Negative Correlation Between Serum Levels of Homocysteine and Apolipoprotein M

BACKGROUND

Homocysteine (Hcy) has been suggested as an independent risk factor for atherosclerosis. Apolipoprotein M (apoM) is a constituent of the HDL particles. The goal of this study was to examine the serum levels of homocysteine and apoM and to determine whether homocysteine influences apoM synthesis.

METHODS

Serum levels of apoM and Hcy in 17 hyperhomocysteinemia (HHcy) patients and 19 controls were measured and their correlations were analyzed. Different concentrations of homocysteine (Hcy) and LY294002, a specific phosphoinositide 3- kinase (PI3K) inhibitor, were used to treat HepG2 cells. The mRNA levels were determined by RT-PCR and the apoM protein mass was measured by western blot.

RESULTS

We found that decreased serum apoM levels corresponded with serum HDL levels in HHcy patients, while the serum apoM levels showed a statistically significant negative correlation with the serum Hcy levels. Moreover, apoM mRNA and protein levels were significantly decreased after the administration of Hcy in HepG2 cells, and this effect could be abolished by addition of LY294002.

CONCLUSIONS

Present study demonstrates that Hcy downregulates the expression of apoM by mechanisms involving the PI3K signal pathway.

Standard versus Mini-Percutaneous Nephrolithotomy for Renal Stones: A Meta-Analysis

Objective:

To compare the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy in order to determine the optimal tract size for patients with renal stones.

Methods:

A systematic search of Web of Science, EMBASE, Cochrane Library, and PubMed databases was conducted for articles published through 20 August 2019, reporting on a comparison of the standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results:

Of 763 studies, 14 were considered for the evidence synthesis. A total of 1980 cases were included. Of these patients, 897 cases underwent standard percutaneous nephrolithotomy, and 1083 cases underwent mini-percutaneous nephrolithotomy. Stone-free rates were 87.6% (786 of 897 patients) for standard percutaneous nephrolithotomy and 87.8% (951 of 1083 patients) for mini-percutaneous nephrolithotomy ( p = 0.57). Tract sizes of 30F and 22–26F in standard percutaneous nephrolithotomy group shorten operation time compared with mini-percutaneous nephrolithotomy ( p = 0.02; p = 0.004; respectively). Leakage ( p = 0.04), bleeding ( p = 0.01), blood transfusion ( p < 0.00001), and renal pelvis perforation ( p = 0.02) were more common in standard percutaneous nephrolithotomy group than in mini-percutaneous nephrolithotomy group. Subgroup analysis showed only blood transfusion for 30F and 22–26F standard percutaneous nephrolithotomy group was more common than mini-percutaneous nephrolithotomy ( p < 0.0001, p = 0.005, respectively).

Conclusion:

Standard percutaneous nephrolithotomy was associated with higher leakage, bleeding, blood transfusion, and renal pelvis perforation, but had a shorter operation time. Tract size of 30F improved the stone-free rate compared with mini-percutaneous nephrolithotomy, but led to more complications. Tract size of 22–26F was no better than 30F or mini-percutaneous nephrolithotomy.

SAT0357 LEVELS OF PERIPHERAL LYMPHOCYTE SUBPOPULATIONS IN PATIENTS WITH ANKYLOSING SPONDYLITIS AND THEIR CHANGES AFTER RECEIVING IMMUNOREGULATORY COMBINATION THERAPIES

Background:

Ankylosing spondylitis is an immune-mediated inflammatory disease involving of the axial skeleton, joints, and entheses1. Although the homeostatic balance of effector T cells (Teffs) and regulatory T cells (Tregs) is considered to play an important role in the pathogenesis of ankylosing spondylitis(AS)2, it is unclear whether the levels of peripheral blood lymphocyte subpopulations in patients with ankylosing spondylitis are abnormal or not.

Objectives:

To explore the differences of lymphocyte subpopulations of peripheral blood (PB) between AS patients and healthy controls (HCs), and further evaluate the therapeutic effect of immunoregulatory drugs on the lymphocyte subpopulations.

Methods:

Total 1141 patients with AS and 206 healthy individuals were enrolled in the study and donated their blood to measure the levels of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs by flow cytometry combined with standard absolute counting beads. And 456 patients received immunoregulatory combination treatments which includes low-dose interleukin-2, rapamycin, metformin, retinoic acid etc. and donated their PB after the therapies. Data were expressed as mean ± standard deviation to the distribution. Independent-samples T test and paired-samples T test were applied.Pvalue <0.05 were considered statistically significant.

Results:

Compared with HCs, AS patients had a lower absolute number of Tregs but higher numbers of peripheral T, B, CD4+T, CD8+T and Th17 cells (P<0.05). Further, there was a significant increase in the percentage of B, CD4+T and the ratios of Teffs/Tregs such as Th1/Tregs, Th2/Tregs and Th17/Tregs compared with HCs (P<0.05)(Figure 1). Although, after receiving the immunoregulatory combination treatments, the absolute numbers of various peripheral lymphocyte subpopulations such as T, B, NK, CD4+T, CD8+T, Th1, Th17 and Tregs and the percentage of Tregs, Th1 and CD8+T significantly increased (P<0.05), the ratios of Th2/Tregs significantly decreased (P<0.05)(Figure 2), suggesting a rebalance of immune systems.

Conclusion:

The insufficiency of Tregs may involve in pathogenesis of AS. Immunoregulatory combination therapies could promote the proliferation of Tregs as well as other lymphocytes to some degree, which may be a new target for AS treatment.

References:

[1]van der Heijde D, Song IH, Pangan AL, et al. Efficacy and safety of upadacitinib in patients with active ankylosing spondylitis (SELECT-AXIS 1): a multicentre, randomised, double-blind, placebo-controlled, phase 2/3 trial. Lancet 2019;394(10214):2108-17. doi: 10.1016/S0140-6736(19)32534-6 [published Online First: 2019/11/17]

[2]Xu D, Fan J, Chen Q, et al. OP0028 Low dose IL-2 therapy can recovery TH17/TREG cell balance in patients with ankylosing spondylitis. Oral Presentations, 2017:63.1-63.

Disclosure of Interests:

None declared

0913 Ambulatory Blood Pressure Monitoring In Children With Obstructive Sleep Apnea Syndrome

Introduction

This study was performed to investigate the differences in blood pressure among different groups of snoring children and among different sleep stages.In recent years, the incidence of OSAS in children has increased year by year. Blood pressure research of OSAS children can better understand the occurrence of OSAS related complications. Early detection and intervention of blood pressure changes in children with OSAS can effectively reduce the incidence of cardiovascular disease in adulthood and lower the disease burden.

Methods

Habitually snoring children (snoring frequency of ≥3 nights per week) aged 3to 11 years were recruited from Beijing Children’s Hospital, Capital Medical University from 1 January 2017 to 30 June 2018. All children underwent polysomnography, and their blood pressure was monitored and calculated by the pulse transit time. The children were divided into those with primary snoring (PS), mild obstructive sleep apnea syndrome (OSAS), and moderate to severe OSAS according to their obstructive apnea-hypopnea index (OAHI).

Results

In total, 140 children were recruited. Ninety-seven had PS, 24 had mild OSAS, and 19 had moderate to severe OSAS. There were no differences in age, sex, or body mass index z-score among the groups. Statistically significant differences were found in the OAHI, oxygen desaturation index 3%, respiratory arousal index, and lowest oxygen saturation among the three groups. Children with moderate to severe OSAS had higher systolic and diastolic blood pressure than those with mild OSAS and PS (P &lt; 0.001). In all children, systolic and diastolic blood pressure was higher in the rapid eye movement (REM) sleep stage than in the non-REM sleep stage (P &lt; 0.05).

Conclusion

Children with moderate to severe OSAS had higher blood pressure than those with PS and mild OSAS. Blood pressure in the REM sleep stage was higher than that in other sleep stages in all groups of children.

Support

The Pediatric Medical Coordinated Development Center of Beijing Hospitals Authority (XTYB201807);Capital Health Research and Development of Special Funding (2018-1-2091);National Key Research and Development Plan (2017YFC0112502)

MiR-20a ameliorates diabetic angiopathy in streptozotocin-induced diabetic rats by regulating intracellular antioxidant enzymes and VEGF

OBJECTIVE

We evaluated the beneficial effect of miR-20a mimic against diabetic angiopathy (DA) in rats by regulating intracellular antioxidant enzymes and vascular endothelial growth factor (VEGF).

MATERIALS AND METHODS

Diabetes was induced by intraperitoneal administration of streptozotocin (STZ; 65 mg/kg). Rats were then treated with miR-20a mimic (250 nmol/kg orally) for 8 weeks after STZ administration. The effect of miR-20a mimic against DA in rats was evaluated by estimating serum glucose concentration, lipid profile, Lp-a, kidney function test, inflammatory mediators, and markers of endothelial cell function. Markers of oxidative stress in the aortic tissue were estimated in rats treated with miR-20a mimic. Western blot assay, RT-PCR, and histopathology of kidney and myocardial tissues were also performed.

RESULTS

Serum levels of blood glucose and markers of renal function were significantly lower, and the lipid profile improved in the miR-20a mimic group compared to the DA group. Treatment with miR-20a mimic ameliorated the altered markers of endothelial function and oxidative stress, as well as mediators of inflammation, in the DA rats. Protein expressions of ERK1/2, JNK, and p38 MAPK, as well as mRNA expressions of TLR-4 and NF-κB, in aortic tissues were lower in the miR-20a mimic group than in the DA group. The miR-20a mimic group had fewer histopathological changes in kidney and myocardial tissues than the DA group.

CONCLUSIONS

MiR-20a mimic can protect against DA in rats by regulating vascular endothelial function and oxidative stress.

Isolation of swine-derived Lactobacillus plantarum and its synergistic antimicrobial and health-promoting properties with ZnO nanoparticles

AIMS

The purpose of this study was to isolate Lactobacillus from gastrointestinal tract of healthy postweaning piglets and investigate its synergistic antimicrobial and probiotic effects with ZnO nanoparticles (nZnO).

METHODS AND RESULTS

Of the 128 isolates, Lactobacillus plantarum BLPL03 was selected based on its excellent acid and bile salt tolerance properties. Lactobacillus plantarum BLPL03 was sensitive to β-lactams, macrolides, amphenicols and cephalosporins, whereas it displayed the steady resistance to aminoglycosides, tetracyclines, quinolones and peptide antibiotics. In vitro analysis of antibacterial activities showed that L. plantarum BLPL03 inhibited the four common food-borne pathogenic bacteria including Escherichia coli O157:H7 CMCC 44828, Salmonella Typhimurium ATCC 13311, Staphylococcus aureus CMCC 26003 and Listeria monocytogenes CMCC 54007 in synergy with nZnO. Furthermore, the quantitative polymerase chain reaction test demonstrated that the combined administration of L. plantarum BLPL03 fermentation liquor (LFL) and nZnO synergistically elevated the faecal number of Bifidobacterium by 73·19-fold, and reduced the two potential enteropathogenic bacteria Enterobacteriaceae and Clostridium perfringens in mice challenged with Salm. Typhimurium. Finally, dietary supplementation with low dose of nZnO (20 mg kg^-1 ) when combined with LFL administration enhanced final body weight, fur appearance and average daily gain, and decreased feed conversion ratio and diarrhoea incidence in weaned piglets. The faecal Bifidobacterium and Lactobacillus of piglets were dramatically enhanced by 81·96- and 3·15-fold, respectively, after administration of a mixture of nZnO and LFL. Meanwhile, combination of nZnO with LFL resulted in low levels of Bacteroides, Enterococcus, and Enterobacteriaceae.

CONCLUSIONS

A combination of nZnO and LFL exhibits potential health-benefit properties for the control of gut microbial composition by their synergistic antimicrobial and probiotic effects.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study may provide a potential nutritional strategy to improve performance and gut health of animals with gut microbiota disorders caused by pathogen infections and weanling, and so on.

[The prevalence of snoring and its related family factors of children from 3 to 14 years old in Beijing]

Objective: To investigate the snoring status and related family factors of children from 3 to 14 years old in Beijing. Methods: From May to July, 2015, data of children from 3 to 14 years old were obtained from a status survey from 7 districts(Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou) in Beijing. A total of 11 420 children from 25 primary and middle schools were randomly selected. Pediatric Sleep Questionnaire (PSQ) and a self-administered questionnaire were carried out for the adopted children. Self-administered questionnaire included the snoring related family factors. Logistic regression was used to estimate the odd ratio(OR) with 95% confidence intervals for variables. Results: A total of 9 198 children meet the inclusion criteria and are analyzed in the study, of whom 901 (9.80%) were found with snoring behavior. The incidence of boys is higher than girls. Obese children take higher risk of snoring. Compared with younger children (≤6 years old), older children (≥12 years old) have a significantly lower risk of snoring (OR=0.464, 95%CI 0.368-0.585). There is no statistical association between full-term infants, infant feeding pattern, parental cigarette smoking and child snoring.The children with family history of snoring have a significantly higher risk of snoring occurrence. The educational background of mother is statistically related to children snoring (OR=1.241, 95%CI 1.058-1.457). Conclusions: The incidence of children snoring in Beijing is 9.80%, male gender, obesity, and young age are all risk factors for children snoring. There is a significantly statistical relationship between snoring and related family factors, such as family snoring history and education experience.

[Gastroenteropancreatic neuroendocrine tumor microenvironment and related therapy]

Neuroendocrine tumor(NET) is a kind of highly heterogeneous and ubiquitous tumor, frequently localized in the gastrointestinal tract and pancreas. Surgery combined with regional ablation, endocrine therapy,chemotherapy and targeted therapy presents a favorable prognosis when treated with G1 or G2 gastroenteropancreatic neuroendocrine tumor(GEP-NET). However, there are only limited therapeutic strategies for metastatic unresectable tumors and poorly differentiated NEC,which are closely related to the special tumor microenvironment of neuroendocrine tumors.Targeting tumor microenvironment therapy is an important method in current systematic therapy, but till now the knowledge of neuroendocrine tumor microenvironment and its related treatment are limited. This article will specifically introduce the characteristics of tumor microenvironment in GEP-NET from the following aspects: the formation of enrichment vascular supply in TME,the role of tumor stroma,immune cells and cancer associacted fibroblast, and immune checkpoint and future trend of immunotherapy.

Investigation of Streptococcus agalactiae using pcsB-based LAMP in milk, tilapia and vaginal swabs in Haikou, China

AIMS

To develop a pcsB-based Loop-mediated isothermal amplification (LAMP) method for the detection of Streptococcus agalactiae (GBS) in milk, tilapia and vaginal swabs.

METHODS AND RESULTS

The sensitivity of the LAMP method using real-time turbidity monitoring was 1 pg of template within 1 h at 64°C, 100-fold higher than conventional PCR. The sensitivity of visual detection dropped an order of magnitude using SYBR Green I or hydroxynaphthol blue. The validity of the visual LAMP assay was assessed by the detection of GBS in 180 vaginal swabs from one hospital, 14 brain tissues samples of diseased tilapias from two fishponds and fresh milk of 67 dairy cattle from one farm. In total, 17 samples (4 vaginal swabs, 13 tilapia brain tissues but no milk sample) tested positive for GBS. Subsequent bacterial identification confirmed the specificity and reliability of the LAMP method. Molecular serotyping and multilocus sequence typing demonstrated that all 13 tilapia GBS isolates were identical (serotype Ia, ST7), whereas the four human GBS isolates were more diverse and could be classified into two serotypes (Ia, III) and four sequence types (ST19, ST23, ST24, ST862). Virulence gene testing showed that only the bac, rib and lmb genes were not present in all isolates. Antimicrobial susceptibility profiles of the isolates were basically consistent with their genotypes, except for sulphonamide and fluoroquinolone.

CONCLUSIONS

We developed a reliable pcsB-based LAMP assay for GBS detection. Our results demonstrated that the prevalence of GBS was 92·9% among diseased tilapia, 2·2% among female patients and 0% on a dairy farm in Hainan.

SIGNIFICANCE AND IMPACT OF THE STUDY

The pcsB-based LAMP method is suitable for GBS detection and contains great potential of application in dairy industry, aquiculture and clinical.

Characterization of hsa_circ_0000594 as a new biomarker and therapeutic target for hepatoblastoma

OBJECTIVE

Various studies have shown that aberrant expression of circular RNAs (circRNAs) has a pivotal role in multifarious cancers. However, the role of circRNAs in hepatoblastoma (HB) is not clearly understood. In the present study, we attempted to explore the underlying mechanism of hsa_cric_0000594 in HB along with its clinical importance.

PATIENTS AND METHODS

In our research, the expression pattern of hsa_circ_0000594 in HB tissues and matched normal liver tissues was determined by in situ hybridization and RT-qPCR. Proliferation, viability, migration, and apoptosis of HB cell lines were detected via Cell Counting Kit-8 (CCK-8), colony formation, transwell, and flow cytometry assays. The interaction of hsa_circ_0000594 with miR-217 was investigated by Dual-Luciferase reporter assay.

RESULTS

Expression levels of hsa_circ_0000594 were significantly upregulated in HB tissues compared with those in paired normal liver tissues and showed a clear association with the subtype of HB. The knockdown of hsa_circ_0000594 inhibited the malignant phenotype of HB. Bioinformatics analysis suggests that sirtuin 1 (SIRT1) may serve as a target gene of miR-217.

CONCLUSIONS

Mechanically, hsa_circ_0000594 was identified to have a critical role in HB development through the hsa_circ_0000594/mir-217/SIRT1 regulatory axis, which might become a novel diagnostic marker and potential therapeutic target in HB.

The cardiovascular macrophage: a missing link between gut microbiota and cardiovascular diseases?

The prevalence of cardiovascular diseases is on the rise. Interventions that would aid prevention or treatment of these diseases are essential. The microbes residing in the gut, collectively called "gut microbiota", produce a plethora of compounds that enter the bloodstream and affect the cardiovascular system. Signals ascending from gut microbiome are believed to modulate differentiation and functional activity of macrophages residing in perivascular tissue, atherosclerotic plaques, and perivascular areas of the brain. Cardiovascular macrophages may be the key players that transform the signals ascending from gut microbiome into increased predisposition to cardiovascular diseases. The present review summarizes the knowledge to date on potential relationships between gut microbiota, cardiovascular macrophages, and cardiovascular diseases.

A radiomics model for determining the invasiveness of solitary pulmonary nodules that manifest as part-solid nodules

AIM

A nomogram model was developed to predict the histological subtypes of lung invasive adenocarcinomas (IAs) and minimally invasive adenocarcinomas (MIAs) that manifest as part-solid ground-glass nodules (GGNs).

MATERIALS AND METHODS

This retrospective study enrolled 119 patients with histopathologically confirmed part-solid GGNs assigned to the training (n=83) or testing cohorts (n=36). Radiomic features were extracted based on the unenhanced computed tomography (CT) images. R software was applied to process the qualitative and quantitative data. The CT features model, radiomic signature model, and combined prediction model were constructed and compared.

RESULTS

A total of 396 radiomic features were extracted from the preoperative CT images, four features including MaxIntensity, RMS, ZonePercentage, and LongRunEmphasis_angle0_offset7 were indicated to be the best discriminators to establish the radiomic signature model. The performance of the model was satisfactory in both the training and testing set with areas under the curve (AUCs) of 0.854 (95% confidence interval [CI]: 0.774 to 0.934) and 0.813 (95% CI: 0.670 to 0.955), respectively. The CT morphology of the lesion shape and diameter of the solid component were confirmed to be a significant feature for building the CT features model, which had an AUC of 0.755 (95% CI: 0.648 to 0.843). A nomogram that integrated lesion shape and radiomic signature was constructed, which contributed an AUC of 0.888 (95% CI: 0.82 to 0.955).

CONCLUSIONS

The radiomic signature could provide an important reference for differentiating IAs from MIAs, and could be significantly enhanced by the addition of CT morphology. The nomogram may be highly informative for making clinical decisions.

[Analysis of sleep quality and related factors among children in Beijing]

Objective: To investigate the sleep quality of children in Beijing and to analyze the related factors. Methods: The data were collected from the survey of 3-14 years old children in 7 urban districts of Beijing in 2015. By using multi-stage stratified cluster random sampling method, 26 kindergartens and primary and secondary schools in 7 districts and counties, including Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou, were randomly selected, with a total of 11 420 children. Children's sleep status was investigated with Children's Sleep Questionnaire (PSQ), and the proportion of children with sleep quality problems when the PSQ score was greater than 7. Various sleep related factors were investigated with self-made questionnaire. A multilevel model was used to analyze the relationship between PSQ score and related factors. Results: The average PSQ score of the children was 3.60±2.69. The proportion of children with sleep quality problems was 8.87%(816/9 198). Multilevel model analysis showed that the younger the children, the higher the PSQ score (<6 years old vs. 6~12 years old vs. >12 years old: 3.94±2.58 vs. 3.58±2.66 vs. 3.30±2.84, F=33.015, P<0.001); male PSQ score higher than female (3.89±2.75 vs. 3.30±2.60, t=10.560, P<0.001); and snoring, obesity, father/mother snoring, playing games before bed, surfing the internet, eating and other factors were statistically related to PSQ. Conclusions: Sleep quality of children in Beijing should not be neglected, especially preschool children with high PSQ scores. Parents should pay attention to children's snoring problems and try to reduce some pre-sleep behaviors that may affect sleep quality.

Generation of Amelx-iCre Mice Supports Ameloblast-Specific Role for Stim1

The identification and targeting of the molecular pathways regulating amelogenesis is an ongoing challenge in dental research, and progress has been restricted by the limited number of genetic tools available to study gene function in ameloblasts. Here, we generated 4 transgenic Cre-driver mouse lines that express improved Cre (iCre)-recombinase from the locus of the mouse ameloblast-specific gene amelogenin X (Amelx-iCre) with a large (250-kb) bacterial artificial chromosome DNA vector. All 4 Amelx-iCre transgenic lines were bred with ROSA26 reporter mice to characterize the iCre developmental pattern with the LacZ gene encoding β-galactosidase enzyme activity assay and Cre protein immunohistochemistry. From the 4 generated transgenic lines, 2 were selected for further analysis because they expressed a high amount of Cre recombinase exclusively in ameloblasts and showed developmental stage- and cell-specific β-galactosidase activity mimicking the endogenous amelogenin expression. To test the functionality of the selected transgenic models, we bred the 2 Amelx-iCre mice lines with stromal interaction molecule 1 (Stim1) floxed mice to generate ameloblast-specific Stim1 conditional knockout mice (Stim1 cKO). STIM1 protein serves as one of the main calcium sensors in ameloblasts and plays a major role in enamel mineralization and ameloblast differentiation. Amelx-iCre mice displayed exclusive CRE-mediated recombination in incisor and molar ameloblasts. Stim1 cKO mice showed a severely defected enamel phenotype, including reduced structural integrity concomitant with increased attrition and smaller teeth. The phenotype and genotype of the Amelx-iCre/Stim1 cKO showed significant differences with the previously reported Ker14-Cre/Stim1 cKO, highlighting the need for cell- and stage-specific Cre lines for an accurate phenotype-genotype comparison. Furthermore, our model has the advantage of carrying the entire Amelx gene locus rather than being limited to an Amelx partial promoter construct, which greatly enhances the stability and the specificity of our Cre expression. As such, the Amelx-iCre transgenic lines that we developed may serve as a powerful tool for targeting ameloblast-specific gene expression in future investigations.

[Surgical treatment of uremic secondary hyperparathyroidism complicated with thyroid nodules]

Objective:To investigate the surgical treatment of secondary hyperparathyroidism(SHPT) with thyroid nodule(TN) in uremic patients.Method:The clinical data of 26 patients diagnosed as SHPT combined with TN were retrospectively analyzed.Result:The patients underwent total parathyroidectomy and parathyroid granuless were transplanted subcutaneously into the forearm. The levels of parathyroid hormone,alkaline phosphatase,serum calcium,serum phosphorus and calcium-phosphorus product in 6 months and 12 months after operation were significantly lower than those before operation(P<0.01).The quality of life assessed by KDQOL-SF scale was significantly higher than that before operation(P<0.01). Concomtiant TN was operated simultaneously, and gravel calcification was significantly associated with papillary thyroid carcinoma(P<0.01).Conclusion:Total parathyroidectomy plus subcutaneous minimal forearm autograft and concurrent surgery with TN are feasible, and can not only properly treat TN, but also significantly improve SHPT-related prognosis and quality of life. We should be alert to the possibility of malignant TN in SHPT background, especially those with grit calcification.

A comparison of the BISAP score and Amylase and BMI (CAB) score versus for predicting severe acute pancreatitis

BACKGROUND AND AIMS

Early prediction of severe acute pancreatitis (SAP)would be helpful for triaging patients to the appropriate level of care and intervention. The aim of this study is to compare the performance of the Change in Amylase And Body mass index (CAB) score and BISAP score for predicting SAP.

PATIENTS AND METHODS

A total of 406 with AP were enrolled. The age, gender, body mass index(BMI), blood urea nitrogen determined at the time of admission and serum amylase determined on day 1 and day 2 after hospitalization were collected and analyzed statistically.

RESULTS

Multivariable analysis confirmed that blood urea nitrogen (OR 1.06; 95%CI 1.03-1.09) and percentage change in amylase day 2 (OR 0.75; 95%CI 0.65-0.87) were independently associated with development of SAP. No statistically significant association was observed between BMI (OR 1.04; 95%CI 0.951.13) and severity of acute pancreatitis. The area under the receiver operating characteristic curve for Body mass index (BMI), percentage change in amylase day 2, BISAP score and CAB score were 0.57±0.05, 0.68±0.04, 0.84±0.03 and0.53±0.05, respectively.

CONCLUSION

BISAP is more accurate for predicting the severity of acute pancreatitis than the CAB score.

[Analysis of sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome]

Objective: To investigate the sleep structure and related factors in children with severe obstructive sleep apnea-hypopnea syndrome(OSAHS). Method: We summarized the characteristics of 250 children withsevere OSAHS diagnosed by polysomnography（PSG）in our hospital from January 1, 2017 to December 31, 2017. According to AHI, the patients were divided into three groups, 159 in group A with 20 < AHI≤0, 57 in group B with 40 < AHI≤60, and 34 in group C with AHI > 60. We collected the basic data, sleep parameters (sleep efficiency, latency, sleep stage, sleep index, etc.), preoperative arterial blood gas test results (awake and postsleep state), echocardiographic findings of the three groups. Statistical comparisons between groups were performed with SPSS19.0. Result: BMI, AHI, OAHI, LSaO₂ was significantly different with among the three groups (all P<0.01), and there was a linear correlation between BMI and AHI (r=0.251). There was significant differences in sleep efficiency (SE), sleep latency (SO), and rapid eye movement (REM) latency among the three groups. Compared with group A, the proportion of sleep in stage 1 increased by 38%, the proportion of sleep in stage 3+4 was decreased by 19%, and the proportion of REM was decreased by 14% in group C. There was no significant difference between group A and B. There was a significant linear correlation between AHI and ODI in NREM and REM, respectively (r¹=0.663, r₂=0.499, P< 0.001), and the ODI in REM (63.8±35.0) was significantly higher than that in NREM (29.7±36.0), accounting for 68% of the sleep. Sixty-five children had received preoperative arterial blood gas test (awake and post-sleep state). There was a significant negative correlation between AHI and SaO₂ after sleep (r=-0.444, P=0.000), and no significant correlation in awake state. Forty-four patients underwent preoperative echocardiographic examination. There was significant differences between group A and C in interventricular septum thickness, left ventricular diameter, and main pulmonary artery diameter (P<0.05). There was no significant difference between group A and B. There were no significant differences in aortic annulus diameter, left atrial diameter, left ventricular end diastolic dimension (LVEDD), ejection fraction(EF), and right ventricular anteroposterior diameter among the groups (P>0.05). Conclusion: Obesity is an important factor affecting the severity of OSAHS. As the severity of disease increased, the proportion of awakening time and stage 1 of sleep increased, but stage 3, 4 and REM decreased significantly. The SE, SO, and REM latency were significantly associated with the severity of OSAHS. The severity of hypoxemia is significantly related to AHI, and mainly occur in REM stage. Severe OSAHS is risk factor for cardiovascular complications.