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BackgroundThe epidemic of rabies showed a rising trend in China in recent years. To identify the potential factors involved in the emergence, we investigated and analyzed the status and characteristics of human rabies between 1996 and 2008. Moreover, the status of rabies infection and vaccination in dogs, and prophylaxis of humans after rabies exposure were analyzed.MethodsHuman rabies data in China between 1996 and 2008 collected from the annual reports of Chinese Center for Disease Control and Prevention (China CDC) were analyzed. To investigate the status of dogs and postexposure prophylaxis (PEP) of humans, brain specimens of domestic dogs were collected and detected, and the demographic details, exposure status and PEP of rabies patients were obtained in 2005 and 2006 in Guangxi, Hunan and Guizhou provinces.ResultsThe results showed 19,806 human rabies cases were reported in China from 1996 to 2008, with an average of 1,524 cases each year, and the incidence almost was rising rapidly, with the peak in 2007 (3,300 cases). It was notable that nearly 50% of the total rabies cases nationwide were reported in Guangxi, Hunan and Guizhou provinces. In these three provinces, the rabies infection rate in dogs was 2.3%, and 60% investigated cities had a dog vaccination rate of below 70%; among the 315 recorded human cases, 66.3% did not receive any PEP at all, 27.6% received inadequate PEP, and only 6.0% received a full regime of PEP.ConclusionsIn recent years, rabies is reemerging and becoming a major public-health problem in China. Our analysis showed that unsuccessful control of dog rabies and inadequate PEP of patients were the main factors leading to the high incidence of human rabies in China, then there are following suggestions: (1) Strict control of free-ranging dogs and mandatory rabies vaccination should be enforced. (2)Establishing national animal rabies surveillance network is imperative. (3) PEP should be decided to initiate or withhold according to postmortem diagnosis of the biting animal. (4) The cost of PEP should be decreased or free, especially in rural areas. (5)Education of the public and health care staff should be enhanced.

Metabolic syndrome (MetS) has become a global public health problem affecting all nations and races. Few studies on the epidemic of metabolic syndrome (MetS) examined multi-ethnic adults in rural areas in Xinjiang, China. We thus investigated the prevalence and risk factors of MetS there. A cross-sectional study was performed in a representative sample of 15020 rural multi-ethnic adults from 2009 to 2010. Four widely used criteria (ATPIII\IDF\JIS\CDS) were used to measure the prevalence of MetS. Multiple logistic regression analysis was used to explore the risk factors of MetS. The age-adjusted prevalence of MetS was 14.43%, 21.33%, 26.50%, and 19.89% based on the ATP III, IDF, JIS and CDS criterion, respectively. The prevalence of MetS was higher in women and increased with age. According to JIS criterion, the prevalence of components in MetS was 57.75% for abdominal obesity, 44.05% for elevated blood pressure, 40.98% for reduced HDL-cholesterol, 23.33% for elevated triglycerides, 18.95% for raised fasting plasma glucose. Lower consumption of vegetables, milk, and higher consumption of red meat were associated with higher likelihood of having MetS. The prevalence of MetS in Xinjiang rural multi-ethnic adults was high. Diet factors were associated with the prevalence of MetS.

The Ras-like small GTPase Rheb is an upstream activator of the mammalian target of rapamycin (mTOR). It has recently been shown that Rheb activates mTOR by binding to its endogenous inhibitor FKBP38 and preventing it from association with mTOR. The interaction of Rheb with FKBP38 is controlled by its guanine nucleotide binding states, which are responsive to growth factor and amino acid conditions. In this study, we show that Rheb interacts with FKBP38 through a section within its switch I region that is equivalent to the effector domain of other Ras-like small GTPases. We find that the ability for Rheb to interact with FKBP38 correlates with its activity for mTOR activation. Our findings suggest that FKBP38 is a bona fide effector of Rheb and that the ability to interact with FKBP38 is important for Rheb as an activator of mTOR.Rheb is a Ras-related small GTPase that functions as an upstream activator of the mammalian target of rapamycin (mTOR) 2 (1, 2). Like other members of the Ras superfamily of small GTPases, the activity of Rheb is regulated by its guanine nucleotide binding states. It is active upon GTP bound but becomes inactive following hydrolysis of the bound GTP to GDP (3). The nucleotide binding states of Rheb are controlled mainly by the TSC1-TSC2 complex, which acts as a GTPaseactivating protein that stimulates GTP hydrolysis of Rheb and prevents its activation (4 -7). A complex signaling network converges both growth factor and energy signals to the TSC1-TSC2 complex, altering its GTPase-activating protein activity and consequently the guanine nucleotide binding states of Rheb (8). Changes in amino acid conditions also regulate Rheb activity through mechanisms independent of the TSC1-TSC2 complex (9, 10). In response to those diverse signals, Rheb cycles between active GTP-bound and inactive GDP-bound states, acting as a molecular switch to control mTOR activity (8).How Rheb activates mTOR has been a key focus of current studies in mTOR signaling. mTOR elicits its rapamycin-sensitive function in the context of a multiple protein complex termed the mTOR complex 1 (mTORC1). Upon activation, mTORC1 promotes protein synthesis by phosphorylating S6 kinase (S6K) at position Thr 389 and 4E-BP1 at positions Thr 37 / Thr 46 , two factors involved in translation initiation (11). It has been recently shown that Rheb activates mTORC1 by antagonizing its endogenous inhibitor, FKBP38 (12, 13). Under growth factor deprivation or amino acid starvation condition, FKBP38 binds directly to mTOR and down-regulates mTORC1 activity. When amino acids and growth factors are present, Rheb interacts with FKBP38 and releases mTORC1 for activation.TheinteractionofRhebwithFKBP38isguaninenucleotide-dependent. It binds strongly to FKBP38 in GTP-bound form and weakly in GDP bound form. This GTP-dependent binding suggests that FKBP38 is an effector of Rheb in the mTOR pathway, which represents the first known effector of Rheb that is regulated by guanine nucleotide (12).FKBP38, also known as FKBP8, belongs to the peptidyl prolyl...

Folliculin (FLCN) is the tumor suppressor associated withBirt-Hogg-Dubé (BHD) syndrome that predisposes patients to incident of hamartomas and cysts in multiple organs. Its inactivation causes deregulation in the mammalian target of rapamycin complex 1 (mTORC1) signaling pathway. However, the underlying mechanism is poorly defined. In this study, we show that FLCN is a ciliary protein that functions through primary cilia to regulate mTORC1. In response to flow stress, FLCN associates with LKB1 and recruits the kinase to primary cilia for activation of AMPK resided at basal bodies, which causes mTORC1 down-regulation. In cells depleted of FLCN, LKB1 fails to accumulate in primary cilia and AMPK at the basal bodies remains inactive, thus nullifying the inhibitory effect of flow stress on mTORC1 activity. Our results demonstrate that FLCN is part of a flow sensory mechanism that regulates mTORC1 through primary cilia. Birt-Hogg-Dubé (BHD)4 syndrome is a rare autosomal dominant genetic disorder characterized by development of hamartomas and cysts in multiple organs, including skin, lung, colon, and kidney (1, 2). The syndrome is caused by germ-line mutations in the BHD gene, which encodes the folliculin protein (FLCN), a 64-kDa polypeptide that shares little sequence similarity with any other known proteins (3). FLCN is found to complex with AMPK and FNIP1, although the significance of the complex for FLCN function remains unclear (4). In mouse models FLCN deficiency leads to development of polycystic kidneys and renal cell carcinoma that are characteristically similar to those found in BHD patients (5, 6). Inactivation of FNIP1, together with its homolog FNIP2, in mice also produces similar phenotypes as does by FLCN deficiency (7), suggesting that FNIP1 may be required for FLCN function. Analyses of tumors derived from BHD patients and FLCN deficient animals have revealed deregulation in mammalian target of rapamycin complex 1 (mTORC1) signaling, a key event in tumorigenesis (5, 8 -12). This abnormality in mTORC1 signaling is believed to be a major contributor to the pathological conditions in BHD, as inhibition of mTORC1 with rapamycin has been found to reduce the BHD tumor growth in animal models (5, 6). However, the mechanism by which FLCN regulates mTORC1 remains poorly understood.At non-cycling resting state, most eukaryotic cells possess a microtubule-based membranous protrusion from cell surface termed as primary cilium (13). This unique structure plays a critical role in maintaining tissue homeostasis by functioning as a sensor for extracellular fluidic shear stress and chemicals (14, 15). Many signaling pathways involved in cell growth and proliferation are regulated by this environmental sensor, among which is the mTORC1 pathway (16 -18). Several upstream regulators of mTORC1 have been found to localize to primary cilia, including the tuberous sclerosis complex proteins, LKB1 and AMPK (19 -21). A recent study has shown that primary cilia are able to act through a LKB1-and AMPK-dependent mechanism to dow...

IMPORTANCEThe L-asparaginase-based SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide) chemotherapy regimen has shown higher response rates and survival benefit over an anthracycline-containing regimen. However, the safety profile was not satisfied. A well-tolerated regimen with promising efficacy is lacking.OBJECTIVE To compare the efficacy and safety of the DDGP (dexamethasone, cisplatin, gemcitabine, and pegaspargase) regimen with the SMILE regimen in newly diagnosed advanced-stage (III/IV) extranodal natural killer/T-cell lymphoma (ENKL). DESIGN, SETTING, AND PARTICIPANTSThis was an open-label, multicenter, randomized clinical trial that took place across 12 participating hospitals in China from January 2011 to February 2019. Patients were eligible if they were 14 to 70 years old with newly diagnosed ENKL in stages III/IV and had an Eastern Cooperative Oncology Group performance status of 0 to 2. Eligible patients were evenly randomized to either the DDGP or SMILE group.INTERVENTIONS Patients in each group were treated with the assigned regimen every 21 days for 6 cycles. MAIN OUTCOMES AND MEASURESThe primary end point was progression-free survival (PFS), and secondary end points included overall response rate and overall survival (OS). The adverse events between the DDGP and SMILE groups were compared. RESULTS Among the 87 randomized patients, 80 received treatment (40 in the DDGP group and 40 in the SMILE group); the median (IQR) age was 43 (12) years, and 51 (64%) were male. The baseline characteristics were similar between the groups. At a median follow-up of 41.5 months, the median PFS was not reached in the DDGP group vs 6.8 months in the SMILE group (HR, 0.42; 95% CI, 0.23-0.77; P = .004), and the median OS was not reached in the DDGP group vs 75.2 months in the SMILE group (HR, 0.41; 95% CI, 0.19-0.89, P = .02). The PFS rate at 3 years and OS rate at 5 years were higher in the DDGP group vs the SMILE group (3-year PFS, 56.6% vs 41.8%; 5-year OS, 74.3% vs 51.7%). The overall response rate was higher in the DDGP group than in the SMILE group (90.0% vs 60.0%; P = .002). Grade 3 and 4 hematologic toxic effects were more frequently reported in the SMILE group vs the DDGP group (leukopenia, 85.0% vs 62.5%; neutropenia, 85.0% vs 65.0%). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, the DDGP regimen showed promising preliminary results for patients with newly diagnosed local advanced ENKL. A confirmation trial based on larger population is warranted.

Objective: This study aimed to estimate the prevalence of diabetes mellitus (DM) and impaired fasting glucose (IFG) in a Kazakh population aged ≥18 years living in the YiLi District of Xinjiang, China and to evaluate the associated risk factors of diabetes. Methods: Randomly selected adults, living for at least 6 months in the YiLi District in Xinjiang had their clinical characteristics and standard blood chemistries measured. DM and IFG were defined according to WHO 1999 criteria. The adjusted odds ratio (ORs) and 95% confidence intervals were calculated for the association of diabetes risk factors in multivariate logistic regression models. Results: A total of 3919 subjects were randomly selected. The age-and gender-standardized prevalence of DM and IFG were 5.9% and 10.0%, respectively. The prevalence of DM and IFG increased with age and BMI. Prevalence of 7.4%, 12.2% in males and 4.9%, 8.6% in females for DM and IFG. Compared by sex, prevalence of DM and IFG was higher in males. Prevalence of 3.4%, 8.1% in normal, 6.7%, 11.9% in overweight and 12.0%, 13.0% in obesity for diabetes and IFG. In the multivariable logistic models, male sex, older age, unmarried, overweight, obesity, hypertension, triglycerides and smoking were all significantly associated with an increased risk of diabetes. Conclusions: The prevalence of DM and IFG among minorities was lower than the overall national level both in men and women (9.7% in total, 10.6% in males, 8.8% in females), and also lower than among the Han ethnicity (9.26%) which predominates in China today.