Prevalence and Burden of Multiple Sclerosis in China, 1990-2019: Findings From the Global Burden of Disease Study 2019

BACKGROUND AND OBJECTIVES

Multiple sclerosis (MS) is the leading cause of neurologic disability in young adults, but the burden caused by MS in China is lacking. We aimed to comprehensively describe the prevalence and health loss due to MS by demographic and geographical variables from 1990 to 2019 across China.

METHODS

Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). We used GBD methodology to systematically analyze the prevalence, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to MS by age, sex, and location from 1990 to 2019 in mainland China and its provinces. We also compared the MS burden in China with the world and other Group of 20 (G20) countries.

RESULTS

In 2019, 42,571 (95% uncertainty interval [UI] 33,001-53,329) individuals in China had MS, which doubled from 1990. The age-standardized prevalence rate of MS was 2.32 per 100,000 (95% UI 1.78-2.91), which increased by 23.31% (95% UI 20.50-25.89) from 1990, with most of the growth occurring after 2010. There was a positive latitudinal gradient with the increasing prevalence from south to north across China. The total DALYs caused by MS were 71,439 (95% UI 58,360-92,254) in 2019, ranking China third among G20 countries. Most of the MS burden in China derived from premature mortality, with the higher fraction of YLLs than that at the global level and most other G20 countries. From 1990 to 2019, the age-standardized DALY and YLL rate had nonsignificant changes; however, the age-standardized YLD rate substantially increased by 23.33% (95% UI 20.50-25.89). The geographic distribution of MS burden varied at the provincial level in China, with a slight downward trend in the age-standardized DALY rates along with increasing Socio-Demographic Index over the study period.

DISCUSSION

Although China has a low risk of MS, the substantial and increasing prevalent cases should not be underestimated. The high burden due to premature death and geographic disparity of MS burden reveals insufficient management of MS in China, highlighting the needs for increased awareness and effective intervention.

MSGD: a manually curated database of genomic, transcriptomic, proteomic and drug information for multiple sclerosis

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system. 'Omics' technologies (genomics, transcriptomics, proteomics) and associated drug information have begun reshaping our understanding of multiple sclerosis. However, these data are scattered across numerous references, making them challenging to fully utilize. We manually mined and compiled these data within the Multiple Sclerosis Gene Database (MSGD) database, intending to continue updating it in the future. We screened 5485 publications and constructed the current version of MSGD. MSGD comprises 6255 entries, including 3274 variant entries, 1175 RNA entries, 418 protein entries, 313 knockout entries, 612 drug entries and 463 high-throughput entries. Each entry contains detailed information, such as species, disease type, detailed gene descriptions (such as official gene symbols), and original references. MSGD is freely accessible and provides a user-friendly web interface. Users can easily search for genes of interest, view their expression patterns and detailed information, manage gene sets and submit new MS-gene associations through the platform. The primary principle behind MSGD's design is to provide an exploratory platform, aiming to minimize filtration and interpretation barriers while ensuring highly accessible presentation of data. This initiative is expected to significantly assist researchers in deciphering gene mechanisms and improving the prevention, diagnosis and treatment of MS. Database URL: http://bio-bigdata.hrbmu.edu.cn/MSGD.

LncRNA CCRR maintains Ca2+ homeostasis against myocardial infarction through the FTO-SERCA2a pathway

Cardiac conduction regulatory RNA (CCRR) has been documented as an antiarrhythmic lncRNA in our earlier investigation. This study aimed to evaluate the effects of CCRR on SERCA2a and the associated Ca2+ homeostasis in myocardial infarction (MI). Overexpression of CCRR via AAV9-mediated delivery not only partially reversed ischemia-induced contractile dysfunction but also alleviated abnormal Ca2+ homeostasis and reduced the heightened methylation level of SERCA2a following MI. These effects were also observed in CCRR over-expressing transgenic mice. A conserved sequence domain of CCRR mimicked the protective function observed with the full length. Furthermore, silencing CCRR in healthy mice led to intracellular Ca2+ overloading of cardiomyocytes. CCRR increased SERCA2a protein stability by upregulating FTO expression. The direct interaction between CCRR and FTO protein was characterized by RNA-binding protein immunoprecipitation (RIP) analysis and RNA pulldown experiments. Activation of NFATc3 was identified as an upstream mechanism responsible for CCRR downregulation in MI. This study demonstrates that CCRR is a protective lncRNA that acts by maintaining the function of FTO, thereby reducing the m6A RNA methylation level of SERCA2a, ultimately preserving calcium homeostasis for myocardial contractile function in MI. Therefore, CCRR may be considered a promising therapeutic strategy with a beneficial role in cardiac pathology.

Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.

METHODS

We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.

FINDINGS

Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.

INTERPRETATION

As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed.

FUNDING

Bill & Melinda Gates Foundation.

LncRNA CCRR Attenuates Postmyocardial Infarction Inflammatory Response by Inhibiting the TLR Signalling Pathway

BACKGROUND

Timely and proper suppression of inflammation can effectively reduce myocardial injury and promote the postmyocardial infarction (post-MI) wound-healing process. We have previously found that cardiac conduction regulatory RNA (CCRR), a long noncoding RNA (lncRNA) transcribed by the gene located on chromosome 9, with abundant expression in the heart, elicits antiarrhythmic effects in heart failure, and this is a continuing study on the role of CCRR in MI.

METHODS

CCRR was overexpressed in CCRR transgenic mice or after injection of adeno-associated virus-9 (AAV-9). MI surgery was performed, and cardiac function was assessed in vivo by echocardiography, followed by histologic analyses. Western blot analysis and qRT-PCR were performed to investigate the effects of CCRR on macrophages, cardiomyocytes, and cardiomyocytes cocultured with macrophages. Through microarray analysis and RNA-binding protein immunoprecipitation (RIP) and other related techniques were also employed to study the effects of CCRR on Toll-like receptor (TLR)2 and TLR4.

RESULTS

We found that CCRR level was significantly decreased with increases in proinflammatory cytokines and activation of the TLR signalling pathway in the heart of the 3-day MI mice. CCRR overexpression downregulated TLR2 and TLR4 in MI and effectively inhibited the inflammatory responses in primary cardiomyocytes and macrophages cultured under hypoxic conditions. Downregulation of CCRR induced excessive inflammatory responses by activating the TLR signalling pathway. CCRR acted by suppressing TLR2 and TLR4 to inhibit the secretion of proinflammatory factors to reduce infarct size, thereby improving cardiac function.

CONCLUSIONS

CCRR protected cardiomyocytes against MI injury by suppressing inflammatory response through targeting the TLR signalling pathway.

Integrative multi-omics analysis identifies genetically supported druggable targets and immune cell specificity for myasthenia gravis

BACKGROUND

Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fluctuating muscle weakness. Despite the availability of established therapies, the management of MG symptoms remains suboptimal, partially attributed to lack of efficacy or intolerable side-effects. Therefore, new effective drugs are warranted for treatment of MG.

METHODS

By employing an analytical framework that combines Mendelian randomization (MR) and colocalization analysis, we estimate the causal effects of blood druggable expression quantitative trait loci (eQTLs) and protein quantitative trait loci (pQTLs) on the susceptibility of MG. We subsequently investigated whether potential genetic effects exhibit cell-type specificity by utilizing genetic colocalization analysis to assess the interplay between immune-cell-specific eQTLs and MG risk.

RESULTS

We identified significant MR results for four genes (CDC42BPB, CD226, PRSS36, and TNFSF12) using cis-eQTL genetic instruments and three proteins (CTSH, PRSS8, and CPN2) using cis-pQTL genetic instruments. Six of these loci demonstrated evidence of colocalization with MG susceptibility (posterior probability > 0.80). We next undertook genetic colocalization to investigate cell-type-specific effects at these loci. Notably, we identified robust evidence of colocalization, with a posterior probability of 0.854, linking CTSH expression in TH2 cells and MG risk.

CONCLUSIONS

This study provides crucial insights into the genetic and molecular factors associated with MG susceptibility, singling out CTSH as a potential candidate for in-depth investigation and clinical consideration. It additionally sheds light on the immune-cell regulatory mechanisms related to the disease. However, further research is imperative to validate these targets and evaluate their feasibility for drug development.

China's carbon-neutral policies will reduce short-term PM2.5-associated excess incidence of cardiovascular diseases

China's carbon-neutral target could have benefits for ambient fine particulate matter (PM2.5)-associated mortality. Although previous studies have researched such benefits, the potential impact on cardiovascular disease incidence burden is yet to be investigated thoroughly. Here, we first estimate the association between short-term PM2.5 exposure and the incidence of stroke and coronary heart disease (CHD) via a case-crossover study before projecting future changes in short-term PM2.5-associated excess incidence across China from 2025 to 2060 under three different emission scenarios. We find that, compared to the 2015-2020 baseline, average PM2.5 concentrations nationwide in 2060 under SSP119 (an approximation of a carbon-neutral scenario) are projected to decrease by 81.07%. The short-term PM2.5-related excess incidence of stroke and CHD is projected to be reduced to 3,352 cases (95% confidence interval: 939, 5,738)-compared with 34,485 cases under a medium-emissions scenario (SSP245)-and is expected to be accompanied by a 95% reduction in the related economic burden. China's carbon-neutral policies are likely to bring health benefits for cardiovascular disease by reducing short-term PM2.5-related incidence burden.

An EEG motor imagery dataset for brain computer interface in acute stroke patients

The brain-computer interface (BCI) is a technology that involves direct communication with parts of the brain and has evolved rapidly in recent years; it has begun to be used in clinical practice, such as for patient rehabilitation. Patient electroencephalography (EEG) datasets are critical for algorithm optimization and clinical applications of BCIs but are rare at present. We collected data from 50 acute stroke patients with wireless portable saline EEG devices during the performance of two tasks: 1) imagining right-handed movements and 2) imagining left-handed movements. The dataset consists of four types of data: 1) the motor imagery instructions, 2) raw recording data, 3) pre-processed data after removing artefacts and other manipulations, and 4) patient characteristics. This is the first open dataset to address left- and right-handed motor imagery in acute stroke patients. We believe that the dataset will be very helpful for analysing brain activation and designing decoding methods that are more applicable for acute stroke patients, which will greatly facilitate research in the field of motor imagery-BCI.

Ambient air pollution and the dynamic transitions of stroke and dementia: a population-based cohort study

Background

Stroke and dementia are the leading causes of neurological disease burden. Detrimental effects of air pollution on both conditions are increasingly recognised, while the impacts on the dynamic transitions have not yet been explored, and whether critical time intervals exist is unknown.

Methods

This prospective study was conducted based on the UK Biobank. Annual average air pollution concentrations at baseline year 2010 estimated by land-use regression models were used as a proxy for long-term air pollution exposure. Associations between multiple air pollutants (PM2.5, PM2.5-10, and NO2) indicated by air pollution score and the dynamic transitions of stroke and dementia were estimated, and the impacts during critical time intervals were explored. The date cutoff of this study was February 29, 2020.

Findings

During a median follow-up of 10.9 years in 413,372 participants, 6484, 3813, and 376 participants developed incident stroke, dementia, and comorbidity of stroke and dementia. For the overall transition from stroke to comorbid dementia, the hazard ratio (HR) for each interquartile range (IQR) increase in air pollution score was 1.38 (95% CI, 1.15, 1.65), and the risks were limited to two time intervals (within 1 year and over 5 years after stroke). As for the transition from dementia to comorbid stroke, increased risk was only observed during 2-3 years after dementia.

Interpretation

Our findings suggested that air pollution played an important role in the dynamic transition of stroke and dementia even at concentrations below the current criteria. The findings provided new evidence for alleviating the disease burden of neurological disorders related to air pollution during critical time intervals.

Funding

The State Scholarship Fund of China Scholarship Council.

Temperature-related death burden of various neurodegenerative diseases under climate warming: a nationwide modelling study

Limited knowledge exists regarding the ramifications of climate warming on death burden from neurodegenerative diseases. Here, we conducted a nationwide, individual-level, case-crossover study between 2013 and 2019 to investigate the effects of non-optimal temperatures on various neurodegenerative diseases and to predict the potential death burden under different climate change scenarios. Our findings reveal that both low and high temperatures are linked to increased risks of neurodegenerative diseases death. We project that heat-related neurodegenerative disease deaths would increase, while cold-related deaths would decrease. This is characterized by a steeper slope in the high-emission scenario, but a less pronounced trend in the scenarios involving mitigation strategies. Furthermore, we predict that the net changes in attributable death would increase after the mid-21st century, especially under the unrestricted-emission scenario. These results highlight the urgent need for effective climate and public health policies to address the growing challenges of neurodegenerative diseases associated with global warming.

[The predictive values of platelet mitochondrial mass and quantity during the perioperative period in elderly patients on the occurrence of postoperative delirium]

Objective: To investigate the changes of platelet mitochondrial mass and quantity during perioperative period in elderly patients, and assess their predictive values on the occurrence of postoperative delirium (POD). Methods: In this prospective study, 162 elderly patients scheduled for abdominal surgery under general anesthesia were enrolled from November 2021 to January 2022 in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School. Among them, 20 patients [10 males, 10 females, aged (71.4±6.8) years] developed POD within 3 days after surgery (POD group), and another 20 patients[12 males, 8 females, aged (67.7±5.3) years] who did not develope POD were selected as controls (control group) using propensity score matching method. Blood samples were collected preoperatively, at the end of surgery and on the first postoperative day. Platelets were extracted and mitochondrial mass was detected with flow cytometry. Transmission electron microscopy was used to determine mitochondrial quantity. The receiver operating characteristic (ROC) curve was drawn to analyze the value of mitochondrial mass and quantity in predicting the occurrence of POD. Results: The mean fluorescence intensities of platelet mitochondrial mass were 193±46, 236±61, 264±53 preoperatively, at the end of surgery and on the first postoperative day in the POD group, respectively. The corresponding values were 209±61, 191±67 and 201±56 in the control group. The platelet mitochondrial mass of patients in the POD group was significantly increased on the first postoperative day compared to preoperative levels (P<0.001). In contrast, there was no significant difference in the control group (P=0.410). Patients in the POD group had higher platelet mitochondrial mass than patients in the control group on the first postoperative day(P=0.002). Meanwhile, platelets from patients in the POD group showed significantly higher number of mitochondria than platelets from patients in the control group [3 (2, 4) vs 2 (1, 2), P<0.001]. According to the ROC curve of platelet on the first postoperative day, at a mitochondrial mass cut-off value of>275.35, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 55%, 90% and 0.800 (95%CI: 0.666-0.934, P<0.001). At a mitochondrial quantity cut-off value of>2, the sensitivity, specificity and area under the ROC curve to detect the occurrence of POD were 53%, 78% and 0.680 (95%CI: 0.584-0.776, P<0.001). Conclusions: Patients who developed POD show higher platelet mitochondrial mass after surgery compared to preoperative levels. The mitochondrial mass of platelets on the first postoperative day has good predictive value on the occurrence of POD.

Sema3C Signaling is an Alternative Activator of the Canonical WNT Pathway in Glioblastoma

PURPOSE/OBJECTIVE(S)

Wnt signaling maintains normal and cancer stem cells. The Wnt pathway is frequently dysregulated in many cancers, underscoring it as a therapeutic target. Although Wnt inhibitors appear promising in many preclinical studies, they have failed uniformly in clinical trials. Molecular mechanisms of resistance are poorly defined. Further dissection of the precise mechanisms of Wnt pathway activation in specific tumor types is needed to develop new Wnt pathway inhibitors with less toxicity. Here, we identify an alternative activator of the Wnt pathway that may mediate resistance to upstream Wnt inhibition in glioblastoma.

MATERIALS/METHODS

Glioma stem-like cells (GSCs) were enriched in defined media. GSCs were transduced with lentiviruses to knockdown or overexpress Sema3C or Wnt pathway components. Cell viability, proliferation, apoptosis, and self-renewal were assessed. Expression of Sema3C and Wnt pathway components were assessed in GSCs, mouse models of GBM, and human glioblastoma by qPCR, Western blot, and/or immunostaining. Beta-catenin subcellular localization was assessed by cell fractionation and immunofluorescence. GSC-derived orthotopic models of GBM were used to assess the impact of genetic or pharmacologic inhibition of Sema3C or Wnt pathway components alone or in combination on tumor growth and animal survival.

RESULTS

The axonal guidance protein Sema3C promotes the tumorigenicity of GSCs through binding its NRP/PlxnD1 receptor complex leading to Rac1 activation. Sema3C signaling directs beta-catenin nuclear accumulation in a Rac1-dependent process, leading to transactivation of Wnt target genes. Sema3C-driven Wnt signaling occurred despite suppression of Wnt ligand secretion, suggesting that Sema3C may drive canonical Wnt signaling independent of Wnt ligand binding. In human glioblastoma, Sema3C expression and Wnt pathway activation were highly concordant. In a mouse model of glioblastoma, combined depletion of Sema3C and beta-catenin partner TCF1 extended animal survival more than single target inhibition alone.

CONCLUSION

Sema3C signaling may represent an alternative mechanism of WNT pathway activation even when WNT ligand-receptor interaction is inhibited. Since Sema3C is overexpressed in >85% glioblastoma and is used to maintain GSCs but not normal neural progenitor cells, this pathway may represent a major mechanism of Wnt pathway activation and resistance to upstream Wnt pathway inhibitors in GSCs. Our data provide a therapeutic strategy to achieve clinically significant Wnt pathway inhibition in GSCs potentially without the toxicity of currently available WNT inhibitors.

Loss of life expectancy due to stroke and its subtypes in urban and rural areas in China, 2005-2020

Stroke is characterised by high mortality and disability rate in China. This study aimed to explore the temporal trends in years of life lost (YLL) and loss of life expectancy due to stroke and its subtypes in urban and rural areas in China during 2005-2020. Data were obtained from China National Mortality Surveillance System. Abbreviated life and stroke-eliminated life tables were generated to calculate loss of life expectancy. The YLL and loss of life expectancy due to stroke in urban and rural areas at both national and provincial level during 2005-2020 were estimated. In China, the age-standardised YLL rate due to stroke and its subtypes were higher in rural areas than in urban areas. The YLL rate due to stroke showed a downward trend in both urban and rural residents from 2005 to 2020, decreased by 39.9% and 21.5%, respectively. Loss of life expectancy caused by stroke decreased from 1.75 years to 1.70 years from 2005 to 2020. During which, loss of life expectancy due to intracerebral haemorrhage (ICH) decreased from 0.94 years to 0.65 years, while that of ischaemic stroke (IS) increased from 0.62 years to 0.86 years. A slightly upward trend was observed in loss of life expectancy caused by subarachnoid haemorrhage (SAH), from 0.05 years to 0.06 years. Loss of life expectancy due to ICH and SAH was always higher in rural areas than in urban areas, whereas that of IS was higher in urban areas than in rural areas. Rural males suffered the greatest loss of life expectancy due to ICH and SAH, while the highest loss of life expectancy caused by IS was found in urban females. Furthermore, Heilongjiang (2.25 years), Tibet (2.17 years) and Jilin (2.16 years) were found to have the highest loss of life expectancy caused by stroke in 2020. Loss of life expectancy caused by ICH and SAH was higher in western China, while the disease burden of IS was heavier in northeast China. Stroke remains a major public health problem in China, although the age-standardised YLL rate and loss of life expectancy due to stroke decreased. Evidence-based strategies should be conducted to reduce the premature death burden caused by stroke and prolong life expectancy in Chinese population.

[Distribution and reference intervals of daytime intraocular pressure in the eye health screening population of Handan]

Objective: To describe the distribution and establish reference intervals (RI) of daytime intraocular pressure (IOP) in the eye health screening population of Handan. Methods: This cross-sectional study included subjects who participated in eye health screening at the Physical Examination Center of Handan First Hospital from May 2021 to June 2022. A complete general and ocular examination was performed, including measurements of visual acuity and IOP (using Goldmann tonometry), slit lamp microscopy, fundus photography, and anterior and posterior segment optical coherence tomography. Subjects with factors that could cause significant changes in IOP or affect the accuracy of IOP measurement, or with an inability to measure IOP were excluded. Simple random sampling was used to select participants, who were grouped by gender and age (18 to <30, 30 to <40, 40 to <50, 50 to <60, 60 to <70, and ≥70 years). Central corneal thickness and IOP at 8 to 11 o'clock in one eye of each participant were recorded. The independent sample t test and ANOVA were used for statistical analysis, and the RI of IOP values was calculated by x¯±1.96s. Results: A total of 9 310 subjects had their IOP measured, and 3 491 participants (3 491 eyes) were randomly selected from 7 886 healthy subjects. The age of the participants was (47.74±14.47) years old, ranging from 18 to 90 years old. There were 1 694 males and 1 797 females. The central corneal thickness of all participants was (525.56±49.39) μm. The daytime IOP of all participants was (15.40±2.54) mmHg (1 mmHg=0.133 kPa), and the RI was 10.42 to 20.39 mmHg. The IOP was (15.49±2.58) mmHg for males and (15.29±2.49) mmHg for females, and the gender difference was statistically significant (P<0.05). The RI of daytime IOP values was 10.43 to 20.54 mmHg for males and 10.41 to 20.18 mmHg for females. There were significant differences in daytime IOP [(15.13±2.58), (15.33±2.53), (15.49±2.50), (15.53±2.55), (15.39±2.62), and (15.28±2.52) mmHg] among 6 age groups (P<0.05). Conclusions: The distribution of daytime IOP in different gender and age groups in the eye health screening population of Handan and the RIs derived from the distribution were roughly the same as the international normal IOP RI (10 to 21 mmHg). It is recommended to refer to the RI of daytime IOP values of different genders and ages for clinical decision.

Mortality of myasthenia gravis: a national population-based study in China

OBJECTIVE

As a potentially life-threatening condition, myasthenia gravis (MG) has limited epidemiological studies on mortality. We aim to provide demographic distribution, geographical variation, and temporal trend of MG-related mortality in China.

METHODS

The national population-based analysis was conducted based on records derived from the National Mortality Surveillance System of China. All deaths related to MG were identified from 2013 to 2020, and MG-related mortality was evaluated by sex, age, location, and year.

RESULTS

A total of 4224 deaths were related to MG during 2013-2020, and the median age at death of MG was 59.45 years, significantly lower than that in the general population (75.47 years, P < 0.05). In 2020, the age-standardized mortality rate of MG was 1.86 per million people and markedly higher in males than in females (2.37 vs. 1.31 per million). The mortality rate per million was lower than 1 in young children, peaking at 2.83 only in males (vs. 0.36 in females) aged 10-19 years, and substantially increased with age, reaching the highest rate of 13.31 for males and 10.58 for females aged 80 years and older. Geographical disparity across China was observed with the highest age-standardized mortality rate in Southwest (2.53 per million). From 2013 to 2020, MG-related mortality rate showed an increasing trend with the average annual percentage change of 3.5% (95% CI, 1.4-5.6). The notable increases occurred in age 10-19 years and over 70 years.

INTERPRETATION

In China, MG-related mortality was notably high among adolescent males and the elderly. The increasing death burden due to MG highlight challenges to disease management.

PMotion: An advanced markerless pose estimation approach based on novel deep learning framework used to reveal neurobehavior

OBJECTIVE

The evaluation of animals' motion behavior has played a vital role in neuromuscular biomedical research and clinical diagnostics, which reflects the changes caused by neuromodulation or neurodamage. Currently, the existing animal pose estimation methods are unreliable, unpractical, and inaccurate.

APPROACH

Data augmentation (random scaling, random standard deviation Gaussian blur, random contrast, and random uniform color quantization) is adopted to augment image dataset. For the key points recognition, we present a novel efficient convolutional deep learning framework (PMotion), which combines modified ConvNext using multi-kernel feature fusion and self-defined stacked Hourglass block with SiLU activation function.

MAIN RESULTS

PMotion is useful to predict the key points of dynamics of unmarked animal body joints in real time with high spatial precision. Gait quantification (step length, step height, and joint angle) was performed for the study of lateral lower limb movements with rats on a treadmill.

SIGNIFICANCE

The performance accuracy of PMotion on rat joint dataset was improved by 1.98, 1.46, and 0.55 pixels compared with deepposekit, deeplabcut, and stacked hourglass, respectively. This approach also may be applied for neurobehavioral studies of freely moving animals' behavior in challenging environments (e.g., Drosophila melanogaster and openfield-Pranav) with a high accuracy.

Microglia/macrophages require vitamin D signaling to restrain neuroinflammation and brain injury in a murine ischemic stroke model

Vitamin D deficiency is associated with worse clinical outcomes after ischemic stroke; nevertheless, the pathophysiological mechanisms remain largely unexplored. In this study, we characterized the molecular mechanisms of how vitamin D signaling modulated stroke progression in male mouse ischemia-reperfusion stroke models. We found that vitamin D receptor (VDR) exhibited a predominant upregulation in peri-infarct microglia/macrophages following cerebral ischemia. Conditional Vdr inactivation in microglia/macrophages markedly augmented infarct volumes and neurological deficits. VDR-deficient microglia/macrophages exhibited a more primed proinflammatory phenotype with substantial secretion of TNF-α and IFN-γ. These inflammatory cytokines further enhanced CXCL10 release from endothelial cells and blood-brain barrier disruption, and ultimately infiltration of peripheral T lymphocytes. Notably, blocking TNF-α and IFN-γ significantly ameliorated stroke phenotypes in Vdr conditional knockout mice. Collectively, VDR signaling in microglia/macrophages plays a crucial role in restraining ischemia-elicited neuroinflammation and stroke progression. Our findings delineate a novel mechanism underlying the association between vitamin D deficiency and poor stroke outcomes, and underline the significance of maintaining a functional vitamin D signaling in the management of acute ischemic stroke.

[The research progress of clinical features and pathogenesis of acute acquired concomitant esotropia]

Acute acquired concomitant esotropia (AACE) is a special type of esotropia that occurs suddenly and is accompanied by diplopia. In recent years, the number of patients with this eye disease has increased significantly. With differences in age and refractive status, children and adults have their own characteristics in terms of AACE classification, refractive status, eye position, and binocular visual function. However, the pathogenesis of AACE is still unclear. This article explores the pathogenesis and risk factors of AACE, including refractive error, convergence spasm, extraocular muscle, and visual cortex, that may be involved. The authors recommend that AACE, which is not related to intracranial and systemic diseases, should be classified according to the dominant mechanism of the disease.

Single-cell RNA-seq reveals the transcriptional landscape in ischemic stroke

Ischemic stroke (IS) is a detrimental neurological disease with limited treatments options. It has been challenging to define the roles of brain cell subsets in IS onset and progression due to cellular heterogeneity in the CNS. Here, we employed single-cell RNA sequencing (scRNA-seq) to comprehensively map the cell populations in the mouse model of MCAO (middle cerebral artery occlusion). We identified 17 principal brain clusters with cell-type specific gene expression patterns as well as specific cell subpopulations and their functions in various pathways. The CNS inflammation triggered upregulation of key cell type-specific genes unpublished before. Notably, microglia displayed a cell differentiation diversity after stroke among its five distinct subtypes. Importantly, we found the potential trajectory branches of the monocytes/macrophage's subsets. Finally, we also identified distinct subclusters among brain vasculature cells, ependymal cells and other glia cells. Overall, scRNA-seq revealed the precise transcriptional changes during neuroinflammation at the single-cell level, opening up a new field for exploration of the disease mechanisms and drug discovery in stroke based on the cell-subtype specific molecules.

Association between Ultra-Processed Food Consumption and Frailty in American Elder People: Evidence from a Cross-Sectional Study

OBJECTIVES

Our study aims to explore the association between ultra-processed foods (UPFs) and frailty in participants with different body mass indexes (BMIs).

DESIGN

A cross-sectional study.

SETTING

Data were collected from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002.

PARTICIPANTS

We analyzed data from 2,329 participants.

MEASUREMENTS

Dietary data were obtained using 24-h dietary recall method. Frail status was assessed by modified Fried frailty phenotype. The association between the grams, energy, and energy proportion of UPFs and the risk of pre-frailty/frailty was estimated using logistic regression analysis, and odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Participants were categorized into underweight-normal weight (BMI <25 kg/m2), overweight (25 kg/m2 ≤ BMI < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2) groups. The multiplicative interaction between BMIs and UPFs on pre-frailty/frailty was assessed using the logistic regression analysis.

RESULTS

We analyzed data from 2,329 participants, and 2,267 (97.77%) of whom consumed UPFs. There were 1,063 participants in pre-frailty or frailty group and 1,266 participants in non-frailty group. In underweight-normal weight participants, every 100 kcal increase in energy of UPFs intake was associated with increased 0.08 times of pre-frailty or frailty risk (OR: 1.08, 95%CI: 1.00-1.16, P = 0.045), and every 10% increase in energy proportion of UPFs intake was correlated with a 0.02-fold increase in pre-frailty or frailty risk (OR: 1.02, 95%CI: 1.00-1.03, P = 0.018). Similar results were found in overweight participants, with OR of 1.06 (95%CI: 1.01-1.10) and 1.01 (95%CI: 1.00-1.02) for energy and energy proportion, respectively (both P < 0.05). This association was not found in obesity participants.

CONCLUSION

The energy and energy proportion of UPFs intake was positively associated with the frailty risk in underweight-normal weight and overweight people, indicating that population with BMI less than 30 kg/m2 should pay more attention to reasonable diet and balanced source of energy intake.

Toward Clinically Applicable 3-Dimensional Tooth Segmentation via Deep Learning

Digital dentistry plays a pivotal role in dental health care. A critical step in many digital dental systems is to accurately delineate individual teeth and the gingiva in the 3-dimension intraoral scanned mesh data. However, previous state-of-the-art methods are either time-consuming or error prone, hence hindering their clinical applicability. This article presents an accurate, efficient, and fully automated deep learning model trained on a data set of 4,000 intraoral scanned data annotated by experienced human experts. On a holdout data set of 200 scans, our model achieves a per-face accuracy, average-area accuracy, and area under the receiver operating characteristic curve of 96.94%, 98.26%, and 0.9991, respectively, significantly outperforming the state-of-the-art baselines. In addition, our model takes only about 24 s to generate segmentation outputs, as opposed to >5 min by the baseline and 15 min by human experts. A clinical performance test of 500 patients with malocclusion and/or abnormal teeth shows that 96.9% of the segmentations are satisfactory for clinical applications, 2.9% automatically trigger alarms for human improvement, and only 0.2% of them need rework. Our research demonstrates the potential for deep learning to improve the efficacy and efficiency of dental treatment and digital dentistry.

Clinical and Imaging Features of Patients With Encephalitic Symptoms and Myelin Oligodendrocyte Glycoprotein Antibodies

Background

Myelin oligodendrocyte glycoprotein-antibody (MOG-ab)-associated disease (MOGAD) has highly heterogenous clinical and imaging presentations, in which encephalitis is an important phenotype. In recent years, some atypical presentations in MOG-ab-associated encephalitis (MOG-E) have been increasingly reported but have not yet been described well. The aim of the study was to describe the clinical and imaging features of patients with MOG-E in our center. Atypical phenotypes would be reported, which is expected to expand the spectrum of MOGAD.

Methods

We reviewed medical records of 59 patients with MOGAD diagnosed in our center and identified cases who had ever experienced encephalitic symptoms. Three hundred ten patients with autoimmune encephalitis (AE) were also reviewed, and cases with positive MOG-ab were identified. Besides, patients with chronically progressive encephalitis were identified from 13 MOG-E and 310 AE patients. We collected demographic, clinical, laboratory, radiological, and outcome data to explore clinical and imaging characteristics in MOG-E, especially in the atypical phenotype of chronically progressive encephalitis.

Results

We identified 13 patients (7 males, 6 females) with MOG-E. The median age at onset was 33 years (range 13~62 years). Most (9/13, 69.2%) of patients showed acute or subacute onset of encephalitic symptoms. Brain MRI abnormalities were observed in all patients. The most common lesion locations on MRI were cortical/subcortical (11/13, 84.6%), deep/periventricular white matter (10/13, 76.9%) and corpus callosum (4/13, 30.8%). Brain MRI patterns were categorized into four phenotypes. The most common pattern was cortical encephalitis with leptomeningeal enhancement/brain atrophy (10/13, 76.9%). Eight (8/13, 61.5%) patients had a good response to immunotherapy. Four (4/13, 30.8%) patients with chronically progressive course were identified from MOG-E cohort. They showed leukodystrophy-like pattern, multifocal hazy lesions, or cortical encephalitis on MRI. With immunotherapy, they only showed mild or no improvement. We also identified four (4/310, 1.3%) patients with chronically progressive course from AE cohort. They had better outcomes than counterparts in MOG-E.

Conclusions

This study demonstrates that encephalitic presentations in MOGAD had complex clinical patterns. Chronically progressive encephalitis may be a new phenotype of MOGAD. We recommend to test MOG-ab in subacute and chronic progressive dementia with leukodystrophy-like MRI lesions.

The clinical features of combined central and peripheral demyelination and antibodies against the node of Ranvier

BACKGROUND

Combined central and peripheral demyelination (CCPD) is a disease of inflammatory demyelination that affects central and peripheral nerves simultaneously or temporally separated.

OBJECTIVES

This study evaluated the clinical characteristics and the existence of antinodal/paranodal antibodies in patients with CCPD.

METHODS

We reviewed the clinical manifestations, laboratory tests, electrophysiological examinations, neuroimaging findings, treatment, and prognosis of 31 patients with CCPD. Using a live cell-based assay, we tested antinodal/paranodal antibodies.

RESULTS

The most common symptoms were motor weakness (83.3%), hyporeflexia (63.3%), and sphincter disturbance (58.1%). In total, 16.6% of patients had impaired vision symptoms, whereas 33.3% of patients had abnormal visual-evoked potentials (VEPs). A total of 21.1% (4/19) of patients were positive for anti-AQP4 (aquaporin 4) antibodies, 20.0% (2/10) of patients were positive for anti-NF155 (neurofascin-155) antibodies, and 10.0% (1/10) of patients were positive for anti-MAG (myelin-associated glycoprotein) antibodies. The effective rates of intravenous corticosteroids, intravenous immunoglobulins, and rituximab were 72.2%, 37.5%, and 100%, respectively. At the illness peak, 75% of patients with CCPD had an mRS (modified Rankin Scale) score of 4 or greater. In remission, 37.5% had an mRS score of 4 or greater.

CONCLUSION

The clinical manifestations of patients with CCPD are highly heterogeneous. We recommend testing antinodal/paranodal antibodies for patients with CCPD.

Brain to periphery in acute ischemic stroke: Mechanisms and clinical significance

The social and public health burdens of ischemic stroke have been increasing worldwide. In addition to focal brain damage, acute ischemic stroke (AIS) provokes systemic abnormalities across peripheral organs. AIS profoundly alters the autonomic nervous system, hypothalamic-pituitary-adrenal axis, and immune system, which further yield deleterious organ-specific consequences. Poststroke systemic pathological alterations in turn considerably contribute to the progression of ischemic brain injury, which accounts for the substantial impact of systemic complications on stroke outcomes. This review provides a comprehensive and updated pathophysiological model elucidating the systemic effects of AIS. To address their clinical significance and inform stroke management, we also outline the resulting systemic complications at particular stages of AIS and highlight the mechanisms. Future therapeutic strategies should attempt to integrate the treatment of primary brain lesions with interventions for secondary systemic complications, and should be tailored to patient individualized characteristics to optimize stroke outcomes.

Microglial PGC-1α protects against ischemic brain injury by suppressing neuroinflammation

BACKGROUND

Neuroinflammation and immune responses occurring minutes to hours after stroke are associated with brain injury after acute ischemic stroke (AIS). PPARγ coactivator-1α (PGC-1α), as a master coregulator of gene expression in mitochondrial biogenesis, was found to be transiently upregulated in microglia after AIS. However, the role of microglial PGC-1α in poststroke immune modulation remains unknown.

METHODS

PGC-1α expression in microglia from human and mouse brain samples following ischemic stroke was first determined. Subsequently, we employed transgenic mice with microglia-specific overexpression of PGC-1α for middle cerebral artery occlusion (MCAO). The morphology and gene expression profile of microglia with PGC-1α overexpression were evaluated. Downstream inflammatory cytokine production and NLRP3 activation were also determined. ChIP-Seq analysis was performed to detect PGC-1α-binding sites in microglia. Autophagic and mitophagic activity was further monitored by immunofluorescence staining. Unc-51-like autophagy activating kinase 1 (ULK1) expression was evaluated under the PGC-1α interaction with ERRα. Finally, pharmacological inhibition and genomic knockdown of ULK1 were performed to estimate the role of ULK1 in mediating mitophagic activity after ischemic stroke.

RESULTS

PGC-1α expression was shortly increased after ischemic stroke, not only in human brain samples but also in mouse brain samples. Microglia-specific PGC-1α overexpressing mice exhibited significantly decreased neurologic deficits after ischemic injury, with reduced NLRP3 activation and proinflammatory cytokine production. ChIP-Seq analysis and KEGG pathway analysis revealed that mitophagy was significantly enhanced. PGC-1α significantly promoted autophagic flux and induced autolysosome formation. More specifically, the autophagic clearance of mitochondria was enhanced by PGC-1α regulation, indicating the important role of mitophagy. Pharmacological inhibition or knockdown of ULK1 expression impaired autophagic/mitophagic activity, thus abolishing the neuroprotective effects of PGC-1α.

CONCLUSIONS

Mechanistically, in AIS, PGC-1α promotes autophagy and mitophagy through ULK1 and reduces NLRP3 activation. Our findings indicate that microglial PGC-1α may be a promising therapeutic target for AIS.

Anti-contactin-associated protein-like 2 antibody-associated cerebellar ataxia: A case report and literature review

The spectrum of anti-contactin-associated protein-like 2 (CASPR2) antibody-associated disease is expanding and the involvement of cerebellum was reported in the past few years. We report a 45-year-old male with chronically progressive cerebellar ataxia. CASPR2 antibodies were detected in his serum and cerebellar atrophy was observed on MRI. His symptoms improved prominently with steroids and intravenous immunoglobulins. 23 cases with CASPR2 antibodies and cerebellar ataxia were identified from previous publications. Most of patients showed acute or subacute onset with other typical presentations of anti-CASPR2 antibody-associated disease, such as limbic encephalitis. Immunotherapy was effective in the majority of patients.

Coordination of primary metabolism and virulence factors expression mediates the virulence of Vibrio parahaemolyticus towards cultured shrimp (Penaeus vannamei)

AIMS

Acute hepatopancreatic necrosis disease (AHPND) caused by Vibrio parahaemolyticus has emerged as a severe bacterial disease of cultured shrimp. To identify the key virulence factors, two AHPND-causing V. parahaemolyticus (Vp_AHPND ) strains (123 and 137) and two non-Vp_AHPND strains (HZ56 and ATCC 17082) were selected.

METHODS AND RESULTS

Challenge tests showed that the four strains exhibited different virulence towards shrimp with cumulative mortalities at 48 h postinfection (hpi) ranging from 10 to 92%. The expression of pirAB^VP in strain 123 and 137 was not significantly different. Genomic analysis revealed that the two Vp_AHPND strains contain a plasmid with the PirAB^VP toxins (pirAB^VP ) flanked by the insertion sequence (ISVal1) that has been identified in various locations of chromosomes in Vp_AHPND strains. The two Vp_AHPND strains possessed almost identical virulence factors, while ISVal1 disrupted three genes related to flagellar motility in strain 137. Phenotype assay showed that strain 123 possessed the highest growth rate and swimming motility, followed by strain 137, suggesting that the disruption of essential genes mediated by ISVal1 significantly affected the virulence level. Transcriptome analysis of two Vp_AHPND strains (123 and 137) further suggested that virulence genes related to the capsule, flagella and primary metabolism were highly expressed in strain 123.

CONCLUSIONS

Here for the first time, it is demonstrated that the virulence of Vp_AHPND is not only determined by the expression of pirAB^VP , but also is mediated by ISVal1 which affects the genes involved in flagellar motility and primary metabolism.

SIGNIFICANCE AND IMPACT OF THE STUDY

The genomic and transcriptomic analysis of Vp_AHPND strains provides valuable information on the virulence factors affecting the pathogenicity of Vp_AHPND.

Long non-coding RNA DSCAM-AS1 indicates a poor prognosis and modulates cell proliferation, migration and invasion in ovarian cancer via upregulating SOX4

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "Long non-coding RNA DSCAM-AS1 indicates a poor prognosis and modulates cell proliferation, migration and invasion in ovarian cancer via upregulating SOX4, by Y. Li, J. Hao, Y.-M. Jiang, Y. Liu, S.-H. Zhang, published in Eur Rev Med Pharmacol Sci 2019; 23 (10): 4143-4148-DOI: 10.26355/eurrev_201905_17916-PMID: 31173284" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/17916.

Long non-coding RNA DSCAM-AS1 indicates a poor prognosis and modulates cell proliferation, migration and invasion in ovarian cancer via upregulating SOX4

OBJECTIVE

Recent studies have revealed that long noncoding RNAs (lncRNAs) play a crucial role in tumor progression. Ovarian cancer is a common type of fatal gynecological cancer worldwide. This study aims to investigate how lncRNADSCAM-AS1 functions in the progression of ovarian cancer.

PATIENTS AND METHODS

DSCAM-AS1 expression of both ovarian cancer cells and 56 paired of tissue samples was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Moreover, the function of DSCAM-AS1 was identified via transwell assay, wound healing assay, colony formation assay and proliferation assay in vitro. The underlying mechanism was explored through qRT-PCR and Western blot assay.

RESULTS

DSCAM-AS1 expression was remarkably upregulated in tumor tissues compared with that in the adjacent normal tissues. Besides, ovarian cancer proliferation, migration and invasion were promoted after overexpression of DSCAM-AS1 in vitro. Moreover, after overexpression of DSCAM-AS1, SOX4 was upregulated at mRNA and protein level in vitro. Furthermore, the expression of SOX4 in tumor tissues was positively correlated with the expression of DSCAM-AS1.

CONCLUSIONS

The above results suggested that DSCAM-AS1 can promote cell migration, invasion and proliferation in ovarian cancer by upregulating SOX4, which may offer a new therapeutic intervention for patients with ovarian cancer.

SERPINA1 gene expression in whole blood links the rs6647 variant G allele to an increased risk of large artery atherosclerotic stroke

The rs6647 variant G allele in SERPINA1 gene was reported to be associated with the risk of large artery atherosclerotic stroke (LAS), however, the mechanism remains unclear. Here, we performed a functional annotation of the rs6647 variant by using the software HaploReg version 4.1 (HaploReg v4.1). Next, the expression quantitative trait loci (eQTLs) analysis of multiple datasets was conducted for determining the association between the rs6647 and SERPINA1 expression in various tissues. Then, a case-control gene expression analysis was done using two independent ischemic stroke (IS) gene expression datasets. Finally, SERPINA1 expression in whole blood samples from 8 LAS patients and 14 healthy persons were compared. The functional annotation suggested that the rs6647 regulates gene expression in multiple human tissues especially in brain and blood. The eQTLs analysis revealed a significant association of the rs6647 G allele with increased expression of SERPINA1 gene only in whole blood. Compared with the controls, there was an increased expression of SERPINA1 gene in whole blood in both IS patients and LAS patients. SERPINA1 gene expression in whole blood bridges the rs6647 variant G allele with increased LAS risk, providing new insights into the mechanisms underlying role of the rs6647 in determining LAS risk.

Research Advances in How the cGAS-STING Pathway Controls the Cellular Inflammatory Response

Double-stranded DNA (dsDNA) sensor cyclic-GMP-AMP synthase (cGAS) along with the downstream stimulator of interferon genes (STING) acting as essential immune-surveillance mediators have become hot topics of research. The intrinsic function of the cGAS-STING pathway facilitates type-I interferon (IFN) inflammatory signaling responses and other cellular processes such as autophagy, cell survival, senescence. cGAS-STING pathway interplays with other innate immune pathways, by which it participates in regulating infection, inflammatory disease, and cancer. The therapeutic approaches targeting this pathway show promise for future translation into clinical applications. Here, we present a review of the important previous works and recent advances regarding the cGAS-STING pathway, and provide a comprehensive understanding of the modulatory pattern of the cGAS-STING pathway under multifarious pathologic states.

Inhibition of double-strand DNA-sensing cGAS ameliorates brain injury after ischemic stroke

Cytosolic double‐stranded DNA (dsDNA) is a danger signal that is tightly monitored and sensed by nucleic acid‐sensing pattern recognition receptors. We study the inflammatory cascade on dsDNA recognition and investigate the neuroprotective effect of cyclic GMP‐AMP (cGAMP) synthase (cGAS) antagonist A151 and its mechanisms of neuroprotection in a mouse model of experimental stroke. Here, we found that cerebral ischemia promoted the release of dsDNA into the cytosol, where it initiated inflammatory responses by activating the cGAS. A151 effectively reduced the expression of cGAS, absent in melanoma 2 (AIM2) inflammasome, and pyroptosis‐related molecules, including caspase‐1, gasdermin D, IL‐1β, and IL‐18. Furthermore, mice treated with A151 showed a dampened immune response to stroke, with reduced counts of neutrophils, microglia, and microglial production of IL‐6 and TNF‐α after MCAO. Moreover, A151 administration significantly reduced infarct volume, attenuated neurodeficits, and diminished cell death. Notably, the protective effect of A151 was blocked in a microglia‐specific cGAS knockout mouse. These findings offer unique perspectives on stroke pathogenesis and indicate that inhibition of cGAS could attenuate brain inflammatory burden, representing a potential therapeutic opportunity for stroke.

Upregulation of neuronal PGC-1α ameliorates cognitive impairment induced by chronic cerebral hypoperfusion

Rationale: Mitochondrial dysfunction and oxidative stress occur in vascular dementia (VaD), but the specific molecular mechanism regulating these events remains unclear. Peroxisome proliferator-activated receptor-γ co-activator-1α (PGC-1α) is a master regulator for mitochondrial function. This study aims to investigate whether PGC-1α is involved in the pathophysiology of VaD. Methods: We firstly generated PGC-1α ^f/f Eno2-Cre mice to induce neuron-specific overexpression of PGC-1α by crossbreeding PGC-1α ^f/f mice with Eno2-cre mice. Then, the mice were subjected to bilateral common carotid artery stenosis to induce chronic cerebral hypoperfusion. Neurological function and hippocampal PGC-1α expression was evaluated. Next, RNA-Seq analysis and Seahorse assay were performed on the hippocampal neurons. In addition, mitochondrial antioxidants, uncoupling proteins, ROS production and the activation of glial cells were also measured. Results: Our results showed that hippocampal PGC-1α expression is down-regulated in the mouse VaD model induced by chronic cerebral hypoperfusion. In contrast, neuronal PGC-1α overexpression significantly ameliorated cognitive deficits. RNA-Seq analysis indicated that PGC-1α improved energy metabolism of neurons under hypoxic condition, and Seahorse assay confirmed that PGC-1α increases the metabolic activity of neurons. Further study demonstrated that PGC-1α boosted the expressions of mitochondrial antioxidants and uncoupling proteins (UCPs), including SOD2, Prx3, GPx1, UCP2, UCP4 and UCP5, which in turn reduced reactive oxygen species (ROS) production. Moreover, the activation of microglia and astrocytes was also found to decrease in the hippocampus. All of these changes greatly contributed to protect hippocampal neurons against ischemic insults. Conclusions: PGC-1α could suppress the excessive ROS and neuroinflammation in the hippocampus, opening up a potential therapeutic target for cognitive impairment.

MOF-derived hollow Co4S3/C nanosheet arrays grown on carbon cloth as the anode for high-performance Li-ion batteries

Cobalt sulfide (Co4S3) is considered one of the most promising anode materials for lithium-ion batteries owing to its high specific capacity. However, some disadvantages, such as poor electrical conductivity and volume expansion, lead to low rate capability and may hinder its practical applications. Herein, we firstly fabricated leaf-like hollow Co4S3/C nanosheet arrays growing on carbon cloth (h-Co4S3/C NA@CC) by a facile solution method combined with carbonization, sulfidation and annealing treatments. The carbon coated leaf-like nanosheet structure can facilitate the electron transfer and shorten the ion transfer path, while the hollow space inside Co4S3 can buffer the volume variation. As the anode for LIBs, h-Co4S3/C NA@CC demonstrates an impressive rate capability (654.3 mA h g-1 at 1 A g-1 and 394.1 mA h g-1 at 2 A g-1), and an excellent cycling stability (720 mA h g-1 at 1 A g-1 after 200 cycles and 79% capacity retention at 2 A g-1 after 500 cycles).

Detection of hepatitis E virus genotypes 3 and 4 in donkeys in northern China

BACKGROUND

Hepatitis E virus (HEV) is the causative agent of acute self-limiting hepatitis in humans in developing countries. Hepatitis E virus RNA was first detected in donkeys in Spain, but little is known about the possible presence of HEV in donkeys in China.

OBJECTIVES

To investigate the prevalence of HEV in donkeys in northern China.

STUDY DESIGN

Investigation of the prevalence of HEV in donkeys using serological, molecular and phylogenetic approaches.

METHODS

A total of 401 donkey serum specimens were tested for serological and molecular detection of HEV via enzyme-linked immunosorbent assay and quantitative reverse transcription polymerase chain reaction. The amplified products were cloned in pMD18-T vector and sequenced. The alignment and phylogenetic analysis of partial HEV ORF2 genes were compared with the corresponding sequences of the obtained HEV representative strains.

RESULTS

Serological results showed that 49 donkeys (12.22%, 95% CI: 9.18-15.83%) were positive for anti-HEV-specific antibodies, and 17 donkeys (4.24%, 95% CI: 2.49-6.70%) were positive for HEV viral RNA. On the basis of sequence alignment and phylogenetic analysis, all isolated HEV strains belonged to genotype 3 (HEV-3) or HEV-4, sharing more than 76.2-96.3% identities with 67 other HEV representative strains of HEV-1 to HEV-8.

MAIN LIMITATIONS

Further studies about the prevalence of HEV in organs or faecal samples from donkeys are needed to evaluate the possible role of HEV reservoir and to determine the risk factors associated with the transmission of this zoonotic virus in donkeys in China.

CONCLUSIONS

This is the first report documenting the molecular analysis of donkey HEV strains worldwide and the serological evidence of HEV infection in donkeys in northern China. The results suggest that young donkeys are more susceptible to HEV infection compared with older donkeys. Further investigation is required to determine whether donkeys should be considered reservoirs for zoonotic HEV. The Summary is available in Chinese - see Supporting information.

Up-regulation of PGC-1α in neurons protects against experimental autoimmune encephalomyelitis

Reactive oxygen species (ROS) generation and mitochondrial dysfunction are related to neuron loss in multiple sclerosis (MS). Although peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) appears to play a key role in modulating levels of mitochondrial ROS, antioxidants, and uncoupling proteins (UCPs), and PGC-1α expression is reduced in the neocortex of patients with MS, it is unclear what its role is in neurons and in the manifestation of clinical symptoms of MS. Here, we show in wild-type (WT) experimental autoimmune encephalomyelitis (EAE) mice that PGC-1α is decreased 13 d after EAE induction followed by a steady decline up to 20 d. These changes were accompanied by parallel alterations in levels of superoxide dismutase 2, peroxiredoxin 3, thioredoxin 2, UCP4, and UCP5. In transgenic (TG) mice with neuron-specific overexpression of PGC-1α (PGC-1α^f/fEno2-Cre), clinical symptoms after EAE induction were delayed and less severe than in WT mice. The degrees of apoptotic neuron loss and demyelination were also less severe in PGC-1α-TG mice. Overexpression of PGC-1α in neuronal neuroblastoma spinal cord 34 cells subjected to EAE inflammatory conditions showed similar results to those obtained in vivo. RNA sequencing analysis showed that apoptotic processes were significantly enriched in the top 10 significant gene ontology (GO) terms of differentially expressed genes, and the apoptotic pathway was significantly enriched in Kyoto Encyclopedia of Genes and Genomes pathway analysis. Our findings indicate that up-regulation of neuronal PGC-1α protected neurons from apoptosis in EAE. Manipulating PGC-1α levels in MS may help stave off this devastating disease.-Dang, C., Han, B., Li, Q., Han, R., Hao, J. Up-regulation of PGC-1α in neurons protects against experimental autoimmune encephalomyelitis.

Augmented Brain Infiltration and Activation of Leukocytes After Cerebral Ischemia in Type 2 Diabetic Mice

Background: Stroke patients with diabetes suffer from higher mortality rate and worsened neurological outcome. However, the responses of immune system to cerebral ischemia in the setting of diabetes remain poorly understood. Methods: In this study, we investigated the temporal profile of leukocyte mobilization and brain infiltration following distal middle cerebral artery occlusion (dMCAO) in db/db mouse model of type 2 diabetes (T2D) and its db/+ normoglycemic controls. Results: We found a significant increase of brain-infiltrating CD4⁺ T cell at day 3 after dMCAO, and a delayed and dramatic increase of brain-infiltrating neutrophils, CD4⁺ T cells, CD8⁺ T cells, and B cells at day 7 after dMCAO in db/db mice vs. db/+ controls. Leukocyte subsets in the circulation and spleen were also measured, however, there is no significant difference between non-diabetic and diabetic groups. Furthermore, we identified an increased expression of activation marker CD69 in brain-infiltrating neutrophils, CD4⁺ T and CD8⁺ T cells, and IFN-γ in brain-infiltrating CD4⁺ T cells in db/db mice at day 7 after dMCAO. Conclusions: These findings for the first time demonstrate that cerebral ischemia induces a delayed and sustained augmentation of brain infiltration and activation of neutrophils and lymphocytes in type 2 diabetic mice and these altered immune responses might contribute to the severer brain tissue damage and worse neurological outcomes of diabetes stroke, which warrants further investigation.

Quantum computation with universal error mitigation on a superconducting quantum processor

Medium-scale quantum devices that integrate about hundreds of physical qubits are likely to be developed in the near future. However, these devices will lack the resources for realizing quantum fault tolerance. Therefore, the main challenge of exploring the advantage of quantum computation is to minimize the impact of device and control imperfections without complete logical encoding. Quantum error mitigation is a solution satisfying the requirement. Here, we demonstrate an error mitigation protocol based on gate set tomography and quasi-probability decomposition. One- and two-qubit circuits are tested on a superconducting device, and computation errors are successfully suppressed. Because this protocol is universal for digital quantum computers and algorithms computing expected values, our results suggest that error mitigation can be an essential component of near-future quantum computation.

[Changes of eye care use among rural adults under the reform of New Rural Cooperative Medical Scheme: the Handan Eye Study]

Objective: To assess the utilization of eye care services in the rural area of Handan, China under the New Rural Cooperative Medical Scheme, and to analyze the factors associated with the uptake of these services. Methods: In a cohort population-based study, subjects who joined both the baseline (2006-2007) and follow-up (2012-2013) were included. Information of demographic characteristics, participation in the New Rural Cooperative Medical Insurance and use of eye care services, comprehensive ophthalmic examinations, blood pressure and fasting was collected. The protocol got approved by the ethics committee of Beijing Tongren Hospital, and each subject signed the informed consent. Results: Of 5 193 eligible participants, 549 [10.6%; 95% confidence interval (CI), 9.8%-11.4%] had used eye care services, and the prevalence had no significant difference from baseline surveys (P=0.20). The municipal hospitals undertook 50.1% of eye care services. "No need" (4 422, 95.2%) was the most common reason cited for not using an eye care service; 2 875 (65.0%) of these participants had at least one type of eye diseases, 3 505 (79.3%) had at least one type of ocular complaints. In the multiple binary logistics regression model, participants who were elder [adjusted odds ratio (OR), 1.319; 95%CI, 1.177-1.478], were female (adjusted OR, 1.466; 95%CI, 1.085-1.981), had a diabetes history (adjusted OR, 1.930; 95%CI, 1.381-2.696), had a low income (adjusted OR, 0.826; 95%CI, 0.688-0.922), had ocular complaints (adjusted OR, 3.556; 95%CI, 2.484-5.091), had refractive errors (adjusted OR, 1.256; 95%CI, 1.007-1.567), had visual impairment (adjusted OR, 4.398; 95%CI, 2.667-7.253) or had cataract (adjusted OR, 1.278; 95%CI, 1.013-1.612) were more likely to take an eye care service. Conclusions: Under the New Rural Cooperative Medical Scheme, the prevalence of New Rural Cooperative Medical Insurance was increased significantly, but the rate of eye care use in the rural area was still low. Further efforts towards higher quality medical service in county hospitals and village clinics as well as better education about eye disease among the rural population may raise the eye care use in rural areas. (Chin J Ophthalmol, 2018, 54:570-579).

Multiple parametric nanoscale measurements with high sensitivity based on through-focus scanning optical microscopy

High-throughput through-focus scanning optical microscopy (TSOM) involves defocusing along the optical axis and capturing a series of defocus images and is useful in optical nanoscale measurement. However, TSOM is usually affected by its optical and mechanical noises. In this study, the issue of sensitivity and application in three-dimensional (3D) multiple parameter measurement of TSOM is investigated. First, a TSOM system with objective scanning and its relative simulation algorithm are proposed. Second, based upon the system and algorithm, an experiment on an isolated Au line is performed and the corresponding matching library is established. Comparing the experimental TSOM image and simulated TSOM images of the library, 3D multiple parameter results of the Au line are extracted. Third, the precision of the system is analysed through a fidelity test particular for through-focus images. According to this study, the system is robust to the optical and mechanical noises and hence could be useful in 3D multiple parametric measurement and high-volume nanomanufacturing.