Exploration of restless legs syndrome under the new concept: A review

Restless leg syndrome (Restless legs syndrome, RLS) is a common neurological disorder. The pathogenesis of RLS remains unknown, and recent pathophysiological developments have shown the contribution of various genetic markers, neurotransmitter dysfunction, and iron deficiency to the disease, as well as other unidentified contributing mechanisms, particularly chronic renal dysfunction. RLS enhancement syndrome is frequently observed in patients with RLS who have received long-term dopamine agonist therapy, manifesting as a worsening of RLS symptoms, usually associated with an increase in the dose of dopamine agonist. Some patients with RLS can adequately control their symptoms with non-pharmacological measures such as massage and warm baths. First-line treatment options include iron supplementation for those with evidence of reduced iron stores, or gabapentin or pregabalin, as well as dopamine agonists, such as pramipexole. Second-line therapies include opioids such as tramadol. RLS seriously affects the quality of life of patients, and because its pathogenesis is unclear, more biological evidence and treatment methods need to be explored.

Hypoxia-induced upregulation of matrix metalloproteinase 9 increases basement membrane degradation by downregulating collagen type IV alpha 1 chain

Hypoxia can cause basement membrane (BM) degradation in tissues. Matrix metalloproteinase 9 (MMP-9) is involved in various human cancers as well as BM degradation by downregulating type IV collagen (COL4). This study investigated the role of MMP-9 in hypoxia-mediated BM degradation in rat bone marrow based on its regulation of collagen type IV alpha 1 chain (COL4A1). Eighty male rats were randomly divided into four groups based on exposure to hypoxic conditions at a simulated altitude of 7,000 m, control (normoxia) and 3, 7, and 10 days of hypoxia exposure. BM degradation in bone marrow was determined by transmission electron microscopy. MMP-9 levels were assessed by western blot and real-time PCR, and COL4A1 levels were assessed by western blot and immunohistochemistry. Microvessels BMs in bone marrow exposed to acute hypoxia were observed by electron microscopy. MMP-9 expression increased, COL4A1 protein expression decreased, and BM degradation occurred in the 10-, 7-, and 3-day hypoxia groups compared with that in the control group (all P < 0.05). Hypoxia increased MMP-9 levels, which in turn downregulated COL4A1, thereby increasing BM degradation. MMP-9 upregulation significantly promoted BM degradation and COL4A1 downregulation. Our results suggest that MMP-9 is related to acute hypoxia-induced BM degradation in bone marrow by regulating COL4A1.

Treatment of Alzheimer's disease by combination of acupuncture and Chinese medicine based on pathophysiological mechanism: A review

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by neurodegeneration, nerve loss, neurofibrillary tangles, and Aβ plaques. In modern medical science, there has been a serious obstacle to the effective treatment of AD. At present, there is no clinically proven and effective western medicine treatment for AD. The reason is that the etiology of AD is not yet fully understood. In 2018, the international community put forward a purely biological definition of AD, but soon this view of biomarkers was widely questioned, because the so-called AD biomarkers are shared with other neurological diseases, the diagnostic accuracy is low, and they face various challenges in the process of clinical diagnosis and treatment. Nowadays, scholars increasingly regard AD as the result of multimechanism and multicenter interaction. Because there is no exact Western medicine treatment for AD, the times call for the comprehensive treatment of AD in traditional Chinese medicine (TCM). AD belongs to the category of "dull disease" in TCM. For thousands of years, TCM has accumulated a lot of relevant treatment experience in the process of diagnosis and treatment. TCM, acupuncture, and the combination of acupuncture and medicine all play an important role in the treatment of AD. Based on the research progress of modern medicine on the pathophysiology of AD, this paper discusses the treatment of this disease with the combination of acupuncture and medicine.

TCM syndrome differentiation and treatment of narcolepsy based on neurobiological mechanism: A review

Narcolepsy is a relatively rare brain disorder caused by the selective loss of orexin neurons. Narcolepsy is divided into Narcolepsy Type 1 (NT1) and Narcolepsis Type 2 (NT2). The pathogenesis of NT1 has been well established due to the severe loss of orexin neurons, while NT2 is still poorly understood, and little is known about its underlying neurobiological mechanisms. human leukocyte antigen alleles have been found to strongly influence the development of narcolepsy, with more than 90% of NT1 patients carrying the human leukocyte antigen II allele DQB1*06:02. In addition to the genetic evidence for the DQBI*06:02 allele, some other evidence suggests that a T cell-mediated immune mechanism destroys the orexin neurons of NT1, with CD4 + T cells being key. For this disease, traditional Chinese medicine (TCM) therapy has its own characteristics and advantages, especially the combination of acupuncture and medicine in the treatment of this disease in TCM, which has made considerable and gratifying progress. The purpose of this review is to introduce the frontier progress of neurobiology of narcolepsy, and to explore the syndrome differentiation and treatment of narcolepsy with the combined use of TCM and Western medicine combined with TCM.

MicroRNA-506 ameliorates breast cancer-induced osteolytic bone metastasis via the NFATc-1 signaling pathway

Breast cancer is becoming a common life-threatening disease, especially in women, along with higher incidence and mortality. MicroRNA (miR)-506 was reported to participate in breast cancer progression, while the role of miR-506 in breast cancer-induced osteolytic bone metastasis is unclear. In the present study, we found significant downregulation of miR-506 in breast cancer tissues and cell lines. Overexpression of miR-506 notably reduced the proliferative, migratory and invasive rates of MCF7 and MDA-MB-231 cells, and reduced the production of inflammatory factors IL-6 and TNF-α in MCF7 cells. Moreover, overexpression of miR-506 obviously inhibited tumor growth in an in vivo animal model. In addition, overexpression of miR-560 efficiently attenuated breast cancer-induced osteolysis in vivo, which was characterized by increased bone volume/total volume (BT/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th), as well as the reduced trabecular separation (Tb. Sp). The nuclear factor of activated T cell cytoplasmic 1 (NFATc1) was identified as a downstream target of miR-506, and overexpression of miR-506 could inhibit breast cancer progression by targeting NFATc1. Furthermore, our results showed that NFATc-1 might participate in the inhibition of miR-506 on breast cancer-induced osteolysis. In conclusion, our findings provide insights into understanding the pathogenesis of breast cancer and breast cancer-induced osteolytic bone metastasis, and miR-506 might serve as a novel biomarker for this disease.

[Safety and efficacy of dual guiding catheter kissing technique in the treatment of stent partially dislodgement in coronary artery]

Objective: To investigate the safety and efficacy of dual guiding catheter kissing technique (DCK) in the treatment of stent partly dislodgement in coronary artery. Methods: The study retrospectively involved 6 hospitalized patients with coronary artery stent partly dislodgement during PCI at The First Affiliated Hospital of Zhengzhou University from February 2016 to June 2019, DCK was used in these patients. We observe the success rate of stent retrieval, success rate of PCI, incidence of complications and major adverse cardiovascular events in 1 year follow up. Results: 6 patients were involved, of which 3 are male, ages range 49 to 68 years old, 4 patients are diagnosed with unstable angina, the other two are stable angina. All the partially disloged stents in the 6 patients were successfully removed from coronary artery. Except for 1 patient who refused coronary artery stenting again, the other 5 patients were successfully implanted coronary artery stenting. No serious complications occurred, no patients died and no major adverse cardiovascular events happened during 1 year follow up. Conclusions: DCK is safe and effective to remove partially dislodged stent in coronary artery.

[Consistency evaluation between patient-completed and physician-completed Caprini scores]

Objective: To evaluate the consistency of patient-completed and physician-completed Caprini scores. Methods: This study was a diagnostic study. We prospectively recruited 200 inpatients (including respiratory and critical care medicine, rheumatology and immunology, obstetrics and gynecology, and orthopedics). Clinical data of the recruited patients were collected. The Wechat applet was developed based on the Chinese version of the patient-completed Caprini score. Patient could enter the Wechat applet by scanning the QR code, and enter the height, weight and other contents to the Wechat applet. The applet could automatically calculate the score and make the risk stratification according to total score. At the same time, physicians would calculate the traditional Caprini score for the same patient and make risk stratification to evaluate the consistency of scores derived from the two methods. Results: The average age of these 200 patients was (59.6±13.9) years, 112(56.0%) of them were female and 184(92.0%) with high school education or above. There was no significant difference between the patient-completed and physician-completed scores (4.8±2.5 vs. 4.7±2.5,P=0.336). The time of physician-completed score was shorter than that of patient-completed score ((2.0±1.0) minutes vs.(2.4±1.2) minutes, P<0.000 1). There was no significant difference on the number of high-highest venous thromboembolism risk patients assessed by the patient-completed and the physician-completed scores: 84.5% (169/200) vs. 83.0%(166/200)(χ²=0.165, P=0.684).There was strong positive correlations between patient-completed and physician-completed scores (r=0.98, P<0.000 1). Cohen's ĸ evaluation showed that the patient-completed Caprini score was in excellent consistency with physician-completed Caprini score(κ=0.97,P<0.000 1). The result of Bland Altman method showed that only 3.0% (6/200) of the scores biased greatly, which was not within the 95% confidence interval, the result proved that the bias belonged to a small probability event. It was inferred that the scores of patient-completed were consistent with those of the physician-completed. Conclusions: The patient-completed Caprini score is in good agreement with the physician-completed Caprini score in this patient cohort.

[Application and Inspiration of Information System used in National Health and Nutrition Examination Survey of America]

The National Health and Nutrition Examination Survey (NHANES) of America has been running for more than 60 years and has achieved many significant achievements with international influence. The application of modern information technologies in NHANES provides a supplementary tool for the project's high quality and refined implementation. This paper introduces the information system of NHANES from seven aspects: project management, survey participant interview, physical examination, laboratory examination, field follow-up, data sharing, and social services. The construction and application prospects of the China National Health Survey Information System, suitable for China's native conditions, are also discussed in this article.

Rule extraction from biased random forest and fuzzy support vector machine for early diagnosis of diabetes

Due to concealed initial symptoms, many diabetic patients are not diagnosed in time, which delays treatment. Machine learning methods have been applied to increase the diagnosis rate, but most of them are black boxes lacking interpretability. Rule extraction is usually used to turn on the black box. As the number of diabetic patients is far less than that of healthy people, the rules obtained by the existing rule extraction methods tend to identify healthy people rather than diabetic patients. To address the problem, a method for extracting reduced rules based on biased random forest and fuzzy support vector machine is proposed. Biased random forest uses the k-nearest neighbor (k-NN) algorithm to identify critical samples and generates more trees that tend to diagnose diabetes based on critical samples to improve the tendency of the generated rules for diabetic patients. In addition, the conditions and rules are reduced based on the error rate and coverage rate to enhance interpretability. Experiments on the Diabetes Medical Examination Data collected by Beijing Hospital (DMED-BH) dataset demonstrate that the proposed approach has outstanding results (MCC = 0.8802) when the rules are similar in number. Moreover, experiments on the Pima Indian Diabetes (PID) and China Health and Nutrition Survey (CHNS) datasets prove the generalization of the proposed method.

AB0144 PD-1 DEFICIENCY IN THE REGULATORY T CELL MAY BE INVOLVED IN THE PATHOGENESIS IN TAKAYASU’S ARTERITIS

Background

Regulatory T cell (Treg cell) has been demonstrated decreased in peripheral blood of TAK patients in recent researches. PD-1 may regulate Treg cell differentiation and apoptosis as an important checkpoint molecule.

Objectives

This study aims to investigate whether PD-1 is involved in the abnormal of Treg cell in TAK.

Methods

This study enrolled 49 patients with TAK and 23 healthy controls. Treg cell related serum cytokines IL-10, IL-7, IL-2 and IL-15, as well as serum chemokines CCL2, CCL3 and CXCL10 were detected using cytokine cytometric bead array. The expression of PD-1 in CD4+Foxp3- T cells and Treg cells were analyzed by flow cytometry analysis in 15 patients with TAK and 18 healthy controls.

Results

Mean fluorescence intensity of PD-1 in CD4+PD-1+ cells decreased in TAK patients [72.2 (45.8, 84.7) vs. 363.00(335, 431), P = 0.000]. The frequency of CD4+Foxp3-PD-1+ cells in CD4+T cells decreased in peripheral blood（9.05 ± 1.06% vs. 12.61 ± 1.17%，P = 0.034）of TAK patients. The percentage of CD4+CD25+Foxp3+PD-1+ cells in CD4+CD25+T cells（0.40 ± 0.05% vs. 0.63 ± 0.09%，P = 0.047）is lower in TAK patients than healthy controls. Higher serum levels of IL-10[4.84（0.07,409.57）vs.3.16（0,69.15）, P = 0.004] and IL-7[10.05（2.68,227.2）vs. 7.4（2.68,16.77）, P = 0.014] level were observed in TAK patients. Compared to healthy controls, serum CCL2[30.64（0，686.84）vs. 10.31（0，32.92），P = 0.000] and CCL3[3.01(0.69,19.24)vs.1.84（0.87，4.6），P = 0.000] increased obviously.

Conclusion

The frequency of CD4+Foxp3-PD-1+/CD4+T cells and CD4+CD25+Foxp3+PD-1+/CD4+CD25+T cells decreased. This study suggested that PD-1 may contribute to the imbalance of regulatory T cell in TAK.

References

[1]Tombetti E, Mason JC. Takayasu arteritis: advanced understanding is leading to new horizons. Rheumatology (Oxford). 2019;58(2):206–219.

[2]Gao N, Cui W, Zhao LM, Li TT, Zhang JH, Pan LL. Contribution of Th2-like Treg cells to the pathogenesis of Takayasu’s arteritis. Clin Exp Rheumatol. 2020; 38 Suppl 124(2):48-54.

[3]Patsoukis N, Wang Q, Strauss L, Boussiotis VA. Revisiting the PD-1 pathway. Sci Adv. 2020;6(38):eabd2712.

[4]Zhang S, Wang L, Li M, Zhang F, Zeng X. The PD-1/PD-L pathway in rheumatic diseases. J Formos Med Assoc. 2021;120(1):48-59.

[5]Le Burel S, Champiat S, Routier E, Aspeslagh S, Albiges L, Szwebel TA, et al. Onset of connective tissue disease following anti-PD1/PD-L1 cancer immunotherapy. Ann Rheum Dis. 2018;77(3):468–470.

[6]Daxini A, Cronin K, Sreih AG. Vasculitis associated with immune checkpoint inhibitors-a systematic review. Clin Rheumatol. 2018;37(9):2579–2584.

[7]Zhang H, Watanabe R, Berry GJ, Vaglio A, Liao YJ, Warrington KJ, et al. Immunoinhibitory checkpoint deficiency in medium and large vessel vasculitis. Proc Natl Acad Sci U S A. 2017;114(6):E970–E979.

[8]Kermani TA. Takayasu arteritis and giant cell arteritis: are they a spectrum of the same disease? Int J Rheum Dis. 2019;22 Suppl 1:41–48.

[9]Kong X, Sun Y, Ma L, Chen H, Wei L, Wu W, et al. The critical role of IL-6 in the pathogenesis of Takayasu arteritis. Clin Exp Rheumatol. 2016;34(3 Suppl 97):S21–S27.

[10]Samson M, Bonnotte B. Pathogenesis of large vessel vasculitis. Rev Med Interne. 2016;37(4):264–273.

[11]Rosenzwajg M, Lorenzon R, Cacoub P, Pham HP, Pitoiset F, El Soufi K, et al. Immunological and clinical effects of low-dose interleukin-2 across 11 autoimmune diseases in a single, open clinical trial. Ann Rheum Dis. 2019;78(2):209–217.

[12]Saraiva M, Vieira P, O’Garra A. Biology and therapeutic potential of interleukin-10. J Exp Med. 2020;6;217(1):e20190418.

[13]Barata JT, Durum SK, Seddon B. Flip the coin: IL-7 and IL-7R in health and disease. Nat Immunol. 2019;20(12):1584-1593.

[14]Luo CT, Liao W, Dadi S, Toure A, Li MO. Graded Foxo1 activity in Treg cells differentiates tumour immunity from spontaneous autoimmunity. Nature. 2016;28;529(7587):532-6.

[15]Postow MA, Sidlow R, Hellmann MD. Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med. 2018;378(2):158–168. doi:10.1056/NEJMra1703481.

Disclosure of Interests

None declared

POS0724 RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A MULTI-CENTER, RETROSPECTIVE, COHORT STUDY

Background

Coronary artery disease (CAD) not only has an increased prevalence but also is a major cause of premature mortality in systemic lupus erythematosus (SLE) [1, 2]. However, information is limited regarding the risk factors for CAD in Chinese patients with SLE.

Objectives

To assess the risk factors for CAD in Chinese patients with SLE.

Methods

This multi-center, retrospective, cohort study included 3778 consecutive SLE patients, with CAD (CAD group) or without a medical history of CAD (control group). CAD was defined as a coronary stenosis ≥50% in any major epicardial coronary vessel detected by coronary angiography or a history of myocardial infarction confirmed by medical records. General parameters, clinical features, laboratory tests and medical therapies were compared between groups, and the risk factors for CAD in SLE were analyzed by logistic regression analysis.

Results

The age at baseline was older, male ratio was higher and body mass index was greater in CAD group (all P<0.001). Traditional CAD risk factors including diabetes mellitus, hypertension, dyslipidemia, family history of CAD and smoking were more common in CAD group (all P<0.001) (Figure 1). SLE Disease Activity Index 2000 was greater (P=0.012), hyperuricemia and elevated C-reactive protein (CRP) were more prevalent (both P<0.001), and an increased corticosteroids’ usage (P=0.018) was detected in CAD group (Table 1). Binary logistic regression analysis showed hyperuricemia (odds ratio: 3.082, 95% confidence interval: 1.283-7.403; P=0.012) and CRP (odds ratio: 7.248, 95% confidence interval: 2.931-17.925; P<0.001) were independent risk factors for CAD in SLE patients.

Table 1.

Comparison of clinical features in SLE patients between CAD group and control group.

ParametersControl group (n=3732)CAD group (n=46)PAge at baseline [years, median (P25, P75)]35.00 (29.00, 45.00)59.50 (50.25, 67.75)<0.001Male, n (%)296 (7.94)11 (23.91)<0.001Disease duration [years, median (P25, P75)]8.00 (4.00, 12.00)10.00 (4.00, 19.00)0.173Body mass index [kg/m2, median (P25, P75)]21.77 (19.63, 24.16)23.50 (22.09, 25.36)<0.001Renal disorder, n (%)1737 (46.57)9 (19.57)<0.001Neurologic disorder, n (%)595 (15.95)3 (6.52)0.082Thrombocytopenia, n (%)859 (23.03)8 (17.39)0.366SLEDAI-2K [median (P25, P75)]3.00 (0.00, 8.00)5.50 (1.50, 14.00)0.012Elevated creatinine, n (%)295 (7.91)10 (21.74)0.002Hyperuricemia, n (%)209 (5.60)16 (34.78)<0.001Elevated ESR, n (%)951 (25.5)22 (47.83)0.001Elevated CRP, n (%)210 (5.63)15 (32.61)<0.001Positive aPL, n (%)734 (19.68)11 (23.91)0.474Corticosteroids, n (%)2752 (73.78)41 (89.13)0.018Immunosuppressants, n (%)2950(79.09)37 (80.43)0.823

Abbreviations: aPL, antiphospholipid antibody; CAD, coronary artery disease; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; SLE, systemic lupus erythematosus; SLEDAI-2K, SLE Disease Activity Index 2000. P <0.05 are shown as italics and bold.

Figure 1.

Comparison of traditional risk factors in SLE patients between CAD group and control group. Abbreviations: CAD, coronary artery disease; SLE, systemic lupus erythematosus. All P<0.001.

Conclusion

Hyperuricemia and CRP are independent risk factors for CAD in SLE patients. This study highlights the association between hyperuricemia, CRP and CAD burden in SLE, and might provide a modifiable perspective on improving SLE outcomes.

References

[1]Gonzalez LA, Alarcon GS. The evolving concept of SLE comorbidities [J]. Expert Rev Clin Immunol, 2017, 13(8): 753-768.

[2]Kostopoulou M, Nikolopoulos D, Parodis I, et al. Cardiovascular Disease in Systemic Lupus Erythematosus: Recent Data on Epidemiology, Risk Factors and Prevention [J]. Curr Vasc Pharmacol, 2020, 18(6): 549-565.

Disclosure of Interests

None declared

AB0598 ASSOCIATION OF PROLONGED DISEASE DURATION AND TG/HDL-C RATIO IN ACCELERATING ATHEROSCLEROSIS IN PATIENTS WITH TAKAYASU’S ARTERITIS

Background

Takayasu’s arteritis (TA) is an autoimmune vasculitis that frequently occur in young women.Multiple previous studies have demonstrated that accelerated atherosclerotic changes were commonly found in TA patients[1-4].More specifically, data indicated that as much as 27% of all TA patients developed carotid artery plaque, while which was only 2% in the age- and sex-matched healthy individuals[1]. In addition, up to 20% of TA patients developed stroke and/or transient ischemic attack(TIA), which both have been known to be associated with atherosclerotic lesions[1-3]. Inflammation of the vascular wall may promotes atherosclerosis (As) in TA,which accelerates the development of As.Higher triglyceride (TG)/HDL-C ratio was found to be associated with presence of endothelial dysfunction and As[5].

Objectives

This study aimed to identify the risk factors associated with the development of atherosclerosis in TA.

Methods

This retrospective study enrolled a total of 101 TA patients. All patients were divided into two groups according to the absence or presence of atherosclerosis(43 vs 58). Baseline demographic features and clinical characteristics were compared between two groups. A logistic model was applied to determine the risk factors associated with the development of atherosclerosis.

Results

Our data suggested that the disease duration of patients in the atherosclerosis group was significantly longer than that of patients in the non-atherosclerosis group [96(18.00,180.00) vs 48.00(12.00,111.00) months] (p=0.015). In addition, the average age of patients with atherosclerosis was significantly older compared to patients without atherosclerosis [44.00（38.00，48.00）vs 28.50（24.00，37.00）years] (p<0.001). Logistic regression analysis showed that the risk of developing atherosclerosis increased by 9.2% per 1 year increase in thedisease duration(p=0.005, OR 1.092,95%CI:1.027-1.162).Patients with TG/HDL-C ratio more than 0.8875 were associated with a 5.861fold increase of risk developing atherosclerosis(p<0.001, 95%CI:2.299-14.939).

Conclusion

Our study indicated that prolonged disease duration and elevated TG/HDL-C ratio are associated with the development of atherosclerosis in TA patients.

References

[1]Seyahi E, Ugurlu S, Cumali R, Balci H, Seyahi N, Yurdakul S, et al. Atherosclerosis in Takayasu arteritis. Ann Rheum Dis. 2006;65(9):1202-7.

[2]Numano F, Okawara M, Inomata H, Kobayashi Y. Takayasu’s arteritis. Lancet. 2000;356(9234):1023-5.

[3]Park KC, Kim JH, Yoon SS, Heo SH. Takayasu’s disease presenting with atherothrombotic ischaemic stroke. Neurol Sci. 2008;29(5):363-6.

[4]Seyahi E, Ucgul A, Cebi Olgun D, Ugurlu S, Akman C, Tutar O, et al. Aortic and coronary calcifications in Takayasu arteritis. Semin Arthritis Rheum. 2013;43(1):96-104.

[5]Keles N, Aksu F, Aciksari G, et al. Is triglyceride/HDL ratio a reliable screening test for assessment of atherosclerotic risk in patients with chronic inflammatory disease?:[J]. Northern Clinics of Istanbul, 2016, 3(1):39-45.

Figure 1.

Disclosure of Interests

None declared

AB0600 ANALYSIS OF RISK FACTORS AND PROGNOSIS IN PATIENTS OF TAKAYASU’S ARTERITIS WITH CORONARY ARTERY LESIONS

Background

Takayasu’s arteritis（TA）can involve coronary artery lesions. The pathogenesis is complex and lacks the best treatment strategy.The coronary artery lesions were typical seen in the ostia of the left and right coronary arteries which were major risk factors for sudden death and ischemia heart failure[1-2].Coronary artery lesions is an important predictor of poor prognosis in TA patients.The incidences of coronary artery lesions were more common in type V TA patients [3-4].The prevalence of metabolic syndrome and its related characteristics (including dyslipidemia, diabetes and hyperinsulinemia) in TA patients are higher compared with healthy people[5].Thus，under the action of vascular inflammation and traditional risk factors, coronary artery stenosis or even occlusion occurs earlier, which can lead to MACE events.

Objectives

The aim of our study is to investigate the risk factors and prognosis of coronary artery lesions in TA patients.

Methods

This retrospective study enrolled a total of 120 TA patients.All patients were divided into two groups according to the absence or presence of coronary artery lesions in TA patients (61 vs 59). A logistic model was applied to determine the risk factors associated with the incidence of coronary artery lesions in TA patients.According to the before and after imaging comparison of TA with coronary artery lesions, the influencing factors of improving TA with coronary artery lesions were analyzed.

Results

The incidence of coronary artery lesions in TA patients increased by 1.618 times for each additional year (p=0.034, OR1.618,95%CI: 1.036-2.529). History of hyperlipidemia indicated 10.124 fold higher risk of coronary artery lesions in TA patients(p=0.003, OR10.124,95%CI: 2.159-47.483).In the follow-up of TA with coronary artery lesions, 27 patients had coronary CTA results before and after comparison. It was found that 11 patients had remission of coronary artery lesions and 16 patients had no remission of coronary artery lesions. The age in the group with improved coronary imaging was significantly younger than that in the group without improved coronary imaging[（39.00±9.81 vs (47.44±10.06) years,p=0.041)].TNF-α and interleukin-6 were significantly higher in the group with improved coronary imaging than in the group without improved coronary imaging[（26.40(10.08，165.90) vs 7.80(6.73，21.70)pg/dl,p=0.047;12.50(5.83，19.30) vs3.71(2.80，4.40)pg/dl,p<0.001].Numano type V (75.00% vs 27.27%, p = 0.022) and vascular calcification (56.25% vs 9.09%, p= 0.018) were significantly higher than those in the group without improved coronary imaging, while numano type IIb in the group with improved coronary imaging was significantly higher than that in the group without improved coronary imaging(45.45% vs 6.25%，p=0.027).

Conclusion

Hyperlipidemia and age are the risk factors of coronary artery lesions in Takayasu arteritis.Numano type V and vascular calcification are not conducive to the improvement of TA with coronary artery lesions.All patients with TA of numano type IIb should be screened for coronary artery. Early control of inflammation is more conducive to the imaging improvement of arteritis coronary lesions.

References

[1]Matsubara, O, Kuwata, T, Nemoto, T, et al., Coronary artery lesions in Takayasu arteritis: pathological considerations, Heart and vessels. Supplement, 1992;7:26-31.

[2]Wang H, Liu Z, Shen Z, et al. Impact of coronary involvement on long-term outcomes in patients with Takayasu’s arteritis. Clin Exp Rheumatol 2020;38:1118-26.

[3]LiJ,et al.. (2017) Clinical characteristics of heart involvement in Chinese patients with Takayasu arteritis. J Rheumatol 44:1867–1874.

[4]Li T, Du J, Gao N, et al. Numano type V Takayasu arteritis patients are more prone to have coronary artery involvement. Clin Rheumatol 2020;39:3439-47.

[5]Soto ME, et al..(2011) Coronary CT angiogra- phy in Takayasu arteritis. JACC Cardiovasc Imaging 4(9):958–966

Figure 1.

Disclosure of Interests

None declared

[The correlation of physical activity and sedentary leisure time with low muscle mass, strength, and quality in Chinese adults]

Objective: To explore the relationship of physical activity and sedentary leisure time with muscle mass, strength, and quality in Chinese adults. Methods: Based on the second resurvey of China Kadoorie Biobank (CKB) in 2013-2014, logistic regression models were used to analyze the correlation of physical activity and sedentary leisure time with low muscle mass, grip strength, and muscle quality. Results: A total of 24 245 participants were included in the analysis. The average daily physical activity level was (18.3±13.8) MET-h/d, and the sedentary leisure time was (4.4±1.9) hours. We took the lowest physical activity quartile as the reference and found that the participants' physical activity was negatively correlated to low muscle mass, strength, and quality. The ORs (95%CIs) of low appendicular skeletal muscle mass index (ASMI), low total skeletal muscle mass index (TSMI), low grip strength and low arm muscle quality (AMQ) were 0.68 (0.60-0.77), 0.66 (0.58-0.75), 0.82 (0.72-0.94) and 0.84 (0.74-0.95), respectively. The subtypes of physical activity, including those related to work, transportation, housework, and leisure, also showed negative correlations with low muscle mass, strength, and quality to varying degrees. Compared with participants with the shortest sedentary leisure time, those who had the longest were more likely to have low TSMI (OR=1.13, 95%CI: 0.99-1.30). Conclusions: Physical activity was negatively correlated with a lower risk of low muscle mass and strength, while longer sedentary leisure time positively correlated with low muscle mass.

[The correlation of sleep duration and insomnia with low muscle mass, strength and quality in Chinese adults]

Objective: To explore the relationship of sleep duration and insomnia with muscle mass, strength, and quality in Chinese adults. Methods: Based on the second resurvey of China Kadoorie Biobank (CKB) in 2013-2014, logistic regression models were used to analyze the correlation of sleep duration, insomnia, and its duration with low muscle mass, handgrip strength, and muscle quality. Results: The average sleep duration of the study population was (7.4±1.5) hours. Morbidities of short sleep duration (<6 hours), long sleep duration (≥9 hours), and insomnia were 9.3%,17.4%,and 29.9%,respectively. Compared with those who slept for 7- hours, those who slept for ≥9 hours were more likely to have low muscle mass, low handgrip strength,and low arm muscle quality (AMQ), and the OR (95%CI) of low appendicular skeletal muscle mass index (ASMI), low total skeletal muscle mass index (TSMI), low grip strength and low AMQ were 1.32 (1.18-1.48),1.26 (1.13-1.41), 1.33 (1.18-1.49) and 1.16 (1.03-1.30), respectively. Compared with participants without insomnia, insomnia patients were more likely to have low muscle mass,and the longer the duration of insomnia,the higher the risk (P for trend <0.001). Participants who reported <6 hours sleep duration and insomnia had a higher proportion of low ASMI and low TSMI,compared with those who slept for 7- hours and without insomnia, the OR (95%CI) were 1.26 (1.08-1.47) and 1.25 (1.07-1.46), respectively. Conclusions: Participants who reported ≥9 hours sleep duration were more likely to have low muscle mass,low handgrip strength,and low AMQ. Participants with insomnia had lower muscle mass, and the longer the duration of insomnia, the higher the proportion of low ASMI and low TSMI.

Sodium MRI at 7T for Early Response Evaluation of Intracranial Tumors following Stereotactic Radiotherapy Using the CyberKnife

BACKGROUND AND PURPOSE

Conventionally, early treatment response to stereotactic radiotherapy in intracranial tumors is often determined by structural MR imaging. Tissue sodium concentration is altered by cellular integrity and energy status in cells. In this study, we aimed to investigate the feasibility of sodium MR imaging at 7T for the preliminary evaluation of radiotherapeutic efficacy for intracranial tumors.

MATERIALS AND METHODS

Data were collected from 16 patients (12 men and 4 women, 24-75 years of age) with 22 intracranial tumors who were treated with stereotactic radiation therapy using CyberKnife at our institution between December 1, 2016, and August 15, 2019. Sodium MR imaging was performed at 7T before and 48 hours, 1 week, and 1 month after CyberKnife radiation therapy. Tissue sodium concentration (TSC) was calculated and analyzed based on manually labeled regions of tumors.

RESULTS

Ultra-high-field sodium MR imaging clearly showed the intratumoral signal, which is significantly higher than that of normal tissue (t = 5.250, P <.001)., but the edema zone has some influence. The average TSC ratios of tumor to CSF in the 22 tumors, contralateral normal tissues, edema zones, frontal cortex, and frontal white matter were 0.66 (range, 0.23-1.5), 0.30 (range, 0.15-0.43), 0.58 (range, 0.25-1.21), 0.25 (range, 0.17-0.42), and 0.30 (range, 0.19-0.49), respectively. A total of 12 tumors in 8 patients were scanned at 48 hours, 1 week, and 1 month after treatment. The average TSC at 48 hours after treatment was 0.06 higher than that before treatment and began to decrease at 1 week. The TSC ratios of 10 continued to decline and 2 tumors increased at 1 month, respectively. Tumor volume decreased by 2.4%-99% after 3 months.

CONCLUSIONS

Changes in the TSC can be quantified by sodium MR imaging at 7T and used to detect radiobiologic alterations in intracranial tumors at early time points after CyberKnife radiation therapy.