Atomically Thin Bilayer Janus Membranes for Cryo-electron Microscopy

Cryo-electron microscopy (cryo-EM) has emerged as a vital tool to reveal the native structure of beam-sensitive biomolecules and materials. Yet high-resolution cryo-EM analysis is still limited by the poorly controlled specimen preparation and urgently demands a robust supporting film material to prepare desirable samples. Here, we developed a bilayer Janus graphene membrane with the top-layer graphene being functionalized to interact with target molecules on the surface, while the bottom layer being kept intact to reinforce its mechanical steadiness. The ultraclean and atomically thin bilayer Janus membrane prepared by our protocol on one hand generates almost no extra noise and on the other hand reduces the specimen motion during cryo-EM imaging, thus allowing the atomic-resolution characterization of surface functional groups. Using such Janus membranes in cryo-EM specimen preparation, we were able to directly image the lithium dendrite and reconstruct macromolecules at near-atomic resolution. Our results demonstrate the bilayer Janus design as a promising supporting material for high-resolution cryo-EM and EM imaging.

The transcriptional landscape of the clustered protocadherins in the cardiovascular system

Background

The alpha, beta and gamma clustered protocadherins (cPcdhs) genes encode homotypic cell adhesion molecules that are highly expressed in the brain. They are well described to be expressed in a combinatorial fashion to specify neuronal identity for coding synaptic connectivity. Unexpectedly, we recently uncovered evidence from studies in mice and human showing PCHDA variants can cause congenital heart defects. As all the genes of the alpha or gamma PCDH cluster share a common 3' end and are highly homologous, the expression of these gene clusters has been underestimated or overlooked due to multimapping issues. This is especially problematic in single cell RNAseq (scRNA) data generated using 3' based amplification protocols.

Methods and results

We constructed a modified bioinformatic pipeline for analyzing the cPcdhs transcripts (Fig. 1a). Raw data of Publicly available scRNA datasets were downloaded and re-processed and analyzed for expression of the cPCDH transcripts using our custom pipeline. Integrating 10 scRNA datasets of mouse heart tissues from embryonic 7.75 (E7.75) to postnatal 30 months (PM30) were performed by Harmony and Seurat. This showed Pcdhg had the highest expression among the three Pcdh gene clusters, with next being Pcdhb and then Pcdha (Fig. 1b). Pcdhb and Pcdhg were enriched in endocardial cells and fibroblasts (Fig. 1b). Unlike gene expression in neurons, expression of the cPcdhs in cardiac cell types did not shown the stochastic, sparse, combinatorial expression patterns seen in neurons (Fig. 1b). Despite the relatively low level of Pcdha expression in all cardiac cell types, it is intriguing that independent scRNA datasets showed Pcdha is expressed most highly in the atrium in the early embryo, possibly due to known atrial dominance in the early embryo (Fig. 1c). Pcdhb is highly expressed in the OFT and atrioventricular canal of both human and mouse heart, suggesting its perturbation may contribute to outflow tract or AV valve abnormalities (Fig. 1c-d). Consistent with our previous finding of an important role for the Pcdha gene cluster in left ventricular outflow obstructive (LVOTO) lesions, we observed expression of Pcdhg was broadly upregulated in the Adamts19 homozygous knockout mice exhibiting aortic valve dysfunction, a CHD phenotype in the LVOTO spectrum (Fig. 1e).

Conclusions

Using a new bioinformatics pipeline, we systematically mapped the transcriptional landscapes of cPcdhs during heart development using scRNA data. This revealed cell type-specific and anatomical characteristics in the expression of the different cPcdhs. These findings show the cPcdhs are transcriptionally regulated very differently in the cardiovascular system from regulation observed in the brain. The single cell transcriptional profile for the cPcdhs in the cardiovascular system can serve as the foundation for future investigations into the broader role of the cPcdhs in cardiovascular development and disease.

Funding Acknowledgement

Type of funding sources: None.

Single-cell transcriptome analysis yields new insights into the pathogenic mechanisms and possible genetic etiology of cardiomyopathies

Background

Inherited cardiomyopathies (CM) represent a clinically heterogeneous group of primary cardiac muscle disorders with a strong genetic underpinning. Recent rapid genomic advances have led to the identification of numerous disease-causing genes for both non-syndromic (nsCM) and syndromic (sCM) cardiomyopathies. This has greatly facilitated molecular genetic testing, thus enabling accurate disease diagnosis needed for the practice of precision medicine and the optimization of patient outcome. However, many cardiomyopathies remain unexplained with the known genes and dominant genetic model of disease.

Purpose

To reassess the genetic features of known CM genes as a strategy to recover novel candidate CM genes.

Methods

Known hypertrophic CM (HCM), dilated CM (DCM) and pediatric CM genes were curated from the literature and from 23 commercial CM diagnostic panels. They were classified as non-syndromic and syndromic, and further annotated using two constraint metrics, the missense Z score and pLI score obtained from the GnomAD database. Publicly available mouse (n=6) and human (n=3) single-cell RNA (scRNA) datasets were downloaded and cardiomyocyte specific differentially expressed genes (DEGs) (fold change >0.1; adjusted P<0.0001) were recovered. Genes identified as DEGs in at least 4 mouse or 3 human scRNA datasets were recovered as nsCM candidate genes.

Results

Analyses of 9 scRNA datasets showed the majority of known nsCM genes are cardiomyocyte specific (Fig. 1a-b). nsCM and sCM genes have distinct expression and genetic profile. nsCM genes are associated with higher heart expression and lower loss intolerance (Fig. 1c). In contrast, syndromic CM genes mostly showed lower expression with high loss intolerance, consistent with their higher clinical impact. However, interestingly some of the nsCM genes (MYLK2, TMPO and KLF10) show low or even no detectable expression in mouse and human cardiac cells. Using the scRNA data, we assessed cellular expression of genes in the 23 commercial CM diagnostic panels. This analysis showed some of the CM genes with high cardiomyocytes expression have low coverage on the current commercial CM panels (Fig. 1d). Using human and mouse scRNA data, we recovered 224 mouse and 157 human nsCM candidate genes. MTUS2 (microtubule-associated tumor suppressor candidate 2) was identified as a strong nsCM candidate gene supported by evidence from both mouse and human studies (Fig. 1e-f).

Conclusions

Our analysis showed many of the nsCM genes have differential cardiomyocyte expression with low loss intolerance, while the reverse was observed for many sCM genes. We propose increasing commercial panel coverage of cardiomyocytes-specific expressed genes may help increase disease diagnostic yield. Additionally, novel candidate genes uncovered trained on cardiomyocyte expression profile may help accelerate elucidation of unsolved cardiomyopathy cases.

Funding Acknowledgement

Type of funding sources: None.

Six-Year Follow-Up Outcomes of Catheter Ablation of Para-Hisian Accessory Pathways

Background: Ablation of para-hisian accessory pathways (APs) remains challenging due to anatomic characteristics, and a few studies have focused on the causes for recurrence of radiofrequency ablation of para-hisian APs.

Objective: This retrospective single center study aimed to explore the risk factors for recurrence of para-hisian APs.

Methods: One hundred thirteen patients who had para-hisian AP with an acute success were enrolled in the study. In the 6-year follow-up, 15 cases had a recurrent para-hisian AP. Therefore, 98 patients were classified into the success group, while 15 patients were classified into the recurrence group. Demographic and ablation characteristics were analyzed.

Results: Gender difference was similar in two groups. The median age was 36.2 years old and was younger in the recurrence group. Maximum ablation power was significantly higher in the success group (29 ± 7.5 vs. 22.9 ± 7.8, p < 0.01). Ablation time of final target sites was found to be markedly higher in the success group (123.4 ± 53.1 vs. 86.7 ± 58.3, p < 0.05). Ablation time <60 s was detected in 12 (12.2%) cases in the success group and 7 (46.7%) cases in the recurrence group (p < 0.01). Occurrence of junctional rhythm was significantly higher in the recurrence group (25.5% vs. 53.3%, p < 0.05). No severe conduction block, no pacemaker implantation, and no stroke were reported. Junctional rhythm during ablation (OR = 3.833, 95% CI 1.083–13.572, p = 0.037) and ablation time <60 s (OR = 5.487, 95% CI 1.411–21.340, p = 0.014) were independent risk factors for the recurrence of para-hisian AP.

Conclusions: With careful and accurate mapping, it is relatively safe to ablate para-hisian AP. If possible, proper extension of ablation time could reduce the recurrence rate of para-hisian APs.

Pulmonary artery pressure is associated with mid-term major adverse cardiovascular events and postprocedure pericardial effusion in atrial fibrillation patients undergoing left atrial appendage occlusion

Background

Patients with nonvalvular atrial fibrillation (NVAF) undergoing left atrial appendage occlusion (LAAO) are at high risk of stroke or bleeding. However, risk factors for their adverse cardiovascular events remain largely unknown. Pulmonary hypertension has been shown to be related to poor prognosis in many heart diseases. In this study, we determined whether elevated pulmonary artery systolic pressure (PASP) is associated with postprocedure adverse events and major adverse cardiovascular events (MACE) in these patients.

Methods

From June 2017 and December 2019, 530 consecutive patients with NAVF at high risk of stroke or bleeding who undergone LAAO were retrospectively enrolled in our study. The preprocecure PASP was obtained by transthoracic echocardiography using the simplified Bernoulli's equation. Patients were followed-up through clinic visits or over the phone at discharge at 1-3 months, 6 months, and annually thereafter. The median follow-up time was 12 months, and clinical data were analyzed. MACE was defined as myocardial infarction, definite heart failure, stroke, or all-cause death. The outcome of postprocedure pericardial effusion included in-hospital pericardial effusion and pericardial effusion detected after discharge.

Results

Univariate analyses indicated that patients who had MACE tended to have elevated PASP (P=0.005). After dividing the cohort according to the cut-off value of PASP, Kaplan-Meier curves indicated that patients with PASP ≥39.5 mmHg had a higher risk of MACE (P=0.007) and heart failure hospitalization (P=0.005) compared to patients whose PASP <39.5 mmHg. Cox regression analysis showed that PASP was a predominant risk factor of MACE (HR =2.337, 95% CI, 1.207-4.526, P=0.012) and heart failure hospitalization (HR =3.701, 95% CI, 1.118-12.251, P=0.032). Furthermore, the PASP cut-off added incremental discriminatory capacity to the MACE risk model of this cohort. In addition, logistic regression showed that PASP had as a significant association with postprocedure pericardial effusion (OR =1.061, P=0.032).

Conclusions

Elevated PASP was associated with postprocedure pericardial effusion and mid-term MACEs in patients with atrial fibrillation (AF) undergoing LAAO.

Mechanisms of instantaneous inactivation of SARS-CoV-2 by silicon nitride bioceramic

The hydrolytic processes occurring at the surface of silicon nitride (Si3N4) bioceramic have been indicated as a powerful pathway to instantaneous inactivation of SARS-CoV-2 virus. However, the virus inactivation mechanisms promoted by Si3N4 remain yet to be elucidated. In this study, we provide evidence of the instantaneous damage incurred on the SARS-CoV-2 virus upon contact with Si3N4. We also emphasize the safety characteristics of Si3N4 for mammalian cells. Contact between the virions and micrometric Si3N4 particles immediately targeted a variety of viral molecules by inducing post-translational oxidative modifications of S-containing amino acids, nitration of the tyrosine residue in the spike receptor binding domain, and oxidation of RNA purines to form formamidopyrimidine. This structural damage in turn led to a reshuffling of the protein secondary structure. These clear fingerprints of viral structure modifications were linked to inhibition of viral functionality and infectivity. This study validates the notion that Si3N4 bioceramic is a safe and effective antiviral compound; and a primary antiviral candidate to replace the toxic and allergenic compounds presently used in contact with the human body and in long-term environmental sanitation.

Robust d-Wave Superconductivity in the Square-Lattice t-J Model

Unravelling competing orders emergent in doped Mott insulators and their interplay with unconventional superconductivity is one of the major challenges in condensed matter physics. To explore the possible superconducting state in a doped Mott insulator, we study the square-lattice t-J model with both the nearest-neighbor and next-nearest-neighbor electron hoppings and spin interactions. By using the state-of-the-art density matrix renormalization group calculation with imposing charge U(1) and spin SU(2) symmetries on the six-leg cylinders, we establish a quantum phase diagram including three phases: a stripe charge density wave phase, a superconducting phase without static charge order, and a superconducting phase coexistent with a weak charge stripe order. Crucially, we demonstrate that the superconducting phase has a power-law pairing correlation that decays much slower than the charge density and spin correlations, which is a quasi-1D descendant of the uniform d-wave superconductor in two dimensions. These findings reveal that enhanced charge and spin fluctuations with optimal doping is able to produce robust d-wave superconductivity in doped Mott insulators, providing a foundation for connecting theories of superconductivity to models of strongly correlated systems.

[Relationship of quality and duration of sleep with hypertension among adults in Guangzhou]

Objective: To explore the relationship of sleep quality and sleep duration with hypertension among adults aged 30-79 years old in Guangzhou. Methods: According to multi-stage stratified cluster sampling, 12 747 residents aged 30-79 years old were sampled and surveyed in Guangzhou from January 2018 to March 2019. Data on general demographic characteristics, sleep quality, sleep duration and hypertension were collected through questionnaire survey, the Pittsburgh sleep quality index (PSQI) and physical examination. Multivariate logistic regression models were used to analyze the putative association between sleep quality, sleep duration and hypertension. Restrictive cubic spline curve was used to draw the dose-response relationship curve between sleep quality, sleep time and hypertension. Results: The mean age of the subjects was (52.68±12.17) years, the prevalence of hypertension was 36.6% (4 664/12 747), the average score of PSQI was (4.70±2.88), and the average sleep time was (7.00±1.32) hours. The prevalence of hypertension was positively associated with the PSQI score. Compared to the subjects with a score less than 3, OR (95%CI) of hypertension with a PSQI score of 3-5, 5-8, ≥9 were 1.14 (1.02-1.27), 1.17 (1.03-1.34), 1.41 (1.21-1.64), respectively. The relationship between sleep duration and hypertension appeared U-shaped. Compared with 6 to 8 hours sleep duration, both sleep duration<6 hours with OR(95%CI) of 1.27(1.12-1.43) or >8 hours with OR(95%CI) of 1.20(1.05-1.38) was associated with hypertension. Conclusion: Both poor sleep quality, longer or shorter sleep duration were responsible for increased risk of cognitive impairment in older Chinese.

High ionic conductivity Li0.33La0.557TiO3nanofiber/polymer composite solid electrolyte for flexible transparent InZnO synaptic transistors

With the rapid development of wearable artificial intelligence devices, there is an increasing demand for flexible oxide neuromorphic transistors with the solid electrolytes. To achieve high-performance flexible synaptic transistors, the solid electrolytes should exhibit good mechanical bending characteristics and high ion conductivity. However, the polymer-based electrolytes with good mechanical bending characteristics show poor ion conductivity (10^-6-10^-7S cm^-1), which limits the performance of flexible synaptic transistors. Thus, it is urgent to improve the ion conductivity of the polymer-based electrolytes. In the work, a new strategy of electrospun Li_0.33La_0.557TiO₃nanofibers-enhanced ion transport pathway is proposed to simultaneously improve the mechanical bending and ion conductivity of polyethylene oxide/polyvinylpyrrolidone-based solid electrolytes. The flexible InZnO synaptic transistors with Li_0.33La_0.557TiO₃nanofibers-based solid electrolytes successfully simulated excitatory post-synaptic current, paired-pulse-facilitation, dynamic time filter, nonlinear summation, two-terminal input dynamic integration and logic function. This work is a useful attempt to develop high-performance synaptic transistors.

Effect of Combined Atropine and Patching vs Patching Alone for Treatment of Severe Amblyopia in Children Aged 3 to 12 Years: A Randomized Clinical Trial

Importance

Patching is often less effective for severe amblyopia because of poor adherence. For the treatment of severe amblyopia, although combined atropine and patching therapy (CAPT) has been found to be efficacious, it is currently unknown whether CAPT is more efficacious than patching alone.

Objective

To compare the efficacy of CAPT vs patching alone in children aged 3 to 12 years with severe amblyopia.

Design, Setting, and Participants

This single-center randomized clinical trial was conducted from November 2018 to May 2020. The visual acuity (VA) examiner was masked to the treatment groups. The follow-up visits were at 3 months and 6 months. Participants aged 3 to 12 years with severe amblyopia (20/100 to 20/500) resulting from strabismus, anisometropia, or both were randomly assigned to CAPT or patching therapy.

Interventions

CAPT or patching alone for 6 months.

Main Outcomes and Measures

Change of the amblyopic eye VA from baseline to 6 months.

Results

Among 108 participants, the mean (SD) age was 5.2 (1.8) years, and 54 (50%) were female. Overall, 53 participants (49%) were randomized to CAPT and 55 (51%) were randomized to patching therapy. At baseline, the mean (SD) amblyopic eye VA was 0.95 (0.22) logMAR (approximately 20/200 [2.2 lines]). At 6 months, the CAPT group's mean improvement in amblyopic eye VA was 0.72 logMAR (7.2 lines) compared with 0.58 logMAR (5.8 lines) in the patching alone group (difference, 0.14 logMAR [1.4 lines] greater in the CAPT group; 95% CI, 0.05-0.22 logMAR [0.5-2.2 lines]; P = .002). The amblyopic eye VA improvement in the CAPT group also was greater than that in the patching alone group at 3 months (difference in the means, 0.13 logMAR [1.3 lines]; 95% CI, 0.04-0.22 logMAR [0.4-2.2 lines]; P = .004). No participants were withdrawn because of adverse effects.

Conclusions and Relevance

CAPT resulted in more mean improvement of amblyopic eye VA than patching alone among participants enrolled in this trial, although the clinical relevance of this relatively small VA difference cannot be determined from this trial.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR1800018663.

Nanosilicon enhances maize resistance against oriental armyworm (Mythimna separata) by activating the biosynthesis of chemical defenses

Silicon, in its nanoscale form, has shown plant-promoting and insecticidal properties. To date, however, we lack mechanistic evidence for how nanoscale silicon influences the regulation of plant chemical defenses against herbivore attacks. To address this gap, we compared the effect of Si nanodots (NDs) and sodium silicate, a conventional silicate fertilizer, on maize (Zea mays L.) chemical defenses against the oriental armyworm (Mythimna separata, Walker) caterpillars. We found that Si NDs and sodium silicate additions, at the dose of 50 mg/L, significantly inhibited the growth of caterpillars by 53.5% and 34.2%, respectively. This increased plant resistance was associated with a 44.2% increase in the production of chlorogenic acid, as well as the expression of PAL, C4H, 4CL, C3H and HCT, core genes involved in the biosynthesis of chlorogenic acid, by 1.7, 2.4, 1.9, 1.8 and 4.5 folds, respectively. Particularly, in the presence of M. separata, physiological changes in maize plants treated with 50 mg/L Si NDs, including changes in shoot biomass, leaf nutrients (e.g., K, P, Si), and chemical defense compounds (e.g., chlorogenic acid, total phenolics), were higher than those of plants added with equivalent concentrations of conventional silicate fertilizer. Taken together, our findings indicate that Si, in nanoscale form, could replace synthetic pesticides, and be implemented for a more effective and ecologically-sound management of insect pests in maize crop farming.

MiR-199a-5p suppresses proliferation and invasion of human laryngeal cancer cells

OBJECTIVE

To explore the roles of micro ribonucleic acid (miR)-199a-5p in the proliferation, apoptosis, invasion and metastasis of laryngeal cancer cells, and its molecular mechanisms.

PATIENTS AND METHODS

The expression of miR-199a-5p in 25 cases of laryngeal cancer tissues and paracancerous tissues was detected via quantitative real-time polymerase chain reaction (qRT-PCR). Its expression in TU212, TU686 and human epithelial type 2 (HEp-2) laryngeal cancer cell lines and normal nasopharyngeal epithelial cell line NP69 was also detected via qRT-PCR. HEp-2 cells were transiently transfected with miR-199a-5p mimic or miR-199a-5p inhibitor, and the expression of miR-199a-5p was verified using RT-PCR after transfection. The regulatory effects of miR-199a-5p on the proliferation, apoptosis, invasion and migration abilities of HEp-2 cells were observed through methyl thiazolyl tetrazolium (MTT) assay, flow cytometry, wound healing assay and transwell assay, respectively. Then, the mechanisms of miR-199a-5p in regulating Caspase-3 activity and epithelial-mesenchymal transition (EMT)-related proteins were further explored.

RESULTS

The qRT-PCR results revealed that miR-199a-5p was significantly lowly expressed in the laryngeal cancer tissues and tumor cell lines, and overexpression of miR-199a-5p substantially inhibited the proliferation of HEp-2 cells. According to the results of flow cytometry, overexpression of miR-199a-5p promoted the apoptosis of HEp-2 cells, whereas down-regulating miR-199a-5p suppressed their apoptosis. It was found that the activity of Caspase-3 was notably enhanced after overexpression of miR-199a-5p, which was evidently weakened after down-regulating miR-199a-5p. Wound healing assay and transwell assay results manifested that overexpressing miR-199a-5p weakened the invasion and migration abilities of HEp-2 cells, which were facilitated by down-regulating miR-199a-5p. Based on Western blotting results, miR-199a-5p regulated the expressions of E-cadherin, N-cadherin and vimentin. Overexpression of miR-199a-5p could inhibit EMT process, whereas suppressing miR-199a-5p could accelerate the process.

CONCLUSIONS

The expression of miR-199a-5p in laryngeal cancer tissues is substantially lower than that in the paracancerous tissues. MiR-199a-5p suppresses proliferation, invasion and migration in laryngeal cancer cell proliferation, while triggers cell apoptosis.

Effect of inferior oblique muscle belly transposition on versions and vertical alignment in primary position

PURPOSE

To evaluate the effect of inferior oblique muscle belly transposition (IOBT) on vertical deviation (VD) in primary position and inferior oblique overaction (IOOA).

METHODS

Twenty-eight patients who underwent unilateral IOBT for mild hypertropia (≤ 10^△) due to unilateral IOOA were included. Surgical results regarding the correction of hypertropia, IOOA, and fovea disc angle (FDA) were analyzed and compared between groups A (VD ≤ 5^△) and B (5^△ < VD ≤ 10^△).

RESULTS

IOBT showed an overall reduction of 5.86^△ (± 2.24^△) of primary position VD, a mean correction of 1.00 (± 0.27) of IOOA, and an average change of 1.83° (± 3.02°) of FDA. The surgical success rate of IOBT for VD correction and IOOA elimination in all patients was 68% and 71%, respectively. The correction of VD was correlated with preoperative VD significantly (r = 0.86, p < 0.001). Consistently, IOBT demonstrated comparable efficacy in reduction of VD between group A and group B (p = 0.507). Furthermore, the two groups were comparable in the success rates for correcting VD and IOOA (both p > 0.05). None of the patients developed consecutive hypotropia, postoperative contralateral IOOA, or anti-elevation syndrome postoperatively.

CONCLUSIONS

IOBT achieved satisfactory outcomes in patients with mild primary position VD (≤ 10^△) that is associated with unilateral IOOA, without any risk of overcorrection of VD and contralateral IOOA for a follow-up period of up to 12 months. This procedure is considered effective and safe alternative for weakening the IO in patients with appropriate surgical indications.

POS1189 THE IMPACT OF TELEMEDICINE AND COVID-19 ON A TERTIARY RHEUMATOLOGY SERVICE: A RETROSPECTIVE AUDIT

Background:

Telemedicine was widely utilised to complement face-to-face (F2F) care in 2020 during the COVID-19 pandemic, but the impact of this on patient care is poorly understood.

Objectives:

To investigate the impact of telemedicine during COVID-19 on outpatient rheumatology services.

Methods:

We retrospectively audited patient electronic medical records from rheumatology outpatient clinics in an urban tertiary rheumatology centre between April-May 2020 (telemedicine cohort) and April-May 2019 (comparator cohort). Differences in age, sex, primary diagnosis, medications, and proportion of new/review appointments were assessed using Mann-Whitney U and Chi-square tests. Univariate analysis was used to estimate associations between telemedicine usage and the ability to assign a diagnosis in patients without a prior rheumatological diagnosis, the frequency of changes to immunosuppression, subsequent F2F review, planned admissions or procedures, follow-up phone calls, and time to next appointment.

Results:

3,040 outpatient appointments were audited: 1,443 from 2019 and 1,597 from 2020. There was no statistically significant difference in the age, sex, proportion of new/review appointments, or frequency of immunosuppression use between the cohorts. Inflammatory arthritis (IA) was a more common diagnosis in the 2020 cohort (35.1% vs 31%, p=0.024). 96.7% (n=1,444) of patients seen in the 2020 cohort were reviewed via telemedicine. In patients without an existing rheumatological diagnosis, the odds of making a diagnosis at the appointment were significantly lower in 2020 (28.6% vs 57.4%; OR 0.30 [95% CI 0.16-0.53]; p<0.001). Clinicians were also less likely to change immunosuppressive therapy in 2020 (22.6% vs 27.4%; OR 0.78 [95% CI 0.65-0.92]; p=0.004). This was mostly driven by less de-escalation in therapy (10% vs 12.6%; OR 0.75 [95% CI 0.59-0.95]; p=0.019) as there was no statistically significant difference in the escalation or switching of immunosuppressive therapies. There was no significant difference in frequency of follow-up phone calls, however, patients seen in 2020 required earlier follow-up appointments (p<0.001). There was also no difference in unplanned rheumatological presentations but significantly fewer planned admissions and procedures in 2020 (1% vs 2.6%, p=0.002). Appointment non-attendance reduced in 2020 to 6.5% from 10.9% in 2019 (OR 0.57 [95% CI 0.44-0.74]; p<0.001), however the odds of discharging a patient from care were significantly lower in 2020 (3.9% vs 6%; OR 0.64 [95% CI 0.46-0.89]; p=0.008), although there was no significance when patients who failed to attend were excluded. Amongst patients seen via telemedicine in 2020, a subsequent F2F appointment was required in 9.4%. The predictors of needing a F2F review were being a new patient (OR 6.28 [95% CI 4.10-9.64]; p<0.001), not having a prior rheumatological diagnosis (OR 18.43 [95% CI: 2.35-144.63]; p=0.006), or having a diagnosis of IA (OR 2.85 [95% CI: 1.40-5.80]; p=0.004) or connective tissue disease (OR 3.22 [95% CI: 1.11-9.32]; p=0.031).

Conclusion:

Most patients in the 2020 cohort were seen via telemedicine. Telemedicine use during the COVID-19 pandemic was associated with reduced clinic non-attendance, but with diagnostic delay, reduced likelihood of changing existing immunosuppressive therapy, earlier requirement for review, and lower likelihood of discharge. While the effects of telemedicine cannot be differentiated from changes in practice related to other aspects of the pandemic, they suggest that telemedicine may have a negative impact on the timeliness of management of rheumatology patients.

Disclosure of Interests:

None declared.

Garlic skin induces shifts in the rumen microbiome and metabolome of fattening lambs

Garlic (Allium sativum L.) and its constituents have been shown to modify rumen fermentation and improve growth performance. Garlic skin, a by-product of garlic processing, contains similar bioactive components as garlic bulb. This study aimed to investigate the effects of garlic skin supplementation on growth performance, ruminal microbes, and metabolites in ruminants. Twelve Hu lambs were randomly assigned to receive a basal diet (CON) or a basal diet supplemented with 80 g/kg DM of garlic skin (GAS). The experiment lasted for 10 weeks, with the first 2 weeks serving as the adaptation period. The results revealed that the average daily gain and volatile fatty acid concentration were higher (P < 0.05) in lambs fed GAS than those in the CON group. Garlic skin supplementation did not significantly (P > 0.10) affect the α-diversity indices, including the Chao1 index, the abundance-based coverage estimator value, and the Shannon and Simpson indices. At the genus level, garlic skin supplementation altered the ruminal bacterial composition by increasing (P < 0.05) the relative abundances of Prevotella, Bulleidia, Howardella, and Methanosphaera and decreasing (P < 0.05) the abundance of Fretibacterium. Concentrations of 139 metabolites significantly differed (P < 0.05) between the GAS and the CON groups. Among them, substrates for rumen microbial protein synthesis were enriched in the GAS group. The pathways of pyrimidine metabolism, purine metabolism, and vitamin B6 metabolism were influenced (P < 0.05) by garlic skin supplementation. Integrated correlation analysis also provided a link between the significantly altered rumen microbiota and metabolites. Thus, supplementation of garlic skin improved the growth performance of lambs by modifying rumen fermentation through shifts in the rumen microbiome and metabolome.

11-year follow-up outcomes of catheter ablation of para-hisian accessory pathways

Funding Acknowledgements

Type of funding sources: None.

Background

Ablation of para-hisian accessory pathways (APs) remains challenging due to anatomic characteristics and few studies have focused on the causes for recurrence of radiofrequency ablation of para-hisian APs.

Objective

This retrospective single center study was aimed to explore the risk factors for recurrence of para-hisian APs.

Methods

113 patients who had a para-hisian AP with an acute success were enrolled in the study. In the 11-year follow-up, 15 cases had a recurrent para-hisian AP. Therefore 98 patients were classified into success group while 15 patients were classified into recurrence group. Demographic and ablation characteristics were analyzed.

Results

Gender difference was similar in two groups. The median age was 36.2 years old and was younger in recurrence group. Maximum ablation power was significantly higher in success group (29 ± 7.5 vs 22.9 ± 7.8, p &lt; 0.01). Ablation time of final target sites was found to be markedly higher in success group (123.4 ± 53.1 vs 86.7 ± 58.3, p &lt; 0.05). Ablation time less than 60 seconds was detected in 12 (12.2%) cases in success group and 7 (46.7%) cases in recurrence group (p &lt; 0.01). Occurrence of junctional rhythm was significantly higher in recurrence group (25.5% vs 53.3%, p &lt; 0.05). No severe conduction block, no pacemaker implantation and no stroke were reported. Junctional rhythm during ablation (OR = 3.833, 95%CI 1.083-13.572, p = 0.037) and ablation time &lt;60s (OR = 5.487, 95%CI 1.411-21.340, p = 0.014) were independent risk factors for the recurrence of para-hisian AP.

Conclusions

Considering the long-term safety of ablation of para-hisian AP, proper extension of ablation time and increase of ablation power could be applied during operation.

Post-annealing Effect on Optical and Electronic Properties of Thermally Evaporated MoOX Thin Films as Hole-Selective Contacts for p-Si Solar Cells

Owing to its large work function, MoOX has been widely used for hole-selective contact in both thin film and crystalline silicon solar cells. In this work, thermally evaporated MoOX films are employed on the rear sides of p-type crystalline silicon (p-Si) solar cells, where the optical and electronic properties of the MoOX films as well as the corresponding device performances are investigated as a function of post-annealing treatment. The MoOX film annealed at 100 °C shows the highest work function and proves the best hole selectivity based on the results of energy band simulation and contact resistivity measurements. The full rear p-Si/MoOX/Ag-contacted solar cells demonstrate the best performance with an efficiency of 19.19%, which is the result of the combined influence of MoOX's hole selectivity and passivation ability.

Agreement of Optic Nerve Head Evaluation of Primary Open-Angle Glaucoma Between General Ophthalmologists and Glaucoma Specialists

Purpose

To investigate the agreement of optic nerve head evaluations and initial diagnoses of primary open-angle glaucoma (POAG) by general ophthalmologists and glaucoma specialists in Shanghai, China.

Methods

This multicenter, cross-sectional study involved the outpatients from the general ophthalmology departments of four top eye hospitals in Shanghai. The participants underwent ocular examinations, including intraocular pressure, fundus photography, corneal thickness, refractometry, visual acuity, visual field and gonioscopy. General ophthalmologists and glaucoma specialists performed the diagnoses and classified them as non-glaucoma, POAG suspects, and POAG. The consistency of initial diagnosis between general ophthalmologists and glaucoma specialists was measured using the weighted kappa coefficient. Logistic regression analysis was used to detect the risk factors for the reliability of POAG diagnosis.

Results

In 922 participants, the initial diagnosis rates of POAG and non-glaucoma were much higher in the glaucoma specialist group than in the general ophthalmologist group, while the initial diagnosis rates of POAG suspects were higher in the general ophthalmologist group. The weighted kappa coefficient between the two groups was 0.831±0.027 (95% confidence interval, 0.779–0.884). Logistic regression analysis of the risk factors for the reliability of POAG diagnosis showed that the independent risk factors were intraocular pressure (OR 8.363, 95% CI: 4.27–16.37) and vertical cup-to-disc ratio (OR 3.459, 95% CI: 1.54–7.76).

Conclusion

The diagnosis consistency between the general ophthalmologists and the glaucoma specialists was similar among outpatients in the area of Shanghai. However, general ophthalmologists tended to classify the indefinite subjects as POAG suspects, and their accuracy in diagnosing POAG was low. By paying more attention to the risk factors of POAG diagnosis, general ophthalmologists could improve the diagnosis accuracy.

Use of Hybrid PEDOT:PSS/Metal Sulfide Quantum Dots for a Hole Injection Layer in Highly Efficient Green Phosphorescent Organic Light-Emitting Diodes

In this study, we have synthesized the molybdenum sulfide quantum dots (MoS2 QDs) and zinc sulfide quantum dots (ZnS QDs) and demonstrated a highly efficient green phosphorescent organic light-emitting diode (OLED) with hybrid poly (3,4-ethylenedioxythiophene)/poly (styrenesulfonate) (PEDOT:PSS)/QDs hole injection layer (HIL). The electroluminescent properties of PEDOT:PSS and hybrid HIL based devices were explored. An optimized OLED based on the PEDOT:PSS/MoS2 QDs HIL exhibited maximum current efficiency (CE) of 72.7 cd A-1, which shows a 28.2% enhancement as compared to counterpart with single PEDOT:PSS HIL. The higher device performance of OLED with hybrid HIL can be attributed to the enhanced hole injection capacity and balanced charge carrier transportation in the OLED devices. The above analysis illustrates an alternative way to fabricate the high efficiency OLEDs with sulfide quantum dots as a HIL.

Clinical and genetic spectrum of a Chinese cohort with SCN4A gene mutations

Skeletal muscle sodium channelopathies due to SCN4A gene mutations have a broad clinical spectrum. However, each phenotype has been reported in few cases of Chinese origin. We present detailed phenotype and genotype data from a cohort of 40 cases with SCN4A gene mutations seen in neuromuscular diagnostic service in Huashan hospital, Fudan University. Cases were referred from 6 independent provinces from 2010 to 2018. A questionnaire covering demographics, precipitating factors, episodes of paralysis and myotonia was designed to collect the clinical information. Electrodiagnostic studies and muscle MRI were retrospectively analyzed. The clinical spectrum of patients included: 6 Hyperkalemic periodic paralysis (15%), 18 Hypokalemic periodic paralysis (45%), 7 sodium channel myotonia (17.5%), 4 paramyotonia congenita (10%) and 5 heterozygous asymptomatic mutation carriers (12.5%). Review of clinical information highlights a significant delay to diagnosis (median 15 years), reports of pain and myalgia in the majority of patients, male predominance, circadian rhythm and common precipitating factors. Electrodiagnostic studies revealed subclinical myotonic discharges and a positive long exercise test in asymptomatic carriers. Muscle MRI identified edema and fatty infiltration in gastrocnemius and soleus. A total of 13 reported and 2 novel SCN4A mutations were identified with most variants distributed in the transmembrane helix S4 to S6, with a hotspot mutation p.Arg675Gln accounting for 32.5% (13/40) of the cohort. Our study revealed a higher proportion of periodic paralysis in SCN4A-mutated patients compared with cohorts from England and the Netherlands. It also highlights the importance of electrodiagnostic studies in diagnosis and segregation studies.