LncRNA PVT1 accelerates malignant phenotypes of bladder cancer cells by modulating miR-194-5p/BCLAF1 axis as a ceRNA

Background: Numerous studies proved that long non-coding RNA (lncRNA) is involved in the progression of multifarious diseases, especially in some carcinomas. As a potential tumor biomarker, plasmacytoma variant translocation 1 gene (PVT1) is involved in the development and progression of multifarious cancers. Nevertheless, the intrinsic and concrete molecular mechanism of PVT1 in bladder cancer still remained unclear, which is also the dilemma faced in many non-coding RNA studies.

Results: Our research revealed that PVT1 was significantly higher expression in bladder carcinoma specimens and cell lines. Further experiments indicated that knockdown or overexpression of PVT1 restrained or promoted the malignant phenotype and WNT/β-catenin signaling in bladder cancer cells. Meanwhile miR-194-5p was in contrast and miR-194-5p could partially reverse the function of PVT1 in malignant bladder tumor cells. As a microRNA sponge, PVT1 actively promotes the expression of b-cells lymphoma-2-associated transcription factor 1 (BCLAF1) to sponge miR-194-5p and subsequently increases malignant phenotypes of bladder cancer cells. Therefore, it performs a carcinogenic effect and miR-194-5p as the opposite function, and serves as an antioncogene in the bladder carcinomas pathogenesis.

Conclusion: PVT1-miR-194-5p-BCLAF1 axis is involved in the malignant progression and development of bladder carcinomas. Experiments revealed that PVT1 has a significant regulatory effect on bladder cancer (BC) and can be used as a clinical diagnostic marker and a therapeutic molecular marker for patients suffering from BC.

Methods: In urothelial bladder carcinoma specimens and cell lines, the relative expression levels of PVT1 and miR-194-5p were detected by quantitative reverse transcription PCR (RT-qPCR). Through experiments such as loss-function and over-expression, the biological effects of PVT1 and miR-194-5p on the proliferation, migration, apoptosis and tumorigenicity were explored in bladder cancer cells. Co-immunoprecipitation, proteomics experiments, dual luciferase reporter gene analysis, western blot and other methods were adopted to investigate the PVT1 potential mechanism in bladder carcinomas.

Epicardial adipose tissue is associated with the formation of left ventricular aneurysm after myocardial infarction

Background

Left ventricular aneurysm (LVA), a serious complication of transmural myocardial infarction, is generally related to poor cardiovascular outcomes. The formation of LVA is essentially an inflammatory remodeling process regulated by multiple systemic and local factors. Epicardial adipose tissue (EAT), a depot of visceral adipose tissue directly overlying the myocardium, is increasingly recognized as an important immune organ by secreting a variety of bioactive adipocytokines. However, the relation of EAT to the development of LVA is still unclear.

Purpose

In this study, we sought to investigate the association between EAT volume and the formation of LVA in subjects with previous myocardial infarction (MI).

Methods

A total of 55 subjects with previous MI and the presence of LVA, and age- and sex-matched 50 subjects with previous MI but without LVA were enrolled between October 2011 and June 2019. EAT was quantified and the presence of LVA was ascertained by cardiac magnetic resonance (CMR). EAT volume was indexed to body surface area.

Results

In the overall population, EAT volume index was correlated positively to log-transformed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (Pearson's r=0.332, P=0.002), and inversely to left ventricular ejection fraction (LVEF; Pearson's r=−0.240, P=0.031). The indexed EAT volume was significantly higher in subjects with than without LVA (41.10±11.73 vs. 33.25/11.70 mL/m2, P=0.003). In subjects with LVA, EAT volume index was further increased in those at older age (43.59±13.09 mL/m2 vs. 37.29±8.26 mL/m2, P=0.029) or with type 2 diabetes (43.38±12.32 mL/m2 vs. 35.20±7.67 mL/m2, P=0.013). After adjusting for sex, age and the presence of diabetes in the multivariate analysis, tertiles of EAT volume index remained significantly associated with the presence of LVA (P for trend=0. 003). Strikingly, compared to the lowest tertile (≤30.80 mL/m2), the intermediate (30.80–44.13 mL/m2) and highest (>44.13 mL/m2) tertiles of EAT volume index corresponded to 4.869– (95% CI 1.792–14.155, P=0.003) and 4.876– (95% CI, 1.787–14.206, P=0.003) increased risk for LVA.

Conclusion

Our study suggests that EAT volume is independently associated with the formation of LVA and reduced cardiac function after myocardial infarction.

EAT in patients with or without LVA

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China

Chromogranin B is associated with impaired coronary collateralization and heart failure in patients with stable angina and chronic total occlusion

Background

Chromogranin B (CgB) is a member of granin family that can be cleaved into a number of bioactive peptides. Previous studies showed that CgB is produced in cardiomyocytes and is increased in heart failure animals and patients in proportion to disease severity. Chronic total occlusion (CTO) of coronary artery leads to sustained myocardial ischemia which predisposes to adverse cardiovascular outcomes including heart failure.

Purpose

In this study, we sought to investigate the association between CgB and coronary collateralization formation and heart failure in patients with stable angina and CTO.

Methods

A total of 720 subjects with stable angina and CTO of at least one major coronary artery were enrolled in this study. CgB was assayed using an ELISA kit and the degree of coronary collaterals supplying the distal aspect of a total occlusion from the contralateral vessel was graded according to Rentrop classification.

Results

These was a stepwise decrease in levels of CgB with increasing Rentrop grades of coronary collateralization (P=0.001). Compared with the good collateralization (Rentrop grade 2–3) group, CgB was significantly higher in subjects with poor coronary collateralization (Rentrop grade 0–1; 1222.95 [IQR 506.24–2710.24] pg/mL vs. 776.17 [IQR 276.24–2209.39] pg/mL, P<0.001). Consistent results were found across subgroups of age, sex and the presence of diagnosed diabetes. In subjects with poor collateralization, CgB was positively correlated to N-terminal–pro-brain natriuretic peptide (NT-proBNP) levels (both log-transformed; Pearson's r=0.280, P=0.005). This correlation was markedly enhanced (Pearson's r=0.501, P<0.001) in the poorly-collateralized heart failure subgroup with left-ventricular ejection fraction (LVEF) <50%. Consistently, an inverse correlation was present between log-transformed CgB and LVEF (Pearson's r=−0.528, P<0.001) in the same subgroup. After adjusting for conventional confounding factors and LVEF, CgB remained significantly associated with impaired coronary collateralization (odds ratio: 1.314 [95% CI 1.097–1.590], P=0.004). Inclusion of CgB led to a better diagnostic accuracy as confirmed by net reclassification improvement (NRI) of 17.70% (95% CI 8.08–27.32%, P<0.001) and integrated discrimination improvement (IDI) of 1.98% (95% CI 0.63–3.34%, P=0.004).

Conclusions

CgB is an independent predictor of poor coronary collateralization and is related to worse heart function in patients with stable angina and CTO.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China

Identification and application of the Pigm-1 gene in rice disease resistance breeding

Rice blast, caused by Magnaporthe oryzae, is one of the most destructive diseases of rice worldwide. The identification and utilization of resistance genes are crucial and significant for breeding resistant rice cultivars. We identified a resistance gene from Shuangkang77009, which is highly resistant to the rice blast isolate Guy11 using map-based cloning. We performed bulked segregant analysis combined with specific length amplified fragment sequencing. We also performed association analysis, candidate gene prediction and cDNA sequencing to identify the candidate gene. The resistance gene is located on chromosome 6, and we ultimately mapped the resistance locus to a 92-kb region. The resistance gene in Shuangkang77009 was allelic to PigmR, hereafter referred to as Pigm-1. The Pigm-1 protein had one amino acid change: serine (Ser) residue 860 was replaced by tyrosine (Tyr) in Pigm-1 compared with the previously identified Pigm protein, which significantly changed the structure of the Pigm-1 protein based on 3-D structure simulation. In addition, using the developed molecular marker linked to the Pigm-1 gene and molecular marker-assisted selection technology, we introduced the Pigm-1 gene into Minghui86, a widely used and excellent restorer. We generated 11 stable homozygous rice lines with desirable agronomic traits and strong resistance to rice blast. In conclusion, Pigm-1, a natural allelic variant of PigmR, was responsible for blast resistance in Shuangkang77009 rice. The molecular marker-assisted breeding strategy for Pigm-1 was highly efficient.

eV-Scale Sterile Neutrino Search Using Eight Years of Atmospheric Muon Neutrino Data from the IceCube Neutrino Observatory

The results of a 3+1 sterile neutrino search using eight years of data from the IceCube Neutrino Observatory are presented. A total of 305 735 muon neutrino events are analyzed in reconstructed energy-zenith space to test for signatures of a matter-enhanced oscillation that would occur given a sterile neutrino state with a mass-squared differences between 0.01 and 100  eV^{2}. The best-fit point is found to be at sin^{2}(2θ_{24})=0.10 and Δm_{41}^{2}=4.5  eV^{2}, which is consistent with the no sterile neutrino hypothesis with a p value of 8.0%.

[Establishment of Mathematical Models for Skeletal Age Determination of Extremitas Sternalis of Clavicle in Shanxi Adolescents]

Objective To develop mathematical models for skeletal age determination with multiple statistic method based on the correlation between age and the growth of the epiphysis of extremitas sternalis of clavicle in Shanxi adolescents. Methods The 562 Shanxi sternoclavicular joint samples （454 cases of modelling, 108 cases of external verification） were scanned by the thin-section computed tomography. After volume rendering was obtained, indicators such as area of epiphysis, area of metaphysis, longest diameter of epiphysis and longest diameter of metaphysis of both extremitas sternalis of clavicle were collected. Indicators such as the ratio of area of epiphysis to area of metaphysis, and the ratio of longest diameter of epiphysis to longest diameter of metaphysis of both sides were calculated. Then multiple linear regression and random forest discriminant models were used to build mathematical models for age determination of adolescents. Results The obtained indicators exhibited a strong correlation with age （r>0.85）. The multiple linear regression model for males and females （all 4 indicators entering the model） based on the ratio of longest diameter of epiphysis to longest diameter of metaphysis and the ratio of area of epiphysis to area of metaphysis had an internal validation accuracy rate （±1.0 year） of over 92% and 108 cases had an external validation accuracy rate of over 70% （±1.0 year）. The out of bag error rates of random forest discriminant models were less than 2% for people over 18.0 years old （≥18.0 years old） and under 18.0 years old. The external validation accuracy rates of the 108 cases were over 80%. Conclusion The regression and discriminant models established in this study have certain reliability and accuracy and can be used in age determination of Shanxi adolescents.

Relationship between the MAPK/ERK pathway and neurocyte apoptosis after cerebral infarction in rats

OBJECTIVE

The aim of this study was to explore the relationship between the mitogen-activated protein kinase (MAPK)/extracellular regulated protein kinase (ERK) pathway and neurocyte apoptosis after cerebral infarction in rats.

MATERIALS AND METHODS

Neural stem cells were isolated from rats by establishing the cerebral infarction model and sham model. Isolated cells were cultured in complete culture medium in vitro. Real-time quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) was used to detect the messenger ribonucleic acid (mRNA) expression of ERK1 and ERK2 in the MARK pathway. Western blotting was applied to examine the activation of the MAPK/ERK pathway and neuron-specific markers. The expression of neuron-specific enolase (NSE) was detected via immunofluorescence. Cell activity and apoptosis were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and flow cytometry, respectively.

RESULTS

The mRNA expressions of ERK1 and ERK2 in neural stem cells increased in a time-dependent manner after cerebral infarction in rats. The expressions of ERK1, ERK2, cyclin D1, Nestin, NSE and glial fibrillary acidic-protein (GFAP) in neural stem cells were significantly decreased after being treated with SCH772984. Cell activity, proliferation and differentiation were markedly inhibited. However, cleaved-caspase 3 protein and apoptosis rate were remarkably increased.

CONCLUSIONS

The MAPK/ERK pathway seriously affects neurocyte apoptosis after cerebral infarction in rats. When the MAPK/ERK pathway is inhibited, neurocyte apoptosis is remarkably increased after cerebral infarction in rats.

CircleNet: Anchor-free Glomerulus Detection with Circle Representation

Object detection networks are powerful in computer vision, but not necessarily optimized for biomedical object detection. In this work, we propose CircleNet, a simple anchor-free detection method with circle representation for detection of the ball-shaped glomerulus. Different from the traditional bounding box based detection method, the bounding circle (1) reduces the degrees of freedom of detection representation, (2) is naturally rotation invariant, (3) and optimized for ball-shaped objects. The key innovation to enable this representation is the anchor-free framework with the circle detection head. We evaluate CircleNet in the context of detection of glomerulus. CircleNet increases average precision of the glomerulus detection from 0.598 to 0.647. Another key advantage is that CircleNet achieves better rotation consistency compared with bounding box representations.

Characteristics of the Diffuse Astrophysical Electron and Tau Neutrino Flux with Six Years of IceCube High Energy Cascade Data

We report on the first measurement of the astrophysical neutrino flux using particle showers (cascades) in IceCube data from 2010-2015. Assuming standard oscillations, the astrophysical neutrinos in this dedicated cascade sample are dominated (∼90%) by electron and tau flavors. The flux, observed in the sensitive energy range from 16 TeV to 2.6 PeV, is consistent with a single power-law model as expected from Fermi-type acceleration of high energy particles at astrophysical sources. We find the flux spectral index to be γ=2.53±0.07 and a flux normalization for each neutrino flavor of ϕ_{astro}=1.66_{-0.27}^{+0.25} at E_{0}=100  TeV, in agreement with IceCube's complementary muon neutrino results and with all-neutrino flavor fit results. In the measured energy range we reject spectral indices γ≤2.28 at ≥3σ significance level. Because of high neutrino energy resolution and low atmospheric neutrino backgrounds, this analysis provides the most detailed characterization of the neutrino flux at energies below ∼100  TeV compared to previous IceCube results. Results from fits assuming more complex neutrino flux models suggest a flux softening at high energies and a flux hardening at low energies (p value ≥0.06). The sizable and smooth flux measured below ∼100  TeV remains a puzzle. In order to not violate the isotropic diffuse gamma-ray background as measured by the Fermi Large Area Telescope, it suggests the existence of astrophysical neutrino sources characterized by dense environments which are opaque to gamma rays.

[Systematic reviews and evidence quality assessment on effectiveness of 1 dose varicella attenuated live vaccine for healthy children aged 1-12 years in China]

Objective: To assess the effectiveness of 1 dose varicella attenuated live vaccine (VarV) for healthy children aged 1-12 years in China and explore the application of the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework in observational studies of vaccine effectiveness (VE). Methods: We searched studies about the VE of 1-dose VarV for children aged 1-12 years in China which published before 2019 and evaluated the quality of the studies by the Newcastle Ottawa Scale (NOS) table. We used Meta-analysis models to obtain the pooled 1-dose VE and that in subgroups by study design, outbreak or not, study quality and age of subjects. The evidences of VEs were rated by means of the GRADE system. Results: Thirty-two studies were included and the pooled 1-dose VE was 75% [95% confidence interval (CI): 68%-80%]. The VE of outbreak studies [VE=66% (95%CI: 57%-73%)] was lower than non-outbreak studies [VE=85% (95%CI: 78%-89%)], and the VE in <6 years old children [VE=84% (95%CI:77%-89%)] was higher than that in ≥6 years old children [VE=60% (95%CI: 51%-68%)]. There was no significant difference in VE among studies with different design and quality. The quality of the evidences of pooled 1-dose VE was"very low", which was downgraded in bias risk and inconsistency and not downgraded in indirectness, imprecision and publication bias. Conclusions: The 1-dose VarV can provide medium level protection for 1-12 years old children in China, but it will decrease significantly for ≥6 years old children, so it is suggested to implement the strategies of two-dose vaccination of VarV in children <6 years old. The GRADE framework can be used in the observational studies of VE and it is suggested that the technical guidelines of observational study should be worked out to improve the overall quality of evidence.

[Clinical characteristics of testicular adrenal rest tumor and factors associated with its occurrence in 21-hydroxylase deficiency patients]

Objective: To analyze the occurrence and clinical characteristics of testicular adrenal rest tumor (TART) in 21-hydroxylase deficiency (21-OHD) patients, and further explore the possible factors related to the occurrence of TART. Methods: Twenty-seven male 21-OHD patients who visited Peking Union Medical College Hospital from January to December 2018 were enrolled and their clinical and biochemical data were collected. The CYP21A2 mutations were identified by Sanger sequencing and multiple ligation probe amplification (MLPA). Patients were divided into different subgroups according to the residual activity of 21-hydroxylase: Null (residual enzymatic activity 0, 3 cases), group A (0-<1%, 9 cases), group B (1%-5%, 7 cases), group C (20%-50%, 2 cases) and group D (6 cases). The ultrasound of testis was used to detect whether there was TART and its morphological characteristics. Results: Among 27 patients with 21-OHD [average age (17.4±9.3) years], 55.6% (15/27) had TART lesions, most of them were adolescents, and the youngest was only 4 years old. The lesions were mostly bilateral and hypoechoic. The levels of 17α-hydroxyprogesterone (17-OHP) and progesterone in patients with TART were higher than those in patients without TART [17-OHP: 199.6 (62.1, 232.7) nmol/L vs 7.4 (3.2, 105.0) nmol/L, P=0.003; progesterone: 97.1 (42.0, 126.8) nmol/L vs 5.4 (0.7, 20.0) nmol/L, P=0.004]. There was a correlation between the occurrence of TART and genotype of CYP21A2. Patients with Null and A genotypes were more likely to have TART than those with B and C genotypes (8/12 vs 4/9, P=0.021). Conclusions: TART is common in 21-OHD male patients, which is related to 17-OHP and CYP21A2 genotype. It is of great significance for the early screening of TART in 21-OHD patients.

[Heritability of alcohol intake among adult twins, calculate by the structural equation model]

Objective: To explore the genetic and environmental effects on alcohol intake. Methods: Data on 9 231 pairs of adult twins of the same sex was collected from the Chinese National Twin Registry (CNTR), between 2015 and 2018 and used in this study. Structural equation model was used to estimate the effects of genetic and environmental factors on alcohol intake. Results: A total of 9 231 pairs of twins were included in the analysis, of which 6 085 pairs were monozygotic (MZ). The average age of MZ was (36.91±13.07) years old, and males accounted for 56.80%. The average age of dizygotic twins (DZ) was (35.22±12.48) years old, and males accounted for 55.91%. There were 350 pairs of alcohol-drinking twins were with high-risk, accounting for 1.90% and another 367 pairs (1.99%) were with medium-risk. Alcohol-drinkers with medium-risk were affected by additive genetics, common and unique environmental factors, seen among the twins. The overall heritability appeared as 24.3% (95%CI: 0 to 56.8%). Furthermore, 50.7% of the variation (95%CI: 20.4%-79.0%) could be explained by the common environmental factors and 24.9% (95%CI: 18.3%-36.5%) by unique environmental factors. High-risk related drinking behavior was affected by both common and unique environmental factors. The common environmental component appeared as 75.6% (95%CI: 69.6%-80.8%) and unique environmental component as 24.4% (95%CI: 19.2%-30.4%), respectively. Gender difference was seen in the heritability of those with medium or high-risk drinking behaviors. The heritability of men was 30.8% (95%CI: 9.8%-53.5%), while in women it was mainly affected by the environment. Conclusion: Both alcohol drinkers with medium and high-risk drinking behaviors were mainly affected by the environment factors and gender. With the increase of drinking volume, the effect of environment on drinking behaviors became more obvious.

SAT0303 SINGLE-CELL DECONVOLUTION OF SKIN FIBROBLAST HETEROGENEITY IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Fibroblast heterogeneity and homeostasis has long been recognized in patients with systemic sclerosis (SSc). However, there is no common consensus on fibroblast subtypes, lineages, biological properties, signaling, and plasticity, which severely hampers our understanding of SSc pathogenesis.

Objectives:

This study is aimed to comprehensively classify skin fibroblast populations from SSc patients.

Methods:

We applied single-cell RNA sequencing on skin fibroblasts from two SSc patients and two health control (HC) with matched age and sex. Cell clustering were mainly determined by UMAP with batch effect correction. Differently expressed genes in each cell cluster was analyzed by Gene Set Enrichment Analysis (GSEA).

Results:

With an unbiased approach, single-cell transcriptome analyses showed classified and defined eight fibroblast types in SSc skin and six in normal skin. The cell types seldom overlapped between the patients and HC. Extracellular interaction and collagen production were remarkably stronger in SSc fibroblasts. A subgroup of dramatic cell proliferation and activation was defined only in SSc fibroblast. Two subtypes responding inflammatory stimuli were only found in SSc patients. Furthermore, delineation of their differentiation trajectory was achieved by a machine learning method.

Conclusion:

This collection of single-cell transcriptomes and the distinct classification of fibroblast subsets provide a new resource for understanding the fibroblast landscape and the roles of fibroblasts in SSc.

References:

N/A

Disclosure of Interests:

None declared

OP0015 SEX-SPECIFIC U-SHAPED RELATIONSHIP BETWEEN SERUM URATE AND MORTALITY IN THE UNITED STATES GENERAL POPULATION

Background:

A U-shaped relationship may exist between serum urate (SU) and cardiovascular events, although the relationship between SU and mortality is unclear. The most recent EULAR recommendations for gout advise against maintaining SU <3 mg/dl for prolonged periods.

Objectives:

To examine the relationship between SU and all-cause and cause-specific mortality in large cohorts in the United States (US).

Methods:

We examined National Health and Nutrition Examination Survey (NHANES) data from 1988-1994 (NHANES III) and 1999-2007 including subjects aged ≥18 with an enrollment SU measurement. We used Cox proportional hazards regression models to estimate sex-specific mortality risk relative to a referent SU 5-6 mg/dL, adjusting for NHANES cycle, age, race, body mass index (BMI), education, alcohol use, smoking, hypertension, total cholesterol, estimated glomerular filtration rate (GFR), and competing risks, using age as a time scale for survival analysis.

Results:

Among 19,954 men and 21,853 women, there were 5,714 male deaths and 4,901 female deaths (median follow-up 14.2 ± 6.9 years). Among men, there was a 33% increased all-cause mortality risk at SU <4 mg/dL (HR 1.33, 95% CI 1.17-1.51) and 52% increased all-cause mortality risk at SU >8 mg/dL (HR 1.52, 95% CI 1.37-1.69) compared to subjects with SU 5-6 mg/dL, driven by cause-specific mortality from diabetes at low SU and chronic lower respiratory diseases and cardiovascular disease at high SU (Table). In women, there was no increased mortality risk at low SU and a 45% increased all-cause mortality risk at SU >7 mg/dL (HR 1.45, CI 1.31-1.61) compared to subjects with SU 5-6 mg/dL, driven by cause-specific mortality from diabetes. Mortality from Alzheimer’s disease was lower at high SU among men (HR 0.23, 95% CI 0.05-0.99) and women (HR 0.54, 95% CI 0.25-1.15).

Table.

Multivariable hazard ratios for all-cause and cause-specific mortality in NHANES III and 1999-2007.

Conclusion:

In large cohorts representative of the US population, there was a U-shaped relationship between SU and all-cause mortality in men but not women. In men with low SU, mortality was driven primarily by diabetes, which may be explained by the uricosuric effect of uncontrolled hyperglycemia in diabetes patients. The lower mortality from Alzheimer’s disease at high SU agrees with previously shown inverse associations between gout and Alzheimer’s disease. Further studies are needed to determine the presence of causality underlying these associations.

Disclosure of Interests:

Kristin D’Silva: None declared, Chio Yokose: None declared, Leo Lu: None declared, Yuqing Zhang: None declared, Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood

THU0054 NKTR-358, A NOVEL IL-2 CONJUGATE, STIMULATES HIGH LEVELS OF REGULATORY T CELLS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Impaired IL-2 production and dysfunction of regulatory T cells (Tregs) have been identified as key immunological defects leading to the breakdown of immune self-tolerance in SLE. Low-dose IL-2 can expand Tregs, but the effect is limited by a narrow therapeutic window for Treg selectivity. Furthermore, the short half-life of IL-2 necessitates frequent administration. NKTR-358 is a polyethylene glycol (PEG) conjugate of recombinant human IL-2 (aldesleukin sequence) and is differentiated from native IL-2 by its altered binding to the IL-2 receptor and prolonged biological activity. NKTR-358 resulted in marked and selective stimulation of Tregs when administered as a single SC injection to healthy volunteers.

Objectives:

This multiple ascending dose study assessed the safety, tolerability, pharmacokinetics (PK), and immune effects of NKTR-358 in patients with SLE after repeated administration of SC doses. The time course and extent of changes in numbers and percentages of Tregs, conventional CD4+ and CD8+ T cells, NK cells, and cytokine levels in peripheral blood were investigated.

Methods:

In this double-blind, multiple ascending dose study, patients with mild to moderate SLE received 3 SC doses q2w in 4 cohorts ranging from 3.0 to 24.0 µg/kg (9 active:3 placebo per cohort); patients were followed for a total of 79 days.

Results:

There were no dose-limiting toxicities, deaths, or clinically significant abnormalities in either vital signs or electrocardiograms. Adverse events attributed to NKTR-358 were primarily limited to mild (grade 1) injection site reactions. At the highest dose, one subject had transient and mild (grade 1) symptoms of a flu-like syndrome after administration, without associated elevated cytokine levels, and another subject had dosing stopped due to elevated eosinophil levels. No other individual at any dose level had systemic signs or symptoms known to be associated with IL-2 therapy. No anti-drug antibodies were detected. NKTR-358 demonstrated dose-proportional PK with repeated dosing; plasma levels peaked 3-6 days post-dose and declined with a terminal half-life of ~10-13 days.

The primary and consistent effect of NKTR-358 was seen on Tregs. In the four dose cohorts, dose-dependent and sustained increases in absolute numbers and percentages of circulating CD4+FoxP3+CD25brightTregs were observed. Treg levels remained elevated throughout the dosing period, peaking at Day 10 after the first administration of NKTR-358 and returning to baseline ~ 20-30 days following last administration. At 24.0 µg/kg, the mean peak increase in numbers of CD25brightTregs was 11-fold above baseline. In addition, there was an increase in Treg activation markers at doses ≥12.0 µg/kg. In contrast to effects on Tregs, no changes in percentages or numbers of conventional CD4+ or CD8+ T cells were observed at any dose tested. At the highest dose, there were low-level increases in the percentages and numbers of NK cells. Overall, NKTR-358 selectively induced Tregs, evidenced by a 12-fold increase in the mean peak Treg:CD8 ratio over baseline in the 24.0 µg/kg group.

Conclusion:

NKTR-358, an IL-2 conjugate Treg stimulator, was well tolerated when repeatedly administered (q2w) at doses up to 24 µg/kg. Its administration led to marked, selective, prolonged, and dose-dependent increases in circulating CD25brightTregs. This clinical study in SLE patients extends the previous results in healthy volunteers and provides strong support for continued testing of NKTR-358 as a new therapeutic in SLE and other inflammatory diseases.

Disclosure of Interests:

Suresh Siddhanti Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Christie Fanton Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Neha Dixit Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Lin Lu Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Vishala Chindalore Grant/research support from: Nektar Therapeutics for conducted studies, Speakers bureau: > 5 years ago, Robert Levin Grant/research support from: Payments for clinical research for industry-sponsored trials, Consultant of: Gilead, Exagen, Myriad Rheumatology, Speakers bureau: Sanofi/Genzyme, Regeneron, Bristol-Myers Squibb, AbbVie, Isam Diab: None declared, Richard Furie Grant/research support from: Nektar Therapeutics to Northwell Rheumatology to conduct this study, Consultant of: Nektar Therapeutics, Jonathan Zalevsky Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Brian Kotzin Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics

SAT0564 BONE TEXTURE ANALYSIS WITH DEEP LEARNING IN HAND RADIOGRAPHS FOR ASSESSING THE RISK OF RHEUMATOID ARTHRITIS

Background:

Conventional x-rays are essential to identify radiographic changes of rheumatoid arthritis (RA) in structure and bone texture. Limited evidence suggests that the bone texture analysis may quantify the radiographic changes in RA;1however, current techniques such as the fractal dimension characterize fixed texture features. Deep learning offers novel methods to ‘learn’ radiographic texture features relevant to RA.

Objectives:

To develop a deep learning model to assess the radiographic bone texture in the distal metacarpal bone relevant to RA.

Methods:

We collected 3,738 conventional hand radiographs from 2,128 individuals (RA, n = 908; non-RA, n = 1220). The second, third, and fourth metacarpal bone images were segmented using a curve Graph Convolutional Network (GCN), and the distal third was used as the input to train a texture model to classify RA. The texture model was based on the Deep Texture Encoding Network (Deep-TEN) architecture (figure 1),2which put an encoding layer on top of a pre-trained 18-layered residual network (ResNet18). The vectors produced by the model represent the orderless texture features that were used to generate a texture score for RA. Five texture models are trained using 5-fold cross-validation and are ensembled during inference by averaging the model outputs to produce the final score. We then validate the model using hand radiographs of 166 RA patients and 166 non-RA patients. Overall model performance was measured by area under the curve of the receiver operator curve (AUROC). Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of RA.

Figure 1.

Schematic representation of deep learning models to extract and encode texture features for RA classification.

Results:

We included 140 women and 26 men with RA (mean age, 55.9±1.8 years) and 166 non-RA individuals (F: M, 140:26; mean age, 55.5 ± 1.8 years). The mean texture score was 0.49 (95% CI, 0.48–0.50) in RA patients, which is significantly higher than non-RA patients (0.42, 95% CI, 0.40–0.43; p<0.01). The AUROC of the model was 0.68. In the multivariate logistic regression model, a high texture score (>0.43) is associated with an OR (95% CI) of 3.42 (2.48–4.72) for RA, adjusted by age and sex.

Conclusion:

This study indicates that the texture model can delineate radiographic changes in texture relevant to RA and, coupled with automatic joint detection and segmentation, it has the potential to aid early RA diagnosis and monitor radiographic progression.

References:

[1]Zandieh S, Haller J, Bernt R, et al. Fractal analysis of subchondral bone changes of the hand in rheumatoid arthritis. Medicine (Baltimore) 2017;96(11):e6344.

[2]Zhang H, Xue J, Dana K. Deep TEN: Texture Encoding Network. The IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 2017:708-17.

Disclosure of Interests:

None declared

SAT0604 FAST FOOD HABITS AND SERUM URATE CHANGE IN YOUNG ADULTS: 15-YEAR PROSPECTIVE ANALYSIS

Background:

Fast food consumption has strong positive associations with weight gain and insulin resistance.1Obesity and insulin resistance are in turn strongly associated with elevated serum urate (SU) levels, largely mediated by insulin’s anti-uricosuric ability.2

Objectives:

To investigate the relation between fast food consumption and changes in SU over a 15-year period among young black and white adults in the United States.

Methods:

Participants for the CARDIA study included 3,122 young (age 18-30 years in 1985-86) black and white adults in the United States who were followed up with repeated dietary and clinical assessments and had both baseline and year 15 SU measurement available. Frequency of fast food consumption (fast food frequency, FFF) was quantified on a semicontinuous scale and classified as <1, 1-2, or >2 times per week. We used multivariable linear regression models to investigate the association of FFF at baseline as well as change in FFF with 15-year changes in SU.

Results:

Our analysis included data from 3,122 subjects who had SU data available both at baseline and year 15 (Table 1). After adjustment for age, sex, education, baseline height and weight, and baseline SU, baseline FFF (defined as 3 times per week year 0 differences between participants) was independently associated with increases in SU among both black (beta=0.11, p=0.04) and white (beta=0.11, p=0.01) individuals (Table 2). Change in FFF (defined as 3 times a week 15-year change within participants) was also independently associated with increases in SU among white (beta=0.09, p=0.01) individuals but not blacks (beta=0.03, p=0.93) (Table 2). There was a significant correlation between weight change and SU change (correlation coefficient 0.34, p<0.001).Figure 1depicts the joint associations of year 0 FFF and 15-year changes in FFF with change in weight. Compared to the average 15-year SU change among participants with baseline FFF <1 time per week and 15-year FFF change <0 time per week, those with high FFF at both baseline and follow-up had an extra 0.21 mg/dL increase (i.e., 75% of overall population SU increase over 15 years [0.28 mg/dL]) in SU during that time. After adjusting for covariates in model 2, change in weight (beta=0.03, p<0.001) and homeostasis model for insulin resistance (HOMA) (beta=0.05, p<0.001) remained significantly associated with SU change.

Table 1.

Participant Characteristics

CharacteristicBlacks (n=1468)Whites (n=1654)Age, years (year 0)24.4 (3.8)25.6 (3.3)Male (%)4448Weight, kg (year 0)72.8 (16.7)70.0 (14.0)Weight, kg (year 15)87.9 (20.9)80.7 (18.6)Serum urate, mg/dL (year 0)5.1 (1.4)5.4 (1.4)Serum urate, mg/dL (year 15)5.6 (1.4)5.5 (1.4)

All values reported as mean (SD) unless otherwise noted.

Table 2.

Mean Adjusted Change in Serum Urate by Baseline and Change in Fast Food Frequency

Fast Food VariableBlacksWhitesBeta (SE)pBeta (SE)pModel 1Baseline0.11 (0.04)0.010.11 (0.04)0.01Change0.003 (0.033)0.930.09 (0.04)0.01Model 2Baseline0.12 (0.04)0.010.09 (0.04)0.02Change0.004 (0.03)0.880.08 (0.04)0.03

Model 1: age, sex, education, baseline height and weight, baseline SU

Model 2: model 1 + alcohol, physical activity, and smoking (both baseline and year 15 change)

Conclusion:

Fast-food consumption has strong positive associations with SU, suggesting that fast food increases the risk of hyperuricemia and gout. The observed association is likely mediated by weight gain and resultant changes in insulin resistance.

References:

[1]Pereira MA, Kartashov AI, Ebbeling CB, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 2005;365:36-42.

[2]Mount DB MT, Mandal A. Insulin: Genetic and Physiological Influences on Human Uric Acid Homeostasis [abstract]. Arthritis Rheumatol 2018; 70 (suppl 10).

Disclosure of Interests:

Chio Yokose: None declared, Leo Lu: None declared, Natalie McCormick: None declared, Jeewoong Choi: None declared, Yuqing Zhang: None declared, Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood

OP0247 PERSISTENT PREMATURE MORTALITY GAP IN IDIOPATHIC INFLAMMATORY MYOPATHY: A GENERAL POPULATION-BASED COHORT STUDY

Background:

Idiopathic inflammatory myopathy (IIM) is associated with significant premature mortality; however, whether the mortality gap has improved over recent years is unknown.

Objectives:

To determine trends in premature mortality in patients with IIM in a large cohort, representative of the United Kingdom (UK) general population.

Methods:

Using The Health Improvement Network (THIN), an electronic medical record database representative of the UK general population, we identified patients with incident IIM between 18 and 89 years of age (defined by at least one Read diagnosis code for dermatomyositis, polymyositis, or interstitial myositis with at least one year of continuous enrollment in THIN prior to the cohort entry date) and up to 10 controls without IIM matched on age, sex, birth year, and database entry year. The cohort was divided in two based on the year of IIM diagnosis: the early cohort (1999-2006) and the late cohort (2007-2014). We calculated adjusted hazard ratios for death using a multivariable Cox-proportional hazards model and adjusted rate differences using an additive hazard model.

Results:

The early cohort consisted of 355 patients with IIM and 3182 matched controls, while the late cohort consisted of 396 IIM patients and 3551 matched controls. In both cohorts, IIM patients had excess mortality compared to matched controls [57.4 vs. 15.2 deaths/1000 person-years (PY) in the early cohort and 43.2 vs. 14.1 deaths/1000 PY in the late cohort] (Table). The corresponding multivariate mortality hazard ratios were 2.73 (95% CI, 1.85 to 4.03) vs. 2.61 (95% CI, 1.75 to 3.89) in the early and late cohorts, respectively (p-value for interaction = 0.63) (Figure). The absolute multivariate mortality differences were 36.6 (95% CI, 20.4 to 52.8) and 25.8 (95% CI, 13.7 to 37.9) deaths/1000 PY, in the early and late cohorts, respectively (p-value for interaction = 0.24).

Conclusion:

In this general population-based cohort study, patients with IIM had over 2.5 times the risk of death compared to matched controls, even after adjusting for comorbidities and medications. Unlike trends seen in rheumatoid arthritis and granulomatosis with polyangiitis, there appears to be no improvement in mortality in IIM in recent years. This highlights the need for improved strategies for the management of patients with IIM and its comorbidities.

Table.

Association between idiopathic inflammatory myopathy (IIM) and all-cause mortality according to time period.

1999-20062007-2014IIM cohort (n=355)Non-IIM cohort (n=3182)IIM cohort (n=396)Non-IIM cohort (n=3551)p-value for interactionFollow-up time, years (mean ± SD)2.6 ± 2.12.9 ± 2.13.2 ± 2.43.5 ± 2.4Number of deaths5314055177Death rate/1000 PY (95% CI)57.4 (43.0, 75.1)15.2 (12.7, 17.9)43.2 (32.5, 56.2)14.1 (12.1, 16.3)Age-, sex-, and entry year-matched hazard ratio (95% CI)4.02 (2.89, 5.59)1.00 (ref)3.43 (2.49, 4.73)1.00 (ref)0.50Multivariable-adjusted hazard ratio (95% CI)*2.73 (1.85, 4.03)1.00 (ref)2.61 (1.75, 3.89)1.00 (ref)0.63Age-, sex-, and entry year-matched rate difference/1000 PY (95% CI)42.2 (26.6, 57.9)0.0 (ref)29.1 (17.5, 40.7)0.0 (ref)0.24Multivariable-adjusted rate difference/1000 PY (95% CI)36.6 (20.4, 52.8)0.0 (ref)25.8 (13.7, 37.9)0.0 (ref)0.24

* Multivariable models were adjusted for age, sex, entry year, number of GP visits, BMI, smoking status (i.e., non-smokers, ex-smokers, current smokers), alcohol consumption (i.e., non-drinkers, ex-drinkers, current drinkers), comorbidities, and medication use.

PY, person-year; BMI, body mass index; GP, general practitioner

Figure.

Cumulative mortality of patients with idiopathic inflammatory myopathy and matched controls without IIM in early versus late cohorts (1999-2006 versus 2007-2014).

Disclosure of Interests:

Kristin D’Silva: None declared, Leo Lu: None declared, Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer, Antonio Aviña: None declared, Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood

OP0301 PREDICTION OF LOW BONE MINERAL DENSITY AND FRAX SCORE BY ASSESSING HIP BONE TEXTURE WITH DEEP LEARNING

Background:

Osteoporosis is a widespread health concern associated with an increased risk of fractures in individuals with low bone mineral density (BMD). Dual-energy x-ray absorptiometry (DXA) is the gold standard to measure BMD, but methods based on the assessment of plain films, such as the digital radiogrammetry,1are also available. We describe a novel approach based on the assessment of hip texture with deep learning to estimate BMD.

Objectives:

To compare the BMD estimated by assessing hip texture using a deep learning model and that measured by DXA.

Methods:

In this study, we identified 1,203 patients who underwent DXA of left hip and hip plain film within six months. The dataset was split into a training set with 1,024 patients and a testing set with 179 patients. Hip images were obtained and regions of interest (ROI) around left hips were segmented using a tool based on the curve Graph Convolutional Network. The ROIs are processed using a Deep Texture Encoding Network (Deep-TEN) model,2which comprises the first 3 blocks of Residual Network with 18 layers (ResNet-18) model followed by a dictionary encoding operator (Figure 1). The encoded features are processed using a fully connected layer to estimate BMD. Five-fold cross-validation was conducted. Pearson’s correlation coefficient was used to assess the correlation between predicted and reference BMD. We also test the performance of the model to identify osteoporosis (T-score ≤ -2.5)

Figure 1.

Schematic representation of deep learning models to extract and encode texture features for estimation of hip bone density.

Results:

We included 151 women and 18 men in the testing dataset (mean age, 66.1 ± 1.7 years). The mean predicted BMD was 0.724 g/cm2compared with the mean BMD measured by DXA of 0.725 g/cm2(p = 0.51). Pearson’s correlation coefficient between predicted and true BMD was 0.88. The performance of the model to detect osteoporosis/osteopenia was shown in Table 1. The positive predictive value was 87.46% for a T-score ≤ -1 and 83.3% for a T-score ≤ -2.5. Furthermore, the mean FRAX® 10-year major fracture risk did not differ significantly between scores based on predicted (6.86%) and measured BMD (7.67%, p=0.52). The 10-year probability of hip fracture was lower in the predicted score (1.79%) than the measured score (2.43%, p = 0.01).

Table 1.

Performance matrices of the deep texture model to detect osteoporosis/osteopenia

T-score ≤ -1T-score ≤ -2.5Sensitivity91.11%(95% CI, 83.23% to 96.08%)33.33%(95% CI, 17.29% to 52.81%)Specificity86.08%(95% CI, 76.45% to 92.84%)98.56%(95% CI, 94.90% to 99.83%)Positive predictive value88.17%(95% CI, 81.10% to 92.83%)83.33%(95% CI, 53.58% to 95.59%)Negative predictive value89.47%(95% CI, 81.35% to 94.31%)87.26%(95% CI, 84.16% to 89.83%)

Conclusion:

This study demonstrates the potential of the bone texture model to detect osteoporosis and to predict the FRAX score using plain hip radiographs.

References:

[1]Zandieh S, Haller J, Bernt R, et al. Fractal analysis of subchondral bone changes of the hand in rheumatoid arthritis. Medicine (Baltimore) 2017;96(11):e6344.

[2]Zhang H, Xue J, Dana K. Deep TEN: Texture Encoding Network. The IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 2017:708-17.

Disclosure of Interests:

None declared

OP0062 PREDICTIVE VALUE OF BONE TEXTURE FEATURES EXTRACTED BY DEEP LEARNING MODELS FOR THE DETECTION OF OSTEOARTHRITIS: DATA FROM THE OSTEOARTHRITIS INITIATIVE

Background:

Osteoarthritis is a degenerative disorder characterized by radiographic features of asymmetric loss of joint space, subchondral sclerosis, and osteophyte formation. Conventional plain films are essential to detect structural changes in osteoarthritis. Recent evidence suggests that fractal- and entropy-based bone texture parameters may improve the prediction of radiographic osteoarthritis.1In contrast to the fixed texture features, deep learning models allow the comprehensive texture feature extraction and recognition relevant to osteoarthritis.

Objectives:

To assess the predictive value of deep learning-extracted bone texture features in the detection of radiographic osteoarthritis.

Methods:

We used data from the Osteoarthritis Initiative, which is a longitudinal study with 4,796 patients followed up and assessed for osteoarthritis. We used a training set of 25,978 images from 3,086 patients to develop the textual model. We use the BoneFinder software2to do the segmentation of distal femur and proximal tibia. We used the Deep Texture Encoding Network (Deep-TEN)3to encode the bone texture features into a vector, which is fed to a 5-way linear classifier for Kellgren and Lawrence grading for osteoarthritis classification. We also developed a Residual Network with 18 layers (ResNet18) for comparison since it deals with contours as well. Spearman’s correlation coefficient was used to assess the correlation between predicted and reference KL grades. We also test the performance of the model to identify osteoarthritis (KL grade≥2).

Results:

We obtained 6,490 knee radiographs from 446 female and 326 male patients who were not in the training sets to validate the performance of the models. The distribution of the KL grades in the training and testing sets were shown in Table 1. The Spearman’s correlation coefficient was 0.60 for the Deep-TEN and 0.67 for the ResNet18 model. Table 2 shows the performance of the models to detect osteoarthritis. The positive predictive value for Deep-TEN and ResNet18 model classification for OA was 81.37% and 87.46%, respectively.

Table 1

Distribution of KL grades in the training and testing sets.

KL grades01234TotalTraining set1089341.9%458218.7%611423.5%332012.8%7993.1%25,978Testing set247238.1%135320.8%169626.1%77511.9%1943.0%6,490Table 2

Performance matrices of the Deep-Ten and ResNet18 models to detect osteoarthritis

Deep-TENResNet18Sensitivity62.29%(95% CI, 60.42%–64.13%)59.14%(95% CI, 57.24%–61.01%)Specificity90.07%(95% CI, 89.07%–91.00%)94.09%(95% CI, 93.30%–94.82%)Positive predictive value81.37%(95% CI, 79.81%–82.84%)87.46%(95% CI, 85.96%–88.82%)Negative predictive value77.42%(95% CI, 77.64%–79.65%)76.77%(95% CI, 75.93%–77.59%)

Conclusion:

This study demonstrates that the bone texture model performs reasonably well to detect radiographic osteoarthritis with a similar performance to the bone contour model.

References:

[1]Bertalan Z, Ljuhar R, Norman B, et al. Combining fractal- and entropy-based bone texture analysis for the prediction of osteoarthritis: data from the multicenter osteoarthritis study (MOST). Osteoarthritis Cartilage 2018;26:S49.

[2]Lindner C, Wang CW, Huang CT, et al. Fully Automatic System for Accurate Localisation and Analysis of Cephalometric Landmarks in Lateral Cephalograms. Sci Rep 2016;6:33581.

[3]Zhang H, Xue J, Dana K. Deep TEN: Texture Encoding Network. The IEEE Conference on Computer Vision and Pattern Recognition (CVPR) 2017:708-17.

Disclosure of Interests:

None declared

[Heritability of coronary heart disease, based on the data from the Chinese adult twins]

Objective: To analyze the heritability of coronary heart disease (CHD) among the Chinese twin adults. Methods: A total of 20 477 same-sex twin pairs aged 25 years and older from the Chinese National Twin Registry were interviewed. Structure equation model was used to estimate the heritability of CHD. Results: After adjusting for age and gender, the overall heritability of CHD was 0.75(0.68-0.81). Stratified analyses showed that genetic factors play a more important role in CHD incidence in ≥40 years or female twins. While the development of CHD was mainly influenced by environmental factors in 25-39 years or male twins. Conclusion: CHD is influenced by both genetic and environmental factors and the heritability is high.

Spatio-Temporal Convolutional LSTMs for Tumor Growth Prediction by Learning 4D Longitudinal Patient Data

Prognostic tumor growth modeling via volumetric medical imaging observations can potentially lead to better outcomes of tumor treatment management and surgical planning. Recent advances of convolutional networks (ConvNets) have demonstrated higher accuracy than traditional mathematical models can be achieved in predicting future tumor volumes. This indicates that deep learning based data-driven techniques may have great potentials on addressing such problem. However, current 2D image patch based modeling approaches can not make full use of the spatio-temporal imaging context of the tumor's longitudinal 4D (3D + time) patient data. Moreover, they are incapable to predict clinically-relevant tumor properties, other than the tumor volumes. In this paper, we exploit to formulate the tumor growth process through convolutional Long Short-Term Memory (ConvLSTM) that extract tumor's static imaging appearances and simultaneously capture its temporal dynamic changes within a single network. We extend ConvLSTM into the spatio-temporal domain (ST-ConvLSTM) by jointly learning the inter-slice 3D contexts and the longitudinal or temporal dynamics from multiple patient studies. Our approach can incorporate other non-imaging patient information in an end-to-end trainable manner. Experiments are conducted on the largest 4D longitudinal tumor dataset of 33 patients to date. Results validate that the proposed ST-ConvLSTM model produces a Dice score of 83.2%±5.1% and a RVD of 11.2%±10.8%, both statistically significantly outperforming (p < 0.05) other compared methods of traditional linear model, ConvLSTM, and generative adversarial network (GAN) under the metric of predicting future tumor volumes. Additionally, our new method enables the prediction of both cell density and CT intensity numbers. Last, we demonstrate the generalizability of ST-ConvLSTM by employing it in 4D medical image segmentation task, which achieves an averaged Dice score of 86.3%±1.2% for left-ventricle segmentation in 4D ultrasound with 3 seconds per patient case.

[Etiology and clinical features of primary adrenal insufficiency]

Objective: To summarize the etiology of primary adrenal insufficiency (PAI) and analyze its clinical features. Methods: A retrospective analysis was performed in the Department of Endocrinology, Peking Union Medical College Hospital from October 1981 to June 2019. Patients with PAI as the first symptom were enrolled. The etiology of PAI was analyzed and the clinical characteristics was also summarized. Results: A total of 131 patients with PAI were enrolled, including 87 males and 44 females (57 adolescents, and 74 adults). The age ranged from 0 to 73 years. The primary cause of PAI in adolescents was genetic defects (52.6%, 30/57), in which congenital adrenal dysplasia caused by DAX1 gene deficiency accounted for 50.0% (15/30), followed by autoimmunity (22.8%, 13/57). The primary cause of adult PAI was infection (58.1%, 43/74), of which tuberculosis accounted for the majority (93.0%, 40/43), and autoimmune adrenalitis accounted for 19.0% (14/74). Compared with the tuberculosis group, female patients were more common, and the onset age was younger, the plasma cortisol, serum sodium, fasting blood glucose, creatinine and aldosterone were lower (all P<0.05), and serum potassium and renin levels were higher in the autoimmune adrenalitis group (both P<0.05). Conclusions: In the current study, the proportion of PAI caused by infection in the adult group was higher than that in the adolescent group. The most common cause of adult PAI was tuberculosis infection. The most common cause of childhood PAI was genetic defects. Autoimmune damage to the adrenal glands may be more severe than tuberculosis infection.

Signal protein-functionalized gold nanoparticles for nuclear targeting into osteosarcoma cells for use in radiosensitization experiments

The standard therapy for malignant primary bone tumors such as osteosarcoma involves major surgeries. For tumors located in difficult regions such as the pelvis, surgical intervention could lead to serious side effects for example loss of a limb and/or function, loss of bowel, bladder and sexual function as well as problems with wound healing and surgical complications. Therefore, exploring other approaches that can improve or complement current surgical techniques is important. Hence, sensitizing primary bone tumors to radiation could offer an additional strategy that could complement surgery and significantly improve survival and quality of life. Gold nanoparticles (AuNPs) have been shown to enhance radiosensitivity by increasing the local dose of radiation inside tumors. Therefore, the referred procedure of preparation and functionalization of gold nanoparticles may be used for investigation whether DNA repair inhibition in the presence of AuNPs leads to an effective radiosensitizing strategy for primary bone tumor cells and explore the mechanism of how this may be happening. In our work, we prepared gold nanoparticles and verified the relation between the size of the AuNPs and their uptake in tumor 143B cells and also investigated whether the optimal size of the AuNPs should not be smaller than the size of nuclear envelope pores (20-50 nm). Hence, two different AuNPs systems were prepared: the first one with AuNPs core size of about 5 nm (BS) and the second one with AuNPs core size of about 50 nm (ZA). For cellular AuNPs uptake enhancement, we functionalized the AuNPs with signaling peptides. For this purpose we prepared PEG-coated AuNPs functionalized with signal peptides for targeted transport into the cytoplasm (CPP) and into the cell nucleus (CPP + NLS). The toxicity of the AuNPs systems was assessed by MTS assay. We prepared stable functionalized AuNPs systems of both sizes. With the functionalizing of the AuNPs using signal peptides (CPP, NLS), the AuNPs penetrated into the cell nucleus. The referred procedure of preparation and functionalization of gold nanoparticles may be used for investigating inhibition of DNA repair in the presence of AuNPs and it could lead to new understanding in overcoming radioresistance in primary bone tumor cells.

[Detection of CYP21A2 gene mutations and the differences in the levels of hormones in patients with 21-hydroxylase deficiency]

Objective: To analyze the detection of CYP21A2 gene mutations in 21-hydroxylase deficiency (21-OHD) patients, so as to determine the accuracy of clinical diagnosis. Methods: Totally, 514 patients with 21-OHD who visited Peking Union Medical College Hospital from January 2015 to January 2018 were enrolled and their clinical and biochemical data were collected. DNAs were extracted from peripheral blood leukocytes and CYP21A2 mutations were detected by Sanger sequencing and multiple ligation probe amplification (MLPA) technique. We divided 514 patients into three groups: two mutations of CYP21A2 alleles (group A), one mutation of CYP21A2 (group B), and no mutation of CYP21A2 (group C). Results: Mutation was detected in each allele of CYP21A2 gene in 401 (78.0%) patients, ninety (17.5%) had only one mutant allele and 23 (4.5%) had no mutation. There was no significant difference between the patients with different clinical phenotypes and the number of CYP21A2 gene mutations detected. In male, the cortisol of the patients with simple virilizing 21-OHD in group A [0.04 (0.02, 0.20) nmol/L] was lower than that of group B [0.24 (0.17, 0.28) nmol/L] and the difference was statistically significant (P=0.014). In female, 17-hydroxyprogesterone (17-OHP) of patients with salt wasting 21-OHD in group A [153.7 (90.1, 204.5) nmol/L] was higher than that of group B [38.2 (31.0, 183.3) nmol/L] and C [42.6 (27.8, 48.1) nmol/L] and the differences were statistically significant (both P<0.05). The progesterone of patients with simple virilizing 21-OHD in group C [23.0 (8.6, 33.2) nmol/L] was lower than that of gourp A [57.8 (34.4, 110.2) nmol/L] and B [63.6 (31.4, 110.8) nmol/L] and the difference were statistically significant (both P<0.05). The 17-OHP of patients with non-classical 21-OHD in group C [24.5 (20.4, 54.2) nmol/L] was lower than that of group A [158.7 (59.1, 187.6) nmol/L] and B [147.8 (131.9, 179.3) nmol/L]. The difference were statistically significant (both P<0.05). Conclusions: Mutations of two alleles have not been found in all patients with clinically diagnosed 21-OHD. Other congenital adrenal hyperplasia (CAH) types which can cause similar changes in 17-OHP and other hormones may be misdiagnosed as 21-OHD. Therefore, 21-OHD cannot be diagnosed with help of 17-OHP level only, and gene detection plays a vital role in the differential diagnosis of different CAH types.

Ultraviolet B-induced MdWRKY72 expression promotes anthocyanin synthesis in apple

Ultraviolet-B (UV-B) radiation promotes anthocyanin synthesis in many plants. Although several transcription factors promote anthocyanin synthesis in response to UV-B radiation, the underlying mechanism remains unclear. In this study, the MdWRKY72 transcription factor gene was isolated from the 'Taishanzaoxia' apple genome. Quantitative real-time PCR analyses revealed that the genes encoding enzymes and transcription factors involved in the anthocyanin synthesis pathway (MdANS, MdDFR, MdUFGT, and MdMYB1) were more highly expressed in MdWRKY72-overexpressing transgenic calli than in the wild-type 'Orin' apple calli. The results indicated that MdWRKY72 increases anthocyanin synthesis in transgenic calli exposed to UV-B radiation. The results of a gel shift assay and chromatin immunoprecipitation proved that MdWRKY72 promotes MdMYB1 expression indirectly by binding to a W-box element in the MdHY5 promoter and directly by binding to a W-box element in the MdMYB1 promoter. Thus, MdWRKY72 increases anthocyanin synthesis via direct and indirect mechanisms. These findings may be useful for elucidating the molecular mechanism underlying UV-B-induced anthocyanin synthesis mediated by MdWRKY72.

Parasitological and molecular detection of human fascioliasis in a young man from Guizhou, China

A 24-year-old man born in Guizhou province was diagnosed with obstructive jaundice and bile duct stones in 2013. Four living trematodes were found during laparotomy and cholecystectomy. Based on the morphology and molecular genetics analysis of internal transcribed spacer and pcox1 genes of the flatworm specimens, the trematodes from the patient were confirmed to be Fasciola hepatica. This report provided the clinical and molecular diagnosis information on human fascioliasis, which is an emerging sanitary problem still ignored in China. Human fascioliasis constantly occurs due to climatic changes and frequency of human travel. Therefore, it deserves more attention from physicians working in both developing and developed countries.

Time-Integrated Neutrino Source Searches with 10 Years of IceCube Data

This Letter presents the results from pointlike neutrino source searches using ten years of IceCube data collected between April 6, 2008 and July 10, 2018. We evaluate the significance of an astrophysical signal from a pointlike source looking for an excess of clustered neutrino events with energies typically above ∼1  TeV among the background of atmospheric muons and neutrinos. We perform a full-sky scan, a search within a selected source catalog, a catalog population study, and three stacked Galactic catalog searches. The most significant point in the northern hemisphere from scanning the sky is coincident with the Seyfert II galaxy NGC 1068, which was included in the source catalog search. The excess at the coordinates of NGC 1068 is inconsistent with background expectations at the level of 2.9σ after accounting for statistical trials from the entire catalog. The combination of this result along with excesses observed at the coordinates of three other sources, including TXS 0506+056, suggests that, collectively, correlations with sources in the northern catalog are inconsistent with background at 3.3σ significance. The southern catalog is consistent with background. These results, all based on searches for a cumulative neutrino signal integrated over the 10 years of available data, motivate further study of these and similar sources, including time-dependent analyses, multimessenger correlations, and the possibility of stronger evidence with coming upgrades to the detector.

Heat shock transcription factor 1 regulates exercise-induced myocardial angiogenesis after pressure overload via HIF-1α/VEGF pathway

Exercise training is believed to have a positive effect on cardiac hypertrophy after hypertension. However, its mechanism is still not fully understood. Herein, our findings suggest that heat shock transcription factor 1 (HSF1) improves exercise‐initiated myocardial angiogenesis after pressure overload. A sustained narrowing of the diagonal aorta (TAC) and moderately‐ intense exercise training protocol were imposed on HSF1 heterozygote (KO) and their littermate wild‐type (WT) male mice. After two months, the cardiac function was assessed using the adaptive responses to exercise training, or TAC, or both of them such as catheterization and echocardiography. The HE stains assessed the area of myocyte cross‐sectional. The Western blot and real‐time PCR measured the levels of expression for heat shock factor 1 (HSF1), vascular endothelial growth factor (VEGF) and hypoxia inducible factor‐1 alpha (HIF‐1α) in cardiac tissues. The anti‐CD31 antibody immunohistochemical staining was done to examine how exercise training influenced cardiac ontogeny. The outcome illustrated that exercise training significantly improved the cardiac ontogeny in TAC mice, which was convoyed by elevated levels of expression for VEGF and HIF‐1α and preserved the heart microvascular density. More importantly, HSF1 deficiency impaired these effects induced by exercise training in TAC mice. In conclusion, exercise training encourages cardiac ontogeny by means of HSF1 activation and successive HIF‐1α/VEGF up‐regulation in endothelial cells during continued pressure overload.

Two-way desorption coupling to enhance the conversion of syngas into aromatics by MnO/H-ZSM-5

We herein report a composite catalyst containing partially reducible and highly active manganese oxide and nano-size H-ZSM-5 with short b-axis, prepared for the direct conversion of syngas into aromatics.

Psychometric assessment and application of the Chinese version of the Compliance with Annual Diabetic Eye Exams Survey in people with diabetic retinopathy

AIM

To translate the Compliance with Annual Diabetic Eye Exams Survey (CADEES) into Chinese, allowing assessment of its reliability and validity, and to identify variables that predict attendance at annual eye examinations.

METHODS

People with vision-threatening diabetic retinopathy were recruited from the Shanghai Diabetic Eye Study. The study involved three phases: (1) translation and cross-cultural adaptation, (2) a pilot study (n = 496) to evaluate the psychometric properties of the Chinese-CADEES, and (3) a primary cross-sectional survey (n = 3818) to assess self-reported attendance at annual eye examinations. Factors related to non-attendance were identified using univariate analysis, and then a multiple logistic regression model. Finally, a component model and individual item models were built to predict attendance.

RESULTS

The Chinese-CADEES had satisfactory reliability and validity. The issue of low attendance at annual eye examinations was serious. In addition to 13 health belief items, living in semi-urban suburban areas, shorter duration of diabetes, poor glucose control, lower education level, better presenting visual acuity and milder diabetic retinopathy diagnosis were significantly related to non-attendance. The multivariate predictive model was able to predict, with 64.7% accuracy, whether or not participants were going to attend annual eye examinations and explained ~ 11.3% of the variance in attendance.

CONCLUSIONS

The Chinese-CADEES showed good reliability and validity for predicting attendance at annual eye examinations in people with diabetic retinopathy. Clinicians and researchers can improve attendance by addressing modifiable characteristics and increasing education on diabetic retinopathy and the importance of eye health in people with diabetes.

Dual roles of misshapen/NIK-related kinase (MINK1) in osteoarthritis subtypes through the activation of TGFβ signaling

OBJECTIVE

To identify the role of misshapen/NIK-related kinase (MINK1) in age-related Osteoarthritis (OA) and injury-induced OA, and the effects of enhanced TGFβ signaling in these progresses.

DESIGN

The effect of MINK1 was analyzed with MINK1 knock out (Mink1-/-) mice and C57BL/6J mice. OA progress was studied in age-related OA and instability-associated OA (destabilization of the medial meniscus, DMM) models. The murine knee joint was evaluated through histological staining, Osteoarthritis Research Society International (OARSI) scores, immunohistochemistry, and μCT analysis. Primary chondrocytes were isolated from wild type and Mink1-/- mice and subjected to osteogenic induction and Western blot analysis.

RESULTS

MINK1 is highly expressed during cartilage development and in normal cartilage. Mink1-/- mice displayed markedly lower OARSI scores, aggrecan degradation neoepitope positive cells and increased Safranin O and pSMAD2 staining in aging-related OA model. However, in injury-induced OA, loss of MINK1 accelerates extracellular matrix (ECM) destruction, osteophyte formation, and subchondral bone sclerosis. Accelerated subchondral bone remodeling in Mink1-/- mice was accompanied with increased numbers of nestin-positive mesenchymal stem cells (MSCs) and osterix-positive osteoprogenitors. pSMAD2 staining was increased in the subchondral bone marrow of Mink1-/- mice and overexpression of MINK1 inhibited SMAD2 phosphorylation in vitro.

CONCLUSIONS

This study shows for the first time that activation of TGFβ/SMAD2 by MINK1 deficiency plays opposite roles in aging-related and injury-induced OA. MINK1 deficiency protects cartilage from degeneration in aging joints through increased SMAD2 activation in chondrocytes, while accelerating OA progress in injury-induced model through enhanced osteogenesis of MSCs in the subchondral bone. These findings provide insights for developing precision OA therapeutics targeting TGFβ/SMAD2 signaling.

[Analysis of copy number variation of CYP21A2 gene and the type of CYP21A1P/CYP21A2 fused gene in patients with 21-hydroxylase deficiency]

Objective: To analyze the copy number variation of CYP21A2 gene in 21-hydroxylase deficiency (21-OHD) patients, and identify the three copy repetition, single copy deletion of CYP21A2 gene and the type and proportion of CYP21A1P/CYP21A2 fused gene in 21-OHD patients. Methods: A total of 424 patients (140 males and 284 females) with 21-OHD who visited Peking Union Medical College Hospital from January 2015 to January 2018 were enrolled and the average age was (17.1±12.4) years. All clinical and biochemical data were collected. DNAs were extracted from peripheral blood leukocytes, and CYP21A2 gene mutation and copy number variation were detected by Sanger sequencing and multiple ligation probe amplification (MLPA). Results: Of 424 21-OHD patients, 287 (67.7%) had two copies of CYP21A2 gene, 137 (32.3%) had copy number variation, of which 1 patients (0.2%) had 3 copies of CYP21A2 gene and 136 (32.1%) were carriers of large deletion/rearrangement mutation of CYP21A2 gene. Three pathogenic mutations including a truncated Q319X protein mutation were detected in the patient with 3 copies of CYP21A2 gene. Of 136 patients with large deletion/rearrangement mutation of CYP21A2 gene, 82 (60.3%) carried fused CYP21A1P/CYP21A2 gene, and the remaining 54 harbored the one allele deletion of CYP21A2. The most common types of fused CYP21A1P/CYP21A2 gene were CH-5, CH-1 and CH-2, with the frequency being 31.7% (26 cases), 26.8% (22 cases) and 19.5% (16 cases), respectively, and followed by CH-4 and CH-7, with the incidence being 8.5% (7 cases) and 4.9% (4 cases), respectively. In addition, two cases of CH-3, CH-6 and CH-8 and one case of CH-9 were detected. Conclusions: This is the first study to detect the occurrence of CYP21A2 gene copy number variation and fused CYP21A1P/CYP21A2 gene in a large cohort of 21-OHD patients. The number of CYP21A2 gene copies in 21-OHD patients includes 2 copies, 1 copy deletion and 3 copies duplication. One copy deletion of CYP21A2 includes one allele deletion of CYP21A2 gene and fused CYP21A1P/CYP21A2 gene. In patients with 3 copies of CYP21A2 gene, pathogenic mutations should be verified in all 3 copies of CYP21A2 gene to make the precise diagnosis. Therefore, the accurate molecular diagnosis of 21-OHD patients should take both genotype and copy number variation of CYP21A2 into account.

Capture Deformation Twinning in Mg during Shock Compression with Ultrafast Synchrotron X-Ray Diffraction

Deformation twinning plays a vital role in accommodating plastic deformation of hexagonal-close-packed (hcp) metals, but its mechanisms are still unsettled under high strain rate shock compression. Here we investigate deformation twinning in shock-compressed Mg as a typical hcp metal with in situ, ultrafast synchrotron x-ray diffraction. Extension twinning occurs upon shock compression along ⟨112[over ¯]0⟩ and ⟨101[over ¯]0⟩, but only upon release for loading along ⟨0001⟩. Such deformation mechanisms are a result of the polarity of deformation twinning, which depends on directionality and relative magnitude of resolved shear stress and may be common for Mg and its alloys in a wide range of strain rates.

Effect of manganese source on manganese absorption and expression of related transporters in the small intestine of broilers

An experiment was conducted to investigate the effect of manganese (Mn) source on Mn absorption and expressions of Mn, amino acid, and peptide transporters in the small intestine of broilers. A total of 320 Mn-deficient 15-day-old Arbor Acres male broilers were randomly assigned to 5 treatments with 8 replicates/treatment and 8 chicks/replicate and fed an Mn-unsupplemented control diet or the control diet supplemented with 110 mg Mn/kg from either MnSO4, or 1 of 3 organic Mn chelates with weak (OW), moderate (OM), or strong (OS) chelation strength for 14 D. The plasma Mn contents were higher (P < 0.03) in supplemental Mn groups than in the control group, in OS group than in OM group, and in OM group than in OW and MnSO4 groups on day 28. Broilers fed diets supplemented with Mn had higher (P < 0.02) duodenal divalent metal transporter 1 (DMT1) and ferroportin 1 (FPN1) mRNA levels and FPN1 protein level on both days 21 and 28 than those fed the control diet. Duodenal DMT1 mRNA and protein levels were higher (P < 0.05) in OM and OS groups than in OW and MnSO4 groups on day 28. The mRNA levels of amino acid transporters [b0, +-type amino acid transporter 1 (B0AT1) and excitatory amino acid transporter 3 (EAAT3)] were higher (P < 0.0005), and peptide transporter 1 was lower (P < 0.04) in the ileum than in the duodenum and jejunum; however, Mn source did not affect (P > 0.05) mRNA levels of amino acid and peptide transporters in the small intestine of broilers. The results from the present study indicate that both DMT1 and FPN1 facilitated Mn absorption, however, the amino acid and peptide transporters might not be involved in the transport of the organic Mn chelates; organic Mn chelates with moderate and strong chelation strength, especially strong chelation strength, showed higher Mn absorption possibly due to enhanced DMT1 expression in the duodenum of broilers.

Chitinase-like protein YKL-40 regulates human bronchial epithelial cells proliferation, apoptosis, and migration through TGF-β1/Smads pathway

In order to study the effects of chitinase-like protein YKL-40 on proliferation, apoptosis, and migration of human bronchial epithelial cell line (BEAS-2B), and the underlying mechanisms, we cultured BEAS-2B alone or with different concentrations of YKL-40. thiazolyl blue tetrazolium bromide (MTT) assay was used to examine the cell proliferation. Annexin V-fluorescein isothiocyanate isomer (FITC)/propidium iodide staining and scratch assay were performed to test the cell apoptosis and migration. The concentrations of transforming growth factor-β1 (TGF-β1), Smad3, Smad7, alpha-smooth muscle actin (α-SMA), interleukin-4 (IL-4), IL-6, and IL-8 in the cell culture supernatant were detected by enzyme-linked immunosorbent assay. The messenger RNA and protein levels of YKL-40, TGF-β1, Smad3, Smad7, and α-SMA were detected by reverse transcription polymerase chain reaction and Western blot. BEAS-2B cells cultured with different concentrations of YKL-40 showed significantly higher cell proliferation and migration and inflammatory cytokines compared with that of control group, while the cell apoptosis was significantly lower than that of control group (p < 0.05). In addition, BEAS-2B cells cultured with YKL-40 had increased TGF-β1, Smad3, Smad7, and α-SMA levels in the supernatant, compared with that of BEAS-2B cells cultured alone (p < 0.05). Furthermore, LY364947, as TGF-β1/Smads signaling pathway inhibitor, decreased cell proliferation and migration ability and enhanced cell apoptosis of BEAS-2B cells compared with control group (p < 0.05). However, YKL-40 administration reversed the effect of LY364947 on the biological behavior of BEAS-2B cells. YKL-40 could affect the biological behaviors of BEAS-2B cells, which might be related to the TGF-β1/Smads pathway.

[Influence of five-in-one management mode on disease prevention and control of school children with asthma]

Objective: To investigate the influence of five-in-one management mode(standardized asthma treatment, asthma diary, peak expiratory flow (PEF) monitoring, reasonable diet and physical exercise) on disease prevention and control of school children with asthma. Methods: From April to October 2018, 70 children with asthma in clinical remission were selected from Affiliated Hospital of Qingdao University using randomized controlled study design. These children were randomly divided into study group and control group, with 35 cases in each group. In the study group, 5 cases were lost to follow-up, and 30 cases were actually enrolled. In the control group, 6 cases were lost to follow-up, and 29 cases were actually enrolled. Children in the control group received routine medication and regular outpatient consultation, and children in the study group received the five-in-one asthma management model. In the first time of seeing a doctor, after 3 months and 6 months of follow-up, asthma control test score, medication compliance index score and lung function index (forced expiratory volume in 1 second (FEV1), PEF were evaluated respectively.Parental satisfaction, asthma acute episodes, weight, height and biochemical index were recorded during the 6 months of follow-up. Pulmonary function index, asthma control score and body mass index of overweight children with asthma were compared with t-test, medication compliance was compared with chi-square test, and the rank sum test was used for the comparison of the number of emergency visits of asthma attacks and parents' satisfaction. Results: A total of 59 children with asthma were included, among them 30 were in the study group (8.1±1.5) years old and 29 in the control group (9.2±1.1) years old. After 3 months of follow-up, FEV1, PEF, asthma control score in the study group were (86.3±1.5)%, (83.3±2.4)%, (24.7±2.6) points respectively; and in the control group, FEV1, PEF, asthma control score were (84.4±2.5)%, (82.2±1.9)%, (21.1±1.3) points respectively. The indicators in the study group were higher than those in the control group (t=3.62, 1.97, 6.64, P<0.05). After 6 months of follow-up, FEV1, PEF, asthma control score in the study group were (88.4±2.3)%, (85.4±2.2)%, (26.8±1.8) points respectively; and in the control group, FEV1, PEF, asthma control score were (85.5±1.9)%, (83.2±1.7)%, (22.5±1.4) points respectively. The indicators in the study group were significantly higher than those in the control group (t=5.34, 4.24, 10.41, P<0.05). During the 6-month follow up, the number of emergency visits of asthma attacks in the study group and in the control group were 0.42(0.36, 0.51) and 0.92(0.72, 1.27) respectively. The indicator in the study group was significantly lower than that in the control group (Z=3.21, P<0.05). After 3 months of follow-up, the proportions of children with good compliance in the study group and control group were 67% (20/30) and 62% (18/29), the proportions of poor compliance were 27% (8/30) and 34% (10/29), the proportions of non-compliance were 7% (2/30) and 7% (2/29). There were no statistically significant differences (χ(2)=0.14, 0.43, 0.00, P=0.71, 0.51, 0.97). After 6 months of follow-up, the proportions of children with good compliance in the study group and control group were 87% (26/30) and 69% (20/29), the proportion of poor compliance were 10% (3/30) and 28% (8/29), the proportion of non-compliance were 3% (1/30) and 7% (2/29), There were no statistically significant differences (χ(2)=2.70, 3.00, 0.39, P=0.10, 0.08, 0.53). After 6 months of follow-up, the number of great satisfaction, satisfaction and dissatisfaction in the study group were 20, 10 and 0 respectively, the satisfaction rate was 100%, meanwhile those indicators in the control group were 4, 15 and 10 respectively, the satisfaction rate was 66%, The indicator in the study group was significantly higher than that in the control group (Z=4.60, P<0.05). Conclusions: The application of "five-in-one" asthma management model (standardized asthma treatment, asthma diary, PEF monitoring, reasonable diet and physical exercise) for school-age children with asthma can significantly improve lung function, as well as reduce the number of acute asthma attacks. It has a high parent satisfaction, therefore it should be recommended for clinical implementation.