White Protein Research Articles

Antimicrobial Defenses of Table Eggs: Importance of Antibacterial Proteins in Egg White as a Function of Hen Age in an Extended Production Cycle

Antimicrobial Defenses of Table Eggs: Importance of Antibacterial Proteins in Egg White as a Function of Hen Age in an Extended Production Cycle

Preparation of a boronate affinity-functionalized metal–organic framework material for selective recognition and separation of glycoproteins at physiological pH

A boronate affinity functionalized metal–organic framework material was successfully prepared for the efficient and selective extraction of OVA glycoprotein from egg white samples and protein powder.

Increased serum citrullinated histone H3 levels in COVID-19 patients with acute ischemic stroke

Prevalence of acute ische­mic stroke (AIS) is increased in patients with coronavirus disease 2019 (COVID-19). A proposed hypothesis is increased virus-induced propensity to hypercoagulation resulting in arterial thrombosis. Our aim was to provide evidence regarding the involvement of neutrophil extracellular trap (NET) formation (NETosis) in COVID-19 related AIS. Twenty-six consecutively enrolled COVID-19+ pneumonia patients with AIS, 32 COVID-19+ pneumonia patients without AIS and 24 AIS patients without COVID-19 infection were included to the study. Clinical characteristics of recruited patients were collected. Serum levels of citrullinated histone H3 (H3Cit; a factor of NETosis), IL-8 and C5a (mediators associated with NETosis) were measured by ELISA (enzyme-linked immunosorbent assay). H3Cit levels were significantly higher in COVID-19+ AIS patients, whereas all study groups showed comparable IL-8 and C5a levels. There were no significant differences among etiological subgroups of AIS patients with or without COVID-19. AIS patients with COVID-19 showed relatively increased white blood cell, lymphocyte, neutrophil, D-dimer, C-reactive protein and procalcitonin levels than control groups. H3Cit levels did not correlate with clinical/prognostic features and inflammation parameters. H3Cit and IL-8 levels were correlated in COVID-19 patients without stroke but not in COVID-19 positive or negative AIS patients. Increased levels of inflammation parameters and H3Cit in COVID-19 related AIS suggest that NETosis may cause susceptibility to arterial thrombosis. However, H3Cit levels do not correlate with clinical severity measures and inflammation parameters diminishing the prognostic biomarker value of NETosis factors. Moreover, the link between IL-8 and NETosis appears to be abolished in AIS.

Predictive accuracy of blood inflammatory markers on COVID-19 mortality

Background: The impact of COVID-19 may be more severe in developing countries. Our study aims to analyze the accuracy of several inflammatory biomarkers in predicting COVID-19 mortality, providing information about the most suitable markers for developing countries.
 Methods: A retrospective cohort study was conducted at Dr. Soetomo General Hospital, Indonesia, from March to June 2020. White Blood Cells (WBC) count, Neutrophil-Lymphocyte Ratio (NLR), Procalcitonin (PCT), D-Dimer, and C-Reactive Protein (CRP) have been collected from the electronic medical records. We performed survival analysis to provide the hazard ratio and Receiver Operating Characteristic (ROC) curve analysis to test for accuracy for each parameter.
 Results: A total of 423 patients who met the criteria for participating had a median age of 54 (IQR 45-61) years. Patients in the death group are characterized by older age and shorter length of hospitalization. The WBC, NLR, PCT, D-Dimer, and CRP are found significantly higher in the death group (P=0.000). The WBC, NLR, PCT, D-Dimer, and CRP have an Area Under the Curve (AUC) of 0.709, 0.773, 0.738, 0.721, and 0.769, respectively moderate accuracy in predicting COVID-19 patient mortality. We found that NLR is significantly more accurate than the age parameter (Z=3.527; P=0.000) but has equal accuracy with other laboratory parameters. 
 Conclusions: Since NLR obtained the highest accuracy, we still recommend routine complete blood count tests as prognostic biomarkers with the highest feasibility to be performed in developing countries.

Development and evaluation of potential functional food biscuits made from White Lupin

Abstract Potential functional food bakery products were developed and characterized based on White Lupin (Lupinus albus cv. Nelly) flour. Analytical properties of the seeds resemble to previously described Lupinus species, with significantly high protein content (45%). The high protein and dietetic fiber content of the seeds makes Lupin flour suitable to develop potential functional food products with high nutritional values. Results of the development of sweet biscuits and salty crackers enriched with Lupin flour are presented. Sensory evaluation of the bakery products was carried out by 15 panelists using the nine points hedonic scale. Heat stability of White Lupin proteins were investigated by gel-electrophoretic analysis, White Lupin proteins are quite stable at 140°C, after 35 min heating the biscuits still contain 69% of the original amount of proteins. Baking conditions were optimized also based on gel-electrophoretic experiments, the optimal baking time was 30 min at 140°C. Gluten-free Lupin-based biscuits and crackers were produced by completely omitting wheat flour from the recipes.

Eosinophilia during Hantavirus infection: a cohort study

Background There are emerging eosinophil-related considerations concerning viral infections. The role of eosinophils has poorly been evaluated during Hantavirus infection. Methods The aim of this study was to determine the prevalence of eosinophilia (defined as an eosinophil count above 500 cells/mm3) during haemorrhagic fever with renal syndrome (HFRS) in a large cohort of patients, and to identify factors associated with eosinophilia. Results Among 387 patients hospitalized for HFRS, 98 (25.3%) had eosinophilia. By univariate analysis, eosinophilia was significantly associated with more severe thrombocytopenia, high C-reactive protein level, white blood cell count and neutrophil count and lower nephrotoxic drug intake. As there was a collinearity between white blood cell count and C-reactive protein level, only C-reactive protein level with platelet count and nephrotoxic drug intake were entered in the multivariable analysis. Elevated C-reactive protein concentrations remained independently associated with eosinophilia. Conclusion Eosinophilia during HFRS affects one quarter of patients, and supports the role of eosinophils in antiviral immunity against hantavirus infection.

Pneumonic-type lung adenocarcinoma with different ranges exhibiting different clinical, imaging, and pathological characteristics

BackgroundPneumonic-type lung adenocarcinoma (PLADC) with different ranges might exhibit different imaging and clinicopathological features. This study divided PLADC into localized PLADC (L-PLADC) and diffuse PLADC (D-PLADC) based on imaging and aimed to clarify the differences in clinical, imaging, and pathologic characteristics between the two new subtypes.ResultsThe data of 131 patients with L-PLADC and 117 patients with D-PLADC who were pathologically confirmed and underwent chest computed tomography (CT) at our institute from December 2014 to December 2020 were retrospectively collected. Patients with L-PLADC were predominantly female, non-smokers, and without respiratory symptoms and elevated white blood cell count and C-reactive protein level, whereas those with D-PLADC were predominantly male, smokers, and had respiratory symptoms and elevated white blood cell count and C-reactive protein level (all p < 0.05). Pleural retraction was more common in L-PLADC, whereas interlobular fissure bulging, hypodense sign, air space, CT angiogram sign, coexisting nodules, pleural effusion, and lymphadenopathy were more frequent in D-PLADC (all p < 0.001). Among the 129 patients with surgically resected PLADC, the most common histological subtype of L-PLADC was acinar-predominant growth pattern (76.7%, 79/103), whereas that of D-PLADC was invasive mucinous adenocarcinoma (80.8%, 21/26). Among the 136 patients with EGFR mutation status, L-PLADC had a significantly higher EGFR mutation rate than D-PLADC (p < 0.001).ConclusionsL-PLADC and D-PLADC have different clinical, imaging, and pathological characteristics. This new imaging-based classification may help improve our understanding of PLADC and develop personalized treatment plans, with concomitant implications for patient outcomes.

The timing of laparoscopic cholecystectomy and nano-ligation clip for acute calculous cholecystitis under guidance of Tokyo guidelines 2018 (multi-center retrospective analysis)

Laparoscopic cholecystectomy (LC) has been recognized as the standard surgical method for cholecystectomy. A nano-absorbable ligation clip. The material used in the ligation clip is composed of basic materials (poly(p-dioxanone), poly trimethylene carbonate or polycaprolactone) and nano-short fibers (Polyglycolide acid or polylactide). The short nano-fibers maintain the crystalline form evenly dispersed in the base material. The diameter of short nano-fibers is 300–500 nm and the length is 20–50 µm. The nano-absorbable ligation clip has strong closing force and will not cause closure failure. However, there are still some controversies about the optimum time for LC treatment of acute calculous cholecystitis (ACC) patients, and the optimum time for performing LC based on evidence-based medicine has not been unanimously recognized. Here, we explore LC timing for ACC treatment under the guidance of the Tokyo Guidelines for Acute Cholecystitis 2018 (TG18). We retrospectively analyzed the data of 3,147 ACC cases undergoing LC in eight hospitals in China. According to the time from the onset of the patient’s symptoms to the operation, they were divided into the following three groups: Group A (onset to operation time of ≤3 days), Group B (onset to operation time of 4–7 days), and Group C (onset to operation time of &gt;7 days). There was no obvious statistical difference in preoperative indicators, such as gender ratio, history of hypertension, diabetes, and abdominal operation; ASA Classification; and TG18 Classification between the three groups. Similarly, the results of preoperative laboratory indices (e.g., white blood cell, C-reactive protein, procalcitonin, platelet, serum creatinine, and international normalized ratio) showed no obvious statistical difference between the three groups. The comparison of gallbladder characteristics under B-ultrasound showed no significant statistical difference between the three groups. However, the conversion rate in Group C was significantly higher than that in Groups A and B, the incidence of complications (e.g., bile leakage, bile duct injury, and wound infection) was significantly higher in Group C than that in Groups A and B, and the postoperative hospital stay was significantly shorter in Group A than that in Groups B and C. A comprehensive analysis of patients’ medical records in multiple medical centers confirms that it is safe and feasible to perform early LC 7 days before the onset of ACC, which can significantly decrease postoperative complications and shorten the postoperative hospital stay for ACC patients. Performing early LC for ACC patients under the TG18 guidelines is safe and feasible. Additionally, since TG18 has obvious practicability and guidance for the clinical practice of hepatobiliary surgery, it is worthy of popularization and application in China.

Evaluation of the relationship between intravascular hemolysis and clinical manifestations in sickle cell disease: decreased hemopexin during vaso-occlusive crises and increased inflammation in acute chest syndrome.

The aims of this study were to determine the possible relationships between the levels of hemin, hemopexin, acid sphingomyelinase, nitrite/nitrate (NOx), and other parameters in patients with SCD and to assess whether they were associated with vaso-occlusive crises (VOCs) or acute chest syndrome (ACS). Patients with SCD (homozygous or sickle beta-thalassemia) who were confirmed to have VOC or ACS were included. Blood samples were obtained at admission, on the third day of hospitalization, and at steady state. Demographic characteristics, pain (visual analog scale), complication history, complete blood count, lactate dehydrogenase, and C-reactive protein levels were recorded. Hemin, hemopexin, acid sphingomyelinase, and NOx were measured via ELISA. A total of 31 patients (22 VOC, 9 ACS) were included. Mean age was 16.4 ± 4.7years. Admission white blood cell count and C-reactive protein levels were significantly higher in the ACS group. Patients with ACS also demonstrated a significant decreasing trend of LDH and an increasing trend of NOx values from admission to steady state. Notably, hemopexin levels were significantly lower on the third day of hospitalization compared to steady-state levels. Despite limited patient count in the ACS group, these patients appear to have strikingly greater inflammatory activation at admission, and the progression of ACS may be associated with LDH and NOx levels. Lower hemopexin levels during hospitalization versus steady state appear to support a role for the administration of hemopexin therapy during crises.

Influencing Factors of Early Neurological Deterioration and Short-Term Prognosis after Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

Objective To explore the factors affecting the early neurological deterioration (END) and short-term prognosis of patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods The clinical data of 212 patients with AIS who received intravenous thrombolysis in our hospital from July 2017 to November 2020 were selected and divided into the END group (n = 71) and the non-END group (n = 141) according to the National Institute of Health Stroke Scale (NIHSS) score and divided into the poor prognosis group (n = 85) and the good prognosis group (n = 127) according to the modified Rankin scale (mRS) score at discharge. The basic data of patients, vascular risk factors, imaging examinations, and laboratory indicators were collected. A logistic regression model was used to analyze the influencing factors of END and the short-term prognosis of AIS patients after intravenous thrombolysis. Results Univariate analysis showed that the patient's age, time from onset to treatment (OTT), NIHSS score, diabetes, hypertension, atrial fibrillation, TOAST classification, infarct size, carotid artery stenosis, white blood cell count (WBC), C-reactive protein (CRP), and D-dimer (DD) were associated with END (P < 0.05). Multiple logistic regression analysis found that NIHSS score, diabetes, atrial fibrillation, infarct size, carotid stenosis, and CRP were independent influencing factors of END after intravenous thrombolysis in AIS patients (P < 0.05). Univariate analysis showed that the patient's age, OTT, NIHSS score, diabetes, hypertension, atrial fibrillation, infarct size, carotid stenosis, and the occurrence of END were all related to the short-term prognosis of AIS patients (P < 0.05). Multiple logistic regression analysis showed that age, NIHSS score, infarct size, carotid artery stenosis, and the occurrence of END were all independent factors affecting the short-term prognosis of AIS patients. Conclusion High NIHSS score, combined with diabetes, atrial fibrillation, moderate to severe carotid stenosis, and elevated CRP are all risk factors for END after intravenous thrombolysis in AIS patients. Moreover, advanced age, high NIHSS score, moderate to severe carotid stenosis, and occurrence of END are risk factors for poor short-term prognosis after intravenous thrombolysis in AIS patients.

The Role of Molecular Testing in Pediatric Meningitis Surveillance in Southern and East African Countries, 2008-2017.

BackgroundAs part of the global Invasive Bacterial Vaccine-Preventable Diseases Surveillance Network, 12 African countries referred cerebrospinal fluid (CSF) samples to South Africa’s regional reference laboratory. We evaluated the utility of real-time polymerase chain reaction (PCR) in detecting and serotyping/grouping Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae (HNS).MethodsFrom 2008 to 2017, CSF samples collected from children <5 years old with suspected meningitis underwent routine microbiology testing in-country, and 11 680 samples were submitted for HNS PCR at the regional reference laboratory. Unconditional logistic regression, with adjustment for geographic location, was performed to identify factors associated with PCR positivity.ResultsThe overall HNS PCR positivity rate for all countries was 10% (1195 of 11 626 samples). In samples with both PCR and culture results, HNS PCR positivity was 11% (744 of 6747 samples), and HNS culture positivity was 3% (207 of 6747). Molecular serotype/serogroup was assigned in 75% of PCR-positive specimens (762 of 1016). Compared with PCR-negative CSF samples, PCR-positive samples were more often turbid (adjusted odds ratio, 6.80; 95% confidence interval, 5.67–8.17) and xanthochromic (1.72; 1.29–2.28), had elevated white blood cell counts (6.13; 4.71–7.99) and high protein concentrations (5.80; 4.34–7.75), and were more often HNS culture positive (32.70; 23.18–46.12).ConclusionPCR increased detection of vaccine-preventable bacterial meningitis in countries where confirmation of suspected meningitis cases is impeded by limited culture capacity.

Unusual intramuscular locations as a first presentation of hydatid cyst disease in children: a report of two cases

BackgroundHydatid disease is an endemic disease in many countries of the world including the Middle East. It mainly affects the liver and lungs. Intramuscular hydatid disease is rarely reported in children. Such uncommon localization of hydatid cyst may pose difficulties in the clinical and radiological diagnosis; hence affecting patient’s management and outcome even in endemic areas.Case presentationWe herein describe intramuscular hydatid cysts in 2 different children. The first case is a 5-year-old boy who presented with a painless palpable lump over the right lumbar paraspinal region. His history was remarkable for sheep contact. His laboratory results revealed a mild increase in white blood cell (WBC) count and C-reactive protein. The lesion showed typical features of a hydatid cyst on ultrasound. Further imaging including ultrasound of the abdomen and CT of the chest, abdomen, and pelvis showed infestation of the liver and lung as well. The lesions were resected surgically without complications. The patient received Albendazole preoperatively and after surgery for 3 months. No evidence of recurrence was seen during follow-up.The second case is a 6-year-old girl who presented with an incidental palpable lump in her left thigh during her hospital admission for recurrent meningitis. Ultrasound and MRI imaging were performed demonstrating a unilocular cystic lesion in the left proximal rectus femoris muscle. A provisional diagnosis of hematoma vs. myxoma was given. Biopsy was performed and yielded blood products only. The lesion was resected surgically with a postoperative diagnosis of hydatid cyst. Blood tests performed afterward showed a positive titer for Echinococcus. The patient received Albendazole for 3 months. No evidence of recurrence was seen during follow-up.ConclusionsDespite its rarity; skeletal muscle hydatid cyst should always be considered in the differential diagnosis of cystic muscle lesions in children in endemic areas even if imaging studies did not show any of the typical signs. This will improve patient outcome by preventing unnecessary cystic puncture which might lead to serious complications, such as anaphylaxis and local dissemination.

Lower Expression of miR-26a in PBMCs Indicates the Occurrence of Early-Onset Neonatal Sepsis and Is Partly Mediated by the Upregulation of PTEN.

Aim: It is difficult to identify neonatal sepsis early due to the lack of specific markers. The aim of the present study was to explore whether miR-26a expression in peripheral blood mononuclear cells (PBMCs) could be used as a diagnostic marker of the disease and whether phosphatase and tensin homolog (PTEN) was involved in suppressing miR-26a expression.Methods: A total of 51 early-onset septic newborns and 102 healthy newborns were included. Blood specimens were collected from septic newborns at the time of clinical diagnosis (baseline) and again between 72 and 96 h after birth. Blood specimens were collected from healthy newborns on admission. The expressions of miR-26a and PTEN in PBMCs were measured using real-time quantitative PCR (RT-qPCR). Other data, including hemoculture, were collected from medical records.Results: In septic newborns with and without a positive hemoculture, a lower baseline level of miR-26a in PBMCs was associated with a higher risk of disease. Additionally, at baseline, there was a certain linear relationship between the levels of miR-26a and two serological inflammatory markers (i.e., white blood cell count and C-reactive protein level) in septic newborns. In addition, the baseline expressions of miR-26a and PTEN showed a reverse linear relationship. Compared with those at baseline, the expression of miR-26a was higher and the expression of PTEN was lower in septic newborns starting at 72 h after birth.Conclusion: A lower baseline miR-26a expression in PBMCs indicated the occurrence of early-onset neonatal sepsis, and a reduced miR-26a expression might be partly related to the inflammatory process and PTEN upregulation.

Subarachnoid hemorrhage secondary to Brucella-induced cerebral aneurysm: a case report

BackgroundBrucellosis is a common zoonotic disease that is prevalent in many areas worldwide. This infectious disease can occasionally affect the central nervous system but intracranial arteries are rarely involved.Case presentationA 17-year-old female who had a history of recurrent fever for 1 month was admitted for subarachnoid hemorrhage due to cerebral aneurysm rupture. Surgery was performed to fix the aneurysm, but the patient had persistent fever after the surgery. Cerebrospinal fluid testing showed a high white blood cell count and elevated protein level but no pathogen was identified in the first two tests. Brucella melitensis was identified in the third cerebrospinal fluid culture, and a diagnosis of brucellosis was finally rendered. The patient was subsequently treated with anti-Brucella medications and her symptoms improved significantly at the last follow-up.ConclusionAlthough extremely rare, Brucella-induced cerebral aneurysms can occur and this should be considered in the differential diagnosis of cerebrovascular accidents, especially in Brucella epidemic areas.

Determining the Relationship Between Fever of Without focus and Latent Pneumonia in Feverish Children in Bandar Abbas, Iran

Background: Fever is one of the most common causes of children’s referral to the emergency department, for which in 20% of cases no clear source is found. Latent pneumonia is not easily differentiable as one of the differential diagnoses of fever of unknown origin (FUO). This study aimed to determine the relationship between FUO and latent pneumonia in feverish children referring to pediatric emergency department. Materials and Methods: The present analytical research was carried out on 220 children with FUO aged 3-36 months referred to pediatric hospital of Bandar Abbas, Iran in 2019. To find the signs and symptoms, demographic information, history, and physical examination results were recorded by a physician using a predetermined checklist. Chest x-ray and blood sample were prepared for white blood cell (WBC) count, C-reactive protein (CRP), and absolute neutrophil count (ANC). Results: The mean age of the patients was 18.38±8.6 months. There was no significant difference between the mean fever, pulse rate, respiratory rate, WBC count, erythrocyte sedimentation rate (ESR), and ANC among the three groups differentiated by their diagnosis. The mean CRP in the bacterial pneumonia group was 68.17±24.13, while it was 35.00±20.43 in the viral infection group and 35.71±26.20 in the group of other diseases; the difference was statistically significant (P=0.004). Conclusion: Although there was no significant difference between WBC, ANC, and ESR and latent pneumonia, there was a significant difference between CRP and latent pneumonia, whose value was larger in these patients.

A case of peritoneal dialysis-associated peritonitis caused by Rhodococcus kroppenstedtii

BackgroundRhodococcus kroppenstedtii is an aerobic, gram-positive bacterium firstly identified in the environment, which has not been reported in human-related infection. Herein, we reported the first case of peritoneal dialysis (PD)-associated peritonitis caused by R. kroppenstedtii which was identified by whole genome sequencing.Case presentationA 69-year-old man was admitted to hospital with abdominal pain and fever. Over the last 2 years, he had been undergoing continuous ambulatory peritoneal dialysis (CAPD) due to end-stage renal disease. Clinical symptom and sign in combination with laboratory examinations supported the clinical diagnosis of PD-associated peritonitis. Thus, ceftizoxime and teicoplanin were empirically used after PD effluent was collected for bacterial culture. A gram-positive bacterium was found from the PD effluent culture, which could not be identified by either Vitek 2 Compact ANC card or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The strain was finally confirmed to be R. kroppenstedtii by whole genome sequencing (WGS) through the average nucleotide identity (ANI) analysis. With a continuous treatment with teicoplanin and imipenem for 15 days and intraperitoneal catheter removed, the infection symptom was improved evidenced by a normal body temperature, also with white blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) dropped to normal levels. Peritoneal dialysis effluent culture showed a negative result. Then, hemodialysis and arteriovenous fistula angioplasty were performed, but the patient developed a progressive blood pressure loss, accompanied by multiple organ disorder, and died on Feb 25, 2020.ConclusionsTo the best of our knowledge, this is the first time to report a peritoneal dialysis-associated peritonitis caused by R. kroppenstedtii which was identified by average nucleotide identity analysis based on WGS.

Latamoxef for Neonates With Early-Onset Neonatal Sepsis: A Study Protocol for a Randomized Controlled Trial.

Early-onset neonatal sepsis (EONS), a bacterial infection that occurs within 72 h after birth, is associated with high likelihood of neonatal mortality. Latamoxef, a semi-synthetic oxacephem antibiotic developed in 1980s, has been brought back into empirical EONS treatment in recent years. In the preliminary work, we established a population pharmacokinetics (PPK) model for latamoxef in Chinese neonates. Moreover, in order to better guide clinical treatment, we conducted dose simulation and found that ascending administration frequency could improve the target rate of 70% of patients having a free antimicrobial drug concentration exceeding the MIC during 70% of the dosing interval (70% fT > MIC). Accordingly, this study is aimed to compare the 70% fT > MIC, efficacy and safety between conventional regimen and PPK model regimen for rational use of latamoxef in EONS treatment. A single-blind, multicenter randomized controlled trial (RCT) for latamoxef will be conducted in Chinese EONS patients. Neonates (≤3 days of age, expected number = 114) admitted to the hospital with the diagnosis of EONS and fulfilling inclusion and exclusion criteria will be randomized (ratio of 1:1) to either a conventional regimen (30 mg/kg q12h) or model regimen (20 mg/kg q8h) latamoxef treatment group for at least 3 days. Primary outcome measure will be 70% fT > MIC and secondary outcome indicators will be the latamoxef treatment failure, duration of antibiotic therapy, changes of white blood cell count (WBC), C-reactive protein (CRP) and procalcitonin (PCT), blood culture results during administration and incidence of adverse event (AE)s. Assessments will be made at baseline, initial stage of latamoxef treatment (18–72 h) and before the end of latamoxef treatment. Ethical approval of our clinical trial has been granted by the ethics committee of the Beijing Children’s Hospital (ID: 2020-13-1). Written informed consent will be obtained from the parents of the participants. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR 2000040064).It is hoped that our study will provide a clinical basis for the rational clinical use of latamoxef in EONS treatment.

Infected simple renal cyst due to Streptococcus pneumoniae rapidly diagnosed by the melting temperature mapping method: a case report

BackgroundSpontaneous infection of preexisting solitary renal cysts has been documented in adults but is extremely rare in children. To date, no cases of simple renal cysts infected with Streptococcus pneumoniae have been described. Recently, reports have described the diagnosis of bacterial infection using the 16 S rRNA gene as well as the accompanying antimicrobial stewardship for microorganisms that are difficult to culture and for culture-negative cases after preceding antibacterial administration.Case presentationA four-year-old Japanese girl who had a pleuroperitoneal shunt inserted to drain a right pleural effusion due to occlusion of the hepatic portion of the inferior vena cava at three years old visited our hospital due to fever and respiratory discomfort. She was incidentally found to have a right simple renal cyst 10 months before admission. The patient was suspected to have pneumonitis or catheter-related blood stream infection on chest X-ray, which showed right-side pleural effusion. She was diagnosed with invasive pneumococcal infection, as Streptococcus pneumoniae was detected from blood culture on admission. Transient improvements in her symptoms and decreases in the white blood cell count and C-reactive protein level were observed after effective antibiotic administration, but her respiratory condition deteriorated. Enhanced CT showed right renal cyst enlargement and enhancement and thickening of the surrounding wall. Using the melting temperature (Tm) mapping method, S. pneumoniae was rapidly detected directly from pus 4.5 hours after drainage. The specimen culture was negative, but the extracted 16 S rDNA sequence revealed 100 % identity for S. pneumoniae from the same specimen the subsequent day. We successfully performed optimal treatment and reduced medical cost based on the positive Tm mapping method result.ConclusionsWe report the first case of a S. pneumoniae-infected simple renal cyst. The drainage culture was negative, but the Tm mapping method rapidly detected S. pneumoniae directly from the drainage. The Tm mapping method may have great impacts on rapid diagnosis and effective antimicrobial stewardship.

Abstract P110: Proteomics Identified Novel Proteins Associated With Genetic Risk Of Abdominal Aortic Aneurysm: The Atherosclerosis Risk In Communities Study (ARIC)

Introduction: Abdominal aortic aneurysm (AAA) is a condition characterized by a weakened dilated vessel wall with the potential for lethal rupture. A recent genome-wide association study identified and replicated nine AAA-related variants (rs602633, rs4129267, rs3827066, rs1795061, rs10757274, rs10985349, rs9316871, rs6511720, and rs2836411), but pathways through which these loci may influence disease have not been elucidated. Hypothesis: AAA risk variants were hypothesized to be associated with plasma proteins with numerous roles including, but not limited to, inflammation and extracellular matrix remodeling. Methods: Data from participants of the community-based ARIC Study were used. Genomic DNA from whole blood was genotyped using the Affymetrix Genome-Wide Human SNP array 6.0. Concentrations of 4,870 proteins were determined using the SomaLogic aptamer-based capture array in plasma collected at visit 3 (1993-95). Outliers that were 6 standard deviations from the means were excluded. Race-specific multiple linear regression analysis evaluated associations between genetic variants and log base 2 transformed protein levels, with adjustment for age, sex, estimated glomerular filtration rate, field center, and ten principal components of ancestry. Identified proteins in whites (N=7,241) were then examined for replication in Black participants (N=1,671). Cox regression was used to evaluate the associations between identified proteins and incident AAA (n=454) over a median 21.2-year follow-up in all 11,064 participants. Results: In white participants twenty-six protein associations were identified for rs602633 ( PSRC1-CELSR2-SORT1 ), rs4129267 ( IL6R ), and rs3827066 ( PCIF1-ZNF335-MMP9 ) following Bonferroni correction ( p ≤5.13x10 -6 ). Associations were observed between rs4129267 and soluble interleukin-6 receptor subunit alpha (β=-0.339; p&lt;1.0E-200) and CRP (β=0.093; p=2.24E-7); rs602633 and granulin (β=0.184; p&lt;1.0E-200), complement C1q TNF-related protein-1 (β=0.115; p=2.17E-184), and neogenin (β=-0.031; p=5.60E-13); and rs3827066 and kit ligand (β=-0.045; p=2.41E-08). Five associations were replicated in Black participants ( p ≤1.9x10 -3 ). In the whole cohort, top quintiles of CRP (HR: 1.68; 95% CI: 1.22, 2.31), kit ligand (HR: 0.56; 95% CI: 0.40, 0.78) and neogenin (HR: 0.57 95% CI: 0.42, 0.78) were significantly related to incident AAA risk compared to corresponding bottom quintiles. Conclusions: Three of the nine AAA risk variants were associated with plasma protein concentrations, with the strongest associations for those involved in inflammation, endothelial dysfunction, and extracellular matrix remodeling. Granulin, complement C1q tumor necrosis factor-related protein-1, kit ligand, and neogenin represent novel targets for genetic risk of AAA and may link genetic susceptibility to disease pathogenesis.

Clinical characteristics and genetic analysis of A20 haploinsufficiency

PurposeTo evaluate the clinical and genetic characteristics of 3 children with Haploinsufficiency of A20 (HA20). Methods:The clinical and genetic testing data of 3 children with HA20 treated at Capital Institute of Pediatrics (CIP) between August 2016 and October 2019 were retrospectively analysed.ResultPatient 1 presented with arthritis and inflammatory bowel disease, patient 2 presented with axial spinal arthritis and lupus-like syndrome, and patient 3 presented with recurrent oral ulcers, gastrointestinal ulcers, and perianal abscesses. Regarding laboratory tests, patients were found to have elevated white blood cell (WBC) count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The CRP and ESR was reported to be high in all the patients. The WBC was reported to be high in patient 1 and 3. Patient 2 was positive for antinuclear antibodies, anti-Sjögren’s syndrome antigen A, dsDNA, rheumatoid factor and Coombs test. Genetic testing showed that all three patients had heterozygous mutation in TNFAIP3 gene. As for the treatment, patient 1 was treated with TNFα antagonist, patient 2 was treated with TNF α antagonist and sulfasalazine, and patient 3 was treated with corticosteroids and thalidomide. Patients 1 and 2 were followed for four and 3 months, respectively. There was an improvement in joint and gastrointestinal symptoms; inflammatory indices and rheumatoid factor (RF) were normal, and dsDNA and Coombs test became negative. Patient 3 was treated at another hospital and showed gradual improvement in oral ulcers and perianal abscesses.ConclusionHA20 is a single-gene auto-inflammatory disease caused by mutation in tumour necrosis factor (TNF)-α-induced protein 3 (TNFAIP3) gene. It may present as Behçet-like syndrome and resemble various other autoimmune diseases as well. Corticosteroids and immunosuppressive agents are effective treatments, and cytokine antagonists can be used in refractory cases. Whole-exome genetic testing should be proactively performed for children with early-age onset or Behçet-like syndrome to achieve early diagnosis and accurate treatment.