P–044 A non-classical splice site variant in ANOS1 gene leading to Kallmann syndrome

Study question

Genetic risk of the non-classical splice site variant in ANOS1 gene

Summary answer

A non-classical ANOS1 splice site variant, c.1062 + 4T>C, causes Kallmann syndrome.

What is known already

Genetic abnormalities play a key role in the development of Kallmann syndrome. Although an overwhelming majority of missense and nonsense mutations occur in the exons of a gene, intron mutations can also be pathogenic.

Study design, size, duration

The research object is a family. Eight patients of the family were recruited in this study, three of them were diagnosed with Kallmann syndrome.

Participants/materials, setting, methods

Genomic DNA was extracted from peripheral blood and whole-exome sequencing (WES) was performed to identify the genetic abnormalities. PCR was performed to verify the WES results. The functional splicing reporter mini gene assay was performed to assess the impact of sequence variants on splicing.

Main results and the role of chance

The proband and other two patients exhibited the typical clinical features of KS. A non-classical splice site variant, c.1062 + 4T>C in ANOS1 gene was identified, whereas the other unaffected family members did not have this mutation. This mutation caused the disappearance of the splicing site of intron 7 and the splicing position became the 156th base of exon 7, which caused a frame-shift mutation, leading to a premature termination of translation.

Limitations, reasons for caution

Since the ANOS1 gene is almost not expressed in the blood, in order to uncover the effect of this splice site variant of ANOS1, we carried out a functional splicing reporter mini gene assay in the mini gene vector pEGFP-N1.

Wider implications of the findings: This study shows that mutations in non-classical splicing regions are also pathogenic. Therefore, it is recommended that the detection and analysis of this gene should pay attention to the non-classical splice site variant.

Trial registration number

Not applicable

A Safe Flexible Self-Powered Wristband System by Integrating Defective MnO2-x Nanosheet-Based Zinc-Ion Batteries with Perovskite Solar Cells

The booming market of portable and wearable electronics has aroused the requests for advanced flexible self-powered energy systems featuring both excellent performance and high safety. Herein, we report a safe, flexible, self-powered wristband system by integrating high-performance zinc-ion batteries (ZIBs) with perovskite solar cells (PSCs). ZIBs were first fabricated on the basis of a defective MnO_2-x nanosheet-grown carbon cloth (MnO_2-x@CC), which was obtained via the simple lithium treatment of the MnO₂ nanosheets to slightly expand the interlayer spacing and generate rich oxygen vacancies. When used as a ZIB cathode, the MnO_2-x@CC with a ultrahigh mass loading (up to 25.5 mg cm^-2) exhibits a much enhanced specific capacity (3.63 mAh cm^-2 at current density of 3.93 mA cm^-2), rate performance, and long cycle stability (no obvious degradation after 5000 cycles) than those of the MnO₂@CC. Importantly, the MnO_2-x@CC-based quasi-solid-state ZIB not only achieves excellent flexibility and an ultrahigh energy density of 5.11 mWh cm^-2 (59.42 mWh cm^-3) but also presents a high safety under a wide temperature range and various severe conditions. More importantly, the flexible ZIBs can be integrated with flexible PSCs to construct a safe, self-powered wristband, which is able to harvest light energy and power a commercial smart bracelet. This work sheds light on the development of high-performance ZIB cathodes and thus offers a good strategy to construct wearable self-powered energy systems for wearable electronics.

POS0785 CHANGING EXPRESSION PROFILES OF LONG NONCODING RNAS, MIRNAS, MRNAS AND CIRCULAR RNAS IN LABIAL SALIVARY GLANDS OF PRIMARY SJÖGREN’S SYNDROME (PSS)

Background:

Primary Sjögren’s syndrome (pSS) is a relatively common autoimmune disease characterized by oral and ocular dryness. An increasing number of studies have revealed that long non-coding RNA (lncRNA), miRNA, mRNA and circular RNA (circRNA) contributes to the pathogenesis of autoimmune diseases.

Objectives:

To explore lncRNA, miRNA, mRNA and circRNA expression profiles in labial salivary glands (LSGs) in pSS patients and their biological functions in the regulation of pSS.

Methods:

The expression of 75,550 lncRNAs, 2,318 miRNA, 20,292 mRNAs and 6,877 circRNAs were determined in the LSG of six pSS patients and six healthy controls using microarray experiments. Validation was performed in pSS patients and controls using real-time PCR. LncRNA-mRNA co-expression and gene-pathway networks were constructed using bioinformatics software.

Results:

A total of 599 lncRNAs (upregulated: 279, downregulated: 320), 78 miRNAs (upregulated: 26, downregulated: 52), 615 mRNAs (upregulated: 590, downregulated: 25) and 160 mRNAs (upregulated: 110, downregulated: 50) were differentially expressed in the LSGs of pSS patients. Five of these lncRNAs were validated using real-time PCR. lncRNA HCP5, lncRNA SNHG5, lncRNA IFI44L, lncRNA CMPK2 were significantly upregulated and lncRNA TTYH1 were downregulated in pSS. GO and KEGG biological pathway analysis were performed to predict the functions of differentially expressed lncRNAs and co-expressed potential targeting genes. Subsequently, a ceRNA (lncRNA-miRNA-mRNA) network including 2320 ceRNA pairs was constructed based on predicted miRNAs shared by lncRNAs and mRNAs.

Conclusion:

The expression profile provided a systematic perspective on the potential functions of lncRNAs miRNAs, mRNAs and circRNAs in the pathogenesis of pSS. Therefore, this study will aid in the development of new diagnostic biomarkers and drug therapies.

References:

[1]Le Dantec C, Varin MM, Brooks WH, Pers JO, Youinou P, Renaudineau Y. Epigenetics and Sjogren’s syndrome.Curr Pharm Biotechnol. 2012 Aug;13(10):2046-53.

Disclosure of Interests:

None declared

Combined analysis of metagenomic data revealed consistent changes of gut microbiome structure and function in inflammatory bowel disease

AIMS

To reveal the consistency and discrepancy in the gut microbial structure and function in inflammatory bowel disease (IBD) patients from different regions.

METHODS AND RESULTS

Gut microbes, antibiotic resistance genes (ARGs) and virulence factors genes (VFGs) were analysed using metagenome data from three cohorts. The abundance of Escherichia coli extensively increased in IBD patients, whereas Subdoligranulum unclassified decreased dramatically in IBD patients from three countries. Escherichia coli showed a positive correlation with multiple ARGs and VFGs in cohorts from China and the United States, including multidrug-related resistance genes and Capsule and LOS-related virulence factors genes. Escherichia coli biofilm synthesis pathways significantly enriched in IBD patients from three different regions. Notably, Subdoligranulum unclassified and Eubacterium hallii were negatively related to ARGs and VFGs.

CONCLUSIONS

Consistent changes of microbiome structure and function were observed in IBD patients from three different regions. As pathogenic bacteria, E. coli may accelerate IBD progression through encapsulation in biofilms by upregulating antibiotic resistance in Crohn's disease patients. Subdoligranulum unclassified and E. hallii may be beneficial for IBD patients and could serve as potential probiotics for IBD treatment.

SIGNIFICANCE AND IMPACT OF THE STUDY

This work dispels worries about the regional differences in gut microbial changes in IBD patients and provides useful guidance for more rational microbiome-based therapies.

[Mechanism of Ziyin recipe for treatment of ovulatory infertility: a network pharmacology-based study and clinical observations]

OBJECTIVE

To explore the mechanisms of Ziyin recipe for treatment of ovulatory infertility based on network pharmacology analysis and evaluate the clinical efficacy of this recipe.

OBJECTIVE

TCMSP, PubChem, Genecards, String, Swiss Target Prediction, and Uniprot databases were searched to identify all the action targets of Ziyin recipe and ovulatory infertility to construct the PPI network. Gene ontology (GO) and KEGG pathway enrichment analyses were performed and the "TCM-active ingredient-target-pathway" network was constructed using Cytoscape 3.6.0. We also designed a controlled clinical trial to verify the clinical effectiveness of Ziyin recipe. The patients were randomized into 2 groups to receive treatment with Western medicine including CC and HMG (control group) and additional treatment with Ziyin recipe, and the dosage of GN, follicular development days, E₂ level of a single dominant follicle on trigger day, ovulation rate, the rate of LUFS, and clinical pregnancy rate were compared between the two groups.

OBJECTIVE

We identified 22 active ingredients and 354 targets of action in Ziyin recipe, 791 targets of ovulatory infertility, and 96 common targets of action shared by Ziyin recipe and ovulatory infertility. According to Degree, the key targets included SRC, MAPK1, HSP90aa1, MAPK3, PTPN11, ESR1, Akt1, EGFR, NR3C1 and KNG1. Enrichment analysis of GO biological process showed that Ziyin recipe mainly focused on steroid hormonemediated signaling pathway, oxidation, reduction, and apoptosis. The most significantly enriched signaling pathways included PI3K-Akt signaling pathway, RAP1 signaling pathway, HIF-1 signaling pathway, estrogen signaling pathway, ovarian steroid production, and steroid hormone biosynthesis. The results of the clinical trial showed that Ziyin recipe significantly reduced the dose of GN, accelerated follicle development, increased E₂ level of single dominant follicle on the trigger day, and increased the cycle ovulation rate and pregnancy rate.

OBJECTIVE

The therapeutic effects of Ziyin recipe are probably mediated through different pathways to promote follicle development, thus improving ovulation rate and clinical pregnancy rate of infertile patients with ovulatory disorders.

Temperature dependent onset of shear thinning in supercooled glass-forming network liquids

The onset of shear thinning and the transition from Newtonian to non-Newtonian behavior in the viscous flow of select chalcogenide and oxide network glass-forming liquids in the deeply supercooled regime and its temperature dependence are studied using parallel plate rheometry. In all cases, the onset occurs at a shear rate γ̇_c that is several orders of magnitude lower than the shear relaxation rate τ₀ ^-1 and the former increases with increasing temperature. These results are in good qualitative agreement with the predictions of the existing models of shear relaxation and shear thinning based on the nonlinear Langevin equation theory, random first order transition theory, and the free volume model. However, in contrast to the theoretical predictions, the reduced shear rate W₀ (=τ₀γ̇_c) at the onset is found to range between 10^-3 and 10^-5 and decrease with increasing temperature. This temperature dependence becomes stronger with increasing fragility of the liquid. These results likely indicate that the shear thinning mechanism in network liquids could be fundamentally different from those in molecular, metallic, or polymeric glass-formers.

[Influence of fasting duration on blood volume status of pediatric patients evaluated by ultrasonic technique]

Objective: To evaluate the influence of preoperative fasting duration on blood volume status of pediatric patients during induction based on ultrasonic technique. Methods: One hundred and ten pediatric patients, scheduled for elective operation in the Second Affiliated Hospital & Yuying Children's Hospital, were recruited during January and October in 2018. After sedation by inhalation of sevoflurane, the maximum (expiratory) and minimum (inspiratory) diameter of inferior vena cava (IVC(max), IVC(min)) and aorta velocity-time integral (VTI) in apical five-chamber cardiac view were measured with an ultrasound machine. Respiratory variabilities of these parameters were further calculated. Furthermore, passive leg raising (PLR) test was performed and above measurements/calculations were repeated. The correlation between the duration of fasting and IVC respiratory variations index (IVC(RVI)) or aortic VTI variability (ΔVTI) was then analyzed. Results: Before PLR, IVC(max), IVC(min) and IVC(RVI) were (0.78±0.19), (0.43±0.15) cm and 0.45±0.12, respectively. After PLR, IVC(max) and IVC(min) increased to (0.94±0.20), (0.55±0.18) cm, while IVC(RVI) decreased to 0.42±0.13, the differences were statistically significant (t=15.66, 10.85, 3.14, all P<0.05). However, IVC(max), IVC(min) and IVC(RVI) were not significantly correlated with the duration of fasting analyzed by linear regression (before PLR: r=0.052, 0.163, 0.171; after PLR, r=0.062, 0.169, 0.165, all P>0.05). Before PLR, expiratory aortic VTI (VTI(max)), inspiratory aortic VTI (VTI(min)) and ΔVTI were 21±5, 17±4 and 17±8, respectively. After PLR, the VTI(max) and VTI(min) significantly increased to 23±5 and 19±4 (t=13.60, 10.43, all P<0.05), but ΔVTI was not changed significantly, which was 17±8(t=0.34, P>0.05). Linear regression analysis showed that VTI(max), VTI(min) and ΔVTI were not significantly correlated with the duration of fasting (before PLR: r=0.111, 0.100, 0.047; after PLR: r=0.003, 0.033, 0.073, all P>0.05). Further multiple linear regression analysis indicated that, age and body weight were independent factors influencing IVC(RVI) and ΔVTI before and after PLR (IVC(RVI): β=-0.441, 0.515, -0.451, 0.507; ΔVTI: β=-0.442, 0.545, -2.422, 2.850; all P<0.05). However, the duration of fasting was not correlated with IVC(RVI) and ΔVTI after adjusting the age and weight (IVC(RVI): β=0.177, 0.160; ΔVTI: β=0.037, 0.054; all P>0.05). Conclusion: Age and weight, but not preoperative fasting duration, are correlated with respiratory variabilities of inferior vena cava diameter and aortic VTI in pediatric patients.

Computational investigation of Zn-doped and undoped SrEu2Fe2O7 as potential mixed electron and proton conductors

Understanding the electrode properties at the atomistic level is of great benefit to the evaluation of electrode performance and design of better electrode materials in solid oxide fuel cells. In this work, density functional theory (DFT) calculations are employed to investigate the formation and conducting behaviors of oxygen vacancies and proton defects in Ruddlesden–Popper oxide SrEu₂Fe₂O₇ (SEFO), which has been experimentally characterized as a promising cathode. The calculation results suggest both oxygen vacancies and proton defects can be formed in SEFO, and especially, the formation of these defects is largely dependent on oxygen sites in the special crystal structure with alternative stacking of rock-salt layers and double-layered perovskite slabs. The oxygen vacancies within the perovskite slabs have very low formation energies, but demonstrate high energy barriers for migration and low hydration properties; while in the case of those in the rock salt layers, it’s contrary. Interestingly, protons have similar migration abilities in the perovskite slabs and rock salt layers. And therefore, increasing the vacancy concentration of the rock salt layer is beneficial to increase the concentration of proton defects and to improve the proton conductivity. DFT calculations also indicate that substituting Zn for Fe in SEFO can largely depress the oxygen vacancy formation energy, which helps to increase the concentration of both defects. Importantly, the energy barriers for migration of both oxygen ions and protons are barely enhanced, implying a negligible trapping effect of the Zn dopant.

Density functional theory calculations are employed to investigate the formation and conducting behaviors of oxygen vacancies and proton defects in Ruddlesden–Popper oxide SrEu₂Fe₂O₇.

Identification of important factors in an inpatient fall risk prediction model to improve the quality of care using EHR and electronic administrative data: A machine-learning approach

BACKGROUND

Inpatient falls, many resulting in injury or death, are a serious problem in hospital settings. Existing falls risk assessment tools, such as the Morse Fall Scale, give a risk score based on a set of factors, but don't necessarily signal which factors are most important for predicting falls. Artificial intelligence (AI) methods provide an opportunity to improve predictive performance while also identifying the most important risk factors associated with hospital-acquired falls. We can glean insight into these risk factors by applying classification tree, bagging, random forest, and adaptive boosting methods applied to Electronic Health Record (EHR) data.

OBJECTIVE

The purpose of this study was to use tree-based machine learning methods to determine the most important predictors of inpatient falls, while also validating each via cross-validation.

MATERIALS AND METHODS

A case-control study was designed using EHR and electronic administrative data collected between January 1, 2013 to October 31, 2013 in 14 medical surgical units. The data contained 38 predictor variables which comprised of patient characteristics, admission information, assessment information, clinical data, and organizational characteristics. Classification tree, bagging, random forest, and adaptive boosting methods were used to identify the most important factors of inpatient fall-risk through variable importance measures. Sensitivity, specificity, and area under the ROC curve were computed via ten-fold cross validation and compared via pairwise t-tests. These methods were also compared to a univariate logistic regression of the Morse Fall Scale total score.

RESULTS

In terms of AUROC, bagging (0.89), random forest (0.90), and boosting (0.89) all outperformed the Morse Fall Scale (0.86) and the classification tree (0.85), but no differences were measured between bagging, random forest, and adaptive boosting, at a p-value of 0.05. History of Falls, Age, Morse Fall Scale total score, quality of gait, unit type, mental status, and number of high fall risk increasing drugs (FRIDs) were considered the most important features for predicting inpatient fall risk.

CONCLUSIONS

Machine learning methods have the potential to identify the most relevant and novel factors for the detection of hospitalized patients at risk of falling, which would improve the quality of patient care, and to more fully support healthcare provider and organizational leadership decision-making. Nurses would be able to enhance their judgement to caring for patients at risk for falls. Our study may also serve as a reference for the development of AI-based prediction models of other iatrogenic conditions. To our knowledge, this is the first study to report the importance of patient, clinical, and organizational features based on the use of AI approaches.

Quantitative determination of circulating L-cartinine and its derivates contributes to Heart failure diagnosis, etiology discrimination and clinical prognosis prediction

Background

Despite the latest progress in heart failure therapy, early diagnosis and clinical prognosis prediction are still critical issues nowadays. It has been proved that carnitines play an essential role in fatty acid metabolism. However, it is unclear about the changes and clinical effects of circulating carnitines in heart failure.

Objectives

This study was designed to clarify the alteration of serum carnitine and its derivates in heart failure patients, and to verify the impact of carnitines on heart failure etiology discrimination and mortality prediction.

Methods

A total of 161 heart failure patients (Dilated cardiomyopathy: DCM, n=98; ischemia cardiomyopathy: ICM, n=63) and control patients (n=48) were enrolled from Feb to Sep in 2017. Serum L-carnitines were quantitatively measured by liquid chromatography/ mass spectrometry. All patients underwent follow-up (mean 30.8 months). Multi-variable Cox survival was performed to verify the impact of carnitines on heart failure mortality prediction.

Results

A total of 27 different carnitine derivates were detected. Compared with control group, 26 types of carnitines were increased significantly in heart failure patients. Several circulating carnitines were independent biomarkers for heart failure even adjusted by multi-variable logistic analysis. We also found 7 carnitines were obviously increased in DCM group than those in ICM group. Isobutyryl-L-carnitine and stearoyl-L-carnitine were independently associated with higher probability of DCM than ICM. DCM prediction model established by adding carnitines (isobutyryl-L-carnitine and stearoyl-L-carnitine) to age, serum creatinine and left ventricular ejection fraction,had favorable discrimination (C-index = 0.832, P&lt;0.01, Figure 1A and B) and calibration efficiency (Hosmer-Lemeshow χ2=7.376, P=0.497&gt;0.05).

Meanwhile, a total of 43 mortality event occurred, 18 death (31.6%) in ICM group and 25 (27.2%) in DCM group. Independent clinical risk factors for the occurrence of mortality were serum creatinine &gt;2mg/dl, left atrial diameter 0.55mm and N-terminal pro-B-type natriuretic peptide &gt;4000 pg/ml. Using multi-variable COX survival analysis simultaneously adjusted by serum creatinine, left atrial diameter, NT-pro-BNP and age, oleoyl L-carnitine &gt;300nmo/L (HR=2.364, 95% CI: 1.122–4.976, P=0.024) and isovaleryl-L-carnitine &lt;100nmol/L (HR=2.108, 95% CI: 1.091–4.074, P=0.026) were also independently associated with higher mortality.

Conclusions

As one of critical participants in fatty acid metabolism, L-carnitines alteration not only differentiates DCM patients from ICM ones, but also independently predicts the risk of long-term mortality in heart failure patients.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China, Grant of Shanghai Municipal Commission of Health and Family Planning

[Effectiveness and safety of sofosbuvir/velpatasvir combination ± ribavirin in the treatment of Chinese adults with chronic hepatitis C virus infection]

Objective: To understand the effectiveness and safety sofosbuvir/velpatasvir (SOF/VEL) combination ±ribavirin in the treatment of chronic hepatitis C virus (HCV) infection in China. Methods: A total of 96 Chinese adults with chronic HCV infection who were treated with SOF/VEL combination ± ribavirin for 12 weeks between July 2018 and February 2020 were selected. HCV RNA, routine blood test, liver, kidney and coagulation function, abdominal Color Doppler ultrasound or CT and liver stiffness were detected at baseline, 4 weeks of treatment, end of treatment and 12 weeks of follow-up. Adverse events and laboratory abnormalities during the treatment were recorded. A t-test was used to compare the measurement data between the two groups, and the analysis of variance was used for multiple group comparison. Results: A total of 93 cases (96.9%) achieved sustained virological response (SVR12), of which 3 cases had relapsed. 88 cases (91.7%, 88/96) had achieved rapid virological response (RVR). 96 cases (100%) had achieved virological response by the end of treatment (EOT). In patients with decompensated liver cirrhosis, the average baseline Child-Pugh score and Model for End-Stage Liver Disease score was 7.4±1.0, and 11.4±1.7, respectively. Among them, 12 cases of the SOF/VEL combined with RBV treatment had achieved SVR12 (100%) at 12 weeks, while only 3 of the 5 cases of single-tablet regimen of SOF/VEL had achieved SVR12 (60%). There was no significant difference between creatinine levels and baseline during or 12 weeks after treatment. The incidence of adverse events in patients with chronic hepatitis C and compensated cirrhosis was 6.3% (5/79), while that in patients with decompensated cirrhosis was 35.3% (6/17). The most common adverse events were hyperbilirubinemia, fatigue and anemia. There were no serious adverse events, deaths or discontinuation of treatment due to adverse events. Conclusion: SOF/VEL combination ± ribavirin in the treatment of various common genotypes of chronic hepatitis C, compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma has higher SVR12 in China, and the tolerance and safety are good.

[Correlation analysis of newly diagnosed coal worker's pneumoconiosis and GDP in Hubei Province from 2006 to 2015]

Objective: To analysis the distribution characteristics of coal worker's pneumoconiosis in Hubei Province during 2006-2010 (the 11th Five-Year Plan period) and 2011-2015 (the 12th Five-Year Plan period) , and its correlation with the gross domestic product (GDP) of Hubei Province from 1986 to 2015. Methods: In September 2019, the data of newly diagnosed coal worker's pneumoconiosis reported in Occupational Disease and Occupational Health Information Monitoring System from 2006 to 2015 and the GDP data from 1986 to 2015 in Hubei Province were collected. The distribution characteristics of time, region, enterprise size, industry and economic type of coal-worker's pneumoconiosis and its correlation with GDP were analyzed. Results: In 2006-2015, 3807 new cases of coal worker's pneumoconiosis were reported in Hubei Province. The time distribution generally ascended as a wave trend. The number of new cases reached its peak in 2013 (722 cases) . GDP growth continued between 1986-1995, 1996-2005 and 2006-2015, especially in 2006-2015. New cases of coal worker's pneumoconiosis were mainly distributed in Huangshi city, Yichang city and Enshi prefecture, accounting for 82.40% (3137/3807) of the total cases. The proportion of new cases in Huangshi city was higher than that in Yichang city and Enshi prefecture (χ(2)=272.66, 243.19, P<0.05) . New cases were mainly distributed in coal mining industry (3103 cases, 81.51%) , small-sized and medium (1675 cases, 44.00%) , and private enterprises (1621 cases, 42.58%) . The rank correlation (r(s)) of coal worker's pneumoconiosis in 2006-2015 with GDP in1986-1995, 1996-2005 and 2006-2015 were 0.157, 0.144, 0.200, respectively, and there were no significant differences (P>0.05) . Conclusion: The coalworker's pneumoconiosis in Hubei Province are mostly distributed in small and medium-sized private enterprises, and the regional distribution is concentrated in Huangshi city, Yichang city and Enshi prefecture. The concentration of cases is closely related to the number and energy production of local coal mines. There is no correlation between the growth of GDP and the distribution of cases.