Fauna of scrub typhus vector chigger mites in Yunnan Province / 中国热带医学

@#Abstract: Chigger mites belong to the phylum Arthropoda, class Arachnida, sub-class Acari, order Parasitiformes, family Trombiculidae and Leeuwenhoekiidae, with a wide range of species. There are more than 3 700 known species of mites globally, of which 531 species in 46 genera from three sub-families have been recorded in China, and 320 species of chigger mites recorded from 3 subfamilies and 32 genera in Yunnan Province. At this stage, chigger mites are the only vectors of scrub typhus, with about 60 species worldwide being potential vectors. Six vectorial mite species have been confirmed in China, including Leptotrombidium deliense, L.scutellare, L.rubellum, L.sialkotense, L.kaohuense, L.insulare. Yunnan Province has reported five vectorial mite species, including the previously-mentioned five species except for L.sialkotense. The zoogeographic study divided Yunnan Province into 5 zoogeographic areas, namely, Central Hengduan Mountains subregion, Southern Hengduan Mountains subregion, Eastern Yunnan Plateau subregion, Western Yunnan Plateau subregion, Southern Yunnan Mountainous subregion. The Southern Hengduan Mountains subregion has the highest number of known genera and species of scrub typhus and the highest number of scrub typhus cases, with 216 species in 22 genera from 3 subfamilies, and all 5 species of vector scrub typhus were distributed. Southern Yunnan Mountain subregion has the least number of mite species, with 91 species in 12 genera from three sub-families, with L. scutellare being the dominant vectorial mite species across the province. Due to suitable natural geographic conditions in Yunnan Province, vectorial mites can propagate rapidly, leading to a large number of scrub typhus cases. According to statistics, the number of scrub typhus cases in Yunnan Province has rapidly increased, with 15.40 times, 20.64 times and 28.91 times more cases in 2016, 2017 and 2018 respectively than in 2006. Scrub typhus remains a serious public health problem in Yunnan Province, posing a threat to the health of the local population. Therefore, prevention and control efforts should continue to focus on the affected areas and the general public.

Prognostic value of serum cystatin C in patients with congenital heart disease-associated pulmonary arterial hypertension / 中国胸心血管外科临床杂志

@#Objective    To explore the prognostic value of serum cystatin C (Cys C) in patients with congenital heart disease-associated pulmonary arterial hypertension (PAH-CHD). Methods    A retrospective cohort study was conducted on adult PAH-CHD patients who were hospitalized for the first time in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2020. The serum Cys C and other related data of patients were collected. The median follow-up time was 57 months. The main end event was all-cause death. According to the prognosis, the patients were divided into a survival group and a death group. Cox regression was used to analyze the risk factors for all-cause death in patients with PAH-CHD. Results    A total of 456 patients were enrolled, including 160 males and 296 females, aged 38.99±14.72 years. The baseline data showed that there were statistical differences in resting heart rate, serum Cys C, creatinine, NT-proB-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), high-sensitivity C reactive protein (hs-CRP), New York Heart Association (NYHA) cardiac function classification and serum potassium between the survival group and the death group. Univariate Cox regression analysis showed that serum  Cys C, NT-proBNP, hs-cTnT, creatinine and NYHA cardiac function classification were related risk factors for all-cause death in patients with PAH-CHD. Multivariate Cox regression analysis showed that serum Cys C (HR=3.820, 95%CI 2.053-7.108, P<0.001), NYHA grade Ⅲ (HR=2.234, 95%CI 1.316-3.521, P=0.010), NYHA grade Ⅳ (HR=4.037, 95%CI 1.899-7.810, P=0.002) and NT-proBNP (HR=1.026, 95%CI 1.013-1.039, P<0.001) were independent risk factors for all-cause death in patients with PAH-CHD and had a good predictive value. Conclusion    As a new cardiac marker, serum Cys C can predict all-cause death in patients with PAH-CHD and is an independent risk factor.

Parental smoking and congenital heart disease: a meta-analysis / 中华围产医学杂志

Objective:To assess the association between maternal smoking, passive exposure to smoking, or paternal smoking in the first trimester and the risk of congenital heart disease (CHD) in offspring.Methods:A meta-analysis was performed on selected case-control studies on parents in the first trimester and CHD involving CHD patients regardless of age or ethnicity, after searching PubMed, Web of Science, Cochrane Library, CNKI, WanFang Data, and China Biology Medicine up to April 2021. The main outcome was CHD confirmed by cardiac ultrasound or cardiac surgery and the quality of included studies was assessed using the Newcastle-Ottawa Scale (≥4 scores). Statistical analysis was carried out using RevMan5.4 software and heterogeneity was determined by Q test combined with I 2 test. In accordance with the heterogeneity test results, the appropriate model (random or fixed) was selected. Subgroup analysis was performed according to the subtype of CHD. Potential publication bias was assessed by funnel plots. Results:A total of 35 studies involving 38 125 subjects were included. The pooled results showed that the risk of CHD in offspring born to mothers who were active or passive smokers in the first trimester was 1.20 ( OR=1.20, 95% CI:1.15-1.26, Z=8.15, P<0.001, I 2=35%) and 1.95 times ( OR=1.95, 95% CI:1.70-2.24, Z=9.52, P<0.001, I 2= 69%) that of non-smoking mothers. The risk of CHD in offspring of fathers who smoked in the first trimester was 1.88 times higher than that of non-smoking parents ( OR=1.88, 95% CI:1.49-2.36, Z=5.39, P<0.001, I 2= 69%). Subgroup analysis indicated an association between active maternal smoking in the first trimester and an increased risk of atrial septal defect ( OR=1.41, 95% CI:1.03-1.92, P=0.030, I 2= 71%) as well as between maternal passive smoking and increased risk of atrioventricular septal defect ( OR=1.76, 95% CI:1.37-2.26, P<0.001, I 2= 11%). Conclusion:Maternal and paternal smoking in the first trimester may both increase the risk of CHD in offspring.

Risk evaluation and mitigation strategy in oncology products / 中国药学杂志

OBJECTIVE: To review and analyze the specificity and dynamic changes in developing the Risk Evaluation and Mitigation Strategy (REMS) in oncology products. METHODS: Based on FDA's requirement for REMS for some high-risk drugs and biologics, the REMS literatures of oncology products were tracked and accessed. The approved and released REMS programs of anti-cancer drugs were summarized and analyzed. RESULTS: REMS is a key tool for FDA to help manage and ensure the safe use of the medications. Though a disproportionate number of drugs with complex REMS are required in patients with cancer, the percentage of the oncology drugs with REMS requirement is not much higher than non-oncology products. This mainly resulted from the specificity of cancer and chemotherapy, in which much collaborative interaction among health care practitioners as well as the emerging target therapy with highly specificity and selectivity may contribute to minimize risk from medications.CONCLUSION: The necessity of developing REMS for an oncology product depends on its properties and the new circumstances in oncology practice.

Effect of antiviral treatment on expression of programmed death 1 and programmed death ligand 1 on peripheral T lymphocytes in patients with chronic hepatitis C / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the changes in programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) expression on peripheral blood T lymphocytes of patients with chronic hepatitis C (CHC) over the 24 weeks course of antiviral therapy.</p><p><b>METHODS</b>Twenty-four CHC patients administered 24 weeks of combination antiviral therapy with pegylated-interferon-alpha-2a (Peg-IFNa-2a) and ribavirin (RBV) were enrolled for study from the Nanjing Second Hospital between October 2008 and October 2011. Peripheral blood was collected before treatment initiation, at treatment weeks 4, 12 and 24, and post-treatment week 24 (to investigate sustained virologic response (SVR), and used to measure expression of PD-1 and PD-L1 on CD4+ and CD8+ T lymphocytes by flow cytometry, load of serum hepatitis C virus (HCV) RNA by real-time polymerase chain reaction, and level of serum alanine aminotransferase (ALT) by auto-biochemical analyzer. Intergroup differences were analyzed by the two-sample t-test, and the significance of differences between pre- and post-treatment measurements was determined by one-way or two-way repeated measurements analysis of variance tests.</p><p><b>RESULTS</b>At treatment week 4, 19 of the CHC patients were HCV RNA-negative. Among those patients the PD-1 expression on both T lymphocyte subsets showed a significant decrease from pre-treatment to post-treatment week 24 (CD4+: 18.6 +/- 6.1% vs. 10.3 +/- 7.7%, F = 12.406, P = 0.002; CD8+: 16.6 +/- 13.8% vs. 9.4 +/- 4.6%, F = 4.955, P = 0.039). However, the CD8+ lymphocyte subset showed significant increase in PD-L1 expression during treatment (pre-treatment: 17.5 +/- 13.7% vs. treatment week 4: 25.9 +/- 11.1%, F = 9.063, P less than 0.01; 12: 29.6 +/- 15.1%, F = 8.365, P less than 0.01; 24: 32.0 +/- 15.7%, F = 9.736, P less than 0.01). Among the five CHC patients showing HCV RNA-positivity at treatment week 4 there was only a significant difference observed in the increased expression of PD-L1 on CD8+ lymphocyte subset from pre-treatment to treatment week 24 (17.4 +/- 16.7% vs. 39.2 +/- 15.6%, F = 10.292, P = 0.033). Twenty of the CHC patients achieved SVR. among whom the PD-1 expression was significantly decreased during treatment on the CD4+ lymphocyte subset (pre-treatment: 20.2 +/- 7.5% vs. treatment week 4: 14.4 +/- 7.5%, F = 6.133, P less than 0.05; 12: 14.0 +/- 6.9%, F = 5.541, P less than 0.05; 24: 10.7 +/- 7.6%, F = 14.780, P less than 0.05) and on the CD8+ lymphocyte subset (pre-treatment: 16.8 +/- 13.4% vs. treatment week 12: 10.2 +/- 4.6%, F = 4.964, P less than 0.05; 24: 10.1 +/- 4.9%, F = 4.613, P less than 0.05). Additionally, the PD-L1 expression was significantly increased during treatment on the CD8+ lymphocyte subset (pre-treatment: 19.0 +/- 14.5% vs. treatment week 12: 30.8 +/- 16.6%, F = 6.442, P = 0.020; 24: 35.2 +/- 16.5%, F = 12.349, P = 0.002). Among the four CHC patients who relapsed there were no significant differences observed in the expressions of PD-1 or PD-L1 on the CD4+ or CD8+ T lymphocytes.</p><p><b>CONCLUSION</b>The standard Peg-IFNa-2a + RBV combination antiviral therapy reduces PD-1 expression on CD4+ and CD8+ T lymphocytes and increases PD-L1 expression on CD8+ T lymphocytes in peripheral blood. The clinical outcome of CHC patients may be related to the antiviral therapy-induced changes in expressions of PD-1 and PD-L1 on T lymphocytes.</p>

Expression of endothelial differemtiation gene receptors in human pancreatic cancer / 中华胰腺病杂志

ObjectiveTo evaluate the expression of endothelial differentiation gene/lysophosphatidic acid (LPA) receptors (Edg/LPA) and its clinical significance in human pancreatic cancer.MethodsFifty cases of pancreatic cancer and adjacent normal tissues were collected,and Real-time PCR,Western blot and immunohistochemistry was used to determine the expression of Edg-2/LPA1,Edg-4/LPA2 and Edg-7/LPA3 receptors mRNA and protein,and its relationship with clinicopathological parameters was analyzed.Results The expressions of Edg-2/LPA1,Edg-4/LPA2,Edg-7/LPA3 receptor mRNA were (0.142 ± 0.042 ) ％,(0.471 ±0.064)％,(0.231 ±0.043)％ in pancreatic cancer,and the corresponding values were (0.132 ±0.029)％,(0.027 ±0.015)％,(0.163 ±0.046)％ in adjacent normal tissues.The expressions of Edg-4/LPA2 receptor mRNA in pancreatic cancer were significantly lower than that in adjacent normal tissues ( P ＜0.05 ).The expressions of Edg-4/LPA2 receptor protein in pancreatic cancer were significantly lower than that in adjacent normal tissues ( P ＜ 0.05 ).The expressions of three types of Edg /LPA receptor mRNA in pancreatic cancer were parallel to serum CA19-9 levels.The expressions of Edg-4/LPA2 receptor mRNA were associated with tumor size,differentiation degree,and invasive ability and metastasis.While the expressions of Edg-2/LPA1,Edg-7/LPA3 receptor mRNA was associated with invasive ability and metastasis only.ConclusionsEdg-4/LPA2 receptor is highly expressed in pancreatic cancer,which suggesting the malignant biological behavior of pancreatic cancer.

Analysis of short-term death after transcatheter hepatic arterial chemoembolization in 265 patients with liver cancer / 中国综合临床

Objective To explore the effective way to decrease serious complications and to minimize the mortality following transcatheter hepatic arterial chemoembolization (TACE).Methods In 265 liver cancer patients experiencing TACE,the causes of death in 19 (20 days after TACE) were analyzed.Results 9 cases died of liver failure,4 died of the rupture of liver tumors, and 2 died of upper digestive tract bleeding.Gastroduodenal perforation,pulmonary embolism,myocardial infarction,and hyperkalemia resulted in death in one case,respectively.The mortality rates of primary liver cancer and liver metastasis were 9.2% and 1.4%,respectively (P