An arthroscopic technique for closure of perforations in temporomandibular joint retrodiscal tissues

The objective of this retrospective study was to introduce and evaluate an arthroscopic discopexy for closure of retrodiscal tissue perforations. A total of 112 patients (135 joints) receiving an arthroscopic discopexy for management of retrodiscal tissue perforations between January 2016 and September 2019 were included. Pre- and postoperative visual analogue scale (VAS) pain scores and maximum inter-incisal opening (MIO), as well as magnetic resonance imaging (MRI) data, were collected and analysed. Success was recorded when the disc position was >11 o'clock, VAS pain score <3, and MIO>25 mm. For patients with a condyle deformity, postoperative bone remodelling was also recorded. The VAS pain score decreased from 3.04 ± 2.66 preoperatively to 0.88 ± 1.13 at 12 months postoperatively (P < 0.001) and MIO increased from 33.90 ± 7.39 mm to 35.19 ± 6.14 mm (P = 0.029). MRI evaluation revealed that 133 discs were successfully repositioned back on top of the condyle. Among these, 11 joints were associated with either VAS pain score ≥3 or MIO ≤25 mm. Therefore, a success rate of 90.4% (122/135) was achieved at 12 months postoperative. Bone remodelling was detected in 72 joints. Arthroscopic discopexy is a minimally invasive and effective treatment for retrodiscal tissue perforations that achieves the purpose of simultaneously restoring the intra-articular structures and relieving clinical symptoms.

Intra- and inter-reader agreement of iRECIST and RECIST 1.1 criteria for the assessment of tumor response in patients receiving checkpoint inhibitor immunotherapy for lung cancer

OBJECTIVES

To investigate the inter- and intra-reader agreement of immune Response Evaluation Criteria in Solid Tumors (iRECIST) and Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) in patients with lung cancer treated with immunotherapy.

MATERIALS AND METHODS

This retrospective study included 85 patients with lung cancer treated with PD-1 blockade. Four radiologists evaluated computed topography (CT) scans before and after initiation of immunotherapy using iRECIST and RECIST 1.1. Weighted kappa (k) with equal weights was used to assess the intra-reader agreement between 2 repeated reads on overall response at all time points, best overall response, and the response at the time point of progression, as well as the intra-reader agreement between iRECIST and RECIST. The inter-reader agreement was calculated using Light's kappa.

RESULTS

Intra-reader agreement for overall response at all time points, best overall response, and time point of progression was substantial to almost perfect for both iRECIST and RECIST 1.1 (k = 0.651-0.983). Inter-reader agreement was substantial for iRECIST (κ = 0.657-0.742) while RECIST 1.1 was moderate to substantial (κ = 0.587-0.686). The level of inter-reader agreement was not higher on repeat read for iRECIST (κ = 0.677-0.709 and κ = 0.657-0.742 for first and second read, respectively) as well as for RECIST 1.1 (κ = 0.587-0.659 and κ = 0.633-0.686 for first and second read, respectively). Almost perfect agreement was observed between RECIST 1.1 and iRECIST at first (κ = 0.813-0.923) and second read (κ = 0.841-0.912).

CONCLUSION

The inter- and intra-reader agreement of iRECIST is high and similar to RECIST 1.1 in patients with lung cancer treated with immunotherapy.

[Anatomical study and clinical application of in situ reduction and fixation of anterior medial fenestration approach of femoral head fracture]

Objectives: To explore the feasibility of anterior medial fenestration approach in situ reduction and fixation in the treatment of PipkinⅠ and Ⅱ femoral head fractures,and to explore the clinical effect of this operation. Methods: Hips of two anti-corrosion adult specimens treated with formalin were dissected, then anatomical structures and directional characteristics of anterior medial main muscles,ligaments,blood vessels and nerves were observed.The anterior medial fenestration approach was performed on bilateral hips of four fresh frozen specimens to determine pulling direction of stripped muscles and ligaments required during operation,and to observe and analyze vascular and nerve traction protection directions exposed in the approach.Determine extent of exposure to the approach and assess feasibility of this approach.The clinical data of 12 patients with Pipkin Ⅰ and Ⅱ femoral head fractures who underwent in situ reduction and fixation of anterior medial fenestration at Department of Orthopaedics,Affiliated Hospital of Chengdu University from February 2016 to April 2018 were retrospectively analyzed.There were 3 males and 9 females with an age of 48.5 years(range:37 to 59 years).There were 8 cases of Pipkin type Ⅰ and 4 cases of Pipkin type Ⅱ.The operation time,blood loss,fracture healing time,last Thompson-Epstein evaluation and Harris score were observed. Results: Anterior medial fenestration approach to expose the femoral head in 4 bilateral hips with a total of 8 sides of fresh frozen specimens.The upper boundary of observation fenestration was pubic body (anterior acetabulum),and the outer upper boundary was iliacus and psoas muscle.The lateral boundary is rectus femoris and femoral vessels,the lower boundary was transverse branch of the medial femoral circumflex artery and vein.The medial boundary was pubis muscle,short adductor muscle and long adductor muscle.Pubofemoral and iliofemoral ligament were seen in fenestration. Four quadrants in front of femoral head in fenestration can be seen after cutting switch capsule active hip joint. In 12 patients with femoral head fracture,the operation time was 107.5 minutes(range:90 to 135 minutes),and the intraoperative bleeding volume was 115.0 ml(range:85 to 150 ml).The patients were followed up for 18.6 months(range:12 to 28 months).The fracture healing time of 12 patients was 144.2 days(range:120 to 180 days).The curative effect was evaluated according to Thompson-Epstein standard at the last follow-up:excellent in 6 cases,good in 4 cases and fair in 2 cases.At the last follow-up,the Harris score of hip joints was 85.1(range:75 to 93). Conclusions: Anterior medial fenestration in situ reduction and fixation surgery is feasible for the treatment of Pipkin Ⅰ and Ⅱ femoral head fractures. The short and midterm follow-up reveal satisfactory effect.

Post-treatment CT LI-RADS categories: predictors of overall survival in hepatocellular carcinoma post bland transarterial embolization

PURPOSE

The LI-RADS Treatment Response (LR-TR) algorithm was introduced in 2017 to assist radiologists in assessing hepatocellular carcinoma (HCC) response following locoregional therapy. The objective of this study was to evaluate the associations between pre-treatment LI-RADS diagnostic categories, post-treatment LR-TR categories, and mRECIST response categories with overall survival (OS) of patients with HCC.

METHODS

This retrospective study included untreated patients with one or two lesions who underwent transarterial embolization with or without concomitant ablation from December 2003 to December 2017. Two radiologists (R1 and R2) reviewed pre- and post-treatment CT imaging. Associations between pre- and post-treatment variables, including post-treatment LR-TR categories (Viable, Equivocal, Nonviable), with OS were assessed using the Kaplan-Meier method and Cox proportional hazards regression.

RESULTS

Eighty-five patients were included (median age = 71 years, range 50-87; 17 women). The median OS from first embolization was 43.92 months. Pre- and post-treatment tumor size, pre-treatment LR-TIV (compared with LR-5), and post-treatment LR-TR Viable (compared with LR-TR Nonviable) were associated with OS (p < 0.05 for all). Median OS was shorter for LR-TR Viable patients (R1, 25.64 months, 95% CI 18.58-35.70; R2, 26.43 months 95% CI 20.68-43.92) than for LR-TR Nonviable patients (64.21 months R1 and R2, 95% CI 42.71-92.45 and 36.30-94.09, respectively). mRECIST categories showed similar associations with OS. Inter-reader agreement was moderate for LI-RADS categories (κ = 0.57, 95% CI 0.35-0.78) and substantial for LR-TR categories (κ = 0.68, 95% CI 0.55-0.81).

CONCLUSIONS

LR-TR categories show a strong association with OS in HCC patients treated with transarterial embolization.

Study of PWR hot leg creep rupture and RCS depressurization strategy during an SBO accident

Preventing the leakage of radioactive materials is important to nuclear safety. During a station blackout accident in pressurized water reactors, the hot leg creep rupture caused by hot leg countercurrent flow occurs before the reactor pressure vessel failure that caused by lower head rupture. The secondary fission products barrier is lost after hot leg creep rupture. An analysis for this phenomenon was done using the Modular Accident Analysis Program version 4.0.4 code. A station blackout accident for CPR1000 is simulated and the occurrence and influence of hot leg creep rupture phenomenon are analyzed in detail. After that, a sensitivity analysis of the opening of different pressurizer pilot-operated relief valves at five minutes after entering severe accident management guideline (before the hot leg creep rupture occurs) is studied. The results show that reactor pressure vessel failure time can be extended by at least 4 h if at least one pilot-operated relief valve is opened and direct containment heating phenomenon can be eliminated if at least two pilot-operated relief valves are opened.

Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation

Background and objectives Acute kidney injury (AKI) is a major complication of allogeneic hematopoietic stem cell transplantation, increasing risk of non-relapse mortality. AKI etiology is often ambiguous due to heterogeneity of conditioning/graft-versus-host disease (GVHD) regimens. To date, GVHD and calcineurin inhibitor effects on AKI are not well defined. We aimed to describe AKI and assess pre/post-hematopoietic transplant risk factors in a large recent cohort. Design, setting, participants, and measurements We performed a single-center retrospective study of 616 allogeneic hematopoietic cell transplant recipients from 2014-2017. We defined AKI and CKD based on KDIGO criteria and estimated GFR using CKD-EPI equation. We assessed AKI pre/post-hematopoietic transplant risk factors using cause-specific Cox regression and association of AKI with CKD outcomes using Chi-squared test. AKI was treated as a time-dependent variable in relation to non-relapse mortality. Results Incidence of AKI by day-100 was 64%. Exposure to tacrolimus and other nephrotoxins conferred a higher risk of AKI, but tacrolimus levels were not associated with severity. Reduced intensity conditioning carried higher AKI risk compared to myeloablative conditioning. Most stage 3 AKIs were due to ischemic acute tubular necrosis and CNI nephrotoxicity. Kidney replacement therapy was initiated in 21/616 (3%) of whom 9/21 (43%) recovered and 5/21 (24%) survived to hospital discharge. T-cell depleted transplants, higher baseline albumin, and non-Hispanic ethnicity were associated with lower risk of AKI. CKD developed in 21% (73/345) of patients after 12 months. Non-relapse mortality was higher in those with AKI (HR 2.77, 95% CI: 1.8-4.27). Conclusions AKI post-hematopoietic cell transplant remains a major concern. Risk of AKI was higher with exposure to CNIs. T cell depleted hematopoietic cell transplants and higher albumin had lower risk of AKI. Forty-three percent of patients requiring KRT recovered kidney function. Prospective studies are needed to further assess modification of these risk factors.

AB0011 EXPRESSION PROFILE AND POTENTIAL FUNCTION OF CIRCRNAS IN PERIPHERAL BLOOD MONONUCLEAR CELLS FROM PATIENTS WITH PRIMARY GOUT

Background:

Autophagy is a phenomenon of “self-phagocytosis” in eukaryotic cells, which maintains cell homeostasis by transporting intracellular materials to lysosomes for degradation and recycling. In recent years, studies have shown that autophagy may be involved in the pathogenesis of rheumatoid arthritis(RA)[1], but its specific mechanism is still unclear.

Objectives:

The expression levels of autophagy-related genes(ATG) unc-51-like kinase 1(ULK1), ATG13, ATG17, microtubule associated protein 1 light chain 3 (LC3), and P62 in peripheral blood mononuclear cells (PBMC) of patients with RA were detected, and their role and clinical significance in the pathogenesis of RA were explored.

Methods:

Real-time fluorescent quantitative PCR was performed to detect the expression levels of ULK1, ATG13, ATG17, LC3, and P62 in PBMCs of 50 RA patients, 50 healthy controls (HC), and 25 moderate to severe RA patients before and after treatment. Then, t test, χ2 test, Mann-Whitney U test, Pearson test were used for statistical analysis.

Results:

1.The levels of hsCRP, white blood cell(WBC), neutrophils(GR), platelet(PLT) and plateletcrit(PCT) in RA group were higher than those in HC group (P <0.05). Lymphocytes (LY), red blood cell(RBC), hemoglobin(HGB), hematocrit(HCT), mean corpuscular hemoglobin(MCH), mean red blood cell volume(MCV) and mean red blood cell hemoglobin concentration(MCHC) in RA group were lower than those in HC group (P <0.05). 2.The expressions of ULK1, ATG17, and LC3 in RA group were higher than those in HC group, while the expressions of P62 was lower than those in HC group(P<0.05) (Figure 1). The correlation analysis suggested that ATG17 was positively correlated with tender joint count (TJC), swollen joint count (SJC), and health assessment questionnaire (HAQ) (P<0.05); ULK1 and HAQ were negatively correlated (P<0.05).3. Compared with before treatment with TNFi, ATG17, HAQ, DAS-28, ESR, hsCRP, WBC, GR, PLT and PCT were significantly reduced after treatment (P<0.05); the expressions of RBC, HCT, MCV and MCH were significantly increased after treatment,(P<0.05); ULK1, ATG13, LC3, P62 and other related clinical and laboratory indicators were not significantly different before and after treatment with TNFi (P>0.05).

Figure 1.

The expression levels of ATGs in HC and RA groups.

Conclusion:

There is abnormal expression of autophagy genes in the peripheral blood of RA patients. ULK1, ATG17, LC3 and P62 may be related to the pathogenesis of RA, among them, ATG17 may regulate the pathogenesis of RA by participating in the TNF-α pathway.

References:

[1]Rockel Jason S,Kapoor Mohit,Autophagy: controlling cell fate in rheumatic diseases.[J].Nat Rev Rheumatol, 2016, 12: 517-31.

Disclosure of Interests:

Yu-Feng Qing Grant/research support from: Science and Technology Project of Nanchong City (no.18SXHZ0522), Fei Dai: None declared, Quan-Bo Zhang Grant/research support from: the National Natural Science Foundation of China(General Program) (no.81974250), and Science and Technology Plan Project of Sichuan Province (no.2018JY0257), Yi-Ping Tang: None declared, Zeng-Rong Dong: None declared, Yi-Xi He: None declared, Yi Jiang: None declared, Yu-Qin Huang: None declared, Jianxiong Zheng: None declared

AB0075 HSA_CIRC_0012732, HSA_CIRC_0008961, HSA_CIRC_0405239 AND HSA_CIRC_0068784 MIGHT BE INVOLVED IN THE PATHOGENESIS AND DEVELOPMENT OF ANKYLOSING SPONDYLITIS

Background:

CircRNAs have been found to be involved in the occurrence and development of many rheumatic diseases[1-2]. Are circRNAs involved in the pathogenesis of ankylosing spondylitis (AS)? How do these circRNAs participate in the pathogenesis of AS? This all needs further study.

Objectives:

This study is to clarify the expression levels of hsa_circ_0012732, hsa_circ_0008961, hsa_circ_0405239 and hsa_circ_0068784 in the peripheral blood of AS patients, and to explore whether these circRNAs are involved in the pathogenesis of AS.

Methods:

To collected 60 cases of AS (30 cases of active AS (ASA): BASDA> 6 or 6> BASDAI> 4, ESR> 22mm / h or 6> BASDAI> 4, hsCRP> 9mg / L; 30 cases of stable AS (ASS): BASDAI <4) and 30 health control (HC) peripheral blood samples, related clinical and laboratory indicators. The relative expression levels of hsa_circ_0012732, hsa_circ_0008961, hsa_circ_0405239 and hsa_circ_0068784 in each group were detected by real-time quantitative polymerase chain reaction (qPCR). The relationships between the 4 circRNAs and clinical and laboratory indicators were explored by correlation analysis.

Results:

1. The qPCR results suggested that the expression of hsa_circ_0012732 between the ASA and ASS groups was statistically significant (p<0.05), and the expression of hsa_circ_0008961 was statistically significant between the ASA and HC groups (p<0.05). Howeverthere was no statistical significance among other groups (p>0.05)Figure 1. Similarly, the expression level of hsa_circ_0405239 was not statistically significant among the groups (p>0.05), and the same was true for hsa_circ_0068784 (p>0.05).

2. Correlation analysis results (Figure 2) showed that hsa_circ_0012732 is positively correlated with lymphocyte count (LY), mean corpusular volume (MCV), albumin (ALB), and negatively correlated with Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), high sensitivity C-reactive protein (hsCRP), Globulin (GLOB) (p<0.05); hsa_circ_0008961 is negatively correlated with platelet (PLT) (p<0.05); hsa_circ_0405239 is negatively correlated with BASDAI and BASFI; hsa_circ_0068784 was negatively correlated with BASDAI (p<0.05); and there was no statistically significant (p>0.05) between these 4 circRNAs and other indicators.

Conclusion:

Hsa_circ_0012732, hsa_circ_0008961, hsa_circ_0405239 and hsa_circ_0068784 may be related to the pathogenesis of AS. Among them, hsa_circ_0012732 may be involved in AS inflammation and has the potential to participate in the judgment of disease activity.

References:

[1]LS, K., et al., The biogenesis, biology and characterization of circular RNAs. 2019. 20(11): p. 675-691.

[2]J, W., et al., Non-coding RNAs in Rheumatoid Arthritis: From Bench to Bedside. 2019. 10: p. 3129.

Disclosure of Interests:

Yi-Ping Tang Grant/research support from: Science and Technology Project of Nanchong City (18SXHZ0522)., Yu-Feng Qing: None declared, Zeng-Rong Dong: None declared, Fei Dai: None declared, Jianxiong Zheng: None declared, Yi Jiang: None declared, Yi-Xi He: None declared, Quan-Bo Zhang Grant/research support from: National Natural Science Foundation of China(General Program) (81974250); Science and Technology Plan Project of Sichuan Province (2018JY0257)

AB0449 CLINICAL CHARACTERISTICS AND RISK FACTORS OF SYSTEMIC SCLEROSIS WITH HEMATOLOGIC SYSTEM DAMAGES

Background:

SSc characterized by varying degrees of fibrosis of the skin and internal organs, clinicians pay more attention to skin and viscera conditions, tend to ignore hematologic system damage. Studies have shown that rheumatic disease such as SLE, RA, pSS often accompanied with hematologic system damages, and hematologic system damages is multiple organ involvement and risk factor of poor prognosis[1-2].

Objectives:

To investigate the the clinical features, laboratory characteristics and risk factors of Systemic Sclerosis (SSc) patient with hematologic system damages.

Methods:

The clinical data of 180 patients were collected from January 2010 to April 2020, at the Affiliated Hospital of North Sichuan Medical College. The demographic information, laboratory tests, and clinical symptoms were analyzed retrospectively.

Results:

Among 180 SSc patients, 70(38.9%) cases were complicated with hematologic system damages. 51(72.9%) cases had anemia, 24 cases (34.3%) had leukopenia, 24 cases (34.3%) had thrombocytopenia, and 22 cases had hematologic system damages associated with more than two cell line involvement. Clinical symptoms: arthritis was significantly higher in the hematologic system damages group than patient without (P<0.05), however, there was no significantly difference in gender, age, disease course, respiratory symptoms, gastrointestinal symptoms, Raynaud’s phenomenon, interstitial lung disease and pulmonary hypertension (all P>0.05). Laboratory tests: ESR and hsCRP were increased in the hematologic system damages group, while the albumin decreased (all P<0.05). The positive rates of resistance to anti-dsDNA antibody and anti-ribosomal P protein antibody was higher in the hematologic system damages group (all P<0.05). Prognosis: During follow-up, leukopenia was more likely to recover, while the thrombocytopenia was more difficult to recover. Logistics regression analysis showed that positive of anti-ribosomal P protein antibody maght be a risk factor for SSc complicated with hematologic system damages [OR = 3.930(P<0.05)] (Table 1).

Conclusion:

SSc complicated with hematologic system damages is common, and patients with hematologic system damages have more serious clinical symptoms, some of whom have difficulty in recovey. Anti-ribosomal P protein antibody may be a risk factor of SSc hematologic system damages.

Table 1.

Bivariate logistics regression analysis on risk factors associated with hematologic damages in SSc.

FactorBSEWaldOR(95%CI)P valuearthritis0.6540.3473.5431.922(0.973-3.797)0.060ESR-0.0810.4870.0280.922(0.355-2.393)0.868hsCRP-0.0070.4920.0000.993(0.379-2.607)0.989anti-dsDNA0.8680.6731.6642.393(0.637-8.916)0.197anti-Rib-P1.3690.6364.6333.930(1.130-13.666)0.031

References:

[1]González-Naranjo L A, Betancur O M, Alarcón G S, et al. Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort[J]. Seminars in Arthritis and Rheumatism, 2016,45(6):675-683.DOI:10.1016/j.semarthrit.2015.11.003.

[2]Skare T, Damin R, Hofius R. Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients[J]. Revista Brasileira de Hematologia e Hemoterapia, 2015,37(2):115-119.DOI:10.1016/j.bjhh.2015.01.006

Disclosure of Interests:

None declared.

Bone lesions on baseline staging rectal MRI: prevalence and significance in patients with rectal adenocarcinoma

A T1 sequence on routine baseline staging rectal magnetic resonance imaging (MRI) is thought to help detect bone lesions. Our primary aim was to evaluate the incidence of bone lesions encountered on baseline staging rectal MRI, particularly the prevalence of bone metastases. This retrospective study included patients with rectal adenocarcinoma who underwent baseline rectal MRI at our institution between January 2010 and December 2017. The MRI report was reviewed for presence of bone lesions. When found, lesion type, presence of axial T1 non-fat-suppressed sequence, primary tumor T-stage, and presence of other organ metastases were recorded. In the absence of bone biopsy, the reference standard was follow-up imaging via computed tomography (CT), MRI, and/or positron emission tomography/CT (PET/CT) ≥ 1 year after the baseline MRI. The Wilcoxon rank-sum test and Fisher's exact test were used to compare clinicopathologic data of patients with malignant or benign bone lesions. A total of 1197 patients were included. 62/1197 patients (mean age 56.8 years (SD: 13.8), with 39 men) had bone lesions on baseline imaging, with 6 being bone metastases (0.5%, 95% CI 0.2%-1.1%). Of the 6 patients with bone metastases, 5/6 had other metastases (i.e., liver, lung) at baseline. Bone metastases on baseline rectal MRI performed for rectal adenocarcinoma are extremely rare. Furthermore, bone metastases without other organ (i.e., liver, lung) involvement is extremely rare.

POS0430 EXPRESSION AND CLINICAL SIGNIFICANCE OF AUTOPHAGY-RELATED GENES IN PERIPHERAL BLOOD MONONUCLEAR CELLS OF SYSTEMIC SCLEROSIS

Background:

Growing evidences have demonstrated that autophagy is a powerful regulators in the pathogenesis of fibrosis and autoimmune diseases. Autophagy abnormalities in SSc involve abnormal autophagy-related protein and autophagy-related gene polymorphism[1-2], however there is a few reports on the expression and clinical significance of autophagy-related genes.

Objectives:

To investigate the expression and clinical significance of autophagy-related genes LC-3 mRNA, Becline-1 mRNA, Agt-3 mRNA, Agt-5 mRNA, Agt-12 mRNA and Agt-16L1 mRNA in peripheral blood mononuclear cells (PBMC) of systemic sclerosis (SSc).

Methods:

51 cases of SSc and 60 cases of normal control were received from the Affiliated Hospital of North Sichuan Medical College, and autophagy-related genes were detected by RT-PCR. SPSS19.0 statistical software was used to compare the expression of autophagy-related genes between groups and analyze the relationship between autophagy-related genes and clinical data, P<0.05 was considered statistically significant

Results:

LC-3, Becline-1, and Agt-3 were highly expressed in SSc compared with normal control [LC-3: 0.78(0.60) ×10-3 vs. 0.52(0.54) ×10-3; Beclin-1: 6.68(3.56)×10-3 vs. 5.22(3.54)×10-3; Agt-3: 17.58(12.33)×10-3 vs. 11.00(4.56)×10-3, P<0.05], however Agt-5, Agt-12 and Agt-16L1 of autophagy-related genes were not statistically significant [AGT-5: 6.67(3.58) ×10-3 vs. 6.67(2.64) ×10-3; AGT-12: 8.64(5.56)×10-3 vs. 8.57(4.66)×10-3; Agt-16L1: 2.69(2.19)×10-3 vs. 2.52(2.26)×10-3] (Figure 1). Beclin-1 and Agt-5 high expressed in SSc with the positive of anti-SSA/Ro antibody. LC-3 was positively correlated with Age(r=0.662) and ESR(r=0.355) (all P<0.05).

Conclusion:

Autophagy-related genes were increased in PBMC of SSc, and were correlated with Age, ESR and autoantibody, suggested that autophagy is a key feature in the pathogenesis of systemic sclerosis.

Figure 1.

The relative expression of autophagy-related genes

References:

[1]LIU C, ZHOU X, LU J, et al. Autophagy mediates 2-methoxyestradiol-inhibited scleroderma collagen synthesis and endothelial-to-mesenchymal transition induced by hypoxia[J]. Rheumatology, 2019;58(11):1966–1975.

[2]Mayes M D, Bossini-Castillo L, Gorlova O, et al. Immunochip Analysis Identifies Multiple Susceptibility Loci for Systemic Sclerosis[J]. The American Journal of Human Genetics, 2014,94(1):47-61.DOI:10.1016/j.ajhg.2013.12.002.

Disclosure of Interests:

None declared

Effect of pretreatment central adiposity on the cardiometabolic risk of male germ cell tumor survivors after cisplatin-based chemotherapy

5019

Background: Preferential fat accumulation in the visceral compartment (i.e. central adiposity) increases cardiovascular risk in the general population independent of body mass index (BMI). We investigated how body fat distribution modulates the cardiometabolic risk of male germ cell tumor (GCT) survivors after cisplatin-based chemotherapy. Methods: For 456 patients in The Platinum Study enrolled at Memorial Sloan Kettering Cancer Center, visceral (VAT) and subcutaneous (SAT) adipose tissue compartments were quantified on pre-chemotherapy computed tomography (CT) scans (median time between CT and chemotherapy: 13 days, range: 0-56). The VAT/SAT ratio was calculated as a quantitative indicator of central adiposity. Endpoints were (I) post-chemotherapy cardiovascular risk as per the office-based Framingham risk calculator, and (II) incidence of post-chemotherapy cardiometabolic disease defined as need for new anti-hypertensive drugs, or lipid-lowering drugs, or medication used to treat diabetes. Changes in fat distribution after chemotherapy were analyzed in a subgroup with post-chemotherapy CTs (n = 108; median interval from chemotherapy start: 18 months, range: 7-185). Linear regression with interaction terms (endpoint 1, subgroup analysis) and Cox proportional hazard regression (endpoint 2) were applied. Results: For all 456 patients, median age at chemotherapy initiation was 31 years and median follow-up was 27 months (range: 7, 207). At baseline (pre-chemotherapy), the median BMI was 26.2 kg/m2, and 102 patients (22.4%) had a BMI of ≥30 kg/m2. The median VAT/SAT ratio at baseline CT was 0.49, and positively associated with higher post-chemotherapy Framingham risk scores after adjustment for age, BMI, and blood pressure measurements at chemotherapy start, as well as post-therapy follow-up time (adjusted β-estimate: 1.36, 95% CI: 1.15, 1.59, p < 0.001). A higher VAT/SAT ratio also inferred a higher likelihood of new onset cardiometabolic disease in patients with BMI ≥30 kg/m2 (age-adjusted HR: 3.11, 95%CI: 1.01, 9.62, p = 0.048), but not in those with BMI < 30 kg/m2. In the subgroup analysis, we observed a significant increase of BMI after chemotherapy (mean: +1.1 kg/m2, 95% CI: +0.58, +1.54; p < 0.001). Changes in BMI were positively associated with changes of the VAT/SAT ratio (β-estimate: 3.0, 95% CI: 2.23, 4.04; p < 0.001), meaning that weight gain occurred preferentially in the VAT compartment, while weight loss tended to be paralleled by an improved body fat distribution. Conclusions: In male GCT patients, central adiposity at baseline increases cardiometabolic risk after cisplatin-based chemotherapy, particularly for obese individuals. Quantification of an individual’s body fat distribution on pre-chemotherapy CT could potentially help to identify high risk individuals who may benefit from intensified risk-modulating interventions.

Genome sequencing of pancreatic cancer: differential expression by location

The results demonstrated that pancreatic ductal carcinoma (PDAC) of the body/tail was associated with more transcriptional and genomic changes, and correlated with worse prognosis, than PDAC of the pancreatic head. The different mutation types and gene expression of tumour locations provide deep insight into the carcinogenesis or metastasis of PDAC, and suggest different early diagnostic and therapeutic strategies. SNV, single-nucleotide variations; NLS, Nuclear localization sequence; MB, million base-pairs; UTR, untranslated region.

[Amentoflavone inhibits M1 polarization of THP-1-derived foam cells by activating PPAR-α/γ]

OBJECTIVE

To investigate the mechanism by which amentoflavone inhibits polarization of THP-1-derived foam cells to M1 phenotype.

OBJECTIVE

Human monocyte cell line THP-1 was stimulated to differentiate into M1-type macrophages using phorbol 12-myrislate13-acetate (PMA) combined with lipopolysaccharide (LPS) and recombinant human interferon-γ (rhlFN-γ). M1 polarization of THP-1-derived macrophages was confirmed by observing morphological changes of the cells and detecting the mRNA expression of L-6 and TNF-α with RT-qPCR. THP-1-derived foam cells treated with 5 or 10 μmol/L amentoflavone for 24 h were examined for cytokines using ELISA. The mRNA and protein expressions of IL-6, IL-10, TNF-α, TGF-β, PPAR-α/γ, Arg-1 and Fizz1 in the cells were detected using RT-qPCR and Western blotting.

OBJECTIVE

Amentoflavone prevented induced M1 polarization of THP-1 cells. Amentoflavone down-regulated the mRNA expressions of IL-6 and TNF-α, up-regulated mRNA expressions of IL-8 and TGF-β mRNA (P < 0.05), and increased the protein expressions of PPAR-α/γ, Arg-1 and Fizz1. Molecular docking simulation showed that amentoflavone could bind to the surface of PPARα/γ.

OBJECTIVE

Amentoflavone can inhibit the differentiation of macrophages into M1 type by activating PPAR-α/γ and restoring the expressions of the gene Arg-1 and Fizz1.

Does microenema administration improve the quality of DWI sequences in rectal MRI?

PURPOSE

To determine whether the administration of a microenema immediately prior to rectal magnetic resonance imaging (MRI) decreases the level of gas-related artifacts on diffusion-weighted imaging (DWI) sequences.

METHODS

This retrospective analysis included 492 (183 baseline and 309 post-total neoadjuvant treatment [TNT]) consecutive MRI scans for rectal cancer from January 2019 to January 2020. Scan-related factors were identified including microenema use (yes or no), field of view (FOV) in DWI (b = 800 or b = 1500), and magnet strength (1.5 T or 3 T). Two readers scored DWI studies for gas-related artifacts and T2-weighted sequences for the amount of intraluminal gas on a 5-point scale. Fisher's exact test and the Rao-Scott Chi-squared test were used to examine associations between microenema use and other factors. Generalized estimating equation and multivariable regression models were performed to examine the effect of microenema use in subgroups of scans for each reader. Cohen's κ was used to assess inter-reader agreement.

RESULTS

Gas-related artifact levels decreased in scans with microenema overall (P < 0.001) as well as when scans were stratified by FOV (P ≤ 0.003). For both readers, post-TNT scans with microenema showed lower artifact levels overall (P < 0.014 and P < 0.001) and in post-TNT subgroups of axial DWI scans (P ≤ 0.006 and P < 0.001) and scans acquired with a 3 T magnet (P ≤ 0.001 for both FOV). No evidence of decreased artifact level was found for baseline studies. Decreased gas was seen with microenema use (P < 0.001 for both readers). Inter-reader agreement on artifact-level and gas-level assessments ranged from slight to substantial (κ = 0.273-0.685).

CONCLUSION

Microenema use prior to rectal MRI reduces gas-related artifacts on DWI, including both large and small FOV sequences and particularly on post-TNT scans performed at 3 T, and offers a viable solution to improve DWI quality.

Measurement of rectal tumor height from the anal verge on MRI: a comparison of internal versus external anal sphincter

PURPOSE

To determine the most accurate measurement technique to assess rectal tumor height on MRI using two different anatomic landmarks for the anal verge.

INTRODUCTION

Accurate measurements and standardized reporting of MRI for rectal cancer staging is essential. It is not known whether measurements starting from the internal anal sphincter (IAS) or external anal sphincter (EAS) more closely correlate with tumor height from the anal verge on endoscopy.

METHODS

This retrospective study included baseline staging MRI examinations for 85 patients after exclusions. Two radiologists blinded to endoscopic results measured the distance of rectal tumors from the internal anal sphincter and external anal sphincter on sagittal T2 images. The reference standard was endoscopic measurement of tumor height; descriptive statistics were performed.

RESULTS

For reader 1, the mean difference in measurement of tumor height between MRI and endoscopy was - 0.45 cm (SD ± 1.76 cm, range - 6.0 to 3.9 cm) for the IAS and 0.51 cm (SD ± 1.75 cm range - 4.7 to 4.8 cm) for the EAS. For reader 2, the mean difference in measurement of tumor height between MRI and endoscopy was - 0.57 (STD ± 1.81, range - 5.9 to 4.8 cm) for the IAS and 0.52 cm (STD ± 1.85, range - 4.3 to 5.6 cm) for the EAS. Interobserver ICC was excellent between reader 1 and reader 2 for measurements from both the IAS (0.955 95% CI 0.931-0.97) and EAS (0.952, 95% CI 0.928, 0.969).

CONCLUSION

Measurement of tumor height on MRI was highly reproducible between readers; beginning measurements from the EAS tends to slightly overestimate tumor height on average and from the IAS tends to slightly underestimate tumor height on average.