Adalimumab Dose Reduction and Withdrawal in Stable Non-Infectious Pediatric Uveitis: An Open-Label, Prospective, Pilot Study

PURPOSES

This study investigated the feasibility of adalimumab (ADA) dose reduction and withdrawal strategy in children with stable pediatric non-infectious uveitis (PNIU).

METHODS

This open-label prospective pilot trial recruited 18 stable PNIU patients (33 eyes) between two and eighteen years old who were treated with standard doses of ADA (20/40 mg every 2 weeks) plus oral methotrexate. The interval of ADA injection was extended to 4 weeks and followed up for 24 weeks. If the uveitis remained stable, ADA was discontinued and followed up for another 24 weeks. ADA was considered successfully stopped if no relapse occurred during this period. The relapse-free survival rate, best corrected visual acuity (BVCA), anterior chamber cell (ACC), vitritis, macular thickness (MT), and serum ADA levels were evaluated. Approval Number: 2021KYPJ201. ClinicalTrials.gov identifier: NCT05155592.

RESULTS

The relapse-free survival rate was 22.2% (4/18) at 48 weeks. 33.3% (6/18) of patients relapsed when ADA was given every 4 weeks, while 44.5% of patients (8/18) relapsed after ADA was stopped. The four patients successfully withdrawn from ADA were all diagnosed with BD. No statistically significant differences (p > 0.05) were observed in BCVA and MT between baseline and final follow-up. The proportion of ACC and vitritis exhibited an upward trend (p < 0.05) during follow-up. Serum ADA gradually decreased to zero during follow-up in both non-recurrence and recurrence groups.

CONCLUSIONS

In PNIU children who reached remission for 6 months, ADA dose reduction and withdrawal were associated with a high risk of inflammation recurrence. Timely adjustment of ADA to the last effective dosage frequency can regain control of the inflammation. Detection of ADA serum levels in patients with recurrence may help find the appropriate interval of ADA use.

[Prevention and control of pediatric tinea capitis]

Tinea capitis is a superficial fungal infection of the scalp and hair caused by Dermatophytes. It represents the most prevalent superficial fungal infection among preadolescent children worldwide, including in developing countries such as China. The highly contagious nature of tinea capitis can result in outbreaks within communal settings for children. Furthermore, pustular lesions associated with this condition can lead to permanent scarring and hair loss, imposing a significant psychological burden on affected children and their parents. This article aims to provide a comprehensive literature review encompassing the susceptible person, epidemiological characteristics, trends, etiology, modes of transmission, clinical manifestations, treatment, and prevention strategies of tinea capitis. The ultimate objective is to raise awareness, implement effective prevention and control measures, interrupt the transmission cycle, and ultimately reduce the incidence of tinea capitis in the pediatric population.

[Early recognition and prevention of systemic sclerosis]

Systemic sclerosis is a disease characterized by skin and internal organ fibrosis, lacking specific therapeutic drugs and having a poor prognosis. Early diagnosis and intervention of the disease is of significant value in improving patient prognosis. This article provides a systematic review of the early diagnosis and treatment of systemic sclerosis, including early symptom recognition, laboratory testing, and drug intervention. It will provide a reference for the prevention of this disease.

Tumor Treatment Response Assessed During the Concurrent Chemoradiotherapy for Nasopharyngeal Patients

PURPOSE/OBJECTIVE(S)

To evaluate intratumoral treatment response distribution with using FDG-PET/CT during the chemoradiotherapy of nasopharyngeal patients (NPC).

MATERIALS/METHODS

A total of 5 of 30 patients with stage III-IVA NPC were enrolled in the institutional protocol for induction/concurrent chemoradiotherapy with radiation dose of 70 Gy in 33 fractions. For each patient, a pre-radiation treatment FDG-PET/MRI image (SUV0) and a mid-treatment image (SUVm) at the treatment dose of 31.8 Gy were obtained. Followed by deformable PET/MRI registration between SUV0 and SUVm, the tumor voxel SUV reduction ratio was obtained to construct a tumor dose response matrix (DRM). Tumor SUVavid was also constructed by limiting tumor voxel SUVm > a given value. Spatial correlations of the tumor SUV0, SUVm, SUVavid and DRM were determined.

RESULTS

The mean and coefficient variation (CV) of the SUV0, SUVm and DRM for all tumors were 5.05 (52%), 2.72 (49%) and 0.64 (63%) (Table contains the individual data), which were smaller than those on the SUVs of head-n-neck HPV+ patients reported previously due to the induction chemotherapy, but had much larger DRM mean and CV. The inter-tumoral CVs of SUV0 and DRM were 29% and 27%, which were much lower than those of the intra-tumoral CVs 43% and 57%. Meanwhile, the intra-tumoral variations on SUV0 was smaller than the one of head-neck HPV+ patients, but the DRM intra-variation was much larger. There was a weak correlation between SUV0 and SUVm with the correlation coefficient 0.13, a medium correlation of -0.55 between SUV0 and DRM, but a strong correlation, 0.72, between SUVm and DRM. However, the spatial correlation between tumor DRM and SUVavid was getting weaker as the SUVavid value increasing and equal 0.47 with SUVavid value > 3.

CONCLUSION

The spatial dose response DRM for NPC in the concurrent chemoradiotherapy was relatively high, while had relatively low baseline tumor metabolic activity SUV0. It was most likely due to the induction chemotherapy. In addition, the tumor dose response showed vary large intra-tumoral variation. The high correlations between DRM and SUVm imply that SUVavid could be used partially to guide adaptive modification of NPC treatment with carefully selected boundary value.

[Cardiac amyloidosis: pathological classification and clinical analysis of 48 cases]

Objective: To investigate the histological features and clinical manifestations in different types of cardiac amyloidosis to improve diagnostic accuracy. Methods: The histopathological features and clinical manifestations of 48 patients diagnosed with cardiac amyloidosis by Congo red stain and electron microscopy through endomyocardial biopsy were collected in West China Hospital of Sichuan University from January 2018 to December 2021. Immunohistochemical stains for immunoglobulin light chains (κ and λ) and transthyretin protein were carried out, and a review of literature was made. Results: The patients age ranged from 42 to 79 years (mean 56 years) and the male to female ratio was 1.1 to 1.0. The positive rate of endomyocardial biopsy was 97.9% (47/48), which was significantly higher than that of the abdominal wall fat (7/17). Congo red staining and electron microscopy were positive in 97.9% (47/48) and 93.5% (43/46), respectively. Immunohistochemical stains showed 32 cases (68.1%) were light chain type (AL-CA), including 31 cases of AL-λ type and 1 case of AL-κ type; 9 cases (19.1%) were transthyretin protein type (ATTR-CA); and 6 cases (12.8%) were not classified. There was no significant difference in the deposition pattern of amyloid between different types (P>0.05). Clinical data showed that ATTR-CA patients had less involvement of 2 or more organs and lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) than the other type patients (P<0.05). The left ventricular stroke volume and right ventricular ejection fraction of ATTR-CA patients were better than the other patients (P<0.05). Follow-up data of 45 patients was obtained, and the overall mean survival time was 15.6±2.0 months. Univariate survival analysis showed that ATTR-CA patients had a better prognosis, while cardiac amyloidosis patients with higher cardiac function grade, NT-proBNP >6 000 ng/L, and troponin T >70 ng/L had a worse prognosis (P<0.05). Multivariate survival analysis showed that NT-proBNP and cardiac function grade were independent prognostic factors for cardiac amyloidosis patients. Conclusions: AL-λ is the most common type of cardiac amyloidosis in this group. Congo red staining combined with electron microscopy can significantly improve the diagnosis of cardiac amyloidosis. The clinical manifestations and prognosis of each type are different and can be classified based on immunostaining profile. However, there are still a few cases that cannot be typed; hence mass spectrometry is recommended if feasible.

[Read-through circular RNA rt-circ-HS promotes hypoxia inducible factor 1α expression and renal carcinoma cell proliferation, migration and invasiveness]

OBJECTIVE

To identify and characterize read-through RNAs and read-through circular RNAs (rt-circ-HS) derived from transcriptional read-through hypoxia inducible factor 1α (HIF1α) and small nuclear RNA activating complex polypeptide 1 (SNAPC1) the two adjacent genes located on chromosome 14q23, in renal carcinoma cells and renal carcinoma tissues, and to study the effects of rt-circ-HS on biological behavior of renal carcinoma cells and on regulation of HIF1α.

METHODS

Reverse transcription-polymerase chain reaction (RT-PCR) and Sanger sequencing were used to examine expression of read-through RNAs HIF1α-SNAPC1 and rt-circ-HS in different tumor cells. Tissue microarrays of 437 different types of renal cell carcinoma (RCC) were constructed, and chromogenic in situ hybridization (ISH) was used to investigate expression of rt-circ-HS in different RCC types. Small interference RNA (siRNA) and artificial overexpression plasmids were designed to examine the effects of rt-circ-HS on 786-O and A498 renal carcinoma cell proliferation, migration and invasiveness by cell counting kit 8 (CCK8), EdU incorporation and Transwell cell migration and invasion assays. RT-PCR and Western blot were used to exa-mine expression of HIF1α and SNAPC1 RNA and proteins after interference of rt-circ-HS with siRNA, respectively. The binding of rt-circ-HS with microRNA 539 (miR-539), and miR-539 with HIF1α 3' untranslated region (3' UTR), and the effects of these interactions were investigated by dual luciferase reporter gene assays.

RESULTS

We discovered a novel 1 144 nt rt-circ-HS, which was derived from read-through RNA HIF1α-SNAPC1 and consisted of HIF1α exon 2-6 and SNAPC1 exon 2-4. Expression of rt-circ-HS was significantly upregulated in 786-O renal carcinoma cells. ISH showed that the overall positive expression rate of rt-circ-HS in RCC tissue samples was 67.5% (295/437), and the expression was different in different types of RCCs. Mechanistically, rt-circ-HS promoted renal carcinoma cell proliferation, migration and invasiveness by functioning as a competitive endogenous inhibitor of miR-539, which we found to be a potent post-transcriptional suppressor of HIF1α, thus promoting expression of HIF1α.

CONCLUSION

The novel rt-circ-HS is highly expressed in different types of RCCs and acts as a competitive endogenous inhibitor of miR-539 to promote expression of its parental gene HIF1α and thus the proliferation, migration and invasion of renal cancer cells.

[Clinical and genetic characteristics of young patients with myeloproliferative neoplasms]

Objectives: To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN). Methods: In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients. Results: 1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion: Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.

[Cognition and reflection on the "lateral ligament of rectum"]

As total mesorectal excision (TME) for rectal cancer is widely carried out in China, lateral ligament of rectum, as an important anatomical structure of the lateral rectum with certain anatomical value and clinical significance, has been the focus of attention. In this paper, by comparing and analyzing the characteristics about ligaments of the abdomen and pelvis, reviewing the membrane anatomy and the theory of primitive gut rotation, and combining clinical observations and histological studies, the author came to a conclusion that lateral ligament of rectum does not exist, but is only a relatively dense space on the rectal side accompanied by numerous tiny nerve plexuses and small blood vessels penetrating through it.

[Efficacy and safety of omalizumab in patients with refractory allergic asthma: a meta-analysis]

Objective: To evaluate the efficacy and safety of omalizumab in patients with refractory allergic asthma using meta-analysis. Methods: We searched databases including PubMed, Web of Science, Embase and the website of ClinicalTrials. gov registry for randomized controlled trials (RCTs), using the search terms: ("anti-IgE" OR "anti-immunoglobulin E" OR "anti-IgE antibody" OR "omalizumab" OR "rhuMAb-E25" OR "Xolair") AND ("allergic asthma"). The time was up to September 19th 2020. Review Manager 5.4 software and Stata16 software were used to calculate pooled RR or WMD, perform heterogeneity test, and assess publication bias. Results: Fifteen RCTs with 6 316 patients in total (omalizumab, n=3 469; placebo, n=2 847) met our selection criteria. Comparing with placebo, omalizumab reduced the risk of asthma exacerbations during both stable-inhaled corticosteroid (ICS) phase (RR=0.69, 95%CI: 0.63-0.75, P<0.001; I²=39.0%, P=0.090) and ICS-reduction phase (RR=0.55, 95%CI: 0.46-0.66, P<0.001; I²=41.0%, P=0.180), reduced emergency visits (RR=0.53, 95%CI: 0.38-0.73, P<0.001; I²=0, P=0.420), made a significant reduction in dosage of ICS (RR=1.35, 95%CI: 1.25-1.45, P<0.001; I²=22.0%, P=0.280) and even withdrew from ICS completely (RR=1.80, 95%CI: 1.41-2.31, P<0.001; I²=57.0%, P=0.070). Omalizumab significantly improved asthma-related quality of life (RR=1.81, 95%CI: 1.51-2.17). The use of rescue bronchodilators was significantly reduced in the omalizumab group (RR=0.78, 95%CI: 0.67-0.92) but there was no significant difference in the dosage of rescue bronchodilators (puff per day) (WMD=-0.32, 95%CI: -0.77-0.13). Patients taking omalizumab did not increase the frequency of any adverse events (RR=1.01, 95%CI: 0.98-1.03) and serious adverse events (RR=0.89, 95%CI: 0.74-1.06). Conclusions: Omalizumab is an ideal adjunctive treatment for refractory allergic asthma with good efficacy and safety. Further randomized controlled trials are needed to determine the appropriate duration of treatment.

[Microfocal prostate cancer: a clinicopathological analysis of 206 cases]

Objective: To investigate the clinical and pathological features and prognosis of patients with microfocal prostate adenocarcinoma. Methods: Clinical and pathological data of the patients diagnosed with microfocal adenocarcinoma on prostate biopsy at the West China Hospital from 2013 to 2019 were collected. Microfocal adenocarcinoma was defined as follows: Gleason score of 3+3=6, total number of the cores ≥10, number of the positive cores ≤2, and proportion of the tumor in each positive core<50%. Clinicopathological parameters, treatment plans and follow-up data were collected. Pathological information of the biopsy and radical resection specimens was used to analyze the correlation between pathological parameters in the biopsy report and adverse pathological features of radical resection specimens, including increased Gleason score, capsule invasion, positive surgical margin and perineural invasion. Results: A total of 206 cases of microfocal adenocarcinoma were diagnosed on prostate biopsies from 2013 to 2019, accounting for 6.7% of all adenocarcinoma cases. There were 139 cases of 1 positive core and 67 cases of 2 positive cores. Patients with microfocal adenocarcinoma were younger than those with non-microfocal adenocarcinoma (69 years versus 71 years, P<0.001). Compared with patients with non-microfocal adenocarcinoma, the pre-biopsy total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) levels in patients with microfocal adenocarcinoma were both lower (11.2 μg/L² versus 23.7 μg/L²; 1.4 μg/L² versus 3.0 μg/L², P<0.001), the fPSA/tPSA level was higher (12.9% versus 10.7%, P<0.05), the prostate volume was larger (38.9 mL versus 34.3 mL, P<0.05), and the PSA density was lower (0.3 μg/L² versus 0.8 μg/L², P<0.001). 130 patients underwent radical prostatectomy, 30 patients chose active monitoring, 31 patients chose endocrine or radiation therapy, and 15 patients were lost to follow-up. Three patients in the active surveillance group underwent radical prostatectomy for disease progression after 21-39 months observation. Biochemical relapses occurred in two patients in the radical prostatectomy group. The remaining patients have no disease progression or recurrence at present. Compared with radical prostatectomy specimens, Gleason score in the biopsy material was increased in 64/115 patients (55.7%). Among resection excision specimens, 14 cases (12.2%) had extraprostatic extension (EPE), 35 cases (30.4%) had perineural invasion, and 16 cases (13.9%) had a positive margin. Univariate and multivariate analyses showed that low fPSA/tPSA ratio and 2 positive cores were independent risk factors for Gleason score increase in the radical prostatectomy specimens. A low fPSA/tPSA ratio was an independent risk factor for perineural invasion. Low fPSA/tPSA ratio and low prostate volume were associated with a positive margin in radical prostatectomy specimens. Conclusions: In this study, patients diagnosed with microfocal adenocarcinoma on prostate biopsy account for a high proportion of the patients with increased Gleason score in the radical prostatectomy specimens, and there is a certain proportion of adverse pathological features in the radical specimens. Therefore, for the patients with only a small amount of low-grade adenocarcinoma found in biopsy, PSA levels and PSA density should be taken into consideration in treatment selection.

[Morphological and molecular identification of trematode isloates from laying ducks in Nanchang City]

OBJECTIVE

To identify the species of trematodes isolated from laying ducks in Nanchang City using morphological and molecular approaches.

METHODS

Trematodes were isolated from the hepatobiliary duct, gallbladder and large intestine of market-sold laying ducks in Nanchang City. Following morphological characterization, total DNA was extracted from all trematode specimens, and internal transcribed spacer region (ITS) and cytochrome C oxidase subunit 1 (Cox1) genes were amplified using PCR assay and sequenced. Sequence alignment was performed using the Blast software, and homology and phylogenetic analyses were done in the trematode isolates based on ITS and Cox1 gene sequences.

RESULTS

The morphological characteristics of two trematode isolates from the large intestine of laying ducks were similar to those of Echinostoma revolutum and E. miyagawai, and the morphological characteristics of eight trematode samples isolated from the hepatobiliary duct and gallbladder of laying ducks were similar to those of Amphimerus anatis. The ITS and Cox1 gene sequences of the two trematode isolates from the large intestine of laying ducks had 99.3% and 98.9%-99.4% homology with E. miyagawai, and the phylogenetic analysis showed that two trematode isolates had the closest genetic relationship with E. miyagawai based on ITS and Cox1 gene sequences. The ITS gene sequences of eight trematode isolates from the hepatobiliary duct and gallbladder of laying ducks shared 95.1%-95.5% with Opisthorchis sudarikovi and Clonorchis sinensis, while the Cox1 gene sequences of eight trematode isolates from the hepatobiliary duct and gallbladder of laying ducks shared 86.3%-86.4% and 85.5%-85.7% with O. viverrini and O. sudarikovi. ITS gene sequence-based phylogenetic analysis showed that the duck-derived trematode isolates had the closest genetic relationship with C. sinensis, and Cox1 gene sequence-based phylogenetic analysis showed that the duck-derived trematode isolates had the closest genetic relationship with Metorchis orientalis and O. viverrini.

CONCLUSIONS

The trematode isolates from the large intestine of laying ducts in Nanchang City may be E. miyagawai, and the trematode isolates from the hepatobiliary duct and gallbladder may be an unidentified trematode species of the family Opisthorchiidae.

Taurine Reduces Liver Damage in Non-Alcoholic Fatty Liver Disease Model in Rats by Down-Regulating IL-9 and Tumor Growth Factor TGF-β

The study employed a rat model to examine the effects of taurine (Tau) on prevention and therapy of non-alcoholic fatty liver disease (NAFLD). In model rats maintained on a high-fat diet (HFD), the serum levels of ALT, AST, triglycerides, cholesterol, and LDL were higher than the corresponding levels in normal control and NP groups (p<0.05). In Tau-prevention and Tau-treatment groups, the serum levels of AST and triglycerides were lower than in HFD rats (p<0.05). In HFD rats, diffuse fatty degeneration and infiltration with inflammatory cells was observed in the liver; in the ileal mucosa, the villi were fractured or absent, the epithelium was exfoliated and infiltrated with inflammatory cells. The levels of TGF-β, IL-9, and their mRNA in the liver and ileal mucosa of HFD rats were significantly higher than in normal control and NP groups (p<0.05). In Tau-prevention and Tau-treatment groups, these levels were significantly lower than in HFD rats (p<0.05). Thus, TGF-β and IL-9 can be implicated in NAFLD genesis, while Tau can preventively or therapeutically diminish the damage to the liver and ileal mucosa in rats with this disease by down-regulating the expression of TGF-β and IL-9.

[Bortezomib interferes with DNA repair and exerts synergistic anti-multiple myeloma activity with doxorubicin]

目的

探讨系统性免疫球蛋白轻链淀粉样变性（AL）初治患者的外周血免疫细胞表型特征及其与临床指标的相关性。

方法

采用流式细胞仪多参数免疫荧光分析技术，对36例AL初诊患者和28名健康供者的外周血单个核细胞的表面抗原CD3、CD56、CD4、CD8、CD25、CD45RA、CD28、CD57及核内抗原FOXP3进行检测和比较。根据梅奥2012分期对AL患者进行分期，比较Ⅰ~Ⅱ、Ⅲ~Ⅳ期患者的免疫细胞表型差异。分析λ轻链型AL患者T细胞亚群比例与多项临床指标的相关性。

结果

AL患者的外周血T（CD3⁺CD56⁻）和NKT（CD3⁺CD56⁺）细胞比例，T细胞中的CD4⁺CD8⁻、CD4⁻CD8⁺、Treg（CD4⁺CD25⁺FOXP3⁺）细胞比例与健康供者相比差异无统计学意义（P>0.05）。AL患者的CD4⁻CD8⁺细胞中，CD57⁺细胞的比例较健康供者显著降低（P<0.05），但CD45RA⁺和CD28⁺细胞的比例在AL和健康供者间差异无统计学意义。Ⅰ~Ⅱ期和Ⅲ~Ⅳ期AL患者T细胞及其亚群的比例差异无统计学意义（P>0.05）。在λ轻链型AL患者中，外周血CD4⁻CD8⁺细胞的比例与24 h尿蛋白和血肌酐呈正相关（P<0.05），与eGFR呈负相关（P<0.05），与其他临床指标无显著相关性。与此相反，CD4⁺CD8⁻细胞的比例与eGFR呈正相关，而与24 h尿蛋白和血肌酐呈负相关（P<0.05）。

结论

AL患者外周血的T细胞亚群与健康供者相比差异无统计学意义，但CD8⁺ T细胞的比例与肾脏损伤程度呈正相关，提示CD8⁺ T细胞的比例在评估AL患者肾脏预后中具有一定的价值。

[Rapamycin in the treatment of renal diseases associated with tuberous sclerosis complex]

Objective: To investigate the efficacy and safety of rapamycin in children with tuberous sclerosis complex (TSC) associated renal disease. Methods: A prospective self-control study was conducted. The clinical data of 92 children diagnosed with tuberous sclerosis complex associated kidney disease at the People's Liberation Army General Hospital from January 2011 to January 2019 were collected. The long-term rapamycin treatment for all patients initiated at 1 mg/(m(2)·d), which was gradually adjusted to reach a blood concentration of 5-10 μg/L. The changes of the maximum diameter of renal lesions in children after rapamycin treatment were observed and analyzed with Wilcoxon test. Results: Ninety-two children, including 52 males and 40 females, who met the criteria were analyzed. Sixty patients had only renal angiomyolipoma(RAML), while 24 patients had only multiple renal cysts(MRC), and 8 patients had both lesions. The age of TSC diagnosis was 16.0 (7.0, 42.0) months, and the age of initial treatment with rapamycin was 63.5 (21.0, 103.0) months. The follow-up lasted for 12.0 (4.0, 23.0) months. Sequencing of TSC1 and TSC2 genes was performed in 54 children with TSC, including 3 patients (6%) with mutations in TSC1 gene and 51 patients (94%) with mutations in TSC2 gene. The maximum RAML diameter before treatment was 7.0 (4.0, 9.0) mm. The best effect reached at 3 months of treatment, with the diameter of 4.0 (0,7.0) mm. The maximum diameters at 6 months, 1 year and 1-2 years were 5.0 (0,9.8) mm, 5.0 (1.5, 8.5) mm, 5.5 (3.0, 9.0) mm, respectively, and were significantly different from the baseline (Z=-2.404,-2.350,-2.750,P=0.016,0.019,0.006, respectively). The maximum diameter after 2-3 years, and ≥3 years were 5.0 (3.9,7.0) mm and 6.0 (1.0, 11.0) mm, without significant difference from the baseline (Z=-0.856,-0.102,P=0.393,0.919, respectively).The maximum diameters of MRC after 3 months, 6 months, 1 year,1-2 years, 2-3 years, and ≥3 years were 11.0 (5.0, 14.0) mm,3.0 (0.0,11.0) mm,5.0 (0,21.0) mm,0 (0,14.0) mm,0 (0,10.0) mm, and 0 (0,18.3) mm, respectively, but were not significantly different rom the baseline (7.0 (5.0, 15.7) mm)(Z=-0.944,-1.214,-1.035,-1.896,-1.603,-1.214,P=0.345,0.225,0.301,0.058,0.109,0.225, respectively).Twenty-nine patients (32%) had oral ulcers during the entire treatment period, and no serious adverse reactions were observed. Conclusions: Rapamycin could decrease the diameter of TSC-related RAML, but could not inhibit the growth of cysts. It is well tolerated in the treatment of renal diseases associated with tuberous sclerosis complex.

[Preliminary study on effect of intraoperative goal-directed fluid management on pulmonary function and oxygen dynamics in patients with severe burns]

Objective: To preliminarily investigate the effect of intraoperative goal-directed fluid management (GDFM) on pulmonary function and oxygen dynamics in patients with severe burns. Methods: From February 2017 to May 2018, 30 patients admitted to Burn Department of our hospital with severe burns who met the criteria for inclusion and needed escharectomy and skin grafting were enrolled in this prospective randomized controlled trial. The patients were divided into group GDFM of 15 cases [14 males and 1 female, (45±14) years old] and conventional liquid management group of 15 cases [12 males and 3 females, (42±10) years old] according to the random number table. During escharectomy and skin grafting, volume of patients in group GDFM was managed according to the GDFM scheme, based on cardiac output index, stroke volume variation, stroke volume index, hemoglobin, central venous oxygen saturation (ScvO(2)), and other parameters; volume of patients in conventional liquid management group was managed according to clinical experience and conventional liquid management scheme, based on mean arterial pressure, central venous pressure, urine output, hemoglobin, and other parameters. At post operation hour (POH) 1, 6, 12, and 24, arterial and venous blood was collected from patients of the two groups to determine the levels of extravascular lung water index (ELWI), global end-diastolic volume index (GEDI), oxygenation index, ScvO(2), central venous-to-arterial blood carbon dioxide partial pressure difference (Pcv-aCO(2)), lactic acid, pH value, bicarbonate ion, and base excess routinely. Data were processed with Fisher's exact probability test, t test, analysis of variance for repeated measurement, and least significant difference test. Results: (1) The ELWI of patients in group GDFM was (4.3±1.1) mL/kg at POH 1, which was significantly lower than (6.5±3.6) mL/kg in conventional liquid management group (t=2.26, P<0.05). The ELWI levels of patients in group GDFM at POH 6, 12, and 24 were (6.8±2.2), (6.6±2.0), and (6.9±1.6) mL/kg, respectively, significantly higher than the level at POH 1 within the same group (P<0.01), and similar to (8.5±3.1), (7.8±2.3), and (8.0±3.5) mL/kg in conventional liquid management group (t=1.73, 1.53, 1.10, P>0.05). The GEDI levels between patients of the two groups were similar, and there was no significantly statistical difference between the two groups as a whole (treatment factor main effect F=2.35, time factor main effect F=0.44, interaction F=0.07, P>0.05). (2) The oxygenation index of patients in group GDFM was (350±78) mL/kg at POH 1, which was significantly higher than (259±109) mL/kg in conventional liquid management group (t=2.63, P<0.05). In conventional liquid management group, the oxygenation index of patients at POH 6 was significantly higher than that at POH 1, 12, or 24 (P<0.01). The ScvO(2) levels of patients in group GDFM at POH 1, 6, and 12 were 0.516±0.105, 0.679±0.121, and 0.713±0.104, respectively, which were significantly higher than 0.382±0.194, 0.545±0.194, and 0.595±0.191 in conventional liquid management group (t=2.35, 2.27, 2.10, P<0.05). The ScvO(2) levels of patients in the two groups at POH 6, 12, and 24 were significantly higher than those levels at POH 1 within the same group (P<0.01), and the ScvO(2) of patients in conventional liquid management group at POH 24 was significantly higher than that at POH 6 or 12 within the same group (P<0.05 or P<0.01). The Pcv-aCO(2) levels of patients in group GDFM were significantly lower than those in conventional liquid management group at POH 1 and 6 (t=2.55, 2.71, P<0.05). The Pcv-aCO(2) of patients in group GDFM at POH 12 was significantly lower than that at POH 6 or 24 within the same group (P<0.05). (3) The blood lactic acid levels and pH values between patients of the two groups were similar at POH 1, 6, 12, and 24 (t=0.89, 0.19, 0.26, 0.23; 1.55, 0.71, 0.77, 0.77, P>0.05). In conventional liquid management group, the blood lactic acid levels of patients at POH 6, 12, and 24 were significantly lower than the level at POH 1 within the same group (P<0.05), and the pH values of patients at POH 6, 12, and 24 were significantly higher than the value at POH 1 within the same group (P<0.05). The levels of bicarbonate ion and base excess between patients of the two groups were similar, and there were no significantly statistical differences between the two groups as a whole (treatment factor main effect F=0.06, 0.11, time factor main effect F=2.07, 1.59, interaction F=1.45, 0.91, P>0.05). Conclusions: GDFM is helpful to improve the pulmonary function and oxygen dynamics in patients with severe burns in the short term after escharectomy and skin grafting. It has certain significance in preventing and reducing pulmonary edema and pulmonary complications in patients with severe burn after operation.

[Advances in the research of smart dressings]

Smart dressings, which show obvious advantage and potential in wound treatment and real-time monitoring, attract widespread attention in recent years. Real-time and dynamic acquiring wound information is vital to the treatment and prognosis of wound. Further research on smart dressings is helpful for wound management, personalized treatment, and realization of medical application translation of health monitoring technology. In the article, we categorize smart dressings and conclude their functions according to the type of micro-environment information of wound gathered by smart dressings.

[The subgroup analysis of the prognostic value of the intraductal carcinoma of the prostate in patients with metastatic prostate cancer]

Objective: To determine the prognostic value of the intraductal carcinoma of the prostate IDC-P in metastatic prostate cancer (mPCa) patients of different subgroups. Methods: Data of 582 de novo mPCa patients between January 2011 and December 2017 diagnosed at Departments of Urology, West China Hospital, Sichuan University were retrospectively analyzed. The age was (70±8) years (range: 45 to 89 years). IDC-P was identified from 12-core prostate biopsy. The prognostic role of IDC-P was assessed by Kaplan-Meier curves and Cox regression. Subgroup analysis was conducted by the forest plot. The endpoints were castration-resistant prostate cancer free survival (CFS) and overall survival (OS). Results: In total, 177/582 (30.4%) patients harbored IDC-P. Patients with IDC-P had poorer CFS and OS than those without IDC-P (mCFS: 12.1 months vs. 16.9 months, P=0.000; mOS: 39.7 months vs. not reached, P=0.000). Multivariate Cox regression analysis indicated that, the existence of IDC-P was an independent prognosticator of both CFS (HR=1.40, 95% CI: 1.10 to 1.79, P=0.006) and OS (HR=1.51, 95% CI: 1.02 to 2.25, P=0.041). Subanalysis indicated that, in most subgroups, IDC-P was an adverse prognosticator of both CFS and OS. Even in subgroups with adverse clinicopathological features, e.g. Gleason score 9 to 10 (CFS: HR=1.467, P=0.007; OS: HR=1.807, P=0.013), baseline prostate specific antigen≥50 μg/L (CFS: HR=1.616, P=0.000; OS: HR=1.749, P=0.006), anemia (CFS: HR=1.653, P=0.036; OS: HR=2.100, P=0.038), alkaline phosphatase≥160 U/L (CFS: HR=1.326, P=0.038; OS: HR=1.725, P=0.010) or abnormal lactate dehydrogenase level (CFS: HR=1.614, P=0.001; OS: HR=1.900, P=0.003), IDC-P was still closely associated with shorter CFS and OS. Conclusions: The presence of IDC-P was closely related to poor survival outcomes for patients with mPCa. IDC-P was an adverse prognosticator in most subgroup patients. The description of IDC-P in the pathological report of prostate biopsy would help clinicians to evaluate the prognosis of mPCa patients more accurately and make better treatment choices.

Functional Diversity of p53 in Human and Wild Animals

The common understanding of p53 function is a genome guardian, which is activated by diverse stresses stimuli and mediates DNA repair, apoptosis, and cell cycle arrest. Increasing evidence has demonstrated p53 new cellular functions involved in abundant endocrine and metabolic response for maintaining homeostasis. However, TP53 is frequently mutant in human cancers, and the mutant p53 (Mut-p53) turns to an "evil" cancer-assistant. Mut-p53-induced epithelial-mesenchymal transition (EMT) plays a crucial role in the invasion and metastasis of endocrine carcinomas, and Mut-p53 is involved in cancer immune evasion by upregulating PD-L1 expression. Therefore, Mut-p53 is a valuable treatment target for malignant tumors. Targeting Mut-p53 in correcting sequence and conformation are increasingly concerned. Interestingly, in wild animals, p53 variations contribute to cancer resistant and high longevity. This review has discussed the multiple functions of p53 in health, diseases, and nature evolution, summarized the frequently mutant sites of p53, and the mechanisms of Mut-p53-mediated metastasis and immune evasion in endocrine cancers. We have provided a new insight for multiple roles of p53 in human and wild animals.

[Prognostic significance of combined TERT and IDH gene mutation analysis in diffusely infiltrating gliomas]

Objective: To investigate the status and prognostic significance of TERT and IDH1/2 genes mutations in diffusely infiltrating gliomas. Methods: Hot spot mutations of TERT and IDH1/2 genes were detected by DNA sequencing in 236 cases of gliomas at West China Hospital from 2012 to 2016, including pilocytic astrocytoma (WHO grade Ⅰ, 16 cases), diffuse astrocytoma and oligodendroglioma (WHO grade Ⅱ, 89 cases), anaplastic astrocytoma and oligodendroglioma (WHO grade Ⅲ, 72 cases) and glioblastoma (WHO grade Ⅳ, 59 cases). The prognostic significance of TERT and IDH1/2 hot spot mutations was evaluated. Results: No IDH or TERT mutations were detected in pilocytic gliomas. TERT promoter mutation frequency was higher in patients aged ≥40 years(60.8%, 93/153) than in patients aged <40 years (32.8%, 22/67; P<0.01). TERT promoter mutation rate was also significantly higher in oligodendroglioma (87.5% , 56/64) than that in astrocytoma(37.8%, 59/156; P<0.01). Young age (<40 years), oligodendroglioma and IDH1 mutation were favorable prognostic factors for diffusely infiltrating astrocytic and oligodendroglial tumors. TERT mutation alone was not of prognostic significance. Diffusely infiltrating astrocytic and oligodendroglial tumors were divided into four molecular subtypes according to TERT and IDH1 mutation status: IDH(+ )/TERT(+ ), IDH(+ )/TERT(-), IDH(-)/TERT(-) and IDH(-)/TERT(+ ). There was significant prognostic difference among the 4 subtypes. Conclusions: Combined IDH and TERT gene mutation analysis may be useful for prognostic subgrouping. Notably, IDH1 wild-type cases can be further subdivided into TERT(+ ) or (-) subgroups with significant prognostic difference.

[Advances in the research of biomechanical effects of negative-pressure wound therapy in promoting wound healing]

Recently, researchers have focused on the micro-mechano-environment and the resulting mechanical cues which can regulate the morphology, structure, and function of cells. As a novel mechanotherapy, negative-pressure wound therapy (NPWT) has revolutionized the treatment of acute and chronic wounds. The effects of mechanics in use of NPWT has been noticed by researchers, and sporadic results have been reported, while the mechanisms of mechanosensitivity and mechanotransduction in affecting cell behaviors and promoting wound healing haven't been elucidated yet. In this article, we review the progress about the relevant mechanical forces of NPWT and the mechanical effects on major repairing cells involved in wound healing, in order to provide references for the better understanding of mechanobiology of NPWT to better wound healing.

[Experimental study on the effect of Yiqi Wenyang Decoction on nasal mucosa infiltration of NK cells in mice with allergic rhinitis]

Objective: To observe the effect of Yiqi Wenyang Decoction on the infiltration and activation of NK cells in nasal mucosa of mouse model with allergic rhinitis (AR), and to explore the potential mechanism for effective intervention of AR with Yiqi Wenyang Decoction. Methods: Fourty-eight mice were randomly divided into blank group, model group, low, medium and high dose of Yiqi Wenyang Decoction group and Cetirizine group, with 8 rats in each group. After modeling of AR, the model group was filled with 0.9% sodium chloride solution. Yiqi Wenyang Decoction groups of each dose were given different concentrations of Yiqi Wenyang Decoction water extract, while the Cetirizine group was given aqueous solution of Cetirizine. The behavior, morphological changes of nasal mucosa and infiltration of NK cells in nasal mucosa were observed. The levels of IL-4 and INF-γ in nasal lavage fluid were measured. Besides, the drug safety was observed by acute toxicity test. Results: In the respect of behavioral scoring, middle and high dose of Yiqi Wenyang Decoction group were superior to the model group (number of sneezing: q value was 7.189, 8.748, respectively; number of scratching nose: q value was 12.074, 14.560, respectively; all P<0.05). In middle and high dose of Yiqi Wenyang Decoction group, the infiltration of NK cells and nasal lavage fluid IL-4 levels were lower than those in model group (IOD: q value was 10.073, 12.322, respectively; IOD/Area: q value was 10.954, 14.073, respectively; IL-4: q value was 4.705, 6.801, respectively; all P<0.05). There was no significant difference in nasal lavage fluid of INF-γ among each group (Fv=1.166, P>0.05). In acute toxicity test, no obvious poisoning symptoms and death occurred in mice. Conclusion: Yiqi Wenyang Decoction can control the nasal symptom, reduce the local NK cell infiltration of nasal mucosa and inhibit the expression of the 2-type cytokines released by NK cells, which may be related with the potential mechanism of effective intervention of AR with Yiqi Wenyang Decoction.

[Vibrant soundbridge implantation of congenital atresia of oval window(with summary of nine cases]

Objective:To investigate the surgical effects of round window implantation of vibrant soundbridge(VSB)for patients with congenital oval window atresia.Method:Retrospectively analyze the clinical information of 9 cases of congenital oval window atresia as well as the pre-and post-operative hearing and speech results. Three of them had undergone or attempted the vestibulotomy but obtained poor results. All cases underwent round window implantation of VSB. Result:All patients obtained an improvement of 21-33 dBHL after implantation. In the speech recognition rate test, the average increase of disyllabic words was 62%, and 60% in the sentence test. During the follow-up of 51 months in average, 2 cases had a decline of auditory benefit and finally 1 case regained the improvement after reoperation. Conclusion:Round window implantation can get a fairly good result in congenital oval windows atresia cases.

[The application of mandarin acceptable noise level and COS in hearing aid fitting for presbyacusis]

Objective:The purpose of this study was to inquiry into the application of mandarin acceptable noise level(M-ANL) and client oriented scale of improvement in evaluation of hearing aid fitting for presbyacusis. Method:Thirty-two adults with presbycusis who used the hearing aid for the first time were selected for the study. M-ANL tests were done prior to the hearing aid fitting. Six weeks later, these patients were asked to fill in questionnaire of client oriented scale of improvement (COSI).The subjects were divided into 3 groups according to the time of hearing aid using in their daily lives: less than one hour per day, 1 to 4 hours per day and more than 4 hours per day. The relativity of M-ANL and the score of COSI were compared. Result:①There were significant differences of the M-ANL among 3 groups(P<0.05); ②The scores of COSI of group 1(less than one hour per day) was lower than group 2(1 to 4 hours per day), while there were no significant differences between the scores of group 2(1 to 4 hours per day) and group 3(more than 4 hours per day); ③There was good correlation between the score of M-ANL and COSI. Conclusion:M-ANL can forecast the satisfaction of hearing aids fitting. And COSI can play an effective role in outcome measurement.

[Evaluation of the level of urinary cysteinyl leukotriene E4 in diagnosis of bronchopulmonary dysplasia in premature infants]

OBJECTIVE

To explore the correlation of urinary cysteinyl leukotriene E4 (CysLTE4) and diagnosis of bronchopulmonary dysplasia (BPD) in premature infants.

METHOD

One hundred and fifty-eight newborn infants were consecutively admitted to the neonatal intensive care units of First Affiliated Hospital of Nanjing Medical University from November 2014 to October 2015.The infants were divided into 3 groups according to the diagnosis on discharge.Sixty-one term infants were classified as having no pulmonary diseases, 52 premature infants were classified as without BPD, and 45 premature infants with BPD were diagnosed at 28 d after birth.Urinary CysLTE4 levels of newborns within 3 days after birth were measured in a blinded way by enzyme- linked immunosorbent assay and were compared among 3 groups, and were evaluated for the diagnostic value and the correlation of gestational age and birth weight.Statistical analysis was performed using correlation analysis, one-way analysis of variance and χ(2) test etc.

RESULT

In infants with BPD, the mean urinary CysLTE4 level was (191.0±29.3) ng/L which significantly higher than the premature group without BPD ((164.1±22.7) ng/L) and term infant group ((151.6±41.9) ng/L, F=18.70, P<0.05). Urinary CysLTE4 level within 3 days of life in newborn inversely correlated with gestational age and birth weight (Pearson=-0.33, -0.38, P<0.01). The area under the curve was 0.78, 95%CI: 0.70-0.86, P<0.01, when cutoff was 187.7 ng/L, with Youden index 0.59, sensitivity 77.8% and specificity 81.4%, respectively.

CONCLUSION

Urinary CysLTE4 level is up-regulated in BPD infants within early days of life which may be a useful biomarker of early diagnoses of BPD.

[Clinical analysis of the character and prognostic factors of 23 cases of mantle cell lymphoma]

OBJECTIVE

To investigate the clinical characteristics and prognostic factors of mantle cell lymphoma (MCL) patients.

METHODS

The clinical data of 23 MCL patients were retrospectively analyzed. Immunohistochemical stain was performed to detect the protein expressions of Mcl-1, pNF-κB p65 and 14-3-3ζ of MCL patients to analyze its prognostic factors.

RESULTS

Among 23 MCL patients, there were 17(73.9%) patients with IPI 0-2 (low risk group) and 6(26.1%) patients with IPI 3-4. Only the rate of 2y-progression-free survival (PFS) of group IPI 0-2 was superior to that of group IPI 3-4 patients (47.1% vs 0, P=0.049); There were 16 (69.5%) patients with MIPI < 5.7, whose rates of overall response rate (ORR), 2y overall survival (OS) and PFS were better than those of the ones with MIPI ≥ 5.7(ORR: 81.3% vs 33.3% P=0.032; OS: 68.8% vs 16.7% P=0.041; PFS: 50% vs 0, P=0.040 respectively). The rates of ORR, 2y-OS and 2y-PFS (100.0%, 80.0% and 70.0%) of patienets received regimen R+CHOP(E) were all superior to those (38.5%, 30.8% and 7.7%) of ones received regimen CHOP(E) (P=0.002, P= 0.024, P=0.003, respectively). Among 12 patients, 2 out of 6 cases with Mcl-1 positive expression achieved good response (CR+PR) and 2y-OS, 1 case 2y-PFS; All 6 cases with Mcl-1 negative expression achieved good response (CR+PR) and 2y-OS, 5 cases 2y-PFS. 3 out of 6 cases with pNF-κB p65 positive expression achieved good response (CR+PR) and 2y-OS, 1 case 2y-PFS; 5 out of 6 cases with pNF-κB p65 negative expression achieved good response (CR+ PR) and 2y-OS/PFS. 5 out of 8 cases with 14-3-3ζ positive expression achieved good response (CR+PR), 4 cases 2y-OS, and 3 cases 2y-PFS. 3 out of 4 cases with 14-3-3ζ negative expression achieved CR, 4 cases 2y-OS, and 3 cases 2y-PFS.

CONCLUSION

MCL patients had high heterogeneity. MIPI has better prognostic significance than IPI. R+CHOP(E) as first line treatment improved the rates of OS/PFS. The expressions of Mcl-1, pNF-κB p65 and 14-3-3ζ proteins in MCL might be related to prognosis.

[Cortical auditory evoked potentials in congenital hearing impaired children with cochlear implants]

OBJECTIVE

By investigating the auditory cortical evoked potential in congenital hearing impaired children with cochlear implants, the association between central auditory development and the age of implantation was studied.

METHODS

P1-N1-P2 were recorded in 110 profound hearing impaired children, aged from 12 to 80 months old and being implanted with cochlear implants before the age of 5 years. Their implant using time ranged from just at the switch-on to 48 months. The stimuli were /m/, /t/, /g/, presented at 65 dB SPL in sound field. The presence rate of each wave was obtained and the relationship between P1 latency and implant age, the time of speech processor switch-on were analyzed.

RESULTS

The presence rate of P1, N1 and P2 was 66.4%, 15.5% and 12.7%, respectively. The presence of P1 was significantly higher than that of N1(χ(2)=228.542, P=0.00)and P2(χ(2)=257.438, P=0.00). There was no significant difference of P1 presence rate elicited by /m/, /t/ and /g/(64.1%, 66.9% and 68.3%, χ(2)=0.589, P=0.75). There existed no significant difference either among P1 latency(P=0.22)or amplitude(P=0.09) elicited by /m/, /t/ and /g/. There was significant difference between the implant age before and after 42-month-old regarding the proportion that entered the age-appropriate normal P1 latency range(P=0.02). No significant difference was found among groups of implant using time of 1, 2, 3 and 4 years in aspect of the proportion that entered the age-appropriate normal P1 latency range(P=1.00).

CONCLUSIONS

Compared with implanted after the age of 42-month-old children with prelingual hearing impairment younger than 5 years old, the ones implanted before 42-month-old have more chance for normal development for central auditory system. Once implanted before 42-month-old, the cortical auditory system restored its normal development as early as 1 year after implantation.

Systemic pro-inflammatory response facilitates the development of cerebral edema during short hypoxia

BACKGROUND

High-altitude cerebral edema (HACE) is the severe type of acute mountain sickness (AMS) and life threatening. A subclinical inflammation has been speculated, but the exact mechanisms underlying the HACE are not fully understood.

METHODS

Human volunteers ascended to high altitude (3860 m, 2 days), and rats were exposed to hypoxia in a hypobaric chamber (5000 m, 2 days). Human acute mountain sickness was evaluated by the Lake Louise Score (LLS), and plasma corticotrophin-releasing hormone (CRH) and cytokines TNF-α, IL-1β, and IL-6 were measured in rats and humans. Subsequently, rats were pre-treated with lipopolysaccharide (LPS, intraperitoneal (ip) 4 mg/kg, 11 h) to induce inflammation prior to 1 h hypoxia (7000 m elevation). TNF-α, IL-1β, IL-6, nitric oxide (NO), CRH, and aquaporin-4 (AQP4) and their gene expression, Evans blue, Na(+)-K(+)-ATPase activity, p65 translocation, and cell swelling were measured in brain by ELISA, Western blotting, Q-PCR, RT-PCR, immunohistochemistry, and transmission electron micrography. MAPKs, NF-κB pathway, and water permeability of primary astrocytes were demonstrated. All measurements were performed with or without LPS challenge. The release of NO, TNF-α, and IL-6 in cultured primary microglia by CRH stimulation with or without PDTC (NF-κB inhibitor) or CP154,526 (CRHR1 antagonist) were measured.

RESULTS

Hypobaric hypoxia enhanced plasma TNF-α, IL-1β, and IL-6 and CRH levels in human and rats, which positively correlated with AMS. A single LPS injection (ip, 4 mg/kg, 12 h) into rats increased TNF-α and IL-1β levels in the serum and cortex, and AQP4 and AQP4 mRNA expression in cortex and astrocytes, and astrocyte water permeability but did not cause brain edema. However, LPS treatment 11 h prior to 1 h hypoxia (elevation, 7000 m) challenge caused cerebral edema, which was associated with activation of NF-κB and MAPKs, hypoxia-reduced Na(+)-K(+)-ATPase activity and blood-brain barrier (BBB) disruption. Both LPS and CRH stimulated TNF-α, IL-6, and NO release in cultured rat microglia via NF-κB and cAMP/PKA.

CONCLUSIONS

Preexisting systemic inflammation plus a short severe hypoxia elicits cerebral edema through upregulated AQP4 and water permeability by TLR4 and CRH/CRHR1 signaling. This study revealed that both infection and hypoxia can cause inflammatory response in the brain. Systemic inflammation can facilitate onset of hypoxic cerebral edema through interaction of astrocyte and microglia by activation of TLR4 and CRH/CRHR1 signaling. Anti-inflammatory agents and CRHR1 antagonist may be useful for prevention and treatment of AMS and HACE.

Inactivation of corticotropin-releasing hormone-induced insulinotropic role by high-altitude hypoxia

We have shown that hypoxia reduces plasma insulin, which correlates with corticotropin-releasing hormone (CRH) receptor 1 (CRHR1) in rats, but the mechanism remains unclear. Here, we report that hypobaric hypoxia at an altitude of 5,000 m for 8 h enhances rat plasma CRH, corticosterone, and glucose levels, whereas the plasma insulin and pancreatic ATP/ADP ratio is reduced. In islets cultured under normoxia, CRH stimulated insulin release in a glucose- and CRH-level-dependent manner by activating CRHR1 and thus the cAMP-dependent protein kinase pathway and calcium influx through L-type channels. In islets cultured under hypoxia, however, the insulinotropic effect of CRH was inactivated due to reduced ATP and cAMP and coincident loss of intracellular calcium oscillations. Serum and glucocorticoid-inducible kinase 1 (SGK1) also played an inhibitory role. In human volunteers rapidly ascended to 3,860 m, plasma CRH and glucose levels increased without a detectable change in plasma insulin. By contrast, volunteers with acute mountain sickness (AMS) exhibited a marked decrease in HOMA insulin sensitivity (HOMA-IS) and enhanced plasma CRH. In conclusion, hypoxia may attenuate the CRH-insulinotropic effect by reducing cellular ATP/ADP ratio, cAMP and calcium influx, and upregulated SGK1. Hypoxia may not affect HOMA-IS in healthy volunteers but reduces it in AMS volunteers.

Corticotropin-releasing factor receptor type 1 colocalizes with type 2 in corticotropin-releasing factor-containing cellular profiles in rat brain

OBJECTIVES

To investigate whether CRHR1 and CRHR2 are colocalized in CRH-specific neurons in rat brain.

METHODS

Double/triple immunofluorescence, and combined in situ hybridization were performed in the PVN, amygdala and hippocampus, and triple immunofluorescence was applied to the median eminence (ME), dorsal raphe (DR) and locus coeruleus (LC).

RESULTS

Both CRHR1 and CRHR2 immunoreactivity were highly coexpressed in the PVN, central nucleus of the amygdala (CeA) and hippocampus. Triple immunofluorescence under confocal microscopy confirmed that CRHR1 and CRHR2 are coexpressed in CRH-producing neurons in these regions. The results of in situ hybridization combined with double immunofluorescence further strengthened the finding that CRHR1 and CRHR2 were coexpressed in CRH-specific neurons in the PVN, CeA and hippocampus. In addition, CRH immunoreactivity signals were evidently distributed in the ME, DR and LC, and were coexpressed with both receptors.

CONCLUSION

CRH receptors colocalize in CRH-containing neurons in the PVN, CeA and hippocampus, and CRH, CRHR1, and CRHR2 coexist in the DR and LC. Our results implicate CRHR1 and CRHR2 in coordinating the regulation of CRH neuronal activity in stress and behavioral responses.

Prenatal stress, anxiety and depression: a mechanism involving CRH peptide family

Prenatal stress (PNS) is associated with increased biological risk for mental disorders such as anxiety and depression later in life, and stress appear to be additive to the PNS influences. Among the most widely cited and accepted alternative hypotheses of anxiety and depression is dysfunction of the HPA axis, a system that is central in orchestrating the stress response. Therefore, understanding how PNS exerts profound effects on the HPA axis and stress-sensitive brain functions including anxiety and depression has significant clinical importance. In this mini-review, we will focus on novel and evolving concepts regarding the potential mechanisms underlying the short and long-term effects of PNS involving CRH peptide family. We present evidence demonstrating prenatal hypoxia exposure induced anxiety-like behavior in adult male rat offspring and CRHR1 in PVN of the hypothalamus is involved.

Association between the c.910A>G genetic variant of the XRCC1 gene and susceptibility to esophageal cancer in the Chinese Han population

Esophageal cancer (EC) is a common malignancy worldwide. The X-ray repair cross-complementing 1 gene (XRCC1) is one of the most important candidate genes for influencing susceptibility to EC. This study aimed to investigate the effect of XRCC1 genetic variants on susceptibility to EC. A total of 383 EC patients (males: 239, females: 144, mean age: 56.62) and 387 cancer-free controls (males: 251, females: 136, mean age: 58.23) were enrolled in this study. The c.910A>G genetic variant of the XRCC1 gene was determined by polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing methods. The allele and genotype frequencies indicated statistical differences between EC patients and cancer-free controls. The c.910A>G genetic variant was statistically associated with increased susceptibility to EC [GG vs AA: odds ratio (OR)=1.79, 95% confidence interval (CI)=1.12-2.86, P=0.014; GG vs AG/AA: OR=1.76, 95%CI=1.13-2.75, P=0.013; G vs A: OR=1.25, 95%CI=1.01-1.55, P=0.041]. The allele G and genotype GG could contribute to the increased susceptibility to EC. Our findings suggest that the c.910A>G genetic variant is associated with susceptibility to EC in the Chinese Han population, and might be used as a molecular marker for detecting susceptibility to EC.

CRHR1 mediates p53 transcription induced by high altitude hypoxia through ERK 1/2 signaling in rat hepatic cells

We have previously reported that hypoxia activates corticotrophin-releasing hormone (CRH) and the expression of its type-1 receptor (CRHR1) and induces disorders of the brain-endocrine-immune network. p53 is activated by hypoxia and involved in tumorigenesis and apoptosis. Whether CRHR1 regulates p53 transactivation to further influence apoptotic genes remains unclear. Here, we showed that hypoxia at a simulated altitude of 5km or 7km for 8 and 24h increased p53 protein and mRNA, and reduced apoptotic bax and IGFBP3 gene expression while upregulating the cell-arrest gene p21 for 8h in rat liver cells. The upregulation of p53 mRNA and downregulation of bax mRNA induced by hypoxia were blocked by pretreatment with the specific CRHR1 antagonist CP-154,526, but the downregulation of IGFBP3 and upregulation of p21 mRNA were not. Furthermore, CRH stimulated p53 mRNA via the ERK 1/2 pathway in the BRL-3A cell line and this was blocked by the ERK 1/2 antagonist U0126. These data provide novel evidence that the CRHR1-triggered ERK 1/2 pathway is involved in the activation of p53 and suppression of the apoptotic bax gene by hypoxia in rat liver.

Upregulation of PVN CRHR1 by gestational intermittent hypoxia selectively triggers a male-specific anxiogenic effect in rat offspring

We previously reported that gestational intermittent hypoxia (GIH) causes anxiety-like behavior in neonatal rats. Here, we showed that the anxiogenic effect was correlated with upregulation of corticotropin-releasing hormone receptor 1 (CRHR1) in the hypothalamic paraventricular nuclei (PVN) by GIH, and was selective to male offspring. The anxiety-like behavior was assessed by both the open field (OF) and elevated plus maze (EPM) tests. We demonstrated that GIH triggered anxiety-like behavior in male offspring, but not in female offspring or in the postpartum dams. Microinjection of antalarmin, a CRHR1-selective antagonist, into the PVN of the male offspring significantly increased the distance traveled and time spent in the central portion of the OF, and the time spent in the open arms in the EPM compared with controls. However, microinjection of the CRHR2 agonist, urocortin III, into the PVN did not affect anxiogenic behavior in the male offspring. These findings clearly demonstrate a gender-selective effect of GIH to increase anxiety-like behavior and this anxiogenic effect might be linked to embryogenically-driven upregulation of PVN CRHR1.

High-altitude hypoxia induces disorders of the brain-endocrine-immune network through activation of corticotropin-releasing factor and its type-1 receptors

High-altitude hypoxia can induce physiological dysfunction and mountain sickness, but the underlying mechanism is not fully understood. Corticotrophin-releasing factor (CRF) and CRF type-i receptors (CRFR1) are members of the CRF family and the essential controllers of the physiological activity of the hypothalamo-pituitary-adrenal (HPA) axis and modulators of endocrine and behavioral activity in response to various stressors. We have previously found that high-altitude hypoxia induces disorders of the brain-endocrine-immune network through activation of CRF and CRFR1 in the brain and periphery that include activation of the HPA axis in a time- and dose-dependent manner, impaired or improved learning and memory, and anxiety-like behavioral change. Meanwhile, hypoxia induces dysfunctions of the hypothalamo-pituitary-endocrine and immune systems, including suppression of growth and development, as well as inhibition of reproductive, metabolic and immune functions. In contrast, the small mammals that live on the Qinghai-Tibet Plateau alpine meadow display low responsiveness to extreme high-altitude-hypoxia challenge, suggesting well-acclimatized genes and a physiological strategy that developed during evolution through interactions between the genes and environment. All the findings provide evidence for understanding the neuroendocrine mechanisms of hypoxia-induced physiological dysfunction. This review extends these findings.

Tritium release during nuclear power operation in China

Overviews were evaluated of tritium releases and related doses to the public from airborne and liquid effluents from nuclear power plants on the mainland of China before 2009. The differences between tritium releases from various nuclear power plants were also evaluated. The tritium releases are mainly from liquid pathways for pressurised water reactors, but tritium releases between airborne and liquid effluents are comparable for heavy water reactors. The airborne release from a heavy water reactor is obviously higher than that from a pressurised water reactor.

Analysis of 13 cases of venous compromise in 178 radial forearm free flaps for intraoral reconstruction

The purpose of this study was to analyse the causes of venous compromise and flap failure in radial forearm free flap (RFFF) surgery for intraoral reconstruction. One hundred seventy-eight RFFF reconstructions were reviewed retrospectively for intraoral defects. Of the 13 flaps with venous obstruction, 9 flaps were salvaged, and 4 were lost, with a salvage rate of 69.2%. Eleven venous occlusions occurred within the first 72h. The main reasons for venous failure were mechanical obstruction or technical errors due to inadequate pedicle length and geometry, inadequate venous drainage, compression and kinking of the vein. The main cause of failure for oropharynx reconstruction was unrecognized vascular events due to the lack of reliable monitoring for buried flap. Oozing of dusky blood from the flap margin may be directly related to venous congestion in the early postoperative period and a late indication of a change in skin colour. In conclusion, a thorough operative plan, including carefully selected drainage vein for the flap and recipient vessels, adequate pedicle length and geometry, precise surgical technique, avoidance of haematoma, and expert monitoring of buried flaps may improve the success rate of RFFF transfer in intraoral reconstruction.

The biomimetic immunoassay based on molecularly imprinted polymer: a comprehensive review of recent progress and future prospects

Immunoassay, based on a selective affinity of the biological antibody for its antigen, is one of the most usual analytical methods in food safety and environmental chemistry. However, it presents several drawbacks because of the nature of the antibody. Molecular imprinting technique, due to its high selectivity and stability, ease of preparation and low cost, has shown great potential in producing artificial antibodies in biomimetic immunoassays. This article focuses on the recent states, advantages, current problems and outlooks of molecularly imprinted radio, fluoro, enzyme-linked and chemiluminescent immunoassays, and biomimetic immunosensor, with special emphasis on the challenges in developing biomimetic enzyme-linked immunosorbent assays (BELISAs). The biomimetic immunoassay method will provide an important new analysis platform in food safety, although the sensitivity and specificity is relatively low.

PRACTICAL APPLICATION

As a new simple analysis method, the biomimetic immunoassay has attractive prospect, although some limitations were existed in real-sample assay. In this critical review, some promising solutions for overcoming its drawbacks were put forward, which may promote the more quick development and extensive application of this method in food safety.

Fabrication and characterization of elastomeric polyester/carbon nanotubes nanocomposites for biomedical application

A novel biodegradable polymer elastomer nanocomposite composing of poly(1,8-octanediol-citrate) (POC) polymer matrix and carbon nanotubes (CNTs) additive was successfully fabricated and systematically investigated using Fourier transform infrared (FT-IR), X-ray diffractometer (XRD), differential scanning calorimetry (DSC), tensile test, incubation and cytotoxicity tests. It was found that the addition of CNTs in POC elastomer did not result in any noticeable change in its chemical structure and the amorphous state. However, the tensile strength and elongation at break were greatly improved by the addition of CNTs in POC polymer matrix. It revealed that the swelling ratio and percentage of weight loss of POC/CNTs nanocomposite were lower, compared with the pure POC material. Moreover, the adsorption amount of bovine serum albumin (BSA) increased with an increase of the CNTs mass content in POC matrix revealing the enhanced hydrophilicity of POC/CNTs nanocomposites contributed by the carboxyl of the CNTs. Additionally, the cytotoxicity tests with L929 cell line revealed that the experimental POC/CNTs nanocomposites possessed good in vitro biocompatibility.

Shoaling and mate choice of wild-type Tanichthys albonubes in the presence of the red fluorescent transgenic conspecifics

Shoaling and sexual behaviour of wild-type male and female white cloud mountain minnow Tanichthys albonubes were measured in the presence of the red fluorescent transgenic conspecifics under laboratory conditions. Wild-type female test fish showed no significant preference, whereas wild-type male test fish preferred to be near a shoal of red transgenic fish rather than wild-type fish. When placed in a potentially reproductive context, wild-type males had a higher competitive ability over transgenic males; wild-type females spent more time with wild-type males in visually mediated experiments, but wild-type males performed more courtship displays towards transgenic females. These results suggest that the red body colouration does not appear to disturb signal communication between wild-type and transgenic T. albonubes in shoaling behaviour; transgenic males have no mating advantage over wild-type males, but the red body colouration of transgenic females may affect mate choice of wild-type males.