[Risk factors of occurrence and treatment failure of peritoneal dialysis-associated polymicrobial peritonitis: a multicenter retrospective study]

OBJECTIVE

To determine the risk factors of occurrence and treatment failure of peritoneal dialysis associatedperitonitis (PDAP) due to polymicrobial infections.

METHODS

We retrospectively collected the clinical data of patients with PDAP from the peritoneal dialysis (PD) centers in 4 general hospitals in Jilin Province from 2013 to 2019. The patients were divided, according to the results of peritoneal dialysate culture, into polymicrobial PDAP group and control group for comparison of the clinical data, treatment outcomes, and long-term prognosis. The independent risk factors of the occurrence and treatment failure of polymicrobial PDAP were explored using multivariate regression analysis.

RESULTS

We recruited a total of 625 patients from the 4 PD centers, among whom 1085 episodes of PDAP were recorded. Polymicrobial PDAP accounted for 7.6% of the total PDAP episodes, and this proportion increased from 5.3% in 2013-2016 to 9.4% in 2017-2019 (P= 0.012). Compared with the control group, polymicrobial PDAP group had higher proportions of elderly patients and patients with refractory PDAP, with greater white blood cell counts in the first-day dialysate and longer course of antibiotic treatment (P < 0.05). The risk of catheter removal and treatment failure (catheter removal or PDAP-related death) in polymicrobial PDAP group was 2.972 times (OR=2.972, 95% CI: 1.634-5.407, P < 0.001) and 2.692 times (OR=2.692, 95% CI: 1.578-4.591, P < 0.001) that in the control group, respectively. The risk of withdrawal from PD (technical failure + all-cause death) was 1.5- fold higher in polymicrobial PDAP group than that in the control group (OR=1.500, 95% CI: 1.085-2.074, P=0.014). Elderly patients (>65 years) had a 1.937-fold higher risk of experiencing polymicrobial PDAP than younger patients (OR=1.937, 95% CI: 1.207-3.109, P= 0.006). Diabetes mellitus (OR=5.554, 95% CI: 1.021-30.201, P=0.047), mixed fungal infeciton (OR=343.687, 95% CI: 21.554- 5480.144, P < 0.001), and Pseudomonas aeruginosa infection (OR=11.518, 95% CI: 1.632 to 81.310, P=0.014) were associated with increased risks of treatment failure by 4.554, 342.687 and 10.518 times, respectively.

CONCLUSION

The proportion of polymicrobial PDAP in the total PDAP cases tends to increase in recent years. Polymicrobial infection is an independent risk factor of both treatment failure and poor prognosis in patients with PDAP. An old age is an independent risk factor for polymicrobial PDAP, while diabetes mellitus and infections with mixed fungi or Pseudomonas aeruginosa are independent risk factors for treatment failure.

Multiharmonic Correlations of Different Flow Amplitudes in Pb-Pb Collisions at sqrt[s_{NN}]=2.76 TeV

The event-by-event correlations between three flow amplitudes are measured for the first time in Pb-Pb collisions, using higher-order symmetric cumulants. We find that different three-harmonic correlations develop during the collective evolution of the medium when compared to correlations that exist in the initial state. These new results cannot be interpreted in terms of previous lower-order flow measurements since contributions from two-harmonic correlations are explicitly removed in the new observables. A comparison to Monte Carlo simulations provides new and independent constraints for the initial conditions and system properties of nuclear matter created in heavy-ion collisions.

Stem cells from human exfoliated deciduous teeth relieve pain via downregulation of c-Jun in a rat model of trigeminal neuralgia

BACKGROUND

Stem cells from human exfoliated deciduous teeth (SHED) have excellent immunomodulatory and neuroprotective abilities. It is possible that systemic SHED transplantation could ameliorate trigeminal neuralgia. The phosphorylation of c-Jun contributes to the development of hyperalgesia and allodynia.

OBJECTIVE

The present study aimed to evaluate whether systemic SHED transplantation could lead to analgesic effects by regulating peripheral c-Jun in the trigeminal ganglia (TG) in a rat model of trigeminal neuralgia.

METHODS

Chronic constriction injury of the infraorbital nerve (CCI-ION) was performed to establish a rat pain model. SHED were obtained from discarded exfoliated deciduous teeth from children and transplanted by a single infusion through the tail vein. SHED were labelled with the PKH26 red fluorescent cell linker mini kit for tract distribution. The mechanical threshold was determined using von Frey filaments. The mRNA levels of c-Jun in the ipsilateral TG were quantified. The phosphorylation of c-Jun in the ipsilateral TG was assessed by immunohistochemistry and Western blotting.

RESULTS

PKH26-labelled SHED were distributed to both sides of TG, lung, liver and spleen. Systemic SHED transplantation significantly elevated the mechanical thresholds in CCI-ION rats and blocked the upregulation of c-Jun mRNA levels in the TG caused by nerve ligation. The activation of c-Jun in the TG was blocked by SHED transplantation.

CONCLUSIONS

These findings demonstrate that systemic SHED administration reverts trigeminal neuralgia via downregulation of c-Jun in the TG.

P–138 When is low quality really low? Should we transfer low-grade blastocysts?

Study question

What is the live birth rate after single, low-grade blastocyst (LGB) transfer?

Summary answer

The live birth rate for LGBs is 28%, ranging between 15–31% for the different inner cell mass (ICM) and trophectoderm (TE) subgroups of LGBs.

What is known already

Live birth rates following LGB transfer are varied and have been reported to be in the range of 5–39%. However, these estimates are inaccurate as studies investigating live birth rates following LGB transfer are inherently limited by sample size (n = 10–440 for LGB transfers) due to LGBs being ranked last for transfer. Further, these studies are heterogenous with varied LGB definitions and design. Collating LGB live birth data from multiple clinics is warranted to obtain sufficient numbers of LGB transfers to establish reliable live birth rates, and to allow for delineation of different LGB subgroups, including blastocyst age and female age.

Study design, size, duration

We performed a multicentre, multinational retrospective cohort study in 9 IVF centres in China and New Zealand from 2012 to 2019. We studied the outcome of 6966 single blastocyst transfer cycles on days 5–7 (fresh and frozen) according to blastocyst grade, including 875 transfers from LGBs (&lt;3bb, this being the threshold typically applied to LGB studies). Blastocysts with expansion stage 1 or 2 (early blastocysts) were excluded.

Participants/materials, setting, methods

The main outcome measured was live birth rate. Blastocysts were grouped according to quality grade: good-grade blastocysts (GGBs; n = 3849, aa, ab and ba), moderate-grade blastocysts (MGBs; n = 2242, bb) and LGBs (n = 875, ac, ca, bc, cb and cc) and live birth rates compared using the Pearson Chi-squared test. A logistic regression analysis explored the relationship between blastocyst grade and live birth after adjustment for the confounders: clinic, female age, expansion stage, and blastocyst age.

Main results and the role of chance

The live birth rates for GGBs, MGBs and LGBs were 45%, 36% and 28% respectively (p &lt; 0.0001). Within the LGB group, the highest live birth rates were for grade c TE (30%) and the lowest were for grade c ICM (19%). The lowest combined grade (cc) maintained a 15% live birth rate (n = 7/48). After accounting for confounding factors, including female age and blastocyst characteristics, the odds of live birth were 2.33 (95% CI = 1.88–2.89) for GGBs compared to LGBs and 1.56 (95% CI = 1.28–1.92) for MGBs compared to LGBs following fresh and frozen blastocyst transfers (p &lt; 0.0001, odds ratios confirmed in exclusively frozen blastocyst transfer cycles). When stratified by individual ICM and TE grade, the odds of live birth according to ICM grade were 1.31 (a versus b; 95% CI = 1.15–1.48), 2.82 (a versus c; 95% CI = 1.91–4.18) and 2.16 (b versus c; 95% CI = 1.48–3.16; all p &lt; 0.0001). The odds of live birth according to TE grade were 1.33 (a versus b; 95% CI = 1.17–1.50, p &lt; 0.0001), 1.85 (a versus c; 95% CI = 1.45–2.34, p &lt; 0.0001) and 1.39 (b versus c; 95% CI = 1.12–1.73, p = 0.0024).

Limitations, reasons for caution

Despite the large multicentre design of the study, analyses of transfers occurring within the smallest subsets of the LGB group were limited by sample size. The study was not randomised and had a retrospective character.

Wider implications of the findings: LGBs maintain satisfactory live birth rates (averaging 28%) in the general IVF population. Even those in the lowest grading tier maintain modest live birth rates (15%; cc). It is recommended that LGBs not be universally discarded, and instead considered for subsequent frozen embryo transfer to maximize cumulative live birth rates.

Trial registration number

Not applicable

Soft-Dielectron Excess in Proton-Proton Collisions at sqrt[s]=13 TeV

A measurement of dielectron production in proton-proton (pp) collisions at sqrt[s]=13  TeV, recorded with the ALICE detector at the CERN LHC, is presented in this Letter. The data set was recorded with a reduced magnetic solenoid field. This enables the investigation of a kinematic domain at low dielectron (ee) invariant mass m_{ee} and pair transverse momentum p_{T,ee} that was previously inaccessible at the LHC. The cross section for dielectron production is studied as a function of m_{ee}, p_{T,ee}, and event multiplicity dN_{ch}/dη. The expected dielectron rate from hadron decays, called hadronic cocktail, utilizes a parametrization of the measured η/π^{0} ratio in pp and proton-nucleus collisions, assuming that this ratio shows no strong dependence on collision energy at low transverse momentum. Comparison of the measured dielectron yield to the hadronic cocktail at 0.15<m_{ee}<0.6  GeV/c^{2} and for p_{T,ee}<0.4  GeV/c indicates an enhancement of soft dielectrons, reminiscent of the "anomalous" soft-photon and soft-dilepton excess in hadron-hadron collisions reported by several experiments under different experimental conditions. The enhancement factor over the hadronic cocktail amounts to 1.61±0.13(stat)±0.17(syst,data)±0.34(syst,cocktail) in the ALICE acceptance. Acceptance-corrected excess spectra in m_{ee} and p_{T,ee} are extracted and compared with calculations of dielectron production from hadronic bremsstrahlung and thermal radiation within a hadronic many-body approach.

Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10^-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.

Elliptic Flow of Electrons from Beauty-Hadron Decays in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The elliptic flow of electrons from beauty hadron decays at midrapidity (|y|<0.8) is measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The azimuthal distribution of the particles produced in the collisions can be parametrized with a Fourier expansion, in which the second harmonic coefficient represents the elliptic flow, v_{2}. The v_{2} coefficient of electrons from beauty hadron decays is measured for the first time in the transverse momentum (p_{T}) range 1.3-6  GeV/c in the centrality class 30%-50%. The measurement of electrons from beauty-hadron decays exploits their larger mean proper decay length cτ≈500  μm compared to that of charm hadrons and most of the other background sources. The v_{2} of electrons from beauty hadron decays at midrapidity is found to be positive with a significance of 3.75  σ. The results provide insights into the degree of thermalization of beauty quarks in the medium. A model assuming full thermalization of beauty quarks is strongly disfavored by the measurement at high p_{T}, but is in agreement with the results at low p_{T}. Transport models including substantial interactions of beauty quarks with an expanding strongly interacting medium describe the measurement within uncertainties.

Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma

BACKGROUND

Immune-related adverse events (irAEs) typically occur within 4 months of starting anti-programmed cell death protein 1 (PD-1)-based therapy [anti-PD-1 ± anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4)], but delayed irAEs (onset >12 months after commencement) can also occur. This study describes the incidence, nature and management of delayed irAEs in patients receiving anti-PD-1-based immunotherapy.

PATIENTS AND METHODS

Patients with delayed irAEs from 20 centres were studied. The incidence of delayed irAEs was estimated as a proportion of melanoma patients treated with anti-PD-1-based therapy and surviving >1 year. Onset, clinical features, management and outcomes of irAEs were examined.

RESULTS

One hundred and eighteen patients developed a total of 140 delayed irAEs (20 after initial combination with anti-CTLA4), with an estimated incidence of 5.3% (95% confidence interval 4.0-6.9, 53/999 patients at sites with available data). The median onset of delayed irAE was 16 months (range 12-53 months). Eighty-seven patients (74%) were on anti-PD-1 at irAE onset, 15 patients (12%) were <3 months from the last dose and 16 patients (14%) were >3 months from the last dose of anti-PD-1. The most common delayed irAEs were colitis, rash and pneumonitis; 55 of all irAEs (39%) were ≥grade 3. Steroids were required in 80 patients (68%), as well as an additional immunosuppressive agent in 27 patients (23%). There were two irAE-related deaths: encephalitis with onset during anti-PD-1 and a multiple-organ irAE with onset 11 months after ceasing anti-PD-1. Early irAEs (<12 months) had also occurred in 69 patients (58%), affecting a different organ from the delayed irAE in 59 patients (86%).

CONCLUSIONS

Delayed irAEs occur in a small but relevant subset of patients. Delayed irAEs are often different from previous irAEs, may be high grade and can lead to death. They mostly occur in patients still receiving anti-PD-1. The risk of delayed irAE should be considered when deciding the duration of treatment in responding patients. However, patients who stop treatment may also rarely develop delayed irAE.

A catalog of associations between rare coding variants and COVID-19 outcomes

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease-19 (COVID-19), a respiratory illness that can result in hospitalization or death. We investigated associations between rare genetic variants and seven COVID-19 outcomes in 543,213 individuals, including 8,248 with COVID-19. After accounting for multiple testing, we did not identify any clear associations with rare variants either exome-wide or when specifically focusing on (i) 14 interferon pathway genes in which rare deleterious variants have been reported in severe COVID-19 patients; (ii) 167 genes located in COVID-19 GWAS risk loci; or (iii) 32 additional genes of immunologic relevance and/or therapeutic potential. Our analyses indicate there are no significant associations with rare protein-coding variants with detectable effect sizes at our current sample sizes. Analyses will be updated as additional data become available, with results publicly browsable at https://rgc-covid19.regeneron.com.

Mapping research trends of temporomandibular disorders from 2010 to 2019: A bibliometric analysis

BACKGROUND

Because of various clinical manifestations and complicated courses, temporomandibular disorders (TMDs) are difficult to treat. Current knowledge about this disease remains insufficient for precise treatment after diagnosis.

OBJECTIVES

The objective of this study is to obtain and map the overall literature trends and most cited keywords in TMDs research.

METHODS

Many indicators, including annual number of publications, country distribution, global cooperations, author contributions, original journals, cited references and keywords, were calculated and evaluated using VOSviewer v.1.6.13, which visualised many results, from the WoSCC database.

RESULTS

A total of 3121 papers on TMDs research were retrieved from 2010 to 2019. The United States produced the most articles published, but the most productive institution was the University of Sao Paulo (Brazil). Researchers and institutions conducting TMDs research have shown a very widespread and close connection. TMDs have been studied worldwide by many research centres. Professor Svensson P was the most published researcher in TMDs research and the Journal of Oral Rehabilitation published the most TMDs research articles. The top cited references mainly presented diagnostic criteria of TMDs. The most cited keywords formed clusters: (a) Anatomical factor of TMDs, (b) Symptoms of TMDs and (c) RDC/TMD, the risk factors, biopsychosocial factors and epidemiology of TMDs.

CONCLUSIONS

The research results provide very valuable data for a thorough understanding of the research status of TMDs and demonstrated international cooperation.

[Effects of Astragaloside Ⅳ on exosome secretion and its microRNA-126 expression in human endothelial progenitor cells]

Objective: To investigate the effects of Astragaloside Ⅳ on the secretion of exosomes in human endothelial progenitor cells (EPCs) and the expression of microRNA (miRNA)-126 in exosomes. Methods: The umbilical cord blood from one healthy full-term newborn from the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine in 2019 was harvested for isolating mononuclear cells by density gradient centrifugation and cultured for 7 days. Morphological observation was performed during this period. Cells of the third passage were collected for identification by CD31 immunomagnetic bead sorting and double fluorescence staining. According to the random number table, the identified EPCs were divided into Astragaloside Ⅳ group and phosphate buffer solution (PBS) group. The cells in Astragaloside Ⅳ group were cultured with Astragaloside Ⅳ in final mass concentration of 100 mg/L for 24 hours, and the cells in PBS group were cultured with the same volume of PBS for 24 hours. After culture, the exosomes from the cell culture supernatant of the two groups were collected, and the expressions of characteristic markers of exosomes CD9, CD63, and CD81 were detected by Western blotting, the morphology of EPC exosomes (EPC-Exos) was observed under transmission electron microscope, and the particle size of EPC-Exos was detected by nanoparticle tracking analysis technique. The concentration of EPC-Exos was determined by dioctyl butyric acid method (the sample number was 3), and the expressions of miRNA-126-3p and miRNA-126-5p related to angiogenesis in EPC-Exos were determined by reverse transcription polymerase chain reaction (the sample number was 3). Data were statistically analyzed with independent sample t test. Results: (1) On the 4th day of culture, the cells began to adhere to the wall, and the multi-forms such as circle, fusiform, and strip appeared at the same time. On the 7th day of culture, the edge of the cells was clear and arranged like a paving stone, the central cells were round, and the surrounding cells were fusiform. (2) CD31 immunomagnetic beads sorting method identification showed that the membrane was stained with green fluorescence and the nucleus was stained with blue fluorescence. Double fluorescence staining method showed that the cells were orange-yellow. The cells were identified as EPCs. (3) After 24 hours of culture, the expressions of CD9, CD63, and CD81 in EPC-Exos were all positive, confirming that EPC-Exos were extracted successfully in this experiment. (4) After 24 hours of culture, the EPC-Exos of the two groups showed round membrane vesicles, and there was no significant difference in morphology. (5) After 24 hours of culture, the particle size of 98.7% EPC-Exos in Astragaloside Ⅳ group was 84.7 to 143.1 nm, and that of 98.0% EPC-Exos in PBS group was 88.7 to 123.5 nm. (6) After 24 hours of culture, the mass concentration of EPC-Exos in Astragaloside Ⅳ group was (310±5) μg/mL, which was significantly higher than (257±5) μg/mL in PBS group, t=13.369, P<0.01. (7) After 24 hours of culture, there were more miRNA-126-3p (t=16.062, P<0.01) and miRNA-126-5p (t=3.252, P<0.05) in EPC-Exos of Astragaloside Ⅳ group than in PBS group. Conclusions: Astragaloside Ⅳ can improve the function of human EPC secretory exosomes, and the secreted exosomes are loaded with miRNA-126.

Discharge heart rate and clinical outcomes in hospitalized heart failure patients with coexisted atrial fibrillation

Background

Whether discharge heart rate for hospitalized heart failure (HF) patients with coexisted atrial fibrillation (AF) is associated with long-term clinical outcomes and whether this association differs between patients with and without beta-blockers have not been well studied.

Purpose

We investigated the associations between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF, while stratified to beta-blockers at discharge.

Methods

The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. We analyzed association between outcome and heart rate at discharge with restricted cubic spline and Cox proportional hazard ratios (HR).

Results

The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, the relationship between discharge heart rate and clinical outcome may be nonlinear (P&lt;0.01). Based on above result, these patients were divided into 3 groups: lowest &lt;65 bpm, middle 65–86 bpm and highest ≥87 bpm, clinical outcomes occurred in 128 (64.32%), 624 (53.42%) and 156 (59.32%) patients in the lowest, middle, and highest groups respectively. In the Cox proportional hazard analysis, the lowest and highest groups were associated with increased risks of clinical outcome compared with the middle group (HR: 1.289, 95% confidence interval (CI): 1.056 - 1.573, p=0.013; HR: 1.276, 95% CI: 1.06 - 1.537, p=0.01, respectively). And a significant interaction between discharge heart rate and beta-blocker use was observed (P&lt;0.001 for interaction). Stratified analysis showed the lowest group was associated with increased risks of clinical outcomes in patients with beta-blockers (HR: 1.584, 95% confidence interval (CI): 1.215–2.066, p=0.001).

Conclusion

There may be a U-curve relationship between discharge heart rate and clinical outcomes in hospitalized HF patients with coexisted AF. They may have the best clinical outcomes with heart rates of 65 - 86 bpm. And strict heart rate control (&lt;65 bpm) may be avoided for patients who discharge with beta-blockers.

Figure 1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).

Discharge heart rate and beta-blockers treatments in hospitalized heart failure patients with coexisted atrial fibrillation

Background

Beta-blockers are widely used to improve clinical outcomes in heart failure (HF) patients. However, the effects of beta-blockers on clinical outcomes in those who have coexisted atrial fibrillation (AF) remains uncertain.

Purpose

We investigated the associations between beta-blockers and clinical outcomes according to discharge heart rate.

Methods

The study cohort included 1631 HF patients hospitalized primarily with AF, which was from the China PEACE Prospective Heart Failure Study. Clinical outcome was 1-year combined all-cause mortality and HF hospitalization after discharge. The associations between beta-blockers and clinical outcome were assessed using Cox proportional hazard and standardization mortality weighting regression models, with stratified discharge heart rate group predefined by restricted cubic spline.

Results

The median age was 68 (IQR: 60- 77) years, 41.9% were women, discharge heart rate was (median (IQR)) 75 (69- 84) beats per minute (bpm), and 60.2% received beta-blockers at discharge. According to the result of restricted cubic spline plot, these patients were divided into 3 groups: lowest &lt;65 bpm, middle 65–86 bpm and highest ≥87 bpm (Fig.1). In the Cox proportional hazard analysis, a significant interaction between discharge heart rate and beta-blocker use was observed (P&lt;0.001 for interaction). Stratified analysis showed beta-blocker prescription at discharge was associated with reduced risk for clinical outcomes in patients with high heart rates (hazard ratio 0.336, 95% CI: 0.144–0.786, p=0.012) but not in those with lowest and middle heart rates (hazard ratio: 1.32; 95% CI, 0.95–1.63; hazard ratio: 1.02; 95% CI, 0.68–1.55, respectively).

Conclusion

The associations between beta-blockers and clinical outcomes may be significantly influenced by baseline heart rate. Hospitalized HF patients with AF benefit the most from beta-blockers use if they had high heart rate (≥87 bpm) at discharge.

Figure 1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).

Pattern and predictors of one-year mortality in heart failure: China PEACE Prospective Heart Failure Study

Background

Heart failure (HF) is a global public health problem, which causes high mortality.

Purpose

To characterize the pattern of 1-year mortality, including the rate and timing of death, and to identify clinical and non-clinical factors predicting 1-year all-cause mortality after hospitalization for HF.

Methods

We prospectively enrolled patients who were hospitalized primarily for HF and discharged alive from 52 hospitals across 20 provinces in China between August 2016 and May 2018, and followed them up by face-to-face interview or telephone. Patients' fatal status were ascertained according to investigators' report and national death registration. Cognitive function was measured by Mini-Cog score and health status was measured by Kansas City Cardiomyopathy Questionnaire (KCCQ). We fitted a Cox proportional hazards model accounting for hospital as random effects to identify patient characteristics associated with 1-year all-cause mortality.

Results

Among 4899 patients, 4882 (97.7%) completed 1-year follow-up. The median (IQR) age was 67 (57, 75) years and 37.5% were women. The main etiology of HF was ischemic heart disease (53.1%), 66.0% of patients had history of HF before the index hospitalization. Among 813 deaths within one year after discharge, 13.4% and 58.4% occurred within one months and six months, respectively. Systolic blood pressure &lt;100mmHg at admission (hazard ratio [HR] 2.33, 95% CI 1.76–3.08), NYHA class IV (HR 1.37, 95% CI 1.1–1.7), anemia (HR 1.3, 95% CI 1.1–1.54), hs-cTNT≥18 ng/L (HR 1.84, 95% CI 1.53–2.22), hyponatremia (HR 1.66, 95% CI 1.38–1.98), LVEF&lt;40% (HR 1.25, 95% CI 1.02–1.53), QRS interval≥120mms (HR 1.19, 95% CI 1.02–1.4), Cognitive impairment (HR 1.25, 95% CI 1.07–1.46) and low KCCQ score (HR 1.24 per 25 score decrease, 95% CI 1.11–1.39) were associated with higher risks of 1-year all-cause mortality. In contrast, female (HR 0.83, 0.7–0.99), sleep apnea syndrome (HR 0.55, 95% CI 0.35–0.88) were associated with lower risks of 1-year all-cause mortality.

Conclusion

In China, one in six patients hospitalized for HF die within 1-year, with the majority occurring during the first 6 months after hospital discharge. Both clinical and non-clinical factors predict 1-year mortality.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science; the 111 Project from the Ministry of Education of China

Measurement of the Low-Energy Antideuteron Inelastic Cross Section

In this Letter, we report the first measurement of the inelastic cross section for antideuteron-nucleus interactions at low particle momenta, covering a range of 0.3≤p<4  GeV/c. The measurement is carried out using p-Pb collisions at a center-of-mass energy per nucleon-nucleon pair of sqrt[s_{NN}]=5.02  TeV, recorded with the ALICE detector at the CERN LHC and utilizing the detector material as an absorber for antideuterons and antiprotons. The extracted raw primary antiparticle-to-particle ratios are compared to the results from detailed ALICE simulations based on the geant4 toolkit for the propagation of (anti)particles through the detector material. The analysis of the raw primary (anti)proton spectra serves as a benchmark for this study, since their hadronic interaction cross sections are well constrained experimentally. The first measurement of the inelastic cross section for antideuteron-nucleus interactions averaged over the ALICE detector material with atomic mass numbers ⟨A⟩=17.4 and 31.8 is obtained. The measured inelastic cross section points to a possible excess with respect to the Glauber model parametrization used in geant4 in the lowest momentum interval of 0.3≤p<0.47  GeV/c up to a factor 2.1. This result is relevant for the understanding of antimatter propagation and the contributions to antinuclei production from cosmic ray interactions within the interstellar medium. In addition, the momentum range covered by this measurement is of particular importance to evaluate signal predictions for indirect dark-matter searches.

Sevoflurane improves circulatory function and pulmonary fibrosis in rats with pulmonary arterial hypertension through inhibiting NF-κB signaling pathway

OBJECTIVE

The aim of this study was to explore the influences of sevoflurane inhalation therapy on circulation function and pulmonary fibrosis in rats with pulmonary arterial hypertension (PAH) and the nuclear factor-κB (NF-κB) signaling pathway.

MATERIALS AND METHODS

A total of 30 adult male Sprague-Dawley rats were randomly divided into three groups, including control group (CTL group, n=10), PAH group (n=10), and PAH + sevoflurane group (n=10) using a random number table. Subsequently, the pulmonary artery right ventricular systolic pressure (RVSP) and right ventricular hypertrophy index (RVHI) were measured. Rats in PAH group were subcutaneously injected with 60 mg/kg monocrotaline once to establish the model of PAH. 28 d later, the differences in the morphology of pulmonary tissues and the protein expression levels of phosphorylated inhibitory κB (p-IκB), p-P65, P65, cyclin D1, proliferating cell nuclear antigen (PCNA) and tubulin among the three groups were analyzed via hematoxylin-eosin (HE) staining and Western blotting, respectively. Meanwhile, the messenger ribonucleic acid (mRNA) expression level of P65 was determined via Reverse Transcription-quantitative Polymerase Chain Reaction (RT-qPCR). Additionally, changes in the expression levels of Ki-67 and α-smooth muscle actin (α-SMA) in rat pulmonary tissues of the three groups were evaluated through immunohistochemistry.

RESULTS

According to HE staining results, compared with CTL group, rats in PAH group exhibited significant thickening of the pulmonary artery wall, reduction of the vascular lumen, inflammatory cell infiltration, and thrombosis in some small arteries. This indicated that the PAH model was successfully established in rats. Compared with PAH group, PAH + sevoflurane group showed a significantly improved morphology of rat pulmonary tissues. Western blotting demonstrated that the protein expression levels of p-IκB, p-P65, and P65 in rat pulmonary tissues of PAH group were remarkably higher than CTL group (p<0.01). However, they were notably down-regulated in PAH + sevoflurane group when compared with those in PAH group (p<0.05). The above experimental results suggested that the NF-κB signaling pathway in pulmonary tissues of rats in PAH group was activated and was inhibited by sevoflurane. Subsequent RT-qPCR results indicated that no significant (N.S.) differences were observed in the mRNA level of P65 among the three groups. Compared with CTL group, PAH group showed significantly up-regulated levels of Ki-67 and α-SMA in rat pulmonary tissues (p<0.01). However, their expression levels were markedly reduced in PAH + sevoflurane group when compared with PAH group (p<0.05). Finally, the detection of pulmonary circulatory function-related indicators illustrated that RVSP and RVHI increased significantly in PAH group in comparison with CTL group. However, they declined remarkably in PAH + sevoflurane group when compared with those in PAH group (p<0.05).

CONCLUSIONS

Sevoflurane down-regulates the levels of p-IκB, p-P65, and P65 to repress the activation of the NF-κB signaling pathway. This may reduce pulmonary fibrosis and ultimately prevent PAH.

[Research progress in standardized dental treatments of patients receiving bisphosphonate]

Bisphosphonate (BP), a group of anti-resorptive drugs, has been widely used for the treatments of osteoporosis and metastatic bone diseases. Medication-related osteonecrosis of the jaw (MRONJ), a serious well-recognized complication of patients receiving BP, adversely affects patients' oral health and quality of life. Its clinical signs include pain, bone exposure and necrosis of the jaws. Invasive oral treatments, which may affect the repair of jaws in patients using BP, could cause the occurrence of MRONJ. Therefore, it is important to avoid the risk factors of MRONJ and to standardize the operations in order to reduce the occurrence of MRONJ in oral treatments for patients receiving BP. After reviewing the related literature, this article aims to conclude the research progress on the standardized oral treatments of patients receiving BP and to provide clinical instructions for clinicians to treat these patients.

eV-Scale Sterile Neutrino Search Using Eight Years of Atmospheric Muon Neutrino Data from the IceCube Neutrino Observatory

The results of a 3+1 sterile neutrino search using eight years of data from the IceCube Neutrino Observatory are presented. A total of 305 735 muon neutrino events are analyzed in reconstructed energy-zenith space to test for signatures of a matter-enhanced oscillation that would occur given a sterile neutrino state with a mass-squared differences between 0.01 and 100  eV^{2}. The best-fit point is found to be at sin^{2}(2θ_{24})=0.10 and Δm_{41}^{2}=4.5  eV^{2}, which is consistent with the no sterile neutrino hypothesis with a p value of 8.0%.

Immune checkpoint inhibitor-associated pituitary adverse events: an observational, retrospective, disproportionality study

PURPOSE

The aim of this study was to identify and characterize immune checkpoint inhibitors (ICIs)-associated pituitary adverse events (AEs).

METHODS

This is a retrospective disproportionality study based on VigiBase, the World Health Organization (WHO) global database of individual case safety reports (ICSRs), with a study period from January 1, 2011 to March 6, 2019. Information component (IC) and reporting odds ratio (ROR) are measures of disproportionate analysis. IC was used to evaluate the association between ICIs and pituitary AEs, while ROR was used to evaluate the differences in reporting of pituitary AEs between different ICI subgroups.

RESULTS

The following ICI-associated pituitary diseases have been increasingly reported: hypophysitis (835 reports; information component 6.74 [95% CI 6.63-6.83]), hypopituitarism (268; 6.12 [95% CI 5.92-6.27]), pituitary enlargement (28; 5.19 [95% CI 4.57-5.63]). The anti-CTLA-4 subgroup had a stronger association with hypophysitis/hypopituitarism than the anti-PD (anti-PD-1 or anti-PD-L1) subgroup (ROR 8.0 [95% CI 6.7-9.6]). Among ICI-associated hypophysitis/hypopituitarism cases, the proportion of male was higher than female (630 [63.9%] vs 356 [36.1%]). Anti-CTLA-4 subgroup and ICI combination (nivolumab plus ipilimumab) subgroup both had a significantly earlier onset time than anti-PD subgroup (67 days [IQR 48-87]; 90 [IQR 34-155]; 140 [IQR 62-218], both p < 0.05). Other endocrinopathies that co-occurred with hypophysitis/hypopituitarism were adrenal insufficiency, thyroid dysfunction, diabetes mellitus and diabetes insipidus. Gastrointestinal disorder was the most common concurrent disease except for endocrinopathies.

CONCLUSIONS

ICI-associated pituitary adverse events have significantly increased, and their clinical characteristics should be kept in mind by oncologists and endocrinologists who manage patients treated by immunotherapy.