[Current status and progress in novel drug research for gastrointestinal stromal tumors]

Imatinib has created the era of precise treatment of gastrointestinal stromal tumor (GIST). However, in recent years, there has been a lack of satisfactory drugs for imatinib resistance. Recently, the emergence of a series of new agents not only brings new hope to break this situation, but also verifies that the drug development of GIST treatment still needs to lock the driving gene as the main target. New drugs, such as avapritinib and ripretinib, have shown surprising therapeutic efficacy, which may lead to a new situation in the treatment of GIST. The precise treatment of GIST guided by different primary gene mutations and secondary drug resistance mutations will replace the traditional guidelines based on the number of treatment lines.

[Association between sleep and serum hemoglobin A1c in nondiabetic population in Beijing]

Objective: To understand the status quo of sleep and its associations with serum hemoglobin A1c (HbA1c) among nondiabetic people of 18-79 years old in Beijing. Methods: Data was gathered from the 2017 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified clusters sampling method was used while the 18-79 years old were sampled from the 16 districts of Beijing. Questionnaires would include information on demographic characteristics, chronic diseases and related risk factors, sleep duration and related problems (snore/asphyxia, difficult to get to sleep, waking often during the night, waking up early or taking sleeping pills) within the last 30 days. Complex sampling logistic regression models were established to analyze the association between sleep-related problems and serum HbA1c. Results: A total of 11 608 non-diabetic participants were involved in this study, with average age, reported sleep duration and median of serum HbA1c level as (43.36±15.27) years old, (7.49±1.29) h/d and 5.30%, respectively. 47.38% of them reported having sleep problems within the last 30 days. With the increasing time of sleep, serum HbA1c level was fluctuating significantly (F=413.06, P<0.01). Significant differences appeared in serum HbA1c levels among different age groups (t=358.3, P<0.01). Among participants with several kinds of sleep problems, the serum HbA1c levels were significantly higher than those without, through the single factor analysis (U=15.11, P<0.01). After adjusting for potential confounding factors, the combination of one sleep-related problem (OR=1.21, 95%CI: 1.03-1.41) and snore/asphyxia were associated with higher serum HbA1c levels (HbA1c≥5.7%) (OR=1.37, 95%CI: 1.16-1.61). People under 60 years of age were with higher risk of having higher serum HbA1c levels. Conclusion: Duration and sleep-related problems might affect the serum HbA1c levels, especially among those younger than 60 years of age.

A Cationic Oligomer as an Organic Template for Direct Synthesis of Aluminosilicate ITH Zeolite

There are a large number of zeolites, such as ITH, that cannot be prepared in the aluminosilicate form. Now, the successful synthesis of aluminosilicate ITH zeolite using a simple cationic oligomer as an organic template is presented. Key to the success is that the cationic oligomer has a strong complexation ability with aluminum species combined with a structural directing ability for the ITH structure similar to that of the conventional organic template. The aluminosilicate ITH zeolite has very high crystallinity, nanosheet-like crystal morphology, large surface area, fully four-coordinated Al species, and abundant acidic sites. Methanol-to-propylene (MTP) tests reveal that the Al-ITH zeolite shows much higher selectivity for propylene and longer lifetime than commercial ZSM-5. FCC tests show that Al-ITH zeolite is a good candidate as a shape-selective FCC additive for enhancing propylene and butylene selectivity.

[Study on intention of smoking concession, awareness of smoking hazards and impact on smoking status in residents aged 18-65 years in Beijing]

Objective: To understand the awareness of smoking hazards and intention of smoking concession in residents aged 18-65 years in Beijing, and provide scientific evidence for the development and improvement of tobacco control policies and measures. Methods: Data were collected from the 2017 Beijing Non-communicable and Chronic Disease surveillance. A multi-stage stratified cluster sampling method was used to take samples from 165 communities in 16 districts of Beijing. Logistic regression was used to analyze the influencing factors. Results: Among 11 594 participants, 49.93% had no intention of smoking concession. The percentage of refusing smoking concession was higher in men (50.39%) than in women (43.01%), the difference was significant ( χ(2)=14.211, P=0.002), and higher in suburban residents (56.78%) than in urban residents (45.30%), the difference was significant ( χ(2)=51.977, P<0.001). For the smoking cessation motivation, "illness" was the reason for more former smokers (29.88%) compared with current smokers (11.50%), the difference was significant ( χ(2)=85.865, P<0.001). The awareness rates of smoking hazards was higher in women (34.97%) than in men (32.63%), the difference was significant (Z=5.612, P<0.001), higher in suburban residents (35.44%) than in urban residents (33.03%), the difference was significant (Z=-3.734, P<0.001), and higher in never smokers (35.15%) than in smokers (30.06%), the difference was significant ( χ(2)=62.277, P=0.005). Multiple logistic regression analysis results showed people with general awareness (OR=0.61, 95%CI: 0.39-0.94) and poor awareness (OR=0.67, 95%CI: 0.50-0.90) of smoking hazards were less likely to quit smoking and people with general awareness (OR=0.64, 95%CI: 0.53-0.76) and poor awareness (OR=0.87, 95%CI: 0.78-0.98) of smoking hazards were more likely to smoke. Conclusions: Smokers aged 18-65 in Beijing had low willingness for smoking cessation. Health problem was main consideration for smoking cessation. Never-smokers had better awareness of smoking hazards than smokers, and the awareness of smoking hazards was an influencing factor of smoking status.

[Study on the relationship between sleep-related problems and dyslipidemia among adults in Beijing]

Objective: To investigate the status quo of sleelated problems and relationship with dyslipidemia among adults in Beijing. Methods: From August to December 2017, 13 188 residents aged 18-79 years old were randomly selected as the subjects of this study, by stratified multi-stage cluster sampling method. Questionnaire, physical examination and laboratory testing were used in this study. The questionnaire included demographic characteristics and status quo of sleep. Height and weight were measured, with fasting venous blood collected to test the levels of TC, HDL-C, LDL-C and TG. Results: In Beijing, 52.1% of the adults involved in this study were having sleep-related problems which appeared higher in patients with dyslipidemia (55.1%) than those without (50.7%). Rates of sleep-related problems as snoring, difficult to get into sleep, waking at night, waking early and taking sleeping pills were 30.1%, 18.8%, 24.6%, 20.1% and 3.0%, respectively. The prevalence rates of high TC, high TG and high LDL-C were 7.5%, 23.5% and 6.6%, respectively among subjects with snoring and as, 5.7%, 15.5% and 4.9%, respectively among those without. The average level of TC of people easy to wake at night was 4.74 mmol/L, higher than that of those without (4.66 mmol/L). The prevalence of high TC among those waking at night was 7.5%, higher than that of those without (5.8%). After controlling potential confounding factors as age, sex, smoking, overweight and obesity, snoring was significantly positively correlated to the levels of TC, TG and LDL-C (P<0.05) and presenting as risk factor for dyslipidemia, with OR=1.248 (P<0.05). Conclusion: Sleep-related problems appeared serious, with snoring and waking at night the main ones among adults in Beijing. Snoring was significantly positively correlated with the levels of TC, TG and LDL-C and served an independent risk factor for dyslipidemia.

[Heritability of alcohol intake among adult twins, calculate by the structural equation model]

Objective: To explore the genetic and environmental effects on alcohol intake. Methods: Data on 9 231 pairs of adult twins of the same sex was collected from the Chinese National Twin Registry (CNTR), between 2015 and 2018 and used in this study. Structural equation model was used to estimate the effects of genetic and environmental factors on alcohol intake. Results: A total of 9 231 pairs of twins were included in the analysis, of which 6 085 pairs were monozygotic (MZ). The average age of MZ was (36.91±13.07) years old, and males accounted for 56.80%. The average age of dizygotic twins (DZ) was (35.22±12.48) years old, and males accounted for 55.91%. There were 350 pairs of alcohol-drinking twins were with high-risk, accounting for 1.90% and another 367 pairs (1.99%) were with medium-risk. Alcohol-drinkers with medium-risk were affected by additive genetics, common and unique environmental factors, seen among the twins. The overall heritability appeared as 24.3% (95%CI: 0 to 56.8%). Furthermore, 50.7% of the variation (95%CI: 20.4%-79.0%) could be explained by the common environmental factors and 24.9% (95%CI: 18.3%-36.5%) by unique environmental factors. High-risk related drinking behavior was affected by both common and unique environmental factors. The common environmental component appeared as 75.6% (95%CI: 69.6%-80.8%) and unique environmental component as 24.4% (95%CI: 19.2%-30.4%), respectively. Gender difference was seen in the heritability of those with medium or high-risk drinking behaviors. The heritability of men was 30.8% (95%CI: 9.8%-53.5%), while in women it was mainly affected by the environment. Conclusion: Both alcohol drinkers with medium and high-risk drinking behaviors were mainly affected by the environment factors and gender. With the increase of drinking volume, the effect of environment on drinking behaviors became more obvious.

AB0530 CHARACTERISTICS AND MEDIUM-TERM OUTCOMES OF TAKAYASU ARTERITIS–RELATED RENAL ARTERY STENOSIS: ANALYSIS OF A LARGE CHINESE COHORT

Background:

The incidence of renal artery stenosis in Takayasu arteritis (TA) was 20%–60% according to previous reports. The specific characteristics of patients with TA-related renal artery stenosis and the effect of revascularization procedures on prognosis have not been fully investigated.

Objectives:

To investigate the characteristics of patients with TA-related renal artery stenosis and identify the predictors of medium-term adverse outcomes.

Methods:

Data for 567 patients registered in a large prospective observational cohort-the East China Takayasu arteritis cohort-up to April 30, 2019, were retrospectively analyzed.

Results:

Renal artery stenosis was confirmed in 172/567 (30.34%) patients, with left renal artery involvement seen in 73/172 (42.44%) patients. Renal insufficiency at presentation (HR = 2.37, 95% CI: 1.76-15.83, p = 0.03), bilateral renal artery involvement (HR = 6.95, 95% CI: 1.18-21.55, p = 0.01), and severe (>75%) stenosis (HR = 4.75, 95% CI 1.08-11.33, p = 0.05) were predictors of adverse outcomes. Revascularization was performed for 46/172 (26.74%) patients. Patients without preoperative treatment had higher rate of restenosis (44.44% vs. 15.79%, p < 0.01) and hypertension deterioration (25.93% vs. 10.53%, p < 0.01) after the procedure. Non-receipt of preoperative treatment (HR = 6.5, 95% CI: 1.77-32.98, p = 0.04) and active disease at revascularization (HR = 4.21, 95% CI 2.01-21.44, p = 0.04) were independent predictors of adverse outcomes after revascularization.

Conclusion:

Patients with uncontrolled or worsening hypertension or/and renal function may benefit from revascularization. Those who have received preoperative treatment may have more favorable revascularization outcomes. Prognosis appears to be poorer for patients with renal insufficiency at presentation, bilateral artery involvement, and severe stenosis.

References:

[1]Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from a cross-country research in Japan: age and sex specificity. Circulation 2015; 132: 1701-9.

[2]Peng M, Jiang XJ, Dong H, et al. Etiology of renal artery stenosis in 2047 patients: a single-center retrospective analysis during a 15-year period in China. J Hum Hypertens 2016; 30: 124-8

Disclosure of Interests:

None declared

[Heritability of coronary heart disease, based on the data from the Chinese adult twins]

Objective: To analyze the heritability of coronary heart disease (CHD) among the Chinese twin adults. Methods: A total of 20 477 same-sex twin pairs aged 25 years and older from the Chinese National Twin Registry were interviewed. Structure equation model was used to estimate the heritability of CHD. Results: After adjusting for age and gender, the overall heritability of CHD was 0.75(0.68-0.81). Stratified analyses showed that genetic factors play a more important role in CHD incidence in ≥40 years or female twins. While the development of CHD was mainly influenced by environmental factors in 25-39 years or male twins. Conclusion: CHD is influenced by both genetic and environmental factors and the heritability is high.

Seasonal nitrogen uptake strategies in a temperate desert ecosystem depends on N form and plant species

Symbiotic plants might be able to regulate a limited nitrogen (N) pool, thus avoiding and reducing competition for resources, through the uptake of different chemical N forms. Our aim was to see whether coexisting herbs showed preference for different forms of N in a temperate desert. We conducted a situ experiment using the ¹⁵ N labeling method in the Gurbantunggut Desert of Northwestern China dominated by Erodium oxyrrhynchum, Hyalea pulchella, Nonea caspica and Lactuca undulata during their growing period (April and May). Four desert herb species preferentially relied on ¹⁵ N-NO₃ for their N nutrition. Multi-factor analysis of variance (ANOVA) analysis results showed that species, N forms, months, and soil depths strongly affected N uptake rate. The uptake rate by herbs was higher in May than in April, and higher at 0-5 cm than at 5-15 cm soil layers. Erodium oxyrrhynchum, N. caspica and L. undulata showed different preference on N form over months. Erodium oxyrrhynchum and L. undulata changed their uptake preference from more ¹⁵ N-Glycine in April to more ¹⁵ N-NH4 in May. Although the N uptake rate of four desert herbs varied across different soil depths and months, all species absorbed more inorganic N compared with organic N. The higher preference for ¹⁵ N-NO₃ and ¹⁵ N-NH4 over ¹⁵ N-Gly possibly reflects adaptation to different N forms in temperate desert.

Atomic-level handedness determination of chiral crystals using aberration-corrected scanning transmission electron microscopy

Handedness or chirality determination is a challenging and important topic in various fields including chemistry and biology, as two enantiomers have the same composition and mirror symmetry related structures, but might show totally different activities and properties in enantioselective separations, catalysis and so on. However, current methods are unable to reveal the handedness locally of a nanocrystal at the atomic-level in real-space imaging due to the well-known fact that chiral information is lost in a two-dimensional projection. Herein, we present a method for handedness determination of chiral crystals by atomic-resolution imaging using Cs-corrected scanning transmission electron microscopy. In particular, we demonstrate that enantiomorphic structures can be distinguished through chirality-dependent features in two-dimensional projections by comparing a tilt-series of high-resolution images along different zone axes. The method has been successfully applied to certify the specific enantiomorphic forms of tellurium, tantalum silicide and quartz crystals, and it has the potential to open up new possibilities for rational synthesis and characterization of chiral crystals.

Handedness or chirality determination of crystals has always been challenging for chemists, biologists and materials scientists. Here, the authors report a method for handedness determination by atomic-resolution imaging using Cs-corrected scanning transmission electron microscopy.

[Birth weight predicts physical indicators in adulthood: a large population-based study in Chinese twins]

Objective: To quantitate the association between birth weight and phenotypes of physical indicators in adulthood, i.e. BMI and waist circumference (WC) and to what degree genetic or environmental factors affect birth weight-obesity association. Methods: A total of 6 623 gender matched twin pairs aged 25 to 79 years were recruited through the Chinese National Twin Registry. The twins reported their own birth weight, current height and weight, and WC using a self-administered questionnaire. BMI was calculated according to the self-reports of body height and weight. Within twin-pair design was used to quantitate the association between birth weight and phenotypes related to obesity while bivariate structural equation models were used to decompose the phenotype correlation. Results: After adjusted for multiple factors, twin-pair analyses within monozygotic (MZ) showed that, on average, a 1.0 kg increase in birth weight corresponded to an increase of 0.33 kg/m(2) in BMI and 0.95 cm in WC in adulthood (P<0.001). Bivariate structural equation models showed significant positive unique environmental correlation between birth weight and the two obesity-related phenotypes. Conclusion: The study supported the role of twin-specific supply line factors on relationship between birth weight and physical indicators in adulthood.

Plasma fluoroacetic acid concentrations: Symptoms, hematological, and biochemical characteristics in patients with fluoroacetic acid poisoning in the emergency department

Fluoroacetic acid (FAcOH) was once a highly toxic rodenticide widely used in the world. In the past, studies on the toxicity of FAcOH have focused on animal experiments. The toxicity of FAcOH to humans and the changes of FAcOH in plasma have not been studied. Therefore, the present study aimed to describe the changes of plasma FAcOH concentrations, hematological, and biochemical characteristics in patients with FAcOH intoxication. According to clinical symptoms, 68 patients from the emergency department were divided into different groups: convulsion group, unconsciousness group, death group, and control groups. Plasma FAcOH concentrations, hematological, and biochemical parameters were investigated. Results demonstrated that patients in the convulsion group and the unconsciousness group had a significant increase (p < 0.01) in the level of neuron-specific enolase (NSE), creatine kinase MB (CKMB), glucose (GLU), and white blood cell count (WBC) and a significant decrease (p < 0.01) in serum potassium compared with the control group, respectively. Moreover, patients in the death group had a significant increase (p < 0.01) in the level of NSE, CKMB, N-terminal pro-brain natriuretic peptide, GLU, and WBC and a significant decrease (p < 0.01) in serum potassium and total calcium compared with the survival group. The concentrations of FAcOH in plasma in the convulsion group, the unconsciousness group, and the death group were 72.31 ± 42.29, 118.33 ± 55.41, and 163.78 ± 43.32 μg/mL, respectively. These changes and the plasma FAcOH concentrations may increase our understanding of the toxicity of FAcOH to humans and may help doctors to judge the clinical prognosis of patients with FAcOH intoxication.

Catalytic methane technology for carbon nanotubes and graphene

The catalytic methane technology for the production of carbon nanotubes and graphene is summarized in this review.

Analysis of related factors of orolingual angioedema after rt-PA intravenous thrombolytic therapy

OBJECTIVE

Orolingual angioedema (OA) is a rare clinical complication with a potentially fatal risk that occurs after the intravenous application of alteplase (rt-PA) in patients with acute ischemic stroke. The purpose of this work is to investigate the related factors of OA in patients with acute ischemic stroke after the administration of intravenous thrombolytic therapy, to improve the predictive ability of OA during intravenous thrombolytic therapy, and to reduce the prevalence of complications.

PATIENTS AND METHODS

We recruited 1223 cases of patients with acute ischemic stroke that were treated in the Department of Neurology No. 4 of the Tianjin Huanhu Hospital from June 2014 to April 2015. The clinical manifestations of rt-PA related OA were recorded, the clinical prevalence was counted, related factors of OA after intravenous thrombolytic therapy were analyzed, and the risk assessment of rt-PA related OA was conducted.

RESULTS

14 cases of patients developed OA, with a prevalence rate of 1.14%. Among them, 5 had a history of urticaria, 4 of drug allergy, and 3 of food allergy. Among the 14 cases of patients, 10 developed OA in the process of intravenous thrombolysis and 4 after intravenous thrombolysis, 12 showed lip edema, 9 showed extensive swelling of tongue, 3 showed swelling of lateral tongue, 3 were complicated by respiratory distress, 10 showed infarction in the middle cerebral artery territory, and 6 had previously been given oral ACEI drugs.

CONCLUSIONS

Orolingual angioedema is a rare complication that occurs after rt-PA intravenous thrombolytic therapy; when serious, it may endanger a patient's life. If patients take an oral hypotension such as ACEI drugs before the onset of OA, they have a history of allergies, or the lesion is an infraction in the dominated area of the middle cerebral artery, the risk of OA after rt-PA intravenous thrombolytic therapy will be increased. The prevalence of OA should be monitored during the rt-PA intravenous thrombolytic therapy process; timely detection and early intervention should be conducted, which can avoid serious adverse consequences.

Obesity Prevalence in Alabama: Trends from 2011 to 2017 and Evaluation of a State Obesity Program

Background

Alabama, one of the southeastern states in the US, suffers from a heavy burden of obesity. In 2014, Alabama launched a state program named ’ALProHealth’, aiming to prevent and reduce obesity prevalence. The objective of this study is to evaluate the potential impact of the ALProHealth Program on the prevalence of obesity in Alabama from 2014 to 2017.

Methods

Data for this study come from the Behavioral Risk Factor Surveillance System (BRFSS). An interrupted time series design was employed. The state obesity prevalence trend for the pre-program period (2011-2014) was estimated and compared with the post-program period (2015-2017). Statistical analyses were conducted using segmented linear regression. Indiana was chosen as the control group in this study.

Results

The obesity prevalence in Alabama significantly increased from 31.8% in 2011 to 36.2% in 2017, increasing by 0.81% on average each year (95% CI: 0.47 to 1.15, p = 0.002). Before the ALProHealth Program, the obesity prevalence increased by 0.59% (p = 0.11) and 0.32% (p = 0.34) in both Alabama and Indiana respectively, though it is not statistically significant. After the program implementation, the slope of obesity prevalence increased by 0.43 (p = 0.45) and 0.03 (p = 0.96) in Alabama and Indiana respectively, though change is not significant. When comparing Alabama and Indiana, the rate of slope change is higher in Alabama (0.73) compared with Indiana (0.093), indicating the rate of slope change in obesity prevalence increased faster in Alabama than Indiana.

Conclusions

To sum up, the study found no evidence that the ALProHealth Program contributed to the decrease of obesity prevalence in Alabama. One possible reason is that there was low program coverage. Future studies should examine the potential effectiveness of other programs using a similar conceptual model as ALProHealth Program.

Key messages

In 2014, Alabama launched a state program named ‘ALProHealth’, aiming to prevent and reduce obesity prevalence. The study found no evidence that the ALProHealth Program contributed to the statewide decrease of obesity prevalence in Alabama, which may attribute to low program coverage.

P11.07 LAPTM5 functions as a tumor suppressor via CD40 - NFêB pathway inhibition and represents a potential biomarker for temozolomide sensitivity in CD40 proficient glioblastoma

BACKGROUND

Glioma therapy is challenged by the invasive nature of glioma resulting in tumor recurrence and treatment resistance. Lysosomal protein transmembrane 5 (LAPTM5) was identified to inhibit invasion by screening for invasion-associated genes in glioma. The aim of this study was to decipher the function of LAPTM5 in glioblastoma and its interaction with the CD40 receptor which was shown to be highly expressed in up to 40% of glioblastoma.

METHODS

LAPTM5 expression was correlated with clinical outcome of glioma patients. Knockdown of LAPTM5 was performed in different glioma cell lines to analyze the impact on clonogenicity, invasiveness, sensitivity to temozolomide chemotherapy and tumorigenicity in-vitro and in-vivo in a subcutaneous xenograft mouse model. Expression array was used to elucidate the underlying pathways. CD40 knockdown and overexpression was induced to prove the crosstalk of LAPTM5 and CD40.

RESULTS

LAPTM5 expression correlated with better overall survival in high grade glioma patients and acted as a tumor suppressor in CD40 positive glioblastoma cells. LAPTM5 inhibited CD40-mediated NFκB activation resulting in anti-invasive, anti-clonogenic and temozolomide sensitizing effects in-vitro and in-vivo. Vice-versa, knockdown of LAPTM5 enhanced tumorigenicity by activation of the NFκB pathway which was overcome by NFκB inhibition. Importantly, CD40 expression was required for LAPTM5-mediated tumor suppressive activity.

CONCLUSION

LAPTM5 conveyed tumor suppressive and temozolomide sensitizing effects in CD40-positive glioblastoma by inhibition of CD40-mediated NFκB activation and thereby might provide a reasonable biomarker for sensitivity to temozolomide in CD40-positive glioblastoma.

The Chinese National Twin Registry: a 'gold mine' for scientific research

The Chinese National Twin Registry (CNTR) currently includes data from 61 566 twin pair from 11 provinces or cities in China. Of these, 31 705, 15 060 and 13 531 pairs are monozygotic, same-sex dizygotic and opposite-sex dizygotic pairs, respectively, determined by opposite sex or intrapair similarity. Since its establishment in 2001, the CNTR has provided an important resource for analysing genetic and environmental influences on chronic diseases especially cardiovascular diseases. Recently, the CNTR has focused on collecting biologic specimens from disease-concordant or disease-discordant twin pairs or from twin pairs reared apart. More than 8000 pairs of these twins have been registered, and blood samples have been collected from more than 1500 pairs. In this review, we summarize the main findings from univariate and multivariate genetic effects analyses, gene-environment interaction studies, omics studies exploring DNA methylation and metabolomic markers associated with phenotypes. There remains further scope for CNTR research and data mining. The plan for future development of the CNTR is described. The CNTR welcomes worldwide collaboration.

Integrated analysis of differentially expressed genes in esophageal squamous cell carcinoma using bioinformatics

Esophageal squamous cell carcinoma (ESCC) is a deadly disease. To identify key genes in esophageal squamous cell carcinoma, we followed a strategy utilizing the laiurger microarray dataset (GSE38129) as the training set and another independent microarray dataset (GSE20347) as the validation set. Following quality control, differentially expressed genes (DEGs) were obtained using R software. Functional enrichment analysis was performed using DAVID database and the DEG co-expression network was established with Weighted Gene Co-Expression Network Analysis (WGCNA) and visualized by Cytoscape. The prognosis-related hub genes were then identified by Kaplan-Meier analysis based on the TCGA database. A total of 188 DEGs were obtained; 88 up-regulated genes and 100 down-regulated. The up-regulated DEGs were significantly associated with extracellular matrix organization and disassembly while down-regulated DEGs were significantly related to keratinocyte differentiation. Blue and turquoise co-expression modules were established and 18 hub genes were identified. The blue module was associated with mitotic nuclear division, cell division and mitotic cytokinesis and the turquoise module was associated with collagen catabolic process, extracellular matrix organization and keratinocyte differentiation. We established that the TPX2, CDK1 and CEP55 blue module hub genes were associated with relapse-free survival, and our overall results not only identify key genes but also provide potential novel biomarkers for ESCC diagnosis and treatment.

[Changes of eye care use among rural adults under the reform of New Rural Cooperative Medical Scheme: the Handan Eye Study]

Objective: To assess the utilization of eye care services in the rural area of Handan, China under the New Rural Cooperative Medical Scheme, and to analyze the factors associated with the uptake of these services. Methods: In a cohort population-based study, subjects who joined both the baseline (2006-2007) and follow-up (2012-2013) were included. Information of demographic characteristics, participation in the New Rural Cooperative Medical Insurance and use of eye care services, comprehensive ophthalmic examinations, blood pressure and fasting was collected. The protocol got approved by the ethics committee of Beijing Tongren Hospital, and each subject signed the informed consent. Results: Of 5 193 eligible participants, 549 [10.6%; 95% confidence interval (CI), 9.8%-11.4%] had used eye care services, and the prevalence had no significant difference from baseline surveys (P=0.20). The municipal hospitals undertook 50.1% of eye care services. "No need" (4 422, 95.2%) was the most common reason cited for not using an eye care service; 2 875 (65.0%) of these participants had at least one type of eye diseases, 3 505 (79.3%) had at least one type of ocular complaints. In the multiple binary logistics regression model, participants who were elder [adjusted odds ratio (OR), 1.319; 95%CI, 1.177-1.478], were female (adjusted OR, 1.466; 95%CI, 1.085-1.981), had a diabetes history (adjusted OR, 1.930; 95%CI, 1.381-2.696), had a low income (adjusted OR, 0.826; 95%CI, 0.688-0.922), had ocular complaints (adjusted OR, 3.556; 95%CI, 2.484-5.091), had refractive errors (adjusted OR, 1.256; 95%CI, 1.007-1.567), had visual impairment (adjusted OR, 4.398; 95%CI, 2.667-7.253) or had cataract (adjusted OR, 1.278; 95%CI, 1.013-1.612) were more likely to take an eye care service. Conclusions: Under the New Rural Cooperative Medical Scheme, the prevalence of New Rural Cooperative Medical Insurance was increased significantly, but the rate of eye care use in the rural area was still low. Further efforts towards higher quality medical service in county hospitals and village clinics as well as better education about eye disease among the rural population may raise the eye care use in rural areas. (Chin J Ophthalmol, 2018, 54:570-579).

Increased Phosphatidylserine on Blood Cells in Oral Squamous Cell Carcinoma

The specific function of phosphatidylserine (PS) in the context of the development of a hypercoagulable state among individuals with oral squamous cell carcinoma (OSCC) is uncertain. The goal of this study was therefore to assess the exposure of PS on microparticles (MPs) as well as on endothelial and blood cells and to assess procoagulant activity (PCA) as a function of the stage of OSCC progression. We recruited patients with OSCC (n = 63) as well as healthy controls (n = 26) to participate in this study. PS exposure was then assessed via confocal microscopy and flow cytometry, revealing that patients with stage III/IV OSCC exhibited higher frequencies of PS-exposing blood cells, MPs, and serum-cultured endothelial cells (ECs) than did patients with stage I/II OSCC or healthy controls. When we conducted functional coagulation assays, we discovered that PS⁺ blood cells, MPs, and serum-cultured ECs from patients with stage III/IV OSCC mediated more rapid coagulation and more substantial production of FXa, thrombin, and fibrin as compared with controls. When samples were treated with the PS antagonist lactadherin, this resulted in an 80% disruption of PCA. Strikingly, when pre- and postoperative samples were compared from patients with stage III/IV OSCC undergoing resective surgery, PCA was significantly reduced in the postoperative samples. After stimulating ECs with inflammatory cytokines, we found by confocal microscopy that they expose PS on their cell membranes, thus generating FVa and FXa binding sites and mediating the formation of fibrin. Together our findings provide evidence that PS⁺ blood cells and MPs are important mediators of the development of a hypercoagulable and prothrombotic state among individuals afflicted by advanced-stage OSCC. As such, a PS blockade may be a viable therapeutic strategy for treating such patients.

[Analysis on the heritability of diabetes, based on data from the Chinese adult twins]

Objective: To analyze the heritability of diabetes among the Chinese twin adults. Methods: A total of 10 253 same-sex twin pairs aged 25 years and older, were selected from the Chinese National Twin Registry (CNTR) program. Heritability of diabetes was calculated by using the structural equation model. Results: After adjusted for age and gender, the overall heritability rates of diabetes were 0.41 (0.15-0.75), 0.83 (0.72-0.91) and 0.34 (0.04-0.73) in the <45 and ≥45 years twin pairs, respectively. After adjusted for age, rates of heritability appeared as 0.37 (0.05-0.78) and 0.88 (0.79-0.94) in men and women, respectively. Conclusions: Diabetes is affected by both genetic and environmental factors. The genetic effect of diabetes seemed stronger on female than that on male twins but was dying down along with ageing.

Implication of lymph node staging in migration and different treatment strategies for stage T2N0M0 and T1N1M0 resected gastric cancer: a SEER population analysis

PURPOSE

The purpose of this study was to explore the differences between stage T2N0M0 and stage T1N1M0 gastric cancer (GC) and to identify the necessity of adjuvant treatment (AT) for these stages.

METHODS

Between years 2004 and 2015, 1971 stage IB GC patients who underwent radical surgery were recruited using the Surveillance, Epidemiology and End Results database. We conducted univariate/multivariate analyses, the propensity score matching and evaluated gastric cancer-specific survival (GCSS) and overall survival (OS) with the log-rank test.

RESULTS

T1N1M0 had a significantly worse survival than T2N0M0 in both GCSS and OS before and after the propensity score matching. Examined lymph nodes (ELN) ≤ 15 and T1N1M0 were independent risk factors for worse GCSS and OS in stage IB GC. The absence of adjuvant chemotherapy (CT) was an independent risk factor for worse GCSS and OS in T1N1M0 but not in T2N0M0. AT demonstrated similar GCSS and OS with surgery alone (SA) for T2N0M0 but better survival for T1N1M0. Compared to CT and adjuvant chemoradiotherapy (CRT) group, SA demonstrated significantly worse GCSS and OS for T1N1M0. There was no significant difference between CT and CRT in both T2N0M0 and T1N1M0 stages. T2N0M0 had a better survival than T1N1M0 in ELN ≤ 15 subgroup. However, similar survival was demonstrated in ELN > 15 subgroup.

CONCLUSIONS

T2N0M0 GC has a better survival rate than T1N1M0 GC when ELN are ≤ 15. Moreover, T2N0M0 GC may not benefit from AT. T1N1M0 GC requires CT but not adjuvant radiotherapy.

Factors affecting the efficacy and safety of aminophylline in treatment of apnea of prematurity in neonatal intensive care unit

BACKGROUND

The factors affecting the safety and efficacy of aminophylline use in the treatment of apnea of prematurity (AOP) in the neonatal intensive care unit (NICU) are not clear. In this study, we aimed to evaluate the potential factors affecting the efficacy and safety of aminophylline in AOP treatment at standard doses and to determine appropriate patients for this therapy.

METHODS

Over a 3-year period (January 2012 to December 2014), the medical records of 206 preterm infants with apnea who were admitted to the NICU of our hospital to receive aminophylline infusions were retrospectively reviewed. These infants were subjected to routine theophylline monitoring by reversed-phase high performance liquid chromatography. The primary outcome measures were the efficacy of aminophylline treatment and adverse reactions observed upon administration.

RESULTS

One-hundred and twenty-seven (61.65%) infants were considered to have undergone effective therapy and classified accordingly. Gestational age, body weight at the initiation of aminophylline, and serum theophylline concentration were identified as protective factors of therapeutic efficacy. Receiver operating characteristic (ROC) analysis indicated cutoff values of 30.36 weeks for gestational age and 1.69 kg for body weight at initiation of aminophylline administration for ensuring high efficacy of aminophylline for AOP. Fifty-three (25.73%) infants had adverse reactions. Birth weight and serum concentration of theophylline were associated with an increased risk of adverse reactions, with odds ratios of 0.167 and 1.346, respectively. The ROC curves indicated a birth weight cutoff value of 1.48 kg.

CONCLUSION

Infants with apnea and gestational age >30.36 weeks, body weight at initiation of aminophylline treatment above 1.69 kg, and birth weight >1.48 kg are suitable for treatment with aminophylline. Monitoring of serum theophylline concentration should be implemented in the absence of clinical response or in case of suspected adverse reactions.

CRISPR/Cas9-mediated disruption of the immediate early-0 and 2 as a therapeutic approach to Bombyx mori nucleopolyhedrovirus in transgenic silkworm

The CRISPR/Cas9 system is a powerful tool for the treatment of infectious diseases. In our previous study, we knocked out the Bombyx mori nucleopolyhedrovirus (BmNPV) key genes and BmNPV-dependent host factor to generate transgenic antiviral strains. To further expand the range of target genes for BmNPV and more effectively prevent and control pathogenic infections, we performed gene editing and antiviral analysis by constructing a target-directed baculovirus early transcriptional activator immediate early-0 (ie-0) and 2 (ie-2) transgenic silkworm line. We hybridized it with Cas9 transgenic line to produce a double-positive transgenic Cas9(+)/sgIE0-sgIE2(+) line that could activate the CRISPR gene editing system. We first demonstrated that the system is capable of efficiently editing target genes and resulting in fragment deletions in the BmNPV genome. Survival rate of the transgenic Cas9(+)/sgIE0-sgIE2(+) line reached 65% after inoculation with 1 × 10⁶ occlusion bodies/larva. Molecular analysis showed that BmNPV DNA replication and viral gene expression level in the transgenic Cas9(+)/sgIE0-sgIE2(+) line were significantly inhibited compared with the control Cas9(-)/sgIE0-sgIE2(-) line. These results indicated that IE-0 and IE-2, as baculovirus early transcriptional activators, can be used as target sites for gene therapy and that multigene editing could expand the range of target sites for research to create silkworm resistance breeds.

[The applications of "Lacha" in Sheng Ji Zonglu]

The earliest appearance of "Lacha" was in the Tang Dynasty. At first, it was only served as a type of tribute tea to the emperor and the royal families.Since the Song Dynasty, "Lacha" was viewed as a kind of medicine or drug.Sheng Ji Zonglu(, Comprehensive Record of Sagely Beneficence) is the most abundant literature of the medicinal formulas of "Lacha" since the Song Dynasty. The book presented 72 prescriptions, which involved 62 diseases.Its application forms were diverse, including decoction, pill, powder and so on.The main functions included resuscitating, clearing up the heads, aiding digestion, dissipating phlegm, detoxifying and treating sores, eliminating miasma, and reducing the toxicity of other drugs.

Phylogenetic identification of lactic acid bacteria isolates and their effects on the fermentation quality of sweet sorghum (Sorghum bicolor) silage

AIM

To isolate, screen and identify the lactic acid bacteria (LAB) from elephant silage during the process of the fermentation and their effects on the fermentation quality of sweet sorghum silage.

METHODS AND RESULTS

The isolated strains were identified based on morphological, physiological and biochemical characteristics as well as 16S rRNA analysis. Seven LAB strains were isolated from elephant grass silage. Three strains (Pediococcus acidilactici (AZZ1), Lactobacillus plantarum subsp. plantarum (AZZ4), L. plantarum subsp. argentoratensis (AZZ7) and one commercial bacteria L. plantarum, ecosyl MTD/1(CB)) were chosen as additives at 6 log colony forming units per gram of fresh sweet sorghum grass in laboratory silos (680 g). Silos for each treatment were opened after 5, 7, 14, 30 and 60 days, respectively. All isolates were characterized as Gram-positive, catalase-negative and grow normally in 6·5% NaCl. The strains AZZ1, AZZ2 and AZZ5, were identified as Pediococcus genus while AZZ3, AZZ4, AZZ6 and AZZ7 were Lactobacillus genus. Compared to the control, all the isolates improved the silage quality of sweet sorghum silage, indicated by significantly (P < 0·05) lower pH and ammonia-nitrogen contents and undesirable micro-organism counts, and higher lactic acid (LA) contents and ratios of lactic acid/acetic acid. During ensiling, AZZ4 performed better among all of inoculants, indicated by significantly (P < 0·05) decreased on pH and ammonia-N contents and higher increased on LA contents.

CONCLUSION

Strain AZZ4 is recommended as starter culture for sweet sorghum.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first time to investigate the effects of LAB isolates from elephant grass silage and use them as additives, which is to find out how LAB inoculants improve the fermentation quality of sweet sorghum silage.

Serum Stem Cell Factor Level Predicts Decline in Kidney Function in Healthy Aging Adults

BACKGROUND AND OBJECTIVES

Stem cell factor (SCF), the ligand of the c-kit receptor, actively participates in the organ reconstruction and fibrosis associated with various diseases, including kidney disease. However, it remains unclear whether SCF plays a role in kidney aging.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

In the present study, we measured the serum SCF level, estimated glomerular filtration rate (eGFR), and other biological parameters in a Chinese Han group of 892 subjects, and explored the relationship between SCF level and renal function during aging; we sought to define novel biomarkers of kidney aging.

RESULTS

Multiple linear regression was used to select potential indicators of decline in renal function. Only age, SCF level, and 25% maximum expiratory flow (25% MEF) were significant predictors after redundancy analysis (|r| > 0.70 and P < 0.05). Multiple linear regression showed that the relationship among eGFR, SCF level, and age could be described as follows: eGFR = 154.486 - (0.846 × age) - (0.011 × SCF level).

CONCLUSIONS

We found no between-gender difference in the effect of SCF on kidney aging. In conclusion, the SCF level is an ideal biomarker of renal aging and may help to predict changes in eGFR during aging.

Enhanced production of aromatics from propane with a temperature-shifting two-stage fluidized bed reactor

A temperature-shifting two-stage fluidized bed reactor technology was used to convert propane and its intermediate products into aromatics. The first stage served for the aromatization of propane with a Ga/ZSM-5 catalyst at 570 °C. The second stage served for the alkylation of the intermediates of olefins at 300 °C. The increased yield of aromatics was attributed to the effective transformation of C₂–C₃ olefins as well as due to the suppression of the hydrogen transfer effect of the olefins.

High-yield production of aromatics from propane with a temperature shifting, two-stage fluidized bed reactor technology.

The fungal-resistance factors BmSPI38 and BmSPI39 predominantly exist as tetramers, not monomers, in Bombyx mori

Previous studies have indicated that trypsin inhibitor-like cysteine-rich domain (TIL)-type protease inhibitors, BmSPI38 and BmSPI39, suppress conidial germination and integument penetration of entomopathogenic fungi by inhibiting their cuticle-degrading proteases and might functions as fungal-resistance factors in the silkworm. To date, the physiological forms and functional significance of multimerization of BmSPI38 and BmSPI39 remain unknown. In this study, we investigated the physiological forms of BmSPI38 and BmSPI39 in Bombyx mori silkworms using multiple complementary methods, including activity staining, reducing and nonreducing sodium dodecyl sulfate polyacrylamide gel electrophoresis, matrix-assisted laser desorption ionization time-of-flight mass spectrometry, western blotting and immunofluorescence. We found that recombinant BmSPI38 and BmSPI39 tend to form homologous multimers, and their dimers, trimers and tetramers possessed intense inhibitory activity against subtilisin A from Bacillus licheniformis. In contrast, their monomers showed no detectable inhibitory activity. Both BmSPI38 and BmSPI39 also exist mainly as stable tetramers in silkworm tissues, and they also predominantly function as a tetramer in these tissues. This study is the first to demonstrate this preferred quaternary form of a TIL-type protease inhibitor and will likely help to elucidate the mechanisms of BmSPI38 and BmSPI39 in the innate immune response of the silkworm.

Effects of storage temperature and combined microbial inoculants on fermentation end products and microbial populations of Italian ryegrass (Lolium multiflorum Lam.) silage

AIMS

To examine five lactic acid bacteria (LAB) strains (LCG9, LTG7, I5, TG1 and LI3) isolated from the Tibetan Plateau, and evaluate their combined effects on the silage quality of Italian ryegrass (Lolium multiflorum Lam.) at three temperatures (10, 15 and 25°C).

METHODS AND RESULTS

The isolated strains were evaluated by morphological, physiological and biochemical tests. Six combined inoculants LCG9+LI3, LCG9+I5, LCG9+TG1, LTG7+LI3, LTG7+I5 and LTG7+TG1 were added to Italian ryegrass for ensiling 30 days in laboratory silos (1L) at various temperatures, respectively. All the isolates could grow normally at 5-20°C, pH 3·5-7·0 and NaCl (3·0, 6·5%). Compared to three corresponding controls, all the inoculants improved the silage quality of Italian ryegrass at different temperatures, indicated by markedly (P < 0·05) higher lactic acid (LA) contents and ratios of lactic acid/acetic acid (LA/AA), and lower pH and ammonia nitrogen (NH3 -N) contents and undesirable micro-organism counts. At 10°C, LTG7+LI3, I5 or TG1 inoculants performed superior to LCG9+LI3, I5 or TG1 inoculants, evidenced by distinctly (P < 0·05) higher LA contents and ratios of LA/AA, and lower pH and NH3 -N contents. LTG7+LI3 or TG1 silages had obviously (P < 0·05) higher LAB counts than LTG7+I5 silage at 10°C.

CONCLUSIONS

Therefore, the combined inoculants LTG7 + LI3 or TG1 are recommended as starter cultures for Italian ryegrass silage at low temperatures.

SIGNIFICANCE AND IMPACT OF THE STUDY

Temperature is a key factor affecting ensilage. In cold regions, low temperature could be an adverse environmental condition during ensiling. However, few studies have focused on improving silage quality at low temperatures. Moreover, analysis of effects of combined LAB strains with their physiological and biochemical characteristics help us use combined LAB inoculants to realize the fermentation optimization.

Obesity, weight change, and mortality in older adults with metabolic abnormalities

BACKGROUND AND AIMS

It is expected that older adults with metabolic abnormalities may benefit from weight loss; however, data on this population are limited. Our study was to assess the effect of obesity and weight change on mortality risk in older adults with metabolic abnormalities.

METHODS AND RESULTS

A total of 3649 Chinese older adults aged 60-90 years with metabolic abnormalities were included between 2000 and 2014. Weight change between two health checkup periods was calculated. During a median follow-up period of 37 months, 503 all-cause mortality and 235 cardiovascular disease mortality occurred. Death rate was the lowest in overweight participants and in the participants with weight stability. After adjustment for covariates, hazard ratios (95% confidence intervals) of overweight participants for all-cause mortality and cardiovascular mortality were 0.71 (0.59, 0.86) and 0.72 (0.55, 0.95), respectively, whereas obesity was not significantly associated with mortality risk. Furthermore, relative to weight stability, risks of mortality significantly increased with the increase in weight loss or weight gain, except small weight gain. These associations were unchanged when the participants were stratified by baseline covariates and even when several definitions of weight change were considered.

CONCLUSIONS

Overweight was associated with less mortality risk, and obesity was not associated with mortality risk in older adults with metabolic abnormalities. Mortality risk increased with the increase in weight loss or weight gain, regardless of body weight levels at the baseline. These findings suggest that maintaining a stable weight may be the best choice in older adults with metabolic abnormalities.

[Study on the current status of smoking, intention of tobacco concession and related risk factors among 18-65-year olds patients with chronic diseases in Beijing]

Objective: To understand the status, attitude and related risk factors on smoking among 18-65 years old patients with hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD) or asthma in Beijing. Methods: Data was gathered from the 2014 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified cluster sampling method was used and 19 815 participants aged 18-65 were sampled from 16 districts in Beijing. Results: Among all the 18 405 participants, male hypertensive patients showed a higher rate on current smoking than the other groups (χ(2)=17.695, P<0.001). Male patients with dyslipidemia had higher current smoking rate than the other groups (χ(2)=39.292, P<0.001). However, female patients with COPD or with asthma showed higher rate on current smoking than the other groups (χ(2)=6.276, P=0.012), (χ(2)=8.245, P=0.004). Among the smokers, hypertensive patients presented lower rate (χ(2)=20.487, P<0.001) on intention of smoking concession, than the other groups. Patients with COPD showed greater intention in quitting smoking (χ(2)=6.085, P=0.048), than the other groups. Male patients with diabetes (χ(2)=9.219, P=0.010) or dyslipidemia (χ(2)=13.513, P=0.001) who had stopped smoking tobacco appeared having higher rates in keeping the current status. Results from logistic regression analyses showed that smoking was the risk factor for hypertension (OR=1.17), dyslipidemia (OR=1.25), COPD (OR=1.78), and asthma (OR=1.57). Conclusions: Patients with certain kinds of chronic diseases showed higher rate of current smoking and lower rate of quitting. Cigarette consumption appeared an important risk factor for patients with hypertension, dyslipidemia, COPD, or asthma in Beijing.

Triceps motor branch transfer for isolated axillary nerve injury: Outcomes in 9 patients

INTRODUCTION

Triceps motor branch transfer has been used for more than ten years to restore deltoid function after axillary nerve injury. However, there have been few reports of the outcome of this procedure in isolated axillary nerve injury.

HYPOTHESIS

Triceps motor branch transfer could be an effective method to restore deltoid function for patients with isolated axillary nerve injury.

MATERIALS AND METHODS

Nine patients who underwent triceps motor branch transfer for treatment of isolated axillary nerve injury were followed up for at least 22 months. Shoulder abduction was assessed for all patients. The DASH outcome questionnaire was completed by every patient. Electrophysiological study was performed on 7 patients.

RESULTS

All patients regained≥90° (mean, 137°) shoulder abduction. Mean DASH score decreased from 35.2 before surgery to 13.1 at the last follow-up. There was no noticeable weakness of elbow extension in any patient.

DISCUSSION

Triceps motor branch transfer provided good results and may be a feasible alternative to nerve grafting for the treatment of complete isolated axillary nerve injury.

TYPE OF STUDY

IV, retrospective cohort study.

Comparative efficacy of five long-term weight loss drugs: quantitative information for medication guidelines

Quantitative information is scarce in current obesity medication guidelines, and they do not clearly reflect the differences in the efficacy characteristics among various drugs. This study quantitatively assessed the efficacy characteristics of five FDA-approved long-term weight loss drugs. Potentially eligible studies were obtained from public databases. Using the differences in the weight change from baseline between the drug group and the corresponding placebo group as the major indicator of efficacy, a time-effect model was established, and crucial pharmacodynamic parameters, such as the maximal efficacy, drug onset time and rate of body weight regain after the maximal efficacy point, were used to reflect the differences in efficacy among the five drugs. Finally, 50 reports (involving 43,443 participants) were included. After deducting the placebo effects, the maximal efficacies (95% CI) of orlistat (120 mg), lorcaserin, naltrexone-bupropion, phentermine-topiramate (PT, 7.5/46 mg) and liraglutide were -2.94 (-5.82, -1.27), -3.06 (-4.39, -1.71), -6.15 (-9.78, -3.25), -7.45 (-9.76, -3.88) and -5.50 (-10.62, -2.97) kg at weeks 60, 54, 67, 59 and 65 respectively, and their rates of body weight regain were 0.51, 0.48, 0.91, 1.27and 0.43 kg per year respectively. The 1-year dropout rates of orlistat, lorcaserin, naltrexone-bupropion, PT and liraglutide were 29.0, 40.9, 49.1, 34.9 and 24.3% respectively. In addition, a significant dose-effect correlation was observed for orlistat and PT. This study provides valid quantitative information for medication guidelines.