[Effect of dietary water-soluble vitamins on the poor prognosis of low-grade cervical intraepithelial neoplasia-a prospective cohort study]

Objective: To explore the effect of dietary water-soluble vitamins on the poor prognosis of low-grade cervical intraepithelial neoplasia (CINⅠ). Methods: A total of 564 participants with CINⅠ were selected from a community-based married women cohort established in 2014. The general baseline information was collected, and HPV genotyping was detected. A food frequency questionnaire was used to investigate dietary water-soluble vitamins' consumption and determine their exposure levels. The follow-up program was carried out for 12 months, and the regression, persistence, and progression of CINⅠ was determined according to histopathological results at 12-month. Results: The low-levels of dietary water-soluble vitamins could promote CINⅠ's persistence and progression, showing the increasing tendency of CINⅠ poor prognosis with the decrease of water-soluble vitamin levels. Especially folate, VB1, VB2, VB6, niacin, biotin, and VC (RR values were 15.22, 1.86, 1.92, 2.11, 2.98, 2.14, 2.19, respectively) played an important role. Considering the status of high-risk human papillomavirus (HR-HPV) infection, our results showed that the low levels of folate, niacin, biotin could promote the poor prognosis of CINⅠ. Conclusions: The low-level of dietary water-soluble vitamins could facilitate the poor prognosis of CINⅠ. In addition, folate, niacin, biotin were more effective on HR-HPV positive women.

[The optimal model of diagnosis to low-grade cervical intraepithelial neoplasia by combined detecting vaginal micro-environmental factors, based on the high-risk HPV infection]

Objective: To investigate the diagnostic value of different vaginal micro-environmental factors in low-grade cervical intraepithelial neoplasia (CIN Ⅰ) and determine the optimal model in high-risk human papillomavirus (HR-HPV) infection. Methods: A total of 926 women, including 623 with normal cervical (NC) condition and 303 CINⅠ patients, had undergone pathological examinations, and were enrolled in the study. All the women were from a community previously established cohort. Vaginal cleanliness, pH, H₂O₂, β-glucuronidase, coagulase, sialidase, and leukocyte esterase (LE) were detected by the combined detection method aerobic vaginitis/bacterial vaginosis in vaginal secretions. HPV genotyping was performed by using the flow-through hybridization technology. The data were analyzed by SAS 9.2 and SPSS 23.0. Results: The vaginal cleanliness, pH, sialidase, and LE were determined as the representative vaginal micro-environment factors by principal component analysis. Based on logistic regression theory to analyze the ROC curve, the results showed that the highest sensitivity was with pH value (76.2%), and the highest specificity was with sialidase (90.9%). The area under ROC curve were higher in combination detection modes of sialidase+LE (0.714), pH+sialidase+LE (0.719), vaginal cleanness+sialidase+LE (0.713) and pH+vaginal cleanness+sialidase+LE (0.709). According to HR-HPV infection status, the TOPSIS method was used to analyze the combined detection optimal model. Specifically, we found that the best diagnostic model was pH+sialidase +LE (C_i=0.585) in the HR-HPV positive group and vaginal cleanness+sialidase+LE (C_i=0.641) in the negative group. Conclusions: The combined detection of vaginal microenvironment factors could be used for auxiliary diagnosis for CINⅠ. It would be more effective when detecting pH, sialidase, and LE in HR-HPV positive women while vaginal cleanness, sialidase, and LE in HR-HPV negative women at the same time.

[Prognosis of high-risk HPV infection and its influences by vaginal micro-environmental factors]

Objective: To describe the characteristics of high-risk human papillomavirus (HR-HPV) infection and its influences by vaginal micro-environmental factors. Methods: A total of 421 women with HR-HPV infection and normal cervix diagnosed by pathology were selected from a community cohort established earlier by our research group for a 24-month follow-up. The baseline data were collected at enrollment. The vaginal micro-environmental factors were detected by using the combined detection kit of aerobic vaginitis and bacterial vaginosis. And the HPV was detected by using the flow-through hybridization technology. According to the HR-HPV infection status in baseline and 24 months of follow-up, with the prognosis characteristics of HR-HPV infection described, the impact of vaginal micro-environmental factors on the prognosis of HR-HPV infection was explored as well. Results: Among 390 HR-HPV infected women who completed 24 months of follow-up, the top five types of persistent HR-HPV infection rate appeared as HPV16 (24.1%), HPV58 (22.2%), HPV53 (21.7%), HPV52 (20.0%), and HPV39 (11.8%), respectively. The results showed that women with abnormal vaginal pH (aOR=1.74, 95%CI: 1.08-2.80), abnormal neuraminidase (aOR=2.70, 95%CI: 1.52-4.83), or abnormal leucocyte esterase (aOR=3.41, 95%CI: 2.13-5.44), the risk of HR-HPV persistent infection increased. The abnormalities of neuraminidase and leukocyte esterase could increase the risk of persistent infection of homotype and heterotypic HR-HPV. Conclusions: HPV16 was prone to persistent infection. Abnormalities of vaginal pH, neuraminidase, and leukocyte esterase might increase the risk of HR-HPV persistent infection. Both the abnormalities of neuraminidase and leukocyte esterase play an essential role in the HR-HPV persistent infection.

POS0647 EFFICACY, SAFETY AND CHARACTERISTICS OF IGURATIMOD-BASED THERAPY IN THE TREATMENT OF UA, ERA AND RA PATIENTS FOR 24 WEEKS: A PROSPECTIVE COHORT STUDY

Background:

Experts emphasize early diagnosis and treatment in RA, but the widely used diagnostic criterias fail to meet the accurate judgment of early rheumatoid arthritis. In 2012, Professor Zhanguo Li took the lead in establishing ERA “Chinese standard”, and its sensitivity and accuracy have been recognized by peers. However, the optimal first-line treatment of patients (pts) with undifferentiated arthritis (UA), early rheumatoid arthritis (ERA), and rheumatoid arthritis (RA) are yet to be established.

Objectives:

To evaluate the efficacy and safety of Iguratimod-based (IGU-based) Strategy in the above three types of pts, and to explore the characteristics of the effects of IGU monotherapy and combined treatment.

Methods:

This prospective cohort study (ClinicalTrials.gov Identifier NCT01548001) was conducted in China. In this phase 4 study pts with RA (ACR 1987 criteria[1]), ERA (not match ACR 1987 criteria[1] but match ACR/EULAR 2010 criteria[2] or 2014 ERA criteria[3]), UA (not match classification criteria for ERA and RA but imaging suggests synovitis) were recruited. We applied different treatments according to the patient’s disease activity at baseline, including IGU monotherapy and combination therapies with methotrexate, hydroxychloroquine, and prednisone. Specifically, pts with LDA and fewer poor prognostic factors were entered the IGU monotherapy group (25 mg bid), and pts with high disease activity were assigned to combination groups. A Chi-square test was applied for comparison. The primary outcomes were the proportion of pts in remission (REM)or low disease activity (LDA) that is DAS28-ESR<2.6 or 3.2 at 24 weeks, as well as the proportion of pts, achieved ACR20, Boolean remission, and good or moderate EULAR response (G+M).

Results:

A total of 313 pts (26 pts with UA, 59 pts with ERA, and 228 pts with RA) were included in this study. Of these, 227/313 (72.5%) pts completed the 24-week follow-up. The results showed that 115/227 (50.7%), 174/227 (76.7%), 77/227 (33.9%), 179/227 (78.9%) pts achieved DAS28-ESR defined REM and LDA, ACR20, Boolean remission, G+M response, respectively. All parameters continued to decrease in all pts after treatment (Fig 1).

Compared with baseline, the three highest decline indexes of disease activity at week 24 were SW28, CDAI, and T28, with an average decline rate of 73.8%, 61.4%, 58.7%, respectively. Results were similar in three cohorts.

We performed a stratified analysis of which IGU treatment should be used in different cohorts. The study found that the proportion of pts with UA and ERA who used IGU monotherapy were significantly higher than those in the RA cohort. While the proportion of triple and quadruple combined use of IGU in RA pts was significantly higher than that of ERA and UA at baseline and whole-course (Fig 2).

A total of 81/313 (25.8%) pts in this study had adverse events (AE) with no serious adverse events. The main adverse events were infection(25/313, 7.99%), gastrointestinal disorders(13/313, 4.15%), liver dysfunction(12/313, 3.83%) which were lower than 259/2666 (9.71%) in the previous Japanese phase IV study[4].

The most common reasons of lost follow-up were: 1) discontinued after remission 25/86 (29.1%); 2) lost 22/86 (25.6%); 3) drug ineffective 19/86 (22.1%).

Conclusion:

Both IGU-based monotherapy and combined therapies are tolerant and effective for treating UA, ERA, and RA, while the decline in joint symptoms was most significant. Overall, IGU combination treatments were most used in RA pts, while monotherapy was predominant in ERA and UA pts.

References:

[1]Levin RW, et al. Scand J Rheumatol 1996, 25(5):277-281.

[2]Kay J, et al. Rheumatology 2012, 51(Suppl 6):vi5-9.

[3]Zhao J, et al. Clin Exp Rheumatol 2014, 32(5):667-673.

[4]Mimori T, et al. Mod Rheumatol 2019, 29(2):314-323.

Disclosure of Interests:

None declared

Genome sequencing of pancreatic cancer: differential expression by location

The results demonstrated that pancreatic ductal carcinoma (PDAC) of the body/tail was associated with more transcriptional and genomic changes, and correlated with worse prognosis, than PDAC of the pancreatic head. The different mutation types and gene expression of tumour locations provide deep insight into the carcinogenesis or metastasis of PDAC, and suggest different early diagnostic and therapeutic strategies. SNV, single-nucleotide variations; NLS, Nuclear localization sequence; MB, million base-pairs; UTR, untranslated region.

Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016

STUDY QUESTION

What is the current status of assisted reproductive technology (ART) service availability, efficacy and safety in mainland China?

SUMMARY ANSWER

In this first national report on ART status in mainland China, data on treatment numbers, outcomes and complications in 2016 are provided and analyzed, respectively.

WHAT IS KNOWN ALREADY

National ART Service Provision Surveys are conducted in mainland China regularly. Data were analyzed, and this manuscript was written by team members from the National Center for Women and Children's Health, China CDC and the Department of Women and Children Health, National Health Commission of the People's Republic of China.

STUDY DESIGN, SIZE AND DURATION

A cross-sectional nationwide survey was completed in 2018, in which data regarding ART treatments, performed from 1st January to 31st December2016 in 445 ART clinics located in 31 provinces of mainland China, were collected.

PARTICIPANTS/MATERIALS, SETTING AND METHODS

There were in total 451 licensed ART clinics (including artificial insemination clinics) in mainland China in 2016, of which 445 submitted service data. A total of 906 840 cycles were provided by 323 in vitro fertilization (IVF) clinics, involving 375 770 conventional IVF cycles, 154 948 intracytoplasmic sperm injection (ICSI) cycles, 367 146 frozen embryo transfer (FET) thawing cycles and 8976 preimplantation genetic diagnosis (PGD) treatment cycles. A total of 161 376 artificial (i.e. intrauterine) insemination (AI) cycles were reported by 443 clinics, with 126 872 cycles using the husband's semen (AIH) and 34 504 using donor semen (AID).

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 98.7% of the licensed clinics, contributing to 100% of the ART services (including AID and AIH cycles), were included in this report. (Six clinics provided institutional information only and were excluded.) There were 906 840 in vitro fertilization cycles performed in mainland China with a population of over 1.3 billion inhabitants, with cycles per million inhabitants (C/M) increasing from 360 in 2013 to 657 in 2016, nationwide (range among provinces: 45-3676). After treatment with conventional IVF, the clinical pregnancy rate (PR) per oocyte retrieval cycle was 23.2%, the delivery rate (DR) per oocyte retrieval cycle was 18.7% and the proportion of twin delivery among the total deliveries was 27.9%. For ICSI cycles, the PR, DR and TDR were 20.5%, 16.7% and 27.2%, respectively. For FET per thawing cycles, the PR, DR and TDR were 48.2%, 37.6% and 24.2%. For PGD per diagnosis cycles, the PR, DR and TDR were 38.1%, 29.7% and 4.2%. For AIH cycles, the PR and DR were 13.3% and 10.5%; for AID cycles, the PR and DR were 24.3% and 21.1%, respectively. The total number of live infants born in mainland China in 2016, was 18.46 million, and the number of infants born through ART conducted in 2016 was 311 309, which accounted for 1.69% of the total. The reported rate of birth defects was about 87/10 000. The incidence of moderate to severe ovarian hyper-stimulation syndrome (OHSS) was 11.5 per 1000 oocyte retrieval cycles, and other complications were much more rare.

LIMITATIONS AND REASONS FOR CAUTION

This report is based on the summary data of ART services provided. The success rates were not calculated by age stratification. A low rate of birth defects was reported, which might be confounded by variations in birth follow-up methods, statistical timing and record taking.

WIDER IMPLICATIONS OF THE FINDINGS

ART service availability has improved significantly in recent years in mainland China. Because China is a vast country, significant imbalances in ART service provision do exist; however, the main efficacy and safety indicators were close to those of western countries.

TRIAL REGISTRATION NUMBER

N/A.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by the National Key R&D Program of China (2016YFC1000307-2). There are no competing interests.

[The variation of serum uric acid levels among patients with myocardial infarction treated with ticagrelor and the association between serum uric acid and platelet reactivity]

Objectives: To compare the impact of ticagrelor or clopidogrel on serum uric acid levels among patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and further evaluate the effects of variation of serum uric acid levels on platelet reactivity. Methods: STEMI patients who admitted to Fuwai Hospital from April 2017 to January 2020, and underwent primary PCI and discharged alive with aspirin and ticagrelor or clopidogrel were included in this study. Patients were divided into ticagrelor group and clopidogrel group. The baseline clinical data were collected. Serum uric acid and creatinine levels at baseline and 30 days post-PCI were measured. Light transmittance aggregometry was used to assess maximum aggregation rate induced by adenosine diphosphate and arachidonic acid. The changes of serum uric acid and creatinine were compared between the two groups. Multivariate logistic regression was performed to evaluate independent related factors for rise in the uric acid levels, and the effect of variation of serum uric acid level on platelet reactivity was analyzed. Results: A total of 967 patients were included, the age was (59.4±12.1) years, and 163 case were female. There were 550 cases in ticagrelor group (56.9%) and 417 cases in clopidogrel group (43.1%). Baseline serum uric acid and creatinine levels were similar between the 2 groups. At 30 days, the serum uric acid level [(347.2±96.5) mmol/L vs. (341.2±105.3) mmol/L, P=0.009] and absolute [46.4 (-2.4, 88.1) mmol/L vs. 25.0 (-21.9, 73.0) mmol/L, P=0.001] and percentage [13.2 (-0.01, 29.0) % vs. 7.9 (-5.7, 25.0) %, P=0.007] increase in the serum uric acid levels were significantly higher in ticagrelor group than in clopidogrel group. The level of serum creatinine at 30 days was significantly lower in ticagrelor group than in clopidogrel group [(89.7±21.3) μmol/L vs. (94.4±43.9) μmol/L, P<0.05], whereas there were no differences in absolute [8.0 (-1.4, 16.6) μmol/L vs. 7.8 (-2.0, 16.6) μmol/L] and percentage [10.5 (-1.7%, 22.6%) vs. 9.8 (-2.4%, 22.1%)] change in the serum creatinine between the 2 groups (all P>0.05). Logistic regression analysis showed that, after adjusting for confounding factors, ticagrelor therapy was an independent related factor of serum uric acid elevation (OR=1.582, 95% CI:1.023-2.447, P=0.039). The variation of the serum uric acid levels did not affect platelet aggregation and the percentage of high platelet reactivity in both groups. Conclusions: Ticagrelor use is related to a significant increase in the serum uric acid levels at 30 days post-PCI in this patient cohort. The variations in the uric acid levels do not increase the percentage of high platelet reactivity in STEMI patients treated with ticagrelor or clopidogrel.

[The safety and efficacy of Firesorb bioresorbable scaffold in first-in-man study for coronary artery disease: the four-year outcomes]

Objective: To evaluate the 4-year clinical outcomes of patients following Firesorb bioresorbable scaffold (BRS) implantation. Methods: The study reported the 4-year follow-up results of the FUTURE I study. FUTURE I was a prospective, single-center, open-label, first-in-man study which evaluated the feasibility, preliminary safety, and efficacy of Firesorb stent in the treatment of coronary artery stenosis. A total of 45 patients with single de novo lesions in native coronary arteries ,who hospitalized in Fuwai Hospital from January to March 2016 were enrolled. After successfully stent implantation these patients were randomized in a 2∶1 ratio into cohort 1 (n=30) or cohort 2 (n=15). The patients in cohort 1 underwent angiographic, IVUS or OCT examination at 6 months and 2 years; and cohort 2 underwent angiographic, IVUS or OCT at 1 and 3 years. All patients underwent clinical follow-up at 1, 6 months and 1 year and annually thereafter up to 5 years. The primary endpoint was target lesion failure (TLF, including cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization). Secondary endpoints included patient-oriented composite endpoint (PoCE, defined as composite of all death, all miocardial infarction, or any revascularization). Results: A total of 45 patients were enrolled and implanted with Firesorb BRS, including 35 males (77.8%), and the age was (54.4±9.3) years. At 4 years, 10 patients in cohort 1 were reexamined by coronary angiography and OCT examination. Among them, 2 patients' stents were completely degraded and absorbed. Compared with the OCT images of the other 8 patients in cohort 2 at 3 years, the degree of stent degradation was increased, and no stent adherence was found. The 4-year clinical follow-up rate was 100%. In 4-year clinical following up, 2 patients suffered PoCE (4.4%): 1 patient underwent non-target vessel revascularization the day after index procedure and target vessel revascularization (Non-target lesion revascularization) at 2-year imaging follow-up; the other patient underwent target lesion revascularization during imaging follow-up at 4 years but not due to ischemic driven. There was no scaffold thrombosis or TLF events through 4 years. Conclusions: Four years after the implantation, complete degradation and absorption of the Firsorb stent are evidenced in some patients. Firesorb stent is feasible and effective in the treatment of patients with non-complex coronary lesions.

[Effects of hnRNP E1 on expression of early genes E2, E6 of HPV16 and biological function in cervical cancer cells]

Objective: To explore the effects of hnRNP E1 on the expression of early genes E2, E6 of HPV16 and the biological function in cervical cancer SiHa cell lines. Methods: The cell experiments in vitro were carried out in cervical cancer cell lines SiHa. The expression levels of E2, E6 mRNA and protein of HPV16 were detected by Real-time PCR and Western blot, respectively, before and after up-regulating hnRNP E1. Meanwhile, the cell proliferation, cycle and apoptosis were evaluated by CCK-8 and flow cytometry. Data analyses were performed using SPSS 22.0 and Graphpad Prism 7.0 software. Results: Compared with the blank and the blank plasmid group, the cells activity and proliferation decreased at 24, 48 and 72 h after up-regulating hnRNP E1 (P<0.05), while the percentage of cells in G0/G1 phase increased and the percentage in S and G2/M phase and proliferation index decreased (P<0.05). Moreover, the late apoptotic rate and the total apoptotic rate increased (P<0.05). The expression levels of E6 mRNA and protein of HPV16 in hnRNP E1 up-regulated group were significantly lower than that in both blank group and blank plasmid group, the differences were significant (P<0.05), showing the tendency of cells proliferation index decrease and total apoptotic rate increase with decreased HPV16 E6 expression. There were no significant differences in the expression of E2 mRNA of HPV16 among the three groups (P=0.427), and no E2 protein of HPV16 was detected. Conclusions: hnRNP E1 could inhibit the transcription and translation of E6 oncogene of HPV16 and further inhibit the proliferation and promote apoptosis of cervical cancer cells, suggesting that hnRNP E1 might be a potential target marker to prevent cervical lesions. But no association between hnRNP E1 and HPV16 E2 was found in SiHa cells.

[Clinical analysis of 14 infective endocarditis in patients with obstructive hypertrophic cardiomyopathy]

Objective: This observational study was aimed to analyze the clinical characteristics of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM). Methods: A total of 668 patients with IE, and 7 427 patients with HCM were treated in Fuwai Hospital from August 2006 to December 2018. Among them, 14 patients were diagnosed with HCM and IE. The clinical characteristics of these patients including clinical manifestations, pathogen distribution, echocardiography features, in-hospital treatment and outcomes were analyzed retrospectively. Results: The proportion of HCM patients with IE was 0.19%,with the estimated incidence of 0.15/1 000 person-years in HCM patients. Of the 14 patients, 11 patients were male. The most common clinical manifestations were fever and heart murmur, and the main complications were heart failure (12/14) and bacterial embolism (8/14). There were 8 cases (8/14) with positive blood culture, and all causative bacteria were gram positive coccus, in which 5/8 were Streptococcus. The median interventricular septum thickness was (21.2±2.7) mm, and left ventricular outflow obstruction was severe based on echocardiography (Echo) examination. The Echo showed that vegetation was found in all 14 patients and most of the vegetation attached at the anterior leaflet of mitral valve (12/14). The proportions of patients with circulatory embolism (8/14) and valve lesions (12/14) were relatively high. Most cases (10/14) were cured, especially those underwent cardiac surgery (8 cases). The rest 4 cases died with 2 in hospital and 2 after auto-discharge. Conclusions: HCM patients complicated with IE are rare. Septic embolization and valve lesions are common in these patients. IE patients with HCM might have a poor prognosis compared to those without HCM and should receive cardiac surgery as early as possible.

[Relations of human papillomavirus infection, vaginal micro-environmental disorder with cervical lesion]

Objective: To study the relations of human papillomavirus (HPV) infection, vaginal micro-environmental disorder with cervical lesion. Methods: A total of 1 019 women including 623 with normal cervical (NC), 303 with low-grade cervical lesion (CIN Ⅰ) and 93 with high-grade cervical lesion (CIN Ⅱ/Ⅲ) were enrolled in this study from the communities in Shanxi province, China. Case-control method was adopted, with NC as the control group and CIN as the case group. Related information was collected including demographic characteristics and relevant factors related to cervical lesions. HPV genotypes were detected by flow-through hybridization technology. Vaginal pH was detected by the pH test paper. Vaginal H(2)O(2) was detected by the combined detection kit of aerobic vaginitis and bacterial vaginosis. Vaginal cleanliness was detected by smear method. Results: Data from the unconditional logistic regression analysis showed that HPV infection (CINⅠ: aOR=1.39, 95%CI: 1.01-1.90; CINⅡ/Ⅲ: aOR=11.74, 95%CI: 6.96-19.80), H(2)O(2) (CINⅠ: aOR=2.09, 95%CI: 1.47-2.98; CINⅡ/Ⅲ: aOR=4.12, 95%CI: 2.01-8.43), cleanliness (CIN Ⅱ/Ⅲ: aOR=2.62, 95%CI: 1.65-4.14), and composite indicators (CINⅠ: aOR=1.67, 95%CI: 1.24-2.25; CINⅡ/Ⅲ: aOR=4.24, 95%CI: 2.30-7.81) all had increased the risk of cervical lesion and the trend on the severity (P<0.001) of cervical lesions. Additionally, we observed a synergic effect between HPV infection and vaginal micro-environmental composite indicator in CINⅡ/Ⅲ. With or without HPV infection, the ORs value of CINⅠ caused by vaginal micro-environment disorder remained close. Conclusions: Results from our study revealed that vaginal micro-environmental composite indicator could increase the risk for cervical lesion, in particular with the high-grade ones which all posed stronger risks when combined with HPV infection. However, the role of vaginal micro-environment disorder in the occurrence of CIN Ⅰ should not be ignored.

[Risk factors for surgical site infection after emergency abdominal surgery: a multicenter cross-sectional study in China]

Objective: Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence. Methods: Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS. Results: A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ(2)=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ(2)=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ(2)=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ(2)=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ(2)=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ(2)=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ(2)=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions: For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

Prognostic value of age-adjusted d-dimer cutoff thresholds in patients with myocardial infarction treated by percutaneous coronary intervention

Introduction

The association between D-dimer and outcomes of patients with myocardial infarction (MI) remains controversial. Using age-adjusted D-dimer cutoff thresholds significantly improves the accuracy of diagnosis for thrombotic diseases. This study aimed to investigate the prognostic value of age-adjusted D-dimer in MI patients treated by percutaneous coronary intervention (PCI).

Methods

In this observational study, 3614 consecutive patients with MI treated by PCI were retrospectively recruited. The baseline age-adjusted D-dimer threshold was 500 ng/mL, and was calculated as age × 10 in patients older than 50 years. Cox regression was used for outcome analysis. The primary outcome was all-cause death. Discrimination and reclassification were calculated to assess the additional prognostic value of D-dimer when combined with established clinical risk factors and the Global Registry of Acute Coronary Events (GRACE) risk score.

Results

During a median follow-up of 652 days, a total of 194 deaths occurred. High D-dimer level, as defined by age-adjusted thresholds, was an independent predictor for all-cause death (hazard ratio:1.67, 95% confidence interval: 1.23–2.27, P=0.001). Addition of D-dimer level (high or low) significantly improved risk classification for death when combined with established clinical risk factors (net reclassification index [NRI]: 0.601, P&lt;0.001; integrated discrimination improvement [IDI]: 0.011, P=0.046) and GRACE score (NRI: 0.618, P&lt;0.001; IDI: 0.015, P=0.011).

Conclusions

In patients with MI treated by PCI, D-dimer elevation defined by age-adjusted thresholds was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and GRACE score.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

Association between pre-infarction angina and culprit-lesion morphology in patients with ST-segment elevation myocardial infarction: an optical coherence tomography study

Background

Previous studies reported the cardiac protection effect of pre-infarction angina (PIA) in patients with acute myocardial infarction (AMI). However, the association between PIA and culprit plaques characteristics in AMI patients through optical coherence tomography (OCT)assessment remains unclear.

Purpose

We sought to identify culprit-plaque morphology associated with PIA in patients with ST-segment elevation myocardial infarction (STEMI) using OCT.

Methods

A total of 279 STEMI patients who underwent intravascular OCT of culprit-lesion were included. Baseline clinical data and culprit-plaque characteristics were compared between the PIA group the non-PIA group.

Results

Patients with PIA represented 54.8% of the study population (153 patients). No differences were observed in clinical and angiographic data between two groups, except STEMI onset with exertion was significantly less common in PIA group (24.2% versus 40.5%, P=0.004). Patients with PIA exhibited a significantly lower incidence of plaque rupture (40.5% versus 61.9%, P&lt;0.001) and lipid-rich plaques (48.4% versus 69.0%, P=0.001). The thin-cap fibroatheroma (TCFA) prevalence was lower in PIA group, presenting a thicker fibrous cap thickness, although statistically significant differences were not observed (20.3% versus 30.2%, P=0.070; 129.1±92.0μm versus 111.4±78.1μm, P=0.088; respectively). Multivariate logistic regression analysis indicated that PIA was an independent negative predictor for plaque rupture (odds ratio: 0.44, 95% confidence interval: 0.268–0.725, P=0.001).

Conclusion

STEMI patients with PIA showed a significantly lower prevalence of plaque rupture and lipid-rich plaques in culprit-lesion than non-PIA group, implying different mechanisms of STEMI attack.

Flow chart + Bar graphs of OCT findings

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Association between pre-infarction angina and culprit-lesion morphology in patients with ST-segment elevation myocardial infarction: An optical coherence tomography study

[Analysis on the relationship between smoking status and the onset age of onset and the direct medical expenditure expenses of gastric cancer patients]

Objective: To investigate the relationship between smoking status and the onset age of stomach cancer patients and estimate the patients' direct medical cost burden of stomach cancer due to smoking in Anhui province. Methods: The information about the primary stomach cancer patients and their direct treatment expenditures in 10 cancer-registered areas in Anhui were collected in 2017. The association between smoking status and the age of onset of stomach cancer patients was analyzed by univariate regression and multivariate logistic regression models. The median and smoking-attributed risk method was used to describe the direct treatment expenditure of stomach cancer patients in Anhui due to smoking. Results: A total of 736 patients with stomach cancer were analyzed in this study. Univariate regression analysis showed that rural household registration (t=2.091, P=0.037), smoking (t=-2.357, P=0.001 9) and alcohol consumption (t=-2.036, P=0.042) were related to the age of onset of stomach cancer. After adjusting for gender, alcohol consumption, body mass index and household registration type, the risk of early stomach cancer in people who quitted smoking cessation was lower than that in smokers (OR=0.36, 95%CI: 0.17-0.75). The total direct medical cost burden of 736 newly diagnosed stomach cancer patients was 6.939 6 million RMB. The direct medical expenditure in stomach cancer patients who had smoking behavior was higher than that in stomach cancer patients who quitted smoking and never smoked. Conclusions: Smoking is one of the risk factors for the earlier onset of stomach cancer in Anhui. It is necessary to strengthen tobacco control to reduce the economic burden of patients with stomach cancer.

IL-10 inhibits apoptosis in brain tissue around the hematoma after ICH by inhibiting proNGF

OBJECTIVE

To explore the roles of interleukin-10 (IL-10), proNGF and p75NTR in apoptosis of brain tissues induced by intracerebral hemorrhage (ICH).

PATIENTS AND METHODS

According to the time of sample collection after ICH, brain tissue samples were divided into < 6 h group, 6-24 h group (including 24 h), 24-72 h group (including 72 h) and > 72 h group. Meanwhile, 10 tissues that dropped from the beginning at the cortical stoma (distal part of the hematoma) were harvested as controls. AI in brain tissues around the hematoma after ICH was calculated based on TUNEL staining. Expression levels of IL-10, proNGF and p75NTR in brain tissues were determined by quantitative Real-time polymerase chain reaction (qRT-PCR) and Western blot, respectively. Protein expressions of Bcl-2 and Bax were detected by Western blot. Rat cortical astrocytes were harvested and cultured in vitro. After transfection of IL-10 overexpression plasmid, expression levels of IL-10, proNGF and p75NTR were detected by Western blot.

RESULTS

AI increased in 6-24 h group, 24-72 h group and > 72 h group compared with < 6 h group and control group, which achieved the peak at 24-72 h. However, no significant difference in AI was observed between < 6 h group and control group. With the prolongation of ICH, IL-10 level gradually decreased and achieved the lowest level at 24-72 h. After 72 h, IL-10 level began to increase. Additionally, mRNA and protein levels of proNGF and p75NTR started to upregulate within 6 h of ICH, achieveing the peak at 24-72 h. Bcl-2 level gradually decreased after 6 h of ICH, while Bax level increased. We did not found significant difference in mRNA and protein levels of IL-10 in brain tissues around hematoma between < 6 h group and control group. With the prolongation of ICH, IL-10 level gradually decreased and achieved the lowest level at 24-72 h. After 72 h, IL-10 level began to increase. Transfection with IL-10 overexpression plasmid in rat astrocytes markedly downregulated protein levels of proNGF and p75NTR compared with those of controls.

CONCLUSIONS

IL-10 expression is downregulated in brain tissues around the hematoma after ICH. IL-10 alleviates inflammation and apoptosis by inhibiting levels of proNGF, p75NTR and Bax/Bcl-2, thus protecting brain tissue after ICH.

Value of serum collagen triple helix repeat containing-1(CTHRC1) and 14-3-3η protein compared to anti-CCP antibodies and anti-MCV antibodies in the diagnosis of rheumatoid arthritis

INTRODUCTION

Serological markers are important in the diagnosis of rheumatoid arthritis (RA) and other connective tissues diseases This study explored the clinical value of collagen triple helix repeat containing-1 (CTHRC1) and 14-3-3η protein, compared to routine markers, in the diagnosis of RA.

METHODS

We recruited 103 RA patients, 105 non-RA patients (osteoarthritis, ankylosing spondylitis, systemic lupus erythematosus) and 59 healthy controls. CTHRC1, 14-3-3η, anti-cyclic citrullinated peptide antibody (anti-CCP), anti-mutated citrullinated vimentin antibody (anti-MCV), rheumatoid factor and erythrocyte sedimentation rate (ESR) levels were measured, and their diagnostic value for RA evaluated and compared.

RESULTS

All laboratory indices were elevated in RA (P < 0.05). Of these, anti-MCV had the highest sensitivity (86.4%) and anti-CCP the highest specificity (94.5%). The areas under the curve (AUC) of CTHRC1, 14-3-3η, anti-CCP, anti-MCV, rheumatoid factor and ESR were 0.84, 0.81, 0.89, 0.91, 0.85 and 0.77 respectively (all P < 0.01). Anti-CCP and anti-MCV were the most valuable in the diagnosis of RA. The combination of anti-CCP and anti-MCV had the maximum Youden index, followed by the combination of anti-CCP and 14-3-3η. Binary logistic regression analysis showed that 14-3-3η had the largest odds ratio value (95% CI) at 5.1 (2.1-12.5) for RA.

CONCLUSION

CTHRC1 and 14-3-3η are promising serological indicators of RA, and when combined with anti-CCP, anti-MCV and ESR, can improve the diagnosis of this disease.

Policy infrastructure and mechanism to Promote “Health by All” Movement for Overturning Obesity

Background

Obesity is a pressing pandemic. However, major policies have targeted individual responsibility and focused on “losing weight or lowering calories”. Such approach has limited effect and overlooks the hidden obesity.

Methods

Under auspices of NHRI Forum, Taiwan; the WAKE.TAIWAN Research Team analyzed the global trends of policies, strategies, and literatures to formulate guiding principles for a total solution. 1. Defining obesity should go beyond body weight and emphasize more on healthy body composition and muscle mass, etc. 2. Effective obesity control strategy should facilitate building healthy living environments, lifestyle, and culture for natural flow of healthy behaviors. 3. All sectorial leaders should be involved in engaging and promoting healthy lifestyle culture and environment.

Results

”Guidelines for Establishing a lifestyle and Culture of Healthy Body Build” has been published as a blueprint for policy reform and strategies development, which consists of three parts. Part I emphasizes the active roles, social responsibilities, influence, and opportunities confronted the leaders and experts in all sectors and how government may facilitate these societal engagements, “Healthy by All”. The crucial sectors should include academia, NGO/NPO, industry/business, workplaces, healthcare systems, educational sectors, media and press, etc. Part II details on community spatial planning and architectural designs for healthy lifestyles. Part III proposes governmental “Health in All” infrastructure and mechanism.

Conclusions

We anticipate that the Guideline may draw out expertise and volunteering in all sectors of the society and help guide the public to take initiative in building such a culture of healthy-body-build and achieving this goal in all aspects of daily life.

Key messages

Emphasize on healthy body composition rather than body weight. Propagate 'Health by all' movement to foster building 'healthy physique' culture.

[The impact of metabolic syndrome and its individual components on long-term prognosis of patients undergoing percutaneous coronary intervention]

Objective: To investigate the impact of metabolic syndrome (MS) and its individual components on long-term prognosis of patients undergoing percutaneous coronary intervention(PCI). Methods: Patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided to two groups: with MS and without MS. The primary endpoint of 2-year follow-up was major adverse cardiovascular events (MACE), including death, myocardial infarction, and repeat revascularization. Results: Of the 10 422 PCI patients, there were 5 656 (54.27%) without MS and 4 766 (45.73%) with MS. Patients in the MS group were younger, tended to be male and had more comorbidities. There were no significant differences between the two groups in the proportion of drug-coated stents and the success rate of interventional therapy. The 2-year follow-up showed that the incidence of MACE in the MS group was significantly higher than that in the MS-free group (12.0% vs 10.0%, P<0.001), which was mainly due to the significantly higher revascularization rate in the MS group than in the non-MS group (9.5% vs 7.9%, P=0.003). Cox's regression analysis showed that MS was an independent risk factor for MACE. In MS component analysis, abnormal glucose metabolism was an independent risk factor for MACE events. Conclusions: Among the patients undergoing PCI, the incidence of MACE in patients with MS is significantly higher than that in patients without MS, and MS was an independent risk factor for MACE. In addition, hyperglycemia is an independent predictor for MACE.

Microbial diversity of representative traditional fermented sausages in different regions of China

AIMS

The purpose of this experiment was to study the bacterial diversity of traditional fermented sausages from four typical regions of China (Chengdu, Shenzhen, Changsha and Harbin) and to further evaluate their microbiological safety.

METHODS AND RESULTS

The diversity of the microbiota of the sausages was studied using the Illumina HiSeq platform. The results showed that compared with the highest diversity of fermented bacteria in Guangdong, the bacterial diversity of fermented sausage was the lowest in Sichuan. The percentage of dominant phylum (Firmicutes, Cyanophyta, Proteobacter) were 78·39, 13·13 and 7·14% in SC, 35·47, 30·36 and 28·04% in GD, 54·81, 28·91 and 14·00% in HN, 20·20, 58·16 and 17·31% in HB respectively. The main genus distribution of fermented sausages in different regions is varied, but lactic acid bacteria and cyanobacteria are generally the main ones. Traditional fermented sausages using natural fermentation methods have poor microbiological safety, and pathogenic and spoilage micro-organisms such as Acinetobacter, Brochothrix and Pseudomonas have been detected in all four regions.

CONCLUSIONS

The results in this paper provide a microbiota profile of four typical fermented sausages in China. There is a big difference in the microbiota of sausages in different regions, and the good flavour of traditional Chinese fermented sausage is related closely with the abundant microbial resources, however, the natural fermentation method also expose to the product security threats, including spoilage, pathogenic micro-organisms and biogenic amines, etc. SIGNIFICANCE AND IMPACT OF THE STUDY: The results would offer guidance for industrial fermented sausage production with certain flavour and also improve the microbial resource utilization, and contribute to the control of harmful micro-organisms in traditional fermented sausage.

[Prognostic factors of cyclosporine A combined with androgen in the treatment of transfusion dependent non-severe aplastic anemia]

目的

调查影响环孢素A（CsA）联合雄激素方案治疗输血依赖非重型再生障碍性贫血(TD-NSAA)获得血液学反应的因素。

方法

回顾性分析2010–2013年连续收治的77例TD-NSAA患者临床资料，单因素和多因素分析影响CsA联合雄激素治疗方案获得血液学反应患者的基线临床和血液学特征。

结果

77例TD-NSAA患者治疗后6个月和12个月获得血液学反应分别为43例（55.8％）和53例（68.8％），单因素分析基线血小板计数［19（6～61）×10⁹/L对13.5（5～45）×10⁹/L，P＝0.001］是影响6个月获得血液学反应的唯一因素；基线血小板计数［18（6～61）×10⁹/L对10.5（5～45）×10⁹/L，P<0.001］、网织红细胞绝对值［0.03（0.01～0.06）×10¹²/L对0.03（0.02～0.06）×10¹²/L，P＝0.043］、血小板输注依赖（P＝0.007）和红细胞及血小板输注依赖（P＝0.012）为治疗后12个月能否获得血液学反应相关因素。多因素分析显示基线血小板水平为获得血液学反应独立影响因素（P值分别为0.010和0.009）。受试者工作特征曲线（ROC曲线）方法显示基线PLT界值为15.5×10⁹/L。

结论

TD-NSAA患者初诊时较高的血小板基线水平、网织红细胞基线水平和不伴血小板输注依赖均提示预后较好，血小板水平≥15.5×10⁹/L时可以考虑采用CsA联合雄激素治疗。

[The differential diagnosis for novel coronavirus pneumonia and similar lung diseases in general hospitals]

Novel coronavirus pneumonia was a novel coronavirus infection that has dominated pulmonary infection since December 2019. The main manifestations were fever, dry cough, shortness of breath, normal or leukopenia in peripheral blood and changes in chest CT and in severe cases, multiple organ failure might occur. The National Health Commission, PRC has revised the consensus on diagnosis and treatment seven times in a short period of time, indicating the growing understanding of the disease. Patients with novel coronavirus pneumonia usually had history of travelling or living in the epidemic area including Wuhan within 14 days before onset, or have been exposed to patients who had fever or respiratory symptoms from the epidemic area, or had clustering diseases. However, novel coronavirus pneumonia was becoming more and more blurred after vanishing epidemic. The diagnosis and differential diagnosis of novel coronavirus pneumonia were challenges not only because of large number of tourists increasing dramatically after the relieving of epidemic, but also patients with other diseases from different areas to search for medical care. In this article, the clinical and chest imaging features of the novel coronavirus pneumonia were reviewed and compared with other infections and non-infectious diffuse pulmonary diseases. We try to find the similarities and differences among them, and to identify clues to the diagnosis of novel coronavirus pneumonia, so as to ensure accurate diagnosis and treatment.

[Associations between postprocedural D-dimer, hs-CRP, LDL-C levels and prognosis of acute myocardial infarction patients treated by percutaneous coronary intervention]

Objective: To investigate the association between postprocedural D-dimer, high sensitivity C-reactive protein(hs-CRP) and low-density lipoprotein-cholesterol(LDL-C) and outcomes of acute myocardial infarction (AMI) patients treated by percutaneous coronary intervention(PCI), in order to clarify the impacts of thrombotic, inflammatory and cholesterol risks on long-term prognosis. Methods: Patients with AMI who underwent emergency PCI from January 2010 to June 2017 in Fuwai Hospital with complete baseline data were enrolled. Patients were stratified into four groups according to quartiles of D-dimer, hs-CRP and LCL-C. Cox regression was used to analyze the relationship between these biomarkers and prognosis. Restricted cubic spline (RCS) was used to characterize the continuous association between risk of all-cause death and biomarkers. The primary outcome was all-cause death. Results: A total of 3 614 patients were included in the analysis. The age was (59.2±12.0) years old, and 2 845 (78.7%) were male and 3 161 (87.5%) patients were diagnosed as ST-segment elevation myocardial infarction. The follow-up time was 652 (414, 1 880) days. Survival analysis showed that postprocedural D-dimer and hs-CRP were significantly associated with all-cause mortality (all P<0.05). Cox regression with multiple adjustments showed that patients with D-dimer≥580 μg/L presented higher risk of all-cause death (HR=2.03, 95%CI 1.22-3.38, P=0.006), compared to patients with D-dimer<220 μg/L. RCS analysis showed that risk of all-cause death was stably high when D-dimer reached 500 μg/L. Multivariable Cox regression also showed that patients with hs-CRP<2.74 mg/L (HR=1.86, 95%CI 1.10-3.15, P=0.020)or hs-CRP≥11.99 mg/L (HR=2.14, 95%CI 1.35-3.40, P=0.001) presented higher mortality compared to patients whose hs-CRP was 2.74-7.18 mg/L. RCS analysis indicated a J-shaped relation between hs-CRP and mortality, as greater risk of death was observed when hs-CRP was lower than 2 mg/L or higher than 10 mg/L. LDL-C was not associated with outcomes (all P>0.05). Conclusions: Postprocedural D-dimer is significantly associated with long-term prognosis of AMI patients treated by PCI. Patients with extremely high or low levels of hs-CRP presents worse outcomes. Intensive and tailored antithrombotic or anti-inflammatory therapies should be considered for patients with increased thrombotic risk and those with extremely high or low inflammatory risk.

[Association between plasma HDL-C levels and coronary artery severity and impact on outcomes of patients underwent percutaneous coronary intervention]

Objective: To analyze the association between plasma high-density lipoprotein cholesterol (HDL-C) levels and the severity of coronary artery disease, and to evaluate the impact of HDL-C levels on long-term outcomes in patients underwent percutaneous coronary intervention (PCI). Methods: A total of 10 458 consecutive patients underwent PCI from January 2013 to December 2013 at Fuwai hospital were enrolled in this study. Patients were divided into three groups according to HDL-C tertiles: low HDL-C group (HDL-C≤0.89 mmol/L, n=3 525), median HDL-C group (HDL-C>0.89-1.11 mmol/L, n=3 570) and high HDL-C group (HDL-C>1.11 mmol/L, n=3 363). SYNTAX score was used to evaluate the severity of coronary artery disease, linear regression was used to analyze the relationship of HDL-C and SYNTAX score. Kaplan-Meier survival analysis was used to compare the outcomes among the three groups. Multivariate Cox regression was used to define the potential associations of HDL-C and outcomes. Results: The HDL-C level was (1.03±0.28) mmol/L and the SYNTAX score was 11.7±8.1. Patients were older, proportion of female, stable angina pectoris, successful PCI and left ventricular eject fraction value were higher, while incidence of diabetes mellitus was lower, hyperlipidemia, old myocardial infraction, smoking history and left main and three vessels disease were lower in high HDL-C group (all P<0.05). Patients in high HDL-C group also had the lowest SYNTAX score (12.2±8.4 vs. 11.7±8.1 vs. 11.2±7.8, P<0.001). Both univariate and multivariate linear regression analysis showed that HDL-C was negatively associated with SYNTAX score, e.g. Univariate analysis: β=-0.046, P<0.001; Multivariate analysis: β=-0.058, P=0.001. And 10 400 (99.4%) patients completed 2-year follow up. At 2-year follow-up, there were no difference in all-cause death, cardiac death, myocardial infarction, revascularization, stroke, major adverse cardiovascular and cerebral events (MACCE) and stent thrombosis among three groups (P for trend>0.05), while patient in high HDL-C group experienced the highest BARC type 2 bleeding events (P for trend=0.018). Multivariate Cox regression analysis showed that HDL-C level was not an independent risk factor of 2-year adverse ischemia events (P>0.05) and 2-year bleeding events (P>0.05). Conclusion: In patients underwent PCI, plasma HDL-C level is negatively associated with SYNTAX score, but not an independent risk factor of ischemic and bleeding events post PCI.

[Long-term outcomes of patients with ST-elevation myocardial infarction undergoing early versus late delayed percutaneous coronary intervention using drug-eluting stents]

Objective: To compare the long-term outcomes in ST-elevation myocardial infarction (STEMI) patients who underwent early or late delayed percutaneous coronary intervention (PCI) using drug-eluting stents (DES). Methods: This study was a retrospective, observational and single-center study. Consecutive STEMI patients (n=977), who admitted to Fuwai Hospital in 2013 and underwent successful selective PCI using drug-eluting stents (DES) within 3 to 35 days after symptom onset were enrolled and divided into the early delayed PCI (3-14 d) group (n=495) and the late delayed PCI (15-35 d) group (n=482). General clinical data of the patients and related data of coronary angiography and interventional therapy were collected, and the endpoint events were followed up. The primary endpoint was 2-year major adverse cardiac and cerebrovascular events (MACCE) including cardiac death, recurrent myocardial infarction, definite or probable stent thrombosis and ischemic stroke. The secondary endpoint was 2-year ischemia-driven target vessel revascularization. The incidence of endpoint events of the two groups was compared, and it was compared again after the primary baseline characteristics such as age and gender were matched by the propensity scoring method at a 1∶1 ratio. Results: A total of 910 (93.1%) patients who underwent delayed PCI were transferred from other hospitals, and 292 (29.9%) patients received thrombolysis before PCI. The time interval before PCI was 14 (10, 20) days. The incidence of 2-year MACCE (3.0%(15/495) vs. 2.3%(11/482), P=0.468) and ischemia-driven target vessel revascularization (3.8%(19/495) vs. 5.0%(24/482), P=0.385) were similar between the two groups. The incidence of 2-year MACCE (3.3%(15/453 vs. 2.4%(11/453), P=0.426) and ischemia-driven target vessel revascularization (4.2% (19/453) vs. 4.9%(22/453), P=0.632) were also similar between the two groups after matching propensity score. Conclusion: The long-term clinical outcomes after early delayed PCI using DES is statistically equivalent to those of late delayed PCI using DES for STEMI patients who missed the time window for emergency PCI.

[Research progress on health effects of aniline]

Aniline is one of the important chemical raw materials in daily life and the chemical industry. Aniline exposure might occur through intact skin, respiratory tract and digestive tract. It could pose negative impacts on many organs and systems of the human body, including toxicity or carcinogenicity to blood, liver, and spleen. This paper summarized the direct effects of aniline on human health and the indirect hazards of aniline on human health through environmental pollution and discussed the future research directions of aniline-induced health hazards.

[The role of human papillomavirus 16 early genes E2 and E6 and heterogeneous nuclear ribonucleoprotein E2 in cervical carcinogenesis and their interaction effect]

Objective: To investigate the role of human papillomavirus (HPV) 16 early genes E2 and E6 and heterogeneous nuclear ribonucleoprotein (hnRNP) E2 and their interaction effects in the progression of the cervical cancer. Methods: Women with normal cervix (NC), low cervical intraepithelial neoplasia (CIN Ⅰ) and high cervical intraepithelial neoplasia (CIN Ⅱ/Ⅲ) from the cervical lesions cohort in Jiexiu County of Shanxi Province from June 2014 to September 2014, and patients with cervical squamous cell carcinoma (SCC) treated at the Second Hospital of Shanxi Medical University in the same period were enrolled in this study. There were 257 participants, about 67 NC cases (26.07%), 69 CIN Ⅰ cases (26.85%), 68 CIN Ⅱ/Ⅲ cases (26.46%), and 53 SCC cases (20.62%), respectively. The information of demographic characteristics, life health habits and cervical lesions were collected by using the structured questionnaire. Cervical exfoliated cells and cervical biopsy tissues were collected to detect the infection of HPV16 and the protein expression levels of hnRNP E2, HPV16 E2 and E6. According to the median-value of the protein expression levels of hnRNP E2, HPV16 E2 and E6 and E2/E6 ratio in the NC group, the study participants were divided into the high and low expression groups/ratio groups. The multivariate logistic regression model was used to analyze the correlation between HPV16 early gene E2 and E6, hnRNP E2 and cervical cancer. The interaction effect was analyzed by using the generalized multifactor dimensionality reduction (GMDR) model. Results: The ages of NC, CIN Ⅰ, CIN Ⅱ/Ⅲ and SCC groups were (47.00±9.07), (47.64±7.35), (46.37±8.67) and (51.26±8.03) years old, respectively. The multivariate logistic regression model analysis showed that the HPV16 E2 low expression, E6 high expression and E2/E6 low ratio could increase the risk of CIN Ⅱ/Ⅲ, about OR (95%CI) values 11.11 (1.63-75.56), 8.00 (1.28-50.04), and 9.75 (1.22-77.72), respectively and SCC, about OR (95%CI) values 14.22 (2.11-95.88), 10.33 (1.67-64.00), and 12.38 (1.56-97.91), respectively. The hnRNP E2 low expression could increase the risk of CIN Ⅱ/Ⅲ and SCC, about OR (95%CI) values 3.35 (1.39-8.10) and 5.53 (1.54-19.88). The result of GMDR showed that there were interaction effects of the hnRNP E2 low expression, HPV16 E2 low expression and HPV16 E6 high expression in both CIN Ⅱ/Ⅲ and SCC groups. Conclusion: The HPV16 E2 low expression, HPV16 E6 high expression and hnRNP E2 low expression could increase the risk of high-grade cervical intraepithelial neoplasia and cervical cancer, and they might have an important interaction effect in the progression of the cervical cancer.

LncRNA XIST knockdown suppresses the malignancy of human nasopharyngeal carcinoma through XIST/miRNA-148a-3p/ADAM17 pathway in vitro and in vivo

BACKGROUND

Long non-coding RNA (lncRNA) X inactivate-specific transcript (XIST) has been verified as an oncogenic gene in human cancers, including nasopharyngeal carcinoma (NPC). However, the role of XIST in NPC remains to be largely uncovered, as well as its underlying mechanism.

METHODS

Expression of XIST, miR-148a-3p and ADAM17 was detected using qPCR and western blot assay. Cell proliferation and apoptosis assay were measured with MTT and flow cytometry, separately. Migration and invasion abilities were examined by transwell assays. Epithelial-mesenchymal transition (EMT) was assessed by western blot analyzing levels of E-cadherin, N-cadherin and vimentin. The potential binding between miR-148a-3p and XIST/ADAM17 was validated by luciferase reporter assay, Ago2-RNA immunoprecipitation and RNA pull-down assay. Xenograft experiments were conducted to measure tumor growth.

RESULTS

XIST was upregulated and miR-148a-3p was downregulated in NPC tissues and cell lines. Both XIST knockdown and miR-148a-3p overexpression promoted apoptosis, suppressed cell proliferation, migration, invasion, and EMT of NPC cells in vitro. In addition, miR-148a-3p was validated as a target of XIST, and silencing of miR-148a-3p could reverse XIST knockdown-mediated functions in SUNE-1 and CNE2 cells. Furthermore, miR-148a-3p was identified to target ADAM17, and ectopic expression of ADAM17 could abate miR-148a-3p-induced effects as well. Notably, ADAM17 was downregulated by XIST knockdown through upregulating miR-148a-3p. In vivo, XIST knockdown resulted in a slower tumor growth.

CONCLUSION

Knockdown of XIST suppresses the malignant progression of NPC cells through targeting miR-148a-3p/ADAM17 axis both in vitro and in vivo.

[Red blood cell lifespan detected by endogenous carbon monoxide breath test in patients with polycythemia vera]

Objective: To detect the red blood cell lifespan in patients with polycythemia vera (PV), and explore the influencing factors. Methods: From February 2017 to December 2018, 27 patients with PV at Blood Diseases Hospital, Chinese Academy of Medical Science and 18 normal controls were recruited. Red blood cell lifespan was detected by endogenous carbon monoxide (CO) breath test. The related factors were analyzed. Results: The average red blood cell lifespan of 27 PV patients was 80 (range, 35-120) days (d), which was significantly shorter than that of the normal controls [110.5(69-166) d, P<0.05], namely 35.3 d shorter. The red blood cell lifespan of ten newly diagnosed patients and 17 patients who were treated with hydroxyurea and/or interferon were 98 (35-117) d and 69 (45-120) d, respectively, which were both shorter than that of the normal control (P=0.010, 0.000). Correlation analysis showed that red blood cell lifespan of patients with newly diagnosed PV was associated with JAK2 mutation allele burden (r=0.900, P=0.037), peripheral blood lymphocyte count (r=-0.742, P=0.014) and the level of serum vitamin B(12) (r=-0.821, P=0.023). Conclusion: The lifespan of red blood cells in patients with PV is about one-third shorter than normal, and is related to JAK2 mutation allele burden, absolute lymphocyte count, and serum vitamin B(12) level.

Molecular cloning and functional characterisation of duck (Anas platyrhynchos) tumour necrosis factor receptor-associated factor 3

1. Tumour necrosis factor receptor-associated factor 3 (TRAF3) is a key regulator of innate immunity and acquired immunity, and has a salient anti-viral role. 2. In this experiment, the duck TRAF3 (DuTRAF3) gene was cloned according to the Anas platyrhynchos TRAF3 sequence to explore its function. The TRAF3 open reading frame contains 1704 bp that encode a protein of 567 amino acids, which contain a RING finger domain, two zinc finger motifs, a coiled-coil region, and a MATH domain. 3. Reverse transcription-polymerase chain reaction showed that DuTRAF3 was expressed in all the examined tissues, with a comparatively higher expression in the spleen and brain tissues. 4. In HEK293T cells, DuTRAF3 overexpression resulted in a significantly increased NF-κB activity and interferon (IFN)-β promoter activation. 5. Following resiquimod (R848) and poly(I:C) stimulation of duck peripheral blood mononuclear cells (PBMCs), the expressions of TRAF3 and IFN-β were significantly upregulated; in addition, following R848 stimulation, the mRNA levels of IL-6, IL-8 and IL-10 were also significantly upregulated. After infection with the Newcastle Disease Virus LaSota vaccine strain, the mRNA levels of IL-6 and IL-10 were significantly upregulated, while that of TRAF3 was downregulated. 6. These results suggest that DuTRAF3 has an important role to play in innate antiviral immune responses.

[Clinical experience in the diagnosis and treatment of aortic stenosis caused by Takayasu arteritis in pediatric patients]

Objective: To analyze the clinical features and summarize the experience on the diagnosis and treatment of aortic stenosis caused by Takayasu arteritis in pediatric patients. Methods: This study was a retrospective study. Five pediatric patients diagnosed as aortic stenosis caused by Takayasu arteritis in Fuwai Hospital of Chinese Academy of Medical Sciences from January 2016 to August 2018 were included. The clinical features, methods of examination, treatment and outcome were analyzed. Results: There were 2 male and 3 female patients in this cohort. The age of onset ranged from 10 to 13 years. The main clinical symptoms were as follows: intermittent claudication and hypertension (5 patients), heart failure (3 patients). Three patients with heart failure were misdiagnosed with dilated cardiomyopathy in other hospitals. Except 1 patient died due to disease aggravation before operation, the other 4 patients received interventional therapy for severe heart failure or refractory hypertension on the basis of hormone anti-inflammatory treatment, including 2 patients treated with aortic balloon dilatation and 2 patients treated with aortic balloon dilatation and stent implantation. In post-operational follow-up, clinical symptoms and laboratory examination values of the 4 patients treated with interventional therapy were significantly improved. Conclusions: The clinical symptoms of pediatric patients with aortic stenosis caused by Takayasu arteritis mainly present with intermittent claudication, hypertension and heart failure. Aortic intervention strategy should be applied for pediatric patients with severe heart failure or refractory hypertension as early as possible.

P819Post-procedural cholesterol and inflammatory risk in acute myocardial infarction patients undergoing percutaneous coronary intervention

Objective

This study sought to depict the combined association of post-procedural cholesterol and inflammatory risk with clinical outcomes among acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) and pick out patients with highest comprehensive risk.

Methods

A total of 4802 AMI-PCI patients were divided into quartiles according to post-procedural low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP) level respectively and in combinations for risk analysis. Univariate and adjusted multivariate analysis with Cox model were performed. Hazard ratio (HR) for short-term (90 days) and long-term (1 year) were compared for major adverse cardiovascular events (MACE), including cardiac death, recurrent myocardial infarction and ischemic stroke.

Results

A significant change in the hazards of 90-day MACE was seen among patients in the highest quartile of post-procedural LDL-C [HR: 0.526 (0.291, 0.951), p=0.034] and highest quartile of CRP [HR: 2.119 (1.150, 3.920), p=0.016]. For 1-year outcomes, only a trend for increasing risk was seen in patients with higher post-procedural CRP (p-trend = 0.016). Combination analysis for cholesterol/inflammatory risk showed that patients lying simultaneously in the lowest quartile of LDL-C and highest quartile of CRP gained the highest risk in the 90-day [HR: 3.16 (1.124, 8.886), p=0.029] and 1-year [HR: 2.515 (1.153, 5.486), p=0.020] follow up.

Hazard ratios (HR) for short-term (90 days) and long-term (1 year) primary outcomes according to cholesterol and inflammatory risk 90 days 1 year Type of risk Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend LDL, mmol/L   Quartile 2 0.742 (0.441, 1,248) 0.260 0.663 (0.390, 1.125) 0.128 0.033 0.722 (0.364, 1.125) 0.150 0.683 (0.435, 1.072) 0.097 0.251   Quartile 3 0.653 (0.381, 1.121) 0.122 0.597 (0.344, 1.038) 0.068 0.850 (0.557, 1.229) 0.453 0.850 (0.550, 1.312) 0.462   Quartile 4 0.517 (0.288, 0.928) 0.027 0.526 (0.291, 0.951) 0.034 0.673 (0.427, 1.061) 0.088 0.708 (0.444, 1.131) 0.149 CRP, mg/L   Quartile 2 1.365 (0.717, 2.599) 0.334 1.295 (0.654, 2.522) 0.448 0.007 1.063 (0.656, 1.722) 0.805 0.998 (0.608, 1.636) 0.992 0.016   Quartile 3 1.306 (0.681, 2.502) 0.442 1.279 (0.654, 2.499) 0.472 0.999 (0.612, 1.630) 0.996 0.968 (0.586, 1.597) 0.897   Quartile 4 2.354 (1.312, 4.221) 0.004 2.119 (1.150, 3.920) 0.016 1.657 (1.069, 2.570) 0.024 1.528 (0.967, 2.413) 0.069 Multivariate analysis was adjusted for age, sex and traditional cardiovascular risk factors.

Combined cholesterol/inflammatory risk

Conclusion

AMI-PCI patients with lower post-procedural LDL-C and higher CRP might encounter greater cardiovascular risk. Patients with the lowest LDL-C and highest CRP gained extremely high risk and required special attention.

P5314Albumin is a prognostic marker of long-term outcomes in patients with triple-vessel coronary artery Disease: a large data from China

Background

Hypoalbuminemia was reported to be associated with poor prognosis in severe diseases. Triple-vessel coronary artery disease (TVD) has high risk of death. We aimed to evaluate the predictive value of hypoalbuminemia in TVD patients.

Methods

A total of 8,943 consecutive TVD patients were enrolled from April 2004 to February 2011. The primary endpoint was all-cause death and the secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE; a composite of all-cause death, myocardial infarction or stroke). Patients were divided into two groups according to normal serum albumin level (<4.0 g/dL and ≥4.0 g/dL).

Results

During the median of follow-up 7.5 years, 1365 deaths and 2354 MACCE occurred. Multivariate Cox regression indicated that hypoalbuminaemia (<4.0 g/dL) was an independent predictor of all-cause death (HR 1.30, 95% CI 1.14–1.50, P<0.001) and MACCE (HR 1.19, 95% CI 1.07–1.32, P<0.001). Adjustment of the all-cause death risk estimated by albumin improved the predictive value of SYNTAX score (AUC from 0.585 to 0.602, P=0.002; IDI=0.005, P<0.001; NRI=0.205, P<0.001). For SYNTAX II score, improvement was shown for NRI and IDI but not for AUC (SYNTAX II for PCI: IDI=0.003, P<0.001; NRI=0.205, P<0.001; AUC from 0.711 to 0.713, P=0.257; SYNTAX II for CABG: IDI=0.002, P<0.001; NRI=0.205, P<0.001; AUC from 0.696 to 0.698, P=0.120).

Predictive value for all-cause death using the AUC, NRI and IDI AUC (95% CI) P value NRI (95% CI) P value IDI (95% CI) P value SYNTAX 0.585 (0.568–0.602) Ref. Ref. – Ref. – SYNTAX + albumin 0.602 (0.586–0.619) 0.002 0.205 (0.145–0.264) <0.001 0.005 (0.004–0.007) <0.001 SYNTAX II (for PCI) 0.711 (0.696–0.726) Ref. Ref. – Ref. – SYNTAX II (for PCI) + albumin 0.713 (0.698–0.728) 0.257 0.205 (0.145–0.264) <0.001 0.003 (0.001–0.004) <0.001 SYNTAX II (for CABG) 0.696 (0.680–0.711) Ref. Ref. – Ref. – SYNTAX II (for CABG) + albumin 0.698 (0.683–0.714) 0.120 0.205 (0.145–0.264) <0.001 0.002 (0.001–0.004) <0.001

Multi-factor adjusted KM analysis in TVD

Conclusions

For TVD patients, hypoalbuminaemia was a strong independent prognostic factor for long-term outcomes of death and MACCE. Albumin improved the prediction of death with the SYNTAX score and the SYNTAX II score.

Acknowledgement/Funding

CAMS Innovation Fund for Medical Sciences (2016-I2M-1-002), Beijing Natural Science Foundation (7181008)