[Effects of comorbid gestational diabetes mellitus and depression on glucose metabolism during pregnancy and neonatal morphological outcome]

Objective: To estimate the effect of comorbid gestational diabetes mellitus (GDM) and depression on glucose metabolism and neonatal morphology. Methods: From March 2015 to October 2018, recruited 18 to 28 weeks pregnant women who met the criteria in the Hefei First People's Hospital or First Affiliated Hospital of Anhui Medical University or Anhui Maternal and Child Health Hospital, including a total of 4 380 study subjects, of which the birth outcome information of 3 827 newborns were collected. The self-made questionnaire "Maternal Health Questionnaire for Hefei City" and Edinburgh Postpartum Depression Scale were used to obtain basic demographic characteristics and emotional state of depression. Data from the 75-g oral-glucose-tolerance test were obtained at 24-28 weeks of gestation. After delivery, delivery outcome information were collected from the hospital medical records. Covariance analysis was used to analyze the differences in glucose metabolism indicators and neonatal outcome indicators in pregnant women with different GDM and depression status. Multiple logistic regression model was used to analyze the correlation between GDM and depression, with different groups of GDM and depression status (no GDM and depression, simple depression, simple GDM, comorbid GDM and depression)as independent variables and whether they were large for gestational age as dependent variables. The interaction between GDM and depression was also analyzed. Results: The 4 380 pregnant women were (28.8±4.2) years old. The incidence of GDM was 19.5% (852/4 380), and the detection rates of depression in the second and third trimesters were 12.1% (526/4 380) and 12.3% (536/4 367). PG-1h and AUC in the comorbid GDM and depression group were significantly higher than those in the group with no GDM and depression (P<0.05) and the single GDM group (P<0.05). After adjusting for factors such as the childbirth age, education level, family's main economic income, BMI before pregnancy, parity, number of physical activities, and weight gain during pregnancy, compared with the group with no GDM and depression, the RR(95%CI) of LGA occurred in the single depression group, the single GDM group and the comorbid group were 1.31(0.89-1.91), 1.51(1.14-2.00) and 2.43(1.29-4.57), respectively. Further analysis showed that the association between GDM pregnant women with depression and newborn LGA ［RR (95%CI): 2.12 (1.01-4.49)］ was stronger than that between GDM pregnant women without depression and newborn LGA ［RR (95%CI): 1.50 (1.12-1.99)］, the P interaction value was<0.05. Conclusion: The status of comorbid GDM and depression can impair glucose metabolism and increase the risk of LGA.

[Association between sleep and serum hemoglobin A1c in nondiabetic population in Beijing]

Objective: To understand the status quo of sleep and its associations with serum hemoglobin A1c (HbA1c) among nondiabetic people of 18-79 years old in Beijing. Methods: Data was gathered from the 2017 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified clusters sampling method was used while the 18-79 years old were sampled from the 16 districts of Beijing. Questionnaires would include information on demographic characteristics, chronic diseases and related risk factors, sleep duration and related problems (snore/asphyxia, difficult to get to sleep, waking often during the night, waking up early or taking sleeping pills) within the last 30 days. Complex sampling logistic regression models were established to analyze the association between sleep-related problems and serum HbA1c. Results: A total of 11 608 non-diabetic participants were involved in this study, with average age, reported sleep duration and median of serum HbA1c level as (43.36±15.27) years old, (7.49±1.29) h/d and 5.30%, respectively. 47.38% of them reported having sleep problems within the last 30 days. With the increasing time of sleep, serum HbA1c level was fluctuating significantly (F=413.06, P<0.01). Significant differences appeared in serum HbA1c levels among different age groups (t=358.3, P<0.01). Among participants with several kinds of sleep problems, the serum HbA1c levels were significantly higher than those without, through the single factor analysis (U=15.11, P<0.01). After adjusting for potential confounding factors, the combination of one sleep-related problem (OR=1.21, 95%CI: 1.03-1.41) and snore/asphyxia were associated with higher serum HbA1c levels (HbA1c≥5.7%) (OR=1.37, 95%CI: 1.16-1.61). People under 60 years of age were with higher risk of having higher serum HbA1c levels. Conclusion: Duration and sleep-related problems might affect the serum HbA1c levels, especially among those younger than 60 years of age.

TFPI-2 inhibits the invasion and metastasis of bladder cancer cells

INTRODUCTION

Bladder cancer metastasis seriously affects the prognosis of patients, but its molecular mechanism is unclear. This study sought to explore the roles of tissue factor pathway inhibitor-2 (TFPI-2) gene overexpression in the infiltration and metastasis of bladder cancer.

MATERIALS

Firstly, real-time PCR and immunohistochemistry were used to compare the mRNA and protein expression levels, respectively, of TFPI-2 and matrix metalloproteinase-1 (MMP-1) in adjacent non-tumoral tissues, muscle-invasive bladder cancer (MIBC) tissues, and non-muscle-invasive bladder cancer (NMIBC) tissues. BIU-87-TFPI-2 cells that stably expressed TFPI-2 were generated by transfection with pcDNA3.1-TFPI-2. Real-time PCR and western blotting were performed to determine the mRNA and protein expression levels, respectively, of TFPI-2 and MMP-1 in BIU-87-TFPI-2 cells. The invasion and migration abilities of BIU-87-TFPI-2 cells were investigated using the Transwell chamber method.

RESULTS

TFPI-2 was found to be significantly downregulated in bladder cancer tissue. The expression of MMP-1 was increased with the progression of bladder cancer. BIU-87 cells that overexpressed TFPI-2 were successfully generated by transfection with pcDNA3.1-TFPI-2. TFPI-2 overexpression in BIU-87 cells significantly inhibited cancer cell invasion and metastasis. Furthermore, the mRNA and protein expression levels of MMP-1 were significantly reduced in TFPI-2-overexpressing cells.

CONCLUSION

Decreased TFPI-2 expression in bladder tissue was correlated with invasion and metastasis in bladder cancer. TFPI-2 overexpression could inhibit bladder cancer cell invasion and migration in vitro by inhibiting MMP-1 protein expression.

LEVEL OF PROOF

3.

Automated Tortuosity Analysis of Nerve Fibers in Corneal Confocal Microscopy

Precise characterization and analysis of corneal nerve fiber tortuosity are of great importance in facilitating examination and diagnosis of many eye-related diseases. In this paper we propose a fully automated method for image-level tortuosity estimation, comprising image enhancement, exponential curvature estimation, and tortuosity level classification. The image enhancement component is based on an extended Retinex model, which not only corrects imbalanced illumination and improves image contrast in an image, but also models noise explicitly to aid removal of imaging noise. Afterwards, we take advantage of exponential curvature estimation in the 3D space of positions and orientations to directly measure curvature based on the enhanced images, rather than relying on the explicit segmentation and skeletonization steps in a conventional pipeline usually with accumulated pre-processing errors. The proposed method has been applied over two corneal nerve microscopy datasets for the estimation of a tortuosity level for each image. The experimental results show that it performs better than several selected state-of-the-art methods. Furthermore, we have performed manual gradings at tortuosity level of four hundred and three corneal nerve microscopic images, and this dataset has been released for public access to facilitate other researchers in the community in carrying out further research on the same and related topics.

Corneal nerve tortuosity grading via ordered weighted averaging-based feature extraction

PURPOSE

Tortuosity of corneal nerve fibers acquired by in vivo Confocal Microscopy (IVCM) are closely correlated to numerous diseases. While tortuosity assessment has conventionally been conducted through labor-intensive manual evaluation, this warrants an automated and objective tortuosity assessment of curvilinear structures. This paper proposes a method that extracts the image-level features for corneal nerve tortuosity grading.

METHODS

For an IVCM image, all corneal nerve fibers are first segmented and then, their tortuosity are calculated by morphological measures. The ordered weighted averaging (OWA) approach, and the k-Nearest-Neighbor guided dependent ordered weighted averaging (kNNDOWA) approach are proposed to aggregate the tortuosity values and form a set of extracted features. This is followed by running the Wrapper method, a supervised feature selection, with an aim to identify the most informative attributes for tortuosity grading.

RESULTS

Validated on a public and an in-house benchmark data sets, experimental results demonstrate superiority of the proposed method over the conventional averaging and length-weighted averaging methods with performance gain in accuracy (15.44% and 14.34%, respectively).

CONCLUSIONS

The simultaneous use of multiple aggregation operators could extract the image-level features that lead to more stable and robust results compared with that using average and length-weighted average. The OWA method could facilitate the explanation of derived aggregation behavior through stress functions. The kNNDOWA method could mitigate the effects of outliers in the image-level feature extraction.

[Study on intention of smoking concession, awareness of smoking hazards and impact on smoking status in residents aged 18-65 years in Beijing]

Objective: To understand the awareness of smoking hazards and intention of smoking concession in residents aged 18-65 years in Beijing, and provide scientific evidence for the development and improvement of tobacco control policies and measures. Methods: Data were collected from the 2017 Beijing Non-communicable and Chronic Disease surveillance. A multi-stage stratified cluster sampling method was used to take samples from 165 communities in 16 districts of Beijing. Logistic regression was used to analyze the influencing factors. Results: Among 11 594 participants, 49.93% had no intention of smoking concession. The percentage of refusing smoking concession was higher in men (50.39%) than in women (43.01%), the difference was significant ( χ(2)=14.211, P=0.002), and higher in suburban residents (56.78%) than in urban residents (45.30%), the difference was significant ( χ(2)=51.977, P<0.001). For the smoking cessation motivation, "illness" was the reason for more former smokers (29.88%) compared with current smokers (11.50%), the difference was significant ( χ(2)=85.865, P<0.001). The awareness rates of smoking hazards was higher in women (34.97%) than in men (32.63%), the difference was significant (Z=5.612, P<0.001), higher in suburban residents (35.44%) than in urban residents (33.03%), the difference was significant (Z=-3.734, P<0.001), and higher in never smokers (35.15%) than in smokers (30.06%), the difference was significant ( χ(2)=62.277, P=0.005). Multiple logistic regression analysis results showed people with general awareness (OR=0.61, 95%CI: 0.39-0.94) and poor awareness (OR=0.67, 95%CI: 0.50-0.90) of smoking hazards were less likely to quit smoking and people with general awareness (OR=0.64, 95%CI: 0.53-0.76) and poor awareness (OR=0.87, 95%CI: 0.78-0.98) of smoking hazards were more likely to smoke. Conclusions: Smokers aged 18-65 in Beijing had low willingness for smoking cessation. Health problem was main consideration for smoking cessation. Never-smokers had better awareness of smoking hazards than smokers, and the awareness of smoking hazards was an influencing factor of smoking status.

Antifungal mechanism of Streptomyces ma. FS-4 on fusarium wilt of banana

AIM

Research on prevention and cure of banana wilt is important to ensure the healthy development of the banana industry. In this study, antifungal mechanism of Streptomyces ma. FS-4 on fusarium wilt of banana was investigated.

METHODS AND RESULTS

The physiological strain of banana fusarium pathogen Fusarium oxysporum f. sp. cubense Race 4 (FOC.4) was used as the target fungus, and the antifungal mechanism of the crude extract of Streptomyces ma. FS-4 was investigated. Eighteen different compounds identified by gas chromatography-mass spectrometry were composed of aldehydes, methyl, hydrocarbons, amides, esters and acids. FS-4 significantly inhibited the spore germination of the target fungi, with an EC₅₀ of 22·78 μg ml^-1 . After treatment with 100 μg ml^-1 FS-4 crude extract, the N-acetylglucosamine content in the mycelium increased 1·95-fold. However, the extract had no significant effect on β-1,3-glucanase. At the FS-4 crude extract dose of 100 μg ml^-1 , the total sugar and protein contents decreased by 28·6 and 29·1% respectively, and the fat content was 41·3%. FS-4 significantly inhibited the activity of the mitochondrial complex III of Foc4, which was reduced by 52·45%. Moreover FS-4 reduced the activity of succinate dehydrogenase, a key enzyme in the Krebs cycle, by 60·2%. However, FS-4 had no significant effect on malate dehydrogenase. The membrane potential on the mitochondrial inner membrane was significantly reduced at the test concentration of 100 μg ml^-1 . ROS gradually accumulated in the Foc4 hypha, and the burst was 3·97 times higher than the control.

CONCLUSIONS

This study demonstrated that the antifungal mechanism of Streptomyces ma. FS-4 against Foc4 includes the destruction of the plasma membrane and mitochondrial dysfunction and finally induction of cell apoptosis.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results may indicate the prevention and control of banana wilt, which is of great significance to the healthy development of banana industry system.

Objective response of first-line chemotherapy of triple-negative breast cancer translates into survival benefit: an analysis in an independent, prospective clinical trial and a real-world setting

This study sought to assess whether the objective response (OR, including complete response and partial response) of first-line chemotherapy can predict overall survival (OS) for patients with metastatic triple-negative breast cancer (mTNBC) in both clinical trial and a real-world setting. The survival predictable parameters were assessed in two independent cohorts, the training cohort of 236 patients as part of a phase 3 trial (CBCSG006, Trial registration number NCT0128762) and the validation cohort of 360 patients from the real-world setting. Univariable and multivariable Cox proportional hazard models were applied to explore associations with progression-free survival and OS in the training cohort and then in the validation cohort. OR (OR vs non-OR, HR, 0.438, p<0.001) together with Eastern Cooperative Oncology Group (ECOG) performance status, disease-free survival, number of metastatic organ sites and platinum-based chemotherapy used as first-line chemotherapy were observed to be independent prognostic factors for progression-free survival (PFS), and OR (OR vs non-OR, HR, 0.602, p=0.002) together with ECOG score, disease-free survival, number of metastatic organ sites and previous anthracycline and/or taxane treatment were observed to be independent predictive factors for OS in the training cohort. These predictors were confirmed in the validation cohort. For OR and non-OR group, median OS was 23.72 and 13.83 months in the training cohort (HR, 0.637, p=0.002), and 21.95 and 13.80 months in the validation cohort (HR, 0.608, p<0.001), respectively. By adding OR in the OS predictors, the concordance index (C-index) improved from 0.622 to 0.645 in the training cohort and 0.653 to 0.675 in the validation cohort. PFS and OS of mTNBC can be predicted by OR status with any regimen of first-line chemotherapy in an independent prospective clinical trial and a real-world setting. Therefore, TNBC, not like other subtypes of breast cancer, may be in need of combination chemotherapy or intense chemotherapy to achieve a high response rate for survival.

Three phytotoxins produced by Neopestalotiopsis clavispora, the causal agent of ring spot on Kadsura coccinea

Phytotoxins are widely found in plant pathogens. In recent years, many diseases caused by Neopestalotiopsis clavispora have been reported. To better understand the pathogenicity of N. clavispora, a solid fermentation strategy was employed to isolate and identify virulence factors afritoxinone B, afritoxinone A and oxysporone. The phytotoxic activities of these toxins were evaluated. Oxysporone exhibited high levels of phytotoxic activity after 72 h and the lesion area ranged from 21.5-84.3 mm2 after 9 days of treatment. The phytotoxic activities of the other two compounds were lower than that for oxysporone. The phytotoxic activity towards non-host organisms was also assessed for the three analyzed compounds; phytotoxic activity was observed in each case. Based on these results, we conclude that oxysporone is the main virulence factor in N. clavispora. We also suggest that each of the three compounds were non-host-specific toxins (NHST). To our knowledge, this is the first study to analyze phytotoxins produced by N. clavispora.

Interleukin-6 and severity of COVID-19 patients in Hefei, China

•

Twenty-four out of 75 patients developed into severe condition in the course of the infection.

•

The prominent laboratory abnormalities of COVID patients were lymphopenia, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH).

•

Elevated interleukin 6 (IL-6) correlated with decrease of LYM%, CD4⁺ and CD8⁺ T cell counts, and increase of CRP, LDH and Procalcitonin (PCT) levels.

OP0280 TEMPORAL TRENDS OF OPIOID USE AMONG INCIDENT OSTEOARTHRITIS PATIENTS IN CATALONIA, 2007-2016: A POPULATION-BASED COHORT STUDY

Background:

Opioids are not recommended as first-line treatments for chronic pain management in osteoarthritis (OA), but recent data suggest they are commonly used in routine practice in North America and northern Europe.

Objectives:

To characterise the secular trends of opioid and strong opioids use in patients with incident OA from 2007 to 2016, and to explore the impact of patient characteristics on the use of opioid/s for OA.

Methods:

Data was obtained from the SIDIAP (The System for the Development of Research in Primary Care) database, which contains primary care records and pharmacy dispensing data for 80 % of the population in Catalonia (~ 6 million people). All persons aged 18 or older at the beginning of each calendar year with an incident OA diagnosis (including both peripheral and central joints) in the study period were included. Index date was the date of first OA diagnosis, and the observation period of opioid use was 1-year after index date. Opioids considered included codeine, tramadol, fentanyl, and morphine, with the latter three classified as strong opioids. The period prevalence of any opioid use was estimated in whole and sub-population stratified by sex, age, socio-economic status (U1 – U5, higher values of the indicator equivalent to deprivation) and residence area (rural/urban).

Results:

The 1-year prevalence of any opioid use among incident OA patients was around 15% from 2007 to 2012. After that, this figure grew by 10% approaching 25% in 2016. However, strong opioid use increased continuously to nearly triple, from 8% in 2007 to 20% in 2016. The different subgroups followed similar trends over time, with women 4% higher than men, oldest 10% higher than youngest, most deprived 6% higher than least deprived, and rural 1% higher than urban.

Conclusion:

The use of opioids (and especially strong opioids) has substantially increased in recent years among newly diagnosed OA patients in Catalonia. Our findings call for urgent action for safe opioid prescribing to avoid opioid abuse in OA patients especially amongst older women living in deprived areas.

Figure 1.

Trends of 1-year prevalence of opioid/s use among incident OA patients, whole and subgroup population.

Disclosure of Interests:

Junqing Xie: None declared, Aleksandra Turkiewicz: None declared, Gary Collins: None declared, Martin Englund Consultant of: Advisory Board 1 day (2019) Pfizer (Tanezumab)., Victoria Y Strauss: None declared, Carlen Reyes: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen

AB1104 ANALYSIS OF ANTINUCLEAR ANTIBODY TITERS AND PATTERNS USING HEP 2 INDIRECT IMMUNOFLUORESCENCE IN VARIOUS LIVER DISEASES

Background:

Abnormal liver function can be seen in not only hepatitis B virus infection (HBV), hepatitis C virus infection (HCV), hepatic carcinoma (HCC), but also in primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH), and systemic autoimmune rheumatic diseases (SARD). Antinuclear antibody (ANA) testing using indirect immunofluorescence assay (IIFA) is a common and economical method which contributes to detect SARD and autoimmune liver diseases [1].

Objectives:

Our objective was to investigate ANA positivity, titers and their patterns in multiple liver diseases, including PBC, AIH, HBV, HCV, and HCC, compared to healthy controls (HC).

Methods:

2537 patients with SARD, 137 PBC cases, 57 AIH cases, 3420 HBV cases, 769 HCV cases, 268 HCC cases, and 1073 HC were retrospectively assessed. The titers and patterns of ANA were detected with the IIFA method.

Results:

ANA positivity rate was considerably discernible between these diseases, which is 90.1% in SARD, 93.4% in PBC, 49.1% in AIH, 19.1% in HBV, 13.9% in HCV and 23.5% in HCC. Moreover, only 4.9% of HCC cases, 2.5% of HBV patients and 1.6% of HCV patients had an ANA titer ≥ 1:320. The mixed pattern which composed of at least two patterns majorly lied in PBC. AC-15 and AC-21 was frequently related to liver diseases; the former pattern was more frequently found in AIH (84.2%) and PBC (8.8%), and the latter pattern was easily seen in PBC (62.2%) and HCC (22.6%). The positive rate of ANA in HC was 12.2% and its major pattern was AC-2.

Conclusion:

There are differences in ANA positivity among patients with SARD and various liver diseases. Some mixed patterns may provide important evidence for the diagnosis of PBC. Clinicians should pay attention to ANA patterns and titer during the interpretation of this test.

References:

[1]Damoiseaux J, Andrade L, Carballo OG, Conrad K, Francescantonio P, Fritzler MJ, Garcia DLTI, Herold M, Klotz W, Cruvinel WM, Mimori T, von Muhlen C, Satoh M, Chan EK, (2019) Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective. ANN RHEUM DIS 78: 879-889

Figure 1.

The Proportion of Each ANA Pattern Exhibited in Different Diseases and HCANA: antinuclear antibodies; HC: healthy controls; PBC: primary biliary cirrhosis; AIH: autoimmune hepatitis; SARD: systemic autoimmune rheumatic diseases; HBV: hepatitis B virus infection: HCV: hepatitis C virus infection: HCC: hepatic carcinoma.

Acknowledgments:

None.

Disclosure of Interests:

None declared

AB0490 CIRCULATING REGULATORY T CELLS WERE ABSOLUTELY DECREASED IN TAKAYASU’S ARTERITIS PATIENTS

Background:

Takayasu arteritis (TA) refers to chronic progressive non-specific inflammation that involves the aorta and its main branches, causing stenosis and occlusion of arteries in different parts, and ischemic manifestations in the corresponding parts. A variety of immune dysfunctions are involved in the occurrence and development of TA(1)Recent studies have shown that Th17/Treg imbalance plays an important role in the pathogenesis of Takayasu’s arteritis, in which T help 17 cells (Th17) cells are up-regulated in TA patients(2). Th17 cells are closely related to Treg cells during differentiation. There are few studies on the expression level of CD4+CD25+FOX3+T lymphocyte (Treg) cells. This study aims to study the clinical significance of Treg cell expression in peripheral blood of patients with Takayasu’s arteritis.

Objectives:

To analyze the levels of circulating lymphocyte subsets and serum cytokines in patients with takayasu arteritis (TA), and explore the relationship between their changes and TA disease activity.

Methods:

A total of 46 TA patients and 43 gender-age-matched healthy controls were enrolled. According to the NIH standard, 30 patients were in active disease. Flow cytometry was used to detect the absolute numbers and ratios of Th1, Th2, Th17 and Treg cells in peripheral blood of all subjects. Magnetic bead-based multiplex immunoassay was used to detect cytokines and statistical analysis was performed.

Results:

Compared with the healthy controls, the absolute number and proportion of peripheral Treg cells of TA patients significantly decreased while those of Th17 cells increased significantly, leading to the increased ratio of Th17 / Treg. Compared with the inactive group, the TA active group had significantly increased IL-6 and TNF-α, and there was no significant difference in the expression of Th17 cells and Treg cells.

Conclusion:

In peripheral blood of TA patients, Treg cells decreased, while Th17 cells increased as compared with healthay controls, leading to an imbalance between Th17 and Treg cells. The levels of IL-6 and TNF-α were related to disease activity.

References:

[1]Russo, R.A.G. and M.M. Katsicas, Takayasu Arteritis. Front Pediatr, 2018. 6: p. 265.

[2]Misra, D.P., S. Chaurasia, and R. Misra. Increased Circulating Th17 Cells, Serum IL-17A, and IL-23 in Takayasu Arteritis. Autoimmune Dis, 2016. 2016: p. 7841718.

Figure 1.

Characteristics of the absolute numbers and proportions of Th1cells,Th2cells,Th17 cells and CD4Treg cells in the PB of patients with TA.(A-C)The levels of Th17 cells and the ratio of Th1/Treg,Th2/Treg,Th17/Treg in PB were significantly increased in patients with TA (n=46). The absolute number and the proportion of CD4Treg cells were significantly decreased in TA(n=46). (D-F) The absolute number of Th2 cells and ratio of Th2/Treg in PB were significantly decreased in active patients with TA (n=30).Neither the absolute number nor proporation of Th1, Th17 and Treg cells was altered significantly between active TA patients(n=30) and inactive TA patients(n=16).*P<0.05; **P<0.001. P<0.05 was considered statistically significant.TA,takayasu arteritis;PB peripheral blood;Tregs, regulatory Tcells.

Figure 2.

Characteristics of serum concentrations of cytokine (including IL-6, IL-10, IL-17 and TNF-α) between active TA patients(n=30) and inactive TA patients(n=16).(A,D)In terms of cytokines, the concentration of IL-6 and TNF-α was significantly up-regulated,(B,C)but no significant changes in IL-10, and IL-17 were found.*P<0.05; **P<0.001. P < 0.05 was considered statistically significant.

Disclosure of Interests:

None declared

1190 Engaging Patients And Family Members To Understand What Matters Most Living With Obstructive Sleep Apnea

Introduction

As a common but modifiable chronic condition, obstructive sleep apnea (OSA) has been identified as the top secondary cause of many other diseases including cardiovascular diseases and type 2 diabetes. Diagnosing and managing OSA provides neurological, cardiovascular and metabolic benefits, however real-world studies indicate disconnections between evidence and outcomes. Using an engagement approach and qualitative design, this project aims to better understand care and research gaps in OSA in a community healthcare setting.

Methods: Methods

Patient and family representatives were identified and recruited through OSA support meetings hosted by MultiCare Sleep Medicine Centers, to form a board of 12, with three key patient advocates. Six meetings, each facilitated by one or two members of the board, were held to encourage focus group discussion and accommodate interactive conversations on the topic. Discussions were audio recorded and edited to exclude patients’ identifiable information, then transcribed. Manual open coding was completed by two coders for each transcription to develop a codebook, followed by auto-coding and inductive content analysis using Nvivo 11.

Results

All enrolled patients had diagnosed moderate-to-severe OSA and were prescribed with continuous positive airway pressure (CPAP) therapy. Two participants were African American and one was multiethnic. Patients’ age ranged from early 30s to 80s. Seven main themes were identified: OSA diagnostic issues; treatment experiences and options; comorbidities; patient community and support needs; long-term management challenges beyond “compliance”; knowledge of OSA, CPAP and care; and patient-driven research. The first few weeks after CPAP initiation appeared to be a critical time window that impacted patients’ adaptation and use.

Conclusion

Our study revealed barriers and facilitators in OSA diagnosis and treatment. Results showed highly prevalent chronic co-morbidities and the needs to care for patients in the comorbid scenario. It was highlighted that a paradigm of patient-centered care and research is lacking and warranted. Participants also called for better coordination between sleep medicine, primary care, other specialists, durable device suppliers and insurance. Key research efforts are expected to focus on the first 30-day post CPAP dispense to improve compliance.

Support

Patient Centered Outcomes Research Institute (PCORI) (Contract #: 7717241)

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) &gt;0.7 and FVC&lt;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 &lt;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 &gt;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.

Retinal Vascular Network Topology Reconstruction and Artery/Vein Classification via Dominant Set Clustering

The estimation of vascular network topology in complex networks is important in understanding the relationship between vascular changes and a wide spectrum of diseases. Automatic classification of the retinal vascular trees into arteries and veins is of direct assistance to the ophthalmologist in terms of diagnosis and treatment of eye disease. However, it is challenging due to their projective ambiguity and subtle changes in appearance, contrast, and geometry in the imaging process. In this paper, we propose a novel method that is capable of making the artery/vein (A/V) distinction in retinal color fundus images based on vascular network topological properties. To this end, we adapt the concept of dominant set clustering and formalize the retinal blood vessel topology estimation and the A/V classification as a pairwise clustering problem. The graph is constructed through image segmentation, skeletonization, and identification of significant nodes. The edge weight is defined as the inverse Euclidean distance between its two end points in the feature space of intensity, orientation, curvature, diameter, and entropy. The reconstructed vascular network is classified into arteries and veins based on their intensity and morphology. The proposed approach has been applied to five public databases, namely INSPIRE, IOSTAR, VICAVR, DRIVE, and WIDE, and achieved high accuracies of 95.1%, 94.2%, 93.8%, 91.1%, and 91.0%, respectively. Furthermore, we have made manual annotations of the blood vessel topologies for INSPIRE, IOSTAR, VICAVR, and DRIVE datasets, and these annotations are released for public access so as to facilitate researchers in the community.