Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control

Background

Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes.

Methods

The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life.

Results

The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan.

Conclusions

This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.

Determination of hydrogen gas by 1,4-bis(phenylethynyl)benzene hydrogenation coupled with gas chromatography-mass spectrometry

Knowing the H2 concentration released from polymer materials is essential to understand the degradation degree of polymer materials. In this study, a novel strategy of 1,4-bis(phenylethynyl)benzene (DEB) hydrogenation in combination with gas chromatography - mass spectrometry (GC-MS) determination of hydrogen gas (H2) was developed. In this strategy, DEB was utilized to react with H2 for establishing the quantitative analysis method of H2. A H2 analysis platform that could accurately control H2 concentration was designed and fabricated to be used to establish the quantitative method of H2. The linear regression curve was established between the H2 standard and the MS signal of the reaction products on GC-MS. Finally, the H2 released from polyethylene under gamma radiation was detected by this method. This method could be a powerful auxiliary tool for studying the content changes of H2.

[One case of acute severe nitrite poisoning with massive pulmonary thromboembolism]

This paper reported a case of acute severe nitrite poisoning with massive pulmonary thromboembolism (PTE), discussed the pathogenesis and summarized the treatment experience. Common symptoms of nitrite poisoning include headache, abdominal pain, shortness of breath, cyanosis, etc., which can be followed by encephalopathy, neurological dysfunction, hemolysis, etc. However, the cases of PTE are rare in clinical practice and are prone to missed diagnosis. Nitrite and methemoglobin may lead to vascular endothelial damage and promote thrombosis. In the diagnosis and treatment of acute severe nitrite poisoning patients, the targeted preventive measures should be taken.

[Evaluation of uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculous empyema]

Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ² test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ²=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ²=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ²=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.

[Mechanism of Leakage in Phosphatidylserine-Containing Membranes by Melittin]

Phosphatidylserine (PS) is an important apoptotic-cell surface signal that exists in bacterial and cancer cells. The mechanism by which melittin interacts with the PS membrane remains unclear. Here, we revealed this mechanism by using a dual-channel fluorescence microscope to observe the concentration-dependent process of pore formation in giant unilamellar vesicles (GUVs) that were exposed to melittin solution. We found that unsaturated PS membranes differed significantly from saturated PS membranes in different phases. This study provides a reference for research and development of anticancer drugs.

[A protein complex recognition method based on spatial-temporal graph convolution neural network]

OBJECTIVE

To propose a new method for mining complexes in dynamic protein network using spatiotemporal convolution neural network.

METHODS

The edge strength, node strength and edge existence probability are defined for modeling of the dynamic protein network. Based on the time series information and structure information on the graph, two convolution operators were designed using Hilbert-Huang transform, attention mechanism and residual connection technology to represent and learn the characteristics of the proteins in the network, and the dynamic protein network characteristic map was constructed. Finally, spectral clustering was used to identify the protein complexes.

RESULTS

The simulation results on several public biological datasets showed that the F value of the proposed algorithm exceeded 90% on DIP dataset and MIPS dataset. Compared with 4 other recognition algorithms (DPCMNE, GE-CFI, VGAE and NOCD), the proposed algorithm improved the recognition efficiency by 34.5%, 28.7%, 25.4% and 17.6%, respectively.

CONCLUSION

The application of deep learning technology can improve the efficiency in analysis of dynamic protein networks.

Downregulation of miR-21 promotes tibial fracture healing in rabbits through activating ERK pathway

OBJECTIVE

The aim of this study was to investigate the effect of micro ribonucleic acid (miR)-21 on tibial fracture healing in rabbits by regulating the extracellular signal-regulated kinase (ERK) signaling pathway, and to explore its possible underlying mechanism.

MATERIALS AND METHODS

A total of 15 healthy male rabbits were randomly divided into three groups, including: model group A (fracture group, n=5), model group B (fracture treatment group, n=5), and model group C (miR-21 siRNA + treatment group, n=5). Fracture healing was observed by imaging. The content of the serum collagen I and collagen II in rabbits was detected via enzyme-linked immunosorbent assay (ELISA). The morphology of bone tissues was observed via staining. Moreover, the expressions of ERK, transforming growth factor-β1 (TGF-β1), and Smad in osteoblasts of tibia were observed via Western blotting and Reverse Transcription-Polymerase Chain Reaction (RT-PCR), respectively.

RESULTS

There was bony callus formation in group B and C when compared with group A. Compared with group B, bony callus formation was significantly accelerated in group C, while healing cycle was shortened. Hematoxylin-eosin (HE) staining and Masson staining indicated that compared with group A, group C had more fibrous calluses, new capillaries, and fibroblasts in tissues. Meanwhile, group C exerted better maturity of collagen tissues and higher osteoid content at 20 d after modeling. Compared with group C, there were more osteoid tissues with poor maturity in group B. Meanwhile, intramembranous bone formation was deformed, and collagen content was remarkably lower in group B. The content of serum collagen I and collagen II remarkably increased in group B compared with group A (p<0.05). However, it was significantly upregulated in group C compared with group B, showing statistically significant differences (p<0.05). According to the results of Western blotting, the protein expressions of TGF-β1, Smad, and ERK in osteoblasts were significantly upregulated in group B when compared with those in group A (p<0.05). However, they increased remarkably in group C when compared with group B (p<0.05). Besides, RT-PCR results revealed that the messenger RNA (mRNA) expressions of TGF-β1, Smad, and ERK in osteoblasts were significantly higher in group B than those in group A (p<0.05). However, they were markedly raised in group C in comparison with group B (p<0.05).

CONCLUSIONS

Down-regulation of miR-21 promotes tibial fracture healing in rabbits by activating the ERK signaling pathway.

[A birth cohort study of the association between prenatal serum bisphenol A concentration and infant neurobehavior development]

Objective: To explore the association between maternal bisphenol A (BPA) exposure during pregnancy and neurobehavioral development in infant. Methods: Participants were from the Ma'anshan Birth Cohort, which was established from October 2008 to October 2010 based on four municipal medical and health institutions in Ma'anshan. High-performance liquid chromatography-tandem mass spectrometry was applied for the determination of serum BPA concentration in 1 783 pregnant women sampled at their first filing, and during 2.97 to 28.1 months age of the infants. Neurobehavioral development were assessed by 0-6-year-old pediatric examination table of neuropsychological development. Generalized linear model was used to analyze the association between serum BPA levels during pregnancy and infants' neurobehavioral development. Results: A total of 931 mother-child pairs had complete data on serum BPA detection during pregnancy and assessment of infants' neurobehavioral development status. The age of pregnant women at their first filing was (26.67±3.45) years old, and the M (P₂₅,P₇₅) of serum BPA concentration (ng/ml) was 0.23 (0.11, 0.52), with a detection rate of 84.1% (783/931). The age of infants was (13.18±5.46) months, and 53.5% (498) were boys. The developmental quotient scores of large motor, fine motor, adaptive ability, language ability and social behaviors of infants were (97.88±16.32), (97.16±15.35), (99.64±15.47), (95.3±16.04) and (98.95±14.76) points, respectively. Generalized linear model showed that after adjusting for factors such as delivery mode, feeding mode, family per capita monthly income, preterm delivery, gender, maternal age, residence, pre-pregnancy body mass index and residence time, serum BPA level in pregnancy was negatively associated with infant's development of social behavior [β (95%CI):-2.42 (-4.71, -0.12)]. The post-stratification analysis by infant age revealed that the serum BPA level in pregnancy was only negatively associated with the development of language and social behavior developmental quotient scores in infants between the ages of 12 and 18 months, with β (95%CI) about -6.66 (-13.06, -0.25) and -7.401 (-12.97, -1.83), respectively. Conclusion: BPA exposure during pregnancy affects language and social behavior development in infants, and the detection window is between 12 and 18 months old of the infant.

Molecular epidemiology of Pseudomonas aeruginosa isolated from lower respiratory tract of ICU patients

Lower respiratory tract infections (LRTIs) caused by Pseudomonas aeruginosa are the most common infection among hospitalized patients, associated with increased levels of morbidity, mortality and attributable health care costs. Increased resistant Pseudomonas worldwide has been quite meaningful to patients, especially in intensive care unit (ICUs). Different species of Pseudomonas exhibit different genetic profile and varied drug resistance. The present study determines the molecular epidemiology through DNA fingerprinting method and drug resistance of P. aeruginosa isolated from patients with LTRIs admitted in ICU. A total of 79 P. aeruginosa isolated from patients with LRTIs admitted in ICU were characterized by Restriction Fragment Length Polymorphism (RFLP), Random Amplified Polymorphic DNA (RAPD) and Repetitive Extrapalindromic PCR (REP-PCR). Antibiotic resistance was determined by minimum inhibitory concentration (MIC) assay while MDR genes, viz, blaTEM, blaOXA, blaVIM, blaCTX-M-15 were detected by polymerase chain reaction (PCR). Of the 137 Pseudomonas sp isolated from ICU patients, 57.7% of the isolates were reported to be P. aeruginosa. The overall prevalence of P. aeruginosa among the all included patients was 34.5%. The RAPD analysis yielded 45 different patterns with 72 clusters with 57% to 100% similarity level. The RFLP analysis yielded 8 different patterns with 14 clusters with 76% to 100% similarity level. The REP PCR analysis yielded 37 different patterns with 65 clusters with 56% to 100% similarity level. There was no correlation among the different DNA patterns observed between the three different methods. Predominant of the isolates (46.8%) were resistant to amikacin. Of the 79 isolates, 60.8% were positive for blaTEM gene and 39.2% were positive for blaOXA gene. P. aeruginosa was predominantly isolated from patients with LRTIs admitted in ICU. The difference in the similarity level observed between the three DNA fingerprinting methods indicates that there is high inter-strain variability. The high genetic variability and resistance patterns indicates that we should continuously monitor the trend in the prevalence and antibiotic resistance of P. aeruginosa especially in patients with LRTIs admitted in ICU.

Association between Skeletal Muscle Strength and Dysphagia among Chinese Community-Dwelling Elderly Adults

OBJECTIVES

Swallowing disorder is a health burden for the elderly in China. This study aimed to investigate the prevalence of dysphagia and to test the association between skeletal muscle strength and swallowing problems among community-dwelling older adults.

DESIGN

A cross-sectional study.

SETTING

Community-dwelling Chinese elderly in China.

PARTICIPANTS

3361 adults aged 65 years or above were involved, among which 1740 (51.8%) were female, with average age of 72.64 (Standard deviation, SD=6.10) years old.

MEASUREMENTS

Handgrip strength (HGS) was used to evaluate skeletal muscle strength. Dysphagia assessment was performed using the Eating Assessment Tool-10 (EAT-10) and the 30mL water swallow test (WST). Binary logistic regression was used to evaluate the relationship between skeletal muscle strength and dysphagia, and covariates as age, gender, material status, etc. were adjusted.

RESULTS

The prevalence of dysphagia were 5.5% and 12.9%, screened by EAT-10 and 30mL WST respectively. Participants with dysphagia showed lower HGS (21.73 ± 9.20 vs. 25.66 ± 11.32, p<0.001, by EAT-10; 20.26 ± 9.88 vs. 26.22 ± 11.28, p<0.001, by WST). The adjusted model suggested that muscle strength is a protective factor for swallowing disorders (adjusted OR=0.974, 95%CI: 0.950-0.999, by EAT-10; adjusted OR=0.952, 95%CI: 0.933-0.972, by WST). Subgroup analyses of WST found the effects were significant among participants aged in 70-74 years group and ≥75 years group, rather than those aged under 70.

CONCLUSION

Dysphagia was significantly associated with skeletal muscle strength among the community-dwelling elderly population. Effective interventions should be taken to manage the decline of muscle strength for the older adults, especially early prevention before 70 years old.

Histological study of intestinal goblet cells, IgA, and CD3+ lymphocyte distribution in Huang-huai white goat

BACKGROUND

Ten healthy adult Huang-huai white goats were selected and sacrificed by jugular vein bleeding after anaesthesia to observe the distribution characteristics of the histological structure of the intestinal mucosa, goblet cells, IgA, and CD3+ lymphocytes.

MATERIALS AND METHODS

Three sections of the duodenum, the jejunum, and the ileum were immediately collected and fixed with 4% paraformaldehyde for 72 h to prepare tissue sections. After haematoxylin and eosin, periodic acid Schiff, and immunohistochemical staining was performed, the distribution characteristics of goblet cells, IgA-positive cells, and CD3+ lymphocytes were observed. Results showed high columnar epithelial cells in the duodenum and jejunum of Huang-huai white goat and low columnar epithelial cells in the ileum mucosa.

RESULTS

Mucopolysaccharides secreted by intestinal goblet cells were mainly neutral, and the number of ileum goblet cells was significantly higher than that of the duodenum and the jejunum (p < 0.05). IgA-positive cells were distributed in the lamina propria of the duodenum, and the number of cells was significantly higher than that in the jejunum and the ileum (p < 0.01). The significant difference was found between the jejunum and the ileum (p < 0.01). The CD3+ cells in the intestinal mucosa were distributed in the lamina propria mucosae, and some of the positive cells in the jejunum were distributed between epithelial cells. CD3+ cells had the largest number in the jejunal lamina propria but had the lowest number in the ileum.

CONCLUSIONS

The jejunum was significantly higher than the duodenum (p < 0.05), and the ileum was much less than the jejunum (p < 0.01).

[Association between early pregnancy bisphenol A exposure and sleep problems among preschool children]

Objective: To analyze the association between maternal bisphenol A exposure during early pregnancy and sleep problems among preschool children. Methods: Research subjects were from one of the sub-cohorts(Ma'anshan Cohort) of the China-Anhui Birth Cohort Study (C-ABCS) in Ma'anshan city. The basic situation of pregnant women and sleep information of preschool children were investigated. We selected preschool children whose mother's maternal serum bisphenol A concentrations of the first trimester had been already detected between December 2012 to Januray 2014. 1 259 pairs of mothers and children were included. The concentrations of bisphenol A exposure during early pregnancy were divided into low, medium and high exposure groups according to 25(th) percentile (P(25)) and 75(th) percentile (P(75)) levels. Multivariate multinomial logistic regression model was used to analyze the association between maternal bisphenol A exposure during early pregnancy and sleep-related problems in preschool children. Results: The P(50) (P(25)-P(75)) of serum bisphenol A exposure level during early pregnancy was 0.231 (0.106-0.512) ng/ml. The sleep-related problems scores of 1 259 preschool children were (16.43±3.82) points. The occasional sleep-related problems were detected about 47.8% (602 cases) and frequent sleep-related problems were detected about 18.3% (230 cases). After the adjustment of the confounding factors such as children's gender, age, BMI, sleep position (lying down, sleeping on one's back), the length of time to sleep and the length of sleep at night, in comparison with bisphenol A low exposure group, the OR (95%CI) value of preschool children with occasional sleep-related problems in maternal bisphenol A high exposure group during early pregnancy was 1.44 (1.01-2.06). After the gender stratification, the results showed that in comparison with bisphenol A low exposure group, the OR (95%CI) value of preschool girls with occasional sleep-related problems in maternal bisphenol A medium and high exposure group during early pregnancy were 1.61 (1.05-2.46) and 2.40 (1.42-4.04), respectively. The OR (95%CI) value of preschool girls with frequent sleep-related problems in maternal bisphenol A high exposure group during early pregnancy was 2.64 (1.34-5.17). However, in boys, there was no statistically significant association between maternal bisphenol A exposure during early pregnancy and sleep-related problems (P>0.05). Conclusion: Maternal bisphenol A exposure during early pregnancy might be related to sleep-related problems in preschool children.

[Association between the internal exposure levels of phthalates and executive function of preschool children]

Objective: To investigate the association between the internal exposure levels of phthalic acid esters (PAEs) and executive function (EF) of preschool children. Methods: Between October 2008 and October 2010, pregnant women who accepted pregnancy health care services in four municipal medical and health institutions in Ma'anshan city, Anhui Province, were recruited as study objects. A total of 5 084 pregnant women and 4 669 singleton live births were enrolled in this cohort. The follow-up study was conducted from April 2014 to April 2015. A total of 3 725 data-completed preschool children aged 3 to 6 years older entered in this study. The method of analysis seven metabolites of phthalates in urine was high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and divided objects into low (P(0)-P(24)), medium (P(25)-P(74)) and high (P(75)-P(100)) groups according to their exposure concentrations. To investigate the executive function of preschool children, we used the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Univariate and multivariate statistical method was used to analyze the etiology association between the phthalate metabolites levels and preschool children's executive function. Results: In this study, 53.6% (1 997/3 725) of preschoolers were boys, children's age was (51.5±5.6) months. The detection rates of seven phthalate esters were: mono-n-methyl phthalate (MMP) was 99.89% (3 721/3 725); mono-ethyl phthalate (MEP) was 99.97% (3 724/3 725); mono-benzyl phthalate (MBzP) was 69.10% (2 574/3 725); mono-butyl phthalate (MBP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono- (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) were 100.00% and mono-ethylhexyl phthalate (MEHP) was 99.95% (3 723/3 725). The median concentrations of the seven phthalate metabolites were: 17.71, 15.36, 0.07, 155.24, 10.73, 14.67, 3.59 µg/L, respectively. The median concentrations corrected by urinary creatinine were 29.65, 26.65, 0.12, 257.73, 17.94, 24.80, 6.27 µg/g Cr, respectively. The P(25) and P(7)5 concentration of the total PAEs metabolites corrected by urinary creatinine were 1.20 µmol/g Cr and 3.04 µmol/g Cr. After adjusted the relevant demographic information: children sex, children age in month, maternal age, parental education levels, household exposure to secondhand smoke and whether the child is the only child as confounds, multivariate logistic regression model showed that the risk of inhibitory self-control index (ISCI) dysplasia in MEHHP high concentration group and MEOHP high concentration group were 1.71 and 1.54 times (OR=1.71, 95% CI: 1.11-2.62; OR=1.54, 95% CI: 1.01-2.34) than in low concentration group. The risk of ISCI dysplasia in total PAEs metabolites high concentration group was 1.55 times (OR=1.55, 95% CI: 1.00-2.38) than in low concentration group. Conclusion: Phthalates exposure may damage the executive function of preschool children.

Interpretation of liver stiffness measurement-based approach for the monitoring of hepatitis B patients with antiviral therapy: A 2-year prospective study

Liver biopsy is not routinely performed in treated chronic hepatitis B. Liver stiffness measurement has been validated for noninvasive liver fibrosis assessment in pretreatment chronic hepatitis B but has not been assessed for fibrosis monitoring during antiviral therapy. Liver stiffness was systemically monitored by Fibroscan^® every 6 months in a cohort of patients with hepatitis B receiving antiviral therapy and compared with liver biopsies at baseline and week 104. A total of 534 hepatitis B e antigen-positive treatment-naive patients receiving telbivudine-based therapy with qualified liver stiffness measurement at baseline and week 104 were analyzed, 164 of which had adequate paired liver biopsies. Liver stiffness decreased rapidly (-2.2 kPa/24 weeks) in parallel with alanine aminotransferase (ALT) from 8.6 (2.6-49.5) kPa at baseline to 6.1 (2.2-37.4) kPa at week 24. Interestingly, liver stiffness decreased slowly (-0.3 kPa/24 weeks) but continually from week 24 to week 104 (6.1 vs 5.3 kPa, P < .001) while ALT levels remained stable within the normal range. More importantly, liver stiffness declined significantly irrespective of baseline ALT levels and liver necroinflammation grades. From baseline to week 104, the proportion of patients with no or mild fibrosis (Ishak, 0-2) increased from 74.4% (122/164) to 93.9% (154/164). Multivariate analysis revealed that percentage decline of 52-week liver stiffness from baseline was independently associated with 104-week liver fibrosis regression (odds ratio, 3.742; P = .016). Early decline of 52-week liver stiffness from baseline may reflect the remission of both liver inflammation and fibrosis and was predictive of 104-week fibrosis regression in treated patients with chronic hepatitis B.

[Surgical treatment of intractable odontoid fracture with atlantoaxial dislocation in children with spinal cord injury]

Objective: To discuss the surgical treatment and its effectiveness of odontoid fracture complicated with atlantoaxial dislocation in children with spinal cord injury. Methods: From January 2010 to December 2014, 10 cases of children under 14 years old, with intractable odontoid fracture with atlantoaxial dislocation were enrolled. The mean duration between injury and admission was 8.5 d (range 1-30 d). The surgery was performed using posterior reduction and internal fixation or anterior release combined with posterior fixation. The medical date including preoperative and postoperative neurological function, degree of reduction and fusion. Results: All cases were followed-up for 12-48 months. The last follow-up X ray and CT examinations showed good reduction and fusion. No fixation failure was observed among all the patients. According to the Frankel, the preoperative neurological function was C in 2 cases, D in 4 cases, and E in 4 cases. At the last follow-up, out of 2 cases with Frankel C improved to D, and the other 8 cases were back to normal. Conclusions: Diagnosis of odontoid fracture complicated with atlantoaxial dislocation is usually delayed in children. One-stage posterior reduction and internal fixation or anterior release combined with posterior fixation is an effective and safe surgical procedure for such cases.

Abstract P6-12-21: Breast cancer survivors undergoing survivorship visits at Johns Hopkins are a high-risk population

Background: Survivorship care plans (SCPs) are strongly recommended for all breast cancer survivors to address sequelae of cancer care, plan cancer surveillance and screening, and encourage health promotion and care coordination. Ongoing studies are evaluating the impact of SCPs in cancer survivor populations and the role of survivorship visits (SVs) as an intervention. Here we describe characteristics and outcomes of patients who participated in SVs at Johns Hopkins (JH).

Methods: We retrospectively reviewed the charts of patients who participated in a SV with one of two nurse practitioners ˜1-3 months after completion of locoregional therapy and initial systemic therapy, as referred by their JH breast cancer provider. We collected patient demographics, comorbidity status, tumor characteristics, treatments received, and responses to GAD7 (generalized anxiety disorder 7-item), PHQ9 (patient health questionnaire-9), and a symptom questionnaire. Characteristics of SV participants were compared to analytical breast cancer cases from the JH Cancer Registry (JHCR 2010-2015), matched for stage.

Results: 87 women (stages I-III) who participated in a SV in 2010-2016 were identified. Compared to patients in the JHCR (n=2,942), the SV cohort was younger (age ≤50, 43% v 34%, p=0.14), more likely to be African American (33% v 22%, p=0.04), and more likely to have a higher TNM stage (I, 26% v 49%; II, 48% v 37%; III, 25% v 15%, p&lt;0.001), node-positive status (60% v 33%, p&lt;0.001), hormone receptor-negative disease (44% v 18%, p&lt;0.001), and HER2-positive disease (38% v 14%, p&lt;0.001). The SV cohort was also more likely to receive chemotherapy (94% v 43%, p&lt;0.001) and undergo radiation therapy (78% v 54%, p&lt;0.001). The SV cohort had a higher recurrence event rate than the JHCR cohort (11.5% v 8.0%) and a shorter median follow-up (886 v 1292 days), suggestive of a higher risk profile. In the SV cohort, a comparison of comorbidities at breast cancer diagnosis versus time of SV visit identified a significant increase in the prevalence of peripheral neuropathy (9% v 73%, p&lt;.001), anemia (15% v 50%, p&lt;.001), lymphedema (0% v 28%, p&lt;.001), anxiety (15% v 38%, p&lt;.001), and depression (13% v 29%, p&lt;.001). Patients in the SV cohort were overweight at diagnosis (body mass index, median 29 [IQR 24, 32]). At the time of the SV, patients reported symptoms of sleep difficulty (53%), numbness or tingling (46%), weight changes (45%), muscle aches (44%), and pain (37%).

Conclusions: Patients who participated in SVs had high-risk cancers and, compared to baseline, a higher frequency of comorbidities that are potentially associated with breast cancer and its treatment. These data can inform future breast cancer survivorship care models as they describe a population that may be at greater risk for worse cancer and non-cancer outcomes, and that might benefit more from interventions like SCPs and SVs. Ongoing studies are identifying optimal target populations, appropriate timing of such interventions, and informative measures of patient-centered outcomes.

Funding: Komen Maryland/Komen Scholar SAC110053 (ACW).

Citation Format: Skuli SJ, Bantug ET, Zafman N, Riley C, Ruck JM, Sheng J, Smith KC, Snyder CF, Smith KL, Stearns V, Wolff AC. Breast cancer survivors undergoing survivorship visits at Johns Hopkins are a high-risk population [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-21.

The impact of isolated maternal hypothyroxinaemia on the incidence of large-for-gestational-age infants: the Ma'anshan Birth Cohort study

OBJECTIVE

The purpose of this study was to investigate whether isolated maternal hypothyroxinaemia (IMH) is associated with risks of small/large-for-gestational-age (SGA/LGA) infants.

DESIGN

Population-based prospective cohort study.

SETTING

Ma'anshan Maternal and Child Health (MCH) clinics, China.

POPULATION

Pregnant women with singleton births (n = 3178).

METHODS

Descriptive statistics were calculated for the demographic characteristics of the mothers and their newborns. Linear regression was applied to estimate the association between thyroid hormone levels and birthweight. Logistic regression was performed to calculate the association between IMH and SGA/LGA.

MAIN OUTCOME MEASURES

Outcomes included SGA/LGA.

RESULTS

The prevalence of IMH, defined as a free thyroxine value (FT4) lower than the 2.5th percentile with normal thyroid stimulating hormone, was 2.5% (78/3080) and 2.5% (74/2999) in the first and second trimesters, respectively. Additionally, 306 (9.6%) and 524 (16.5%) infants were defined as SGA and LGA, respectively. No evidence supported the notion that IMH is associated with an increased risk for SGA in either the first [odds ratio (OR): 1.762, 95% confidence interval (CI): 0.759-4.089] or the second (OR: 0.763, 95% CI: 0.231-2.516) trimester. However, an increased risk of LGA was observed among IMH women in the second trimester (OR: 2.088, 95% CI: 1.193-3.654). Maternal TPO-Ab positivity in the second trimester increased the risk of SGA (OR: 2.094, 95% CI: 1.333-3.290).

CONCLUSION

This study provides evidence that IMH is associated with LGA.

FUNDING

This work was supported by the National Natural Science Foundation of China (No. 81330068).

TWEETABLE ABSTRACT

Isolated maternal hypothyroxinaemia may increase the risk of large-for-gestational-age infants.

Abdominal diameter index is a stronger predictor of prevalent Barrett's esophagus than BMI or waist-to-hip ratio

Abdominal obesity is associated with gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE). Increased body mass index (BMI) and waist-to-hip ratio (WHR) have been associated with BE. Abdominal diameter index (ADI, sagittal abdominal diameter divided by thigh circumference) was previously shown to be a more accurate predictor of incident cardiovascular disease compared to other measurements. Our aim is to examine whether abdominal diameter index was a more accurate predictor of prevalent BE compared to other anthropometric measurements. We conducted a case-control study of patients presenting to our institution. Our study population was consecutive Caucasian men with a known history of BE, and we recruited control patients who had GERD without BE. Both groups completed a questionnaire about demographics, smoking, and medications and underwent a series of anthropometric body measurements using standardized measuring tools. BMI, waist-to-hip ratio, and abdominal diameter index were calculated. Thirty-one BE patients and 27 control patients were recruited. The BE cohort were older and had a higher rate of hiatal hernia. The mean abdominal diameter index for patients with BE was 0.65 ± 0.07 and without BE was 0.60 ± 0.07 (p = 0.01). The predictive value of abdominal diameter index was analyzed using a receiver-operator characteristic (ROC) curve and was a more powerful predictor of BE than waist-to-hip ratio or BMI (AUROC = 0.70 vs. 0.60 vs. 0.52, respectively). Using a cut-point abdominal diameter index value of 0.60, abdominal diameter index had a sensitivity of 77.4% and a specificity of 63.0% for the presence of BE. When controlling for age, smoking status, and BMI, an abdominal diameter index ≥0.60 was a significant independent risk factor for BE (OR = 5.7, 95% CI = 1.29-25.4). In this pilot study, the abdominal diameter index appears to be a more powerful predictor of the presence of BE than BMI and waist-to-hip ratio and remained the only significant predictor of BE in multivariate analysis. We propose further validation of abdominal diameter index before inclusion in future prediction tools for BE.

[Evaluation of endometriosis fertility index in follow-up treatment of endometriosis combined with infertility patients after laparoscopic surgery]

Objective: To explore the application of endometriosis fertility index (EFI) in guidance after laparoscopic surgery of endometriosis patients combined with infertility and to explore methods to improve pregnancy rate in different EFI groups. Methods: A prospective research was done in endometriosis patients combined with infertility in Beijing Obstetrics and Gynecology Hospital from January 2010 to June 2011, after laparoscopic surgery, these 146 patients were divided into 3 groups by EFI score. Using different pregnancy guidance, these patients had 5 years follow-up. Results: (1) The 5 years overall pregnancy rate was 89.0% (130/146). The pregnancy rate was 95.7% (45/47) in EFI≥9 group, 92.8% (77/83) in EFI 5-8 group and 8/16 in EFI≤4 group, three groups were all reach satisfactory pregnancy rate; the rate of the first two groups had no statistically significance (P=0.498), but had significant difference with the last group (P<0.01). (2) In EFI≥5 patients, pregnancy rate was the highest in 6 months after operation; in EFI≥9 group, the pregnancy rate was 66.7% (30/45), and EFI 5-8 group was 50.6% (39/77). (3) EFI≥9 group had the highest natural pregnancy rate [83.6% (46/55)], natural pregnancy rate was significant statistical different in different EFI groups (P=0.001). Conclusions: EFI score is a useful evaluation in predicting and guiding pregnancy in endometriosis patients combined with infertility after laparoscopic surgery. EFI score guidance, strict post-operation management and positive pregnancy scheme could significantly improve the pregnancy rate of endometriosis patients with infertility.

Anterior uterocervical angle measurement improves prediction of cerclage failure

OBJECTIVE

To compare the anterior uterocervical angle and cervical length as predictors of spontaneous preterm delivery in patients with transvaginal cerclage.

STUDY DESIGN

We retrospectively evaluated a cohort of 142 pregnant women with transvaginal cerclage placed over a 5-year period (2010 to 2015) were evaluated. Cervical morphology characteristics were measured from endovaginal imaging, including cervical length, cerclage height, funnel volume and anterior uterocervical angle prior to cerclage placement (UCA 1), shortly after cerclage placement (UCA 2) and the last image prior to delivery (UCA 3). Cerclage failure was defined as delivery prior to 36 weeks. Univariate analysis, receiver operator characteristic curves and binary logistic regression were used for statistical analysis. Statistical significance was defined as a P<0.05.

RESULTS

Among the 142 women with a transvaginal cerclage, 38% had cerclage failure. The mean gestational age at birth was 29.3±5.2 weeks in the failure group compared with 37.9±2.8 weeks in those that did not fail (P<0.001). Univariate analysis identified cervical length (P=0.034) and UCA 3 (P<0.001) as significantly associated with gestational age at birth. Receiver operator characteristic curves demonstrated improved prediction of delivery prior to 34 weeks at UCA 3=108^o (97% sensitivity, 65% specificity) compared to a cervical length of 25 mm. At <28 weeks, optimal performance of UCA 3 was found at 112^o (100% sensitivity, 62% specificity) compared with cervical length of 25 mm (29% sensitivity, 39% specificity). Binary logistic regression revealed UCA 3>108^o conferred an OR 35.1 (95% CI 7.7 to 160.3) for delivery prior to 34 weeks, and UCA 3>112^o an OR 42.0 (95% CI 5.3 to 332.1) for delivery prior to 28 weeks. In comparison, CL<25 mm had an OR 4.7 (95% CI 1.8 to 12.2) for delivery prior to 34 weeks and OR 6.0 (95% CI 1.9 to 19.3) prior to 28 weeks.

CONCLUSIONS

In patients with transvaginal cerclage, an increasingly obtuse anterior uterocervical angle reflects an increased risk of cerclage failure in the mid-trimester. Utilization of UCA measurement as a surveillance tool may improve identification of patients at risk for cerclage failure.

[A cohort study on association between the first trimester phthalates exposure and fasting blood glucose level in the third trimester]

Objective: To examine the association between the phthalate exposure in the first trimester and fasting blood glucose level or gestational diabetes mellitus (GDM) in the third trimester in pregnant women. Methods: A total of 3 474 pregnant women, receiving their prenatal examination in Ma' anshan Maternal and Child Health-Care Hospital of Anhui province, were selected from May 2013 to September 2014. Questionnaires were used to collect the information about their socio-demographic characteristics, clinical characteristics and GDM diagnostic results in the first, second and third trimesters. Urine samples and fasting venous blood samples were collected. Concentrations of 7 kinds of phthalate metabolites in urine samples were detected by solid phase extraction-high performance liquid chromatography-tandem mass spectrometry (SPE-HPLC-MS/MS), and multiple linear regression model was used for statistical analyses. Logistic regression analysis on the risk of the first trimester phthalate exposure for GDM in the third trimester was conducted. Results: The prevalence of GDM in this study was 12.8%, monomethyl phthalate (MMP), monoethyl phthalate (MEP), mono-n-butyl phthalate (MBP), monobenzyl phthalate (MBzP) and mono-(2-ethyl-5-oxohexyl) phthalate (MEHHP) exposure levels were positively correlated with the fasting blood glucose level in the third trimester (P<0.05), but mono-(2-ethylhexyl) phthalate (MEHP) and mono-(2-ethyl-5-hydroxylhexyl) phthalate (MEOHP) exposure levels were negatively correlated with the fasting blood glucose level in the third trimester (P<0.05). Stratified analysis showed a positive correlation between MEHHP exposure and the third trimester fasting blood glucose level in both normal group and GDM group. However, MMP, MEP, MBP, MBzP, MEHP and MEOHP exposure levels had influences on the third trimester fasting blood glucose level in normal group but not in GDM group. MMP and MBP exposure might increase the risk of GDM, but MEOHP exposure might reduce the risk of GDM. Conclusion: The phthalate exposure in the first trimester might be associated with the fasting blood glucose level in the third trimester, MMP, MEP, MBP, MBzP and MEHHP concentrations were positively associated with the third trimester blood glucose level, MEHP and MEOHP concentrations were negatively associated with the third trimester blood glucose level. Moreover, the effects of different kinds of phthalates might be different.

A fast click-slow release strategy towards the HPLC-free synthesis of RNA

A general strategy for purification of oligonucleotides synthesized by solid phase synthesis is described. It is based on a recently developed concept involving a bio-orthogonal inverse electron demand Diels-Alder reaction between trans-cyclooctene and tetrazine, termed 'click-to-release'. The strategy has been applied towards the synthesis and purification of a model hairpin RNA strand, as well as a 34 nt long aptamer.

Perinatal sulfamonomethoxine exposure influences physiological and behavioral responses and the brain mTOR pathway in mouse offspring

Sulfamonomethoxine (SMM) is widely used in the veterinary field in China. Although some clinical surveys have revealed that sulfonamide antibiotics cause adverse nervous system symptoms, the related mechanisms of maternal SMM exposure on the neurobehavioral development of offspring remain unclear. Here, we investigated the effects of perinatal SMM exposure on the physiological and behavioral responses of pubertal offspring mice and the underlying mechanisms. We randomly allocated pregnant mice into the groups treated with SMM at different doses and the saline-treated groups. Maternal mice were orally administered SMM daily from gestational day 1 to postpartum day 21. On postnatal day (PND) 22, the parameters of growth, endocrine hormones, and brain amino acid composition were assessed, as well as the brain transcript levels of key genes involved in the mammalian target of rapamycin (mTOR) signaling pathway. From PND 50 to 55, a battery of behavioral tests relevant to anxiety and memory were then administered. Analysis of the results indicated that the pups, particularly the pubertal female offspring, showed anxiety-like behavior. Moreover, the pubertal offspring showed cognitive impairments and fat accumulation. Furthermore, the relative mRNA expression of genes involved in the mTOR signaling pathway in females on PND 22 was elevated, whereas the expression of N-methyl-d-aspartate receptor 2B (NR2B) was reduced. Together, the results showed that perinatal SMM exposure perturbs neuroendocrine functions, and further alters gene expression in the mTOR pathway and NR2B gene expression early in life, which may contribute to brain dysfunction in pubertal life.

Intestinal CD103(+)CD11b(-) dendritic cells restrain colitis via IFN-γ-induced anti-inflammatory response in epithelial cells

A crosstalk between commensals, gut immune cells, and colonic epithelia is required for a proper function of intestinal mucosal barrier. Here we investigated the importance of two distinct intestinal dendritic cell (DC) subsets in controlling intestinal inflammation. We show that Clec9A-diphtheria toxin receptor (DTR) mice after depletion of CD103(+)CD11b(-) DCs developed severe, low-dose dextran sodium sulfate (DSS)-induced colitis, whereas the lack of CD103(+)CD11b(+) DCs in Clec4a4-DTR mice did not exacerbate intestinal inflammation. The CD103(+)CD11b(-) DC subset has gained a functional specialization that able them to repress inflammation via several epithelial interferon-γ (IFN-γ)-induced proteins. Among others, we identified that epithelial IDO1 and interleukin-18-binding protein (IL-18bp) were strongly modulated by CD103(+)CD11b(-) DCs. Through its preferential property to express IL-12 and IL-15, this particular DC subset can induce lymphocytes in colonic lamina propria and in epithelia to secrete IFN-γ that then can trigger a reversible early anti-inflammatory response in intestinal epithelial cells.

Decreased serum levels of T-cell immunoglobulin mucin-1 and T-cell immunoglobulin mucin-3 in systemic lupus erythematosus patients

This study aims to investigate the serum T-cell immunoglobulin mucin (TIM)-1 and TIM-3 levels in systemic lupus erythematosus (SLE) patients and analyze their correlations with clinical features. Sixtyone SLE patients and 69 healthy controls were enrolled, serum TIM-1 and TIM-3 levels were detected by ELISA. Results demonstrated that both serum TIM-1 and TIM-3 levels were significantly decreased in SLE patients compared with controls (both P less than 0.05). Lower serum TIM-3 levels in SLE patients with nephritis were observed when compared to those without nephritis, with a marginal statistical significance (P=0.059). However, both serum TIM-1 and TIM-3 levels had no significant correlation with SLE disease activity (both >0.05). In summary, decreased serum TIM-1 and TIM-3 levels and association of TIM-3 with nephritis suggest their possible role in the development and pathogenesis of SLE. However, further studies are needed to confirm these preliminary results.

miR-96 inhibits cardiac hypertrophy by targeting growth factor receptor-bound 2

Increasing evidence has indicated that microRNAs are involved in the pathogenesis of cardiac hypertrophy. However, whether miR-96 is involved in heart diseases, particularly cardiac hypertrophy, remains unclear. In this study, we found that miR-96 is a negative regulator of cardiac hypertrophy. In primary cardiomyocytes, overexpression of miR-96 inhibited phenylephrine-induced cardiomyocyte hypertrophy and decreased the mRNA expression of cardiac hypertrophy markers such as atrial natriuretic factor and β-myosin heavy chain. Interestingly, we found that growth factor receptor-bound 2 is a direct target of miR-96, which is a negative regulator of cardiac hypertrophy. Overexpression of miR-96 in cardiomyocytes led to reduced growth factor receptor-bound 2 expression. More importantly, miR-96 repressed the extracellular-regulated protein kinase signaling pathway by targeting growth factor receptor-bound 2 in cardiomyocytes. Our data demonstrate that miR-96 is a negative regulator of cardiac hypertrophy and extracellular-regulated protein kinase signaling, thus offering a new therapeutic strategy for cardiac hypertrophy.

High-mobility group box 1 induces neuron autophagy in a rat spinal root avulsion model

Autophagy, a tightly regulated lysosome-dependent catabolic pathway, is implicated in various pathological states in the nervous system. High-mobility group box 1 (HMGB1) is an inflammatory mediator known to be released into the local microenvironment from damaged cells. However, whether autophagy is induced and exogenous HMGB1 is involved in the process of spinal root avulsion remain unclear. Here, we investigated the induction effect of autophagy and the possible role of HMGB1 during spinal root avulsion. It was found that autophagy was activated in the anterior horn of the spinal cord as represented by the increased expression of the autophagic marker microtubule-associated protein light chain 3-II (LC3-II), degradation of sequestosome 1 (p62), and formation of autophagosomes, and that autophagy was inhibited after intraperitoneal injection of anti-HMGB1-neutralizing antibodies in the rat spinal root avulsion model. In addition, HMGB1-induced autophagy and activated mitogen-activated protein kinases (MAPKs) in primary spinal neurons, including c-Jun N-terminal kinase (JNK), extracellular-signal-regulated kinase (ERK), and p38MAPK. Inhibition of JNK or ERK activity significantly blocked the effect of HMGB1-induced autophagy in primary spinal neurons. Finally, HMGB1-induced autophagy increased cell viability in primary spinal neurons under oxygen-glucose deprivation conditions. The above results suggest that HMGB1 is a critical regulator of autophagy and HMGB1-induced autophagy plays an important role in protecting spinal neurons against injury, which may provide new insights into the pathophysiological process of spinal root avulsion.

Prediction of virological response by pretreatment hepatitis B virus reverse transcriptase quasispecies heterogeneity: the advantage of using next-generation sequencing

Prediction of antiviral efficacy prior to treatment remains largely unavailable. We have previously demonstrated the clinical value of on-treatment hepatitis B virus (HBV) reverse transcriptase (RT) quasispecies (QS) evolution patterns. In this study, we aimed to elucidate the relevance for prediction of pretreatment HBV RT QS characteristics by comparing the performance of next-generation sequencing (NGS) and clone-based Sanger sequencing (CBS). Thirty-six lamivudine-treated patients were retrospectively studied, including 18 responders and 18 non-responders. CBS and NGS data of pretreatment serum HBV were used to generate RT QS genetic complexity and diversity scores, according to our previous studies. The ability of both methods to predict responsiveness was evaluated with receiver operating characteristic (ROC) curves. A cut-off value was generated on the basis of prediction ability. Responders had significantly higher pretreatment RT QS genetic complexity and diversity (in the first two parts, which overlapped with the S gene, at both the nucleotide and amino acid levels) than non-responders by NGS-based testing. NGS-based algorithms predicted response better than CBS in the ROC curve analysis. The mean distance of the second contig had the highest area under the curve (AUC) value. When the cut-off value was set to 0.007186, the difference between survival curves was significant (p 0.0090). Pretreatment HBV RT QS heterogeneity in the overlapping region of the RT and S genes could be a predictor of antiviral efficacy. NGS improves the predictions of virological outcomes relative to CBS algorithms. This may have important implications for the clinical management of subjects chronically infected with HBV.

Composting and gypsum amendment of broiler litter to reduce nutrient leaching loss

The effect of composted litter relative to fresh litter on leaching losses of nutrients has not been well documented. Fresh and composted broiler litter was surface-applied to bermudagrass (hay) [ (L.) Pers.] established in undisturbed soil columns based on N need of the grass in the presence or absence of flue gas desulfurization (FGD) gypsum to evaluate an approach to reduce broiler litter nutrient leaching potential. Columns were periodically leached and biomass was harvested during the 60-d experiment. Total N applied to bermudagrass from broiler litter was 320 kg ha. Gypsum was mixed with fresh and composted litter at the rate based on 20% of litter weight. For composted broiler litter, NO-N, P, K, Cu, and Zn contents in the leachate obtained from the first leaching event were 58, 50, 40, 32, and 38% less than fresh broiler litter, respectively. Significant decreases in NO-N (13%), P (53%), Cu (17%), and Zn (28%) in leachate were obtained when gypsum was mixed with fresh broiler litter. Fresh broiler litter and composted broiler litter applications increased bermudagrass growth compared with the control and gypsum significantly increased yields when mixed with broiler litter. Composted broiler litter application significantly increased N and organic C in the soil compared with fresh litter. Results demonstrate that coapplication of composted broiler litter with FGD gypsum provide the most effective management option for minimizing leaching losses of nutrients while sustaining crop productivity.

Analysis and forecast for multidrug-resistant Acinetobacter baumannii Infections among liver transplant recipients

BACKGROUND

Acinetobacter baumannii (Ab) has become an important pathogenic bacterium with specific epidemic features in the intensive care unit. We explored the epidemiology of multidrug-resistant Ab infections among liver transplant recipients at the Liver Transplantation Center, 1st Affiliated Hospital of Shanghai Jiao Tong University.

METHODS

Seventeen multidrug-resistant Ab strains were isolated from the sputum and bronchoalveolar lavage fluid specimens of 249 liver transplant recipients from January 2007 to December 2009. The drug resistance and minimum inhibitory concentration (MIC) for the 17 Ab strains were determined. The Ab strains were genotyped with the use of repetitive element-based polymerase chain reaction. The risk factors were also characterized by single-factor and multifactor analysis to the clinical data of the 249 liver transplant recipients.

RESULTS

The drug sensitivity results showed that the 17 Ab strains isolated displayed 100% drug resistance rate to aminoglycosides (gentamicin), quinolones (ciprofloxacin), penicillins (piperacillin), cephalosporins (ceftazidime, cefotaxime, and cefepime), and carbapenems (imipenem and meropenem). The 17 Ab strains could be divided into 3 genotypes: 1, 1, and 15 strains for types A, C, and B, respectively. Fungal culture positivity after operation (odds ratio [OR], 5.470) and tracheal intubation twice (OR, 11.538) were the independent risk factors for multidrug-resistant Ab strain infection.

CONCLUSIONS

Type B multidrug-resistant Ab strains are prevalent in the liver transplantation center, and they could be transmitted clonally. Liver transplant recipients with postoperational fungal culture positivity and tracheal intubation twice are prone to multidrug-resistant Ab infections. Therefore, a high degree of vigilance should be paid to those recipients to avoid nosocomial Ab infections.