[The clinical study of modified transseptal suturing after septoplasty]

Objective:To study whether modified transseptal suturing could be an alternative to packing after septoplasty. Method:We conducted a prospective randomized controlled trial. The study involved 40 patients who underwent septoplasty. Patients were randomly divided into two groups, one with anterior nasal packing and the other with modified transseptal suturing. Patients were asked to record their subjective discomfort levels on a visual analogue scale（VAS） during 48 h postoperatively. Both groups were compared for VAS, postoperative complications 2 weeks after septoplasty through nasal endoscope, the datum of rhinomanometry before surgery and 2 weeks after surgery. Result:The differences of mean postoperative VAS score between two groups were statistically significant（P<0.05）. The patients of nasal packing group experienced more discomforts than the other group. No statistically significant between two groups in terms of the datum of rhinomanometry before surgery and 2 weeks after surgery（P>0.05）. There were no bleeding, septal hematoma, nasal septum perforation and local infection in all patients 2 weeks after septoplasty. During follow-up 1 case was found with postoperative nasal adhesion, nasal vestibular swelling and fester were seen in two patients and nasal peculiar smell was found in 1 case in nasal packing group. We can find that there were a lot of blood crust in silicone ventilation tube about in 14 patients in packing group. However, the suturing group could see none of the above questions. Conclusion:Modified transseptal suturing is more simple and convenient than nasal packing. In a word, the use of modified transseptal suturing could be an alternative topacking after septoplasty.

Genome-wide association study for growth and fatness traits in Chinese Sujiang pigs

Growth and fatness traits are complex and economically important traits in the pig industry. The molecular basis underlying porcine growth and fatness traits remains largely unknown. To uncover genetic loci and candidate genes for these traits, we explored the GeneSeek GGP Porcine 80K SNP chip to perform a GWAS for seven growth and fatness traits in 365 individuals from the Sujiang pig, a recently developed breed in China. We identified two, 17, one and 11 SNPs surpassing the suggestively significant threshold (P < 1.86 × 10^-5 ) for body weight, chest circumference, chest width and backfat thickness respectively. Of these SNPs, 20 represent novel genetic loci, and five and four SNPs were respectively associated with chest circumference and backfat thickness at a genome-wide significant threshold (P < 9.31 × 10^-7 ). Eight SNPs had a pleiotropic effect on both chest circumference and backfat thickness. The most remarkable locus resided in a region between 72.95 and 76.27 Mb on pig chromosome 4, harboring a number of previously reported quantitative trait loci related to backfat deposition. In addition to two reported genes (PLAG1 and TAS2R38), we identified four genes including GABRB3, ZNF106, XKR4 and MGAM as novel candidates for body weight and backfat thickness at the mapped loci. Our findings provide insights into the genetic architecture of porcine growth and fatness traits and potential markers for selective breeding of Chinese Sujiang pigs.

Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population

OBJECTIVES

Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals.

DESIGN

Cross-sectional study.

SETTING

General community.

PARTICIPANTS

A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty.

MEASUREMENTS

The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1-2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults.

RESULTS

Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty.

CONCLUSIONS

The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.

Associations of Preoperative Irisin Levels of Paired Cerebrospinal Fluid and Plasma with Physical Dysfunction and Muscle Wasting Severity in Residents of Surgery Wards

BACKGROUND

Myokine Irisin has been proposed to regulate metabolic homeostasis, which is related to chronic diseases or physical activity. However, whether irisin levels in paired cerebrospinal fruid (CSF), plasma and their ratio of inpatients, could use as biomarkers, and be independently related to the varying physical dysfunction, muscle wasting severity and chronic diseases with varying severe degrees, remain largely elusive.

METHODS

We conducted an observational study to assess the independent associations between irisin levels in paired cerebrospinal fruid (CSF), plasma and their ratio, and the independence in activities of daily life (ADLs), muscle wasting severity and chronic diseases with varying severe degrees among elderly Chinese in-patient subjects.

RESULTS

Among 217 inpatients in surgery wards with a mean age of 68.07 years (±15.94years), 31.3% of women and 68.7% of men were included in the study. Bivariate correlation analysis showed that Log transformed CSF and plasma irisin levels and their ratio were potential associated with age, fat%, muscle wasting time, ADLs, number of multimorbidity, the severity of bone mass loss and anemia. Regression models analysis indicated that CSF and plasma irisin levels and their ratio in inpatient individuals were independently associated with the independence in ADLs. Plasma irisin levels were independently related to the change of muscle wasting use.

CONCLUSIONS

Collectively, the evaluation of paired plasma and CSF irisin levels, and their ratio in in-patient individuals is intriguing candidates for the susceptibility of the independence in ADLs. Plasma irisin levels were positively associated with indepedence in ADLs, negatively related to muscle wasting severity, and could use as biomarkers for muscle wasting severity.

Association Between Multimorbidity and Depressive Symptom Among Community-Dwelling Elders in Eastern China

Purpose

This study aimed to investigate the prevalence of depressive symptoms and the association between multimorbidity and depressive symptoms among the elderly in eastern China.

Patients and methods

A multicenter cross-sectional study was conducted in four cities (Jianggan, Yiwu and Anji in Zhejiang Province and Taixing in Jiangsu Province) in eastern China. We collected the information on 27 chronic conditions through the self-reported medical history and used the Geriatric Depression Scale (GDS) short form to evaluate depressive symptoms. Multivariate Logistic regression was used to evaluate the relationship between multimorbidity and depressive symptoms.

Results

Five thousand two hundred and ninety-six participants were included into the current study, among which 2687 (50.74%) were female, with the mean ± SD age 72.0 ± 8.1 years old. The overall prevalence of depressive symptoms in eastern China was 23.5%. And the percentage of multimorbidity in depressed participants was higher compared with non-depressed participants (50.8% vs 38.8%, P<0.001). The univariate model and adjusted model suggested that participants with multiple chronic diseases were more likely to have a depressive symptom (adjusted OR=1.42; 95% CIs 1.19–1.70).

Conclusion

Depressive symptom was significantly associated with multimorbidity among the community-dwelling elderly population in eastern China.

MiR-100 up-regulation enhanced cell autophagy and apoptosis induced by cisplatin in osteosarcoma by targeting mTOR

OBJECTIVE

Mammalian target of rapamycin (mTOR) can negatively regulate cell autophagy, while its expression and activity are associated with the pathogenesis of osteosarcoma. MicroRNA 100 (MiR-100) down-regulation is associated with the pathogenesis and chemo-sensitivity of osteosarcoma. Bioinformatics analysis revealed the targeted relationship between miR-100 and the 3'-UTR of mTOR. We investigate the role of miR-100 in affecting mTOR expression, osteosarcoma cell autophagy, and sensitivity to cisplatin.

PATIENTS AND METHODS

MiR-100, mTOR, and Beclin-1 expressions in osteosarcoma tissue and normal control were compared. The relationship between miR-100 and mTOR was verified by dual luciferase assay. MiR-100, mTOR, and Beclin-1 levels in MG-63 cells and MG-63/DDP cells were tested. Cell apoptosis was determined by using flow cytometry. Cell malignancy was evaluated by colony formation assay.

RESULTS

MiR-100 and Beclin-1 significantly declined, while mTOR significantly increased in osteosarcoma tissue compared with that of normal tissue (p<0.05). MiR-100 targeting significantly inhibited mTOR expression compared to that of untreated (p<0.05). MiR-100 expression was down-regulated and mTOR level was elevated in MG-63/DDP cells compared with MG-63 cells (p<0.05). MG-63/DDP cells exhibited reduced cell autophagy and apoptosis, and enhanced colony formation induced by DDP. MiR-100 mimic and/or small interfere mTOR (si-mTOR) significantly promoted Beclin-1 expression, cell autophagy, and cell apoptosis, while attenuated colony formation.

CONCLUSIONS

MiR-100 declined, while mTOR up-regulated in osteosarcoma tissue. MiR-100 up-regulation enhanced cell autophagy and apoptosis induced by cisplatin via targeted inhibiting of mTOR.

Toward the improvement of total nitrogen deposition budgets in the United States

Frameworks for limiting ecosystem exposure to excess nutrients and acidity require accurate and complete deposition budgets of reactive nitrogen (Nr). While much progress has been made in developing total Nr deposition budgets for the U.S., current budgets remain limited by key data and knowledge gaps. Analysis of National Atmospheric Deposition Program Total Deposition (NADP/TDep) data illustrates several aspects of current Nr deposition that motivate additional research. Averaged across the continental U.S., dry deposition contributes slightly more (55%) to total deposition than wet deposition and is the dominant process (>90%) over broad areas of the Southwest and other arid regions of the West. Lack of dry deposition measurements imposes a reliance on models, resulting in a much higher degree of uncertainty relative to wet deposition which is routinely measured. As nitrogen oxide (NOx) emissions continue to decline, reduced forms of inorganic nitrogen (NHx = NH3 + NH4+) now contribute >50% of total Nr deposition over large areas of the U.S. Expanded monitoring and additional process-level research are needed to better understand NHx deposition, its contribution to total Nr deposition budgets, and the processes by which reduced N deposits to ecosystems. Urban and suburban areas are hotspots where routine monitoring of oxidized and reduced Nr deposition is needed. Finally, deposition budgets have incomplete information about the speciation of atmospheric nitrogen; monitoring networks do not capture important forms of Nr such as organic nitrogen. Building on these themes, we detail the state of the science of Nr deposition budgets in the U.S. and highlight research priorities to improve deposition budgets in terms of monitoring and flux measurements, leaf- to regional-scale modeling, source apportionment, and characterization of deposition trends and patterns.

[Expression of NUSAP1 and its relationship with prognosis in non-small cell lung cancer]

Objective: To investigate the expression of nucleolar and spindle-associated protein 1 (NUSAP1) in non-small cell lung cancer (NSCLC) and analyze its relationship with the prognosis of NSCLC patients. Methods: Real-time fluorescent quantitative PCR and immunohistochemical staining were performed to determine the expression of NUSAP1 in NSCLC tissues and adjacent tissues collected from hospital. The relationship between NUSAP1 expression and prognosis of NSCLC patients was analyzed by online database. Results: The expression level of NUSAP1 mRNA in tumor tissues was significantly higher than that of adjacent tissues (P<0.05). The high expression rate of NUSAP1 protein in NSCLC tissues was 58.0% (29/50), significantly higher than 22.0% (11/50) of adjacent tissues (P<0.05). The high expression of NUSAP1 protein in NSCLC tissues was closely correlated with tumor size, lymph node metastasis and TNM stage (P<0.05), but was not related to age and gender. The data showed that the expression level of NUSAP1 mRNA was inversely associated with the overall survival (OS) of NSCLC patients (P<0.001). The expression of NUSAP1 mRNA was significantly correlated with the pathological grade, clinical stage, gender, chemotherapy, smoking history, and histological type of NSCLC patients (P<0.05). Conclusions: The expression of NUSAP1 is up-regulated in NSCLC, which is correlated with the growth and development of NSCLC and prognosis of the patients. These results indicate that NUSAP1 can be used as a potential prognostic marker for NSCLC.

P5239Cost-effectiveness of direct oral anticoagulants for cancer-associated venous thromboembolism

Background

Direct oral anticoagulants (DOACs) are at least as effective as low-molecular weight heparins (LMWH) at preventing recurrence after cancer-associated venous thromboembolism (CA-VTE). DOACs are also oral and far less costly, but they may confer a higher bleeding risk than LMWH.

Purpose

To estimate the cost-effectiveness of DOACs and LMWHs for CA-VTE.

Methods

We developed a health state transition model to estimate recurrent VTE, bleeding events, quality-adjusted life years (QALY), and direct healthcare costs (2018 United States dollars) associated with DOACs vs. LMWH use. The model had four states: (1) long-term anticoagulation (first 3 months after VTE), (2) extended anticoagulation (more than 3 months after VTE), (3) off anticoagulants, and (4) death. We used a United States healthcare sector perspective, 3-month cycle length, and 1-year time horizon. Event probabilities were derived from the Hokusai Cancer VTE trial and other literature. Event and medication costs were obtained from national sources. We used a threshold of less than $50,000 per QALY gained to define cost-effectiveness.

Results

Compared to LMWH, DOACs were less costly (mean costs: $8,477 vs. $33,917 per year) and similarly effective (mean QALY: 0.616 vs. 0.622). The incremental cost-effectiveness ratio was $4,479,374 per QALY gained with LMWH, indicating that DOACs are cost-effective (Table 1). In threshold analyses, LMWH therapy only became cost-effective when DOAC recurrent VTE risk increased to at least 72% (relative risk vs. LMWH, 6.19) or DOAC clinically relevant bleeding increased to at least 39% (relative risk vs. LMWH, 10.09).

Scenarios Recurrent VTE, % Major bleed, % Mean difference DOAC − LMW ICER DOAC LMWH Relative Risk DOAC LMWH Relative Risk Cost QALY Base case 8.1 11.6 0.71 6.8 4.0 1.75 −$25,440 (−26,496, −24,274) −0.006 (−0.019, 0.008) $4,479,374 DOAC outcome rate threshold at which LMWH becomes cost-effective*   Recurrent VTE 71.5 11.7 6.19 – – – −$6,064 (−7,534, −4,627) −0.121 (−0.136, −0.108) $49,886   Major Bleed – – – 38.9 4.0 10.09 −$2,192 (−3,400, −704) −0.044 (−0.056, −0.030) $49,878 DOAC = direct oral anticoagulant, ICER = incremental cost-effectiveness ratio, LMWH = low-molecular-weight heparin, VTE = venous thromboembolism. Values are mean (95% Uncertainty Interval). Uncertainty was derived from 1,000 stochastic model iterations. *Represents the minimum increased risk with DOAC that would result in LMWH achieving an ICER <$50K per QALY gained.

Conclusion

In this simulation study, DOACs were a cost-effective oral alternative to LMWH for the treatment of CA-VTE. For LMWH to be cost-effective, DOAC event rates needed to be far higher than what is likely to be observed in clinical practice.

Acknowledgement/Funding

Agency for Health Research and Quality R18HS026156

P11.01 TMZ-LEV- IFN cocktail regimen significantly inhibited the growth of glioma

BACKGROUND

TMZ, is the first line chemotherapeutic drug for glioma, and drug resistance is one of the most important reasons for glioma treatment failure. Our previous studies have found that: 1) Type I interferon (IFN) could reverse the resistance of TMZ by inhibiting NF-κB activity, and down-regulating the expression of MGMT in vivo and in vitro; 2) IFN-α could significantly improve chemtherapeautic effect of TMZ for GBM patients. We aim to investigate the therapeutic effect of a cocktail chemotherapy regimen combining temozolomide (TMZ)- Levetiracetam(LEV) - interferon (IFN) on human glioma U138 and U251 subcutaneous xenograft tumor.

MATERIAL AND METHODS

30 xenograft tumors were established by subcutaneously injecting 1×106 glioma cells into the right flank of 4-week-old female BALB/C nude mice and then randomly divided into 5 groups (n=6/group): Control group; TMZ group; TMZ+IFN group; TMZ+LEV group; TMZ+LEV+IFN group. Anti-tumor efficacy of five regimens for tumor-bearing mice was tested after treatment with TMZ (50 mg/kg, i.p.), IFN (2×105 IU, s.c.), LEV (150 mg/kg, i.p.), while TMZ dose were reduced to 12.5 mg/kg for U251 tumors. All drugs are given once a day for five consecutive days. After therapy, the size of tumor was measured every day until the control tumors reached 2000 mm3. Mice bearing U138 tumors were sacrificed at 40 days after therapy, and mice bearing U251 tumors were killed at 26 days after therapy.

RESULTS

We identified that both U138 and U251 tumor growth among TMZ group, TMZ+IFN group, TMZ+LEV group and TMZ+LEV+IFN group were significantly inhibited (P<0.05), compared with the control group. Tumor weight of all treating group was lower than that of the control group (P<0.05). The tumor weight of TMZ+LEV+IFN group was the lowest and significantly lower than that of TMZ+LEV group and TMZ group (P<0.05, respectively). No significant difference was found between TMZ+LEV+IFN group and TMZ+IFN group in U251 subcutaneous xenograft tumors, although the tumor weight was lower in TMZ+LEV+IFN group (P>0.05). In the treatment of mice bearing U138 glioma, TMZ+LEV+IFN regimen was significantly superior to TMZ+IFN regimen.

CONCLUSION

Our data demonstrate that both IFN and LEV can sensitize TMZ effect on glioma. TMZ-LEV-IFN cocktail appears the best regimen.

Microbial diversity in the tick Argas japonicus (Acari: Argasidae) with a focus on Rickettsia pathogens

The soft tick Argas japonicus mainly infests birds and can cause human dermatitis; however, no pathogen has been identified from this tick species in China. In the present study, the microbiota in A. japonicus collected from an epidemic community was explored, and some putative Rickettsia pathogens were further characterized. The results obtained indicated that bacteria in A. japonicus were mainly ascribed to the phyla Proteobacteria, Firmicutes and Actinobacteria. At the genus level, the male A. japonicus harboured more diverse bacteria than the females and nymphs. The bacteria Alcaligenes, Pseudomonas, Rickettsia and Staphylococcus were common in nymphs and adults. The abundance of bacteria belonging to the Rickettsia genus in females and males was 7.27% and 10.42%, respectively. Furthermore, the 16S rRNA gene of Rickettsia was amplified and sequenced, and phylogenetic analysis revealed that 13 sequences were clustered with the spotted fever group rickettsiae (Rickettsia heilongjiangensis and Rickettsia japonica) and three were clustered with Rickettsia limoniae, which suggested that the characterized Rickettsia in A. japonicus were novel putative pathogens and also that the residents were at considerable risk for infection by tick-borne pathogens.

Effect of infectious bursal disease virus infection on energy metabolism in embryonic chicken livers

1. The purpose of this study was to investigate ATP levels and the activities of important enzymes involved in glycolysis and TCA cycle in livers of embryonated chicken eggs infected by infectious bursal disease virus (IBDV).2. Embryonated chicken eggs (9 days) were randomly divided into two groups (50 eggs per group). The first group was inoculated with a very virulent IBDV (vvIBDV) isolate into the chorioallantoic membrane. The second group was maintained as uninfected control eggs and inoculated with physiological saline. Embryo survival was assessed daily, and six embryos were sacrificed at 24, 48, 72, 96, and 120 hpi for examining livers. Viral loads in the livers were evaluated by qRT-PCR. A comparative analysis of markers associated with the regulation of energy metabolism across several functional classes (ATP, pyruvic and lactic acids, mitochondrial protein, NAD+/NADH ratios, and enolase, lactic acid dehydrogenase and the respiratory chain complex I activities) were examined in the context of IBDV infection.3. The results indicated that increases in the enzymatic activities associated with glycolytic metabolism in turn affected the synthesis and cytoplasmic concentrations of ATP at early timepoints in infected chicken embryos. Subsequently, energy metabolism was inhibited through the pathological perturbations of metabolic enzymes and mitochondrial damage, as inferred from reduced ATP generation.4. These results suggested impaired bioenergetics, which may lead to liver dysfunction consequent to IBDV infection, contributing to the disease pathogenesis.