Can serum IgE or blood eosinophil count predict postoperative oral corticosteroid response in chronic rhinosinusitis with nasal polyps?

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterised by inflammatory mucosa and polyp formation in the paranasal sinuses. The study's primary objective was to evaluate the outcomes of postoperative oral corticosteroid (OCS) in treating patients with bilateral CRSwNP. The secondary objective was to determine whether preoperative serum IgE levels (sIgE)and/or blood eosinophil count (BEC) correlate with postoperative outcomes following OCS use. METHODS: Patients with bilateral CRSwNP (n=236) who underwent endoscopic sinus surgery (ESS) were randomly assigned to receive 15 mg OCS twice daily or a placebo for 2 weeks. We investigated the treatment effects based on the subjective visual analogue scale (VAS), Sino-Nasal Outcome Test 22 (SNOT-22), and objective Lund-Kennedy Endoscopy Score (LKES) over 6 months; subgroups were stratified preoperatively as follows: sIgE <150 IU/mL, sIgE>=150 IU/mL, BEC <0.39x10(9) cells/L, and BEC>=0.39x10(9) cells/L. RESULTS: A total of 193 participants completed the study up to the 6-month follow-up; no apparent linear relationship was noted between sIgE and BEC. No significant differences in scores were noted upon assessment of the VAS, SNOT-22, and LKES among the follow-up timepoints in the primary analysis. However, in the primary or subgroup analyses with sIgE or BEC, significant differences in the longitudinal scores of sleep dysfunction were observed at the 1-month follow-up. CONCLUSION: Postoperative OCS did not significantly affect bilateral CRSwNP outcomes. sIgE levels and BEC may not be surrogate predictive biomarkers to assess the role of postoperative OCS use. OCS may increase the risk of transient sleep disturbance.

Effects of cadmium exposure on metabolism, antioxidant defense, immune function, and the hepatopancreas transcriptome of Cipangopaludina cathayensis.

Cadmium (Cd) is a common contaminant in aquatic environments. However, little is known about the mechanisms underlying Cd toxicity in the freshwater snail Cipangopaludina cathayensis (Heude, 1890). This study to investigate the toxic effects of Cd on the standard metabolism, antioxidant activities, immune function, and hepatopancreas transcriptome profiles of C. cathayensis. C. cathayensis was exposed to 0.25, 0.5, 1.0, or 1.5 mg/L Cd for 3 h, with results showing that Cd significantly inhibited oxygen consumption and ammonia excretion and disrupted the respiratory metabolism of C. cathayensis. In addition, the O:N ratio dropped below 7, indicating that C. cathayensis may rely exclusively on proteins as an energy source under Cd stress. To understand how Cd impacts the antioxidant activities, immune function, and transcriptional profiles, C. cathayensis were exposed to 0.5 (low exposure, L14) or 1.5 (high exposure, H14) mg/L Cd for 14 days. Our results indicate that Cd exposure leads to oxidative stress and immunosuppression, with the latter effect being larger for exposure to higher Cd concentrations. A total of 2172 differentially expressed genes (DEGs) were identified by transcriptome analysis of the hepatopancreas, of which 885 were upregulated and 1287 were downregulated. Gene ontology and KEGG analyses revealed that the DEGs in the H14 group are enriched for energy generation terms and the "oxidative phosphorylation" pathway, respectively. Therefore, up-regulation of energy metabolism may be an adaptive strategy under Cd stress. Moreover, several genes involved in antioxidant activity were downregulated, whereas genes related to reactive oxygen species generation were upregulated. In addition, many immunity-related genes were identified within the DEGs, indicating that Cd toxicity may affect immune defense. Further, DEGs in the H14 group were enriched for disease-associated pathways. Taken together, our results indicate that Cd exposure leads to metabolic disorders, oxidative stress, and immunosuppression and thus may potentially contribute to disease outbreaks.

[Association of ICOS and CD28 single nucleotide polymorphisms with pulmonary tuberculosis susceptibility].

Objective: To investigate the association of inducible co-stimulator (ICOS) and CD28 gene polymorphisms with pulmonary tuberculosis susceptibility. Methods: In this case-control study, from Mar 2015 to Sep 2016, peripheral venous blood of 100 pulmonary tuberculosis patients (pulmonary tuberculosis group) in the Jintan People's Hospital of Changzhou and 100 community physical examination volunteers (health control group) were collected. A total of 56 single nucleotide polymorphisms (SNP) in ICOS and CD28 sequences were selected and SNP genotype and allele frequency were analyzed using the next-generation sequencing technology. Association of these SNP with pulmonary tuberculosis susceptibility was investigated using linkage disequilibrium (LD) analysis and genetic models. Results: Among these 56 SNP, 23 SNP with Hardy-Weinberg equilibrium P (HWE-P) value<0.001 or minimum allele frequency<0.05 were kicked out. The frequencies of T allele and TT genotype of ICOS gene SNP locus (rs55663036), and GG genotype of CD28 gene locus (rs45620941) in tuberculosis group were significantly higher than those in healthy control group (all P<0.05). There was a strong linkage imbalance between rs45620941 at CD28 locus and rs56262258 (r(2)=0.757). Conclusion: The polymorphisms of rs55663036 of ICOS gene and rs45620941 of CD28 gene are significantly associated with the risk of pulmonary tuberculosis.

[Clinical characteristics and diagnosis of early hydatidiform mole].

Objective: To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. Methods: A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Results: Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all P<0.05). The serum level of ß-hCG in the early group was significantly lower than that in the late group (Z=-2.382, P=0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ(2)=2.697, P=0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ(2)=0.745, P=0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57(KIP2) immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ(2)=199.224, P<0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (r=-0.211, P<0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; Z=-8.048, P<0.01). Conclusions: The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57(K)IP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.

[Clinical significance of centralized surveillance of hydatidiform mole].

Objective: To explore the clinical significance of centralized surveillance of hydatidiform mole. Methods: From Feb. 2013 to Feb. 2017 all patients with hydatidiform mole, who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and Child Health Care Hospital, were registered centrally for serum hCG monitoring and treatment if necessary. Prophylactic chemotherapy was not administered regardless of risk factors for malignant transformation of hydatidiform mole. The risk factors included age of over 40 years, excessive uterine enlargement for presumed gestational age, a serum hCG level greater than 5 00 000 U/L, large theca lutein ovarian cysts (>6 cm), and a history of previous hydatidiform mole. The centralized surveillance of hydatidiform mole was based on the central pathology review, team cooperation and service improvement. Their treatments and outcomes were analyzed retrospectively. Results: A total of 407 women of hydatidiform mole were registered with histopathology confirmation, including 70 high-risk hydatidiform moles. The follow-up rate was 97.5% (397/407) . The incidence of post-mole neoplasia was 8.1% (32/397) , which was diagnosed in 22.9% (16/70) of high-risk and in 4.9% (16/327) of low-risk hydatidiform moles, showed statistically significant difference between high-risk and low-risk groups (χ(2)=25.108, P<0.01) . Thirty-two patients with post-mole neoplasia were all at low risk of International Federation of Gynecology and Obstetrics (FIGO) score (range, 0-6) and received complete remission with chemotherapy alone in 31 of them except one treated by hysterectomy. The primary cure rate of single-agent chemotherapy was 60.0% (18/30) . Patients with low-risk or high-risk post-mole neoplasia were both 16. There were no significant differences between the two groups in interval that was end of antecedent pregnancy to start of treatment, the serum level of hCG before treatment, clinical stage or risk factor score (all P>0.05) . Conclusions: The risk of malignant transformation is increased in high-risk hydatidiform mole, however, the high risk factor itself does not affect the prognosis in patients with timely diagnosis and treatment of post-mole neoplasia. Therefore, prophylactic chemotherapy is not recommended to high-risk hydatidiform mole patients. Centralized surveillance of hydatidiform mole is practical in a local hospital of China and could greatly improve the prognosis of post-mole neoplasia.

[Radiographic assessment of vertebral artery injury in anterior cervical surgery in healthy adults].

Objectives: To study the relationship between the anatomical parameters of transverse foramen and intervertebral discs in the cross-section of the cervical spine in healthy adults, and to evaluate the risk of vertebral artery injury in the anterior cervical spine surgery. Methods: There were 24 healthy adults(12 male, 12 female) underwent neck CT angiography with clear vertebral artery and the adjacent structure imaging from June to December 2014 in Huashan Hospital, Fudan University. The anatomical parameters of vertebral artery V2 segment with lower cervical vertebrae and intervertebral discs were measured by cross-sectional images of C(3-6). The corresponding parameters of different sex and both sides of the same segment were analyzed by independent samples t-test and paired t test, respectively. The least significant difference(LSD) t test was used to compare the corresponding data between different segments. Results: The vertebral artery was not walking in the middle of the transverse foramen in healthy individual, but partial medial, partial front walking. Transverse diameter of transverse foramen in male and female were 6.62-6.89 mm and 6.21-6.45 mm, and sagittal diameter was 5.41-6.48 mm and 5.40-6.10 mm, respectively.The transverse foramen were slightly oval. The distance between vertebral artery and midline in male and female were 14.23-16.12 mm and 13.60-15.04 mm, respectively, which was much larger than the width of cervical vertebral corpectomy. Compared with C(3-4), intervertebral disc, the transverse distance between the vertebral artery and the uncovertebral joint of C(4-5), C(5-6) was smaller, and the distance from the vertebral artery to the posterior margin of the uncovertebral joint was relatively small, the difference was statistically significant (t=2.449, P=0.022). The distance from vertebral artery to the posterior margin of uncinate process was 1/5-2/5 of the distance between the anterior and posterior edge of the corresponding segmental vertebra. Conclusion: Based on this anatomical study, the risk of vertebral artery injury in conventional anterior cervical decompression is small, and the risk of vertebral artery injury in different segments is slightly different.

Modal analysis and efficient coupling of TE01 mode in small-core THz Bragg fibers.

We report a design of low-loss THz Bragg fibers with a core size on the order of wavelength that operates near the cutoff frequency of its TE01 mode. We also propose a broadband Y-type mode converter based on branched rectangular metallic waveguides to facilitate coupling between the TE01 mode of the Bragg fiber and the TEM mode in free space with 60% efficiency. Our fiber holds strong promise to facilitate beam-wave interaction in gyrotron for high-efficiency THz generation.

Preset ureter catheter in laparoscopic radical hysterectomy of cervical cancer.

The aim of this study was to evaluate the clinical efficacy of a temporary ureteral catheter in preventing iatrogenic ureteral damage in cervical cancer patients undergoing laparoscopic radical hysterectomy. All cases had confirmed diagnoses of cervical cancer preoperatively between December 2008 and December 2012 in our hospital and were in clinical stages IA2 to IIA. In total, 176 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed. The 176 cases were divided into two groups: ureteral catheters were installed using cystoscopy before the operation in 86 patients (group A), and ureteral catheters were not placed in 90 patients (group B). These cases were retrospectively analyzed based on postoperative hospitalization time and intraoperative and postoperative complications. A total of 6 cases (3.41%) had ureteral injuries, and 4 of the cases (4.65%) of ureteral injuries occurred in group A. In two of these cases, urinary leaking appeared at the post-operative 8th and 9th days and at the 10th and 25th days, respectively. There were 2 cases (2.22%) of ureteral injuries in group B: 1 case of intraoperative direct injury and the other of urinary leaking, which appeared at post-operative day 21. Statistically significant differences between the two groups were observed in operating time and the incidence of hemorrhage, hematuria (including microscopic hematuria), post-operative urinary tract infection, and pain (P < 0.05). A ureteral catheter that is placed preoperatively can help to identify the ureter in laparoscopic radical hysterectomy, but does not decrease the incidence of ureteral injury.

[Different methods in predicting mortality of pediatric intensive care units sepsis in Southwest China].

Objective: To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China. Methods: This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis. Results: Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) (Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS (Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion: Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.

Gene expression analysis of ruptured and un-ruptured saccular intracranial aneurysm.

BACKGROUND: Although Saccular intracranial aneurysm (sIA) is the most common type abnormality of all intracranial aneurysms, the biological mechanisms of sIA are not fully understood. METHODS: We downloaded microarray datasets from Gene Expression Omnibus (GEO) database which includes 11 ruptured intracranial aneurysm samples and 8 unruptured intracranial aneurysm samples. Significant Analysis of Microarray (SAM) was employed to identify the differentially expressed genes (DEGs) between ruptured and unruptured intracranial aneurysms. RESULTS: We found 2129 genes differentially expressed in rupture sIA, of which 1062 genes up-regulated and 1057 genes down-regulated. Functional analysis demonstrated these genes were significantly associated with inflammatory response, wounding response and defense response. Protein-protein interaction (PPI) analysis revealed that these genes may play important roles in the pathogenesis of sIAs. Results suggested that four transcription factors (TFs) could cooperated with each other, together with several microRNAs play roles in the pathonegensis of ruptured sIAs. CONCLUSIONS: All of above results indicate the existence of DEGs between ruptured and unruptured sIAs, which regulating the pathogenesis of ruptured sIAs. TFs and microRNAs may also play key roles in ruptured sIAs. This research hints a new thought to the therapy of ruptured sIAs.

Discontinuation of angiotensin-converting enzyme inhibitors: a cohort study.

WHAT IS KNOWN AND OBJECTIVE: Angiotensin-converting enzyme inhibitors (ACEI) are among the most commonly used antihypertensive agents worldwide. Factors associated with their discontinuation in clinical practice are not well defined as studies undertaken in different ethnic populations have yielded conflicting result. We aimed to identify predictors of ACEI discontinuation among Chinese patients. METHODS: We used a validated clinical database for this cohort study. We included all adult patients aged ≥ 18 years who visited any primary care clinic in one Territory of Hong Kong and who were prescribed an ACEI from January 2004 to June 2007. The cumulative incidence of discontinuation 180 days after prescription of an ACEI was measured. Factors associated with discontinuation were evaluated by multiple regression analyses. RESULTS: Among 9398 eligible patients, 14·0% discontinued their prescriptions. After controlling for patient's age, gender, socio-economic status, service type, district of residence, visit type and number of comorbidities, patients aged 70 or above [adjusted odds ratio (AOR) = 1·27, 95% CI 1·04-1·56, P = 0·022], male subjects (AOR = 1·21, 95% CI 1·05-1·40, P = 0·008), new visitors (AOR = 0·64, 95% CI 0·55-0·75, P < 0·001), patients who obtained their prescriptions in Family Medicine Specialist Clinic (FMSC) (AOR = 1·43, 95% CI 1·14-1·79, P = 0·002), patients who lived in the less urbanized district (AOR = 1·96, 95% CI 1·55-2·48, P < 0·001) and the most rural district (AOR = 1·24, 95% CI 1·03-1·49, P = 0·027), and patients with no comorbidity, were more likely to discontinue their medications. WHAT IS NEW AND CONCLUSION: Physicians should pay attention to adherence problems particularly when prescribing ACEI to male patients, those who are older than 70 years, have no comorbidity, live in less urbanized or more rural areas, qualify for fee-waiver, are new attendees of consultations or obtain their ACEI prescriptions in FMSC. Future research should evaluate the reasons for ACEI discontinuation among these higher-risk groups.

The prognostic role of albumin-bilirubin grade in patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors.

OBJECTIVE: Our aim was to explore the prognostic role of baseline albumin-bilirubin levels (ALBI) on the efficacy of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: This retrospective study enrolled 58 cases of advanced NSCLC patients who received immune checkpoint inhibitor therapy from January 2019 to February 2022 in People's Hospital of Macheng. Patients were grouped according to the levels of baseline ALBI. The corresponding cut-off values ​​were determined by receiver operating characteristic (ROC) curves. We also assessed potential predictive models for predicting efficacy of immunotherapy in advanced NSCLC. RESULTS: The median overall survival (OS) was not reached. The median OS of patients with PS ≤ 1 after immunotherapy was significantly longer than that of PS ≥ 2, which was NR vs. 6.67 months (HR=0.14, 95% CI: 0.05-0.46; p<0.01). The risk of death for patients with low ALBI (<-2.52) was significantly lower than that of patients with high ALBI (HR=0.28, 95% CI: 0.08-0.94; p=0.03). Univariate analysis showed that baseline ALBI and PS were factors significantly affecting OS in patients with advanced NSCLC after immunotherapy (p<0.05 for all). The combination of ALBI and PS showed a good predictive value in prognosis of these patients after immunotherapy (p<0.01). CONCLUSIONS: The baseline ALBI and PS may serve as prognostic factors for advanced NSCLC patients treated with immunotherapy.

Pharmacoepidemiological profiles of prescriptions for antihypertensive agents among ethnic Chinese patients.

OBJECTIVE: We compared the short- and long-term cumulative incidences of add-on therapy across the major anti-hypertensive drug classes among Chinese patients who had newly received an antihypertensive agent. MATERIALS AND METHODS: We analyzed 16,154 adult patients with uncomplicated hypertension who had newly received an antihypertensive monotherapy in one large territory of Hong Kong during January 2004 to June 2007. We compared the cumulative incidences of and factors associated with add-on therapy by drug classes at 180 days and 360 days using binary logistic regression analyses. RESULTS: The crude cumulative incidences of add-on therapy at 180 days were not statistically significantly different among those receiving thiazide diuretics (6.26%), b-blockers (5.99%), calcium channel blockers (CCB) (5.95%) or drugs acting on the renin angiotensin system (RAS) (4.41%), and these figures were similar at 360 days (both p = 0.213). The odds ratios of add-on therapy for RAS (0.72, 95% CI 0.49 - 1.06), thiazide diuretics (1.08, 95% CI 0.85 - 1.37) and beta-blockers (1.02, 95% CI 0.86 - 1.22) were not statistically significant compared to CCB at 180 days and 360 days. Male patients and younger subjects were more likely to receive an add-on therapy in both time frames. CONCLUSIONS: This study suggested that the major antihypertensive drug classes had similar add-on rates in real-life clinical practice.

Adherence to lipid-lowering agents among 11,042 patients in clinical practice.

AIMS: Dyslipidaemia is a poorly-controlled condition in clinical practice largely because of poor adherence to medication regimens by patients. This study evaluated the levels of and factors associated with adherence to lipid-lowering agents in a large Chinese population. METHODS: From a validated clinical database, we included all patients who attended any public, primary care clinics in one large Territory of Hong Kong for medication refill at least twice during the study period January 2004 to June 2007. The major outcome variable was Medication Possession Ratio (MPR), an internationally-recognised metric to measure drug adherence. The factors associated with optimal drug adherence (MPR ≥ 0.8) were evaluated by multivariate regression analysis. RESULTS: From 11,042 eligible patients, 90% were adherent. After adjusting for patients' age, gender, socioeconomic status, service type, district of residence, visit type (new visits vs. follow-up visits), the number of comorbidities and the drug class (statin vs. fibrates), older patients [aged 50-59 years; adjusted odds ratio (AOR) 1.30, p = 0.009; 60-69 years; AOR 1.53, p < 0.001; ≥ 70 years; AOR 1.72, p < 0.001], attendance in family medicine specialist clinics (FMSC; AOR 1.56, p < 0.001), follow-up visits (AOR 2.93, p < 0.001) and the presence of comorbidities (one comorbidity; AOR 1.45, p < 0.001; ≥ 2 comorbidities; AOR 1.56, p < 0.001) were associated with optimal drug adherence. DISCUSSION AND CONCLUSION: These findings carry an implication that younger subjects, new patients, visitors in clinics other than FMSC and those without comorbidities should receive more meticulous monitoring of their medication-taking behaviour. Future studies should evaluate the major reasons for non-adherence among them.

Factors associated with compliance to thiazide diuretics among 8551 Chinese patients.

WHAT IS KNOWN AND OBJECTIVE: Good compliance to anti-hypertensive medications has been recognized as a crucial factor to achieve optimal blood pressure control, but there were few studies addressing this issue among ethnic Chinese patients. This study aims to evaluate the factors associated with compliance to thiazide diuretics in a Chinese hypertensive population. METHODS: From a clinical database, all adult Chinese patients aged ≥ 18 years who were prescribed a thiazide diuretic from the public health care sector in one large Territory of Hong Kong during January 2004 to June 2007 and attended at least twice for anti-hypertensive drug refill were included. Medication Possession Ratios were used to measure drug compliance for each patient, with a level ≥ 80% defined as compliant. We used binary logistic regression analysis to evaluate the factors associated with good compliance. RESULTS AND DISCUSSION: From 8551 eligible patients, 84·5% were compliant (defined as MPR ≥ 80%). Fee payers (adjusted odds ratio [aOR] 1·28; 95% CI 1·12-1·46, P < 0·001) and follow-up visitors (aOR 2·47, 95% CI 2·13-2·87, P < 0·001) were significantly associated with better anti-hypertensive compliance. Patients who were newly prescribed thiazide diuretics and those with poorer socioeconomic status were more likely to be non-compliant to anti-hypertensive therapies. Patients' age, gender and number of co-morbidities were not significant associated factors. WHAT IS NEW AND CONCLUSION: Among Chinese patients, those who were newly prescribed thiazide diuretics and those with poorer socioeconomic status were more likely to be non-compliant to anti-hypertensive therapies. Closer monitoring and more intensive compliance-enhancing strategies had to be targeted towards these patients to enhance clinical outcomes.

Development of a cell immobilization technique for the conversion of polysialogangliosides to monosialotetrahexosylganglioside.

CONTEXT: Monosialotetrahexosylganglioside (GM1) prepared from the brain of pig or bovine is an effective clinical drug in the treatment of different nervous system diseases. Generally, polysialogangliosides are transformed into GM1 by enzymic or chemical hydrolysis due to the very poor level of natural GM1. OBJECTIVE: To continuously obtain GM1 by cell immobilization in a packed-bed reactor. MATERIALS AND METHODS: Brevibacterium casei, which is Gram-positive bacteria belonging to the order Actinomyces and family Brevibacteriaceae, can produce high-activity sialidase, are encapsulated in silk fibroin hydrogel, and subsequently packed into a reactor. The crude ganglioside is pumped into the reactor and continuously turned to GM1. RESULTS: The optimal silk fibroin concentration for hydrogel preparation is 6.0% (w/v). The optimal initial biomass for immobilization is ~12% (wet weight). The optimal conversion conditions are 35 °C and 6 mL/min of flow rate. Under above conditions, the maximum GM1 productive strength and conversion ratio can reach to 4.2 g/L·h and 313.5%, respectively. DISCUSSION: Silk fibroin is a promising material for cell immobilization because it has predominant characteristics of higher permeability and intensity. Cell immobilization for continuous GM1 transformation could eliminate the asialo GM1 and decrease the foreign matter from transfer medium and metabolism product. CONCLUSION: In the packed-bed reactor, continuous production of GM1 had been under effective running at least for 15 days indicating a potential for industrial production. It is significant that this is a first report on cell immobilization for GM1 production.

Dural arteriovenous fistula at the foramen magnum presenting with subarachnoid hemorrhage: case reports and literature review.

BACKGROUND AND PURPOSE: Spinal dural arteriovenous fistulas (DAVFs) may arise at any level from the foramen magnum to the sacrum. Only a few case series of DAVFs at the foramen magnum have been reported, especially with patients presenting with subarachnoid hemorrhage (SAH). We performed a retrospective study of four such cases and summarize experiences in the diagnosis and surgical treatment of a DAVF at the foramen magnum. METHODS: Four male patients, aged from 35 to 51 years, were admitted with severe headache. The cranial computerized tomography scans of all four patients showed SAH, with hemorrhage in the fourth ventricle with or without hemorrhage in the occipital horns of the lateral ventricles. Pre-operative digital subtraction cerebral angiography showed a DAVF at the foramen magnum draining to medullary veins and/or the straight sinus and the confluence of sinuses. Two DAVFs were fed by the vertebral artery, whilst the others were fed by dural branches of the occipital artery and/or the ascending pharyngeal artery. RESULTS: Three patients underwent direct microsurgical electrocoagulation and disconnection of the arteriovenous shunt via an enlargement of the foramen magnum and a hemilaminectomy at C1 by the far lateral suboccipital approach. Post-operative angiography confirmed complete obliteration of the fistula. CONCLUSIONS: Cerebral digital subtraction angiography is an effective and accurate method for examination of a DAVF at the foramen magnum. It can be treated effectively and with minimal surgical trauma by microsurgical electrocoagulation and disconnection of the shunt.

[Epidemic situation of malaria in Yunnan Province from 2014 to 2019].

OBJECTIVE: To investigate the epidemiological characteristics of malaria and implementation of the "1-3-7" approach in malaria elimination in Yunnan Province, so as to provide the data support for the development of post-elimination surveillance interventions. METHODS: All data pertaining to malaria cases in Yunnan Province from 2014 to 2019 were captured from the Notifiable Disease Reporting System of Chinese Center for Disease Control and Prevention, and the changes in the epidemic situation of malaria were analyzed during the 5-year period. In addition, the core indexes regarding the "1-3-7" approach in malaria elimination of Yunnan Province from 2014 to 2019 were retrieved from the Malaria Control System in the Parasitic Disease Information Reporting System, and all changes in the indexes were descriptively analyzed. RESULTS: During the period from 2014 to 2019, a total of 2 283 malaria cases were reported in Yunnan Province, including 1 927 cases with vivax malaria, 326 cases with plasmodium malaria, 29 cases with other species of malaria, and one case with unidentified species. There were 64 local cases, 2 219 overseas imported cases. Among the 2 283 malaria cases, the male/female ratio was 4.58∶1, and 80.25% of the cases were aged from 15 to 50 years. Farmer (70.00%) was the predominant occupation, and 76.70% (1 751/2 283) of the cases were identified in 25 border counties (districts). Malaria cases were reported in each month during the 5-year period, and the number of malaria cases increased from April, peaked on May to July, and started to decline on August. From 2014 to 2019, the reporting rate of malaria cases within 24 hours upon diagnosis was 100%, and the detection of malaria cases was 99.69% (2 276/ 2 283) in the laboratory, with a 99.65% (2 275/2 283) rate of definite diagnosis. In addition, the percentage of individual epidemiological investigations within 3 days was 100.00% (2 283/2 283), and the number of epidemic foci survey and treatment within 7 days was 576 during the 3-year period from 2017 to 2019. The goal of malaria elimination was achieved in Yunnan Province on June, 2020. CONCLUSIONS: Malaria has been eliminated in Yunnan Province, and management of overseas imported malaria is the primary challenge to consolidate the malaria elimination achievements in the future. However, the approach in malaria elimination remains to be maintained, and the role of the Yunnan Provincial Malaria Diagnostic Reference Laboratory requires to be strengthened.

MiR-223-5p inhibitor suppresses microglia inflammation and promotes Nrg-1 in rats of spinal cord injury.

OBJECTIVE: The aim of this study was to investigate the role of microRNA-233-5p (miR-233-5p) in spinal cord injury (SCI), and to explore the possible underlying mechanism. MATERIALS AND METHODS: Microglia were first isolated from neonate rats and cultured in a suitable environment in vitro. Lipopolysaccharide (LPS) and interleukin-4 (IL-4) were used to activate microglia. The expressions of miR-223-5p, inducible nitric oxide synthase (iNOS) and arginase 1 (Arg-1) were measured by qRT-PCR, respectively. After transfection of miR-233-5p inhibitor, the expression levels of miR-223-5p, iNOS and Arg-1 in cells were detected as well. A moderate SCI model was successfully established in rats (10 g fallen on T10 spinal cord at the height of 5 cm). Subsequently, inflammation indexes at miR-223-5p peak moment were observed. Meanwhile, its neuro-protective effect at 28 days after SCI was estimated. Finally, Basso, Beattie, and Bresnahan (BBB) rating scale was applied to evaluate the hindlimb locomotor function of rats at 1, 3, 7, 14, 21, 28 days after SCI. RESULTS: MiR-223-5p inhibitor significantly promoted M2 microglia expression and degenerated M1 microglia expression in vitro. SCI elevated the level of miR-223-5p in injured spinal cord tissues within one week, which reached a peak at 5 days after injury. Meanwhile, miR-223-5p inhibitor remarkably reduced the expressions of inflammatory factors, including interleukin-1 beta (IL-1ß), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) at 3 days after SCI, as well as increased neuregulin1 (NRG-1) expression. However, miR-223-5p inhibitor significantly declined the levels of apoptosis key enzyme-caspase-3 and glia reaction marker-glial fibrillary acidic protein (GFAP) at 7 and 28 days after SCI, respectively. As a result, BBB rating scale demonstrated that hindlimb locomotor function was significantly recovered in miR-223-5p injection group. CONCLUSIONS: MiR-223-5p was up-regulated in M1 microglia, whereas down-regulated in M2 microglia. MiR-223-5p inhibitor could significantly increase M2 microglia expression, while decrease M1 microglia expression in vitro. In vivo, miR-223-5p inhibitor suppressed the inflammatory response and reinforced NRG-1 level to reduce glia reaction and neuron apoptosis. Thereby, its treatment promoted the hindlimb locomotor function of rats.