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Introduction:The objective of this study was to report on the clinical performance of non-invasive prenatal testing (NIPT) for trisomies 21, 18 and 13 in twin pregnancies and to define the performance of NIPT by combining our cohort study results with published studies in a systematic meta-analysis. Material and methods:A cohort study was carried out in the First Affiliated Hospital of Sun Yat-sen University and Kanghua Hospital. Meanwhile, searches of PubMed, EMBASE, The Cochrane Library and Web of Science for all relevant peer-reviewed articles were performed with a restriction to English language publication before 15 June 2019. Quality assessments were conducted with the Quality Assessment Tool for Diagnostic Accuracy Studies-2 checklist. Data analysis, heterogeneity, subgroup analysis and publication bias were carried out using META-DISC 1.4 and STATA 12.0.Results: In all, 141 twin pregnancies included in our cohort study; confirmation revealed one true-positive case for trisomy 21 and 140 true-negative cases. The sensitivity and specificity for trisomy 21 by NIPT were both 100%. Twenty-two eligible studies were enrolled in this meta-analysis together with our study. There were 199 cases of trisomy 21, 58 cases of trisomy 18, 14 cases of trisomy 13 and 6347 cases of euploids in total. For trisomy 21, NIPT showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.99, 1.00, 145.81, 0.06 and 1714.09, respectively. For trisomy 18, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.88, 1.00, 200.98, 0.19 and 483.68, respectively. Conclusions:The performance of NIPT for trisomy 21 in twin pregnancy was excellent and it was similar to that reported in singleton pregnancy. However, due to publication bias (trisomy 18) and small number of cases (trisomy 13), accurate assessment of the predictive performance of NIPT for trisomies 18 and 13 could not be achieved.Our study was approved by the institutional review board of the First Affiliated Hospital, Sun Yat-sen University (no. 2016-03). | Systematic review and meta-analysis | Literature search and study selectionSearches of PubMed, EMBASE, The Cochrane Library and Web of Science for all relevant peer-reviewed articles were performed with K E Y W O R D S non-invasive prenatal testing, trisomy 13, trisomy 18, trisomy 21, twin pregnancies Key messageNon-invasive prenatal testing performs well in twin pregnancies with trisomy 21 and can be popularized for routine prenatal screening in twin pregnancies.

Background Bloodstream infection (BSI) caused by carbapenem resistant Klebsiella pneumoniae (CRKP), especially in elderly patients, results in higher morbidity and mortality. The purpose of this study was to assess risk factors associated with CRKP BSI and short-term mortality among elderly patients in China. Methods In this retrospective cohort study, we enrolled 252 inpatients aged ≥ 65 years with BSI caused by KP from January 2011 to December 2020 in China. Data regarding demographic, microbiological characteristics, and clinical outcome were collected. Result Among the 252 BSI patients, there were 29 patients (11.5%) caused by CRKP and 223 patients (88.5%) by carbapenem-susceptible KP (CSKP). The overall 28-day mortality rate of elderly patients with a KP BSI episode was 10.7% (27/252), of which CRKP BSI patients (14 / 29, 48.3%) were significantly higher than CSKP patients (13 / 223, 5.83%) (P < 0.001). Hypertension (OR: 13.789, [95% CI: 3.883–48.969], P < 0.001), exposure to carbapenems (OR: 8.073, [95% CI: 2.066–31.537], P = 0.003), and ICU stay (OR: 11.180, [95% CI: 2.663–46.933], P = 0.001) were found to be associated with the development of CRKP BSI in elderly patients. A multivariate analysis showed that isolation of CRKP (OR 2.881, 95% CI 1.228–6.756, P = 0.015) and KP isolated in ICU (OR 11.731, 95% CI 4.226–32.563, P < 0.001) were independent risk factors for 28-day mortality of KP BSI. Conclusion In elderly patients, hypertension, exposure to carbapenems and ICU stay were associated with the development of CRKP BSI. Active screening of CRKP for the high-risk populations, especially elderly patients, is significant for early detection and successful management of CRKP infection.

Abnormal metabolism, including abnormal lipid metabolism, is a hallmark of cancer cells.Some studies have demonstrated that the lipogenic pathway might promote the development of hepatocellular carcinoma (HCC). However, the role of adipose triglyceride lipase (ATGL) in hepatocellular carcinoma cells has not been elucidated.We evaluated the function of ATGL in hepatocellular carcinoma using methyl azazolyl blue and migration assay through overexpression of ATGL in HepG2 cells. Quantitative reverse-transcription polymerase chain reaction and Western blot analyses were used to assess the mechanisms of ATGL in hepatocellular carcinoma. In the current study, we first constructed and transiently transfected ATGL into hepatocellular carcinoma cells.Secondly, we found that ATGL promoted the proliferation of hepatoma cell lines via upregulating the phosphorylation of AKT, but did not affect the metastatic ability of HCC cells. Moreover, the p-AKT inhibitor significantly eliminated the effect of ATGL on the proliferation of hepatoma carcinoma cells. Taken together, our results indicated that ATGL promotes hepatocellular carcinoma cells proliferation through upregulation of the AKT signaling pathway. K E Y W O R D S ATGL, hepatocellular carcinoma cells, p-AKT signaling pathway, tumor proliferation 1 | INTRODUCTIONThe occurrence, development, and metastasis of tumors are closely related to fat and lipids. [1,2] It is reported that serum lipid abnormalities are one of the high risk factors for breast cancer, prostate cancer, and liver cancer, [3,4] but the exact mechanism is not yet clear. The triacylglycerols (TGs) in the cell exist in human adipose tissue in the form of lipid droplets. When hungry, TGs, stored in fat cells, are hydrolyzed to glycerol and fatty acid, and then perform β oxidation to provide energy for the body. The hydrolysis of TGs to glycerol and fatty acid requires at least three lipolytic enzymes. [5,6] Adipose triglyceride lipase (ATGL) catalyzes the initial step of lipolysis, converting TGs to diacylglycerols (DGs); hormone-sensitive lipase is mainly responsible for the hydrolysis of DGs to monoacylglycerols (MGs) and MG lipase (MGL) hydrolyzes MGs. [7] ATGL is the newest member of the lipolytic enzyme trio. The enzyme, first described in 2004, belongs to the family patatin domain-containing proteins including nine human and eight murine members. [8,9] However, the role of ATGL in hepatocellular carcinoma cells is not yet clear. The aim of this study was to study the effect of ATGL on hepatocellular carcinoma cells by silencing or overexpression of ATGL, and to further elucidate its molecular mechanism, providing a theoretical basis and experimental data for the treatment of HCC with ATGL as a target in future.