Publications by authors named "Xu Ji"

379 Publications

Restriction of Iron Loading into Developing Seeds by A YABBY Transcription Factor Safeguards Successful Reproduction in Arabidopsis.

Mol Plant 2021 Jun 8. Epub 2021 Jun 8.

State Key Laboratory of Plant Physiology and Biochemistry, College of Life Sciences, Zhejiang University, Hangzhou 310058, China;. Electronic address:

Iron (Fe) storage in plant seeds is not only necessary for seedling establishment following germination, but also a major source of dietary Fe for human and animal life. Seed Fe accumulation was known to be low during early seed development. However, the underlying mechanism and biological significance remain elusive. Here, we show that reduced expression of Arabidopsis YABBY transcription factor INNER NO OUTER (INO) increases embryonic Fe accumulation, while transgenic overexpression of INO has opposite effect. INO is highly expressed during early seed development, and that decreased expression of INO increases the expression of NATURAL RESISTANCE ASSOCIATED MACROPHAGE PROTEIN 1 (NRAMP1), a gene encoding a transporter contributing to Fe loading into the seed. The relatively high embryonic Fe accumulation conferred by decreased expression of INO is rescued by the nramp1 loss-of-function mutation. We further demonstrate that INO represses NRAMP1 expression by binding to NRAMP1 specific promoter region. Moreover, we show that excessive Fe loading into developing seeds in ino mutants produces more oxidative damage, leading to increased cell death and seed abortion, a phenotype that can be rescued by nramp1 mutation. Taken together, these results indicate that INO plays an important role in safeguarding reproduction by reducing Fe loading into developing seeds via repression of NRAMP1 expression.
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http://dx.doi.org/10.1016/j.molp.2021.06.005DOI Listing
June 2021

Association of Medicaid Expansion with Cancer Stage and Disparities in Newly Diagnosed Young Adults.

J Natl Cancer Inst 2021 May 21. Epub 2021 May 21.

Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.

Background: Young adults (YAs) experience higher uninsurance rates and more advanced stage at cancer diagnosis than older counterparts. We examined the association of the Affordable Care Act Medicaid expansion with insurance coverage and stage at diagnosis among YAs newly diagnosed with cancer.

Methods: Using the National Cancer Database, we identified 309,413 YAs aged 18-39 years who received a first cancer diagnosis in 2011-2016. Outcomes included percentages of YAs without health insurance at diagnosis, with stage I (early-stage) diagnoses, and with stage IV (advanced-stage) diagnoses. We conducted difference-in-difference (DD) analyses to examine outcomes, before and after states implemented Medicaid expansion compared with non-expansion states. All statistical tests were 2-sided.

Results: The percentage of uninsured YAs decreased more in expansion than non-expansion states (adjusted DD = -1.0 percentage points [ppt]; 95% Confidence Interval [CI] = -1.4 to -0.7 ppt; p<0.001). The overall percentage of stage I diagnoses increased (adjusted DD = 1.4 ppt; 95% CI = 0.6 to 2.2 ppt; p<0.001) in expansion compared with non-expansion states, with greater improvement among YAs in rural areas (adjusted DD = 7.2 ppt; 95% CI = 0.2 to 14.3 ppt; p=0.045) than metropolitan areas (adjusted DD = 1.3 ppt; 95% CI = 0.4 to 2.2 ppt; p=0.004), and among non-Hispanic Black patients (adjusted DD = 2.2 ppt; 95% CI = -0.03 to 4.4 ppt; p=0.05) than non-Hispanic White patients (adjusted DD = 1.4 ppt; 95% CI = 0.4 to 2.3 ppt; p=0.008). Despite the non-statistically significant change in stage IV diagnoses overall, the percentage declined more (adjusted DD = -1.2 ppt; 95% CI = -2.2 to -0.2 ppt; p=0.02) among melanoma patients in expansion relative to non-expansion states.

Conclusions: We provide the first evidence on the association of Medicaid expansion with shifts to early-stage cancer at diagnosis and a narrowing of rural-urban and Black-White disparities in YA cancer patients.
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http://dx.doi.org/10.1093/jnci/djab105DOI Listing
May 2021

The regulation of the mammalian maternal-to-embryonic transition by eukaryotic translation initiation factor 4E.

Development 2021 May 20. Epub 2021 May 20.

Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, China.

Eukaryotic translation initiation factor 4E (eIF4E) mediates CAP-dependent translation. Genetic and inhibitor studies show its expression was required for the successful transition from maternal to embryonic control of mouse embryo development. eIF4E was in the oocyte and in the cytoplasm soon after fertilization, and at each stage of early development. Functional knockout (Eif4e-/-) by PiggyBac (PB) [Act-RFP] transposition caused peri-implantation embryonic lethality due to the failure of normal epiblast formation. Maternal stores of eIF4E supported development up to the 2-4-cell stage after which new expression occurred from both alleles. Inhibition of the maternally acquired stores of eIF4E (4EGI-1 inhibitor) resulted in a block at the 2-cell stage. eIF4E activity was required for new protein synthesis in the 2-cell embryo and knockout embryos had lower translational activity than wildtype embryos. 4E-BP1 is a hypophosphorylation-dependent negative regulator of eIF4E. mTOR activity was required for 4E-BP1 phosphorylation and inhibiting mTOR retarded embryo development. This study shows that eIF4E activity is regulated at key embryonic transitions in the mammalian embryo and is essential for the successful transition to embryonic control of development.
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http://dx.doi.org/10.1242/dev.190793DOI Listing
May 2021

Post-Surgery Subcutaneous Seeding of Laryngeal Squamous Cell Carcinoma: A Rare Case.

Case Rep Oncol 2021 Jan-Apr;14(1):568-572. Epub 2021 Mar 22.

Department of Otolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Laryngeal squamous cell carcinoma (LSCC) is the most common malignant head and neck cancer, with a 40% recurrence rate in the first 3 years after radical treatment. Recurrence of LSCC mostly comprises lymphogenous metastasis, hematogenic metastasis, and locoregional recurrence, while LSCC seeding is rarest: there are only 4 cases reported in PubMed, and none of them is one of subcutaneous seeding. We report a case with post-surgery subcutaneous seeding of LSCC. The final biopsy demonstrated that the subcutaneous seeding of the LSCC was 2 cm away from the primary lesion, with no recurrent foci observed in the larynx and tracheostoma and little relation to the primary lesion. Thus, we drew the conclusion that LSCC surgeries should stick to the principle of the non-tumor technique to prevent subcutaneous seeding.
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http://dx.doi.org/10.1159/000510361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077469PMC
March 2021

Substance use, substance use disorders, and treatment in adolescent and young adult cancer survivors-Results from a national survey.

Cancer 2021 May 11. Epub 2021 May 11.

Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.

Background: Substance use can exacerbate cancer-related morbidity and mortality in adolescent/young adult (AYA) cancer survivors and place them at increased risk for adverse health outcomes. The objective of this study was to assess substance use, misuse, and substance use disorders [SUDs], as well as receipt of treatment for SUDs, among AYA cancer survivors.

Methods: The authors used data from the National Survey of Drug Use and Health (2015-2018) to identify a nationally representative sample of AYAs aged 12 to 34 years. Outcomes assessed past-year tobacco, alcohol, marijuana, and illicit drug use; misuse of prescription opioids; SUDs; and SUD treatment. Multiple logistic regression was estimated to compare outcomes between 832 AYAs who reported a cancer history (survivors) and 140,826 AYAs who did not, adjusting sequentially for sociodemographic characteristics and health status.

Results: In regressions adjusting for sociodemographic characteristics, survivors were more likely than a noncancer comparison group of peers to use alcohol (6% relative increase; P = .048) and illicit drugs (34% relative increase; P = .012), to misuse prescription opioids (59% relative increase; P < .001), and to have a marijuana (67% relative increase; P = .011), illicit drug (77% relative increase; P < .001), or prescription opioid (67% relative increase; P = .048) SUD. When further adjusting for health status, survivors were still 41% more likely (P < .001) to misuse prescription opioids than noncancer peers. Among those with SUDs, survivors were more likely than peers to receive treatment (unadjusted, 21.5% vs 8.0%; adjusted, P < .05).

Conclusions: AYA survivors were as likely as or more likely than noncancer peers to report substance use problems. These findings underscore the importance of interventions to reduce substance use and improve SUD treatment among AYA cancer survivors.

Lay Summary: The authors assessed substance use, misuse, and substance use disorders, as well as the receipt of treatment for substance use disorders, among adolescent and young adult (AYA) cancer survivors. In a nationally representative AYA sample, cancer survivors, despite their increased risk for morbidity and early mortality, were as likely as or more likely than peers without cancer to experience substance use problems. In particular, survivors had a significantly higher rate of prescription opioid misuse than peers. However, only 1 in 5 AYA survivors who experienced substance use disorders received treatment. These findings underscore the importance of interventions toward reducing substance use and improving access to treatment among AYA survivors.
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http://dx.doi.org/10.1002/cncr.33634DOI Listing
May 2021

A Moderate Reduction of Dietary Crude Protein Provide Comparable Growth Performance and Improve Metabolism via Changing Intestinal Microbiota in Sushan Nursery Pigs.

Animals (Basel) 2021 Apr 19;11(4). Epub 2021 Apr 19.

Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, College of Animal Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.

In this paper, we investigated the effects of a diet with a moderate reduction of dietary crude protein (CP) level, supplemented with five crystalline amino acids (Lys, Met, Thr, Try, and Val), on the growth, metabolism, and fecal microbiota of Sushan nursery pigs. Seventy Sushan nursery pigs with an average body weight of 19.56 ± 0.24 kg were randomly allocated to two experimental dietary treatments: 18% CP (high protein; group HP), and 15% CP (low protein; group LP). We found that the differences in the two diets had no significant effect on the growth performance of Sushan nursery pigs. Nursery pigs on the 15% CP diet showed significantly improved protein, amino acid, and energy utilization. Furthermore, the LP diet cloud optimized the gut microflora composition to some extent. The functional structure of bacterial communities implied improved metabolic capabilities in group LP. Additionally, correlation analysis between fecal microbiota and metabolic profiles confirmed that the increase of beneficial bacterial in the feces was beneficial to the health and metabolism of the nursery pigs. In conclusion, a moderate reduction in the dietary protein level can improve growth and metabolism due to the improvement of intestinal microbiota in Sushan nursery pigs. This finding could provide useful reference data for the application of a different nutrition strategy in indigenous pig production.
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http://dx.doi.org/10.3390/ani11041166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073206PMC
April 2021

High-Performance Blue Quantum Dot Light Emitting Diode via Solvent Optimization Strategy for ZnO Nanoparticles.

Nanomaterials (Basel) 2021 Apr 9;11(4). Epub 2021 Apr 9.

Department of Physics, College of Science, Beijing University of Chemical Technology, 15 East Road, Beijing 100029, China.

Here, we report on the high-performance blue quantum dots (QDs) light-emitting diodes (QLEDs), in which the ZnO nanoparticles (NPs) are employed as the electron transport layer (ETL) and optimized with different alcohol solvents. The experimental results demonstrate that the properties of solvent used for ZnO NPs-such as polarity, viscosity and boiling point-play a crucial role in the quality of film where they modulate the electron injection across the QDs/ETL interface. The maximum current efficiency of 3.02 cd/A and external quantum efficiency (EQE) of 3.3% are achieved for blue QLEDs with ZnO NPs dispersed in butanol, exhibiting obvious enhancement compared with the other solvents. This work provides a new method to select proper solvent for ETL which can further improve the device performance.
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http://dx.doi.org/10.3390/nano11040959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070000PMC
April 2021

Metformin prevents PFKFB3-related aerobic glycolysis from enhancing collagen synthesis in lung fibroblasts by regulating AMPK/mTOR pathway.

Exp Ther Med 2021 Jun 31;21(6):581. Epub 2021 Mar 31.

Department of Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, P.R. China.

Aerobic glycolysis has been shown to contribute to the abnormal activation of lung fibroblasts with excessive collagen deposition in lipopolysaccharide (LPS)-induced pulmonary fibrosis. Targeting aerobic glycolysis in lung fibroblasts might therefore be considered as a promising therapeutic approach for LPS-induced pulmonary fibrosis. In the present study, the aim was to investigate whether metformin, a widely used agent for treating type 2 diabetes, could alleviate LPS-induced lung fibroblast collagen synthesis and its potential underlying mechanisms. Different concentrations of metformin were used to treat the human lung fibroblast MRC-5 cells after LPS challenge. Indicators of aerobic glycolysis in MRC-5 cells were detected by measuring glucose consumption and lactate levels in culture medium in addition to lactate dehydrogenase activity in cellular lysates. The glucose consumption, lactate levels and the lactate dehydrogenase activity were measured respectively using colorimetric/fluorometric and ELISA kits. The effects of metformin in AMP-activated protein kinase (AMPK) activation was assessed by mitochondrial complex I activity kits. Collagen I, α-smooth muscle actin (α-SMA) and collagen III were used as markers of collagen synthesis, which was measured using western blotting, whereas phosphorylated (p-) AMPK, AMPK, 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) and mTOR were detected by western blotting. Metformin significantly decreased mitochondrial complex I activity and upregulated the expression of p-AMPK/AMPK protein in a concentration-dependent manner. Furthermore, the aerobic glycolysis mediated by PFKFB3 and collagen synthesis in LPS-treated MRC-5 cells was gradually inhibited with increasing concentrations of metformin. However, this inhibitory role of metformin on PFKFB3-meditaed aerobic glycolysis and collagen synthesis was prevented by treatments with 3BDO and compound C, which are specific mTOR activator and AMPK inhibitor, respectively. Taken together, the findings from this study suggested that metformin may prevent PFKFB3-associated aerobic glycolysis from enhancing collagen synthesis in lung fibroblasts via regulating the AMPK/mTOR pathway.
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http://dx.doi.org/10.3892/etm.2021.10013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027738PMC
June 2021

Anomalous edge response of cadmium telluride-based photon counting detectors jointly caused by high-flux radiation and inter-pixel communication.

Phys Med Biol 2021 Apr 14;66(8). Epub 2021 Apr 14.

Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America.

This work reports an edge enhancing effect experimentally observed in cadmium telluride (CdTe)-based photon counting detector (PCD) systems operated under the charge summing (CS) mode and irradiated by high-flux x-rays. Experimental measurements of the edge spread functions (ESFs) of a PCD system (100m pixel size, 88 ns deadtime) were performed at different input flux levels from 4.5 × 10count per second (cps) mmto 1.5 × 10cps mmfor the single pixel mode (SP) and the CS mode. A theoretical model that incorporates the impacts of inter-pixel communications and the arbitration process involved in the CS mode was developed to help explain the physical origin of the observed edge enhancing effect. Compared with the monotonically increasing ESF of the SP mode, the ESF of the CS mode measured at high-flux levels shows a peak at an intermediate location (50m from the edge). The peak became more pronounced with increasing flux levels. The theoretically calculated ESFs agreed well with experimental results with relative errors less than 5% at all flux levels and tested. These results indicate that the anomalous edge enhancing effect is jointly caused by the pileup effect and the CS circuit that introduces negative correlations between adjacent pixels. When the input flux is high enough to deliver photons to multiple adjacent pixels within the same deadtime period, the CS mode may treat the coincident x-rays as shared charges and thus introduce count losses in addition to the well-known pileup count loss. When a high contrast object partially blocks certain pixels from x-rays, the adjacent unblocked pixels have an increased probability of registering counts as a result of the negative correlation. This leads to a peak on the ESF at a pixel-to-edge distance half of the pixel pitch.
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http://dx.doi.org/10.1088/1361-6560/abf1feDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086811PMC
April 2021

Comprehensive Machine Learning-Based Model for Predicting Compressive Strength of Ready-Mix Concrete.

Materials (Basel) 2021 Feb 25;14(5). Epub 2021 Feb 25.

Department of Chemical Engineering, Sichuan University, Chengdu 610065, China.

Considering that compressive strength (CS) is an important mechanical property parameter in many design codes, in order to ensure structural safety, concrete CS needs to be tested before application. However, conducting CS tests with multiple influencing variables is costly and time-consuming. To address this issue, a machine learning-based modeling framework is put forward in this work to evaluate the concrete CS under complex conditions. The influential factors of this process are systematically categorized into five aspects: man, machine, material, method and environment (4M1E). A genetic algorithm (GA) was applied to identify the most important influential factors for CS modeling, after which, random forest (RF) was adopted as the modeling algorithm to predict the CS from the selected influential factors. The effectiveness of the proposed model was tested on a case study, and the high Pearson correlation coefficient (0.9821) and the low mean absolute percentage error and delta (0.0394 and 0.395, respectively) indicate that the proposed model can deliver accurate and reliable results.
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http://dx.doi.org/10.3390/ma14051068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956418PMC
February 2021

Etanercept as a new therapeutic option for cytokine release syndrome following chimeric antigen receptor T cell therapy.

Exp Hematol Oncol 2021 Feb 19;10(1):16. Epub 2021 Feb 19.

Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.

Cytokine release syndrome (CRS) is the most common toxicity induced by chimeric antigen receptor (CAR) T cell therapy. At present, anti-IL-6 agents including tocilizumab and siltuximab have been applied in the treatment of CRS. However, tocilizumab and siltuximab are expensive and some patients fail to respond to anti-IL-6 therapy, which urges the need for new drugs. In clinical practice, we found some patients with multiple myeloma developed markedly increased levels of tumor necrosis factor (TNF)- α during the CRS period after anti-BCMA CAR T cell infusion. Here we present the successful use of TNF-α inhibitor (etanercept) to cure CRS in three patients. The introduction of etanercept did not alter patients' response to CAR T cell therapy and no adverse event was observed directly related to the administration of etanercept. Furthermore, in vitro experiments confirmed that etanercept did not affect the proliferation and effector function of CAR T cells. Our results indicate that etanercept could be considered as a treatment option for CRS in patients with significantly elevated TNF-α levels.
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http://dx.doi.org/10.1186/s40164-021-00209-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893957PMC
February 2021

Identification of a Novel Mutation in the Runt-Related Transcription Factor 2 Gene in a Chinese Family With Cleidocranial Dysplasia.

J Craniofac Surg 2021 Feb 2. Epub 2021 Feb 2.

Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, School of Stomatology, and Key Laboratory of Oral Biomedical Research of Zhejiang Province The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China.

Abstract: Cleidocranial dysplasia (CCD) is an uncommon autosomal dominant disease, characterized by hypoplasia of clavicles, delayed fontanelle closure, dental anomalies, and short stature. It has been reported in the literature that the pathogenic variants of Runt-related transcription factor 2 (RUNX2) gene are correlated with CCD patients.Here, we report a consanguineous Chinese family with 2 patients suffering from CCD, presenting similar skeleton and dentition malformation. Upon whole-exome sequencing, 52863 variants were detected in the propositus. Based on the genotype phenotype correlation, a frameshift deletion c.1554delG p.(Trp518Cysfs*61), located in exon 8 of RUNX2, remained after filtration. For Sanger sequencing, all exons of the RUNX2 gene in members of this Chinese family were amplified by polymerase chain reaction. Mutation mentioned above was confirmed in the propositus and his mother, which has not been reported previously and cannot be found in the publicly available databases. The present study expands the pathogenic variant spectrum of RUNX2 gene and contributes to molecular diagnosis.
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http://dx.doi.org/10.1097/SCS.0000000000007510DOI Listing
February 2021

Peripheral blood eosinophil levels in chronic rhinosinusitis and its predictive value in eosinophilic chronic rhinosinusitis.

Acta Otolaryngol 2021 Apr 7;141(4):386-391. Epub 2021 Jan 7.

Department of Otorhinolaryngology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

Background: The prevalence of eosinophilic CRSwNP in China has increased significantly over the last 20 years, noninvasive methods that could assist in diagnosis are urgently needed.

Aims: The aim of this study is to explore the clinical significance of peripheral blood eosinophil in diagnosing ECRS.

Materials And Methods: We conducted a prospective study of 221 patients diagnosed with CRS. Lund-Mackay score, peripheral blood eosinophil absolute count, peripheral blood eosinophil percentage were detection to compare the clinical features with ECRS and non-ECRS. ROC curve was performed to assess the efficiency of clinical index to predict ECRS.

Results: The ECRS group of patients had significantly higher scores compared with those of the non-ECRS group. Different extent and severity of mucosal thickening on total Lund-Mackay scores, anterior ethmoidal, posterior ethmoidal and ostiomeatal complex have confirmed different blood eosinophil levels in CRS patients. The combination of peripheral blood eosinophil percentage and posterior ethmoidal score to predict ECRS was 0.807.

Conclusions And Significance: The increase in peripheral blood eosinophil percent indicates the deterioration the inflammation of chronic rhinosinusitis and the level of posterior ethmoidal score and peripheral blood eosinophil percentage have a positive predictive value regarding ECRS identification.
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http://dx.doi.org/10.1080/00016489.2020.1862910DOI Listing
April 2021

Association Between State Policies on Improving Opioid Prescribing in 2 States and Opioid Overdose Rates Among Reproductive-aged Women.

Med Care 2021 02;59(2):185-192

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.

Background: The opioid overdose epidemic has been declared a public health emergency. Women are more likely than men to be prescribed opioid medications. Some states have adopted policies to improve opioid prescribing, including prescription drug monitoring programs (PDMPs) and pain clinic laws.

Objective: Among reproductive-aged women, we examined the association of mandatory use laws for PDMPs in Kentucky (concurrent with a pain clinic law) and New York with overdose involving prescription opioids or heroin and opioid use disorder (OUD).

Study Design, Subjects, And Outcome Measures: We conducted interrupted time series analyses estimating outcome changes after policy implementation in Kentucky and New York, compared with geographically close states without these policies (comparison states), using 2010-2014 State Inpatient and State Emergency Department Databases. Outcomes included rates of inpatient discharges and emergency department visits for overdoses involving prescription opioids or heroin and OUD among reproductive-aged women.

Results: Relative to comparison states, following Kentucky's policy change, we found an immediate postpolicy decrease and a decreasing trend in the rate of overdoses involving prescription opioids, an immediate postpolicy increase in the rate of overdoses involving heroin, and a decreasing trend in the OUD rate (P<0.01); New York's policy change was not associated with the assessed outcomes.

Conclusions: PDMPs and pain clinic laws, such as those implemented in Kentucky, may be promising strategies to reduce the adverse impacts of high-risk opioid prescribing among reproductive-aged women. As states continue efforts to improve inappropriate opioid prescribing, similar strategies as those adopted in Kentucky merit consideration.
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http://dx.doi.org/10.1097/MLR.0000000000001475DOI Listing
February 2021

The prognostic role of plasma fibrinogen in adult secondary hemophagocytic lymphohistiocytosis.

Orphanet J Rare Dis 2020 11 25;15(1):332. Epub 2020 Nov 25.

Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing, 210029, China.

Background: In adult patients with secondary hemophagocytic lymphohistiocytosis (sHLH), no valid immune biomarker has been available for predicting the prognosis of untreated sHLH patients.

Methods: Circulating plasma levels of fibrinogen (FIB) were measured at diagnosis in 293 cases of adult sHLH. We categorized FIB levels into tertiles. Multivariable Cox proportional hazards models were used to evaluate the relationship between FIB and survival. Restricted cubic spline models and two-piecewise Cox proportional hazards models were used to address the nonlinear association between FIB and mortality.

Results: During a median follow-up of 52 (interquartile ranges, 18-221) days, 208 deaths occurred, with 137 deaths in malignancy-associated hemophagocytic lymphohistiocytosis (MHLH) and 71 deaths in non-malignancy-associated hemophagocytic lymphohistiocytosis (non-MHLH). After multivariable adjustment, compared with the highest tertile of FIB, the hazard ratios (HRs) with 95% confidence intervals (CIs) of survival for tertile 2 and tertile 1 were 1.06 (0.90-1.24) and 0.84 (0.71-0.98), respectively. The restricted cubic spline curve displayed a nonlinear and inverse relationship between FIB and mortality. Furthermore, the threshold effect analysis demonstrated that the inflection point for the curve was at an FIB level of 1.76 g/L. The HRs (95% CIs) for survival were 0.68 (0.55-0.83) and 1.08 (0.96-1.21) on the left and right side of the inflection point, respectively.

Conclusions: These results suggest that plasma fibrinogen is nonlinearly and inversely associated with the risk of mortality in adult secondary hemophagocytic lymphohistiocytosis.
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http://dx.doi.org/10.1186/s13023-020-01622-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690012PMC
November 2020

Rewiring Central Carbon Metabolism Ensures Increased Provision of Acetyl-CoA and NADPH Required for 3-OH-Propionic Acid Production.

ACS Synth Biol 2020 12 13;9(12):3236-3244. Epub 2020 Nov 13.

Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, 100029 Beijing, China.

The central carbon metabolite acetyl-CoA and the cofactor NADPH are important for the synthesis of a wide array of biobased products. Here, we constructed a platform yeast strain for improved provision of acetyl-CoA and NADPH, and used the production of 3-hydroxypropionic acid (3-HP) as a case study. We first demonstrated that the integration of phosphoketolase and phosphotransacetylase improved 3-HP production by 41.9% and decreased glycerol production by 48.1% compared with that of the control strain. Then, to direct more carbon flux toward the pentose phosphate pathway, we reduced the expression of phosphoglucose isomerase by replacing its native promoter with a weaker promoter, and increased the expression of glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase by replacing their native promoters with stronger promoters. This further improved 3-HP production by 26.4%. Furthermore, to increase the NADPH supply we overexpressed cytosolic aldehyde dehydrogenase, and improved 3-HP production by another 10.5%. Together with optimizing enzyme expression of acetyl-CoA carboxylase and malonyl-CoA reductase, the final strain is able to produce 3-HP with a final titer of 864.5 mg/L, which is a more than 24-fold improvement compared with that of the starting strain. Our strategy combines the PK pathway with the oxidative pentose phosphate pathway for the efficient provision of acetyl-CoA and NADPH, which provides both a higher theoretical yield and overall yield than the reported yeast-based 3-HP production strategies the malonyl-CoA reductase-dependent pathway and sheds light on the construction of efficient platform cell factories for other products.
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http://dx.doi.org/10.1021/acssynbio.0c00264DOI Listing
December 2020

Evaluation of the efficacy and safety of fire needle compared to filiform needle on knee osteoarthritis: study protocol for a randomized controlled trial.

Trials 2020 Nov 4;21(1):911. Epub 2020 Nov 4.

Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, China.

Background: Knee osteoarthritis is a common clinical chronic degenerative disease associated with high morbidity and long-term disability. Previous studies have confirmed the efficacy of acupuncture on knee osteoarthritis. Fire needle acupuncture is a combination of heat and acupuncture, which may be more effective than the commonly used filiform needle acupuncture. This study is designed as a randomized controlled trial to evaluate the efficacy and safety of fire needle acupuncture compared to filiform needle acupuncture in knee osteoarthritis patients.

Methods And Analysis: This is a prospective randomized controlled superiority clinical trial to evaluate the efficacy and safety of fire needle acupuncture compared to filiform needle acupuncture for knee osteoarthritis. A total of 100 participants will be randomly assigned to two different groups. Participants will receive fire needle acupuncture treatment in the fire needle group, while participants in the filiform needle group will be treated with a filiform needle at the same acupuncture points as the fire needle group. All participants will receive 6 weeks of treatment (2 times per week). The primary outcome is the change of the Western Ontario and McMaster Universities Osteoarthritis Index, and the secondary outcomes include the change of the visual analog scale and 12-item Short Form Health Survey from baseline to endpoint.

Ethics And Dissemination: Ethical approval of this study was granted by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University (2018SB-066). Written informed consent will be obtained from all participants. Outcomes of the trial will be disseminated through peer-reviewed publications.

Trial Registration: Chinese Clinical Trial Registry ChiCTR1800019579 . Registered on November 18, 2018.
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http://dx.doi.org/10.1186/s13063-020-04827-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640691PMC
November 2020

Healthcare Costs of Pediatric Autism Spectrum Disorder in the United States, 2003-2015.

J Autism Dev Disord 2020 Oct 28. Epub 2020 Oct 28.

Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.

Published healthcare cost estimates for children with autism spectrum disorder (ASD) vary widely. One possible contributor is different methods of case ascertainment. In this study, ASD case status was determined using two sources of parent reports among 45,944 children ages 3-17 years in the Medical Expenditure Panel Survey (MEPS) linked to the National Health Interview Survey (NHIS) Sample Child Core questionnaire. In a two-part regression model, the incremental annual per-child cost of ASD relative to no ASD diagnosis was $3930 (2018 US dollars) using ASD case status from the NHIS Child Core and $5621 using current-year ASD case status from MEPS. Both estimates are lower than some published estimates but still represent substantial costs to the US healthcare system.
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http://dx.doi.org/10.1007/s10803-020-04704-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079509PMC
October 2020

Precise targeting of miR-141/200c cluster in chondrocytes attenuates osteoarthritis development.

Ann Rheum Dis 2020 Oct 27. Epub 2020 Oct 27.

Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China

Objectives: Despite preclinical studies involving miRNA therapeutics conducted in osteoarthritis (OA) over the years, none of these miRNAs have yet translated to clinical applications, owing largely to the lack of efficient intra-articular (IA) delivery systems. Here, we investigated therapeutic efficacy of the chondrocyte-specific aptamer-decorated PEGylated polyamidoamine nanoparticles (NPs)-based miRNAs delivery for OA.

Methods: The role of miR-141/200c cluster during skeletal and OA development was examined by miR-141/200c mice and Col2a1-CreER; miR-141/200c mice. Histological analysis was performed in mouse joints and human cartilage specimens. Chondrocyte-specific aptamer-decorated NPs was designed, and its penetration, stability and safety were evaluated. OA progression was assessed by micro-CT analysis, X-ray and Osteoarthritis Research Society International scores after destabilising the medial meniscus surgery with miR-141/200c manipulation by NPs IA injection. Mass spectrometry analysis, molecular docking and molecular dynamics simulations were performed to investigate the interaction between aptamer and receptor.

Results: Increased retention of NPs inside joint space is observed. The NPs are freely and deeply penetrant to mice and human cartilage, and unexpectedly persist in chondrocytes for at least 5 weeks. OA chondrocytes microenviroment improves endo/lysosomal escape of microRNAs (miRNAs). Therapeutically, IA injection of miR-141/200c inhibitors provides strong chondroprotection, whereas ectopic expression of miR-141/200c exacerbates OA. Mechanistically, miR-141/200c promotes OA by targeting SIRT1, which acetylates histone in the promoters of interleukin 6 (IL-6), thereby activating IL-6/STAT3 pathway.

Conclusions: Our findings indicate that this nanocarrier can optimise the transport kinetics of miR-141/200c into chondrocytes, fostering miRNA-specific disease-modifying OA drugs development.
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http://dx.doi.org/10.1136/annrheumdis-2020-218469DOI Listing
October 2020

Spending on Young Children With Autism Spectrum Disorder in Employer-Sponsored Plans, 2011-2017.

Psychiatr Serv 2021 01 20;72(1):16-22. Epub 2020 Oct 20.

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta (Grosse, Nichols, Yeargin-Allsopp); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (Ji); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland (Zuvekas); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Rice). This work was performed when Dr. Ji was a Prevention Effectiveness Fellow at the CDC.

Objective: Rapid increases in the prevalence of autism spectrum disorder (ASD) and increased access to intensive behavioral interventions have likely increased health care spending. This study estimated recent changes in spending among privately insured children with and without current ASD.

Methods: A repeated cross-sections analysis of 2011-2017 claims data from large-employer-sponsored health plans assessed changes in annual expenditures by service type for children ages 3-7 enrolled for ≥1 year and with two or more claims with ASD billing codes within a calendar year and for all other children.

Results: Mean spending per child with a current-year ASD diagnosis increased by 51% in 2017 U.S. dollars, from roughly $13,000 in 2011 to $20,000 in 2017. Among children who did not meet the current-year ASD case definition, per-child spending increased by 8%. Spending on children with ASD accounted for 41% of spending growth for children ages 3-7 during 2011-2017. Outpatient behavioral intervention-related spending per child with ASD increased by 376%, from $1,746 in 2011 to $8,317 in 2017; spending on all other services increased by 2%. Their share of behavioral intervention-related spending increased from 13.2% in 2011 to 41.7% in 2017. In 2011, 2.5% of children with current-year ASD diagnoses incurred ≥$20,000 in outpatient behavioral intervention-related spending, which increased to 14.4% in 2017.

Conclusions: During 2011-2017, spending increased six times as much for privately insured children ages 3-7 with current-year ASD as for children without ASD, largely from increased behavioral intervention-related spending. One in seven children received at least $20,000 in services in 2017.
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http://dx.doi.org/10.1176/appi.ps.202000099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879423PMC
January 2021

[The Embryo Toxicity Research of Manufacturing Water of Medical Device of Fertilization Technology].

Zhongguo Yi Liao Qi Xie Za Zhi 2020 Oct;44(5):439-442

National Institute of Food and Drug Control, Beijing, 102629.

Water is an important component in liquid medical device products for human assisted reproductive technology. Water traits, conductivity, microbial limits, total organic carbon, easy oxides, heavy metal content, bacterial endotoxin and other indicators have an important impact on sperm, egg and embryo development , so for such products, the quality of water control is extremely important. The production water for producing such products is generally prepared by MilliQ purification system. In this research, we used four different types of water to fabricate the IVF liquids. It included deionized reverse osmosis water, ultra purified water and ultra purified water without endotoxin or nucleic acid, and compared with tap water. The rat embryo test system was used to study the embryotoxicity of this four different culture liquid production waters. From the result, the group of the super purified water without endotoxin and nucleic acid has the best result of the embryo formation rate, the number of total cell number and the inner cell number. This study proved the importance of removing endotoxin and nucleic acid from the water used for the preparation of the liquid products for assisted reproduction, and provided the basis for the selection of water quality for the liquid products for assisted reproduction.
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http://dx.doi.org/10.3969/j.issn.1671-7104.2020.05.014DOI Listing
October 2020

Clinical features of 47 secondary hemophagocytic lymphohistiocytosis patients complicated with capillary leak syndrome.

Int J Hematol 2021 Feb 9;113(2):263-270. Epub 2020 Oct 9.

Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.

The clinical features of patients with secondary hemophagocytic lymphohistiocytosis (sHLH) complicated with capillary leak syndrome (CLS) remain controversial. The data of 259 sHLH patients were retrospectively analyzed. The clinical manifestations, laboratory findings, treatment, and prognosis of the CLS-sHLH group and non-CLS-sHLH group were compared. The levels of fibrinogen, albumin, and serum calcium in the CLS-sHLH group were lower than in the non-CLS-sHLH group, and serum triglycerides in the CLS-sHLH group were higher than in the non-CLS-sHLH group (P < 0.05). Univariate analysis showed that fibrinogen level was an independent prognostic factor in sHLH patients complicated with CLS. The median survival time was significantly shorter in patients with fibrinogen ≤ 1.3 g/L than in patients with fibrinogen > 1.3 g/L (P < 0.05). Patients with improved CLS conditions in the CLS-sHLH group had significantly increased albumin and serum calcium after treatment (P < 0.05); patients without improved conditions in the CLS-sHLH group also had significantly increased albumin after treatment (P < 0.05), but the serum calcium did not change significantly (P > 0.05). sHLH patients complicated with CLS had significantly worse prognosis than without CLS. Significant reduction in fibrinogen may be an independent prognostic factor for poor prognosis in sHLH patients complicated with CLS.
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http://dx.doi.org/10.1007/s12185-020-03011-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546163PMC
February 2021

Experimental Evidence on Stability of N Substitution for O in ZnO Lattice.

J Phys Chem Lett 2020 Oct 6;11(20):8901-8907. Epub 2020 Oct 6.

School of Materials, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.

Although the dispute remains, the N substitution for the lattice O (N) in zinc oxide (ZnO) demonstrates the promising future in achieving the p-type ZnO-based semiconductor. In this context, a highly crystallized N-doped ZnO (ZnO:N) film is fabricated with ultralow defect density. Based on the synchrotron radiation X-ray absorption near-edge structure (XANES) and low-temperature photoluminescence (PL) spectra combined with first-principles calculations, the results demonstrate that the majority of N ions locate stably at the lattice O site to succeeding the N substitution for lattice O as the N defects. A prototype LED device is built based on the homojunction of ZnO:N film and ZnO:Ga wafer with good electroluminescence performance. These important findings provide a rewarding avenue to the p-type ZnO semiconductor design and device fabrication, and demonstrate a prevailing guidance on the materials design and development as well.
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http://dx.doi.org/10.1021/acs.jpclett.0c02698DOI Listing
October 2020

A Feature Optimization Approach Based on Inter-Class and Intra-Class Distance for Ship Type Classification.

Sensors (Basel) 2020 Sep 22;20(18). Epub 2020 Sep 22.

Key laboratory of Speech Acoustics and Content Understanding, Institute of Acoustics, Chinese Academy of Sciences, Beijing 100190, China.

Deep learning based methods have achieved state-of-the-art results on the task of ship type classification. However, most existing ship type classification algorithms take time-frequency (TF) features as input, the underlying discriminative information of these features has not been explored thoroughly. This paper proposes a novel feature optimization method which is designed to minimize an objective function aimed at increasing inter-class and reducing intra-class feature distance for ship type classification. The objective function we design is able to learn a center for each class and make samples from the same class closer to the corresponding center. This ensures that the features maximize underlying discriminative information involved in the data, particularly for some targets that usually confused by the conventional manual designed feature. Results on the dataset from a real environment show that the proposed feature optimization approach outperforms traditional TF features.
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http://dx.doi.org/10.3390/s20185429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570517PMC
September 2020

Prenatal diagnosis of a rare β-thalassemia gene -90 (C>T) (HBB: c.-140 C>T) mutation associated with deletional Hb H disease (-- /-α ).

Mol Genet Genomic Med 2020 11 3;8(11):e1472. Epub 2020 Sep 3.

The Medical Genetics & Molecular Diagnosis Laboratory, Shenzhen, China.

Background: Hemoglobin H (Hb H) disease can be caused by compound heterozygosity for two different mutations or from homozygotes for mutations, and conventional genetic methods may lead to misdiagnosis when Hb H disease is combined with a rare β-thalassemia.

Methods: Hematology parameters and hemoglobin electrophoresis analysis, gap-polymerase chain reaction (gap-PCR) and reverse dot-blot hybridization (RDB-PCR) were employed to identify common α-thalassemia and Hb H disease. Rare β-thalassemia mutations were detected by DNA sequencing.

Results: Hematological analysis and hemoglobin electrophoresis revealed a mild anemia α -thalassemia trait (Hb 90 g/L, MCV 71 fL, and MCH 22.7 pg) compound with β -thalassemia trait (MCV 71 fL, MCH 22.7 pg, and HbA2 5.51%) for the pregnant woman. DNA sequencing for the β-globin gene revealed rare a -90 (C>T) (HBB: c.-140 C>T) mutation for the woman. DNA analysis identified that the fetus inherited the α -thalassemia mutation [-- (Southeast Asian)] and a rare β -thalassemia mutation -90 (C>T) (HBB: c.-140 C>T) from the mother, and the α -thalassemia mutation [-α (leftward)] from the father.

Conclusion: We reported a rare -90 (C>T) (HBB: c.-140 C>T) mutation combined with the -- /-α in a family. This finding enriched the mutation spectrum of thalassemia molecular characteristics in China and emphasized the significance in DNA sequencing in mutation screening for the families with thalassemia.
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http://dx.doi.org/10.1002/mgg3.1472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667371PMC
November 2020

Association of smoke-free laws with preterm or low birth weight deliveries-A multistate analysis.

Health Serv Res 2021 Feb 2;56(1):61-72. Epub 2020 Sep 2.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: To assess the association between the change in statewide smoke-free laws and the rate of preterm or low birth weight delivery hospitalizations.

Data Source: 2002-2013 Healthcare Cost and Utilization Project State Inpatient Databases.

Study Design: Quasi-experimental difference-in-differences design. We used multivariate logistic models to estimate the association between the change in state smoke-free laws and preterm or low birth weight delivery hospitalizations. The analyses were also stratified by maternal race/ethnicity to examine the differential effects by racial/ethnic groups.

Data Collection/extraction Methods: Delivery hospitalizations among women aged 15-49 years were extracted using the International Classification of Diseases, Ninth Revision, and Diagnosis-Related Group codes.

Principal Findings: Non-Hispanic black mothers had a higher rate of preterm or low birth weight delivery hospitalization than other racial/ethnic groups. Overall, there was no association between the change in smoke-free laws and preterm or low birth weight delivery rate. Among non-Hispanic black mothers, the change in statewide smoke-free laws was associated with a 0.9-1.9 percentage point (P < .05) reduction in preterm or low birth weight delivery rate beginning in the third year after the laws took effect. There was no association among non-Hispanic white mothers. A decline in the black-white disparity of 0.6-1.6 percentage points (P < .05) in preterm or low birth weight delivery rates was associated with the change in state smoke-free laws.

Conclusion: The change in state smoke-free laws was associated with a reduction in racial/ethnic disparities in preterm or low birth weight delivery hospitalizations in selected US states.
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http://dx.doi.org/10.1111/1475-6773.13552DOI Listing
February 2021

Piperlongumine inhibits head and neck squamous cell carcinoma proliferation by docking to Akt.

Phytother Res 2020 Dec 15;34(12):3345-3358. Epub 2020 Aug 15.

Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of China Medical University, Shenyang, China.

Piperlongumine (PL) is a biologically active alkaloid isolated from the long pepper roots and widely used as a traditional medicine in Ayurvedic medicine. However, the mechanism of PL's effect on head and neck squamous cell carcinoma (HNSCC) is not well understood. We performed cell experiments to confirm PL's inhibitory effect on HNSCC and employing cisplatin as positive control. Next, we conducted bioinformatics to predict PL's potential targets and verified by western blotting. Molecular docking, Biacore experiment and kinase activity assays were applied to elucidate the mechanism by which PL inhibited target activity. In vivo efficacy was verified by xenotransplantation and immunohistochemistry. PL inhibited proliferation, promoted late apoptosis, arrested cell cycle and inhibited DNA replication of the HEp-2 and FaDu cell lines. Employing bioinformatics, we found that PL's target was Akt and PL attenuated Akt phosphorylation. We found from molecular docking, Biacore experiment and kinase activity assay that PL inhibited Akt activation by docking to Akt to restrain its activity. In addition, PL significantly inhibited the growth of xenograft tumors by down regulating the expression of p-Akt in vivo. This study provides new insights into the molecular functions of PL and indicate its potential as a therapeutic agent for HNSCC.
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http://dx.doi.org/10.1002/ptr.6788DOI Listing
December 2020

Urgency Promotes Affective Disengagement: Effects From Bivalent Cues on Preference Formation for Abstract Images.

Front Psychol 2020 23;11:1404. Epub 2020 Jun 23.

Graduate School of Systems Life Sciences, Kyushu University, Fukuoka, Japan.

Although previous research has characterized the important role for spatial and affective pre-cues in the control of visual attention, less is known about the impact of pre-cues on preference formation. In preference formation, the gaze cascade phenomenon suggests that the gaze serves both to enhance and express "liking" during value-based decision-making. This phenomenon has been interpreted as a type of Pavlovian approach toward preferred objects. Decision-making here reflects a process of gradual commitment in which the gaze functions as a precursor to choice; by this account, overt attention produces a necessarily positive, additive effect on the value of the attended object. The implication is that drawing attention to an object should initiate, and therefore promote, preference formation for that object. Alternatively, information-integration models of attention propose that attention produces a multiplicative effect on the value of the attended object, implying that negative information can impede preference formation. To pitch the gradual-commitment hypothesis against the information-integration hypothesis, we conducted four experiments that combined the spatial-cueing paradigm with a value-based choice paradigm. In each trial in all experiments, subjects were presented with an irrelevant, peripheral pre-cue for a duration of 500 ms, followed by a 500 ms blank, and then a pair of abstract images (one at the pre-cued position; one in the opposite hemifield). The subjects were asked to choose their preferred abstract image by pressing the corresponding button. We manipulated the type of pre-cues (images of faces versus foods; with varying affective associations) and the time constraints (a deadline of 1,500 ms versus self-paced). Overall, the choice data showed a clear pattern of influence from the pre-cues, such that, given a deadline, abstract images were chosen less often if they had been preceded by a pre-cue with a negative affective association (both for face and food images). Analyses of the gaze data showed the emergence of significant gaze biases in line with the subjects' choices. Taken together, the data pattern provided support for the information-integration hypothesis, particularly under urgency. When tasked with a speeded preference choice, subjects showed affective disengagement following pre-cues that carried a negative association.
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http://dx.doi.org/10.3389/fpsyg.2020.01404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325338PMC
June 2020

Low T3 syndrome is a prognostic marker of poor outcomes in secondary hemophagocytic lymphohistiocytosis.

Leuk Lymphoma 2020 12 9;61(12):2947-2954. Epub 2020 Jul 9.

Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.

This study aimed to examine the association between low T3 syndrome and overall survival (OS) in patients with secondary hemophagocytic lymphohistiocytosis (sHLH). The study consisted of 111 consecutive patients hospitalized due to newly diagnosed sHLH with detailed thyroid hormone profiles on admission. Low T3 syndrome was found in 75.7% of the studied sHLH population. After a median follow-up of 83 (interquartile range 25-365) days, there were 60 (71.4%) cumulative deaths in the low T3 syndrome group and 13 (48.1%) in the euthyroid group. Survival analysis showed a lower survival probability for patients with low FT3 than for those with normal FT3 (median OS, 60 vs. 365 days,  = .011). In the multivariate analysis, low T3 syndrome was an independent prognostic factor for OS (HR = 2.474; 95% CI 1.351-4.532,  = .003). Low T3 syndrome is frequently found and associated with worse outcomes in patients with sHLH.
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http://dx.doi.org/10.1080/10428194.2020.1789623DOI Listing
December 2020

Capsule Commentary on Nelson et al., Changes in Coverage, Access, and Health Following Implementation of Healthy Behavior Incentive Medicaid Expansions vs. Traditional Medicaid Expansions.

Authors:
Xu Ji

J Gen Intern Med 2020 09;35(9):2832

Department of Pediatrics, Emory University School of Medicine / Children's Healthcare of Atlanta, Atlanta, GA, USA.

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http://dx.doi.org/10.1007/s11606-020-06003-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458952PMC
September 2020