-aza infusion rats by quantitative real-time PCR and high performance liquid chromatography, respectively.

RESULTS

Rats were exposed to CUMS for 21 days and depressive-like behaviors were induced as expected. We observed significant decrease in mRNA and protein expressions of Dnmt1 and DNA hypomethylation in LHb of depressive rats. These phenomenon suggests that CUMS-induced depressive-like behaviors are related with DNA hypomethylation in the LHb. Local 5-aza infusion into LHb of native rat resulted in global DNA hypomethylation in the LHb and induced depressive-like behaviors which are featured with lack of interest and investment in the environment, behavioral despair and anhedonia. Moreover, DNA hypomethylation in the LHb increased transcription of β calcium/calmodulin dependent protein kinase II and glutamate receptor 1 in the LHb and attenuated the levels of 5-HT and 5-HIAA in the DRN. Our data suggested that alteration of DNA methylation in the LHb may control 5-HT neuronal activity in the DRN to regulate emotional state.

CONCLUSIONS

DNA hypomethylation in the LHb is involved in the development of depressive-like behavior and suitable methylation state contributes to the emotional stabilization.

[Three-level logistic analysis related to influencing factors on condom use among female sex workers aged 35 years and above in Qingdao]

Objective: To analyze the influencing factors on condom use among 35-years-or-older female sex workers (OFSWs) in Qingdao by using the three-level logistic model. Methods: From March to June 2014, OFSWs were recruited in Qingdao, using respondent-driven sampling. Related information on OFSWs and their recent five sexual partners (not including husband) were obtained by conducting a questionnaire survey on OFSWs. A Three-level logistic regression model was conducted to analyze the influencing factors of condom use between OFSWs and their sexual partners. Results: A total of 420 OFSWs participated the survey as well as information on 2 100 sexual partners. Results from the empty model showed that the use of condoms among OFSWs having an aggregation that related to the levels of working sites and their own behaviors. Results from the three-levels of logistic model analysis showed that, OFSWs that having had junior middle school education (OR=1.450, 95%CI: 1.054-1.994)/high school education or above (OR=2.264, 95%CI: 1.215-4.222), knowing the function of condom use (OR=2.004, 95%CI: 1.273-3.154) would have higher rates of condom use. OFSWs with higher score of attitude on condom use (OR=0.796, 95%CI: 0.745-0.849), having had syphilis infections in the past (OR=0.657, 95%CI: 0.478-0.902) would have lower rate of condom use. For the sexual partners, the rate of condom use among OFSWs' regular partners were higher than that of OFSWs' boyfriends (OR=15.291, 95%CI: 8.441-27.700; OR=29.032, 95%CI: 15.413-54.682). Conclusion: Condom use of OFSWs was affected by behaviors of both OFSWs themselves and their sexual partners. Prevention and control programs should focus on OFSWs and their sexual partners at the same time. The key intervention contents should include target populations as: OFSWs with low level of education, having had infections of syphilis, those who do not use condoms with their trusted partners.

[Construction and in vitro verification of a new humanized anti-CD19 CAR-T cells with high affinity]

目的

构建人源化抗CD19嵌合抗原受体T细胞（CAR-T），通过体外实验验证其杀伤白血病细胞的能力。

方法

将人CD19的鼠源抗体（FMC63）进行了人源化改造，获得高亲和力的人源化CD19抗体；构建携带人源化CD19 CAR慢病毒载体，感染T细胞获得人源化CD19 CAR-T细胞（hCART19）；按不同效靶比将效应细胞[hCART19、未转染的T细胞（阴性组）及对照病毒转染的T细胞（对照组）]及靶细胞（CHO-K1-CD19及Raji细胞）混合培养，LDH释放实验及ELISA法检测hCART19杀伤白血病细胞的能力及细胞因子释放水平；白血病小鼠模型检测hCART19的杀瘤效果。

结果

LDH释放实验证实随着效靶比的不断增加，对靶细胞的杀伤率逐渐增加，当效靶比为10∶1时hCART19组的杀伤率最大，在Raji细胞中为（87.56±1.99）%，明显高于阴性组[（19.31±1.16）%]及对照组[（21.35±1.19）%]（P值均<0.001）。ELISA法检测显示Raji细胞作为靶细胞时，hCART19组IL-2水平[（10.56±0.88）pg/ml]及IFN-γ[（199.02±12.66）pg/ml]较阴性组[IL-2：（3.55±0.26）pg/ml；IFN-γ：（37.63±0.85）pg/ml]及对照组[IL-2：（2.92±0.32）pg/ml；IFN-γ：（52.07±3.33）pg/ml]明显升高（P值均<0.001）。以上实验在CHO-K1-CD19细胞作为靶细胞时也出现了相似的结果。给予白血病小鼠模型尾静脉分别注射hCART19、对照病毒转染的T细胞及未转染的T细胞，结果显示hCART19组小鼠存活时间>40 d，另外两组小鼠在20~30 d全部死亡，差异有统计学意义（χ²=11.73，P=0.008）。

结论

成功构建了具有抗白血病活性的人源化CD19 CAR-T细胞，为下一步的临床研究奠定了基础。

[Clinical characteristics and prognosis of long-term glucocorticoid users with community-acquired pneumonia]

Objective: To explore the clinical features, etiological features and prognostic risk factors of long-term glucocorticoid users with community-acquired pneumonia (CAP). Methods: A retrospective study included 100 long-term glucocorticoid users with CAP (G-CAP group) from 11 hospitals of China between January 2014 and December 2014, while 100 non-immunocompromised patients with community-acquired pneumonia were enrolled as controls (nICH-CAP group). Characteristics including age, gender, underlying diseases, corticosteroids, symptoms, disease severity, imaging manifestations, etiology, respiratory failure, mechanical ventilation, whether the application of vasoactive drugs, antibiotics application, hospital mortality rate between the two groups were compared, and the prognostic factors of G-CAP were investigated using Logistic regression. Results: The peripheral blood lymphocytes[1.06(0.70, 1.68) vs 1.44 (0.87, 1.98)]in G-CAP group was less than nICH-CAP group (P<0.05). CT with pulmonary interstitial change (28.6% vs 9.9%), the proportion of patients with respiratory failure (25.0% vs 7.0%), mechanical ventilation (9.0% vs 2.0%), noninvasive mechanical ventilation (12.0% vs 2.0%), septic shock (9.0% vs 2.0%), and the hospital mortality rate (13.0% vs 3.0%) in G-CAP group were significantly higher than in nICH-CAP group (all P<0.05). Bacterial infection accounted for the highest proportion of infection (61.3%) in G-CAP group, but also virus infection (19.4%) and mixed infection (16.1%). Pseudomonas accounted for the highest proportion (47.4%) in bacterial infection of G-CAP. Logistic regression analysis showed that peripheral blood lymphocytes (OR=0.004, 95% CI: 0.000-0.234; P<0.05) and respiratory failure (OR=17.766, 95% CI: 4.933-131.0; P<0.05) were independent predictors of death in G-CAP group. Conclusions: The proportion of severe pneumonia and the mortality rate of patients with G-CAP are higher than the patients with nICH-CAP. Lymphopenia and respiratory failure are associated with poor outcome of patients with G-CAP.

[Effect of peripheral bloodgenomic DNA methylation on the relationship between methyl donor status and risk of breast cancer]

Objective: To explore the effect of peripheral blood genomic DNA methylation on the relationship between methyl donor status and risk of breast cancer. Methods: A case-control study was conducted. Each three hundred breast cancer cases and controls were consecutively recruited. Food frequency questionnaire was used to collect dietary information. Amounts on folate, methionine, choline and betaine intake were calculated. Blood samples were collected for DNA extraction. Peripheral blood genomic DNA methylation was measured by using the Methyl Flash(TM) Methylated DNA Quantification Kit. Pathway analysis was used to examine the effect of genomic DNA methylation on the relations between methyl donor status and risk of breast cancer. Results: The genome DNA methylation rates were 0.46%±0.25% and 0.53%±0.34%, respectively on both cases and controls, with differences statistically significant (P<0.01). Results from the pathway analysis, results showed that methionine consumption was related to genomic DNA methylation (β=0.065, P<0.05) while genomic DNA methylation was related to the risk of breast cancerk (β=-0.027, P<0.05), respectively. Conclusions: The level of peripheral blood genomic DNA methylation in breast cancer cases was significantly lower than that in the controls. Genomic DNA methylation seemed to have played a mediated role between methionine and the risk of breast cancer.

De novo assembly and characterization of seabass Lateolabrax japonicus transcriptome and expression of hepatic genes following different dietary phosphorus/calcium levels

Fish farming seriously influences the aquatic environment because most dietary phosphorus (P) is excreted in the effluent. To increase the P utilization in fish, molecular techniques should be explored given the remarkable development of these techniques. Thus, to identify the candidate genes related to P utilization and molecular alterations following administration of a P-deficient diet in seabass Lateolabrax japonicus, we assessed the de novo pituitary, gill, intestine, liver, kidney, scales and vertebra transcriptomes, and we compared the expression of hepatic genes with three diets varying in P and Ca levels: diet I (0.4% P, 0.3% Ca), diet II (0.8% P, 0.3% Ca), and diet III (0.8% P, 3% Ca). In total, we identified 99,392 unigenes, and 37,086 (37.31%) unigenes were annotated. The results showed that 48 unigenes were significantly (P<0.05) up-regulated, while 55 genes were significantly down-regulated in the liver of group I compared with group II. Offering the P-sufficient and high Ca diet, diet III significantly up-regulated 24 unigenes and down-regulated 46 genes in the liver. There were significant differences in the regulation of 8 unigenes (3 up-regulated and 5 down-regulated) between groups II and III. Gene ontology (GO) functional enrichment and KEGG pathway analysis of differently expressed genes were performed for each pair of groups. The GO analysis showed that a large number of biological processes were significantly altered between P-deficient and P-sufficient treatments (I vs II and I vs III). Comparing group I and group II, seven KEGG terms were enriched significantly: glycine, serine and threonine metabolism, one carbon pool by folate, arginine and proline metabolism, the biosynthesis of unsaturated fatty acids, fatty acid elongation, drug metabolism-cytochrome P450, and fatty acid metabolism. There was no significantly enriched KEGG pathway between groups II and III. In conclusion, our study revealed that a P-deficient diet could increase catabolism and decrease anabolism of protein, as highlighted by low protein efficiency in fish fed the P-deficient diet. Furthermore, P-deficiency could motivate the biosynthesis of fatty acids. However, the dietary Ca level had no significant effect on the growth and expression of hepatic genes in L. japonicus.

Sex-related variations in cortical and trabecular bone of the femoral neck in an elderly Chinese population

Quantitative computed tomography (QCT) was used to investigate sex-related variations in cortical and trabecular bone of the femoral neck. Cortical bone thickness of women in the superior quadrant was thinner than that of men, and the cortex in all four quadrants was negatively associated with age in women.

INTRODUCTION

This cross-sectional study aimed to investigate sex-related similarities and differences in femoral neck structure in an elderly Chinese population by QCT bone investigational toolkit (BIT) analysis.

METHODS

This study included 207 male (67.9 ± 7.7 years; range, 55-87 years) and 400 female subjects (68.0 ± 8.7 years; range, 55-96 years). BIT module was used to measure cortical and trabecular bone in anatomic quadrants of the femoral neck. Measurements of cortical thickness (Ct.Th), cortical vBMD (Ct.vBMD), trabecular vBMD (Tb.vBMD), and integral vBMD (It.vBMD) at the femoral neck were determined in four anatomical sectors.

RESULTS

The greatest difference between sexes, after adjusting for age, height, and weight, was in Ct.Th of Quadrant Supero-anterior (SA), which was 27.4% lower in women (p<0.001). Ct.Th of Quadrant Supero-posterior (SP) was 15.1% lower in women (p = 0.027). Ct.Th and Tb.vBMD in all four quadrants appeared to be negatively associated with age in females, whereas no significant relationship was observed in males, except Ct.Th of Quadrant SP.

CONCLUSIONS

The superior femoral neck geometry between males and females was significantly different, even after adjustment for body size and age, and the sub-regional cortical and trabecular bone negatively age-related changes in women indicated that women apparently have a more vulnerable geometrical outcome with age for fractures than men.

Optical signatures of parity anomaly in a gapped graphene-like system

Parity anomaly refers to the violation of coordinate reflection symmetry induced by the quantum fluctuations. It is proposed to exist in a graphene-like system with a finite bare mass for Dirac fermions, and manifests itself as a parity-violating quantum correction to the current of each species of fermions. Coulomb interaction greatly increases the fermion mass, and produces various types of excitons. Of particular interest is the ρ-exciton, which is directly connected to parity anomaly and can be generated by absorbing a specific photon. The exciton is a particle-hole bound state, and can be regarded as condensed-matter analogue of meson composed of quark-anti-quark pair. By virtue of this correspondence, we analyze the optical conductivity and calculate the mass of ρ-exciton by employing the Shifman-Vainshtein-Zakharov sum rule method that is widely used in the studies of hadron phenomenology. We show that ρ-exciton leads to a sharp peak in the optical conductivity, which is observable in optical experiments. Moreover, we study the impact of scalar-like excitons on two-photon processes by computing the decay amplitude, and also find peaks in the Raman spectra.

[Inflammatory myofibroblastic tumour of thyroid: a case report]

A elderly woman patient，with a unclear boundary,solid,smooth surface,moderately active mass that estimated 0.4 cm at its greatest diameter in the left lobe of thyroid. Ultrasonography revealed a hypoechoic mass in the left lobe and Computed Tomography showed a 38 mm×25 mm×23 mm oval lesion with uniform density in the left lobe also. The surgical findings revealed tumor located in the inner side of left thyroid lobe near the isthmus,with unclear boundary. Pathological examination showed unclear boundaries between thyroid and tumor,the tumor cells attack into the muscle tissue,braided/ fascicles spindle shaped or star shaped myofibroblasts cells in the tumor area with myxedema inflammatory background and the lesion did not have any mitotic figures. Immunohistochemical analysis indicated that the spindle cells were positive for Vim,ACT,SMA,Bcl2 and ClyD1,and focal lesion histiocytes showed focal positive for CD68,CK and S-100,but negative for DES,Mgo,CD99,CD34,CD117,IgG4,ALK-1.The pathological diagnosis supports inflammatory myofibroblastic tumor of thyroid. Imaging and immunohistochemistry and others are useful in differential diagnosis.

Five low energy phosphorene allotropes constructed through gene segments recombination

Based on the crystal structures of the previously proposed low energy η-P and θ-P, five new phosphorene allotropes were predicted through gene segments recombination method. These five new phosphorene allotropes are confirmed dynamically stable and energetically more favorable than their parents (η-P and θ-P). Especially, the XX-XX type G1-P is confirmed energetically more favorable than most of all the previously proposed phosphorene allotropes, including black phosphorene and blue phosphorene, which is highly expected to be synthesized in future experiment through vapor deposition or epitaxial growth method like blue β-P. The calculated results also show that such a new promising phosphorene allotrope G1-P is a potential candidate for application in nano-electronics according to its middle band gap of about 1.491 eV from DFT-HSE06 calculation.

Pre-harvest foliar application of ethephon strengthens gibberellins-induced fruit expansion in Pyrus pyrifolia

To identify the roles of ethylene in fruit development in Japanese pear Pyrus pyrifolia 'Niitaka', one of the non-climacteric genotypes, source-sink strength and fruit development during fruit expansion were investigated when ethephon was applied after a conventional gibberellic acid (GA) lanolin paste treatment on the pedicel. The results demonstrate that the conventional GA treatment during the early stage of fruit expansion resulted in larger fruit size and advanced fruit maturation, but pre-harvest foliar application of ethephon only advanced fruit maturation. However, pre-harvest foliar application of ethephon with a preceding conventional GA treatment during the early stage of fruit expansion dramatically improved fruit size and advanced fruit maturation over GA or ethephon alone. Moreover, the early foliar application of ethephon showed a better efficacy in increasing fruit size than the late spraying. A further study revealed that when ethephon was applied after the conventional GA treatment, it improved source-sink strength associated with leaf photosynthesis and the specific rate of [¹³C] accumulation in fruit, and also strengthened cell expansion more than did GA or ethephon alone.

Effects of carbomer eye drops in combination with orthokeratology lens in treating adolescent myopia

To investigate the effects of carbomer eye drops (CED) during long-time wearing of overnight orthokeratology lens of adolescents with myopia, 260 teenagers with myopia treated in the Henan Provincial People’s Hospital from June 2012 to August 2014 and followed-up for more than 2 years were enrolled. All the patients underwent regular fitting of orthokeratology lens. They were divided into a CED (Vidisic) group (130 cases, 260 eyes treated with CED) and rewetting drops (RD) (Baushe and Lomb) group (130 cases, 260 eyes treated with RD). The effects in the two groups were observed. The incidence of corneal epithelial defects one day, one week and one month after treatment of the CED group was lower than that of the RD group, and the difference was statistically significant (P less than 0.05); the tear break up time (TBUT) of the CED group was higher than that of the RD group at different time points, and the difference had statistical significance (P less than 0.05); the difference of the value of Schirmer I test between the two groups had no statistical significance (P>0.05). It is concluded that carbomer eye drops can stabilize tear film and protect and repair corneal epithelium during the wearing of orthokeratology lens.

Association between pretreatment Glasgow prognostic score and gastric cancer survival and clinicopathological features: a meta-analysis

BACKGROUND

Glasgow prognostic score (GPS) is widely known as a systemic inflammatory-based marker. The relationship between pretreatment GPS and gastric cancer (GC) survival and clinicopathological features remains controversial. The aim of the study was to conduct a meta-analysis of published studies to evaluate the association between pretreatment GPS and survival and clinicopathological features in GC patients.

METHODS

We searched PubMed, Embase, MEDLINE, and BioMed databases for relevant studies. Combined analyses were used to assess the association between pretreatment GPS and overall survival, disease-free survival, and clinicopathological parameters by Stata Version 12.0.

RESULTS

A total of 14 studies were included in this meta-analysis, including 5,579 GC patients. The results indicated that pretreatment high GPS (HGPS) predicted poor overall survival (hazard ratio =1.51, 95% CI: 1.37-1.66, P<0.01) and disease-free survival (hazard ratio =1.45, 95% CI: 1.26-1.68, P<0.01) in GC patients. Pretreatment HGPS was also significantly associated with advanced tumor-node-metastasis stage (odds ratio [OR] =3.09, 95% CI: 2.11-4.53, P<0.01), lymph node metastasis (OR =4.60, 95% CI: 3.23-6.56, P<0.01), lymphatic invasion (OR =3.04, 95% CI: 2.00-4.62, P<0.01), and venous invasion (OR =3.56, 95% CI: 1.81-6.99, P<0.01).

CONCLUSION

Our meta-analysis indicated that pretreatment HGPS could be a predicative factor of poor survival outcome and clinicopathological features for GC patients.

Combining corneal crosslinking and phakic toric Implantable Collamer Lenses for the treatment of keratectasia: A case report

The present study reports the use of a phakic toric Implantable Collamer Lens (ICL) that improved the refraction correction of high myopia and astigmatism in a case of keratectasia following corneal cross-linking. A 31-year-old male was diagnosed with keratectasia 12 years after laser-assisted in situ keratomileusis (LASIK). Following LASIK, the manifest refraction was -3.50-2.25×90 [0.1 logarithmic expression (LogMAR) best corrected visual acuity (BVCA)] in the right eye and -8.00-3.50×175 (0.3 LogMAR BCVA) in the left eye, with a LogMAR uncorrected distance visual acuity (UDVA) of 0.8 and a 'counting fingers' value of 3 ft (CF @3 ft) in the left and right eyes, respectively. Riboflavin/ultraviolet A light (UVA) corneal crosslinking (CXL) was conducted on both eyes. Seven months after cross-linking, LogMAR UDVA was 0.4, the manifest refraction was -2.75-2.50×85 and LogMAR BCVA was 0.1 in the right eye. In the left eye, LogMAR UDVA was CF @3 ft, the manifest refraction was -15.00 and LogMAR BCVA was 0.3. The corneal topography was stable 7 months after CXL. Phakic toric ICL was implanted to correct the refractive error, following which the LogMAR UDVA improved to 0.1 in the right eye and 0.3 in left eye, and visual acuity remained stable for 6 months after ICL implantation. In conclusion, combining riboflavin/UVA corneal cross-linking and phakic toric ICL implantation may be an alternative in the correction of high refractive error in patients with keratectasia.