Up-regulated ONECUT2 and down-regulated SST promote gastric cell migration, invasion, epithelial-mesenchymal transition and tumor growth in gastric cancer

OBJECTIVE

Gastric cancer is a common malignancy, with high metastasis and poor prognosis. Our purpose was to explore potential molecular mechanisms of gastric cancer.

PATIENTS AND METHODS

A total of 10 pairs of gastric cancer tissues and adjacent normal gastric tissues were collected for RNA sequencing (RNA-seq), followed by differential expression analysis. Combining qRT-PCR results, two novel genes were selected for in-depth analysis, including up-regulated ONECUT and down-regulated SST. To investigate the effects of ONECUT and SST on the biological behaviors of gastric cancer cells, gastric cancer cell lines were transfected by ONECUT2 knockdown and SST overexpression. Afterwards, cell migration and invasion were examined using transwell assays, and the expressions of epithelial-mesenchymal transition (EMT)-related proteins were measured by Western blot analysis. Furthermore, cell viability was detected by CCK-8 assay. Finally, tumorigenicity in nude mice was performed.

RESULTS

Gastric cancer cell migration and invasion were inhibited in BGC823 cells transfected by shONECUT2. Similar results were observed in SST overexpression in MGC803 cells. Silencing ONECUT2 or overexpressing SST reduced the expressions of mesenchymal markers (N-cadherin and vimentin), STAT3, fibronectin, Wnt2, β-catenin and increased epithelial marker (E-cadherin), p-STAT3, smad2/3, α-catenin protein levels. In addition, inhibiting ONECUT2 or elevated SST suppressed tumor cell viability in vitro. Moreover, ONECUT2 silencing or elevated SST significantly inhibited tumor growth in vivo.

CONCLUSIONS

Up-regulated ONECUT2 and down-regulated SST promote gastric cell migration, invasion, epithelial-mesenchymal transition and tumor growth in gastric cancer.

Effect of additive-assisted fat transplantation on fat graft survival rate: A preliminary experimental study based on a rabbit animal model

BACKGROUND

Improving the survival rate of fat grafts is yet a difficult problem in the field of autologous fat transplantation. Prevailing methods such as making nanofat and SVF are time-consuming. Hence, the role of additives application in the improvement of fat graft survival during fat transplantation was considered and preliminarily evaluated in a rabbit animal model.

METHODS

A rabbit animal model was established where rabbit ears were injected with a mixture of 1.5mL of adipose tissue and 1mL of saline (group A), 1.5mL of adipose tissue and 1mL of botulinum toxin A (BoNTA) (group B), 1.5mL of adipose tissue and 1mL of prostaglandin E2 (groupC), 1.5mL of adipose tissue and 1mL of PDRN (group D) respectively. Then, the extents of neovascularization and inflammation were evaluated on the 7th, 14th, 28th, 42nd, 56th and 70th day after injection by ELISA assays and H&E and immunofluorescence staining.

RESULTS

The results showed that pre-treatment with BoNTA, prostaglandin E2 and PDRN improved graft volume and weight. The H&E and immunofluorescence staining revealed that BoNTA, prostaglandin E2 and PDRN improved the graft angiogenesis. Simultaneously, TNF-α expression level detected by ELISA was the lowest in the PDRN group.

CONCLUSION

Henceforth, the present preliminary study suggests that pre-transplantation treatment with BoNTA, prostaglandin E2 and PDRN can improve the fat graft angiogenesis and graft integrity, whereby the effect of adding PDRN may be significant.

Proliferation and migration of hepatocellular carcinoma are accelerated by LINC01287 via the miR-559/TCF12 axis

OBJECTIVE

To uncover the role of LINC01287 in the progression of hepatocellular carcinoma (HCC) and the indicated molecular mechanism.

PATIENTS AND METHODS

Relative levels of LINC01287 and miR-559 in 32 pairs of HCC tissues and normal ones, as well as HCC cell lines were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were depicted for assessing the diagnostic and prognostic potentials of LINC01287 in HCC, respectively. Proliferative and migratory capacities in HCC cells influenced by LINC01287 were assessed by cell counting kit-8 (CCK-8) and transwell assay, respectively. The regulatory loop LINC01287/miR-559/TCF12 was ascertained by Dual-Luciferase reporter assay. The involvement of the regulatory loop in the progression of HCC was examined via rescue experiments.

RESULTS

LINC01287 was upregulated in HCC tissues and cell lines, whereas miR-559 was downregulated. LINC01287 displayed certain diagnostic and prognostic potentials in HCC. Knockdown of LINC01287 could inhibit proliferative and migratory capacities in HCC cells. The regulatory loop LINC01287/miR-559/TCF12 was responsible for the aggravation of HCC.

CONCLUSIONS

LINC01287 drives proliferative and migratory capacities in HCC via targeting the miR-559/TCF12 axis.

Association of polypharmacy and Parkinson's disease prevalence

OBJECTIVE

Polypharmacy and multiple diseases are common in geriatric practice; however, such kind of multiple interventions might result in adverse effects. Some previous studies have found the association of polypharmacy and Parkinson's disease, to confirm this relationship, we conducted a meta-analysis to analyze this issue quantitively.

MATERIALS AND METHODS

In total, we included 8 studies, 165,689 polypharmacy subjects and 373,660 non-polypharmacy controls, and 5644 PD patients among these subjects and controls.

RESULTS

For model without any adjustment, polypharmacy group has a significantly higher prevalence than control, OR = 2.53, 95 %CI [2.00, 3.20] (p < 0.001). However, this model showed a very high heterogeneity (I2 = 91 %, p < 0.001). In age, gender and disease history adjusted model, polypharmacy group has a significantly higher prevalence than control, OR = 1.43, 95 %CI [1.35, 1.52], p < 0.001. The heterogeneity decreased to zero (I2 = 0 %, p < 0.45).

CONCLUSION

In this study we have found an association between PD risk and polypharmacy, a better designed prospective long-term cohort study might be required for further discussion on this issue (Tab. 1, Fig. 5, Ref. 14).

[miR-758-3p inhibits the proliferation and invasion of non-small cell lung cancer cells by targeting NUSAP1]

Objective: To investigate the biological function of miR-758-3p and the underlying mechanism in non-small cell lung cancer (NSCLC). Methods: miR-758-3p mimics was transfected to A549 NSCLC cells, miRNA control was used as a negative control, cells transfected with nucleolar and spindle associated protein 1 (NUSAP1)-overexpression vector indicated as NUSAP1 group, cells co-transfected with miR-758-3p mimics and NUSAP1-overexpression vector indicated as miR-758-3p mimics+ NUSAP1 group. The effects of miR-758-3p on the proliferation, migration and invasion abilities of A549 cells were detected by cell counting kit-8 (CCK-8) and Transwell assays, respectively. Bioinformatics and dual luciferase reporter assay were used to predict and verify the target gene of miR-758-3p. Results: The expressions of miR-758-3p and NUSAP1 in A549 cells were significantly up-regulated at 24 hours after transfection with miR-758-3p mimics (P<0.05). Compared with the miRNA control group (1.15±0.06), the OD value of miR-758-3p mimic group (0.78±0.06) was significantly decreased at 72 hours after transfection (P<0.05). The number of migrated cells of miR-758-3p mimic group (119.04±11.49) was significantly lower than that of the control group (271.38±19.05) (P<0.05). The number of invaded cells of miR-758-3p mimic group (71.33±5.36) was significantly lower than the control group (164.30±8.11) (P<0.05). The result of dual-luciferase reporter assay showed that NUSAP1 was a direct target of miR-758-3p. Moreover, up-regulation of NUSAP1 abolished the inhibitory effects of miR-758-3p on the proliferation, migration and invasion abilities of A549 cells. Conclusion: miR-758-3p inhibits the proliferation, migration and invasion of NSCLC cells by targeting NUSAP1.

Repair of facial scars using free and pedicle-expanded deltopectoral flaps

This study aimed to evaluate the effectiveness and long-term outcomes of free and pedicled, expanded deltopectoral flaps with perforation of the internal thoracic artery to repair facial scars. This retrospective review was of 37 patients who presented between June 2013 and June 2019 with various types of facial scar. Ten patients received a free expanded deltopectoral flap and 27 a pedicled, expanded deltopectoral flap. During the stage-one operation, the expander was implanted into the deltopectoral area and fully expanded by normal saline injection. In stage two, the facial lesions were incised, and the free or pedicled flap transferred to reconstruct the defect. Flap necrosis did not occur in the 10 patients treated with free flaps. Two patients need to have the pedicle trimmed three months after surgery because it had become bloated. Distal necrosis occurred in five of 27 patients who received a pedicled, expanded deltopectoral flap. Healing by conservative treatment was noted in two cases and healing after skin grafting was documented in the other three. All 37 patients achieved satisfactory results. A pedicled, expanded deltopectoral flap appears to be a reliable and safe option for the treatment of facial scars.

Treatment of secondary lower limb lymphedema after gynecologic cancer with complex decongestive therapy

Secondary lower extremity lymphedema is a common complication of treatment for gynecological cancers. Conservative therapy plays an important role in the treatment of patients with secondary lower extremity lymphedema; in particular, complex decongestive therapy (CDT) has been recognized as an effective nonoperative technique for these patients. But CDT therapy for secondary lower extremity lymphedema remains a problem in China because this technique and its effectiveness have not achieved widespread use and popularity. Our goal was to assess effects of CDT in patients with secondary lower limb lymphedema after treatment for gynecological cancers. The retrospective study consisted of 60 patients who were treated with 20 sessions of CDT. Assessments included objective changes in limb circumference, degree of LE, imaging features, and incidence of erysipelas before and after CDT treatment. We found that CDT can effectively improve lymph stasis and promote backflow, and decrease circumference, interstitial fluid content, and incidence of erysipelas of lymphedematous lower limb. Our results demonstrate that CDT is an effective treatment method for patients with secondary lower limb lymphedema following treatment for gynecologic cancers. This technique should be more widely utilized and popularized in China to improve the quality of life of millions of patients with secondary lower limb lymphedema.

Catalytic co-pyrolysis of microwave pretreated chili straw and polypropylene to produce hydrocarbons-rich bio-oil

In this work, the kinetic behavior and products of the co-pyrolysis of chili straw (CS) and polypropylene (PP) of distinguishing conditions (blending ratios, addition of catalysts, and microwave pretreatment at different power) had been investigated. Co-pyrolysis effectively reduced the proportion of oxygenated composition in CS, and the Oxygenated composition of 5CS5PP decreased by 76.69% compared to CS. When HZSM-5 was added, the aromatic hydrocarbons in the product increased from 4.46% to 17.34%, and the final residual mass decreased from 12.75% to 7.71%, illustrating that HZSM-5 had a positive effect on co-pyrolysis. Compared with P0HZSM-5, the microwave pretreatment at a higher power level of 567 W reduced the oxygenated composition from 17.41% to 13.09%, and the weight loss peak in the first stage increased from -18.11%/min to -19.94%/min. At the same time, the activation energy decreased from 271.25 kJ/mol to 231.13 kJ/mol.

[NUSAP1 promotes lung cancer progression by activating AKT/mTOR signaling pathway]

Objective: To investigate the inhibitory effects of nucleolar and spindle associated protein 1 (NUSAP1) on lung cancer and the related mechanisms. Methods: A549 cells were transfected with NUSAP1 siRNA, the cell proliferation, migration and invasion, and apoptosis were detected by CCK8, Transwell and flow cytometry, respectively. Western blot was used to detect the expressions of apoptosis and AKT/mTOR signal pathway related proteins. Results: Compared with the negative control group, the proliferation [(0.610±0.058) vs (1.724±0.067), P<0.05], migration [(178.267±14.780) vs (272.464±36.232), P<0.05] and invasion [(73.527±6.617) vs (120.585±13.235), P<0.05] of NUSAP1 deleted A549 cells were significantly inhibited, while the apoptosis [(3.572±0.214)% vs (11.358±1.047)%, P<0.05] was significantly increased. The expressions of apoptosis related protein Bax and active-caspase 3 were increased (P<0.05), while the expressions of anti-apoptosis protein Bcl-2 and proliferation related protein P70, the phosphorylation levels of AKT and mTOR were reduced in NUSAP1 knockdown cells (P<0.05). Conclusion: NUSAP1 knockdown can inhibit the proliferation, migration and invasion, and promote the apoptosis of tumor cells through suppressing AKT/mTOR signaling pathway in lung cancer cells.

Successful interruption of seasonal influenza transmission under the COVID-19 rapid response in Zhejiang Province, China

Objectives

The objective of this study was to evaluate whether the non-pharmaceutical interventions (NPIs) introduced to curb the spread of coronavirus disease 2019 (COVID-19) also interrupted the transmission of influenza.

Study design

This is a descriptive epidemiological study.

Methods

Data on changes in the number of reported influenza cases, number of influenza-like illness (ILI) visits, ILI percentage and influenza virus positivity were compared between the first 18 weeks of 2020 and the same period of 2019.

Results

The changes in the weekly average number of influenza cases were statistically significant between 2020 and 2019 (−4319 vs −525 per week; P < 0.05). The slopes of regression lines for the number of ILI visits were also statistically significant between 2020 and 2019 (−911 vs −98 per week; P < 0.05).

Conclusions

This study found that the prevalence of influenza was substantially decreased when NPIs were implemented for the containment of COVID-19.

•

The prevalence of influenza was substantially decreased when non-pharmaceutical interventions were implemented for the containment of coronavirus disease 2019.

•

Changes in the weekly average number of influenza cases were statistically significant between 2020 and 2019 (−4319 vs −525 per week; P < 0.05).

•

Changes in the number of influenza-like illness visits were also statistically significant between 2020 and 2019 (−911 vs −98 per week; P < 0.05).

PHACTR1, a pro-atherosclerotic mechanosensitive PPARgamma corepressor in endothelial cells

Background

Numerous genome-wide association studies revealed that SNPs at phosphatase and actin regulator 1 (PHACTR1) locus are strongly correlated with coronary artery disease (CAD). However, the mechanism linking these variants to CAD remains uncertain.

Purpose

We studied the biological functions and molecular mechanisms of PHACTR1 in atherosclerosis.

Methods and results

Analysis of GTEx database showed that CAD-related SNPs in PHACTR1 are cis-eQTLs for PHACTR1 in arteries. Therefore, we generated Phactr1 knockout mice and crossed them with apolipoprotein E-deficient (ApoE−/−) mice to induce atherosclerosis by high-fat/high-cholesterol (HF-HC) diet. Phactr1 deficiency significantly inhibited atherosclerosis with decreased inflammatory cell infiltration. Western blot showed that PHACTR1 was restricted to endothelial cells (ECs) in mice. Mechanistically, RNAseq of aortic ECs revealed that the major molecular function of PHACTR1 was transcriptional regulation. PPARγ/RXRα was the top transcription factor, and PPARγ target gene expression substantially increased in Phactr1−/− mice. Moreover, we generated endothelial cell specific Phactr1−/−, ApoE−/− mice and found decreased atherosclerotic plaque area in aortic sinus. In vitro, PHACTR1 associated with PPARγ and inhibited PPARγ transcriptional activity. The inhibitory effect of PHACTR1 on PPARγ required its shuttling from cytosol to nucleus triggered by disturbed flow, a well-established pro-atherosclerotic stimulus.

Conclusion

Our results identified PHACTR1 as a mechanosensitive corepressor of PPARγ in ECs to promote atherosclerosis. Endothelial PHACTR1 is a potential therapeutic target for atherosclerosis treatment.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China (NSFC), China Postdoctoral Science Foundation (CPSF)

Comparing nanoparticle polymeric micellar paclitaxel and solvent-based paclitaxel as first-line treatment of advanced non-small-cell lung cancer: an open-label, randomized, multicenter, phase III trial

BACKGROUND

Polymeric micellar paclitaxel (pm-Pac) is a novel Cremophor EL-free, nanoparticle micellar formulation of paclitaxel. We aimed to compare the efficacy and safety between pm-Pac plus cisplatin and solvent-based paclitaxel (sb-Pac) plus cisplatin in advanced non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

A total of 448 stage IIIB to IV NSCLC patients were randomly assigned (2:1) to receive six 3-week cycles of either pm-Pac (230 mg/m²) plus cisplatin (70 mg/m²; n = 300), followed by dose escalation of pm-Pac to 300 mg/m² from the second 3-week cycle if prespecified toxic effects were not observed after the first cycle, or sb-Pac (175 mg/m²) plus cisplatin (70 mg/m²; n = 148). The primary end point was objective response rate (ORR) assessed by independent review committees (IRCs). The secondary end points included IRC-assessed progression-free survival (PFS), overall survival (OS), and safety.

RESULTS

Patients in the pm-Pac-plus-cisplatin group showed significant improvements in IRC-assessed ORR compared with those in the sb-Pac-plus-cisplatin group (50% versus 26%; rate ratio 1.91; P < 0.0001). Additionally, subgroup analysis showed that a higher ORR was consistently observed in both squamous and nonsquamous histological types. IRC-assessed median PFS was significantly higher in the pm-Pac-plus-cisplatin group than in the sb-Pac-plus-cisplatin group (6.4-month versus 5.3-month; hazard ratio 0.63; P = 0.0001). Median OS was not significantly different between the two groups. The incidence of treatment-related serious adverse events (9% versus 18%; P = 0.0090) was significantly lower in the pm-Pac-plus-cisplatin group than in the sb-Pac-plus-cisplatin group.

CONCLUSION

Pm-Pac plus cisplatin yielded superior ORR and PFS along with a favorable safety profile and should become an option for patients with advanced NSCLC.

CLINICAL TRIAL IDENTIFIER

ClinicalTrials.gov NCT02667743; https://clinicaltrials.gov/ct2/show/NCT02667743.

MicroRNA-148a regulates the MAPK/ERK signaling pathway and suppresses the development of esophagus squamous cell carcinoma via targeting MAP3K9

OBJECTIVE

Esophagus squamous cell carcinoma (ESCC) was a dominant histological type of esophagus cancer, which has a very high incidence due to distant metastasis and local invasion. MicroRNA-148a (miR-148a) functioned as a tumor suppressor in a variety of cancers. The purpose of our study was to explore the vital role of miR-148a in esophagus squamous cell carcinoma.

PATIENTS AND METHODS

The Kaplan-Meier method was applied to calculate the 5-year overall survival of esophagus squamous cell carcinoma patients. Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) and Western blot were conducted to calculate the mRNA levels of miR-148a and genes. The cell counting kit-8 (CCK-8) and transwell assays were performed to measure the proliferative and invasive ability.

RESULTS

MiR-148a was observed to be significantly downregulated and the downregulation of miR-148 predicted poor prognosis of esophagus squamous cell carcinoma patients. MAP3K9 was a target gene of miR-148a and its expression was mediated by miR-148a through directly binding to the 3'-untranslated region (3'-UTR) of its mRNA in the esophagus squamous cell carcinoma. Moreover, miR-148a remarkably inhibited the proliferation and invasion through directly targeting to MAP3K9 via extracellular-signal-regulated kinase (ERK)/mitogen-activated protein kinase (MAPK) pathway and epithelial-mesenchymal transition (EMT) in the ESCC cells. In addition, overexpression of miR-148a inhibited the growth of ESCC in vivo.

CONCLUSIONS

MiR-148a inhibited the proliferation and invasion through directly targeting to MAP3K9 by ERK/MAPK pathway and EMT in ESCC cells. The newly identified miR-148a/MAP3K9 axis provides a novel insight into the pathogenesis of the esophagus squamous cell carcinoma.

[Later approach sinus floor elevation using deproteinized bovine bone mineral with staged implant placement: follow-up for more than 3 years in a prospective clinical study]

Objective: To evaluate clinical effect of deproteinized bovine bone for delayed implantation after fenestration. Methods: This trial is a continuation of a prospective clinical trial. From May 2011 to February 2015 in Department of Implantology, School of Stomatology, The Fourth Military Medical University after planting division of 55 cases of maxillary teeth missing area of residual alveolar bone height ≤5 mm patients. There were 21 female and 34 male patients, their average age were (55.2±7.1) years. A total of 62 side fenestration of maxillary sinus floor lift, clinical and imaging examination, evaluation of implant retention rate, complications, peripheral soft tissue health and marginal bone resorption. Results: A total of 82 implants were followed up in 41 patients. The average follow-up time was (51.8±14.3) months (36-78 months). The follow-up rate of the maxillary sinus was 75.8% (47/62), the follow-up rate of the implant was 73.9% (82/111), and the implant survival rate was 98.8% (81/82). The bone resorption results at the implant margins were (0.64±0.63) mm (-0.28 mm, 1.47 mm) in the near and (0.49±0.73) mm (-0.51 mm, 1.21 mm) in the far, the improved hemorrhage index was 0.46±0.72, the improved plaque index was 0.60±0.87, and the keratinized mucosa width was (2.14±1.22) mm. The incidence rate of peri-implant mucositis was 28.4% (23/81) among 23 implants, and there was no complication of peri-implant inflammation. Conclusions: This study shows that under the condition of insufficient sinus ridge spacing in the maxillary posterior area, it is feasible to use bovine bone alone to remove protein for delayed implantation of maxillary sinus floor elevation by windowing, and the clinical effect is reliable.

Comparison of catalytic effect on upgrading bio-oil derived from co-pyrolysis of water hyacinth and scrap tire over multilamellar MFI nanosheets and HZSM-5

Catalytic co-pyrolysis of water hyacinth and scrap tire experiments were performed to evaluate the feasibility of improving the monocyclic aromatic hydrocarbons production. The production of monocyclic aromatic hydrocarbons increased from 5.31% (sole pyrolysis of water hyacinth) to 13.11% (co-pyrolysis with scrap tire). With use of zeolites, the highest production of monocyclic aromatic hydrocarbons can reach up to 69.18%. Comprehensive comparison on catalytic effects of HZSM-5 and multilamellar MFI nanosheets were provided. With the material to multilamellar MFI nanosheets ratios changes from 2:1 to 1:4, the production of monocyclic aromatic hydrocarbons increases significantly from 37.15-69.18%. The average production of monocyclic aromatic hydrocarbons produced by using multilamellar MFI nanosheets were 12.07% higher than that using HZSM-5, indicating the better performance of multilamellar MFI nanosheets in producing monocyclic aromatic hydrocarbons. This work provided a reference for the reuse of water hyacinth and scrap tire over multilamellar MFI nanosheets in energy field.

Structural insight into the Staphylococcus aureus ATP-driven exporter of virulent peptide toxins

Staphylococcus aureus is a major human pathogen that has acquired alarming broad-spectrum antibiotic resistance. One group of secreted toxins with key roles during infection is the phenol-soluble modulins (PSMs). PSMs are amphipathic, membrane-destructive cytolytic peptides that are exported to the host-cell environment by a designated adenosine 5'-triphosphate (ATP)-binding cassette (ABC) transporter, the PSM transporter (PmtABCD). Here, we demonstrate that the minimal Pmt unit necessary for PSM export is PmtCD and provide its first atomic characterization by single-particle cryo-EM and x-ray crystallography. We have captured the transporter in the ATP-bound state at near atomic resolution, revealing a type II ABC exporter fold, with an additional cytosolic domain. Comparison to a lower-resolution nucleotide-free map displaying an "open" conformation and putative hydrophobic inner chamber of a size able to accommodate the binding of two PSM peptides provides mechanistic insight and sets the foundation for therapeutic design.

MiR-100 up-regulation enhanced cell autophagy and apoptosis induced by cisplatin in osteosarcoma by targeting mTOR

Since this article has been suspected of research misconduct and the corresponding authors did not respond to our request to prove originality of data and figures, "MiR-100 up-regulation enhanced cell autophagy and apoptosis induced by cisplatin in osteosarcoma by targeting mTOR, by Z. Yu, N. Li, K. Jiang, N. Zhang, L.-L. Yao, published in Eur Rev Med Pharmacol Sci 2018; 22 (18): 5867-5873-DOI: 10.26355/eurrev_201809_15913 -PMID: 30280766" has been withdrawn. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/15913.

Detecting the presence of bacterial RNA by polymerase chain reaction in low volumes of preoperatively aspirated synovial fluid from prosthetic joint infections

Aims

Preoperative diagnosis is important for revision surgery after prosthetic joint infection (PJI). The purpose of our study was to determine whether reverse transcription-quantitative polymerase chain reaction (RT-qPCR), which is used to detect bacterial ribosomal RNA (rRNA) preoperatively, can reveal PJI in low volumes of aspirated fluid.

Methods

We acquired joint fluid samples (JFSs) by preoperative aspiration from patients who were suspected of having a PJI and failed arthroplasty; patients with preoperative JFS volumes less than 5 ml were enrolled. RNA-based polymerase chain reaction (PCR) and bacterial culture were performed, and diagnostic efficiency was compared between the two methods.According to established Musculoskeletal Infection Society (MSIS) criteria, 21 of the 33 included patients were diagnosed with PJI.

Results

RNA-based PCR exhibited 57.1% sensitivity, 91.7% specificity, 69.7% accuracy, 92.3% positive predictive value, and 55.0% negative predictive value. The corresponding values for culture were 28.6%, 83.3%, 48.5%, 75.0%, and 40.0%, respectively. A significantly higher sensitivity was thus obtained with the PCR method versus the culture method.

Conclusion

In situations in which only a small JFS volume can be acquired, RNA-based PCR analysis increases the utility of preoperative puncture for patients who require revision surgery due to suspected PJI.

Cite this article:Bone Joint Res. 2020;9(5):219–224.

AB1009 THE EFFICACY OF TOCILIZUMAB ON THE TREATMENT OF TAKAYASU ARTERITIS IN CHINESE CHILDREN

Background:

Takayasu arteritis (TA) is the most prevalent large-vessel vasculitis in children. Patients with TA have a high mobidity and mortality.It remains a therapeutic challenge because corticosteroids monotherapy can rarely cure TAK and the relapse rate is high during GC tapering.

Objectives:

The aim of this study is to investigate the efficacy and safety of tocilizumab (TCZ)in Chinese children with Takayasu arteritis(TAK).

Methods:

We retrospectively studied 6 TAK children treated with TCZ in our hospital from July 2017 to October 2018. The demographic and clinical data, laboratory examination results and vascular imaging data were collected.

Results:

Six pediatric patients with critical or refractory TAK treated with TCZ were analyzed, including 3 males and 3 females.The diagnosis age was ranging in age from 2 to 13 years(median age:7 years).Three patients were initially treated with TCZ and Mycophenolate Mofetil(MMF) as the first-line regimen without corticosteroid or with a quite rapid GC taper duration,two of which had lifte-threatening coronary arteries involved and heart failure.The other three paitients were swcithed to TCZ from conventional disease modifying anti-rheumatic drugs (DMARDs) or other biologics due to being refractory to them and recurrent relapses.Four patients were given TCZ at 4 weeks regular intervals for 10 to 22 months,while two patients withdrew TCZ because of disease deterioration and unbearable abdominal or chest pain after the second dose.After 6 months follow-up,four patients experienced significant clinical and biological improvement with angiographically progression in one patient. A corticosteroid-sparing effect is obvious. Drug-related side effects occur in 1 patients manifesting as a mild elevated liver fuction. Neither neutropenia nor infection was observed.

Conclusion:

Our study shows a clinical, biological, and radiological response in patients with refractory TAK treated with TCZ.

References :

[1]Hellmich B, Agueda A, Monti S,et al.2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2019;0:1–12. doi:10.1136/annrheumdis-2019-215672.

[2]BravoMancheño B, Perin F, Guez Vázquez Del ReyMDMR, García Sánchez A, Alcázar Romero PP. Successful tocilizumab treatment in a child with refractory Takayasu arteritis.Pediatrics 2012;130(6):e1720-724.

[3]Goel R, Danda D, Kumar S, Joseph G. Rapid control of disease activity by tocilizumab in 10 «difficult-to-treat» cases of Takayasu arteritis. Int J Rheum Dis 2013;16(6):754–61.

[4]Cañas CA, Cañas F, Izquierdo JH, Echeverri A-F, Mejía M, Bonilla-Abadía F, et al. Efficacy and safety of anti-interleukin 6 receptor monoclonal antibody (tocilizumab) in Colombian patients with Takayasu arteritis. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 2014;20(3):125–9.

[5]Batu ED, Sönmez HE, Hazirolan T, Özaltin F, Bilginer Y, Özen S. Tocilizumab treatment in childhood Takayasu arteritis: case series of four patients and systematic review of the literature. Semin Arthritis Rheum 2017 Feb;46(4):529–35.

Disclosure of Interests:

None declared

AB0691 CHARACTERIZATION OF DIFFERENT GROUPS WITH IMAGING AND NON-IMAGING FINDINGS OF ANKYLOSING SPONDYLITIS COMBINE WITH HIP LESION IN WESTERN CHINESE

Background:

Hip joint lesion are the main cause of disability in patients with Ankylosing Spondylitis(AS) in western China. Seriously affect the quality of life of patients.The early clinical characteristics of hip joint disease are not typical, the disease is insidious, and the radiological diagnosis is delayed.The main prevention is early screening and early diagnosis.

Objectives:

This study attempted to find out the main characteristics and related factors in different groups of AS combine with hip joint lesion in western China.

Methods:

A-First evaluation:How many patients have 1) active SIJ changes on MRI. 2) chronic SIJ changes (each for erosion, clerosis, ankylosis, or any of those) on MRI. 3) a combination of active changes and chronic changes (each for erosion, sclerosis, ankylosis, or any of those) on MRI. 4) active hip changes on MRI. 5) chonic hip changes (erosion, effusion any of those) on MRI. 6) a combination of active changes and chronic hanges (erosion, effusion any of those) on MRI. B-Then, combination SIJ / hip. 7) active SIJ changes on MRI and in parallel active hip changes on MRI. 8) chronic (see above) SIJ changes on MRI and in parallel active hip changes on MRI. 9) chronic (see above) SIJ changes on MRI and in parallel chronic (see above) hip changes on MRI. 10) chronic (see above) SIJ changes on MRI and in parallel any (active or chronic) hip changes on MRI. C-Then, characterization of these groups with non-imaging findings. Characteristics of groups 7-10 above, for age, sex, Disease duration, Hip pain, Joint pain, enthesitis, Diarrhea, uveitis, ASDAS-CRP, BASDAI, BASFI, BASMI, Pat. Global, CRP, ESR, Harris Score, HLA-B27.

Results:

Retrospective analysis total 558 SpA patients (mean age 29, mean duration 5 years). 1) HIP-Active+Chronic group (N=288, AS=151) vs SIJ+HIP-Active group (N=241, AS=138): hip pain (p<0.0001), diarrhea (p<0.0001), joint pain (p<0.0001) and BASFI (p<0.05); 2) HIP-Active+Chronic(N=117, AS=58) vs SIJ-Chronic+HIP-Active group (N=214, AS=134): hip pain(p<0.0001), joint pain (p<0.0001), enthesitis (p<0.0001), ASDAS-CRP (p<0.05) and ESR (p<0.05); 3) SIJ-Active+Chronic group (N=204, AS=125) vs SIJ-Chronic+HIP-Active group (N=214, AS=134): hip pain (p<0.0001), joint pain (p<0.0001); 4) SIJ-Active+Chronic group (N=204, AS=125) vs SIJ+HIP-Chronic group (N=72, AS=40):hip pain (p<0.0001), Pat. Global (p<0.05); 5) SIJ+HIP-Active group (N=241, AS=138) vs SIJ-Chronic+HIP-Active group (N=214, AS=134): HLA-B27 positive (Chi-square, df, 24.98, 4) (p<0.0001); 6) SIJ+HIP-Chronic group (N=72, AS=40) vs SIJ-Chronic+HIP-Active/Chronic group (N=228, AS=144): Pat. Global (p<0.05), ESR (p<0.05).

Conclusion:

Hip joint lesion are closely related to sacroiliac joint lesion and HLA-B27 positive in AS. Hip pain is the main clinical manifestation of hip joint lesion in AS. Hip joint lesion may lead to function declines, disease activity in AS.

References:

[1]Vander C B, Munoz-Gomariz E, Font P, et al. Hip involvement in ankylosing spondylitis:epidemiology and risk factors associated with hip replacement surgery[J]. Rheumatology (Oxford), 2010,49(1):73-81.

[2]Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis[J]. Ann Rheum Dis, 2009,68 Suppl 2:i1-i44.

[3]Ward M M, Deodhar A, Akl E A, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis[J]. Arthritis Rheumatol, 2016,68(2):282-298.

Disclosure of Interests:

Qing Han: None declared, Zhaohui Zheng: None declared, Kui Zhang: None declared, Zheng Yu: None declared, Fengfan Yang: None declared, Qiang Liang: None declared, Ping Zhu: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

OP0297 EFFICACY AND SAFETY OF ROMOSOZUMAB AMONG POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS AND MILD-TO-MODERATE CHRONIC KIDNEY DISEASE

Background:

Osteoporosis and renal insufficiency are coexisting disease states in a substantial proportion of postmenopausal women. Since bisphosphonates are generally contraindicated in patients with estimated glomerular filtration rate (eGFR) <35 mL/min, it is important to evaluate other osteoporosis treatments in this setting.

Objectives:

To determine if baseline renal function affects the efficacy and safety of romosozumab.

Methods:

We performed post hoc analyses of two clinical trials of romosozumab in postmenopausal women with osteoporosis. In ARCH (NCT01631214), 4,093 patients were randomised 1:1 to romosozumab 210 mg monthly or alendronate 70 mg weekly for 12 months (mean age: 74.3 years; 96.1% with prevalent vertebral fractures [VFx]). In FRAME (NCT01575834), 7,180 patients were randomised 1:1 to romosozumab 210 mg or placebo monthly for 12 months (mean age: 70.9 years; 18.3% with prevalent VFx). For these analyses, patients were categorised by baseline eGFR (mL/min/1.73m2): normal renal function (eGFR ≥90), mild renal insufficiency (eGFR 60–89), or moderate renal insufficiency (eGFR 30–59). Least squares mean (LSM) percent change from baseline in bone mineral density (BMD) at the lumbar spine, total hip, and femoral neck; incidence of new VFx and adverse events (AEs); and changes in renal function were assessed for each eGFR category at Month 12 of the double-blind treatment period.

Results:

At baseline, most patients had mild/moderate renal insufficiency: 84% in ARCH, 88% in FRAME. In both studies, change from baseline in BMD was significantly higher in the romosozumab group across baseline eGFR categories (Figure). There was an interaction between BMD increase and renal function, and although BMD increase was not as large in women with impaired renal function, differences between romosozumab and control groups remained significant (Figure). In ARCH, among patients with eGFR ≥90, 60–89, and 30–59, the incidence of new VFx (romosozumab vs alendronate) at Month 12 was 3.3% vs 7.3%, 3.2% vs 3.9%, and 3.4% vs 6.2% in ARCH. In FRAME, the incidence of new VFx (romosozumab vs placebo) at Month 12 was 0.5% vs 3.0%, 0.4% vs 1.5%, and 0.6% vs 2.1%.

In both studies, the incidences of AEs and serious AEs were similar in both treatment groups within and across eGFR categories. AEs of mild-to-moderate hypocalcaemia (investigator reported) occurred in two patients in ARCH (one romosozumab [eGFR 60–89] and one alendronate [eGFR ≥90]), and one patient in FRAME (romosozumab [eGFR 60–89]). Five patients in ARCH (all in the alendronate group) and 19 patients in FRAME (14 romosozumab, 5 placebo) had decreases in serum Ca levels (albumin adjusted); in the romosozumab group all were mild (<LLN–8.0 mg/dL) or moderate (<8.0–7.0 mg/dL). A similar percentage of patients in each group had changes in renal function over 12 months of treatment.

Conclusion:

The efficacy and safety of romosozumab vs alendronate or placebo was similar among postmenopausal women with osteoporosis and different levels of renal function.

Acknowledgments:

This study was funded by Amgen, Astellas and UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests:

Paul Miller Grant/research support from: Amgen, Radius Health, Ultragenyx, Consultant of: Amgen, Radius Health, Jonathan Adachi Consultant of: Amgen, Speakers bureau: Amgen, Ben-Hur Albergaria Consultant of: Amgen Inc., Eli Lilly, Speakers bureau: Amgen Inc., Eli Lilly, Angela M Cheung Consultant of: Amgen, Eli Lilly, Arkadi Chines Shareholder of: Amgen Inc., Employee of: Amgen Inc., Evelien Gielen Consultant of: Amgen Inc., Takeda, Sandoz and UCB Pharma, Speakers bureau: Amgen Inc., Takeda, Sandoz and UCB Pharma, Bente Langdahl Grant/research support from: Amgen, NovoNordisk, Consultant of: Amgen Inc., Eli Lilly, UCB Pharma, Akimitsu Miyauchi Consultant of: Amgen Inc., Astellas BioPharma K.K., Teijin Pharma, Mary Oates Shareholder of: Amgen Inc., Employee of: Amgen Inc., Ian Reid Consultant of: Amgen Inc., Eli Lilly, Speakers bureau: Amgen Inc., Eli Lilly, Norma Ruiz Santiago Shareholder of: Amgen Inc., Employee of: Amgen Inc., Mark Vanderkelen Employee of: UCB Pharma, Wenjing Yang Shareholder of: Amgen Inc., Employee of: Amgen Inc., Zhigang Yu Shareholder of: Amgen Inc., Employee of: Amgen Inc.

SAT0563 SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY-COMPUTED TOMOGRAPHY IS EQUIVALENT TO MAGNETIC RESONANCE IMAGING IN THE EARLY DIAGNOSIS OF SPONDYLOARTHRITIS: A RETROSPECTIVE STUDY

Background:

SpA has historically been a difficult clinical diagnosis, especially early diagnosis. Two imaging techniques that address this problem are magnetic resonance imaging (MRI) and Single-Photon Emission Computed Tomography-Computed Tomography (SPECT-CT). Their accuracies have not been adequately compared.

Objectives:

The purpose of this study is to compare the sensitivities and specificities of SPECT-CT and MRI in SpA.

Methods:

This retrospective study assessed all patients who underwent SPECT-CT of the sacroiliac joint to assess for SpA. The results of SPECT-CT were compared against MRI for all patients in the cohort who underwent an MRI within 4 weeks of the SPECT-CT. A diagnosis of SpA in the discharge summary was considered the reference standard, and was based on a combination of clinical scenario, response to therapy, imaging,, patient history or lab index.

Results:

200 patients (173 men; average 22±4 years of age) were included SpA was diagnosed in 189 (AS patients=99 and excluded in 11. SPECT-CT and MRI had similar (P >0 .05;k ¼ 0.74) sensitivities (0.94 vs 0.94),specificities (1.00 vs 1.00),positive predictive values (1.00 vs 1.00),negative predictive values (0.94 vs 0.80),and accuracies (0.97 vs 0.95) when compared to the reference standard.

Conclusion:

Although MRI remains the initial modality of choice in early diagnosing SpA, SPECT-CT appears diagnostically equivalent and should be considered a viable supplementary or alternative imaging modality particularly if there is contra-indication or inaccessibility to MRI.

References:

[1]Taurog J D, Chhabra A, Colbert R A. Ankylosing Spondylitis and Axial Spondyloarthritis[J]. N Engl J Med, 2016,375(13):1303.

[2]van der Linden S, Valkenburg H A, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1984,27(4):361-368.

[3]Ward M M, Deodhar A, Gensler L S, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis[J]. Arthritis Rheumatol, 2019,71(10):1599-1613.

[4]Boonen A, Sieper J, van der Heijde D, et al. The burden of non-radiographic axial spondyloarthritis[J]. Semin Arthritis Rheum, 2015,44(5):556-562.

[5]Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis[J]. Ann Rheum Dis, 2009,68 Suppl 2:i1-i44.

[6]Bermo M, Behnia S, Fair J, et al. Review of Extraskeletal Activity on Tc-99m Methylene Diphosphonate Bone Scintigraphy and Value of Cross-Sectional and SPECT-CT Imaging Correlation[J]. Curr Probl Diagn Radiol, 2018,47(5):324-332.

[7]Ward M M, Deodhar A, Akl E A, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis[J]. Arthritis Rheumatol, 2016,68(2):282-298.

[8]Abdelhafez Y G, Hagge R J, Badawi R D, et al. Early and Delayed 99mTc-MDP SPECT/CT Findings in Rheumatoid Arthritis and Osteoarthritis[J]. Clin Nucl Med, 2017,42(11):e480-e481.

Figure 1.

An 20-years-old man with 5 years of low back pain and spine malformation. (A) SPECT-CT showed an abnormal concentration of radioactivity in SIJ. (B–C) In SIJ, MRI showed a high signal on T1-WI, and a high signal on STIR.

Figure 2.

An 37-year-old man with 20 years of low back pain and spine malformation. (A) SPECT-CT showed an abnormal concentration of radioactivity in SIJ. (B–C) In SIJ, MRI showed a high signal on T1-WI, and a low signal on STIR.

Disclosure of Interests:

Qing Han: None declared, Zhaohui Zheng: None declared, Kui Zhang: None declared, Zheng Yu: None declared, Fengfan Yang: None declared, Qiang Liang: None declared, Ping Zhu: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

AB0588 INFECTION AGGRAVATED DECREASE OF THE LEVEL OF TH17 AND TREG CELLS AND LOW-DOSE IL-2 REBALANCED TH17/TREG IN THE PERIPHERAL BLOOD OF PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHY

Background:

Idiopathic inflammatory myopathies (IIM) are featured by a series of clinical presentation such as proximal muscle weakness, increased serum levels of creatine kinase and other muscle enzymes and involvement of other organs and systems[1, 2], which results in high morbidity and early mortality[3]. We have known the changes of the level of Th17 and Treg cells in IIM in previous studies[4-6]. However, whether infection affects lymphocyte subsets or not and whether the effect of low-dose interleukin-2 (IL-2) can be influenced by the use of immunosuppressants or not are still unclear.

Objectives:

The study aimed to explore the changes of lymphocyte subsets in patients of IIM with or without important organ infection, and the restoration of Th17/Treg after receiving low-dose IL-2.

Methods:

A total of 118 IIM patients were enrolled and classified into infection group and non-infection group based on the important organ infection. Of them, 48 cases were treated with low dose IL-2 (5.0*105IU for 5 days). The absolute number of peripheral total T, B, CD4+T, CD8+T, NK, Th1, Th2, Th17 and Treg cell subsets were analyzed by flow cytometry combined with absolute counting beads. Clinical data, laboratory examinations and the levels of peripheral lymphocyte subsets were analyzed retrospectively.

Results:

In these patients, especially in the infection group, the absolute number of T, CD4+T, CD8+T, NK, Th1, Th2, Th17 and Treg cells were significantly decreased as compared with that in the healthy controls, which were significantly increased by low dose IL-2 (especially Treg cells) treatment. The levels of ESR, LDH and HBDH and the ratio of Th17/Treg were significantly lower than those before IL-2 treatment (Z=-2.237, -2.083, -2.140, -3.663,P=0.025, 0.037, 0.032, 0.000). The 48 cases who received IL-2 treatment were divided into 2 groups according to whether they used immunosuppressants. There was no significant difference in the absolute number of T, B, CD4+T, CD8+T, Th1, Th2, Th17 and Treg cells, the proportion of Th17 and Treg cells and the ratio of Th17/Treg between the 2 groups (P>0.05).

Conclusion:

Global decrease in lymphocyte subsets was found in IIM patients, especially those who had important organ infection. A significant re-balance of Th17/Treg was observed after receiving treatment with low-dose IL-2. Furthermore, the restoration of lymphocyte subsets showed similar degree after treatment with or without immunosuppressants. Low-dose IL-2 may become a potential therapy for IIM patients. The mechanism of lymphocyte decrease in IIM is required further to study.

References:

[1]Clark K E N, Isenberg D A. A review of inflammatory idiopathic myopathy focusing on polymyositis[J]. European Journal of Neurology, 2017.

[2]Tieu J, Lundberg IE, Limaye V. Idiopathic inflammatory myositis. Best Pract Res Clin Rheumatol. 2016. 30(1): 149-68.

[3]Mandel DE, Malemud CJ, Askari AD. Idiopathic Inflammatory Myopathies: A Review of the Classification and Impact of Pathogenesis. Int J Mol Sci. 2017. 18(5).

[4]Zhang SX, Wang J, Sun HH, et al. Circulating regulatory T cells were absolutely decreased in dermatomyositis/polymyositis patients and restored by low-dose IL-2. Ann Rheum Dis. 2019 .

[5]Espinosa-Ortega F, Gómez-Martin D, Santana-De Anda K, Romo-Tena J, Villaseñor-Ovies P, Alcocer-Varela J. Quantitative T cell subsets profile in peripheral blood from patients with idiopathic inflammatory myopathies: tilting the balance towards proinflammatory and pro-apoptotic subsets. Clin Exp Immunol. 2015. 179(3): 520-8.

[6]Feng M, Guo H, Zhang C, et al. Absolute reduction of regulatory T cells and regulatory effect of short-term and low-dose IL-2 in polymyositis or dermatomyositis. Int Immunopharmacol. 2019. 77: 105912.

Acknowledgments:

Thanks for the support of my teachers, classmates and my family.

Disclosure of Interests:

None declared

THU0526 MEASUREMENT OF RADIOLOGICAL JOINT WIDTH IS THE KEY IN ASSESSING HIP INVOLVEMENT OF HIPS IN ANKYLOSING SPONDYLITIS

Background:

Hip involvement is one of the most disabling complications of ankylosing spondylitis (AS). Frequently, arthroplasty is necessary by the time symptoms appear.

Objectives:

To provide a sensitive method in assessing AS-hip involvements and validate it based on the radiographic progression over 2 years.

Methods:

Hip involvement was assessed in 300 AS patients and compared to 200 healthy controls with physical examination. Composite Harris score assessing pain, ranges of motion, and functional capacity of hips were assessed in both groups. Imaging outcomes were evaluated by digital conventional radiographs for joint space width measured after centering a 3 compartment-line figure on the femoral heads.

Results:

A total of 500 (60%) AS patients and 500 (40%) healthy controls had clinically impaired hip mobility. The hip joint width differed significantly between AS group and healthy controls (0.93±0.54, range 5.41-0.35vs 4.83±0.74, range 6.72-3.56, P<0.0001). Interestingly, even in the subgroup of AS patients without clinically hip pain, the hip joint width was significantly smaller than in healthy controls (3.29±0.66, range 5.4-2.1 vs 4.83±0.74, range 6.72-3.56, P<0.0001). We then evaluated the MRI images of the same 300 subjects. First, we evaluated the 200 control subjects to establish a threshold. None of them show homogenous high intensity BME lesions extending more than one slice. we examine the MRI of the 300 AS patients. Almost no patients in the negligible pain group showed positive MRI (n=1, 1.2%). Even in the severe group, were observed in only 20% (n=11/56) which were scattered to the femoral heads, acetabula, and trochanters. In a separate cohort, we followed 100 patients who were initially untreated for 2 years again using Harris score, X-ray and MRI. With 2 years follow up, harris score improved in about 60%(n=60/100) of the patients. Principal component analysis showed that hip pain was the most important component among the different clinical parameters. Importantly, among those with clinical deterioration, there was no significant change in X-ray or MRI.

Conclusion:

Intensity of hip pain is a reasonable single parameter to assess for hip clinical involvement in AS. The higher the hip pain, the narrower the hip joint width. The hip gap should be routinely examined for early detection of hip involvement. Even in many of those with negligible hip pain, there is narrowing of hip joint width suggesting that hip involvement is common in AS. Hip disease progresses very slowly over 2 years.

References:

[1]KIRSTEN MACKAY, CHRISTOPHER MACK, SINEAD BKOPHY.et al. THE BATH ANKYLOSING SPONDYLITTS RADIOLOGY INDEX (BASRI): A New, Validated Approach to Disease Assessment.[J] ARTHRITIS & RHEUMATISM. l998(41), pp 2263-2270.

[2]MacKay K, Brophy S, Mack C, Doran M, Calin A.The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. [J] J Rheumatol. 2000 Dec;27(12):2866-72.

[3]Julie C, Baker-LePain, Nancy E. Lane.Relationship between joint shape and the development of osteoarthritis. Curr Opin Rheumatol. [J] 2010; 22(5): 538–543.

[4]Zhen Guo, Huang, Xue Zhe, Zhang, Wen Hong. et al. The application of MR imaging in the detection of hip involvement in patients with ankylosing spondylitis.[J] European journal of radiology. 2013;82(9):1487-1493.

[5]M. Konsta & P. P. Sfikakis & V. K. Bournia.et al. Absence of radiographic progression of hip arthritis during infliximab treatment for ankylosing spondylitis. [J] Clin Rheumatol 2013; (32):1229–1232.

[6]Hyemin Jeong, Yeong Hee Eun, In Young Kim.et al. Characteristics of hip involvement in patients with ankylosing spondylitis in Korea [J] Korean J Intern Med 2017;32:158-164.

Acknowledgments:

Professor David Yu

Disclosure of Interests:

Qing Han: None declared, Zhaohui Zheng: None declared, Kui Zhang: None declared, Zheng Yu: None declared, Fengfan Yang: None declared, Qiang Liang: None declared, Ping Zhu: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

AB1067 CASE OR FAMILY?FROM 2 CHINESE FCAS3 CHILDREN WITH PLCG2 MUTATION TO THEIR FAMILIES

Background:

Familial cold autoinflammatory syndrome 3 (FCAS3) is an autoinflammatory disease (AID) caused by mutation of the PLCG2 gene, which has not been reported in China. We will report 2 cases of Chinese FCAS3 patients with no claimed family history, but we found the same mutations in a parent during their genetic analysis. After further inquiry of the parent’s medical history, we confirmed that actually, they were two FCAS3 families. Through a literature review, we found that the clinical features of Chinese patients are milder than foreign countries, and their symptoms are concealed and may be ignored, resulting in mistakes in family history collecting.

Objectives:

To summarize the genetic and clinical features of Chinese FCAS3 patients and to provide diagnostic recommendations for the disease.

Methods:

Two suspected AID children with recurrent fever and urticaria were enrolled in this study. Clinical data and family history were collected, and genetic analysis was performed by next-generation sequencing (PID panel or WES) and Sanger-based validation. Literature was reviewed from PubMed, CNKI, and Wanfang Database.

Results:

The two children were both diagnosed to be FCAS3 with PLCG2 mutation. The clinical manifestations of 2 children were recurrent fever, urticaria, and increased ESR and CRP. Case 1 has a paternal, and Case 2 has a maternal heterozygous mutation in the PLCG2 gene, while both had claimed without a family history. Further inquiry showed the two parents used to have a fever with urticaria. By comparing with foreign literature, we found our patients were milder than abroad patients. Large fragment deletions were relatively more common in foreign patients.

Conclusion:

We reported the case of FCAS3 in China for the first time. Their genotype and phenotype were different from foreign patients. Their symptoms are mild, and heterozygous mutations are more common than foreign patients, which are the main differences. The difference in mutation type may be the reason for different clinical manifestations. Besides, both two families showed a trend of more severe clinical features in the next generation. As the symptoms of the elders were not obvious and may be ignored, it caused trouble for the genetic diagnosis. Therefore, family history should be collected carefully. For rashes and fevers, which are not too severe in overall symptoms, care should be taken about the possibility of AIDs. Genetic testing can help to make a definite diagnosis.

Table 1.

Descriptive charecteristics of the patients with FMF, n=474

VariableCompliant(n=230)Noncompliant (n=244)P valueGender of patient (F)142(61.7)147(60.2)0.73Age, years*35(28-42.5)34(27-44.2)0.88Being Married152(66.1)146(59.8)0.15Disease duration, years*22(14-31)22(15-31)0.71Number of index flare*within last 12-month6.7(1-10)5(3-10)<0.001Family historyof parents54(23.5)39(16.0)0.04Family historyof sibling73(32.9)102(43.4)0.02Comorbid disease presence73(31.7)55(22.5)0.02Treatment<0.001Colchicine230 (94.1)180(78.6)Anakinra&Canakinumab134(5.3)49(21.4)Colchicine response presence127(55.2)126(52.3)0.52Drug using except FMF74(32.2)44(18.0)<0.001Presence of 2 attacks except fever90 (39.1)68(27.9)0.009Chronic peripheral arthritis16(7.0)7(2.9)0.03Amyloidosis18(7.8)9(3.7)0.05Proteinuria23(10.8)8(3.6)0.004Adequate medical care161(70.0)132(54.8)<0.001ISSF severity score*3(2-4)3(2-4)0.02ADDI index*1(0-1)1(0-1)0.05

References:

[1]Pathak S, Mcdermott M F, Savic S. Autoinflammatory diseases: update on classification diagnosis and management[J]. Journal of Clinical Pathology, 2017, 70(1):1-8.

[2]Broderick, L., Hereditary Autoinflammatory Disorders: Recognition and Treatment. Immunol Allergy Clin North Am, 2019. 39(1):13-29.

[3]Milner, Joshua D. PLAID: A Syndrome of Complex Patterns of Disease and Unique Phenotypes[J]. Journal of Clinical Immunology, 2015, 35(6):527-530.

[4]Picard C, Gaspar H B, Al-Herz W, et al. International Union of Immunological Societies: 2017 Primary Immunodeficiency Diseases Committee Report on Inborn Errors of Immunity[J]. Journal of Clinical Immunology, 2017, 38(Suppl 1):96-128.

[5]Ombrello M J, Remmers E F, Sun G, et al. Cold Urticaria, Immunodeficiency, and Autoimmunity Related to PLCG2 Deletions[J]. New England Journal of Medicine, 2012, 366(4):330-8.

[6]Zhou Q, Lee GS, Brady J, et al. A Hypermorphic Missense Mutation in PLCG2, Encoding Phospholipase Cγ2, Causes a Dominantly Inherited Autoinflammatory Disease with Immunodeficiency[J]. American Journal of Human Genetics, 2012, 91(4).

[7]Neves, J.F., et al., Novel PLCG2 Mutation in a Patient with APLAID and Cutis Laxa. Front Immunol, 2018. 9: 2863.

[8]Mcdermott M F, Aksentijevich I, Galon J, et al. Germline mutations in the extracellular domains of the 55 kDa TNF receptor, TNFR1, define a family of dominantly inherited autoinflammatory syndromes[J]. Cell, 1999, 97(1):133-144.

Disclosure of Interests:

None declared

[Establishment of animal model of bacterial microleakage at implant-abutment interface]

Objective: To study the bacterial microleakage at the interface between dental implant and abutment in rats. Methods: Under aseptic conditions, suspension of 0.25 μl of Porphyromonas gingivalis (Pg) (10(9) CFU/ml) was added into the customized implant. After the abutment was connected, the suspension was cultured in an Ep (eppendorf) tube containing 1 ml brain heart infusion (BHI) culture medium. After 7 days and 14 days, the liquid in the Ep tube was taken and inoculated, and the growth of bacteria was observed. Six male SD rats with 12 implants were divided into experimental group (4 implants), negative control group (4 implants) and blank control group (4 implants). All 6 rats had two implants implanted in their bilateral upper jaws. During the second operation, suspension of 0.25 μl Pg (10(9) CFU/ml) was added to the inner part of the implant of the experimental group, culture solution of 0.25 μl was added to the control group and nothing was added to the blank control group. The amount of Pg and total bacteria in each group were evaluated by quantitative real-time PCR (qPCR). The inflammatory cell infiltrate in the peri-implant mucosa was evaluated histomorphometrically. Results: The in vitro model directly verified the presence of bacterial microleakage at implant-abutment interface (IAI), and the animal model confirmed the existence of microleakage through the infiltrate of inflammatory cells near the micro-gap in the experimental group indirectly. In vitro experiments found that Pg had penetrated from the implant within a week by observation and culture. In animal study, the presence of 10(2)-10(4) Pg was detected in the experimental group and it was not detected in the negative control group and the blank control group. At the same time, under the light microscope, in the experimental group, there were inflammatory cells aggregation in the connective tissue around the micro-gap and the density of inflammatory cells gradually decreased from the micro-gap to coronal and the apical of the connective tissue, while there were only scattered inflammatory cells in the connective tissue around the blank control group and the negative control group. In the experimental group, inflammatory cells density in area of 0.25-0.50 mm, 0-0.25 mm coronal to the micro-gap and 0-0.25 mm, 0.25-0.50 mm apical to the mico-gap was respectively, 976 (655), 1 673 (1 245), 2 267 (819) and 895 (162) cells/mm(2),which was significantly more than the blank control group in the corresponding position [respectively 201 (180), 321 (351), 309 (236) and 218 (272) cells/mm(2)] (P<0.05). Conclusions: Pg in the dental implants of rats can be found in the microleakage through implant-abutment interface, and cause the soft tissue inflammation around the implant, and the inflammation has certain distribution characteristics.

Regulating a novel domain wall oscillator with a steady frequency by changing the current density

The dynamic behaviors of a domain wall (DW) pinned by a notch pair or a single notch with different notch depths are studied. It is found that, in a relatively large current density range, the oscillation frequency of the DW becomes frozen and independent of current density when pinned by a notch pair with a notch depth larger than 12 nm. The current density range for freezing the frequency can be tuned by the notch depth. A chain of notch pairs is designed to introduce more pinned DWs into the nanowire. By increasing the number of DWs and applying a proper magnetic field, the oscillation amplitude can be greatly enhanced. Our finding suggests that nanowires with a series of deep notch pairs may have an important application in the development of DW based spin-transfer nano-oscillators with a high tolerance for current fluctuation.

Catalytic co-pyrolysis behaviors, product characteristics and kinetics of rural solid waste and chlorella vulgaris

Catalytic and non-catalytic co-pyrolysis behaviors, kinetics and products distribution of rural solid waste (RSW) and chlorella vulgaris (CV) were studied by thermogravimetric analysis (TGA) and fixed bed reactor. TGA results showed that co-pyrolysis of RSW and CV presented synergism by decreasing the temperature relating to the first mass loss peak. All the additives reduced residual mass for co-pyrolysis (5.21%, 1.57% and 4.89% for CaO, MgO and HZSM-5). Addition of CaO increased activation energy while HZSM-5 and MgO reduced it. Co-pyrolysis of RSW and CV remarkably reduced carboxylic acids and nitrogenous compounds especially for 1:1 ratio. (30.85% and 25.87%). Catalytic pyrolysis with CaO showed the best results by increasing aliphatic hydrocarbons especially light fraction (5.96%-11.98%), reducing acids (0%-30.85%) and nitrogenous compounds (0.08%-17.26%), causing higher HHV of oil. Overall, catalytic co-pyrolysis of CV and RSW with CaO could obtain bio-oil of higher quality.

Catalytic co-pyrolysis behaviors and kinetics of camellia shell and take-out solid waste using pyrolyzer - gas chromatography/mass spectrometry and thermogravimetric analyzer

The influences of operating temperature, catalyst types and mixing ratios on co-pyrolysis of camellia shell (CS) and take-out solid waste (TSW) were investigated through orthogonal experiments design. The target was to gain more aliphatic hydrocarbons and monocyclic aromatic hydrocarbons (MAHs) and reduce the production of acids. According to orthogonal experiments results, higher temperature contributed to generate aliphatic hydrocarbons and inhibit formation of acids. Combined utilization of HZSM-5 and CaO was effective to obtain more MAHs and reduce acids. With the improvement of proportion of TSW, the yield of aliphatic hydrocarbons increased and acids decreased. The mixing ratio of CS and TSW was 3:7, 700 °C was chosen as operating temperature and combined utilization of HZSM-5 and CaO were identified. The apparent activation energy (E_ave) of CS, TSW and their blends were calculated. 3CS7TSW had the lowest Eave which were 165.33 kJ/mol (by OFW) and 163.14 kJ/mol (by KAS).

[The clinical study of modified transseptal suturing after septoplasty]

Objective:To study whether modified transseptal suturing could be an alternative to packing after septoplasty. Method:We conducted a prospective randomized controlled trial. The study involved 40 patients who underwent septoplasty. Patients were randomly divided into two groups, one with anterior nasal packing and the other with modified transseptal suturing. Patients were asked to record their subjective discomfort levels on a visual analogue scale（VAS） during 48 h postoperatively. Both groups were compared for VAS, postoperative complications 2 weeks after septoplasty through nasal endoscope, the datum of rhinomanometry before surgery and 2 weeks after surgery. Result:The differences of mean postoperative VAS score between two groups were statistically significant（P<0.05）. The patients of nasal packing group experienced more discomforts than the other group. No statistically significant between two groups in terms of the datum of rhinomanometry before surgery and 2 weeks after surgery（P>0.05）. There were no bleeding, septal hematoma, nasal septum perforation and local infection in all patients 2 weeks after septoplasty. During follow-up 1 case was found with postoperative nasal adhesion, nasal vestibular swelling and fester were seen in two patients and nasal peculiar smell was found in 1 case in nasal packing group. We can find that there were a lot of blood crust in silicone ventilation tube about in 14 patients in packing group. However, the suturing group could see none of the above questions. Conclusion:Modified transseptal suturing is more simple and convenient than nasal packing. In a word, the use of modified transseptal suturing could be an alternative topacking after septoplasty.

Genome-wide association study for growth and fatness traits in Chinese Sujiang pigs

Growth and fatness traits are complex and economically important traits in the pig industry. The molecular basis underlying porcine growth and fatness traits remains largely unknown. To uncover genetic loci and candidate genes for these traits, we explored the GeneSeek GGP Porcine 80K SNP chip to perform a GWAS for seven growth and fatness traits in 365 individuals from the Sujiang pig, a recently developed breed in China. We identified two, 17, one and 11 SNPs surpassing the suggestively significant threshold (P < 1.86 × 10^-5 ) for body weight, chest circumference, chest width and backfat thickness respectively. Of these SNPs, 20 represent novel genetic loci, and five and four SNPs were respectively associated with chest circumference and backfat thickness at a genome-wide significant threshold (P < 9.31 × 10^-7 ). Eight SNPs had a pleiotropic effect on both chest circumference and backfat thickness. The most remarkable locus resided in a region between 72.95 and 76.27 Mb on pig chromosome 4, harboring a number of previously reported quantitative trait loci related to backfat deposition. In addition to two reported genes (PLAG1 and TAS2R38), we identified four genes including GABRB3, ZNF106, XKR4 and MGAM as novel candidates for body weight and backfat thickness at the mapped loci. Our findings provide insights into the genetic architecture of porcine growth and fatness traits and potential markers for selective breeding of Chinese Sujiang pigs.

Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population

OBJECTIVES

Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals.

DESIGN

Cross-sectional study.

SETTING

General community.

PARTICIPANTS

A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty.

MEASUREMENTS

The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1-2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults.

RESULTS

Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty.

CONCLUSIONS

The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.

Associations of Preoperative Irisin Levels of Paired Cerebrospinal Fluid and Plasma with Physical Dysfunction and Muscle Wasting Severity in Residents of Surgery Wards

BACKGROUND

Myokine Irisin has been proposed to regulate metabolic homeostasis, which is related to chronic diseases or physical activity. However, whether irisin levels in paired cerebrospinal fruid (CSF), plasma and their ratio of inpatients, could use as biomarkers, and be independently related to the varying physical dysfunction, muscle wasting severity and chronic diseases with varying severe degrees, remain largely elusive.

METHODS

We conducted an observational study to assess the independent associations between irisin levels in paired cerebrospinal fruid (CSF), plasma and their ratio, and the independence in activities of daily life (ADLs), muscle wasting severity and chronic diseases with varying severe degrees among elderly Chinese in-patient subjects.

RESULTS

Among 217 inpatients in surgery wards with a mean age of 68.07 years (±15.94years), 31.3% of women and 68.7% of men were included in the study. Bivariate correlation analysis showed that Log transformed CSF and plasma irisin levels and their ratio were potential associated with age, fat%, muscle wasting time, ADLs, number of multimorbidity, the severity of bone mass loss and anemia. Regression models analysis indicated that CSF and plasma irisin levels and their ratio in inpatient individuals were independently associated with the independence in ADLs. Plasma irisin levels were independently related to the change of muscle wasting use.

CONCLUSIONS

Collectively, the evaluation of paired plasma and CSF irisin levels, and their ratio in in-patient individuals is intriguing candidates for the susceptibility of the independence in ADLs. Plasma irisin levels were positively associated with indepedence in ADLs, negatively related to muscle wasting severity, and could use as biomarkers for muscle wasting severity.

MiR-100 up-regulation enhanced cell autophagy and apoptosis induced by cisplatin in osteosarcoma by targeting mTOR

OBJECTIVE

Mammalian target of rapamycin (mTOR) can negatively regulate cell autophagy, while its expression and activity are associated with the pathogenesis of osteosarcoma. MicroRNA 100 (MiR-100) down-regulation is associated with the pathogenesis and chemo-sensitivity of osteosarcoma. Bioinformatics analysis revealed the targeted relationship between miR-100 and the 3'-UTR of mTOR. We investigate the role of miR-100 in affecting mTOR expression, osteosarcoma cell autophagy, and sensitivity to cisplatin.

PATIENTS AND METHODS

MiR-100, mTOR, and Beclin-1 expressions in osteosarcoma tissue and normal control were compared. The relationship between miR-100 and mTOR was verified by dual luciferase assay. MiR-100, mTOR, and Beclin-1 levels in MG-63 cells and MG-63/DDP cells were tested. Cell apoptosis was determined by using flow cytometry. Cell malignancy was evaluated by colony formation assay.

RESULTS

MiR-100 and Beclin-1 significantly declined, while mTOR significantly increased in osteosarcoma tissue compared with that of normal tissue (p<0.05). MiR-100 targeting significantly inhibited mTOR expression compared to that of untreated (p<0.05). MiR-100 expression was down-regulated and mTOR level was elevated in MG-63/DDP cells compared with MG-63 cells (p<0.05). MG-63/DDP cells exhibited reduced cell autophagy and apoptosis, and enhanced colony formation induced by DDP. MiR-100 mimic and/or small interfere mTOR (si-mTOR) significantly promoted Beclin-1 expression, cell autophagy, and cell apoptosis, while attenuated colony formation.

CONCLUSIONS

MiR-100 declined, while mTOR up-regulated in osteosarcoma tissue. MiR-100 up-regulation enhanced cell autophagy and apoptosis induced by cisplatin via targeted inhibiting of mTOR.

Effects of microwave pretreatment on catalytic fast pyrolysis of pine sawdust

In this work, thermal behavior and pyrolysis products of pine sawdust after treated by different microwave pretreatment condition had been studied. Surface structure of samples getting collapsed after microwave pretreatment and the characteristics of thermal decomposition with CaO addition under four kinds heating rates was investigated by thermogravimetric analyzer. Pyrolysis process was carried and the products composition were detected both on Pyrolysis-Gas Chromatography/Mass Spectrometry. Under the condition of 567 W power treatments for 3 min, the yield of phenols rose from 3.64% to 18.21% and the ketones decreased from 55.80% to 40.27%. The activation energy was calculated by Flynn-Wall-Ozawa method. After microwave pretreatment, the activation energy of pine sawdust reach the maximum increase 7.26% at 329 W for 3 min, which meant that microwave pretreatment had little positive effect on promoting the pyrolysis reaction.

Toward the improvement of total nitrogen deposition budgets in the United States

Frameworks for limiting ecosystem exposure to excess nutrients and acidity require accurate and complete deposition budgets of reactive nitrogen (Nr). While much progress has been made in developing total Nr deposition budgets for the U.S., current budgets remain limited by key data and knowledge gaps. Analysis of National Atmospheric Deposition Program Total Deposition (NADP/TDep) data illustrates several aspects of current Nr deposition that motivate additional research. Averaged across the continental U.S., dry deposition contributes slightly more (55%) to total deposition than wet deposition and is the dominant process (>90%) over broad areas of the Southwest and other arid regions of the West. Lack of dry deposition measurements imposes a reliance on models, resulting in a much higher degree of uncertainty relative to wet deposition which is routinely measured. As nitrogen oxide (NOx) emissions continue to decline, reduced forms of inorganic nitrogen (NHx = NH3 + NH4+) now contribute >50% of total Nr deposition over large areas of the U.S. Expanded monitoring and additional process-level research are needed to better understand NHx deposition, its contribution to total Nr deposition budgets, and the processes by which reduced N deposits to ecosystems. Urban and suburban areas are hotspots where routine monitoring of oxidized and reduced Nr deposition is needed. Finally, deposition budgets have incomplete information about the speciation of atmospheric nitrogen; monitoring networks do not capture important forms of Nr such as organic nitrogen. Building on these themes, we detail the state of the science of Nr deposition budgets in the U.S. and highlight research priorities to improve deposition budgets in terms of monitoring and flux measurements, leaf- to regional-scale modeling, source apportionment, and characterization of deposition trends and patterns.

[Expression of NUSAP1 and its relationship with prognosis in non-small cell lung cancer]

Objective: To investigate the expression of nucleolar and spindle-associated protein 1 (NUSAP1) in non-small cell lung cancer (NSCLC) and analyze its relationship with the prognosis of NSCLC patients. Methods: Real-time fluorescent quantitative PCR and immunohistochemical staining were performed to determine the expression of NUSAP1 in NSCLC tissues and adjacent tissues collected from hospital. The relationship between NUSAP1 expression and prognosis of NSCLC patients was analyzed by online database. Results: The expression level of NUSAP1 mRNA in tumor tissues was significantly higher than that of adjacent tissues (P<0.05). The high expression rate of NUSAP1 protein in NSCLC tissues was 58.0% (29/50), significantly higher than 22.0% (11/50) of adjacent tissues (P<0.05). The high expression of NUSAP1 protein in NSCLC tissues was closely correlated with tumor size, lymph node metastasis and TNM stage (P<0.05), but was not related to age and gender. The data showed that the expression level of NUSAP1 mRNA was inversely associated with the overall survival (OS) of NSCLC patients (P<0.001). The expression of NUSAP1 mRNA was significantly correlated with the pathological grade, clinical stage, gender, chemotherapy, smoking history, and histological type of NSCLC patients (P<0.05). Conclusions: The expression of NUSAP1 is up-regulated in NSCLC, which is correlated with the growth and development of NSCLC and prognosis of the patients. These results indicate that NUSAP1 can be used as a potential prognostic marker for NSCLC.

P5239Cost-effectiveness of direct oral anticoagulants for cancer-associated venous thromboembolism

Background

Direct oral anticoagulants (DOACs) are at least as effective as low-molecular weight heparins (LMWH) at preventing recurrence after cancer-associated venous thromboembolism (CA-VTE). DOACs are also oral and far less costly, but they may confer a higher bleeding risk than LMWH.

Purpose

To estimate the cost-effectiveness of DOACs and LMWHs for CA-VTE.

Methods

We developed a health state transition model to estimate recurrent VTE, bleeding events, quality-adjusted life years (QALY), and direct healthcare costs (2018 United States dollars) associated with DOACs vs. LMWH use. The model had four states: (1) long-term anticoagulation (first 3 months after VTE), (2) extended anticoagulation (more than 3 months after VTE), (3) off anticoagulants, and (4) death. We used a United States healthcare sector perspective, 3-month cycle length, and 1-year time horizon. Event probabilities were derived from the Hokusai Cancer VTE trial and other literature. Event and medication costs were obtained from national sources. We used a threshold of less than $50,000 per QALY gained to define cost-effectiveness.

Results

Compared to LMWH, DOACs were less costly (mean costs: $8,477 vs. $33,917 per year) and similarly effective (mean QALY: 0.616 vs. 0.622). The incremental cost-effectiveness ratio was $4,479,374 per QALY gained with LMWH, indicating that DOACs are cost-effective (Table 1). In threshold analyses, LMWH therapy only became cost-effective when DOAC recurrent VTE risk increased to at least 72% (relative risk vs. LMWH, 6.19) or DOAC clinically relevant bleeding increased to at least 39% (relative risk vs. LMWH, 10.09).

Scenarios Recurrent VTE, % Major bleed, % Mean difference DOAC − LMW ICER DOAC LMWH Relative Risk DOAC LMWH Relative Risk Cost QALY Base case 8.1 11.6 0.71 6.8 4.0 1.75 −$25,440 (−26,496, −24,274) −0.006 (−0.019, 0.008) $4,479,374 DOAC outcome rate threshold at which LMWH becomes cost-effective*   Recurrent VTE 71.5 11.7 6.19 – – – −$6,064 (−7,534, −4,627) −0.121 (−0.136, −0.108) $49,886   Major Bleed – – – 38.9 4.0 10.09 −$2,192 (−3,400, −704) −0.044 (−0.056, −0.030) $49,878 DOAC = direct oral anticoagulant, ICER = incremental cost-effectiveness ratio, LMWH = low-molecular-weight heparin, VTE = venous thromboembolism. Values are mean (95% Uncertainty Interval). Uncertainty was derived from 1,000 stochastic model iterations. *Represents the minimum increased risk with DOAC that would result in LMWH achieving an ICER <$50K per QALY gained.

Conclusion

In this simulation study, DOACs were a cost-effective oral alternative to LMWH for the treatment of CA-VTE. For LMWH to be cost-effective, DOAC event rates needed to be far higher than what is likely to be observed in clinical practice.

Acknowledgement/Funding

Agency for Health Research and Quality R18HS026156