0718 Hypoxemia and Pulmonary Hypertension in Patients with Concomitant Restrictive Ventilatory Defect and Sleep Apnea: The Overlap Syndrome

Introduction

Patients with severe restrictive ventilatory defect (RVD) have hypoxemia and a high risk of pulmonary hypertension (PHTN). Sleep apnea (SA) aggravates the severity of nocturnal desaturation significantly. The aim of this study was to investigate the severity of hypoxemia and prevalence of PHTN in patient with the overlap syndrome (OS) of RVD and SA.

Methods

Patients referred for both sleep test and spirometry for suspected SA and RVD or obstructive ventilatory defect (OVD) were recruited prospectively from January-December, 2018. SA was determined by an apnea-hypopnea index ≥5/h; mean nocturnal oxygen saturation (meanSaO2), minimum oxygen saturation (minSaO2), saturation lower than 90% (T90) were calculated automatically. RVD was diagnosed in the presence of forced expiratory volume in the first second/forced vital capacity (FVC) >0.7 and FVC<80% predicted value. PHTN was defined by systolic pulmonary arterial pressure (SPAP) ≥ 50mmHg, documented by noninvasive transthoracic echocardiography. Patients with PHTN secondary to extrapulmonary factors were excluded.

Results

Of 65 patients who completed the investigation, 16 (24.6%) subjects were diagnosed with isolated SA (without RVD or OVD), and 28 (43.1%) subjects were verified to have RVD, in which 22 (78.6%) were diagnosed with OS and 6 (21.4%) presented as isolated RVD. Patients with OS vs. those with isolated RVD had lower minSaO2 (78.3% vs. 88.7%, p=0.003) and meanSaO2 (91.5% vs. 95.8%, p=0.007) but higher T90 (37.2% vs. 0.3%, p=0.009). Patients with OS vs. those with isolated RVD or with isolated SA had higher SPAP (62.6 mmHg vs. 45.3 mmHg or 35.9 mmHg, p=0.334 or p=0.016 respectively). Higher proportion of patients with OS were diagnosed with PHTN than those with isolated RVD or isolated SA (8 [36.4%] vs. 1 [16%] or 1 [6.25%], p=0.360 or p=0.031, respectively). T90 was the only polysomnographic data associated with the prevalence of PHTN after adjusting for age and sex (OR 4.90, 95% CI 1.23-25.56, p=0.023).

Conclusion

Patients with the OS of RVD and SA had high odds of PHTN, which is probably associated with severe hypoxemia. Further investigation is needed to discern whether therapeutic strategies toward OS might eliminate PHTN in this cohort.

Support

 

1035 Sleep Duration and Metabolic Syndrome: An Updated Systematic Review and Meta-Analysis

Introduction

To systematically examine the association between sleep duration and metabolic syndrome (Mets) risk in cross-sectional and prospective cohort studies.

Methods

Data were collected from 36 cross-sectional and 9 longitudinal studies with a total of 164799 MetS subjects and 430895 controls. Odds ratios (ORs) for MetS in cross-sectional studies and risk ratios (RRs) for incident MetS were calculated through meta-analyses of adjusted data from individual studies. Subgroup analyses were performed to investigate the association between MetS and the duration of short-and-long sleep.

Results

Short sleep duration was significantly associated with increased prevalent MetS (OR= 1.11, 95% CI =1.05-1.18) and incident MetS (RR= 1.28, 95% CI =1.07-1.53,) in cross-sectional and longitudinal studies, respectively. Furthermore, long sleep duration was significantly associated with increased prevalent MetS in cross-sectional studies (OR= 1.14, 95% CI =1.05-1.23), rather than incident MetS (RR= 1.16, 95% CI =0.95-1.41) in longitudinal studies. Interestingly, the association between long sleep and prevalent MetS was found in sleep duration defined by 24-hour sleep (including naps) rather than nighttime sleep. In cross-sectional studies, pooled odds for MetS were 1.36 (95% CI=1.04-1.78, I2=83.3%) in ≤ 5 hours, 1.09 (95% CI=1.02-1.16, I2=67.8%) in ≤6 hours, 1.01 (95% CI=0.93-1.10, I2=24.9%) in <7 hours, 1.11 (95% CI=1.02-1.21, I2=67.0%) in ≥9 hours and 1.31 (95% CI=1.22-1.40, I2=0%) in ≥10 hours, respectively. The association of short sleep and MetS was stronger in young and middle age adults, but lost in adults age >60 years.

Conclusion

Our findings suggest 1) a “U-shape” relationship between sleep duration and MetS in cross-sectional studies and 2) association between short sleep duration, but not long sleep duration with incident MetS. Future studies should shed light on the underlying mechanisms related to the association between sleep duration and MetS and examine if normalizing sleep duration reduces MetS risk in the general population.

Support

This study was supported by National Natural Science Foundation of China (No. 81600068 & 81970087), the Young Elite Scientists Sponsorship Program by CAST (No. YESS20160072), Medical Science Foundation of Guangdong Provence (A2018296) and Grant for Key Disciplinary Project of Clinical Medicine under the Guangdong High-level University Development Program.

Breed difference and regulatory role of CRTC3 in porcine intramuscular adipocyte

The cAMP responsive element binding protein (CREB)-regulated transcription coactivator 3 (CRTC3) is a member of the CRTC protein family and plays an important role in energy metabolism. The aim of this study was to determine if the expression of porcine CRTC3 is related to intramuscular fat (IMF) deposition and meat quality in Heigai pigs (a local fatty breed in China) and Duroc × Landrace × Yorkshire (DLY) pigs (a lean crossbred pig widely cultured in China). In addition, the effect of ectopic expression of CRTC3 on gene expression in porcine IMF adipocytes was also examined. Our results showed that Heigai pigs had lower lean percentage, thicker back fat thickness and smaller loin muscle area than DLY pigs. Compared with DLY pigs, Heigai pigs had higher marbling scores, better meat color and higher IMF contents and triglyceride concentrations. Higher levels of oxidative metabolic enzyme and expression of the slow oxidative muscle fiber-related genes were observed in longissimus dorsi muscle and psoas major muscle (P < 0.05) from Heigai pigs. Notably, CRTC3 and adipocyte-specific marker genes were highly expressed in muscle tissues of Heigai pigs. The expression of lipolysis-related genes ATGL and HSL were lower in Heigai muscles. Moreover, forced expression of CRTC3 promoted lipid accumulation and increased the expression of PPARγ, C/EBPα, leptin and FABP4 (P < 0.05), whereas it decreased the expression of ATGL and HSL in IMF adipocytes. These results suggest that CRTC3 expression is associated with lipid accumulation and IMF deposition in pigs.

Trichostatin A exerts anti-inflammation functions in LPS-induced acute lung injury model through inhibiting TNF-α and upregulating micorRNA-146a expression

OBJECTIVE

Acute lung disease is characterized by inflammation. This research aimed to investigate effect of trichostatin A (TSA) on microRNA-146a (miR-146a) and tumor necrosis factor α (TNF-α) in lipopolysaccharide (LPS)-induced alveolar macrophage injury model.

MATERIALS AND METHODS

Rat alveolar macrophage, NR8383, was cultured and induced using LPS to establish acute lung injury model in vitro level. Cell Counting Kit-8 (CCK-8) assay was used to determine cell viability of NR8383 cells. TSA was administrated to LPS-induced NR8383 cells. Quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) assay was utilized to evaluate TNF-α and miR-146a mRNA expression in LPS and/or TSA treated NR8383 cells. Enzyme-link immunosorbent assay (ELISA) was used to examine TNF-α levels.

RESULTS

This study selected 1 ng/ml and 10 ng/ml TSA as the optimal concentrations for treating NR8383 cells. LPS-induced acute lung injury model was successfully established. TSA administration significantly enhanced accounts of LPS-stimulated NR8383 cells. LPS induction significantly increased miR-146a mRNA expression in NR8383 cells compared to NR8383 cells (p<0.05). TSA administration significantly reduced the levels of TNF-α in LPS-induced NR8383 cells compared to those in LPS-induced NR8383 cells (p<0.05). TSA administration significantly enhanced miR-146a expression in LPS-induced NR8383 cells compared to that in LPS-induced NR8383 cells (p<0.05).

CONCLUSIONS

TSA administration exerted anti-inflammation functions in LPS-induced acute lung injury model in vitro, which might be triggered by inhibiting TNF-α molecule and upregulating miR-146a expression. The present data hint that TSA could be considered as a potential therapeutic agent for treating acute lung injury.

[Interpretation of the guidelines for multidisciplinary treatment of epistaxis of the British Academy of Rhinology]

SummaryEpistaxis is a common condition that can be associated with significant morbidity, and it places a considerable burden on our healthcare system. In China, a draft guidelines for diagnosis and treatment of epistaxis was released in 2015. In UK, a national audit of management for epistaxis was promulgated in 2016, followed by multidisciplinary consensus recommendations on the hospital management of epistaxis in 2017. Here, we compared the management of diagnosis and treatment for epistaxis between China and UK in five clinical aspects, including initial assessment, cautery, intranasal agents, antithrombotic therapy and hematological factors, as well as surgery and radiological intervention. The results demonstrate that the management recommendations in UK combined a wide-ranging review of the relevant literature with established and rigorous methods of guideline generation, while the guidelines in China is more specific on the procedures of diagnosis and treatment for epistaxis. The current discussion provides perspectives to improve the guidelines for epistaxis in China.

[Analysis of the prevalence and influencing factors of occupational musculoskeletal disorders among rural migrant workers in Tianjin]

Objective: To explore the prevalence of occupational musculoskeletal disorders (OMD) and its influencing factors among rural migrant workers in Tianjin, with the aim of developing strategies to improve the health condition of this specific population. Methods: Questionnaire survey was conducted among 415 rural migrant workers working in Tianjin about their fundamental state and occupational musculoskeletal disorders (OMD) during January 2015 to January 2016. Statistical methods were utilized to analyze the influencing factor. Results: A total of 415 rural migrant workers were investigated, in which young Young adults and low education level were in the majority of rural migrant workers. The prevalence of OMD for whole population, male and female were 28.92% (120/415), 33.06% (81/245) and 22.94% (39/170), respectively. Prevalence showed significant differences njin and workplace hygiene. Multivariate logistic regression analysis showed that the risks of OMD increased with age group, and decreased with higher education level. The risk of OMD among rural migrant workers with monthly income between 3000 to 5000 yuan was 2.26 times (95%CI: 1.37-3.75) higher than that of low-income workers (<3000 yuan per month). Workers engaged in housekeeping service had 2.28 times higher risk of OMD than those in manufacturing industry (95%CI: 1.06-4.89) . Conclusion: Prevalence of OMD among rural migrant workers is higher than that of general people. Age, education, monthly income, occupation are the independent influencing factors for OMD among rural migrant workers.

Study on the epigenetic methylation modification of bipolar disorder major genes

OBJECTIVE

We aimed to study changes and possible roles of epigenetic modification of candidate genes in the pathogenesis of bipolar disorder, and provide the basis for clinical diagnosis and analysis.

PATIENTS AND METHODS

A total of 150 patients with bipolar disorder were enrolled in this study from January 2014 to June 2015; also, 50 healthy subjects were enrolled as control group. The patients were followed up for 18 months and followed up once every 3 months to review the methylation status. The methylation status was examined before and after treatment, and the patients were followed up every 3 months after treatment, and the follow-up period was 18 months.

RESULTS

Compared with the healthy control group, there were 2075 CpG island aberrant methylation points in patients with bipolar disorder, which can be divided into 24 categories. Log-Ratio > 0.5 was used as the positive criteria, and COMT and PPIEL were identified as the genes associated with bipolar disorder. Compared with the control group, the levels of COMT and PPIEL gene methylation in the observation group were significantly higher (p < 0.05). There was no significant difference in the methylation level of COMT and PPIEL gene between the two groups (p > 0.05) after 12 months of treatment.

CONCLUSIONS

The methylation level of COMT and PPIEL gene is closely related to bipolar disorder.

The relationship between number and function of EPCs and concentration of VEGF165 and SDF-1 in coronary artery spasm

OBJECTIVE

We aimed at investigating the functions of endothelial progenitor cells (EPCs) in the pathophysiology of coronary artery spasm (CAS) and coronary artery disease (CAD), as well as to evaluate the correlation of these diseases with the number and function of EPCs, the plasma concentration of vascular endothelial growth factor 165 (VEGF165) and stromal cell-derived factor 1 (SDF-1).

PATIENTS AND METHODS

Participants were recruited into three groups, CAS, CAD and the control. The number and functions of early EPCs and outgrowth endothelial cells (OECs) were determined in peripheral blood samples, and the endothelial function was evaluated by measuring endothelium-dependent flow-mediated vasodilation (FMD).

RESULTS

No differences of baseline characteristics were found among CAS, CAD, and the control groups. The OECs isolated from CAS and CAD exhibited significant decrease in the percentage of CD34+/CD45- population, OEC colony formation, OEC proliferation and OEC tubulogenesis, nitric oxide (NO) production, endothelial nitric oxide synthase (eNOS) activity, and the phosphorylation level at Ser1177 of eNOS, compared with OECs isolated from control participants. Meanwhile, FMD was significantly reduced in CAS and CAD (CAS, 4.1% ± 1.9%; CAD, 4.3% ± 1.8%; control, 11.2% ± 3.5%). FMD was positively correlated to OEC functions including NO production, eNOS phosphorylation, colony formation, and proliferation. No differences of plasma VEGF165 and SDF-1 concentrations were recorded among these three groups. Similarly, there was no correlation between plasma VEGF165 (and SDF-1) concentration and EPC number and function.

CONCLUSIONS

EPCs show the potential of repairing damaged endothelium in CAS and CAD.

[Analysis of factors related to human soil-transmitted nematode infections in Chongqing City]

OBJECTIVE

To investigate the related factors of soil-transmitted nematode infections in Chongqing City, so as to provide the basis for scientific prevention and treatment of the infections.

METHODS

From 2011 to 2015, the stool samples of residents of the surveillance sites in Chongqing City were collected every year, and the soil-transmitted nematode eggs were examined by the modified Kato-Katz thick smear method (three smears for a single stool sample). The respondents were surveyed by questionnaires, and the factors affecting soil-transmitted nematode infections were identified.

RESULTS

The prevalence of human soil-transmitted nematode infections were 6.44%, 7.30%, 6.85%, 6.93% and 5.56% in Chongqing City from 2011 to 2015, respectively. The more unclean drinking water and the lower frequency of washing hands after using the toilet were the risk factors for Ascaris lumbricoides infection. The more harmless toilets, the higher level of fertilizer application, the lower frequency of drinking raw water, and the lower frequency of food without washing were the protective factors for A. lumbricoides infection.

CONCLUSIONS

The local soil-transmitted nematode infections are at a low epidemic level in Chongqing City, and it is necessary to ad-here to the classified guidance, comprehensive prevention and further monitoring on the basis of health education, water and toilet improvement, and environmental sanitation improvement in order to consolidate the prevention and control achievements.

A C-type lectin with a single carbohydrate-recognition domain involved in the innate immune response of Tribolium castaneum

C-type lectins are one of the pattern-recognition proteins involved in innate immunity in invertebrates. Although there are 16 C-type lectin genes that have been identified in the genome of Tribolium castaneum, their functions and mechanisms in innate immunity remain unknown. Here, we identified one C-type lectin orthologue, TcCTL6 (TC003708), by sequencing random clones from the cDNA library of the coleopteran beetle, T. castaneum. TcCTL6 contains a 654 bp open reading frame encoding a protein of 217 amino acids that includes a single carbohydrate-recognition domain. The expression of TcCTL6 was significantly induced by Escherichia coli, Staphylococcus aureus and stimulation with carbohydrates, including lipopolysaccharide and peptidoglycan. A binding assay suggested that the recombinant TcCTL6 not only bound to lipopolysaccharide and peptidoglycan but also bound to Gram-positive (S. aureus, Bacillus subtilis and Bacillus thuringiensis) and Gram-negative bacteria (E. coli and Pseudomonas aeruginosa) in the presence of calcium ions. Furthermore, when TcCTL6 was knocked down by RNA interference, four antimicrobial peptides (attacin1, attacin2, coleoptericin1 and coleoptericin2) were significantly decreased. These results demonstrate that TcCTL6 plays a vital role in the immune response towards pathogen infection by influencing the expression of antimicrobial peptides and the agglutination of bacteria in the presence of calcium ions in T. castaneum.

Cerebral blood flow abnormalities in neuropsychiatric systemic lupus erythematosus

OBJECTIVE

To investigate the clinical characteristics, imaging changes and early diagnostic methods of neuropsychiatric systemic lupus erythematosus (NPSLE).

METHODS

Thirty-five SLE patients, of which 16 had overt neuropsychiatric symptoms, underwent examination for multiple autoantibodies, including anti-double-stranded DNA (anti-dsDNA) antibody, anti-nucleosome antibody, anti-cardiac-phospholipid antibody (aCL)-IgG, aCL-IgM, anti-β2-glycoprotein I antibody and anti-ribosomal P antibody, and the SLEDAI score of every patient was recorded. All patients further received neuropsychological tests, including the Mini-Mental State Examination, the Self-Rating Anxiety Scale and the Self-Rating Depression Scale. Imaging examination using 3D arterial spin labeling was performed on 3.0 T MRI scanners. After processing the 3D arterial spin labeling image, the cerebral blood flow map was obtained and the cerebral blood flow value was calculated.

RESULTS

The values of anti-dsDNA, anti-nucleosome antibody, aCL-IgG and anti-β2-glycoprotein I antibodies were significantly higher in the NPSLE group than those in the SLE group. The SLEDAI scores of the NPSLE group were significantly higher than those of the SLE group. There were no significant differences between the NPSLE group and the SLE group in the directional ability, memory, attention, numeracy, recall ability or language ability scores on the Mini-Mental State Examination scale. Furthermore, there were no symptoms of anxiety or depression in any of the patients, according to the Self-Rating Anxiety Scale and Self-Rating Depression Scale. In the 35 patients with SLE, decreases in blood perfusion were seen in some areas, and were unilateral and asymmetrically distributed. There was obvious asymmetry between sides in areas including the frontal lobe, temporal lobe, parietal lobe and occipital lobe. The incidence of perfusion decreases in frontal lobe in the NPSLE group was significantly higher than in the SLE group.

CONCLUSION

Neurological lesions in SLE patients can be detected by arterial spin labeling. Cerebral blood flow abnormalities may be helpful for the early diagnosis of neurological lesions in NPSLE.

Knockdown of CERB expression inhibits proliferation and migration of glioma cells line U251

BACKGROUND

Glioma is a type of tumor that occurs in the brain and accounts for almost 30 % of all brain and central nervous system tumors and 80 % of all malignant brain tumors. In this study, we investigate the role of cAMP response element-binding protein (CREB) in the progression of glioma.

METHODS

Tissue samples from glioma patients were collected and examined for expression of CREB and its correlation with tumor grades. CREB was then knocked down via siRNA to see if reduced expression of CREB affects cell proliferation and migration. Factors involved in cell cycles, adhesion and apoptosis were examined as well. Moreover, CRESP/CAS9 mediated knockout of CREB was conducted and athymic Nude mice model was used to investigate CREB's role in vivo.

RESULTS

The evaluated expression level of CREB in glioma patients was correlated with tumor grades. Knockdown of CREB via siRNA in glioma cell line U251 significantly inhibited the proliferation and migration of tumor cells. Moreover, CyclinD1 and Bcl-2 expression were reduced, as well as phosphorylation of IRK1/2 and AKT. Additionally, knockout of CREB via CRESP/CAS9 inhibited tumor formation of U251 cells in athymic Nude mice model.

CONCLUSIONS

In conclusion, our data suggest that over expression of CREB may contribute to progression of glioma and knockdown of CREB expression may serve as a novel target for therapy (Tab. 1, Fig. 6, Ref. 25).