A novel function of CREG in metabolic disorders

Metabolic disorders are public health problems that require prevention and new efficient drugs for treatment. Cellular repressor of E1A-stimulated genes (CREG) is ubiquitously expressed in mature tissues and cells in mammals and plays a critical role in keeping cells or tissues in a mature, homeostatic state. Recently, CREG turns to be an important mediator in the development of metabolic disorders. Here in this review, we briefly discuss the structure and molecular regulation of CREG along with the therapeutic strategy to combat the metabolic disorders.

[Effects of eye exercises on axial eye elongation in junior students]

Objective: To evaluate the association between the eye exercises and one-year axial eye elongation in grade 7 students in Beijing. Methods: Sampling was performed using a multistage random cluster approach, and 1 443 students of grade 7 were selected from 9 middle schools in 6 districts for the baseline survey. Data were collected by questionnaires and axial length measurement. Multiple linear regression analysis was used to evaluate the association between eye exercises and excessive axial eye elongation. Results: Among 1 197 (82.95%) students with complete information, the median (Q_R) age was 12.00 (1.00) years old, girls accounted for 44.28%, and the median (Q_R) axial eye elongation was 0.22 (0.18) mm. In the multiple linear regression analysis, the frequency of eye exercises was significantly correlated with excessive axial eye elongation in boys (β=-0.135, 95%CI:-0.253--0.018) but not in girls (β=-0.075, 95%CI:-0.207- 0.058) after adjusting for sex, age, body height, the number of myopic parents, time spent outdoors and time spent on reading and writing outside class; while the seriousness of eye exercises was not significantly associated with axial eye elongation in boys (β=-0.028, 95%CI: -0.114-0.058) and girls (β=-0.035, 95%CI: -0.134-0.064). Conclusion: The increased frequency of eye exercises is beneficial to control the axial eye elongation in boys in Beijing.

[Clinicopathological features of malignant mixed mesodermal tumor: analysis of 50 cases]

Objective: To investigate the clinicpathological, immunohistochemical and molecular genetic features of malignant mixed mesodermal tumor (MMMT) in the female reproductive system. Methods: To analyze its histopathological characteristics, we performed a retrospective review of the MMMT cases diagnosed at PLA General Hospital, Beijing, China during 2005-2019 using its surgical and pathological databases. EnVision immunohistochemical staining was used to detect the expression of ER, PR, p16, p53 and MMR proteins. Results: Fifty cases were conformed to the diagnosis, including 29 cases originated in the uterus, 16 cases in ovary, 4 cases of synchronous occurrence in uterus and ovary, 1 case in cervix. The tumor was histologically composed of two components, namely carcinoma and sarcoma ones, with clear borderline or blend mutually. The proportion of cancer component in the whole tumor ranged from 5%-90%. The proportion of carcinoma was more than 50% in 76% of the cases, and less than 50% in 24% of cases, including 2 cases with<10% of carcinoma. In the cases of primary uterine MMMT, the main carcinoma type was high grade endometrioid carcinoma (55%, 16/29). In ovarian MMMT, the main carcinoma type was serous carcinoma (12/16), while that of cervical MMMT was squamous cell carcinoma. The others were clear cell carcinoma or the undifferentiated carcinoma. There was one carcinoma type in most cases, only 7 cases had two carcinoma types. Homologous sarcomas, including stromal sarcoma, leiomyosarcoma and high-grade spindle cell sarcomas, were more commonly found in uterine MMMT (72.4%, 21/29). While heterogenic sarcomas, including chondrosarcoma, osteosarcoma and rhabdomyosarcoma, were more commonly noted in ovarian MMMT (12/16) than MMMT of other sites. There were 10 cases that consisted of two types of sarcomas. The synchronous MMMT of uterus and ovary had similar morphology and the types of carcinoma and sarcoma. The tumor cells that spread or metastasized to lymph node, omentum, intestinal wall or skin were all carcinoma cells, and were morphologically consistent with the original tumors. Immunohistochemically, ER and PR were both negative (23/25 in uterine, 8/10 in ovarian tumors). p16 was strongly positive (11/11 in uterine tumors, and 6/6 in ovarian tumors), with similar expression patterns in the carcinoma and sarcoma components. p53 showed mutant-type staining (64%, 21/33) and expressed synchronously in carcinoma and sarcoma components. p53 mutation was found in 35% cases of endometrial carcinoma and 46.7% cases of non-endometrial carcinoma. p53 mutation was also found in only 31.8% cases of heterogenic sarcomas, but in 50% of non-heterogenic sarcomas. Twenty-eight cases (28/33, 85%) presented intact mismatch repair proteins, while 5 cases (5/33, 15%) presented deficient mismatch repair proteins. Conclusions: MMMT in female reproductive system is a rare high-grade biphasic tumor with complex and diverse morphology. The immunohistochemical features are characterized by negative ER/PR and strongly positive p16, mostly mutant p53 and proficient mismatch repair proteins. The patients with a high FIGO stage have worse prognosis.

Long noncoding RNA PR11-387H17.6 as a potential novel diagnostic biomarker of atherosclerotic renal artery stenosis

BACKGROUND

Atherosclerotic renal artery stenosis (ARAS) is frequently related to ischemic nephropathy, secondary hypertension, and end-stage renal failure. Thus, this study aimed to explore whether certain circulating long noncoding RNAs (lncRNAs) may be used as potential specific ARAS biomarkers.

METHODS

In the present study, a microarray analysis was performed to screen for lncRNAs in renal artery tissue from four ARAS patients and four non-ARAS individuals. To identify specific lncRNAs as candidate potential biomarkers of ARAS, we used the following criteria: the fold change was set to >3.0 (compared with non-ARAS tissues), and p value cutoff was set at .05. According to these criteria, six lncRNAs were identified from 1150 lncRNAs. After validation by quantitative PCR (qPCR), these lncRNAs were independently validated in blood from groups of 18 ARAS patients, 18 non-ARAS individuals, and 18 healthy volunteers, furthermore, the predictive value of lncRNA PR11-387H17.6 was further assessed using blood from groups of 99 ARAS patients, 49 non-ARAS individuals, and 50 healthy volunteers. A receiver operating characteristic (ROC) curve analysis was performed to assess the performance of these lncRNAs as biomarkers.

RESULTS

In the ROC analysis, the area under the curve (AUC) of PR11-387H17.6 was 0.733, with 52.5% sensitivity and 84.8% specificity in predicting the occurrence of ARAS. After considering the risk factors, the AUC of PR11-387H17.6 was 0.844, and the optimal sensitivity increased from 52.5% to 74.5%, although the specificity decreased from 84.8% to 81.9%. In the multivariable logistic analysis, PR11-387H17.6 was an independent predictor of major adverse events (OR: 3.039; 95% CI: 1.388-6.654; p= .006).

CONCLUSIONS

PR11-387H17.6 is a potential diagnostic biomarker of ARAS. The lncRNA levels in blood cells are regulated in ARAS. Thus, further investigations of the role of lncRNAs in ARAS are warranted.

P–420 uncomplicated oocyte donation pregnancies display elevated CD163 positive type 2 macrophage load in the decidua, which is associated with fetal-maternal HLA class II mismatches

Study question

Do quantity and composition of decidual macrophages differ between uncomplicated oocyte donation (OD) pregnancies and non-OD in vitro fertilization (IVF) pregnancies?

Summary answer

OD placentas show higher decidual CD163 positive fraction within the total macrophage population compared to non-OD IVF placentas.

What is known already

The embryo of an OD pregnancy is completely allogeneic to the mother, which may lead to a bigger challenge for the maternal immune system to tolerize the fetus compared to autologous pregnancies. Placental macrophages may be essential in maintaining a healthy pregnancy. Macrophages can be classified into different categories based on phenotype and characteristics, in which type 2 macrophages are thought to exhibit immune suppressive activity.

Study design, size, duration

This retrospective case-control study included patients who delivered in the Leiden University Medical Center between January 1st 2006 and July 1st 2016. A total of 42 pregnancies were enrolled in this study, conceived by uncomplicated singleton OD pregnancies (n = 25) or non-OD IVF pregnancies (n = 17). Medical records were reviewed and clinical data were collected. Placental tissue samples were collected for immunohistochemical staining and blood samples were collected for HLA typing.

Participants/materials, setting, methods

Placentas were collected and immunohistochemically stained for CD14 (pan-macrophage marker) and CD163 (type 2 macrophage marker). The extent of staining was quantitated by digital image analysis software. To assess mismatching, maternal and fetal DNA was typed for HLA-A, -B, C, -DRB1, and -DQB1.

Main results and the role of chance

A significantly lower percentage of CD14 positive staining was observed in the decidua basalis of OD pregnancies compared to non-OD IVF pregnancies (p = 0.030). Consequently, the CD163/CD14 ratio in OD group was higher than in non-OD IVF group (p = 0.243). In the parietalis, OD pregnancies demonstrated a significantly higher percentage of CD163+ staining (p = 0.040) and a significantly higher CD163/CD14 ratio (p = 0.032) compared to non-OD IVF group. The reproducibility of this quantitative analysis was found to be high. OD group was separated into a syngeneic group (number of mismatches lower than half of the antigens per HLA locus) and an allogeneic group (number of mismatches higher than half of the antigens per HLA locus). Significant differences of CD163+ and CD163/CD14 ratio were found in the decidua parietalis when comparing the HLA-classII-allogeneic OD group with the non-OD IVF group (p = 0.047). This difference was not found for the HLA-class-II-syngeneic OD group.

Limitations, reasons for caution

Our study only focused on decidua basalis and parietalis, no other locations in the placentas. Larger sample size might be needed to verify the association between macrophages and HLA mismatches.

Wider implications of the findings: To our knowledge, this study is the first to quantify a higher CD163 positive M2 macrophages load within the total decidual macrophages of uncomplicated OD pregnancy compared to non-OD IVF pregnancies.

Trial registration number

Not applicable

P-420 Pre-selected for an award: Uncomplicated oocyte donation pregnancies display elevated CD163 positive type 2 macrophage load in the decidua, which is associated with fetal-maternal HLA class II mismatches

Study question

Do quantity and composition of decidual macrophages differ between uncomplicated oocyte donation (OD) pregnancies and non-OD in vitro fertilization (IVF) pregnancies?

Summary answer

OD placentas show higher decidual CD163 positive fraction within the total macrophage population compared to non-OD IVF placentas.

What is known already

The embryo of an OD pregnancy is completely allogeneic to the mother, which may lead to a bigger challenge for the maternal immune system to tolerize the fetus compared to autologous pregnancies. Placental macrophages may be essential in maintaining a healthy pregnancy. Macrophages can be classified into different categories based on phenotype and characteristics, in which type 2 macrophages are thought to exhibit immune suppressive activity.

Study design, size, duration

This retrospective case-control study included patients who delivered in the Leiden University Medical Center between January 1st 2006 and July 1st 2016. A total of 42 pregnancies were enrolled in this study, conceived by uncomplicated singleton OD pregnancies (n = 25) or non-OD IVF pregnancies (n = 17). Medical records were reviewed and clinical data were collected. Placental tissue samples were collected for immunohistochemical staining and blood samples were collected for HLA typing.

Participants/materials, setting, methods

Placentas were collected and immunohistochemically stained for CD14 (pan-macrophage marker) and CD163 (type 2 macrophage marker). The extent of staining was quantitated by digital image analysis software. To assess mismatching, maternal and fetal DNA was typed for HLA-A, -B, C, -DRB1, and -DQB1.

Main results and the role of chance

A significantly lower percentage of CD14 positive staining was observed in the decidua basalis of OD pregnancies compared to non-OD IVF pregnancies (p = 0.030). Consequently, the CD163/CD14 ratio in OD group was higher than in non-OD IVF group (p = 0.243). In the parietalis, OD pregnancies demonstrated a significantly higher percentage of CD163+ staining (p = 0.040) and a significantly higher CD163/CD14 ratio (p = 0.032) compared to non-OD IVF group. The reproducibility of this quantitative analysis was found to be high. OD group was separated into a syngeneic group (number of mismatches lower than half of the antigens per HLA locus) and an allogeneic group (number of mismatches higher than half of the antigens per HLA locus). Significant differences of CD163+ and CD163/CD14 ratio were found in the decidua parietalis when comparing the HLA-classII-allogeneic OD group with the non-OD IVF group (p = 0.047). This difference was not found for the HLA-class-II-syngeneic OD group.

Limitations, reasons for caution

Our study only focused on decidua basalis and parietalis, no other locations in the placentas. Larger sample size might be needed to verify the association between macrophages and HLA mismatches.

Wider implications of the findings

To our knowledge, this study is the first to quantify a higher CD163 positive M2 macrophages load within the total decidual macrophages of uncomplicated OD pregnancy compared to non-OD IVF pregnancies.

Trial registration number

not applicable

Asymmetric expression patterns of B- and C-class MADS-box genes correspond to the asymmetrically specified androecial identities of Canna indica

Canna indica is a common ornamental plant with asymmetric flowers having colourful petaloid staminodes. The only fertile stamen comprises a one-theca anther and a petaloid appendage and represents the lowest stamen number in the order Zingiberales. The molecular mechanism for the asymmetric androecial petaloidy remains poorly understood. Here, we studied the identity specification in Canna stamen. We observed four types of abnormal flower in terms of androecium identity transformation and analysed the corresponding floral symmetry changes. We further tested the expression patterns of B- and C-class MADS-box genes using in situ hybridization in normal Canna stamen. Homeotic conversions in the androecium were accompanied by floral symmetry changes, and the asymmetric stamen is key in contributing to the floral asymmetry. Both B- and C-class genes exhibited higher expression levels in the anther primordium than in other androecial parts. This asymmetric expression pattern precisely corresponded to the asymmetric identities of the Canna androecium. We identified C. indica as a model species for studying androecial organ identity and floral symmetry synthetically in Zingiberales. We hypothesized that homeotic genes specify floral organ identity in a putative dose-dependent manner. The results add to the current understanding of organ identity-related floral symmetry.

Effect of miR-132 on lung injury in sepsis rats via regulating Sirt1 expression

OBJECTIVE

The aim of this study was to explore the effects of the expressions of micro ribonucleic acid (miR)-132 and sirtuin1 (Sirt1) on lung injury in sepsis rats, and to elucidate the regulatory relation between miR-132 and Sirt1.

MATERIALS AND METHODS

The model of sepsis-induced lung injury was successfully established in rats via injection of lipopolysaccharide (LPS) into the caudal vein (model group). Before modeling, the rats were infused with miR-132 antagomir via the trachea (miR-132 antagomir group) or intraperitoneally injected with the Sirt1 activator (SRT1720) (SRT1720 group). Meanwhile, the rats injected with an equal volume of normal saline via the caudal vein were enrolled in the control group. The expressions of the inflammatory factors interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were determined using enzyme-linked immunosorbent assay (ELISA). Quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) and Western blotting were applied to detect gene and protein expressions in lung tissues, respectively. Targeted relationship between miR-132 and Sirt1 was explored using Luciferase reporter assay. In addition, tissue sections of the right lung were stained with hematoxylin-eosin (HE) to observe the degree of lung injury.

RESULTS

The model of sepsis-induced lung injury was successfully established in rats by LPS. The results showed that the expressions of IL-6, IL-1β, TNF-α and miR-132 rose significantly in lung tissues (p<0.01), whereas the expression of Sirt1 significantly declined (p<0.01). Lung injury was alleviated by miR-132 antagomir and SRT1720. Both miR-132 antagomir and SRT1720 significantly reduced the expressions of miR-132, IL-6, IL-1β and TNF-α (p<0.01). However, the expression of Sirt1 was remarkably upregulated in rats with lung injury (p<0.01). Luciferase reporter gene assay indicated that miR-132 regulated Sirt1 in a targeted manner.

CONCLUSIONS

MiR-132 may cause lung injury in sepsis rats by regulating the expression of Sirt1.

POS0754 DEVELOPMENT OF A RISK PREDICTION MODEL FOR VENOUS THROMBOEMBOLISM IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: THE SLE-VTE SCORE

Background:

Patients with systemic lupus erythematosus (SLE) have a substantially increased risk of venous thromboembolism (VTE). An individual VTE risk assessment is important to ensure that all patients are assessed and given adequate thromboprophylaxis.

Objectives:

We conducted this study to develop a risk score for VTE in patients with SLE.

Methods:

Patients with SLE who participated in the Chinese SLE Treatment and Research group were enrolled in this study. Patient baseline information and clinical laboratory indicators were obtained, and VTE events were recorded every 3-6 months during follow-up visits. The risk prediction model was created and internally validated using the bootstrap methods, and a scoring system was established (Figure 1).

Figure 1.

Flow chart of study design.

Results:

Out of 4,502 patients included in this study, 135 had a VTE event. After univariate analysis and Lasso regression, the following 11 variables were identified and included in the risk prediction model: male sex, age, BMI ≥25 kg/m2, hyperlipidemia, hypoalbuminemia, hsCRP>3 mg/L, renal involvement, nervous system involvement, anti-β2-glycoprotein I antibody positivity, lupus anticoagulant positivity, and no use of hydroxychloroquine. The AUC for the SLE-VTE score (Table 1) was 0.947 (95% CI, 0.9249-0.9694). The SLE-VTE score’s sensitivity and specificity with the optimal cutoff value of 13 were 0.919 and 0.881, respectively. The SLE-VTE score was superior to the GAPSS system in predicting the risk of VTE in patients with SLE (AUC= 0.947 vs. 0.680, P< 0.001; integrated discrimination improvement (IDI)= 0.6652, P< 0.001; net reclassification improvement (NRI)= 0.6652, P< 0.001).

Table 1.

Final multivariable analysis for venous thromboembolism risk in patients with SLE

β coefficientsOdds ratio* (95% CI)P-valuePoints in scoring systemMale0.6211.86(0.953-3.503)0.0612Age at study entry(≥50)0.8372.308(1.339-3.915)0.0023BMI02(kg/m20.7922.209(1.333-3.627)0.0023Hyperlipemia0.8382.313(1.246-4.166)0.0063Hypoalbuminemia2.1638.697(5.185-14.794)< 0.0017hsCRP>3 mg/L1.4524.272(2.618-6.968)< 0.0015Anti β2GPI1.0132.754(1.543-4.853)0.0013LA1.5594.752(2.799-8.072)< 0.0015Nervous system2.38210.832(6.163-18.998)< 0.0018Lupus nephritis0.8352.305(1.414-3.756)0.0013No use of hydroxychloroquine1.7715.876(3.722-9.401)< 0.0016

BMI: body mass index; hsCRP: Hypersensitive c-reactive protein; ACL: anticardiolipin, antiβ2GPI: anti-β2-glycoprotein I, LA: lupus anticoagulantm;

Values in bold are statistically significant at p <0.05.

Conclusion:

Various factors are related to the occurrence of VTE in patients with SLE. The proposed SLE-VTE risk score can accurately predict the risk of VTE and help identify SLE patients with a high risk of VTE who may benefit from thromboprophylaxis.

References:

[1]Ramirez GA, Efthymiou M, Isenberg DA, Cohen H. Under crossfire: thromboembolic risk in systemic lupus erythematosus. Rheumatology. 2018;58:940-952.

[2]Chung WS, Lin CL, Chang SN, Lu CC, Kao CH. Systemic lupus erythematosus increases the risks of deep vein thrombosis and pulmonary embolism: a nationwide cohort study. J Thromb Haemost. 2014;12:452-458.

[3]Liew NC, Alemany GV, Angchaisuksiri P, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. Int Angiol. 2017;36:1.

[4]Savino S, Giovanni S, Veronica M, Dario R, Khamashta MA, Laura BM. GAPSS: the Global Anti-Phospholipid Syndrome Score. Rheumatology. 2013:8.

[5]Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41:543-603.

[6]Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Nguyen NT, Stamos MJ. A Nationwide Analysis of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Colon and Rectal Surgery. J Gastrointest Surg. 2014;18:2169-2177.

Disclosure of Interests:

None declared

OP0290 CLINICAL CHARACTERISTICS AND PROGNOSIS OF ANTIPHOSPHOLIPID SYNDROME PATIENTS BASED ON CLUSTER ANALYSIS: A 10-YEAR COHORT STUDY

Background:

APS is an autoimmune disease characterized by persistent antiphospholipid antibodies (aPLs) positivity, leading to thrombotic events or pregnancy morbidity. High-risk aPLs profiles included positive lupus anticoagulant (LA) and multiple aPLs positivity1. Association was also found between aPLs and a variety of manifestations beyond thrombosis, referred to “non-criteria manifestations” (i.e. thrombocytopenia, hemolytic anemia, heart valve disease and aPL-related nephropathy)2, of which the role in APS risk stratification is poorly understood. The manifestation spectrum of APS is wide, ranging from asymptomatic aPLs positivity to life-threatening catastrophic APS, and patients other than confirmed APS also need proper management. Therefore, a risk stratification integrating demographic data, aPL-related manifestations, aPLs profiles, coexisting cardiovascular risk factors and SLE is needed for management guidance and prognosis assessment.

Objectives:

Using cluster analysis, to identify phenotypes among aPL-positive patients and assess the prognosis of each phenotype.

Methods:

This is a single-center, prospective cohort study of aPL-positive patients who presented to Peking Union Medical College Hospital from 2004 to 2020. Demographic characteristics, aPL-related manifestations, cardiovascular risk factors, antibodies profile and follow-up data were recorded. The primary end point was defined as a combination of newly onset arterial thrombosis (AT) or deep venous thrombosis (DVT), major bleeding events, non-criteria manifestations and all-cause death. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of patients and variables separately. Multiple comparison and Kaplan-Meier survival analysis were performed among clusters.

Results:

Four clusters among 383 patients (70.2% female; mean age 37.7 years) were identified (Figure 1A). Cluster 1 (n=138): female patients with SLE, non-criteria manifestations, triple aPLs positivity, high AT rate and moderate DVT rate. Cluster 2 (n=112): male patients with obesity, smoking history, hypertension, hyperhomocysteinemia, triple aPLs positivity and the highest rate of AT and DVT. Cluster 3 (n=83): female patients with the highest pregnancy morbidity rate and the lowest thrombosis rate. Cluster 4 (n=50): 62% male patients with isolated LA positivity, high AT rate and moderate DVT rate. Four clusters of variables were also identified (Figure 1A). From Kaplan-Meier survival analysis, 1-, 5- and 10-year event-free survival rates were 92.6%, 79.8% and 66.8%, respectively. Cluster 3 showed lowest incidence of primary endpoint (Figure 1B), while Cluster 1 and 2 showed higher newly-onset AT risk compared with other clusters (P=0.028 for 2 vs 3 and P=0.049 for 2 vs 4).

Figure 1.

Conclusion:

We identified 4 clinical phenotypes of aPL-positive patients. APS secondary to SLE was always aggregated with non-criteria manifestations. Clinicians should be alert to the possibility of SLE in aPL-positive patients with coexisting non-criteria manifestations, for whom immunosuppressive therapy besides anticoagulation may be necessary. Cluster 4 represented patients with isolated LA positivity and shared similar prognosis with secondary APS and male patients, which confirmed that LA represented a high-risk antibody spectrum. Additionally, cardiovascular risk factors (i.e. male, smoking history and obesity) played an important role in thrombosis events, and led to poor prognosis. Therefore, more attention should be paid to male patients, and the screening and management of cardiovascular risk factors should not be ignored.

References:

[1]Tektonidou MG, Andreoli L, Limper M et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019;78:1296–304.

[2]Miyakis S, Lockshin MD, Atsumi T et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306.

Disclosure of Interests:

None declared.

POS0775 APLS-ASSOCIATED RETINAL VASCULOPATHY AS A PRESENTATION OF THROMBOTIC MICROANGIOPATHY

Background:

Persistent antiphospholipid antibodies (aPL) positivity was a recognized risk factor for thrombotic events, obstetric morbidity and a variety of manifestations beyond thrombosis. The presence of some non-criteria manifestations including thrombocytopenia, hemolytic anemia, and APS nephropathy should prompt consideration for thrombotic microangiopathy (TMA).1 Patients with APS can also present with a variety of ocular and neuro-ophthalmic manifestations, such as retinal artery/vein occlusion, retinal arteritis, optic neuritis and ischemic optic neuropathy, with underlying mechanisms remained elusive. Retinal vasculopathy including retinal artery occlusion (RAO) or retinal vein occlusion (RVO) was recently found occurred more frequently in APS patients with thrombocytopenia2, suggested other possible mechanisms besides thromboembolism.

Objectives:

To explore risk factors and possible mechanisms of retinal vasculopathy among APS patients.

Methods:

In this single-center case-control study among APS patients, we evaluated patients who fulfilled 2006 Sapporo APS Classification Criteria3 with or without retinal vasculopathy during 2018-2020 at Peking Union Medical College Hospital. Demographic data, aPL-related manifestations, cardiovascular risk factors and antibodies profile were compared and a logistical regression model was built. Hierarchical cluster analysis with the Euclidean distance and the Ward method was applied to identify clusters of variables.

Results:

A total of 310 APS patients (67.4% female, mean age 38.1 years) were included, of whom 18 patients were diagnosed with retinal vasculopathy (9 with RVO and 9 with RAO). No significant differences was found among most demographic characteristics, clinical manifestations, or antibody profile. However, APS-related heart valve disease (OR 13.66, 95% confidence interval [CI] 4.55-40.98), APS nephropathy (OR 12.77, 95% CI 4.04-40.35), thrombocytopenia (OR 2.63, 95% CI 1.01-6.89) and high serum IgM (OR 3.67, 95% CI 1.30-10.40) were predictive of retinal vasculopathy (Figure 1 A). APS-related heart valve disease and nephropathy were also found statistical significant in multivariate logistical regression (Figure 1 B). They and other non-criteria manfestations were aggregated with retinal vasculopathy from cluster analysis of variables (Figure 1 C).

Conclusion:

Patients with APS-related heart valve disease and nephropathy suffered a higher risk of retinal vasculopathy including RAO and RVO. The underlying mechanisms of aPLs-associated retinal vasculopathy may involve TMA, leading to a poor prognosis and therapeutic changes.

References:

[1]Kotzen ES, Roy S, Jain K. Antiphospholipid Syndrome Nephropathy and Other Thrombotic Microangiopathies Among Patients With Systemic Lupus Erythematosus. Adv Chronic Kidney Dis. 2019 Sep;26(5):376-386.

[2]Ermakova NA, Alekberova ZS, Reshetniak TM, Kalashnikova LA, Kosheleva NM. [Retinal vascular lesions in systemic lupus erythematosus and secondary antiphospholipid syndrome]. Vestn Oftalmol. 2005 Sep-Oct;121(5):31-6.

[3]Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006 Feb;4(2):295-306.

Figure 1. A) Forest plot of univariate analysis; B) Forest plot of multivariate logistic regression; C) Cluster analysis of variables.

Disclosure of Interests:

None declared

CREG1 improves the capacity of the skeletal muscle response to exercise endurance via modulation of mitophagy

CREG1 (cellular repressor of E1A-stimulated genes 1) is involved in tissue homeostasis and influences macroautophagy/autophagy to protect cardiovascular function. However, the physiological and pathological role of CREG1 in the skeletal muscle is not clear. Here, we established a skeletal muscle-specific creg1 knockout mouse model (creg1;Ckm-Cre) by crossing the Creg1-floxed mice (Creg1^fl/fl) with a transgenic line expressing Cre recombinase under the muscle-specific Ckm (creatine kinase, muscle) promoter. In creg1;Ckm-Cre mice, the exercise time to exhaustion and running distance were significantly reduced compared to Creg1^fl/fl mice at the age of 9 months. In addition, the administration of recombinant (re)CREG1 protein improved the motor function of 9-month-old creg1;Ckm-Cre mice. Moreover, electron microscopy images of 9-month-old creg1;Ckm-Cre mice showed that the mitochondrial quality and quantity were abnormal and associated with increased levels of PINK1 (PTEN induced putative kinase 1) and PRKN/PARKIN (parkin RBR E3 ubiquitin protein ligase) but reduced levels of the mitochondrial proteins PTGS2/COX2, COX4I1/COX4, and TOMM20. These results suggested that CREG1 deficiency accelerated the induction of mitophagy in the skeletal muscle. Mechanistically, gain-and loss-of-function mutations of Creg1 altered mitochondrial morphology and function, impairing mitophagy in C2C12 cells. Furthermore, HSPD1/HSP60 (heat shock protein 1) (401-573 aa) interacted with CREG1 (130-220 aa) to antagonize the degradation of CREG1 and was involved in the regulation of mitophagy. This was the first time to demonstrate that CREG1 localized to the mitochondria and played an important role in mitophagy modulation that determined skeletal muscle wasting during the growth process or disease conditions.Abbreviations: CCCP: carbonyl cyanide m-chlorophenylhydrazone; CKM: creatine kinase, muscle; COX4I1/COX4: cytochrome c oxidase subunit 4I1; CREG1: cellular repressor of E1A-stimulated genes 1; DMEM: dulbecco's modified eagle medium; DNM1L/DRP1: dynamin 1-like; FCCP: carbonyl cyanide p-trifluoro-methoxy phenyl-hydrazone; HSPD1/HSP60: heat shock protein 1 (chaperonin); IP: immunoprecipitation; MAP1LC3B/LC3B: microtubule-associated protein 1 light chain 3 beta; MFF: mitochondrial fission factor; MFN2: mitofusin 2; MYH1/MHC-I: myosin, heavy polypeptide 1, skeletal muscle, adult; OCR: oxygen consumption rate; OPA1: OPA1, mitochondrial dynamin like GTPase; PINK1: PTEN induced putative kinase 1; PPARGC1A/PGC-1α: peroxisome proliferative activated receptor, gamma, coactivator 1 alpha; PRKN/PARKIN: parkin RBR E3 ubiquitin protein ligase; PTGS2/COX2: prostaglandin-endoperoxide synthase 2; RFP: red fluorescent protein; RT-qPCR: real-time quantitative PCR; SQSTM1/p62: sequestosome 1; TFAM: transcription factor A, mitochondrial; TOMM20: translocase of outer mitochondrial membrane 20; VDAC: voltage-dependent anion channel.

CREG ameliorates the phenotypic switching of cardiac fibroblasts after myocardial infarction via modulation of CDC42

Phenotype switching of cardiac fibroblasts into myofibroblasts plays important role in cardiac fibrosis following myocardial infarction (MI). Cellular repressor of E1A-stimulated genes (CREG) protects against vascular and cardiac remodeling induced by angiotensin-II. However, the effects and mechanisms of CREG on phenotype switching of cardiac fibroblasts after MI are unknown. This study aimed to investigate the role of CREG on the phenotype switching of cardiac fibroblasts following MI and its mechanism. Our findings demonstrated that, compared with littermate control mice, cardiac function was deteriorated in CREG+/- mice on day 14 post-MI. Fibrosis size, αSMA, and collagen-1 expressions were increased in the border regions of CREG+/- mice on day 14 post-MI. Conversely, exogenous CREG protein significantly improved cardiac function, inhibited fibrosis, and reduced the expressions of αSMA and collagen-1 in the border regions of C57BL/6J mice on day 14. In vitro, CREG recombinant protein inhibited αSMA and collagen-1 expression and blocked the hypoxia-induced proliferation and migration of cardiac fibroblasts, which was mediated through the inhibition of cell division control protein 42 (CDC42) expression. Our findings could help in establishing new strategies based on the clarification of the role of the key molecule CREG in phenotype switching of cardiac fibroblasts following MI.

Thrombopoietic effects of CCAAT/enhancer-binding protein β on the early-stage differentiation of megakaryocytes

CCAAT/enhancer-binding protein β (C/EBPβ) is a transcription factor that is involved in adipocytic and monocytic differentiation. However, the physiological role of C/EBPβ in megakaryocytes (MKs) is not clear. In this study, we investigated the effects of C/EBPβ on the early-stage differentiation of MKs, and explored the potential mechanisms of action. We established a cytosine arabinoside-induced thrombocytopenia mouse model using C57BL/6 mice. In the thrombocytopenia mice, the platelet count was found to be decreased, and the mRNA and protein expression levels of C/EBPβ in MKs were also reduced. Furthermore, the maturation of Dami (MKs cell line) cells was induced by phorbol 12-myristate 13-acetate. When C/EBPβ was silenced in Dami cells by transfection using C/EBPβ-small interfering RNA, the expression of MKs-specific markers CD41 and CD62P, was dramatically decreased, resulting in morphological changes and differentiation retardation in low ploidy, which were evaluated using flow cytometry, real-time polymerase chain reaction, western blot, and confocal microscopy. The mitogen activated protein kinase-extracellular signal-regulated kinase signaling pathway was found to be required for the differentiation of MKs; knockdown of C/EBPβ in MEK/ERK1/2 pathway attenuated MKs differentiation. Overexpression of C/EBPβ in MEK/ERK1/2 pathway inhibited by U0126 did not promote MKs differentiation. To the best of our knowledge, C/EBPβ plays an important role in MKs differentiation and polyploidy cell cycle control. Taken together, C/EBPβ may have thrombopoietic effects in the differentiation of MKs, and may assist in the development of treatments for various disorders.

Role of Neutrophil-Derived S100B in Acute Myocardial Infarction Patients From the Han Chinese Population

Objective: This study aimed to clarify the novel role of homeostatic calmodulin S100B and determined whether S100B genetic variants affected atherosclerosis progression in acute myocardial infarction (AMI) patients.

Methods: Plasma levels of S100B were measured systemically in AMI patients, stable angina pectoris patients, and control subjects. S100B was obtained from the human coronary artery thrombi using a thrombectomy catheter and quantified via immunohistochemical analysis, qRT-PCR and Western blot analyse. We also screened for S100B variations (rs9722, rs9984765, rs2839356, rs1051169, and rs2186358) via direct sequencing, and investigated the relationship between these variants and AMI patients in the Chinese Han population.

Results: Plasma S100B levels increased significantly in AMI patients compared to the levels in stable angina pectoris patients and control subjects (119.45 ± 62.46, 161.96 ± 73.30, and 312.91 ± 127.59 pg/ml, respectively). Immunohistochemical staining results showed that S100B expression was increased in the neutrophils of coronary artery thrombi obtained from AMI patients, as compared to that in normal blood clot, and S100B expression was significantly increased in fresh thrombi tissues, as compared to that in organized thrombi tissues. Western blot and qRT-PCR analysis showed that S100B expression increased in coronary artery thrombi, as compared to that in normal blood clots. After pre-treating the neutrophils with siRAGE, the neutrophils migration induced by S100B were abolished through the NFκB-IL1β/IL6 signaling pathway. Compared to their corresponding wild-type genotypes, the S100B rs9722 variant was associated with increased susceptibility to AMI (OR = 1.35, 95%CI: 1.12–1.65, P = 0.02). Individuals with the S100B 9722 A allele had higher plasma S100B levels than those with the G allele in control subjects and AMI patients (141.70 ± 76.69 vs. 107.31 ± 56.05 and 347.13 ± 148.94 vs. 273.05 ± 133.62, respectively).

Conclusions: Levels of neutrophil-derived S100B, a novel homeostatic calmodulin, were elevated in the early stages of myocardial infarction. The S100B rs9722 allele was independently associated with AMI patients in the Han Chinese population.

Overexpression of Kininogen-1 aggravates oxidative stress and mitochondrial dysfunction in DOX-induced cardiotoxicity

BACKGROUND

Doxorubicin (DOX) is a widely used cancer chemotherapeutic drug with cardiotoxicity effect limiting its clinical use. DOX induced cardiotoxicity is mediated by oxidative stress and mitochondrial damage. Kininogen-1(KNG1) is an important pro-inflammatory and pro-oxidant factor, and studies have found that it can aggravate lung and brain damage. However, it has not been known in terms of cardiotoxicity. Therefore, the purpose of this study is to understand the mechanism of KNG1 in DOX-induced heart injury.

METHODS

C57 mice were selected for intraperitoneal injection of DOX. The model was successfully established, and fresh ventricular tissues were isolated from the ctrl group and the DOX group for mass spectrometry analysis to screen for differentially expressed proteins. Nuclear Factor-Like 2 (Nrf2), Heme Oxygenase 1 (HO-1), 4-Hydroxynonenal (4-HNE) were used to evaluate oxidative stress level, Cytochrome C Oxidase Subunit 4 (COX4) was used to evaluate mitochondria function. Mitochondrial inner membrane potential (ΔΨm) was monitored with JC-1 fluorescence.

RESULTS

KNG1 was identified as a core gene which was highly expressed in the DOX myocardial injury model. Following this, an overexpression adenovirus was constructed, and KNG1 was overexpressed in vivo (mice) and in vitro (neonatal mouse cardiomyocytes (NMCMs)). It was found that overexpression of KNG1 can aggravate heart oxidative stress and mitochondrial damage. Besides, a knockdown KNG1 model was constructed, and the low expression of KNG1 was performed in cytology. It was found that knockdown of KNG1 can improve cardiomyocyte oxidative stress and mitochondrial damage caused by DOX. Nrf2 is an important antioxidant factor. Further, following KNG1 knock down, Nrf2 was also knocked down, and found that its cardiomyocyte protective effect was weakened.

CONCLUSION

The overexpression of KNG1 aggravates the oxidative stress and mitochondrial damage of the heart in vivo and in vitro, which might play a role by regulating Nrf2, providing a therapeutic target for DOX-induced cardiotoxicity.

A High-Fat Diet Attenuates AMPK α1 in Adipocytes to Induce Exosome Shedding and Nonalcoholic Fatty Liver Development In Vivo

Exosomes are important for intercellular communication, but the role of exosomes in the communication between adipose tissue (AT) and the liver remains unknown. The aim of this study is to determine the contribution of AT-derived exosomes in nonalcoholic fatty liver disease (NAFLD). Exosome components, liver fat content, and liver function were monitored in AT in mice fed a high-fat diet (HFD) or treated with metformin or GW4869 and with AMPKα1-floxed (Prkaα1 ^fl/fl/wild-type [WT]), Prkaα1 ^-/-, liver tissue-specific Prkaα1 ^-/-, or AT-specific Prkaα1 ^-/- modification. In cultured adipocytes and white AT, the absence of AMPKα1 increased exosome release and exosomal proteins by elevating tumor susceptibility gene 101 (TSG101)-mediated exosome biogenesis. In adipocytes treated with palmitic acid, TSG101 facilitated scavenger receptor class B (CD36) sorting into exosomes. CD36-containing exosomes were then endocytosed by hepatocytes to induce lipid accumulation and inflammation. Consistently, an HFD induced more severe lipid accumulation and cell death in Prkaα1 ^-/- and AT-specific Prkaα1 ^-/- mice than in WT and liver-specific Prkaα1 ^-/- mice. AMPK activation by metformin reduced adipocyte-mediated exosome release and mitigated fatty liver development in WT and liver-specific Prkaα1 ^-/- mice. Moreover, administration of the exosome inhibitor GW4869 blocked exosome secretion and alleviated HFD-induced fatty livers in Prkaα1 ^-/- and adipocyte-specific Prkaα1 ^-/- mice. We conclude that HFD-mediated AMPKα1 inhibition promotes NAFLD by increasing numbers of AT CD36-containing exosomes.

TRPV5 attenuates abdominal aortic aneurysm in mice by regulating KLF4-dependent phenotype switch of aortic vascular smooth muscle cells

Abdominal aortic aneurysm (AAA) is a fatal vascular disease with insidious symptoms. However, the mechanism behind its development remains unclear. The transient receptor potential vanilloid (TRPV) family has crucial protective effects against cardiovascular diseases, but the role of TRPV5 in AAA has yet to be reported. In this study, ApoE^-/- mice were intraperitoneally injected with AAV-GFP or AAV-TRPV5. After 30 days, mice were further administered with angiotensin II (Ang II, 1.44 mg/kg/day) by using osmotic pumps to induce the AAA model or Saline for 28 days, (i.e., Saline + AAV-GFP, Saline + AAV-TRPV5, Ang II + AAV-GFP and Ang II + AAV-TRPV5 groups were established). Compared with the control group, the incidence of AAA and the maximal diameter of the abdominal aorta markedly decreased in Ang II + AAV-TRPV5, which was detected by vascular ultrasound at 28 day. Meanwhile, less collagen and elastin degradation were observed in the Ang II + AAV-TRPV5 group by using Masson and Elastin stains. Moreover, more α-SMA and less MMP2 was observed in the abdominal aortas collected at 28 day by immunohistochemistry. In vitro, primary mouse vascular smooth muscle cells (VSMCs) were treated with Ang II (1 μM) to induce phenotype switch. Sh-TRPV5 and AdTRPV5 were used to transfect VSMCs. PCR and Western blotting were used to access the expression of contractile marker, including α-SMA and SM-22α. The results showed that the mRNA and protein level of α-SMA and SM-22α were decreased under the stimulation of Ang II, but could be attenuated by TRPV5 overexpression. The cell scratch assay demonstrated that the migration ability of VSMCs was increased in Ang II treated group and could be ameliorated by TRPV5 overexpression. Above all, VSMCs transformed from the contractile into secretory phenotype under Ang II stimuli, but could be rescued by TRPV5 overexpression. Furthermore, TRPV5 overexpression suppressed the increased expression of KLF4 induced by Ang II treatment in VSMCs. The data demonstrated that TRPV5 could inhibit AAA formation and play a critical role in the VSMC phenotype switch by downregulating KLF4, suggesting TRPV5 as a new strategy for treating AAA.

Hydrogen gas (XEN) inhalation ameliorates airway inflammation in asthma and COPD patients

BACKGROUND

Hydrogen was proven to have anti-oxidative and anti-inflammation effects to various diseases.

AIM

We wish to investigate the acute effects of inhaled hydrogen on airway inflammation in patients with asthma and chronic obstructive pulmonary disease (COPD).

DESIGN

Prospective study.

METHODS

In total, 2.4% hydrogen containing steam mixed gas (XEN) was inhaled once for 45 min in 10 patients with asthma and 10 patients with COPD. The levels of granulocyte-macrophage colony stimulating factor, interferon-γ, interleukin-1β (IL-1β), IL-2, IL-4, IL-6 and so on in peripheral blood and exhaled breath condensate (EBC) before and after 'XEN' inhalation were measured.

RESULTS

45 minutes 'XEN' inhalation once decreased monocyte chemotactic protein 1 level in both COPD (564.70-451.51 pg/mL, P = 0.019) and asthma (386.39-332.76 pg/mL, P = 0.033) group, while decreased IL-8 level only in asthma group (5.25-4.49 pg/mL, P = 0.023). The level of EBC soluble cluster of differentiation-40 ligand in COPD group increased after inhalation (1.07-1.16 pg/mL, P = 0.031), while IL-4 and IL-6 levels in EBC were significantly lower after inhalation in the COPD (0.80-0.64 pg/mL, P = 0.025) and asthma (0.06-0.05 pg/mL, P = 0.007) group, respectively.

CONCLUSIONS

A single inhalation of hydrogen for 45 min attenuated inflammatory status in airways in patients with asthma and COPD.

LncRNA DARS-AS1 regulates microRNA-129 to promote malignant progression of thyroid cancer

OBJECTIVE

To investigate the expression of long non-coding RNA (lncRNA) DARS-AS1 in thyroid cancer, and to further investigate whether it can promote the development of thyroid cancer by regulating microRNA-129.

PATIENTS AND METHODS

Real-time quantitative polymerase chain reaction (qPCR) was used to detect the level of DARS-AS1 in tumor tissues and paracancerous tissues of 34 thyroid carcinomas. It was also used to analyze the relationship between the expression of DARS-AS1 and the clinical indicators of thyroid cancer and the prognosis of patients. qPCR was used to further verify the expression of DARS-AS1 in thyroid cancer cell lines. The DARS-AS1 knockdown model was constructed using lentivirus in thyroid cancer cell lines. Cell counting kit-8 (CCK-8), cell clone formation, and transwell migration assays were performed to evaluate the effects of DARS-AS1 on the biological function of thyroid cancer cells. Finally, the potential mechanism was explored by using recovery experiments and the interplay between DARS-AS1 and microRNA-129 was further studied.

RESULTS

qPCR results revealed that the level of DARS-AS1 in tumor tissues of thyroid cancer patients was remarkably higher than that in adjacent tissues, and the difference was statistically significant. Compared with patients with low expression of DARS-AS1, patients with high DARS-AS1 expression had a higher incidence of high tumor stage, distant metastasis, and a lower overall survival rate. Besides, compared with NC group, the proliferation and migration ability of shRNA-AS1 expression knockdown group sh-DARS-AS1 was remarkably decreased. qPCR results indicated that there was a negative correlation between the level of microRNA-129 and DARS-AS1 in thyroid cancer tissues. In addition, cell proliferation and migration ability in the microRNA-129 overexpression group were remarkably decreased. The recovery experiment also found that there was a mutual regulation between DARS-AS1 and microRNA-129, which together affected the malignant progression of thyroid cancer.

CONCLUSIONS

DARS-AS1 level in tumor tissues of thyroid cancer was remarkably increased and was correlated with the pathological stage, distant metastasis, and poor prognosis of thyroid cancer. Moreover, DARS-AS1 could promote the proliferation and migration capabilities of thyroid cancer cells by modulating microRNA-129.

Serum soluble ST2 is a potential long-term prognostic biomarker for transient ischaemic attack and ischaemic stroke

BACKGROUND AND PURPOSE

Soluble ST2 (sST2) is a promising biomarker in inflammation, atherosclerosis and cardiovascular diseases. We investigated the association between serum sST2 and poor outcome in patients with transient ischaemic attack (TIA)/ischaemic stroke.

METHODS

Patients within 24 h after onset and with measured serum sST2 were prospectively enrolled in this study. Poor outcome was a combination of a new stroke event (ischaemic or haemorrhagic) and all-cause death within 90 days and 1 year. The associations of serum sST2 with poor outcome were analysed by Cox proportional hazards.

RESULTS

Among the 430 patients included, the median (interquartile range) sST2 was 17.72 (9.31-28.84) ng/mL. A total of 19 (4.4%) and 38 (8.8%) patients experienced poor outcome within 90 days and 1 year, respectively. Compared with the lowest sST2 tertile, hazard ratios (HRs) [95% confidence intervals (CI)] for the highest tertile were 5.14 (1.43-18.51) for poor outcome within 90 days and 3.00 (1.29-6.97) at 1 year after multivariate adjustments. Adding sST2 to a prediction model significantly improved risk stratification of poor outcome in TIA/ischaemic stroke, as observed by the continuous net reclassification improvement of 60.98% (95% CI, 15.37-106.6%, P = 0.009) and integrated discrimination improvement of 2.63% (95% CI, 0.08-5.18%, P = 0.043) at 90 days and the continuous net reclassification improvement of 41.68% (95% CI, 8.74-74.61%, P = 0.013) at 1 year.

CONCLUSIONS

Increased serum sST2 levels in TIA/ischaemic stroke were associated with increased risks of poor outcome within 90 days and 1 year, suggesting that serum sST2 may be a potential long-term prognostic biomarker for TIA/ischaemic stroke.

MiR-601 inhibits the proliferation and metastasis of esophageal squamous cell carcinoma (ESCC) by targeting HDAC6

OBJECTIVE

The aim of this study was to explore the role of microRNA-601 (miR-601) in the proliferation and invasion of esophageal squamous cell carcinoma (ESCC) cells, thereby providing new thoughts for prognosis evaluation and targeted therapy of ESCC.

PATIENTS AND METHODS

23 pairs of ESCC tissue samples and adjacent normal tissues were collected, and the expression level of miR-601 was detected. Biological information analysis and Luciferase report gene assay were used to verify the potential target genes of miR-601. Then, three groups were established in ESCC cell line (TE-1) to perform similar experiments, including the miR-NC group, the miR-601 mimics group and the mimics + HDAC6 group. Cell counting kit-8 (CCK-8) assay was used to detect cell proliferation ability. Meanwhile, transwell assay and scratch-wound assay were applied to observe the effect of miR-601 on cell invasion and migration. Quantitative reverse transcription Polymerase Chain Reaction (qPCR) and Western blot assay were applied to determine the mRNA and protein expression changes after transfection.

RESULTS

Compared with normal adjacent tissues and normal esophageal epithelial cells, the expression of miR-601 was significantly decreased in ESCC tissues and cells. HDAC6 was identified as a target gene of miR-601. The expression of HDAC6 in esophageal carcinoma cells transfected with miR-601 mimics was significantly down-regulated. The negative correlation between miR-601 and HDAC6 expression was assessed by qPCR and Western blot (WB) assay. Furthermore, miR-601 remarkably suppressed the proliferation of ESCC cells. Meanwhile, cell invasion and migration were also found markedly restricted after transfection of miR-601 mimics. However, the overexpression of HDAC6 significantly counteracted the effects of miR-601.

CONCLUSIONS

MiR-601 suppressed the proliferation, invasion and migration of esophagus carcinoma cells by down-regulating HDAC6 expression.

[Expression of ARID1A in ovarian seromucinous neoplasms and its clinicopathological significance]

Objective: To investigate the clinical, pathological and immunohistochemical features of seromucinous neoplasms, including seromucinous cystadenoma, borderline tumour and seromucinous carcinomas of the ovary. Methods: A retrospective review of the seromucinous neoplasms collected between June 2006 and December 2018 was conducted at the First Medical Center of PLA General Hospital. EnVision immunohistochemical staining was used to detect the expression of CK7, PAX8, ER, PR, WT1, p16, p53 and Baf250a which was encoded by the ARID1A gene. Results: A total of 75 ovarian seromucinous neoplasms were included. There were 30 cases of benign seromucinous cystadenoma, whose patients aged 12 to 83 years (mean, 36 years). The tumor histologically composed of endocervical-type mucinous epithelium and serous-type cells, each of which accounted for more than 10%. Among the 34 cases of seromucinous borderline tumour including 7 cases with concurrent endometriosis, the patients aged 21 to 72 years (mean, 39 years). Characteristic histologic features were broad papilla structure and an admixture of cell types, predominant endocervical-like mucinous cells (non-intestinal, no goblet cells), eosinophilic cells and others such as clear cells, hobnail cells, ciliated cells, and endometrioid cells. The larger papillae tended to have oedematous stroma containing neutrophils. In the 11 cases of seromucinous carcinomas including 2 cases with concurrent endometriosis, patients aged 26 to 61 years (mean, 40 years). Seromucinous carcinomas exhibited a predominant papillary architecture with smaller components of confluent glandular, microglandular and solid structure, expansive stromal invasion pattern, and sometimes locally destructive infiltration. An admixture of epithelial cell types was in seromucinous carcinomas, as well as borderline tumour. Immunohistochemically, the tumours were positive for CK7, PAX8, p16, estrogen receptor and progesterone receptor (positive in 10% to 80% of the cases). They were negative for WT1, while p53 staining showed a "wild-type" pattern. The Ki-67 positive rate was 20% to 60%. Loss of ARID1A-encoded protein Baf250a staining was observed in 6 (30%) of the 20 seromucinous borderline tumors, and 2 of the 11 seromucinous carcinomas. According to FIGO 2014 staging system, there were 4 cases of ⅠA, 3 cases of ⅡA and 4 cases of ⅢC. Follow-up information was available in 9 patients of seromucinous carcinomas, and 2 lost to follow-up. Eight were alive (follow-up for 6 to 108 months), including 2 patients with relapse, but 1 patient who initially presented with a stage ⅢC tumor died of disease 60 months after the cancer diagnosis. Thirty-four patients of borderline tumour were all alive at the end of follow-up, including 1 with relapse. Conclusions: Seromucinous neoplasms have characteristic histopathological and immunopathological features. Both borderline tumors and carcinomas have complex structures and cellular components. ARID1A as a tumor-suppressor gene plays a role in the oncogenesis of ovarian seromucinous neoplasms. The loss of staining with ARID1A-encoded Baf250a and wild-type p53 in seromucinous neoplasms together support that seromucinous neoplasms could be type Ⅰ tumor of dualistic model of epithelial ovarian cancer, with favourable prognosis.

SAT0241 PLATELET INDICES COULD BE SIMPLE RELIABLE PREDICTORS OF THROMBOTIC EVENTS IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME

Background:

Platelet activation is considered as a pivot pathogenic process to be responsible for thromboembolism in antiphospholipid syndrome (APS). severalstudies shown that platelet indices including platelet distribution width (PDW), mean platelet volume (MPV), large platelet rate (P-LCR) are associated with platelet activation.

Objectives:

This study aims to determine the correlation between platelet indices and thrombotic events in patients with APS.

Methods:

Platelet activation is considered as a pivot pathogenic process to be responsible for thromboembolism in antiphospholipid syndrome (APS). severalstudies shown that platelet indices including platelet distribution width (PDW), mean platelet volume (MPV), large platelet rate (P-LCR) are associated with platelet activation.

Results:

A total of 207 patients [135(65.2%) female, 72(34.8%) male], medianage 35(IQR 10)] was classified into thrombotic group (n=150,72.5%) and non-thrombotic group(n=57,27.5%). PDW, MPV, P-LCR were significantly higher in thrombotic group than non-thrombotic group (13.0±3.4 vs. 11.2±7.3)p<0.001, 10.7±1.4vs.10.0±3.0,p<0.001, 30.25±11.6vs. 25.1±10.4 p<0.001, respectively]. No differences in age, WBC count, hsCRP and C3 were observed between groups. Also, HGB was found to be notably higher in thrombotic group than non-thrombotic group (143±29 vs. 132±15, p=0.001).Upon univariate logistic analysis, PDW (OR 1.554, 95%CI 1.289-1.873, p<0.001), MPV (OR 1.772, 95%CI 1.268-2.476, p=0.001), P-LCR (OR 1.089, 95%CI 1.040-1.140, p<0.001) were all significantly associated with the occurrenceof thrombosis. In multivariate logistic analysis, only PDW and positive LAwere identified to be risk factors of thrombotic events (Table 1). The ROC curve showed that PDW combinedwith positive LAwas a reliable indicator of thrombotic events with an AUC of 0.796 (95%CI 0.728-0.864). The optimal cut-off value for PDW was 12.4fl with a sensitivity of 72.0% and specificity of 77.2%.

Conclusion:

This study confirmed that PDW, P-LCR and MPV (especially PDW) were significantly associated with thrombotic events in APS patients, which could support the theory of platelet activation being a crucial factor of thrombosis inAPS. Caution should be raised when patients with positive LA has relatively high PDW level.

Disclosure of Interests:

None declared

AB0498 CHARACTERISTICS AND OUTCOME OF CORONARY ARTERY LESIONS DUE TO POLYARTERITIS NODOSA: ANALYSIS OF A SINGLE CENTER COHORT IN CHINA

Background:

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that mainly affects medium-sized muscular arteries. The coronary artery could be affected. Some severe cases can lead to spontaneous coronary artery dissection (SCAD) and about 0.02% will die abruptly. Early diagnosis will improve prognosis, but relative studies are all case reports so far.

Objectives:

To investigate the clinical characteristics, risk factors and outcome of patients with polyarteritis nodosa (PAN) complicated with coronary artery lesions in China.

Methods:

Data of 158 patients with PAN who were admitted to Peking Union Medical College Hospital from September 1986 to September 2019 were retrospective collected. Data were analyzed and compared according to with and without coronary artery lesions due to PAN.

Results:

17 (10.8%) patients with PAN had the coronary artery lesions due to PAN. The age at coronary artery lesion was 36.9±10.3 years. 12 (70.6%) patients were male. There are not statistical differences between two groups in common risk factors of coronary arterial atherosclerosis including smoking, hypertension, diabetes mellitus and hyperlipidemia. Most of them are multi-vessel lesions (8 cases are triple-vessel lesions and 3 cases are bi-vessel lesions). Type of coronary artery affected is shown mainly in stenosis (13 cases). Myocardial infarction are shown in 8 cases (47.1%). Compared to patients without coronary artery lesions, patients with coronary artery lesions had less nervous system involvement (17.6% vs.46.8%) and elevated number of leukocyte (17.6% vs.56%). Besides, patients with coronary artery affected exhibit more cranial and carotid artery involvement(29.4% vs. 5.0%), renal artery involvement (41.2% vs.17.0%), coeliac artery involvement (58.8% vs.27.0%), new onset hypertension (47.1% vs.14.5%), renal infarction (27.3% vs.5.4%, ) and higher proportion of 2009 Five-factor score (FFS)≥2 (62.5% vs.15.6%). All patients with coronary artery lesions received at least moderate dose of prednisone and CTX except one refused medication. 3 cases underwent interventional therapy. Stent placement was performed on 2 of them, and in-stent restenosis was appeared in a patient one year later. 2 cases died,one for vascular rupture after coronary aneurysmsutrue plus coronary artery bypass grafting, another for myocardial infarction after stopping immunosuppressant therapy himself.Survival analysis showed patients with digital g angrene had poor prognosis though no significant difference(p=0.055).

Conclusion:

PAN with coronary artery lessions are not uncommon. These patients exhibit young age, more proportion of multi-vessel of coronary artery involvement, more combined involvments of other organ arteries and more severe disease.

References:

[1]Munguti CM, Ndunda PM, Muutu TM. Sudden Death From Spontaneous Coronary Artery Dissection Due to Polyarteritis Nodosa. Cureus, 2017;9 (10), e1737

[2]Kritta nawong C, Kumar A, Johnson KW, et al.Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (From a National Population-Based Cohort Study).Am J Cardiol, 2019; 123 (2): 249-253

[3]Hwang J, Yang JH, Kim DK, Cha HS.Polyarteritis Nodosa Involving Renal and Coronary Arteries. J Am Coll Cardiol. 2012;59(7):e13

Disclosure of Interests: :

Chinchih Lai: None declared, Lin Zhao: None declared, Jiaxin Zhou: None declared, Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared

THU0544 MULTIMODAL PHOTOACOUSTIC/ULTRASONIC IMAGING SYSTEM: A NEW IMAGING METHOD FOR EVALUATING RA

Background:

Photoacoustic imaging (PAI), a new imaging technique which can be integrating with ultrasound (US) imaging, has shown potential in visualizing small joints. We have developed a multimodal photoacoustic/ultrasound (PA/US) imaging system, equipped with a handheld probe, which can provide dual-wavelength PA/US imaging to identify the micro-vessels of the inflamed articular regions and measure the oxygenation level of human inflamed synovium.

Objectives:

To validate the potential value for RA of the imaging system.

Methods:

A total of 32 RA patients received PA/US examination on seven small joints (MCP2, MCP3, PIP2, PIP3, MTP2, MTP5, and wrist of the clinically dominant side). The 0-3 score was used to semi-quantify the PA and PD signals of the inflammatory articular lesions, and the sums of PA and PD scores (PA-sum and PD-sum) were utilized. The relative oxygen saturation (SO2) values of the inflamed regions were measured by calculating the ratio of PA signals at the wavelength of 750nm and 830nm. All the patients were classified to 3 PA+SO2 patterns (Pattern 1: no or minimal PA signals; Pattern 2: evident PA signals and hyperoxia; Pattern 3: evident PA signals and hypoxia). The correlations between imaging scores and laboratory data, as well as clinical scoring systems were assessed.

Results:

A total of 32 patients of RA were recruited aged from 25-71 years-old were examined. PD-sum had moderate correlation with the clinical scores (r=0.529, 0.546, 0.490, 0.493 for DAS28ESR, DAS28CRP, SDAI, CDAI), moderate correlations with TJC (r=0.575) and SJC (r=0.491), fair correlation with VAS (r=0.239), poor correlation with PGA (r=0.153), and moderate correlation with EGA (r=0.457). The PA-sum had substantial correlations with the clinical scores (r= 0.699, 0.746, 0.723, 0.736 for DAS28ESR, DAS28CRP, SDAI, CDAI), substantial correlations with TJC (r=0.787) and SJC (r=0.694), moderate correlations with VAS (r=0.544) and PGA (r=0.529), and substantial correlation with EGA (r=0.708).

Ten patients were classified as Pattern 1, 12 as Pattern 2, 9 as Pattern 3. The PA+ SO2 patterns presented substantial correlations with the clinical scores (DAS28ESR r=0.690, DAS28CRP r=0.782, SDAI r=0.805, CDAI r=0.799, SJC r=647, TJC r=0.676, respectively), substantial correlation with VAS (r=0.714), and moderate correlation with PGA (r=0.476) and EGA (r=0.502). Significant differences between those who were classified as hypoxia and hyperoxia with evident PA signals, were detected in VAS (p=0.020) and PGA (p=0.026).

Conclusion:

The PA-sum scores and the PA+SO2 patterns can be utilized as objective imaging parameters reflecting the disease activity of RA. PAI may serve as a supplement to conventional US examinations for RA patients.

References:

[1]Backhaus, M., et al., Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum, 2009. 61(9): p. 1194-201.

[2]Colebatch, A.N., et al., EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis, 2013. 72(6): p. 804-14.

Figure 1.

the photo of the multimodal PA/US imaging system

Figure 2.

an example of the PA/US imaging

Disclosure of Interests:

Chenyang Zhao: None declared, Qian Wang: None declared, Xixi Tao: None declared, Chen Yu: None declared, Sirui Liu: None declared, Mengtao Li: None declared, Xinping Tian: None declared, Zhenhong Qi: None declared, Jianchu Li: None declared, Fang Yang: None declared, Lei Zhu: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Meng Yang: None declared, Yuxin Jiang: None declared

FRI0224 IDENTIFICATION OF RISK AND PROGNOSTIC FACTORS FOR POLYARTERITIS NODOSA PATIENTS WITH DIGITAL GANGRENE

Background:

Polyarteritis nodosa (PAN) is a segmental, necrotizing vascular disease that primarily impacts medium-sized muscle arteries. The estimated annual incidence of PAN is still lacking in China. Digital gangrene is an ischemic manifestation of the limb. However, the causes and the treatment methods vary from case to case, and the outcome is unpredictable. These features emphasize the need to identify measurable variables that accelerate digital gangrene development in PAN patients. However, little effort has been made to identify the clinical and laboratory factors that affect PAN patients with digital gangrene to anticipate their natural history and response to therapy.

Objectives:

Many patients with polyarteritis nodosa (PAN) complicated with digital gangrene have poor outcomes and related research information is limited. This study was carried out to identify the associated risk and prognostic factors.

Methods:

We conducted a retrospective study of 148 PAN patients admitted to Peking Union Medical College Hospital (PUMCH) from September 1986 to December 2018. The characteristics, therapeutic regimens, and outcome data for patients with and without gangrene were compared. The Kaplan–Meier method and Cox hazard regression model were used to evaluate the prognostic factors.

Results:

Forty-seven (31.8%) PAN patients had digital gangrene complications. The average age was 40.4±17.9 years and the average disease duration was 11 (4-27) months. The presence of digital gangrene was correlated with smoking history [odds ratio (OR), 4.27; 95% confidence interval (95% CI), 1.56-11.66] and eosinophil elevation (28.12; 10.30-76.8). Thirty-two (68.1%) gangrene patients received methylprednisolone pulse therapy and all of these patients were treated with cyclophosphamide. Nine patients suffered irreversible organ injury and two died. Disease duration ≥ 24 months and elevated serum C-reactive protein (CRP) were identified as hazardous factors for poor prognosis in patients with gangrene (P=0.003, HR=8.668, 95% CI 2.11, 35.55 andP=0.042, HR=27.062, 95% CI 1.13, 648.57, respectively).

Conclusion:

Smoking history and eosinophil elevation in PAN patients were more prone to digital gangrene and high serum CRP level predicted poor outcomes. PAN patients with smoking history and elevated eosinophils need to be seriously evaluated by clinicians. Furthermore, the CRP level should be efficiently controlled for good prognosis.

References:

[1]De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: A contemporary overview. Autoimmun Rev. 2016;15:564-70.

[2]Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62:616-26.

[3]Xu D, You X, Wang Z, Zeng Q, Xu J, Jiang L, et al. Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry VI: Effect of Cigarette Smoking on the Clinical Phenotype of Chinese Patients with Systemic Lupus Erythematosus. PLoS One. 2015;10:e0134451.

Acknowledgments:

No

Disclosure of Interests:

Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared, Lin Zhao: None declared, Shangzhu Zhang: None declared, Jiaxin Zhou: None declared, Jiu-liang Zhao: None declared, Xiaodan Kong: None declared

FRI0017 ACTIVATION OF TOLL-LIKE RECEPTORS IN PERIPHERAL BLOOD MONONUCLEAR CELLS OF TAKAYASU ARTERITIS PATIENTS

Background:

The activation of self-specific T cells is essential in pathogenesis of Takayasu arteritis (TAK). Dendritic cell (DC) plays an indispensable role as the only antigen presenting cell for initial T cell, and Toll-like receptors (TLRs) are common source of activation signals for DCs. Then we speculate that there are activation of TLRs in TAK patients.

Objectives:

To investigate the activation of TLRs in TAK patients.

Methods:

Twenty-seven TAK patients were enrolled during April to October in 2019, with diagnosis met the 1990 criteria of American College of Rheumatology. Patient were divided into groups by the disease activity and medication history. Disease activity was assessed by the 1994 NIH criteria. Quantitative Real-time Polymerase Chain Reaction (RT-qPCR) was used to analyze the mRNA relative abundance of 28 target genes in peripheral blood mononuclear cells (PBMCs). Differences between groups and correlation between any two genes were analyzed.

Results:

The demographic data and clinical features of TAK patients were shown in Table 1. (1) Compared with health control (HC) group, mRNA abundance ofTLR2, TLR4, P50, P65, IκBα, CTLA4, CD3,andBCL6in untreated TAK group was upregulated (<0.05), whereas mRNA abundance ofCD40was downregulated (p <0.05). (2) Compared with HC group, mRNA abundance ofTLR2, TLR4, IκBα, PD-1 and BCL6in treated TAK group was upregulated (p <0.05), whereas mRNA abundance ofLAG3, CD40andTCRwas downregulated (p <0.05). (3) Compared with untreated TAK group, mRNA abundance ofP50, P65, CD28, CTLA4, TLR2, TLR4, IκBα, PD-1 and RORCwas upregulated in treated TAK group (p <0.05). (4) Compared with non-active treated TAK group, mRNA abundance ofp50, CD28, TCR, GATA3, RORC and FOXP3was upregulated in nonactive treated TAK group (p <0.05). BCL6 showed correlation with the TLRs-NFκB pathway. (Figure 1~2, Table 2)

Table 1.

Demographic data and clinical features of patients with TAK

Age (year)Gender (male/ female)Disease duration* (months)ESR (mm/h)hs-CRP* (mg/L)Interleukin 6 (pg/mL)TNFα(pg/mL)Prednisoneused/ non-usedDosage (mg/d)Treated (n=20)39.37±9.271/1943 (12, 103)14.60±8.941 (0.55, 5.625)2.1 (2, 3.95)7.56±4.3918/210 (10, 32.5) Active (n=11)39.30±7.8891/10118 (16, 166.5)16.82±10.815.63 (1.49, 8.33)3.15 (2.025, 5.775)8.42±5.5710/110 (10, 15) Nonactive (n=9)39.44±10.590/940 (12, 44)11.89±4.610.84 (0.31, 1)2 (2, 2.4)6.60±2.118/18.75 (6.875, 16.25) Pvalue0.89—0.160.340.020.080.65—0.37Untreated (n=7) Active (n=4)  1 31 M — 91 140.72 — ——0  2 25 F — 19 11.28 6.3 5.2—0  3 23 M — 71 77.36 6.3 6.2—0  4 29 F — 127 113.62 22.2 8.4—0 Nonactive (n=3)  5 34 F — 7 0.34 2 4.3—0  6 27 F — 14 0.16 25.7 4—0  7 38 F — 5 0.32 3 4—0

* median (min, max)

Table 2.

Genes expressed abnormally in PBMCs of TAK patients

Abnormally expressed in untreated TAKAbnormally expressed in treated TAKInfluenced by treatmentAssociated with the TAK activityupregulateddownregulatedupregulateddownregulatedupregulateddownregulatedUpregulateddownregulatedGenes associated with the TLRs-NFκB pathwayTLR2, TLR4, p50, p65, IκBα—TLR2, TLR4, IκBα——p50, p65p50—Positive and negative costimulatory molecules and their ligandsCTLA4CD40PD-1CD40, LAG3—CD28, CTLA4CD28—Genes associated with the activation or differentiation of T cell or B cellCD3, BCL6—BCL6TCR—CD3, TCR, RORCTCR, GATA3, RORC, FOXP3—

Conclusion:

TLRs-NFκB pathway may be activated in TAK patients, with upregulation ofBCL6, and there may be deficiency ofCD40.TLR2, TLR4, PD-1, LAG3, CD40andBCL6may play roles in the pathogenesis of TAK.p50, CD28, TCR, GATA3, RCRCandFOXP3may be related to the disease activity of TAK.

Disclosure of Interests:

Yixiao Tian: None declared, Jing Li: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals

DNA hypermethylation: A novel mechanism of CREG gene suppression and atherosclerogenic endothelial dysfunction

OBJECTIVE

Cellular repressor of E1A-stimulated genes (CREG), a vasculoprotective molecule, is significantly downregulated in atherosclerotic vessels through unclear mechanisms. While epigenetic regulation is involved in atherosclerosis development, it is not known if the CREG gene is epigenetically regulated. The aim of this study was to assess the potential role of CREG methylation in contributing to atherosclerosis.

APPROACH AND RESULTS

Overexpression of DNA methyltransferase (DNMT)3B significantly inhibited CREG expression in human umbilical vein endothelial cells (HUVECs) and human coronary aortic endothelial cells (HCAECs).Conversely, inhibition of DNA methylation with 5-aza-2'-deoxycytidine (5-aza-dC) dose-dependently increased CREG expression. A CREG promoter analysis identified +168 to +255 bp as a key regulatory region and the CG site at +201/+202 bp as a key methylation site. The transcription factor GR-α could bind to the +201/+202 bp CG site promoting CREG transcription, a process significantly inhibited by DNMT3B overexpression. Treatment of cells with oxidized low-density lipoprotein (ox-LDL), a critical atherosclerogenic factor, significantly increased DNMT3B expression, increasing CREG promotor methylation, blocking GR-α binding, and inhibiting CREG expression. Consistently, CG sites in the CREG promoter fragment were hyper-methylated in human atherosclerotic arteries, and CREG expression was significantly reduced. A negative correlation between DNMT3B and CREG expression levels was observed in human atherosclerotic arteries. Finally, Ox-LDL-induced endothelium dysfunction was significantly attenuated by both 5-aza-dC and an anti-oxidative molecular N-acetylcysteine (NAC) administration through rescue the expression of CREG and activation of the p-eNOS/NO pathway.

CONCLUSIONS

Our study provides the first direct evidence that DNMT3B-mediated CREG gene hypermethylation is a novel mechanism that contributes to endothelial dysfunction and atherosclerosis development. Blocking CREG methylation may represent a novel therapeutic approach to treat ox-LDL-induced atherosclerosis.

Comparing Diagnostic Properties of the FRAIL-NH Scale and 4 Frailty Screening Instruments among Chinese Institutionalized Older Adults

OBJECTIVE

To examine the diagnostic test accuracy (DTA) of the FRAIL-NH and four frailty screening instruments among institutionalized older adults.

DESIGN

Cross-sectional study.

SETTING

Institutionalized setting, Jinan, China.

PARTICIPANTS

A total of 305 older adults (mean age 79.3 ± 8.4 years, 57.0% female) were enrolled from nursing homes.

MEASUREMENTS

Frailty was assessed by the FRAIL-NH, Physical Frailty Phenotype (PFP), FRAIL, Tilburg Frailty Indicator (TFI), and Groningen Frailty Indicator (GFI), respectively. The Comprehensive Geriatric Assessment (CGA) was used as a reference standard of frailty. The receiver operating characteristic (ROC) curve was plotted to examine the DTA of five frailty screening instruments against the CGA. The optimal cut-point was determined by the maximum value of the Youden index (YI, calculated as sensitivity + specificity - 1).

RESULTS

The prevalence of frailty ranged from 25.9% (FRAIL) to 56.4% (GFI). Areas under the curve (AUCs) against the CGA ranged from 0.80 [95% confidence interval (CI) 0.74 - 0.85: FRAIL] to 0.83 (95% CI 0.78 - 0.88: PFP). At their original cut-points, all five frailty screening instruments presented low sensitivity (32.9% - 69.3%) and high specificity (80.0% - 93.8%), as well as high positive predictive values (90.7% - 94.9%) and low negative predictive values (33.2% - 48.1%). At their optimal cut-points, the sensitivity and specificity of the FRAIL-NH, PFP, and FRAIL tended to be balanced, and their correctly classified rates (76.1% - 81.3%) and kappa values (0.465 - 0.523) increased a lot. ROC contrasts showed that all five frailty screening instruments had similarly good diagnostic accuracy (χ2: 0.0003 - 1.38, P > .05).

CONCLUSION

In the institutionalized setting, the specific FRAIL-NH, self-report FRAIL, TFI, and GFI as well as hybrid PFP, show similarly good diagnostic properties in identifying frailty against the CGA.

Efficacy and safety of oral Guanxinshutong capsules in patients with stable angina pectoris in China: a prospective, multicenter, double-blind, placebo-controlled, randomized clinical trial

BACKGROUND

To assess the efficacy and safety of oral Guanxinshutong (GXST) capsules in Chinese patients with stable angina pectoris (SAP) in a prospective, multicenter, double-Blind, placebo-controlled, randomized clinical trial (clinicaltrials.gov Identifier: NCT02280850).

METHODS

Eligible patients were randomized 1:1 to the GXST or placebo group. Current standard antianginal treatment except for nitrate drugs was continued in both groups, who received an additional 4-week treatment of GXST capsule or placebo. Primary endpoint was the change from baseline in angina attack frequency after the 4-week treatment. Secondary endpoints included the reduction of nitroglycerin dose, score of Seatntle Agina Questionnaire, exercise tolerance test defined as time to onset of chest pain and ST-segment depression at least 1 mm greater than the resting one.

RESULTS

A total of 300 SAP patients from 12 centers in China were enrolled between January 2013 and October 2015, and they were randomly divided into the GXST group and the placebo group (150 patients in each group). Of whom, 287 patients completed the study (143 patients in the GXST group, 144 patients in the placebo group). The baseline characteristics of the two groups were comparable. After 4-week treatment with GXST capsules, the number of angina attacks and the consumption of short-acting nitrates were significantly reduced. In addition, the quality of life of patients were also substantially improved in the GXST group. No significant differences in the time of onset of angina and 1-mm ST segment depression were noted between the two groups. 7 patients (4.1%) in the GXST group and 3 patients (2.1%) in the placebo group reported at least one adverse event, respectively.

CONCLUSIONS

GXST capsules are beneficial for the treatment of SAP patients.

Low-dose nicotine promotes autophagy of cardiomyocytes by upregulating HO-1 expression

Nicotine as a major component of addiction in cigarettes has been reported to play protective roles in some pathological processes. It is reported that activation of the nicotinic acetylcholine receptor also has a cardioprotective effect. Thus, in our study, we investigated the effect and mechanism of nicotine on the autophagy of cardiomyocytes, and whether nicotine protects cardiomyocytes against palmitic acid (PA) injury. The results indicated that low-dose nicotine promoted neonatal mouse cardiac myocytes (NMCMs) autophagy and accelerated autophagic flux while inhibiting NMCMs apoptosis, but high-dose nicotine inhibited autophagy and promoted apoptosis. Moreover, low-dose nicotine upregulated heme oxygenase-1 (HO-1) expression and knocking down HO-1 abolished the effects of nicotine on the autophagy and apoptosis of NMCMs. Methyllycaconitine citrate (α7-nAChR blocker, MLA) inhibited HO-1 expression and the effects of nicotine on autophagy and apoptosis of NMCMs. Furthermore, low-dose nicotine improved the inhibited autophagy and increased apoptosis induced by palmitic acid (PA) in NMCMs and these effects were reversed by knocking down HO-1. In conclusion, our data suggested that low-dose nicotine promoted autophagy and inhibited apoptosis of cardiomyocytes by upregulating HO-1.

Development of a rapid immunochromatographic assay for detection of antibodies against porcine epidemic diarrhea virus

An immunochromatographic test strip was developed for the detection of antibodies against porcine epidemic diarrhea virus (PEDV) in porcine serum. In this test, the recombinant nucleocapsid protein of PEDV was expressed in soluble form and purified by using Ni-NTA resin and gel filtration chromatography. The purified recombinant N protein conjugated with colloidal gold was dispensed on a conjugate pad as the detector. Staphylococcal protein A and rabbit anti-N protein IgG were blotted on a nitrocellulose membrane for the test and control lines, respectively. The immunochromatographic test strip specifically detected PEDV antibodies within 10 min and had higher sensitivity (96.0%) and specificity (90.8%) than those of commercial enzyme-linked immunosorbent assay (ELISA) kits. Our newly developed strip has great potential for the early diagnosis of PEDV infection.

[Canalplasty: surgical technique and analysis of the results]

Objective:To determine the applications and results of canalplasty for closed middle ear surgery.Method:Charts of 74 ears who underwent a canalplasty and closed middle ear surgery because of chronic otitis media or middle ear cholesterol granuloma between 2012 and 2016 were reviewed for general condition, disease, surgery methods,surgical outcome,complications,results of pure tone audiometry pre-and post-operatively.Result:Sixteen(21.6%) ears have some problems of their anterior ligament of malleus.Post-operative there are 69 ears totally epithelization, of which the rate is 93.2%,and the average epithelization time is 5.3 weeks. The myringoplasties are successful on 72 ears(97.3%).There are 5 ears(6.8%) occurring complications relating to canalplasty.One year after surgery the air-bone gap has decreased by 8 dB, which has been improved significantly than pre-operative(P<0.05).Conclusion:This study shows that technique for canalplasty is safe and effective,which can exposure the whole tympanic membrane and is easy for tympanoplasty. The epithelization rate of our technique is high.And it's good for myringoplasty and hearing outcomes.

Gaseous pollutant exposure affects semen quality in central China: a cross-sectional study

BACKGROUND

Limited studies have explored the association between gaseous pollutant exposures and male reproductive outcomes, and findings remained inconsistent.

OBJECTIVES

To evaluate the potential association  between gaseous pollutants and semen quality within different exposure windows. MATERIALS AND METHODS: We adopted semen quality data of 1852 subjects who attended the Reproductive Medicine Center of Renmin Hospital at Wuhan University during January 1st, 2013, to August 3rd, 2015. A generalized linear model was employed to assess the relationship between each exposure variable and sperm parameters in different exposure windows.

RESULTS

SO₂ exposure with lag 0-90 days was significantly associated with decreased sperm concentration (β: -1.362; 95% CI: -1.844, -0.879), sperm count (β: -2.979; 95% CI: -4.267, -1.691), and PR (β: -0.551; 95% CI: -0.710, -0.393). Similar trends were observed for SO₂ exposure with three other key periods (lag 0-9, 10-14, and 70-90 days). NO₂ exposure with lag 0-90 days was also associated with decreased sperm concentration (β: -0.517; 95% CI: -1.006, -0.027), sperm count (β: -1.914; 95% CI: -3.214, -0.615), and PR (β: -0.264; 95% CI: -0.425, -0.102). No relationship between gaseous pollutant exposure and ejaculate volume was observed in any exposure window.

DISCUSSION AND CONCLUSION

Our study indicated a strong adverse effect of gaseous pollutants on semen quality outcomes during the sperm development. Gaseous pollution exposure appeared to be more detrimental in the initial phase of spermatogenesis.