The efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled study

BACKGROUND

Dupilumab is an antibody against interleukin 4 receptor α, used in treating atopic dermatitis (AD).

OBJECTIVES

To evaluate the efficacy and safety of dupilumab in adult Chinese patients with moderate-to-severe AD.

METHODS

In this randomized, double-blind, placebo-controlled, parallel-group, phase III study, conducted between December 2018 and February 2020, patients with AD received dupilumab (300mg) or placebo once every 2 weeks for 16 weeks, and were followed up for 12 weeks. The primary efficacy endpoint was the proportion of patients with both Investigator's Global Assessment (IGA) score of 0-1 and a reduction from baseline of ≥2 points at week 16.

RESULTS

Overall, 165 patients (mean age: 30.6 years; 71.5% male) were randomized: 82 to dupilumab and 83 to placebo. At week 16, 26.8% of patients in the dupilumab group and 4.8% of patients in the placebo group achieved the primary endpoint (difference, 22.0%; 95% confidence interval [CI], 11.37-32.65%; p<0.0001). Compared with placebo, higher proportions of patients in the dupilumab group achieved ≥75% reduction in the Eczema Area and Severity Index score (57.3% vs 14.5%; difference, 42.9%; 95% CI, 29.75-55.97%; p<0.0001) and had ≥3-point (52.4% vs 9.6%; difference, 42.8%; 95% CI, 30.26-55.34%; p<0.0001) and ≥4-point (39.0% vs 4.8%; difference, 34.2%; 95% CI, 22.69-45.72%; p<0.0001) reductions in weekly average daily peak daily pruritus numerical rating scale scores. The incidence of TEAEs during the treatment period was similar in the two groups. The incidence of conjunctivitis, allergic conjunctivitis, and injection site reaction was higher in the dupilumab group than in the placebo group.

CONCLUSIONS

In adult Chinese patients, dupilumab was effective in improving the signs and symptoms of AD and demonstrated a favorable safety profile.

[Clinical pathological characteristics of 4 cases of gastric gland-derived tumors]

Objective: To investigate the pathological features of gastric tumor originated from the fundic gland, including oxyntic gland adenoma (OGA) and gastric adenocarcinoma of the fundic gland (GA-FG). Methods: A retrospective analysis of 2 cases of OGA and 2 cases of GA-FG admitted to our hospital from February 2019 to September 2019 was performed. The histological features were analyzed by immunohistochemical staining combined with endoscopic observation. Results: The four cases arose from the deep layer of the lamina propria mucosae and well differentiated. Two cases of OGA confined to the mucosa, including 1 case of irregular tubules showing low-degree dysplasia and another case of irregular branching and anastomosing tubules showing high-degree dysplasia. Two cases of GA-FG combined with submucosal invasion, showed irregular branching and anastomosing tubules and formed a so-called "endless glands" pattern. Atypia, helicobacter pylori (HP) infection, chronic gastritis, intestinal metaplasia, or gastric atrophy were not observed in the superficial epithelium covering the tumor extent. Two cases of OGA and 2 cases of GA-FG showed the same result of immunohistochemical staining: pepsinogen-1 was diffusely positive in the tumor tissues and indicated chief cell differentiation, while positive ATPase and PDGFRA-α indicated parietal cells differentiation. The expression of Syn were positive in all cases, while CD10, MUC2 and CD-X2 were negative. The upregulation of p53 protein or nuclear positivity of β-catenin was not observed. The Ki-67 labeling index in the hot area was approximately 1-5%. Conclusions: GA-FG is a well-differentiated, low-grade malignant novel subtype of gastric cancer. The immunohistochemical markers and narrowband imaging combined with magnifying endoscopy (NBI-ME) enhance the diagnostic sensitivity. Whether Syn positive expression can be one of the diagnostic item needs to be further investigate. The process of tumorigenesis of GA-FG might be the transition from low-grade dysplasia to high-grade dysplasia of OGA and further to submucosal infiltration. However, the mechanism of GAFG was still unclear. Disregulation of the Shh and Wnt/β-catenin signaling pathway might be associated with tumorigenesis of GA-FG. Endoscopic submucosal dissection (ESD) is often the preferred and curative treatment.

[A challenge for colorectal surgeons: pathogenesis, progression and management of the secondary tumors of the ovary]

A common clinical problem encountered by colorectal surgeons is the secondary tumors of the ovary (STO), particularly in young female patients. Most STO are from the digestive tract, and the known possible metastatic mechanisms include lymphatic, hematogenous, and intraperitoneal spreading. The molecular and histopathological characteristics of STO from different sites are diverse. It is particularly important to correctly identify the origin and feature of STO, which should be clarified by combining medical history, histopathology, immunohistochemistry, molecular biology, imaging and other means. The prognosis of patients with STO is poor in general. Comprehensive therapies based on surgical resection can benefit some patients. There is no specific treatment for STO at present, but not giving up easily on these patients is the right choice that every surgeon should understand.

POS0415 BLOOD-DERIVED DNA METHYLATION EPI-SIGNATURES ASSOCIATED WITH ANKYLOSING SPONDYLITIS

Background:

Most (~90%) of the ankylosing spondylitis (AS) susceptibility loci are undefined and located in non-coding regions. Epigenetic changes may alter the expression of genes involved in AS and explain part of the missing heritability. 1

Objectives:

To identify novel DNA methylation sites significant for AS and comprehensively understand the underlying pathological mechanism.

Methods:

Genome-wide DNA methylation of blood samples from 30 AS patients and 15 health controls was measured on the Infinium® MethylationEPIC BeadChip microarray. Methylome data were analyzed with ChAMP package in R.

Results:

The epigenome-wide association analysis identified 4,794 differentially methylated positions (DMPs) (FDR <0.05 and delta β >0.05), including 3,294 (68.7%) hypermethylated and 1,500 (31.3%) hypomethylated positions in AS patients (Figure 1A). The identified DMPs allowed clear distinction of most AS cases from controls in the PCA (Figure 1B) and unsupervised hierarchical clustering (Figure 1C). KEGG pathway analysis of AS associated DMPs enriched in T cell receptor signaling pathway, Th1 and Th2 cell differentiation. Besides, a total of 1,048 differentially variable positions (DVPs) were identified, the majority of which (974, 92.9%) were hypervariable in AS, while only 74 DVPs were hypovariable. The increased DNA methylation variability in disease were in line with the previous observation in other diseases, indicating the intrinsic heterogeneity in AS patients, which might be influenced by diverse factors, such as disease activity and treatment.

Figure 1.

Conclusion:

Peripheral blood mononuclear cells from AS patients display aberrant DNA methylome and increased DNA methylation variability. The results enhanced our understanding of the important role of DNA methylation in pathology of AS and offered the possibility of identifying new targets for intervention.

References:

[1]Whyte JM, Ellis JJ, Brown MA, et al. Best practices in DNA methylation: lessons from inflammatory bowel disease, psoriasis and ankylosing spondylitis. Arthritis Res Ther 2019; 21:133.

Acknowledgements:

We appreciate all the staff members of the department of rheumatology of the Third Affiliated Hospital of Sun Yat-sen University for assistance and support in the patient’s recruitment and sample collection.

Disclosure of Interests:

None declared

OP0047 IDENTIFICATION OF CLINICAL PHENOTYPES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS, PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS ACCORDING TO PERIPHERAL MUSCULOSKELETAL MANIFESTATIONS: A CLUSTER ANALYSIS IN THE INTERNATIONAL ASAS-PERSPA STUDY

Background:

Patients with a diagnosis of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA) may have predominant axial or peripheral symptoms, and the frequency and distribution of these symptoms may determine the clinical diagnosis by the rheumatologist (“clinical clusters”). Clustering analysis represents an unsupervised exploratory analysis which tries to identify homogeneous groups of cases (“statistical clusters”) without prior information about the membership for any of the cases.

Objectives:

To identify “statistical clusters” of peripheral involvement according to the specific location of these symptoms in the whole spectrum of SpA and PsA (without prior information about the diagnosis of the patients), and to evaluate whether these “statistical clusters” are in agreement with the “clinical clusters”.

Methods:

Cross-sectional and multicentre study with 24 participating countries. Consecutive patients considered by their treating rheumatologist as suffering from either PsA, axial SpA (axSpA) or peripheral SpA (pSpA) were enrolled. Four different cluster analyses were conducted: the first one using information about the specific location from all the peripheral musculoskeletal manifestations (i.e., peripheral arthritis, enthesitis and dactylitis), and thereafter a cluster analysis for each peripheral manifestation individually. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters.

Results:

4465 patients were included in the analysis. Two clusters were found with regard to the location of all the peripheral manifestations (Fig. 1). Cluster 1 showed a low prevalence of peripheral manifestations in comparison with cluster 2; however, when peripheral involvement appeared in cluster 1, this was mostly represented by arthritis of hip, knee and ankle, as well as enthesitis of the heel. Patients from cluster 1 showed a higher prevalence of males (63% vs 44%), HLA-B27 positivity (69% vs 38%) and axial involvement (80% vs 52%), as well as more frequent diagnosis of axSpA (66% vs 21%) and more frequently fulfilling the ASAS axSpA criteria (69% vs. 41%). Patients from cluster 2 showed a higher prevalence of psoriasis (63% vs 25%), a more frequent diagnosis of PsA (61% vs 19%), and they fulfilled more frequently the peripheral ASAS (26% vs 11%) and the CASPAR criteria (57% vs 19%).

Figure 1.

Distribution of the peripheral involvement across clusters

Three clusters were found with regard to the location of the peripheral arthritis. Clusters 2 and 3 showed a high prevalence of peripheral joint disease, although this was located more predominantly in the lower limbs in cluster 2, and in the upper limbs in cluster 3. Cluster 1 showed a higher prevalence of males, HLA-B27 positivity, axial involvement, a lower presence of psoriasis, a more frequent diagnosis of axSpA and fulfilling the ASAS axSpA criteria in comparison with clusters 2 and 3, respectively. Clusters 2 and 3 showed a higher prevalence of enthesitis and dactylitis in comparison with cluster 1, a more frequent diagnosis of PsA and fulfillment of the CASPAR criteria.

Information about the location of enthesitis exhibited three groups: cluster 1 showed a very low prevalence of enthesitis, while cluster 2 and 3 showed a high prevalence of enthesitis, with a predominant involvement of axial enthesis in cluster 2 and peripheral enthesitis in cluster 3.

Finally, the analysis of dactylitis also exhibited three clusters that showed a very low prevalence of dactylitis, predominantly toes and predominantly fingers involvement, respectively.

Conclusion:

These results suggest the presence of heterogeneous patterns of peripheral involvement in SpA and PsA patients without clearly defined groups, confirming the clear overlap of these peripheral manifestations across the different underlying diagnoses.

Acknowledgements:

This study was conducted under the umbrella of ASAS with unrestricted grant of Abbvie, Pfizer, Lilly, Novartis, UCB, Janssen and Merck.

Disclosure of Interests:

None declared

Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies

BACKGROUND

Spinal anesthesia is the standard for elective cesarean section but spinal anesthesia-induced hypotension remains an important problem. Accurate prediction of hypotension could enhance clinical decision-making, alter management, and facilitate early intervention. We performed a systematic review of predictors of spinal anesthesia-induced hypotension and their predictive value during cesarean section.

METHODS

PubMed, Embase, Cochrane Library, Google Scholar and Web of Science databases were searched for prospective observational studies assessing the diagnostic accuracy of predictors of spinal anesthesia-induced hypotension in elective cesarean section. The quality of studies was assessed and predictors were grouped in domains based on the type of predictor.

RESULTS

Thirty-eight studies (n=3086 patients) were included. In most studies, patients received 500-1000 mL crystalloid preload or 500-2000 mL crystalloid coload. Vasopressors for post-spinal hypotension were boluses of ephedrine 5-15 mg and/or phenylephrine 25-100 µg in most studies. The hypotension rate varied from 29% to 80% based on the definition. For analysis, >30 predictors were classified into seven domains: demographic characteristics, baseline hemodynamic variables, baseline sympathovagal balance, postural stress testing, peripheral perfusion indices, blood volume and fluid responsiveness indices, and genetic polymorphism.

CONCLUSIONS

Environmental and individual factors increased outcome variability, which restricted the value of the autonomic nervous system and peripheral perfusion indices for prediction of spinal anesthesia-induced hypotension. Supine stress tests may reflect parturients' cardiovascular tolerance during hemodynamic fluctuations and may optimize the predictive value of static state predictors. Future research for predicting spinal anesthesia-induced hypotension should focus on composite and dynamic parameters during the supine stress tests.

[Research study on nucleic acid testing of hemostatic stickers used and the surface of the recipients' hands after the inoculation of inactivated SARS-CoV-2 vaccine]

Among the staff of Beijing Chao-Yang Hospital, Capital Medical University, who received the inactivated SARS-CoV-2 vaccine on January 30 in 2021, 28 recipients were selected for this research. Samples for nucleic acid tests were collected from the surface of the recipients' both hands before and after vaccination. The hemostatic stickers used after the inoculation were also collected for nucleic acid tests. The nucleic acid tests of the samples collected from the surface of both hands of the 28 recipients before vaccination were all negative. After vaccination, the nucleic acid tests of the samples collected from the surface of both hands of recipients were positive in 3 cases, and suspicious in 8 cases, with a positive rate of 10.7%. A total of 25 hemostatic stickers used were collected, 24 of them had positive nucleic acid tests, and the rest one had suspicious nucleic acid test result, with a positive rate of 96%. The hemostatic stickers used after the inoculation have the risk of nucleic acid contamination.

The biological characters of Bmelav-like genes in the development of Bombyx mori

The ELAV/Hu family is a conserved multigene family of pan-neuronal RNA-binding protein involved in post-transcriptional regulation in metazoans. In Drosophila, three members of this family, ELAV, RBP9 and FNE, are involved in neuronal differentiation, gene expression regulation and so on. This family is less well characterized in Bombyx mori. Two orthologs BmELAV-like-1 (BmEL-1) and BmELAV-like-2 (BmEL-2) share 55%-71% and 47%-62% identity with that of in Drosophila and humans, respectively. Bmel-1 is ubiquitously expressed while Bmel-2 is expressed in the head and ovaries specifically. Proteins encoded by both genes are localized in nuclear and cytoplasm. The weight of body, cocoon, pupae and cocoon shell are differently affected in Bmel-1^- /-2^- mutants created using CRISPR/Cas9 technology. Mutations of both genes increase the expression of four silk protein genes, Fib-L, Fib-H, P25 and Ser-1. In addition, the oviposition ability of Bmel-2^- females is decreased. This study not only provides valuable insights into the functional roles of Bmelav-like genes in the growth, cocoon characters and regulation of silk protein genes expression, but also provides useful information for silkworm variety breeding.

Supramolecular Solvent Extraction-Gas Chromatography-Tandem Mass Spectrometry for Detection of Benzodiazepines in Urines

Objective To establish a method using supramolecular solvent and gas chromatography-tandem mass spectrometry （GC-MS/MS） to analyze 9 benzodiazepines in urines. Methods Urine samples containing 9 benzodiazepines reference substance were subjected to liquid-liquid extractions with supramolecular solvent, which consisted of tetrahydrofuran and 1-hexanol. The solvent layer was evaporated to dryness by stream of nitrogen. The residue was reconstituted with methanol, and GC-MS/MS analysis was performed on it. The way of data collection was multiple reaction monitoring （MRM） mode; internal standard method was employed for quantification. Results In urine samples, when the range of mass concentration was 1-100 ng/mL for diazepam, midazolam, flunitrazepam and clozapine, 5-100 ng/mL for lorazepam and alprazolam, 2-100 ng/mL for nitrazepam and clonazepam, and 0.2-100 ng/mL for estazolam, respectively, good linearities were obtained, correlation coefficients were 0.999 1-0.999 9, the lower limits of the quantifications ranged from 0.2 to 5 ng/mL, the extraction recovery rates were 81.12%-99.52%. The intra-day precision ［relative standard deviation （RSD）］ and accuracy （bias） were lower than 9.86% and 9.51%, respectively; the inter-day precision （RSD） and accuracy （bias） were lower than 8.74% and 9.98%, respectively. Nine drugs in urine samples showed good stability at ambient temperature and -20 ℃ within 15 days. The mass concentrations of alprazolam in urine samples obtained from 8 volunteers who took alprazolam tablets orally within 8-72 h after ingestions ranged from 6.54 to 88.28 ng/mL. Conclusion The supramolecular solvent extraction GC-MS/MS method for analysis of 9 benzodiazepines in urines provided by this study is simple, fast, accurate and sensitive, which can provide technical support for monitoring of poisoning by benzodiazepines for clinical treatment and judicial identification.

[Sampling survey report on Chinese physicians' cognition of the guidelines on diagnosis and treatment of colorectal cancer]

Objective: To investigate and evaluate the mastery and recognition degree of Chinese clinicians on the 2015 edition of the Chinese Criteria for Diagnosis and Treatment of Colorectal Cancer in order to provide useful suggestions for updating and formulating diagnosis and treatment standards. Methods: Simple random sampling was used to conduct a questionnaire survey in 1500 colorectal cancer-related doctors in general hospitals and cancer hospitals from 115 cities in China. The study included the following guidelines: (1) Chinese Criteria for Diagnosis and Treatment of Colorectal Cancer (2015 edition); (2) Chinese Society of Clinical Oncology Colorectal Cancer Guidelines 2017 (CSCO 2017); (3) National Comprehensive Cancer Network (NCCN) Colon Cancer Guidelines 2017.v1; (4) European Society for Medical Oncology (ESMO) Rectal Cancer Guidelines. The survey was carried out in 2017 and 2019 respectively. In the first phase, the questionnaire included 4 dimensions (guideline cognition, detection and diagnosis, pathology and staging, treatment), and 1500 questionnaires were distributed. In the second phase, the questionnaire contained 3 dimensions (basic information, current treatment status of metastatic colorectal cancer, academic expectations), and 350 questionnaires were distributed. Case (%) was used to indicate the categorical variable data, and chi-square test was used for comparison between groups. P<0.05 indicated that the difference was statistically significant. Results: In the first phase, 1472 valid questionnaires were collected, and the questionnaire efficiency was 98.1% (1472/1500). In the second phase, 337 valid questionnaires were collected, and the questionnaire efficiency was 96.3% (337/350). In the survey of the first phase, doctors had some knowledge and compliance with various guidelines, but the most familiar one was the NCCN guidelines, accounting for 90.7% (1335/1472). In the dimension of detection and diagnosis, the overall correct rate was 64.1% (944/1472). The correct rate of doctors in the first-tier cities was 55.6% (148/266), which was lower than 59.1% (182/308) and 72.9% (369/506) in the second- and the third-tier cities, and the difference was statistically significant (χ(2)=42.140, P<0.001). More than 60.0% (883/1472) of doctors was clear about the specification requirements of the staging evaluation and pathological examination. However, in terms of rectal cancer local staging evaluation, the ratio of doctors who would choose rectal MRI in the first-tier cities was lower than that of those in other tier cities [51.5% (137/266) vs. 65.6% (202/308), 63.2% (320/506) and 61.2% (240/392)], and the difference was statistically significant (χ(2)=41.886, P<0.001). In the dimensions of staging evaluation and pathological examination, there were no statistically significant differences in cognition between general and specialist hospitals (P>0.05). In the treatment dimension, 79.8% (1175/1472) of doctors considered the preoperative treatment as a necessary option for patients with middle and low locally advanced (over cT3) rectal cancer. 46.3% (681/1472) of doctors, including 60.3% (433/718) of surgeons, and 31.4% (225/716) of physicians, had a vague idea that irinotecan could not be used for postoperative adjuvant treatment of colorectal cancer. In the survey of the second phase, 93.8% (316/337) of doctors approved potentially curative systemic (conversion) therapy, and 95.3% (321/337) of doctors followed the clinical guidelines in the treatment of metastatic colorectal cancer. Regarding academic expectations, the clinician's concern for surgery was more practical, and 79.2% (267/337) of doctors wanted to know the best options of conversion therapy for potentially curable metastatic colorectal cancer. In contrast, the clinician's concern for internal medicine was more exploratory, and 80.1% (270/337) of doctors focused on selecting targeted drugs and the sequence of treatment. Conclusions: This investigation has a preliminary understanding of the diagnosis and treatment of colorectal cancer in China. (1) There are many guidelines for doctors' reference, but doctors' understanding of domestic guidelines is not as good as NCCN guidelines. (2) The degree of understanding of the guidelines varies significantly among doctors in different cities. (3) The promotion of guidelines should focus on basic concepts and theories. (4) The detection, diagnosis, and treatment of colorectal cancer should be better trained and promoted. (5) The concept of conversion therapy for metastatic colorectal cancer is highly recognized.

HMGB3 small interfere RNA suppresses mammosphere formation of MDA-MB-231 cells by down-regulating expression of HIF1α

OBJECTIVE

Breast cancer has been proven as the most common malignancy influencing the health of females. This research aimed to clarify the effects of high-mobility group box 3 (HMGB3)-small interfere RNA (HMGB3-siRNA) on the proliferation of breast cancer cells.

MATERIALS AND METHODS

HMGB3-mimic and HMGB3-siRNA lentiviral vectors were structured. The above lentiviral vectors were then transfected into normal breast cells (MCF10A) and breast cancer cells (MDA-MB-231). Cell counting kit-8 (CCK-8) analysis was employed to assess proliferative viabilities of cells. The formation of the mammosphere in breast cancer cells was examined using mammosphere-forming assay. The mRNA expression of Nanog, Sox2, and OCT-4 genes was evaluated using quantitative real time-PCR (qRT-PCR). CD44 positive/CD24 negative (CD44+/CD24-) cell levels were evaluated using flow cytometry assay. The correlation between HMGB3 and hypoxia-inducible factor 1α (HIF1α) was analyzed using Linear-Regression analysis. The interaction between HMGB3 and HIF1α expression was determined using the Dual-Luciferase assay.

RESULTS

HMGB3 expression was remarkably enhanced in breast cancer cells compared to that in normal cells (p<0.05). HMGB3-siRNA significantly decreased the proliferative activity and remarkably suppressed the mammosphere formation compared to that in single MDA-MB-231 cells (p<0.05). HMGB3-siRNA remarkably reduced Nanog, SOX2, and OCT-4 and significantly enhanced CD44+/CD24- cells compared to single MDA-MB-231 cells (p<0.05). HMGB3-siRNA significantly weakened the expression of HIF1α in MDA-MB-231 cells compared to single MDA-MB-231 cells (p<0.05). HMGB3 was positively correlated with HIF1α expression (p<0.05). There was an interaction between HMGB expression and HIF1α expression.

CONCLUSIONS

HMGB3 small interfering RNA suppressed the formation of mammosphere in MDA-MB-231 cells by downregulating the expression of HIF1α.

The relationship between glucose homeostasis status and prostate size in aging Chinese males with benign prostatic hyperplasia

PURPOSE

Increasing evidence shows that many metabolic factors are involved in the progression of benign prostatic hyperplasia (BPH). We aimed to assess the relationship between the status of glucose homeostasis and prostate size in aging Chinese males undergoing transurethral resection of the prostate (TURP) for BPH.

METHODS

A total of 1006 medical records of BPH patients undergoing TURP were reviewed. Prostate size was measured by transrectal ultrasound. Annual total prostate (TP) and transitional zone (TZ) growth rates were calculated. According to the American Diabetes Association criteria, the patients were categorized as normoglycemic, prediabetic, or diabetic. Levels of glucose homeostasis and other variables were considered independent variables in an effort to evaluate any potential correlations using non-adjusted and multivariate-adjusted regression models.

RESULTS

A total of 659 individuals were included in the study. BPH patients < 70 years old and ≥ 70 years old in the normoglycemic group had a stable prostate growth rate. The change in prostate size in those younger than 70 years, however, was faster in the prediabetic and diabetic group. Further analysis revealed that abnormal glucose homeostasis was positively correlated with prostate size. In those younger than 70 years, compared with the normal glucose group, the adjusted odds ratio (OR) for TP and TZ enlargement in the prediabetic group was 2.27 (95%CI 1.29-4.00) and 3.19 (95%CI 1.78-5.72), respectively, and the adjusted ORs were 4.74 (95%CI 2.18-10.30) and 6.16 (95%CI 2.70-14.06), respectively, for men with diabetes. However there was no significant difference among men aged ≥ 70 years.

CONCLUSIONS

Among patients undergoing TURP, the prostate volume and growth rate were affected by different status of glucose homeostasis. Hyperglycemia may play an important role in prostate growth.

[Analysis of treatment modalities and prognosis of patients with gallbladder cancer in China from 2010 to 2017]

Objective: To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China. Methods: This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed. Results: Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn't be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%. Conclusions: More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

[Estimating the distribution of COVID-19 incubation period by interval-censored data estimation method]

Objectives: The COVID-19 has been the public health issues of global concern, but the incubation period was still under discussion. This study aimed to estimate the incubation period distribution of COVID-19. Methods: The exposure and onset information of COVID-19 cases were collected from the official information platform of provincial or municipal health commissions. The distribution of COVID-19 incubation period was estimated based on the Log- normal, Gamma and Weibull distribution by interval-censored data estimation method. Results: A total of 109 confirmed cases were collected, with an average age of 39.825 years. The median COVID-19 incubation period based on Log-normal, Gamma, and Weibull distribution were 4.958 (P(25)-P(75): 3.472-7.318) days, 5.083 (P(25)-P(75): 3.511-7.314) days, and 5.695 (P(25)-P(75): 3.675-7.674) days, respectively. Gamma distribution had the largest log-likelihood result. Conclusions: The distribution of COVID-19 incubation period followed the Gamma distribution, and the interval-censored data estimation method can be used to estimate the incubation period distribution.

[Open hepatectomy versus laparoscopic in the treatment of primary left-sided hepatolithiasis: a propensity, long-term follow-up analysis at a single center]

To compare short-term and long-term efficacy after laparoscopic left hepatectomy(LLR) to open left hepatectomy(OLH) for primary left-sided hepatolithiasis. Methods: Clinical data of 187 patients with left-sided hepatolithiasis and underwent laparoscopically or open left-sided hepatectomy from October 2014 to October 2019 at the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed in this propensity score matching (PSM) study and were matched in terms of age, sex, body mass index, liver function, ASA score, comorbidities, history of biliary surgery, and smoking history on the ratio of 1∶1.There were 47 cases in each group and the mean age were (54.7±12.3)years old(range:34 to 75 years old) and (53.2±12.6) years old (range: 34 to 75 years old) in open and laparoscopically group respectively. The data of operation time, intraoperative blood loss, postoperative hospital-stay, complication rate, biliary fistula rate, stone clearance rate, and stone recurrence rate were compared. The quantitative data were compared using t-test or rank-sum test. Count data were analyzed with χ(2) test or Fisher test. Results: No significant difference was observed in the clinical characteristics of included 94 patients in this study(all P>0.05).The length of the postoperative hospital-stay after OLH was significantly higher than that in the LLH group((10.8±3.1) days vs.(8.5±2.2)days, t=4.085, P=0.000). LLR significantly decreased the incidence of postoperative biliary fistula compared with the OLH (6.3% vs.21.2%, χ(2)=4.374, P=0.036) and the rates of postoperative complications in the OLH group was significantly higher than that in the LLH group (48.9% vs.27.6%, χ(2)=4.502, P=0.034). Moreover, the stone recurrence rates in the LLH group was significantly lower than that after OLR (4.2% vs. 17.0%, χ(2)=4.029, P=0.045). OLH (95% CI: 1.55 to 10.75, P=0.004) and postoperative complications (95% CI: 1.29 to 9.52, P=0.013) were independent risk factors for prolonged hospital stay. OLH (95% CI: 1.428 to 44.080, P=0.018) and residual stones (95% CI: 1.580 to 62.379, P=0.014) were independent risk factors for the occurrence of postoperative biliary fistula. Biliary fistula (95% CI: 1.078 to 24.517, P=0.040) was an independent risk factor for the recurrence of stones. Conclusion: Compared with OLH, LLH is safe and effective for the treatment of the primary left-sided hepatolithiasis with the clinical benefits of shorter hospital stay, fewer morbidity and biliary fistula occurrence, and lower stone recurrence rates.

AB1104 ANALYSIS OF ANTINUCLEAR ANTIBODY TITERS AND PATTERNS USING HEP 2 INDIRECT IMMUNOFLUORESCENCE IN VARIOUS LIVER DISEASES

Background:

Abnormal liver function can be seen in not only hepatitis B virus infection (HBV), hepatitis C virus infection (HCV), hepatic carcinoma (HCC), but also in primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH), and systemic autoimmune rheumatic diseases (SARD). Antinuclear antibody (ANA) testing using indirect immunofluorescence assay (IIFA) is a common and economical method which contributes to detect SARD and autoimmune liver diseases [1].

Objectives:

Our objective was to investigate ANA positivity, titers and their patterns in multiple liver diseases, including PBC, AIH, HBV, HCV, and HCC, compared to healthy controls (HC).

Methods:

2537 patients with SARD, 137 PBC cases, 57 AIH cases, 3420 HBV cases, 769 HCV cases, 268 HCC cases, and 1073 HC were retrospectively assessed. The titers and patterns of ANA were detected with the IIFA method.

Results:

ANA positivity rate was considerably discernible between these diseases, which is 90.1% in SARD, 93.4% in PBC, 49.1% in AIH, 19.1% in HBV, 13.9% in HCV and 23.5% in HCC. Moreover, only 4.9% of HCC cases, 2.5% of HBV patients and 1.6% of HCV patients had an ANA titer ≥ 1:320. The mixed pattern which composed of at least two patterns majorly lied in PBC. AC-15 and AC-21 was frequently related to liver diseases; the former pattern was more frequently found in AIH (84.2%) and PBC (8.8%), and the latter pattern was easily seen in PBC (62.2%) and HCC (22.6%). The positive rate of ANA in HC was 12.2% and its major pattern was AC-2.

Conclusion:

There are differences in ANA positivity among patients with SARD and various liver diseases. Some mixed patterns may provide important evidence for the diagnosis of PBC. Clinicians should pay attention to ANA patterns and titer during the interpretation of this test.

References:

[1]Damoiseaux J, Andrade L, Carballo OG, Conrad K, Francescantonio P, Fritzler MJ, Garcia DLTI, Herold M, Klotz W, Cruvinel WM, Mimori T, von Muhlen C, Satoh M, Chan EK, (2019) Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective. ANN RHEUM DIS 78: 879-889

Figure 1.

The Proportion of Each ANA Pattern Exhibited in Different Diseases and HCANA: antinuclear antibodies; HC: healthy controls; PBC: primary biliary cirrhosis; AIH: autoimmune hepatitis; SARD: systemic autoimmune rheumatic diseases; HBV: hepatitis B virus infection: HCV: hepatitis C virus infection: HCC: hepatic carcinoma.

Acknowledgments:

None.

Disclosure of Interests:

None declared