Population-based evaluation of the risk factors and prognosis among renal cell carcinoma patients with initially diagnosed lung metastases

OBJECTIVES

To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

56,617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2906 patients were initially diagnosed with lung metastases, and then were used to research the prognostic factors. Multivariable Cox regression analyses were performed for the prediction of cancer-specific mortality.

RESULTS

In total, 2906 RCC patients were initially diagnosed with lung metastases. The prevalence of lung metastases in RCC was approximately 5% with poor survival. Aging, male, other race (American Indian/AK native, Asian Pacific islander) uninsured status, bilateral tumor, collecting duct, higher T stage, local lymph node metastases, higher tumor grade, and evidence of other distant metastases were significantly associated with developing lung metastases at diagnosis. Age >70 years-old, black, female, bilateral tumor, T4 stage, higher tumor grade, local lymph node metastases, collecting duct, and evidence of bone, liver, or brain metastases were related to higher risk of mortality. Blacks and female have lower odds of developing lung metastases at the time of diagnosis both in crude and adjusted logistic regression. Meanwhile, blacks and female showed higher risk of mortality compared with whites and male in Cox regression analyses.

CONCLUSION

Several factors related to the development and prognosis of lung metastases were revealed, especially black people and female gender have lower risk of developing lung metastatic RCC at initial diagnosis but have higher risk of mortality. These may provide preventive guidelines for the screening and treatment of lung metastases in patients with renal cell carcinoma.

[TRIM59 regulates invasion and migration of nasopharyngeal carcinoma cells by targeted modulation of PPM1B]

OBJECTIVE

To investigate whether TRIM59 regulates invasion and metastasis of nasopharyngeal carcinoma cells by targeting PPM1B.

METHOD

We analyzed the expression of TRIM59 in nasopharyngeal carcinoma tissues based on data from TCGA database and detected the expressions of TRIM59 and PPM1B in nasopharyngeal carcinoma and adjacent tissues using Western blotting. We also detected the expressions of TRIM59 and PPM1B at both the mRNA and protein levels in nasopharyngeal carcinoma cell lines using RT-PCR and Western blotting. Stable cell lines with TRIM59 overexpression or knockdown were established in HNE1 cells, in which the targeting relationship between TRIM59 and PPM1B was analyzed using Western blotting and a luciferase reporter gene assay. Transwell chamber assay was used to assess changes in the invasion and migration abilities of HNE1 cells with TRIM59 overexpression or knockdown.

RESULTS

Analysis based on TCGA database showed that TRIM59 expression was significantly higher in nasopharyngeal carcinoma tissues than in adjacent tissues (P=0.006); the expression of TRIM59 increased (P=0.01) and PPM1B expression decreased significantly (P=0.03) in nasopharyngeal carcinoma tissues. Compared with HNEpC cells, HNE1 cells expressed a significantly higher level of TRIM59 (P=0.04) but a lower level of PPM1B (P=0.01). Luciferase reporter gene assay indicated that PPM1B was a downstream target gene of TRIM59 and its expression was negatively correlated with TRIM59 expression (P=0.01). In HNE1 cells, TRIM59 overexpression significantly promoted cell invasion (P=0.01) and migration (P=0.02) while TRIM59 knockdown obviously suppressed cell invasion (P=0.01) and migration (P=0.01). TRIM59 knockdown with simultaneous PPM1B overexpression more strongly inhibited invasion (P=0.02) and migration (P=0.01) of HNE1 cells as compared with TRIM59 knockdown alone.

CONCLUSION

TRIM59 regulates invasion and migration of nasopharyngeal carcinoma cells through targeted modulation of PPM1B.

Telomerase enhances osteogenic ifferentiation of sheep bone marrow mesenchymal stem cells (BMSCs) by up-regulating PI3K/Akt pathway in vitro

Telomerase reverse transcriptase (TERT) vectors were transfected into bone marrow mesen- chymal stem cells (BMSCs) which were then cultured and selected to establish TERT-BMSC cell lines whilst sequencing BMSCs and TERT-BMSCs via transcriptome in this study to explore their regulatory mechanism and effect on osteogenic differentiation after TERT ectopic expres- sion in sheep BMSCs. After sequencing and analysing differential genes, PI3K/Akt signalling pathway related to osteogenic differentiation was investigated. Western blot was used before and after applying the PI3K/Akt signalling pathway inhibitor LY294002 to detect protein expression levels of AKT and p-AKT. On the twenty-first day of osteogenic differentiation, RT-qPCR and Western blot were used to detect mRNA and protein expression levels of RUNX2 and OPN and alizarin red staining was utilised to analyse calcium salt deposition. Results showed that pro- tein expression levels of AKT and p-AKT were significantly up-regulated, mRNA and protein expression levels of RUNX2 and OPN increased and calcium salt deposition increased after ectopic expression of TERT. After applying LY294002, the protein expression of AKT and p-AKT was down-regulated, mRNA and protein expression levels of RUNX2 and OPN were reduced and calcium salt deposition was reduced. These results confirmed the stable integration and expression of the exogenous TERT gene in BMSCs to promote the differentiation of BMSC osteoblasts, which may be mediated by the PI3K/Akt signalling pathway.

[Treatment status of tyrosine kinase inhibitors in Chinese patients with chronic myeloid leukemia in 2020]

目的

调查中国慢性髓性白血病（CML）患者的治疗现状。

方法

横断面研究，2020年4月末至5月中旬，以填写调研问卷的形式在全国范围内调研CML患者，分析酪氨酸激酶抑制剂（TKI）一线选择、目前用药、药物转换和获得主要分子学反应（MMR）的比例及其影响因素。

结果

2933份来自全国31个省市自治区CML受访者的问卷可供分析，男性1683例（57.4％），中位年龄38（16～87）岁。一线选择：伊马替尼2481例（84.6％），原创性新药（原研药）1803例（61.5％）。填写问卷时用药：伊马替尼1765例（60.2％），原研药1791例（61.1％）。共1185例（40.4％）受访者曾经历TKI药物转换。1944例初发慢性期受访者TKI中位治疗45（3～227）个月，1417例（72.9％）获得≥MMR的疗效。多因素分析显示，城镇户籍（OR＝0.6，95％CI 0.5～0.8，P<0.001）、≥大学学历（OR＝0.5，95％CI 0.4～0.7，P<0.001）和进展期（OR＝0.5，95％CI 0.3～0.8，P＝0.001）受访者更少首选仿制TKI，而来自中部地区受访者比东部地区更多首选国产仿制TKI（OR＝1.7，95％CI 1.4～2.0，P<0.001）。进展期受访者更多首选二代TKI（OR＝5.4，95％CI 3.6～8.2，P<0.001），≥60岁受访者更少首选二代TKI（OR＝0.4，95％CI 0.2～0.7，P＝0.002）。诊断时处于进展期（OR＝2.2，95％CI 1.6～3.2，P<0.001）、首选伊马替尼（OR＝2.0，95％CI 1.6～2.6，P<0.001）、首选国产仿制药（OR＝1.3，95％CI 1.1～1.6，P＝0.002）、诊断距开始TKI治疗的时间更长（OR＝1.2，95％CI 1.1～1.2，P<0.001）和服用TKI的时间更长（OR＝1.1，95％CI 1.0～1.1，P<0.001）与药物转换比例增高显著相关。城镇户籍（OR＝0.7，95％CI 0.6～0.8，P<0.001）、获≥MMR（OR＝0.6，95％CI 0.5～0.8，P<0.001）和疗效未知（OR＝0.7，95％CI 0.6～0.9，P＝0.003）与药物转换比例低显著相关。女性（OR＝1.4，95％CI 1.1～1.7，P＝0.003）、城镇户籍（OR＝1.6，95％CI 1.3～2.0，P<0.001）、初始服用伊马替尼（OR＝1.4，95％CI 1.1～1.9，P＝0.016）和TKI治疗时间更长（OR＝1.2，95％CI 1.2～1.3，P<0.001）与获得≥MMR显著相关，而年龄≥60岁（OR＝0.7，95％CI 0.4～1.0，P＝0.047）和药物转换（OR＝0.6，95％CI 0.5～0.7，P<0.001）与未获得MMR显著相关。

结论

截至2020年，中国CML患者中大多数首选并持续服用伊马替尼，半数以上服用原研药。社会人口学特征和疾病分期影响了患者的TKI选择、药物转换和治疗反应。

Application of remote online learning in oral histopathology teaching in China

Background

The aim of this study was to investigate the application of remote learning and virtual microscopy in oral histopathology teaching, a unique experience in China. The oral histopathology teaching in Nanjing Medical University has been extraordinary.

Material and Methods

98 third-year dental students of Grade 2016 took oral histopathology theoretical course face-to-face in 2019 (Traditional group). The 94 participants of Grade 2017 took online oral histopathology course using digital methods(E-Learning platform and Virtual Simulation Experiment Teaching Center for Dentistry) in 2020. During the practical laboratory sessions, the students in both Traditional group and Online group observed the same glass slides for morphological learning. A questionnaire survey explored students' attitudes towards the remote online learning. Results: The mean Theory test scores of the Online group (80.93±12.15) were significantly higher than those of the Traditional group (73.65±8.46) (P < 0.01). The mean total scores of the Online group (82.94±10.76) were significantly higher than those of the Traditional group (77.25±7.55) (P < 0.01). The percentage of high total test score (test score > 85) of the Online group (54%) was also significantly higher than that of the Traditional group (15%) (P< 0.01). Furthermore, both remote learning and virtual microscopy courses were well accepted by students according to the questionnaire.

Conclusions

This study found that remote learning and virtual technology have a positive impact on oral histopathology. The findings reveal that the application of remote online learning has enhanced oral histopathology teaching in China.

Key words:Oral histopathology, dental undergraduate students, virtual microscopy, remote online learning, questionnaire.

Screening and bioinformatics analysis of cellular proteins interacting with chicken bromodomain-containing protein 2 in DF-1 cells

1. Bromodomain-containing protein 2 (BRD2) is an important member of the BET protein family, which can specifically bind histone acetylated lysine to participate in gene transcriptional regulation, chromatin remodelling, cell proliferation and apoptosis. The following investigation of cellular proteins interacting with chBRD2 will be helpful in understanding the new functions of chBRD2 and the mechanism of NDV replication.2. The recombinant eukaryotic expression vector pEGFP-chBRD2 and empty vector pEGFP-C1 were transfected into DF-1 cells to overexpress GFP-chBRD2 and GFP, respectively. GO annotation, KEGG pathway, and protein-protein interaction network were used to analyse the cellular proteins interacting with chBRD2. In addition, one targeted protein was selected to verify its interaction with chBRD2 using fluorescent co-localisation and Co-IP.3. A total of 225 cellular proteins were identified that potentially interact with chBRD2. GO analysis showed that these play key roles in gene transcriptional regulation, cell cycle and development, immunity and viral infection. Further KEGG pathway analysis showed that these proteins were mainly involved in genetic information processing, immune system, cellular processes and translation. In addition, one targeted cellular protein chicken matrin 3 (chMATR3) was also identified as chBRD2 complex using both fluorescence co-localisation and Co-IP analysis.4. This study presents the interactome data of chBRD2 protein in DF-1 cells, which provides new information to understand the functions of chBRD2 and new targets for further investigating the replication and pathogenesis of NDV.

LINC00641 regulates prostate cancer cell growth and apoptosis via the miR-365a-3p/VGLL4 axis

OBJECTIVE

Long non-coding RNA (lncRNA) was frequently abnormally expressed in cancers. LINC00641 was reported to play crucial roles in regulating tumor progression. However, its role in prostate cancer (PCa) has not been fully explored.

PATIENTS AND METHODS

In this work, proliferation, invasion and apoptosis assays were performed to detect the biological roles of LINC00641 in PCa. Bioinformatic analyses, Luciferase activity reporter assay, and rescue experiments were performed to investigate the potential mechanisms of LINC00641 in PCa. Expression levels of LINC00641, microRNA-365a-3p (miR-365a-3p), and vestigial like family member 4 (VGLL4) in PCa tissues and normal tissues were analyzed at ENCORI.

RESULTS

We found LINC00641 and VGLL4 was reduced, while miR-365a-3p was elevated expression in PCa tissues compared with normal tissues. LINC00641 overexpression inhibited growth and invasion abilities of PCa cells in vitro. Functional assays revealed that miR-365a-3p/VGLL4 pair was the downstream targets of LINC00641.

CONCLUSIONS

The findings of our work provided evidence that LINC00641 serves as a tumor suppressive lncRNA in PCa by regulating miR-365a-3p/VGLL4 axis.

Sex-specific associations of serum insulin-like growth factor-1 with bone density and risk of fractures in Chinese patients with type 2 diabetes

We evaluated the associations of serum insulin-like growth factor-1 (IGF-1) with bone mineral density (BMD) and risk of fractures in Chinese patients with type 2 diabetes (T2D). We found positive associations between IGF-I and BMD and negative associations between IGF-I and all three modified 10-year probabilities of MOFs and HFs in men, but not in women.

INTRODUCTION

The objective was to investigate the associations of serum insulin-like growth factor-1 (IGF-1) with bone mineral density (BMD) and risk of fractures in Chinese patients with type 2 diabetes (T2D) in each gender.

METHODS

This was a cross-sectional, retrospective study that included men over 50 years and postmenopausal women with T2D without medical conditions or medications known to significantly affect BMD or serum IGF-I levels. Data of IGF-1, bone metabolism markers, lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD were obtained; 10-year probability of major osteoporotic fractures (MOFs) and hip fractures (HFs) was calculated and modified with rheumatoid arthritis, femoral neck T-score, and age. Correlations of IGF-1 levels with bone metabolism and risk of fractures were statistically analyzed in men and women, respectively.

RESULTS

A total of 391 patients, including 226 men and 165 women, were included. The age, serum fasting C-peptide, glycosylated hemoglobin (HbA1c), bone formation marker, and all three modified 10-year probabilities of MOFs and HFs were higher in women than those in men (all p < 0.05). The levels of 25 hydroxyvitamin D (25OHD), IGF-1, and BMD were lower in women than those in men (all p < 0.05). In men, IGF-1 was positively correlated with FN and TH BMD (FN BMD: r = 0.267, p < 0.001; TH BMD: r = 0.235, p < 0.001) and negatively correlated with all three modified 10-year probabilities of MOFs (RA-modified MOFs: r = - 0.289, p < 0.001; age-modified MOFs: r = - 0.237, p < 0.001; FN T-score-modified MOFs: r = - 0.280, p < 0.001) and HFs (RA-modified HFs: r = - 0.291, p < 0.001; age-modified HFs: r = - 0.271, p < 0.001; FN T-score-modified HFs: r = - 0.270, p < 0.001), while no significant correlations were found between serum IGF-I and BMD and three modified 10-year probability in women.

CONCLUSIONS

According to this study, we found sex differences in the associations of serum IGF-1 with BMD and risk of fractures in Chinese patients with T2D. These results suggested that increasing serum IGF-1 might be a clinical target for protecting fractures in T2D, especially in men.

POS0320 POOR PROGNOSIS PREDICTION IN ANTI-MDA5 POSITIVE DERMATOMYOSITIS ASSOCIATED WITH INTERSTITIAL LUNG DISEASE: THE CROSS-CAR DECISION TREE MODEL

Background:

The prognosis of anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM) – associated interstitial lung disease (ILD) is poor and heterogeneity.

Objectives:

The aim of this study was to evaluate prognostic factors and to develop a simple and generally applicable bedside decision tree model for predicting outcomes in patients with anti-MDA5+ DM and to guide treatment.

Methods:

We analyzed data for 246 anti-MDA5+ DM patients from Myositis Study Group-Jiangsu, a multicenter cohort across eighteen tertiary hospitals in Jiangsu province, from March 2019 to October 2020. The primary end point was all-cause death, and the secondary end point was occurring of rapidly progressive-ILD (rp-ILD). We used a multivariable Cox proportional hazards model to identify the independent prognostic risk factors of death and rp-ILD respectively. A decision-tree prediction model was developed by using data from 10 hospital of southern region (n=163), with validation by using contemporaneous data from northern region (n=83).

Results:

To assess the risk of rp-ILD, we developed a combined risk score, the CROSS score, that included the following values and scores: C-reactive protein (≤8mg/L, 0; >8mg/L, 3), anti-Ro52 antibody (negative, 0; positive, 4), Sex (Female, 0; Male, 2) and Short course of disease (More than 3 months, 0; Less than 3 months, 2). The mortality risk was identified by the CAR score, including C-reactive protein (≤8mg/L, 0; >8mg/L, 1), Alanine Transaminase (≤50units/L, 0; >50units/L, 1) and rp-ILD (non-rpILD, 0; rp-ILD, 3). We divided patients into three risk groups according to the CROSS score: low, 0 to 3; medium, 4 to 7; and high 8-11. And then Use of a simple decision tree prediction model permitted stratification into three different outcome prediction groups. High-risk patients had significantly higher mortality rates than low- and medium-risk patients in both discovery and validation cohorts (p < 0.0001).

Conclusion:

The CROSS-CAR decision tree model is easy to evaluate the poor prognostic risk in MDA5+ DM patients during any follow-up period. Unnecessary lung examination, such as chest CT scan and arterial blood gas analysis was avoided in low- and medium- rpILD risk patients. The special ambulance, with red cross sign tagged on car in China, may help to screen the high risk patients and to guide further treatment.

Disclosure of Interests:

None declared

POS0943 GEOGRAPHIC VARIATION OF ANKYLOSING SPONDYLITIS (AS) DIAGNOSIS AND TREATMENT IN THE UNITED STATES: A REAL-WORLD EVIDENCE STUDY

Background:

AS is a chronic inflammatory immune-mediated disease primarily affecting the sacroiliac joints and spine, with a prevalence of 0.2%–0.5% in the United States.1 Because radiographic features of the disease can take years to develop, diagnosis may be delayed by up to 10 years2, which can negatively affect patients’ function, ability to work, and overall quality of life.

Objectives:

To describe geographic variations in AS diagnostic prevalence and treatment in the United States.

Methods:

This study utilized the IBM® MarketScan® Administrative Claims Database from 2014–2019. Patients (pts) ≥18 years of age with AS, continuous medical and pharmacy enrollment during the calendar year, and complete geographic information during the study period were included. Pts were identified by having ≥1 claim with ICD-9-CM or ICD-10-CM codes for AS (720.0 or M45.x, respectively). Two AS diagnosis definitions were used; Definition 1 (D1): Pts with ≥1 claim for an AS diagnosis in the year by any provider and Definition 2 (D2): Pts with ≥2 claims for an AS diagnosis within 18 months by rheumatologists. Annual AS diagnostic prevalence rates were calculated for both groups; treatment was evaluated among pts with D2. Diagnosis and treatment rates were assessed from 2014–2019 at the national and state levels and reported for states where >20 pts received an AS diagnosis (D1 or D2) or respective treatment (D2). The effect of age, sex, race (surrogate for HLA-B27), and rheumatologist per capita on geographic variation was assessed.

Results:

The number of pts included per year ranged between 10,811–13,077 (D1) and 3,775–4,901 (D2). AS diagnostic prevalence increased over time for both groups, with the annual prevalence rate per 10,000 persons for D2 pts increasing from 2.5 in 2014 to 3.5 in 2019 (Table 1). The AS diagnostic prevalence by D2 in 2019 was highest for Idaho (13) and Colorado (6), and lowest for Michigan (2). The state variations in prevalence did not appear to be explained by age, sex, racial distribution, or rheumatologists per capita. The percentage of D2 pts receiving advanced therapies (all FDA-approved indicated biologic disease-modifying antirheumatic drugs [bDMARDs] for AS) were >70% and increased each year, whereas the use of conventional synthetic DMARDs (csDMARDs) decreased (Figure 1. next page). While opioid use decreased, 37% of D2 pts were prescribed such treatment in 2019. Percentage of D2 pts receiving advanced therapy in 2019 was highest (91) in Minnesota and South Carolina and lowest in Idaho (69) and Indiana (70). In 2019, the percentage of D2 pts using csDMARDs in 2019 was highest in Oklahoma (33) and lowest (16) in North Carolina and New York, while for opioids it was highest in Idaho (69) and lowest in Wisconsin (28).

Conclusion:

The prevalence of AS is increasing each year nationally, with significant variability observed across states that is not explained by differences in age, sex, race, or rheumatologists per capita. Among pts with confirmed AS diagnosis (D2), national rates of csDMARDs and opioids are decreasing although opioid use is still high, and high treatment rates exist for advanced therapies. Rates of all treatments also vary substantially across states. Observed variations may indicate the opportunity for further education that can be targeted based on regional need to improve diagnosis and treatment.

References:

[1]Reveille JD. Am J Med Sci. 2011. 2. Deodhar A, et al. Arthritis Rheumatol. 2016.

Table 1.

AS diagnostic prevalence by calendar year, 2014–2019

Patients with ≥1 AS diagnosis (D1)Patients with ≥2 AS diagnoses by rheumatologists (D2)YearNumber of annual enrolleesNumber of patients with ASPrevalence rate/10,000Number of patients with ASPrevalence rate/10,000201419,470,78013,0776.74,9012.5201515,159,11811,8637.84,2782.8201614,836,59412,8018.64,4733.0201712,618,30110,8118.63,7753.0201813,460,22412,2599.14,3023.2201912,105,04911,6469.64,2943.5

Acknowledgements:

Medical writing services provided by Alan Saltzman of Fishawack Facilitate Ltd, part of Fishawack Health, and funded by AbbVie.

The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract. No honoraria or payments were made for authorship.

Disclosure of Interests:

Atul Deodhar Speakers bureau: Novartis, Pfizer, Consultant of: Novartis, Pfizer, AbbVie, Eli Lilly, UCB Pharma, GlaxoSmithKline, Galapagos, Janssen, Boehringer Ingelheim, Celgene, Amgen, Grant/research support from: Novartis, Pfizer, AbbVie, Eli Lilly, UCB Pharma, GlaxoSmithKline, Denise Kruzikas Shareholder of: AbbVie, Employee of: AbbVie, Lili Zhou Employee of: AbbVie, Ana Biljan Shareholder of: AbbVie, Employee of: AbbVie, Christopher Saffore Shareholder of: AbbVie, Employee of: AbbVie

Figure 1.

Drought conditions appraisal using geoinformatics and multi-influencing factors

The world including South Africa is faced with unprecedented environmental changes, which can be linked to climate-related disasters such as drought and extreme heat. Several studies have indicated that these changes are likely to accelerate in the future and cause an adverse impact on the environment. The Eastern Cape Province of South Africa, especially Amathole District Municipality (ADM), has recorded a high number of climate change-related disasters including prolonged drought conditions witnessed during the winter season of 2008, 2009, 2014 and 2015 among others. Consequently, this study aimed at exploring remote sensing information to assess and document drought occurrences in the ADM from 2007 to 2017. To accomplish the aim, the Normalized Difference Vegetation Index, Land Surface Temperature and Precipitation were utilised to access drought spatiotemporal variations. For the analysis, a total of 396 satellite imageries (MODIS and TRMM) were used. The results revealed that different correlations exist between the three variables. The significance of correlations differed from one season to another. Furthermore, it was revealed that the drought conditions in the district differed in the spatial distribution. The study accurately identified the drought episodes that occurred in the ADM in the years 2008, 2009, 2014, 2015 and 2016. The chosen methodology and variables proved to be suitable for analysing drought conditions offering space and temporal variation dimension, which is vital in monitoring drought events.

Association between household debt and depressive mood among Chinese residents

OBJECTIVES

The aim of this study was to examine the association of household debt and depressive mood among Chinese adults and to evaluate whether the association varies across types of debt.

STUDY DESIGN

This is a secondary data analysis of a nationally representative survey.

METHODS

A prospective cohort study of participants was drawn from the China Family Panel Studies (CFPS). In total, 5135 participants had their depressive mood measured in the CFPS starting from 2014 to 2016 and had participated in the biennial survey. We used logistic regression models to identify predictors of depressive mood with debts, sociodemographic factors, health status factors and health behaviors factors. Adjusted for all measured covariates, we conducted an independent analysis for the experience of housing loans from formal institutions (HLFI), other loans from formal institutions (OLFI), housing loans from relatives and friends (HLRF) and other loans from relatives and friends (OLRF).

RESULTS

Multiple logistic regression analyses revealed that household debt was a significant risk factor for depressive mood (1.35; 95% confidence interval [CI], 1.19-1.54), after controlling for potential confounders. Independent analysis revealed that HLFI was not a significant predictor, while HLRF (1.26; 95% CI, 1.08-1.48), OLFI (1.45; 95% CI, 1.13-1.87) and OLRF (1.23; 95% CI, 1.02-1.47) remained significant risk factors.

CONCLUSION

OLFI, HLRF and OLRF were associated with depressive mood, while HLFI was not. To address the problem of individual depressive mood, its apparent association with household debt should be paid more attention.

Population-based evaluation of the risk factors and prognosis among renal cell carcinoma patients with initially diagnosed lung metastases

OBJECTIVES

To evaluate risk factors and prognosis of lung metastases in patients with renal cell carcinoma (RCC) based on the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

56, 617 patients with RCC were selected from the SEER database. Based on univariate and multivariate logistic regression, the risk factors for developing lung metastases were derived. 2, 906 patients were initially diagnosed with lung metastases, and then were used to research the prognostic factors. Multivariable Cox regression analyses were performed for the prediction of cancer-specific mortality.

RESULTS

In total, 2,906 RCC patients were initially diagnosed with lung metastases. The prevalence of lung metastases in RCC was approximately 5% with poor survival. Aging, male, other race (American Indian /AK native, Asian Pacific islander) uninsured status, bilateral tumor, collecting duct, higher T stage, local lymph node metastases, higher tumor grade, and evidence of other distant metastases were significantly associated with developing lung metastases at diagnosis. Age > 70 years-old, black, female, bilateral tumor, T4 stage, higher tumor grade, local lymph node metastases, collecting duct, and evidence of bone, liver, or brain metastases were related to higher risk of mortality. Blacks and female have lower odds of developing lung metastases at the time of diagnosis both in crude and adjusted logistic regression. Meanwhile, blacks and female showed higher risk of mortality compared with whites and male in Cox regression analyses.

CONCLUSION

Several factors related to the development and prognosis of lung metastases were revealed, especially black people and female gender have lower risk of developing lung metastatic RCC at initial diagnosis but have higher risk of mortality. These may provide preventive guidelines for the screening and treatment of lung metastases in patients with renal cell carcinoma.

QSPR modelling for intrinsic viscosity in polymer-solvent combinations based on density functional theory

Linear and nonlinear quantitative structure-property relationship (QSPR) models were developed based on a dataset with 65 polymer-solvent combinations. Seven quantum chemical descriptors, dipole moment, hardness, chemical potential, electrophilicity index, total energy, HOMO and LUMO orbital energies, were calculated with density functional theory at the B3LYP/6-31 G(d) level for polymers and solvents. Considering the strong correlation between intrinsic viscosity and weight, size, shape as well as topological structure of polymers and solvents, topological descriptors were also applied in this work. Meanwhile, the most appropriate polymer structure representation was investigated by considering 1-5 monomeric repeating units. The molecular descriptors were first screened by using the genetic algorithms-multiple linear regression (GA-MLR), with coefficient of determinations (r2) of 0.78 and 0.83 for the training set and the prediction set, respectively. The support vector machine model (SVM) model based on the selected descriptors subset showed a r2 value of 0.95 for the training set and 0.93 for the prediction set. All statistical results suggest that the established QSPR models have good predictability. Furthermore, a new test set obtained from the literature was used for further validation. The r2 values were 0.81 for the MLR model and 0.90 for the SVM model.

Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy

OBJECTIVE

We compared demographic and clinic-pathological variables related to the number of surgeries for thyroid conditions or for cancer, morbidity, and fine needle aspiration (FNA) practices among Covid19 pandemic phases I, II, III and the same seasonal periods in 2019.

METHODS

The prospective database of the Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China was used for this study. Covid19 emergency levels were stratified according to the World Health Organization: phase I (January 25-February 25, 2020), phase II (February 26-March 19), phase III (March 20-April 20).

RESULTS

There were fewer outpatient FNAs and surgeries in 2020 than in 2019. There were no thyroid surgeries during phase I. There were also fewer surgeries for cancer with a significant reduction of advanced stage cancer treatments, mainly stage T1b N1a in phase II and T3bN1b in phase III. Operative times and postoperative stays were significantly shorter during the pandemic compared to our institutional baseline. In phase III, vocal cord paralysis (VCP) increased to 4.3% of our baseline numbers (P = 0.001). There were no cases of Covid19-related complications during the perioperative period. No patients required re-admission to the hospital.

CONCLUSION

The Covid19 outbreak reduced thyroid surgery patient volumes. The decrease of Covid19 emergency plans contributed to unexpected outcomes (reduction of early stage cancer treatment, decreased operative times and hospital stays, increased VCP rate).

Childhood TB in China: notification, characteristics and risk factors for outcomes, 2010-2017

SETTING: China National Tuberculosis Programme, 2010-2017.OBJECTIVE: To describe the epidemiology of childhood (age < 15 years) TB, including treatment outcomes and risk factors for unfavourable outcomes and death.DESIGN: We used a cross-sectional design for the descriptive component and a cohort design for treatment outcomes and their risk factors (assessed using log binomial regression).RESULTS: Of 40 561 children, 77.7% (n = 31 529) were aged 10-14 years and 19.6% (n = 7931) were bacteriologically confirmed. Around 14% (n = 5827) belonged to migrant families (internal migration) and 4.0% (n = 1,642) were actively detected. Over 8 years, annual notification was consistently very low (<1%), and notification of bacteriologically confirmed TB decreased by half. Unfavourable outcomes were seen in 6% and deaths in 0.4%; there were no significant changes over the years. The independent predictors of unfavourable outcomes were active case finding and extrapulmonary TB. Children belonging to migrant family were more likely to die. Independent predictors of unfavourable outcomes as well as death were age < 5 years and previous treatment.CONCLUSION: China needs to address the issue of under-detection of childhood TB, especially in younger age groups. The risk factors identified require attention if China is to attain zero child TB deaths.

[Clinical and prognostic features of ovarian endometrioid carcinoma with synchronous endometrial lesions]

Objective: To compare the clinical and prognostic characteristics of ovarian endometrioid carcinoma (OEC) patients with synchronous endometrial lesions and patients with pure OEC. Methods: A retrospective review of the medical records of patients received initial treatment and a postoperative pathological diagnosis of OEC at Peking University People's Hospital between August 1998 and December 2017 were performed. According to the inclusion criteria, a total of 56 patients with OEC were included in the study, including 13 patients concurrent with simultaneous endometrial lesions (Group A) and 43 patients with pure OEC (Group B). Results: Patients with synchronous endometrial lesions accounted for 23% (13/56). Mean age of Group A at diagnosis was (44.9±8.3) years old, 2/13 of patients were postmenopausal, and no one had a history of hypertension, the first symptom of 5/13 people was irregular vaginal bleeding. Mean age of Group B patients at diagnosis was (52.7±10.2) years old, 53% (23/43) of patients were postmenopausal, and 28% (12/43) patients had the history of hypertension, the first symptom of 4 (9%, 4/43) people was irregular vaginal bleeding. The differences of age, menopause status, history of hypertension and initial symptoms between the two groups were statistically significant (all P<0.05). There were no significant differences in fertility history, dysmenorrhea history, age of menarche, history of endometriosis, preoperative and postoperative CA₁₂₅ level, International Federation of Gynecology and Obstetrics (FIGO) stage, tumor grade, metastatic site and platinum-based chemotherapy drug resistance between the two groups (all P>0.05). The overall 5-year survival rate of OEC patients was 91.6%, and the overall 5-year progression-free survival rate was 76.6%. Among them, the 5-year survival rate of the OEC concurrent with simultaneous endometrial lesions group was 80.2%, and the pure OEC group was 93.4%; the 5-year progression-free survival rate of the OEC concurrent with simultaneous endometrial lesions group was 74.1%, and the 5-year progression-free survival rate of the pure OEC group was 77.3%. There were no significant differences between the two groups (all P>0.05). Multivariate analysis showed that the independent factors for the prognosis of OEC patients were FIGO stage (P=0.006) and residual lesion size (P=0.020). Conclusions: OEC patients have a high proportion of simultaneous endometrial lesions. OEC with simultaneous endometrial lesions are younger than patients with pure OEC. Synchronous endometrial lesions do not affect the prognosis of patients with OEC.

Clinical and genetic spectrum of a Chinese cohort with SCN4A gene mutations

Skeletal muscle sodium channelopathies due to SCN4A gene mutations have a broad clinical spectrum. However, each phenotype has been reported in few cases of Chinese origin. We present detailed phenotype and genotype data from a cohort of 40 cases with SCN4A gene mutations seen in neuromuscular diagnostic service in Huashan hospital, Fudan University. Cases were referred from 6 independent provinces from 2010 to 2018. A questionnaire covering demographics, precipitating factors, episodes of paralysis and myotonia was designed to collect the clinical information. Electrodiagnostic studies and muscle MRI were retrospectively analyzed. The clinical spectrum of patients included: 6 Hyperkalemic periodic paralysis (15%), 18 Hypokalemic periodic paralysis (45%), 7 sodium channel myotonia (17.5%), 4 paramyotonia congenita (10%) and 5 heterozygous asymptomatic mutation carriers (12.5%). Review of clinical information highlights a significant delay to diagnosis (median 15 years), reports of pain and myalgia in the majority of patients, male predominance, circadian rhythm and common precipitating factors. Electrodiagnostic studies revealed subclinical myotonic discharges and a positive long exercise test in asymptomatic carriers. Muscle MRI identified edema and fatty infiltration in gastrocnemius and soleus. A total of 13 reported and 2 novel SCN4A mutations were identified with most variants distributed in the transmembrane helix S4 to S6, with a hotspot mutation p.Arg675Gln accounting for 32.5% (13/40) of the cohort. Our study revealed a higher proportion of periodic paralysis in SCN4A-mutated patients compared with cohorts from England and the Netherlands. It also highlights the importance of electrodiagnostic studies in diagnosis and segregation studies.

Long noncoding RNA LINC00511 promoted cell proliferation and invasion via regulating miR-124-3p/EZH2 pathway in gastric cancer

OBJECTIVE

Growing evidence has shown that long non-coding RNAs (lncRNAs) can serve as prospective markers for survival in patients with gastric cancer (GC). In this study, we mainly focused on the potential roles of LINC00511 in the development process of GC.

PATIENTS AND METHODS

RT-PCR was used to detect the expressions of LINC00511 and miR-124-3p in GC tumor tissues, adjacent tissues and GC cell lines. Furthermore, correlations between LINC00511 with miR-124-3p, and miR-124-3p with EZH2, were analyzed by Correlation analysis. Moreover, the overall survival (OS) of patients was analyzed using Kaplan-Meier method. Additionally, proliferation ability was measured by CCK-8 assay and invasion ability of GC cell line was detected by transwell assay. Besides, Western blot was performed to measure protein levels of GC tissues and GC cell lines. Finally, Dual-Luciferase reporter assay was performed to prove the potential binding sites between LINC00511 and miR-124-3p, miR-124-3p and EZH2.

RESULTS

We found that LINC00511 was significantly increased in GC tissues and GC cell lines, which was associated with tumor growth, metastasis and predicted poor diagnosis of GC patients. MiR-124-3p was decreased in GC tissues and GC cell lines, which was negatively correlated with LINC00511 and EZH2. Furthermore, EZH2 was increased in GC tissues and GC cell lines, which was positively correlated with LINC00511. Moreover, LINC00511 inhibition repressed cell proliferation and invasion in MKN28 cells, the protein levels of Cyclin D1, ICAM-1, VCAM-1 and N-cadherin were repressed, while E-cadherin was increased. Besides, Luciferase gene reporter assay indicated that LINC00511 could sponge with miR-124-3p, which could directly target at EZH2, an oncogenic gene. We found that miR-124-3p/EZH2 axis regulated cell proliferation and invasion in MKN28 cells. Finally, the inhibited cell proliferation and invasion abilities were eliminated following with miR-124-3p inhibition in MKN28 cells with LINC00511 knockdown.

CONCLUSIONS

According to the results, we found that LINC00511 was increased in GC tissues, which was associated with the poor OS in patients with GC. We uncovered a previously unappreciated LINC00511/miR-124-3p/EZH2 signaling axis in promoting cell proliferation and invasion in GC patients and GC cell lines, which suggested that it might be a potential target for treating human GC.

Carbachol alleviates myocardial injury in septic rats through PI3K/AKT signaling pathway

OBJECTIVE

To explore the effect of carbachol on myocardial injury in septic rats, and to further study its influence on the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway.

MATERIALS AND METHODS

A total of 48 healthy male Sprague-Dawley rats were randomly divided into sham group (n=16), model group (n=16), and carbachol group (n=16). The rat model of sepsis was established via cecal ligation and puncture. Carbachol was intraperitoneally injected (10 μg/kg) immediately after operation in carbachol group, and no cecal ligation was performed in sham group. At 48 h after operation, the survival rate of rats in each group was recorded, the activity of plasma creatine kinase-MB (CK-MB) was detected, and the cardiac function in each group was determined. Moreover, the heart was isolated, and the myocardial tissues were taken to detect the apoptosis level using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) apoptosis kit. The content of inflammatory factors in myocardial tissues was determined using enzyme-linked immunosorbent assay (ELISA) kits, and the expression levels of apoptosis-related proteins and the PI3K/AKT signaling pathway-related proteins were detected via Western blotting.

RESULTS

Carbachol could significantly raise the survival rate of septic rats (p<0.01), remarkably decrease the activity of CK-MB (p<0.01), markedly reduce the left ventricular internal diameter at end-systole (LVIDs), and markedly increase the left ventricular ejection fraction (LVEF, %) and left ventricular fractional shortening (LVFS, %). Besides, carbachol could evidently lower the apoptosis level of myocardial cells of septic rats (p<0.01), reduce the content of inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß) and IL-6 (p<0.01), notably decrease the expression of Caspase-3 in myocardial tissues (p<0.01), remarkably increase the expression of Bcl-2/Bax (p<0.01), and distinctly inhibit the expressions of phosphorylated (p-)PI3K, p-AKT, Nod-like receptor protein 3 (NLRP3), and Caspase-1 (p<0.01).

CONCLUSIONS

Carbachol can reduce the release of inflammatory factors in myocardial cells, the expression of apoptotic proteins and the apoptosis of myocardial cells, and improve the cardiac function and survival rate of septic rats by inhibiting the PI3K/AKT signaling pathway.

[Experience and thinking on the normalization stage of prevention and control of COVID-19 in China]

COVID-19 is an important public health issue of great concern at home and abroad, and it is still in the state of global pandemic. During the normalization stage of prevention and control of the epidemic of COVID-19, China effectively controlled the outbreak and spread of the epidemic by adopting the strategy of "import of external prevention and rebound of internal prevention", and effectively reduced the occurrence of death cases. The social economy recovered quickly, and various measures were highly recognized by the public, and the positive trend of the epidemic continued to consolidate. At present, although the spread of the local epidemic has been basically stopped, the international epidemic continues to rise rapidly, and the pressure of "imported prevention and control" in China continues to increase. Considering the characteristics of the normalization of epidemic prevention and control and the particularity of the virus, the connotation of the normalization of epidemic prevention and control should be understood scientifically. The prevention and control goal of the epidemic in the normalization stage should be to maximize early detection, early treatment and early disposal, and resolutely prevent the continuous spread of the epidemic in communities, that is, to prevent the infection as much as possible, and resolutely prevent the rebound (sustained spread in communities), rather than "zero infection". The prevention and control policy of "timely detection, rapid disposal, precise management and control, and effective treatment" has been implemented in various localities, and a series of effective and regular experience in prevention and control has been formed in the practice of prevention and control. Winter and spring are the key periods for the prevention and control of the epidemic. We should continue to work together to prevent and control the epidemic, fulfill the responsibilities of all parties, and prevent and control the epidemic in a scientific and effective way.

Lactate augments intramuscular triglyceride accumulation and mitochondrial biogenesis in rats

Regular exercise induces intramuscular triglyceride accumulation with improved mitochondrial ability, but the mechanism remains unknown. The glycolytic product of exercise, lactate, has long been rec-ognized to suppress lipolysis and promote lipogenesis in adipocytes through inhibition of the cAMP-PKA pathway by activation of the G protein-coupled receptor (GPR81). However, whether lactate results in a similar process in skeletal muscle is unclear. Here, by using intramuscular injection of lactate to the gastrocnemius, the lipid metabolism effects were investigated in rat skeletal muscle. Firstly, the lactate-injection effect was verified by comparing changes in blood lactate levels from injection and exercise (30 min, 31 m/min, treadmill running). After five weeks of lactate intervention, intramuscular triglyceride levels in the gastrocnemius and the proportion of epididymis adipose mass to body weight increased. Chronic intramuscular injection of lactate elevated lactate receptor, GPR81, and reduced cAMP response element-binding (CREB) and P-CREB abundance in the gastrocnemius. Additionally, there was a significant decline in lipolytic-related proteins (AMPK, P-AMPK, P-HSL, CPT-1B, TGF-β2, SDHA) and a significant increase in fat synthesis proteins (SREBP-1C, PPAR-γ). Surprisingly, mitochondrial biomarkers (PGC-1α, CS) were also increased in the gastrocnemius, suggesting that chronic lactate might promote mitochondria biogenesis. Together, these results demonstrated that lactate may play a crucial role in triglyceride storage and mitochondria biogenesis in the skeletal muscle of rat.