[Functional characterization of SLC12A1 gene variants in 3 patients with Bartter syndrome type Ⅰ]

Objective: To clarify the molecular basis of patients with Bartter syndrome type I and explore the therapeutic effect of trafficking-defective variations by chemical chaperone 4-Phenylbutyric acid(4-PBA). Methods: The clinical characteristics, laboratory findings and genetic data of 3 patients diagnosed with Bartter syndrome type I who were admitted to Department of Nephrology, Children's Hospital of Nanjing Medical University from 2017 to 2018 were retrospectively analyzed. Wild type and variant SLC12A1 gene constructs were transiently overexpressed in HEK293 cells. Western blotting was used to detect the expression levels of Na⁺-K⁺-2Cl^-cotransporter(NKCC2) protein. Immunofluorescent staining was applied to investigate the subcellular localization of NKCC2 protein. In addition, the effect of the chemical chaperone 4-PBA on the expression and localization of the SLC12A1 gene variants was investigated. Unpaired t test was used for statistical analysis of 4-PBA treatment. Results: All the 3 patients (2 males and 1 female), aged 3.0, 4.0 and 1.2 years, respectively. All patients had antenatal onset with polyhydramnios and were born prematurely. After birth, all patients presented with hypochlorine alkalosis accompanied by hypokalemia and hyponatremia. Sequencing analysis revealed that the 3 patients were homozygotes or compound heterozygotes for variants in the SLC12A1 gene. In HEK293 cells, the surface expression of NKCC2 in 3 variants (p.L463S, p.L479V, p.507-510del) are all lower than in wild type (0.718±0.039, 0.287±0.081, 0.025±0.156 vs. 1.001±0.028, t=5.92, 8.35, 30.49, all P<0.01). Moreover, the total protein expression of p.L479V and p.507-510del group were all lower than that in wild type group (0.630±0.032, 0.043±0.003 vs. 1.000±0.111, t=3.21, 8.65, all P<0.05). 4-PBA treatment increased the mature protein expression level of the p.L463S and p. L479V group in 4-PBA treatment group are all higher than the untreated group (0.459±0.018 vs. 1.123±0.024, 0.053±0.012 vs. 1.256±0.037, t=2.75, 18.35, all P<0.05). Cytoplasmic retention of the L479V and 507-510del variants were observed by immunofluorescent staining. 4-PBA treatment could rescue a number of NKCC2 L479V variants to the membrane. Conclusions: The 3 SLC12A1 variants cause expression or subcellular localization defects of the protein. The findings that plasma membrane expression and activity can be rescued by 4PBA might help to develop novel therapeutic strategy for Bartter syndrome type Ⅰ.

Microwave vacuum-dried durian flour and its application in biscuits

Durian is one of most popular fruits due to its nutritional values and unique flavor. Durian products have been continuously developed to meet market needs. In this study, durian (Durio zibethinus Murr.) cv. 'Monthong' was subjected to microwave vacuum-drying at 1,200 W to produce durian flour for use in biscuits that are normally made from wheat flour. The microwave treatment induced starch gelatinization to a significant extent. As a result, compared to the wheat flour, the durian flour had lower viscosity, pasting temperature, gelatinization temperatures, and enthalpy of gelatinization but higher water absorption capacity. Dough properties including development time, dough stability, time to breakdown and the phase angle tangent of the durian dough were less than those of the wheat dough. The elastic modulus (G') and viscous modulus (G″) of the durian dough were higher than for the wheat dough. All the tested durian doughs had higher G' values than G″, indicating a viscoelastic structure. Substitution of wheat flour with durian flour should not exceed 50% to obtain reasonable dough properties and baking quality of durian biscuits.

Coupled electronic and magnetic relaxation in Fe1+yTe: direct evidence for the interaction between itinerant carriers and local moments

Iron chalcogenides are of particular interests among iron-based superconductors due to their distinct properties such as high-T_con FeSe monolayer and competing magnetic correlations in Fe_1+yTe. Here we report unusual transport properties observed near the critical composition of Fe_1+yTe (y∼ 0.09) where competing magnetic correlations exist. The resistivity exhibits surprising temperature-dependent relaxation behavior belowT_N, resulting in the increase of resistivity with time for 35 K <T<T_N, but the decrease of resistivity with time for 10 K <T< 35 K. Such resistivity relaxation is intimately coupled to the magnetization relaxation and can be attributed to the glassy magnetic states induced by the competing magnetic orders. These findings demonstrate strong coupling between itinerant carriers and local ordered moments in Fe_1+yTe.

Chronic inflammation in psoriasis promotes visceral adipose tissue association with lipid-rich necrotic core through atherogenic myeloid score

Background/Introduction

Psoriasis is a chronic inflammatory condition associated with adipose dysfunction and high-risk coronary artery disease features, including non-calcified coronary burden (NCB) and lipid-rich necrotic core (LRNC). Visceral adipose tissue (VAT) is a metabolically-active depot that secretes inflammatory and proatherogenic factors, and is associated with increased NCB. Additionally, an atherogenic myeloid score (AMS) comprised of classical monocytes, low-density granulocytes, and platelets was shown to associate with psoriasis severity and NCB.

Purpose

To investigate the relationship between VAT and high-risk plaque features and test whether this relationship was potentially mediated by myeloid cells.

Methods

A cohort of 131 psoriasis patients were included in this study. Atherogenic myeloid score components were calculated using complete blood count data (platelets) and by flow cytometry (monocytes, LDGs). Coronary NCB and LRNC were quantified using QAngio and vascuCAP respectively. VAT was defined as intra-abdominal fat and was quantified using an automated contouring software with abdominal CT scans. Statistical analyses were performed using STATA 12.

Results

The cohort was middle-aged 50 (42–61) (median (IQR)), and predominantly male (61%). High VAT vs low VAT groups differed significantly in their NCB ((0.910±0.279) vs (1.431±0.517)); p&lt;0.001), (mean ± SD). After adjustment for cardiovascular risk factors, VAT associated with the atherogenic myeloid score (β=0.221, p=0.044), with LRNC (β=0.128, p=0.047), and atherogenic myeloid score associated with LRNC (β=0.161, p=0.003). The relationship of VAT to LRNC was partially mediated by atherogenic myeloid score (25.14%, p=0.029) (Figure 1).

Conclusions

VAT associated with LRNC, and this relationship was partially mediated by the atherogenic myeloid score. These findings suggest that bioactive VAT may impart risk on coronary artery disease in part through myeloid cells.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute Intramural Research Program in Bethesda, Maryland Figure 1. Log-transformed atherogenic myeloid score partially mediates the relationship between VAT and log-transformed LRNC. Adjusted by Framingham Risk Score, PASI score, biologic therapy, statin therapy, type 2 diabetes, hyperlipidemia, and subcutaneous adipose tissue volume. Red arrow: represents indirect effect; Beta: standard regression coefficient.

Bone marrow and splenic metabolic activity by 18F-FDG PET/CT are associated with noncalcified coronary burden and lipid-rich necrotic core in psoriasis

Background/Introduction

Psoriasis is an immune-mediated inflammatory skin condition with an increased risk of myocardial infarction (MI). Elevated bone marrow (BM) and splenic hematopoiesis occurs after MI. In stable patients without chronic inflammation, higher splenic hematopoiesis predicts major adverse cardiovascular events (MACE). Nevertheless, studies in humans investigating these relationships in states of chronic inflammation on coronary artery disease features associated with MACE are limited.

Purpose

To investigate the relationships between bone marrow and splenic metabolic activity by [18]-fluorodeoxyglucose (FDG) PET/CT and subclinical cardiovascular disease in psoriasis.

Methods

Healthy participants (N=30) and psoriasis participants (N=210) were age and sex matched. All participants underwent 18FDG PET/CT and CT angiography (Toshiba 320 slice). Coronary artery plaque characteristics were assessed using QAngio CT (Medis, The Netherlands) and lipid rich necrotic core (LRNC) was assessed using vascuCAP (Elucid Bioimaging, Boston, MA). For tissue metabolic activities target-to-background ratio (TBR) was calculated as the ratio of arterial and venous standardized uptake values (SUV).

Results

The psoriasis cohort was middle aged 49.2 (±SD 11.9) years and predominantly male (64%). Those with psoriasis vs. healthy participants had higher BM (1.58 (IQR 1.35–1.89) vs. 1.23 (IQR 1.14–1.35); p&lt;0.001) and splenic (1.40 (IQR 1.21–1.66) vs.1.17 (IQR 1.11–1.26); p&lt;0.001) metabolic activity. After adjustment for cardiovascular risk factors bone marrow metabolic activity was associated with total burden, non-calcified burden (NCB) and LRNC (β=0.36, β=0.39, β=0.26; all p&lt;0.001) respectively. Similar findings were observed for splenic activity (β=0.33, β=0.36, β=0.36; all p&lt;0.001). In ROC analysis, when comparing area under the curve, BM activity better incrementally predicted non-calcified burden and lipid rich necrotic core compared to splenic activity (Figure).

Conclusions

BM and splenic metabolic activity are increased in psoriasis. Both are associated with coronary artery disease but there was a slightly stronger association with BM activity compared to splenic activity, These findings warrant further study to understand immune mechanisms underlying these observations.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung and Blood Institute Intramural Research Program in Bethesda, Maryland Figure 1. Median values of NCB and LRNC were used to convert these continuous variables into dichotomous variables such that values ≤ median were designated as 0 and values &gt;median were designated 1. Bone marrow model compared to base model and splenic model added incremental value in predicting NCB (p&lt;0.0001) and LRNC (p=0.0003). Base model: Framingham risk score, lipid treatment, biologic therapy, homeostasis model assessment as an index of insulin resistance (HOMA-IR), low density lipoprotein (LDL).

Prevalence and association of mycoplasma infection in the development of coronary artery disease

Coronary heart disease (CHD) has been associated with significant morbidity and mortality worldwide. Although remain controversial, several studies have demonstrated the association of M. pneumoniae infections with atherosclerosis. We evaluated the possible association of mycoplasma infections in patients diagnosed with atherosclerosis by ELISA and PCR methods. Atherosclerotic tissue samples and blood samples were collected for the detection of mycoplasma antibodies (IgA) by ELISA from the 97 patients with coronary artery disease (CAD). M. pneumoniae specific IgA, IgG and IgM were measured by using the Anti-M. pneumoniae IgA/IgG/IgM ELISA. Detection of M. pneumoniae targeting the P1 adhesion gene was performed by PCR Acute infection of M. pneumoniae was diagnosed in 43.3% (42) of patients by PCR. The M. pneumoniae specific antibodies were detected in 36.1% (35) of patients. Twenty-five (25.8%) cases had IgG antibodies, 15 (15.5%) cases had IgM antibodies, 3 (3.1%) cases had IgA antibodies, 10 (10.3%) cases had both IgM + IgG antibodies and 1 (1%) case of each had IgM + IgA and IgG + IgA antibodies. None of the cases was positive for all three antibodies. A Pearson correlation coefficient analysis revealed an excellent correlation between the PCR and the serological results (r=0.921, p<0.001). A majority (17, 40.5%) of the M. pneumoniae positive patients are within the 41-50 years of age group, followed by 10 (23.8%) patients in the age group of 61-70 years and 2 (4.8%) patients were >70 years of age. Our study reported an unusually higher prevalence of M. pneumoniae by serological tests (36.1%) and PCR (43.3%). Although the hypothesis of the association of M. pneumoniae and CAD is yet to be proven, the unusually high prevalence of M. pneumoniae in CAD patients indicates an association, if not, in the development of atherosclerosis.

P16.08 Inhibition of melanoma brain metastasis by targeting miR-146a

BACKGROUND

Melanoma has the highest propensity of any cancer to metastasize to the brain, with late-stage patients developing brain metastasis (MBM) in 40% of cases. Survival of patients with MBM is around 8 months with current therapies, illustrating the need for new treatments. MBM development is likely caused by molecular interactions between tumor cells and the brain, constituting the brain metastatic niche. miRNAs delivered by exosomes released from the primary tumor cells may play a role in niche establishment, yet the mechanisms are poorly understood. Here, the aim was to identify miRNAs released by exosomes from melanomas, which may be important in niche establishment and MBM progression.

MATERIAL AND METHODS

miRNAs in exosomes collected from human astrocytes, melanocytes, and MBM cell lines were profiled to determine differential expression. Functional in vitro validation was performed by cell growth and migration assays, cytokine arrays, qPCR and Western blots. Functional in vivo studies were performed after miR knockdown in MBM cell lines. An in silico docking study was performed to determine drugs that potentially inhibit transcription of miR-146a to impede MBM development.

RESULTS

miR-146a was the most upregulated miRNA in exosomes from MBM cells and was highly expressed in human and animal MBM samples. miR-146a mimics activated human astrocytes, shown by increased proliferation and migration, elevated expression of GFAP in vitro and in mouse brain tumor samples, and increased cytokine production. In animal studies, knockdown of miR-146 in MBM cells injected intracardially into mice reduced BM burden and increased animal survival. Based on the docking studies, deserpidine was found to be an effective inhibitor of MBM growth in vitro and in vivo.

CONCLUSION

miR-146a may play an important role in MBM development, and deserpidine is a promising candidate for clinical use.

The OsIME4 gene identified as a key to meiosis initiation by RNA in situ hybridization

The formation of asexual seeds in plants holds great promise as a breeding system for one-line hybrid rice. Entry into meiosis is a key developmental decision in gametogenesis, especially in formation of asexual seeds in plants. Apomeiosis in MeMCs can be achieved by identifying and manipulating meiosis-specific genes. Using methods based on in situ hybridization and expression analysis, we identified OsIME4 (inducer of meiosis 4) sense and antisense transcripts involved in rice meiosis initiation, similar to initiation of meiosis in budding yeast. Our data suggest that the OsIME4 sense transcript, which encodes a putative mRNA N6-adenosine methyltransferase, keeps rice cells at mitosis stage through some form of epigenesis (DNA/RNA methylation), and the non-coding antisense transcript of OsIME4 converts the cell status from mitosis to meiosis by inhibiting expression (transcription and translation) of the sense transcript. We identified that the non-coding antisense transcript of OsIME4 converts archesporial cell status from mitosis to meiosis by inhibiting expression of the OsIME4 sense transcript in rice. Our results provide novel insights into meiosis initiation in rice and for engineering of apomixis in sexual crops by manipulating the OsIME4 sense and antisense transcripts, which has great promise for producing apomictic rice in the future.

[Risk factors of occurrence and treatment failure of peritoneal dialysis-associated polymicrobial peritonitis: a multicenter retrospective study]

OBJECTIVE

To determine the risk factors of occurrence and treatment failure of peritoneal dialysis associatedperitonitis (PDAP) due to polymicrobial infections.

METHODS

We retrospectively collected the clinical data of patients with PDAP from the peritoneal dialysis (PD) centers in 4 general hospitals in Jilin Province from 2013 to 2019. The patients were divided, according to the results of peritoneal dialysate culture, into polymicrobial PDAP group and control group for comparison of the clinical data, treatment outcomes, and long-term prognosis. The independent risk factors of the occurrence and treatment failure of polymicrobial PDAP were explored using multivariate regression analysis.

RESULTS

We recruited a total of 625 patients from the 4 PD centers, among whom 1085 episodes of PDAP were recorded. Polymicrobial PDAP accounted for 7.6% of the total PDAP episodes, and this proportion increased from 5.3% in 2013-2016 to 9.4% in 2017-2019 (P= 0.012). Compared with the control group, polymicrobial PDAP group had higher proportions of elderly patients and patients with refractory PDAP, with greater white blood cell counts in the first-day dialysate and longer course of antibiotic treatment (P < 0.05). The risk of catheter removal and treatment failure (catheter removal or PDAP-related death) in polymicrobial PDAP group was 2.972 times (OR=2.972, 95% CI: 1.634-5.407, P < 0.001) and 2.692 times (OR=2.692, 95% CI: 1.578-4.591, P < 0.001) that in the control group, respectively. The risk of withdrawal from PD (technical failure + all-cause death) was 1.5- fold higher in polymicrobial PDAP group than that in the control group (OR=1.500, 95% CI: 1.085-2.074, P=0.014). Elderly patients (>65 years) had a 1.937-fold higher risk of experiencing polymicrobial PDAP than younger patients (OR=1.937, 95% CI: 1.207-3.109, P= 0.006). Diabetes mellitus (OR=5.554, 95% CI: 1.021-30.201, P=0.047), mixed fungal infeciton (OR=343.687, 95% CI: 21.554- 5480.144, P < 0.001), and Pseudomonas aeruginosa infection (OR=11.518, 95% CI: 1.632 to 81.310, P=0.014) were associated with increased risks of treatment failure by 4.554, 342.687 and 10.518 times, respectively.

CONCLUSION

The proportion of polymicrobial PDAP in the total PDAP cases tends to increase in recent years. Polymicrobial infection is an independent risk factor of both treatment failure and poor prognosis in patients with PDAP. An old age is an independent risk factor for polymicrobial PDAP, while diabetes mellitus and infections with mixed fungi or Pseudomonas aeruginosa are independent risk factors for treatment failure.

The effect of strength-endurance training on serum and urine metabolic profiles of female adolescent volleyball athletes

Aim

Limited investigations on metabolic responses to exercise training in female adolescent volleyball athletes exist. The aim of this study was to obtain serum and urine metabolite markers in female adolescent volleyball athletes within 2-week strength-endurance training using a metabolomics approach coupled with biochemical analysis, which would be potential biomarkers for evaluating the physiological state of athletes.

Methods

Twelve female adolescent volleyball athletes were recruited for 2-week strength-endurance training. Differential serum and urine metabolic profiles between the pre- and post-training group were obtained on gas chromatography coupled to mass spectrometry (GC-MS) and data subsequently underwent orthogonal partial least-squares analysis (OPLS).

Results

Strength-endurance training exerted a significant influence on the athletes' serum and urine metabolic profiles. The changed metabolites were primarily involved in energy metabolism, lipid metabolism and amino acids metabolism. Results support the hypothesis that female athletes displayed an increased propensity to oxidize lipids as the major energy source. Exposure to strength-endurance training also led to a significant increase in cortisol, but a decrease in testosterone, indicating disordered hormone adjustment. Exercise-induced oxidative stress occurred, as was evidenced by the decrease in reduced glutathione, and increases in blood malondialdehyde and oxidized glutathione. Since the muscle damage markers creatine kinase and lactate dehydrogenase did not show significant changes, the training might not cause cell membrane damage and the athletes did not cross the adaptive injury level.

Conclusion

By measurement of endogenous metabolites, the metabolomics study has the potential to reveal the global physiological changes in response to exercise training.

Effect of age at first egg on reproduction performance and characterization of the hypothalamo-pituitary-gonadal axis in chickens

As an important indicator of sexual maturity of hens, age at first egg (AFE) is significantly associated with reproduction performance. In this study, 400 hens were divided into 6 groups based on AFE to analyze the difference of reproduction performance, reproduction hormone levels and the characterization of the hypothalamo-pituitary-gonadal axis in chickens. The results showed that the egg production of the hens in the late-maturing groups was significantly lower than that of the ones in other groups and the precocious hens had a lower egg production rate. The hens in late-maturing group had a lower fertility rate, LH levels and shorter duration of peak of egg production (PEP), the precocious hens had lower PRL levels. In addition, the characterization of the hypothalamo-pituitary-gonadal axis showed that the individuals with normal AFE had higher GNRH, GNRHR, ESR1, KITLG, and CYP11A1 expression levels than late-maturing and precocious individuals, which indicated that the chickens with normal AFE advantages on reproduction regulation system.

Analysis of the MCL-1 gene in Chinese women with idiopathic premature ovarian insufficiency

OBJECTIVE

Animal studies have demonstrated that myeloid cell leukemia-1 (Mcl-1) gene deficiency leads to premature ovarian failure and decreased reproductive ability in mice. This study investigated the relationship between MCL-1 gene variation and idiopathic premature ovarian insufficiency (POI) in Chinese women.

METHODS

A total of 200 idiopathic POI patients and 100 healthy controls were recruited for this study, and peripheral blood was collected. First, genomic DNA was extracted from peripheral leukocytes. Then, the entire coding region and splice sites of the MCL-1 gene were amplified by polymerase chain reaction. Chi-squared tests were used to compare the genotype distribution and allele frequency of single nucleotide polymorphisms between the POI and control groups.

RESULTS

Three mutations of the MCL-1 gene (c.-36C > T, c.-131C > T and c.78C > T) were identified. After data analysis, c.-36C > T and c.-131C > T in the 5'-untranslated region were both found in the POI group and the control group. No difference was found in the genotype distribution or allelic frequency of either variant between the POI group and the control group (p > 0.05). The synonymous variant (c.78C > T) in exon 1 was discovered in only one of the control subjects and did not result in a change in amino acid sequence (p.Gly26Gly).

CONCLUSION

MCL-1 gene mutation may not be associated with idiopathic POI in Chinese women.

AB0146 HAND AND WRIST ACTIVE RANGE OF MOTIONS AND CONTRIBUTING FACTORS IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY

Background:

Patients with rheumatoid arthritis (RA) usually impaired range of motions (ROMs), especially hand and wrist active ROMs (AROMs), thus influencing their ability to perform daily activities and health-related quality of life (HR-QoL). However, little is known about the potential factors of reduced hand and wrist AROMs and their relations to quality of life in Chinese RA patients.

Objectives:

To explore the contributing factors of hand and wrist AROMs and their associations with HR-QoL and functional limitation in Chinese RA population.

Methods:

In this cross-sectional study, 108 patients were enrolled from Affiliated Hospital of Nantong University between November 2018 and July 2019. We measured all the participants’ AROMs with different directions of the hand and wrist in both sides, including volar flexion, ulnar deviation, radial deviation and radial deviation of the wrist joint, the first metacarpophalangeal (MCP1) flexion, interphalangeal (IP) flexion, volar abduction, radial abduction and thumb opposition (cm) in the thumb, average flexion, hypertension and abduction of the MCP2-5, average proximal interphalangeal (PIP) 2-5 and distal interphalangeal (DIP) 2-5 flexions, total active range of motion (TAM) of the second to the fifth fingers (TAM2-TAM5). Their sociodemographic, physical, psychological, disease-related data, acute phase reactants, laboratory indicators, drug usage and HR-QoL were examined as well. Statistical analysis used Pearson’s and Spearman’s correlation analysis, univariate and multivariate linear regression analyses.

Results:

In univariate analyses, we found that living in rural area, longer disease duration, comorbidity, hospitalization, more swollen joints, higher disease activity, pain level, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), red blood cell count and glucocorticoids usage were associated with most of the decreased hand and wrist AROMs (P ≤ 0.050), while higher education and annual income were related to most of the increased hand and wrist AROMs (P ≤ 0.048). In multivariate analyses, higher disease duration (P ≤ 0.023) and higher disease activity (P ≤ 0.033) were corelated with most of the decreased hand and wrist AROMs. Interestingly, the psychological factor, anxiety, was only positively associated with thumb opposition in both univariate and multivariate analyses (P ≤ 0.001). Additionally, most of the declined hand and wrist AROMs were associated with functional impairment and poor HR-QoL, especially in physical components (P < 0.05).

Conclusion:

Various factors, especially longer disease duration and higher disease activity, were related to decreased hand and wrist AROMs, and thus causing functional impairment and poor HR-QoL in RA patients. Clinical physicians and medical faculties should pay more attention to disease activity and disease-related symptoms of these patients in order to maintain their activity of daily living (ADL) ability and improve HR-QoL.

References:

[1]Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18002.

[2]Zhang L, Cao H, Zhang Q, Fu T, Yin R, Xia Y, et al. Motion analysis of the wrist joints in Chinese rheumatoid arthritis patients: a cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):270.

Acknowledgements:

This work was funded by Postgraduate Research & Practice Innovation Program of Jiangsu Province (Grant/Award number: KYCX19_2071), National Natural Science Foundation of China (Grant/Award number: 81871278, Science and technology Project of Jiangsu Province (Grant/Award number: BE2018671)

Disclosure of Interests:

None declared

[Electronic cigarette use-associated lung injury: a case report and literature review]

Objective: To improve the clinical recognition of electronic cigarette or vaping product use-associated lung injury. Methods: A 67 year old patient with lung injury induced by e-cigarette was reported. The concentrations of vitamin E acetate (VEA) and tetrahydrocannabinol (Δ9-THC) in BALF were measured by UHPLC-MS/MS. A literature review was performed with"Vaping-Associated Lung Injury""vape","e-cigarette","electronic cigarette","EVALI","electronic nicotine device","lung","injury","case"as Mesh terms in PubMed. Results: There were 208 cases reported in the literature, 71.6% of whom were male, and 28.4% were female, with a median age of 27 years (17-67 years), while 2 patients (1%) were over 60 years old. The median time of using e-cigarette was 90 days (2 weeks-3 years). Of the 208 patients, the most common symptoms were dyspnea, fever, chest pain, hemoptysis, and gastrointestinal symptoms such as nausea, abdominal pain or diarrhea. The most common manifestation of chest CT was bilateral ground glass opacity (n=119, 57.2%). A total of 70 patients received bronchoscopy and BALF, which showed that the ratio of macrophages was (49.5±29.8)%, neutrophil (34.7±28.7)%, lymphocytes (10.1±7.4)%, and eosinophils (2.4±3.6)%. The "foamy" alveolar macrophages were positive in 65 cases (92.9%).A total of 132 patients (63.5%) were treated with antibiotics, and 162 patients (77.9%) were treated with glucocorticoids. The initial dose of methylprednisolone was 40 mg and the maximum was 500 mg. 48 patients (23.1%) were mechanically ventilated and 10 patients (4.8%) were treated with extracorporeal membrane oxygenation (ECMO). Of the 208 patients, 202(97.1%) patients improved and 6 (2.9%) died. Conclusion: Our case and reported cases should alert physicians to the clinical presentation of vaping-associated lung injury for early diagnosis and prompt management. It is suggested that the standardized management of e-cigarette should be strengthened to avoid similar situation of e-cigarette-related lung injury in China. Additional work is needed to characterize the pathophysiology of this disease.

Accurate diagnosis of colorectal cancer based on histopathology images using artificial intelligence

BACKGROUND

Accurate and robust pathological image analysis for colorectal cancer (CRC) diagnosis is time-consuming and knowledge-intensive, but is essential for CRC patients' treatment. The current heavy workload of pathologists in clinics/hospitals may easily lead to unconscious misdiagnosis of CRC based on daily image analyses.

METHODS

Based on a state-of-the-art transfer-learned deep convolutional neural network in artificial intelligence (AI), we proposed a novel patch aggregation strategy for clinic CRC diagnosis using weakly labeled pathological whole-slide image (WSI) patches. This approach was trained and validated using an unprecedented and enormously large number of 170,099 patches, > 14,680 WSIs, from > 9631 subjects that covered diverse and representative clinical cases from multi-independent-sources across China, the USA, and Germany.

RESULTS

Our innovative AI tool consistently and nearly perfectly agreed with (average Kappa statistic 0.896) and even often better than most of the experienced expert pathologists when tested in diagnosing CRC WSIs from multicenters. The average area under the receiver operating characteristics curve (AUC) of AI was greater than that of the pathologists (0.988 vs 0.970) and achieved the best performance among the application of other AI methods to CRC diagnosis. Our AI-generated heatmap highlights the image regions of cancer tissue/cells.

CONCLUSIONS

This first-ever generalizable AI system can handle large amounts of WSIs consistently and robustly without potential bias due to fatigue commonly experienced by clinical pathologists. It will drastically alleviate the heavy clinical burden of daily pathology diagnosis and improve the treatment for CRC patients. This tool is generalizable to other cancer diagnosis based on image recognition.

[Investigation and analysis of noise hazards in three key industries in Shenzhen City]

Objective: To understand the basic situation of noise hazards in wood furniture manufacturing, stone processing and special equipment manufacturing industries in Shenzhen City, and to provide basis for preventing and controlling noise hazards. Methods: In August 2019, stratified random sampling ws used to select 21 wood funiture manafacturing, 15 stone processing and 24 special equipment manufactruing as survey object. Through the methods of occupational health field investigation, noise intensity measurement and occupational health examination data collection, the noise hazards of 60 enterprises in three industries were statistically analyzed. Results: There were 154, 44 and 113 noise detection points in wood furniture manufacturing, stone processing and special equipment manufacturing enterprises, and 101, 27 and 78 out of standard points respectively, and the exceeding standard rates were 65.6% (101/154) , 61.4% (27/44) and 69.0% (78/113) , respectively. There were 1670, 172 and 856 workers exposed to noise in the three industries. Among them, 1198, 134 and 703 people had taken occupational health examination. The physical examination rates were 71.7% (1198/1670) , 77.9% (134/172) and 82.1% (703/856) , respectively. The abnormal rates were 19.1% (229/1198) , 51.5% (69/134) and 37.8% (266/703) , respectively. Conclusion: High intensity noise working environment, too long noise exposure time, incorrect wearing of personal protective equipment and neglect of occupational health examination are important reasons for hearing loss of noise exposed personnel.