[Short-term effect of sodium zirconium cyclosilicate on potassium lowering in chronic kidney disease patients with hyperkalemia]

Objective: To investigate the efficacy of sodium zirconium cyclosilicate on emergency correction of hyperkalemia in chronic kidney disease patients. Methods: Patients with chronic kidney disease who were admitted to the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from May to June 2020 were selected. Those who had hyperkalemia and took sodium zirconium cyclosilicate powder were finally included. The patient's clinical data and laboratory results were collected. Results: A total of 24 results were included from 21 patients. The age of patients was (48.9±13.5) years old. Fourteen patients were male, and 7 patients were female. After 2 hours of administration, the venous potassium level decreased from (5.85±0.52) mmol/L to (5.15±0.43) mmol/L (P<0.001, n=21), with an average decline of (0.71±0.43) mmol/L. Meanwhile, the arterial potassium level decreased from (5.50±0.40) mmol/L to (4.88±0.33) mmol/L (P<0.001, n=10), with an average decline of (0.62±0.29) mmol/L. Based on the initial venous potassium level, the patients were further divided into three groups. The average potassium decrease in<5.5 mmol/L group (4 patients), 5.5-<6.0 mmol/L group (11 patients) and ≥6.0 mmol/L group (6 patients) was (0.46±0.26) mmol/L, (0.62±0.38) mmol/L and (1.04±0.45) mmol/L, respectively. There was statistically significant difference of potassium reduction among the three groups (P=0.045). Moreover, the extent of potassium reduction was positively correlated with baseline venous potassium level (r=0.603, P=0.004, n=21). The study did not reveal any treatment-related adverse event. Conclusion: Sodium zirconium cyclosilicate powder can rapidly and effectively reduce the serum potassium level in chronic kidney disease patients with hyperkalemia.

Resveratrol alleviates osteoporosis through improving the osteogenic differentiation of bone marrow mesenchymal stem cells

OBJECTIVE

To investigate the protective effect of Resveratrol (RES) on TNF-α-induced inhibition of osteogenic differentiation, thus alleviating the progression of osteoporosis (OP).

MATERIALS AND METHODS

OP model in rats was first conducted by performing ovariectomy (OVX). Rats were randomly divided into sham group, OVX group, and RES+OVX group. Body weight of each rat was regularly recorded every week. Bone mineral density (BMD) of rat femoral metaphysis was measured by micro-CT. Changes in radial degrees and loads of rat femora were examined through three-point bending experiments. Relative levels of OCN and Runx2 in each group were determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Alkaline phosphatase (ALP) activity and calcification ability were assessed through ALP staining and alizarin red staining, respectively. Bone mesenchymal stem cells (BMSCs) were extracted from healthy rats and divided into control group, Tumor necrosis factor-α (TNF-α) group, RES group, and TNF-α+RES group based on different treatments. Relative levels of OCN and Runx2, ALP activity, and calcification ability in each group were detected in the same way. Finally, protein levels of NF-κB and β-catenin in BMSCs were determined.

RESULTS

Rats in each group gained body weight during the experimental period, especially those in OVX group and RES+OVX group. No significant difference in the body weight was found between OVX group and RES+OVX group. BMD in rat femora of RES+OVX group was higher than in OVX group but lower than sham group. Elastic/max radial degree and elastic/max load of femora were markedly reduced in OVX group compared to RES+OVX group. Relative levels of OCN and Runx2, ALP activity and calcification ability decreased in OVX group relative to sham group, which were partially reversed by RES treatment. After osteogenic differentiation in BMSCs induced with TNF-α, viability and calcification ability were markedly reduced and were upregulated by RES treatment. Moreover, RES treatment enhanced the downregulated levels of OCN and Runx2 in BMSCs undergoing TNF-α induction. Upregulated protein levels of nuclear factor kappa-B (NF-κB) and β-catenin in TNF-α-induced BMSCs were downregulated by RES treatment.

CONCLUSIONS

The inhibited osteogenic differentiation of BMSCs undergoing TNF-α induction is improved by resveratrol treatment, which contributes to alleviate the progression of osteoporosis.

Effect of dexmedetomidine on kidney injury in sepsis rats through TLR4/MyD88/NF-κB/iNOS signaling pathway

OBJECTIVE

The aim of this study was to investigate the effect of dexmedetomidine (DEX) on kidney injury in sepsis rats through the Toll-like receptor 4 (TLR4)/myeloid differential protein-88 (MyD88)/nuclear factor-κB (NF-κB)/inducible nitric oxide synthase (iNOS) signaling pathway.

MATERIALS AND METHODS

A total of 30 Sprague-Dawley (SD) rats were randomly divided into three groups, including the control group (n=10), lipopolysaccharide (LPS)-induced acute kidney injury (AKI) group (model group, n=10) and DEX treatment group (DEX group, n=10). The model of sepsis was successfully established in rats. The levels of serum creatinine (Cr), blood urea nitrogen (BUN), serum interleukin-6 (IL-6), IL-1β, IL-10 and tumor necrosis factor-α (TNF-α) were detected via enzyme-linked immunosorbent assay (ELISA). The pathological changes in kidney tissues were detected via hematoxylin-eosin (HE) staining. Furthermore, the mRNA and protein expressions of TLR4, MyD88, NF-κB, and iNOS in the kidney were detected via fluorescence quantitative Polymerase Chain Reaction (PCR) and Western blotting, respectively.

RESULTS

Compared with the control group, rats in the model group showed significant kidney injury, markedly increased levels of serum Cr, BUN and pro-inflammatory cytokines, remarkably decreased the level of IL-10 (p<0.05), and significantly increased mRNA and protein expressions of TLR4, MyD88, NF-κB, and iNOS. In the DEX group, AKI was markedly improved, while the expressions of inflammatory cytokines were remarkably declined. Furthermore, the mRNA and protein expressions of TLR4, MyD88, NF-κB, and iNOS decreased significantly.

CONCLUSIONS

DEX has a protective effect on LPS-induced AKI, whose mechanism may be related to the inhibition of the TLR4/MyD88/NF-κB/iNOS pathway.

Silencing the long noncoding RNA NORAD inhibits gastric cancer cell proliferation and invasion by the RhoA/ROCK1 pathway

OBJECTIVE

The current study aimed to examine the role and mechanism of a conserved long noncoding RNA termed NORAD (noncoding RNA activated by DNA damage, also named LINC00657) in gastric cancer (GC) progression.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to determine the expression level of relevant genes in GC cell lines. Cell proliferation was examined by cell counting kit-8 (CCK-8) assays. Cell migration and invasion were detected by transwell migration and invasion assays. Protein levels of the indicated genes were detected by Western blotting. Cell apoptosis was examined by flow cytometry.

RESULTS

Results showed that NORAD knockdown decreased cell proliferation, migration and invasion but increased cell apoptosis. NORAD knockdown affected the expression of genes related to apoptosis and Epithelial-Mesenchymal Transition (EMT). In addition, NORAD's depletion resulted in reduced Ras Homolog Family Member A (RhoA) and Rho-associated coiled-coil containing protein kinase 1 (ROCK1) expression. Furthermore, NORAD's expression was positively correlated with RhoA and ROCK1 expressions in GC based on The Cancer Genome Atlas (TCGA) database.

CONCLUSIONS

Our results demonstrate the oncogenic role of NORAD in gastric cancer progression.

Effects of the prebiotic inulin-type fructans on post-antibiotic reconstitution of the gut microbiome

AIMS

Interventions using prebiotic inulin-type fructans (ITFs) are widely prescribed to modulate the gut microbiota composition and activity to promote health. However, the impacts of ITFs on post-antibiotic reconstitution of the gut microbiome remain incompletely understood. The aim of the present study was to investigate the effects of ITFs supplementation on intestinal inflammation, the composition of the intestinal microbiota and the colonic transcriptome after antibiotic treatment.

METHODS AND RESULTS

Male BALB/c mice were subjected to an antibiotic cocktail (ABx) treatment for 7 days, and their microbiomes were then reconstituted either spontaneously or with ITFs supplementation (5%) for 14 days. Our data showed that ITFs supplementation delayed the recovery of antibiotic-induced colitis compared with the spontaneous recovery. Neither ITFs supplementation nor spontaneous recovery could restore the microbial community composition at the genus level back to its initial composition. ITFs supplementation increased the relative abundance of some beneficial bacteria and butyrate levels, but resulted in selective blooms of some opportunistic pathogens and elevated the pathways associated with diseases linked to gut microbiota function. Both ITFs supplementation and spontaneous recovery could restore the colonic transcriptome nearly to the initial profile to a certain extent; however, ITFs supplementation delayed the restoration of the immunoglobulin genes compared to spontaneous recovery.

CONCLUSION

These data showed that post-antibiotic ITFs consumption did not always lead to beneficial effects but might lead to potential adverse effects in the context of dysbiosis.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings highlighted that caution is required when supplementing ITFs to restore intestinal homeostasis in the context of dysbiosis resulting from broad-spectrum antibiotics.

The first two months epidimiological study of COVID-19, related public health preparedness, and response to the ongoing epidemic in Pakistan

As an underdeveloped country, the coronavirus disease 2019 (COVID-19) epidemic has posed a major risk to the health and economy of Pakistan. The SIR (susceptible-infected-recovered) model of epidemiologic analysis predicts that there should have been more cases since late March 2020 in Pakistan. We therefore sought to investigate COVID-19's prevalence and epidemiologic trends in Pakistan. Research for COVID-19 is still in its early stages, so data were collected from official websites and research journals, then analyzed for the disease's prevalence, epidemiology, mortality and recoveries. The results indicated that a rapid increase had indeed occurred in the number of COVID-19 infections in Pakistan, with the first case reported on 25 February, 2020. From 25 February 25 to April, 2020, COVID-19 infected 11,155 people in Pakistan, with 237 deaths (2.12%) and 2527 recoveries (19.96%). We found a statistically significant positive correlation between the prevalence of COVID-19 and the mortality ratio (r = 0.983, r 2 = 0.966; p ≤ 0.05). We concluded that proper management must be undertaken to improve the quarantine system, and the World Health Organization guidelines must be closely followed to cope with COVID-19. There is no vaccine for COVID-19, so antiviral drugs (interferon alfa, ribavirin) may be useful to prevent COVID-19; however, severe control measures implemented in China have significantly mitigated the spread of COVID-19. Suspected and confirmed cases must be treated in separate rooms. Staying home and social distancing are the safe way to proceed.

The moving of high emission for biomass burning in China: View from multi-year emission estimation and human-driven forces

Biomass burning (BB) has significant impacts on air quality, climate and human health. In China, the BB emission has changed substantially over the past decades while the multi-year variation held high uncertainty and the driving forces have addressed little attention. Here, this research aimed to conduct a comprehensive and systematic analysis of BB variation in China and provided precise and targeted BB emission reduction suggestions. The moving of high emission for BB from 2003 to 2014 was clearly identified, by the view of reliable emission estimation and anthropogenic impacts. Multiple satellite products, field survey, time varying biomass loading data and measured emission factors were adopted to better estimating BB emission and reducing the uncertainty. Social-economic analysis was added to assess the anthropogenic impacts on high emission variation quantitatively. Results showed that the cumulative BB emissions of OC, EC, CH₄, NO_X, NMVOC, SO₂, NH₃, CO, CO₂, PM_2.5 and PM₁₀ during 2003-2014 were 1.6 × 10⁴, 5.64 × 10³, 3.57 × 10⁴, 1.7 × 10⁴, 5.44 × 10⁴, 2.96 × 10³, 6.77 × 10³, 6.5 × 10⁵, 1.15 × 10⁷, 5.26 × 10⁴ and 6.04 × 10⁴ Gg, respectively. Crop straw burning (in-field and domestic) in northeast China plain (NEP), north China plain (NCP), northern arid and semiarid region and loess plateau were the key sources, averagely contributed 73% for all the pollutants emission. While domestic straw burning and firewood burning in Sichuan basin (SB), Yunnan-Guizhou plateau and southern China were main contributors, averagely accounting for 70% of all the pollutants emission. On regional level, high emissions were mainly found in SB, NCP and NEP. Temporally, high emissions were mainly found in crop sowing harvesting and heating seasons. From 2003 to 2014, the BB emission for different biomass species has changed significantly in different regions. High emission has gradually moved from SB to NCP and NEP. Firewood burning and domestic straw burning emission decreased by 47% and 14% in SB, respectively. In-field straw burning emission increased by 52% and 231% in NCP and NEP respectively and domestic straw burning emission increased by 62% in NEP. Emissions from heating season have decreased while emissions in corn harvest season were continuously increased. Analysis of Environmental kuznets curve, agricultural productivity level, human burning habits, rural energy structure and local control policies revealed the internal human driving strength of the variation for BB emission. The unbalanced development of social economy and the policy bias were primary drivers of limiting the BB management. BB emission will alleviate in NCP and aggravate in NEP. For the further emission reduction, effective measures for corn sources management, straw returning and rural energy utilization should be systematically considered. This research provides a clear evidence for the multi-year variation pattern of BB emissions, which is critical for pollution prediction, air quality modeling and targeted mitigation strategies for the key regions of China.

Assessment of Ischemic Volumes by Using Relative Filling Time Delay on CTP Source Image in Patients with Acute Stroke with Anterior Circulation Large Vessel Occlusions

BACKGROUND AND PURPOSE

Thrombectomy up to 24 hours after stroke onset in patients with specific ischemic brain volumes remains a challenge, because many stroke centers do not apply specialized software to calculate ischemic volumes at advanced imaging. We aimed to establish the association between relative filling time delay on CTP source imaging and ischemic volume parameters and the infarct penumbra to core volume mismatch in patients with acute ischemic stroke.

MATERIALS AND METHODS

Consecutive patients with acute ischemic stroke and with M1 segment MCA with or without terminal ICA occlusions on baseline CTA and CTP within 24 hours of stroke symptom onset were included. Ischemic volumes were analyzed with software based on CTP maps. Relative filling time delay was classified into 4 grades-grade 0: relative filling time delay = 0 seconds; grade 1: relative filling time delay >0 to ≤4 seconds; grade 2: relative filling time delay >4 to ≤8 seconds; and grade 3: relative filling time delay > 8 seconds. Differences in ischemic volume parameters among relative filling time delay grades were tested.

RESULTS

We recruited 138 patients (median age, 69 years; 62.3% male). Different median volumes of the infarct core (grade 0, 7.3 mL; grade 1, 23.3 mL; grade 2, 45.7 mL; grade 3, 135 mL [P < .001]) and the penumbra (grade 0, 47.6 mL; grade 1, 90 mL; grade 2, 110 mL; grade 3, 92 mL [P = .043]) were observed among relative filling time delay grades. Target mismatch (defined by the criteria of the DEFUSE 3 trial) was identified in 71.7% of the patients (99/138). A relative filling time delay grade ≤ 1 independently predicted target mismatch, with a sensitivity of 0.79 (95% CI, 0.7-0.87) and a specificity of 0.66 (95% CI, 0.49-0.8).

CONCLUSIONS

Relative filling time delay grade based on CTP source imaging is a simple and effective parameter for evaluating ischemic volumes and target mismatch in patients with acute ischemic stroke. Further studies that compare relative filling time delay grade with clinical functional outcomes are necessary.

[Relationship between both quality and duration of sleep and type 2 diabetes in middle-aged and elderly people in Shanghai]

Objective: To analyze the relationship between both quality and duration of sleep and type 2 diabetes in middle-aged and elderly people in Shanghai. Method: Baseline data was from the '2017 epidemiological survey in Shanghai community residents aged 35 and above on type 2 diabetes'. Restricted cubic splines were used to draw dose-response curves to show the relationship between PSQI score, sleep duration and type 2 diabetes. Logistic regression model was used to analyze the effects of quality and duration of sleep as well as the interaction, on type 2 diabetes. Results: Results showed that the average PSQI score was (4.09±0.10) points, the proportion of poor sleep quality was 12.55% (95%CI: 10.77-14.58) and the average sleep duration was (7.19±0.03) hours. The relationship between PSQI score and diabetes appeared linear, with the relationship between sleep duration and diabetes as U-shaped. After adjusting for confounders, both poor sleep quality (>7 for PSQI score) and short sleep duration (sleep duration <6 hours) significantly increased the risk of type 2 diabetes, with OR=1.17 (95%CI: 1.06-1.30) and 1.20 (95%CI: 1.01-1.41), respectively. From the interaction analysis, data showed that after adjusting for confounders, both sleep duration <6 hours (OR=1.30, 95%CI: 1.12-1.52) and ≥8 hours (OR=1.79, 95%CI: 1.04-3.07) with poor sleep quality would increase the risks on diabetes. Conclusion: Both poor sleep quality and short sleep duration were associated with the risk of diabetes, while long sleep duration was only associated with the risk of diabetes when accompanied by poor quality of sleep.

Impact of the improvements in Fusarium head blight and agronomic management on economics of winter wheat

Fusarium head blight (FHB) is a devastating disease to cereal crops worldwide that decreases grain yield, grain quality, and causes mycotoxin contamination. FHB resulted in an estimated $2 billion USD loss in the US between 1993 and 2001, and 520 million Canadian dollars (CAD) in Canada in the 1990s. In the wheat producing areas in Canada and the United States, it is perceived that significant progress has been made to manage FHB, but the economic impact of various innovations has not been quantified. Therefore, the main objective of this study was to assess the economic impact of various practices deployed in the province of Ontario, Canada, on managing deoxynivalenol and improving agronomic performance in winter wheat since an epidemic in 1996. The impacts of four hypothetical FHB management scenarios on total deoxynivalenol (DON) concentration and grain yield were estimated in field experiments that compared old (mid-1990s) and modern era (mid-2010s) production practices. Management scenarios included old and new cultivars varying in susceptibility to FHB, fungicide application and nitrogen rates. These impacts were applied to farm survey data collected in 1996 to estimate farm revenue and profit. A similar economic estimate was conducted for the recent FHB epidemic in 2013. If a modern MR cultivar, a modern fungicide, and the combination were deployed in the epidemic of 1996, farm revenue would have increased by 26-32, 23-36 and 48-60%, and profit increased by 88-157, 42-59 and 165-207 CAD per ha, respectively, depending on the nitrogen rate. In the province of Ontario, up to 68 million CAD of revenue losses could have been avoided in 1996 with the use of modern agronomic and FHB management practices. Our study has quantified some of the major economic advances in managing FHB and DON since 1996, but further research is needed to develop better cultivars and management strategies.

[Heritability of alcohol intake among adult twins, calculate by the structural equation model]

Objective: To explore the genetic and environmental effects on alcohol intake. Methods: Data on 9 231 pairs of adult twins of the same sex was collected from the Chinese National Twin Registry (CNTR), between 2015 and 2018 and used in this study. Structural equation model was used to estimate the effects of genetic and environmental factors on alcohol intake. Results: A total of 9 231 pairs of twins were included in the analysis, of which 6 085 pairs were monozygotic (MZ). The average age of MZ was (36.91±13.07) years old, and males accounted for 56.80%. The average age of dizygotic twins (DZ) was (35.22±12.48) years old, and males accounted for 55.91%. There were 350 pairs of alcohol-drinking twins were with high-risk, accounting for 1.90% and another 367 pairs (1.99%) were with medium-risk. Alcohol-drinkers with medium-risk were affected by additive genetics, common and unique environmental factors, seen among the twins. The overall heritability appeared as 24.3% (95%CI: 0 to 56.8%). Furthermore, 50.7% of the variation (95%CI: 20.4%-79.0%) could be explained by the common environmental factors and 24.9% (95%CI: 18.3%-36.5%) by unique environmental factors. High-risk related drinking behavior was affected by both common and unique environmental factors. The common environmental component appeared as 75.6% (95%CI: 69.6%-80.8%) and unique environmental component as 24.4% (95%CI: 19.2%-30.4%), respectively. Gender difference was seen in the heritability of those with medium or high-risk drinking behaviors. The heritability of men was 30.8% (95%CI: 9.8%-53.5%), while in women it was mainly affected by the environment. Conclusion: Both alcohol drinkers with medium and high-risk drinking behaviors were mainly affected by the environment factors and gender. With the increase of drinking volume, the effect of environment on drinking behaviors became more obvious.

SAT0447 CORRELATES OF RADIAL BONE MICROARCHITECTURES IN OLDER ADULTS

Background:

Weight, dietary patterns, vitamin D, physical activity and grip strength have been suggested to be associated with bone loss in older adults. However, studies have yet been performed to investigate the associations between these factors and radial bone microarchitecture.

Objectives:

This study aimed to describe the associations of weight, dietary patterns, serum 25-hydroxyvitamin D (25(OH)D) concentrations, physical activity and grip strength with bone measures in older adults.

Methods:

Cross-sectional data on 201 older adults (mean age 72 years, female 46%) from a population-based cohort study were analysed. Weight, dietary patterns, serum 25(OH)D concentrations, physical activity (steps per day), grip strength were collected and analysed from baseline to 10-year follow-up. Areal bone mineral density (aBMD) at spine, hip and whole body were measured by dual-energy X-ray absorptiometry (DXA). Radial cortical and trabecular bone microarchitectures were measured by high-resolution peripheral computed tomography (HRpQCT). Multivariable linear regression was used to analyse associations of study factors with bone measures.

Results:

Weight was positively associated with radial bone area (total: β=0.18, 95% CI: 0.07, 0.29; cortical: β=0.12, 95% CI: 0.03, 0.21; trabecular: β=0.18, 95% CI: 0.05, 0.32), and was inversely associated with compact cortical volumetric bone mineral density (vBMD) (β= -0.19, 95% CI: -0.37, -0.01) and trabecular thickness (β= -0.25, 95% CI: -0.43, -0.07). Ten-year changes in weight were not significantly associated with bone measures, apart from radial trabecular separation (β= 0.15, 95%CI: 0.009, 0.28). Western dietary pattern scores were inversely associated with radial vBMD (total: β= -0.17, 95% CI: -0.32, -0.01; cortical: β= -0.19, 95% CI: -0.34, -0.04; compact cortical: β= -0.19, 95% CI: -0.34, -0.04; outer transitional zone: β= -0.20, 95% CI: -0.35, -0.06), and were positively associated with cortical porosity (cortical: β= 0.18, 95% CI: 0.03, 0.33; compact cortical: β= 0.19, 95% CI: 0.04, 0.34; outer transitional zone: β= 0.20, 95% CI: 0.06, 0.35). Steps per day were not significantly associated with bone measures, apart from inner transitional zone area and thickness (β= 0.12, 95% CI: 0.003, 0.24; β= 0.19, 95% CI: 0.05, 0.33). Healthy food pattern scores, serum 25(OH)D and grip strength were not significantly associated with radial HRpQCT measures.

Conclusion:

Higher weight, but not weight change, was beneficial for radial cortical and trabecular bone area but also associated with worse compact cortical vBMD and trabecular thickness. Higher western dietary pattern scores had adverse effects on radial vBMD and cortical porosity while physical activity had inconsistent associations.

Disclosure of Interests:

None declared

Detection of multiple hypervirulent Klebsiella pneumoniae strains in a New York City hospital through screening of virulence genes

OBJECTIVES

The 'hypervirulent' variant of Klebsiella pneumoniae (hvKp) is a predominant cause of community-acquired pyogenic liver abscess in Asia, and is an emerging pathogen in Western countries. hvKp infections have demonstrated 'metastatic' dissemination in immunocompetent hosts, an unusual mode of infection associated with severe complications. Two cases alerted us to the possible presence of hvKp at our hospital, both involving elderly Hispanic males who presented with recurrent fever, bacteraemia, epigastric pain and liver abscesses/phlegmon, thus prompting an assessment of hvKp prevalence.

METHODS

A surveillance of K. pneumoniae blood, body fluid and wound isolates was conducted using real-time PCR to detect virulence-associated genes (uni-rmpA, iucA and peg344). Positive isolates were further characterized by wzi gene sequencing to determine capsular types (K-type) and by multilocus sequence typing and pulsed-field gel electrophoresis to determine strain relatedness.

RESULTS

Four-hundred and sixty-three K. pneumoniae isolates, derived from 412 blood, 21 body fluids and 30 abdominal wound specimens, were screened over a 3-year period. Isolates included 98 multidrug-resistant strains. Eighteen isolates from 17 patients, including two from the index patient, screened positive for all three virulence genes. Sixteen of 18 positive isolates had K-types associated with hvKp, and isolates from different patients were unrelated strains, indicating likely community acquisition. Of 13 patients with significant morbidity, five died; eight patients had co-existing hepatobiliary disease, and six had diabetes mellitus.

CONCLUSIONS

Multiple strains of hvKp are emerging in New York City and are associated with high mortality relative to multidrug-resistant and classical Klebsiella infections. Co-existing hepatobiliary disease appears to be a potential risk factor for these infections.

[Heritability of coronary heart disease, based on the data from the Chinese adult twins]

Objective: To analyze the heritability of coronary heart disease (CHD) among the Chinese twin adults. Methods: A total of 20 477 same-sex twin pairs aged 25 years and older from the Chinese National Twin Registry were interviewed. Structure equation model was used to estimate the heritability of CHD. Results: After adjusting for age and gender, the overall heritability of CHD was 0.75(0.68-0.81). Stratified analyses showed that genetic factors play a more important role in CHD incidence in ≥40 years or female twins. While the development of CHD was mainly influenced by environmental factors in 25-39 years or male twins. Conclusion: CHD is influenced by both genetic and environmental factors and the heritability is high.

Sub-type source profiles of fine particles for fugitive dust and accumulative health risks of heavy metals: a case study in a fast-developing city of China

Sub-type source profiles for atmospheric fine particle (PM_2.5) were still scare in China, which limited the accurate source identification of it. Fugitive dust (including road dust, soil dust, resuspended dust, and construction dust, etc.) was one type of the most important contributors to PM_2.5 and its associated toxic metals held potential threaten to human health. The chemical compositions, sources, and health risks of sub-type fugitive dust deserved an investigation for further accurate control of particles and alleviating human health risks. A total of sixty-five fugitive dust samples were collected in Suzhou, a fast-developing city in southern China, including eleven sub-types of road dust (overpass, main street, collector street, and ordinary street), soil dust (farmland and tree lawn), resuspended dust (site types were corresponding to those of road dust), and construction dust (large construction sites). Chemical analysis of water-soluble ions, elements, and carbonaceous components was carried out to establish the sub-type source profiles of PM_2.5 for fugitive dust. Results showed that crustal elements were the most abundant components of fugitive dust, and soil dust was less polluted by anthropogenic activities. High contents of OC and low contents of EC were found in all the eleven types of dust. Equivalent ratios of anions and cations indicated that the fugitive dust was obviously alkaline. The contents of OC and EC in the four types of road dust were higher than those in other types of dust, while there existed differences among the sub-types of road dust. The NO₃^-/SO₄^2- ratios (0.03-0.09) implied that coal-burning and motor vehicle emission co-existed in Suzhou. Coefficient divergence (CD) values of eleven sub-type source profiles showed that there were certain differences among them, which suggested the possibility of sub-type source identification. Cluster analysis indicated the heavy metals in fugitive dust were mainly from crustal materials, metallurgical manufacturing, vehicle emissions, and industrial activities. The enrichment degree of heavy metals for the four types of road dust was also inconsistent. Heavy metals in road dust and soil dust posed a non-carcinogenic risk to children through direct ingestion, and the non-carcinogenic risk of direct intake of heavy metals was much higher than that of respiratory and skin contact. It was found that the accumulative health risks of heavy metals were higher in densely populated areas, traffic intensive areas, and industrial areas through the spatial analysis. This study firstly discussed the chemical compositions of PM_2.5 for eleven sub-types of fugitive dust in a Chinese city and assessed the accumulative health risks of heavy metals, which could be a demonstration for further related researches.

[Real world study of influenza vaccination intervention among key population of chronic disease management in Shanghai community]

Objective: To analyze the effect of influenza vaccination intervention among key populations of chronic disease management in communities of Shanghai. Methods: A total of 50 787 patients aged ≥60 with diabetes, hypertension and chronic obstructive pulmonary disease (COPD) in Huangpu, Yangpu, Baoshan and Qingpu districts of Shanghai from January 2013 to August 2017 were selected as the intervention group, and 52 268 people from key populations with chronic disease management in Xuhui, Hongkou, Jiading and Fengxian districts were selected as the control group according to the geographical location and economic level. The intervention group accepted follow-up and health education of influenza vaccination via chronic disease outpatient based on information system. The implementation time of the intervention was from September 2017 to January 2018. The basic information and diagnosis information of two groups, and intervention completion of the intervention group were obtained from Shanghai chronic disease management information system and hospital record system. Results: The age of the intervention group and the control group were (76.76±8.33) and (77.97±8.51) years old, respectively (P<0.001); and there were statistical differences in gender, occupational and influenza vaccination rate between the two groups (P<0.001). A total of 28 644 (56.40%) subjects of the intervention group received intervention. There was no significant difference in age composition between finished and unfinished intervention groups (P=0.095), and there was significant difference in gender composition (P=0.044). Before the intervention, the vaccination rate of the intervention group was 0.75% (382 subjects) which was lower than that of the control group with 1.02% (533 subjects) (χ(2)=20.96, P<0.001). After the intervention, the vaccination rate of the intervention group was 1.73% (496 subjects) which was higher than that of the control group with 1.42% (744 subjects) (χ(2)=11.65, P=0.001). Subjects that were male, younger, uptake of influenza vaccine before the intervention, received intervention and professional and technical personnel were more likely to take influenza vaccine, with OR (95%CI) 1.29 (1.13-1.47), 0.97 (0.96-0.98), 260.30 (215.21-314.83), 1.85 (1.61-2.11) and 1.48 (1.10-1.99), respectively. Conclusion: Influenza vaccination intervetion raised the vaccination rate of key population of chronic disease management. Male, younger, those who had been vaccinated before the intervention, who received the intervention, and professional and technical personnel were more likely to be vaccinated.

COVID-19: Initial experience of an international group of hand surgeons

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons throughout the world. The survey comprised 47 surgeons working in 34 countries who responded to an online questionnaire. We found that the protocols varied in terms of visitors, health professionals in the operating room, patient waiting areas, wards and emergency rooms. Based on these preliminary findings, an international consensus on hand surgery practices for the current viral pandemic, and future ones, needs to be built rapidly.

The association of subchondral and systemic bone mineral density with osteoarthritis-related joint replacements in older adults

OBJECTIVE

To describe the association of subchondral and systemic bone mineral density (BMD) with knee and hip replacements (KR and HR, respectively) due to osteoarthritis.

DESIGN

1,095 participants (mean age 63 years, 51% female) were included. At baseline, subchondral BMD of the medial and lateral tibia in three regions of interest (ROI) for the right knee, and systemic BMD of the lumbar spine, femoral neck, total hip and whole-body, were measured using dual-energy X-ray absorptiometry. Subchondral BMD of the hip was not measured. Competing risk regression models were used to estimate sub-distribution hazard ratios (SHRs) of KR/HR per one standard deviation (SD) higher in BMD measures, with adjustment of potential confounders.

RESULTS

Over 12.2 years, 79 (7.2%) participants underwent a KR and 56 (5.1%) an HR due to osteoarthritis. For the right side, medial subchondral BMD in ROI-3 was associated with an increased risk of KR (SHR 1.95 per SD; 95% Confidence Interval [CI], 1.57 to 2.43). In contrast, systemic BMD was not associated with the risk of KR, but higher BMD at the lumbar spine (1.42, 1.07 to 1.88) and whole-body (1.29, 1.00 to 1.66) were associated with an increased risk of HR at both sides.

CONCLUSIONS

Subchondral BMD is positively associated with an increased risk of KR and systemic BMD with an increased risk of HR, suggesting a role of BMD in the progression of osteoarthritis.