Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample

Background

Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population.

Methods

We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline.

Results

We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14).

Conclusions

Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse.

Predictors of SCA in Adolescent MVP

Funding Acknowledgement

Type of funding source: None

10-year trend analysis of in-hospital cardiac arrest: 2008–2017 United State hospitalizations

Introduction

In-hospital cardiac arrest (IHCA) survival trends have not been well reported in recent years. Whether the implementation of the new 2015 AHA guideline affects the survival of IHCA is largely unknown. Our study aims to provide an updated analysis of the trends of IHCA among the hospitals in the United States

Method

Using United States National Inpatient Sample Database 2008–2017, the cohort was generated with patients age above 18 who received Cardiopulmonary resuscitation during Hospitalization. Hospitalization with a principle diagnosis of cardiac arrest or ventricular fibrillation/ventricular tachycardia were excluded as outside hospital cardiac arrest. Demographic features, baseline characteristic as well as hospital outcomes were described. Trend analysis was performed using a multivariate model adjusted for age, sex, and comorbidities score.

Results

From 2008 to 2017, the cases of In-hospital cardiac arrest (IHCA) has steadily increased from 96,771 to 106,320. This trend was accompanied by a decline in age from (67.48±0.30 to 65.78±0.13, Ptrend <0.001) but increase in comorbidity score (from 2.44±0.27 to 3.47±0.21, Ptrend <0.001). It is noted that the mortality rate has been steadily declining since 2008 (from 74.01% to 68.68%, Ptrend <0.001)), although no significant changes before or after 2015 were noted (from 68.90 to 68.68, P>0.05). Length of stay has decreased from an average of 9.06± days to 8.76±0.13 days at the cost of increased health care costs (from 30.78 to 37.40 thousand dollar P<0.001 adjusted for inflation rate).

Conclusion

The survival rate of In-hospital cardiac arrest has increased from 2008 to 2017 despite increased comorbidity burden. The length of stays has decreased at the cost of an increase in health costs.

Funding Acknowledgement

Type of funding source: None

Breast cancer patients have lower in-hospital mortality after acute coronary syndrome, a 5 year nationwide analysis

Background

Breast cancer and cardiovascular disease (CVD) share common risk factors, and breast cancer therapies are well known to cause cardiotoxicity. Prior studies highlighted the higher burden coronary artery disease and the importance to further assess its consequences on breast cancer patients.

Purpose

We sought to evaluate the revascularization rate and in-hospital short-term outcomes of breast cancer patients following acute coronary syndrome (ACS) compared to the general female population.

Methods

We reviewed the Nationwide Inpatient Sample from 2010 to 2014 to identify female patients with principal diagnosis of ACS (ST-elevation and non ST-elevation myocardial infarction, and unstable angina). Two subgroups were identified, women with a history of breast cancer and women without, and were propensity matched.

Multivariate regression analyses were performed to evaluate the impact of breast cancer on primary outcome (in-hospital mortality) and secondary outcomes: occurrence of shock, acute kidney injury (AKI), mechanical ventilation (MV), and length of stay (LOS). We also compared the rate of cardiac procedures. Statistical significance of odd ratios (OR) is defined with p-value<0.05 and reported 95% confidence intervals (CI).

Results

We identified a total of 245,563 female patients with primary diagnosis of ACS, among them 10,625 (4.3%) had a history of breast cancer. The comorbidity of breast cancer was associated with statistically significant lower rates of mortality (OR 0.83, CI 0.74–0.94), shock (OR 0.87, CI 0.77–0.99), AKI (OR 0.90, CI 0.82–0.98), MV (OR 0.81, CI 0.71–0.92) and relative 5.4% decrease in LOS (CI: −7.8%, −3.0%). The cardiac procedural rates were similar for left heart catheterization (OR 0.96, CI 0.90–1.02), for percutaneous coronary intervention (OR 0.95, CI 0.89–1.02) and for CABG (OR 0.88, CI 0.78–1.00) compared to control group.

Conclusion

Breast cancer patients received a comparable catheterization and revascularization procedure rate and exhibited a statistically significant lower morbidity and mortality rates during hospitalization after an ACS event compared to the general female population.

Funding Acknowledgement

Type of funding source: None

10-year trend analysis of atrioventricular node ablation in patient with atrial fibrillation: 2005–2014 United State hospitalization

Introduction

Atrial fibrillation (AF) ablation and Atrioventricular Node (AVN) ablation are both important non-pharmacological therapy of AF. In spite of increased availability of AF ablation data, that of AVN ablation per se is limited.

Method

AF ablation was identified using ICD-9 procedure code with principle diagnosis of AF from United States National Inpatient Sample database 2005–2014. From procedure and diagnosis codes of pacemaker insertion followed by ablation, the cohort who underwent AVN ablation was identified. Patients hospitalization with any diagnosis of other type of arrythmia or epicardial ablation were excluded. Complications were defined as per the Agency for Health Care Research and Quality guideline.

Results

Total AF ablation was noted to increase from 2005- 2011, and declined steadily from 2011–2014. In contrast, the number of AVN ablations increased from 4505 cases to 5175 (Figure 1). AVN ablation were mainly performed in elderly patient (mean age 72), and increasingly in patient with higher Charlson Commobidity index (0.9 to 1.7)and higher CHA2DS2-VASc score (2.8 to 3.7) (Table 1). An increasing trend in procedure complications but no significant change in mortalitywere observed with AVN ablation. Progressive increase in the length of stay and the hospitalization cost were also observed over the years with AVN ablation.

Conclusion

AVN ablation is being performed at a steady volume, and increasingly in patients with multiple comorbidities. This trend although was not associated with increased mortality, it was associated with increased hospital complications.

Funding Acknowledgement

Type of funding source: None

RNA-seq reveals transcriptome changes of the embryonic lens cells in Prox1 tissue specific knockout mice

OBJECTIVE

Prox1 is expressed in both lens epithelial cells and fiber cells and is essential for lens fiber cell elongation. This study aimed to explore the molecular mechanisms of how Prox1 mutations influence lens fiber cells development.

MATERIALS AND METHODS

Comparative transcriptomes analysis of Prox1 conditional knockout (cKO) lens and wild-type (WT) lens were performed using the data GSE69940 downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were determined by the R package "edgeR" of Trinity software. GO (Gene Ontology) enrichment analysis and KEGG (Kyoto Encyclopedia of Genes and Genomes databases) enrichment analysis were performed using the cluster Profiler R package. Then, the protein-protein interaction (PPI) network was predicted using Cytoscape, and the Module analysis of the PPI network was analyzed through the Cytoscape MCODE plugin. Moreover, MotifDb package in R was used to predict the transcription factors binding to Prox1 promoter regions.

RESULTS

In total, 2263 differentially expressed genes were identified between the two groups. GO and KEGG analysis showed that the down-regulated genes were enriched in camera-type eye term, nucleosome assembly, lens fiber cell differentiation, and cell modified and amino acid metabolism. The KEGG pathway of up-regulated genes was associated with lens development, including Hedgehog signaling pathway and MAPK signaling pathway. GO terms of up-regulated DEGs were mainly relevant to bone morphological development, muscle development, and sensory organ morphological development. Next, the PPI network of DEGs was constructed, and 4 modules were analyzed. Moreover, 30 transcription factors were predicted, which are likely to be downstream targets of Prox1 with potential roles in lens development in mice.

CONCLUSIONS

This study provides insights into the unique transcriptome profile of lens cells in Prox1 conditional knockout mice, which is a valuable resource for further study of mouse lens genomics.

[Predictive factors of poor prognosis in children with acute kidney injury treated with renal replacement therapy]

Objective: To investigate the predictive factors of poor prognosis in children with acute kidney injury (AKI) treated with renal replacement therapy (RRT). Methods: In this retrospective case-control study, the clinical data were collected from 134 pediatric patients (82 male, 52 female) with AKI treated with RRT in six tertiary hospitals from May 2015 to June 2018. According to the serum creatinine level at discharge, the patients were divided into the favorable outcome group and unfavorable outcome group. The data of sex, age, primary diseases, AKI stage, time from diagnosis of AKI to start of RRT (h) and whether to start RRT within 24 hours, urine volume and complications between the two groups were compared. Continuous variables were compared by t test and Mann-Whitney U test, and percentage or proportions were compared by Chi square test. The predictive factors of adverse prognosis were analyzed by using univariate and unconditional binary logistic regression analysis. Results: The average age of the 134 AKI patients was (6±4) years. There were 114 patients (85.0%) in the favorable outcome group and 20 patients (15.0%) in the unfavorable outcome group. No statistically significant differences were found between the two groups in terms of sex (χ(2)=2.596, P=0.107), age (t=0.718, P=0.474), primary disease (χ(2)=2.076, P=0.722), AKI stage (χ(2)=0.004, P=0.998), time from diagnosis of AKI to start RRT (h) (P=0.745), whether to start RRT within 24 hours (χ(2)=0.016, P=0.899), urine volume (χ(2)=3.118, P=0.374), fluid overload (χ(2)=0.014, P=0.905), multiple organ dysfunction syndrome (MODS) (χ(2)=2.972, P=0.085), acidosis (χ(2)=3.204, P=0.073), hyperkalemia (χ(2)=2.829, P=0.093), the level of blood urea nitrogen (t=1.351, P=0.179) and serum creatinine (P=0.901) at the beginning of RRT. In the unfavorable outcome group, the proportion of patients with mechanical ventilation (45.0% (9/20) vs. 12.3% (14/114), χ(2)=12.811, P<0.01) and the incidence of extra organ injury (≥3) (30.0% (6/20) vs. 10.5% (12/114), χ(2)=6.365, P=0.041) were higher than those in the favorable outcome group. Logistic regression analysis showed that mechanical ventilation (OR=12.540, 95%CI: 3.376-46.577, P<0.01) and hyperkalemia (OR=4.611, 95%CI: 1.265-16.805, P=0.021) were the predictive factors of poor prognosis in patients with AKI treated with RRT. Conclusion: Mechanical ventilation and hyperkalemia may predict a poor prognosis in AKI patients treated with RRT.

[Clinical feature changes of a COVID-19 patient from mild to critical condition and cardiopulmonary pathological results]

Objective: To analyse the clinical history, laboratory tests and pathological data of a patient who suffered from novel coronavirus pneumonia(COVID-19) and provide reference for the clinical treatment of similar cases. Methods: Data of clinical manifestation, laboratory examination, bronchoscopy, echocardiography and cardiopulmonary pathological results were retrospectively reviewed in a case of COVID-19 with rapid exacerbation from mild to critical condition. Results: This patient hospitalized at day 9 post 2019 novel coronavirus(2019-nCoV) infection, experienced progressive deterioration from mild to severe at day 12, severe to critical at day 18 and underwent extracorporeal membrane oxygenation(ECMO) and continuous renal replacement therapy(CRRT) as well as heart lung transplantation during day 28-45 post infection, and died at the second day post heart and lung transplantation. The patient had suffered from hypertension for 8 years. At the early stage of the disease, his symptoms were mild and the inflammatory indices increased and the lymphocyte count decreased continuously. The patient's condition exacerbated rapidly with multi-organ infections, and eventually developed pulmonary hemorrhage and consolidation, pulmonary hypertension, right heart failure, malignant ventricular arrhythmias, liver dysfunction, etc. His clinical manifestations could not be improved despite viral RNAs test results became negative. The patient underwent lung and heart transplantation and finally died of multi organ failure at the second day post lung and heart transplantation. Pathological examination indicated massive mucus, dark red secretions and blood clots in bronchus. The pathological changes were mainly diffused pulmonary hemorrhagic injuries and necrosis, fibrosis, small vessel disease with cardiac edema and lymphocyte infiltration. Conclusions: The clinical course of severe COVID-19 can exacerbate rapidly from mild to critical with lung, liver and heart injuries.

[Ergonomic risk factors of carpal tunnel syndrome in workers of an automobile factory]

Objective: To investigate the occurrence of pain symptoms and risk factors of carpal tunnel syndrome (CTS) in automobile manufacturing workers and provide theoretical basis for the prevention of CTS. Methods: From Nov.5th to Nov.19th, 2017, 446 workers in an automobile factory whose work age was above one year participate in questionnaires by cluster sampling. Chi square test and multifactor logistics regression analysis were used to analyze the factors related to the occurrence of CTS pain symptoms in workers. Results: The incidence of CTS pain among workers in this automobile factory was 20.8%. Working in the same position for a long time (OR=2.137, 95% CI:1.183-3.862) and unable to work reasonably because of uncomfortable posture (OR =2.067, 95% CI: 1.075-3.974) were identified as the risk factors of CTS pain symptoms by multifactor logistics regression analysis. Working age (OR=0.537, 95%CI:0.311-0.926) and work break (OR= 0.489, 95% CI: 0.282-0.849) were identified as the benefit factors of CTS pain symptoms. Conclusion: The incidence of CTS pain in automobile manufacturing workers is related to the posture in the process of labor . Effective ergonomic interventions should be carried out to prevent the occurrence of CTS pain in automobile manufacturing workers.

[Efficacy of percutaneous transluminal renal angioplasty for pediatric renovascular hypertension: a meta-analysis]

Objective: To evaluate the efficacy and the related factors of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH) by a systematic review and meta-analysis. Methods: A systematic search was performed on international and domestic databases (Pubmed, Excerpt Medical Database (EMBASE), Cochrane library, Clinical trial.gov, Medline, China Biology Medicine (CBM), China national knowledge infrastructure (CNKI), VIP database and Wanfang) which included studies on PTRA for pediatric RVH from the establishment of the databases to March 2019. Key words of "pediatric" "children" "renal artery stenosis" "renovascular hypertension" "angioplasty" and "intervention" were used. Meta-analysis was made on the rate of technical success, clinical blood pressure improvement, complication and restenosis of PTRA as well as the predictors of its efficacy. The data consolidation, analysis of heterogeneity and sensitivity, and publication bias were performed using Comprehensive meta analyst and Open meta analyst software. Results: Seventeen observational non-controlled studies comprising 384 patients with RVH who underwent PTRA were identified. The technical success rate of PTRA was 93.9% (95% confidence interval (CI) 89.3%-97.5%). The improvement rate of blood pressure was 68.4% (95%CI 57.2%-78.7%), and the cure rate was 40.0% (95%CI 25.0%-55.8%). The subsequent subgroup analysis showed that there was no significant difference in the improvement rate of blood pressure after PTRA among the patients with RVH caused by fibromuscular dysplasia, Takayasu arteritis and neurofibromatosis type 1, respectively (P>0.05). The improvement rate of blood pressure in patients with combined lesions in renal artery branches was significantly lower than that in patients with lesions only in main renal artery (RR=1.659, 95%CI 1.023-2.689, P=0.040). It was found that 25.5% (95% CI 19.3%-32.2%) of patients required repeat procedure because of restenosis of lesions. Procedural complication of PTRA occurred in 8.3% (95%CI 3.5%-14.4%) of patients. In terms of clinical blood pressure improvement rate after PTRA, there was heterogeneity among the enrolled studies, but the results of meta-analysis were robust with low risk of publication bias (t=1.690, 95%CI -0.363-3.124, P=0.110). Conclusion: The result of the Meta-analysis suggests that PTRA may provide a safe and effective treatment for pediatric RVH, and patients with stenosis of renal arterial branches are associated with relatively poor clinical outcomes.

MFN2 contributes to metabolic disorders and inflammation in the aging of rat chondrocytes and osteoarthritis

OBJECTIVE

Metabolic disorders and inflammation of chondrocytes are major pathological changes in aging cells and osteoarthritis (OA). Recent studies demonstrated age-related mitochondrial dysfunction may be a key contributing factor in the development of OA. Mitofusin 2 (MFN2) is a key regulator of mitochondrial fusion, cell metabolism, autophagy and apoptosis. This study was performed to ascertain whether MFN2 was involved in the aging of chondrocytes and OA.

METHODS

Metabolic measurements were taken in rat chondrocytes between different ages (3-week, 5-month, 12-month). MFN2 activity was detected in both human and rat chondrocytes during aging and OA. Then, knockdown of MFN2 with small interfering RNA (siRNA) was performed to confirm whether MFN2 contributes to metabolic changes. Lentiviruses were used to establish MFN2-overexpression/knockdown OA models both in vivo and in vitro to confirm whether MFN2 contributes to OA progress. Further, regulatory mechanism of MFN2 was assessed and interaction between MFN2 and PARKIN was performed.

RESULTS

A metabolic shift to mitochondrial respiration was confirmed in rat chondrocytes during aging. MFN2 expression was elevated in both human and rat chondrocytes during aging and OA. Knockdown of MFN2 with siRNA reversed the age-related metabolic changes in rat chondrocytes. Overexpression of MFN2 exacerbated inflammation and OA progress, while knockdown of MFN2 ameliorated inflammation and OA progress. Further, MFN2 could be ubiquitinated by PARKIN, declined PARKIN expression during aging and OA might result in elevated MFN2 expression.

CONCLUSIONS

Elevated MFN2 contributes to metabolic changes and inflammation during aging of rat chondrocytes and osteoarthritis.

[Effect and underling mechanism of 6% hydroxyethyl starch 130/0.4 on serum albumen in trauma orthopedic patients during operation]

Objective: To investigate the effect of 6% hydroxyethyl starch 130/0.4(HES) on protein in severe trauma orthopedic patients after acute hemodilution. Methods: Fourty-eight severe trauma patients who met the inclusion criteria were selected from June 2018 to December 2018 in Yantaishan Hospital, and were randomly divided into two groups (n=24): group A and group B. Group A was ringer's sodium lactate control group, and group B was HES treatment group. After the tracheal intubation, the patients of group A were infused with 10% blood volume of sodium lactate ringer at 0.5 ml·kg(-1)·min(-1), and the patients in group B were infused with 10% blood volume of HES at 0.5 ml·kg(-1)·min(-1). Total protein (TP), human serum albumin (HSA), numbers of circulating endothelium cells (CEC), C-reactive protein (CRP), and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-10 and IL-6 were measured immediately after acute hemodilution (T(0)), 24 hours (T(1)) and 48 hours (T(2)) after acute hemodilution. After infusion into human body, HES bond to HSA, and fluorescence spectroscopy was used to analyze the binding relationship between HES and HSA in order to further study the effects of HES on HSA. Results: The HSA, TP, CEC, TNF-α, IL-6, IL-10, CRP at T(0) of group A were (38±5) g/L, (66±5) g/L, (5.5±0.4)/0.9 μl, (24±5) μg/L, (8.9±0.8) μg/L, (44±6) μg/L, (13.6±1.4) mg/L; While at T(1) were (33±5) g/L, (60±6) g/L, (10.2±0.7)/0.9 μl, (87±9) μg/L, (38.8±2.3) μg/L, (57±7) μg/L, (23.4±2.4) mg/L. The HSA, TP, CEC, TNF-α, IL-6, IL-10, CRP at T(0) of group B were(38±4)g/L, (66±5) g/L, (5.4±0.6)/0.9 μl, (24±6) μg/L, (9.1±0.9) μg/L, (45±6) μg/L, (13.4±1.8) mg/L; While at T(1) were (35±5)g/L, (62±5)g/L, (7.4±0.6)/0.9 μl, (70±8) μg/L, (29.5±3.1) μg/L, (72±6) μg/L, (19.7±2.2) mg/L. HSA and TP decreased at T(1) in group A as compared with T(0) (P<0.05), contrarily CEC increased significantly at T(1), TNF-ɑ, IL-6, IL-10 and CRP augmented at T(1) and T(2) in two groups (P<0.05). In comparison with the patients of group A, CEC decreased significantly at T(1) (P<0.05). TNF-ɑ, IL-6, CRP reduced significantly at T(1) and T(2) (P<0.05), but IL-10 increased at T(1) and T(2) in group B (P<0.05). The secondary structure of HSA changed after HES was added in the HES solution. The fluorescence intensity of HSA decreased with the increase of HES concentration,which suggested that HES induced HSA fluorescence quenching. HES could bind to Trp-214 residue in HSA at a molecular ration of 1∶1. Conclusions: 6% HES reduces the occurrence of low protein level in severe trauma patients after operation. HES could bind to Trp-214 amino acid residue in HSA and form the complex at a molecular ratio of 1∶1. The formation of HES-HSA complex increases the volume of HES, avoids the vascular leakage, protects the vascular endothelial cells, and induces anti-inflammatory immunity in the patients with capillary syndrome.

[Clinical effect of nebulized acetylcysteine inhalation combined with bronchoscopy in the treatment of elderly patients with severe ventilator-associated pneumonia]

Objective: To explore the clinical effect of nebulized acetylcysteine inhalation combined with bronchoscopy in treating elderly patients with severe ventilator-associated pneumonia (VAP). Methods: From January 2016 to December 2017, 80 elderly patients with severe VAP who were hospitalized in Zhejiang Hospital were divided into acetylcysteine+ bronchoscopy group [24 males and 16 females, aged (78±7) years] and bronchoscopy group [26 males and 14 females, aged (80±7) years]using random number table for a prospective cohort study. Patients in bronchoscopy group were treated with bronchoscopy in addition to conventional supportive care of symptoms. Patients in acetylcysteine+ bronchoscopy group received nebulized acetylcysteine inhalation therapy on the basis of the treatment given to patients in bronchoscopy group. Patients in both groups received treatment continuously for 7 days. The simplified clinical pulmonary infection score (CPIS) in both groups was assessed before and after treatment. Venous blood of 10 mL was collected before and after treatment to detect leukocyte count, serum C-reactive protein, and procalcitonin. Arterial blood of 1 mL was collected before and after treatment to detect partial arterial oxygen pressure (PaO(2)), partial arterial carbon dioxide pressure (PaCO(2)), oxygenation index. The inhalation platform pressure (Pplat), dynamic lung compliance (Cdyn), airway resistance, work of breathing, time of antibiotic use, and time of mechanical ventilation of patients in two groups were recorded before and after treatment. Data were statistically analyzed with chi-square test and t test. Results: (1) The simplified CPIS, leukocyte count, serum C-reactive protein, and procalcitonin of patients in acetylcysteine+ bronchoscopy group were significantly lower than those in bronchoscopy group after treatment (t=2.32, 2.15, 6.08, 7.12, P<0.05 or P<0.01). The simplified CPIS, leukocyte count, serum C-reactive protein, and procalcitonin of patients in acetylcysteine+ bronchoscopy group and bronchoscopy group after treatment were significantly lower than those before treatment (t=13.76, 13.60, 12.70, 8.32, 11.44, 14.28, 9.48, 9.50, P<0.01). (2) Compared with bronchoscopy group, patients in acetylcysteine+ bronchoscopy group had significantly higher PaO(2) and oxygenation index (t=4.14, 2.55, P<0.05 or P<0.01) but significantly lower PaCO(2) (t=4.36, P<0.01) after treatment. The PaO(2) and oxygenation index of patients in acetylcysteine+ bronchoscopy group after treatment were significantly higher than those before treatment (t=10.90, 43.72, P<0.01). The PaO(2) and oxygenation index of patients in bronchoscopy group after treatment were also significantly higher than those before treatment (t=6.55, 43.03, P<0.01). The PaCO(2) of patients in both groups after treatment were significantly lower than those before treatment (t=21.54, 21.92, P<0.01). (3) The Cdyn of patients in acetylcysteine+ bronchoscopy group after treatment was significantly higher than that in bronchoscopy group (t=5.41, P<0.01), and Pplat, airway resistance, and work of breathing were significantly lower than those in bronchoscopy group (t=2.18, 5.46, 2.49, P<0.05 or P<0.01). The Cdyn of patients in both groups after treatment were significantly higher than those before treatment (t=16.10, 10.90, P<0.01), and Pplat, airway resistance, and work of breathing were significantly lower than those before treatment (t=21.18, 11.13, 9.32, 15.50, 5.17, 5.97, P<0.01). (4)The time of mechanical ventilation and antibiotic usage of patients in acetylcysteine+ bronchoscopy group were (6.9±1.9)and (8.7±2.8) d, respectively, which were significantly shorter than (10.1±2.2) and (11.6±3.5) d in bronchoscopy group (t=6.85, 4.09, P<0.01). Conclusions: Nebulized acetylcysteine inhalation combined with bronchoscopy can significantly control the degree of lung infection in elderly patients with severe VAP, improve patients' respiratory mechanics parameter and blood gas analysis indicator, and shorten the time for mechanical ventilation and antibiotic usage.

[Analysis on the efficacy and safety of fibrinolytic therapy in patients with acute ST-segment elevation myocardial infarction during the COVID-19 epidemic]

Objective: To evaluate the efficacy and safety of fibrinolysis strategy in patients with acute ST-segment elevation myocardial infarction (STEMI) during the COVID-19 epidemic, and to provide reference value for optimization of fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff. Methods: The efficacy and safety of fibrinolysis were retrospectively analyzed in 7 patients with acute STEM, who hospitalized from February 29, 2020 to April 3, 2020 in the Department of Cardiology, Wuhan Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. To optimize the fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, a full-time medical team in charge of fibrinolysis under third-grade protection was established. The acute STEMI patients were treated immediately in a fixed and isolated area in emergency department before receiving green channel fibrinolysis. Blood samples for complete blood count, COVID-19 antibody test and nasopharyngeal swab samples for COVID-19 nucleic acid test were made before fibrinolysis, while the chest CT examination was accomplished after fibrinolysis. By comparing differences of time from the first electrocardiogram (ECG) to fibrinolysis before and after the improvement of fibrinolytic process, the effect of optimization of the fibrinolytic process was evaluated. Results: In the present study, seven patients with acute STEMI received fibrinolysis therapy, 6 of them achieved reperfusion and no bleeding was observed in all of the patients. Five out of the 7 patients were hospitalized after fibrinolysis, and the hospitalization days were 19.6 days on average. By following up to April 14, 2020, none of the 7 patients died. The first 2 patients were treated according to the routine medical procedure and the time from the first ECG to fibrinolysis were 201 and 106 minutes, respectively. After the optimization of the fibrinolytic process, the time from the first ECG to fibrinolysis of the last 5 patients were 42, 46, 51, 43 and 54 minutes, respectively，which was significantly shorter than that before optimization. Conclusions: During the COVID-19 epidemic, fibrinolysis in patients with acute STEMI is safe, effective and easy to implement. Therefore, it is recommended as the top priority for the patients with acute STEMI with indications for fibrinolysis. On the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, the duration of myocardial ischemia can be shortened by optimization of the fibrinolytic process.

AB1136 THE DIAGNOSTIC VALUE OF SERUM KL-6 IN CONNECTIVE TISSUE DISEASE ASSOCIATED INTERSTITIAL LUNG DISEASE IN THE UYGUR POPULATION OF CHINA

Background:

Connective tissue diseases are a group of inflammatory, immune mediated disorders.Interstitial lung disease (ILD) is associated with significant morbidity and mortality.Currently,, scientists are still looking for serum markers to diagnose interstitial lung disease.Althought serum KL-6 level has been studied in ILD of various aetiologies and revealed to be an important serum marker for ILD,but differences in KL-6 expression related to ethnic and/or genetic variants may exist.

Objectives:

To evaluate the diagnosis of the serum Krebs von den Lungen-6 (KL-6) for CTD-ILD in the Uygur population of China.

Methods:

117 Patients with CTD-ILD (CTD-ILD group) and 182 patients with CTD (CTD group) who visited the department of rheumatology and immunology of People’s Hospital of Xinjiang Uygur Autonomous Region between January, 2015 and December, 2019 were included. Serum KL-6 levels were measured by chemiluminescent enzyme immunoassay kit.

Results:

The significantly higher levels of KL-6 were determined in the RA-ILD group than RA group [569(287.5,984)U/ml vs 194(152,266.5)U/ml](P<0.001)(figure 1).The optimal cutoff value of serum KL-6 for diagnosis of RA-ILD was 345.5 U/ml, and the sensitivity and specificity were71.8% and 90.1 %, respectively. Area Under the Curve (AUC) was 0.875.(figure 2)

Figure 1.

Comparison of serum KL-6 concentrations in CTD-ILD group and CTD group.

Fig 2.

Receiver-operating characteristic curve(ROC) of KL-6 for the diagnosis of CTD-ILD

Conclusion:

The serum KL-6 is a important biomarker for the diagnosis of CTD-ILD and Serum KL-6 could be a clinically useful biomarker in screening CTD-ILD in the Uygur population of China.

References:

[1]Woodhead F, Wells A U, Desai S R. Pulmonary Complications of Connective Tissue Diseases[J]. Clinics in Chest Medicine, 2008, 29(29):149–164.

Tanaka S, Hattori N, Ishikawa N, et al. Krebs von den Lungen-6 (KL-6) is a progn -ostic biomarker in patients with surgically resected nonsmall cell lung cancer. Int J Cancer 2012; 130:377–87.

[2]Ogz E O, Kucuksahin O, Turgay M, et al. Association of serum KL-6 levels with interstitial lung disease in patients with connective tissue disease: a cross-sectional study. Clinical Rheumatology, 2016, 35(3):663-666.

Disclosure of Interests:

None declared

SAT0250 CLINICAL CHARACTERISTICS AND THE DISEASE ACTIVITY OF BEHCET’S DISEASE IN CHINA: A STUDY BASED ON SMART SYSTEM OF DISEASE MANAGEMENT (SSDM)

Background:

Behcet´s disease (BD) is a systemic autoimmune disease that affects multiple organ systems with recurrent oral ulcers, genital ulcers and skin lesions. Behcet´s Disease Current Activity Form (BDCAF) and Electronic Medical Record-based Activity Index (EMRAI) are commonly used internationally to evaluate the disease activity of BD.

Objectives:

This study aimed to analyze the clinical characteristics, the level of disease activity, and the incidence of anxiety and depression for Chinese BD patients. Patients can perform self-management of disease with SSDM.

Methods:

SSDM is a series of doctor-patient interactive applications for self-management of patients with chronic diseases. Patients can perform self-assessment with SSDM and upload the data to their authorized doctors. The SSDM patients’ application system integrates the BDCAF and EMRAI into one scoring system. Patients could obtain scores of BDCAF and EMRAI by responding to one questionnaire through SSDM.

Results:

From Apr 2017 to Jan 2020, 719 BD patients from 166 hospitals used SSDM, with a mean age of 38.97±12.71 (14~81) years old, and median disease duration of 20.8 months. 719 patients performed BDCAF and EMRAI self-assessment 1321 times, 252 patients repeat assessments for 855 times. The mean score of BDCAF and EMRAI are 3.57±2.17 and 3.44±1.90, respectively. The matching degree of the two score was 0.8747.

The most common clinical characteristics were oral ulcers (83.73%), ocular symptoms (62.03%), joint pain (50.07%). The comparative study between males and females revealed significant difference in the aspects of epididymitis (10.94% vs 0, p<0.001), genital ulcer (35.09% vs 44.93%, p=0.01), headache (24.15% vs 33.92%, p=0.01) and superficial thrombophlebitis (24.15% vs 33.92%, p=0.01). Table 1.

Table 1.

Clinical Characteristics of different systems in Chinese BD patients.

Presence of clinical characteristicsTotalMalesFemalesP valueOral ulcer83.73% (602)86.42% (229)82.16% (373)0.14Genital ulcer41.31% (297)35.09% (93)44.93% (204)0.01*Epididymitis4.03% (29)10.94% (29)0 (0)<0.001**Erythema29.49% (212)29.43% (78)29.52% (134)0.98Skin lesions26.84% (193)28.68% (76)25.77% (117)0.4Superficial thrombophlebitis30.32% (218)24.15% (64)33.92% (154)0.01*Headache30.32% (218)24.15% (64)33.92% (154)0.01*Joint pain50.07% (360)51.32% (136)49.34% (224)0.61Arthritis14.60% (105)14.72% (39)14.54% (66)0.95Gastrointestinal involvement24.90% (179)27.92% (74)23.13% (105)0.15Ocular symptoms62.03% (446)62.64% (166)61.67% (180)0.79Nervous involvement23.78% (171)25.66% (68)22.69% (103)0.37Vascular involvement15.72% (113)18.11% (48)14.32% (65)0.18

*P values are for the comparison between the males and females.

Conclusion:

Chinese BD patients can effectively perform BDCAF and EMRAI self-assessment with SSDM. The results of the assessment conducted by the two scoring systems are similar. The clinical characteristics of Chinese BD were different depending on gender.

Acknowledgments: :

Smart system of disease management (SSDM) was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

FRI0593 CORRELATION BETWEEN DISEASE ACTIVITY AND MENTAL HEALTH OF AS PATIENTS: A CROSS-SECTION STUDY WITH SELF-ASSESSMENTS BASED ON SMART SYSTEM OF DISEASE MANAGEMENT (SSDM) MOBILE TOOLS

Background:

WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. Ankylosing Spondylitis Disease Activity Score (ASDAS) and Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate AS patients’ disease activity and mental health. All those assessments were mainly performed by health professionals (HCPs) with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-assessments on ASDAS and HADS by mobile terminals.

Objectives:

To estimate the prevalence of anxiety and depression in Chinese patients with AS and to analyze the potential association between disease activity and mental health.

Methods:

Under the guidance and training by HCPs, AS patients downloaded SSDM and performed self-assessments bundle of ASDAS and HADS with SSDM. ASDAS<=1.3, 1.3-2.1, 2.1-3.5 and >3.5 are defined as inactive (IDA), moderate (MDA), high (HDA) and very high (VHDA) disease activity, respectively. ASDAS score <=1.3 represents inactive disease status and achievement of T2T. HADS score >=8 can be diagnosed with anxiety or depression.

Results:

From June 2016 to Jan 2020, 1,931 AS patients (1,118 male, 813 female) with a mean age of 34.09 ± 11.86 (12-82) years and the median disease duration of 2.61 years from 207 hospitals performed bundle self-assessments for 2,477 times in total. According to the HADS and ASDAS assessment results, the prevalence of anxiety and depression in all patients was 36.7% and 39.3% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on T2T was 29% and 71%, respectively. The prevalence of anxiety (A) and depression (D) was 25% and 23% among T2T achievers; and 37% and 32% among T2T failures, respectively (pA<0.05, pD<0.05).

According to ASDAS, in IDA, MDA, HDA and VHDA subgroups, the prevalence of anxiety and depression was 27%, 36%, 41%, 52% and 29%, 38%, 45%, 56%, respectively. The correlation coefficients of anxiety (A) and depression (D) with ASDAS were rA=0.9908 and rD=0.9964. It suggested that with the increase of disease activity, the proportion of AS patients with anxiety and depression increased significantly. (Figure 1)

Figure 1.

The prevalence of anxiety and depression according to ASDAS.

Conclusion:

The prevalence of anxiety and depression in AS patients was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. Higher prevalence of anxiety and depression were associated with higher levels of disease activity. SSDM is an effective mobile interface to monitor and study entanglement of disease activity and mental health in AS patients, which build a foundation for proactive interventions in future.

Acknowledgments:

Smart system of disease management (SSDM) was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

AB0504 THE DIFFERENCES OF IMMUNE CHARACTERISTICS AND ITS RELATIONSHIP WITH DISEASE ACTIVITY IN LARGE VESSEL VASCULITIS PATIENTS

Background:

Large vessel vasculitis(LVV) is a rare refractory disease, giant cell arteritis (GCA) and Takayasu arteritis (TAK) constitute different types of primary LVV.Despite considerable discussion on the potential differences between GCA and TAK, the immunological difference and its relationship to disease activity remains unclear.

Objectives:

To investigate the differences of peripheral blood immuno-phenotype between TAK and GCA, and to analyze the correlation between immune metabolism level and disease activity in TAK.

Methods:

All patients with TAK and GCA who come to our department from January 2010 to January 2020 were included, all of them met the classification criteria of American college of rheumatology.General information, clinical manifestations, laboratory index, artery involvement and therapeutic schedule were collected.According to the National Institutes of Health criteria, there were 29 active and 23 inactive TAK patients.

Results:

[1]Baseline characteristics, treatment,involvement artery in LVV patients are summarized in Table 1.

Table 1.

Clinical characteristics of patients with LVV

VariableTAK,n=52GCA,n=4Age,X±S29±1364±7Female,n(%)45(86.6)1(25)Constitutional symptoms,n(%)23 (43.4)3(75)Cephalic symptoms,n(%)33 (62.3)2 (50)Peripheral limb ischemia,n(%)22 (41.5)-Ocular signs,n(%)3 (5.7)2 (50)Stroke,n(%)2 (3.8)-GC,n(%)40(76.9)3(75)GC dose >7.5mg/day,n(%)36 (90)2 (66.7)Surgical intervention,n(%)7(13.2)-Coronary artery,n(%)3(5.7)-Common carotid artery,n(%)31(58.5)-Subclavian artery,n(%)23(43.4)-thoracic aorta,n(%)6(11.3)-abdominal aorta,n(%)13(24.5)-

GC Glucocorticoids,bDMARDS biologic DMARDs

(2)Compared with GCA patients,TAK patients were younger (29±13vs64±7,P=0.015), with higher peripheral blood lymphocyte count of CD8+T cells and lower CD4/CD8(Table 2).

Table 2.

Comparison of peripheral immune cells,humoral immunity among TAK and GCA,active and inactive TAK

VariableTAK,n=52GCA,n=4p valueinactive TAK,n=23active TAK,n=29p valueNeutrophils5.5±2.35.8±1.10.8274.4±1.66.3±2.50.009*Lymphocytes2.4±0.81.0±0.60.010*2.3±0.72.4±0.90.901Monocytes0.5±0.20.7±0.10.2180.5±0.20.6±0.20.431CD3+T1959±4901154±5410.1892195±921842±5850.467CD4+T1074±305758±3030.3811250±198987±3330.376CD8+T859±212297±870.048*945±41815±2580.542CD4+CD8+42±2712±70.34463±232±280.229CD4-CD8-90±7591±630.99997±7487±680.914CD19+B273±97191±940.470202±106309±840.242CD16+CD56+135±72104±670.709112±63146±830.639CD4/CD81.25±0.152.55±0.510.001*1.33±0.261.21±0.100.440IgG11.7±3.78.3±0.50.12410.3±3.412.9±3.60.025*IgA2.6±1.32.3±0.80.7242.1±1.33.0±1.10.021*IgM1.7±0.90.8±0.20.1181.5±0.81.8±0.90.202Κ light chain9.5±3.96.6±0.30.2228.1±3.310.8±4.00.033*λ light chain5.2±1.93.9±0.30.2604.7±1.95.8±1.90.086

*P<0.05

(3)The levels of neutrophils, monocytes,IgG, IgA and Κ light chain active TAK were higer than inactive TAK, with lower lymphocyte level (Table 2). Further correlation analysis showed that the levels of neutrophils, IgG,IgA and Κ light chain were positively correlated with disease activity (r=0.434,P=0.005;r=0.380,P=0.019;r=0.452,P=0.004;r=0.380,P=0.022).

Conclusion:

Compared with GCA patients,TAK patients had higer level of CD8+T lymphocytes, consistenting with previous studies.In addition,TAK patients had persistent immune cell involvement,while humoral immunity is related to disease activity.Deeper studies may be required about the role of immune profile in in large vessel vasculitis.

References:

[1]Miyabe C, Miyabe Y, et al. An expanded population of pathogenic regulatory T-cells in giant cell arteritis is abrogated by IL-6 blockade therapy. Ann Rheum Dis. 2017;76:898–905.

[2]Kermani TA, Crowson CS, Muratore F, Schmidt J, Matteson EL, Warrington KJ. Extra-cranial giant cell arteritis and Takayasu arteritis: how similar are they? Semin Arthritis Rheum. 2015;44:724–8.

Disclosure of Interests:

None declared

FRI0435 THE CLINICAL SIGNIFICANCE OF SERUM AUTOANTIBODIES AND HLA-B27 MOLECULE TESTING IN UYGUR PATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION

Background:

AIDS is a deadly infectious disease caused by the HIV. When HIV infects a host, it may induce production of autoantibodies due to the structural antigen similarity between viral proteins and selfantigens.The molecular mimicry between HIV protein and self-antigens could cause antibody cross-reactions and lead to development of autoimmune disease.

Objectives:

To explore the clinical value of serum autoantibodies and human leukocyte antigen (HLA-B27) molecular testing in Uygur patients with human immunodeficiency virus (HIV) infection.

Methods:

A total of 727 HIV-infected Uygur patients who visited Kuche Infectious Diseases Hospital during May 2016 to March 2017 were include in this study. The other 390 healthy people were enrolled as controls. Serum antinuclear antibodies (ANA) and ANA Profile, anti-cyclic citrullinated peptide (CCP) antibody, and HLA-B27 molecule were tested.

Results:

Among 727 HIV-infected Uygur patients, 317 were males and 410 were females with mean age (35.52±13.44) years old. The mean duration of disease was (6.34±3.05)years. There were 697(95.87%) patients receiving Highly active antiretroviral therapy (HAART) with mean duration of treatment (6.34±3.05)years. Rheumatic manifestations were recorded in 238 (32.74%) HIV-infected Uygur patients, mainly with dry mouth and dry eye (15.41%), alopecia (9.90%), arthralgia (8.94%), ect. Compared with the health controls, positive ANA was more common in HIV infected Uygur patients (33.42%vs.17.43%,P< 0.001) with low titers (ANA titer:1:100). HIV-infected Uygur patients had higher positive anti-u1-RNP antibodies positive rate (1.10%), but lower anti-SSA antibodies positive rate (0.14%) and anti-CCP antibodies positive rate (0.28%). Patients with positive ANA in HAART group were significantly less than that in non-treatment group (38.72%vs.50.00%,P=0.049).Only one female patient was HLA-B27 positive (0.14%), which was significantly lower than that in healthy controls (3.08%) (P<0.001). Also, only one patient was diagnosed with rheumatoid arthritis (RA).

Conclusion:

Rheumatic manifestations are common in HIV-infected Uygur patients. Several autoantibodies are positive, but the coincidence of rheumatic diseases is rare. It’s noted that patients with Rheumatic manifestations and low titre positive ANA should be considered as a differential diagnosis of HIV infection.

Disclosure of Interests:

None declared

AB0446 CLINICAL AND IMMUNOLOGICAL CHARACTERISTICS OF 484 SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN XINJIANG OF CHINA: A COMPARATIVE ANALYSIS

Background:

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease. Epidemiological studies in SLE have been reported in the literature in many countries and ethnic groups. Although SLE in China has been described in the past, there has not been a detailed evaluation of SLE patients in Xinjiang of China, a largely Uygur population.

Objectives:

To describe the clinical featuresand immunological features of 484 SLE subjects.

Methods:

484 adult patients followed in the The People’s Hospital of the Xinjiang Uygur Autonomous Region, 211 patients with Uygur SLE as welI as 273patients with Han SLE.

Results:

Of the 211 Uygur SLE patients, 195 (92.4%) were female and 16 (7.6%) were male (female:male=12.2:1),the mean age at SLE onset was 34.67±11.57 years, mean disease duration was 20.77±35.16 months.Of the 273 Han SLE patients,247(90.5%)were female and 26(9.5%) were male,the mean age at SLE onset was 36.68±14.44 years,mean disease duration was 41.64±61.89 months.(2)between the Uygur and Han SLE patients,the Raynaud phenomenon(χ2=6.066 P=0.014), Chest pain(χ2=7.906 P=0.005), headache(χ2=4.572 P=0.029)has obvious differences(table 1).(3)The anti-nuclear (χ2=8.108 P=0.004), anti-AHA (χ2=4.952 P=0.026)were higer in Uygur SLE patients than those in Han SLE patients;the Uygur SLE patients has been anemia(χ2=6.904,P=0.009), high level of immunoglobulin (χ2=8.939,P=0.003),decrease of complement(χ2=6.330 P=0.012).(table 2)

figure 1. Clinical manifestations

Clinical manifestationsUygur SLE patients(n=211)Han SLE (n=273)χ2Prash106(50.2%)157(57.5%)2.5370.111Photosensitivity40(19%)56(20.5%)0.1810.670Alopecia73(34.6%)101(37.0%)0.2980.585Oral ulcers49(23.2%)64(23.5%)0.0060.937Raynaud phenomenon28(13.3%)60(22%)6.0660.014livedo reticularis5(2.4%)7(2.6%)0.0200.866arthralgia/arthritis105(49.8%)159(58.5%)3.6230.057abnormal liver-function8(3.8%)7(2.6%)0.5970.440Chest pain28(13.3%)16(5.9%)7.9060.005Suffocation49(23.2%)52(19%)1.2560.262palpitation27(12.8%)41(15%)0.4870.485Shortness of breath24(11.4%)35(12.8%)0.2330.630Ophthalmia2(0.9%)6(2.2%)1.1540.283Visual impairment1(0.5%)3(1.1%)0.5670.457hemiplegia1(0.5%)0(0.0%)1.2970.436Mental disorder4(1.9%)11(4.0%)1.8040.179headache14(6.6%)7(2.6%)4.5720.029Lower Limb Edem36(17.1%)34(12.5%)2.0420.153pleurisy37(17.5%)43(15.8%)0.2560.613pericarditis38(18%)33(12.1%)3.2730.070pulmonary fibrosis7(3.3%)9(3.3%)0.0000.982

figure 2. immunological manifestations

manifestationsUygur SLE patients(n=211)Han SLE (n=273)χ2Pantinuclear antibodies185(87.7%)212(77.7%)8.1080.004anti-dsDNA115(54.5%)144(52.7%)0.1470.701anti-SSA101(47.9%)149(54.6%)2.1470.143anti-SSB45(21.3%)63(23.1%)0.2100.647anti-Sm44(21%)68(25%)1.0880.297ACL29(13.8%)26(9.5%)2.1610.142antiU1-RNP74(35.1%)100(36.6%)0.1260.723anti-AHA60(28.4%)54(19.8%)4.9520.026Low white blood cell46(22.1%)79(29%)2.9380.087anemia90(42.9%)85(36.3%)6.9040.009Thrombocytopenia36(17.1%)51(18.7%)0.2120.645Urine protein positive84(39.8%)114(41.9%)0.2170.641Rise of urine RBC29(13.7%)35(12.8%)0.0880.766Increased immunoglobulin82(38.9%)71(26.1%)8.9390.003Complement decline120(57.1%)124(45.6%)6.3300.012

Conclusion:

The Uygur SLE patients have their own clinical and immunological characteristics, which has guiding significance in the diagnosis, treatment and prognosis of SLE.

References:

[1]Martyna TS,Hanna SS, Marek F. Clinical and immunological characteristics of Polish patients with systemic lupus erythematosus. Adv Clin Exp Med. 2018;27(1):57–61

[2]Maloney K C, Ferguson T S, Stewart H D, et al. Clinical and immunological characteristics of 150 systemic lupus erythematosus patients in Jamaica: A comparative analysis[J]. Lupus, 2017, 26(13):961203317707828.

[3]Ching K H, Burbelo P D, Christopher T, et al. Two Major Autoantibody Clusters in Systemic Lupus Erythematosus[J]. PLoS ONE, 2012, 7(2):e32001.

Disclosure of Interests:

None declared

FRI0571 THE DIAGNOSTIC VALUE OF KL-6 IN RHEUMATOID ARTHRITIS ASSOCIATED WITH INTERSTITIAL LUNG DISEASE IN XINJIANG OF CHINA

Background:

Rheumatoid arthritis (RA) is a systemic inflammatory disease.Many researchers have observed that extra articular organs were highly involved in RA patients.The most common extra-articular manifestations were pulmonary involvement.Serum levels of KL-6 have been reported to be elevated in various ILD such as idiopathic pulmonary fibrosis, collagen vascular disease associated interstitial pneumonias, and other interstitial lung disorders.However, little is known regarding the usefulness of this biomarker in connective tissue diseases related interstitial lung diseases(CTD-ILD). Especially,the diagnostic value of KL-6 in interstitial lung disease associated with rheumatoid arthritis(RA-ILD) still has a dispute.

Objectives:

To assess the diagnosis of the serum Krebs von den Lungen-6(KL-6) for RA-ILD patients in Xinjiang of China.

Methods:

This retrospective study included 184 patients with RA in who visited the department of rheumatology and immunology of People’s Hospital of Xinjiang Uygur Autonomous Region between January, 2015 and December, 2019.The patients were divided into RA-ILD group(n=95) and RA group(n=89) according to the presence of ILD. Serum KL-6 concentration (U/mL) was measured using the chemiluminescent enzyme immunoassay kit.

Results:

The mean age(p < 0.001) and median value of CCP (p = 0.006) were significantly higher in the RA-ILD group.RA-ILD group had elevated serum KL-6 levels compared to RA group [447(281, 687)U/ml vs 195(151.5,265.5)U/ml](p < 0.001)(figure 1).According to the Receiver Operating Characteristic Curve (ROC) analysis, the area under the curve was of 0.879 and the optimal cut-off value of serum KL-6 to discriminate the presence of ILD was 277 U/ml, with sensitivity of 77.9%, specificity of 79.8%(figure 2).

Figure 1.

Comparison of serum KL-6 concentrations in RA-ILD group and RA group.

Figure 2.

Receiver-operating characteristic curve(ROC) of KL-6 for the diagnosis of RA-ILD

Conclusion:

The present study confirms that KL-6 is a biological marker which is associated with RA-ILD. Furthermore, Patients with RA who are older and have a higher value of CCP are more likely to develop ILD.

References:

[1] Anaya JM, Diethelm L, Ortiz LA et al (1995) Pulmonary involvement in rheumatoid arthritis. Semin Arthritis Rheum 24:242–254

[2] Bonella F, Costabel U (2014) Biomarkers in connective tissue disease-associated interstitial lung disease. Semin Respir Crit Care Med 35:181–200

[3] Doishita S, Inokuma S, Asashima H et al (2011) Serum KL-6 level as an indicator of active or inactive interstitial pneumonitis associated with connective tissue diseases. Intern Med 50: 2889–2892

Disclosure of Interests:

None declared

Noninvasive prenatal diagnosis for pregnancies at risk for β-thalassaemia: a retrospective study

OBJECTIVE

To evaluate the clinical feasibility of noninvasive prenatal diagnosis (NIPD) for β-thalassaemia using circulating single molecule amplification and re-sequencing technology (cSMART).

DESIGN

Through carrier screening, 102 pregnant Chinese couples carrying pathogenic HBB gene variants were recruited to the study. Pregnancies were managed using traditional invasive prenatal diagnosis (IPD). Retrospectively, we evaluated the archived pregnancy plasma DNA by NIPD to evaluate the performance of our cSMART assay for fetal genotyping.

SETTING

Chinese prenatal diagnostic centres specialising in thalassaemia testing.

POPULATION

Chinese carrier couples at high genetic risk for β-thalassaemia.

METHODS

Fetal cell sampling was performed by amniocentesis and HBB genotypes were determined by reverse dot blot. NIPD was performed by a newly designed HBB cSMART assay and fetal genotypes were called by measuring the allelic ratios in the maternal cell-free DNA.

MAIN OUTCOME MEASURES

Concordance of HBB fetal genotyping between IPD and NIPD and the sensitivity and specificity of NIPD.

RESULTS

Invasive prenatal diagnosis identified 29 affected homozygotes or compound heterozygotes, 54 heterozygotes and 19 normal homozygotes. Compared with IPD results, 99 of 102 fetuses (97%) were correctly genotyped by our NIPD assay. Two of three discordant samples were false positives and the other sample involved an incorrect call of a heterozygote carrier as a homozygote normal. Overall, the sensitivity and specificity of our NIPD assay was 100% (95% CI 88.06-100.00%) and 97.26% (95% CI 90.45-99.67%), respectively.

CONCLUSIONS

This study demonstrates that our cSMART-based NIPD assay for β-thalassaemia has potential clinical utility as an alternative to IPD for pregnant HBB carrier couples.

TWEETABLE ABSTRACT

A new noninvasive test for pregnancies at risk for β-thalassaemia.

An update on the status of COVID-19: a comprehensive review

The last two decades have witnessed two large-scale pandemics caused by coronaviruses, including severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). At the end of 2019, another novel coronavirus, designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hit Wuhan, a city in the center of China, and subsequently spread rapidly to the whole world. Latest reports revealed that more than 800 thousand people in over 200 countries are involved in the epidemic disease by SARS-CoV-2. Due to the high mortality rate and the lack of optimum therapeutics, it is crucial to understand the biological characteristics of the virus and its possible pathogenesis to respond to the SARS-CoV-2. Rapid diagnostics and effective therapeutics are also important interventions for the management of infection control. However, the rapid evolution of SARS-CoV-2 exerted tremendous challenges on its diagnostics and therapeutics. Therefore, there is an urgent need to summarize the existing research results to guide decision-making on the prioritization of resources for research and development. In this review, we focus on our current understanding of epidemiology, pathogenesis, diagnostics and therapeutics of coronavirus disease 2019 (COVID-19).

[Paraganglioma of urinary bladder: a clinicopathological features analysis of 23 cases]

Objective: To investigate the clinicopathological features, diagnosis, differential diagnosis and immunohistochemical (IHC) characteristics of paraganglioma of urinary bladder (PUB). Methods: The clinical and pathological data of 23 cases of PUB were collected at the Second Affiliated Hospital of Fujian Medical University (7 cases); Fujian Provincial Hospital (8 cases); Fujian Medical University Union Hospital (6 cases); and First Affiliated Hospital of Fujian Medical University (2 cases) from May 2010 to November 2018. IHC staining for CK, GATA3, CD56, Syn, CgA, S-100 protein, HMB45, SDHB, OCT3/4 and Ki-67 was done using EliVision method; and the relevant literature was reviewed. Results: There were 14 women and 9 men, aged ranged from 21 to 73 years (median 51 years). Clinically, patients presented with headache, vertigo, palpitation, hypertensive crisis during micturition, hypertension, blurred vision, gross hematuria and paroxysmal pallor. The tumor sizes ranged from 0.9 to 6 cm (mean2.5 cm). Macroscopically, most tumors were exophytic and well delineated within the lamina propria or muscularis propria. The tumors were firm and nodular and showed grayish-tan cut surface. Histologically,the tumor growth pattern was expansive or showed interpenetrating infiltrative growth within the lamina propria or muscularis propria; the tumor cells were typically arranged in distinctive nests (Zellballen) with organoid arrangement; pseudo-rosette were seen in some cases. The cells were rounded or polygonal and had rich, acidophilic or amphophilic cytoplasm and may contain pigmented granules and vacuoles; the nuclei were central or eccentric, with small nucleoli, although occasionally some nuclei were pleomorphic and hyperchromatic. Spindled sustentacular cells could be seen around the nests of tumor cells in some cases. There were abundant vessels that were fissure-like, hemangioma-like or dilated. By IHC, the tumor cells were positive for GATA3 (2/23), OCT3/4 (2/23), CD56 (22/23), Syn (23/23), CgA (22/23), S-100 (sustentacular cell, 23/23) and SDHB (23/23); and negative for CK and HMB45; Ki-67 index was 1%-5%. At follow-up, there was no recurrence or metastasis in 18 cases. Conclusions: The diagnosis of PUB relies on the morphologic and IHC features; but there may be histomorphologic heterogeneity. The most important differential diagnosis is invasive urothelial carcinoma. The tumor cells may show aberrant cytoplasmic expression of OCT3/4; there is no clear correlation between SDHB and OCT3/4 expression in the group.

Intraoperative Observation during Total Extraperitoneal Repair (TEP)

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4-10 cm). D2: 4.9 ± 0.8 cm (3.5-7 cm). D3: 6.8 ± 0.9 cm (5-9 cm). D4: 6.1 ± 1 cm (4.8-8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.

Intraoperative Observation during Total Extraperitoneal Repair (TEP)

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4–10 cm). D2: 4.9 ± 0.8 cm (3.5–7 cm). D3: 6.8 ± 0.9 cm (5–9 cm). D4: 6.1 ± 1 cm (4.8–8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.

Genomic origin and EGFR-TKI treatments of pulmonary adenosquamous carcinoma

BACKGROUND

Adenosquamous carcinoma (ASC) of the lung is a heterogeneous disease that is composed of both adenocarcinoma components (ACC) and squamous cell carcinoma components (SCCC). Their genomic profile, genetic origin, and clinical management remain controversial.

PATIENTS AND METHODS

Resected ASC and metastatic tumor in regional lymph nodes (LNs) were collected. The ACC and SCCC were separated by microdissection of primary tumor. The 1021 cancer-related genes were evaluated by next-generation sequencing independently in ACC and SCCC and LNs. Shared and private alterations in the two components were investigated. In addition, genomic profiles of independent cohorts of adenocarcinomas and squamous cell carcinomas were examined for comparison. We have also carried out a retrospective study of ASCs with known EGFR mutation status from 11 hospitals in China for their clinical outcomes.

RESULTS

The most frequent alterations in 28 surgically resected ASCs include EGFR (79%), TP53 (68%), MAP3K1 (14%) mutations, EGFR amplifications (32%), and MDM2 amplifications (18%). Twenty-seven patients (96%) had shared variations between ACC and SCCC, and pure SCCC metastases were not found in metastatic LNs among these patients. Only one patient with geographically separated ACC and SCCC had no shared mutations. Inter-component heterogeneity was a common genetic event of ACC and SCCC. The genomic profile of ASC was similar to that of 170 adenocarcinomas, but different from that of 62 squamous cell carcinomas. The incidence of EGFR mutations in the retrospective analysis of 517 ASCs was 51.8%. Among the 129 EGFR-positive patients who received EGFR-TKIs, the objective response rate was 56.6% and the median progression-free survival was 10.1 months (95% confidence interval: 9.0-11.2).

CONCLUSIONS

The ACC and SCCC share a monoclonal origin, a majority with genetically inter-component heterogeneity. ASC may represent a subtype of adenocarcinoma with EGFR mutation being the most common genomic anomaly and sharing similar efficacy to EGFR TKI.

The optimal peripheral oxygen saturation may be 95-97% for post-cardiac arrest patients: A retrospective observational study

BACKGROUND

Current post-resuscitation guidelines recommend oxygen titration in adults with the return of spontaneous circulation after cardiac arrest. However, the optimal peripheral oxygen saturation (SpO₂) is still unclear for post-cardiac arrest care.

METHODS

We conducted a retrospective observational study of prospectively collected data of all cardiac arrest patients admitted to the intensive care units between 2014 and 2015. The main exposure was SpO₂, which were interfaced from bedside vital signs monitors as 1-min averages, and archived as 5-min median values. The proportion of time spent in different SpO₂ categories was included in separate multivariable regression models along with covariates. The primary outcome measure was hospital mortality and the proportion of discharged home as the secondary outcome was reported.

RESULTS

2836 post-cardiac arrest patients in ICUs of 156 hospitals were included. 1235 (44%) patients died during hospitalization and 818 (29%) patients discharged home. With multivariate regression analysis, the proportion of time spent in SpO₂ of ≤89%, 90%, 91%, and 92% were associated with higher hospital mortality. The proportion of time spent in SpO₂ of 95%, 96%, and 97% were associated with a higher proportion of discharged home outcome, but not associated with hospital mortality.

CONCLUSIONS

In this retrospective observational study, the optimal SpO₂ for patients admitted to the intensive care unit after cardiac arrest may be 95-97%. Further investigation is warranted to determine if targeting SpO₂ of 95-97% would improve patient-centered outcomes after cardiac arrest.

Sensitivity and specificity of the red reflex in Costa Rican newborns

OBJECTIVE

To compare the results of indirect ophthalmoscopy versus determination of the red reflex in newborns admitted to the intermediate neonatal intensive care unit.

METHODS

All the patients (71) admitted to the intermediate neonatal intensive care unit from July to September of 2017 were screened with the red reflex. Immediately afterwards, they were pharmacologically dilated and indirect ophthalmoscopy was performed. All of the red-reflex screening and the funduscopic examination were performed by the same evaluator.

RESULTS

A total of 14.1% (20/142) of the eyes had an altered red reflex. Indirect ophthalmoscopy revealed that 21.8% (31/142) of the eyes had intraocular abnormalities. Two of these eyes had optic nerve colobomas, two eyes had cataracts, and the rest had intra-retinal haemorrhages. Indirect ophthalmoscopy revealed that only 35% (7/20) of the eyes with an altered red reflex had intraocular disease. Indirect ophthalmoscopy also revealed that intraocular disease was present in 77.4% (24/31) of the eyes despite a normal red reflex. The false positive rate of the red reflex was calculated to be 9.2%, and the false negative rate was 16.9%. The sensitivity of the red reflex was only 56.4%, and the specificity was 89.5%. The positive predictive value was 70.4%, and the negative predictive value was 82.2%.

CONCLUSIONS

Neonatal screening with the red reflex is not sufficient to detect intraocular disease. A normal neonatal red reflex does no exclude intraocular disease. It has a specificity of nearly 90%, but its sensitivity is only 56%. Most retinal haemorrhages are undiagnosed as they cannot be detected with a red reflex.

Interleukin-1β Regulates Lipid Homeostasis in Human Glomerular Mesangial Cells

BACKGROUND

Recent studies have shown that hyperlipidemia is closely related to the progression of kidney disease and glomerulosclerosis has similar pathophysiological mechanisms with atherosclerosis. Atherosclerosis is essentially a chronic inflammatory process and various kidney diseases are characterized by a micro-inflammatory state. Hyperlipidemia levels are not parallel to the degree of glomerulosclerosis, inflammatory factors together with lipids may contribute to the pathogenesis of glomerulosclerosis. Therefore, it is key to clarify lipid-mediated renal injury through studying the mechanism by which inflammation affects cholesterol homeostasis at the cellular level. Intracellular lipid homeostasis involves both lipid uptake and excretion, therefore in this study, we aimed to explore whether interleukin-1β (IL-1β) promotes the uptake of oxidized low-density lipoprotein (Ox-LDL) to increase in intracellular lipid levels, and to clarify the effect of IL-1β on the expression of lectin-like oxidized LDL receptor 1 (LOX-1) and ATP-binding cassette transporter A1 (ABCA1), which may regulate cholesterol homeostasis in human mesangial cells (HMCs).

METHODS

The effect of IL-1β on uptake of Ox-LDL labeled with fluorescent Dil (Dil-Ox-LDL) by HMCs was observed using laser confocal microscopy. The effect of IL-1β on LOX-1 and ABCA1 expression in HMCs was detected by polymerase chain reaction and western blotting.

RESULTS

Laser confocal microscopy revealed that HMCs took up Dil-Ox-LDL. Treatment of HMCs with 5 ng/ml IL-1β for 24 h significantly increased uptake of Dil-Ox-LDL. IL-1β also promoted LOX-1 mRNA and protein expression in a dose-dependent manner. Moreover, ABCA1 mRNA and protein expression were reduced by IL-1β in lipid-loaded HMCs in a dose-dependent manner.

CONCLUSIONS

IL-1β promotes the uptake of Ox-LDL and expression of LOX-1 in HMCs, whereas it inhibits expression of ABCA1 under lipid load. The imbalance in intracellular cholesterol resulted by IL-1β can in turn transform HMCs into foam cells and aggravate glomerulosclerosis.

Ischemic preconditioning protects brain from ischemia/reperfusion injury by attenuating endoplasmic reticulum stress-induced apoptosis through PERK pathway

OBJECTIVE

The purpose of this study was to explore the effects of cerebral ischemic preconditioning which can decrease brain ischemia/reperfusion (I/R) injury by inhibiting endoplasmic reticulum (ER) stress-induced apoptosis.

MATERIALS AND METHODS

The focal cerebral ischemia rat was selected as the experimental model. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) positive cells in ischemic penumbra were assessed after cerebral reperfusion. We assessed terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) positive cells and measured the expressions of phosphorylation PERK (p-PERK), glucose-regulated protein 78 (GRP78), activating transcription factor-4 (ATF4) and caspase-12 in ischemic penumbra after cerebral reperfusion.

RESULTS

We showed that the infarct sizes can be reduced due to the preconditioning under the influence of brain ischemia after reperfusion. The effect of preconditioning on the expression of ER stress proteins suggested the expressions of the 4 proteins p-PERK, ATF4, caspase-12 and GRP78 in the penumbra cortex by immunohistochemistry and Western blot increased after cerebral ischemia. Significant reduction of the number of TUNEL-positive cells was in the penumbra cortex of the preconditioning group.

CONCLUSIONS

We found that cerebral ischemic preconditioning can protect the brain from I/R injury by inhibiting ER stress-induced apoptosis; the pathway of PERK is involved.