[Airway parameters and reference value range of high-resolution CT reconstruction in general population]

Objective: To investigate the measurement of small airways by high-resolution CT and image post-processing software. Screen and analyze the reconstructed airway parameters in order to find the best imaging biomarker parameters of small airway changes and calculate the reference value range; meanwhile, explore its influencing factors. Methods: From a water plant and a medical school, 169 cases of the general population aged 20 to 60 were selected as research objects, and questionnaire surveys and CT tests were performed, and CT data were reconstructed with image post-processing software. The reference value range of the general population was evaluated, and a linear mixed effect model was used to adjust the age, gender, height, BMI, and smoking status, and analyze the influencing factors of airway parameters. Results: The ratio of sixth-grade tracheal wall area to total tracheal area in the Left B1+2 to carina was (53.01±13.35) %, Left B9 to carina was (50.44±12.98) %, Right B1 to carina was (52.73±12.22) %, and Right B9 to carina was (52.93±11.85) %. The ratio of nineth-grade tracheal wall area to total tracheal area in the Left B1+2 to carina was (44.08±14.66) %, Left B9 to carina was (42.44±15.89) %, Right B1 to carina was (46.51±14.03) %, and Right B9 to carina is (43.54±15.87) %. BMI affect the area of the tracheal wall, all p value<0.05. Conclusion: High-resolution CT small airway morphology can make a preliminary assessment of the susceptible population of small airway-related diseases based on a range of reference values, and prevent and control it in combination with influencing factors.

Effects of lncRNA HOTAIR on proliferation and apoptosis of myeloma cells through NF-κB pathway

OBJECTIVE

The aim of this study was to explore the influences of long non-coding ribonucleic acid (lncRNA) homeobox transcript antisense intergenic RNA (HOTAIR) on the proliferation and apoptosis of myeloma cells and its molecular mechanism.

MATERIALS AND METHODS

The myeloma cells were randomly divided into three groups, including: group A (myeloma cell group), group B [HOTAIR-small-interfering RNA (siRNA) group], and group C (HOTAIR negative control group). The Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was performed to detect the expression of lncRNA HOTAIR in myeloma cells. The flow cytometry was adopted to determine the apoptosis of myeloma cells. Meanwhile, the protein expression of nuclear factor-kappa-light-chain-enhancer of activated B cells (NF-κB) was detected via Western blotting. In addition, the activity of the myeloma cells was measured using methyl thiazolyl tetrazolium (MTT) assay.

RESULTS

The expression of HOTAIR in group A, group B, and group C was (2.19 ± 0.33), (1.37 ± 0.25), and (2.51 ± 0.27), respectively. Compared with group A and group C, the expression of HOTAIR was significantly downregulated in group B, in which the cells interfered with siRNAs. The expression of HOTAIR was significantly higher in group C than group A and group B (p<0.05). HOTAIR expression reached the highest level in group C, followed by group A and group B, respectively. The results of MTT indicated that the activity of the myeloma cells significantly increased at 24 h, 48 h, and 72 h in group C when compared with group A and group B. However, the activity of the myeloma cells was relatively low in group B, showing a slow rising trend. The activity of myeloma cells in group A remarkably increased when compared with group B, but it was lower than group C. Furthermore, the activity of the myeloma cells was higher in group C than group B (p<0.05). Western blotting indicated that the protein expression of NF-κB in group A, group B, and group C was (0.79 ± 0.22), (0.51 ± 0.17), and (0.95 ± 0.31), respectively. Compared with group A and group C, the protein expression of NF-κB was significantly downregulated in group B (the cells interfered with siRNAs) (p<0.05). Meanwhile, the protein expression of NF-κB was markedly higher in group C than in group A and group B (p<0.05). The protein expression of NF-κB was the highest in the cells of group C. Flow cytometry demonstrated that the apoptosis rate in group A, group B, and group C was (9.57 ± 1.71), (20.33 ± 1.63), and (8.74 ± 1.23), respectively. Compared with group A and group C, the apoptosis was significantly elevated in group B, in which the cells interfered with siRNAs (p<0.05). Compared with group A, the number of apoptotic myeloma cells significantly decreased in group C (p<0.05).

CONCLUSIONS

LncRNA HOTAIR activates the expression of NF-κB in myeloma cells and promotes the proliferation of myeloma cells.

[One case of extremely severe burn combined with stillbirth and multiple organ dysfunction syndrome in the third trimester of pregnancy]

One 24 years old female patient who suffered extremely severe burn in the third trimester of pregnancy was admitted to the Department of Burns and Skin Repair Surgery of the Third Affiliated Hospital of Wenzhou Medical University on 9th May, 2015. Intrauterine distress occurred after injury and stillbirth was confirmed within 12 hours. In cooperation with the obstetrician, the labor was induced on post injury day (PID) 5. Septic shock and multiple organ dysfunction syndrome occurred on PID 8. Through treatments including anti-infection, ventilator-assisted ventilation, cardiotonic diuresis, and escharectomy and skin grafting, the patient was finally cured. This case indicates that it is crucial to grasp the right time and choose a reasonable induction of labor to deal with stillbirth. The scheme of transvaginal induction of labor after shock is a worthy question to explore. The main characteristics of this patient include the extreme paroxysmal changes in breath, circulation, and urine volume within 24 hours after induced labor, which should be monitored dynamically for effective and timely adjustment of respiratory circulation support. This may be another key point for the rescue of this type of patient. To seize the opportunities to perform escharectomy, cover the wound with xenogenic skin graft, and perform skin grafting in time for wound repair remain the top priority.

[Investigation on two family clusters of COVID-19 in a county of Baotou city in Inner Mongolia Autonomous Region]

Objective: To investigate the epidemiological characteristics and transmission chain of COVID-19 in two families, and to provide scientific evidence for effective prevention and control measures. Methods: Field epidemiological investigation was conducted for the COVID-19 cases occurred in two families and the close contacts in a county of Baotou city in Inner Mongolia Autonomous Region. Descriptive statistical analysis on epidemiological data was conducted. Results: The infection source of the COVID-19 cases in the two families was a man who had living history in Wuhan. After his return, his parents were infected by him. A few days later, the members of a neighbor family were found to be infected, and relatives of this family were also infected after dining together repeatedly. Finally, ten confirmed cases and three suspected cases of COVID-19 were detected in the two families. Conclusions: Human-to-human transmission of COVID-19 can occur not only in a family but also in neighborhoods. The cases in two families had close relationship, indicating the necessity to strengthen the health education about COVID-19 prevention and control and the management of groups at high risk to reduce the incidence of COVID-19 in families and neighborhoods.

[Preventive medicine curriculum system in training program of clinical medicine in the era of Healthy China]

Objective: To understand the provision of preventive medicine curriculum system in the training programs of clinical medicine in the era of Healthy China. Methods: A total of 36 training programs of clinical medicine were selected from different areas of China for a statistical analysis on their basic information, involvement of concept of preventive medicine in program objectives, and provision of preventive medicine curriculum system. Results: Of all the 36 training programs of clinical medicine, 22(61%) have no mentions of prevention medicine in their program objectives; only one university's training program states preventive medicine together with basic medicine and clinical medicine as one of the three main disciplines. The total class hours for the core courses of preventive medicine (hygiene, medical statistics, epidemiology, evidence-based medicine, and social medicine) range from 80 to 252, with an average of (156.7±43.2) hours. The average percentage of class hours for preventive medicine courses among the total class hours is 4.3%±1.1% (range: 2.5%-7.5%), and obvious differences exist among universities. Conclusions: In current training programs of clinical medicine, the proportion of prevention medicine curriculum is insufficient, the percentage of hours for preventive medicine course is very low, and the differences among various universities are obvious. It is urgently needed to strengthen preventive medicine curriculum in training programs for clinical medical students in new era. It is suggested to further promote the concept of putting prevention first, improve the curriculum system of clinical medicine, intensify the integrated development preventive medicine and clinical medicine and pay attention to clinical research ability enhancement for the further improvement of training program of clinical medicine.

Assessing the impact of drinking water iodine concentrations on the iodine intake of Chinese pregnant women living in areas with restricted iodized salt supply

PURPOSE

The supply of non-iodized salt and the water improvement project have been conducted to reduce the iodine concentration in drinking water in areas with elevated water iodine. We aimed to assess the impact of water iodine concentration (WIC) on the iodine intake of pregnant women in areas with restricted iodized salt supply, and determine the cutoff values of WIC in areas with non-iodized salt supply.

METHODS

Overall, 534 pregnant women who attended routine antenatal outpatient visits in Zibo Maternal and Child Health Hospital in Gaoqing County were recruited. The 24-h urine iodine excretion (UIE) in 534 samples and the iodine concentration in 534 drinking water samples were estimated. Urinary iodine excretion, daily iodine intake, and daily iodine intake from drinking water (WII) were calculated. The relationship between WIC and daily iodine take was analyzed.

RESULTS

The median WIC, spot urine iodine concentration (UIC), and 24-h UIE were 17 (6, 226) μg/L, 145 (88, 267) μg/L, and 190 (110, 390) μg/day, respectively. A significant positive correlation was found between WIC and UIE (R² = 0.265, p < 0.001) and UIC (R² = 0.261, p < 0.001). The contribution rate of WII to total iodine intake increased from 3.0% in the group with WIC of < 10 μg/L to 45.7% in the group with WIC of 50-99 μg/L.

CONCLUSION

The iodine content in drinking water is the major iodine source in pregnant women living in high-water iodine areas where iodized salt supply is restricted. The contribution rate of daily iodine intake from drinking water increases with the increase in water iodine concentration.

Attitude and knowledge for menopause management among health professionals in mainland China

OBJECTIVE

This study aims to understand the attitude of health-care professionals (HPs) in mainland China toward menopause management (MM) as well as the knowledge they have received regarding MM during training.

METHODS

An anonymous survey recruited 3709 medical workers nationwide (including physicians, orthopedists, obstetricians and gynecologists, and general practitioners) through online surveys and on-site interviews at professional meetings.

RESULTS

Of the 3709 questionnaires completed, 3426 questionnaires met the inclusion criteria. Of the participants, 1532 HPs had not received menopause management training (MMT) in nearly 1 year. Among the residents and physician assistants, 103 reported they were not familiar with MM. Satisfyingly, 98.3% of HPs considered it very important or essential to accept MM. Although most interviewees replied some correct menopausal knowledge, nearly half of them could not correctly identify the contraindications for menopause hormone therapy (MHT). Additionally, 73.1% of HPs would advise patients with premature ovarian insufficiency to receive hormone replacement therapy at least until the average age of menopause.

CONCLUSION

This survey indicated that HPs have some knowledge regarding MM, but a gap remains to master the basic theory of MHT. In order to manage the growing menopausal population in China, creating more in-depth educational MMT programs for HPs is necessary.

Effect of IF-WS2 Nanolubricant on R134a Boiling on a Reentrant Cavity Surface

This report quantifies the influence of inorganic fullerene-like tungsten disulfide (IF-WS₂) nanoparticles on the pool-boiling performance of R134a/polyolester mixtures on a commercial (Turbo-ESP) boiling surface. Tungsten disulfide nanoparticles, of roughly 150 nm, were used at a 15% mass fraction in a base polyolester lubricant to produce the test nanolubricant. The nanolubricant was mixed with R134a at a 1% mass fraction. The study showed that the nanolubricant caused an average 37% degradation in the boiling heat flux as compared to R134a/neat-lubricant boiling on a reentrant cavity surface at the same superheat. Similarly, boiling with R134a/neat-lubricant caused, on average, a 27% degradation in the boiling heat flux as compared to pure R134a boiling and the same superheat. An analysis was presented which showed that the nanoparticles were too large and too dense to promote a boiling enhancement. In addition, the fullerene-like structure and the large size encouraged nanoparticle settling, which presumably filled cavities of the boiling surface leading to additional boiling degradations.

0026 Strong Gene-Environment Interactions of Trank1 Gene Polymorphisms with Birth Difficulties in Kleine Levin Syndrome

Introduction

Kleine-Levin Syndrome (KLS) is a rare disorder affecting adolescents and characterized by relapsing-remitting episodes of severe hypersomnia, cognitive impairment, and behavioral disturbances such as hyperphagia and sexual disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas and in cortical areas during episodes. Familial occurrence is increased, and risk is associated with reports of complicated birth.

Methods

A worldwide Genome wide association (GWA) study was conducted in 673 KLS patients and ethnically matched 15,341 control individuals.

Results

We found a strong genome-wide significant association (OR=1.48 at rs150168018, p=8.6x10-9) with 24 single nucleotide polymorphisms (SNPs) encompassing a 35kb region located in the 5’ region of TRANK1 gene previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with TRANK1 had statistically increased reports of difficult birth. As perinatal outcomes have dramatically improved over the last 40 years, we further stratified our sample by birth years, and found that recent cases had a significantly reduced TRANK1 association. These findings were confirmed in an independent replication cohort of 171 new patients where polygenic risk scores constructed on the discovery cohort replicated (r2=0.15; p&lt;2.7x10-22 at p=0.1 threshold) and the TRANK1 association was found to be dependent on reports of birth difficulties (OR=1.54, p=0.01 versus OR=1.12, p=0.4). Pathway analysis of the overall GWAS association revealed significant association (p=0.02) with 19 genes in a pathway modulating rhythmic behaviors.

Conclusion

Our results demonstrate links between hypersomnia, behavioral rhythmicity and bipolar disorder and indicate that a polymorphism in the TRANK1 region affect brain development in the presence of a perinatal injury, with pathophysiological consequences such as KLS, bipolar disorder and schizophrenia.

Support

NIH NIMH 1R01MH080957 to EM PHRC 070138 to IA

0959 Associations Between Sleep and Academic Performance in Typically Developing Adolescent Girls

Introduction

Healthy sleep promotes cognitive functioning and is associated with better academic performance, whereas insufficient, poor, and inconsistent sleep schedules are associated with poor school performance. Several studies have identified gender differences in the timing, duration, and quality of sleep in adolescence, with adolescent girls having poorer sleep compared to adolescent boys, yet research shows that girls outperform boys academically. This could be because sleep might not affect all subjects similarly and previous studies regarding sleep and academic performance combined both genders. The goal of the present study was to determine which aspects of academic performance are specifically associated with short or poor sleep in typically developing adolescents girls.

Methods

80 adolescent girls aged 12-17 years participated in the study. Sleep was assessed in the home environment for five consecutive weeknights using actigraphy. Academic performance was assessed using report card grades.

Results

Hierarchical regression analyses adjusted for age, pubertal status, and socioeconomic status revealed that longer average sleep time was significantly associated with higher grades in mathematics. No significant associations were found between sleep variables and grades in other subjects.

Conclusion

Longer average weekday sleep duration is associated with better mathematics grades in typically developing adolescent girls.

Support

NSERC grant to Reut Gruber

0773 Why Did Pandemrix Trigger Narcolepsy? A Structural Approach

Introduction

The 2009 Pandemrix influenza A pH1N1 vaccine has been linked to an increased number of Narcolepsy type I onsets in children across Europe whereas administration of a very similar adjuvanted vaccine, Arepanrix, had little effects in Canada. One possible explanation for the difference may be vaccine composition differences that could modify peptide binding to narcolepsy associated HLA-DQ0602 allele, as viral extracts for these two vaccines used distinct processes in different factories. Other explanations may involve differences in vaccination timing in relation to the pandemic H1N1 infection wave, or other environmental factors. We have previously compared the amino acid sequence of the Hemagglutinin (HA) component of the Pandemrix and the 2010 Arepanrix vaccine, finding possible contributors, but excluding most of these after DQ0602-tetramer analysis of T cell reactivity in narcolepsy versus controls.

Methods

Mass spectrometric characterization of multiple additional batches of Pandemrix and Arepanrix used during 2009 influenza pandemic vaccination campaign was performed.

Results

In addition to confirming previously published results such as increased deamidation of hemagglutinin (HA) (146N&gt;D) in Pandemrix (p=2.1e-9), we identified novel differences, including a significant 2-fold post-translation deamidation increase in 277N in Arepanrix versus Pandemrix (p=0.032), together with increased 2-fold glycosylation in the 286-323 positions in Arepanrix (p=0.00036). The 277 N to D/isoD substitution is located in pocket 1 of the binding core of a strong binder NAGSGIIIS, (&lt; 10% rank) for HLA-DQ0602 allele and abolishes epitope binding. The increased glycosylation in Arepanrix occurs in the immediate flanking area of the same 277N epitope and could also reduce DQ0602 presentation of the same epitope through differential binding and/or proteolysis of HA in this region of the molecules. As CD4 T cells recognizing this epitope have been reported to be significantly increased in narcolepsy versus DQ0602 controls, with possible mimicry with homologous hypocretin sequence.

Conclusion

These changes could explain why Arepanrix was less narcolepsy inducing. Confirmatory studies, as well as studies of all novel changes observed, are ongoing, but this is a promising result.

Support

Wake Up Narcolepsy