[Effect of HIF-1α and BRD4 on autophagy level of breast cancer cell in hypoxic microenvironment]

Objective: To investigate the expressions of HIF-1α, BRD4, Beclin1, LC3B and p62 in breast cancer tissues and their clinicopathological significance, and to study alterations of their expression in breast cancer cells under hypoxic microenvironment. Methods: Immunohistochemistry was used to detect HIF-1α, BRD4, Beclin1, LC3B and p62 protein expressions in 125 breast cancer tissues and 50 para-cancer normal breast tissues, and their correlation with clinicopathologic characteristics were analyzed. The expression of these proteins were also measured after 24 hours of hypoxia stimulation was detected in different breast cancer cell lines and normal breast epithelial cells. Results: The expression of HIF-1α, BRD4, Beclin1 and LC3B proteins in breast cancer tissues were significantly higher than in para-cancer normal breast tissues (P<0.05). There was a positive association between histologic grade, the expression of HIF-1α, BRD4, Beclin1 and LC3B (P<0.05). High expressions of HIF-1a and Beclin1 were often correlated with lymph node metastasis and lymphatic invasion (P<0.05). Increased HIF-1α, BRD4, Beclin1 and LC3B expression was associated with ER or PR negativity, but only HIF-1α was associated with HER2 positivity (P<0.05). HIF-1α, BRD4, Beclin1, and LC3B were positively correlated with each other in breast cancer tissues (P<0.01). After 24 hours of hypoxic stimulation, the expression of HIF-1α, BRD4, Beclin1 and LC3B was up-regulated in breast cancer cells. Conclusions: Hypoxia induces autophagy in breast cancer tissues. HIF-1α is positively correlated with BRD4, suggesting that BRD4 is involved in the regulation of autophagy by hypoxic microenvironment in breast cancer. High expression of HIF-1α, BRD4 and autophagy may play an important role in the development of breast cancer.

Evaluation of an accelerated 3D modulated flip-angle technique in refocused imaging with an extended echo-train sequence with compressed sensing for imaging of the knee: comparison with routine 2D MRI sequences

AIM

To accelerate the acquisition of high-resolution magnetic resonance imaging (MRI) by using the three-dimensional (3D) matrix sequence with compressed sensing and to compare it with conventional two-dimensional (2D) proton-density (PD) and fast spin-echo (FSE) sequences.

MATERIALS AND METHODS

3D matrix, 2D FSE, and PD sequences were acquired from 68 participants using 3 T magnetic resonance imaging (MRI). Two radiologists scored image quality independently on a four-point scale. The structural similarity index (SSIM), and signal- (SNRs) and contrast-to-noise ratios (CNRs) of different anatomical structures of the knee were assessed and compared between sequences using Wilcoxon signed-rank tests and Cohen's kappa.

RESULTS

The median acquisition time reduction was 44.5%. There was a substantial to perfect agreement for the rating between the 3D matrix FSE and 2D FSE or PD sequences when evaluating cartilage, subchondral bone, and ligaments (κ=0.783-872, p>0.05). The mean SSIM values between the 3D matrix FSE and 2D FSE, and between the 3D matrix PD and 2D PD sequences was 0.994 and 0.971, respectively, which are acceptable. No significant differences were found in SNR between the 3D matrix FSE and 2D FSE, and between the 3D matrix PD and 2D PD sequences, even though the SNR appeared to be higher on routine 2D sequences. The CNR of subchondral bone-meniscus, subchondral bone-joint fluid, and meniscus-joint fluid did not differentiate significantly between the 3D matrix sequence and routine 2D sequences.

CONCLUSIONS

3D matrix reduced the acquisition time in routine clinical knee MRI without the loss in image quality, SNR, and CNR.

Double-cone ignition scheme for inertial confinement fusion

While major progress has been made in the research of inertial confinement fusion, significant challenges remain in the pursuit of ignition. To tackle the challenges, we propose a double-cone ignition (DCI) scheme, in which two head-on gold cones are used to confine deuterium-tritium (DT) shells imploded by high-power laser pulses. The scheme is composed of four progressive controllable processes: quasi-isentropic compression, acceleration, head-on collision and fast heating of the compressed fuel. The quasi-isentropic compression is performed inside two head-on cones. At the later stage of the compression, the DT shells in the cones are accelerated to forward velocities of hundreds of km s^-1. The head-on collision of the compressed and accelerated fuels from the cone tips transfer the forward kinetic energy to the thermal energy of the colliding fuel with an increased density. The preheated high-density fuel can keep its status for a period of approximately 200 ps. Within this period, MeV electrons generated by ps heating laser pulses, guided by a ns laser-produced strong magnetic field further heat the fuel efficiently. Our simulations show that the implosion inside the head-on cones can greatly mitigate the energy requirement for compression; the collision can preheat the compressed fuel of approximately 300 g cm^-3 to a temperature above keV. The fuel can then reach an ignition temperature of greater than 5 keV with magnetically assisted heating of MeV electrons generated by the heating laser pulses. Experimental campaigns to demonstrate the scheme have already begun. This article is part of a discussion meeting issue 'Prospects for high gain inertial fusion energy (part 1)'.

Novel variants and uncommon cases among southern Chinese children with X-linked hypophosphatemia

PURPOSE

X-linked hypophosphatemia (XLH) is the most common inherited renal phosphate wasting disorder and is often misdiagnosed as vitamin D deficiency. This study aims to provide clinical and mutational characteristics of 65 XLH pediatric patients in southern China.

METHODS

In this work, a combination of DNA sequencing and qPCR analysis was used to study the PHEX gene in 80 pediatric patients diagnosed with hypophosphatemia. The clinical and laboratory data of confirmed 65 XLH patients were assessed and analyzed retrospectively.

RESULTS

In 65 XLH patients from 61 families, 51 different variants in the PHEX gene were identified, including 23 previously reported variants and 28 novel variants. In this cohort of XLH patients, the c.1601C>T(p.Pro534Leu) variant appears more frequently. Fourteen uncommon XLH cases were described, including four boys with de novo mosaic variants, eight patients with large deletions and a pair of monozygotic twins. The clinical manifestations in this cohort are very similar to those previously reported.

CONCLUSION

This study extends the mutational spectrum of the PHEX gene, which will contribute to accurate diagnosis. This study also suggests a supplementary qPCR or MLPA assay may be performed along with classical sequencing to confirm the gross insertion/deletion.

Are craniocervical angulations or syrinx risk factors for the initiation and progression of scoliosis in Chiari malformation type I?

The pathophysiology behind the instigation and progression of scoliosis in Chiari malformation type I (CMI) patients has not been elucidated yet. This study aims to explore the initiating and progressive factors for scoliosis secondary to CMI. Pediatric patients with CMI were retrospectively reviewed for radiological characteristics of tonsillar herniation, craniocervical anomaly, syrinx morphology, and scoliosis. Subgroup analyses of the presence of syrinx, scoliosis, and curve progression were also performed. A total of 437 CMI patients were included in the study; 62% of the subjects had syrinx, and 25% had scoliosis. In the subgroup analysis of 272 CMI patients with syrinx, 78 of them (29%) had scoliosis, and multiple logistic regression analysis showed that tonsillar herniation ≥ 10 mm (OR 2.13; P = 0.033) and a clivus canal angle ≤ 130° (OR 1.98; P = 0.025) were independent risk factors for scoliosis. In the subgroup analysis of 165 CMI patients without syrinx, 31 of them (19%) had scoliosis, and multiple logistic regression analysis showed that a clivus canal angle ≤ 130° (OR 3.02; P = 0.029) was an independent risk factor for scoliosis. In the subgroup analysis of curve progression for 97 CMI patients with scoliosis, multiple logistic regression analysis showed that anomalies of the craniocervical junction and syrinx were not risk factors for curve progression. Many complex factors including craniocervical angulation, tonsillar herniation, and syrinx might participate in the instigation of scoliosis for CMI patients, and the relationship between craniocervical angulation and scoliosis deserves further study.

Particle-in-cell simulation method for macroscopic degenerate plasmas

Nowadays hydrodynamic equations coupled with external equation of states provided by quantum mechanical calculations is a widely used approach for simulations of macroscopic degenerate plasmas. Although such an approach is proven to be efficient and shows many good features, especially for large scale simulations, it encounters intrinsic challenges when involving kinetic effects. As a complement, here we have invented a fully kinetic numerical approach for macroscopic degenerate plasmas. This approach is based on first principle Boltzmann-Uhling-Uhlenbeck equations coupled with Maxwell's equation, and is eventually achieved via an existing particle-in-cell simulation code named LAPINS. In this approach, degenerate particles obey Fermi-Dirac statistics and nondegenerate particles follow the typical Maxwell-Boltzmann statistics. The equation of motion of both degenerate and nondegenerate particles are governed by long range collective electromagnetic fields and close particle-particle collisions. Especially, Boltzmann-Uhling-Uhlenbeck collisions ensure that evolution of degenerate particles is enforced by the Pauli exclusion principle. The code is applied to several benchmark simulations, including electronic conductivity for aluminium with varying temperatures from 2 eV to 50 eV, thermalization of alpha particles in a cold fuel shell in inertial confinement fusion, and rapid heating of solid sample by short and intense laser pulses.

[Evaluation of the analgesic effect of Acute Pain Service in thoracic surgery]

Objective: To observe the analgesic effect, complication and patient satisfaction of Acute Pain Service (APS) after thoracic surgery. Methods: The clinical data were collected from 264 patients who underwent different thoracic surgery from January 2017 until December 2019 retrospectively. They were divided into thoracotomy group (group O) and thoracoscopy surgery group (group T). There were 90 cases in group O and 174 cases in group T. According to the use of APS, the group O is divided into the no-APS group (group O1) and the APS group (group O2), the group T is divided into the no-APS group (group T1) and the APS group (group T2). The effect of postoperative analgesia, the incidence of nausea and vomiting and the satisfaction of patients were compared between group O1 and group O2, group T1 and group T2, respectively. Results: In the resting state, the Numeric Rating Scales (NRS) scores of the group O2 at 0 h (0.92±0.50 vs 1.59±0.62), 4 h (0.92±0.50 vs 2.06±1.03), 8 h (0.92±0.50 vs 2.18±1.13), 12 h (0.92±0.50 vs 2.47±1.42), 24 h (1.00±0.71 vs 2.53±1.42), and 48 h (1.00±0.71 vs 2.35±1.80) after leaving the Anesthesia Recovery Room (PACU) were significantly lower than those of the group O1 (all P<0.05), and in the active state, the NRS scores of the group O2 at 0 h (P=0.023), 4 h (P=0.001), 8 h (P=0.000), 12 h (P=0.001), 24 h (P=0.000), 48 h (P=0.000), and 72 h (P=0.019) after leaving the PACU were significantly lower than those of the group O1 (all P<0.05). In the resting state, the NRS scores of the group T2 at 4 h (P=0.029), 8 h (P=0.008), 12 h (P=0.006), and 24 h (P=0.013) after leaving the PACU were significantly lower than those of the group T1 (all P<0.05). In the active state, the NRS scores of the group T2 at 4 h (P=0.019), 8 h (P=0.000), 12 h (P=0.001), 24 h (P=0.002), and 48 h (P=0.002) after leaving the PACU were significantly lower than those of the group T1 (all P<0.05). Conclusion: APS can significantly reduce the NRS scores after thoracotomy and thoracoscopic surgery compared to ordinary analgesia model.

An open-source handheld extruder loaded with pore-forming bioink for in situ wound dressing

The increasing demand in rapid wound dressing and healing has promoted the development of intraoperative strategies, such as intraoperative bioprinting, which allows deposition of bioinks directly at the injury sites to conform to their specific shapes and structures. Although successes have been achieved to varying degrees, either the instrumentation remains complex and high-cost or the bioink is insufficient for desired cellular activities. Here, we report the development of a cost-effective, open-source handheld bioprinter featuring an ergonomic design, which was entirely portable powered by a battery pack. We further integrated an aqueous two-phase emulsion bioink based on gelatin methacryloyl with the handheld system, enabling convenient shape-controlled in situ bioprinting. The unique pore-forming property of the emulsion bioink facilitated liquid and oxygen transport as well as cellular proliferation and spreading, with an additional ability of good elasticity to withstand repeated mechanical compressions. These advantages of our pore-forming bioink-loaded handheld bioprinter are believed to pave a new avenue for effective wound dressing potentially in a personalized manner down the future.

Forsythia suspensa extract enhances performance via the improvement of nutrient digestibility, antioxidant status, anti-inflammatory function, and gut morphology in broilers

This experiment aims to determine the effects of Forsythia suspense extract (FSE) as an antibiotic substitute on performance, antioxidant status, anti-inflammatory function, intestinal morphology, and meat fatty acid deposition in broilers. 192 male Arbor Acre broilers (1-day-old, weighing 45.6 ± 1.3 g) were randomly allocated to 3 treatments, 8 replicate pens per treatment, 8 broilers per pen. The treatments contain a control diet (corn-soybean meal basal diet, CTL), an antibiotic diet (basal diet + 75 mg/kg chlortetracycline, CTC), and an FSE diet (basal diet + 100 mg/kg FSE; FSE). The experiment includes phase 1 (day 1 to 21) and 2 (day 22 to 42). Compared with CTL and CTC, broilers supplemented with FSE showed higher (P < 0.05) ADG and ADFI in phase 2 and overall (day 1 to 42). On day 21, serum catalase and total antioxidant capacity contents were enhanced (P < 0.05) in broilers fed FSE compared with CTL. On day 42, broilers fed FSE showed increased (P < 0.05) serum superoxide dismutase and glutathione peroxidase contents, and enhanced (P < 0.05) apparent total tract digestibility of dry matter, organic matter, gross energy, total carbohydrates, and phosphorus, as well as reduced (P < 0.05) nitrogen and phosphorus excretion in feces compared with CTL. These broilers also showed decreased (P < 0.05) n-6/n-3 polyunsaturated fatty acid ratio in thigh meat, and tumor necrotic factor-alpha, interleukin-1β and interleukin-6 contents in the liver on day 42 compared with CTL. The villus height was increased (P < 0.05) in the duodenum, jejunum, and ileum of broilers fed FSE compared with CTL. In conclusion, dietary F.suspense extract supplementation as a chlortetracycline substitute under non-challenge conditions enhanced performance via the improvement of nutrient digestibility, antioxidant status, anti-inflammatory function, and intestinal morphology in broilers. Moreover, F.suspense extract may also benefit environment by reducing nitrogen and phosphorus excretion and benefit human health via modulating meat fatty acid profiles in broilers.

AI detection of M. Tuberculosis pathogens using Generative Adversarial Network (GAN) analyses

Background

Rapid identification of pathogens is critical to outbreak detection and sentinel surveillance; however most diagnoses are made in laboratory settings. Advancements in artificial intelligence (AI) and computer vision offer unprecedented opportunities to facilitate detection and reduce response time in field settings. An initial step is the creation of analysis algorithms for offline mobile computing applications.

Methods

AI models to identify objects using computer vision are typically “trained” on previously labeled images. The scarcity of labeled image-libraries creates a bottleneck, requiring thousands of labor hours to annotate images by hand to create “training data.” We describe the applicability of Generative Adversarial Network (GAN) methods to amass sufficient training data with minimal manual input.

Results

Our AI models are built with a performance score of 0.84-0.93 for M. Tuberculosis, a measure of the AI model's accuracy using precision and recall. Our results demonstrate that our GAN pipeline boosts model robustness and learnability of sparse open source data.

Conclusions

The use of labeled training data to identify M. Tuberculosis developed using our GAN pipeline techniques demonstrates the potential for rapid identification of known pathogens in field settings. Our work paves the way for the development of offline mobile computing applications to identify pathogens outside of a laboratory setting. Advancements in artificial intelligence (AI) and computer vision offer unprecedented opportunities to decrease detection time in field settings by combining these technologies. Further development of these capabilities can improve time-to-detection and outbreak response significantly.

Key messages

Rapidly deploy AI detectors to aid in disease outbreak and surveillance. Our concept aligns with deploying responsive alerting capabilities to address dynamic threats in low resource, offline computing environs.

Effect of chestnut wood extract on performance, meat quality, antioxidant status, immune function, and cholesterol metabolism in broilers

Plant extracts have been proved as natural antioxidants resources as well as alternative feed additives in livestock and poultry species. Chestnut wood extract (CWE) as a source of hydrolysable tannic acid was used to evaluate the growth performance, nutrient retention, meat quality, antioxidant status, and immune function of broilers. A total of 168, day-old Arbor Acre male broilers (weight 46.59 ± 0.44 g) were randomly divided to 3 treatments, 7 replicate pens per treatment, 8 broilers per pen. The treatments contain a control diet, CON (corn-soybean meal basal diet); an antibiotic diet, CTC (basal diet + 75 mg/kg chlortetracycline); and chestnut wood extract diet, CWE (basal diet + 1,000 mg/kg chestnut tannins). At the finisher phase, final body weight was higher (P < 0.05) in CWE supplemented diet than in CON. Average daily body weight gain was higher (P < 0.05) and feed gain ratio was lower (P < 0.05) in broilers fed CWE than in those fed CON at the finisher phase. Crude protein digestibility was higher (P < 0.05) in broilers offered CWE than that in broilers fed CON and CTC diets. Breast muscle pH value at 24 h (pH24 h) was higher (P < 0.05) in broilers fed CWE than that in those fed CON and CTC diets. The bursa weight was higher (P < 0.05) in broilers offered CWE than that in those fed CON and CTC. Total antioxidant capacity (T-AOC), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) values were higher (P < 0.05) in both breast muscle and thigh muscle of broilers offered CWE supplemented diet than those in broilers fed CON and CTC diets. Similarly, broilers offered with CWE diets showed higher (P < 0.05) T-AOC, GSH-PX, and SOD value in serum than those fed CON and CTC diets. Serum concentration of IgG was higher (P < 0.05) in broilers offered with CWE diets than that in those fed CON and CTC diets. Total cholesterol, low-density lipoprotein cholesterol, and urea-N concentration were lower (P < 0.05) in broilers offered CWE diet than those in broilers fed CON and CTC diets. It was recommended to supply CWE at the 1,000 mg/kg level for improving antioxidant status, cholesterol metabolism, and growth performance without affecting normal meat quality in broilers.

[Efficacy and safety of non-vitamin K antagonist versus vitamin K antagonist oral anticoagulants in the prevention and treatment of thrombotic disease in active cancer patients: a systematic review and meta-analysis of randomized controlled trials]

Object We aimed to compare the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonist (VKA) in the prevention and treatment of thrombotic diseases in patients with active cancer. Methods: To find randomized controlled trials (RCT) in which NOACs were compared VKAs in active cancer, we searched the electronic databases (PubMed, Web of Science and Clinical Trials) up to May 2019 and and languages restricted to Chinese and English. According to the screening strategy, two researchers independently screened and extracted literature, evaluated the quality of literature, the suitability of collected cross study data for analysis, and tested the heterogeneity. The relative risk (RR) and 95% confidence interval (95%CI) of major bleeding, clinically related non-major bleeding, VTE, stroke and all-cause mortality in active cancer patients with VTE, active cancer patients with non-valvular atrial fibrillation (NVAF) was calculated and the results were compared between NOAC with VKA. Results: A total of 9 RCTs were included, including 5 cancers with VTE (5/9) and 4 cancers with NVAF (4/9). A total of 5 867 patients were included. After excluding 1 818 (30.99%) patients with cancer history, 4 049 (68.86%) patients with active cancer were statistically analyzed. Among them, 2 278 (56.26%) received NOAC treatment, 1 771 patients (43.74%) received VKA treatment. The quality of the included documents was high (all scores were>5 points), and the data of each included document could be summarized and analyzed (P>0.05). The heterogeneity of main outcome events was very low (I2 = 0). In VTE patients with active cancer, NOACs were more effective in reducing recurrence of VTE （RR=0.55, 95%CI 0.36 -0.84; P = 0.005) and clinically related non-major bleeding (RR=0.77, 95%CI 0.60 -0.98; P = 0.03) than VKAs. In NVAF patients with active cancer, efficacy of NOACs and VKAs was similar in terms of reducing VTE, stroke, clinically related non-major bleeding, major bleeding and all-cause mortality events (P>0.05). Conclusions: For patients with active cancer accompanied by VTE, NOAC may has more advantages in efficacy and safety compared to VKA in the prevention and treatment of thrombotic diseases.

[Endoscopic features and clinical correlation analysis of 24 patients with Cronkhite-Canada syndrome]

Objective: To clarify the endoscopic changes prior to corticosteroid therapy in Cronkhite-Canada syndrome (CCS) patients and to explore the correlation between endoscopic features and clinical characteristics. Methods: A total of 24 CCS patients who were hospitalized in Peking Union Medical College Hospital from January 1999 to June 2019 and underwent gastroscopy and colonoscopy before corticosteroid therapy were retrospectively enrolled. The endoscopic images were re-interpreted. The demographic characteristics, clinical manifestations, laboratory tests and histopathological data were collected and analyzed. Results: Of all 24 patients, 15 (62.5%) were male and 9(37.5%) were female, with an average age of (59±10) years and disease course of 6 (1~36) months. Based on the endoscopic findings, the percentages of stomach, colon, duodenum, rectum and terminal ileum involvement were 100%, 100%, 95.7%, 66.7% and 50.0% respectively. Gastric involvement was more severe in the lower part of the body and the antrum of the stomach, while the cardia and the fundus were spared in 5 (20.8%) cases. Colonic involvement was more severe in the right colon. No patient showed remarkable esophageal involvement. The typical appearance under endoscopy were diffuse mucosal hyperemia and edema with polyps or nodular changes. The lesions may have mulberry-like or imbricate changes in severe cases. Lymphatic dilation in the duodenum was found in 47.8% patients. Most of the polyps were pedunculated or sub-pedunculated, with occasionally seen sessile polyps in the colon. The pit patterns of the 12 resected colon polyps in 11 patients could be classified as Kudo type Ⅲ(S), Ⅲ(L), Ⅳ and Ⅴ(I), among which 2 tubular adenomas had the Kudo type Ⅲ(L). Other resected polyps were hyperplastic polyps or CCS polyps. The disease duration prior to diagnosis was positively correlated with the maximum diameter of colon polyps (r=0.625, P=0.006). Serum albumin levels in patients with whole stomach involvement were significantly lower than those in patients with cardia spared [(29±8) g/L vs (37±5) g/L, P=0.034]. Conclusions: The typical initial endoscopic finding of CCS is multiple polyps or nodular changes on the background of diffuse hyperemia and edema lining the gastric, duodenal and colonic mucosa. Lymphatic dilatation in the duodenum could also be found. Some endoscopic features are correlated to clinical characteristics.

Uniform warm dense matter formed by direct laser heating in the presence of external magnetic fields

With the recent realization of kilotesla quasistatic magnetic fields, the interaction of a laser with magnetized solids enters an unexplored new regime. In particular, a circularly polarized (CP) laser pulse may propagate in a highly magnetized plasma of any high density without encountering cutoff reflection in the whistler mode. With this, we propose a scheme for producing uniform warm dense matter (WDM) by direct laser heating with a CP laser irradiating onto the target along the magnetic field. It is shown by particle-in-cell simulations, which include advanced ionization dynamics and collision dynamics, moderately intense right-hand CP laser light at 10^{15}W/cm^{2} can propagate in solid aluminum and heat it efficiently to the 100 eV level within picoseconds. By using two laser pulses irradiating from two sides of a thin solid target, uniform heating to WDM can be achieved. This provides a controllable way to create WDM at different temperatures.

OP0210 EFFICACY AND SAFETY OF SM03, A RECOMBINANT ANTI-HUMAN CD22 MONOCLONAL ANTIBODY IN CHINESE PATIENTS WITH RHEUMATOID ARTHRITIS: A PHASE II RANDOMIZED, DOUBLE-BLIND, MULTI-DOSE, PLACEBO-CONTROLLED STUDY

Background:

Rheumatoid arthritis (RA) is a common chronic inflammatory rheumatic disease in China. SM03 is a novel chimeric monoclonal antibody (mAb) specific to the B cell restricted antigen CD22 developed for the treatment of rheumatoid arthritis (RA) and other B cell related immunological diseases.

Objectives:

We aim to evaluate the efficacy and safety of SM03 in patients with moderately-to-severely active RA in China.

Methods:

In this 24-week Phase II randomized, double-blind, multi-dose, placebo-controlled study, 156 patients were randomized with ratio of 1:1:1 to receive 3600mg cumulative dose of SM03 (group A, 600mg * 6 infusions at 0, 2, 4, 12, 14, and 16 week), 2400mg cumulative dose of SM03 (group B, 600mg*4 infusions at 0, 2, 12, and 14 week) and placebo (group C). All patients remained on background treatment of MTX. Efficacy and safety were assessed at weeks 4, 8, 12,16 and 24.The primary efficacy end point was the American College of Rheumatology 20% improvement criteria (ACR20) response rate at week 24.Safety profile was also assessed.

Results:

ACR20 response rates at 24-week were significant for group A (65.3%, p=0.002) and B (56.9 %, p=0.024) versus group C (34.0%). There is no significant difference in ACR20 between group A and B(Table 1 & Fig 1). We did not observe significant difference in any adverse event (AE) among group A (35.3%), B (51.9%) and C (34.6%)(Table 2). In groups A and B, 13 (12.6%) patients reported treatment-related infection, and 5 (6.8%) patients were positive in anti-drug antibodies analysis. In group A (higher dose), 3.9% patient had AE of treatment-related infections. No patients reported treatment-related severe infection or any malignancies caused by treatment in groups A and B.

Table 1.

Summary of ACR/DAS EULAR Responses of Patients with RA to SM03 at Week 24

ResponseGroup CPlacebo+MTX(n=47)Group A SM03600mg*6+MTX(n=49)Group B SM03600mg*4 +MTX(n=51)ACR 2034.0%65.3% *56.9% *ACR 5017.0%44.9%**29.4%ACR 704.3%18.4%***9.8%EULAR response good & moderate40.4%75.5%^70.6%^EULAR response good12.8%30.6%^^15.7%Change of DAS28 from baseline-0.70-1.65^^^-1.38^^^DAS28≤3.214.9%30.6%19.6%DAS28<2.68.5%18.4%5.9%

Compared with group C(Placebo), results of group A and B were shown respectively

*P=0.002, P=0.024; **P= 0.003; ***P= 0.03;

^ P<0.001, P=0.003; ^^ P=0.034; ^^^P=0.008, P=0.047

Table 2.

Profile of Adverse Events

Adverse event, N (%)Group C(N=52)Group A(N=51)Group B(N=52)Any AE18(34.6)18(35.3)27(51.9)AE-drug related7(13.5)5(9.8)8(15.4)AE-mild16 (30.8)15(29.4)24(46.2)AE-moderate2(3.8)2(3.9)3(5.8)AE-severe-1(2.0)-AE-leading to discontinuation-2(3.9)-Serious adverse event, SAE1(1.9)1(2.0)-AE-1stcycle(week 0-12)151322AE-2ndcycle(week 12-24)9914Fig 1.

Percent of Patients Achieving ACR 20 Response by Visit

Conclusion:

In Chinese patients with active RA, both 2400mg and 3600mg cumulative doseof SM03,in combination with MTX were efficacious and well tolerated. throughout the 24 weeks of treatment.Moreover, SM03 has demonstrated a good safety profile, especially in terms of treatment-related infection, malignancy and immunogenicity.

References:

None

Disclosure of Interests:

None declared

AB1277 AUTOANTIBODIES IN NLRP3-ASSOCIATED AUTOINFLAMMATORY DISEASE: A CASE REPORT AND LITERATURE REVIEW

Background:

We present the first report of high-titer autoantibodies inNLRP3-associated autoinflammatory disease(NLRP3-AID).Because systemic autoinflammatory disease(SAID) is characterised by the lack of autoreactive T-cells or autoantibodies,we made a systemic review on the theme of autoantibody in SAID to clarify this phenomenon.

Objectives:

We present the first report of high-titer autoantibodiesNLRP3-AID, and discuss autoantibody in classical SAID.

Methods:

We collected the clinical data of the patient withNLRP3-AID who had high-titer autoantibodies,and made a systemic review about autoantibody in SAID.

Results:

A 38-year-old Chinese Han patient was definitely diagnosed asNLRP3-AID because of cold-triggered urticaria-like rash and fever,arthralgia,binaural sensorineural deafness,chronic meningitis,high inflammatory marker and de novoNLRP3T348M variant. Figure 1 shows pedigree of the patient.Meanwhile,she had positive antinuclear antibody(ANA) with a nucleolar pattern of 1:160, positive anti-β2GPI antibody 54-68 AU/ml (normal range < 20 AU/ml) and positive lupus anticoagulant 1.24-1.29 (normal range ≤ 1.2). Literature review found that 13 articles reported autoantibodies in Familial Mediterranean fever (FMF), and there was no autoantibody reported in hyperimmunoglobulinemia D syndrome (HIDS),TNF receptor–associated periodic syndrome(TRAPS) andNLRP3-AID. The prevalence of ANA,anti-dsDNA,RF and anti-CCP in patients with FMF was similar to healthy controls.

Fig. 1.

Pedigree of the patient. The black arrow indicates the proband. The asterisks indicate the individuals who had clinical manifestations and carry the NLRP3 T348M variant.

Conclusion:

Patients withNLRP3-AID can have high-titer ANA and APLs by accident. If patients with high-titer autoantibodies have characteristic manifestations of SAIDs instead of typical features of autoimmune diseases, we should make the final diagnosis through detailed investigation and genetic testing.

References:

[1]Ben-Chetrit E, Gattorno M, Gul A, et al. Consensus proposal for taxonomy and definition of the autoinflammatory diseases (AIDs): a Delphi study. Annals of the rheumatic diseases 2018; 77(11): 1558-65.

[2]Kuemmerle-Deschner JB, Ozen S, Tyrrell PN, et al. Diagnostic criteria for cryopyrin-associated periodic syndrome (CAPS). Annals of the rheumatic diseases 2017; 76(6): 942-7.

Disclosure of Interests:

None declared

Automated quantitative analysis of Ki-67 staining and HE images recognition and registration based on whole tissue sections in breast carcinoma

Background

The scoring of Ki-67 is highly relevant for the diagnosis, classification, prognosis, and treatment in breast invasive ductal carcinoma (IDC). Traditional scoring method of Ki-67 staining followed by manual counting, is time-consumption and inter−/intra observer variability, which may limit its clinical value. Although more and more algorithms and individual platforms have been developed for the assessment of Ki-67 stained images to improve its accuracy level, most of them lack of accurate registration of immunohistochemical (IHC) images and their matched hematoxylin-eosin (HE) images, or did not accurately labelled each positive and negative cell with Ki-67 staining based on whole tissue sections (WTS). In view of this, we introduce an accurate image registration method and an automatic identification and counting software of Ki-67 based on WTS by deep learning.

Methods

We marked 1017 breast IDC whole slide imaging (WSI), established a research workflow based on the (i) identification of IDC area, (ii) registration of HE and IHC slides from the same anatomical region, and (iii) counting of positive Ki-67 staining.

Results

The accuracy, sensitivity, and specificity levels of identifying breast IDC regions were 89.44, 85.05, and 95.23%, respectively, and the contiguous HE and Ki-67 stained slides perfectly registered. We counted and labelled each cell of 10 Ki-67 slides as standard for testing on WTS, the accuracy by automatic calculation of Ki-67 positive rate in attained IDC was 90.2%. In the human-machine competition of Ki-67 scoring, the average time of 1 slide was 2.3 min with 1 GPU by using this software, and the accuracy was 99.4%, which was over 90% of the results provided by participating doctors.

Conclusions

Our study demonstrates the enormous potential of automated quantitative analysis of Ki-67 staining and HE images recognition and registration based on WTS, and the automated scoring of Ki67 can thus successfully address issues of consistency, reproducibility and accuracy. We will provide those labelled images as an open-free platform for researchers to assess the performance of computer algorithms for automated Ki-67 scoring on IHC stained slides.

[Early containment strategies and core measures for prevention and control of novel coronavirus pneumonia in China]

In December 2019, novel coronavirus pneumonia epidemic occurred in Wuhan, Hubei Province, and spread rapidly across the country. In the early stages of the epidemic, China adopted the containment strategy and implemented a series of core measures around this strategic point, including social mobilization, strengthening case isolation and close contacts tracking management, blocking epidemic areas and traffic control to reduce personnel movements and increase social distance, environmental measures and personal protection, with a view to controlling the epidemic as soon as possible in limited areas such as Wuhan. This article summarizes the background, key points and core measures in the country and provinces. It sent prospects for future prevention and control strategies.

[Guidelines for the use of post-traumatic tetanus vaccines and passive immune preparation]

Post-traumatic tetanus is the main type of non-neonatal tetanus. To reduce the incidence and mortality rateof tetanus and guide the primary medical institutions to prevent and control tetanus after trauma, the National Immunization Planning Technical Working Group of the Chinese Center for Disease Control and Prevention has compiled this document in the reference with Position Paper by World Health Organization, and the latest research progress both at home and abroad. The guidelines focus on the basic procedures for the prevention and treatment of post-traumatic tetanus, the application of tetanus vaccines and immune preparation, and pre-exposure immunization in high-risk populations of trauma.

The efficacy and safety of ipriflavone in postmenopausal women with osteopenia or osteoporosis: A systematic review and meta-analysis

OBJECTIVES

Ipriflavone (IP) is one of the over-the-counter drugs and found in foods, which is available for prevention of osteoporosis (OP) since 1989 in over 22 countries. Although some clinical trials have suggested that IP is appropriate for treatment of OP, there continues to be controversy regarding the efficacy and safety due to some contradictory reports. With the wide usage of IP for osteoporotic women, there is a critical need for evaluation of the evidence for IP in clinical practice.

METHODS AND MATERIALS

We searched randomized control trials (RCTs) in PubMed, CENTRAL and CNKI which used the regimen of IP in postmenopausal women with osteopenia or OP. The efficacy referred to the absolute change and relative change in bone mineral density (BMD) and bone turnover markers. The safety profiles were associated with adverse events and the number of subject withdrawals due to adverse reactions.

RESULTS

Eleven RCTs (n = 1605) met the eligibility criteria were included. The increase of the BMD in lumbar spine of the IP group is greater than that of the placebo group (random effect model: SMD = 0.36; 95%CI= (0.09, 0.62)). For safety profile, most frequent reactions are gastrointestinal symptoms, but withdrawals due to adverse reactions are similar in both the IP group and placebo control at the same time intervals.

CONCLUSIONS

IP significantly increases BMD and has inhibitory effect on bone resorption markers in postmenopausal women with osteopenia or OP. Gastrointestinal symptoms may occur, but adverse drug withdrawal events were not statistically increased when compared with placebo group.

Transport of intense particle beams in large-scale plasmas

Transport of particle beams in plasmas is widely employed in fundamental research, industry, and medicine. Due to the high inertia of ion beams, their transport in plasmas is usually assumed to be stable. Here we report the focusing and flapping of intense slab proton beams transporting through large-scale plasmas by using a recently developed kinetic particle-in-cell simulation code. The beam self-focusing effect in the simulation is prominent and agrees well with previous experiments and theories. Moreover, the beam can curve and flap like turbulence as the beam density increases. Simulation and analysis indicate that the self-generated magnetic fields, produced by movement of collisional plasmas, are the dominant driver of such behaviors. By analyzing the spatial growth rate of magnetic energy and energy deposition of injected proton beams, it is found that the focusing and flapping are significantly determined by the injected beam densities and energies. In addition, a remarkable nonlinear beam energy loss is observed. Our research might find application in inertial confinement fusion and also might be of interest to the laboratory astrophysics community.

Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study

Human cadaveric study has indicated that the metacarpal head (MCH) is intracapsular in location. We hypothesized that exposure to the intra-articular inflammatory milieu in psoriatic arthritis (PsA) will lead to bone loss in the MCH.

INTRODUCTION

To compare the bone structure and microstructure in the MCH between patients with PsA and healthy controls by high-resolution peripheral quantitative CT (HR-pQCT), and to ascertain factors associated with bone loss in PsA patients.

METHODS

Sixty-two PsA patients without joint destruction and 62 age-, gender-, and body mass index-matched healthy subjects underwent HR-pQCT imaging of the second and third MCH (MCH 2&3). The number and volume of bone erosion and enthesiophytes, as well as volumetric bone mineral density (vBMD) and microstructure at the MCH 2&3, were recorded. Correlation analysis and multivariable linear regression models were used to determine the association of demographic and disease-specific variables with compromised bone structure and microstructure in PsA.

RESULTS

At the MCH 2&3, bone erosion (p = 0.003) and enthesiophyte (p = 0.000) volumes in PsA patients were significantly larger than healthy controls. In PsA patients, older age was associated with a larger erosion and enthesiophyte volume. Concerning the mean vBMD and microstructure at the MCH 2&3, PsA patients had significantly lower mean vBMD (average vBMD - 6.9%, trabecular vBMD - 8.8%, peri-trabecular vBMD - 7.7%, meta-trabecular vBMD - 9.8%), trabecular bone volume fraction (- 8.8%), and trabecular thickness (- 8.1%) compared with control subjects. Multivariable regression analysis revealed that older age and a higher C-reactive protein level were associated with trabecular bone loss.

CONCLUSIONS

PsA patients had a higher burden of bone damages (erosions and enthesiophytes) and trabecular bone loss compared with healthy control at the MCH. Inflammation contributed to the deterioration in trabecular microstructure in these patients.

[The 475th case: renal tubular acidosis, renal failure, anemia, and lactic acidosis]

A 47-year-old female patient presented nausea and vomiting for half a year and elevated serum creatinine for 3 days. Proximal renal tubular acidosis (RTA) complicated with anemiawas confirmed after admission. Secondary factors, such as autoimmune disease, drugs, poison, monoclonal gammopathy, were excluded. Renal biopsy revealed acute interstitial nephritis. The patient was administrated with daily prednisone 50 mg, sodium bicarbonate 4 g, 3 times per day, erythropoietin 3 000 U, 2 times per week, combined with potassium, calcium, and calcitriol tablets. Serum creatinine reduced to 90 μmol/L. However nausea and vomiting deteriorated with lactic acidosis. Bone marrow biopsy indicated the diagnosis of non-Hodgkin lymphoma, therefore the patient was treated with chemotherapy. Although metabolic acidosis improved gradually after chemotherapy, severe pneumocystis carinii pneumonia developed two weeks later. The patient refused further treatment and was discharged.

[Clinical characteristics of metastasis-induced acute pancreatitis in patients with lung cancer]

Objective: To analyze the clinical features and prognosis of lung cancer patients with metastasis-induced acute pancreatitis (MIAP), and to provide clues for early diagnosis. Methods: The characteristics and prognosis of 8 patients with MIAP in lung cancer admitted to Peking Union Medical College Hospital from January 2002 to September 2019 were retrospectively analyzed and were compared with non-tumor-induced AP. Results: Sevencases(7/8) were Mild AP, one (1/8) was Severe AP. Four patients (4/8) presented with AP as the reporting sign and lung cancer was not diagnosed until (112±36) days after the onset of AP. Clinical manifestations included abdominal pain (8/8), weight loss (4/8), nausea and vomiting (2/8), and jaundice (1/8). Stages of lung cancer were all Ⅳ.Histopathology proved that seven cases (7/8) were small cell lung cancer, and one case (1/8) was poorly differentiated adenocarcinoma. The median survival time was 11 months. Compared with non-tumor-induced AP, lung cancer patients with MIAP were older[(62±9) vs (48±15), P=0.018], the incidence of primary pancreatic duct dilatation (37.5% vs 3.1%, P=0.004) and abdominal lymphadenopathy (37.5% vs 6.3%, P=0.017) were higher; the level of hemoglobin [105.3±15.6) g/L vs (147.9±24.8) g/L, P<0.001] and hematocrit [(31.4±5.3) vs (42.5±6.1), P<0.001] were lower. Conclusions: Patientswith MIAP in lung cancer had poor outcome and unspecific symptoms. Old age, anemia, main pancreatic duct dilatation and abdominal lymphadenopathy are diagnostic clues that merit clinical attention.

[Guidelines for the use of post-traumatic tetanus vaccines and passive immune preparation]

Post-traumatic tetanus is the main type of non-neonatal tetanus. To reduce the incidence and mortality rate of tetanus and guide the primary medical institutions to prevent and control tetanus after trauma, National Immunization Planning Technical Working Group of the Chinese Center for Disease Control and Prevention has compiled this document in the reference with Position Paper by World Health Organization, the latest research progress from home and abroad. The guidelines focus on the basic procedures for the prevention and disposition of post-traumatic tetanus, the application of tetanus vaccines and immune preparation, and the pre-exposure immunization in high-risk populations of trauma.

[The 471st case: duodenal ulcer, mucor infection, and elevated IgG(4)]

Mucor infection is rarely reported in non-immunocompromised population, especially in isolated gastrointestinal tracts. IgG(4)-related diseases (IgG(4)-RD) have been recognized in recent years, but secondary causes of IgG(4) elevation should be differentiated. We reported a young man with duodenal mass and ulcer and high serum IgG(4) level. Histological biopsy of the mass revealed positive mucor mycelium and infiltration of IgG(4) positive plasma cells. Serum IgG(4) decreased to normal range after surgical resection and systemic antifungal treatment. This case suggests that isolated mucor mycosis infection can develop in the digestive tract and mimics as IgG(4)-related disease.