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Objective: Infantile spasms (IS) is a common epilepsy syndrome in infancy. Genetically based birth defects are among the many causes of infantile spasms. Genetic diagnosis can reveal the etiology of IS and guide treatment strategies and genetic counseling, but significant challenges surround the choice of appropriate genetic diagnostic strategies to improve the diagnostic yield in IS.Methods: For a cohort of Chinese patients with IS, appropriate genetic testing methods were selected according to etiological classification. Methods included karyotyping, copy number variation detection, single-gene sequencing, targeted sequencing panel, and whole-exome sequencing.Results: A total of 728 children with IS from fifteen provinces and municipalities in China from June 2015 to October 2020 were recruited in the study. Among them, 436 were males (59.9%). The median age was 9.46 months. The diagnostic yield of our study was 31.5% (185/587). The top five causative genes were TSC2 (n = 91), STXBP1 (n = 21), TSC1 (n = 15), SCN2A (n = 6), and CDKL5 (n = 6). The genetic diagnostic yield was 100% in Down syndrome (n = 1), neurofibromatosis (n = 2), and methylmalonic acidemia (n = 2), 83.5% in tuberous sclerosis complex (n = 127), and 16.7% in unsolved infantile spasms (n = 442). Different genetic testing methods for different etiologies show large differences in diagnostic yields.Conclusion: This study demonstrates that appropriate genetic testing procedures for different phenotypes can ensure a high diagnostic yield. [ABSTRACT FROM AUTHOR]

Purpose: To assess the safety of inactivated coronavirus 2019 disease (COVID-19) vaccine in tuberous sclerosis complex (TSC) patients with epilepsy.Methods: All patients with epilepsy were selected from Efficacy and Safety of Sirolimus in Pediatric Patients with Tuberous Sclerosis (ESOSPIT) project and younger than 17 years old. The patients were treated with mTOR inhibitors (rapamycin). A total of 44 patients who completed the two-dose inactivated COVID-19 vaccine between July 7, 2021, and January 1, 2022, were enrolled.Results: The median age of seizure onset was 23 months. About two-thirds of patients have focal seizures. Thirty-three patients use antiseizure medications. The mean duration of rapamycin treatment was 55.59 ± 18.42 months. Adverse reactions within 28 days after injection occurred in 11 patients (25%), all were under 12 years old. Injection site pain was the most reported event (20.45%), which was mild in severity and improved within one day. All patients had no seizure-related changes after vaccination.Conclusion: This study shows that the inactivated COVID-19 vaccine was well tolerated and safe in TSC patients with epilepsy, as well as for those treated with mTOR inhibitors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether sirolimus treatment could relieve the later burden of new-onset seizures in patients with tuberous sclerosis complex (TSC) prior to epilepsy.Methods: A real-world matched case-control study was nested in another registry cohort study. Infants with TSC (<12 months old) without seizures whose parents agreed on sirolimus treatment for other symptoms were eligible for inclusion to the early sirolimus (ES) group. These patients were enrolled from 2015 to 2018. Controls in the late sirolimus (LS) group were matched from the registry cohort database for 2015-2018. Age and genotype were used as the initial stratifying criteria and other symptoms as the greedy matching criteria at a matching ratio of 1:4. None of the preventive drugs were introduced before seizure onset or before 2 years of age in the LS group. Both groups were followed up until June 2020. The primary objective was a comparison of the characteristics of the first seizure between the two groups. The secondary objective was the assessment of the final seizure status at the endpoint.Results: There were 42 and 168 patients with TSC in the ES and LS groups, respectively. Early sirolimus treatment significantly reduced the seizure onset, especially in the patients aged <6 months. The mean onset-age was significantly delayed by sirolimus treatment (11.34±7.93 months vs. 6.94±6.03 months, P<0.001). The subtype of seizures that benefited the most was spastic (onset) seizures (all were infantile spasms) [5/42 (11.90%) vs. 73/168 (43.45%), P<0.001]; these seizures were either eliminated or alleviated. The sirolimus treatment addition prior to seizures was more effective than its addition after seizures in reducing drug-resistant epilepsy [10/42 (23.81%) vs. 70/147 (47.62%), P=0.004].Conclusion: Early sirolimus treatment for TSC effectively modified the disease by preventing infantile spasms, delaying seizure onset, and relieving its severity. The anti-epileptogenic effect of sirolimus may be time- and dose-dependent. [ABSTRACT FROM AUTHOR]

Folate receptor (FR) overexpression occurs in a variety of cancers, including pancreatic cancer. In addition, enhanced macropinocytosis exists in K-Ras mutant pancreatic cancer. Furthermore, the occurrence of intensive desmoplasia causes a hypoxic microenvironment in pancreatic cancer. In this study, a novel FR-directed, macropinocytosis-enhanced, and highly cytotoxic bioconjugate folate (F)-human serum albumin (HSA)-apoprotein of lidamycin (LDP)-active enediyne (AE) derived from lidamycin was designed and prepared. F-HSA-LDP-AE consisted of four moieties: F, HSA, LDP, and AE. F-HSA-LDP presented high binding efficiency with the FR and pancreatic cancer cells. Its uptake in wild-type cells was more extensive than in K-Ras mutant-type cells. By in vivo optical imaging, F-HSA-LDP displayed prominent tumor-specific biodistribution in pancreatic cancer xenograft-bearing mice, showing clear and lasting tumor localization for 360 h. In the MTT assay, F-HSA-LDP-AE demonstrated potent cytotoxicity in three types of pancreatic cancer cell lines. It also induced apoptosis and caused G2/M cell cycle arrest. F-HSA-LDP-AE markedly suppressed the tumor growth of AsPc-1 pancreatic cancer xenografts in athymic mice. At well-tolerated doses of 0.5 and 1 mg/kg, (i.v., twice), the inhibition rates were 91.2% and 94.8%, respectively (P <0.01). The results of this study indicate that the F-HSA-LDP multi-functional bioconjugate might be effective for treating K-Ras mutant pancreatic cancer. [Display omitted] • We designed and generated a folate receptor-targeted and macropinocytosis-enhanced recombinant protein conjugate. • F-HSA-LDP displayed highly specific biodistribution and long-lasting tumor accumulation in pancreatic cancer cells. • F-HSA-LDP-AE induced apoptosis and G2/M cell cycle arrest and markedly suppressed the growth of pancreatic cancer cells. [ABSTRACT FROM AUTHOR]

Objective: Syntaxin binding protein 1 (STXBP1) plays an important role in the release of synaptic vesicles. STXBP1-related encephalopathy is a brain dysfunction caused by STXBP1 variation. Levetiracetam (LEV) exerts antiepileptic effects by binding to synaptic vesicle protein 2A (SV2A). This study aimed to analyze the prognosis of LEV treatment of STXBP1 encephalopathy (STXBP1-E) and the correlation among genotype, phenotype, and LEV efficacy.Methods: Patients with pathogenic STXBP1 variants were collected from multiple centers, and their clinical history, video electroencephalogram (vEEG) characteristics, imaging examination data, and anti-seizure medication (ASM) history were systematically analyzed. The ASMs related to the prognosis were explored.Results: Forty patients with STXBP1-E were enrolled in this study. The detailed ASM usage of 37 patients was recorded without intervening in ASM selection. At the endpoint of six months treatment, the results of Fisher's exact test showed that in all ASMs, LEV affected the prognosis of patients with STXBP1-E. LEV was effective in improving the partial remission rate but did not achieve seizure freedom. However, LEV monotherapy could achieve seizure freedom in patients with other early-onset epileptic and encephalopathy. For refractory West syndrome (WS) or Ohtahara syndrome (OS), LEV combined with other ASMs could improve the seizure remission rate.Conclusion: LEV increased the seizure reduction rate and improved the vEEG characteristics in patients with STXBP1-E, but not seizure freedom. LEV combined with other ASMs could increase the seizure reduction rate, especially for refractory WS or OS. Thus, LEV could be considered after identifying the pathogenicity of STXBP1 variants. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to analyze the therapeutic effect of sirolimus on seizures in pediatric patients with tuberous sclerosis.Methods: We first compared the efficacy of controlling seizures in all patients after they had taken sirolimus for one year, and then we performed a subgroup analysis based on whether the administered antiepileptic drugs were changed to determine whether the efficacy was associated with changes of antiepileptic drugs.Results: A total of 91 eligible children were enrolled. The response rate was 78.0 % (71/91), and 47.2 % (43/91) of all patients were became seizure-free. The improvement in seizure control before and after treatment with sirolimus was significant (p < 0.001). In the AEDs unaltered group, 34 were responders (34/45, 75.6 %, 95 % CI 17.4-88.3), of which 24 were seizure-free (24/34, 70.6 %). In the AEDs-altered group, 37 were responders (37/46, 80.4 %, 95 % CI 56.7-88.1), of which 19 were seizure-free (19/37, 51.4 %). There was no significant difference between the two groups for reductions in rate of seizure frequency (p = 0.308). In the patients with refractory epilepsy, treatment with sirolimus was also effective (p = 0.01). Logistic regression analysis showed that age was an important factor affecting outcome of epilepsy (p = 0.003, 95 % CI 2.05-38.31). No Grade 3 or 4 adverse events were noted during the follow-up.Conclusions: Sirolimus has a significant effect on seizures associated with tuberous sclerosis complex (TSC), with no or only moderate adverse events after long-term administration. Sirolimus could be used as the first-line medication for pediatric patients with TSC-associated epilepsy. [ABSTRACT FROM AUTHOR]

• The establishment of iPSCs from skin fibroblasts with childhood cerebral ALD and Addison's disease. • The two iPSCs demonstrated pluripotent differentiation characteristics. • The iPSCs can be used as an alternative in vitro model for ALD studies. X-linked adrenoleukodystrophy (ALD) is a rare peroxisome disease with phenotypic heterogeneity. There is a lack of suitable in vitro models to study its pathogenesis. We established two strains of iPSCs from skin fibroblasts of patients with childhood cerebral ALD and Addison's disease, respectively. CytoTune™2.0 Sendai reprogramming kit was used. The iPSC lines showed typical stem cell morphology, normal karyotype, and carrying ABCD1 variation. The iPSC lines express pluripotency markers, and have the capacity to differentiate into three germ layers. iPSCs can be used as an alternative cell source for ALD in vitro model to study its pathogenesis and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Purpose: Tuberous sclerosis (TSC) is an autosomal dominant inherited disease caused by mutations in the TSC1 or TSC2 gene and results in the over-activation of the mammalian target of the rapamycin (mTOR) signaling pathway. Rapamycin, an mTOR inhibitor, is clinically used to treat hamartomatous lesionsas in TSC and its effect on controlling epilepsy is also reported in many studies. This study aims to evaluate the risk factors of pharmacoresistant epilepsy in patients with TSC receiving long-term rapamycin treatment.Method: A total of 108 patients with TSC taking rapamycin for over 1 year were enrolled in this study. Factors that might influence seizure control were statistically analyzed by multiple factor analysis. A subgroup analysis was also conducted to access the relationship between calcified epileptic foci and pharmacoresistant epilepsy. (Clinical trial registration number: ChiCTR-OOB-15006535(2015-05-29)).Results: Seizure was controlled in 53 patients but was not managed in 55 patients considered to be drug resistant. Logistic regression analysis showed that calcification in the cerebral parenchyma was a risk factor of pharmacoresistant epilepsy [P = 0.006, odds ratio (OR) = 4.831 (1.577, 14.795)]. Fifteen of 17 patients with calcified epileptic foci suffered from pharmacoresistant epilepsy (88.2%). Seizures in patients with calcified epileptic foci were probably pharmacoresistant (P = 0.010).Conclusion: Calcification in epileptic foci strongly indicates pharmacoresistant epilepsy in patients with TSC even when treated with appropriate anti-epilepsy drugs (AEDs) and rapamycin. Calcification can be used to evaluate pharmacoresistant epilepsy in patients with TSC. [ABSTRACT FROM AUTHOR]

A series of consecutively adjustable submerged vegetation nets were constructed in a polluted shallow river with a length of about 200 m and nearby the water resource protection area of Taihu Lake in East China, forming an aquatic vegetation consisted of submerged plant species Cabomba caroliniana, Vallisneria natans, Elodea nuttallii, Hydrilla verticillata, and Potamogeton crispus. The water quality indices including total nitrogen (TN), ammonium nitrogen (NH4+-N), nitrite nitrogen (NO2--N), nitrate nitrogen (NO3--N), total phosphorus (TP), and phosphate (PO43--P) were monitored, and the bioremediation effect of the vegetation nets was evaluated. After setting up the vegetation nets, the Secchi depth (SD) of the river changed from 0. 5 m to 1. 7-1. 8 m, and the TN and TP concentrations 15 and 20 days after the nets constructed decreased by 35. 6% and 66. 3%, and 29. 4% and 63. 2%, respectively. After five months, the concentrations of NH4+-N,NO2--N, NO3--N, TN, TP, and PO43--P decreased by 92. 4%, 76. 8%, 72. 7%, 73.9%, 90.5%, and 92. 0%, respectively. This study showed that consecutively adjustable submerged vegetation net could be a potential approach for treating polluted river waters, particularly for the bioremediation of polluted small landscape shallow water bodies. [ABSTRACT FROM AUTHOR]

From April 2007 to January 2008, a bioremediation experiment was conducted in a diversion channel of D-port pilot area of Dishui Lake (the channel length is 950 m, and its water volume is 10000 m³).Daphnia magna was first introduced to filter the high biomass of phytoplankton and other particulate organic matter, and then, five submerged plant species Elodea canadensis, Vallisneria spiralis, Hydrilla verticillata, Potamogeton lucens, and Potamogeton crispus were transplanted. Water samples were collected monthly to monitor the water quality and to investigate the bioremediation efficiency. Ten months monitoring data showed that in the remediation area, the water body's total nitrogen(TN), ammonium nitrogen (NH4+-N),nitrate nitrogen(NO3--N), nitrite nitrogen (NO2--N), total phosphorus (TP), and reactive phosphate ( PO43--P) concentrations and chemical oxygen demand (COD)were significantly lower (P<0.01), dissolved oxygen (DO) was increased by 50.4%, and the Secchi depth (SD) reached to an average of 3.4-3.7 m. Overall,the water quality was up to grades ? or ? of state water quality standards for surface water. In March 2008,the established submerged plant community was used to test its effectiveness in improving the eutrophicated water body from Dishui Lake, and the results showed that after 7-day treatment, except biological oxygen demand (BOD), the TN, TP, NO3--N, NO2--N, NH4+-N, and PO43--P concentrations and COD of the eutrophicated water were all decreased significantly, the DO was increased by 17.98%, and the SD was increased by 30 cm. The present study demonstrated the effectiveness of introducing D.magna and transplanting submerged plants in improving the water quality of Dishui Lake. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the efficacy and safety of sirolimus in the treatment of cardiac rhabdomyomas associated with tuberous sclerosis complex and the specific benefits in different subgroups.Study Design: The study was a prospective cohort and self-controlled case series study. Based on the prevalence of cardiac rhabdomyoma at different ages, we estimated the natural tumor disappearance rate. The subgroup analysis was done by Cox regression. Self-controlled case series method was used to assess the magnitude and duration of the drug effect. Adverse events were described.Results: A total of 217 patients were included in the cohort study. Tumor disappearance rate was higher in younger age groups (hazard ratio = 0.99, P = .027) and female patients (hazard ratio = 2.08, P = .015). The age-adjusted incidence ratio showed that the disappearance of rhabdomyomas between 3 and 6 months was more related to sirolimus. Adverse events were observed 60 times in 42 of 217 children, mainly stomatitis.Conclusions: Sirolimus can increase the disappearance rate of cardiac rhabdomyoma in the tuberous sclerosis complex population. Efficacy varies by sex and age: female and younger patients have higher tumor disappearance rate. Sirolimus is well-tolerated. [ABSTRACT FROM AUTHOR]

DDTs were detected in yellowfin tuna (Thunnus albacares , 92.1–221.8 ng‧g−1 lipid weight) and their prey (54.9–93.5 ng‧g−1 lipid weight) from the South China Sea (SCS). DDT levels reported in this study were lower than those of the previous studies indicated the recent mitigation of DDT contamination in the SCS. Higher DDT levels were observed in fat abdominal muscle than lean dorsal muscle in adult yellowfin tuna. Meanwhile, DDT levels in adult yellowfin tuna were higher than the young ones. The composition profiles of DDT and its metabolites suggested DDTs in fish in the SCS were mainly derived from the historical use of technical DDTs. DDTs were biomagnified through food chains with the trophic magnification factor of 2.5. Risk assessment results indicated that dietary exposure to DDTs through lifetime fish consumption from the SCS would pose little cancer and noncarcinogenic risk to coastal residents. • DDTs in yellowfin tuna and their prey from the SCS were investigated. • DDT levels reported in this study were lower than those of the previous work. • The potential main source of DDTs was the historical use of technical DDTs. • The trophic magnification of DDTs was found in food chains. • Health risk posed by DDTs through fish consumption was below the acceptable level. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of paroxysmal events in infants is often challenging. Reasons include the child's inability to express discomfort and the inability to record video electroencephalography at home. The prevalence of mobile phones, which can record videos, may be beneficial to these patients. In China, this advantage may be even more significant given the vast population and the uneven distribution of medical resources. Objective: The aim of this study is to investigate the value of mobile phone videos in increasing the diagnostic accuracy and cost savings of paroxysmal events in infants. Methods: Clinical data, including descriptions and home videos of episodes, from 12 patients with paroxysmal events were collected. The investigation was conducted in six centers during pediatric academic conferences. All 452 practitioners present were asked to make their diagnoses by just the descriptions of the events, and then remake their diagnoses after watching the corresponding home videos of the episodes. The doctor's information, including educational background, profession, working years, and working hospital level, was also recorded. The cost savings from accurate diagnoses were measured on the basis of using online consultation, which can also be done easily by mobile phone. All data were recorded in the form of questionnaires designed for this study. Results: We collected 452 questionnaires, 301 of which met the criteria (66.6%) and were analyzed. The mean correct diagnoses with and without videos was 8.4 (SD 1.7) of 12 and 7.5 (SD 1.7) of 12, respectively. For epileptic seizures, mobile phone videos increased the mean accurate diagnoses by 3.9%; for nonepileptic events, it was 11.5% and both were statistically different (P =.006 for epileptic events; P <.001 for nonepileptic events). Pediatric neurologists with longer working years had higher diagnostic accuracy; whereas, their working hospital level and educational background made no difference. For patients with paroxysmal events, at least US $673.90 per capita and US $128 million nationwide could be saved annually, which is 12.02% of the total cost for correct diagnosis. Conclusions: Home videos made on mobile phones are a cost-effective tool for the diagnosis of paroxysmal events in infants. They can facilitate the diagnosis of paroxysmal events in infants and thereby save costs. The best choice for infants with paroxysmal events on their initial visit is to record their events first and then show the video to a neurologist with longer working years through online consultation. [ABSTRACT FROM AUTHOR]