[Expression of tropomyosin 2 in aortic dissection tissue]

Objective: To investigate the expression pattern of tropomyosin 2(TPM2) in aorta of patients with aortic dissection and explore its clinical implication. Methods: Thirteen cases with acute type A aortic dissection(TAAD) diagnosed by transabdominal aortic angiography from 2015 in Tongji Hospital were included. During the operation, the aortic wall tissues of these patients were collected. Ten patients with heart transplantation were selected as control group, and normal aortic wall tissues were taken. The hematoxylin-eosin (HE) and Verhoeff's Van Gieson (EVG) staining were performed to observe the morphological changes of aorta. The mRNA expression level of TPM2 was measured by real-time fluorescent quantitative-PCR, and the protein levels of TPM2 were detected by Western blot and immunohistochemical staining. Image The J software was used to collect the optical density values of each point on the image, obtain the integrated optical density(IOD) value, and calculate the average density(%, IOD/area of the target distribution area). Results: HE and EVG staining revealed medial degeneration and broken elastic fiber in aorta of TAAD patients. The mRNA expression levels of TPM2 were significantly upregulated in aorta of TAAD patients as compared to the control group (P<0.05), so as the TPM2 protein expression levels ((9.73±1.20)% vs. (0.11±0.04)%, P<0.05). And TPM2 was mainly expressed in cytoplasm. Conclusion: The increased expression of TPM2 in TAAD patients hints that TPM2 might be involved in the pathogenesis of aortic dissection.

Lee Silverman Voice Treatment for dysarthria in patients with Parkinson's disease: a systematic review and meta-analysis

Approximately 89% of patients with Parkinson's disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta-analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage', monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31 dB, respectively, after 1 month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage' and monologue immediately after treatment (13.39, 6.66 and 3.19 dB). Positive improvement still existed after 24 months. There was no difference in the therapeutic effect between face-to-face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.

Circ-VANGL1 promotes the progression of osteoporosis by absorbing miRNA-217 to regulate RUNX2 expression

OBJECTIVE

This study aims to investigate whether circ-VANGL1 can promote the progression of osteoporosis (OP) by absorbing miRNA-217 to regulate RUNX2 expression.

PATIENTS AND METHODS

The serum levels of circ-VANGL1, miRNA-217 and RUNX2 in OP patients and non-OP patients were detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Their expression levels in human bone marrow mesenchymal stem cells (hBMSCs) at different time points of osteogenesis differentiation were determined as well. The expression levels of RUNX2 and osteogenic proteins (BSP, OCN, OPN) in hBMSCs were detected by Western blot. Dual-Luciferase reporter gene assay was performed to verify the relationship among circ-VANGL1, miRNA-217 and RUNX2. Alkaline phosphatase (ALP) staining was conducted to evaluate the degree of osteogenic differentiation influenced by circ-VANGL1 and miRNA-217.

RESULTS

OP patients presented a higher serum level of miRNA-217 and lower serum levels of circ-VANGL1 and RUNX2 relative to non-OP patients. Circ-VANGL1 accelerated osteogenic differentiation by absorbing miRNA-217 to regulate RUNX2 expression. Moreover, miRNA-217 inhibited osteogenic differentiation by degrading RUNX2 by targeting to RUNX2 3'UTR. The overexpression of circ-VANGL1 upregulated expressions of RUNX2, BSP, OCN, and OPN. Meanwhile, ALP activity increased in hBMSCs overexpressing circ-VANGL1. However, co-overexpression of circ-VANGL1 and miRNA-217 did not alter RUNX2 expression. ALP activity in hBMSCs co-overexpressing circ-VANGL1 and miRNA-217 slightly increased, but had no difference with controls.

CONCLUSIONS

Circ-VANGL1 promotes the development of OP via binding to miRNA-217 to downregulate RUNX2 expression.

AB0474 CAROTID CONTRAST ENHANCED ULTRASOUND IN CASES OF TAKAYASU ARTERITIS COMPLICATED WITH BEHCET’S DISEASE

Background:

Carotid contrast enhanced ultrasound (CEUS) is used for diagnosis and activity determination of patients with Takayasu’s arteritis (TA). However, very little is known about the carotid CEUS features of TA complicated with Behcet’s disease (BD).

Objectives:

This study reports the carotid CEUS features in cases of TA complicated with BD (TBD).

Methods:

A total of 10 carotid CEUS examinations were performed on 4 patients of TBD. 10 TA patients complicated with no rheumatoid disease were included as control group. For each carotid artery lesion, the carotid CEUS features was graded as follows: Grade 0, artery wall shows no microbubbles, Grade 1, artery wall shows limited or moderate microbubbles, Grade 2, artery wall shows severe microbubbles.

Results:

2/10 patients in TBD group has oral ulcer during the CEUS examination, while all the other patients included in our study showed no clinical symptoms related to active TA or BD. The carotid wall thickness was greater of CEUS grade 2 than grade 1 in both group(TBD: 2.62±0.74mm vs 1.66±0.22mm,p=0.001; TA:1.84±0.31mm vs 1.53±0.5mm,p=0.136). The carotid wall thickness was significantly greater in TBD group than TA group, but there was no significant differences between the two groups in clinical data and CEUS grade (table 1).

Table 1.

Clinical data and carotid CEUS features of both groups

TBDTApAge (year)32.5±3.4430.5±9.20.487Male320.605ESR (mm/h)4(2, 10)7(3.5, 11)0.406CRP (mg/L)6.42(0.55, 15.38)0.58(0.44, 5.05)0.168Wall thickness (mm)2.10±0.701.67±0.440.030CEUS grade 29120.527

Conclusion:

This study first shows carotid CEUS features in cases of TA complicated with BD, which may help with the comprehensive treatments of the disease.

Disclosure of Interests: :

None declared

0727 Study Onthe Effect Of Obstructive Sleep Apnea-hypopnea Syndrome Onperioperative Management Inendoscopic Sinussurgerypatients

Introduction

To determine the frequency of undiagnosed OSA patients in patients received endoscopic sinus surgery (ESS) and to investigate the effect of OSA on the perioperative management in those patients.

Methods

308 patients undergoing ESS from 2017-2019 were enrolled. The patients were divided into two groups according to whether OSA was combined. STOP-Bang questionnaire scoring system was used to classify patients into high risk and low risk for OSA. The differences between perioperative management and complications between the two groups were compared.

Results

308 consecutive cases were included, 46 cases (14.9%) combined with OSA and 108 cases (35.0%) were at high risk of OSA. OSA patients have higher morbidity of hypertension (OR, 2.05; CI, 1.07-3.92; P=0.03), hyperlipidemia (OR, 2.19; CI, 1.06- 4.51; P=0.03), longer hospitalization time(7.0±2.7 vs. 5.4±3.6, P≤0.01) and higher incidence of intubation difficulties (OR, 3.74; CI,1.39-10.1; P=0.01). Patients at high risk of OSA also had increased rates of hypertension, hyperlipidemia, coronary heart disease and post-operative cardiovascular and respiratory complications.

Conclusion

OSA or high scores of STOP-Bang are associated with increased perioperative complications in ESS patients. Preoperative OSA screening should be strengthened to improve the safety and prognosis of ESS surgery.

Support

National Natural Science Foundation of China under Grant [number 81670903]; and Beijing Municipal Administration of Hospitals Ascent Plan under Grant [number DFL20150602]

[Etiology, diagnosis, prevention and treatment of dental fluorosis]

Dental fluorosis is the most common and prominent symptom in the early stage of chronic fluorosis, which is caused by excessive fluorine intake during tooth development. In severe cases, it may be accompanied by skeletal fluorosis. There are also systemic damages to the nervous system, cardiovascular system, endocrine system and so on. The pathogenesis of dental fluorosis is not totally clear, which may be a complex pathological process involving both genetic and environmental factors. The prevalence of dental fluorosis has an upward trend arround the world, thus certain public prevention and treatment strategies need to be taken. This article focuses on the prevalence, etiology, diagnosis and scoring system, as well as the public prevention and treatment strategies, of dental fluorosis, so that to provide reference for the research and prevention of the disease.

Venous Thromboembolism During Chemotherapy for Testicular Cancer: A Population-Based Study

AIMS

Venous thromboembolism (VTE) is a potential complication among germ cell tumour patients. We evaluated the incidence rate, timing and factors associated with VTE among patients with germ cell cancer in routine practice.

MATERIALS AND METHODS

The Ontario Cancer Registry was linked to electronic records of treatment to identify all cases of testicular cancer treated in Ontario during 2000-2010. Administrative databases were used to identify VTE in the 3 months before and 5 years after orchiectomy. We explored patient-, disease- and treatment-related factors associated with VTE among all patients as well as those with detailed chemotherapy records available.

RESULTS

During 2000-2010, 2650 patients underwent orchiectomy for testicular cancer; among this cohort, 920 (33%) received chemotherapy. The VTE rate was 8% (69/920) among patients treated with chemotherapy and 0.6% (11/1730) among those without chemotherapy. Among the patients treated with chemotherapy who had VTE, 13% (9/69) occurred in the month before starting chemotherapy, 62% (42/69) in the first 3 months after starting and 25% thereafter. For patients who received three and four cycles, VTE rates were 8% (21/258) and 16% (19/121), respectively. In adjusted analyses, the only factor independently associated with VTE was increasing number of cycles (odds ratio 3.91 for four cycles, odds ratio 1.63 for three cycles (P = 0.022) compared with one to two cycles).

CONCLUSION

This population-based study confirms findings from institutional case series regarding the high rate of VTE among patients with germ cell tumours treated with chemotherapy. Future studies should evaluate the extent to which VTE prophylactic strategies might mitigate this risk.

[Expression of H3.3 G34W mutant-specific antibody in giant cell tumors of bone and its diagnostic value]

Objective: To investigate the expression of H3.3 G34W mutant-specific antibody in giant cell tumors of bone (GCTB), and its value in the diagnosis of GCTB. Methods: Immunohistochemical (IHC) EnVision method was used to detect the expression of H3.3 G34W mutant-specific antibody and p63 in 83 GCTBs, 18 aneurysmal bone cysts, 23 chondroblastomas and 28 osteosarcomas diagnosed at Nanjing Jinling Hospital from June 2001 to April 2019. Results: Among the 83 cases of GCTB, 69 cases (69/83, 83.1%) expressed H3.3 G34W. H3.3 G34W expression was found exclusively in the mononuclear cell population with strong and diffuse nuclear staining. H3.3 G34W was expressed in 55 of 57 (96.5%) cases of GCTB in long bones, but only 14 of 26 (53.8%) cases of non-long bone GCTB. All recurrent (9/9)/metastatic GCTB (2/2), post-denosumab GCTB (3/3), primary malignant GCTB (3/3) and secondary malignant GCTB (5/5) also expressed H3.3 G34W. H3.3 G34W was negative in all aneurysmal bone cysts and chondroblastomas. H3.3 G34W was positive in 3 of 28(10.7%) cases of osteosarcomas, and giant cell-rich osteosarcoma(GCRO) was the only histological subtype of osteosarcoma that expressed H3.3 G34W. p63 was expressed in 71.1%(59/83) of GCTB, while the positive rates of p63 in aneurysmal bone cysts,chondroblastomas and osteosarcomas were 3/18, 43.5% (10/23) and 21.4% (6/28) respectively. The sensitivity and specificity of H3.3 G34W mutant-specific antibody in the diagnosis of GCTB were 83.1% and 95.7%. Conclusions: H3.3 G34W mutant-specific antibody is a highly sensitive and specific marker for GCTB and helpful for the diagnosis of GCTB and its variants. The limitation of this antibody is that as a mall number of GCTB harbor G34 mutation other than G34W, and thus that cannot be detected. The incidental expression of H3.3 G34W mutant protein in osteosarcoma could be a potential diagnostic dilemma, and the results of H3.3 G34W IHC staining needs careful interpretation.

DT-13 inhibits breast cancer cell migration via non-muscle myosin II-A regulation in tumor microenvironment synchronized adaptations

BACKGROUND

Tumor metastasis is a terrifying characteristic of cancer. Numerous studies have been conducted to overcome metastasis by targeting tumor microenvironment (TME). However, due to complexity of tumor microenvironment, it remained difficult for accurate targeting. Dwarf-lillytruf tuber monomer-13 (DT-13) possess good potential against TME.

OBJECTIVE

As TME is supportive for tumor metastasis, alternatively it is a challenging for therapeutic intervention. In our present study, we explored molecular mechanism through which TME induced cell migration and how DT-13 interferes in this mechanism.

METHODS

We used a novel model of co-culture system which is eventually developed in our lab. Tumor cells were co-cultured with hypoxia induced cancer-associated fibroblasts (CAF) or with chemically induced cancer-associated adipocytes (CAA). The effect of hypoxia in conditioned medium for CAF was assessed through expression of α-SMA and HIF by western blotting while oil red staining was done to assess the successful chemical induction for adipocytes (CAA), the effect of TME through conditioned medium on cell migration was analyzed by trans-well cell migration, and cell motility (wound healing) analyses. The expression changes in cellular proteins were assessed through western blotting and immunofluorescent studies.

RESULTS AND CONCLUSION

Our results showed that tumor microenvironment has a direct role in promoting breast cancer cell migration by stromal cells; moreover, we found that DT-13 restricts this TME regulated cell migration via targeting stromal cells in vitro. Additionally we also found that DT-13 targets NMII-A for its effect on breast cancer cell migration for the regulation of stromal cells in TME.

Optimal operation strategy of LWR based on the PCI online prognosis model

The pellet-cladding interaction (PCI) is one of the major issues in fuel rod during the power change operation in light water reactors (LWR). The frequent power transient will lead to the PCI failure, which results in the radioactive leakage. Unfortunately, the failure cannot be detected on time during operation. For solving this problem, the PCI results is calculated and predicted before the power transient, and the results is used for optimizing the operation strategy. As everyone knows, the calculation of the fuel is a cumbersome work, which is not fit for online evaluation. At first, we present a PCI online prognosis model in this paper by the method of radial basis function neural network (RBFNN). Based on this online model, an optimal operation strategy is present then. The PCI evaluation results is treated as the feedback of the strategy, which will go to the power control system to decide to carry out the power plan or to modify it. The presented operation strategy used the fast online prognosis model to predict the PCI status, which is used as a feedback signal to the power control system. The optimal operation strategy is tested by the experimental data from the references, and the results demonstrate its effectiveness.

Effects of vineyard soil management on the characteristics of soils and roots in the lower Oltrepò Apennines (Lombardy, Italy)

Cultivation of grapevines in sloping soils is very widespread all over the world, representing also fundamental branch of local economy of several hilly areas. Vineyards can be managed in different ways. Agronomical practices in inter-rows can be significantly different and may influence deeply the soil properties and the grapevine root development. Therefore, this paper aimed to analyze the effects of different management practices of inter-rows. We focused on the traditional agricultural techniques of tillage and permanent grass mulching as well as the alternation of these two practices between adjacent inter-rows, in terms of: i) soil physical properties; ii) soil hydrological properties; iii) root density; iv) root mechanical properties and root reinforcement; as well as v) biodiversity. The research was conducted in several test-sites of Oltrepò Pavese (Lombardy region, north-western Italy), one of the most important Italian zones for wine production in northern Italian Apennines. Among the examined soil properties, hydraulic conductivity was the most influenced soil property by different soil management practices. The absence of soil tillage allowed to increase superficial (first 0.2 m of soil) hydraulic conductivity, as a consequence of higher macroporosity and amount in organic matter. Vineyards with alternation management (grass mulching together with tillage) of inter-rows had the highest root density and the strongest root reinforcement, of up to 45% in comparison to permanent grass cover, and up to 67-73% in comparison to tilled vineyards. Soil microarthropod communities had more complexity where sustainable agricultural practices (permanent grass cover; alternation management of the inter-rows) were applied. The results of this study yielded important information to establish effective management practices of vineyards such as conserving organic matter and reducing slope instabilities by a better development of root apparatus in the soil.

[Eosinophilic solid and cystic renal cell carcinoma: clinicopathological analysis and molecular characterization]

Objective: To study the clinicopathological features, immunohistochemical phenotype, molecular changes, differential diagnosis and prognosis of eosinophilic solid and cystic renal cell carcinoma (ESC RCC). Methods: A total of 15 cases were selected from 2005 to 2019 at Nanjing Jinling Hospital,Nanjing University School of Medicine for clinicopathological and immunohistochemical analysis, 10 of which were subject to cancer-associated mutation analysis using targeted next-generation sequencing (NGS) panel. A literature review was also performed. Results: The patients' ages ranged from 15 to 68 years (mean, 33 years). The male-to-female ratio was 1.1∶1.0. During a mean follow-up of 22 months, none of the patients developed tumor recurrence, progression or metastasis. Histologically, the tumors typically demonstrated solid and cystic architectures and the neoplastic cells contained voluminous eosinophilic cytoplasm with prominent granular cytoplasmic stippling. Immunohistochemically, tumor cells in all cases were immunoreactive for CK20. Signal pathway related protein mTOR and S6 were positive in 14/15 and 6/15 cases, respectively. Cathepsin K, Melan A and HMB45 were at least focally positive in 12/15, 6/15 and 2/15 cases, respectively. CK7 and CD10 showed focal immunostain positivity in some cases, while TFE3, TFEB, CA9 and CD117 were negative in all cases. NGS demonstrated TSC1/TSC2 mutations in all tested cases (10/10). Conclusions: ESC RCC is a rare tumor that tends to occur in young patients with an indolent behavior. Diagnosis can be established by its distinct clinical and histopathologic findings, immunohistochemical phenotype and molecular genetics. The tumor may be considered as a new subtype of RCC.

Transmission of multidrug-resistant tuberculosis in Shanghai: roles of residential status

SETTING

Shanghai is a mega city where 39% of the population comprises internal migrants.

OBJECTIVE

To examine the different roles played by migrants and permanent residents in the transmission of multidrug-resistant tuberculosis (MDR-TB).

DESIGN

We conducted a population-based cohort study to assess MDR-TB transmission in Shanghai between 1 January 2009 and 31 December 2012 using genotyping and geospatial analyses.

RESULTS

A total of 367 MDR-TB cases formed the study cohort. Significant differences between MDR-TB cases who were internal migrants and those who were permanent residents were found with regard to age, sex, region, genetic characteristics and treatment outcomes. Permanent residents had a higher transmission rate than internal migrants (OR 3.36, 95%CI 1.86-6.09). Permanent residents and genotypic clustering cases had similar clusters in central downtown and some parts of suburban areas. Most of the clusters of internal migrants were found in rural areas bordering suburban areas. Clusters of genotypic non-clustering cases showed patterns that closely matched those of internal migrants, suggesting acquired drug resistance in migrants.

CONCLUSION

In Shanghai, permanent residents were significantly associated with recent transmission of MDR-TB in central downtown areas. Clustered cases of internal migrants in rural areas were most likely to have contracted MDR-TB through acquired resistance.

Noninvasive fetal genotyping in pregnancies at risk for PKU using a comprehensive quantitative cSMART assay for PAH gene mutations: a clinical feasibility study

OBJECTIVE

To assess the diagnostic performance of a novel circulating single molecule amplification and re-sequencing technology (cSMART) method for noninvasive prenatal testing (NIPT) of Phenylketonuria (PKU).

DESIGN

Blinded NIPT analysis of pregnancies at high risk for PKU.

SETTING

Shanghai Xinhua Hospital and Hunan Jiahui Genetics Hospital, China.

POPULATION

Couples (n = 33) with a child diagnosed with PKU.

METHODS

Trio testing for pathogenic PAH mutations was performed by Sanger sequencing. In second pregnancies, invasive prenatal diagnosis (IPD) was used to determine fetal genotypes. NIPT was performed using a PAH gene-specific cSMART assay. Based on the plasma DNA mutation ratio relative to the fetal DNA fraction, fetal genotypes were assigned using a maximum-likelihood algorithm.

MAIN OUTCOME MEASURES

Concordance of fetal genotyping results between IPD and NIPT, and the sensitivity and specificity of the NIPT assay.

RESULTS

Compared with gold standard IPD results, 32 of 33 fetuses (96.97%) were accurately genotyped by NIPT. The sensitivity and specificity of the NIPT assay was 100.00% (95% CI 59.04-100.00%) and 96.15% (95% CI 80.36-99.90%), respectively.

CONCLUSIONS

The novel cSMART assay demonstrated high accuracy for correctly calling fetal genotypes. We propose that this test has useful clinical utility for the rapid screening of high-risk and low-risk pregnancies with a known history of PKU on one or both sides of the family.

TWEETABLE ABSTRACT

NIPT of couples at high risk for PKU using a full-coverage cSMART PAH gene test.