Development of a quartz crystal microbalance diagnostic for measuring material erosion and deposition on the first wall in EAST

A quartz crystal microbalance (QMB) diagnostic system has been established in Experimental Advanced Superconducting Tokamak (EAST) for real-time and in situ measurements of erosion and deposition rates of plasma-facing materials at the first wall. A ∼70 nm aluminum (Al) film has been coated on the QMB crystal surface to measure the erosion rate by charge exchange neutral particles. Dual sensors of the QMB system have been used with a closed sensor for reference. The stability and light sensitivity of the QMB system have been tested in the lab, demonstrating its feasibility on the application of EAST experiments. The QMB system with cooling water has been successfully applied in the 2018 EAST campaign. The net erosion thickness measured by the QMB has been well validated by thickness measurements using the Rutherford backscattering spectrometry. The developed QMB systems can help us to understand the physics processes of material erosion and deposition at main chamber walls for long pulse operations in EAST.

[Polarization of bone marrow-derived macrophages induced by recombinant Trichinella spiralis cysteine protease inhibitors in vitro]

OBJECTIVE

To investigate the regulatory role of recombinant Trichinella spiralis cysteine protease inhibitors (rTs-Cys) in induction of polarization of bone marrow-derived macrophages (BMDMs) in vitro.

METHODS

BMDMs were captured and cultured in conditioned medium for 7 days. Then, mature BMDMs were harvested and assigned into four groups. Cells in Group A (negative control) were given 10 ng/mL IFN-γ combined with 100 ng/mL LPS, cells in Group B (positive control) were treated with IL-4 and IL-10 (at 10 ng/mL both), and cells in Group C (recombinant protein alone) were stimulated with 1 μg/mL rTs-Cys, while cells in Group D (protein co-culture) were simultaneously treated with 1 μg/mL rTs-Cys, 10 ng/mL IFN-γ and 100 ng/mL LPS. Cells and culture supernatant were collected 24 hour post-treatment, and the proportions of F4/80⁺, CD11b⁺, CD206⁺ and CD11c⁺ cells were detected by flow cytometry. The levels of interleukin IL-6 (IL-6), tumor necrosis factor-α (TNF-α), IL-10 and transforming growth factor-β (TGF-β) in the cell culture supernatant were measured by ELISA and the CD86⁺ and CD206⁺ phenotypes were identified by immunofluorescent staining.

RESULTS

Flow cytometry detected no significant difference in the proportion of F4/80⁺ CD11b⁺ CD11c⁺ cells among the four groups (F = 46.184, P < 0.001), and a lower proportion of F4/80⁺ CD11b⁺ CD11c⁺ cells was seen in groups C and D than in group A (all P values < 0.001). There was a significant difference in the proportion of F4/80⁺ CD11b⁺ CD206⁺ cells among the four groups (F = 11.032, P < 0.001), and a greater proportion of F4/80⁺ CD11b⁺ CD206⁺ cells was seen in groups C and D than in group A (all P values < 0.01). Immunofluorescent staining showed higher CD206⁺ expression and lower CD86⁺ expression in groups C and D than in Group A. There were significant differences in the IL-6 and (F = 3.950, P < 0.001) and TNF-α (F = 205.827, P < 0.001) levels in the cell culture supernatants among the four groups, and significantly lower IL-6 and TNF-α levels were measured in groups C and D than in Group A (both P < 0.05). There were significant differences in the IL-10 and (F = 8.274, P < 0.001) and TGF-β (F = 13.559, P < 0.01) levels in the cell culture supernatants among the four groups, and greater IL-10 and TGF-β levels were measured in Group C than in Group A (both P values < 0.01). In addition, the TGF-β level was significantly higher in Group D than in Group A (P < 0.05); however, there was no significant difference in the IL-10 level between groups D and A (P > 0.05).

CONCLUSIONS

rTs-Cys may induce the polarization of BMDMs to antiinflammatory M2 macrophages in vitro and inhibit the activation of M1 macrophages.

SAT0605 TRENDS OF TOTAL JOINT ARTHROPLASTY AMONG PATIENTS WITH OSTEOARTHRITIS, RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS IN BRITISH COLUMBIA, CANADA, 1998-2013

Background:

Total joint replacement or arthroplasty (TJA) is an expensive surgical treatment for severe arthritis when other treatments have failed. Given the substantial changes in the available treatments over the past 2 decades, it is of interest to describe the trends in the use of TJA among patients with different types of arthritis in the general population.

Objectives:

The aim of this study was to examine longitudinal trends of TJA including total hip, knee and shoulder replacement performed in British Columbia, Canada, between the year of 1998 and 2013 due to three different types of arthritis conditions:1) Osteoarthritis (OA), 2) Rheumatoid arthritis (RA) and 3) Ankylosing spondylitis (AS).

Methods:

We analyzed large, population-based administrative data obtained from Population Data BC that includes patients aged 20+ in B.C., Canada, linked to diagnostic codes of hospitalizations and physician visits. Using the Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures (CCP) procedure codes and the Canadian Classification of Health Intervention (CCI) procedure codes, we identified total joint arthroplasty procedures (TJA) including total hip arthroplasty (THA), total knee arthroplasty (TKA) and total shoulder arthroplasty (TSA) performed among OA, RA and AS prevalent cases. We calculated annual rates of THA, TKA and TSA performed among OA, RA and AS patients. We divided the study period into four equal-length periods and calculated period prevalence rates of THA, TKA and TSA per 100,000 person years as the ratio of the number of cases per period (numerator) to the total follow up time within the same period (denominator). We performed trend tests to test if there are changes in these rates over time.

Results:

For OA and RA, TKA was the most common types of TJA performed, while THA remained to be the most common types of TJA performed among AS patients. For OA, period prevalence rate of THA, TKA and TSA increased during the study period (Table 1.). For RA patients, THA and TKA rates showed a decreasing trend. For AS patients, THA rates decreased and TSA increased. For RA and AS, TSA rates did not show a significant trend.

Table 1.

Trends in arthroplasty rates (cases per 100,000 person years) among patients with OA, RA and AS by arthroplasty site.

Period1998-20012002-20052006-20092010-2013Period Trend (P†)Among OA patients THA816.26920.621035.51947.030.05459 (0.0002) TKA1024.71244.711653.891475.440.13114 (<0.0001) TSA25.9632.0143.253.920.2495 (0.0007)Among RA patients THA79.5355.6346.3133.11-0.28321 (<0.0001) TKA131.66111.99106.0874.79-0.16765 (0.0001) TSA19.4416.6213.7713.13-0.1391 (0.221)Among AS patients THA89.0176.7510.0215.48-0.6753 (<0.0001) TKA<5<5<57.740.6263 (0.0178) TSA<5<5<5<5-0.4196 (0.354)

†Pvalues were derived in Poisson regression analysis.

Among patients with OA, annual TJA rates per 100,000 persons show an overall increasing trend. The TJA rates remained relatively flat from 1998 to 2003, started to increase and peaked in 2006, and declined slightly thereafter (Figure 1.). Among patients with inflammatory arthritis (RA and AS), annual TJA rates decreased over the study period (Figure 1.). Annual proportion of TJA perfromed due to inflammatory arthritides significantly decreased from 1998 to 2013 (4.3% versus 1.0%) (Figure 2.).

Conclusion:

There have been important changes in the annual rate of total joint replacement in B.C., Canada, during the study period from 1998 to 2013. TJA use increased in OA patients but decreased in patients with inflammatory arthritis (RA and AS). Effective treatment for inflammatory arthritis, such as TNF-α inhibitors introduced in British Columbia in 2001-2002, may have effectively reduced the need for arthroplasty in RA and AS.

Acknowledgments:

This study was supported by CIHR (team grant THC-135235), and NSERC (RGPIN-2018-04313).

Disclosure of Interests:

None declared

SAT0242 REGIONAL VARIATION IN CARDIOVASCULAR DISEASE AMONG SLE PATIENTS

Objectives:

To evaluate whether the risk of cardiovascular disease (CVD) including myocardial infarction (MI) and cerebrovascular (CVA) differs across geographic regions among SLE patients.

Methods:

We identified SLE patients using two ICD codes 60 days apart within two years recorded in Medical Services Plan (MSP) or hospital discharge database (DAD). We defined the second of two diagnosis dates as the index date. We included incident SLE patients (7-year continuous registries in MSP before the first diagnosis date) with an index date between 1997 and 2012 and excluded patients with previous MI or CVA before the index date. We followed each patient from the index date up to 10 years and censored at the date of death date, leaving the province, or March 31, 2015.

We assessed the incident CVD that was defined as the first ever diagnosis of MI or CVA recorded in DAD or as the primary cause of death in Vital Statistics. We also evaluated MI and CVA separately.

The Province’s publicly administered and funded health care system is organized into five regional health authorities (HA): Interior (IHA), Fraser (FHA), Vancouver Coastal (VCHA), Vancouver Island (VIHA), and Northern (NHA) [Figure 1(a)].We assigned each patient the HA she/he was registered at the index date. We extracted baseline covariates using the information during a period of 365 days prior to the index date, including socio-demographic characteristics, health care resource use, comorbidities, and prescription medication use. We calculated the incident rate (IR) of MI, CVA, and CVD (first ever MI or CVA) by HA. Using Cox Proportional Hazard model adjusting for potential confounders at baseline, we estimated the adjusted hazard ratios (aHR) of CVD for each HA compared to FHA or VCHA which have the large proportion of provincial population and SLE patients. We evaluated the regional disparities in MI and CVA separately using the same methods.

Figure 1.

HA and CVD Incident Rate

Results:

We included 3,960 incident SLE patients free of CVD at baseline with a mean (SD) age of 48.5 (15.8), including 726 (18.3%) from IHA, 1634 (42.3%) from FHA, 854 (21.6%) from VCHA, 504 (12.7%) from VIHA, and 242 (6.1%) from NHA. During 26378 person-year (PY) follow-up, 133 patients developed incident CVD including 91 MI and 43 CVA. [Table 1]

Table 1.

Incident Rates and HR

HAIncidenceaHR (95%CI)NPYIR (95%CI)10,000 PYReference: FHAReference: VCHACVDIHA35457976(54,105)1.93(1.17,3.2)2.05(1.17,3.58)FHA391119735(25,47)ref1.06(0.64,1.76)VCHA27584446(31,66)0.94(0.57,1.57)refVIHA22316570(44,103)1.65(0.96,2.83)1.74(0.98,3.11)NHA10159263(31,110)1.81(0.86,3.8)1.92(0.88,4.17)MIIHA24457952(34,76)2.09(1.14,3.83)1.81(0.95,3.47)FHA271119724(16,34)ref0.87(0.48,1.56)VCHA21584436(23,54)1.15(0.64,2.07)refVIHA12316538(20,64)1.29(0.64,2.58)1.12(0.54,2.31)NHA7159244(19,85)2.11(0.88,5.11)1.84(0.74,4.56)CVAIHA11457924(12,41)1.79(0.71,4.55)2.35(0.8,6.88)FHA121119711(6,18)ref1.31(0.49,3.48)VCHA7584412(5,23)0.76(0.29,2.03)refVIHA10316532(16,55)2.79(1.14,6.85)3.66(1.34,10.01)NHA<5159219(5,49)1.45(0.36,5.72)1.89(0.44,8.22)

The IR of CVD varied from 35 in FHA to 76 per 10,000 PY in IHA [Figure 1(b)]. IHA had significantly higher risk of CVD than FHA (aHR=1.93, 95%CI=1.17~3.2) and VCHA (aHR=2.05, 95%CI=1.17~3.58).

The IR of MI varied from 24 in FHA to 52 per 10,000 PY in IHA [Figure 2(a)]. IHA had significantly higher risk of MI than FHA (aHR=2.09, 95%CI=1.14~3.83).

Figure 2.

MI and CVA incident Rate by HA

The IR of CVA varied from 11 in FHA to 32 per 10,000 PY in VIHA [Figure 2(b)]. VIHA had significantly higher risk of CVA than FHA (aHR=2.79, 95%CI=1.14~6.85) and VCHA (aHR=3.66, 95%CI=1.34~10.01).

Conclusion:

Compared with FHA and VCHA, IHA had higher risk of CVD and VIHA had higher risk of CVA. IHA also had higher risk of MI than FHA.

Disclosure of Interests:

None declared

AB1143 BURDEN OF GLUCOCORTICOIDS AMONG RHEUMATOID ARTHRITIS PATIENTS AT DIFFERENT STAGES OF DISEASE-MODIFYING ANTIRHEUMATIC DRUG MANAGEMENT

Background:

EULAR and ACR guidelines recommend a treat-to-target approach for patients with RA including regular assessments of disease activity. Glucocorticoids are commonly used to control inflammation associated with uncontrolled disease. However, patients using glucocorticoids may develop short- and long-term side effects.

Objectives:

To examine the real-world use of glucocorticoids among patients with RA who are disease-modifying antirheumatic drug (DMARD)-naïve or failing their first conventional synthetic DMARD (csDMARD) or biologic DMARD (bDMARD).

Methods:

From a large US health claims database, this study included adults with ≥2 RA claims ≥30 days apart who started (index date [ID], 1/1/2012–3/31/2017) a first DMARD (DMARD-naïve) or patients who newly initiated a csDMARD and then switched to or added another DMARD (csDMARD switchers), and patients who initiated a first bDMARD and then switched to another bDMARD or Janus kinase inhibitor (JAKi; bDMARD switchers). All patients had continuous enrollment 1-year before and ≥1 year after ID and were evaluated for pre- and post-ID use of glucocorticoids (oral or injectable), prednisone equivalent dose (PED), and duration of exposure ≥30 days.

Results:

The study included 28,201 patients in the DMARD-naïve cohort, 7,816 csDMARD switchers, and 4,656 bDMARD switchers (median age 54 years for all, 73%–78% female).

Among DMARD-naïve patients, 66.5% used glucocorticoids during the pre-ID period (Figure 1) and 61.2% had >7.5 mg/day PED, 21.2% had >30 mg/day PED, and 21.2% had ≥30 days of exposure to glucocorticoids (Figure 2). Post-ID, 69.4% of patients used glucocorticoids, while 54.7% had >7.5 mg/day PED, 13.5% had >30 mg/day PED, and 44.9% had ≥30 days of exposure to glucocorticoids.

Among csDMARD switchers, 84.5% of patients used glucocorticoids during the pre-ID period (Figure 1), and 73.4% had >7.5 mg/day PED, 16.0% had >30 mg/day PED, and 56.4% had ≥30 days of exposure to glucocorticoids (Figure 2). During the post-ID treatment, 74.1% of patients used glucocorticoids, 56.2% had >7.5 mg/day PED, 14.4% had >30 mg/day PED, and 45.8% had ≥30 days of exposure to glucocorticoids.

Among bDMARD switchers, 85.1% of patients used glucocorticoids in the pre-ID period (Figure 1), and 70.2% had >7.5 mg/day PED, 17.4% had >30 mg/day PED, and 55.2% had ≥30 days of exposure to glucocorticoids (Figure 2). During post-ID treatment, 75.4% of patients used glucocorticoids and 59.7% of patients had >7.5 mg/day PED, 16.7% had >30 mg/day PED, and 45.6% had ≥30 days of exposure to glucocorticoids.

Conclusion:

Real world glucocorticoid use was high in all categories of DMARD-treated RA patients, at baseline and during their next treatment, suggesting ongoing medical needs. Glucocorticoid doses exceeded 7.5 mg/day for most patients. In addition, many patients had ≥30 days exposure to glucocorticoids, posing an additional safety risk.

Disclosure of Interests:

Robin K Dore Grant/research support from: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Jenya Antonova Employee of: Gilead Sciences. Inc., Magdaliz Gorritz Consultant of: Gilead Sciences, Inc., Lawrence Chang Consultant of: Gilead Sciences, Inc., Handing Xie Consultant of: Gilead Sciences, Inc., Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme

SAT0175 IMPACT OF ANTIMALARIAL ADHERENCE ON MORTALITY AMONG PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A POPULATION-BASED COHORT STUDY

Background:

Evidence has consistently shown that adherence to AM is poor in systemic lupus erythematosus (SLE) patients. However, data on the impact of adherence to AM on mortality is scarce.

Objectives:

To assess the effect of AM adherence on all-cause mortality in SLE patients from the general population.

Methods:

This study used administrative databases from British Columbia, Canada. We created an incident SLE cohort between January 01, 1997, and March 31, 2015, using the physician billing data and a 7-year washout period. The inclusion criteria were at least two physician visits, at least two months apart, within two years, with an ICD-9 code (710.0) or ICD-10 code (M32.1, M32.8, M32.9) for SLE. Follow-up started at the first day of having both SLE and AM, i.e., at the SLE index date (second ICD code) for those whose first AM use occurred before the SLE index date, or the date of the first AM use if otherwise. Our outcome was all-cause mortality, obtained from the vital statistics registry. In the analysis, the follow-up time was divided into 30-days windows, for a total of 293,190 person-months. For each window, a measure of adherence, the proportion of days covered (PDC), was calculated and categorized as adherent (PDC≥0.90), non-adherent (0<PDC<0.90), and discontinuer (no drug or PDC = 0). We used both Cox’s proportional hazards models and marginal structural models (MSM) to estimate the effect of AM adherence on all-cause mortality. Both analysis controlled for baseline demographics (age, sex, residence, income quintile), as well as the following baseline and time-varying covariates: immunosuppressive and other medications, hospitalizations, impatient, and other visits, and Charlson comorbidity index. To account for the possibility of a few time-varying covariates being mediators in the causal pathway from AM adherence to mortality, which may cause the Cox model to yield biased estimates of the adherence effects, we conducted the MSM analysis that can produce valid estimates as it balances the distributions of time-varying confounders among the three adherence groups via inverse probability weighting.

Results:

We identified 3,385 individuals with incident SLE (mean age 47.3 years, 89% were women) who had at least one filled AM prescription. Over the mean follow-up of 6.66 years, 288 (8.5%) incident SLE patients died. The incidence rate (IR) of mortality for AM adherent, non-adherent, and discontinuer patients were 4.31, 11.86, and 19.51 per 1000 person-years, respectively. Using the Cox model, the adjusted hazard ratio (HRs) obtained for AM adherent and non-adherent SLE patients were 0.20 and 0.66, respectively, compared to discontinuer SLE patients (Table 1). Using MSM, those adjusted HRs were found as 0.18 and 0.64. Also, the adjusted HRs for adherers compared to the non-adherers were 0.30 (Cox) and 0.28 (MSM). A statistically significant linear trend in the HRs of mortality risk over the adherence levels was found (Table 1, Linear Trend).

Table 1.Adherence LevelsNo. of DeathsIR Ratios (95%CI)Adjusted Cox HRs (95%CI)Adjusted MSM HRs (95%CI)Discontinuer (Reference)198Non-adherent470.61(0.44-0.84)0.66(0.47-0.93)0.64(0.46-0.89)Adherent430.22(0.16-0.31)0.20(0.14-0.28)0.18(0.12-0.25)Contrast: Partial vs. Full0.36(0.24-0.55)0.30(0.19-0.46)0.28(0.18-0.42)Linear Trend0.32(0.25-0.41)0.29(0.23-0.37)

Conclusion:

SLE patients that adhere to AM therapy have a lower risk of death than patients who do not adhere or who discontinue AM (5 and 3 times, respectively) in both the MSM and Cox analysis. Our findings support the importance of AM adherence to prevent premature deaths in SLE patients.

Disclosure of Interests:

None declared

OP0191 ASSOCIATION OF TRAMADOL WITH ALL-CAUSE MORTALITY, CARDIOVASCULAR DISEASE, VENOUS THROMBOEMBOLISM AND HIP FRACTURES AMONG PATIENTS WITH OSTEOARTHRITIS. A POPULATION-BASED STUDY

Background:

Both tramadol (narcotic-like drug) and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for pain relief among osteoarthritis (OA) patients. Evidence comparing risks of adverse events between tramadol and NSAIDs users is inconclusive.

Objectives:

To examine the association of tramadol with all-cause mortality, cardiovascular disease (CVD), venous thromboembolism (VTE) and hip fractures (HFx) compared with NSAIDs and codeine in OA.

Methods:

Design: Sequential propensity score-matched cohort study. Sample: All patients with OA who received medical care from 2005 to 2014 in the entire province of British Columbia, Canada. Tramadol cohort: Initial prescription of tramadol (n=56325). Four comparator cohorts: the initiation of one of the following: naproxen (n=13798), diclofenac (n=17675), cyclooxygenase-2 [Cox-2] inhibitor (n= 17039), or codeine (a weak opioid) (n=7813). Patients required to be prescribed neither tramadol nor its comparators during the year before the initial prescription date (i.e., index date). Outcomes: 1) all-cause mortality;first ever2) CVD, 3) VTE, 4) HFx within the 1styear after the initiation of tramadol or its comparators. Follow-up: from index date until the event occurred, disenrollment, or the end of a 1-year follow-up period. Statistical analysis: We created baseline covariates (demographics, comorbidities, medications and health resource utilization) from the year prior to the index date. Calendar years from 2005 to 2014 were divided into 10 blocks; propensity scores were calculated using logistic regression within each block. We used 1:1 greedy matching method. We estimated hazard ratios (HRs) using Cox proportional hazard models.

Results:

After propensity score matching, 112650 patients with OA were included (mean age of 68 years, 62.8% were females). During the 1-year follow-up, 296 deaths (21.5/1000 person-years) occurred in the tramadol cohort and 246 (17.8/1000 person-years) in the naproxen cohort (Table 1). All-cause mortality was higher for tramadol compared with all NSAIDs cohorts, but not with the codeine cohort (Table 1, Figure 1). Tramadol initiators have also a higher risk of CVD and VTE compared with the diclofenac and Cox-2 inhibitor initiators with HRs ranging from 1.2 to 1.7. Furthermore, tramadol was also associated with a higher risk of HFx compared with all NSAIDs cohorts (HRs ranging from 1.4 to 1.5). No significant difference was found between tramadol and codeine (Table 1).

Table 1Group1Group2Group3Group4All-cause MortalityTramadolNaproxenTramadolDiclofenacTramadolCox-2 inhibitorTramadolCodeineOA (n)13798137981767517675170391703978137813Death (n)296246439345402267168199Rate (/1000 PY)21.517.824.819.523.615.721.525.5HR (95% CI)1.2 (1.0-1.4)1.01.3 (1.1-1.5)1.01.5 (1.3-1.8)1.00.8 (0.7-1.0)1.0CVDOA (n)11708117081492414924147791477968096809CVD (n)309319410349404353156164Rate (/1000 PY)26.427.327.523.427.323.922.924.1HR (95% CI)1.0 (0.9-1.1)1.01.2 (1.1-1.3)1.01.2 (1.0-1.3)1.00.9 (0.8-1.1)1.0VTEOA (n)13472134721723017230166991669976607660VTE (n)4137604070402830Rate (/1000 PY)3.02.83.52.34.22.43.73.9HR (95% CI)1.2 (0.9-1.6)1.01.5 (1.1-1.9)1.01.7 (1.3-2.3)1.01.0 (0.7-1.4)1.0HFxOA (n)13378133781721617216166701667075937593HFx (n)6649885991603540Rate (/1000 PY)5.03.75.13.45.53.64.65.3HR (95% CI)1.4 (1.0-1.8)1.01.5 (1.2-1.9)1.01.5 (1.2-1.9)1.00.9 (0.7-1.2)1.0

Conclusion:

OA patients initiating tramadol have an increased risk of mortality, CVD, VTE, and HFx within 1 year compared with NSAIDs, but no statistically significant difference in the risk was observed between tramadol and codeine.

Disclosure of Interests:

None declared

OP0010 EFFECTIVENESS OF THE MAKING IT WORK™ PROGRAM AT IMPROVING PRESENTEEISM AND WORK CESSATION IN WORKERS WITH INFLAMMATORY ARTHRITIS – RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background:

Arthritis often leads to presenteeism (decreased at-work productivity), missed days from work and permanent work disability, leading to reduced quality of life and high costs to individuals and society. Yet, health services addressing the employment needs of people with arthritis are lacking.

Objectives:

We evaluated the effectiveness of the Making-it-WorkTM(MiW) program, an online self-management program developed to help people with inflammatory arthritis (IA) deal with employment issues.

Methods:

A multi-center RCT evaluated the effectiveness of MiW at improving presenteeism and preventing work cessation (WC) over two years. Participants were recruited from rheumatologist practices, consumer organizations and arthritis programs, in three Canadian provinces. Eligibility criteria: diagnosis of IA, employed, age 18-59, and concerned about ability to work. Participants were randomized 1:1 to MiW or usual care plus printed material on workplace tips. MiW consists of five online self-learning modules and group meetings, and individual vocational counselling and ergonomic consultations. Questionnaires were administered every 6 months. Outcomes were presenteeism [Rheumatoid Arthritis Work Instability Scale (RA-WIS)], time to WC ≥ 6 months, and time to WC ≥ 2 months (secondary outcome). Baseline characteristics (age, gender, ethnicity, occupation, education, disease duration and self-employment) were collected. Intention-to-treat (ITT) longitudinal analysis of RA-WIS using linear mixed effect regression models with 2-year comparison as primary endpoint and survival analysis for time to WC using Kaplan-Meier and Cox Proportional Hazard models were performed. Robustness analyses were conducted by using various missing values imputation methods like last observation carried forward, imputation using worse possible outcomes and model-based multiple imputations; using square root transformation of RA-WIS outcome; and adjusting for baseline covariates. SAS version 9.4 was used.

Results:

A total of 564 participants were recruited, with 478 (84.75%) completing 2-year follow-up. Baseline characteristics were similar between groups. Mean RA-WIS scores were significantly lower in the intervention group from 6 months onwards, with the greatest difference observed at 2 years (-1.78, 95%CI: -2.7, -0.9, p < .0001), yielding a standardized effect size of 32%. Satisfactory robustness was observed. Work cessation occurred less often in intervention than control groups, but only reached statistical significance for WC ≥ 2 months (WC ≥ 6 months: 31 versus 44 events, aHR 0.70, 95%CI: 0.44, 1.11, p = 0.13; WC ≥ 2 months: 39 versus 61 events, aHR: 0.65, 95%CI: 0.43, 0.98, p = 0.04).

Conclusion:

Results of the RCT reveal the program was effective at improving presenteeism and preventing short-term WC. Effectiveness at preventing long-term work disability will be assessed at 5 years. This program fills one of the most important and costly unmet needs for people with inflammatory arthritis.

References:

[1]Carruthers EC, Rogers P, Backman CL, et al. “Employment and arthritis: making it work” a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).BMC Med Inform Decis Mak. 2014;14:59. Published 2014 Jul 21. doi:10.1186/1472-6947-14-59

Disclosure of Interests:

Andre Luquini: None declared, Yufei Zheng: None declared, Hui Xie: None declared, Catherine Backman: None declared, Pamela Rogers: None declared, Alex Kwok: None declared, Astrid Knight: None declared, Monique Gignac: None declared, Dianne Mosher: None declared, Linda Li: None declared, John Esdaile: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Diane Lacaille: None declared

[A survey on clinical characteristics and risk factors of severe asthma in China]

Objective: To investigate the clinical characteristics and risk factors of severe bronchial asthma in Chinese people over 14 years old. Methods: According to the multi-stage random cluster sampling methods, a total of 164 215 subjects were visited by a questionnaire in the epidemiology survey from eight provinces (Beijing, Shanghai, Guangdong, Liaoning, Henan, Shanxi, Jiangsu, Sichuan provinces) located in seven regions (north, northeast, east, central China, south, southwest and northwest) of China from February 2010 to August 2012. A total of 2 034 were diagnosed as asthma. The clinical characteristics and related risk factors of patients with severe asthma in China were analyzed. Results: Among all asthma patients, 560 were newly diagnosed, accounting for 27.5% (560/2 034) and the percentage of previously confirmed patients was 72.5% (1 474/2 034). A total of 145 were eligible for severe asthma, accounting for 9.8% (145/1 474) of previously confirmed asthmatics and 7.1% (145/2 034) of all asthmatics. 83.5% (121/145) severe asthmatics had at least one trigger factor. Correlation analysis showed that the risk factors of severe asthma were: smoking (OR=1.543, 95%CI: 1.250-1.814), obesity (OR=2.186, 95%CI: 1.972-2.354), petting (OR=2.135, 95%CI: 1.904-2.283), combined with allergic rhinitis (OR=3.456, 95%CI: 2.721-4.326), gastroesophageal reflux disease (OR=1.842, 95%CI: 1.682-2.140), bronchiectasis (OR=1.665, 95%CI: 1.347-1.912) or chronic obstructive pulmonary disease (OR=1.312, 95%CI: 1.171-1.694). Conclusions: The most common comorbidities in severe asthmatics in China are allergic rhinitis and gastroesophageal reflux disease. The risk factors of severe asthma include obesity, allergic rhinitis, gastroesophageal reflux disease, chronic obstructive pulmonary disease, bronchiectasis, smoking and petting.

Umifenovir treatment is not associated with improved outcomes in patients with coronavirus disease 2019: a retrospective study

Objectives

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Umifenovir (Arbidol®) is an antiviral drug being used to treat influenza in Russia and China. This study aimed to investigate the effectiveness and safety of umifenovir for COVID-19.

Methods

A retrospective study was performed in a non-intensive care unit (ICU) ward in Jinyintan Hospital from 2 February 2020 to 20 March 2020. COVID-19 was confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay of pharyngeal swab specimens. The confirmed patients were divided into the umifenovir group and the control group according to the use of umifenovir. The main outcomes were the rate of negative pharyngeal swab tests for SARS-CoV-2 within 1 week after admission and the time for the virus to turn negative. The negativity time of SARS-CoV-2 was defined as the first day of a negative test if the nucleic acid of SARS-CoV-2 was negative for two consecutive tests.

Results

A total of 81 COVID-19 patients were included, with 45 in the umifenovir group and 36 in the control group. Baseline clinical and laboratory characteristics were comparable between the two groups. Thirty-three out of 45 (73%) patients in the umifenovir group tested negative for SARS-CoV-2 within 7 days after admission, the number was 28/36 (78%) in the control group (p 0.19). The median time from onset of symptoms to SARS-CoV-2 turning negative was 18 days (interquartile range (IQR) 12–21) in the umifenovir group and 16 days (IQR 11–21) in the control group (p 0.42). Patients in the umifenovir group had a longer hospital stay than patients in the control group (13 days (IQR 9–17) vs 11 days (IQR 9–14), p 0.04). No deaths or severe adverse reactions were found in both groups.

Discussion

Umifenovir might not improve the prognosis or accelerate SARS-CoV-2 clearance in non-ICU patients. A randomized control clinical trial is needed to assess the efficacy of umifenovir.

[A Qualitative Proteome-Wide Lysine Succinylation Profiling of Tea Revealed its Involvement in Primary Metabolism]

Lysine succinylation of proteins has potential impacts on protein structure and function, which occurs on post-translation level. However, the information about the succinylation of proteins in tea plants is limited. In the present study, the significant signal of succinylation in tea plants was found by western blot. Subsequently, we performed a qualitative analysis to globally identify the lysine succinylation of proteins using high accuracy nano LC-MS/MS combined with affinity purification. As a result, a total of 142 lysine succinylation sites were identified on 86 proteins in tea leaves. The identified succinylated proteins were involved in various biological processes and a large proportion of the succinylation sites were presented on proteins in the primary metabolism, including glyoxylate and dicarboxylate metabolism, TCA cycle and glycine, serine and threonine metabolism. Moreover, 10 new succinylation sites were detected on histones in tea leaves. The results suggest that succinylated proteins in tea plants might play critical regulatory roles in biological processes, especially in the primary metabolism. This study not only comprehensively analyzed the lysine succinylome in tea plants, but also provided valuable information for further investigating the functions of lysine succinylation in tea plants.

Source of Energetic Protons in the 2014 September 1 Sustained Gamma-ray Emission Event

We report on the source of > 300 MeV protons during the SOL2014-09-01 sustained gamma-ray emission (SGRE) event based on multi-wavelength data from a wide array of space- and ground-based instruments. Based on the eruption geometry we provide concrete explanation for the spatially and temporally extended γ -ray emission from the eruption. We show that the associated flux rope is of low inclination (roughly oriented in the east-west direction), which enables the associated shock to extend to the frontside. We compare the centroid of the SGRE source with the location of the flux rope's leg to infer that the high-energy protons must be precipitating between the flux rope leg and the shock front. The durations of the SOL2014-09-01 SGRE event and the type II radio burst agree with the linear relationship between these parameters obtained for other SGRE events with duration ≥ 3 hrs . The fluence spectrum of the SEP event is very hard, indicating the presence of high-energy (GeV) particles in this event. This is further confirmed by the presence of an energetic coronal mass ejection with a speed > 2000 km s - 1 , similar to those in ground level enhancement (GLE) events. The type II radio burst had emission components from metric to kilometric wavelengths as in events associated with GLE events. All these factors indicate that the high-energy particles from the shock were in sufficient numbers needed for the production of γ -rays via neutral pion decay.

Altered resting-state dynamic functional brain networks in major depressive disorder: Findings from the REST-meta-MDD consortium

BACKGROUND

Major depressive disorder (MDD) is known to be characterized by altered brain functional connectivity (FC) patterns. However, whether and how the features of dynamic FC would change in patients with MDD are unclear. In this study, we aimed to characterize dynamic FC in MDD using a large multi-site sample and a novel dynamic network-based approach.

METHODS

Resting-state functional magnetic resonance imaging (fMRI) data were acquired from a total of 460 MDD patients and 473 healthy controls, as a part of the REST-meta-MDD consortium. Resting-state dynamic functional brain networks were constructed for each subject by a sliding-window approach. Multiple spatio-temporal features of dynamic brain networks, including temporal variability, temporal clustering and temporal efficiency, were then compared between patients and healthy subjects at both global and local levels.

RESULTS

The group of MDD patients showed significantly higher temporal variability, lower temporal correlation coefficient (indicating decreased temporal clustering) and shorter characteristic temporal path length (indicating increased temporal efficiency) compared with healthy controls (corrected p < 3.14×10^-3). Corresponding local changes in MDD were mainly found in the default-mode, sensorimotor and subcortical areas. Measures of temporal variability and characteristic temporal path length were significantly correlated with depression severity in patients (corrected p < 0.05). Moreover, the observed between-group differences were robustly present in both first-episode, drug-naïve (FEDN) and non-FEDN patients.

CONCLUSIONS

Our findings suggest that excessive temporal variations of brain FC, reflecting abnormal communications between large-scale bran networks over time, may underlie the neuropathology of MDD.

Risk factors of calculi in upper urinary tract after radical cystectomy with urinary diversion

INTRODUCTION AND OBJECTIVES

The study was conducted to identify the risk factors of upper tract stone formation in patients with diversions after radical cystectomy (RC).

MATERIALS AND METHODS

All patients with diversion after RC were collected in our center from January 2005 to December 2013. Three different common diversions were included: Orthotopic neobladder (ON: 168 patients), Ileal Conduit (IC: 93 patients) or Ureterocutaneostomy (UC: 104 patients). Univariable and multivariable logistic regression analysis were conducted to identify the independent predictors of stone formation in the upper tract.

RESULTS

A total of 365 consecutive patients (316 males, 49 females) were included. At a median follow-up of 48 months (range 12-65 months), 36 patients (9.9%) developed upper tract stone. Among them, 26 (72.2%), 5 (13.9%) and 5 (13.9%) patients underwent ON, IC and UC, respectively. 25 patients had renal stone and 11 ureter stone. Minimally invasive operations (endoscopic laser lithotripsy via the anterograde or retrograde approach in 24 cases, percutaneous nephrolithotomy in 9 cases and shock wave lithotripsy in 3 cases) were carried out successfully in all stone cases. On univariable and multivariable logistic regression analysis, diabetes mellitus, hypertension, urinary tract infection (UTI), anastomotic stenosis and types of diversions (P<.05) were positively associated with upper tract stone formation.

CONCLUSIONS

The variable predictors of upper tract stone may contain diabetes mellitus, hypertension, UTI, anastomotic stenosis and types of diversion.

MiR-138-5p is downregulated in patients with atrial fibrillation and reverses cardiac fibrotic remodeling via repressing CYP11B2

OBJECTIVE

To investigate the connection between atrial fibrillation (AF) and miR-138-5p and to further explore the possible mechanism.

PATIENTS AND METHODS

MiR-138-5p expression of right atrial appendage (RAA) tissues in 28 patients with AF and 22 patients with sinus rhythm (SR) was detected by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Moreover, cell proliferation assay was conducted in AC16 cells which were transfected by miR-138-5p inhibitors or mimics. Furthermore, Western blot assay, luciferase assay, and RNA immunoprecipitation assay were performed to uncover the mechanism.

RESULTS

In the present research, miR-138-5p expression in RAA samples decreased significantly in AF patients than that in SR ones. Moreover, in AC16 cells, higher miR-138-5p expression level suppressed cell growth, while cell growth was promoted after miR-138-5p was knockdown. In addition, further experiments showed that CYP11B2 acted as the main target of miR-138-5p and its expression in AF tissues negatively correlated to miR-138-5p expression.

CONCLUSIONS

All the results above elucidated that cell proliferation of AF could be inhibited by miR-138-5p via suppressing CYP11B2, which may offer a new vision for interpreting the mechanism of AF development.

Role of Zebrafish fhl1A in Satellite Cell and Skeletal Muscle Development

Background:

Four-and-a-half LIM domains protein 1 (FHL1) mutations are associated with human myopathies. However, the function of this protein in skeletal development remains unclear.

Methods:

Whole-mount in situ hybridization and embryo immunostaining were performed.

Results:

Zebrafish Fhl1A is the homologue of human FHL1. We showed that fhl1A knockdown causes defective skeletal muscle development, while injection with fhl1A mRNA largely recovered the muscle development in these fhl1A morphants. We also demonstrated that fhl1A knockdown decreases the number of satellite cells. This decrease in satellite cells and the emergence of skeletal muscle abnormalities were associated with alterations in the gene expression of myoD, pax7, mef2ca and skMLCK. We also demonstrated that fhl1A expression and retinoic acid (RA) signalling caused similar skeletal muscle development phenotypes. Moreover, when treated with exogenous RA, endogenous fhl1A expression in skeletal muscles was robust. When treated with DEAB, an RA signalling inhibitor which inhibits the activity of retinaldehyde dehydrogenase, fhl1A was downregulated.

Conclusion:

fhl1A functions as an activator in regulating the number of satellite cells and in skeletal muscle development. The role of fhl1A in skeletal myogenesis is regulated by RA signaling.

[Analysis on the standardized management of hospitalized asthmatic patients: a single center 10-years experience]

Objective: To analyze the outcome of standardized management on the hospitalized asthmatic patients in the past 10 years in a single center. Methods: Clinical data of 2 207 asthmatic patients, who were hospitalized in the Center of Respiratory Medicine and Allergic Diseases, the General Hospital of Northern Military District from January 1, 2008 to December 31, 2017, was retrospectively collected and analyzed. Results: Asthmatic in-patients accounted for 11.5% of total hospitalized patients(2 207/19 134) over the 10-year study period. The highest percentage of asthmatic patients over the total hospitalized patients (16.9%, 207/1 223) was in the year 2008, and it was gradually reduced from 2009 through 2017: a median of 13.2% (221/1 674) from 2009 to 2013 with 3.7% decrease, and a median of 9.4% (224/2 385) from 2014 to 2017 with 7.5% decrease. There was a significant difference in the percentages between the year of 2008 (16.9%) and the years from 2009 through 2017 (P<0.05). Over the 10-year study period, 69.1% (1 526/2 207) of the asthmatic in-patients were hospitalized only once, 13.3% (294/2 207) were twice, and 3.8% (85/2 207) were hospitalized more than twice. Totally 1,553 patients were hospitalized with acute asthmatic attack, which accounted for 8.1% (1 553/19 134) of the total in-patient number over the 10 years, and 14.2% (174/1 223) of which was in the year 2008, while 9.7% (163/1 674) was in the years from 2009 through 2013 with a decrease of 4.5% from 2008, and 5.9% (141/2 385) was in 2014 through 2017 with a decrease of 8.3% from 2008. The differences between the 2008 incidence and that of 2009-2013 or 2014-2017 were statistically significant (P<0.05). However, the incidence of acute exacerbation of comorbid conditions was lowest in 2008 (15.9%, 33/207), while it was 25.8% (58/221) from 2009 to 2013 with an increase of 9.9% from 2008, and 37.0% (83/224) from 2013 to 2017 with an increase of 21.1% compared to 2008. Asthmatic hospitalization peaked in March (9.2%, 150/1 628) and August (9.7%, 157/1 612), respectively, while it was lowest in February (7.1%,101/1 423). The difference between the peak months (March and August) and February was statistically significant (P<0.05), while there was no significant difference between February and the rest of months (P>0.05). When the risk factors for acute asthmatic attack was analyzed by grouping single-time attack (n=1 074) versus multiple-time attack (hospitalized ≥ 2 times, n=479), we found the following risk factors were significant: airway infection (OR=2.006), male (OR=1.355), age ≥ 65 years old (OR=1.364), wet rales on physical examination (OR=1.762), hospitalization ≥ 14 days (OR=1.892), and invasive mechanical ventilation (OR=1.798). In addition, there were significant differences in per capital cost comparison between the following pairs (P<0.05): multiple-time (16 219±16 628, n=681) vs single-time asthmatic hospitalization (13 752±20 692, n=1 526), multiple-time (13 933±13 036, n=479) vs single-time hospitalization with acute asthmatic attack (11 208±13 853, n=1 074), multi-time asthmatic hospitalization (n=681) vs multi-time hospitalization with acute asthmatic attack (n=479), and single-time asthmatic hospitalization (n=1 526) vs single-time hospitalization with acute asthmatic attack (n=1 074). Conclusions: Standardized management of asthma could significantly reduce the risk of hospitalization as well as acute asthmatic attack. Findings of the current study suggested that risk factors for acute and recurrent asthmatic attack should be assessed and managed efficiently in order to reduce incidence of multiple hospitalization for asthma.

Improving lung cancer treatment: Hyaluronic acid‑modified and glutathione‑responsive amphiphilic TPGS‑doxorubicin prodrug‑entrapped nanoparticles

Lung cancer nanotherapeutics aim to overcome the limitations of conventional therapeutic methods. In the present study, a self‑assembled amphiphilic prodrug‑based nanocarrier delivery system was developed that exhibited high therapeutic efficiency. D‑alpha‑tocopheryl polyethylene glycol 1000 succinate (TPGS) conjugated to doxorubicin (DOX) through disulfide (S‑S) bonds to constitute TPGS‑S‑S‑DOX was synthesized; furthermore, hyaluronic acid (HA) was conjugated to TPGS to obtain HA‑TPGS. TPGS‑S‑S‑DOX prodrug‑based and HA‑TPGS ligand‑modified nanoparticles (HA‑TPGS DOX‑NPs) were prepared for the treatment of lung cancer. In vitro and in vivo evaluation of the system was performed on lung cancer cell lines and lung tumor‑bearing mice. HA‑TPGS DOX‑NPs had a uniformly spherical shape with a white core and grey shell, with a size of 172.3 nm and a polydispersity index of 0.16. All of the NPs exhibited a drug encapsulation efficiency of >90%. The blank NPs exhibited low toxicity to all the tested cell lines, resulting in viabilities of >85%. HA‑TPGS DOX‑NPs had a more prominent in vitro antitumor effect than the other NPs tested, with cell viabilities of 80.2, 73.4, 57.8, 39.1, 28.3 and 10.9% observed after 72 h of incubation with 0.01, 0.05, 0.1, 0.5, 1 and 5 µM, respectively. The in vivo results demonstrated that HA‑TPGS DOX‑NPs had the highest antitumor efficacy, with 10.5% tumor inhibition efficiency after 28 days of injection. Overall, HA‑TPGS DOX‑NPs had significant antitumor effects and minimal systemic toxicity, and their application may be a promising strategy for the treatment of lung cancer.