Correlation between Sarcopenia and Arteriosclerosis in Elderly Community Dwellers: A Multicenter Study

BACKGROUND

Evidence suggests that arteriosclerosis and sarcopenia (decreased muscle mass) share some of their many causes. However, after controlling for confounding factors, it is unclear whether the presence of arteriosclerosis correlates with sarcopenia.

OBJECTIVES

The aim of this paper is to explore whether sarcopenia is associated with arteriosclerosis.

DESIGN

A multicenter cross-sectional community-based study.

MATERIALS AND METHODS

A total of 2511 elderly subjects from six Chinese community health service centers in Anhui province were surveyed through an e-health promotion system to collect basic data and measurements of brachial-ankle pulse wave (baPWV), body composition, and handgrip strength (HGS). Pearson's correlation and binary logistic regression analyses were performed to identify associations between sarcopenia and high baPWV.

RESULTS

The prevalence rates of sarcopenia were 12.9% in men and 15.3% in women according to the 2019 standard of Asian Working Group for Sarcopenia. Among subjects with high baPWV, the proportion of sarcopenia was higher compared to those with normal baPWV (men: 17.7% vs. 3.7%; women: 20.4% vs. 4.9%, both p<0.001). Binary logistic regression analysis revealed that sarcopenia was associated with high baPWV (p<0.0001, odds ratio=1.619) after adjusting for confounding factors. HGS slightly and negatively correlated with baPWV (-0.19 in men and -0.18 in women).

CONCLUSIONS

The intertwined pathophysiological mechanisms shared by arteriosclerosis and sarcopenia are potential targets for future interventions to reduce morbimortality in subjects with both disorders. Upcoming prospective studies and clinical trials are expected to advance these findings.

Maintenance treatment in advanced HER2-negative gastric cancer

Survival for patients with advanced gastric cancer (GC) remains poor. Systemic chemotherapy which has reached a plateau stays the standard first-line (1L) treatment for advanced human epidermal growth-factor receptor 2 (HER2)-negative GC. To maximize the benefit of 1L treatment, the concept of maintenance treatment is constantly being explored. In advanced HER2-negative GC, current clinical guidelines do not recommend a standard maintenance therapy strategy. In addition to the monotherapy maintenance with fluorouracil after 4-6 cycles of 1L chemotherapy, some agents that are active against novel targets have been evaluated in clinical trials for maintenance treatment. Whereas most of these trials do not reach their primary endpoints, they open new horizons for the 1L treatment of advanced HER2-negative GC. Therefore, we reviewed the clinical trials in the field of maintenance treatment in advanced HER2-negative GC and discussed some of the problems in clinical trials.

Comparison of contrast-enhanced ultrasound and contrast-enhanced computed tomography for the diagnosis of cervical lymph node metastasis in squamous cell carcinoma of the oral cavity

Early detection of cervical lymph node metastasis (CLNM) from squamous cell carcinoma (SCC) of the oral cavity remains challenging. This prospective study was performed to evaluate the ability of contrast-enhanced ultrasound (CEUS) to detect CLNM from oral cavity SCC. Additionally, its diagnostic value was compared with that of contrast-enhanced computed tomography (CECT). Forty-eight consecutive patients with SCC of the oral cavity were enrolled. All subjects were examined preoperatively with both CEUS and CECT. Subsequently, neck dissections were performed for these patients, and cervical lymph nodes separated from the surgical specimens were assessed histologically. The diagnostic performance of these two examinations was compared based on the results of histopathology. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index for CEUS and CECT were 69.39% vs. 44.90%, 94.71% vs. 97.12%, 89.88%% vs. 87.16%, 75.56% vs. 78.57%, 92.92% vs. 88.21%, and 64.10% vs. 42.02%, respectively. A significant difference was observed in terms of sensitivity (P=0.024) and Youden index (rate difference 22.08%, 95% confidence interval 2.72-41.44%). Therefore, CEUS appears to be a promising diagnostic tool that is superior to CECT for detecting CLNM from SCC of the oral cavity, with a higher sensitivity.

A combination of three probiotic strains for treatment of acute diarrhoea in hospitalised children: an open label, randomised controlled trial

Acute diarrhoea continues to be a leading cause of morbidity, hospitalisation, and mortality worldwide, and probiotics have been proposed as a complementary therapy in the treatment of acute diarrhoea. The goal of this study is to assess the efficacy and safety of three combined probiotic strains, Bifidobacterium lactis Bi-07, Lactobacillus rhamnosus HN001, and Lactobacillus acidophilus NCFM, as an adjunct to rehydration therapy in treatment of acute watery diarrhoea in hospitalised children. Eligible diarrheal children were randomised into intervention group (IG, n=96, conventional treatment for diarrhoea in combination with probiotics) and control group (CG, n=98, conventional treatment for diarrhoea without probiotics). The primary assessments of this study were duration of diarrhoea and hospital stay and improvement in diarrhoea symptoms. Significantly more children in the IG showed improvements in diarrhoea (defined as a decrease of stool frequency to no more than four times per day and an improved stool consistency within 24-48 h after the treatment) than those in the CG (96.9 vs 79.6%, P<0.05). Children supplemented with the mixed strains had a 22.5 h shorter (121.4±13.7 h vs 143.9±19.8 h) mean duration of diarrhoea and 1.2 d shorter hospital stays (5.1±1.2 d vs 6.3±1.4 d) than children only receiving the rehydration therapy (P<0.05). The prevalence of constipation of children in the IG (3.1%) was markedly lower (P<0.05) than that of children in the CG (13.3%) after treatment. In conclusion, the mixture of three probiotic strains given to children aged 1-3 years resulted in shorter durations of diarrhoea and hospitalisation and a higher percentage of improved children.

[An epidemiological survey on clinical features, self-management and cognitive level of elderly asthmatics in China]

Objective: To investigate the prevalence of asthma among the elderly people in China and to analyze the clinical features, self-management and cognitive level of elderly asthma patients. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the last epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) and seven regions (north, northeast, southern china, east, south, southwest and northwest) in China from February 2010 to August 2012. 2 034 were diagnosed as asthma. The elderly patients aged ≥65 years were selected from the 2 034 asthma patients. The clinical characteristics, comorbidities, the status of asthma control and self-management and insights of the disease in elderly asthma patients were analyzed. Results: Among the 2 034 asthma patients, 584 (28.7%) were elderly asthmatics aged ≥65 years old and 1 450 (71.3%) were<65 years old. In the elderly asthma group, Early-onset asthma accounted for 439 (75.2%) and 145 (24.8%) were late-onset. The common clinical manifestations of elderly asthma patients were: chest distress 395 (67.6%), wheezing 304 (52.1%), cough 298 (51.0%). Common comorbidities of elderly asthmatics were: chronic obstructive pulmonary disease 144 (24.7%), allergic rhinitis 122(20.9%), gastroesopheal reflux disease (GERD) 114(19.5%), allergic conjunctivitis 86 (14.7%), eczema 82 (14.0%), chronic bronchitis 76 (13.0%). The Asthma Control Test (ACT) scores of elderly asthmatics and non-elderly asthmatics were (18.5±3.2) and (21.7±3.4) respectively. There was a significant difference between the two groups (P=0.042). Of the elderly asthmatics, only 13 (2.2%) patients monitored daily using a peak flow meter. 93 (15.9%) patients aware that asthma was characterized by chronic airway inflammation. 64 (11.0%) asthmatics understood that the treatment goal. Conclusions: The clinical manifestations of elderly asthmatics are atypical, especially paroxysmal wheezing. Asthma in elderly people causes more comorbidities and mortality. The self-management and cognitive level of patients with asthma needs to be improved.

Development of a quartz crystal microbalance diagnostic for measuring material erosion and deposition on the first wall in EAST

A quartz crystal microbalance (QMB) diagnostic system has been established in Experimental Advanced Superconducting Tokamak (EAST) for real-time and in situ measurements of erosion and deposition rates of plasma-facing materials at the first wall. A ∼70 nm aluminum (Al) film has been coated on the QMB crystal surface to measure the erosion rate by charge exchange neutral particles. Dual sensors of the QMB system have been used with a closed sensor for reference. The stability and light sensitivity of the QMB system have been tested in the lab, demonstrating its feasibility on the application of EAST experiments. The QMB system with cooling water has been successfully applied in the 2018 EAST campaign. The net erosion thickness measured by the QMB has been well validated by thickness measurements using the Rutherford backscattering spectrometry. The developed QMB systems can help us to understand the physics processes of material erosion and deposition at main chamber walls for long pulse operations in EAST.

[Polarization of bone marrow-derived macrophages induced by recombinant Trichinella spiralis cysteine protease inhibitors in vitro]

OBJECTIVE

To investigate the regulatory role of recombinant Trichinella spiralis cysteine protease inhibitors (rTs-Cys) in induction of polarization of bone marrow-derived macrophages (BMDMs) in vitro.

METHODS

BMDMs were captured and cultured in conditioned medium for 7 days. Then, mature BMDMs were harvested and assigned into four groups. Cells in Group A (negative control) were given 10 ng/mL IFN-γ combined with 100 ng/mL LPS, cells in Group B (positive control) were treated with IL-4 and IL-10 (at 10 ng/mL both), and cells in Group C (recombinant protein alone) were stimulated with 1 μg/mL rTs-Cys, while cells in Group D (protein co-culture) were simultaneously treated with 1 μg/mL rTs-Cys, 10 ng/mL IFN-γ and 100 ng/mL LPS. Cells and culture supernatant were collected 24 hour post-treatment, and the proportions of F4/80⁺, CD11b⁺, CD206⁺ and CD11c⁺ cells were detected by flow cytometry. The levels of interleukin IL-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-10 and transforming growth factor-β (TGF-β) in the cell culture supernatant were measured by ELISA and the CD86⁺ and CD206⁺ phenotypes were identified by immunofluorescent staining.

RESULTS

Flow cytometry detected no significant difference in the proportion of F4/80⁺ CD11b⁺ CD11c⁺ cells among the four groups (F = 46.184, P < 0.001), and a lower proportion of F4/80⁺ CD11b⁺ CD11c⁺ cells was seen in groups C and D than in group A (all P values < 0.001). There was a significant difference in the proportion of F4/80⁺ CD11b⁺ CD206⁺ cells among the four groups (F = 11.032, P < 0.001), and a greater proportion of F4/80⁺ CD11b⁺ CD206⁺ cells was seen in groups C and D than in group A (all P values < 0.01). Immunofluorescent staining showed higher CD206⁺ expression and lower CD86⁺ expression in groups C and D than in Group A. There were significant differences in the IL-6 and (F = 3.950, P < 0.001) and TNF-α (F = 205.827, P < 0.001) levels in the cell culture supernatants among the four groups, and significantly lower IL-6 and TNF-α levels were measured in groups C and D than in Group A (both P < 0.05). There were significant differences in the IL-10 and (F = 8.274, P < 0.001) and TGF-β (F = 13.559, P < 0.01) levels in the cell culture supernatants among the four groups, and greater IL-10 and TGF-β levels were measured in Group C than in Group A (both P values < 0.01). In addition, the TGF-β level was significantly higher in Group D than in Group A (P < 0.05); however, there was no significant difference in the IL-10 level between groups D and A (P > 0.05).

CONCLUSIONS

rTs-Cys may induce the polarization of BMDMs to antiinflammatory M2 macrophages in vitro and inhibit the activation of M1 macrophages.

SAT0605 TRENDS OF TOTAL JOINT ARTHROPLASTY AMONG PATIENTS WITH OSTEOARTHRITIS, RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS IN BRITISH COLUMBIA, CANADA, 1998-2013

Background:

Total joint replacement or arthroplasty (TJA) is an expensive surgical treatment for severe arthritis when other treatments have failed. Given the substantial changes in the available treatments over the past 2 decades, it is of interest to describe the trends in the use of TJA among patients with different types of arthritis in the general population.

Objectives:

The aim of this study was to examine longitudinal trends of TJA including total hip, knee and shoulder replacement performed in British Columbia, Canada, between the year of 1998 and 2013 due to three different types of arthritis conditions:1) Osteoarthritis (OA), 2) Rheumatoid arthritis (RA) and 3) Ankylosing spondylitis (AS).

Methods:

We analyzed large, population-based administrative data obtained from Population Data BC that includes patients aged 20+ in B.C., Canada, linked to diagnostic codes of hospitalizations and physician visits. Using the Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures (CCP) procedure codes and the Canadian Classification of Health Intervention (CCI) procedure codes, we identified total joint arthroplasty procedures (TJA) including total hip arthroplasty (THA), total knee arthroplasty (TKA) and total shoulder arthroplasty (TSA) performed among OA, RA and AS prevalent cases. We calculated annual rates of THA, TKA and TSA performed among OA, RA and AS patients. We divided the study period into four equal-length periods and calculated period prevalence rates of THA, TKA and TSA per 100,000 person years as the ratio of the number of cases per period (numerator) to the total follow up time within the same period (denominator). We performed trend tests to test if there are changes in these rates over time.

Results:

For OA and RA, TKA was the most common types of TJA performed, while THA remained to be the most common types of TJA performed among AS patients. For OA, period prevalence rate of THA, TKA and TSA increased during the study period (Table 1.). For RA patients, THA and TKA rates showed a decreasing trend. For AS patients, THA rates decreased and TSA increased. For RA and AS, TSA rates did not show a significant trend.

Table 1.

Trends in arthroplasty rates (cases per 100,000 person years) among patients with OA, RA and AS by arthroplasty site.

Period1998-20012002-20052006-20092010-2013Period Trend (P†)Among OA patients THA816.26920.621035.51947.030.05459 (0.0002) TKA1024.71244.711653.891475.440.13114 (<0.0001) TSA25.9632.0143.253.920.2495 (0.0007)Among RA patients THA79.5355.6346.3133.11-0.28321 (<0.0001) TKA131.66111.99106.0874.79-0.16765 (0.0001) TSA19.4416.6213.7713.13-0.1391 (0.221)Among AS patients THA89.0176.7510.0215.48-0.6753 (<0.0001) TKA<5<5<57.740.6263 (0.0178) TSA<5<5<5<5-0.4196 (0.354)

†Pvalues were derived in Poisson regression analysis.

Among patients with OA, annual TJA rates per 100,000 persons show an overall increasing trend. The TJA rates remained relatively flat from 1998 to 2003, started to increase and peaked in 2006, and declined slightly thereafter (Figure 1.). Among patients with inflammatory arthritis (RA and AS), annual TJA rates decreased over the study period (Figure 1.). Annual proportion of TJA perfromed due to inflammatory arthritides significantly decreased from 1998 to 2013 (4.3% versus 1.0%) (Figure 2.).

Conclusion:

There have been important changes in the annual rate of total joint replacement in B.C., Canada, during the study period from 1998 to 2013. TJA use increased in OA patients but decreased in patients with inflammatory arthritis (RA and AS). Effective treatment for inflammatory arthritis, such as TNF-α inhibitors introduced in British Columbia in 2001-2002, may have effectively reduced the need for arthroplasty in RA and AS.

Acknowledgments:

This study was supported by CIHR (team grant THC-135235), and NSERC (RGPIN-2018-04313).

Disclosure of Interests:

None declared

SAT0242 REGIONAL VARIATION IN CARDIOVASCULAR DISEASE AMONG SLE PATIENTS

Objectives:

To evaluate whether the risk of cardiovascular disease (CVD) including myocardial infarction (MI) and cerebrovascular (CVA) differs across geographic regions among SLE patients.

Methods:

We identified SLE patients using two ICD codes 60 days apart within two years recorded in Medical Services Plan (MSP) or hospital discharge database (DAD). We defined the second of two diagnosis dates as the index date. We included incident SLE patients (7-year continuous registries in MSP before the first diagnosis date) with an index date between 1997 and 2012 and excluded patients with previous MI or CVA before the index date. We followed each patient from the index date up to 10 years and censored at the date of death date, leaving the province, or March 31, 2015.

We assessed the incident CVD that was defined as the first ever diagnosis of MI or CVA recorded in DAD or as the primary cause of death in Vital Statistics. We also evaluated MI and CVA separately.

The Province’s publicly administered and funded health care system is organized into five regional health authorities (HA): Interior (IHA), Fraser (FHA), Vancouver Coastal (VCHA), Vancouver Island (VIHA), and Northern (NHA) [Figure 1(a)].We assigned each patient the HA she/he was registered at the index date. We extracted baseline covariates using the information during a period of 365 days prior to the index date, including socio-demographic characteristics, health care resource use, comorbidities, and prescription medication use. We calculated the incident rate (IR) of MI, CVA, and CVD (first ever MI or CVA) by HA. Using Cox Proportional Hazard model adjusting for potential confounders at baseline, we estimated the adjusted hazard ratios (aHR) of CVD for each HA compared to FHA or VCHA which have the large proportion of provincial population and SLE patients. We evaluated the regional disparities in MI and CVA separately using the same methods.

Figure 1.

HA and CVD Incident Rate

Results:

We included 3,960 incident SLE patients free of CVD at baseline with a mean (SD) age of 48.5 (15.8), including 726 (18.3%) from IHA, 1634 (42.3%) from FHA, 854 (21.6%) from VCHA, 504 (12.7%) from VIHA, and 242 (6.1%) from NHA. During 26378 person-year (PY) follow-up, 133 patients developed incident CVD including 91 MI and 43 CVA. [Table 1]

Table 1.

Incident Rates and HR

HAIncidenceaHR (95%CI)NPYIR (95%CI)10,000 PYReference: FHAReference: VCHACVDIHA35457976(54,105)1.93(1.17,3.2)2.05(1.17,3.58)FHA391119735(25,47)ref1.06(0.64,1.76)VCHA27584446(31,66)0.94(0.57,1.57)refVIHA22316570(44,103)1.65(0.96,2.83)1.74(0.98,3.11)NHA10159263(31,110)1.81(0.86,3.8)1.92(0.88,4.17)MIIHA24457952(34,76)2.09(1.14,3.83)1.81(0.95,3.47)FHA271119724(16,34)ref0.87(0.48,1.56)VCHA21584436(23,54)1.15(0.64,2.07)refVIHA12316538(20,64)1.29(0.64,2.58)1.12(0.54,2.31)NHA7159244(19,85)2.11(0.88,5.11)1.84(0.74,4.56)CVAIHA11457924(12,41)1.79(0.71,4.55)2.35(0.8,6.88)FHA121119711(6,18)ref1.31(0.49,3.48)VCHA7584412(5,23)0.76(0.29,2.03)refVIHA10316532(16,55)2.79(1.14,6.85)3.66(1.34,10.01)NHA<5159219(5,49)1.45(0.36,5.72)1.89(0.44,8.22)

The IR of CVD varied from 35 in FHA to 76 per 10,000 PY in IHA [Figure 1(b)]. IHA had significantly higher risk of CVD than FHA (aHR=1.93, 95%CI=1.17~3.2) and VCHA (aHR=2.05, 95%CI=1.17~3.58).

The IR of MI varied from 24 in FHA to 52 per 10,000 PY in IHA [Figure 2(a)]. IHA had significantly higher risk of MI than FHA (aHR=2.09, 95%CI=1.14~3.83).

Figure 2.

MI and CVA incident Rate by HA

The IR of CVA varied from 11 in FHA to 32 per 10,000 PY in VIHA [Figure 2(b)]. VIHA had significantly higher risk of CVA than FHA (aHR=2.79, 95%CI=1.14~6.85) and VCHA (aHR=3.66, 95%CI=1.34~10.01).

Conclusion:

Compared with FHA and VCHA, IHA had higher risk of CVD and VIHA had higher risk of CVA. IHA also had higher risk of MI than FHA.

Disclosure of Interests:

None declared

AB1143 BURDEN OF GLUCOCORTICOIDS AMONG RHEUMATOID ARTHRITIS PATIENTS AT DIFFERENT STAGES OF DISEASE-MODIFYING ANTIRHEUMATIC DRUG MANAGEMENT

Background:

EULAR and ACR guidelines recommend a treat-to-target approach for patients with RA including regular assessments of disease activity. Glucocorticoids are commonly used to control inflammation associated with uncontrolled disease. However, patients using glucocorticoids may develop short- and long-term side effects.

Objectives:

To examine the real-world use of glucocorticoids among patients with RA who are disease-modifying antirheumatic drug (DMARD)-naïve or failing their first conventional synthetic DMARD (csDMARD) or biologic DMARD (bDMARD).

Methods:

From a large US health claims database, this study included adults with ≥2 RA claims ≥30 days apart who started (index date [ID], 1/1/2012–3/31/2017) a first DMARD (DMARD-naïve) or patients who newly initiated a csDMARD and then switched to or added another DMARD (csDMARD switchers), and patients who initiated a first bDMARD and then switched to another bDMARD or Janus kinase inhibitor (JAKi; bDMARD switchers). All patients had continuous enrollment 1-year before and ≥1 year after ID and were evaluated for pre- and post-ID use of glucocorticoids (oral or injectable), prednisone equivalent dose (PED), and duration of exposure ≥30 days.

Results:

The study included 28,201 patients in the DMARD-naïve cohort, 7,816 csDMARD switchers, and 4,656 bDMARD switchers (median age 54 years for all, 73%–78% female).

Among DMARD-naïve patients, 66.5% used glucocorticoids during the pre-ID period (Figure 1) and 61.2% had >7.5 mg/day PED, 21.2% had >30 mg/day PED, and 21.2% had ≥30 days of exposure to glucocorticoids (Figure 2). Post-ID, 69.4% of patients used glucocorticoids, while 54.7% had >7.5 mg/day PED, 13.5% had >30 mg/day PED, and 44.9% had ≥30 days of exposure to glucocorticoids.

Among csDMARD switchers, 84.5% of patients used glucocorticoids during the pre-ID period (Figure 1), and 73.4% had >7.5 mg/day PED, 16.0% had >30 mg/day PED, and 56.4% had ≥30 days of exposure to glucocorticoids (Figure 2). During the post-ID treatment, 74.1% of patients used glucocorticoids, 56.2% had >7.5 mg/day PED, 14.4% had >30 mg/day PED, and 45.8% had ≥30 days of exposure to glucocorticoids.

Among bDMARD switchers, 85.1% of patients used glucocorticoids in the pre-ID period (Figure 1), and 70.2% had >7.5 mg/day PED, 17.4% had >30 mg/day PED, and 55.2% had ≥30 days of exposure to glucocorticoids (Figure 2). During post-ID treatment, 75.4% of patients used glucocorticoids and 59.7% of patients had >7.5 mg/day PED, 16.7% had >30 mg/day PED, and 45.6% had ≥30 days of exposure to glucocorticoids.

Conclusion:

Real world glucocorticoid use was high in all categories of DMARD-treated RA patients, at baseline and during their next treatment, suggesting ongoing medical needs. Glucocorticoid doses exceeded 7.5 mg/day for most patients. In addition, many patients had ≥30 days exposure to glucocorticoids, posing an additional safety risk.

Disclosure of Interests:

Robin K Dore Grant/research support from: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Jenya Antonova Employee of: Gilead Sciences. Inc., Magdaliz Gorritz Consultant of: Gilead Sciences, Inc., Lawrence Chang Consultant of: Gilead Sciences, Inc., Handing Xie Consultant of: Gilead Sciences, Inc., Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme

SAT0175 IMPACT OF ANTIMALARIAL ADHERENCE ON MORTALITY AMONG PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A POPULATION-BASED COHORT STUDY

Background:

Evidence has consistently shown that adherence to AM is poor in systemic lupus erythematosus (SLE) patients. However, data on the impact of adherence to AM on mortality is scarce.

Objectives:

To assess the effect of AM adherence on all-cause mortality in SLE patients from the general population.

Methods:

This study used administrative databases from British Columbia, Canada. We created an incident SLE cohort between January 01, 1997, and March 31, 2015, using the physician billing data and a 7-year washout period. The inclusion criteria were at least two physician visits, at least two months apart, within two years, with an ICD-9 code (710.0) or ICD-10 code (M32.1, M32.8, M32.9) for SLE. Follow-up started at the first day of having both SLE and AM, i.e., at the SLE index date (second ICD code) for those whose first AM use occurred before the SLE index date, or the date of the first AM use if otherwise. Our outcome was all-cause mortality, obtained from the vital statistics registry. In the analysis, the follow-up time was divided into 30-days windows, for a total of 293,190 person-months. For each window, a measure of adherence, the proportion of days covered (PDC), was calculated and categorized as adherent (PDC≥0.90), non-adherent (0<PDC<0.90), and discontinuer (no drug or PDC = 0). We used both Cox’s proportional hazards models and marginal structural models (MSM) to estimate the effect of AM adherence on all-cause mortality. Both analysis controlled for baseline demographics (age, sex, residence, income quintile), as well as the following baseline and time-varying covariates: immunosuppressive and other medications, hospitalizations, impatient, and other visits, and Charlson comorbidity index. To account for the possibility of a few time-varying covariates being mediators in the causal pathway from AM adherence to mortality, which may cause the Cox model to yield biased estimates of the adherence effects, we conducted the MSM analysis that can produce valid estimates as it balances the distributions of time-varying confounders among the three adherence groups via inverse probability weighting.

Results:

We identified 3,385 individuals with incident SLE (mean age 47.3 years, 89% were women) who had at least one filled AM prescription. Over the mean follow-up of 6.66 years, 288 (8.5%) incident SLE patients died. The incidence rate (IR) of mortality for AM adherent, non-adherent, and discontinuer patients were 4.31, 11.86, and 19.51 per 1000 person-years, respectively. Using the Cox model, the adjusted hazard ratio (HRs) obtained for AM adherent and non-adherent SLE patients were 0.20 and 0.66, respectively, compared to discontinuer SLE patients (Table 1). Using MSM, those adjusted HRs were found as 0.18 and 0.64. Also, the adjusted HRs for adherers compared to the non-adherers were 0.30 (Cox) and 0.28 (MSM). A statistically significant linear trend in the HRs of mortality risk over the adherence levels was found (Table 1, Linear Trend).

Table 1.Adherence LevelsNo. of DeathsIR Ratios (95%CI)Adjusted Cox HRs (95%CI)Adjusted MSM HRs (95%CI)Discontinuer (Reference)198Non-adherent470.61(0.44-0.84)0.66(0.47-0.93)0.64(0.46-0.89)Adherent430.22(0.16-0.31)0.20(0.14-0.28)0.18(0.12-0.25)Contrast: Partial vs. Full0.36(0.24-0.55)0.30(0.19-0.46)0.28(0.18-0.42)Linear Trend0.32(0.25-0.41)0.29(0.23-0.37)

Conclusion:

SLE patients that adhere to AM therapy have a lower risk of death than patients who do not adhere or who discontinue AM (5 and 3 times, respectively) in both the MSM and Cox analysis. Our findings support the importance of AM adherence to prevent premature deaths in SLE patients.

Disclosure of Interests:

None declared

OP0191 ASSOCIATION OF TRAMADOL WITH ALL-CAUSE MORTALITY, CARDIOVASCULAR DISEASE, VENOUS THROMBOEMBOLISM AND HIP FRACTURES AMONG PATIENTS WITH OSTEOARTHRITIS. A POPULATION-BASED STUDY

Background:

Both tramadol (narcotic-like drug) and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for pain relief among osteoarthritis (OA) patients. Evidence comparing risks of adverse events between tramadol and NSAIDs users is inconclusive.

Objectives:

To examine the association of tramadol with all-cause mortality, cardiovascular disease (CVD), venous thromboembolism (VTE) and hip fractures (HFx) compared with NSAIDs and codeine in OA.

Methods:

Design: Sequential propensity score-matched cohort study. Sample: All patients with OA who received medical care from 2005 to 2014 in the entire province of British Columbia, Canada. Tramadol cohort: Initial prescription of tramadol (n=56325). Four comparator cohorts: the initiation of one of the following: naproxen (n=13798), diclofenac (n=17675), cyclooxygenase-2 [Cox-2] inhibitor (n= 17039), or codeine (a weak opioid) (n=7813). Patients required to be prescribed neither tramadol nor its comparators during the year before the initial prescription date (i.e., index date). Outcomes: 1) all-cause mortality;first ever2) CVD, 3) VTE, 4) HFx within the 1styear after the initiation of tramadol or its comparators. Follow-up: from index date until the event occurred, disenrollment, or the end of a 1-year follow-up period. Statistical analysis: We created baseline covariates (demographics, comorbidities, medications and health resource utilization) from the year prior to the index date. Calendar years from 2005 to 2014 were divided into 10 blocks; propensity scores were calculated using logistic regression within each block. We used 1:1 greedy matching method. We estimated hazard ratios (HRs) using Cox proportional hazard models.

Results:

After propensity score matching, 112650 patients with OA were included (mean age of 68 years, 62.8% were females). During the 1-year follow-up, 296 deaths (21.5/1000 person-years) occurred in the tramadol cohort and 246 (17.8/1000 person-years) in the naproxen cohort (Table 1). All-cause mortality was higher for tramadol compared with all NSAIDs cohorts, but not with the codeine cohort (Table 1, Figure 1). Tramadol initiators have also a higher risk of CVD and VTE compared with the diclofenac and Cox-2 inhibitor initiators with HRs ranging from 1.2 to 1.7. Furthermore, tramadol was also associated with a higher risk of HFx compared with all NSAIDs cohorts (HRs ranging from 1.4 to 1.5). No significant difference was found between tramadol and codeine (Table 1).

Table 1Group1Group2Group3Group4All-cause MortalityTramadolNaproxenTramadolDiclofenacTramadolCox-2 inhibitorTramadolCodeineOA (n)13798137981767517675170391703978137813Death (n)296246439345402267168199Rate (/1000 PY)21.517.824.819.523.615.721.525.5HR (95% CI)1.2 (1.0-1.4)1.01.3 (1.1-1.5)1.01.5 (1.3-1.8)1.00.8 (0.7-1.0)1.0CVDOA (n)11708117081492414924147791477968096809CVD (n)309319410349404353156164Rate (/1000 PY)26.427.327.523.427.323.922.924.1HR (95% CI)1.0 (0.9-1.1)1.01.2 (1.1-1.3)1.01.2 (1.0-1.3)1.00.9 (0.8-1.1)1.0VTEOA (n)13472134721723017230166991669976607660VTE (n)4137604070402830Rate (/1000 PY)3.02.83.52.34.22.43.73.9HR (95% CI)1.2 (0.9-1.6)1.01.5 (1.1-1.9)1.01.7 (1.3-2.3)1.01.0 (0.7-1.4)1.0HFxOA (n)13378133781721617216166701667075937593HFx (n)6649885991603540Rate (/1000 PY)5.03.75.13.45.53.64.65.3HR (95% CI)1.4 (1.0-1.8)1.01.5 (1.2-1.9)1.01.5 (1.2-1.9)1.00.9 (0.7-1.2)1.0

Conclusion:

OA patients initiating tramadol have an increased risk of mortality, CVD, VTE, and HFx within 1 year compared with NSAIDs, but no statistically significant difference in the risk was observed between tramadol and codeine.

Disclosure of Interests:

None declared

OP0010 EFFECTIVENESS OF THE MAKING IT WORK™ PROGRAM AT IMPROVING PRESENTEEISM AND WORK CESSATION IN WORKERS WITH INFLAMMATORY ARTHRITIS – RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background:

Arthritis often leads to presenteeism (decreased at-work productivity), missed days from work and permanent work disability, leading to reduced quality of life and high costs to individuals and society. Yet, health services addressing the employment needs of people with arthritis are lacking.

Objectives:

We evaluated the effectiveness of the Making-it-WorkTM(MiW) program, an online self-management program developed to help people with inflammatory arthritis (IA) deal with employment issues.

Methods:

A multi-center RCT evaluated the effectiveness of MiW at improving presenteeism and preventing work cessation (WC) over two years. Participants were recruited from rheumatologist practices, consumer organizations and arthritis programs, in three Canadian provinces. Eligibility criteria: diagnosis of IA, employed, age 18-59, and concerned about ability to work. Participants were randomized 1:1 to MiW or usual care plus printed material on workplace tips. MiW consists of five online self-learning modules and group meetings, and individual vocational counselling and ergonomic consultations. Questionnaires were administered every 6 months. Outcomes were presenteeism [Rheumatoid Arthritis Work Instability Scale (RA-WIS)], time to WC ≥ 6 months, and time to WC ≥ 2 months (secondary outcome). Baseline characteristics (age, gender, ethnicity, occupation, education, disease duration and self-employment) were collected. Intention-to-treat (ITT) longitudinal analysis of RA-WIS using linear mixed effect regression models with 2-year comparison as primary endpoint and survival analysis for time to WC using Kaplan-Meier and Cox Proportional Hazard models were performed. Robustness analyses were conducted by using various missing values imputation methods like last observation carried forward, imputation using worse possible outcomes and model-based multiple imputations; using square root transformation of RA-WIS outcome; and adjusting for baseline covariates. SAS version 9.4 was used.

Results:

A total of 564 participants were recruited, with 478 (84.75%) completing 2-year follow-up. Baseline characteristics were similar between groups. Mean RA-WIS scores were significantly lower in the intervention group from 6 months onwards, with the greatest difference observed at 2 years (-1.78, 95%CI: -2.7, -0.9, p < .0001), yielding a standardized effect size of 32%. Satisfactory robustness was observed. Work cessation occurred less often in intervention than control groups, but only reached statistical significance for WC ≥ 2 months (WC ≥ 6 months: 31 versus 44 events, aHR 0.70, 95%CI: 0.44, 1.11, p = 0.13; WC ≥ 2 months: 39 versus 61 events, aHR: 0.65, 95%CI: 0.43, 0.98, p = 0.04).

Conclusion:

Results of the RCT reveal the program was effective at improving presenteeism and preventing short-term WC. Effectiveness at preventing long-term work disability will be assessed at 5 years. This program fills one of the most important and costly unmet needs for people with inflammatory arthritis.

References:

[1]Carruthers EC, Rogers P, Backman CL, et al. “Employment and arthritis: making it work” a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).BMC Med Inform Decis Mak. 2014;14:59. Published 2014 Jul 21. doi:10.1186/1472-6947-14-59

Disclosure of Interests:

Andre Luquini: None declared, Yufei Zheng: None declared, Hui Xie: None declared, Catherine Backman: None declared, Pamela Rogers: None declared, Alex Kwok: None declared, Astrid Knight: None declared, Monique Gignac: None declared, Dianne Mosher: None declared, Linda Li: None declared, John Esdaile: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Lacaille: None declared

[A survey on clinical characteristics and risk factors of severe asthma in China]

Objective: To investigate the clinical characteristics and risk factors of severe bronchial asthma in Chinese people over 14 years old. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) located in seven regions (north, northeast, east, central China, south, southwest and northwest) of China from February 2010 to August 2012. A total of 2 034 were diagnosed as asthma. The clinical characteristics and related risk factors of patients with severe asthma in China were analyzed. Results: Among all asthma patients, 560 were newly diagnosed, accounting for 27.5% (560/2 034) and the percentage of previously confirmed patients was 72.5% (1 474/2 034). A total of 145 were eligible for severe asthma, accounting for 9.8% (145/1 474) of previously confirmed asthmatics and 7.1% (145/2 034) of all asthmatics. 83.5% (121/145) severe asthmatics had at least one trigger factor. Correlation analysis showed that the risk factors of severe asthma were: smoking (OR=1.543, 95%CI: 1.250-1.814), obesity (OR=2.186, 95%CI: 1.972-2.354), petting (OR=2.135, 95%CI: 1.904-2.283), combined with allergic rhinitis (OR=3.456, 95%CI: 2.721-4.326), gastroesophageal reflux disease (OR=1.842, 95%CI: 1.682-2.140), bronchiectasis (OR=1.665, 95%CI: 1.347-1.912) or chronic obstructive pulmonary disease (OR=1.312, 95%CI: 1.171-1.694). Conclusions: The most common comorbidities in severe asthmatics in China are allergic rhinitis and gastroesophageal reflux disease. The risk factors of severe asthma include obesity, allergic rhinitis, gastroesophageal reflux disease, chronic obstructive pulmonary disease, bronchiectasis, smoking and petting.

Umifenovir treatment is not associated with improved outcomes in patients with coronavirus disease 2019: a retrospective study

Objectives

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Umifenovir (Arbidol®) is an antiviral drug being used to treat influenza in Russia and China. This study aimed to investigate the effectiveness and safety of umifenovir for COVID-19.

Methods

A retrospective study was performed in a non-intensive care unit (ICU) ward in Jinyintan Hospital from 2 February 2020 to 20 March 2020. COVID-19 was confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of pharyngeal swab specimens. The confirmed patients were divided into the umifenovir group and the control group according to the use of umifenovir. The main outcomes were the rate of negative pharyngeal swab tests for SARS-CoV-2 within 1 week after admission and the time for the virus to turn negative. The negativity time of SARS-CoV-2 was defined as the first day of a negative test if the nucleic acid of SARS-CoV-2 was negative for two consecutive tests.

Results

A total of 81 COVID-19 patients were included, with 45 in the umifenovir group and 36 in the control group. Baseline clinical and laboratory characteristics were comparable between the two groups. Thirty-three out of 45 (73%) patients in the umifenovir group tested negative for SARS-CoV-2 within 7 days after admission, the number was 28/36 (78%) in the control group (p 0.19). The median time from onset of symptoms to SARS-CoV-2 turning negative was 18 days (interquartile range (IQR) 12–21) in the umifenovir group and 16 days (IQR 11–21) in the control group (p 0.42). Patients in the umifenovir group had a longer hospital stay than patients in the control group (13 days (IQR 9–17) vs 11 days (IQR 9–14), p 0.04). No deaths or severe adverse reactions were found in both groups.

Discussion

Umifenovir might not improve the prognosis or accelerate SARS-CoV-2 clearance in non-ICU patients. A randomized control clinical trial is needed to assess the efficacy of umifenovir.

[A Qualitative Proteome-Wide Lysine Succinylation Profiling of Tea Revealed its Involvement in Primary Metabolism]

Lysine succinylation of proteins has potential impacts on protein structure and function, which occurs on post-translation level. However, the information about the succinylation of proteins in tea plants is limited. In the present study, the significant signal of succinylation in tea plants was found by western blot. Subsequently, we performed a qualitative analysis to globally identify the lysine succinylation of proteins using high accuracy nano LC-MS/MS combined with affinity purification. As a result, a total of 142 lysine succinylation sites were identified on 86 proteins in tea leaves. The identified succinylated proteins were involved in various biological processes and a large proportion of the succinylation sites were presented on proteins in the primary metabolism, including glyoxylate and dicarboxylate metabolism, TCA cycle and glycine, serine and threonine metabolism. Moreover, 10 new succinylation sites were detected on histones in tea leaves. The results suggest that succinylated proteins in tea plants might play critical regulatory roles in biological processes, especially in the primary metabolism. This study not only comprehensively analyzed the lysine succinylome in tea plants, but also provided valuable information for further investigating the functions of lysine succinylation in tea plants.

Source of Energetic Protons in the 2014 September 1 Sustained Gamma-ray Emission Event

We report on the source of > 300 MeV protons during the SOL2014-09-01 sustained gamma-ray emission (SGRE) event based on multi-wavelength data from a wide array of space- and ground-based instruments. Based on the eruption geometry we provide concrete explanation for the spatially and temporally extended γ -ray emission from the eruption. We show that the associated flux rope is of low inclination (roughly oriented in the east-west direction), which enables the associated shock to extend to the frontside. We compare the centroid of the SGRE source with the location of the flux rope's leg to infer that the high-energy protons must be precipitating between the flux rope leg and the shock front. The durations of the SOL2014-09-01 SGRE event and the type II radio burst agree with the linear relationship between these parameters obtained for other SGRE events with duration ≥ 3 hrs . The fluence spectrum of the SEP event is very hard, indicating the presence of high-energy (GeV) particles in this event. This is further confirmed by the presence of an energetic coronal mass ejection with a speed > 2000 km s - 1 , similar to those in ground level enhancement (GLE) events. The type II radio burst had emission components from metric to kilometric wavelengths as in events associated with GLE events. All these factors indicate that the high-energy particles from the shock were in sufficient numbers needed for the production of γ -rays via neutral pion decay.

Risk factors of calculi in upper urinary tract after radical cystectomy with urinary diversion

INTRODUCTION AND OBJECTIVES

The study was conducted to identify the risk factors of upper tract stone formation in patients with diversions after radical cystectomy (RC).

MATERIALS AND METHODS

All patients with diversion after RC were collected in our center from January 2005 to December 2013. Three different common diversions were included: Orthotopic neobladder (ON: 168 patients), Ileal Conduit (IC: 93 patients) or Ureterocutaneostomy (UC: 104 patients). Univariable and multivariable logistic regression analysis were conducted to identify the independent predictors of stone formation in the upper tract.

RESULTS

A total of 365 consecutive patients (316 males, 49 females) were included. At a median follow-up of 48 months (range 12-65 months), 36 patients (9.9%) developed upper tract stone. Among them, 26 (72.2%), 5 (13.9%) and 5 (13.9%) patients underwent ON, IC and UC, respectively. 25 patients had renal stone and 11 ureter stone. Minimally invasive operations (endoscopic laser lithotripsy via the anterograde or retrograde approach in 24 cases, percutaneous nephrolithotomy in 9 cases and shock wave lithotripsy in 3 cases) were carried out successfully in all stone cases. On univariable and multivariable logistic regression analysis, diabetes mellitus, hypertension, urinary tract infection (UTI), anastomotic stenosis and types of diversions (P<.05) were positively associated with upper tract stone formation.

CONCLUSIONS

The variable predictors of upper tract stone may contain diabetes mellitus, hypertension, UTI, anastomotic stenosis and types of diversion.

MiR-138-5p is downregulated in patients with atrial fibrillation and reverses cardiac fibrotic remodeling via repressing CYP11B2

OBJECTIVE

To investigate the connection between atrial fibrillation (AF) and miR-138-5p and to further explore the possible mechanism.

PATIENTS AND METHODS

MiR-138-5p expression of right atrial appendage (RAA) tissues in 28 patients with AF and 22 patients with sinus rhythm (SR) was detected by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Moreover, cell proliferation assay was conducted in AC16 cells which were transfected by miR-138-5p inhibitors or mimics. Furthermore, Western blot assay, luciferase assay, and RNA immunoprecipitation assay were performed to uncover the mechanism.

RESULTS

In the present research, miR-138-5p expression in RAA samples decreased significantly in AF patients than that in SR ones. Moreover, in AC16 cells, higher miR-138-5p expression level suppressed cell growth, while cell growth was promoted after miR-138-5p was knockdown. In addition, further experiments showed that CYP11B2 acted as the main target of miR-138-5p and its expression in AF tissues negatively correlated to miR-138-5p expression.

CONCLUSIONS

All the results above elucidated that cell proliferation of AF could be inhibited by miR-138-5p via suppressing CYP11B2, which may offer a new vision for interpreting the mechanism of AF development.

Role of Zebrafish fhl1A in Satellite Cell and Skeletal Muscle Development

Background:

Four-and-a-half LIM domains protein 1 (FHL1) mutations are associated with human myopathies. However, the function of this protein in skeletal development remains unclear.

Methods:

Whole-mount in situ hybridization and embryo immunostaining were performed.

Results:

Zebrafish Fhl1A is the homologue of human FHL1. We showed that fhl1A knockdown causes defective skeletal muscle development, while injection with fhl1A mRNA largely recovered the muscle development in these fhl1A morphants. We also demonstrated that fhl1A knockdown decreases the number of satellite cells. This decrease in satellite cells and the emergence of skeletal muscle abnormalities were associated with alterations in the gene expression of myoD, pax7, mef2ca and skMLCK. We also demonstrated that fhl1A expression and retinoic acid (RA) signalling caused similar skeletal muscle development phenotypes. Moreover, when treated with exogenous RA, endogenous fhl1A expression in skeletal muscles was robust. When treated with DEAB, an RA signalling inhibitor which inhibits the activity of retinaldehyde dehydrogenase, fhl1A was downregulated.

Conclusion:

fhl1A functions as an activator in regulating the number of satellite cells and in skeletal muscle development. The role of fhl1A in skeletal myogenesis is regulated by RA signaling.

[Analysis on the standardized management of hospitalized asthmatic patients: a single center 10-years experience]

Objective: To analyze the outcome of standardized management on the hospitalized asthmatic patients in the past 10 years in a single center. Methods: Clinical data of 2 207 asthmatic patients, who were hospitalized in the Center of Respiratory Medicine and Allergic Diseases, the General Hospital of Northern Military District from January 1, 2008 to December 31, 2017, was retrospectively collected and analyzed. Results: Asthmatic in-patients accounted for 11.5% of total hospitalized patients(2 207/19 134) over the 10-year study period. The highest percentage of asthmatic patients over the total hospitalized patients (16.9%, 207/1 223) was in the year 2008, and it was gradually reduced from 2009 through 2017: a median of 13.2% (221/1 674) from 2009 to 2013 with 3.7% decrease, and a median of 9.4% (224/2 385) from 2014 to 2017 with 7.5% decrease. There was a significant difference in the percentages between the year of 2008 (16.9%) and the years from 2009 through 2017 (P<0.05). Over the 10-year study period, 69.1% (1 526/2 207) of the asthmatic in-patients were hospitalized only once, 13.3% (294/2 207) were twice, and 3.8% (85/2 207) were hospitalized more than twice. Totally 1,553 patients were hospitalized with acute asthmatic attack, which accounted for 8.1% (1 553/19 134) of the total in-patient number over the 10 years, and 14.2% (174/1 223) of which was in the year 2008, while 9.7% (163/1 674) was in the years from 2009 through 2013 with a decrease of 4.5% from 2008, and 5.9% (141/2 385) was in 2014 through 2017 with a decrease of 8.3% from 2008. The differences between the 2008 incidence and that of 2009-2013 or 2014-2017 were statistically significant (P<0.05). However, the incidence of acute exacerbation of comorbid conditions was lowest in 2008 (15.9%, 33/207), while it was 25.8% (58/221) from 2009 to 2013 with an increase of 9.9% from 2008, and 37.0% (83/224) from 2013 to 2017 with an increase of 21.1% compared to 2008. Asthmatic hospitalization peaked in March (9.2%, 150/1 628) and August (9.7%, 157/1 612), respectively, while it was lowest in February (7.1%,101/1 423). The difference between the peak months (March and August) and February was statistically significant (P<0.05), while there was no significant difference between February and the rest of months (P>0.05). When the risk factors for acute asthmatic attack was analyzed by grouping single-time attack (n=1 074) versus multiple-time attack (hospitalized ≥ 2 times, n=479), we found the following risk factors were significant: airway infection (OR=2.006), male (OR=1.355), age ≥ 65 years old (OR=1.364), wet rales on physical examination (OR=1.762), hospitalization ≥ 14 days (OR=1.892), and invasive mechanical ventilation (OR=1.798). In addition, there were significant differences in per capital cost comparison between the following pairs (P<0.05): multiple-time (16 219±16 628, n=681) vs single-time asthmatic hospitalization (13 752±20 692, n=1 526), multiple-time (13 933±13 036, n=479) vs single-time hospitalization with acute asthmatic attack (11 208±13 853, n=1 074), multi-time asthmatic hospitalization (n=681) vs multi-time hospitalization with acute asthmatic attack (n=479), and single-time asthmatic hospitalization (n=1 526) vs single-time hospitalization with acute asthmatic attack (n=1 074). Conclusions: Standardized management of asthma could significantly reduce the risk of hospitalization as well as acute asthmatic attack. Findings of the current study suggested that risk factors for acute and recurrent asthmatic attack should be assessed and managed efficiently in order to reduce incidence of multiple hospitalization for asthma.

Plasma cell-free DNA integrity plus circulating tumor cells: a potential biomarker of no distant metastasis breast cancer

Cell-free DNA integrity (cfDI) is a promising diagnostic and prognostic biomarker in breast cancer. However, no specific study has evaluated the diagnostic ability of cfDI in patients with no distant metastasis breast cancer (no-MBC) and benign breast tumor (BBT) to date. We assessed the plasma cfDI of 84 patients with no-MBC and 30 patients with BBT using quantitative PCR and compared it with circulating tumor cells (CTCs) and carbohydrate antigen 153 (CA153). The no-MBC group had significantly lower mean cfDI (0.58) than the BBT group (0.74, p = 0.004). Subgroup analysis showed that decreased cfDI seem to be associated with risk factors such as age 14% (mean cfDI = 0.57), tumor size > 2 cm (mean cfDI = 0.58), and positive lymph node status (mean cfDI = 0.56), but had no statistical significance. McNemar's test suggested that cfDI had stronger diagnostic power than CTCs, cfDNA concentration, or CA153 (p < 0.001). Spearman's rho showed that the correlation coefficient between cfDI and CTCs was 0.278 (p = 0.04) in the no-MBC group. Receiver operating characteristic curve analysis also suggested that cfDI was superior to CTCs or CA153. Combined with CTCs, cfDI reduced the false positive rate from 50% to 10.71% and increased the area under the curve value from 0.66 to 0.68. Our results suggest that cfDI is a potential diagnostic biomarker of no-MBC. Using cfDI and CTCs as a combined diagnostic tool for no-MBC could improve diagnostic sensitivity and specificity but more samples will be needed.

[The necessity of artificial kidney seeper in the ultrasonography-guided percutaneous nephrolithotomy: a randomized controlled study]

Objective: To investigate the necessity of artificial kidney seeper which made through inserting a ureteral tube in the ureter to the ultrasonography-guided percutaneous nephrolithotomy (PCNL). Methods: This was a randomized prospective study. Patients who conformed to the inclusion and exclusion criteria were enrolled at Department of Urology, Frist Affiliated Hospital of Wenzhou Medical University from January 2016 to May 2017. Totally 291 patients were included in the study. Patients were randomly assigned into two groups (artificial kidney seeper group and non-artificial kidney seeper group) in different kidney seeper level (5 to <10 mm, 10 to 20 mm) respectively. The artificial kidney seeper group was inserted by a ureteral cathedral, then were underwent the ultrasonography-guided PCNL in prone position. The non-artificial kidney seeper group were underwent the ultrasonography-guided PCNL in prone position directly. The t test, χ(2) test, repeated measure analysis was used to data measurement, respectively. Results: Four patients who diagnosed pyonephrosis were excluded. On the 5 to <10 mm level, fever rate (14.6% vs. 4.8%, χ(2)=5.07, P=0.03), operation time ((65.7±9.9)min vs. (50.3±7.4)min, t=11.47, P=0.00), cost ((18 327±903) yuan vs. (14 583±784) yuan, t=24.50, P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences. And on the 10 to 20 mm level, fever rate (14.5% vs. 3.39%, χ(2)=4.53, P=0.03), operation time ((66.0±9.9)min vs. (52.4±8.9)min, t=8.30, P=0.00), cost ((16 548±537) yuan vs. (13 102±629) yuan, t=32.10, P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences. And there were no statistical differences in the success rate of puncturing, the failures of the treatment to the stone pieces falling into the ureter and clearance rate of the stone and so on. In this study, 2 cases recovered after received transfusion and digital subtraction angiography artery embolization treatments; D-J tube was indwelled into 4 cases guiding by super smooth thread; 4 cases were finished the surgeries with the help of ureteroscopy, because the stone pieces fell into the ureter during the surgeries. And there was no patients developing septic shock, adjacent viscera injury or other serious complications. Conclusion: For seasoned doctors, there is no necessity of regularly artificial kidney seeper for PCNL when the pre-operation seeper ranging from 5 to 20 mm.

Risks of colorectal neoplasms and cardiovascular thromboembolic events after the combined use of selective COX-2 inhibitors and aspirin with 5-year follow-up: a meta-analysis

AIM

We aimed to evaluate the association between selective COX-2 inhibitors (coxibs) and the risk of colorectal neoplasms and vascular events with and without low-dose aspirin.

METHOD

We searched for randomized controlled trials and comparative studies in PubMed, EMBASE and Cochrane Library databases using pertinent key terms. Risk ratios (RRs) were calculated for each study with a fixed- or random-effects model.

RESULTS

Eight clinical studies with 44 566 subjects were eligible. The use of coxib significantly reduced the overall risk of colorectal neoplasms by 21% (RR = 0.79, 95% CI 0.70-0.89; P = 0.000). The chemopreventive effect of coxibs was beneficial in the first year (RR = 0.74, 95% CI 0.58-0.94; P = 0.013), marginal in the third year (RR = 0.79, 95% CI 0.63-1.01; P = 0.059) and counterproductive in the fifth year (RR = 1.65, 95% CI 1.23-2.21; P = 0.001). Compared with the use of aspirin alone, combined use of coxib and aspirin for 3 years increased the risk of a colorectal neoplasm by 80% in the fifth year (RR = 1.80, 95% CI 1.22-2.66; P = 0.003) but decreased by 79% and 30%, respectively, the risks of cardiovascular thromboembolic events (RR = 1.79, 95% CI 1.33-2.41; P = 0.0001) and renal impairment/hypertension (RR = 1.30, 95% CI 1.09-1.54; P = 0.003) caused by coxib use alone.

CONCLUSION

Coxibs may reduce the overall risk of colorectal neoplasms, but the chemopreventive effects are attenuated over time. When participants take low-dose aspirin simultaneously, coxibs may not be useful for chemoprevention of colorectal neoplasm.

Swept-source optical coherence tomography microsystem with an integrated Mirau interferometer and electrothermal micro-scanner

In the rapid evolution of gastrointestinal endomicroscopy, optical coherence tomography (OCT) has found many diverse applications. Until recently, the micro-opto-electro-mechanical systems (MOEMS) technology has been playing a key role in shaping the miniaturization of these components. We report here, to the best of our knowledge, a novel endoscopic microsystem. It is based on a spectrally tuned MOEMS Mirau micro-interferometer integrated with micro-electro-mechanical systems (MEMS) electro-thermal micro-scanner, operating in the regime of swept-source (SS) OCT imaging. This Letter validates our initial proof-of-concept toward the development of such MOEMS probe and the presentation of experimental performances of the resulting SS-OCT microsystem.

[Prevention for glucocorticoid-induced osteonecrosis of femoral head: a long-term clinical follow-up trail]

Objective: To evaluated the outcome of prevention and treatment for glucocorticoid-induced osteonecrosis of femoral head with anticoagulant and vasodilator drugs. Methods: A prospective, randomized, double-blind study was performed. From August 2003 to August 2006, 58 patients with large amounts of hormone therapy in the Zhongshan Hospital Affiliated Dalian University were enrolled and randomly assigned to the control group (placebo) or preventive group (anticoagulant and vasodilator drugs). And we prospectively analyzed the clinical outcomes of 24 patients with glucocorticoid-induced osteonecrosis of femoral head early stage (treatment group)treated by anticoagulant and vasodilator drugsat the same time. Disease incidence rate and progression were evaluated by radiography and magnetic resonance imaging (MRI), Follow-up of patients with femoral head survival curve was drawn. The Harris Hip Score and the Short Form 36 health survey were used to rate hip function and quality of life, respectively. Results: Thus, a total of 80 patients were assessed in this study, 24 cases in control group[follow up from 7.5 to 13.0(10.7±1.6)years], 22 cases in preventive group and 24 cases in treatment group. There was significant difference in theincidence rate of Osteonecrosis of femoral head, survive rate of femoral head and HHS score between the control groupand preventive group(41.7% vs 13.6%, 66.7% vs 70.8% , P<0.01). Conclusion: Anticoagulant and vasodilator drugs could effect on preventing theglucocorticoid-induced osteonecrosis of femoral head, reducing disease progression, or improving life quality.

Thrombin-reduced miR-27b attenuates platelet angiogenic activities in vitro via enhancing platelet synthesis of anti-angiogenic thrombospondin-1

Essentials It is unclear if platelet micro-RNAs can regulate de novo protein synthesis of platelets. Platelet de novo protein synthesis of thrombospondin-1 (TSP-1) was induced by thrombin. Thrombin stimulation in vitro altered platelet microRNA profiles, including decreased miR-27b. Decreased miR-27b hampers platelet angiogenic activities via enhancing de novo TSP-1 synthesis.

SUMMARY

Background Platelets can synthesize proteins upon activation. Platelets contain a number of microRNAs (miRNA) and a fully functional miRNA effector machinery. It is, however, unclear if platelet miRNAs can regulate protein synthesis of platelets, and whether the regulation may produce a physiological impact. Objectives To investigate if and how platelet miRNAs regulate de novo syntheses of angiogenic regulators and subsequently modulate platelet angiogenic activities. Methods and Results Microarray-based miRNA profiling showed that thrombin stimulation in vitro down- or up-regulated a number of platelet miRNAs, both in the total platelet miRNAs and in Ago2-associated miRNAs. Among those altered miRNAs, miR-27b was down-regulated in both the total and Ago2-immunoprecipitated miRNA profiles of platelets, which was confirmed by reverse transcription-quantitative PCR (RT-qPCR). Using western blotting assays, we showed that thrombin induced platelet de novo synthesis of thrombospondin-1, and that the level of thrombospondin-1 synthesis could reach a level of 3-5-fold higher than that before thrombin stimulation. With either the platelet precursor megakaryocyte cell line MEG-01 cells or mature platelets, we demonstrated that transfection of miR-27b mimic, but not the negative control of miRNA mimic, markedly reduced thrombospondin-1 protein levels. The latter subsequently enhanced platelet-dependent endothelial tube formation on matrigel. Conclusions Thrombin stimulation in vitro reduces platelet miR-27b levels that may markedly enhance thrombin-evoked platelet de novo synthesis of thrombospondin-1. Elevation of platelet miR-27b by transfection inhibits thrombospondin-1 synthesis, and subsequently enhances platelet pro-angiogenic activities. Hence, platelet activation-dependent reduction of miR-27b levels may represent a novel negative regulatory mechanism of platelet angiogenic activities.

Enhanced adhesion of ZnO nanowires during in situ scanning electron microscope peeling

The interfacial adhesion behaviour of a ZnO nanowire-Si substrate system is investigated using an in situ scanning electron microscope (SEM) mechanical peeling technique. The peel front of a nanowire advances via stick-slip events, and an equilibrium between the driving and resistant force to separation occurs immediately prior to a slip event. The interfacial adhesion energy is one order higher than that predicted theoretically by van der Waals interactions. The enhanced adhesion is primarily attributed to chemical and electrostatic interfacial interactions induced by electron irradiation. This work demonstrates that the operating environment of a nanoscale system could dramatically influence its adhesion behaviour. These findings are expected to have significant implications for interpreting the adhesion behaviour exhibited by a 1D nanostructure-substrate system when applying different testing methodologies, and for the fabrication of future NEMS devices.

A Closed Queueing Network Approach to the Analysis of Patient Flow in Health Care Systems

Objectives: To model patient flow in health care systems with bed capacity constraints in order to provide a useful decision aid for health service managers.

Methods: We model the patient flow of health care systems using a closed queueing network framework with the assumption that the system is always full. Key performance measures of the health care system are also derived.

Results: Using parameters taken from a study of a geriatric department in the UK, we show that the model is useful in helping service managers to gain better understanding of the behaviour of the system. In addition, we demonstrate that the model could help improving decision-making by allowing managers to explore different options and evaluate their impacts on performance. Our findings highlight the importance of policy makers taking into account the interactions between different phases of care.

Conclusions: We have developed a novel approach to modelling the flow of patients through health care systems with constrained bed capacity.

Enhanced antitumor efficacy through microwave ablation in combination with immune checkpoints blockade in breast cancer: A pre-clinical study in a murine model

PURPOSE

The purpose of this study was to investigate the therapeutic efficacy of the combination of microwave ablation (MWA) in combination with immune checkpoints blockade in the treatment of breast cancer using the 4T1 tumor-bearing mice model.

MATERIALS AND METHODS

We treated tumor-bearing mice with MWA, programmed cell death protein1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) blockade (P+C), MWA plus PD-1 and CTLA-4 blockade (combination therapy), or no-treatment. Survival time was evaluated with the Kaplan-Meyer method comparing survival curves by log-rank test. On day 15 after MWA, five mice from the combination therapy group received tumor rechallenge with 4T1 or CT26 cells and the volumes of rechallenge tumor were calculated every 5 days. Immune cells were identified by immunohistochemistry and flow cytometry, and the concentrations of plasma interferon-γ (IFN-γ) were identified by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The combination therapy significantly prolonged tumor-bearing mice survival compared to no-treatment group, P+C group or MWA group (P<0.001, P<0.001 and P=0.01, respectively) and protected most surviving mice from 4T1 tumor rechallenge (P=0.002) but not CT26 tumor rechallenge (P=0.905). Both local and systemic CD8+ T-cell responses were induced by MWA (all P<0.05) and further augmented by subsequent administration of PD-1 and CTLA-4 blockade (all P<0.05). Plasma IFN-γ concentrations were significantly elevated in the combination therapy group compared to no-treatment group, P+C group or MWA group (P<0.001, P<0.001 and P=0.01, respectively).

CONCLUSION

MWA combined with immune checkpoints blockade could synergistically enhance antitumor efficacy with augmented specific immune responses, and the combination therapy is a promising approach to treat breast cancer.

The MTHFR polymorphism affect the susceptibility of HCC and the prognosis of HCC liver transplantation

BACKGROUND

Methylenetetrahyfrofolate reductase (MTHFR) is the key enzyme for one carbon and folate metabolism. Previous studies have drawn different conclusions about the relationship between the mutation of MTHFR and hepatocellular carcinoma (HCC) occurrence. MTHFR polymorphisms' influence on liver transplantation for HCC recurrence has yet not been reported. Aim of this study was to clarify the impact of MTHFR polymorphism on hepatocarcinogenesis and the prognosis of liver transplant recipient with HCC.

METHODS

This study enrolled 244 HCC patients and 487 healthy individuals in Chinese Han population to analyze the influence of MTHFR polymorphism on HCC susceptibility first. Furthermore, this research choose another 100 donors' and 104 recipients' specimens to detect the association between polymorphism of MTHFR and post-transplant HCC recurrence.

RESULT

rs1801131 polymorphism A to C was associated with the occurrence of HCC in Chinese Han population (p < 0.05), especially in age exceeding 50 years (p < 0.01). No association was observed with rs1801133 polymorphism and HCC occurrence. The mean tumor-free survival for recipients with donor liver graft rs1801133 C to T variants was shorter than CC type (12.63 ± 3.84 vs 22.43 ± 4.74 months, p < 0.05). Multivariate analysis revealed that Donor rs1801133 and Hangzhou criteria were two independent prognostic factors for tumor-free survival (p < 0.05). Neither donor rs1801131 polymorphism nor recipients' MTHFR polymorphisms was associated with HCC recurrence.

CONCLUSION

This study demonstrated that MTHFR polymorphism was associated with HCC occurrence and post-transplant HCC recurrence. rs1801131 mutation A to C is a valuable molecular biomarker for predicting HCC occurrence in Chinese Han population. Donor MTHFR rs1801133 C to T polymorphism could present as a promising prognostic biomarkers for HCC recurrence in liver transplant recipients.

Reactive oxygen species downregulate ARID1A expression via its promoter methylation during the pathogenesis of endometriosis

OBJECTIVE

Oxidative stress caused by reactive oxygen species (ROS) plays an important role in the pathogenesis of endometriosis. The gene AT-rich interactive domain 1A (ARID1A), is frequently down regulated and inactivated in endometriosis. This report is focused on the molecular mechanism of the correlation between oxidative stress and ARID1A gene expression in endometrial cell oxidative damage model.

PATIENTS AND METHODS

In this study, the ARID1A gene expression level and its promoter methylation level were detected in 30 endometriosis and normal tissues. The primary endometrial cell was co-cultured with H2O2. Then, MDA and Gpx level were used to test the ROS level, RT-PCR was employed to detect the expression level of ARID1A. At last, the ARID1A gene promoter methylation level was detected by methylation-specific PCR (MSP). Finally, the expression level of DNMT1 was detected by both RT-PCR and Western blot.

RESULTS

The expression level of ARID1A gene was down regulated in endometriosis compared with normal tissues. The low expression level of ARID1A gene was associated with its promoter hyper-methylation. In H2O2 simulated endometrial cells, ARID1A gene expression level was decreased. Finally, ROS regulated ARID1A gene expression by changing the methylation level of ARID1A gene promoter. Finally, both the mRNA level and protein level of DNMT1 increased in H2O2 simulated endometrial cells.

CONCLUSIONS

In endometriosis, the down-regulated ofARID1A gene was highly correlated with its promoter hyper-methylation. ROS decreased the expression level of ARID1A gene via regulating methylation of its promoter which contributing to the understanding of the pathogenesis of endometriosis. The possible mechanism of ARID1A gene promoter hyper-methylation is ROS up-regulated DNMT1gene expression.

Upregulation of LncRNA PANDAR predicts poor prognosis and promotes cell proliferation in cervical cancer

OBJECTIVE

To investigate the expression level of long non-coding RNA promoter of CDKN1A antisense DNA damage activated RNA (lncRNA PANDAR) in cervical cancer and to analyze the effects of PANDAR on biological behaviors of cervical cancer and the clinical significance of PANDAR.

PATIENTS AND METHODS

A total of 68 pairs of cervical cancer and paired cancer-adjacent tissue specimens were collected. The relative expression of PANDAR in tissues was detected by quantitative Real-time polymerase chain reaction (qRT-PCR) so as to analyze the relationship between PANDAR and clinicopathological factors of cervical cancer and evaluate its clinical significance. qRT-PCR was used to detect the relative expression of PANDAR in cervical cancer cells. Interference in PANDAR was conducted. Cell counting kit-8 (CCK-8) assay was used to detect the changes in cell proliferation capacity.

RESULTS

The results of qRT-PCR showed that the expression level of PANDAR was significantly up-regulated in cervical cancer tissues compared with that in cancer-adjacent tissues. Statistical analysis showed that PANDAR expression was correlated with International Federation of Gynecology and Obstetrics (FIGO) staging, tumor size and tumor invasion degree. Kaplan-Meier survival analysis showed that the survival time of patients with highly expressed PANDAR was shorter than that of patients with lowly expressed PANDAR. Cox multivariate regression analysis showed that PANDAR could be used as an independent prognostic factor for patients with cervical cancer. CCK-8 results showed that interference in PANDAR significantly inhibited tumor cell proliferation.

CONCLUSIONS

The expression level of PANDAR is up-regulated in cervical cancer tissues and cells, and PANDAR promotes tumor growth. PANDAR may be a biomarker for the early diagnosis of cervical cancer and a potential therapeutic target for reversing the malignant phenotype of tumors.

Functional Odontoblastic-Like Cells Derived from Human iPSCs

The induced pluripotent stem cells (iPSCs) have an intrinsic capability for indefinite self-renewal and large-scale expansion and can differentiate into all types of cells. Here, we tested the potential of iPSCs from dental pulp stem cells (DPSCs) to differentiate into functional odontoblasts. DPSCs were reprogrammed into iPSCs via electroporation of reprogramming factors OCT-4, SOX2, KLF4, LIN28, and L-MYC. The iPSCs presented overexpression of the reprogramming genes and high protein expressions of alkaline phosphatase, OCT4, and TRA-1-60 in vitro and generated tissues from 3 germ layers in vivo. Dentin discs with poly-L-lactic acid scaffolds containing iPSCs were implanted subcutaneously into immunodeficient mice. After 28 d from implantation, the iPSCs generated a pulp-like tissue with the presence of tubular dentin in vivo. The differentiation potential after long-term expansion was assessed in vitro. iPSCs and DPSCs of passages 4 and 14 were treated with either odontogenic medium or extract of bioactive cement for 28 d. Regardless of the passage tested, iPSCs expressed putative markers of odontoblastic differentiation and kept the same mineralization potential, while DPSC P14 failed to do the same. Analysis of these data collectively demonstrates that human iPSCs can be a source to derive human odontoblasts for dental pulp research and test bioactivity of materials.