The changes in peripheral blood Th17 and Treg ratios in Hashimoto's thyroiditis are accompanied by differential PD-1/PD-L1 expression.

Objective: The aim of this study was to analyze the percentages of T helper 17 cells (Th17s) and T regulatory cells (Tregs) in autoimmune Hashimoto's thyroiditis (HT), and the expression of the checkpoint molecules programmed death receptor 1/programmed death ligand 1 (PD-1/PD-L1) on these cells. Methods: This is a case-control study involving 53 initially diagnosed HT patients (HT group) and 21 normal controls (NC group). The peripheral blood mononuclear cells from the individuals of the two groups were isolated and restimulated ex vivo; the percentage of Th17s, Tregs, PD-1+ Th17s, PD-L1+ Th17s, PD-1+ Tregs, and PD-L1+ Tregs was assessed by flow cytometric analysis. Results: (1) The percentage of Th17s in the peripheral blood of the HT group was significantly higher than that of the NC group [(6.38 ± 1.32)% versus (3.12 ± 0.66)%; t = 14.110, P < 0.001], while the percentage of peripheral blood Tregs was significantly lower [(3.82 ± 1.48)% versus (5.61 ± 1.60)%; t = -4.599, P < 0.001]. (2) HT patients' Th17s expressed PD-1 at a significantly lower frequency than their counterparts in the NC [(6.46 ± 2.77)% versus (18.51 ± 3.96)%; t = -14.842, P < 0.001], while no difference was observed for PD-L1 between the two groups. (3) In contrast, both PD-1 and PD-L1 were expressed at significantly higher frequency on HT patients' Tregs than on NC [respectively: (17.01 ± 3.04)% versus (10.23 ± 2.77)%; t = 8.850, P < 0.001 for PD-1; (16.60 ± 9.58)% versus (11.36 ± 10.14)%; t = 2.089, P < 0.005, for PD-L1]. Conclusion: (1) The increased percentage of Th17s and decreased percentage of PD-1+ Th17s in the HT group suggest that a loss of control on Th17 activity through the checkpoint inhibitory axis PD-1/PD-L1 may participate in disease pathogenesis. (2) While the decreased percentage of Tregs in HT patients may explain a lack of regulatory functions able to prevent the autoimmune destruction of the thyroid, the significance of the increased frequency of Tregs expressing PD-1 and PD-L1, previously reported to boost Tregs differentiation, remains to be established. Elucidating this apparent contradiction may reveal important mechanisms underlying HT pathogenesis.

Intelligent automatic sleep staging model based on CNN and LSTM.

Since electroencephalogram (EEG) is a significant basis to treat and diagnose somnipathy, sleep electroencephalogram automatic staging methods play important role in the treatment and diagnosis of sleep disorders. Due to the characteristics of weak signals, EEG needs accurate and efficient algorithms to extract feature information before applying it in the sleep stages. Conventional feature extraction methods have low efficiency and are difficult to meet the time validity of fast staging. In addition, it can easily lead to the omission of key features owing to insufficient a priori knowledge. Deep learning networks, such as convolutional neural networks (CNNs), have powerful processing capabilities in data analysis and data mining. In this study, a deep learning network is introduced into the study of the sleep stage. In this study, the feature fusion method is presented, and long-term and short-term memory (LSTM) is selected as the classification network to improve the accuracy of sleep stage recognition. First, based on EEG and deep learning network, an automatic sleep phase method based on a multi-channel EGG is proposed. Second, CNN-LSTM is used to monitor EEG and EOG samples during sleep. In addition, without any signal preprocessing or feature extraction, data expansion (DA) can be realized for unbalanced data, and special data and non-general data can be deleted. Finally, the MIT-BIH dataset is used to train and evaluate the proposed model. The experimental results show that the EEG-based sleep phase method proposed in this paper provides an effective method for the diagnosis and treatment of sleep disorders, and hence has a practical application value.

Efficacy and Safety of Once-Weekly versus Twice-Weekly Bortezomib in Patients with Hematologic Malignancies: A Meta-analysis with Trial Sequential Analysis.

STUDY OBJECTIVE: To compare the efficacy and safety of once-weekly and twice-weekly bortezomib therapy in patients with hematologic malignancies. DESIGN: Meta-analysis of 13 clinical or randomized controlled trials, with trial sequential analysis (TSA). PATIENTS: A total of 1567 patients with hematologic malignancies who received either once-weekly or twice-weekly bortezomib therapy. MEASUREMENTS AND MAIN RESULTS: We conducted a comprehensive literature search of the PubMed, EMBASE, and Cochrane Library databases. A meta-analysis was conducted to calculate the pooled effect size; TSA was performed to assess the reliability of the pooled results. The pooled risk ratio (RR) for the overall response rate (ORR) was 1.00 (95% confidence interval [CI] 0.77-1.29, p=0.99), indicating no significant differences between patients who received once-weekly bortezomib and those who received twice-weekly bortezomib. TSA showed that the cumulative Z-curve of the ORR entered the futility area, implying that reliable evidence was obtained for this pooled result. The pooled RR for any grade of peripheral neuropathy was 0.48 (95% CI 0.26-0.88, p=0.02); however, the TSA plot revealed that there was insufficient evidence for this result. The pooled RR for peripheral neuropathy grade 3 or higher was 0.21 (95% CI 0.13-0.34, p<0.00001), and reliable evidence was obtained according to TSA. Regarding the other toxicities, including anemia, thrombocytopenia, neutropenia, infection, diarrhea, constipation, nausea, vomiting, and fatigue, we did not find any significant differences between patients who received once-weekly bortezomib and those who received twice-weekly bortezomib. CONCLUSION: Compared with twice-weekly bortezomib, once-weekly bortezomib had a comparable ORR and a probable lower incidence of peripheral neuropathy. More clinical trials are needed to draw a conclusion regarding the difference in peripheral neuropathy between the two groups because of the insufficient evidence detected by TSA and the inconsistent results among subgroups.

Efficacy and safety of subcutaneous versus intravenous bortezomib in multiple myeloma: a meta-analysis
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PURPOSE: We performed this meta-analysis to compare the efficacy and safety between two different administration routes of bortezomib, subcutaneous and intravenous. METHODS: Six retrospective studies and three randomized controlled trials (RCTs) were included in our study. Data from retrospective studies or RCTs were pooled and displayed in their corresponding subgroup, retrospective studies subgroup or RCTs subgroup. We comprehensively compared the overall response rate (ORR) and the incidence of adverse events between subcutaneous and intravenous bortezomib. RESULTS: We did not find statistical difference in ORR between the two administration routes. The pooled RRs for ORR were 0.99 (95% CI = 0.79 - 1.25, p = 0.95; retrospective studies subgroup) and 1.02 (95% CI = 0.93 - 1.11, p = 0.69; RCTs subgroup). Compared with intravenous bortezomib, the subcutaneous bortezomib reduced the incidence of peripheral neuropathy, both any grade and grade ≥ 3. The pooled RRs for any grade of peripheral neuropathy were 0.33 (95% CI = 0.15 - 0.71, p = 0.004; retrospective studies subgroup) and 0.55 (95% CI = 0.31 - 0.97, p = 0.04; RCTs subgroup), and for peripheral neuropathy grade ≥ 3 were 0.40 (95% CI = 0.16 - 0.95, p = 0.04; retrospective trials subgroup) and 0.39 (95% CI = 0.19 - 0.80, p = 0.01; RCTs subgroup). Only retrospective trials subgroup found that the incidence of thrombocytopenia and renal and urinary disorders were lower in subcutaneous bortezomib than in intravenous, with the pooled RRs 0.46 (95% CI = 0.29 - 0.72, p = 0.0007; retrospective trials subgroup) and 0.23 (95% CI = 0.09 - 0.56, p = 0.001; retrospective trials subgroup), respectively. The RCTs subgroup did not find statistical differences in these two adverse events. CONCLUSIONS: Subcutaneous bortezomib did not significantly reduce therapeutic efficacy but resulted in a lower incidence of peripheral neuropathy than intravenous bortezomib. Compared with intravenous bortezomib, subcutaneous bortezomib might reduce the incidence of thrombocytopenia and renal and urinary disorders, but this needs more clinical trials to confirm.
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[The role of B cell-activating factor secreted by peripheral blood monocyte-derived dendritic cell in chronic idiopathic thrombocytopenic purpura].

OBJECTIVE: To explore the characteristics of B cell-activating factor (BAFF) secreted by peripheral blood monocyte-derived dendritic cell (MoDC) in chronic idiopathic thrombocytopenic purpura (cITP) and the function of MoDC on B cell proliferation. METHODS: Ten cITP patients were studied dynamically before and after treatment. The BAFF levels in serum and the supernatant of LPS stimulated MoDC were tested with ELISA. The BAFF gene expression in LPS stimulated MoDC was tested with RQ-PCR, the B cell proliferation co-cultured with the supernatant of LPS stimulated MoDC for 5 days was tested with flow cytometry for CFSE and (3)H thymidine incorporation. RESULTS: The BAFF level in serum (serum BAFF) \[(2461 ± 483) ng/L\], and supernatant of LPS stimulated MoDC (supernatant BAFF) \[(1113 ± 113) ng/L\] and BAFF mRNA in LPS stimulated MoDC (BAFF mRNA) (1.70 ± 0.23) before treatment were higher than that after treatment \[(621 ± 53) ng/L, (490 ± 49) ng/L and 0.37 ± 0.12\] and normal group \[(742 ± 77) ng/L, (582 ± 63) ng/L and 0.52 ± 0.08\]. There was a positive correlation among serum BAFF, supernatant BAFF and BAFF mRNA, and a negative correlation among serum BAFF, supernatant BAFF and BAFF mRNA and blood platelet count (BPC) in all ITP patients. The supernatant of LPS-stimulated MoDC from untreated patients enhanced B cell proliferation as compared with the supernatant of LPS-stimulated MoDC from treated patients and normal group. CONCLUSION: BAFF might contribute to disease development in cITP. MoDC may directly increase B cell proliferation by secreting BAFF without T cell help, playing an important role in the antibody production in cITP.

Direct B-cell stimulation by peripheral blood monocyte-derived dendritic cells in idiopathic thrombocytopenic purpura patients.

OBJECTIVE: Dendritic cells (DCs) play a major role in regulating lymphocytes. The emergence of antiplatelet autoantibodies remains the central pathogenetic mechanism in idiopathic thrombocytopenic purpura (ITP); defective DC functions have been implicated in ITP. The purpose of this study was to assess the contribution of DCs to B-cell hyperactivity in ITP patients. METHODS: Ten ITP patients were studied before treatment (group untreated) and after treatment (group treated ) with improvement. We compared the effects of monocyte-derived DC from ITP and healthy control (group control) on naive B cells in the presence of lipopolysaccharide, or anti-CD40. We measured the proliferation, antibody production, and expression of activation markers for B cells, as well as DC-secreted B-cell activating factor (BAFF) production. We also measured the serum BAFF level in ITP patients and control. The role of DC-produced BAFF was evaluated with anti-BAFF. RESULTS: Lipopolysaccharide, or anti-CD40, stimulated DCs from group untreated increased B-cell proliferation and antibody production as compared with DCs from group treated and group control. Cell-to-cell contact was not necessary for the augmented effect of the ITP DCs. Anti-CD40 treatment induced a higher production of BAFF in group untreated DCs. Serum BAFF levels, supernatant BAFF from anti-CD40-activated DCs, and BAFF mRNA expression of anti-CD40-activated DCs in group untreated were significantly higher than that in group treated and group control. In ITP patients, there was positive correlation among serum BAFF, supernatant BAFF, and BAFF mRNA levels, and there was negative correlation between serum BAFF, supernatant BAFF, BAFF mRNA levels, and blood platelet count. Blocking BAFF abrogated the effects of ITP DCs on naive B partially. CONCLUSION: Activated monocyte-derived DCs from ITP patients directly increase B-cell effector functions; this effect depends on soluble factors released by activated DCs and cell-to-cell contact. This might play an important role in the antibody production in ITP. DC-secreted BAFF is involved and might contribute to disease development.

Doxorubicin-induced vasomotion and [Ca(2+)](i) elevation in vascular smooth muscle cells from C57BL/6 mice.

AIM: To explore the action of doxorubicin on vascular smooth muscle cells. METHODS: Isometric tension of denuded or intact thoracic aortic vessels was recorded and [Ca(2+)](i) in isolated aortic smooth muscle cells was measured by using Fluo-3. RESULTS: Doxorubicin induced phasic and tonic contractions in denuded vessels and increased levels of [Ca(2+)](i) in single muscle cells. Treatment with 10 micromol/L ryanodine had no effect on basal tension, but it did abolish doxorubicin-induced phasic contraction. Treatment with 10 mmol/L caffeine induced a transient phasic contraction only, and the effect was not significantly altered by ryanodine, the omission of extracellular Ca(2+) or both. Phenylephrine induced rhythmic contraction (RC) in intact vessels. Treatment with 100 micromol/L doxorubicin enhanced RC amplitude, but 1 mmol/L doxorubicin abolished RC, with an increase in maximal tension. Caffeine at 100 micromol/L increased the frequency of the RC only. In the presence of 100 micromol/L caffeine, however, 100 micromol/L doxorubicin abolished the RC and decreased its maximal tension. Treatment with 10 micromol/L ryanodine abolished the RC, with an increase in the maximal tension. In Ca(2+)-free solution, doxorubicin induced a transient [Ca(2+)](i) increase that could be abolished by ryanodine pretreatment in single muscle cells. The doxorubicin-induced increase in [Ca(2+)](i) was suppressed by nifedipine and potentiated by ryanodine and charybdotoxin. CONCLUSION: Doxorubicin not only releases Ca(2+) from the sarcoplasmic reticulum but also promotes the entry of extracellular Ca(2+) into vascular smooth muscle cells.

[Study on the effect of Ginkgo biloba extract on the tension of diabetic rat artery].

OBJECTIVE: To investigate the effect and possible mechanism of Ginkgo biloba extract EGB50 on vascular tension of type II diabetes mellitus (DM) induced by hyperglycemia and hyperlipidemia. METHODS: Rats were randomly divided into normal control rats (Control), diabetic rats (DM), diabetic rats oral-treated with higher dose Ginkgo biloba extract EGB50 (H) and diabetic rats treated with lower dose EGB50 (L). The serum levels of Advanced Glycosylation end-products (AGEs), cholesterol (CHOL), triglyceride (TRIG) and superior mesenteric artery tension were quantified and measured. RESULTS: After 5 weeks' oral-treatment, serum CHOL, TRIG and AGEs increased, sustained phase of contractile response in high K+ solution and PD2 of phenylephine decreased in diabetic arteries. The biochemical indexes and the tension of vascular function had less significance in L group, but improved distinctly in EGB50 H group (decreasing rate in high K+ solution: 22.52 +/- 5.48%, vs DM:44. 19 +/- 11.03%, P < 0.05) (PD2 of PE: 6.15 +/- 0.22 vs DM: 6.62 +/- 0.13, P < 0.05). CONCLUSION: EGB50 is capable of reducing serum hyperlipidemia,the concentration of AGEs, thus it can reduce the impairment of the oxidants to endothelium cells of vessels and improve pathological and functional change of artery of diabetes.