Background: Globally syphilis is an important yet preventable cause of stillbirth, neonatal mortality and morbidity. Objectives: This review sought to estimate the effect of detection and treatment of active syphilis in pregnancy with at least 2.4MU benzathine penicillin (or equivalent) on syphilis-related stillbirths and neonatal mortality. Methods: We conducted a systematic literature review of multiple databases to identify relevant studies. Data were abstracted into standardised tables and the quality of evidence was assessed using adapted GRADE criteria. Where appropriate, meta-analyses were undertaken. Results: Moderate quality evidence (3 studies) supports a reduction in the incidence of clinical congenital syphilis of 97% (95% c.i 93 – 98%) with detection and treatment of women with active syphilis in pregnancy with at least 2.4MU penicillin. The results of meta-analyses suggest that treatment with penicillin is associated with an 82% reduction in stillbirth (95% c.i. 67 – 90%) (8 studies), a 64% reduction in preterm delivery (95% c.i. 53 – 73%) (7 studies) and an 80% reduction in neonatal deaths (95% c.i. 68 – 87%) (5 studies). Although these effect estimates were large and remarkably consistent across studies, few of the studies adjusted for potential confounding factors and thus the overall quality of the evidence was considered low. However, given these large observed effects and a clear biological mechanism for effectiveness the GRADE recommendation is strong. Conclusion: Detection and appropriate, timely penicillin treatment is a highly effective intervention to reduce adverse syphilis-related pregnancy outcomes. More research is required to identify the most cost-effective strategies for achieving maximum coverage of screening for all pregnant women, and access to treatment if required.

/pdf/lives-saved-tool-supplement-detection-and-treatment-of-cqweu2972w.pdf

Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality

Purpose of review
China has experienced an increase in the incidence and prevalence of syphilis that is especially remarkable since this infection was virtually eradicated in the country 50 years ago. The purpose of this analysis is to provide an overview of recent literature on syphilis proximate determinants and potential public health responses.

/pdf/china-s-syphilis-epidemic-epidemiology-proximate-4132mv0us4.pdf

China's syphilis epidemic: epidemiology, proximate determinants of spread, and control responses

Background: Despite the considerable decrease in the seroprevalence of syphilis in South Africa, with an estimated prevalence of 1.5% in 2010, the disease remains a threat particularly to pregnant women, hence there is a need for a rapid, reliable, and affordable screening and diagnostic test. A laboratory evaluation study was conducted in response to a call by the KwaZulu-Natal (KZN) Provincial Department of Health that is considering using rapid point-of-care syphilis tests. Methods: The performances of the Hexagon and the SD Bioline syphilis tests were compared with the Treponema pallidum hemagglutination assay (TPHA) reference test using 297 (142 positive and 155 negative) serum specimens. Results: Both assays demonstrated good performance with negative and positive concordance of 97 and 94% for the Hexagon assay and 98 and 90% for SD Bioline assay, respectively, when compared to the TPHA. The Hexagon test was quicker and easier to read than the SD Bioline test. Conclusion:Althoughtherapidsyphilistests performed favorably, a number of issues need to be considered prior to their use for syphilis screening in the public sector of South Africa. J. Clin. Lab. Anal. 28:77–81, 2014. C � 2014 Wiley Periodicals, Inc.

/pdf/evaluation-of-rapid-syphilis-tests-in-kwazulu-natal-551f3vt3e3.pdf

Evaluation of rapid syphilis tests in KwaZulu-Natal.

Our study aimed to identify key genes involved in the use of fluvastatin and zoledronate against breast cancer, as well as to investigate the roles of vascular endothelial growth factor A (VEGFA) in the malignant behaviors of breast cancer cells. The expression data GSE33552 was downloaded from Gene Expression Omnibus database, including mocked-, fluvastatin- and zoledronate-treated MDA-MB-231 cells. Differentially expressed genes (DEGs) were identified in fluvastatin- and zoledronate-treated cells using limma package, respectively. Pathway enrichment analysis and protein-protein interaction (PPI) network analysis were then performed. Then we used shRNA specifically targeting VEGFA (shVEGFA) to knock down the expression of VEGFA in MDA-MB-231 cells. Cell viability assay, scratch wound healing assay, Transwell invasion assay and flow cytometry were performed to explore the effects of VEGFA knockdown on the malignant behaviors of breast cancer cells. VEGFA was up-regulated in both fluvastatin- and zoledronate-treated breast cancer cells. Moreover, VEGFA was a hub node in PPI network. In addition, VEGFA was successfully knocked down in MDA-MB-231 cells by shVEGFA. Suppression of VEGFA promoted the migration and invasion of breast cancer MDA-MB-231 cells. Suppression of VEGFA inhibited the apoptosis of MDA-MB-231 cells. Our results indicate that up-regulation of VEGFA may prevent the progression of breast cancer after fluvastatin and zoledronate treatment via inducing cell apoptosis and inhibiting migration and invasion. VEGFA may serve as a potential prognostic indicator for clinical outcome in the management of breast cancer.

VEGFA Involves in the Use of Fluvastatin and Zoledronate Against Breast Cancer

Objectives Cadmium causes the pollution of marine habitat and Chlamys farreri is an effective concentrator of heavy metals, the aim of this study was to study the response mechanism of C. farreri to cadmium stress at transcriptomic and proteomic levels. Methods Transcriptomic analysis based on RNA-sequencing and proteomic analysis based on isobaric tags for relative and absolute quantitation were performed to reveal the molecular response of C. farreri to different concentrations of cadmium (0.1, 0.3, and 1 mg/L). In addition, a protein-protein interaction (PPI) network was constructed based on the Cytoscape tool to identify hub proteins related to the response of C. farreri to cadmium stress. Results A total of 24 190 unigenes from 58 683 candidates were annotated in known databases. The numbers of the differentially expressed unigenes (DEGs) was different among the three cadmium-treated groups compared with the control group. DEGs were involved in many pathways such as ABC transporters, protein processing in endoplasmic reticulum and endocytosis. A total of 660 proteins were identified, and differentially expressed proteins (DEPs) among different groups were determined. The overlapping DEGs and DEPs were associated with cadmium response. The upregulated unigene0002618 and downregulated unigene0000904 may be more important for the response of C. farreri to cadmium stress. Unigene0009750 was the hub protein in the PPI network with the highest degree of 20. Conclusions Our transcriptomic and proteomic analyses elucidated the molecular response of C. farreri to cadmium stress.

Integrated transcriptomic and proteomic analyses of the tissues from the digestive gland of Chlamys farreri following cadmium exposure.

Background: China is experiencing a growing syphilis epidemic. Individuals are currently screened and cases are confirmed using traditional serological testing methods. Methods: A total of 11 558 serum specimens from patients at 14 sexually transmitted diseases (STD) clinics at provincial, prefecture and county levels in Guangxi Autonomous Region were tested at local clinics using the toluidine red unheated serum test (TRUST) and the SD Bioline Syphilis 3.0 Treponema Pallidum (SD-TP) test and then transported to the National STD Reference Laboratory for TRUST and confirmatory Treponema pallidum particle assay (TPPA) testing. Results: In local clinics, 13.2% of specimens were TRUST positive and 12.8% were TRUST and SD-TP positive. At the Reference Laboratory, 15.4% of specimens were TRUST positive and 11.8% were TRUST and TPPA positive. Local clinics showed a significantly higher prevalence of active syphilis compared with results from the Reference Laboratory (12.8 v. 11.8%, χ2 = 4.59, P = 0.03). The local TRUST tests had consistent results with Reference Laboratory tests qualitatively among 96.2% of the specimens and quantitatively among 95.5% of the specimens. The algorithm of TRUST screening and then SD-TP confirmation among positive TRUST specimens at local STD clinics had 96.6% sensitivity and 99.3% specificity in diagnosing active syphilis compared with the ‘gold standard’ based on TRUST and TPPA positivity at the Reference Laboratory (positive predictive value 95.1% and negative predictive value 99.5%). Conclusion: The TRUST screening and SD-TP confirmation in combination can be used at local STD clinics for the efficient diagnosis of serologically active syphilis. However, continuing capacity building and quality assurance remain critical in ensuring the quality of syphilis diagnosis at local clinics.

Performance of serological tests for syphilis in sexually transmitted diseases clinics in Guangxi Autonomous Region, China: implications for syphilis surveillance and control

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Performance of serological tests for syphilis in sexually transmitted diseases clinics in Guangxi Autonomous Region, China: implications for syphilis surveillance and control