[Value of glycosylated hemoglobin A1c and apolipoprotein A-1 ratio on predicting outcome of patients with acute coronary syndrome]

Objective: To investigate the predictive value of glycosylated hemoglobin A1c/apolipoprotein A-1 (HbA1c/ApoA-1) ratio for major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS). Methods: The present study is a retrospective cohort study. ACS patients who were hospitalized and underwent coronary angiography at Beijing Hospital from March 2017 to March 2019 were enrolled. Baseline information such as sex, age, previous history, Gensini score, HbA1c and ApoA-1 were analyzed. Patients were divided into two groups according to presence or absence of MACEs and the difference on HbA1c/ApoA-1 ratio was compared between the two groups. According to the tertiles of HbA1c/ApoA-1 levels, patients were divided into high (5.87-16.12), medium (4.50-5.83) and low (2.11-4.48) HbA1c/ApoA-1 groups. Cox proportional risk model was used to evaluate the differences in MACEs and all-cause mortality among the three groups. Kaplan-Meier survival analysis was used to compare the differences of MACEs between the various HbA1c/ApoA-1 groups. Results: A total of 366 ACS patients were included in this study. The mean age of the patients was (65.9±10.3) years. There were 59 MACEs and 10 all-cause deaths during the mean of (22.3±4.4) months follow-up. After adjusting for age, systolic blood pressure, history of diabetes and Gensini score, the incidence of MACEs was 2.45 times higher in the high HbA1c/ApoA-1 group than in the low HbA1c/ApoA-1 group (95%CI 1.16-5.18, P=0.019). There was no significant difference in all-cause mortality between the high and low HbA1c/ApoA-1 groups (P=1.000). Kaplan-Meier survival analysis showed that patients in the high HbA1c/ApoA-1 group had the highest risk of MACEs, while patients in the low HbA1c/ApoA-1 group had the lowest risk of MACEs (P<0.01). Spearman rank correlation analysis showed that HbA1/ApoA-1 ratio was positively correlated with Gensini score in ACS patients (r=0.274, P<0.01). Conclusion: High HbA1c/ApoA-1 ratio was an independent risk factor for MACEs in ACS patients. Patients with high HbA1c/ApoA-1 ratio had more severe coronary artery disease lesions. HbA1c/ApoA-1 ratio may be used as a potential risk stratification biomarker for ACS patients, it might be useful for the early identification of high-risk population and for predicting the incidence of MACEs among ACS patients.

[Relationship between the risk factors of coronary artery disease and degree of coronary artery plaques assessed by multi-detector row spiral computed tomography]

Objective: To assess the association of the traditional risk factors of coronary artery disease(CAD) and degree of coronary artery plaque. Methods: A total of 3 752 patients who had a suspicion of CAD from September 2011 to November 2012 at the First Hospital of China Medical University underwent the coronary artery computed tomography. The univariable and multivariable Logistic regression were employ to assess the association the traditional risk factors of CAD and degree of coronary artery plaque. Results: Age, diabetes, hypertension and smoking were the independent risk factor for significant stenosis, multivessel lesions and high coronary artery calcium score(all P <0.05), male was an independent risk factor for significant stenosis(P=0.039), however HDL-C was the independent protect factor(all P<0.05). Conclusion: Age, diabetes, hypertension and smoking are the independent risk factor for degree of coronary artery plaque, HDL-C is the independent protect factor.Male is only an independent risk factor for significant stenosis.

[Drug resistance and molecular typing of diarrheagenic escherichia coli from the diarrhea clinics in Qingpu District, Shanghai City from 2015 to 2019]

Objective: To analyze the drug resistance and multilocus sequence typing of five types of diarrheagenic Escherichia coli (DEC) isolated from diarrhea outpatients of diarrhea comprehensive monitoring designated hospital in Qingpu District, Shanghai City from 2015 to 2019. Methods: From January 2015 to December 2019, five types of DEC, isolated and identified from diarrhea outpatient cases' anal swabs of the Qingpu branch of Zhongshan Hospital were collected to determine the minimal inhibitory concentration by using the micro broth dilution susceptibility test. The strains, resistant to the third-generation cephalosporins or carbapenems, or producing ESBLs, were selected based on the results of sensitivity tests and determined by WGS. The MLST typing of DEC was analyzed based on the WGS technology and the minimum spanning tree was constructed by BioNumerics 7.6 software to analyze the local dominant flora. Results: A total of 513 strains of DEC were detected and isolated from 4 494 anal swabs, with a detection rate of 11.42%. About 500 strains were tested for drug sensitivity to nine antibiotics in four classes, including 330 strains of enterotoxigenic E.coli (ETEC), 72 strains of enteroaggregative E.coli (EAEC), 95 strains of enteropathogenic E.coli (EPEC), 1 strain of enterohemorrhagic E.coli (EHEC), and 2 strains of enteroinvasive E.coli (EIEC). From 2015 to 2019, the resistance rate of cefotaxime-clavulanic acid was significantly different (P<0.05). The resistance rate of virulence types of DEC to nalixic acid was significantly different (P<0.05). About 71 strains of DEC were determined by WGS, and 77 drug-resistant genes were detected. Strains were classified into 32 ST subtypes, with the dominant genotypes being ST-1491 (29.6%, 21/71) and ST-10 Complex (23.9%, 17/71). All ST-1491 produced ESBLs, which were blaCTX-M gene mutant strains. The dominant type of ST-10 complex was ST-218 (35.3%, 6/17). In addition, 8 strains of EAEC, 14 strains of EPEC and 49 strains of ETEC were classified into 7, 14 and 18 ST subtypes, respectively. Conclusion: The drug resistance of DEC strains from the diarrhea outpatient case of Qingpu District is serious. The ST types of EAEC and EPEC are highly polymorphic. The dominant ST types of DEC are basically consistent with the common genotypes in southeast China.

Hypothetical Interventions on Cardiovascular Health Metrics for Abnormal Cognitive Aging: An Application of the Parametric g-formula in the CLHLS Cohort Study with 12 Years Follow-Up

BACKGROUND

Abnormal cognitive aging is closely related to dementia.

OBJECTIVES

This study aimed to estimate the effect of cardiovascular health (CVH) metrics on abnormal cognitive aging.

DESIGN

A longitudinal cohort study.

SETTING

Participants were recruited from the Chinese Longitudinal Health Longevity Survey.

PARTICIPANTS

A total of 3298 participants aged ≥65 years with normal cognitive performance at baseline were included.

MEASUREMENTS

Cognitive performance was measured by the Chinese version of the Mini-Mental State Examination (MMSE). CVH was assessed with six metrics, including hypertension, diabetes, exercise, body mass index (BMI), diet, and smoking. Group-based trajectory model was used to identify the trajectory groups of cognitive aging over 12 years (2002-2014 and 2005-2018). The parametric g-formula was applied to estimate the effect of each single six CVH metrics and their combinations on the 12-year cognitive aging trajectory.

RESULTS

Four trajectory groups of cognitive aging were identified: Stable-high (77.4%), Unstable (4.9%), Slow decline (11.1%), and Rapid decline (6.6%). Unstable, Slow decline, and Rapid decline trajectory groups were considered as abnormal cognitive aging (22.6%). Single interventions on hypertension, exercise, BMI, and diet could reduce the risk of abnormal cognitive aging. Moreover, the risk ratios of joint intervention on exercise, BMI, and diet for Unstable, Slow decline, and Rapid decline trajectory groups were 0.38 (95% CI: 0.30-0.48), 0.45 (95% CI: 0.37-0.54), and 0.3 (95% CI: 0.23-0.41), respectively.

CONCLUSION

A considerable proportion of the participants experienced abnormal cognitive aging during their aging process. Interventions on these CVH metrics (i.e., exercise, BMI, and diet), which are fairly practical and feasible for older adults, may be effective strategies for preventing abnormal cognitive aging.

[Plasma exchange combined with continuous renal replacement therapy for imported severe Plasmodium falciparum malaria: a case report]

The article presents the diagnosis and treatment of an imported case with severe Plasmodium falciparum malaria, and the effect of plasma exchange combined with continuous renal replacement therapy. Severe P. falciparum malaria is characterized by complex clinical symptoms and multiple complications, and plasma exchange combined with continuous renal replacement therapy has a satisfactory therapeutic efficacy for severe P. falciparum malaria.

A phase Ib/II study of AK112, a PD-1/VEGF bispecific antibody, as first- or second-line therapy for advanced non–small cell lung cancer (NSCLC)

9040

Background: Besides the well-known antiangiogenic effects, anti-VEGF agents also modulate the tumor immune micro-environment, leading to synergic anti-tumor effects. AK112 is a humanized IgG1 bispecific antibody against PD-1 and VEGF. Here, we reported results of an ongoing phase Ib/II trial of AK112 in advanced NSCLC pts. Methods: Pts with stage IIIB/IIIC/IV NSCLC, ECOG PS 0-1 and negative oncogenic drivers were enrolled and given AK112 (10 mg/kg Q3W, 20 mg/kg Q2W, 20 mg/kg Q3W or 30 mg/kg Q3W) intravenously. The primary endpoints were ORR per RECIST v1.1 and safety. Results: At data cutoff (January 5, 2022), 94 pts were enrolled: median age 66.0 years (range: 48-75), PS 1 90.4%, male 85.1%, non-squamous 48.9%, PD-L1 positive (TPS ≥1%) 70.2% and treatment-naïve 84.0%. Of 83 pts evaluable for efficacy, ORR (unconfirmed, similarly hereinafter) and DCR were 22.2%/88.9%, 44.0%/92.0%, 37.9%/93.1% and 100%/100% at doses of 10 mg/kg Q3W, 20 mg/kg Q2W, 20 mg/kg Q3W and 30 mg/kg Q3W, respectively. When doses of AK112 > 10mg/kg Q3W, ORR and DCR were 42.9% (24/56) and 92.9% (52/56) in 56 evaluable pts, 56.3% (18/32) and 100% (32/32) in pts with TPS≥1% at 1st line setting, and 23.5% (4/17) and 76.5% (13/17) in pts with PD-L1 TPS < 1%, respectively. Grade≥3 treatment-related adverse events (TRAEs) occurred in 10.6% (10/94) pts, in which the most common event (occurring in > 1 pt) was pneumonia (2.1%, 2/94). No TRAEs led to permanent treatment discontinuation. Most frequent TRAEs (incidence ≥10%) were proteinuria (17.0%), hypertension (16.0%), lipase increase (12.8%), alanine aminotransferase increase (12.8%), blood urea increase (10.6%), apolipoprotein E increase (10.6%) and hyperglycaemia (10.6%). No significant difference in the incidences of TRAEs were observed between non-squamous and squamous pts. Conclusions: In advanced NSCLC, AK112 was well-tolerated and presented remarkable anti-tumor efficacy. Further phase III studies are planned to validate the findings of this study. Clinical trial information: NCT04900363.

AB0762 THE CHARACTERISTICS OF PERIPHERAL LYMPHOCYTE SUBSETS IN PATIENTS WITH IGG4-RELATED DISEASE

Background:

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune disease with chronic systemic inflammation and fibrosis. The main feature of the disease was diffuse swell of the affected organs, and the serum IgG4 level was increased. Histopathology of the lesions showed infiltration of IgG4+ plasma cells. However, the pathogenesis of IgG4-RD is still unclear[1].

Objectives:

To explore the clinical characteristic of lymphocyte subsets of IgG4-related disease patients, and make comparisons with healthy controls.

Methods:

A total of 31 patients with IgG4-RD who were admitted to the Rheumatic Immunology Department of the Second Hospital of Shanxi Medical University from January 2016 to June 2020 were included. We collected their Clinical and laboratory data, and selected 30 age and sex matched healthy people as the control group. Flow cytometry was used to detect the percentage and absolute number of lymphocyte subsets (T, B, NK, CD4+T, CD8+T) and CD4+T subsets (Th1, Th2, Th17, CD4+CD25+Foxp3+Treg) in peripheral blood of IgG4-RD patients and healthy controls.

Results:

(1)The percentage of CD4+T cells in peripheral blood of IgG4-RD patients was higher than that of healthy controls [45.00(33.97-51.48) vs. 39.36(33.78-43.30), P<0.05]. (2)The percentage and absolute number of Th17 cells was increased in IgG4-RD patients [1.13(0.70-1.55) vs. 0.77(0.43-1.07), P<0.05; 7.90(5.20-12.23) vs. 5.60(3.12-8.47), P<0.05], while the percentage of Treg cells was decreased [3.37(2.82-5.65) vs. 4.96(4.18-6.34), P<0.01]. But Treg cells number showed no difference between the two groups. (3) Th17/Treg ratio was significantly increased in IgG4-RD patients [0.29(0.16-0.46) vs. 0.15(0.08-0.23), P<0.01], and it was positively correlated with IgG4-RD response index score(r=0.491, P<0.01). (Table 1).

Table 1.

Comparation of absolute number and percentage of peripheral blood lymphocyte subsets between IgG4-RD patients(n=31) and healthy controls (n=30).

cell subsetsIgG4-RD (n=31)HC(n=30)P valueB150.59(120.14-212.38)203.27(152.90-244.27)0.089B%8.74(6.46-11.45)10.03(8.26-13.21)0.059NK261.98(178.82-303.08)290.83(179.93-451.45)0.175NK%13.14(9.92-18.10)16.50(11.24-21.75)0.105CD3+T1357.44(992.00-1844.82)1305.81(978.24-1597.94)0.708 CD3+T%72.62(69.32-76.96)71.62(64.97-75.25)0.135CD8+T436.40(342.71-596.86)513.50(359.73-620.53)0.665CD8+T%24.26(19.48-31.27)26.50(20.67-32.90)0.535CD4+T741.00(562.78-1095.52)664.50(585.52-789.97)0.428CD4+T%45.00(33.97-51.48)39.36(33.78-43.30)0.032Th1162.32(108.11-216.61)144.27(81.52-161.66)0.094Th1%19.00(15.24-25.54)18.46(14.86-24.27)0.644Th27.82(5.35-11.78)8.25(5.32-10.87)0.817Th2%1.00(0.76-1.27)1.24(0.89-1.64)0.399Th177.90(5.20-12.23)5.60(3.12-8.47)0.010Th17%1.13(0.70-1.55)0.77(0.43-1.07)0.026Treg24.45(19.76-44.79)34.55(27.29-46.57)0.076Treg%3.37(2.82-5.65)4.96(4.18-6.34)0.003Th1/Th220.00(13.78-36.36)14.97(10.31-21.58)0.135Th1/Treg5.72(2.92-8.86)3.68(2.53-4.77)0.021Th2/Treg0.27(0.16-0.52)0.22(0.15-0.32)0.199Th17/Treg0.29(0.16-0.46)0.15(0.08-0.23)0.002

Conclusion:

Th17/Treg immune disorder exists in IgG4-RD patients, and it is related to the disease activity, indicating that Th17/Treg imbalance may be an important pathogenesis of IgG4-RD.

References:

[1]Kamisawa T, Zen Y, Pillai S, et al. IgG4-related disease[J]. Lancet, 2015, 385(9976): 1460-1471.

Disclosure of Interests:

None declared

POS0471 INDUCED ANTIBODIES DIRECTED TO THE ANGIOTENSIN RECEPTOR TYPE 1 PROVOKE SKIN AND LUNG INFLAMMATION AND DERMAL FIBROSIS AND ACT SPECIES OVERARCHING

Background

Antibodies directed to the angiotensin receptor type 1 (AT1R) were found to be increased in patients with SSc ad they predict mortality and SSc complications (1, 2). In vitro studies suggested an involvement in the pathogenesis of systemic sclerosis (SSc).

Objectives

Here, we aim to determine the contribution and functions of AT1R autoantibodies (Abs) in vivo and in vitro as well as their capacity to recognize AT1R from different species.

Methods

C57BL/6J mice were immunized with membrane-embedded human AT1R or empty membrane as control. Phenotypic properties of various organs were examined by immunohistochemistry, immunofluorescence, and TUNEL apoptosis assay. A monoclonal (m)AT1R Ab was generated based upon this mouse model by hybridoma technology and transferred into C57BL/6J mice. Mice deficient for CD4+ and CD8+ T cells, B cells and AT1Ra/b served as controls. In vitro, Abs responses towards AT1R were measured using rat cardiomyocytes, human epithelial cells, AT1R-transfected HEK293 cells and primary human monocytes.

Results

AT1R-immunized mice developed perivascular skin and lung inflammation, lymphocytic alveolitis, weak endothelial apoptosis and skin fibrosis, not present in controls or mice deficient for CD4+ T and B cells. The contribution of AT1R Abs to skin manifestations and interstitial lung disease was demonstrated by application of a mAT1R Ab, which induced skin and lung inflammation, not observed in the AT1Ra/b knockout mice. IgG from immunized mice containing AT1R Abs and/or the mAT1R Ab activated rat cardiomyocytes and human monocytes. Treatment of AT1R-transfected HEK293 cells with the mAT1R Ab enhanced AT1R signaling in the presence of the endogenous agonist Angiotensin II.

Conclusion

Our immunization strategy successfully induced AT1R Abs, contributing to inflammation and most likely to fibrosis via activation of AT1R. Therefore, AT1R Abs are valuable targets for future therapies in SSc and possibly other AT1R Ab-related diseases.

References

[1]Riemekasten, G. et al. Involvement of functional autoantibodies against vascular receptors in systemic sclerosis. Ann. Rheum. Dis. 70, 530–536 (2011).

[2]Becker, M. O. et al. Vascular receptor autoantibodies in pulmonary arterial hypertension associated with systemic sclerosis. Am. J. Respir. Crit. Care Med. 190, 808–817 (2014).

Figure 1.

AT1R immunization and induction of AT1R Abs in C57BL/6J mice induced lymphocytic alveolitis in bronchoalveolar fluid (A), interstitial lung disease (B) with increased inflammatory score (C)

Figure 2.

AT1R immunization and induction of AT1R Abs in C57BL/6J mice induced skin fibroses (A) as determined by collagen content (B) and skin thickness (C).

Acknowledgements

This manuscript was founded by the German Research Council RI1056/11-1-3 and the Excellence Cluster Precision Medicine in Inflammation and by the BMBF-founded Mesinflame project.

Disclosure of Interests

None declared.

[A clinical study of 100 cases of AIDS in Africa]

In this article, 100 cases of AIDS observed in Africa by the Chinese Medical Team are reported. The general clinical data were analyzed and studied, and the changes in the oral cavity and on the skin (Kaposi's sarcoma) are described. The results showed that oral mycotic infection and Kaposi's sarcoma are the strong evidences of this immunity deficiency and may be regarded as the early stage clinical manifestations of AIDS in Africa.

[Difference of the discharges from the postganglionic fibers of the celiac ganglion induced by electroacupuncture at zusanli and yanglingquan]

The changes of the discharge from postganglionic fibers of the celiac ganglion induced by electroacupuncture (EA) at Zusanli and Yanglingquan were measured on 25 healthy rabbits. The result shows that the sympathetic activity can be inhibited by EA at both acupoints above. The depression of the sympathetic activity resulted from EA at Zusanli was significant stronger than that at Yanglingquan (P < 0.05). This result indicates that there is the relative individuality in the function of the different acupoints on the different channels.

[The effect of nifedipine on the microcirculation in pregnancy-induced hypertension]

OBJECTIVES

To study the effects of nifedipine on the microcirculation in pregnancy-induced hypertension (PIH).

METHODS

We observed the microcirculation in nailfold of 30 normal pregnant women and 76 cases of PIH. 20 mg nifedipine was given and nailfold microcirculation was observed after 30 minutes.

RESULTS

Nifedipine increased the velocity of blood flow, reduced the aggregation of erythrocytes, and dilated capillaries. After the administration of nifedipine, the total score of the nailfold microcirculation decreased significantly in mild and moderate PIH (P < 0.05), but no marked difference was observed in severe PIH cases (P > 0.05).

CONCLUSION

The disorder of the microcirculation of PIH can be improved by nifedipine.

[Evaluation of performance and blood compatibility of polyethersulfone hollow fiber plasma separator]

In this study, we evaluated the performance and blood compatibility of polyethersulfone hollow fiber membrane plasma separator by animal experiment. Hemolysis did not occur under the usual conditions of plasma separation. The sieving coefficients of total protein, albumin and globulin were over 95%, and about 60% of total plasma were extracted from the whole blood. White blood cells, platelets, fibrinogen, and coagulation factors were decreased during the early stage of plasma separation and appeared to be within acceptable ranges for clinical use.

[Overexpression of p27(KIP1) induced by Bak gene leads to the arrest in G(1) phase of HCC-9204 cell line]

OBJECTIVE

To explore whether p27(KIP1) plays an important role in prolonging cell cycle in G(1) phase and leading to apoptosis of HCC-9204 cells.

METHODS

A model of Bak-induced cell cycle arrest in G(1) phase and subsequent apoptosis was established. p27(KIP1) was obtained from the model and sequenced afterwards. A zinc inducible p27(KIP1) stable transfectant was constructed. The effects of inducible p27(KIP1) on cell growth and cell cycle arrest were examined in control pMD and pMD-KIP1 transfected HCC-9204 cells. Western blot was performed to evaluate the expression of p27(KIP1).

RESULTS

The cell growth was reduced by 35% upon 48h of p27(KIP1) induction with zinc treatment as determined by trypan blue exclusion assay. p27(KIP1) caused cell cycle arrest at 24h after induction, with 40% increase in G(1) population.

CONCLUSIONS

Bak may induce cell cycle arrest in G(1) phase through up-regulating expression of p27(KIP1). The inducible p27(KIP1)-expressing cells provide a model to assess p27(KIP1) function.

Effect of restorative materials on cuspal flexure

The purposes of this study were (1) to establish a methodology for determining surface strains in two locations of the same tooth under intact, prepared, and restored conditions and (2) to compare the effects on stiffness of different restorative materials in a tooth subjected to cuspal loading. Two linear strain gauges were mounted on each of 30 extracted maxillary premolar teeth. Teeth were mounted in poly(methyl methacrylate) resin and randomly assigned to one of three study groups according to the restorative material and application technique to be used. Statistical analysis indicated a statistically significant interaction between restorative material and tooth condition at both proximal and buccal sites and a statistically significant difference in stiffness between teeth restored with Tenure/Marathon V and those restored with either amalgam or Scotchbond 2/P-50 at the proximal site. Results suggest that the methods employed provide a useful, nondestructive means of testing the same tooth under various conditions.

[A novel method for preparation of C18 ester-bond RP-HPLC packing]

RP-HPLC packings have found widespread application in the fields of biology, chemistry and pharmaceutical industry, etc. C18-bonded phase is one of the most important packing. In order to avoid using toxic and unstable chloro-containing silane as derivatization reagent, a new practical and economic procedure had been developed to prepare RP packing. Octadecyl group was bound onto YQG80, 5 microns silica (Tsingdao Oceanic Chemical Factory, particle size d.p. 5 microns) with gamma-glycidoxypropyltrimethoxysilane as coupling agent. Elemental analysis and chromatographic evaluation confirmed the feasibility of the procedure and RP behavior of the packing. After eluting with 500 column volume of mobile phase at different pH (2, 5 and 8), the column still showed good performance (> 64,000 theoretical plates/m) and stability.

[Studies on biosorption of Au3+ by Bacillus megaterium]

Some characteristics of Au3+ biosorption and bioreduction by Bacillus megaterium D01 biomass were reported. The optimum pH value of Au3+ biosorption by strain D01 was 3.0. The biosorption was a rapid process, reaching 95% of the maximal capacity within the first 5 min of contact. Temperature did not affect the biosorption. The biosorptive efficiency(99.1%) and capacity (302.0 mg Au3+/g dry weight biomass) were achieved under the conditions of pH 3.0 and 30 degrees C, both concentration with an initial Au3+/biomass radio of 305 mg/g dry weight for 30 min of the contact. The D01 biomass could reduce Au3+ in the solution to Au0, Au0 on the cells surface and in the contact solution could be crystallized to different forms gold crystals, Au3+ impregnated on SiO2 and alpha-Fe2O3 could be reduced to Au0 by D01 biomass. The results of electrochemical reaction indicated that the strain D01 exhibited a high selectivity for Au3+.