[C-reactive protein is associated with impaired working capacity in Chinese patients with ankylosing spondylitis in paid employment: the real-world evidence from Smart-phone SpondyloArthritis Management System]

To investigate the relationship between serum C-reactive protein (CRP) levels and work impairment in patients with ankylosing spondylitis (AS) based on real-world evidence. Outpatients with confirmed AS at Chinese PLA General Hospital were recruited consecutively by Smart-phone SpondyloArthritis Management System (SpAMS) from April 2016 to April 2018. The relationship between CRP and work productivity and activity impairment questionnaire (WPAI) were evaluated. Five hundred and fifty-one outpatients with AS in paid employment were recruited. The presenteeism, overall work impairment, and activity impairment rates increased by 1.4% (1.1%, 1.8%), 1.1% (0.5%, 1.6%), and 1.7% (1.3%, 2.1%), respectively, for every 10 mg/L increase in the CRP level (all P value<0.01). However, the CRP level was not associated with absenteeism after adjusting for covariates [0.5%(-0.4%, 1.0%),P>0.05]. There is a significant association between increased serum CRP levels at baseline and the previous 7-day work impairment in patients with AS. Higher CRP levels contribute to worse presenteeism, overall work impairment, and activity impairment rates, which suggests the necessity of monitoring CRP on treatment, and also indicates that anti-inflammatory therapy may be effective for improving work productivity.

Species of Botryosphaeriaceae associated with citrus branch diseases in China

Citrus is an important and widely cultivated fruit crop in South China. Although the species of fungal diseases of leaves and fruits have been extensively studied, the causal organisms of branch diseases remain poorly known in China. Species of Botryosphaeriaceae are known as important fungal pathogens causing branch diseases on citrus in the USA and Europe. To determine the diversity of Botryosphaeriaceae species associated with citrus branch diseases in China, surveys were conducted in the major citrus-producing areas from 2017 to 2020. Diseased tissues were collected from twigs, branches and trunks with a range of symptoms including cankers, cracking, dieback and gummosis. Based on morphological characteristics and phylogenetic comparison of the DNA sequences of the internal transcribed spacer region (ITS), the translation elongation factor 1-alpha gene (tef1), the β-tubulin gene (tub2) and the DNA-directed RNA polymerase II second largest subunit (rpb2), 111 isolates from nine provinces were identified as 18 species of Botryosphaeriaceae, including Botryosphaeria dothidea, B. fabicerciana, Diplodia seriata, Dothiorella alpina, Do. plurivora, Lasiodiplodia citricola, L. iraniensis, L. microconidia, L. pseudotheobromae, L. theobromae, Neodeightonia subglobosa, Neofusicoccum parvum, and six previously undescribed species, namely Do. citrimurcotticola, L. guilinensis, L. huangyanensis, L. linhaiensis, L. ponkanicola and Sphaeropsis linhaiensis spp. nov. Botryosphaeria dothidea (28.8 %) was the most abundant species, followed by L. pseudotheobromae (23.4 %), which was the most widely distributed species on citrus, occurring in six of the nine provinces sampled. Pathogenicity tests indicated that all 18 species of Botryosphaeriaceae obtained from diseased citrus tissues in this study were pathogenic to the tested Citrus reticulata shoots in vitro, while not all species are pathogenic to the tested Cocktail grapefruit (C. paradisi × C. reticulata) shoots in vivo. In addition, Lasiodiplodia was the most aggressive genus both in vitro and in vivo. This is the first study to identify Botryosphaeriaceae species related to citrus branch diseases in China and the results provide a theoretical basis for the implementation of prevention and control measures. Citation: Xiao XE, Wang W, Crous PW, et al. 2021. Species of Botryosphaeriaceae associated with citrus branch diseases in China. Persoonia 47: 106-135. https://doi.org/10.3767/persoonia.2021.47.03.

[Effectiveness of influenza vaccination for school-age children in preventing school absenteeism in Shenzhen: an empirical study]

Objective: To assess the impact of vaccination at school and influenza vaccination rates among school-age children on school absenteeism in Shenzhen. Methods: The study subjects were primary school students in Shenzhen. School absenteeism panel database from December 2017 to June 2020 of 286 primary schools in Shenzhen was merged with vaccination rates and organizational patterns (i.e., vaccination at school vs. non-school) data of 9 districts in Shenzhen after influenza vaccination for children. The outcome was the number of school absenteeism. The treatment and control groups were distinguished by organizational patterns and district vaccination rates. Difference-in-Difference (DiD) Poisson regressions were used to analyze the effectiveness of vaccination at school and higher vaccination rates. Besides, a robustness test was performed on the regression results. Results: Poisson regression analysis and robustness test of regression results showed that vaccination at school and higher vaccination rates effectively reduced the risk of school absenteeism, with effectiveness against absenteeism of 32.6% (95%CI: 17.0%-45.3%, P<0.01) and 53.0% (95%CI: 42.1%-61.8%, P<0.01), respectively. Conclusion: A free influenza vaccination program for school-age children in Shenzhen and prioritizing school-based vaccination may be an effective measure to reduce the risk of school absenteeism.

Substrate dependent terahertz magneto-optical properties of monolayer WS2

Terahertz (THz) magneto-optical (MO) properties of monolayer (ML) tungsten disulfide (WS₂), placed on different substrates and subjected to external magnetic fields, are studied using THz time-domain spectroscopy (TDS). We find that the THz MO conductivity exhibits a nearly linear response in a weak magnetic field, while a distinctly nonlinear/oscillating behavior is found in strong magnetic fields owing to strong substrate-induced random impurity scattering and interactions. The THz MO response of ML WS₂ depends sensitively on the choice of the substrates, which we trace back to electronic localization and the impact of the substrates on the Landau level (LL) spectrum. Our results provide an in-depth understanding of the THz MO properties of ML WS₂/substrate systems, especially the effect of substrates, which can be utilized to realize atomically thin THz MO nano-devices.

[Chuanxiong Rhizoma inhibits brain metastasis of lung cancer through multiple active ingredients acting on multiple targets, pathways and biological functions]

OBJECTIVE

To explore the molecular mechanism mediating the inhibitory effect of Chuanxiong Rhizoma against brain metastasis of lung cancer using network pharmacology methods and molecular docking.

METHODS

The chemical components of Chuanxiong Rhizoma and their targets were obtained through the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database. The relevant targets for brain metastasis of lung cancer were screened using the GeneCards database. Clusterpro-filerR package was used to perform GO and KEGG enrichment analysis. Cytoscape and STRING database were used to construct the "active ingredient-target-disease" network and protein-protein interaction (PPI) network of Chuanxiong Rhizoma. The core components of Chuanxiong Rhizoma and their targets in the treatment of lung cancer brain metastasis were screened based on the topological parameters, and the results were verified using molecular docking and in Chuanxiong extract- treated human lung cancer PC9 cells by detecting the core target with Western blotting.

RESULTS

Forty-eight active ingredients of Chuanxiong Rhizoma including (Z)-ligustilide, butylphthalide, oleic acid, and myricetone were screened, which target 49 proteins including INS, BDNF, FOS, VEGFA, PTGS2, ESR1, MAPK14, and PTGS1. These proteins participated in 57 biological functions such as nuclear receptor activity, ligand activation, and transcription factor activity, involving 40 signaling pathways such as prolactin signaling pathway, breast cancer, and etrogen signaling. The results of molecular docking showed that myricetone, butylphthalide, 4-hydroxy-3 butylphthalide, (Z)-ligustilide, and ligustalide-E, among others, had strong affinities to 7 cores targets including BDNF, FOS, PTGS2, and MAPK14. In PC9 cells, treatment with Chuanxiong Rhizoma extract resulted in significant reductions in the phosphorylation levels of PI3K, Akt and VEGF (P < 0.01).

CONCLUSION

Chuanxiong Rhizoma contains multiple active ingredients against brain metastasis lung cancer, and these ingredients act on multiple targets involving multiple signal pathways and biological functions.

[Autologous stem cell transplantation improves outcomes of patients with multiple myeloma receiving proteasome inhibitors and lenalidomide treatment]

OBJECTIVE

To evaluate the effect of autologous stem cell transplantation (ASCT) on treatment response and survival outcomes in patients with newly diagnosed multiple myeloma (MM) receiving treatments with proteasome inhibitors and lenalidomide.

METHODS

We retrospectively collected the clinical data of newly diagnosed MM patients, who were eligible for ASCT and received proteasome inhibitors or lenalidomide-based treatment in our hospital from January, 2015 to December, 2019. The patients were divided into transplantation group and non-transplantation group, and in transplantation group, the patients received 4 to 6 courses of induction therapy with proteasome inhibitors or lenalidomide before ASCT, while those in the non-transplantation group received more than 8 courses of induction and consolidation therapy with proteasome inhibitors or lenalidomide-based regimens. The therapeutic efficacy and survival outcomes of the patinets were compared between the two groups.

RESULTS

A total of 105 patients were enrolled in the study, including 48 (45.7%) in transplantation group and 57 (54.3%) in non-transplantation group. The two groups were matched for gender, age and treatment response after 4 courses of induction therapy (P > 0.05). The rate of optimal response before relapse differed significantly between the two groups (P=0.000), and the patients receiving ASCT had significantly higher rates of complete response (85.4% vs 54.4%, P= 0.001) and very good partial response or better (95.8% vs 73.7%, P=0.002) than those without ASCT. At the end of follow-up, the median progression-free survival in the transplantation group was not reached, as compared with 29 months in the nontransplantation group (P=0.013). The median overall survival (OS) in the two groups was not reached, but the OS was better in the transplant group than in the non-transplant group (P=0.022).

CONCLUSION

ASCT can further improve the depth of remission and survival outcomes in patients with newly diagnosed MM receiving treatments with proteasome inhibitors and lenalidomide.

Caspase-1 inhibitor reduced the lung injury in a mouse model of pleuropneumonia caused by Actinobacillus pleuropneumoniae

The pathogenesis of porcine contagious pleuropneumonia is poorly understood. In the present study, a mouse model of intranasal infection by Actinobacillus pleuropneumoniae (App) was used to examine lung inflammation. The pathogical results of lung tissues showed that App-infected mice showed dyspnea and anorexia, with severe damage by acute hemorrhage, and infiltration of eosinophils and lymphocytes, as well as increased expression of caspase-1 p20, interleukin (IL)-1β, IL-6, IL-8, IL-18 and tumor necrosis factor (TNF)-α. Caspase-1 inhibitors reduced both lung tissue damage and the expression of caspase-1 p20, IL-1β, IL-6, IL-8, TNF-α and IL-18 in infected mice. These findings suggest that the caspase-1 dependent pyroptosis involved in the pathogenesis of the mouse pleuropneumonia caused by App and the inhibition of caspase-1 reduced the lung injury of this pleuropneumonia.

[Effect of primary lesion resection on the prognosis of patients with advanced breast cancer]

Objective: To explore the effect of the resection of the primary lesion on the prognosis for patients with stage Ⅳ breast cancer. Methods: A total of 132 breast cancer patients who were first diagnosed as stage Ⅳ in the Hebei Cancer Hospital from June 2008 to June 2015 were divided into two groups: the primary resection group (n=85) and the unresection group (n=47). The influences of primary resection, timing of operation, lymph node removal or dissection and radiotherapy on the prognosis of stage Ⅳ breast cancer patients were analyzed. Results: Multivariate Logistic regression analysis showed that visceral metastasis was an independent influencing factor for primary lesion resection in stage Ⅳ breast cancer patients (OR=2.590, 95% CI: 1.090-6.159). Multivariate Cox regression analysis showed that primary resection was an independent factor for the improvement of prognosis in stage Ⅳ breast cancer patients (OR=0.582, 95% CI: 0.400-0.847). The median overall survival (OS) was 37.20 months in the resection group, which was higher than 24.10 months in the unresection group (χ(2)=8.108, P=0.004). Among patients aged ≥50 years old, the median OS was 39.30 months in the resection group and 23.03 months in the unresection group, and the difference was statistically significant (χ(2)=14.191, P<0.001). The median OS was 38.00 months in the 66 patients with the operation time from diagnosis to resection of primary lesion<6 months (n=66), and 35.20 months for ≥6 months (n=19) (χ(2)=4.430, P=0.035), the difference was statistically significant (χ(2)=4.430, P=0.035). The median OR of axillary lymph node dissection and axillary lymph node excision group were 45.37 months and 33.44 months, respectively, the difference was statistically significant (χ(2)=7.832, P=0.005). The median OS of postoperative radiotherapy group and non-radiotherapy group were 44.80 months and 33.20 months, respectively, the difference was not statistically significant (χ(2)=2.950, P=0.086). Conclusion: Resection of the primary lesion may prolong the survival time of some advanced breast cancer patients.

[Epidemiological characteristics of Chlamydia pneumoniae in cases with acute respiratory infection in Beijing, 2015-2019]

Objective: To analyze the epidemiological characteristics of Chlamydia pneumoniae infection among patients with acute respiratory infection in Beijing from 2015 to 2019. Methods: The epidemiological data of acute respiratory infection patients from 35 sentinel hospitals in Beijing were collected by the respiratory pathogen surveillance system in Beijing. The clinical samples were collected to detect Chlamydia pneumoniae, and the sequence of the VD4 region of the ompA gene in positive samples was analyzed. Results: From January 2015 to December 2019, the overall positive rate of Chlamydia pneumoniae among patients with acute respiratory infection in Beijing was 0.34% (129/37 460). The positive rate of Chlamydia pneumoniae generally increased in March, reaching the peak in May, and started to drop in July, with a duration of about 5-8 months. The epidemic season in different years fluctuated by 1-2 months. The positive monthly rate of Chlamydia pneumoniae was no less than 0.30% in every epidemic season. The positive rate of Chlamydia pneumoniae was the highest in the 5-44 years old group and the highest in 10-14 year-olds. The risk of Chlamydia pneumoniae infection increased with age in patients younger than 25 years old and decreased in those older one aged than 25 years of age. The positive rates in male and female patients were 0.33% (68/20 830) and 0.37% (61/16 528), respectively, and there was no significant difference between the two groups (χ²=0.486, P=0.486). The positive rate of Chlamydia pneumoniae in patients with common pneumonia was higher than that in patients with upper pneumonia and severe pneumonia (χ²=36.797, P<0.01). Other respiratory pathogens were also detected in the Chlamydia pneumoniae samples, and the top four pathogens appeared as Haemophilus influenzae (15 cases), Streptococcus pneumoniae (13 cases), Rhinovirus (8 cases), and Stenotrophomonas maltophilia (7 cases). 101 strains of 129 Chlamydia pneumoniae positive samples were identified as type A by sequencing. Conclusions: The annual epidemic pattern of Chlamydia pneumoniae in Beijing, is unimodal, and the epidemic season generally appears from March to July. The seasonal characteristics of Chlamydia pneumoniae in Beijing can be used for the differential diagnosis of Chlamydia pneumoniae from other respiratory pathogens. Chlamydia pneumoniae is most common in people aged 5-44 years, and the primary genotype is type A. People aged 10-44 years old suffer the highest incidence. If the nucleic acid positive rate of Chlamydia pneumoniae exceeds 0.30% for two consecutive months, the high prevalence period of Chlamydia pneumoniae can be preliminarily expected. Chlamydia pneumoniae infection has a higher probability of progressing to severe pneumonia from general pneumonia.

Species of Botryosphaeriaceae associated with citrus branch diseases in China

Citrus is an important and widely cultivated fruit crop in South China. Although the species of fungal diseases of leaves and fruits have been extensively studied, the causal organisms of branch diseases remain poorly known in China. Species of Botryosphaeriaceae are known as important fungal pathogens causing branch diseases on citrus in the USA and Europe. To determine the diversity of Botryosphaeriaceae species associated with citrus branch diseases in China, surveys were conducted in the major citrus-producing areas from 2017 to 2020. Diseased tissues were collected from twigs, branches and trunks with a range of symptoms including cankers, cracking, dieback and gummosis. Based on morphological characteristics and phylogenetic comparison of the DNA sequences of the internal transcribed spacer region (ITS), the translation elongation factor 1-alpha gene (tef1), the β-tubulin gene (tub2) and the DNA-directed RNA polymerase II second largest subunit (rpb2), 111 isolates from nine provinces were identified as 18 species of Botryosphaeriaceae, including Botryosphaeria dothidea, B. fabicerciana, Diplodia seriata, Dothiorella alpina, Do. plurivora, Lasiodiplodia citricola, L. iraniensis, L. microconidia, L. pseudotheobromae, L. theobromae, Neodeightonia subglobosa, Neofusicoccum parvum, and six previously undescribed species, namely Do. citrimurcotticola, L. guilinensis, L. huangyanensis, L. linhaiensis, L. ponkanicola and Sphaeropsis linhaiensis spp. nov. Botryosphaeria dothidea (28.8 %) was the most abundant species, followed by L. pseudotheobromae (23.4 %), which was the most widely distributed species on citrus, occurring in six of the nine provinces sampled. Pathogenicity tests indicated that all 18 species of Botryosphaeriaceae obtained from diseased citrus tissues in this study were pathogenic to the tested Citrus reticulata shoots in vitro, while not all species are pathogenic to the tested Cocktail grapefruit (C. paradisi × C. reticulata) shoots in vivo. In addition, Lasiodiplodia was the most aggressive genus both in vitro and in vivo. This is the first study to identify Botryosphaeriaceae species related to citrus branch diseases in China and the results provide a theoretical basis for the implementation of prevention and control measures. Citation: Xiao XE, Wang W, Crous PW, et al. 2021. Species of Botryosphaeriaceae associated with citrus branch diseases in China. Persoonia 47: 106-135. https://doi.org/10.3767/persoonia.2021.47.03.

[Evaluation of the effectiveness of community health education for the prevention and control of retransmission of imported malaria in Zhangjiagang City]

OBJECTIVE

To increase the awareness of malaria prevention and control among people going abroad and returners, so as to prevent the local retransmission of oversea imported malaria.

METHODS

Health education interventions for malaria control were given to people going abroad and returners in communities, and the changes of malaria prevention and control knowledge and medical-seeking behaviors were observed among the target populations.

RESULTS

There were 367 people going abroad and oversea returners from malaria-endemic areas in Zhangjiagang City from July 2018 to December 2019, and 18 imported malaria cases were found. Following the implementation of community health education, the awareness of malaria prevention and control knowledge increased significantly from 35.09% to 93.08% among the target populations (χ² = 78.130, P < 0.01), and the proportions of carrying anti-malarial drugs and administration of anti-malarial drugs for emergency treatment increased from 12.14% and 11.46% to 26.79% and 26.79% (χ² = 8.793 and 9.834, P < 0.05), respectively. In addition, the mean duration from malaria onset to the definitive diagnosis reduced from (5.86 ± 4.45) days to (3.11 ± 1.28) days (U = 64.000, P < 0.05).

CONCLUSIONS

Community health education based on the precision community administration is an effective approach for malaria control in current era.

EGFR tyrosine kinase inhibitor Almonertinib induces apoptosis and autophagy mediated by reactive oxygen species in non-small cell lung cancer cells

Almonertinib, a new third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is highly selective to EGFR T790M-mutant non-small cell lung cancer (NSCLC). However, there is no available information on the form and molecular mechanism of Almonertinib-induced death in NSCLC cells. Herein, CCK-8 and colony formation assays, flow cytometry, electron microscopy, and western blots assay showed that Almonertinib inhibited NSCLC cells growth and proliferation by inducing apoptosis and autophagy which can be inhibited by a broad spectrum of caspase inhibitor Z-VAD-fmk or autophagy inhibitor chloroquine. Importantly, Almonertinib-induced autophagy was cytoprotective in NSCLC cells, and the blockade of autophagy improved cell apoptosis. In addition, Almonertinib increased reactive oxygen species (ROS) generation and clearance of ROS through pretreatment with N-acetyl-L-cysteine (NAC) inhibited the decrease of cell viability, apoptosis and increase of LC3-II induced by Almonertinib. The results of Western blot showed that both EGFR activity and downstream signaling pathways were inhibited by Almonertinib. Taken together, these findings indicated that Almonertinib induced apoptosis and autophagy by promoting ROS production in NSCLC cells.

[The prediction of disease progression by 18Fluorodeoxyglucose-positron emission computed tomography/CT in patients with dermatomyositis and interstitial lung disease]

To investigate the predictive value of [¹⁸F]fluorodeoxyglucose-positron emission computed tomography(PET)/CT for disease progression in patients with dermatomyositis (DM) and interstitial lung diseases (ILD). Sixty-seven DM patients who underwent [¹⁸F] FDG-PET/CT imaging were retrospectively analyzed from January 2012 to September 2017 at PLA General Hospital. Their clinical manifestations and imaging characteristics were recorded. Compared with those chronically progressed (C-ILD), patients with rapid progression (RP-ILD) had significantly higher erythrocyte sedimentation rate (ESR) and standardized uptake value (SUV) in lungs (P<0.05). In patients with RP-ILD, SUV in lungs was positively correlated with age, disease course, and ESR. Receiver operating characteristic curve analysis suggested that when lung SUV cut off value was 2.25, the sensitivity and specificity to predict disease progression was 77.8% and 72.8%, respectively. Old age, longer disease course, low creatine kinase level, higher ESR, and high SUV are prognostic factors for DM-associated ILD.

POS0925 EFFICACY OF SECUKINUMAB IN TNFI-NAÏVE PATIENTS ACROSS THE AXIAL SPONDYLOARTHRITIS SPECTRUM OVER 52 WEEKS: A POST HOC ANALYSIS OF THE MEASURE AND PREVENT CLINICAL TRIALS

Background:

Secukinumab (SEC) has demonstrated significant efficacy in patients (pts) with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA).1-5 However, evidence regarding the efficacy of SEC across the axSpA disease spectrum is limited.

Objectives:

To assess the efficacy of SEC on key efficacy endpoints in pts with axSpA (nr-axSpA and AS) over 52 weeks from 6 pooled phase 3 clinical trials.

Methods:

This post hoc analysis included pooled data from tumour necrosis factor inhibitors (TNFi)-naïve pts in the MEASURE 1-5 (AS) and PREVENT (nr-axSpA) phase 3 trials. Assessments included proportion of patients achieving ASAS40, ASAS 5/6, ASAS partial remission (ASAS-PR), ASDAS-CRP major improvement, ASDAS-CRP inactive disease (ASDAS-CRP ID), BASDAI50 and mean change from baseline in nocturnal back pain and morning stiffness with any SEC 150 mg or SEC 300 mg or placebo (PBO) at Week 16, and sustainability was measured in pts treated with SEC at Week 52. Data are reported as non-responder imputation.

Results:

A total of 1558 TNFi-naïve pts (SEC 150 mg, N=932; SEC 300 mg, N=57 and PBO, N=569) with a mean age of 39.3 ± 11.58 years were included in the study. At Week 16, significantly higher improvements in pts treated with SEC versus PBO were observed in all efficacy endpoints (Table 1) with improvements sustained up to Week 52.

Conclusion:

SEC 300 mg and 150 mg provided significant and sustained improvement in the signs and symptoms of TNFi-naïve pts with axSpA regardless of radiographic status.

References:

[1]Baeten D, et al. N Engl J Med 2015;373:2534–48.

[2]Pavelka K, et al. Arthritis Res Ther 2017;19:285.

[3]Kivitz AJ, et al. Rheumatol Ther 2018;5:447–62.

[4]Feng H, et al. Chin Med J 2020;133:2521–31.

[5]Deodhar A, et al. Arthritis Rheumatol 2021;73:110–20.

Table 1.

Efficacy endpoints at Week 16 and Week 52 in TNFi-naïve patients with axSpA

EndpointsWeekAny secukinumab 150 mg (N = 932)Secukinumab 300 mg(N = 57)Placebo(N = 569)ASAS40, n (%)16399 (42.8)†25 (43.9)†134 (23.6)52508 (54.5)33 (57.9)-ASAS 5/6, n (%)16414 (44.4)†24 (42.1)†125 (22.0)52508 (54.5)33 (57.9)-ASAS partial remission, n (%)16166 (17.8)†12 (21.1)†35 (6.2)52240 (25.8)13 (22.8)-ASDAS-CRP major improvement, n (%)16266 (28.5)†16 (28.1)†43 (7.6)52336 (36.1)20 (35.1)-ASDAS-CRP ID, n (%)16171 (18.3)†11 (19.3)†31 (5.4)52247 (26.5)13 (22.8)-BASDAI50, n (%)16356 (38.2)†22 (38.6)§110 (19.3)52459 (49.2)27 (47.4)-Nocturnal back pain, mean change from baseline ± SE16−31.82 ± 0.87−37.99 ± 3.56†−18.12 ±1.13 52*−41.31 ± 27.58−46.56 ± 24.30-Overall level of morning stiffness, mean change from baseline ± SE16−3.23 ± 0.09†−3.62 ± 0.35†−1.95 ± 0.11†52*−4.24 ± 2.75−4.71 ± 2.74-

Data presented as NRI.

†P <0.001; §P<0.01 vs placebo; *mean change ± SD.

ASAS, Assessment of SpondyloArthritis international Society; ASDAS, Ankylosing Spondylitis Disease Activity Score; axSpA, axial spondyloarthritis; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; CRP, C-reactive protein; ID, inactive disease; NRI, non-responder imputation; SD, standard deviation; SE, standard error; TNFi, tumour necrosis factor inhibitor.

Disclosure of Interests:

Marina Magrey Consultant of: Novartis, Pfizer, Abbvie, UCB, Eli Lilly, Grant/research support from: Clinical trials with Abbvie and UCB, Jessica A. Walsh Consultant of: AbbVie, Novartis, Eli Lilly and Company, UCB, Grant/research support from: AbbVie, Pfizer, Janssen, feng huang: None declared, Hideto Kameda Speakers bureau: AbbVie, Asahi-Kasei, Astellas, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Gilead Sciences, Janssen, Kyowa Kirin, Mitsubishi-Tanabe, Novartis, Pfizer and UCB., Consultant of: AbbVie, Asahi-Kasei, Astellas, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly, Gilead Sciences, Janssen, Kyowa Kirin, Mitsubishi-Tanabe, Novartis, Pfizer and UCB., Grant/research support from: AbbVie, Asahi-Kasei, Astellas, Behringer, Chugai, Eisai, Mitsubishi-Tanabe, Novartis, Jianyuan Wang Employee of: Novartis, Christopher Herrem Employee of: Novartis, Patricia Pertel Employee of: Novartis, Helena Marzo-Ortega Speakers bureau: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, Pfizer, Takeda, and UCB., Consultant of: AbbVie, Celgene, Janssen, Eli Lilly and Company, Novartis, Pfizer, Takeda, and UCB., Grant/research support from: Janssen, Novartis

POS0921 EFFICACY AND SAFETY OF ACEMETACIN IN THE TREATMENT OF 1215 ACTIVE ANKYLOSING SPONDYLITIS PATIENTS: DATA FROM A PROSPECTIVE COHORT MANAGED BY SMART-PHONE SPONDYLOARTHRITIS MANAGEMENT SYSTEM

Background:

Biological DMARDs have widely used in the treatment of AS in last two decades, but NSAIDs still serves as a cornerstone in the treatment. Given the wide use of Acemetacin in AS and relative lack of clinical evidence on the selection of NSAIDs in the treatment of AS, the investigation on acemetacin treating AS is of great significance.

Objectives:

Our study aims to investigate efficacy and safety of acemetacin in the treatment of AS.

Methods:

Data on efficacy and safety is available in 1215 patients from the Chinese Ankylosing Spondylitis Imaging Cohort (CASPIC), which is collected through the Smart-phone SpondyloArthritis Management System (SpAMS)[1]. Patients’ self-assessments are completed online at baseline and every subsequent clinic visit. Physician-reported assessments, laboratory tests, and treatments were recorded by rheumatologists at every clinic visit.

Results:

1215 patients with AS were registered, of whom 992 were treated with acemetacin and 123 were treated with other NSAIDs. The results showed that total back pain and BASFI were significantly improved after three-month treatment of acemetacin, while comparing to other NSAIDs (P=0.027 and 0.015, respectively). After six-month treatment, patients taking acemetacin showed greater improvement in PGA (P=0.013), total back pain (P=0.049), night back pain (P=0.047), BASFI (P=0.042), ASDAS (P=0.007) and CRP (P=0.032) compared to those taking other NSAIDs. During the follow-up periods, no serious adverse events were reported. Mild abnormal liver function occurred in nine patients (9/992) treated with acemetacin and in six patients treated with other NSAIDs (6/123). See Table 1 for details.

Conclusion:

Acemetacin showed better efficacy and acceptable safety profile in the treatment of active ankylosing spondylitis comparing with other NSAIDs.

References:

[1]Ji, X., et al., Improvement of Disease Management and Cost Effectiveness in Chinese Patients with Ankylosing Spondylitis Using a Smart-Phone Management System: A Prospective Cohort Study. BioMed research international, 2019. 2019: p. 2171475.

Table 1.

The comparation of two groups at 0, 3 and 6 months after treatment

Baseline3 months6 months95%CIP95%CIP95%CIPPGA-0.13(-0.49, 0.24)0.494-0.28(-0.74, 0.18)0.235-0.59(-1.06, -1.13)0.013*Total back pain-0.03(-0.37, 0.32)0.889-0.50(-0.94, -0.06)0.027*-0.44(-0.88, -0.002)0.049*Night back pain0.01(-0.36, 0.38)0.956-0.30(-0.75, 0.16)0.203-0.46(-0.91, -0.006)0.047*BASFI-0.30(-0.59, 0.004)0.053-0.55(-0.99, -0.11)0.015*-0.34(-0.67, -0.01)0.042*ASDAS-0.10(-0.29, 0.08)0.287-0.15(-0.46, 0.16)0.342-0.41(-0.70, -0.11)0.007*CRP-4.39(-8.87, 0.10)0.0550.91(-10.39, 12.21)0.874-7.86(-15.03, -0.68)0.032*

Disclosure of Interests:

None declared

POS1481-HPR SEXUAL EXPERIENCE IN MALE PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS FROM A CROSS-SECTIONAL STUDY OF 113 PATIENTS

Background:

The expression and experience of sexuality is a key part of an individual self-identity1, so it is essential for both healthy individuals and patients. Patients with ankylosing spondylitis (AS) may be susceptible to sexual issues due to disease activity, dysfunction and comorbid emotional problems. However, sexuality, especially sexual experience, are rarely paid attention in patients with AS.

Objectives:

Our study aims to assess sexual experience in male patients with AS, and analyze the factors affecting sexual experience.

Methods:

This is a cross-sectional study. A total of 113 patients with AS and 46 healthy people were investigated, matched according to age and body mass index. The Sexual Experience Questionnaire is used to assess male sexual experience. Linear regression analysis is used to explore the contributions of clinical variables to worse sexual experience.

Results:

There is a significant difference in the total sexual experience score between AS patients and healthy controls (41.92±8.83 vs 46.98±8.10, P=0.0013). Also, patients with AS have a worse score in all dimensions of sexual experience, including erectile function, individual satisfaction and couple satisfaction, comparing to healthy people. In the regression model after controlling for the effects of age, disease duration and body mass index, disease activity (BASDAI), function (BASFI), mobility (BASMI, chest expansion and finger-floor distance), health index (ASAS HI), sleep quality (PSQI) and psychological status (HADS, HADS-A and HADS-D) are significant determinants of sexual experience, including erectile function (except for chest expansion), individual satisfaction (except for BASMI) and couple satisfaction (except for BASMI). See Table 1 for details.

Table 1.

Multivariable regression analysis of association between sexual experience and clinical outcomes

IndependentSexual experience total scoreErectile functionIndividual satisfactionCouple satisfactionβ (95%CI)Pβ (95%CI)Pβ (95%CI)Pβ (95%CI)PPain total-0.09 (-0.25, 0.07)0.28-0.27 (-0.58, 0.03)0.073-0.51 (-0.91, -0.100.014-0.15 (-0.32, 0.02)0.077BASDAI1.35 (-2.24, -0.45)0.003-0.42 (-0.75, -0.09)0.014-0.72 (-1.16, -0.28)0.001-0.21 (-0.40, -0.02)0.028BASFI-1.80 (-2.59, -1.01)<0.001-0.62 (-0.91, -0.32)<0.001-0.89 (-1.28, -0.50)<0.001-0.30 (-0.47, -0.13)0.001BASMI-1.04 (-2.01, -0.07)0.036-0.47 (-0.82, -0.12)0.008-0.48 (-0.96, 0.001)0.051-0.09 (-0.29, 0.12)0.413Chest expansion1.60 (0.24, 2.96)0.0210.50 (-0.004, 0.99)0.0520.74 (0.07, 1.42)0.0320.36 (0.08, 0.64)0.011Finger-floor distance-0.20 (-0.33, -0.07)0.003-0.07 (-0.11, -0.02)0.009-0.10 (-0.17, -0.03)0.003-0.04 (-0.06, -0.01)0.011ASAS HI-1.27 (-1.64, -0.91)<0.001-0.42 (-0.55, -0.28)<0.001-0.62 (-0.80, -0.43)<0.001-0.24 (-0.32, -0.16)<0.001PSQI-0.60 (-1.11, -0.09)0.021-0.19 (-0.38, -0.004)0.045-0.28 (-0.54, -0.03)0.03-0.13 (-0.23, -0.02)0.019HADS-0.53 (-0.76, -0.29)<0.001-0.18 (-0.27, -0.09)<0.001-0.24 (-0.36, -0.13)<0.001-0.10 (-0.15, -0.05)<0.001HADS-A-0.86 (-1.30, -0.42)<0.001-0.28 (-0.44, -0.12)0.001-0.42 (-0.63, -0.20)<0.001-0.17 (-0.26, -0.07)<0.001HADS-D-0.99 (-1.45, -0.53)<0.001-0.35 (-0.52, -0.19)<0.001-0.44 (-0.67, -0.21)<0.001-0.20 (-0.29, -0.10)<0.001

Conclusion:

Worse sexual experience is associated with increased disease activity, decreased function, poor mobility, decreased health index, poor sleep quality and psychological status. Therefore, special attention to worse sexual experience in patients with AS is essential to assess disease-related suffering and develop new patient management strategies.

References:

[1]Hill J, Bird H, Thorpe R. Effects of rheumatoid arthritis on sexual activity and relationships. Rheumatology (Oxford), 2003. 42(2):280-6.

Disclosure of Interests:

None declared

Pharmacokinetic modeling and simulation support for age- and weight-adjusted dosing of dabigatran etexilate in children with venous thromboembolism

BACKGROUND

Dabigatran etexilate (DE), a direct oral thrombin inhibitor, has been evaluated in children with venous thromboembolism (VTE) using oral solution, pellets, or capsules.

OBJECTIVES

This study evaluated DE pharmacokinetics (PK) in children with VTE and the appropriateness of a DE pediatric age- and weight-based dosing algorithm.

PATIENTS/METHODS

A population PK model was fitted to data from four single-arm and one randomized, comparative pediatric VTE studies (358 children aged birth to <18 years; 2748 PK observations) and one healthy-adult study (32 males aged <40 years; 1523 PK observations) using nonlinear mixed-effects modeling. A stepwise, covariate, model-building procedure evaluated the influence of covariates (e.g., age, body weight, body surface area [BSA]-normalized renal function, and sex). The final model was used to evaluate the pediatric dosing algorithm, with simulations comparing pediatric trough exposure with reference exposure defined for the pediatric studies.

RESULTS

The population PK of dabigatran was adequately described by a two-compartment model with first-order elimination and absorption. Age, weight, BSA-normalized renal function, and sex were statistically significant covariates (all P < .05). Apparent clearance increased with age (independently of body weight), diminished with decreasing BSA-normalized renal function, and was lower in females than males. All disposition parameters increased with body weight escalation (allometric scaling). Simulations confirmed that for all DE formulations, the final pediatric dosing algorithms achieved reference exposure without dose adjustment.

CONCLUSIONS

Using a population PK model of DE for children with VTE, simulations showed that the final dosing algorithms were appropriate for all DE formulations; no dose titration was needed.

COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices

BACKGROUND

The coronavirus disease (COVID-19) pandemic has affected healthcare workers (HCWs) in their clinical practice. HCWs were challenged with new guidelines and practices to protect themselves from occupational risks.

AIM

To determine whether hand hygiene behaviour by real-time measurement was related to the dynamic of the epidemic, and the type of patient being cared for in France.

METHODS

This study used an automated hand hygiene recording system to measure HCW hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic. The correlation between hand hygiene compliance and COVID-19 epidemiological data was analysed. Analysis of variance was performed to compare compliance rate during the different periods of the epidemic.

FINDINGS

HCW hand hygiene rate on room entry decreased over time; on room exit, it increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, then rebounded by 2.82% during the second wave of the epidemic. Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic; conversely, hand hygiene on room entry did not depend on the trend of the epidemic, nor on nursing of COVID-19 patients, and it decreased over time.

CONCLUSION

HCWs modified their behaviours to face the risk propensity of the pandemic. However, to improve the poor compliance at room entry, reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary; disinfection of gloving hands might solve this issue.

Childhood TB in China: notification, characteristics and risk factors for outcomes, 2010-2017

SETTING: China National Tuberculosis Programme, 2010-2017.OBJECTIVE: To describe the epidemiology of childhood (age < 15 years) TB, including treatment outcomes and risk factors for unfavourable outcomes and death.DESIGN: We used a cross-sectional design for the descriptive component and a cohort design for treatment outcomes and their risk factors (assessed using log binomial regression).RESULTS: Of 40 561 children, 77.7% (n = 31 529) were aged 10-14 years and 19.6% (n = 7931) were bacteriologically confirmed. Around 14% (n = 5827) belonged to migrant families (internal migration) and 4.0% (n = 1,642) were actively detected. Over 8 years, annual notification was consistently very low (<1%), and notification of bacteriologically confirmed TB decreased by half. Unfavourable outcomes were seen in 6% and deaths in 0.4%; there were no significant changes over the years. The independent predictors of unfavourable outcomes were active case finding and extrapulmonary TB. Children belonging to migrant family were more likely to die. Independent predictors of unfavourable outcomes as well as death were age < 5 years and previous treatment.CONCLUSION: China needs to address the issue of under-detection of childhood TB, especially in younger age groups. The risk factors identified require attention if China is to attain zero child TB deaths.