[Progress in research of determinants of healthy life expectancy]

Objective: To analyze the influencing factors of healthy life expectancy (HLE). Methods: Seven Chinese and English databases were used for the retrieval of related literatures published by May 7, 2022 to identify influencing factors of HLE, including diseases and injuries and their risk factors. Based on the ecological model of health determinants, this study classifies the risk factors of diseases and injuries into five levels: personal characteristics, individual behavior and lifestyle, social network, living and working conditions, and macroscopic socio-economic, cultural and environmental conditions. Contents of research area, HLE indicators, research population, influencing factors, data sources and results were extracted. The frequencies of reported documents of different HLE indicators and influencing factors of different dimensions were visualized by using evidence map, and the empirical studies of four authoritative English medical journals and Chinese core medical journals were further compared and described. Results: A total of 90 studies were selected, in which 26 were conducted in China (28.9%). Fifty-three studies are about diseases and injuries in the first dimension, and all of them have studied non-communicable diseases, accounting for the highest proportion (58.9%). There were 77 studies about the analysis on the determinants of health at five levels by an ecological model, all the studies reported multi-level results. Among them, 53 studies reported personal characteristics (58.9%), 47 studies reported individual behavior and lifestyle (52.2%), 10 studies reported social networks (11.1%), 35 studies reported living and working environment (38.9%), 8 studies reported social economy, culture status and environment condition (8.9%). The literatures about HLE published by 4 authoritative English medical journals and 21 Chinese core medical journals in recent three years were selected. Non-communicable diseases and personal characteristics were the top two most commonly studied factors of HLE, and 11 (52.3%) and 12 (57.1%) studies reported these two kinds of factors respectively. The most important factor contributing to the global disability-adjusted life years of non-communicable diseases was individual behavior and lifestyle, which was the most changeable factor. Conclusions: In recent three years, studies involving influencing factors of HLE were mainly non-communicable diseases and personal characteristics. In the future, individual behavior, lifestyle and working environment should be strengthened.

[Real-world evidence and randomized controlled trials: the initiation, implementation, progress interpretation and revelation of RCT DUPLICATE (part 1)]

In recent years, researchers, pharmaceutical companies, and political makers gradually using more real-world data (RWD) to produce real-world evidence (RWE) for policy-making. A research team of Harvard University launched the RCT DUPLICATE project in 2018, aiming to replicate 30 randomized controlled trials using the medical claims database in order to explore methods for quantifying the efficacy-effectiveness gap and explain its potential sources, to enhance the credibility of the RWE. This paper reviews the background of RCT DUPLICATE Initiative, highlights the research purposes, research design and implementation process of the RCT DUPLICATE Initiative, to help domestic scholars better understand the scope and application value of RWE.

[Real-world evidence and randomized controlled trials: the initiation, implementation, progress interpretation and revelation of RCT DUPLICATE (part 2)]

With the promotion and application of big medical data, non-interventional real-world evidence (RWE) has been used by regulators to assess the effectiveness of medical products. This paper briefly introduces the latest progress and research results of the RCT DUPLICATE Initiative launched by the research team of Harvard University in 2018 and summarizes relevant research experience based on the characteristics of China's medical service to provide inspiration and reference for domestic scholars to conduct related RWE research in the future.

[Clinical research progress and implications of therapeutic vaccines for cervical cancer and precancerous lesions: a qualitative systematic review]

Objective: To systematically summarize and analyze the clinical research progress of therapeutic vaccines for cervical cancer or precancerous lesions. Methods: English databases (PubMed, Embase, Web of Science, Cochrane library, Proquest, and ClinicalTrails.gov) and Chinese databases (SinoMed, CNKI, WanFang, and VIP Database) were systematically searched to collect literature on therapeutic vaccines for cervical cancer or precancerous lesions from inception to February 18, 2021. After screening, we evaluated the risk of bias of included studies, and combed the basic information of the literature, research designs, information of vaccines, study patients, outcome indicators and so on, qualitatively summarized the clinical research progress. Results: A total of 71 studies were included in this systematic review, including 14 random controlled trials, 15 quasi-random controlled trials, 4 cohort studies, 1 case-control study, 34 case series studies and 3 case reports. The study patients included women aged 15~79 with cervical cancer or precancerous lesions in 18 countries from 1989 to 2021. On the one hand, there were 40 studies on therapeutic vaccines for cervical precancerous lesions (22 867 participants), involving 21 kinds of vaccines in 6 categories. Results showed 3 marketed vaccines (Cervarix, Gardasil, Gardasil 9) as adjuvant immunotherapies were significant effective in preventing the recurrence of precancerous lesions compared with the conization only. In addition, MVA E2 vaccine had been in phase Ⅲ clinical trials as a specific therapeutic vaccine, with relative literature showing it could eliminate most high-grade precancerous lesions. Therapeutic vaccines for precancerous lesions all showed good safety. On the other hand, there were 31 studies on therapeutic vaccines for cervical cancer (781 participants), involving 19 kinds of vaccines in 7categories, with none had been marketed. 25 studies were with no control group, showing the vaccines could effectively eliminate solid tumors, prevent recurrence, and prolong the median survival time. However, the vaccines effectiveness couldn't be statistically calculated due to the lack of a control group. As for the safety of therapeutic vaccines for cervical cancer, 9 studies showed that patients experienced serious adverse events after treatments, where 7 studies reported that serious adverse events occurred in patients couldn't be ruled out as the results of therapeutic vaccines. Conclusions: The literature review shows that the literature evidence for the therapeutic vaccines for cervical precancerous lesions is relatively mature compared with the therapeutic vaccines for cervical cancer. The four kinds of vaccines on the market are all therapeutic vaccines for precancerous lesions, but they are generally used as vaginal infection treatments or adjuvant immunotherapies for cervical precancerous lesions, not used for the specific treatments of cervical precancerous lesions. Other specific therapeutic vaccines are in the early stage of clinical trials, mainly phase Ⅰ/Ⅱ clinical trials with small sample size. The effectiveness and safety data are limited, and further research is still needed.

[Strengthening the Reporting of Pharmacogenetic Studies (STROPS) guideline]

Pharmacogenetic studies are designed to investigate the associations between genetic variation and treatment response for a particular drug in terms of both efficacy and adverse events and have high sample size requirements. To improve the quality of pharmacogenetic studies and facilitate the Meta-analyses to investigate statistically significant associations, Strengthening the Reporting of Pharmacogenetic Studies (STROPS) guideline was developed in 2020 based on the Strengthening the Reporting of Genetic Association Studies (STREGA) statement. The objective of this article is to present a brief introduction to the STROPS guideline and an interpretation of the key points in some items with examples for the better understanding and application.

Vitrification by transient vacuum flashing spray cooling of liquid nitrogen

BACKGROUND

The transient vacuum flashing spray cooling of liquid nitrogen (LN₂) on a microstructured surface can provide ultra-fast cooling rate and may improve cell survival rates.

OBJECTIVE

To utilize flashing spray cooling of LN₂ instead of film boiling to improve further cell vitrification.

METHOD

This study analyzed the effects of the three key parameters (flow rate of liquid nitrogen, ambient pressure, and spray distance) on the cooling process by experimentation.

RESULTS

The experimental results showed that the vacuum flashing spray cooling of LN₂ can gain higher cooling rates than that achieved by film boiling in conventional vitrification methods. The three parameters all affected the vacuum flash evaporation spray cooling of LN2, and their effect trends were not monotonous but followed a parabolic trend that increased and then decreased. That is, the three parameters all have optimum values to the cooling process.

CONCLUSION

Vacuum flash evaporation spray cooling can develop the ultra-fast cooling rates needed to enhance cell vitrification. doi.org/10.54680/fr22310110212.

[How to report adaptive design randomized trials-A interpretation of international reporting guideline ACE]

Concerns has been raised in improving the quality of adaptive design randomized trials reports. Based on the CONSORT 2010 (Consolidated Standards of Reporting Trials), The Adaptive designs CONSORT Extension (ACE) has developed items and reporting specifications for adaptive design trials. This paper presents a brief explanation of the extension and new items of ACE and introduces the applications of ACE checklist with examples.

[Artificial intelligence-based literature data warehouse for vaccine safety]

Objective: To establish a sustainable updated literature data warehouse for global vaccine safety assessment, and provide data support for evidence-based vaccine safety assessment. Methods: Semi-automated construction and updating of a literature data warehouse were achieved through the continuous integration of standard operating steps of evidence-based reviews with artificial intelligence technologies. Following the standard procedure of a systematic literature review, the literatures about vaccine safety assessment published before November 29, 2020 were retrieved from 9 databases including OVID, Scopus, Web of Science, Cochrane Library, and ClinicalTrails.org in English and Wanfang, CNKI, VIP, and SinoMed in Chinese. Literatures were screened for two rounds in a semi-automatic manner (by artificial intelligence literature processing system and manual work) according to the inclusion/exclusion criteria. Furthermore, the literatures were classified according to the types of vaccines and adverse events. The updating strategy was established, and the literature data warehouse was updated regularly. Experts were organized to select specific vaccine safety topics and carry out special demonstration studies. Results: More than 0.41 million articles were retrieved. According to the inclusion/exclusion criteria, 23 304 articles were included after two rounds of screening. At present, we have selected and completed three prior topics as demonstration studies, including the systematic review of "DPT (diphtheria, pertussis and tetanus) vaccine and encephalopathy/encephalitis", and the classified management of literatures about allergic purpura and brachial plexus neuritis. Conclusions: The sustainable updated literature data warehouse of vaccine safety can provide high-quality research data for vaccine safety research, including evidence support for immunization related policy-making and adjustment and vaccine safety-related methodological research or clinical tool development; and further demonstration studies can provide references for building a new methodological framework system for timely and efficient completion of the evidence-based assessment of vaccine safety.

[Introduction of a tool to assess Risk of Bias in Non-randomized Studies-of Environmental Exposure (ROBINS-E)]

This paper summaries the Risk of Bias in Non-randomized Studies-of Environmental Exposure (ROBINS-E), a tool for evaluating risk of bias about non-randomized studies of exposures (NRSE), and introduces the application of ROBINS-E in a published NRSE. According to the characteristics of NRSE, evaluation fields and signaling questions were designed in ROBINS-E to provide essential information about risk of bias for NRSE included in systematic reviews and GRADE. ROBINS-E is the tool in assessment of risk of bias in observational studies and quasi-randomized studies. Although the tool has been used in practice to some extent, but it still needs further improvement. Attention should be paid to its update and progress.

Development of ruminating behavior in Holstein calves between birth and 30 days of age

Ruminating behavior accompanies the development of the rumen and the intake of solid feed in calves. However, few studies have reported on the emergence and development of rumination. In this study, we observed ruminating behavior changes of 56 Holstein calves (body weight at birth = 40.1 ± 3.96 kg; mean ± standard deviation) from birth to 30 d of age under the feeding management of suckling calves that were only fed pelleted concentrate feed and milk. All calves were housed in individual pens equipped with infrared cameras. We explored feed intake within 30 d of age, body weight on 61 d of age, and other apparent indicators, including the age of first eating the bedding, duration of non-nutritive oral behavior at 25 and 30 d of age, total starter feed intake within 30 d of age, average daily starter feed intake within 30 d of age, and duration of ruminating behavior at 25 and 30 d of age for all calves, to further explore the effects of the age of first ruminating behavior (AFR). The AFR fitted the normal distribution and ranged from 15 to 20 d of age for 50% of the experimental population. The AFR was positively correlated with the age of first eating the bedding and duration of non-nutritive oral behavior at 30 d of age. Total starter feed intake within 30 d of age, average daily starter feed intake within 30 d of age, duration of ruminating behavior at 25 and 30 d of age, and duration of eating the bedding at 25 and 30 d of age were negatively correlated with AFR. Overall, to the best of our knowledge, this is the first study that has analyzed the correlation between AFR and other indicators. We found that earlier AFR was associated with shorter duration of non-nutritive oral behavior, longer durations of rumination and eating the bedding, and higher feed intake by 30 d of age.

Macrophage M1/M2 ratio as a predictor of pleural thickening in patients with tuberculous pleurisy

We evaluated the association between macrophage polarization and the development of pleural thickening in patients with tuberculous pleurisy. Patients with tuberculous pleurisy admitted to our hospital between October 2018 and March 2019 were prospectively recruited. Pleural fluid samples were obtained before treatment for detection of adenosine deaminase (ADA) and macrophage phenotype (M1: CD14+ CD86+; M2: CD14+ CD163+). Peripheral blood samples were subjected to interferon gamma release assay (IGRA). All subjects were administered standard anti-tuberculosis regimen (2HREZ/4HR); high-resolution CT was performed to determine pleural thickening (thickness>2mm) after completion of treatment. Pleural effusion in patients with thickened pleura had significantly more M1 but fewer M2 macrophages, and higher ADA level, as compared to those with normal pleura (P<0.05). No significant between-group difference was observed with respect to IGRA. In receiver operating characteristic (ROC) curve analysis, the optimal cut-off level of M1/M2 ratio for predicting pleural thickening was 1.149 (area under the curve: 0.842; sensitivity: 88.6%; specificity: 69.2%; positive predictive value: 86.3%; negative predictive value: 81.7%). M1/M2 ratio in the pleural fluid is a promising marker for predicting the development of pleural thickening in patients with tuberculous pleurisy. Macrophage-mediated immune response may play an important role in the pathogenesis of tuberculous pleurisy.

P–422 Acylglycerol Kinase is a new novel marker in preeclampsia

Study question

What is the potential function of Acylglycerol Kinase (AGK) in the pathogenesis of preeclampsia(PE).

Summary answer

AGK plays an important role in the pathogenesis of PE by influencing the function of the trophoblast cells.

What is known already

PE is the leading cause of maternal and perinatal mortality and morbidity. The underlying mechanism is still not completely elucidated. Disorder migration, invasion and mitochondria function of trophoblast cells are one of mechanism in preeclampsia. AGK is a subunit of the mitochondrial channel protein complex TIM22, and maintain the stability of mitochondrial structure and function. Studies have shown that AGK is related to the development of various cancers by infecting the cells migration and invasion. It will be interesting to explore the potential function of AGK in the process of early trophoblast development and the pathogenesis of PE.

Study design, size, duration

Firstly, explore the expression of AGK in PE. Secondly, lentivirus systems was used to generate loss and gain of function models in trophoblast cell line-HTR8/Sneov to study the role of AGK in the pathogenesis of PE.

Participants/materials, setting, methods

We examined the expression of AGK both in placental tissues from PE patients and normal pregnant patients. Meanwhile, we generated AGK loss and gain of function models in HTR8/Sneov cells by using lentivirus systems. Transwell assays, scratch-wound assays, EDU and plate clone formation assays, cell apoptosis assays, cell cycle assays, ATP concentration, mtDNA level and transmission electron microscopy were used to examine the function of AGK in HTR8/Sneov cells model.

Main results and the role of chance

In this study, AGK was significantly decreased in the extra-villous trophoblast (EVT) cells in placental tissues of PE patients compared with that in control group by immunohistochemistry. And further confirmed the expression of AGK in placental tissues by QPCR, western blot. We demonstrated that knockdown of AGK in HTR8 dramatically decreased the cell proliferation, migration and invasion. It also showed the significantly lower plate clone formation rate in AGK knockdown -HTR8 cells compare with the WT HTR8 cells. While overexpression of AGK in HTR8 dramatically increased the cell proliferation, migration, invasion and higher plate clone formation rate. Further, we demonstrated that AGK regulated the ATP level and mtDNA level in HTR8 cells model. And we found that knockdown AGK decreased the number of mitochondria, and shown the mitochondrial crista disorder, mitochondrial swelling and dissolution and mitochondrial membrane fragmentation. While overexpression AGK increased the number of mitochondria.

Limitations, reasons for caution

Although we show that AGK played an important role in the function of HTR8, the study of working mechanism of AGK in PE is still very limited. More studies will be performed to explore its underline mechanism.

Wider implications of the findings: This study was the first time to explore the role of AGK in PE. It will help us to better understand the pathogenesis of PE, which might be helpful in future application of novel therapeutic targets in PE.

Trial registration number

Not applicable

[Application of multi-state Markov model in studying transition of number of chronic complications and influencing factors in type 2 diabetes mellitus patients]

Objective: To establish a multi-state Markov model of type 2 diabetes mellitus (T2DM) patients and explore the transition rule between the cumulative number of different chronic complications, estimate the transition probability and intensity between status, and explore the possible factors affecting the transition between status. Methods: A retrospective cohort study of 33 575 patients with T2DM was conducted. According to the baseline and the cumulative number of chronic complications during the follow-up period, the patients were classified based on five status: T2DM, one complication, two complications, three complications, four and above complication, indicated by S0, S1, S2, S3 and S4, respectively. A time-continuous and state-discrete multi-state irreversible Markov model was used for statistical analysis. Results: The study included 33 575 T2DM patients, and their average age was 60 years old, the median of follow-up length was 8 years. In these patients, 32 653 had no baseline complications. At the end of follow-up, the transition probabilities of S0→S1, S1→S2, S2→S3 and S3→S4 were 16.4%, 32.4%, 45.6% and 25.9%, respectively. The results of multivariate analysis showed that being female (HR=0.919), less than 60 years old (HR=0.929), higher fasting plasma glucose (HR=1.601), lower high-density lipoprotein (HR=1.087), higher total cholesterol (HR=1.090),weekly exercise (HR=0.897), vegetarian diet (HR=0.852) and heavy diet (HR=1.887) were the risk factors for S0 to S1. And being female (HR=0.768), less than 60 years old (HR=0.859) and lower high-density lipoprotein (HR=1.160) were the risk factors for S1 to S2. Conclusions: The probability of multiple complications in T2DM patients increased over time, the transition intensity of S2→S3 was largest, followed by S1→S2. Therefore, we need to conduct both early and long-term indicators monitoring and disease prevention, strengthen the health education to improve patients' daily living habits at early stage of the illness, encourage patients to have moderate exercise and balanced diet, strengthen the monitoring of fasting blood- glucose, cholesterol and high-density lipoprotein levels to prevent the deterioration of the illness.

[Expression of nicotinamide-N-methyltransferase in gastric cancer and its biological and clinicopathological significance]

OBJECTIVE

To investigate the expression of nicotinamide-N-methyltransferase (NNMT) in gastric cancer (GC) and explore its biological and clinicopathological significance.

OBJECTIVE

We screened the candidate genes associated with the classification and prognosis of gastric cancer by analyzing GEO, Oncomine and TCGA datasets. The molecular pathways and protein interaction network involving these candidate genes were analyzed using STRING, GSEA, David and Cytoscape software. The expressions of the candidate genes in 28 pairs of gastric cancer and adjacent tissues were detected with qRTPCR, and CCK-8 assay, clone formation assay, wound healing assay and Transwell assay were carried out to analyze the effects of modulation of NNMT expression on proliferation, invasion and migration of different gastric cancer cell lines.

OBJECTIVE

NNMT was highly expressed in gastric cancer tissues and was negatively correlated with the prognosis of patients with gastric cancer. Pathway analysis showed that the high expression of NNMT was associated with adhesion-related pathway molecules such as extracellular matrix receptors, cell adhesion molecules, and cytokine receptors, while its low expression was associated with base mismatch repair and riboflavin metabolism. Protein interaction analysis showed that NNMT interacted with 16 differentially expressed proteins such as AURKA and was co-expressed with TAGLN, PTRF, AKAP12 and IGF2BP2. In clinical tissue specimens, qRT-PCR results showed that the expression of NNMT mRNA was significantly higher in gastric cancer tissues than in the adjacent tissues (P < 0.05). In gastric cancer cell lines, overexpression of NNMT was found to significantly promote cell proliferation, invasion and migration, while NNMT knockdown produced obvious inhibitory effects on cell proliferation, invasion and migration.

OBJECTIVE

NNMT is highly expressed in gastric cancer and negatively correlated with the prognosis of gastric cancer patients. The high expression of NNMT promotes the proliferation, invasion and metastasis of gastric cancer cells, suggesting the potential of NNMT as prognostic marker of gastric cancer.

Low expression of lncRNA TUBA4B promotes proliferation and inhibits apoptosis of colorectal cancer cells via regulating P15 and P16 expressions

OBJECTIVE

To explore the expression, function, and regulation mechanism of the long non-coding ribonucleic acid (lncRNA) tubulin alpha 4b (TUBA4B) in colorectal cancer (CRC) tissues and cells.

PATIENTS AND METHODS

Cancer and adjacent tissues were collected from 60 CRC patients. CRC cell lines SW480, SW620, HCT116, Caco-2, DLD-1 and HT29, and colonic epithelial cell line CCD841 were also enrolled. Then, the expression of TUBA4B in CRC tissues and cell lines was detected via quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR). In vitro assays [cell counting kit-8 (CCK-8) assay, clone formation assay, and flow cytometry] were performed to study the biological function of TUBA4B in CRC. Additionally, the downstream regulatory targets of TUBA4B were investigated through Western blotting analysis and qRT-PCR assay.

RESULTS

The results of qRT-PCR revealed that compared with adjacent tissues, the expression of TUBA4B was down-regulated in 47/60 CRC tissues (47/60, 78.3%). According to in vitro assays (CCK-8 assay, clone formation assay, and flow cytometry), over-expression of TUBA4B inhibited the proliferation and promoted the apoptosis of CRC cells. TUBA4B remarkably regulated mRNA and protein levels of p15 and p16.

CONCLUSIONS

LncRNA TUBA4B is down-regulated expression in CRC tissues and cells, which facilitates CRC cell proliferation and suppresses apoptosis by regulating the expressions of p15 and p16.