Matrix Matters: Assessment of Commutability among BK Virus Assays and Standards

Quantitative testing of BK virus (BKPyV) nucleic acid has become the standard of care in transplant patients. While the relationship between interassay harmonization and commutability has been well characterized for other transplant-related viruses, it has been less well studied for BKPyV, particularly regarding differences in commutability between matrices. Here, interassay agreement was evaluated among six real-time nucleic acid amplification tests (NAATs) and one digital PCR (dPCR) BKPyV assay. Differences in the commutability of three quantitative standards was examined across all assays using a variety of statistical approaches. Panels, including 40 samples each of plasma and urine samples previously positive for BKPyV, together with one previously negative plasma sample and four previously negative urine samples, were tested using all assays, with each real-time NAAT utilizing its usual quantitative calibrators. Serial dilutions of WHO, National Institute for Standards and Technology (NIST), and commercially produced (Exact/Bio-Rad) reference materials were also run by each assay as unknowns. The agreement of the clinical sample values was assessed as a group and in a pairwise manner. The commutability was estimated using both relativistic and quantitative means. The quantitative agreement across assays in the urine samples was within a single log10 unit across all assays, while the results from the plasma samples varied by 2 to 3 log10 IU/mL. The commutability showed a similar disparity between the matrices. Recalibration using international standards diminished the resulting discrepancies in some but not all cases. Differences in the sample matrix can affect the commutability and interassay agreement of quantitative BKPyV assays. Differences in commutability between matrices may largely be due to factors other than those such as amplicon size, previously described as important in the case of cytomegalovirus. Continued efforts to standardize viral load measurements must address multiple sources of variability and account for differences in assay systems, quantitative standards, and sample matrices.

[Global guidelines of colorectal cancer screening in high-risk population with family history of colorectal cancer: a systematic review]

Objective: To systematically summarize and evaluate the development of update and detailed recommendations of the existing global screening guidelines in high-risk population with a family history of colorectal cancer. Methods: The words "colorectal cancer", "screening", "guideline", "consensus", "recommendations" and "family history" in Chinese and English were used as MESH terms for literature retrieval, as well as entry terms. The retrieval was performed based on China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed, Embase, Cochrane Library and Web of Science, as well as official websites. The languages of literatures were limited in Chinese and English. As of May 24, 2022, a total of 20 valid literatures had been retrieved. The basic information of the literatures and the recommendations of colorectal cancer screening for people with family history were collected and analyzed. Results: The analysis on the 20 literatures indicated that most countries/regions/institutions recommended age range of screening, screening modalities and intervals for people with family history of colorectal cancer. For the individuals who have one first-degree relative diagnosed with colorectal cancer before 60 years of age,most guidelines recommended the screening to be started at 40 years or 10 years earlier than the age when the youngest first-degree relative was diagnosed. The most commonly recommended screening modality was colonoscopy. Conclusions: Most current screening guidelines for high-risk people with family history of colorectal cancer recommend colonoscopy as the main modality. This review will provide reference for the update of screening strategies in high-risk people with family history of colorectal cancer in China, and further improve the practices of screening, early diagnosis and treatment of colorectal cancer.

The association of coffee consumption with the risk of osteoporosis and fractures: a systematic review and meta-analysis

To elucidate the association of coffee and bone health would help fracture risk reduction via dietary intervention. Although those who had higher coffee consumption were less likely to have osteoporosis, the associations between coffee consumption and fracture risk need further investigations with better study designs.

INTRODUCTION

The associations between coffee consumption and the risk of osteoporosis and fracture remain inconclusive. We aimed to better quantify these associations by conducting meta-analyses of observational studies.

METHODS

Relevant studies were systematically searched on PubMed, Web of Science, Cochrane library, and Embase Database up to November 25, 2021. The odds ratio (OR) or relative risk (RR) with 95% confidence intervals (CI) was pooled and a dose-response analysis was performed.

RESULTS

Four studies with 7114 participants for osteoporosis and thirteen studies with 391,956 participants for fracture incidence were included in the meta-analyses. High versus low coffee consumption was associated with a lower risk of osteoporosis [pooled OR (95% CI): 0.79 (0.65-0.92)], while it was non-significantly associated with fracture incidence [pooled OR (95% CI): 0.86 (0.67-1.05) at hip and 0.89 (0.42-1.36) at non-hip]. A non-linear association between the level of coffee consumption and hip fracture incidence was shown (P = 0.004). The pooled RR (95% CI) of hip fracture risk in those who consumed 1, 2-3, 4, and ≥ 9 cups of coffee per day was 0.92 (0.87-0.97), 0.89 (0.83-0.95), 0.91 (0.85-0.98), and 1.10 (0.76-1.59), respectively. The significance in the association between coffee consumption and the hip fracture incidence decreased in those studies that had larger sample size, higher quality, and more adjustments.

CONCLUSIONS

A dose-dependent relationship may exist between coffee consumption and hip fracture incidence. The effect of high versus low coffee consumption was influenced by study designs. Further studies with dedicated designs are needed to confirm the independent effects of coffee consumption on bone health.

The SARS-CoV-2 envelope protein disrupts barrier function in an in vitro human blood-brain barrier model

Patients with coronavirus disease 2019 (COVID-19) have been frequently reported to exhibit neurological manifestations and disruption of the blood-brain barrier (BBB). Among the risk factors for BBB breakdown, the loss of endothelial cells and pericytes has caused widespread concern. Recent studies have revealed that severe acute respiratory syndrome coronavirus 2 envelope (S2E) protein caused cell death. We tested the hypothesis that the S2E protein alone could induce BBB dysfunction. The S2E protein bound to human BBB-related cells and inhibited cell viability in a dose- and time-dependent manner. Importantly, the S2E protein disrupted barrier function in an in vitro BBB model composed of HCMEC/D3 (brain endothelial cell line), HBVP (brain vascular pericyte), and U87MG (astrocyte cell line) cells and suppressed the expression of major genes involved in maintaining endothelial permeability and function. In addition, the S2E protein crossed the HCMEC/D3 monolayer. The S2E protein triggered inflammatory responses in HCMEC/D3 and U87MG cells. Taken together, these results show for the first time that the S2E protein has a negative impact on the BBB. Therapies targeting the S2E protein could protect against and treat central nervous system manifestations in COVID-19 patients.

Non-invasive prediction of p53 and Ki-67 labelling indices and O-6-methylguanine-DNA methyltransferase promoter methylation status in adult patients with isocitrate dehydrogenase wild-type glioblastomas using diffusion-weighted imaging and dynamic susceptibility contrast-enhanced perfusion-weighted imaging combined with conventional MRI

AIM

To assess whether conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) could non-invasively predict p53 and Ki-67 labelling index (LI) and O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status in adult isocitrate dehydrogenase (IDH) wild-type glioblastomas.

METHODS

The conventional MRI, DWI, and DSC-PWI results of 120 adult patients with IDH wild-type glioblastomas were reviewed retrospectively and their efficacy was analysed using chi-square tests or Fisher's exact test. Relative minimum apparent diffusion coefficient (rADCmin) and relative maximum cerebral blood volume (rCBVmax) values were compared between glioblastomas with different molecular statuses using the Mann-Whitney U-test. Receiver operating characteristic (ROC) curves and logistic regression were used to evaluate predictive performance.

RESULTS

Glioblastomas with a high p53 LI were more likely to show a well-defined enhancement margin (p=0.047). Glioblastomas in the high-Ki-67-LI group demonstrated significantly lower rADCmin (p<0.001) and higher rCBVmax (p=0.001) values than those in the low-Ki-67-LI group. Tumours without MGMT promoter methylation showed lower rADCmin (p<0.001) and higher rCBVmax (p<0.001) values than those with it. The rCBVmax value exhibited a greater efficacy in predicting the MGMT promoter methylation status of adult IDH wild-type glioblastomas than the rADCmin value (p=0.001).

CONCLUSIONS

The present results suggest that conventional and DWI and DSC-PWI results are influenced by the molecular status of the glioblastoma and indicate that DWI and DSC-PWI may help to identify regions of high invasiveness within heterogeneous glioblastomas.

[Recommendations for diagnosis and treatment of ankylosing spondylitis]

Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the sacroiliac joints, spine and peripheral joints. In China, standardized diagnosis and treatment of AS is still to be popularized. Based on the evidence and guidelines from China and other countries, Chinese Rheumatology Association developed standardization of diagnosis and treatment of AS. The purposes are: (1) to standardize the diagnosis and evaluation of AS; (2) to promote rational use of non-steroidal anti-inflammatory drugs, biological as well as traditional disease modifying anti-rheumatic drugs, so as to improve the patient's quality of life.

[Recommendations for diagnosis and treatment of psoriatic arthritis in China]

Psoriatic arthritis is a chronic systemic autoimmune disease, characterized by psoriasis skin lesions and inflammation of the spine and joint. It has complicated clinical manifestations and individual variations. Nearly half of the patients will have joints erosion in two years, which is crippling. The severity of the skin and joint disease frequently do not correlate with each other. Currently, the understanding of the disease is insufficient in China with the lack of standardized diagnosis and treatment. Therefore, researchers from the Chinese Rheumatology Association formulated this specification based on the diagnosis and management experience together with guidelines at home and abroad. The specification summarizes the present situation of domestic diagnosis and treatment, aiming to standardize the diagnosis process and treatment protocols of psoriatic arthritis. Furthermore, it can reduce misdiagnosis and missed diagnosis, as well as improve the prognosis.

ASSOCIATION BETWEEN THE CTLA-4 EXON 1+49A/G POLYMORPHISM AND THE RELAPSE OF GRAVE'S DISEASE AFTER ATD WITHDRAWAL: A META-ANALYSIS

Background

The cytotoxic T lymphocyte-associated molecules-4 (CTLA-4) is related to the relapse of Graves' disease (GD) after anti-thyroid drugs (ATDs) withdrawal. We performed a meta-analysis to generate large-scale evidence on whether the CTLA-4 exon 1+49A/G polymorphism can predict the relapse of GD after ATDs withdrawal.

Methods and Results

The PubMed, EMBASE,the Cochrane Library and reference lists of relevant studies were searched to identify eligible studies from inception to Jan, 2021. Ten eligible studies consisting of 1450 GD patients with a total of 848 relapsed patients were included in the meta-analysis.In Caucasians patients, the CTLA-4 exon 1+49A/G polymorphism significantly elevated the relapse risk of GD in additive (OR = 2.07, 95% CI: 1.18-3.62, P=0.011), dominant (OR = 2.52, 95% CI: 1.17-5.41, P=0.02), homozygote model(OR = 3.264, 95% CI: 1.25-8.52, P=0.016), except recessive (OR = 2.18, 95% CI = 0.98-4.86, P = 0.062) and heterozygote model (OR = 2.141, 95% CI = 0.958-4.786, P = 0.064). In Asian subgroup, none of these genotypes show any associations with the relapse of GD after ATDs withdrawal.

Conclusion

This meta-analysis suggests that the CTLA-4 exon1 +49A/G polymorphism is associated with the relapse risk of GD after ATDs withdrawal in Caucasians, not Asians. Compared with the AA genotype, Caucasian patients with GG genotype have 3.264 times risk of relapse. A more aggressive treatment such as radioactive iodine or thyroidectomy, or longer periods treatment of ATDs should be recommended in Caucasian patients with the GG genotype.

Enteric viruses replicate in salivary glands and infect through saliva

Enteric viruses like norovirus, rotavirus and astrovirus have long been accepted as spreading in the population through fecal-oral transmission: viruses are shed into feces from one host and enter the oral cavity of another, bypassing salivary glands (SGs) and reaching the intestines to replicate, be shed in feces and repeat the transmission cycle1. Yet there are viruses (for example, rabies) that infect the SGs2,3, making the oral cavity one site of replication and saliva one conduit of transmission. Here we report that enteric viruses productively and persistently infect SGs, reaching titres comparable to those in the intestines. We demonstrate that enteric viruses get released into the saliva, identifying a second route of viral transmission. This is particularly significant for infected infants, whose saliva directly transmits enteric viruses to their mothers' mammary glands through backflow during suckling. This sidesteps the conventional gut-mammary axis route4 and leads to a rapid surge in maternal milk secretory IgA antibodies5,6. Lastly, we show that SG-derived spheroids7 and cell lines8 can replicate and propagate enteric viruses, generating a scalable and manageable system of production. Collectively, our research uncovers a new transmission route for enteric viruses with implications for therapeutics, diagnostics and importantly sanitation measures to prevent spread through saliva.

[Clinical characteristics and prognostic analyses of cervical neuroblastoma]

Objective: To determine the characteristics of cervical neuroblastoma and the effect of resection extent on survival and outcomes. Methods: We performed a retrospective review of 32 children with cervical neuroblastoma treated at Beijing Children's Hospital between April 2013 and August 2020. Data were collected from the medical record. The individualized therapy was designed based on staging and risk group. Based on the extent of resection, patients were divided into incomplete and complete resection groups. Event free and overall survival rates were compared between two groups using the Kaplan-Meier method. Results: The ages of patients ranged from 1 month to 81 months, with a median age of 11 months, including 7 males and 15 females. Twenty-nine patients (90.6%) presented with cervical painless mass. The average diameter of the primary tumors was (5.12±1.43) cm. Tumors were located in the parapharyngeal space in 25 cases (78.1%) and in the root of the neck in 7 cases (21.9%). None had MYCN amplification. According to International Neuroblastoma Staging System (INSS), 15 patients (46.9%) were identified as stage 1, 11 patients (34.3%) as stage 2B, 3 patients (9.4%) as stage 3 and 3 patients (9.4%) as stage 4. There were 12 patients (37.5%) at low risk, 17 patients (53.1%) at intermediate risk and 3 patients at high risk according to Children's Oncology Group (COG) risk classification system. All patients underwent tumor resection. Postoperatively Horner's syndrome occurred in 13 patients (40.6%), pneumonia in 9 patients (28.1%), pharyngeal dysfunction in 8 patients (25.0%) and transient hoarseness in 4 patients (12.5%). At a median follow-up of 36.5 months, the overall survival rate was 96.4%, with no significant difference between incomplete and complete resection groups (100.0% vs. 96.3%, χ²=0.19, P=0.667); the event free survival rate was 78.1%, with a significant difference between the two groups (40.0% vs. 85.2%, χ²=6.71, P=0.010). Conclusions: Primary cervical neuroblastoma has a young onset age, mostly in low and medium risk groups, and represents favorable lesions with good outcomes after multidisciplinary therapy. Less aggressive surgery with preservation of important structures is recommended. Complete resection should not be attempted if it would compromise vital structures.

Unique motif shared by HLA-B*59:01 and HLA-B*55:02 is associated with methazolamide-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Han Chinese

BACKGROUND

Methazolamide (MTZ) has been occasionally linked to the lethal Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which are associated with HLA-B*59:01. However, some MTZ-induced SJS/TEN (MTZ-SJS/TEN) cases are negative for HLA-B*59:01, implying that other genetic factors besides HLA-B*59:01 are contributing to MTZ-SJS/TEN.

OBJECTIVES

To comprehensively identify HLA and non-HLA genetic susceptibility to MTZ-SJS/TEN in Han Chinese.

METHODS

Eighteen patients with MTZ-SJS/TEN, 806 subjects of the population control and 74 MTZ-tolerant individuals were enrolled in this study. Both exome-wide and HLA-based association studies were conducted. Molecular docking analysis was employed to simulate the interactions between MTZ and risk HLA proteins.

RESULTS

We found a strong signal in the major histocompatibility complex region on chromosome 6 with 22 SNPs reaching exome-wide significance. Compared with MTZ-tolerant controls, a significant association of HLA-B*59:01 with MTZ-SJS/TEN was validated (odds ratio [OR] = 146.00, 95% confidence interval [CI]: 16.12-1321.98; P = 6.19 × 10^-10 ). Moreover, 66.7% of MTZ-SJS/TEN patients negative for HLA-B*59:01 were carriers of HLA-B*55:02, while 2.7% of the tolerant individuals were observed with HLA-B*55:02 (OR = 71.00, 95% CI: 7.84-643.10; P = 1.43 × 10^-4 ). Within HLA-B protein, the E45-L116 motif could completely explain the association of HLA-B*59:01 and HLA-B*55:02 with MTZ-SJS/TEN (OR = 119.33, 95% CI: 29.19-1227.96; P = 4.36 × 10^-13 ). Molecular docking analysis indicated that MTZ binds more stably to the pocket of HLA-B*59:01 and HLA-B*55:02 than to that of non-risk alleles of HLA-B*40:01 and HLA-C*01:02.

CONCLUSIONS

This study confirmed the association of HLA-B*59:01 with MTZ-SJS/TEN and identified HLA-B*55:02 as a novel risk allele in Han Chinese with the largest sample size to date. Notably, the rs41562914(A)-rs12697944(A) haplotype, encoding E45-L116, is capable of serving as a powerful genetic predictor for MTZ-SJS/TEN with a sensitivity of 89% and specificity of 96%.

Exploring Lorentz Invariance Violation from Ultrahigh-Energy γ Rays Observed by LHAASO

Recently, the LHAASO Collaboration published the detection of 12 ultrahigh-energy γ-ray sources above 100 TeV, with the highest energy photon reaching 1.4 PeV. The first detection of PeV γ rays from astrophysical sources may provide a very sensitive probe of the effect of the Lorentz invariance violation (LIV), which results in decay of high-energy γ rays in the superluminal scenario and hence a sharp cutoff of the energy spectrum. Two highest energy sources are studied in this work. No signature of the existence of the LIV is found in their energy spectra, and the lower limits on the LIV energy scale are derived. Our results show that the first-order LIV energy scale should be higher than about 10^{5} times the Planck scale M_{Pl} and that the second-order LIV scale is >10^{-3}M_{Pl}. Both limits improve by at least one order of magnitude the previous results.

Prevalence of autoimmune thyroid disease in patients with psoriasis: a meta-analysis

OBJECTIVE

Psoriasis is a chronic inflammatory disease with autoimmune aetiology. A possible link between psoriasis and autoimmune thyroid disease (AITD) has been suggested in some studies with inconsistent findings. This meta-analysis aims to determine the association between psoriasis and AITD.

DESIGN

A meta-analysis of observational studies.

DATA SOURCES

PubMed, EMBASE, Scopus and the Cochrane Library were searched up to 1 November 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included non-randomised studies, each with over 50 cases in every group, focusing on the rate of comorbidity between psoriasis and AITD.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened the articles and extracted data. The restricted maximum-likelihood was applied to perform the meta-analysis. OR and 95% CIs were pooled to compare the prevalence of AITD in psoriasis and control groups. Heterogeneity was assessed with I² statistic. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality were applied for quality assessment. The risk of bias was assessed with Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I).

RESULTS

Eleven available studies with data on 253 313 patients with psoriasis and 1 376 533 controls were included. Meta-analysis showed that patients with psoriasis had a higher prevalence of AITD (OR 1.76, 95% CI 1.35 to 2.28, Z=4.25, p<0.01), especially loss-of-function disorder of the thyroid gland. Both thyroglobulin antibodies positive rate (OR 1.98, 95% CI 1.27 to 3.10, Z=3.00, p<0.01) and thyroid peroxidase antibodies positive rate (OR 2.15, 95% CI 1.31 to 3.52, Z=3.05, p<0.01) were also increased in the psoriasis group compared with the control group.

CONCLUSIONS

Our study indicates that the rate of co-occurring AITD was significantly increased in patients with psoriasis. It suggests that the increased risk of AITD should be concerned in patients with psoriasis.

PROSPERO REGISTRATION NUMBER

CRD42020206005.

Analyses of the clinical and immunological characteristics of patients with lupus erythematosus

BACKGROUND

Lupus erythematosus (LE) is a broad-spectrum, heterogeneous disease. At one end of the spectrum is the cutaneous LE (CLE) without systemic involvement, and at the other end is the systemic LE (SLE) with multisystem involvement. Analyses of clinical and immunological indicators and pathological examinations are helpful for early diagnosis, differential diagnosis, and prognosis of LE.

AIM AND OBJECTIVES

We described the clinical and laboratory characteristics of patients with LE and assessed the diagnostic value of immunohistochemical detection of C3d, C4d, IgG, IgG4, and CD123 in skin lesions of LE.

MATERIALS AND METHODS

Clinical and laboratory data of 62 patients with LE were collected. The expression levels of C3d, C4d, IgG, IgG4, and CD123 in skin lesions of LE were detected by immunohistochemistry (IHC).

RESULTS

Clinical manifestations such as hematological involvement, C3, C4, ESR, hematuresis, proteinuria, anti-Sm, anti-ribosomal P-protein, anti-U1-RNP, anti-histone, and anti-nucleosome antibodies are helpful for classificatory diagnosis of LE. The positive rate of C3d and/or C4d along the basement membrane zone in LE skin lesions by IHC was 74.6%, which was higher than that by direct immunofluorescence (47.5%) (P = 0.002). The expression of CD123 protein and the number of CD123+ plasmacytoid dendritic cells (PDCs) in skin lesions of patients with LE were higher than those of dermatomyositis (DM), while the distributed form of CD123 + PDCs in the dermis was different between LE and DM.

CONCLUSIONS

The diagnosis of CLE and SLE requires a combination of clinical manifestations, laboratory indicators, and pathological examination. Immunohistochemical detection of C3d, C4d, and CD123 in skin lesions is important for the classificatory diagnosis of LE.

Decreased microRNA-126 expression in psoriatic CD4+ T cells promotes T-helper 17 cell differentiation and the formation of dermatitis in imiquimod-induced psoriasis-like mice

Psoriasis is a chronic inflammatory skin disease with multiple genetic backgrounds, whose etiology and pathogenesis are still unclear. Complex T-cell immune imbalance has been demonstrated to play an important role in pathogenesis of psoriasis. This study reported that microRNA-126 (miR-126) expression was decreased in CD4⁺ T cells of both psoriasis patients and psoriasis-like mouse models and its expression was negatively correlated with the Psoriasis Area and Severity Index (PASI) score of psoriasis patients. Conditional Mir126 knockout in mouse CD4⁺ T cells can obviously aggravate the psoriasis-like dermatitis and promote T-helper (Th)1 and Th17 cells' infiltration in spleen of imiquimod (IMQ)-induced psoriasis-like mouse model. In addition, the mRNA expression of Il17a and Il17f were significantly increased in mouse naïve CD4⁺ T cells with Mir126 knockout after stimulating with CD3 and CD28. Compared with naïve CD4⁺ T cells, the expression of Mir126 was decreased in Th17 cells, and Mir126 knockout notably promoted the differentiation of naïve CD4⁺ T cells to Th17 cells as well as the mRNA expression of Il17a, Il17f, Rorc, and Il23R. Our results revealed that decreased miR-126 in psoriatic CD4⁺ T cells might accelerate the formation of skin lesions through promoting the differentiation of Th17 cells, thus suggesting a potential intervention target for psoriasis.

Bone marrow mesenchymal stem cells promote the progression of prostate cancer through the SDF-1/CXCR4 axis in vivo and vitro

PURPOSE

The aim of this study was to investigate the involvement of the SDF-1/CXCR4 axis in the process of BMMSC homing in prostate cancer (PCa) in vivo and in vitro.

METHODS

After verification of BMMSCs, we fixed the concentration gradient of SDF-1 for BMMSC cultivation to analyze CXCR4 expression by qRT-PCR and flow cytometric analysis. Furthermore, we developed a non-contact co-culture system and explored the participation of the SDF-1/CXCR4 axis in PCa using qRT-PCR, flow cytometry, and ELISA. In addition, A green fluorescent protein (GFP)-transplanted methylnitrosourea (MNU)-induced PCa mouse model was established to investigate the CXCR4 expression in vivo.

RESULTS

The CXCR4 expression was up-regulated with the increase in SDF-1 concentrations, and elevated SDF-1 had a significant promoting effect on cell proliferation and migration in BMMSCs. Moreover, the CXCR4 expression of BMMSCs was significantly increased in the non-contact co-culture model with vascular endothelial cells (VECs), and analysis of this model also showed that the proliferation and migration of BMMSCs were promoted in the presence of VECs. The ELISA assay showed that the SDF-1 levels in the co-culture model at 48 h were significantly increased. Twenty of the GFP-transplanted mice were divided into a PCa group and a control group, and four GFP-transplanted mice were observed to have prostate tumorigenesis. It also showed that CXCR4 was obviously increased in the prostate tissue of PCa mice.

CONCLUSION

Our findings suggest that BMMSCs could home and promote the proliferation and migration of PCa through the SDF-1/CXCR4 axis in vivo and in vitro.

ToxR modulates biofilm formation in fish pathogen Vibrio harveyi

Vibrio harveyi is a common aquaculture pathogen causing diseases in a variety of aquatic animals. toxR, a conserved virulence-associated gene in vibrios, is identified in V. harveyi 345, a pathogenic strain isolated from diseased fish. In this study, to gain insight into function of ToxR in V. harveyi, an in-frame deletion of the toxR gene was constructed to reveal the role of ToxR in the physiology and virulence of V. harveyi. The statistical analysis showed no significant differences in the growth ability, motility, extracellular protease secretion, antibiotic susceptibility, virulence by intraperitoneal injection and the ability of V. harveyi to colonize the spleen and liver tissues of the pearl gentian grouper between the wild-type (WT) and the toxR mutant. However, the deletion of toxR increased the biofilm formation. The structure of the V. harveyi biofilm was further analysed by using scanning electron microscopy (SEM) and confocal laser scanning microscopy, and the results showed that deletion of toxR increased the number and density of V. harveyi biofilm. Since biofilm production is flagella, exopolysaccharide (EPS) and lipopolysaccharide dependent, 16 of V. harveyi biofilm-related genes were selected for further analysis. Based on quantitative real-time reverse transcription-PCR, the expression levels of these genes, including genes flrB, motY and mshA, flaE, flrA and gmhD, were significantly up-regulated in the ΔtoxR⁺ strain as compared with the WT⁺ and C-ΔtoxR strains during the early and mid-exponential, while epsG, flaA, flaE, flgD, flgE, flrB, flrC, lpxB, motY, mshA and scrG genes were inhibited because of deletion of the toxR gene in the stationary growth phase. Our results indicate that ToxR plays an important role in controlling the biofilm in V. harveyi.

Optical coherence tomography-defined vulnerable plaque characteristics in relation to functional severity of coronary stenoses stratified by quantitative flow ratio

Background

The functional severity and morphological features of epicardial lesions are both related to plaque vulnerability and adverse coronary events. However, their relationship remains controversial, especially in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Purpose

This study aimed to examine whether quantitative flow ratio (QFR), an angiography-based computation of fractional flow reserve, was associated with optical coherence tomography (OCT)-defined vulnerable plaques such as thin-cap fibroatheromas (TCFAs) in a board spectrum of population, including patients presenting stable angina and NSTE-ACS.

Methods

We identified patients who underwent OCT examinations from 2 prospective cohorts and then assessed interrogated vessels with QFR. Lesions were divided into tertiles: QFR-T1 (QFR &lt;0.85)&lt;qfr),&gt;, QFR-T2 (0.85 to 0.93) and QFR-T3 (QFR &gt;0.93).

Results

This post-hoc analysis included 83 lesions from 79 patients (mean age: 61.5±9.8 years, males: 58%). Patients with NSTE-ACS accounted for the majority of the population (67%). The median % diameter stenosis and median QFR value were 42% (36 to 49%) and 0.88 (0.83 to 0.95), respectively. The prevalence of OCT-TCFA was significantly higher in QFR-T1 (50%) than in QFR-T2 (14%) and QFR-T3 (19%) (p=0.003 and 0.018, respectively). Overall significant differences were observed among tertiles in maximum lipid arc, thinnest fibrous cap thickness (FCT), and minimal lumen area (MLA) (p=0.017, 0.040, and &lt;0.001, respectively). The Spearman's correlation analysis showed that QFR was significantly related to MLA (ρ = 0.537, p&lt;0.001), % area stenosis (ρ = –0.512, p&lt;0.001), maximum lipid arc (ρ = –0.360, p=0.002), lipid length (ρ = –0.242, p=0.038), lipid index (ρ = –0.333, p=0.004), and thinnest FCT (ρ = 0.315, p=0.006). In the multivariable analysis, QFR ≤0.80 remained as a significant determinant of TCFAs regardless of the presence of NSTE-ACS and the level of low-density lipoprotein cholesterol (adjusted odds ratio = 4.387, 95% confidence interval: 1.297 to 14.839, p=0.017). In addition, QFR demonstrated moderate predictive ability for OCT-TCFA (area under the curve = 0.72, 95% confidence interval: 0.58 to 0.86, p=0.003) with the best cutoff of ≤0.86 (sensitivity: 65%; specificity: 73%; negative predictive value: 85%; accuracy: 71%).

Conclusions

Lower QFR was related to OCT-TCFA and other vulnerable plaque characteristics in angiographically mild-to-intermediate stable lesions and culprit lesions from NSTE-ACS. The QFR might be a useful tool for ruling out high-risk, rupture-prone plaques without using any pressure wires or vasodilators.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Jiangsu Provincial Key Research and Development Program Flow diagram of patient selectionOCT findings according to QFR tertiles

Phenotypic and genetic correlations of pork myoglobin content with meat colour and other traits in an eight breed-crossed heterogeneous population

Meat colour is one of the most important meat quality traits affecting consumption desire. Genetic improvement for meat colour traits is not so easy because pigs can be phenotyped only after slaughter. Besides the parameters from the optical instrument, other indexes that reflect the material basis of meat colour should be measured accurately and used in the genomic analysis. Myoglobin (Mb) is the main chemical component determining meat colour. However, to what extent the Mb content contributes to meat colour, and whether it can be used as a trait for pig breeding to improve meat colour, and the correlations of Mb content with complex porcine traits are largely unknown. To address these questions, we measured the muscle Mb content in 624 pigs from the 7th generation of a specially designed eight breed-crossed pig heterogeneous population, evaluated its phenotypic and genetic correlations with longissimus thoracis colour score at 24 h after slaughter. More than that, we also systematically phenotyped more than 100 traits on these animals to evaluate the potential correlations between muscle Mb content and economically important traits. Our results showed that the average muscle Mb content in the 624 pigs was 1.00 mg/g, ranging from 0.51 to 2.17 mg/g. We found that higher Mb content usually correlated with favourable meat colour, higher marbling score, less moisture content, and less drip loss. Genetic correlation analysis between muscle Mb content and 101 traits measured in this study shows that Mb content is also significantly correlated with 31 traits, including marbling, shear force, firmness, and juiciness. To our knowledge, this is one of the largest studies about the correlations of muscle Mb content with as many as 100 various traits in a large-scale genetically diversified population. Our results showed that the Mb content could be a selection parameter for the genetic improvement of meat colour. The selection for higher Mb content will also benefit marbling, shear force, firmness, and overall liking but might not affect the growth, carcass, and fat deposition traits.

MiR-181a promotes cell proliferation and migration through targeting KLF15 in papillary thyroid cancer

INTRODUCTION

Papillary thyroid cancer (PTC) is the predominant histological type of thyroid cancer, accounting for 80% of thyroid cancers. MiR-181a is a novel microRNA that is usually upregulated in multiple cancers. This study aims to explore the role and underlying mechanism of miR-181a in PTC.

METHODS

CCK8 and Transwell assays were performed to evaluate cell viability and migration. The mRNA level of miR-181a and KLF15 was calculated by qRT-PCR. The protein level of E-Cadherin, N-Cadherin and GAPDH was evaluated by western blot. Dual luciferase assay was conducted to validate that miR-181a directly targeting the 3'-UTR of KLF15 mRNA in TPC-1 cells.

RESULTS

We observed that miR-181a was overexpressed and KLF15 was low expressed in PTC tissues and cell lines. Upregulation of miR-181a or downregulation of KLF15 predicted poor outcomes in PTC patients. MiR-181a improved cell growth of PTC, migration and epithelial-mesenchymal transition (EMT) in TPC-1 cells. KLF15 was a target gene of miR-181a and its expression was mediated by miR-181a. KLF15 partially reversed the facilitating effect of miR-181a on cell proliferation and migration in TPC-1 cells.

CONCLUSION

We discovered that miR-181a served as an oncogene downregulating KLF15, thereby inhibiting cell proliferation, migration and the EMT. These findings demonstrate that miR-181a plays a significant role in PTC progression and could be a therapeutic target for PTC.

Peta-electron volt gamma-ray emission from the Crab Nebula

The Crab Nebula is a bright source of gamma rays powered by the Crab Pulsar's rotational energy through the formation and termination of a relativistic electron-positron wind. We report the detection of gamma rays from this source with energies from 5 × 10^-4 to 1.1 peta-electron volts with a spectrum showing gradual steepening over three energy decades. The ultrahigh-energy photons imply the presence of a peta-electron volt electron accelerator (a pevatron) in the nebula, with an acceleration rate exceeding 15% of the theoretical limit. We constrain the pevatron's size between 0.025 and 0.1 parsecs and the magnetic field to ≈110 microgauss. The production rate of peta-electron volt electrons, 2.5 × 10³⁶ ergs per second, constitutes 0.5% of the pulsar spin-down luminosity, although we cannot exclude a contribution of peta-electron volt protons to the production of the highest-energy gamma rays.

AB0758 CLINICAL PROFILES DIFFER IN IGG4-RELATED DISEASE WITH AND WITHOUT ATOPY: A LARGE CASE-CONTROL STUDY IN CHINA

Background:

IgG4-related ophthalmic disease (IgG4-ROD) is one of the phenotypes of IgG4-related disease (IgG4-RD), and its lesions are mainly located in the ocular. Currently, there are few studies on IgG4-ROD and no study has compared the phenotypic differences between IgG4-ROD and non IgG4-ROD (nIgG4-ROD). Thus, it is difficult to establish the optimal treatment strategy for IgG4-ROD.

Objectives:

The aim of this study was to identify the disparities between the two groups and to clarify the risk factors for IgG4-ROD relapse.

Methods:

The IgG4-RD patients diagnosed at Peking University People’s Hospital between January 2009 and January 2020 were recruited in this study. Patients were divided into IgG4-ROD and nIgG4-ROD group according to the ophthalmic involvement. Demographic, clinical and laboratory data of two groups were collected and compared. Cox regression analysis was used to identify the independent risk factors for IgG4-ROD relapse.

Results:

Two hundred and fifty-five cases of IgG4-ROD were identified in 434 IgG4-RD patients in this study. IgG4-ROD group had almost equal sex ratio (male to female 0.96:1 vs 2.14:1, P<0.001), younger age of disease onset (51.1±13.2 vs 55.5±13.5, P<0.001) and diagnosis (54.4±12.6 vs 56.9±13.4, P=0.054) comparing with nIgG4-ROD patients. As compared to nIgG4-ROD group, higher percentage of IgG4-ROD patients met the 2019 American College of Rheumatology/European League Against Rheumatism classification criteria (AECC) for IgG4-RD (89.4% vs 64.8%, P<0.001), moreover, IgG4-ROD patients had higher AECC scores (37.0±12.9 vs 27.2±14.0, P<0.001) and IgG4-RD responder index (11.4±6.0 vs 10.2±6.3, P=0.045). Allergic diseases (65.5% vs 26.3%, P<0.001) and multiorgan involvement [6(4-7) vs 3(2-5), P<0.001] were more common in IgG4-ROD group. IgG4-ROD was frequently associated with salivary gland (92.5% vs 45.3%, P<0.01), paranasal sinuses (38.8% vs 12.8%, P<0.01), lung (47.8% vs 32.4%, P<0.01) and lymph node (64.3% vs 46.4%, P<0.01) involvement, while retroperitoneal fibrosis (7.1% vs 21.2%, P<0.01) and biliary system lesions (25.1% vs 35.2%, P<0.05) were more common in nIgG4-ROD. IgG4-ROD patients had higher serum IgG4 levels [983(409-1838) vs 523(225-1370), P<0.001], IgG4/IgG ratio [0.529(0.272-0.879) vs 0.294(0.143-0.629), P<0.001], IgE levels [339.7(160.8-847.6) vs 259.4(83.1-653.3), P=0.022] and lower CRP levels [2.24(1.00-4.70) vs 3.05(1.26-12.45), P=0.004]. The initial glucocorticoid plus immunosuppressant was a protective factor for IgG4-ROD relapse (HR 0.279, 95%CI 0.165-0.470, P<0.001), and IgG4-ROD patients treated with initial glucocorticoid plus immunosuppressant had longer relapse-free survival time than patients treated with initial glucocorticoid monotherapy (43 vs 17, P<0.001).

Conclusion:

IgG4-ROD patients had distinctive clinical features compared with nIgG4-ROD patients. The initial glucocorticoid plus immunosuppressant was a protective factor for IgG4-ROD relapse, which could prolong the relapse-free survival time of IgG4-ROD patients. These findings may have important implications for understanding and management of IgG4-ROD.

Disclosure of Interests:

None declared

AB0046 THE EXPRESSION AND CLINICAL SIGNIFICANCE OF TAM RECEPTOR TYROSINE KINASE ON MONOCYTE SUBSETS IN RHEUMATOID ARTHRITIS

Background:

The TAM receptor tyrosine kinases (Tyro3/Axl/Mer TK) are a subfamily of receptor tyrosine kinases, the role of which in autoimmune diseases such as systemic lupus erythematosus has been well explored, while their functions in rheumatoid arthritis (RA) remain largely unknown [1].

Objectives:

The study aimed to investigate the expression and clinical significance of Tyro3, Axl and MerTK on monocyte subsets in rheumatoid arthritis (RA).

Methods:

The expression of Tyro3, Axl and MerTK on CD14+ monocytes, nonclassical monocytes (NCM, CD14+CD16++), intermediate monocytes (IM, CD14++CD16+), and classical monocytes (CM, CD14++CD16-) were evaluated in peripheral blood of RA by flow cytometry and qPCR. And the correlation between the expression of Tyro3TK and MerTK on NCM, IM, and CM with RA patient clinical feature were further analyzed.

Results:

The results revealed that the expression of Tyro3TK on CD14+ monocytes was significantly upregulated in RA patients (F = 9.18, P < 0.0001), while there was no significant difference of the expression MerTK on HC, OA, and RA, and the expression of AxlTK was minimal (Fig 1). The expression of Tyro3TK on CM was significantly upregulated in RA patients as compared with HC and osteoarthritis (OA) patients (P < 0.05, Fig 2-3), and positively correlated with the disease manifestations, such as swollen joint count (SJC), tender joint count (TJC) and the disease activity score (Fig 4).

Figure 1.

The expression of Tyro3, Axl and MerTK on CD14+ monocytes is increased in RA. (a) Gating strategy for flow cytometry of Tyro3, Axl and MerTK on CD14+ monocytes. (b) The expression of Tyro3, Axl and MerTK on CD14+ monocytes were compared between HC (n = 40), OA (n = 27), and RA patients (n = 40). *P < 0.05, **P < 0.01, ns, not significant.

Figure 2.

The expression of Tyro3TK on IM and CM were increased in RA. (a) Gating strategy for flow cytometry of TAMTK on monocyte subsets. The expression of (b) Tyro3TK and (c) MerTK on NCM, IM, and CM were compared between HC (n = 40), OA (n = 27), and RA patients (n = 40). *P < 0.05, **P < 0.01, ***P < 0.001, ns, not significant.

Figure 3.

The mRNA expression of Tyro3TK on CM is increased in RA. (a) The mRNA expression of Tyro3TK on NCM, IM, and CM in HC (n = 3) and RA (n = 3) patients. (b) The mRNA expression of MerTK on NCM, IM, and CM in HC (n = 3) and RA (n = 3) patients. **P < 0.01.

Conclusion:

These findings indicate that Tyro3TK on CM was elevated in RA patients and correlated positively with disease activity, which may serves as an important participant in RA pathogenesis.

References:

[1]Rothlin CV, Lemke G, TAM receptor signaling and autoimmune disease. Curr Opin Immunol, 2010. 22(6): p. 740-6.

Footnotes:

The study was supported by grants from the National Natural Science Foundation of China (81671609 and 81871290 to Dr. Y. Su, 82001718 to Dr. L. Xu), the Beijing Science and Technology Planning Project (Z191100006619111 to Dr. Y. Su), the Beijing Municipal Natural Science Foundation (7194329 to Dr. L. Xu).

Figure 4.

Correlation analysis of Tyro3TK on IM and CM with RA patient clinical manifestations. The associations of Tyro3TK on IM (r = 0.492, *P = 0.001) (a) and CM (r = 0.577, *P = 0.0001) (b) with RA patient swollen joint counts (SJC) were analyzed, respectively. The expression of Tyro3TK on IM and CM were also compared between different RA patient groups: (c) RA with high disease activity (DAS28-ESR > 3.2) and non-high disease activity (DAS28-ESR ≤ 3.2), (d) RA with and without swollen joints, (e) tender joints. *P < 0.05, **P < 0.01.

Disclosure of Interests:

None declared

AB0564 RHEUMATOLOGISTS’ VIEWS AND EXPERIENCES IN MANAGING PsA PATIENTS BASED ON TREATING TO TARGET STRATEGY: A CROSS-SECTIONAL STUDY IN CHINA

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with progressive, erosive destruction associated with functional impairment. Principles of treat-to-target (T2T) have been widely used in rheumatoid arthritis, which has powerfully improved patient outcomes. In 2017, the concept of T2T has proposed to apply in PsA patients. However, the awareness and implementation of evidence-based T2T treatment guidelines varies across different geographical regions of China, hospital grades, professional status and specialities.

Objectives:

The study aimed to investigate Rheumatologists’ views and experiences in managing PsA patients with T2T strategy in china.

Methods:

A cross-sectional questionnaire survey of Rheumatologists in China from 5 August to 15 August 2020 was conducted for this study. Rheumatologists were contacted by WeChat (a Chinese cell/web app) and asked to complete a web-based questionnaire anonymously. The electronic questionnaire was sent out by the internet platform of WenJuanXing via WeChat (https://www.wjx.cn/). The questionnaire was designed to collect: (a) demographic information; (b) patient management in clinical practice for Rheumatologists; (c) familiarity and application of T2T strategy in Rheumatologists. P values ≤0.05 were considered significant.

Results:

(1) A total of 823 rheumatologists (69.87% female, 30.13% male) provided valid answers to the questionnaire. 71.09% of the participants major in Modern Western Medicine, 28.91% major in traditional chinese medicine. A total of 75.94% worked in Grade-A Tertiary Hospital. A total of 52.73% had more than 10 years of work experience and 63.55% had High-level title. (2) More than half of the patients were followed up by 69% Rheumatologists in their daily practice. The proportion of follow-up patients increased powerfully in the group of Rheumatologists who major in Modern Western Medicine (P=0.014), work in Grade-A Tertiary Hospital (P<0.001), have more than 10 years of work experience (P<0.001) and High-level title (P<0.001). (3) 36.45% Rheumatologist thought the frequency for patient disease activity assessment was every 1 month and 53.1% was every 3 months. And 41.7% Rheumatologist prefer to use PASDAS for disease activity criteria, and only 3.6% choose MDA. (4) A total of 62.43% thought they were familiar with T2T strategy, and 83.6% Rheumatologists applied T2T strategy in clinical practice. Among 135 Rheumatologists who did not apply T2T strategy, 62.2% of Rheumatologists thought that the main barrier to T2T application was that they did not fully understand the strategy. The frequency of application of T2T strategy in clinical practice was significantly different between Rheumatologists who major in Modern Western Medicine (60.75%) and traditional chinese medicine (22.84%) (P=0.023).

Conclusion:

In china, the management of PsA patients need to be standardized to improve patient outcomes. And the promotion of T2T strategy in PsA need to be further strengthened.

References:

[1]Smolen JS, Schöls M, Braun J,et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018 Jan;77(1):3-17.

[2]Tucker LJ, Ye W, Coates LC. Novel Concepts in Psoriatic Arthritis Management: Can We Treat to Target? Curr Rheumatol Rep. 2018 Sep 18;20(11):71.

[3]Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: how to implement in clinical practice. Ann Rheum Dis. 2016;75(4):640-643.

Figure 1

A. Rheumatologist priority of frequency for patient follow-up in different disease status. B. Rheumatologist priority of frequency for patient disease activity assessment in clinical practice. C. Rheumatologist priority of disease activity criteria for PsA patients.

Disclosure of Interests:

None declared.

AB0372 TOCILIZUMAB WAS EFFECTIVE IN REFRACTORY ARTERIAL INVOLVEMENT OF BEHCET’S DISEASE: A REAL-LIFE SINGLE- CENTER EXPERIENCE IN CHINA

Background:

Behcet’s disease (BD) is a chronic and relapsing vasculitis, in which major vessel involvement is a main cause of mortality and morbidity. The therapeutic arsenal is mainly composed of classical immunosuppressants. However, when faced with resistance to these drugs, no alternative therapeutic strategy is currently recommended.

Objectives:

To assess the efficacy and safety of interleukin 6 receptor inhibitor tocilizumab (TCZ) in refractory arterial involvement of BD in a real-life observational setting.

Methods:

10 patients were enrolled in our center between 2014 and 2019. All patients met the international criteria for BD and had severe arterial involvement evaluated by echocardiography, angio-Computerized Tomography scan and vascular Doppler. The diagnosis of refractory arterio-BD was based on objective vascular symptoms not explained by any other known disease and non-response to conventional immunosuppressants combined with glucocorticoids therapy. All patients underwent TCZ infusions at 8mg/kg every 4 weeks. Concomitant therapy with immunosuppressants and glucocorticoids was continued. Clinical and imaging findings were assessed before and after TCZ therapy. All adverse events were recorded during follow-up.

Results:

All the patients were males, with a mean age of 44.3±10.5 years in this study. The mean age at presentation of arterial involvement was 40.8±9.2 years old. The patterns of arterial involvement were aneurysm (n=9), stenosis (n=3) and aortic valve lesion (n=2). After a mean follow-up of 26.8±7.2 months, TCZ yielded rapid and maintained clinical improvement in 9 patients, with complete remission in 6 of them and partial response in 3 of them. Discontinuation of TCZ treatment due to relapse occurred in one case as the enlargement of abdominal aortic aneurysm. The mean glucocorticoid dosage was tapered from 54.5±20.6mg/d to 8.3±3.6mg/d (p<0.001). And the use of immunosuppressants was tapered in 4 (40.0%) patients. As for serological improvement, the median ESR and CRP levels decreased from 50 (2-82) mm/h and 32.9 (2.1-62.3) mg/dL to 4 (1-10) mm/h (p<0.001) and 2.9 (0.2-12.1) mg/dL (p<0.001), respectively. Radiologic improvement of artery lesion was demonstrated in 4(40%) patients. None of the patients had serious adverse events during follow-up.

Conclusion:

TCZ was a safe and effective therapeutic option for refractory arterial involvement of BD, with a favorable steroid-sparing effect.

References:

[1]G Hatemi, R Christensen, D Bang, et al. 2018 update of the EULAR recommendations for the management of Behçet’s syndrome. Ann Rheum Dis. 2018;77(6):808-818.

[2]Y Ozguler, P Leccese, R Christensen, et al. Management of major organ involvement of Behcet’s syndrome: a systematic review for update of the EULAR recommendations. Rheumatology (Oxford). 2018;57(12):2200-2212.

[3]M Akiyama, Y Kaneko, T Takeuchi. Effectiveness of tocilizumab in Behcet’s disease: A systematic literature review. Semin Arthritis Rheum. 2020;50(4):797-804.

Table 1.

Tocilizumab therapy in ten cases of refractory arterio-BD

PatientAge, yearDisease duration, monthsClinical features*Arterial lesionsPrevious therapyResponse at week 24134228O, G, P, S, IStenosis of CA/ SMA/RA/SCA, aortic valve prolapsePred/CYC/MMFCR22024O, SDissecting aneurysm of AA (Debakey I)Pred/MMFPR367276O, G, P, S, Athoracoabdominal aortic aneurysmPred/CYC/TACCR46775O, S, UStenosis of LAD/LCX/RCAPred /CYCCR55080O, G, AAbdominal and coronary aortic aneurysmsPred /CYCRelapse64826O, GAortic insufficiencyPred /CYCPR726147O, P, S, VIliac artery aneurysmPred /MMFCR849466O, S, VThoracoabdominal and coronary aortic aneurysmsPred /CYC/AZACR927181O, P, SPseudoaneurysm of CCAPred /CYCPR10Male/55354O, P, SAbdominal aneurysm, stenosis of LAD/LCX/RCAPred /CYC/AZACR

*O: oral ulcer; G: genital ulcer; P: pathergy test; S: skin lesions; I: intestinal ulcer; A: arthritis; U: uveitis; V: venous thrombosis

Figure 1.

Changes from baseline in BSAS, BDCAF, ESR, CRP and steroid daily dose at 24 weeks

Disclosure of Interests:

None declared

[Reconstruction of complex tissue defects in temporal region: report of 3 cases]

Objective: To discuss the techniques and repairing methods of various degree of compound tissue defects in the auriculotemporal region. Methods: Retrospective analysis was conducted on three cases of different repairing methods for huge compound tissue defects in different degrees in the auriculotemporal region after the resection of the malignant tumor or sinus tract due to repeated infection in our hospital. Results: Following total removal of the tumors or sinus tract in all patients, we applied retroauricular lingual flap transfer repairing, latissimus dorsi flap free transfer repairing and vascular anastomosis, scalp tissue expansion in stage Ⅰ, then repairing the lesion with expanded scalp and filling the huge mastoid cavity with abdominal fat in stage Ⅱ, respectively, according to the characteristics of compound tissue defects in the auriculotemporal region. All free flaps survived well. Conclusions: The anatomy of the auricular-temporal area is complex and involves important vascular and neural structures of head and neck and lateral skull base. The huge composite tissue defect following auriculotemporal region surgery, which is composed of skin, muscle and bone tissue, needs to be repaired in one stage. Therefore, flexible repairing methods should be chosen based on different situations, for attaining the goal of completely removing tumor and lesions, and then, covering the operation cavity.

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.

Oral manifestations of patients with systemic sclerosis: a meta-analysis for case-controlled studies

Background

Systemic sclerosis (SSc) is a multisystem rheumatic disease. Orofacial manifestations are commonly in SSc but maybe usually ignored and overshadowed by other systemic complications. Multiple comparative studies have been conducted to investigate the possible links between SSc and oral manifestations. The present study aimed to investigate the oral health status in patients with SSc.

Methods

Pubmed, Embase, Web of Science, and Scopus were searched up to July 2020. Following outcomes were evaluated: Probing depth (PD), Attachment loss (AL), Bleeding on probing (BOP), Number or percentage of Sites with PD ≥ 4 mm, Prevalence of periodontitis, Number of teeth, Decayed Teeth, Missing teeth, Filled teeth, DMFT index, and the interincisal distance. Newcastle-Ottawa Scale (NOS) were applied for quality assessment. The statistical analysis was processed using the software STATA.

Results

11 eligible studies were included. The maximum interincisor distance was significantly restricted in SSc patients (SMD − 1.061; 95 %CI [− 1.546, − 0.576]; Z = 4.29, P = 0.000).The prevalence of Periodontitis (OR 7.007; 95 %CI [3.529, 13.915]; Z = 5.56, P = 0.000), PD (SMD 3.101; 95 %CI [1.374, 4.829]; Z = 3.52, P = 0.000), AL(SMD 2.584; 95 %CI [0.321, 4.846]; Z = 2.24, P = 0.025), sites with PD ≥ 4mm (SMD 2.071 ; 95 %CI [0.267, 3.875]; Z = 2.25, P = 0.024) and the number of decayed teeth (SMD, 0.186; 95 %CI [0.007, 0.365]; Z = 2.04, P = 0.041) were increased significantly in SSc population in comparison with the controls.

Conclusions

SSc patients have limited mouth opening, higher periodontitis prevalence, and worse periodontal status, as well as an increased number of decayed teeth. Routinely oral hygiene instruction and initial periodontal treatment is recommended for SSc patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01603-2.

Sources, variability and parameterizations of intra-city factors obtained from dispersion-normalized multi-time resolution factor analyses of PM2.5 in an urban environment

Ambient fine particulate matter (PM_2.5) data of similar continuously monitored species at two air monitoring sites with different characteristics within the City of Toronto were used to gauge the intra-city variations in the PM composition over a largely concurrent period spanning two years. One location was <8 m from the side of a major highway while the other was an urban background location. For the first time, multi-time resolution factor analysis was applied to dispersion-normalized concentrations to identify and quantify source contributions while reducing the influence of local meteorology. These factors were particulate sulphate (pSO4), particulate nitrate (pNO3), secondary organic aerosols (SOA), crustal matter (CrM) that were common to both sites, a hydrocarbon-like organic matter (HOM) exclusive to the urban background site, three black carbon related factors (BC, BC-HOM at the highway site, and a brown carbon rich factor (BC-BrC) at the urban background site), biomass burning organic matter (BBOM) and brake dust (BD) factors exclusive to the highway site. The PM_2.5 composition was different between these two locations, over only a 10 km distance. The sum of SOA, pSO4 and pNO3 at the urban background site averaged 57% of the PM_2.5 mass while the same species represented 43% of the average PM_2.5 mass at the highway site. Local or site-specific factors may be of greater interest for control policy design. Thus, regression analyses with potential explanatory, site-specific variables were performed for results from the highway site. Three model approaches were explored: multiple linear regression (MLR), regression with a generalized reduced gradient (GRG) algorithm, and a generalized additive model (GAM). GAM gave the largest fraction of variance for the locally-found factors at the highway site. Heavy-duty vehicles were most important for explaining the black carbon (BC and BC-HOM) factors. Light-duty vehicles were dominant for the brake dust (BD) factor. The auxiliary modelling for the local factors showed that the traffic-related factors likely originated along the main roadways at their respective sites while the more regional factors, - pSO4, pNO3, SOA, - had sources that were both regional and local in origin and with contributions that varied seasonally. These results will be useful in understanding ambient particulate matter sources on a city scale that will support air quality management planning.

Location and Vascular Classification of 188 parathyroid glands in New Zealand White Rabbits

ABSTRACT The function and protection of the parathyroid glands are increasingly popular research topics. New Zealand white rabbits are the most commonly used animal model of parathyroid ischemia. However, information on the vasculature of their parathyroid glands is limited. We used 94 healthy New Zealand white rabbits, 3-4 months of age and 2-3kg in weight, for exploration of the parathyroid glands, which were stained using hematoxylin and eosin (HE) after removal. The following types were classified according to the relationship between the position of the inferior parathyroid gland and the thyroid: Type A, Close Type, Type B, and Distant Type. There were 188 cases, 4 where the inferior parathyroid glands were located near the dorsal side of thyroid (2.13%), 8 where the inferior parathyroid glands were located superior to the upper pole of the thyroid (4.26%), 20 where the inferior parathyroid glands were located parallel to the thyroid (10.64%), and 155 cases where the inferior parathyroid glands were located inferior to the lower pole of thyroid (82.45%). Identifying the location and classifying the vasculature of the parathyroid glands in New Zealand white rabbits will provide an anatomical model to assist in future research.

[Detection and analysis of serum food-specific IgG antibody in Beijing area]

Objective: The level of food specific IgG antibody in serum of patients with suspected food intolerance in Beijing area was detected and analyzed, so as to provide a basis for patients to eliminate the food that causes disease in their diet. Methods: Data were retrospectively analyzed in a total of 2368 suspected chronic food intolerance patients (all resident population in Beijing) admitted to Beijing Jishuitan Hospital from October 2015 to December 2019, including 859 males and 1509 females. The age range ranged from 2 months to 90 years, (40.2±18.6) years, and the median age was 36 years. Serum specific IgG (sIgG) antibody concentrations in 14 kinds of food (beef, chicken, pork, cod, shrimp, crab, egg, milk, corn, wheat, mushroom, soybean, tomato and rice) were determined by enzym-linked immunosorbentassay (ELISA).SPSS V22.0 was used for statistical analysis, and χ² was used to compare the positive rate of each group. Results: The positive rate of food sIgG in 2 368 patients was 82.7% (1959/2368), the higher sIgG positive rates were found in eggs (54.7%), shrimp (29.0%) and milk (26.0%), and the lowest sIgG positive rates were found in pork (4.1%) and beef (1.2%) (P<0.05).There was significant gender difference in egg (χ²=10.885) and shrimp (χ²=6.607) sIgG, and female was significantly higher than male (P<0.05).The sIgG positive rates of egg (χ²=515.645), shrimp (χ²=74.20.4), milk (χ²=305.65), soybean (χ²=39.413), wheat (χ²=133.222), cod (χ²=25.540), crab (χ²=55.521), corn (χ²=20.645), tomato (χ²=118.108), chicken (χ²=32.821), pork (χ²=26.539), beef (χ²=21.632) and rice (χ²=25.335) were significant in different age groups. The positive rate of shrimp and crab sIgG increased with age (P<0.05).The positive rate of tomato sIgG decreased with age, and then increased slightly after 45 years. However, egg, milk, soybean, wheat, corn, and rice all showed a decreasing positive rate with the increase of age. The increase of chicken, pork and cod was observed in childhood, and then decreased with age, and then increased in middle and old age. Conclusions: There may be a certain correlation between food intolerance and elevated food sIgG levels in Beijing area. It is suggested that patients of different genders and ages should be optimized and adjusted according to their own characteristics, and children patients are still the key population for food intolerance control.

[Clinical characteristics and prognostic analysis of 458 children with high-risk neuroblastoma in a single center]

Objective: To summarize the clinical characteristics of high-risk neuroblastoma (HR-NB) in a single center, analyze the prognostic factors of HR-NB. Methods: The clinical data of children with HR-NB who were treated and followed up at the hematology-oncology center of Beijing Children's Hospital from February 1, 2007 to June 30, 2018 were analyzed retrospectively. The clinical features were summarized. Kaplan-Meier method was used for survival analysis and Cox regression was used to analyze the prognostic factors. The last follow-up time was June 30, 2019. Results: A total of 458 children with HR-NB were enrolled in this study, including 265 males (57.9%) and 193 females (42.1%), the age at diagnosis was 40.0 months (4.5-148.0 months), the follow-up time was 22.0 months (0.2-138.0 months) and the time of tumor progression or recurrence was 15 months (1-72 months). The 5-year event-free survival (EFS) rate was (31.2±2.6)% and the 5-year overall survival (OS) rate was (43.9±3.2)%. The 5-year EFS rate and 5-year OS rate in 142 hematopoietic stem cell transplantation (HSCT) patients with bone marrow metastases were better than that in 196 non-transplantation cases with bone marrow metastases ((26.5±4.5)% vs. (25.1±3.6)%, χ²=13.773, P=0.001; (38.1±5.5)% vs. (35.7±4.7)%, χ²=9.235, P=0.002); 128 transplantation patients with bone metastases had higher 5-year EFS rate and 5-year OS rate than 188 non-transplantation cases with bone metastases ((28.5±5.0)% vs. (26.7±3.8)%, χ²=10.222, P=0.001; (37.1±6.0)% vs. (36.2±4.8)%, χ²=7.843, P=0.005). The 5-year EFS rate was higher in 37 HSCT patients with MYCN amplification than in 49 non-transplantation cases with MYCN amplification ((26.8±8.0) % vs. (20.5±6.4) %, χ²=5.732, P=0.017). No significant difference was found in 5-years OS rate between transplantation group with MYCN amplification and non-transplantation group with MYCN amplification ((31.4±8.6) % vs. (26.2±7.4) %, χ²=3.230, P=0.072). Univariate survival analysis showed that lactate dehydrogenase (LDH)≥1 500 U/L was associated with poor prognosis of patients with MYCN amplification (χ²=6.960, P=0.008). Multivariate Cox analysis showed bone marrow metastasis and LDH≥1 500 U/L were independent risk factors for poor prognosis of patients with non-MYCN amplification (HR=2.427, 1.618;95%CI：1.427-4.126, 1.275-2.054, P<0.05) for both comparisons. Conclusions: LDH≥1 500 U/L was the poor prognostic factor for patients with MYCN amplification. The bone marrow metastasis and LDH≥1 500 U/L were the poor prognostic factors for HR-NB patients with non-MYCN amplification. HSCT can improve the prognosis of patients with bone or bone marrow metastasis. It can also retard the time of progression or recurrence for patients with MYCN amplification.

COVID-19 and psoriasis: Recommendation for patients on regular infliximab therapy

During COVID-19 outbreak hospitals were congested and infliximab was interrupted. Thus, we performed this observational study to understand the consequent burden of complications in these special cluster of psoriatic patients. We followed up 56 psoriatic patients who were receiving Infliximab treatment by telephone. The majority of patients had lesions exacerbation, accompanied by anxiety emotion. It is suggested that reserving common drugs for psoriasis at home is necessary. Besides, telemedicine should be advocated as a main medical visit mode during the outbreak of COVID-19.

Development of machine learning models to predict response after cardiac resynchronization therapy

Background

There have been few practical and precise tools to predict response after cardiac resynchronisation therapy (CRT).

Purpose

We intend to develop predictive models using machine learning (ML) approaches and easily available features prior to implantation.

Methods

The baseline features of 596 patients receiving CRT were retrospectively collected. Nine predictive models were established, including logistic regression (LR), Elastic Net (EN), lasso regression, ridge regression (Ridge), neural network, support vector machine (SVM), random forest, XGBoost and k-nearest neighbor. Sensitivity, specificity, precision, accuracy, F1, area under receiver operating characteristic curve (AU-ROC) and average precision of each model were evaluated, and AU-ROC was compared between each pair of ML models and further between ML models and the latest guidelines.

Results

Sensitivity was highest with SVM by 0.69, and specificity was highest with LR by 0.81. The models EN and Ridge showed the highest overall predictive power with an average AU-ROC of 0.77. Specifically, the Ridge model provided significant higher AU-ROC than any other model (all P&lt;0.05). All ML models showed significant higher AU-ROC than those derived from the latest guidelines (all P&lt;0.05). Additionally, the effect size analysis identified LBBB, LVESD, and history of PCI as the most crucial predictive features.

Conclusion

ML algorithms produced efficient predictive models for evaluation of response after CRT with features prior to implantation. Tools developed accordingly might improve selection of CRT candidates and reduce rate of non-response in the future.

ROC and PR curves of predictive models

Funding Acknowledgement

Type of funding source: None

Impact of smoking on psoriasis risk and treatment efficacy: a meta-analysis

Objective

Psoriasis is an immune-mediated chronic inflammatory disease with skin and joint manifestations. Smoking is considered an unfavorable lifestyle factor for psoriasis. We aimed to explore the association between smoking, disease risk, and treatment efficacy in relation to psoriasis.

Methods

We searched the Cochrane Library, Embase, and PubMed databases for studies examining the relationship between smoking and psoriasis, up to 12 April 2020. We then conducted a meta-analysis using a fixed-effects model to obtain odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Ever, current, and former smokers all had higher risks of developing psoriasis than non-smokers (pooled ORs (95% CIs): 1.60 (1.51–1.69), 1.63 (1.48–1.80), and 1.36 (1.13–1.64), respectively). Ever smokers were less likely to show disease improvement at 6 months following treatment with biologic agents than non-smokers (pooled OR (95% CI): 0.80 (0.67–0.95)).

Conclusions

Smoking increases psoriasis risk and negatively impacts the benefits of biologic agents. However, the number of reports is limited and more studies are needed to confirm the effects of smoking and smoking cessation on therapeutic response in patients with psoriasis. Education to encourage a healthy lifestyle remains a valuable approach in clinical practice.

Wilms' tumor 1-associating protein contributes to psoriasis by promoting keratinocytes proliferation via regulating cyclinA2 and CDK2

BACKGROUND

Wilms' tumor 1-associating protein (WTAP) is a ubiquitously expressed nuclear protein, and involved in multiple pathophysiological processes, including cell cycle, RNA splicing and stabilization, N6-methyladenosine RNA modification, cell proliferation, and apoptosis as well as embryonic development. Here, we investigated the specific role of WTAP in the pathogenesis of psoriasis and its underlying mechanism.

METHODS

Reverse transcription-quantitative polymerase chain reaction (RT-qPCR), western blot analyses and multi-spectrum immunohistochemistry were applied to evaluate the level of WTAP expression in psoriatic skin and normal skin. HaCaT cells was stably transfected with WTAP small interfering (si)RNA and plasmid using Lipofectamine®2000 and proliferation was determined by CCK8. Apoptosis and cell cycle analysis were conducted by flow cytometry. Western blot assay was used to explore the expression levels of cell cycle-related proteins in HaCaT cells after WTAP overexpression or inhibition. Furthermore, HaCaT cells were stimulated with proinflammatory cytokines (ie, IL-17A, IL-22, IL-1a, oncostatin M, and TNF-a) to assess WTAP expression.

RESULTS

We demonstrated that the mRNA and protein levels of WTAP were significantly increased in lesional skins of psoriasis patients and psoriatic cell model compared with normal controls. WTAP was highly expressed in epidermis rather than dermis. Overexpression of WTAP promoted keratinocytes proliferation, which might be related to the up-regulation of cyclinA2 and CDK2.

CONCLUSIONS

These results indicate that overexpression of WTAP may contribute to the pathogenesis of psoriasis by regulating cell cycle progression and highlight WTAP as a potential therapeutic target for psoriasis treatment.

Efficacy of pre-expanded forehead flap based on the superficial temporal artery in correction of cicatricial ectropion of the lower eyelid

Lower eyelid retraction or ectropion bring suffering to the patients both physically and mentally. Efforts to explore pertinent surgical treatments are still needed. Here we have described our preferred surgical technique for lower eyelid ectropion repair with pre-expanded island forehead flaps or pedicled forehead flaps. Between July 2007 and March 2017, a retrospective review of 12 patients who suffered from cicatricial lower eyelid ectropion as a result of trauma, surgery, or infection was conducted. Forehead skin flap based on the superficial temporal artery was expanded depending on the area of defect of the lower eyelid. Tissue expansion, flap transfer, pedicle delaying and division were involved in this process. There were no major complications, such as expander exposure, infection, haematoma or large skin flap necrosis in all the 12 patients. Venous congestion was reported in two patients. No recurrent ectropion was noted in any patient. During the three-month to two-year follow-up all patients were satisfied with the results in terms of the skin texture, colour, and flexibility after the treatment with an expanded forehead skin flap. This study suggests that expanded forehead skin flaps are effective for correction of cicatricial lower eyelid ectropion.