AB1057 EFFICACY AND SAFETY OF LOW-DOSE RASBURICASE IN COMBINATION WITH CONVENTIONAL URATE-LOWERING THERAPY FOR REFRACTORY CHRONIC GOUTY ARTHRITIS: A PILOT STUDY IN

Background

Recombinant uricase such as pegloticase are indicated for chronic gouty arthritis who have failed to achieve serum urate level <300μmol/L even though receiving conventional urate-lowering drugs. Rasburicase which is currently approved at a dosage of 0.2 mg/(kg.d) for 5 days for the prevention of tumor lysis syndrome in pediatric patients with hematological tumors, is the only available uricase in China at present.

Objectives

To evaluate the efficacy and safety of low-dose rasburicase in refractory chronic gouty arthritis.

Methods

We retrospectively collected data of 17 patients with refractory chronic gouty arthritis who were treated with rasburicase from January 2021 to September 2021 at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The refractory chronic gouty arthritis was defined as serum urate level was still more than 300μmol/L and dual-energy CT showed the volume of urate more than 10 cm3, even though the allopurinol, febuxostat, and/or benzbromarone of the maximum tolerable amount were received for more than 3 months. Rasburicase was added every four weeks (week 0, week 4, and week 8) with a dosage of 1.5 mg/d for three consecutive days, on the basis of daily oral urate-lowering drugs of the maximum tolerable amount. The serum urate level was monitored. The primary outcome was the change in urate volume at week 12 compared to week 0 by dual-energy CT.

Results

① Seventeen patients were recruited with 16 males (94%) and mean age 47±15 years old. The median gout course was 11 (6.5, 15) years with gout flares number 20 (11, 36) times in the previous year. At week 0 before the rasburicase add-on treatment, the mean serum urate was 652±94μmol/L and the median urate volume was 44 (21, 215) cm3 (Table 1). ② Urate level after the rasburicase add-on treatment was significantly decreased than that before the treatment either at week 0, week 4, or week 8 (Figure 1A, all p< 0.001). The median reduction of serum urate were 565 (446, 621) at week 4, 214 (57, 373) at week 8, and 118 (21, 185) at week 12 (all p<0.017). Five cases (29%) showed serum urate lower than 300μmol/L at week 12. ③ The urate volume decreased at week 12 compared to week 0 in all patients (Figure 1B~D). The median volume of urate reduction was 24 (12, 60) cm3 (p<0.001) and the median percentage of urate reduction 42% (25%, 66%). Urate reduction volume was positively correlated with baseline urate volume (r=0.890, p<0.001), while the percentage of urate reduction volume negatively correlated with baseline urate volume (r=-0.689, p=0.002). ④ Rasburicase was generally well tolerated. No gout attack occurred on the basis of intravenous methylprednisone 20mg before each rasburicase add-on treatment and oral colchicine 0.5mg/d to 1mg/d. No hypersensitive reaction occurred during the treatment. Phlebitis occurred in a patient (6%), while dizziness and nausea occurred in two patients (13%). One patient (6%) who was suffering chronic kidney disease of stage 3 developed acute kidney injury after rasburicase injection at week 0 and week 8, but the serum creatinine spontaneously returned to the baseline level during follow-up.

Figure 1.

The serum urate and urate volume before and after rasburicase add-on treatment. A: Paired comparison of serum urate level before and after each time of rasburicase administration; B. Reduction value and percentage of urate volume at week 12 for each patient. C&D: Dual-energy CT (DECT) showed a dramatical reduction in urate volume from week 0 (C, urate volume: 72.15 cm3) to week 12 (D, urate volume: 7.66 cm3). ***: p< 0.001; #: Received rasburicase at week 0 only; ##&###: Received rasburicase 7.5mg at week 0.

Conclusion

This pilot study shows rasburicase is well tolerated in patients with refractory chronic gouty arthritis and may be a reasonable option to effectively lower the urate burden of these patients, although this is an off-label use. Further prospective randomized controlled studies to verify the efficacy and safety are needed.

Funding

This study was funded by Yat-sen Clinical Research Project.

Disclosure of Interests

None declared

POS0889 CASE SERIES OF PATIENTS WITH EOSINOPHILIC FASCIITIS SECONDARY TO IMMUNE CHECKPOINT INHIBITORS THERAPY

Background

Eosinophilic fasciitis (EF), a fibrotic disease that causes inflammatory infiltration in the subcutaneous fascia is clinically characterized by edema and subsequent induration and tightening of the skin and subcutaneous tissue. EF is a rare immune-related adverse event of immune checkpoint inhibitors (ICI).

Objectives

This article aims to investigate the clinical features of ICI-related EF and to improve the understanding of the disease among rheumatologists.

Methods

Searching relevant articles in the electronic databases Medline, PubMed, Science Citation Index, China Biomedical Literature Database (CBM), China Journal Full Text Database (CNKI), and WANFANG Data with the key words of “eosinophilic fasciitis” or “Shulman syndrome” and “checkpoint inhibitor”, “CTLA-4”, “PD-1” or “PD-L1”. Only articles or case reports with detailed medical records of ICI-related EF patients were included. ICI-related EF patients in our department were also included.

Results

A 58-year-old male patient with angioimmunoblastic T cell lymphoma presented with skin edema, subsequent induration, tightening of the skin, and subcutaneous tissue (Figure 1 A&B). The eosinophils elevated in peripheral blood after 6-month treatment of PD-1 inhibitor (Camrelizumab). The patient was diagnosed as ICI-related EF and then was referred to our rheumatology department. Other seventeen EF patients from the above databases were also included for analysis. Among these 18 patients, 50% (9/18) were male and the mean age was 57±14 years. The most commonly used ICI was PD-1 inhibitor such as nivolumab and pembrolizumab, accounting for 72% (13/18), next was PD-L1 inhibitor (17%, 3/18), and 3 patients used PD-L1 inhibitor combined with CTLA-4 inhibitor. Of all cases, 50% (9/18) was metastatic melanoma and 17% (3/18) was lung cancer. After ICI treatment, the median onset time of EF was 12 months. The most common involved organ was skin and 94% (17/18) of patients presenting with symmetrical skin edema and sclerosis. For other skin manifestations, 44% (8/18) of patients had typical “groove sign”, and one case showed unilateral skin involvement of skin tension and erythema from pubis to left anterior iliac crest. When the affected limb raised, there is a visible sulcus due to the decrease of venous dilation pressure, namely “sulcus sign”. The second common involved organ was the joints which were presented with limited function in 56% (10/18) of patients. Additionally, 39% (7/18) showed muscle involvement such as myalgia and myasthenia. Increased eosinophils in peripheral blood was observed in 72% (13/18) of patients. Twelve patients (63%) received MRI examinations which showed the signal in the subcutaneous and deep fascia increased in both fat-suppressed T2 images(Figure 1 C&E) and post-enhancement T1 images(Figure 1 D&F). Fifteen patients underwent full-thickness skin biopsy at the lesion site, the pathological changes in all patients supported the diagnosis of EF. The ICI was discontinued in 94% of patients. Meanwhile, 83% received glucocorticoids and 56% of patients were treated with methotrexate. After these treatment, the clinical symptoms of EF improved in 89% of patients (n=16), while eosinophils returned to normal after a median treatment time of 2.5 months. EF progressed even through the combined treatment of prednisone, MTX, and abatacept in one patient. Another one case died after 6 months due to metastasis of bladder cancer (stageIV).

Conclusion

Although EF is a rare adverse effect of ICI treatment, individuals receiving these drugs should be monitored closely for symptoms of EF. Discontinuation of ICI and administration of immunosuppressants may prevent the progression of EF.

Disclosure of Interests

None declared

AB0276 COMPARISON OF METABOLIC DYSFUNCTION-ASSOCIATED FATTY LIVER DISEASE WITH NON-ALCOHOLIC FATTY LIVER DISEASE IN IDENTIFYING CARDIOVASCULAR RISK IN CHINESE INDIVIDUALS WITH RHEUMATOID ARTHRITIS

Background

The nomenclature from non-alcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD) is considered to identify more cardiovascular disease (CVD) risk in general population, and patients with rheumatoid arthritis (RA) carry an excess risk for CVD.

Objectives

To compare MAFLD with NAFLD in identifying CVD risk in RA patients.

Methods

Clinical data from a Chinese RA cohort were retrospectively analyzed. Hepatic steatosis was defined by abdominal ultrasound examination. CVD risk in RA patients was estimated by the Prediction for Atherosclerotic Cardiovascular Disease Risk in China.

Results

Among 513 included RA patients, 78.4% were female and the mean ± SD age was 51.8 ± 12.6 years. The prevalence of MAFLD and NAFLD was 21.4% and 20.5%, respectively. 10.9% RA patients concomitated with CVD events and 32.4% had a high 10-year CVD risk. Multivariate logistic regression analysis showed that both MAFLD and NAFLD were associated with an increase in CVD events (MAFLD: AOR = 2.303 [95% CI 1.197, 4.429]; NAFLD: AOR = 2.478 [95% CI 1.185, 4.779] and high 10-year CVD risk (MAFLD: AOR = 3.184 [95% CI 1.777, 5.705]; NAFLD: AOR = 2.870 [95% CI 1.597, 5.156]; all p < 0.05). The NRI and IDI was -0.011 (95% CI -0.025, 0.003) and -0.002 (95% CI -0.007, 0.002) for CVD events, and 0.012 (95% CI -0.014, 0.038) and 0.005 (95% CI -0.003, 0.013; all p > 0.05) for high 10-year CVD risk, which indicated no additional CVD events and high 10-years CVD risk were identified when replacing NAFLD with MAFLD in RA patients.

Conclusion

Both MAFLD and NAFLD are associated with an increased CVD risk which implies the importance of early detection and management of MAFLD or NAFLD in RA patients. However, new nomenclature of MAFLD identify no additional CVD risk in RA patients.

Financial support:

National Natural Science Foundation of China (No. 81971527, 82171780 and 82101892), Science and Technology Program of Guangzhou (No. 202102010188 and 201904010088), and Guangdong Basic and Applied Basic Research Foundation (No. 2019A1515011928 and 2020A1515110061).

Figure 1.

The prevalence of MAFLD and NAFLD in RA patients with different stratification.

The prevalence in different genders (A) and ages groups (B); The prevalence in different disease activity groups (C) and disease duration (D); remission (CDAI ≤ 2.8); active (CDAI > 2.8).

Disclosure of Interests

None declared

RND3 Transcriptionally Regulated by FOXM1 Inhibits the Migration and Inflammation of Synovial Fibroblasts in Rheumatoid Arthritis Through the Rho/ROCK Pathway

Rheumatoid arthritis (RA) is a systemic immune disease. Rho family GTPase 3 (RND3) has been reported to play an important role in inflammatory diseases. In this study, the expression of RND3 in RA was analyzed by gene chips. After RND3 was overexpressed, cell counting kit-8 assay was to detect the viability of fibroblast-like synovial cells (RA-FLSs). Transwell assays were to appraise the migratory and invasive capacities of RA-FLSs. Enzyme-linked immunosorbent assay (ELISA) and Western blot analysis were to estimate inflammatory response. In addition, MMP3 and MMP9 levels were also tested by ELISA analysis. After forkhead box M1 (FOXM1) was overexpressed, RND3 expression was detected by Western blot. The transcriptional relationship between FOXM1 and RND3 was predicted by HumanTFDB and JASPAR databases. Luciferase reporter and chromatin immunoprecipitation assays verified the binding ability of FOXM1 and RND3. The role of FOXM1/RND3 axis in RA was detected again by functional experiments. Western blot detected the expression of Rho/ROCK pathway-related proteins. RND3 expression was downregulated in RA. Overexpression of RND3 reduced the proliferation, migration, invasion, and inflammation of RA-FLSs. RND3 was inhibited by FOXM1 transcription, and upregulated FOXM1 reduced the inhibitory effect of RND3 overexpression on cell growth and inflammation, which might be associated with the Rho/ROCK pathway. RND3 transcriptionally regulated by FOXM1 inhibited the migration and inflammation of RA-FLSs in RA through the Rho/ROCK pathway.

OP0163 A MATRIX PREDICTION MODEL FOR THE SIX-MONTH MORTALITY RISK IN PATIENTS WITH ANTI-MELANOMA DIFFERENTIATION-ASSOCIATED PROTEIN-5 POSITIVE DERMATOMYOSITIS

Background

Recently, the autoantibody recognizing melanoma differentiation-associated gene 5 (anti-MDA5) is of the greatest concern as a specific autoantibody of dermatomyositis (DM), since it delineates a unique clinical phenotype of DM with a high risk of life-threatening lung complications. Considering routine clinical characteristics at baseline are still desired candidates for screening potential mortality predictors, in order to as early as possible stratify the mortality risk in anti-MDA5 positive DM patients before making therapeutic strategies.

Objectives

To investigate the baseline independent risk factors for predicting 6-month mortality of anti-MDA5-positive DM patients and develop a matrix prediction model formed by these risk factors.

Methods

This was a real-world prospective observational study. The hospitalized patients with DM were included if they fulfilled the criteria including: aged over 18 years old; diagnosed as having DM according to the criteria proposed by Bohan and Peter or the modified Sontheimer definitions; and positive anti-MDA5 which was determined by both line immunoassay testing and enzyme-linked immunosorbent testing. The primary outcome was all-cause 6-month mortality after enrolment. A matrix prediction model was built with the mortality risk probability.

Results

There were 82 DM patients enrolled (mean age of onset 50±11 years and 63% female), with 40 (49%) showing positive anti-MDA5. Gottron sign/papules (OR: 5.135, 95%CI: 1.489~17.708), arthritis (OR: 5.184, 95%CI: 1.455~18.467), interstitial lung disease (ILD, OR: 7.034, 95%CI: 1.157~42.785), and higher level of C4 (OR: 1.010, 95%CI: 1.002~1.017) were independent associators with positive anti-MDA5 in DM patients. Anti-MDA5-positive DM patients had significant higher 6-month all-cause mortality than those with anti-MDA5-negative (30% vs. 0%). Among anti-MDA5-positive DM patients, compared to the survivors, non-survivors had significantly advanced age of onset (59±6 years vs. 46±9 years), higher rates of fever (75% vs. 18%), positive carcinoma embryonic antigen (CEA, 75% vs. 14%), higher level of ferritin (median 2858 ug/L vs. 619 ug/L, all p<0.05). Multivariate COX regression showed ferritin≥1250 μg/L (HR: 10.4, 95%CI: 1.8~59.9), fever (HR: 11.2, 95%CI: 2.5~49.9), and positive CEA (HR: 5.2, 95%CI: 1.0~25.7) were independent risk factors of 6-month mortality.

According to the matrix prediction model, anti-MDA5-positive DM patients could be stratified into three subgroups based on various probabilities of predicted mortality: (i) High-risk: eight patients with two of the above three features (including fever, serum ferritin≥1250 μg/L, and positive CEA) had high predicted mortality probability with 64%~85% (three red grids in Figure 1A), and the actual mortality was 75% (n=6) with 60%, 100%, and 100% respectively in three red grids (Figure 1B). Five patients with all of three features had extremely high predicted mortality probability with 97% (95%CI: 70%~100%, the dark red grid of Figure 1A), and the actual mortality was 100% in Figure 1B; (ii) Moderate-risk: nine patients with one of the above three features had moderate predicted mortality probability with 11%~29% (three yellow grids in Figure 1A), and the actual mortality was 11% (n=1) with 0%, 0%, and 17% respectively in three yellow grids (Figure 1B); (iii) Low-risk: eighteen patients with none of the above three features had low predicted mortality probability with 2% (95%CI: 0.2%~20%, the green grid in Figure 1A), and the actual mortality was 0% in the green grid (Figure 1B).

Conclusion

Baseline characteristics of fever, positive CEA, and ferritin≥1250 μg/L are risk factors for 6-month all-cause mortality in anti-MDA5-positive DM patients. A novel matrix prediction model composed of these three clinical indicators is firstly proposed to provide a chance for exploration of individual treatment strategies in anti-MDA5-positive DM subgroups with various probabilities of mortality risk.

Disclosure of Interests

None declared

Tests of Lepton Universality Using B^{0}→K_{S}^{0}ℓ^{+}ℓ^{-} and B^{+}→K^{*+}ℓ^{+}ℓ^{-} Decays

Tests of lepton universality in B^{0}→K_{S}^{0}ℓ^{+}ℓ^{-} and B^{+}→K^{*+}ℓ^{+}ℓ^{-} decays where ℓ is either an electron or a muon are presented. The differential branching fractions of B^{0}→K_{S}^{0}e^{+}e^{-} and B^{+}→K^{*+}e^{+}e^{-} decays are measured in intervals of the dilepton invariant mass squared. The measurements are performed using proton-proton collision data recorded by the LHCb experiment, corresponding to an integrated luminosity of 9  fb^{-1} . The results are consistent with the standard model and previous tests of lepton universality in related decay modes. The first observation of B^{0}→K_{S}^{0}e^{+}e^{-} and B^{+}→K^{*+}e^{+}e^{-} decays is reported.

Observation of the Decay Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ}

The first observation of the semileptonic b-baryon decay Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ}, with a significance of 6.1σ, is reported using a data sample corresponding to 3  fb^{-1} of integrated luminosity, collected by the LHCb experiment at center-of-mass energies of 7 and 8 TeV at the LHC. The τ^{-} lepton is reconstructed in the hadronic decay to three charged pions. The ratio K=B(Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ})/B(Λ_{b}^{0}→Λ_{c}^{+}π^{-}π^{+}π^{-}) is measured to be 2.46±0.27±0.40, where the first uncertainty is statistical and the second systematic. The branching fraction B(Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ})=(1.50±0.16±0.25±0.23)% is obtained, where the third uncertainty is from the external branching fraction of the normalization channel Λ_{b}^{0}→Λ_{c}^{+}π^{-}π^{+}π^{-}. The ratio of semileptonic branching fractions R(Λ_{c}^{+})≡B(Λ_{b}^{0}→Λ_{c}^{+}τ^{-}ν[over ¯]_{τ})/B(Λ_{b}^{0}→Λ_{c}^{+}μ^{-}ν[over ¯]_{μ}) is derived to be 0.242±0.026±0.040±0.059, where the external branching fraction uncertainty from the channel Λ_{b}^{0}→Λ_{c}^{+}μ^{-}ν[over ¯]_{μ} contributes to the last term. This result is in agreement with the standard model prediction.

Integrated Multi-Omics Perspective to Strengthen the Understanding of Salt Tolerance in Rice

Salt stress is one of the major constraints to rice cultivation worldwide. Thus, the development of salt-tolerant rice cultivars becomes a hotspot of current rice breeding. Achieving this goal depends in part on understanding how rice responds to salt stress and uncovering the molecular mechanism underlying this trait. Over the past decade, great efforts have been made to understand the mechanism of salt tolerance in rice through genomics, transcriptomics, proteomics, metabolomics, and epigenetics. However, there are few reviews on this aspect. Therefore, we review the research progress of omics related to salt tolerance in rice and discuss how these advances will promote the innovations of salt-tolerant rice breeding. In the future, we expect that the integration of multi-omics salt tolerance data can accelerate the solution of the response mechanism of rice to salt stress, and lay a molecular foundation for precise breeding of salt tolerance.

[The characteristics of non-alcoholic fatty liver disease and its associated factors in patients with rheumatoid arthritis]

Objective: To investigate the characteristics of non-alcoholic fatty liver disease (NAFLD) and its associated factors in rheumatoid arthritis (RA) patients. Methods: This cross-sectional study recruited 385 RA patients [including 72 (18.7%) male and 313 (81.3%) female] who received abdominal sonographic examination from August 2015 to May 2021 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. There were 28 RA patients at 16-29 years old and 32, 80, 121, 99, 25 at 30-39, 40-49, 50-59, 60-69, ≥ 70 years old, respectively. Demographic and clinical data were collected including age, gender, history of alcohol consumption, disease duration, body mass index (BMI), waist circumference, blood pressure, RA disease activity indicators and previous medications. Logistic regression analyses were used to identify the associated factors of NAFLD in RA patients. Results: The prevalence of NAFLD was 24.2% (93/385) in RA patients, 26.3% (21/80) in 40-49 age group and 33.1% (40/121) in 50-59 age group. There were 22.1% (85/385) and 3.6% (14/385) RA patients with overweight and obese, in which the prevalence of NAFLD was 45.9% (39/85) and 78.6% (11/14) respectively, which was 2.6 folds and 4.5 folds that of RA patients with normal BMI. Although there was no significant difference of age, gender and RA disease activity indicators between RA patients with or without NAFLD, those with NAFLD had higher proportions of metabolic diseases including obese (11.8% vs. 1.0%), central obesity (47.3% vs. 16.8%), hypertension (45.2% vs. 29.8%) and type 2 diabetes mellitus (24.7% vs. 12.0%), consistent with higher levels of total cholesterol [(5.33±1.31) mmol/L vs. (4.73±1.12) mmol/L], triglyceride [(1.51±1.08) mmol/L vs. (0.98±0.54) mmol/L] and low-density lipoprotein cholesterol [(3.37±0.97) mmol/L vs. (2.97±0.78) mmol/L, all P<0.05]. Multivariate logistic regression analysis showed that BMI (OR=1.314) and triglyceride (OR=1.809) were the independent factors positively associated with NAFLD in RA patients. Conclusion: NAFLD is a common comorbidity in RA patients, especially in those with middle-aged, overweight or obese, which is associated with high BMI or high triglyceride. Screening and management of NAFLD in RA patients especially those with overweight, obese or dyslipidemia should be emphasized.

Recovery of phosphate and ammonium nitrogen as struvite from aqueous solutions using a magnesium-air cell system

The addition of alkaline and magnesium sources during the recovery of NH₄⁺ and PO₄^3- in the form of struvite using the traditional struvite precipitation method increases the production cost. To solve this problem, a magnesium-air cell (MAC) system was used herein to recover NH₄⁺ and PO₄^3- as struvite from wastewater using a magnesium strip (Mg²⁺) and the oxygen adsorbed on the surface of a titanium plate (OH^-) as the anode and cathode, respectively. Experimental parameters (i.e. initial solution pH, temperature, NH₄⁺/PO₄^3- molar ratio, NH₄⁺ and PO₄^3- initial concentrations and stirring intensity) were found to affect the removal rate of NH₄⁺ and PO₄^3-. The presence of Ca²⁺ decreased the struvite purity. At Ca²⁺/PO₄^3- ratios of 0:1 and 0.5:1, the purity of the obtained struvite after 6 h was 93.8% and 58.9%, respectively. Struvite with a purity of 95.7%, electricity with an average output power of 2.53 mW, and an energy density of 1.05 W/m² were obtained when the proposed system was used to recover NH₄⁺ and PO₄^3- from an actual supernatant of domestic sludge anaerobic digestion. Scanning electron microscopy-energy-dispersive X-ray spectroscopy, X-ray diffraction, Fourier transform infrared spectroscopy, Raman spectroscopy and thermogravimetric analyses showed that the obtained struvite exhibited almost the same physicochemical properties as commercial struvite. Thus, the MAC system can be regarded as an effective method for recovering NH₄⁺ and PO₄^3- in the form of struvite from wastewater.

Observation of Two New Excited Ξ_{b}^{0} States Decaying to Λ_{b}^{0}K^{-}π^{+}

Two narrow resonant states are observed in the Λ_{b}^{0}K^{-}π^{+} mass spectrum using a data sample of proton-proton collisions at a center-of-mass energy of 13 TeV, collected by the LHCb experiment and corresponding to an integrated luminosity of 6  fb^{-1}. The minimal quark content of the Λ_{b}^{0}K^{-}π^{+} system indicates that these are excited Ξ_{b}^{0} baryons. The masses of the Ξ_{b}(6327)^{0} and Ξ_{b}(6333)^{0} states are m[Ξ_{b}(6327)^{0}]=6327.28_{-0.21}^{+0.23}±0.12±0.24 and m[Ξ_{b}(6333)^{0}]=6332.69_{-0.18}^{+0.17}±0.03±0.22  MeV, respectively, with a mass splitting of Δm=5.41_{-0.27}^{+0.26}±0.12  MeV, where the uncertainties are statistical, systematic, and due to the Λ_{b}^{0} mass measurement. The measured natural widths of these states are consistent with zero, with upper limits of Γ[Ξ_{b}(6327)^{0}]<2.20(2.56) and Γ[Ξ_{b}(6333)^{0}]<1.60(1.92)  MeV at a 90% (95%) credibility level. The significance of the two-peak hypothesis is larger than nine (five) Gaussian standard deviations compared to the no-peak (one-peak) hypothesis. The masses, widths, and resonant structure of the new states are in good agreement with the expectations for a doublet of 1D Ξ_{b}^{0} resonances.

Measurement of the Nuclear Modification Factor and Prompt Charged Particle Production in p-Pb and pp Collisions at sqrt[s_{NN}]=5 TeV

The production of prompt charged particles in proton-lead collisions and in proton-proton collisions at the nucleon-nucleon center-of-mass energy sqrt[s_{NN}]=5  TeV is studied at LHCb as a function of pseudorapidity (η) and transverse momentum (p_{T}) with respect to the proton beam direction. The nuclear modification factor for charged particles is determined as a function of η between -4.8<η<-2.5 (backward region) and 2.0<η<4.8 (forward region), and p_{T} between 0.2<p_{T}<8.0  GeV/c. The results show a suppression of charged particle production in proton-lead collisions relative to proton-proton collisions in the forward region and an enhancement in the backward region for p_{T} larger than 1.5  GeV/c. This measurement constrains nuclear PDFs and saturation models at previously unexplored values of the parton momentum fraction down to 10^{-6}.

Effect of Eucommia ulmoides leaves on hyperuricemia and kidney injury induced by a high-fat/high-fructose diet in rats

OBJECTIVES

To investigate the protective and preventive treatment effects of Eucommia ulmoides leaves on a rat model of high-fat and high-fructose diet (HFFD) induced hyperuricemia and renal injury.

MATERIALS AND METHODS

Network pharmacology and molecular-docking methods were used to predict the effects and action mechanisms of the major components of E. ulmoides leaves on hyperuricemia. Combining literature collection, we used SciFinder and the Traditional Chinese Medicine Systems Pharmacology Database (TCMSP) and Analysis Platform to collect E. ulmoides leaf flavonoid and iridoid components. Swiss Target Prediction, Similarity ensemble approach (SEA), GeneCards, and the Online Mendelian Inheritance in Man (OMIM) database were used to obtain core targets, and the Search Tool for Recurring Instances of Neighbouring Genes (STRING) protein database was used as core target for gene ontology enrichment Set and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Molecular docking was applied to predict the pathways regulating the metabolism of uric acid. The selected targets and targeting efficacy were validated using a rat model of hyperuricemia and renal injury induced by a high-fat and high-fructose diet.

RESULTS

A total of 32 chemical components with effective targets, which regulated the PI3K-AKT pathway and endocrine resistance, were collected. Molecular docking results showed that iridoids and flavonoids are bound to proteins related to inflammation and uric acid metabolism. In addition, it was verified via animal experiments that an E. ulmoides leaf extract ameliorated hyperuricemia, renal injury, and inflammation, which are closely related to the targets Interleukin- 6 (IL-6), Tumor necrosis factor-α (TNF-α), Toll-Like Receptor 4 (TLR4), and Glucose transporter 9 (GLUT9).

CONCLUSION

E. ulmoides leaf flavonoids and iridoids ameliorate hyperuricemia and uric-acid-induced inflammation through a multi-component, multi-target, and multi-pathway mechanism, which provides a theoretical basis for the development of therapeutics from E. ulmoides leaf components.

Recovery of trivalent and hexavalent chromium from chromium slag using a bipolar membrane system combined with oxidation

Chromium slag (CS) with large quantities of multivalent Cr species (III and VI) generated during chromium salt production is hazardous to nature and living organisms. Furthermore, CS discharge leads to considerable resource wastage. Herein, a bipolar membrane electrodialysis (BMED) system was employed along with hydrogen peroxide (H₂O₂) oxidation for simultaneously recovering Cr(III) and Cr(VI) from CS in the form of Na₂CrO₄. A bipolar membrane was used to produce OH^- under a direct electric field, providing an alkaline environment for the oxidative conversion of Cr(III) to Cr(VI) in the presence of H₂O₂, followed by the recovery of Cr(III) and Cr(VI) as Na₂CrO₄. The effect of H₂O₂content on Cr(III) oxidation and that of the current density on chromium recovery, current efficiency and specific energy consumption were investigated. Moreover, the morphology of chromium in CS before and after the BMED treatment was analysed. The H₂O₂ content affected the Cr oxidation rate from Cr(III) to Cr(VI). The current density affected chromium removal, current efficiency and specific energy consumption. At a current density of 2 mA/cm², the total chromium recovery exceeded 67% and the remaining chromium was mainly in the residual state (RES). When the number of CS compartments increased, the current efficiency was enhanced and the specific energy consumption decreased. Binding state analysis show that Cr(III) and different species of Cr(VI) could be transformed into exchangeable Cr(VI) after H₂O₂ oxidation and BMED treatment. After the treatment, 92% of the remaining chromium in CS was in the RES. Thus, the employed method can effectively recover chromium from CS and other chromium-contaminated solid waste.

Role of raphe magnus 5-HT1A receptor in increased ventilatory responses induced by intermittent hypoxia in rats

Background

Intermittent hypoxia induces increased ventilatory responses in a 5-HT-dependent manner. This study aimed to explore that effect of raphe magnus serotonin 1A receptor (5-HT_1A) receptor on the increased ventilatory responses induced by intermittent hypoxia.

Methods

Stereotaxic surgery was performed in adult male rats, and acute and chronic intermittent hypoxia models were established after recovery from surgery. The experimental group received microinjections of 5-HT_1A receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) into the raphe magnus nucleus (RMg). Meanwhile, the control group received microinjections of artificial cerebrospinal fluid instead of 8-OH-DPAT. Ventilatory responses were compared among the different groups of oxygen status. 5-HT expressions in the RMg region were assessed by immunohistochemistry after chronic intermittent hypoxia.

Results

Compared with the normoxia group, the acute intermittent hypoxia group exhibited higher ventilatory responses (e.g., shorter inspiratory time and higher tidal volume, frequency of breathing, minute ventilation, and mean inspiratory flow) (P < 0.05). 8-OH-DPAT microinjection partly weakened these changes in the acute intermittent hypoxia group. Further, compared with the acute intermittent hypoxia group, rats in chronic intermittent hypoxia group exhibited higher measures of ventilatory responses after 1 day of intermittent hypoxia (P < 0.05). These effects peaked after 3 days of intermittent hypoxia treatment and then decreased gradually. Moreover, these changes were diminished in the experimental group. 5-HT expression in the RMg region increased after chronic intermittent hypoxia, which was consistent with the changing trend of ventilatory responses. While activation of the 5-HT_1A receptor in the RMg region alleviated this phenomenon.

Conclusions

The results indicate that RMg 5-HT_1A receptor, via changing the expression level of 5-HT in the RMg region, is involved in the modulation of the increased ventilatory responses induced by intermittent hypoxia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-022-01970-6.

Molecular simulation of linear octacosane via a CG10 coarse grain scheme

Following our previous work on the united-atom simulation on octacosane (C₂₈H₅₈) (Dai et al., Phys. Chem. Chem. Phys., 2021, 23, 21262-21271), we developed a coarse grain scheme (CG10), which is able to reproduce the pivotal phase characteristics of octacosane with highly improved computational efficiency. The CG10 octacosane chain was composed of 10 consecutive beads, maintaining the fundamental zigzag chain morphology. When the potential functions were set up and the coefficients were parameterized, our CG10 models yielded solid phase diagrams and transitions during an annealing process. We also detected the melting point by various means: direct observation, bond order, density tracking, and an enthalpy plot. Furthermore, our CG10 successfully reproduced the liquid density with only 2% underestimation, indicating its applicability across the solid and liquid phases. Therefore, with the ability to reproduce critical structure and property characteristics, our CG10 scheme provides an effective means of numerically modelling octacosane with highly improved computational efficiency.

Study of Z Bosons Produced in Association with Charm in the Forward Region

Events containing a Z boson and a charm jet are studied for the first time in the forward region of proton-proton collisions. The data sample used corresponds to an integrated luminosity of 6  fb^{-1} collected at a center-of-mass energy of 13 TeV with the LHCb detector. In events with a Z boson and a jet, the fraction of charm jets is determined in intervals of Z-boson rapidity in the range 2.0<y(Z)<4.5. A sizable enhancement is observed in the forwardmost y(Z) interval, which could be indicative of a valencelike intrinsic-charm component in the proton wave function.

[Association of thrombocytopenia with mortality after surgery in patients with Standford type A aortic dissection]

Objective: To evaluate the association of thromboytopenia with mortality of Standford type A aortic dissection after cardiopulmonary bypass surgery. Methods: Total of 498 patients with Standford type A aortic dissection after surgery in Fuwai Hospital of the Chinese Academy of Medical Sciences from May 2017 to December 2018 were collected retrospectively. There were 350 males and 148 females, with a mean age of (51.7±12.0) years. The patients were divided into thrombocytopenia group (platelet count<75×10¹⁵/L, n=178) and normal platelet group (platelet count≥75×10¹⁵/L, n=320) according to the lowest platelet count within 72 hours after surgery. The perioperative in-hospital mortality and related complications were calculated by univariate and multivariate logistic regression analysis. The primary endpoint was in-hospital mortality, and the secondary endpoints included secondary thoracotomy, pneumonia, postoperative continuous renal replacement therapy, paraplegia, heart failure, length of hospital stay and intensive care unit (ICU) stay time. Results: The morbidity of thrombocytopenia after Standford type A aortic dissection surgery was 35.7% (178/498). Univariate logistic regression analysis showed that postoperative thrombocytopenia was significantly associated with in-hospital mortality and 7 secondary endpoints (P<0.05). Multivariate logistic regression analysis showed thrombocytopenia after aortic dissection surgery was significantly associated with increased postoperative mortality (OR=12.57, 95%CI: 2.26-69.93, P=0.004), secondary thoracotomy (OR=6.21, 95%CI: 1.31-29.46, P=0.022), continuous renal replacement therapy (OR=7.51, 95%CI: 2.53-22.34, P<0.001), paraplegia (OR=23.99, 95%CI: 1.47-392.21, P=0.026), heart failure (OR=4.71, 95%CI: 1.19-18.62, P=0.027) and longer ICU stay time (OR=1.86, 95%CI: 1.11-3.12, P=0.019). Conclusions: Thrombocytopenia after Standford type A aortic dissection after cardiopulmonary bypass surgery (the lowest platelet count within 72 hours) is strongly associated with postoperative in-hospital mortality. Trying to avoid the factors related to thrombocytopenia can prevent more complications at the same time.

The active ingredient (DSH-20) of Salvia miltiorrhiza flower reduces oxidative damage and apoptosis in cardiomyocytes by regulating miR-1

BACKGROUND

DSH-20, the active ingredient of Salvia miltiorrhiza flower extract, is used to treat cardiovascular diseases. However, its mechanism of action remains unclear. Herein, we investigated the intervention of DSH-20 in H₂O₂-induced oxidative damage and apoptosis in cardiomyocytes. METHODS AND RESULTS: H₂O₂ was used to induce oxidative damage and apoptosis in H9c2 cardiomyocytes. Based on concentration gradient studies, we found that 62.5 µg/mL DSH-20 significantly reduced reactive oxygen species and lactate dehydrogenase levels and increased superoxide dismutase levels. DSH-20 also alleviated the apoptosis rate, the changes in mRNA of apoptosis-related genes (Bcl-2, BAX, and Caspase-3) and miR-1 expression. Moreover, transfection of miR-1 mimics aggravated oxidative damage and apoptosis, whereas DSH-20 alleviated these effects.

CONCLUSIONS

DSH-20 reduced H₂O₂-induced oxidative damage and apoptosis in H9c2 cardiomyocytes likely by downregulating miR-1 expression.

Evidence for a New Structure in the J/ψp and J/ψp[over ¯] Systems in B_{s}^{0}→J/ψpp[over ¯] Decays

An amplitude analysis of flavor-untagged B_{s}^{0}→J/ψpp[over ¯] decays is performed using a sample of 797±31 decays reconstructed with the LHCb detector. The data, collected in proton-proton collisions between 2011 and 2018, correspond to an integrated luminosity of 9  fb^{-1}. Evidence for a new structure in the J/ψp and J/ψp[over ¯] systems with a mass of 4337_{-4}^{+7} _{-2}^{+2}  MeV and a width of 29_{-12}^{+26} _{-14}^{+14}  MeV is found, where the first uncertainty is statistical and the second systematic, with a significance in the range of 3.1 to 3.7σ, depending on the assigned J^{P} hypothesis.

[The characteristics and associated factors of functional limitation in patients with rheumatoid arthritis]

Objective: To investigate the characteristics of functional limitation and associated factors in patients with rheumatoid arthritis (RA). Methods: Consecutive patients with RA were recruited from August 2015 to June 2019 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. Demographic and clinical characteristics including age, gender, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) of pain, clinical disease activity index (CDAI), modified total Sharp score were collected. Physical function was assessed by the Stanford health assessment questionnaire disability index (HAQ-DI).Ordered logistic regression was used to analyze the related factors of HAQ-DI. Results: A total of 643 RA patients were finally recruited including 114 males and 529 females with mean age (49.7±12.9) years. There were 399 (62.1%) patients having different degrees of functional limitation, who were classified as mild (293, 45.6%), moderate (73, 11.4%) and severe (33, 5.1%). The prevalence of functional limitation was positively correlated with age and disease activity. The most restricted activity was walking [43.5% (280/643)], followed by gripping [36.1% (232/643)], reaching [35.5% (228/643)], daily activities [33.4% (215/643)], hygiene [33.0% (212/643)], dressing and grooming [29.7% (191/643)] and arising [29.1% (187/643)], and the last eating [18.4% (118/643)]. Multivariate ordered logistic regression analysis showed that age (OR=1.019, 95%CI 1.004-1.035),pain VAS (OR=1.820, 95%CI 1.616-2.050), ESR (OR=1.009, 95%CI 1.001-1.017), CDAI (OR=1.080, 95%CI 1.059-1.102) and modified total Sharp score (OR=1.010, 95%CI 1.004-1.015) were associated factors of functional limitation. Conclusion: The majority RA patients have functional limitation. Age, pain and active disease are independent associated factors. Therefore, target treatment and control of pain should be emphasized in RA patients.

A Diagnostic Model With IgM Autoantibodies and Carcinoembryonic Antigen for Early Detection of Lung Adenocarcinoma

Immunoglobulin M (IgM) autoantibodies, as the early appearing antibodies in humoral immunity when stimulated by antigens, might be excellent biomarkers for the early detection of lung cancer (LC). We aimed to develop a multi-analyte integrative model combining IgM autoantibodies and a traditional tumor biomarker that could be a valuable and powerful auxiliary diagnostic tool and might improve the accuracy of early detection of lung adenocarcinoma (LUAD). A customized protein array based on cancer driver genes was constructed and applied in the discovery cohort consisting of 68 LUAD patients and 68 normal controls (NCs); 31 differentially expressed IgM autoantibodies were identified. The top 5 candidate IgM autoantibodies [based on the area under the receiver operating characteristic curve (AUC) ranking], namely, TSHR, ERBB2, survivin, PIK3CA, and JAK2, were validated in the validation cohort using enzyme-linked immunosorbent assay (ELISA), which included 147 LUAD samples, 72 lung squamous cell carcinoma (LUSC) samples, 44 small cell lung carcinoma (SCLC) samples, and 147 NCs. These indicators presented diagnostic capacity for LUAD, with AUCs of 0.599, 0.613, 0.579, 0.601, and 0.633, respectively (p < 0.05). However, none of them showed a significant difference between the SCLC and NC groups, and only the IgM autoantibody against JAK2 showed a higher expression in LUSC than in NC (p = 0.046). Through logistic regression analysis, with the five IgM autoantibodies and carcinoembryonic antigen (CEA), one diagnostic model was constructed for LUAD. The model yielded an AUC of 0.827 (sensitivity = 56.63%, specificity = 93.98%). The diagnostic efficiency was superior to that of either CEA (AUC = 0.692) or IgM autoantibodies alone (AUC = 0.698). Notably, the accuracy of this model in early-stage LUAD reached 83.02%. In conclusion, we discovered and identified five novel IgM indicators and developed a multi-analyte model combining IgM autoantibodies and CEA, which could be a valuable and powerful auxiliary diagnostic tool and might improve the accuracy of early detection of LUAD.

Mechanism by which Eucommia ulmoides leaves Regulate Nonalcoholic fatty liver disease based on system pharmacology

ETHNOPHARMACOLOGICAL RELEVANCE

Eucommia ulmoides (E. ulmoides) leaves are included in the Chinese Pharmacopoeia, and are traditionally used to treat hypertension, obesity, diabetes, and other diseases. Numerous pharmacological studies have shown that E. ulmoides has a good effect on lowering blood lipids and can improve obesity and nonalcoholic fatty liver.

AIM

To study the mechanism of E. ulmoides leaves in regulating nonalcoholic fatty liver disease by combining prediction and validation.

METHODS

Using network pharmacology, and molecular docking to predict E. ulmoides in regulating the action mechanism and potential active ingredients of nonalcoholic fatty liver, large hole adsorption resin enrichment active sites, in vitro experiments were performed to verify its fat-lowering effect and mechanism.

RESULTS

The major components of E. ulmoides leaves exhibited good combination with lipid metabolism-regulating core proteins, particularly flavonoids. EUL 50 significantly reduced lipid accumulation, and increased PPARγ. Compared with the control group, the autophagy level increased after the administration of EUL 50. PPARγ decreased significantly after the addition of chloroquine (CQ, autophagy inhibitor).

CONCLUSION

The active ingredients in E. ulmoides leaves regulating nonalcoholic fatty liver disease are mainly flavonoids and phenolics. EUL 50 may play a role in lowering lipids by regulating PPARγ expression through inducing autophagy.

Effect of Continuous Positive Airway Pressure on Chronic Cough in Patients with Obstructive Sleep Apnea and Concomitant Gastroesophageal Reflux

BACKGROUND

Obstructive sleep apnea (OSA) and/or gastroesophageal reflux (GER) may be the contributors to chronic cough in patients with OSA and concomitant GER. This study aimed to explore whether continuous positive airway pressure (CPAP), antireflux treatment and lifestyle modifications improve chronic cough in patients with OSA and concomitant GER.

METHODS

Patients with OSA and concomitant GER who also experienced chronic cough were enrolled, and were divided into two groups. Patients who were treated with general treatment (antireflux treatment and lifestyle modifications) as the control group, and patients who were treated with CPAP and general treatment as the treatment group. Effects of different treatments on chronic cough were assessed, and the association among chronic cough, GER and OSA was evaluated by Pearson's correlation analysis.

RESULTS

The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were better in the treatment group after 1 week of treatment; further, the improvement became stronger with the duration of therapy. The gastroesophageal reflux disease questionnaire, visual analog scale (VAS) for cough, and daytime and nighttime cough symptom scores significantly improved in both groups after treatment, whereas this improvement was more significant in the treatment group. Significant associations between the apnea-hypopnea index (AHI) and VAS, weak acid reflux and VAS, and weak acid reflux and AHI were observed.

CONCLUSION

CPAP improved the symptoms of chronic cough and GER in patients with OSA and concomitant GER. AHI and weak acid reflux may be important factors affecting the therapeutic effect of chronic cough in patients with OSA and concomitant GER.