The use of carbon monoxide breath test to detect the effect of iron overload on erythrocyte lifespan in MDS

Objective

To investigate the effect of iron overload (IO) on red blood cell (RBC) lifespan in MDS patients with the use of carbon monoxide breath test

Methods

The red blood cell lifespan of 93 patients with myelodysplastic syndrome (MDS) and 22 healthy volunteers in the control group were measured by alveolar gas carbon monoxide (CO) assay, with the detection of liver iron concentration, iron metabolism index, erythropoietin (EPO) concentration, peripheral blood inflammatory cytokines, etc. The MDS patients were divided into the severe IO group, mild IO group and non IO group according to liver iron concentration. The effect of IO on RBC lifespan was analyzed in MDS patients.

Results

The RBC lifespan of MDS patients in the severe IO group was significantly lower than that in the mild IO group (p<0.05), while the RBC life span in the mild IO group was significantly lower than that in the non IO group (p<0.05). The expression of inflammatory cytokines in the severe IO group was significantly higher than that of the mild and non IO groups. After receiving iron removal treatment(ICT), the expression of inflammatory cytokines was decreased significantly, and the RBC lifespan was significantly prolonged (p<0.05).Besides, liver iron concentration was significantly positively correlated with EPO concentration, while EPO concentration was significantly negatively correlated with RBC lifespan, especially in the MDS-RS subgroup. The RBC lifespan in the EPO>1000 group was significantly lower than that in the EPO<1000 group.

Conclusion

IO can shorten RBC lifespan in MDS patients, which may be result from the increase of endogenous EPO and the over-expression of inflammatory cytokines. After ICT, the ineffective hematopoiesis caused by increased EPO may reduced and the decrease of inflammatory cytokine may significantly prolong the RBC lifespan in MDS patients.

The significance of cognitive-behavioral therapy on suicide: An umbrella review

BACKGROUND

Suicide becomes a widespread public health concern. Cognitive-behavioral therapy (CBT) is used to correct negative thoughts and behaviors of patients at risk of suicide. The aim of this research is to summarize and evaluate the existing evidence to explore the impact of CBT on suicide.

METHOD

We conducted a systematic searched in PubMed, Web of Science, Cochrane database from the first available year to March 2021. The methodological quality was evaluated by AMSTAR-2 tool, and the evidence quality was evaluated by GRADE classification. We summarized all the comparative effects of CBT on suicide, and used forest plots to describe the impact of CBT on suicide related outcomes included suicidal ideation, suicide attempts. The random effects model was used to summarize data.

RESULTS

Nine systematic reviews and meta-analysis were included. Most of the systematic reviews and meta-analysis were of medium methodological and evidence quality. The impact of CBT on suicide outcomes could be divided into the following two categories: CBT reduced levels of suicidal ideation (SMD -0.28, 95 % CI -0.36 to -0.21), CBT relieved suicide attempts (RR 0.77, 95 % CI 0.69 to 0.87).

CONCLUSION

Based on the current evidence, CBT could relieve suicide, including suicide ideation, suicide attempts. CBT is scalable and cost-effective. It is helpful for health professionals to formulate personalized CBT programs, promote clinical and community applications and integrate them into comprehensive suicide interventions and prevention strategies.

V2ReID: Vision-Outlooker-Based Vehicle Re-Identification

With the increase of large camera networks around us, it is becoming more difficult to manually identify vehicles. Computer vision enables us to automate this task. More specifically, vehicle re-identification (ReID) aims to identify cars in a camera network with non-overlapping views. Images captured of vehicles can undergo intense variations of appearance due to illumination, pose, or viewpoint. Furthermore, due to small inter-class similarities and large intra-class differences, feature learning is often enhanced with non-visual cues, such as the topology of camera networks and temporal information. These are, however, not always available or can be resource intensive for the model. Following the success of Transformer baselines in ReID, we propose for the first time an outlook-attention-based vehicle ReID framework using the Vision Outlooker as its backbone, which is able to encode finer-level features. We show that, without embedding any additional side information and using only the visual cues, we can achieve an 80.31% mAP and 97.13% R-1 on the VeRi-776 dataset. Besides documenting our research, this paper also aims to provide a comprehensive walkthrough of vehicle ReID. We aim to provide a starting point for individuals and organisations, as it is difficult to navigate through the myriad of complex research in this field.

[Advances of tight junction damage in the corneal epithelial barrier in the pathogenesis of corneal diseases]

The cornea is a transparent tissue with significant refractive and barrier functions. Corneal epithelium constitutes the first line of defense against foreign pathogens. Corneal epithelial cells interact to form a functionally selective permeability barrier. Dysfunction of this barrier leads to corneal impairment followed by a series of ocular surface diseases and even blindness. Tight junctions (TJ), located at the top of the intercellular space of corneal epithelial superficial cells, play a critical role in establishing and maintaining the barrier function. Previous studies have shown that destruction of the TJ acts as a crucial step of the occurrence and progression of multiple ocular surface diseases. Understanding the fundamental features and functions of the TJ, noticing the risk factors of TJ disruption, and clarifying the key role of TJ in the pathogenesis of various ocular surface diseases will help to better understand and treat ocular surface diseases.

Several semiconducting two-dimensional silicon nanosheets assembled from zigzag silicene nanoribbons

Semiconducting two-dimensional intrinsic silicon nanosheets are ideal materials for many applications in modern industry, since they are the only ones that can match well with previous silicon components. However, such materials are still lacking, especially those with moderate band gaps. In this work, by using first-principles theory, a series of two-dimensional intrinsic silicon nanosheets are assembled from zigzag silicene nanoribbons with different widths. The result shows that all the nanosheets behave as semiconductors, although some of them possess small band gaps of dozens of meV. Two of them, individually assembled from the two narrowest zigzag silicene nanoribbons, possess the largest indirect band gaps of 0.20 and 0.26 eV, respectively. Under low compressive strain, these two nanosheets would turn into quasi-direct or direct band gap semiconductors, and the gaps increase up to 0.62 or 0.54 eV, respectively. Due to the electron transfer from three-fold to four-fold coordinated Si atoms, the charge carriers prefer to transport along the zigzag direction, and electrons and holes transport in the respective Si chains. Interestingly, the investigation of Poisson's ratio reveals that the assembled silicon nanosheets have a negative Poisson's ratio in certain strain ranges if the width n of zigzag silicene nanoribbons is even. This work provides a new approach to design semiconducting silicon nanosheets and benefits to the applications of two-dimensional silicon nanosheets in many electronic and mechanical fields.

Clinical and resistance characterization of carbapenem-resistant Klebsiella pneumoniae isolated from intensive care units in China

Background

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a serious threat to health, and the detection rate in intensive care units (ICUs) is relatively high. We compared regional differences in the clinical and molecular characteristics of CRKP from three ICUs in different hospitals, to make a reference and contribution for infection control and clinical medication.

Methods

A total of 150 CRKP strains from Chongqing, Beijing, and Nantong, as well as the clinical data of the infected patients, were collected between 2019 and 2021. The carbapenemase phenotype was determined by CarbaNP test, and the outer membrane porin (OMP) genes (ompK35/ompK36), multi-locus sequence typing (MLST) and resistance genes were identified by polymerase chain reaction (PCR) amplification and sequencing.

Results

Patients infected with CRKP were mainly elderly, with comorbidity, and had undergone invasive operation and multiple antibiotic therapy. All strains exhibited high-level resistance to most antibiotics except for polymyxin B and tigecycline. Among the CRKP strains, 100 had the bla_KPC-2 gene and 8 had bla_NDM-1 gene, which were distributed in all of the hospitals. Nearly all the strains harbored extended-spectrum beta-lactamase (ESBL) genes (bla_SHV, bla_CTX-M, and bla_TEM). Class C carbapenemase genes (bla_CIT, bla_DHA), and deletion and mutation of ompK35/ompK36 existed in some strains. ST11 was the main MLST type, followed by ST15.

Conclusions

There were a few significant differences in the molecular epidemiology and clinical characteristics, but generally the features of CRKP from the three ICUs aligned fairly well, which might have resulted from dissemination through frequent personnel exchanges between regions.

[Effect of dyslipidemia on clinical outcome of infertility patients receiving donor eggs]

Objective: To explore the effect of dyslipidemia on the clinical outcome of intracytoplasmic sperm injection-embryo transfer (ICSI-ET) in infertility patients receiving donor eggs. Methods: A total of 118 patients were selected to receive egg donors and ICSI-ET at the First Affiliated Hospital of Nanjing Medical University between April 2007 and December 2020. According to the levels of triacylglycerol, serum cholesterol, high density lipoprotein (HDL), and low density lipoprotein, they were divided into dyslipidemia group (35 cases) and normal blood lipids group (83 cases). The influence of body mass index (BMI) and age was adjusted by 1∶1 propensity score matching, and the general condition and clinical outcome of the two groups were analyzed retrospectively. Finally, the relationship between lipid composition and clinical outcome was analyzed according to patients' age and BMI. Results: (1) Comparing the pre-matching dyslipidemia group with the normal blood lipids group, the BMI of the dyslipidemia group was significantly higher than that of the normal blood lipids group [(23.5±2.4) vs (22.4±2.7) kg/m²], and the embryo implantation rate was significantly lower than that of the normal blood lipids group [13.6% (8/59) vs 27.3% (36/132)], the differences were statistically significant (both P<0.05). (2) There were no significant differences in years of infertility, number of pregnancies, number of abortions, number of transplanted embryos, protocol of endometrial preparation, endometrial thickness on transplantation day and high quality embryo rate between the two groups, through propensity score matching (all P>0.05). The biochemical pregnancy rate [28.6% (10/35)], embryo implantation rate [13.6% (8/59)] and live birth rate [20.0% (7/35)] in dyslipidemia group were significantly lower than those in the normal blood lipids group (P<0.05). The clinical pregnancy rate was lower than that of the normal blood lipids group (P>0.05). (3) The results of stratified analysis showed that the level of HDL in the clinically non-pregnant group was significantly lower than that in the pregnant group in patients ≤ 35 years old [(1.5±0.3) vs (1.8±0.5) mmol/L; P<0.05]. In the overweight recipient patients, the level of HDL of the clinically non-pregnant group was lower than that of the pregnant group (P>0.05). Conclusions: Dyslipidemia significantly reduces the biochemical pregnancy rate, embryo implantation rate and live birth rate in patients with receiving donor eggs. Especially in patients aged ≤35 years old, the reduction of HDL is closely related to adverse pregnancy outcomes.

Acute effects of exposure to fine particulate matter and ozone on lung function, inflammation and oxidative stress in healthy adults

Both fine particulate matter (PM_2.5) and ozone (O₃) may have adverse effects on human health. However, previous studies on the effects of air pollutants mainly have focused on susceptible population, and evidence on healthy young adults is limited. We aimed to examine the associations of the two main air pollutants (PM_2.5 and O₃) with lung function, inflammation and oxidative stress in healthy young adults. We recruited 30 healthy young adults for a longitudinal panel study in Beijing and implemented health examination seven times, including lung function (FEV₁ and PEF) and biomarkers of inflammation and oxidative stress (i.e. C-reactive protein, CRP; interleukin-6, IL-6; malondialdehyde, MDA) from December 2019 to May 2021. Hourly ambient air pollutants data were obtained from the closest air quality monitoring station. Linear mixed-effect model was applied to explore the associations between air pollutants and lung function, inflammation and oxidative stress. We observed higher PM_2.5 exposure was associated with decrement in lung function and increment in CRP and MDA. Each 10 μg/m³ increase in PM_2.5 (lag 2 day) is associated with a 17.06 ml (95% CI: -31.53, -2.58) decrease in FEV₁, 46.34 ml/s (95% CI: -76.41, -16.27) decrease in PEF and increments of 2.86% (95% CI: 1.47%, 4.27%) in CRP, 1.63% (95% CI: 0.14%, 3.14%) in MDA respectively. However, there is no significant association between ozone exposure and health indicators. The study suggested that short-term exposure to PM_2.5 may decrease lung function and induce inflammation and oxidative stress in healthy adults, but there is no association between O₃ and each outcome.

[Surgical treatment of papillary thyroid carcinoma involving larynx and trachea]

Objective: To evaluate the efficacy of surgical treatment of papillary thyroid carcinoma (PTC) involving larynx and trachea. Methods: A total of 1 436 cases of thyroid malignant tumors were admitted to the Department of Otolaryngology, Qilu Hospital of Shandong University from 2004 to 2019, including 110 cases of PTC involving larynx and trachea, and of which 105 cases with complete follow-up data were retrospectively analyzed. There were 42 males and 63 females, with a male/female ratio of 1∶1.5, aged from 28 to 81 years. All lesions involved trachea, including 11 cases involving both trachea and larynx. Of those 83 cases underwent laryngeal and airway wall tumor excision, and 22 cases underwent radical tumor excision plus laryngeal and trachea repair. Extubation rate was analyzed and the postoperative survival curve of patients was analyzed by Kaplan-Meier method. Results: Among 105 cases, 16 cases underwent tracheotomy and 12 cases were successfully extubated. The overall 3- 5- and 10-year survival rates were 100.0%, 86.4% and 72.5%, and the disease-free survival rates were 93.1%, 81.6% and 57.7%, respectively. There was significant difference in survival curve between the two groups (χ²=4.21, P=0.040). The 5-year and 10-year survival rates were 94.6% and 77.3% in laryngeal and tracheal tumor exclusion group, and 85.7% and 51.4% in the radical tumor resection group. There was no significant difference in the survival curves between the two groups (χ²=3.50, P=0.061). Conclusion: PTC patients with laryngeal and tracheal involvement can achieve long survival and good quality of life through reasonable surgical treatment.

Relationship between depressive symptoms and internet usage time among adolescents: Results from a nationwide survey

Adolescent depression is becoming a public health problem. In this study the association between depressive symptoms and internet usage time in adolescents was examined, with data collected from the China Education Tracking Survey (CEPS). The survey is publicly available and carried out nationwide. A logistic regression analysis was conducted with odds ratios (OR) and 95% confidence intervals (CI), the subgroup analysis examined the relationships between internet usage time and depressive symptoms. A total of 10,705 adolescents were involved, where 46.4% of them are caught by the internet for more than two hours per day. Adolescents keeping on the internet for 6-8 h per day were reported to have higher odds of depressive symptoms than adolescents who were free from it with the confounders of individual, family, and school adjusted, which were observed among groups with a medium family economic status without living with their father and with a sleep time less than nine hours. The results revealed that adolescents spending more time online had a higher risk of experiencing depression symptoms. This study suggested that it is helpful for mental health professionals to evaluate and develop prevention interventions for depressive symptoms in adolescents promptly through monitoring and managing online time.

Effects of e-waste exposure on biomarkers of coronary heart disease (CHD) and their associations with level of heavy metals in blood

Excess heavy metals increase the risk of various diseases. Electronic waste (e-waste) is a potential route to heavy metal exposure, and Taizhou is a large e-waste dismantling area in China. In this study, we acquire blood samples from residents living near an e-waste recycling area (exposed group) and other residents in a selected reference area (reference group) for a comparative study in Taizhou in December 2017. Seven heavy metals, including cobalt (Co), nickel (Ni), cadmium (Cd), tin (Sn), copper (Cu), zinc (Zn), and lead (Pb), are quantitatively determined in all blood samples. It is discovered that the levels of Co, Ni, Sn, and Pb in the exposed group are higher than those in the reference group. Additionally, two crucial biomarkers of coronary heart disease (CHD), i.e., troponin (Tn) and myeloperoxidase (MPO), and two biomarkers of oxidative stress, i.e., malondialdehyde (MDA) and 8-isoprostane (8-I), are measured. We discovered that the levels of these indicators in the exposed group are significantly higher than those in the reference group. Meanwhile, both the Spearman correlation and multiple linear regression analysis show that Ni is positively correlated with Tn, MPO, 8-I, and MDA. Hence, we hypothesize that exposure to e-waste increases the risk of CHD and that Ni is an important contributor to the initiation of the disease.

MicroRNA-21 promotes epithelial-mesenchymal transition and migration of human bronchial epithelial cells by targeting poly (ADP-ribose) polymerase-1 and activating PI3K/AKT signaling

Epithelial-mesenchymal transition (EMT) is known to be involved in airway remodeling and fibrosis of bronchial asthma. However, the molecular mechanisms leading to EMT have yet to be fully clarified. The current study was designed to reveal the potential mechanism of microRNA-21 (miR-21) and poly (ADP-ribose) polymerase-1 (PARP-1) affecting EMT through the PI3K/AKT signaling pathway. Human bronchial epithelial cells (16HBE cells) were transfected with miR-21 mimics/inhibitors and PARP-1 plasmid/small interfering RNA (siRNA). A dual luciferase reporter assay and biotin-labeled RNA pull-down experiments were conducted to verify the targeting relationship between miR-21 mimics and PARP-1. The migration ability of 16HBE cells was evaluated by Transwell assay. Quantitative real-time polymerase chain reaction and Western blotting experiments were applied to determine the expression of Snail, ZEB1, E-cadherin, N-cadherin, Vimentin, and PARP-1. The effects of the PI3K inhibitor LY294002 on the migration of 16HBE cells and EMT were investigated. Overexpression of miR-21 mimics induced migration and EMT of 16HBE cells, which was significantly inhibited by overexpression of PARP-1. Our findings showed that PARP-1 was a direct target of miR-21, and that miR-21 targeted PARP-1 to promote migration and EMT of 16HBE cells through the PI3K/AKT signaling pathway. Using LY294002 to block PI3K/AKT signaling pathway resulted in a significant reduction in the migration and EMT of 16HBE cells. These results suggest that miR-21 promotes EMT and migration of HBE cells by targeting PARP-1. Additionally, the PI3K/AKT signaling pathway might be involved in this mechanism, which could indicate its usefulness as a therapeutic target for asthma.

Single-cell RNA-seq dissecting heterogeneity of tumor cells and comprehensive dynamics in tumor microenvironment during lymph nodes metastasis in gastric cancer

Lymph node metastasis is the common metastasis route of gastric cancer. However, until now, heterogeneities of tumor cells and tumor microenvironment in primary tumors (PT) and metastatic lymph nodes (MLN) of gastric cancer (GC) remains uncharacterized. In this study, scRNA-seq was performed on tissues from PT and MLN of gastric cancer. Trajectory analysis and function enrichment analyses were conducted to decode the underlying mechanisms contributing to LN metastasis of gastric cancer. Heterogeneous composition of immune cells and distant intercellular interactions in PT and MLN were analyzed. Based on the generated single cell transcriptome profiles, dynamics of gene expressions in cancer cells between PT and MLN were characterized. Moreover, we reconstructed the developmental trajectory of GC cells' metastasis to LN and identified two sub-types of GC cells with distinct potentials of having malignant biological behaviors. We characterized the repression of neutrophil polarization associated genes, like LCN2, which would contribute to LN metastasis, and histochemistry experiments validated our findings. Additionally, heterogeneity in neutrophils, rather than macrophages, was characterized. Immune checkpoint associated interaction of SPP1 was found active in MLN. In conclusion, we decode the dynamics of tumor cells during LN metastasis in GC and to identify a sub-type of GC cells with potentials of LN metastasis. Our data indicated that the disordering the neutrophils polarization and maturation and the activation of immune checkpoint SPP1 might contribute to LN metastasis in GC, providing a novel insight on the mechanism and potential therapeutic targets of LN metastasis in GC. This article is protected by copyright. All rights reserved.

Regorafenib third-lined therapy in advanced GISTs: A single center analysis based on different genotypes

11537

Background: The relationship between primary and secondary mutational status and efficacy of regorafenib in third-line therapy on GISTs is yet clear. Methods: From Jun 2017 to Dec 2021, a total of 62 patients with advanced GIST refractory to imatinib and/or sunitinib were enrolled in this study from the First Affiliated Hospital, Sun Yat-sen University. Results: Primary mutational was most common in KIT exon 11(40/62, 64.5%), followed by exon 9 (19.4%), exon 17 (4.8%). Six cases (9.7%) belonged to SDH deficiency and one case (1.6%) was NF1-associated GISTs. Before receiving treatment of regorafenib, specimens obtaining for secondary mutations were as follows: 39 cases from surgery，12 from core-needle biopsy; ctDNA alone was performed in 9 cases and 2 patients refused to secondary mutational test. Excluding 6 patients with SDH deficiency, 14 patients (25.8%) had mutations in exon 11+13, 15 (27.7%) in exon 11+17, 7 (13.0%) in exon 9+17, 4 (7.4%) in exon 11+13+17. Exon 11 + 18, exon 11 + 13 + 18, exon 11 + 13 + 17 + 18, exon 9 + 16, exon 11 + 17 + 18 and NF-1 were found in 1 case, respectively (1.9%). Eight (14.7%) patients with primary KIT mutation were not detected any secondary mutation（2nd-not-detected）. There was no complete response, 4 of partial response (4/54, 7.4%), 27 of stable disease (50.0%). Progression disease was seen in 23 patients (42.6%) and 8 were not applicable (no assessable lesion) to imaging response assessment due to R0/1 surgery before using regorafenib. The median follow-up time was 19.0 months. The median progression-free survival (mPFS) was 5.4 months (0.2-29.1 months) and the median overall survival (mOS) was 20.3 months (0.2-37.0 months). For primary mutation analysis, it was found that SDH-deficient patients had longer mPFS (29.1 months) than those with mutations in exon 9 or exon 11 (5.4 and 4.8 months, respectively; P= 0.013). In terms of secondary mutations, patients with activation loop mutations (exon 17+18) showed both longer mPFS (7.3 months vs 1.9 months, P= 0.001) and longer mOS (20.3 months vs 7.7 months, P= 0.059) than those patients with non-activation loop mutations. Not any specific or new adverse reaction was found in all patients. By Cox-regression analysis, response to regorafenib and mutational status were independent predictors of PFS，response to regorafenib was also an independent predictor of OS. Conclusions: Regorafenib seems to have better treatment efficacy in GIST patients with SDH deficiency compared to those with primary KIT mutations, and better with secondary mutations in activation loop than those with non-activation loop mutations. It is necessary to carry out clinical research for later-line treatment choice based on different genotypes for imatinib-resistant GISTs.

POS0521 RISKS OF SEVERE INFECTION AFTER THE INTRODUCTION OF bDMARDs IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS PATIENTS: A POPULATION-BASED INTERRUPTED TIME-SERIES ANALYSIS

Background

Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effective in suppressing inflammation and preventing joint damage. But bDMARDs may be associated with increased risk of severe infection. Evidence on this is contradictory with some studies showing increased risk, whereas others reporting no significant changes.

Objectives

To determine the impact of the introduction of bDMARDs on severe infection among patients newly diagnosed with RA compared with non-RA individuals.

Methods

In this age- and gender-matched cohort study using administrative health data for the population of BC, Canada, all incident RA patients diagnosed between 1995–2007 were identified. Non-RA individuals were randomly selected from the general control population to match with RA. Incident RA/non-RA individuals were then divided into quarterly cohorts according to their diagnosis date. Two outcomes were examined: (1) first severe infection (FSI) after RA onset necessitating hospitalization or occurring during hospitalization; and (2) all severe infections (ASI) after RA onset. We calculated the 8-year FSI and ASI rate for each cohort. We conducted interrupted time-series analyses to compare levels and trends of FSI and ASI in RA and non-RA individuals diagnosed during pre-bDMARDs (1995–2001) and post-bDMARDs (2003–2007) periods. Adjusted 8-year FSI and ASI rates for RA and non-RA cohorts diagnosed five years after bDMARDs introduction were compared with expected rates assuming no bDMARDs introduction, based on extrapolation of pre-bDMARDs trends.

Results

A total of 60,226 and 588,499 incident RA/non-RA individuals were identified. We identified 8,954 FSI and 14,245 ASI in RA, and 56,153 FSI and 79,819 ASI in non-RA. The 8-year FSI rates among RA patients diagnosed in the pre-bDMARDs period decreased over time but leveled off among those diagnosed in the post-period (Figure 1). The adjusted difference between the post- and pre-bDMARDs secular trends of 8-year FSI rates was 0.68 (p=0.03) in RA and 0.03 (p=0.67) in non-RA (Table 1). The 8-year ASI rates among RA patients diagnosed in the pre-bDMARDs period decreased over time but increased significantly among those diagnosed in the post-period (Figure 1). The adjusted difference between the post- and pre-bDMARDs secular trends of 8-year ASI rates was 1.85 (p=0.001) in RA and 0.12 (p=0.29) in non-RA (Table 1). For RA cohort diagnosed 5 years after bDMARDs introduction, ASI rate increased by 20.4% than expected rates assuming no bDMARDs introduction. In contrast, ASI rate in non-RA increased by only 10.9%.

Table 1.

Results of interrupted time-series analysis of FSI/ASI rates, adjusting for age, gender, chronic obstructive pulmonary disease, Romano Charlson Comorbidity Index, diabetes, chronic kidney diseases, alcoholism, cancer, prior hospitalization with infection and socio-economic status at disease diagnosis year, using stepwise model selection

OutcomeParameterRANon-RAUnadj. Diff (95% CI)Adj. Diff (95% CI)Unadj. Diff (95% CI)Adj. Diff (95% CI)p-valuep-valuep-valuep-valueFSITrend0.63 (0.03, 1.22) 0.04410.68 (0.09, 1.27) 0.02920.08 (-0.08, 0.25) 0.32370.03 (-0.12, 0.19) 0.6728Level (1 year post-intervention)0.50 (-2.00, 2.99) 0.69890.31 (-1.88, 2.49) 0.78470.41 (-0.21, 1.03) 0.20410.26 (-0.24, 0.75) 0.31035 years post-intervention3.01 (-0.85, 6.87) 0.13313.02 (-0.48, 6.52) 0.09860.75 (-0.24, 1.73) 0.14330.39 (-0.46, 1.25) 0.3721ASITrend1.84 (0.83, 2.84) 0.00091.85 (0.81, 2.89) 0.00110.28 (0.04, 0.53) 0.03050.12 (-0.10, 0.34) 0.2877Level (1 year post-intervention)-1.21 (-5.41, 3.00) 0.5763-1.44 (-5.44, 2.56) 0.48501.46 (0.42, 2.49) 0.00851.20 (0.38, 2.02) 0.00645 years post-intervention6.14 (0.26, 12.01) 0.04665.97 (0.02, 11.93) 0.05602.60 (1.08, 4.12) 0.00171.69 (0.45, 2.92) 0.0109Figure 1.

Unadjusted rates.

Conclusion

Arthritis onset after bDMARDs introduction is associated with an elevated risk of severe infection in RA patients, compared with matched non-RA individuals.

Acknowledgements

We would like to thank the Ministry of Health of British Columbia and Population Data BC for providing access to the administrative data. All inferences, opinions, and conclusions drawn in this publication are those of the authors, and do not reflect the opinions or policies of the Data Stewards or the [British Columbia] Ministry of Health. No personal identifying information was made available as part of this study. Procedures used were in compliance with British Columbia’s Freedom in Information and Privacy Protection Act. Ethics approval was obtained from the University of British Columbia’s Behavioral Research Ethics Board (H15-00887).

Disclosure of Interests

None declared.

POS0503 RISKS OF CARDIOVASCULAR EVENTS AFTER THE INTRODUCTION OF bDMARDs IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS PATIENTS: A POPULATION-BASED INTERRUPTED TIME-SERIES ANALYSIS

Background

Rheumatoid arthritis (RA) is associated with increased risk of cardiovascular (CV) events. Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effective in suppressing inflammation and preventing joint damage and may help lower the risk of CV events. However, recent epidemiological studies have shown mixed results with some suggesting a lower risk of CV events, while others reporting no significant differences.

Objectives

To determine the impact of the introduction of bDMARDs on incident cardiovascular disease (CVD) among patients newly diagnosed with RA compared with matched non-RA individuals.

Methods

In this age- and gender-matched cohort study using administrative health data for the population of BC, Canada, all incident RA patients diagnosed between 1995–2007 were identified. Non-RA individuals were randomly selected from the general control population to match with RA. Incident RA and non-RA individuals were then divided into quarterly cohorts according to their diagnosis date. The outcome of interest was incident CVD event after RA onset, which include acute myocardial infarction, cerebrovascular accident, and venous thromboembolism. We calculated the 8-year incident CVD rate for each cohort. We conducted interrupted time-series analyses to compare levels and trends of CVD in RA and non-RA individuals diagnosed during pre-bDMARDs (1995–2001) and post-bDMARDs (2003–2007) periods with intervention time set at year of 2002. Adjusted 8-year CVD rates for RA and non-RA cohorts diagnosed five years after bDMARDs introduction were compared with expected rates assuming no bDMARDs introduction, based on extrapolation of pre-bDMARDs trends.

Results

A total of 60,226 and 588,499 incident RA and non-RA individuals were identified. We identified 6,740 and 48,653 incident CVD events in total in RA and non-RA individuals, respectively. We observe no change in the secular trends of the 8-year CVD rates in both RA and non-RA individuals diagnosed in pre- and post-bDMARDS periods (Figure 1): the adjusted difference between the post- and pre-bDMARDs secular trends of 8-year CVD rates was 0.23 (p=0.26) for RA patients and -0.07 (p=0.33) for non-RA individuals (Table 1). However, we observed a reduction in the level of CVD rates among RA patients diagnosed in the post-bDMARDs period and no change in non-RA (Figure 1): the adjusted difference in level comparing points immediately before and after the intervention, and accounting for pre-intervention trend was -1.61 (p=0.03) in RA, while it was -0.02 (p=0.93) in non-RA (Table 1).

Table 1.

Results of interrupted time-series analysis of incident CVD rates, adjusting for age, gender, chronic obstructive pulmonary disease, Romano Charlson Comorbidity Index, diabetes, angina, hypertension, chronic kidney disease, peripheral vascular disease, atrial fibrillation, glucocorticoid, non-steroidal anti-inflammatory drugs, CVD medications, fibrates, contraceptives, and aspirin use at disease diagnosis year, using stepwise model selection

OutcomeParameterRANon-RAUnadj. Diff (95% CI)Adj. Diff (95% CI)Unadj. Diff (95% CI)Adj. Diff (95% CI)p-valuep-valuep-valuep-valueCVDTrend-0.15 (-0.72, 0.42) 0.60860.23 (-0.17, 0.64) 0.2620-0.09 (-0.27, 0.08) 0.3084-0.07 (-0.20, 0.07) 0.3290Level (1 year post-intervention)-1.36 (-3.17, 0.45) 0.1474-1.61 (-2.96, -0.25) 0.02510.22 (-0.41, 0.84) 0.5011-0.02 (-0.44, 0.40) 0.93455 years post-intervention-1.96 (-4.48, 0.55) 0.1332-0.67 (-2.80, 1.46) 0.5418-0.15 (-1.06, 0.75) 0.7421-0.29 (-0.97, 0.39) 0.4102Figure 1.

Unadjusted rates.

Conclusion

Arthritis onset after bDMARDs introduction is associated with a significant reduction in the risk of incident CVD events among RA patients, but not in the matched non-RA individuals.

Acknowledgements

We would like to thank the Ministry of Health of British Columbia and Population Data BC for providing access to the administrative data. All inferences, opinions, and conclusions drawn in this publication are those of the authors, and do not reflect the opinions or policies of the Data Stewards or the [British Columbia] Ministry of Health. No personal identifying information was made available as part of this study. Procedures used were in compliance with British Columbia’s Freedom in Information and Privacy Protection Act. Ethics approval was obtained from the University of British Columbia’s Behavioral Research Ethics Board (H15-00887).

Disclosure of Interests

None declared.

COVID-19 in patients with systemic lupus erythematosus: A systematic review

The objectives of the study were to review the articles to identify (a) the epidemiology of systemic lupus erythematosus (SLE) and coronavirus disease 2019 (COVID-19); (b) the clinical characteristics of SLE patients with COVID-19; (c) the treatment of COVID-19 in SLE patients; and (d) the impact of COVID-19 pandemic on SLE patients. PubMed was systematically reviewed for literature published from December 2019 to June 2021. Our search was limited to human studies, with language restriction of English. Studies were included if they reported COVID-19 in SLE patients. Our systematic review included 52 studies. The prevalence of COVID-19 infection ranged from 0.0% to 18.1% in SLE patients, and the hospitalisation rates ranged from 0.24% to 10.6%. COVID-19 infection is likely to mimic SLE flare. Hydroxychloroquine (HCQ) was ineffective in prevention of COVID-19, and SLE patients with COVID-19 faced difficulty in healthcare access, had financial constraints and suffered from psychological distress during the pandemic. The pandemic had a significant effect on mental and physical health. Adequate healthcare access, along with containment policies, social distancing measures and psychological nursing was required.

The association between lymphocyte-monocyte ratio and postoperative acute kidney injury in patients with acute type A aortic dissection

BACKGROUND

The aim of this study was to investigate the relationship between baseline lymphocyte-monocyte ratio (LMR) and postoperative acute kidney injury (AKI) in patients with acute type A aortic dissection (ATAAD).

METHODS

ATAAD patients undergoing surgery in Nanjing First Hospital were enrolled from January 2019 to April 2021. Lymphocyte and monocyte were measured on admission. Multivariable logistic regression analyses were performed to explore the relationship between LMR and postoperative AKI. We also used receiver operating characteristic (ROC), net reclassification index (NRI) and integrated discrimination improvement (IDI) analyses to assess the predictive ability of LMR.

RESULTS

Among the 159 recruited patients, 47 (29.6%) were diagnosed with AKI. Univariate logistic regression analysis indicated that ATAAD patients with higher levels of LMR were prone to have lower risk to develop AKI (odds ratio [OR], 0.493; 95% confidence interval [CI] 0.284-0.650, P = 0.001). After adjustment for the potential confounders, LMR remained an independent related factor with postoperative AKI (OR 0.527; 95% CI 0.327-0.815, P = 0.006). The cutoff value for LMR to predict AKI was determined to be 2.67 in the ROC curve analysis (area under curve: 0.719). NRI and IDI further confirmed the predictive capability of LMR in postoperative AKI.

CONCLUSION

Elevated baseline LMR levels were independently associated with lower risk of postoperative AKI in ATAAD patients.

m6 A-mediated regulation of PBX1-GCH1 axis promotes gastric cancer proliferation and metastasis by elevating tetrahydrobiopterin levels

BACKGROUND

Methyltransferase 3 (METTL3)-mediated N6-methyladenosine (m6 A) RNA modification has been demonstrated to be a potential factor in promoting gastric cancer (GC). METTL3 regulates a series of signaling pathways by modifying various mRNAs. This study aimed to identify novel METTL3-mediated signaling pathways and explored possible targets for use in the clinical setting of gastric cancer.

METHODS

To investigate the proliferation and metastatic capacity of GC cell lines with METTL3 knockdown, a xenograft, lung metastasis, and popliteal lymph node metastasis model was used. The m6 A-modified RNA immunoprecipitation (Me-RIP) sequence was utilized to explore the target mRNAs of METTL3. Cell counting kit 8 and transwell assays were performed to investigate the promoting function of pre-B cell leukemia homeobox 1 (PBX1) and GTP cyclohydrolase 1 (GCH1). Western blotting and chromatin immunoprecipitation were employed to confirm the involvement of the METTL3-PBX1-GCH1 axis. ELISA and liquid chromatography-mass spectrometry were used to explore the biological function of tetrahydrobiopterin (BH4 ).

RESULTS

Knockdown of METTL3 suppressed xenograft tumor growth and lung/lymph node metastasis in vivo. Mechanistically, we found that METTL3 combined with and stabilized PBX1 mRNAs. Chromatin immunoprecipitation (ChIP) and further experiments suggested that PBX1 acted as a transcription factor inducing GCH1 expression. Moreover, the METTL3-PBX1-GCH1 axis increased BH4 levels in GC cells, thereby promoting tumor progression.

CONCLUSIONS

This study suggested that METTL3 enzymes promote tumor growth and lung/lymph node metastasis via METTL3-PBX1-GCH1 axis increasing BH4 levels in GC.

Risk of neurodegeneration among residents of electronic waste recycling areas

The abnormal disposal process of electronic waste (e-waste) always emits a variety of toxic substances that enter the human body through various environmental media and can have many adverse health effects. Metals are thought to be inextricably linked to neurodegeneration. In the present study, we tried to explore the neurodegenerative status of subjects exposed to e-waste and the association between metal intake and neurodegeneration. We recruited the residents near the e-waste recycling area (the exposed group) and the residents without any e-waste contact history (the reference group) for a comparative study with detection and analysis of metals, biomarkers associated with neurodegeneration or oxidative stress (OS). The results showed that the metals between the reference and exposed group were significantly different. The concentrations of Brain-derived neurotrophic factor (BDNF) and β-amyloid protein 42 (Aβ42) in the exposed groups were significantly lower, while the levels of Euchromatic Histone lysine Methyltransferase 1 (EHMT1), Bromodomain Adjacent to Zinc finger domain 2B (BAZ2B) and Malondialdehyde (MDA) were significantly higher than in the reference groups. Although the ratio of Aβ42/Aβ40 had no statistical significance in the two groups, the medians of the ratio in the exposed group was lower than in the reference group. The linear regression and mediating effect analysis showed that MDA (OS) might mediate the effects of metals on EHMT1(pAg-MDA <0.001, pMDA-EHMT1 <0.05, pAg-EHMT1 <0.001). It could be inferred from the results of the present investigation that e-waste exposure had a high risk of neurodegeneration, especially Sliver (Ag) and Nickel (Ni).

[Clinical characteristics of human adenovirus infection in hospitalized children with acute respiratory infection in Beijing]

Objective: To compare the clinical characteristics of different types of human adenovirus (HAdV) infection in hospitalized children with acute respiratory infection in Beijing, and to clarify the clinical necessity of adenovirus typing. Methods: In a cross-sectional study, 9 022 respiratory tract specimens collected from hospitalized children with acute respiratory infection from November 2017 to October 2019 in Affiliated Children's Hospital, Capital Institute of Pediatrics were screened for HAdV by direct immunofluorescence (DFA) and (or) nucleic acid detection. Then the Penton base, Hexon and Fiber gene of HAdV were amplified from HAdV positive specimens to confirm their HAdV types by phylogenetic tree construction. Clinical data such as laboratory results and imaging data were analyzed for children with predominate type HAdV infection using t, U, or χ² test. Results: There were 392 cases (4.34%) positive for HAdV among 9 022 specimens from hospitalized children with acute respiratory infection. Among those 205 cases who were successfully typed, 131 were male and 74 were female, age of 22.6 (6.7, 52.5) months,102 cases (49.76%) were positive for HAdV-3 and 86 cases (41.95%), HAdV-7, respectively, while 17 cases were confirmed as HAdV-1, 2, 4, 6, 14 or 21. In comparison of clinical characteristics between the predominate HAdV type 7 and 3 infection, significant differences were shown in proportions of children with wheezing (10 cases (11.63%) vs. 25 cases (24.51%)), white blood cell count >15 ×10⁹/L (4 cases (4.65%) vs.14 cases (13.73%)), white blood cell count <5×10⁹/L (26 cases (30.23%) vs.11 cases (10.78%)), procalcitonin level>0.5 mg/L (43 cases (50.00%) vs. 29 cases (28.43%)), multilobar infiltration (45 cases (52.33%) vs.38 cases (37.25%)), pleural effusion (23 cases (26.74%) vs. 10 cases (9.80%)), and severe adenovirus pneumonia (7 cases (8.14%) vs. 2 cases (1.96%)) with χ²=5.11, 4.44, 11.16, 9.19, 4.30, 9.25, 3.91 and P=0.024, 0.035, 0.001, 0.002, 0.038, 0.002, 0.048, respectively, and also in length of hospital stay (11 (8, 15) vs. 7 (5, 13) d, Z=3.73, P<0.001). Conclusions: HAdV-3 and 7 were the predominate types of HAdV infection in hospitalized children with acute respiratory tract infection in Beijing. Compared with HAdV-3 infection, HAdV-7 infection caused more obvious inflammatory reaction, more severe pulmonary symptoms, longer length of hospital stay, suggesting the clinical necessity of further typing of HAdVs.

Patterns of adverse childhood experiences and depressive symptom trajectories in young adults: A longitudinal study of college students in China

BACKGROUND

Adverse childhood experiences (ACEs) tend to cluster together in daily life, and most studies focus on the level of depression at certain points, but the dynamic process of depression is often neglected. Thus, research is urgently needed to explore the relationship between ACEs pattern and trajectory of depressive symptom levels at multiple time points in order to provides early targeted interventions to those who are most at risk.

OBJECTIVE

We aimed to explore patterns of ACEs, including types and timing, associated with depression trajectories in college students.

METHODS

A school-based health survey was used to collect data as part of a longitudinal study in two medical college in Anhui province, China. Questionnaires were issued to 3,662 participants aged 17-22 and recorded details of ACEs (types and timing) and depression. Latent class analysis (LCA) was used to identify "patterns" of ACEs type and timing. Depressive symptom trajectories employed latent class growth analysis (LCGA). Multiple logistic regressions were employed to evaluate the relationships between ACEs patterns and depressive symptom trajectories.

RESULTS

We identified five ACEs patterns: "High neglect/emotional abuse/community violence," "High neglect/emotional abuse," "High neglect/family dysfunction," "High neglect," "Low ACEs." We traced three depression trajectories: "High depressive symptom" "Moderate depressive symptom," "Low depressive symptom." "High neglect/emotional abuse/community violence," "High neglect/emotional abuse" and "High neglect/family dysfunction" demonstrated a high risk for "High depressive symptom" and "Moderate depressive symptom." "High neglect" showed a high risk for "Moderate depressive symptom" but not for "High depressive symptom" (P < 0.05).

CONCLUSIONS

The findings address the need for a comprehensive consideration of exposure to childhood adversity associated with the risk of depression in young adults through identifying more problematic ACEs patterns amongst exposed children.