Use of real-time artificial intelligence in detection of abnormal image patterns in standard sonographic reference planes in screening for fetal intracranial malformations

OBJECTIVES

To develop and validate an artificial intelligence system, the Prenatal ultrasound diagnosis Artificial Intelligence Conduct System (PAICS), to detect different patterns of fetal intracranial abnormality in standard sonographic reference planes for screening for congenital central nervous system (CNS) malformations.

METHODS

Neurosonographic images from normal fetuses and fetuses with CNS malformations at 18-40 gestational weeks were retrieved from the databases of two tertiary hospitals in China and assigned randomly (ratio, 8:1:1) to training, fine-tuning and internal validation datasets to develop and evaluate the PAICS. The system was built based on a real-time convolutional neural network (CNN) algorithm, You Only Look Once, version 3 (YOLOv3). An image dataset from a third tertiary hospital was used to further validate, externally, the performance of the PAICS and to compare its performance with that of sonologists with different levels of expertise. Furthermore, a prospective video dataset was employed to evaluate the performance of the PAICS in a real-time scan scenario. The diagnostic accuracy, sensitivity, specificity and area under the receiver-operating-characteristics curve (AUC) were calculated to assess the performance of the PAICS and to compare this with the performance of sonologists with different levels of experience.

RESULTS

In total, 43 890 images from 16 297 pregnancies and 169 videos from 166 pregnancies were used to develop and validate the PAICS. The system achieved excellent performance in identifying 10 types of intracranial image pattern, with macro- and microaverage AUCs, respectively, of 0.933 (95% CI, 0.798-1.000) and 0.977 (95% CI, 0.970-0.985) for the internal validation image dataset, 0.902 (95% CI, 0.816-0.989) and 0.898 (95% CI, 0.885-0.911) for the external validation image dataset and 0.969 (95% CI, 0.886-1.000) and 0.981 (95% CI, 0.974-0.988) in the real-time scan setting. The performance of the PAICS was comparable to that of expert sonologists in terms of macro- and microaverage accuracy (P = 0.863 and P = 0.775, respectively), sensitivity (P = 0.883, P = 0.846) and AUC (P = 0.891, P = 0.788), but required significantly less time (0.025 s per image for PAICS vs 4.4 s for experts, P < 0.001).

CONCLUSIONS

Both in the image dataset and in the real-time scan setting, the PAICS achieved excellent diagnostic performance for various fetal CNS abnormalities. Its performance was comparable to that of experts, but it required less time. A CNN algorithm can be trained to detect fetal CNS abnormalities. The PAICS has the potential to be an effective and efficient tool in screening for fetal CNS malformations in clinical practice. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

The amino acids, bacterial communities, and their correlations in Wuliangye-flavour liquor production

With the enhancement of people’s awareness of drinking health, the health factors in Wuliangye-flavour liquor is worth our attention. Bacterial communities in 4 layers of Zaopei from the same fermentation pit and amino acids as major health factors in 4 liquors directly related Zaopeis were investigated by Illumina MiSeq sequencing and liquid chromatography mass spectrometry, respectively. Results indicated that 18 amino acids were detected and 8 dominant bacteria (genus level) were observed. Meanwhile, total amino acids, 11 amino acids (Glu, Asp, Val, etc), bacterial diversity, and the percentages of Lactobacillus and Pseudomonas increased with the increase of Zaopei’s depth; 5 amino acids (Pro, Ser, Phe, etc) and the percentages of Pediococcus and Bacteroides first increased and then decreased with the increase of Zaopei’s depth. Moreover, 11 amino acids were significantly (P < 0.01) and strongly (|ρ| > 0.8) positively correlated with Lactobacillus and Pseudomonas numbers.

[Influence of guided bone regeneration on marginal bone loss of implants in the mandible posterior region: a 10-year retrospective cohort study]

Objective: To investigate the effect of guided bone regeneration (GBR) on marginal bone loss (MBL) in the region of the mandibular posterior tooth by using a retrospective cohort study, in order to provide reference for clinical practice. Methods: The research subjects were patients who received dental implants from October 2008 to June 2011 in the region of the mandibular posterior tooth at the Department of Oral Implantology, School of Stomatology, The Fourth Military Medical University. According to whether GBR was performed or not and the time of implant insertion, the patients were divided into the controls group (patients without bone grafting), simultaneous GBR implantation group, and delayed GBR implantation group. On this basis, the MBL was measured according to radiographs by comparing the marginal bone level from that of immediate postoperation 10 years ago. General data was collected and compared among groups, including modified plaque index (mPI), modified sulcus bleeding index (mSBI), probing depth (PD), and gingival papilla height. Results: The controls group (patients without bone grafting), implantation group, and delayed GBR implantation group followed 58, 76, 26 implants in 26, 32, 13 patients aging at (46.5±9.9), (45.5±10.7), (58.3±6.4) respectively. The duration of the follow-up was (11.2±0.7), (11.1±0.8), (11.1±0.9) years respectively. The 10-year implant survival rate was 100% (58/58), 100% (76/76), 100% (26/26). The MBL was (0.91±0.28), (0.84±0.27), (1.01±0.27) mm respectively. The MBL difference of patients with simultaneous GBR implantation and delayed GBR implantation showed statistical significance (P<0.05), but these two groups showed no statistical significance compared with the controls group (P>0.05). The mPI, mSBI, PD, and gingival papilla height of the three groups all had no significance on statistics (P>0.05). Conclusions: It can be concluded that there is no difference in long-term marginal bone resorption between simultaneous and delayed implantation with or without GBR (using autologous blood mixed with granular bone meal) in the posterior mandibular area.

Expression and immunogenicity study of a novel mhp183 gene fragment of Mycoplasma hyopneumoniae

A highly immunogenic nucleotide fragment (195bp) was selected from the Mhp183 gene of Mycoplasma hyopneumoniae using information software technology and was named Mhp183195bp. Three Mhp183195bp were linked to form a new nucleotide sequence called Mhp183615bp. Mhp183615bp was directly synthesized and cloned into a pET100 vector and expressed in Escherichia coli. After purification, the proteins were successfully validated using SDS-PAGE and Western blot. BALB/c mice were injected with purified proteins on the first, eighth, and fifteenth days of feeding, respectively; serum samples were collected from mice on the day of immunization and on the 22nd day after immunization. The antibody level in mouse serum was detected by Western blotting using purified expressed proteins as antigens. IL-2, TNF-α and IFN-γ were simultaneously detected in mouse serum by ELISA. The 30 kDa protein was successfully expressed and reacted specifically with the specific serum Mhp His-Tag mouse monoclonal antibody and pig antibody. The expressed recombinant protein was immunogenic. The expression levels of IFN-γ, IL-2 and TNF-α were found to be significantly higher on day 22 than in the control group. This study suggests that the expressed recombinant protein could be used as one of the novel vaccine candidates for Mhp.

[Effects of radical radiotherapy combined with different regimens of chemotherapy on radiation intestinal injury in patients with non-metastatic anal squamous cell carcinoma]

Objective: To investigate the effects of radical radiotherapy combined with different chemotherapy regimens (fluorouracil-based versus docetaxel plus cisplatin) on the incidence of radiation intestinal injury and the prognosis in patients with non-metastatic anal squamous cell carcinoma. Methods: A retrospective cohort study was conducted to recruit non-metastatic anal squamous cell carcinoma patients who underwent chemoradiotherapy in the Sixth Affiliated Hospital of Sun Yat-sen University and Nanfang Hospital from July 2013 to January 2021. Inclusion criteria: (1) newly diagnosed anal and perianal squamous cell carcinoma; (2) completed radical radiotherapy combined with concurrent chemotherapy; (3) tumor could be evaluated before radiotherapy. Exclusion criteria: (1) no imaging evaluation before treatment, or the tumor stage could not be determined; (2) patients undergoing local or radical resection before radiotherapy; (3) distant metastasis occurred before or during treatment; (4) recurrent anal squamous cell carcinoma. A total of 55 patients (48 from the Sixth Affiliated Hospital of Sun Yat-sen University and 7 from Nanfang Hospital) were given fluorouracil (the 5-FU group, n=34) or docetaxel combined with the cisplatin (the TP group, n=21). The evaluation of radiation intestinal injury, hematological toxicity and 3-year disease-free survival (DFS) rate were compared between the two groups. The effects of chemotherapy regimen and other clinicopathological factors on the incidence and severity of acute and chronic radiation intestinal injury were analyzed. The assessment of radiation intestinal injury was based on the American Cancer Radiotherapy Cooperation Group (RTOG) criteria. Results: During radiotherapy and within 3 months after radiotherapy, a total of 45 patients developed acute radiation intestinal injury, including 18 cases of grade 1 (32.7%), 22 cases of grade 2 (40.0%) and 5 cases of grade 3 (9.1%). No patient developed chronic radiation intestinal injury. Among the 34 patients in the 5-FU group, 21 had grade 2-3 radiation intestinal injury (21/34, 61.8%), which was significantly higher than that in the TP group (6/21, 28.6%) (χ(2)=5.723, P=0.017). Multivariate analysis showed that 5-FU chemotherapy regimen was an independent risk factor for radiation intestinal injury (HR=4.038, 95% CI: 1.250-13.045, P=0.020). With a median follow-up period of 26 (5-94) months, the 3-year DFS rate of patients in TP group and 5-FU group was 66.8% and 77.9%, respectively, whose difference was not significant (P=0.478). Univariate analysis showed that the DFS rate was associated with sex, age, tumor location, T stage, N stage, and induction chemotherapy (all P<0.05), while the DFS rate was not associated with chemotherapy regimen or radiation intestinal injury (both P>0.05). Multivariate analysis revealed that age ≥ 50 years old was an independent risk factor affecting the prognosis of patients (HR=8.301, 95% CI: 1.130-60.996, P=0.038). Conclusions: For patients with non-metastatic anal squamous cell carcinoma, radical radiotherapy combined with TP chemotherapy regimen can significantly reduce the incidence of radiation intestinal injury as compared to 5-FU regimen. However, due to the short follow-up time, the effect of different chemotherapy regimens on the prognosis is not yet clear.

High precision machine learning-enabled ECG algorithm for predicting sites of idiopathic ventricular arrhythmia origin

Introduction

Radiofrequency catheter ablation (CA) is an efficient antiarrhythmic treatment with a class I indication for idiopathic ventricular arrhythmia (IVA). The accurate prediction of the origins of IVA can significantly increase the procedure success rate, reduce operation duration and decrease the risk of complications. The present work proposes an ECG analysis algorithm to estimate 21 possible origins of idiopathic ventricular arrhythmia at a clinical-grade level accuracy, which include left coronary cusp (LCC), right coronary cusp (RCC), aortomitral continuity (AMC), summit, LCC-RCC commissure, left His bundle, mitral valve (MV), left septal including left anterior fascicle (LAF), left posterior fascicle (LPF), left anterior papillary muscle (LAPM), left posterior papillary muscle (LPPM), anterior cusp (AC), left cusp (LC), right cusp (RC), RVOT septal, free wall, right His bundle, tricuspid valve (TV), and right anterior papillary muscle (RAPM).

Method

A total of 18,612 ECG recordings extracted from 545 patients who underwent successful CA to treat IVA were proportionally sampled into training, validation and testing cohorts. We designed four classification schemes responding to different hierarchical levels of the possible IVA origins. The first scheme will help the operators to figure out the origin from epicardium of left ventricular summit, right, and left ventricle. The second one can separate origins from left/right outflow tract and left/right non-out flow tract, respectively. The third one is able to predict 18 anatomical locations, and the fourth scheme can distinguish 21 possible sites. For every classification scheme, we compared 98 distinct machine learning models with optimized hyperparameter values obtained through extensive grid search and reported an optimal algorithm with the highest accuracy scores attained on the validation cohorts.

Results

In the first classification scheme used to predict right ventricular endocardium, left ventricular endocardium, and epicardium of left ventricular summit, the model achieved an accuracy of 99.79 (99.41–99.89) and a F1-score of 99.84 (99.6–99.96). For scheme 2, the proposed method reached an accuracy of 99.62 (99.09–99.78) and a F1-score of 99.42 (98.79–99.75). For scheme 3, the model achieved an accuracy of 97.78 (96.76–98.41), a F1-score of 97.74 (94.15–99.73), and an adjusted accuracy of 98.53 (98.33–99.15). For scheme 4 that can distinguish 21 origin sites, the proposed model attained an accuracy of 98.24 (97.36–98.71), a F1-score of 98.56 (97.88–99.12) and an adjusted accuracy of 98.75 (98.35–99.38).

Conclusion

The proposed machine learning model can be immediately and effortlessly deployed to electrophysiology labs allowing cardiologists to predict the exact origins of arrhythmia and provide an optimum treatment plan both before and during the CA procedure. This approach will significantly reduce the CA procedure duration and the risk of complications.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): 2020 Natural Science Foundation of Zhengjiang Province Confusion matrix for classification schemes

An arthroscopic technique for closure of perforations in temporomandibular joint retrodiscal tissues

The objective of this retrospective study was to introduce and evaluate an arthroscopic discopexy for closure of retrodiscal tissue perforations. A total of 112 patients (135 joints) receiving an arthroscopic discopexy for management of retrodiscal tissue perforations between January 2016 and September 2019 were included. Pre- and postoperative visual analogue scale (VAS) pain scores and maximum inter-incisal opening (MIO), as well as magnetic resonance imaging (MRI) data, were collected and analysed. Success was recorded when the disc position was >11 o'clock, VAS pain score <3, and MIO>25 mm. For patients with a condyle deformity, postoperative bone remodelling was also recorded. The VAS pain score decreased from 3.04 ± 2.66 preoperatively to 0.88 ± 1.13 at 12 months postoperatively (P < 0.001) and MIO increased from 33.90 ± 7.39 mm to 35.19 ± 6.14 mm (P = 0.029). MRI evaluation revealed that 133 discs were successfully repositioned back on top of the condyle. Among these, 11 joints were associated with either VAS pain score ≥3 or MIO ≤25 mm. Therefore, a success rate of 90.4% (122/135) was achieved at 12 months postoperative. Bone remodelling was detected in 72 joints. Arthroscopic discopexy is a minimally invasive and effective treatment for retrodiscal tissue perforations that achieves the purpose of simultaneously restoring the intra-articular structures and relieving clinical symptoms.

[Anatomical study and clinical application of in situ reduction and fixation of anterior medial fenestration approach of femoral head fracture]

Objectives: To explore the feasibility of anterior medial fenestration approach in situ reduction and fixation in the treatment of PipkinⅠ and Ⅱ femoral head fractures,and to explore the clinical effect of this operation. Methods: Hips of two anti-corrosion adult specimens treated with formalin were dissected, then anatomical structures and directional characteristics of anterior medial main muscles,ligaments,blood vessels and nerves were observed.The anterior medial fenestration approach was performed on bilateral hips of four fresh frozen specimens to determine pulling direction of stripped muscles and ligaments required during operation,and to observe and analyze vascular and nerve traction protection directions exposed in the approach.Determine extent of exposure to the approach and assess feasibility of this approach.The clinical data of 12 patients with Pipkin Ⅰ and Ⅱ femoral head fractures who underwent in situ reduction and fixation of anterior medial fenestration at Department of Orthopaedics,Affiliated Hospital of Chengdu University from February 2016 to April 2018 were retrospectively analyzed.There were 3 males and 9 females with an age of 48.5 years(range:37 to 59 years).There were 8 cases of Pipkin type Ⅰ and 4 cases of Pipkin type Ⅱ.The operation time,blood loss,fracture healing time,last Thompson-Epstein evaluation and Harris score were observed. Results: Anterior medial fenestration approach to expose the femoral head in 4 bilateral hips with a total of 8 sides of fresh frozen specimens.The upper boundary of observation fenestration was pubic body (anterior acetabulum),and the outer upper boundary was iliacus and psoas muscle.The lateral boundary is rectus femoris and femoral vessels,the lower boundary was transverse branch of the medial femoral circumflex artery and vein.The medial boundary was pubis muscle,short adductor muscle and long adductor muscle.Pubofemoral and iliofemoral ligament were seen in fenestration. Four quadrants in front of femoral head in fenestration can be seen after cutting switch capsule active hip joint. In 12 patients with femoral head fracture,the operation time was 107.5 minutes(range:90 to 135 minutes),and the intraoperative bleeding volume was 115.0 ml(range:85 to 150 ml).The patients were followed up for 18.6 months(range:12 to 28 months).The fracture healing time of 12 patients was 144.2 days(range:120 to 180 days).The curative effect was evaluated according to Thompson-Epstein standard at the last follow-up:excellent in 6 cases,good in 4 cases and fair in 2 cases.At the last follow-up,the Harris score of hip joints was 85.1(range:75 to 93). Conclusions: Anterior medial fenestration in situ reduction and fixation surgery is feasible for the treatment of Pipkin Ⅰ and Ⅱ femoral head fractures. The short and midterm follow-up reveal satisfactory effect.

Study of PWR hot leg creep rupture and RCS depressurization strategy during an SBO accident

Preventing the leakage of radioactive materials is important to nuclear safety. During a station blackout accident in pressurized water reactors, the hot leg creep rupture caused by hot leg countercurrent flow occurs before the reactor pressure vessel failure that caused by lower head rupture. The secondary fission products barrier is lost after hot leg creep rupture. An analysis for this phenomenon was done using the Modular Accident Analysis Program version 4.0.4 code. A station blackout accident for CPR1000 is simulated and the occurrence and influence of hot leg creep rupture phenomenon are analyzed in detail. After that, a sensitivity analysis of the opening of different pressurizer pilot-operated relief valves at five minutes after entering severe accident management guideline (before the hot leg creep rupture occurs) is studied. The results show that reactor pressure vessel failure time can be extended by at least 4 h if at least one pilot-operated relief valve is opened and direct containment heating phenomenon can be eliminated if at least two pilot-operated relief valves are opened.

AB0011 EXPRESSION PROFILE AND POTENTIAL FUNCTION OF CIRCRNAS IN PERIPHERAL BLOOD MONONUCLEAR CELLS FROM PATIENTS WITH PRIMARY GOUT

Background:

Autophagy is a phenomenon of “self-phagocytosis” in eukaryotic cells, which maintains cell homeostasis by transporting intracellular materials to lysosomes for degradation and recycling. In recent years, studies have shown that autophagy may be involved in the pathogenesis of rheumatoid arthritis(RA)[1], but its specific mechanism is still unclear.

Objectives:

The expression levels of autophagy-related genes(ATG) unc-51-like kinase 1(ULK1), ATG13, ATG17, microtubule associated protein 1 light chain 3 (LC3), and P62 in peripheral blood mononuclear cells (PBMC) of patients with RA were detected, and their role and clinical significance in the pathogenesis of RA were explored.

Methods:

Real-time fluorescent quantitative PCR was performed to detect the expression levels of ULK1, ATG13, ATG17, LC3, and P62 in PBMCs of 50 RA patients, 50 healthy controls (HC), and 25 moderate to severe RA patients before and after treatment. Then, t test, χ2 test, Mann-Whitney U test, Pearson test were used for statistical analysis.

Results:

1.The levels of hsCRP, white blood cell(WBC), neutrophils(GR), platelet(PLT) and plateletcrit(PCT) in RA group were higher than those in HC group (P <0.05). Lymphocytes (LY), red blood cell(RBC), hemoglobin(HGB), hematocrit(HCT), mean corpuscular hemoglobin(MCH), mean red blood cell volume(MCV) and mean red blood cell hemoglobin concentration(MCHC) in RA group were lower than those in HC group (P <0.05). 2.The expressions of ULK1, ATG17, and LC3 in RA group were higher than those in HC group, while the expressions of P62 was lower than those in HC group(P<0.05) (Figure 1). The correlation analysis suggested that ATG17 was positively correlated with tender joint count (TJC), swollen joint count (SJC), and health assessment questionnaire (HAQ) (P<0.05); ULK1 and HAQ were negatively correlated (P<0.05).3. Compared with before treatment with TNFi, ATG17, HAQ, DAS-28, ESR, hsCRP, WBC, GR, PLT and PCT were significantly reduced after treatment (P<0.05); the expressions of RBC, HCT, MCV and MCH were significantly increased after treatment,(P<0.05); ULK1, ATG13, LC3, P62 and other related clinical and laboratory indicators were not significantly different before and after treatment with TNFi (P>0.05).

Figure 1.

The expression levels of ATGs in HC and RA groups.

Conclusion:

There is abnormal expression of autophagy genes in the peripheral blood of RA patients. ULK1, ATG17, LC3 and P62 may be related to the pathogenesis of RA, among them, ATG17 may regulate the pathogenesis of RA by participating in the TNF-α pathway.

References:

[1]Rockel Jason S,Kapoor Mohit,Autophagy: controlling cell fate in rheumatic diseases.[J].Nat Rev Rheumatol, 2016, 12: 517-31.

Disclosure of Interests:

Yu-Feng Qing Grant/research support from: Science and Technology Project of Nanchong City (no.18SXHZ0522), Fei Dai: None declared, Quan-Bo Zhang Grant/research support from: the National Natural Science Foundation of China(General Program) (no.81974250), and Science and Technology Plan Project of Sichuan Province (no.2018JY0257), Yi-Ping Tang: None declared, Zeng-Rong Dong: None declared, Yi-Xi He: None declared, Yi Jiang: None declared, Yu-Qin Huang: None declared, Jianxiong Zheng: None declared

AB0075 HSA_CIRC_0012732, HSA_CIRC_0008961, HSA_CIRC_0405239 AND HSA_CIRC_0068784 MIGHT BE INVOLVED IN THE PATHOGENESIS AND DEVELOPMENT OF ANKYLOSING SPONDYLITIS

Background:

CircRNAs have been found to be involved in the occurrence and development of many rheumatic diseases[1-2]. Are circRNAs involved in the pathogenesis of ankylosing spondylitis (AS)? How do these circRNAs participate in the pathogenesis of AS? This all needs further study.

Objectives:

This study is to clarify the expression levels of hsa_circ_0012732, hsa_circ_0008961, hsa_circ_0405239 and hsa_circ_0068784 in the peripheral blood of AS patients, and to explore whether these circRNAs are involved in the pathogenesis of AS.

Methods:

To collected 60 cases of AS (30 cases of active AS (ASA): BASDA> 6 or 6> BASDAI> 4, ESR> 22mm / h or 6> BASDAI> 4, hsCRP> 9mg / L; 30 cases of stable AS (ASS): BASDAI <4) and 30 health control (HC) peripheral blood samples, related clinical and laboratory indicators. The relative expression levels of hsa_circ_0012732, hsa_circ_0008961, hsa_circ_0405239 and hsa_circ_0068784 in each group were detected by real-time quantitative polymerase chain reaction (qPCR). The relationships between the 4 circRNAs and clinical and laboratory indicators were explored by correlation analysis.

Results:

1. The qPCR results suggested that the expression of hsa_circ_0012732 between the ASA and ASS groups was statistically significant (p<0.05), and the expression of hsa_circ_0008961 was statistically significant between the ASA and HC groups (p<0.05). Howeverthere was no statistical significance among other groups (p>0.05)Figure 1. Similarly, the expression level of hsa_circ_0405239 was not statistically significant among the groups (p>0.05), and the same was true for hsa_circ_0068784 (p>0.05).

2. Correlation analysis results (Figure 2) showed that hsa_circ_0012732 is positively correlated with lymphocyte count (LY), mean corpusular volume (MCV), albumin (ALB), and negatively correlated with Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), high sensitivity C-reactive protein (hsCRP), Globulin (GLOB) (p<0.05); hsa_circ_0008961 is negatively correlated with platelet (PLT) (p<0.05); hsa_circ_0405239 is negatively correlated with BASDAI and BASFI; hsa_circ_0068784 was negatively correlated with BASDAI (p<0.05); and there was no statistically significant (p>0.05) between these 4 circRNAs and other indicators.

Conclusion:

Hsa_circ_0012732, hsa_circ_0008961, hsa_circ_0405239 and hsa_circ_0068784 may be related to the pathogenesis of AS. Among them, hsa_circ_0012732 may be involved in AS inflammation and has the potential to participate in the judgment of disease activity.

References:

[1]LS, K., et al., The biogenesis, biology and characterization of circular RNAs. 2019. 20(11): p. 675-691.

[2]J, W., et al., Non-coding RNAs in Rheumatoid Arthritis: From Bench to Bedside. 2019. 10: p. 3129.

Disclosure of Interests:

Yi-Ping Tang Grant/research support from: Science and Technology Project of Nanchong City (18SXHZ0522)., Yu-Feng Qing: None declared, Zeng-Rong Dong: None declared, Fei Dai: None declared, Jianxiong Zheng: None declared, Yi Jiang: None declared, Yi-Xi He: None declared, Quan-Bo Zhang Grant/research support from: National Natural Science Foundation of China(General Program) (81974250); Science and Technology Plan Project of Sichuan Province (2018JY0257)

AB0449 CLINICAL CHARACTERISTICS AND RISK FACTORS OF SYSTEMIC SCLEROSIS WITH HEMATOLOGIC SYSTEM DAMAGES

Background:

SSc characterized by varying degrees of fibrosis of the skin and internal organs, clinicians pay more attention to skin and viscera conditions, tend to ignore hematologic system damage. Studies have shown that rheumatic disease such as SLE, RA, pSS often accompanied with hematologic system damages, and hematologic system damages is multiple organ involvement and risk factor of poor prognosis[1-2].

Objectives:

To investigate the the clinical features, laboratory characteristics and risk factors of Systemic Sclerosis (SSc) patient with hematologic system damages.

Methods:

The clinical data of 180 patients were collected from January 2010 to April 2020, at the Affiliated Hospital of North Sichuan Medical College. The demographic information, laboratory tests, and clinical symptoms were analyzed retrospectively.

Results:

Among 180 SSc patients, 70(38.9%) cases were complicated with hematologic system damages. 51(72.9%) cases had anemia, 24 cases (34.3%) had leukopenia, 24 cases (34.3%) had thrombocytopenia, and 22 cases had hematologic system damages associated with more than two cell line involvement. Clinical symptoms: arthritis was significantly higher in the hematologic system damages group than patient without (P<0.05), however, there was no significantly difference in gender, age, disease course, respiratory symptoms, gastrointestinal symptoms, Raynaud’s phenomenon, interstitial lung disease and pulmonary hypertension (all P>0.05). Laboratory tests: ESR and hsCRP were increased in the hematologic system damages group, while the albumin decreased (all P<0.05). The positive rates of resistance to anti-dsDNA antibody and anti-ribosomal P protein antibody was higher in the hematologic system damages group (all P<0.05). Prognosis: During follow-up, leukopenia was more likely to recover, while the thrombocytopenia was more difficult to recover. Logistics regression analysis showed that positive of anti-ribosomal P protein antibody maght be a risk factor for SSc complicated with hematologic system damages [OR = 3.930(P<0.05)] (Table 1).

Conclusion:

SSc complicated with hematologic system damages is common, and patients with hematologic system damages have more serious clinical symptoms, some of whom have difficulty in recovey. Anti-ribosomal P protein antibody may be a risk factor of SSc hematologic system damages.

Table 1.

Bivariate logistics regression analysis on risk factors associated with hematologic damages in SSc.

FactorBSEWaldOR(95%CI)P valuearthritis0.6540.3473.5431.922(0.973-3.797)0.060ESR-0.0810.4870.0280.922(0.355-2.393)0.868hsCRP-0.0070.4920.0000.993(0.379-2.607)0.989anti-dsDNA0.8680.6731.6642.393(0.637-8.916)0.197anti-Rib-P1.3690.6364.6333.930(1.130-13.666)0.031

References:

[1]González-Naranjo L A, Betancur O M, Alarcón G S, et al. Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort[J]. Seminars in Arthritis and Rheumatism, 2016,45(6):675-683.DOI:10.1016/j.semarthrit.2015.11.003.

[2]Skare T, Damin R, Hofius R. Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients[J]. Revista Brasileira de Hematologia e Hemoterapia, 2015,37(2):115-119.DOI:10.1016/j.bjhh.2015.01.006

Disclosure of Interests:

None declared.