Plasma concentration of ZCCHC14 contributes to prognostic efficacy in intracerebral hemorrhage patients

OBJECTIVE

Intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease of the central nervous system. In this study, we aimed to investigate plasma ZCCHC14 expression and its correlation with the diagnosis, prognosis, and clinical features of ICH.

PATIENTS AND METHODS

The plasma levels of ZCCHC14, TNF-α, IL-6, and IL-10 were dynamically detected among 130 ICH patients and 60 corresponding healthy subjects. A receiver operating characteristic (ROC) curve was used for the statistical analysis of the diagnostic and prognostic efficacy of ICH.

RESULTS

Hypertension (p = 0.005), ARB application (p = 0.014), ZCCHC14 level (p < 0.001), TNF-α (p < 0.001), IL-6 (p < 0.001), and IL-10 (p < 0.001) were found to be different between ICH patients and healthy controls. Multiple logistic regression analysis indicated that ZCCHC14 levels at admission were significantly different between the two groups (p = 0.002, OR = 0.440, 95% CI 0.290-0.718). Plasma ZCCHC14 levels dynamically changed, increasing at admission, and peaking on day 7. ZCCHC14 was a potential diagnostic marker for ICH (AUC = 0.953, p < 0.0001, 95% CI: 0.901-1.004) with a specificity and sensitivity of 84.6% and 95.5%, respectively. The plasma ZCCHC14 level was negatively correlated with IL-6 concentration (p = 0.024, r = -0.311) but was positively correlated with IL-10 concentration (p = 0.041, r = 0.298). Furthermore, the plasma ZCCHC14 level was correlated with hypertension (p = 0.005), GOS (p = 0.025), bleeding volume (p < 0.001), midline shift (p = 0.003), and poor outcome (p = 0.006). The low ZCCHC14 expression group had poorer outcomes (death or severe disability) than high ZCCHC14 expression group (Breslow, p < 0.001).

CONCLUSIONS

We found that the plasma ZCCHC14 level might be a potential biomarker for both the early diagnosis of and prediction of outcomes in ICH.

The acquisition of Mycobacterium tuberculosis infection in village doctors in China: a prospective study

BACKGROUND: Occupational exposure-related risk of Mycobacterium tuberculosis infection has been reported for village doctors in China. This prospective study aims to estimate the infection acquisition in this key population.METHODS: At baseline, all village doctors registered in Zhongmu County were tested by QuantiFERON^®-TB Gold In-Tube (QFT) and QuantiFERON^®-TB Gold Plus (QFT-Plus) in parallel. Those negatives for either of the tests were retested to identify conversions at the 2-year follow-up investigation.RESULTS: A total of 367 eligible participants completed the 2-year follow-up survey with frequency of conversion of 5.0% (18/361) for QFT and 6.1% (21/343) for QFT-Plus. The agreement of follow-up results between the tests was 93.2% with a κ coefficient of 0.43 (95%CI 0.20-0.65). Among QFT-Plus convertors, the difference between TB1 and TB2 tubes (TB2-TB1) was significantly increased as compared with baseline results (P = 0.039). Participants from the villages with occurrence of microbiologically confirmed pulmonary TB showed higher frequency of QFT conversions (11.0% vs. 3.2%, P = 0.011) and QFT-Plus conversions (12.3% vs. 4.4%, P = 0.027) than those from the villages without occurrence.CONCLUSION: Our results consistently suggest that capability on occupational protection and M. tuberculosis infection control should be improved in village doctors in China.

[Clinical analysis of 126 patients with coronavirus disease 2019 with pharyngeal symptoms]

Objective: To investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with pharyngeal symptoms. Methods: From January 10 to May 15, 2020, clinical data of 1 228 patients with COVID-19 in Renmin Hospital of Wuhan University was collected (554 males and 674 females, with the range of age from 10 to 95 years old, the average age was 55.2 years old). The patients were divided into pharyngeal symptoms group (PS, 126 cases) and non-pharyngeal symptoms group (Non-PS, 1 102 cases) according to the presence or absence of pharyngeal symptoms such as pharyngalgia, pharyngeal dryness, pharyngeal itching, and pharyngeal foreign body sensation. The clinical data in terms of age, sex, medical history, duration of symptoms, treatment time, clinical classification, pulmonary imaging findings, whole blood cell count, serum hypersensitivity C-reactive protein, C-reactive protein, procalcitonin were statistically analyzed between the two groups. Chi-square, Fisher's exact test and Mann-Whitney U test were used for statistical analysis. Results: The most common pharyngeal symptoms were pharyngalgia (59.52%, 75/126), followed by foreign body sensation (23.02%, 29/126), pharyngeal dryness (8.73%, 11/126), and itching (8.73%, 11/126). The median age of the patients in the PS group was 51.50 years old, which was less than 57.50 years old in the non-PS group, showing a significant difference (P<0.05). The female cases accounted for 65.08% (82/126), which was higher than 53.72% (592/1 102) of the non-PS group (P<0.05). The incidence of bilateral lung inflammation confirmed by CT images was 73.81% (93/126), which was significantly lower than 83.48% (920/1 102) in the non-PS group (P<0.05). No significant differences were shown in the proportion of patients with clinical types, treatment days, duration of symptoms, white blood cell count, lymphocyte count, lymphocyte percentage, eosinophil count, eosinophil percentage, hypersensitive C-reactive protein, C-reactive protein, D-dimer, procalcitonin and other indicators (P>0.05). Conclusions: The incidence of pharyngeal symptoms in patients with COVID-19 is 10.26%. Most of these symptoms occur before or at the same time as the common symptoms of the disease. Therefore, patients with such symptoms may bring a greater risk of infection to otolaryngologist. According to the current clinical classification criteria, pharyngeal symptoms have no obvious correlation with the degree of the disease; but the presence of pharyngeal symptoms may suggest a milder clinical presentation and a better prognosis.

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.

[Isolation and Identification of two Escherichia albertii strains in Shanxi Province, China]

Objective: To investigate the prevalence of Escherchia albertii in Shanxi province. Methods: The chicken intestines were enriched in EC broth. The eae gene was detected by PCR, and the eae-positive EC enrichments were inoculated in MacConkey agar plate. The eae-positive lactose non-fermenting isolates were presumed as Escherchia albertii, and then analyzed by triplex-PCR, 16S rDNA sequencing and MLST. Results: Two suspected Escherchia albertii were isolated from 250 samples of chicken intestines. It was identified as Escherchia albertii by phenotypic, specific genes,16S rDNA sequencing, and MLST analyses. The cytolethal distending toxin B (cdtB) showed positive by PCR,and they were clusted to Ⅱ/Ⅲ/Ⅴ group by sequencing. Conclusion: This study showed that the Escherchia albertii was existed in Shanxi province, China.

[Clinical analysis of children with cardiac syncope caused by anomalous origin of the left coronary artery from the right sinus]

Objective: To analysis the clinical characteristics and to summarize therapy experience of pediatric patients with cardiac syncope caused by anomalous origin of the left coronary artery from the right sinus (ALCA-R). Methods: We retrospectively analyzed the clinical data including clinical manifestations, myocardial injury biomarkers, radiological features, treatments and prognoses of pediatric patients with ALCA-R who were admitted to Beijing Children's Hospital from November 2015 to June 2018. Results: Four female patients were included in this analysis, age of onset was 7 to 14 years. All the patients presented with exercise-induced syncope and acute myocardial infarction. During the course, three patients presented with acute left heart failure, and one patient had history of sudden cardiac arrest. Laboratory data showed significant elevation of both the creatine kinase and troponin levels in four patients. All electrocardiogram (ECG) showed left main coronary artery occlusion, echocardiography suggested the possible anomalous origin of the left coronary artery in one child. Coronary CT angiography (CTA) revealed there was no coronary ostium in the left coronary sinus, and the left coronary artery had an anomalous origin from the right sinus. The left main coronary artery passed between the ascending artery and the root of the main pulmonary artery, which was compressed by these two large vessels. Two patients underwent cardiac magnetic resonance examination, which detected late gadolinium enhancement in ALCA-R with an interarterial course. Unroofing of the left coronary ostium (cut-back procedure) was performed in two patients, and the other two patients who were not operated were recommended to restrict their physical activities. During a regular follow-up period of 12-43 months, all the children survived without recurrent cardiovascular event. Conclusion: If an adolescent presents with exercise-induced syncope, acute myocardial infarction and even sudden death, and ECG shows left main coronary artery occlusion characteristics, we should consider the possibility of developmental abnormality of coronary artery, particularly the ALCA-R. Once diagnosed as ALCA-R, patients should be recommended to avoid strenuous activities，early recognition and surgical treatment are imperative for these patients.

LncRNA MEG3 accelerates apoptosis of hypoxic myocardial cells via FoxO1 signaling pathway

OBJECTIVE

To explore the effects of long non-coding ribonucleic acid (lncRNA) maternally expressed gene 3 (MEG3) on the proliferation and apoptosis of hypoxic myocardial cells by regulating the expression of forkhead box O1 (FoxO1).

MATERIALS AND METHODS

The myocardial A10 cell lines were divided into myocardial cell group (group A), hypoxic myocardial cell group (group B), and hypoxic myocardial cell + transfection with lncRNA MEG3 mimic group (group C). The correlations of the adenosine triphosphate (ATP) concentration, the degree of apoptosis, and the proliferation with FoxO1 and FoxO3a proteins in the cells were observed via ATP assay, Cell Counting Kit-8 (CCK-8) assay, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, Western blotting, and quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR), respectively.

RESULTS

The ATP concentration in myocardial cells was the highest in group A (p<0.05), and it was higher in group B than that in group C (p<0.05). The results of the CCK-8 assay showed that the proliferation rate of the myocardial cells was the highest in group A and the lowest in group C (p<0.05), and it was significantly increased in group B compared with that in group C (p<0.05). The results of the TUNEL assay revealed that the normal cells displayed the purple color, and apoptotic cells displayed the green color. The myocardial cells were arranged orderly, and the number of apoptotic cells was smaller in group A, the number of apoptotic cells was significantly larger in group B than that in group A, and it was the largest in group C (p<0.05). Moreover, the results of Western blotting manifested that the concentrations of FoxO1 and FoxO3 proteins in myocardial cells were the lowest in group A (p<0.05), and they were significantly higher in group C than those in group B (p<0.05). According to the results of qRT-PCR, the mRNA expressions of FoxO1 and FoxO3 in myocardial cells were the lowest in group A (p<0.05), and they were remarkably lower in group B than those in group C (p<0.05).

CONCLUSIONS

LncRNA MEG3 can increase the activity of FoxO1 to promote myocardial apoptosis in a hypoxic environment.

Universal structure of dark matter haloes over a mass range of 20 orders of magnitude

Cosmological models in which dark matter consists of cold elementary particles predict that the dark halo population should extend to masses many orders of magnitude below those at which galaxies can form^1-3. Here we report a cosmological simulation of the formation of present-day haloes over the full range of observed halo masses (20 orders of magnitude) when dark matter is assumed to be in the form of weakly interacting massive particles of mass approximately 100 gigaelectronvolts. The simulation has a full dynamic range of 30 orders of magnitude in mass and resolves the internal structure of hundreds of Earth-mass haloes in as much detail as it does for hundreds of rich galaxy clusters. We find that halo density profiles are universal over the entire mass range and are well described by simple two-parameter fitting formulae^4,5. Halo mass and concentration are tightly related in a way that depends on cosmology and on the nature of the dark matter. For a fixed mass, the concentration is independent of the local environment for haloes less massive than those of typical galaxies. Haloes over the mass range of 10^-3 to 10¹¹ solar masses contribute about equally (per logarithmic interval) to the luminosity produced by dark matter annihilation, which we find to be smaller than all previous estimates by factors ranging up to one thousand³.

Differential biomarker profiles between unprovoked venous thromboembolism and cancer

BACKGROUND

The relationship between cancer and venous thromboembolic disease (VTD) are complex because the activated coagulation factors are not only involved in thrombosis but also in malignant processes, such as angiogenesis and metastasis.

OBJECTIVE

To compare phenotypes of extracellular vesicles (EVs), and levels of D-dimer, soluble P-selectin (sP-selectin) and antigenic tissue factor (TF) between unprovoked VTD patients, who did not develop cancer during one-year follow-up, and those with advanced stage of cancer but not associated with VTD.

METHODS

A prospective study in which we included 138 unprovoked VTD patients and 67 advanced cancer patients, who did not develop thrombosis. Levels of EVs of different cellular origin (platelet, endothelium and leukocyte), EVs positive for tissue factor (TF) and P-selectin glycoprotein ligand 1 were quantified by flow cytometry. D-dimer, soluble P-selectin (sP-selectin) and antigenic TF were determined by ELISA.

RESULTS

TF-positive EVs, D-dimer, and sP-selectin were markedly elevated in unprovoked VTD patients compared to cancer patients without association with thrombosis.

CONCLUSIONS

Levels of TF-positive EVs, D-dimer and sP-selectin are able to discriminate between unprovoked VTD patients not related to cancer and cancer patients not associated with VTD. These results could lead to the application of EVs as biomarkers of both diseases. Key messages: Circulating EVs, specifically TF-positive EVs, in combination with plasmatic markers of hypercoagulable states, such as D-dimer, sP-selectin and antigen TF, are able to discriminate between cancer patients without thrombosis and patients with unprovoked VTD. Research fields could be opened. Future studies will assess if these biomarkers together serve as predicting thrombotic events in cancer populations.

Overweight and high serum total cholesterol were risk factors for the outcome of IVF/ICSI cycles in PCOS patients and a PCOS-specific predictive model of live birth rate was established

PURPOSE

The clinical outcome after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is diverse in infertility patients with polycystic ovary syndrome (PCOS). The aim of this study was to develop a nomogram based on an association of patients' characteristics to predict the live birth rate in PCOS patients.

METHODS

All women in a public university hospital who attempted to conceive by IVF/ICSI for PCOS infertility from January 2014 to October 2018 were included. The nomogram was built from a training cohort of 178 consecutive patients and tested on an independent validation cohort of 81 patients. PCOS was confirmed in all participants.

RESULTS

Three variates significantly associated with live birth rate of PCOS patients were BMI, total serum cholesterol (TC) and basal FSH. This predictive model built on the basis of BMI, TC, basal FSH, type of embryo transferred and age showed good calibration and discriminatory abilities, with an area under the curve (AUC) of 0.708 (95% CI 0.632-0.785) for the training cohort. The nomogram showed satisfactory goodness-of-fit and discrimination abilities in the independent validation cohort, with an AUC of 0.686 (95% CI 0.556-0.815).

CONCLUSION

Our simple evidence-based nomogram presents graphically risk factors and prognostic models for IVF/ICSI outcomes in patients with PCOS, which can offer useful guidance to clinicians and patients for individual adjuvant therapy.

[Clinical characteristics and survival analysis of 15 cases of HIV-negative plasmablastic lymphoma]

目的

分析HIV阴性的浆母细胞淋巴瘤（PBL）患者的临床病理特征及转归。

方法

回顾性分析海军军医大学附属长海医院2013年1月至2019年8月诊断及治疗的15例HIV阴性PBL患者的临床病理资料及随访结果。

结果

15例HIV阴性PBL患者中男8例，女7例，中位年龄59（17~69）岁，均无明确的免疫抑制状态。所有患者均出现结外受累，Ann Arbor-Cotswolds分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为1例（6.7%）、2例（13.3%）、3例（20.0%）、9例（60.0%）。病理形态表现为类似免疫母细胞的大肿瘤细胞弥漫性增生，免疫组化示肿瘤细胞主要表达浆细胞标志CD38、CD138、Mum-1，B细胞标志CD20、CD10、PAX-5、BCL-6少见，Ki-67中位数为80%（70%~90%）。3例患者行EBER原位杂交检测，1例阳性。15例患者均接受化疗，80%（12/15）联合硼替佐米作为一线治疗。最佳疗效6例完全缓解（其中2例分别于治疗后4.9和26.1个月疾病进展），2例部分缓解（分别于治疗后3.0和6.8个月疾病进展），4例疾病进展，3例无法评估。中位随访时间30.3（4.8~61.1）个月，11例患者中位无进展生存（PFS）期6.8（95%CI 2.5~11.1）个月，预计3年PFS率为21.2%（95%CI 1.4%~56.8%）。所有患者中位总生存（OS）期为17.9（95%CI 5.6~30.2）个月，预计3年OS率为38.5%（95%CI 12.0%~65.0%）。

结论

HIV阴性PBL侵袭性强，结外受累常见，多数患者诊断时分期较晚。通过以硼替佐米为基础的强化疗方案序贯自体造血干细胞移植可望获得长期生存。

A preliminary study: proteomic analysis of exosomes derived from thyroid-stimulating hormone-stimulated HepG2 cells

BACKGROUND

Thyroid-stimulating hormone (TSH) plays an important role in the regulation of lipid metabolism. However, little is known about the role that exosomes play in the process of TSH-induced lipotoxicity in non-alcoholic fatty liver disease (NAFLD). As a preliminary step, the present study set out to investigate alterations in protein expression in exosomes derived from TSH-stimulated HepG2 cells.

METHODS

HepG2 cells were treated with TSH, exosomes were collected, and proteins were identified by mass spectrometry (MS). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway analysis were performed to analyze the identified proteins.

RESULTS

TSH treatment significantly increased exosomal production and changed the exosomal proteomic profile in HepG2 cells. Among the 1728 proteins, 140 identified proteins were upregulated and seven proteins were downregulated. GO analysis and KEGG analysis revealed that these proteins were involved in multiple processes including metabolism, apoptosis, and inflammation.

CONCLUSION

Our preliminary study demonstrated that exosomes derived from TSH-stimulated hepatocytes were increased and showed a specific altered spectrum of proteins, many of which were involved in metabolism, signal transduction, apoptosis, and inflammation. This study offers new insights into the pathogenesis of TSH-induced lipotoxicity in NAFLD.

Correction to: Maternal Hypertension, Advanced Doppler Haemodynamics and Therapeutic Precision: Principles and Illustrative Cases

The original publication of this article, unfortunately, contains the following errors.

[Advances in researches of intrinsically photosensitive retinal ganglion cells]

Intrinsically photosensitive retinal ganglion cells (ipRGCs) are atypical photoreceptors that are different from classical cone and rod cells. The primary role of ipRGCs is to signal light for largely subconscious, non-image vision such as photoentrainment of circadian rhythm and pupillary light reflex. Recent researches have revealed additional roles for ipRGCs in communication with synapses around, conscious vision reception and pathogenesis of some diseases. Here we review the research advances of morphology, functions and clinical applications of ipRGCs. (Chin J Ophthalmol, 2020, 56: 308-312).

Topologically-tuned spin Hall shift around Fano resonance

The topological magnetoelectric effect is associated with the photonic spin-orbit interaction. However, due to the proportionate fine structure constant of the topological term, the topological magnetoelectric effect is usually weak. In this paper, we demonstrate that the axion term enables manipulation of the spin Hall shift of light around Fano resonance. And, the excited surface plasmon near the nanoparticle's interface could enhance the topological magnetoelectric effect for several orders. Numerical simulation of near field and far-field scattering confirms our theoretical results. Our work may pave the way to exploit the topological magnetoelectric effect in practical applications, such as optical sensing and nanoprobing.

Maternal Hypertension, Advanced Doppler Haemodynamics and Therapeutic Precision: Principles and Illustrative Cases

PURPOSE OF REVIEW

Maternal hypertension is a common and serious condition associated with increased maternal and foetal morbidity and mortality, with early detection and management improving outcomes.

RECENT FINDINGS

Blood pressure (BP) changes of pre-eclampsia are defined after 20 gestational weeks, while haemodynamic changes can be detected at 5-11 weeks using a specialised non-invasive Doppler stroke volume (SV) monitor. Thus, advanced haemodynamic monitoring allows for physiologically precise identification of circulatory abnormalities, and implementation of appropriate therapy within the first trimester. We measured the oscillometric BP and advanced haemodynamics (USCOM 1A) of 3 unselected women with singleton pregnancies, consecutively listed for therapeutic induction for maternal hypertension at 32-41 weeks gestational age. While the BP's of the patients varied, it was the haemodynamics, particularly SV, cardiac output, systemic vascular resistance, Smith Madigan Inotropy Index, and oxygen deliver, that identified differing patterns of circulatory dysfunction, therapeutic objectives, and predicted post-partum complications of the mother and child. First trimester screening of maternal haemodynamics may allow for earlier detection of circulatory derangements, selection of patient precise interventions, and improved maternal-foetal outcomes.

[Current global development of screening guidelines for hepatocellular carcinoma: a systematic review]

Objective: The objective of the study was systematically summarized the current status of the hepatocellular carcinoma (HCC) screening guidelines, and evaluated the HCC screening guidelines according to the authoritative framework of cancer screening guidelines of authoritative institutions, which provided important value for the formulation of HCC screening evidence-based guidelines. Methods: Literature search was conducted in multiple databases from their inception dates to January 3, 2019. In addition, we sought relevant websites further was searched to identify potentially eligible studies. Two reviewers independently screened literature and extracted data. Qualitative description of the basic information, recommendations of HCC screening, source of evidence and update progress of the HCC screening guidelines was conducted. Results: At present, there were no independent HCC screening guidelines worldwide. There were only 17 clinical practice HCC guidelines briefly provided the recommendation of HCC screening. Current HCC screening guidelines only recommended screening for high-risk groups of HCC. All guidelines have identified patients with chronic hepatitis B, hepatitis C and cirrhosis as high-risk groups for HCC. Most of guidelines recommended screening intervals was 6 months. The latest guidelines in Europe and the United States recommended ultrasound for screening HCC. The combination of ultrasound and AFP was recommended in the Asian guidelines. Currently, HCC screening guidelines mainly recommended screening strategies based on factors such as risk of HCC, accuracy of screening modality, screening cost, etc.. The key factors such as screening efficacy and safety have not yet been considered comprehensively. Conclusions: There were no independent HCC screening guidelines worldwide. Only some clinical practice HCC guidelines briefly mentioned HCC screening. Currently, the guidelines only recommend screening for high-risk groups of HCC, with a screening interval of 6 months. There are differences in screening modalities recommended by European, American and Asian guidelines for screening HCC. It is suggested that the relevant institutions should formulate the evidence-based HCC screening guidelines by referring to the theoretical framework of other authoritative other cancer screening guidelines.

[Anti-PD-1 therapy in advanced malignant liver tumor-induced type-1 diabetes mellitus: a case report]

Immune checkpoint inhibitor (ICI) has been emerged as a major breakthrough in tumor immunotherapy, but its unique mechanism of action has also led to a number of immune-related adverse events (irAE). Type 1 diabetes mellitus (T1DM) is one of the rarest irAEs. This paper reports a case of advanced malignant liver tumor-induced T1DM who received second-line anti-PD-1 therapy and showed initial symptoms of hyperosmolar coma and hyperglycemia. In addition, the relevant literature at home and abroad was collected and reviewed, and the clinical characteristics of T1DM induced by anti-PD-1 therapy were summarized with a view to achieve early detection, diagnosis and treatment.

Realizing optical bistability and tristability in plasmonic coated nanoparticles with radial-anisotropy and Kerr-nonlinearity

We theoretically study the optical bistability and tristability in plasmonic coated nanospheres containing the nonlinear plasmonic shell and the dielectric core with radial anisotropy. Based on self-consistent mean-field approximation, we establish the relationship between the local field in the shell and the applied incident field, taking into account the Lorentz local field. One or two optical bistabilities and even optical tristability can be observed. Especially, there are two critical geometric parameters between which two optical bistabilities exist. Physically, two optical bistablities result from the excitations of two surface plasmonic resonant modes in the inner and outer interfaces of coated nanospheres, which are well reflected from the spectral representation with two poles. Moreover, the involvement of the radial anisotropy is quite essential to realize the optical tristability. Further discussion on the field-induced tuning of the reflectance reveals the macroscopic properties of this nonlinear optical structure, which provides a potential candidate for designing multi-stable optical devices at the nanoscale.

OP0042 THE TRANSCRIPTOME OF PAIRED MINOR AND MAJOR SALIVARY GLAND TISSUE IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME: TWO OF A KIND?

Background:

In patients with primary Sjögren’s syndrome (pSS), both minor and major salivary glands are targets of the disease. Infiltration of salivary glands by immune cells is characteristic for pSS. However, significant inter- and intra-individual variation exists in the size and composition of the infiltrates. Potential differences between minor and major salivary glands in immune cell presence and inflammatory pathway activation are unclear. This knowledge is essential for clinical trial design and precision therapy.

Objectives:

To compare the transcriptome of paired labial and parotid salivary gland tissue of patients with pSS and non-SS sicca controls.

Methods:

Thirty-nine pSS patients and 20 age- and sex-matched non-SS sicca controls, who participated in a prospective diagnostic cohort[1], were included. All pSS patients fulfilled 2016 ACR-EULAR criteria. RNA was isolated from formalin-fixed, paraffin-embedded labial and parotid gland tissue sections from the same individuals. Complementary DNA libraries were prepared and sequenced. Biopsies with evidence of sclerosing chronic sialoadenitis or mucosa-associated lymphoid tissue lymphoma were excluded in the current analysis. For differential gene expression analysis, patients were subdivided in four categories: I) non-SS sicca without lymphocytic infiltration, II) non-SS sicca with aspecific infiltration, III) pSS with negative biopsy (focus score<1), IV) pSS with positive biopsy (focus score≥1). For each differentially expressed gene (DEG), a false detection rate (FDR) was calculated. FDR<0.05 was considered significant.

Results:

Principal component analysis (PCA) showed that only pSS patients with a positive biopsy (group IV) could be separated from the non-SS sicca patients based on gene expression. When comparing the labial and parotid gland transcriptome, resp. 798 and 1461 DEGs (FDR-adjusted p-value<0.05, log2 fold change >1) were identified between groups I and IV. The top differentially regulated genes were mostly related to T and B cells.CXCL13, CCR6, MS4A1(CD20), FCRL4andDAZLwere among the genes with the highest positive fold change in both glands of biopsy-positive pSS patients. Overall, there was a moderate to strong correlation between fold changes in labial and parotid glands (R2=0.58, p-value<0.0001). Between biopsy-negative and biopsy-positive pSS (groups III and IV), 226 and 962 DEGs were identified for labial and parotid gland tissue, respectively. Interestingly, we could not identify DEGs between biopsy-negative pSS (group III) and non-SS sicca patients (group I).

Conclusion:

The transcriptome of labial and parotid gland tissue from pSS patients with a positive biopsy is overall comparable, while salivary gland tissue from biopsy-negative pSS patients shows a comparable gene expression profile to non-SS sicca controls. These results indicate that different treatment strategies may be necessary for biopsy-negative and biopsy-positive pSS patients.

References:

[1]van Nimwegen JF,et al.Validation of the ACR-EULAR criteria for primary Sjögren’s syndrome in a Dutch prospective diagnostic cohort.Rheumatology (Oxford) 2018;57:818–25.

Disclosure of Interests:

Gwenny M. Verstappen: None declared, Lu Gao Employee of: BMS, Sarah A. Pringle: None declared, Silvia C. Liefers: None declared, Bert van der Vegt Consultant of: Advisory board member for Philips and Visiopharm., Vishal Patel Employee of: BMS, Sarah Hu Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sumanta Mukherjee Employee of: BMS, Arjan Vissink: None declared, Hendrika Bootsma Grant/research support from: Unrestricted grants from Bristol-Myers Squibb and Roche, Consultant of: Consultant for Bristol-Myers Squibb, Roche, Novartis, Medimmune, Union Chimique Belge, Speakers bureau: Speaker for Bristol-Myers Squibb and Novartis., Frans G.M. Kroese Grant/research support from: Unrestricted grant from Bristol-Myers Squibb, Consultant of: Consultant for Bristol-Myers Squibb, Speakers bureau: Speaker for Bristol-Myers Squibb, Roche and Janssen-Cilag

1141 Daytime Napping Trajectory Over Time And Its Association With Cognitive Aging: A 13-year Community-based Longitudinal Study Of Older Adults

Introduction

Daytime napping is common in elderly adults and has been associated with cognitive impairment. Prior studies have assessed napping at one time point, making it difficult to examine the longitudinal progression of napping and its association with cognitive aging. We examined objectively measured daytime napping longitudinally across different stages of Alzheimer’s disease (AD): from no cognitive impairment (NCI), to mild cognitive impairment (MCI), and to Alzheimer’s dementia.

Methods

We studied 1,066 participants (female: 810; age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 13 years. Motor activities of up to 10 days were recorded annually and used to assess napping objectively. We defined daytime napping episodes as segments between 10AM and 7PM with continuous zero-activity for ≥10min but &lt;1h (to avoid off-wrist periods). Segments that were &lt;5min apart were merged. Cognitive and clinical evaluations were administered annually to render a clinical diagnostic classification of NCI, MCI, or Alzheimer’s dementia. To examine how napping duration and frequency change with the progression of AD, we performed linear mixed-effects models with 2 change points anchored at the diagnoses of MCI and AD while adjusted for age, sex, and education.

Results

At baseline, participants had 1.44±0.04 (mean±standard error) naps with an accumulated duration of 35.0±1.1 min per day. Napping duration increased by 5.2±0.3 min and frequency increased by 0.21±0.01 times every year (both p&lt;0.0001). The rate of increase was more than doubled after MCI diagnosis with an annual increase of 11.4±0.7 min in duration and 0.40±0.02 times in frequency (both p&lt;0.0001); these were doubled further after AD diagnosis with an annual change of 26.3±3.1 min in duration and 0.84±0.08 times in frequency (both p&lt;0.0001).

Conclusion

Daytime napping duration and frequency increase with aging, and the increase was accelerated with AD progression.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.

1159 Sleep Traits And Incident Delirium During A Decade Of Follow-up In 173,000 Participants

Introduction

Delirium is an acute decline in attention and cognition that is with associated long-term cognitive dysfunction in elderly patients. Accumulating evidence points to strong associations between sleep health and disorders of the brain. We tested whether baseline sleep duration, chronotype, daytime dozing, insomnia or sleep apnea predict incident delirium during hospitalization.

Methods

We studied participants from the UK Biobank who have been followed for up to 10 years until 2017. We included 173,221 participants (mean age 60±5; range 50-71 at baseline) who had at least one episode of hospitalization/surgery and were free from prior episodes of delirium. Delirium diagnosis, hospitalization and surgical events were derived using ICD-10 coding. Multivariate logistic regression models were performed to examine the associations of self-reported baseline sleep duration (&lt;6hrs/6-9h/&gt;9h), daytime dozing (often/rarely), insomnia (often/rarely) and presence of sleep apnea (ICD-10 and self-report) with incident delirium during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, and major confounders (number of hospitalizations/surgical procedures, BMI, diabetes, major cardiovascular diseases and risk factors, major neurological diseases, major respiratory diseases, cancer, alcohol, depression/anxiety, sedatives/sleep aides, antipsychotics, steroids and opioids).

Results

In total, 1,023 (5.7 per 1,000 subjects) developed delirium. A prior diagnosis of sleep apnea (n=1,294) saw almost a two-fold increased odds (OR 1.96, 95% CI: 1.30-2.30 p=0.001) while those who often had daytime dozing were also at increased risk (OR 1.35, 95% CI: 1.02-1.80, p=0.025). Both these effects were independent of each other. No independent effects on incident delirium were observed from sleep duration, insomnia, or chronotype.

Conclusion

Certain sleep disturbances, in particular sleep apnea and daytime dozing, are independently associated with an increased risk for developing delirium. Further work is warranted to examine underlying mechanisms and to test whether optimizing sleep health can reduce the risk of developing delirium.

Support

This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

1135 Longer And More Frequent Naps Predict Incident Alzheimer’s Dementia In Community-based Older Adults

Introduction

Excessive napping duration has been associated with cognitive decline. The effect of napping frequency is less understood, and little is known about the development of Alzheimer’s dementia associated with napping. We tested whether longer or more frequent naps in the elderly are linked to the development of incident Alzheimer’s dementia.

Methods

We studied 1,180 older adults (age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 14 years. Motor activities of up to 10 days were recorded at baseline to assess napping characteristics objectively. We defined daytime napping episodes as motor activity segments between 10AM and 7PM with continuous zero-activity for ≥10min but &lt;1h (to avoid off-wrist periods). Segments that were &lt;5min apart were merged. Alzheimer’s dementia diagnosis was determined using the criteria of the National Institute of Neurological and Communicative Disorders and Strone and the Alzheimer’s Disease and Related Disorders Association. Cox proportional hazards models were performed to examine the associations of daily napping duration and frequency with incident AD.

Results

Of 1,180 non-demented participants at baseline (including 264 with mild cognitive impairment), 277 developed Alzheimer’s dementia within 5.74±3.36 years. On average, participants napped for 38.3±1.0 (SE) min and1.56±0.04 (SE) times per day at baseline. After adjustment for age, sex, and education, every 30-min increase in daily napping duration was associated with a 20% increase in the risk of incident AD (95% confidence interval [CI]: 9%-31%; p=0.0002). One more nap per day was associated with a 19% increase in the risk of AD (95% CI: 8%-30%; p=0.0003). These associations remained after further adjustment for total sleep time.

Conclusion

Longer and more frequent daytime naps predict a higher risk of incident Alzheimer’s dementia. Future studies are needed to examine specific underlying mechanisms.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.

0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

Introduction

In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse.

Methods

We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases).

Results

In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia.

Conclusion

Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms.

Support

This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

[Exploring the mechanism of liver enzyme abnormalities in patients with novel coronavirus-infected pneumonia]

Objective: To explore and analyze the possible mechanism of liver injury in patients with coronavirus disease 2019 (novel coronavirus pneumonia, NCP). Methods: The correlation between ALT, AST and other liver enzyme changes condition and NCP patients' disease status reported in the literature was comprehensively analyzed. ACE2 expression in liver tissue for novel coronavirus was analyzed based on single cell sequencing (GSE115469) data. RNA-Seq method was used to analyze Ace2 expression and transcription factors related to its expression in liver tissues at various time-points after hepatectomy in mouse model of acute liver injury with partial hepatectomy. t-test or Spearman rank correlation analysis was used for statistical analysis. Results: ALT and AST were abnormally elevated in some patients with novel coronavirus infection, and the rate and extent of ALT and AST elevation in severe NCP patients were higher than those in non-severe patients. Liver tissue results of single cell sequencing and immunohistochemistry showed that ACE2 was only expressed in bile duct epithelial cells of normal liver tissues, and very low in hepatocytes. In a mouse model of acute liver injury with partial hepatectomy, Ace2 expression was down-regulated on the first day, but it was elevated up to twice of the normal level on the third day, and returned to normal level on seventh day when the liver recovered and hepatocyte proliferation stopped. Whether this phenomenon suggests that the bile duct epithelial cells with positive expression of Ace2 participate in the process of liver regeneration after partial hepatectomy deserves further study. In RNA-Seq data, 77 transcription factors were positively correlated with the expression of Ace2 (r > 0.2, FDR < 0.05), which were mainly enriched in the development, differentiation, morphogenesis and cell proliferation of glandular epithelial cells. Conclusion: We assumed that in addition to the over activated inflammatory response in patients with NCP, the up-regulation of ACE2 expression in liver tissue caused by compensatory proliferation of hepatocytes derived from bile duct epithelial cells may also be the possible mechanism of liver tissue injury caused by 2019 novel coronavirus infection.

[Investigation and analysis on characteristics of a cluster of COVID-19 associated with exposure in a department store in Tianjin]

Objective: To describe the epidemiological characteristics of a cluster of COVID-19 cases reported in Baodi district of Tianjin as of 18 February, 2020, which might be associated with the exposure in a local department store, and provide suggestions for prevention and control strategy development. Methods: The basic characteristics, time and area distributions, clinical manifestations, epidemiological history and transmission mode of the COVID-19 cases associated with the department store exposure were analyzed. Results: A total of 40 COVID-19 cases were associated with the department store exposure, accounting for 75.47% of the total confirmed cases (53 cases) reported in Baodi district. The cases were mainly at the age of 60 years or older (35.00%) and farmers (40.00%). The main clinical manifestations included fever (95.00%), cough (35.00%), and diarrhea (15.00%). The proportion of confirmed severe cases was 32.50%. The incidence curve showed that the incidence peak occurred on 31 January, 2020. Among the 40 cases, 6(15.00%) were department store employees, 19 (47.50%) were customers and 15 (37.50%) were close contacts (secondary cases). The first case occurred on 21 January, 2020, this case was a department store employee who had a purchasing history at whole sale markets in other provinces and cities before the onset, and 3 employees were still on duty after symptom onsets. The median of the incubation period of customer cases was 6 days, and the median of the interval between onset and medical treatment of customer cases was 7 days. Conclusion: This was a cluster epidemic of COVID-19, which might be associated with the exposure in the department store. By now, the current prevention and control measures have achieved satisfied effects.

Accuracy of molecular diagnostic tests for drug-resistant tuberculosis detection in China: a systematic review

OBJECTIVE: To evaluate the accuracy of molecular diagnostics for the detection of drug-resistant tuberculosis (TB) in Chinese patients.METHOD: Seven databases were searched for eligible studies that evaluated the accuracy of molecular diagnostics against drug susceptibility testing (DST) for detecting drug resistance. A bivariate random-effects meta-analysis was conducted to pool sensitivity and specificity by the index test and drug resistance type.RESULTS: A total of 159 studies were included. Compared with DST (reference standard), Xpert^® could diagnose rifampicin (RMP) resistant TB accurately, with a pooled sensitivity and pooled specificity of 92% (95%CI 90-94) and 98% (95%CI 97-98), respectively. Line-probe assays (LPAs) also performed well for RMP resistance, with a pooled sensitivity of 91% (95%CI 88-93) and pooled specificity of 98% (95%CI 96-99), but not for isoniazid (INH) or second-line drugs due to lower sensitivity (<80%). The pooled sensitivity of GeneChip^® microarrays for RMP, INH and multidrug resistance was 89% (95%CI 86-91), 79% (95%CI 75-82) and 79% (95%CI 73-84), respectively, and the specificities were all >97%. Similarly, the MeltPro^® TB/STR assay had better sensitivity and specificity for first-line drugs, varying from 87% to 89% and 97% to 98%, respectively, than for second-line drugs.CONCLUSION: The Xpert assay, LPA, GeneChip assay, and MeltPro assay are credible methods with high accuracy for RMP resistance detection, but they may not be appropriate for other anti-tuberculosis drugs due to low sensitivity.

[Application of two-step approach for tuberculosis infection testing in tuberculosis control in schools]

Latent tuberculosis infection (LTBI) testing and treatment in high risk populations is an important tool for tuberculosis control. In China, tuberculin skin test (TST) has been recommended as a primary testing method for Mycobacterium tuberculosis (MTB) infection in new students and close contacts in schools, which laid a solid foundation for the early case finding and management. However, Due to the influence of multiple factors including BCG vaccination and nontuberculous mycobacteria infection, TST showed limitations in specificity for MTB infection detection. Guidelines issued by other countries showed that using the two-step approach (TST-IGRA) has advantages in improving diagnostic accuracy as compared with using TST alone. From the perspective of precise intervention, two-step approach for MTB infection testing might be a favorable choice for tuberculosis control in schools in China.

[Value of contrast - enhanced ultrasonography and acoustic radiation force impulse elastography in identification of boundary range and viability of hepatic alveolar echinococcosis]

OBJECTIVE

To investigate the biologic viability and boundary range of hepatic alveolar echinococcosis (HAE) by the contrast-enhanced ultrasonography (CEUS) and acoustic radiation force impulse elastography (ARFI).

METHODS

Totally 27 HAE patients confirmed by pathology underwent CEUS and ARFI examinations.

RESULTS

Gray scale sonography of HAE showed unclear boundary, inhomogeneous, and middle hyperechoic nodules, and the maximum area was (6.08 ± 4.47) cm² in 27 lesions. CEUS of HAE showed non-enhancement in three phases and black hole sign. Circumferential enhancement on the pe riphery of the lesion was synchronized with the liver parenchyma and showed "fast in and slow out". The maximum area was (8.87 ± 4.83) cm². The area of ECUS was larger than gray scale sonography in HAE (t = 2.20, P = 0.03). The mean shear wave velocities (SWVs) of the interior, the boundary range, and the surrounding liver tissues of HAE were statistically different by ARFI (F = 84.538, P < 0.001), and the interior had the highest values.

CONCLUSIONS

CEUS and ARFI examinations can detect the biologic viability and boundary range of migrating zone around HAE, which is valuable for guiding treatment, judging curative effect, and predicting prognosis.

[Efficacy and safety of Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension]

Objective: To study the efficacy and safety of Balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Patients who were diagnosed CTEPH in China-Japan Friendship Hospital from Feb 2018 to Sep 2019 were evaluated. The ineligibility for pulmonary endarterectomy (PEA) and the indication for BPA were decided on the basis of a consensus among the multidisciplinary team for all CTEPH patients. 6-min walk distance (6MWD), the plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary artery pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were collected and analyzed before the first and the last BPA session. Results: A total of 67 BPA sessions were performed for 302 subsegmental pulmonary arteries in 25 inoperable CTEPH patients. 10 males (40.0%) and 15 females (60.0%), with the age of (57.8±7.1) years old. The median interval between CTEPH diagnosis and first BPA was 20.0 (9.0, 48.5) months. 18 patients were received more than 2 BPA sessions, the median follow-up time was 5.0 (3.5, 8.3) months. 6MWD, CI and the mixed venous oxygen saturation were significant improved after BPA [(425±74) vs (345±109) m, (1.99±0.45) vs (1.62±0.35) L·min(-1)·m(-2), (68.1%±6.5%) vs (61.2%±6.3%)](all P<0.05). The plasma level of NT-proBNP, mPAP and PVR were significantly decreased after BPA [259 (93, 739) vs 806 (148, 2 159) ng/L, (40.6±8.3) vs (47.3±10.7) mmHg (1 mmHg=0.133 kPa), (11.9±4.9) vs (17.2±6.5) WU (1 WU=80 dyn·s·cm(-5))](all P<0.05). Hemoptysis occurred in 5 sessions (7.5%) and reperfusion pulmonary edema (RPE) occurred in 2 sessions (1.5%), 1 patient needed non-invasive mechanical ventilation because of RPE, 1 patient died from right heart failure caused by hemoptysis during perioperative period. Conclusions: BPA can significantly improve the exercise tolerance and hemodynamic parameters for inoperable CTEPH patients, the risks of BPA are acceptable. BPA is an effective and relatively safe treatment for inoperable CTEPH patients.

Dynamic changes of interferon gamma release assay results with latent tuberculosis infection treatment

OBJECTIVES

Using QuantiFERON-TB Gold In-Tube (QFT-GIT) for monitoring tuberculosis (TB) and latent TB infection treatment effect is controversial. The present study aimed to evaluate the dynamic changes of interferon gamma (IFN-γ) levels along with latent TB infection treatment via a randomized controlled study.

METHODS

A total of 910 participants treated with 8 weeks of once-weekly rifapentine plus isoniazid (group A), 890 treated with 6 weeks of twice-weekly rifapentine plus isoniazid (group B) and 818 untreated controls (group C) were followed for 2 years to track active TB development. QFT-GIT tests were repeated three times for all groups: before treatment (T0), at completion of treatment (T1) and 3 months after completion of treatment (T2).

RESULTS

Similar rates of persistent QFT-GIT reversion were observed in groups A (19.0%, 173/910), B (18.5%, 165/890) and C (20.7%, 169/818) (p 0.512). The dynamic changes of IFN-γ levels were not statistically significant among the three groups. In treated participants, individuals with higher baseline IFN-γ levels showed increased TB occurrence (1.0%, 9/896) compared to those with lower baseline levels (0.2%, 2/904) (p 0.037). A similar but statistically insignificant trend was also observed in untreated controls (1.8% (7/400) vs. 0.5% (2/418), p 0.100). When TB cases were matched with non-TB cases on baseline IFN-γ levels, no significant differences were found with respect to the dynamic changes in IFN-γ levels with time, regardless of whether they received treatment.

CONCLUSIONS

QFT-GIT reversion or decreased IFN-γ levels should not be used for monitoring host response to latent TB infection treatment.

[Effect of consolidation before allogeneic hematopoietic stem cell transplantation for non-favorable acute myeloid leukemia patients with first complete remisson and negative minimal residual disease]

目的

探讨异基因造血干细胞移植（allo-HSCT）前巩固化疗对第1次形态学完全缓解且微小残留病阴性（CR₁/MRD⁻）中/高危急性髓系白血病（AML）患者预后的影响。

方法

对2010年1月至2019年3月在CR₁/MRD⁻状态下接受allo-HSCT的155例中/高危AML（不含急性早幼粒细胞白血病）患者进行回顾性分析。

结果

全部155例患者中，102例获得CR₁/MRD⁻后接受移植前巩固化疗（巩固组），53例获得CR₁/MRD⁻后直接行allo-HSCT（非巩固组），两组中位年龄分别为39（18~56）岁、38（19~67）岁。巩固组、非巩固组移植后5年总生存率分别为（59.3±7.5）%、（62.2±6.9）%（P=0.919），无复发生存率分别为（53.0±8.9）%、（61.6±7.0）%（P=0.936），累积复发率分别为（21.9±5.4）%、（18.3±6.0）%（P=0.942），非复发死亡率分别为（22.4±4.3）%、（28.4±6.5）%（P=0.464）。多因素分析显示，移植前是否接受巩固化疗及其疗程（<2个/≥2个）对预后无显著影响。

结论

中/高危AML患者可在获得CR₁/MRD⁻后直接进行allo-HSCT。

[Construction of key question list in the evidence-based guidelines for colorectal cancer screening in China]

Objective: To establish the key question list for the development of evidence- based guideline in China according to the content and limitation of current evidence-based guidelines around the world. Methods: First, we introduced the evidence-based guidelines in detail which met the criteria based on World Health Organization guideline development handbook and then formulated the draft list of key questions for the development of evidence-based guidelines. At last, the Delphi method was used to determine the list of key questions in developing evidence-based guidelines of colorectal cancer screening. Results: Totally, 34 questionnaires were collected, with experts from clinical and epidemiological fields. The average experts' authority coefficient was 0.81, indicating a high degree of authority. The concentration of opinions on all items in the questionnaire was relatively high, with the full score ratio greater than 75% and the coefficient of variation less than 0.3. The list of key questions on evidence-based guidelines for colorectal cancer screening has been divided into six parts: epidemiological problems, risk classification, screening age, screening tools, implementation and selection of steering group members, which covers the issues that need to be considered in the development of evidence-based colorectal cancer screening guidelines in China. Conclusion: The key question list for evidence-based guideline development in our study can be applied to the development of evidence-based guidelines for colorectal cancer screening in the future, as well as the development of evidence-based guidelines for other cancer screening in China.

Prognostic alternative splicing regulatory network of splicing events in acute myeloid leukemia patients based on SpliceSeq data from 136 cases

This study aimed to create prognostic signatures to predict AML patients' survival using alternative splicing (AS) events. The AS data, RNA sequencing data, and the survival statistics of 136 AML patients were obtained from The Cancer Genome Atlas (TCGA) and TCGA SpliceSeq databases. Total 34,984 AS events generated from 8,656 genes, 2,583 of which were survival-associated AS events, were identified using univariate Cox regression. The prognostic models constructed using independent survival-associated AS events revealed that low-risk splicing better predicted patients' survival. ROC analysis indicated that the predictive efficacy of the alternate terminator model was best in the area under the curve at 0.781. Enrichment analysis revealed several important genes (TP53, BCL2, AURKB, PPP2R1B, FOS, and BIRC5) and pathways, such as the protein processing pathway in the endoplasmic reticulum, RNA transport pathway, and HTLV-I infection pathway. The splicing network of splicing events and factors revealed interesting interactions, such as the positive correlation between HNRNPH3 and CALHM2-13010-AT, which may indicate the potential splicing regulatory mechanism. Taken together, survival-associated splicing events and the prognostic signatures for predicting survival can help provide an overview of splicing in AML patients and facilitate clinical practice. The splicing regulatory network may improve the understanding of spliceosomes in AML.

[Analysis of four children with anomalous origin of the left coronary artery from the right sinus with interarterial course]

Objective: To investigate the clinical features and improve the diagnosis and treatment of anomalous origin of the left coronary artery from the right coronary sinus with an interarterial course (ALCA-R-IAC) between the ascending aorta and main pulmonary artery in children. Methods: A retrospective analysis of the clinical manifestation, laboratory test, radiological feature, treatment and prognosis were conducted in four female children presented with ALCA-R-IAC in Beijing Children's Hospital from November 2015 to June 2018. Results: The four girls with onset age of 7.5-14.7 years were diagnosed with ALCA-R-IAC by CT coronary angiography (CTCA). Four children presented with exercise-induced syncope and clinical manifestations of acute myocardial infarction including 3 patients with acute left heart failure, 1 cardiogenic shock and 1 cardiac arrest. Nervous system involvement was found in one patient. Troponin I increased significantly to 20.65-50.00 μg/L in the four patients. Electrocardiogram (ECG) developed signs of left main coronary artery involvement. Echocardiography revealed reduced left ventricular ejection fraction (LVEF) of 25%-45% in three children and suspected anomalous origin of the left coronary artery in one child. CTCA showed an anomalous left coronary artery originating from the right coronary sinus, which had an interarterial course between the aorta and pulmonary artery leading to a slim left main coronary trunk. Two children underwent unroofing procedure and the other two children in whom physical activities were restricted received conservative managements. During a regular follow-up period of 12-43 months, all the children survived without recurrent symptoms and had good prognosis. Conclusions: ALCA-R-IAC can present as exercise-related syncope and acute myocardial infarction, even sudden death in children and adolescents. CTCA is helpful to clarify the early diagnosis of ALCA-R-IAC. Surgical intervention is the main treatment for ALCA-R-IAC and strenuous physical activities should be avoided.

[Clinical characteristics and treatment of myoepithelial carcinoma of head and neck]

Objective:To investigate the clinical features, diagnosis, treatment and prognosis of myoepithelial carcinoma of the head and neck. Method:The clinical data of 59 patients with head and neck myoepithelial carcinoma admitted from January 2012 to October 2018 were analyzed retrospectively. The data was analyzed with SPSS 21.0 statistical software. Result:The follow-up period was 6 to 131 months. The mean follow-up time was 36 months. One patient（1.7%） was lost to follow-up, 17 patients（28.8%） had postoperative local recurrence, 8 patients（13.6%） had distant metastasis, and 5 patients（8.5%） had cervical lymph node metastasis; 14 patients（23.7%） died. The 1-, 3-, and 5-year cumulative survival rates were 92%, 73%, and 62%, respectively. Survival rate curves of different treatment methods were significantly different by Gehan method（P<0.05）. Compared between the two groups, there was significant difference between surgery alone and surgery plus radiotherapy than radiotherapy alone and chemotherapy alone（P<0.05）. There was no significant difference between the other two treatment methods. Multivariate logistic regression analysis showed that tumor location, clinical stage and survival status and local recurrence rate were significantly correlated（P<0.05）, but gender, age and survival status and local recurrence rate were not significantly correlated（P>0.05）. Conclusion:The incidence of myoepithelial carcinoma is low, and the clinical manifestations and imaging studies lack specificity. The tumor is prone to local recurrence, invasive, and has a high incidence of distant metastasis. It is a highly malignant tumor. Surgical treatment is preferred and the requirements for first surgery are high, and major salivary glands and advanced tumors（stage Ⅲ-Ⅳ） are risk factors for survival and local recurrence. Early diagnosis and early treatment can significantly improve the survival rate of patients, reduce the local recurrence rate of tumors, and improve the prognosis of patients.

[Treatment of parotid hemangioma in children]

Objective:To summarize the treatment and effect of children with parotid hemangioma. Method:Thirty-three children with parotid hemangioma were treated with drug in 22 cases, 9 of which received propranolol orally, accounting for 27%; 13 cases underwent B-ultrasound guided bleomycin injection, accounting for 40%; another 11 cases were used. The treatment of surgical removal of hemangioma, accounting for 33%. Result:In 22 children with drug therapy, the evaluation criteria were evaluated by Achauer et al. 12 cases of grade Ⅳ, accounting for 54.5%; 7 cases of grade Ⅲ, accounting for 31.8%; 2 cases of grade Ⅱ, accounting for 9%. For example, accounted for 4.5%; 2 of them（1 in gradeⅠand Ⅱ） were treated with drug therapy for 6 months after surgical resection of hemangioma. Eleven children underwent surgical resection of hemangioma, and 8 patients underwent complete resection of the tumor, accounting for 73%. Among them, 3 patients had residual hemangiomas during operation, and the residual tumor was treated with bleomycin. This group of medications showed that children aged<12 months, after oral propranolol, the tumors were reduced to varying degrees, the most significant change within 1 week after administration, and then the tumor was further reduced until the end of treatment. Conclusion:B-ultrasoun lower bleomycin injection in children with parotid hemangioma is effective, and the incidence of adverse reactions is low, but multiple courses of treatment are required. For patients with poor drug treatment, recurrence or limited range, surgical resection of blood vessels can be selected. Tumor surgery should pay attention to the choice of indications and surgical operation skills, reduce the risk of facial nerve injury and postoperative facial scars. There are many different treatments for infantile hemangioma, but there is still no treatment for all children. The drug treatment of this group showed that after oral propranolol, the tumors were all reduced to varying degrees, the color became lighter, the texture became softer, and the change was most significant within 1 week after administration, and then the tumor was further reduced until the end of treatment. B-ultrasound guided bleomycin injection in children with parotid hemangioma is effective. After 1-2 courses of treatment, the tumor shrinks significantly and the incidence of adverse reactions is low. Drug treatment of parotid hemangioma in children is simple. A safe and effective method. For children with poor drug treatment, recurrence or limited range, surgical treatment of hemangioma can be selected. Surgery should pay attention to the choice of indications and surgical operation skills, reduce the risk of facial nerve injury and postoperative facial scars.

[The clinical observation of serum specific biomarkers in patients with chronic graft-versus-host disease]

目的

研究异基因造血干细胞移植后患者血清生物标志物表达水平对慢性移植物抗宿主病（cGVHD）早期诊断的价值。

方法

采用液相悬浮芯片法检测接受异基因造血干细胞移植后发生和未发生cGVHD患者5种血清蛋白标志物（IL-1b、IL-16、CXCL9、CCL19、CCL17）表达水平。

结果

相较于未发生cGVHD的对照组，cGVHD患者血清中CXCL9、CCL17表达水平显著升高（P<0.05），其中CCL17与cGVHD的疾病严重程度相关（P<0.001）；CXCL9在皮肤损害的cGVHD患者血清中显著升高（P<0.01），CCL17在肝脏为靶器官的cGVHD患者中表达水平显著升高（P<0.01）。

结论

CXCL9联合CCL17可作为cGVHD的血清生物标志物，对辅助cGVHD诊断和评估严重程度有一定参考价值。

[Chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy]

Objective: To investigate chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy. Methods: A total of 831 tissue samples of spontaneous abortion in early pregnancy were collected from June 2015 to August 2018 in the First Affiliated Hospital of Nanjing Medical University. Chromosomal copy number was analyzed by next generation sequencing (NGS). The relationships between chromosome abnormality and maternal age, in vitro fertilization-embryo transfer (IVF-ET) pregnancy, number of previous spontaneous abortions, history of live birth were analyzed by statistical methods. Results: Among 831 tissue samples of spontaneous abortion in early pregnancy, 461 (55.5%, 461/831) were found to have chromosome abnormalities. Maternal age (OR=1.107, 95%CI: 1.070- 1.145) and history of live birth (OR=1.909, 95%CI: 1.182-3.083) were the positive correlative factors of chromosome abnormality. Times of previous spontaneous abortion (OR=0.807, 95%CI: 0.702-0.928) and IVF-ET pregnancy (OR=0.554, 95%CI: 0.404-0.760) were the negative correlative factors of chromosome abnormality. Conclusions: Chromosome abnormality is an important cause of spontaneous abortion in early pregnancy. The rate of chromosome abnormality increases with the increase of maternal age and the history of live birth, and decreases with the increase of number of previous spontaneous abortion and IVF-ET pregnancy.

[Prognostic value of donor chimerism at +90 days after allogeneic hematopoietic stem cell transplantation in young patients with intermediate-risk acute myeloid leukemia]

Objective: To investigate the relationship between donor chimerism and relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: The clinical data of 105 patients with acute myeloid leukemia (AML) who underwent allo-HSCT and recurrence-free survival>90 days from January 2010 to January 2019 were retrospectively analyzed. The bone marrow samples were collected at 15, 30, 60, 90, 180, 270, 360 days after transplantation. Donor chimerism was detected by single nucleotide polymorphism (SNP) -PCR. Results: Of the 105 patients, 43 cases were male and 62 cases were female, with a median age of 38 (16-60) years. Till April 2019, the median follow-up was 843 (94-3 261) days. Ninety days after transplantation, 18 cases relapsed, 33 cases died, and 72 cases survived. The 3-year overall survival (OS) rate was (66.8±5.1) %, and the recurrence-free survival (RFS) rate was (65.1±5.0) %. Pre-transplant disease status, pre-transplant minimal residual disease (MRD) , and 90 day post-transplantation chimerism were independent risk factors related to RFS. The risk of recurrence was significantly increased in patients with a donor chimerism rate ≤97.24% at 90 days after transplantation[HR=6.921 (95%CI 2.669-17.950) , P<0.001], which was considered as a sign of early relapse. Conclusion: SNP-PCR is an applicable method for detecting donor chimerism in patients after allo-HSCT. Chimerism rate equal or less than 97.24% at 90 days after transplantation predicts a higher risk of relapse.