Non-pharmaceutical therapy for post-stroke shoulder-hand syndrome: Protocol for a systematic and network meta-analysis

BACKGROUND

Shoulder-hand syndrome (SHS) is a common complication in post-stroke patients. SHS has a large impact on patients and their families, communities, healthcare systems and businesses throughout the world. Non-pharmaceutical therapy for post-stroke SHS is the most common treatment in clinical practice, but their effectiveness is still unclear. The aim of this study is to assess the effect and safety of non-pharmaceutical therapeutic strategies for post-stroke SHS.

METHOD

We will search 3 in English and 4 in Chinese languages electronic databases regardless of publication date or language. We will include randomized controlled trials (RCTs) assessing the effect of any non-pharmaceutical therapy for post-stroke SHS. Primary outcomes will be any effective instrument for post-stroke SHS. Two authors will independently assess the risk of bias by using Cochrane tool of risk of bias. We will perform network meta-analysis in random effects model to estimate the indirect and mixed effects of different therapeutic strategies by R-3.5.1 software. We will assess the confidence in cumulative evidence by Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

This study will be to assess the effect and safety of non-pharmaceutical therapy for post-stroke SHS.

CONCLUSIONS

This study will assess the effect of different non-pharmaceutical therapeutic strategies for post-stroke SHS and provide reliable evidence for the choice of treatments.Systematic review registration: PROSPERO (CRD42019139993).

AB0050 EXTENDED POLYDIMENSIONAL IMMUNOME CHARACTERISATION (EPIC) PLATFORM AS A TOOL FOR TRANSLATIONAL RESEARCH

Background:

We created a high dimensionality healthy human Immunome atlas by interrogating the peripheral blood mononuclear cells (PBMC) of >200 healthy subjects (cord blood to adult) with 63 unique mechanistic and phenotypic markers per cell by mass cytometry (CyTOF). This database is built with an open source, web-based bioinformatics toolkit, enabling its mining and uploading of datasets for comparison with the EPIC healthy database.

Objectives:

Here, we demonstrate the platform’s ability to identify the immunological differences of mechanistically important cell subsets in the uploaded data in comparison with EPIC.

Methods:

CyTOF data from 37 healthy elderly (>60 years old) was uploaded onto the EPIC Discovery tool where down-sampling, normalising and FlowSOM (Flow analysis with Self-Organising Maps) clustering were done with the EPIC database for comparison. Online visualisation outputs include cluster frequency boxplots, correspondence analysis (CA) plot and markers expression heat-map. The CA 2-dimensional plot depicts the global differences in immune cells composition between subjects with proximity between points (subjects) denoting similarity. Kruskal-Wallis test was done to identify age groups differences.

Results:

Increasing distances on the CA plot with age were observed with the elderly being farthest from the new-borns. Notably, we observed significant changes in naive CD4+IL8+T cells (p<1×10-20), memory CD4+IL17A+T cells (p<1×10-20) and type 2 innate lymphoid cells (ILC2) (Lin-CD7+CD25+CD127+CD161+, p<1×10-17) with increasing age. The naive CD4+IL8+T cells (median: 0.68%, interquartile range: 0.415 to 1.055% of CD45+ PBMC) and ILC2 (0.09%, 0.065 to 0.12%) were lowest and memory IL17A+T cells (0.58%, 0.41 to 0.905%) highest in the elderly. Significantly, the memory IL17A+T cells and ILC2 have been implicated in the pathogenesis of auto-immune conditions1,2.

Conclusion:

With EPIC, we have created an online tool enabling data uploading for comparison to a healthy database, allowing the holistic characterisation of immunological changes in different clinical scenarios. Using it, we were able to identify mechanistically important differences in immune cells composition in a distinct clinical cohort (elderly) compared to the younger ages. Translationally, the EPIC platform can be utilised similarly to catalyse the discovery process in auto-immune diseases interrogated with the EPIC antibody panels.

References:

[1]Fasching P, Stradner M, Graninger W, Dejaco C, Fessler J. Therapeutic Potential of Targeting the Th17/Treg Axis in Autoimmune Disorders. Molecules. 2017 Jan 14;22(1). pii: E134.

[2]Klose CS, Artis D. Innate lymphoid cells as regulators of immunity, inflammation and tissue homeostasis. Nat Immunol. 2016 Jun 21; 17(7): 765-74.

Disclosure of Interests:

None declared

Effects of environment and breed on growth performance and meat quality of fattening pigs

Meat quality is not only influenced by breed but also rearing environment. The aim of this study was to evaluate the influence of different housing environments on growth performance, carcase traits, meat quality, physiological response pre-slaughter and fatty acid composition in two pig breeds. A total of 120 growing pigs at 60–70 days of age were arranged in a 2 × 2 factorial design with the breeds (Duroc × Landrace × Large White [D × L × LW] and Duroc × Landrace × Min pig [D × L × M]) and environmental enrichment (barren concrete floor or enriched with straw bedding) as factors. Each treatment was performed in triplicate with ten pigs per replicate. The pigs housed in the enriched environment exhibited a higher average daily gain, average daily feed intake, saturated fatty acid percentage and backfat depth than the pigs reared in the barren environment. Plasma cortisol levels were lower and growth hormone higher in enriched compared to barren pens. The D × L × M pigs showed lower cooking loss compared with the D × L × LW pigs. Moreover, the D × L × M pigs exhibited poor growth performance but had a better water-holding capacity. Only carcase traits and meat quality interaction effects were observed. We concluded that an enriched environment can reduce pre- slaughter stress and improve the growth performance of pigs and modulate the fatty acid composition of pork products.

Near-Infrared Voltage Nanosensors Enable Real-Time Imaging of Neuronal Activities in Mice and Zebrafish

Optical voltage sensors with the ability to monitor neuronal activities are invaluable tools for studying information processing of the brain. However, the current genetically encoded voltage indicators usually require high-power visible light for excitation and are limited to genetically addressable model animals. Here, we report a near-infrared (NIR)-excited nongenetic voltage nanosensor that achieves stable recording of neuronal membrane potential in intact animals. The nanosensor is composed of a Förster resonance energy transfer (FRET) pair, the outer membrane-anchored upconversion nanoparticle (UCNP), and the membrane-embedded dipicrylamine (DPA). The negative charge of DPA allows membrane potential fluctuation to affect the distance between the DPA and UCNP, therefore changing the FRET efficiency. Consequently, the emission intensity of the nanosensor can report the membrane potential. Using the nanosensor, we monitor not only electrically evoked changes in the membrane potential of cultured cells but also sensory responses of neurons in intact zebrafish and brain state-modulated subthreshold activities of cortical neurons in intact mice.

A sensitive and specific nanosensor for monitoring extracellular potassium levels in the brain

Extracellular potassium concentration affects the membrane potential of neurons, and, thus, neuronal activity. Indeed, alterations of potassium levels can be related to neurological disorders, such as epilepsy and Alzheimer's disease, and, therefore, selectively detecting extracellular potassium would allow the monitoring of disease. However, currently available optical reporters are not capable of detecting small changes in potassium, in particular, in freely moving animals. Furthermore, they are susceptible to interference from sodium ions. Here, we report a highly sensitive and specific potassium nanosensor that can monitor potassium changes in the brain of freely moving mice undergoing epileptic seizures. An optical potassium indicator is embedded in mesoporous silica nanoparticles, which are shielded by an ultrathin layer of a potassium-permeable membrane, which prevents diffusion of other cations and allows the specific capturing of potassium ions. The shielded nanosensor enables the spatial mapping of potassium ion release in the hippocampus of freely moving mice.

A highly sensitive and selective nanosensor for near-infrared potassium imaging

Potassium ion (K⁺) concentration fluctuates in various biological processes. A number of K⁺ probes have been developed to monitor such fluctuations through optical imaging. However, the currently available K⁺ probes are far from being sensitive enough in detecting physiological fluctuations in living animals. Furthermore, the monitoring of deep tissues is not applicable because of short-wavelength excitation prevailingly used so far. Here, we report a highly sensitive and selective nanosensor for near-infrared (NIR) K⁺ imaging in living cells and animals. The nanosensor is constructed by encapsulating upconversion nanoparticles (UCNPs) and a commercial K⁺ indicator in the hollow cavity of mesoporous silica nanoparticles, followed by coating a K⁺-selective filter membrane. The membrane adsorbs K⁺ from the medium and filters out interfering cations. The UCNPs convert NIR to ultraviolet light, which excites the K⁺ indicator, thus allowing the detection of the fluctuations of K⁺ concentration in cultured cells and intact mouse brains.

[Association between socioeconomic status and overweight/obesity in Yi people, Sichuan province]

Objective: To explore the association between socioeconomic status (SES) and overweight/obesity in Yi people in Sichuan province. Methods: A cross-sectional study was conducted in Liangshan Yi Autonomous Prefecture in 2015. Stratified cluster sampling method was used to enroll Yi farmers and rural-to-urban Yi migrants aged 20-80 years. SES was measured by education level, personal annual income, and compound SES index. Unconditional logistic regression models were used to determine the association between SES and overweight/obesity (BMI≥24.0 kg/m(2)). Results: 1 894 Yi farmers and 1 162 rural-to urban migrants were included in the analysis. After adjustment for age, smoking, drinking and physical activity, compared with illiteracy, OR for farmer males with higher education level (primary or junior school, senior high school or higher) were 1.71 (95%CI: 1.13-2.58) and 4.15 (95%CI: 2.10-8.22). Compared with lower income group (<5 000 CNY/y), the higher income group had increased risk (OR=1.66, 95%CI: 1.12-2.44). For farmer males with medium and high SES level, the risk of overweight/obesity were 1.65 (95%CI: 1.02-2.67) and 3.26 (95%CI: 1.97-5.42) compared with low level of SES. For farmer females, the risk increased with the higher income, with OR as 1.49 (95%CI: 1.10-2.02). Compared with low SES level, farmer females with medium level of SES was associated with 1.47 (95%CI: 1.11-1.95) times higher risk of overweight/obesity. In Yi migrants, the association between SES and overweight/obesity was not found. Conclusion: Socioeconomic status was positively associated with overweight/obesity only in Yi farmers.

Propagation of temporal coherence gratings in dispersive medium with a chirper

In this paper, the propagation of Temporal Coherence Grating (TCG) pulse trains in a dispersive medium with a chirp is investigated for the first time. The two-time mutual coherence function of the TCG pulse trains propagating through extended dispersive medium specified by temporal ABCD matrix is derived and the evolution of their mean intensity and temporal degree of coherence (DOC) is explored. It is shown that the distribution of the mean intensity can be modulated freely by the number of grating lobes N, grating constant a, pulse duration T₀, power distributions vn, group-velocity dispersion coefficient β₂ and the medium chirper s. Upon dispersive-medium propagation, the single pulse splits into N+1 subpulses with the same or different peak intensities which depend on power distributions vn. What's more, during the propagation the pulse self-focusing occurs being the chirp-induced non-linear phenomenon. And the distribution of temporal DOC will degenerate into Gaussian form from initial periodic coherence distribution with increasing propagation distance z or adjusting incident pulse parameters and medium dispersion. The physical explanation and numerical illustrations relating to the pulse behavior are included.

Dexmedetomidine elevates the lethal dose threshold of bupivacaine in rats: A dosing study

Dexmedetomidine (DMED), an alpha-2 adrenoreceptor agonist, has been widely used in regional anesthesia procedures. However, the effect of DMED on local anesthetic cardiotoxicity has not been well delineated. This study consisted of two experiments. In experiment A, 42 Sprague–Dawley (SD) rats were randomly divided into 6 groups ( n = 7), each group was pretreated with DMED 0 μg kg−1 (D0 group), 1 μg kg−1 (D1 group), 3 μg kg−1 (D3 group), 6 μg kg−1 (D6 group), 12 μg kg−1 (D12 group), and 24 μg kg−1 (D24 group), administered through the right femoral vein. In experiment B, 20 SD rats were randomly divided into 4 groups ( n = 5), such as control group, DMED group, yohimbine (YOH) group, and DMED + YOH group. Each subgroup in experiment B was also pretreated similarly as in experiment A. After pretreatment of rats as described above (in experiments A and B), bupivacaine 2.5 mg kg−1 min−1 was infused to induce cardiac arrest. In experiment A, the lethal dose threshold of bupivacaine and plasma bupivacaine concentration in D3 and D6 group were higher than the other groups. In experiment B, there was no interaction between DMED and YOH in lethal dose threshold, arrhythmia time, plasma concentration of bupivacaine, and myocardial content of bupivacaine. DMED doses of 3–6 μg kg−1 elevated the lethal dose threshold of bupivacaine without involvement of the alpha-2 adrenoceptors.

Characteristics of decline in cognition and locomotion among the elderly in seven provinces of China

BACKGROUND

Decline in cognition and in locomotion is associated with aging. However, the relationship between them and the current occurrence of them in Chinese elderly people was weak.

METHODS

To investigate the details of these two functions in Chinese elderly people and to try to find some early recognition and intervention clues, data of MMSE test and usual gait speed from 4487 elderly people from seven provinces in China were analysed.

RESULTS

The prevalence of mild cognitive impairment (MCI) and dementia in persons aged 60 and over was 17.83% and 4.08%, respectively. Among 11 items of MMSE, calculation, three-word recall, drawing two pentagons, and temporal orientation were the most commonly impaired items in persons with MCI or dementia. The gait speed of old persons with dementia was significantly slower than that of persons with MCI or NCI. Meanwhile, old persons with gait speed >1.39 m/s fast gait speed also had high MMSE scores and no dementia was detected by MMSE.

CONCLUSION

The prevalence of dementia observed in this population was similar to that reported 20 years ago. Loss of temporal orientation and drawing two pentagons may supply more information for early recognition of cognitive impairment. Maintaining locomotion in a proper way may help old persons to prevent cognitive function decline.

Higher thyroid-stimulating hormone levels in the first trimester are associated with gestational diabetes in a Chinese population

AIM

To evaluate the relationship between maternal thyroid-stimulating hormone levels during the first trimester and gestational diabetes risk.

METHODS

In Tianjin, China, 7258 women underwent a thyroid-stimulating hormone screening test within 12 gestational weeks and then had a glucose challenge test at 24-28 weeks of gestational age. The women with a glucose challenge test ≥7.8 mmol/l underwent a 75 g oral glucose tolerance test. Gestational diabetes was diagnosed following International Association of Diabetes and Pregnancy Study Group criteria. Restricted cubic spline analysis was performed to explore full-range risk associations of thyroid-stimulating hormone levels with gestational diabetes. Logistic regression was performed to obtain odds ratios and 95% confidence intervals.

RESULTS

In all, 594 women (8.2%) had gestational diabetes. Among women with thyroid-stimulating hormone ≤3.2 mIU/l, a positive association between thyroid-stimulating hormone levels and gestational diabetes risk was found (adjusted OR: 1.13, 95% CI: 1.00-1.27). There was no relationship between thyroid-stimulating hormone levels and gestational diabetes risk in univariable and multivariable analyses among women with thyroid-stimulating hormone >3.2 mIU/l. In subgroup analyses, among women with thyroid-stimulating hormone ≤3.2 mIU/l and BMI ≥25 kg/m² , the adjusted odds ratio for thyroid-stimulating hormone levels with gestational diabetes was enhanced to 1.25 (95% CI: 1.02-1.53).

CONCLUSIONS

In pregnant Chinese women, thyroid-stimulating hormone levels even within normal range in the first trimester were positively related to gestational diabetes risk, especially for pre-pregnancy overweight/obese women.

Oral cancer-associated tertiary lymphoid structures: gene expression profile and prognostic value

Tertiary lymphoid structure (TLS) provides a local and critical microenvironment for both cellular and humoral immunity and supports effective antigen presentation and lymphocyte activation. However, the gene expression profile and prognostic significance of TLS in oral cancer remain largely unrevealed. In this study, we found the presence of both intratumoral and peritumoral TLSs in a series of 65 patients with oral cancer treated by surgical resection, with positive detection rates of 33.8 and 75.4%, respectively. The presence of intratumoral TLSs, but not peritumoral TLSs, was significantly associated with decreased P53 and Ki67 scores (P = 0·027 and 0·047, respectively). The survival analyses revealed that oral cancer patients with higher grades of TLSs was associated with improved disease-free survival (DFS) and overall survival (OS) (P = 0·037 and 0·031, respectively). Gene expression profiling analysis of the cytokines and chemokines responsible for lymph-node neogenesis identified a three-up-regulated-gene set, i.e. IL7, LTB and CXCL13, which was shown to be correlated with human oral cancer-associated TLSs. This study provides a framework for better understanding of oral cancer-associated TLSs and for delineating future innovative prognostic biomarkers and immune therapeutic strategies for oral cancer.

Weeping forsythia extract alleviates dexamethasone-induced oxidative injury of breast muscles in broilers

Antioxidants have been always used to improve post-slaughter meat quality in broilers subjected to stress. Forsythia suspensa extract (FSE), a traditional Chinese herbal medicine, is generally regarded as a natural source of antioxidants. Therefore, the objective of this study was to test the hypothesis that FSE could protect post-slaughter breast muscles against oxidative injury induced by dexamethasone (DEX) mimicking chronic physiological stress in poultry production. Average daily gain and feed efficiency of poultry were suppressed by DEX and improved by FSE (P < 0.05). Dexamethasone caused the decrease in the redness value and the increase in the lightness and yellowness values and drip loss of the breast muscles (P < 0.05), and FSE had the converse effects (P < 0.05). Dietary FSE supplementation decreased monounsaturated fatty acid (FA) and increased polyunsaturated FA in breast muscles of broilers (P < 0.05). In addition, FSE decreased malondialdehyde and carbonyl content in the breast muscles of DEX-treated broilers (P < 0.05). The inhibition of 1,1-diphenyl-2-picryl-hydrazyl in the breast muscles was decreased by DEX and increased by FSE (P < 0.05). Total-antioxidant capacity and glutathione peroxidase activity in the breast muscles were decreased in birds subjected to DEX and increased in birds supplemented with FSE (P < 0.05). Totally, DEX suppressed growth performance and induced breast muscle oxidative injury in broilers, and FSE supplementation improved antioxidant capacity to attenuate these adverse effects. Therefore, FSE could be a potential natural antioxidant to alleviate oxidative injury of the breast muscles in broilers and to improve the meat quality for human consumption.

P742Effects of platelet microparticles on the formation and stability of atherosclerotic plaque in ApoE knockout mice

Background

After activation by different factors, platelets can release a large number of platelet microparticles (PMPs), and continue to play a more durable and extensive role in promoting inflammation and thrombosis. Previous studies by our group have shown that PMPs can promote endothelial cell migration and lumen formation in vitro, and promote the release of inflammatory factors from monocytes. However, it is unclear whether PMPs can promote angiogenesis in the plaque and promote vascular wall inflammation and further lead to plaque instability.

Purpose

To investigate the effect of platelet microparticles (PMPs) from C57BL/6 mice on promoting atherosclerotic plaque formation and plaque stability in ApoE−/− mice.

Methods

Forty male apolipoprotein E knockout (ApoE−/−) mice, aged 8 weeks and fed for 4 weeks with high-fat diet, were randomly divided into four groups (n=10 in each group)according to the table of random digit. The mice were respectively injected with PBS (PBS group), PMPs-free supernatants (SUP group), low-dose PMPs (LDP group) and high-dose PMPs (HDP group) once a week through tail vein injection for 8 weeks. At the end of the experiment, the mice were euthanized and the blood samples were collected to detect blood routine, blood lipids, liver and kidney function and inflammatory factors including CRP, IL-1β, TNF-α; The aorta and brachiocephalic trunk were sampled to detect the atherosclerotic plaque formation. Oil Red O staining, H&E staining, Masson staining and immunohistochemistry (CD68, MMP-9, α-SMA) were used to examine the stability of the atherosclerotic plaque in each group.

Results

There were no significant differences in body weight, blood routine (WBC, RBC, PLT, HGB), blood lipids (TG, TCH, LDL, HDL), liver (ALT, AST)and kidney function (UN, Cr)in each group. The levels of serum CRP, IL-1β and TNF-α in LDP group and HDP group were significantly higher than those in PBS group and SUP group (P<0.05). The total area of aortic atherosclerotic plaques in LDP group and HDP group were significantly greater than those in PBS group and SUP group (P<0.05). Compared with the PBS group, the lipid cores of the plaques in the other three groups were significantly increased (P<0.05). The content of collagen and the amount of smooth muscle cells in the plaques were significantly lower in HDP group than in PBS group (P<0.05), while macrophages increased significantly in HDP group (P<0.05).

Conclusion

PMPs promote the formation of atherosclerotic plaques in high-fat-fed ApoE−/− mice, as well as macrophage infiltration and inflammation in the plaques, reduce the content of collagen and the amount of smooth muscle cells, thus decreasing the stability of plaques.

[Outcomes of patients treated with drug-coated balloons for de novo large coronary vessels]

Objective: To evaluate the efficacy and safety of drug-coated balloons (DCB) for de novo large coronary vessels. Methods: One hundred and two patients were retrospectively enrolled in this study, there were 104 lesions with the reference lumen diameter of target vessel more than 2.8 mm and patients were treated with DCB in de novo lesions during May 2015 and July 2017 in our center. Coronary artery angiography and quantitative coronary angiography were performed in 82 (80.4%) patients at follow up period ((8.1±1.7) months post procedure). The endpoints were late lumen loss (LLL) at follow up,and major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and stent or target lesion thrombosis at 12 months post procedure. Results: Ninety-eight lesions were treated with DCB only, 6 (5.9%) bailout drug-eluting stent (DES) were used because of severe coronary dissection, 2 patients (2.0%) received revascularization driven by acute ischemic events during hospitalization. Cutting balloons and NSE balloons were used in 65.4% (68/104) and 26.0% (27/104) lesions. The lesion length was (12.57±3.58) mm and the DCB length was (19.87±4.55) mm. The late lumen loss was (0.01±0.52) mm during angiographic follow up. The TLR rate and overall MACE rate was 3.9% (4/102) and 3.9% (4/102) and there was no death,MI and target lesion thrombosis at 12 months follow up. Conclusion: DCB treatment for de novo large coronary vessels is effective and safe.

Diagnostic accuracy of droplet digital PCR analysis of cerebrospinal fluid for tuberculous meningitis in adult patients

OBJECTIVES

Tuberculous meningitis (TBM) is difficult to diagnose. Digital PCR (dPCR) is a novel method which can quantify trace nucleic acids. This study sought to evaluate the diagnostic accuracy of dPCR analysis of cerebrospinal fluid (CSF) for TBM.

METHODS

We collected CSF specimens from hospitalized TBM and non-TBM patients. Total CSF DNA was purified and the concentrations of Mycobacterium tuberculosis insert sequence 6110 (IS6110) and gyrase subunit B (gyrB) were quantified using droplet dPCR. The receiver operating characteristic curves of dPCR were established and the diagnostic performances were obtained. We also compared the sensitivity of dPCR with routine diagnostic tests.

RESULTS

A total of 101 patients were recruited, 68 of whom suffered from TBM (26 definite, 34 probable and eight possible TBM) and 33 from non-TBM. The sensitivity of IS6110-dPCR assay for total TBM was higher than that of gyrB-dPCR assay (57.4% (44.8-69.3%) vs. 22.1% (12.9-33.8%)), and there was no significant difference for specificity between them (97.0% (84.2-99.9%) vs. 100% (89.4-100.0%)). The sensitivity of IS6110-dPCR in definite TBM was higher than that in probable and possible TBM (73.1% vs. 52.9% and 25.0%, respectively). IS6110-dPCR assay showed a higher sensitivity than smear microscopy (53.3% vs. 6.7%), mycobacterial culture (50.0% vs. 12.5%), IS6110-quantitative PCR (53.1% vs. 21.9%) and Xpert MTB/RIF (70.4% vs. 29.6%). Long anti-tuberculosis treatment time was found to be significantly associated with negative dPCR results.

CONCLUSION

CSF IS6110-dPCR assay is a rapid and sensitive molecular test, which has the potential to be used to enhance the diagnosis of TBM.