[Research progress in endoluminal treatment of urethral stricture]

Urethral stricture is regarded as a common disease in urology whose treatment modalities usually include open surgery and endoluminal treatment. Endoluminal techniques have gradually become one of the essential treatments in urethral stricture due to easier operation, less trauma, faster recovery, higher safety and fewer complications. The popularity of plasma knife and laser, and the application of new urethral stents and grafts, make endoscopic surgery easier and less invasive. However, due to its anatomical particularity and diverse etiologies of urethral stricture, the endoluminal treatment is still not satisfactory and a considerable number of patients still experience poor long-term treatment effect. Non-operative managements, such as intracavitary brachytherapy, intracavitary injection of drugs or stem cells and new urinary catheters are also being explored in treating urethral stricture, which would improve the effect of endoscopic surgery. This review summarizes the clinical application and new progress of various kinds of endoluminal treatments and pharmacotherapy in urethral stricture at home and abroad. More prospective randomized controlled studies are needed to confirm its feasibility, effectiveness and optimal time of operation.

Measurements of angular distance and momentum ratio distributions in three-jet and Z + two-jet final states in pp collisions

Collinear (small-angle) and large-angle, as well as soft and hard radiations are investigated in three-jet and Z  + two-jet events collected in proton-proton collisions at the LHC. The normalized production cross sections are measured as a function of the ratio of transverse momenta of two jets and their angular separation. The measurements in the three-jet and Z  + two-jet events are based on data collected at a center-of-mass energy of 8 TeV , corresponding to an integrated luminosity of 19.8 fb - 1 . The Z  + two-jet events are reconstructed in the dimuon decay channel of the Z  boson. The three-jet measurement is extended to include s = 13 TeV data corresponding to an integrated luminosity of 2.3 fb - 1 . The results are compared to predictions from event generators that include parton showers, multiple parton interactions, and hadronization. The collinear and soft regions are in general well described by parton showers, whereas the regions of large angular separation are often best described by calculations using higher-order matrix elements.

Observation of Forward Neutron Multiplicity Dependence of Dimuon Acoplanarity in Ultraperipheral Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The first measurement of the dependence of γγ→μ^{+}μ^{-} production on the multiplicity of neutrons emitted very close to the beam direction in ultraperipheral heavy ion collisions is reported. Data for lead-lead interactions at sqrt[s_{NN}]=5.02  TeV, with an integrated luminosity of approximately 1.5  nb^{-1}, are collected using the CMS detector at the LHC. The azimuthal correlations between the two muons in the invariant mass region 8<m_{μμ}<60  GeV are extracted for events including 0, 1, or at least 2 neutrons detected in the forward pseudorapidity range |η|>8.3. The back-to-back correlation structure from leading-order photon-photon scattering is found to be significantly broader for events with a larger number of emitted neutrons from each nucleus, corresponding to interactions with a smaller impact parameter. This observation provides a data-driven demonstration that the average transverse momentum of photons emitted from relativistic heavy ions has an impact parameter dependence. These results provide new constraints on models of photon-induced interactions in ultraperipheral collisions. They also provide a baseline to search for possible final-state effects on lepton pairs caused by traversing a quark-gluon plasma produced in hadronic heavy ion collisions.

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Yagil A, Amin N, Campagnari C, Citron M, Dorsett A, Dutta V, Incandela J, Kilpatrick M, Marsh B, Mei H, Ovcharova A, Quinnan M, Richman J, Sarica U, Stuart D, Wang S, Bornheim A, Cerri O, Dutta I, Lawhorn JM, Lu N, Mao J, Newman HB, Ngadiuba J, Nguyen TQ, Spiropulu M, Vlimant JR, Wang C, Xie S, Zhang Z, Zhu RY, Alison J, Andrews MB, Ferguson T, Mudholkar T, Paulini M, Vorobiev I, Cumalat JP, Ford WT, MacDonald E, Patel R, Perloff A, Stenson K, Ulmer KA, Wagner SR, Alexander J, Cheng Y, Chu J, Cranshaw DJ, Mcdermott K, Monroy J, Patterson JR, Quach D, Reichert J, Ryd A, Sun W, Tan SM, Tao Z, Thom J, Wittich P, Zientek M, Albrow M, Alyari M, Apollinari G, Apresyan A, Apyan A, Banerjee S, Bauerdick LAT, Beretvas A, Berry D, Berryhill J, Bhat PC, Burkett K, Butler JN, Canepa A, Cerati GB, Cheung HWK, Chlebana F, Cremonesi M, Petrillo KFD, Elvira VD, Freeman J, Gecse Z, Gray L, Green D, Grünendahl S, Gutsche O, Harris RM, Heller R, Herwig TC, Hirschauer J, Jayatilaka B, Jindariani S, Johnson M, Joshi U, Klabbers P, Klijnsma T, Klima B, Kortelainen MJ, Kwok KHM, Lammel S, Lincoln D, Lipton R, Liu T, Lykken J, Madrid C, Maeshima K, Mantilla C, Mason D, McBride P, Merkel P, Mrenna S, Nahn S, O’Dell V, Papadimitriou V, Pedro K, Pena C, Prokofyev O, Ravera F, Hall AR, Ristori L, Schneider B, Sexton-Kennedy E, Smith N, Soha A, Spiegel L, Stoynev S, Strait J, Taylor L, Tkaczyk S, Tran NV, Uplegger L, Vaandering EW, Weber HA, Woodard A, Acosta D, Avery P, Bourilkov D, Cadamuro L, Cherepanov V, Errico F, Field RD, Guerrero D, Joshi BM, Kim M, Konigsberg J, Korytov A, Lo KH, Matchev K, Menendez N, Mitselmakher G, Rosenzweig D, Shi K, Sturdy J, Wang J, Yigitbasi E, Zuo X, Adams T, Askew A, Diaz D, Habibullah R, Hagopian S, Hagopian V, Johnson KF, Khurana R, Kolberg T, Martinez G, Prosper H, Schiber C, Yohay R, Zhang J, Baarmand MM, Butalla S, Elkafrawy T, Hohlmann M, Verma RK, Noonan D, Rahmani M, Saunders M, Yumiceva F, Adams MR, Apanasevich L, Gonzalez HB, Cavanaugh R, Chen X, Dittmer S, Evdokimov O, Gerber CE, Hangal DA, Hofman DJ, Mills C, Oh G, Roy T, Tonjes MB, Varelas N, Viinikainen J, Wang X, Wu Z, Ye Z, Alhusseini M, Dilsiz K, Durgut S, Gandrajula RP, Haytmyradov M, Khristenko V, Köseyan OK, Merlo JP, Mestvirishvili A, Moeller A, Nachtman J, Ogul H, Onel Y, Ozok F, Penzo A, Snyder C, Tiras E, Wetzel J, Amram O, Blumenfeld B, Corcodilos L, Eminizer M, Gritsan AV, Kyriacou S, Maksimovic P, Roskes J, Swartz M, Vámi T, Barrera CB, Baringer P, Bean A, Bylinkin A, Isidori T, Khalil S, King J, Krintiras G, Kropivnitskaya A, Lindsey C, Minafra N, Murray M, Rogan C, Royon C, Sanders S, Schmitz E, Takaki JDT, Wang Q, Williams J, Wilson G, Duric S, Ivanov A, Kaadze K, Kim D, Maravin Y, Mitchell T, Modak A, Nam K, Rebassoo F, Wright D, Adams E, Baden A, Baron O, Belloni A, Eno SC, Feng Y, Hadley NJ, Jabeen S, Kellogg RG, Koeth T, Mignerey AC, Nabili S, Seidel M, Skuja A, Tonwar SC, Wang L, Wong K, Abercrombie D, Andreassi G, Bi R, Brandt S, Busza W, Cali IA, Chen Y, D’Alfonso M, Ceballos GG, Goncharov M, Harris P, Hu M, Klute M, Kovalskyi D, Krupa J, Lee YJ, Maier B, Marini AC, Mironov C, Paus C, Rankin D, Roland C, Roland G, Shi Z, Stephans GSF, Tatar K, Wang J, Wang Z, Wyslouch B, Chatterjee RM, Evans A, Hansen P, Hiltbrand J, Jain S, Krohn M, Kubota Y, Lesko Z, Mans J, Revering M, Rusack R, Saradhy R, Schroeder N, Strobbe N, Wadud MA, Acosta JG, Oliveros S, Bloom K, Bryson M, Chauhan S, Claes DR, Fangmeier C, Finco L, Golf F, Fernández JRG, Joo C, Kravchenko I, Siado JE, Snow GR, Tabb W, Yan F, Agarwal G, Bandyopadhyay H, Hay L, Iashvili I, Kharchilava A, McLean C, Nguyen D, Pekkanen J, Rappoccio S, Williams A, Alverson G, Barberis E, Freer C, Haddad Y, Hortiangtham A, Li J, Madigan G, Marzocchi B, Morse DM, Nguyen V, Orimoto T, Parker A, Skinnari L, Tishelman-Charny A, Wamorkar T, Wang B, Wisecarver A, Wood D, Bhattacharya S, Bueghly J, Chen Z, Gilbert A, Gunter T, Hahn KA, Odell N, Schmitt MH, Sung K, Velasco M, Band R, Bucci R, Dev N, Goldouzian R, Hildreth M, Anampa KH, Jessop C, Lannon K, Loukas N, Marinelli N, Mcalister I, Meng F, Mohrman K, Musienko Y, Ruchti R, Siddireddy P, Wayne M, Wightman A, Wolf M, Zarucki M, Zygala L, Bylsma B, Cardwell B, Durkin LS, Francis B, Hill C, Lefeld A, Winer BL, Yates BR, Addesa FM, Bonham B, Das P, Dezoort G, Elmer P, Frankenthal A, Greenberg B, Haubrich N, Higginbotham S, Kalogeropoulos A, Kopp G, Kwan S, Lange D, Lucchini MT, Marlow D, Mei K, Ojalvo I, Olsen J, Palmer C, Stickland D, Tully C, Xie Z, Malik S, Norberg S, Bakshi AS, Barnes VE, Chawla R, Das S, Gutay L, Jones M, Jung AW, Karmarkar S, Liu M, Negro G, Neumeister N, Paspalaki G, Peng CC, Piperov S, Purohit A, Schulte JF, Stojanovic M, Thieman J, Wang F, Xiao R, Xie W, Dolen J, Parashar N, Baty A, Dildick S, Ecklund KM, Freed S, Geurts FJM, Kumar A, Li W, Padley BP, Redjimi R, Roberts J, Shi W, Leiton AGS, Bodek A, de Barbaro P, Demina R, Dulemba JL, Fallon C, Ferbel T, Galanti M, Garcia-Bellido A, Hindrichs O, Khukhunaishvili A, Ranken E, Taus R, Chiarito B, Chou JP, Gandrakota A, Gershtein Y, Halkiadakis E, Hart A, Heindl M, Hughes E, Kaplan S, Karacheban O, Laflotte I, Lath A, Montalvo R, Nash K, Osherson M, Salur S, Schnetzer S, Somalwar S, Stone R, Thayil SA, Thomas S, Wang H, Acharya H, Delannoy AG, Spanier S, Bouhali O, Dalchenko M, Delgado A, Eusebi R, Gilmore J, Huang T, Kamon T, Kim H, Luo S, Malhotra S, Mueller R, Overton D, Rathjens D, Safonov A, Akchurin N, Damgov J, Hegde V, Kunori S, Lamichhane K, Lee SW, Mengke T, Muthumuni S, Peltola T, Undleeb S, Volobouev I, Wang Z, Whitbeck A, Appelt E, Greene S, Gurrola A, Johns W, Maguire C, Melo A, Ni H, Padeken K, Romeo F, Sheldon P, Tuo S, Velkovska J, Arenton MW, Cox B, Cummings G, Hakala J, Hirosky R, Joyce M, Ledovskoy A, Li A, Neu C, Tannenwald B, Wolfe E, Karchin PE, Poudyal N, Thapa P, Black K, Bose T, Buchanan J, Caillol C, Dasu S, De Bruyn I, Everaerts P, Fienga F, Galloni C, He H, Herndon M, Hervé A, Hussain U, Lanaro A, Loeliger A, Loveless R, Sreekala JM, Mallampalli A, Mohammadi A, Pinna D, Savin A, Shang V, Sharma V, Smith WH, Teague D, Trembath-Reichert S, Vetens W. Precision luminosity measurement in proton-proton collisions at s = 13 TeV in 2015 and 2016 at CMS

The measurement of the luminosity recorded by the CMS detector installed at LHC interaction point 5, using proton-proton collisions at s = 13 TeV in 2015 and 2016, is reported. The absolute luminosity scale is measured for individual bunch crossings using beam-separation scans (the van der Meer method), with a relative precision of 1.3 and 1.0% in 2015 and 2016, respectively. The dominant sources of uncertainty are related to residual differences between the measured beam positions and the ones provided by the operational settings of the LHC magnets, the factorizability of the proton bunch spatial density functions in the coordinates transverse to the beam direction, and the modeling of the effect of electromagnetic interactions among protons in the colliding bunches. When applying the van der Meer calibration to the entire run periods, the integrated luminosities when CMS was fully operational are 2.27 and 36.3 fb - 1 in 2015 and 2016, with a relative precision of 1.6 and 1.2%, respectively. These are among the most precise luminosity measurements at bunched-beam hadron colliders.

Constraints on the Initial State of Pb-Pb Collisions via Measurements of Z-Boson Yields and Azimuthal Anisotropy at sqrt[s_{NN}]=5.02 TeV

The CMS experiment at the LHC has measured the differential cross sections of Z bosons decaying to pairs of leptons, as functions of transverse momentum and rapidity, in lead-lead collisions at a nucleon-nucleon center-of-mass energy of 5.02  TeV. The measured Z boson elliptic azimuthal anisotropy coefficient is compatible with zero, showing that Z bosons do not experience significant final-state interactions in the medium produced in the collision. Yields of Z bosons are compared to Glauber model predictions and are found to deviate from these expectations in peripheral collisions, indicating the presence of initial collision geometry and centrality selection effects. The precision of the measurement allows, for the first time, for a data-driven determination of the nucleon-nucleon integrated luminosity as a function of lead-lead centrality, thereby eliminating the need for its estimation based on a Glauber model.

Intracervical intracapsular myomectomy using loop ligation: a proposed technique

Performing laparoscopic myomectomy for an intracervical myoma, especially a single giant myoma, is challenging. Only skilled surgeons attempt this operation. Surgeons frequently encounter cases of massive intraoperative bleeding, difficulty suturing the cervical incision, risk of injuring the neighbouring tissues, haematoma formation and conversion to laparotomy or hysterectomy. We previously developed a the technique of loop ligation of the pseudocapsule and have been using it to treat sizeable intracervical myomas laparoscopically. Its advantages include less blood loss, lower risk of injuries to the neighbouring tissues, maintenance of the cervical canal and sparing of the pseudocapsule. This technique is safe and feasible, and facilitates fertility.

Survival of itinerant excitations and quantum spin state transitions in YbMgGaO4 with chemical disorder

A recent focus of quantum spin liquid (QSL) studies is how disorder/randomness in a QSL candidate affects its true magnetic ground state. The ultimate question is whether the QSL survives disorder or the disorder leads to a “spin-liquid-like” state, such as the proposed random-singlet (RS) state. Since disorder is a standard feature of most QSL candidates, this question represents a major challenge for QSL candidates. YbMgGaO₄, a triangular lattice antiferromagnet with effective spin-1/2 Yb³⁺ions, is an ideal system to address this question, since it shows no long-range magnetic ordering with Mg/Ga site disorder. Despite the intensive study, it remains unresolved as to whether YbMgGaO₄ is a QSL or in the RS state. Here, through ultralow-temperature thermal conductivity and magnetic torque measurements, plus specific heat and DC magnetization data, we observed a residual κ₀/T term and series of quantum spin state transitions in the zero temperature limit for YbMgGaO₄. These observations strongly suggest that a QSL state with itinerant excitations and quantum spin fluctuations survives disorder in YbMgGaO₄.

It remains an open question as to whether the quantum spin liquid state survives material disorder, or is replaced by some spin-liquid like state. Here, Rao et al succeed in resolving a resolving a κ₀/T residual in the thermal conductivity of YbMgGaO₄ strongly suggesting the survival of the quantum spin liquid state.

Search for charged Higgs bosons produced in vector boson fusion processes and decaying into vector boson pairs in proton-proton collisions at s = 13 TeV

A search for charged Higgs bosons produced in vector boson fusion processes and decaying into vector bosons, using proton-proton collisions ats = 13 TeV at the LHC, is reported. The data sample corresponds to an integrated luminosity of 137fb - 1 collected with the CMS detector. Events are selected by requiring two or three electrons or muons, moderate missing transverse momentum, and two jets with a large rapidity separation and a large dijet mass. No excess of events with respect to the standard model background predictions is observed. Model independent upper limits at 95% confidence level are reported on the product of the cross section and branching fraction for vector boson fusion production of charged Higgs bosons as a function of mass, from 200 to 3000GeV . The results are interpreted in the context of the Georgi-Machacek model.

[Mesenchymal chondrosarcoma in central nervous system: a clinicopathological analysis]

Objective: To investigate the clinicopathological features of central nervous system (CNS) mesenchymal chondrosarcoma (MCS). Methods: Nine cases of CNS MCS were collected at the First Affiliated Hospital of Fujian Medical University from September 2010 to September 2020. The clinical,imaging,histopathological and immunohistochemical features were reviewed. NCOA2 gene rearrangement was evaluated by fluorescence in situ hybridization (FISH). Results: There were three male and six female patients, with age range of 1 to 59 years (median 31 years). Six cases were intracranial and three cases were intraspinal, and the tumors showed dural attachment. They were often diagnosed as meningioma basing on preoperative imaging. Microscopically, the tumors showed a characteristic biphasic histologic pattern composed of undifferentiated mesenchymal small cells and well-differentiated hyaline cartilage islands. The small cells area were positive for SOX9 (9/9), CD99 (8/9), and without BRG1 and INI1 deletion. The cartilaginous component expressed SOX9 (9/9) and S-100 protein (8/9). NCOA2 gene break apart signal was identified in five cases (5/5). Eight patients were followed up for 4-124 months. Three patients (3/8) had recurrences within one year and two patients died of the tumor. Conclusions: CNS MCS is an extremely rare malignant neoplasm with a propensity to dural involvement. Preoperative imaging has low diagnostic accuracy. CNS MCS should be differentiated from other CNS small round cell tumors and chondrosarcoma. FISH detection of NCOA2 gene rearrangement will assist the diagnosis of MCS.

Search for a heavy vector resonance decaying to a Z boson and a Higgs boson in proton-proton collisions at s = 13 Te

A search is presented for a heavy vector resonance decaying into a Z boson and the standard model Higgs boson, where the Z boson is identified through its leptonic decays to electrons, muons, or neutrinos, and the Higgs boson is identified through its hadronic decays. The search is performed in a Lorentz-boosted regime and is based on data collected from 2016 to 2018 at the CERN LHC, corresponding to an integrated luminosity of 137fb - 1 . Upper limits are derived on the production of a narrow heavy resonanceZ ' , and a mass below 3.5 and 3.7Te is excluded at 95% confidence level in models where the heavy vector boson couples predominantly to fermions and to bosons, respectively. These are the most stringent limits placed on the Heavy Vector TripletZ ' model to date. If the heavy vector boson couples exclusively to standard model bosons, upper limits on the product of the cross section and branching fraction are set between 23 and 0.3fb for aZ ' mass between 0.8 and 4.6Te , respectively. This is the first limit set on a heavy vector boson coupling exclusively to standard model bosons in its production and decay.

Quantitative analysis of flow vortices: differentiation of unruptured and ruptured medium-sized middle cerebral artery aneurysms

BACKGROUND

Surgical intervention for unruptured intracranial aneurysms (IAs) carries inherent health risks. The analysis of "patient-specific" IA geometric and computational fluid dynamics (CFD) simulated wall shear stress (WSS) data has been investigated to differentiate IAs at high and low risk of rupture to help clinical decision making. Yet, outcomes vary among studies, suggesting that novel analysis could improve rupture characterization. The authors describe a CFD analytic method to assess spatiotemporal characteristics of swirling flow vortices within IAs to improve characterization.

METHODS

CFD simulations were performed for 47 subjects harboring one medium-sized (4-10 mm) middle cerebral artery (MCA) aneurysm with available 3D digital subtraction angiography data. Alongside conventional indices, quantified IA flow vortex spatiotemporal characteristics were applied during statistical characterization. Statistical supervised machine learning using a support vector machine (SVM) method was run with cross-validation (100 iterations) to assess flow vortex-based metrics' strength toward rupture characterization.

RESULTS

Relying solely on vortex indices for statistical characterization underperformed compared with established geometric characteristics (total accuracy of 0.77 vs 0.80) yet showed improvements over wall shear stress models (0.74). However, the application of vortex spatiotemporal characteristics into the combined geometric and wall shear stress parameters augmented model strength for assessing the rupture status of middle cerebral artery aneurysms (0.85).

CONCLUSIONS

This preliminary study suggests that the spatiotemporal characteristics of flow vortices within MCA aneurysms are of value to improve the differentiation of ruptured aneurysms from unruptured ones.

PRKD3 promotes malignant progression of OSCC by downregulating KLF16 expression

OBJECTIVE

We aimed to clarify the molecular mechanism of how PRKD3 promotes the malignant progression of oral squamous cell carcinoma (OSCC).

PATIENTS AND METHODS

62 cases of OSCC tissues and normal adjacent ones which were further confirmed by a qualified pathologist were collected from patients in the Department of Pathology and Stomatology of our hospital. PRKD3 expression in the above tissue samples was studied by quantitative real-time polymerase chain reaction (qRT-PCR) analysis, and its relationship with clinicopathological characteristics of these OSCC patients was analyzed. Meanwhile, a PRKD3 knockdown expression model was constructed in OSCC cell lines for cell functional experiments. The relationship between PRKD3 and KLF16 was elucidated through bioinformatics and Luciferase reporter gene experiments.

RESULTS

Our data showed that PRKD3 expression in OSCC specimens was remarkably higher than that in adjacent ones. PRKD3 expression showed positive association with the incidence of distant metastasis, but not with other clinical indicators such as gender, age, tumor stage or lymph node metastasis incidence. Patients with high PRKD3 expression had lower overall survival compared to those with low expression. In addition, OSCC cells migration ability and invasiveness were remarkably attenuated after PRKD3 was knocked down. Bioinformatics and Luciferase assay revealed that PRKD3 could directly bind to KLF16 and Western blot suggested that KLF16 was upregulated after PRKD3 was knocked down. In addition, knocking down KLF16 reversed the inhibitory effect of PRKD3 knockdown on invasiveness and metastasis of OSCC cells.

CONCLUSIONS

The highly-expressed PRKD3, remarkably associated with metastasis incidence and poor prognosis of OSCC patients, may accelerate the malignant progression of OSCC through modulating KLF16 expression.

Measurement of the Wγ Production Cross Section in Proton-Proton Collisions at sqrt[s]=13 TeV and Constraints on Effective Field Theory Coefficients

A fiducial cross section for Wγ production in proton-proton collisions is measured at a center-of-mass energy of 13 TeV in 137  fb^{-1} of data collected using the CMS detector at the LHC. The W→eν and μν decay modes are used in a maximum-likelihood fit to the lepton-photon invariant mass distribution to extract the combined cross section. The measured cross section is compared with theoretical expectations at next-to-leading order in quantum chromodynamics. In addition, 95% confidence level intervals are reported for anomalous triple-gauge couplings within the framework of effective field theory.

Observation of a New Excited Beauty Strange Baryon Decaying to Ξ_{b}^{-}π^{+}π^{-}

The Ξ_{b}^{-}π^{+}π^{-} invariant mass spectrum is investigated with an event sample of proton-proton collisions at sqrt[s]=13  TeV, collected by the CMS experiment at the LHC in 2016-2018 and corresponding to an integrated luminosity of 140  fb^{-1}. The ground state Ξ_{b}^{-} is reconstructed via its decays to J/ψΞ^{-} and J/ψΛK^{-}. A narrow resonance, labeled Ξ_{b}(6100)^{-}, is observed at a Ξ_{b}^{-}π^{+}π^{-} invariant mass of 6100.3±0.2(stat)±0.1(syst)±0.6(Ξ_{b}^{-})  MeV, where the last uncertainty reflects the precision of the Ξ_{b}^{-} baryon mass. The upper limit on the Ξ_{b}(6100)^{-} natural width is determined to be 1.9  MeV at 95% confidence level. The low Ξ_{b}(6100)^{-} signal yield observed in data does not allow a measurement of the quantum numbers of the new state. However, following analogies with the established excited Ξ_{c} baryon states, the new Ξ_{b}(6100)^{-} resonance and its decay sequence are consistent with the orbitally excited Ξ_{b}^{-} baryon, with spin and parity quantum numbers J^{P}=3/2^{-}.

[Establishment of a 3D ultrasound imaging system based on pulse-triggered image acquisition]

OBJECTIVE

To establish a 3D ultrasound imaging system based on pulse-triggered image acquisition using the linear probe on the Verasonics^TM vantage 128 platform and evaluate its performance in scanning standard phantom and human carotid artery.

OBJECTIVE

The 3D ultrasound imaging system included 3 modules for probe motion control, image acquisition and storage, and 3D image reconstruction and display. To improve the precision of image acquisition, we used fixed frequency pulses to control the external trigger function combined with mechanical scanning. Voxel-based 3D reconstruction was used for image reconstruction and display. The user interface was designed to allow direct operations of the platform. We carried out scanning tests of standard ultrasound phantom and human carotid artery to evaluate the performance of this imaging system.

OBJECTIVE

We successfully constructed a 3D ultrasound imaging system based on pulse-triggered image acquisition. The results of standard phantom and human carotid scanning tests showed that each module of the system was fully functional. The self-designed user interface of this ultrasound imaging system allowed full control of the system functions for original image acquisition, 3D image reconstruction, and display of cross-sections in 3 different views.

OBJECTIVE

This 3D ultrasound imaging system achieves high-quality 3D ultrasound imaging and provides the basis for further study and clinical application of 3D ultrasound imaging.

[Effectiveness of TRB3 on human hepatocellular carcinoma cells proliferation, apoptosis and migration]

Objective: To explore the regulatory role and mechanism of tribbles pseudokinase 3 (TRB3) on hepatocarcinoma (HCC) cells proliferation, apoptosis and migration. Methods: Immunohistochemistry and Western blot were used to detect TRB3 expression in cancerous and adjacent cancerous liver tissues of HCC patients. TRB3 expression was detected in vitro in HepG2 and Huh7 hepatocarcinoma cell lines. Simultaneously, CCK8 and EdU were used to detect cell proliferation after TRB3 targeted inhibition with small interfering RNA. CCK8 and EdU were used to detect cell proliferation. Flow cytometry assay was used to detect apoptosis. Transwell assay was used to evaluate migration ability. Simultaneously, Western blot was used to detect changes in apoptosis, migration-related proteins and AKT phosphorylation activity. The mean comparison between the two groups was performed by t-test, and the comparison between multiple groups was performed by one-way analysis of variance. Results: Western blot showed that the expression of TRB3 was significantly up-regulated in HCC tissues. Compared with normal liver tissues adjacent to cancer, the relative expression levels were 0.78 ± 0.12 and 0.29 ± 0.09, respectively, P < 0.01, and the difference was statistically significant. After interfering siRNA inhibited TRB3, CCK8 and EdU tests showed that the proliferation activity of HepG2 and Huh7 cells were significantly weakened (P < 0.05). Flow cytometry results showed that the apoptotic proportions of HepG2 and Huh7 cells was significantly increased (P < 0.01). Western blot also showed that the expression of apoptosis regulatory proteins BAX and BIM were significantly increased (P < 0.01). Transwell assay results showed that the migration ability of HepG2 and Huh7 cells was decreased (P < 0.05), and the expression of migration regulatory proteins MMP4 and MMP9 was also significantly down-regulated. Western blot results showed that the AKT phosphorylation level was significantly increased. Conclusion: TRB3 regulates hepatocarcinoma cells proliferation, apoptosis and migration by inhibiting the AKT phosphorylation activity. Therefore, TRB3 may be a potential target site for the liver cancer treatment.

Measurements of production cross sections of the Higgs boson in the four-lepton final state in proton-proton collisions at s = 13 TeV

Production cross sections of the Higgs boson are measured in the H → Z Z → 4 ℓ ( ℓ = e , μ ) decay channel. A data sample of proton-proton collisions at a center-of-mass energy of 13 TeV , collected by the CMS detector at the LHC and corresponding to an integrated luminosity of 137 fb - 1 is used. The signal strength modifier μ , defined as the ratio of the Higgs boson production rate in the 4 ℓ channel to the standard model (SM) expectation, is measured to be μ = 0.94 ± 0.07 (stat) - 0.08 + 0.09 (syst) at a fixed value of m H = 125.38 GeV . The signal strength modifiers for the individual Higgs boson production modes are also reported. The inclusive fiducial cross section for the H → 4 ℓ process is measured to be 2 . 84 - 0.22 + 0.23 (stat) - 0.21 + 0.26 (syst) fb , which is compatible with the SM prediction of 2.84 ± 0.15 fb for the same fiducial region. Differential cross sections as a function of the transverse momentum and rapidity of the Higgs boson, the number of associated jets, and the transverse momentum of the leading associated jet are measured. A new set of cross section measurements in mutually exclusive categories targeted to identify production mechanisms and kinematical features of the events is presented. The results are in agreement with the SM predictions.

AB0050 A NOVEL METHOD FOR ISOLATION OF EXOSOMES FROM SYNOVIAL FLUID

Background:

Exosomes in synovial fluid (SF) has a close relationship with the pathogenesis of rheumatiod arthritis. As a complex biological fluid, SF presents challenges for exosomes isolation using standard methods, such as ExoquickTM kit and ultracentrifugation.

Objectives:

The study aims to compared the quality of exosomes separated by ExoquickTM kit (TM), ExoquickTM kit+ExoquickTC kit (TM-TC), ultracentrifugation (UC) and TM-TC+UC(TM-TC-UC) from SF.

Methods:

Exosomes was separated by TM, TM-TC, UC and TM-TC-UC respectively. The size and concentrations of exosomes were detected by high sensitivity flow cytometry for nanoparticle analysis. Total protein and RNA were extracted from exosomes. SDS-PAGE was used to detect the protein distribution of exosomes. Western blot was used to examine the level of albumin and exosomes marker (TSG101 and CD81).

Results:

There was no statistic difference in the diameters of exosomes separated by the four methods. The concentrations of exosomes in TM, TM-TC, TM-TC-UC and UC were (5.65±0.93), (3.02±1.19), (1.67±0.25) and (4.61±0.73) *109Particles/mL. The protein concentrations of exosomes separated by the four methods were consistent with the concentrations of exosomes. SDS-PAGE showed that the protein distribution of exosomes separated by the four methods were different. Low levels of albumin were detected in TM-TC and TM-TC-UC, while high levels of albumin in TM and UC. Total RNA concentrations from exosomes in TM-TC was higher than other groups.

Conclusion:

TM-TC can be used to obtain higher quality exosomes from SF for the study of exosome-enriched components.

References:

[1]Helwa I, et al, A Comparative Study of Serum Exosome Isolation Using Differential Ultracentrifugation and Three Commercial Reagents. PloS one, 2017. 12(1): p. e0170628-e0170628.

Figure 1.

A: SDS-PAGE showed the protein distribution of exosomes; B: the detection of albumin, TSG101 and CD81 by western blot.

Disclosure of Interests:

None declared

AB0791 THE DIAGNOSIS VALUE OF SYNOVIAL FLUID LYMPHOCYTE IN GOUT PATIENTS

Background:

Synovial fluid cell counts have long been recognised to have utility in the diagnosis and management of arthritis. Few studies have explained the diagnosis value of synovial fluid cell counts in gout patients.

Objectives:

The study aims to investigate the diagnosis value of synovial fluid cell counts in gout patients.

Methods:

A total of 185 gout, 64 rheumatoid arthritis(RA), 26 axial spondyloarthritis(axSpA) and 24 osteoarthritis(OA) patients were included into the study. According to serum uric acid(sUA) level on attack, gout patients were divided into normal sUA gout patients and high sUA gout patients. The laboratory data was recorded and ROC curve was performed.

Results:

The synovial fluid WBC, PBMC, monocyte, PMN and neutrophil in gout patients were higher than OA patients (P<0.05). The synovial fluid PBMC and lymphocyte in gout patients were lower than RA and axSpA patients (P<0.05). Compared with RA, axSpA and OA patients, ROC curve showed that the AUC value of lymphocyte and sUA for gout were 0.728 and 0.881, which were higher than other variables. The optimal cut off value of lymphocyte for gout was 1.362, with sensitivity of 83.3% and specificity of 60.6%. The AUC value of lymphocyte and sUA for normal sUA gout patients were 0.694 and 0.643, which were higher than other variables. The optimal cut off value of lymphocyte for normal sUA gout patients was 1.362, with sensitivity of 81.6% and specificity of 60.6%.

Conclusion:

Synovial fluid cell counts of gout patients were different from RA, axSpA, and OA patients. Synovial fluid lymphocyte had a higher diagnosis value for gout.

References:

[1]Scanu A, Oliviero F, Ramonda R, et al. Cytokine levels in human synovial fluid during the different stages of acute gout: role of transforming growth factor β1 in the resolution phase. Ann Rheum Dis. 2012, 71(4): 621-4.

Table 1.

Basic characteristics of the participants

Gout(n=185)RA(n=64)axSpA (n=26)OA(n=24)P valueAge (years)48.58±15.5856.19±12.39*32.96±15.19*#69.63±12.43*#&<0.001Gender (male/female)176/911/5321/58/16<0.001WBC(×109/L)18.58±22.9422.24±20.8715.52±15.033.03±5.59*#&0.002PBMC(×109/L)1.85±1.993.68±2.43*3.85±3.34*0.74±1.01*#&<0.001Monocyte(×109/L)1.02±1.591.24±1.111.34±1.520.29±0.37*#&0.030PMN(×109/L)16.77±21.5118.57±19.3215.75±24.172.30±5.00*#&0.008Lymphocyte (×109/L)0.80±0.832.43±1.76*2.50±2.04*0.45±0.80#&<0.001Eosinophil (×109/L)1.32±3.750.56±0.930.11±0.170.49±1.850.098Neutrophil (×109/L)16.42±21.1618.82±20.8911.13±14.232.23±4.87*#0.003UA(μM)497.92±132.24299.31±97.91*351.81±118.93*333.38±75.19*<0.001ESR(mm/h)61.02±37.6882.42±32.87*68.12±36.2542.34±35.91*#&<0.001CRP(mg/L)56.52±45.6444.01±35.27*65.49±39.85#22.11±40.65*#&<0.001

*P<0.05 vs gout group, #P<0.05 vs RA group, &P<0.05 vs axSpA group

Disclosure of Interests:

None declared

AB0845 THE COMBINATION OF PLASMA FIBRINOGEN CONCENTRATION AND NEUTROPHIL-LYMPHOCYTE RATIO (F-NLR) AS A NOVEL INFLAMMATORY MARKER OF RHEUMATOID ARTHRITIS

Background:

The combined index of fibrinogen and neutrophil-lymphocyte ratio (F-NLR) has recently been reported as a new predictive factor in patients with cancer. However, the fibrinogen and NLR have not been simultaneously evaluated in rheumatoid arthritis (RA).

Objectives:

This study aimed to explore the clinical value of F-NLR in RA and its relationship with disease activity.

Methods:

This retrospective study collected 143 RA patients and 82 age- and gender-matched healthy controls. Neutrophil, lymphocyte, monocyte, platelet, fibrinogen, NLR, monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Disease Activity Score of 28 joints-ESR (DAS28-ESR) and other laboratory parameters were recorded. Receiver operating characteristic (ROC) curves were used to defined the optimization cut-off values of fibrinogen and NLR, which were 3.9g/L and 2.42. The F-NLR score was 2 for patients with high fibrinogen (> 3.9g/L) and elevated NLR (> 2.42), while those with one or neither were indexed as 1 or 0. The correlations between F-NLR as well as other inflammatory indexes and DAS28-ESR were measured.

Results:

The F-NLR score was higher in RA patients than that in healthy individuals (P < 0.05). The proportion of higher F-NLR score increased significantly along with the disease activity (P < 0.05). According to the ROC curve which was conducted to discriminate RA patients from healthy subjects, the area under curve (AUC) of F-NLR (0.803, 95% CI: 0.744 - 0.861) was higher than that of fibrinogen (0.735, 95% CI: 0.670 - 0.801), NLR (0.724, 95% CI: 0.655 - 0.794), MLR (0.687, 95% CI: 0.615 - 0.759) and PLR (0.732, 95% CI: 0.664 - 0.800). Furthermore, F-NLR was more strongly associated with DAS28-ESR (r = 0.572, P < 0.001) when compared with fibrinogen (r = 0.518, P < 0.001), NLR (r = 0.365, P < 0.001), MLR (r = 0.140, P = 0.096), PLR (r = 0.239, P = 0.004), CRP (r = 0.539, P < 0.001) and ESR (r = 0.487, P < 0.001).

Conclusion:

The results demonstrated that the F-NLR score was elevated in RA patients. The F-NLR score may be a potential marker to monitor the disease activity of RA patients.

References:

[1]Wang H, Zhao J, Zhang M, Han L, Wang M, Xingde L. The combination of plasma fibrinogen and neutrophil lymphocyte ratio (F-NLR) is a predictive factor in patients with resectable non small cell lung cancer. J Cell Physiol. 2018 May; 233(5):4216-4224.

Disclosure of Interests:

None declared

Increasing fasting glucose and fasting insulin associated with elevated bone mineral density-evidence from cross-sectional and MR studies

We performed a cross-sectional study using the National Health Examination and Nutrition Survey (NHANES) data and a Mendelian randomisation (MR) study using the GWAS summary statistics from European populations. The T2D-related indices (fasting plasma glucose (FPG), fasting insulin (FI), and insulin resistance (IR)) were found to associate with elevated bone mineral density (BMD).

INTRODUCTION

The known associations amongst FPG, FI, IR, and BMD remain inconsistent. This study aims to explore the abovementioned associations by using cross-sectional and MR designs.

METHODS

Data from adults aged ≥ 20 years (n = 7170) in four rounds of the U.S. NHANES (2005-2010 and 2013-2014) were analysed in this cross-sectional study. Multiple linear and logistic regression models were used for statistical analyses. A two-sample MR study was performed using the genome-wide association study summary statistics obtained from the Meta-analyses of Glucose and Insulin-related traits Consortium (n = 108,557) and Genetic Factors for Osteoporosis Consortium (n = 32,735) to examine the causality of the FI-BMD association.

RESULTS

Multiple linear regression revealed that FPG was positively associated with the BMDs at the hip, femur neck, and 1st lumbar spine (L1). Multiple logistic regressions revealed that FPG levels were associated with elevated BMDs at the hip and L1, and FI and IR levels were associated with elevated BMD at the hip. Patients with type 2 diabetes had higher hip BMD than those without diabetes. In the MR study, the lumbar spine BMD increased by 0.49 g/cm² (95% confidence interval: 0.01, 0.97) in response to per unit increase in log-transformed FI.

CONCLUSION

Findings from our cross-sectional and MR studies revealed the associations between the studied diabetic indices and BMD measurements in the US and European adults.

POS1443 RELATIONSHIP BETWEEN FIBRINOGEN TO ALBUMIN RATIO AND DISEASE ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is a systemic inflammatory autoimmune disease characterized by excessive production of immune complexes and proinflammatory cytokine. Low complement, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been used as inflammatory biomarkers to assess the disease activity of SLE. Recently, the fibrinogen to albumin ratio (FAR) has emerged as an effective indicator to reflect the systemic inflammation in many diseases. However, the role of FAR in SLE has been scarcely studied.

Objectives:

This study was to investigate the association between FAR and SLE Disease Activity Index 2000 (SLEDAI-2K) in SLE.

Methods:

This retrospective study included 74 SLE patients and 79 age- and sex-matched healthy subjects. According to the SLEDAI-2K score, SLE patients were divided into Group 1 with a score ≤ 9 (patients with mild disease activity, N = 41) and Group 2 with a score > 9 (patients with moderate to severe disease activity, N = 33). Neutrophil, lymphocyte, monocyte, platelet, albumin, fibrinogen, NLR, PLR, monocyte to lymphocyte ratio (MLR), FAR, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), complement 3 (C3), complement 4 (C4) and SLEDAI-2K were collected. Receiver operation characteristic (ROC) curves were conducted to discriminate SLE patients from healthy controls and SLE patients with different disease activity. Correlations between the inflammatory markers and SLEDAI-2K were analyzed.

Results:

FAR, NLR, PLR, MLR and fibrinogen in SLE patients were higher compared to those of the healthy controls (P < 0.05), while albumin was lower (P < 0.05). Patients in Group 2 had higher levels of FAR, NLR, PLR, fibrinogen and CRP than those in Group 1 (P < 0.05) except MLR (P = 0.579) and ESR (P = 0.130), albumin and C3 were lower (P < 0.05). Furthermore, FAR were higher in SLE patients with nephritis than those without nephritis (P = 0.009). The ROC curve for differentiating SLE patients from healthy individuals showed that the area under curve (AUC) of FAR (0.801, 95%CI: 0.728 - 0.874) and albumin (0.833, 95%CI: 0.764-0.903) were higher than NLR (0.798, 95%CI: 0.725 - 0.871), PLR (0.680, 95%CI: 0.588 - 0.771), MLR (0.785, 95%CI: 0.712 - 0.859) and fibrinogen (0.645, 95%CI: 0.556 - 0.733). Besides, the ROC curve for predicting the disease activity of SLE patients indicated that the AUC of FAR (0.911, 95%CI: 0. 842 - 0.980) was higher than NLR (0.697, 95%CI: 0.574 - 0.821), PLR (0.695, 95%CI: 0.571 - 0.820), MLR (0.553, 95%CI: 0.415 - 0.691), fibrinogen (0.718, 95%CI: 0.590 - 0.847), CRP (0.672, 95%CI: 0.540 - 0.803), ESR (0.640, 95%CI: 0.510 - 0.770), C3 (0.644, 95%CI: 0.515 - 0.773), C4 (0.544, 95%CI: 0.407 - 0.681) and albumin (0.894, 95%CI: 0.819 - 0.969). FAR was positively correlated with SLEDAI-2K (r = 0.682, P < 0.001), yielding a highest relevance than other inflammatory parameters.

Conclusion:

FAR was significantly elevated in SLE patients compared with healthy subjects and related with the disease activity of SLE. FAR might be a useful inflammatory index to evaluate disease activity in patients with SLE.

References:

[1]Liu M, Huang Y, Huang Z, Zhong Z, Deng W, Huang Z, et al. The role of fibrinogen to albumin ratio in ankylosing spondylitis: Correlation with disease activity. Clin Chim Acta. 2020 Jun; 505:136-140.

Disclosure of Interests:

None declared

POS0133 MONOSODIUM URATE CRYSTALS REDUCE HUMAN LIGAMENT CELLS VIABILITY THROUGH INCREASE OF ROS PRODUCTION

Background:

Ligament destruction is a frequent complication of gout and is strongly associated with tophi. Ligament fibroblasts are important cellular mediators of ligament remodeling. None of study has paid attention to the effects of monosodium urate (MSU) crystals on ligament fibroblasts.

Objectives:

The study aims to investigate the effects and mechanism of MSU crystals on ligament fibroblasts.

Methods:

MSU crystals were added to human ligament fibroblasts(HLFs) cultures or primary ligament cells cultures. Cell counting kit-8 (CCK-8) assay, cell migration assay, Annexin V-FITC/PI assay were conducted. Reactive Oxygen Species(ROS) was tested by ROS Assay Kit.

Results:

The higher concentrations of MSU crystals (0.5-1mg/mL) reduced the viability of HLFs or primary ligament cells after 24 h as assessed by CCK8 assays, with a further reduction in viability observed at the 48 h time point. When observed under light microscopy, HLFs cultured with MSU crystals (0.5mg/mL) appeared unhealthy with fewer cells present. The cell migration ability of HLFs was decreased significantly on MSU crystals (0.5mg/mL). According to the result of Annexin V-FITC/PI assay, the survival rate of HLFs on MSU crystals (0.5mg/mL) was lower than that of 0.25mg/ml and 0 mg/ml at 72h. ROS assay results showed that the production of ROS increased as the concentrations of MSU crystals increased.

Conclusion:

MSU crystals inhibit human ligament cells viability through the increase of ROS production. It may contribute to disordered ligament remodeling in gout patients with ligament destruction.

References:

[1]Ashika Chhana, et al. Monosodium urate crystals reduce osteocyte viability and indirectly promote a shift in osteocyte function towards a proinflammatory and proresorptive state. Arthritis Res Ther. 2018, 20(1): 208.

Figure 1.

MSU crystals reduce human ligament fibroblasts and primary human ligament cells viability over time. A: CCK-8 assay; B: Observation of HLFs morphology; C: Annexin V-FITC/PI assay.

Disclosure of Interests:

None declared

POS0044 T315 SUPPRESSES OSTEOGENIC DIFFERENTIATION IN SAOS-2 CELLS BY INHIBITING PHOSPHORYLATION OF AKT

Background:

New bone formation is common in the late stage of various inflammatory arthritis, while osteoblasts play a vital role in this process. Activation of PI3K/ Akt pathway promotes the differentiation and enhances the function of osteoblasts [1]. T315 is a novel small molecule drug, which may induce apoptosis and suppress the expression of cellular markers of chronic lymphocytic leukemia cells by disrupting PI3K/ Akt pathway [2]. However, the lack of study focuses on the influence of T31T on the other cells, except tumor cell lines.

Objectives:

We aimed to assess the effect of T315 on human osteoblast-like Saos-2 cells, while its potential mechanism in PI3K/ Akt pathway was evaluated as well.

Methods:

(1) Saos-2 was stimulated with an osteogenic reagent which contained L-ascorbic acid, β-glycerophosphoric acid, and dexamethasone. The concentration of T315 was adjusted to 0μg/ml, 1μg/ml, and 2μg/ml in the culture medium. (2) Alizarin red stain and alkaline phosphatase (ALP) stain were performed at d0, d7, d14, and d21 after being treated with T315. (3) Cellular protein was extracted at d0, d3, and d6 after being treated with T315, then ALP activity was tested based on a recommendation from the manufacturer of the kit. (4) Collagen type 1α2 Chain (Col1α2) and osteocalcin (OCN), two osteogenic markers, were measured through western blot, with glyceraldehyde 3-phosphate dehydrogenase (GAPDH) as an endogenous control. (5) Phospho-phosphoinositide 3-kinase (pPI3K), phospho-protein kinase B (pAkt), and runt-related transcription factor 2 (Runx2) was tested through western blot as well. GAPDH or protein kinase (Akt) was chosen as an internal reference as appropriate. (6) Analysis of variance with the least significant difference was used to analyze the data. A P<0.05 was considered statistically significant.

Results:

(1) The higher concentration of T315 related to the less relative mineralized area and the positive area of ALP, while longer incubation time with T315 decreased these regions as well (Figure 1A-C). (2) T315 reduced the activity of ALP accordingly (Figure 1D). (3) T315 suppressed the protein expression of Col1α2 and OCN in a dose-dependent and time-dependent manner (Figure 1E, F). (4) T315 did not alter pPI3K, but it inhibited the phosphorylation of Akt (Figure 1G, H). (5) Runx2 was reduced because of the greater dose or longer incubation time with T315 (Figure 1).

Conclusion:

T315 inhibits the differentiation of osteoblasts through inhibiting the phosphorylation of Akt. Surprisingly, pPI3K seldom changes in this process, so its detail mechanism should be investigated in further.

References:

[1]Exp Biol Med (Maywood) 2020;245(6):552-561.

[2]Blood 2015;125(2):284-295.

Figure 1.

Effect of T315 on Saos-2 cells and PI3K/Akt pathway. (A) Alizarin red stain and ALP stain at d21. (B) Relative mineralized area in Alizarin red stain. (C) Positive area in ALP stain. (D) ALP activity. Western blot analysis and its bands at d6 for Col1α2 (E), OCN (F), pPI3K (G), pAkt (H), and Runx2 (I). Results were normalized by GAPDH or Akt. ALP: Alkaline phosphatase; Col1α2: Collagen type 1α2 Chain; GAPDH: Glyceraldehyde 3-phosphate dehydrogenase; OCN: Osteocalcin; pPI3K: Phospho-phosphoinositide 3-kinase; pAkt: Phospho-protein kinase B; Akt: Protein kinase; Runx2: Runt-related transcription factor 2. a Compared with d3 in the same concentration of T315, P<0.05. b Compared with d0 in the same concentration of T315, P<0.05. c Compared with 1μg/ml T315 in the same incubation time, P<0.05. d Compared with 2μg/ml T315 in the same incubation time, P<0.05.

Disclosure of Interests:

None declared.

POS1144 SERUM URIC ACID TO CREATININE RATIO IS ASSOCIATED WITH URINARY URIC ACID EXCRETION IN PATIENTS WITH GOUT

Background:

Underexcretion of uric acid is the dominant mechanism leading to hyperuricemia [1] and the 24-hour urinary uric acid excretion is an important measurement. However, it is inconvenient due to accurate timing and complete collection of the specimen.

Objectives:

The aim of this study was to investigate the relationship between serum uric acid to creatinine ratio (sUACR) and 24-hour urinary uric acid excretion in gout patients.

Methods:

A total of 110 gout patients fulfilling 2015 ACR/EULAR classification criteria from Guangdong Second Provincial General Hospital from January 2019 to January 2021 were retrospectively enrolled in this study. Patients were divided into underexcretion group (<3600 μmol/24h) and non-underexcretion group (≥3600 μmol/24h). The correlation between sUACR and 24-hour urinary uric acid excretion was analyzed by the Pearson’s correlations analysis. Receiver operation characteristic (ROC) curves were performed to assess the utility of sUACR for discriminating between underexcretion group and non-underexcretion group. Furthermore, the risk factors of uric acid underexcretion were evaluated using binary logistic regression analysis.

Results:

sUACR in the underexcretion group was significantly lower than the non-underexcretion group (p=0.0001). Besides, sUACR was positively correlated with 24-hour urinary uric acid excretion (r=0.4833, p<0.0001). Furthermore, ROC suggested that the area under the curve (AUC) of sUACR was 0.728, which was higher that of serum uric acid and creatinine. The optimal cutoff point of sUACR was 5.2312, with a sensitivity and specificity of 71.9% and 67.9%. Logistic analysis results revealed that decreased sUACR (<5.2312) was an independent risk factor of underexcretion of uric acid (OR =5.510, 95% CI: 1.952-15.550, P=0.001).

Conclusion:

sUACR is lower in gout patients with underexcretion of uric acid and may serve as a useful and convenient marker of assessing underexcretion of uric acid in gout patients.

References:

[1]Perez-Ruiz F, Calabozo M, Erauskin GG, Ruibal A, Herrero-Beites AM. Renal underexcretion of uric acid is present in patients with apparent high urinary uric acid output. Arthritis Rheum 2002; 47: 610–13.

Figure 1.

A. Comparison of serum uric acid to creatinine ratio between underexcretion group and non-underexcretion group. B. Correlation between serum uric acid to creatinine ratio and 24h uric acid excretion.

Disclosure of Interests:

None declared.

AB0642 CLINICAL CHARACTERISTICS AND FACTORS ASSOCIATED WITH BONE EROSION IN GOUT PATIENTS WITH TOPHI

Background:

Bone erosion is a frequent complication of gout patients with tophi and can lead to joint damage, deformity and musculoskeletal disability. Few studies have focused on clinical characteristics and factors associated with bone erosion in gout patients with tophi.

Objectives:

The aim of this study was to describe clinical characteristics of bone erosion in gout patients with tophi.

Methods:

Bone erosion was detected by X-ray. Gout patients with tophi were divided into bone erosion group and non bone erosion group. The clinical characteristics were recorded. Comparison of clinical characteristics and risk factors for bone erosion were analyzed between two groups. Multivariate logistic regression analysis was conducted.

Results:

A total of 171 gout patients with tophi were enrolled, 121 patients with bone erosion and 50 patients without bone erosion. Bone erosion group were older, with prolonged duration with gout and tophi, higher levels of serum creatinine, lower levels of glomerular filtration rate (GFR), C-reactive protein and BMI. In univariate regression analysis, age, gout duration, tophi duration, GFR were associated with bone erosion. In multivariable logistic regression analysis, tophi duration was independently associated with bone erosion.

Conclusion:

Gout patients with bone erosion present different clinical characteristics compared with those without bone erosion. Tophi duration was strongly associated with bone erosion in patients with gout.

Table 1.

Comparison of clinical characteristics between bone erosion patients and non bone erosion patients.

Non Bone erosionBone erosionP ValueN(male)50(47)121(118)0.255Age(year)45.82±14.1553.74±14.880.002BMI (kg/m2)26.01±4.5824.18±4.720.027WBC(109/mL)9.73±3.4011.37±13.260.404PLT(109/mL)329.86±96.22328.31±124.020.938HGB(g/L)86.58±63.78102.75±51.160.201ALT(U/L)37.74 ±26.5634.26±35.260.561sUA(umol/L)540.16±121.79539.00±121.460.962sCr(umol/L)111.47±25.26135.77±52.43<0.001GFR(ml/min/1.73m2)74.01±27.9456.68±22.840.003ESR(mm/h)61.78±37.3253.08±36.700.181CRP(mg/L)60.00±58.2636.45±42.620.014Gout duration (year)9.22±5.4612.63±7.590.001Tophi duration(year)3.77±3.226.64±4.810.001Hypertension, n17520.277Diabetes, n9120.143Smoking history, n20550.513Drinking history, n14370.737Ulceration, n10350.228

Disclosure of Interests:

None declared.

Magnetic ordering in the Ising antiferromagnetic pyrochlore Nd2ScNbO7

The question of structural disorder and its effects on magnetism is relevant to a number of spin liquid candidate materials. Although commonly thought of as a route to spin glass behaviour, here we describe a system in which the structural disorder results in long-range antiferromagnetic order due to local symmetry breaking. Nd₂ScNbO₇is shown to have a dispersionless gapped excitation observed in other neodymium pyrochlores belowT_N= 0.37 K through polarized and inelastic neutron scattering. However the dispersing spin waves are not observed. This excited mode is shown to occur in only 14(2)% of the neodymium ions through spectroscopy and is consistent with total scattering measurements as well as the magnitude of the dynamic moment 0.26(2)μ_B. The remaining magnetic species order completely into the all-in all-out Ising antiferromagnetic structure. This can be seen as a result of local symmetry breaking due disordered Sc⁺³and Nb⁺⁵ions about theA-site. From this work, it has been established thatB-site disorder restores the dipole-like behaviour of the Nd⁺³ions compared to the Nd₂B₂O₇parent series.

Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms

It is important for dental care professionals to reliably assess carbon dioxide (CO₂) levels and ventilation rates in their offices in the era of frequent infectious disease pandemics. This study was to evaluate CO₂ levels in dental operatories and determine the accuracy of using CO₂ levels to assess ventilation rate in dental clinics. Mechanical ventilation rate in air change per hour (ACH_VENT) was measured with an air velocity sensor and airflow balancing hood. CO₂ levels were measured in these rooms to analyze factors that contributed to CO₂ accumulation. Ventilation rates were estimated using natural steady-state CO₂ levels during dental treatments and experimental CO₂ concentration decays by dry ice or mixing baking soda and vinegar. We compared the differences and assessed the correlations between ACH_VENT and ventilation rates estimated by the steady-state CO₂ model with low (0.3 L/min, ACH_SS30) or high (0.46 L/min, ACH_SS46) CO₂ generation rates, by CO₂ decay constants using dry ice (ACH_DI) or baking soda (ACH_BV), and by time needed to remove 63% of excess CO₂ generated by dry ice (ACH_DI63%) or baking soda (ACH_BV63%). We found that ACH_VENT varied from 3.9 to 35.0 in dental operatories. CO₂ accumulation occurred in rooms with low ventilation (ACH_VENT ≤6) and overcrowding but not in those with higher ventilation. ACH_SS30 and ACH_SS46 correlated well with ACH_VENT (r = 0.83, P = 0.003), but ACH_SS30 was more accurate for rooms with low ACH_VENT. Ventilation rates could be reliably estimated using CO₂ released from dry ice or baking soda. ACH_VENT was highly correlated with ACH_DI (r = 0.99), ACH_BV (r = 0.98), ACH_DI63% (r = 0.98), and ACH_BV63% (r = 0.98). There were no statistically significant differences between ACH_VENT and ACH_DI63% or ACH_BV63%. We conclude that ventilation rates could be conveniently and accurately assessed by observing the changes in CO₂ levels after a simple mixing of household baking soda and vinegar in dental settings.

Measurement of the Higgs boson production rate in association with top quarks in final states with electrons, muons, and hadronically decaying tau leptons at s = 13 TeV

The rate for Higgs ( H ) bosons production in association with either one ( t H ) or two ( t t ¯ H ) top quarks is measured in final states containing multiple electrons, muons, or tau leptons decaying to hadrons and a neutrino, using proton-proton collisions recorded at a center-of-mass energy of 13 TeV by the CMS experiment. The analyzed data correspond to an integrated luminosity of 137fb - 1 . The analysis is aimed at events that contain H → W W , H → τ τ , or H → Z Z decays and each of the top quark(s) decays either to lepton+jets or all-jet channels. Sensitivity to signal is maximized by including ten signatures in the analysis, depending on the lepton multiplicity. The separation among t H , t t ¯ H , and the backgrounds is enhanced through machine-learning techniques and matrix-element methods. The measured production rates for the t t ¯ H and t H signals correspond to 0.92 ± 0.19 (stat) - 0.13 + 0.17 (syst) and 5.7 ± 2.7 (stat) ± 3.0 (syst) of their respective standard model (SM) expectations. The corresponding observed (expected) significance amounts to 4.7 (5.2) standard deviations for t t ¯ H , and to 1.4 (0.3) for t H production. Assuming that the Higgs boson coupling to the tau lepton is equal in strength to its expectation in the SM, the coupling y t of the Higgs boson to the top quark divided by its SM expectation,κ t = y t / y t SM , is constrained to be within - 0.9 < κ t < - 0.7 or 0.7 < κ t < 1.1 , at 95% confidence level. This result is the most sensitive measurement of the t t ¯ H production rate to date.

Effects of IFNG-AS1 and ANRIL on intestinal epithelial cells and their relationship with colitis

OBJECTIVE

To explore the effects of IFNG-AS1 and ANRIL on intestinal epithelial cells and their relationship with colitis.

PATIENTS AND METHODS

From May 2017 to May 2019, 118 colitis patients admitted to our hospital were selected as the research group (RG), and 124 healthy controls were selected as the control group (CG). In addition, the normal intestinal epithelial cells HIEC and HIEC-6 were purchased to detect the IFNG-AS1 and ANRIL in the peripheral blood of patients in the two groups, and the effects of IFNG-AS1 and ANRIL on the intestinal epithelial cells were analyzed.

RESULTS

IFNG-AS1 and ANRIL were highly expressed in colitis (p<0.050), and their combined detection had good diagnostic value for the occurrence of colitis and complications (p<0.050). In intestinal epithelial cells transfected with IFNG-AS1 and ANRIL, it was found that inhibition of IFNG-AS1 and ANRIL remarkably increased the proliferation and decreased the apoptosis of intestinal epithelial cells (p<0.050).

CONCLUSIONS

IFNG-AS1 and ANRIL are highly expressed in colitis, and inhibiting their expression can promote the proliferation of intestinal epithelial cells and reduce apoptosis, which may be potential therapeutic targets for Crohn's colitis in the future.

Effectiveness and Safety of an Inactivated Enterovirus 71 Vaccine in Children Aged 6-71 Months in a Phase IV Study

BACKGROUND

Evaluation of a licensed inactivated enterovirus type 71 (EV71) vaccine is needed in a phase IV study with a large population to identify its effectiveness and safety for further application.

METHODS

An open-label, controlled trial involving a large population of 155 995 children aged 6-71 months was performed; 40 724 were enrolled in the vaccine group and received 2 doses of inactivated EV71 vaccine at an interval of 1 month, and the remaining children were used as the control group. The EV71-infected cases with hand, foot, and mouth disease were monitored in the vaccine and control groups during a follow-up period of 14 months since the 28th day postinoculation through the local database of the Notifiable Infectious Diseases Network. The effectiveness of the vaccine was estimated by comparing the incidence density in the vaccine group versus that in the control group based upon EV71-infected patients identified via laboratory testing. In parallel, the active and passive surveillance for safety of the vaccine was conducted by home or telephone visits and by using the Adverse Event Following Immunization (AEFI) system, respectively.

RESULTS

An overall level of 89.7% (95% confidence interval, 24.0-98.6%) vaccine effectiveness against EV71 infection and a 4.58% rate of reported adverse events were observed. Passive surveillance demonstrated a 0.31% rate of reported common minor reactions.

CONCLUSIONS

The clinical protection and safety of the EV71 vaccine were demonstrated in the immunization of a large population.

CLINICAL TRIALS REGISTRATION

NCT03001986.

[Changes of guanylate cyclase C in colon tissues of rats with intestinal injury associated with severe acute pancreatitis]

OBJECTIVE

To explore the dynamic changes of guanylate cyclase C (GC-C) in the colon tissues of rats with intestinal injury associated with severe acute pancreatitis (SAP).

OBJECTIVE

Thirty-six SD rats were randomized equally into two groups to receive either sham operation or retrograde pumping of 5% sodium taurocholate (0.1 mL/100 g) into the pancreaticobiliary duct following laparotomy to induce SAP. At 12, 24, and 48 h after modeling, 6 rats from each group were euthanized and the colon tissues were collected for Western blotting, immunohistochemistry and RT-PCR to determine the changes in GC-C expression, and the lowest GC-C expression was deemed to indicate the most serious intestinal injury and the time window for intervention. Another 18 SD rats were randomized into 3 groups for sham operation, SAP modeling or intragastric administration of linaclotide (a GC-C agonist) solution once daily at the dose of 10 μg/kg. At 12 h after modeling, the pathological changes in the pancreas and colon were observed with HE staining; the serum level of AMY, DAO, D-Lac and TNF-α were measured with ELISA, and the expressions of GC-C and claudin-1 were detected using Western blotting, immunohistochemical and transmission electron microscopy.

OBJECTIVE

The expression of GC-C was significantly reduced in the colon of rats in SAP group, and its lowest expression occurred at 12 h after modeling (P < 0.05) followed by gradual increase over time. Claudin-1 showed a similar trend in the colon. Compared with the sham-operated rats, the rats in SAP and Linaclotide groups showed significantly increased pathological scores of the colon tissues (P < 0.05) and serum levels of AMY, DAO, D-Lac and TNF-α and decreased expressions of GC-C and claudin-1 in the colon (P < 0.05). Compared with those in SAP group, the rats in linaclotide group had significantly lower colonic histopathological scores, lower serum levels of AMY, DAO, D-Lac and TNF-α, and higher expression levels of GC-C and claudin-1 in the colon tissue.

OBJECTIVE

In rats with SAP-related intestinal injury, the expression of GC-C in the colon tissue decreases to the lowest level at 12 h after SAP onset followed by gradual increase. activating GC-C can increase the expression levels of GC-C and claudin-1 and alleviate intestinal injury, suggesting the role of GC-C in maintaining intestinal barrier integrity by regulating the expression of tight junction proteins.

Medical ozone induces proliferation and migration inhibition through ROS accumulation and PI3K/AKT/NF-κB suppression in human liver cancer cells in vitro

BACKGROUND

Hepatocellular carcinoma is one of the most common malignancies and leading cancer-associated deaths worldwide. Ozone has been proposed as a promising therapeutic agent in the treatment of various disorders.

PURPOSE

The purpose of this paper is to assess the potential anticancer effects of the ozone on liver cancer cells.

METHOD

The liver cancer cell line of bel7402 and SMMC7721 was used in this study. Proliferation was evaluated using the CCK-8 and the colony formation assay. Wond healing assay and transwell assay without Matrigel were used to evaluate their migration ability. Flow cytometry was used for cell cycle analysis and reactive oxygen species (ROS) determination. Glutathione detection kit was used for measurement of glutathione level. Protein expression was estimated by western blot analysis.

RESULTS

Ozone treatment inhibited liver cancer cell proliferation, colony formation. Ozone induced G2/M phase cell cycle arrest, which could be elucidated by the change of protein levels of p53, p21, Cyclin D1, cyclin B1, cdc2, and CDK4. We also found that ozone treatment inhibited migration ability by inhibiting EMT-relating protein. Ozone also induced ROS accumulation and decreased glutathione level decreased, which contributed to the inactivation of the PI3K/AKT/NF-κB pathway. Finally, we found that pre-treatment of liver cancer cells with N-acetylcysteine resisted ozone-induced effects.

CONCLUSIONS

Ozone restrains the proliferation and migration potential and EMT process of liver cancer cells via ROS accumulation and PI3K/AKT/NF-κB suppression.

Acellular bovine pericardium matrix in immediate breast reconstruction compared with conventional implant-based breast reconstruction

Background

Acellular Bovine Pericardium Matrix (ABPM) is a new material in implant-based breast reconstruction (IBBR). Few studies have reported on its outcome and complications worldwide and most studies were without a control group. Our aim was to compare its use in IBBR with the other two conventional implant-based reconstruction methods.

Methods

A retrospective review of patients undergoing IBBR from January to December 2018 was performed. Patients were assigned to the ABPM-assisted IBBR (group A), latissimus dorsi-assisted IBBR (group B) and two-stage IBBR (group C). Patients’ post-operative complications, cost-effectiveness and Quality of Life were compared.

Results

100 patients with 100 breasts were included in the study. No complications occurred in group C (n = 11). No significant differences were noted between group A (n = 44) and group B (n = 45) in terms of overall complications (9.1% vs 11.1%, p = 0.973). Group B had the longest operative duration (310.8 ± 62.3 min, p<0.001). The cost of hospitalization forthe three groups was $8051.3 ± 849.2, $7566.0 ± 1172.7 and $7896.5 ± 1762.2, respectively (p = 0.128). The postoperative Breast-Q scores  were similar across the three groups.

Conclusions

ABPM demonstrated acceptable complication rates, cost-effectiveness and quality of life outcomes when compared to LD-assisted IBBR and two-stage IBBR.

[Use of new diagnostic criteria for reclassification of polyarteritis nodosa]

With the recognition of antineutrophil cytoplasmic antibodies (ANCA)-related vasculitis and widespread vaccination against viral hepatitis B, the prevalence of polyarteritis nodosa (PAN) varied considerably. In our study, patients diagnosed as polyarteritis nodasa (PAN)based on the 1990 American College of Rheumatology(ACR) criteria were reclassified using 2007 European Medicines Agency(EMA) algorithm modified by 2012 Chapel Hill Consensus Conference(CHCC) definitions, aiming to evaluate the new classification criteria for the diagnosis of PAN. A total of 113 PAN patients admitted to Peking Union Medical College Hospital from January 2002 to December 2018 were retrospectively analyzed, who were classified into three subtypes including 9 patients with cutaneous, 80 with classic and 24 Hepatitis B virus (HBV) associated PAN. All patients were reclassified according to 2007 EMA algorithm using CHCC 2012 definitions. As a result, 7 patients were diagnosed as microscopic polyangiitis(MPA) and 19 patients with unclassified vasculitis based on the new classification criteria. The diagnostic rate of PAN was gradually declined as the classification criteria of vasculitides was update. However, there are quite a few PAN patients in China, whom rheumatologists should pay attention to the early diagnosis and treatment.

Measurements of p p → Z Z production cross sections and constraints on anomalous triple gauge couplings at s = 13 TeV

The production of Z boson pairs in proton-proton ( p p ) collisions, p p → ( Z / γ ∗ ) ( Z / γ ∗ ) → 2 ℓ 2 ℓ ' , where ℓ , ℓ ' = e or μ , is studied at a center-of-mass energy of 13TeV with the CMS detector at the CERN LHC. The data sample corresponds to an integrated luminosity of 137fb - 1 , collected during 2016-2018. The Z Z production cross section,σ tot ( p p → Z Z ) = 17.4 ± 0.3 (stat) ± 0.5 (syst) ± 0.4 (theo) ± 0.3 (lumi) pb , measured for events with two pairs of opposite-sign, same-flavor leptons produced in the mass region 60 < m ℓ + ℓ - < 120 GeV is consistent with standard model predictions. Differential cross sections are also measured and agree with theoretical predictions. The invariant mass distribution of the four-lepton system is used to set limits on anomalous Z Z Z and Z Z γ couplings.

Photoproduction of the f_{2}(1270) Meson Using the CLAS Detector

The quark structure of the f_{2}(1270) meson has, for many years, been assumed to be a pure quark-antiquark (qq[over ¯]) resonance with quantum numbers J^{PC}=2^{++}. Recently, it was proposed that the f_{2}(1270) is a molecular state made from the attractive interaction of two ρ mesons. Such a state would be expected to decay strongly to final states with charged pions due to the dominant decay ρ→π^{+}π^{-}, whereas decay to two neutral pions would likely be suppressed. Here, we measure for the first time the reaction γp→π^{0}π^{0}p, using the CEBAF Large Acceptance Spectrometer detector at Jefferson Lab for incident beam energies between 3.6 and 5.4 GeV. Differential cross sections, dσ/dt, for f_{2}(1270) photoproduction are extracted with good precision due to low backgrounds and are compared to theoretical calculations.

Beam Spin Asymmetry in Semi-Inclusive Electroproduction of Hadron Pairs

A first measurement of the longitudinal beam spin asymmetry A_{LU} in the semi-inclusive electroproduction of pairs of charged pions is reported. A_{LU} is a higher-twist observable and offers the cleanest access to the nucleon twist-3 parton distribution function e(x). Data have been collected in the Hall-B at Jefferson Lab by impinging a 5.498-GeV electron beam on a liquid-hydrogen target, and reconstructing the scattered electron and the pion pair with the CLAS detector. One-dimensional projections of the A_{LU}^{sinϕ_{R}} moments are extracted for the kinematic variables of interest in the valence quark region. The understanding of dihadron production is essential for the interpretation of observables in single-hadron production in semi-inclusive DIS, and pioneering measurements of single-spin asymmetries in dihadron production open a new avenue in studies of QCD dynamics.

[The efficacy of hemostatic powder for chronic rhinosinusitis in endoscopic sinus surgery: a prospective, randomised, controlled and single blinded clinical trial]

Objective: To study the efficacy and patient comfort of absorbable hemostatic powder after endoscopic sinus surgery (ESS). Methods: A total of 21 (17 males, 4 females) patients with an average age of 42(ranging from 18 to 65) underwent bilateral ESS for chronic rhinosinusitis(CRS) in Beijing Tongren Hospital, Capital Medical University between October 2015 and July 2019 were enrolled to compare the effect of absorbable hemostasis powder with Nasopore using an intrapatient control design. A randomized controlled trial was conducted in the left and right nasal cavities of the same patient. If hemostatic powder was applied in the experiment nasal cavity, the Nasopore was applied in the control nasal cavity. The mean preoperative sinus computed tomography (CT) score was 6.25. All patients competed for symptom diaries using a visual analog scale (VAS, score out of 10) at baseline, through 1, 7, 14 and 30 days. Outcomes including bleeding, facial pain, nasal obstruction, nasal discharges using VAS were recorded separately for both sides. Postoperative endoscopic scores were also investigated. SPSS 22 and Graphpad prism 8.0 statistical softwares were used for the analysis. Paired t-test or nonparametric test was used between the test side and the control side. The difference was statistically significant (P<0.05). Results: The bleeding score and total nasal symptom VAS scores at postoperative days (POD) 1, 7, 14 and 30 were not significantly different(t=1.341, 0.552, 0.631, 0.158, all P>0.05;t=0.944, 1.471, 1.612, 2.251, all P>0.05). There was no significant difference between absorbable hemostasis powder and Nasopore side on POD 1, 7, 14 and 30 in terms of each nasal symptom VAS scores(all P>0.05). On POD 1, 7 and 14, the packing material degeneration scores of the absorbable hemostasis powder side were significantly lower than those of the Nasopore side [(1.33±0.21)vs(2.00±0.00),(0.38±0.18) vs (1.95±0.22), 0 vs (1.80±0.13), all P<0.01]. There were significant differences between absorbable hemostasis powder and Nasopore side on POD 1, 7, 14 and 30 in terms of endoscopic scores (edema, crusting, discharges, scar, polyps and material degeneration, t=3.07, 7.00, 6.41, 2.69, all P<0.05). Conclusions: The absorbable hemostasis powder and Nasopore has similar postoperative hemostasis effect. The absorbable hemostasis powder is rapidly cleared and without negative effects on mucosal wound healing 14 days postoperatively.

Orbital competition of Mn3+ and V3+ ions in Mn1+x V2-x O4

The structural and magnetic properties of Mn1+x V2-x O4 (0 < x ⩽ 1) have been investigated by the heat capacity, magnetization, x-ray diffraction and neutron diffraction measurements, and a phase diagram of temperature versus composition was built up. For x ⩽ 0.3, a cubic-to-tetragonal (c > a) phase transition was observed. For x > 0.3, the system maintained the tetragonal lattice. Although the collinear and noncollinear magnetic transitions of V3+ ions were obtained in all compositions, the canting angles between the V3+ ions decreased with Mn3+-doping, and the ordering of the Mn3+ ions was only observed as x > 0.4. In order to study the dynamics of the ground state, the first principles simulation was applied to analyze not only the orbital effects of Mn2+, Mn3+, and V3+ ions, but also the related exchange energies.