Effect of age on the severity of chronic lithium poisoning

Objectives: Severe lithium toxicity is commonly observed in older people. We aimed to determine the extent to which age is associated with increased severity of chronic lithium poisoning and of which a range of possible factors might explain the associations.Method: We did a retrospective review of patients aged ≥15 years old with serum lithium concentrations ≥1.3 mmol/L from three hospitals. Clinical details, treatment and outcomes were recorded. eGFR, creatinine and lithium clearance were calculated. The severity of lithium toxicity was graded into five categories (Amdisen score). ANOVA was used to quantify the association between age and severity. Spearman correlation coefficient was used to explore relationships between age and different factors expected to alter severity. Ordinal regression analysis was used to determine the interdependence of age and these factors and age on severity of lithium toxicity.Results: From 2008-2018, there were 242 patients with a median age of 56.5 years (IQR: 41-69). There were 156 females (64%). There was a statistically significant association between Amdisen severity scores and age (p = .0004). The median calculated eGFR was 65 mL/min/1.73 m² (IQR: 41-91) with a corresponding estimated lithium clearance of 18 mL/min (IQR: 13.8-22.8). There was no correlation of age with initial serum lithium concentration (p = .76). There was a strong correlation between age and estimated lithium clearance (r = -0.72, 95% CI: -0.78 to -0.66, p < .001), lithium daily dose (r = -0.65, 95% CI: -0.72 to -0.57, p < .0001) and lithium concentration/dose (r = 0.62, 95% CI: 0.53-0.69, p < .0001). There was a weak correlation between age and infection (r = 0.18, 95% CI: 0.04-0.31, p = .009) and drug interactions (r = 0.25, 95% CI: 0.11-0.37, p = .0003). Ordinal regression indicated the independent predictors for severity of lithium toxicity were lithium concentration (p < .0001) and lithium clearance (p = .03) adjusted for age and dose.Conclusions: Despite lower lithium doses, older patients had more severe toxicity. Increased severity of lithium toxicity in the elderly is largely explainable by decreased lithium clearance from multiple factors such as age-related decline in renal function, drug interactions and infection.

Comparative Transcriptome Analysis Identifying the Different Molecular Genetic Markers Related to Production Performance and Meat Quality in Longissimus Dorsi Tissues of MG × STH and STH Sheep

Crossbred sheep have many prominent traits, such as excellent production performance and high-quality meat, when compared to local sheep breeds. However, the genetic molecular markers related to these characteristics remain unclear. The crossbred MG × STH (small-tailed Han sheep (STH) × Mongolian sheep (MG)) breed and the STH breed were selected to measure production performance and meat quality. We used 14 indexes of production performance and meat quality, which in the MG × STH population showed significant differences compared to the STH breed. Subsequently, the longissimusdorsi from the two sheep were subjected to comparative transcriptomic analyses to identify differentially expressed genes (DEGs) related to production performance and meat quality. A total of 874 DEGs were identified between the two sheep groups. A total of 110 unique DEGs related to sheep production performance and meat quality were selected as the candidate DEGs. We found 6 production-performance-related and 30 meat-quality-related DEGs through a correlation analysis, including SPARC, ACVRL1, FNDC5 and FREM1. The expression levels of 11 DEGs were validated by real-time PCR, and the results were in accordance with the results of the comparative transcriptomic and correlation analyses. These results will assist in understanding sheep heterosis and molecular marker-assisted selection.

A decision-making method based on Bayesian optimization algorithm for small modular reactor

Small modular reactors (SMRs) are suitable for deployment in isolated underdeveloped areas to support highly localized microgrids. In order to achieve almost autonomous operation for reducing the cost of operating personnel, an autonomous control system with decision-making capability is needed. In this paper, a decision-making method based on Bayesian optimization algorithm (BOA) is proposed to explore the optimal operation scheme under fault conditions. BOA is used to adjust exploration strategy of operation scheme according to observations (operation schemes previously explored). To measure the feasibility of each operation scheme, an objective function that considers security and economy is established. BOA attempts to obtain the optimal operation scheme with maximum of the objective function in as few iterations as possible. To verify the proposed method, all main pump powered off fault is simulated by RELAP5 code. The optimal operation scheme of the fault is applied, the transient result shows that all key parameters are within safe limits and SMR is maintained at relatively high power, which means that BOA has the decision-making capability to get an optimal operation scheme on fault conditions.

Effect of an upstream grid on the fluidization of pharmaceutical carrier powders

The influence of grid generated mixing on the fluidization of pharmaceutical carrier powders is studied in a channel-flow experiment using direct high-speed imaging and particle image velocimetry (PIV). Four different lactose powders with mass median diameters that range between 61 µm and 121 µm are used. The degree of powder mixing in the flow as a function of grid position relative to the powder bed and grid area blockage ratios (ranging from ~25% to ~40%) is studied for a range of flow-rates. The study presents comprehensive mappings of how pharmaceutical powders are fluidised under the influence of mixing, by examining powder bed morphology, powder emptying rate, and the local flow-field surrounding the pocket. The use of a grid results in higher evacuation percentages (void fraction) and a faster evacuation rate but is associated with randomized evacuation behaviour as observed from the powder bed morphology. Use of a grid can enable evacuation of powder at lower overall flow-rates, which may have important implications on respiratory drug delivery. PIV results show the trend of mean velocities with the mass median powder diameter and demonstrates how a grid with lower blockage ratio can increase the degree of mixing of the evacuating powder and make the evacuation process more rapid. This study contributes towards a better understanding of fluidization processes as relevant to dry powder inhaler devices and sheds light on how simple design alterations, such as adding an upstream grid, can be incorporated to optimise device effectiveness.

Calf starter containing a blend of essential oils and prebiotics affects the growth performance of Holstein calves

Essential oils extracted from specific plants can exhibit antimicrobial properties that make them potential antibiotic alternatives. The objective was to evaluate an essential oil and prebiotic combination (EOC) on the growth, development, and health status of growing neonatal calves. Forty Holstein newborn calves were blocked by birth date and alternately assigned to 1 of 2 treatments. Treatments were a pelleted calf starter (CS) without (control) or with EOC at 44.1 ppm. Calves were fed the experimental CS for ad libitum consumption from 3 d of age through the end of the 70-d experiment. Calves were fed 2 L of whole milk twice daily to 10 d of age, then 3 L twice daily through d 35, and then fed 3 L once daily with abrupt weaning occurring after 42 d of age. The average daily gain (0.78 and 0.87 kg/d for control and EOC, respectively) was greater for calves fed EOC compared with calves fed the control. Calves fed EOC demonstrated greater dry matter intake (1.63 and 1.74 kg/d) compared with calves fed the control. Feed conversion ratio (0.62 and 0.65 kg of gain/kg of dry matter intake) was greater for calves fed EOC compared with calves fed the control. At 70 d of age, calves fed EOC demonstrated increased body frame measurements (hip height, body length, heart girth, abdominal girth, and pastern) compared with calves fed the control. The incidence of scours score 4 (mild diarrhea) was 3.5 incidences lower for calves fed EOC compared with calves fed the control, whereas the incidence of scours score 5 (severe diarrhea) for calves fed EOC was 0.5 incidences lower than calves fed the control. Blood concentrations of IgG and IgM on d 14, IgA on d 28, and total serum protein on d 42 were all greater for calves fed EOC compared with calves fed the control. The blood volatile fatty acid concentrations were greater for calves fed EOC compared with calves fed the control, which indicated enhanced ruminal development. Total-tract digestibility of dry matter, crude protein, acid detergent fiber, neutral detergent fiber, starch, and many minerals were increased for calves fed EOC compared with calves fed the control. The inclusion of an EOC blend into a CS demonstrates promising benefits for enhancing calf growth, ruminal development, gut health, nutrient digestibility, and immunity. The use of an EOC blend can be a plausible alternative to feeding subtherapeutic antibiotics for improving calf performance, health, and immunity.

lncRNA CCHE1 increased proliferation, metastasis and invasion of non-small lung cancer cells and predicted poor survival in non-small lung cancer patients

OBJECTIVE

Lung cancer is common cancer worldwide. Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancers. Thus, we studied whether long non-coding RNAs influence malignancy in NSCLC to discover new therapeutic targets for increasing the survival rate of NSCLC patients. lncRNA has been proven to be important in different cancer progression. In this study, we mainly focused on the role of lncRNA CCHE1 (cervical carcinoma high expressed 1) expressed PCNA regulatory lncRNA in NSCLC cancer.

PATIENTS AND METHODS

qRT-PCR was used to detect the expression of CCHE1 in 126 cases of NSCLC tissue and adjacent tissue, and the clinical significance was also analyzed. Cell Counting Kit-8 (CCK8) assay was used to detect the proliferation ability of NSCLC cancer cell lines, and Western-blot was used to measure the expression of the protein when the expression of CCHE1 was suppressed.

RESULTS

We found that the CCHE1 was highly expressed in the NSCLC tissue, compared with the adjacent tissue. We also found that the expression of CCHE1 was closely related to the size and survival time of patients. Moreover, CCHE1 could promote the proliferation, metastasis, and invasion of NSCLC cell line via increasing the expression of ERK/MAPK signaling pathway.

CONCLUSIONS

According to the results, we found that CCHE1 was closely related the progression of NSCLC, which could be a potential target for treating NSCLC.

[Effect of optimized preoperative dietary management in patients with consecutive operation of robot-assisted radical prostatectomy at night]

Objective: To investigate the effect of optimized preoperative dietary management on enhanced recovery in patient with consecutive operation of robot-assisted radical prostatectomy(RARP) at night. Methods: Forty patients undergoing consecutive operation of robot-assisted radical prostatectomy at night in the department of urology in our hospital from Jun 2018 to March 2019 were divided into two groups, 23 patients in the study group and 17 patients in the control group. The control group followed the traditional fasting program at 24∶00 p.m. the day before the surgery. In the study group, the preoperative fasting procedure was optimized. The fasting time, water deprivation time, intravenous infusion volume, scores of hunger and thirst, blood glucose level, length of postoperative hospital stay and adverse reactions were compared between two groups. The level of hunger and thirst were evaluated using the Likert score. Results: The preoperative fasting time and water deprivation time of the study group and the control group were (11.9±4.4 vs 19.3±4.8) h and (6.0±2.9 vs 19.3±4.8) h, respectively (P<0.01). The infusion volume of study group was (406.5±310.5) ml and that of control group (744.1±443.0) ml, the difference was statistically significant (P<0.01). The hunger and thirst scores of the study group were lower than those of the control group before surgery, and the postoperative hospital stay was shorter than the control group (P<0.05). Conclusion: The optimized preoperative dietary management shortens fasting and water deprivation time, reduces the intravenous infusion volume, relieves the hungry and thirsty in patients with consecutive operation of robot-assisted radical prostatectomy at night.

Integrating transcriptome-wide association study and mRNA expression profiling identified candidate genes and pathways associated with osteomyelitis

Objective: Osteomyelitis (OM) is an acute or chronic inflammatory process, characterized by severe inflammation and progressive bone destruction. Limited efforts have been made to explore the genetic basis of OM.Method: The genome-wide association study data set of OM was obtained from the UK Biobank. A transcriptome-wide association study (TWAS) of OM was conducted by the FUSION tool using the gene expression reference weights of lymphocytes and blood. The OM-associated genes identified by TWAS were subjected to gene ontology (GO) enrichment analysis to explore OM-related gene sets. The TWAS results of OM were finally compared with a genome-wide mRNA expression profiling of OM to detect common genes and gene sets.Results: TWAS of OM detected 86 genes for lymphocytes and 387 genes for blood. Comparing the genes identified by TWAS and mRNA expression profiling detected eight common genes for OM, including VWF (p_TWAS = 0.0030, p_mRNA = 3.44 × 10^-9), CCDC50 (p_TWAS = 0.0130, p_mRNA = 0.0003), and TPD52 (p_TWAS = 0.0180, p_mRNA = 1 × 10^-6). GO analysis of the genes identified by TWAS detected multiple OM-associated GO terms, e.g. peroxisomal matrix (p_TWAS = 0.0082), extracellular exosome (p_TWAS = 0.0248), and monooxygenase activity (p_TWAS = 0.0040). Further comparing the GO results of TWAS and mRNA expression profiling detected one common GO term, named extracellular exosome (p_TWAS = 0.0248, p_mRNA = 0.0027).Conclusion: This integrative study of TWAS and mRNA expression profiling detected multiple candidate genes and GO terms for OM. Our results provide novel clues for understanding the pathogenesis of OM.

P2258Pulse wave velocity, total arterial compliance, and cardiac structure and function in late life

Background

Coupled abnormalities in arterial and left ventricular (LV) stiffness characterize aging and heart failure with preserved ejection fraction. We hypothesized that two measures of aortic stiffness, pulse wave velocity (PWV; reflecting segmental arterial wall stress in late systole) and total arterial compliance (TAC; reflecting distensibility of entire arterial system) differentially relate to cardiac structure and function in the elderly.

Methods

Among participants in the Atherosclerosis Risk In Community (ARIC) study, we assessed the cross-sectional relationship of carotid-femoral PWV (cfPWV) and TAC with echocardiographic measures of cardiac structure and function using multivariable linear regression adjusting for demographics and co-morbidities. TAC defined as stroke volume over pulse pressure [mL/mmHg]. Exclusions were LVEF <50%, prevalent HF, ≥moderate valvular disease.

Results

Of the 4,141 participants included in this study, mean age was 75±5 years, 41% were male, and 80% were white. Mean values were: cfPWV: 11.7±3.4 m/sec; TAC: 1.1±0.3 mL/mmHg. Greater cfPWV was associated with greater LV mass, worse systolic function, and worse diastolic function (Table). In contrast, worse TAC was not related to LV structure and did not demonstrate consistent relationships with measures of LV diastolic function, but was associated with worse LV longitudinal strain.

Echo measures cfPWV (1SD increase) TAC (1SD decrease) β Coefficient p-value β Coefficient p-value Cardiac structure Mean wall thickness, cm 0.10 <0.001 -0.01 0.499 LVMI, g/m2 0.04 0.016 0.02 0.299 LVEDVI, ml/m2 -0.07 <0.001 -0.02 0.332 LV systolic function LVEF (Simpson's), % -0.04 0.01 -0.16 <0.001 Longitudinal strain, % 0.14 <0.001 0.19 <0.001 LV diastolic function Septal e', cm/sec -0.08 <0.001 -0.02 0.169 E/e' septal 0.04 0.005 -0.02 0.138 LAVI, ml/m2 -0.05 0.003 -0.04 0.026

Conclusion

Two non-invasive measures of aortic stiffness, cfPWV and TAC, demonstrate differential associations with LV structure and function in late life. Greater cfPWV is more robustly associated with LV structure and function than TAC.

[Impact of solid tumor history on treatment response and survival of patients with diffuse large B-cell lymphoma]

Objective: To observe whether the history of solid tumors affects the treatment response and survival situation of patients with diffuse large B-cell lymphoma (DLBCL) . Methods: A retrospective study was conducted in 836 patients with DLBCL who were treated in the Department of Hematology at Ruijin Hospital from 2013 to 2018. Among them, 34 DLBCL patients who had the history of solid tumors were classified into double cancer group. From 802 patients without history of solid tumors, 68 DLBCL patients were selected as control group, using 1∶2 matching on propensity scores for age, gender, IPI score and etc. All patients included in the study had follow-up interviews through medical record and telephone for mortality from any cause. Treatment response and 3-year overall survival (OS) and progression-free survival (PFS) of two groups were analyzed. Results: The complete remission rates after RCHOP (Rituximab+Cyclophosphamide+Vincristine+Adriamycin 50 mg/m(2) or Epirubicin or Liposome Adriamycin+Prednisone) regimen were 79.4% and 67.6% in the double cancer group and the control group, respectively (P=0.210) . Among the 102 patients, 6 patients died in the double cancer group while 24 patients died in the control group and the median survival time of both two groups were not reached. The 3-year OS were (74.7±9.5) % and (63.5±6.1) % (χ(2)=2.791, P=0.095) , while 3-year PFS were (72.1±8.8) % and (54.3±6.4) % (χ(2)=1.400, P=0.237) in the double cancer group and the control group, respectively. Conclusion: The history of solid tumors didn't affect DLBCL patients' treatment response and short-term survival.

Ambient ammonia does not appear to inhibit the immune response to infectious bronchitis virus vaccination and protection from homologous challenge in broiler chickens

Commercial broilers are commonly exposed to gaseous ammonia (NH₃) originating from degradation of nitrogen-containing excreta in the litter during the grow-out period. Ammonia concentrations in the air are higher in poorly ventilated houses and appear to coincide with the elevated incidence of respiratory disease occurring during the winter months. This study examined the effect of NH₃ on the immune response to infectious bronchitis virus (IBV) vaccination and protection against homologous serotype challenge in commercial broiler chickens. One-day-old chicks were administered IBV vaccine and exposed to 30-60 ppm of NH₃. At 28 DOA, birds were challenged oculonasally with a pathogenic homologous IBV, and protection was measured by viral detection, clinical signs, ciliostasis, and presence of airsacculitis. IBV-specific serum IgG and lacrimal fluid IgA titers, as well as Harderian gland (HG) immune cell phenotypes, were evaluated. Ammonia exposure was associated with an increased incidence of airsacculitis among non-vaccinated, challenged birds. Vaccinated, NH₃-exposed birds were completely protected from IBV challenge. Ammonia had subtle effects on cilia morphology and function but did not affect vaccine or challenge virus replication and clearance, clinical signs, ciliostasis, tracheal histopathology scores, or immune responses. In the HG of vaccinated birds, the percent of leukocytes, MHC I⁺/MHC II^hi expression, IgM⁺ expression, and CD8⁺ expression was increased, while mucosal IgA and serum IgG titers were nominal. Non-vaccinated, IBV-challenged birds exhibited an increased percent of leukocytes, MHC I⁺/MHC II^hi expression, and IgM⁺ expression in the HG at 5 dpc, followed by increased mucosal IgA and serum IgG titers and CD8⁺ expression at 10-14 dpc. In contrast, vaccinated, IBV-challenged birds had a minimal increase in MHC I⁺/MHC II^hi expression, and serum IgG antibody titers in vaccinated birds increased rapidly. The results indicate that commercial broilers exposed to moderate levels of ambient NH₃ are equally protected against IBV challenge if appropriately vaccinated, and the absence of robust immune activation in vaccinated, challenged birds suggests that the challenge virus was efficiently neutralized before establishing infection. In contrast, ambient NH₃ exposure was associated with a higher incidence of airsacculitis in non-vaccinated, challenged birds, despite the apparent lack of differences in the immune response between birds in the NH₃-exposed and NH₃ control groups.

Integrating transcriptome-wide association study and mRNA expression profiling identifies novel genes associated with bone mineral density

To scan novel candidate genes associated with osteoporosis, a two-stage transcriptome-wide association study (TWAS) of bone mineral density (BMD) was conducted. The BMD-associated genes identified by TWAS were then compared with the gene expression profiling of BMD in bone cells, B cells, and mesenchymal stem cells. We identified multiple candidate genes and gene ontology (GO) terms associated with BMD.

INTRODUCTION

Osteoporosis (OP) is a metabolic bone disease characterized by decrease in BMD. Our objective is to scan novel candidate genes associated with OP.

METHODS

A transcriptome-wide association study (TWAS) was performed by integrating the genome-wide association study (GWAS) summary of bone mineral density (BMD) with two pre-computed mRNA expression weights of peripheral blood and muscle skeleton. Then, another independent GWAS data of BMD was used to verify the discovery results. The BMD-associated genes identified between discovery and replicate TWAS were further subjected to gene ontology (GO) analysis implemented by DAVID. Finally, the BMD-associated genes and GO terms were further compared with the mRNA expression profiling results of BMD to detect the common genes and GO terms shared by both DNA-level TWAS and mRNA expression profile analysis.

RESULTS

TWAS identified 95 common genes with permutation P value < 0.05 for peripheral blood and muscle skeleton, such as TMTC4 in muscle skeleton and DDX17 in peripheral blood. Further comparing the genes detected by discovery-replicate TWAS with the differentially expressed genes identified by mRNA expression profiling of OP patients found 18 overlapped genes, such as MUL1 in muscle skeleton and SPTBN1 in peripheral blood. GO analysis of the genes identified by discovery-replicate TWAS detected 12 BMD-associated GO terms, such as negative regulation of cell growth and regulation of glycogen catabolic process. Further comparing the GO results of discovery-replicate TWAS and mRNA expression profiles found 6 overlapped GO terms, such as membrane and cell adhesion.

CONCLUSION

Our study identified multiple candidate genes and GO terms for BMD, providing novel clues for understanding the genetic mechanism of OP.

[Prognostic study of 229 follicular lymphoma patients treated with rituximab combined with chemotherapy]

目的

探究滤泡性淋巴瘤（FL）的临床特征，以及FL国际预后指数（FLIPI）、FLIPI2、IPI、修正IPI（R-IPI）、NCCN-IPI在中国FL患者的预后意义。

方法

对2008年11月至2018年4月期间以利妥昔单抗联合CHOP（环磷酰胺、多柔比星、长春新碱及泼尼松）方案治疗的229例初治FL患者资料进行回顾性分析，并对所有患者进行各项预后指数评分。对201例完成化疗且有完整随访记录的患者进行单因素及多因素生存分析。

结果

229例患者中男126例，女103例，中位年龄53（21~82）岁。①对上述预后评分系统中所含的危险因素在患者总生存（OS）和无进展生存（PFS）中的影响进行分析，单因素分析结果显示：年龄>60岁、HGB<120 g/L、血β₂微球蛋白升高、骨髓浸润及C反应蛋白（CRP）升高是影响患者OS和PFS的不良因素（P值均<0.05），利妥昔单抗维持组（RM）与非维持组（non-RM）患者的5年OS率分别为93.33%、87.10%（P=0.020），5年PFS率分别为90.81%、63.47%（P=0.003），前者均优于后者；多因素分析结果显示：HGB<120 g/L（P=0.001）、骨髓浸润（P=0.050）、CRP升高（P=0.010）和non-RM（P=0.010）是影响OS的不良预后因素，HGB<120 g/L（P=0.003）、CRP升高（P=0.009）和non-RM（P=0.003）是影响PFS的不良预后因素。②对FLIPI和FLIP2评分预后模型进行比较分析，结果显示：FLIPI预后模型中，低危、中危和高危组患者的5年OS率（P=0.230）和5年PFS率（P=0.160）差异均无统计学意义。FLIP2预后模型中，5年OS率和5年PFS率差异均有统计学意义（P值均<0.001），在利妥昔单抗治疗组中进行分析，低危、中危和高危组患者的5年OS率分别为96.77%、88.89%、80.00%，差异有统计学意义（P=0.042）。

结论

利妥昔单抗时代FLIPI2可以更好地用于FL危险分层。