Effects of simulation training on COVID-19 control ability and psychological states of nurses in a children's hospital

OBJECTIVE

This study aims to discuss the effects of simulation training on improving the pre-examination, triage, prevention, and control of coronavirus disease 2019 (COVID-19), explain the psychological states of pre-examination and triage staff in general hospitals during the COVID-19 epidemic, and analyze relevant influencing factors. This study may serve as a reference of psychological consultation services to medical staff.

SUBJECTS AND METHODS

This study included 60 nurses assigned in the pre-examination department, fever clinics, and isolation wards of a general hospital from January 26th to February 1st, 2020. Before assuming the posts, the nurses received simulation training on the clinical reception of suspected patients with COVID-19. Operation skills of the nurses before and after the training were assessed.

RESULTS

The percent of passing significantly increased from 65% before the training to 98.33% after training (p<0.05). Training also significantly relieved the anxiety and depression of the nurses (p<0.05).

CONCLUSIONS

Scenario-simulation training can increase the emergency abilities of pediatric nurses in the prevention and control of the COVID-19 epidemic and relieve the anxiety of nurses.

Two replication fork remodeling pathways generate nuclease substrates for distinct fork protection factors

Fork reversal is a common response to replication stress, but it generates a DNA end that is susceptible to degradation. Many fork protection factors block degradation, but how they work remains unclear. Here, we find that 53BP1 protects forks from DNA2-mediated degradation in a cell type-specific manner. Fork protection by 53BP1 reduces S-phase DNA damage and hypersensitivity to replication stress. Unlike BRCA2, FANCD2, and ABRO1 that protect reversed forks generated by SMARCAL1, ZRANB3, and HLTF, 53BP1 protects forks remodeled by FBH1. This property is shared by the fork protection factors FANCA, FANCC, FANCG, BOD1L, and VHL. RAD51 is required to generate the resection substrate in all cases. Unexpectedly, BRCA2 is also required for fork degradation in the FBH1 pathway or when RAD51 activity is partially compromised. We conclude that there are multiple fork protection mechanisms that operate downstream of at least two RAD51-dependent fork remodeling pathways.

[Interpretation for the group standards in technical specification for health risk investigation of central air conditioning ventilation system during coronavirus disease 2019 epidemic]

The central air conditioning ventilation system plays an important role in the air circulation of buildings such as centralized isolation medical observation points and general public buildings. In order to meet the requirements of COVID-19 epidemic prevention and control, Beijing Preventive Medicine Association organized Beijing CDC and other professional institutes to write up the group standard entitled "Technical specification for health risk investigation of central air conditioning ventilation system during the COVID-19 epidemic (T/BPMA 0006-2020)" . According to the particularity of central air conditioning ventilation system risk control during the outbreak of similar respiratory infectious diseases, based on current laws and regulations and the principle of scientific, practical, consistency and normative, 8 key points of risk investigations were summarized, which were the location of fresh air outlet, air conditioning mode, air return mode, air system, air distribution, fresh air volume, exhaust and air conditioner components. The contents, process, method, data analysis and conclusion of the investigation implementation were also defined and unified. It could standardize and guide institutions such as disease control and health supervision to carry out relevant risk managements, and provided solutions and technical supports for such major public health emergencies in city operations.

[Interpretation for the group standards in the handling of accidental leak coronavirus disease 2019 sample]

Biosafety is an important guarantee of the new coronavirus laboratory test. The accident treatment of sample overflow and sprinkle is a necessary part of the emergency plan for testing activities. Beijing Preventive Medicine Association coordinated biosafety experts of COVID-19 laboratories from Beijing CDC, to write up "The standard for handling of accidents of corona virus disease 2019 sample (T/BPMA 0005-2020)" . The group standard was based on the guidelines of China and WHO, and combined with the practical experience of COVID-19 epidemic and the principle of "scientific, normative, applicable and feasible" . Through all kinds of risk Assessment, it included the spillover of samples caused by the packing of COVID-19 (highly pathogenic) samples, the overflow and sprinkle in the laboratory during the detection operation, and the spillage accident occurred during the transfer of samples in the same building. The standard could guide and standardize the handling methods of accidental overflow and sprinkle that may occur in the SARS-CoV-2 testing laboratories in the city.

Heterogeneity of enhancement kinetics in dynamic contrast-enhanced MRI and implication of distant metastasis in invasive breast cancer

AIM

To investigate the heterogeneity of enhancement kinetics for breast tumour in order to demonstrate the predictive power of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) features for distant metastasis (DM) in invasive breast cancer.

MATERIALS AND METHODS

Time-signal intensity curve (TIC) patterns from 128 patients with invasive breast cancer were analysed by a pixel-based DCE-MRI analysis. This MRI technique enabled pixels with varying TIC patterns (persistent, plateau, washout and non-enhancement) to be categorised semi-automatically and the percentage of different TIC patterns in each breast tumour to be calculated. The percentage of TIC patterns was compared between the DM and non-DM groups. DM-free survival was estimated using Kaplan-Meier survival analysis.

RESULTS

This study demonstrated a larger percentage of persistent TIC and non-enhancement TIC was associated with DM in invasive breast cancer. The cut-off values of persistent TIC and non-enhancement TIC were 22.5% and 2.5%. Combining TIC patterns and traditional predictors (tumour size and axillary lymph node status) can improve the prediction efficiency. The multivariable model yielded an area under the receiver operating characteristic curve (AUC) of 0.87 with 0.70 sensitivity and 0.87 specificity in leave-one-out cross-validation (LOOCV). These predictors showed significant differences in DM-free survival by Kaplan-Meier analysis.

CONCLUSION

This study shows that breast tumours with higher heterogeneity are more likely to metastasise, and pixel-based TIC analysis has utility in predicting distant metastasis of invasive breast cancer.

Effects of glucocorticoids on osteoporosis in rheumatoid arthritis: a systematic review and meta-analysis

We evaluated the effects of glucocorticoids on bone mineral density (BMD), and prevalence of osteoporosis and fracture in rheumatoid arthritis (RA) by meta-analysis. Until June 26, 2019, we conducted a systematic literature search in EMBASE, Web of science, PubMed, and Cochrane Library to obtain BMD and the prevalence of osteoporosis and fracture in glucocorticoid-treated subjects with RA. The BMD of the treatment and control groups were analyzed by meta-analysis (Stata. version 15), and the 95% confidence interval (CI) was calculated. We identified 15 observational studies, including 46,711 RA subjects and 857 healthy controls. The BMD of the lumbar spine (- 0.038 g/cm²; CI, - 0.052, - 0.024) and femoral neck (- 0.017 g/cm²; - 0.030, - 0.003) in RA treated with glucocorticoids were significantly lower than those in RA controls. Compared with healthy control group, the BMD of the lumbar spine (- 0.094 g/cm²; - 0.126, - 0.061) and femoral neck (- 0.097 g/cm², - 0.109, - 0.085) of RA treated with glucocorticoids decreased more significantly. The prevalence of osteoporosis in whole body, spine, and femur was 38.6% (0.305, 0.466), 32.9% (0.277, 0.381), and 21.7% (0.106, 0.328), respectively. And the prevalence of vertebral fracture was 13.0% (0.058, 0.203). Glucocorticoids may lead to a decline in skeletal health in subjects with RA, especially in vertebral and femoral BMD, compared with normal people or RA without glucocorticoid therapy. Meanwhile, osteoporosis and fractures were also common. Therapeutic measures should be targeted at individuals, which needs further study. Through meta-analysis, we found that glucocorticoids have some negative effects on the bone health of subjects with rheumatoid arthritis. Therefore, when using glucocorticoids to treat rheumatoid arthritis, we should take strategic measures to prevent the decline of bone quality.

[Overview of multi-center registry of aortic dissection]

Aortic dissection is a life-threatening cardiovascular disease. Multi-center registration databases for aortic dissection have been established in many countries. The International Registry of Acute Aortic Dissection has produced a number of research results, which had a significant impact on the diagnosis and treatment of aortic dissection worldwide. The Society for Thoracic Surgeons Adult Cardiac Surgery Database summarizes perioperative data on aortic dissection. German Registry for Acute Aortic Dissection Type A has made remarkable achievements in the neurological protection and organ perfusion of type A aortic dissection. The Nordic Consortium for Acute Type A Aortic Dissection provides guidelines for perioperative administration of aortic dissection. However, the first Registry of Aortic Dissection in China (Sino-RAD) has not reported any new aortic dissection data in the past five years, although it has proposed a number of pathogenic characteristics of Chinese people. Therefore, it is necessary to establish our own aortic dissection database.

Direct-write 3D printing and characterization of a GelMA-based biomaterial for intracorporeal tissue

We develop and characterize a biomaterial formulation and robotic methods tailored for intracorporeal tissue engineering (TE) via direct-write (DW) 3D printing. Intracorporeal TE is defined as the biofabrication of 3D TE scaffolds inside of a living patient, in a minimally invasive manner. A biomaterial for intracorporeal TE requires to be 3D printable and crosslinkable via mechanisms that are safe to native tissues and feasible at physiological temperature (37 °C). The cell-laden biomaterial (bioink) preparation and bioprinting methods must support cell viability. Additionally, the biomaterial and bioprinting method must enable the spatially accurate intracorporeal 3D delivery of the biomaterial, and the biomaterial must adhere to or integrate into the native tissue. Current biomaterial formulations do not meet all the presumed intracorporeal DW TE requirements. We demonstrate that a specific formulation of gelatin methacryloyl (GelMA)/Laponite^®/methylcellulose (GLM) biomaterial system can be 3D printed at physiological temperature and crosslinked using visible light to construct 3D TE scaffolds with clinically relevant dimensions and consistent structures. Cell viability of 71%-77% and consistent mechanical properties over 21 d are reported. Rheological modifiers, Laponite^® and methylcellulose, extend the degradation time of the scaffolds. The DW modality enables the piercing of the soft tissue and over-extrusion of the biomaterial into the tissue, creating a novel interlocking mechanism with soft, hydrated native tissue mimics and animal muscle with a 3.5-4 fold increase in the biomaterial/tissue adhesion strength compared to printing on top of the tissue. The developed GLM biomaterial and robotic interlocking mechanism pave the way towards intracorporeal TE.

[Focus on application of dermabrasion in the treatment of deep partial-thickness burn wound at early stage]

There are several advantages in using dermabrasion to treat burn wound of deep-partial thickness at early stage, including accurate positioning, little damage to normal tissue, partial-damaged tissue preservation, easy to operate, no limited by burn wound location and area, fast wound healing, short hospital-stay, less hospitalization cost, slight scarring, wide indications, etc. It is of important clinical value for the treatment of deep partial-thickness burn wound at early stage.

Overall adjustment acupuncture for postmenopausal osteoporosis (PMOP): a study protocol for a randomized sham-controlled trial

BACKGROUND

Osteoporosis is becoming more prevalent in aging societies worldwide, and the economic burden attributable to osteoporotic fractures is substantial. The medications presently available to treat osteoporosis have side effects. Acupuncture is widely used for treating osteoporotic postmenopausal women because it is non-invasive and has fewer side effects, but the powerful clinical evidence for its efficacy remains insufficient. Our study intends to explore the effect of overall adjustment acupuncture (OA) in the treatment of postmenopausal osteoporosis (PMOP).

METHODS/DESIGN

This study is a randomized, sham-controlled, patient- and assessor-blinded trial and aims to evaluate the effect of OA in women with PMOP. We will recruit 104 women aged 45-70 years with a diagnosis of PMOP. Participants will be randomly allocated in a 1:1 ratio to the OA group and the sham acupuncture (SA) group. Both groups will receive real herbal medicine treatment as a basic treatment twice a day for 3 months, the OA group receives real acupuncture treatment and the SA group receives placebo acupuncture treatment (non-penetrating, sham skin-needle therapy, sham cupping). All patients will receive acupuncture treatment twice per week for 3 months. The primary outcome is bone mineral density (BMD) and the secondary outcomes include estradiol (E2), follicle-stimulating hormone (FSH), bone gla protein (BGP), bone alkaline phosphatase (BALP), total antioxidant capacity (TAC), advanced oxidation protein products (AOPP), PPARγ, β-catenin, FoxO3a levels, visual analog pain scale score (VAS), Traditional Chinese medicine (TCM) syndrome scores and quality of daily life score (QOL). Outcome measures will be collected at baseline, middle of the treatment (1.5 months), the end of treatment (3 months). The present protocol followed the SPIRIT guidelines and fulfills the SPIRIT Checklist.

CONCLUSION

This study will be conducted to compare the efficacy of OA versus SA. This trial should help to evaluate whether OA can effectively prevent and treat PMOP by improving the estrogen levels of postmenopausal women. The mechanism is to improve the imbalance of osteogenic differentiation and lipogenesis of bone-marrow cells under oxidative stress.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ID: ChiCTR1800017581. Registered on 5 August 2018. URL: http://www.chictr.org.cn.

AB1331-HPR ACTIVE DISEASE ACTIVITY IN ANKYLOSIS SPONDYLITIS: WORSE OUTCOMES AND POORER HR-QOL

Background:

Ankylosing spondylitis (AS) is a chronic inflammatory disease that mainly affects the sacroiliac joints and the spine, resulting in decline in quality of life[1,2]. Poor QoL is significantly related to high disease activity[3]. However, there is no systematic report on which prognosis indicators are affected by disease activity in AS patients.

Objectives:

This study aimed to evaluate the patient-reported outcome measures and health-related quality of life (HR-QoL) in AS patients defined on the basis of the Bath Spondylitis Ankylosing Disease Activity Index (BASDAI).

Methods:

204 AS patients were involved in this study. A serious of questionnaires were used to overall assess AS patients, which include: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), the 10 cm Visual Analog Scale (VAS), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the Pittsburgh Sleep Quality Index (PSQI), the Health Assessment Questionnaire-Disability Index (HAQ-DI), the Fatigue Severity Scale(FSS) and the Short Form 36 Health Survey (SF-36). Independent samples t-test, Mann–Whitney U-test, Chi-square analysis and Pearson /Spearman correlation were used to analyze the data.

Results:

The results demonstrated 31.4% AS patients were in active disease activity stage. Active AS patients were older, unemployed, and had less exercise therapy than stable AS patients. Besides, AS patients with active disease activity presented more severe pain(P<0.001), poor physical function(P<0.001) and spinal mobility(P<0.001). They were more anxious(P<0.001), depressed(P<0.001) and had more sleep disturbance(P=0.001). Compared with active AS patients, stable AS patients had more leukocytes(P=0.040), lymphocytes(P=0.002), erythrocytes(P=0.001) and hemoglobin(P<0.001). Active disease activity had a significant impact on all dimensions of quality of life in AS patients(P<0.001).

Conclusion:

These findings suggested that medical personnel should pay more attention to active AS patients and make effective interventions to improve quality of life.

References:

[1]Exarchou S, Lindstrom U, Askling J, Eriksson JK, Forsblad-d’Elia H, Neovius M, Turesson C, Kristensen LE, Jacobsson LT (2015) The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations: a nationwide register study. Arthritis research & therapy 17:118. doi:10.1186/s13075-015-0627-0

[2]Qian Q, Xu X, He H, Ji H, Zhang H, Ding Y, Dai SM, Zou Y, Zhu Q, Yang C, Ye S, Jiang L, Tang JP, Tong Q, He D, Zhao D, Li Y, Ma Y, Zhou J, Yuan Z, Zhang J, Jin L, Zhou X, Reveille JD, Zou H, Wang J (2017) Clinical patterns and characteristics of ankylosing spondylitis in China. Clinical rheumatology 36 (7):1561-1568. doi:10.1007/s10067-017-3660-3

[3]Huang JC, Qian BP, Qiu Y, Wang B, Yu Y, Zhu ZZ, Hu J, Qu Z (2017) Quality of life and correlation with clinical and radiographic variables in patients with ankylosing spondylitis: a retrospective case series study. BMC musculoskeletal disorders 18 (1):352. doi:10.1186/s12891-017-1711-1

Acknowledgments:

Thanks to all the authors for their efforts and thanks to all members of the Department of Rheumatology of Affiliated Hospital of Nantong University for their helpfulness in the acquisition of data.

Disclosure of Interests:

None declared

SAT0181 ALTERATIONS OF PERIPHERAL LYMPHOCYTE SUBSETS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND THEIR CHANGES AFTER OUR NEW IMMUNOREGULATORY COMBINATION THERAPIES

Background:

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by abnormal activation of circulating lymphocytes and overproduction of autoantibodies1. Breakdown of self-tolerance is considered as a critical cause in the development of SLE2. However, the quantitative changes of lymphocyte subsets in SLE are unclear. Since low-dose IL-2 and several drugs have been used to promote the proliferation of regulatory T cells (Tregs)3, we developed immunoregulatory therapies using these drugs to rebalance effector T cells with Tregs and test whether they are benefit to remission disease activity of SLE.

Objectives:

To observe the different levels of peripheral lymphocyte subsets at the first laboratory examination of SLE patients with those of healthy controls (HCs) and to evaluate the effect of immunoregulatory combination therapies on levels of lymphocyte subsets in patients with SLE.

Methods:

From September 2014 to December 2019, a total of 985 diagnosed patients with SLE (878 females, 107 males, mean age 42.99±13.37 years) and 206 healthy adults were enrolled in this retrospective cross-sectional study. And 795 patients with SLE (711 females and 84 males, mean age 38.26±15.242 years) were received the immunomodulatory drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid, coenzymes Q10 or other immunomodulatory treatments. The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and CD4+CD25+Foxp3+T regulatory cells (Tregs) in peripheral blood (PB) of these individuals were measured by Flow Cytometer (FCM) combined with standard absolute counting beads.

Results:

As compared with those of HCs, patients with SLE had lower absolute numbers of total T, NK, and CD4+T but higher proportions of all lymphocyte subpopulations except NK, CD4+T cells(P< 0.001) (Figure 1 A, C). Notably, the absolute numbers and proportions of Tregs as well as Th1 in CD4+T subsets were decreased (P<0.05) (Figure 1 B, D). Further, there was a significant increase in the ratio of Teffs/Tregs such as Th1/Tregs, Th2/Tregs and Th17/Tregs (P<0.05) (Figure 1 E). After receiving immunoregulatory combination therapies, the absolute numbers and proportions of T, NK, CD4+T, and CD8+T were increased, while the proportion of B cells was decreased (Figure 2 A, C); the absolute numbers of most CD4+T subsets as well as the proportions of only Th1 and Tregs were significantly increased (P< 0.001) (Figure 2 B, D). The ratios of Th1/Th2 and Th1/Tregs increased while that of Th17/Tregs and Th2/Tregs decreased (P<0.01) (Figure 2 E).

Conclusion:

Quantitative and functional alterations of peripheral lymphocyte subsets, especially reduced Tregs, play crucial roles in the pathogenesis of the patients. Immunoregulatory combination therapies mainly promote the proliferation and functional recovery of Tregs to rebalance pro- and anti-inflammatory T cells in patients with SLE for patients’ symptoms remission.

References:

[1]Sharabi A, Tsokos GC. T cell metabolism: new insights in systemic lupus erythematosus pathogenesis and therapy. Nat Rev Rheumatol 2020 doi: 10.1038/s41584-019-0356-x [published Online First: 2020/01/18]

[2]Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet 2019;393(10188):2332-43. doi: 10.1016/S0140-6736(19)30237-5 [published Online First: 2019/06/11]

[3]Spolski R, Li P, Leonard WJ. Biology and regulation of IL-2: from molecular mechanisms to human therapy. Nat Rev Immunol 2018;18(10):648-59. doi: 10.1038/s41577-018-0046-y [published Online First: 2018/08/10]

Acknowledgments :

None.

Disclosure of Interests:

None declared

THU0044 SINGLE CELL ANALYSIS OF BONE MARROW AND PERIPHERAL ALTERED B CELL DIFFERENTIATION IN PATIENTS WITH ACTIVE SLE AND THE MECHANISM OF ABNORMAL EARLY B CELL DEVELOPMENT

Background:

B cell differentiation and dysfunction play a key role in the pathogenesis of Systemic lupus erythematosus (SLE). Bone marrow (BM) is the development organ of B cells, and also the home and residence place of plasma cells and memory B cells. However, there is a lack of studies on B cells in BM with lupus.

Objectives:

To map the development of BM and peripheral B cells and investigate the mechanism of abnormal early B cell development in SLE.

Methods:

A total of 11 SLE patients and 5 age- and sex-matched controls were recruited.BM and peripheral B cell subsets were measured by flow cytometry. sorting-purified B cell subsets were subject toSingle-cell RNA sequencing (scRNA-seq) and functional studies. Plasma cytokines and secreted immunoglobulins were detected by Luminex or ELISA. Disease activity of SLE patients was measured using the SLE Disease Activity Index (SLEDAI).

Results:

In the present study, we find out that the percentage of monocytes in MNC (p=0.070) and plasma cells(p=0.001)in CD19+ were significantly decreased in BM of SLE, compared to healthy controls. While, SLE patients had increased T%MNC(p=0.008) and B%CD19+(p=0.002) in BM that controls. In detail, the B cell subsets of bone marrow in patients with active lupus (SLEDAI≥8 score) were seriously disordered, showing the increasing T%MNC(p=0.049), propre-B%CD19+ (p=0.006)and immature B cell%CD19+ (p=0.010) than healthy donors. propre-B%CD19+ exhibited good relationship with SLEDAI. By integrating single B cell expression profiling and repertoire analysis, we map the development of B cells in BM and peripheral and pathogenic characteristics of early B cells, especially propre-B.

Conclusion:

These findings demonstrated that early B cells in BM, especially propre-B are abnormally differentiated with dysregulations. BM is an important organ targeted by SLE. This studyis not only to clarify the internal mechanism of the disorder of differentiation of B cells, but also to provide new clues for the targeted diagnosis and treatment of SLE.

References:

[1]Palanichamy, A., et al.,Neutrophil-mediated IFN activation in the bone marrow alters B cell development in human and murine systemic lupus erythematosus.J Immunol, 2014.192(3): p. 906-18.

[2]Papadaki, H.A., J.C. Marsh, and G.D. Eliopoulos,Bone marrow stem cells and stromal cells in autoimmune cytopenias.Leuk Lymphoma, 2002.43(4): p. 753-60.

[3]Karrar, S. and D.S. Cunninghame Graham,Abnormal B Cell Development in Systemic Lupus Erythematosus: What the Genetics Tell Us.Arthritis Rheumatol, 2018.70(4): p. 496-507.

[4]Woods, M., Y.R. Zou, and A. Davidson,Defects in Germinal Center Selection in SLE.Front Immunol, 2015.6: p. 425.

[5]Upregulation of p16INK4A promotes cellular senescence of bone marrow-derived mesenchymal stem cells from systemic lupus erythematosus patients.Cell Signal, 2012.24(12): p. 2307-14.

Disclosure of Interests:

None declared

AB1330-HPR ASSOCIATION OF INTERSTITIAL LUNG DISEASE AND QUALITY OF LIFE IN CHINESE RHEUMATOID ARTHRITIS

Background:

The health-related quality of life (HRQL) of patients with rheumatoid arthritis associated interstitial lung disease (RA-ILD) is less concerned(1). This study hypothesized that HRQL of such patients decreased.

Objectives:

The aim of this study was to assess the difference in HRQL between RA with and without ILD, and to predict risk factors of HRQL in Chinese RA-ILD.

Methods:

A cross-sectional survey of RA-ILD patients included socio-demographic characteristics, clinical variables, psychological factors and HRQL. Data were analyzed by Student’s t or chi-square test. Linear regression analysis was used to investigate the predictors of HRQL in RA-ILD.

Results:

The data showed that 35.17% (51/145) of RA patients had ILD. There are significant differences in age, sex, smoking history, disease duration and activity between RA with and without ILD. HRQL of RA-ILD was impaired. Physical component score (PCS) of patients with RA-ILD was also worse than that of RA without ILD (48.91±2.48 vs. 50.80±2.55). Linear regression analysis showed that DAS28 and fatigue were risk factors for PCS in patients with RA-ILD, while depression and rural residence were risk factors for mental components summary in Table 1.

Table 1.

Stepwise multiple linear regression analysis of PCS and MCS in RA-ILD

PredictorsBSEtP95%CIPCSDAS28-0.7770.227-3.4250.001-1.236,-0.319Fatigue-0.6550.206-3.1770.003-1.071, -0.238MCSDepression2.1880.6693.2720.0020.836, 3.539Rural residents-1.6090.756-2.1280.040-3.137,-0.081

Footnotes: CI=Confidence interval. PCS=Physical component score; MCS=Mental component score; DAS28=28-joint disease activity score.

Conclusion:

Compared with RA without ILD, HRQL of patients with RA-ILD was significantly impaired. Disease activity, fatigue, depression and rural residence were independent predictors of HRQL in Chinese RA-ILD.

References:

[1]Zamora-Legoff JA, Krause ML, Crowson CS, Ryu JH, Matteson EL. Patterns ofinterstitial lung disease and mortality in rheumatoid arthritis. Rheumatology (Oxford, England). 2017;56(3):344-50.

Disclosure of Interests:

None declared

SAT0330 NEW IMMUNOMODULATORY COMBINATION THERAPIES IN PATIENTS WITH SYSTEMIC SCLEROSIS: A RETROSPECTIVE CROSS-SECTIONAL STUDY

Background:

Systemic sclerosis (scleroderma, SSc) is a rare complex connective tissue disease associated with high mortality and high morbidity1. Active SSc are typically treated with immunosuppressants, which may create a variety of severe side-effects, especially for long-term treatment2. As the pathogenesis of SSc is still a matter of debate, growing evidences have focused on the immune disorders3. However, the quantitative status of lymphocyte subsets in SSc patients are unclear and effects of immunomodulatory combination therapies (avoiding side-effects of conventional therapy) on the lymphocyte subsets are unknown.

Objectives:

To investigate the quantitative status of peripheral lymphocyte subpopulations and CD4+T subsets in SSc patients for the exploration of SSc pathogenesis and evaluate the effects of new immunomodulatory combination therapies on those cells.

Methods:

From July 2014 to December 2019, total 166 patients with SSc and 206 healthy controls (HCs) were enrolled in this study, in which, 79 follow-up patients received immunomodulatory drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10. The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs in peripheral blood of these subjects were detected by flow cytometry combined with standard absolute counting beads.

Results:

Patients with SSc had lower absolute counts of total T, NK, Th2, Th17 and Tregs as compared with those of HCs (P<0.05) (Figure 1). After immunomodulatory combination treatments, there were increases in a various of peripheral lymphocyte subsets such as T, B and CD8+T (P< 0.05). Moreover, the increased level of Tregs was much more dramatical than those of other lymphocyte subsets, resulting in the decrease ratios of Teffs/Tregs such as Th1/Tregs and Th2/Tregs and rebuilding immunologic equilibrium (Figure 2).

Conclusion:

This cross-sectional study clarified the abnormal status of lymphocyte subsets in SSc patients, suggesting lymphocyte subsets, especially Tregs, might be relevant and play a crucial role in the pathogenesis of SSc, thus providing a potential therapeutic target for SSc patients. Immunomodulatory combination therapies effectively increase the level of Tregs as well as other lymphocytes to some degree and maintain the immunologic equilibrium, which may help for SSc patients’ symptom remission.

References:

[1]Denton CP, Khanna D. Systemic sclerosis. Lancet 2017;390(10103):1685-99. doi: 10.1016/S0140-6736(17)30933-9 [published Online First: 2017/04/18]

[2]Winthrop KL, Weinblatt ME, Bathon J, et al. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2019. Ann Rheum Dis 2020;79(1):88-93. doi: 10.1136/annrheumdis-2019-216151 [published Online First: 2019/10/31]

[3]Skaug B, Khanna D, Swindell WR, et al. Global skin gene expression analysis of early diffuse cutaneous systemic sclerosis shows a prominent innate and adaptive inflammatory profile. Ann Rheum Dis 2019 doi: 10.1136/annrheumdis-2019-215894 [published Online First: 2019/11/27]

Acknowledgments :

None.

Disclosure of Interests:

None declared

AB0587 IMMUNOMODULATORY COMBINATION THERAPIES IN PATIENTS WITH DERMATOMYOSITIS /POLYMYOSITIS: A RETROSPECTIVE CROSS-SECTIONAL STUDY

Background:

Dermatomyositis (DM)/Polymyositis(PM) is an autoimmune disease that typically involve the striated muscle with a variable involvement of the skin and other organs1. Lymphocyte subsets disorders may contribute to the pathogenesis of DM/PM. It has been discovered that immunomodulatory drugs such as low-dose interleukin (IL)−2, rapamycin can help to regulate the lymphocyte subsets and control the disease and improve the prognosis2-4.

Objectives:

To investigate the levels of peripheral lymphocyte and CD4+T subsets of DM/PM patients and further to observe the regulatory effect of modulatory therapy on these cells in PM/DM at a relative large-sample size.

Methods:

Total 450 patients with PM/DM and 206 healthy controls (HCs) were enrolled in this study. Among these participations, 320 patients received immunomodulatory combination therapies (immunomodulatory drugs include low-dose interleukin-2, rapamycin, metformin, retinoic acid etc). The absolute numbers of T, B, NK, CD4+T, CD8+T, Th1, Th2, Th17 and Tregs in peripheral blood of these individuals were detected by flow cytometry combined with standard absolute counting beads before and after the treatment.

Results:

Patients with DM/PM had lower levels of total T, CD4+T, CD8+T, Th2, Th17, NK, Th1 and Tregs compared with those of HCs (P < 0.05). After immunomodulatory combination treatments, there was a dramatically increases various peripheral lymphocyte subsets such as T, B, CD4+T, CD8+T, NK, Th1, Th17 and Tregs (P < 0.05). Moreover, the increase in Tregs was much more than that in effector T cells (Teffs), resulting a rebalance of immune systems.

Conclusion:

The unbalance of lymphocyte cells should contribute to the pathogenesis of DM/PM patients. Immunomodulatory combination therapies could promote the proliferation and functional recovery of Tregs in patients and might help to alleviate disease activity.

References:

[1]Herbelet S, De Bleecker JL. Immune checkpoint failures in inflammatory myopathies: An overview. Autoimmunity reviews 2018;17(8):746-54. doi: 10.1016/j.autrev.2018.01.026 [published Online First: 2018/06/10]

[2]Feng M, Guo H, Zhang C, et al. Absolute reduction of regulatory T cells and regulatory effect of short-term and low-dose IL-2 in polymyositis or dermatomyositis. International immunopharmacology 2019;77:105912. doi: 10.1016/j.intimp.2019.105912 [published Online First: 2019/11/02]

[3]Zhang SX, Wang J, Sun HH, et al. Circulating regulatory T cells were absolutely decreased in dermatomyositis/polymyositis patients and restored by low-dose IL-2. Annals of the rheumatic diseases 2019 doi: 10.1136/annrheumdis-2019-216246 [published Online First: 2019/10/16]

[4]Zhao C, Chu Y, Liang Z, et al. Low dose of IL-2 combined with rapamycin restores and maintains the long-term balance of Th17/Treg cells in refractory SLE patients. BMC immunology 2019;20(1):32. doi: 10.1186/s12865-019-0305-0 [published Online First: 2019/09/06]

Acknowledgments:

None

Disclosure of Interests:

None declared

SAT0625-HPR FATIGUE AND CONTRIBUTING FACTORS IN CHINESE PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:

Ankylosing spondylitis (AS) is a systemic chronic inflammatory disease, which most likely occurs in young men. It mainly affects sacroiliac joints, axial skeleton, thoracic cage and seriously decreasing quality of life in AS patients[1,2]. In recent years, fatigue of AS patients has been paid more and more attention[3]. Fatigue is a complex feeling, diseased individuals describe fatigue as a sense of tiredness at rest, exhaustion with activity, lack of energy which affects daily work, inertia or lack of endurance, or as loss of vitality. It has been confirmed that fatigue is not only a symptom but may also be quantified by fatigue scores and can be modified by various measures depending on the underlying cause[4]. However, there has been no study about fatigue in AS patients in China.

Objectives:

This study aimed to evaluate the predictors of fatigue and the effects of fatigue on HR-QoL among patients with AS.

Methods:

A total of 150 AS patients were involved in the study. A series of questionnaires included: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), the 10 cm Visual Analog Scale (VAS), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the Pittsburgh Sleep Quality Index (PSQI), the Health Assessment Questionnaire-Disability Index (HAQ-DI), the Short Form 36 Health Survey (SF-36) and the Fatigue Severity Scale(FSS). Independent samples t-test, Mann–Whitney U-test, Chi-square analysis, Pearson /Spearman correlation and binary logistic regression were used to analyze the data.

Results:

The results demonstrated that 48.7% individuals with AS suffered from fatigue. Compared with AS patients without fatigue, AS patients with fatigue showed higher WHR(P<0.05), increased BASDAI (P<0.01) and poorer BASFI (P<0.05). Meanwhile, AS patients with fatigue tended to have more severe pain(P<0.05), higher degree of anxiety(P=0.001), more serious functional disability(P=0.001) and worse sleep quality(P=0.001). Binary logistic regression indicated that WHR (OR=1.78,P<0.05), BASDAI (OR=1.34,P=0.01), sleep disturbance (OR=2.35,P<0.05) were independent predictors of fatigue in AS patients. Additionally, the occurrence of fatigue significantly reduced the quality of life in AS patients both physically and psychologically.

Conclusion:

These findings suggested that medical personnel should pay more attention to AS patients with fatigue and take effective measures to relieve fatigue.

References:

[1]Law L, Beckman Rehnman J, Deminger A, Klingberg E, Jacobsson LTH, Forsblad-d’Elia H (2018) Factors related to health-related quality of life in ankylosing spondylitis, overall and stratified by sex. Arthritis research & therapy 20 (1):284. doi:10.1186/s13075-018-1784-8

[2]Hanson A, Brown MA (2017) Genetics and the Causes of Ankylosing Spondylitis. Rheumatic diseases clinics of North America 43 (3):401-414. doi:10.1016/j.rdc.2017.04.006

[3]Ulus Y, Akyol Y, Bilgici A, Kuru O (2019) Association of work instability with fatigue and emotional status in patients with ankylosing spondylitis: comparison with healthy controls. Clinical rheumatology 38 (4):1017-1024. doi:10.1007/s10067-018-4366-x

[4]Finsterer J, Mahjoub SZ (2014) Fatigue in healthy and diseased individuals. The American journal of hospice & palliative care 31 (5):562-575. doi:10.1177/1049909113494748

Acknowledgments:

Thanks to all the authors for their efforts and thanks to all members of the Department of Rheumatology of Affiliated Hospital of Nantong University for their helpfulness in the acquisition of data.

Disclosure of Interests:

None declared

AB0346 THE NUMERAL CHANGES OF PERIPHERAL LYMPHOCYTE SUBSETS IN PATIENTS WITH RHEUMATOID ATHRITIS AND THEIR RESTORATIONS AFTER RECEIVED COMBINED IMMUNOMODULATORY THERAPY

Background:

Rheumatoid arthritis (RA) is an aggressive immune-mediated joint disease with synovial inflammation and joint destruction characterized by abnormal immune responses to self-antigens1. An imbalance in pro- and anti-inflammatory lymphocyte subsets has been considered to contribute to the pathogenesis of RA2. However, the detailed lymphocyte statuses of RA patients are required clarified and the effect of immunomodulatory therapy on the lymphocyte subsets is unclear3.

Objectives:

To investigate the status of lymphocyte subsets in peripheral blood (PB) of RA patients at relatively large-sample size and the changes of them after our immune regulatory combination treatment.

Methods:

This cross-sectional study enrolled 3016 patients with RA who met the ACR’s revised RA diagnostic classification in 1987 as well as 206 healthy controls (HCs). Among these participations, 1415 patients have received the treatment of immunomodulatory drugs (IMiDs) such as low-dose interleukin-2, rapamycin, metformin, retinoic acid etc. Flow cytometry (FCM) was used to measure the levels of PB lymphocyte subgroups and CD4+T subsets in RA patients before and after the treatments and HCs. 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, patients with RA had a lower absolute numbers of total T, CD8+T, NK and Tregs (P<0.05), decreased percentages of NK, Th1, Th2 and Th17 (P<0.05), but higher ratios of Teffs/Tregs such as Th1/Tregs and Th17/Tregs (P<0.05), indicating a disturbance of immune systems (Figure 1). After receiving combined immunomodulatory therapy, the absolute numbers of T, B, CD4+T, CD8+T, NK, Th1, Th17 and Tregs were dramatically increased (P<0.05) and the percentages of B, Th1, CD4+T and Tregs were also increased (P<0.05). Although these subsets increased globally, the ratio of Teffs/Tregs such as Th2/Tregs and Th17/Tregs tended to decrease, suggesting a rebalance of immune systems(Figure 2).

Conclusion:

Impaired peripheral lymphocytes especially insufficiency of Tregs might played an important role in pathogenesis of RA. Immunoregulatory combination therapies could promote the proliferation and functional recovery of Tregs in patients and help to alleviate disease activity.

References:

[1]Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. (1474-547X (Electronic))

[2]Kondo Y, Yokosawa M, Kaneko S, et al. Review: Transcriptional Regulation of CD4+ T Cell Differentiation in Experimentally Induced Arthritis and Rheumatoid Arthritis. (2326-5205 (Electronic))

[3]Fonseka CY, Rao DA, Raychaudhuri S. Leveraging blood and tissue CD4+ T cell heterogeneity at the single cell level to identify mechanisms of disease in rheumatoid arthritis. (1879-0372 (Electronic))

Acknowledgments:

None.

Disclosure of Interests:

None declared

AB0032 ABNORMAL STATUSES OF PERIPHERAL CD4+T CELL SUBSETS IN PATIENTS WITH GOUT AND THEIR CHANGES AFTER RECEIVING COMBINED IMMUNOMODULATORY THERAPY

Background:

Gout is a chronic systemic inflammatory disease that results from the deposition of monosodium urate crystals in joints and the associated activation of the innate immune system associated with hyperuricemia1. As the pathogenesis of gout is still a matter of speculation and debate, accumulating evidence converges on inflammasome activation and immunological dysregulation2. However, the detailed statuses of lymphocyte subsets in patients with gout are unknown and influence of immunomodulatory combination therapies on the lymphocyte subsets remain to be clearly evaluate3.

Objectives:

To evaluate the quantitative statuses of peripheral CD4+T subpopulations in patients with gout and further investigate the effects of immunomodulatory combination therapies on those cells.

Methods:

Total 247 patients who met the clinical criteria of gout from the American College of Rheumatology and 206 healthy controls (HCs) were enrolled in this retrospective cross-sectional study. Among those patients, 70 follow-up patients donated their peripheral blood after receiving immunomodulatory drugs (e.g., low-dose interleukin-2, rapamycin, metformin, retinoic acid, etc). The absolute numbers of Th1, Th2, Th17 and Tregs in peripheral CD4+T subsets were detected by flow cytometry combined with standard absolute counting beads.

Results:

Compared with HCs, the absolute numbers of Th1 and Th17 were evidently increased in gout patients (P<0.001), while the level of Tregs was significantly decreased (P<0.05) (Figure 1). After immunomodulatory combination treatments, there were dramatical increases in a wide variety of CD4+T subsets such as Th1, Th17 and Tregs (P<0.05). Interestingly, the increased amount of Tregs was much more than that of other Teffs, leading to the decrease ratios of Teffs/Tregs such as Th2/Tregs, restoring immune homeostasis (Figure 2).

Conclusion:

This cross-sectional study clarified the abnormal statuses of CD4+T subsets in gout patients, suggesting that CD4+T subsets, especially Tregs, might be relevant and play a crucial role in the pathogenesis of gout, thus providing a potential therapeutic target for gout patients. Immunomodulatory combination therapies effectively increase the number of Tregs and may help for gout patients’ symptom remission.

References:

[1]Ramsubeik K, Ramrattan LA, Kaeley GS, et al. Effectiveness of healthcare educational and behavioral interventions to improve gout outcomes: a systematic review and meta-analysis. Therapeutic advances in musculoskeletal disease 2018;10(12):235-52. doi: 10.1177/1759720x18807117 [published Online First: 2018/12/06]

[2]Stiburkova B, Pavelcova K, Pavlikova M, et al. The impact of dysfunctional variants of ABCG2 on hyperuricemia and gout in pediatric-onset patients. Arthritis Res Ther 2019;21(1):77. doi: 10.1186/s13075-019-1860-8 [published Online First: 2019/03/22]

[3]Raucci F, Iqbal AJ, Saviano A, et al. In-depth immunophenotyping data relating to IL-17Ab modulation of circulating Treg/Th17 cells and of in situ infiltrated inflammatory monocytes in the onset of gouty inflammation. Data Brief 2019;25:104381. doi: 10.1016/j.dib.2019.104381 [published Online First: 2019/09/07]

Acknowledgments:

None.

Disclosure of Interests:

None declared

0588 Ring Pulse Oximeter for Screening of Moderate to Severe OSA: A Pilot Study

Introduction

To evaluate the utility of the ring pulse oximeter for screening of OSA in adults.

Methods

87 adults were monitored by a ring pulse oximeter and PSG simultaneously during a nocturnal in-lab sleep testing. 3% oxygen desaturation index (ODI3); Mean oxygen saturation(MSpO2), Saturation impair time below 90% (SIT90) derived from an automated algorithm of the ring pulse oximeter. Meanwhile, the parameters of PSG were scored manually according to the AASM Manual. Correlation and receiver operator characteristic curve analysis were used to measure the accuracy of ring pulse oximeter and its diagnostic value for moderate to severe OSA (AHI≥15).

Results

Among the 87 participants, 18 cases were AHI&lt;5, 17 cases were diagnosed with mild OSA (AHI:5-14.9), 25 cases were diagnosed with moderate OSA (AHI:15-29.9) and 27 cases were diagnosed with severe OSA (AHI≥30). There was no significant difference between PSG and ring pulse oximeter in regard to ODI3 (23.4±23.5 vs 24.7 ± 21.7), and SIT90 (1.54%, range 0.14%-8.99% vs. 3.20%, range 0.60%, 12.30%) (P&gt;0.05], Further analysis indicated that two parameters from the oximeter correlated well with that derived from PSG (r=0.889, 0.567, respectively, both p&lt;0.05). Although MSpO2 correlated significantly (r=0.448, P&lt;0.05), the difference was remarkable [95.9%, range 94.0% to 97.0% vs. 94.5%, range 93.3% to 95.7%, p&lt;0.05]. Bland-Altman plots showed that the agreement of these three parameters was within the clinical acceptance range. The ROC curve showed that the sensitivity and specificity of the ring pulse oximeter when the oximeter derived ODI3 ≥12.5 in the diagnosis of moderate to severe OSA were 82.7% and 74.3%, respectively.

Conclusion

The pilot study indicated that ring pulse oximeter can detect oxygen desaturation events accurately, therefore to be used as a screening tool for moderate to severe OSA.

Support

The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083).