Interplay between the Reorientational Dynamics of the B3H8 - Anion and the Structure in KB3H8

The structure and reorientational dynamics of KB₃H₈ were studied by using quasielastic and inelastic neutron scattering, Raman spectroscopy, first-principles calculations, differential scanning calorimetry, and in situ synchrotron radiation powder X-ray diffraction. The results reveal the existence of a previously unknown polymorph in between the α'- and β-polymorphs. Furthermore, it was found that the [B₃H₈]^- anion undergoes different reorientational motions in the three polymorphs α, α', and β. In α-KB₃H₈, the [B₃H₈]^- anion performs 3-fold rotations in the plane created by the three boron atoms, which changes to a 2-fold rotation around the C ₂ symmetry axis of the [B₃H₈]^- anion upon transitioning to α'-KB₃H₈. After transitioning to β-KB₃H₈, the [B₃H₈]^- anion performs 4-fold rotations in the plane created by the three boron atoms, which indicates that the local structure of β-KB₃H₈ deviates from the global cubic NaCl-type structure. The results also indicate that the high reorientational mobility of the [B₃H₈]^- anion facilitates the K⁺ cation conductivity, since the 2-orders-of-magnitude increase in the anion reorientational mobility observed between 297 and 311 K coincides with a large increase in K⁺ conductivity.

MicroRNA-429 inhibits the proliferation and migration of esophageal squamous cell carcinoma cells by targeting RAB23 through the NF-κB pathway

OBJECTIVE

Esophageal squamous cell carcinoma (ESCC) is the main type of esophageal cancer and is a devastating malignancy. Recent research shows that microRNA-429 (miR-429) has a role in suppressing cell proliferation, cell cycle and promoting apoptosis in many cancers. This study aims to explore the great role of miR-429 in esophageal squamous cell carcinoma.

MATERIAL AND METHODS

The mRNA and protein levels of miR-429 and genes were calculated by using Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) and Western blot. We applied Cell Counting Kit-8 (CCK-8) and transwell assays to measure the proliferative and migratory abilities. Meanwhile, the Kaplan-Meier method was used to calculate the overall survival of esophageal squamous cell carcinoma patients.

RESULTS

MiR-429 was downregulated while RAB23 was upregulated in ESCC tissues and cell lines, and downregulation of miR-429 predicted poor prognosis in ESCC. RAB23 was found to be a direct target gene of miR-429 and its expression was regulated by miR-429 in ESCC. Moreover, miR-429 inhibited the proliferation through nuclear factor-kappa B (NF-κB) pathway and inhibited cell migration-mediated epithelial-mesenchymal transition (EMT) in TE-2 cells. In addition, overexpression of miR-429 suppressed tumor growth of ESCC in vivo.

CONCLUSIONS

MiR-429 inhibited the proliferation through the RAB23/NF-κB pathway and the migration-mediated EMT in ESCC. The newly identified miR-429/RAB23 axis provides novel insight into the pathogenesis of ESCC.

[Efficacy and safety of Kangbingdu granules in the treatment of influenza: a randomized, double-blind, double-dummy, positive-drug parallel control multicenter clinical trial]

Objective: To observe the efficacy and safety of Kangbingdu granules (KBD) in the treatment of influenza. Methods: A multicenter, randomized, double-blind, double-dummy, and positive-drug parallel control trial was conducted in 27 Grade ⅢA hospitals in China and the subjects were randomly assigned to the KBD test group or the oseltamivir phosphate capsule control group at a ratio of 1∶1. 200 subjects were planned to be enrolled in each group. The experimental group was given KBD (18g each time, 3 times a day) and oseltamivir phosphate simulator orally, while the control group was given oseltamivir phosphate capsule (75 mg each time, twice a day) and KBD simulator orally for 5 days. The primary efficacy indicators included the remission time of major clinical symptoms and the time of complete defervescence. The secondary efficacy indicators included dosage of acetaminophen, the change of traditional Chinese medicine (TCM) syndrome score and the remission time of other important clinical symptoms. The efficacy of KBD in the test group and Oseltamivir phosphate control group were compared. Adverse events or adverse reactions were observed at the same time to evaluate the safety of KBD Granules. Results: A total of 393 subjects from 27 Grade ⅢA hospitals in China were enrolled. The experimental group included 195 subjects and 191 subjects (97.95%) completed the trial, While the control group included 198 subjects and 195 subjects (98.48%) completed the trial. There was no significant difference in the shedding rate and rejection rate between the two groups (P>0.05). In the Full Analysis Set (FAS), the mean age of the experimental group was (34.9±14.4) years old, with 83 males (42.78%). The mean age of the control group was (33.3±13.5) years old, with 78 males (39.59%). There were no statistically significant differences between the two groups in demographic data, physical examination, viral pathogen detection, total score of TCM syndromes and scores of each symptom at baseline (P>0.05). In the FAS, the remission time M (Q₁, Q₃) of major clinical symptoms was 3.0 (3.0, 4.0) days in the experimental group and 3.0 (3.0, 4.0) days in the control group, and the difference was not statistically significant (P>0.05). The time M (Q₁, Q₃) of complete defervescence was 34.0 (20.3, 49.0) hours in the experimental group and 36.5 (19.6, 48.8) hours in the control group, and the difference was not statistically significant (P>0.05). KBD granules had the same effect as Oseltamivir phosphate capsule (P>0.05) in terms of acetaminophen dosage, TCM syndrome effect and disappearance rate of most important clinical symptoms. Meanwhile, the disappearance rate of dizziness and chest distress on day 3 in the KBD granules group was better than that of oseltamivir phosphate capsule (P<0.05). Conclusion: KBD granules have the same efficacy as Oseltamivir Phosphate capsule in the treatment of influenza and the drug safety is good.

BMI modifies the association between serum HDL cholesterol and stroke in a hypertensive population without atrial fibrillation

PURPOSE

Both high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI) have an impact on the prevalence of stroke. However, it is unclear whether BMI can modify the relationship between HDL-C and stroke. Therefore, we aimed to assess the effect of the BMI on the association between HDL-C and stroke in a hypertensive population without atrial fibrillation (AF).

METHODS

We analyzed data of 10,925 hypertensive patients without AF from the Chinese Hypertension Registry Study. BMI was categorized as < 24 and ≥ 24 kg/m². Multivariate logistic regression and smooth curve fitting (penalized spline method) were used to analyze the association between HDL-C and stroke in different BMI groups. Subgroup analysis and interaction tests were used to explore the effect of other variables on this relationship.

RESULTS

The results showed a negative association between HDL-C and stroke in the BMI < 24 kg/m² group, but HDL-C was not associated with stroke in the BMI ≥ 24 kg/m² group. In the BMI < 24 kg/m² group, each 1 mmol/L increase in HDL-C was associated with a 50% decreased risk of stroke [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.38-0.66]. No significant relationship between HDL-C and stroke was observed in the BMI ≥ 24 kg/m² group (OR 0.73, 95% CI 0.49-1.10). There was a significant interaction between BMI and HDL-C in regard to the prevalence of stroke in the hypertensive population without AF (P_Interaction = 0.027).

CONCLUSIONS

We found an inverse association between HDL-C and stroke only in the BMI < 24 kg/m² group. The finding suggested that BMI could modify the association between HDL-C and stroke in hypertensive populations without AF.

LncRNA RHPN1-AS1 accelerates proliferation, migration, and invasion via regulating miR-485-5p/BSG axis in hepatocellular carcinoma

It is reported that long noncoding RNA RHPN1-AS1 (lncRNA RHPN1-AS1) functions as an oncogene among multiple types of cancers; however, the effect of lncRNA RHPN1-AS1 in hepatocellular carcinoma (HCC) is left to be investigated. The main purpose of this work was to study the effects of lncRNA RHPN1-AS1/miR-485-5p system on proliferation, migration, and invasion in HCC and future investigate the latent mechanisms. Our work found that lncRNA RHPN1-AS1 was observably up-regulated in HCC tissues and cell lines, especially HCCLM3 and SMMC-7721 cells. LncRNA RHPN1-AS1 knockdown decreased the capacity of proliferation, invasion, and migration in HCCLM3 and SMMC-7721 cells, which could be crippled by miR-485-5p inhibitor. Besides, the expression of basigin (BSG) was decreased after lncRNA RHPN1-AS1 silence, indicating the function of lncRNA RHPN1-AS1/miR-485-5p/BSG axis in HCC progression. Our study opens novel insights to help understand the mechanisms of lncRNA RHPN1-AS1/miR-485-5p/BSG axis in HCC progression, which may provide a new therapeutic target for HCC treatment.

[Risk factors for surgical site infection after emergency abdominal surgery: a multicenter cross-sectional study in China]

Objective: Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence. Methods: Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS. Results: A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ(2)=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ(2)=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ(2)=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ(2)=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ(2)=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ(2)=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ(2)=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions: For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

[Feasibility study of contrast injection scheme based on body mass and iodine flow rate in coronary computed tomography angiography with wide detector CT]

Objective: To investigate the feasibility of coronary computed tomography angiography (CCTA) with the individualized contrast medium injection scheme based on body mass and iodine flow rate by using wide detector CT at 100 kV. Methods: From May 2018 to July 2018,270 patients with clinically suspected coronary artery disease underwent CCTA in TEDA International Cardiovascular Hospital. They were randomly divided into three groups, 90 cases in each group: group A was 0.5 ml/kg, group B was 0.6 ml/kg, the flow rate of contrast medium injection in group A and group B was (body mass×25 mg)/the concentration of contrast medium,group C was 0.8 ml/kg and the flow rate of contrast medium was 5 ml/s. Iohexol (iodine concentration 350 mgI/ml) was used in all three groups. The CT values of the aorta root in the three groups, the CT value of the middle segment of LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery and effective dose (ED) were compared. Results: There was no significant difference in CT value of aortic root, CT value of middle LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery among group A, group B and group C (all P>0.05). The flow rates of the three groups of contrast agents were statistically different (4.5±0.5 vs 4.5±0.5 vs 5, P=0.015), and there was no statistical difference between group A and group B (P>0.05) but lower than group C (P=0.015); the amount of contrast agent in the three groups was statistically different (32±3 vs 38±4 vs 53±7, P<0.001), group A<B Group<C group; there was no significant difference in ED between the three groups (1.5±0.5 vs 1.5±0.6 vs 1.3±0.6, P=0.613). Conclusions: CCTA imaging with a wide body detector based on a 0.5 ml/kg contrast agent dosage and a flow rate of ((body mass × 25)/350) ml/s individualized injection scheme can ensure the image quality while reducing the total amount of contrast agent and realizing individualized iodine flow rate.

A Phase 1 randomized study compare the pharmacokinetics, safety and immunogenicity of HLX02 to reference CN- and EU-sourced trastuzumab in healthy subjects

PURPOSE

This study evaluated the bioequivalence of China-manufactured biosimilar, HLX02, to reference China (CN)- and European Union (EU)-sourced trastuzumab.

METHODS

This was a two-part Phase 1 study conducted in healthy Chinese males. Part 1 evaluated the safety of different doses of HLX02 (2, 4, 6 or 8 mg/kg; intravenous infusion over 90 min, n = 3 per group). Part 2, a randomized, double-blind study, investigated the pharmacokinetics (PK), safety and immunogenicity of study drugs (HLX02 [n = 37], CN-trastuzumab [n = 35] or EU-trastuzumab [n = 37] at the dose suggested by Part 1 results). The primary PK endpoint was the area under the serum concentration-time curve from time 0 to infinity (AUC_inf). Equivalence was concluded if the 90% confidence interval (CI) for the geometric least squares mean ratio (GLSMR) fell in the equivalence criteria of 0.80-1.25.

RESULTS

In Part 1, all doses of HLX02 were well tolerated and 6 mg/kg was suggested for Part 2. The GLSMRs and 90% CIs for AUC_inf were: 0.950 (0.891-1.013), 0.914 (0.858-0.973) and 0.962 (0.902-1.025) for HLX02 versus CN-trastuzumab, HLX02 versus EU-trastuzumab and CN-trastuzumab versus EU-trastuzumab, respectively. Secondary endpoints comparisons also fell in the equivalence criteria. Treatment-emergent adverse events were reported in 75.7, 86.5 and 70.3% of the subjects in HLX02, CN-trastuzumab, and EU-trastuzumab groups, respectively. No serious adverse events or deaths occurred. No treatment-related anti-drug antibodies were detected.

CONCLUSION

This study demonstrated comparable safety profiles and PK bioequivalence among HLX02, CN-trastuzumab and EU-trastuzumab in healthy Chinese male subjects.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT02581748, registered at October 19, 2015.

2D shear wave elastography combined with age and serum biomarkers prior to kasai surgery predicts native liver survival of biliary atresia infants

BACKGROUND

The prognosis of patients with biliary atresia (BA) after Kasai portoenterostomy (KPE) varies, and precisely predicting the outcomes of KPE before surgery is still challenging.

METHODS

A total of 158 patients who underwent KPE in our hospital were included in this study. The patients in the training cohort were recruited from January 2012 to October 2017 (n = 118), and then, those in the validation cohort were recruited from November 2017 to April 2019 (n = 40). Combined nomogram models were developed based on two-dimensional shear wave elastography (2D SWE) values and other biomarkers. The utility of the proposed models was evaluated by C-index.

RESULTS

2D SWE played a potentially important role in predicting native liver survival (NLS) of BA patients with a C-index of 0.69 (0.63 to 0.75) in the training cohort and 0.76 (0.67 to 0.85) in the validation cohort. The nomogram A based on 2D SWE values, age, gamma-glutamyl transferase (GGT) and aspartate aminotransferase-to-platelet ratio (APRI) had a better C-index in the training cohort [0.74 (0.68-0.80) vs. 0.66 (0.60-0.73), P = 0.017] and in the validation cohort [0.78 (0.70-0.86) vs. 0.60 (0.49-0.71), P = 0.002] than the nomogram B (without 2D SWE). Using risk score developed from nomogram A, we successfully predicted 88.0% (22/25) of patients in the training cohort and 75.0% (9/12) in the validation cohort to have survival time of less than 12 months after KPE.

CONCLUSION

The combined nomogram model based on 2D SWE values, age, GGT and APRI prior to KPE can effectively predict NLS in BA infants.

Interobserver variability between experienced radiologists in evaluating the number of abnormal lymph nodes seen on preoperative axillary ultrasound

AIM

To determine the interobserver variability of experienced radiologists in evaluating the number of suspicious lymph nodes (LNs) seen on axillary ultrasound (AUS) examination, and to evaluate the effects of clinicopathological features on the discordance.

MATERIAL AND METHODS

A prospective non-randomised triple-blind study was conducted from July 2016 to December 2017 at Shanghai Ruijin Hospital. Three experienced radiologists performed AUS on 462 patients (469 axillae) with invasive breast cancer independently and assessed the number of abnormal LNs during the real-time AUS examination. Interobserver agreement was determined according to the kappa statistic.

RESULTS

The mean numbers of metastatic LNs on final histology study were 0.35, 0.98, 3.05 and 4.70 for patients with 0, 1, 2 and >2 abnormal nodes on preoperative AUS. When the cut-off (the number of abnormal LNs seen on AUS was >1) at which the maximal sum of sensitivity and specificity for diagnosis of ≥3 tumour-involved LNs was achieved was applied, the Az values ranged from 0.776 to 0.811. When the number of abnormal LNs was grouped into two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS), good interobserver agreement (kappa: 0.601-0.687) was found, and disagreement between the radiologists was more frequently found in patients with T2-stage tumour and in those with one or two tumour-involved nodes.

CONCLUSION

Abnormal LN count according to two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS) was a feasible method with good accuracy and high repeatability to select patients with heavy nodal disease in the post-Z0011 trial era.

[Three-dimensional imaging study on the anatomical morphology of trabecular bone of the condyle based on the distribution of volume of interests]

Objective: To analyze the anatomical morphological characteristics of the trabecular bone of human mandibular condyle by observing the distribution of volume of interests (VOI). Methods: The micro-CT images of a right condyle specimen of a 61-year-old adult male was analyzed in this study. The cylindrical VOI with both diameter and height of 2 mm were arranged, according to a certain pattern, as many as possible at various levels within the trabecular bone of the condyle. Each VOI had no intersection area. The selected VOI were divided into 5 parts: medial part, middle part, lateral part, anterior part and posterior part, with 6 layers from top to bottom. And the distribution of the overall anatomical morphological characteristics of three-dimensional (3D) images of the trabecular bone of the condyle was analyzed by using seven morphological parameters of each VOI, i.e. bone mineral density (BMD), bone volume/total volume (BV/TV), bone surface area/bone volume (BS/BV), trabecular thickness (Tb.Th), trabecular bone number (Tb.N), trabecular spacing (Tb.Sp) and trabecular bone pattern factor (Tb.Pf). Results: In the present study, totally 34 VOI were selected from the condyle specimen.The morphological distribution of the VOI was uneven in the 3D structure of the trabecular bone of the human condyle. BMD, BV/TV, Tb.N and Tb.Th were much higher at the middle part, while showed the smallest at the medial part. The anterior part demonstrated much higher parameters than the posterior part at the first, second, fifth and sixth layers, respectively, however, the posterior part showed much higher parameters than the anterior part at the third and fourth layers, respectively. The BMD was much higher at the first [(332.66±97.11) mg/cm³] and sixth [(255.79±45.68) mg/cm³] layers, while the lowest at the second layer [(255.79±41.06) mg/cm³]. The BV/TV and Tb.N were much higher at the first layer, with the lowest at the fifth layer. The Tb.Th at the first layer [(0.11±0.03) mm] was much higher than the others, which were similarly lower. The BS/BV, Tb.Sp and Tb.Pf were lower at the first layer and much higher at the medial and lateral parts, while were lower at the middle and anterior parts. The posterior part demonstrated much higher BS/BV, Tb.Sp and Tb.Pf than the anterior part at the first, fifth and sixth layers, respectively. However, the anterior part showed much higher scores than the posterior part at the third and fourth layers, respectively. The ANOVA results showed that the 7 morphological parameters of VOI were not statistically significant amongst the 6 layers (P>0.05). However, the 6 out of the 7 parameters, i.e. BV/TV, BS/BV, Tb.Th, Tb.N, Tb.Sp and Tb.Pf, were statistically significant amongst the five parts (P<0.05), while the only parameter of BMD was not statistically significant (P>0.05). Conclusions: The anatomical distribution characteristics of the trabecular bone of condyle were analyzed by using 3D imaging measurement based on the VOI. The results showed uneven distributions and indicated that the method of dividing the trabecular bone of mandibular condyle into VOI sets, which accorded with its specific anatomical characteristics, was feasible for further reference.

[Predictive value of four score systems on the bleeding risk in atrial fibrillation patients treated with dabigatran]

Objective: To compare the predictive value of HAS-BLED, HEMORR₂HAGES, ATRIA and ORBIT scores on the bleeding risk in nonvalvular atrial fibrillation (NVAF) patients treated with dabigatran. Methods: Data of 942 NVAF patients participating a non-interventional prospective study of anticoagulant therapy with dabigatran, which was conducted in 12 centers from February 2015 to December 2017 in China, were analyzed. Complete HAS-BLED HEMORR₂HAGES, ATRIA and ORBIT bleeding risk scores data and follow-up data were available in the enrolled patients. The endpoint of the study was bleeding events occurred during a 6 months follow-up. Cox proportional hazards models were constructed to analyze the associations between HAS-BLED, HEMORR₂HAGES, ATRIA and ORBIT scores and risk of bleeding, and the area under the curve (AUC) of receiver operating characteristics curves (ROC) of each score was used to set the predictive value for bleeding risk. Results: Among the 942 patients, the mean age was (65.3±11.2) years old, 542 (57.5%) were males. A total of 93 (9.9%) bleeding events occurred during follow up, 89 (9.4%) events were minor bleeding, and 4 (0.4%) events were major bleeding. Patients with a high-risk HAS-BLED score had a 1.87-fold increased risk of bleeding compared with low-risk patients (HR = 2.87, 95% CI:1.26-6.51, P = 0.012). There was no statistically significant difference between low-medium-high-risk grading in other scoring systems and bleeding risk (all P>0.05). The AUC (95%CI) of HAS-BLED, HEMORR₂HAGES, ATRIA and ORBIT bleeding risk scores were 0.558 (0.525-0.590), 0.520 (0.487-0.553), 0.513(0.480-0.545), 0.523(0.490-0.555), respectively. The AUC of all bleeding score systems were of ≤ 0.700. Conclusion: Among the NVAF patients taking dabigatran in China, the HAS-BLED bleeding risk score is superior to other 3 bleeding risk score on predicting the bleeding risk in these patients, but its predictive value is still relatively low.

A genetic predictive model for precision treatment of diffuse large B-cell lymphoma with early progression

Background

Early progression after the first-line R-CHOP treatment leads to a very dismal outcome and necessitates alternative treatment for patients with diffuse large B-cell lymphoma (DLBCL). This study aimed to develop a genetic predictive model for early progression and evaluate its potential in advancing alternative treatment.

Methods

Thirty-two hotspot driver genes were examined in 145 DLBCL patients and 5 DLBCL cell lines using next-generation sequencing. The association of clinical features, cell-of-origin, double expression, positive p53 protein, and gene alterations with early progression was analyzed, and the genetic predictive model was developed based on the related independent variables and assessed by the area under receiver operating characteristic. The potential of novel treatment based on the modeling was investigated in in-vitro DLBCL cell lines and in vivo xenograft mouse models.

Results

The frequency of CD79B (42.86% vs 9.38%, p = 0.000) and PIM1 mutations (38.78% vs 17.71%, p = 0.005) showed a significant increase in patients with early progression. CD79B and PIM1 mutations were associated with complex genetic events, double expression, non-GCB subtype, advance stage and unfavorable prognosis. A powerful genetic predictive model (AUROC = 0.771, 95% CI: 0.689–0.853) incorporating lactate dehydrogenase levels (OR = 2.990, p = 0.018), CD79B mutations (OR = 5.970, p = 0.001), and PIM1 mutations (OR = 3.021, p = 0.026) was created and verified in the other cohort. This modeling for early progression outperformed the prediction accuracy of conventional International Prognostic Index, and new molecular subtypes of MCD and Cluster 5. CD79B and PIM1 mutations indicated a better response to inhibitors of BTK (ibrutinib) and pan-PIM kinase (AZD 1208) through repressing activated oncogenic signaling. Since the two inhibitors failed to decrease BCL2 level, BCL2 inhibitor (venetoclax) was added and demonstrated to enhance their apoptosis-inducing activity in mutant cells with double expression.

Conclusions

The genetic predictive model provides a robust tool to identify early progression and determine precision treatment. These findings warrant the development of optimal alternative treatment in clinical trials.

MiR-21 promotes fracture healing by activating the PI3K/Akt signaling pathway

OBJECTIVE

This study aims to elucidate the potential mechanism of micro ribonucleic acid (miR)-21 in promoting fracture healing.

MATERIALS AND METHODS

30 male Sprague-Dawley rats were randomly divided into group A (phosphate-buffered saline, PBS, n=10), group B (AntagomiR-21, n=10) and group C (AntagomiR-NC, n=10) according to the different treatments. The femoral fracture operation was performed in every rat, which was pathologically diagnosed via X-ray. After the successful modeling, 50 μL (2 nmoL) PBS, 50 μL AntagomiR-21 or 50 μL AntagomiR-NC was intraperitoneally injected into rats in group A, B or C, respectively. The above agents were injected once a week for 6 weeks. At 6 weeks, 3 rats were executed in each group, and the tissue at the fracture end was observed via hematoxylin-eosin (HE) staining. The fracture healing of rats was evaluated via imaging at 1 and 7 weeks. At the same time, the expression of miR-21 in the three groups was detected via Reverse Transcription-Polymerase Chain Reaction (RT-PCR), and the expression of phosphatidylinositol 3-hydroxy kinase (PI3K) and phosphorylated-serine/threonine-protein kinase B (p-Akt) in the three groups was detected via Western blotting.

RESULTS

According to the histological staining, the bone repair at the fracture end of rats in group B was not significant with fracture and poor continuity compared with those in group A and group C. The imaging evaluation revealed that in group B, the callus tissues were significantly reduced, the fracture line had undesirable healing. There were no displacement and loosening of internal fixation compared with group A and group C. Besides, RT-PCR showed that the miR-21 expression declined markedly in group B compared with that in group A and group C, and the differences were statistically significant (p<0.05). Western blotting manifested that the protein levels of PI3K and p-Akt also declined in group B compared with those in group A and group C, and there were statistically significant differences (p<0.05).

CONCLUSIONS

MiR-21 promotes the fracture healing in fractured rats by activating the PI3K/Akt signaling pathway.

Comparative metabolomic responses of low- and high-cadmium accumulating genotypes reveal the cadmium adaptive mechanism in Brassica napus

Recently, oilseed rape has gathered interest for its ability to withstand elevated metal contents in plant, a key feature for remediation of contaminated soils. In this study, comparative and functional metabolomic analyses using liquid chromatography/mass spectrometry were undertaken to explore the metabolic basis of this attribute under cadmium (Cd) stress. Results revealed both conserved and differential metabolomic responses between genotype CB671 (tolerant Cd-accumulating) and its sensitive counterpart ZD622. CB671 responded to Cd stress by rearranging carbon flux towards production of compatible solutes, sugar storage forms and ascorbate, as well as jasmonates, ethylene and vitamin B6. Intriguingly, IAA abundance was reduced by 1.91-fold, which was in connection with tryptophan funnelling into serotonin (3.48-fold rise). In ZD622 by contrast, Cd provoked drastic depletion of carbohydrates and vitamins, but subtle hormones alteration. A striking accumulation of unsaturated fatty acids and oxylipins in CB671, paralleled by glycerophospholipids build-up and induction of inositol-derived signalling metabolites (up to 5.41-fold) suggested ability for prompt triggering of detoxifying mechanisms. Concomitantly, phytosteroids, monoterpenes and carotenoids were induced, denoting fine-tuned mechanisms for membrane maintenance, which was not evident in ZD622. Further, ZD622 markedly accumulated phenolics from upstream sub-classes of flavonoids; in CB671 however, a distinct phenolic wiring was activated, prioritizing anthocyanins and lignans instead. Along with cell wall (CW) saccharides, the activation of lignans evoked CW priming in CB671. Current results have demonstrated existence of notable metabolomic-based strategies for Cd tolerance in metal-accumulating oilseed rapes, and provided a holistic view of metabolites potentially contributing to Cd tolerance in this species.

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

FRI0593 CORRELATION BETWEEN DISEASE ACTIVITY AND MENTAL HEALTH OF AS PATIENTS: A CROSS-SECTION STUDY WITH SELF-ASSESSMENTS BASED ON SMART SYSTEM OF DISEASE MANAGEMENT (SSDM) MOBILE TOOLS

Background:

WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. Ankylosing Spondylitis Disease Activity Score (ASDAS) and Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate AS patients’ disease activity and mental health. All those assessments were mainly performed by health professionals (HCPs) with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-assessments on ASDAS and HADS by mobile terminals.

Objectives:

To estimate the prevalence of anxiety and depression in Chinese patients with AS and to analyze the potential association between disease activity and mental health.

Methods:

Under the guidance and training by HCPs, AS patients downloaded SSDM and performed self-assessments bundle of ASDAS and HADS with SSDM. ASDAS<=1.3, 1.3-2.1, 2.1-3.5 and >3.5 are defined as inactive (IDA), moderate (MDA), high (HDA) and very high (VHDA) disease activity, respectively. ASDAS score <=1.3 represents inactive disease status and achievement of T2T. HADS score >=8 can be diagnosed with anxiety or depression.

Results:

From June 2016 to Jan 2020, 1,931 AS patients (1,118 male, 813 female) with a mean age of 34.09 ± 11.86 (12-82) years and the median disease duration of 2.61 years from 207 hospitals performed bundle self-assessments for 2,477 times in total. According to the HADS and ASDAS assessment results, the prevalence of anxiety and depression in all patients was 36.7% and 39.3% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on T2T was 29% and 71%, respectively. The prevalence of anxiety (A) and depression (D) was 25% and 23% among T2T achievers; and 37% and 32% among T2T failures, respectively (pA<0.05, pD<0.05).

According to ASDAS, in IDA, MDA, HDA and VHDA subgroups, the prevalence of anxiety and depression was 27%, 36%, 41%, 52% and 29%, 38%, 45%, 56%, respectively. The correlation coefficients of anxiety (A) and depression (D) with ASDAS were rA=0.9908 and rD=0.9964. It suggested that with the increase of disease activity, the proportion of AS patients with anxiety and depression increased significantly. (Figure 1)

Figure 1.

The prevalence of anxiety and depression according to ASDAS.

Conclusion:

The prevalence of anxiety and depression in AS patients was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. Higher prevalence of anxiety and depression were associated with higher levels of disease activity. SSDM is an effective mobile interface to monitor and study entanglement of disease activity and mental health in AS patients, which build a foundation for proactive interventions in future.

Acknowledgments:

Smart system of disease management (SSDM) was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

AB0380 THERAPEUTIC CHOICES AND OUTCOMES IN CHINESE PATIENTS WITH SEROLOGICALLY ACTIVE CLINICALLY QUIESCENT SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Patients with systemic lupus erythematosus (SLE) who achieved the clinical state as serologically active clinically quiescent (SACQ). It appears to account for 6–12% of all patients with SLE, but there is disagreement about whether such patients are indeed clinically stable [1-3], especially in Chinese patients. And there is no conclusion as to what kind of treatment should be taken for such patients.

Objectives:

To clarify the frequency and outcome of SACQ patients in lupus. And to identify factors associated with the flare of disease.

Methods:

Clinical data of patients diagnosed as SLE and followed in Peking University First Hospital from 2009 to 2015 were retrospectively reviewed. 682 patients with systemic lupus erythematosus who were followed up for more than 6 months at Peking University First Hospital from January 2007 to December 2015 were summarized. SACQ was defined as an at least a 6-month period with persistent serologic activity and without clinical activity and could be taking a daily dose of prednisone or equivalent less than 7.5 mg. Serologically quiescent clinically quiescent (SQCQ) patients and serologically active clinically active (SACA) patients served as control groups. Data including demographics, initial symptoms, duration to SACQ, treatments before and after SACQ, and characteristics of the flare group were analyzed.

Results:

Of the 682 patients, 170 were SACQ patients (24.9%), 187 were SQCQ patients, and 325 were SACA patients (47.7%). SQCQ patients (38.61±15.08 years old) were older at study start than SACQ patients (38.61±15.08 years vs. 32.09±14.35 years, p<0.001), but there was no significant difference between that of SACQ and SACA patients. 56 of the 170 SACQ patients (32.9%) experienced flare. Corticosteroids (OR 1.317, 95% CI 1.131 to 1.534; p<0.001) was an independent risk factor for flare, while antimalarials (OR 0.265, 95% CI 0.118 to 0.599; p=0.001) and immunosuppressants (OR 0.316, 95% CI 0.149 to 0.670; p=0.003) were protective factors.

Conclusion:

About one third of SLE patients with SACQ experience flare, more than that of patients with SQCQ. Thus, approach to prevent relapse in SACQ patient is required. Maintenance therapy of hydroxychloroquine and immunosuppressant agents may be protective and beneficial treatment strategy in these patients need further investigation.

References:

[1]Gladman DD, Urowitz MB, Keystone EC. Serologically active clinically quiescent systemic lupus erythematosus: a discordance between clinical and serologic features. Am J Med 1979; 66:210-5.

[2]Huang WN, Tso TK, Wu HC, Yang HF, Tsay GJ. Impaired phagocytosis of apoptotic cell material in serologically active clinically quiescent patients with systemic lupus erythematosis. Int J Rheum Dis 2016; 19:1310-6.

[3]Steiman AJ, Gladman DD, Ibañez D, Urowitz MB. Prolonged serologically active clinically quiescent systemic lupus erythematosus: frequency and outcome. J Rheumatol 2010; 37:1822-7.

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