Genome-wide Analyses Identify a Novel Risk Locus for Nonsyndromic Cleft Palate

The 3 major subphenotypes observed in patients with nonsyndromic orofacial clefts (NSOFCs) are nonsyndromic cleft lip only (NSCLO), nonsyndromic cleft lip with palate (NSCLP), and nonsyndromic cleft palate only (NSCPO). However, the genetic architecture underlying NSCPO is largely unknown. Here we performed a 2-stage genome-wide association study (GWAS) on NSCPO and replication analyses of selected variants in other NSOFCs from the Chinese Han population. We identified a novel locus (15q24.3) and a known locus (1q32.2) where variants in or near the gene reached genome-wide significance (2.80 × 10^-13 < P < 1.72 × 10^-08) in a test for association with NSCPO in a case-control design. Although a variant from 15q24.3 was found to be significantly associated with both NSCPO and NSCLP, the direction of estimated effects on risk were opposite. Our functional annotation of the risk alleles within 15q24.3 coupled with previously established roles of the candidate genes within identified risk loci in periderm development, embryonic patterning, and/or regulation of cellular processes supports their involvement in palate development and the pathogenesis of cleft palate. Our study advances the understanding of the genetic basis of NSOFCs and provides novel insights into the pathogenesis of NSCPO.

Erratum: Evolution of π^{0} Suppression in Au+Au Collisions from sqrt[s_{NN}]=39 to 200 GeV [Phys. Rev. Lett. 109, 152301 (2012)]

This corrects the article DOI: 10.1103/PhysRevLett.109.152301.

OP0090 EFFICACY OF SUBCUTANEOUS TANEZUMAB FOR THE TREATMENT OF CHRONIC LOW BACK PAIN: AN ANALYSIS OF BRIEF PAIN INVENTORY-SHORT FORM SCORES FROM A 56-WEEK, RANDOMIZED, PLACEBO- AND TRAMADOL-CONTROLLED, PHASE 3 TRIAL

Background:

Tanezumab, a monoclonal antibody against nerve growth factor, was recently evaluated in an 80 week placebo and tramadol-controlled trial in patients with chronic low back pain (CLBP) and a history of inadequate response to standard-of-care analgesics (NSAIDs, opioids, etc). Primary endpoint was change in Low Back Pain Intensity (LBPI) at week 16 vs placebo. Key secondary endpoints were the proportion of patients with ≥50% improvement in LBPI at week 16, change in Roland Morris Disability Questionnaire score at week 16, and change in LBPI at week 2 (all vs placebo). Tanezumab 10mg met the primary and all key secondary endpoints. Tanezumab 5mg did not meet the primary endpoint, but improved 2 of 3 key secondary endpoints. Due to the primary endpoint result and the statistical gate-keeping approach to control for multiple comparisons, a conclusion of superiority over placebo could not be made for the 5mg dose.

Objectives:

To further characterize tanezumab’s effects on pain and function in this trial through analysis of Brief Pain Inventory-short form (BPI-sf) scores.

Methods:

Patients received placebo (n=406), subcutaneous (SC) tanezumab 5mg (every 8 weeks; n=407), SC tanezumab 10mg (every 8 weeks; n=407) or oral tramadol prolonged-release (100-300mg/day; n=605). Pre-specified secondary endpoints included BPI-sf worst pain, average pain, the overall pain interference index, and selected individual domains of the index (general activity, walking ability, sleep, and normal work). Least squares (LS) mean (standard error [SE]) changes from baseline in BPI-sf scores were compared between groups (unadjusted for multiplicity) at week 16 using an analysis of covariance model. Scores range from 0-10 with higher scores indicating greater pain severity or functional impairment.

Results:

LS mean (SE) differences from placebo for worst pain were -0.52 (0.19) for tanezumab 5mg (p≤0.01), -0.54 (0.19) for tanezumab 10mg (≤0.01), and -0.24 (0.17) for tramadol (p=0.17). LS mean (SE) differences from placebo for average pain were -0.37 (0.18) for tanezumab 5mg (p=0.04), -0.46 (0.18) for tanezumab 10mg (≤0.01), and -0.17 (0.16) for tramadol (p=0.29). LS mean (SE) differences from placebo for the pain interference index were -0.41 (0.18) for tanezumab 5mg (p=0.03), -0.58 (0.18) for tanezumab 10mg (≤0.01), and -0.15 (0.17) for tramadol (p=0.39). Effects of tanezumab were not statistically different (p>0.05) from tramadol for worst pain, average pain, and the pain interference index, with exception of the pain interference index for tanezumab 10mg (p=0.01). Mean dose of tramadol was 203mg/day at week 16.

Tanezumab 10mg significantly (p<0.05) improved individual domains of the pain interference index (general activity, walking ability, sleep, and normal work) vs placebo and vs tramadol. Tanezumab 5mg significantly (p<0.05) improved pain interference with general activity and normal work vs placebo, and sleep vs placebo and vs tramadol. No statistical differences in any domain was observed for tramadol vs placebo.

Conclusion:

Tanezumab 5mg and 10mg significantly improved worst pain, average pain, and overall pain interference index scores vs placebo in patients with CLBP. Tanezumab 10mg also significantly improved the overall pain interference index vs tramadol. Tanezumab 5mg significantly improved most individual domains of the pain interference index vs placebo, while tanezumab 10mg significantly improved all domains assessed vs placebo and vs tramadol.

Disclosure of Interests:

John Markman Consultant of: Consultant: Trigemina, Editas Medicine, and Plasma Surgical; Advisory board: Clexio Biosciences, Flexion Therapeutics, Quark Pharmaceuticals, Quartet Medicine, Collegium Pharmaceutical, Purdue Pharma, Biogen, Novartis, Aptinyx, Nektar, Allergan, Grünenthal, Eli Lilly and Company, Depomed, Janssen Pharmaceuticals, Teva Pharmaceutical Industries, KemPharm, Abbott Laboratories, Plasma Surgical, Chromocell, Convergence Pharmaceuticals, Inspirion, Pfizer, Sanofi, Daiichi Sankyo, and Trevena; Data safety monitoring boards for Novartis and Allergan, Serge Perrot Consultant of: Grunenthal, Pfizer, Lilly, MSD, Sanofi, Menarini, Seiji Ohtori: None declared, Thomas Schnitzer Consultant of: Pfizer, Lilly, AstraZeneca, GSK, Said Beydoun Grant/research support from: Argenx, Catalyst Pharma, Mallinckrodt, Pfizer, UCB, Consultant of: Alexion, Akcea, Alnylam, CSL, Takeda, Mitsubishi Tanabe, Speakers bureau: Alexion, Akcea, Alnylam, CSL, Takeda, Mitsubishi Tanabe, Lars Viktrup Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Ruoyong Yang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Candace Bramson Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Christine West Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ken Verburg Shareholder of: Pfizer Inc, Employee of: Pfizer Inc

AB0527 PHARMACOGENETICS AND PHARMACODYNAMICS OF RESPONSE TO APREMILAST IN A PHASE 3 CLINICAL STUDY IN SUBJECTS WITH ACTIVE BEHÇET’S DISEASE

Background:

Apremilast (APR), an oral phosphodiesterase 4 (PDE4) inhibitor, modulates inflammatory mediators1and has demonstrated efficacy in treating oral ulcers in a phase III Behçet’s syndrome study (BCT-002 [RELIEF]).2

Objectives:

To conduct an exploratory analysis of genetic polymorphisms, plasma biomarkers, and blood leukocytes with clinical response in RELIEF.

Methods:

Subjects with active Behçet’s disease (BD) were randomized (1:1) to APR 30 mg twice daily or placebo (PBO). The primary clinical efficacy endpoint was the area under the curve for the number of oral ulcers through Week 12 (AUCWk0-12). Among the 207 subjects enrolled, 140 provided consent for DNA genotyping, 116 for plasma biomarker testing, and 96 for leukocyte subset testing. Genotyping was performed on the Illumina Omni2.5 BeadChip (Covance Genomics Laboratory). TNF-α, IL-6, interferon-γ, and IL-17A levels were measured using Simoa Single Molecule Array; IL-8 and IL-23 were measured using the Human DiscoveryMAP multiplex panel (Myriad RBM). Th17, Treg, and CD3 T cells were counted using bisulfite-specific RT-PCR (Epiontis Gmbh). A rank ANCOVA model was used to estimate between-treatment differences (APR vs. PBO) in percent change from baseline for each biomarker/leukocyte subtype over the 12 weeks of treatment. Within each treatment group, the correlation of percent change from baseline at Week 12 in biomarker/leukocyte subtype with the primary efficacy endpoint AUCWk0-12was examined using a univariate regression model. A separate regression model was used to assess the interaction between treatment and the biomarker/leukocyte subtype clinical response.

Results:

Pharmacogenetic analysis of BD risk variants in HLA-B, IL-10, TLR2, ACE, TNF, GIMAP, PDGFRL, and UBAC2 + 55 genes associated with PDE4 biology yielded no candidate variants that were significantly associated with response to APR or PBO at a Bonferroni-correctedPvalue of 2 x 10−6. Clinical response to APR with respect to HLA-B51 yielded an odds ratio (OR) of 1.21 (95% CI, 0.53-2.75), indicating no significant relationship (Figure 1). Pharmacodynamic changes for IL-6, IL-3, IL-17A, IL-23, and TNF-α were not statistically significant. APR treatment was associated with a significant change in interferon-γ (mean: +107.4%; median: −19.2%) vs. PBO (mean: +78.8%; median: +7.9%) (P=0.0077). Using a univariate regression model, TNF-α showed strong positive correlation with AUCWk0-12in the APR group (r=0.90;P=0.0140); IL-8 had weak positive correlation with AUCWk0-12in the APR group (r=0.04;P=0.0333). A significant negative correlation was observed between the percent change from baseline in the number of Th17 cells and AUCWk0-12in the APR group (r=−0.79;P=0.0392) and a significant positive correlation was observed with the percent change from baseline in the number of Treg cells and AUCWk0-12in the PBO group (r=0.94;P=0.0182). Of all the biomarkers and leukocyte subtypes examined in a regression model using treatment as a factor, only Treg had a statistically significant treatment interaction (P=0.0069).

Conclusion:

Although there were no genetic predictors of clinical response to APR treatment, strong correlation was observed between the percent change from baseline in plasma TNF-α with AUCWk0-12in the APR group. A negative correlation was observed between percent change from baseline in Th17 cells and AUCWk0-12in the APR group and a positive association was observed between Treg cells and AUCW0-12in the PBO group.

References:

[1]Schafer P.Biochem Pharmacol. 2012; 83:1583-1590. 2. Hatemi G, et al. Presented at: ACR/ARHP Annual Meeting; November 8–13, 2019; Atlanta, GA. Presentation 0946.

Disclosure of Interests: :

Joseph Maranville Employee of: Celgene Corporation – employment at the time of study conduct, Irina Medvedeva Employee of: Celgene Corporation – employment at the time of study conduct, Robert Yang Employee of: Celgene Corporation – employment at the time of study conduct, Mindy Chen Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of the conduct, Lorraine (Ruoying) Fang Employee of: Celgene Corporation – employment at the time of study conduct, Sandra Collazo Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of the conduct, Shannon McCue Employee of: Amgen Inc. – employment; Celgene Corporation – employment at the time of the conduct, Peter Schafer Employee of: Bristol-Myers Squibb – employment; Celgene Corporation – employment at the time of study conduct

Spin-Canting-Induced Band Reconstruction in the Dirac Material Ca_{1-x}Na_{x}MnBi_{2}

The ternary AMnBi_{2} (A is alkaline as well as rare-earth atom) materials provide an arena for investigating the interplay between low-dimensional magnetism of the antiferromagnetic MnBi layers and the electronic states in the intercalated Bi layers, which harbor relativistic fermions. Here, we report on a comprehensive study of the optical properties and magnetic torque response of Ca_{1-x}Na_{x}MnBi_{2}. Our findings give evidence for a spin canting occurring at T_{s}∼50-100  K. With the support of first-principles calculations we establish a direct link between the spin canting and the reconstruction of the electronic band structure, having immediate implications for the spectral weight reshuffling in the optical response, signaling a partial gapping of the Fermi surface, and the dc transport properties below T_{s}.

Rapamycin-induced autophagy plays a pro-survival role by enhancing up-regulation of intracellular ferritin expression in acute lymphoblastic leukemia

Elevated mammalian target of rapamycin (mTOR) signaling has been reported to correlate with poor prognosis in acute lymphoblastic leukemia (ALL) patients. Rapamycin, an mTOR kinase inhibitor, and also a potent autophagy inducer, could not only effectively reverse glucocorticoid resistance, but also promote autophagy in the ALL cells. Autophagy has been suggested to play a paradoxical role in cancer treatment. The aim of this study was to address the role of the rapamycin-induced autophagy in the leukemia treatment.

MATERIALS AND METHODS

Cell proliferation was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay in ALL cell lines of CEM-C1 and CEM-C7. Western Blot analysis was performed to test protein expressions.

RESULTS

Inhibition of mTOR by rapamycin could reverse glucocorticoid resistance in CEM-C1 cells, and also induce autophagy in these cells by up-regulation of LC3-II and Beclin-1 expressions. This autophagy played a pro-survival role since its inhibition by 6-amino-3-methylpurine or chroloquine could enhance rapamycin-induced cell death. Rapamycin increased the expression of intracellular ferritin, and this effect could be totally blocked by 6-amino-3-methylpurine and chroloquine, suggesting that the protective role of autophagy might be mediated through up-regulation of ferritin, the major iron-binding stress protein. Ciclopirox olamine, an iron chelator, could enhance rapamycin's anti-leukemia effect by down-regulation of intracellular ferritin expression.

CONCLUSIONS

All these findings would suggest that rapamycin-induced autophagy plays a pro-survival role in leukemia cells and this effect might be mediated by up-regulation of intracellular ferritin expression. We hypothesize that the combination of mTOR pathway inhibitors and autophagy inhibition is rational and would induce strong anti-leukemia effects in ALL.

CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone

This study compares the results of computed tomography X-ray absorptiometry (CTXA) hip volumetric BMD (vBMD) analyses of cortical and trabecular bone with and without partial volume correction. For cortical bone in some circumstances, corrected cortical volumes were negative and corrected vBMD was very high. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.

PURPOSE

Previous studies have reported concerns about the reliability of CTXA hip cortical vBMD measurements generated using partial volume (PV) correction (the "default" analysis, with cortical PV correction). To date, no studies have examined the results of the alternative ("new") analysis (with trabecular PV correction). This study presents in vivo and phantom data comparing the corrected and uncorrected data for cortical and trabecular bone respectively.

METHODS

We used the commercial QCTPro CTXA software to analyze CT scans of 129 elderly Chinese men and women and an anthropomorphic European Proximal Femur phantom (EPFP) and accessed data for two alternative scan analyses using the database dump utility. The CTXA software gives the user two methods of performing the PV correction: (1) a default analysis in which only cortical bone results are corrected; (2) a new analysis in which only trabecular bone results are corrected. Both methods are based on a numerical recalculation of vBMD values without any change in volume of interest (VOI) placement.

RESULT

In vivo, the results of the two analyses for integral bone were the same while cortical and trabecular results were different. PV correction of cortical bone led to a decrease of cortical volume for all four VOIs: total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter (IT) volumes were reduced on average by 7.8 cm³, 0.9 cm³, 2.5 cm³, and 4.3 cm³ respectively. For TR, where cortex was thinnest, average corrected cortical volume was negative (- 0.4± 1.3 cm³). Corrected cortical vBMD values were much larger than uncorrected ones for TH, FN, and IT. Scatter plots of corrected cortical vBMD against cortical bone thickness showed that elevated results correlated with thinner cortices. When trabecular bone was corrected for the PV effect, trabecular volumes of TH, FN, TR, and IT were reduced on average by 7.9 cm³, 0.8 cm³, 2.6 cm³, and 4.4 cm³ respectively, while vBMD measurements were increased correspondingly. The trabecular volume and vBMD measurements of the two datasets both had highly positive correlations. For the EPFP, the PV-corrected FN data deviated from the nominal phantom value, but was closer for the TR and IT VOIs. Both corrected and uncorrected data overestimated trabecular vBMD, with the corrected results showing greater deviation from nominal values.

CONCLUSION

The default and new CTXA analyses for volumetric data generate different results, both for cortical and trabecular bone. For cortical bone, the uncorrected results are subject to partial volume effects but the correction method of the default analysis overcorrects the effect leading to in part unreasonable results for cortical bone volume and BMD. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.

Porphyromonas gingivalis Induces Insulin Resistance by Increasing BCAA Levels in Mice

Insulin resistance is one of the critical pathogeneses of type 2 diabetes mellitus (T2DM). Elevated levels of plasma branched-chain amino acids (BCAAs) are associated with insulin resistance. Recent studies have demonstrated the role of Porphyromonas gingivalis in the development of insulin resistance. However, the mechanisms by which P. gingivalis induces insulin resistance are still unclear. The purpose of this study was to investigate whether P. gingivalis induces insulin resistance through BCAA biosynthesis. We established a murine model of periodontitis by infecting mice with P. gingivalis. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs were measured. A P. gingivalis BCAA aminotransferase-deficient strain (∆bcat) was constructed, and its kinetic growth, biofilm formation, and in vivo colonization were compared with its wild-type strain. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs of the mice infected with either wild-type strain or ∆bcat strain were further measured. We found that periodontal infection with P. gingivalis significantly upregulated the plasma level of BCAAs and aggravated the high-fat diet (HFD)-induced insulin resistance. Bcat deletion did not alter the growth, biofilm formation, and in vivo colonization of P. gingivalis. More important, the ∆bcat strain was unable to upregulate the plasma level of BCAAs and induce insulin resistance in HFD-fed mice. These findings suggest that the BCAA biosynthesis of P. gingivalis plays a critical role in the development of insulin resistance in the HFD-fed mice. The BCAA biosynthesis pathways may provide a potential target for the disruption of linkage between periodontitis and T2DM.

Feasibility of energy adaptive angular meshing for perpendicular and parallel magnetic fields in a grid based Boltzmann solver

PURPOSE

To develop the enabling algorithmic techniques which allow forward-peaked adaptive angular meshing to be compatible with angular advection of magnetic fields within a deterministic Grid Based Boltzmann Solver (GBBS) for MRI-guided radiotherapy, and establish appropriate energy adaptive meshing schemes which minimize total numerical degrees of freedom while preserving high dosimetric accuracy for parallel and perpendicular magnetic fields.

METHODS

A framework to independently adapt angular mesh resolution and basis function refinement of forward and backscattering hemispheres is developed, uniquely accommodating angular advection introduced by magnetic fields. Upwind stabilization techniques to accurately transfer fluence between hemispheres having different discretization are established. To facilitate oblique beam and magnetic field orientations, cardinal forward-peaked mesh orientations were devised to balance requirements for acyclic space-angle sweep ordering, while ensuring the beam predominantly overlaps the forward hemisphere. Energy-dependent fluence anisotropy is investigated, leading to adaptive angular meshing schemes for parallel and perpendicular magnetic fields. Calculated dose distributions were validated against GEANT4 Monte Carlo calculations on slab geometry and anthropomorphic phantoms.

RESULTS

Forward-peaked and isotropic energy adaptive angular meshing schemes were developed for parallel and perpendicular magnetic fields respectively, which reduce the number of elements solved by 52.8% and 47.7% respectively compared to static discretization using 32 quadratic elements while retaining over 97% of points passing the gamma 1%/1 mm criterion against Monte Carlo.

CONCLUSIONS

Techniques to preserve angular upwind-stabilization between hemispheres of a forward-peaked mesh and establish an acyclic directed space-angle sweep graph enabled energy-adaptive meshing schemes to be developed while accurately solving for magnetic fields. This substantially reduced the numerical degrees of freedom while retaining excellent dosimetric agreement with Monte Carlo. These algorithmic underpinnings contribute towards a fast deterministic GBBS for MRI-guided radiotherapy.

[Interaction of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students]

Objective: To explore the interaction of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students. Methods: From November 2015 to January 2016, 22 628 middle school students from Shenyang of Liaoning Province, Bengbu of Anhui Province, Xinxiang of Henan Province, Ulanqab of Inner Mongolia Autonomous Region, Chongqing Municipality, and Yangjiang of Guangdong Province were enrolled by using the multi-stage cluster convenience sampling method. A questionnaire was used to collect the data including demographic information, health literacy, second-hand smoke exposure, and psychopathological symptoms. A multivariate logistic regression model was used to analyze the interaction of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students. Results: The age of students was (15.36±1.79) years old, of which 10 990 were boys, accounting for 48.6% of total students. The detection rate of psychopathological symptoms was 29.1% (6 581/22 628). The detection rate of psychopathological symptoms in those who were exposed to second-hand smoke was 38.1% (2 401/6 304), which was higher than that in the non-second-hand smoke exposure group [25.6% (4 180/16 324)] (P<0.001). The OR (95%CI) of the interaction between medium and low levels of overall health literacy, low level of interpersonal dimension of health literacy and second-hand smoke exposure was 1.19 (1.15-1.24), 2.00 (1.92-2.10) and 1.59 (1.52-1.66), respectively. Conclusion: There was a positive interaction between middle and low levels of overall health literacy, low level of interpersonal dimension of health literacy and second-hand smoke exposure on psychopathological symptoms of middle school students.

Functional role of SIRT1-induced HMGB1 expression and acetylation in migration, invasion and angiogenesis of ovarian cancer

OBJECTIVE

Ovarian cancer is a commonly occurred tumor in females. High motility group box-1 protein (HHMB1) is a chromosome-related protein with multiple functions. A recent study revealed critical roles of HMGB1 in occurrence and progression of ovarian cancer. Sirtuin 1 (SIRT1) is a recently identified novel molecule, which regulates acetylation of HMGB1. Whether SIRT1 is involved in migration, invasion or angiogenesis of ovarian cancer is unclear. This study aims to investigate the role of SIRT1-induced HMGB1 acetylation in migration, invasion, and angiogenesis in ovarian cancer.

PATIENTS AND METHODS

In ovarian cancer cell line, SIRT1 expression was potentiated. Western blot and immunofluorescence were used to measure HMGB1 expression, acetylation level, and nuclear translocation. Scratch assay and transwell chamber methods were used to examine cell migration and invasion potency. A mouse model with ovarian cancer cell transplantation was generated to measure induced nitric oxide synthase (iNOs) and CD105 expression.

RESULTS

Compared to adjacent tissues, ovarian cancer tissues had significantly decreased SIRT1 expression. In ovarian cancer cells, SIRT1 over-expression decreased HMGB1 and acetylation levels, and SIRT1 knockdown facilitated HMGB1 expression and acetylation. SIRT1 over-expression also suppressed nuclear translocation of HMGB1. Meanwhile, SIRT1 could suppress, migration and angiogenesis of ovarian cancer cells via HMGB1.

CONCLUSIONS

SIRT1 over-expression effectively inhibited HMGB1 expression and acetylation, thus inhibiting ovarian cancer migration, invasion and angiogenesis. HMGB1 modulated behaviors of ovarian cancer via SIRT1. Therefore, SIRT1 might work as a treatment target for managing ovarian cancer migration.

The Predictive Value of Sarcopenia and Its Individual Criteria for Cardiovascular and All-Cause Mortality in Suburb-dwelling Older Chinese

OBJECTIVES

The aim of the present study is to investigate the associations between the Asian Working Group for Sarcopenia (AWGS) sarcopenic definition, and its individual criteria, and risk of cardiovascular disease (CVD) and all-cause mortality in the Chinese elderly.

METHODS

Longitudinal analysis of 1,264 participants aged 60 years or older at baseline (2013-2014) living in suburban areas, China. Sarcopenia was defined according to the recommended algorithm of AWGS. Muscle mass was measured by a direct segmental multifrequency bioelectrical impedance analysis. Muscle strength was assessed by handgrip strength, and physical performance measured via usual walking speed.

RESULTS

Cox proportional hazard models were used to assess the risk of CVD and all-cause mortality. After 40 months of follow-up, forty-eight deaths (4.2%) died in this cohort. The mortality rate with sarcopenia was 4.7% in men and 3.8% in women. After adjusting for potential confounders, the risk of all-cause death was 4.15 times higher in subjects with sarcopenia. Furthermore, low muscle mass (HR: 2.62, 95% CI 1.34-5.13) and low grip strength (HR: 5.79; 95% CI 2.28-14.71), but not walking speed, were found to be significantly associated with all-cause mortality. Risk of CVD mortality was significantly greater in sarcopenia. Low grip strength and low walking speed were associated with 11 times (HR: 11.03, 95% CI 1.58-77.02) and 13 times (HR: 13.02; 95% CI 1.18-143.78) higher risk of CVD mortality.

CONCLUSIONS

Sarcopenia and components of sarcopenia were associated with greater CVD and all-cause mortality. Pertinent prevention or rehabilitation programs projects should look to promote healthy aging in different types of sarcopenia group.

Addressing Vaccine Hesitancy in China: A Scoping Review of Chinese Scholarship

Despite the well-developed Chinese National Immunization Program, vaccine hesitancy in China is rising. As part of the response, Chinese scholars have studied determinants and proposed solutions to vaccination hesitancy. We performed a scoping review of Chinese literature (2007-2019), drawn from four Chinese databases. We mapped relevant information and presented a systemic account of the proposed determinants and responses to vaccine hesitancy in China. We identified 77 relevant studies that reveal four approaches to vaccine hesitancy. Most Chinese studies define vaccine hesitancy as a problem of vaccine safety and vaccine incident response and place accountability on the level of governance, such as regulation deficits and inappropriate crisis management. A first minority of studies tied vaccination hesitancy to unprofessional medical conduct and called for additional resources and enhanced physician qualifications. A second minority of studies positioned vaccination hesitancy as a problem of parental belief and pointed to the role of media, proposing enhanced communication and education. Chinese literature ties vaccine hesitancy primarily to vaccine safety and medical conduct. Compared to international research, parental concerns are underrepresented. The Chinese context of vaccination scandals notably frames the discussion of vaccination hesitancy and potential solutions, which stresses the importance of considering vaccination hesitancy in specific social and political contexts.

[Association of health literacy and smoking behaviors among middle school students in six cities of China]

Objective: To explore the association between the health literacy (HL) and smoking behaviors in middle school students. Methods: From November 2015 to January 2016, middle school students in Shenyang City of Liaoning Province, Bengbu City of Anhui Province, Xinxiang City of Henan Province, Ulanqab City of Inner Mongolia Autonomous Region, Chongqing City and Yangjiang City of Guangdong Province were enrolled by using a multistage stratified cluster sampling method. A total of 23 137 questionnaires were issued and 22 628 questionnaires were valid. A questionnaire survey was conducted to collect demographic information, HL and smoking behaviors. The low, middle, and high-level group were classified according to the tertile of HL score. A multiple logistic regression model was conducted to explore the association between the HL and smoking behaviors. Results: The age of subjects was (15.4±1.8) years old, and HL score was (104.1±18.7) points. The proportion of former smoking, recent smoking and passive smoking was 9.2% (2 071), 2.8% (635) and 27.9% (6 304), respectively. The proportion of former smokers who tried to quit smoking was 50.1% (1 037/2 071). Compared to the high-level HL, the low-level HL increased the risk of former smoking [OR (95%CI): 1.85 (1.61-2.13)], recent smoking [OR (95%CI): 1.68 (1.33-2.14)] and passive smoking [OR (95%CI): 1.34 (1.23-1.46)], and decreased the likelihood of smoking cessation [OR (95%CI): 0.70 (0.53-0.92)], after adjusting for the gender, school type, registered residence, household structure, accommodation type, educational level of patients, and self-reported family economic status. Conclusion: The HL of middle school students was related to their smoking behaviors.

Preliminary evaluation of GLP-1R PET in the diagnosis and risk stratification of pheochromocytomas

Noninvasive imaging methods for the diagnosis and risk stratification of pheochromocytomas (PHEOs) remain a great clinical challenge. The glucagon-like peptide-1 receptor (GLP-1R) has been validated to be overexpressed in PHEOs and therefore may be a reliable target for PHEOs. In this study, we firstly synthesized a novel radiotracer 68Ga-NOTA-MAL-Cys39-exendin-4 that specifically targets GLP-1R and evaluated the performance of GLP-1R PET for the diagnosis and risk stratification of PHEOs. Cys39-exendin-4 was conjugated to NOTA-MAL and then radiolabeled with 68Ga. The reaction was completed within 20 min with a yield of 91.6 ± 2.8%. In vitro cell uptake studies validated its high specificity. PET images showed promising tumor visualization with high uptake (1.88 ± 0.10 %ID/g for PC-12 poorly differentiated tumors and 1.09 ± 0.003 %ID/g for PC-12 highly differentiated tumors at 30min after injection). There was a significant difference in the uptake of 68Ga-NOTA-MAL-Cys39-exendin-4 between PC-12 poorly and highly differentiated tumors (p < 0.001), but no significant difference could be observed by 18F-FDG PET. Biodistribution results confirmed the findings of GLP-1R PET and demonstrated that 131I-MIBG couldn't be used for the risk stratification of PHEOs. Immunohistochemistry (IHC) staining revealed differences in GLP-1R expression between PC-12 poorly and highly differentiated tumor tissues. These results demonstrated that 68Ga-NOTA-MAL-Cys39-exendin-4 can specifically target GLP-1R with favorable pharmacokinetic properties. GLP-1R PET can be used for PHEOs detection and has potential for the risk stratification of PHEOs.