AB0499 ABNORMALITY OF PERIPHERAL LYMPHOCYTE SUBSETS IN BECHET’S DISEASE AND EFFECTS OF NEW IMMUNOREGULATORY COMBINATION THERAPIES ON THESE CELLS

Background:

Bechet’s disease (BD) is a chronic multisystemic vasculitis. Although its exact etiopathology is unknown, both autoimmune imbalances associated with genetic and abnormal immune response of effector lymphocytes promoted by infectious factors are suggested1. The increase of effector T cells (Teffs) and the decrease of regulatory T cells (Tregs) are possibly the involving factors in the pathogenesis of BD2. Importantly, we have developed new immunoregulatory combination therapies trying to restore the reduction of Tregs in rheumatic patients.

Objectives:

To examine abnormal levels of lymphocyte subsets in BD patients at a relatively large-sample size and to investigate whether the immunoregulatory combination therapies have therapeutic efficacy in BD.

Methods:

Total 384 BD patients and 206 healthy controls (HCs) were enrolled in this cross-sectional study. Proportions and absolute numbers of peripheral T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Treg subsets were analyzed by flow cytometry (FCM) for all participants. Among these patients,183 cases of BD patients were treated with immunoregulatory combination drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10. The levels of peripheral lymphocyte subsets were measured before and after the treatment. Compared-T test was used to compare continuous measures and to assess effect of these drugs.

Results:

Compared to HCs, the absolute numbers of various Teffs such as T, B, CD4+T, CD8+T, Th1 and Th17 cells were significantly increased in BD group (P<0.01), while the level of Tregs in patients with BD was severely decreased (P< 0.05), resulting in increased ratios (imbalance) of Th1/Tregs, Th2/Tregs and Th17/Tregs (P< 0.05) (Figure 1). After the IMiDs treatment, the levels of NK, CD4+T, CD8+T, Th1, Th17 cells as well as Tregs were significantly increased (P<0.05). But the increased Tregs was much more dramatical than those of Teffs, resulting in a decrease in ratios of Teffs/Tregs such as Th2/Tregs (P< 0.001) (Figure 2).

Conclusion:

Impaired balance of pro- and anti-inflammatory immune cells, especially insufficiency of Tregs, might be a cornerstone of the pathogenesis of BD. Immunoregulatory combination therapies could promote the proliferation and functional recovery of Tregs in patients with BD and might help to alleviate disease activity.

References:

[1]Yazici H, Seyahi E, Hatemi G, et al. Behcet syndrome: a contemporary view. Nat Rev Rheumatol 2018;14(2):107-19. doi: 10.1038/nrrheum.2017.208 [published Online First: 2018/01/04]

[2]Rosenzwajg M, Lorenzon R, Cacoub P, et al. Immunological and clinical effects of low-dose interleukin-2 across 11 autoimmune diseases in a single, open clinical trial. Ann Rheum Dis 2019;78(2):209-17. doi: 10.1136/annrheumdis-2018-214229 [published Online First: 2018/11/26]

Acknowledgments:

None

Disclosure of Interests:

None declared

AB0032 ABNORMAL STATUSES OF PERIPHERAL CD4+T CELL SUBSETS IN PATIENTS WITH GOUT AND THEIR CHANGES AFTER RECEIVING COMBINED IMMUNOMODULATORY THERAPY

Background:

Gout is a chronic systemic inflammatory disease that results from the deposition of monosodium urate crystals in joints and the associated activation of the innate immune system associated with hyperuricemia1. As the pathogenesis of gout is still a matter of speculation and debate, accumulating evidence converges on inflammasome activation and immunological dysregulation2. However, the detailed statuses of lymphocyte subsets in patients with gout are unknown and influence of immunomodulatory combination therapies on the lymphocyte subsets remain to be clearly evaluate3.

Objectives:

To evaluate the quantitative statuses of peripheral CD4+T subpopulations in patients with gout and further investigate the effects of immunomodulatory combination therapies on those cells.

Methods:

Total 247 patients who met the clinical criteria of gout from the American College of Rheumatology and 206 healthy controls (HCs) were enrolled in this retrospective cross-sectional study. Among those patients, 70 follow-up patients donated their peripheral blood after receiving immunomodulatory drugs (e.g., low-dose interleukin-2, rapamycin, metformin, retinoic acid, etc). The absolute numbers of Th1, Th2, Th17 and Tregs in peripheral CD4+T subsets were detected by flow cytometry combined with standard absolute counting beads.

Results:

Compared with HCs, the absolute numbers of Th1 and Th17 were evidently increased in gout patients (P<0.001), while the level of Tregs was significantly decreased (P<0.05) (Figure 1). After immunomodulatory combination treatments, there were dramatical increases in a wide variety of CD4+T subsets such as Th1, Th17 and Tregs (P<0.05). Interestingly, the increased amount of Tregs was much more than that of other Teffs, leading to the decrease ratios of Teffs/Tregs such as Th2/Tregs, restoring immune homeostasis (Figure 2).

Conclusion:

This cross-sectional study clarified the abnormal statuses of CD4+T subsets in gout patients, suggesting that CD4+T subsets, especially Tregs, might be relevant and play a crucial role in the pathogenesis of gout, thus providing a potential therapeutic target for gout patients. Immunomodulatory combination therapies effectively increase the number of Tregs and may help for gout patients’ symptom remission.

References:

[1]Ramsubeik K, Ramrattan LA, Kaeley GS, et al. Effectiveness of healthcare educational and behavioral interventions to improve gout outcomes: a systematic review and meta-analysis. Therapeutic advances in musculoskeletal disease 2018;10(12):235-52. doi: 10.1177/1759720x18807117 [published Online First: 2018/12/06]

[2]Stiburkova B, Pavelcova K, Pavlikova M, et al. The impact of dysfunctional variants of ABCG2 on hyperuricemia and gout in pediatric-onset patients. Arthritis Res Ther 2019;21(1):77. doi: 10.1186/s13075-019-1860-8 [published Online First: 2019/03/22]

[3]Raucci F, Iqbal AJ, Saviano A, et al. In-depth immunophenotyping data relating to IL-17Ab modulation of circulating Treg/Th17 cells and of in situ infiltrated inflammatory monocytes in the onset of gouty inflammation. Data Brief 2019;25:104381. doi: 10.1016/j.dib.2019.104381 [published Online First: 2019/09/07]

Acknowledgments:

None.

Disclosure of Interests:

None declared

0344 Age-Related Longitudinal Trajectories in NREM and REM Spectral Power

Introduction

Knowledge of how aging impacts sleep physiology is based almost exclusively on cross-sectional studies. Longitudinal studies, by contrast, can inform how macro- and micro-features of NREM and REM sleep change dynamically across time in individual trajectories. For the current work, we conducted quantitative EEG analyses from a longitudinal polysomnography study to inform age-related trajectories in sleep macro- and micro-architecture.

Methods

We conducted a secondary data analysis on 2208 participants in the Sleep Heart Health Study (mean age =62.47, SD=10.46, 55.30% females). Participants underwent one night of in-home polysomnography recording during two study visits (M=5.21 years apart, SD=0.53). Spectral power density was calculated for each 0.5 Hz frequency bin for NREM and REM sleep separately.

Results

In cross-sectional analyses, older chronological age was significantly associated with worse sleep macro-architecture. Plots of the individual trajectories over 5 years, however, revealed considerable inter-individual variability in whether sleep physiology was preserved or declined. Interestingly, there were strong associations between the longitudinal changes in power density in NREM and REM sleep (slow oscillations: r=.53 [.50-.56]; delta: r=.58 [.55-.60]; alpha: r=.69 [.67-.71]; sigma: r=.74 [.73-.76]; beta: r=.82 [.80-.83]; ps&lt;.001). The strongest NREM-REM association was for theta band power (r=.85 [.83-.86]), particularly in the 5.5-6.0 Hz bin (r=.94, [.94, .95]).

Conclusion

There is substantial inter-individual variability in how aging impacts sleep physiology. Nevertheless, within individuals, power density declines similarly across NREM and REM stages, with nearly perfect convergence for theta activity, indicating a common age-related neurobiological mechanism.

Support

The National Sleep Research Resource is supported by NIH HL114473.

0212 Questionnaire Assessment of Intraindividual Variability in Sleep: Inconsistent Sleep Can Be Worse Than Short Average Sleep

Introduction

The consequences of short sleep are well-documented, but recent evidence indicates that night-to-night consistency in sleep may be just as important. For the current work, we developed an intraindividual variability in sleep (IIV) questionnaire to make IIV measurement possible in single-time-point studies. We investigated whether self-reported IIV explained unique variance in sleep quality and health beyond average total sleep time (TST), focusing on a critical transition period (first semester of college) in which high variability was predicted.

Methods

First-semester college students (N=126, Mage=18.28, 75.40% females) completed an IIV questionnaire in which participants indicated their average sleep duration, then estimated how much their sleep duration deviated from their average duration for each day of a typical week. We quantified IIV as the mean day-to-day change in sleep. Participants also completed standard questionnaires on global sleep quality, social jetlag, daytime sleepiness, depression, and stress.

Results

Participants reported substantial IIV in their sleep durations (M=1.77 hours, SD=0.86) that was largely distinguishable from measures of social jetlag (r=.25) and average TST (r=-.18). Patterns of IIV differed across race/ethnicities: in white/Asian students, IIV was strongly associated with social jetlag (r=-.44) whereas in underrepresented minority students, IIV and social jetlag were separate constructs (r=-.03), suggesting that fluctuations in the latter group occur across all days of the week. Greater IIV was associated with significantly worse global sleep quality (r=.24, p=.01), stress (r=.20, p=.03), and depression, r=.20, p=.03). These associations were significant after adjusting for average TST, and only marginally reduced when controlling for social jetlag.

Conclusion

IIV in sleep/wake patterns can be captured using a questionnaire, and such measurement provides unique explanatory power to understanding sleep quality and mental health. Future research is needed to compare IIV questionnaire data to actigraphy data and to understand the underlying mechanisms by which inconsistent sleep detrimentally affects individuals.

Support

National Science Foundation (NSF 1920730)

0197 Chronotype is Influenced by Behavioral Choices and Can Fluctuate Across the Semester in STEM Students

Introduction

A delay in endogenous biological rhythms is assumed to cause undergraduate students to be “night owls,” but neurodevelopmental effects may only partially explain chronotype (circadian preference). Instead, perceived chronotype in students may result from poor sleep hygiene practices including bedtime social media use, afternoon caffeine consumption, and daytime napping. If so, then chronotype should be malleable in students to the extent that behavioral choices change.

Methods

We surveyed 1,120 undergraduate students who were enrolled in STEM courses across up to 3 time points during the semester. The survey assessed perceived chronotype (morning/evening type), global sleep quality, and daily habits that impact alertness and sleep hygiene (e.g., social media usage and timing, caffeine consumption and timing, and napping behavior).

Results

Relative to Morning Types, students who perceived themselves as being Evening Types showed 23.1% greater bedtime social media usage (t=3.14, p=.002), 35.1% greater daytime napping duration (t=4.44, p&lt;.001), and a 44 minute later average time of caffeine consumption (even though total caffeine consumption was reduced; t=2.30, p=.022). Evening Types also reported lower subjective health (t=3.55, p&lt;.001), with 14.2% of the association between chronotype and subjective health being mediated by bedtime social media use (direct effect: b=0.050, p=.002; indirect effect: b=0.009, p&lt;.05). Ninety-one students reported switching from being Evening Types at baseline to Morning Types at a later survey; those who switched to Morning Types used less social media and consumed less caffeine after 5pm and they showed significant improvements across the semester in sleep duration, sleep quality, and exam scores (ps&lt;.05).

Conclusion

Perceived chronotype is related to social media and caffeine consumption behaviors and is modifiable. Students who perceive themselves as night owls may find better health and academic success if they behave like morning larks.

Support

National Science Foundation (DRL 1920730)

0391 Gateways, Disparities, and Finals Week, Oh My! Translating Sleep Science from the Laboratory to the Classroom

Introduction

Organic chemistry can be an insurmountable “gateway” course for otherwise-qualified students in pre-health pathways. Recent data indicate that organic chemistry increases drop-out risk for females and underrepresented minority students (URMs), raising the provocative possibility that sleep disparities are an underrecognized contributor to achievement gaps in gateway STEM courses.

Methods

In Study 1, 481 students enrolled in organic chemistry courses completed sleep questionnaires at the beginning, midpoint, and end of the semester. In Study 2, non-chemistry majors were randomly assigned to normal sleep (8 hours) or sleep restriction (5.5 hours) before taking an organic chemistry virtual lecture and test. In Study 3, 35 students wore actigraphy for five nights and could earn extra credit on a mid-semester test by averaging ≥8 hours of sleep; actigraphy sleep durations were compared to 40 active-control students who only received sleep education.

Results

In Study 1 (classroom), URM and female students earned lower organic chemistry grades than comparison students, p&lt;.001. Baseline weekday sleep duration predicted test grades across the semester, and students who improved their weekday sleep subsequently improved their organic chemistry grades. In Study 2 (laboratory), mild sleep loss impaired meta-cognitive judgments of organic chemistry learning, a potential causal mechanism for reduced persistence in chemistry courses. In Study 3 (classroom), when better sleep behaviors were incentivized by extra credit, students slept an hour longer/night than control groups (7.8 vs 6.8 hours, p&lt;.001). These benefits persisted 1 month later into finals week when sleep behaviors were not externally incentivized (7.3 vs 6.3 hours, p=.001). Improving sleep improved performance on difficult short answer questions after correcting for pre-final grades (Madjusted=78% vs 72%, p=.04).

Conclusion

Sleep disparities contribute to achievement gaps in gateway STEM courses, but incentives can reverse poor sleep habits. University administrators should develop and implement behavioral change programs to reduce sleep disparities.

Support

National Science Foundation (DRL 1920730)

0101 Episodic Future Thinking Triggers Age-Related Differences in Spindles and Slow Oscillations

Introduction

In young adults, sleep spindles are theorized to represent memory consolidation. Spindle density may be especially prominent when young adults encode information that has future relevance. Older adults, on the other hand, show reduced capacity for future thinking and deficits in sleep-dependent memory consolidation. To advance these literatures, we investigated whether the process of mentally simulating the future (versus remembering the past) was associated with subsequent alterations to sleep microarchitecture in young and older adults.

Methods

64 healthy adults aged 18–84 completed a polysomnography adaptation night followed by two in-laboratory experimental nights. On both nights, participants completed the Modified Future Crovitz Test (MFCT) in which they mentally simulated only future events or remembered only past events (night order counterbalanced). To quantify the extent of future/past thinking, we conducted linguistics analyses on tense (future/past) using LIWC 2015 software.

Results

On the future-thinking night, young adults with greater future-tense MFCT scores showed significantly greater spindle density across frontal, midline, and central sites (r=.42 to r=.51), even when controlling for age, gender, and total word count (all ps &lt; .01). The opposite was true for middle-to-older aged adults; greater future-tense MFCT scores were associated with less spindle density across midline and central sites after controlling for age, gender, and word count (r=-.44 to r=-.46, ps&lt;.05). However, while spindle density decreased, frontal slow oscillations increased in older adults with greater future-tense MFCT scores (r=.39, p&lt;.05). On the past-thinking night, spindle density and slow oscillations were unrelated to past-tense or future-tense MFCT scores for either age group.

Conclusion

Age-related deficits in memory consolidation may be due to impaired tagging of information as having future relevance, or impaired physiological responses during sleep to wake-based tagging. Addressing encoding—spindle interactions may inform why cognitive functioning declines in some adults more than others.

Support

Sleep Research Society Foundation

[The clinical features and prognosis of interstitial lung disease patients with positive anti-neutrophil cytoplasmic antibody]

Objective: To investigate the clinical features and prognosis of interstitial lung disease patients with positive anti-neutrophil cytoplasmic antibody. Methods: The patients with interstitial lung disease who visited Peking Union Medical College Hospital from March 2006 to March 2016 were divided into three groups: interstitial lung disease with ANCA-positive(ANCA-ILD), connective tissue disease associated interstitial lung disease and interstitial pneumonia with autoimmune features (CTD-ILD/IPAF) and idiopathic interstitial pneumonia (IIP). The three groups were analyzed in terms of clinical manifestations, serology, lung function, imaging, survival and recurrence. Results: Two hundred and seventy four patients were enrolled and 38 (14%) were ANCA-positive of whom 16 were male and 22 were female. The age of 38 ANCA-positive patients was (59±10) years and the follow-up time was (52±31) months. Seven among the 38 ANCA-positive patients died and the death rate is 18.42%. The ANCA-positive patients with interstitial lung disease have higher onset age (ANCA-ILD:59±10,CTD-ILD/IPAF:52±10,IIP:53±11,H=19.29, P<0.001), lower hemoglobin (ANCA-ILD: 129±21, CTD-ILD/IPAF: 138±15, IIP: 140±19, H=8.17, P=0.017), higher erythrocyte sedimentation rate (ANCA-ILD:45±35, CTD-ILD/IPAF:26±24,IIP:19±22,H=19.73, P<0.001), lower lung function improvement rate after treatment (ANCA-ILD:31%,CTD-ILD/IPAF:59%,IIP: 39%,χ(2)=11.74,P=0.003), lower absorption rate of CT lesion (ANCA-ILD:61%,CTD-ILD/IPAF:82%,IIP:67%, χ(2)=9.23,P=0.010) and higher death rate(ANCA-ILD:18%,CTD-ILD/IPAF:6%,IIP:12%, χ(2)=7.16,P=0.028). Conclusions: There are significant differences in clinical characteristics between ANCA-positive patients and other types of pulmonary interstitial disease. And both the treatment effect and the prognosis is poor for the ANCA-positive patients.

Microwave-Water Bath Hybrid Warming for Frozen Cryoprotectant Solution Using a Helical Antenna

BACKGROUND

Successful cryopreservation of organs and/or tissues of large dimension is challenging due to damages by solute concentration and thermal stress caused by crystallization during cooling and devitrification/recrystallization during rewarming. The key to reduce thermal stresses in cryopreserved biomaterials during rewarming is fast and uniform heating.

OBJECTIVE

To explore a hybrid warming process using two heat sources (microwave and water bath) simultaneously to achieve faster and more uniform heating.

MATERIALS AND METHODS

Rewarming of frozen cryoprotectants (CPA) using microwave and 37ºC water bath at the same time was experimentally studied. A helical antenna was installed at the center of a 1.8 mL cryovial. Microwave (2.4 GHz) was generated, amplified and transported to the helical antenna through the matched coaxial cables. Frozen CPA solution in the cryovial at an initial temperature of -196ºC was rewarmed by microwave and water bath. The temperature of two selected points in the sample with the maximum temperature difference was measured by thermocouples during rewarming.

RESULTS

During rewarming of the frozen sample in 37ºC water bath without microwave, the warming rate was 70.2ºC min-1 with the maximum temperature gradient of 1.07ºC mm^-1 in the sample. With microwave added to form a hybrid warming process, the warming rate was increased to be 100.5ºC min^-1 with a smaller temperature gradient of 0.68ºC mm^-1.

CONCLUSION

The study indicated that warming rate and temperature uniformity increased with the microwave-water bath hybrid heating process.

[Chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy]

Objective: To investigate chromosome abnormality rate and related factors of spontaneous abortion in early pregnancy. Methods: A total of 831 tissue samples of spontaneous abortion in early pregnancy were collected from June 2015 to August 2018 in the First Affiliated Hospital of Nanjing Medical University. Chromosomal copy number was analyzed by next generation sequencing (NGS). The relationships between chromosome abnormality and maternal age, in vitro fertilization-embryo transfer (IVF-ET) pregnancy, number of previous spontaneous abortions, history of live birth were analyzed by statistical methods. Results: Among 831 tissue samples of spontaneous abortion in early pregnancy, 461 (55.5%, 461/831) were found to have chromosome abnormalities. Maternal age (OR=1.107, 95%CI: 1.070- 1.145) and history of live birth (OR=1.909, 95%CI: 1.182-3.083) were the positive correlative factors of chromosome abnormality. Times of previous spontaneous abortion (OR=0.807, 95%CI: 0.702-0.928) and IVF-ET pregnancy (OR=0.554, 95%CI: 0.404-0.760) were the negative correlative factors of chromosome abnormality. Conclusions: Chromosome abnormality is an important cause of spontaneous abortion in early pregnancy. The rate of chromosome abnormality increases with the increase of maternal age and the history of live birth, and decreases with the increase of number of previous spontaneous abortion and IVF-ET pregnancy.

Protective effect of simvastatin on arterial plaque instability induced by p-cresyl sulfate

OBJECTIVE

To study the protective effect of simvastatin on arterial plaque instability induced by p-cresyl sulfate (PCS).

MATERIALS AND METHODS

Apolipoprotein E (ApoE)-/- mice were selected as objects of this study. All mice were randomly divided into three groups: 1) the control group, 2) the PCS group and 3) the PCS + simvastatin group. After successful modeling, the levels of plasma cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-β (TNF-β) were detected. The gross specimen of coronary artery was stained. Meanwhile, oil red O staining and Sirius red staining were performed for coronary arterial sections to observe the lipid and collagen components. The expression levels of smooth muscle cells and macrophages were observed by immunohistochemistry. In addition, the expression levels of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs) and monocyte chemoattractant protein-1 (MCP-1) in tissues were detected by Western blotting.

RESULTS

Simvastatin could improve atherosclerotic plaque growth and atherosclerotic plaque instability induced by PCS. Moreover, simvastatin could also improve the changes of MMPs and TIMPs caused by PCS as well as the inflammatory status in mice.

CONCLUSIONS

Simvastatin can improve the inflammatory status in mice, eventually improving the arterial plaque instability caused by PCS.

LncRNA HOTAIRM1 inhibits the progression of hepatocellular carcinoma by inhibiting the Wnt signaling pathway

OBJECTIVE

To explore the possible role of long non-coding RNA (lncRNA) HOTAIRM1 in the pathogenesis of hepatocellular carcinoma (HCC) and its underlying mechanism.

PATIENTS AND METHODS

LncRNA HOTAIRM1 expressions in 30 pairs of hepatocellular carcinoma tissues and paracancerous tissues were detected by quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR). The survival analysis and receiver operating characteristic (ROC) curve were introduced to explore the relationship between lncRNA HOTATRM expressions and prognosis of HCC patients. The correlation between progression-free survival (PFS) and clinical variables of HCC patients was estimated by single-factor and multiple-factor regression analysis, respectively. Overexpression plasmid of lncRNA HOTAIRM1 was designed and transfected into HCC cells according to the instructions of Lipofectamine 2000. Cell proliferation and apoptosis were detected by cell counting kit-8 (CCK-8) assay and flow cytometry, respectively. Moreover, expressions of apoptosis-related genes and the Wnt pathway-related proteins were detected by Western blot.

RESULTS

Lower lncRNA HOTAIRM1 expressions were observed in the HCC tissues than those of the paracancerous tissues. ROC curve indicated a high sensitivity and specificity of lncRNA HOTAIRM1 for HCC. PFS in HCC patients was correlated with tumor size and lncRNA HOTAIRM1 expression, whereas not correlated with age, sex, GGT, AFP, Child-Pugh grade, HBsAg, cirrhosis, number of tumors, micro-vessel metastasis, tumor differentiation, and TNM stage of HCC. Overexpression of HOTAIRM1 led to decreased proliferative ability and increased apoptosis of HepG2 and HHCC cells. In addition, overexpressed lncRNA HOTAIRM1 remarkably increased the expression of apoptosis promotor Bax, but decreased the expressions of apoptosis inhibitors Bcl-2 and Bid. Meanwhile, expressions of related proteins in the Wnt pathway were decreased as well.

CONCLUSIONS

HOTAIRM1, which was downregulated in HCC, might inhibit the proliferative ability and promote the apoptosis of HCC cells by suppressing the Wnt pathway, thereby inhibiting the progression of hepatocellular carcinoma.

[Introduction to Guidelines for Salt Reduction in Chinese Food Industry]

Excessive salt intake is an important risk factor of diseases such as hypertension, stroke, and stomach cancer. China is one of countries with high salt intake in the world. Recently, the intake of sodium from pre-packaged foods in China has been increasing, and the situation of salt control is rigorous. Based on the summary of the domestic and international experience of salt reduction, the "Guidelines for Salt Reduction in Chinese Food Industry" presents the basic principles, targets at different stages within various categories, technical routes, steps and measures, and social environment co-construction of salt reduction in Chinese food industry. This article focuses on the background, basis, process, key content and promotion of the guideline. The implementation of this guideline will contribute to the vigorous advancement of salt reduction action in Chinese food industry.

The function of miR-218 and miR-618 in postmenopausal osteoporosis

OBJECTIVE

Postmenopausal osteoporosis (POMP) is a serious disorder with significant physical, psychosocial, and financial consequences, which greatly reduce the postmenopausal women's life quality. The related issues of postmenopausal osteoporosis are increasingly concerned by society. Past researches have shown that miRNAs play an important role in the occurrence and development of postmenopausal osteoporosis. However, the role of miR-218 and miR-618 in the osteoporosis regulation is still unclear.

MATERIALS AND METHODS

First of all, we investigated the alteration of miR-218 and miR-618 during osteoclastogenesis of RAW264.7 cells. Next, we transfected RAW264.7 cells with miR-218 or miR-618 mimics and inhibitors to explore the influences of miR-218 and miR-618 on osteoclast differentiation. Then, we conducted bioinformatics analysis and luciferase reporter assay to identify and test the target gene of miR-218 and miR-618.

RESULTS

MiR-218 and miR-618 were down-regulated when RAW264.7 cells differentiated into osteoclasts. In addition, overexpression of miR-218 or miR-618 attenuated RAW264.7 cells differentiated into osteoclasts in vitro, whereas inhibition of miR-218 or miR-618 promoted this progress. This was demonstrated by increased expression of osteoclast-specific genes and TRAP staining. TLR-4 was confirmed to be the direct target of miR-218 and miR-618 by bioinformatics and luciferase reporter assay.

CONCLUSIONS

These results suggested that miR-218 and miR-618 play an important role in osteoclastogenesis via TLR-4/MyD88/NF-κB signaling pathway. Thus, targeting miR-218 and miR-618 promise a therapeutic potential in the treatment of osteoporosis.

[Role of circulating T follicular helper subsets and T follicular helper effector memory cells in systemic lupus erythematosus]

Objective: To investigate the role of T follicular helper (Tfh) subsets and T follicular helper effector memory (Tfhem) cells in circulation of patients with systemic lupus erythematosus (SLE), and explore their roles in SLE disease activity index as biomarkers. Methods: This study enrolled 64 patients with SLE and 15 healthy controls. In peripheral blood from patients with SLE and health controls, the percentage of Tfhem (CD3(+)CD4(+)CD45RA(-)CXCR5(+)CCR7(low)PD-1(high)) cells, Tfh (CD3(+)CD4(+)CD127(high)CD25(l)ow CD45RA(-)CXCR5(+)) subset: Tfh1 (CXCR3(+)CCR6(-)Tfh), Tfh2 (CXCR3(-)CCR6(+) Tfh), Tfh17 (CXCR3(-)CCR6(+) Tfh), were detected by flow cytometry. The correlations of Tfhem/Tfh subsets with clinical indicators which we collected were analyzed. Results: The percentage of Tfhem was significantly increased in SLE patients compare to health controls (1.40±1.12 vs 0.51±0.24, P<0.000 1), and it was also correlated with systemic lupus erythematosus disease activity index (SLEDAI) (P=0.015 3) and anti-dsDNA antibody (P=0.003 1), but not with complement C3 (C3), complement C4 (C4), erythrocyte sedimentation rate (ESR), and C reaction protein (CRP). In addition, the percentage of Tfh2, but not Tfh1 or Tfh17, was significantly increased in SLE patients compare to health controls (3.83±2.74 vs 2.18±1.07, P=0.000 4). As compared to anti-dsDNA antibody<25 group, the percentage of Tfh2 in anti-dsDNA antibody>25 group was increased with no significant statistical difference (4.33±3.20 vs 3.70±1.070, P=0.069 6). Conclusion: Our investigation show that Tfhem is associated with SLEDAI and it is a valuable evaluation biomarker for disease process and treatment. Meanwhile Tfhem is also associated with anti-dsDNA antibody, and it plays an important role in autoantibody production in SLE pathogenesis. Tfhem may be a good therapeutic target in SLE. For the meantime, the percentage of Tfh2 is significantly increased in SLE patients, and it had certain correlation with anti-dsDNA antibody, it might be involved in the development of SLE.

Adaptive antibacterial biomaterial surfaces and their applications

Bacterial infections on the implant surface may eventually lead to biofilm formation ​and thus threaten the use of implants in body. Despite efficient host immune system, the implant surface can be rapidly occupied by bacteria, resulting in infection persistence, implant failure, and even death of the patients. It is difficult to cope with these problems because bacteria exhibit complex adhesion mechanisms to the implants that vary according to bacterial strains. Different biomaterial coatings have been produced to release antibiotics to kill bacteria. However, antibiotic resistance occurs very frequently. Stimuli-responsive biomaterials have gained much attention in recent years ​but are not effective enough in killing the pathogens because of the complex mechanisms in bacteria. This review is focused on the development of highly efficient and specifically targeted biomaterials that release the antimicrobial agents or respond to bacteria on demands in body. The mechanisms of bacterial adhesion, biofilm formation, and antibiotic resistance are discussed, and the released substances accounting for implant infection are described. Strategies that have been used in past for the eradication of bacterial infections are also discussed. Different types of stimuli can be triggered only upon the existence of bacteria, leading to the release of antibacterial molecules that in turn kill the bacteria. In particular, the toxin-triggered, pH-responsive, and dual stimulus-responsive adaptive antibacterial biomaterials are introduced. Finally, the state of the art in fabrication of dual responsive antibacterial biomaterials and tissue integration in medical implants is discussed.

Peripheral neutrophil CD64 index combined with complement, CRP, WBC count and B cells improves the ability of diagnosing bacterial infection in SLE

OBJECTIVE

To investigate the diagnostic role of complement C3, complement C4, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), neutrophil CD64 (nCD64) index, lymphocyte subsets and their combination in differentiating bacterial infection from disease relapse in systemic lupus erythematosus (SLE).

METHODS

The above biomarkers in 36 hospitalized SLE patients with bacterial infection and 45 with lupus flare without infection were retrospectively studied. Bacterial infection was proven by positive cultures or typical clinical symptoms and signs combined with positive response to antibiotics. Lupus flare was defined as three points greater than their previous SLE disease activity index score. The diagnostic value for bacterial infection was evaluated by the areas under the receiver operating characteristic curves (AUC) and a novel bioscore system combining multiple biomarkers.

RESULTS

Increased CRP ( p = 0.049), WBC ( p = 0.028) and nCD64 index ( p = 0.034) were observed in the infected group and C3 ( p = 0.001), C4 ( p = 0.016) and B cells levels ( p = 0.010) were significantly reduced. The AUC for the above six biomarkers had no significant difference. Interestingly, the combination of nCD64 index, CRP, WBC, C3 and C4 improved significantly the diagnostic potential of SLE infection (AUC 0.783 (interquartile range 0.672, 0.871), p < 0.001; sensitivity 85.29% specificity 62.50%). In the bioscore system including the above six biomarkers, the bacterial infection rate in patients with bioscore ≤2, 3, 4, 5 and 6 were 0.00, 39.29, 59.10, 61.54 and 100.00%, respectively.

CONCLUSION

The combination of nCD64 index, C3, C4, CRP, WBC and B cells in a bioscore is useful to diagnose bacterial infection in SLE.

[Effect of functional exercises on patients with rheumatoid arthritis: a meta-analysis]

OBJECTIVE

To evaluate the effect of functional exercises on disease activity, joint function and quality of life of patients with rheumatoid arthritis (RA).

METHODS

Randomized controlled trials were searched in Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), VIP database and Wanfang database with keywords being "rheumatoid arthritis/RA", "function exercise (training)/joint exercise (training)/physical exercise (training)/resistance movement (exercise)/isotonic and isometric/stretching exercise/muscle exercise", and "trials/clinical trials". Then literature selection, extraction and literature quality evaluation were carried out by two of the authors independently following the including and excluding standards. Then the outcome indicators were analyzed with Review Manager 5.3 software.

RESULTS

In the study, 2 173 articles were achieved by searching in databases, including 1 522 English papers and 651 Chinese papers. Then 913 duplicated papers were identified and removed using EndNote software. After reading the titles and abstracts, 1 194 papers were excluded that did not satisfy the including standards. Finally, the full texts of these papers were read and papers with insufficient data were excluded, resulting in 13 included papers for systematic review, including 8 English and 5 Chinese papers. A total of 812 cases were studied in these papers, including 426 in the experimental groups and 386 in the conventional groups. For the outcome index in these articles, disease activity score 28 (DAS28) was used in 5 of them, health assessment questionnaire (HAQ) was used in 8 articles, visual analogue scale (VAS) for pain was used in 6 articles, and morning stiffness duration was used in 3 articles. The meta-analysis showed that functional exercises could delay the development of the disease activity of RA patients (mean difference=-0.76; 95%CI: -1.13, -0.38; P<0.001), improve the joint function (mean difference=-0.36; 95%CI: -0.47, -0.24; P<0.001), alleviate the pain of joints (mean difference=-1.75; 95%CI: -1.98, -1.53; P<0.001), and reduce the duration of morning stiffness (mean difference=-17.65; 95%CI: -22.09, -13.21; P<0.001).

CONCLUSION

This study showed the positive effects of functional exercises on alleviating the pain of joints, reducing the morning stiffness duration, and delaying the disease exacerbation of RA patients. It has a positive effect on improving the joint function and improving the quality of life in patients with RA.

[Therapeutic efficacy of ultraviolet combined with riboflavin for the rabbit bacterial keratitis]

Objective: To study the effects of ultraviolet light combined with riboflavin treatment (corneal collagen-crosslinking, CXL) on infectious control and stromal reconstruction of bacterial keratitis. Methods: Experimental Study. A Staphylococcus aureus rabbit keratitis model was established by injecting Staphylococcus aureus broth into the shallow stromal layer of the right eye cornea of New Zealand white rabbits. Forty-four rabbits that successfully established the model were randomly divided into four groups: corneal collagen cross-linking (CXL) group, antibiotic group, CXL+ antibiotic group and untreated group, with 11 rabbits in each group. Before the treatment and at 3, 7, 14 and 28 days after treatment, slit lamp corneal examination, AS-OCT and in vivo confocal microscopy (IVCM) were performed. Clinical efficacy of different treatments were evaluated at different time points. Parameters including conjunctival hyperemia, corneal ulcer, infiltration, edema, and neovascular. Histopathological examinations of corneal lesions were performed in order to detect the infiltration, inflammatory cells and repair in corneal tissue. Normal data were compared with paired t-test and non-normal data were compared with paired rank sum test before and after treatment. Kruskal-Wallis rank sum test was used to compare 4 groups of data and the generalized estimation equation is used to compare the repeated measurement data at each time point and the comparison between the groups of the treatment groups. Results: After treatment, different time points and specimens for pathological observation, we obtained the following results:Conjunctival hyperemia: in CXL and CXL+ antibiotic groups after treatment for 3 days from treatment before 3 (2, -4) and 3 (2, -3),The reduction was 2 (1, -3) and 2 (1, -2), the difference was statistically significant (Z=-3.91, -5.50; P<0.008); 14 days, the antibiotic group changed from 3 (3, -4) to 2 (1, -2) after treatment, the difference was statistically significant (Z=-5.11, P<0.008); the untreated group had no statistical significance before and after treatment. After 14 days of treatment, the area of corneal ulcer (0.08±0.11) cm(2), (0.07±0.05) cm(2) in CXL group and CXL+ antibiotic group was significantly lower than that before treatment (0.40±0.18) cm(2), (0.49±0.24) cm(2). The difference was statistically significant. Significance (Z=-3.29, -3.64; P<0.008); after 14 days of treatment, after 14 days of treatment, neovascularization in the CXL and CXL+ antibiotic groups began to resolve, 1 (1, -2) and 1 (0, -2) at 7 days of treatment. decreased to 1 (1, -1) and 0 (0, -1), the difference was statistically significant (Z=4.57, 3.80; P<0.012 5); The degree of corneal edema was significantly reduced in the CXL group and the CXL+ antibiotic group at 14 days after treatment, which was reduced from (650±154) μm and (785±255) μm before the treatment to (432±95) μm and (455±109) μm, the difference was statistically significant (t=4.50, 4.92; P=0.00); The density of corneal stromal cells was also reduced from (446±257)/mm(2), (321±145)/mm(2) to (107±66)/mm(2), (114±94)/mm(2), the difference was statistically significant (t=4.15, 4.76; P<0.05). Histopathological observation under light microscope showed that most of the corneal ulcers healed in the CXL group and the CXL+ antibiotic group at 7 days of treatment. The epithelial cells were clearly visible and misaligned, and a small amount of neutrophils in the stromal layer. The upper epithelial layer was treated for 14 days. The cells are arranged neatly, the structure is clear, and the inflammatory cells are significantly reduced. Conclusion: Ultraviolet light combined with riboflavin corneal collagen cross-linking has a certain therapeutic effect on rabbit bacterial keratitis infection control and ulcer repair, and can be used as an auxiliary treatment for antibiotics. (Chin J Ophthalmol, 2018, 54:902-910).