Effect of shaking speed on immobilization of cephalosporin C acylase: Correlation between protein distribution and properties of the immobilized enzymes

During enzyme immobilization, enzyme activity and protein distribution are affected by various factors such as enzyme load, temperature, and pH. In general, two types of protein distribution patterns (heterogeneous or homogeneous) are observed inside a porous carrier, owing to differences in preparation parameters. During the immobilization of a fusion protein (CCApH) of cephalosporin C acylase (CCA) and pHluorin (a pH-sensitive mutant of green fluorescent protein), different shaking speeds induced obvious differences in protein distribution on an epoxy carrier, LX-1000EPC. Enzyme immobilization with a homogeneous distribution pattern was observed at a low shaking speed (120 rpm) with an operational stability of 10 batches at 37°C. The operational stability of an immobilisate with heterogeneous protein distribution prepared at a high shaking speed (200 rpm) was six batches. Given the pH-sensitive characteristics of pHluorin in the fusion protein, the intraparticle pH of CCApH immobilisates during catalysis was monitored using confocal laser scanning microscopy. The microenvironmental pH of the immobilisate with heterogeneous protein distribution sharply decreased by about 2 units; this decrease in the pH may be detrimental to the life-span of immobilized CCA. Thus, this work demonstrates the good operational stability of pH-sensitive proton-forming immobilized enzymes with homogeneous protein distribution.

Differentially proteomic analysis of the hemocytes against Aeromonas hydrophila infection in oriental river prawn Macrobrachium nipponense by iTRAQ approach

As the direct executors of biological function, the expression level of proteins in host will reveal the molecular mechanisms regulating bacteria infection more directly. In the present study, the differential proteomes of Macrobrachium nipponense hemocytes response to Aeromonas hydrophila infection were identified with isobaric tags for relative and absolute quantitation (iTRAQ) labeling followed by liquid chromatography electrospray ionization tandem mass spectrometry. The hemocyte proteins from the unchallenged and A. hydrophila challenged prawn, M. nipponense, at 12, 24 and 36 h post infection were compared. From this, a total of 3372 proteins were identified and 1014 proteins were considered differentially expressed, of which 117 common differentially expressed proteins were indicated between the time points. Hierarchical clustering, Gene Ontology, Kyoto Encyclopedia of Genes and Genomes enrichment and protein-protein interaction network analyses were performed for the general characterization of overall enriched proteins. Cytoskeletal proteins including myosin heavy chain, myosin regulatory light chain, actin, tubulin alpha/beta chain, troponin I and troponin T as well as antioxidant enzymes such as catalase and cytosolic MnSOD were found significantly up-regulated in hemocytes, indicating that the phagocytosis process and ROS system were induced after challenge with A. hydrophila. And other proteins such as integrin β, innexin inx2-like and heat shock protein 60 also participate in prawn immune response against bacteria. Parallel reaction monitoring analyses were carried out for validation of the expression levels of differentially expressed proteins, which indicated high reliability of the proteomic results. This is the first report on proteome of M. nipponense hemocytes against A. hydrophila infection, which contributes to better understanding on the molecular mechanisms of prawns.

Improved Constraints on Sterile Neutrino Mixing from Disappearance Searches in the MINOS, MINOS+, Daya Bay, and Bugey-3 Experiments

Searches for electron antineutrino, muon neutrino, and muon antineutrino disappearance driven by sterile neutrino mixing have been carried out by the Daya Bay and MINOS+ collaborations. This Letter presents the combined results of these searches, along with exclusion results from the Bugey-3 reactor experiment, framed in a minimally extended four-neutrino scenario. Significantly improved constraints on the θ_{μe} mixing angle are derived that constitute the most constraining limits to date over five orders of magnitude in the mass-squared splitting Δm_{41}^{2}, excluding the 90% C.L. sterile-neutrino parameter space allowed by the LSND and MiniBooNE observations at 90% CL_{s} for Δm_{41}^{2}<13  eV^{2}. Furthermore, the LSND and MiniBooNE 99% C.L. allowed regions are excluded at 99% CL_{s} for Δm_{41}^{2}<1.6 eV^{2}.

A targeted metabolomic profiling of plasma acylcarnitines in nonalcoholic fatty liver disease

OBJECTIVE

Nonalcoholic fatty liver disease (NAFLD) has become a common liver disorder caused by lipid accumulation and insulin resistance (IR). Acylcarnitines have become a new biomarker of IR. However, their roles in NAFLD are still poorly studied. Thus, we performed a targeted metabolomic analysis to study the level of plasma acylcarnitines in patients with NAFLD.

MATERIALS AND METHODS

The levels of 34 plasma acylcarnitines were measured by a targeted metabolomic approach in NAFLD patients (n = 50) and in healthy control subjects (n = 50) by liquid chromatography-tandem mass spectrometry. Detailed demographic and clinical characteristics of all subjects were also analyzed.

RESULTS

The clinical presentation of IR was identified in the NAFLD group but not in the healthy control group. Significant differences were found in the levels of several short-, medium- and long-chain acylcarnitines. A high degree of correlation (r>0.7) was found between even-numbered-carbon long-chain acylcarnitines in NAFLD patients. The area under the receiver operator characteristic of long-chain acylcarnitines, especially C20 (AUC=0.952), C16:1 (AUC=0.949) and C14:1OH (AUC=0.944) acylcarnitines, was greater in NAFLD patients than in healthy control subjects.

CONCLUSIONS

The accumulation and disorders of acylcarnitines are associated with NAFLD. A positive correlation between even-numbered-carbon long-chain acylcarnitines was found, and these even-numbered-carbon long-chain acylcarnitines. could be used as potential novel screening markers for nonalcoholic fatty liver disease.

Salinomycin enhances radiotherapy sensitivity and reduces expressions of BIRC5 and NEIL2 in nasopharyngeal carcinoma

OBJECTIVE

The aim of this study was to investigate the effects of salinomycin (Sal) on expressions of baculoviral IAP repeat-containing 5 (BIRC5) and Nei endonuclease VIII-like 2 (NEIL2) and radiotherapy sensitivity of nasopharyngeal carcinoma (NPC).

MATERIALS AND METHODS

Human NPC CNE-2 cell lines were used as research objects in this study. Subsequently, the cells received intervention with Sal at different concentrations, radioactive rays at different doses and Sal combined with radioactive rays. The growth inhibition rate of CNE-2 cells was detected via methyl thiazolyl tetrazolium (MTT) assay. The dose-effect relations of Sal, radioactive rays and combination therapy with the inhibitory effect on CNE-2 cells were obtained. CNE-2 cells receiving intervention with Sal at an appropriate concentration or radioactive rays at an appropriate dose alone and Sal combined with radioactive rays were used as intervention groups (Sal group, Radiation group and Combination group). However, those added with an equal amount of DMSO were set as Control group. Next, the cycle, apoptosis and apoptotic morphology of CNE-2 cells were observed via flow cytometry and Hoechst assay, respectively. Moreover, the expressions of apoptosis-related proteins Caspase-3, B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X protein (Bax), as well as BIRC5 and NEIL2 proteins in CNE-2 cells were determined using Western blotting.

RESULTS

Under the intervention with Sal or radioactive rays alone, the growth inhibition rate of CNE-2 cells rose in a concentration/dose-dependent manner. With the increase in Sal concentration in combination therapy, the growth inhibition rate of CNE-2 cells significantly increased (p<0.05). Compared with Control group, Sal group, Radiation group, and Combination group exhibited remarkably lower colony formation rate, higher proportion of CNE-2 cells in the G2/M phase, enhanced apoptosis of CNE-2 cells with nuclear fragmentation, increased expressions of pro-apoptotic proteins Caspase-3 and Bax, decreased expression of anti-apoptotic protein Bcl-2, and lower protein expressions of BIRC5 and NEIL2 in cells (p<0.05). Compared with Radiation group, the Combination group had significantly decreased colony formation rate, increased proportion of CNE-2 cells in the G2/M phase, enhanced apoptosis of CNE-2 cells with more nuclear fragmentation and other apoptosis characteristics, increased expressions of pro-apoptotic proteins Caspase-3 and Bax, decreased expression of anti-apoptotic protein Bcl-2, and decreased protein expressions of BIRC5 and NEIL2 in cells (p<0.05).

CONCLUSIONS

Sal enhances the radiotherapy sensitivity of NPC and reduces the protein expressions of BIRC5 and NEIL2 in cells.

0342 Self-Silencing within Intimate Relationships, Sleep, and Subclinical Atherosclerosis in Midlife Women

Introduction

Social relationships are important for health. In some relationships, women learn to self-silence, or to inhibit self-expression to avoid conflict or loss. Self-silencing is associated with reported psychiatric and physical symptoms, but no studies have examined whether self-silencing is related to worse sleep or cardiovascular (CV) health. We tested relationships of self-silencing to sleep and carotid plaque in midlife women; secondary analyses examined whether sleep mediated or moderated relationships between self-silencing and plaque.

Methods

In an ongoing community-based study of nonsmoking women, 304 women aged 40-60 were assessed at baseline; 157 of these women have been assessed 5 years later. At baseline, women reported on self-expression in their current/last intimate relationship via the Silencing the Self Scale. At both visits, women provided self-reports (demographics, medical history, CESD depression, PSQI sleep quality), physical measures, actigraphy (total sleep time [TST], wake after sleep onset [WASO], and efficiency), and carotid artery ultrasound to quantify plaque. Relationships of self-silencing and subscales to sleep (subjective and actigraphic sleep at baseline and averaged across visits) and carotid plaque (0, 1, ≥2) were tested in linear regression and multinomial regression models, respectively, adjusted for demographic and health indices, including depressive symptoms and snoring.

Results

At baseline, women (72% White) were on average 54 years old; 44% reported poor sleep quality, 46% had plaque (24% score ≥2), and average TST, WASO, and efficiency were 6.2 hrs, 46 min, and 84%, respectively. At baseline, self-silencing (particularly the tendency to judge oneself by external standards) was related to worse sleep quality (p=.001), but better actigraphic WASO (p=.02) and efficiency (p=.02). Self-silencing was related to worse average sleep quality across visits (p=.001). Self-silencing related to higher odds of baseline plaque ≥2 [OR(95% CI)=1.14 (1.02,1.28), p=.02], yet sleep did not explain or moderate this relationship.

Conclusion

Self-silencing was associated with worse subjective, but better actigraphic sleep at baseline, and with poorer sleep quality over 5 years. Self-silencing related to carotid atherosclerosis, yet sleep did not appear to impact this relationship. Emotional expression is relevant to midlife women’s sleep and CV health.

Support

R01HL105647, K24123565 (RCT); RF1AG053504 (RCT & PM); T32MH018269 (KPJ)

0857 Factors Associated With Sleep Health Among Middle-aged And Older Adults

Introduction

The concept of Sleep Health (SH) was developed to provide a multidimensional framework consisting of characteristics of sleep that have been closely associated with physical and mental well-being. Identification of key factors associated with SH can identify targets for intervention for its improvement. This study aimed to identify factors related to SH among middle-aged and older adults.

Methods

A valid Sleep Health Composite Measure was recently developed from the data of the 2014 Core Survey of the Health and Retirement Survey and was used to assess overall SH in middle-aged and older adults. Spearman’s correlations, T-test, and Kruskal-Wallis tests were used to explore the association of SH with age, gender, self-rated health, chronic disease burden, disability, pain, and modifiable lifestyle behaviors (physical activity, smoking, alcohol, sleep medication).

Results

Our sample included 6,095 adults with mean age of 68 years (SD=10.1; range 50-99 years). The majority were female (59.7%) and white (77%). Correlations showed significant moderate associations between SH and self-rated health (r=.404), sleep medications (r=.390), pain (r=-.315). There were significant but small associations between vigorous activity (r=-.193), alcohol (r=.112), currently smoking (r=-.089) and SH. SH was significantly worse among women compared to men (t(6093)=6.996, p&lt;0.001). Furthermore, SH scores were significantly different between middle-aged versus older adults (p&lt;0.001); varying levels of self-rated health (p&lt;0.001), number of chronic diseases (p&lt;0.001), and degree of physical disability (p&lt;0.001).

Conclusion

These findings provide evidence of factors related to SH among middle-aged and older adults, providing targets for intervention to improve health in this population. Age-related differences in relation to SH indicate intervention tailored for middle-aged adults may improve health outcomes as they age. Future studies are warranted to extend these findings using multivariable statistical approaches.

Support

This study was supported by the University at Buffalo Clinical and Translational Science Institute (CTSI) funded by the National Institutes of Health (Lorenz PI).

0854 Exploration Of Sleep Health Among Middle-aged And Older Adults

Introduction

Sleep health, a construct introduced to characterize the multidimensional attributes of sleep, has been explored in a variety of populations; however has not been adequately examined for middle-aged and older adults. As attributes of sleep may change with age, the dimensional structure of sleep health may differ in this population. This study aimed to validate a composite measure of sleep health among middle-aged and older adults using data from the Health and Retirement Survey (HRS).

Methods

Data from the 2014 Core survey of the HRS was used to create a composite measure of Sleep Health including sleep efficiency, duration, timing, satisfaction, and alertness. We standardized and averaged the original variables before transforming to T scores. Sleep Health T scores (ranging 0-100, higher scores indicating better sleep health) were examined using exploratory and confirmatory factor analysis (EFA; CFA).

Results

Our sample included 6,095 adults with mean age of 68 years (SD=10.1; range 50-99 years). The majority were female (59.7%), white (77%), with high school education (53.9%). Sleep Health T scores ranged from 27-61 (mean=50; SD=6.7). EFA identified one factor. Timing was removed due to low factor loading (&lt;0.4). The revised four-dimension composite Sleep Health measure had acceptable reliability (Cronbach’s alpha 0.6). CFA showed a well-adjusted model (REMSA=0.097; NFI=0.964; RMR=0.035; GFI=0.990; AGFI=0.951).

Conclusion

These results suggest that the composite measure was valid for assessing sleep health among middle-aged and older adults. Limitations include the use of secondary data, as sleep health dimensions were based on variables not created specifically for our research question. Future research should further examine the role of sleep timing in overall sleep health among middle-aged and older adults.

Support

This study was supported by the University at Buffalo Clinical and Translational Science Institute (CTSI) funded by the National Institutes of Health (Lorenz, PI).

Osteoarthritis-related nociceptive behaviour following mechanical joint loading correlates with cartilage damage

OBJECTIVE

In osteoarthritis (OA), the pain-structure relationship remains complex and poorly understood. Here, we used the mechanical joint loading (MJL) model of OA to investigate both knee pathology and nociceptive behaviour.

DESIGN

MJL was used to induce OA in the right knees of 12-week-old male C57BL/6 mice (40 cycles, 9N, 3x/week for 2 weeks). Mechanical sensitivity thresholds and weight-bearing ratios were measured before loading and at weeks one, three and six post-loading. At these time points, separate groups of loaded and non-loaded mice (n = 12/group) were sacrificed, joints collected, and fur corticosterone levels measured. μCT analyses of subchondral bone integrity was performed before joint sections were prepared for nerve quantification, cartilage or synovium grading (scoring system from 0 to 6).

RESULTS

Loaded mice showed increased mechanical hypersensitivity paired with altered weight-bearing. Initial ipsilateral cartilage lesions 1-week post-loading (1.8 ± 0.4) had worsened at weeks three (3.0 ± 0.6, CI = -1.8-0.6) and six (2.8 ± 0.4, CI = -1.6-0.4). This increase in lesion severity correlated with mechanical hypersensitivity development (correlation; 0.729, P = 0.0071). Loaded mice displayed increased synovitis (3.6 ± 0.5) compared to non-loaded mice (1.5 ± 0.5, CI = -2.2-0.3) 1-week post-loading which returned to normal by weeks three and six. Similarly, corticosterone levels were only increased at week one post-loading (0.21 ± 0.04 ng/mg) compared to non-loaded controls (0.14 ± 0.01 ng/mg, CI = -1.8-0.1). Subchondral bone integrity and nerve volume remained unchanged.

CONCLUSIONS

Our data indicates that although the loading induces an initial stress reaction and local inflammation, these processes are not directly responsible for the nociceptive phenotype observed. Instead, MJL-induced allodynia is mainly associated with OA-like progression of cartilage lesions.

Subclinical thyroid dysfunction, bone mineral density, and osteoporosis in a middle-aged Korean population

Thyroid dysfunction is associated with the loss of bone density (osteoporosis). However, the connection between subclinical thyroid dysfunction and osteoporosis remains controversial. This study found no apparent association between subclinical hypothyroidism or subclinical hyperthyroidism and bone mineral density (BMD) in the lumbar spine and femur.

INTRODUCTION

The present study examined the relationship between subclinical thyroid dysfunction and BMD in healthy middle-aged adults.

METHODS

A total of 25,510 healthy Koreans with normal free thyroxine levels were enrolled from January 2011 to December 2016, and 91% of subjects visited only once. The average age of the 15,761 women was 45, and the average age of the 9749 men was 48. Levels of thyroid-stimulating hormone (TSH) and BMD were recorded in all subjects. BMD was measured using dual-energy X-ray absorptiometry.

RESULTS

No apparent association was found between subclinical thyroid dysfunction and BMD in the lumbar spine, femur-neck, and proximal femur sites compared with a euthyroid group. Age, body mass index (BMI), and postmenopausal status affected BMD in women, and only BMI affected BMD in men. Subclinical hypothyroidism was independently associated with a lower risk of osteoporosis (odds ratio 0.657, 95% confidence interval 0.464-0.930) in 4710 postmenopausal women.

CONCLUSIONS

No apparent association was found between subclinical hypothyroidism or subclinical hyperthyroidism defined on single TSH measurement and BMD at the lumbar spine and femur in a large cohort of middle-aged men and women. Subclinical hypothyroidism was independently associated with a lower risk of osteoporosis in postmenopausal women.

One-day protocol for 18F-FDG and 13N-ammonia PET/CT with uptake decoupling score in differentiating untreated low-grade glioma from inflammation

PURPOSE

Accurate identification of low-grade gliomas (LGGs; World Health Organization grades I and II) and their differentiation from brain inflammation lesions (BILs) remains difficult; however, it is essential for treatment. This study assessed whether a one-day protocol for voxel-wise ¹⁸F-FDG and ¹³N-ammonia PET/CT with uptake decoupling analysis could differentiate LGGs from BILs.

MATERIALS AND METHODS

Twenty-eight patients with LGGs and 16 patients with BILs underwent ¹⁸F-FDG and ¹³N-ammonia PET/CT on the same day before any type of therapy. The decoupling score and tumor-to-normal tissue (T/N) ratio of ¹⁸F-FDG and ¹³N-ammonia were calculated at each location. Student's t-test was used to compare values, and ROC curve analysis was used to establish a cut-off value for the T/N ratio and decoupling score. Area under the curve (AUC) was calculated to evaluate differential efficacy.

RESULTS

Significant differences were observed in ¹³N-ammonia T/N ratio (p=0.018) and decoupling score (p=0.003) between LGGs and BILs; however, the ¹⁸F-FDG T/N ratio did not show any differences (p=0.413). Optimal cut-off values for ¹⁸F-FDG T/N ratio, ¹³N-ammonia T/N ratio, and decoupling score were 0.73, 0.97, and 2.31, respectively, with corresponding AUCs of 0.48, 0.68, and 0.77. The respective sensitivity, specificity, and accuracy parameters using these cut-off values were 53.6%, 62.5%, and 56.8%, respectively, for ¹⁸F-FDG; 50.0%, 75.0%, and 59.1%, respectively, for ¹³N-ammonia; and 60.7%, 93.8%, and 72.7%, respectively, for decoupling score.

CONCLUSIONS

¹⁸F-FDG/¹³N-ammonia uptake decoupling score can be used to discriminate between LGGs and BILs. Use of a decoupling map of these two tracers can improve visual analysis and diagnostic accuracy.

[Characteristic and prognostic significance of leukemia stem cells associated antigens expressions in t (8;21) acute myeloid leukemia]

Objective: To investigate the characteristic and prognostic significance of leukemia stem cells associated antigens expressions including CD34, CD38, CD123, CD96 and TIM-3 in t (8;21) AML. Methods: Bone marrow samples of 47 t (8;21) AML patients were collected at diagnosis from October 2015 to April 2018 in Peking University Peoples' Hospital, then flow cytometry method was performed to detect the expression frequencies of CD34, CD38, CD123, CD96 and TIM-3 to analyze the relationship between leukemia stem cells associated antigens expressions and relapse. Results: Of 47 t (8;21) AML patients tested, the median percentages of CD34(+)CD38(-), CD34(+) CD38(-)CD123(+), CD34(+)CD38(-) CD96(+) and CD34(+) CD38(-) TIM-3(+) cells among nucleated cells were 2.37%, 0.24%, 0.27% and 0.06%, respectively. All the frequencies of CD34(+)CD38(-), CD34(+)CD38(-)CD123(+), CD34(+)CD38(-)CD96(+) and CD34(+) CD38(-)TIM-3(+) cells had no impact on the achievement of CR after the first course of induction. All higher frequencies of CD34(+)CD38(-), CD34(+)CD38(-)CD123(+), CD34(+)CD38(-)CD96(+) cells were related to higher 2-year CIR rate. Whereas, the frequency of CD34(+) CD38(-) TIM-3(+) cells had no impact on CIR rate. Both high frequency of CD34(+) CD38(-) cells and the high level of minimal residual diseases (patients with <3-log reduction in the RUNX1-RUNX1T1 transcript level after the second consolidation therapy) were independent poor prognostic factors of CIR[P=0.025, HR=6.9 (95%CI 1.3-37.4) ; P=0.031, HR=11.1 (95%CI 1.2-99.2) ]. Conclusion: Different leukemia stem cells associated antigens had distinct prognostic significance in t (8;21) AML. High frequencies of CD34(+) CD38(-), CD34(+) CD38(-) CD123(+) and CD34(+)CD38(-)CD96(+) cells at diagnosis predicted relapse in patients with t (8;21) AML.

Cardiovascular hospitalisation before and during the financial crisis among occupations in Taiwan

Background

Cardiovascular diseases (CVD) were related to financial stress. Little was known about the effects of financial crisis on cardiovascular health by occupations. This study examined CVD hospitalisations before and during the 2008 financial crisis among five occupational groups in Taiwan.

Methods

Data were collected from the Taiwan Survey on Hypertension, Hyperglycemia and Hyperlipidaemia 2007, including 4,673 participants aged 20 and above, categorized into five types of occupations, i.e., professional & manager (PM), office clerk & administrative staff (OA), skilled work (SW), unskilled worker (UW) and non-worker (NW). We abstracted their CVD hospitalisation records in the three years before (September 2005 to August 2008) and during the 2008 financial crisis (September 2008 to August 2011) from the National Health Insurance Research Database. Using incidence rate ratios (IRRs), we compared CVD hospitalisation of the first, second, third year from September 2008 to the three-year average before September 2008 for five occupational groups. Random effect negative binomial models were performed to estimate IRRs.

Results

After adjusting for covariates including age, sex, education, smoking, alcohol drinking, exercise and body mass index, there was an increase of CVD hospitalisation incidence for NW in the first year of the financial crisis (IRR=1.46, 95% Confidence Interval [95% CI]=1.19-1.77); in the second year, SW had a raised risk of CVD hospitalisation (IRR= 2.71, 95% CI = 1.59-4.60). For all occupational groups, the incidence rates of CVD hospitalisation reached the peak in the third year (PM: IRR=2.68, 95% CI = 1.05-6.83; OA: IRR=2.70, 95% CI = 1.18-6.19; SW: IRR=5.13, 95% CI = 2.89-9.09; UW: IRR=2.12, 95% CI = 1.02-4.41; NW: IRR=1.85, 95% CI = 1.18-2.67).

Conclusions

CVD hospitalisation of all occupations were affected by the financial crisis; when non-workers were the early victims, skilled workers may be the most vulnerable in the 2008 financial crisis.

Key messages

This study investigated the effects of the 2008 financial crisis on cardiovascular disease hospitalization by five occupational types in Taiwan. All occupations, particularly skilled workers, were affected by the financial crisis.

[Utility of the type 3 portable monitor for the diagnosis of patients with obstructive sleep apnea]

Objective: To evaluate the utility of a portable monitor at home for diagnosis of obstructive sleep apnea (OSA) in Chinese adults. Methods: Eighty nine patients suspected of OSA underwent overnight, unattended home sleep apnea testing (HSAT) with a portable monitor (Nox-T3, Nox Medical Inc. Iceland)followed by an in-laboratory polysomnogram (PSG) with simultaneous portable monitor (PM) recording within one week. PSG and PM recorder were scored according to recommended guidelines by independent technicians. The correlation between PSG apnea hypopnea index (AHI) and PM respiratory disturbance index (RDI) were evaluated. Results: Sleep testing showed RDI was (30.0±20.9) events/h on HSAT, and (33.4±22.4) events/h on in-laboratory PM recording. Apnea-hypopnea index (AHI) on PSG was (35.1±23.7) events/h. There was significantly statistical difference among the three group (P<0.001). Both RDI on HSAT and RDI on in-laboratory PM correlated significantly with AHI on PSG (r=0.877, P<0.001 and r=0.962, P<0.001, respectively). Bland-Altman analysis of AHI on PSG versus RDI on HSAT showed a mean difference of 4.4 events/h; limits of agreement was -17.6 to 26.5 events/h. Closer agreements were present when comparing the simultaneous recordings, with AHI on PSG versus RDI on in-laboratory PM showing a mean difference of 1.4 events/h, and limits of agreement was -11.3 to 14.2 events/h. Based on a threshold of AHI≥5 events/h, RDI on HSAT had 98.8% sensitivity, 40.0% specificity. Using an AHI ≥ 15 events/h, RDI on HSAT had 91.5% sensitivity, 76.5% specificity. Conclusion: Type 3 PM has a good diagnostic value for adult OSA patients and there is close agreement between the Type 3 portable monitor and PSG.

Comparison of the difference between income quintiles with the slope index of inequality

Background

The difference between income quintiles in health is relatively well accepted by the general public as a measure of health inequality. However, the slope index of inequality (SII) in health reflects the patterns of all social groups, including the middle 60%, and it could therefore be considered more academically desirable. If these two measures are closely correlated, the widespread use of the difference between income quintiles in health would be better supported. This study was conducted to compare differences between income quintiles in life expectancy (LE) and healthy life expectancy (HLE) with the SII.

Methods

Data on LE and HLE by income quintile from all 252 subnational districts of Korea were obtained using the National Health Information Database of the National Health Insurance Service and the Korea Community Health Survey. The SII was estimated with linear regression analysis, and Pearson correlation coefficients between differences between income quintiles and the SII were computed.

Results

The correlation coefficients between differences between income quintiles and the SII were generally high: 0.97 (95% CI: 0.96-0.98) for LE in men and women combined and 0.96 (95% CI: 0.94-0.97) for HLE in men and women combined. In most districts, the SII was greater than the difference between income quintiles.

Conclusions

Differences between income quintiles were closely correlated with the SII. The widespread use of differences between income quintiles in health as a measure of health inequality may be preferable for communicating results of health inequality measurements to the public.

Key messages

Differences in life expectancy and health life expectancy between income quintiles were closely correlated with the slope index of inequality in life expectancy and healthy life expectancy. The widespread use of differences between income quintiles in health as a measure of health inequality may be preferable for communicating results of health inequality measurements to the public.

[Anatomical relationship between fascia propria of the rectum and visceral pelvic fascia in the view of continuity of fasciae]

Objective: To perform an anatomical observation on the extension of the mesocolon to the mesorectum and the continuity of the fasciae lining the abdomen and pelvis, in order to clarify the appropriate surgical plane of total mesorectal excision. Methods: This is an descriptive study. The operation videos of 61 cases (28 males, 33 females, median age of 61) were collected. All the patients underwent laparoscopic colorectal surgery from January 2018 to December 2018 in Yangpu Hospital, including low anterior resection for rectal cancer in 25 cases, left hemicolectomy for descending colon cancer in 15 cases, and subtotal resection of the colon for intractable constipation in 21 cases. Among these 21 constipation patients, 8 received additional modified Duhamel surgeries. Gross anatomy was performed on 24 adult cadavers provided by Department of Anatomy, Shanghai Jiaotong University School of Medicine, including 23 formalin-fixed and 1 fresh cadaver (12 males, 12 females). Sixty-one patients and 24 cadavers had no previous abdominal or pelvic surgical history. The anatomy and extension of fasciae related to descending colon, sigmoid colon and rectum, especially the morphology of Toldt fascia, and the continuities of mesocolon and mesorectum were observed carefully. The distribution characteristics of the fasciae and anatomical landmarks during laparoscopic surgery were recorded and described. Results: The anatomical study on 24 cadavers showed that visceral fascia was the densest connective tissue in the pelvic, posterolateral to the rectum, and stretched as a hammock to lift all pelvic organs. Among 61 patients undergoing laparoscopic surgery, 36 (59.0%) needed to free the left colon during operation, and Toldt fascia in the descending colon segment presented as potential, avascular and extensible loose connective tissue plane between the mesocolon and posterior Gerota fascia; 33 (54.1%) needed to free the rectum during operation, and Toldt fascia extended downward to pelvis as loose connective tissue between the fascia propria of the rectum and visceral fascia; the fascia propria of the rectum exposed completely in 32 (32/33, 97.0%) cases, which ran downward and fused with visceral fascia at the level of the fourth sacral vertebra. The anatomy of 24 cadavers also showed that fascia propria of the rectum fused with visceral fascia at the level of Waldeyer fascia. The fusion line of these two fasciae was supposed to be the extension of Waldeyer fascia. There were two avascular planes behind the rectum: one between the fascia propria of the rectum and visceral fascia, and the other between the visceral fascia and parietal fascia. In 8 constipation cases undergoing laparoscopic subtotal colon resection plus modified Duhamel operation, both mesocolon and mesorectum needed to be mobilized. It was obvious that the mesocolon of descending colon extended and became the mesocolon of sigmoid colon, and ran further into the pelvic and became the mesorectum. The colon fascia of descending colon served as the natural boundary of mesocolon extended downward as the fascia of sigmoid colon and the fascia propria of the rectum, respectively. Toldt fascia locating between mesocolon of descending colon and Gerota fascia extended to pelvis as the 'presacral space' between the fascia propria of the rectum and visceral fascia. Gerota fascia in descending colon segment extended as urogenital fascia in sigmoid colon segment and visceral fascia in the pelvis, respectively. In the cadaver anatomy study, the visceral fascia served as a corridor carrying the hypogastric nerve, and ureter was observed in 23 (23/24, 95.8%) cases. The visceral fascia passed from posterior to anterior lateral of rectum, fusing with Denonvilliers fascia in a fan shape. The pelvic plexus located exactly external to the junction of visceral fascia and Denonvilliers fascia. Pelvic splanchnic nerves went through the parietal fascia toward to the inferolateral of the pelvic plexus. Conclusion: Fascia propria of the rectum and the visceral pelvic fascia are two independent layers of fascia, and the TME surgical plane is between the fascia propria of the rectum and visceral pelvic fascia instead of between the visceral and the parietal pelvic fascia.