[Evidence-based interventional radiology: past, present and future]

Evidence-based interventional radiology is the result of the evolution and integration of evidence-based medicine and interventional radiology. It adopts the concepts and methods of evidence-based medicine to guide the best clinical practice in interventional radiology. We aim to systematically elaborate on the status quo of Clinical Research, Systematic Review/Meta-Analysis and Clinical Practice Guidelines in interventional radiology, analyze the existing problems, and put forward thoughts and suggestions on promoting the development of evidence-based interventional radiology in the future.

The effective coupling coefficient for a completed PIN-PMN-PT array

The computation of the electromechanical coupling coefficient (EMCC) of a fully assembled medical ultrasound transducer array is directly computed with closed form expressions. The Levenberg-Marquardt non-linear regression algorithm (LMA) is employed to help confirm the EMCC calculated prediction (k_EFF) and provide statistical insights. The complex electrical impedance spectra of a 1-3 composite array with two matching layers operating at a 3.75 MHz center frequency using PIN-PMN-PT single crystal material is measured in air both before and after oven heating at 160 °C for 15 min. The oven heating produces changes in the EMCC of -4.9%, clamped dielectric constant of -11%, and effective transducer longitudinal velocity of -2.5%. Utilizing the pre- and post-heating array impedance data, the calculated EMCC values from the new closed form expressions agree well with the complete KLM model based LMA, and also exhibit approximately one tenth the error as compared to the formulas for a flat, unloaded transducer.

Long noncoding RNA SOX2OT maintains the stemness of pancreatic cancer cells by regulating DEK via interacting with miR-200a/141

The article "Long noncoding RNA SOX2OT maintains the stemness of pancreatic cancer cells by regulating DEK via interacting with miR-200a/141, by C.-S. Liu, Q. Zhou, Y.-D. Zhang, Y. Fu, published in Eur Rev Med Pharmacol Sci 2020; 24 (5): 2368-2379-DOI: 10.26355/eurrev_202003_20504-PMID: 32196588" has been withdrawn from the authors stating that "to validate the effect of lncRNA-SOX2OT, we constructed SOX2OT overexpressed cells using lentiviral vector with -IRES2-EGFP to easily visualize the transfection efficiency. Therefore, the stably transfected cells were carrying the green fluorescence. However, during our Flow cytometry assay, we took PC cells (Control) with no fluorescence to standardize our equipment and measured the negative control (NC) and overexpressed-Sox2ot (oe-Sox2ot) according to the manufacturer's guidance, without removing the disturbance that the green fluorescence caused. This means that, despite having performed the standard assay, the results obtained in Figure 2D were wrong and unscientific". The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/20504.

[Epidemic characteristics and dynamic changes of spatio-temporal distribution of hemorrhagic fever with renal syndrome in Guangzhou, 2010-2019]

Objective: To analyze the epidemic characteristics and spatio-temporal distribution of hemorrhagic fever with renal syndrome (HFRS) in Guangzhou from 2010 to 2019 and provide a basis for prevention and control strategies. Methods: The data of HFRS was from National Disease Reporting Information System and the epidemic investigation. A descriptive analysis was used. OpenGeoDa 1.2.0 software was used for global spatial autocorrelation and local spatial autocorrelation analysis. SatScan 9.6 software was used for detecting the hot spot area in time and space. ArcGIS 10.2 software was used for map visualization. Results: 1 298 cases of HFRS were reported, and three patients died in Guangzhou in 2010-2019. The annual incidence rate was 0.99/100 000. The proportion of 21-50 years old cases accounted for 70.88% and the male to female ratio was 2.98∶1. Most patients were house workers or unemployed, accounting for 31.28%, followed by business servants (accounting for 17.33%). The incidence peak in spring and winter accounted for 33.74% and 26.35% of the year. All districts reported cases in recent ten years. A total of 407 cases had been reported in Haizhu district, accounting for 31.36% of the total number of cases in the whole city. The annual incidence rate was 2.52/100 000. The number of reported cases and the annual incidence rate were the highest in Guangzhou. The clustered area showed that there was spatio-temporal clustering in Guangzhou. The aggregation area was mainly concentrated in the urban villages adjacent to Wan-mu orchard and the Haizhu Lake Wetland Park in Haizhu district (logarithmic likelihood ratio was 44.08, P<0.001). Conclusions: The prevalence and concentration of HFRS in winter and spring Guangzhou city from 2010 to 2019, showed a high incidence. Young and middle-aged men engaged in domestic and unemployed, and commercial services appeared the main risk groups. The urban-rural junction with many immigrants and low health environment, streets adjacent to Wan-mu orchard, and the Haizhu Lake Wetland Park in Haizhu district were the important regions for preventing and controlling HFRS. The government should formulate prevention and control measures to curb the rise and spread of the HFRS epidemic.

Adipokinetic hormone enhances CarE-mediated chlorpyrifos resistance in the brown planthopper, Nilaparvata lugens

Adipokinetic hormone (AKH), the principal stress-responsive neurohormone in insects, has been implicated in insect responses to insecticides. However, the functionality of AKH and its mode of signalling in insecticide resistance are unknown. Herein, we demonstrated that the enhanced activity of carboxylesterases (CarEs) is involved in the chlorpyrifos resistance in Nilaparvata lugens [brown planthopper (BPH)]. Chlorpyrifos exposure significantly induced the expression of AKH and its receptor AKHR in the susceptible BPH (Sus), and these two AKH signalling genes were over-expressed in the chlorpyrifos-resistant strain (Res) compared to Sus. RNA interference (RNAi) against AKH or AKHR decreased the CarE activity and suppressed the BPH's resistance to chlorpyrifos in Res. Conversely, AKH peptide injection elevated the CarE activity and enhanced the BPH's survival against chlorpyrifos in Sus. Furthermore, five CarE genes were identified to be positively affected by the AKH pathway using RNAi and AKH injection. Among these CarE genes, CarE and Esterase E4-1 were found to be over-expressed in Res compared to Sus, and knockdown of either gene decreased the BPH's resistance to chlorpyrifos. In conclusion, AKH plays a role in enhancing chlorpyrifos resistance in the BPH through positive influence on the expression of CarE genes and CarE enzyme activity.

Real world cardiovascular risk assessment using reduced DAD, SCORE and Framingham equations in a German HIV cohort

Introduction

People living with HIV are at increased risk for cardiovascular disease (CVD). Therefore, prevention of CVD should be integrated in HIV care. Although several risk scores exist to predict the risk of developing CVD, none of this specifically addresses the fact of HIV. Previously, the reduced Data Collection on Adverse Events of Anti-HIV Drug score (D:A:D-R) model has been proposed to assess the CVD risk for HIV patients. However, this score has not been validated in an independent cohort, or compared to traditional CVD prediction models established in the non-HIV population.

Purpose

We aim to compare the predictive value of the CVD risk scores D:A:D-R, SCORE and Framingham CVD in a German HIV population and evaluate their CVD risk in a real world setting.

Methods

This is a prospective, cross-sectional, single center study. Patients with HIV and older than 30 years were enrolled between January 2018 and December 2019. Exclusion criteria were preexisting CVD and statin therapy. CVD risk estimates were calculated using the D:A:D-R, Framingham CVD (FRS), and SCORE models. Agreement between estimates was assessed using Cohen's kappa coefficient. The indication for statin therapy was calculated using the AHA and EACS guidelines.

Results

488 patients with HIV and a median age of 47.8 years were included. Median time since HIV diagnosis was 9.9 years. All, but one Patient were on ART for a median time of 5.9 years. 61% were female. Using the D:A:D-R score, the highest proportion of patients with high or very high risk for CVD were identified (17.8%). In comparison, using SCORE and FRS only 4.7% and 13.7% of patients were identified as high or very high risk, respectively. There was a poor agreement between D:A:D-R and SCORE (k=0.11), and D:A:D-R and FRS (k=0.33). Based on the calculated CVD risk using the three models, indication for primary statin medication varied between 34.8% to 92%.

Conclusion

Our data demonstrate that standard CVD risk scores underestimate the CVD risk in patients with HIV. Using SCORE and FRS, a high proportion of patients with HIV and at high risk for CVD would be underestimated and miss the indication for statin medication. Therefore, using scores including HIV specific parameters should be considered in this patient population.

Funding Acknowledgement

Type of funding source: None

Loss of platelet BMP4 reduces vascular inflammation and ameliorates vascular remodelling after carotid wire injury

Background

Bone morphogenic proteins (BMPs) are members of the TGFβ superfamily. They have distinct functions during hemostasis and play a central role in various pathologic conditions, including cardiovascular diseases. Recent findings demonstrate that BMPs are also expressed in platelets. However, their function is poorly understood. Here, we investigate the role of platelet BMP4 during vascular inflammation and vascular remodelling.

Methods

BMP4 floxed mice were crossed with PF4 Cre mice to generate platelet-specific deletion of BMP4 (BMP4Plt−/−). Intravital microscopy of mesenteric veins was performed to evaluate leukocyte adhesion upon stimulation with TNFα. Expression of adhesion molecules and chemokines were analysed by RT-PCR and Western Blot. P-selectin and platelet-leukocyte aggregates were evaluated using flow cytometry. For carotid wire injury, BMP4Plt−/− were further crossed with LDLr−/− mice (BMP4Plt−/−/LDLr−/−). At 8 weeks of age, BMP4Plt−/−/LDLr−/− mice and control littermates received a 2-week diet containing 15.8% wt/wt fat and 1.25% cholesterol. Carotid wire injury was performed at the age of 10 weeks. Re-endothelialisation and neointimal hyperplasia were evaluated.

Results

Platelet morphology and function did not differ between BMP4Plt−/− and control mice. Stimulation with TNFα resulted in increased rolling and adherence of leukocytes to the vessel wall which was reduced in BMP4Plt−/− mice (175±25 versus 50±7 rolling cells and 16±3 versus 7±2 adherent cells, respectively). Expression of P-selectin, adhesion molecules and the chemokines RANTES and PF-4 were reduced in BMP4Plt−/− mice. Platelet activation by thrombin was reduced in BMP4Plt−/− mice, resulting in diminished P-Selectin and JONA expression. Furthermore, monocyte infiltration and circulating leukocyte-platelet complexes were reduced in BMP4Plt−/− mice. Loss of platelet BMP4 prevented neointima formation after carotid wire injury (4.2x104±0.9x104μm2 versus 14.9x104±2.2x104μm2 in BMP4Plt−/−/LDLr−/− and control mice, respectively). Interestingly, endothelial regeneration after injury was decelerated in BMP4Plt−/− mice. This is further demonstrated in-vitro, where platelet BMP4 promoted endothelial cell proliferation and migration.

Conclusion

Platelet-BMP4 deficiency reduced vascular inflammation and ameliorated intima hyperplasia after wire injury. This is partly mediated by inhibition of platelet activation, reduced expression of adhesion molecules and inflammatory response. Our finding suggests that BMP4 is a promising target for the treatment of vascular inflammation and restenosis.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Else-Kröner Fresenius Foundation; German Cardiac Society

Abscisic acid and hydrogen peroxide are involved in drought priming-induced drought tolerance in wheat (Triticum aestivum L.)

Drought is one of the major stress factors in wheat production on a global scale. Drought priming during the early growth stage can enhance drought tolerance in wheat (Triticum aestivum L.). Abscisic acid (ABA) and hydrogen peroxide (H₂ O₂ ) are important signal molecules in the adaptation of plants to drought stress. However, the roles of ABA and H₂ O₂ in drought priming-induced drought tolerance are not clear. In the present study, we evaluated the responses of wheat to an ABA inhibitor, H₂ O₂ scavenger and an inhibitor to investigate the (i) relationship between ABA and H₂ O₂ in osmotic adjustment after drought priming in the vegetative stage and (ii) responses to drought stress during grain filling. In the drought priming alone treatments, chemical application resulted in the scavenging of ABA and H₂ O₂ , weakening the alleviation effects of drought priming on drought stress, as demonstrated by the lower leaf water potential and grain yield. The ABA inhibitor completely inhibited accumulation of ABA and H₂ O₂ ; the ABA inhibitor inhibited respiratory burst oxidase homologue expression, whereas the H₂ O₂ inhibitor resulted in higher 9-cis-epoxycarotenoid dioxygenase expression and ABA concentration in primed plants, indicating that ABA scavenging inhibited H₂ O₂ biosynthesis while H₂ O₂ scavenging did not inhibit ABA biosynthesis. The results further demonstrated that NADPH oxidase-mediated H₂ O₂ production functions downstream of ABA, which induces osmolyte transcript expression and accumulation, and thus contributes to drought priming-induced stress tolerance. These results provide a theoretical basis for a better understanding of the mechanisms involved in drought priming-induced tolerance in wheat plants.

MiR-92b inhibited cells EMT by targeting Gabra3 and predicted prognosis of triple negative breast cancer patients

OBJECTIVE

Triple negative breast cancer (TNBC) is a subtype of breast cancer without the three markers, which has a poor prognosis than other types. Recently, studies have identified that microRNA-92b (miR-92b) acted as potential oncogene in tumor progression, however, the biological roles of miR-92b in TNBC remain unknown. The purpose of this study was to investigate the functions of miR-92b and verify its effect on the regulation of Gabra3 in TNBC.

MATERIALS AND METHODS

Dual-Luciferase reporter assay was recruited to confirm whether miR-92b directly binds to the 3'-untranslated region (3'-UTR) of Gabra3 mRNA in TNBC. Transwell assay was employed to analyze the capacities of migration and invasion. Western blot was applied to evaluate the expression of the special proteins that including Gabra3, epithelial-mesenchymal transition (EMT) markers and GAPDH.

RESULTS

We demonstrated that miR-92b was remarkably low expressed in TNBC tissues and cell lines, and particularly in inhibiting the migration, invasion and EMT of TNBC cells. On the contrary, Gabra3 was significantly overexpressed in TNBC tissues and cell lines in comparison with the corresponding paracancerous tissues and the normal breast epithelial cell line. The expression of miR-92b had a negative correlation with the expression of Gabra3 in TNBC tissues. Downregulation of Gabra3 could inhibit the migration, invasion and EMT of TNBC cells. MiR-92b mediated the expression of Gabra3 through directly binding to the 3'-UTR of Gabra3 mRNA. In addition, low expression of miR-92b or overexpression of Gabra3 predicted poor prognosis of TNBC patients.

CONCLUSIONS

MiR-92b inhibited the migration and invasion-mediated EMT through directly targeting the 3'-UTR of Gabra3 mRNA in triple negative breast cancer. The newly identified miR-92b/Gabra3 axis may make it to be a new target for clinical diagnosis and treatment of TNBC.

Functional inhibition of regulatory CD4+CD25+T cells in peripheral blood of patients with pemphigus vulgaris

BACKGROUND

Pemphigus vulgaris (PV) is a potentially life-threatening autoimmune bullous disease affecting the skin and mucous membranes. Its pathogenic mechanism is still not fully understood. Regulatory T cells (Tregs) have been reported to play a significant role in regulating immune homeostasis in autoimmune disorders, such as PV.

AIM

To investigate the potential role of Tregs in the immunopathogenesis of PV.

METHODS

We enrolled 15 patients with PV and 15 healthy controls (HCs). Peripheral blood samples were collected from all participants before treatment. This was followed by flow cytometric, real-time reverse transcription PCR, and in vitro inhibition-based functional assays to explore the immunopathogenesis of Tregs in PV.

RESULTS

Our results showed no statistically significant differences in total CD4+CD25+ cells and CD4+CD25^high cells. In addition, expression levels of FOXP3 mRNA and the corresponding FOXP3 protein remained unchanged in the patients with PV and the HCs. However, the in vitro suppressive activity of CD4+CD25+ T cells was impaired in patients with PV compared with HCs.

CONCLUSIONS

Our observations suggest that inhibition of suppressive activity of Treg cells may be involved in the pathogenesis of PV.

[Design and application of static progressive ankle foot orthosis]

The scar contracture of Achilles tendon in burn patients after operation is easy to cause " foot drop" , which leads to ankle dorsiflexion dysfunction. To solve this problem, the authors designed and made a static progressive ankle foot orthosis. The foot support part and the crus support part of the orthotic device are connected by rivets, and the distal end of the foot support part and the proximal end of the crus support part are pulled by the traction belt on both sides, gradually improving the ankle dorsiflexion function. This static progressive ankle foot orthosis is simple, practical, cost-effective, and worthy of clinical promotion.

Observation of the Doubly Cabibbo-Suppressed Decay D^{+}→K^{+}π^{+}π^{-}π^{0} and Evidence for D^{+}→K^{+}ω

Using 2.93  fb^{-1} of e^{+}e^{-} collision data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, the first observation of the doubly Cabibbo-suppressed decay D^{+}→K^{+}π^{+}π^{-}π^{0} is reported. After removing decays that contain narrow intermediate resonances, including D^{+}→K^{+}η, D^{+}→K^{+}ω, and D^{+}→K^{+}ϕ, the branching fraction of the decay D^{+}→K^{+}π^{+}π^{-}π^{0} is measured to be (1.13±0.08_{stat}±0.03_{syst})×10^{-3}. The ratio of branching fractions of D^{+}→K^{+}π^{+}π^{-}π^{0} over D^{+}→K^{-}π^{+}π^{+}π^{0} is found to be (1.81±0.15)%, which corresponds to (6.28±0.52)tan^{4}θ_{C}, where θ_{C} is the Cabibbo mixing angle. This ratio is significantly larger than the corresponding ratios for other doubly Cabibbo-suppressed decays. The asymmetry of the branching fractions of charge-conjugated decays D^{±}→K^{±}π^{±}π^{∓}π^{0} is also determined, and no evidence for CP violation is found. In addition, the first evidence for the D^{+}→K^{+}ω decay, with a statistical significance of 3.3σ, is presented and the branching fraction is measured to be B(D^{+}→K^{+}ω)=(5.7_{-2.1}^{+2.5}_{stat}±0.2_{syst})×10^{-5}.

[Expression of SOX-11 and TFE3 in solid-pseudopapillary tumor of pancreas and its clinical significance]

Objective: To investigate the expression status and diagnostic value of SRY related high mobility group box 11 (SOX-11) and transcription factor E-3 (TFE3) in solid pseudopapillary tumors of pancreas (SPTPs). Methods: Thirty-eight cases of SPTPs, 36 cases of well-differentiated pancreatic neuroendocrine tumors (PanNETs) and six cases of pancreatic acinar cell carcinomas (PACCs) were collected at the Affiliated Drum Tower Hospital of Nanjing University Medical School from 2012 to 2019. The expression of SOX-11, TFE3 and β-catenin was detected by immunohistochemistry, and the TFE3 gene status was detected by FISH in 18 cases of SPTPs. Results: Among the 38 SPTP patients, 29 were female and 9 were male, with a mean age of 50 years; among 36 PanNET patients, 32 were female and 4 were male, with a mean age of 39 years; for the six PACC patients, four were male and two were female, with a mean age of 60 years. β-catenin was positive in all 38 SPTPs, but was negative in all 36 PanNETs and 5/6 PACCs. SOX-11 was positive in 35/38 (92.1%) of SPTPs, but was negative in all 36 PanNETs and 6 PACCs. TFE3 was positive in 36/38 (94.7%) of SPTPs, but was negative in all 36 PanNETs and 6 PACCs. Among these three tumors, the specificity and sensitivity of β-catenin were 97.6% and 100.0%, the specificity and sensitivity of SOX-11 were 92.1% and 100.0%, the specificity and sensitivity of TFE3 were 94.7% and 100.0%, respectively. There was a significant difference of the expression status of all three markers in SPTPs compared with PanNETs and PACCs (P<0.01). The results of SOX-11 and TFE3 immunostaining showed high consistency (Kappa>0.6). No gene rearrangement (0/18) of TFE3 was found in SPTPs. Conclusion: SOX-11 and TFE3 are highly expressed in SPTPs, and their specificity in the differential diagnosis of SPTPs is better than that of β-catenin.

[Effect of aspirin on hepatocellular carcinoma and its related mechanism]

Aspirin, as a traditional non-steroidal anti-inflammatory drug, has therapeutic and preventive effects on gastrointestinal tumors. Hepatocellular carcinoma is one of the most common malignant tumors in the digestive tract, so it is necessary to find effective preventive and therapeutic measures. This article reviews the research progress and mechanism of aspirin on hepatocellular carcinoma with a view to provide references for future clinical treatment.

[Nursing strategies for the facial skin injuries caused by wearing medical-grade protective equipment]

For effective resistance to virus attack and infection and reducing virus transmission chance, it is extremely important for the medical staff and related workers to have their own safe protection. The paper summarizes the occurrence causes, common locations, and prevention ways about the device related pressure ulcers on the face resulted from wearing medical-grade protective equipment for a long working time. The paper proposes the prevention and nursing strategies for device related pressure ulcers and other related skin injuries during application of medical-grade protective equipment. The paper aims to provide reference for the prevention and nursing of device related pressure ulcers and related skin diseases for clinical medical staff, especially to the respectable personnel in front line of fighting against coronavirus disease 2019.

[Efficacy of esophageal cancer screening program on population at high risk: a survey carried out in people aged 40-69 years in Yangzhong, Jiangsu province]

Objective: To understand the incidence of esophageal cancer in population at high risk in Yangzhong of Jiangsu province. Methods: Cluster random sampling method was conducted to select several natural villages from the high risk area of esophageal cancer in Yangzhong during 2011-2017. Local residents aged 40-69 years were selected as the target population and a total of 14 687 persons were diagnosed esophageal cancer by endoscopy and pathology. Results: Precancerous lesions were detected in 341 persons, with the detection rate as 2.32% (341/14 687). Among them, there were 234 (1.59%) cases with mild and 107 (0.73%) cases with moderate esophageal hyperplasia. There were 77 positive cases with esophageal hyperplasia and the detection rate was 0.52%. Among these positive cases, 41 showed severe esophageal hyperplasia/carcinoma in situ (0.28%), with another 19 as early esophageal cancer (0.13%) and 17 with invasive carcinoma (0.12%). The overall early detection rate of positivity through active screening was 77.92% (60/77), with trends of upwarding and then downwarding. The detection rate of esophageal lesions in men was higher than that in women (P<0.05), but without significant gender specific differences seen in the detection rates of early esophageal cancer or invasive carcinoma (P>0.05). The detection rates of all lesions other than invasive carcinoma, gradually increased with age (P<0.05). The detection rate of invasive carcinoma reached the highest (0.39%, 10/2 547) in the age group of 60-years and slightly decreased in the age group of 65-years old. Conclusions: Considerable numbers of patients with cancer and precancerous lesions in groups at high-risk can be found through the screening program for esophageal cancer, suggesting that the screening program is of great significance in improving the survival rate and quality of life. Attention should be paid to men, with elderly groups in particular, at high-risk in order to increase the detection rate of early cases.

Σ^{+} and Σ[over ¯]^{-} Polarization in the J/ψ and ψ(3686) Decays

From 1310.6×10^{6}  J/ψ and 448.1×10^{6}  ψ(3686) events collected with the BESIII experiment, we report the first observation of Σ^{+} and Σ[over ¯]^{-} spin polarization in e^{+}e^{-}→J/ψ[ψ(3686)]→Σ^{+}Σ[over ¯]^{-} decays. The relative phases of the form factors ΔΦ have been measured to be (-15.5±0.7±0.5)° and (21.7±4.0±0.8)° with J/ψ and ψ(3686) data, respectively. The nonzero value of ΔΦ allows for a direct and simultaneous measurement of the decay asymmetry parameters of Σ^{+}→pπ^{0}(α_{0}=-0.998±0.037±0.009) and Σ[over ¯]^{-}→p[over ¯]π^{0}(α[over ¯]_{0}=0.990±0.037±0.011), the latter value being determined for the first time. The average decay asymmetry, (α_{0}-α[over ¯]_{0})/2, is calculated to be -0.994±0.004±0.002. The CP asymmetry A_{CP,Σ}=(α_{0}+α[over ¯]_{0})/(α_{0}-α[over ¯]_{0})=-0.004±0.037±0.010 is extracted for the first time, and is found to be consistent with CP conservation.

[Effect of using scenario infiltration joint interactive training mode for junior nurse training in the prevention and treatment of pressure sore]

Objective: To explore the application effect of scenario infiltration joint interactive training mode for junior nurse training in the prevention and treatment of pressure sore. Methods: A total of 118 junior nurses starting to work in the First Affiliated Hospital of Air Force Medical University from July 2017 to July 2018 met the inclusion criteria and were divided into routine training (RT) group and scenario infiltration joint interactive training (SIJIT) group using the random number table for prospective randomized controlled trial. There were 2 males and 57 females, aged (23.9±1.2) years in RT group and 3 males and 56 females, aged (23.5±1.3) years in SIJIT group. Before the training, nurses in both groups received theory and practical tests for the prevention and treatment of pressure sore with a homemade theory test paper and operation requirements designed by the training group. The training content was drawn up in 3 themes according to the weak points shown in the test. Nurses in RT group were trained in a large classroom with the help of multimedia teaching technique, and one lesson of 2 h targeting one theme was given once a week.Nurses in SIJIT group were trained by using the SIJIT mode, with online self-study for 2 weeks and then multimedia theory and practical teaching, and interaction in scene. After the training, theoretical and practical tests were conducted again in nurses of two groups. Satisfaction scores of nurses for the training mode, training effect, and curriculum design and answers to open questions about the degree of training satisfaction were investigated through homemade questionnaire for satisfaction degree. Homemade training contents and requirements questionnaire designed by the training group was used to understand the demands of nurses for training contents and requirements in 2 groups. Data were statistically analyzed with chi-square test and independent sample t test. Results: (1) The theoretical and practical scores on the prevention and treatment of pressure sore before the training were (78±11) and (83±10) points respectively in RT group, similar to (79±11) and (84±10) points in SIJIT group (t=0.522, 0.615, P>0.05). The theoretical and operational scores on prevention and treatment of pressure score of nurses after the training were (90±8) and (92±5) points in SIJIT group, significantly higher than (82±10) and (85±9) points in RT group (t=4.581, 5.259, P<0.01). (2) The satisfaction degree scores for training mode, curriculum design, and training effect of nurses in SIJIT group were significantly higher than those in RT group (t=5.169, 7.976, 4.463, P<0.01). Nurses in the 2 groups were satisfied with the curriculum content, and unsatisfied with the curriculum time and the ways of test. (3) The top demand of the training nurses for curriculum content was the treatment of phase Ⅱ-Ⅲ pressure sore, accounting for 81.36% (96/118). Conclusions: The SIJIT has flexible training mode, and reasonable curriculum design and content, which significantly improves the theoretical and operational levels on prevention and treatment of pressure sore of the training nurses and receives recognition of the training nurses.

Interleukin-4 Restores Insulin Sensitivity in Insulin-Resistant Osteoblasts by Increasing the Expression of Insulin Receptor Substrate 1

Obesity and latent inflammation can give rise to insulin resistance and type 2 diabetes. Here we established an insulin resistance model of osteoblasts to explore the restoration effect of anti-inflammatory interleukin-4 (IL-4) on insulin sensitivity and its mechanism. We found that IL-4 inhibited cell proliferation in a concentration- and time-dependent manner. Insulation resistance significantly reduced the phosphorylation levels of the insulin receptor substrate 1 (IRS1; Tyr612), Akt (Ser473), and AS160 (Ser318) proteins. The addition of IL-4 to the insulin resistance model led to a dose-dependent stimulation of the phosphorylation of IRS1, Akt, and AS160. IL-4 fully restored the activation of the insulin cascade in insulin-resistant cells at the concentration of 50 ng/ml. Additionally, IL-4 promoted the expression of IRS1 in a time-dependent manner. We conjecture that IL-4 restores insulin sensitivity in osteoblasts by upregulating the expression of IRS1. It was also found that IL-4 promoted the expression of osteoprotegerin depending on the time of exposure. This effect may play an important role in the regulation of the energy metabolism in the whole body.

Study of Open-Charm Decays and Radiative Transitions of the X(3872)

The processes X(3872)→D^{*0}D[over ¯]^{0}+c.c.,γJ/ψ,γψ(2S), and γD^{+}D^{-} are searched for in a 9.0  fb^{-1} data sample collected at center-of-mass energies between 4.178 and 4.278 GeV with the BESIII detector. We observe X(3872)→D^{*0}D^{0}[over ¯]+c.c. and find evidence for X(3872)→γJ/ψ with statistical significances of 7.4σ and 3.5σ, respectively. No evident signals for X(3872)→γψ(2S) and γD^{+}D^{-} are found, and the upper limit on the relative branching ratio R_{γψ}≡{B[X(3872)→γψ(2S)]}/{B[X(3872)→γJ/ψ]}<0.59 is set at 90% confidence level. Measurements of branching ratios relative to decay X(3872)→π^{+}π^{-}J/ψ are also reported for decays X(3872)→D^{*0}D^{0}[over ¯]+c.c.,γψ(2S),γJ/ψ, and γD^{+}D^{-}, as well as the non-D^{*0}D^{0}[over ¯] three-body decays π^{0}D^{0}D^{0}[over ¯] and γD^{0}D^{0}[over ¯].

Measurements of Absolute Branching Fractions of Fourteen Exclusive Hadronic D Decays to η

Using 2.93  fb^{-1} of e^{+}e^{-} collision data taken at a center-of-mass energy of 3.773 GeV with the BESIII detector, we report the first measurements of the absolute branching fractions of 14 hadronic D^{0(+)} decays to exclusive final states with an η, e.g., D^{0}→K^{-}π^{+}η, K_{S}^{0}π^{0}η, K^{+}K^{-}η, K_{S}^{0}K_{S}^{0}η, K^{-}π^{+}π^{0}η, K_{S}^{0}π^{+}π^{-}η, K_{S}^{0}π^{0}π^{0}η, and π^{+}π^{-}π^{0}η; D^{+}→K_{S}^{0}π^{+}η, K_{S}^{0}K^{+}η, K^{-}π^{+}π^{+}η, K_{S}^{0}π^{+}π^{0}η, π^{+}π^{+}π^{-}η, and π^{+}π^{0}π^{0}η. Among these decays, the D^{0}→K^{-}π^{+}η and D^{+}→K_{S}^{0}π^{+}η decays have the largest branching fractions, which are B(D^{0}→K^{-}π^{+}η)=(1.853±0.025_{stat}±0.031_{syst})% and B(D^{+}→K_{S}^{0}π^{+}η)=(1.309±0.037_{stat}±0.031_{syst})%, respectively. The charge-parity asymmetries for the six decays with highest event yields are determined, and no statistically significant charge-parity violation is found.

Determination of Strong-Phase Parameters in D→K_{S,L}^{0}π^{+}π^{-}

We report the most precise measurements to date of the strong-phase parameters between D^{0} and D[over ¯]^{0} decays to K_{S,L}^{0}π^{+}π^{-} using a sample of 2.93  fb^{-1} of e^{+}e^{-} annihilation data collected at a center-of-mass energy of 3.773 GeV with the BESIII detector at the BEPCII collider. Our results provide the key inputs for a binned model-independent determination of the Cabibbo-Kobayashi-Maskawa angle γ/ϕ_{3} with B decays. Using our results, the decay model sensitivity to the γ/ϕ_{3} measurement is expected to be between 0.7° and 1.2°, approximately a factor of three smaller than that achievable with previous measurements, based on the studies of the simulated data. The improved precision of this work ensures that measurements of γ/ϕ_{3} will not be limited by knowledge of strong phases for the next decade. Furthermore, our results provide critical input for other flavor-physics investigations, including charm mixing, other measurements of CP violation, and the measurement of strong-phase parameters for other D-decay modes.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

First Observation of D^{+}→ημ^{+}ν_{μ} and Measurement of Its Decay Dynamics

By analyzing a data sample corresponding to an integrated luminosity of 2.93  fb^{-1} collected at a center-of-mass energy of 3.773 GeV with the BESIII detector, we measure for the first time the absolute branching fraction of the D^{+}→ημ^{+}ν_{μ} decay to be B_{D^{+}→ημ^{+}ν_{μ}}=(10.4±1.0_{stat}±0.5_{syst})×10^{-4}. Using the world averaged value of B_{D^{+}→ηe^{+}ν_{e}}, the ratio of the two branching fractions is determined to be B_{D^{+}→ημ^{+}ν_{μ}}/B_{D^{+}→ηe^{+}ν_{e}}=0.91±0.13_{(stat+syst)}, which agrees with the theoretical expectation of lepton flavor universality within uncertainty. By studying the differential decay rates in five four-momentum transfer intervals, we obtain the product of the hadronic form factor f_{+}^{η}(0) and the c→d Cabibbo-Kobayashi-Maskawa matrix element |V_{cd}| to be f_{+}^{η}(0)|V_{cd}|=0.087±0.008_{stat}±0.002_{syst}. Taking the input of |V_{cd}| from the global fit in the standard model, we determine f_{+}^{η}(0)=0.39±0.04_{stat}±0.01_{syst}. On the other hand, using the value of f_{+}^{η}(0) calculated in theory, we find |V_{cd}|=0.242±0.022_{stat}±0.006_{syst}±0.033_{theory}.

Numerical and experimental study on wind environment at near tower region of a bridge deck

The Large Eddy Simulation (LES) turbulence model was used to investigate the wind environment over the deck near bridge tower and was verified using the wind tunnel tests. Compared with the wind tunnel tests, the computational fluid dynamics (CFD) approach was more convenient for the investigations of the local wind field. It was found that the influence of bridge tower on the wind flow can increase rapidly the wind speed on vehicles while bearing off a narrow zone near the tower. The dangerous situation can be effectively compromised by installing a proper local windshield barrier (WSB) with varying heights and porosity ratios along the bridge span. The length of the influence region of tower on the wind environment over the bridge deck was about 7 times of the tower width, implying a proper length of local windshield barriers on each side of the tower. Parametric studies demonstrated that the length of local WSB with different porosity ratios could affect the slope of equivalent wind speeds, indicating that the shorter the length of local WSB was, the rapider the wind speed of the tower influence region varied.

SAT0356 THE ROLE OF IL-36 AS A POTENTIAL NOVEL THERAPEUTIC TARGET IN SPONDYLARTHROPATHY ASSOCIATED PATHOLOGY DUE TO ITS UPSTREAM INDUCTION OF IL-23/IL-17 PATHWAY CYTOKINES AND STROMAL ACTIVATION IN AN IN VITRO ENTHESITIS MODEL

Background:

Enthesitis, defined as inflammation of anchorage points of tendons, ligaments and joint capsules to bones, is now understood to be the cardinal pathogenic lesion in spondyloarhtopathies (SpA). Evidence from genetic studies, animal models, and therapeutic studies firmly implicates the IL-23/IL-17 axis in the pathogenesis of SpA. We have recently confirmed the presence of IL-23 myeloid cells and IL-17 producing T cells populations in the human enthesis (McGonagle, ARD 2019). The upstream drivers of these key cytokines in the enthesis is, however, not defined. Emerging evidence suggests that IL-36 may be critical in regulating the IL-23/IL-17 axis in various organs. Also IL-38 SNPs have been associated with SpA which is of interest given that IL-38 is an IL-36 antagonist. Further, IL-36α is upregulated in the joints of psoriatic arthritis patients and deficiency of the IL-36 receptor antagonist (DITRA) results in generalized pustular psoriasis with comorbid arthritis in at least third of patients. Thus, we hypothesised that IL-36 could be an upstream regulator of the IL23/17 axis at the enthesis.

Objectives:

To confirm the induction of IL-36 at the human enthesis and to test the effect of IL-36 on resident innate and adaptive immune cell populations and enthesis stromal cells.

Methods:

Entheseal spinous processes from patients undergoing elective orthopaedic surgeries was obtained and mechanically digested. Peri-entheseal bone (PEB), and entheseal soft tissue (EST) digests were stimulated with fungal and bacterial adjuvants and IL-36 measured by ELISA. Disease relevant compounds such as methotrexate and PDE4i were assessed for their ability to attenuate IL-36 secretion. IHC was used to confirm the presence of IL-36R+ cells in the enthesis. Digested PEB was stimulated with IL-36, and IL-6, IL-8, IL-23, and TNF-alpha were analysed by ELISA and Flow Cytometry. As the IL-36 cytokines require protease mediated post translational processing for full activation, these were measured in enthesis digests. Entheseal fibroblasts were isolated and stimulated with IL-36 and ICAM-1 measured by Flow Cytometry and genes by qPCR.

Results:

TLR ligands induced the production of IL-36 at the enthesis. Further cell sorting, revealed CD11+ myeloid cells were the predominant entheseal producer of IL-36. Induced IL-36 could be significantly attenuated by PDE4i but not by methotrexate. IHC confirmed the presence of IL-36R+ in the enthesis. Stimulation of enthesis digest with IL-36 significantly upregulated the production of IL-6, IL-8, TNF-a, and IL-23. Stimulation of enthesis fibroblasts with IL-36 upregulated surface ICAM-1 and secretion of IL-6, CCL2 and CCL20. Enthesis digests showed high basal expression of IL-36 activating protease including cathepsin S and G.

Conclusion:

IL-36 is inducible from enthesis myeloid cells and IL-36R+ cells are present at the enthesis. Enthesis stimulation with IL-36 results in the upregulation of several disease relevant mediators such as TNF, IL-23 and CCL20 in both immune and stromal lineage cells. This is the first demonstration of IL-36 production in human enthesis. Given its pleiotropic effect and relation to IL-23/IL-17 axis, IL-36 is a potential novel therapeutic target in SpA.

Figure 1.

Expression and role of IL-36 at the enthesis. (A). IL-36 is induced by stimulation with lipopolysaccharide (LPS) and Mannan. (B) IL-36 is predominantly produced by CD11c+ cells. (C) IL-36 stimulation of PEB resulted in increased TNF-alpha production by CD14+ cells, and increased production of IL-23 (D) IL-36 stimulation of stromal cells increased ICAM-1 expression, and CCL2, CCL20, IL-6 and IL8 secretion

Figure 2.

Gene expression by qPCR following stromal cell stimulation by IL-36

Disclosure of Interests:

Kassem Sharif: None declared, Charlie Bridgewood: None declared, Tobias Russell Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Hannah Rowe Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Qaio Zhou: None declared, Abhay S Rao: None declared, Almas Khan: None declared, Robert Dunsmuir: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC

FRI0443 CLINICAL CHARACTERISTICS AND RELATED FACTORS OF COMMON RHEUMATIC DISEASES COMPLICATED WITH TUBERCULOSIS INFECTION

Background:

Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and syndrome(SS) are common rheumatic diseases with high incidence. Patients with those rheumatic diseases are at high risk of tuberculosis (TB) infection. However, manifestations can be atypical and easily confused with those of rheumatic disease itself. For those patients, diagnosis is usually much more difficult and further make treatment delayed. Sometimes it may lead to mistreatment. Therefore, it is important to recognize the clinical characteristics of those patients.

Objectives:

To explore the clinical characteristics and high risk factors of common systemic rheumatism complicated with tuberculosis infection.

Methods:

A total of 3,906 cases of RA, SLE, and SS common systemic rheumatism diagnosed in the People’s Hospital of Sichuan Province from January 2007 to January 2017 were collected with carefully exclusion with other infectious diseases and neoplastic disease. One hundred and five patients with TB were included as infection group, including 42 cases of RA, 41 cases of SLE, and 22 cases of SS. In the control group, 84 patients with RA, 82 patients with SLE, and 44 patients with SS were randomly selected from the corresponding rheumatoid non-infected patients hospitalized during the same period.

Results:

Fever was the most common symptom among 42 cases of RA, 41 cases of SLE, and 22 cases of SS with TB, accounting for 83.3%, 92.7%, and 68.2%, respectively. Cough, weight loss or fatigue was less common. For 41 cases of SLE and 22 cases of SS with TB, the proportion of pulmonary was 46.3%, 59.01%, respectively.In TB infection group, 27 cases of RA, 21 cases of SLE, and 13 cases of SS with TB had two or more chest CT findings, accounting for 59%, 57%, 62%, respectively. Lesions located in the posterior or posterior segment which TB usually affected were 9 cases(33.3%),9cases(42.9%),6cases(27.2%),respectively.The daily average dose of hormones within 1 year in TB infection group was higher than that in the control group (P<0.05). For SLE patients, lower counts of CD4+TL were found in TB infection group (P<0.05), while no such differences were found in RA and SS group.

Conclusion:

Patients with RA who have TB infection are mainly pulmonary TB. For SLE and SS patients, the chance of pulmonary tuberculosis and extra-pulmonary tuberculosis is similar.Symptoms of RA, SLE, SS with TB, such as fever, cough, weight loss, fatigue, are similar with the primary disease or other infection. Chest imaging is diversity. It is difficult to diagnose.Daily average dose of hormone within one year may be a common risk factor for RA, SLE and SS patients with TB. Decreased CD4+TL may also be a risk factor for SLE patients with TB.

References:

[1]Cantini F, Nannini C, Niccoli L, et al. Risk of Tuberculosis Reactivation in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis Receiving Non-Anti-TNF-Targeted Biologics[J]. Mediators of Inflammation, 2017, 2017(6):1-15.

[2]Ruangnapa K, Dissaneewate P, Vachvanichsanong P. Tuberculosis in SLE patients: rare diagnosis, risky treatment.[J]. Clinical & Experimental Medicine, 2015, 15(3):429-432.

[3]Manuela D F, Bruno L, Martina S, et al. Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections[J]. International Journal of Molecular Sciences, 2017, 18(2):293-315.

[4]Disseminated tuberculosis masquerading as a presentation of systemic lupus erythematosus.Li JC, Fong W, Wijaya L, Leung YY.Int J Rheum Dis. 2017 Oct 2. doi: 10.1111/1756-185X.13195.

[5]Handa R, Upadhyaya S, Kapoor S, et al. Tuberculosis and biologics in rheumatology: India – A special situation[J]. International Journal of Rheumatic Diseases, 2017, 51(2):115.

Disclosure of Interests:

None declared

SAT0209 PREVALENCE AND RELATED FACTORS OF SLEEP DISTURBANCE IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME

Background:

The incidence of primary Sjögren’s syndrome(pSS) is increasing gradually,and it was ranking second among connective tissue diseases(CTDs)in China.Studies recently have shown that many patients with various CTDs have sleep disturbances,which seriously degraded the patient’s quality of life.As well known, Sleep is an important physiological process to maintain human metabolism, tissue repair,and homeostasis. At present,there are relatively several studies on sleep quality in patients with Rheumatoid arthritis(RA)and Systemic lupus erythematosus(SLE),but less reports on pSS in China have been published.Therefore,it is important to explore the quality of sleep and its influencing factors in such patients.

Objectives:

The purpose of this study is to evaluate the quality of sleep and related factors in China Mainland patients with primary Sjögren’s syndrome(pSS),and to provide reference and theoretical basis for constructing targeted sleep interventions and improve their quality of life.

Methods:

A all of 103 pSS patients and 40 matched healthy controls were enrolled in a comparative study of sleep quality using the Pittsburgh Sleep Quality Index(PSQI),and demographic,clinical,and laboratory data were collected from them.The patients completed questionnaires on the European League Against Rheumatism (EULAR)SS Patient Reported Index(ESSPRI), EULAR SS Disease Activity Index (ESSDAI),Xerostomia inventory(XI)with the help of researchers,Pain and fatigue were evaluated with a 100-mm visual analogue scale(VAS).Generalized Anxiety Disorder(GAD-7) and Patient Health Questionnaire(PHQ-9) were used to assess anxiety and depression separately,and whether they have autonomic symptoms (such as sweating, palpitations.)will be asked.

Results:

The PSQI score and the frequency of poor sleep quality(PSQI>7) were higher in the pSS patients (11.60±5.03,71.8%)than the healthy controls(5.98±3.85,25%).Poor sleepers had a significantly higher GAD-7,PHQ-9,XI,ESSPRI,pain and fatigue VAS,and longer disease duration than good sleepers.Additionally, poor sleepers show more frequent autonomic symptoms.Sleep quality of patients with pSS was positive correlated with GAD-7,PHQ-9,XI,ESSPRI,pain and fatigueVAS scores,but no correlation with disease activity.Meanwhile,depression is a independent factor of sleep quality.

Conclusion:

Our study showed that the sleep disturbance seen in patients with pSS may contribute to the depression associated with this disease,Future research should investigate that whether antidepressant treatment improve sleep and directly improve quality of life.

References:

[1]AustadC, Kvien TK, Olsen I C.Sleep disturbance in patients with rheumatoid arthritis is related to fatigue, disease activity,and other patient-reported outcomes[J]. Scandinavian journal of rheumatology, 2017, 46(2): 95-103.

[2]Lewis I, Hackett K L,Ng W F,et al.A two-phase cohort study of the sleep phenotype within primary Sjögren’s syndrome and its clinical correlates[J].Clinical and experimental rheumatology,2019,37(3):78-82.

[3]Chung S W, Hur J, Ha Y J, et al. Impact of sleep quality on clinical features of primary Sjögren’s syndrome[J]. The Korean journal of internal medicine, 2019,34(5):1154.

[4]Liu X, Tang M, Hu L. Reliability and validity of the Pittsburgh sleep quality index[J].Chinese journal of psychiatry,1996,29:103-107.

[5]Grabovac I,Haider S, Berner C,et al.Sleep quality in patients with rheumatoid arthritis and associations with pain, disability, disease duration, and activity[J].Journal of clinical medicine,2018,7(10):336.

Disclosure of Interests:

None declared

Communication skills of providers at primary healthcare facilities in rural China

INTRODUCTION

Effective provider-patient communication has been confirmed to improve diagnosis, treatment planning, health outcomes, patient satisfaction, and treatment compliance. Few studies have measured the effectiveness of communication between patients and rural providers in China. To fill this gap in the literature, the present study describes the communication skills of providers at primary healthcare facilities in rural China and investigates the provider- and facility-level factors underlying these communication skills.

METHODS

The standardised patients successfully completed 504 interactions across two tiers of China's rural health system and engaged with providers at village clinics and township health centres. We assessed providers' communication skills based on recorded interactions between the providers and the standardised patients using the SEGUE Framework, which contains the following five dimensions: 'Set the stage', 'Elicit information', 'Give information', 'Understand the patient's perspective', and 'End the encounter'.

RESULTS

The providers' overall average score was 50.6% on the SEGUE communication tasks. They did well in 'Set the stage' (54.4%) and 'Elicit information' (56.2%) but performed poorly in 'End the encounter' (24.5%) and 'Understand the patient's perspective' (44.0%). Female and younger providers scored 0.75 (P<0.05) and 0.04 (P<0.01) points higher than their male and older counterparts on total SEGUE score, respectively.

CONCLUSION

Providers in rural China had relatively poor communication skills overall, especially in terms of their demonstration of care for patients and inviting them to participate in the interaction. Gender and age were significantly associated with providers' level of communication skills in rural China.

THU0028 AN EXPLANTION FOR HOW VIRAL INFECTION MAY TRIGGER SPONDYLOARTHROPATHY BASED ON TLR9 DRIVEN TNF RESPONSES FROM ENTHESEAL DERIVED PLASMACYTOID DENDRITIC CELLS

Background:

It is well known that viral infections may trigger psoriatic arthritis (PsA), a disease that typically has extensive pre-clinical entheseal abnormalites. Skin resident plasmacytoid dendritic cells (pDCs) produce IFNα that contribute to T cell expansion and the development of experimental psoriasis [1, 2]. IFN pathway SNPs have been reported in both PsA and psoriasis and we previously reported the presence of pDCs at the human enthesis [3].

Objectives:

To investigate whether the TLR9 agonist ODN that replicates viral infection activate a wide array of of entheseal derived pDCs molecular cascades including the TNF pathway that might provide a link between viral infection and PsA.

Methods:

pDCs were sorted from enthesis and blood and stimulated with ODN as previously described (n=16) [3, 4]. IFNα protein pre and post stimulation were detected by ELISA. Intracellular flow cytometry (IFC) of entheseal pDCs was used to detect TNF protein. RNA was extracted post-stimulation. The mRNA were hybridised and tagged by probes then measured on the nCounter platform. Data was analysed using nSolver 4.0. Log2 |fold change| >1 and P-value <0.05 were considered statistically significant. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) of differentially expressed genes (DEGs) were analyzed using DAVID. Protein-protein interaction (PPI) network was drawn by STRING.

Results:

Stimulated entheseal pDCs showed a strong DEGs pattern pointing towards increased TNF expression. There were 11 genes significantly upregulated including TNF. RIPK3 is involved in TNF signalling pathway. TNF, RIPK3 and ZBP1 are involved in necroptosis. TNF and ITGB2 are involved in IL-4 and IL-13 signaling pathway. TNF, HLA-DOA, ITGB2/TLR7 are involved in virus infection. Together it highlights extremely activated TNF pathway genes.

IFN protein was induced in sorted entheseal pDCs following stimulation (n=8). TNF protein was detected by IFC on stimulated entheseal pDCs (CD45+HLA-DR+CD123+CD303+ CD11c-) (n=3). We also compared entheseal and matched peripheral blood pDCs (n=8) following stimulation where no major differences in the TNF pathway were present between groups.

The KEGG analysis was mapped in Figure 1. GO analysis showed the most significant change in biological processes was enriched in the positive regulation of DNA binding transcription factor activity. The change in molecular function was mainly enriched in p53 binding.

Conclusion:

Entheseal pDCs, upon viral molecule stimulation, show several markers of activation. However, TNF pathway genes were highly activiated which provides a novel mechanistic link between viral infection and PsA as reported in epidemiological studies.

References:

[1]Nestle, F.O., et al.,Plasmacytoid predendritic cells initiate psoriasis through interferon-alpha production.J Exp Med, 2005.202(1): p. 135-43.

[2]Christophers, E., et al.,The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics.J Eur Acad Dermatol Venereol, 2010.24(5): p. 548-54.

[3]Zhou, Q.,PLASMACYTOID DENDRITIC CELLS IN THE ENTHESIS: PHENOTYPING AND FUNCTION INVESTIGATION.Annals of the Rheumatic Diseases, 2019.78.

[4]Bridgewood, C., et al.,Identification of myeloid cells in the human enthesis as the main source of local IL-23 production.Ann Rheum Dis, 2019.78(7): p. 929-933.

Disclosure of Interests:

Qiao Zhou: None declared, Jayakumar Vadakekolathu: None declared, Kassem Sharif: None declared, Tobias Russell Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Hannah Rowe Grant/research support from: Novartis UK Investigator Initiated non-clinical research funding support, Peter Millner: None declared, Peter Loughenbury: None declared, Abhay S Rao: None declared, Robert Dunsmuir: None declared, Charlie Bridgewood: None declared, Yasser El-Sherbiny: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC